[Endovascular treatment of aneurysms and pseudoaneurysms of visceral arteries]. / Éndovaskuliarnoe lechenie anevrizm i psevdoanevrizm vistseral'nykh arterii.

AIM: The purpose of the study was to demonstrate the possibilities and efficacy of endovascular interventions in patients with visceral artery aneurysms. PATIENTS AND METHODS: From 2013 to June 2020, we performed 15 embolizations of visceral artery aneurysms in 15 patients (8 men and 7 women). The technical success rate was 100%. The patients' age varied from 32 to 71 years. In 8 cases, the aneurysm was located in the basin of the splenic artery, in 3 cases in the gastroduodenal artery, in 2 cases in the superior mesenteric artery and in 2 cases in the renal artery. Three aneurysms were classified as false, and 12 as true. All aneurysms were saccular, with their diameter ranging from 6 to 32 mm. In 2 patients aneurysms were detected after endured infective endocarditis, in 8 during examination in abdominal pain syndrome, and in 5 cases as an incidental finding while performing computed tomography of abdominal organs. One patient was subjected to embolization of the afferent vessel, two underwent implantation of stent grafts into the aneurysmal neck area, and eleven underwent aneurysmal sac embolization with microcoils. In 9 cases, embolization was performed using microcoils only in 1 case using microcoils with balloon assistance, and in 2 cases using microcoils with stent assistance. We used from 1 to 12 microcoils, with a diameter of from 2 to 30 mm. RESULTS: During endovascular embolization of visceral artery aneurysms there were no target-organ infarctions, haemorrhagic complications, nor lethal outcomes. In the early postoperative period, 7 patients developed pain syndrome. In 1 case pain syndrome was relieved by narcotic analgesics, in 4 cases by spasmolytics, and in 2 cases by a combination of spasmolytics and non-narcotic analgesics. CONCLUSION: Endovascular treatment of visceral arterial aneurysms is an efficient and safe method.

[Embolization of a pseudoaneurysm of the inferior gastroduodenal artery]. / Émbolizatsiia lozhnoi anevrizmy nizhnei zheludochno dvenadtsatiperstnoi arterii.

Aneurysms and pseudoaneurysms of visceral arteries are relatively rare clinical entities and their pathogenesis has not yet been fully understood. Aneurysmal rupture appears to be a complication leading to life-threatening internal haemorrhage and is a cause of high mortality. However, advances in endovascular surgery techniques have extended the capabilities of treating aneurysms, allowing microemboli to be delivered even to the hard-to-reach portions of the vascular bed with complicated anatomy. Presented in the article is a clinical case report regarding embolization of a false aneurysm of the inferior gastrointestinal artery, separated by a microcoil, and demonstrating possibilities of endovascular superselective embolization of the target vessel.

[Intracardiac and Pulmonary Cement Embolism after Percutaneous Vertebroplasty].

The article presents a clinical case of embolism with bone cement of the right ventricle of the heart and pulmonary artery after percutaneous vertebroplasty in a patient aged 63 years. According to the results of a comprehensive examination using ultrasound and x-ray methods, three foreign bodies were found: in the right ventricle cavity, in the trunk of the pulmonary artery, in the branches of the left pulmonary artery. Considering the stable condition, normal blood oxygen saturation, the lack of influence of formations on intracardiac hemodynamics, it was decided to refrain from surgery, since the risk of intervention exceeded the possible benefit. Conservative treatment tactics and dynamic observation were chosen. The literature data on the frequency of such events and tactics of management of these patients are presented.

[Mini-invasive operations in patients with vessels diseases].

Hybrid operations combining open and endovascular surgeries are used in cardio-vascular surgery for the last 10-15 years. It leads to decrease complications frequency and mortality in case of pronounced comorbidities and severe heart, aorta and its branches disease. Authors have experience in performing of 10 hybrid surgeries and 7 aneurysms endoprosthesis of abdominal aorta. All operated patients had severe comorbidities which significantly increase risk of open surgery. These comorbidities were contraindication for open surgery in patients with abdominal aorta aneurysm. Thanks to introduction into practice hybrid operations and aorta aneurysms endoprosthesis the authors decreased complications frequency and avoided deaths in operated patients.

[Stagewise bilateral stenting of vertebral arteries in a patient with occlusion of both internal carotid arteries].

The authors describe herein a case report concerning stagewise endovascular treatment of a 69-year-old male patient presenting with occlusion of the right and left internal carotid arteries admitted to Clinical Hospital № 1 of the RF President's Affairs Administration with the following diagnosis: atherosclerotic occlusion of carotid arteries, arterial hypertension, chronic bronchitis, chronic prostatitis, and a history of multiple episodes of unconsciousness. Duplex scanning and angiography of the brachiocephalic arteries revealed occlusion of the both internal carotid arteries, as well as pronounced narrowing of the ostium of the right and left vertebral arteries supplying blood to all portions of the brain. Computed tomography revealed no signs of endured stroke. The first stage consisted in stenting of critical stenosis of the left vertebral artery ostium, followed by stenting of the right vertebral artery ostium performed 2 weeks after (with implanting drug-covered stents «Promus¼ in both cases). The patient was discharged home in a satisfactory condition.

[Landmark of the internal carotid artery stenting, anterior interventricular branch of the left coronary artery and vertebral artery in a patient with multifocal atherosclerosis].

Presented herein is a clinical case report concerning a 59-year-old male patient suffering from multifocal atherosclerosis after endured repeat acute ischaemic attacks in various arterial basins of the brain. Analysing his case history revealed functional class II-IV angina of effort. Ultrasonographic and angiographic findings showed a haemodynamically significant plaque in the ostium of the left internal carotid artery, hypoplasia of the right vertebral artery, a haemodynamically meaningful narrowing of the left vertebral artery, subtotal stenosis of the anterior interventricular branch and pronounced alterations in the right vertebral artery. The first stage of surgery consisted in stenting of the left internal carotid artery and anterior interventricular branch, followed by the second stage consisting in the stenting of the left vertebral artery with an angiographically good outcome. The check-up CT of the brain and 24-hour ECG monitoring showed no negative dynamics. In July 2005, the patient was subjected to craniocerebral microarterial shunting on the right. No relapses of AIAs have so far been observed.

[Short- and long-term effects of internal carotid arteries stenting in high-risk patients].

The efficacy of endovascular treatment of internal carotid arteries (ICA) stenosis (20 patients) has been compared to that of conventional carotid endarterectomy (25 control cases). ICA stenting was performed in case of stenosis, narrowing arteries to > or = 60% in "symptomatic" patients and to > or = 80% in "asymptomatic" ones. Angiographic indices revealed favorable outcome after stenting in 100%. Mean extent of residual stenosis was 8.3 +/- 0.8%. Significant complications (stroke/fatal outcome) after 22 procedures developed in 3 (13.6%) cases. Mortality was estimated as 4.5%. Taking stroke and fatal cases into account, the interventions were successful in 86.4% cases. The duration of follow-up study was from 1 to 48 months, with 1 case resulting in death and 2--in development of acute disturbance of cerebral blood circulation of contralateral ICA. Short- and long-term results of the intervention did not significantly differ between the study and control groups thus indicating ICA stenting as an alternative to carotid endarterectomy procedure.