Репозиторий Университета

© 2018 Elsevier Ltd The variation of blood flow waveform in the internal carotid artery (ICA) with age is a well-documented hemodynamic phenomenon, but little is known about how such variation affects the characteristics of blood flow in aneurysms present in the region. In the study, hemodynamic simulations were conducted for 26 ICA aneurysms, with flow waveforms measured in the ICAs of young and older adults being used respectively to set the inflow boundary conditions. Obtained results showed that replacing the young-adult flow waveform with the older-adult one led to little changes (<10%) in simulated time-averaged wall shear stress (WSS), transient maximum WSS, relative residence time and trans-aneurysm pressure loss coefficient, but resulted in a marked increase (32.36 ± 17.24%) in oscillatory shear index (OSI). Frequency-domain wave analysis revealed that the progressive enhancement of low-frequency harmonics dominated the observed flow waveform variation with age and was a major factor contributing to the increase in OSI. Cross-sectional comparisons among the aneurysms further revealed that the degree of increase in OSI correlated positively with some specific morphological features of aneurysm, such as aspect ratio and size ratio. In summary, the study demonstrates that the variation in flow waveform with age augments the oscillation of WSS in ICA aneurysms, which underlies the importance of setting patient-specific boundary conditions in hemodynamic studies on cerebral aneurysms, especially those involving long-term patient follow-up or cross-sectional comparison among patients of different ages.

© 2018, Pediatria Ltd.. All rights reserved. Objective of the research: to define peculiarities of Kawasaki syndrome (KS) course in patients with giant coronary artery aneurysms (GCAA) to assess risk factors for complicated course, frequency, development time, the dynamics of coronary thrombosis and stenosis, and to rationale for the examination and treatment of convalescents. Materials and methods: in 2003–2017 342 children with KS were examined, GCAA was found in 17. Results: in all patients with GCAA KS treatment was started untimely (on the 12th–60th day of the KS). Thrombi in GCAA were found in 14, coronary arteries stenosis (CA) – in 6 patients. Thrombi regressed in 7, decreased – in 2, occlusion of right CA – in 2. Myocardial infarction was in one patient. Surgical treatment was in 5 patients: 3 – mammaroconary shunting (MSC), 2 – CA stenting, in one of them after 10 months – stent occlusion, MCS. Conclusion: to reduce the risk of life-threatening complications, timely treatment of KS, assessment of CA lesions nature for adequate thrombosis prophylaxis, detection of significant CA stenosis, timely consultation with cardiac surgeon are necessary.

RESULTS: There were no any complications after proximal debranching and aortic stenting. Abdominal debranching was followed by lethal outcome in 3 (13.0%) patients and early postoperative occlusion of the prosthesis brunch in 3 out of 87 cases.CONCLUSION: Staged approach for hybrid surgical treatment is optimal solution, especially in high risk patients. In our opinion no necessity for cardiopulmonary bypass is the main advantage of this technique.AIM: To generalize our experience of step-by-step hybrid thoracoabdominal aortic replacement.MATERIAL AND METHODS: Twenty-three patients were enrolled who underwent staged hybrid treatment of thoracoabdominal aortic aneurysm. There were 5 (21.7%) women and 18 (78.3%) men aged 61.4±8.3 years (37-74 years). The first stage was proximal debranching, the second - distal (abdominal) procedure and the third - stenting of the thoracoabdominal aorta.

© 2018 Russian Electronic Journal of Radiology.All right reserved. Purpose: To assess the role of modern imaging techniques in the planning and implementation of hybrid interventions for an aortic arch aneurysm in an elderly patient with a burdened comorbid background. Materials and methods: Hybrid intervention in patient, 80 years, with acute rupture of the thoracic aorta was performed - aortic arch endografting from the level of the brachiocephalic trunk with endoprosthesis Zenit Alpha endoprosthesis with simultaneous "chimney" stent-graft Advanta V12 implantation in left common carotid artery and left-side carotid-subclavian bypass with Gore-Tex 6 mm prosthesis. Results: A female of 80 years with acute rupture of the thoracic aorta, massive rightside hemothorax has been successfully treated with hybrid intervention - endoprosthetics of the aorta with a subclavian left subclavian shunt. On the second day after procedure the patient underwent puncture of the right pleural cavity with subsequent drainage because of persisting respiratory failure. On the fourth day the patient was transferred from intensive care unit in stable condition, on the twelfth day the patient was discharged on postoperative day 12. Multislice computed tomography (MSCT) is commonly used for diagnosis of acute aortic pathology and planning the optimal method of surgical treatment, as it allows to obtain detailed images of the entire aorta and surrounding anatomical structures, three-dimensional reconstructions of blood vessels, to give an accurate assessment of the morphological characteristics of the aneurysmal sac, proximal and distal neck, degree of calcification and parietal thrombus, localization and extent of aortic wall defect. Conclusion: The use of new methods of endovascular and hybrid surgery in the treatment of aortic rupture of thoracic aortic aneurysms makes it possible to achieve clinical success even in extremely severe patients of elderly and senile age. The leading role in the planning of these operations belongs to actual imaging methods, primarily MSCT.

© 2018, Media Sphera Publishing Group. All rights reserved. Arterial aneurysms of the A2 segment are very rare (<1%) peripheral aneurysms of the anterior cerebral artery (ACA) territory. Usually, these are saccular aneurysms; there are single reports of fusiform aneurysms of this location. Surgical treatment of these aneurysms involves both microsurgical and endovascular interventions. In the presented case, we used deconstructive surgery (proximal clipping of the aneurysm) with intraoperative awakening of the patient, which verified sufficient collateral blood flow. In the case of focal deficit development, we planned to simultaneously perform an interarterial anastomosis between the A3 segments of the right and left ACAs.

© 2018 Media Sphera Publishing Group. All rights reserved. This article presents an overview of the literature publications concerning pathological changes in the cerebral blood vessels and the factors underlying the development of hemorrhagic complications leading to sudden death of young people. The special emphasis is placed on the most important causes behind the changes in the vascular wall (including the congenital ones) responsible for the high risk of rupture of the intracerebral vessels associated with the development of hemorrhagic complications.