The purpose of the work isto analyze and improve the results of treatment of patients with diabetes and anastomotic false aneurysm (FA) after reconstructive interventions. Materials and methods. The results of diagnostic examinations in 79 patients with 93 false anastomotic aneurysms were analyzed, the criteria of wound complication (hematoma, infiltrate), patency of shunts, bleeding, heart attack, stroke were evaluated. Among the patients there were 75 (94.9 %) men and 4 (5.1 %) women aged 40—75 years (mean age — (58.4 ± 2.9) years). 69 (87.3 %) patients underwent surgery for atherosclerotic lesions of the pelvic vessels and lower extremities, including 43 (54.4 %) patients with diabetes, 3 (3.8 %) — for abdominal aortic aneurysm, 4 (5.1 %) — after vascular injury, 3 (3.8%) — due to nonspecific aortic arteritis. A total of 79 patients underwent 93 reconstructive interventions. Results and discussion. The time of onset of clinical symptoms (pain, pulsation), which give reason to suspect the occurrence of FA, ranged from 8 days to 19 years: in 15 patients — less than 1 year, in 59 — up to 10 years, in 5 — up to 20 years. The average duration of FA formation after surgery is 62.5 months. The absence of pathological changes in the area of the proximal anastomosis and the presence of adequate outflow pathways in most cases allow us to limit the reconstruction of the distal anastomosis. Conclusions. Early diagnosis and surgical tactics for false anastomotic aneurysms in patients with diabetes can prevent complications and improve the results of surgical treatment. The optimal type of surgery for false aneurysms is their removal with re-prosthesis of the affected segment, which allows to save the limb and the patient's life. The use of modern pharmacological agents allows to reduce the progression of atherosclerosis, which is the main cause of false aneurysms. Dynamic ultrasound monitoring is required for patients who have undergone reconstructive vascular surgery.

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The aim: The features and efficiency of performing fine-needle angiography for Chronic Limb-Threatening Ischemia (CLTI) in Diabetic Patients diagnosis. Materials and methods: From 2015-2020, a total of 180 angiography procedures were performed in below-the-knee (BTK) arterial disease diabetic patients with CLTI (Rutherford category 4 to 6). Relative contraindications such as severe heart failure, myocardial infarction (MI), arterial hypertension, impaired renal function, allergy to contrast media and intolerance to antiplatelet therapy we carefully evaluated and compared with the major amputation risks. Patients were selected with adequate inflow to the common and popliteal arterys, as defined by presence of normal ipsilateral femoral and popliteal pulse, biphasic or triphasic Doppler waveform. Ultrasound controlled fine-needle angiography, by retrograde puncture of the superficial femoral artery (SFA) was performed with an 18G-70mm angiographic needle in 96 patients (1st group). Antegrade angiography using femoral sheath in 84 patients (2nd group). Results: We have obtained adequate visualization BTK vessels by administering “Omnipak 300” 70% solution 9 mL with a power injector at a 3 mL/sec rate through the needle. Through the sidearm of the femoral sheath a total of contrast 15 mL, administered at 5 mL/sec rate. Fine-needle angiography 2.16 times reduces the injected contrast amount in patients. The hemorrhagic events frequency in the 1st group was significantly lower. Conclusions: Fine-needle angiography is recommended for CLTI Diabetic Patients diagnosis.

The aim — to improve the treatment results of patients with a bdominal aorta aneurysm (AAA) by reducing their neurological complications risk.Materials and methods. During 2001 — 2018 an ultrasound duplex scan of carotid arteries was performed for 847 patients with AAA. In 84 (9.9 %) patients, concomitant stenosis of the internal carotid artery > 75 % was found. The average age of the patients was 61.3 ± 2.7 years. Men prevailed among the patients (78 (92.9 %)). All patients underwent a comprehensive examination. One‑stage carotid endarterectomy and open resection of AAA were performed in 25 (29.8 %) patients, staged carotid endarterectomy with the second stage of AAA repair — in 24 (28.6 %), staged AAA resection with the second stage of carotid arteries revascularization — in 16 (19.1 %) patients. Two‑stages intervention was performed in 7 (8.3 %) patients with a combination of an internal carotid artery stenosis, AAA and peripheral artery disease , the first stage was intervention on the carotid arteries, on the second stage (from 3 to 7 days) the reconstruction of the abdominal aorta and arteries of the lower extremities were done. In 7 (8.3 %) patients with concomitant coronary artery disease the two‑stages intervention was performed, with the primary one‑stage revascularization of the carotid and coronary arteries, and in 5 (6.0 %) — three‑staged reconstruction in the following sequence: carotid endarterectomy, coronary artery bypass grafting, reconstruction of the abdominal aorta.Results and discussion. No case of cerebrovascular accident in patients undergoing primary revascularization of the carotid arteries, either simultaneous, or staged was noted. In a group of patients who underwent an intervention on the abdominal aorta without carotid and coronary pathology correction, 1 patient developed ischemic stroke with a fatal outcome. Another 1 patient had myocardial infarction in the first postoperative day. The overall level of neurological complications was 1.2 %. The duration of hospitalization was 11.7 ± 0.7 days for patients with simultaneous interventions and 19.5 ± 0.6 days for staged treatment, stay duration in the intensive care unit were 2.1 ± 0.3 and 4.3 ± 0.5 days respectively.Conclusions. During planning of interventions on AAA the screening test of even clinically non‑manifested arterial segments (carotid and coronary arteries, arteries of the lower extremities) is necessary according to multi‑vascular nature of atherosclerotic lesions. The primary revascularization of the carotid arteries (symptomatic stenoses over 75 %, asymptomatic stenoses with high embolic risk) has to be done prior to the reconstruction of the AAA. The method of one‑stage operation on carotid arteries and abdominal aorta with a weighted risk assessment and plan of aortic intervention is more appropriate.

Аim — to improve the results of treatment of patients with atherosclerotic lesions of the arteries of femoral-popliteal segment, who underwent auto­venous femoral-popliteal bypassgrafting.Materials and methods. During the period of years 2018 to 2021, 34 patients with critical ischemia of the lower extremities underwent autovenous shunting with a reversed great saphenous vein with treatment of the inner surface of the vein with a solution of cytostatics (paclitaxel). Besides, the treatment was analysed in two control groups, who underwent autovenous reverse vein shunting (30 patients) and autovenous in-situ shunting (33 patients). The follow-up periods lasted for 24 months. The evaluation criteria included the cases of shunt thrombosis, shunt stenosis, mortality, serious ischemic events — acute lower extremity ischemia, myocardial infarction, ischemic stroke, cases of high amputations of the lower extremities.Results. In the postoperative period, no deaths were observed; absence of complicationswas registered in 96 (98 %) patients. In the main group, the frequency of shunt thrombosis was 5 (14.7 %), hemodynamically significant restenosis was diagnosed in 6 patients (17.6 %), acute myocardial infarction in 1 patient (2.9 %). In the comparison group, 11 cases of autovenous shunt thrombosis were defined.Conclusions. Our clinical experience showed promising short- and medium-term results. The chosen surgical approach and topical application of cytostatic drugs enabled to achieve long-term patency of venous shunt, which is of particular importance for patients with diabetes mellitus.