Main Vessels Research Articles

The influence of post-amputation pain syndrome and intraosseous main vessels on the formation of limb bone stump

Until now, remains quit high a percentage of unsatisfactory results of amputations. At the same time, a special place is occupiedby the healing of the bone remnant — the main supporting element of the stump. Objective. To study the influence of post-amputationpain syndrome and intraosseous main vessels on the nature of reparative processes in the bone stump. Methods. Three series of 15 experimentswere conducted on 45 rabbits with amputation of the femur in the middle third and muscle plastic surgery. In the 1st and2nd series, d uring a mputation, a p erineural c atheter w as b rought to the stumps of the sciatic nerve. With its help, animals were subjectedto the following daily for 20 days: 1st series — mechanical irritation of the nerve, 20 minutes; 2nd — injection of 0.3 ml of 1 %lidocaine twice a day into the surrounding area of the nerve. Animals of the 3rd series were the control. In 1, 3, 6 months. a histologicalexamination was performed with the pouring of carcass (gelatin mixture) into the vessels. The results. In the 1st series, there was a sharpviolation of the reparative process: a change in the shape and loosening of the cortical diaphyseal plate, fractures and deformationof the stump, a significant expansion of the feeding artery and its branches with perforation of the endosteal regenerate, the absenceof formation of the bone closing plate, a violation of the microcirculation. In the animals of the 2nd series, the stumps mostly kept the shapeand structure characteristic of the diaphysis with normalization of macro- and microcirculation. In the 3rd series, the results of stumpformation were better than in the 1st, but worse than in the 2nd. Conclusions. If the pain syndrome subsides after amputation, a bonestump is formed with an organotypic shape and structure characteristic of the diaphysis, normalization of the state of bone marrowtissues and blood circulation. The rapid and complete formation of the bone closing plate contributes to the reduction of the branchesof the feeding artery and prevents the functional depressurization of the bone marrow cavity. In the presence of post-amputation painsyndrome, there are significant violations of the reparative process with the formation of an inferior bone closing plate, its penetrationby the branches of the feeding artery without the organotypic formation of the stump.

Head arteries of the red squirrel (Sciurus vulgaris)

The red squirrel (Sciurus vulgaris) is a medium-sized rodent protected in most of Europe. The present study aimed to investigate and describe the arterial vascularization of the head of the adult red squirrel. In the study, 48 specimens of adult red squirrels were used. The first preparation method used in the study was corrosion casting using a stained solution of the chemo-setting acrylic material injected into bilateral common carotid arteries resulting in corrosion castings of the vessels on a bone scaffold. The second method was injecting liquid-stained latex into both common carotid arteries. It resulted in a stained arterial vessel on fixed soft tissue preparations. The main vessels providing blood to the head were paired with common carotid arteries that divide into external and internal carotid arteries. The internal carotid artery passes into the stapedial artery. After giving its branches, the stapedial artery exits the cranial cavity through the sphenofrontal foramen and enters the orbit. The suborbital and the mandibular regions were supplied by the maxillary artery, linguofacial trunk, and their branches. Description of the detailed anatomy of the head arteries in red squirrels may contribute to establishing diagnostic and treatment protocols for wildlife rehabilitation centers, which may be crucial since red squirrels are endangered by the spreading of invasive Eastern gray squirrels (Sciurus carolinensis) in Europe. It may also contribute to veterinary care for other members of the Sciuridae family kept as pets.

Эффективность адресной доставки лекарственных средств в кровеносное русло переднего отдела глаза при иридоциклитах

The results of targeted drug delivery using to the main arterial vessels of the anterior part of the eye – the anterior ciliary arteries – were presented. Targeted drug delivery was performed by means of electrophoresis conducted over the zone of the episcleral depot, which was previously created by drug injection over the superior anterior ciliary artery. The study included patients with iridocyclitis both in the acute phase of inflammation and with residual signs of the inflammatory process. The effectiveness of the proposed method of treatment was shown, in which a sufficiently high concentration of the necessary drug in the iris and ciliary body was achieved. Such clinical advantages were obtained as shortening the patients treatment time and improvement of their functional results. The exact targeting of drug delivery was confirmed by fluorescein-angioscopic control. Keywords: iridocyclitis, treatment, targeted delivery, anterior ciliary arteries, electrophoresis

Abstract 13469: A Risk Score Model to Identify Patients With High Likelihood of Left Main or 3-vessel Coronary Artery Disease

Introduction: Revascularization improves outcomes only for stable coronary artery disease (CAD) patients with high-risk coronary anatomy (HRCA). While exercise stress test (EST) is the screening modality for CAD, identifying HRCA noninvasively is challenging. We aimed to derive a prediction model, incorporating clinical and EST characteristics, to screen for HRCA. Methods: We included adult patients who underwent EST followed by elective invasive coronary angiography (ICA) at our center between 2017 and 2019. HRCA was defined as left main (LM) or 3-vessel disease on ICA. Significant CAD was defined as ≥50% stenosis in the LM and/or ≥70% stenosis in the 3 main vessels. We excluded patients with acute coronary syndrome or ejection fraction <50%. Variables with p<0.1 at univariable analysis were selected as candidates to enter a multivariable stepwise backward regression model to derive a HRCA risk model. Results: 304 consecutive patients met inclusion criteria (64[13]years, 81.6% M). 15.5% were found to have HRCA on ICA. Median time from EST to ICA was 11[31]days. The following hit the threshold for inclusion into the multivariable model: hypertension, maximal predicted heart rate (MPHR), diabetes, rate pressure product, metabolic equivalents, exercise time, chronotropic response index ≥0.8, heart rate recovery, Duke Treadmill Score (DTS). After backward selection, hypertension (OR 17.08, p=0.008), MPHR (0.98, p=0.048), and very abnormal DTS (8.26, p=0.001) were the only significant predictors of HRCA ( Fig.1A ). The fully adjusted model showed good discrimination for HRCA (AUC 0.74, p<0.001, Fig.1B ). Conclusions: In an era of declining emphasis on EST in favor of imaging stress test, we identified a risk model based on clinical and EST-derived parameters, that can accurately predict likelihood of HRCA, enabling personalized risk-stratification. Further studies are needed to externally validate our model.

Deep learning to detect significant coronary artery disease from plain chest radiographs AI4CAD

BackgroundThe predictive role of chest radiographs in patients with suspected coronary artery disease (CAD) is underestimated and may benefit from artificial intelligence (AI) applications. ObjectivesTo train, test, and validate a deep learning (DL) solution for detecting significant CAD based on chest radiographs. MethodsData of patients referred for angina and undergoing chest radiography and coronary angiography were analysed retrospectively. A deep convolutional neural network (DCNN) was designed to detect significant CAD from posteroanterior/anteroposterior chest radiographs. The DCNN was trained for severe CAD binary classification (absence/presence). Coronary angiography reports were the ground truth. Stenosis severity of ≥70% for non–left main vessels and ≥ 50% for left main defined severe CAD. ResultsInformation of 7728 patients was reviewed. Severe CAD was present in 4091 (53%). Patients were randomly divided for algorithm training (70%; n = 5454) and fine-tuning/model validation (10%; n = 773). Internal clinical validation (model testing) was performed with the remaining patients (20%; n = 1501). At binary logistic regression, DCNN prediction was the strongest severe CAD predictor (p < 0.0001; OR: 1.040; CI: 1.032–1.048). Using a high sensitivity operating cut-point, the DCNN had a sensitivity of 0.90 to detect significant CAD (specificity 0.31; AUC 0.73; 95% CI DeLong, 0.69–0.76). Adding to the AI chest radiograph interpretation angina status improved the prediction (AUC 0.77; 95% CI DeLong, 0.74–0.80). ConclusionAI-read chest radiographs could be used to pre-test significant CAD probability in patients referred for suspected angina. Further studies are required to externally validate our algorithm, develop a clinically applicable tool, and support CAD screening in broader settings.

Mediating effect assessment of ifosfamide on limb salvage rate in osteosarcoma: A study from a single center in China

Osteosarcoma is one of the most prevalent primary bone malignancies in children and adolescents. Surgery and chemotherapy are the standard treatment methods of osteosarcoma. Methotrexate, adriamycin, and cisplatin, and methotrexate, adriamycin, cisplatin, and ifosfamide regimens are both first-line neoadjuvant chemotherapy regimens for osteosarcoma. Moreover, the use of ifosfamide is highly controversial. Most studies of ifosfamide focused on the overall survival rate and event-free survival rate; few studies concentrated on surgical options. We conducted this retrospective study to compare the baseline characteristic of amputation and limb salvage osteosarcoma patients. Furthermore, we analyzed the direct and indirect roles in surgical decision-making and found that ifosfamide may play a partial mediating role in the surgery option choice by mediating tumor mass volume change, tumor response, and the shortest distance from the center of main blood vessels to the margin of the tumor lesion.

An optimized segmentation of main vessel in coronary angiography images via removing the overlapping pacemaker

Coronary angiography (CAG) as a typical imaging modality for the diagnosis of coronary diseases hasbeen widely employed in clinical practices. For CAG-based computer-aided diagnosis systems, accurate vessel segmentation plays a fundamental role. However, patients with bradycardia usually have a pacemaker which frequently interferes the vessel segmentation. In this case, the segmentation of vessels will be hard. To mitigate interferences of pacemakers and then extract main vessels more effectively in CAG images, we propose an approach. At first, a pseudo CAG (pCAG) image is generated through a part of a CAG sequence, in which the pacemaker exists. Then, a local feature descriptor is employed to register the relative location of pacemaker between the pCAG image and the target CAG image. Finally, combining the registration result and segmentation results of main vessels and pacemaker, interferences of pacemaker are removed and the segmentation of main vessels is improved. The proposed method is evaluated based on 11 CAG images with pacemakers acquired in clinical practices. An optimization ratio of the Dice coefficient is 12.04%, which demonstrates that our method can remove overlapping pacemakers and achieve the improvement of main vessel segmentation in CAG images.Our method can further become a helpful component in a CAG-based computer-aided diagnosis system, improving its diagnosis accuracy and efficiency.

Combined staged surgical hemostasis in a case of Placenta previa and Placenta accreta spectrum disorders

The objective: to develop the optimal delivery algorithm in persons with Placenta previa alone and with partial Placenta accreta, using innovative technologies with the priority of organ-saving operations.Materials and methods. 106 pregnant women with prenatal diagnosis of Placenta previa and the possibility of the safe pregnancy prolongation till 34-36 weeks of gestation were included in the study. To achieve the aim of the study, two groups were formed: the first (control) group – 75 patients were delivered via standard elective cesarean section in terms of 34-36 weeks; the second (main) group – 51 patients delivered in the same terms via our organ-saving method (elective cesarean section using argon-plasma tissue coagulation, agonists of oxytocin and vasopressors; and ligation of main uterine vessels and internal iliac arteries).The following characteristics of cesarean section were taken into account: time of the fetal extraction, duration of the operation, intraoperative blood loss volume and Placenta accreta spectrum disorders (PAS) complications were compared in groups with further statistical data analysis.Results. The mean indices of the cesarean section duration and time from the start of an operation till the fetal extraction were significantly lower (p&lt;0.05) in the second group and amounted 55.7±5.1 min and 195.0±21.0 sec, respectively, versus 74.5±4.3 min and 274.0±17.0 sec in the first group. Intraoperative blood loss volume was also significantly lower in the second group than in the first one – 775.0±60.0 ml versus 970.0±55.0 ml, p&lt;0.05).The part of Placenta previa and PAS combination in one patient amounted to 20.0% in the first group and 17.6% in the second one. Pl. accreta was diagnosed in 17.33% cases in the first group, Pl. increta – in 1.33%, Pl. percreta – in 1.33%. Hysterectomy has been performed in 8.0% cases, all Pl. increta and percreta cases required the hysterectomy and were followed by massive obstetric hemorrhages (MOH). DIC-syndrome developed in 2.67%. In the second group Pl. accreta was diagnosed in 19.61% and Pl. increta – in 3.92%, patients with Pl. increta had hysterectomy. MOH were observed in 38.7% cases in the first group versus 9.7% cases in the second group (p&lt;0.05). Furthermore, in the first group hysterectomy was performed almost four times more frequently than in the second group (24.0% versus 6.5% respectively, p&lt;0.05).Conclusions. The developed delivery algorithm in pregnant women with Placenta previa alone or in a combination with PAS allowed to reduce intraoperative blood loss significantly, prevent the MOH development, therefore to reach secure hemostasis and save the uterus.

Radiomics-based analysis by machine learning techniques improves characterization of functionally significant coronary lesions

Abstract Background Computed Tomography Coronary Angiography (CTCA) is an effective non-invasive imaging modality for anatomo-functional assessment of coronary artery disease (CAD). Radiomics features have been used for diagnosis or outcome prediction, however, their potential value for characterizing flow limiting coronary lesions has not been explored. Purpose To assess whether application of novel radiomics and machine learning (ML) techniques on CTCA derived datasets improves characterization of functionally significant coronary lesions. Methods Consecutive patients with stable chest pain and intermediate pre-test likelihood for CAD, who underwent CTCA and PET-or SPECT-Myocardial Perfusion Imaging (MPI) respectively, were prospectively evaluated and included in the analysis. PET-MPI was considered abnormal when &amp;gt;1 contiguous segments showed both stress Myocardial Blood Flow ≤2.3mL/g/min and Myocardial Flow Reserve (MFR) ≤2.5 for 15O-water or &amp;lt;1.79 mL/g/min and ≤2.0 for 13N-ammonia respectively. Defect reversibility (DR) was defined as a summed difference score (SDS) between stress and rest images ≥2. CTCA and functional images were fused to assign each myocardial segment to the pertinent coronary territory. Stenosis severity, plaque characteristics and radiomic plaque features were assessed in the total length of the 3 main coronary vessels. In total, 1765 features were extracted from each vessel and a feature reduction and model creation pipeline was constructed [Figure 1]. Two separate datasets: a) coronary stenosis (≥50%) + plaque characteristics and b) coronary stenosis (≥50%) + plaque characteristics + radiomics were formulated and compared in terms of AUCs accordingly. Results A total of 292 coronary vessels (140 with corresponding PET-MPI data and 152 with SPECT MPI data) were analysed. Plaque burden and stenosis severity were the only independent predictors of impaired myocardial perfusion on PET-MPI, with an AUC = 0.749, (95% CI: 0.658–0.826). Stenosis severity, kurtosis, contrast, interquartile range and entropy were predictors of an abnormal PET-MPI result and their combination resulted in an AUC = 0.854, (95% CI: 0.775–0.914). The difference between the 2 models was statistically significant (p-diff: 0.02, 95% CI: 0.0165–0.194). Stenosis severity was the only predictor of a DR on SPECT-MPI, AUC = 0.624 (95% CI: 0.542–0.702). Small Dependence High Gray Level Emphasis, Cluster Prominence, Region Length, wavelet Median and square Median were predictors of a positive SPECT result, with AUC = 0.816, (95% CI: 0.745–0.875). The difference between the two models was statistically significant (p-diff: 0.006, 95% CI: 0.152–0.329) Conclusion Radiomic futures can be combined with anatomical and morphological characteristics of coronary lesions in CTCA imaging and provide valuable complementary information for characterizing functionally significant coronary lesions. Funding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This work was supported from European Regional Development Fund, Operational Programme “Competitiveness, Entrepreneurship and Innovation 2014-2022 (EPAnEK)”, titled: The Greek Research Infrastructure for Personalized Medicine (pMED-GR)

Evaluation of coronary artery side branches (SB) with Quantitative Flow Ratio (QFR) by comparing the use of recommended angiographic projections with routine angiographic projections as Reference

Abstract Background Contrast-flow quantitative flow ratio (QFR) is a novel, noninvasive method for the quantitative evaluation of coronary physiology using computational fluid dynamics based on 3D vessel reconstruction in angiograms. Computing this 3D-model with analyzing the dynamics of the contrast medium flow with a specialized algorithm, the software computes the virtual FFR. This new technique has shown a high accuracy in determining the functional significance of coronary stenosis of the three main epicardial coronary arteries using the gold standard FFR as reference. However, QFR data for the evaluation of coronary side branches (SB) are scarce. Therefore, the study aimed to determine the feasibility of this novel method to analyze SB and to characterize optimal viewing angles for evaluation using QFR. Methods A total of 87 patients, who underwent invasive coronary angiography with routine core lab projections, were enrolled in the study and were analyzed retrospectively by two certified experts with the software QAngio XA 3D 3.2. In addition, 37 patients were enrolled prospectively using coronary angiography projections recommended for the virtual QFR-Analysis. Quantitative Analysis was performed only for SB with a maximum lumen diameter (MLD) of ≥2mm. The following outcome parameters were analyzed: baseline characteristics, anatomical SB parameters such as MLD (mm) and vessel length (VL; mm) of the SB, result of the QFR-computation and procedure parameters, such as use of applicated contrast medium and fluoroscopy time. Results 187 side branches (obtuse marginal [OM], diagonal branch [DB], intermediate artery [IA], posterolateral branch [PLB] and posterior descending artery [PDA]) were analyzed using QFR. Out of 87 patients undergoing an invasive coronary angiography with routine core lab projections with 244 SB ≥2mm, 123 SB (55%) were computable with the use of QFR. In the prospective cohort of 37 patients with recommended angiographic projections for QFR analysis of main branches, 75 SB ≥2mm were found. 64 of the 75 SB (84%) were computable with the use of QFR. The use of recommended projections led to an overall higher evaluability of SB (85% vs. 55%). The data show that the fluoroscopy time for recommended QFR projections was not significantly different as the time for routine cath lab projections (3.7±2.2 vs. 4.6±3, p=2.69). The study shows a significant increase of the amount of contrast medium used for QFR projections (55.4±24.2 vs. 87.9±43.7, p&amp;lt;0.01). Conclusion To our knowledge this is the first study evaluating QFR for SB analysis. QFR is feasible for the routine assessment of side branches (SD) with MLD ≥2mm. The use of recommended projections significantly improved the quality of the QFR SB analysis apart from PDA, without increasing the fluoroscopy time during coronary angiography. Overall QFR could increase the use of physiologically guided coronary interventions, not only for the main epicardial vessels, but also for the SB. Funding Acknowledgement Type of funding sources: None.

COMPUTED TOMOGRAPHY IN THE DIAGNOSIS OF CONGENITAL HEART DISEASE

Aim of the study – Evaluate the value of multispiral computed tomography (MSCT) with intravenous contrast in the diagnosis of congenital heart disease (CHD) at the stage of preoperative preparation and choice of surgical tactics. Methods. Between January 2021 and June 2022, 30 CT cardiographies were performed in our center, of different age and mediastinal pathology. A 64-slice Somaton Siemens sensation 64 CT scanner complete with digital processing systems was used. The main vessels of the heart were examined with intravenous bolus injection of contrast agent. Image analysis included study of anatomy of the defect by three-plane tomograms and construction of multiplanar 3-D reconstructions. Results. Modern approaches to the imaging diagnosis of CHD in all age groups are presented. The role of CT-angiography with intravenous contrast in the diagnosis of congenital, acquired cardiovascular and thoracic pathology is shown. Qualitative assessment of CT-angiographic picture of CHD was performed. Conclusion. Our experience with CT cardiography in the examination of patients with CHD, in contrast to traditional ultrasound and invasive techniques, in most cases allows to obtain more valuable diagnostic information, especially extracardiac structures, which determines its significance in the examination of CHD. It details anatomy of malformations in reliable morphometric indices, diagnosis of aortic, pulmonary artery, right ventricular pathology, including pathology of its outflow tract, to assess ventricular-artery connections and atrialventricular connections.

История применения гомографтов в сосудистой хирургии (литературный обзор)

INTRODUCTION: In the article, problems of use of allografts from a posthumous donor in the practice of a vascular surgeon are analyzed. The need for donor material in special clinical situations is reflected. The main stages of the historical development of the use of homografts are listed. The experience of foreign and domestic authors in reconstructive interventions on the main vessels and aorta using homografts is demonstrated in the historical perspective of the XXth century. Historical milestones in the development of tissue banks in the world are considered on an example of America, Europe, Africa, Asia and Russia. The legal regulation of use of homografts is at present especially relevant for the Russian Federation. The use of homografts as a material for reconstruction is stated to be within the legal framework of the Russian Federation. A large number of modern studies in the 21st century are carried out with choice of cadaveric homografts, both cryopreserved and of wet storage, as the material for reconstruction of the main arteries. Critical ischemia is a probable indication for the use of cadaveric homographs, but their implantation shows ambiguous results. Infection of a permanent vascular access for hemodialysis can also be considered as an indication for the use of a venous homograph as the material for access reconstruction. CONCLUSION: The donor material is currently being actively used in the practice of vascular surgery in many centers, and the hope for the diversification of clinical indications is growing, as well as for homografts finding the place in Russian clinical guidelines in future.

Experience in the Treatment of Wounds of Circulatory Organs in the Chest and Main Vessels of Other Localizations in Wartime

The article presents the principles of providing care for injuries to the heart, aorta, pulmonary artery, or other main vessels. The described principles can be applied in the treatment of civil injuries.&#x0D; The aim. Consider a treatment tactic in the cases of heart and main vessels combat injuries using own experience.&#x0D; Materials and methods. Twelve cases of combat wounds of blood circulation organs in the chest were analyzed: 5 gunshot injuries of the subclavian vessels, 4 gunshot injuries of the heart, 1 gunshot injury of the ascending aorta, 1 gunshot injury of the pulmonary artery and 1 suspected gunshot injury of the left ventricle.&#x0D; Also we analyzed 78 cases of combat gunshot injuries of main vessels of other locations: 3 injuries of vessels of the neck, 68 injuries of main vessels of limbs, 6 injuries of iliac arteries, 1 injury of abdominal aorta.&#x0D; Most of the operations, with the exception of those that required artificial blood circulation, were performed in advanced hospitals at the II level of military medical evacuation, which enabled to shorten the time from injury to the performance of the final surgical intervention and save life or limbs.&#x0D; Results and discussion. Two cases with penetrating wounds to the chest and damage to the subclavian vessels were fatal. Death was attributed to uncontrolled chest bleeding.&#x0D; Among the 78 cases of injury of main vessels of other locations, one case with damage to the iliac arteries was fatal, and death also occurred as a result of uncontrolled massive intra-abdominal bleeding.&#x0D; Conclusions. Wounded individuals with unstable hemodynamics against the background of ongoing massive bleeding and with suspicion of injury of the heart or main vessels in the chest should be operated on immediately. Due to the urgency of performing such operations and impossibility of an adequate additional examination, localization and degree of the damage to the organs of the circulatory system is determined during the operation. A thoracoscopic approach can be used in stable patients with non-penetrating gunshot wounds to the heart.&#x0D; In the relatively stable condition of patients with an established injury of the heart, aorta, or pulmonary artery, it is advisable to perform additional examinations. Patients with trauma to the main vessels of the extremities and ischemia thereof need rapid revascularization.

Experience of Endovascular Treatment of Pulmonary Artery Atresia

The aim. To analyze the results of the use of endovascular treatments for pulmonary artery atresia (PAA).&#x0D; Materials and methods. Treatment of this heart defect at the National Amosov Institute of Cardiovascular Surgery of the NAMS of Ukraine with application of endovascular methods began in 2006. Since then, 138 patients were operated, 57 of them female (41.3%) and 81 (58.6%) were male. Endovascular methods were used in 23 patients, and 115 patients underwent open-heart surgery. The mean length of hospital stay was 25±16.3 days.&#x0D; Of 115 patients who underwent open-heart surgery, 62 (54%) were male and 53 (46%) were female. On the day of surgery, the mean age of these patients was 607.8±1023.7 days, mean weight was 8.8±8.1 kg. The average length of hospital stay was 26±18.6 (maximum 215, minimum 5). Of 23 patients who underwent endovascular surgery, 18 (77%) were male and 5 (23%) were female. The mean age on the day of surgery was 220.5±650.2 days, mean weight was 5.0±4.4 kg. The mean length of hospital stay was 22±5.7 days (maximum 34, minimum 4).&#x0D; In the treatment of PAA, a stepwise procedure is used, correcting part of the defect at each stage and thereby reducing the traumaticity of the operation. In our case, correction of the defect was performed on the open heart and using endovascular methods of treatment. After endovascular interventions, no fatal effects were observed. Open-heart surgery was performed in case if endovascular interventions could not be performed. The condition of such patients was usually more severe. It should also be noted that the open-heart surgery itself is a serious trauma to the body. Due to the above, postoperative period in this group of patients more often proceeded with complications. Due to more severe preoperative condition of the patients and surgical trauma, in some cases of open-heart interventions, some patients did not recover after surgery. As a result, the total mortality in the group of patients who underwent open-heart surgery was 13.0%. In addition, in 7 cases, such surgery was supplemented by the Rashkind procedure. In case of recurrent surgery after 6 months, stenting of patent ductus arteriosus was performed. Repeated surgical interventions were accompanied by the improvement of the condition and the patients were discharged from the clinic in satisfactory condition.&#x0D; Conclusions. PAA is one of the most complex congenital pathologies of the heart and main vessels, and therefore preservation of such a newborn depends on the preservation of patent ductus arteriosus. Endovascular surgery for PAA is the operation of choice that allows to prepare the patient for the next stage of treatment, including open-heart surgery. Endovascular interventions in PAA are minimally invasive, which increases the chances of patients with complicated anatomy to survive despite their serious condition on admission to the hospital.

PREDICTORS OF THROMBOGENICITY AND DEVELOPMENT OF ENDOTHELIITIS IN PATIENTS WITH СOVID-19 — ASSOCIATED CARDIAC AND VASCULAR SURGICAL PATHOLOGY IN THE ACUTE AND POST-COVID PERIODS

PREDICTORS OF THROMBOGENICITY AND DEVELOPMENT OF ENDOTHELIITIS IN PATIENTS WITH СOVID-19 — ASSOCIATED CARDIAC AND VASCULAR SURGICAL PATHOLOGY IN THE ACUTE AND POST-COVID PERIODS

Effect of dorsal nerve fascial island flap on repairing distal soft tissue defects at the proximal segment of the index, middle, ring, and little fingers

BackgroundTo investigate the effect of the dorsal nerve fascial island (DNFI) flap on repairing finger soft tissue defects at the distal segments.MethodsFifty patients with distal soft tissue defects at the index, middle, ring, or little fingers were treated with a DNFI flap at the proximal phalanx between February 2008 and May 2018. The nutrient vascular chain around the dorsal branch of the proper palmar digital nerves served as the flap axis. The dorsal branch of the proper palmar digital arteries provided blood supply. The fascia pedicle served as the venous system. All patients were followed for 6 months.ResultsAll 50 flaps survived. The appearance, color, and texture of the skin returned to normal. The sensory function was partially restored. The two-point discrimination of the finger flap was 7–10 mm.ConclusionsThe DNFI flap at the proximal phalanges of the index, middle, ring, and little fingers is an effective surgical option. The technique has a high flap survival rate and long pedicle, which can repair different parts of the finger. The flap also restores the sensory function of the finger without damaging the main nerves or blood vessels. The flap treatment is an optimal option for finger soft tissue defects at the distal segments.

Ultrasound examination of the upper extremity vessels in the early diagnosis of peripheral angiodystonic syndrome of occupational etiology

Introduction. The cardiovascular system reacts to almost all occupational hazards. Various methods for diagnostics, in particular ultrasound, may help to identify preclinical forms of the disease. The study aims to development of criteria for early diagnosis of occupational diseases of the vessels of the upper extremities in machine-building workers. Materials and methods. One hundred twenty-six workers of a machine-building plant were examined using standard clinical and laboratory methods, ultrasound examination of the vessels of the upper extremities and X-ray examination of the hands. Results. Laboring job, hand-arm and whole-body vibration, and noise with an average work experience of 21 years are risk factors for spastic changes in the vessels of the upper extremities in workers of machine-building production. X-ray changes in the hands are determined in 83% of cases and manifest themselves as a violation of local blood circulation, cystic restructuring in the bones of the wrists, and peri-articular osteopenia. Characteristic signs of vascular pathology detected by ultrasound are an increase in the resistance index with the preservation of speed indices (in 100%), impaired venous outflow (in 82%), and pathological tortuosity of blood vessels (in 76%). Limitations. We did not standardize workers depending on tobacco smoking due to the low number of workers in certain occupations. Conclusion. The results of ultrasound examination of the main vessels of the upper extremities in power engineering workers showed the presence of spastic vascular changes, which, with further exposure to occupational hazards, develop into angiodystonic syndrome, which is one of the syndromes of effects of vibration or polyneuropathy.

Topical and intravenous administration of human umbilical cord mesenchymal stem cells in patients with diabetic foot ulcer and peripheral arterial disease: a phase I pilot study with a 3-year follow-up

BackgroundDiabetic foot ulcer (DFU) is a serious chronic complication of diabetes mellitus that contributes to 85% of nontraumatic lower extremity amputations in diabetic patients. Preliminary clinical benefits have been shown in treatments based on mesenchymal stem cells for patients with DFU or peripheral arterial disease (PAD). However, the long-term safety and benefits are unclear for patients with both DFU and PAD who are not amenable to surgical revascularization.MethodsIn this phase I pilot study, 14 patients with PAD and incurable DFU were enrolled to assess the safety and efficacy of human umbilical cord mesenchymal stem cell (hUC-MSC) administration based on conservative treatments. All patients received topical and intravenous administrations of hUC-MSCs at a dosage of 2 × 105 cells/kg with an upper limit of 1 × 107 cells for each dose. The adverse events during treatment and follow-up were documented for safety assessments. The therapeutic efficacy was assessed by ulcer healing status, recurrence rate, and 3-year amputation-free rate in the follow-up phase.ResultsThe safety profiles were favorable. Only 2 cases of transient fever were observed within 3 days after transfusion and considered possibly related to hUC-MSC administration intravenously. Ulcer disclosure was achieved for more than 95% of the lesion area for all patients within 1.5 months after treatment. The symptoms of chronic limb ischaemia were alleviated along with a decrease in Wagner scores, Rutherford grades, and visual analogue scale scores. No direct evidence was observed to indicate the alleviation of the obstruction in the main vessels of target limbs based on computed tomography angiography. The duration of rehospitalization for DFU was 2.0 ± 0.6 years. All of the patients survived without amputation due to the recurrence of DFU within 3 years after treatments.ConclusionsBased on the current pilot study, the preliminary clinical benefits of hUC-MSCs on DFU healing were shown, including good tolerance, a shortened healing time to 1.5 months and a favorable 3-year amputation-free survival rate. The clinical evidence in the current study suggested a further phase I/II study with a larger patient population and a more rigorous design to explore the efficacy and mechanism of hUC-MSCs on DFU healing.Trial registration: The current study was registered retrospectively on 22 Jan 2022 with the Chinese Clinical Trial Registry (ChiCTR2200055885), http://www.chictr.org.cn/showproj.aspx?proj=135888Graphical

The Great Saphenous Vein-An Underrated Recipient Vein in Free Flap Plasty for Lower Extremity Reconstruction: A Retrospective Monocenter Study.

Background Reconstruction of large soft tissue defects of the lower extremity often requires the use of free flaps. The main limiting factor and potential for complications lie in the selection of proper donor and recipient vessels for microvascular anastomosis. While the superficial veins of the lower leg are easier to dissect, they are thought to be more vulnerable to trauma and lead to a higher complication rate when using them instead of the deep accompanying veins as recipient vessels. No clear evidence exists that proves this concept. Methods We retrospectively studied the outcomes of 97 patients who underwent free flap plasty to reconstruct predominantly traumatic defects of the lower extremity at our institute. The most used flap was the gracilis muscle flap. We divided the population into three groups based on the recipient veins that were used for microvascular anastomosis and compared their outcomes. The primary outcome was the major complication rate. Results Overall flap survivability was 93.81%. The complication rates were not higher when using the great saphenous vein as a recipient vessel when comparing to utilizing the deep concomitant veins alone or the great saphenous vein in combination to the concomitant veins. Conclusions In free flap surgery of the lower extremity, the selection of the recipient veins should not be restricted to the deep accompanying veins of the main vessels. The superficial veins, especially the great saphenous vein, offer an underrated option when performing free flap reconstruction.

Ischemic and hemorrhagic abdominal complications in COVID-19 patients: experience from the first Italian wave

PurposeTo report ischemic and haemorrhagic abdominal complications in a series of COVID-19 patients. To correlate these complications with lung involvement, laboratory tests, comorbidities, and anticoagulant treatment.MethodsWe retrospectively included 30 COVID-19 patients who undergone abdomen CECT for abdominal pain, between March 16 and May 19, 2020. Ischemic and haemorrhagic complications were compared with lung involvement (early, progressive, peak or absorption stage), blood coagulation values, anticoagulant therapy, comorbidities, and presence of pulmonary embolism (PE).ResultsIschemic complications were documented in 10 patients (7 receiving anticoagulant therapy, 70%): 6/10 small bowel ischemia (1 concomitant obstruction, 1 perforation) and 4/10 ischemic colitis. Main mesenteric vessels were patent except for 1 superior mesenteric vein thrombosis. Two ischemia cases also presented splenic infarctions. Bleeding complications were found in 20 patients (all receiving anticoagulant treatments), half with active bleeding: hematomas in soft tissues (15) and retroperitoneum (2) and gastro-intestinal bleeding (3). Platelet and lymphocyte were within the normal range. d-Dimer was significantly higher in ischemic cases (p < 0.001). Most of the patients had severe lung disease (45% peak, 29% absorption), two patients PE.ConclusionsIschemic and haemorrhagic abdominal complications may occur in COVID-19 patients, particularly associated to extended lung disease. CT plays a key role in the diagnosis of these potentially life- threatening conditions.