Abstract:

Two clinical cases of treatment of spontaneous hematomas in elderly patients with COVID-19 using endovascular diagnostic and treatment methods are presented.

Aim: was to show the effectiveness of endovascular hemostasis and, in some cases, there is no alternative to the use of other techniques.

Material and methods: we presented two clinical cases and analyzed the work of domestic and foreign authors on the prevention of venous thrombosis in patients with COVID-19 and endovascular treatment of spontaneous hematomas in patients with COVID-19.

Results: article describes two case reports of catheter embolization in patients with spontaneous hematoma during treatment of severe COVID-19. Elderly patients underwent prevention of thromboembolic complications with low-molecular-weight anticoagulants in prophylactic dosages; during therapy, soft tissue hematomas were revealed in one case in abdominal wall, in the other in chest. In both cases, conservative treatment was ineffective; bleeding required transfusion of blood components. In both cases, embolization was effective, and patients' condition stabilized. In one case, the progression of respiratory failure led to death, the second patient was discharged for out-patient treatment.

Conclusion: catheter embolization for arterial bleeding can be used as monotherapy or as a stage of stabilizing the patient before open surgical treatment.

Abstract:

Aim: was to study the mutual influence of new coronavirus infection COVID-19 and acute coronary syndrome and to evaluate the effectiveness of percutaneous coronary interventions in these conditions.

Material and methods: for the period from March 21, 2020 to October 31, 2021, 5093 patients were treated for COVID-19. Including 208 patients with acute coronary syndrome with concurrent COVID-19 disease. All patients underwent following diagnostic procedures: computed tomography of the chest, electrocardiography, echocardiography, coronary angiography and, if necessary, percutaneous coronary intervention.

Results: we present data on the distribution of patients with COVID-19 according to the presence or absence of ST segment elevation on the electrocardiogram and the degree of lung tissue damage, as well as information on the nature of coronary interventions and mortality in these groups. A high frequency of massive thrombosis of infarct-related coronary arteries was demonstrated in the group of patients with STEMI. Possible mechanisms of left ventricular dysfunction that persist after percutaneous coronary intervention are described. A positive effect of endovascular myocardial revascularization on the degree of hypoxia in patients with COVID-19 was shown.

Conclusions: development of acute coronary syndrome with concurrent coronavirus infection significantly worsens the prognosis of the disease. Despite of the success of endovascular treatment, worsening COVID-19 infection can be accompanied by a sharp deterioration in the condition of patients, leading to death.

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:

Introduction: coronavirus (COVID) pandemic has caused temporary changes in work algorithms of different hospitals, that have not previously provided care for infectious patients. However, the consequences of COVID go beyond infectious pathology. Widespread use of therapeutic doses of anticoagulants as a necessary treatment option and resistant to treatment, cough as a typical symptom, led to an increase in spontaneous ruptures of epigastric arteries with hematomas of abdominal wall, which was an undesirable complication of the main disease.

Aim: was to demonstrate possibilities of endovascular methods in treatment of patients with spontaneous rupture of epigastric arteries on the background of COVID-19 and anticoagulant therapy.

Material and methods: at joinant infectious hospital, inpatient care was provided to 421 patients with coronavirus infection. At the same time, during treatment 9 patients had hematomas of abdominal wall and two of them had spontaneous rupture of rectus abdominis muscle and branches of inferior epigastric artery were damaged. In this article, we present both observations demonstrating the potential of endovascular surgery in treatment of such lesions in patients with COVID-19. Both patients, on the 6 and 10th day of inpatient treatment (severity of lung involvement was Grade 1 and Grade 2) during intense coughing, noted pain and swelling of anterior abdominal wall, accompanied by clinical and laboratory signs of blood loss. Computed tomography angiography (CT-A) revealed extravasation from small branches of inferior epigastric artery with an extensive hematoma that spread into the retroperitoneal space. In a hybrid operating room, a selective embolization of inferior (in one case, due to the high localization of the hematoma, inferior and superior) epigastric artery with an adhesive composition (N-butyl cyanoacrylate with iodolipol) was performed with successful angiographic and clinical results. Patients were discharged without complications on the 7th and 9th days of the postoperative period.

Conclusion: timely CT-diagnostic of severe bleeding, even in cases with atypical localization, and its management by selective embolization of damaged artery is the basis in treatment of spontaneous (cough-associated) ruptures of rectus abdominis muscle in patients with new coronavirus infection.

Abstract:

Article describes cases of detection of viral pneumonia in patients who underwent additional examination before planned hospitalization for surgical treatment in the presence of negative test results for the SARS-CoV-2 virus.

Aim: was to detect early computed tomography (CT) signs of COVID-19 during admission to hospital, in case of presence of normal clinical and laboratory data and negative results of PCR test.

Material and methods: image analysis of CT examinations of chest organs in patients admitted for surgical treatment for various osteoarticular pathologies, for the period of 3 months, was carried out in radiology department.

Results: during CT examination of chest organs, in 9,1% patients, signs of viral pneumonia were revealed, including those caused by SARS-CoV-2, in condition of negative results of PCR tests, immunoserological tests for the presence of immunoglobulins M and G to SARS-CoV-2.

Conclusion: computed tomography of lungs can be considered the «gold standard» of diagnostics, which makes it possible to detect early subclinical inflammatory changes in lungs, in particular, in pneumonia associated with COVID-19, which is the main task during a pandemic.