<p>Treatment of patients with multilevel arterial occlusive disease in lower limb arteries is one of the challenges in vascular surgery. The need in blood flow restoration in several arterial segments usually leads to the problem of choosing a surgical procedure. Open surgery of several arterial segments is linked with a high risk of intraoperative complications, while endovascular procedures are not always possible, especially with long lesions. In such cases, hybrid surgery turns out to be a method of choice. We report the case of 50-year old patient with complaints of the right lower limb pain at rest, trophic ulcers in the right foot. The medical record showed 5-year claudification, with a gradual decrease in painless walking distance. In 2017, he underwent right common iliac artery stenting without a positive effect. Upon admission, occlusion of the right external iliac artery and superficial femoral artery was identified. After additional examination, crossing of lesions, balloon angioplasty and stenting of aorto-iliac and femoral-popliteal segments were successfully performed. The presented clinical case demonstrates high effectiveness in combination of open and endovascular procedures, while treating multilevel arterial occlusive disease. Hybrid surgical procedures allow to reduce traumatism, risk of postoperative complications and length of in-hospital stay. The main advantages and disadvantages of current surgical methods for treatment of multilevel aorto-iliac-femoral lesions are discussed. Performing hybrid surgical procedures is possible only with an experienced vascular team and in specialized hybrid operating room.</p><p>Received 3 August 2018. Revised 26 November 2018. Accepted 30 November 2018.</p><p><strong>Informed consent:</strong> The patient’s informed consent to use his records for medical purposes is obtained.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p>
РезюмеТромбоэмболия легочной артерии является жизнеугрожающим состоянием вследствие развития острой правожелудочковой недостаточности и кардиогенного шока. Основным методом реперфузии при массивной легочной эмболии остается системный тромболизис, проведение которого сопряжено с риском фатальных геморрагических осложнений. В течение последних двух десятилетий наблюдается все больший интерес к использованию эндоваскулярных технологий, позволяющих восстановить кровоток по окклюзированным легочным артериям в сроки до трех недель от верифицированного эпизода эмболии и снизить риск больших кровотечений. Проводимые в настоящее время исследования подтверждают высокую эффективность и безопасность интервенционных методов лечения, внедрение которых в клиническую практику позволит улучшить прогноз больных с массивной тромбоэмболией легочной артерии.
This article demonstrates a case of effective and save endovascular treatment of distal aortic dissection and underlines its advantages over open surgery. The case describes successful implantation of bare metal stent into abdominal aorta. The patient of 78 years old underwent thoracic endovascular aortic repair as first stage, then bare metal stent implantation as second stage. There were no complications. CT-scan in 3 month showed no endoleaks or stent migration.
Purpose. The purpose of the article is to access possibilities of blood flow mathematical analysis in aortic aneurysm before and after bare metal stent implantation.Materials and methods. Mathematical models of aortic blood flow were based on data received at studying 15 CT-scans of patients with abdominal aorta aneurysms (12) and dissections (3) and their duplex ultra-sound hemodynamic data. At constructing mathematical model the program SolidWorks was used. Working with the program consisted of two stages: establishment of conditions for geometric objects; forming of abdominal aorta model from these objects. In the study hemodinamic aneurysm indexes was evaluated on rectilinear and curvilinear segments. Some of characteristics were variable: diameter, aneurysm wall thickness, its length, elasticity.Results. Correlation of extreme tension into aneurysm wall on rectilinear and curvilinear segments according to aneurysm wall thickness was assessed. Possibilities of pathological blood flow changes correction at bare metal stent implantation into aortic aneurysm were estimated: if presence of bare metal stent were introduced into mathematical parameters blood flow characteristics became almost as standard characteristics. Received data can enhance successful endovascular treatment of aortic diseases with using of bare metal stents.Conclusion. Mathematical models of aortic and vascular aneurysms before and after surgery can be an effective tool in bettering quality of medical help for vascular patients.
Objective: To reveal relations of the arterial stiffness, central blood pressure (BP) with left ventricular (LV) structure and function in patients with ascending aortic aneurysms (AAA). Design and method: We examined 44 patients with AAA (30 (68%) males; 55 ± 13 years old) before AAA surgical repair. Office brachial BP (BBP) was measured by OMRON (Japan). Arterial stiffness was evaluated by carotid-femoral pulse wave velocity (PWV). Central BP (CBP) and PWV were measured with the SphygmoCor (Australia). Ambulatory BP monitoring was performed with the BPLab (Russia) with 24-hour measuring of BBP and CBP. A transthoracic echocardiographic examination was performed with a Vivid 7 GE (USA). Results: Hypertension was observed in 40 (91%) patients. LV hypertrophy (LVH) was found in 41 (94%) patients (mean LV mass index (LVMI) 163 ± 48 g/m2). Diastolic dysfunction presented in 39 (89%) patients. PWV was inversely related to the AAA diameter (r = - 0.389, P = 0.03): PWV decreased with an increase of the aortic diameter at the level of the aortic root. A decrease of PWV correlated with a decline of relative wall thickness (RWT) (r = 0.365, P = 0.040), but eccentric LVH occurred only in 17 (38%) patients with AAA. PWV correlated directly with LV ejection fraction (r = 0.464, P = 0.048), but PWV was inversely related to LV end-diastolic size (LVED) (r = -0.533, P = 0.003). Rigid type diastolic disturbances (E/A ratio>2) were negatively correlated with PWV (r = -0.652, P = 0.041). Office pulse BBP and CBP correlated with the LVMI (r = 0.428, P = 0.019 and r = 0.508, P = 0.002, respectively). 24-hour pulse BBP and CBP were correlated with LVMI (r = 0.660, P = 0.018 and r = 0.721, P = 0.008, respectively). The increase of LVED had a closer association with office pulse CBP (r = 0.459, P = 0.007) than with office pulse BBP (r = 0.410, P = 0.017). Conclusions: Eccentric LV hypertrophy was accompanied by a significant reduction of PWV in patients with AAA. The severity of the diastolic dysfunction increased with a decline of PWV. PWV is probably not suitable for accurate assessment of the arterial stiffness in AAA due to the apparent confounding effect of aortic diameter. In AAA central pulse BP had a closer association with LVMI and LVED than brachial pulse BP.
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