JOURNAL «ANGIOLOGY AND VASCULAR SURGERY»

History is an important section for any specialty, expanding the understanding of the field under study. Surgery of thoracoabdominal aortic aneurysms has undergone significant changes over time at the level of diagnostic and therapeutic measures, however, for the further development of technical aspects in this area, it is important to understand the origins of this issue.

The article highlights the main stages of the development of thoracoabdominal aortic aneurysm surgery, and also highlights the scientists who have made the greatest contribution to the development and improvement of interventions for this surgical pathology.

Chronic thromboembolic pulmonary hypertension (CTEPH) is a distinct type of pulmonary hypertensive disease, characterized by incomplete or abnormal resolution of acute pulmonary embolism such that residual emboli become organized and fibrotic. Pulmonary endarterectomy (PEA) is the treatment of choice for many patients with chronic thromboembolic pulmonary hypertension. Karl Storz Endoscopy is a useful tool used in our department to improve the quality of pulmonary endarterectomy surgery while removing the thrombus lying on the segmental and subsegmental branches of right and left pulmonary arteries.

Material and methods. From 16.12.2021–15.08.2023 14 cases of pulmonary endarterectomy were performed also using Karl Storz Endoscopy with these parameters: rigid, 0º angled, straight, 30 cm length and 2 mm width. It has an HD camera attached on the distal part of it which is connected to a monitor and at the same time magnifies the image and provides visualization with a high quality. Vision, quality of surgery and teaching potential were evaluated during this period. Overall impressions and feedback were generated by the surgical team.

Results. All 14 PEA surgeries were completed without any complication. Overall impressions and feedback were positive on the usage of Karl Storz Endoscopy as a useful tool on pulmonary endarterectomy operations. This tool provides a better view of the thrombus that lies on the segmental arteries of right and left pulmonary arteries using an HD camera attached to its distal end and its connection with a monitor. Surgical team agreed that Karl Storz Endoscopy is crucial on the removal of thrombus lying on segmental and subsegmental branches of right and left pulmonary arteries. It also has an important impact as a teaching potential of PEA technique to the trainees.

Conclusion. Karl Storz Endoscopy is a useful part of the surgical tools used in our clinic during pulmonary endarterectomy operations. It provides excellent visualization of segmental and subsegmental branches of right and left pulmonary artery during the removal of thrombus. Secondarily, we found this tool to be important in teaching trainees pulmonary endarterectomy operation technique.

Background. There are few results comparing the effectiveness of interwoven (INS) and laser cut (CNS) nitinol stents in the revascularization of prolonged occlusions of the superficial femoral artery. The purpose of our study was to evaluate the short- and mid-term results of the effectiveness of laser cut and interwoven nitinol stents in the revascularization of long femoropopliteal occlusions.

Material and methods. A retrospective analysis of 251 patients who underwent stenting with cut or interwoven stents for long femoral-popliteal occlusions (≥150 mm) was conducted. The INS group included 126 patients. The CNS group included 125 patients. Above the knee stenting in the INS and CNS groups was performed in 89 (70.6%) and 98 (78.4%) patients, respectively. Below the knee stenting in the INS and CNS groups was performed in 37 (29.4%) and 27 (21.6%) patients, respectively. The primary endopoint was the primary patency in 2 years. Propensity score stratification was used to minimise bias.

Results. 424 patients met the inclusion criteria (INS: n=216; CNS: n=208). After propencity score matching, 126 and 125 patients remained in the INS and CNS groups, respectively. There were no cases of major cardiovascular events or major limb events in both groups during the early postoperative period. There were no significant differences in primary, secondary patency, primary and secondary sustained clinical improvement and mortality in the groups during a 2-year follow-up. Major limb events were 22.2% in the INS group and 34.4% in the CNS group (p=0.03). In an above-the-knee subgroup analysis, INS and CNS showed significant differences in secondary patency rates (82.0% in INS vs 96.9% in CNS, p=0.001) and secondary sustained clinical improvement (79.8% in INS subgroup vs. 93.9% in CNS subgroup, p=0.004). In a below-the-knee subgroup analysis, INS showed superiority in term of primary patency (INS: 64.9% CNS: 37.1%; p=0.04), primary sustained clinical improvement (INS: 75.7%, CNS: 37.1%; p=0.004) and secondary sustained clinical improvement (INS: 86.5%, CNS: 51.9%, p=0.004).

Conclusion. 2-year patency and sustained clinical improvement did not differ between the INS and CNS groups. There was a higher incidence of major limb events in the CNS group. In the below knee subgroup, patients with INS had statistically significantly better rates of primary patency and sustained clinical improvement compared with patients in the CNS subgroup.

Objective. To improve the quality of diagnosis of pelvic venous diseases in women by means of a developed protocol of ultrasound examination (USE) of pelvic veins.

Materials and methods. The article deals with the basic information about the anatomy of pelvic veins, geodynamic and anatomic parameters to be examined during pelvic vein USE, indications for and contraindications to pelvic vein USE, preparation of pelvic veins for USE, tasks of this examination, the equipment used, and modifications of pelvic vein USE.

Results. The developed protocol of pelvic vein USE makes it possible to comprehensively evaluate the state of pelvic veins and major pathways of outflow therefrom. Described herein are the sequence of performing USE, characteristics of pelvic venous reflux, methods of determination of and ultrasonographic criteria for hemodynamically significant stenoses of the left renal and common iliac veins, as well as possibilities and limitations of transabdominal, transvaginal and translabial ultrasound in assessment of renal, iliac and pelvic veins. Also considered are terminological problems, the significance of pelvic-vein diameters and the duration of pelvic venous reflux in the occurrence and severity of clinical manifestations of pelvic venous diseases (PVD).

Conclusion. Performing pelvic vein USE according to the standardized protocol will make it possible to significantly improve the quality and timeliness of PVD diagnosis, hence promoting formation of unified ultrasonographic assessment of pelvic veins, ruling out unnecessary invasive diagnostic tests from the program of examination of patients with PVD, and contributing to optimal therapeutic decision-making.

Relevance. There are more and more publications about cases of damage to the internal carotid artery (ICA) in stylohyoid syndrome Eagle. It is assumed that extravasal compression can lead to delamination, the formation of pseudoaneurysms or thrombosis of the ICA. Several retrospective studies have been conducted on the role of stylohyoid syndrome in the development of ICA dissection.

The purpose. Summarizing current data on clinical manifestations and treatment options, as well as analyzing studies on ICA dissection against the background of stylohyoid syndrome.

Material and methods. An electronic search of publications in the databases PubMed (Medline), Google Scholar and RSCI (Elibrary) was conducted without restrictions on the publication status of the article in accordance with the PRISMA criteria. In the analysis of clinical cases, the following parameters were taken into account: gender, age, side of the lesion, length of the styloid process (SP) and ossification of the stylohyoid ligament, the presence of a provoking factor, symptoms of the disease, the presence of stroke or transient ischemic attack (TIA), medication and surgical treatment, follow-up time, the presence of a recurrence of the disease. The Russian-language AMSTAR and Newcastle-Ottawa Quality Assessment Scales were used to assess the methodological quality of reviews and studies.

Results. The final analysis included 78 articles. Of these, 68 articles describing clinical cases, 5 systematic reviews and 7 retrospective case-control studies. In the process of analyzing the review articles, it was proved that stylohyoid syndrome can lead to the development of vascular complications and a link between ICA dissection and an elongated SP or a decrease in the distance between SP and ICA was shown. However, the reviews had a number of limitations and were of low methodological quality. When considering clinical cases, it was found that without resection of the SP, a recurrence of stroke or TIA occurred in 29% after drug treatment and in 56% after stenting of the ICA. No recurrence was observed in patients after SHO resection in the median follow-up period of 6 months (3–18). Most studies have shown a significant relationship between the length of the styloid process (4 out of 7), the distance between SP and ICA (6 out of 7) and the risk of ICA dissection. One study did not confirm the relationship between the parameters of SP (length, distance to ICA, calcification of the stylohyoid ligament) and dissection of ICA. All the studies turned out to be of low methodological quality.

Conclusion. Most studies confirm the connection of the pathology of the stylohyoid complex with the ICA stratification. Given the low methodological level and incomplete consistency of the conclusions, additional high-quality studies are needed, taking into account the identified limitations, in order to prove the connection of stylohyoid syndrome with ICA dissection.

The guidelines were worked out in accordance with the requirements of the Ministry of Health of the Russian Federation by the All-Russian Public Organization “Russian Society of Angiologists and Vascular Surgeons” with participation of the Association of Cardiovascular Surgeons of Russia, Russian Scientific Society of Specialists in X-ray Endovascular Diagnosis and Treatment, Russian Society of Surgeons, Russian Society of Cardiology, Association of Phlebologists of Russia, Russian National Atherosclerosis Society, Russian Association of Specialists in Functional Diagnostics.