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.

Anatomic and hemodynamic changes in the inferior vena cava associated with prevention of pulmonary thromboembolism.

This paper analyzes the results of a multimodality instrumental study of the structural and functional properties of the inferior vena cava (IVC) in 173 patients with acute venous thrombosis, who underwent different interventions aimed at pulmonary thromboembolism (PTE) prevention. Of these, 63% of patients were examined in the long-term period, within the time 2 to 36 months. 26% of patients were found to have variants of the anatomic structure of the IVC system, such as the doubling of the renal veins, ring-shaped structure or entry to the IVC at a distance exceeding 5 cm from each other. The paper also provides a detailed analysis of the hemodynamic parameters (maximal and minimal linear flow velocities in the IVC, time-averaged maximal linear flow velocities and their different indices) and of their changes as dependent on the type of interventions on the IVC. It has been established on the basis of the data obtained that endovascular catheter thrombectomy is the method for PTE prevention because it restores the IVC lumen and refines the regional hemodynamics. Cava filter implantation induces a rounded deformation and expansion of the infrarenal IVC up to 40.9% of the area of its cross section but exerts a minimal adverse effect on the flow. IVC plication leads to a slit-like deformation and a 12.9% stenosis of its lumen as well as to deceleration of the flow acquiring a turbulent character.

[Endovascular surgery in prophylaxis of pulmonary thromboembolism and treatment of acute venous thrombosis]. / Endovaskuliarnaia khirurgiia v profilaktike tromboémbolii legochnoi arterii i lechenii ostrykh venoznykh trombozov.

From 1995 to 2001 1089 patients underwent 1141 endovascular procedures for treatment of acute thrombosis of vena cava inferior (VCI) system and prophylaxis of pulmonary thromboembolism (PT) including 61 catheter thrombectomies from VCI and common iliac veins, 35 regional thrombolyses, 880 implantations of permanent cava-filter "hourglass" and it modifications, 159 implantations of temporary cava-filter "umbrella", 3 implantations of filter-stent, 3 thrombectomies of a giant mobile thrombus with Dotter basket with subsequent cava-filter implantation. Efficacy of PT prophylaxis after these procedures was 97.9%. Catheter thrombectomy and regional thrombolysis permitted to repair passage through deep veins in 69.8% patients. Temporary cava-filter after treatment was removed in 49.1% patients. After implantations of permanent cava-filters early and late complications were seen in 8.9% cases.

[Endovascular embolization of the gastric veins in portal hypertension complicated by esophagogastric hemorrhages]. / Endovaskuliarnaia émbolizatsiia ven zheludka pri portal'noi gipertenzii, oslozhnennoi ézofagogastral'nymi krovotecheniiami.

Through a period from 1981 to 1996 127 roentgen-endovascular embolization of gastric veins were carried out in 95 patients for portal hypertension complicated by esophagogastric bleeding or in its threatening relapse. Group 1 consisted of 73 patients, to whom endovascular treatment was carried out urgently at the background of continuing hemorrhage, in 52 patients--it was delayed and in 21 patients in the nearest posthemorrhagic period. In 73 patients bleeding resulting from embolization was stopped. In the earliest postembolization period recurrence of hemorrhage developed in 6 patients, thus initial hemostatic effect of embolization made up 91.8%, and survival rate--74% (54 from 73 patients of the 1-st group were discharged from the clinic). Group 2 consisted of 22 patients to whom embolization of gastric veins was carried out as an elective procedure. There were bleedings in the anamnesis in the patients of the latter group, and varicose veins of the esophagus with trophic disturbances in esophageal mucosa manifested real treat of the hemorrhage. The survival rate in this group of patients made up 95.5%. The analysis of the results of elective endovascular embolization of gastric veins revealed more favourable results in the nearest postembolization period, than in urgent procedures. Far off results of embolization of gastric veins were followed up in 61 patients (43 patients of the 1st group and 18 patients of the 2nd group). Index of survival up to 6 months made up 87.8%, up to 12 months--80.5%, up to 3 years--57.5% and up to 6 years--19.6%. Hemostatic effect up to 6 months made up 100%, to 12 months--84.6%, to 3 years--54.9%, to 6 years--15.6%.

[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.

[The results of endovascular embolization of the gastric veins in patients with portal hypertension complicated by esophagogastric hemorrhage]. / Rezul'taty éndovaskuliarnoi émbolizatsii ven zheludka u bol'nykh portal'noi gipertenziei, oslozhnennoi ézofagogastral'nym krovotecheniem.

An experience with using endovascular venous embolization in 53 patients with bleeding from varices of esophageal veins is presented. Transhepatic, transsplenic and laparotomic accesses were used. Embolization of the gastric veins was fulfilled with nonlysing materials--teflon velour in combination with metallic spirals. The results obtained proved to be better than those known from the literature.

[Transcutaneous transsplenic catheterization of the splenic vein]. / Chreskozhnaia chresselezenochnaia kateterizatsiia selezenochnoi veny.

The authors have developed a method for transcutaneous transsplenic catheterization of the portal vein basin and used this method in clinical studies. This method permits a higher quality of spot splenoportography, selective catheterization and embolization of the gastric veins in bleedings from varicose veins of the esophagus in the patients in whom catheterization of the portal vein bain via the transcutaneous transhepatic approach is impossible because of liver tumors of occlusive stenotic deformation of the portal vein.

[The procedure for percutaneous endovascular angioplasty in multiple occlusive-stenotic lesions of the arteries of the pelvis and lower extremities]. / Taktika chreskozhnoi éndovaskuliarnoi angioplastiki pri mnozhestvennykh okkliuzionno-stenoticheskikh porazheniiakh arterii taza i nizhnikh konechnostei.

The authors consider the tactical features of transcutaneous endovascular angioplasty in 110 patients with multiple arterial occlusive and stenotic lesions of the pelvis and lower extremities. A total of 299 arteries were operated on and desobliteration of stenoses and occlusions were performed. Five procedures of transcutaneous endovascular angioplasty: via transfemoral antegrade, transfemoral retrograde, transfemoral contralateral, transpopliteal, and transaxillary accesses were used alone or in combination. The tactics of transcutaneous endovascular angioplasty was determined by the nature, site, and extent of lesions, as well as the status of the distal arterial bed. Clinical positive results of transcutaneous endovascular angioplasty were obtained in 94 (85.4%) patients. Complications following endovascular interventions were encountered in 5 (4.6%) cases.

[Correction of dyslipidemia in patients with arteriosclerosis obliterans as a method for improving the results of endovascular angioplasty]. / Korrektsiia dislipidemii u bol'nykh obliteriruiushchim aterosklerozom kak sposob uluchsheniia rezul'tatov éndovaskuliarnoi angioplastiki.

The authors analyse the results of endovascular angioplasty of the pelvic and lower limb arteries in 147 patients of various age suffering from arteriosclerosis obliterans. It was found that the results of endovascular angioplasty depended on the state of the lipid balance. The necessity for correcting the shifts in the lipid metabolism is shown. The article evaluates the results of dyslipidemia correction by dietotherapy, pharmacotherapy, and operation for partial ilio-shunting in patients with arteriosclerosis obliterans of the pelvic and lower limb arteries. The efficacy of the listed methods of treatment are analysed according to the severity of dyslipidemia.

[Age and dyslipidemia as risk factors in transcutaneous transluminal angioplasty]. / Vozrast i dislipidemiia kak faktory riska pri chreskozhnoi transliuminal'noi angioplastike.

The paper outlines the analysis of immediate and late outcomes of transcutaneous transluminal angioplasty (TTA) in 147 patients with atherosclerosis obliterans of the lower extremities. The study has revealed that age and dyslipidemia as TTA risk factors fail to affect the immediate outcomes in the early postoperative period. There is a positive correlation of the reocclusion time after TTA and the age and lipid metabolic disturbances in patients with atherosclerosis obliterans of the lower extremities in long-term periods. The paper provides strong evidence for that it is essential to correct dyslipidemias in order to make TTA results better in these patients.

[Regional thrombolytic therapy of thrombosis of arteries of the pelvis and lower extremities]. / Regionarnaia tromboliticheskaia terapiia v lechenii trombozov arterii taza i nizhnikh konechnostei.

Regional thrombolysis was performed in 62 patients with thrombosis of the aorta and arteries of the pelvis and lower extremities. The thrombolytics used were avelysin (20 patients) and celiase (42 patients). Complete lysis of the thrombi was recorded in 49 cases. After successful thrombolytic therapy balloon angioplasty of the revealed stenoses was carried out in 39 patients. After thrombolysis was completed 15 patients underwent various reconstructive operations which failed to produce an effect in 4 patients and the extremity was amputated. The complications of thrombolysis included hematomas at the site of catheterization of the arteries in 5 patients, distal embolism in 7, and an allergic reaction in one patient. The authors appraise the dependence of thrombolysis efficacy on the level, extent, and duration of the thrombotic occlusion.

[Morphological changes in patent ductus arteriosus after endovascular occlusion (clinico-experimental study)]. / Morfologicheskie izmeneniia v otkrytom arterial'nom protoke posle endovaskuliarnoi okkliuzii (kliniko-éksperimental'noe issledovanie).

The work is based on a comparison of data gained in experiments with the results of clinical examination of a large group of patients in the late-term period after endovascular occlusion of a patent ductus arteriosus (PDA). The regular features of the course of the morphological process in the zone of the PDA after implantation of a botallo-occluder into it were studied. Clinico-morphological parallels were made. The high efficacy and reliability of the new method of endovascular treatment of PDA, developed at the Moscow Second Medical institute, was substantiated morphologically and confirmed clinically.

[Transhepatic endoprosthesis of the bile ducts]. / Chrespechenochnoe éndoprotezirovanie zhelchnykh protokov.

The authors analysed the results of percutaneous transhepatic endoprosthetics of the hepaticocholedochus in 38 patients with incurable tumors of the organs of the hepato-pancreato-duodenal zone, complicated by obstructive jaundice. Nine different types of bile ejection blocking were distinguished, according to which the method and tactics of the endobiliary intervention were elaborated. Measures for the prevention of cholangitis, bleeding into the abdominal cavity, and hemobilia in the postoperative period are described in detail. The article shows the results recorded in flow-up periods of one to 11 months in 26 patients who had been subjected to endoprosthetics of the bile ducts and discharged from the clinic for out-patient treatment. Recurrence of obstructive jaundice caused by incrustation of the prosthesis was encountered only in 2 patients 4 and 9 months after the intervention. This allowed the authors to conclude that endoprosthetics of the hepaticocholedochus is very effective in the treatment of patients with obstructive jaundice of neoplastic etiology and to consider a transhepatic intervention an alternative of a surgical operation.

[The use of digital subtraction angiography in diseases of the arteries of the pelvis and lower limbs]. / Primenenie digital'noi subtraktsionnoi angiografii pri zabolevaniiakharterii taza i nizhnykh konechnostei.

The diagnostic potentialities of digital subtraction angiography (DSA) in diseases of the pelvic arteries and lower limbs were studied. Intravenous (iv) and intraarterial (ia) DSA were performed in 613 patients, among them were patients with obliterating atherosclerosis and endarteritis, thromboembolism, aneurysms and arteriovenous fistulas. Iv DSA provided good information for the solution of therapeutic and tactical problems in pelvic, femoral and popliteal arterial lesions but in 16% of the cases it gave no opportunity to assess the status of the crural arteries. Ia DSA was shown to be no inferior to routine arteriography in the visualization of the lower limb arteries. This method is economical, well tolerated by patients, permits the intensification of examination of patients with acute and chronic arterial pathology. It can be employed under outpatient conditions and in the early postoperative period.

[Prevention of pulmonary thromboembolism by percutaneous implantation of REPTELA vena cava-filter]. / Profilaktika tromboémbolii legochnoi arterii metodom chreskozhnoi implantatsii kava-fil'tra REPTELA.

Experience in clinical application of the new antiembolic REPTELA cava-filter is generalized. The immediate (750 patients) and late-term results (400 patients) of implantation of the filter are discussed. Thromboembolism of the pulmonary artery was encountered in the postimplantation period in 1.2% of patients with 0.2% lethality. Technical faults of implantation were the causes of antiembolic inefficacy of the cava-filter.