Angiologiia i sosudistaia khirurgiia = Angiology and vascular surgery最新文献

{"title":"[Comparative analysis of endovascular and open surgical treatment of aortoiliac bifurcation lesions].","authors":"Sh B Saaya, A A Gostev, O S Osipova, A V Cheban, V B Starodubtsev, E L Valiev, P V Ignatenko, A A Karpenko, A M Chernyavsky","doi":"10.33029/1027-6661-2025-31-4-62-70","DOIUrl":"https://doi.org/10.33029/1027-6661-2025-31-4-62-70","url":null,"abstract":"<p><strong>Objective: </strong>To compare endovascular treatment (kissing stenting, KS) with traditional open aortobifemoral bypass grafting (ABBG) in management of patients with lesions of the abdominal aorta bifurcation and iliac arteries.</p><p><strong>Patients and methods: </strong>We performed a single-center analysis of patients subjected to endovascular treatment with bare-metal stents by means of kissing stenting or ABBG for TASCII C/D lesions of the aortoiliac segment (AIS) from 2012 to 2021. We assessed the parameters of the perioperative risk scale (American Society of Anesthesiologists, ASA and Society for Vascular Surgery, SVS), frequency of hospital complications, early 30-day mortality and long-tern patency. The obtained results were analyzed by means of the Kaplan-Meyer curves, with the Cox regression used to determine predictors influencing patency parameters.</p><p><strong>Results: </strong>The study included 57 patients with KS and 86 patients with ABBG. The KS group had a higher perioperative risk: ASA (ACP=0.06), SVS (ACP=0.08) and less frequent lesions of the AIS (TASC D lesions 26.3% vs 46.5%, ACP=0.202). After propensity score matching, the study comprised a total of 80 patients (40 with KS and 40 with ABBG), thus forming well balanced groups in terms of demographic data, risk factors, lower limb ischemia degree, perioperative risk: ASA (ACP=0.006), SVS (ACP=0.003) and AIS lesion anatomy (TASC D - 40%, ACP=0.000). 36-month mortality amounted to 5% after KS vs 2.5% in the ABBG group. The length of hospital stay in the KS group was significantly shorter than in the ABBG group (3.9±1.6 days vs 9.1±1.9 days, p<0.001), as well as that of ICU stay (0 days vs 2.1±0.4 days, p=0.001). The rate of early postoperative complications was comparable (7.5% vs 15%, p=0.47). Three-year primary patency was similar between the KS and ABBG groups (87.5% vs 95%, p=0.24); multivariate analysis showed that critical limb ischemia and hemodynamically significant lesions of the efferent arteries were risk factors for developing restenosis/reocclusion (6.65 [1.29; 34.37], p=0.02 and 6.4 [0.72; 50.22], p=0.04, respectively).</p><p><strong>Conclusion: </strong>Endovascular treatment of lesions of the aortic bifurcation and iliac arteries with bare-metal stents demonstrated primary patency comparable with that of ABBG over the 3-year follow-up period. The incidence of early postoperative complications was comparable. Thus, endovascular reconstruction of the aortoiliac segment for TASC C, D lesions by means of kissing stenting can be considered as an alternative to ABBG.</p>","PeriodicalId":7821,"journal":{"name":"Angiologiia i sosudistaia khirurgiia = Angiology and vascular surgery","volume":"31 4","pages":"62-70"},"PeriodicalIF":0.0,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147429562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Five-year results of cyanoacrylate adhesive сlosure in the treatment of patients with varicose veins of the lower extremities].","authors":"O Shirinbek, G V Mnatsakanyan, S N Odinokova","doi":"10.33029/1027-6661-2025-31-4-100-109","DOIUrl":"https://doi.org/10.33029/1027-6661-2025-31-4-100-109","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Cyanoacrylate adhesive сlosure (САС) of subcutaneous veins is a modern method of treating varicose veins of the lower extremities, demonstrating a number of advantages over traditional surgical and thermal ablation techniques. Unlike endovenous thermal сlosure, tumescent anesthesia is not performed in САС, which significantly reduces pain and impact on perivenous tissues, especially for patients with trophic skin disorders. In addition, postoperative compression is not required, which is contraindicated in the presence of obliterating atherosclerosis of the lower extremities. Given the relative novelty of the methodology, the number of studies with long-term results is limited. The aim is to evaluate the long-term outcomes of the use of САС in the treatment of patients with IBD.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Material and methods: &lt;/strong&gt;A retrospective analysis of electronic medical records of patients with IBD has been carried out since the integration of the considered technique into the work of the Phlebology Center of the Multidisciplinary Medical Holding SM-Clinic from 2019 to 2024. The study included patients with varicose-transformed tributaries of the main subcutaneous veins, corresponding to classes C2-C6 according to CEAP, with terminal valve dysfunction with axial reflux (&gt;0.5 s, diameter of the trunk of the subcutaneous vein - 0.6 cm and higher). САС was performed using the VenaSeal Closure System (Medtronic) according to a standard protocol. In the course of the work, demographic and clinical data, key preoperative characteristics (diameter of the target subcutaneous vein, number of venous basins) were evaluated, which were analyzed using descriptive statistics methods. A visual analog scale (VAS) was used to assess the intensity of pain directly during surgery. Postoperative follow-up of patients, including ultrasound duplex scanning, was performed on the 3rd day, then 1, 3, 6 and 12 months after surgery, and thereafter annually. The criterion for the effectiveness of САС was the occlusion of the trunk of the target vein. The safety criterion is the frequency of postoperative adverse events and complications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Evaluation of long-term results with a follow-up period of 5 years was performed in 39 patients who underwent CT in the second half of 2019. 52 lower extremities and 53 venous basins corresponded to this number of patients. There were 24 women (61.5%) and 15 men (38.5%). The average age of the patients was 58.3±16.2 years. 19 (48.7%) patients were elderly and senile. The distribution of patients according to the CEAP classification: C2 - 21 (53.8%), C3 - 15 (38.5%), C4 - 3 (7.7%). The average diameter of the large saphenous vein was 10.8±4.1 mm, the small saphenous vein was 6.7±2.3 mm. In 25 (64.1%) patients, CT was performed on the 1st venous basin, in the remaining 14 (39.5%) - simultaneously on the 2nd venous artery. The average duration of the intervention was 35±25.7 minute","PeriodicalId":7821,"journal":{"name":"Angiologiia i sosudistaia khirurgiia = Angiology and vascular surgery","volume":"31 4","pages":"100-109"},"PeriodicalIF":0.0,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147429764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[The role of direct carotid access in endovascular treatment of ischemic stroke. Emergency hospital experience].","authors":"M V Strutsenko, P A Bolotov, P L Logvinenko, V D Polyanskiy, D M Murtazalieva, F F Khamitov, I P Parfenov","doi":"10.33029/1027-6661-2025-31-4-126-131","DOIUrl":"https://doi.org/10.33029/1027-6661-2025-31-4-126-131","url":null,"abstract":"<p><strong>Relevance: </strong>Stroke continues to occupy a leading position among the causes of mortality in the population. In the Russian Federation, more than 450 thousand cases of acute cerebrovascular accident are recorded annually, with the vast majority (75-80%) being ischemic stroke. Timely restoration of cerebral blood flow allows minimizing the infarction zone by preserving viable areas in the ischemic penumbra, which significantly improves the prognosis of the disease. The aim of the study is to analyze the results of endovascular thrombectomy by direct carotid access in the treatment of patients with ischemic stroke.</p><p><strong>Material and methods: </strong>Within the theoretical section, an analysis of foreign and domestic experience in endovascular treatment of ischemic stroke with complex anatomy was carried out. Within the practical section, the results of our own experience were generalized and analyzed. Over the past 5 years, 613 endovascular mechanical thrombectomies with occlusion in the anterior circulation basin have been performed at the V.V. Veresaev City Clinical Hospital. Of these, 17 patients underwent direct carotid access. The decision on direct access to the common carotid artery was made with unsuccessful selective catheterization of the common carotid artery on the affected side for 30 minutes.</p><p><strong>Results and discussion: </strong>Mechanical reperfusion by direct carotid access in combination with systemic thrombolytic therapy was performed in 3 (17.6%) patients. Reperfusion at the TICI-2b-3 level was considered successful. Endovascular reperfusion was successful in 16 (95%) сases. Effective first-pass thrombectomy was performed in 14 (82%) cases. Manual hemostasis after introducer removal was performed in 6 (35.3%) patients, in 11 (64.7%) cases the puncture hole of the common carotid artery was sutured. Symptomatic hemorrhagic transformation was observed in 3 (17.6%) сases. Three patients died. Mortality was 17.6%. The average National Institutes of Health Stroke Scale at discharge was 13.4±6.2 points. In patients with percutaneous puncture, the average time from the beginning of the operation to reperfusion was 62 minutes.</p><p><strong>Conclusion: </strong>Direct carotid access can be considered as an effective and safe method of mechanical thrombectomy in patients with difficult selective catheterization.</p>","PeriodicalId":7821,"journal":{"name":"Angiologiia i sosudistaia khirurgiia = Angiology and vascular surgery","volume":"31 4","pages":"126-131"},"PeriodicalIF":0.0,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147429986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First experience with endovascular recanalization of chronic internal carotid artery occlusion.","authors":"A E Petrov, N Yu Tukanov, V V Bobinov, S A Goroshchenko, A A Ivanov, E G Kolomin, K A Samochernykh, L V Rozhchenko","doi":"10.33029/1027-6661-2025-31-4-48-54","DOIUrl":"https://doi.org/10.33029/1027-6661-2025-31-4-48-54","url":null,"abstract":"<p><strong>Background: </strong>According to WHO, the number of people suffering from atherosclerotic lesions of the brachiocephalic arteries in different age groups is 20-50%. The development of ischemic stroke with existing chronic occlusion of the internal carotid artery (ICA) occurs with a frequency of 6-15%, and the annual risk of developing acute ischemic disorders in the ipsilateral basin, despite adequate drug treatment, ranges from 6 to 20%. The aim is to evaluate the efficacy and safety of endovascular recanalization in chronic ICA occlusion.</p><p><strong>Material and methods: </strong>The analysis of the first results of intravascular treatment of 12 patients with chronic ICA occlusion on the basis of the vascular neurosurgical department of the Russian Research Neurosurgical Institute named after Professor A.L. Polenov. The age range is from 42 to 75 years (the average age is 57 years). There were 11 men (91.6%) and 1 woman (8.4%). Depending on the type of chronic occlusion, according to the D. Hasan scale (2018), the distribution of patients was as follows: type A (the presence of a proximal ICA stump of the 'candle' type + retrograde filling of the ICA to the stony/cavernous segments) - 4 patients; type B (the presence of a blindly ending proximal ICA stump without the formation of a 'candle' + retrograde filling of the ICA to the rocky/cavernous segments) - 3 patients; type C (occlusion of the ICA from the mouth + retrograde filling of the ICA to the rocky/cavernous segments) - 2 patients; type D (occlusion of the ICA from the mouth with the absence of retrograde filling of the stony/cavernous segments of the ICA) - 3 patients.</p><p><strong>Results: </strong>In 8 (66.6%) of the 12 patients, the ICA lumen was completely restored. According to the D. Hasan scale, type A was noted in 4 patients, type B in 3 patients, and type C in 1 patient. In 4 (33.3%) patients, technical success was not achieved, of which according to the D. Hasan scale: type D was observed in 3 patients, type C in 1 patient. Of the 8 patients with successful ICA recanalization, all underwent remote monitoring by computed tomographic angiography or digital subtraction angiography. No data confirming restenosis were obtained in 6 patients. There were no episodes of recurrent ischemic disorders. In 1 patient, thrombosis of stented ICA was detected against the background of the patient's self-withdrawal of double disaggregant therapy. Unsuccessful recanalization (4 patients), in our opinion, is associated with convolution of the ICA and severe scarring in the lumen of the occluded artery.</p><p><strong>Conclusion: </strong>Intravascular recanalization of chronic ICA occlusion is a promising method that can be effectively used to restore the full-fledged lost artery lumen and normalize brain perfusion to reduce the risks of recurrent ischemic cerebral events.</p>","PeriodicalId":7821,"journal":{"name":"Angiologiia i sosudistaia khirurgiia = Angiology and vascular surgery","volume":"31 4","pages":"48-54"},"PeriodicalIF":0.0,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147430242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Incidence, predictors and prognosis of major vascular complications (VARC-3) following transfemoral transcatheter aortic valve implantation: data from a two- center retrospective registry].","authors":"A A Baranov, O V Krestiyaninov, A G Badoyan, D A Khelimskiy, A Yu Tsydenova, M A Yusupova, S V Maingart, A N Fedorchenko","doi":"10.33029/1027-6661-2025-31-4-71-82","DOIUrl":"10.33029/1027-6661-2025-31-4-71-82","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Improving transcatheter bioprostheses and systems of their delivery, gaining surgical experience, as well as optimizing patient selection made it possible to achieve high levels of efficacy and safety of the procedure of transcatheter implantation of the aortic valve (AV). Nevertheless, complications of this technique with a negative influence on both short- and long-term outcomes are still encountered in many patients. Despite the fact that transcatheter implantation of the AV has historically been associated with lower incidence of hemorrhagic events than traditional surgery, bleeding occurring during this operation is fraught with a worse prognosis. Complications of the vascular access still remain the main cause of hemorrhage.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To assess the incidence, predictors and prognostic significance of major vascular complications associated with the transfemoral vascular access for transcatheter implantation of the aortic valve.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients and methods: &lt;/strong&gt;This retrospective study initially enrolled a total of 628 patients who underwent transcatheter implantation of the AV from March 2015 to October 2024. After exclusion of patients with other than transfemoral vascular approach, as well as with unsatisfactory quality of preoperative multislice computed tomography not allowing for the assessment of vascular anatomy, the final analysis included 548 patients. The primary endpoint of the study was defined as predictors of major vascular complications of the transfemoral approach after transcatheter implantation of the AV, with the secondary endpoint being long-term survival and freedom from cardiovascular death in patients having endured nonfatal major vascular complications of the access site at the in-hospital stage after transcatheter implantation of the AV.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results and discussion: &lt;/strong&gt;There were a total of 32 major vascular complications. Of these, 3 (0.6%) resulted in a lethal outcome, with 29 (5.3%) accompanied by BARC type 3a and 3b bleeding. Puncture percutaneous vascular access was used in 94.9% of patients. The most frequently applied method of vascular access closure was a combination of two ProGlide devices (70.9%). The group of patients with major vascular complications of the transfemoral access was found to have a higher frequency of puncture of the left common femoral artery (21.9% vs 10.5%, p=0.04), as well as a longer length of hospital stay (13.3±8.3 vs 9.4±5.8, p=001). The only independent predictor of major vascular complications was the left side of the vascular access (odds ratio 8.85; 95% confidence interval 1.58-69.40, p=0.02). With an average follow-up period of 2.1±2.2 years, the log-rank test revealed no statistically significant differences in freedom from all-cause mortality (log-rank p=0.11) and freedom from cardiovascular death (log-rank p=0.30) in patients with and without non-fatal major vascular complications of the acc","PeriodicalId":7821,"journal":{"name":"Angiologiia i sosudistaia khirurgiia = Angiology and vascular surgery","volume":"31 4","pages":"71-82"},"PeriodicalIF":0.0,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147429785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Comparison of antejugular and retrojugular approaches to the carotid bifurcation: a prospective randomized study].","authors":"A V Maksimov, R M Mullakhmetov, R M Nuretdinov, M V Plotnikov","doi":"10.33029/1027-6661-2025-31-4-55-61","DOIUrl":"10.33029/1027-6661-2025-31-4-55-61","url":null,"abstract":"<p><p>Carotid endarterectomy is the gold standard for stroke prevention. Although it is one of the most common procedures in vascular surgery, its technique has not been fully standardized. In particular, there is no consensus on the optimal approach for dissection of the carotid bifurcation. Data suggest differences in the safety and efficacy of the retrojugular and/or antejugular approaches, primarily regarding local wound complications and the incidence of cranial nerve injuries, which occur in 1.4-31% of cases and significantly impair patients' quality of life.</p><p><strong>Objective: </strong>To compare the safety and efficacy of the antejugular and retrojugular approaches to the carotid bifurcation within a prospective randomized study.</p><p><strong>Material and methods: </strong>The study enrolled 280 patients (140 retrojugular, 140 antejugular).</p><p><strong>Inclusion criteria: </strong>internal carotid artery (ICA) stenosis >70% (asymptomatic) or >50% (symptomatic).</p><p><strong>Exclusion criteria: </strong>primary - pre-existing neurological deficits, reoperations. secondary - perioperative stroke, wound hematomas, early reinterventions.</p><p><strong>Design: </strong>Prospective randomized study.</p><p><strong>Results: </strong>Common complications: perioperative acute cerebral circulatory disorders/transient ischemic attacks - 2.14%/1.43% with antejugular access, 1.43%/0.71% with retrojugular access (p=0.658/0.566); hematomas - 0.7%/2.1%, respectively (p=0.63). Local neurological symptoms: on day 1 - 33.8% (dysphonia - 33.1%, vocal fold paresis - 1.9%), on day 3 - 22.9%, after 3 months - complete regression in all patients. After applying the secondary exclusion criteria, 134 patients with retrojugular access and 132 patients with antejugular access were included in the comparative analysis. The frequency of cranial nerve damage, dysphonia, and dysphagia did not differ depending on the type of access (p>0.05). The surgery time was 76.1±1.8 min (antejugular) vs 74.2±2.4 min (retrojugular, p=0.51).</p><p><strong>Conclusion: </strong>The retrojugular approach facilitates internal carotid artery exposure and obviates venous ligation but does not reduce local neurological complications or operative duration compared to the antejugular approach. Both techniques demonstrate comparable safety profiles, with approach selection contingent on surgeon preference and patient-specific anatomy.</p>","PeriodicalId":7821,"journal":{"name":"Angiologiia i sosudistaia khirurgiia = Angiology and vascular surgery","volume":"31 4","pages":"55-61"},"PeriodicalIF":0.0,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147429748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[No-touch vein: modern prospects for use as a conduit for coronary artery bypass grafting].","authors":"D S Khvan, A G Makaev, D A Sirota, A V Bogachev-Prokofiev","doi":"10.33029/1027-6661-2025-31-4-157-165","DOIUrl":"https://doi.org/10.33029/1027-6661-2025-31-4-157-165","url":null,"abstract":"<p><p>The article provides a review of the no-touch technique for harvesting the great saphenous vein in coronary artery bypass grafting. The morphological advantages of the no-touch method are discussed, including preservation of the endothelium, adventitia, and perivascular tissue, thus contributing to improved long-term graft patency. The findings of clinical trials are presented demonstrating that no-touch - great saphenous vein yields outcomes comparable to those of arterial conduits and superior patency compared to the conventional technique. Various configurations of composite grafts (I-, Y-, and T-grafts) and their role in revascularization of the right coronary artery are also analyzed.</p>","PeriodicalId":7821,"journal":{"name":"Angiologiia i sosudistaia khirurgiia = Angiology and vascular surgery","volume":"31 4","pages":"157-165"},"PeriodicalIF":0.0,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147429872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Vasodilators in acute pulmonary embolism: promising directions of fundamental research (literature review)].","authors":"V I Evlahkov, E V Lopatina","doi":"10.33029/1027-6661-2025-31-4-7-15","DOIUrl":"https://doi.org/10.33029/1027-6661-2025-31-4-7-15","url":null,"abstract":"<p><strong>Background: </strong>Acute pulmonary embolism (PE) is the third leading cause of cardiovascular mortality after ischemic heart disease and stroke. Along with thrombolysis, reducing pulmonary vascular resistance in PE is one of the important pathogenetic ways of treating this pathology. The article presents a review of current literature data on the prospects for fundamental research into potential pulmonary vasodilators. A vasodilator used in clinical practice should be selective, if possible, for pulmonary vessels, not contribute to the aggravation of arterial hypotension, and not have a negative inotropic effect on the heart.</p><p><strong>Objective: </strong>The purpose of this study was to analyze the available literature data on experimental research aimed at using vasodilators in modeling of PE in animals. The publications were retrieved from such databases as PubMed, Scopus, Web of Science, and Russian Science Citation Index.</p><p><strong>Results and discussion: </strong>Since the development of pulmonary vasoconstriction in PE is promoted by neurogenic, humoral, and local mechanisms, it is impossible to single out the only key 'target' for the use of a vasodilator. Promising areas of research may include the search for new nitric oxide donors and the study of the vasodilator properties of such compounds as 1.2-propanediol and N-nitroso-N-morpholino-amino-acetonitrile. It is also necessary to study the vasodilator properties of argon as a potential agonist of GABA receptors in pulmonary vascular smooth muscle cells. Selective action on Ca2+, K+, and Na+ ion channels in pulmonary vascular smooth muscle cells could be a potential method of vasodilation in pulmonary thromboembolism. Piezo1 mechanosensitive channels of the pulmonary vascular endothelium may be a pharmacological target for vasodilation in PE. Further study of the mechanisms regulating intrapulmonary and bronchopulmonary shunt blood flow is also necessary to find new approaches to reducing pulmonary vascular resistance in PE. The effects of vasodilators in PE could be more pronounced if pathogenetic constrictor neurogenic mechanisms are eliminated simultaneously with their use. One of the approaches to reducing the neurogenic component of the constrictor reaction of pulmonary vessels in PE conditions could be the effect on inhibitory presynaptic receptors located at the endings of sympathetic nerves.</p>","PeriodicalId":7821,"journal":{"name":"Angiologiia i sosudistaia khirurgiia = Angiology and vascular surgery","volume":"31 4","pages":"7-15"},"PeriodicalIF":0.0,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147430104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Ultrasound aspects of the application of Carotid Plaque-RADS, a risk stratification system for acute ischemic cerebral events].","authors":"T V Balakhonova, I E Timina, A O Chechetkin, L E Shulgina","doi":"10.33029/1027-6661-2025-31-4-22-32","DOIUrl":"10.33029/1027-6661-2025-31-4-22-32","url":null,"abstract":"<p><strong>Background: </strong>Stratification of the risk of acute ischemic cerebrovascular events in atherosclerotic carotid artery stenosis is an urgent task, which has traditionally been based on the degree of narrowing of the arterial lumen, underestimating the role of morphological characteristics of plaque. In 2024, a new Carotid Plaque system, RADS, was proposed, standardizing the morphological description of plaques revealed by different imaging modalities and supplementing the assessment of the degree of stenosis by NASCET.</p><p><strong>Objective: </strong>The purpose of this work was to identify the possibilities and limitations of ultrasound examination within the framework of the Carotid Plaque-RADS classification as a first-line diagnostic method. Сontent of the review. Ultrasound criteria of Carotid Plaque RADS 1-4 categories are described: normal wall (RADS 1); uncomplicated eccentric plaques <3 mm high (RADS 2) and plaques ≥3 mm high with a thick/thin fibrous covering or healed ulceration regardless of their height (RADS 3a/3b/3c); complicated plaques with hemorrhage, fibrous cap rupture or parietal thrombus (RADS 4a/4b/4c). Additional signs of instability (calcifications, neovascularization, inflammation, positive remodeling, 'plaque loading', stenosis progression) and modifiers affecting the quality of ultrasound imaging are considered. A moderately high accuracy of the ultrasound method in the identification of key plaque components was demonstrated, while certain limitations remain in the differentiation of a thin/thick plaque cap, healed ulceration/rupture of the fibrous membrane, as well as in the distinction of the lipid necrotic core, intraplaque hemorrhage and parietal thrombus. The algorithm of a structured ultrasound conclusion is described.</p><p><strong>Conclusion: </strong>The Carotid Plaque-RADS classification unifies the description of plaque characteristics, facilitates interdisciplinary communication, and improves patient selection for surgical treatment, but is currently not included in professional guidelines and requires further validation in large centers and prospective studies. Ultrasound evaluation of individual plaque components requires further refinement, possibly with the development of new software approaches.</p>","PeriodicalId":7821,"journal":{"name":"Angiologiia i sosudistaia khirurgiia = Angiology and vascular surgery","volume":"31 4","pages":"22-32"},"PeriodicalIF":0.0,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147430110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Isolated stenting of the common and deep femoral arteries in a patient with critical limb ischemia and severe comorbidity].","authors":"T Kh Gamzatov, A V Kebriakov, A V Svetlikov, V S Gurevich, P P Iablonskii, V A Ratnikov, P K Iablonskii, V P Gorelov, A A Bogatikov","doi":"10.33029/1027-6661-2025-31-4-151-156","DOIUrl":"https://doi.org/10.33029/1027-6661-2025-31-4-151-156","url":null,"abstract":"<p><p>This clinical case demonstrates an example of successful lower limb revascularization in a patient with an extended distal type of atherosclerotic lesion and critical ischemia with the formation of necrosis of the heel area. Due to the inability to perform distal bypass and angioplasty, as well as high surgical risks, the patient underwent isolated stenting of common and deep femoral arteries, which made it possible to achieve regression of critical ischemia and save the limb.</p>","PeriodicalId":7821,"journal":{"name":"Angiologiia i sosudistaia khirurgiia = Angiology and vascular surgery","volume":"31 4","pages":"151-156"},"PeriodicalIF":0.0,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147429751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}