[Endovascular surgery in treatment of patients with acute impairment of mesenteric circulation in the stage of intestinal ischaemia]. / Éndovaskuliarnaia khirurgiia pri lechenii bol'nykh s ostrym narusheniem mezenterial'nogo krovoobrashcheniia v stadii ishemii kishki.

Analysed herein are the results of endovascular revascularization of the superior mesenteric artery (SMA). The study included a total of 18 patients with acute impairment of mesenteric circulation in the stage of intestinal ischaemia. The patients underwent multispiral computed tomography (MSCT) and once impairments of blood flow in the SMA were revealed, we performed endovascular revascularization of the artery. Patency of the SMA was assessed by repeat contrast-enhanced MSCT. Thirteen (72.2%) patients were found to have occlusion in the system of the SMA and five (27.8%) were diagnosed as having significant stenoses of the SMA. All 13 patients with occlusion of the SMA underwent vacuum thrombextraction followed by transluminal balloon angioplasty (TBA). Of these, thrombotic masses were obtained in 11 (84.6%) patients. Stents were implanted in 3 cases wherein TBA turned out inefficient. The patients with haemodynamically significant stenoses of the SMA were subjected to TBA followed by stent implantation. Good roentgenoendovascular results of restoration of blood flow through the SMA and its branches were obtained in 83.4% of cases. Assessing blood parameters and patients' condition severity revealed positive dynamics or a tendency towards improvement. The mortality rate amounted to 16.6%. A conclusion drawn is that this technique is efficient and appropriate for SMA lesions of any localization.

[Endovascular arterial embolization for duodenal bleeding as an alternative to surgical approach].

AIM: To present possibilities of transcatheter arterial embolization (TAE) in duodenal bleeding management. MATERIAL AND METHODS: Treatment of 212 patients with acute duodenal bleeding for the period from 2012 to 2014 was analyzed. In 32 (22.5%) patients of the study group bleeding recurrence or its high risk was indication for TAE. RESULTS: Change of surgical tactics for bleeding from upper gastrointestinal tract including endoscopic hemostasis optimization, wide introduction of TAE and sharp decrease of surgical activity reduced overall mortality to 1.6% in 2012--2014. CONCLUSION: TAE is effective to control bleeding and reduces mortality rate especially in high risk and elderly patients.

[Tactics by the acute intestinal ischemia].

Treatment results of the acute intestinal ischemia in 72 patients were analyzed. Patients aged 69.2 ± 5.8 years. Occlusive vascular lesions of the intestinal vessels (thrombosis and embolism of the superior mesenteric artery and thrombosis of the superior mesenteric vein) were obliged to the ischemic disorders in 84.5% of patients. The rest 15.5% of patients demonstrated microvascular disorders (nonocclusive ischemia). The issue presents the novel algorithm for treatment and diagnostics of the acute intestinal ischemia.