Peripheral artery disease
Lesion of the arteries of the lower extremities by atherosclerosis. Manifested by pain in the calf muscles when walking. Critical leg ischemia with gangrene may develop in 2% of patients.
Multifocal atherosclerosis – a clinically significant atherosclerotic arteries in multiple vascular beds (coronary arteries, the carotid arteries, the arteries of the lower extremities). With this type of disease, the doctor is faced with the question – what to treat first? If all lesions are operated on at once, then the patient can receive significant surgical trauma and exponentially increase the number of risks.
Coronary artery bypass grafting (CABG)
Minimally invasive direct coronary artery bypass grafting (MIDCABG)
Minimally invasive technique: during the procedure surgeon doesn’t cut the sternum. This helps patients recover faster, allows to shorten postoperative period and has a cosmetic effect. Surgeon utilizes internal thoracic artery for the grafting, accessing it through a small 6-8 cm incision on the left side of the chest.
This type of a surgery is considered a benchmark for the CABG operations. Advantages of the procedure are the minimal risk of inflammation and vascular blockage. This is due to the fact that cellular elements are being damaged less without the use of a heart-lung machine. Such an operation can be performed even on patients with lung or kidney dysfunctions, ischaemic heart disease, or recent myocardial infarction.
No-touch aorta technique
During this type of surgical intervention cardiac surgeon doesn’t touch the main artery of the heart (the aorta), but uses other arteries instead. It’s advantageous because of the minimal chance of complications associated with damage to the aorta, as well as reducing the risk of developing embolic strokes from atherosclerotic plaques destroyed when working with the porcelain aorta.
Total arterial myocardial revascularization
It’s based on utilization of arterial grafts. Arteries walls are thicker than those of veins, therefore arteries do better adapt to the pressure and strength of the blood flow, and also remain patent for longer. Usually, cardiac surgeon uses both thoracic arteries or the radial artery of the forearm on the passive side.
Aortic valve repair surgery: the Ozaki procedure
With the Ozaki approach, the diseased aortic valve leaflets are removed, and a new aortic valve is recreated by sewing the leaflets into the native aortic valve annulus and aortic root, providing a new functioning valve.
DeBakey type I aortic dissection, Stanford type A
Type I aortic dissection is a pathology requiring surgical correction. Cardiac tamponade, stroke, bleeding into the pleural cavity, acute aortic valve insufficiency with left ventricular failure, organ malperfusion, especially kidney malperfusion – this is the main list of threats to the patient that must be prevented or corrected surgically.
Abdominal aortic rupture
A ruptured aneurysm can cause massive internal bleeding, which is usually fatal. Around 8 out of 10 people with a rupture either die before they reach hospital or don’t survive surgery. The most common symptom of a ruptured aortic aneurysm is sudden and severe pain in the abdomen.
Aortic arch reconstruction without circulatory arrest
Hybrid aortic arch surgery allows the use of open surgery to “move” the brachiocephalic arteries supplying the brain to a safe area and then implant an endoprosthesis, isolating the aortic aneurysm. This reduces the operation time, surgical trauma, avoids the use of artificial circulation with cardiac arrest and cooling of the patient’s body.
Hybrid coronary revascularization
Such surgical interventions are performed in cases when coronary angiography (examination of the heart vessels) reveals multiple lesions of the heart arteries and it’s necessary to combine the advantages of two treatment methods: minimally invasive open surgery and stenting. Cardiac surgeon performs minimally invasive bypass grafting of the coronary artery that’s most important for life, and then performs stenting of the damaged areas in other zones. Thus, the patient receives a life-prolonging bypass grafting from a mini-access, and stents that improve the blood supply of the heart muscles.
Oncology and cardiovascular surgery
Oncology and cardiovascular surgery. Possibilities for achieving radicalism
How to achieve radicalism in oncosurgery? Only removal of the “tumor in one block” without touching the tumor tissue! Resection and restoration of blood vessels involved in the tumor process is the key moment of radicality, and therefore obtaining good long-term results.
Relocation of the splenic artery to the hepatic artery in invasive pancreatic head cancer: how to “rescue” the right lobe of the liver
Lung cancer with invasion of the aortic wall: pulmonectomy with resection of the thoracic aorta and its replacement with xenograft
“Stucked” catheter for dialysis
If the dialysis catheter has completely grown into the tissues of the body over the years of use, then it can be removed using endovascular, or rather “endo catheter” methods.
Formation of an artificial fistula using a polytetrafluoroethylene vascular prosthesis
If the patient has exhausted the resource of his own tissues, for the formation of a dialysis fistula and he has problems with his permanent dialysis catheter – the way out of the situation is the formation of an A-V fistula on the forearm with the help of a vascular prosthesis.
Osteomyelitis of sternum
VAC therapy in osteomyelitis of sternum
The VAC device is useful in the treatment of sternal osteomyelitis in three contexts: (1) as a temporary wound care technique preoperatively that minimizes dressing changes and prevents shear stresses of an open sternum, (2) as the sole method of wound closure in specific cases, and (3) as a technique to facilitate healing in postoperative flap reconstruction cases complicated by reinfection.
Why is it my method of choice?
A. It’s safer and better than other methods:
- The vein as a substrate is being removed completely, in contrast to damaging its walls chemically (sclerotherapy, cyanoacrylate adhesives) or thermally (laser, radiofrequency ablation (RFA)).
- There is no need for resorption of the tissue of the dead vein along with coagulated blood in its lumen.
- There’s no likelihood of relapse (happening especially often with chemical methods of destruction) of varicose great saphenous vein (GSV) due to recanalization of its lumen.
- There is no need for prevention of deep vein thrombosis with anticoagulants during postoperative period (“abdominal” injections of the low molecular weight heparins for three days).
- There’s no need to purchase an optical fiber (laser) and a generator.
- There isn’t a potential threat (temptation) of using re-sterilized equipment (that is manufactured and sold as disposable) in order to save money.
- Risk of relapse of the varicose veins is minimized, since the sapheno-femoral anastomosis is being “worked out” surgically with a crossectomy and ligation of all tributaries.
- Patient doesn’t need to walk for a certain amount of time during postoperative period to prevent venous thrombosis as with other modern methods of destruction.
B. Invagination stripping is just as painless or minimally invasive as laser ablation or RFA:
- The same tumescent anesthesia as in techniques mentioned above.
- Ultrasound-guided vein cannulation.
- There is impact on that part of the vein only, which is altered pathologically (healthy veins aren’t removed).
- Patient isn’t in need of any other kind of anesthesia except tumescent one. Comes along and goes away off the operating table himself.