Abstract: Aim: was to optimize technics of ultrasound-guided vacuum-aspiration breast biopsy at 3 and 4A categories of BI-RADS scale and subsequent maintenance of patients. Materials and methods: vacuum-aspiration breast biopsy was performed on 100 female patients aged 23-66 years. Long acting anesthetics were used for anesthesia. After the biopsy no residual tissue was detected. Results: in 15% of cases (n=15), complications requiring different treatment tactics were revealed. According to histological studies 97% of tumors were benign. 3 patients were diagnosed with breast cancer classified into BI-RADS category 3. For 24% (n=24) of women, long-term results were obtained in 6 months with no signs of relapse. Conclusions: ultrasound-guided vacuum-aspiration breast biopsy is an effective technics, that doesn't require complex preparation and doesn't take a long time to conduct. With sufficient training of the operator, it is possible to effectively control the completeness of the removal of mass. Using of long acting anesthetics allows ensuring good acceptability of the procedure and providing comfort to patients. References 1. Papathamelis T, Heim S, Lux MP. et al. Minimally Invasive Breast Fibroadenoma Excision Using an Ultrasound-Guided Vacuum-Assisted Biopsy Device. Geburtshilfe und Frauenheilkunde 2017; (2):176-181. 2. Lakoma A, Kim ES, Minimally invasive surgical management of benign breast lesions. Gland surgery. 2014; (2):142-8. 3. ACR BI-RADS Atlas® 5th Edition. www.acr.org 4. Bennett I. C. The Changing Role of Vacuum-assisted Biopsy of the Breast: A New Prototype of Minimally Invasive Breast Surgery. Clinical breast cancer. 2017; (5): 323-325 5. Seo J, Kim SM, Jang M, et al. Ultrasound-guided cable-free 13-gauge vacuum-assisted biopsy of non-mass breast lesions. Public Library of Science one. 2017; 12 (6) 6. Jung I, Min JK, Hee J M, et al. Ultrasonography-guided 14-gauge core biopsy of the breast: results of 7 years of experience. Ultrasonography. 2018; (1):55-62 7. Hui-ping Huo., Wen-bo Wan., Zhi-li Wang., et al. Percutaneous Removal of Benign Breast Lesions with an Ultrasound-guided Vacuum-assisted System: Influence Factors in the Hematoma Formation. Chinese medical sciences journal. 2016; (1):31-36. 8. Zhang YJ, Wei L, Li J., et al. Status quo and development trend of breast biopsy technology. Gland surgery. 2013; (1):15-24. 9. Xiao-Fang He, Feng Y Jia-Huai Wen, et al. High Residual Tumor Rate for Early Breast Cancer Patients Receiving Vacuum-assisted Breast Biopsy. Journal of Cancer. 2017; 3: 490-496. 10. Liu S, Zou JL, Zhou FL., et al. Efficacy of ultrasound-guided vacuum-assisted Mammotome excision for management of benign breast diseases: analysis of 1267 cases. Journal of Southern Medical University. 2017; (8):1121-1125. 11. Brennan M.E., Turner R.M., Ciatto S., et al. Ductal Carcinoma in Situ at Core-Needle Biopsy: Meta-Analysis of Underestimation and Predictors of Invasive Breast Cancer. Radiology 2011; (1):119-128. 12. Safioleas PM, Koulicheri D, Michalopoulos N, et al. The value of stereotactic vacuum assisted breast biopsy in the investigation of microcalcifications. A six-year experience with 853 patients. Journal of Balkan Union of Oncology. 2017; (2): 340-346.
Abstract: Current indications for transcatheter aortic valve replacement (TAVR) are limited for inoperable and high risk patients only. Meanwhile, TAVR may be successfully performed in young patients with low risk and with high technical and functional results according to short- and long-term follow-up. 54 patients underwent TAVR, 7 (12,9%) of them were younger than 65. Cause for endovascular procedure was the presence of oncological process in liver/autoimmune hepatitis/liver cirrhosis/severe bronchial asthma/atherosclerotic lesion of major vessels/severe diabetes mellitus. In 3 cases additional visualization method (intracardiac ultrasound examination) was necessary. All patients underwent implantation of CoreValve. Technical success was 100%. Function of valves was satisfactory. Light near-valve regurgitation was found in 6 cases, valve regurgitation class II was found in 1 case with decrease to class I after treatment. Intracardiac ultrasound examination is useful to attend successful results in this group of patients. References 1. 2012 ACCF/AATS/SCAi/STS Expert Consensus Document on Transcatheter Aortic Valve Replacement. JACC. 2012; 59: 1200-1254. 2. Lemos PA, Lee CH, Degertekin M, et al. Early outcome after sirolimus-eluting stent implantation in patients with acute coronary syndromes: insights from the Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital (RESEARCH) registry. JACC. 2003; 41: 2093-2099. 3. Ong A.T., Serruys P.W., Aoki J., et al. The unrestricted use of paclitaxel versus sirolimus-eluting stents for coronary artery disease in an unselected population: one-year results of the Taxus-Stent Evaluated at 4. Hoye A., Tanabe K., Lemos P.A., et al. Significant reduction in restenosis after the use of sirolimus-eluting stents in the treatment of chronic total occlusions. JACC. 2004; 43: 1954-1958. 5. Rao S.V., Shaw R.E., Brindis R.G., Klein L.W., Weintraub W.S., Peterson E.D. On- versus off-label use of drug-eluting coronary stents in clinical practice (report from the American College of Cardiology National Cardiovascular Data Registry [NCDR]). Am. J. Cardiol. 2006; 97: 1478 -1481. 6. Beohar N., Davidson C.J., Kip K.E., et al. Outcomes and complications associated with off-label and untested use of drug-eluting stents. JAMA. 2007; 297: 1992-2000. 7. Grines C.L. Off-label use of drug-eluting stents putting it in perspective. JACC. 2008; 51: 615-617. 8. Piazza N., Otten A., Schultz C., et al. Adherence to patient selection criteria in patients undergoing transcatheter aortic valve implantation with the 9. Eltchaninoff H., Prat A., Gilard M., et al. Transcatheter aortic valve implantation: earlyresults of the FRANCE (FRench Aortic National CoreValve and Edwards) registry. Eur. Heart J. 2011; 32:19-197. 10. Zahn R., 11. Rodes-Cabau J., Webb J.G., Cheung A., et al. Transcatheter aortic valve implantation for the treatment of severe symptomatic aortic stenosis in patients at very high or prohibitive surgical risk: acute and late outcomes of the multicenter Canadian experience. JACC. 2010; 55:1080-1090. 12. Tamburino C., Capodanno D., Ramondo A., et al. incidence and predictors of early and late mortality after transcatheter aortic valve implantation in 663 patients with severe aortic stenosis. Circulation. 2011; 123: 299-308. 13. Webb J.G., Altwegg L., Boone R.H., et al. Transcatheter aortic valve implantation: impact on clinical and valve-related outcomes. Circulation. 2009; 119: 3009-3016. 14. Piazza N., Grube E., Gerckens U., et al. Procedural and 30-day outcomes following transcatheter aortic valve implantation using the third generation (18 Fr) corevalve revalving system: results from the multicentre, expanded evaluation registry 1-year following CE mark approval. EuroIntervention. 2008; 4: 242-249. 15. Leon M.B., Smith C.R., Mack M., et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N. Engl. J. Med. 2010; 363: 1597-1607. 16. Smith C.R., Leon M.B., Mack M.J., et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N. Engl. J. Med. 2011; 364: 2187-2198. 17. Lee D.H., Buth K.J., Martin B.J., et al. Frail patients are at increased risk for mortality and prolonged institutional care after cardiac surgery. Circulation. 2010; 121: 973-978. 18. Roques F., Nashef S.A., Michel P., et al. Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patients. Eur. J. Cardiothorac. Surg. 1999; 15: 816-822. 19. Lange R., Bleiziffer S., Mazzitelli D., et al. improvements in Transcatheter Aortic Valve implantation Outcomes in Lower Surgical Risk Patients. JACC. 2012; 59: 280-287
