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Study objective: to present the immediate and mid-term results of onestage surgical treatment of patients in the volume of CEE and CABG based on a differentiated approach to patient selection.
Materials and methods: in FCCVS n.a. S.G. Suhanov, Perm developed an algorithm for choosing treatment tactics in patients with combined atherosclerotic lesions of the coronary and brachiocephalic arteries. According to this algorithm, for the period from 01.07.2014-01.01.2021, one-stage correction of CABG + CEE was performed in 104 patients. The primary endpoints were all-cause death, acute myocardial infarction (MI), transient ischemic attack (TIA), and stroke. Hospital and midterm results were analyzed. The average follow-up time in the study of mid-long-term results was 40.3 ± 20.4 months.
Results: in the study of hospital outcomes, the mortality rate was 0%. There were recorded 3 (2.9%) cases of perioperative stroke and 1 (0.9%) case of myocardial infarction. There were no cases of TIA. The combined endpoint (death, acute MI, stroke, TIA) reached 4 (3.8%) patients. In the study of mid-term results, we were able to contact 96 patients out of 104 operated on (92.3%). The survival rate was 94.8%. 5 (5.2%) people died. There were 2 (2.1%) cases of myocardial infarction, 4 (4.1%) cases of stroke.
Conclusions: simultaneous revascularization of the carotid and coronary regions of CABG + CEE is safe and allows adequate elimination of the lesion in both regions.

Goal. Consider the management of patients with effort thrombosis (Paget-Schretter syndrome).
The article presents the modern vision of the problem of effort thrombosis. This review is aimed at describing the epidemiology, pathophysiology, diagnosis and treatment of patients with Paget-Schretter syndrome. SPS occurs spontaneously, as a rule, in young, healthy and active patients aged 20-30 years after strenuous physical activity. The ratio of men and women is 2:1, recently there has been a growing trend among women. The main complaints of patients with SPS include swelling of the affected limb, discomfort when moving the affected arm, pain and heaviness when trying to raise the arm up. When examining these patients, attention is paid to hyperemia of the skin or their cyanotic nature, pasty limbs, as well as an enhanced venous pattern on the shoulder, the so-called Arshel sign. The diagnosis is based on the data of anamnesis, physical examination, the “gold standard of diagnostics” – ultrasound examination of veins, the sensitivity and specificity of which is 70-100%. The first step in the diagnosis can be the evaluation of the D-dimer, with its negative values, the SPSH is rejected. With an obvious clinic and controversial results of serial ultrasound examinations, other imaging methods are used, such as computed contrast tomography, magnetic resonance imaging, the diagnostic value of which is especially significant in occlusive venous thrombosis.
SPS differs not only from DVT of the lower extremities, but also from secondary DVT of the upper extremities, which determines the peculiarities of management of this category of patients, including surgical treatment aimed at preventing subclavian vein compression in the future. The article summarizes the experience in the management of patients with blood thrombosis.

The article describes a clinical case of a 37-year-old patient with pulmonary capillary hemangiomatosis of functional class IV according to the WHO classification with difficulties of diagnostic search and features of PAH-specific therapy.
Pulmonary arterial hypertension - group 1 in the clinical classification is represented by several forms of pathology, including very rare diseases such as pulmonary veno-occlusive disease and pulmonary capillary hemangiomatosis.
The difficulties of diagnostic search consist in the absence of specific symptoms, a variety of interstitial or focal changes according to spiral computed tomography, and the final diagnosis can be made only after performing a lung biopsy, which is associated with a high risk of possible complications. During the initial treatment and examination of the patient, clinical and hemodynamic parameters did not immediately allow to suspect the presence of pulmonary capillary hemangiomatosis. And only the difficulties of the patient’s management associated with the lack of the expected effect of the therapy with PAH-specific drugs served as the basis for further diagnostic search.
Against the background of taking vasodilators, with the normalization of hemodynamic parameters, the progression of respiratory and right ventricular insufficiency was noted in the patient. According to the results of an additional examination, a diagnosis of pulmonary capillary hemangiomatosis was established, therapy was corrected and further tactics of management and treatment of the patient were determined. Currently, the patient is awaiting transplantation at V.I. Shumakov national medical research center and receives specific therapy with riociguate 2.5 mg TID and bosentan 125 mg BID.

Our observation demonstrates a case of a 40-year-old female with idiopathic pulmonary arterial hypertension World Health Organization functional class III, who was admitted to NMRC of Cardiology repeatedly due to disease progression including dyspnea worsening and exercise tolerance decrease after previous COVID-19 infection on riociguat (7.5 mg daily), macitentan (10 mg daily) and selexipag (1600 mcg daily) therapy. Clinical examination demonstrated high-risk status according to the expected 1-year mortality. Due to unreleased treatment goals and high-risk status, we performed transition from selexipag to inhale iloprost. After therapy escalation the patient demonstrated a significant improvement in clinical condition, dyspnea reduction and exercise tolerance increase. The current treatment strategy for pulmonary arterial hypertension is based on regular multiparametric risk stratification approach in PAH patients. The impact of COVID-19 may become an important cause of clinical worsening in PAH patients during COVID-19 pandemic. Directed on vasodilatation and antiproliferation mechanisms of action of PAH-specific drugs are supposed to be protective in COVID-19 patients. However, the probability of clinical worsening in PAH patients despite PAH-specific therapy intake needs to be closely monitored to perform timely treatment correction in order to achieve low-risk status and to improve the prognosis of PAH patients.