RESUMEN
The authors made a comparative assessment of carotid endarterectomy and endovascular angioplasty with stenting in patients with atherosclerotic lesions of the carotid arteries. The authors consider that indications to stenting and carotid endarterectomy are identical in patients with stenose and occlusions of the carotid arteries. Contraindications to angioplasty of carotid arteries are determined. It was shown that angioplasty and stenting in atherosclerotic lesions of the carotid arteries was an effective method with a less number of complications as compared with carotid endarterectomy and are thought to be an adequate alternative to open surgical method of treatment of patients with stenoses and occlusions of the carotid arteries.
Asunto(s)
Angioplastia , Arterias Carótidas/cirugía , Estenosis Carotídea/cirugía , Endarterectomía Carotidea/métodos , Complicaciones Posoperatorias/prevención & control , Stents , Anciano , Angiografía , Angioplastia/efectos adversos , Angioplastia/métodos , Encéfalo/irrigación sanguínea , Arterias Carótidas/patología , Arterias Carótidas/fisiopatología , Estenosis Carotídea/diagnóstico , Estenosis Carotídea/fisiopatología , Contraindicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Selección de Paciente , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
About 500 patients with ischemic brain lesions were studied. Out of them 201 patients underwent 230 operations: 140 extra-intracarotid bypass (EIB) and 90 various interventions on brachiocephalic branches. The study of cerebral hemodynamics by examining blood pressure in the central artery of the retina and middle cerebral artery during surgery, comparison of these findings with those of Doppler sonography and angiography made the authors conclude that EIB improves cerebral hemodynamics, and in some cases it is the only intervention able to improve the status of patients. In severe disseminated atherosclerosis with occlusion of one of the carotid arteries, EIB should follow other interventions on brachiocephalic branches. EIB was found to make the natural history of cerebral failure steady in 80.3%.
Asunto(s)
Isquemia Encefálica/cirugía , Arteria Carótida Externa/cirugía , Arteria Carótida Interna/cirugía , Adulto , Anastomosis Quirúrgica , Enfermedad Crónica , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The effects of fractional apparatus plasmapheresis in a volume of 25% of circulating blood plasma on the processes of lipid peroxidation and on the antioxidant defence system parameters were studied in 31 patients with ischemia of the lower limbs, stage III-IV. It has been shown that plasmapheresis induces elevation of ceruloplasmin activity and superoxide dismutase activity of blood plasma, lowers the ratio of lipid oxidation to lipid peroxidation products simultaneously with intensification of lipid peroxidation that leads to regeneration of biological membranes of the body.
Asunto(s)
Antioxidantes/metabolismo , Arteriosclerosis Obliterante/terapia , Pierna/irrigación sanguínea , Peroxidación de Lípido/fisiología , Plasmaféresis , Arteriosclerosis Obliterante/sangre , Humanos , Oxidación-Reducción , Factores de TiempoRESUMEN
An analysis of the complex examination of 170 patients with ischemic diseases of the brain has been made. Seventy patients were operated upon. Operations either in brachiocephalic branches or extra-intracarotid shunts were performed corresponding to the three established levels of the injuries. The nearest and remote results were obtained in more than 80% of the patients.
Asunto(s)
Prótesis Vascular , Revascularización Cerebral , Arteriosclerosis Intracraneal/cirugía , Adulto , Anciano , Tronco Braquiocefálico/cirugía , Arterias Carótidas/cirugía , Arterias Cerebrales/cirugía , Femenino , Humanos , Arteriosclerosis Intracraneal/fisiopatología , Masculino , Persona de Mediana Edad , Arteria Subclavia/cirugíaAsunto(s)
Enfermedades del Sistema Nervioso/etiología , Poliarteritis Nudosa/complicaciones , Enfermedades de la Piel/etiología , Adulto , Biopsia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades del Sistema Nervioso/patología , Poliarteritis Nudosa/patología , Piel/patología , Enfermedades de la Piel/patologíaRESUMEN
Ten observations of replantations of the hand, forearm and shoulder after their traumatic abjunction are analyzed. Seven patients had complete reimplantation. Failures resulted from prolonged anoxia of the abjuncted segment or from extensive lesions to soft tissues of the replant. Success of the operation was mostly related with the quality of the vascular sutures (microtechnique), careful primary treatment of the wound and organization of the urgent surgical aid.
Asunto(s)
Brazo/cirugía , Microcirugia , Reimplantación , Adulto , Traumatismos del Brazo/cirugía , Femenino , Mano/cirugía , Traumatismos de la Mano/cirugía , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Microsurgical techniques permit high-quality intervascular anastomosis in small and mid-caliber arterial surgery of lower extremities. This improves immediate outcomes in surgical patients with obliterating atherosclerosis of lower extremities. Microsurgical femoropopliteal autovenous shunting in patients with ischemia of the third or fourth degree (by Fontana) reduced the rate of shunt thrombosis from 37 to 27%. Microsurgical autovenoplasty of the deep femoral artery showed actually no thromboses at follow-up.
Asunto(s)
Arteriosclerosis Obliterante/cirugía , Prótesis Vascular , Arteria Femoral/cirugía , Pierna/irrigación sanguínea , Microcirugia/métodos , Arteria Poplítea/cirugía , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Venas/trasplanteRESUMEN
In modern surgery of coronary arteries both surgical therapy of early stages of acute infarction and its surgical prophylaxis in preinfarction conditions seem to be quite feasible. 100 consecutive operations for ischemic heart disease are analysed. The principal type of surgery is a mammary coronary anastomosis. Among the mentioned patients one had a progressive acute myocardial infarction, resulting in death, and 14 patients were in primary preinfarction conditions. A surgical classification of acute disturbances in coronary circulation is described. Marked segmental stenoses of large coronary vessels underlie preinfarction status. Mosaic electrocardiotopography is of great value in recognition of preinfarction conditions. An early recognition and urgent surgical intervention are absolutely necessary in preinfarction state patients.