Abstract:

Aim: was to estimate efficacy of methods of permanent or temporary blocking of blood flow through the gastroduodenal artery (GDA) during arterial chemoinfusion/chemoembolization of hepatic and pancreatic malignancies.

Materials and methods: for the period of 5 years (2015-2019), GDA embolization with coils was performed in 90 patients. Of them, 39 patients with liver tumors underwent occlusion of proximal GDA. GDA embolization distally to pancreatic branches (commonly on the level of gastroepiploic artery) was done in 51 patients with pancreatic head adenocarcinoma. Alternatively, in 12 patients with liver and 23 patients with pancreatic cancer, hand compression of GDA was used.

Results: technical success was 98% (88/90 patients). During embolization, coil migration into the hepatic artery developed in two patients with liver tumors: in one case stenting of the common hepatic artery was performed, the other case was asymptomatic and the presence of coil did not complicate the following arterial therapy. There were no other complications. Patients received multiple repeated courses of arterial chemotherapy.

Conclusion: methods of blocking of GDA blood flow are relatively safe, effective, simple and inexpensive. Both, embolization and hand compression, help to prevent non-target chemoinfusion and embolization.

References

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2.     Arybzhanov DT, Gantsev SH, Kulakeev OK, et al. Results of endovascular methods of treatment in liver tumors in South Kazakhstan. Diagnosticheskaya i Intervenzionnaya Radiologiya. 2009; 3(1): 15-19 [In Russ].

3.     Popov AA, Skupchenko AV, Polarush NF. Colorectal liver metastases after chemoembolization with microspheres: comparison of the different criteria for tumor response assessment. Diagnosticheskaya i Intervenzionnaya Radiologiya. 2014; 8(1): 37-46 [In Russ].

4.     Dolgushin Bl, Virshke ER, KosyrevVJ. Interventional radiological technologies in treatment of intermediate stage HCC (BCLC B). Onkologicheskiy Zhurnal. 2018. 1(1): 60-62 [In Russ].

5.     Kozlov AV, Granov DA, Tarazov PG et al. Intra-arterial chemotherapy in patients with unresectable pancreatic cancer. Annaly Khirurgicheskoy Gepatologii. 2019; 24(3): 73-86 [In Russ].

6.     Pavlovskij AV, Stacenko AA, Popov SA et al. The first experience of selective intra-arterial injection of albuminbound paclitaxel (Abraxane) in patients with pancreatic adenocarcinoma. Diagnosticheskaya i Intervenionnaya Radiologiya. 2019; 13(1): 59-64 [In Russ].

7.     Bagdasarov W, Bagdasarova EA, Chernookov Al et al. Endovascular arterial embolization in duodenal bleeding - alternative to surgical treatment. Khirurgiya. 2016; (2): 45-50 [In Russ].

8.     Musinov IM, Chikin AE, Ganin AS, Kachesov EYu. Transcatheter arterial embolization in treatment of gastroduodenal ulcers with bleeding. Vestnik Khirugii. 2018; 177(6): 27-30 [In Russ].

9.     Tibilov AM, BaymatovMS. Endovascular intervention in the treatment of recurrent gastroduodenal hemorrhage. Diagnosticheskaya i Intervenzionnaya Radiologiya. 2009; 3(3): 45-48 [In Russ].

10.   Tarazov PG, Granov DA, Polikarpov AA et al. Endovascular control of arterial bleeding after major surgery in pancreatic cancer. Vestnik Khirugii. 2012; 171(1): 24-30 [In Russ].

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14.   Kuyumcu G, Latich I, Hardman RLet al. Gastroduodenal embolization: indications, technical pearls, and outcomes. Journal o f Clinical Medicine. 2018; 7(5): pii E101.

http://doi.org/10.3390/icm7050101

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17.   Tarazov PG, Ryzhkov VK. Gastroduodenal artery embolization during endovascular interventions in cirrhosis and tumors of the liver. Vestnik Khirugii. 1988; 140(1): 83- 85 [In Russ].

18.   Lopez-Benitez R, Hallscheidt P, Kratochwil C et al. Protective embolization of the gastroduodenal artery with a one HydroCoil technique in radioembolization procedures. Cardiovascular and Interventional Radiology. 2013; 36(1): 105-110.

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Abstract:

Infra-popliteal lesions rarely were the zone of interest in first years of endovascular era. Nowadays, broad worldwide experience of transluminal interventions and appearance of low-profile instruments allowed broadening of the indications for transluminal repair of the below-the-knee arteries. The method is proved to be safe and effective.

Results of 121 angioplasties in 70 patients with chronic ischemia of the legs (12 years work of a city hospital) are analyzed in the article. The main indication was stenotic and occlusive infrapopliteal lesions excluding the possibilities of bypass surgery. It was shown that the endovascular approach is extremely effective, and in cases of diabetic angiopathy and critical lower extremities ischemia, an endovascular intervention can be not only the way to save a leg, but the only way to save the patient's life.

Reference

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2.     Sivananthan U.M., Browne T.F., Thorley P.J., Rees M.R. Percutaneous transluminal angioplasty of the tibial arteries. Br. J. Surg. 1994; 81 (9): 1282-1285.

3.     Baum S., Pentecost M.J. Infrapopliteal revascularization. Abrams angiography interventional radiology second edition. 2006;348-261.

4.     Dorros G., Jaff M.R., Kelly K.J. et al. The acuteoutcome of tibioperoneal vessel angioplasty in417 cases with claudication and critical limbischemia. Cathet. Cardiovasc. Diagn. 1998; 45: 251-256..

5.     Alfkel H. Long-term results after infrapopliteal/CIRSE. Италия. 2006.Покровский А.В. Состояние сосудистой хирургии в России в 2006 году. М. 2007; 9-13.

6.     Rizzati R., Tartari S.. Infra-popliteal revascu larization in critical limb ischemia: three year experience in endovascular and surgical treatment/CIRSE. Италия. 2006; 191.

7.     Tsetis D., Belli A.M. The role of infrapopliteal angioplasty. Br. J. Radiol. 2004; 77 (924): 1007-1015.

8.     Затевахин И.И., Шиповский В.Н., Золкин В.Н. Баллонная ангиопластика при ишемии нижних конечностей. М.: Медицина. 2004; 231-249.

9.     Siablis D., Karпabatidis D., Katsanos К. Infrapopliteal paclitaxel-eluting stents for critical limb ischemia: six-month clinical and angiographic results/CIRSE. Италия. 2006; 196.

10.   Зеленов М.А., Ерошкин И.А., Коков Л.С. Особенности ангиографической картины у больных с сахарным диабетом с окклюзионно-стенотическим поражением артерий нижних конечностей. Диагностическая и интервенционная радиология: 2007; 1 (2): 22-30.

Abstract:

It has been described the experience of use of automatic injector Mark V Pro Vis (Medrad) for endovascular interventions in pediatry. The choice of optimal roentgen contrast media for angiography and endovascular interventions is considerated. It has been concluded that contrast enhancement by iopromide and automatic injector Mark V Pro Vis is effective and safety method of visualization of vessels, tumors and other pathology.  

References

1.      Поляев Ю.А., Мыльников А.А. Эндоваскулярная окклюзия в лечении гиперваскулярных образований головы. Практикующий врач. 2003; 1: 38–41.

2.      Поляев Ю.А., Щенев С.В. Опыт лечения некоторых форм ангиодисплазий периферической локализации у детей. Практикующий врач. 2003; 1: 42–45.

3.      Поляев Ю.А., Шимановский Н.Л., Лазарев В.В., Голенищев А.И. Десятилетний опыт использования неионного рентгеноконтрастного средства Ультравист в детской интервенционной радиологии. Детская больница. 2004; 1: 55–60.

4.      Сергеев П.В., Поляев Ю.А., Юдин А.Л., Шимановский Н.Л. Контрастные средства. М: Известия. 2007; 496.

5.      Liss P., Persson P.B., Hansell P., Lagerqvist B. Renal failure in 57 925 patients undergoing coronary procedures using iso-osmolar or low-osmolar contrast media. Kidney Int. 2006;. 70: 1811–1817.

6.      Ultravist. Monograph, Schering AG, Berlin, Second edition. 2005; 72.

7.      Misawa M., Sato Y., Hara M. et al. Use of non-ionic contrast medium, iopromide (Proscope-370), in pediatric cardiovascular angiography. Nihion Shoni Hoshasen Gakkai Zasshi. 2000; 2: 42–48.

8.      Liss P., Hansell P., Lagerkvist B. Higher Incidence of Renal Failure in 23 224 Patients Using Iso-osmolar Compared to Low-osmolar Contrast Media during Coronary Interventions in Swedish Hospitals. RSNA, 2008; SSG 08–01.

Abstract:

Purpose. To assess the effectiveness of palliative endovascular interventions in patients with CTO anatomy infavorable for recanalisation.

Material and methods. The authors analyzed the results of interventions in 60 patients (50 male (83,3%), 10 female (16,7%)) aged 38 – 75 years (mean age 53,9±3,2), with occlusive coronary disease. Palliative revascularizations were performed in 30 patients, and CTO recanalization was done in 30 cases. The LV function was assessed echocardiographically in both groups before and after the intervention.

Results. 12 month follow-up showed significant improvement or normalization of LV function in both groups. Results of palliative interventions were shown to be as effective as recanalization of CTO.

Conclusions. Endovascular palliation is effective in treatment of patients with coronary CTO. It results in myocardial function improvement comparable to that in patients with complete coronary revascularization.   

References

1.        Danchin N., Angioi M., Rodriguez R. Angioplasty in chronic coronary occlusion. Arch. Mal. Coeur Vaiss. 1999, 99 (11): 1657–1660.

2.        Meier B. Chronic total coronary acclusion angioplasty. Cathet Cardiovasc. Diagn, 2006; 25: 1–11.

3.        Ганюков В.И., Осиев А.Г. Частные вопросы коронарной ангиопластики. Новосибирск. 2002; 4–23.

4.        Лопотовский П.Ю., Яницкая М.В. Клинический эффект эндоваскулярной реперфузии миокарда в бассейне длительно окклюзированной коронарной артерии. Между народный журнал интервенционной кардиоангиологии. 2006; 10: 22–26.

5.        Султан М.В. Реваскуляризация миокарда при остром коронарном синдроме. Авто-реф. дис. канд. мед. наук. М. 2006: 15–20.  

6.        Иоселиани Д.Г., Громов Д.Г., Сухоруков О.Е., Хоткевич Е.Ю., Семитко С.П., Исаева И.В., Верне Ж.-Ш., Арабаджян И.С., Овесян З.Р., Алигишева З.А. Хирургическая и эндоваскулярная реваскуляризация миокарда у больных с многососудистым поражением венечного русла: сравнительный анализ ближайших и среднеотдаленных результатов. Международный журнал интервенционной кардиоангиологии. 2008; 15: 22–31.

7.        Араблинский А.В. Степень реваскуляризации миокарда с помощью транслюминальной баллонной ангиопластики у больных с многососудистым поражением коронарного русла. Международный медицинский журнал. 2000; 1: 2–6.

8.        Ott R.A., Tobis J.M., Mills T.C., Allen B.J., Dwyer M.L. ECMO assisted angioplasty for cardiomyopathy patients with unstable angina. Department of Cardiothoracic Surgery, University of California. Irvine Medical Center. 2006.  

9.        Gaudino M., Santarelli P., Bruno P., Piancone F.L., Possati G. Palliative coronary artery surgery in patients with severe noncardiac diseases. Department of Cardiac Surgery, Catholic University. Rome. Italy. 2006.  

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11.      Петросян Ю.С., Иоселиани Д.Г. О суммарной оценке состояния коронарного русла у больных ишемической болезнью сердца. Кардиология. 1976; 12 (16): 41–46.

12.      Петросян Ю.С., Шахов Б.Е. Коронарное русло у больных с постинфарктной аневризмой левого желудочка сердца. Горький. 1983; 17–37.

13.      Rahimtoola S.H. The hibernating myocardium. Ibid. 1989; 117: 211–221.

Abstract:

Endovascular interventions became widespread for last decade. The directional atherectomy with a SilwerHawk device is one of such methods of possible vascular restoration. This method has some advantages than balloon angioplasty or stenting.

Aim: Was to evaluate the efficiency of directional atherectomy with a SilwerHawk device with iliac arteries disease and arteries of legs disease.

Materials and methods: We have included nine patients with peripheral arterial disease in our study the endovascular directional atherectomy with a SilwerHawk device (EV-3) was performed in all patients. We used different accesses to the artery and protocols of interventions. In all cases we used distal embolic protection device «Spider» (EV-3).

Results: The immediate results of intervention were evaluated. We developed operation algorithms in different cases of vessel disease. The article describes the technical aspects and nuances of work with SilwerHawk device. The perioperative tactics of treatment are also considered in it.

Conclusion: Endovascular atherectomy is a new and effective method in treatment of patients with different peripheral arteries disease. It provides allows considerably to expand the field of methodics application. 

References 

1.      Norgren L., Hiatt W., Dormandy J. et al. Inter Society Consensus for the Management of peripheral Arterial Disease (TASC II). J. Vasc. Surg. 2007; 1:1-75.

2.      Покровский А.В., Алекян Б.Г., Аралекян В.С. и соавт. Диагностика и лечение больных с заболеваниями периферических артерий. (Рекомендации Российского общества ангиологов и сосудистыххирургов) Москва 2007.

3.      King S., Smith S., Hirshfeld J. et al. 2007 focused update of the ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice guidelines. J. Am. Coll. Cardiol. 2008; 51(2): 172-209.

4.      Abstracts of CIRSE (Cardiovascular and Interventional Radiological Society of Europe) 2010.Cardiovasc Intervent Radiol. 2010; 33(2):14-313.

5.      John L. Limitations of Percutaneous Transluminal Angioplasty and Stenting for the Treatment of Disease of the Superficial Femoral and Popliteal Arteries. Journal of Endovascular Therapy. 2006; 13(2): 30-40.

6.      Thomas Z. Current state of endovascular treatment of femoro-popliteal artery disease. Vasc Med. 2007; 12: 223.

7.      Adam D., Beard D., Cleveland T. et al. Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial. Lancet. 2006; 367(9525): 14.

8.      Schillinger M, Minar E. Past, present and future of femoropopliteal stenting. J Endova,sc Ther. 2009; 16(1): 52-147.

9.      Cotroneo A., Pascali D., Santoro M. et al. Endovascular treatment of femoropopliteal steno-obstructive disease with percutaneous transluminal angioplasty: midterm results. Radiol. Med. 2008; 113(7): 1043-55.

10.    Furuichi S., Sangiorgi G., Colombo A. Early Occlusive Restenosis Due to Self- Expandable Stent Squeeze in the Popliteal Artery. J. Invasive Cardiol. 2007; 19(10): E300-2.

11.    Laird J., Katzen B., Scheinert D. et Al. Nitinol stent implantation versus balloon angioplasty for lesions in the superficial femoral artery and proximal popliteal artery: twelvemonth results from the RESIL

Abstract:

Purpose. To assess early and late results of iliac arteries balloon angioplasty and stenting in patients with chronic lower limb ischemia.

Material and methods. We analyzed the results of terminal aortic and iliac lesions endovascular treatment in 222 patients. All the patients presented symptoms of lower-limb chronic ischemia: 2nd «b» grade - 51,2%; 3rd grade - 27,1%; 4th grade - 21,7%. Two hundred and fifty eight procedure were performed, including 98 (38%) balloon angioplasty and 160 (62%) stenting. The lesions were Type A -26%, Type B - 45%, Type C - 23%, and Type D - 51% according to TASC II classification.

Results. Immediate angiographic success rate was 99,4%, complication rate -1,3% (4 of 314). Cumulative primary patency after balloon angioplasty in terms of 1, 3 and 5 years were correspondingly 97,9%, 82,0% and 64,2%. After stenting it was as high as 98,1%, 85,2% and 71,8%. Secondary patency after balloon angioplasty in terms of 1, 3 and 5 years was correspondingly 99,0%, 89,4% и 75,6%. For stenting it was 99,4%, 93,0% and 85,6% (Kaplan - Meier). Long-term clinical success rates in 1 year, 3 and 5 years were correspondingly 97,9%, 98,7% and 88,8% for angioplasty and 92,6%, 63,7% and 72,6% for stenting. Five-year limb preservation rate was 92,4% for angioplasty and 98,6% for stenting.

Conclusions. Endovascular interventions are proved to be safe and efficient for iliac arteries atherosclerotic lesions, and to have good long-term results. 

References 

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4.    Живарев Г.В., Коротков Н.И., Александров А.Л. и др. Исходы аортобедренного шунтирования при синдроме Лериша. III всероссийский съезд сердечно-сосудистых хирургов. М. 1996; 253.

5.    Казанчян П.О., Попов В.А., Дебелый Ю.В. и  др.  Аорто-подвздошно-бедренные   реконструкции       методом       эверсионной эндартерэктомии.   Разумный   возврат   к прошлому. Ангиология и сосудистая хирургия. 1999; 5: 71-80.

6.    Гуч А.А., Верещагин С.В., Кондратюк В.А. Определение   показаний   к   первичному рентгеноэндоваскулярному протезированию артерий подвздошно-бедренного сегмента. Эхография. 2000; 1 (2): 155-158.

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            11.  Затевахин И.И., Дроздов С.А., Хабазов Р.И. Допплеросфигмоманометрия в диагностике поражений глубокой артерии бедра. Клиническая хирургия. 1985; 7: 24-2

Abstract:

Purpose. To assess safety and efficiency of simultaneous RCA and major branches of LCA stenting in patients with myocardial infarction (MI).

Material and methods. Authors analyzed data of 237 patients. Coronary angiography (CAG) revealed triple vessel stenotic and/or occlusive disease. Pre-procedure systemic thrombolysis (streptokinase) used in 54 patients. Endovascular interventions (PTCA and stenting of the infarct related artery) performed in all the cases; in 24 patients, simultaneous complete anatomical coronary revascularization (CACR) attempted. In 30 cases, after PTCA of the infarct related artery (PTCA IRA) patients were transferred to other hospitals for bypass surgery as a second stage.

Results. Systemic thrombolysis efficiency was 40 %(22 patients) according to echocardiography and 26% (14 patients) by CAG. TIMI III flow restored in 100%, immediate clinical success rate was 97,5%. There were no procedural complications. Six patients died early after the PTCA for cerebral hemorrhage, acute LV failure, and LV rupture. Absence of myocardial ischemia in CACR subgroup was confirmed clinically and in treadmill test. Patients of PTCA IRA subgroup presented with angina of various functional class.

Conclusions. Endovascular interventions are highly efficient as a component of complex IM treatment. Primary CACR is proved to decrease symptoms of myocardial ischemia. 

References 

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2.    Бокерия Л.А., Гудкова Р.Г. Сердечно-сосудистая хирургия-2007. Болезни и врожденные    аномалии системы кровообращения. М.: НЦССХ им. А.Н. Бакулева РАМН.  2007; 144.

3.    Бокерия Л.А., Гудкова Р.Г. Сердечно-сосудистая хирургия-2007. Болезни и врожденные аномалии системы кровообращения. М.: НЦССХ им. А.Н. Бакулева РАМН. 2008; 161.        7.

4.    Carver A. et al. Longer-term follow-up of patients recruited to the REACT (Rescue Angioplasty Versus Conservative Treatment or Repeat Thrombolysis) trial. J. Am. Coll. Cardiol. 2009; 54:1 18-126.

5.      Gershlick A.H. et al. Rescue angioplasty after failed thrombolytic therapy for acute myo-cardial infarction. N. Engl. J. Med. 2005; 353: 2758-2768.

6.     Cantor W.J. et al. Routine early angioplasty after fibrinolysis for acute myocardial infarction. N. Engl.J. Med. 2009; 360: 2705-2718.

7.      Stone G.W. et  al. Paclitaxel-Eluting Stents vs Vascular Brachytherapy for In-Stent Restenosis Within Bare-Metal Stents. The TAXUS V ISR Randomized Trial. JAMA. 2006; 295: 1253-1263.

8.    Holmes J.D.R. et al. Sirolimus-Eluting Stents vs Vascular Brachytherapy for In-Stent Restenosis Within Bare-Metal Stents. The SISR Randomized Trial. JAMA. 2006; 295: 1264-1273.

9.    Serruys P.W. et al. Periprocedural quantitative coronary angiography after Palmaz-Schatz stent implantation predicts the restenosis rate at six months. J. Am. Coll. Cardiol. 1999; 34: 1067-1074.

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13.  Colombo A. et al. Sirolimus-Eluting Stents in bifurcation Lesions. Six-Month Angiographic Results According to the Implantation Technique. Presented at the American College of Cardiology 52nd Annual Scientific Session. 2003.

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