[Multidisciplinary approach in cardio-oncology for high inferior vena cava thrombosis]. / Mul'tidistsiplinarnyi podkhod v kardioonkologii pri lechenii bol'nykh s opukholevym trombozom nizhnei poloi veny vysokogo urovnya.

The authors present a 75-year-old patient with renal cell carcinoma and subdiaphragmatic inferior vena cava thrombosis. Renal cell carcinoma stage III T3bN1M0, inferior vena cava thrombosis, anemia, severe intoxication syndrome, coronary artery disease, multivessel atherosclerotic lesion of coronary arteries, angina pectoris class 2, paroxysmal atrial fibrillation, chronic heart failure NYHA class IIa and post-inflammatory lung lesion after previous viral pneumonia were diagnosed at admission. A council included urologist, oncologist, cardiac surgeon, endovascular surgeon, cardiologist, anesthesiologist and specialists for X-ray diagnosis. Stage-by-stage surgical treatment was preferred with off-pump internal mammary artery grafting at the first stage and right-sided nephrectomy with thrombectomy from inferior vena cava at the second stage. Nephrectomy with thrombectomy from inferior vena cava is the «gold standard¼ for patients with renal cell carcinoma and inferior vena cava thrombosis. This highly traumatic surgery requires not only accurate surgical technique, but also specific approach to perioperative examination and therapy. Treatment of such patients is recommended to be carried out in a highly specialized multi-field hospital. Teamwork and surgical experience are very important. Team of specialists (oncologists, surgeons, cardiac surgeons, urologists, vascular surgeons, anesthesiologists, transfusiologists, diagnostic specialists) harmonizing a single management strategy at all stages of treatment increases effectiveness of treatment.

[Endovascular treatment of delayed arterial bleeding after pancreatic surgery: single-center experience]. / Rezul'taty rentgenendovaskulyarnogo lecheniya pozdnego arterial'nogo krovotecheniya posle operatsii na podzheludochnoi zheleze. Opyt odnogo tsentra.

OBJECTIVE: To evaluate technical aspects and clinical results of transcatheter arterial embolization (TAE) for delayed postoperative arterial bleeding after pancreatic surgery. MATERIAL AND METHODS: There were 821 pancreatectomies between 2012 and 2020. Delayed bleeding occurred in 106 (12.9%) patients; 74 patients were included in the study. Previous pancreatic head resection was carried out in 75.7% of cases, pancreatic body resection - in 17.6% of cases, pancreatic tail resection - in 6.8% of patients. Primary endpoint was technical success of TAE, secondary endpoints - complications after TAE, as well as recurrent bleeding after embolization. RESULTS: Angiography of celiac-mesenteric arterial system was performed in 74 patients (91 procedures). The most common sources of bleeding were gastroduodenal and superior mesenteric arteries (35.7%), jejunal arteries (13.1%), common hepatic artery (11.9%). Combination of embolization agents was applied for TAE (metal coils and non-calibrated PVA particles, 48.6%). In 11 (14.9%) patients, we applied stent-grafts. Technical success rate was 100%. Recurrent bleeding occurred in 13 (17.6%) patients. In-hospital mortality was 12.2% (n=9). CONCLUSION: TAE is an effective treatment procedure in patients with arrosive bleeding. This method is characterized by high technical efficiency and low in-hospital mortality, but it does not affect recurrence of bleeding.