Endarterectomy and saphenous vein ‘Y’ patchplasty technique for severe carotid artery bifurcation lesion

Arteriosclerosis, is mostly affect coronary and carotid arteriesespecially the ostium and bifurcation due to the natureof the flow. Arterial bifurcation lesions cause dilemmafor the treating physician during both surgical and invasiveprocedures because they require a higher clinical experienceand longer processing time. In carotid artery surgery,it is accepted that patchplasty prevents perioperativeand postoperative restenosis, and as a result of this, itreduces the incidence of ipsilateral stroke. In the presenttime synthetic patch materials (PTFE, Dacron) and autologouspatch materials (saphenous and jugular veins) areused. We report a case of carotid endarterectomy and ‘Y’shaped saphenous patchplasty to the carotid bifurcation.According to our research in the literature, we didn’t findany case with ‘Y’ shaped saphenous vein patch. Therewas only one Y shaped carotid patchplasty case by usingPTFE material. Our original technic is advantageous interms of easy preparation and application as well as itssuccessful outcome.Key words: Carotid artery diseases, saphenous vein,patchplast

THE RATE OF MYOCARDIAL INFARCTION WITH NON-OBSTRUCTIVE CORONARY ARTERIES

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica MoldovaIntroducere. Infarctul miocardic acut cu artere coronarine non-obstructive (MINOCA) este tot mai frecvent discutat în practica medicală, fiind utilizat ca diagnostic prezumtiv ce impune evaluări suplimentare pentru depistarea cauzei directe de injurie miocardică și implementarea terapiei specifice. Scopul lucrării. A evalua frecvența apariției infarctului miocardic fără afectare obstructivă ale arterelor coronariene studiind o cohorta de pacienți cu infarct miocardic acut. Materiale și metode. Au fost analizate datele a două clinici implicate în Programul Național pentru Infarct Miocardic Acut ce prestează servicii de coronaroangiografie, fiind selectați din totalul pacienților spitalizați cu infarct miocardic acut cei care au prezentat stenoze coronariene < 50%. Ulterior s-a analizat structura lotului și a cohortei generale utilizând metode statistice standard. Rezultate. Dintr-o cohorta de 2756 pacienți spitalizați cu infarct miocardic acut în perioada 2018-2021 au fost selectați consecutiv în lotul de studiu 91 de pacienții cu infarct miocardic la care nu au fost depistate stenoze coronariene semnificative (<50% din lumenul vasului). Dintre aceștia 40 sunt bărbați si 51 sunt femei, cu vârsta medie (ani) de 63 ± 12,08. Vârsta medie a cohortei generale a fost 67 ± 9,9 ani. Durata medie de spitalizare a pacienților din lotul de studiu a constituit 5,1 zile. Astfel, studiind cohorta generală s-a calculat că rata infarctului miocardic fără leziuni obstructive coronariene este de 3,3%. Concluzie. Infarctul miocardic cu artere coronariene non-obstructive are o rată de 3,3% din totalul pacienților cu infarct miocardic acut, fiind mai frecvent întâlnit la genul feminin, fără o diferență semnificativă asupra vârstei medii.Introduction. Myocardial infarction with non-obstructive coronary arteries (MINOCA) became more frequently discussed in contemporary practice. It is considered as a working diagnosis in order to determine physicians find the specific causes of its appearance and involve its specific treatments. Aim of study. Evaluate the frequency of appearance of MINOCA in a cohort of patients with acute myocardial infarction. Methods and materials. The data of two hospitals involved in the National Program of Acute Myocardial Infarction that can provide coronary angiography services, have been analyzed. There were selected patients with acute myocardial infarction with coronary obstruction below 50%. Further, the group’s and cohort’s structure were analyzed using the standard statistic methods. Results. Out of a cohort of 2756 patients with acute myocardial infarction hospitalized between 2018 and 2021, were selected consecutively in the study group 91 patients with myocardial infarction in whom no significant coronary stenosis was detected (<50% of the vessel lumen). Men presenting with MINOCA were 40 of them and 51 were women, with an average age (years) of 63 ± 12.08. The mean age of the general cohort was 67 ± 9.9 years. The mean duration of hospitalization of the patients in the study group was 5.1 days. Thus, after studying the general cohort, the rate of myocardial infarction without coronary obstructive lesions is 3.3%. Conclusions. Myocardial infarction with non-obstructive coronary arteries has a rate of 3.3% of 2756 patients with acute myocardial infarction, being more common in females, without a significant difference in average age

Rata infarctului miocardic acut cu artere coronariene non-obstructive

Introduction. Myocardial infarction with non-obstructive coronary arteries (MINOCA) became more frequently discussed in contemporary practice. It is considered as a working diagnosis in order to determine physicians find the specific causes of its appearance and involve its specific treatments. Aim of study. Evaluate the frequency of appearance of MINOCA in a cohort of patients with acute myocardial infarction. Methods and materials. The data of two hospitals involved in the National Program of Acute Myocardial Infarction that can provide coronary angiography services, have been analyzed. There were selected patients with acute myocardial infarction with coronary obstruction below 50%. Further, the group’s and cohort’s structure were analyzed using the standard statistic methods. Results. Out of a cohort of 2756 patients with acute myocardial infarction hospitalized between 2018 and 2021, were selected consecutively in the study group 91 patients with myocardial infarction in whom no significant coronary stenosis was detected (<50% of the vessel lumen). Men presenting with MINOCA were 40 of them and 51 were women, with an average age (years) of 63 ± 12.08. The mean age of the general cohort was 67 ± 9.9 years. The mean duration of hospitalization of the patients in the study group was 5.1 days. Thus, after studying the general cohort, the rate of myocardial infarction without coronary obstructive lesions is 3.3%. Conclusions. Myocardial infarction with non-obstructive coronary arteries has a rate of 3.3% of 2756 patients with acute myocardial infarction, being more common in females, without a significant difference in average age.Introducere. Infarctul miocardic acut cu artere coronarine non-obstructive (MINOCA) este tot mai frecvent discutat în practica medicală, fiind utilizat ca diagnostic prezumtiv ce impune evaluări suplimentare pentru depistarea cauzei directe de injurie miocardică și implementarea terapiei specifice. Scopul lucrării. A evalua frecvența apariției infarctului miocardic fără afectare obstructivă ale arterelor coronariene studiind o cohorta de pacienți cu infarct miocardic acut. Materiale și metode. Au fost analizate datele a două clinici implicate în Programul Național pentru Infarct Miocardic Acut ce prestează servicii de coronaroangiografie, fiind selectați din totalul pacienților spitalizați cu infarct miocardic acut cei care au prezentat stenoze coronariene < 50%. Ulterior s-a analizat structura lotului și a cohortei generale utilizând metode statistice standard. Rezultate. Dintr-o cohorta de 2756 pacienți spitalizați cu infarct miocardic acut în perioada 2018-2021 au fost selectați consecutiv în lotul de studiu 91 de pacienții cu infarct miocardic la care nu au fost depistate stenoze coronariene semnificative (<50% din lumenul vasului). Dintre aceștia 40 sunt bărbați si 51 sunt femei, cu vârsta medie (ani) de 63 ± 12,08. Vârsta medie a cohortei generale a fost 67 ± 9,9 ani. Durata medie de spitalizare a pacienților din lotul de studiu a constituit 5,1 zile. Astfel, studiind cohorta generală s-a calculat că rata infarctului miocardic fără leziuni obstructive coronariene este de 3,3%. Concluzie. Infarctul miocardic cu artere coronariene non-obstructive are o rată de 3,3% din totalul pacienților cu infarct miocardic acut, fiind mai frecvent întâlnit la genul feminin, fără o diferență semnificativă asupra vârstei medii

Hemodinamica intrarenală în hipertensiunea arterială și disglicemie - veriga de conexiune între afectarea microvasculară și macrovasculară

Summary of Ph.D. Thesis in Medical Sciences 321.03 – Cardiology[...] CONCEPTUAL RESEARCH BENCHMARKS The research actuality. Today, we witness a steady increase in obesity prevalence, as well as in different types of dysglycemia and cardiovascular diseases(CVD). The overall incidence of arterial hypertension (HTN) accounted for 1.13 billion in 2015, being over 150 million across Eastern Europe. The overall incidence of HTN in adult population is about 30-45%, with an ageadjusted prevalence of 20% and 24% for men and women, respectively. The high rate of HTN is consistent across the globe, regardless of the income level [1]. Hypertension gets more common with aging, being > 60% in the population over 60 years. [2]. It is estimated that the number of hypertensive individuals will have increased by 15-20% before 2025, reaching to almost 1.5 billion of the global population [3]. According to statistical data provided by the World Health Organization (STEPS study), about 40,4% of the population from the Republic of Moldova are hypertensive. [...][...] REPERELE CONCEPTUALE ALE CERCETĂRII Actualitatea temei. Prevalența globală a hipertensiunii arteriale (HTA) a fost estimată la 1,13 miliarde în anul 2015, aceste valori depășind cifra de 150 de milioane în Europa de est. Prevalența generală a HTA în populația adultă este în jur de 30-45%, cu o prevalență ajustată la vârstă de 20% și respectiv de 24% pentru bărbați și femei. Rata înaltă a HTA este consecventă pe tot globul pământesc, independent de nivelul de venit [1]. Hipertensiunea devine tot mai frecventă o dată cu înaintarea în vârstă, cu o rată >60% în populația de peste 60 de ani [2]. Se estimează faptul că numărul populației hipertensive va crește cu 15-20% până în anul 2025, atingând aproape de 1,5 miliarde din cuantumul populațional global [3]. Conform datelor statistice furnizate de Organizația Mondială a Sănătății (studiul STEPS), circa 40.4% din populația Republicii Moldova suferă de HTA. [...

Minimally invasive double lung transplantation technique (Anteroaxillary approach)

Lung transplantation has been performed through several approaches in the past. Sternothoracotomy is the most widely used approach for double lung transplantation. Although bilateral anterolateral thoracotomy for double lung transplantation has been described in the past, this approach has not widely adopted worldwide. The 'anteroaxillary approach' utilizes a limited incision compared to others, preserves sternal anatomy as well as thoracic arteries, and provides an excellent exposure to hilum. We would like to present our standard approach at University of Pittsburgh through anteroaxillary incision

Karotis arter stenozunda stent uygulaması regionel anestezi ile selektif şant kullanılarak yapılan karotis endarterektomiye alternatifmidir?

Serobrovasküler hastalıklar; risk faktörlerinin azaltılma çalışmaları ile özellikle gelişmiş ülkelerde sıklığında düşme izlensede hala erişkinlerde koroner arter hastalığı ve kanserden sonra önemli bir morbidite ve mortalite sebebidir.Toplum sağlığını ilgilendiren önemli bir sorun olarak güncelliğini korumaktadır. Buna mütakip yapılan çalışmalarda elde edilen sonuçlar ile yeni tedavi stratejileri geliştirme ve uygulama imkanı olmaktadır. Tüm inmelerin en önemli sebebini, karotis arterlerin aterosklerotik hastalığı oluşturmaktadır. İnternal karotis arter (İKA) darlıkları iskemik inmenin önemli nedenlerinden biridir. İnternal karotis arter darlığı sıklığı 6. dekatta %0.5 iken, 80 yaşın üzerinde %10 ulaşmaktadır.North America Symptomatic Carotid Endarterectomy Trial (NASCET) ve European Carotid Surgery Trial (ECST) çalışmalarında: %70 üzerindeki semptomatik İKA darlıklarında iskemik beyin felcinin önlenmesi açısından endarterektominin medikal tedaviye üstün olduğu gösterilmiştir.Teknolojik gelişmelere paralel olarak, balon anjiyoplasti ve stent kullanımı karotis endarterektomiye alternatif olarak ortaya çıkmıştır. Son yıllarda yapılan çalışmalarda endovasküler tedavinin karotis endarterektomiye eşdeğer, hatta ondan daha üstün olduğu bildirilmektedir. Karotid endarterektomi günümüzde extrakranial karotis hastalıklarının tedavisinde standart yöntem olarak kabul edilmektedir. Son 20 yılda anjioplasti ile başlayıp stent uygulamaların da eklenmesiyle giderek artış gösteren minimal invaziv endovasküler teknikler giderek daha sık kullanılmaya başlanmıştır.Yaptığımız çalışmada regionel anestezi altında selektif şant kullanılarak karotis endarterektomi yapılmış 82 hastanın sonuçları ile karotis artere stent uygulanan 39 hastanın sonuçları karşılaştırıldı. Her iki grub da demografik olarak belirgin farklılık yoktu, hastalar işlem sonrası komlikasyonlar majör SVO minör SVO yoğun bakım kalış süreleri antikoagulasyon tedavi farklılıkları mortalite tedavi maliyeti yönünden irdelendi. Minör SVO’ nun stent grubunda anlamlı yüksek olduğu mortalitenin anlamlı yüksek olduğu tedavi maliyetlerinin anlamlı yüksek olduğu tesbit edildi.Günümüzde endovasküler tedavi endüstriyel gelişmeye parelel olarak yeni stent ve filtre tipleri ile özellikle reküren İKA stenozu ve boyuna radyasyon tedavisi almış hastalarda tercih sebebi olabilecekken regionel anestezi altında ve şant kullanılmadan yapılan karotis endarterektomi stent tedavisi ile kıyaslandığında hala çok daha güvenli çok daha ucuz mortalitesi ve morbiditesi çok daha düşük seçkin bir tedavidir. Semptomatik ve asemptomatik İKA stenozunun modern ve kompetan tedavisi söz konusu olduğunda karotis endarterektomi; güvenirlik, etkinlik, hız maliyet hesabı yapıldığında talepleri karşılamaktadır. Cerebrovascular disease; despite its reduced incidence due to the works to reduce the risk factors especially in industialised countries; is still the most important reason of mortality and morbidity in the adult population following coronary artery disease and malignancy. It is an important threat to the public health and is subject for many studies. The results of these studies lead to the develoment and application of new management strategies. The most common etiology for all the cases with stroke is the atherosclerotic disease of the carotid arteries. Internal carotid artery stenosis is an important etiology for ischemic stroke. The insidence of internal carotid artery stenosis is 0,5% in the sixth decade and it rises up to 10% over the age of 80.In the two major studies related with the subject; North America Symptomatic Carotid Endarterectomy Trial (NASCET) and European Carotid Surgery Trial (ECST); it has been shown that endarterectomy is superior to medical treatment in the prevention of ischemic cerebral paralysis in symptomatic carotid artery stenosis over 70%.With the advanced technology, baloon angioplasty and stent techniques have been developed as an alternative for carotid endarterectomy. In the recent studies, the endovascular treatment is reported to be equivalent with and even superior to carotid artery endarterectomy. Carotid artery endarterectomy is already accepted to be the standart method for management of extracranial carotid artery stenosis. In the last 2 decades, minimally invasive endovascular techniques started with angioplasty and increased with the development of stent applications and they are becoming more and more popular. In this study 82 patients who underwent carotid endarterectomy under regional anesthesia using carotid artery shunts selectively were compared to 39 patients who underwent carotid artery stenting. The demographic data of the two groups were similar. Postoperative complications, major cerebrovascular occlusion rates, minor cerebrovascular occlusion rates, lenghts of intensive care unit stay, anticoagulation management strategies and costs were compared. Minor cerebrovascular occlusion rate and treatment cost was significantly higher in the stent group. Lately with the industrial development new stent and filter types can be prefered especially in patients with recurrent internal carotid artery stenosis and those who received radiotherapy on the neck. However, when carotid endarterectomy without using a shunt under regional anesthesia is compared to stenting, it is still much more safe, cheap and has much lower mortality and morbidity. As a result; when modern and competent managent of symptomatic and asymptomatic internal carotid artery stenosis is the subject of interest, carotid endarterectomy fulfills the demand considering safety, efficacy, speed and cos

Splenic artery variations in panaortographic investigations

Catedra de anatomie a omului, Universitatea de Stat de Medicină și Farmacie ”Nicolae Testemiţanu”, Chișinău, Republica MoldovaRezumat. Introducere. Nivelul înalt de dezvoltare al chirurgiei abdominale, de creştere al numărului intervenţiilor operatorii, inclusiv pe splină, necesită informaţie amplă privind morfologia vaselor lienale în contextul variabilităţii individuale. Din aceste considerente, a fost realizat un studiu de identificare a variantelor structurale și topografice individuale. Material și metode. Variantele traiectului arterei lienale, a valorilor unghiurilor de ramificare în relaţie cu vârsta și sexul, au fost studiate pe 95 de panaortograme. Rezultate. Artera lienală, în majoritatea cazurilor, are traiect ușor curbat sau sinuos accentuat. Bifurcaţia arterei lienale a fost înregistrată la 82 de pacienţi, trifurcaţia – la 10 pacienţi. În trei cazuri, artera lienală era ramificată în patru vase primare. Concluzii. Panaortografia, la fel ca și metodele macromezoscopice de confecţionare a pieselor, pune în evidenţă variabilitatea individuală a traiectului și ramificării arterei lienale la om.Abstract. Introduction. The advances in abdominal surgery increase in the number of surgical procedures, including on the spleen made it necessary to have more profound information about the morphology of splenic arteries in the context of their individual variability. Taking all this in consideration we performed a study to identify individual structural and topographical variants. Material and methods. We studied the variation in the trajectory of splenic artery, their angle of ramification depending on the age and sex in 95 panaortograms. Results. In the majority of cases the splenic artery slightly bent or accentuated sinous. The bifurcation of splenic artery was seen in 82 patients, trifurcation – in 10 patients. In three cases the splenic artery divided in four primary vessels. Conclusions. Panaortographic method, as well as macromezoscopic methods of splenic vessels cast preparation highlights individual variability of splenic artery branching pattern in humans

Variabilityof lenticulostriate arteries and their clinical importance

(Conducători ştiinţifici : Ilia Cateriniuc, dr. hab., prof. univ.; Zinaida Zorina, asist. univ.) Catedra Anatomia OmuluiTopographic variations have been investigated and numerical lenticulostriate arteries and their clinical importance highlighted. The results displayed have been confronted with those obtained in similar studies and conclusions that have made their growth targets. According to the study, the distribution of lenticulustriate arteries in at least two distribution groups remains evident, which provides a safety margin that elevated subcortical structures of irrigation. Au fost investigate variantele topografice şi numerice ale arterelor lenticulostriate şi evidenţiată importanţa lor clinică. Rezultatele etalate au fost confruntate cu cele obţinute în studii similare şi, respectiv, s-au formulat concluzii obiective privind dinamica acestora. Conform studiului efectuat, compartimentizarea arterelor lenticulustriate în cel puţin două grupuri de distribuţie rămîne evidentă, fapt ce asigură o marjă de siguranţă elevată a irigării structurilor subcorticale respective

The splenic artery in lienal hilum region

Department of Anatomy, Nicolae Testemitsanu State University of Medicine and Pharmacy, Chisinau, the Republic of MoldovaBackground: To know the structural and topographic aspects of the blood vessels of the spleen is an interest, particularly at present stage when surgical interventions are practiced more and more preserving mostly the injured organs because of the abdomen’s traumatisms. Splenography is often considered to be dangerous because of the risk of hemorrhage from the tissues of the sutured spleen. This danger can be reduced by improvement of surgical technique and by cognition of collateral ways of the blood circulation. Material and methods: The types of ramification of the splenic artery at the level of lienal hilum were determined on complex of organs by tiny macroscopic dissection and corrosion. The results have been analyzed statistically depending on the age and the sex of the patients. Results: In men, the ramification of the lienal artery in the hilum with a sharp angle (22.5 ± 3.96%) as well as with an obtuse angle (12.6 ± 3.15%), came about more often in age group VIII1 . In women the greatest frequency of the lienal artery ramification was found under an obtuse angle in the IX age group (20.0 ± 4.47%), but with a sharp angle the X age group (17.5 ± 4.25%). The results achieved in men and women of different age group were of a significant difference: p < 0.01 (for the ramification of the vessel under an obtuse angle) and p < 0.05 (for the ramification of the vessel under a sharp angle). Conclusions: Both structurally and topographically, the lienal artery is highlighted by a large range of variations in the region of the hilum