Endovascular procedures in pancreatic surgery

Revishvili, A. Sh.; Кригер, А Г; Горин, Д. С.; Варава, А. Б.; Goev, A A; Берелавичус, С. В.; Smirnov, A. V.; Akhtanin, E A

doi:10.17116/hirurgia201844-16

Cited by 7 publications

(6 citation statements)

References 14 publications

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“…при экстравазации контрастного вещества (ЭКВ) в БП/СС/ЗП/паренхиму ПЖ (нестабильная гематома) выполняется эндоваскулярная эмболизация (ЭЭ) (В2 [19,21]) [27]. Метод хорошо себя зарекомендовал и при гемобилии.…”

Section: лечебно-диагностический алгоритмunclassified

“…При эффективной ЭЭ («стабилизация» нестабильной гематомы, в т.ч. забрюшинной), стабильной гемодинамике выполняется динамическое наблюдение в отделении реанимацииинтенсивной терапии (ОРИТ) [27].…”

Section: лечебно-диагностический алгоритмunclassified

“…При отсутствии ЭКВ в свободную БП/ЗП/ СС/ПЖ, отсутствии СГ в БП/СС/ЗП, отсутствии гемоперитонеума (стабильная гематома) выполняется динамическое наблюдение [27].…”

Section: лечебно-диагностический алгоритмunclassified

“…2) наличие соответствующего медицинского оборудования и персонала для круглосуточного наблюдения в условиях орит, проведение кт с ангиоконтрастированием, ангиографии и ангиоэмболизации, ЭРХПГ/МРХПГ/чрескожных вмешательств, возможности быстрого доступа к препаратам крови (А2 [4]) [26,27];…”

Section: лечениеunclassified

“…на II этапе тактики DCS выполняется ангиография для определения источника ранее неустановленного или вторичного кровотечения и ЭЭ (А2 [21])/стентирование [27,33]. Это особенно актуально в хирургии ПЖ, где летальность от послеоперационных кровотечений достигает 11-38% [27].…”

Section: лечениеunclassified

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Blunt Injury of Pancreas, Gall Bladder and Extrahepatic Bile Ducts: Tactics Based on the Principles of Evidence-Based Medicine

Maskin¹,

Александров²,

Matyukhin³

et al. 2022

Novosti Khirurgii

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Objective. Optimization of treatment and diagnostic tactics for blunt injury of the pancreas, gall bladder and extrahepatic bile ducts. Methods. This current review was undertaken by Russian and foreign literature (2015-2020 yrs) search according to the following themes: pancreatic injury, traumatic pancreatitis, gall bladder injury, extrahepatic bile ducts injury, damage control surgery tactics, blunt abdominal trauma, therapeutic and diagnostic algorithm, conservative (non-operative) management, with subsequent exception from the request of experimental studies and cases of open trauma in the Internation scientific datebase PubMed, Cochrane Library, Scopus, Embase, ScienceDirect, Google Scholar Search, eLibrary. Multicenter studies, systematic reviews, meta-analyses, large case series, original articles, and randomized controlled trials were analyzed, indicating the levels of evidence and effectiveness of recommendations. An original algorithmfor thediagnosis and management is proposed, the concept of damage control is described, and indications for diagnostic methods, conservative treatment, and types of surgical, endovascular, and minimally invasive interventions are specified depending on the severity of organ injury according to the classification of the American Association of the Surgery of Trauma (AAST) (table). Results. The algorithmfor thediagnosis and management for combined blunt trauma of the pancreas, gallbladder, and extrahepatic bile ducts is standardized, and indications for minimally invasive and open interventions in this category of patients are clarified. Conclusion. Accurate knowledge of the algorithm for the diagnosis and management, indications for endovascular, minimally invasive techniques and open interventions, the choice of tactics based on the patient’s condition, the time of the injury, and possible complications can improve the results of treatment.

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Section: лечебно-диагностический алгоритмunclassified

Section: лечениеunclassified

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Blunt Injury of Pancreas, Gall Bladder and Extrahepatic Bile Ducts: Tactics Based on the Principles of Evidence-Based Medicine

Maskin¹,

Александров²,

Matyukhin³

et al. 2022

Novosti Khirurgii

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Factors for early postoperative cognitive impairment in patients after coronary bypass surgery and carotid endarterectomy

Малева

Соснина

Uchasova

et al. 2022

Cardiovasc Ther Prev

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Aim. To determine the relationship between perioperative factors and cognitive function in patients after coronary bypass grafting (CABG) in combination with unilateral carotid endarterectomy (CE).Material and methods. We examined 56 men in the perioperative period with CABG combined with unilateral CE (mean age, 64,0±7,1 years). Cognitive assessment was performed before and 5-7 days after surgery with Status PF program. An advanced psychometric examination included an assessment of voluntary attention (Bourdon test), short-term memory (tests on memorizing 10 numbers, 10 words, and 10 syllables), neurodynamics (visual-motor reaction time, level of functional mobility of nervous processes, brain performance, as well as the number of errors in these tasks and missed positive signals). The concentration of neuron-specific enolase (NSE) and S100β protein in the blood serum of patients before surgery, 24 hours and 5-7 days after surgery was determined using enzyme immunoassay.Results. In the early postoperative period, an increase in reaction time (p=0,031) was accompanied by an increase in errors in this test (p=0,042) and a decrease in the number of memorized numbers (p=0,022). Twenty four hours and 5-7 days after surgery, there were no differences between the perioperative NSE level (p1-2-3>0.05). Twenty four hours after CABG surgery, the level of S100β protein increased by 9,0% (p=0,001), while regression of S100β protein to the preoperative level was observed 5-7 days after operation.Conclusion. A relationship was found between the CABG factor and the attention level (r=-0,518; p=0,031), functional mobility reaction time (r=0,476; p=0,041), and the number of errors (r=0,449; p=0,032). A correlation was found between the factor of neurochemical markers, the number of processed letters on the 1st minute of Bourdon test (r=-0,642; p=0,014), the total number of processed letters in Bourdon test (r=-0,617; p=0,017). The combined factor of perioperative period was associated with functional mobility reaction time (r=0,609; p=0,041), the number of processed letters at 4 min (r=-0,490; p=0,017), and the total number of processed letters in the Bourdon test (r=-0,334; p=0,006).

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Experience of using stent grafts in the treatment of patients with arrosive bleeding after pancreatic surgery

Alekyan¹,

Варава²,

Gorin³

et al. 2022

Cardiovasc Ther Prev

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Aim. To evaluate inhospital outcomes of endovascular treatment in patients who underwent endoprosthetic replacement of the culprit vessel due to arrosive bleeding after pancreatic surgery.Material and methods. In the period 2012-2021 at the A. V. Vishnevsky National Medical Research Center of Surgery, 821 operations on the pancreas due to tumors and complicated chronic pancreatitis were performed. Seventy-five (9,1%) patients developed postoperative arrosive bleeding. Stent grafts were used to stop bleeding in 14 (18,7%) of them. There were 9 men (64,3%) and 5 women (35,7%). The median age of patients was 60 years (men — 61 years, women — 59 years). Arrosive bleeding occurred after pancreaticoduodenal resection in 13 patients, while in one case — after distal pancreatic resection. In all 14 cases, postoperative bleeding was severe and classified as grade C according to the International Study Group for Pancreatic Surgery (ISGPS) classification.Results. There were following sources of bleeding: gastroduodenal artery — 4 (28,6%) patients, proximal hepatic arteries (right/left) — in 4 (28,6%) patients, proximal superior mesenteric artery — in 2 (14,3%), dorsal pancreatic artery — in 1 (7,1%), false aneurysm of proximal splenic artery — in 1 (7,1%), proximal common hepatic artery — in 2 (14,3%). In 10 (71,4%) patients, endoprosthetic replacement of the proximal segment of culprit artery was performed, while in 4 (28,6%) patients with arrosion of short gastroduodenal artery stump and false aneurysm, endoprosthesis replacement of the common hepatic artery was performed with a transition to the proper hepatic artery. The technical success of endovascular hemostasis (absence of contrast media extravasation) was achieved in 100% of cases. Three (21,4%) of 14 patients developed rebleeding from another arterial source. Inhospital mortality was 28,6% (n=4). The cause of deaths in 3 cases was the direct complications of endovascular hemostasis, while in one patient — progressive postoperative pancreatitis with the outcome in multiple organ failure.Conclusion. Endovascular hemostasis using a stent graft is an effective surgical method for the treatment of arrosive bleeding after pancreatic surgery. The intervention is associated with possible complications, the risk of which must be taken into account before the procedure. We consider arrosive bleeding from a defect in the main vessel (common/ proper/right or left hepatic arteries, superior mesenteric artery) as an indication for performing endoprosthetic replacement.

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Endovascular procedures in pancreatic surgery

Abstract: EVT provides thrombosis of FAs of celiac trunk and superior mesenteric artery branches in patients with chronic pancreatitis, as well as hemostasis for postoperative bleeding after pancreatectomy.

Cited by 7 publications

References 14 publications

Blunt Injury of Pancreas, Gall Bladder and Extrahepatic Bile Ducts: Tactics Based on the Principles of Evidence-Based Medicine

Blunt Injury of Pancreas, Gall Bladder and Extrahepatic Bile Ducts: Tactics Based on the Principles of Evidence-Based Medicine

Factors for early postoperative cognitive impairment in patients after coronary bypass surgery and carotid endarterectomy

Experience of using stent grafts in the treatment of patients with arrosive bleeding after pancreatic surgery

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