Abstract:

Background: atrial septal defect (ASD) is characterized by a progressive increase in pulmonary vascular resistance and, accordingly, pressure in small circulation circle. It is noteworthy that these hemodynamic changes go in parallel with morphofunctional changes in small vessels of pulmonary artery system. At the same time, changes in hemodynamics of small circulatory circulation after endovascular closure in this category of patients and reversibility of pulmonary hypertension are not fully studied.

Aim: was to assess clinical course, indicators of cardiac chamber geometry and hemodynamics of small circulation circle after transcatheter closure of secondary ASD in adult patients with moderate and significant pulmonary hypertension in immediate and long-term periods.

Material and methods: from 2009 to 2020, 103 patients (mean age 48,3 ± 15,3 years) with secondary ASD underwent endovascular transcatheter closure of the defect. 60 (58,3%) patients had pulmonary hypertension. Depending on systolic pulmonary arterial pressure (SPAP), patients were divided into 3 groups: the first group consisted of 41 (68,3%) patients with mild PH (from 40 to 49 mm Hg); the second group included 10 (16,6%) patients with moderate PH (50 to 59 Hg); and the third group consisted of 9 (15%) patients with high SPAP (? 60 mm Hg). Average pulmonary artery systolic pressure in groups was: 43,6 ± 2,9 mm Hg; 52,1 ± 2,5 mm Hg; 64,4 ± 5,2 mm Hg, respectively. Average sizes of ASD (according to Pre-TEE data) were 18,7 + 6,1 mm; 22,1 ± 7,5 mm and 21,3 ± 5,3 mm, respectively. In all cases, echocardiographic signs of the right heart volume overload were detected. Follow-up was performed on an outpatient basis with an assessment of the clinical status and TTE in the long-term period.

Results: technical success of endovascular defect closure was 100%. Average size of the occluder was 26,3 + 6,96 (from 12 to 40) mm. Immediately after implantation of device, complete closure of ASD was observed in 55 (91,7%) cases. Residual flow (<3 mm) was observed in 5 cases (2 cases in the first group, 1 case in second group, and 2 cases in third group, (p >0,05)). In the vast majority of cases - 54 (90%) hospital period proceeded smoothly. All patients were examined in the long-term period (on average 12,5 + 6,5 months). The survival rate in groups was 100%. In the long- term follow-up remodeling of the right heart was observed in all patients. In the first group the size of RA decreased from 6,0 ± 0,5 cm to 3,3 ± 0,4 cm, RV size decreased from 4,7 ± 0,5 to 3,1 ± 0,4 cm; in the second group RA from 5,7 ± 0,7 cm to 3,8 ± 0,5 cm, RV - from 4,7 ± 0,9 to 3,8 ± 0,6 cm; in the third group RA - from 5,5 ± 0,6 cm and 4,2 ± 0,5 cm, the size of RV decreased from 4,5 ± 0,6 4,0 ± 0,5 cm, respectively. In all patients, significant decrease in SPAP was observed, in some cases up to normalization. In the first group, SPAP decreased from 43,7 ± 2,9 to 32,1 ± 2,6 mmHg, in the second group - from 52,1 ± 2,5 to 34,3 ± 2,6 mmHg; in the third group - from 64,4 ± 5,2 to 50,3 ± 4,8 mmHg. The most expressed decrease of pressure occurred in the second group of patients. At the same time, in the third group, dynamics of pressure reduction was significantly less expressed in comparison with the other two groups. At the same time in two patients of third group high PH remained in the long-term period, despite the successful closure of the defect.

Conclusion: results show that in case of left-right shunt in the absence of hypoxemia, transcatheter closure of ASD in adult patients with moderate and significant pulmonary hypertension is a pathophysiologically and clinically justified, is a highly effective treatment method that allows achieving significant improvement of both clinical manifestations and intracardiac and systemic hemodynamics. In patients with a significant degree of pulmonary hypertension and a high probability of the latter, the following tactical approaches may be considered:

1. primary closure of defect with further drug therapy;

2. primary drug therapy aimed on regulating of the anatomic-functional state of the arterial bed of the small circulation and hence reducing pulmonary vascular resistance followed by endovascular ASD-closure;

3. closure of the defect with a fenestrated occluder (in case of a negative test for temporary balloon occlusion), followed by drug therapy. This assumption can be considered in future research.

References

1.     Jain S, Dalvi B. Atrial septal defect with pulmonary hypertension: when/how can we consider closure? J Thorac Dis. 2018; 10(24): 2890-2898.

2.     Fraisse, et al. Atrial Septal Defect Closure: Indications and Contra-Indications. J Thorac Dis. 2018; 10(24): 2874-2881.

3.     Akagi T. Current concept of transcatheter closure of atrial septal defect in adults. J Cardiol. 2015; 65(1): 17-25.

4.     Kefer J. Percutaneous Transcatheter Closure of Interatrial Septal Defect in Adults: Procedural Outcome and Long-Term Results. Catheter Cardiovasc Interv. 2012; 79(2): 322-30.

5.     Gruner C, Akkaya E, Kretschmar O, et al. Pharmacologic preconditioning therapy prior to atrial septal defect closure in patients at high risk for acute pulmonary edema. J Interv Cardiol. 2012; 25: 505-12.

6.     Abaci A, Unlu S, Alsancak Y, et al. Short- and long-term complications of device closure of atrial septal defect and patent foramen ovale: metaanalysis of 28,142 patients from 203 studies. Catheter Cardiovasc Interv. 2013; 82(7): 1123-1138.

7.     Humenberger M, Rosenhek R, Gabriel H, et al. Benefit of atrial septal defect closure in adults: impact of age. Eur Heart J. 2011; 32: 553-560.

8.     Ioseliani DG, Kovalchuk IA, Rafaeli TR, et al. Simultaneous Percutaneous Coronary Intervention and Endovascular Closure of Atrial Septal Defect in Adults. Kardiologia. 2019; 59(2): 56-60 [In Russ].

9.     Correction to: 2018 AHA/ACC Guideline for the Management of Adults with Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019; 139(14): 833-834.

10.   Gali? N, Humbert M, Vachiery JL, et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J. 2016; 37(1): 67-119.

11.   Haas NA, Soetemann DB, Ates I, et al. Closure of secundum atrial septal defects by using the occlutech occluder devices in more than 1300 patients: the IRFACODE project: a retrospective case series. Catheter Cardiovasc Interv. 2016; 88: 71-81.

12.   Nakahawa K, Akagi T, Taniguchi M, et al. Transcatheter closure of atrial septal defect in a geriatric population. Catheter Cardiovasc Interv. 2012.

13.   Marwick TH, Gillebert TC, Aurigemma G, et al. Recommendations on the Use of Echocardiography in Adult Hypertension: A Report from the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE). J Am Soc Echocardiogr. 2015; 28(7): 727-754.

14.   Galderisi M, Cosyns B, Edvardsen T, et al. Standardization of adult transthoracic echocardiography reporting in agreement with recent chamber quantification, diastolic function, and heart valve disease recommendations: an expert consensus document of the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2017; 18(12): 1301-1310.

15.   Bossone E, D'Andrea A, D'Alto M, et al. Echocardiography in pulmonary arterial hypertension: from diagnosis to prognosis. J Am Soc Echocardiogr. 2013; 26(1): 1-14.

16.   Miranda WR, Hagler DJ, Reeder GS, et al. Temporary balloon occlusion of atrial septal defects in suspected or documented left ventricular diastolic dysfunction: Hemodynamic and clinical findings. Catheter Cardiovasc Interv. 2019; 93(6): 1069-1075.

17.   Shin C, Kim J, Kim J-Y, et al. Determinants of serial left ventricular diastolic functional change after device closure of atrial septal defect. JACC. 2020; 75(11).

18.   Martin-Garcia AC, Dimopoulos K, Boutsikou M, et al. Tricuspid regurgitation severity after atrial septal defect closure or pulmonic valve replacement. Heart. 2020; 106(6): 455-461.

19.   Zwijnenburg RD, Baggen VJM, Witsenburg M, et al. Risk Factors for Pulmonary Hypertension in Adults After Atrial Septal Defect Closure. Am J Cardiol. 2019; 123(8): 1336-1342.

Abstract:

Purpose. Was to еstablish the informative value of 3-phase scintigraphy in assessment of blood flow and identify pyo-inflammatory process in patients with neuropathic, ischemic, and mixed forms of diabetic foot.

Materials and methods. This study includes the results of three-phase scintigraphy of 76 patients with diabetes mellitus and with suspicion of osteomyelitis in diabetic foot. Results were verified with morphological study in 39 patients.

Results. In patients with diabetic foot the depression of the main vessels blood flow and blood flow prevalence the changes intraosseous blood flow. Three-phase scintigraphy revealed a lower specificity (66,7%) in the diagnosis of osteomyelitis in patients with diabetes mellitus at the sensitivity (94,7%) and accuracy (73,7%).

Conclusions. Three-phase scintigraphy is high-performance method in revealing the arterial and peripheral blood flow disorder in patients with diabetes mellitus. The low specificity of the three-phase scintigraphy with high sensitivity indicates the limited possibilities of the method in the identification of pyo-inflammatory process in patients with diabetes mellitus. The observed preservation of blood flow makes it possible to expand indications of methods of nuclear medicines and applies scintigraphy with labeled leukocytes for indication purulent infection in patients with complicated course. 

References

1.    Capriotti G. et al. Nuclear medicine imaging of diabetic foot infection: results of meta-analysis. Nucl. Med. Commun. 2006; 27 (10):757–764.

2.    Kaim A. et al. Chronic complicated osteomyelitis of the appendicular skeleton.Diagnosis with 99mTc labeled monoclonal anti-granulocyte antibody-immunoscintigraphy. Eur. J. Nucl. Med. 1997; 24 (7): 732–738.

3.    Unal S.N. et al. Comparison of 99mTc methylene diphosphonate, 99mTc human immuneglobulin, and 99mTc labeled white blood cell scintigraphy in the diabetic foot. Clin. Nucl. Med. 2001; 26 (12): 101–1021.

4.    Devillers A. et al. Contribution of 99mTc hex-amethylpropylene amine oximelabelled leucocyte scintngraphy to the diagnosis of diabetic foot infection. Eur. J. Nucl. Med. 1998; 25(2): 132–138.

5.    E-Maghraby T.A. Nuclear medicine methods for evaluation of skeletal infection among other diagnostic modalities. J. Nucl. Med. Mol. Imaging. 2006; 50 (3): 167–192.

6.    Soluri A. et al. High resolution mini-gammacamera and 99mTc [HMPAO] leukocytes for diagnosis of infection and radioguided surgery in diabetic foot. G. Chir. 2005; 26 (6–7): 246–250.

7.    Prandini N. et al. Nuclear medicine imaging of bone infections. Nucl. Med. Commun. 2006;27 (8): 633–644.

8.    Christopher J.P. et al. Osteomyelitis: Diagnosis with 99mTc labeled Antigranulocyte Anti-bodies Compared with Diagnosis with 111Inlabeled Leukocytes – Initial Experience. Radiology. 2002; 223: 758–764.

9.    Palestro C.J. et al. Rapid diagnosis of pedal osteomyelitis in diabetics with a technetium-99mTc labeled monoclonal antigranulocyte antibody. J. Foot. Ankle. Surg. 2003; 42 (1): 2–8.

10.  Stephen L.H. et al. The Effects of Peripheral Vascular Disease with Osteomyelitis in the Diabetic Foot. Am. J. of Surg. 1999; 177:282–286.

11.  Завадовская В.Д. Лучевая диагностика остеомиелита Дис. Д-ра мед. наук. Томск. 1995; 290.

Abstract:

Aim: was to perform indirect estimation of pumping function of left ventricle (LV) in patients with ischemic heart disease (IHD), before and after mini-invasive intracoronary procedures or elimination of cardiac arrhythmias, basing on condition of pulmonary circulation.

Material and methods: research includes data of 44 patients with IHD (aged 43-89), who were admitted to the hospital with acute coronary syndrome (ACS) or cardiac arrhythmia. Estimation of pulmonary flow condition in IHD patients was made basing on data of chest multislice computec tomography (MSCT), changes of density of lung parenchyma in selected volume of lung before and after coronary stenting/placement of pacemaker, disruption of ectopic lesions and conduction pathway

Results: sighs of reliable changes in pulmonary circulation as local lung pneumatization changes with increased densitometric value within 10 hounsfield units (HU) after mini-invasive surgical treatment were found in 19 patients.

Conclusions: the study has showed high sensitivity of lung MSCT in diagnostics of left ventricular disfunction within coronary blood flow changes and normalization of cardiac rhythm. 

References

1.     Информационный бюллетень ВОЗ N 317 Март 2013г. http://www.who.int/mediacentre/factsheets/ fs317/ru/. Informacionnyj bjulleten' VOZ N 317 Mart 2013g [WHO Information bulletin # 317, march 2013]. http://www.who.int/mediacentre/factsheets/fs317/ru/ [In Russ]

2.    Demograficheskij ezhegodnik Rossii, 2012 [Demographic yearbook of Russian Federation, 2012]. Stat sb. Rosstat. M: 2012; 535 [In Russ].

3.     Oganov R.G., Maslennikova G.Ja. Demograficheskie tendencii v Rossijskoj Federacii: vklad boleznej sistemy krovoobrashhenija [Demographic trends in Russian Federation: the role of diseases of blood circulation]. Kardiovask. ter. i prof 2012; 1:5-10 [In Russ].

4.     Koncevaja A.V, Kalinina A.M., Koltunov I.E., Oganov R.G. Social'no-jekonomicheskij ushherb ot ostrogo koronarnogo sindroma v Rossijskoj Federacii.GNIC profilakticheskoj mediciny [Social-economic lesion of acute coronary syndrome in Russian Federation]. Racionarnaja farmakoterapija v kardiologii. 2011 7(2): 158-166 [In Russ].

5.     Salvador M.J., Sebaoun, F. Sonntag, P. et. al. European Study of Ambulatory Management of Heart Failure . Rev. Esp. Cardiol. 2004;57(12):1170-8.

6.     Obrezan A.G., Vologdina I.V. Hronicheskaja serdechnaja nedostatochnost [Chronic heart insufficiency]'. «Vita Nova». 2002; 320 s [In Russ].

7.     Belenkov Ju.N., Mareev VJu., Principy racional'nogo lechenija serdechnoj nedostatochnosti [Principles of heart insufficiency treatment]. M. 2000; 173s [In Russ].

8.     Rezcalla S.H., Kloner R.A. Coronary no-reflow phenomenon: from the experimental laboratory to the cardiac catheterization laboratory. Catheter Cardiovasc. Interv. 2008; 72: 950-957.

9.     Tihonov K.B. Funkcional'naja rentgenoanatomija serdca [Functional endovascular anatomy]. Izd. Medicina. M. 1990; 272 s [In Russ].

10.   Sebastian C.A., Bekkers M., Waltenberger J. Microvascular Obstruction: underlying pathophisiology and clinical diagnosis. J. Am. Coll. Car. 2010; 55:16491660.

11.   Abbate A., Kontos M.C. No-Reflow: the next challenge in treatment of ST-elevation acute myocardial infarction. Eur. Heart J. 2008; 29: 1795-1797.

12.   Beljalov F.I Aritmii serdca [Cardiac arrythmias]. RIO IMAPO. 2011; 333s [In Russ].

13.   Trufanov G.E., Zheleznjak I.S., Rud' S.D., Men'kov I.A. MRT v diagnostike ishemicheskoj bolezni serdca [MRI in diagnostics of ischemic heart diseases]. Jelbi-SPb. 2012; 64 s [In Russ].

14.   Гранов А.М., Тютин Л.А. Позитронно-эмиссионная томография. Издательстово Фолиант. 2008;368 c. Granov A.M., Tjutin L.A. Pozitronno-jemissionnaja tomografija [Positron Emission Tomography]. Izdatel'stovo Foliant. 2008;368 s [In Russ].

15.   Turner F., Lau F., Jacobson G. A method for estimation of pulmonary venosus and arterial pressures from the routine chest roentgenogram. Amer. J. Roentgenol. 1972; 116: 97-106.

16.   Petrenko I.E. Rentgenologicheskie projavlenija levozheludochkovoj nedostatochnosti serdca i rentgenodiagnostika nekotoryh oslozhnenij pri ostrom infarkte miokarda [Radiographic manifestations of left ventricle insufficiency and radiographic diagnostics of complications of acute coronary syndrome]. Avtoreferat. dis. uchen. ctep. kand. med. nauk L. 1982 [In Russ].

17.   Storto M.L., Kee S.T., Golden, J.A. Webb W.R. Hydrostatic pulmonary edema: high-resolution CT findings. AJR:165, October 1995: 817-820.

18.   Kato S., Nakamoto T., Iizuka M. Early diagnosis and estimation of pulmonary congestion and edema in patients with left-sided heart disease from histogram. Pulmonary CT Number. ST 1996; 109:1439-45.

19.   Pelosi P, Gama de Abreu M. Lung CT scan. The Open Nuclear Medicine Journal. 2010; 2: 86-98.

20.   Hanneman K., Nguyen E.T., Crean A.M. Hypertrophic cardiomyopathy complicated by pulmonary edema in the postpartum period. Hinduri рublishing corporation сase reports in radiology. V. 2013; Article ID 802352, 3 pages http://dx.doi.org/10.1155/2013/80235.

21.   Claudia M., Cunha R., Edson M., Rodrigeus R., Hydrostatic pulmonary edema: high-resolution computed tomography aspects. J. Bras. Pneumol. 2006; 32 (6): 515-22.

22.   Gonzales J., Verin A. Non-Cardiogenic Pulmonary Edema, Lung Diseases - Selected State of the Art Reviews, Ed. Dr. Elvisegran M. I. 2012, ISBN: 978-953-51-0180-2, InTech, Available from:http://www.intechopen.com/ books/lung-diseases-selected-state-of-the-art- reviews/non-cardiogenic-pulmonary-edema.

23.   Min'ko B.A., Vologdina I.V., Borodich P.L. Rol' kompjuternoj tomografii legkih u bol'nyh ishemicheskoj boleznju serdca v ocenke funkcii levogo zheludochka pri maloinvazivnyh hirurgicheskih vmeshatel'stvah [The role of computed tomography of lungs in estimation of left ventricle function during mini-invasive interventions in patients with ischemic heart disease]. REJR. 2015; 5(1): 64-67 [In Russ]. 

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. 

References

1.     Atayan A.A. Optimizacia lechebno-diagnosticheskoy taktiki u bolnih s ostroy intestinalnoy ishemiei. [Optimization of treatment and diagnostic tactics in patients with acute intestinal ischemia]. Diss. kand. med. Moskva. 2013:124 s [In Russ].

2.     Ermolov A.S., Alekseechkina O.A., Abuchina V.M. i dr. Vozmozhnosti ultrazvukovogo issledovaniya v diagnostike neokkluzionnogo narusheniya krovoobrashenia kishechnika. [Possibilities of ultrasound in the diagnosis of nonocclusive mesenteric blood-flow disorders]. Diagnosticeskaya I intervancionnaya radiologia. 2015; 9(2): 10-15 [In Russ].

3.     Goleanu V, Alecu L, Lazar O. Acute mesenteric ischemia after heart surgery. Chirurgia (Bucur). 2014; 109(3):402-6.

4.     Pokrovskiy A.V., Yudin V.I. Ostraya mezenterial’naya neprokhodimost. Klinicheskaya Angiologia: rukovodstvo pod red. A.V.Pokrovskogo. [Acute mesenteric ischemia. Clinical angiology: under edition of A.V.Pokrovskiy]. V dvuh tomah. Tom 2. M: Meditsina. 2004; 626-645 [In Russ].

5.     Trotter LBG. Tiedemann: embolism and thrombosis of mesenteric vessels. Cambridge. Cambridge University Press. 1913: 143.

6.     Yushkevich D.V., Hryischanovich V.Ya., Ladutko I.M. Diagnostika i lechenie ostrogo narusheniya mezenterial’nogo krovoobrasheniya: sovremennoe sostoyanie problemi. [Diagnostics and treatment of acute disorders of mesenterial blood flow: modern condition of problem]. Medicinskiy nauchniy zhurnal: nauchno-practicheskiy retsenziruemiy zhurnal. 2013; 3: 38-44 [In Russ].

7.     Andrew Oldenburg W., Louis Lau L., Thomas J. Rodenberg, Hope J. Edmonds, Charles D. Burger Acute Mesenteric Ischemia: A Clinical Review. Arch Intern Med. 2004;164(10):1054-1062.

8.     Eliot J.W. The operative relief of gangrene of the intestine due to occlusion of the mesenteric vessels. Ann. Surg. 1895;21:9-23.

9.     Davidov Yu.A. Infarkt kishechnika i hronicheskaya mesenterial’naya ishemiya. [Intestinal infarction and chronic mesenteric ischemia]. M: Medicina. 1997; 208 [In Russ].

10.   Savel’ev V.S., Spiridonov I.V. Ostrie narusheniaya mesenterial’nogo krovoobrashenia. [Acute mesenteric blood-flow disorders]. M: Medicina. 1979; 232 [In Russ].

11.   Savel’ev V.S., Spiridonov I.V., Boldin B.V. Ostrie narusheniaya mesenterial’nogo krovoobrashenia. Infarkt kishechnika. Rukovodstvo po neotlozhnoy hirurgii pod red. V.S. Savel’ev [Acute mesenteric blood-flow disorders. Intestinal infarction. Urgent surgery guideline under edition of V.S. Savel’ev]. Triada-X. 2005; 281-302 [In Russ].

12.   Shugaev A.I., Vovk A.V., Babkin V.Ya. Ostrie narusheniya mezenterialnogo krovoobrasheniya - aktualnaya problema v neotlozhnoi khirurgii organov brushnoi polosti. [Acute disorders of mesenteric blood flow - an actual problem of urgent abdominal surgery]. Ambulatornaya hirurgia. Statsionarzameshayushie tehnologii. 2005;20 (4):112 [In Russ].

13.   Grinberg A.A. Neotlozhnaya abdominalnaya hirurgia. [Urgent abdominal surgery (guide-book for phisicians)]. M: Triada-X. 2000: 496 S. [In Russ].

14.   Acosta S. Epidemiology of mesenteric vascular disease: clinical implications. Semin Vasc Surg. 2010 Mar; 23(1):4-8.

15.   Bradbury A.W., Brittenden, J.McBride, K.Ruckley, C.V. Mesenteric ischaemia: a multidisciplinary approach. Br. J. Surg. 1995;821446-1459.

16.   Solomentseva T.A.. Ostrie narusheniya mesenterialnogo kroovbrasheniya v terapevticheskoi clinike. [Acute disorders of mesenteric blood flow in therapeutic clinics.] Ostrie I neotlozhnie sostoyania v praktike vrachha. (Electronic version - http://urgent.com.ua/article/369.html) 2011: #2(26) [In Russ].

17.   Acosta S., Ogren M., Sternby N.H. et al. Mesenteric venous thrombosis with transmural intestinal infarction: a population-based study. J. Vasc. Surg. 2005; 41: 1683-1688.

18.   Timerbulatov Sh.V., Sagitov R.B., Sultanbaev A.Y., Asmanov D.I. Diagnostika ishemicheskih povrazhdeniy pri ostrih hirurgicheskih zabolevaniyah organov brushnoi polosti. [Diagnostics of ischemic lesions in patients with acute diseases of abdominal organs]. Klinicheskaya o eksperimentalsya hirurgia. 2012; 3: 40-52 [In Russ].

19.   Lubyanskiy V.G., Zharikov A.N., Kanteeva Ju.L.. Hirurgicheskoe lechenie bolnih s ostrim mesenterial’nim trombozom s nekrozom kishki I peritonitom. [Surgical treatment of patients with acute mesenteric thrombosis complicated by intestinal necrosis and peritonitis]. Kubanskiy nauchniy meditsinskiy vestnik. 2013; 138 (3): 85-89 [In Russ].

20.   AbuRahma A.F., Stone P.A., Bates M.C., Welch C.A. Angioplasty/stenting of the superior mesenteric artery and celiac trunk: Early and late outcomes. J Endovasc Ther. 2003;10:1046-1053.

21.   Hadi Rokni Yazdi, Fadi Youness, Sandeep Laroia, Shiliand Sun, Hicham Abada, Melhem Sharafuddin, Jafar Golzarian. Mesenteric Artery Stenting for Chronic Mesenteric Ischemia. Vascular disease management. 2007;4(6): 180-184.

22.   Hoffmann M., Keck T. Management of mesenteric ischemia and mesenteric vein thrombosis. Dtsch Med Wochenschr. 2014 Jul;139(30):1540-4.

23.   Cunningham C.G. et al. Chronic visceral ischemia. Ann Surg. 1991 Sep;214(3):276-87.

24.   Kubanov A.V., Rudman V.Ya., Grigoriev I.A., Shubin E.A., Polyarush V.P., Letskin A.Ya., Poshataev K.E. Sluchai uspeshnogo endovaskularnogo lesheniya ostrogo tromboza verkhney brizheechnoi arterii. [Case report: successful endovascular treatment of acute thrombosis of superior mesenteric artery]. Dalnevostochniy medicinskiy zhurnal. 2013; 2: 95-97 [In Russ].

25.   Arthurs Z.M., Titus J., Bannazadeh M. A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia, J. Vascular Surgery. 2011 № 53(3): 698-704.

26.   Urayama H, Ohtake H, Kawakami T, Tsunezuka Y Yokoi K, Watanabe Y Acute mesenteric vascular occlusion: analysis of 39 patients. Eur J Surg. 1998 Mar; 164(3): 195-200.