Репозиторий Университета

© 2018, Media Sphera Publishing Group. All rights reserved. Venous surgery prescribed to the patients receiving anticoagulation therapy for the treatment of atrial fibrillation especially with the use of warfarin is considered to constitute a serious challenge due to the increased risk of the development of venous thromboembolism and other hemorrhagic complications in case of withdrawal of the anticoagulant. A clinical case of successful perioperative management of the patient with varicose veins with the use of long-term warfarin therapy for the management of atrial fibrillation is presented. Several surgical clinics refused to treat the patient on a regular basis on the ground of impracticability of any invasive procedures because of the patient’s condition taking into consideration the involuntary intake of the anticoagulation agent and the concomitant cardiac pathology. We performed the primary clinical examination and duplex ultrasound study of the patient who was found to have varicose veins in right lower extremity (С2, 3S, Ер, Аs, p, Pr2,18, LII) with the international normalized ratio (INR) being 3,64. We confirmed the indication for the surgical treatment and offered the patient high ligation, stripping and phlebectomy. Prior to surgery, the patient was switched to a subcutaneous injection of enoxaparin. After reducing INR down to less the 2.0, we performed surgery under spinal anesthesia. The anticoagulation treatment was restarted 12 hours after the operation. No complications was documented within the first weeks after the intervention. The patient was switched back to warfarin therapy.

PURPOSE: To evaluate various methods of stripping Descemet's membrane of a donor corneoscleral flap for Descemet's membrane endothelial keratoplasty (DMEK). MATERIAL AND METHODS: The study included 60 corneoscleral flaps (mean donor age was 62.9 years) from the eye bank of Research Institute of Eye Diseases, which were not suitable for clinical use due to positive serological results. Four alternative methods of donor material dissection in preparation for DMEK were compared: SCUBA (group A), our newly suggested method utilizing intracapsular ring (group B), 'liquid bubble' (group C), 'big bubble' (group D). Parameters under evaluation were mean transplant preparation time, density of endothelial cells before and after dissection, presence of complications during detachment of Descemet's membrane. RESULTS: Mean detachment time in group A was 8.5 min, in group B - 7 min, in group C - 8 min, and in group D - 5 min. Loss of endothelial cells as compared with baseline was in average 10.5% in group A, 9.3% in group B, 10.7% in group C, and 10.3% in group D. Group A had two cases with complications occurring during separation of Descemet's membrane, group B had one such case, group C - 2 cases, and group D - 3 cases. Histologic examination confirmed absence of stromal fibers on the detached Descemet's membrane in groups A, B and C. CONCLUSION: Among the described methods of preparing donor material for DMEK surgery, all except 'big bubble' proved equal in terms of resulting transplant quality. The 'big bubble' dissection technique requires more time to complete, while the resulting transplant has stromal fibers. Our newly suggested method of Descemet's membrane stripping that utilizes intracapsular ring proved safe and effective alternative for preparing donor material for DMEK.

© 2018, Media Sphera Publishing Group. All rights reserved. This article was designed as a comparative review of the literature publications pertaining to the two opposite approaches to the surgical treatment of varicose veins of the lower extremities based on the vein-sparing and radical principles. We compare classical phlebectomy (i.e. endovenous treatment of varicose veins including thermal obliteration) and the vein-savings treatment with the use of the methods for the hemodynamic correction of venous insufficiency, such as ASVAL, CHIVA, and short stripping with special reference to its location and extent. Also covered in the article is the issue of the appropriate length of great saphenous vein stripping. The authors emphasize that it should be based on the extent of reflux rather than on the desire to avoid saphenous nerve injury. It is maintained that either partial or complete preservation of the stem of the great saphenous vein (GSV) in addition to the endovenous obliteration techniques is an efficient and safe modification of the surgical intervention. Stripping is indicated when the endovasal intervention is either impossible or undesirable because of clinical, anatomical, and/or technical limitations. Short stripping in the absence of total reflux in the great saphenous vein is a safer procedure in comparison with the total extirpation of the venous stem.