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Ultra sound diagnostics of brachiocephal arteries in multifocal atherosclerotic damage
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Khaidarov Nodir Kadirovich, Neuropathologist of the 3rd clinic, Tashkent Medical Academy
E-mail: [email protected]
Ultra sound diagnostics of brachiocephal arteries in multifocal atherosclerotic damage
Abstract: It was determined that ultra sound assessment of the degree of arteries damage possessing high descriptiveness, no invasion and absence of radiation load, in combination with aortal arteriography, provides optimal tactics of stages of surgical or endovascular re-vasvularization performance.
Keywords: multifocal atherosclerosis, damage of brachiocephal arteries, ultra sound diagnostics.
Topicality. Cardiac-vascular diseases take a leading place in the structure of mortality rate of the population in the world. In the mortality structure of cardiac vascular diseases 85-90% is the part of insult and myocardial infarction. In the structure of cerebral vascular diseases the leading place is taken by the disorders of cerebral blood circulation of ischemic character (up to 80%) conditioned by atherosclerosis. Surgical therapy of stenose (including asymptomic) damages of aortal arch branches provide significant diminishing ofthe possibility of insult development, and improvement ofthe quality life ofmultiple contingent of the patients, which conditions not only medical, but also social-economic significance of the problem [1; 2; 11].
For a long time a special attention in clinical practice was paid to local manifestations of atherosclerotic process [3; 10]. Though atherosclerotic damage of vessels of one arterial lumen is rather an exclusion, than a rule. At the modern time according to many authors combined damage of several arterial lumens compose up to 50-60% [4; 5]. Often patients with asymptomic stenoses of aortal arch branches apply for medical aid because of the damage of other vascular lumens: coronary, renal, arteries oflower limbs, aortal aneurism. That's why in modern conditions it is rational to perform active diagnostic tests for detection of the lesion of carotid arteries if there are clinical manifestations of atherosclerosis of any location [6].
The most informative methods of the modern diagnostics today are ultra sound doplerography with duplex scanning, roentgenologic angiography, magnetic-resonance angiography [9]. According to the report of some researchers the most reliable information about the degree of stenosis and the structure of atherosclerotic plaque can be received with duplex scanning, and, respectively, on the basis of these data perform surgical treatment [7; 8].
The objective is to study peculiarities of ultra sound values of brachiocephal arteries in multifocal atherosclerosis
Materials and methods. The work was based on the study of the results of checking of 40 patients with atherosclerotic stenosis ofbrachiocephal arteries in multifocal atherosclerosis, among them 30 men 30 (75%) and 10 women (25%). Hyper cholesterolemia was observed in all examined patients.
In the analysis of the values of ultra sound diagnostics it was determined that among these 40 patients seven had combination of atherosclerotic damage with renal artery, 22 with coronary artery, and eleven with arteries of the lower limbs.
Simultaneous damage of several vascular lumens by atherosclerosis promotes development of clinical picture from clear manifesta-
tion to asymptomic latent progress. Among these 40 patients with atherosclerotic stenoses of brachiocephal arteries we registered asymptomic progression in fourteen (35.0%), and that corresponded to the results of other authors. Bilateral hem dynamically significant stenoses (60% and more) of carotid arteries in combination with stenoses ofvertebral arteries were diagnosed in 21 (52.4%) of 40 patients, interim stenoses (50%) in 12 (30.0%) patients. Bifurcation stenoses were detected in 29 (72.5%) patients.
Hem dynamic significance of stenosis-occlusive damage is determined by its potential danger to be a source ofblood supply deficit in distal part. With stenosis more than 60% along the diameter (and occlusion) and absence of compensatory mechanisms distal deficit of blood supply develops.
Unilateral stenosis of brachiocephal arteries was diagnosed in 8 (20.0%) patients. The more expressed were the stenoses of brachiocephal arteries, the more hem dynamically significant stenoses (70% and more) of CA were detected with the help of coronary angiography.
Ataxy, weakness of legs, headaches, dizziness was noted in 23 (57.5%) out of 40 patients.
In 16 (80%) patients with diabetes mellitus there was visualization ofheterogenic atherosclerotic plaques with prevailing of hyper echogenic component and inclusions of calcinates.
In 17 (42.5%) patients with hypo echogenic and heterogenic atherosclerotic plaques with prevailing hypo echogenic component on computer tomography we revealed post ischemic cysts of brain with various location.
Ultra sound technologies provided definition of stenosis degree, morphology of atherosclerotic damage ofbrachiocephal arteries in 40 patients, and that was confirmed in aortal arteriography.
Performed comparative analysis of the results of complex USD and digital angiography in the definition of stenosis degree in arteries further undergoing stenting confirmed the fact that USD data provide reliable definition of artery stenosis.
Different from the data of digital angiography, ultra sound research methods more accurately defined duration and structure of atherosclerotic plaque in superficially located arteries, and that was important for the choice of stent length. The choice of the optimal length of the stent is important factor for prevention of the development of dangerous dissection and re-stenosis.
Thus, the results of non-invasive sonographic researches are informative, reliable, available, safe in the definition of artery stenosis
Section 6. Medical science
degree, length and structure of atherosclerotic plaque in superficially located arteries. The data of sonographic studies provide more accurate definition of the length and diameter of the stent in the performance of revascularization in superficially located arteries and by these means improvement of angioplastic quality.
Analysis of the results of USD with CDC and ED ofvarious vascular lumens allow earlier study of the morphology of atherosclerotic plaques, definition of early symptoms of destabilization, and performance of prophylactics of possible complications with corresponding therapy.
References:
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2. Balakhonova T. V. Ultra sound checking of arteries in patients with cardiac vascular diseases: Abstract of Doct diss./T. V. Balakhonova., M., 2002. - 40 p.
3. Bokeria L/A. Endovascular methods of therapy for patients with multifocal atherosclerosis/L. A. Bokeria, B. G. Alekyan, U. I. Buziash-villi and orther//Annals of surgery. 2002. - № 1. - P. 11-17.
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6. Mikhailov M. K. Endovascular methods of therapy for ischemic heart disease and acute myocardial infarction in clinic without cardi-surgical service/M. K. Mikhailov, R. F. Akberov, V. V. Korobov and others. Kazan -2006. - 160p.
7. Shevchenko O. P. Fragility of atherosclerotic plaque/O. P. Shevchenko, O. D. Mishnev//Ischemic heart disease (M.). 2005. - p. 5875.
8. Alzahari, A. S. Severe hypertension secondary to renal artery stenosis and Cuschings syndrome/A. S. Alzahari, Al-Hajjaj, J. Al-Watban et al.//Saudi Med. J. 2007. - V. 26 (4). - P. 668-673.
9. Bardelli M. New intrarenal echo-Doppler velocimetric indices for the diagnosis of renal artery stenosis/M. Bardelli, F. Veglio, E. Arosio et al.//Kidney Int. 2006. - V. 69 (3). - P. 580-587.
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Berkinov Ulugbek Bozorbaevich, Professor in the department of faculty and hospital surgery of the Tashkent Medical Academy, Republic of Uzbekistan
Khalikov Sarvar Pulatovich, Assistant in the department of faculty and hospital surgery of the Tashkent Medical Academy, Republic of Uzbekistan E-mail: [email protected]
Treatment of the cicatricial tracheal stenosis
Abstract: From 1984 to the present time in the 2nd clinic of the Tashkent Medical Academy (TMA) there were treated 186 patients with the cicatricial tracheal stenosis (CTS). Indications to the surgical treatment of cicatricial stenosis of the trachea were established at 76 (40.9%) patients. At 110 (59.1%) patients we used endoscopic techniques to expand and maintain the lumen of the trachea. The surgical intervention was circular resection with anastomosis. From hospital discharged 180 patients, 6 people died. Hospital mortality was 3.2%. Intraoperative complications and adverse postoperative period were observed after 12 (6.5%) interventions. Proper surgical treatment algorithm for patients with cicatricial stenosis allowed to achieve good and satisfactory long-term outcome at 93.5% of patients. Unsatisfactory results are directly related to postoperative complications, prevention of which will helps to improve the final outcome.
Keywords: trachea, cicatricial stenosis of trachea, circular resection of trachea, trachea-laryngeal anastomosis.
Among the diseases the cicatricial tracheal stenosis is the main indication to surgical treatment. There are various types of operations: circular resection of the narrowed segment with anastomosis, stage reconstructive- plastic surgery with the formation of the new airway at different tubes, endoscopic dilatation, laser recanaliza-tion of the lumen, using of endotracheal stents.These diseases treat surgeons, ENT, endoscopists. Each specialist elect him the most familiar method of treatment, which he is fluent. [14] The choice of treatment is not always rational. Most research in this area reflects the possibility of a single type of treatment. Only a multidisciplinary
approach allows to choose the best treatment for a particular patient [2; 3; 6; 8].
From 1984 to the present time in the clinic of the Tashkent Medical Academy (TMA) there were treated 186 patients with the cicatricial tracheal stenosis (STS) aged 15 to 68 years. Among them 112 were males and 74 — females. Most patients, 172 patients (92.4%) were young and mature age. The most common tracheal narrowing occurs after respiratory resuscitation in trauma patients, the frequency of which in young and middle age, especially in males is higher. In identifying of the causes of cicatricialring tra-
