Abstract:

Background: coronavirus disease is characterized by hypercoagulation and requires treatment with anticoagulants. At the background of anticoagulant therapy, life-threatening soft tissue bleeding may occur.

Aim: was to evaluate the efficacy of transcatheter arterial embolization in patients with severe COVID-19 complicated by soft tissue bleeding.

Materials and methods: within the period from January 30, 2021 to February 18, 2022, transcatheter arterial embolization of soft tissue bleeding was performed in 25 patients with COVID-19-associated pneumonia.

Results: transcatheter arterial embolization was performed in 19 of 25 patients (76%). Postoperative mortality was 42%, and overall mortality was 40%. Fifteen patients (60%) were discharged in satisfactory condition.

Conclusions: severe soft tissue bleeding may occur in patients with coronavirus disease while treated with anticoagulants. The method of choice for treatment of these hemorrhages is transcatheter arterial embolization.

Abstract:

Case report is devoted to atypical recanalization of chronic occlusions of the common iliac artery Today, there are several ways for recanalization of chronic occlusions of arteries of lower limbs. Recanalization is known to be the major point of endovascular procedures. The success of endovascular surgery at recanalization depends mainly on 2 factors. One of the most important factors is the choice of access. Another factor is the choise of recanalization method . In case of rare failures - performing open surgery.

Refrrences 

1.    Pokrovsky A.V. and other. Russian consensus. Recommended standards for the evaluation of patients with chronic lower limb ischemia. M. 2001; 16 [In Russ].

2.    Koshkin V.M. Outpatient treatment of atherosclerotic lesions of lower extremities. Angiology and Vascular Surgery. 1999; 1: 106-113 [In Russ].

3.    Saket R.R. et al. Novel intravaskular ultrasound-guided method to create transintimal arterial communications: initial experience in peripheral occlusive disease and aortic dissection. J.Endovasc. Ther. 2004; 11 (3): 274-280.

4.    Troickij A.V., Behtev A.G., Habazov R.I., Beljakov G.A., Lysenko E.R., Kolodiev G.P. Gibridnaja hirurgija pri mnogojetazhnyh ateroskleroticheskih porazhenijah arterij aorto-podvzdoshnogo i bedrenno-podkolennogo segmentov. Diagnosticheskaja i intervencionnaja radiologija. 2012; 6(4): 67-77 [In Russ].

5.    Zatevakhin 1.1., Shipovskiy V.N., Zolkin V.N. Balloon angioplasty for lower limb ischemia. M. 2004; 176-229 [In Russ].

Article exists only in Russian.

Abstract:

Purpose. To assess early and late results of iliac arteries balloon angioplasty and stenting in patients with chronic lower limb ischemia.

Material and methods. We analyzed the results of terminal aortic and iliac lesions endovascular treatment in 222 patients. All the patients presented symptoms of lower-limb chronic ischemia: 2nd «b» grade - 51,2%; 3rd grade - 27,1%; 4th grade - 21,7%. Two hundred and fifty eight procedure were performed, including 98 (38%) balloon angioplasty and 160 (62%) stenting. The lesions were Type A -26%, Type B - 45%, Type C - 23%, and Type D - 51% according to TASC II classification.

Results. Immediate angiographic success rate was 99,4%, complication rate -1,3% (4 of 314). Cumulative primary patency after balloon angioplasty in terms of 1, 3 and 5 years were correspondingly 97,9%, 82,0% and 64,2%. After stenting it was as high as 98,1%, 85,2% and 71,8%. Secondary patency after balloon angioplasty in terms of 1, 3 and 5 years was correspondingly 99,0%, 89,4% и 75,6%. For stenting it was 99,4%, 93,0% and 85,6% (Kaplan - Meier). Long-term clinical success rates in 1 year, 3 and 5 years were correspondingly 97,9%, 98,7% and 88,8% for angioplasty and 92,6%, 63,7% and 72,6% for stenting. Five-year limb preservation rate was 92,4% for angioplasty and 98,6% for stenting.

Conclusions. Endovascular interventions are proved to be safe and efficient for iliac arteries atherosclerotic lesions, and to have good long-term results. 

References 

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Abstract:

A literature review is devoted to endovascular treatment of occlusive and stenotic lesions in arteries of femoral-popliteal segment.

Currently, 2-3% of the RF population suffer from atherosclerotic lesions of arteries of lower limbs. In the structure of cardiovascular disease, atherosclerosis of lower limbs has the level about 20%. In 82% the cause of vascular disease is atherosclerosis. In the structure of atherosclerotic arterial disease of lower limbs more often (47% to 65%) occurs defeat of the femoral-popliteal segment particularly in patients older than 60 years; that is confirmed by numerous statistical observations. The aim of the article was to compare results of endovascular treatment of arterial lesions of the femoral-popliteal segment.

This article presents results of a solo balloon angioplasty, balloon angioplasty with drug-eluting balloons, subintimal angioplasty, stenting drug-eluting and bare-metal stents, cryo-plastics,catheter atherectomy, hybrid interventions and compare results of open and endovascular interventions. Data of STAR register, published in 2001, show that the correction of lesions category C, TASC II, using balloon angioplasty is quite possible to count on similar results in category B.

According to Conrad M. et.al, Amato B. et.al and Dey C., despite the high incidence of the primary success of endovascular interventions for femoral-popliteal segment long-term results often look depressing.

Great importance is given to study the possibility of the use of drug-eluting stents, which have proven effectiveness in suppressing the inflammatory response and intimal hyperplasia after stenting of coronary arteries, as evidenced by research SIROCCO, SIROCCO II, STRIDES, Zilver PTX. Thus, the use of drug-eluting stents in the femoral-popliteal segment did not reduce the frequency of restenosis.

THUNDER, FemPac and LEVANT researches indicate that drug-eluting balloons provide some benefits that are absent in other endovascular techniques such as solo balloon angioplasty and stenting.

The final stage of a multicenter randomized trial BASIL, which carried out a comparative analysis of FPB and PTA groups, was reached in 2010. As a result, the preservation of limbs and survival did not differ significantly

Thus, the literature report reveals a clear tendency of domination of endovascular strategies in defeated limb blood-flow recovery Minimally invasive balloon angioplasty and stenting compared with results of bypass operations, reconstructions - is not worse and consider endovascular treatment strategy in the surgical treatment of femoral-popliteal segment to be method of first choice. 

References

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results. EuroIntervention. 2011. May; 7. Suppl K:K77-82.

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29.     Forbes J.F., Adam D.J., Bell J., Fowkes F.G., Gillespie I., Raab G.M., Ruckley C.V., Bradbury A.W. Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial: Health-related quality of life outcomes, resource utilization, and cost-effectiveness analysis. J. Vasc. Surg. 2010 May; 51(5 Suppl):43S-51S. 

Abstract:

Article describes results of single-balloon angioplasty and stenting in patients with occlusive-stenotic lesions of femoral-popliteal segment for the period of 30 months. It was performed 209 endovascular interventions, single-balloon angioplasty in 95 patients; stenting - 114 patients. Long-term results of primary patency: 43,1% in group of single-balloon angioplasty 57,1% - in group with stenting.

References

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