[Use of a filtering protective device during angioplasty and stenting of the brachiocephalic trunk]. / Primenenie fil'truiushchego zashchitnogo ustroistva pri angioplastike i stentirovanii brakhiotsefal'nogo stvola.

The authors carried out a pilot study aimed at assessing the possibility and efficacy of using filtering systems for protection of cerebral arteries from distal embolism during angioplasty and stenting of the brachiocephalic trunk. A total of five patients presenting with lesions of the brachiocephalic trunk underwent 5 roentgenoendovascular interventions with the use of the filtering protective device Spider FX. Angiographic and clinical success was achieved in 100% of cases. Particles of debris were obtained from the protective device in all cases. All the five patients were found to have symptoms of vertebrobasilar insufficiency. During follow-up in the medium-term period at check examinations the implanted stents were patent, with neither major nor minor neurological complications observed. The patients turned out to be free from cerebrovascular insufficiency relapses. Presented herein are clinical case reports describing technical peculiarities of using the protective device in different variants of the anatomy and vascular lesion.

[Use of an ex vivo technique in a patient with renal arteriovenous malformation in complication endovascular treatment]. / Ispol'zovanie tekhniki ex vivo u patsienta s arteriovenoznoi mal'formatsiei pochek pri oslozhnenii éndovaskuliarnogo lecheniia.

Renal arteriovenous malformation is a rarely encountered disease characterized by the presence of a direct arteriovenous shunt between the renal artery and vein. This nosology was first described by Varela in 1928, and by 1997 the number of such cases amounted to slightly more than 200. Endovascular closure of a fistula seems to be an attractive method of treatment in view of low traumaticity and a short period of rehabilitation. However, as shown by our case report, this type of intervention in large-diameter fistulas may be associated with the development of life-threatening complications. In case of rupture of the renal capsule and/or arteriovenous aneurysm, radical nephrectomy, unfortunately, remains to be a method of choice. Described below is a case concerning treatment of a female patient presenting with bilateral arteriovenous malformations and the world's first emergency operation for a ruptured intraparenchymatous arteriovenous aneurysm using an extracorporeal technique.

[Endoprosthetic repair with stent grafts in coronary artery restenosis].

Timely performed reconstructive operations on carotid arteries considerably decrease the incidence rate of ischaemic-type acute impairments of cerebral circulation. Nevertheless, restenoses developing in the zone of reconstruction of carotid arteries level the positive result of the primary operation in remote terms of follow up. In such cases it is more preferable to perform stenting of the damaged portions. The article deals with cases of successful use of self-expandable stent grafts in restenoses of carotid arteries after carotid endarterectomy and operations of prosthetic repair of carotid arteries. The analysis was carried out by international publications concerning this problem.

[Roentgen endovascular treatment of common carotid artery dissection after eversion carotid endarterectomy]. / Rentgenendovaskulyarnoe lechenie dissektsii obshchei sonnoi arterii posle eversionnoi karotidnoi endarterektomii.

The article deals with the use of self-expanding stents for endovascular treatment in patients presenting with dissection of the common carotid artery, exemplified by two clinical case reports. In both cases, dissection of the common carotid artery developed after eversion carotid endarterectomy. Intimal detachment was eliminated in both cases by implanting self-expanding stents. These cases demonstrated possibilities of roentgen endovascular methods of treatment making it possible to successfully replace a repeat, technically difficult surgical intervention for iatrogenic dissection of the common carotid artery.

[Experience with the ovations stent graft system for totally percutaneous endovascular repair of the infrarenal portion of the abdominal aorta].

Presented in the article are clinical cases of successful totally percutaneous endovascular repair of the infrarenal portion of the abdominal aorta using the Ovation Prime ultra-low profile stent graft in high-surgical-risk patients, yielding good immediate and short-term results, thus demonstrating new possibilities in endovascular treatment of aneurysms of the infrarenal portion of the abdominal aorta.

[Use of self-expandable stent grafts in aneurysms of internal carotid arteries].

Open surgical intervention is an operation of choice in lesions of coronary arteries. In some cases, however, performing reconstructive surgery is either impossible or associated with high risk of both intra- and postoperative complications. In such cases it is possible to perform an endovascular intervention, including endoprosthetic repair. The Russian and foreign literature contains either sporadic or small-in-number case reports concerning the use of stent grafts in carotid arteries aneurysms. The article describes cases of successful use of self-expandable stent grafts in three patients with a true aneurysm and pseudoaneurysms of internal carotid arteries.

[Endovascular treatment of traumatic arteriovenous fistulas of the vertebral artery].

The authors describe herein the use of balloon-distensible stent grafts for endovascular treatment of patients presenting with traumatic arteriovenous fistulas in the first segment of the vertebral artery, exemplified by two clinical case reports. In both cases, the arteriovenous fistula formed after a stab-and-slash wound in the neck area. In order to exclude the arteriovenous aneurysm from the blood flow in the first case we performed endoprosthetic repair of the first segment of the subclavian artery with shutting off of the ostium of the vertebral artery carrying the aneurysm. In the second case, in order to remove the arteriovenous shunt we carried out performed endoprosthetic repair of the first segment of the vertebral artery. These cases show possibilities of roentgenoendovascular methods of treatment, making it possible to successfully replace technically complicated surgical interventions in traumatic arteriovenous fistulas of vertebral arteries.

[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.

[Endovascular treatment of post-traumatic arteriovenous fistulae].

AIM: To summarize the experience of endovascular treatment of traumatic arteriovenous fistulae. MATERIAL AND METHODS: Endovascular interventions for arteriovenous fistulae of different locations were applied in 16 patients aged 19 to 83 years (mean 50.4±14.3) in A.V. Vishnevskiy Institute of Surgery from 2003 to 2014. Among causes there were stab wounds, gunshot wounds, blunt trauma, iatrogenic. Different endovascular methods including stenting with self-opening and balloon-expanding stent-grafts, embolic coils and occluders implantation were used. RESULTS: Pain syndrome, disorders of support function and trophic changes were observed in patients with arteriovenous fistulae more localized more distal than lower one third of the thigh. More proximally located arteriovenous fistulae regardless of their diameter resulted severe heart failure and portal hypertension. Angiographic and clinical success was achieved in 100% of cases. Manifestations of heart failure and portal hypertension disappeared in all patients after endovascular interventions. Also support function restored, pain and trophic disorders were cured. CONCLUSION: Arteriovenous fistulae regardless of their size, location and time of existence must be dissociated. Prolonged arteriovenous shunting leads to severe heart failure. Current technologies and tools used in endovascular interventions provide reliable dissociation of arteriovenous fistulae even in case of difficult anatomical features.

Use of polymethylmethacrylate in treatment of arteriovenous angiodysplasia with bone lesions.

Arteriovenous dysplasia is rather uncommon disease, quite often leading to severe complications even in young age. Involvement of the osseous apparatus into the pathological process is frequently associated with the problem of amputation of the affected limb. Therefore, salvage of the extremity while removing arteriovenous shunt and trophic impairments is an extremely important clinical task. In the presented herein clinical case report, a female patient with arteriovenous angiodysplasia of the lower limb with the tibial bone involved into the pathological process underwent repeated stagewise embolisations, failing however to achieve complete liquidation of the arteriovenous reflux. In this connection, after removal of angiomatous tissues, requiring also excochleation of the damaged portions of the bone, in order to reinforce the axis of the tibial bone the intramedullary canal of the latter was filled with polymethylmethacrylate (PMMA). Expansion of the spectrum of auxiliary methods, besides the most frequently performed in such patients embolisations of afferent arteries and removal of angiomatous tissues would make it possible to increase radical nature of interventions with salvage of the supporting function of limbs.

[Nesidioblastosis (diagnosis, surgical treatment)]. / Nezidioblastoz (diagnostika i khirurgicheskoe lechenie).

INTRODUCTION: Nesidioblastosis (NB) is rare disease with organic hyperinsulinism syndrome and caused by diffuse hyperplasia and/or hypertrophy of pancreatic islands of Langerhans. MATERIAL AND METHODS: The results of surgical treatment of 3 patients with NB are presented. In all patients the diagnosis was suspected at the preoperative stage and confirmed by histological examination later. Herewith in 2 patients NB was combined with insulinoma. All patients underwent corpora-caudal pancreatectomy. RESULTS: In postoperative period one patient hadn't episodes of hypoglycemia for the entire follow-up period (5 months), in another patient hypoglycemic states occurred at 1.5 months after surgery. The third patient required pancreatic head extirpation at 11 days after surgery due to persistent severe course of organic hyperinsulinism. In immediate postoperative period in the same patient hyperinsular hypoglycemia was observed that pointed on extrapancreatic source of insulin secretion. However contrast-enhanced CT did not reveal any formations. CONCLUSION: Thus, corpora-caudal pancreatectomy is preferable as surgical treatment. Results of surgical management can provide a complete regression of the symptoms, but do not guarantee absence of recurrence and even any changes in frequency and severity of hypoglycemic states.

[Use of balloon-expandable stent graft for treatment of a false pseudoaneurysm of the proximal anastomosis of the iliac-femoral bypass graft].

The authors present in the article a case report of successful use of a balloon-expandable stent graft for endovascular prosthetic reconstruction of an aneurysm of the proximal anastomosis of the iliac-femoral bypass graft by puncture approach through the brachial artery. We implanted a balloon-expandable stent graft measuring 6.0-12.0 mm in diameter and 58-mm long with good immediate and short-term results in the anastomosis with large alteration in the diameter along the length.

[Microscopic investigation of vessel wall after endovascular catheter atherectomy].

Endovascular target catheter atherectomy (ETCA) - method of artery patency allowing to obtain occlusion substrate. Given the high destructive effect of atherectome's elements on tissue the objective was determination possibility of histological and electron microscopic investigation of this substrate after atherectomy. The research included 8 patients who underwent ETCA of legs arteries. It was observed substrate removal from broken stent in 1 case. 2 of 8 patients had diabetes. Obtained substrate was available for histological and electron microscopic investigation. Atherosclerosis was confirmed in all cases. It was not observed substrate significant morphological changes in patients with presence or absence of diabetes. Microscopic investigation of substrate from broken stent shows pronounced development of granulation tissue that was regarded as special form of reparative regeneration. Finding internal elastic membrane during microscopic investigation in some cases proves radical intervention. The authors consider that microscopic investigation of substrate after ETCA may be used for diagnosis verification, thorough analysis of morphological changes in lesion area and radicalism of atherectomy.

[Diagnosis of neuroendocrine neoplasms of the pancreas].

The rare clinical case of multiple primary gastrointestinal stromal tumors (GIST) in one patient is presented in the article. The analysis of the available material confirmed that there is the problem of early detection of this type of tumors and their differential diagnosis. The minutes of outpatient radiological methods of research should include methods of identifying GIST in various locations. Early diagnosis of the disease allows you to make a radical mini-invasive intervention in the endoscopic or robotic-assisted version. This tactic is characterized by high efficiency in combination with the chemotherapeutic treatment.

[Antegrade catheterization of the brachial artery during treatment of arteriovenous angiodysplasia of the forearm and hand].

The authors share herein their experience with an antegrade brachial access for treatment of patients presenting with arteriovenous angiodysplasia localizing on the distal portions of the upper limbs, also describing the choice of the site for puncture and the technique of antegrade catheterization of the brachial artery. This is followed by reporting the results of successful use of this access in a total of 27 patients. The access is simple to create, making it possible to easily perform the intervention using instruments of standard length. It is also safe, requires no bed rest in the postoperative period, and is well tolerated by the patients.

[Endovascular treatment of posttraumatic arteriovenous fistulas of the subclavian artery].

The authors describe the use of different methods of endovascular treatment of patients with presenting with posttraumatic arteriovenous fistulas in the first segment of the subclavian artery exemplified by two clinical cases. The first case report concerns a patient having developed was an arteriovenous fistula after catheterization of the jugular vein. The arteriovenous aneurysm was occluded by means of embolizing spirals. In the second case report is patient having developed an arteriovenous fistula after a stab-and-slash wound in the area of the sternoclavicular junction. Long-term existence of the arteriovenous fistula was complicated by severe right-ventricular insufficiency. The arteriovenous fistula was separated by means of endoprosthetic repair of the first segment of the subclavian artery. These case reports demonstrate possibilities of roentgenovascular methods of treatment making it possible to successfully replace a technically complicated, traumatic surgical intervention for false arteriovenous aneurysms.

[Experience with transradial approach in roentgenoendovascular interventions on coronary arteries].

OBJECTIVE: To assess efficacy of the transradial approach and to evaluate possibility of its wide application for coronary interventions as an alternative to the transfemoral access. MATERIAL AND METHODS: A total of 317 percutaneous coronary interventions were performed in 312 patients presenting with coronary artery disease. Percutaneous coronary interventions (PCI) performed through the radial artery (RA) were made using the instruments manufactured by the Terumo Corporation. RESULTS: The right-sided radial approach (RA) was used to perform 172 (54.25%) diagnostic and 42 (13.25%) therapeutic coronary interventions. In 18.30% (n=58) of cases we failed to perform PCI through the RA due to various reasons. Compression haemostasis on the right radial artery in 100% of cases was performed using the device for compression of the puncture site TR Band (Terumo, Japan). Complications related to the approach occurred in 1.25% of cases: thrombosis of the radial artery with no evidence of ischaemia of the hand (n=1), haematoma of soft tissues of the forearm (n=1), haematoma of soft tissues of the shoulder (n=2). A dramatic decrease in the duration of PCI was achieved at the expense of using the RA, hydrophilic guide wire and introducer, universal catheter Tiger and Ikari guide catheters (Terumo, Japan). CONCLUSION: The radial approach makes it possible to perform coronary interventions rapidly, conveniently for both the patient and the roentgenosurgeon. The use of specialized tools makes it possible to perform an atraumatic and mild arterial access, decreasing the rate of haemorrhagic complications, providing rapidity, safety, and full control over PCI.

[Angiodysplasias of the head and neck: present-day principles of treatment using elements of plastic surgery].

The authors assessed the outcomes of treatment of fifty-one patients presenting with angiodysplasias of the head and neck. Of these, 24 patients suffered from the venous form and 27 had the arteriovenous form. The 51 patients accounted for 23.5% of the total number of patients with congenital vascular malformations over a five-year period. The topicity and angioarchitectonics of the lesion were specified by means of the standard diagnostic complex (i. e., duplex scanning of the vessels, ultrasonographic study of the soft tissues and osseous structures, computed and magnetic resonance tomography, echocardiography, and angiography). Radical excision of the angiomatous tissues was performed in 15 patients and palliative one - in 36 cases. Eight patients were subjected to stagewise resection interventions, ten patients underwent stagewise sessions of laser coagulation, and seven patients endured stagewise roentgenoendovascular embolisations of the afferent arteries. Two patients with the venous form were postoperatively subjected to sessions of sclerotherapy of the residual venous caverns. Two patients in the remote period (7-10 days) underwent autodermoplasty with a free perforated cutaneous flap. This technique was used while closing the wound surface after removing the angiomatous tissues of the parotid region and hairy portion of the head. In five patients the wound surface was closed with a mobilized cervical fat-cutaneous flap. Taking into consideration the importance of the cosmetic outcome after excising the angiomatous tissues on the face and neck, it is necessary to seek for wide application of plastic methods of closing the wound. These methods simultaneously allow of making operative interventions for angiodysplasias more radical.

[Tactics of surgical treatment of chronic pancreatitis].

585 patients were operated on the reason of chronic pancreatitis. 246 patients received various drainig operations: cystojejunostomy with Roux-en-Y anastomosis (n=97), longitudinal pancreatojejunostomy (n=86), external draining of the absceding postnecrotic cysts (n=51), internal draining (n=12). Resections of the pancreas were performed in 327 cases: Frey operation (n=83), Beger operation (n=46), pancreatoduodenal resection (n=61) - of them 55 were suspicious to cancer and 6 had pancreatic dystrophy. Distal resection of the pancreas was performed in 6 cases. 33 patients were operated on pseudoaneurisms, of the 12 patients received endovascular operations. Posoperative complications were registerd in 119 (20.3%) patients. 7 (1.2%) patients died.

[Endografting of a true aneurysm of the internal carotid artery].

Aneurysms of the internal carotid artery are a rarely encountered nosological entity, with only sporadic clinical cases being reported in both Russian and foreign literature. In the majority of instances, this pathology is removed by means of prosthetic repair of the internal carotid artery. However, recent trends are toward increased use of endovascular endografting. Described in the article is a case of an internal carotid artery aneurysm successfully treated by a self-opening stent graft.