Abstract:

Introduction: renal arteriovenous malformation (AVM) is a pathological communication between renal arteries and veins, both acquired and congenital. Congenital AVMs of kidneys, on average, remain asymptomatic for up to 30-40 years, occurring mainly in women, may manifest with hematuria and pain. Nephrectomy is known to be historical method of treating AVM of the kidney, however, with the development of angiographic instrumentation, endovascular methods of treatment began to be introduced into practice more often.

Case report: a 30-year-old female patient with ongoing recurrent bleeding from the urogenital tract. Performed preoperative examination: laboratory tests, cystoscopy, ultrasound, multispiral computed tomography. Patient underwent angiography followed by embolization of kidney AVM with Squid.

Results: intraoperatively, it was noted that AVM embolization is partial. During the first day of the observation period, the presence of postembolization syndrome in the form of hyperthermia, pain and dysuric syndromes, a phenomenon of systemic reaction according to laboratory tests were noted. After 1,5 months, patient was hospitalized for second stage of embolizaion, but during angiography it appeared, that AVM is totally embolized.

Conclusions: renal artery embolization in patients with renal arteriovenous malformations is a minimally invasive, effective method of treatment.

1. The process of selective embolization is controlled and can be used as an independent method of treatment.

2. Due to selective catheterization of arteries and the infusion of agent directly into the affected area, segmental infarction occurs, as a result of which there is minimal destruction of the healthy part of the kidney parenchyma, the function of the kidney will not suffer.

References

1.     Kenny DPN, Egizi T, Camp R. Cirsoid renal arteriovenous malformation. Applied Radiology. 2016; 45: 35-37.

2.     Mukendi AM, Rauf A, Doherty S, et al. Renal arteriovenous malformation: An unusual pathology. SA Journal of Radiolog. 2019: 23(1).

3.     Rosen RJ, Ryles TS: Arterial venous malformations. In Vascular disease. Surgical and Interventional Therapy Volume 2. Edited by: Strandness DE, Van Breda A. New York, Churchill Livingstone; 1994:1121-37.

4.     Neeraj V, Cinosh M, Kim JM, et al. Massive hematuria due to congenital renal arteriovenous malformation successfully treated by renal artery embolization. J Assoc Phys India. 2018; 66: 78-80.

5.     Sorokin NI. Superselective renal artery occlusion. Diss. doct. med. sciences. M., 2015; 346 [In Russ].

Abstract:

Introduction: more than 10 million ischemic strokes are recorded in the world every year - a disease, the mechanism of development of which is associated with impaired blood flow to the brain tissues, mainly due to embolism in intracranial arteries. One of treatment methods of ischemic stroke within the «therapeutic window», in the absence of contraindications, is systemic thrombolytic therapy. Thrombolytic therapy has a number of limitations and contraindications, including ongoing or occurring bleeding of various localization within a period of up to 6 months.

Aim: was to evaluate the possibility of performing and the effectiveness of «off-label» simultaneous selective thrombolytic therapy and uterine arteries embolization in a patient with acute ischemic stroke with multiple distal lesions of middle cerebral artery branches against the background of ongoing uterine bleeding.

Case report: patient S., 42 years old, was hospitalized to the pulmonary department for bronchial asthma treatment with the aim of preoperative preparation before extirpation of the uterus, against the background of menometrorrhagia. At one of days of hospitalization, patient suffered from acute dysarthria, right-sided hemiparesis. When performing multislice computed tomography and angiography, multiple occlusions were revealed in the distal segments (M3-M4) of the left middle cerebral artery. The patient underwent simultaneous selective thrombolytic therapy of the left middle cerebral artery and uterine artery embolization.

Results: in the next few hours of the postoperative period, the patient experienced regression of neurological deficit: symptoms of dysarthria were arrested, almost complete restoration of motor activity in the right extremities, residual slight asymmetry of the face; bleeding from uterine stopped.

The patient was discharged on the 16th day with a slight neurological deficit. The follow-up period is 18 months. Neurological status with minor deficits: slight asymmetry of facial muscles; the strength of muscles of right limbs is reduced to 4-4,5 points. Ultrasound: a significant decrease in the size of the uterus and myomatous nodes. Menstrual cycle is restored.

Conclusions: a wide range of angiographic instruments and skills of endovascular surgeons made it possible to perform «off-label» simultaneous intervention in a patient with ischemic stroke and multiple distal lesions of branches of the middle cerebral artery against the background of ongoing uterine bleeding and giant myoma. The use of methods of endovascular hemostasis makes it possible to stop bleeding by overcoming contraindications to thrombolytic therapy. The use of thrombolytic therapy within the «therapeutic window» allows regression of neurological deficits in patients with multiple distal cerebral artery lesions.

References 

1.     GBD 2016 Stroke Collaborators. Global, regional, and national burden of stroke, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019; 18(5): 439-458.

https://doi.org/10.1016/S1474-4422(19)30034-1

2.     Клинические рекомендации по ведению больных с ишемическим инсультом и транзиторными ишемическими атаками. Москва; 2017: 92.

Clinical guidelines for the management of patients with ischemic stroke and transient ischemic attacks. Moscow; 2017: 92 [In Russ].

3.     Клинические рекомендации по проведению тромболитической терапии при ишемическом инсульте. Москва; 2015: 34.

Clinical guidelines for thrombolytic therapy in ischemic stroke. Moscow; 2015: 34 [In Russ].

4.     Chiasakul T, Bauer KA. Thrombolytic therapy in acute venous thromboembolism. Hematology Am Soc Hematol Educ Program. 2020; 1: 612-618.

5.     Yuan K, Zhang JL, Yan JY, et al. Uterine Artery Embolization with Small-Sized Particles for the Treatment of Symptomatic Adenomyosis: A 42-Month Clinical Follow-Up. Int J Gen Med. 2021; 14: 3575-3581.

6.     Клинические рекомендации: миома матки. Москва; 2020: 48.

Clinical guidelines: uterine fibroids. Moscow; 2020: 48 [In Russ].

Abstract:

Introduction: the main indicator that determines the prognosis of cancer is the degree of prevalence of tumor process at the time of detection. In terms of the growth of primary morbidity among urological cancers, bladder cancer ranks third, and prostate cancer is second. Treatment of patients in advanced stages is palliative and aimed at improving the quality of life and increasing its duration.

Bleeding from the bladder or prostate in such cases is a life-threatening complication and one of the most common causes of death in advanced cancer.

Aim: was to evaluate the effectiveness of embolization of arteries of the bladder and prostate in cancer patients with bleeding from the lower urinary tract as a preparatory stage for the subsequent specialized therapy of the oncological process.

Materials and methods: from 2019 to August 2021, 38 embolizing interventions were performed in 36 patients with recurrent bleeding from the bladder with ineffective conservative hemostatic therapy. Of these, there were 30 men and 6 women. The average age was 63 ± 2,6 years. All patients at the prehospital stage were diagnosed with pelvic cancer with invasion of the bladder wall without the possibility of radical treatment. Particles with a size of 300-500 µm, embolization coils and fragmentated hemostatic sponge were used for embolization.

Results: immediate angiographic success in the form of stagnation of blood flow through the target arteries was achieved in 100% of operations. In most cases, the relief of macrohematuria was achieved at day 4 (average values of erythrocytes in urine are 3,66 in p/sp). 2 patients (5,6%) underwent a second endovascular intervention during hospitalization due to the many small afferents suppluying the bladder tumor from the a. pudenta interna. Bleeding stopped in these patients by the 8th day of hospital stay. The early postoperative period in 100% of patients was accompanied by mild postembolization syndrome, which was stopped by symptomatic therapy within 24 hours.

Conclusions: endovascular embolization in patients with oncopathology using the superselective technique has shown efficacy in stopping urological oncological bleeding, allows to achieve stable hemostasis in a short time and to continue specific treatment of cancer in patients of the 2nd clinical group.

References

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https://doi.org/10.1016/s0022-5347(17)58892-8

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https://doi.org/10.1016/j.aju.2018.01.004

5.     Mohan S, Kumar S, Dubey D, et al. Superselective vesical artery embolization in the management of intractable hematuria secondary to hemorrhagic cystitis. World J Urol. 2019; 37(10): 2175 - 2182.

https://doi.org/10.1007/s00345-018-2604-0

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7.     Bilhim T, Pisco JM, Tinto HR, et al. Prostatic arterial supply: anatomic and imaging findings relevant for selective arterial embolization. J. Vasc. Interv. Radiol. 2012; 23 (11): 1403-1415.

https://doi.org/10.1016/j.jvir.2012.07.028

8.     Bilhim T, Pereira JA, Tinto HR, et al. Middle rectal artery: myth or reality? Retrospective study with CT angiography and digital subtraction angiography. Surg Radiol Anat. 2013; 35(6): 517-522.

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9.     Korkmaz M, Sanal B, Aras B, et al. The short- and long-term effectiveness of transcatheter arterial embolization in patients with intractable hematuria. Diagn Interv Imaging. 2016; 97: 197-201.

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10.   Liguori G, Amodeo A, Mucelli FP, et al. Intractable haematuria: long-term results after selective embolization of the internal iliac arteries. BJU Int. 2010; 106: 500-503.

https://doi.org/10.1111/j.1464-410X.2009.09192.x

11.   Karpov VK, Kapranov SA, Shaparov BM, Kamalov AA. Superselective embolization of urinary bladder arteries in the treatment of recurrent gross hematuria in bladder tumors. Urology. 2020; 5: 133-138 [In Russ].

https://doi.org/10.18565/urology.2020.5.133-138

Abstract

Background: pancreatic cancer (PC) - oncologic disease with nonsignificant clinics on early stages and tendention of spreadind in population, as a result - late diagnosis and low rate of radical treatment (10-25%). Carried radical treatment, such as pancreaticoduodenectomy (PDE) - has a high risk of postoperative complications (30-70%) due to its difficulty Most often and dangerous complications are: bleeding, anastomotic leakage, postoperative pancreatitis, purulent complications. Bleeding occurs in 5-10% of cases, mortality varries between 30,7% and 58,5% according to moderd literature. "Sentinel bleeding" - term that meand non-fatal bleeding through drainage or gastrointestinal bleeding (GIB) that follows PDE, and is a predictor of further massive fatal bleeding. Material and methods: article presents data of patient (male, 64y) who underwent gastropancreaticoduodenectomy (GPDE) through bilateral hypochondriacal access as treatment of moderate differentiated (MD) ductal adenocarcinoma of pancreatic head. On 21st day after surgery - massive GIB with source of bleeding as pseudoaneurysm of right hepatic artery Taking into consideration "adverse anatomy", impossibility of stent-graft implantation and failure of primary embolization with "front-to-back-door" technique - against the background of reccurent bleeding, patient undewent coiling of pseudoaneurysm and subseqent coil implantation into right hepatic artery anc common hepatic artery Against the background of second reccurency of GIB - patient underwent successful "front-to-back-door" embolization with combinaton of coils and Onyx.

Results: technique of «front-to-back-door» embolization led to stable hemostasis and patient's discharge in satisfactory condition without recurrence of bleeding.

Conclusions: surgical hospital, carrying on resections of pancreas as a routine, should have a CathLab unit, equipped with wide specter of angiografic instruments and 24/7 surgical team with experience of hemostatic interventions. Bleeding after PDE should be considered as «sentinel bleeding». In case of side-injury of large vessels - stent-graft implantation is preferable, if it is impossible - "front-to-back-door" embolization should be used. 

References

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Abstract:

In clinical practice, ischemic stroke still remains a difficult problem, being in most leading causes of death. Development of new treatments, founding of new therapeutic algorythmes and untiringly technical progress in sphere of instrumental support of operation-room allow to proceed endovascular intervention in group of patients with cardioembolic stroke.

Case report presents successful endovascular treatment of patient from cardio-surgical department of Belgorod Region Clinical Hospital named after St. loasaf, with cardioembolic stroke, onset in preoperative period (before aorto-coronary bypass).

Materials and methods: patient A., 59 years, diagnosis: «Ischemic heart disease. Exertional angina FC II. Post-infarction cardiosclerosis. (AMI in September 2014). Stenosis of coronary arteries according to coronary angiography (CAG), hemodynamically significant. Hypertensive heart disease III st., 2 degree, with the defeat of the heart and blood vessels of the brain, with the achievement of target blood pressure (BP). Diabetes mellitus type 2, the second insulin-depended, stage subcompensation. Risk factor 4. congestive heart failure 2a class, functional class III. Chronic gallstone disease. Chronic calculous cholecystitis without exacerbation». 05.02.15 - onset of ischemic stroke in left hemisphere of brain. Patient urgently underwent: multislice computed tomography (MSCT), MSCT-angiography of main brain arteries, direct angiography of main brain arteries. Survey showed: occlusion of proximal third of left common carotid artery (CCA) with TICI-0 blood flow; left middle cerebral artery (MCA) and anterior cerebral artery (ACA) were filled threw anterior communicating artery (ACoA) from right internal carotid artery (ICA). Patient underwent: recanalization of occlusion, thrombectomy from left CCA, stenting of CCA-ICA segment, selective thrombolythic therapy into left MCA.

Results: «Time-To-Treatment» was 4 hours 15 minutes. Made endovascular treatment leaded to regression of neurological deficit.

Conclusions: the use of endovascular methods in patients with cardioembolic stroke car decrease neurological deficit and increase quality of life of patients in this group.  

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Abstract:

Aim: was to study properties of nanostructured carbon coating stents in coronary arteries with the help of intravascular ultrasonic visualization.

Materials and Methods: experimental implantation of stents in coronary artery was performed on 8 yearling sheep. Estimation of bioinertness properties of stents was made by intravascular ultrasonic method on the 14, 28, 180 day. Bioinertness properties were estimated in comparison with analogical bare-metal stents.

Results: The analysis of results showed that in early stages (up to 28 days) experimental samples of stents cause less formation of trombus than simple balloon-extendable stents. In the period of late outcomes, coronary nanostructured carbon coating stents have lower level of «in-stent stenosis».

Conclusion: stent implantation with nanostructured carbon coating does not prevent the natural reparative processes taking place in the artery wall, does not cause the formation of thrombotic masses under standard doses of antiaggregants. Experimental stents significantly less affected in-stent stenosis, than stents without surface modification, indicating their higher bioinertness. 

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Abstract:

At the present level of development of medicine, a group of disorders of mesenteric blood flow remains extremely difficult to diagnose. High mortality at this disease is related to the late detectability, lesion volume, patient's age and the presence of severe comorbidity. However, modern specialized hospitals, with a large arsenal of diagnostic methods, as well as a high level of surgical care in this group of patients apply endovascular interventions for early detection of disease and its possible correction.

Case report describes a clinical case of the female patient A., 58 years old, who was treated at the neurovascular department of Belgorod regional clinical hospital named after St. Ioasaf, with acute stroke of ischemic type in the left hemisphere of the brain, cardioembolic subtype. On the 5th day of hospital treatment, the patient complained on a discomfort and further abdominal pain, bloating - suspected mesenteric ischemia. The patient underwent spiral computed tomography (CT) with bolus-enhansment: diagnosed significant stenosis of celiac trunk (CT), subtotal stenosis of the proximal segment of the superior mesenteric artery (SMA) with signs of local occlusion. As a matter of urgency, in endovascular operating room, patient underwent endovascular procedure: Angiography of visceral branches of the abdominal aorta, followed by thrombectomy and stenting. Control angiography - hemodynamics in the stented segment - is not disturbed, the width of the arterial lumen is fully restored, signs of dissection and distal embolism are absent.

Conclusions: angiographic diagnostic methods in patients with mesenteric arteries thromboembolism is a highly informative, they do not require special preparation of the patient and it can immediately perform a medical intervention. Endovascular diagnosis and treatment can be recommended as a method of choice in the diagnosis and treatment of such severe disease as acute mesenteric thrombosis and thromboembolism. 

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