Backgound. The number of patients with Leriche’s syndrome has increased dramatically. Despite the compensatory development of collaterals, this condition most often leads to symptoms of intermittent claudication and can result in critical ischemia and amputations. TASC II guidelines recommend reconstructive surgery, but this approach is associated with high perioperative mortality. So far, only few studies reported the results of endovascular correction of the atherogenic process in the infrarenal aorta.

Objective. To present a clinical case of hybrid revascularization of the aortofemoral segment in a patient with ischemic heart disease.

Design and methods. A 68-year-old patient with Leriche’s syndrome underwent ultrasound of the brachiocephalic arteries, coronary angiography, and multispiral computed tomography with angiography. Subsequently, hybrid surgery was performed.

Results. Given the critical ischemia of the lower extremities and comorbidities, a hybrid surgical intervention was performed: endarterectomy from the femoral arteries and endovascular recanalization of the occlusion of the aortoiliac segment using the “kissing stents” technique.

Conclusions. The requirements for equipment and experience of the surgical team limit the widespread use of hybrid correction of an occlusive lesion of the infrarenal aorta. The lack of randomized trials creates uncertainty in the choice of revascularization tactics. In the framework of this clinical case, the effectiveness of hybrid surgery in the treatment of a patient with multifocal atherosclerosis has been proven.

Background. Development of personalized medicine and study of the genetic basis of cardiovascular diseases are promising areas in modern cardiology.

Objective. To evaluate effect of NOS3 gene polymorphism on the prognosis in patients undergoing coronary artery bypass grafting (CABG).

Design and methods. The study included 60 patients with stable coronary heart disease (CAD) and multivessel coronary disease according to the SYNTAX I score > 23. The first group included 39 patients — carriers of the 786CC and 786TC genotypes, the second — 21 patients with the 786TT genotype of the NOS3 gene. We accessed the severity of the systemic inflammatory response (SIR) in the postoperative period, the dynamics of changes in the ejection fraction (EF) of the left ventricle, as well as clinical data during 12 months after CABG.

Results. The presence of heterozygous and homozygous variants (TC/CC) of the NOS3 gene is associated with a more pronounced and prolonged SIR in the postoperative period. The chances of developing symptoms of acute decompensation of chronic heart failure (CHF) within 12 months after CABG were significantly 4 higher in the group of carriers of TC/CC genotypes.

Conclusions. In patients with CAD and carriage of the 786TC/786CC genotypes of the NOS3 gene undergoing CABG, there is a more pronounced and prolonged SIR in the postoperative period, as well as an increased risk of acute decompensation of CHF within 12 months after CABG.

Background. Arteriovenous malformations of the brain are a rare vascular pathology. Many studies focus on the features of venous drainage of arteriovenous malformations. The angioarchitectural and hemodynamic features of the venous component of arteriovenous malformations can influence on the patient management.

Objective. To evaluate the relationship between the features of venous drainage of arteriovenous malformations of the brain and the types of clinical course. Design and methods. Survey included 61 adult patients of the neurosurgical department № 3 of the Polenov RNSI with arteriovenous malformations of the brain of supratentorial localization. Demographic and morphometric characteristics, as well as features of venous drainage of arteriovenous malformations, were assessed. Groups of patients were distinguished according to the type of the course of the disease.

Results. The dependence of the hemorrhagic type of course on such factors as drainage exclusively into the deep vein system, as well as the presence of a combination of macrofistula with venous lacunae. The epileptic type was more typical for patients with superficial localization of the arteriovenous malformation. The torpid type of course had no distinctive features.

Conclusion. Drainage exclusively into the deep vein system and the presence of a combination of macrofistula and venous lacunae is characteristic of the hemorrhagic type of course. The epileptic type of course was characterized by superficial localization of the malformation.

Assessing the sympathetic-vagal balance is an important task for predicting shifts in the functioning of the body when adapting to changing external conditions, as well as aging, various pathological processes and therapy. Today, the method of analyzing the spectrum of heart rate variability (HRV) for determining the sympathetic-vagal balance due to its simplicity and non-invasiveness has become widespread both in clinical practice and in experimental studies. The article analyzes the results of our own and literary studies of influence of various effects on hemodynamic parameters, the level of circulating catecholamines, sympathetic nervous activity, the baroreceptor reflex, and also on the components of the HRV spectrum (LF (low frequency), HF (high frequency) and LF/HF). Often different authors under the same impact register different changes. Reasons for this include different doses of drugs, nature/strength of exposure (for stress and exercise), time between drug administration and registration. In addition, the effect of some drugs can be enhanced in the case of pathology, such as hypertension. Based on the comparison of the vectors of changes in the studied parameters, we concluded that, using the frequency analysis of HRV, it is necessary to draw a conclusion about the sympatho-vagal balance with great care due to the ambiguous nature of LF component, but HF component gives information of the tone of the vagus with sufficient accuracy.

Background. Chronic thromboembolic pulmonary hypertension (CTEPH) and chronic thromboembolic disease (CTEP) are manifestations of post-thromboembolic syndrome in patients with pulmonary embolism. Extracellular vesicles (EVs) are involved in the pathogenesis of these diseases due to the activation of the hemostasis system.

Objective. Evaluation of the relative amount of EVs and their coagulation activity using the thrombin generation test in CTEP and CTEPH patients. Design and methods. The study included 21 patients: the CTEP group (n = 7) and the CTEPH group (n = 14); and 11 healthy donors. EVs were isolated with the Exo-FACS kit and analyzed by flow cytometry using fluorescently labeled antibodies. The activity of the microparticles was assessed in a thrombin generation test using a trigger reagent without the addition of TF using a plate fluorimeter.

Results. The relative content of EVs of platelet and endothelial origin was increased in CTEPH and CTEP groups. The level of platelet EVs correlates with the levels of CRP and D-dimer. LT and ttPeak were significantly increased in patients with CTEPH.

Conclusion. An increase in the level of platelet and endothelial EVs in patients with CTEPH and CTEP indicates the contribution of microvesiculation to the formation of post-thromboembolic syndrome. The activity of thrombin generation decrease under the action of TF-EVs could be a result of TF consumption in endothelial dysfunction, or prolonged activation of procoagulant pathways.

Background. Acute mesenteric thrombosis (AMT) is a condition that develops with thrombosis in the vessels of the mesenteric pool, which causes hypoperfusion of the intestinal wall and leads to secondary inflammatory changes. Mortality in OMT is 80–85 %. Early diagnosis of OMT is difficult due to the lack of specific clinical signs and laboratory markers.

Objective. To identify preoperative risk factors for adverse clinical outcomes in OMT.

Design and Methods. A single-center retrospective observational cohort study included 47 patients diagnosed with OMT. The following patient data were analyzed: age, gender, body mass index (BMI), assessment of the patients’ condition according to the SOFA, APACHE II, EuroSCORE scales. Various laboratory parameters in the preoperative and postoperative periods were analyzed.

Results. The incidence of oncological diseases and history of acute cerebrovascular accident (ACV) were significantly higher in the group of lethal outcomes of OMT than in the group of surviving patients. The correlation of higher serum levels of lactate, D-dimer, creatinine, leukocytosis and procalcitonin in the preoperative period with the development of an unfavorable clinical outcome was revealed.

Conclusion. The main risk factors for the development of an unfavorable clinical outcome of mesenteric thrombosis in patients are the presence of malignant neoplasms, a history of stroke, a high level of mixed venous blood lactate, creatinine, D-dimers, procalcitonin, leukocytosis in the preoperative period.

Background. Diagnosis, treatment, prevention of echinococcosis remain relevant tasks for most Russian regions. One of the key problems is the diagnosis of this disease in non-endemic regions.

Objective. To describe a clinical case of cystic echinococcosis of the lungs.

Materials and methods. A multislice computed tomography of the chest with contrast enhancement, serological diagnosis and histological examination and subsequent surgical treatment of a 6-year-old patient were performed.

Results. A case of cystic echinococcosis of the lungs in a 6-year-old boy is presented. Echinococcosis was diagnosed at the stage of a large diameter cyst during chest X-ray to exclude pneumonia. Surgical treatment was performed. The decrease in titers of antiparasitic antibodies in dynamics after the operation allowed to conclude that the patient had recovered. The presented clinical case demonstrates a typical error in the diagnosis of pulmonary echinococcosis. Cystic echinococcosis is a rare pathology in the Arkhangelsk region (up to 4 per year). This situation leads to late diagnosis of this helminthiasis. The main mistake in the diagnosis was the lack of alertness in relation to echinococcosis and, as a result, the establishment of an incorrect diagnosis — pneumonia.

Conclusions. The use of multislice computed tomography of the chest with contrast enhancement, serological diagnosis and histological examination in combination allows you to accurately establish the diagnosis of echinococcosis of the lungs.