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: 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.

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