[Principles of choosing the surgical approach].
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Biomedical subjects
Publications and source records attributed to G L Ratner.
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The article analyzes results of 123 primary operations for associated lesions of the aorto-iliac and femoro-popliteal segments. The authors consider that in overwhelming majority of patients the blood flow may be reestablished via the profound artery of the femur after its plasty. In patients with a wild stenosis of the femoral artery due to thickening of the intima in the zone of distal anastomosis no endarterectomy should be performed.
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Advantages of the unilateral thoracotomy were established by a comparison of the cervical, longitudinal transsternal, transbipleural accesses with a transverse dissection of the breast bone and unilateral thoracotomic access in the light of requirements to the operative access in myasthenia. This access was used in operations upon 15 patients. There were no operative complications, the operation time was shorter, the postoperative period less severe. The earlier reestablishment of the adequate ventilation was noted.
The authors consider that the surgeon's tactics in acute thrombosis of the aorta, its branches and main arteries of extremities should be differentiated.
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The article analyzes the treatment of 45 patients with a gangrene stage of obliterating endarteritis subjected to small amputations in combination with free skin autoplasty. The amputation and skin plasty were preceded by intensive therapy both before operation and in the postoperative period, HBO included. A method of HBO therapy by changing barometric pressure under conditions of hyperbaric oxygenation is described. The patients were also subjected to sympathectomy and continuous intraarterial infusions.
The article concerns different variations of associated lesions of visceral arteries, aorta or its other branches in 125 patients. The variations of such combinations are classified into 5 groups, for each of them different operation accesses and means of reestablishing the blood flow being used.
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This is a collected report on 95 patients with chronic lesions of one or several visceral branches of the abdominal aorta. Restorative operations were performed on 92 patients. Necessity of examining patients with suspicion of the syndrome of chronic abdominal ischaemia in a special vascular surgery department is mandatory. For final diagnosis and choice of surgical tactics aortography in two projections is necessary. The progressive character of the disease is underlined. Restorative operations on the visceral branches of the abdominal aorta are preferred.
The experience with the treatment of 77 patients with 86 traumatic aneurysms and arterial-venous fistulas of the aorta branches and peripheral vessels is analyzed. Three stages of such aneurysms are distinguished by the authors: pulsative hematoma, non-mature aneurysm and mature aneurysm. The expediency of active surgical methods at all the stages of aneurysm is explained and indications for choosing the operative methods are formulated. Good and satisfactory immediate functional results were obtained after operations in 94,6% of patients.
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