scholarly journals Hybrid approach of arterial allograft application in reconstructive surgery of the great arteries

2021 ◽  
Vol 102 (1) ◽  
pp. 104-109
Author(s):  
R E Kalinin ◽  
I A Suchkov ◽  
V V Karpov ◽  
N A Solianik ◽  
A S Pshennikov ◽  
...  
Keyword(s):  
Balloon Angioplasty ◽  
Postoperative Period ◽  
Blood Circulation ◽  
Hybrid Approach ◽  
Clinical Situation ◽  
Early Postoperative Period ◽  
Patient Treatment ◽  
Tibial Arteries ◽  
Arterial Allograft ◽  
Dacron Prostheses

The article presents a case of a hybrid intervention using an arterial allograft on the great arteries of the lower extremities in a patient with chronic limb threatening ischemia and prosthetic infection. The patient has a history of repeated operations using synthetic polytetrafluoroethylene and dacron prostheses. In the early postoperative period, a clinical presentation of the prosthesis bed suppuration developed. The article shows the main phases of patient treatment: removal of synthetic prostheses, transplantation of the donor femoral artery, and balloon angioplasty of the popliteal and anterolateral arteries. In the postoperative period, blood circulation in the lower limb is fully compensated, and the dorsal pedis artery pulse is determined. Wounds were healed by primary intention. At the control visit after 6 months, no adverse events were revealed; according to the data of duplex scanning, the main blood flow in the arteries of the leg was recorded, the blood circulation was fully compensated. Thus, hybrid intervention using arterial allograft and balloon angioplasty of the popliteal and anterolateral tibial arteries proved to be an effective method of treatment in the current clinical situation.

scholarly journals Changes in Indicators of Microcirculation in the Early Postoperative Period in the Treatment of Diaphyseal Fractures of the Shin Bones Using a Plate with Limited Contact

2019 ◽  
Vol 4 (3) ◽  
pp. 58-62
Author(s):  
A. I. Plakhov ◽  
L. I. Kolesnikova ◽  
L. I. Korytov ◽  
V. G. Vinogradov ◽  
M. A. Darenskaya
Keyword(s):  
Postoperative Period ◽  
Lower Limb ◽  
Blood Circulation ◽  
Early Period ◽  
Metal Plate ◽  
Early Postoperative Period ◽  
Control Group ◽  
Doppler Flowmetry ◽  
Results Of Treatment ◽  
Diaphyseal Fractures

Background. Unsatisfactory results of treatment, such as delayed consolidation and non-fusion of fractures, the formation of false joints and limb bone defects, have no tendency to decrease. We can assume that one of the leading factors of complications in traumatology is a violation of microcirculation in the affected segment of the limb.Aims. To identify patterns of changes in the parameters of the microcirculatory bed of the damaged segment of the lower limb when fixing bone fragments with a plate with limited contact in the early period after surgery.Materials and methods. In 25 patients, we studied four parameters of microcirculation of the lower limb segment with application of laser Doppler flowmetry. The control group consisted of 25 healthy volunteers, comparable in age and sex with the study group.Results. We found that in the early postoperative period (from the first to the 10th day after the surgery) in patients with diaphyseal fractures of the tibia operated with metal plate with limited contact there was an increase in microcirculation by 75.69 %, an increase in the proportion of the nutritive component of microcirculation compared to the shunt fraction by 24.64 %, as well as an increase in more than one ratio of the amplitude of the heart and respiratory range. All of that indicates a local circulatory disorder in the nutritive arterial hyperemia. We note that the increase in the amplitude of the respiratory component by 17.22 % and the equality of the amplitude of the cardiac range compared with the control group indicate violations of local blood circulation by the type of venous stagnation.Conclusion. On the basis of the results obtained, we note that patients with diaphyseal fractures of the shin bones treated with metal osteosynthesis with a plate with limited contact in the early postoperative period develop a violation of local blood circulation in the stagnant-hyperemic type.

Balloon angioplasty for Blalock-Taussig shunt failure in the early postoperative period

2005 ◽  
Vol 66 (4) ◽  
pp. 585-589 ◽  
Author(s):  
Margaret MacMillan ◽  
Thomas K. Jones ◽  
Flavian M. Lupinetti ◽  
Troy Alan Johnston
Keyword(s):  
Balloon Angioplasty ◽  
Postoperative Period ◽  
Early Postoperative Period ◽  
Shunt Failure ◽  
Blalock Taussig Shunt

scholarly journals FORMATION OF OUTFLOW PATHWAYS IN PATIENTS WITH COMBINED STENOTIC-OCCLUSIVE LESIONS OF THE FEMORAL AND TIBIAL ARTERIAL SEGMENTS

2021 ◽  
Vol 4 (18) ◽  
pp. 38-44
Author(s):  
S.Y. Kostiv ◽  
I.K. Venger ◽  
B.Y. Maslii ◽  
B.P. Selskyi ◽  
N.I. Tsiupryk ◽  
...  
Keyword(s):  
Postoperative Period ◽  
Lower Extremities ◽  
Early Postoperative Period ◽  
Arterial Blood Flow ◽  
Arterial Segment ◽  
Arterial Blood ◽  
Tibial Arteries ◽  
Group I ◽  
Hybrid Revascularization ◽  
Stenotic Lesions

                The aim of the study. To prevent the development of postoperative thrombosis of the reconstruction segment after endovascular and hybrid revascularization of the femoral-distal arterial portion in the conditions of stenotic-occlusive process of the tibial arteries by forming functionally capable pathways in the tibial segment.                 Materials and methods. The results of treatment 135 patients with atherosclerotic occlusive-stenotic lesions of the infrainguinal arterial segment of the lower extremities were analyzed. According to the severity violation of chronic arterial insufficiency of the lower extremities, grade IIB was detected in 50 (37.04%) patients, grade III - in 63 (46.66%) examinee, grade IV- in 22 (16.30%) examinee. Patients were divided into 2 groups. Group I included 61 (45.19%) patients with occlusal-stenotic lesions at the level of the infrainguinal segment, who underwent only endovascular correction of the peripheral arterial portion, the second group consisted of 74 (54.81%) patients with multilevel occlusive-stenotic lesions of the infrainguinal arterial segment which was performed hybrid arterial reconstruction.                 Results and discussion. The proposed tactic involves endovascular angioplasty of at least two tibial arteries. During revascularization of 135 patients by endovascular (61 supervision) and hybrid (74 supervision) methods of a femoral-distal arterial blood flow under conditions of arterial sclerotic disease of tibial arteries carried out in 115 (85,18%) patients endovascular dilatation of two arteries. Thrombosis of the reconstruction segment in the postoperative period was finding in 9 (6.67%) cases: when using endovascular and hybrid revascularization methods, respectively - in 4 (6.56%) and 5 (6.76%) cases. Thrombosis of the reconstruction segment in the early postoperative period in 8 cases developed after endovascular angioplasty of one of the tibial arteries and only in 1 observation after endovascular angioplasty of 2 tibial arteries.                 Conclusion. Reconstruction of outflow pathways at the tibial arterial segment with occlusive-stenotic lesions of the infranguinal arterial portion during endovascular and hybrid techniques of revascularization by performing angioplasty of the two tibial arteries of the tibia can provide a positive result of revascularization in the early postoperative period, respectively in 95.08% and 95.95% of cases.

scholarly journals BLOOD COAGULATION SYSTEM AND PERSONALIZATION OF TREATMENT IN PATIENTS WITH IMPLANTED SYSTEM OF LEFT VENTRICLE ASSIST DEVICE IN THE EARLY POSTOPERATIVE PERIOD

2020 ◽  
pp. 43-48
Author(s):  
О. П. Мазуренко ◽  
П. Надзякевич ◽  
О. А. Лоскутов ◽  
Л. В. Згржебловська
Keyword(s):  
Left Ventricle ◽  
Blood Coagulation ◽  
Postoperative Period ◽  
Blood Circulation ◽  
Left Ventricular ◽  
Early Postoperative Period ◽  
Coagulation System ◽  
Mechanical Support ◽  
Blood Coagulation System ◽  
Membrane Oxygenation

The work is devoted to the study of the blood coagulation system and the correction of its indicators with a personalized anticoagulant target therapy in the early postoperative period to ten patients with implanted left ventricle assist devices for mechanical circulation support in the Silesian Center Heart Diseases, according to a bilateral agreement with the National Medical Academy of Postgraduate Education named after P. Shupik. The study included ten patients who were implanted in the Silesian Center for Heart Disease from March 11, 2016 to Nov 22, 2017, devices for mechanical support of left ventricular circulation LVAD in the aftermath of the terminal stage of heart failure.The subjects were men 55 ± 13.5 years old, with a body mass index of 30.8 ± 8.3 and a body surface area of 2.12 ± 0.2 m2 with a left ventricular ejection fraction of 15.4 ± 9.5%, which was mechanically supported blood circulation in the period from 11.03.2016 to 22.11.2017 in conditions of artificial blood circulation and combined endotracheal anesthesia, five of which had implanted cardioverts-defibrillators.Patients were divided according to the INTERMAKS Level 1 (cardiogenic shock) - 6 (60% of cases), Level 2 (progressive circulatory failure) - 4 men (40% of cases). Patients in the early postoperative period that time received an anticoagulant target mono and combination therapy with heparin (6-11U / kg / h), Aspirin (75-150mg.), Clopidogrel (75-150mg.), Warfarin (1.5-7mg), Nadroparinum Ca(0.3-0.6 ml / 2p / d), Fondaparinux Na (2.5-5 mg / 2p / d). The duration of support - POLVAD ranged from 102 to 156 days. Results - transplanted 2, died 2. The studies revealed a non-linear relationship between mortality, the number of days of general and intensive therapy for hospitalization, the use of extracorporeal membrane oxygenation and intra-aortic membrane oxygenation in patients with implanted systems of mechanical blood circulation, who used large doses of catecholamines during the postoperative period.Analyzing the needs of patients with implanted mechanical systems to support the blood circulation of the left ventricle in blood donations, it should be noted that in the early postoperative period the erythrocyte mass was most often used. During surgery, fresh-frozen plasma was the drug of choice, while the platelet mass was used in most cases during the pre-operative preparation of the patient.The main complications that developed in patients with implanted mechanical support systems of the left ventricular blood circulation were: bleeding, thrombosis of the mechanical blood circulation systems, cerebral circulation disorders due to hemorrhagic and ischemic type, infectious complications.

scholarly journals Treatment of patients with occlusive-stenotic diseases of the arteries of the infrarenal aorta by the hybrid method

2021 ◽  
Vol 25 (4) ◽  
pp. 593-598
Author(s):  
V. V. Shaprynskyi
Keyword(s):  
Balloon Angioplasty ◽  
Postoperative Period ◽  
Causes Of Death ◽  
Early Postoperative Period ◽  
Limb Amputation ◽  
Infrarenal Aorta ◽  
Hybrid Surgery ◽  
Common Causes ◽  
The Right ◽  
Stenotic Lesions

Annotation. The treatment results of patients with arterial occlusive-stenotic diseases of the lower extremities as a result of obliterating atherosclerosis were analyzed. 79 patients underwent hybrid surgery. Most patients were ranged in age from 46 to 86 years. There were 175 men (72.0%) and 68 women (28.0%). The right lower extremity was affected more often – 148(60.9%) patients than the left ones – 95(39.1%). Of the 20 patients with stenosis of the iliac-femoral segment, 14 hybrid surgeries were completed with stenting. Endarterectomy or profundoplasty with different angioplasty options were mainly performed. Endarterectomy or thrombectomy with various angioplasty options was mainly performed in the occlusion of the femoral-popliteal segment. The main hybrid type of operation in the popliteal segment was thrombectomy of the popliteal segment and balloon angioplasty of the tibial segment. In occlusive stenotic lesions of the arteries of the tibial-foot segment in the vast majority of cases, autovenous plastics of the tibioperoneal trunk with balloon angioplasty of distal arteries were performed. The thrombosis was diagnosed in 8(10,12%) individuals as the most common complication in the early postoperative period. Limb amputation was performed in 3 patients. Mortality rate in the early postoperative period was 4,76%(2 patients died in the comparison group), in the main group there was no mortality. Acute myocardial infarction and stroke are among the most common causes of death.

scholarly journals Prevention of hemorrhagic complications during operations on the thoracic aorta

2018 ◽  
pp. 70-76
Author(s):  
D. C. Panfilov ◽  
B. N. Kozlov ◽  
V. V. Zatolokin ◽  
I. V. Ponomarenko ◽  
I. A. Khodashinsky ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Thoracic Aorta ◽  
Postoperative Period ◽  
Blood Circulation ◽  
Circulatory Arrest ◽  
Early Postoperative Period ◽  
Artificial Blood ◽  
Brachiocephalic Trunk ◽  
Hemorrhagic Complications ◽  
Artificial Blood Circulation

Aim. To assess the efficiency of guideline for the prevention of hemorrhagic complications in the early postoperative period.Material and methods. In the period from 2008 to 2017, 166 patients with pathology of the thoracic aorta were operated. The patients were divided into 2 comparable groups: group 1 — patients with reconstructed aortic arch of the type “Hemiarch” (group “hemiarch”, n=90), group 2 — patients with fully reconstructed aortic arch (group “arch”, n=76). All operations were performed with artificial blood circulation, circulatory arrest with moderate hypothermia (25­28° C) and unilateral antegrade cerebral perfusion through the brachiocephalic trunk.Results. The reconstructions of the thoracic aorta in patients of the “hemiarch” group were accompanied by significantly less period of artificial blood circulation (p=0,027), cardiac arrest period (p=0,012), duration of circulatory arrest (p=0,019), and duration of antegrade brain perfusion (p=0,021). The volume of discharge through the drainage was 350 [192;506] ml and 400 [250;723] ml in the “hemiarch” and “arch” groups, respectively (p=0,29). Patients of the “arch” group more often required transfusion of packed red cells (p=0,003), fresh frozen plasma (p=0,0006), platelet concentrate (p=0,002) in comparison with patients of the “hemiarch” group. At the same time, the frequency of bleeding requiring reoperation was comparable in both groups (5,6% versus 5,3%, p=0,969). The 30­day mortality also had no statistically significant differences in patients of the “hemiarch” and “arch” groups (3,3% versus 9,2%, p=0,119).Conclusion. The frequency of hemorrhagic complications requiring reoperation in patients with a fully or partially reconstructed aortic arch does not have significant differences when using the guideline for preventing of hemorrhagic complications, which makes it possible to provide acceptable frequency of bleeding episodes and reoperations in the early postoperative period.

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