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:

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: 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:

Article presents a case report of a 38-year-old patient who was admitted to our hospital with symptoms of acute appendicitis, she was examined and then urgently operated.

Postoperative period was complicated by clinical picture of colonic bleeding. During 1 st day of postoperative period, patient underwent a diagnostic search of bleeding source, conservative hemostatic therapy, transfusion of blood components, however, taking into consideration negative dynamics of patient's condition, laboratory test indicators, the next day, she was urgently operated: lower midline laparotomy, suturing of cecum hematoma, drainage of the abdominal cavity. Eight hours after repeated surgical treatment, against the background of transfusion of blood components, further negative dynamics of patient's condition, laboratory test indicators also worsened, medical concilium decided to perform angiography, followed by a decision on the amount of treatment intraoperatively. Selective angiography of branches of the mesenteric artery was performed, the source of bleeding was diagnosed, and a successful temporary pharmacologic endovascular hemostasis of the branch of the superior mesenteric artery was performed. Post-hemorrhagic anemia in the patient was corrected on the 3rd day after endovascular intervention, 10 days after, patient was discharged in a satisfactory condition.

The choice of the method of endovascular intervention was carried out taking into consideration the ineffective of reoperation, patient's condition, as well as peculiarities of the blood supply to the area of the alleged source of bleeding.

The study also discusses indications and methods of endovascular treatment of colonic bleeding.

References

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4.     Tan К К, Wong D, Sim R. Superselective Embolization for Lower Gastrointestinal Hemorrhage: An Institutional Review Over 7 Years. World J Surg. 2008; 32:2707-2715.

http://doi.org/10.1007/s00268-008-9759-6

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7.     Walker TG, Salazar GM, Waltman AC. Angiographic evaluation and management of acute gastrointestinal hemorrhage. World J Gastroenterol. 2012;18 (11): 1191-1201.

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8.     Jang Bl. Lower gastrointestinal bleeding: is urgent colonoscopy necessary for all hematochezia? Clinical Endosc. 2013; 46: 476-479.

9.     Green ВТ, Rockey DC, Portwood G et al. Urgent colonoscopy for evaluation and management of acute lower gastrointestinal hemorrhage: a randomized controlled trial. Am J Gastroenterol. 2005; 100: 2395-2402.

10.   Loffroy R, Falvo N, Nakai M et al. When all else fails - radiological management of severe gastrointestinal bleeding. Best Practice & Research Clinical Gastroenterology. 2019; 1-9.

http://doi.org/10.1016/j.bpg.2019.04.005

11.   Shi Z X, Yang J, Liang H W et al. Emergency transcatheter arterial embolization for massive gastrointestinal arterial hemorrhage. Medicine. 2017; 96(52): 9437.

http://doi.org/10.1097/md.0000000000009437

12.   Nanavati S M. What if endoscopic hemostasis fails? Alternative treatment strategies: interventional radiology. Gastroenterol Clin North Am. 2014;43(4): 739-752.

http://doi.org/10.1016/i.gtc.2014.08.013

Abstract:

Introduction: among patients with ischemic stroke (IS), more than 17% has atrial fibrillation (AF). The active application of aspiration thrombectomy (AT), in addition to thrombolytic therapy (TLT), can significantly improve functional outcome, prognosis and survival of patients with IS. The main method of preventing of IS in patients with nonvalvular AF today is still an anticoagulant therapy, but percutaneous transcatheter occlusion of the left atrium appendage (LAA) can be an alternative method, especially if anticoagulant therapy is contraindicated or ineffective.

Aim: was to demonstrate results of a complex staged treatment of an age-related patient with nonvalvular atrial fibrillation, complicated by the development of cardioembolic ischemic stroke while taking anticoagulants.

Material and methods: a clinical observation of a 81-year-old patient delivered to the hospital with a clinical manifestation of ischemic stroke in the “therapeutic window”, with a history of persistent AF and taking anticoagulants, is presented. After conservative therapy - a regression of neurological symptoms was achieved. Three days after - negative dynamics in the clinical picture with development of aphasia and right-sided hemiplegia. Multispiral computed tomography with contrast (MSCT-A): occlusion of M2 segment of the left middle cerebral artery (MCA). Patient underwent aspiration thrombectomy with complete restoration of blood flow and regression of neurological symptoms. After 2 months from the episode of IS, patient underwent implantation of occlude in the left atrial appendage as a prophylaxis of re-embolism, followed by the abolition of warfarin.

Results: a senile patient returned to normal life and self-care (assessed using the modified Rankin scale 1). During next 13 months patient had no major adverse cardiac events (MACE) or significant bleeding and all that shows that occlusion of LAA is effective.

Conclusions: in the early period of ischemic stroke, isolated aspiration thrombectomy is the operation of choice in patients with atrial fibrillation and contraindication for thrombolytic therapy, and endovascular occlusion of the left atrial appendage can be the method of choice for secondary prevention of ischemic stroke. Further studies are required to assess applicability and reproducibility of the approach we have described in routine clinical practice.

References

1.     Hankey G.J. Stroke. The Lancet. 2017; 389 (10069): 641-654.

https://doi.org/10.1016/S0140-6736(16)30962-X

2.     Feigin V.L., Krishnamurthi R.V., Parmar P., et al; GBD Writing Group; GBD 2013 Stroke Panel Experts Group. Update on the Global Burden of Ischemic and Hemorrhagic Stroke in 1990-2013: The GBD 2013 Study. Neuroepidemiology. 2015; 45 (3):161-76.

https://doi.org/10.1159/000441085

3.     Savello AV, Voznjuk IA, Svistov DV, Babichev KN, Kandyba DV, Shenderov SV, Vlasenko SV, Shlojdo EA, Kachesov JeJu, Esipovich ID, Haritonova TV. Results of treatment of ischemic stroke using intravascular thromboembolectomy in conditions of regional vascular centers in a metropolis (St. Petersburg). Zhurnal nevrologii i psihiatrii im. C.C. Korsakova. 2018; 118 (12-2): 54-63.

https://doi.org/10.17116/jnevro201811812254

4.     Savello AV, Svistov DV, Sorokoumov VA. Endovascular treatments for ischemic stroke: Present status and prospects. Nevrologia, nejropsihiatria, psihosomatika. 2015; 7 (4): 42-49.

https://doi.org/10.14412/2074-2711-2015-4-42-49

5.     Saposnik G., Gladstone D., Raptis R., et al. Investigators of the Registry of the Canadian Stroke Network (RCSN) and the Stroke Outcomes Research Canada (SORCan) Working Group. Atrial fibrillation in ischemic stroke: predicting response to thrombolysis and clinical outcomes. Stroke. 2013; 44 (1): 99-104.

https://doi.org/10.1161/STROKEAHA.112.676551

6.     Lin H.J., Wolf P.A., Kelly-Hayes M., et al. Stroke severity in atrial fibrillation. The Framingham Study. Stroke. 1996; 27 (10): 1760-1764.

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7.     Pistoia F., Sacco S., Tiseo C., et al. The Epidemiology of Atrial Fibrillation and Stroke. Cardiol Clin. 2016; 34 (2): 255-268.

https://doi.org/10.1016/j.ccl.2015.12.002

8.     Aguilar M.I., Hart R., Pearce L.A. Oral anticoagulants versus antiplatelet therapy for preventing stroke in patients with non-valvular atrial fibrillation and no history of stroke or transient ischemic attacks. Cochrane Database Syst Rev. 2007; 18 (3): CD006186.

https://doi.org/10.1002/14651858.CD006186.pub2

9.     Kamel H., Healey J.S. Cardioembolic Stroke. Circ Res. 2017; 120 (3): 514-526.

https://doi.org/10.1161/CIRCRESAHA.116.308407

10.   Go A.S., Hylek E.M, Phillips K.A., et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA. 2001; 285 (18): 2370-2375.

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11.   Demaerschalk B.M., Kleindorfer D.O., Adeoye O.M., et al. American Heart Association Stroke Council and Council on Epidemiology and Prevention. Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke: A Statement for Healthcare Professionals From the American Heart Association/ American Stroke Association. Stroke. 2016; 47 (2): 581-641.

https://doi.org/10.1161/STR.0000000000000086

12.   Powers W.J., Rabinstein A.A., Ackerson T., et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2019; 50 (12): 344-418

https://doi.org/10.1161/STR.0000000000000211

13.   Bajwa R.J., Kovell L., Resar J.R., et al. Left atrial appendage occlusion for stroke prevention in patients with atrial fibrillation. Clin Cardiol. 2017; 40 (10): 825-831.

https://doi.org/10.1002/clc.22764

14.   Kirchhof P., Benussi S., Kotecha D., et al. 2016 ESC Guidelines for the Management of Atrial Fibrillation Developed in Collaboration With EACTS. 2017; 70 (1): 50.

https://doi.org/10.1016/j.rec.2016.11.033 

Abstract

Background: ongoing abdominal and pelvic bleeding is one of main causes of deaths among patients with penetrating and blunt trauma. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a method for temporary patient's stabilization and reducing blood loss.

Aim: was to present result of work of 1st-level trauma-center: to describe experience of application of methodics of REBOA in center, to estimate its efficacy on the base of retrospective analysis of hospital charts of injured and heavy damaged patients.

Materials and methods: during the period between April 2013 and November 2017, 14 REBOA procedures to patients with abdominal (thoracic aorta occlusion) and pelvic (occlusion of the aortic bifurcation) bleeding were performed at the War Surgery Department of the «KirovMilitaryMedicalAcademy». A decision to do REBOA was made upon admission according to significant hypotension (systolic blood pressure [sBP] less than 70 mm Hg.) or cardiac arrest, abdominal free fluid and/or mechanically unstable pelvic fractures.

Results: mean time from admission to REBOA was 27,5 [10,0-52,5] minutes. The procedure took 10 [5-13] minutes. Average BP elevation after balloon inflation was 43±16 mm Hg. Survival in acute phase of trauma (first 12 hours) was 57.1%, while total survival rate was only 14.3% (2/14 patients). One REBOA-associated major complication was registered - development of irreversible ischemia due to long sheath dwell time in the femoral artery.

Conclusion: REBOA is effective for temporary hemodynamic stabilization and internal hemorrhage control, it allows increasing early survival in severe trauma. Factors to improve short- and long-term outcome, total survival warrant to be additionally investigated, especially in terms of intensive care improvement.

References

1.     Stannard A., Eliason J.L., Rasmussen T.E. Resuscitative endovascular balloon occlusion of the aorta (REBOA) as an adjunct for hemorrhagic shock. J. Trauma. 2011; 71(6): 1869-1872.

2.     Barnard E.B.G., Morrison J.J., Madureira R.M. et al. Resuscitative endovascular balloon occlusion of the aorta (REBOA): a population based gap analysis of trauma patients in England and Wales. Emerg. Med. J. 2015; 32 (12): 926-932.

3.     Brenner M.L., Moore L.J., DuBose J.J. et al. A clinical series of resuscitative endovascular balloon occlusion of the aorta for hemorrhage control and resuscitation. J. Trauma Acute Care Surg. 2013; 75 (3): 506-511.

4.     Moore L.J., Brenner M., Kozar R.A. et al. Implementation of resuscitative endovascular balloon occlusion of the aorta as an alternative to resuscitative thoracotomy for resuscitative balloon occlusion of the aorta (REBOA). J. Trauma Acute Care Surg. 2016; 81 (3): 409-419.

5.     Zavrazhnov A.A. Damage of large vessels of the abdomen: ways to improve diagnosis and treatment: Diss. kand. med. Nauk. St.Petersburg. 1996; 201 [In Russ].

6.     Sadeghi M., Nilsson K.F., Larzon T. et al. The use of aortic balloon occlusion in traumatic shock: first report from the ABO trauma registry. Eur. J. Trauma Emerg. Surg. 2018; 44 (4): 491-501.

7.     Hughes C.W. Use of an intra-aortic balloon catheter tamponade for controlling intra-abdominal hemorrhage in man. Surgery. 1954; 36 (1): 65-68.

8.     DuBose J.J., Scalea T.M., Brenner M. et al. The AAST prospective Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) registry: Data on contemporary utilization and outcomes of aortic occlusion and resuscitative balloon occlusion of the aorta (REBOA). J. Trauma Acute Care Surg. 2016; 81 (3): 409-419.

9.     Martinelli T., Thoni F., Declety P. et al. Intra-aortic balloon occlusion to salvage patients with life-threatening hemorrhagic shocks from pelvic fractures. J. Trauma. 2010; 68 (4): 942-948.

10.   Brenner M., Hoehn M., Pasley J. et al. Basic endovascular skills for trauma course: bridging the gap between endovascular techniques and the acute care surgeon. J. Trauma Acute Care Surg. 2014; 77 (2): 286-291.

11.   DuBose J., Fabian T., Bee T. et al. Contemporary utilization of resuscitative thoracotomy: results from the AAST aortic occlusion for resuscitation in trauma and acute care surgery (AORTA) multicenter registry. Shock. 2018; 50 (4): 414-420.

12.   Gumanenko E.K. An objective assessment of the severity of injuries. Voenno-medicinskij zhurnal. 1996; 317 (10): 25-34 [In Russ].

13.   Samokhvalov I.M., Reva V.A., Pronchenko A.A., Agliulin V.F. Comparison of the effectiveness of emergency thoracotomy in wounded and injured. Zdorov'e. Medicinskaja jekologija. Nauka. 2012; 1-2 (47-48): 43 [In Russ].

14.   White J.M., Cannon J.W., Stannard A. et al. Endovascular balloon occlusion of the aorta is superior to resuscitative thoracotomy with aortic clamping in a porcine model of hemorrhagic shock. Surgery. 2011; 150 (3): 400-409.

15.     Ogura T., Lefor A.T., Nakano M. et al. Nonoperative management of hemodynamically unstable abdominal trauma patients with angioembolization and resuscitative endovascular balloon occlusion of the aorta. J. Trauma Acute Care Surg. 2015; 78 (1): 132-135

Abstract:

Background: study presents data of recanalization of occlusions of access vein in patients after pacemaker implantation.

Material and methods: for the period of 2010-2018 a total of 461 patients underwent repeated antiarrhythmic device implantation. In 82(17,8%) patients we found malfunctioning leads. Total venous occlusion was found in 8(10%) cases. Attempt of recanalization was performed in 4 patients, in rest 4 cases recanalization was not performed, because of different reasons, and in 1 case it was unsuccessful.

Results: In 3 cases successful recanalization of venous occlusion and leads reimplantation were performed. In 2 cases - recanalization was performed using a guidewire and in 1 case a dilator for leads extraction was used. 5 patients underwent the contralateral implantation of a completely new system were performed.

Conclusions: recanalization of venous occlusion using a guidewire or a dilator is an effective method of treatment. These techniques allow to save contralateral access for other lifesaving procedures. However, recanalization using a dilator sheath might be associated with greater risk of complications such as perforation of subclavian vein, innominate vein or superior vena cava.

Thus, the choice of one or another strategy of recanalization is associated with technical difficulties and requires specialized tools and special skills of operating surgeon.

References

1.      Stoney W.S., Addlestone R.B., Alford Jr. W.C., Burrus G.R., Frist R.A., Thomas Jr C.S. The incidence of venous thrombosis following long-term transvenous pacing. The Annals of Thoracic Surgery. 1976; 22 (2): 166170.

2.      Mitrovic V., Thormann J., Schlepper M., Neuss H. Thrombotic complications with pacemakers. International Journal of Cardiology. 1983; 2: 363-374.

3.      Basil Abu-El-Haija, MD; Prashant D. Bhave, MD, FHRS; Dwayne N. Campbell, MD, FHRS; Alexander Mazur, MD; Denice M. Hodgson-Zingman, MD, FHRS; Vlad Cotar- lan, MD; Michael C. Giudici, MD, FHRS. Venous Stenosis After Transvenous Lead Placement: A Study of Outcomes and Risk Factors in 212 Consecutive Patients. Journal of the American Heart Association. 2015; 1-6.

4.      Jose M. Marcial, MD, Seth J. Worley, MD, FHRS. Venous System Interventions for Device Implantation. Cardiac Electrophysiology Clinics. 2018; 10: 163-177

5.      Haran Burri. Overcoming the challenge of venous occlusion for lead implantation. Indian pacing and electrophysiology journal. 2015; 15: 110-112.

6.      Lars Lickfett, Alexander Bitzen, Aravind Arepally. Khurram Nasir. Incidence of venous obstruction following insertion of an implantable cardioverter defibrillator. A study of systematic contrast venography on patients presenting for their first elective ICD generator replacement. EP Europace. 2004; 6: 25-31.

7.      Mehrdad Golian, Minh Vo, Amir Ravandi, Colette M. Seifer. Venoplasty of a chronic venous occlusion allowing for cardiac device lead placement: A team approach. Indian pacing and electrophysiology journal. 2016; 6: 197-200.

8.      Marcio GK, MD, MSc, PhD, Ricardo Luiz Lima Andrade, MD, Gustavo Ramalho da Silva, MD, Hanry Barros Souto, MD. ICD Leads Extraction and Clearing of Access Way in a Patient With Superior Vena Cava Syndrome. Medicine. 2015; 38: 1-4.

9.      Maytin M, Epstein LM, Henrikson CA. Lead extraction is preferred for lead revisions and system upgrades: when less is more. Circulation: Arrhythmia and Electrophysiology. 2010; 3(4): 413-424.

10.    Worley SJ, Gohn DC, Pulliam RW. Excimer laser to open refractory subclavian occlusion in 12 consecutive patients. Heart Rhythm. 2010; 7(5): 634-638.

11.    Mathur G, Stables RH, Heaven D, Ingram A., Sutton R. Permanent pacemaker implantation via the femoral vein: an alternative in cases with contraindications to the pectoral approach. EP Europace. 2001; 3: 56-59.

12.    Agosti S, Brunelli C, Bertero G. Biventricular pacemaker implantation via the femoral vein. Journal of Clinical Medicine Research. 2012; 4: 289-291.

13.    Elayi CS, Allen CL, Leung S, Lusher S, Morales GX, Wiisanen M, et al. Inside-out access: a new method of lead placement for patients with central venous occlusions. Heart Rhythm. 2011; 8: 851-857.

14.    Auricchio A, Delnoy PP, Butter C, Brachmann J, Van Erven L, Spitzer S, et al. Feasibility, safety, and short-term outcome of leadless ultrasound-based endocardial left ventricular resynchronization in heart failure patients: results of the wireless stimulation endocardially for CRT (WiSE-CRT) study. Europace. 2014; 16: 681-688.

15.    Reddy VY Exner DV, Cantillon DJ, et al. Percutaneous Implantation of an Entirely Intracardiac Leadless Pacemaker. The New England Journal of Medicine. 2015; 373: 1125—1135.

16.    Worley SJ, Gohn DC, Pulliam RW, et al. Subclavian venoplasty by the implanting physicians in 373 patients over 11 years. Heart Rhythm. 2011; 8(4): 526-533.

17.    Ozyer U, Harman A, Yildirim E, Aytekin C, Karakayali F, Boyvat F. Long-term results of angioplasty and stent placement for treatment of central venous obstruction in 126 hemodialysis patients: a 10-year single-center experience. American Jounnal of Rentgenology 2009; 193(6): 1672-1679. 

Abstract:

Aim: was to assess efficiency of mechanical thrombectomy using stent-retriever pREset in patients with acute ischemic stroke (AIS).

Materials and methods: study included 27 patients with AIS. The average age of patients was 66 years, female - 12(44,4%). The average NIHSS was 20. Occlusion of middle cerebral artery (MCA) was observed in 21(77,8%) patients, internal carotid artery (ICA) - 4 patients, basilar artery - 2 patients.

Results: effective recovery of cerebral blood flow (TICI2b-3) was achieved in 22 patients (81,5%). The frequency of distal embolisms was 11,1%. The frequency of symptom hemorrhagic transformation was 7,4%. A favorable neurological outcome (mRs 0-2) was observed in 29,6% of patients, mortality was 25,9%.

Conclusions: the use of stent-retriever pREset allows to efficiently restore blood flow during occlusion of large cerebral arteries.

References

1.      Powers W., Rabinstein A., Ackerson T., et al. 2018 Guidelines for the early management of patients with acute ischemic stroke a guideline for healthcare professionals from the American heart association/American stroke association. Stroke. 2018; (49): DOI 10.1161/ STR.0000000000000158.

2.      Savello A.V., Voznyuk I.A., Svistov D.V. Vnutrisosudistoe lechenie ishemicheskogo insul'ta v ostrejshem periode (klinicheskie rekomendacii) [Intravascular treatment of ischemic stroke in the acute period (clinical recommendations)]. Sankt-Peterburg. 2015; [In Russ].

3.      Volodyuhin M.YU., Hasanova D.R., Dyomin T.V., i dr. Vnutriarterial'naya reperfuzionnaya terapiya u pacientov s ostrym ishemicheskim insul'tom [Intraarterial reperfusion therapy in patients with acute ischemic stroke.]. Medicinskij sovet. 2015; (10): 6-11 [In Russ].

4.      Krylov V.V., Savello A.V., Volodyuhin M.YU. Rentgenehdovaskulyarnoe lechenie ostrogo ishemicheskogo insul'ta [Endovascular treatment of acute ischemic stroke.]. Rukovodstvo. Moskva. 2017; 120 s [In Russ].

5.      Schwaiger B., Kober F., Gersing A., et al. The pREset stent retriever for endovascular treatment of stroke caused by MCA occlusion: safety and clinical outcome. Clin Neuroradiol. 2016; (26): 47-55.

6.      Machi P., Jourdan F., Ambard D., et. al. Experimental evaluation of stent retrievers mechanical properties and effectiveness. J. Neurolntervent. Surg. 2016; (0): 1-7.

7.      Prothmann S., Schwaiger B., Gersing A., et al. Recanalization of Thrombo-Embolic Ischemic Stroke with pREset (ARTESp): the impact of occlusion time on clinical outcome of directly admitted and transferred patients. J. Neuro. Intervent. Surg. 2017; (9): 817-822.

8.      Shams T., Zaidat O., Yavagal D., et al. Society of Vascular and Interventional Neurology (SVIN) Stroke Interventional Laboratory Consensus (SILC) criteria: A 7M management approach to developing a stroke interventional laboratory in the era of stroke thrombectomy for large vessel occlusions. Intervent. Neurol. 2016; (5): 1-28.

9.      Seker F., Pfaff J., Wolf M., et al. Correlation of thrombectomy maneuver count with recanalization success and clinical outcome in patients with ischemic stroke. Am. J. Neuroradiol. 2017; (38): 1368-1371.

10.    Mokin M., Nagesh S., Ionita C., et al. Comparison of modern stroke thrombectomy approaches using an in vitro cerebrovascular occlusion model. Am. J. Neuroradiol. 2016; (36): 547-551.

11.    Raymond J., Ghostine J., Khoury N., et al. Endovascular interventions for acute stroke: past practice and current research. J. Neurolntervent.Surg. 2017; (9): 1-4.

Abstract:

The article presents analysis of 1500 cases of varicocele endovascular occlusion (EO) in children and adolescents, giving the exhaustive account of varicocele diagnostics and treatment. Standardization of the endovascular procedure was performed, and algorithm proposed for choosing the occlusion technique and embolization agent depending on the lesion anatomy.

The authors specify 5 anatomical varieties of left testicular vein (LTV), each having some particularities in occlusion procedure. For the first time in pediatric practice the Foam-form was used for LTV occlusion against the background of prominent veno-venous reflux, which considered to be one EO contraindications. The causes were specified for false and true varicocele recurrence: the former is shown to occur due to technical imperfections, and the causes of the latter can be LTV lumen recanalization or formation of the bridging collaterals.

EO of LTV is proved to be the effective for recurrent varicocele after conventional surgery in children and adolescents.   

Reference 

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3.     Кондаков В.Т., Пыков М.И., Годлевский Д.Н. Андрологические аспекты хирургического лечения варикоцеле у подростков. Медицина и здравоохранение. 2004;     10.9: 35-39.

4.     Годлевский Д.Н. Сперматогенная функцияяичек и органный кровоток при варикоцеле у детей и подростков. Автореф. канд. мед. наук. М. 2003.

5.     Корзникова И.И. Эндоваскулярная склеротерапия в лечении варикоцеле у детей.Автореф. канд. мед. наук. М. 1988.      12.

6.     Страхов С.Н. Варикозное расширение венгроздевидного сплетения и семенногоканотика. М. 2001.

7.     Лопаткин Н.А., Морозов А.В., Дзеранов Н.К. Трансфеморальная эндоваскулярная облитерация яичковой вены в лечении варикоцеле. Урол. нефрол. 1983; 6: 1-53.

8.     Tauber R., Johnsen N. Antegrade scrotal sclerotherapy for the treatment of varicocele. Technique and late results. J. Urol. 1994; 51 (2): 386-390.

9.     Palomo A., Bernard C.A. A practical resource in the surgical treatment of the scrotalrgans. Rev. Col. Med. Guatem. 1959; 10: 246-247.

10.   Esposito C, VallaJ.S., Najmaldin A. et al. Incidence and management of hydrocele following varicocele surgery in children. J. Urol. 2004; 171 (3): 1271-1273.

11.   Tessari L., Cavezzi A., Frullini A. Preliminary. Еxperience with a new sclerosing foam in the treatment of varicose veins. Dermatol. Surg. 2001; 27 (1): 58-60.

12.   Mali W.P., Oei H.Y., Arndt J.W. et al. Hemodynamics of the varicocele. II. Correlation among the results of renocaval pressure measurements, varicocele scintigraphy and phlebography. Urol. 1986; 135 (3): 489-493.

Abstract:

Aim: was to assess computed tomography angiography (CTA) abilities in analysis of internal carotid artery (ICA) critical atherosclerotic lesions.

Material and method: for the period 2014-2016 - 321 patients underwent examination (ultrasound and CTA of brachiocephalic arteries) prior to surgical treatment of ICA occlusive disease. CTA was made on Philips iCT 256-slice (noncontrast examination, arterial and venous phases), 50 ml on nonionic contrast agent was injected (4-4,5 ml/sec). We distinguished several types of ICA changes: stenosis more than 60% and 70%, critical stenosis, subocclusion (also with distal collapse), local occlusion.

Results: CTitical ICA stenosis was detected in 82 patients (26% of all observed cases); ICA changes with diffuse decrease of upper segments - in 20 cases (6,2% of cases). Among group of decreased diameter we saw subocclusion (18 patients) and local occlusion (2 patients). In the setting of local occlusion ICA contrast-enchanced through atypical ascending pharyngeal artery In patients with diffuse decrease of upper ICA segments all elements of circle of Wills were detected in 70% of cases. During surgery CTA results were confirmed, but atherosclerotic plaque extension was higher than observed at CT approximately at 10 mm.

Conclusion: we can refer critical stenosis, subocclusion and local occlusion to critical atherosclerotic ICA changes. The one should consider CTA limitations in differentiation of upper part of atherosclerotic plaque. In majority of cases decrease in ICA diameter was associated with severe atherosclerotic involvement and not with congenital changes CTA is necessary for preoperative assessment of carotid occlusive disease, especially in critical ICA changes.

References

1.     John J. Ricotta, Ali AbuRahma, Enrico Ascher, Mark Eskandari, Peter Faries and Brajesh K. Lal. Washington, DC; Charleston, WV; Brooklyn, NY; Chicago, Ill; New York, NY; and Baltimore, Md Updated Society for Vascular Surgery guidelines for management of extracranial carotid disease. J Vasc Surg. 2011: Sep; 54(3):1-31.

2.     Nacional'nye rekomendacii po vedeniyu pacientov s zabolevaniyami brahiocefal'nyh arterij [National recommendations on treatment of brachicephalic arteries disease]. Rossijskij soglasitel'nyj dokument. 2013; 72S [ In Russ].

а)  Nacional'nye rekomendacii po vedeniyu pacientov s zabolevaniyami brahiocefal'nyh arterij [National recommendations on treatment of brachicephalic arteries disease] [Elektronnyj resurs]: ros. soglasit. dok. /Ros. o-vo angiologov i sosudistyh hirurgov, Assoc. serdech.-sosudistyh hirurgov Rossii, Ros. nauch. o-vo rentgenehndovaskulyar. hirurgov i intervencion. radiologov, Vseros. nauch. o-vo kardiologov, Assoc. flebologov Rossii ; L. A. Bokeriya, A. V. Pokrovskij, G. YU. Sokurenko [i dr.]. - M., 2013. - 72 s. - Rezhim dostupa: www. url: http://www.angiolsurgery.org /recommendations2013/recommendations_brachio- cephalic.pdf . 03.04.2015 [In Russ].

b)  Nacional'nye rekomendacii po vedeniju pacientov s zabolevanijami brahiocefal'nyh arteriT [National recommendations on treatment of brachicephalic arteries disease]. M.2013 [In Russ].

3.     Johansson E. and A.J. Fox., Carotid Near-Occlusion: A Comprehensive Review, Part 2-Prognosis and Treatment, Pathophysiology, Confusions, and Areas for Improvement. American Journal of Neuroradiology 2016; 37(2):200-204.

4.     Johansson E. and A.J. Fox., Carotid Near-Occlusion: A Comprehensive Review, Part 1- Definition, Terminology, and Diagnosis. American Journal of Neuroradiology Jan 2016; 37(1):2-10.

5.     Vishnyakova M.V., Pronin I.N., Lar'kov R.N., Zagarov S.S. Komp'yuterno-tomograficheskaya angiografiya v planirovanii rekonstruktivnyh operacij na vnutrennih sonnyh arteriyah [CT-angiography in planning of reconstructive operations on internal carotid arteries]. Diagnosticheskaya i intervencionnaya radiologiya. 2016; 10(3):11-19 [In Russ].

6.     Suzie M. El-Saden, Edward G. Grant, Gasser M. Hathout, Peter T. Zimmerman, Stanley N. Cohen, and J. Dennis Baker. Imaging of the internal carotid artery: the dilemma of total versus near total occlusion. Radiology 2001; 221(2):301-308.

7.     Mamedov F.R., Arutyunov N.V., Usachev D. YU, Lukshin V.A., Mel'nikova-Pickhelauri T.V., Fadeeva L.M., Pronin I.N., Kornienko V.N. Sovremennye metody nejrovizualizacii pri stenoziruyushchej i okklyuziruyushchej patologii sonnyh arterij [Modern methods of neurovisualization in stenotic and occlusive pathology of carotid arteries.]. Luchevaya diag nostika i terapiya. 2012; 3(3):109-116 [In Russ].

8.     Vishnyakova M.V. (ml), Pronin I.N., Lar'kov R.N., Vishnyakova M.V.. Detalizaciya okklyuziruyushchego porazheniya vnutrennej sonnoj arterii pri komp'yuternoj tomograficheskoj angiografii dlya planirovaniya rekonstruktivnyh operacij [Detalization of occlusive lesion of internal carotid artery in CT angiography for planning of reconstrutive operations]. Vestnik rentgenologii i radiologii. 2017; 98(2):69-77 [In Russ].

9.     Lippman H.H., Sundt T.M. Jr., Holman C.B.. The poststenotic carotid slim sign: spurious internal carotid hypolasia. Mayo Clin Proc. 1970; 45:762-767.

10.   Fox Allan J., Michael Eliasziw, Peter M. Rothwell, Matthias H. Schmidt, Charles P. Warlow, Henry J.M. Barnett. Identification, Prognosis, and Management of Patients with Carotid Artery Near Occlusion. American Journal of Neuroradiology. Sep 2005; 26(8):2086-2094

11.   Johansson E., Chman K., Wester P.. Symptomatic carotid near-occlusion with full collapse might cause a very high risk of stroke. J Intern Med 2015; 277:615-623.

Abstract:

Aim: was to carry out a comparative evaluation of results of stenting of bifurcation lesions in the segment of coronary chronic total occlusions (CTO) using different methods of percutaneous coronary intervention (PCI).

Materials and methods: present study is based on results of treatment of 146 patients (2010-2013) with coronary artery disease (CAD), who underwent CTO recanalization and had bifurcation with side-branch diameter more than 2mm. After successful recanalization of CTO, patients were randomized into two groups with respect to the used method of stenting: a group with stenting of major vessel and side branch with technique «Mini Crush», and a group with Provisional «Т-stenting» technique. The primary composite endpoint - incidence of major adverse cardiac and cerebrovascular events (MACCE), which includes thrombosis, restenosis, repeated intervention in the target vessel, acute myocardial infarction, stroke and cardiovascular death.

Results: absence of MACCE in the remote period of observation was significantly higher when using and amounted to 87,7% against 63,1% at 12 months after surgery

Conclusions: the use of technique «Mini crush» stenting is more effective (to reduce frequency of post-operative complications, risk of restenosis and repeat intervention in long term) in patients with bifurcation lesions in chronic total occlusion of coronary artery in comparison with using «T-provisional» stenting. 

References 

1.    Popma J., Mauri L., O’Shaughnessy C., et al. Frequency and clinical consequences associated with side branch occlusion during stent implantation using zotarolimus-eluting and paclitaxel-eluting coronary stents. Circ. Cardiovasc. Interv. 2009; 2:133-9.

2.    Colombo A., Moses J., Morice M., et al. The randomized study to evaluate sirolimus-eluting stents implanted in coronary bifurcation lesions. Circ. 2004; 109:1244-9.

3.    Garot P, Lefevre T., Savage M., et al. Nine-month outcome of patients treated by percutaneous coronary interventions for bifurcation lesions in the recent era: a report from the Prevention of Restenosis with Tranilast and its Outcomes (PRESTO) Trial. J. Am. Coll. Cardiol. 2005; 46:606-612.

4.    Nakamura S., Muthusamy T., Bae J., et al. Impact of sirolimus-eluting stent on the outcome of patients with chronic total occlusions: multicenter registry in Asia. J. Am. Coll. Cardiol. 2004; 43:35A.

5.    Werner G., Krack A., Schwarz G., et al. Prevention of lesion recurrence in chronic total coronary occlusions by paclitaxel-eluting stents. J. Am. Coll. Cardiol. 2004; 44: 2301-2306.

6.    Hoye A., Tanabe K., Lemos P, et al. Significant reduction in restenosis after the use of sirolimus-eluting stents in the treatment of chronic total occlusions. J. Am. Coll. Cardiol. 2004; 43: 1954-1958.

7.    Kini A., Lee P, Marmur J., et al. Correlation of post-percutaneous coronary intervention creatine kinase-MB and troponin I elevation in predicting mid-term mortality. Am. J. Cardiol. 2004; 93:18-23.

8.    Osiev A.G., Baystrukov V.I., Biryukov A.V. Taktika endovaskulyarnogo lecheniya pri bifurkacionnom porazhenii posle rekanalizacii khronicheskoy okklyuzii koronarnyh arteriy.[ Endovascular treatment tactics in patients with bifurcation lesions after recanalization of chronic coronary arteries occlusions]. Diagnosticheskaya i intervencionnaya radiologiya. 2013; 7(1): 27-31[In Russ].

9.    Albiero R., Boldi E. Provisional Stenting Technique for Non-Left Main Coronary Bifurcation Lesions: Patient Selection and Technique. Tips and Tricks in Interventional Therapy of Coronary Bifurcation Lesions, 1st ed. By Issam D. Moussa and Antonio Colombo. London: Informa Healthcare. 2010; 48.

10.  Galassi A., Colombo A., Buchbinder M., et al. Long term outcome of bifurcation lesions after implantation of drug-eluting stents with the «Mini-Crush technique». Catheter. Cardiovasc. Interv. 2007; 69:976-83.

11.  Galassi A., Tomasello S., Capodanno D., et al. «Mini Crush» versus «T-provisional» techniques in bifurcation lesions: clinical and angiographic long-term outcome after implantation of drug-eluting stents. J. Am. Coll. Cardiol. Intv. 2009; 2: 185-94.

Abstract:

Purpose. To assess the effectiveness of palliative endovascular interventions in patients with CTO anatomy infavorable for recanalisation.

Material and methods. The authors analyzed the results of interventions in 60 patients (50 male (83,3%), 10 female (16,7%)) aged 38 – 75 years (mean age 53,9±3,2), with occlusive coronary disease. Palliative revascularizations were performed in 30 patients, and CTO recanalization was done in 30 cases. The LV function was assessed echocardiographically in both groups before and after the intervention.

Results. 12 month follow-up showed significant improvement or normalization of LV function in both groups. Results of palliative interventions were shown to be as effective as recanalization of CTO.

Conclusions. Endovascular palliation is effective in treatment of patients with coronary CTO. It results in myocardial function improvement comparable to that in patients with complete coronary revascularization.   

References

1.        Danchin N., Angioi M., Rodriguez R. Angioplasty in chronic coronary occlusion. Arch. Mal. Coeur Vaiss. 1999, 99 (11): 1657–1660.

2.        Meier B. Chronic total coronary acclusion angioplasty. Cathet Cardiovasc. Diagn, 2006; 25: 1–11.

3.        Ганюков В.И., Осиев А.Г. Частные вопросы коронарной ангиопластики. Новосибирск. 2002; 4–23.

4.        Лопотовский П.Ю., Яницкая М.В. Клинический эффект эндоваскулярной реперфузии миокарда в бассейне длительно окклюзированной коронарной артерии. Между народный журнал интервенционной кардиоангиологии. 2006; 10: 22–26.

5.        Султан М.В. Реваскуляризация миокарда при остром коронарном синдроме. Авто-реф. дис. канд. мед. наук. М. 2006: 15–20.  

6.        Иоселиани Д.Г., Громов Д.Г., Сухоруков О.Е., Хоткевич Е.Ю., Семитко С.П., Исаева И.В., Верне Ж.-Ш., Арабаджян И.С., Овесян З.Р., Алигишева З.А. Хирургическая и эндоваскулярная реваскуляризация миокарда у больных с многососудистым поражением венечного русла: сравнительный анализ ближайших и среднеотдаленных результатов. Международный журнал интервенционной кардиоангиологии. 2008; 15: 22–31.

7.        Араблинский А.В. Степень реваскуляризации миокарда с помощью транслюминальной баллонной ангиопластики у больных с многососудистым поражением коронарного русла. Международный медицинский журнал. 2000; 1: 2–6.

8.        Ott R.A., Tobis J.M., Mills T.C., Allen B.J., Dwyer M.L. ECMO assisted angioplasty for cardiomyopathy patients with unstable angina. Department of Cardiothoracic Surgery, University of California. Irvine Medical Center. 2006.  

9.        Gaudino M., Santarelli P., Bruno P., Piancone F.L., Possati G. Palliative coronary artery surgery in patients with severe noncardiac diseases. Department of Cardiac Surgery, Catholic University. Rome. Italy. 2006.  

10.      Гринхальх Т. Основы доказательной медицины. Учебное пособие. М. 2004; 58.  

11.      Петросян Ю.С., Иоселиани Д.Г. О суммарной оценке состояния коронарного русла у больных ишемической болезнью сердца. Кардиология. 1976; 12 (16): 41–46.

12.      Петросян Ю.С., Шахов Б.Е. Коронарное русло у больных с постинфарктной аневризмой левого желудочка сердца. Горький. 1983; 17–37.

13.      Rahimtoola S.H. The hibernating myocardium. Ibid. 1989; 117: 211–221.

Abstract:

According to newest clinical studies, 20%-30% of acute coronary syndrome patients without БТ elevation have nonsignificant coronary artery stenosis

Aim: was to estimate the effectiveness of percutaneous intermittent coronary sinus occlusior (ICSO) in acute coronary syndrome patients without БТ elevation and nonsignificant coronary arteries stenosis.

Materials and methods: results of endovascular treatment of patients with acute coronary syndrome patients without БТ elevation, for the period 09.10.2014-02.02.2015 were analyzed. All patients underwent ICSO for 10-13 minutes until intravenous wedge pressure plateau was achieved.

Results: in the beginning of the intervention all patients had nonsignificant coronary arteries stenosis, peripheral coronary angiospasm and slow flow in left anterior descending arteries (LAD): Т1М1 frame count in LAD (TFCLAD) was 85,9±17,6 frm; distal diameter of LAD (DLAD) was 2,1±0,5 mm; quantitative blush evaluation score in LAD (QuBELAD) was 11,8±1,4. After the ICSO procedure coronary hemodynamic was improved: TFCLAD=59,5±9,8 frm; DLAD=2,5±0,4 mm; QuBELAD= 27,4±2,2; p=0,01).

Conclusion: ICSO procedure led to the both improvement of the antegrade blood flow in LAD anc myocardial blush flow and reduction of the peripheral coronary angiospasm. ICSO procedure significantly improved the electrocardiography and clinical conditions. 

References 

1.    2014 ESC/EACT Guidelines on myocardial revascularization/The Task Force on Myocardial Revascalarization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACT). European Heart Journal. 2014; 35(37): 2541-619.

2.    Moiseenkov G.V., Gajfulin R.A., Barbarash O.L., Berns S.A., Barbarash L.S. «Chistye» koronarnye arterii u bol'nyh ostrym koronarnym sindromom: [«Clean» coronary arteries in patients with acute coronary syndrome]. Mezhdunarodnyj zhurnalintervencionnoj kardioangiologii. 2008;14: 17 [In Russ].

3.    Ong P., Athanasiadis A., Hill S. Vogelsberg H. et al. Coronary Artery Spasm as a Frequent Cause of Acute Coronary Syndrome: The CASPAR (Coronary Artery Spasm in Patients With Acute Coronary Syndrome) Study. JACC. 2008; 52 (7): 528-530.

4.    Antman E.M., Cohen M., Bernink PJ., McCabe C.H., Horacek T., Papuchis G., Mautner B., Corbalan R., Radley D., Braunwald E. The TIMI risk score for unstable angina/non-ST elevation MI: A method for prognostication and therapeutic decision making. JAMA. 2000; 284(7):835-42.

5.    Tang E.W., Wong C.K., Herbison P Global Registry of Acute Coronary Events (GRACE) hospital discharge risk score accurately predicts long-term mortality post acute coronary syndrome. Am. Heart J. 2007 Jan; 153(1): 29-35.

6.    Gibson C.M., Cannon C.P, Daley W.L., et al. TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation. 1995; 93 (5): 879-88.

7.    Porto I., Hamilton-Craig C., Brancati M., Burzotta F., et al. Angiographic assessment of microvascular perfusion-myocardial blush in clinical practice. Am. Heart J. 2010; 160(6):1015-22.

8.    Vogelzang M., Vlaar PJ., Svilaas T. et al. Computer-assisted myocardial blush quantification after percutaneous coronary angioplasty for acute myocardial infarction: a substudy from the TAPAS trial. European Heart Journal. 2009; 30: 594-599.

9.    Van de Hoef T.P, Nolte F., Delewi R. et al. Intracoronary Hemodynamic Effects of Pressure-Controlled Intermittent Coronary Sinus Occlusion (PICSO): Results from the First-In-Man Prepare PICSO Study. Journal of Interventional Cardiology. 2012; 25 (6): 549-556.

10.  Incorvati R.L., Tauberg S.G., Pecora M.G., et all. Clinical applications of coronary sinus retroperfusion during high risk percutaneous transluminal coronary angioplasty. JACC 1993; 22(1):127-34.

11.  Petrov V.I., Nedogoda S.V. «Medicina, osnovannaja na dokazatel'stvah»: Uchebnoe posobie: [Medicine, based on evidence]. Moskva: Gjeotar-Media, 2009; 144 s [In Russ].

12.  Meerbaum S., Lang T.W., Osher J.V., et al. Diastolic retroperfusion of acutely ischemic myocardium. Am. J. Cadiol. 1978; 41:1191-201.

13.  Mohl W., Gangl C., Jusi A., et al. PICSO: from myocardial salvage to tissue regeneration. Cardiovascular Revascularization Medicine. 2015; 16: 36-46.

14.  Valuckien Z., Vasylius T., Unikas R. Left anterior descending coronary artery spasm and «accordion effect» mimicking coronary artery dissection. Medicina. 2014; 50 (5): 309-311.

Abstract:

Aim: was to estimate possibilities of the CT in patients with anomalies of dental system and asymmetric jaws and to offer a protocol analysis of CT data.

Materials and Methods: 100 patients with anomalies of dental system were examined. They were divided into 4 groups:

- 22 patients with II class without asymmetry of jaws (22%)

- 8 patients with II class with the asymmetry of jaws (8%)

- 52 patients with III class without asymmetry of jaws (52%)

- 18 patients with III class with asymmetry of jaws (18%)

At the stage of preoperative planning, computed tomography was performed. CT protocol of jaws symmetry estimation was developed.

Results: with the help of developed СТ protocol, asymmetry of the maxilla was determined in 11 patients (11.0%): 5 patents (5.0%) with II class, 6 patients (6.0%) with III class. The number of patients with signs of asymmetry of the mandible of II class was 9 patients (9.0%), III class — 13 patients (13.0%). Obtained measurements allowed to analyze degree of asymmetry and calculate required excision and moving of jaws. For planning of surgical stage, CT data of all patients was uploaded into special program «Surgicase CMF».

Conclusions: CT gives possibilities to estimate the anatomy of the facial skeleton and its symmetry; that allows to make plan of further orthognathic surgery.  

References 

1.    Posnick J.C. Orthognathic surgery: principles and practice. Elsevier. 2014; 1864 p.

2.    Persin L.S. Ortodontija. Sovremennye metody diagnostiki zubocheljustno-licevyh anomalij [Orthodontics. Modern methods of diagnosis maxillodental-facial anomalies.]. Moskva: OOO «IZPC «Informkniga». 2007; 248 s [In Russ].

3.    Proffit U.R. Sovremennaja ortodontija. Perevod s anglijskogo pod redakciej prof. L.S. Persina[Modern orthodontics. Under editio of prof. L.S. Persina]. M.: Medpress-inform, 2006; S559 [In Russ].

4.    Дробышев А.Ю., Анастассов Г. Основы ортогнатической хирургии. М.: Печатный город, 2007; С 55. Drobyshev A.Ju., Anastassov G. Osnovy ortognaticheskoj hirurgii[Basics of orthognathic surgery]. M.: Pechatnyj gorod, 2007; S55 [In Russ]

5.    Mani V. Surgical correction of facial deformities. JP Medical Ltd, 2010; 290 p.

6.    Ko E.W.C., Huang C.S., Chen YR.J. Characteristics and corrective outcome of face asymmetry by orthognathic surgery. J. Oral. Maxillofac. Surg. 2009; 67: 2201-2209.

7.    Bishara S.E., Burkey PS., Kharouf J.G. Dental and facial asymmetries: A review. Angle Orthod. 1994; 64: 89-98.

8.    Gordina G.S., Glushko A.V., Klipa I.A., Drobyshev A.Ju., Serova N.S., Fominyh E.V. Primenenie dannyh kompjuternoj tomografii v diagnostike i lechenii pacientov s anomalijami zubocheljustnoj sistemy, soprovozhdajushhimisja suzheniem verhnej cheljusti [The use of computed tomography data in the diagnosis and treatment of patients with anomalies of dental system, accompanied by a narrowing maxilla.]. Medicinskaja vizualizacija. 2014; 3: 104-113 [In Russ].

9.    Gateno J., Xia J.J., Teichgraeber J.F. A New ThreeDimensional Cephalometric Analysis for Orthognathic Surgery. J. Oral Maxillofac. Surg. 2012; 69: 606-622.

10.  Kau C. H., Richmond S. Three-dimensional imaging for orthodontics and maxillofacial surgery. Blackwell Publisheng Ltd., 2010; 320 p.

11.  Olszewski R., Zech F., Cosnard G. et al. Threedimensional computed tomography cephalometric craniofacial analysis: experimental validation in vitro. Int. J. Oral Maxillofac. Surg. 2007; 36: 828-833.

12.  Rooppakhun S., Piyasin S., Sitthiseriprati K., Ruangsitt C., Khongkankong W. 3D CT Cephalometric: A Method to Study Cranio-Maxillofacial Deformities. Papers of Technical Meeting on Medical and Biological Engineering. 2006; 6: 75-94, 85-89.

13.&

Abstract:

One of complications of using hemodialysis catheters is stenosis or occlusion of central veins. This may cause dysfunction of an ipsilateral arteriovenous fistula in the future. Despite of high restenosis rate - balloon angioplasty is a method of choice.

Materials and methods: we present a case report of successful recanalization and balloon angioplasty of left brachiocephalic vein in a patient, undergoing chronic hemodialysis with a functioning arteriovenous fistula on left forearm .

Results: the absence of restenosis during a year is an evidence of the effectiveness of this methoc as a treatment of central vein stenosis or occlusion in order to preserve and increase duration of use of permanent vascular access. 

References

1.    Beljaev A.Ju., Kudrjavceva E.S. Rol' vrachej nefrologicheskih i gemodializnyh otdelenij v obespechenii postojannogo sosudistogo dostupa dlja gemodializa[The role of physicians of nephrology and hemodialysis departments in ensuring of permanent vascular access for hemodialysis]. Nefrologija i dializ. 2007; 9(3): 224-227 [In Russ].

2.    Hernandez D., Diaz F., Rufino M., Lorenzo V. et al. Subclavian vascular access stenosis in dialysis patients: natural history and risk factors. J. Am. Soc. Nephrol. 998; 9 (8): 1507-1510.

3.    Cimochowski G.E., Worley E., Rutherford W.E., Sartain J. et al. Superiority of the internal jugular over the subclavian access for temporary dialysis. Nephron. 1990; 54 (2): 154-161.

4.    Barrett N., Spencer S., Mclvor J., Brown E.A. Subclavian stenosis: a major complication of subclavian dialysis catheter. Nephrol Dial Transplant. 1988; 3 (4): 423-425.

5.    Chan M.R., Yevzlin A.S., Asif A. Vascular Access for the General Nephrologist. Nova Science Publishers, Inc (US). 2013; 423.

12.  Scott O. Trerotola. Venous Interventions. Society of Cardiovascular & Interventional Radiology (SCVIR). 1995; 556.

Abstract:

Aim: was to assess dynamics of angiographic parameters of coronary artery rehabilitation, spasm throughout, below chronic coronary occlusion (CCO), after recanalization and balloon angioplasty, with survey of 8-10 weeks, basing on dynamics of anatomical and morphological characteristics of the artery with a major idea to optimize conditions for stenting.

Materials and methods: research analyzes results of two-stage treatment of 26 patients with CCO, complicated by a spasm, by which result after a recanalization of occlusion, was a contrasted artery with diameter less than 1 mm.

In these cases angioplasty with balloons with a diameter up to 3 mm doesn’t yield desirable results and diameter of an artery below a place of occlusion averaged 1,5 mm, and the difference of diameters of proximal and distally department averages 1,78 mm that is an adverse factor for stenting as is followed by high level of restenosis and thrombosis.

Results: within 4-8 weeks (on average 68 days) all arteries remained passable with equal contours, without angiographic signs of dissection, which took place right after balloon angioplasty Diameter of an artery increased with 1,5 mm to 2,64 mm; a difference of diameters of proximal and distally departments of an artery at the level of CCO decreased from 1,78 mm to 0,45 mm that was a favorable condition for stenting.

Conclusion: within 4-8 weeks after recanalization under normal pressure and blood flow occurs a readaptation of artery, expressed in a significant increase in the diameter of the artery below the CCO, which contributes to the optimization of stenting.

References

1.    Morino Y, Kimura T., Hayashi Y, Muramatsu T., Ochiai M., Noguchi Y, Kato K., Shibata Y, Hiasa Y, Doi O., Yamashita T., Morimoto T., Abe M., Hinohara T., Mitsudo K.; J-CTO Registry Investigators. In-hospital outcomes of contemporary percutaneous coronary intervention in patients with chronic total occlusion insights from the J-CTO Registry (Multicenter CTO Registry in Japan). JACC Cardiovasc Interv. 2010 Feb;3(2): pp. 143-51.

2.    Buller C.E., Dzavik V., Carere R.G., Mancini G.B., Barbeau G., Lazzam C., Anderson T.J., Knudtson M.L., Marquis J.F., Suzuki T., Cohen E.A., Fox R.S., Teo K.K. Primary stenting versus balloon angioplasty in occluded coronary arteries: the Total Occlusion Study of Canada (TOSCA). Circulation. 1999 Jul 20;100(3): pp. 236-242.

3.    Gould K.L. Coronary collateral function assessed by PET. In: « coronary artery stenosis and reversing atherosclerosis», Ed. By Gould KL,2-nd edition, New York, NY: Oxford University Press, 1999; pp. 275-282.

4.    Pixmeo company. Dr. Antoine Rosset, Prof. Osman Ratib and Joris Heuberger ( Geneva, Switzerland ), 2004;

5.    Okabe T., Mintz G.S., Buch A.N., Roy P, Hong YJ., Smith K.A., Torguson R., Gevorkian N., Xue Z., Satler L.F., Kent K.M., Pichard A.D., Weissman N.J., Waksman R. Intravascular ultrasound parameters associated with stent thrombosis after drug-eluting stent deployment. Am. J. Cardiol. 2007 Aug 15;100(4):615-20. Epub 2007 Jun 29.

6.    Costa M.A,, Angiolillo D.J., Tannenbaum M., Driesman M., Chu A., Patterson J., Kuehl W., Battaglia J., Dabbons S., Shamoon F., Flieshman B., Niederman A., Bass T.A.; STLLR Investigators. Impact of stent deployment procedural factors on long-term effectiveness and safety of sirolimus-eluting stents (final results of the multicenter prospective STLLR trial). Am. J. Cardiol. 2008 Jun 15; 101 (12): 1704-11. doi: 10.1016/j.amjcard.2008.02. 053. Epub 2008 Apr 9.

7.    Hong M.K., Mintz G.S., Lee C.W., Park D.W., Choi B.R., Park K.H., Kim YH., Cheong S.S., Song J.K., Kim J.J., Park S.W., Park S.J. Intravascular ultrasound predictors of angiographic restenosis after sirolimus-eluting stent implantation. Eur. Heart J. 2006 Jun;27(11):1305-10.

8.    Werner G.S., Jandt E., Krack A., Schwarz G., Mutschke O., Kuethe F., Ferrari M., Figulla H.R. Growth factors in the collateral circulation of chronic total coronary occlusions: relation to duration of occlusion and collateral function. Circulation Oct. 2004; 110(14): pp. 1940-1945.

9.    Sakurai R.L., Ako J., Morino Y, Sonoda S., Kaneda G., Terashima M., Hassan A.H., Leon M.B., Moses J.W.. Popma J.J., Bonneau H.N., Yock PG., Fitzgerald PJ., Honda Y. Predictors of edge stenosis following sirolimus-eluting stent deployment (a quantitative intravascular ultrasound analysis from the SIRIUS trial). SIRIUS Trial Investigators. Am. J. Cardiol. 2005 Nov 1;96(9):1251-3. Epub 2005 Sep 6.

10.  Cosby R.S., Giddings J.A., See J.R. Coronary collateral circulation. Chest Jul. 1974; 66(1): pp. 27-31.

11.  Kathryn Maiellaro, W. Robert Taylor. The role of the adventitia in vascular inflammation. Cardiovascular Research 2007 Sep 1;75(4): pp. 640-8.

Abstract:

Case report is devoted to atypical recanalization of chronic occlusions of the common iliac artery Today, there are several ways for recanalization of chronic occlusions of arteries of lower limbs. Recanalization is known to be the major point of endovascular procedures. The success of endovascular surgery at recanalization depends mainly on 2 factors. One of the most important factors is the choice of access. Another factor is the choise of recanalization method . In case of rare failures - performing open surgery.

Refrrences 

1.    Pokrovsky A.V. and other. Russian consensus. Recommended standards for the evaluation of patients with chronic lower limb ischemia. M. 2001; 16 [In Russ].

2.    Koshkin V.M. Outpatient treatment of atherosclerotic lesions of lower extremities. Angiology and Vascular Surgery. 1999; 1: 106-113 [In Russ].

3.    Saket R.R. et al. Novel intravaskular ultrasound-guided method to create transintimal arterial communications: initial experience in peripheral occlusive disease and aortic dissection. J.Endovasc. Ther. 2004; 11 (3): 274-280.

4.    Troickij A.V., Behtev A.G., Habazov R.I., Beljakov G.A., Lysenko E.R., Kolodiev G.P. Gibridnaja hirurgija pri mnogojetazhnyh ateroskleroticheskih porazhenijah arterij aorto-podvzdoshnogo i bedrenno-podkolennogo segmentov. Diagnosticheskaja i intervencionnaja radiologija. 2012; 6(4): 67-77 [In Russ].

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Abstract:

Aim: was to estimate the efficiency and safety of stenting of subtotal stenosis of internal carotid artery

Materials and methods: we analyzed data of 31 patients who underwent stenting of subtotal stenosis of internal carotid artery. Middle age was 68,2±6,9 yrs. Research included 23 males (74,2%). 28 patients (90,3%) had ischemic stroke or transient ischemic attack in anamnesis. Asymptomatic patients (9,7%) in the pre-operative stage underwent single-photon emission computed tomography of the brain, which revealed the presence of subtotal stenosis of internal carotid artery complicated with ishemia. Stenting of internal carotid arteries were made with the help of embolic protection devices in all cases (100%), in 90,3% - with additional proximal protection. In 100% - predilatation of critical stenosis zones were performed. Two patients (6,4%) underwent simultaneous stenting of internal carotid artery and vertebral artery in 1 patient (3,2%) - stenting of internal carotid artery and subclavian artery The operative time was equal to the average 32,6±8,7 minutes. The results of endovascular interventions were assessed by the presence / absence of neurological symptoms during hospitalization and in the late postoperative period. Stent patency and the presence / absence of restenosis were determined by ultrasound, selective angiography of the brachiocephalic arteries. Before discharge in asymptomatic patients evaluated cerebral perfusion using single photon emission computed tomography

Results: successful stenting of subtotal stenosis of the internal carotid artery with blood flow restoration (TICI-3) achieved in 100% of cases. According to the single-photon emission computed tomography of the brain, performed before discharge in asymptomatic patients (9.7%) noted improvement in cerebral blood flow. During the observation period, which amounted to 11,6 ± 3,1 months, the new transient ischemic attacks or ischemic strokes were not observed, no deaths. According to the ultrasonic examination - stents in the internal carotid arteries are passable, with no signs of restenosis.

Conclusion: stenting of critical subtotal stenosis of the internal carotid artery is effective and safe. Application of the proximal cerebral protection can reduce the potential risk of embolism during stenting of subtotal stenosis of the internal carotid artery as it provides protection at all stages of the procedure. It is necessary to conduct large randomized studies to confirm the clinical efficacy and determine the indications for this kind of intervention in these group of patients. 

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7.    Gonzalez A., Gil-Peralta A., Mayol А. et al. Internal carotid artery stenting in patients with near occlusion: 30-day and long-term outcome. AJNR Am.J. Neuroradiol. 2011;32:252-258.

8.    Fox A.J., Eliasziw M., Rothwell P.M. Identification, prognosis, and management of patients with carotid artery near occlusion. AJNR Am.J.Neuroradiol. 2005;26:2086-2094.

9.    North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N.Engl.J.Med. 1991; 325:445-453.

10.  Rothwell P.M., Gutnikov S.A., Warlow C.P., The European Carotid Surgery Trialists’ Collaboration. Reanalysis of the final results of the European Carotid Surgery Trial. Stroke. 2003;34:514-523.

11.  Berman S.S., Bernhard V.M., Erly W.K. et al. Critical carotid artery stenosis: diagnosis, timing of surgery, and outcome. J.Vasc.Surg. 1994;20:499-510. Samson R.H., Showalter D.P., Yunis J.P. et al. Color

12.  flow scan diagnosis of the carotid string sign may prevent unnecessary surgery. Cardiovasc.Surg. 1999; 7:236-241.

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14.  Barnett H.J., Meldrum H.E., Eliasziw M., North American Symptomatic Carotid Endarterectomy Trial (NASCET) collaborators. The appropriate use of carotid endarterectomy. CMAJ. 2002;166: 1169-1179.

15.  Pappas J.N. The angiographic string sign. Radiology. 2002; 222: 237-238.

16.  Giannoukas A.D., Labropoulos N., Smith F.C.T. et al. Management of the near total internal carotid artery occlusion. Eur.J.Vasc.Endovasc. Surg. 2005; 29: 250-255.

17.  O’Leary D.H., Mattle H., Potter J.E. Atheromatous pseudo-occlusion of the internal carotid artery. Stroke. 1989; 20:1168 1173.

18.  Houser O.W., Sundt T.M., Holman C.B. et al. Atheromatous disease of the carotid artery. Neurosurg. 1974;41:321-331.

19.  Heros R.C., Sekhar L.N. Diagnostic and therapeutic alternatives in patients with symptomatic «carotid occlusion» referred for extracranial-intracranial bypass surgery. J.Neurosurg. 1981; 54:790-796.

20.  Sekhar L.N., Heros R.C., Lotz P.R. et al. A

Abstract:

Cardiovascular diseases of atherosclerotic genesis are one of the most actual problems of modern medicine. The purpose was to estimate the efficiency of interventional radiology treatment of stenosis and occlusions of arteria iliaca interna et externa (lat.) with self-extracting sten Jaguar SM

95 patients aged 44-79 years (71 male and 34 female) were included into experiment: during the period of 2005-2007 they were underwent nterventional radiology treatment of occlusion-stenosis arteria iliaca defeat. All patients in group had atherosclerotic genesis of disease Minimal length of stenosis was 10 mm, the longest stenosis - 90 mm

All the stenosis were estimated due to TASC II. 10 patients had stenosis type A$ 39 patients - type D, 36 patients - type C, and 10 patients - type D. Endovascular recanalization failed in 5 cases of type D stenosis, and these patients were sent for traditional surgical treatment n 1 case a complication occurred - artery perforation during pre-dilatation, and such problem demanded implantation of stent-graft Afterimplantation balloon dilatation was performed in 95% cases. All patients had angiographycally confirmed restored blood flow. Clinica estimation and angiographycal inspection were spent within 2 years. The inspection in 30 days showed the efficiency 100% in case of stenotic defeat and 80% in case of occlusion defeat. The success rate in 12 month was 87%, in 2 years - 82%.
 

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25.  Harnek J. et al. Insertion of self-expandable nitinol stents without previous balloon angioplasty reduces restenosis compared with PTA prior to stenting. Cardiovasc. Intervent. Radiol. 2002; 25 (5): 430-436.

Abstract:

Aim: was to determine indications for various methods of stenting on the base of conducted earlier interventions on bifurcation lesions after previously coronary artery occlusion.

Methods. In NRICP we studied a group of patients who underwent PCI for occluded arteries since 2009 to 2011. The study included patients with chronic total occlusion and bifurcation lesion with a diameter of side brunch more than 2 mm and stenosis >50%. Patients were divided into two groups (proximal and distal lesions) with respect of the proximal cap occlusion to the bifurcation. The primary end point was the emergence of MACE during the hospital period, including death, myocardial infarction, or repeat revascularization of the target vessel. Immediate angiographic success was considered in the case of blood flow TIMI II-III after stenting and residual stenosis of less than 50%.

Results. For the period of 2009-2011 PCI was performed. 307 patients were included in the study. The group of proximal lesions included 148 cases. The group of distal lesions consisted of 159 patients. Immediate angiographic success was observed in 98.3% of cases. Deaths, myocardial infarction, cerebrovascular accident, re-PCI, CABG during the hospital period were not noted.

Conclusion. Bifurcation lesions occure in 57,9% of cases after recanalization of chronic occlusions. In both groups one stent technique dominated, but in a group of proximal lesions two stents technique was used 5,8 times more often than in the distal lesions group. In both groups, MACE in hospital period were not noted.

References 

1.    Nakamura S., Muthusamy T.S., Bae J.H., Cahyadi Y.H., Udayachalerm W., Tresukosol D. Impact of sirolimus-eluting stent on the outcome of patients6. with chronic total occlusions. Am. J. Cardiol. 2005; 95: 161-166.

2.    Werner G.S., Krack A., Schwarz G., Prochnau D., Betge S., Figulla HR. Prevention of lesion recurrence in chronic total coronary occlusions by paclitaxel-eluting stents. J. Am. Coll. Cardiol. 2004; 44: 2301-2306.

3.    Valent R.I., Migliorini A., Signorini U., Vergara R., Parodi G., Carrabba N., et al. Impact of complete revascularization with percutaneous coronary intervention on survival in patients with at least one chronic total occlusion. Eur. Heart. J.2008; 29: 2336-2342.

4.    Kahn J.K. Angiographic suitability for catheter revascularization of total coronary occlusions in patients from a community hospital setting. Am. Heart J. 1993; 126: 561-4.

5.    Christofferson R.D., Lehmann K.G., Martin G.V. et al. Effect of chronic total coronary occlusions on treatment strategy. Am. J. Cardiol. 2005; 95: 1088-91.

6.    Garot P., Lefevre T., Savage M., Louvard Y., Bamlet W.R., Willerson J.T., Morice M.C., Holmes D.R. Jr. Nine-month outcome of patients treated by percutaneous coronary interventions for bifurcation lesions in the recent era: a report from the Prevention of Restenosis with Tranilast and its Outcomes(PRESTO) trial. J. Am Coll. Cardiol. 2005; 46: 606-12.

7.    Colombo A., Moses J.W., Morice M.C., Ludwig J., Holmes D.R. Jr., Spanos V., Louvard Y., Desmedt B., Di Mario C., Leon M.B. Randomized study to evaluate sirolimus-eluting stents implanted at coronary bifurcation lesions. Circulation. 2004; 109:1244-9.

8.    Sharma SK., Sweeny J., Kini A.S. Coronary bifurcation lesions: a current update. Cardiol. Clin. 2010;28:.55-70

9.    Alfredo R. Galassi. Galassi’s Tips & Tricks. Second edition published in Republic of San Marino by Alpha s.r.l. 2010;.275

Abstract:

Pulmonary arteriovenosus aneurisms are rare congenital disorders. There are few scientific data about endovascular corrections. The aim of our study was to estimate possibilities and efficiency of endovascular occlusion with AZUR Peripheral Hydrocoil (TERUMO). Article describes methodics and results of endovascular correction on the base of case report.

References 

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2.    Modaghegh M.-H.S., Kazemzadeh G.H., Jokar M.H. A case of Behcet disease with pulmonary artery pseudoaneurysm: long term follow-up еastern. Mediterranean Health. J. Vol. 2010; 16 (3): 346-349.

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5.    Tzilalis А. et al. Use of an аmplatzer vascular plug in embolization of a pulmonary artery aneurysm in a case of Hughes-Stovin syndrome. A case report. J. of Medical Case Reports. 2011; 5: 425.

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7.    Peter Corr Pulmonary Artery Aneurysm as a Cause of Massive Hemoptysis. Diagnosis and Management Case Reports  in Radiology Volume. 2011; 141563: 2.

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Abstract:

Aim. Was to estimate the role of transcutaneous interventions under the supervision of radiodiagnostics in the maintenance of all mini-nvasive kinds of operation stages of surgical treatment in patients with pancreatic and duodenal zone tumors

Materials and methods. For the period from January 2007 till march 2010, 21 patients, aged 49-75 (10 men, 11 women) - were under aparoscopic pancreaticoduodenectomy (LPDE)

Results. The use bile ducts drainage systems before LPDE in 95% cases leads to small hemorrhage (less than 1 liter). The presence of cholangiostomy also leads to early diagnostics of biliodigistive anastamosis (BDA) stenosis, and makes bile peritonitis – impossible.

Conclusion. Usage of non-vascular methods of interventional radiology allows to make effective and less traumatic biliar decompression in patients with biliopancreatic and duodenal zone tumors as a stage of LPDE preparations. The presence of decompression cholangiostomy prevents further BDA inconsistency, and makes pacreaticojejunoanastamosis healing faster in case of its' decompression.

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Abstract:

Purpose: to prove the safety and efficiency of minimally invasive endovascular and puncture techniques in management of splen diseases in children.

Aims: to develop standard procedures and justify the necessity of splenic artery embolization (SAE) in hemangiomas, extrahepatic portal hypertension, and idiopathic thrombocytopenic purpura (ITP). Develop standard procedures for splenic cysts treatment in pediatric practice.

Materials and methods: there were 129 children aged 3-16 years treated in Endovascular Surgery Department of Russian State Pediatric Hospital (Moscow) with the following diagnoses: hemangiomas (4 patients), hereditary hemolytic globular-cell anemia - HHGCA (41 cases), extrahepatic portal hypertension - EHPG (25 cases), ITP (24 cases), and nonparasitic cysts (35 patients).

Results: SAE is shown to be effective in treatment the diseases where splenic hyperfunctioning is seen. In HHGCA and ITP no hemolytic crises were seen, and there was no need of substitution therapy after performing the SAE procedure. In cases of EHPG splenic artery embolization is proved to reduce the esophageal varices and decrease hypersplenia symptoms. Among the advantages of endovascular approach can be named minimal operation trauma and splenic tissue preservation. The authors present an algorithm for splenic cysts treatment in pediatric practice. It was shown that laparoscopy is effective in big (over 70-80 mm) subcapsular cysts, whereas intraparenchymatous cysts fewer than 70 mm in diameter are more suitable for puncture techniques.

Conclusions: the minimally invasive techniques are shown to be safe and effective in management of splen diseases in pediatric practice. It was shown that their effectiveness is comparable to the conventional methods, meanwhile they cause much less operation trauma, reduce the hospital stay and terms of rehabilitation.

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5.    Григорьева Е.Г., Апарицина К.А.  Органосохраняющая хирургия селезенки.  Новосибирск. 2001; 23-78.

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Abstract:

This case report is about endovascular treatment of pulmonary arteriovenous malformations accompanied by severe arterial hypoxemia in the newborn. The peculiarity of this case is the extreme rarity of manifestation and successful treatment of the pathology in infancy The second feature was the use of vascular occlude devices. Currently due to the sporadic clinical observations in newborn, we consider to appropriate description of this case, focusing on the technical aspects of the intervention. 

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Abstract:

This study was aimed to show effectiveness of endovascular procedures in patients with critical lower limb ischemia (CLI), caused by lesions of iliac and femoral-popliteal-tibial segment's of arteries.

Materials and methods: study includes results of treatment of 68 patients, who underwent endovascular procedures.

Results: primary technical success in group with A, B, C TASC II aortoiliac lesions was 100%, with D TASC II aortoiliac lesions was 91,7%. In group with infrainguinal lesions overall primary technical success was 91,9%. Regression of ischemia was marked in all patients. The average growth of the ankle-brachial index (ABI) was 0,3. During one year of follow-up period, 3 major amputations were performed (5,8% of follow-up patients) in group of interventions of shin arteries with one recanalized tibial artery Salvation of lower limbs was 94,2% without CLI signs reccurence.

Conclusion: endovascular interventions are effective, minimally invasive treatment for CLI. Endovascular procedures such as angioplasty with or without stenting showld be seen as a treatment of choise in patients with CLI for limb salvage.

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