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: сarotid chemodectoma is a benign, slowly growing, vascularized tumor that is one of the most common paragangliomas of head and neck. It is localized in the area of anterior surface of neck - in the area of carotid artery bifurcation. Despite the relative knowledge of the disease, surgical treatment of patients with these newgroth is difficult due to development of intraoperative hemorrhagic complications.

Aim: was to assess possibilities of primary embolization in the complex treatment of patients with chemodectoma.

Materials and methods: 70-year-old female patient was examined and treated. She was admitted with complaints on painless, pulsating, gradually progressive newgrowth of neck. After examination, carotid chemodectoma was diagnosed. The first stage was selective embolization of branches of the external carotid artery (ECA) feeding the tumor. Open chemodectomectomy was performed three days after embolization.

Results: analysis of literature sources and our case report showed that the volume of blood loss during an open operation for removal of chemodectoma using previous embolization is insignificant. This aspect also leads to a reduction of time of the intervention.

Conclusions: preoperative chemodectoma embolization significantly reduces the volume of blood loss and reduces the risk of developing other complications.

References

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Abstract:

Background and aim: in Russian Federation, more than 10 million people suffer from peripheral artery disease (PAD), and from chronic limb-threatening ischemia (CLTI) as one of it’s complications. According to Russian guidelines on treatment of patients with CLTI, the initial diagnosis should include measurement of ankle-brachial and finger-brachial indices (ABI, ТВ I), as well as ultrasound duplex scanning (USDS) - however, the sensitivity and diagnostic accuracy of these methods are often insufficient. In this review, we have summarized the entire range of modern instrumental methods for early and effective diagnosis of critical lower limb-threatening ischemia and for the evaluation of limb perfusion.

Materials and methods: 31 sources of domestic and foreign literature published in last 5 years on the issue of modern possibilities for early precision diagnosis of critical limb-threatening ischemia were examined.

Results and conclusions: AHA Experts recommend some experimental technologies for evaluating lower limb perfusion, including angiography with indigocarmine, perfusion computed tomography (CT perfusion), magnetic resonance imaging (MRI), contrast echography, and hyperspectral imaging. Among other things, implantable bio-sensors can be identified: for example, oxygen-platform LuMee, which works in real time and provides continuous monitoring of oxygen levels in tissues. New technologies allow us to improve the accuracy of diagnosis and quality of treatment of patients with CLTI. It is worth considering switching from traditional methods to more modern ones, which can significantly reduce the frequency of amputations and the risk of disability and improve the quality of life of our patients.

References

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Abstract

The phenomenon of unrecovered coronary blood flow, or the «no-reflow» phenomenon, is the most formidable and insufficiently studied example of clinical failures after percutaneous coronary intervention (PCI) and is manifested as the absence of filling of distal coronary arteries. As a result, endovascular treatment may be completely unsuccessful or may be complicated by delayed recovery, the development of systolic dysfunction, the formation of heart aneurysm and other serious problems. Many experimental and clinical studies have been devoted to «no-reflow», but the evidence for this or that way of influencing the appearance of this phenomenon is very ambiguous. This article presents modern aspects related to risk factors, pathophysiology and methods for diagnosing this complication, as well as an analysis of methods for the prevention and correction of the developed «no-reflow» phenomenon.

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Abstract:

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

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