Website is intended for physicians
Всего найдено: 31



Introduction: surgical treatment of an area of accumulation of breast microcalcifications requires the surgeon to choose the optimal method of surgery. For a long time, the gold standard of surgery was the placement of a wire needle under X-ray control and subsequent removal. In our study, we want to demonstrate one of new methods, which is based on the placement of ultrasound marks in the area of accumulation of calcifications at the preoperative stage and further removal under the control of ultrasound device.

Aim: was to make comparative analysis and estimate the effectiveness of preoperative marking with ultrasound-positive (US-positive) marks in patients with non-palpable breast neoplasms.

Material and methods: the study included 165 patients (age 32 - 71 years). Patients were divided into three groups depending on the preoperative marking. The first group: installed ultrasound-positive Gel Mark UltraCor Bard marks in the region of microcalcifications at the outpatient stage.

The second group: marking with a wire needle «DuaLok» Bard immediately before the operation.

The third group: according to results of a repeated preoperative examination, which included: unilateral mammography in two projections with marker, a skin mark was established in the projection of a non-palpable formation.

Results: study showed that when choosing a surgical treatment using ultrasound-positive marks, the risk of detecting tumor cells at edges of the resection decreases, the time of surgery is shortened, and the volume of resection of healthy breast tissue is minimized.

Study proved that marking using ultrasound-positive marks has an advantage over other methods of preoperative marking and can be implemented in medical organizations that are not equipped with x-ray equipment for marking non-palpable breast formations immediately before surgery.



1.     Kaprin AD, Starinsky VV, Petrova GV. The status of cancer care for the population of Russia in 2018. MNII P.A. Herzen - branch of the Federal State Budgetary Institution Scientific Research Center for Radiology of the Ministry of Health of Russia, 2019: 236 [In Russ].

2.     World Health Organization. World health statistics 2019.

3.     Kaprin AD, Starinsky VV, Petrova GV. Malignant neoplasms in Russia in 2018 (morbidity and mortality). - M.: MNII them. P.A. Herzen - branch of the Federal State Budgetary Institution Scientific Research Center for Radiology of the Ministry of Health of Russia, 2019; 250 [In Russ].

4.     Manuylova OO, Pavlova TV, Didenko VV, et al. Guidelines for the use of the BI-RADS system for mammography examination. Moscow. 2017; 23 [In Russ].

5.     American College of Radiology, ACR BI-RADS Atlas 5th Edition, 2013.

6.     Bonfiglio R, Scimeca M, Urbano N, et al. Breast microcalcifications: biological and diagnostic perspectives. Future Oncol. 2018; 14(30): 3097-3099.

7.     Tardioli S, Ballesio L, Gigli S, et al. Wire-guided Localization in Non-palpable Breast Cancer: Results from Monocentric Experience. Anticancer Res. 2016; 36(5): 2423-2427.



Aim: was to evaluate the effectiveness of endovascular interventions in patients with critical limb ischemia (CLI) with multilevel extended lesions of lower limb arteries of types C and D according to TASC II.

Materials and methods: a retrospective analysis of results of surgical treatment of patients with critical limb ischemia, who underwent 127 endovascular interventions on arteries of the femoral- popliteal-tibial segment for the period from 2007 to 2020, was carried out. 15 patients had ischemic limb pain at rest (11,8%) and 112 patients had trophic lesions (88,2%). Our study included patients with arterial lesions of type C (18 patients, 14,2%) and type D (109 patients, 85,8%) according to TASC II.

Results: technical success of performed endovascular interventions was 95,3%. Within a 30-day period, 2 patients (1,6%) had myocardial infarction, 3 patients (2,4%) underwent early «high» amputation. Perioperative mortality was 0,8% (1 patient). Primary patency of endovascular interventions was 87%, 58% and 36% after 1, 3 and 5 years, respectively, while secondary patency was 91%, 81% and 58% after 1, 3 and 5 years, respectively. Limb salvage rate was 93%, 89% and 79% after 1, 3 and 5 years, respectively. Patient survival rate was 95%, 84% and 78% after 1, 3 and 5 years, respectively.

Conclusions: endovascular interventions on femoral-popliteal-tibial arterial lesions of types C and D according to TASC II in patients with critical limb ischemia are effective, and modern method of treatment with good immediate and long-term results.



1.     Conte MC, Bradbury AW, Kolh Ph, et al. Global vascular guidelines on the management of chronic limb-threatening ischemia. Journal of Vascular Surgery. 2019; 69(6): 123-125.

2.     Pokrovskij AV, Ivandeev AS. Sostojanie sosudistoj hirurgii v Rossii v 2016 godu. M.: Obshhestvo angiologov i sosudistyh hirurgov. Moskva. 2017; 76 [In Russ].

3.     Barriocanal АM, López A, Monreal M, Montané E. Quality assessment of peripheral artery disease clinical guidelines. J Vascular Surgery. 2016; 63(4): 1091-1097.

4.     Farber A, Eberhardt RT. The Current State of Critical Limb Ischemia. A Systematic Review. JAMA Surg. 2016; 151(11): 1070-1077.

5.     Agarwal S, Sud K, Shishehbor MH. Nationwide trends of hospital admission and outcomes among critical limb ischemia patients: from 2003-2011. J Am Coll Cardiol. 2016; 67(16): 1901-1913.

6.     Duff S, Mafilio MS, Bhounsul P, Hasegawa JT. The burden of critical limb ischemia: a review of recent literature. Vascular Health and Risk Management. 2019; 15: 187-208.

7.     Darling JD, McCallum JC, Soden PA, et al. Results for primary bypass versus primary angioplasty/stent for lower extremity chronic limb-threatening ischemia. J Vasc Surg. 2017; 66(2): 466-475.

8.     Antoniou GA, Georgiadis GS, Antoniou SA, et al. Bypass surgery for chronic lower limb ischemia (Review). Cochrane Database of Systematic Reviews. 2017; 3(4): CD002000.

9.     Uccioli L, Meloni M, Izzo V, et al. Critical limb ischemia: current challenges and future prospects. Vascular Health and Risk Management. 2018; 14: 63-74.

10.   Norgren L, Patel MR, Hiatt WR, et al. Outcomes of Patients with Critical Limb Ischaemia in the EUCLID Trial. Eur J Vasc Endovasc Surg. 2018; 55: 109-117.

11.   Spillerová К, et al. Angiosome Targeted PTA is More Important in Endovascular Revascularisation than in Surgical Revascularisation: Analysis of 545 Patients with Ischaemic Tissue Lesions. Eur J Vasc Endovasc Surg. 2017; 3: 1-9.

12.   Pokrovskij AV, Kazakov YuI, Lukin IB. Kriticheskaja ishemija nizhnih konechnostej. Ifraingvinal'noe porazhenie. M.: Tver': Tver. Gos. Un-e. 2018; 225 [In Russ].

13.   Aboyans V, Ricco JB, Bartelink ME, et al. Editor’s choiced 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2018; 55: 305-368.

14.   Brouillet J, Deloose K, Goueffic Y, et al. Primary stenting for TASC C and D femoropopliteal lesions: one-year results from a multicentric trial on 203 patients. The Journal of Cardiovascular Surgery. 2018; 59(3): 392-404.

15.   Schreuder SM, Hendrix Y, Reekers JA, Bipat S. Predictive Parameters for Clinical Outcome in Patients with Critical Limb Ischemia Who Underwent Percutaneous Transluminal Angioplasty (PTA): A Systematic Review. Cardiovasc Intervent Radiol. 2018; 41(1): 1-20.

16.   Norgren L, Patel MR, Hiatt WR, et al. Outcomes of Patients with Critical Limb Ischaemia in the EUCLID Trial. Eur J Vasc Endovasc Surg. 2018; 55: 109-117.

17.   Papojan SA, Shhegolev AA, Radchenko AN, et al. Otdalennye rezul'taty jendovaskuljarnogo lechenija porazhenij poverhnostnoj bedrennoj arterii tipov S i D po klassifikacii TASC II. Angiologija i sosudistaja hirurgija. 2018; 24(1): 73-78 [In Russ].

18.   Biagioni RB, Biagioni LC, Nasser F, et al. Infrapopliteal Angioplasty of One or More than One Artery for Critical Limb Ischaemia: A Randomised Clinical Trial. Eur J Vasc Endovasc Surg. 2018; 55: 518-527.

19.   Schneider PA, Laird JR, Tepe G, et al. Treatment effect of drug-coated balloons is durable to 3 years in the femoropopliteal arteries: long-term results of the IN.PACT SFA randomized trial. Circ Cardiovasc Interv. 2018; 11 (1): 885-891.

20.   Reijnen MJ. Outcomes After Drug-Coated Balloon Treatment of Femoropopliteal Lesions in Patients With Critical Limb Ischemia: A Post Hoc Analysis From the IN.PACT Global Study. J Endovasc Ther. 2019; 26: 305-315.




Currently, the results of diagnostics and treatment of gastric cancer (GC) are still not satisfactory. With the advent of modern catheters and angiographic devices, regional intra-arterial chemotherapy in patients with gastric cancer has become more often used in clinical practice.

Aim: was to improve results of treatment of patients with gastric cancer using regional intra-arterial chemotherapy (RIACT).

Material and methods: the immediate and long-term results of complex treatment of 110 patients with stomach cancer for the period 2005-2020 were analyzed. The average age of patients was 59,2 + 4,3 years. The prevalence of the tumor process according to the TNM classification was as follows: T3N0M0 - 37(33,63%) patients, T3N1M0 - 41 (37,27%) patients, and T3N2M0 - 32 (29,1%) patients. Histologically, all patients showed various forms of adenocarcinoma. At the first stage, all patients underwent neoadjuvant RIACT according to the DPF scheme (Docetaxel 75mg/m2 + Cisplatin 75mg/m2 + Fluorouracil 1000mg/m2 on the 1st day) for 2 courses with an interval of 28 days, then surgery.

Results: the immediate results of RIACT showed the effectiveness of treatment after 2 courses of neoadjuvant intra-arterial regional chemotherapy in 93 (84,5%) patients, partial regression was noted, in 17(15,5%) patients, stabilization of the process was noted. These patients underwent a radical operation with the second stage of complex treatment - extended gastrectomy with D2 lymphadenectomy. The drug pathomorphosis of the 1-2 degree was noted in 34 (30,9%) patients, the third degree was noted in 38 (34,5%), the pathomorphosis of the fourth degree in 9 (8,1%) patients. With dynamic follow-up of patients 9(8,1%) patients lived 6 months, 63 (57,2%) patients lived 12 months, 59 (53,3%) patients lived 18 months, 57(51,8%) patients lived 24 months, 47 (42,7%) patients lived 36 months, 41 (37,2%) patients lived 48 months and 35 (31,8%) patients 60 lived months and still are alive. The median survival rate was 51,8 + 1,5 months.

Conclusions: results of neoadjuvant intra-arterial chemotherapy in the treatment of gastric cancer patients proved to be effective in 84,5% of patients. In 42,6% of patients, grade 3-4 therapeutic pathomorphosis was noted. The 3- and 5-year survival rates were 42,7% and 31,8%, respectively. The median survival rate was 51,8 + 1,5 months.

Preoperative intra-arterial chemotherapy may be the method of choice for improving the survival and quality of life of patients with gastric cancer.






1.     Kaidarova DR. Indicators of the Oncological Service of the Republic of Kazakhstan for 2019 (statistical and analytical materials). Almaty. - 2020. -137 [In Russ].

2.     Kaprin AD, Starinskiy VV, Petrova GV. Malignant neoplasms in Russia in 2016 (morbidity and mortality). - M.: FGBU «MNIOI after named P.A. Herzen» of the Ministry of Health of Russia. - 2018. - 250 [In Russ].


4.     Abdollah MH, Farhad TB, Reza M. Lack of Any Relationship of Stomach Cancer Incidence and Mortality with Development in Asia. Asian Pacific Journal of Cancer Prevention. 2016, 17(8): 3775-3781.

5.     Smyth EC, Nilsson M, Grabsch HI, et al. Gastric cancer. Lancet. 2020; 396(10251): 635-648.

6.     Zyryanov BN, Makarkin NA, Tikhonov VI, Tuzikov SA. Combined treatment with intra-arterial regional chemotherapy for locally advanced gastric cancer. Russian Journal of Oncology. 1997; 1: 17-20 [In Russ].

7.     Barone C, Cassano A, Pozzo C, et al. Long-term follow-up of a pilot phase II study with neoadjuvant epidoxorubicin, etoposide and cisplatin in gastric cancer. Oncology. 2004; 67(1): 48-53.

8.     Wang J, Shi H, Yang G, et al. Combined intra-arterial and intravenous chemotherapy for unresectable, advanced gastric cancer has an improved curative effect compared with intravenous chemotherapy only. Oncology Letters. 2018; 15(4).

9.     Song Z, Wu Y, Yang J, et al. Progress in the treatment of advanced gastric cancer. Tumour Biol. 2017; 39(7): 1010428317714626.

10.   Choi AH, Kim J, Chao J. Perioperative chemotherapy for resectable gastric cancer: MAGIC and beyond. World J Gastroenterol. 2015; 21(24): 7343-8.

11.   Johnston FM, Beckman M. Updates on Management of Gastric Cancer. Curr Oncol Rep. 2019;21(8): 67.

12.   Ikegame K, Terashima M. Perioperative Chemotherapy for Gastric Cancer. Gan to Kagaku Ryoho. 2020; 47(4): 569-573.





Introduction: congenital portosystemic venous shunts (CPVS) are rare vascular abnormalities that occur secondary to abnormal development or involution of fetal vasculature. They allow intestinal blood to enter the systemic circulation, bypassing the liver, which in the long term leads to various symptoms and complications. Today, thanks to advanced imaging techniques, the number of reported cases of CPVS is increasing, although for the most part these are single clinical cases or reports summarizing small series of cases. The overall incidence of CPVS is estimated at 1:30 000 births and 1:50 000 for those persisting beyond early childhood.

Material and methods: article consists of 44 foreign literature sources, that  highlight pathogenesis, classification, clinical picture, diagnosis and treatment of CPVS.

Conclusion: early diagnosis and correction of this anomaly using any (endovascular or surgical) occlusion regresses symptoms and prevents long-term complications. At present, given the rarity of this pathology, there is no large statistical analysis and no standards, developed for the management of this category of patients. However, further collection of material, an emphasis on the pathophysiology and anatomy of these lesions, will help to provide more effective care for patients with congenital portosystemic venous shunts.





1.     Kim MJ, Ko JS, Seo JK, et al. Clinical features of congenital portosystemic shunt in children. Eur J Pediatr. 2012; 171(2): 395-400.

2.     Florio F, Nardella M, Balzano S, et al. Congenital intrahepatic portosystemic shunt. Cardiovasc Intervent Radiol. 1998; 21(5): 421-424.

3.     Baiges A, Turon F, Simуn-Talero M, et al. Congenital Extrahepatic Portosystemic Shunts (Abernethy Malformation): An International Observational Study. Hepatology. 2020; 71(2): 658-669.

4.     Ольхова Е.Б., Туманян Г.T., Венгерская Г.В. и др. Мальформация Абернети у новорожденных. Эхографическая диагностика. Радиология-практика. 2015; 5(54): 46-58.

Olkhova EB, Tumanyan GT, Hungarian GV, et al. Abernathy malformation in newborns. Echographic diagnostics. Radiology-practice. 2015; 5 (54): 46-58 [In Russ].

5.     Малышева Е.Б., Захарова Е.М., Рыхтик П.И., Жулина Н.И. Мальформация Абернетти - редкая причина гемодинамического цирроза печени. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. Приложение. 2017; 27(1) S49; 48.

Malysheva EB, Zakharova EM, Rykhtik PI, Zhulina NI. Abernetty's malformation is a rare cause of hemodynamic cirrhosis of the liver. Russian journal of gastroenterology, hepatology, coloproctology. Application. 2017; 27(1) S49; 48 [In Russ].

6.     Abernethy J. Account of two instances of uncommon formation in the viscera of the human body. Philos Trans R Soc Lond B Biol Sci. 1793; 83: 59-66.

7.     Sokollik C, Bandsma RH, Gana JC, et al. Congenital portosystemic shunt: characterization of a multisystem disease. J. Pediatr. Gastroenterol. Nutr. 2013; 56(6): 675-681.

8.     Guérin F, Blanc T, Gauthier F, et al. Congenital portosystemic vascular malformations. Semin. Pediatr. Surg. 2012; 21(3): 233-244.

9.     Bernard O, Franchi-Abella S, Branchereau S, et al. Congenital portosystemic shunts in children: recognition, evaluation, and management. Semin Liver Dis. 2012; 32(4): 273-287.

10.   Lin ZY, Chen SC, Hsieh MY, et al. Incidence and clinical significance of spontaneous intrahepatic portosystemic venous shunts detected by sonography in adults without potential cause. J Clin Ultrasound. 2006; 34(1): 22-26.

11.   Gitzelmann R, Forster I, Willi UV. Hypergalactosaemia in a newborn: self-limiting intrahepatic portosystemic venous shunt. Eur J Pediatr. 1997; 156: 719-722.

12.   Ponziani FR, Faccia M, Zocco MA, et al. Congenital extrahepatic portosystemic shunt: description of four cases and review of the literature. J Ultrasound. 2019; 22(3): 349-358.

13.   De Paula Oliveira GJ, Ferreira S, Barbosa A. Abernethy Malformation – Congenital Extra-hepatic Portosystemic Shunt Associated with Multiple Liver Adenomatosis: Case Report. Universal Journal of Public Health. 2019; 7(3): 129-137.

14.   Nagata H, Yamamura K, Ikeda K. Balloon-occluded retrograde transvenous obliteration for congenital portosystemic venous shunt: report of two cases. Pediatr Int. 2012; 54(3): 419-421.

15.   Passalacqua M, Lie KT, Yarmohammadi H. Congenital extrahepatic portosystemic shunt (Abernethy malformation) treated endovascularly with vascular plug shunt closure. Pediatr Surg Int. 2012; 28(1): 79-83.

16.   Raghuram KA, Bijulal S, Krishnamoorthy KM, Tharakan JA. Regression of pulmonary vascular disease after therapy of Abernethy malformation in visceral heterotaxy. Pediatr Cardiol. 2013; 34(8):1882-5.

17.   DiPaola F, Trout AT, Walther AE, et al. Congenital Portosystemic Shunts in Children: Associations, Complications, and Outcomes. Dig Dis Sci. 2020; 65(4): 1239-1251.

18.   Ogul H, Bayraktutan U, Yalcin A, et al. Congenital absence of the portal vein in a patient with multiple vascular anomalies. Surg Radiol Anat. 2013; 35(6): 529-534.

19.   Morgan G, Superina R. Congenital absence of the portal vein: two cases and a proposed classification system forportasystemic vascular anomalies. J Pediatr Surg. 1994; 29(9):1239-1241.

20.   Glonnegger H, Schulze M, Kathemann S, et al. Case Report: Hepatic Adenoma in a Child With a Congenital Extrahepatic Portosystemic Shunt. Front Pediatr. 2020; 8: 501.

21.   Raskin NH, Price JB, Fishman RA. Portal-systemic encephalopathy due to congenital intrahepatic shunts. The New England Journal of Medicine. 1964; 270: 225-229.

22.   Park JH, Cha SH, Han JK, Han MC. Intrahepatic portosystemic venous shunt. Am J Roentgenol. 1990; 155: 527-528.

23.   Senocak E, Oğuz B, Edgьer T, Cila A. Congenital intrahepatic portosystemic shunt with variant inferior right hepatic vein. Diagn Interv Radiol. 2008; 14: 97-99.

24.   Niwa T, Aida N, Tachibana K, et al. Congenital absence of the portal vein: clinical and radiologic findings. J Comput Assist Tomogr. 2002; 26(5): 681-6.

25.   Kobayashi N, Niwa T, Kirikoshi H, et al. Clinical classification of congenital extrahepatic portosystemic shunts. Hepatol Res. 2010; 40(6): 585-93.

26.   Benedict M, Rodriguez-Davalos M, Emre S, et al. Congenital Extrahepatic Portosystemic Shunt (Abernethy Malformation Type Ib) With Associated Hepatocellular Carcinoma: Case Report and Literature Review. Pediatr Dev Pathol. 2017; 20(4): 354-362.

27.   Kroencke T, Murnauer M, Jordan FA, et al. Radioembolization for Hepatocellular Carcinoma Arising in the Setting of a Congenital Extrahepatic Portosystemic Shunt (Abernethy Malformation). Cardiovasc Intervent Radiol. 2018; 41(8): 1285-1290.

28.   Alonso-Gamarra E, Parrón M, Pérez A, et al. Clinical and radiologic manifestations of congenital extrahepatic portosystemic shunts: a comprehensive review. Radiographics. 2011; 31(3): 707-722.

29.   Brasoveanu V, Ionescu MI, Grigorie R, et al. Living Donor Liver Transplantation for Unresectable Liver Adenomatosis Associated with Congenital Absence of Portal Vein: A Case Report and Literature Review. Am J Case Rep. 2015; 16: 637-644.

30.   Duprey J, Gouin B, Benazet MF, le Gal J. Glucose intolerance and post-stimulative hypoglycaemia secondary to congenital intra-hepatic porto-caval anastomosis. Annales de Medecine Interne. 1985; 136(8): 655-658.

31.   Watanabe A. Portal-systemic encephalopathy in non-chirrotic patients: classification of clinical types, diagnosis and treatment. Journal of Gastroenterology and Hepatology. 2000; 15(9): 969-979.

32.   Murray CP, Yoo SJ, Babyn PS. Congenital extrahepatic portosystemic shunts. Pediatric Radiology. 2003; 33(9): 614-620.

33.   Nishimura Y, Tajima G, Dwi Bahagia A, et al. Differential diagnosis of neonatal mild hypergalactosaemia detected by mass screening: clinical significance of portal vein imaging. Journal of Inherited Metabolic Disease. 2004; 27(1): 11-18.

34.   Eroglu Y, Donaldson J, Sorensen LG, et al. Improved neurocognitive function after radiologic closure of congenital portosystemic shunts. Journal of Pediatric Gastroenterology and Nutrition. 2004; 39(4): 410-417.

35.   Emre S, Amon R, Cohen E, et al. Resolution of hepatopulmonary syndrome after auxiliary partial orthotopic liver transplantation in Abernethy malformation. A case report. Liver Transplantation. 2007; 13(12): 1662-1668.

36.   Kim MJ, Ko JS, Seo JK, et al. Clinical features of congenital portosystemic shunt in children. European Journal of Pediatrics. 2012; 171(2): 395-400.

37.   Timpanaro T, Passanisi S, Sauna A, et al. Congenital portosystemic shunt: our experience. Case Rep Pediatr. 2015; 691618.

38.   Chocarro G, Amesty MV, Encinas JL, et al. Congenital Portosystemic Shunts: Clinic Heterogeneity Requires an Individual Management of the Patient. Eur J Pediatr Surg. 2016; 26(1): 74-80.

39.   Achiron R, Kivilevitch Z. Fetal umbilical-portal-systemic venous shunt: in utero classification and clinical significance. Ultrasound Obstet Gynecol. 2016; 47: 739-747.

40.   Franchi-Abella S, Gonzales E, Ackermann O, et al. Congenital portosystemic shunts: diagnosis and treatment. Abdom Radiol (NY). 2018; 43(8): 2023-2036.

41.   Musa J, Madani K, Saliaj K, et al. Asymptomatic presentation of a congenital malformation of the portal vein with portosystemic shunt. Radiol Case Rep. 2020; 15(10): 2009-2014.

42.   Back SJ, Maya CL, Khwaja A. Ultrasound of congenital and inherited disorders of the pediatric hepatobiliary system, pancreas and spleen. Pediatr Radiol. 2017; 47: 1069-1078.

43.   Nam HD. Living-donor liver transplantation for Abernethy malformation - case report and review of literature. Ann Hepatobiliary Pancreat Surg. 2020; 24(2): 203-208.

44.   Papamichail M, Pizanias M, Heaton N. Congenital portosystemic venous shunt. Eur J Pediatr. 2018; 177(3): 285-294.



Article presents a case report of a 38-year-old patient who was admitted to our hospital with symptoms of acute appendicitis, she was examined and then urgently operated.

Postoperative period was complicated by clinical picture of colonic bleeding. During 1 st day of postoperative period, patient underwent a diagnostic search of bleeding source, conservative hemostatic therapy, transfusion of blood components, however, taking into consideration negative dynamics of patient's condition, laboratory test indicators, the next day, she was urgently operated: lower midline laparotomy, suturing of cecum hematoma, drainage of the abdominal cavity. Eight hours after repeated surgical treatment, against the background of transfusion of blood components, further negative dynamics of patient's condition, laboratory test indicators also worsened, medical concilium decided to perform angiography, followed by a decision on the amount of treatment intraoperatively. Selective angiography of branches of the mesenteric artery was performed, the source of bleeding was diagnosed, and a successful temporary pharmacologic endovascular hemostasis of the branch of the superior mesenteric artery was performed. Post-hemorrhagic anemia in the patient was corrected on the 3rd day after endovascular intervention, 10 days after, patient was discharged in a satisfactory condition.

The choice of the method of endovascular intervention was carried out taking into consideration the ineffective of reoperation, patient's condition, as well as peculiarities of the blood supply to the area of the alleged source of bleeding.

The study also discusses indications and methods of endovascular treatment of colonic bleeding.




1.     Avdos'ev JuV, Belozerov IV, Kudrevich AN. Endovascular methods for the diagnosis and treatment of acute bleeding into the lumen of the gastrointestinal tract. Novostihirurgii. 2018; 26 (2): 169-178 [In Russ].

2.     Soh B, Chan S. The use of super-selective mesenteric embolisation as a first-line management of acute lower gastrointestinal bleeding. Annals of Medicine and Sur­gery. 2017; 17: 27-32.

3.     Avdos'ev JuV, Bojko W. Angiography and endovascular abdominal bleeding. Ukraina: Savchuk. 2011; 648. [In Russ].

4.     Tan К К, Wong D, Sim R. Superselective Embolization for Lower Gastrointestinal Hemorrhage: An Institutional Review Over 7 Years. World J Surg. 2008; 32:2707-2715.

5.     Annamalai G, Masson N, Robertson I. Acute gastrointestinal haemorrhage: investigation and treatment. Imaging. 2009; 21(2): 142-151.

6.     Urbano J, Manuel Cabrera J, Franco A, Alonso-Burgos A. Selective arterial embolization with ethylenevinyl alcohol copolymer for control of massive lower gastrointestinal bleeding: feasibility and initial experience. J Vase I nterv Radiol. 2014; 25: 839-846.

7.     Walker TG, Salazar GM, Waltman AC. Angiographic evaluation and management of acute gastrointestinal hemorrhage. World J Gastroenterol. 2012;18 (11): 1191-1201.

8.     Jang Bl. Lower gastrointestinal bleeding: is urgent colonoscopy necessary for all hematochezia? Clinical Endosc. 2013; 46: 476-479.

9.     Green ВТ, Rockey DC, Portwood G et al. Urgent colonoscopy for evaluation and management of acute lower gastrointestinal hemorrhage: a randomized controlled trial. Am J Gastroenterol. 2005; 100: 2395-2402.

10.   Loffroy R, Falvo N, Nakai M et al. When all else fails - radiological management of severe gastrointestinal bleeding. Best Practice & Research Clinical Gastroenterology. 2019; 1-9.

11.   Shi Z X, Yang J, Liang H W et al. Emergency transcatheter arterial embolization for massive gastrointestinal arterial hemorrhage. Medicine. 2017; 96(52): 9437.

12.   Nanavati S M. What if endoscopic hemostasis fails? Alternative treatment strategies: interventional radiology. Gastroenterol Clin North Am. 2014;43(4): 739-752.



Aim: was to estimate long-term results of vertebral artery (VA) stenting in patients with vertebrobasilar insufficiency (VBI).

Material and methods: study included 194 patients with VBI caused by lesion of V1 segment of VA. All patients received the best course of drug therapy before admission to the clinic. In all these patients, atherosclerotic stenosis of 70% or more of VA was revealed in V1 sergment. All patients underwent surgical correction of V1 segment of VA. Open surgery was performed in «A» group – with a tortuosity of VA – 129(66,5%), in group «B» – without tortuosity of a VA – 65(33,5%) performed stenting of V1 segment of PA.

Bare-metal stents were implanted in 44 patients, drug-eluted stents - 14, renal stents – 7. Distal protection was used in 14 patients. In remaining patients, stenting was performed without embolic protection devices.

Main criteria for evaluating of results were: patency of the reconstruction zone and clinical improvement in the patient after surgery. Statistical processing of results was carried out by calculating χ2, the exact Fisher test (EFT) and constructing of Kaplan-Meier survival curves.

Results: it was determined that in «hopeless» patients, from the point of view of drug treatment, it is possible to achieve a significant clinical effect by surgical methods. Of 194 patients, clinical improvement in the early postoperative period was achieved in 189(97,4%) patients, after 1 year in 177 (91,2%) patients, and after 3 years in 156(80.2%) patients.

In case of stenting of V1 segment of VA – we received excellent immediate results – 100% of technical and clinical success. However, in the long term, results of open operations were better than results of stenting. 3 years after operation, a higher clinical efficacy of open methods was determined – 79,8%, in contrast to stenting – 73,8%. Although, differences were not statistically significant (p> 0,05). 3 years after operation, in case of open operations, a significantly smaller number of restenosis of the reconstruction zone was 1.6%, than with stenting – 15,4% (p <0.05). However, in patients with open operations, more thrombosis of the reconstruction zone were revealed – 5,5% than in patients with stenting – 1.5% (p>0,05). When performing open operations on V1 segment of VA, strokes were fewer – 2.3%, than in group of V1 stenting segment of VA – 3.1% (p> 0.05). When comparing Kaplan-Meyer curves, the median during open surgeries on VA is not achieved after 18 years, and in group of stenting of VA, it occurs after 7 years.

Conclusion: stenting of V1 segment of vertebral arteries in patients with VBI is not the operation of choice in terms of long-term results. However, this operation can be considered as the first stage of brain revascularization in the presence of significant stenosis of V1 segment of vertebral artery and low brain tolerance to ischemia in patients with multiple lesions of brachiocephalic arteries.



1.     Savitz SI, Caplan LR: Vertebrobasilar disease. N Engl J Med. 2005; 352:2618-2626.

2.     Caplan LR, Wityk RJ, Glass TA, Tapia J, Pazdera L, Chang HM, Teal P, Dashe JF, Chaves CJ, Breen JC, Vemmos K, Amarenco P, Tettenborn B, Leary M, Estol C, Dewitt LD, Pessin MS: New England Medical Center Posterior Circulation registry. Ann Neurol. 2004; 56:389-398.

3.     Vereschagin NV. Pathology of vertebrobasilar system and cerebrovascular accidents. M. 1980; 312. [In Russ].

4.     Puzin MN, Zinoveva GA, МеtelkinaLP. Aspects of medical treatment of patients with vertebrobasilar insufficiency. Klinicheskaya farmakologiya i terapia, 2006; 2: 23-26. [In Russ].

5.     Berguer R, Morasch M, Kline R. A review of 100 consecutive reconstructions of the distal vertebral artery for embolic and hemodynamic disease. J Vasc Surg. 1998; 27 (5): 852-859.

6.     Pokrovskii AV, Belojarcev DF. Long-term results of operations subclavian-carotid transposition. Angiologiya i sosudistaya khirurgiya 2002; 8 (2): 84 - 91. [In Russ].

7.     He Y, Bai W, Li T et al. Perioperative complications of recanalization and stenting for symptomatic nonacute vertebrobasilar arteryocclusion. Ann Vasc Surg. 2014 Feb; 28 (2):386-393.

8.     2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries Endorsed by: the European Stroke Organization (ESO)The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J. 2018 Mar 1; 39(9): 763-816.

9.     National guidelines on the management of patients with brachiocephalic artery disease. Angiologiya i sosudistaya khirurgiya. 2013; 19 (2), appendix: 70 [In Russ].

10.   Schonewille WJ, Algra A, Serena J, Molina CA, Kappelle LJ. Outcome in patients with basilar artery occlusiontreated conventionally. J Neurol Neurosurg Psychiatry. 2005; 76:1238-1241.

11.   Coward LJ, McCabe DJ, Ederle J, Featherstone RL, Clifton A, Brown MM: Long-term outcome after angioplasty and stenting for symptomatic vertebral artery stenosis compared with medical treatment in the Carotid And Vertebral Artery Transluminal Angioplasty Study (CAVATAS): a randomized trial. Stroke. 2007; 38:1526-1530.

12.   Compter A, van der Worp HB, Schonewille WJ, Vos JA, Algra A, Lo TH, Mali WPThM, Moll FL and Kappelle LJ. VAST: Vertebral Artery Stenting Trial. Protocol for a randomized safety and feasibility trial. Trials 2008; 9: 65.

13.   Clifton A, Markus H, Kuker W, Rothwell P.E-050. The Rationale for the Vertebral artery Ischaemia Stenting trial (VIST): NeuroIntervent Surg 2013; 5. Suppl 2 A56.

14.   Compter A et al. VAST investigators. Stenting versus medical treatment in patients with symptomatic vertebral artery stenosis: a randomised open-label phase 2 trial. Lancet Neurol. 2015 Jun; 14(6): 606-614.

15.   VIST (Vertebral artery Ischaemia Stenting Trial) ISRCT N 95212240.

16.   Markus HS, Harshfield EL, Compter A. et al. Stenting for symptomatic vertebral artery stenosis: a preplanned pooled individual patient data analysis. Lancet Neurol. 2019 Jul; 18(7): 666-673.

17.   Markus HS, Larsson SC, Dennis J et al. Vertebral artery stenting to prevent recurrent stroke in symptomatic vertebral artery stenosis: the VIST RCT. Health Technol Assess. 2019 Aug; 23(41): 1-30.



This study presents an overview of modern methods of surgical and endovascular treatment of atherosclerotic lesions of the superficial femoral artery

Aim: was to analyze the state of surgical and endovascular treatment of atherosclerotic lesions of the superficial femoral artery according to the modern literature in the field of vascular surgery

Results: this review analyzes more than 30 relevant publications presented in both domestic anc foreign press over the past 20 years, taking into account a variety of meta-analyses.

Conclusions: this topic is very relevant today, as the increase in the number of surgical and endovascular interventions in lesions of the superficial femoral artery dictates new research to develop optimal tactics of treatment of this category of patients.



1.     Pokrovskij A.V. The state of vascular surgery in 2017. Moskva 2018. [In Russ.]

2.     Pokrovskij A.V. Clinical angiology. Guide-book for physicians. M.: Medicina. 2004; 2: 184 [In Russ.]

3.     Diamantopoulos A, Katsanos K. Treating femoropopliteal disease: established and emerging technologies. Semin Intervent Radiol. 2014 Dec; 31(4):345-52.

4.     Dominguez A, Bahadorani J, Reeves R, et al. Endovascular therapy for critical limb ischemia. Expert Rev Cardiovasc Ther. 2015 Apr; 13(4): 429-44.

5.     Bokeriya L.A., Temrezov M.B., Kovalenko V.I., i dr. Actual problems of surgical treatment of patients with critical ischemia of lower limbs - solutions (state of the problem). Annalyhirurgii. 2011; 1: 5-9. [In Russ.]

6.     Norgen L, Hiatt WR, Dormandy JA. et al. Inter-Society Consensus for the management of Peripheral Arterial Disease (TASC II). Eur. J. Vasc. Endovasc. Surg. 2007; 3(1): 1-75.

7.     Cotroneo AR, Iezzi R, Marano G. Hybryd therapy in patients with complex peripheral ultifocal steno-obstructive vascular disease: two-year results. Cardiovasc. Intervent. Radiol. 2007; 30: 355-361.

8.     Bokeriya L.A. Endovascular surgery of diseases of great vessels. M.:NCSSKH im. A.N. Bakuleva RAMN, 2008;291-310. [In Russ.]

9.     Gavrilenko A.V., Kotov A.E., Murav'eva YA.YU. The effect of tactical errors on results of surgical treatment in patients with critical lower limb ischemia. Angiologiya i sosudistaya hirurgiya. 2010; 16(1):138-143. [In Russ.]

10.   Marston WA, Davies SW, Armstrong В, Farber MA, Mendes RC, Fulton JJ, Keagy BA. Natural history of limbs with arterial insufficiency and chronic ulceration treated without revascularization. J Vase Surg. 2006 Jul; 44(1): 108-114.

11.   Kazakov YU. I., Lukin I. B., Kazakov A. YU. The choice of vascular reconstruction method for critical lower limb ischemia. Angiologiya i sosudistaya hirurgiya. 2015;21(2):152-8.

12.   Bied Dzh. D. Amputation or reconstruction for critical lower limb ischemia. Angiologiya i sosudistaya hirurgiya. 1998;4(1): 72-78. [In Russ.]

13.   Pokrovskij A.V. Russian consensus. Diagnosis and treatment of patients with critical lower limb ischemia. M., Shwarz Pharma, 2002; 40 s. [In Russ.]

14.   Linkert P. et al. Saphenous Vein Versus PTFE for Above-Knee Femoropopliteal Bypass. A Review of the Literature. Eur. J. Vasc. Endovasc. Surg. Elsevier BV. 2004; 27(4): 357-362.

15.   Abramov S.I., Majtesyan D.A., Lazaryan T.A. Longterm results with a semi-closed endarterectomy loop from the superficial femoral artery and femoral-popliteal bypass grafting. Angiologiya i sosudistaya hirurgiya. 2014; 20(4): 147-151 [In Russ.]

16.   Beard JD: which revascularization is best for critical limb ischemia: endovascular or open surgery? J Vasc Surg. 2008, 48: 112-116S. 10.1016 / j.jvs.2008.01.065.

17.   Blevins WA, Schneider PA: Endovascular treatment of critical limb ischemia. Eur J Vasc Endovasc Surg. 2010; 39 (6): 756-761. 10.1016 / j.ejvs.2010.02.008.

18.   Adam DJ, Beard JD, Cleveland T, et al: BASIL trial participants. Shunting and angioplasty in severe ischemia of the foot (basil): a multicenter, randomized controlled trial. Lancet. 2005, 366 (9501): 1925-1934.

19.   Bradbury AW, Adam DJ, Bell J, et al. Bypass versus Angioplasty in Severe Ischemia of the Leg (BASIL) trial: An intention-to-treat analisys of amputation-free and overall survival in patients randomized to a bypass surgery-first or a ballon angioplasty-first revascularization strategy. J. Vasc. Surg. 2010; 51: 5-17.

20.   Lindgren H, Qvarfordt P, Ekesson M, et al Primary Stenting of the Superficial Femoral Artery in Intermittent Claudication Improves Health Related Quality of Life, ABI and Walking Distance: 12 Month Results of a Controlled Randomised Multicentre Trial. Eur J Vasc Endovasc Surg. 2017        May; 53(5):686-694.

21.   Grimme FA., Goverde PA., Van Oostayen JA., et al. Covered stents for aortoiliac reconstruction of chronic occlusive lesions. J. Cardiovasc. Surg. (Torino). 2012; 53 (3):279-89.

22.   Gandini R, Fabiano S, Chiocchi M, et al. Percutaneous treatment in iliac artery occlusion: long-term results. Cardiovasc. Intervent. Radiol. 2008; 31 (6): 1069-76.

23.   Yokoi Y How should recent endovascular trials for femoropopliteal artery disease be interpreted. Cardiovasc Interv Ther. 2017 Apr; 32(2):106-113.

24.   Deloose K, Callaert J. Less is more: the "As Less As Reasonably Achievable Stenting" (ALARAS) strategy in the femoropopliteal area. J Cardiovasc Surg (Torino). 2018 Aug; 59(4):495-503.

25.   Chalmers n Walker PT, Belly AM et al. A randomized study of a smart stent versus balloon angioplasty for long superficial lesions of the femoral artery: a super-study. Cardiovascular and Interventional Radiology. 2013; 36 (2): 353-361

26.   Dake MD. et al. Durable Clinical Effectiveness With Paclitaxel-Eluting Stents in the Femoropopliteal ArteryCLINICAL PERSPECTIVE. Circulation. Ovid Technologies (Wolters Kluwer Health), 2016;133(15): 1472-1483.

27.   Muradin GSR, Bosch Denpasar, Stainen T, Hunink MGM. Balloon dilatation and stent implantation for the treatment of arterial disease of the femur: Meta-analysis. Radiology. 2001; 221 (1): 137-145.

28.   Acin F, de Haro J, Bleda S,et al Primary nitinol stenting in femoropopliteal occlusive disease: a meta-analysis of randomized controlled trials. J Endovasc Ther. 2012 Oct;19(5):585-95. doi: 10.1583/JEVT-12-3898R.1.

29.   Zatevahin         I.I., SHipovskij V.N., Tursunov S.B. i dr. Longterm results of angioplasty using drug-coated balloons for lesions of the femoral-popliteal segment. Angiologiya i sosudistaya hirurgiya. 2014; 20(4): 64-68. [In Russ.]

30.   Katsanos to Karnabatidis D. Kitrou P Spiliopoulos with Christeas H Siablis D. Paclitaxel-coated balloon angioplasty and a conventional dilatation balloon for treatment of non-dialysis access: 6-month interim results from a prospective randomized controlled trial. Journal of Endovascular Therapy. 2012; 19 (2): 263-272.

31.   Werk M, Albrecht T, Dirk-Roelfs Meyer D-R, et al. Paklitaxel-Coated Balloons Reduse Restenosis After Femoropopliteal Angioplasty. Circ. Cardivasc. Interv. 2012; 5:831-840.

32.   Fanelli F, Cannavale A, Boatta E, et al. Lower limb multilevel treatment with drug-eluting balloons: 6-month results from the DEBELLUM randomized trial. J Endovasc Ther. 2012; 19: 571-580.

33.   Diamantopoulos A, Gupta Y, Zayed H. et al Paclitaxel-coated balloons and aneurysm formation in peripheral vessels. J Vasc Surg 2014; epub ahead of print.

34.   Pastromas G, Katsanos K, Krokidis M, et al Emerging stent and balloon technologies in the femoropopliteal arteries. Scientific World Journal. 2014; 2014:695402.

35.   Schmidt A, Piorkowski M, Werner M, et al: First experience with drug-eluting balloons in infrapopliteal arteries: restenosis rate and clinical outcome. J Am Coll Cardiol. 2011; 58 (11): 1105-1109. 10.1016/j.jacc. 2011.05.034.

36.   Fanelli F, Cannavale A, Boatta E, et al: Lower limb multilevel treatment with drug-eluting balloons: 6-month results from the DEBELLUM randomized trial. J Endovasc Ther. 2012; 19 (5): 571-580. 10.1583/JEVT-12-3926MR.1.

37.   Liistro F, Porto I, Angioli P, et al: Drug-eluting balloon in peripheral intervention for below the knee angioplasty evaluation (DEBATE-BTK): a randomized trial in diabetic patients with critical limb ischemia. Circulation. 2013.

38.   Bays S. The use of scoring balloons in the superficial femoral artery. J Cardiovasc Surg (Torino). 2018 Aug; 59(4):504-511.

39.   Saxon rubles. Heparin bonded stent grafts in SFA: VIPER annual results. The report is presented at the International Symposium on Endovascular Therapy; January 18, 2012; Miami, Fla, USA.

40.   Ansel G. 3-year vivid results. The document is available at: Vascular InterVentional Advances; October 2011; Las Vegas, Nev, USA.

41.   Vermassen F. Bouckenooghe I, Morel N Goverde P. Schroe N. The role of biodegradable stents in the superficial femoral artery. Journal of Cardiovascular Surgery. 2013; 54 (2): 225-234.



We performed an analysis of literature data about angiosome concept in treatment of patients wih critical lower limb ishemia. We presented data on the appearance and development of this concept. Possibilities of using this tactic in various situations are considered, advantages and disadvantages of this concept are shown. Factors, limiting the effectiveness of this method, and alternative methods when it is impossible to restore blood flow according to the angiosome concept - the degree of lesion of arteries and the development of collateral blood flow to restore perfusion of soft tissues are given. It has been shown that the correct assessment of collateral arteries in critical lower limb ischemia plays a central role in any type of lower limb revascularization, and this statement also applies to a strategy based on the angiosome concept.



1.      Diabetes: Newsletter. No. 312 [Electronic resource]. Vsemirnaya Organizaciya Zdravoohraneniya. ZHeneva,2011. Rezhim dostupa: factsheets/fs312/ru/index.html. Data dostupa: 31.03.11. [In Russ.]

2.      Wild S et al. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004. Vol. 27. P. 1047-1053.

3.      Sachek M.G., Bulavkin V.P., Eroshkin S.N. Possibilities of direct limb revascularization in treatment of patients with diabetic foot syndrome. Novosti hirurgii tom 19. №4.2011. [In Russ.]

4.      Ancyferov M. B. i dr. Prophylaxis system of lower limb' amputations in patients with diabetes mellitus and prospects for its implementation in Moscow. Problemy endokrinologii. 2007. T. 53, № 5. S. 8-12. [In Russ.]

5.      Norgren L, Hiatt WR, Dormandy JA, et al: Inter-society consensus for the management of peripheral arterial disease [TASC II]. Eur J Vasc Endovasc Surg. 2007; 33Suppl 1:S32-55 S.

6.      Mitchell ME: lower extremity major amputations. In: Diabetic foot, lower extremity arterial disease and limb salvage. Philadelphia, lippincott Williams & Wilkins, 2006:341-350.

7.      Eroshkin S.N.. Long-term results of treatment of patients with purulent-necrotic forms of diabetic foot syndrome, depending on used methods of revascularization. Novosti hirurgii tom 21. № 4. 2013. [In Russ.]

8.      Ikonen T.S., Sund R., Venermo M., Winell K.: Fewer major amputations among individuals with diabetes in Finland in 1997-2007: a population-based study. Diabetes Care 2010;33:2598-2603.

9.      Graziani l., Silvestro A., Bertone V., et al: Vascular involvement in diabetic subjects with ischemic foot ulcer: a new morphologic categorization of disease severity. Eur J Vasc Endovasc Surg 2007;33:453-460.

10.    Lepantalo M., Apelqvist J., Setacci C., et al: Chapter v: Diabetic foot. Eur J Vasc Endovasc Surg. 2011;42 Suppl 2: S60-74.

11.    Alexandrescu V., Sцderstrцm M., Venermo M. Angiosome theory: fact or fiction? Scandinavian Journal of Surgery 101: 125-131, 2012.

12.    Lepantalo M., Biancari F, Tukiainen E.: never amputate without consultation of a vascular surgeon. Diabetes Metab Res Rev2000;[16]: Suppl 1: S27-32

13.    Beard J.D. Which is the best revascularization for critical limb ischemia:endovascular or open surgery? J Vasc Surg. 2008; 48(6 Suppl): 11S-6S. doi: 10.1016/j.jvs.2008.08.036.

14.    Romiti M, Albers M, Brochado-Neto FC, et al. Metaanalysis of infrapopliteal angioplasty for chronic critical limb ischemia. J Vasc Surg. 2008;47(5):975-981. doi: 10.1016/j.jvs.2008.01.005.

15.    Bondarenko O.N., Galstyan G.R., Ayubova N.L., i dr. Outcomes of endovascular interventions in patients with diabetes mellitus and critical lower limb ischemia. Sbornik tezisov. VI Vserossijskij diabetolgicheskij kongress. M.:2013.         S 170. [In Russ.]

16.    Soderstrom M, Arvela E, Alback A, Aho PS, lepantalo M: Healing of ischaemic tissue lesions after infrainguinal bypass surgery for critical leg ischaemia. Eur J Vasc Endovasc Surg 2008;36:90-9515.

17.    CheshireN.J.. Wolfe J.H.N. Does distal revascularization for limb salvage work? It Trials and tribulations of vascular surgery. R.M. Grcenhaugh. F.G.R. Fowkcs. eds. Philadelphia: Saunders. 1996. P 353-363.

18.    Berceli S.A.. Chan A.K.. Pomposelli F.B. ct al. Efficacy of dorsal pedal artery bypass in limb salvage for ischemic heel ulcers. J. Vase. Surg. 1999. Vol. 30. X» 3. P 499-508.

19.    Taylor GI, Palmer JH: The vascular territories [angiosomes] of the body: experimental studies and clinical applications. Br J Plast Surg 1987;40:113-141.

20.    Taylor GI, Pan WR: Angiosomes of the leg: anatomic study and clinical implications. Plast Reconstr Surg 1997;4:183-198.

21.    Attinger CE, Evans KK, Bulan E, Blume P, Cooper P Angiosomes of the Foot and Ankle and Clinical Implications for Limb Salvage: Reconstruction, Incisions, and Revascularization Plast. Reconstr. Surg. 117 (Suppl.): 261S, 2006.

22.    Neville RF, Attinger CE, Bulan EJ, et al: Revascularization of a specific angiosome for limb salvage: does the target artery matter? Ann Vasc Surg 2009;23[3]: 367-7320.

23.    Varela C, Acin nF, Haro JD, et al: The role of foot collateral vessels on ulcer healing and limb salvage after successful endovascular and surgical distal procedures according to an angiosome model. Vasc Endovasc Surg 2010;44:654-660.

24.    Iida o, nanto S, Uematsu M, et al: Importance of the angiosome concept for endovascular therapy in patients with critical limb ischemia. Catheter Cardiovasc Interv 2010;75:830-836.

25.    Iida О, Soga Y Hirano K, et al: long-term results of direct and indirect endovascular revascularization based on the angiosome concept in patients with critical limb ischemia presenting with isolated below-the-knee lesions. J Vasc Surg 2012;55:363-370.

26.    Soderstrom, M., Alback, A., Biancari, F., Lappalainen, K., Lepantalo, M., and Venermo, M. Angiosome-targeted infrapopliteal endovascular revascularization for treatment of diabetic foot ulcers. J Vasc Surg. 2013; 57: 427-435.

27.    Biancari F , Juvonen T. Angiosome-targeted lower limb revascularization for ischemic foot wounds: systematic review and meta-analysis. European journal of vascular and endovascular surgery volume 47. Issue 5 p. 517e522 2014.

28.    Huang Tzu-Yen, Huang Ting-Shuo, MD, PhD, et al, Direct revascularization with the angiosome concept for lower limb ischemia. A Systematic Review and Meta-Analysis.Medicine 94(34):e1427.

29.    Bosanquet D.C., Glasbey J.C.D., Williams I.M., Twine C.P. Systematic Review and Meta-analysis of Direct Versus Indirect Angiosomal Revascularisation of Infrapopliteal Arteries European Journal of Vascular and Endovascular Surgery Volume 48 Issue 1 p. 88e97 July/2014.

30.    Azuma N, Uchida H, Kokubo T, Koya A, Akasaka n, Sasajima T: Factors influencing wound healing of critical ischaemic foot after bypass surgery: is the angiosome important in selecting bypass target artery? Eur J Vasc Endovasc Surg 2012;43: 322-328.

31.    Iram Naz, Kaitlyn M. Dunphy, BS, et al . The Impact on Wound Healing and Major Amputation-free Survival in Patients With Isolated Below-the-Knee Arterial Disease After Angiosome-Directed Endovascular Revascularization Journal of Vascular Surgery August 2018, Volume 68, Issue 2, Page e24.

32.    Elbadawy A, Ali H, Saleh M, Hasaballah. A Prospective Study to Evaluate Complete Wound Healing and Limb Salvage Rates After Angiosome Targeted Infrapopliteal Balloon Angioplasty in Patients with Critical Limb Ischaemia A. Eur J Vasc Endovasc Surg 2018;55:391-6.

33.    Doherty TM, Fitzpatrick LA, Inoue D, et al. Molecular, endocrine, and genetic mechanisms of arterial calcification. Endocr Rev. 2004;25(4):629-672. doi: 10.1210/ er.2003-0015.

34.    Dedov I.I., Anciferov M.B., Galstyan G.R., i dr. Diabetic foot syndrome. M.: «Universum Pablishing»; 1998. [In Russ.]

35.    Shanahan CM1, Cary NR, Salisbury JR, et al. Medial localization of mineralization-regulating proteins in association with Monckeberg’s sclerosis: evidence for smooth muscle cell-mediated vascular calcification. Circulation. 1999; 100(21 ):2168-2176. doi: 10.1161/01.CIR.100. 21.2168.

36.    Ayubova N.L., Bondarenko O.N., Galstyan G.R. i dr. Features of lesions of lower limb’ arteries and clinical outcomes of endovascular interventions in patients with diabetes mellitus with critical ischemia of lower limbs and chronic kidney disease. Saharnyj diabet. 2013. T. 16. №4 S.85-94. [In Russ.]

37.    Bondarenko O.N., Galstyan G.R., Dedov I.I. Clinical features of critical lower limb ischemia and the role of endovascular revascularization in patients with diabetes mellitus. 2015;18(3):57-69. [In Russ.]

38.    O’neal lW: Surgical pathology of the foot and clinicopathologic correlations. In: levin and o’neal’s The Diabetic Foot. Philadelphia, Mosby Elsevier 2008:367-401.

39.    Simons JP, Goodney PP, nolan BW, et al: Failure to achieve clinical improvement despite graft patency in patients undergoing infrainguinal lower extremity bypass for critical limb ischemia. J Vasc Surg 2010;51[6]: 1419-1424.

40.    Khan MU, lall P, Harris lM, et al: Predictors of limb loss despite a patent endovascular-treated arterial segment. J Vasc Surg 2009;49[6]:1445-1446.

41.    Platonov S. A., Kaputin M. YU., Ovcharenko D. V.. CHistyakov S. P., Voronkov A. A., Zavackij V. V., Dudonov I. P. The role of collateral blood supply to the foot in the healing of trophic defects and preservation of the limb in patients with critical lower limb ischemia. Med. akad. zhurn. 2011.T 11. № Z.S. 105-111. [In Russ.]




The article presents a case report of endovascular treatment of acute superior mesenteric artery occlusion in a patient with long reception of new oral anticoagulants. Despite the low incidence of this condition (3-5%), mortality in patients with this pathology is extremely high (80-85%). In this case combination of percutaneous mechanical thrombaspiration from superior mesenteric artery by coronary thrombaspiration system and intravenous GP IIb/IIIa antagonists demonstrated satisfactory outcome. Endovascular interventions proved to be effective, minimally invasive and safe technique in patients with acute mesenteric ischemia in superior mesenteric artery system.



1.      Akberov RF, Sharafeev AZ, Mikhailov MK. Progressive multifocal atherosclerosis: etiology, clinical and radiation diagnosis, modern aspects of treatment. Kazan: Idel-Press. 2008: 214 [In Russ].

2.      Lyubskiy AS. Thrombectomy for superior mesenteric artery thrombosis. Hirurgiya. 1964; 11: 118-121 [In Russ].

3.      Savelyev VS, Spiridonov IV. Acute disorders of mesenteric circulation М.: Medicine; 1979: 232 [In Russ].

4.      Arthurs ZM, Titus J, Bannazadeh M. et al. A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia. J Vasc Surg. 2011; 53 (3): 698-704.

5.      Klas AA. Embolectomy in acute mesenteric occlusion. Ann Surg. 1951; 134: 913-917.

6.      Shaw RS, Maynard EP Acute and chronic thrombosis of the mesenteric arteries associated with malabsorption: A report of two cases successfully treated by thromboendarterectomy. N Engl J Med. 1958; 258 (18): 874-878.

7.      Acosta S. Surgical management of peritonitis secondary to acute superior mesenteric artery occlusion. World J Gastroenterol. 2014; 20(29): 9936-9941.

8.      Revesz ES. Acute mesenteric ischemia: analysis of cases admitted to a hospital during 10 years (20012010). OrvHetil. 2012; 153(36): 1424-1432.

9.      Corcos O, Castier Y Sibert A et al. Effects of a multimodal management strategy for acute mesenteric ischemia on survival and intestinal failure. Clin Gastroenterol Hepatol. 2013; 11 (2): 158-165.

10.    Furrer J, Gruntzig A, Kugelmeier J et al. Treatment of abdominal angina with percutaneous dilatation of an arteria mesenterica superior stenosis. Cardiovasc Intervent Radiol. 1980; 3(1):43-44.

11.    Khripun AI, Mironkov AB, Pryamikov AD. et al. Endovascular surgery in the treatment of superior mesenteric artery acute occlusion (literature review). Diagnosticheskaya iinterventsionnaya radiologiya. 2014; 8 (3): 6771 [In Russ].

12.    Shipovskiy VN, Tsitsiashvili MSh, Khuan Ch. и др. Rheolytic thrombectomy and stenting of the superior mesenteric artery in acute mesenteric thrombosis (clinical observation). Angiologiya i sosudistaya khirurgiya. 2010; 16(3): 49-54 [In Russ].

13.    Kuhelj D, Kavcic P, Popovic P Percutaneous mechanical thrombectomy of superior mesenteric artery embolism. Radiol Oncol. 2013; 47(3): 239-243.

14.    Cortese B, Limbruno U. Acute mesenteric ischemia: primary percutaneous therapy. Catheter CardiovascInterv. 2010; 75(2): 283-285.



Background: we present a literary review of foreign articles on the strategy of treating of patients with blunt abdominal trauma and/or pelvic fractures, without laparotomic access using endovascular diagnosis and treatment.

Aim: was to analyze the modern approach in the diagnosis and treatment of arterial bleeding Г patients with blunt abdominal trauma and/or pelvic fractures according to literary sources. Materials and methods: article reviewed 3 studies, 1 literary review of articles by foreign authors and guidelines of the Eastern Association of Traumatology

Results: computed tomography with contrast enhancement was the method of choice for diagnosing blunt abdominal trauma and pelvic fractures, endovascular treatment of arterial hemorrhage has proven its effectiveness and is increasingly included in routine practice in both hemodynamically stable patients and patients with unstable hemodynamics.

Conclusion: catheter embolization for arterial bleeding can be used as monotherapy or as a stage of stabilizing the patient before open surgical treatment.



1.      Hrupkin VI, Hanevich MD, Zubrickij VF i dr. Urgent endovascular surgery in gastroduodenal bleeding. Petrozavodsk: Izd-vo «IntelTek», 2002 [In Russ].

2.      Health Topics: Injuries, World Health Organization. 2015. ISBN 978 92 4 156506 6.

3.      Upadhyaya P. Splenic trauma in children J. Surg. Gynecol. Obsted. 1968; 126(8): 781 - 790. PMID:5643159.

4.      Stylianos S. Evidence-based guidelines for resource utilization in childrenwith isolated spleen or liver injury. The APS A Trauma J. Pediatr. Surg. 2000; 35 (2): 164-167. PMID:10693659

5.      Stylianos S. Compliance with evidence-based guidelines in children with isolated spleen or liver injury: a prospective study J. of Pediatr. Surg. 2002; 37(3): 453 - 456. PMID:11877665.

6.      Mohamed A.Z., Morsi H.A., Ziada A.M., et al. Management of major blunt pediatric renal trauma: single-center experience. J. Pediatr. Urol. 2010; 6(3): 301-305. PMID:19854105. D0I:10.1016/j.jpurol.2009.09.009

7.      Cogbill T.H., Moore E.E., Jurkovich G.J., et al. Nonoperative management of blunt splenic trauma: a multicenter experience. J. Trauma. 1989; 29(10): 1312-1317. PMID:2681805.

8.      Croce M.A., T.C. Fabian, PG. Menke, et al. Nonoperative management of blunt hepatic trauma is the treatment of choice for hemodynamically stable patients. Results of a prospective trial. Ann. Surg. 1995; 221(6): 744-753. PMID: 7794078

9.      Stassen N.A., BhullarI., Cheng J.D., et al. Nonoperative management of blunt hepatic injury: an Eastern association for the surgery of trauma practice management guideline. J. Trauma Acute Care Surg. 2012; 73(5): PP 288-293. D0I10.1097/TA.0b013e318270160d.

10.    Stassen N.A., Bhullar I., Cheng J.D., et al. Selective nonoperative management of blunt splenic injury: an Eastern association for the surgery of trauma practice management guideline J. Trauma Acute Care Surg. 2012; 73(5): 294-300. PMID:23114484.

11.    Van der Vlies C.H., OlthofD.C., van Delden O.M., et al. Management of blunt renal injury in a level 1 trauma centre in view of the European guidelines Injury. 2012;43(10): 1816-1820. PMID: 21742328.

12.    Karmazanovskij GG, Kokov LS, Stepanova YUA, i dr. Aneurysms of visceral vessels and arrosive bleeding into postnecrotic cysts of pancreas. Annaly hirurgicheskoj gepatologii. 2007; 12(2): 85-95 [In Russ].

13.    Sclafani S.J., Shaftan G.W., Scalea T.M., et al. Nonoperative salvage of computed tomography-diagnosed splenic injuries: utilization of angiography for triage and embolization for hemostasis J. Trauma. 1995; 39(5): 818825. PMID:7473996.

14.    Velmahos G.C., Toutouzas K., Radin R., et al. High success with non-operative management of blunt hepatic trauma: the liver is a sturdy organ. Arch Surg. 2003; 138: 475-480. PMID: 12742948 D0I:10.1001/archsurg. 138.5.475.

15.    Hellins T.E., Morse G., McNabney W.K., et al. Treatment of liver injuries at Level I and II centers in a multi-institutional metropolitan trauma system. J Trauma. 1997; 42: 1091-1096. PMID:9210547

16.    Carrillo E.H., Platz A., Miller FB., et al. Non-operative management of blunt hepatic trauma. Br J Surg. 1998; 85: 461-468. PMID: 9607525 D0I:10.1046/j.1365- 2168.1998.00721.x

17.    Brasel K.J., DeLisle C.M., Olson C.J., et al. Trends in the management of hepatic injury. Am J Surg. 1997; 174: PP 674-677. PMID:9409595.

18.    Coimbra R., Hoyt D.B., Engelhart S., et al. Nonoperative management reduces the overall mortality of Grades 3 and 4 blunt liver injuries. Int Surg. 2006; 91: 251-257. DOI: 10.11648/j.js.20170506.16.

19.    Velmahos G.C., Toutouzas K., Radin R., et al. Nonoperative treatment of blunt injury to solid abdominal organs: a prospective study. Arch Surg. 2003; 138: 844-851. PMID: 12912742 DOI:10.1001/archsurg. 138.8.844.

20.    Mohseni S., et al. The diagnostic accuracy of 64-slice computed tomography in detecting clinically significant arterial bleeding after pelvic fractures. Am Surg. 2011; 77(9): 1176-1182. PMID:21944627.

21.    Stephen D.J., et al. Early detection of arterial bleeding in acute pelvic trauma. J Trauma. 1999; 47(4): 638-642. PMID:10528596.

22.    Brasel K.J., et al. Significance of contrast extravasation in patients with pelvic fracture. J Trauma. 2007; 62(5): 1149-152. PMID: 17495715 DOI:10.1097/ TA.0b013e3180479827 .

23.    Pereira S.J., et al. Dynamic helical computed tomography scan accurately detects hemorrhage in patients with pelvic fracture. Surgery. 2000; 128 (4): 678-685. PMID: 11015102 DOI:10.1067/msy.2000. 108219

24.    Brun J., et al. Detecting active pelvic arterial haemorrhage on admission following serious pelvic fracture in multiple trauma patients. Injury. 2014; 45(1): 101-106. PMID: 23845571 DOI: 10.1016/j.injury 2013.06.011.

25.    Verbeek D.O., et al. Management of pelvic ring fracture patients with a pelvic «blush» on early computed tomography. J Trauma Acute Care Surg. 2014; 76(2): 374-379. PMID:24458044 DOI:10.1097/TA. 0000000000000094

26.    Brown C.V., Kasotakis G., Wilcox A. et al. Does pelvic hematoma on admission computed tomography predict active bleeding at angiography for pelvic fracture? Am Surg. 2005; 71(9): PP 759-762. PMID:16468513.

27.    Fu C.Y, Wang YC., Wu S.C., et al. Angioembolization provides benefits in patients with concomitant unstable pelvic fracture and unstable hemodynamics. Am J Emerg Med. 2012; 30(1): 207-213. PMID:21159470 DOI: 10.1016/j.ajem.2010.11.005

28.    Sarin E.L., Moore J.B., Moore E.E., et al. Pelvic fracture pattern does not always predict the need for urgent embolization. J Trauma: Inj Infect Crit Care. 2005; 58(5): 973-977. PMID:15920411

29.    Salim A., Teixeira P.G., DuBose J., et al. Predictors of positive angiography in pelvic fractures: a prospective study. J Am Coll Surg. 2008; 207(5): 656-662. PMID:18954776 D0I:10.1016/j.jamcollsurg.2008.05.025

30.    Hallinan J.T., Tan C.H., Pua U. et al. Emergency computed tomography for acute pelvic trauma: where is the bleeder? Clin Radiol. 2014; 69(5): 529-537. PMID:24581961 D0I:10.1016/j.crad.2013.12.016.

31.    Cerva Jr D.S., Mirvis S.E., Shanmuganathan K., et al. Detection of bleeding in patients with major pelvic fractures: value of contrast-enhanced CT. AJR Am J Roentgenol. 1996; 166( 1): 131-135. PMID:8571861 D0I:10.2214/ajr. 166.1.8571861.

32.    Dormagen J.B., Totterman A., Roise O., et al. Efficacy of plain radiography and computer tomography in localizing the site of pelvic arterial bleeding in trauma patients. Acta Radiol. 2010; 51(1): 107-116. PMID: 20001476 DOI:10.3109/02841850903286703.

33.    Fu C.Y, Hsieh C.H., WuS.C., et al. Anterior-posterior compression pelvic fracture increases the probability of requirement of bilateral embolization. Am J Emerg Med. 2013; 31(1): 42-49. PMID:22944536 DOI: 10.1016/ j.ajem.2012.05.026

34.    Hagiwara A., Murata A., Matsuda T., et al. The usefulness of transcatheter arterial embolization for patients with blunt polytrauma showing transient response to fluid resuscitation. J Trauma. 2004; 57: PP. 271-276. PMID:15345972

35.    Froberg L., Helgstrand F., Clausen C., et al. Mortality in trauma patients with active arterial bleeding managed by embolization or surgical packing: An observational cohort study of 66 patients. J Emerg Trauma Shock. 2016; 9(3): 107-114. PMID:27512332 DOI:10.4103/0974-2700.185274.

36.    Salcedo E.S., Brown I.E., Corwin M.T., et al. Angioembolization for solid organ injury: A brief review. Int J Surg. 2016; 33: 225-230.

37.    Fu C.Y, Hsieh C.H., Shih C.H., et al. Selective computed tomography and angioembolization provide benefits in the management of patients with concomitant unstable hemodynamics and negative sonography results.World J. Surg. 2012;36(4): PP. 819-825. PMID:22350476 DOI:10.1007/s00268-012-1457-8.

38.    Olthof D.C., van der Vlies C.H., Joosse P., et al. Consensus strategies for the nonoperative management of patients with blunt splenic injury: a Delphi study J. Trauma Acute Care Surg. 2013; 74(6): 1567- 1574.PMID:23694889 DOI:10.1097/TA. 0b013e3182921 627.

39.    Li M., Yu W.K., Wang X.B., et al. Non-operative management of isolated liver trauma. Hepatobiliary Pancreat. Dis. Int. HBPD INT. 2014; 13(5): 545-550. PMID:25308366.

40.    Lin H.L., Lee K.T., Chen C.W., et al. Management of motorcycle accident-related blunt hepatic injury-a different strateg. Am. J. Emerg. Med. 2010; 28(2): 177-182. PMID:20159387 DOI:10.1016/j.ajem.2008.11.001.

41.    Gamanagatti S., Rangarajan K., Kumar A., et al. Blunt abdominal trauma: imaging and intervention. Curr. Problems Diagnostic Radiol. 2015; 44(4): 321-336. PMID:25801463 DOI:10.1067/j.cpradiol.2015.02.005.

42.    Stassen N.A., BhullarI., Cheng, J.D., et al. Nonoperative management of blunt hepatic injury: An Eastern Association for the Surgery of Trauma practice management guideline. Journal of Trauma and Acute Care Surgery. 2015; 73(5): 288-293.

43.    Katsura M., Yamazaki S., Fukuma S., et al. Comparison between laparotomy first versus angiographic embolization first in patients with pelvic fracture and hemoperitoneum: a nationwide observational study from the Japan Trauma Data Bank. Scand J Trauma Resusc Emerg Med. 2013; 21: 82-84. PMID:24299060 DOI: 10.1186/ 1757-7241-21-82.



Article presents a clinical case of 83-year old woman with successful aspiration thrombectomy from the superior mesenteric artery due to its thromboembolism with the help of endovascular reperfusion catheter ACE68. Due to the satisfactory angiographic and clinical results - additional manipulations (artery stenting, selective thrombolysis) were not performed. Time from the onset of the disease to the restoration of blood mesenteric flow in the basin of the superior mesenteric artery was 24 hours, laparotomy or laparoscopy in post-operative period were not necessary. This article also discusses indications for endovascular treatment of acute occlusion of the superior mesenteric artery.



1.      Aboyans V., Ricco J.-B., M.-L. E.L. Bartelink, Bjorck M., Brodmann M., Cohnert T., Collet J.-Ph., Czerny M. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries. Endorsed by: the European Stroke Organization (ESO) The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). European Heart Journal. 2018; 39: 763-821.

2.      Bjorck M., Koelemay M., Acosta S. et al. Manage ment of the Diseases of Mesenteric Arteries and Veins. Clinical Practice Guidelines of the European Society of Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2017; 53: 460-510.

3.      Erben Y, Protack C.D., Jean R.A. et al. Endovascular interventions decrease length of hospitalization and are cost-effective in acute mesenteric ischemia. J Vasc Surg. 2018; 68 (2): 459 - 469.

4.      Karkkainen J.M., Manninen H., Paajanen H. Treatment options for acute mesenteric ischemia have improved. Duodecim. 2017; 132 (2): 150 - 158.

5.      Lawson R.M. Mesenteric ischemia. Crit Care Nurs Clin North Am. 2018; 30 (1): 29 - 39.

6.      Schermerhorn M.L., Giles K.A., Hamdan A.D. et al. Mesenteric revascularization: management and outcomes in the United States, 1988-2006. J Vasc Surg. 2009; 50 (2): 341-348.e1.

7.      Freitas B., Bausback Y, Schuster J. et al. Thrombectomy devices in the treatment of acute mesenteric ischemia: initial single-center experience. Ann Vasc Surg. 2018;51:124 - 131.

8.      Mendes B.C., Oderich G.S., Tallarita T. et al. Superior mesenteric artery stenting using embolic protection device for treatment of acute or chronic mesenteric ischemia. J Vasc Surg. 2018; S0741-5214 (18): 30276-3.

9.      Bala M., Kashuk J., Moore E.E. et al. Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery. World J Emerg Surg. 2017; 12: 38.

10.    Singh M., Long B., Koyfman A. Mesenteric ischemia: a deadly miss. Emerg Med Clin North Am. 2017; 35 (4): 879 - 888.

11.    Khripun A.I., Salikov A.V., Mironkov A.B., Pryamikov A.D. Endovascular interventions in the treatment of patients with acute mesenteric ischemia. Angiologiya i sosydistaya khirurgiya. 2017; 23 (4): 43-48 [In Russ].

12.    Shipovskiy V.N., Tsitsiashvili M.Sh., Juan C. et al. Rheolytic thrombectomy and stenting of the superior mesenteric artery in acute mesenteric thrombosis (case report). Angiologiya i sosydistaya khirurgiya. 2010; 16 (3): 49-54 [In Russ].

13.    Chen T.Y, Wu C.H., Hsu W.F. et al. Primary endovascular intervention in acute mesenteric ischemia performed by interventional cardiologists - a single center experience. Acta Cardiol Sin. 2017; 33 (4): 439-446.

14.    Kerzman A., Haumann A., Boesmans E. et al. Acute mesenteric ischemia. Rev Med Liege. 2018; 73 (5-6): 300-303.

15.    Bagdasarov V.V., Bagdasarova E.A. Acute intestinal occlusion in ischemic bowel disease. Almanakh Instituta khirurgii im. A.V. Vishnevskogo; 2018; 1: 222-223 [In Russ].

16.    Schegolev AA, Papoyan SA, Mitichkin A.E. et al. Endovascular treatment of acute mesenteric ischemia in thrombosis of the superior mesenteric artery. Angiologiya i sosydistaya khirurgiya; 2017; 23 (4): 50-54 [In Russ].

17.    Puippe G.D., Suesstrunk J., Nocito A. et al. Outcome of endovascular revascularisation in patients with acute obstructive mesenteric ischaemia - a single-center experience. Vasa. 2015; 44 (5): 363-370.

18.    Khripun A.I., Salikov A.V., Shurygin S.N. et al. Possibilities of endovascular surgery in the treatment of acute mesenteric ischemia. Angiologiya i sosudistaya khirurgiya. 2014; (2) 2: 68-77 [In Russ]. 



Aim: was to optimize treatment of patients with acute myocardial infarction without significant stenotic lesions of coronary arteries.

Materials and methods: authors present a clinical case of treatment of patient, who was admitted in few hours from onset of myocardial infarction. At first-stage, patient underwent manual vacuum thrombectomy, and it revealed the absence of significant stenotic lesions of coronary arteries. Patient underwent coronary angiography, left ventriculography, optical-coherence tomography of the infarct-dependent artery

Results: in this clinical case the cause of myocardial infarction in patient without significant stenotic coronary lesions was the presence of intramural fibrecalcific plaque without signs of instability

Conclusions: according to authors, in order to reduce the incidence of re-thrombosis of coronary arteries in patients with myocardial infarction without stenotic lesions of coronary arteries, it is recommended to perform optical-coherence tomography to reveal unstable atherosclerotic plaque; in such cases it may be warranted stenting of coronary artery.



1.      Sidel'nikov A.V., Chernysheva I.E., Koledinskij A.G.. Sravnitel'nyj analiz ehffektivnosti primeneniya tromboliticheskih preparatov: poisk prodolzhaetsya [Comparative analysis of efficacy of thrombolytic therapy: further search]. Mezhdunarodnyj zhurnal intervencionnoj kardioangiologii. 2014, 39:48-56 [In Russ].

2.      Chandrasekaran B., Kurbaan A. S. Myocardial infarction with angiographically normal coronary arteries. Journal of Royal Society of Medicine. 2002 Aug; 95(8): 398-400.

3.      Reynolds H. R. Myocardial infarction without obstructive coronary artery disease. Current Opinion in Cardiology. 2012, 27:655-660.

4.      Widimsky P., Stellova B., Groch L. et al. Prevalence of normal coronary angiography in the acute phase of suspected ST-elevation myocardial infarction: Experience from the PRAGUE studies; on behalf of the PRAGUE Study Group Investigators. Can J Cardiol. 2006; 22(13): 1147-1152.

5.      Da Costa A., Isaaz K., Faure E. et al. Clinical characteristics, aetiological factors and long-term prognosis of myocardial infarction with an absolutely normal coronary angiogram; a 3-year follow-up study of 91 patients. Eur Heart J. 2001; 22(16): 1459-1465.

6.      Jamil G., Jamil M., Abbas A. et al. «Lone aspiration thrombectomy» without stenting in young patients with ST elevation myocardial infarction - Am J Cardiovasc Dis. 2013; 3(2):71-78.

7.      Escaned J, Echavarrna-Pinto M, Gorgadze T et al. Safety of lone thrombus aspiration without concomitant coronary stenting in selected patients with acute myocardial infarction. EuroIntervention. 2013;8: 1149-1156.

8.      Talarico G. P., Burzotta F., Trani C. et al. Thrombus Aspiration without Additional Ballooning or Stenting to Treat Selected Patients with ST-Elevation Myocardial Infarction. J Invasive Cardiol. 2010; 22(10): 489-492.

9.      Berger J.S., Elliott L., Gallup D. et al. Sex differences in mortality following acute coronary syndromes. JAMA. 2009; 302(8): 874-882.

10.    Dey S., Flather M.D., Devlin G. et al. Sex-related differences in the presentation, treatment and outcomes among patients with acute coronary syndromes: the Global Registry of Acute Coronary Events. Heart. 2009; 95(1): 20-26.

11.    Roger V.L., Go A.S., Lloyd-Jones D.M. et al. Heart disease and stroke statistics - 2012 update: a report from the American Heart Association. Circulation. 2012; 125:e2-e220.

12.    Glagov S., Weisenberg E., Zarins C. et al. Compensatory enlargement of human atherosclerotic coronary arteries. N Engl J Med. 1987; 316: 1371-1375.

13.    Bentzon J. F., Otsuka F., Virmani R., Falk E. Mechanisms of Plaque Formation and Rupture. Circ Res. 2014; 114: 1852-1866.

14.    Shmatkov M.G., Morozova E.V. Opticheskaya kogerentnaya tomografiya: novye vozmozhnosti vnutrisosudistoj vizualizacii (obzor literatury) [Optical cpherence tomography: new possibilities of intravascular imaging (literature review)]. Diagnosticheskaya i intervencionnaya radiologiya, 2013, 7(4): 89-100 [In Russ] .

15.    Virmani    R., Burke A.P., Farb A., Kolodgie F.D. Pathology of the vulnerable plaque. J Am Coll Cardiol. 2006; 47: 13-18.

16.    Dhume A.S., Soundararajan K., Hunter W.J. III, Agrawal D.K. Comparison of vascular smooth muscle cell apoptosis and fibrous cap morphology in symptomatic and asymptomatic carotid artery disease. Ann Vasc Surg 2003; 17:1-8.

17.    Burke A.P, Farb A., Malcom G.T. et al. Coronary risk factors and plaque morphology in men with coronary disease who died suddenly. N Engl J Med. 1997; 336: 1276-1282.

18.    Lam M. K., Sen H., Tandjung K. et al. Clinical Outcome of Patients With Implantation of Second-Generation Drug-Eluting Stents in the Right Coronary Ostium: Insights From 2-Year Follow-up of the TWENTE Trial/ Catheterization and Cardiovascular Interventions 2015; 85:524-531.



The article presents analysis of 1500 cases of varicocele endovascular occlusion (EO) in children and adolescents, giving the exhaustive account of varicocele diagnostics and treatment. Standardization of the endovascular procedure was performed, and algorithm proposed for choosing the occlusion technique and embolization agent depending on the lesion anatomy.

The authors specify 5 anatomical varieties of left testicular vein (LTV), each having some particularities in occlusion procedure. For the first time in pediatric practice the Foam-form was used for LTV occlusion against the background of prominent veno-venous reflux, which considered to be one EO contraindications. The causes were specified for false and true varicocele recurrence: the former is shown to occur due to technical imperfections, and the causes of the latter can be LTV lumen recanalization or formation of the bridging collaterals.

EO of LTV is proved to be the effective for recurrent varicocele after conventional surgery in children and adolescents.   



1.     Ерохин АП. Варикоцеле у детей (клинико-эксперементальное исследование). Дис.д-ра мед. наук. М. 1979.

2.     Тарусин Д.И. Факторы риска репродуктивных расстройств у мальчиков и юношей-подростков. Автореф. д-ра мед. наук. М. 2005.

3.     Кондаков В.Т., Пыков М.И., Годлевский Д.Н. Андрологические аспекты хирургического лечения варикоцеле у подростков. Медицина и здравоохранение. 2004;     10.9: 35-39.

4.     Годлевский Д.Н. Сперматогенная функцияяичек и органный кровоток при варикоцеле у детей и подростков. Автореф. канд. мед. наук. М. 2003.

5.     Корзникова И.И. Эндоваскулярная склеротерапия в лечении варикоцеле у детей.Автореф. канд. мед. наук. М. 1988.      12.

6.     Страхов С.Н. Варикозное расширение венгроздевидного сплетения и семенногоканотика. М. 2001.

7.     Лопаткин Н.А., Морозов А.В., Дзеранов Н.К. Трансфеморальная эндоваскулярная облитерация яичковой вены в лечении варикоцеле. Урол. нефрол. 1983; 6: 1-53.

8.     Tauber R., Johnsen N. Antegrade scrotal sclerotherapy for the treatment of varicocele. Technique and late results. J. Urol. 1994; 51 (2): 386-390.

9.     Palomo A., Bernard C.A. A practical resource in the surgical treatment of the scrotalrgans. Rev. Col. Med. Guatem. 1959; 10: 246-247.

10.   Esposito C, VallaJ.S., Najmaldin A. et al. Incidence and management of hydrocele following varicocele surgery in children. J. Urol. 2004; 171 (3): 1271-1273.

11.   Tessari L., Cavezzi A., Frullini A. Preliminary. Еxperience with a new sclerosing foam in the treatment of varicose veins. Dermatol. Surg. 2001; 27 (1): 58-60.

12.   Mali W.P., Oei H.Y., Arndt J.W. et al. Hemodynamics of the varicocele. II. Correlation among the results of renocaval pressure measurements, varicocele scintigraphy and phlebography. Urol. 1986; 135 (3): 489-493.



Internal carotid artery (ICA) pathological kinking considered to be one of the main causes of stroke. Aim of our study was to assess endovascular possibilities to manage this condition. Carotid stenting performed in 15 non-fixed human corpses with ICA kinking (6 - L-shaped, 5 - S-shaped, 4 - looping) under hydrodynamic monitoring.

It is shown that endovascular correction (stenting) of kinked ICA straightens the artery, considerably reduces pressure gradient, and increases volume of flow. At the same time carotid stenting, performed for ICA kinking, does not distress the vessel wall, in particular, it causes no significant intimal trauma. 




1.     Riser M.M., Gerause J., Ducoudray J., Ribaunt L. Dolicho-carotide interne avec syndrome vertigneux. Neurology. 1951; 85: 145-147.




2.     Quattlebaum J.L., Upson E.T., Neville R.L. Stroke associated with elongation and kinking of the internal carotid artery: report of three cases treated by segmental resection of the carotid artery. Ann. Surg. 1959; 150:824-832.




3.     Hurwitt E.S. Clinical evolution and surgical correction of obstruction in the branches of arteries. Ann. Surg. 1960; 152:472-475.




4.     Lorimer W.S. Internal carotid artery angioplasty. Surg., Gynecol., Obstet. 1961; 113:783-784.




5.     Паулюкас П.А., Бараускас Э.М. Хирургическая так ика при выпрямлении петель внутренних сонных артерий. Хирургия. 1989; 12: 12-18.




6.     Покровский А.В. Патологическое удлинение и извитость (петлеобразование, кольцеобразование) брахиоцефальных артерий. В кн.: Е.И. Чазов «Болезни сердца и сосудов». Руководство для врачей. М.: Медицина. 1992; 299-302.




7.     Булынин В.И., Мартемьянов С.В., Ласкаржевская М.А. Диагностика и хирургическое лечение различных вариантов патологической извитости внутренних сонных артерий. В сб. 2-й всерос. Съезд серд.-сосуд. хирургов. С.-Пб. 1993; 1: 34-35.




8.     Долматов Е.А., Дюжиков А.А. Хирургическое лечение патологической извитости внутренних сонных артерий. Кардиология. 1989; 3: 45-47.




9.     Еремеев В.П. Хирургическое лечение патологических извитостей, перегибов и петель сонных артерий. Ангиология и сосудистая хирургия. 1998; 2:82-94.




10.   Баркаускас Э.М., Паулюкас П.А. Способ реконструкции устья сонных артерий. Хирургия. 1988; 12: 98-102.




11.   Berger R. Surgical reconstruction of the extracranial carotid internal artery: Management and outcome.J. Vascular Surgery. 2000; 31: 9-18.




12.   Mascoli F., Mari C., Liboni A., VirgiliT., Аrcello D., Mari F., Donin I. The elongation of the internal carotid artery. Diagnosis and surgical treatment. J. Cardiovasc. Surg. 1987; 28 (1): 9-11.




13.   Zanneti P.P., Cremonesi V., Rollo S., Inzani E., Civardi C., Baratta V., Accordino R., Rosa G. Surgical therapy of the kinking of the internal carotid artery. Minerva Chir. 1989; 44 (11): 1561-1567.




14.   Freemann T., Zippit W. Carotid artery syndrome due to kinking: Surgical treatment in 44 cases. Amer. Surg.1962; 28 (11): 745-748.




15.   Derrick. J., Estess M., Williams D. Circulatory dynamics in kinking of the carotid artery. Surgery. 1965; 58 (2): 381-383.




16.   Vannis R.,Joergenson E., Carter R. Kinking of the ICA. Clinical significance and surgical management. Am. J. Surg. 1997; 134(1): 82-89.




17.   Негрей В.Ф., Чернявский А.М., Серкина А.В. Хирургическое лечение патологической извитости брахиоцефальных артерий. Тез. конф. «Диспансеризация и хирургическое лечение больных облитерирующими заболеваниями брахиоцефальных артерий». Москва - Ярославль. 1986; 96-97.




18.   Chino A. Simple method for combined carotid endarterectomy and correction of internal carotid artery kinking.J. Vasc. Surg. 1987; 6 (2): 197-199.




19.   Poindexter J., Patel K., Clauss R. Management of kinked extracranial cerebral arteries. J. Vasc. Surg. 1987; 6 (2): 127-133.




20.   Gyurko G., Reverz J. New surgical procedures for the management of carotid kinking. Acta.Chir. Hung. 1990; 31 (4): 325-331.




21.   Вагнер Е.А., Суханов С.Г., Цемехин Б.Д. Хирургическое лечение патологической извитости брахиоцефальных артерий. В 6 томах. Тез. док. IV съезданевропатологов. 1991; 18-20.




22.   Грозовский Ю.Л., Куперберг Е.Б.,Мучник М.С., Лясс С.Ф., Абрамов И.С., Грибов М.Ю. Тактика и показания к хирургическому лечению больных с сочетанными экстра- и интракраниальными поражениями сонных артерий. Невропатология и психиатрия. 1991; 7: 67-75.




23.   Фокин А. А. Современные аспекты диагностики и хирургического лечения окклюзионно-стенотических поражений ветвей дуги аорты. Дис. д-ра мед. наук. Челябинск. 1995; 320.




24.   Mathias K., Staiger J.,Thon A. et al. Perkutane Katheter Angioplastik der a. Subclavia.Dtsch. med. Wschr. 1980; 105(1): 16-18.




25.   Bachman D., Kim R. Transluminal dilatation for subclavian steal syndrome Amer. J. Roentgenol. 1980; 135: 995-996.




26.   Freitag G., Freitag J., Koch R. et al. Percutaneous angioplasty of carotid artery stenoses. Neuroradiology. 1986; 28 (2): 126-127.




27.   Galichia J. et al. Subclavian artery stenosis treated by transluminal angioplasty. Six cases cardiovasc. Intervent. Radiol. 1983; 6: 78-81.



28.   МашковскийМ.Д.Лекарственныесредства.М. 1984;2: 101.


We presented results of pulmonary arteriovenous fistula's endovascular correction of right lung in patient with subcardiac form of partial anomalous drainage of pulmonary veins, complicated with chronic pulmonary infection of hypoplastic right lung and hemoptysis.



1.     R.C. Anomalies of great vessels associated with lung hypoplasia: the scimitar syndrome. Am. J. Dis. Child. 1966; 111: 35-44.

2.     Neill C.f., Ftrencz C., Sabiston D.S., Sheldon H. The familial occurrence of hypoplastic right lung with systemic arterial supply and venous drainage «scimitar syndrome». Bull. Jons. Hopkins. Hosp. 1960; 107: 1-20.

3.     Dupuis C., Charaf L.A.C., Breviere G. et al. The «- adult» form of the scimitar syndrome. Am. J. Cardiol. 1992; 70: 502-507.

4.     Gao Y., Burrows P.E., Benson L.N. et al. Scimitar syndrome in infancy. J. Am. Coll. Cardiol. 1993; 22: 873-882.

5.     Thibault C., Perrault L.P., Delistle P.A. The continuum of pulmonary developmental anomalies. Radiographics. 1987; 7: 747-772.

6.     Herlong J.R., Jaggirs J.J., Ungleider R.M. Congenital heart surgery nomenclature and database project: pulmonary venous anomalies. Ann. Thorac. Surg. 2000; 69: 56-59.

7.     Korostelev A.N., Kokov L.S., Il'ina M.V. i dr. Anomal'noe vpadenie nizhnedolevoj pravoj legochnoj veny i perifericheskie stenozy legochnoj arterii. Hirurgija [Anomalies of v. pulmonalis inferior and stenosis of pulmonal artery]. 2008; 6: 76-78 [In Russ].

8.     Le Rochais J.P., Icard P., Davani S. et al. Scimitar syndrome with pulmonary arteriovenous fistulas. Ann. Thorac. Surg. 1999; 68: 1416-1418.

9.     Reddy R., Shah R., Thorpe J.A.C., Gibbs J. Scimitar syndrome: a rare cause of haemoptysis. Eur. J. Cardiothorac. Surg. 2002; 22: 821.

10.   Najm H.K., Williams W.G., Coles J.G. et al. Scimitar syndrome: twenty years experience and results of repair. J. Thorac. Cardiovasc. Surg. 1996; 112: 161-168.

11.   Berna P., Cazes A., Bagan P., Riquet M. Intralobar sequestration in adult patients. Interact. Cardiovasc. Thorac. Surg. 2011; 12: 970-972.

12.   Tortoriello T.A., Wesley Vick G., Chang T. et al. Meandering right pulmonary vein to the left atrium and inferior vena cava. Texa.s Heart Institute]. 2002; 29: 319-323.

13.   Kalmer M., Kerkhoff G., Budde T., Jakob H. Scimitar syndrome in the adults: diagnosis and surgical treatment. Interactive Cardiovasc. Thoracic Surg. 2003; 2: 350-351.

14.   Hulkic N., Cuenoud P.F., CorthesyM.E. et al. Рulmonary sequestration: a review of 26 cases. Eur. J. Cardiovasc. Surg. 1998; 14: 127-133.

15.   Izzillo R., El Yajjam M., QanadliS.D. et al. Intralobar sequestration of the lung in the adults (type 1 of Pryce). Treatment by coil embolization. J. Radiol. 2000; 81: 996-999.

16.   Yong Wey, Fan Li. Pulmonary sequestration: a retrospective analysis of 2625 cases in China. Eur. J. Cardiothorac Surg. 2011; 40: 39-42.

17.   Gonzalez M., Bize P., Ris H.B., Krueger T. Scimitar syndrome in association with intrapulmonary sequestration. Eur. J. Cardiothorac. Surg. 2011; 40: 273.

18.   Savic B., Birtel F.J., Tholen W. et al. Lung sequestration: report of seven cases and review of 540 published cases. Thorax. 1979; 34: 96-101.

19.   Zin'kovskij M.F., Gorjachev A.G., Piwurin O.O. Hirurgicheskoe lechenie sindroma «jatagana» (scimitar syndrome). [Surgical treatment of Scimitar syndrome]. Manual «Cardiovascular surgery» Kiev: 2010; 114-119 [In Russ].

20.   Murphy J.W., Kerr A.R., Kirklin J.W. Intracardiac repair for anomalous pulmonary venous connection of right lung to inferior vena cava. Ann. Thorac. Surg. 1971; 11: 38-42.

21.   Torres A.R., Dietl C.A. Surgical management of the scimitar syndrome: an age-dependent spectrum. Cardiovasc. Surg. 1993; 1: 432-438.

22.   Torsten W., Lichtenberg A., Shirada K., KlimaU. Combined correction of an adult scimitar syndrome and coronary artery bypass grafting. Ann. Thorac. Surg. 2002; 73: 640-642.

23.   Brown J.W., Ruzmetov M., Minnich D.J. et al. Surgical management of scimitar syndrome: an alternative approach. J. Thorac. Cardiovasc. Surg. 2003; 125:238-245.

24.   Muramatsu T., Furuichi M., Nishii T., Shiono M.  Type 1 congenital pulmonary airway malformation with a partial anomalous pulmonary venous connection. Eur. J. Cardiothorac. Surg. 2001; 39: 792.

25.   Munos J.J., Garcia J.A., Bentabol M. et al. Endovas. cular treatment of hemoptysis by abnormal systemic pulmonary supply. Cardiovasc. Intervent. Radiol.2008; 31: 427-430.

26.   Curros F., Chigot V., Emond S. et al. Role of ambolization in the treatment of bronchopulmonare sequestration. Pediatr. Radiol. 2000; 30: 769-733. Chien K.J., Huang T.C., Lin C.C. et al. Early and late outcome of coil embolization of pulmonary sequestration in children. Circulation. 2009; 73: 98-942.

27.   Morse C., Ishitani M., Cassivi S.D. Vidio assisted resection of bilateral intralobar pulmonary sequvestration. J. Thorac. Cardiovasc. Surg. 2006; 131: 917-918. Mudhusudhan K.S., Chandan J.D., Dutta R., Kumar A. Endovascular embolization of pulmonary sequestration in an adults. J. Vasc. Interv. Radiol. 2009; 20: 1640-1642.

28.   Leoncini G., Rossi U.G., Ferro C., Cytssa L. Endovascular treatment of pulmonary sequestration in adults using Amplatzer vascular plugs. Interact. Cardiovasc. Thorac. Surg. 2011; 12: 98-100.


Pancreatic transcutaneous necrosectomy from postnecrotic cavities can be a mini-invasive methods of treatment. Such method leads to fast sanation of lesions and is objectivelly a good monitoring method of control.

Aim: was to demonstrate possibilities of transcutaneous pancreatic necrosectomy after spread anc infected pancreatic necrosis.

Results: one of the most illustrative cases of successful mini-invasive treatment of spread infected pancreatic necrosis using transcutaneous necrosectomy under combined control (ultrasound, X- ray and endoscopy) is presented

Conclusion: the use of mini-invasive surgical techniques such as percutaneous drainage under combined control is possbile for panreatic necroectomy in patients with spread infected pancreatic necrosis (necrotic parapancreatitis).  



1.    Rossiyskoe obschestvo hirurgov, Assotsiatsiya gepa- topankreatobiliarnyih hirurgov stran SNG, Rossiyskoe obschestvo skoroy meditsinskoy pomoschi. Diagnostika i lechenie ostrogo pankreatita. (Rossiyskie klinic- heskie rekomendatsii) g. Sankt-Peterburg, 2014. (ssyilka:http://xn—9sbdbejx7bdduahou3a5d.xn-- p1ai/stranica-pravlenija/unkr/urgentnaja-abdominalnaja- hirurgija/nacionalnye-klinicheskie-rekomendaci-po-ostromu-pankreatitu.html [In Russ].

2.    KuleznyovaYu. V., MorozO. V., IzrailovR. E., SmirnovE. A., EgorovV. PChreskozhnyievmeshatelstvaprignoyno-nekroticheskih oslozhneniyahpankreonekroza. Annalyi hirurgicheskoy gepatologii. 2015; 2: 90 (ssyilka Article.asp?an=ASH_2015_2_90) [In Russ].

3.    Ivshin V.G., Ivshin M.V., Malafeev I.V., Yakunin A.Yu., Kremyanskiy M. A., Romanova N. N., Nikitchenko V.V. Originalnyie instrumentyii metodiki chreskozhnogo lecheniya bolnyih pankreonekrozom i rasprostranennyim parapankreatitom. Annalyi hirurgicheskoy pankreatologii. 2014; 19(1): 30-39. [In Russ].

4.    Andreev A. V., Ivshin V. G., Goltsov V. R. Lechenie infitsirovannogo pankreonekroza s pomoschyu miniinvazivnyih vmeshatelstv. Annalyi hirurgicheskoy gepatologii. 2015; 3: 110 (ssyilka 3_110) [In Russ].

5.    Rogal M.L., Novikov S.V., Gyulasaryan S.G., Kuzmin A.M., Shlyahovskiy I.A., Bayramov R.Sh. Optimizatsiya etapov minimalno invazivnogo chreskozhnogo hirurgicheskogo lecheniya ostrogo pankreatita. Tezisyi s'ezda ROH Rostov- na-Donu. 2015, 1161-1162 [InRuss].




Choice of treatment strategy in patients with recurrent angina after coronary artery bypass graft surgery (CABG) is still an actual question. Repeat CABG is associated with an increased risk of mortality and large cardiovascular events, so percutaneous coronary intervention (PCI) is the main strategy in these patients. Criteria for choosing between the bypass and the native vessel stenting are not fully understood, as well as not resolved the question of the differentiated approach to the choice of defeat for stenting

Aim: was to compare long-term results of stenting of bypass and native coronary arteries in patients with recurrent angina after CABG using the algorithm proposed in the study.

Materials and methods: study was conducted in 2010-2014 years. in «3rd Central Military Clinical Hospital named after A.A.Vishnevsky of Ministry of Military Defence». A total of 168 patients with the defeat of coronary bypass graft were operated: revascularization of the native vessel - 80 patients, stenting of coronary bypass graft was performed in 88 patients.

Treatment groups were comparable in all major clinical characteristics of patients, as well as on the number of affected arteries, the total number of bypasses, the number of working bypasses, and diffuse lesion of the native channel.

The degree of stenosis of the native vessel was significantly higher in the second group, and the degree of stenosis of bypasses was significantly higher in the first group. Diffuse lesions of coronary bypasses were significantly more frequent in the first group.

Long-term results of the study were followed up in patients in the observation period of 3 to 36 months (mean follow-up was 21(14-27) months). The average duration was not significantly different between treatment groups.

Results: the incidence of myocardial infarction was comparable between groups. In group of coronary bypass graft stenting, revascularization procedures frequency was higher than in the native vessel revascularization (20,45% and 16,25%, respectively, p = 0,0045), and also had a higher incidence of target lesion revascularization (11.36% and 6.25%, respectively, p = 0,0045).

The cumulative rate of major cardiovascular events did not differ significantly, but there was a certain tendency toward a lower incidence of major cardiovascular events in the group of revascularization of the native vessel. 



1.    Goldman S., Zadina K., Moritz T., et al. Long-term patency of saphenous vein and left internal mammary artery grafts after coronary artery bypass surgery: results from a Department of Veterans Affairs Cooperative Study. J. Am. Coll. Cardiol. 2004; 44:2149 -56.

2.    Бокерия Л.А., Алекян Б.Г. Руководство по рентгеноэндоваскулярной хирургии сердца и сосудов. Москва. Издательство НЦССХ им. А.Н. Бакулева РАМН. 2008. том 3; 592с.

Bokerija L.A., Alekjan B.G. Rukovodstvo po rentgenojendovaskuljarnoj hirurgii serdca i sosudov [Guideline for endovascular surgery of vesels and heart]. Moskva. Izdatel'stvo NCSSH im. A.N. Bakuleva RAMN. 2008. tom 3; 592s [In Russ].

3.    Brilakis E.S., de Lemos J.A., Cannon C.P., et al. Outcomes of patients with acute coronary syndrome and previous coronary artery bypass grafting (from the Pravastatin or Atorvastatin Evaluation and Infection Therapy [PROVE IT-TIMI 22] and the Aggrastat to Zocor [A to Z] trials). Am.J. Cardiol. 2008;102:552-8.

4.    Brilakis E.S., Wang T.Y, Rao S.V., et al. Frequency and predictors of drug-eluting stent use in saphenous vein bypass graft percutaneous coronary interventions: a report from the American College of Cardiology National Cardiovascular Data CathPCI registry. JACC Cardiovasc Interv. 2010; 3:1068-73.

5.    Brodie B.R., Wilson H., Stuckey T., et al. Outcomes with drug-eluting versus bare-metal stents in saphenous vein graft intervention results from the STENT (strategic transcatheter evaluation of new therapies) group. JACC Cardiovasc Interv. 2009; 2:1105-12.

6.    Brilakis E.S1, Rao S.V., Ba


Purpose. Evaluation of twelve-year results of abdominal aortic aneurysm treatment by Ella stent-grafts with regard to safety and effectiveness in relation to morphology of the aneurysm.

Methods. From a group of 297 patients with abdominal aortic aneurysm, for whom elective endovascular treatment was considered, 204 of them (68,68%) were found to be suitable for this type of therapy. The bifurcated type of stent-graft was implanted in 176 patients, uniiliacal type in 23 patients and only 5 patients were found to be suitable for tubular type of stent-graft. Additional necessary procedures (internal iliac artery occlusion or contra lateral common iliac artery occlusion in a group of patients with uniiliacal type of stent-graft) were performed surgically during the stent-graft implantation.

Results. Primary technical success was achieved in 193 of the 204 patients (94,6%). Primary endoleak was recorded in 11 patients (primary endoleak type I in 7 patients, type I b in 3 patients and type III a in one patient). Assisted technical success after reintervention or spontaneous seal was 99,02%.

Surgical conversion was indicated in 2 patients (0,98%). Perioperative mortality rate was 3,43%. In 20 patients (9,80%) secondary endoleak type II and in 4 patients (1,96%) secondary endoleak type III was found at control CT and in three patients partial thrombosis of the stent-graft was found. There was one aneurysm rupture during follow-up.

Conclusion. Treatment of abdominal aortic aneurysm with Ella stent-graft system is effective and safe. Bifurcated stent-graft is the most frequently used type. Uniiliacal type of stent-graft is used by us only in cases of complicated morphology. 




1.        Collin T., Araujo L., Walton J., Lindsell D. Oxford screening program for abdominal aortic aneurysm in men aged 65 to 74 years. Lancet. 1988; 2: 613–615.


2.        Scott R.A.P., Ashton H.A., Kay D.N. Abdominal aortic aneurysm in 4237 screened patients: prevalence, development and management over 6 years. Br. J. Surg. 1991; 78: 1122–1125.


3.        Taufelsbauer H., Prusa A.M., Wolff K., Polterauer P., Nanobashvili J., Prager M., Holzenbein T., Thurnher S., Lammer J., Schemper M., Kretschmer G., Huk I. Endovascular stent-grafting versus open surgical operation in patients with infrarenal aortic aneurysms. A propensity score – adjusted analysis. Circulation. 2002; 106: 782–787.


4.        Schumacher H., Allenberg J.R., Eckstein H.H. Morphological classification of abdominal aortic aneurysm in selection of patients for endovascular grafting. Br. J. Surg. 1996; 83: 949–950.


5.        White G.H., May J., Petrasek P. Specific complications of endovascular aortic repair. Semin. Intervent. Cardiol. 2000; 5: 35–46.


6.        Geller S.C. Imaging guidelines for abdominal aortic aneurysm repair with endovascular stent grafts. J. Vasc. Interv. Radiol. 2003; 14: 263–264.


7.        Blum U., Voshage G., Lammer J., Beyersdorf F., Tollner D., Kretschmer G., Spillner G., Polterauer P., Nagel G., Holzenbein T. Endoluminal stent-grafts for infrarenal abdominal aortic aneurysms. N. Engl. J. Med. 1997; 336: 13–20.


8.        Hausegger K.A., Mendel H., Tiessenhausen K., Kaucky M., Aman W., Tauss J., Koch G. Endoluminal treatment of infrarenal aortic aneurysms: Clinical experience with the Talent stentgraft system. J. Vasc. Interv. Radiol. 1999; 10: 267–274.


9.        Kato N., Dake M.D., Semba C.P., Razavi M.K., Kee S.T., Slonim S.M., Samuels S.L.W., Terasaki K.K., Zarins C.K., Mitchell R.S., Miller D.C. Treatment of aortoiliacal aneurysms with use of single-piece tapered stent-grafts. J. Vasc. Interv. Radiol. 1998; 9: 41–49.


10.      Tutein Nolthenius R.P., van Herwaarden J.A., van den Berg J.C., van Marrewijk C., Teijink J.A., Moll F.L. Three year single centre experience with the AneuRx aortic stent-graft. Eur. J. Vasc. Endovasc. Surg. 2001; 22: 257–264.


11.      Hill B.B., Wolf Y.G., Lee W.A., Arko F.R., Olcott C., Schubart P.J., Dalman R.L., Harris E.J., Fogarty T.J., Zarins C.K. Open versus endovascular AAA repair in patients who are morphological candidates for endovascular treatment. J. Endovasc. Ther. 2002; 9: 255–261.


12.      Pfammatter T., Lachat M.L., Kunzli A., Baur D.R., Koppensteiner R., Turina M., Blum U. Short-term results of endovascular AAA repair with the Excluder bifurcated stentgraft. J. Endovasc. Ther. 2002; 9: 474–480.


13.      Maleux G., Rousseau H., Otal P., Colombier D., Glock Y., Joffre F. Modular component separation and reperfusion of abdominal aortic anerysm sac after endovascular repair of the abdominal aortic anerysm: a case report. J. Vasc. Surg. 1998; 28: 349–352.


14.      Kaufman J.A., Brewster D.C., Geller S.C., Fan C.M., Cambria R.P., Abbott W.A., Waltman A.C. Custom bifurcated stent-graft for abdominal aortic aneurysms: initial experience. J. Vasc. Interv. Radiol. 1999; 10: 1099–1106.


Aim: was to show possibilities of endovascular methods of treatment in patients with acute ischemic stroke in endovascular operation-room of cardiovascular surgical department.

Materials and methods: we present two case reports of treatment of patients with acute ischemic stroke, who were admitted to neurological department during first hours from onset.

Patients underwent CT perfusion, CT angiography of cerebral arteries. For blood-flow restoration, patients underwent thrombectomy

Results: thrombectomy from occluded artery was successful in both cases, that leaded to better recovery of neurological status.

Conclusions: wide application of endovascular techniques for restoration of cerebral blood flow in patients with ischemic stroke in the early hours of the onset of the disease, can lead to a more prosperous clinical outcomes, more rapid and complete recovery of the patient. Important is the presence of specialized personnel with appropriate skills and a wide spectrum of endovascular instruments.  



1.    Feigin V.L., Lawes C.M.M., Bennet D.A., Anderson C.A. (Stroke epidemiology: a review of population-based studies of incidence, prevalence, and casefatality in the late 20th century. Lancet Neurol. 2003;2:43-53.

2.    Stulin I.D., Musin R.S., Belousov Ju.B. Insul't s tochki zrenija dokazatel'noj mediciny. [Stroke from viewpoint of evidence-based medicine]. Kachestvennaja klinicheskaja praktika. 2003; 4: 10-18 [In Russ].

3.    Varakin Ju.A. Jepidemiologicheskie aspekty profilaktiki narushenij mozgovogo krovoobrashhenija. [Epidemiological aspects of the stroke prevention]. Nervnye bolezni. 2005; 2: 4-9 [In Russ].

4.    Hripun A.V., Malevannyj M.V. i soavt. Pervyj opyt oblastnogo sosudistogo centra ROKB po jendovaskuljarnomu lecheniju ostorogo narushenija mozgovogo krovoobrashhenija po ishemicheskomu tipu [First Experience of Regional Vascular Center ROKB in Endovascular Treatment of ischemic stroke]. Mezhdunarodnyj zhurnal intentencionnoj kardiologii. 2010; 23: 32-42 [In Russ].

5.    Gusev E.I., Skvorcova V.I., Martynov M.Ju. Vedenie bol'nyh v ostrom periode mozgovogo insul'ta [The treatment of the acute phase of the stroke]. Vrach. 2003; 3: 8-24 [In Russ].

6.    Nakano S., Iseda T., Yoneyama T., et. Al. Direct percutaneous transluminal angioplasty for acute middle cerebral artery trunk occlusion: an alternative option to intra-arterial thrombollysis. Stroke. 2002; 33: 2872-2876.

7.    White J., Cates Ch., Cowley M. et. al. Interventional stroke therapy: current state of the art and needs assessment. Catheterization and Cardiovascular Intervention. 2007; DOI 10.1002/ccd: 1-7.

8.    Suzuki S., et al. Access to intra-arterial therapies for acute ischemic stroke: an analysis of the US population. AJNR Am. J. Neuroradiol. 2004; 25: 1802-1806.

9.    Wholey M.H, Global experience in cervical carotid artery stent placement. Catheter Cardiovasc. Interv. 2000; 50: 160-167



Aim: was to improve results of treatment of patients with myocardial infarction who underwent emergency coronary stenting, by prevention of bleeding complications from puncture place.

Materials and methods: we present retrospective analysis of clinical case of interventional treatment of myocardial infarction, with late post-puncture bleeding complication (41 day after PCI). Its consequences caused the thrombosis of the external iliac vein with further pulmonary embolism, and acute reocclusion of previously stented coronary artery

Results: developed complications were surgically treated (recurrent coronary stenting, elimination of defect of the femoral artery, implantation of cava filter with its subsequent removal), and thrombolytic therapy Patient was discharged to outpatient care without any indications of cardiopulmonary insufficiency and compensated arterial and venous circulation of operated lower limb. After 11 months, the patient’s condition was without negative dynamics with a satisfactory quality of life.

Conclusion: this clinical example demonstrates how difficult is to detect bleeding from a puncture wound. In cases of femoral access, the routine use of vascular closure devices can reduce the risk of bleeding complications. 



1.    Rekomendacii po lecheniju ostrogo koronarnogo sindroma bez stojkogo pod#joma segmenta ST Evropejskogo obshhestva kardiologov [European cardiological society recommendation: treatment of acute coronary syndrome without stable ST-segment elevation]. Racional'naja farmakoterapija v kardiologii. 2012; 2: 2-64[In Russ].

2.    Sulimov V.A. Antitromboticheskaja terapija pri chreskozhnyh koronarnyh vmeshatel'stvah [Antithrombotic therapy during percutaneous coronary interventions]. Racional'naja farmakoterapija v kardiologii. 2008; 3: 91-100 [In Russ].

3.    Goloshhapov-Aksjonov R.S., Sitanov A.S. Luchevoj arterial'nyj dostup - prioritetnyj dostup dlja vypolnenii chreskozhnoj koronarnoj angioplasti


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.  




1.    «10 ведущих причин смерти в мире». ВОЗ. Информационный бюллетень №310 от 05.2014.



2.    Parfenov V.A., Khasanov D.R.. Ishemicheskiy insult. [Ischemic stroke.] «Medicinskoe informacionnoe agenstov». 2012; 298 [In Russ].


3.    Fonyakin A.V., Geras'kina L.A. Profilaktika ishemicheskogo insulta. Rekomendacii po antitromboticheskoy terapii. [Prophylaxis of ischemic stroke. Recommendations for antithrombotic therapy] (Pod redaktsiei Z.A. Suslinoy). M: IMA-PRESS. 2014; 72.


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


5.    Wilterdink J.L., Furie K.L., Easton D. Cardiak evaluation of stroke patients. Neurology 1998; 51(3): 23-26.


6.    Petty G.W., Brown R.D., Whisnant J.P. et al. Ischemic stroke subtypes. A populationbased study of functional outcome, survival and recurrence. Stroke. 2000; 31: 1062-1068.


7.    Kelley R.E., Minagar A. Cardioembolic Stroke: An Update. South Med J. 2003; 96(4): 343-349.


8.    Secades J.J. Citicoline: pharmacological and clinical review, 2010 update / J. Secades. Revista de Neurologia. 2011; 52(2): 1-62.



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. Mos


One of complications of using hemodialysis catheters is stenosis or occlusion of central veins. This may cause dysfunction of an ipsilateral arteriovenous fistula in the future. Despite of high restenosis rate - balloon angioplasty is a method of choice.

Materials and methods: we present a case report of successful recanalization and balloon angioplasty of left brachiocephalic vein in a patient, undergoing chronic hemodialysis with a functioning arteriovenous fistula on left forearm .

Results: the absence of restenosis during a year is an evidence of the effectiveness of this methoc as a treatment of central vein stenosis or occlusion in order to preserve and increase duration of use of permanent vascular access. 




1.    Beljaev A.Ju., Kudrjavceva E.S. Rol' vrachej nefrologicheskih i gemodializnyh otdelenij v obespechenii postojannogo sosudistogo dostupa dlja gemodializa[The role of physicians of nephrology and hemodialysis departments in ensuring of permanent vascular access for hemodialysis]. Nefrologija i dializ. 2007; 9(3): 224-227 [In Russ].


2.    Hernandez D., Diaz F., Rufino M., Lorenzo V. et al. Subclavian vascular access stenosis in dialysis patients: natural history and risk factors. J. Am. Soc. Nephrol. 998; 9 (8): 1507-1510.


3.    Cimochowski G.E., Worley E., Rutherford W.E., Sartain J. et al. Superiority of the internal jugular over the subclavian access for temporary dialysis. Nephron. 1990; 54 (2): 154-161.


4.    Barrett N., Spencer S., Mclvor J., Brown E.A. Subclavian stenosis: a major complication of subclavian dialysis catheter. Nephrol Dial Transplant. 1988; 3 (4): 423-425.


5.    Chan M.R., Yevzlin A.S., Asif A. Vascular Access for the General Nephrologist. Nova Science Publishers, Inc (US). 2013; 423.


6.    Surratt R.S., Picus D., Hicks M.E., Darcy M.D. et al. The importance of preoperative evaluation of the subclavian vein in dialysis access planning. AJR Am.J. Roentgenol. 1991; 156 (3): 623-625.


7.    Dheeraj K. Rajan. Essentials of Percutaneous Dialysis Interventions. Springer. 2011; 604.


8.    McNally PG., Brown C.B., Moorhead PJ., Raftery A.T. Unmasking of subclavian vein obstruction following creation of arteriovenous fistulae for haemodialysis. A problem following subclavian line dialysis? Nephrol Dial Transplant. 1987; 1 (4): 258-260.


9.    Abbasi M., Soltani G., Karamroudi A., Javan H. Superior Vena Cava Syndrome Following Central Venous Cannulation. International Cardiоvascular Research Journal. 2009; 3 (3): 172-174.


10.  KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for 2006 Updates: Hemodialysis Adequacy, Peritoneal Dialysis Adequacy and Vascular Access. Am. J. Kidney Dis. 2006; 48 (suppl 1): S1-S322.


11.  Kundu S. Central venous obstructionmanagement. Semin Intervent Radiol. 2009; 26(2): 115-121. 

12.  Scott O. Trerotola. Venous Interventions. Society of Cardiovascular & Interventional Radiology (SCVIR). 1995; 556.



Aim. Was to describe the efficiency of conservative treatment of retinoblastoma (RB) by an association of local chemotherapy (LCT) as an alternative method for external beam radiation (EBR) therapy and enucleation. Also to reduce the local and systemic side effects of chemotherapy.

Materials and methods. Seven children (11 eyes) had intraocular RB. All of them underwent LCT at the Institute of pediatric oncology and hematology of the N.N. Blokhin Russian Cancer Research Center between February and 2011. There were two methods of LC -selective intra-arterial chemotherapy (Institute of clinical oncology of the N. N. Blokhin Russian Cancer Research Center) and intravitrea chemotherapy by melphalan.LCT was made after systemic chemotherapy in4of8 patients with advanced RB with clinica stages T2a or group С (n = 1), T2b or group D (n = 3), T2c or group E (n = 3) as an alternative to EBR therapy Other 4 of 8 patients were treated with LCT as alternative to enucleation because of new retinal, subretinal tumors and vitreous seeding after initial treatment - systemic chemotherapy with laser treatment or in combination with brachytherapy and/or EBR therapy. LCT was combined with brachytherapy (106Ru + 10^о) in one case (S. Fyodorov Eye Microsurgery Complex)

Results. Due to using of alternative conservative RB treatment we have saved 8 children with 10 of 11 eyes with indications for EBR therapy or enucleation. There were not systemic side effects of LCT. Ophthalmic complications were minimal, including lid and face hyperemia after intra-arterial chemotherapy.

Conclusion. LCT with melphalan has shown high effectiveness as a method of globe-conserving treatment of locally spread RB with a minimum of immediate complications. A small number of observations and the maximum period of observation 7 months do not allow to reliably estimate the long-term results of treatment that requires further research.  



1.    Shields C.L. et al. Chemoreduction plus focal therapy for retinoblastoma: factors predictive of need for treatment with external beam radiotherapy or enucleation. Am. J. Ophthalmol. 2002; 133 (5): 657-664.


2.    Shields C.L. et al. The international Classification of Retinoblastoma predicts chemoreduction success. Ophthalmol. 2006; 113: 2276-2280.

3.    Shields C.L. et al. Chemoreduction for unilateral retinoblastoma. А. Ophthalmol. 2002;120: 1652-1658.


4.    Shields C.L. Development of new retinoblastomas after 6 cycles of chemo-reduction for retinoblastoma in 162 eyes of 106 consecutive patients. A. Ophthalmol. 2003;121: 1571-1576.


5.    Jehanne M. et al. Analisis of ototoxicity in young children receiving carboplatin in the context of conservative management of unilateral or bilateral retinoblastoma. Pediat. Bl. Cancer. 2009; 52: 637-643.


6.    Bayer E.. et al. Unilateral retinoblastoma with acquired monosomy 7 and secondary acute myelomonosytic leukemia. Cancer Genet. Cytogenet. 1998; 105: 79-82.


7.    Yamane T., Kaneko A., Moori M. The technique of ophthalmic arterial infusion therapy for patients with intraocular retinoblastoma. Int. J.  Clin.  Oncol. 2004; 9: 69-73.


8.    Yamane T. Ophthalmic arterial injection therapy for retinoblastoma patients by using melphalan. Technique and eye preservation rates. T. Yamane, S. Suzuki, A. Kaneko, M. Mohri. ISOO Meeting 2009. Cambridge, UK. Abstracts book. 2009; 8-12: 283.


9.    Kane A., Suzuki S. Eye-preservation treatment of retinoblastoma with vitreous seeding. Jpn. J.Clin. Oncol. 2003; 33 (12): 601-607.


10.  Abramson D.H., Frank C.M., Dunkel I.J. A phase I/II study of subconjunctival carboplatin for intraocular retinoblastoma. Ophthalmology.1999; 106: 1947-1950.


11.  Villablanca J.G., Jubran R., Murphree A.L. Phase I study of subtenon carboplatin I with systemic high dose carboplatin / etoposide / vincristine (CEV) for eyes with disseminated intraocular retinoblastoma (RB). Proceedings of the XIII Biannual Meeting of ISGED and the X International Symposium on Retinoblastoma. USA Fort Lauderdale, Fla. 2001; 4.

12.  Kaneko A. et al. Our recent modifications of local chemotherapies for preservation of eyes with retinoblastoma. ISOO Meeting. Cambridge, UK. Abstracts book. 2009; 8-12: 281.

13.  Abramson D.H. et al. A phase I/II study of direct intra-arterial (ophthalmic artery) chemotherapy with melphalan for intraocular retinoblastoma initial results. Ophthalmology. 2008;115: 1398-1404.

14.  Abramson D.H. et al. Superselective ophthalmic artery chemotherapy as primary treatment for retinoblastoma (chemosurgery). Ophthalmology. 2010; 117: 1623-1629.

15.  Shields C.L., Shields J.A. Intraarterial chemotherapy for retinoblastoma the beginning of a long journey. Clin. Exper. Ophthalmol. 2010; 38: 638-643.

16.  Suzuki S., Kaneko A. Ocular and systemic prognosis of selective ophthalmic arterial injection for intraocular retinoblastoma. ISOO Meeting. Cambridge, UK. Abstracts book. 2009; 8-12: 283.



Purpose. Was to improve results of aortic stenosis (AS) treatment by transluminalballoon valvuloplasty (TLBVP) technicalskill's mprovement

Materials and methods. The article reviews a group of 56 patients who underwent TLBVP of at Republic specialized surgery centre named after V. Vakhidov

Results. It is noted that after TLBVP the peak systolic pressure gradient drecreases from 136,0 ± 39,36 to 38,27 ± 12,55 mm Hg (67,1% shift., р < 0,001), that confirms efficiency of the AS TLBVP All the patients notice better health conditions, increased stability to physical activities and had been discharged from hospital in satisfactory condition.

Conclusions. TLBVP of aortic valve (AV) is an effective and safe method that can be used for treatment of aortic valve stenosis. Indication for the procedure is occurrence of peak systolic gradient at AV of over 50 (with average at 35-40) mm Hg. At the same time aortic regurgitation type 1 is not a contraindication for the procedure. 



1.    Алекян Б.Г., Бондарев Ю.И., Ильин В.Н. и др. Опыт баллонных дилатаций при врожденном клапанном и подклапанном стенозах аорты. М. Грудная и сердечно-сосудистая хирургия. 1996; 1: 121-126.

2.    Бокерия Л.А., Гудкова Р.Г. Тенденции развития кардиохирургии в 2007 году. М.: Бюллетень НЦССХ им. А.Н. Бакулева РАМН. 2008; 3-4.

3.    Дземешкевич    С.Л.,    Стивенсон    Л.У., Алексин-Месхишвили В.В. Болезни аортального клапана. Функция, диагностика,  лечение.   М.:   Гэотар-Мед.   2004;267-299.

4.    Feldman T. Core curriculum for interventional cardiology. Percutaneous valvuloplasty Cath. Cardiovas. Interv. 2003; 60: 48-56.

5.    Gao W. et al. Percutaneous balloon aortic valvuloplasty in the treatment of congenital valvular aortic stenosis in   children.   Chin.   Med. J.   2001;   114: 453-455.


6.    Hidehiko H. et al. Percutaneous balloon аortic valvuloplasty. Revisited Circulation. 2007; 115: 334-338.

7.    Kusa J., Biaikowski J., Szkutnik M. Percutaneous balloon aortic valvuloplasty in children. Early and long-term outcome. Kardiol. Pol. 2004; 60: 48-56



Case report of two-staged treatment of hard palate hemangioendoteliom when at 1st stage has been executed bilateral selective endovascular emblization of maxillar final branches arteries by PVA spheres, and on 2nd tumor has been cut.

In the foreign literature till now it is described only about 30 cases of such tumor hard palate lesion. The combination of endovasculat embolization and traditional surgery methods leads to good esthetic and functional results of treatment with minimum surgical risk.  




1.    Gordуn-Núñcez M.A. et al. Intraoral epithelioid hemangioendothelioma. А case report and review of the literature. Med. Oral. Patol.Oral. Cir. Bucal. 2010; 15 (2): 340–346.



2.    Chatelain B. et al. Maxillary epithelioid hemangioendothelioma. Сase report and review of the literature. Rev. Stomatol. Chir. 2009; 110 (1): 45–49.



3.    Mohtasham N. et al. Epithelioid hemangioendothelioma of the oral cavity. А case report. J. Oral. 2008; 50 (2): 219–223.



4.    Chi A.C. et al. Epithelioid hemangioendothelioma of the oral cavity. Report of two cases and review of the literature. Med. Oral. Pathol. Oral. Radiol. End. 2005; 100 (6): 717–724.



5.    Flaitz C.M. et al. Primary intraoral epithelioid hemangioendothelioma presenting in childhood: review of the literature and case report. Ultrastruct. Pathol. 1995; 19 (4): 275–279.


6.    Sun Z.J. et al. Epithelioid hemangioendothelioma of the oral cavity. Oral Dis. 2007; 13 (2):244–250.



Aim. Improvement of results of treatment sick of a stomach cancer a by application intraarterial regional chemotherapy.

Materials and methods. Direct results of treatment of 50 patients a cancer stomach are analyzed, middle age has made 58,1+0,8 years. Histologycal at 45 (90,0%) by patients it is revealed adenocarcinoma, at 5 (10,0%) skirrous cancer. All sick first stage leads neoadjuvant intraarterial chemotherapy under scheme ТРF (tаxoter 75 m2 + cisplatin 75 m2 + ftoruracili 1000 m2 in one day) 2 rates with an interval of 28 days, then operation.

Results. After 2 rates neoadjuvant intraarterial regional chemotherapy at 42 (84%) patients: partial regress is noted at 29 (58%) by patients and significant regress of process is noted at 13 (26%) by patients. This sick second stage of complex treatment leads radical operation - expanded gasterectomy with lymph node dissections D3.

Conclusions. Neoadjuvant intraarterial regional chemotherapy of a stomach cancer has appeared effective at 84% of patients. Thus radical surgical intervention was possible to lead all of them. At 54% of patients it is noted medical phathomorphosis 3-4 degrees. Neoadjuvant intraarterial regional chemotherapy at a cancer of a stomach is a method of a choice for increase of operability of process and improves direct results of treatment of patients. 



1.      Арзыкулов Ж.А., Сейтказина Г.Д. Показатели  онкологической  службы  Республики Казахстан за 2006 г. (статистические материалы). Алматы. 2005; 66.

2.      Гранов А.М., Давыдов М.И., Таразов П.Г., Гранов    Д.А.    и    др.    Интервенционная радиология в онкологии (пути развития и технологии). СПб.: Фолиант. 2007; 88-97.

3.      Давыдов   М.И.,  Алахвердян  А.С.,   Перевощиков   А.Г.   и   др.   Морфологическая и клиническая       оценка эффективности предоперационной регионарной полихимиотерапии у больных кардиоэзофагеальным раком. Вести ОНЦ АМН России. 1995;53-58.

4.      Зырянов Б.Н.,  Макаркин Н.А.,  Тихонов В.И. и др. Комбинированное лечение с внутриартериальной регионарной химиотерапией при местнораспространенном раке желудка. Российский онкологический журнал. 1997; 1: 17-20.

5.      Щепотин И.Б., Югринов О.Г., Галахин К.А. и др. Десятилетние результаты применения предоперационной суперселективной внутриартериальной химиотерапии в комбинированном и паллиативном лечении рака желудка. Практическая онкология. 2001; 7 (3); 67-71.

6.      Bonenkamp H.J., Hartgrink H.H., Van de Velde C.J. Influence of surgery on outcomes in gastric cancer. Surg. Oncol. Clin. N. Am. 2000; 1: 97-117.



The review presents literature data on the heparin-induced thrombocytopenia, its forms, the pathogenesis of condition and its clinical manifestations. Consideration of options for treatment of this complication and provisions recommendations of the American College of specialist doctors in diseases of the chest (ACCP), adopted at the IX Conference on antithrombotic therapy and prevention of thrombosis in 2012. 



1.     Kelton J.G., Warkentin T.E. Heparin-induced thrombocytopenia: a historical perspective. Blood. 2008; 112 (7): 2607-16.

2.     Weismann R.E., Tobin R.W. Arterial embolism occurring during systemic heparin therapy. AMA Arch. Surg. 1958; 76 (2): 219-25; discussion 225-7.

3.     Natelson E.A., Lynch E.C., Alfrey C.P., Gross J.B. Heparin-induced thrombocytopenia. An unexpected response to treatment of consumption coagulopathy. Ann. Intern. Med. 1969; 71 (6): 1121-5.

4.     Rhodes G.R., Dixon R.H., Silver D. Heparin induced thrombocytopenia with thrombotic and hemorrhagic manifestations. Surg. Gynecol. Obstet. 1973; 136 (3): 409-16.

5.     Jang I.K., Hursting M.J. When heparins promote thrombosis: review of heparin-induced thrombocytopenia. Circulation. 2005; 111 (20): 2671-83.

6.     Greinacher A., Warkentin T.E. Heparin-induced thrombocytopenia.New York, N.Y: Marcel Dekker, 2004; 627 р.

7.     Prechel М.М., Walenga М^ Emphasis on the Role of PF4 in the Incidence, Pathophysiology and Treatment of Heparin Induced Thrombocytopenia. Thrombosis Journal. 2013; 11:7.

8.     Martel N., Lee J., Wells PS. Risk for heparin-induced thrombocytopenia with unfractionated and low-molecular-weight heparin thromboprophylaxis: a meta-analysis. Blood. 2005; 106 (8): 2710-15.

9.     Warkentin T.E., Greinacher A. So, does low-molecular-weight heparin cause less heparin-induced thrombocytopenia than unfractionated heparin or not? Chest. 2007; 132 (4): 1108-10.

10.   Warkentin T.E., Sheppard J.A., Sigouin C.S., et al. Gender imbalance and risk factor interaction in heparin-induced thrombocytopenia. Blood. 2006; 108 (9): 293741.

11.   Brieger D.B., Mak K.H., Kottke-Marchant K., Topol E.J. Heparin-induced thrombocytopenia. J. Am. Coll. Cardiol. 1998; 31 (7): 1449-59.

12.   Franchini M. Heparin-induced thrombocytopenia: an update. Thromb. J. 2005; 3: 14.

13.   Warkentin T.E., Kelton J.G.. Delayed-onset heparin-induced thrombocytopenia and thrombosis. Ann. Intern. Med. 2001; 135 (7): 502-6.

14.   Warkentin T.E., Kelton J.G. Temporal aspects of heparin-induced thrombocytopenia. N. Engl. J. Med. 2001; 344 (17): 1286-92.

15.   Greinacher A., P^zsch B., Amiral J., Dummel V.. Eichner A., Mueller-Eckhardt C. Heparin-associated thrombocytopenia: isolation of the antibody and characterization of a multimolecular PF4-heparin complex as the major antigen. Thromb. Haemost. 1994; 71 (2): 247-51.

16.   Warkentin T.E., Kelton J.G. A 14-year study of heparin-induced thrombocytopenia. Am. J. Med. 1996; 101 (5): 502-7.

17.   Warkentin T.E., Greinacher A., Koster A., Lincoff A.M. Treatment and prevention of heparin-induced thrombocytopenia: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008; 133 (6 Suppl.): 340-80.

18.   Warkentin T.E. Heparin-induced thrombocytopenia: pathogenesis and management. Br. J. Haematol. 2003; 121 (4): 535-55.

19.   Linkins L., Dans A.L., Moores L.K., et al. Treatment and prevention of heparin-induced thrombocytopenia: Antithrombotic therapy and prevention of thrombosis, 9th edition: American College of Chest Physicians evidence-based clinical practice Guidelines. Chest. 2012; 141 (2 suppl.): 495-530.

20.   Warkentin T.E., Roberts T.S., Hirsch J., Kelton J.G. Heparininduced skin lesions and other unusual sequelae of the heparininduced-thrombocytopenia syndrome: a nested cohort study. Chest. 2005; 127 (5): 1857-61.

21.   Bleasel J.F., Rasko J.E., Rickard K.A., Richards G. Acute adrenal insufficiency secondary to heparin-induced thrombocytopenia-thrombosis syndrome. Med. J. Aust. 1992; 157 (3): 192-3.

22.   Greinacher A., Juhl D., Strobel U. et al. Heparin-induced thrombocytopenia: a prospective study on the incidence, platelet-activating capacity and clinical significance of antiplatelet factor 4/heparin antibodies of the IgG, IgM, and IgA classes. J. Thromb. Haemost. 2007; 5 (8): 1666-73.

23.   Warkentin T.E., Sheppard J.A.Testing for heparin-induced thrombocytopenia antibodies. Transfus. Med. Rev. 2006; 20 (4): 259-72.

24.   Tomer A., Masalunga C., Abshire T.C. Determination of heparin-induced thrombocytopenia: a rapid flow cytometric assay for direct demonstration of antibody-mediated platelet activation. Am. J. Hematol. 1999; 61 (1): 53-61.

25.   Meyer O., Salama A., Pittet N., Schwind P. Rapid detection of heparin-induced platelet antibodies with particle gel immunoassay (ID-HPF4). Lancet. 1999; 354 (9189): 1525-6.

26.   Warkentin T.E., Greinacher A. Heparin-induced thrombocytopenia: recognition, treatment, and prevention: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004; 126 (3 Suppl.): 311-337.

27.   Greinacher A., Lubenow N., Eichler P. Anaphylactic and anaphylactoid reactions associated with lepirudin in patients with heparin-induced thrombocytopenia. Circulation. 2003; 108 (17): 2062-5.

28.   Lewis B.E., Matthai W.H., Cohen M., Moses J.W., Hursting M.J., Leya F. Argatroban anticoagulation during percutaneous coronary intervention in patients with heparin-induced thrombocytopenia. Catheter Cardiovasc. Interv. 2002; 57 (2): 177-84.

29.   Campbell K.R., Mahaffey K.W., Lewis B.E. et al. Bivalirudin in patients with heparin-induced thrombocytopenia undergoing percutaneous coronary intervention. J. Invasive Cardiol. 2000; 12 Suppl. F: 14F-9.

30.   Warkentin T.E., Cook R.J., Marder V.J. et al. Anti-platelet factor 4/heparin antibodies in orthopedic surgery patients receiving antithrombotic prophylaxis with fondaparinux or enoxaparin. Blood. 2005; 106 (12): 3791-6.

31.   Walenga J.M., Prechel M., Jeske W.P. et al. Rivaroxaban an oral, direct Factor Xa inhibitor has potential for the management of patients with heparin-induced thrombocytopenia. Br. J. Haematol. 2008; 143 (1): 92-9.

32.   Shantsila E., Lip G.Y, Chong B.H. Heparin-induced thrombocytopenia. A contemporary clinical approach to diagnosis and management. Chest. 2009; 135 (6): 1651-64.

33.   Bokerija L.A., Chigerin I.N. Geparininducirovannaja trombocitopenija (sovremennoe sostojanie problemy) [Heparin-induced thrombocitopenia (modern condition of problem)]. M. Izd. NCSSH im. A.N. Bakuleva. 2007; 96 s [In Russ].

34.   Potzsch B., K^vekorn W.P., Madlener K. Use of heparin during cardiopulmonary bypass in patients with a history of heparin-induced thrombocytopenia. N. Engl. J. Med. 2000; 343 (7): 515. 

35.  Warkentin T.E., Greinacher A. Heparin-induced thrombocytopenia and cardiac surgery. Ann. Thorac. Surg. 2003; 76 (6): 2121-31.


The world data devoted to endovascular treatment of acute thrombotic or thromboembolic occlusion of the superior mesenteric artery are provided in article. Various methods of intra vascular interventions are described at acute mesenteric ischemia: mechanical and rheolytic thrombectomy, retrograde stenting, thrombolytic therapy and some others. Endovascular intervention, according to different authors, may consider as choice option in treatment of patients in a stage of intestine ischemia.



1.     Cho J.S., Carr J.A., Jacobsen G. et al. Long-term outcome after mesenteric artery reconstruction: a 37-year experience. J. Vasc. Surg. 2002; 35(3):453-460.

2.     Kougias P., Lau D., El Sayed H.F. et al. Determinants of mortality and treatment outcome following surgical interventions for acute mesenteric ischemia. J. Vasc. Surg. 2007;46(3): 467-474.

3.     Park W.M., Gloviczki P., Cherry K.J. et al. Contemporary management of acute mesenteric ischemia: factors associated with survival. J. Vasc. Surg. 2002; 35(3): 445-452.

4.     Sreedharan S., Tan YM., Tan S.G. et al. Clinical spectrum and surgical management of acute mesenteric ischaemia in SingaporeSingapore Med. J. 2007; 48(4): 319-323.

5.     Lepedat P. Infarkt kishechnika[Mesenteric necrosis]. Medicinskoe izdatel'stvo, Buharest. 1975; 282 s [In Russ].

6.     Савельев В.С., Петухов В.А., Сон Д.А. и соавт. Новый метод энтеросорбции при синдроме кишечной недостаточности. Анналы хирургии. 2005; 1; 29-32. Savel'ev V.S., Petuhov V.A., Son D.A. i soavt. Novyj metod jenterosorbcii pri sindrome kishechnoj nedostatochnosti [New method of enterosorbtion in acute mesenterial insufficiency]. Annaly hirurgii. 2005; 1; 29-32 [In Russ].

7.     Szabуnй Rйvйsz E. Acute mesenteric ischemia: analysis of cases admitted to a hospital during 10 years (2001-2010). Orv. Hetil. 2012;153(36):1424-1432.

8.     Corcos O., Castier Y, Sibert A. et al. Effects of a Multimodal Management Strategy for Acute Mesenteric Ischemia on Survival and Intestinal Failure. Clin. Gastroenterol. Hepatol. 2012;11(2):158-165.

9.     Markovich O.V., Shkodivskij N.IMorfofunkcional'nye izmenenija v stenke tonkoj kishki pri vremennom narushenii arterial'nogo krovoobrashhenija[Morphologic-functional changes in intestinal wall at temporary disorders of mesenterial blood circulation. Anatomija ta operativna hirurgija. 2005;4(1):12-15[In Russ].

10.   Pokrovskij A.V., Judin V.IOstraja mezenterial'naja neprohodimost'. Klinicheskaja angiologija: rukovodstvo pod red. Pokrovskogo A.V. [Acute mesenterial obstruction.] V 2-h tomah. Tom 2. M.: Izdatel'stvo «Medicina». 2004; 626-645[In Russ].


11.   Marston A. Sosudistye zabolevanija kishechnika. Patofiziologija, diagnostika i lechenie [Vascular diseases of bowel. Pathophysiology, diagnostics and treatment.]. M.: «Medicina».1989; 304 s [In Russ].

12.   Gol'dgammer K.K. Ostryj zhivot pri trombozah i jembolijah verhnih bryzheechnyh sosudov[«Acute abdomen» in thrombosis and embolism in superior mesenteric vessels]. M.: Medicina. 1966;184 s[In Russ].

13.   Давыдов Ю.А. Инфаркт кишечника и хроническая мезентериальная ишемия. М.: Медицина. 1997; 208 с. Davydov Ju.A. Infarkt kishechnika i hronicheskaja mezenterial'naja ishemija []. M.: Medicina. 1997; 208 s[In Russ].

14.   Savel'ev V.S., Spiridonov I.VOstrye narushenija mezenterial'nogo krovoobrashhenija[...]. M.: Medicina. 1979; 232 s[In Russ].

15.   Pokrovskij A.V., Belojarcev D.FIstorija hirurgii torakoabdominal'nogo otdela aorty i ego vetvej v Rossii [History of surgery of thoracic and abdominal aorta and its brunches]. Materialy 13 vserossijskogo s'ezda serdechno-sosudistyh hirurgov, Moskva. 25-28 nojabrja 2007; 368-369[In Russ].

16.   Shipovskij V.N., Ciciashvili M.Sh., Huan  Ch. I soavt. Reoliticheskaja trombjektomija i stentirovanie verhnej bryzheechnoj arterii pri ostrom mezenterial'nom tromboze (klinicheskoe nabljudenie) [Rheolytic thrombectomy and stenting of superior mesenteric artery in acute mesenterial thrombosis (case report)]. 




An important clinical challenge the management of patients with pulmonary embolism is to determine prognosis of the treatment generally, and thrombolytic reperfusion therapy as the main component of a specific pathogenetic treatment in particular. This knowledge is necessary to adjust the plan of remedial measures, the intensification of concomitant pharmacotherapy and provide a personalized approach to patients with thromboembolic lesions of the pulmonary circulation

Aim: was to identify reliable predictors of the onset of reperfusion in patients with pulmonary thromboembolism based on methods of radiographic diagnosis.

Materials and Methods: 138 patients (73 women and 65 men) underwent examination. Age of patients ranged from 20 to 80 years (mean age 55±25 years). The first group includes observation of 102 patients admitted to hospital in early stages of disease ( 1 month after onset of symptoms). The second group consisted of 36 patients admitted to the hospital at a later date (from 1.5 to 12 months). In groups we studied predictors of pulmonary reperfusion channel on the basis of direct angiography and multislice computed tomography As a control, a diagnostic method used direct angiography, which has a high sensitivity and specificity in identifying symptoms of pulmonary embolism. Using the method of multiple logistic regression odds ratios were prepared to achieve reperfusion in patients with certain diagnostic symptoms compared with patients who have no signs data in angiography

Results: diagnostic criteria, in presence of which on angio-pulmonography significantly increased the likelihood of reperfusion are «amputation» of segmental branches of the pulmonary artery ( p<0.05, 16,55(6,50-42,09 ) ), intraluminal defects of contrast staining (p < 0.05, 30.56 (8,66-107,84)) and the absence of distal blood flow (p<0,05; 6,16(2,47-15,40)). Signs, significantly reducing chances of achieving reperfusion are tortuosity of segmental branches of the pulmonary artery (p<0,05; 0,03(0,01-0,08)), slowing of contrast branches of the pulmonary artery (p<0,05; 0,11( 0.05-0.25)), and the presence of defects in the near-wall staining (p<0,05; 73,182 (9,606-557,542)).

Conclusions: basing on results of modern beam-diagnostics may reliably predict the likelihood of reperfusion in patients with pulmonary embolism.


Список литературы:

1.     Котельников М.В. Тромбоэмболия легочной артерии (современные подходы к диагностике и лечению). М.: Медицина. 2002; 136.

2.     Рекомендации Европейского Кардиологического Общества (ЕКО) по диагностике и лечению тромбоэмболии легочной артерии (ТЭЛА). European Heart Journal. 2008; 29: 2276-2315.

3.     Darryl Y. Sue, MD (ed.): Pulmonary Disease. In Frederic

S.    Dongard, MD (ed.): Current: Critical Care Diagnosis & Treatment. US: А Lange medical book. First Edition. 496.

4.     Kline JA, SteuerwaldMT, Marchick MR, et al. Prospective evaluation of right ventricular function and functional status 6 months after acute submassive pulmonary embolism: frequency of persistent or subsequent elevation in estimated pulmonary artery pressure. Chest. 2009; 136: 1202-1210.

5.     Grifoni S., Olivotto I. et al. Short-term clinical outcome of patients with acute pulmonary embolism, normal blood pressure, and echocardiographic right ventricular dysfunction. Circulation. 2000; 101: 2817-2822.

6.     Kreit J.W. The impact of right ventricular dysfunction on the prognosis and therapy of normotensive patients with pulmonary embolism. Chest. 2004; 125: 1539-1545.

7.     Савельев В.С., Яблоков Е.Г, Кириенко А.И., Массивная эмболия легочных артерий. М.: Медицина. 1990; 336 




This study was aimed to show effectiveness of endovascular procedures in patients with critical lower limb ischemia (CLI), caused by lesions of iliac and femoral-popliteal-tibial segment's of arteries.

Materials and methods: study includes results of treatment of 68 patients, who underwent endovascular procedures.

Results: primary technical success in group with A, B, C TASC II aortoiliac lesions was 100%, with D TASC II aortoiliac lesions was 91,7%. In group with infrainguinal lesions overall primary technical success was 91,9%. Regression of ischemia was marked in all patients. The average growth of the ankle-brachial index (ABI) was 0,3. During one year of follow-up period, 3 major amputations were performed (5,8% of follow-up patients) in group of interventions of shin arteries with one recanalized tibial artery Salvation of lower limbs was 94,2% without CLI signs reccurence.

Conclusion: endovascular interventions are effective, minimally invasive treatment for CLI. Endovascular procedures such as angioplasty with or without stenting showld be seen as a treatment of choise in patients with CLI for limb salvage.



1.   Nacional'nye rekomendacii po vedeniju pacientov s zabolevanijami arterij nizhnih konechnostej [National recommendation for treatment of patients with diseases of lower limbs’ arteries]. M. 2013; 74[ In Russ].

2.     Fowkes F.G., Housley E., Cawood E.H. Edinburgh artery study: prevalence о! asymptomatic and symptomatic peripheral arterial disease in the general population. Int. J. Epidimiol. 1991; 20: 38-92.

3.     ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation. Circulation. 2006; 113: 11: 463-654.

4.     Bokerija L.A., Gudkova R.G. Serdechno-sosudistaja hirurgija-2014. Bolezni i vrozhdennye anomalii sistemy krovoobrashhenija [Cardiovascular surgery - 2014. Congenital anomalies and diseases of blood circulation]. M.: NCSSH im. A.N. Bakuleva. 2015[In Russ].

5.    Gavrilenko A.V., Skrylev S.I., Kuzubova E.A. Ocenka kachestva zhizni u pacientov s KINK[Quality of life in patients with CLI]. Angiologija i sosudistaja hirurgija. 2001; 3: 8-13[In Russ].

6.    Papojan S.A., Abramov I.S., Majtesjan D.A. i dr. Gibridnye operacii pri mnogojetazhnyh porazhenijah arterij nizhnih konechnostej [Hybrid operations in multifocal lesions of lower limbs’ arteries]. Angiologija i sosudistaja hirurgija. 2012; 18 (2): 138-141[In Russ].

7.    Pokrovskij A.V. Klinicheskaja angiologija[Clinical angiology]. M: Medicina 2004; 808[ In Russ].

8.     Nasr M.K., McCarthy R.J., Budd J.S., Horrocks M. Infrainguinal bypass graft patency and limb salvage rates in critical limb ischemia: influence of the mode of presentation. Ann Vasc Surg 2003; 17: 192-197.

9.     Faries P.L., Logerfo F.W., Arora S., Hook S., Pulling M.C., Akbari C.M., et al. A comparative study of alternative conduits for lower extremity revascularization: all-autogenous conduit versus prosthetic grafts. J. Vasc. Surg. 2000;32:1080-1090.

10.   Gavrilenko A.V., Kotov A.Je., Shatalova D.V. Rezul'taty otkrytyh rekonstruktivnyh vmeshatel'stv na ranee stentirovannom uchastke arterij u pacientov s kriticheskoj ishemiej nizhnih konechnostej [Results of open reconstructive operations on previously stented arteries of lower limbs in patients with critical ischemia]. Diagnosticheskaja i intervencionnaja radiologija. 2015; 9 (1): 34-38 [In Russ].

11.   Conte M.S., Geraghty P.J., Bradbury A.W. et al. Suggested objective performance goals and clinical trial design for evaluating catheter-based treatment of critical limb ischemia. J. Vasc. Surg. 2009; 50: 1462-1473.

12.   Kudo T., Chandra F.A., Kwun W.H. et al: Changing pattern of surgical revascularization for critical limb ischemia over 12 years: endovascular vs. Open bypass surgery. J. Vasc. Surg. 2006; 44: 304-313.

13.   Molloy K.J., Nasim A., London N.J. et al. Percutaneous transluminal angioplasty in the treatment of critical limb ischemia. J. Endovasc. Ther. 2003; 10 (2): 298-303.

14.   Nasr M.K., McCarthy R.J., Hardman J. et al. The increasing role of percutaneous transluminal angioplasty in the primary management of critical limb ischaemia. Eur. J. Vasc. Endovasc. Surg. 2002; 23 (5): 398-403.

15.   Faglia E., Dalla P.L., Clerici G., et al. Peripheral angioplasty as the first choice revascularizaion procedure in diabetic patients with critical limb ischemia: prospective study of 993 consecutive patients hospitalized and followed between 1999 and 2003. Eur. J. Vasc. Endovasc. Surg. 2005; 29 (6): 620-627.

16.   Giles K.A., Pomposelli F.B., Spence T.L., Hamdan A.D., Blattman S.B., Panossian H., Schermerhorn M.L. Infrapopliteal angioplasty for critical limb ischemia: relation of TransAtlantic InterSociety Consensus class to outcome in 176 limbs. J. Vasc. Surg. 2008; 48:128-136.

17.   Conrad M.F., Cambria R.P., Stone D.H. et al. Intermediate results of percutaneous endovascular therapy of femoropopliteal occlusive disease: a contemporary series. J. Vasc. Surg. 2006; 44:762-769.

18.   Adam D.J., Beard J.D., Cleveland T. et al. Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial. Lancet. 2005; 366: 1925-1934.

19.  Zatevahin I.I., Shipovskij V.N., Zolkin V.N. Balonnaja angioplastika pri ishemii nizhnih konechnostej [Ballon angioplasty in patients with CLI] M.: Medicina. 2004; 256 [In Russ].

20.   Kudo T., Chandra F.A., Ahn S.S. The effectiveness of percutaneous transluminal angioplasty for the treatment of critical limb ischemia: a 10-year experience. J. Vasc. Surg. 2005; 41:423-35; discussion 435.

21.   Beard J.D. Which is the best revascularization for critical limb ischemia: endovascular or open surgery? J. Vasc. Surg. 2008; 48(6 Suppl):11S-6S.

22.   Xiaoyang Fu., Zhidong Zhang., Kai Liang et al. Angioplasty versus bypass surgery in patients with critical limb ischemia - a meta-analysis Int. J. Clin. Exp. Med. 2015; 8(7): 10595-10602.

23.   Philip B.Dattilo, Ivan P.Casserly. Critical Limb Ischemia: Endovascular Strategies for Limb Salvage. Progress in Cardiovascular Diseases. 2011; 54: 47-60.

24.   Faglia E., Clerici G., Caminiti M. et al. Mortality after major amputation in diabetic patients with critical limb ischemia who did and did not undergo previous peripheral revascularization Data of a cohort study of 564 consecutive diabetic patients. J. Diabetes Complications. 2010; 24(4): 265-269.

25.   Hinchliffe R.J., Andros G., Apelqvist J. et al. A systematic review of the effectiveness of revascularization of the ulcerated foot in patients with diabetes and peripheral arterial disease. Diabetes Metab Res Rev. 2012; 28 Suppl 1:179-217.

26.   Holman N., Young R.J., Jeffcoate W.J. Variation in the recorded incidence of amputation of the lower limb in England. Diabetologia. 2012; 55(7): 1919-1925. 



Aim: was to estimate the importance of restoring blood flow in vertebral arteries in the segment V1 by stenting in patients with multivessel lesions of extracranial arteries and vertebrobasilar insufficiency (VBI).

Material and methods: study include 59 patients with a dominant, long-existing clinic of vertebrobasilar insufficiency, with multivessel lesions of brachiocephalic arteries, lower brain tolerance to ischemia, with the presence of stenosis of segment V1 of vertebral artery more than 70%, which is regarded by neurologists, as the main reason for VBI. All patients should have been undergone carotid revascularization. However, due to multivessel lesions and low perfusion reserve, all patients as the first stage of treatment - underwent stenting of V1 segment of vertebral artery. In 38 patients bare-metal stent were used, in 14 - drug-eluting stents, in 7 - renal stents. Distal protection was used in 12 patients. In remaining patients - stenting was performed without protection.

Results: in immediate postoperative period, technical, angiographic success and clinical improvement were noticed in 100% of patients. All 59 patients underwent the second and subsequent stages of cerebral revascularization without ischemic episodes. The duration of follow-up was from 6 months to 6 years. After 3 months, 55(93,2%) patients sustained clinical improvement, with no restenosis in stents. 4 patients (6,8%) had no clinical improvement: in one patient after 3 months developed ischemic stroke (IS) in vertebrobasilar system(VBS), due to the occlusion of the stent. 1 patients had stent restenosis with the increase of clinical manifestations of VBI, which required additional stenting. After 14 months, 1 patient after stenting had IS in VBS due to stent fractures caused by bone compression.

Conclusion: stenting of V1 segment of vertebral artery in patients with multivessel lesions of brachiocephalic arteries and clinic of VBI, can be considered as the first stage of cerebral revascularization in case of significant stenosis segment V1 vertebral artery and low tolerance to cerebral ischemia.



1.     Savitz S.I., Caplan L.R. Vertebrobasilar disease. N Engl J Med. 2005, 352: 2618-2626.

2.     Caplan L.R., Wityk R.J., Glass T.A., Tapia J., Pazdera L., Chang H.M., Teal P, Dashe J.F., Chaves C.J., Breen J.C., Vemmos K., Amarenco P, Tettenborn B., Leary M., Estol C., Dewitt L.D., Pessin M.S. New England Medical

Center Posterior Circulation registry. Ann Neurol. 2004, 56: 389-398.

3.     Vereshhagin N.V. Patologija vertebral'no-baziljarnoj sistemy i narushenija mozgovogo krovoobrashhenija[Pathology of vertebrobasilar system and cerebral blood flow disorders]. M. 1980; S 28 [In Russ].

4.     Puzin M.N., Zinov'eva G.A., Metelkina L.P. Aspekty medikamentoznogo lechenija bol'nyh s vertebral'no-baziljarnoj nedostatochnost'ju [Aspects of pharmacotherapy in treatment of patients with vertebrobasilar insufficiency]. Klinicheskaja farmakologija i terapija. 2006; 2: 23-26 [In Russ].

5.     Berguer R., Morasch M., Kline R. A review of 100 consecutive reconstructions of the distal vertebraf artery for embolic and hemodynamic disease. J Vasc Surg. 1998, 27 (5): 852-859.

6.     Pokrovskiy A.V., Beloyartsev D.F., Otdalemmie rezultati operatsiy podkluchichno-sonnoi transpozitsii. [Longterm results of operations of the subclavian-carotid transposition.] Angiologia I sosudistaya khirurgia. 2002; 8(2): 84-91.

7.     He Y, Bai W., Li T. et al. Perioperative complications of recanalization and stenting for symptomatic nonacute vertebrobasilar arteryocclusion. Ann Vasc Surg. 2014 Feb; 28 (2): 386-393.

8.     European Stroke Organisation et al. ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC). Eur Heart J. 2011 Nov; 32 (22): 2851-906.

9.     Natsionalnie rekomendacii po vedeniyu patsientov s zabolevaniyami brakhiotsefal’nikh arteriy. [National guidelines on the management of patients with diseases of brachiocephalic arteries.] Angiologia I sosudistaya khirurgia. 2013; 19 (2): attachment 70.

10.   Schonewille W.J., Algra A., Serena J., Molina C.A., Kappelle L.J. Outcome in patients with basilar artery occlusion treated conventionally. J Neurol Neurosurg Psychiatry. 2005, 76:1238-1241.

11.   Coward L.J., McCabe D.J., Ederle J., Featherstone R.L., Clifton A., Brown M.M. Long-term outcome after angioplasty and stenting for symptomatic vertebral artery stenosis compared with medical treatment in the Carotid And Vertebral Artery Transluminal Angioplasty Study (CAVATAS): a randomized trial. Stroke. 2007, 38: 1526-1530.

12.   Compter A., van der Worp H.B., Schonewille W.J., Vos J.A., Algra .A., Lo T.H., Mali WPThM, Moll FL. and Kappelle L.J. VAST: Vertebral Artery Stenting Trial. Protocol for a randomised safety and feasibility trial. Trials 2008, 9: 65.

13.   Clifton A., Markus H., Kuker W., Rothwell P. E-050. The Rationale for the Vertebral artery Ischaemia Stenting trial (VIST): NeuroIntervent Surg 2013; 5. Suppl 2 A56.

14.   Compter A., et al. VAST investigators. Stenting versus medical treatment in patients with symptomatic vertebral artery stenosis: a randomised open-label phase 2 trial. Lancet Neurol. 2015 Jun; 14(6): 606-614.

15.   VIST (Vertebral artery Ischaemia Stenting Trial) ISRCT N 95212240. (АНГИОЛОГИЯ.ру) - портал о диагностике и лечении заболеваний сосудистой системы