Objective: Analysis of the results of standard and optimized surgical treatment of vertebral artery (VA) tortuosity. Methods: The results of surgical treatment of 52 patients with VA tortuosity were analyzed. There were 18 men (34.6%), and 34 women (65.4%). The age of patients ranged from 23 to 75 years. C- and S-shaped kicking of VA occurred in 38 cases, coiling in 8 cases and Powers syndrome in 6 cases. In 28 (53.8%) patients there was also hypoplasia of the contralateral VA, and in 7 (13.5%) cases there was a pathological deformation of the internal carotid artery. Results: Depending on the shape of the tortuosity, 4 techniques of reconstructive operations were performed to eliminate tortuosity. In the postoperative period thrombosis of the anastomosis line noted in 2.8% of cases, TIA – in 1.9%, and stroke – in 1.9%. The immediate and long-term results in the groups showed the effectiveness and best results in the group of patients who underwent lateralization of the VA of the author’s modification. Also established that for VA coiling, the method of choice is to move and implantation of VA into the carotid artery. Conclusions: Correction of VA tortuosity should be differentiated, and the choice of the method of surgery technique should depend on the type of tortuosity and concomitant vascular pathology. The lateral and anterior moving VA ostium helps to reduce the rate of anastomosis thrombosis and greatly facilitates the surgery technique. Keywords: Vertebral artery, tortuosity, kinking, coiling, vertebrobasilar insufficiency, chronic cerebral ischemia, surgical treatment.
Aim. To evaluate effectiveness of the scleroobliteration in the treatment of small-diameter varicose veins.Materials and Methods. The analysis incorporated the results of sclerotherapy in 135 patients, comprising those with telangiectasias and reticular varicose veins (n=95) and those with varicose dilation of aberrant subcutaneous veins (n=40) with intact trunks of major and/or minor subcutaneous veins of the lower extremities. The sample included 111 women (82.2%) and 24 men (17.8%), with an average age of 35.2±6.5 years.For the obliteration of expanded subcutaneous veins, two sclerotherapy techniques were employed: liquid (n=65) and foam-form (n=70), prepared as per the L. Tessari method. Sclerosants used were a 0.5–3% sodium tetradecyl sulfate solution (“Fibro vein”) (ATC code: C05BB04) (n=69) or a 1-3% polidocanol solution (“Ethoxisclerol”) (ATC code: C05BB02) (n=66).A detailed analysis was carried out of all complications that developed during and at various times post-sclerotherapy, and the effectiveness of the treatment, which depended on the diameter of the expanded veins and the thoroughness of the procedure.Results. The technical success of the procedure was registered at 100%. The overall frequency of complications post-sclerotherapy was 20.7%, including 27.7% with the liquid form and 14.3% with the foam form of sclerosants (p<0.001). Intradermal and subcutaneous hemorrhages were observed in 10 (7.4%) patients, allergic reactions in 8 (5.9%), localized skin necrosis in 3 (2.2%), folliculitis in 3 (2.2%), and localized purulent complications in 2 (1.5%). Micro-air embolism of the pulmonary artery branches due to exceeding the established norm of air volume during foam sclerotherapy was recorded in 2 (2.9%) cases.Following one session, a positive sclerotherapy effect was noted in 45.9% of patients. The necessity for additional sclerotherapy courses was indicated for over half the patients, with the effectiveness rising to 97.8% after 3 or more courses.Conclusion. Sclerotherapy, being an effective minimally invasive method, is significantly impactful in treating reticular varices and telangiectasias. Greater efficiency and a lower rate of complications have been observed with the use of foam form sclerosant. Proper selection of sclerosant volume and concentration is essential for the prevention and reduction of sclerotherapy complications.
Objective. To compare the demographics, comorbidities and risk factors in patients with abdominal aortic aneurysm (AAA) treated in three different communities; Germany, Tajikistan and Russian Federation. Methods. A retrospective comparative study including patients with an infrarenal AAA who were treated with either endovascular aneurysm repair (EVAR) or open repair (2011-2015) in Cologne, Dushanbe and Ryazan was done. A total number of 711 patients, 499 from Cologne, 46 from Dushanbe and 166 from Ryazan were included in the study. Demographic data including age, gender, body mass index (BMI), comorbidities (diabetes, coronary artery disease (CAD)), hypertension, cerebrovascular disease, chronic obstructive pulmonary disease (COPD, smoking), actual treatment as well as the diameter of the abdominal aorta were collected, retrospectively. Results. There was no statistically significant difference in AAA prevalence with respect to gender between the study centers. Similarly, the BMI did not differ significantly between these 3 centers. Though, the patients from Cologne were older than those from Dushanbe and Ryazan. Moreover, the number of patients treated due to ruptured aneurysm was significantly lower in Cologne in comparison to the other two centers (P<0.05). The AAA-diameter of patients in Ryazan and Dushanbe was greater than that found in Cologne. Regarding the actual medication that patients were presented with, antiplatelet-aggregation medication, statin and beta blockers were used significantly more often in Cologne. Patients from Tajikistan had COPD more often than patients from the other centers. Conclusion. The prevalence of comorbidities, risk factors as well as medication in patients with infrarenal abdominal aortic aneurysm is different in the various geographical regions. What this paper adds The study demonstrates that the prevalence of comorbidities, risk factors as well as medication in patients with infrarenal abdominal aortic aneurysm is different in the various geographical regions. These differences have been firstly demonstrated in patients from the Russian Federation and Tajikistan.
Таджикский государственный медицинский университет им. Абуали ибни Сино; Республиканский научный центр сердечно-сосудистой хирургии Министерства здравоохранения и социальной защиты населения Республики Таджикистан, Душанбе, Таджикистан Цель исследования-обобщение опыта открытого хирургического лечения аневризм систем брахицефальных артерий. Материал и методы. Проанализированы результаты хирургического лечения 25 пациентов с аневризмами экстракраниальных и экстраторакальных сегментов ветвей дуги аорты. Аневризмы сонных артерий и ее ветвей диагностированы у 15 (60%) пациентов, подключичных-у 6 (24%), позвоночных-у 4 (16%). Аневризмы сонных артерий располагались в 6 случаях в области внутренней сонной артерии, в 5-в общей сонной. По характеру поражения зарегистрированы 4 посттравматические и 2 дегенеративно-диспластические аневризмы. В 2 случаях имели место артериовенозные свищи с формированием венозной аневризмы (височной, теменной, затылочных ветвей). Аневризмы подключичной артерии в 3 наблюдениях располагались во II, а в 4-в III сегментах сосуда. Все 4 аневризмы позвоночных артерий были травматического происхождения, лишь в 1 случае аневризма располагалась до входа в костный канал, в остальных 3 случаях сосуд был поврежден в позвоночном канале. Результаты. Объем операции включал частичную резекцию аневризмы с восстановлением или без восстановления пораженного сосуда. Кровоток после устранения аневризмы в наших наблюдениях был восстановлен в 17 (68%) наблюдениях, перевязка сосуда выполнена у 8 (32%). Лишь в 1 случае при распространении аневризмы ВСА в костный канал прибегли к перевязке магистральной артерии, во всех остальных случаях были лигированы позвоночные (n=3) и ветви наружной сонной артерии (n=5). В связи со значительными морфологическими изменениями в стенках сосудов сосудистый шов (прямой или боковой) удалось наложить лишь в 6 случаях. У 10 пациентов после резекции аневризмы из-за образовавшегося большого диастаза кровоток был восстановлен путем шунтирования или протезирования синтетическим протезом (аутовеной). Ликвидация дефекта бифуркации общей сонной артерии после резекции травматической аневризмы в одном наблюдении осуществлялась заплатой, выкроенной из стенки наружной сонной артерии. В послеоперационном периоде кровотечение из раны возникло в одном случае. В четырех наблюдениях отмечали парез n. hypoglosus (n=2) и лимфорею (n=2). Все неспецифические осложнения ликвидированы консервативными методами. Летальных исходов не было. Выводы. Все виды операций, направленных на восстановление кровотока, имеют равное право на применение. Выбор того или иного метода зависит от размеров аневризмы, состояния сосудов за пределами аневризмы, размеров дефекта, образующегося после радикальной резекции аневризматического мешка.
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