[Primary retrograde distal access for endovascular interventions in patients with lower limb ischemia]. / Pervichnyi retrogradnyi distal'nyi dostup pri endovaskulyarnykh vmeshatel'stvakh u patsientov s ishemiei nizhnikh konechnostei.

OBJECTIVE: To evaluate safety and technical efficiency of primary retrograde distal access for endovascular interventions in patients with lower limb ischemia. MATERIAL AND METHODS: A prospective analysis included 25 endovascular procedures via primary retrograde distal access in 23 patients with chronic obliterating diseases of lower limb arteries. Occlusive lesion of femoral-popliteal segment was observed in 68% of cases, occlusion of at least one tibial artery was also found in 68% of cases. In 44% of cases, occlusive lesion was localized at several levels. Percutaneous intervention via anterior tibial artery or dorsalis pedis artery was performed in 68% of cases, posterior tibial artery - 24% of cases, peroneal artery - 8% of cases. We used 2 accesses in 92% of cases (the main one for intervention and additional one for angiography). In 8% of cases, intervention was carried out through a single access. Angiosome artery was punctured in 65% of cases. The only patent tibial vessel was used in 20% of cases. In 24% of cases, we performed antegrade recanalization of 'adjacent' tibial artery via distal access. RESULTS: Primary retrograde distal access was successfully performed in 100% of cases. Retrograde revascularization was not successful in all cases (successful recanalization rate 96%, retrograde intervention rate - 92%). Femoral access was performed in 8% of cases. Antegrade blood flow through at least one tibial artery was restored in all cases. Direct revascularization of the affected angiosome was performed in 15 patients with foot necrosis, indirect revascularization through collaterals - in 5 patients. Local complications of surgical access occurred in 12% of cases. CONCLUSION: Endovascular revascularization via primary retrograde distal access was technically effective in most cases. There were no complications with systemic consequences.

[Combined treatment of complicated forms of angiodysplasias in conditions of a multimodality hospital].

Presented herein is a case report dealing with successive combined treatment for arteriovenous malformation of the left part of the chest, macrofistular form complicated by necroses of the left thoracic portion with arrosive haemorrhage from the area of necrosis. The authors describe diagnosis of this disease, technical peculiarities of performing transcatheter endovascular occlusion and topical treatment of wounds, underlining difficulties of verifying the pathology concerned at the prehospital stage and prevention of complications. Particular emphasis in management of these patients is placed upon therapeutic decision-making. Radical excision of tissue practically completely consisting of dilated thin-walled vessels may result in massive perfuse haemorrhage and is often impossible. Selective exclusion of feeding arteries by endovascular methods frequently leads to formation of necroses, does not differ in radical nature because of the presence of multiple arteriovenous fistulas and requires regular follow up of the patient due to a possibility of relapse. The final therapeutic decision should be made in the context of a particular patient, since there are no versatile approaches to management of the pathology concerned.

[The characteristics of mine-blast wounds in shoals]. / Osobennosti minno-vzryvnykh ranenii na melkovod'e.

The data obtained in experiments on shoal using plastic charges of 100-50-25 g of equivalent power of antipersonnel mines showed that injuring action on shoal was four times greater than that on land and resulted in considerably graver skeletal traumas and distant injuries. Of special significance in pathogenesis of mine-explosive wounds on shoal is pneumonia followed by arterial air embolism and encephalopathy. Although the undermining on land and on shoal have many common etiopathogenetic features, there are substantial differences first of all due to different mechanisms of their appearance. It must be taken into account while performing evacuatory, diagnostic and medical measures in such patients.