Endovascular intervention

Представленный обзор посвящен современным интервенционным методам лечения острой легочной эмболии (ЛЭ). В статье даётся обоснование применения катетерных методик, подробно изложены принципы отбора пациентов, и стратификация риска с учётом оценки массивности тромбоэмболического события, степени риска острой ЛЭ, оценки риска кровотечений и индивидуальных особенностей пациентов. Обзор содержит современную классификацию ЛЭ на основе оценки риска 30-дневной смертности и расчет прогноза заболевания по традиционной и упрощенной шкале Pulmonary Embolism Severity Index. Особое внимание уделено собственно интервенционным методикам, в частности катетер-управляемому тромболизису, реолитической тромбэктомии, фрагментации и аспирации тромбов. Приводятся результаты исследований, посвященных оценке эффективности и безопасности использования эндоваскулярных методов у больных ЛЭ. Подчёркивается важность дальнейшего изучения различных клинических аспектов при использовании указанных методов для получения всесторонней информации при лечении этого грозного заболевания, ассоциирующегося с существенной инвалидизацией и смертности больных.
The presented review concerns to current interventional methods of acute pulmonary embolism (PE) treatment. The article provides a rationale for catheter approaches, detailed description of patient selection and risk stratification including an estimation of thromboembolic burden, risk degree of acute PE, bleeding risk assessment, and patient-specific considerations. The review contains the up-to-date classification of PE on the basis of 30-day mortality assessment and estimation of disease outcome according to the conventional and simplified PE Severity Index. A special attention is paid to interventional methods peculiarly, in particular to catheter directed thrombolysis, rheolytic thrombectomy, thrombus fragmentation and aspiration. The results of studies concerning efficiency and safety of endovascular methods in treatment of PE patients are reported. It was emphasized importance of further investigation of various clinical aspects using these methods for obtaining of comprehensive information about treatment of the dangerous disease associated with significant morbidity and mortality.

Background: Short term results of endovascular therapy in traumatic vascular injuries were evaluated. Methods: Nine patients (7 men, 2 women; mean age 39.8 years; range 14 to 75 years) who had traumatic vascular injuries and in whom pseudoaneurysm and/or arteriovenous fistulas were demonstrated by color Doppler ultrasonography and/or digital subtraction angiography, were treated with stent-grafts. In case of contrast leakage balloon fixation was performed or another cover stent was deployed. Patients were discharged in 72 hours. Following the procedures, stent patencies were evaluated by clinical examination, color Doppler ultrasonography and digital subtraction angiography. Results: Three cases had a pseudoaneurysm, four cases had arteriovenous fistulas and two cases had pseudoaneurysms associated with arterivenous fistulas. Two of the arteriove-nous fistulas were between superficial femoral artery and vein, one was between anterior tibial artery and vein, one was between common iliac artery and vein, and one was between external iliac artery and vein. Pseudoaneurysms were originating from brachial, axillary and anterior tibial arteries, respectively. Balloon expandable cover stents were used in 4 patients and self-expandable cover stents were used in 5 patients. Technical success was 100%, and paten-cy rate was 100% during a mean follow up of 14.7 months. Conclusion: Endovascular approach which has a high success and patency rate, may be an alternative to surgical therapy in suitable lesions in the treatment of traumatic vascular injuries.

Citation: Ashari Bahar., et al. "Persistent Trigeminal Artery Associated with Double Aneurysm". Abstract In this manuscript, we present a rare case of the persistent trigeminal artery (PTA). PTA is the most common of the primitive em-bryonic anastomosis, the incidence is very rare, approximately 0,2% and may associate with aneurysms and vascular anomalies. A primitive embryonic anastomosis (i.e. hypoglossal artery, proatlantal intersegmental artery, otic artery, and trigeminal artery) could persist into adulthood. Here, we report a 53 years old female with right side ptosis and diplopia associated with a double aneurysm, PTA and bilateral vertebral artery hypoplasia which was found during the angiography and successfully treated with endovascular coiling. The finding in these cases may shed light on clinical presentation and give an aid for the treatment of this clinical setting.