RESUMEN
Pathological tortuosity of the internal carotid artery ranks next to atherosclerosis amongst causes leading to development of ischaemic strokes. In some patients pathological tortuosity of the internal carotid artery is combined with pathological kinking of the common carotid artery. Existing methods of surgical treatment for such concomitant pathology include stegewise elimination of kinking of the internal then common carotid artery, with two anastomoses sequentially formed, thus increasing the overall duration of arterial cross-clamping an prolonging cerebral ischaemia. Another method consists of resection of the common carotid artery with bringing down its bifurcation, restoration of straightness of the internal carotid artery, and formation of an end-to-end anastomosis. The second technique is often associated with technical requirement for ligation of the external carotid artery. In the presence of prolonged atherosclerotic lesions of the bifurcation of the internal and external carotid arteries, this method does not always allow carrying out adequate endarterectomy and fix the intima of the internal carotid artery distal to the bifurcation. The authors developed a method of surgical treatment of patients with a combination of pathological kinking of carotid arteries, providing herein a detailed description of the procedure of performing an operation according to an original technique. The proposed method of reconstruction makes it possible to eliminate pathological kinking of the common and internal carotid arteries in single cross-clamping of vessels, to preserve patency of the external carotid artery and in the presence of an atherosclerotic lesion of the bifurcation to perform adequate endarterectomy. Over the period from 2015 to 2019, a total of 10 patients were operated on according to this technique at the Municipal Vascular Centre of Samara, with no postoperative complications observed. The proposed technique of a reconstructive operation may be effectively used in patients with cerebral ischaemia in concomitant pathological kinking of the common and internal carotid arteries.
Asunto(s)
Arteria Carótida Interna , Accidente Cerebrovascular , Anastomosis Quirúrgica , Arteria Carótida Externa , Arteria Carótida Interna/diagnóstico por imagen , Arteria Carótida Interna/cirugía , Humanos , Estudios RetrospectivosRESUMEN
Extracranial carotid artery aneurysms belong to uncommon and dangerous vascular diseases. Reported herein are the results of successive surgical treatment of a patient presenting with an extracranial aneurysm of the internal carotid artery. Given anatomical peculiarities (large dimensions of the aneurysm, tortuosity of the internal carotid artery), it was decided to perform resection of the aneurysm with an end-to-end anastomosis established. The patient examined at 12 months postoperatively was found to be free from the syncopal states, with no restenosis of the zone of the anastomosis revealed. The chosen therapeutic policy provided effective prevention from the development of ischaemic stroke and aneurysmal rupture, as well as improved the patient's quality of life. An open reconstructive operation is an optimal method of treatment of patients presenting with extracranial carotid artery aneurysms.
Asunto(s)
Isquemia Encefálica , Enfermedades de las Arterias Carótidas , Accidente Cerebrovascular , Enfermedades de las Arterias Carótidas/diagnóstico , Enfermedades de las Arterias Carótidas/cirugía , Arteria Carótida Interna/diagnóstico por imagen , Arteria Carótida Interna/cirugía , Humanos , Calidad de VidaRESUMEN
Analysed herein are the results of surgical treatment of 55 patients who from June 2013 to August 2014 underwent a total of 56 reconstructive operations on carotid arteries during an acute period of ischaemic stroke. The operations were performed within the terms varying from 24 hours to 18 days after the onset of first symptoms of ischaemic stroke. The neurological status was assesses by the neurologist according to the NIH Stroke Severity Scale (USA) and the Modified Rankin Scale. Prior to operation neurological deficit in 18 patients corresponded to 4 points by the Rankin Scale. Carotid endarterectomy was performed in 55 patients, of these in 24 according to the eversion technique. In 10 patients eversion carotid endarterectomy was performed in combination with ICA resection. One patient was simultaneously subjected to eversion carotid endarterectomy and carotid-subclavian shunting bypass grafting. Carotid endarterectomy with autovenous-patch plasty was performed in 11 patients. Resection of the occluded internal carotid artery with plasty of the external carotid artery was carried out in 7 patients and resection of the internal carotid artery for pathological tortuosity was carried out in 2 patients. At discharge from hospital, regression of neurological symptomatology was noted in 46 (83%) patients. Nine (20%) patients showed complete restoration of neurological deficit, two (4%) patients were found to have increased manifestations of neurological deficit. In the postoperative period two patients died: one on postoperative day 24 from augmenting respiratory and cardiac failure, the other one on day 29 from augmenting renal insufficiency followed by cardiac failure. In both cases, autopsy revealed no signs of secondary impairment of cerebral circulation. Surgical interventions on carotid arteries performed at a multimodality vascular centre during the first 18 days after the development of ischaemic stroke in the majority of cases are accompanied and followed by regression of neurological deficit, being safe concerning the development of haemorrhagic transformation.
Asunto(s)
Isquemia Encefálica/complicaciones , Arteria Carótida Interna/cirugía , Estenosis Carotídea/cirugía , Endarterectomía Carotidea , Complicaciones Posoperatorias , Accidente Cerebrovascular , Anciano , Circulación Cerebrovascular , Endarterectomía Carotidea/efectos adversos , Endarterectomía Carotidea/métodos , Endarterectomía Carotidea/estadística & datos numéricos , Femenino , Humanos , Masculino , Examen Neurológico/métodos , Gravedad del Paciente , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/mortalidad , Estudios Retrospectivos , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/fisiopatología , Accidente Cerebrovascular/terapia , Análisis de Supervivencia , Tiempo de Tratamiento , Resultado del TratamientoRESUMEN
Assessed herein are the results of treating a total of 119 patients presenting with chronic critical ischaemia of the lower extremities accompanied by necrosis of distal portions of the foot. All patients underwent various successful operations of lower-limb revascularization, followed by evaluating the terms of healing of the wounds on the foot after necrectomy and minor amputations. A conclusion was made that after successful limb revascularization for critical ischaemia in patients with atherosclerosis accompanied by coagulative necrosis, performing minor amputations and necrectomies should be delayed.
Asunto(s)
Amputación Quirúrgica , Arterias/cirugía , Arteriosclerosis Obliterante , Recuperación del Miembro , Extremidad Inferior , Complicaciones Posoperatorias , Anciano , Amputación Quirúrgica/efectos adversos , Amputación Quirúrgica/métodos , Arterias/fisiopatología , Arteriosclerosis Obliterante/complicaciones , Arteriosclerosis Obliterante/diagnóstico , Arteriosclerosis Obliterante/fisiopatología , Arteriosclerosis Obliterante/cirugía , Femenino , Humanos , Isquemia/etiología , Isquemia/fisiopatología , Isquemia/cirugía , Recuperación del Miembro/efectos adversos , Recuperación del Miembro/métodos , Extremidad Inferior/irrigación sanguínea , Extremidad Inferior/patología , Extremidad Inferior/cirugía , Masculino , Monitoreo Fisiológico/métodos , Necrosis/etiología , Necrosis/patología , Necrosis/cirugía , Evaluación de Procesos y Resultados en Atención de Salud , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Pronóstico , Flujo Sanguíneo Regional , Estudios Retrospectivos , Ajuste de Riesgo , Factores de Tiempo , Cicatrización de HeridasRESUMEN
The article deals with outcomes of managing a total of twenty-nine patients of high operational risk with TASK II type С and D lesions of the aortoiliac segment. All patients were subjected to single-stage hybrid operations: open reconstructive interventions on the infrainguinal zone and stenting of iliac arteries. High risk of coronary complications these patients were running was confirmed in accordance with the European guidelines on perioperative assessment of the patients being elected for extracardiac operative treatment. Critical ischaemia was in all cases reliably relieved. Two patients during predilatation developed haemorrhage due to iliac artery rupture which was the cause of changing over to open operation. No lethal outcomes were observed.
Asunto(s)
Aorta Abdominal , Aterosclerosis , Enfermedad Coronaria , Arteria Ilíaca , Recuperación del Miembro/métodos , Extremidad Inferior/irrigación sanguínea , Complicaciones Posoperatorias/prevención & control , Anciano , Angiografía/métodos , Aorta Abdominal/diagnóstico por imagen , Aorta Abdominal/cirugía , Aterosclerosis/complicaciones , Aterosclerosis/diagnóstico , Aterosclerosis/fisiopatología , Aterosclerosis/cirugía , Constricción Patológica/etiología , Constricción Patológica/fisiopatología , Constricción Patológica/cirugía , Enfermedad Coronaria/etiología , Enfermedad Coronaria/prevención & control , Femenino , Humanos , Arteria Ilíaca/diagnóstico por imagen , Arteria Ilíaca/cirugía , Isquemia/etiología , Isquemia/fisiopatología , Isquemia/cirugía , Recuperación del Miembro/efectos adversos , Masculino , Ajuste de Riesgo , Índice de Severidad de la Enfermedad , Stents , Resultado del TratamientoRESUMEN
The experience of 34 operations of omental implantation to the patients with the critical lower limb ischemia due to the obliterative thrombangiitis was analyzed. 5 patients had the procedure on the both limbs simultaneously. The operative technique had been thoroughly described in the article. The procedure, being accomplished according to the certain standards, proved to be extremely effective.
Asunto(s)
Arterias/cirugía , Isquemia/cirugía , Recuperación del Miembro/métodos , Extremidad Inferior/cirugía , Epiplón/trasplante , Tromboangitis Obliterante/complicaciones , Adulto , Femenino , Humanos , Isquemia/etiología , Isquemia/fisiopatología , Extremidad Inferior/irrigación sanguínea , Masculino , Persona de Mediana Edad , Epiplón/irrigación sanguínea , Estructuras Creadas Quirúrgicamente/irrigación sanguínea , Tromboangitis Obliterante/fisiopatología , Resultado del TratamientoRESUMEN
Presented herein are favourable outcomes of surgical management in six patients suffering from thromboangiitis obliterans (TO) with accompanying critical ischaemia of either the both lower extremities (5 subjects) or the both upper limbs (1 patient). They were all treated by means of a surgical intervention with simultaneous transplantation of the greater omentum on a vascular pedicle onto the both limbs. A total of 12 revascularizing procedures were performed. With an overall of the 12 extremities eventually spared, the remote limb-salvage rate amounted to 100%. A detailed description of the procedural technique is followed by analysing long-term therapeutic outcomes having proved encouraging. The obtained results confirmed a possibility of reliably relieving critical ischaemia inpatients with TO by means of transplanting the greater omentum on a vascular pedicle simultaneously onto the both limbs.
Asunto(s)
Pierna/irrigación sanguínea , Epiplón/trasplante , Colgajos Quirúrgicos/irrigación sanguínea , Tromboangitis Obliterante/cirugía , Procedimientos Quirúrgicos Vasculares/métodos , Adulto , Angiografía , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tromboangitis Obliterante/diagnóstico por imagenRESUMEN
The authors are sharing their five-year experience gained at the Department of Vascular Surgery of the Samara State Medical University in performing microsurgical autotransplantation of the greater omentum to a lower extremity in patients presenting with critical ischaemia accompanied by thromboangiitis obliterans. A total of twenty-five operations of microsurgical autotransplantation of the greater omentum on a vascular pedicle were carried out in twenty patients diagnosed with lower limb critical ischaemia accompanied by thromboangiitis obliterans, for five of them underwent surgery simultaneously on the both lower extremities. With an overall number of 22 extremities eventually spared, the remote limb-salvage rate amounted to 88%. The preoperative preparation procedures as well as surgical technique are discussed in detail.