Endovascular Methods Research Articles

Recurrent varicocele

Varicocele is one of the most common problems in modern reproductive medicine. The incidence of varicocele in the structure of the general male population is 15%, 40% of which have problems with fertility. Among the causes of male infertility, varicocele ranks second after idiopathic, thus being the most common curable cause of male infertility. While researching the pathophysiological mechanisms of infertility in varicocele, the question of the reasons for the varicocele relapses, both after surgical and endovascular methods of treatment remains open, as well as the tactics of managing such patients. The review aimed to systematize knowledge about the problem of recurrent varicocele, to analyze the frequency and etiology of relapses after various methods of primary treatment, as well as to select the optimal diagnostic and treatment option for varicocele recurrence.

Management of Coincident Pituitary Macroadenoma and Cavernous Carotid Aneurysm: A Systematic Literature Review

Introduction Pituitary adenomas are a common intracranial pathology with an incidence of 15 to 20% in the population while cerebral aneurysms are less common with a prevalence of 1:50 patients. The incidence of aneurysms in patients with pituitary adenoma has been estimated at 2.3 to 5.4% of patients; however, this remains unclear. Equally, the management of concomitant lesions lacks significant understanding. Methods A case report is presented of a concomitant cerebral aneurysm and pituitary adenoma managed by minimally invasive endovascular and endoscopic methods, respectively. A systematic review of the literature for terms “pituitary adenoma” and “aneurysm” yielded 494 studies that were narrowed to 19 relevant articles. Results We report a case of a 67-year-old patient with an enlarging pituitary macroadenoma, cavernous carotid aneurysm, and unilateral carotid occlusion. After successful treatment of the aneurysm by a pipeline flow diverter, the pituitary adenoma was surgically resected by an endoscopic transsphenoidal approach. Conclusion The use of a pipeline flow diverter and endonasal approach was feasible in the treatment of our patient. This is the first report to our knowledge of the use of pipeline flow diversion in the management of a cavernous carotid aneurysm prior to pituitary adenoma treatment.

A prospective randomized feasibility trial comparing angiography and angiography with intravascular ultrasound for treatment of hemodialysis access failures.

Hemodialysis accesses suffer from limited primary patency requiring frequent interventions, revisions, or even abandonment. Prolongation of access life and usability with minimization of these adverse events is paramount. Endovascular methods are established first-line interventions for failing arteriovenous access and treatment of venous outflow stenoses. The Primary goal of this feasibility study was to evaluate intravascular ultrasound (IVUS) during interventional treatments on outcomes in those undergoing angiography for failing hemodialysis access. Secondary goals were to determine differences between IVUS and angiography on vessel and lesion characteristics and impact on treatment. In this prospective, randomized controlled trial, patients scheduled for angiography to evaluate and treat a failing hemodialysis access were randomized to use of angiography (DSA) alone or angiography plus IVUS (DSA + IVUS). Patients were treated by a standardized protocol and seen in follow-up at 2weeks, and every 3months for 2 years or until a study endpoint was reached. Measurement of vessel diameters, % stenosis, lesion length, and study endpoints (AV access thrombosis, re-intervention, or surgical revision) were recorded. A total of 55 subjects were enrolled, 27 in the DSA cohort and 28 in the DSA + IVUS cohort. There were 41 treated lesions in each group. Freedom from the composite endpoint of AV access thrombosis or re-intervention was 46.3% in the DSA cohort and 61.0% in the DSA + IVUS cohort (p = 0.27). Diameter measurements matched between the two imaging modalities only 9 times out of 41 total comparison measures. In pre-treatment lesions with >80% stenosis, IVUS had a greater tendency than DSA to underestimate the severity of stenosis, whereas in pre-treatment lesions with 50-80% stenosis, DSA was more likely than IVUS to underestimate the severity of stenosis. Post-treatment % stenosis had mean difference of -7.5% between DSA versus DSA + IVUS cohorts. In five lesions with <30% stenosis measured by angiogram, IVUS led to treatment escalation. In the interventional treatment of failing angioaccess, IVUS and angiography differ in the vast majority of cases in measurement of vessel diameter. A significant number of patients were found to have suboptimal therapeutic response by IVUS only, which led to an escalation in treatment, and in over one-third of cases, the IVUS results led to a change in treatment plan. The improved patency rates in the IVUS group was not statistically significant in this small population but should be further investigated in a larger trial.

Complications of Selective Intraarterial Chemotherapy in Children with Intraocular Retinoblastoma

Introduction: Selective ophthalmic arterial injection (SOAI) therapy for intraocular retinoblastoma is currently recognized by the world ophthalmic-oncological communities and this method is used in leading specialized institutions. However, the using of this type of treatment can lead to complications. Side effects can be both systemic, affecting the course of the procedure itself, and local in nature, associated with intraocular changes.Purpose: Conduct an analysis of complications during SOAI in children with intraocular retinoblastoma.Material and methods: The study includes the results of treatment of 110 children (129 eyes) with unilateral and bilateral retinoblastoma who received SOAI both with insufficient efficacy of previous treatment for resistant and recurrent forms of RB (99 children / 116 eyes), and as primary local chemotherapy without previous treatment (11 patients / 13 eyes). 313 procedures were performed, of which the treatment stage was completed in 303 cases. Depending on the hemodynamic characteristics of the blood supply to the eye and the orbital region, 2 methods of delivering of the chemotherapy were used: 1) microcatheter technique (245 procedures performed; 81.0 %) 2) microballoon technique (58 procedures performed; 19.0 %).Results: The structure of the complications was as follows. 1. The group of intraoperative complications included: spasm of the ICA, cerebral arteries — 4 cases (1.3 %), acute cardio-respiratory manifestations and hemodynamic instability — 93 (29.7 %). 2. Group of general complications: cerebrovascular accident — 3 cases (0.9 %), hematological toxicity — 14 (4.5 %). 3. Group of local complications. A) External extraocular manifestations: transient eyelid edema — 49 (15.7 %), frontal arteritis — 2 (0.6 %), ptosis of the upper eyelid — 11 (3.5 %), ptosis and deviation of the eyeball — 2 ( 0.6 %), soft tissue necrosis — 1 (0.3 %). B) Intraocular manifestations: retinal detachment — 13 (4.2 %), chorioretinal atrophy — 4 (1.2 %), edema of the optic nerve head — 2 (0.6 %), atrophy of the optic nerve head — 1 (0.3 %), hemophthalmia — 3 (0.9 %).Conclusion: Modern interventional endovascular methods allow to carry out the SOAI safety and reduce the number of possible complications.

ПРИМЕНЕНИЕ РЕНТГЕНЭНДОВАСКУЛЯРНЫХ МЕТОДОВ ДИАГНОСТИКИ И ЛЕЧЕНИЯ У ПАЦИЕНТА С ПОСТТРАВМАТИЧЕСКОЙ ГЕМОБИЛИЕЙ ПРИ ПРОНИКАЮЩЕМ РАНЕНИИ БРЮШНОЙ ПОЛОСТИ. СОБСТВЕННЫЙ ОПЫТ

Background. Hemobilia is the excretion of blood alongside with bile through intra- and extrahepatic bile ducts. Despite the use of new methods of diagnosis and treatment, the mortality rate from hemobilia remains high (20-40%). Objective. To demonstrate a clinical case and some methods of diagnosis and treatment of a patient with hemobilia. Material and methods. The article presents our own clinical observation of a patient with a penetrating knife wound of the abdominal cavity with liver injury complicated by hemobilia. Two-stage treatment was performed including upper midline laparotomy, cholecystectomy, and biliary tract sanitation with external drainage of the common bile duct according to Pikovsky in combination with angioembolization of the damaged artery of the 4th liver segment. Results. The analysis of the clinical case shows X-ray endovascular methods to be one of the promising ways of increasing surgical management efficiency of traumatic hemobilia. Conclusions. This observation shows the possibility of developing hemobilia without signs of intra-abdominal bleeding in penetrating abdominal wounds with liver injury. The use of X-ray endovascular diagnostic methods can improve treatment outcomes of patients with hemobilia of traumatic origin.

Post-Event Application of Neurotropin Protects against Ischemic Insult toward Better Outcomes in a Murine Model of Subarachnoid Hemorrhage.

Early brain injury (EBI) is closely linked to the development of delayed cerebral ischemia and poor outcomes after aneurysmal subarachnoid hemorrhage (SAH). This study aimed to evaluate the neuroprotective effect of neurotropin on EBI in a murine model of SAH. Twenty-four C57BL/6N mice were treated with intraperitoneal injections of either saline or 2.4 units of neurotropin at 1 h after SAH induction and for 3 days consecutively. SAH was created by an endovascular perforation method. In addition to the assessment of cerebral infarction and survival rate, motor and neurocognitive functions were also measured after SAH. Compared to the saline control group, the neurotropin group showed better recovery from locomotive and neurological declines after SAH. The neurotropin group also showed lower rates of post-SAH acute cerebral infarction and better memory and route-learning scores (p < 0.05). Meanwhile, there was no significant between-group differences in the overall mortality, hemodynamic parameters, or body weights. In conclusion, post-event treatment with neurotropin could be protective against EBI, lowering the incidence of ischemia and improving some motor and neurocognitive functions after SAH.

Providing of a highly specialized medical care for servicemen of the Armed Forces of Ukraine by roentgen-endovascular interventional methods

Aim: to provide high-quality and full-fledged minimally invasive highly specialized medical care by X-ray endovascular methods, according to modern world standards, for the Armed Forces of Ukraine on all territories of the country and direct participants of combat operations in the context of Joint Forces Operation (JFO) in certain parts of Donetsk and Luhansk regions. Materials and methods. The provision of minimally invasive highly specialized medical care by X-ray endovascular techniques for servicemen of the Armed Forces of Ukraine in the conditions of JFO in certain parts of Luhansk and Donetsk regions and the National Military Medical Clinical Center of Kyiv (NMMCC) in critical internal bleedings, pathology and injuries of the main vessels, acute cardiovascular pathology over a period of 2018–2020 was analyzed: 1038 diagnostic coronary interventions to servicemen with acute coronary syndrome, 346 stenting of coronary arteries in an emergency, 36 – angioplasty of coronary arteries. A total of 296 interventions for pathology of the peripheral vascular system including combat trauma were performed. Transcatheter arterial embolization was performed for 100 patients with internal bleeding. An emergency care mechanism was implemented for patients with acute coronary syndrome in the Joint Forces Operation in certain parts of Donetsk and Luhansk regions. Results. The implementation of these methods of highly specialized care in the Armed Forces of Ukraine allowed to realize the standards of emergency care for acute coronary syndrome, the average time of “door – balloon” was 100 minutes (CI 95 %, 98–103 minutes, P &lt; 0.05). In the conditions of JFO, care for patients with acute coronary syndrome, the interval “door – balloon” takes time from 2 to 12 hours (CI 95 %, 5.5–6.5 hours, P &lt; 0.05), fatalities were absent. At transcatheter arterial embolization, technical success of arterial occlusion was 100 %. In the treatment of main vessels, the length of hospital stay after endovascular interventions was 1–18 days (CI 95 %, 1.96–2.51 days, P &lt; 0.05). The main complications were postpuncture hematoma – 4.73 %, acute occlusion after intervention within 24 hours – 2.36 %, pseudoaneurysm – 0.68 %. Effective recanalization of the main blood flow was achieved in 262 cases (88.51 %). Conclusions. The implementation of X-ray endovascular techniques into the medical service of the Armed Forces of Ukraine allowed for providing high-quality highly specialized medical care directly to participants of Joint Forces Operation in certain parts of Donetsk and Luhansk regions in the shortest possible time.

Novel Experimental Technique to Create Size-Controlled Retroperitoneal Bleeding in the Infrarenal Aorta of Anesthetized Pigs.

Rupture of abdominal aortic aneurysm (rAAA) with a contained retroperitoneal hematoma is potentially fatal. Physiological studies are difficult to perform in patients suffering from life-threatening conditions such as rAAA. A translational model of the condition is therefore needed. The aim was to develop and validate an endovascular animal model for retroperitoneal bleeding of the abdominal aorta with contained hematoma. In anesthetized pigs, a puncture hole was made in the posterolateral portion of the infrarenal aorta by an Outback re-entry catheter device. The hole was gradually enlarged using angioplasty balloons to a specific diameter of either 4 mm (n = 6), 6 mm (n = 7), or 8 mm (n = 6). Onset of bleeding was verified by angiography and macroscopically examined on completion of the experiments. Survival up to 180 min was the primary outcome. Hemodynamic and metabolic markers in arterial blood were secondary outcomes. Aortic injury with a contained retroperitoneal hematoma was achieved in all animals. Survival rate at 180 min after onset of bleeding was higher in the 4 mm group compared to the 6 mm (P = 0.021) and 8 mm groups (P = 0.002), but not when comparing the 6 mm and 8 mm groups. Systemic hypotension, arterial acidosis, and lactatemia were provoked in the 6 mm and 8 mm groups but not in the 4 mm group. A porcine model for a controlled contained left posterolateral retroperitoneal bleeding was created using endovascular methods and validated. This model makes it possible to study the pathophysiology of a retroperitoneal hematoma.

Успешное лечение желудочного кровотечения на почве левосторонней портальной гипертензии транскатетерной артериальной эмболизацией (клиническое наблюдение)

Objective: to evaluate the results of transcatheter arterial embolization in patients with acute and chronic pancreatitis complicated by left-sided portal hypertension and bleeding from varicose veins of the stomach fundus and body. Materials and methods: 5 patients with left-sided portal hypertension were treated. Patients were admitted with a clinical picture of gastrointestinal bleeding, which was confirmed by laboratory and instrumental methods of research. Fibrogastroduodenoscopy revealed bleeding from varicose veins of the fundus and body of the stomach in all patients. The average age was 55.4±3.1 years. Results. All patients showed varicose veins of the fundus and body of the stomach, with signs of bleeding. Due to the high risk of recurrent bleeding, subtractive digital angiography with no signs of contrast agent extravasation was performed, followed by spiral embolization of the splenic artery in the proximal third until the blood flow was stopped. The technical and clinical success rate was 100%. Conclusion. Endovascular methods of treatment for left-sided portal hypertension syndrome are minimally invasive but highly effective methods of hemostasis. The indication for their use is unsuccessful endoscopic hemostasis or high risk of recurrence of bleeding from varicose veins of the fundus and body of the stomach.

Comparing Endovascular Treatment Methods in Acute Ischemic Stroke Due to Tandem Occlusion Focusing on Clinical Aspects.

Introduction: Acute ischemic strokes (AIS) due to tandem occlusion (TO) of intracranial anterior large vessel and concomitant extracranial internal carotid artery (EICA) are represent in 15–20% of all ischemic strokes. The endovascular treatment (EVT) strategy for those patients is still unclear. Although the intracranial mechanical thrombectomy (MT) is considered as a standard treatment approach, the EICA lesion stent necessity remains a matter of debate. We sought to assess the efficacy and safety of EVT in tandem lesions, particularly the EICA stenting management. Methods: We retrospectively analyzed all patients with anterior circulation stroke associated with EICA lesion and receiving EVT in the three participated stroke centers between November 2017 and December 2020. Patients’ data were collected from our prospective stroke registry (STAY ALIVE). Patients enrolled in our study were divided into two groups depending on whether acute carotid stenting (ACS) or balloon angioplasty only (BAO) technique was used. Our primary outcome was the 90-day functional outcome assessed by modified Rankin scale (mRS). Mortality at 90 days and symptomatic intracranial hemorrhage (sICH) were considered as secondary outcomes. Results: A total of 101 patients (age: 67 ± 10 years, 38.6% female) were enrolled in our study, including 29 (28.3%) BAO cases, and 72 (71.3%) patients treated with ACS. Patients in the BAO group were slightly older (70 ± 9 years vs. 66 ± 10 years, p = 0.054), and had higher prevalence of comorbidities such as hypertension (100.0% vs. 59.4%, p < 0.001). There was no significant difference in favorable outcomes (51.7% vs. 54.4%, p = 0.808) between the groups. However, we observed a trend towards higher rates of sICH (8.3% vs. 3.4%, p = 0.382) and 90-day mortality (23.5% vs. 13.8%, p = 0.278) with significantly higher frequency of distal embolization (39.1% vs. 17.9%, p = 0.043) in patients with ACS. In the overall population age (p = 0.013), atrial fibrillation (AF) (p = 0.008), National Institutes of Health Stroke Scale (NIHSS) baseline (p = 0.029), and successful recanalization (p = 0.023) were associated with favorable outcome. Conclusion: Endovascular approach of EICA in addition to MT was safe and effective in tandem occlusion of anterior circulation. Furthermore, our results suggest that balloon angioplasty technique without acute stenting shows a comparable favorable outcome rate to ACS with moderately less hemorrhagic events and mortality rates.

Treatment Strategy Options in Inoperable Chronic Thromboembolic Pulmonary Hypertension Patients

This review presents an analysis of recent publications on the principles of diagnosis and management of patients with chronic thromboembolic pulmonary hypertension (CTEPH). The authors emphasize the importance of patient's operability assessment regarding the possibility of performing pulmonary thrombendarterectomy - a radical treatment option due to complete post-thrombotic material removal from the branches of the pulmonary artery. In the case of an inoperable type of CTEPH, such a method of transcatheter treatment as step-by-step balloon angioplasty of the pulmonary artery (BPA) is proposed. The article clearly outlines the principles of selection, patient training and techniques for BPA. The authors demonstrated their own patented method of the peripheral vascular bed visualization in the case of recanalization of chronic occlusions, which increases the safety of this intervention. Particular attention is paid to hybrid approaches using a soluble guanylate cyclase stimulator, riociguate in combination with BPA for high risk CTEPH patients. The review presents the data of the post hoc analysis of the CHEST-1 study and the data of real clinical practice of the use of riociguat in combination with the endovascular method of treatment on the example of the leading expert groups in Europe, who demonstrated in their studies the positive effect of riociguat on the hemodynamic parameters and the frequency of perioperative complications.

Traumatic prolonged hematuria and pseudoaneurysm of the renal segmental arterial branch in a 16-year-old boy treated by endovascular embolisation

Most renal injuries in pediatric patients are treated conservatively, but prolonged hematuria and major blood vessel injuries often require active bleeding control. Traumatic pseudoaneurysms of segmental branches of the renal artery occur in 2.5% of renal injuries. They usually manifest as prolonged or intermittent secondary hematuria, but may be asymptomatic as well. Watchful waiting is the initial treatment, and around one third of patients eventually require active surgical or endovascular treatment. The two main endovascular coil embolisation methods are the “sandwich” and the “coil packing” technique, but occlusion using a stent is also possible. Traumatic prolonged hematuria caused by pseudoaneurysm of the renal segmental arterial branch, and the methods of treatment are rarely reported, especially in children. This report presents a boy in whom a blunt kidney injury lead to the formation of a pseudoaneurysm of the renal segmental arterial branch, causing prolonged hematuria. The patient was treated by endovascular embolisation through the right femoral artery, in local anesthesia and conscious sedation. A 2.7 Fr microcatheter was used to selectively enter the dominant cranial renal artery and show the pseudoaneurysm of a segmental interlobar arterial branch. A 2×4 mm coil was used to occlude the segmental interlobar arterial branch and pseudoaneurysm, with no post-procedural bleeding or significant renal segmental ischemia. Endovascular treatment offers advantages over open surgery, but has certain drawbacks as well, such as high radiation and contrast exposure. In the last few years, a minimally invasive robotic surgical procedure has been described for the treatment of intra-renal pseudoanurysm. The current worldwide trend in pediatric renal injuries treatment is the reduction in the number of nephrectomies, and a shift to non-operative and minimally invasive treatment, including endovascular procedures. University Hospital Centre Zagreb has all the specialities and capacities required for surgical and endovascular procedures in children, making it the national referral centre for pediatric renal injuries treatment.

Flow-diverting devices in the treatment of unruptured ophthalmic segment aneurysms at a mean clinical follow-up of 5\xa0years

A shift toward the endovascular treatment of ophthalmic segment aneurysms is noticeable. However, it is not clear if the long-term treatment results improve with the development of endovascular methods. The aim of this study was to present the outcomes of the treatment of unruptured ophthalmic aneurysms using flow diverting devices (FDD) with or without coiling. This retrospective study included 52 patients with 65 UIAs treated in 2009–2016. The mean aneurysm size was 8.8 mm. Eight aneurysms were symptomatic. Therapeutic procedures included: 5 failed attempts, 55 first sessions with FDD deployment (bilateral procedures in 3) and 3 retreatment procedures. To cover 55 ICAs, 25 Silk, 26 Pipeline, 9 Fred and 1 Surpass FDD were used. FDD with coiling was applied in 19(29.2%), mainly for symptomatic and larger aneurysms. Mean radiological and clinical follow-up was 12 and 61 months, respectively. Postprocedural deterioration was noted in 3(5.8%) patients, but in long-term the modified Rankin Scale grades 0–2 were achieved in 98.1% of patients. One patient died from the treated aneurysm rupture (annual risk—0.07%). Raymond–Roy occlusion classification class I or II was achieved in 98.5% in the long term, with similar results in both groups. Complications occurred in 40.4% of patients and the most frequent were: imperfect FDD deployment (15%), failed attempt of FDD deployment (9.6%) and late FDD stenosis (9.6%). Flow-diverting devices, with additional coiling in selected cases, may offer a very high proportion of satisfactory outcomes. However, in our experience the high risk of complications remains.

The results of complex surgical treatment of patients with coronary heart disease

Coronaryheart disease (CHD) remains one of the main causes of morbidity, early disability and mortality in the adultpopulation, despite significant achievements in the diagnosis and correction of coronary blood flow disorders. An undoubtedachievement at the present stage is the improvement of conservative and X-ray endovascular methods of treatment, but ithas led to an increase in the number of patients with diffuse coronary disorders. We have developed a method of combinedtreatmentof coronary heart disease through direct myocardial revascularization (CABG) in combination with the programYurLeonIII, which allows to improve the results in this group of patients.Aim. To compare the immediate and end resultsof combined surgery (CABG + YurLeon III) with isolated direct myocardial revascularization.Materialand methods.Thestudyincluded 730 patients diagnosed with coronary heart disease, exertional angina pectoris (stages III, IV), who underwentsurgicalrevascularizationof the myocardium in Pirogov National Medical and Surgical Center, Russian Federation. Therewere445 men (60.96%) and 285 (39.04%) women, aged 50 to 73. 580 patients underwent coronary bypass surgery (CABG).150 patients underwent coronary bypass surgery supplemented with indirect revascularization of YurLeon III (CABG +YurLeonIII). Patients underwent gated-SPECT, echocardiography, computer tomography, and quality of life evaluation with the use of SF-36 questionnaire.Results. At the intraoperative stage in the early postoperative period, there were no significantdifferencesin complication rates between t two groups (p &gt; 0.05). 1 year after surgery, statistically significant differences inEF were noted: 55.10 ± 5.98% (after CABG + YurLeon III), 50.07 ± 6.54% (after CABG)(p &lt; 0.05); perfusion defect:18.56 ±9.56%(after CABG) and 8.38 ± 5.79% (after CABG + YurLeon III) (p &lt; 0.05); quality of life: increased in PF, BP, andRE indicators — by 39, 64, and 30 points (after CABG + YurLeon III); by 30, 29, and 26 points (after CABG) (p &lt; 0.05).Conclusion.Coronarybypass surgery, supplemented with YurLeon III, is an effective and safe method of surgical treatment ofpatients with coronary heart disease, especially with diffuse disorders of the coronary arteries. It allows to additionally supplymyocardiumwith the blood.

Coronary stent technology and the role of inflammation in the atherogenesis: problems and prospects

Coronary artery disease (CAD) remains one of the leading causes of death in developed industrial countries. Timely and effective medical care for CAD patients depends on availability and application of endovascular methods for CAD treatment. Percutaneous coronary intervention (PCI) using drug- eluting stents allows to achieve good clinical results even in most severe patients. The issues of personalized invasive treatment for patients with chronic coronary syndrome and optimal prevention of recurrent clinical events in survivors of acute coronary syndrome and PCI remain relevant. One of most important and unresolved problems in the pathophysiology of CAD is assessment of the nature of the inflammatory reaction that develops in the coronary vessels and myocardium in response to ischemic damage and PCI. Clinical studies focused on exploring correlation between the pro-inflammatory parameters of the patient’s status and the rate of secondary adverse events and aimed at revealing triggers of systemic and local inflammation are of great interest. Such a trigger could be the intestinal endotoxin (ET) which is capable of inducing systemic inflammation and, therefore, plays a significant role in the atherogenesis. A relationship between the endotoxin and cytokine system parameters should be investigated to develop a therapeutic concept for supporting CAD patients, including individuals after PCI. Parameters of systemic endotoxemia could be used as additional factors in developing the biomarker-based approach to identify patients with active inflammation or fibrosis. This could result in development of specific therapy aimed at suppressing pro-inflammatory mediators and protecting the heart from inflammation.

Endovascular treatment of the rupture of thoracic aortic aneurysm, manifested by a neurological «mask»

The article describes a case of successful treatment of the rupture of aortic aneurysm by the endovascular method. Patient P., 71 years old, was hospitalized in a multidisciplinary hospital with a diagnosis of acute cerebral circulation disorder. The patient was examined in the intensive care unit. Signs of neurological symptoms regressed. Spiral computed tomography of the chest organs was performed with suspected pulmonary embolism, the results of which revealed an aneurysm of the descending thoracic aorta, complicated by a rupture with the formation of a right-sided hemothorax. The patient underwent endoprosthesis of the thoracic aorta with stent graft. After 2 days, thoracoscopic sanitation, drainage of the right pleural cavity was performed. The postoperative period proceeded without peculiarities. The patient was discharged on the 12th day in satisfactory condition. At control examination in 1, 6, 12 months, the long-term steady positive result was noted. Endovascular methods minimize the risk of postoperative complications, contributing to a favorable outcome of the disease.

Endovascular Repair of infra-renal Abdominal Aortic Aneurysm (Retrospective study)

Patients can be treated by traditional open careful fix (OSR). Nonetheless, there are as yet a few complexities related with OSR. The point of this examination was to layout an edge for location and analysis of patients with stomach aneurysms by means of various clinical and radiological strategies, to consider the patients appropriate for EVAR as per the patient choice standards, to feature the advantages and benefits of endovascular systems and to evaluate the conceivable complexity of endovascular methods and how to dodge it. Patient and strategies: Retrospective investigation of 20 patients went through endovascular fix of infra renal stomach aortic aneurysm . Patients gave convoluted AAA (burst or thrombo-embolism) required crisis intercession were excluded from the investigation. Duplex blood vessel investigation of lower appendages was accomplished for all patients to look at presence of fringe blood vessel infections . CTA is the key examination instrument for full assessment of the condition and arranging the techniques for treatment. It gives every one of the required models and information to choose whether the condition is reasonable for EVAR or not, and if yes what will be required in the gadget to be utilized. So CT Angiography was fundamental in arranging the treatment as well as in deciding the sign of treatment and determination of cases for the examination in any case. Results: No patients showed endoleak. At one year, all patients showed absolute aneurysm apoplexy, 94.4 showed patent unite appendage, and no patients showed endoleak. At a year, 94.4% of patients showed patent unite appendage after one patient had join appendage apoplexy. End: Endovascular fix of stomach aortic aneurysms has improved the perioperative horribleness and mortality of patients going through stomach aortic aneurysms fix contrasted with open careful fix.

Methods and Results of the Brain and Visceral Organs Protection During the Correction of the Ascending Aorta and Aortic Arch Aneurysm or Isolated Aortic Arch Aneurism

The ascending aorta and aortic arch aneurysm surgical correction is the most difficult problem of cardiovascular surgery due to the necessity of management of the main disease and adequate protection of the brain and visceral organs.&#x0D; The aim. To present the methods and results of protection of the central nervous system and visceral organs during the correction of the ascending aorta and aortic arch aneurysm or isolated aortic arch aneurism.&#x0D; Materials and methods. During 1994–2018, we operated 419 patients with the ascending aorta and aortic arch aneurysm (or isolated aortic arch aneurism).&#x0D; Diagnosis of aneurysms was based on clinical data, transthoracic and transesophageal echocardiography, computed tomography, X-ray examination, aortography.&#x0D; All operations were performed under general anesthesia, through the median sternotomy using cardiopulmonary bypass. Valve-sparing technique with aortic valve resuspension/aortic valve plasty and semi-arch/arch replacement was used in 288/9 (68.7%) patients. Bentall operation with semi-arch/arch replacement was used in 86/9 (20.5%) patients. Other operations accounted for 45 (10.7%) patients.&#x0D; Results. The history of the development of aortic aneurysms treatment options is briefly overviewed in the paper. Diagnostic methods are mentioned, but the main method today is computed tomography. Initial status of the patients was severe. All operations were performed through median sternotomy using cardiopulmonary bypass. The following techniques were used for surgical treatment of aneurysms: 1) valve-sparing technique with aortic valve resuspension/ plasty and semi-arc/arch replacement was used in 288/9 (68.7%) patients. In this group there were 8 Yacoub operations, 6 David operations. In 7 patients, plication of one of the leaflets was performed in case of aortic valve prolapse. 3 patients underwent strengthening of the free edge of the leaflets and 4 patients underwent plasty by the patch in case of leaflet fenestrations; 2) Bentall operation with semi-arch/arch replacement was used in 86/9 (20.5%); 3) others: isolated arch in 15 (3.6%); Wheat operation + arch in 9 (1.0%); aortic arch plasty in 4 (1.0%); Elephant trunk (conventional Elephant trunk) + TEVAR was used in 17 (4.1%) patients. The brain protection was performed differently at each of the two stages in our surgical experience. The best result was achieved at the last stage. The number of postoperative complications decreased from 34.4% to 8.4% and hospital mortality from 17.2% to 5.3%, respectively. Also, a modern endovascular method – hybrid operations Elephant trunk + TEVAR – was used in 17 (4.1%) patients with good immediate result.&#x0D; Conclusions.&#x0D; 1. At type A aortic dissection (DeBakey type I) the operation of choice is supracoronary ascending aortic replacement with a semi-arch (arch) replacement of the aorta.&#x0D; 2. Accumulation of surgical experience, team training, improvement of methods of protection of the brain and visceral organs allowed to reduce the number of postoperative complications from 34.4% to 8.4% and hospital mortality from 17.2% to 5.3%.

Percutaneous mechanical thrombectomy in acute and subacute lower-extremity ischemia: impact of adjunctive, solely nonthrombolytic endovascular procedures

We aimed to evaluate the role of adjunctive, solely nonthrombolytic endovascular therapy in treatment of acute lower-extremity ischemia by rotational percutaneous mechanical thrombectomy. A retrospective, single-center evaluation of 165 patients (167 limbs) that underwent rotational percutaneous mechanical thrombectomy between 2009 and 2016 was performed. Rotational percutaneous mechanical thrombectomy was used as a single therapy in 9.0% (15 limbs), followed by percutaneous aspiration thrombectomy in 6.0% (10 limbs), percutaneous transluminal angioplasty in 19.8% (33 limbs) and stenting in 25.7% (43 limbs). Rotational percutaneous mechanical thrombectomy was followed by any combination of these three interventions in 39.5%. Clinical and technical success was documented in 92.2%, complications in 10.3% (n=17). No significant difference in clinical and technical success was observed using rotational percutaneous mechanical thrombectomy alone or with additional endovascular therapy. On a long-term basis, the re-ischemia-free survival was nearly twice as high as in previous studies that reported more cases treated by rotational percutaneous mechanical thrombectomy alone. To assure a long-lasting primary patency after percutaneous mechanical thrombectomy, concomitant treatment of underlying lesions with adjunctive, nonthrombolytic endovascular methods should be considered.

Treatment of large infectious extracranial carotid artery pseudoaneurysms in children: a systematic review of the literature.

Extracranial carotid artery pseudoaneurysm is a rare complication of deep neck space infection, and no evidence-based treatment guidelines are available in the literature. To clarify the existing experience of the different treatment strategies, the authors performed a systematic literature search using the PubMed, Ovid EMBASE, and Scopus databases in accordance with PRISMA guidelines to review all reported cases of pediatric patients with infectious carotid pseudoaneurysms larger than 1 cm. Twenty-six patients with a median age of 4 years (range 6 months-15 years) were identified. Eighteen patients (69.2%) were treated with endovascular methods, 6 patients (23.1%) with surgical methods, 1 patient (3.8%) with a hybrid endovascular/surgical approach, and 1 patient (3.8%) with conservative management. Recurrence of the pseudoaneurysm occurred in 2 cases (7.7%), both of which were successfully retreated. Of the 6 patients (23.1%) who presented with pre-procedure neurologic deficits, 3 patients had complete or near complete resolution of symptoms after intervention and 3 patients had persistent deficits at last follow-up. Four patients (15.4%) experienced new neurologic deficits post-procedure that resolved at last follow-up. The endovascular treatment tends to be the preferred option to treat a large or giant infectious pseudoaneurysm of the carotid artery in the pediatric patient. However, more evidence is necessary to elucidate comparative safety and efficacy profiles of endovascular and surgical management strategies.