Abstract: Introduction: aneurysms of splenic arteries have a fairly high prevalence in relation to the total number of all visceral aneurysms. According to modern clinical guidelines, both symptomatic and asymptomatic aneurysms are subject to treatment. Recently, the priority direction in treatment of visceral aneurysms is endovascular surgery, which is characterized by minimal invasiveness and high efficiency, which makes it possible to consider transcatheter endovascular embolization of splenic artery aneurysms as the preferred method of treatment. Aim: was to estimate the role and possibilities of endovascular methods of treatment in a patient with a false aneurysm of splenic artery (ASA) formed after pancreatic necrosis and complicated by gastrointestinal bleeding. Materials and methods: a case report of transcatheter embolization of splenic artery aneurysm using the «front-to-back-door» technique using coils and telescopic system, is presented. Results: patient was discharged on the 3rd day after embolization. The postoperative period proceeded calmly, there was no abdominal pain, indicators of clinical and biochemical blood tests were within acceptable limits. Conclusions: studies devoted to treatment of giant aneurysms of splenic artery are not described in the modern literature, there are only few reports. Treatment of this type of ASA can lead to an increase in the cost of procedure, but minimal invasiveness, technical success, almost no deaths and early activation of patients make it possible to consider transcatheter endovascular embolization as the only possible method of treatment. References 1. Chaer RA, Abularrage CJ, Coleman DM, et al. The Society for Vascular Surgery clinical practice guidelines on the management of visceral aneurysms. J Vasc Surg. 2020; 72: 3-39. https://doi.org/10.1016/j.jvs.2020.01.039 2. Wang W, Chang H, Liu B, et al. Long-term outcomes of elective transcatheter dense coil embolization for splenic artery aneurysms: a two-center experience. J Int Med Res. 2020; 48: 300060519873256. https://doi.org/10.1177/0300060519873256 3. Musselwhite CC, Mitta M, Sternberg M. Splenic Artery Pseudoaneurysm. J Emerg Med. 2020; 58: 231-232. https://doi.org/10.1016/j.jemermed.2020.02.014 4. Rhusheet P, Mark G. Splenic artery pseudoaneurysm with hemosuccus pancreaticus requiring multimodal treatment. J. Vasc. Surg. 2019; 69: 592-595. https://doi.org/10.1016/j.jvs.2018.06.198 5. Venturini M, Piacentino F, Coppola A, et al. Visceral Artery Aneurysms Embolization and Other Interventional Options: State of the Art and New Perspectives. J Clin Med. 2021; 10: 2520. https://doi.org/10.3390/jcm10112520 6. Hemp JH, Sabri SS. Endovascular management of visceral arterial aneurysms. Tech. Vasc. Interv. Radiol. 2015; 18: 14-23. https://doi.org/10.1053/j.tvir.2014.12.003 7. Regus S, Lang W. Management of true visceral artery aneurysms in 31 cases. J. Visc. Surg. 2016; 153: 347-352. https://doi.org/10.1016/j.jviscsurg.2016.03.008 8. Kok HK, Asadi H, Sheehan M, et al. Systematic review and single center experience for endovascular management of visceral and renal artery aneurysms. J. Vasc. Interv. Radiol. 2016; 27: 1630-1641. https://doi.org/10.1016/j.jvir.2016.07.030 9. Gorsi U, Agarwal V, Nair V, et al. Endovascular and percutaneous transabdominal embolisation of pseudoaneurysms in pancreatitis: An experience from a tertiary-care referral centre. Clin. Radiol. 2021; 76(314): 17-23. https://doi.org/10.1016/j.crad.2020.12.016 10. Barrionuevo P, Malas MB, Nejim B, et al. A systematic review and meta-analysis of the management of visceral artery aneurysms. J. Vasc. Surg. 2020; 72: 40-45. https://doi.org/10.1016/j.jvs.2020.05.018 11. Vemireddy LP, Majlesi D, Prasad S, et al. Early Thrombosis of Splenic Artery Stent Graft. Cureus. 2021; 13: 16285. https://doi.org/10.7759/cureus.16285 12. Kapranov MS, Kulikovskiy VF, Karpachev AA, et al. A Case Report of Successful Endovascular Treatment of «Sentinel Bleeding» in Patient with Adverse Anatomy. EJMCM. 2020; 7(2): 146-150. https://doi.org/10.31838/ejmcm.07.02.24 13. Саховский С.А., Абугов С.А., Вартанян Э.Л. и др. Эндоваскулярная коррекция структурной патологии клапанов и аорты у реципиентов сердца. Эндоваскулярная хирургия. 2021; 8(1): 53-9. Sakhovskii SA, Abugov SA, Vartanyan EL, et al. Transcatheter correction of structural valve and aortic diseases in heart recipients. Endovaskulyarnaya khirurgiya. 2021; 8(1): 53-9 [In Russ]. https://doi.org/10.24183/2409-4080-2021-8-1-53-59 14. Tipaldi MA, Krokidis M, Orgera G, et al. Endovascular management of giant visceral artery aneurysms. Sci Rep. 2021; 11: 700.
Abstract Background: pancreatic cancer (PC) - oncologic disease with nonsignificant clinics on early stages and tendention of spreadind in population, as a result - late diagnosis and low rate of radical treatment (10-25%). Carried radical treatment, such as pancreaticoduodenectomy (PDE) - has a high risk of postoperative complications (30-70%) due to its difficulty Most often and dangerous complications are: bleeding, anastomotic leakage, postoperative pancreatitis, purulent complications. Bleeding occurs in 5-10% of cases, mortality varries between 30,7% and 58,5% according to moderd literature. "Sentinel bleeding" - term that meand non-fatal bleeding through drainage or gastrointestinal bleeding (GIB) that follows PDE, and is a predictor of further massive fatal bleeding. Material and methods: article presents data of patient (male, 64y) who underwent gastropancreaticoduodenectomy (GPDE) through bilateral hypochondriacal access as treatment of moderate differentiated (MD) ductal adenocarcinoma of pancreatic head. On 21st day after surgery - massive GIB with source of bleeding as pseudoaneurysm of right hepatic artery Taking into consideration "adverse anatomy", impossibility of stent-graft implantation and failure of primary embolization with "front-to-back-door" technique - against the background of reccurent bleeding, patient undewent coiling of pseudoaneurysm and subseqent coil implantation into right hepatic artery anc common hepatic artery Against the background of second reccurency of GIB - patient underwent successful "front-to-back-door" embolization with combinaton of coils and Onyx. Results: technique of «front-to-back-door» embolization led to stable hemostasis and patient's discharge in satisfactory condition without recurrence of bleeding. Conclusions: surgical hospital, carrying on resections of pancreas as a routine, should have a CathLab unit, equipped with wide specter of angiografic instruments and 24/7 surgical team with experience of hemostatic interventions. Bleeding after PDE should be considered as «sentinel bleeding». In case of side-injury of large vessels - stent-graft implantation is preferable, if it is impossible - "front-to-back-door" embolization should be used. References 1. Barannikov AYU, Sahno VD. Actual problems of the surgical treatment of diseases of organs of the biliopancreatoduodenal region. Kubanskij nauchnyj medicinskij vestnik. 2018; 25(1): 143-154. DOI: 10.25207/1608-62282018-25-1-143-154. [In Russ.] 2. Kubyshkin VA, Vishnevskij VA. Pancreatic cancer. M.: ID Medpraktika-M; 2003. 386 s. [In Russ.] 3. Egorov VI. Treatment of pancreatic cancer. V kn.: Gal'perin E.I., Dyuzheva T.G., redaktory. Lekcii po gepatopankreatobiliarnoj hirurgii. M.: Vidar-M; 2011. 449478. [In Russ.] 4. 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