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A literature review presents a data concerning the incidence and risk factors for development of venous thromboembolic complications (VTEC), as well as their diagnosis and prevention in long bones fractures of the lower extremities (LBFLE). Literature data show that, despite the widespread implementation of preventive measures in case of LBFLE, it is not always possible to completely avoid VTEC. The main risk factors for their development are the injuries’ severity, the location and nature of the extremity bone fracture, the duration of immobilization, the amount of surgery performed for bone fragments stabilization, as well as age and the presence of concomitant diseases. In the diagnosis of thrombotic process, laboratory and radiation research methods play an essential role, and according to data they has varying degrees of sensitivity and specificity. However, to date, none of them has absolute diagnostic accuracy. Complex thrombosis prophylaxis significantly reduces the risk of VTEC development, however, the choice of the type and dosage of anticoagulants, as well as the duration of their use, remain controversial, and some authors recommend different approaches in this issue. In addition, the diagnostic criteria and therapeutic tactics for embologenic floating thrombi remain open for discussion. In this regard, the conduct of large randomized scientific studies aimed at early diagnosis, prevention and treatment of VTEC using modern diagnostic tests and new generation anticoagulants is relevant and allows to minimize the risk of disability and death.

Diffuse atherosclerosis and calcification of the coronary arteries (CA) create serious difficulties for coronary artery bypass grafting (CABG). The aim of this study was to compare demographic indicators, lipids, and clinical results one year after CABG in patients with different phenotypes of coronary artery (CA) disease. In total, 390 patients hospitalized for elective CABG were included in a single-center prospective study. Demographic data, lipids (total, low-density lipoprotein and high-density lipoprotein cholesterol, and triglycerides), and lipoprotein(a) (Lp(a)) concentrations were analyzed for all patients. Major adverse cardiovascular events (MACE) included myocardial infarction, stroke, percutaneous coronary intervention, and death from cardiac causes within one year after surgery. No significant outcome differences were found between the groups with diffuse vs. segmental lesions, nor the groups with and without calcinosis for all studied parameters except for Lp(a). Median Lp(a) concentrations were higher in the group of patients with diffuse compared to segmental lesions (28 vs. 16 mg/dL, p = 0.023) and in the group with calcinosis compared to the group without it (35 vs. 19 mg/dL, p = 0.046). Lp(a) ≥ 30 mg/dL was associated with the presence of diffuse lesions (OR = 2.18 (95% CI 1.34–3.54), p = 0.002), calcinosis (2.15 (1.15–4.02), p = 0.02), and its combination (4.30 (1.81–10.19), p = 0.0009), irrespective of other risk factors. The risk of MACE within one year after CABG was higher for patients with combined diffuse and calcified lesions vs. patients with a segmental lesion without calcinosis (relative risk = 2.38 (1.13–5.01), p = 0.02). Conclusion: Diffuse atherosclerosis and coronary calcinosis are associated with elevated Lp(a) levels, independent of other risk factors. The risk of MACE in the first year after surgery is significantly higher in patients with diffuse atherosclerosis and coronary calcinosis, which should be considered when prescribing postoperative treatment for such patients.

Aim. To analyze the factors associated with a poor outcome of pulmonary thromboendarterectomy (PTE) and complications of the hospital postoperative period; on the basis of this analysis to optimize preoperative preparation and therapeutic support of the operation. Materials and methods. The study included 47 patients with operable CTEPH, who underwent PTE in the Department of cardiovascular surgery of the national medical research center of cardiology from 2010 to 2018. Patients were observed during the intrahospital period, all were evaluated for clinical, instrumental, hemodynamic, and laboratory parameters. Diagnosis and treatment of complications, assessment of the relationship of factors associated with the development of these pathological conditions were carried out. Results. A comprehensive assessment of the parameters revealed that age over 50 years, the presence of proven antiphospholipid syndrome (AFS) were independently associated with a higher frequency of adverse surgical outcomes and in-hospital complications. Older age and a history of smoking were independently associated with a greater likelihood of developing reperfusion pulmonary edema. The probability of developing transient neurological complications is independently associated with a long duration of deep hypothermic circulatory arrest (DHCA), an increased level of D-dimer. A greater age and longer duration of ventilation are independently associated with the likelihood of developing acute kidney injury (AKI). A higher level of antithrombin III and the presence of AFS were independently associated with the likelihood of developing prolonged ventilation. Conclusion. When selecting candidates for surgery, in addition to the generally accepted clinical and instrumental parameters, it is necessary to take into account a history of Smoking, an increase in d-dimer, and the presence of AFS. Patients with this pathology need a more thorough risk assessment, correction of target levels of activated partial thromboplastin time (aPTT), activated clotting time (ACT) due to their falsely inflated indicators, and further development of standards for perioperative support. The main principle of cardiological support of the operation is the earliest possible diagnosis of all known perioperative complications and the rapid start of their treatment, which ensures the stabilization of the patient’s condition in 85% of cases in the hospital period. In the postoperative period, an early transition from ventilator to independent breathing is indicated for the prevention of associated complications, including AKI.