[Endovascular treatment of a patient with post-thrombotic disease and obstruction of a cava filter]

Balloon angioplasty and stenting have increasingly been gaining widespread application for treatment of post-thrombotic alterations in the system of the vena cava. Endovascular ultrasonographic examination makes it possible with the utmost degree of reliability to determine both the extension and degree of the narrowing of venous segments, thus proving a possibility of choosing a venous stent of an appropriate diameter. Restoration of an adequate venous lumen leads to normalization of blood flow and elimination of venous hypertension. However, unsolved as yet remains the problem concerning proper management of post-thrombotic obstructions of the inferior vena cava at the level of a cava filter. Owing to a wide variety of configurations of cava filters to deploy, there are no common approaches to elimination of such obstruction. Presented herein is a clinical case report regarding successful endovascular treatment of a patient diagnosed with post-thrombotic disease secondary to endured thrombosis. The findings of both phlebography and endovascular ultrasonographic examination made it possible to diagnose obstruction of the left common iliac vein, external iliac vein, and inferior vena cava to the level of the cava filter previously deployed. In the segment of the inferior vena cava at the level of the cava filter also revealed was a pronounced luminal narrowing exceeding 90% of its diameter. We carried out stenting of the common and external iliac veins, inferior vena cava, and the cava filter. Swelling of the left leg subsided spontaneously within 2 weeks and the first postoperative month was accompanied by gradual disappearance of the previously existing feeling of heaviness in the lower limbs and a dramatic decrease in fatigue by the end of the working day.

[Long-term results of clinical application of autologous mononuclear bone marrow fraction for regeneration therapy of ischemic heart disease patients]

An experience with using autologous bone marrow mononuclears for regeneration of the heart was analyzed in 97 patients in whom the intracoronary transplantation of autologous mononuclear bone marrow cells was performed. The results were estimated in terms up to 5 years and compared with a group of 37 patients who underwent only conservative treatment. A distinct positive dynamic of clinical and echocardiographic indices in the main group was noted in a subgroup of patients with a decreased ejection fraction (EF less than 50%) as compared with an analogous subgroup of patients in the control group. Substantial influence is exerted by regeneration therapy upon remote lethality. Thus, as a whole in the main group lethality over 5 years was 13.4% and in the group of control it was 21.6%. In the subgroup with a decreased ejection fraction and symptoms of heart failure lethality was 22.6% in the main group and 54.5%--in the control group. The intracoronary administration of the autologous bone marrow mononuclear fraction to inoperable patients with ischemic heart disease and a severe lesion of the coronary arteries and a decreased ejection fraction of the left ventricle is a safe and useful procedure resulting to substantially decreased lethality followed-up during 5 years against the background of conservative treatment.

[Carotid endarterectomy and endovascular angioplasty with stenting in patients with atherosclerotic stenoses and occlusions of the internal carotid artery]

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.

[The dynamics of the coronary bed state in patients with ischemic heart disease after surgical correction of dyslipoproteidemia]

The investigation included 85 ischemic heart disease patients with the coexistent dyslipoproteidemia. In 39 of the patients the operation of partial shunting was performed for correction of the impaired lipid metabolism. It was found that the partial ileoshunting was an effective method of correction of dyslipoproteidemia. The effect of the operation was due to lowering the total cholesterol level in blood (at an average by 25.6%) and elevation of the HDL level (at an average by 19.6%). The results of the following angiographic examinations have shown a clear effect of the inhibition of progressing coronary atherosclerosis in patients who underwent surgical correction of dyslipoproteidemia that allows the partial ileoshunting to be considered as an effective method of the secondary prophylactics of atherosclerosis. The HDL level is the main marker of the dynamics of the atherosclerotic process in the coronary arteries.

[Complications after angioplasty and stenting of coronary arteries in ischemic heart disease patients]

The authors have made an analysis of most frequent complications of angioplasty and stenting of coronary arteries in 1900 patients with various forms of ischemic heart disease. The mechanisms, pathomorphology, angiographic and clinical manifestations of such complications as dissection of the coronary artery intima, acute occlusion of the coronary artery, "no-reflow" syndrome, perforation and rupture of the coronary artery, acute thrombosis in the stent area and other complications are considered in detail. Special medical strategy, both therapeutic and surgical, is proposed for each case. The authors propose a number of prophylactic measures allowing to avoid the complications described or to minimize them. Intraoperative lethality in this group of patients was 0.5% (10 patients), during the first week after endovascular intervention 26 patients died (1.4%).

[Features of angioplasty and stenting in atherosclerotic stenting of coronary artery occlusions]

The authors analyze results of coronary angioplasty in 257 patients with ischemic heart disease who had occlusions of the coronary arteries. Clinical, angiographic and other findings showing the duration of having the occlusions of the coronary artery are described in detail. The details of the steps of the technique of the endovascular intervention are considered including the most difficult step--passing through the occluded portion of the artery. Great attention is given by the authors to the criteria of using the correct instruments (conducting catheter, conductors, balloon-catheters) during the operation. Good results were obtained in 80.2% of the patients after coronary angioplasty. Stenting of the coronary arteries was performed in 65 patients (25.3%).

[Angioplasty for atherosclerotic lesions of the left main coronary artery]

The authors analyze results of coronary angioplasty and stenting in patients with ischemic heart disease with a lesion of the left main coronary artery. Injuries of the left main coronary artery took place in 14 (0.74%) out of 1900 patients after coronary angioplasty. A detailed analysis of the operation technique, indications and contraindications for endovascular intervention is given. The results of balloon angioplasty with and without the following stenting are compared.

[Surgical treatment of chronic ischemic heart disease]

The authors suggest a new complex approach to the surgical treatment of ischemic heart disease. Operation of coronary shunting for the restoration of the coronary blood flow, operation of partial ileoshunting for correction of hyperlipoproteinemia, plexotomy for removal of the vasospastic component. The sequence of the operations may vary, each one can also be undertaken independently. The operations were conducted on 315 patients. The follow-up period is up to 8 years. Patency of the mammary-coronary shunts was 93.5%, of autologous veins shunt--65%. Disappearance of the signs of coronary spasm++ and stable normalization of the lipid spectrum are noted.

[Internal thoracic artery in coronary surgery]

The authors emphasize advantages of using the internal thoracic artery for mammary-coronary shunts in patients with ischemic heart disease. 257 operations have been performed in the clinic since 1964. Among them there were operations of mammary-coronary anastomosis (after V. I. Kolesov) and mammary-coronary shunts. Long-term results were followed-up which evidence high effectiveness of operative treatment. In 109 patients control angiographic examinations were fulfilled at different terms (up to 12 years). Patency of mammary-coronary shunts was 83.5% as compared with ACSh where it was about 63%.

[Function of the myocardium after revascularization and the patency of coronary shunts]

The article analyzes the contractive function of the myocardium in 149 patients after operation of a single aortocoronary shunt (25 patients), mammaro-coronary shunts with mechanical anastomosis (109 patients) and with manual distal anastomosis (15 patients). Patency of the aorto-coronary shunts was 72%, mammaro-coronary shunts with direct distal anastomosis - 83.5%, with the end-to-side anastomosis - 88.8%. The myocardium function was improved in patients with patent shunts. In patients with incompetent shunts further deterioration of the contractive function of the left ventricle myocardium was noted. It was pointed out that the development of myocardium infarction in the zone of the coronary artery operated upon is not always accounted for by a shunt thrombosis.

[The contractile function of the myocardium in patients with ischemic heart disease after the mammary-coronary artery shunting]

Under investigation there were 91 patients subjected to operations of mammary-coronary shunts with putting end-to-end anastomoses between the left internal thoracic artery and the anterior interventricular artery. Control examinations were performed within the terms from 3 weeks to 7 years. The patency of the shunt was established in 85 of 91 patients. The author considers that the function of the left ventricle myocardium was considerably improved in patients with passable shunts (the patients after myocardium infarction).