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.

[Clinical and morphological aspects of shigellosis flexneri in patients with an aggravated premorbid state]. / Kliniko-morfologicheskie osobennosti shigelleza fleksnera u bol'nykh s otiagoshchennym premorbidnym fonom.

The analysis of 10 fatal outcomes in patients with acute shigellosis during the period of 1999-2000 made it possible to find out that most of deceased shigellosis patients belonged to the group inclined to alcohol abuse and having initial alimentary disturbances. In 6 cases of acute shigellosis with fatal outcome the causative agent was S. flexneri 2a, in 2 cases--S. flexneri 3a, in 1--S. flexneri 4b. The main cause of fatal outcomes was accompanying double pneumonia. Lesions of the intestinal tract in deceased shigellosis patients were of destructive character, resulting, in a number of cases, in serous and perforative peritonitis.

[Transcutaneous transvenous occlusion of patent ductus arteriosus]. / Chreskozhnaia transvenoznaia okkliuziia otkrytogo arterialnogo protoka.

Transvenous closure is described of the patent ductus arteriosus with a conical device that consists of polyurethane foam mounted on a stainless steel flame. Since 1981, the procedure has been performed in 273 patients in Russia. Permanent complete ductus closure was achieved in 258 (95%) patients. In eight cases (3%), the occlusion was incomplete. Complications occurred in 10 patients (4%), seven of whom required emergency surgery. The new technique combines certain advantages of both alternative methods. The conical shape of the occlusion device is well suited for the anatomic structure of the ductus. The possibility of selecting the size of the device permits reduction in the rate of incomplete closure while still taking advantage of transvenous delivery to avoid entryside problems. In the initial 10 years of experience, the described technique proved effective, safe, and applicable in the vast majority of patients older than 2 years.

[A method of percutaneous transhepatic drainage and endoprosthesis of the bile ducts]. / K metodike chreskozhnogo chrespechenochnogo drenirovaniia i éndoprotezirovaniia zhelchnykh putei.

A technique of the external, external-internal and internal drainage (endoprosthesis) of bile ducts is described in detail. It was used in 75 patients with different diseases of organs of the hepato-pancreato-duodenal area. The method of the percutaneous transhepatic drainage and endoprostheses of bile ducts was standardized, the instruments necessary for transhepatic interventions on the biliary system being also determined.