Currently, two methods of coronary revascularization are used in coronary surgery – percutaneous coronary interventions and coronary bypass grafting. Technical capabilities allow using them both for the treatment of chronic coronary heart disease and in surgery for acute myocardial infarction.The development of cardiosurgical and endovascular areas has gone through two main stages. The first was to develop and improve the methodology itself and the second was to create standards and recommendations governing the treatment of coronary heart disease based on experience and accumulated results. At the present stage, individual technical aspects are subject to even greater standardization, which relate to both the selection and preparation for surgical treatment and individual stages of revascularization.
Cardiovascular diseases originating from atherosclerosis appear to be a big problem in the whole world. Type 2 diabetic patients have their specific features of atherosclerosis development. The authors tried to follow up the patients with Type 2 diabetes mellitus and those without it. The average period of the study was 55,1 23,2 months. Mortality in both groups proved to be comparable (p>0,05). In the long-term period, Type 2 diabetic patients underwent coronary revascularization (p = 0,01) and surgery for bilateral carotid arteries (p = 0,005) more often than the patients from the second group.
The purpose of the study was to assess efficacy of endovenous laser ablation of major saphenous veins by means of the Mediola single-ring radial light guides with the use of the 'Optical Handpiece MHP02 (Colibri)'.This non-comparative prospective study included 430 consecutive patients who underwent a total of 511 endovenous laser ablation procedures from January 2018 to March 2019. The great saphenous vein was subjected to obliteration in 343 (67.1%) cases, the anterior accessory saphenous vein - in 94 (18.4%) cases, and the small saphenous vein - in 74 (14.5%) cases. There were 170 (39.5%) men and 260 (60.5%) women, with a mean age of 52±12.8 years.The next day after the intervention the patients revisited the clinic for control examination, with the obtained findings demonstrating that occlusion of the target vein had been achieved in all 511 (100%) cases. At 2 months, we examined 411 (95.6%) people with a total of 484 (94.7%) treated veins. After 6 months, 399 (92.8%) people with 472 (92.4%) veins were examined. Recanalization with pathological reflux during the entire follow-up period was registered in 6 (1.3%) cases. Hence, the long-term rate of obliteration amounted to 98.7%.1) endovenous laser ablation of major saphenous veins by means of the Mediola laser unit with wavelength of 1470 nm and single-ring radial light guides with the use of the 'Optical Handpiece MHP02 (Colibri)' made it possible to achieve obliteration of the target vein in 98.7% of cases at 6 months of follow up; 2) within the mentioned terms, the need for repeat intervention could appear in 1.1% of cases; 3) the Colibri system provides a possibility of decreasing the final cost of radial light guides for endovenous laser ablation by 30-50%.ЦЕЛЬ: Оценить эффективность эндовенозной лазерной облитерации магистральных подкожных вен однокольцевыми радиальными световодами Mediola с применением системы 'Держатель световода ручной MHP02 (Colibri)'. МАТЕРИАЛ И МЕТОДЫ: В несравнительное проспективное исследование были последовательно включены 430 пациентов, перенесших 511 эндовенозных лазерных облитераций с января 2018 по март 2019 гг. Большая подкожная вена подвергалась облитерации в 343 (67,1%) случаях, передняя добавочная подкожная вена – в 94 (18,4%), малая подкожная вена – в 74 (14,5%). Мужчин и женщин было 170 (39,5%) и 260 (60,5%) соответственно. Средний возраст – 52±12,8 лет. РЕЗУЛЬТАТЫ ИССЛЕДОВАНИЯ: На следующие сутки после вмешательства все пациенты явились на контрольный осмотр, при этом окклюзия целевой вены была достигнута во всех 511 (100%) случаях. Через 2 месяца осмотрено 411 (95,6%) человек, 484 (94,7%) вены. Через 6 месяцев явка – 399 (92,8%) человек, 472 (92,4%) вены. Реканализация с патологическим рефлюксом в указанные сроки зарегистрирована в 6 (1,3%) случаях. Таким образом, в отдаленном периоде частота облитерации составила 98,7%. ВЫВОДЫ: 1) эндовенозная лазерная облитерация магистральных подкожных вен на лазерном аппарате с длиной волны 1470 Нм однокольцевыми радиальными световодами Mediola с применением системы 'Держатель световода ручной MHP02 (Colibri)' позволяет добиться облитерации целевой вены в 98,7% случаев на сроке наблюдения до 6 месяцев; 2) в указанные сроки потребность в повторном вмешательстве может возникнуть в 1,1% случаев; 3) благодаря системе Colibri появляется возможность снизить финальную цену радиальных световодов для эндовенозной лазерной облитерации на 30–50%.
The purpose of the study was to assess the depth of damage to the venous wall after endovenous laser coagulation (EVLC) at different power of the unit - 5, 7 and 10 W and similar linear density of energy (LDE) - approximately 70 J/cm. Our prospective comparative morphological study with blinding included a total of 30 patients subjected to EVLC of the great saphenous vein using the unit with a wavelength of 1,470 nm and radial light guides with automatic traction. The patients were divided into three groups, each comprising 10 patients. The unit's power (W) during EVLC and velocity of light guide traction (mm/s) in group one amounted to 5 and 0.7 (LDE - 71.4 J/cm), in group two to 7 and 1.0 (LDE - 70 J/cm) and in group tree to 10 and 1.5 (LDE - 66.7 J/cm), respectively. The coagulated veins were then procured from mini approaches and subjected to three sections made at a distance of 2 mm from each other. Specimens were stained with haematoxylin-eosin and picrofuxin according to the van Gieson technique. Then, in four places of each section (at 3, 6, 9 and 12 hours) we assessed the depth of the damage to the venous wall and calculated the average percentage of alteration - the ratio of the depth of the lesion to the venous wall thickness. The average depth of damage to the venous wall (μm) amounted in the first group to 122.9 ?m, in the second group to 182.9 μm, and in the third group to 267 μmm. The index of alteration (%) averagely amounted: in group one to 25.7, in group two to 37.9 and in group three (at a power of 10 W) to 55.5 (p=0.0001 when comparing each of the groups (the Kruskal-Wallis test)). Hence, despite an inconsiderable decrease of the LDE from the first to the third group, as power increased, the depth and percentage of damage to venous walls increased statistically significantly. It follows from the above-mentioned that: 1) an increase in power (from 5 to 10 W) of the unit during EVLC at comparable LDE (approximately 70 J/cm) leads to a deeper damage of the venous wall; 2) it is necessary to carry out a clinical study aimed at comparing different modes of coagulation, with the assessment of the frequency of recanalization and the level of pain syndrome.Цель работы – оценить глубину повреждения стенки вены после эндовенозной лазерной коагуляции (ЭВЛК) при разной мощности аппарата – 5, 7 и 10 Вт и одинаковой линейной плотности энергии (ЛПЭ) – около 70 Дж/см. В проспективное сравнительное морфологическое исследование с ослеплением вошли 30 пациентов, которым выполняли ЭВЛК большой подкожной вены аппаратом с длиной волны 1 470 нм, используя радиальные световоды с автоматической тракцией. Пациенты были разделены на три группы по 10 человек. Мощность аппарата (Вт) при ЭВЛК и скорость тракции световода (мм/с) составила соответственно: в первой группе – 5 и 0,7 (ЛПЭ – 71,4 Дж/см), во второй – 7 и 1,0 (ЛПЭ - 70 Дж/см), в третьей – 10 и 1,5 (ЛПЭ - 66,7 Дж/см). Затем коагулированные вены забирали из мини-доступов и на каждой из них выполняли по три среза на расстоянии 2 мм друг от друга. Производили окраску препаратов (гематоксилин-эозином и пикрофуксином по методу ван Гизона). Далее в четырех местах каждого среза (на 3, 6, 9 и 12 часах) оценивали глубину повреждения стенки вены и рассчитывали средний процент альтерации – отношение глубины повреждения к толщине стенки вены. Средняя глубина повреждения стенки вены (мкм) составила: в первой группе – 122,9, во второй – 182,9 и в третьей – 267 мкм. Показатель альтерации (%) в среднем составил: в первой группе – 25,7, во второй – 37,9 и в третьей (при мощности 10 Вт) – 55,5 (p=0,0001 при сравнении каждой из групп (тест Краскела–Уоллиса)). Таким образом, несмотря на незначительное уменьшение ЛПЭ от первой к третьей группе, с повышением мощности глубина и процент повреждения стенок вен статистически значимо увеличивались. Из вышеприведенного следует: 1) увеличение мощности (от 5 до 10 Вт) аппарата при ЭВЛК при сопоставимой ЛПЭ (около 70 Дж/см) приводит к большей глубине повреждения стенки вены; 2) необходимо проведение клинического исследования, нацеленного на сравнение разных режимов коагуляции с оценкой частоты реканализации и уровня болевого синдрома.
Carotid stenosis is a multidisciplinary problem that requires the involvement of a specialists’ team, including cardiovascular surgeons, neurosurgeons, endovascular surgeons, cardiologists, neurologists, and internists. In this consensus statement, a group of experts considered the main stages of diagnosing carotid stenosis, as well as discussed, the necessary prevention methods and features of choosing the optimal treatment approach. The aim was to provide concise and structured information on the management of patients with carotid stenosis. This document was developed based on the updated clinical guidelines of the European Society for Vascular Surgery and the American Association for Vascular Surgery, taking into account the consensus opinion of Russian experts.
The estimation of gastric contents pH and gastroduodenal zone mucous membrane condition based on the fibrogastroduodenoscopy data of 40 patients who were examined and received proton pump inhibitors in the postoperative period after heart surgical intervention. It was estimated, that acidic peptic aggression and tissue hypoxia are important factors for occurrence of destructive gastroduodenal membrane changes in heart surgery patients. The differences of antisecretory activity of proton pump inhibitors are revealed, so it was useful to use analogous pH-test using in the intensive care unit. The preferences of original omeprazole for intravenous use with it antisecretory effect were marked in comparison with generic omeprazole: the stability of gastric contents pH more than 4,0 was in 100 %, more than 6,0 was in 86 % of the time for original drug and in 84 % and in 27 % for generic drug respectively. It is also demonstrated, that cardiotonic drugs using and prosthesis of cardiac valves are additional risk factors of gastroduodenal membrane destruction, independent of acidic aggression.
The purpose of the study was to elaborate an algorithm of treatment policy for post-puncture false aneurysms of the femoral artery (FAFA). The study was performed on the basis of the clinical material over 2014-2017 at the Regional Vascular Centre whose specialists have since 2017 been using the femoral arterial approach (FAA) only if the radial arteries are inaccessible for puncture or for inserting the endovascular tools and appliances. The obtained findings demonstrated that the number of coronary interventions performed with the use of the femoral arterial approach in patients presenting with acute coronary syndrome decreased from a total of 758 (100.0%) in 2014 to 166 (13.8%) in 2017. The frequency of FAFAs not subjected to surgical management and those subjected to surgical suturing by 2017 increased to 3.0 and 1.2%, respectively, with the same values for 2014 amounting to 1.8 and 0.4%, respectively. Taking into account the still existing necessity of using the femoral arterial approach in the patients, as a rule, belonging to the cohort of the so-called 'problem patients', the authors worked out an algorithm of therapeutic policy for FAFAs, which would make it possible to increase both efficiency and safety of the carried out endovascular interventions, as well as to determine the risks with their minimization in the postoperative period.
Background Atrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all‐cause mortality may guide interventions. Methods and Results In the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) study, patients with nonvalvular atrial fibrillation were randomized to rivaroxaban or dose‐adjusted warfarin. Cox proportional hazards regression with backward elimination identified factors at randomization that were independently associated with all‐cause mortality in the 14 171 participants in the intention‐to‐treat population. The median age was 73 years, and the mean CHADS 2 score was 3.5. Over 1.9 years of median follow‐up, 1214 (8.6%) patients died. Kaplan–Meier mortality rates were 4.2% at 1 year and 8.9% at 2 years. The majority of classified deaths (1081) were cardiovascular (72%), whereas only 6% were nonhemorrhagic stroke or systemic embolism. No significant difference in all‐cause mortality was observed between the rivaroxaban and warfarin arms ( P =0.15). Heart failure (hazard ratio 1.51, 95% CI 1.33–1.70, P <0.0001) and age ≥75 years (hazard ratio 1.69, 95% CI 1.51–1.90, P <0.0001) were associated with higher all‐cause mortality. Multiple additional characteristics were independently associated with higher mortality, with decreasing creatinine clearance, chronic obstructive pulmonary disease, male sex, peripheral vascular disease, and diabetes being among the most strongly associated (model C‐index 0.677). Conclusions In a large population of patients anticoagulated for nonvalvular atrial fibrillation, ≈7 in 10 deaths were cardiovascular, whereas <1 in 10 deaths were caused by nonhemorrhagic stroke or systemic embolism. Optimal prevention and treatment of heart failure, renal impairment, chronic obstructive pulmonary disease, and diabetes may improve survival. Clinical Trial Registration URL : https://www.clinicaltrials.gov/ . Unique identifier: NCT 00403767.
OBJECTIVE To evaluate the results of direct myocardial revascularization within 72 hours after manifestation of acute coronary syndrome. MATERIAL AND METHODS A retrospective study included 48 (0.47%) out of 10 193 patients with coronary artery disease who underwent coronary artery bypass grafting for the period 2011-2019. Study patients underwent urgent direct myocardial revascularization. SYNTAX Score >22 points was observed in all cases. All patients were divided into 3 groups depending on timing of surgery: 26 patients - within 6 hours after admission, 15 patients - within 6 - 24 hours, 7 patients - within 24-72 hours. RESULTS Level of myocardial damage markers was similar after 1 and 2 days (p>0.05). In the 1st group, 1 (3.84%) patient died in hospital, 5 (19.2%) patients - within 1 year after surgery. In the 2nd group, these values were 1 (6.6%) and 0, respectively. There was no mortality in the 3rd group (p>0.05). Overall 5-year survival was 100%. CONCLUSION Early active open revascularization is advisable in patients with ACS and clear indications for surgery.
Cancer-associated thromboembolic complications in malignant neoplasms are commonly encountered. They deteriorate the course of the underlying disease and are frequent causes of death. The oncological patient is at high risk of not only thrombosis but haemorrhage during anticoagulant therapy. Recent randomized clinical trials have positively appreciated the possibilities of direct oral anticoagulants in treatment and prevention of thromboses in oncological patients. Analysing subgroups in these studies demonstrated that direct oral anticoagulants during long-term administration were at least as effective and safe as vitamin K antagonists. The most significant by the number of cases, duration of therapy, and methodology of analysis are the reports regarding rivaroxaban - an oral, direct factor Xa inhibitor. There are also findings obtained in a separate randomized study, confirming efficacy and safety of rivaroxaban in treatment of patients with cancer-associated venous thromboembolic complications as compared with therapy with low-molecular-weight heparins. Namely these results formed the basis for the guidelines of the International Society on Thrombosis and Hemostasis (SSC ISTH), according to which rivaroxaban may be regarded as an alternative to low-molecular-weight heparins in certain clinical situations.Онкоассоциированные венозные тромбоэмболические осложнения при злокачественных новообразованиях встречаются часто, ухудшают течение основной патологии и являются распространенной причиной смерти. Онкологический больной обладает не только высоким риском тромбообразования, но и кровотечений в ходе антикоагулянтной терапии. Последние рандомизированные клинические испытания положительно оценивают возможности прямых оральных антикоагулянтов в лечении и профилактике тромбозов у онкологических пациентов. Анализ подгрупп в этих исследованиях указывает, что прямые оральные антикоагулянты при долговременном использовании как минимум так же эффективны и безопасны, как антагонисты витамина К. Наиболее значим по количеству наблюдений, срокам терапии и методологии анализа материал, относящийся к ривароксабану – прямому пероральному ингибитору Ха фактора. Также есть данные, полученные в отдельном рандомизированном исследовании, подтверждающие эффективность и безопасность терапии ривароксабаном пациентов с онкоассоциированными венозными тромбоэмболическими осложнениями по сравнению с терапией низкомолекулярными гепаринами. Именно эти результаты легли в основу рекомендаций международного общества тромбоза и гемостаза (SSC ISTH), в соответствии с которыми ривароксабан может рассматриваться как альтернатива низкомолекулярным гепаринам в определенных клинических ситуациях.
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