[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.

[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.

[Endovascular intrahepatic portacaval shunting]. / Endovaskuliarnoe vnutripechenochnoe portokaval'noe shuntirovanie.

Pilot experience in Russia of transjugular intrahepatic portosystemic shunting is presented. Results of endovascular shunting in 14 patients with cirrhosis of the liver were analyzed. Four patients underwent emergency endovascular shunting when conservative treatment was not effective. Ten patients underwent elective surgery. Repeated esophagealgastric bleedings were indications for shunting. Relapse of bleeding was seen in 1 patient 5 days after surgery. Regular dopplerography permitted to reveal timely stenotic process. When stenosis of portosystemic shunt was diagnosed, ambulatory balloon dilatation of anastomosis through transjugular approach was performed. It was enough for opening of anastomosis lumen and decrease of pressure gradient.

[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.

Extraorganic hepatic artery aneurysm: failure of transcatheter embolization.

Hepatic artery aneurysm (HAA) was diagnosed in a 62-year-old man who was a poor candidate for surgery because of severe liver cirrhosis and diabetes mellitus. Two attempts to occlude the HAA by transcatheter embolization failed because of recanalization of the aneurysm. Moreover, aneurysmal dilatation of the superior mesenteric artery and the left renal artery developed and progressed. Both the literature and the present case show that an individual approach to treatment of extraorganic HAA should be chosen in dependantan location and anatomy of the lesion.

Pelvic pain syndrome caused by ovarian varices. Treatment by transcatheter embolization.

PURPOSE: The aim of this study was to evaluate the clinical effect of therapeutic embolization in the pelvic congestion syndrome caused by ovarian varices. MATERIAL AND METHODS: Six women, aged 25-40 years, with pelvic pain syndrome and marked left (n = 5) or bilateral (n = 1) ovarian varicocele were treated by transcatheter retrograde venous embolization. RESULTS: The pelvic pain syndrome disappeared in all patients within 4 weeks, and there was regression of the periodic pain in 2 women with dysmenorrhoea. The patients were free of symptoms during the 1-4-year follow-up. CONCLUSION: Marked ovarian varices may cause a pelvic pain syndrome. Percutaneous embolization improves both the chronic pain and the dysmenorrhea in these patients. Transcatheter treatment could be considered as an alternative to surgical or laparoscopic ligation in ovarian varicocele.

[The large-pore stent in the treatment of abdominal aortic aneurysms]. / Krupnoiacheistyi stent v lechenii anevrizm abdominal'noi aorty.

The authors have performed 8 endoprostheses for aneurysms of the abdominal segment of the abdominal aorta. The open cellular stent of nitinol was implanted with diameter 32 mm, bringing system 9.0 F. The implantation was carried out without problems in 7 patients, in one patient there was dislocation of the distal fragment of the endoprosthesis which required surgical intervention. The average time of operations was (7.6 +/- 4.5) min. The open stent allowed the invasiveness of operation, its technical complexity and duration to be reduced.

Arterioportal fistulas (APF) in liver tumors: prognosis in relation to treatment.

Prognosis of 16 patients with hepatic tumors and angiographically proven arterioportal fistulas was analysed in relation to treatment. Six patients received only conservative therapy; they all died of variceal bleeding in the course of two months after angiography. Hepatic resection was performed in four patients; three of them are still alive 13-52 months later including two free of both the tumor and portal hypertension. Hepatic artery embolization was carried out in six patients. All of them died in 2-36 months after the procedure, but only two from gastroesophageal hemorrhage. It is concluded that prognosis of arterioportal fistulae in liver neoplasms is poor due to hyperkinetic portal hypertension and following variceal bleeding. Hepatic resection of both the tumor and the fistula is the treatment of choice. In unresectable cases hepatic artery embolization will decrease the risk of variceal hemorrhage.

[Long-term results of the embolization of the hepatic and splenic arteries in liver cirrhosis]. / Otdalennye rezul'taty émbolizatsii pechenochnoi i selezenochnoi arterii pri tsirroze pecheni.

The authors studied the long-term results of portal hypertension correction in patients with far-advanced stages of cirrhosis of the liver. Embolization of the hepatic and/or splenic arteries was performed in 231 patients (147 males and 84 females) aged from 17 to 70 years. Sixty-seven patients are alive at present, the average duration of the follow-up period is 57.9 +/- 19.8 months. Four patients were not followed up; 160 patients died, 18 (7.8%) of them within 30 days after an endovascular manipulation. The mean survival of patients who were discharged from the clinic was 21.1 +/- 17.4 months. Survival was higher among patients treated by successive embolization of the hepatic and splenic arteries than in those treated by occlusion of one of these vessels. Comparative analysis showed that embolization of arteries of the hepatolienal zone prolongs the life of patients with complicated forms of portal hypertension in cirrhosis of the liver.