Biomedical subjects
Publications and source records attributed to I P Mikhaĭlov.
A surgical approach to vessels and organs of the upper mediastinum was grounded, developed and tested. An experimental study of flap transverse sternotomy was carried out in 20 cadavers. A wide approach with throwing of the presternum was the best for manipulations in proximal parts of the aortic branches. This approach was also less traumatic.
This paper analyzes the results of the treatment of 92 patients with injury to the great arteries of the lower limbs, which accounted for 15.9% of the number of all patients with injury to the great vessels. As regards lower limb ischemia, the patients were distributed in the following way: 15 (16%) patients had degree I, 27 (29%) degree IIA and 50 (55%) had degree IIB-IIIA ischemia (according to the classification of acute ischemia by I. I. Zatevakhin). All casualties with arterial trauma of the lower limbs were operated on. In the postoperative period, the patients were administered conservative therapy using anticoagulants, spasmolytics, and antiplatelet agents. Intraarterial infusion therapy, detoxification techniques and HBO therapy were applied. Good and satisfactory results were obtained in 78 (80.5%) patients; amputations were performed in 10 (10.8%) patients. The lethality constituted 8.7% (n=8). The authors hold that early hospitalization to the multi-discipline continuous medical institutions forms the basis for refinement of the treatment results in patients with injury to the great arteries of the lower limbs.
The authors describe problems of giving urgent surgical care to patients with wounds of the vertebral arteries in different areas of the neck and propose a simple and reliable method of hemostasis for wounds of the vertebral artery in the bony canal. An analysis of results of the surgical treatment of 16 patients with injured vertebral artery is presented.
Over the last 30 years more than 1000 patients with abdominal aortic aneurysms (AAA) were treated. Results of treatment of 367 patients with disruption of AAA from 1989 to 2002 were analyzed. Elderly and old patients account for 92% (338) of them. In 61% (224) patients after aneurysm's disruption blood outflew into the retroperitoneal space, in 23.4% (86) - into abdominal cavity, in 13,1% (48) patients retroperitoneal hematoma and hemoperitoneum formed, 2% (7) were the patients with functioning aorto-caval fistula, in 0.5% (2) aneurysm disrupted into the duodenum. There was no surgery due to different causes in 161 patients, all these patients died. One hundred and sixty-five patients underwent surgery, lethality was 60% (99 patients). Linear grafting of the aorta or aorto-iliac grafting was performed in the majority of patients - 77 (46.7%). Based on the obtained data three types of clinical picture of AAA disruption are devined: fulminant, acute and sub-acute. Complex treatment improved results of the treatment: lethality from 1989 to 1996 was 71.6%, from 1997 to 2002 - 52%.
Results of surgical treatment of 25 patients with arrhosive bleedings were analyzed. All of them had functioning shunts and severe infectious complications of the wounds in the region of Scarp's triangle. Infected wounds existed from 15 days to 18 months. Bleeding from the wound of Scarp's triangle was seen in 96% cases (24). Insufficiency of distal anastomosis due to arrhosia was in 15 patients (60%). Arrhosive bleeding from anastomosis of the synthetic graft with aorta or common iliac arteries was in 8 (32%) cases, insufficiency of distal anastomosis of femoral-tibial bypass was seen in 2 (8%) patients. Various extrafocal surgeries are method of choice in the treatment of arrhosive bleedings. These surgeries may be performed simultaneously (at first bypass, then removing of graft) or during 2-3 stages in lengthy purulent-inflammatory process.
Presented herein is a case of vein graft aneurysm formation 16 years after femoropopliteal bypass grafting using the reverse autogenous vein.
Results of surgical treatment of 382 patients with III-IV stages critical limb ischemia and concomitant diseases were analyzed. The mean age of the patients was 67.7 years. All the patients underwent reconstructive operations on lower limbarteries. Three variants of antibiotic therapy were compared: 1) antibiotics were administered parenterally; 2) they were injected endolymphatically; and 3) they were used parenterally and endolymphatically. Combined antibiotic, i.e. a combination of parenteral and endolymphatic routes of administration was most effective.
Treatment of patients with abdominal aortic aneurysms has been analyzed. From 506 patients (265 emergency and 241 elective cases) treated in the department of urent vascular surgery 36 had "chronic disruptions". Validity of this term is discussed. The authors consider the term "repeated disruption" as the most adequate.
Results of using different methods of treatment of chronic critical ischemia of lower extremities were analyzed in 267 elderly and senile patients. Ischemia of the lower extremities of the III degree was noted in 83% of the patients, the IV degree ischemia--in 17%. In 86 patients who underwent primary high amputation of the lower extremity 2 years survival was noted in 33.7%. In 89 patients treated conservatively during 12-14 days good and satisfactory results were obtained in 58.4%, amputations were made in 41.6%. The 2 years survival was 66.3%. In 92 patients primary reconstructive operations resulted in good and satisfactory outcomes in 75 (81.5%) out of them with the 2 years survival in 88.0%.
The problem of surgical treatment of elderly and old patients with critical limb ischemia and severe concomitant diseases is discussed. Surgical bypass from remote vascular beds is the only real possibility of effective care for such patients with the lowest risk. The results of treatment of 90 patients with critical limb ischemia were analyzed. The surgical technique is described in details. Modified methods of proximal anastomosis creation and technology of safe installation of graft into subcutaneous canal in subclavial-femoral bypass, surgical technique in femoral-femoral and ileo-femoral cross-over bypass are also described. Results demonstrate high efficacy of these surgeries and their lower risk. It is concluded that improved surgical technique permits to expand indications for surgery in elderly and old patients and to improve immediate and long-term results.
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17-year experience in surgical treatment of 302 elderly and old patients with occlusive disease of aorta and iliac arteries and critical limb ishaemia is analyzed. Different surgical policy depending on the type and length of atherosclerotic lesion and somatic state is offered. For persons in especially grave somatic state extraanatomical bypass operations (90 patients) were recommended, their technique was discussed in detail. Causes of postoperative complications were analyzed and prophylactic measures suggested. Prevention and treatment of infectious complications were considered.
Results of surgical treatment of 156 patients with cervical vessels injuries over 10-year period were analyzed. The majority of the wounds (82.7%) located in zone II of the neck. There were 143 (91.7%) stab-knife and 12 (7.7%) shotgun wounds. Combination of vascular traumas with injuries of deep cervical structures was in 16 (10%) patients. Detailed physical examination permits to avoid special device examinations before surgery in the majority of cases. When injuries of the esophagus or respiratory tract were suspected, the patients underwent diagnostic esophago- and bronchoscopy before and during surgery. Diagnostic and therapeutic policies in these kinds of injuries are systematized.
The article analyses results of treatment of 48 patients with severe posttraumatic decompensated ischemia of extremities. Operations were performed on 484 patients with injuries of 573 major vessels, 374 of them having traumas of the extremity vessels. All the patients were admitted to the hospital with severe hemorrhagic and traumatic shock of the III-IV degrees, 58% of them had combined traumas. The time from admission to operation was 0.5-24 hours. The "end-to-end" anastomoses were applied for the restoration of the vessels and prostheses with autovein and homoarterial prosthesis "Homograft" were used. Lethality was 16.7%. Reconstruction of the injured artery must be always made after performing "stable" osteosynthesis, predominantly with the apparatus of external fixation. Early start of active detoxication is of importance. Positive results with saved extremities were obtained in 68.8% of the patients. Multiprofile medical institutions with a 24-hours regimen of work of different diagnostic and medical units can give effective help to patients of this category.
Retrospective analysis of surgical treatment for injuries of 408 major arteries and veins in 352 patients in the department of vascular surgery of N.V. Sklifossovsky Research Institute of Emergency Care from 1989 to 1996 is presented. Of 126 cases of prosthetic reconstructions in 72.2% autoveins were used, in 18.3%--synthetic prosthesis, and in 9.5% homologous arterial biologic prosthesis. Good results were obtained in 13.1% of patients, amputations were made in 4.8%. Lethality was 4.0%. Principles of treatment of combined injuries, prophylaxis of syndrome of inclusion and other complications are autlined.
Factors influencing result of surgical treatment of patients with festered postoperative wounds have been studied. Algorythm of determination of tactics for examination and treatment of this category of patients was established. The results obtained are based on the analysis of personal surgical treatment autcomes in 1526 patients with decompensated ischemia of extremities and 57 patients with clinical symptoms of deep suppuration. Division of purulent complications into primary and secondary is suggested. Effectiveness of various modes of prophylaxis was studied--systemic and indirect endolymphatic route for introduction antibiotics, intraoperative application of pellicle ESBA, usage of antimicrobial vascular prosthesis "SISAN". The best results were obtained in the two latter methods. Various methods of surgical treatment in infected vascular prosthesis are reviewed.
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