Abstract:

Background: mortality in polytrauma with pelvic injuries and intrapelvic bleeding remains high and can be reduced through a multidisciplinary approach to hemostasis.

Aim: was to determine possibilities and tactics of using endovascular interventions to stop intrapelvic bleeding in polytrauma with pelvic injuries.

Material and methods: a search was made for scientific articles in the PubMed database and the Scientific Electronic Library (eLIBRARY.ru), published from 2017 to 2021. Transcatheter embolization of pelvic arteries is an effective method for stopping intrapelvic bleeding and is indicated for detecting extravasation of contrast in computed tomography and angiography. In patients with unstable hemodynamics, embolization can be used if it is possible to perform it no later than 30-60 minutes after the detection of intrapelvic bleeding. Resuscitation endovascular balloon occlusion of the aorta can serve as an important component of the damage control strategy and a bridge to the application of methods for the final control of abdominal and intrapelvic bleeding in patients with unstable hemodynamics and systolic blood pressure less than 70 mm hg.

Conclusion: methods of endovascular surgery do not oppose and do not exclude the use of extraperitoneal pelvic packing and/or external fixation of the pelvis to stop intrapelvic bleeding in case of polytrauma. The choice of methods of hemostasis and the algorithm for their application are determined by the degree of hemodynamic disturbances, the presence of combined injuries, the data of radiation diagnostics, and the technical and logistical resources of the trauma center.

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: dextrocardia - is a congenital heart disease, in which the heart is located in right half of chest. Incidence of ischemic heart disease in patients with dextrocardia is unknown, but some authors write that it is the same as in the general population. Guiding principles of endovascular treatment of chronic total occlusion (CTO) of coronary arteries, consider dualcatheter angiography to be an obligatory option for successful recanalization.

Aim: was to estimate possibilities of DRON-access and various radial accesses in treatment of multivessel disease in a patient with dextrocardia, severe comorbidity, and single vascular access.

Material and methods: we present case report of a 63-year-old female patient, who previously had ischemic stroke with tleft-sided hemiplegia; she was examined before surgery for instability of the prosthesis of right hip joint. Coronary angiography through traditional radial access revealed multivessel lesions of coronary arteries: chronic total occlusion (CTO) of right coronary artery, stenosis of the left anterior descending artery (LAD) in proximal and distal third; eccentric circumflex artery (Cx) stenosis. Further examination revealed: severe spastic paralysis of left hand, occlusion of left common femoral artery, chronic osteomyelitis of right leg with suppuration.

Medical consilium decided to perform staged endovascular revascularization of the myocardium.

For this purpose, to provide access for double-catheter recanalization of CTO and subsequent interventions, DRON-access (Distal radial and Radial One-handed accesses for interventions iN chronic occlusions of coronary arteries) and various radial accesses were used.

Results: at the first stage, using DRON-access, we performed double-catheter angiography and CTO recanalization of right coronary artery (RCA) with stenting. At the second stage, through traditional radial access, we performed angioplasty and stenting of LAD at two levels. After 3 months, control coronary angiography was performed through distal radial access: implanted stents had no signs of restenosis, there was no progression of atherosclerotic process. Patient was discharged to prepare for correction of instability of right hip joint prosthesis.

Conclusions: patients with severe and variable comorbidities require not only a multidisciplinary approach, but also, in various of clinical situations, need personalized approach. The use of DRON-access may allow operators to perform endovascular intervention using double-catheter angiography even in patients with single vascular access, which meets modern criteria for providing care for chronic coronary artery occlusions.

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

1.     Chaer RA, Abularrage CJ, Coleman DM, et al. The Society for Vascular Surgery clinical practice guidelines on the management of visceral aneurysms. J Vasc Surg. 2020; 72: 3-39.

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

2.     Wang W, Chang H, Liu B, et al. Long-term outcomes of elective transcatheter dense coil embolization for splenic artery aneurysms: a two-center experience. J Int Med Res. 2020; 48: 300060519873256.

https://doi.org/10.1177/0300060519873256

3.     Musselwhite CC, Mitta M, Sternberg M. Splenic Artery Pseudoaneurysm. J Emerg Med. 2020; 58: 231-232.

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4.     Rhusheet P, Mark G. Splenic artery pseudoaneurysm with hemosuccus pancreaticus requiring multimodal treatment. J. Vasc. Surg. 2019; 69: 592-595.

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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.

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6.     Hemp JH, Sabri SS. Endovascular management of visceral arterial aneurysms. Tech. Vasc. Interv. Radiol. 2015; 18: 14-23.

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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:

Introduction: research is dedicated to use of intracerebral laser photobiomodulation therapy (PBMT) in treatment of ischemic stroke after-effects in comparison with conservative therapy methods.

Aim: was to evaluate effectiveness of intracerebral transcatheter laser PBMT in patients with previous ischemic stroke.

Materials and methods: 836 patients were included in study, within the period from 6 months to 6 years after ischemic strokes of various severity, aged 29-81 (mean age 74,9): 593 men (70,93%), 243 women (29,07%). Test Group - 511 (61,12%) patients with distal lesions of intracerebral arteries who underwent transcatheter intracerebral laser PBMT; control Group - 325 (38,88%) patients with similar distal lesions of intracerebral arteries who received conservative treatment.

Results: Test Group: good clinical results were obtained in 259 (87,21%) cases after small focal strokes; in 94 (60,26%) after midfocal strokes; in 12 (20,69%) after macrofocal strokes. Satisfactory clinical results were obtained in 33 (11.11%) cases after small focal strokes; 39 (25,00%) after midfocal strokes; 22 (37,93%) after macrofocal strokes.

Control Group: 51 (21,07%) patients after small focal strokes showed good clinical results; patients after midfocal strokes and macrofocal strokes did not have good results; 60 (24,79%) patients after small focal strokes and 8 (19,05%) patients after midfocal strokes showed satisfactory clinical results; patients after macrofocal strokes did not have satisfactory results.

Conclusions: transcatheter intracerebral laser photobiomodulation therapy is an effective, pathogenetically substantiated method of treatment in patients with ischemic stroke after-effects, leading to restoration of activities of daily living, of cognitive and mental functions and returning patients to fully active life.

References

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6.     Maksimovich IV. Application of transcatheter laser technologies in treatment of atherosclerotic lesions of the brain. Diagnostic and Interventional Radiology. 2016; 10(3): 57-67 [In Russ].

7.     Hamblin MR. Photobiomodulation for Traumatic Brain Injury and Stroke. J Neurosci Res. 2018; 96(4): 731-743.

8.     Maksimovich IV. Results of brain transcatheter laser revascularization in the treatment of the consequences of ischemic stroke. J Vas Dis Treat. 2017; 1(1): 2-5.

9.     Pasi M, Cordonnier Ch. Clinical Relevance of Cerebral Small Vessel Diseases. Stroke. 2020; 51(1): 47-53.

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11.   Pendlebury ST, Rothwell PM. Incidence and prevalence of dementia associated with transient ischaemic attack and stroke: analysis of the population-based Oxford Vascular Study. Lancet Neurol. 2019; 18(3): 248-258.

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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

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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.

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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.

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Abstract:

Introduction: osteoarthritis (OA) is the most common disease of the musculoskeletal system, the main cause of pain development, loss of joint function and, as a consequence, one of leading factors of population disability. Treatment strategy for patients with gonarthrosis is not fully defined, especially in patients with grade 1-2. In this cohort of patients, conservative treatment is indicated, but it does not always lead to a decrease in the severity of pain, significantly reducing the quality of life. One of treatment options for such patients is transcatheter embolization of the hypervascular area of popliteal arteries.

Aim: was to present a case report of the successful use of transcatheter arterial embolization of branches of the popliteal artery in gonarthrosis.

Materials and methods: patient B., 72 years old, consulted a rheumatologist in November 2019 with complaints on pain in knee joints, aggravated by movements, going up and down stairs, as well as pain in the area of small joints of the feet, ankle, and shoulder joints. In view of the ineffectiveness of conservative therapy, patient was offered transcatheter embolization of branches of the hypervascular area of the popliteal artery. Selective embolization of the artery of the hypervascular vasculature of right knee joint was performed under local anesthesia.

Results: 1 month after the procedure, patient noticed a significant decrease in the intensity of pain in right knee joint, increased range of motion. The result of filling out the WOMAC questionnaire 1 month after embolization of popliteal artery branches was 26 points (satisfactory result). At the visit 3 months after the manipulation, patient noted the persistence of effect of procedure. The result of the WOMAC questionnaire is 22 points.

Conclusions: transcatheter arterial embolization of the hypervascular area in osteoarthritis of various origins and localization can be successfully used as an alternative treatment if conservative therapy is ineffective and if there are contraindications to surgical treatment.

References

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7.     Okuno Y, et al. Transcatheter arterial embolization as a treatment for medial knee pain in patients with mild to moderate osteoarthritis. CardioVascular and Interventional Radiology. 2015; 38(2): 336-343.

8.     Landers S, et al. Protocol for a single-centre, parallel-arm, randomised controlled superiority trial evaluating the effects of transcatheter arterial embolisation of abnormal knee neovasculature on pain, function and quality of life in people with knee osteoarthritis. BMJ open. 2017; 7(5).

9.     Palazzo C, et al. Risk factors and burden of osteoarthritis. Annals of physical and rehabilitation medicine. 2016; 59(3): 134-138.

10.   McAlindon TE, Bannuru RR, Sullivan MC, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis and Cartilage. 2014; 22(3): 363-388.

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15.   Turovskaya EF, Alekseeva LI, Filatova EG. Current ideas about the pathogenetic mechanisms of pain in osteoarthrosis. Scientific and practical rheumatology. 2014; 52 (4): 438-444 [In Russ].

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17.   Ashraf S, Mapp PI, Walsh DA. Contributions of angiogenesis to inflammation, joint damage, and pain in a rat model of osteoarthritis. Arthritis & Rheumatology. 2011; 63(9): 2700-2710.

Abstract:

Introduction: left atrial (LA) volumes measured during different phases of the cardiac cycle can be used for the evaluation of the LA functional properties before and after catheter ablation (CA). Increase of LA ejection fraction (EF) supposed to be early and more sensitive marker of LA reverse remodeling process, than LA volume and can be important for assessing the effectiveness of CA.

Aim: was to estimate volumetric parameters and function of LV before and after cryo- and radiofrequency catheter ablation of pulmonary veins in patients with paroxysmal atrial fibrillation.

Materials and methods: 21 patients with paroxysmal atrial fibrillation (AF) were included in study. All patients underwent multidetector computed tomography (MDCT) of pulmonary veins (PV) and LA before CA and 12±2 months after CA. 3-dimensional images at phases 0%, 40%, 75% of the cardiac cycle were used to assess LA functional properties.

Results: LA maximal volume before CA was increased insignificantly in patients with AF recurrence (124,52±38,22 ml vs. 117,89±23,94 ml, p>0,05). In patients without recurrence after CA, LA volumes decreased slightly (LA max 115,31±20,13 ml, p>0,05, LA min 73,43±14,91 ml, p>0,05), while in patients with recurrence increased (LA max 130,88±25,20 ml, p<0,05, LA min to 94,92±31,75 ml, p<0,05). Global LA ejection fraction was less in patients without recurrence before CA (22,37%±4,69 vs. 31,31%±9,89, p=0,013), but increased significantly after CA, while in patients with recurrence global LA EF was without relevant changes (36,54%±3,27 vs. 28,89%±9,41, p=0,011).

Conclusion: improved left atrial mechanical function was demonstrated in patients without any recurrence after ablation. The anatomic and functional reverse remodeling was not significant in patients with atrial fibrillation recurrence.

References

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https://doi.org/10.1177/1747493019897870

2.     Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2021; 42(5): 373-498.

https://doi.org/10.1093/eurheartj/ehaa612

3.     Hindricks G, Sepehri Shamloo A, Lenarczyk R, et al. Catheter ablation of atrial fibrillation: current status, techniques, outcomes and challenges. Kardiol Pol. 2018; 76(12): 1680-1686.

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4.     Artjuhina EA, Revishvili ASh. New technologies in the treatment of cardiac arrhythmias. Vysokotehnologichnaja medicina. 2017; 1: 7-15 [In Russ].

5.     Darby AE. Recurrent Atrial Fibrillation After Catheter Ablation: Considerations For Repeat Ablation And Strategies To Optimize Success. J Atr Fibrillation. 2016; 9(1): 1427.

https://doi.org/10.4022/jafib.1427

6.     Murray MI, Arnold A, Younis M, et al. Cryoballoon versus radiofrequency ablation for paroxysmal atrial fibrillation: a meta-analysis of randomized controlled trials. Clin Res Cardiol. 2018; 107(8): 658-669.

https://doi.org/10.1007/s00392-018-1232-4

7.     Kuck KH, Brugada J, F?rnkranz A, et al. Cryoballoon or Radiofrequency Ablation for Paroxysmal Atrial Fibrillation. N Engl J Med. 2016; 374(23): 2235-2245.

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10.   Tops LF, Bax JJ, Zeppenfeld K, et al. Effect of radiofrequency catheter ablation for atrial fibrillation on left atrial cavity size. Am J Cardiol. 2006; 97(8): 1220-1222.

https://doi.org/10.1016/j.amjcard.2005.11.043

11.   Tsao HM, Hu WC, Wu MH, et al. The impact of catheter ablation on the dynamic function of the left atrium in patients with atrial fibrillation: insights from four-dimensional computed tomographic images. J Cardiovasc Electrophysiol. 2010; 21(3): 270-277.

https://doi.org/10.1111/j.1540-8167.2009.01618.x

12.   Abhayaratna WP, Seward JB, Appleton CP, et al. Left atrial size: physiologic determinants and clinical applications. J Am Coll Cardiol. 2006; 47(12): 2357-2363.

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14.   Costa FM, Ferreira AM, Oliveira S, et al. Left atrial volume is more important than the type of atrial fibrillation in predicting the long-term success of catheter ablation. Int J Cardiol. 2015; 184: 56-61.

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15.   Avelar E, Durst R, Rosito GA, et al. Comparison of the accuracy of multidetector computed tomography versus two-dimensional echocardiography to measureleft atrial volume. Am J Cardiol. 2010; 106(1): 104-109.

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16.   K?hl JT, L?nborg J, Fuchs A, et al. Assessment of left atrial volume and function: a comparative study between echocardiography, magnetic resonance imaging and multi slice computed tomography. Int J Cardiovasc Imaging. 2012; 28(5): 1061-1071.

https://doi.org/10.1007/s10554-011-9930-2

17.   Hof I, Chilukuri K, Arbab-Zadeh A, et al. Does left atrial volume and pulmonary venous anatomy predict the outcome of catheter ablation of atrial fibrillation? J Cardiovasc Electrophysiol. 2009; 20(9): 1005-1010.

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https://doi.org/10.1016/j.amjcard.2013.05.034

20.   Lemola K, Sneider M, Desjardins B, et al. Effects of left atrial ablation of atrial fibrillation on size of the left atrium and pulmonary veins. Heart Rhythm. 2004; 1(5): 576-581.

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21.   Park MJ, Jung JI, Oh YS, et al. Assessment of the structural remodeling of the left atrium by 64-multislice cardiac CT: comparative studies in controls and patients with atrial fibrillation. Int J Cardiol. 2012; 159(3): 181-186.

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https://doi.org/10.1111/j.1540-8167.2007.01086.x 

Abstract

Background: ongoing abdominal and pelvic bleeding is one of main causes of deaths among patients with penetrating and blunt trauma. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a method for temporary patient's stabilization and reducing blood loss.

Aim: was to present result of work of 1st-level trauma-center: to describe experience of application of methodics of REBOA in center, to estimate its efficacy on the base of retrospective analysis of hospital charts of injured and heavy damaged patients.

Materials and methods: during the period between April 2013 and November 2017, 14 REBOA procedures to patients with abdominal (thoracic aorta occlusion) and pelvic (occlusion of the aortic bifurcation) bleeding were performed at the War Surgery Department of the «KirovMilitaryMedicalAcademy». A decision to do REBOA was made upon admission according to significant hypotension (systolic blood pressure [sBP] less than 70 mm Hg.) or cardiac arrest, abdominal free fluid and/or mechanically unstable pelvic fractures.

Results: mean time from admission to REBOA was 27,5 [10,0-52,5] minutes. The procedure took 10 [5-13] minutes. Average BP elevation after balloon inflation was 43±16 mm Hg. Survival in acute phase of trauma (first 12 hours) was 57.1%, while total survival rate was only 14.3% (2/14 patients). One REBOA-associated major complication was registered - development of irreversible ischemia due to long sheath dwell time in the femoral artery.

Conclusion: REBOA is effective for temporary hemodynamic stabilization and internal hemorrhage control, it allows increasing early survival in severe trauma. Factors to improve short- and long-term outcome, total survival warrant to be additionally investigated, especially in terms of intensive care improvement.

References

1.     Stannard A., Eliason J.L., Rasmussen T.E. Resuscitative endovascular balloon occlusion of the aorta (REBOA) as an adjunct for hemorrhagic shock. J. Trauma. 2011; 71(6): 1869-1872.

2.     Barnard E.B.G., Morrison J.J., Madureira R.M. et al. Resuscitative endovascular balloon occlusion of the aorta (REBOA): a population based gap analysis of trauma patients in England and Wales. Emerg. Med. J. 2015; 32 (12): 926-932.

3.     Brenner M.L., Moore L.J., DuBose J.J. et al. A clinical series of resuscitative endovascular balloon occlusion of the aorta for hemorrhage control and resuscitation. J. Trauma Acute Care Surg. 2013; 75 (3): 506-511.

4.     Moore L.J., Brenner M., Kozar R.A. et al. Implementation of resuscitative endovascular balloon occlusion of the aorta as an alternative to resuscitative thoracotomy for resuscitative balloon occlusion of the aorta (REBOA). J. Trauma Acute Care Surg. 2016; 81 (3): 409-419.

5.     Zavrazhnov A.A. Damage of large vessels of the abdomen: ways to improve diagnosis and treatment: Diss. kand. med. Nauk. St.Petersburg. 1996; 201 [In Russ].

6.     Sadeghi M., Nilsson K.F., Larzon T. et al. The use of aortic balloon occlusion in traumatic shock: first report from the ABO trauma registry. Eur. J. Trauma Emerg. Surg. 2018; 44 (4): 491-501.

7.     Hughes C.W. Use of an intra-aortic balloon catheter tamponade for controlling intra-abdominal hemorrhage in man. Surgery. 1954; 36 (1): 65-68.

8.     DuBose J.J., Scalea T.M., Brenner M. et al. The AAST prospective Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) registry: Data on contemporary utilization and outcomes of aortic occlusion and resuscitative balloon occlusion of the aorta (REBOA). J. Trauma Acute Care Surg. 2016; 81 (3): 409-419.

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Abstract:

Aim: was to evaluate immediate and long-term results of using the catheter-directed thrombosis (CDT) in patients with acute iliofemoral thrombosis.

Materials and methods: the study included 26 patients (9 men and 17 women aged 31-70) with primary or iliofemoral thrombosis, which was made by CDT Assessment of immediate results was conducted and long-term results were tracked after 12 months.

Results: technical success of treatment was achieved in 22 (84,6%) patients. In 7 (26.9%) patients after the completion of CDT, hemodynamically significant stenoses were identified and addition stenting of iliac veins were performed. Preservation of primary permeability after 12 months was observed in 26 patients (96.2%). The presence of pathological venous reflux was observed in 6(23.1%) cases. Development of post-thrombotic disease (PTD) of mild and medium severity was observed in 7 (26.9%) patients.

Conclusion: catheter-directed thrombolysis in combination with traditional anticoagulant therapy is a safe and effective method of treatment in patients with acute iliofemoral thrombosis, and allows quickly to restore venous patency and also to reduce risk of development and severity of clinical manifestation of PTD.

References

1.      Vedantham S, Thorpe PE, Cardella JF, Grassi CJ, Patel NH, Ferral H, et al. Quality Improvement Guidelines for the Treatment of Lower Extremity Deep Vein Thrombosis with Use of Endovascular Thrombus Removal. Journal of Vascular and Interventional Radiology. 2006; 17: 435-48.

2.      Henke PK, Comerota AJ. An update on etiology, prevention, and therapy of postthrombotic syndrome. Journal of Vascular Surgery. 2011; 53: 500-509.

3.      Mewissen MW, Seabrook GR, Meissner MH, Cynamon J, Labropoulos N, Haughton SH. Catheter-directed Thrombolysis for Lower Extremity Deep Venous Thrombosis: Report of a National Multicenter Registry. Radiology. 1999; 11: 39-49.

4.      Kahn SR, Partsch H. Definition of post-thrombotic syndrome of the leg for use in clinical investigations: a recommendation for standardization. Journal of Thrombosis and Haemostasis. 2009; 7: 879-83.

5.      Comerota AJ, Kamath V. Thrombolysis for iliofemoral deep venous thrombosis. Expert Review of Cardiovascular Therapy. 2013; 12:1631-1638.

6.      Semba CP, Dake MD. Iliofemoral deep venous thrombosis: aggressive therapy with catheter-directed thrombolysis. Radiology. 1994; 191: 487-494.

7.      Vedantham S., Sista A.K., Klein S.J., Nayak L., Razavi M.K., Kalva S.P., et al. Quality Improvement Guidelines for the Treatment of Lower-Extremity Deep Vein Thrombosis with Use of Endovascular Thrombus Removal. Journal of Vascular and Interventional Radiology. 2014; 25: 1317-1325.

8.      Vedantham S, Goldhaber S, Julian J. ATTRACT Trial Investigators. Pharmacomechanical catheter-directed thrombolysis deep-vein thrombosis. N Engl J Med. 2017; 23: 2240-2252.

9.      Kolbel T, Alhadad A, Acosta S, Lindh M, Ivancev K, Gottsдter A. Thrombus Embolization Into IVC Filters During Catheter-Directed Thrombolysis for Proximal Deep Venous Thrombosis. Journal of Endovascular Therapy. 2008; 15: 605-613.

Abstract:

It is known that the first transvenous probing of the right atrium of own heart in 1929 was conducted by the German physician W. Forsmann. In 1966, with the help of this technique, the American radiologist WJ. Rashkind first conducted atrioseptostomy of congenital heart disease.

Aim: was to search for priorities of Russian physicians in this field of interventional radiology

Materials and methods: articles of W Forsmann (1929), WJ. Rashkind (1966), two Soviet physicians: the therapist A.I. Yarotsky and surgeon I.P Dmitriev, published respectively in 1925 and 1926, and a number of other sources were studied. Their content-analysis was carried out using methods adopted in historical medical research.

Results: It was determined that in 1925 Soviet therapist A.I. Yarotsky from the Moscow Clinical Institute (now MONIKI) proposed to penetrate in the right atrium through the jugular vein for intracardiac procedures, in particular, to create a hole in the interatrial septum with the help of some instrument. In 1926 this idea in the experiment on animals and on the human corpse was realized by his scholar I.P Dmitriev from the Institute of Operative Surgery of the 1st MSU (now - Sechenov University). At the same time, both authors noted that in the absence of visual methods of monitoring the position of the instrument in right chambers of the heart transthoracic approach is preferable to the endovascular one. In 1929 independently of Soviet physicians W Forsmann from Eberswalde (Germany) developed a technique for probing the right heart, which conceptually repeated the method of Yarotsky-Dmitriev In the practice of children cardiac surgery, the technique was introduced in 1966 by WJ. Rashkind from the Children's Hospital in Philadelphia (USA).

Conclusion: thus A.I. Yarotsky who in 1925 formulated the idea of transvenous approach to the right atrium and I.P Dmitriev who in 1926 realized this idea in an experiment are the pioneers of the concept of catheter atrioseptostomy The lack of methods at their disposal for visual control of procedures inside the heart did not allow authors to introduce the technique into the clinic. 

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3.      YArotskij A.I. K voprosu ob operacii vnutri serdca pri suzhenii levogo venoznogo otverstiya. [On the question of surgery inside the heart during the narrowing of the left venous opening.] Vrachebnaya gazeta. 1925; XXIX(21): 498 [In Russ].

4.      Litvinov A.V. A.I. YArotskij (1866 - 1944) i ego rol' v stanovlenii i razvitii otechestvennoj terapevticheskoj shkoly. [A.I. YArotskij (1866 - 1944) and his role in the formation and development of the national therapeutic school.] 2001. EHlektronnyj resurs: http://sgma.alpha-design.ru/ MMORPH/N-7-html/LITVINOV/litvinov.html [In Russ].

5.      Dmitriev I.P. Eksperimental'nye nablyudeniya po voprosu ob operativnyh podstupah k klapanam serdca i peregorodke predserdij. Novyj hirurgicheskij arhiv. 1926; XI (1-2): 3-11 [In Russ].

6.     Bokeriya L.A., Podzolkov V.P., Kokshenev I.V., Glyantsev S.P. Istoriya ucheniya o vrozhdennyh porokah serdca. [History of the doctrine of congenital heart defects.] M.: NCSSKH im. A.N. Bakuleva RAMN, 2011: 278-9 [In Russ].

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Abstract:

Background: article describes methodology of a selective ophtalmic arterieal infusion (SOAI) ir organ-preserving treatment of children with an intraocular retinoblastoma and demonstrates various ways of delivery of chemotherapeutic agent to a tumor.

Aim: was to increase efficacy of SOAI in treatment of children with intraocular retinoblastoma Material and methods: 289 SOAI procedures to 127 children (143 eyes) have been performed from 2013 to 2017. 2 methods of a SOAI were applied: 1) the microcatheter technique (n=223) - superselective catheterization of an eye artery or collateral branches of an external carotid artery (ECA) at blood flow hemodynamic redistribution; 2) the microballoon technique - balloon-occluder on ipsilateral internal carotid artery (ICA) for prevention of chemoinfusion of brain arteries (n=58). Results: technical success was 96,5%(279 procedures). From 223 procedures with using of a microcatheter infusion was carried out in: a. ophthalmica - 156(70%), a.meningea media - 44 (20%), a.infraorbitalis - 20(11%), a. temp. superficialis - 2, a.facialis - 1. From 58 procedures with using of microballoon - 56 were successful. We didn't manage to put a balloon more distally than the place of an entry of an eye artery in 2 cases. Unsuccessful attempts - 10 cases: failure of catheterization of a femoral artery - in 2, a kinking of the ICA - in 2, a vascular collapse as a result of reaction to injection of contrast agent and/or mechanical impact on ICA - in 2, lack of contrasting of a retina - in 3, an occlusion of an ICA - in 1.

Conclusion: possession and use of various techniques for chemotherapeutic agent delivery to an eye tumor allows to achieve the maximum effect and doesn't depend on anatomy options and blood flow hemodynamic redistribution in main vessels of an eye.

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Abstract:

Hepatic artery embolization was perfomed in 14 patients. In 11 of them indications were the following: chronic pain, arterial hypertension, anemia resistant to conservative treatment, portal hypertension. In 3 nearly asymptomatic patients with angioma size of 12 cm and more, the intervention aimed to prevent possible complications of the disease. All in all, 23 interventions were done, Spongostan и Ivalon used for peripheral embolization, and Gianturco coils for feeding vessel occlusion. 16-46 month follow-up showed quality of life improvement (decrease of pain) in 12 of 14 cases. In 3 patients hepatic artery embolization resulted in normalizing of systemic arterial and portal pressure due to arteriovenous shunt cessation. Thus, feeding arteries embolization makes hepatic angiomas amenable to surgery and could be seen as a first-line treatment performed prior to hepatic resections.

Reference

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7.     Журавлев В.А. Особенности хирургического лечения гигантских гемангиом печени. Тезисы докладов научной конференции «Диагностика и лечение печени». С.-Пб. 1999; 64.

Abstract:

122 cases of gastroesophageal bleeding due to portal hypertension are analyzed in the article. It is shown that transcatheter interventions, as a part of the complex hemostasis strategy, can significantly improve the results. Keeping to algorithms and acting in accordance with protocols developed for any diagnostic procedure or intervention are declared to be crucial to success. The complex approach to profuse bleeding management, that included transcatheter procedures, decreased mortality rate from 72,2% to 22,1% and reduced rebleeding rate from 47,2% to 31,4%. 

Reference

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Abstract:

The authors report 44 successful implantations of original retrieval Nitinol stent-filters, unique "closed" design of which comprehensively described in the article. All the devices placed for pulmonary embolism (PE) management in patients with lower extremity and pelvic deep vein (DV) thrombosis. Authors announce absolute efficiency of their stent-filters for PE prophylaxis, and the procedure itself declared to be safe and minimally invasive.

Stent-filter implantation into iliac veins compared to standard filter placement in inferior vena cava (IVC) excludes risks of total infrarenal IVC thrombosis - the major complication of such procedures. It is also associated with early DV recanalization, that in sum radically reduces disability rate. Moreover, in case of IVC abnormalities, kinking or external compression stent-filter into iliac position remains the only option for endovascular PE management. All the above can be mentioned as advantages of using stent-filters.

At the same time authors observe that stent-filters quick incorporation into vessel wall prevented endovascular retrieval of the device in quite a number of cases. Persistent PE threat, requiring prolonged antithrombotic therapy under endovascular protection, might also contribute for low retrievability of the device. 

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Abstract:

Between May 2005 and March 2007, catheter-port systems were placed in 20 pts for continuous hepatic artery infusion chemotherapy in the treatment of unresectable colorectal liver metastases. Carboplatin (or oxaliplatin) plus 5-fluorouracil and systemic leucovorin were administered. No complications occurred during the implantation procedures. The mean number of intrahepatic chemotherapy cycles per patient was 10 (4-25). The mean follow-up period was 412 (100-853) days. During the follow-up period, complications occurred in 9 patients (45%), but surgical or interventional radiological correction was successful in all but one case. At present, 14 patients are alive within 4 and 41 months and continue to receive intraarterial chemotherapy, while 6 patients died in 5 to 21 months from tumor progression. The common 1 -year survival is 90% (18 patients). Percutaneous implantation is potentially effective treatment for patients with CLM.

Reference 

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Abstract:

To show possibilities to diagnose and treat toxic complications of continuous hepatic artery chemoinfusion using percutaneous implanted catheter-port system.

Materials and methods: Between May 2005 and March 2007, 20 patients (pts) underwent percutaneous transfemoral implantation of the catheter-port system for treatment of unresectable colorectal liver metastases. Toxic complications (gastritis, pancreatits or stomach ulcer) occurred in three pts (each in one). Endoscopy (after arterial injection of methylene blue) and scintigraphy (after arterial injection of technetium-99m macroaggregated albumin) showed abnormal liver perfusion. Visceral angiography was performed for verification and embolization of non-targeted vessels. Angiography with embolization of collateral arteries resulted in normalization of liver perfusion and resolution of complications. At present, all pts continue to receive intraarterial chemotherapy. Transcatheter coil embolization of non-targeted arteries is effective for the management of the catheter-port system misperfusion.

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9.     Bledin A., Kantarjian H., Kim E. et al. 99mTc-labeled macroaggregated albumin in intrahepatic arterial chemotherapy. Am.]. Roentgenol. 1982; 139:711-715.

10.   Kaplan W, Ensminger W, Come S. et al. Radionuclide angiography to predict patient response to hepatic artery chemotherapy. Cancer Treat. Rep. 1980; 64: 1217-1222.

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12.   Tanaka Т., Arai Y, Inaba Y. et al. Radiologic placement of side-hole catheter with tip fixation for hepatic arterial infusion chemotherapy. J. Vase. Interv. Radiol. 2003; 14: 63-68.

13.   Yamagami Т., Kato Т., Iida S. et al. Value of transcatheter arterial embolization with coils and n-butyl cyanoacrylate for long-term hepatic arterial infusion chemotherapy. Radiology. 2004; 230: 792-802.

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Abstract:

Department of Obstetrics and Gynaecology of the Therapeutic and Moscow Faculties of Scientific Research Practical Laboratory of intracardiac and contrast methods of roentgenological studies under the Federal Facility Russian State Medical University of the Russian Ministry of Public Health, Moscow.

This article opens a new series of publications dedicated to a currently important issue of endovascular treatment of uterine myoma - uterine artery embolization (UAE). The authors presently possessing the most abundant hands-on experience in UAE in Russia, based on own experience and literature data discuss herein the most urgent problems related to UAE in treatment for uterine myoma and other obstetrical and gynaecological pathology. Amongst them are the problems of determining the indications for and contraindications to an intervention, outcomes of UAE (including that combined with other therapeutic methods), problems of optimization of the technique and development of technical procedures allowing for UAE to be performed virtually in any situation, as well as the problems related to selection of embolizing substances. The authors also give a detailed consideration to the so-called "myths" about UAE - currently existing negative views on certain aspects of intervention, which are based on outdated and inexact evidence. The authors draw a conclusion that endovascular methods are highly promising in obstetrical and gynaecological pathology.

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Abstract:

We present a case report of successful transcatheter closure of patent foramen ovale (PFO) by transcatheter suturing device «Noblestitch EL».

Materials and methods: cryptogenic stroke may be the consequence of the PFO. Percutaneous PFO closure, being less invasive than surgical closure, is increasingly performed; there are, however, early and long-term risks including: device embolization, fracture, thrombosis, infection, erosions of free atrial wall, arrhythmias. Furthermore, device implantation may complicate future percutaneous access to the left atrium. Partially reabsorbable devices and tissue welding to close PFO have recently been introduced. We present a case report of 33-year-old woman with a history of cryptogenic stroke. Echocardiography imaging with bubble study demonstrated a right-to-left shunt through the PFO at rest. The right femoral vein was cannulated. A «Noblestitch EL» device was advanced across the PFO and thread was passed through the septum primum and secundum. Threads were exteriorized and a knot was advanced to the right atrial septum and cut.

Results: successful closing of PTO was confirmed by transesophageal echocardiogram. Later it was shown complete PFO closing, no right-to-left shunt, even during the Valsalva maneuver, no residual shunt was observed.  

References 

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5.    Scacciatella P, Butera G., Meynet I. et al. Percutaneous closure of patent foramen ovale in patients with anatomical and clinical high-risk characteristics: longterm efficacy and safety. J Interv Cardiol. 2011; 24:477-484.

6.    Sievert H., Fischer E., Heinisch C. et al. Transcatheter closure of patent foramen ovale without an implant: Initial clinical experience. Circulation. 2007; 116:1701-1706.

7.    Sigler M., Jux C. Biocompatibility of septal defect closure devices. Heart. 2007; 93:444-449.

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Abstract:

We present case report of patient, with recurrent pulmonary bleeding of malignant genesis and ineffective previous endoscopic hemostasis. During embolization of bronchial artery, to stop massive life-threatening pulmonary bleeding, transradial approach was used for the first time. Full bleeding control was reached after embolization of right bronchial artery with use of microspheres through microcatheter 2,8 Fr. During hospital stage, recurrence of bleeding was not notices; patient discharged on the 7th day in satisfactory condition.

Duration of procedure and radiation exposure at this patient were comparable with same parameters in case of transfemoral approach. Main advantages of this vascular access are increased comfort of the patient after the procedure and the possibility of early activization. Besides, use of transradial vascular approach provides decreased frequency of complications, that is very important among patients with signs of respiratory insufficiency, because of the inability of these patients to stay in bed within a day. 

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10.  Kanei Y, Kwan T., Nakra N.C. et al. Transradial cardiac catheterization: A review of access site complications. Catheter Cardiovasc. Interv. 2011.

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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.  

References 

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4.    Michael J. Schneck et al. Overview cardioembolic stroke. Section 20.01.2015 http://emedicine. medscape.com /article/1160370-overview#aw2aab6b2

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9.    Kuznetsov V.V., Egorova M.S., Fibrillyacia predserdiy kak patogeneticheskiy mekhanizm razvitiya kardioembolicheskogo insulta. [Atrial fibrillation - a pathogenetic mechanism of cardioembolic stroke.] Nevrologia. Kardiologia. 2011; 4(150): 46-49 [In Russ].

10.  Mooe Th., Tienen D., Karp K., et al. Long-term follow-up of patients with anterior miocardial infarction complicated by left ventricular thrombus in the thrombolytic era. Heart. 1996; 75(3):252-6.

11.  Vereshagin N.V., Piradov M.A., Suslina Z.A. (red). Insul’t. Principi diagnostiki, lecheniya I profilaktiki. [Stroke: principles of diagnosis, treatment and prophylaxis.]. M, Intermedika, 2002; 208.

12.  Suslina Z.A., Vereshagin N.V., Piradov M.A., Podtipi ishemicheskikh narusheniy mozgovogo krovoobrasheniya: diagnostika i lechenie. [Subtypes of ischemic cerebrovascular disorder: diagnosis and treatment]. Consilium medicum. - 2001; 3(5): 218-221.

13.  Albers G.W., Comess K.A., De Rook F.A. et al. Transesophageal echocardiographic findings in stroke subtypes. Stroke. 1994; 25: 23-28.

14.  Akhmedov A.D-O. Karotidnaya endarterektomiya u bol’nikh s visokim khirurgicheskim riskom. [Carotid endarterectomy in patients with high operation risk]. Diss. kand.med. Mos

Abstract:

Aim: was to evaluate diagnostic results in patients with left-sided varicocele through the use of occlusive balloon catheter during the diagnostic phlebotesticulography.

Materials and methods: traditional venographic examination was performed in 29 patients with newly diagnosed varicocele. Basing on obtained data a new diagnostic venography approach was worked out, according that - 10 patients with left-sided varicocele underwent venography examination.

Results: Using the new diagnostic venography approach in 10 patients with left-sided varicocele was received complete information about the anatomy of the left internal spermatic vein, its collaterals, as well as hemodynamic changes of external iliac vein and spermatic vein it became possible to determine the type of hemodynamic disturbances of outflow of blood from the pampiniform plexus.

Conclusion. The developed method of diagnostic venography provides a complete picture of causes of changes in veins involved in the drainage of the pampiniform venous plexus. Obtained data of hemodynamic and angioarchitectonics changes of venous basins draining pampiniform plexus, contribute to the choice of the optimal method of surgical correction of venous blood flow spermatic veins.

Angiography is the «gold standard» in the diagnosis of varicocele. The developed method of diagnostic venography improves the efficiency of the method of diagnostic venography, which improves the results of treatment of varicocele.

Abstract:

We have studied the influence of catheterization technique on the quality of contrast imaging, on the base of 94 digital subtraction (DSS) and 30 analog sialograms (AS) in 83 patients. It has been established that catheter depth must be 10 mm. In case of deeper catheter inserting - some artifacts may appear. In case of DSS such problem could be corrected, but during AS such situation can ead to incorrect interpretation and diagnostic mistakes.

References 

1.    Кадочников Б.Ф. К вопросу о сиалографии. Стоматология. 1960; 6: 64-65.

2.    Язукявичюс Л.А. Электрорентгеносиалография в диагностике заболеваний слюнных желез. Стоматология. 1987; 66 (3): 39-41.

3.    Мингазов Г.Г., Шестаков Ю.М., Кузнецов О.Е. Использование полиэтиленовых катетеров для сиалографии. Вестник    рентгенологии    и    радиологии. 1989; 2: 67.

Abstract:

Surgical treatment of aortic valve pathology is an actual problem of modern medicine. Aortic valve pathology is widely spread in population on a stable high level. Due to a large amount of patients with no possibility of open surgical treatment of aortic valve pathology modern hybrid methods of treatment, such as transcatheter aortic valve implantation are being actively proposed and modified.

MSCT angiography before transcatheter aortic valve implantation is obligatory procedure. Data obtained by MSCT is extremely necessary to define the possibility and the access path of transcatheter aortic valve implantation. MSCT allows to select the size and type of aortic valve prosthesis.

Appearance of modern MSCT scanners with 320-640 row of detectors will increase the leading role of MSCT in preoperative inquiry of patients with planned transcatheter aortic valve implantation.

References

1.     Nkomo V.T., Gardin J.M., Skelton T.N. Burden of valvular heart diseases: a population-based study. Lancet 2006; 368: 1005-1011.

2.     Charlson E., Legedza A.T.R., Hamel M.B. Decisionmaking and outcomes in severesymptomatic aortic stenosis. J. Heart Valve Dis. 2006; 15: 312-321.

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4.     Varadarajan P., Kapoor N., Bansal R.C., Pai R.G. Clinical profile and natural history of 453 nonsurgically managed patients with severe aortic stenosis. Ann. Thorac. Surg. 2006; 82: 2111-2115.

5.     Andersen H.R., Knudsen L.L., Hasenkam J.M. Transluminal implantation of artificial heart valves. Description of a new expandable aortic valve and initial results with implantation by catheter technique in closed chest pigs. Eur. Heart J. 1992; 13:704-708.

6.     Cribier A., Eltchaninoff H., Bash A., Borenstein N., Tron C., Bauer F., Derumeaux G., Anselme F., Laborde F., Leon M.B. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description. Circulation. 2002; 106: 3006-3008.

7.     Webb J.G., Pasupati S., Humphries K., Thompson C., Altwegg L., Moss R., Sinhal A., Carere R.G., Munt B., Ricci D., Ye J., Cheung A., Lichtenstein S.V. Percutaneous transarterial aortic valve replacement in selected high-risk patients with aortic stenosis. Circulation. 2007; 116: 755-763.

8.     Callander V. Computed tomography. M. Technosphere, 2006. C-17-23 [In Russ.]

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10.   Sinitsyn V.E., Achenbach S. Electron Beam Computed Tomography. In: M.Oudkerk (ed). Coronary Radiology. Berlin: Springer, 2004.

11.   Bridgewater B., Keogh B., Kinsman R., Walton P Sixth national adult cardiac surgical database report. 2008 [cited 2011 Feb 9].

12.   Ludman PF. British Cardiovascular Intervention Society audit returns: adult interventional procedures Jan 2009 to Dec 2009. BCIS Meeting; 2010 Oct: Cardiff, Wales. Рр17-34.

Abstract:

Current indications for transcatheter aortic valve replacement (TAVR) are limited for inoperable and high risk patients only. Meanwhile, TAVR may be successfully performed in young patients with low risk and with high technical and functional results according to short- and long-term follow-up.

54 patients underwent TAVR, 7 (12,9%) of them were younger than 65. Cause for endovascular procedure was the presence of oncological process in liver/autoimmune hepatitis/liver cirrhosis/severe bronchial asthma/atherosclerotic lesion of major vessels/severe diabetes mellitus. In 3 cases additional visualization method (intracardiac ultrasound examination) was necessary. All patients underwent implantation of CoreValve.

Technical success was 100%. Function of valves was satisfactory. Light near-valve regurgitation was found in 6 cases, valve regurgitation class II was found in 1 case with decrease to class I after treatment.

Intracardiac ultrasound examination is useful to attend successful results in this group of patients. 

References

1.     2012 ACCF/AATS/SCAi/STS Expert Consensus Document on Transcatheter Aortic Valve Replacement. JACC. 2012; 59: 1200-1254.

2.     Lemos PA, Lee CH, Degertekin M, et al. Early outcome after sirolimus-eluting stent implantation in patients with acute coronary syndromes: insights from the Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital (RESEARCH) registry. JACC. 2003; 41: 2093-2099.

3.     Ong A.T., Serruys P.W., Aoki J., et al. The unrestricted use of paclitaxel versus sirolimus-eluting stents for coronary artery disease in an unselected population: one-year results of the Taxus-Stent Evaluated at RotterdamCardiologyHospital (T-SEARCH) registry. JACC. 2005; 45: 1135-1141.

4.     Hoye A., Tanabe K., Lemos P.A., et al. Significant reduction in restenosis after the use of sirolimus-eluting stents in the treatment of chronic total occlusions. JACC. 2004; 43: 1954-1958.

5.     Rao S.V., Shaw R.E., Brindis R.G., Klein L.W., Weintraub W.S., Peterson E.D. On- versus off-label use of drug-eluting coronary stents in clinical practice (report from the American College of Cardiology National Cardiovascular Data Registry [NCDR]). Am. J. Cardiol. 2006; 97: 1478 -1481.

6.     Beohar N., Davidson C.J., Kip K.E., et al. Outcomes and complications associated with off-label and untested use of drug-eluting stents. JAMA. 2007; 297: 1992-2000.

7.     Grines C.L. Off-label use of drug-eluting stents putting it in perspective. JACC. 2008; 51: 615-617.

8.     Piazza N., Otten A., Schultz C., et al. Adherence to patient selection criteria in patients undergoing transcatheter aortic valve implantation with the 18F CoreValve ReValvingTM System: results from a single center study. Heart. 2010; 96: 19-26.

9.     Eltchaninoff H., Prat A., Gilard M., et al. Transcatheter aortic valve implantation: earlyresults of the FRANCE (FRench Aortic National CoreValve and Edwards) registry. Eur. Heart J. 2011; 32:19-197.

10.   Zahn R., GerckensU., Grube E., et al. Transcatheter aortic valve implantation: first results from a multi-centre real-world registry. Eur. Heart J. 2011; 3:198-204.

11.   Rodes-Cabau J., Webb J.G., Cheung A., et al. Transcatheter aortic valve implantation for the treatment of severe symptomatic aortic stenosis in patients at very high or prohibitive surgical risk: acute and late outcomes of the multicenter Canadian experience. JACC. 2010; 55:1080-1090.

12.   Tamburino C., Capodanno D., Ramondo A., et al. incidence and predictors of early and late mortality after transcatheter aortic valve implantation in 663 patients with severe aortic stenosis. Circulation. 2011; 123: 299-308.

13.   Webb J.G., Altwegg L., Boone R.H., et al. Transcatheter aortic valve implantation: impact on clinical and valve-related outcomes. Circulation. 2009; 119: 3009-3016.

14.   Piazza N., Grube E., Gerckens U., et al. Procedural and 30-day outcomes following transcatheter aortic valve implantation using the third generation (18 Fr) corevalve revalving system: results from the multicentre, expanded evaluation registry 1-year following CE mark approval. EuroIntervention. 2008; 4: 242-249.

15.   Leon M.B., Smith C.R., Mack M., et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N. Engl. J. Med. 2010; 363: 1597-1607.

16.   Smith C.R., Leon M.B., Mack M.J., et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N. Engl. J. Med. 2011; 364: 2187-2198.

17.   Lee D.H., Buth K.J., Martin B.J., et al. Frail patients are at increased risk for mortality and prolonged institutional care after cardiac surgery. Circulation. 2010; 121: 973-978.

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19.   Lange R., Bleiziffer S., Mazzitelli D., et al. improvements in Transcatheter Aortic Valve implantation Outcomes in Lower Surgical Risk Patients. JACC. 2012; 59: 280-287 

Abstract:

In the treatment of macro-cystic forms of lymphangiomas, puncture methods have great value. Relapses occure in 50% of cases. The cause of lymphangiomas is the accumulation of liquid and spreading of cystic walls.

Aim. Was to develop and propose methods of interventional radiology in the diagnosis and treatment of macro-cystic lymphangiomas.

Materials and methods. In 2007-2011, in the radiological department of our hospital were examined and treated 31 children with macro-cystic forms of lymphangiomas. The proposed method of treatment was: puncture, catheterization of cyst, aspiration, performance of cystography and then sclerotherapy with 3% solute of Fibro-Vein or ethoxysclerol.Then - inserting active aspiration system into cyst. The system operated for 3-5 days, during which carried constant active aspiration with sclerotherapy sessions. The indications for catheter removal was the end of cyst liquid secretion. In 20 children we performed a single-stage treatment. In 6 - two-staged, and only in 5 cases, after the second phase of treatment, we observed a relapse of the disease, which leaded for the third phase of treatment.

Results. Good results were achieved in 15 of 19 children with lymphangioma of the head and neck, satisfactory - in 4 children. Unsatisfactory results were not noticed. In children with lymphangioma of internal organs a good result was achieved in 11 cases of 12. Only in 1 case remained a small residual cavity

Conclusion. The method of active aspiration of macro-cystic lymphangiomas showed very good results. The use of techniques of interventional radiology in the diagnosis of macro-cystic forms of lymphangiomas can assess the condition, shape and size of the cyst, and spend the most effective treatment. The use of interventional techniques as an alternative to surgical excision of the lymphangioma can significantly improve the quality of life.

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Abstract:

The research investigates the possibility of restoring the blood supply in patients with atherosclerosis of the brain, as well as the treatment of chronic cerebrovascular insufficiency, both not burdened and the burdened development of small strokes, with use for this method of transcatheter laser revascularization.

The research involves 946 patients aged 29-81 (average age 74) suffering from various types of cerebral atherosclerosis. 568(60,04%) patients underwent transcatheter treatment - Test Group. 378 (39,96%) patients underwent conservative treatment - Control Group. The examination plan included laboratory diagnostics, assessment CDR, MMSE, IB, cerebral SG, REG, CT, MRI, MRA, MUGA. To restore the blood supply, the method of transcatheter laser revascularization was applied; high-energy pulsed lasers were used for major intracranial arteries treatment, and low-energy CW lasers - for distal intracranial branches treatment.

Test Group: 459(80,81%) patients had good clinical outcome, 91(16,02%) - satisfactory clinical outcome, 18(3,17%) - relatively satisfactory clinical outcome; relatively positive clinical outcome was not obtained in any case. Control Group: good clinical outcome was not obtained in any case; 65(17,20%) patients had satisfactory clinical outcome, 121(23,26%) - relatively satisfactory clinical outcome; 192(50,79%) - relatively positive clinical outcome.

The method of transcatheter laser revascularization of cerebral vessels is a physiological, effective and low-invasive treatment for patients suffering from atherosclerosis of the brain. Obtained results last up to 10 years and more; it causes regression of mental and motor disorders, promotes regression of dementia and largely improves patients' quality of life; it has virtually no alternative - which makes the proposed method significantly different from conservative treatment methods. 

References

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6.     Qureshi A.I., Caplan L.R. Intracranial atherosclerosis. Lancet. 2014; 15, 383 (9921): 984-998.

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8.     Pendlebury S.T., Wadling S., Silver L.E., et al. Transient Cognitive Impairment in TIA and Minor Stroke. Stroke. 2011; 42: 3116-3121.

9.     Maksimovich I.V. Possibilities of transcatheter treatment of patients after extensive ischemic stroke. World Journal of Neuroscience. 2013; 3: 171-185.

10.   Hashmi J.T., Huang YY, Osmani B.Z., et al. Role of Low-Level Laser Therapy in Neurorehabilitation, PM& R. 2010; 2, 12 Suppl 2: S292-S305.

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13.   Stephan W., Banas L.J., Bennett M., et al. Efficacy of super-pulsed 905 nm Low Level Laser Therapy (LLLT) in the management of Traumatic Brain Injury (TBI): A case study, World Journal of Neuroscience. 2012; 2(4): 231-233.

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29.   Maksimovich I.V. Method of transluminal laser revascularization of cerebral blood vessels having atherosclerotic lesions. 2006; US Patent No. 7490612.

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33.   Kuleshov E.V., Maksimovich I.V. Jendovaskuljarnaja hirkrgija u pacientov starshe 65 let s rasprostranennym aterosklerozom sosdov taza i nizhnih konechnostej. [Endovascular surgery in patients over 65 with disseminated atherosclerosis of the vessels of the pelvis and lower extremities]. Vestnik Surgery Imeni 1.1. Grekova, 1994; 152: 27-30 [In Russ].

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37.   Moskvin S.V. Sistemnyj analiz jeffektivnosti upravlenija biologicheskimi sistemami nizkojenergeticheskim lazernym izlucheniem. [System analysis of efficiency in controlling biological systems with low-energy laser radiation]. Thesis for Degree of Doctor of Biological Sciences. 2008; City of Tula [In Russ].

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41.   Starck T., Nissil J., Aunio A., et al. Stimulating brain tissue with bright light alters functional connectivity in brain at the resting state. World Journal of Neuroscience. 2012; 2: 81-90.

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