Biomedical subjects
Publications and source records attributed to V A Cherniak.
Experimental part of the work included the aortic aneurysm simulation in animals and the studying of the disease course. The results of observation of 12 operated on in clinic and 17 nonoperated patients are presented. Pathogenesis of the disease was studied, indications for the operation and the criterions of the treatment method choice were determined.
The authors suggest an original method for revascularization of the inferior mesenteric artery for the prevention and treatment of ischemic colopathy in operative treatment of abdominal aortic aneurysm. The essence of the method consists in shunting the blood flow from the channel of the celiac trunk by anastomosing the right gastroepiploic artery with the inferior mesenteric artery by the end-to-end techniques. Topographoanatomical studies of the right gastroepiploic and inferior mesenteric arteries were conducted on 22 cadavers for experimental substantiation of the suggested method. Besides that, selected angiograms of the celiac trunk and its branches were studied in 50 patients. The suggested method for revascularization of the inferior mesenteric artery in resection of aneurysm of the abdominal aorta with intraluminal prosthetics was applied in eight patients with good results.
The results of treatment of 174 patients with lesions of the arteries of the aortic arch are presented. Multiple lesions of the coronary arteries were revealed in 78 patients, of the brachiocephalic trunk--in 45, their combination--in 52. In patients with the ischemic heart disease, in average, 3,4 aortocoronary shunts were placed. In patients with the impaired cerebral circulation, reconstruction of 2-3 arteries was performed simultaneously in their unilateral lesions. In case of their bilateral lesions, the blood flow restoration was performed in two stages with a 2-4 week interval. Improvement of the indices of intravascular hemodynamics was achieved in 97.5% of the patients, neurologic symptoms were completely eliminated in 71% of the patients. Three patients died from cardio-vascular failure.
The authors have developed the methods for performance of a reconstructive operation for abdominal aortic aneurysms which permit to avoid prolonged clamping of the abdominal aorta. On the basis of the results obtained, a conclusion of the high effectiveness of these methods has been drawn.
The experience with surgical treatment of 630 patients with the use of extraperitoneal and transabdominal approaches to the abdominal aorta is summarized. Their advantages and disadvantages are noted. The expediency to use a new extraperitoneal approach to suprarenal and infrarenal portions of the abdominal aorta has been proved. The results of a topographic-anatomic study are presented. The technique for performance of a new approach to the abdominal aorta at this region, its advantages over the existing approaches are described.
The results of treatment of 1229 patients with diseases of the abdominal aorta (AA) have been analysed. Two original methods for prevention of colonic ischemia in performance of a reconstructive operation on AA are suggested.
The experimental data on studying surgical anatomy of the popliteal vein and its branches are presented. On the basis of the findings obtained, the experimental models of reconstructive operations--transposition of the small saphenous and muscular veins with the functioning valves to the position of a popliteal vein, its bifurcation or one of the sural veins--have been developed. The clinical assessment of the performed reconstructive operations on the veins of the popliteal -sural segment was carried out. The results of reconstructive operations are good. A conclusion about the expediency to use in the clinic of the developed methods of operative interventions on the major veins of the lower extremities was drawn.
The results of surgical correction of blood flow in the vertebrobasilar basin in 58 patients ranging in age from 32 to 65 years were analysed. In 75.9% of cases, the disease was secondary to atherosclerosis. The tortuosity of the vertebral artery was noted in 12% of the patients. Transitory symptoms of ischemia were observed in 20.6% of the patients, chronic vascular cerebral insufficiency--in 53.6%, sequelae to the ischemic insult--in 25.8%. For diagnosis, the Doppler ultrasound, rheoencephalography, computerized tomography were used. The preference was given to extracranial operative interventions: +carotid-subclavian shunting was performed in 19, +intimo-thrombectomy from the subclavian and ostium of the vertebral artery--in 22, ++aorto-subclavian shunting--in 3 patients. Plasty of the vertebral artery was accomplished in 12 patients. The positive dynamics of neurologic status was noted in 91.3% of the patients.
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The authors have summarized the experience with surgical treatment of 147 patients with the brachiocephalic arterial pathology. Transient disorders in the cerebral circulation were noted in 54%, chronic vascular cerebral insufficiency--in 15%, ischemic insult and its sequelae--in 19% of the patients. Occlusive-stenotic lesions of the extracranial vessels, aneurysms, tortuosity of the brachiocephalic++ trunk, compression of the carotid arteries by chemodectoma were the indications for operative treatment. When choosing a method for operative intervention, the preference was given to extrathoracic techniques. The positive results were achieved in 90% of the patients.
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Platelet aggregation function has been examined by photometry; the procedure is as follows: the blood plasma enriched for platelets is stirred and stabilized in a not full photometer cuvette rotating with a 40-60 r.p.m. speed in a plane perpendicular to the luminous flux. The air hole in the cuvette provides the plasma stirring atraumatic for platelets, whereas the cuvette rotation rules out sedimentation of the blood platelets and their aggregants. Studies of the platelet aggregation in 18 normal subjects and 18 coronary patients have shown that such technique improves the accuracy and sensitivity of blood platelet aggregation photometry.
The experience with examination of 116 patients with suspected abdominal aortic aneurysm permitted to develop the diagnostic programme and define the place of each of the used methods in the diagnostic complex.
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