Biomedical subjects
Publications and source records attributed to E P Kokhan.
Presented herein is a case report concerning successful treatment of the post-traumatic pathological anastomosis between the left external iliac artery and iliac vein using the stent-graft Jostent-graft. The anastomosis emerged after gunshot injury to the abdominal cavity.
Nineteen patients with aneurysms of the popliteal artery have been operated. Indications and type of surgery were determined on the basis of the clinical picture, angiography and duplex scanning data. There were 19 surgeries: ligation of afferent and efferent vessels of aneurysm with auto-venous grafting (8), resection of aneurysm with auto-venous grafting (5), dissection of aneurysm with auto-venous grafting and coverage with duplication from aneurysmatic walls (3), endovascular grafting of aneurysm (2), ligation of afferent vessel of aneurysm (1). In early postoperative period after open surgical revascularizations thrombosis was seen in 4 (25%) patients. One patient died on day 20 after surgery due to decompensation of severe concomitant disease. The patient who has undergone ligation of afferent vessel without revascularization has discharged after compensation of acute ischemia.
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The article deals with analysing examination and surgical treatment of 80 patients with predominant lesions to the distal arterial bed of the lower extremities, who were operated on at the RRSC from 1996 to 2003 with various degree on the background of chronic obliterating diseases of lower limbs arteries. All the patients were subdivided into two groups according to the outcomes of the epidural block: Group I -- with positive outcomes consisted of 36 (45 %) patients, and Group II -- with a negative outcome -- included 44 (55 %) patients. The patients from the both groups underwent the following operations: lumbar sympathectomy combined with direct and indirect methods of revascularisation, as well as lumbar sympathectomy as an independent therapeutic method. To solve the problem concerning feasibility of either done, or concomitant lumbar sympathectomy, we devised assessment of microcirculation state (alterations in volumetric blood flow indices in epidural block in relation to the indices at rest, as well as in the immediate or remote postoperative period) and peripheral haemocirculation (dynamics of the onkle brachial index values on the background of epidural block test, nitroglycerine test in relation to the ARI at rest both in the short-, and long-term postoperative period) by data of scintigraphy and dopplerography of the lower limbs.
The paper analyses vazaprostan administration to 88 patients with lower limb arteriosclerosis obliterans. Effectiveness of the drug is assessed in concordance with initial grade of ischemia.
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In the elderly and old patients with atherosclerosis of lower limb arteries, ultrasonic dopplerography assisted study of hemodynamics in foot with use of Valsalva and corinfar tests was carried out. It is revealed that these patients retain high reaction to sympathetic influences. The obtained data were the base for use of lumbar sympathectomy in 419 patients over 65 years as an independent method of surgical treatment and in combination with reconstructive operations on major arteries. Good results were obtained in 70.1% operated patients, satisfactory results--in 22.7%. There were no significant differences in the results of lumbar sympathectomy between this age group and younger patients.
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The lumbar sympathectomy was conducted for the grade II (according to Fontaine) obliterating atherosclerosis of the lower extremities arteries in 309 cases as the main method of surgery, and in 426--in concurrence with reconstructive intervention on the main vessels. The indications for and the efficacy of the desympathization in various levels of the main arterial bed affection are discussed.
The Doppler laser flowmetry was used in order to study the microcirculation in the skin, muscles and bone marrow at different stages of obliterating atherosclerosis of the lower extremity arteries. Progress of the disease is characterized by a decrease of the absolute indices of blood flow in combination with disturbed regulation of vascular tension. The lumbar sympathectomy causes intensification of microcirculation not only in the skin, but also in the muscular and bone marrow tissues.
The article summarizes the experience of the vascular surgery unit of the Vishnevskiĭ Central Military Hospital on treatment of 128 patients with chronic ischemia, namely atherosclerotic affection of aortofemorotibial segment. The authors show the important significance of the use of modern methods in studying the blood magistral and microcirculation. It is recommended to combine surgical and conservative treatment in order to preserve the affected limb. The article also contains determination and classification of chronic critical ischemia.
The authors summarize the experience of treatment of 178 patients with distal type of obliterated atherosclerosis of arteries of lower limbs. The 2nd stage of this malady was diagnosed in 91 (51.1%) patients; the 3rd stage--in 50 (28.1%); the 4th stage--in 37 (20.8%). 79 (44.4%) patients have received only conservative method of treatment, in 66 (37.1%) patients this method was accompanied by lumbar sympathectomy. Reconstructive operations with connection of one of the shin arteries to bloodstream were conducted in 33 (18.5%) patients. With the aim of improvement of distal artery channel visualization it is necessary to apply the digital subtraction angiography with the help of non-ionic roentgen-contrast preparations after the advanced application of spasmolytics.
The work analyses the causes of early postoperative thromboses which occurred after reconstructive operations on the femoro-popliteal segment in 293 patients. Early postoperative thromboses are a frequent complication in reconstructive operations on the vessels and develop in 27% of cases mostly in the first days after the operation. The most frequent causes of early thromboses were deficient distal arterial blood circulation, technical and tactical errors of the intervention, and insufficiently corrected postoperative therapy. It is pointed out that combination of reconstructive operations on the main vessels with lumbar gangliectomy has a favorable effect on the results of treatment and prevention of early thromboses. The use of microsurgical techniques reduces the probability of the development of early postoperative thromboses. In the absence of an effect of repeated operative interventions, in increase of ischemia and intoxication the limb must be amputated before gangrene develops.
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A 10-year experience in the analysis of stationary examination and treatment of 163 patients with post-thrombotic disease of lower extremities is given in this article. Surgical treatment was conducted in 102 cases, medical treatment was applied for 61 patients. There is a classification of diseases which defines medical tactics. On the basis of the data obtained during these studies the authors make a conclusion that in cases of varicose, indurative of indurative-ulcerated forms of this disease surgical treatment is indicated in the accordance with the character of vein affection. Otherwise, it is more preferable to apply medical treatment in cases of eodemata.
Examined were 156 patients (all the men) at the age of from 41 to 76 years with obliterative atherosclerosis of the arteries of the lower extremities. The antithrombogenic properties of a vascular wall were studied with a use of the functional vascular test with arteriovenous occlusion (cuff test). Reduction of the antithrombogenic properties of a vascular wall, ++anti-aggregative, anticoagulative and fibrinolytic activity as compared with those in normal subjects was revealed. For correction of disorders in antithrombogenic activity of a vascular wall, the administration of a complex of hemostatically active preparations (trental, phytin, glutaminic acid) is recommended.