Objective. To study relation between carotid atherosclerosis and arterial hypertension, and possible benefits of surgery. Design and methods. 70 hypertensive patients operated on cerebral arteries were examined: 50 patients had stenosis of carotid arteries (CA) and 20 - cerebral arterial anomalies. Results. The patients with carotid atherosclerosis had higher blood pressure (BP) than patients with brachiocefalic arterial anomaly (103,6 ± 11,3 and 91,7 ± 6,6 mmHg, respectively; r = 0,00007). This difference has disappeared in postoperative period. Both systolic (from 145,1 ± 14,7 to 135,6 ± 12,3 mmHg; р = 0,02), and diastolic (from 83,3 ± 10,2 to 78,1 ± 9,7 mmHg; р = 0,02) blood pressure reduced after the surgery on CA. Conclusions. We conclude that there is an association between ВР level and carotid atherosclerosis. The reduction of BP was observed in postoperative period in patients with atherosclerosis of CA.
Aim. To investigate the associations between brachiocephalic atherosclerosis (BCAS) and arterial hypertension (AH); to study the potential for AH control after surgery. Material and methods. The study included 70 patients (17 women, 53 men; mean age 62,5±7,5 years), who underwent planned surgery due to BCAS and carotid stenosis, CS (n=50) or brachiocephalic artery (BCA) malformation (n=20). AH duration varied from 4 months to 32 years. Levels of systolic blood pressure (SBP) were 115-192 mm Hg (mean SBP 151,5±27,26 mm Hg). Blood flow in aortal arch arteries was assessed by duplex BCA scanning. BP levels were registered within the 24 hours before the surgery, and then 3-5 days and 1-3 months after the intervention. Results. In patients with CS, risk of BP elevation increased with age (р=0,04). Before the surgery, higher BP levels were registered in Group I patients: mean BP was 103,6±11,3 mm Hg vs. 91,7±6,6 mm Hg (р=0,00007). After the intervention, these differences were no longer observed. In patients with CS, post-intervention BP levels decreased due to reduction in both systolic BP (from 145,1±14,7 to 135,6±12,3 mm Hg; р=0,02) and diastolic BP (from 83,3±10,2 to 78,1±9,7 mm Hg; р=0,02). In patients with BCA malformation, no significant BP reduction was registered.Conclusion. In BCAS patients, BP elevation was mostly explained by CS and progressed with age, while surgery facilitated BP reduction.
Background Trauma with associated damage to major arteries and veins typically occurs in adults; reports on such injuries in children are rare. In the organization of their treatment, difficulties are encountered such as formation of teams that must include angiosurgeons. The issues of restoring limb function after injuries with damage to muscle, nerve trunks or complete amputation of the limb remain relevant in children, despite their high abilities to recover. Each particular case in health care institutions has its own characteristics and difficulties for treatment, which was the reason for this communication. Purpose To share our clinical experience and details of providing urgent medical care to injured children with complete impairment of the main arteriovenous blood flow. Materials and methods Three cases with complete damage to major arteries and veins, including their defects, were studied. We describe the details of tactics and features of their surgical management. All patients underwent clinical and laboratory examination; emergency assistance was provided by orthopedic traumatologists and angiosurgeons. All patients were admitted in a state of hemorrhagic shock in stage 2 or 3. Surgical aid was provided in patients with a critical, almost terminal condition. Results On admission 40 minutes after the injury, one patient was diagnosed with a deep cut wound on the posterior surface of the right thigh with damage to the flexor muscles of the leg, femoral artery and vein with their defects up to 3 cm, and a cut wound on the right lower leg. Combined plasty of vascular defects with grafts from the great saphenous vein of the thigh and muscle suture were performed. An excellent result was noted after 3 months. In the second patient, there was an injury with glass in the area of the left axillary fossa with a transverse cut of all nerves, brachial artery and vein, tendons of the biceps and triceps muscles of the shoulder. An excellent result of primary reconstruction was diagnosed 1.5 years later. In the third case, the patient was admitted with a complete traumatic amputation of the right forearm in the lower third due to the use of a mechanical wood splitter; replantation began 5 hours after the cut off. Replantation was successful. It included 4 stages of treatment; the 2nd one was repeated revision and suture of the vessels 16 hours after the onset of thrombosis following the 1st operation. The next two stages included combined plastic surgery of muscles and tendons, first on the extensor and then of the flexor surface of the forearm. Movements appeared 6 months after the injury during the restoration of sensitivity. A completely satisfactory result of treatment was obtained; the patient began to use his hand in everyday life and to write after one year. Conclusion Damage to the main arteriovenous formations requires urgent surgical treatment, aimed at preserving the limb, restoring blood supply, nerve formations, and bone integrity. In complete amputation, restoration of muscle-tendon formations may be postponed for subsequent stages. In primary care, one should consider the need for subsequent, sometimes long-term rehabilitation, the result of which directly depends on the restoration of neurotrophic and sensitive functions.
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