RESUMEN

AIM: To evaluate the prognostic value of GDF-15 in relation the development of bleeding and events in stable CAD patients, receiving combined antithrombotic therapy. MATERIALS AND METHODS: The data was obtained from the prospective registry REGATA, 343 CAD patients (249 males), median age 68 [IQR 62; 75] years) were enrolled. Patients with sinus rhythm and concomitant PAD received acetylsalicylic acid in combination with rivaroxaban 2.5 mg bid (31.8%) or clopidogrel (24.8%). Other 43.4% with concomitant atrial fibrillation (AF) received direct oral anticoagulants in combination with antiplatelet therapy after elective percutaneous coronary interventions. Median follow-up was 12 months [IQR 9.0; 18.0]. The safety end point was major and clinically relevant bleedings (type 2-5) according to the BARC classification. Plasma samples for GDF-15 identification were taken at the inclusion and analyzed using ELISA assay. RESULTS: Frequency of BARC 2-5 bleedings was 16% (BARC 2 - 46; BARC 3 - 9; BARC 4-5 - 0), median GDF-15 level was 1185.0 pg/ml [850.0; 1680.0]. In patients with AF and concomitant MFA, the level of GDF-15 was significantly higher than in the subgroups of patients with only AF or MFA (p=0.0022). According to the quintile analysis, GDF-15 values in the top three quintiles of distribution (cut-off value >943 pg/ml) were associated with higher frequency of bleeding events: 23.2% versus 5.1%; p=0.0001. The multivariable logistic regression model demonstrated that bleeding events were independently associated with GDF-15 level>943 pg/ml (OR 2.65, 95% CI 1.11-6.30; p=0.0275), AF (OR 2.61, 95% CI 1.41-4.83; p=0.0023) and chronic kidney disease (OR 1.92, 95% CI 1.03-3.60; p=0.0401). Clinical factors determining the risk of bleeding events also determined a GDF-15 elevation. CONCLUSION: Assessment of GDF-15 level may improve bleeding risk stratification in CAD patients with concomitant AF and/or PAD receiving combined antithrombotic therapy.

Asunto(s)

Factor 15 de Diferenciación de Crecimiento , Hemorragia , Sistema de Registros , Humanos , Masculino , Femenino , Anciano , Hemorragia/inducido químicamente , Hemorragia/epidemiología , Hemorragia/etiología , Persona de Mediana Edad , Factor 15 de Diferenciación de Crecimiento/sangre , Estudios Prospectivos , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/sangre , Quimioterapia Combinada , Fibrilación Atrial/tratamiento farmacológico , Fibrilación Atrial/complicaciones , Fibrinolíticos/administración & dosificación , Fibrinolíticos/efectos adversos , Aspirina/administración & dosificación , Aspirina/efectos adversos , Clopidogrel/administración & dosificación , Clopidogrel/efectos adversos , Pronóstico , Federación de Rusia/epidemiología , Inhibidores de Agregación Plaquetaria/administración & dosificación , Inhibidores de Agregación Plaquetaria/efectos adversos , Rivaroxabán/administración & dosificación , Rivaroxabán/efectos adversos , Intervención Coronaria Percutánea/métodos , Intervención Coronaria Percutánea/efectos adversos

RESUMEN

AIM: Analysis of in-hospital and long-term results of carotid endarterectomy (CEE) in patients with different severity of coronary atherosclerosis. MATERIAL AND METHODS: This comparative, retrospective, open study for the period from January 2013 to April 2020 included 1719 patients operated on for occlusive-stenotic lesions of the internal carotid arteries (ICA). Classical and eversion CEA were used as revascularization strategies. The criteria for inclusion in the study were: 1. Presence of coronary angiography within six months before the present CEE; 2. A history of myocardial revascularization in patients with severe coronary lesions. Depending on the severity of coronary atherosclerosis, all patients were divided into 3 groups: Group 1-871 (50.7 %) patients - with the presence of hemodynamically significant stenosis of the coronary arteries (CA) with a history of myocardial revascularization; Group 2-496 (28.8 %) patients - with the presence of hemodynamically insignificant lesions of the coronary artery (up to 70 %, not inclusive, and the trunk of the left coronary artery, up to 50 %, not inclusive); Group 3-352 (20.5 %) patients - without signs of atherosclerotic lesions of the coronary artery. In group 1, the observation period was 56.8±23.2 months, in group 2-62.0±15.6 months, in group 3-58.1±20.4 months. RESULTS: During the hospital observation period, there were no significant intergroup differences in the number of complications. All cardiovascular events were detected in isolated cases. The most common injury was damage to the cranial nerves, diagnosed in every fifth patient in the total sample. The combined endpoint (CET), including death + myocardial infarction (MI) + acute cerebrovascular accident/transient ischemic attack (stroke/TIA), was 0.75 % (n=13). In the long-term follow-up period, when comparing survival curves, group 3 revealed the largest number of ischemic strokes (p = 0.007), myocardial infarction (p = 0.03), and CCT (p = 0.005). There were no intergroup differences in the number of deaths (p=0.62). CONCLUSION: The results of the study showed that there was no significant intergroup difference in the development of complications at the hospital postoperative stage. However, in the long-term follow-up period, a group of patients with isolated lesions of the ICA demonstrated a rapid increase in the number of MI, stroke/TIA, and a combined endpoint, which was apparently associated with low compliance and progression of atherosclerosis in previously unaffected arteries.

Asunto(s)

Aterosclerosis , Estenosis Carotídea , Enfermedad de la Arteria Coronaria , Endarterectomía Carotidea , Ataque Isquémico Transitorio , Infarto del Miocardio , Accidente Cerebrovascular , Humanos , Endarterectomía Carotidea/efectos adversos , Endarterectomía Carotidea/métodos , Estenosis Carotídea/complicaciones , Estenosis Carotídea/cirugía , Estenosis Carotídea/diagnóstico , Ataque Isquémico Transitorio/complicaciones , Enfermedad de la Arteria Coronaria/cirugía , Estudios Retrospectivos , Resultado del Tratamiento , Accidente Cerebrovascular/etiología , Infarto del Miocardio/etiología , Constricción Patológica/complicaciones

RESUMEN

BACKGROUND: Hyperlipoproteinemia (a) is an independent and cause risk factor for atherosclerotic cardiovascular diseases (ASCVD). The correlation between lipoprotein (a) Lp(a) and inflammation in the vessel wall was actively studied during the past few years. C-reactive protein (CRP) plays an important role in ASCVD. AIM: To analyze the relationship between hyperlipoproteinemia (a), inflammatory markers, and the early development of stenosing atherosclerosis (AS) in several vascular pools. MATERIALS AND METHODS: 76 patients, 55 men aged 18 to 55 years and 21women 18 to 60 years, with the results of instrumental examination of coronary, carotid and lower extremities vascular pools were enrolled. Three groups: with stenosing (50%) AS of only one (group 1, n=29); two or three (group 2, n=21) vascular pools. 26 patients without coronary heart disease and AS were included in the control group. All patients in groups 1 and 2 and 65% of those in the control group took statins. The concentrations of Lp(a), CRP, lipids and blood count were determined. RESULTS: The patients of the three groups did not differ in age. In the groups with AS (79% in group 1 and 85% in group 2), there were more men (relative to 54% in the control group). Diabetes mellitus was more common only in patients with multifocal AS. The absolute number of blood monocytes and leukocytes, the neutrophil-lymphocyte ratio, as well as Lp(a) level were higher in patients of groups 1 and 2 relative to the control. The maximum Lp(a) level (median [25%; 75%]) was observed in patients with lesions of two or more vascular pools vs the control group (49 [4; 96] mg/dL, vs 10 [4; 21] mg/dL, p=0.02). The CRP level was significant elevated in patients from group 2 7.2 [4.0; 9.7] mg/L, relative to group 1 2.5 [1.0; 4.7] mg/L, and the control group 2.9 [1.2; 4.9] mg/L, p0.05. The Lp(a) and CRP concentration, or the presence of diabetes mellitus in patients, regardless of other risk factors, were associated with severe stenosing AS in young and middle age. CONCLUSION: An elevated concentration of Lp(a) (30 mg/dL) determines the presence of both isolated and multifocal stenosing AS in the examined patients. A simultaneous increase in the concentration of both Lp(a) and CRP, as well as the presence of diabetes mellitus, are associated with the premature development of stenosing atherosclerotic lesions in several vascular regions at once. Measurement of these predictors in young and middle-aged patients makes it possible to use them as biochemical markers to assess the likelihood of multifocal lesions of the vascular pool.

Asunto(s)

Aterosclerosis , Inhibidores de Hidroximetilglutaril-CoA Reductasas , Hiperlipoproteinemias , Humanos , Masculino , Persona de Mediana Edad , Aterosclerosis/diagnóstico , Aterosclerosis/epidemiología , Aterosclerosis/etiología , Biomarcadores , Proteína C-Reactiva , Lipoproteína(a) , Prevalencia , Factores de Riesgo , Femenino , Adolescente , Adulto Joven , Adulto

RESUMEN

The aim of the study is to assess the possibility of using artificial intelligence to determine the most significant predictors of the operative correction outcomes for patients with damaged coronary and carotid arteries. Materials and Methods: The retrospective study of the simultaneous (or single-stage) surgical intervention results has been carried out in patients with combined atherosclerotic damage of the coronary bed and cerebral arteries (n=42), which was severe and extensive. The parameters which may be predictors of the cardiovascular risk were analyzed using the TADA program. Ten models were built for program learning. The model with 92% predictive accuracy appeared to be the most successful. Results: Simultaneous correction resulted in the absence of 30-day coronary complications in all patients. With respect to the cerebral vascular territory, acute ischemic stroke developed in 2 patients. The lethality rate was 2.4%, the fatal outcome was caused by postoperative gastrointestinal bleeding.The TADA program model considered the following parameters to be the most significant predictors: internal carotid artery cross-clamping time in minutes (51.24%); damage to the left coronary artery stem (30.42%); diastolic AP (18.28%). If cross-clamping of the internal carotid artery lasts for less than 18 min, complications are not likely to occur, while they are practically inevitable if the time exceeds 46 min. The probability of complications grows nonlinearly with the increase of the extent of the left coronary artery stem injury. A high diastolic AP never virtually coincides with the presence of complications, nor does the low one. The highest probability of complications is at the values from 70 to 80 mm Hg.In patients with a triple vessel injury of the coronary arteries, a representative picture of a nonsignificant feature is observed. Conclusion: Application of artificial intelligence for determining risk predictors for patients with concurrent atherosclerotic damage of the coronary and carotid arteries is an effective method for prognosticating the risks of simultaneous interventions.

Asunto(s)

Aterosclerosis , Estenosis Carotídea , Accidente Cerebrovascular Isquémico , Inteligencia Artificial , Aterosclerosis/complicaciones , Arterias Carótidas/cirugía , Estenosis Carotídea/complicaciones , Humanos , Estudios Retrospectivos , Factores de Riesgo

RESUMEN

The aim of the study was to study the effect of arterial stiffness and multifocal atherosclerosis on the 10-year prognosis of patients after coronary artery bypass grafting. Methods. Patients with coronary artery disease (n = 274) who underwent coronary artery bypass grafting (CABG), in whom cardio-ankle vascular index (CAVI) was assessed using the VaSera VS-1000 device and the presence of peripheral atherosclerosis in Doppler ultrasound. Groups were distinguished with normal CAVI (<9.0, n = 163) and pathological CAVI (≥9.0, n = 111). To assess the prognosis, coronary and non-coronary death, myocardial infarction, acute cerebrovascular accident/transient ischemic attack, repeated CABG, percutaneous coronary intervention, carotid endarterectomy, peripheral arterial surgery, pacemaker implantation were analyzed. Results. During the observation period, mortality was 27.7%. A fatal outcome from all causes was in 37 (22.7%) patients in the group with normal CAVI and in 39 (35.14%) in the group with pathological CAVI (p = 0.023). Death from cardiac causes was more common in the group with CAVI ≥ 9.0­in 25 cases (22.52%) than in the group with CAVI < 9.0­in 19 (11.6%, p = 0.016). The combined endpoint in patients with pathological CAVI was detected in 66 (59.46%) cases, with normal CAVI values­in 76 (46.63%) cases (p = 0.03). The presence of diabetes mellitus, multifocal atherosclerosis (p = 0.004), pathological CAVI (p = 0.063), and male gender were independent predictors of death at 10-year follow-up after CABG. The presence of multifocal atherosclerosis and pathological CAVI during the preoperative examination of patients were independent predictors of the combined endpoint development. Findings. Patients with coronary artery disease with pathological CAVI before CABG were more likely to experience adverse events and death in the long-term follow-up than patients with normal CAVI. Further studies are needed to investigate the possibility of correcting pathological CAVI after CABG after secondary prevention and the possible impact of this correction on prognosis.

RESUMEN

The manuscript is devoted to the problem of selection of antithrombotic therapy in the management of patients with multifocal atherosclerosis. The leading role of cerebrovascular pathology in the structure of mortality and causes of disability is noted. The questions of etiology and pathogenesis of acute cerebrovascular accident are considered. The pathogenetic subtypes of ischemic stroke and the criteria for their diagnosis were analyzed. The important role of antithrombotic therapy in the prevention of noncardioembolic stroke is presented. Considering the evidence-based medicine data based on the analysis of randomized trials results, modern strategies of antithrombotic therapy were demonstrated. A comparative analysis of the clinical trials results was carried out. New ideas about the benefits of combination therapy with acetylsalicylic acid at a dose of 100 mg/day and with rivaroxaban 2.5 mg twice daily, established in the COMPASS study, are presented.

Asunto(s)

Aterosclerosis , Accidente Cerebrovascular , Aspirina/uso terapéutico , Aterosclerosis/complicaciones , Aterosclerosis/tratamiento farmacológico , Fibrinolíticos/uso terapéutico , Humanos , Accidente Cerebrovascular/tratamiento farmacológico

RESUMEN

BACKGROUND: Problems concerning the choice of optimal revascularization strategy in patients with simultaneous atherosclerotic lesions of the coronary and brachiocephalic arteries still remain unsolved, since there are no randomized studies and there is uncertainty in Russian and foreign guidelines. AIM: The study was aimed at analysing the remote results of surgical treatment of 391 patients with concomitant lesions of the coronary and brachiocephalic arteries within the framework of a single-centre prospective registry. PATIENTS AND METHODS: Within the timeframe of our study, all patients were divided into 4 groups depending on the method of surgical treatment of the above-mentioned pathology of the coronary and brachiocephalic arteries. Group 1 patients underwent staged surgery in the scope of coronary artery bypass grafting followed by carotid endarterectomy. Group 2 patients endured coronary artery bypass grafting combined with carotid endarterectomy. Group 3 patients were subjected to hybrid revascularization consisting in percutaneous coronary intervention and carotid endarterectomy. Group 4 patients sustained staged surgery consisting of carotid endarterectomy followed by coronary artery bypass grafting. The clinical and demographic characteristics, period of follow up, as well as the results after the respective surgical intervention for each group are presented. RESULTS: We analysed the frequency and structure of adverse cardiovascular events depending on the time intervals within which complications had occurred resulting from a particular surgical policy used. DISCUSSION: The obtained findings demonstrated that adverse cardiovascular events in the total sample of patients were mainly observed in the remote period of follow up, which was related primarily to a progressive course of atherosclerosis, the presence of bilateral lesions of the internal carotid arteries, as well as the lack of protocols ensuring complete revascularization in multifocal atherosclerosis within a limited time interval. CONCLUSION: We made a conclusion on efficacy of the simultaneous strategy of revascularization by means of coronary artery bypass grafting combined with carotid endarterectomy in regard to decreased incidence of strokes in the remote period of follow up.

Asunto(s)

Estenosis Carotídea/cirugía , Endarterectomía Carotidea/efectos adversos , Arterias Carótidas/diagnóstico por imagen , Humanos , Estudios Retrospectivos , Federación de Rusia , Resultado del Tratamiento

RESUMEN

OBJECTIVE: A retrospective analysis of in-hospital results of renal artery stenting in patients with multifocal atherosclerosis. MATERIAL AND METHODS: The study included 19 patients who underwent stenting for renal artery stenosis for the period 2011-2015 in the Kemerovo Cardiology Dispensary. Renal function was assessed considering glomerular filtration rate (GFR). Blood pressure and GFR were evaluated before the stenting procedure and at discharge. RESULTS: Stenting resulted optimal outcomes in all 19 patients. Severity of residual stenosis was 11±3%. In-hospital mortality was absent. Blood pressure in early postoperative period was similar to baseline values. One patient had a normalization of blood pressure up to 115-140/85-90 mm Hg without administration of antihypertensive drugs. Decrease of systolic blood pressure up to 155.3±32.6 mm Hg was noted in other patients at discharge. Blood creatinine levels decreased up to 0.167±0.56 mmol/L. In addition, mean GFR increased from 34.17 ml/min/1.69 m2 up to 37.16 ml/min/1.69 m2. CONCLUSION: Endovascular treatment of renal artery stenosis and secondary hypertension is effective and relatively safe approach.

Asunto(s)

Implantación de Prótesis Vascular , Obstrucción de la Arteria Renal/cirugía , Arteria Renal/cirugía , Stents , Aterosclerosis/complicaciones , Aterosclerosis/cirugía , Humanos , Hipertensión Renovascular/etiología , Hipertensión Renovascular/cirugía , Obstrucción de la Arteria Renal/etiología , Estudios Retrospectivos , Resultado del Tratamiento

RESUMEN

AIM: Study of the remodeling of the carotid arteries with violation of intracardiac hemodynamics in patients with MFA, and the estimation of the main parameters of dyslipidemia, apoptosis, and oxidative stress in patients with high vascular risk older age group (6175 years) in a Regional vascular center of Ufa. MATERIALS AND METHODS: Depending on the predominant lesion of the vascular pool, patients were divided into 3 clusters by the method of hierarchical analysis of categorical variables according to the clinical manifestation of atherosclerotic lesions of the heart, brain and lower limb arteries confirmed by coronary angiography, ultrasound Doppler of the main arteries of the head and lower extremities. 96 of them were IPA with a primary lesion of the heart (1st cluster), the 96 IPA with a predominance of lesions of the carotid arteries (2nd cluster), 96 patients with ischemia of lower extremities (3rd cluster). At the hospital stage, electrocardiography, echocardiography, magnetic resonance imaging of the chest and abdomen, ultrasound of the OBP and kidneys, if necessary, ultrasound of the pelvis were performed. Determination of 8-ON-deoxyguanosine, annexin-5 (An-5) and Aan-5 in blood by ELISA was performed in all patients with MFA, as well as standard biochemical screening for lipidogram examination. RESULTS: We have found that most often in different combinations and with different degrees of severity according to our data are observed: Clinical manifestation of atherosclerotic heart disease (cluster 1) mainly due to its history in combination with stage III hypertension with increasing thickness of intima-media complex and stenosis of the right WASP, left ventricular dilatation, as well as a higher concentration of Aan-5IgMand LP-A as a risk factor for coronary heart disease, atherosclerosis, atherothrombosis. 2. Hemodynamically significant violations of the main arteries of the head in patients of the 2nd cluster mainly with acute ischemic cerebral circulation, in which there was a development of left ventricular hypertrophy with an increase in the size of the left atrium and the presence of atherosclerotic plaque of the right and left WASP. The higher prevalence of stroke was combined with a marked cognitive deficit among patients of cluster 2 with the lowest level of An-5, an increase in total cholesterol and low-density lipoprotein cholesterol. 3. The total severity of the condition in patients with hemodynamic ischemia with clinical manifestation of vascular lesions of the lower extremities was accompanied by a predominant increase in stable angina with FC2, lerish syndrome with occlusion of the iliac, superficial femoral arteries, the presence of insulin-independent type 2 diabetes, which in this group was established in 59.4% of cases, combined with a higher concentration of the marker of oxidative stress 8-ON-deoxyguanosine and hypertriglyceridemia. CONCLUSION: The construction of a three-cluster model in patients at high vascular risk of the elderly age category showed the interaction of cardio-carotid comorbid background on the clinical diversity of systemic vascular lesions in MFA with the development of remodeling of the main arteries and disorders of intracardiac hemodynamics associated with laboratory changes in the assessment of the main parameters of dyslipidemia, apoptosis markers, oxidative stress.

Asunto(s)

Aterosclerosis , Diabetes Mellitus Tipo 2 , Anciano , Biomarcadores , Hemodinámica , Humanos , Factores de Riesgo , Remodelación Vascular

RESUMEN

The purpose of this study was to evaluate the amputation-free survival rate and predictors of major adverse cardiovascular events (extracardiac and cardiac mortality, non-fatal myocardial infarction, non-fatal stroke) in patients with atherosclerotic occlusive-stenotic lesions of the femoropopliteal-tibial segment and critical ischaemia. We analysed the results of treating a total of 122 patients with atherosclerotic lesions of the superficial femoral artery and lower limb critical ischaemia. Of these, 35 patients had no lesions of other arterial basins, 24 patients presented with a concomitant lesion of the carotid basin, 41 subjects had lesions of the coronary basin, and 22 had lesions of the coronary and carotid basins. The patients were subjected to either bypass graft operation (n=75) or endovascular intervention (n=47). The evaluated outcome measures were amputation-free survival and the frequency of major adverse cardiovascular events. The average duration of follow up amounted to 38.2±4.3 months. The carried out multivariate logistic regression analysis demonstrated that the factors associated with lower limb amputation and the development of major adverse cardiovascular events were as follows: a concomitant lesion of the coronary (p=0.044) and coronary-carotid (p<0.05) basins, a history of endured myocardial infarction (p=0.003), a C-reactive protein level not less than 17.0 mg/l (p<0.05) and the value of the apolipoprotein B/A1 ratio above 1.0 (p=0.004).

Asunto(s)

Aterosclerosis , Isquemia , Injerto Vascular , Amputación Quirúrgica , Aterosclerosis/cirugía , Arteria Femoral , Humanos , Isquemia/cirugía , Recuperación del Miembro , Extremidad Inferior/irrigación sanguínea , Factores de Riesgo , Resultado del Tratamiento

RESUMEN

BACKGROUND: Myocardial revascularization involves a wide range of invasive strategies aimed at treating ischaemic heart disease in patients of different age groups. AIM: The purpose of the present study was to analyze the outcomes of coronary artery bypass grafting in patients depending on age. PATIENTS AND METHODS: A total of 905 patients enrolled in our study were subdivided into groups based on age-related characteristics (young age, middle age, old age, senile age). The endpoints of follow up were as follows: myocardial infarction, acute impairment of cerebral circulation, death and haemorrhagic complications. RESULTS: It should be mentioned that the groups were comparable by the majority of the parameters studied. No statistically significant differences in the frequency of the development of complications in the postoperative period were observed. However, amongst patients over 75 years old, revision of the mediastinum for haemorrhage was performed more often. DISCUSSION: Patients of different age groups undergoing coronary artery bypass grafting are extremely heterogeneous by the clinical, anamnestic, instrumental and intraoperative characteristics. A high frequency of haemorrhagic complications amongst patients over 75 years old may be explained by a more aggressive approach to the regimens of anticoagulant/antiaggregant therapy resulting form the presence of atrial fibrillation. In its turn, this fact determines the probability of a high frequency of the development of adverse cardiovascular events. An individual approach to the choice and scope of the strategy of revascularization in patients of different age groups is the fundamental principle for an optimal outcome of coronary surgery. CONCLUSION: The obtained findings and analysis of the statistical data are indicative of the necessity of personified selection of the technique of a surgical intervention for each particular patient, which will make it possible to decrease the rate of adverse cardiovascular events in the postoperative period.

Asunto(s)

Fibrilación Atrial , Puente de Arteria Coronaria , Enfermedad de la Arteria Coronaria , Infarto del Miocardio , Anciano , Humanos , Persona de Mediana Edad , Revascularización Miocárdica , Complicaciones Posoperatorias , Resultado del Tratamiento

RESUMEN

In the review article are provided the approaches to the therapy for improvement of prognosis in patients with peripheral and multifocal atherosclerosis which are available now; some limitations and a real situation are designated for the antithrombotic therapy in this category of patients. According to the clinical trial COMPASS the prospects of wide use of a combination of acetylsalicylic acid and a rivaroxsaban of 2.5 mg 2 times a day in the patients with chronic coronary heart disease and/or symptom peripheral atherosclerosis are designated.

Asunto(s)

Aspirina/uso terapéutico , Aterosclerosis/tratamiento farmacológico , Enfermedad Arterial Periférica/tratamiento farmacológico , Rivaroxabán/uso terapéutico , Quimioterapia Combinada , Humanos

RESUMEN

AIM: To study the features of atherosclerosis of peripheral arteries in patients with coronary artery disease (CAD) depending on the presence of type 2 diabetes mellitus (T2DM) and to identify factors associated with multifocal atherosclerosis. MATERIALS AND METHODS: The study included 140 patients (77 men and 63 women) with CAD (mean age 62.0 (56.0-66.0) years). The first group included 70 people with CAD and T2DM, and the second group included 70 patients with CAD without T2DM. All patients underwent duplex scanning of the carotid and lower limb arteries (LLA). Local vascular stiffness of the common carotid artery (CCA) was assessed by ultrasound scanning. The Peterson elasticity modulus, distensibility and strain of the CCA were determined. The ankle - brachial index (ABI) was measured by the Doppler method. RESULTS AND DISCUSSION: In the group of patients with T2D, there were statistically more patients with atherosclerotic plaques in both carotid arteries and LLA. Also among patients with T2DM the severity of stenosis of carotid arteries and LLA at all levels was significantly greater. Local carotid stiffness was higher in the first group of patients. The proportion of individuals with reduced ABI.

Asunto(s)

Aterosclerosis , Enfermedad de la Arteria Coronaria , Diabetes Mellitus Tipo 2 , Anciano , Índice Tobillo Braquial , Arterias Carótidas , Arteria Carótida Común , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo

RESUMEN

AIM: To analyze long-term results of surgical treatment of atherosclerotic occlusive-stenotic lesion of aorto-femoral segment within the single-center prospective register. MATERIAL AND METHODS: The study included 275 patients who underwent aorto-femoral reconstructive interventions for the period 2011-2014. Inclusion criterion was indications for aorto-femoral surgery due to severe atherosclerotic lesions of the infrarenal aorta and/or ilio-femoral arteries. Mean follow-up was 54±11.6 months. RESULTS: Prognostic significance of various clinical-instrumental, anatomical-angiographic and perioperative variables has been comprehensively analyzed. Five-year outcomes and cardiovascular morbidity were assessed in consecutive patients after reconstructive procedures on the aorto-femoral segment. Multidisciplinary approach to determine optimal revascularization strategy and certain tactical and technical algorithms are necessary to improve the outcomes in these severe patients.

Asunto(s)

Aorta Abdominal/cirugía , Arteriopatías Oclusivas/cirugía , Aterosclerosis/complicaciones , Arteria Femoral/cirugía , Arteria Ilíaca/cirugía , Procedimientos Quirúrgicos Vasculares , Anciano , Arteriopatías Oclusivas/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud , Procedimientos de Cirugía Plástica/métodos , Procedimientos de Cirugía Plástica/estadística & datos numéricos , Sistema de Registros/estadística & datos numéricos , Siberia , Tiempo , Grado de Desobstrucción Vascular , Procedimientos Quirúrgicos Vasculares/métodos , Procedimientos Quirúrgicos Vasculares/estadística & datos numéricos

RESUMEN

We present two cases of surgical treatment of patients with coronary artery steal syndrom and multifocal atherosclerosis, who previously underwent coronary artery bypass grafting using left internal mammary artery. In both cases carotid-subclavian bypass was performed through supraclavicular access using synthetic prosthesis. This method allowed to restore blood flow in the left internal mammary artery, eliminate recurrent angina pectoris, and improve patients quality of life. The article also contains descriptions of possible methods of surgical correction of this pathology, their advantages and disadvantages.

Asunto(s)

Angina de Pecho/etiología , Puente de Arteria Coronaria , Síndrome de Robo Coronario-Subclavio/complicaciones , Angina de Pecho/cirugía , Puente de Arteria Coronaria/efectos adversos , Humanos , Calidad de Vida , Recurrencia

RESUMEN

AIM: To assess the impact of presence of multifocal atherosclerosis (MFA) and gender differences on immediate outcomes after coronary artery bypass grafting (CABG) in patients with ischemic heart disease (IHD). MATERIAL AND METHODS: Medical records of patients with MFA, who underwent elective CABG (n=764, 655 men, 109 women) were reviewed retrospectively. RESULTS: Women were older (<0.001), and more often were overweight (<0.001), had diabetes (<0.001), high angina functional class (=0.012) and congestive heart failure (=0.002). Cigarette smoking was more common among men. Men more often had reduced left ventricular ejection fraction (<0.001). Three-vessel coronary artery disease prevailed among women (=0.080). Rate of hemodynamically significant carotid stenosis was higher among women (=0.010), whereas that of peripheral artery disease - among men (=0.001). Total number of perioperative complications was 48.8% among women and 53.0% among men (=0.399). According to multivariate analysis, history of CABG was associated with increased risk of perioperative complications (=0.034), and combined involvement of left main coronary artery (LMCA) and three coronary arteries - with in-hospital mortality (=0.003). CONCLUSION: There were no gender differences in the incidence of perioperative complications. Women more often had carotid lesions, men - lesions in arteries of lower limbs. Women had more risk factors (other than smoking) what could explain high prevalence of three-vessel disease as well as more severe coronary insufficiency and heart failure. Regardless of patients gender and presence of MFA history of previous CABG and presence of combined LMCA and three coronary arteries involvement increased risk of perioperative complications and in-hospital mortality, respectively.

Asunto(s)

Aterosclerosis/cirugía , Puente de Arteria Coronaria , Anciano , Angina de Pecho/complicaciones , Aterosclerosis/complicaciones , Aterosclerosis/fisiopatología , Enfermedad de la Arteria Coronaria/complicaciones , Femenino , Insuficiencia Cardíaca/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Resultado del Tratamiento

RESUMEN

Coronary artery disease (CAD) is the leading cause of morbidity and mortality in many countries over the world. In recent years, the combination of atherosclerosis of coronary and peripheral artery is increasing which in turn becoming a crucial issue of interventional cardiology and cardiovascular surgery at present days. According to the data reported by different autors (), the incidence of multifocal atherosclerosis (in patients with CAD) varies from 8.1 to 33.9%. In our study prevalence of multifocal atherosclerosis was 12.8% and of all these cases, majority had multiple involvement of coronary arteries as well higher degree of severity in stenosis. Management of surgery in patients with multisystem aterosclerosis very importent issueses of vascular surgery. The choice and strategy of reconstructive surgery still remains controversial when CAD coexists with other peripheral arterial disease. Surgical management of concomitant diseases of coronary, cerebral and peripheral arteries are certainly the most important issue of vascular surgery. In addition to traditional surgical approaches for all common vascular diseases, the endovascular surgical management is developing rapidly. Reported herein is the some cases of a patient presenting with associated atherosclerotic lesion of the coronary artery, extracranial artery and artery of lower extremities. We have different reconstructive vascular surgery patients with multifocal atherosclerosis. There are included some cases of vascular taktics for multifocal atherosclerosis.