Abstract:

Introduction: treatment of patients with bilobar metastatic liver disease remains an unsolved problem. Among methods of regional chemotherapy, the least studied is isolated liver chemoperfusion, which is an unpopular technique due to its high trauma and difficult reproducibility.

Aim: was to demonstrate the method of endovascular isolated liver chemoperfusion (EILHP) developed by us.

Case report: EILCP was performed using a heart-lung machine (HLM) in a patient with cancer of the rectum, stage 2 (pT3N0M0), after combined treatment (radiation therapy (SOD 60 Gy) + anterior resection of the rectum in 2007). Disease progression. Isolated metastatic liver disease (01.2021). Isolated chemoperfusion was performed endovascularly using 2-balloon catheters, which provided vascular isolation of the liver and its isolated perfusion during the procedure. Posi- tioning of balloon catheters was performed in an open way through femoral artery and vein. Perfusion was carried out for 30 minutes with chemotherapy drugs (CtD) oxaliplatin 42,5 mg/m² and irinotecan 82,5 mg/m² injected directly into the circuit.

Results: the duration of intervention was 160 minutes, intraoperative blood loss was 50 ml. During insertion and positioning of aortic balloon, a limited dissection of the aorta developed in area of left common iliac artery deviation, which did not require any intervention in postoperative period. Duration of intensive care unit stay was 1 day. There were no complications associated with aortic dissection during 3-month follow-up. Level of ALT and AST remained within reference values during entire postoperative period. No hematological toxicity was observed. Patient was discharged on the 7th day after operation in satisfactory condition.

Patient underwent control CT scan of abdominal organs, 30 days after endovascular isolated chemoperfusion of the liver. According to the RECIST scale, stabilization of tumor process was noted.

Conclusions: proposed technique of endovascular isolated liver chemoperfusion is technically feasible and safe. The use of this method may be appropriate in treatment of patients with isolated liver metastases who require dose reduction of chemotherapeutic agents due to their severe toxicity or high patient comorbidity.

Abstract:

This review is focused on the problem of the angiosome principle of revascularization in critical limb ischemia.

The blood circulation of the foot is described in accordance with the angiosome concept. Different opinions on the application of the angiosome principle of revascularization in critical lower limb ischemia are presented.

Features of the angiosome principle that limit its routine use in clinical practice are described. Also, methods of perfusion evaluation that can be applied at all stages of the treatment process, allow to assess the severity of macro- and microcirculation impairment and result of revascularization are described. 

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Abstract:

Aim: was to evaluate frequency and features of pedal arteries lesions in diabetic patients with critical limb ischemia (CLI).

Materials and methods: a retrospective review of feet angiograms of 144 diabetic patients with ischemic ulcer-necrotic lesions was performed. We evaluated rate of different variants and features of pedal arterial lesions. Also, we analyzed lesion characteristics of the source artery and the frequency of the plantar arch occlusion.

Results: 219 hemodynamically significant lesions were detected, 179 of which were occlusions (82%). The majority of occlusions (140(78%)) were an extension of tibial arterial lesions. The rate of occlusions of more than 5 cm in length was 86%(154). There were no passable vessel segments in 38 cases (21% of occlusions). Single-vessel occlusive disease was revealed in 67 patients (46%), double-vessel defeat - in 56 (39%) patients. The source artery occlusion was observed in 110 cases (76%). In 92% of cases the length of the source artery occlusion was more than 5 cm. The occlusion of a non-feeding artery was found in 69 cases (48%). The plantar arch occlusion was revealed in 37 patients (26%).

Conclusion: in diabetic patients with CLI the arterial lesion of the foot is predominantly establishec by long occlusions, often with two-vessel involvement. The most often occluded vessel is a feeding artery It explains difficulties with the direct revascularization. The plantar arch is occluded in one quarter of cases. 

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Abstract:

Article describes a rare clinical case: a successful endovascular haemostasis of splenic artery arrosive bleeding into pancreatic enteroanastomosis in early postoperative period in patient with chronic postnecrotic pancreatitis.

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