Abstract:

Aim: was to study the impact of angiographic projection on patient and operator radiation dose during endovascular interventions aimed at diagnosing and treating cerebrovascular diseases.

Materials and methods: in experiment, radiation dose rate of phantom model (cGy?cm²/s) and equivalent dose rate from scattered radiation (mSv/h) measured in the area of conditional location of operator were studied when the angle of the X-ray tube was changed in modes of digital subtraction angiography (DSA) and fluoroscopy. Radiation dose rate of endovascular surgeon (mSv/h) was assessed during 12 cerebral angiography procedures and 15 neuro-interventions in general angiographic projections. Values of the kerma-area product (Gy?cm²), fluoroscopy time (min), operator exposure dose (µSv) during 87 procedures of endovascular occlusion of aneurysm of cavernous and supraclinoid sections of internal carotid arteries (ICA) were retrospectively analyzed to indirectly assess the effect of angiographic projection on patient and surgeon occupational dose. Interventions were divided into 2 groups depending on the location of detected aneurysm. The 1st group included 35 operations in the right ICA, the 2nd group included 53 operations in the left ICA.

Results: in experimental study, highest values of radiation dose rate of the phantom model were found in frontal projection with cranial angulation, lowest - in lateral and oblique projections; The highest average dose rates from scattered radiation in operator's area were found in left lateral projections whereas the smallest in right lateral projection in DSA mode and also in frontal and right lateral projections in fluoroscopy mode.

When studying doses of scattered radiation during neuro-interventional procedures, it was found that when the position of the X-ray tube changes from 0° in the direction of left lateral projection, an increase in the average dose rate of the operator in the DSA mode is up to 2,6 times, with fluoroscopy - up to 2,4 times. The equivalent dose rate in left lateral projection is up to 1.5 times higher than in right lateral projection. In left oblique projection, there is an increase in dose rate up to 2,3 times compared to right oblique projection.When comparing radiation exposure indicators during aneurysm embolization procedures, a significant increase in operator exposure doses is observed in group of interventions in the left ICA.

Conclusion: when performing neuro-interventional procedures, it is possible to achieve a significant reduction in radiation exposure to patient and operator without a significant loss in image quality along with maintaining optimal visualization of pathological changes by choosing angiographic projections with lower radiation doses.

Abstract:

Introduction: aneurysms of splenic arteries have a fairly high prevalence in relation to the total number of all visceral aneurysms. According to modern clinical guidelines, both symptomatic and asymptomatic aneurysms are subject to treatment. Recently, the priority direction in treatment of visceral aneurysms is endovascular surgery, which is characterized by minimal invasiveness and high efficiency, which makes it possible to consider transcatheter endovascular embolization of splenic artery aneurysms as the preferred method of treatment.

Aim: was to estimate the role and possibilities of endovascular methods of treatment in a patient with a false aneurysm of splenic artery (ASA) formed after pancreatic necrosis and complicated by gastrointestinal bleeding.

Materials and methods: a case report of transcatheter embolization of splenic artery aneurysm using the «front-to-back-door» technique using coils and telescopic system, is presented.

Results: patient was discharged on the 3rd day after embolization. The postoperative period proceeded calmly, there was no abdominal pain, indicators of clinical and biochemical blood tests were within acceptable limits.

Conclusions: studies devoted to treatment of giant aneurysms of splenic artery are not described in the modern literature, there are only few reports. Treatment of this type of ASA can lead to an increase in the cost of procedure, but minimal invasiveness, technical success, almost no deaths and early activation of patients make it possible to consider transcatheter endovascular embolization as the only possible method of treatment.

References

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https://doi.org/10.1016/j.jvs.2020.01.039

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https://doi.org/10.1177/0300060519873256

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https://doi.org/10.1016/j.jemermed.2020.02.014

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https://doi.org/10.1016/j.jvs.2018.06.198

5.     Venturini M, Piacentino F, Coppola A, et al. Visceral Artery Aneurysms Embolization and Other Interventional Options: State of the Art and New Perspectives. J Clin Med. 2021; 10: 2520.

https://doi.org/10.3390/jcm10112520

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https://doi.org/10.1016/j.jviscsurg.2016.03.008

8.     Kok HK, Asadi H, Sheehan M, et al. Systematic review and single center experience for endovascular management of visceral and renal artery aneurysms. J. Vasc. Interv. Radiol. 2016; 27: 1630-1641.

https://doi.org/10.1016/j.jvir.2016.07.030

9.     Gorsi U, Agarwal V, Nair V, et al. Endovascular and percutaneous transabdominal embolisation of pseudoaneurysms in pancreatitis: An experience from a tertiary-care referral centre. Clin. Radiol. 2021; 76(314): 17-23.

https://doi.org/10.1016/j.crad.2020.12.016

10.   Barrionuevo P, Malas MB, Nejim B, et al. A systematic review and meta-analysis of the management of visceral artery aneurysms. J. Vasc. Surg. 2020; 72: 40-45.

https://doi.org/10.1016/j.jvs.2020.05.018

11.   Vemireddy LP, Majlesi D, Prasad S, et al. Early Thrombosis of Splenic Artery Stent Graft. Cureus. 2021; 13: 16285.

https://doi.org/10.7759/cureus.16285

12.   Kapranov MS, Kulikovskiy VF, Karpachev AA, et al. A Case Report of Successful Endovascular Treatment of «Sentinel Bleeding» in Patient with Adverse Anatomy. EJMCM. 2020; 7(2): 146-150.

https://doi.org/10.31838/ejmcm.07.02.24

13.   Саховский С.А., Абугов С.А., Вартанян Э.Л. и др. Эндоваскулярная коррекция структурной патологии клапанов и аорты у реципиентов сердца. Эндоваскулярная хирургия. 2021; 8(1): 53-9.

Sakhovskii SA, Abugov SA, Vartanyan EL, et al. Transcatheter correction of structural valve and aortic diseases in heart recipients. Endovaskulyarnaya khirurgiya. 2021; 8(1): 53-9 [In Russ].

https://doi.org/10.24183/2409-4080-2021-8-1-53-59

14.   Tipaldi MA, Krokidis M, Orgera G, et al. Endovascular management of giant visceral artery aneurysms. Sci Rep. 2021; 11: 700.

https://doi.org/10.1038/s41598-020-80150-2

Abstract

Article provides a literature review on problems of diagnosing of intracranial aneurysms (IA) rupture and its complications.

Aim: was to study relevant data on the use of computed tomography (CT), as well as other imaging methods, in patients with ruptured aneurysms in the acute period.

Materials and methods: a search was conducted for publications on this topic, dating up to December 2019, using main Internet resources: PubMed databases, scientific electronic library (Elibrary), Scopus, ScienceDirect, Google Scholar.

Results: we analyzed 45 literature sources, covering the period from 1993 to 2019, which include 3 meta-analyzes, 5 descriptions of studies evaluating the effectiveness of various visualization methods for ruptured IA. Both foreign and Russian publications were involved.

Conclusion: native CT is the leading visualization method to detect hemorrhages in nearest hours after the rupture of IA. CT angiography in combination with digital subtraction angiography (DSA), according to the vast majority of authors, allows to make thorough preoperative planning in the shortest time, as well as to identify unruptured aneurysms. Based on the obtained data, it is advisable to conduct a study to assess the role of CT in the acute period of IA rupture, as well as in the diagnosis of complications in the early postoperative period.

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Abstract:

A 57-year-old woman was on the waiting list of Orthotopic Liver Transplantation (OLT) due to cirrhosis of viral etiology MSCT with contrast enhancement showed two aneurysms of the splenic artery, stenosis of the celiac trunk with aneurysm of the pancreaticoduodenal artery Taking into account asymptomatic course, we decided to eradicate vascular changes during the forthcoming OLT OLT performed 6 month later, was technically difficult and complicated by massive blood loss and episodes of unstable hemodynamics, so surgical correction of aneurysms was not performed because of high risk. The patient was well and asymptomatic for 2 years after the OLT, but then she developed abdominal pain. MSCT showed progression of vascular changes. Successful endovascular treatment included celiac trunk stenting and embolization of aneurysms. 

References

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Abstract:

Aim: was to evaluate possibilities and advantages of endovascular treatment of intracranial aneurysms (IA) and arteriovenous malformations (AVM) using three-dimensional navigation (3D-roadmapping).

Materials and methods: during 2010-2013 years 103 embolizations of IA and AVM ir 88 patients were performed in our angiography department. Embolizations of IA were managed by metallic detachable coils, embolizations of AVM - by Histoacryl : Lipiodol glue composition. 3D-roadmapping technique was applied for guidance of endovascular tools in cerebral arteries anc catheterization the IA cavity and AVM-feeding arteries during the procedure. 3D-roadmapping technique is based on creation of composite images that consist of two-dimensional fluoroscopic views superimposed on virtual three-dimensional model of the vessel.

Results: endovascular interventions with 3D-roadmapping were performed in 65(63%) cases. In 49 (75%) cases we used 3DRA data to create three-dimensional model of cerebral vessels and in 16 (25%) cases - CT-angiography data. Complex algorithm of diagnosis and endovascular treatment of IA and AVM using 3D-roadmapping was introduced.

Conclusion: our experience of the endovascular embolization of IA and AVM with 3D-roadmapping convincingly showed that usage of this technique is possible and effective. In comparison with two-dimensional navigation there was a tendency in reduction of the effective exposure dose, also there was a statistically significant decrease of amount of contrast material , and of time for superselective catheterization of AVM-feeding arteries and IA cavity. 

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3.     Методические Указания 2.6.1.2944-11 «Контроль эффективных доз облучения пациентов при проведении медицинских рентгенологических исследований». Metodicheskie Ukazanija 2.6.1.2944-11 «Kontrol jeffektivnyh doz obluchenija pacientov pri provedenii medicinskih rentgenologicheskih issledovanij»[«Control of effective patient dose in medical X-ray examinations»] [In Russ].

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Abstract:

Aim: was to evaluate efficiency of stents-grafts in treatment of cerebral aneurysms.

Materials and methods: for the period of 2001-2012 implantation of stent-grafts was performedm 10 patients with cerebral aneurysms. Indications for implantation: huge or giant aneurysms; wide«neck» of aneurysm; difficult localization for neurosurgical techniques; absence of significant tortuosity of artery that could interfere successful stent delivery All patients underwent examination:

MSCT-angiography, MRI, cerebral angiography To predict possible stent thrombosis we performed angiographic tests with pinching of pathological artery and contrasting of opposite artery Then we assessed blood-flow of anterior and posterior communicating arteries and also changes in neurological status. Unsatisfactory condition of collateral blood-flow - was not a contraindication for stenting. In 8 patient, aneurysms were localized in internal carotid artery, and in 2 patients in the vertebrobasilar artery In 3 cases implantation of stent-graft was proceeded in acute period of hemorrhage; that caused late disaggregant therapy (immediately after implantation, drugs were injected through nasogastric tube instead of 4-5 days of preoperative treatment).

Results: exclusion of the aneurysm from the blood-flow was reached 100% of cases. In one case, implantation of micro-coils was necessary due to inability to cover the whole neck of the aneurysm because of tortuosity of artery In 1 case we had thrombosis of stent in vertebral artery with spreading of thrombosis on basilar artery with development of ischemic stroke and further death.

Conclusion: use of stent-grafts for exclusion of huge and giant aneurysms from cerebral blood- flow is a highly effective method.

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