Аневризмы артерий бассейна чревного ствола и верхней брыжеечной артерии в клинической практике встречаются редко. Часто первым клиническим проявлением аневризмы становится геморрагический шок в следствие ее разрыва. Риск разрыва аневризм не зависит от их размера и составляет от 3 до 10%. При этом смертность от разрыва аневризм достигает 36%. Учитывая высокий уровень смертности при разры-вах аневризм, лечение как симптомных, так и асимптомных аневризм является обя-зательным. Авторами статьи приводится демонстрация успешного эндоваскулярного лечения аневризмы селезеночной артерии и посттравматической аневризмы общей печеночной артерии при помощи современных эмболизационных материалов. В пер-вом случае проведена эмболизация просвета аневризмы эмболизационной спиралью с последующей установкой в просвет артерии стент-графта, во втором -питающая артерия была эмболизирована микроэмболами. На сегодняшний день инструмен-тарий для проведения рентгенохирургических вмешательств позволяет выполнять полноценную эмболизацию патологических образований, таких как аневризмы ма-гистральных артерий чревного ствола. Благодаря малоинвазивности рентгеноэндо-васкулярные методы лечения можно отнести к методам выбора в лечении многих хи-рургических заболеваний по отношению к открытым способам операции.Ключевые слова: чревный ствол, аневризма, эмболизационные спирали, мик-роэмболы.
Background. Aortic valve stenosis is common with prevalence of about 0.5 %, peaking in people aged over 70 years mostly due to age-related valve calcification. The year 2002 was marked by the invention and use of the endovascular aortic replacement valve by an A. Cribier’s group of French surgeons. Russian endovascular surgery introduced transcatheter aortic valve replacement in 2009, having since built an extensive experience in this practice. Perioperative mortality in patients under 70 years with no serious comorbidity ranges from 1 to 3 %, however, reaching two-fold 4–8 % in elderly patients. The emergence of minimally invasive technologies offered cure to critical patients, who would merely not get over an open surgery.Materials and methods. This case study provides video recordings of transcatheter aortic valve replacement (Accurate Neo) in transfemoral approach performed for the first time in the Republic of Bashkortostan. Patient K., 70 yo, diagnosis: Atherosclerosis. Aortic valve stenosis. FC III. Complications: aortic valve calcification st. III, CHF II A, FC III, persistent atrial fibrillation, tachysystole. Comorbid: CHD. Exertional angina. FC III. CHF II A, FC III.Results and discussion. Improving the transcatheter valve type facilitates an optimal individual aortic valve selection. Pre-replacement valvuloplasty was performed in all patients. The valve replacement is followed by transoesophageal echocardiography to justify possible aortic valve post-dilatation upon marked paravalvular regurgitation. The implant positioning relative to the aortic valve fibrous crown and mitral valve flaps is precisely controlled with ultrasound.Conclusion. Interventional radiology currently provides high-quality, effective, minimally invasive medical aid even in aortic stenosis patients with multiple comorbidity. In the patient’s denial of open surgery, transcatheter aortic valve replacement represents a sole alternative treatment, also increasing the life expectancy and quality. A wider diversity of available transcatheter devices enables a better personalisation of the biological valve replacement procedure.
Introduction. Our first experience in embolization of prostatic arteries at patients with benign prostatic hyperplasia had comprised patients with the symptoms of chronic urinary retention.Material and methods. The average age of patients (n=3) was 61.0±4 years. Among medical indications to embolization there were dysuria significantly degrading the patients’ life quality and their unwillingness to proceed to transurethral resection. Before the embolization of the prostatic artery, it is necessary to identify the place of its departure and its anastomosis by computed tomography. Successful operation was effectuated without microcatheter guides in 3 cases and with the application of microcatheter guides in 3 cases. For the purposes of embolization there were used spherical embolus HydroPearl sized 400 nm. No complications were reported neither in the operational nor in the post-operational periods.Results. All patients admitted a decrease in dysuria as well as the improvement in life quality already in 7–15 days after the endovascular invasion. Control ultrasound dopplerography was performed 3 months after intervention. Two patients with embolization showed decrease of prostate volume by 26%, and one patient — by 35%.Conclusions. Embolization of the prostatic arteries is a promising low-traumatic and safe method for treating patients with benign prostatic hyperplasia. It is necessary to further study its long-term results, to develop an optimized methodology — fast, simple and cheap, but not at the expense of efficiency and safety.
Introduction. Aneurysms of visceral arteries in the abdominal cavity are very rare. Often aneurysms of branches of the abdominal aorta are an incidental finding as patients seldom present obvious clinical signs or pathological changes in the organ supplied by the artery involved. The incidence of aneurysms of branches connecting the celiac trunk and the upper mesenteric artery amounts to 3.5% of all the cases of aneurysms of abdominal aorta arteries, mostly the gastroduodenal artery. This paper presents a case of minimally invasive treatment of gastroduodenal artery pseudoaneurysm at the BSMU Clinic.Materials and methods. Patient K, a 47-year-old female, was admitted for emergency treatment at the Bashkir State Medical University Clinic in May 2019. The patient’s complaints included feeling weak, black stool for seven days prior, faintness and epigastric pain.Results and discussions. Instrumental examination and angiography data demonstrated that the size of the pseudoaneurysm has increased 2.5 times and reached 65×45 mm; the clinical picture led to the conclusion that the aneurysm was ready to rupture and that there was an immediate need to stop the blood flow to the gastroduodenal artery pseudoaneurysm.Conclusion. The range of currently available image-guided surgical procedures makes it possible to perform adequate embolization of pathological structures such as artery aneurysms.
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