Biomedical subjects
Publications and source records attributed to S I Skrylev.
Experience of surgical treatment of 325 patients with critical lower limb ischemia due to affection of infrainguinal vessels are analyzed. Comparative analysis of efficacy of direct, indirect and combined revascularizations was carried out, quality of life of patients in long-term period after surgery was evaluated.
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 presents a new approach to management of lower limb critical ischemia which implements recent advances in molecular biology and genetic engineering technologies. A new original compound incorporating angiogenin gene was developed to activate neoangiogenesis processes after injection into living tissues. Experimental data evidence a potential efficacy of new method for complex management of critical ischemia.
Presented herein is a clinical report of the surgical treatment of a female patient with left internal carotid aneurysm. Patient M, aged 58 years was hospitalized to the Department of Vascular Surgery, RSCS RAMS, with complaints of a pulsatile formation in the area of the neck on the left, persistent headaches, frequently occurring dizziness, and multiple episodes of loss of consciousness. The patient has been ailing for 20 years. Examination discovered a rounded pulsatile formation about 3 cm in diameter in the left lateral area of the neck in the internal carotid projection. Duplex scanning revealed aneurysm of the left internal carotid artery measuring 2,3 cm x 3.8 cm. Computerized tomography confirmed aneurysm of the left internal carotid artery. On December 10, 2002 the patient underwent resection of aneurysm of the left internal carotid artery followed by establishment of an end-to-end anastomosis. The immediate postoperative period was uneventful. The patient was discharged home in a satisfactory condition.
The paper analyzes a correlation between the sonographic and morphological characteristics of the structure of atherosclerotic plaques and the severity of cerebrovascular insufficiency. This significantly expands indications for surgical treatment in patients with carotid atherosclerosis. In the authors' opinion, not only the degree of carotid stenosis, but also the structure of a plaque is an important criterion for assessing indications for surgical treatment. The outcomes of carotid endarterectomy are comparatively evaluated in relation to the mode of carotid plastic repair. A role of intraoperative cerebral oximetry is shown.
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49 patients have been examined and 38 of them operated in RRCS RAMS for carotid hemadectomas (CH). CH is a rather rare tumor developing from the carotid gland locating in bifurcation of the common carotid artery. It is slowly growing tumor which is scantily active and rarely metastasizes. In 35 of the 38 operated patients radical ablation of the tumor was carried out. In the rest 3 patients radical removal of the tumor was impossible due to its dissemination and malignancy. The classification was used according to which all the tumors were distributed in 3 groups in dependence on the character of their growth. The basic principle of their division was the relation of CH to the carotid arteries. The use of this classification allowed to define individual surgical tactics. As a result of the treatment 97.4% of the patients were discharged with improvement. During the follow-up period (94 +/- 5 months) there were no relapses detected in these patients.
On the basis of the literature data and original research, the value of angioscopy in reconstructive surgery of vascular diseases of lower extremities is analyzed with a report of clinical application of intraoperative angioscopy. Practical recommendations for the use of angioscopy as a method of intraoperative control of quality of reconstructive operations on lower limbs vessels are provided.
A clinical case of carotid chemodectoma is reported. Unique character of this case consists in combination of rare manifestations of this disease in a patient (malignancy, bilateral location). Summarizing their own experience and analysis of literature data the authors give recommendations for diagnosis and management of such patients.
Based on the data available in the literature and their own findings, the authors analyzed the value of angioscopy in the reparative surgery of low limb vessels. Some cases of clinical application of intraoperative angioscopy are described and guidelines for the use of angioscopy as an intraoperative control of the quality of reparative surgery on low limb vessels.
The paper analyzes the authors' own experience with femorodistal bypass surgery in situ in patients with lower extremity vascular occlusive lesions. The patent distal bed and the intact superficial saphena are obligatory conditions for these operations. The paper details the surgical procedure, criteria for adequate blood flow recovery, the spectrum and incidence of complications in the immediate postoperative period. The beginning of the paper presents a brief review of the data available in the literature, which shows the present status of this worldwide problem.
The authors discuss their experience in surgical treatment of 37 patients with occlusive lesions of the subclavian arteries. Ten patients had isolated lesions of the subclavian arteries and 37 had combined affections of the carotid and subclavian arteries. Analysis of their own clinical material allowed the authors to put forth their point of view on the indications for surgical treatment, the tactics and order of surgical interventions, and the choice of the optimal method and plastic. material fro reconstructive operations. Sixty-seven reconstructive operations were carried out, in 11 of them one-stage reconstruction of the carotid and subclavian arteries was performed. Fatal outcomes were not encountered. The results of surgery were studied in 20 patients in follow-up periods of 6 months to 3 years. Complete regression of neurological symptomatology was found in 87.5% of patients with TIA and in 88.8% of those with encephalopathy and circulatory disorders. This confirms the effectiveness of surgical treatment of patients with occlusive lesions of the subclavian arteries.
The clinical experience of the Department of Vascular Surgery of the Vishnevsky Institute of Surgery, covering a period between November, 1983 and December, 1987 was analysed. Problems of the etiology and pathogenesis of vertebrobasilar insufficiency and the peculiarities of choosing the methods for surgical correction according to the extent and localization of the occlusive lesions were studied. The sequence and volume of the surgical intervention in patients with isolated and combined affections of the vessels of the vertebrobasilar and carotid channels are discussed.
Intraoperative monitoring of cerebral ischemia during surgery on the brachiocephalic arteries is carried out by several methods: transcranial dopplerography, electroencephalography, recording of the somatosensory evoked potentials, puncture measurement of intravascular pressure, etc. However, not all these methods are sufficiently informative, reliable, and safe. One of the methods meeting these requirements is noninvasive cerebral oximetry. The study was carried out by the Invos-3100 device (Somanetics, USA). The method of cerebral oximetry is based on optic spectroscopy using infrared light in the 650-1100 nm waveband. Monitoring was carried out in 34 patients with involvement of the brachiocephalic arteries. The results persuasively prove high informative value and safety of the method.
The authors analyze their experience gained in prevention of embologenic complications and ischemic injuries to kidneys based on surgical treatment of 25 patients with abdominal aorta aneurysm. Original preventive methods are suggested. In ascending supra-aneurysmatic aortic thrombosis (in 4 patients) a left-side thoracophrenolumbotomic approach and open thrombectomy from the aorta were used and, if necessary, from visceral branches and renal arteries as well. If aortic clamping above renal arteries was needed (in 6 cases) and its time surpassed the permissible duration of thermal ischemia of the kidneys the authors resorted to autoarterial perfusion of the kidneys through an aortorenal shunt with which cannulation of the thoraco-abdominal segment of the aorta was made. No embologenic complications or postischemic renal insufficiency occurred after surgery, this indicating the efficacy of the suggested measures.