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.

The aim: The retrospective analysis of the angiographic picture and clinical results of endovascular treatment of patients with postoperative abdominal and gastrointestinal bleeding was carried out. Materials and methods: The results of 447 endovascular diagnostic and therapeutic interventions in 391 patients (46 military and 345 civilians) with postoperative bleeding performed from 2012 to 2022 were studied. According to computer tomography with contrast enhancement, the source of bleeding was identified in 216 (67.7%) cases. Results: In 345 (88.2%) patients, it was possible to reliably identify the source of bleeding on angiography. In 46 (11.8%) patients with an unexplained source of bleeding, the target arterial pool was determined on the basis of localization, volume, and features of surgical intervention and considered as preventive interventions. A total of 447 endovascular hemostatic interventions were performed on 391 patients. A stent graft was installed in 27 patients, 420 embolization were performed in 364 patients. Thus, in 43 (11.0%) patients, embolization was performed repeatedly, in 12 cases - three times, in 1 case - four times. In 16 cases (15 cases of prophylactic embolization), endovascular hemostasis was ineffective and required subsequent surgical intervention Conclusions: Endovascular interventions are an effective method of diagnosis and treatment of postoperative abdominal bleeding. Prophylactic embolization allows you to prevent the recurrence of postoperative bleeding with an instrumentally undiagnosed source, however, you need to be prepared for the multi-stage treatment aimed at sequentially shutting down the collateral blood supply to the damaged area.

Вступ. Наведений досвід виконання панкреатодуоденальної резекції (ПДР) з резекцією та повним перев’язуванням верхньої брижової (ВБВ) чи ворітної (ВВ) вени у 4 хворих з приводу повної оклюзії пухлиною головки та гачкоподібного відростка підшлункової залози (ПЗ) судин системи ВВ. Матеріали і методи. За період з 2015 по 2017 р. оперовані 4 пацієнта з приводу пухлини правого анатомо-хірургічного сегмента ПЗ з інвазією пухлини у ВВ/ВБВ з повним (відсутність кровотоку) або субкомпенсованим (понад 80%) тромбозом цих судин. Результати. У 3 хворих під час ПДР не виконували реконструкцію судин, дистальний кінець ВБВ зашитий наглухо. В одного хворого сформований циркулярний венозний анастомоз кінець у кінець між ВВ та розширеною колатеральною веною, що відходила від ВБВ. Тривалість операції становила в середньому (390 ± 47) хв, післяопераційного періоду (18 ± 4,2) дня, летальність - 25% (померла одна хвора). Висновки. ПДР з повним перев’язуванням ВБВ без формування судинного анастомозу за її оклюзії пухлиною безпечна і можлива у ретельно відібраних пацієнтів.

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.

Introduction: Nowadays, there is an increase number of patients with abdominal aortic aneurysm. The disease has a constantly progressive nature, the result of which is the rupture of aneurysms and a high mortality rate. However, the technologies of operations are still controversial. Unidentified factors of complications and mortality remain with this pathology. The aim: to determine the risk factors of complications in patients with the aneurysm of the abdominal aorta Materials and methods: Analyze data of the examination and treatment results of 117 patients with aneurysm of the abdominal aorta. 58 patients were examined and treated according to advanced methods in a treatment group. The control group consisted of 59 patients who were examined and operated according to standard, generally - accepted methods. Results: According to our observations after the planned operations, the most common were cardiac complications. Analyzing the frequency of complications depending on the type of surgical intervention, we have not established statistically significant differences. More significant volume of blood loss was observed when performing combined operations and aorto-bifem bypass in comparison with aortic bypass and aorto-biiliac bypass. Conclusions: Combined operations result in a significantly higher blood loss compared to linear prosthetics.The level of intraoperative blood loss in patients with «large» aneurysms is significantly higher than in patients with «small» and «average» aneurysms.