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Наряду с типичными для аневризмы брюшной аорты (АБА) осложнениями, которые представлены разрывом в забрюшинное пространство или свободную брюшную по-лость, а также так называемыми острыми симптомными аневризмами [1], являющимися фактически предвестни-ками будущего разрыва, в весьма редких случаях может наблюдаться формирование соустья между просветом АБА и полой анатомической структурой. В абсолютном большинстве случаев свищ формируется между просве-том аорты и полым органом желудочно-кишечного тракта (ЖКТ) или же просветом крупной вены.Аортокавальная фистула (АКаФ) представляет собой свищ между АБА и просветом крупной вены, обычно -нижней полой (НПВ), реже -подвздошной или почеч-ной [2,3]. К настоящему времени описано порядка 500 Результаты. В послеоперационном периоде вследствие геморрагического шока с диссеминированным внутрисосудистым свертыванием (ДВС-синдромом) (2) и сепсиса с полиорганной недостаточностью умерли 3 пациента, что составило 33,3 и 40% для каждой из патологий соответственно. Выздоровевшие пациенты находились под наблюдением в течение 22-51 мес после операции. Проанализированы причины неблагоприятных результатов лечения, среди которых наибольшее значение имеет поздняя и недостаточная диагностика. Ключевые слова: осложненная аневризма брюшной аорты, аортокишечная фистула, аортокавальная фистула.Aim. To analyze the results of treatment of patients with rare forms of complicated abdominal aortic aneurysm namely aortoenteric and aorto-caval fistulae.Material and methods. 3 cases of aorto-enteric fistula (with jejunum and sigmoid in two and one cases respectively) and 5 cases of aorto-caval fistula were revealed among 149 patients operated for complicated abdominal aortic aneurysms for the period from 2005 to 2014. All patients underwent abdominal aortic replacement using synthetic vascular graft. In patients with aorto-caval fistula anastomosis between the vena cava and aortic lumen was sutured through the aneurysmal sac lumen. Bowel resection (1), the seam of the bowel wall with Brown's interintestinal fistula (1) and the Hartmann's procedure (1) were performed for aortoenteric fistula.Results. In postoperative period 3 patients died due to hemorrhagic shock with DIC (2) and sepsis with multiple organ failure, which accounted for 33.3 and 40% for each disease respectively. Survivors were followed for 22-51 months after surgery. The reasons of adverse outcomes including late and inadequate diagnosis as the most important were analyzed.

Background: This phase III, controlled, patient-blinded, multicentre study in two parallel, equal-sized treatment groups compared the efficacy and safety of TISSEEL Lyo, fibrin sealant versus Manual Compression (MC) with surgical gauze pads for use as a haemostatic agent in patients who underwent vascular surgery in Russia. Methods: Adult patients, both genders, who received peripheral vascular expanded polytetrafluoroethylene conduits and had suture line bleeding after surgical haemostasis were enrolled. Patients were randomized to be treated with TISSEEL Lyo or MC. The bleeding needed additional treatment and had to be assessed as grade 1 or 2 bleeding according to the Validated Intraoperative Bleeding scale. The primary efficacy endpoint was the proportion of patients achieving haemostasis at 4 min after treatment application (T4) at the study suture line, which was maintained until the closure of the surgical wound. The secondary efficacy endpoints included the proportion of patients achieving haemostasis at 6 min (T6) and 10 min (T10) after treatment application at the study suture line, which was maintained until closure of the surgical wound, as well as the proportion of patients with intraoperative and postoperative rebleeding. Safety outcomes included incidence of adverse events (AEs), surgical site infections and graft occlusions. Results: A total of 110 patients were screened; 104 patients were randomized: (TISSEEL Lyo: 51 [49%] patients; MC: 53 [51%] patients). T4 haemostasis was achieved in 43 (84.3%) patients in the TISSEEL Lyo group and in 11 (20.8%) patients in the MC group ( p < 0.001). Significantly more patients in TISSEEL Lyo group achieved the haemostasis at T6 (relative risk (RR) of achieving haemostasis 1.74 [95% confidence interval (CI) 1.37; 2.35]) and T10 (RR 1.18 [95% CI 1.05; 1.38]) versus MC. No one had intraoperative rebleeding. Postoperative rebleeding was reported only in one patient in the MC group. No treatment-emergent serious AEs (TESAEs) related to TISSEEL Lyo/MC, TESAEs leading to withdrawal and TESAEs leading to death were reported in patients during the study. Conclusions: Data demonstrated TISSEEL Lyo had clinically and statistically significant superiority to MC as a haemostatic agent in vascular surgery at all measured time points including 4, 6 and 10 min and had proven to be safe.

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