[Super-selective prostatic artery embolization as minimally invasive surgical treatment in patients with BPH].

Benign prostatic hyperplasia (BPH) is a widespread socially significant disease. Minimally invasive surgical treatments can reduce the surgical and anesthetic risk. One of the most effective methods of minimally invasive surgical treatment of BPH is superselective prostatic artery embolization (prostatic artery embolization; PAE). PAE is a method with proven effectiveness and has been included in the clinical recommendations of the Ministry of health of the Russian Federation for the treatment of BPH since 2019.

[Super-selective embolisation of bladder arteries for treatment of patients with bladder tumors complicated by recurrent macrohematuria].

The prevalence of bladder cancer in Russia over the past 10 years has increased from 49.6 to 74.1 patients per 100,000 population. Hematuria is a life-threatening complication and one of the common causes of mortality in advanced stages of bladder cancer. Conservative methods of hemostasis do not always allow to achieve a stable effect. In addition, in the cases of intractable bleeding, the patients may require surgical treatment. Due to the prevalence of patients with a high anesthetic risk group in bladder cancer patients cohort, the minimally invasive hemostasis technologies are more preferable. This review is devoted to one of such methods - superselective embolization of the urinary bladder arteries.

[Super-selective prostatic artery embolization for bph treatment.]

Benign prostatic hyperplasia (BPH) is one of the most common diseases of the genitourinary system. BPH prevalence increases in men with advancing age, highlighting the necessity of minimally invasive surgical procedure including super-selective prostatic artery embolization (PAE). The current role of the PAE for BPH treatment according to recent national and international publications is discussed in this review. The data from the largest studies are structured and presented along with our experience in PAE. In addition, a need to continue research on this topic is underlined.

[Remote results of endovascular atherectomy with the SilverHawk device].

The authors studied the remote results of 27 endovascular catheter atherectomies performed in 25 patients. All patients had lesions of arteries of the femoropopliteal segment according to the TASC II classification. The duration of follow up varied from 6 to 34 months. Endovascular catheter atherectomy was carried out by means of the SilverHawk EV3 system with protection of the distal bed from embolism using Spider EV3. Our findings prove that catheter atherectomy with the SilverHawk system is most efficient it treatment of short stenotic lesions, lesions localizing in the zone of increased dynamic activity, multi-level lesions of arteries of the femoropopliteal segment, as well as short lesions in patients suffering from diabetes mellitus.

[The problem of hemobilia after transhepatic endobiliary interventions].

OBJECTIVE: To study the causes of hemobilia occurring during percutaneous transhepatic drainage and to develop methods for its prevention. MATERIAL AND METHODS: Treatment results were analyzed in 149 patients with tumors in the hepatopancretoduodenal area. Among the examined patients, there were 65 (43.6%) males and 84 (56.4%) females at the age of 33 to 91 years (mean 64.1 years) who underwent 881 different endobiliary interventions. The condition was severe in 46 (30.9%) patients, moderate in 89 (59.7%), and satisfactory in 14 (9.4%). Extensive abdominal surgery had been performed in 71 (47.6%) cases. The preadmission history of mechanical jaundice was 7 to 30 days (mean 18.5 days). Total bilirubin levels were in the range from 32.9 to 726 µmol/l (mean 249.4 µmol/l). Philips Allura V 3000 and Siemens Axiom Artis devices were used to exercise X-ray TV control during the interventions. RESULTS: The bile ducts were stented applying various models of expanding metallic stents in 93 (62.4%) of the 149 patients. A one-stage stenting protocol was used in 24 (25.8%) of the 93 patients and two-stage endobiliary stenting was carried out in 69 (74.2%). The other 56 (37.6%) of the 149 patients underwent only external-internal biliary drainage. Ten (6.7%) patients were noted to have different hemorrhagic complications as venous (4.7%, n = 7) and arterial (2%, n = 3) hemobilia. CONCLUSION: X-ray surgical hemostatic procedures can ensure a final positive effect of transhepatic bile duct compression.

[Endovascular embolization of ovarian veins in varicose disease of the small-pelvic veins].

Presented herein are therapeutic outcomes obtained in treatment of nineteen female patients suffering from varicose disease of the veins of the small pelvis. Based on the findings obtained by ultrasonographic, radionuclide and roentgenocontrast methods of investigation examination they were diagnosed with the syndrome of pelvic venous plethora. The indications for endovasal occlusion of the ovarian veins were the presence of the clinical signs of pelvic venous congestion, dilatation of and blood reflux along the gonadal veins based on the findings of instrumental methods of examination. It was determined that endovascular embolization of the gonadal veins in 84% of cases resulted in permanent relief of chronic pelvic pain.

[Effect of technical and anatomical factors on efficacy of embolization of uterine arteries].

The article deals with analysis of technical and anatomical factors influencing the efficacy of uterine arteries embolization (UAE) in treatment of patients with uterine myoma. Based on experience gained in 420 interventions, the authors revealed that inefficiency of UAE may be attributed to the following causes: 1) a technical failure associated with anatomical peculiarities of the uterine artery or a spasm thereof; 2) incomplete embolization apparently attributable to both technical and anatomical factors; 3) an adventitious restoration of blood supply to the uterine myoma. We also determined the significance of utero-ovarian arterial anastomoses in blood supply of the myomatous nodes, suggesting technical manipulations making it possible to attain adequate embolization thereof, if such. Technical and anatomical factors play a decisive role in successful outcomes of UAE, which, if failed due to restoration or preservation of blood supply of the myomatous nodes, should be followed by a repeat intervention.

Temporary placement of the cava filter to the suprarenal segment of the inferior vena cava.

This paper describes successful results of temporary placement of the Russian removable cava filter "Zontik" to the suprarenal segment of the inferior vena cava for the time of performing cesarean section and for the short-term postoperative period in a patient with late pregnancy, venous thrombosis of the lower limbs and pulmonary thromboembolism.

The use of the Zontik cava filter for temporary implantation to the inferior vena cava.

The authors review the potential for the use of the Zontik retrievable cava filter (CF) for temporary implantation. In the course of their observations, the CF was to be received by 68 patients for the time needed for the treatment of floating thrombi in the inferior vena cava and its tributaries using thrombectomy, thrombolysis or anticoagulants. In 10 patients, the CF was implanted in view of the risk of pulmonary thromboembolism (PTE) during and after obstetric-gynecological and orthopedic operations carried out in the presence of deep venous thrombosis of the lower limbs. After elimination of the risk of PTE the CF was retrieved in 38 (48.7%) patients over the period 2 to 64 days; 4 patients declined filter retrieval; in 3 patients, the procedure ended in failure. In view of the risk of PTE the CF, was left for permanent implantation in 33 patients. Of these, in 8 patients it was left due to embolism to the filter and in 8 patients due to its thrombosis. One patient developed PTE which prompted CF retrieval on the second day following implantation. Thirty patients were examined over the period 12 to 62 months after CF retrieval. No signs of PTF were detected, the inferior vena cava was patent. Based on their own experience the authors investigate the conditions required for temporary implantation of the CF and the indications for its use, factors providing for the minimal risk of the recurrence of venous thrombosis and PTF after filter retrieval, and the possibilities of a broader practical use of the technique. They believe that temporary implantation of the CF is the most prospective trend in endovascular prevention of PTE.

Endovascular catheter thrombectomy in overall prevention of pulmonary thromboembolism.

The authors performed 72 endovascular catheter thrombectomies (ECT) in patients with "high" floating thromboses of the inferior vena cava (IVC). Thrombi from the IVC were completely evacuated in 48 and from the common iliac veins - in 4 patients. Partial thrombectomy from the IVC was accomplished in 20 patients. As a result of the interventions, a number of problems were solved: the source of embolism was eliminated, the conditions were created for cava filter (CF) placement to the standard position distal to the openings of the renal veins; after complete ECT the patency of the IVC and normal laminar flow were restored. The patency of the IVC at the hospital stage was maintained in 92.9% and in the long-term period - in 83.3% of patients. The study of the short and long-term results enabled the authors to work out an algorithm of using ECT in overall prevention of pulmonary thromboembolism (PTE) and in the treatment of floating thromboses of the IVC as dependent on the patient's condition, coexistent diseases, the etiology, site, extension of thrombosis, and risk factors of rethrombosis.

Endovascular rotary fragmentation in the treatment of massive pulmonary thromboembolism.

Endovascular rotary fragmentation using a modified pigtail catheter was provided to 20 patients with massive pulmonary thromboembolism. Fragmentation wes supplemented by the course of standard thrombolytic therapy (13 patients) or by the shortened treatment course (3 patients). Just after intervention the Miller index dropped on the average from 28.2+/-2,56 marks to 25.5+/-2.1 marks. Systolic pressure in the pulmonary artery increased on the average from 50.9+/-13.08 up to 51.9+/-13.06 mm Hg, One female patient died 1.5 h after intervention because of cardiopulmonary insufficiency progression, 3-11 days after intervention (mean 6.3 days) the patients underwent repeated cardiopulmonography. Within this period the Miller index constituted 16.7+/-4.3 marks on the average, systolic pressure in the pulmonary artery was equal to 33.8+/-9.45 mm Hg. Endovascular rotary fragmentation allows to reach swift recanalization of embolic occlusion and thus to gain a "gold hour" for thrombolysis. It improves the results of thrombolytic therapy and can become an original modality for the treatment of patients contraindicated thrombolysis.

Anatomic and hemodynamic changes in the inferior vena cava associated with prevention of pulmonary thromboembolism.

This paper analyzes the results of a multimodality instrumental study of the structural and functional properties of the inferior vena cava (IVC) in 173 patients with acute venous thrombosis, who underwent different interventions aimed at pulmonary thromboembolism (PTE) prevention. Of these, 63% of patients were examined in the long-term period, within the time 2 to 36 months. 26% of patients were found to have variants of the anatomic structure of the IVC system, such as the doubling of the renal veins, ring-shaped structure or entry to the IVC at a distance exceeding 5 cm from each other. The paper also provides a detailed analysis of the hemodynamic parameters (maximal and minimal linear flow velocities in the IVC, time-averaged maximal linear flow velocities and their different indices) and of their changes as dependent on the type of interventions on the IVC. It has been established on the basis of the data obtained that endovascular catheter thrombectomy is the method for PTE prevention because it restores the IVC lumen and refines the regional hemodynamics. Cava filter implantation induces a rounded deformation and expansion of the infrarenal IVC up to 40.9% of the area of its cross section but exerts a minimal adverse effect on the flow. IVC plication leads to a slit-like deformation and a 12.9% stenosis of its lumen as well as to deceleration of the flow acquiring a turbulent character.

The first experience with endovascular stenting of the iliac veins in patients suffering from post-thrombophlebitic disease.

This paper describes the results of the first experience with endovascular stenting of the iliac veins in patients suffering from post-thrombophlebitic disease. During 11 months, the patient with a history of segmental venous thrombosis and involvement of the left iliac veins received conservative treatment which included phlebotropic therapy and elastic compression. Despite these measures the patient demonstrated the symptoms of venous insufficiency such as edema, and pains in the left lower extremity. In addition, control ultrasonography and radionuclide examinations revealed chronic occlusion of the left iliac veins. In view of this circumstance we performed endovascular dilatation and stenting of the iliac veins. The postoperative period was uneventful. After two months the pains in the left lower extremity and its edema were fully removed. Control radionuclide phleboscintigraphy demonstrated complete patency of the left iliac veins. So, endovascular stenting is an effective and safe modality for the treatment of the occlusive forms of post-thrombophlebitic disease.

[Endovascular surgery in prophylaxis of pulmonary thromboembolism and treatment of acute venous thrombosis]. / Endovaskuliarnaia khirurgiia v profilaktike tromboémbolii legochnoi arterii i lechenii ostrykh venoznykh trombozov.

From 1995 to 2001 1089 patients underwent 1141 endovascular procedures for treatment of acute thrombosis of vena cava inferior (VCI) system and prophylaxis of pulmonary thromboembolism (PT) including 61 catheter thrombectomies from VCI and common iliac veins, 35 regional thrombolyses, 880 implantations of permanent cava-filter "hourglass" and it modifications, 159 implantations of temporary cava-filter "umbrella", 3 implantations of filter-stent, 3 thrombectomies of a giant mobile thrombus with Dotter basket with subsequent cava-filter implantation. Efficacy of PT prophylaxis after these procedures was 97.9%. Catheter thrombectomy and regional thrombolysis permitted to repair passage through deep veins in 69.8% patients. Temporary cava-filter after treatment was removed in 49.1% patients. After implantations of permanent cava-filters early and late complications were seen in 8.9% cases.

[Method of treatment of patients with calculous cholecystitis complicated with mechanical jaundice]. / Taktika lecheniia bolnykh kalkuleznym kholetsistitom, oslozhnennym mekhanicheskoi zheltukhoi.

Data on the treatment of 228 patients with calculous cholecystitis complicated by obstructive jaundice are reported. Two-stage treatment was applied. In the first stage endoscopic and roentgenoendobiliary therapeutic interventions were undertaken to relieve jaundice and remove its causes. In the second stage a planned surgical operation was conducted after elimination of biliary hypertension, which consisted in cholecystectomy in the majority of patients. Such therapeutic tactics reduced mortality by half.

[Endoscopic biliodigestive anastomosis with the use of magnets (experimental and clinical study)]. / Endoskopicheskie biliodigestivnye anastomozy s ispolzovaniem magnitnykh élementov (éksperimentalno-klinicheskoe issledovanie).

A new type of endoscopic operations--cholecystodigestive and choledocho-hepaticoduodenoanastomoses with the use of magnetic elements are suggested as an alternative to the traditional palliative methods of treatment of obstructive jaundice with the level of obstruction below the opening of the cystic duct. Two variants of establishing postponed compression cholecystogastroanastomoses were developed in experiments on a model of obstructive jaundice in 50 unbred dogs, a variant of cholecystoentero- and enteroenteroanastomoses with the use of endoscopic techniques, which may be conducted in clinical practice. To restore internal bile drainage the following operations were carried out on 16 patients: colecystogastroanastomosis (4), cholecystoduodenonastomosis (1), choledochoduodenoanastomosis (10), hapaticoduodenoanastomosis (1). These operations were performed in patients with irresectable obstructions of the terminal part of the choledochus and a high operative risk.

[THe role of portal bacteremia and endotoxinemia in the pathogenesis of multiple organ failure in peritonitis]. / Rol' portal'noi bakteriemii i éndotoksinemii v patogeneze poliorgannoi nedostatochnosti pri peritonite.

The indices of portal bacteremia and endotoxinemia, parameters of metabolism, hepatic hemodynamics, the phagocytic function of the liver and leukocyte reaction were studied in 13 patients with diffuse peritonitis of different etiology. Close interconnections of the level of portal toxemia is shown with the degree of activation of the phagocytic function of the liver, changes in hepatic hemodynamics, degree of metabolic disturbances playing an important role in pathogenesis of polyorganic insufficiency as well as the role of leukocytic reaction in microendocrinous regulation of metabolism in peritonitis.

[Embolization of gastric veins in patients with esophageal hemorrhage during laparotomy]. / Embolizatsiia zheludochnykh ven u bol'nykh pishchevodnymi krovotecheniiami pri laparotomii.

The authors discuss the possibility of a laparotomy approach for endovascular embolization of the gastric veins in patients with portal hypertension and gastroesophageal bleeding. This approach was used in four patients in whom transhepatic catheterization of the portal channel was impossible. After laparotomy, catheterization of the portal vein system was conducted through one of the veins of the small intestine. The effect of embolization in two of three patients who were subjected to the operation consisted in correction of esophagitis and complete cessation of esophageal bleeding. In view of the danger of the development of operative and postoperative complications due to the specific features of the pathological condition, the authors recommend using laparotomy endovascular embolization of the gastric veins only in the presence of strict indications.

[Transhepatic endoprosthesis of the bile ducts]. / Chrespechenochnoe éndoprotezirovanie zhelchnykh protokov.

The authors analysed the results of percutaneous transhepatic endoprosthetics of the hepaticocholedochus in 38 patients with incurable tumors of the organs of the hepato-pancreato-duodenal zone, complicated by obstructive jaundice. Nine different types of bile ejection blocking were distinguished, according to which the method and tactics of the endobiliary intervention were elaborated. Measures for the prevention of cholangitis, bleeding into the abdominal cavity, and hemobilia in the postoperative period are described in detail. The article shows the results recorded in flow-up periods of one to 11 months in 26 patients who had been subjected to endoprosthetics of the bile ducts and discharged from the clinic for out-patient treatment. Recurrence of obstructive jaundice caused by incrustation of the prosthesis was encountered only in 2 patients 4 and 9 months after the intervention. This allowed the authors to conclude that endoprosthetics of the hepaticocholedochus is very effective in the treatment of patients with obstructive jaundice of neoplastic etiology and to consider a transhepatic intervention an alternative of a surgical operation.