The objective of this study was to assess the efficacy and safety of endovascular aneurysm repair (EVAR) of infrarenal aorta (IA) and iliac arteries (IA) with favorable and unfavorable anatomy in the group of high-risk patients after surgery and at follow-up examinations.

Material and methods. The study is based on the results of the study of 95 patients with abdominal aortic aneurysms and iliac arteries aneurysms who underwent

 EVAR at Healthcare «Clinical Hospital № 122 named after L.G. Sokolov» for the period from March 2008 to December 2016. RESULTS. Results of EVAR of infrarenal aorta and iliac arteries in patients with severe concomitant diseases were analyzed. The interventions were successful in 100 % of cases.

Сonclusions. The study has shown that EVAR is an effective and safe method of treatment for endovascular aneurysm repair of infrarenal aorta and iliac arteries in high-risk patients. Long-term care requires abdominal aorta and iliac artery examination with the use of duplex ultrasound angioscanning and multispiral computed tomoangiography to identify specific complications.

The objective of the study was to evaluate the results of carotid endarterectomy in patients with symptomatic and asymptomatic course of hemodynamically significant stenosis of carotid arteries.

Material and methods. The work was based on observations of 88 patients: the main group included 28 patients with asymptomatic lesion, the control group – 60 patients with symptomatic critical carotid stenosis.

Results. There was a predominance of contralateral carotid stenosis, changes in vertebral arteries in the control group. Features of atherosclerotic lesion of carotid arteries associated with the severity of metabolic disorders, perioperative fluctuations of hemodynamics, time of clamping of carotid arteries.

Conclusion. Aggressive course of symptomatic carotid stenosis requires correction of metabolic disorders in the perioperative and in the distant periods, as well as monitoring of hemodynamic abnormalities.

The objective of the study is to clarify the topographic and anatomical features of the most common perforating veins of the lower extremities.

Material and methods. 70 lower extremities (sectional material) without signs of chronic venous diseases and 1700 patients. Research methods: anatomical dissection and ultrasound examination of the venous system of the lower extremities (duplex ultrasound scanning).

Results. 4 to 6 perforants were found on the medial surface of the foot. They directly connected the medial boundary of the vein and vv. plantaris medialis. They are located along the medial intermuscular septum at the subfascial level; have subcutaneous tributaries from the medial surface of the foot at the epifascial level. The most constant localization of perforating veins on the ankle was the distal part of the medial surface of the ankle. On the ana to mic preparations they were the main draining vessels of this area. All perforating veins of the ankle (direct and indirect) and foot are the part of the neurovascular bundle, and at the subfascial level of the perforating veins 2, are located on the sides of the artery, next to the nerve branch. Rare incidence of perforating veins of the popliteal region, combining with the lack of typical saphenopopliteal anastomosis, allows relating them to the atypical PV. Among all of the perforating veins of the thigh, the highest frequency of incidence was in the lower third. These veins connected the great saphenous vein, and the femoral vein in 55.6 %. They passed along the medial intermuscular septum and had a long subfascial course. In all cases there is nearby arterial twig.

Conclusion. Perforating veins in different areas of the lower extremities have their features of structure. General is that perforating veins mostly are the neurovascular bundles (vein – artery – nerve).

The objective of the study was to reveal the features of development and clinical course of acute arterial embolism (AAE) of aorta and main limb arteries in patients with myocardium infarction (MI).

Material and methods. Since 1991 until 2018 in the department of cardiovascular surgery of «North-Western State Medical University named after I. I. Mechnikov» 1782 patients with AAE of aorta and main limb arteries were urgently treated. 102 (5.7 %) patients of them waswith acute IM.

Results. In patients with AAE in acute phase of Q-IM the embolism to large profile arteries was typical. AAE led to rapid progression of limb ischemia. The severity of the general condition of patients due to myocardial lesions, and specific complications associated with limb revascularization and ischemic syndrome, significantly influenced the results of treatment. Postoperative mortality reached 38.8 %.

Conclusion. AAE of aorta and main limb arteries is a threatening complication of acute MI, and it significantly worsens prognosis.

The objective of the study was to conduct a comparative analysis of the results of traditional and modern methods of surgical treatment of patients with severe concomitant injury, accompanied by fractures of the tubular bones of the limbs.

Material and methods. The retro-and prospective analysis of the results of surgical treatment of 1033 patients with severe concomitant injury hospitalized in Baku Clinical Hospital № 3 for the period from 2009 to 2015 is presented. The patients were divided into 2 groups for a comparative evaluation of the results of treatment, depending on the effectiveness of the applied medical tactics. The 1st (main) group consisted of 828 (80.2 %) patients who were treated using the tactics of programmed multi-stage surgical treatment in accordance with the concept of «damage control». The 2nd (comparison group) included 205 (19.8 %) patients, who were treated using the traditional tactics of surgical treatment.

Results. In a multi-field General surgical hospital, the introduction of the «damage control» program using the tactics of programmed surgical treatment in patients with severe concomitant and multiple injury allowed to increase surgical activity and reduce the mortality rate from 45.9 to 21.6 %.

Conclusion. The application of tactics of stage surgical correction of injuries allows to improve the immediate results of treatment of patients with severe concomitant and multiple injury.

The objective was of the study to evaluate the role of preoperative x-ray endovascular interventions – transcatheter arterial chemoembolization (TACE) and portal vein embolization (PVE) – for improvement of resectability of colorectal liver metastases.

Material and methods. Between 1997 and 2017, we treated 11 patients who simultaneously had large-volume (60–70 %) of right liver lobe colorectal metastases and small future remnant liver. The treatment was started from 1–4 cycles of TACE to reduce or stabilize the rapid growth of the tumor. In case of good effect, we performed PVE and then we performed liver resection.

Results. There were no major complications of TACE or PVE. After 1–4 cycles of TACE, the volume of metastases showed partial decrease or stabilization. The following PVE allowed to increase the future remnant volume of the left liver lobe up to a safe 40–45 %. Right – sided hemihepatectomy was performed in 6 patients and extended right-sided hemihepatectomy in 5 patients. There were no postoperative mortality or severe complications. At present, 4 patients are alive without recurrence during 1.5–8 years, and 4 other patients received endovascular treatment for local recurrence are alive during 1.5–5 years. The 3 patients died from tumor progression during 13–30 months. CONCLUSION. In patients with simultaneously extensive for resection volume of right liver lobe metastases and small left liver lobe, the primary treatment with TACE is reasonable. Only after the documentation of tumor decrease or stabilization, it is necessary to determine the timing of PVE and following major liver resection. This order of treatment procedures allows to improve resectability in cases with extensive, large-volume, rapidly grown malignant liver lesions.

The objective of the study was to determine the possibilities of surgical treatment and to evaluate the criteria for selecting the resection volume of the liver in patients with Klatskin tumor.

Material and methods. From 2005 to 2018, 36 patients with Klatskin tumor aged from 30 to 74 years were operated in the Department of surgery of «Russian scientific center of radiology and surgical technologies n.a. acad. A. M. Granov». Radical surgical interventions (R0) were performed in 28 (77.7 %) patients. 7 (19.5 %) patients underwent palliative surgery.

Results. Selection of the resection volume of the liver and bile duct was carried out on the basis of assessment of the functional state, morphological changes in the liver and results of urgent intraoperative histological examination. As a radical intervention for IIIa, IIIb and IV types of Klatskin tumor (93.1 % of patients), extensive liver resection (left-sided or right-sided hemihepatectomy) with biliary and, in the presence of invasion into the main vessels, with vascular reconstruction was performed.

Сonclusion. Timely and adequate liver resection with biliary reconstruction is a radical surgical intervention for Klatskin tumors. Selection of the resection volume of the liver, especially for type IV tumors, is determined by the morphological changes and the reserve capacity of the liver. The status of the resection edge is crucial for the selection of subsequent treatment tactics. Combination of methods of regional chemoinfusion and intraductal photodynamic therapy is necessary after non-radical intervention.

The objective of the study was to evaluation the results of endovideosurgical resections of the liver.

Material and methods. We analyzed the direct results of treatment of 153 patients with liver neoplasms operated in “Russian scientific center of radiology and surgical technologies n.a. acad. A. M. Granov” from 2012 to 2017 with the use of endovideosurgical techniques.

Results. The duration of surgical interventions averaged (173±56) minutes (from 50 to 290 minutes). The degree of blood loss during the performed interventions did not exceed 800 ml and averaged (154.2±44.5) ml. Conversion due to bleeding, serious postoperative complications (Clavien IIIb and above), and also, mortalities were not observed. The postoperative hospital stay was (8.6±3.1) days.

The objective of this study was to compare the results of the MRI-ultrasound fusion-targeted biopsy (MRF-TB) and the systematic 12-core biopsy (SB) of the prostate and investigate the relationship between the results of the biopsy and the multiparametric MRI of the prostate before the biopsy.

Material and methods. The study included 380 men with a total PSA level from 4 to 10 ng/ml (according to Hybritech calibration) and with negative result of finger rectal examination at the age from 45 to 80 years. All men underwent a multiparametric MRI of the prostate before biopsy. The changes detected on the MRI were assessed taking into account the PI-RADS Version 2-criterion. All men (247 men) with PI-RADS 2 or more underwent MRF-TB (4 aiming columns) and SB (12 standard points) of the prostate.

Results. There were no significant differences in the detection of all types of prostate cancer (PC) in all patients between MRF-TB and SB (p=0.731). At the same time, significantly less PC (Gleason 6) (p<0.001) and significantly more PC (Gleason ≥7) (p<0.001) were detected with MRF-TB compared with SB. Also, MRF-TB allows significantly more often to detect the most malignant form of PC (Gleason ≥4+3) compared with SB (p=0.025).

The objective of the study was to develop a mathematical model of differential diagnosis of hematogenous osteomyelitis and malignant bone tumor.

Material and methods. In this research we performed a retrospective analysis of the data on 127 patients with differential diagnosis between hematogenous osteomyelitis and malignant bone tumors. Retrospective validity indicators: sensitivity (Se) – 53.12 % (42.66–63.39 %), specificity (Sp) – 70.97 % (51.96–85.78 %). Data on 96 patients with subsequently diagnosed hematogenous osteomyelitis was compared with data on 31 patients with morphologically confirmed malignant bone neoplasms. In the research we.

Results. The database was created based on studying the data of the retrospective group. It became the basis for the development of a mathematical model for the differential diagnosis of hematogenous osteomyelitis and malignant bone tumors. 13 prognostic criteria were identified, each of which is quantified. These criteria included the age of the patient, sex, the data on concomitant pathology, information about the localization of the pathological process, the indices of some laboratory studies, etc. An algorithm for the differential diagnosis of hematogenous.

Conclusion. Our differential diagnostic model was tested in the prospective study (63 cases). Indicators of the validity of the test was: Sensitivity – 83.05 %, Specificity (Sp) – 86.67 %. Positive Predictive Value (PPV) was 96.08 %, Negative Predictive Value (NPV) – 56.52 %, Accuracy – 83.78 %, which allowed to shorten the time of examination and send patients to specialized hospitals.

The article presents the results of long-term clinical, molecular-biological and laboratory studies on combined poly-stage treatment of patients with colon cancer with liver metastases. The cytotoxicity of various chemotherapeutic agents for colorectal carcinoma in the lines of HT 29 and NMG 64/84 cells was studied by analysis of human colony-forming tumor (HTCA). In vitro studies on the suspension of tumor cells from remote liver metastases were carried out to determine the most effective chemotherapeutic agents for intra-arterial hepatic infusion (HAI). Individual choice of the scheme of systemic chemotherapy depends on the level of thymidylate synthetase (TS) in the tumor tissue. Long-term own clinical experience and analysis of world literature allow authors to state that stage resection of the liver (STR) in combination with regional (HAI) and systemic chemotherapy is the method of choice in the treatment of patients with colorectal cancer with unresectable liver metastases. In comparison with other treatment methods (ALPPS and TSH), STR has the least negative consequences and is beneficial from the tumor-biological point of view.

The objective of the study was to evaluate the long-term results of endoscopic papillosphincterotomy in cases of choledocholithiasis and papillary stenosis.

Material and methods. We carried out retrospective analysis of the results of endoscopic papillosphincterotomy (EPST) due to the presence of choledocholithiasis (group 1, n=117) and papillary stenosis (group 2, n=55) along with the combination of the above (group 3, n=6) in a total of 178 patients. Clinical and endoscopic results of the intervention were studied in all patients in the long-term (from 1 to 30 years).

Results. Based on the analysis of the complex examination, including endoscopic functional tests, treatment results were evaluated as good in 80 % of patients, satisfactory in 16 % of patients and unsatisfactory in 4 % of patients (after endoscopic correction of papillary stenosis).

Conclusion. The cicatrisation process in the papillotomy opening exhibits the most intensively in patients with papillary stenosis combined with choledocholithiasis and without it, lasts until 4.5–5 years after surgery. Dynamic observation of patients after EPST is obligatory for early diagnosis of restenosis in the papillotomy opening.

The objective of this work was to study the frequency and nature of complications after lung resections for tuberculosis in HIV-infected patients.

Material and methods. Retrospective and prospective analysis of complications after lung resections for tuberculosis in 80 HIV-infected and 117 HIV-negative patients was carried out. Developed complications are divided into nonspecific and specific complications, according to the modified Russian classification of postoperative complications on the basis of Accordion classification.

Results. It was noted that among the operated HIV-infected patients, XDR-TB (extensive drug-resistant tuberculosis) and clinically significant concomitant diseases were more common. Differences in the frequency of intraoperative complications in groups have not been established. Postoperative complications were mostly disposable, the frequency of deaths in the main group did not differ from that in the comparison group.

Conclusion. Surgical treatment of pulmonary tuberculosis in HIV-infected patients is reasonable and justified, in general for patients with pulmonary tuberculosis, with adequate antituberculous chemotherapy and antiretroviral therapy.

Endovideoscopic interventions on the liver in combination with intraoperative contrast of blood vessels and bile ducts allow to facilitate performing the manipulation stage of the intervention, diagnose previously hidden pathology and reduce the risk of postoperative complications This clinical observation shows the capabilities of intraoperative ICG/NIR chromoscopy during endovideosurgical left-sided hemihepatectomy in patient with colorectal metastases.

The observation from practice is devoted to the surgical treatment of a giant ventral hernia complicated by postoperative abdominal compartment syndrome, acute intestinal obstruction and subtotal mesenterial thrombosis.

Additional lung is an extremely rare malformation. At an early age the course is often asymptomatic, but sometimes the additional lung may lead to life-threatening clinical manifestations. In these cases, early surgical treatment is required. We describe our own clinical cases with histological verification of the diagnosis of «Additional lung», the timing and algorithm of postnatal radiation examination, the method of treatment.

The objective of the study was to assess the possibility of combined plasty of a chest wall defect in a patient with a massive chondrosarcoma of the chest wall.

Material and methods. The restoration of frame-based structures of the chest wall with 4 titanium prosthesis, flap of the left broadest muscle of the back on the stem.

Results. Functional indices: the function of external respiration is within normal limits; lung capacity – 96 %; Stange assay – 1 min. 26 sec.; Genci test – 28 sec.

Conclusion. The possibility of long-term survival with a good quality of life in a patient with extensive resection of the left half of the chest wall with dimensions up to 420 cm² is shown.

Surgical treatment of coronary heart disease was introduced into clinical practice more than 50 years ago. Only one intervention – the use of left internal thoracic artery for bypass grafting of the anterior interventricular artery – Kolovos’s operation– remains practically unchangeable version of execution as a standard for coronary artery bypass grafting. This review summarizes the half-century use of internal thoracic arteries, autoveins, radiate arteries as conduits for coronary arteries on the basis of the randomized studies and meta-analyzes published by 2018.

Thoraco-abdominal wounds are the most severe injuries of the chest and abdomen, with mortality reaching 13–20 %. The main focus of treatment of such patients is surgical correction of the injuries. Wide range of classical and minimally invasive interventions is used for treatment of victims . The paper presents the range of views of modern researchers on the indications for laparocentesis, drainage of the pleural cavity, thoracoscopy and laparoscopy, thoracotomy and laparotomy in this pathology. The opinions of various researchers on the optimal combination of interventions and tactics of surgical treatment of victims with thoraco-abdominal wounds are presented. It is necessary to continue the search for optimal combinations of classical and minimally invasive interventions in relation to a variety of clinic situations that arise in the treatment of patients with thoraco-abdominal wounds.

Literature review is devoted to immunosuppression in sepsis and possibilities of its correction.

The literature review is dedicated to abdominal sepsis, integral systems assessed the severity of disease course and prediction criteria of the result.