Abstract:

Article describes a rare case of iatrogenic arterial priapism, which was the result of inadequate surgical tactics in treatment of recurrent venous priapism.

Aim: was to formulate an algorithm of examination and treatment of patients with various forms of priapism.

Materials and methods: treatment of patient with iatrogenic arterial priapism, which developed as a result of inadequate surgical tactics in treatment of venous priapism, was analyzed step by step.

Results: reasons for development of arterial priapism in surgical treatment of venous priapism were identified. Achieved success in arresting arterial priapism by selective embolization a. pudenda interna.

Conclusion: angiography and subsequent selective embolization is a highly effective and safe method of arresting arterial priapism.

Abstract:

Two clinical cases of treatment of spontaneous hematomas in elderly patients with COVID-19 using endovascular diagnostic and treatment methods are presented.

Aim: was to show the effectiveness of endovascular hemostasis and, in some cases, there is no alternative to the use of other techniques.

Material and methods: we presented two clinical cases and analyzed the work of domestic and foreign authors on the prevention of venous thrombosis in patients with COVID-19 and endovascular treatment of spontaneous hematomas in patients with COVID-19.

Results: article describes two case reports of catheter embolization in patients with spontaneous hematoma during treatment of severe COVID-19. Elderly patients underwent prevention of thromboembolic complications with low-molecular-weight anticoagulants in prophylactic dosages; during therapy, soft tissue hematomas were revealed in one case in abdominal wall, in the other in chest. In both cases, conservative treatment was ineffective; bleeding required transfusion of blood components. In both cases, embolization was effective, and patients' condition stabilized. In one case, the progression of respiratory failure led to death, the second patient was discharged for out-patient treatment.

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

Abstract:

Introduction: intramural hematoma of the aortic wall is a component of acute aortic syndrome, and is also considered a precursor of aortic dissection. Due to peculiarities of the natural course, there are significant disagreements in choosing the optimal strategy for the treatment of intramural hematoma.

Aim: was to evaluate the possibility of a differential tactical approach to the treatment of acute intramural aortic hematoma in various situations.

Material and methods: two clinical cases demonstrate different approaches to the treatment of intramural aortic hematoma.

Results: in given clinical examples, a conservative tactics of managing patients with intramural hematoma of the aorta "watch and wait" was applied. However, in the first case, an emergency surgical intervention was required, due to the complicated course of the disease, according to dynamic studies. The second case demonstrated the acceptability of a conservative approach with long-term monitoring of the condition of the aortic wall.

Conclusions: the balance between risks of surgery and the safety of conservative therapy is the cornerstone in deciding on the optimal tactics for treating this pathology.

Abstract:

Article presents a review of the scientific literature containing data on the role of ultrasound examination of joints in the diagnosis of rheumatoid arthritis, ultrasound signs of damage of main elements of joints and periarticular tissues, modern semi-quantitative scales for assessing the severity of main pathological changes detected by ultrasound examination of joints and tendons in patients with rheumatoid arthritis.

Aim: was to analyze scientific publications in domestic and world literature on ultrasound examination of joints in rheumatoid arthritis.

Materials and methods: 38 scientific sources of leading domestic and foreign journals were analyzed.

Results: currently, radiography is the gold standard in the diagnosis of rheumatoid arthritis and is widely used to monitor the progression of rheumatoid arthritis. However, it is not sensitive enough to detect changes at early stage of rheumatoid arthritis, since it only allows assessing bone structures that are involved in the pathological process 6-12 months after the onset of first signs of the disease. Ultrasound examination provides new possibilities for early detection of rheumatoid arthritis, since it allows to detect changes at early pre-radiological stage and to prevent the development of significant structural changes leading to early disability of patients.

Conclusion: the use of ultrasound examination of joints in the diagnosis of rheumatoid arthritis accelerates the diagnosis, is used to dynamically assess the course of the disease, evaluate the effectiveness of therapy, and also to predict outcomes. The diagnostic effectiveness of ultrasound examination of joints in rheumatoid arthritis involves the identification of synovitis, tenosynovitis, structural changes in the articular cartilage and bone (erosion), and an assessment of the severity of the inflammatory reaction.

Abstract:

Background: mortality in polytrauma with pelvic injuries and intrapelvic bleeding remains high and can be reduced through a multidisciplinary approach to hemostasis.

Aim: was to determine possibilities and tactics of using endovascular interventions to stop intrapelvic bleeding in polytrauma with pelvic injuries.

Material and methods: a search was made for scientific articles in the PubMed database and the Scientific Electronic Library (eLIBRARY.ru), published from 2017 to 2021. Transcatheter embolization of pelvic arteries is an effective method for stopping intrapelvic bleeding and is indicated for detecting extravasation of contrast in computed tomography and angiography. In patients with unstable hemodynamics, embolization can be used if it is possible to perform it no later than 30-60 minutes after the detection of intrapelvic bleeding. Resuscitation endovascular balloon occlusion of the aorta can serve as an important component of the damage control strategy and a bridge to the application of methods for the final control of abdominal and intrapelvic bleeding in patients with unstable hemodynamics and systolic blood pressure less than 70 mm hg.

Conclusion: methods of endovascular surgery do not oppose and do not exclude the use of extraperitoneal pelvic packing and/or external fixation of the pelvis to stop intrapelvic bleeding in case of polytrauma. The choice of methods of hemostasis and the algorithm for their application are determined by the degree of hemodynamic disturbances, the presence of combined injuries, the data of radiation diagnostics, and the technical and logistical resources of the trauma center.

Abstract:

Introduction: prevalence of atrial fibrillation (AF) in the population continues to rise steadily due to the rapid aging of the population [1]. The search for the morphological substrate of AF has been going on for more than half a century. Left atrial remodeling has become such an important aspect in the pathogenesis of AF that some authors advocate the definition of atrial cardiomyopathies [3].

Aim: was to examine the impact of various imaging techniques on the detection of atrial fibrosis and their key role in the treatment of atrial fibrillation.

Conclusions: currently, radiological imaging techniques are available for clinical practice and provide additional possibilities in the assessment of left anterior segment function in AF. Morpho-functional changes in the left atrium can have a great impact on the global hemodynamic function of the left atrium, and as a consequence, these changes can be a significant predictor of the risk of AF progression and stroke development. Morpho-functional changes in the left atrium can have a great impact on the global hemodynamic function of the left atrium, and as a consequence, these changes can be a significant predictor of the risk of AF progression and stroke development.

Abstract:

Aim: was to compare results of using of direct stenting and coronary artery stenting after pre-dilation (CSaPD) in STEMI patients with occlusive coronary artery thrombosis in terms of frequency of no-reflow syndrome and adverse cardiovascular events (MACE) during in-hospital period.

Material and methods: study included 620 patients with acute myocardial infarction with elevation of the ST segment of the electrocardiogram and occlusive thrombosis of the infarct-dependent coronary artery, who successfully underwent endovascular revascularization by stenting. The CSaPD group included 297 patients who underwent stenting after a preliminary balloon angioplasty. The direct stenting group consisted of 323 patients who underwent stenting without prior dilation. The primary endpoint of the study was the occurrence of no-reflow syndrome, secondary endpoints were cardiac death, certain stent thrombosis, recurrence of myocardial infarction, as well as the combined MACE point. Patients of both groups were monitored during in-hospital period.

Results: there were no significant differences between the groups of CSaPD and direct stenting in main clinical-demographic and clinical-angiographic indicators, with the exception of the average length of hospitalization (11 [8;12] vs 8 [7;9], respectively, p = 0,04). Endpoint analysis revealed differences in the incidence of no-reflow syndrome (34 (11,45%) vs 9 (2,79%) in the CSaPD and direct stenting groups, respectively, p = 0,03), cardiac death (31 (10,44%) vs 7 (2,17%) in the CSaPD and direct stenting groups, respectively, p = 0,04), as well as the combined MACE point (37 (12,46%) vs 8 (2,48%) in the CSaPD and direct stenting groups, respectively, p = 0,02).

Conclusion: in STEMI patients with occlusive coronary artery thrombosis, direct stenting of the infarct-dependent artery during the restoration of coronary blood flow to TIMI I after passage of coronary guide-wire, significantly reduces the incidence of no-reflow syndrome (34 (11,45%) vs 9 (2,79%) in the CSaPD and direct stenting, respectively, p = 0,03) and cardiac death (31 (10,44%) vs 7 (2,17%) in the CSaPD and direct stenting groups, respectively, p = 0,04).

Abstract:

Aim: was to study the mutual influence of new coronavirus infection COVID-19 and acute coronary syndrome and to evaluate the effectiveness of percutaneous coronary interventions in these conditions.

Material and methods: for the period from March 21, 2020 to October 31, 2021, 5093 patients were treated for COVID-19. Including 208 patients with acute coronary syndrome with concurrent COVID-19 disease. All patients underwent following diagnostic procedures: computed tomography of the chest, electrocardiography, echocardiography, coronary angiography and, if necessary, percutaneous coronary intervention.

Results: we present data on the distribution of patients with COVID-19 according to the presence or absence of ST segment elevation on the electrocardiogram and the degree of lung tissue damage, as well as information on the nature of coronary interventions and mortality in these groups. A high frequency of massive thrombosis of infarct-related coronary arteries was demonstrated in the group of patients with STEMI. Possible mechanisms of left ventricular dysfunction that persist after percutaneous coronary intervention are described. A positive effect of endovascular myocardial revascularization on the degree of hypoxia in patients with COVID-19 was shown.

Conclusions: development of acute coronary syndrome with concurrent coronavirus infection significantly worsens the prognosis of the disease. Despite of the success of endovascular treatment, worsening COVID-19 infection can be accompanied by a sharp deterioration in the condition of patients, leading to death.

Abstract:

Background: coronavirus disease is characterized by hypercoagulation and requires treatment with anticoagulants. At the background of anticoagulant therapy, life-threatening soft tissue bleeding may occur.

Aim: was to evaluate the efficacy of transcatheter arterial embolization in patients with severe COVID-19 complicated by soft tissue bleeding.

Materials and methods: within the period from January 30, 2021 to February 18, 2022, transcatheter arterial embolization of soft tissue bleeding was performed in 25 patients with COVID-19-associated pneumonia.

Results: transcatheter arterial embolization was performed in 19 of 25 patients (76%). Postoperative mortality was 42%, and overall mortality was 40%. Fifteen patients (60%) were discharged in satisfactory condition.

Conclusions: severe soft tissue bleeding may occur in patients with coronavirus disease while treated with anticoagulants. The method of choice for treatment of these hemorrhages is transcatheter arterial embolization.

Abstract:

Introduction: one of directions in development of intravascular diagnostic methods is creation of stations or development of methods that allow combining or uniting possibilities of different modalities. This approach makes it possible to overcome limitations inherent in each method of invasive vascular diagnostics, including angiography. This work is devoted to the analysis of possibilities and first results of using the SyncVision station (Philips Volcano), which allows, in various combinations, to carry out joint registration of angiography data, intravascular ultrasound (IVUS) and instantaneous blood flow reserve (iFR) in various combinations - a non-hyperemic version of fractional flow reserve study.

Aim: was to describe possibilities provided by the use of joint recording of data from angiography, IVUS and real-time instantaneous blood flow reserve, the technique for performing these procedures, as well as to analyze the application of these methods in a department with a large volume of intravascular studies.

Material and methods: the first experience in Russian Federation of the clinical use of the SyncVision station, which is an addition to the s5i intravascular ultrasound system (Philips Volcano), is presented. The station allows you to implement five options that expand the operator's ability to analyze study data and develop a treatment strategy directly at the operating table: co-registration of angiography and intravascular ultrasound (IVUS) data; co-registration of angiography data and instantaneous flow reserve (iFR); triple co-registration - angiography, IVUS and iFR; modification of the program for the quantitative calculation of coronary artery stenosis (QCA); real-time image enhancement software for interventional devices.

Results: studies using co-registration with angiography accounted for 21% of all IVUS procedures and 62,4% of iFR procedures. In 67,3% of all studies with angio-IVUS co-registration, the indication for this diagnostic variant was an extended lesion of artery, which required clarification of length of stenotic area, localization of reference segments, and diameter of artery at different levels. In 30 of these patients, triple co-registration was performed. To clarify the hemodynamic significance of lesion with an angiographically indeterminate or borderline picture, co-registration was performed in 13,2% of all cases, to study a bifurcation lesion with a significant difference in the reference segments and angiographically difficult to determine the entry of lateral branch - in 7,3%.

Based on results of triple co-registration, the decision to perform surgical treatment was made in 30 out of 42 patients (71,4%).

Conclusion: joint registration of IVUS data, coronary angiography, and instantaneous flow reserve (iFR) in real time, forms a new diagnostic modality that significantly expands possibilities of intraoperative examination and affects the planning or analysis of intervention results.

Abstract:

Introduction: in recanalization of chronic total occlusions (CTO), contralateral injection is the most important stage, significantly increasing chance of technical success and reducing the incidence of complications.

Materials and methods: 60-year old male patients, with angina pectoris, 3 functional class. After the examination, decision was made to conduct coronary angiography. According to coronarography, occlusion of proximal third of right coronary artery (RCA) was revealed, with collateral filling from the left coronary artery (LCA) R2 and the development of collaterals CC0. According to the scintigraphy data, a «viable myocardium» was detected behind the occlusion zone. Patient underwent mechanical recanalization of RCA with contralateral contrast-agent injection, balloon angioplasty, drug-eluting stents (DES) 3,5?38 mm and 3,5?24 mm were sequentially implanted with a good angiographic result.

Result: contralateral contrast-agent injection during this recanalization helped to avoid complications associated with perforation of lateral branches and greatly facilitated the positioning of guidewire into true lumen of artery. Patient continued military service under the contract.

Conclusion: in case of proper examination, management, and selection of patients, recanalization of chronic occlusion can significantly improve patient's quality of life. It is worth noting that for many patients, social indications are also important, such as the possibility to continue military service or work in a specialty. However, medical indications should be considered first, since unjustified recanalization of chronic occlusion will not improve patient's condition, and a number of serious complications may occur during the operation.

Abstract:

Introduction: coronavirus (COVID) pandemic has caused temporary changes in work algorithms of different hospitals, that have not previously provided care for infectious patients. However, the consequences of COVID go beyond infectious pathology. Widespread use of therapeutic doses of anticoagulants as a necessary treatment option and resistant to treatment, cough as a typical symptom, led to an increase in spontaneous ruptures of epigastric arteries with hematomas of abdominal wall, which was an undesirable complication of the main disease.

Aim: was to demonstrate possibilities of endovascular methods in treatment of patients with spontaneous rupture of epigastric arteries on the background of COVID-19 and anticoagulant therapy.

Material and methods: at joinant infectious hospital, inpatient care was provided to 421 patients with coronavirus infection. At the same time, during treatment 9 patients had hematomas of abdominal wall and two of them had spontaneous rupture of rectus abdominis muscle and branches of inferior epigastric artery were damaged. In this article, we present both observations demonstrating the potential of endovascular surgery in treatment of such lesions in patients with COVID-19. Both patients, on the 6 and 10th day of inpatient treatment (severity of lung involvement was Grade 1 and Grade 2) during intense coughing, noted pain and swelling of anterior abdominal wall, accompanied by clinical and laboratory signs of blood loss. Computed tomography angiography (CT-A) revealed extravasation from small branches of inferior epigastric artery with an extensive hematoma that spread into the retroperitoneal space. In a hybrid operating room, a selective embolization of inferior (in one case, due to the high localization of the hematoma, inferior and superior) epigastric artery with an adhesive composition (N-butyl cyanoacrylate with iodolipol) was performed with successful angiographic and clinical results. Patients were discharged without complications on the 7th and 9th days of the postoperative period.

Conclusion: timely CT-diagnostic of severe bleeding, even in cases with atypical localization, and its management by selective embolization of damaged artery is the basis in treatment of spontaneous (cough-associated) ruptures of rectus abdominis muscle in patients with new coronavirus infection.

Abstract:

Introduction: dextrocardia - is a congenital heart disease, in which the heart is located in right half of chest. Incidence of ischemic heart disease in patients with dextrocardia is unknown, but some authors write that it is the same as in the general population. Guiding principles of endovascular treatment of chronic total occlusion (CTO) of coronary arteries, consider dualcatheter angiography to be an obligatory option for successful recanalization.

Aim: was to estimate possibilities of DRON-access and various radial accesses in treatment of multivessel disease in a patient with dextrocardia, severe comorbidity, and single vascular access.

Material and methods: we present case report of a 63-year-old female patient, who previously had ischemic stroke with tleft-sided hemiplegia; she was examined before surgery for instability of the prosthesis of right hip joint. Coronary angiography through traditional radial access revealed multivessel lesions of coronary arteries: chronic total occlusion (CTO) of right coronary artery, stenosis of the left anterior descending artery (LAD) in proximal and distal third; eccentric circumflex artery (Cx) stenosis. Further examination revealed: severe spastic paralysis of left hand, occlusion of left common femoral artery, chronic osteomyelitis of right leg with suppuration.

Medical consilium decided to perform staged endovascular revascularization of the myocardium.

For this purpose, to provide access for double-catheter recanalization of CTO and subsequent interventions, DRON-access (Distal radial and Radial One-handed accesses for interventions iN chronic occlusions of coronary arteries) and various radial accesses were used.

Results: at the first stage, using DRON-access, we performed double-catheter angiography and CTO recanalization of right coronary artery (RCA) with stenting. At the second stage, through traditional radial access, we performed angioplasty and stenting of LAD at two levels. After 3 months, control coronary angiography was performed through distal radial access: implanted stents had no signs of restenosis, there was no progression of atherosclerotic process. Patient was discharged to prepare for correction of instability of right hip joint prosthesis.

Conclusions: patients with severe and variable comorbidities require not only a multidisciplinary approach, but also, in various of clinical situations, need personalized approach. The use of DRON-access may allow operators to perform endovascular intervention using double-catheter angiography even in patients with single vascular access, which meets modern criteria for providing care for chronic coronary artery occlusions.

Abstract:

Introduction: although great progress has been made in the diagnosis and treatment of oncological diseases, malignant tumors still remain among the leading death causes globally. Thus, improving diagnostic methods, as well as predicting response to cancer treatment is a relevant clinical medicine problem.

Aim: was to study the role of radiomics and radiogenomics in the diagnosis, clinical prognosis and treatment response assessment in oncological diseases on the basis of available scientific information sources.

Material and methods: analysis of 55 domestic and foreign literature sources. Images obtained by the methods of diagnostic radiology (CT, MRI, PET) represent the phenotypic manifestation substrate of malignant tumors and can be correlated with the expression profiles of certain genes.

Malignant tumors radiomics and radiogenomics involves the search for correlations of visualization quantitative signs with a genomic signature using computer algorithms for data analysis. The ultimate goal of this process is to establish a link between imaging features, tumor molecular genetic characteristics and treatment response assessment.

Conclusion: numerous studies illustrate the possibility of involving radiomics and radiogenomics in all stages of oncological care, from diagnosis to therapeutic response evaluation and relapse risk assessment in a particular patient, which contributes to a personalized approach in oncology and clinical decision-making system implementation.

Abstract:

Aim: was to identify and analyze key factors affecting the outcome of subarachnoid hemorrhage (SAH) in patients with ruptured cerebral aneurysms and endovascular embolization.

Materials and methods: as a material for this study, results of endovascular treatment of 150 patients with ruptured cerebral aneurysms operated in the acute period of subarachnoid hemorrhage were analyzed.

Results: statistically significant factors influencing the target indicator «Unfavorable outcome» on the Rankin scale (mRs 3-5) and the indicator «Fatal outcome» in patients with SAH who underwent endovascular method were identified. Among factors contributing to an unfavorable outcome are: severity of neurological status, prevalence of SAH according to computed tomography (CT), timing of surgical treatment from the moment of onset of SAH symptoms.

Conclusion: factors of severity of the condition on the Hunt-Hess scale (HH), severity of subarachnoid hemorrhage on the Fischer scale (F) and timing of the operation have the greatest influence on the outcome of subarachnoid hemorrhage of aneurysmal genesis.

Abstract:

Aim: was to study the impact of angiographic projection on patient and operator radiation dose during endovascular interventions aimed at diagnosing and treating cerebrovascular diseases.

Materials and methods: in experiment, radiation dose rate of phantom model (cGy?cm²/s) and equivalent dose rate from scattered radiation (mSv/h) measured in the area of conditional location of operator were studied when the angle of the X-ray tube was changed in modes of digital subtraction angiography (DSA) and fluoroscopy. Radiation dose rate of endovascular surgeon (mSv/h) was assessed during 12 cerebral angiography procedures and 15 neuro-interventions in general angiographic projections. Values of the kerma-area product (Gy?cm²), fluoroscopy time (min), operator exposure dose (µSv) during 87 procedures of endovascular occlusion of aneurysm of cavernous and supraclinoid sections of internal carotid arteries (ICA) were retrospectively analyzed to indirectly assess the effect of angiographic projection on patient and surgeon occupational dose. Interventions were divided into 2 groups depending on the location of detected aneurysm. The 1st group included 35 operations in the right ICA, the 2nd group included 53 operations in the left ICA.

Results: in experimental study, highest values of radiation dose rate of the phantom model were found in frontal projection with cranial angulation, lowest - in lateral and oblique projections; The highest average dose rates from scattered radiation in operator's area were found in left lateral projections whereas the smallest in right lateral projection in DSA mode and also in frontal and right lateral projections in fluoroscopy mode.

When studying doses of scattered radiation during neuro-interventional procedures, it was found that when the position of the X-ray tube changes from 0° in the direction of left lateral projection, an increase in the average dose rate of the operator in the DSA mode is up to 2,6 times, with fluoroscopy - up to 2,4 times. The equivalent dose rate in left lateral projection is up to 1.5 times higher than in right lateral projection. In left oblique projection, there is an increase in dose rate up to 2,3 times compared to right oblique projection.When comparing radiation exposure indicators during aneurysm embolization procedures, a significant increase in operator exposure doses is observed in group of interventions in the left ICA.

Conclusion: when performing neuro-interventional procedures, it is possible to achieve a significant reduction in radiation exposure to patient and operator without a significant loss in image quality along with maintaining optimal visualization of pathological changes by choosing angiographic projections with lower radiation doses.

Abstract:

Aim: was to evaluate the safety and efficacy of delayed endovascular treatment without stent implantation in ST-elevation myocardial infarction (STEMI) caused by massive thrombotic load and ectasia of infarct-related coronary artery.

Material and methods: out of 4263 primary percutaneous coronary interventions (PCI) performed for STEMI for the period from January 2016 to September 2021, retrospective analysis included data of 21 patients with ectasia of infarct-related coronary artery and massive thrombotic load (TTG ? 3).

Results: method of delayed endovascular treatment, without stent implantation, in STEMI caused by massive thrombotic load and ectasia of infarct-related coronary artery, allowed to significantly improve parameters of epicardial coronary blood flow according to  TIMI and CFTC scales in 71% and 67% of examined patients (p <0,001, p=0,001); increase myocardial perfusion according to MBG in 62% of patients (p=0,001); reduce the severity of thrombotic load according to TTG scale in 71% of the subjects (p=0,001).

Conclusion: in patients with ST-elevation myocardial infarction caused by massive thrombotic load and ectasia of infarct-related coronary artery, the strategy of delayed endovascular treatment with-out stent implantation is safe and effective at the hospital stage.

Abstract:

Introduction: the importance of intravascular diagnostic methods and the frequency of their use in clinical practice is steadily increasing. However, in the Russian Federation, studies on the analysis of possibilities of intravascular imaging or physiology are sporadic, and statistical data are presented only in very generalized form. This makes it relevant to create a specialized register dedicated to these diagnostic methods.

Aim: was to present the structure, tasks and possibilities of the Russian registry for the use of intravascular imaging and physiology based on results of the first year of its operation.

Material and methods: In total, in 2021, forms were filled out for 2632 studies in 1356 patients.

Studies included all types of intravascular imaging and physiology - intravascular ultrasound, optical coherence tomography, measurement of fractional flow reserve and non-hyperemic indices.

The registry's web-based data platform includes 14 sections and 184 parameters to describe all possible scenarios for applying these methodologies. Data entry is possible both from a stationary computer and from mobile devices, and takes no more than one minute per study. Received material is converted into Excel format for further statistical processing.

Results: 13 departments participated in the register, while the share of the eight most active ones accounted for 97,5% of all entered forms. On average, 1.9 studies per patient were performed, with fluctuations between clinics from 1,6 to 2,9. Studies of the fractional flow reserve accounted for 40% of total data array, intravascular ultrasound - 37%, optical coherence tomography - 23%. Of all studies, 80% were performed on coronary arteries for chronic coronary artery disease, 18% - for acute coronary syndrome, 2% were studies for non-coronary pathology. In 41% of cases, studies were performed at the diagnostic stage, without subsequent surgery. In 89,6% of cases, this was due to the detection of hemodynamically insignificant lesions, mainly by means of physiological assessment. In 72% of cases, the use of intravascular imaging or physiology methods directly influenced the tactics or treatment strategy - from deciding whether to perform surgery or not to choose the optimal size of instruments or additional manipulations to optimize the outcome of the intervention. In the clinics participating in the register, the equipment of all major manufacturers represented on the Russian market was used.

Conclusions: the design of the online registry database is convenient for data entry. Participation in the registry of most departments that actively and systematically use methods of intravascular imaging and physiology ensured the representativeness of obtained data for analysis in interests of both practical medicine and industry, as well as for scientific research in the field of intravascular imaging and physiology. The register has great potential for both quantitative and qualitative improvement.

Abstract:

Aim: was to study the efficacy and functionality of the Yukon Chrome PC stent in clinical practice.

Materials and methods: in 2021, a prospective, observational study of the safety, effectiveness of the Yukon Chrome PC stent, as well as its functionality during implantation in clinical practice, was launched on the basis of 25 domestic clinics. The study included 364 patients who underwent implantation of 495 Yukon Chrome PC stents. Mean age of patients was 62,8 years (from 33 to 89 years). Men were 263 (72,3%). The vast majority (82,4%) of patients were diagnosed with acute coronary syndrome (ACS): without ST segment elevation - 180 (49,45%) patients; with ST segment elevation - 120 (32,9%) patients. Unstable angina was verified in 22 (6%) patients. There were 42 (11,5%) patients with stable angina class 2-3.

Moderate tortuosity of vessels occurred in 27,7% of cases, while severe tortuosity of vessels occurred in 3,57% of cases. Moderate calcification was noted in 115 (31,5%) patients, severe/massive - in 23 (6,3%) cases. A complex lesion combining severe/moderate calcification and severe/moderate tortuosity of the target artery occurred in 79 (21,7%) patients.

Results: technical success of the procedure was achieved in 97,5% of cases. In one patient with severe calcification, the Yukon Chrome PC stent could not be inserted into the affected area. Attempts to implant another stent were also unsuccessful.

Depending on the number of implanted stents, the patients were distributed as follows: 3 stents were inplanted in 31 (8,5%) patients; 2 stents - 102 (28%) patients, 1 stent - 231 (63,5%) patients.

Bifurcation stenting using a two-stent technique was performed in 69 (19%) patients. Stenting of the left main was performed in 11 (3%) cases. Predilation was performed in 245 (67%) patients; postdilation - in 179 (49%) patients.

Conclusion: analysis of hospital results of implantation of Yukon Chrome PC stents indicates good flexibility and deliverability of stents even in patients with moderate and severe sheath calcification.

The overall assessment of the functional characteristics of the stent among endovascular surgeons who performed stenting is quite high.

Abstract:

Introduction: pathological tortuosity of internal carotid arteries (ICA) is widespread; its frequency in population varies within 18-34%. Currently, there are several approaches for the determination of indications for surgical intervention in pathological ICA tortuosity. The main criteria are hemodynamic changes in the arterial flow and the presence of neurological symptoms, so an informative preoperative examination is an integral part in treatment strategy determination in patients' subsequent treatment.

Aim: was to estimate the condition of carotid arteries and substance of the brain in isolated pathological tortuosity and in combination with stenotic lesions, based on results of CT angiography.

Materials and methods: we analyzed results of examination and treatment of 70 patients. Ultrasound and CT angiography of brachiocephalic arteries were performed on a Philips iCT 256-slice multislice computed tomograph. During CT angiography, a non-contrast study, arterial and venous phases of contrast enhancement were performed with an intravenous bolus injection of 50.0 ml of isoosmolar iodinated contrast-agent at 4-5 ml/sec.

Patients were divided into two groups: patients with isolated pathological carotid tortuosity (28 pts) and patients with a combination of carotid tortuosity and stenotic lesions (42 pts). We assessed the effect of carotid tortuosity on the severity of the brain tissue alterations using statistical analysis.

Results: a lesser severity of changes in the substance of the brain was noted in patients in the group with isolated pathological tortuosity of ICA. In 9 cases, we did not detect focal lesions; in 15 cases, small foci of microangiopathy and individual cerebrospinal fluid cysts were noted, in 4 patients, we noted areas and zones of cystic-glial changes. S- and C-shaped deformation became the most frequent variants of tortuosity; the formation of 3 saccular aneurysms (two true and one false) was revealed.

Manifestations of ischemic damage of the brain substance in the group of patients with a combination of ICA tortuosity and stenotic lesion were more pronounced. Thus, in 11 cases, zones and areas of cystic-glial changes were determined within the framework of past cerebrovascular accidents; in 20 patients, foci of microangiopathy expressed in varying degrees, as well as individual cerebrospinal fluid cysts, were noted. In 11 cases, no focal lesions were detected in the brain.

Statistical processing showed a correlation between the condition of carotid arteries and the presence of focal brain damage - in the group with combination of pathological tortuosity and stenosis of ICA, more pronounced chronic ischemic brain damage was detected (p=0,012).

Conclusion: CT-angiography was noted to be highly informative in assessment of condition of carotid arteries and brain substance in patients with isolated pathological tortuosity, as well as in combination with a stenotic lesion of internal carotid arteries. With a combination of pathological tortuosity and a stenosis in internal carotid arteries, data were obtained on a more pronounced damage of the brain substance. According to computed tomography, clinical manifestations of chronic cerebrovascular insufficiency were generally more pronounced compared to changes in the brain substance. However, there was a correlation between the increase in the degree of chronic cerebrovascular insufficiency and the aggravation of the state of the brain substance.

Article exists only in Russian.

Abstract:

Introduction: pseudo-aneurysm of subclavian artery is a rare pathology and most often develops due to trauma or iatrogenic causes. Despite the rarity of this pathology, it can be accompanied by the risk of lethal rupture or distal embolism. Article presents a case report of endovascular treatment of post-traumatic pseudo-aneurysm of right subclavian artery with a stent-graft.

Aim: was to demonstrate advantages of endovascular treatment of pseudo-aneurysms, based on case report of patient with post-traumatic pseudo-aneurysm of right subclavian artery.

Material and methods: a case report of a patient with post-traumatic pseudo-aneurysm of right subclavian artery, polytrauma and pulmonary embolism is presented.

Results: successful endovascular treatment of pseudo-aneurysm of right subclavian artery with the implantation of stent-graft was performed. Postoperative period was uneventful, and the patient was discharged with improved health.

Conclusions: endovascular treatment is the preferred method, due to its less invasiveness and lower complication frequency in comparison with open surgery.

Abstract:

Introduction: treatment of patients with bilobar metastatic liver disease remains an unsolved problem. Among methods of regional chemotherapy, the least studied is isolated liver chemoperfusion, which is an unpopular technique due to its high trauma and difficult reproducibility.

Aim: was to demonstrate the method of endovascular isolated liver chemoperfusion (EILHP) developed by us.

Case report: EILCP was performed using a heart-lung machine (HLM) in a patient with cancer of the rectum, stage 2 (pT3N0M0), after combined treatment (radiation therapy (SOD 60 Gy) + anterior resection of the rectum in 2007). Disease progression. Isolated metastatic liver disease (01.2021). Isolated chemoperfusion was performed endovascularly using 2-balloon catheters, which provided vascular isolation of the liver and its isolated perfusion during the procedure. Posi- tioning of balloon catheters was performed in an open way through femoral artery and vein. Perfusion was carried out for 30 minutes with chemotherapy drugs (CtD) oxaliplatin 42,5 mg/m² and irinotecan 82,5 mg/m² injected directly into the circuit.

Results: the duration of intervention was 160 minutes, intraoperative blood loss was 50 ml. During insertion and positioning of aortic balloon, a limited dissection of the aorta developed in area of left common iliac artery deviation, which did not require any intervention in postoperative period. Duration of intensive care unit stay was 1 day. There were no complications associated with aortic dissection during 3-month follow-up. Level of ALT and AST remained within reference values during entire postoperative period. No hematological toxicity was observed. Patient was discharged on the 7th day after operation in satisfactory condition.

Patient underwent control CT scan of abdominal organs, 30 days after endovascular isolated chemoperfusion of the liver. According to the RECIST scale, stabilization of tumor process was noted.

Conclusions: proposed technique of endovascular isolated liver chemoperfusion is technically feasible and safe. The use of this method may be appropriate in treatment of patients with isolated liver metastases who require dose reduction of chemotherapeutic agents due to their severe toxicity or high patient comorbidity.

Abstract:

Introduction: currently, chemoradiation therapy is widely used as the main method of specific treatment for locally advanced head and neck cancer. Previously it was believed that radiation damage of carotid arteries occurs only several years after treatment.

Material and methods: article presents two case reports of internal carotid artery stenosis which arose directly during the course of chemoradiation of head and neck malignant tumors. In the first case, patient K., 54 years old, had laryngeal cancer (stage III: T3N1M0), in the second case, patient M., 40 years old, had tongue cancer (stage I: T1N0M0).

Conlusion: article presents angiographically confirmed carotid artery stenosis arisen directly during chemoradiation and in early stages after its completion. The discussion presents data on the incidence of stenosing lesions of carotid arteries, cerebrovascular events among patients undergoing radiation therapy. It is necessary to draw attention of specialists to the problem of early stenosis of carotid arteries during radiation and chemoradiation therapy of head and neck tumors.

Abstract:

Aim: was to evaluate the effectiveness of the complex use of MRI and high-resolution ultrasound for the diagnostics of fillers.

Material and methods: in presented case report, the study was carried out using a SOMATOM Aera SIMENS 1.5 Т tomograph in T1, T1 Dixon, T1 Fs, T2, T2 STIR modes, the slice thickness was 3 mm. Ultrasound was performed with a MyLab Alpha, Esaote device, linear sensors with a frequency of 6 - 18 MHz and 10 - 22 MHz were used in B-mode, Color Doppler Imaging mode.

Results: case report demonstrates possibilities of complex use of ultrasound and MRI in patients with atypical ultrasound pattern for hyaluronic acid-based fillers. When choosing treatment tactics, data obtained during the examination, indicating the presence of a filler in soft tissues of the chin that does not correspond to the ultrasound and MRI signs of hyaluronic acid, were taken into account.

Conclusions: complex diagnostics of dermal fillers using high-resolution ultrasound and MRI is indicated for patients with complications of contouring, for differential diagnostics of hyaluronic acid with fillers of non-hyaluronic nature.

Abstract:

Introduction: about 200 million people in the world suffer from ischemia of lower limbs. This pathology occupies a large part in the structure of all lesions of the vascular bed. Most patients with lesions of lower limb arteries have critical lower limb ischemia (CLLI), which is characterized by pain at rest and/or trophic lesions of foot. CLLI is the final stage of lower limb vascular bed lesion and is always accompanied by a deterioration in the quality of life, high morbidity and mortality. The only effective way to treat this pathology is revascularization, however, the current lack of clinical data does not allow us to determine the optimal strategy in treatment of this pathology.

Aim: was to determine advantages and disadvantages of using various methods of lower limb revascularization.

Material and methods: literature data from information aggregators Cyberleninka, Pubmed and MEDLINE on this topic, published in Russian and English for the period from 2010 to 2021, were selected for analysis. Articles written in German and French were included in the study in case of available translation to English. Termins as an inclusion criteria: critical limb ischaemia, ischaemic pain, tissue loss, gangrene, hybrid intervention, open surgical recanalization, endovascular revascularization, claudication, stenosis.

Results: it is determined that revascularization by open surgery showed better long-term results, however, it cannot be recommended for patients with severe comorbid diseases and defeat of lower limb and foot arteries, while endovascular revascularization techniques allow the procedure to be performed in almost all patients, regardless of the severity of their somatic status, however, extended multilevel lesions are poorly amenable to this method of treatment, and also have a relatively lower patency in the long-term period. Hybrid interventions combine advantages of both methods, however, they have high requirements for the equipment of the medical institution and the qualifications of the staff. In addition, hybrid methods are also more dangerous for the patient in comparison with revascularization by endovascular methods.

Abstract:

Patients with suspected peripheral artery disease (PAD) with critical limb ischemia (CLI) require intervention for limb salvage. Successful revascularization depends on quality and accurate visualization of vascular bed of lower limbs. Recent advances in imaging technology have significantly impacted the preoperative assessment of patients with PAD. The following is a description of main invasive techniques of obtaining high-quality images of arteries of lower limbs.

Aim: was to summarize data of modern literature sources, on the effectiveness of modern instrumental diagnostic methods for early and effective invasive assessment of blood flow and perfusion of lower limbs for planning revascularization interventions and assessing its effectiveness.

Material and methods: we analyzed sources of Russian and foreign literature over the past 5 years on the issue of modern possibilities of invasive diagnosis of critical lower limb ischemia. When choosing sources, we relied on the information content of described methods, the relevance of research, results of which are being applied today, and outlined prospects for their application in the future.

Conclusions: over the years, digital subtraction angiography has been traditionally the «gold standard» for intravascular imaging of lower limbs. Over time, this method has been improved because technological advances have created high-quality alternatives for preoperative (computed tomography [CT] angiography and magnetic resonance angiography [MRA]) and intraoperative imaging (Vascular Flow Reserve [VFR], intravascular ultrasound [IVUS], optical coherence tomography [OCT] and angiography CO₂).

Abstract:

Introduction: percutaneous coronary intervention plays an important role in treatment of acute myocardial infarction with ST-segment elevation. However, the benefit of performing delayed PCI is controversial (>12h after onset of symptoms typical for STEMI).

Aim: was to compare results of PCI and medical therapy (MT) in patients, who had been admitted to the hospital with verified STEMI, diagnosed 12 hours after the onset of symptoms, and to estimate their effect on clinical outcomes.

Material and methods: data of 100 patients was analyzed, PCI was performed in 62 patients and 38 patients underwent medical therapy. The task was to compare clinical outcomes, which included mortality and major adverse cardiac events (MACE).

Results: all-cause mortality in groups of delayed PCI and MT was 4 (6,45%) and 9 (23,6%) respectively (p <0,05). It was also recorded that minor cases of cardiac death occurred in the group of delayed PCI in comparison with the MT group, 1 (1,6%) and 6 (15,7%) respectively (p <0,05).

Conclusion: delayed PCI (12 hours after the onset of the myocardial infarction in STEMI patients) leads to improvement in all-cause mortality and cardiac death rates compared with conservative treatment.

Abstract:

Article presents a retrospective analysis of using the modified way experience in removing the occlusive substrate from cerebral vessels in the ischemic stroke acute phase after failed standard thrombectomy.

Aim: to study the efficacy and advantages of thrombectomy technique from intracranial arteries in patients with acute ischemic stroke combining a stent-retriever with reperfusion catheter in comparison with the standard stent retriever thromboextraction.

Methods: we analyzed 54 hospital charts of patients who had underwent endovascular recanalization of intracranial large vessel occlusion in acute ischemic stroke. Patients were divided into two equal groups, depending on thrombus removal method. Standard stent-retriever thrombectomy with a balloon guide-catheter was performed as the first stage in both groups. In 27 cases (1st group), after standard stent-retriever technique failed, we carried out combination of retriever extraction with distal aspiration and a guiding balloon-catheter. If we couldn’t safely insert stent-retriever into catheter of distal approach (during thrombectomy), we switched to vacuum aspiration from guiding balloon-catheter (vacuum-blocked) and removed stent-retriever, microcatheter and distal approach catheter simultaneously without reducing tension. In 27 patients (2nd group) after standard thrombectomy failed we repeated this technique several times.

Results: embolic complications relative risk was 2,249, 95% CI (1,126 - 4,492) and reperfusion mTICI 3 100% versus 74,07% rate was higher in the first group, in comparison with the second group. Other complications and hospital outcomes of disease did not differ between groups.

Conclusion: a stent retriever combined with distal aspiration and a simultaneous transition to vacuum-blocked extraction using after an unsuccessful standard thrombectomy increases the efficiency of complete reperfusion by 25%. Its use is 1,8 times safer than standard thrombectomy in terms of embolic complications.

Abstract:

Article describes cases of detection of viral pneumonia in patients who underwent additional examination before planned hospitalization for surgical treatment in the presence of negative test results for the SARS-CoV-2 virus.

Aim: was to detect early computed tomography (CT) signs of COVID-19 during admission to hospital, in case of presence of normal clinical and laboratory data and negative results of PCR test.

Material and methods: image analysis of CT examinations of chest organs in patients admitted for surgical treatment for various osteoarticular pathologies, for the period of 3 months, was carried out in radiology department.

Results: during CT examination of chest organs, in 9,1% patients, signs of viral pneumonia were revealed, including those caused by SARS-CoV-2, in condition of negative results of PCR tests, immunoserological tests for the presence of immunoglobulins M and G to SARS-CoV-2.

Conclusion: computed tomography of lungs can be considered the «gold standard» of diagnostics, which makes it possible to detect early subclinical inflammatory changes in lungs, in particular, in pneumonia associated with COVID-19, which is the main task during a pandemic.

Abstract:

Introduction: a case report of successful treatment of an extremely rare pathology (0,27-0,34%) - acute occlusion of both internal carotid arteries (ICA) is presented.

Aim: was to show possibilities of endovascular surgery in the diagnosis and treatment of acute ischemic stroke (AIS) in patients with bilateral acute ICA occlusion.

Materials and methods: a 38-year-old patient was hospitalized by ambulance with the diagnosis of AIS. Multispiral computed tomography (MSCT) revealed left ICA occlusion in the C2-C5 segment. Selective angiography of ICA was performed: right ICA - non-occlusive thrombosis C2-C3 segments; left ICA - thrombotic occlusion in C1 segment.

Results: thrombaspiration was performed from the left ICA and right ICA; full recovery of antegrade cerebral blood flow was achieved in both ICA, according to the modified treatment in cerebral infarction score (mTICI) - 3. Patient was discharged after 28 days. At the time of discharge, the modified Rankin Scale (mRS) score was 3. 6 months after discharge mRS was 1.

Conclusions: Selective angiography of both ICA in a patient with AIS enabled to detect right ICA thrombosis not detected by MCT, which in its turn changed the treatment tactics of the patient. Aspiration thromebctomy from both internal carotid arteries allowed to achiev full recovery of antergrade cerebral blood flow of both internal carotid arteries.

References

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2.     Shapoval IN, Nikitina SYu, Ageeva LI, et al. Zdravoochranenie v Rossii. 2019 [In Russ].

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3.     Aigner A, Grittner U, Rolfs A, et al. Contribution of established stroke risk factors to the burden of stroke in young adults. Stroke. 2017; 48: 1744-1751.

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4.     Gafarova AV, Gromova EA, Panov DО, et al. Social support and stroke risk: an epidemiological study of a population aged 25-64 years in Russia/Siberia (the WHO MONICA-psychosocial program). Neurology, Neuropsychiatry, Psychosomatics. 2019; 11(1): 12-20 [In Russ].

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5.     Putaala J. Ischemic Stroke in Young Adults. Continuum. 2020; 26(2): 386-414.

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6.     Si Y, Xiang S, Zhang Y. et al. Clinical profile of etiological and risk factors of young adults with ischemic stroke in West China. Clinical Neurology and Neurosurgery. 2020; 193.

https://doi.org/10.1016/j.clineuro.2020.105753

7.     Ekker MS, Boot EM, Singhal AB, et al. Epidemiology, aetiology, and management of ischaemic stroke in young adults. The Lancet Neurology. 2018; 17(9): 790-801.

https://doi.org/10.1016/s1474-4422(18)30233-3

8.     Chi X, Zhao R, Pei H, et al. Diffusion-weighted imaging-documented bilateral small embolic stroke involving multiple vascular territories may indicate occult cancer: A retrospective case series and a brief review of the literature. Aging Med. 2020; 3(1): 53-59.

https://doi.org/10.1002/agm2.12105

9.     Dietrich U, Graf T, Sch?bitzb WR. Sudden coma from acute bilateral M1 occlusion: successful treatment with mechanical thrombectomy. Case Rep Neurol. 2014; 6: 144-148.

https://doi.org/10.1159/000362160

10.   Pop R, Manisor M, Wolff V. Endovascular treatment in two cases of bilateral ischemic stroke. Cardiovasc Intervent Radiol. 2014; 37: 829-834.

https://doi.org/10.1007/s00270-013-0746-4

11.   Larrew T, Hubbard Z, Almallouhi E.et al. Simultaneous bilateral carotid thrombectomies: a technical note. Oper Neurosurg. 2019; 5(18): 143-148.

https://doi.org/10.1093/ons/opz230

12.   Storey C, Lebovitz J, Sweid A, et al. Bilateral mechanical thrombectomies for simultaneous MCA occlusions. World Neurosurg. 2019; 132: 165-168.

https://doi.org/10.1016/j.wneu.2019.08.236

13.   Braksick SA, Robinson CP, Wijdicks EFM. Bilateral middle cerebral artery occlusion in rapid succession during thrombolysis. Neurohospitalist. 2018; 8: 102-103.

https://doi.org/10.1177/1941874417712159

14.   Jeromel M, Milosevic Z, Oblak J. Mechanical recanalization for acute bilateral cerebral artery occlusion - literature overview with a case. Radiology and Oncology. 2020; 54(2): 144-148.

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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].

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14.   Tipaldi MA, Krokidis M, Orgera G, et al. Endovascular management of giant visceral artery aneurysms. Sci Rep. 2021; 11: 700.

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Abstract:

Introduction: half-year data on results of using new domestic NanoMed devices for closing atrial septal defects (ASD) were obtained. The occluder is a nitinol self-expanding and self-centering double disc device with a polyester membrane.

Aim: was to evaluate the safety and efficacy of a new domestic occluder for closing of atrial septal defect in a small group of patients over a 6-month follow-up period.

Material and methods: four pediatric patients underwent closure of atrial septal defects with domestic NanoMed occluders. Clinical examination and transthoracic echocardiography were performed at 24 hours, 1, 3, and 6 months. Endpoints included technical success of intervention, efficacy and safety of the procedure at follow-up instrumentation and physical examination.

Results: the average age of patients was 5,2 years (range 4 to 7 years). Mean ASD diameters and device waist sizes were 11,9 ± 1,2 mm and 13,7 ± 1,2 mm and 13,7 ± 1,2 mm, respectively. Technical and procedural success achieved in 100% of cases. During the six-month follow-up, no adverse events and residual flows were identified.

Conclusion: initial half-year data on the absence of adverse events and residual flows indicate the safety and effectiveness of the use of NanoMed occluders.

References

1.     Stout K, Daniels C, Aboulhosn J, et al. 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019; 73(12): 1494-1563.

https://doi.org/10.1016/j.jacc.2018.08.1028

2.     Pettersen MD, Du W, Skeens ME, Humes RA. Regression equations for calculation of z scores of cardiac structures in a large cohort of healthy infants, children, and adolescents: an echocardiographic study. Journal of the American Society of Echocardiography. 2008; 21(8): 922-934.

https://doi.org/10.1016/j.echo.2008.02.006

3.     Gillespie MJ, Javois AJ, Moore P, et al. Use of the GORE CARDIOFORM septal occluder for percutaneous closure of secundum atrial septal defects: results of the multicenter U.S. IDE trial. Catheterization and Cardiovascular Interventions. 2020; 95(7): 1296-1304.

https://doi.org/10.1002/ccd.28814

4.     Sharifi M, Burks J. Efficacy of clopidogrel in the treatment of post-ASD closure migraines. Catheter Cardiovasc Interv. 2004; 63: 255.

https://doi.org/10.1002/ccd.20144

Abstract: 

Aim: was to present the experience of using blockers of IIb/IIIa glycoprotein receptors in treatment of thromboembolic complications of endovascular treatment of cerebral aneurysms.

Materials and methods: from December 2007 to June 2021, 695 patients underwent embolization of cerebral aneurysms. Thromboembolic complications were observed in 45 patients (6,5%), blockers of IIb/IIIa glycoprotein receptors were used in 32 patients (4,6%).

Results: blockers of IIb/IIIa glycoprotein receptors were used in 10,1% of patients with embolization of aneurysms and stent implantation, in 9,2% of cases with implantation of flow-diverters, and in 1% of patients with embolization of aneurysms using only coils. Effective restoration of blood flow was observed in 90,6% of patients. Intracranial hemorrhagic complications were not observed. The incidence of bleeding from the gastrointestinal tract was 6,3%, the incidence of puncture hematomas was 12,5%.

Conclusion: blockers of glycoprotein IIb/IIIa receptors can be effectively and safely used in treatment of thromboembolic complications of endovascular treatment of cerebral aneurysms.

References

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Abstract:

Aim: was to develop a score scale for the prediction of complete tumor necrosis to assess the potential effectiveness of radiofrequency ablation of colorectal cancer focals in liver, on the base of results of the use of radiological diagnostic methods.

Materials and methods: a comparative analysis of results of radiological diagnosis of solitary colorectal cancer metastases in liver was carried out in 51 patients, depending on their characteristics before and at different times after radiofrequency ablation (RFA).

The survey and interventions were carried out between 2014 and 2020 in accordance with standards of treatment approved in Belarus. Ultrasound and CT with bolus contrast enhancement were used as radiation diagnostic methods.

The initial morphological parameters of tumor focals were evaluated according to results of ultrasound examination. CT with bolus contrast was used to control the effectiveness of RFA (determining the frequency of complete tumor necrosis): on the day of discharge of patients from the hospital, after 1 month, and then - once every 3 months (quarterly) during the year.

Results: the dependence of the effectiveness of RFA (frequency of complete tumor necrosis) on initial characteristics of solitary focals of colorectal cancer in liver was revealed and confirmed by results of a comparative statistical analysis. On the basis of obtained data, a score scale for predicting the effectiveness of RFA was developed and validated. The sensitivity of the new technique was 80,0%; specificity - 82,9%.

Conclusion: for the first time, a scale for the prediction of complete tumor necrosis was developed to assess the potential effectiveness of radiofrequency ablation of solitary colorectal cancer focals in liver.

ROC-analysis of the scale validation results showed that the sensitivity and specificity of the model are sufficient for its application in practice: 80,0% and 82,93%, respectively.

References

1.     Hideo T, Eren B. Role of thermal ablation in the management of colorectal liver metastasis. Hepatobiliary Surg. Nutr. 2020; 9(1): 49-58.

https://doi.org/10.21037/hbsn.2019.06.08

2.     Machi J, Oishi AJ, Nancy LF, Robert HO. Sonographically guided radio frequency thermal ablation for unresectable recurrent tumors in the retroperitoneum and the pelvis. J. Ultrasound. Med. 2003; 22(5): 507-13.

https://doi.org/10.7863/jum.2003.22.5.507

3.     Furrukh J, Cameron S, Iswanto S. The use of thermal ablation in the treatment of colorectal liver metastasis-proper selection and application of technology. Hepatobiliary Surg. Nutr. 2021; 10(2): 279-280.

https://doi.org/10.21037/hbsn-21-54

4.     Vasiniotis KN, Kaye EA, Sofocleous CT. Image-Guided Thermal Ablation for Colorectal Liver Metastases. Tech. Vasc. Interv. Radiol. 2020; 23(2): 100672.

https://doi.org/10.1016/j.tvir.2020.100672

5.     Rafael D-N, Stephen F, Hassan M, Graeme P. Defining the Optimal Use of Ablation for Metastatic Colorectal Cancer to the Liver Without High-Level Evidence. Curr. Treat. Options. Oncol. 2017; 18(2): 8.

https://doi.org/10.1007/s11864-017-0452-6

6.     Мурашко К.Л., Сорокин В.Г., Громов Д.Г. Методы локального воздействия на очаговые образования печени, применяемые в онкорадиологии. Диагностическая и интервенционная радиология. 2020;14: 60-66.

Murashko KL, Sorokin VG, Gromov DG. Metody lokal'nogo vozdejstviya na ochagovye obrazovaniya pecheni, primenyaemye v onkoradiologii. Diagnosticheskaya i intervencionnaya radiologiya. 2020; 14: 60-66 [In Russ].

https://doi.org/10.25512/DIR.2020.14.2.07

7.     Binbin J, Hongjie L, Kun Y, Zhongyi Z. Ten-Year Outcomes of Percutaneous Radiofrequency Ablation for Colorectal Cancer Liver Metastases in Perivascular vs. Non-Perivascular Locations: A Propensity-Score Matched Study. Front. Oncol. 2020; 16(10): 553556.

https://doi.org/10.3389/fonc.2020.553556

8.     Lu DSK, Steven SR, Limanond P, et al. Influence of large peritumoral vessels on outcome of radiofrequency ablation of liver tumors. J. Vasc. Interv. Radiol. 2003; 14(10): 1267-74.

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9.     Lu DS, et al. Effect of vessel size on creation of hepatic radiofrequency lesions in pigs: Assessment of the “heat sink” effect. Am. J. Roentgenol. 2002; 178: 47-51.

https://doi.org/10.2214/ajr.178.1.1780047

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https://doi.org/10.1042/BSR20193875

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https://doi.org/10.3760/cma.j.issn.0253-9624.2019.09.018

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https://doi.org/10.1186/s12874-017-0332-6

13.   Nakas CT, Reiser B. Editorial for the special issue of “Statistical Methods in Medical Research” on “Advanced ROC analysis”. Statistical Methods in Medical Research. 2018; 27(3): 649-650.

https://doi.org/10.1177/0962280217742536

14.   Xieling C, Haoran X, Fu L, et al. A bibliometric analysis of natural language processing in medical research. BMC Med. Inform. Decis. Mak. 2018; 18(1): 14.

https://doi.org/10.1186/s12911-018-0594-x

15.   Young C, Soung WJ, Jae YJ, Yong JK. Recent Updates of Transarterial Chemoembolilzation in Hepatocellular Carcinoma. Int. J. Mol. Sci. 2020; 31; 21(21): 8165.

https://doi.org/10.3390/ijms21218165

16.   Riccardo L. Loco-regional treatment of hepatocellular carcinoma. Hepatology. 2010; 52(2): 762-73.

https://doi.org/10.1002/hep.23725

17.   Hinshaw JL, Lubner MG, Ziemlewicz TJ, et al. Percutaneous tumor ablation tools: microwave, radiofrequency, or cryoablation - what should you use and why? Radiographics. 2014; 34(5): 1344-62.

https://doi.org/10.1148/rg.345140054

18.   Pierre A, Roberto LC, Guillaume K, et al. Percutaneous tumor ablation. Presse. Med. 2019; 48(10): 1146-1155.

https://doi.org/10.1016/j.lpm.2019.10.011

19.   Fan Z, Hongying S, Xiangjun H, et al. Tumor Thermal Ablation Enhancement by Micromaterials. Curr. Drug. Deliv. 2017; 14(3): 323-333.

https://doi.org/10.2174/1567201813666160108114208

20.   Mehta A, Oklu R, Sheth RA. Thermal Ablative Therapies and Immune Checkpoint Modulation: Can Locoregional Approaches Effect a Systemic Response? Gastroenterol. Res. Pract. 2016; 9251375.

https://doi.org/10.1155/2016/9251375

Abstract:

Aim: was to assess the frequency, predominant localization and severity of atherosclerotic plaques in coronary arteries according to multidetector computed tomography (MDCT) in patients with suspicion on coronary heart disease (CHD).

Materials and methods: analysis of results of CT of coronary arteries (CT-CA) was carried out in 1590 patients. The average age was 53,9 ± 10,7 years. The number of men was 1133 (71,3%). Studies were carried out on 64- and 256-slice CT scanners.

Results: in patients with suspicion on coronary artery disease, atherosclerotic lesions of coronary arteries (CA) were not detected in 582 (36,6%) cases. Minimal and initial CA stenoses were observed in 80 (5%) and 416 (26,2%) patients, respectively. Moderate CA stenoses were found in 236 (14,8%) patients. Severe coronary artery stenoses were detected in 183 patients (11,5%). CA occlusions were observed in 84 (5,3%) cases. Most often, the stenotic process was detected in proximal segments of coronary arteries, in particular, in the left anterior descending artery.

Conclusions: MDCT makes it possible to determine in detail the severity and nature of atherosclerotic coronary lesions, as well as to assess the predominant location of plaques.

References

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Abstract:

Introduction: development of intravascular diagnostic methods has significantly increased the amount of information in the study of various vessels in comparison with standard angiography. Technological and software improvement of optical coherence tomography (OCT) allows expanding diagnostic capabilities and providing greater convenience for analyzing of results of this method of intravascular examination, which leads to an increase in its importance both for daily clinical practice and in scientific research.

Aim: was to describe the methodology of performing a new modification of OCT and to analyze accumulated experience, advantages and possibilities provided by this method.

Material and methods: the modern version of the complex for optical coherence tomography OPTIS allows to implement such new features as automatic indication of malapposition of stents, easy-to-perceive three-dimensional image of examination data in various versions, joint presentation (co-registration) of angiography and OCT data in real time. The first experience of clinical use of this system in the Russian Federation is presented, with an analysis of priority indications for the use of new possibilities. Using the angio-OCT-co-registration function, 309 studies of 205 arteries in 178 patients were performed, which accounted for 63,3% of all OCT procedures performed in our department. 

Results: priority indications for the use of the method were identified, which primarily include: cases of extended stenoses with an uncertainty in the hemodynamic significance of individual sections or the entire lesion as a whole; difficulties in constructing an optimal projection of the angiogram (without overlapping branches and significant shortening of the target area); bifurcation lesions; diagnostics of thrombus, dissections, plaque ruptures, severe calcification, including in acute coronary syndrome; selection of the optimal size of biodegradable scaffold and preparation of the artery for its implantation; intermediate or final control of results of coronary artery stenting. The use of co-registration of angiography and OCT contributes to a more accurate determination of the area of interest during repeated studies, which is especially important for the dynamic assessment of the patient's condition and for scientific research.

Conclusions: the development and modernization of optical coherence tomography causes an increase in its importance both in daily clinical practice and in scientific research. The possibility of spatial co-registration of OCT data with angiographic images, as well as new options for automatic processing of resulting images, including stent apposition assessment, significantly increase the operator's ability to quickly and accurately analyze examination data directly at the operating table.

References

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https://doi.org/10.4244/EIJY18M06_011

3.     Johnson TW, Raber L, di Mario C, et al. Clinical use of intracoronary imaging. Part 2: guidance and optimization of coronary interventions. An expert consensus document of the European Association of Percutaneous Cardiovascular Interventions. EuroIntervention. 2019; 15: 434-451.

https://doi.org/10.4244/EIJY19M06_02

4.     Van der Sijde JN, Guagliumi G, Sirbu V, et al. The OPTIS Integrated System: real-time, co-registration of angiography and optical coherence tomography. EuroIntervention. 2016; 12: 855-860.

https://doi.org/10.4244/EIJV12I7A140

5.     Karanasos A, Van der Sijde JN, Ligthart J, et al. Utility of Optical Coherence Tomography Imaging with Angiographic Co-registration for the Guidance of Percutaneous Coronary Intervention. Radcliffe Cardiology.com. 2015. [Internet source]

6.     Demin VV, Demin DV, Seroshtanov EV, et al. Clinical issues of optical coherence tomography for coronary diagnosis. International Journal of Interventional Cardioangilogy. 2016; 44: 34-48 [In Russ].

7.     Ermolaev PA, Khramykh TP, Vyaltsin AS. Use of optical coherence tomography for intermediate coronary artery lesions. Circulation Pathology and Cardiac Surgery. 2019; 23(3): 47-56 [In Russ].

https://doi.org/10.21688/1681-3472-2019-3-47-56

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https://doi.org/10.4244/EIJV11SVA15

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https://doi.org/10.4244/EIJV8I2A34

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https://doi.org/10.4244/EIJV5I5A89

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https://doi.org/10.4244/EIJY14M07_18

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https://doi.org/10.4244/EIJV11I3A59

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https://doi.org/10.4244/EIJV10I10A190

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https://doi.org/10.4244/EIJV7I3A60

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Abstract:

Introduction: it is well known that magnetic resonance imaging (MRI) has superiority above computed tomography (CT) in identification of epileptogenic substrates due to higher resolution of images and the best differentiation between white and gray matter. But in some peculiar cases, CT can be the method of choice.

Aim: was to illustrate the role of CT in presurgical examination in children with drug-resistant focal epilepsy.

Materials and methods: results of CT of 65 patients with focal epilepsy had been analyzed. All patients underwent multimodal presurgical examination with followed antiepileptic surgical operation and morphological analysis.  CT was performed on GE Lightspeed and Philips Ingenity Elite scanners.

Results: in presurgical period, native CT was performed in 11 (16,9%) patients and in 6 patients, structural brain changes responsible for epilepsy were identified. In 13 patients (20%) we’ve used CT angiography for estimation of angio-architectonic environment in the area of potential surgical intervention and in case of suspicion on arteriovenous malformation (AVM). CT on the 1st day of post-operative period was made in 48 (73,8%) of patients, and in 2 cases CT revealed structural changes that influenced further treatment tactics. At the background of exacerbation in 3 patients, repeated CT revealed sings of acute disorders of cerebrospinal fluid cirdulation.

Conclusion: computed tomography can be an effective diagnostic method in examination of patients with epilepsy, especially when verifying bone and vascular (CT-angiography) changes, is used for neuronavigation to control the position of invasive electrodes and exclude post-implantation hemorrhages, and also helps to identify early postoperative complications, thus influencing tactics and outcomes of surgical treatment of epilepsy. In children with focal epilepsy undergoing surgical treatment, computed tomography and magnetic resonance imaging are complementary studies that provide adequate neuroradiological support.

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https://doi.org/10.4103/0972-2327.116928

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https://doi.org/10.3171/2014.9.jns13919

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https://doi.org/10.1016/j.wneu.2017.11.063

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https://doi.org/10.4329/wjr.v6.i1.1

Article exists only in Russian.

Article exists only in Russian.

Article exists only in Russian.

Article exists only in Russian.

Abstract:

In interventional radiology department of clinical hospital № 27 (Moscow) since 2002 till 2009 TIPS was performed in 62 patients for hepatic cirrhosis with portal hypertension. One of the patients underwent orthotopic liver transplantation in Germany.
Material and methods. Mean age in the group was 5f ,6 y. o., 17 women, 45 men. Three types of stents were used: matrix stents, self-expanding and stent-grapfts. Patients were divided in 2 groups. In Group 1 (17 pts) we performed TIPS with stent-grafts (Gore Viatorr TIPS Endoprosthesis); in Group 2 (47 pts) bare metal stents were used (matrix stents Perico, Genesis, JoMed and self-expanding stents Za-stent, Zilver, Wallstent, sinus-SuperFlex Visual-Stent, SMART-control).
Results. During 18 months follow-up there were no thrombosis, significant stenosis in patients of Group 1, and primary patency rate was 100%. In Group 2 primary and secondary patency rates were 69,3% and 85,6% correspondingly. Freedom from recurr­ ent esophageal varices hemorrhage was 82,8% in Group 1 and 69,3% in Group 2, ascitis and hydrothorax regression - 93,9% and 80,0%, absence of hepatic cerebropathy progression - 93,9% and 80,0%, overall survival - 87,8% и 76,0% correspondingly.
Conclusions. Therefore use of stent-graft in TIPS procedure improve patency of intrahepatic shunt (p < 0,01), significantly reduce risk of recurrent variceal hemorrhage (0,1 < p < 0,5), and reduce volume of ascitis (0,1 < p < 0,5). It worth saying that cerebropathy progression was caused by non-compliance to diet, and was corrected with medicamental treatment. In long-term follow-up stent­ graft «Viatorr» deployment improves survival of patients (0,1 < p < 0,5). Introduction of stent-grafts marked a new stage of TIPS pro­ cedure improvement.

Article exists only in Russian.

Abstract:

Chemodectomas are rare, in most cases, benign neoplasms. They originate from the chemoreceptor cells of the carotid glomus in the bifurcation of the carotid artery. Chemodectoma treatment is surgical. Classical removal of the tumor carries a high risk of damage of arteries and nerves. We present a case report of high localization (C1) carotid chemodectoma removal in a hybrid operating room. Tumor was successfully removed after selective embolization of chemodectoma with protection of distal flow of the internal carotid artery. This approach helped to minimize intraoperative blood loss, as well as to shorten time of intervention.

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Abstract:

This case describes successful combined treatment of patient with large hepatocellular carcinoma BCLC «B», occupying the entire right lobe of the liver, extending to the fourth segment and occupying the right lateral flank till small pelvis. As the first stage, selective tumor chemoembolization, mechanical chemoembolization of right portal vein branches with the aim of vicarious hypertrophy of remaining liver segments were performed. One and half months after performed procedure, the volume of remnant parenchyma was 31% of the total volume. According to the test with indocyanine green, the plasma elimination rate (ICG-PDR) was 12,2%/min, and the residual concentration at 15 minutes was 16%. Subsequently, was performed surgical intervention: Starzl laparotomy, revision of abdominal organs, cholecystectomy, right-sided hemihepatectomy + SI, drainage of the common bile duct according to Vishnevsky, lymphadenectomy of the hepatoduodenal ligament, drainage of abdominal cavity. Postoperative period was complicated by formation of an external biliary fistula and hepatic failure, regarded as class «B» according to criteria of the International Research Group for Liver Surgery (ISGLS), which required medical correction of patient's condition without use of extracorporeal detoxification methods. Later, patient was diagnosed with foci of recurrence of disease in the remaining parenchyma of the liver, for which endovascular treatment was carried out. Currently, patient is alive (6 years after surgery) and is receiving systemic treatment for the extrahepatic spread of the underlying disease.

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Abstract:

This review is devoted to critical upper limb ischemia in patients with hemodialysis vascular access. Possible etiological causes of critical ischemia and diagnostic aspects of this pathology are considered. Contemporary approaches of treatment of critical ischemia in this group of patients are demonstrated; indications and contraindications for methods of treatment are discussed. Particular attention has been paid to endovascular method of revascularization of hand, which can become the method of choice in treatment of patients with critical ischemia of the upper limb caused by occlusive lesions of arteries in patients with hemodialysis vascular access.

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Abstract:

Introduction: the main methods for diagnosing cardiac neoplasms, allowing to determine the localization, size, involvement of heart structures, to suggest the nature of the pathological process and to plan treatment tactics, are: echocardiography (EchoCG), contrast multispiral computed coronary angiography (MSCT CAG), magnetic resonance imaging (MRI) and positron emission computed tomography (PET CT). At the same time, any additional information about the pathological process can improve the quality of diagnosis and treatment. So, for example, selective coronary angiography (CAG), which in this case can be performed to clarify the coronary anatomy and exclude concomitant coronary atherosclerosis, in hands of attentive and experienced specialist of endovascular diagnostic and treatment methods can make a significant contribution to understanding the nature of blood supply of heart neoplasm, thereby bringing closer the formulation of the correct diagnosis and, ultimately, improving results of surgical treatment.

Aim: was to study the nature of blood supply of heart myxoma based on results of a detailed analysis of data of selective coronary angiography in patients with this pathology.

Material and methods: since 2005, 20 patients underwent surgery to remove heart myxoma. The average age of patients was 56,6 + 8,0 (43-74) years. According to data of ultrasound examination, sizes of myxomas ranged from 10 to 46 mm in width and from 15 to 71 mm in length (average size ? 25,6 ? 39,1 mm). In 2/3 of all cases (15 out of 20,75%), the fibrous part of the inter-atrial septum (fossa oval region) was the base of myxomas. In 8 of 20 (40%) cases, tumor prolapse into the left ventricle through structures of the mitral valve was noted in varying degrees. In order to exclude coronary pathology, CAG was performed in 14 cases, in the rest - MSCT CAG.

Results: of 14 patients with myxoma who underwent selective coronary angiography, 12 (85,7%) patients had distinct angiographic signs of vascularization. In all 12 cases, the sinus branch participated in the blood supply of myxoma, begins from the right coronary artery (RCA) in 10 cases: in 7 case it begins from proximal segment of the RCA and, in 3 cases, from the posterior-lateral branch (PLB) of the RCA. In one case, the source of blood supply of neoplasm was the sinus branch extending from PLB of dominant (left type) circumflex artery of the left coronary artery (PLB CxA LCA). In one case, the blood supply to the neoplasm involved branches both from the RCA and CxA, mainly from the left atrial branch of CxA. Moreover, in all 12 cases, sinus branch formed two branches: branch of sinus node itself and left atrial branch. It was the left atrial branch that was the source of blood supply of myxoma. Analysis of angiograms in patients with myxoma of LA showed that left atrial branch in terminal section formed a pathological vascularization in the LA projection, accumulating contrast-agent in the capillary phase (MBG 3-4). In addition to newly formed vascularization, lacunae of irregular shape were distinguished, the size of which varied from 2 to 8 mm along the long axis. In 8 cases, hypervascular areas with areas of lacunar accumulation of contrast-agent showed signs of paradoxical mobility and accelerated onset of venous phase. In two cases, there were distinct angiographic signs of arteriovenous shunt. In 2 cases (when the size of the myxoma did not exceed 15-20 mm according to EchoCG and CT), angiographic signs allowing to determine the presence of LA myxoma were not so convincing: there was no lacunar accumulation of contrast-agent; small (up to 10 mm) hypervascular areas were noticed, the capillary network of which stood out against the general background of uniform contrasting impregnation and corresponded to MBG grade 1-2.

Conclusion: according to our data, angiographic signs of vascularization of myxomas are detected in most cases with this pathology (85,7%). The source of blood supply, in the overwhelming majority of cases, is branch of coronary artery, which normally supplies the structure of the heart, on which the basement of the pathological neoplasm is located. The aforementioned angiographic signs characteristic of myxomas deserve the attention of specialists in the field of endovascular diagnosis and treatment and should be described in details in protocols of invasive coronary angiography.

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Abstract:

Currently, endovascular correction has become the method of choice in most cases of secondary atrial septal defects.

The obvious superiority lies in low trauma, a decrease in the incidence of early complications, atrial flutter and fibrillation, systemic thromboembolism, ischemic stroke, and all-cause mortality.

We present the initial experience of using new occluders for ASD closure.

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12.   Sharifi M, Burks J. Efficacy of clopidogrel in the treatment of post-ASD closure migraines. Catheter Cardiovasc Interv. 2004; 63: 255.

Abstract:

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.

References

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.

https://www.who.int/gho/publications/world_health_statistics/2019/EN_WHS_2019_Main.pdf?ua=1

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.

Abstract:

Introduction: all over the world, the number of patients with peripheral arterial lesions is growing, the progression of the disease leads to the chronic limb-threatening ischemia (CLTI) with an increasement in mortality. To carry out revascularization, it is required to accurately determine the degree and length of lesions of arteries of limbs, with the creation of a «road map» of lesions and the choice of the least affected artery ? the target arterial pathway.

Aim: was to determine the effectiveness of CT angiography in diagnosing lesions of shin arteries in patients with critical lower limb ischemia (CLI) by calculating its sensitivity and specificity in comparison with digital subtraction angiography.

Materials and methods: the study included 26 patients (15 men and 11 women, average age of patients 69,3 ± 10,8 years) with critical lower limb ischemia, against the background of lesions of the femoro-popliteal segment of arteries, class D TASC II. All patients underwent CT angiography on a 64-spiral computed tomography scanner. Obtained data was compared with results of catheter angiography (digital subtraction angiography), used as a reference method.

Results: the sensitivity of CT angiography in determining the degree of lesion (stenosis or occlusion) of leg arteries was 100% and 94%, the specificity was 83% and 96%, respectively. The overall accuracy of CT angiography in the tibial segment was 87% for stenoses and 94% for occlusions. According to results of CTA, massive calcification was detected in 13% of cases from the total number of analyzed arteries. When evaluating these arteries according to DSA data, most of arteries (11 of 12) were occluded, and the length of occlusions in 8 cases was maximum according to the GLASS classification (the length was more than 1/3 of the artery length). The presence of strong correlations between CT angiography and digital angiography on the presence of occlusions, stenoses> 50% and their length was determined.

Conclusions: CT angiography is a highly informative method for diagnosing the degree and length of lesions of shin arteries in patients with critical lower limb ischemia.

References

1.     GBD 2017 Disease and Injury Incidence and Prevalence Collaborators (2018). Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018; 392(10159): 1789-1858.

https://doi.org/10.1016/S0140-6736(18)32279-7

2.     Reinecke H, Unrath, M, Freisinger E, et al. Peripheral arterial disease and critical limb ischaemia: still poor outcomes and lack of guideline adherence. European heart journal. 2015; 36(15), 932-938.