V. O. Hubka

Relevance. The nature of combat-related surgical injuries changes over time, driven by developments in weapons and the specific nature of combat operations. At the same time, wounds and injuries to internal organs remain among the most challenging cases for surgeons. Despite advances in modern surgery and pharmacology, the incidence of post-operative complications in combat-related abdominal trauma remains between 54 and 81 per cent, whilst the mortality rate ranges from 12 to 31 per cent.Objective. To analyse the pattern, clinical features and treatment outcomes of combat-related abdominal trauma in civilian patients, and to identify factors associated with in-hospital mortality.Materials and methods. A retrospective analysis was conducted of the treatment outcomes of 616 civilian patients with injuries sustained as a result of combat operations between 2022 and 2025. A separate group of 69 patients with penetrating abdominal wounds was examined. The mechanism of injury, the number of affected organs, surgical management, complications and mortality rates were analysed. The severity of the injury was determined using the Injury Severity Score (ISS). A comparative analysis was carried out between groups of patients who survived and those who died.Results. The incidence of mine-blast injuries was 95 per cent. Abdominal organ injury was detected in 15.3 per cent of patients, with penetrating injuries accounting for 73.4 per cent of cases. The small intestine (50.8 per cent) and the large intestine (38.5 per cent) were the most commonly affected organs. In patients who died, the injury severity score (ISS) (31.9 points) was statistically significantly (p < 0.05) higher than in survivors (15.8 points). Multiple organ injuries, damage to major blood vessels, the need for damage control surgery and massive transfusion therapy were associated with increased mortality. The overall mortality rate for abdominal trauma was 24.6 per cent, with 50 per cent of patients dying within the first 24 hours. Infectious complications occurred in 25 per cent of patients, and severe post-operative complications in 15 per cent.Conclusions. Combat-related abdominal trauma in civilian patients is characterised by a high degree of severity, frequent associated injuries and significant rates of early mortality. Key predictors of poor treatment outcomes include a high ISS score, multiple organ injuries, vascular trauma, and the need for damage control surgery and massive transfusion. The findings of this study highlight the need to standardise treatment approaches and adapt the basic principles of Enhanced Recovery After Surgery (ERAS) to the specific conditions of emergency trauma surgery in wartime.

Aim. To summarize current evidence on the mechanisms of injury, diagnostic approaches, and treatment strategies for combat-related abdominal trauma, with a focus on modern surgical management. Materials and methods. A narrative literature review was conducted using PubMed, Scopus, and Google Scholar databases for the period 2020–2025. Publications addressing combat abdominal trauma, including injury mechanisms, diagnostic algorithms, and treatment strategies, were selected. The analysis considered clinical relevance and evidence quality. Results. Fragmentation and combined injuries predominate in modern combat settings and are associated with a high incidence of polytrauma. Focused Assessment with Sonography for Trauma (FAST) and computed tomography are key diagnostic tools for patient stratification and decision-making. Selective nonoperative management (SNOM) is effective in hemodynamically stable patients without signs of hollow viscus injury. Damage control surgery (DCS) remains the standard of care in patients with the “lethal triad”. The role of endovascular techniques, including angioembolization and resuscitative endovascular balloon occlusion of the aorta (REBOA), and enhanced recovery after surgery (ERAS) protocols adapted to austere environments has expanded. Conclusions. Combat-related abdominal trauma remains associated with significant mortality, particularly in patients with combined injuries. Timely diagnosis and a tailored treatment strategy (SNOM, DCS, and interventional approaches) are associated with improved outcomes. Further research is needed to optimize evidence-based management protocols and adapt ERAS principles to the austere combat environment.

Aim. To describe the emergence, development, and current evidence base for coronary revascularization methods, and to evaluate their effectiveness and safety in patients with chronic coronary artery disease (CAD) in accordance with the principles of evidence-based medicine. Materials and methods. A literature review was conducted using a bibliographic-semantic method. Electronic databases (PubMed, Google Scholar, Scopus, and Web of Science) were searched. Search terms included: coronary artery disease, myocardial revascularization, coronary artery bypass grafting, coronary stenting. Seminal historical publications relevant to the chronological development of revascularization techniques were also included. Results. CAD is a prevalent, progressive cardiovascular disease that threatens patient’s lives even during a stable course of the pathology and characterized by a critical reduction in coronary blood flow due to stenotic atherosclerotic plaques in the subepicardial coronary arteries (CA). Treatment of CAD encompasses optimal medical therapy and invasive myocardial revascularization, including coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). According to current evidence-based guidelines, CABG is the reference standard for complex multivessel or left main CAD, particularly in patients with diabetes or reduced left ventricular function, while PCI is an effective minimally invasive alternative for selected anatomical and clinical subgroups. Revascularization effectively reduces the burden of angina and improves health-related quality of life, with beneficial effects on long-term prognosis. Surgical and interventional technologies have undergone substantial evolution and advances in stent design and intravascular imaging guidance. Conclusions. Given the decrease in the quality of life, exercise tolerance, and the risk of adverse cardiac events from which patients with CAD suffer and die, a necessary condition is the use of effective methods of treatment and prevention of this disease. Myocardial revascularization, as a complement to optimal medical therapy, remains a key treatment strategy for symptom relief and improvement of long-term clinical outcomes in patients with chronic CAD.

In general, the phenomenon of vascular calcification is quite common and might pose considerable impediments for vascular, cardiovascular and endovascular surgeons, as well as for interventional cardiologists when performing surgical manipulations during the treatment of patients with coronary artery disease (CAD) or peripheral atherosclerosis. A high degree of coronary artery (CA) calcification is independently associated with an increased risk of major cardiovascular events after percutaneous coronary intervention (PCI). The aim of the work is to analyze modern professional literature, summarize information and add to our ideas about the impact of CA calcification and methods of its visualization on the PCI technical aspects. Since the second half of the 20th century, various methods that allow for visualization of СA plaque calcification have been developed and introduced into clinical practice. These techniques vary in their potential due to type and technical parameters of the radiation source, possibilities of using specialized software, automation of image analysis, etc. Currently, the methods of intravascular imaging, intravascular ultrasound (IVUS) and optical coherence tomography (OCT), are the most informative for visualization of CA calcification and can help interventionalists when performing PCI to identify and evaluate calcified lesions, to determine the indications and choose an optimal type of device for calcium modification, directing appropriate stent or balloon sizing; to detect signs of suboptimal stent implantation providing control over possible periprocedural complications. In addition, the deposition of such morphological substrate as calcium within coronary atherosclerotic lesions is a predictor of insufficient stent expansion during PCI, which in turn can cause thrombosis and in-stent restenosis. CA lesion preparation before stent implantation involves using specialized angiographic balloons or atherectomy devices. Applying these methods of calcium modification contributes to the compliance of the calcified plaque causing fractures beyond or within the stent, ensures optimal final stent expansion and reduces the risks of possible long-term consequences. Furthermore, other periprocedural difficulties and problems may arise during PCI of calcified CA lesions: increased probability of technical failure due to the impossibility of passing the target lesion with instruments, intimal dissection, wall perforation, distal embolization, etc. Conclusions. CA calcification is a complex issue for an interventional cardiologist during CA stenting, which certainly complicates the PCI procedure and requires a specialist not only theoretical knowledge, but also practical skills in using a wide range of interventional tools and techniques. There are modern methods of identifying calcified CA lesion and its quantitative assessment. Among them are methods of intravascular visualization – IVUS and OCT, which are used directly in a catheterization laboratory during PCI. They provide the amplest opportunities and the most advanced capabilities for determining the morphological substrate of the affected CA area and allow an interventionist to plan PCI and adjust its real-time implementation at different stages of the procedure. The use of intracoronary imaging methods gives more opportunities to improve PCI outcomes.

The aim of the work. To summarize and expand knowledge about current methods used for visualization of coronary arteries, their evolution, capabilities, effectiveness, indications for use, safety for patients, guided by the principles of evidence-based medicine. Coronary artery disease (CАD) is an extremely common clinical cardiovascular disease, which is caused by atherosclerosis of the subepicardial coronary arteries (CAs) and can have both acute and chronic course. The incidence of CАD is increasing every year and getting younger. CАD has not only a high morbidity rate, but also a high mortality rate. In Ukraine, mortality from CАD is the main cause of population mortality. Without timely diagnosis and effective treatment, myocardial infarction or sudden cardiac death may develop. It is possible to ascertain the etiological cause of myocardial ischemia only after visualization of the СAs. A practicing physician is able to visualize the СAs using X-ray contrast coronary angiography or contrast-enhanced computed tomography of the chest. СA visualization methods have been used in clinical practice for more than half a century. The hardware and software are constantly upgraded, the diagnostic options of these methods are improved and expanded, and recommendations regarding their use in general clinical practice are updated. The main task for clinicians is to confirm or rule out the presence of a СA atherosclerotic lesion, as well as to determine its localization, extent, degree of stenosis and its significance for coronary blood flow, the presence of СA calcification, collateral pathways, plaque composition and its internal structure. Only after identifying the anatomical and physiological aspects of the atherosclerotic process in СA, it is possible to choose the right strategy for the treatment of patients by a multidisciplinary heart team including pharmacological therapy, a method of cardiac revascularization, and measures for primary or secondary prevention. Conclusions. CАD is a common disease worldwide. Today, two methods of the CА visualization are available – invasive coronary angiography and non-invasive coronary CT angiography. Further research is needed on the efficacy and safety of different СA imaging methods in CAD. Better results of the diagnostic search depend on both the capabilities of the clinic hardware component and on the optimal sequence for diagnostic processes rationally constructed by physicians. Ішемічна хвороба серця (ІХС) – надзвичайно поширене клінічне серцево-судинне захворювання, що зумовлене атеросклерозом субепікардіальних вінцевих артерій (ВА) та може мати гострий і хронічний перебіг. Захворюваність на ІХС зростає з кожним роком, а пацієнти стають молодшими. ІХС має високий рівень не тільки захворюваності, але й смертності. В Україні ІХС є головною причиною смертності населення. Без своєчасної діагностики та ефективного лікування може виникнути інфаркт міокарда або настати раптова серцева смерть. Мета роботи – узагальнити та розширити знання про сучасні методи, що застосовують для візуалізації вінцевих артерій, їхню еволюцію, можливості, ефективність, показання до використання, безпечність для пацієнта, які ґрунтуються на принципах доказової медицини. Встановити етіологічну причину ішемії міокарда можна лише після візуалізації ВА. Лікар-практик має змогу візуалізувати ВА за допомогою рентгенконтрастної коронароангіографії або комп’ютерної томографії органів грудної клітки з контрастним підсиленням. Методи візуалізації ВА застосовують у клінічній практиці вже понад пів сторіччя. Постійно оновлюють апаратну частину та програмне забезпечення, удосконалюють і розширюють діагностичні можливості цих методів, оновлюють рекомендації щодо їх застосування у загальноклінічній практиці. Головне завдання для клініциста – підтвердити чи спростувати наявність атеросклеротичного ураження ВА, а також встановити його локалізацію, поширення, ступінь стенозування, значущість для коронарного кровотоку, наявність кальцинозу ВА, колатеральних шляхів, склад бляшки та її внутрішню структуру. Лише після визначення усіх анатомічних і фізіологічних аспектів атеросклеротичного процесу в ВА можна обрати правильну стратегію лікування пацієнта мультидисциплінарною серцевою командою: фармакологічну терапію, метод реваскуляризації серця та заходи щодо первинної чи...

A lot of recommendations has been published regarding the treatment of chronic venous disease. At the same time, none of these documents reflects the complete «path» of the patient from the stage of the initial visit (diagnosis) to the choice of the optimal treatment option. Therefore, the creation of a protocol that would take into account on the one hand the most modern and proven effective approaches to diagnosis and treatment, and on the other hand, the individual characteristics of each clinical case is an urgent task.The main task of the publication is to create a practice-oriented instruction for the diagnosis, comprehensive treatment and prevention of chronic venous insufficiency. The management of a patient with chronic venous insufficiency is presented in the form of «AngioLife Venous Protocol®», a set of clear practical recommendations for vascular surgeon and phlebologist. This protocol is based on our own practical experience, existing protocols and guidelines for the treatment of patients with chronic venous insufficiency. The venous protocol includes four stages of a set of medical measures, the purpose of which is to form a clear program of further examination and treatment of the patient. Adherence to all the recommendations specified in the protocol allows to obtain satisfactory functional and cosmetic results of treatment of patients with chronic venous insufficiency with minimal risk of recurrence.