The aim: The retrospective analysis of the angiographic picture and clinical results of endovascular treatment of patients with postoperative abdominal and gastrointestinal bleeding was carried out. Materials and methods: The results of 447 endovascular diagnostic and therapeutic interventions in 391 patients (46 military and 345 civilians) with postoperative bleeding performed from 2012 to 2022 were studied. According to computer tomography with contrast enhancement, the source of bleeding was identified in 216 (67.7%) cases. Results: In 345 (88.2%) patients, it was possible to reliably identify the source of bleeding on angiography. In 46 (11.8%) patients with an unexplained source of bleeding, the target arterial pool was determined on the basis of localization, volume, and features of surgical intervention and considered as preventive interventions. A total of 447 endovascular hemostatic interventions were performed on 391 patients. A stent graft was installed in 27 patients, 420 embolization were performed in 364 patients. Thus, in 43 (11.0%) patients, embolization was performed repeatedly, in 12 cases - three times, in 1 case - four times. In 16 cases (15 cases of prophylactic embolization), endovascular hemostasis was ineffective and required subsequent surgical intervention Conclusions: Endovascular interventions are an effective method of diagnosis and treatment of postoperative abdominal bleeding. Prophylactic embolization allows you to prevent the recurrence of postoperative bleeding with an instrumentally undiagnosed source, however, you need to be prepared for the multi-stage treatment aimed at sequentially shutting down the collateral blood supply to the damaged area.
Objective ‒ to determine the place of transarterial chemoembolization of the liver (TACE) in the modern protocol for treating patients with common hepatocellular carcinoma and by optimizing indications and contraindications to improve the results of complex treatment of these patients.Materials and methods. During the period 2011‒2021 242 TACE procedures were performed on 112 patients with inoperable hepatocellular carcinoma. Conventional lipidol embolization (c-TACE) was performed in 53 patients, procedures with drug eluting beads (DEB-TACE) ‒ in 58. All patients underwent a minimum of 1, a maximum of 5 TACE procedures. The decision to re-TACE was made individually, according the prevalence of the lesion (for bilobar lesions performed at least 2 unilobar TACE) and the tumor’s response to the intervention. Results. TACE results were evaluated according to mRECIST criteria: complete tumor response (CR) was noted in 3 (2.7 %) cases, partial (PR) ‒ in 68 (60.7 %) cases, process stabilization (SD) ‒ in 29 (25.9 %), progression (PD) ‒ 12 (10.7 %) cases. According by the obtained results, convincing data for the superiority of any of the applied TACE methods were not found. Repeated TACE courses increase the overall effectiveness of the treatment. Conclusions. The use of TACE in patients with inoperable hepatocellular carcinoma allows with minimal invasiveness to reduce or stabilize tumor growth in 89.3 % of cases. Repeated performance of the procedure allows to increase the treatment efficiency by 21.2 %.
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