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Risk assessment of the development of the endoleak after evar. State-owned enterprise "National Institute of Surgery and Transplantology named after O. Shalimov" of NAMS of Ukraine, Kyiv ABSTRACT. Background. Treatment of aortic aneurysms is one of the most difficult problems in angiology. The ending of the development of the disease is the rupture of the aneurysm with high mortality. EVAR is a minimally invasive method of treating aneurysms. However, even today its high immediate effectiveness is leveled by an increased need for repeated interventions in the long-term period. The main cause of repeated interventions is endoleaks of blood in the aneurysmal sac (AS), which causes its increase and the risk of rupture. Objective. Develop methods for predicting the risk of EF after endoprosthetics of the infrarenal aorta by analyzing the results of the study of the morphology of the anterior wall of the common femoral artery (CFA). In the course of the study, an original method for the in vivo diagnosis and prognosis of the pathological process in the aortic wall with its aneurysmal lesion was developed and used, including the taking of material during endoprosthesis. The method differs in that in order to determine pathomorphology, in order to establish the etiology of the development of an aortic aneurysm, a histological study is carried out not directly on the aortic wall, but on the CFA wall, as a large elastic artery. Morphological investigations of CFA were performed in 38 patients. The average age of patients was 66.1 ± 2.1, among them 2 women and 36 men. Results. The results showed that in 22 cases (57.8%) there were direct signs of atherosclerosis, in 14 cases (36.8%)-manifestations of dystrophic changes, in 2 cases (5.26%) inflammatory reactions prevailed in the pattern of pathology. Statistical analysis showed that there is a stable and reliable relationship between the nature of the morphological changes in the wall of the CFA and the dynamics of the AS size after EVAR. Atherosclerotic changes are characterized by a decrease in AS in 77.7%, while with dystrophic changes, a decrease in AM is observed only in 28.7%, and in 64.2% there are no changes in the size of the bag, or the bag has increased. Conclusion. Morphological studies of the CFA wall in patients make it possible to judge that with the prevailing atherosclerotic changes in the vessel walls by 16.5 times-OR-16.5 (2.79-97.68) increases the probability of AS decrease after endoprosthesis replacement. In case of dystrophic changes, the prognostic assessment is unfavorable-the probability of decreasing AS decreases by 94%-OR = 0.06 (0.01-0.36).

Arterial hypertension (AH) remains one of the most pressing health problems, due to its high prevalence. With effective treatment of hypertension, the risk of cardiovascular complications and mortality are significantly reduced, that is, the main goal of the treatment of hypertension is achieved. European and Ukrainian recommendations for the diagnosis and treatment of hypertension distinguish five main classes of antihypertensive drugs: diuretics, β-blockers, calcium antagonists, angiotensin converting enzyme inhibitors and angiotensin receptor blockers. Based on the foregoing, we can conclude that the third-generation calcium antagonist lercanidipine is a highly effective, longacting antihypertensive drug for the treatment of hypertension of any stage and severity. It has organoprotective properties, is metabolically neutral, is well tolerated and can be successfully used both as monotherapy and in combination with any other (except dihydropyridine calcium antagonists) antihypertensive drugs in both men and women.

Purpose of the study. Improvement of the results of treatment of patients with arteriovenous forms (AVF) of congenital vascular malformations (CVM) of the extremities based on the development of the classification scheme of CVM and the study of proliferative activity of the pathology.Materials and methods. The clinical data of 155 patients with AVF of CVM of extremities were analyzed in terms of observation from 1 month to 10 years. Patients of sex of men there were 65 (42%), women – 90 (58%), their correlation – 1 : 1,4; the average age was about 25,1 ± 10,4, children's age group – 53 (34%). The division into clinical-anatomical forms (11 groups) was carried out on the basis of the «working» classification scheme «VASC + T». Expression proliferation markers VEGF and KI-67 woos study were performed by immunoperoxidase method with additional hematoxylin staining.Results and discussion. Pathomorphological (66; 45,8%) and immunohistochemical studies (10; 7%) revealed the presence of proliferative activity of angiomatous tissues and degenerative changes in the walls of the vessels both due to developmental defects and disorders of hemodynamics, while the source of progression of the AVF of CVM there are vessels of the microvasculature.Conclusions. The application of the CVM classification scheme and the step-by-step complex treatment approach, depending on the clinical and anatomical AVF of CVM, led to the absence of major postoperative complications. This tactic made it possible to achieve satisfactory long-term results in 136 (94,4%) cases. Keywords: congenital vascular malformation, arteriovenous forms, proliferative activity, classification, complex treatment.