[Transjugular intrahepatic portosystemic shunt (TIPS): an experience with treatment of portal hypertension in patients with cirrhosis of the liver].

TIPS procedures have been successfully performed in 18 of 21 patients aged 34-64 (mean age 40 years) with cirrhosis of the liver with acute gastroesophageal bleedings (5) or history of bleeding episodes from gastroesophageal varices (13). The patients were classified according to Child (1964): A--4; B--8 and C--6. The portal pressure before creation of the shunt measured 17-39 (mean 28.1 +/- 7.6) mm Hg. Dilation of the hepatic tissue was performed by a balloon 10 mm in diameter and 4-6 cm long with placement of metallic endoprostheses 10-12 mm in diameter and 80 mm long. The portal pressure after anastomoses were made dropped to 6-28 (mean 20.3 +/- 5.7) mm Hg. The angiogram showed a rapid flow of the contrast medium through the portocaval anastomosis towards the right heart and no filling of the esophageal veins was seen. TIPS procedure is an effective measure to stop variceal gastroesophageal bleeding in patients with portal hypertension. The necessity of regular surveillance and reinterventions makes this approach a temporary measure to reduce hazardous consequences of gastroesophageal hemorrhages.

[Aneurysms of the pancreaticoduodenal artery in association with stenosis or occlusion of the celiac trunk].

On the basis of an analysis of 69 patients including 2 personal observations the authors discuss the questions of pathogenesis, clinical picture, diagnosis and treatment of aneurysms of the pancreaticoduodenal artery in association with stenosis or occlusion of the celiac trunk (CT). A description of 2 cases with a true not broken aneurysms of the inferior pancreaticoduodenal artery and subocclusion of the celiac trunk is given which was caused by compression of the latter by the median arcuate ligament of the diaphragm and neurofibrous tissue of the celiac plexus. These patients were detected as a result of examinations and operative treatment of 556 patients with compressive stenosis of the celiac trunk for the period from 1982 through 2002. In one case a transcatheter embolization of the aneurysm was fulfilled followed in 3 months by a compression of the celiac trunk, in the other case a compression of the celiac trunk was made first and then in 5 months it was followed by resection of the aneurysm with a favorable outcome.

[Intravascular repair in extended arterial occlusive lesions (a preliminary communication)]. / Vnutrisosudistaia rekonstruktsiia pri protiazhennykh okkliuziruiushchikh porazheniiakh arterii (predvaritel'noe soobshchenie).

Subintimal recanalization as a procedure of percutaneous vascular repair is under study now. The Regional Clinical Hospital has performed 10 procedures of subintimal angioplasty in patients with extended total occlusions of iliac and femoral arteries. All the patients had presented with critical ischemia of the lower extremities with the mean humeromalleolar index of 0.24+/-0.08. A technical success was achieved in 8 patients in whom the mean humeromalleolar index was 0.37+/-0.09. There were no procedure-associated complications.

[Original nitinol monowire stent for percutaneous iliac arterial reconstructions]. / Original'nyi stent iz mononiti nitinola v chreskozhnoi rekonstruktsii arterii podvzdoshnogo segmenta.

Nitinol monowire stents of original construction were implanted to 35 patients (aged from 36 to 84, mean 53.9) with atherosclerotic lesions of iliac arteries. Arterial stenosis ranged from 50% to 100% (mean 72.2%), ankle-brachial index (ABI) averaged 0.45+/-0.12. Initial success was achieved in 97.1% of procedures. Ultrasonography 3 days since the procedure showed the increase of ABI up to 0.78+/-0.16. Restenoses in the stented site was revealed during follow-up period (mean 24.3+/-18.3 months) in 3 patients (8.3%). In conclusion, new stent appeared to be effective tool for treatment of iliac atherosclerotic lesions. However long-term restenoses resulting from intimal hyperplasia can require repetitive revascularization.

[Metallic endoprostheses in the treatment of benign strictures of the biliary tract]. / Metallicheskie éndoprotezy v lechenii dobrokachestvennykh striktur biliarnogo trakta.

Nine original nitinol self-smoothing-out stents and 3 Gianturco stents were implanted to treat benign strictures of biliary ducts and biliodigestive anastomosis after ineffective repeated attempts to make balloon dilatation. There were no complications associated with the implantation procedure. The follow-up of patients varied from 3 to 26 months. After 4 months, reobturation was revealed at the site of repair in one case, which required implantation of an additional stent coated with polytetrafluoroethylene. The patency of the biliary tract was preserved in the remaining patients in the above period.

[Role of spermatic vein phlebography and scleroembolization in treating varicocele and preventing its recurrence]. / Znachenie flebografii i kombinirovannoi skleroémbolizatsii vnutrennikh semennykh ven dlia lecheniia i preduprezhdeniia retsidivov varikotsele.

The phlebograms and intravascular treatment of varicocele were performed in 406 patients aged from 10 to 60 years. Scleroembolization of the left internal spermatic vein was successfully used in 402 of them. Dilatation and retrograde flow through the right internal spermatic vein were recorded in 101 of 238 patients during transjugular catheterization. This investigation has confirmed high effectiveness of the method of the intravascular combined scleroembolization in treatment of varicocele. Using the transjugular access facilitates not only performing the left side intervention but represents the only efficient means to fulfill the right side phlebography of the spermatic vein and its obliteration. The strategy of using the bilateral intervention for the detection of retrograde contrast of the right internal spermatic vein considerably improves the results of treatment of varicocele and decreases risk of relapses.

[Arteriography in critical changes in the iliac arterial bed]. / Arteriografiia pri kriticheskikh izmeneniiakh podvzdoshnogo arterial'nogo rusla.

The authors share their experiences with performing arteriography in 33 patients with spread atherosclerotic occlusions of the iliac vessels. When the traditional accesses were not possible, accesses through the explant (in 22 patients) and the occluded artery (in 11 patients) were used. Investigations with the simultaneous portional administration of heparin were fulfilled in 27 patients with progressing ischemia of the lower extremities and in 6 patients having anastomosis aneurysms. No complications were noted. The femoral access is thought to be preferable in order to reduce the amount of local complications. The experience and up-to-date technical equipment allowed the recanalization of the iliac arteries to be successfully fulfilled which turned the diagnostic measures into the curative endovascular intervention in some patients.