Abstract:

Introduction: the main indicator that determines the prognosis of cancer is the degree of prevalence of tumor process at the time of detection. In terms of the growth of primary morbidity among urological cancers, bladder cancer ranks third, and prostate cancer is second. Treatment of patients in advanced stages is palliative and aimed at improving the quality of life and increasing its duration.

Bleeding from the bladder or prostate in such cases is a life-threatening complication and one of the most common causes of death in advanced cancer.

Aim: was to evaluate the effectiveness of embolization of arteries of the bladder and prostate in cancer patients with bleeding from the lower urinary tract as a preparatory stage for the subsequent specialized therapy of the oncological process.

Materials and methods: from 2019 to August 2021, 38 embolizing interventions were performed in 36 patients with recurrent bleeding from the bladder with ineffective conservative hemostatic therapy. Of these, there were 30 men and 6 women. The average age was 63 ± 2,6 years. All patients at the prehospital stage were diagnosed with pelvic cancer with invasion of the bladder wall without the possibility of radical treatment. Particles with a size of 300-500 µm, embolization coils and fragmentated hemostatic sponge were used for embolization.

Results: immediate angiographic success in the form of stagnation of blood flow through the target arteries was achieved in 100% of operations. In most cases, the relief of macrohematuria was achieved at day 4 (average values of erythrocytes in urine are 3,66 in p/sp). 2 patients (5,6%) underwent a second endovascular intervention during hospitalization due to the many small afferents suppluying the bladder tumor from the a. pudenta interna. Bleeding stopped in these patients by the 8th day of hospital stay. The early postoperative period in 100% of patients was accompanied by mild postembolization syndrome, which was stopped by symptomatic therapy within 24 hours.

Conclusions: endovascular embolization in patients with oncopathology using the superselective technique has shown efficacy in stopping urological oncological bleeding, allows to achieve stable hemostasis in a short time and to continue specific treatment of cancer in patients of the 2nd clinical group.

References

1.     Kaprin AD, Starinskiy VV, Shakhzadova AO. The state of cancer care for the population of Russia in 2019. - M.: MNIOI them. P.A. Herzen - branch of the Federal State Budgetary Institution "National Medical Research Center of Radiology" of the Ministry of Health of Russia. 2020. - ill. – 239 [In Russ].

2.     Schuhrke TD, Barr JW. Intractable bladder hemorrhage: therapeutic angiographic embolization of the hypogastric arteries. J Urol. 1976; 116(4): 523-525.

https://doi.org/10.1016/s0022-5347(17)58892-8

3.     Granov AM, Karelin MI, Tarazov PG. X-ray endovascular surgery in oncourology. Bulletin of roentgenology and radiology. 1996; 1: 35-37 [In Russ].

4.     Taha DE, Shokeir AA, Aboumarzouk OA. Selective embolisation for intractable bladder haemorrhages: A systematic review of the literature. Arab J Urol. 2018; 16(2): 197-205.

https://doi.org/10.1016/j.aju.2018.01.004

5.     Mohan S, Kumar S, Dubey D, et al. Superselective vesical artery embolization in the management of intractable hematuria secondary to hemorrhagic cystitis. World J Urol. 2019; 37(10): 2175 - 2182.

https://doi.org/10.1007/s00345-018-2604-0

6.     Tibilov AM, Baymatov MS, Kulchiev AA, et al. Arterial embolization in the treatment of inoperable bladder tumors complicated by bleeding. Materials of the V Russian Congress of Interventional Cardioangiologists. 2013; 35: 79 [In Russ].

7.     Bilhim T, Pisco JM, Tinto HR, et al. Prostatic arterial supply: anatomic and imaging findings relevant for selective arterial embolization. J. Vasc. Interv. Radiol. 2012; 23 (11): 1403-1415.

https://doi.org/10.1016/j.jvir.2012.07.028

8.     Bilhim T, Pereira JA, Tinto HR, et al. Middle rectal artery: myth or reality? Retrospective study with CT angiography and digital subtraction angiography. Surg Radiol Anat. 2013; 35(6): 517-522.

https://doi.org/10.1007/s00276-012-1068-y

9.     Korkmaz M, Sanal B, Aras B, et al. The short- and long-term effectiveness of transcatheter arterial embolization in patients with intractable hematuria. Diagn Interv Imaging. 2016; 97: 197-201.

https://doi.org/10.1016/j.diii.2015.06.020

10.   Liguori G, Amodeo A, Mucelli FP, et al. Intractable haematuria: long-term results after selective embolization of the internal iliac arteries. BJU Int. 2010; 106: 500-503.

https://doi.org/10.1111/j.1464-410X.2009.09192.x

11.   Karpov VK, Kapranov SA, Shaparov BM, Kamalov AA. Superselective embolization of urinary bladder arteries in the treatment of recurrent gross hematuria in bladder tumors. Urology. 2020; 5: 133-138 [In Russ].

https://doi.org/10.18565/urology.2020.5.133-138

Abstract:

Introduction: vascular closure devices (VCD) for over 20 years have been used as an alternative to manual compression to achieve hemostasis. Despite the fact that clinical efficacy and safety of occlusive type VCD have been confirmed in a number of studies, their use remains controversial due to the formation of complications at the access site when using these devices.

Aim: was to estimate possible advantages and limitations of vascular closure devices of occlusive type (Angio-Seal) in patients, who had underwent percutaneous coronary interventions (PCI) via femoral access in comparison with traditional manual hemostasis.

Material and methods: data of 231 adult patients who underwent therapeutic endovascular procedures in the City Hospital named after M.P. Konchalovsky, Research and Development Center for Preventive Medicine were selected for retrospective research. The main group, with hemostasis after PCI with Angio-Seal (Terumo) obturating device, consisted of 113 patients, control group - included 118 patients with manual hemostasis. Subjective sensations (pain, numbness, etc.), complication rate, hemostasis time, immobilization and hospitalization duration were evaluated.

Results: success of using VCD was 98.23%, complication rate in the main group was 4.37%, in the control group - 6.78% (however, it was not reliable). The time of hemostasis (2.1 min versus 22.25 min), immobilization (3.5 hours versus 20.6 hours) and hospitalization (4 days versus 8 days) significantly decreased, and the patient comfort level was significantly higher in the main group.

Conclusions: the use of Angio-Seal VCD in patients after percutaneous transfemoral therapeutic endovascular procedures is an effective way to reduce hemostasis time in comparison with using of manual compression; allows to reduce patient's immobilization period, significantly increases patient comfort, and reduces patient's hospital stay.

Along with this procedure, it should be considered as an independent surgical intervention and surgeon should follow all necessary rules and stages of its implementation, should control result of hemostasis.

References

1.     Bockeria LA, Alekyan BG. State of endovascular diagnosis and treatment of cardiac and vascular diseases in the Russian Federation (2014). Russian Journal of Endovascular Surgery 2015; 2(1-2):5-20 [In Russ].

2.     Byrne RA, Cassese S, Linhardt M, Kastrati A. Vascular access and closure in coronary angiography and percutaneous intervention. Nat Rev Cardiol. 2013; 10(1):27-40.

3.     Semitko SP, Gubenko IM, Analeev AI, Azarov AV, Maiskov VV, Karpun NA, Iosseliani DG. Vascular complications of percutaneous coronary interventions and clinical results of the use of various devices providing hemostasis. Consilium medicum 2012; 14(10): 51-57 [In Russ].

4.     Dauerman HL, Applegate RJ, Cohen DJ. Vascular closure devices: the second decade. J Am Coll Cardiol. 2007; 50(17):1617-1626.

5.     Biancari F, D’Andrea V, Di Marco C, Savino G, Tiozzo V, Catania A. Meta-analysis of randomized trials on the efficacy of vascular closure devices after diagnostic angiography and angioplasty. Am Heart J. 2010; 159(4): 518-531.

6.     Ndrepepa G, Berger PB, Mehilli J et al. Periprocedural bleeding and 1-year outcome after percutaneous coronary interventions: appropriateness of including bleeding as a component of a quadruple end point. J Am Coll Cardiol 2008; 51:690.

7.     Rao SV, Kedev S. Approaching the post-femoral era for coronary angiography and intervention. JACC Cardiovasc. Interv. 2015; 8: 524–526.

8.     Lo TS et al. Radial artery anomaly and its influence on transradial coronary procedural outcome. Heart 2009; 95(5): 410–415.

9.     Sciahbasi A et al. Transradial approach (left versus right) and procedural times during percutaneous coronary procedures: TALENT study. Am. Heart J. 2011; 161: 172–179.

Abstract

Aim: was to determine the role of radiation and interventional methods of diagnosis and treatment of traumatic pelvic bleeding.

Material and methods: for the period 2016 -2019, we analyzed results of diagnosis and treatment of 37 patients with pelvic injuries, complicated by intra-pelvic bleeding. CT scanning of retroperitoneal pelvic hematoma (RPH) was performed in all cases, results of calculations were compared with the surgical classification of I.Z. Kozlova (1988) on the spread of retroperitoneal hemorrhage and volume of blood loss in pelvic fractures. MSCT-A was performed in 16 (45%) injured. Digital subtraction angiography (DSA) was performed in 10 (27%) cases, of which after MSCT-A – in 4 cases, and as the primary method for the diagnosis of arterial bleeding – in 6 cases.

Results: according to MSCT, the frequency of minor hemorrhages was 18 (50%), medium 16 (43%), large 3 (8%). CT calculation of the volume of small hemorrhages ranged from 92 to 541 cm3, medium – 477-1147 cm3, large –1534 cm3 and more. MSCT-A revealed signs of damage of arteries of the pelvic cavity: extravasation of contrast medium – in 4, cliff and «stop-contrast» – in 1, post-traumatic false aneurysm – in 1, displacement and compression of the vascular bundle – in 4 observations. DSA revealed signs of damage of vessels of the pelvis: extravasation of contrast medium – 3, angiospasm – 2 and occlusion – 2 observations. According to results of angiography, embolization of damaged arteries was performed in 5 observations.

Conclusion: MSCT is a highly sensitive method in assessing the distribution and calculation of RPH volume. The presence of a hematoma volume of more than 50-100 cm3, regardless of the type of pelvic damage, was an indication for MSCT. In patients with stable hemodynamics, DSA was used as a clarifying diagnostic method; in patients with unstable hemodynamics, it was used as the main method for diagnosis and treatment of injuries of pelvic vessels. Damage of pelvic vessels detected by angiography was observed predominantly in unstable pelvic fractures, accompanied by medium and large retroperitoneal pelvic hemorrhages.

References 

1.     Butovskij DI. The role of retroperitoneal hematomas in thanatogenesis in pelvic injuries. Sudmedekspert. 2003; 4: 14-16 [In Russ].

2.     Smolyar AN. Retroperitoneal hemorrhage in pelvic fractures. Hirurgiya. 2009; 8: 48-51 [In Russ].

3.     Fengbiao Wang, Fang Wang. The diagnosis and treatment of traumatic retroperitoneal hematoma. Pakistan Journal of Medical Sciences. 2013 Apr; 29(2): 573-576.

4.     Dorovskih GN. Radiation diagnosis of pelvic fractures, complicated by damage of pelvic organs. Radiologiya-praktika. 2013; 2: 4-15 [In Russ].

5.     Vasil'ev AV, Balickaya NV. Radiation diagnosis of pelvic injuries resulting traffic accidents. Medicinskaya vizualizaciya. 2012; 3: 135-138 [In Russ].

6.     Mahmoud Hussami, Silke Grabherr, Reto A Meuli, Sabine Schmidt. Severe pelvic injury: vascular lesions detected by ante- and post-mortem contrast mediumenhanced CT and associations with pelvic fractures. International Journal of Legal Medicine. 2017; 131: 731-738.

Abstract

Background: pancreatic cancer (PC) - oncologic disease with nonsignificant clinics on early stages and tendention of spreadind in population, as a result - late diagnosis and low rate of radical treatment (10-25%). Carried radical treatment, such as pancreaticoduodenectomy (PDE) - has a high risk of postoperative complications (30-70%) due to its difficulty Most often and dangerous complications are: bleeding, anastomotic leakage, postoperative pancreatitis, purulent complications. Bleeding occurs in 5-10% of cases, mortality varries between 30,7% and 58,5% according to moderd literature. "Sentinel bleeding" - term that meand non-fatal bleeding through drainage or gastrointestinal bleeding (GIB) that follows PDE, and is a predictor of further massive fatal bleeding. Material and methods: article presents data of patient (male, 64y) who underwent gastropancreaticoduodenectomy (GPDE) through bilateral hypochondriacal access as treatment of moderate differentiated (MD) ductal adenocarcinoma of pancreatic head. On 21st day after surgery - massive GIB with source of bleeding as pseudoaneurysm of right hepatic artery Taking into consideration "adverse anatomy", impossibility of stent-graft implantation and failure of primary embolization with "front-to-back-door" technique - against the background of reccurent bleeding, patient undewent coiling of pseudoaneurysm and subseqent coil implantation into right hepatic artery anc common hepatic artery Against the background of second reccurency of GIB - patient underwent successful "front-to-back-door" embolization with combinaton of coils and Onyx.

Results: technique of «front-to-back-door» embolization led to stable hemostasis and patient's discharge in satisfactory condition without recurrence of bleeding.

Conclusions: surgical hospital, carrying on resections of pancreas as a routine, should have a CathLab unit, equipped with wide specter of angiografic instruments and 24/7 surgical team with experience of hemostatic interventions. Bleeding after PDE should be considered as «sentinel bleeding». In case of side-injury of large vessels - stent-graft implantation is preferable, if it is impossible - "front-to-back-door" embolization should be used. 

References

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13.    Patyutko YUI, Kudashkin NE, Kotel'nikov AG. Various types of pancreatodigestive anastomoses in pancreatoduodenal resection. Annaly hirurgicheskoj gepatologii. 2013; 18 (3): 9-14. [In Russ.]

14.    Propp AR. Diagnosis and surgical treatment of chronic pancreatitis with damage to the head of the pancreas. Annaly hirurgicheskoj gepatologii. 2013; 18(1): 103-151.

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Abstract:

Background: the use of vascular closure devices (VCD) reduces the time of hemostasis, accelerates activation and discharge of the patient. Suture-mediated closure devices are closest in it's structure to the traditional surgical method of hemostasis. Advantages and disadvantages of these devices are mainly associated with design features. Stenoses, atherosclerosis, calcification and scars at the site of access are predictors of complications in the use of suturing devices. Although the effectiveness of these devices has been proven in several foreign studies, their data are not sufficient to draw clear conclusions.

Aim: was to evaluate advantages and disadvantages of using the suture-mediated closure devices after PCI.

Material and methods: study enrolled 208 adult patients, who underwent PCI in City Clinical Hospital named after M.P Konchalovsky, Moscow; FSBI «3 Central clinical military hospital n.a. A. A. Vishnevsky» Defense Ministry RF and SMRC preventive medicine of Department of Healthcare. Study group, where hemostasis after PCI was achieved by means of suture-mediated closure devices Perclose Pro Glide (Abbott Vascular), consisted of 90 patients, control group - 118 patients with manual hemostasis. Subjective feelings (pain, numbness, etc.) were assessed using a rating scale. The incidence of complications in the study group was 5.56%, in the control group - 6.78%. The comfort level of patients was higher in the study group

Results of the study: showed that the use of the Perclose device to achieve hemostasis after PC does not increase the frequency of regional vascular complications in compatison with manual hemostasis. But, at the same time, the use of VCD is an effective way to reduce the time of hemostasis, reduces the period of immobilization of the patient, which increases the patient's comfort and reduces patient's hospital stay.

References

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3.      Sheth RA, Walker TG, Saad WE, et al: Quality improvement guidelines for vascular access and closure device use. J Vasc Interv Radiol. 2014; 25: 73-84. http://dx.doi.org/10.1016Zj.jvir.2013.08.011.

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5.      Barbetta I, van den Berg J: Access and hemostasis: femora and popliteal approaches and closure devices — Why, what, when, and how? Semin Interv Radiol 2014; 31:353-360. http://dx.doi.org/10. 1055/s-0034-1393972.

6.      Boschewitz J M, Pieper CC, Andersson M, et al: Efficacy and time-to-hemostasis of antegrade femoral access closure using the exoseal vascular closure device: A retrospective single-center study. Eur J Vasc Endovasc Surg 2014; 48:585-591. http://dx.doi.org/10.1016/ j.ejvs.2014. 08.006.

7.      Gutzeit A, van Schie B, Schoch E, et al: Feasibility and safety of vascular closure devices in an antegrade approach to either the common femoral artery or the superficial femoral artery. 2012; Cardiovasc Intervent Radiol 35:1036-1040. http://dx.doi.org/10.1007/s0 0270012-0454-5.

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10.    Krajcer Z: The preclose technique for AAA repair. Endovasc Today: 2011; 46-54.

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Abstract:

122 cases of gastroesophageal bleeding due to portal hypertension are analyzed in the article. It is shown that transcatheter interventions, as a part of the complex hemostasis strategy, can significantly improve the results. Keeping to algorithms and acting in accordance with protocols developed for any diagnostic procedure or intervention are declared to be crucial to success. The complex approach to profuse bleeding management, that included transcatheter procedures, decreased mortality rate from 72,2% to 22,1% and reduced rebleeding rate from 47,2% to 31,4%. 

Reference

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Abstract:

We present case report of patient, with recurrent pulmonary bleeding of malignant genesis and ineffective previous endoscopic hemostasis. During embolization of bronchial artery, to stop massive life-threatening pulmonary bleeding, transradial approach was used for the first time. Full bleeding control was reached after embolization of right bronchial artery with use of microspheres through microcatheter 2,8 Fr. During hospital stage, recurrence of bleeding was not notices; patient discharged on the 7th day in satisfactory condition.

Duration of procedure and radiation exposure at this patient were comparable with same parameters in case of transfemoral approach. Main advantages of this vascular access are increased comfort of the patient after the procedure and the possibility of early activization. Besides, use of transradial vascular approach provides decreased frequency of complications, that is very important among patients with signs of respiratory insufficiency, because of the inability of these patients to stay in bed within a day. 

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