The article discusses the etiology, pathogenesis, classification, principles of diagnosis and tactics of surgical treatment of dural arteriovenous fistulas. Two clinical cases of successful treatment of patients with symptomatic dural arteriovenous fistulas are presented.
Background Assessment of endovascular methods possibilities in the treatment for carotid-cavernous fistulas.
Material and Methods The results of endovascular treatment in 22 patients with carotid-cavernous fistulas in the period from 2008 to 2018 were evaluated. The number of male patients was 13 (59%), female patients – 9 (41%). Fifteen patients (68%) had traumatic damage, 7 patients developed a spontaneous disease. All patients had a specific clinical features of carotidcavernous fistula, confirmed by anamnesis and angiographic study. After verification of the diagnosis, all patients underwent permanent transcatheter embolization of the pathological connection using detachable balloons, microspirals and adhesive composition.
Results Twenty-one patients (95.5%) underwent one-stage embolization of carotid-cavernous fistulas. One patient (4.5%) required three procedures: two embolization with detachable balloons, final embolization with detachable spirals, due to deflation of the balloons in the early postoperative period. Destructive embolization of carotid-cavernous fistulas was performed in 2 cases (9%), reconstructive interventions were performed in 20 cases (91%). The angiographic success of the procedure was 100%. All treated patients had regression of symptoms during their hospital stay. During this period, one complication was identified in the form of post puncture hematoma, which required conservative treatment.
Conclusion Endovascular treatment is a modern, effective and safe method for treating carotid-cavernous fistulas. Destructive occlusion (if there is no possibility of performing reconstructive intervention) is also a safe and clinically justified method for treating this pathology.
The article is devoted to a clinical case of management of a young woman with an aneurysm and two atrial septal defects after the development of acute myocardial infarction. It conveys aspects of differential diagnosis and long-term management.
In most cases, patients with multifocal atherosclerotic lesions, including brachiocephalic arteries, are denied surgical treatment due to the high risks of intra- and postoperative complications. Despite the severe stenotic lesion of the carotid arteries, which can lead to such a major complication as ischemic stroke, in most cases surgeons refuse to perform the operation. Endovascular surgery is often the only option for these patients. After analyzing the world experience in the treatment of hemodynamically significant lesions of the arteries of the brachiocephalic basin and applying in practice various methods of endovascular interventions in patients with complex stenotic lesions of the internal carotid arteries, we were convinced that endovascular correction of such lesions is often the main method of treatment for patients with multifocal atherosclerosis, and can also be used as a primary method of treatment, as it demonstrates high effectiveness, low risk of complications and good long-term results.
Despite the rapid evolution in the development of endovascular surgery, the mortality of patients undergoing percutaneous coronary interventions (PCI) with high risk of severe cardiac complications and critical conditions (cardiogenic shock, cardiac arrest) remains extremely high. The success of PCI directly depends on the ability of the Heart Team to prevent and timely eliminate severe cardiac disorders. Despite the rapid evolution in the development of endovascular surgery, the mortality of patients undergoing percutaneous coronary interventions (PCI) with high risk of severe cardiac complications and critical conditions (cardiogenic shock, cardiac arrest) remains extremely high. The success of PCI directly depends on the ability of the Heart Team to prevent and timely eliminate severe cardiac disorders. Pharmacological therapy is not able to completely resist the development of severe cardiac events during PCI. In such situations the usage of devices for percutaneous mechanical circulation support (PMCS) can make an invaluable help in the treatment of this group of patients. Despite the fact that the PMCS devices are used to stabilize patients with cardiogenic shock and to provide hemodynamic support for high-risk PCI for several decades, the results of their application remain ambiguous. The purpose of this article is to review all existing literature on modern PMCS devices, available data and research results, indications for their use, and operational considerations that can ensure the decision-making process in selecting optimal PMCS devices.
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