Possibilities of Vascular Transplantation in Urgent Surgery of Main Arteries

Abstract

The article presents the experience of using allografts from a postmortem donor in emergency surgery of the main arteries of the lower extremities. Possible tactical methods of combined use of alloartery and allovein from various donors in urgent surgery have been demonstrated. High risks of interventions aimed at relieving early and late complications of vascular reconstructions remain an actual problem in angiosurgery. Very often, operations are performed in the presence of extensive necrosis and trophic ulcers (stage IV according to the Fontaine-Pokrovsky classification). Autovenous conduit from the great saphenous vein (type of arterial bed lesions C, D according to TASS II) was and remains the gold standard for choosing a shunt for reconstructive operations on infrainguinal arteries. In case of repeated reconstructions in the absence of a suitable autovein, in the presence of trophic ulcers and necrosis, an infectious process in the area of the vascular prosthesis, it is not always possible to use a synthetic prosthesis as a reliable alternative. Unsatisfactory results of using such materials dictate the need to choose a suitable graft. The problem of using allografts requires further advanced study. In this regard, the experience of using allografts in two non-standard urgent clinical situations is presented. The conclusion is made about the possibility of effective use of allografts from a postmortem donor in patients with bleeding after endovascular treatment of critical limb ischemia with trophic changes in the staged surgical treatment, as well as in patients with thrombosed anastomotic false aneurysms after previously performed surgical interventions.

Russian Military Personnel Policy and Proficiency: Reforms and Trends, 1991–2021

“…667 Although satisfaction with compensation rates appeared to be mixed, with younger service members expressing more satisfaction with their compensation than older service members, the majority of respondents in the surveys that we reviewed appeared to be broadly satisfied with their compensation. 668 Finally, prior to 2022, the Russian military increasingly began to use dimensions of family well-being as a tool to recruit and retain desired personnel. According to one source, about 30 percent of contract service members typically become married during their first or second year of service, with the number rising to over 90 percent by the end of the fifth year.…”