Objective. To determine the treatment tactics for varicose dilation of veins, complicated by thrombosis of subcutaneous veins and the shin deep veins, using miniinvasive methods. Маterals and methods. The results of treatment in the IGUS named after V. Т. Zaytsev NAMS of Ukraine in 2015 - 2017 yrs of 80 patients, suffering varicothrombophlebitis, were analyzed. The patients were divided into two groups. In Group I 38 patients, suffering varicothrombophlebitis and/or the shin deep vein thrombosis (DVT), were included, who were treated in accordance to the algorithm proposed. In Group II 42 patients with the same pathology were included, to them a standard treatment was conducted. Results. Immediately after the operation in the Group I patients a severe morbidity, connected with the operation technique (DVT, pulmonary thromboembolism, hemorrhage) were absent. Rate of cutaneous neurological disorders in distal parts of the extremities in patients, to whom endovenous laser coagulation was performed, have constituted 5.2%, and in radiofrequency ablation (RFA) – 2.6%. Due to differentiated approach applied for determination of the operative intervention volume for varicose dilation of veins, complicated by varicothrombophlebitis and/or DVTH of the shin, it became possible to perform operative intervention of lesser traumaticity and to achieve good immediate result in majority of the patients. In Group II in 1 patient postoperative period have complicated by DVT. Of the local complications lymphorrhea was observed in 5% patients, and in 2 patients – the extended femoral hematomas. Conclusion. Operative treatment in the RFA volume or endovenous laser coagulation of the stem on the level of reflux with ligature/ablation of perforant veins after conduction of anticoagulant therapy on stage of total recanalization are indicated in patients, suffering thrombosis of the big subcutaneous vein or small subcutaneous vein and deep veins of the shin. In the patients, suffering thrombosis of stem, the deep shin veins after conduction of operative treatment it is mandatory to administer anticoagulant therapy in the treatment dosage during 7 - 14 days, depending on indices of soluble complexes of the fibrin monomers and/or D-dimer.

Вивчено особливості нейропротективної тактики хірургічного лікування атеросклеротичного стенозу внутрішньої сонної артерії. В аналіз включено 108 пацієнтів з поєднаним атеросклеротичним ураженням церебральних і каротидних артерій, яким була зроблена оцінка резервних можливостей головного мозку. На підставі результатів, які були отримані під час проведення ішемічних проб, пацієнтів розподілили на дві групи. До 1-ї групи увійшло 68 осіб, яким була виконана каротидна ендартеректомія без використання тимчасового шунта, 2-гу групу склали 40 пацієнтів, яким дана операція виконувалася з використанням ТШ (тимчасового шунта). Рішення про використання шунта приймали за сукупністю показників ретроградного тиску, неврологічного дефіциту, кровотоку по середній мозковій артерії. У пацієнтів з оклюзією сонних артерій з контрлатеральної сторони використання ТШ показано незалежно від показників оксиметрії, ретроградного тиску, швидкості по середній мозковій артерії. При поєднаному атеросклеротичному ураженні сонних і церебральних артерій тактика хірургічного лікування повинна ґрунтуватися на оцінці функціональних резервів головного мозку. Результати проведеної проби гіпоксії слугували додатковим критерієм щодо рішення про накладення внутрішнього шунта (ВШ). Це дозволяє уникнути додаткових можливих ускладнень в ранньому післяопераційному періоді. Розімкнене Вілізієве коло не вимагає використання тимчасового шунта у 32 випадках

The results of examination and treatment by carotid endarterectomy method in 23 patients with atrial fibrillation and lesions of the carotid arteries in the State Institution «V.T. Zaitsev IGES NAMSU» from 2017 to 2019. Antiplatelet agents (aspirin were prescribed in 20 patients, clopidogrel were prescribed in 3 patients) were prescribed due to the presence of cardiovascular disease and previous myocardial infarction. No patient was found to have impaired cerebral circulation in the postoperative period. Tension hematoma was diagnosed in two patients and bleeding from soft tissues, which required revision of the postoperative wound with hemostasis, in one. It has been shown that patients with hemodynamically significant stenosis and unstable plaque of the carotid arteries most often develop atherothrombotic stroke. Patients with stenosis of the carotid arteries and rhythm disturbances should receive antiplatelet and anticoagulant therapy with blood pressure correction in the absence of bleeding.

Aim. To define tactics of treatment of patients with infecting of synthetic patch after carotid endarterectomia(CEA). Materials and methods. As a result of treatment of 123 patients with hemodynamically meaningful stenosises of carotids and/or presence of embolic plate in SI «Zaycev V.T. IGUS of NAMSU» from 2014 for 2018 51 CEA was executed with in seaming of patch. In 5 cases autove in used as a patch, at 46 patients were used synthetic patch. As a rule, this group was entered by patients with extensive stenosis (more than 2 cm) - 33 patients, patients with insufficient retrograde pressure and/or presence of neurological deficit in the period of crossclamping of internal carotid — 18 patients. Results. The direct results of operation we estimated complex on the basis of degree of change of clinical status and presence of postoperative complications. At 43 patients in a postoperative period are not educed complications. At 8 patients an early postoperative period was complicated by bleeding from a patch, that demanded the repeated operative treatment. In two cases through 2 and 2,5 year, infecting of synthetic patch, that demanded urgent operative intervention as excision of synthetic patch and inseaming of autovein patch, was educed. To the patients control of passableness of carotids was executed through every 6 months Hemodynamically meaningful Restenilооm was observed in 3 cases at this group of patients. Conclusion. At hemodynamically meaningful extensive stenosises of carotids and insufficient level of retrograde arteriotony it is necessary to execute CEA with inseaming of synthetic patch. In case of the repeated interference on a carotid careful hemostasis and antibacterial therapy allows to bring down the level of infectious complications.

Summary. Goal. To analyze the results of surgical treatment of carotid stenosis in patients with coronary heart disease in order to prevent ischemic stroke. Materials and methods. The analysis included 18 patients treated in the SI «V. T. Zaitseva IGUS of NAMNU» from 2017 to 2019 in combined atherosclerotic lesions of the coronary and carotid arteries which evaluated the reserve brain. Results and discussion. All patients with two-stage treatment of the first and second groups were discharged in a stable state, one had a clinic of transient ischemic attack in the postoperative period. Conclusions. Simultaneous operations are advisable in patients with a reduced reserve of both coronary and cerebral circulation. The risk of developing cerebral and cardiac postoperative complications is comparable with the results of phased operations, reducing the length of hospital stay of the patient. The results of the hypoxic test serve as an additional criterion for the decision to impose an internal intra-arterial shunt. This allows you to reduce the time of the main stage of carotid endarterectomy and to avoid additional possible complications in the early postoperative period.