Uterine leiomyoma (UL) is often complicated by the development of uterine bleeding. In urgent gynecology for the implementation of endovascular hemostasis, uterine artery embolization (UAE) is used. Performing UAE allows to stop and/or significantly reduce the intensity of bleeding and prepare a patient for surgical intervention. At the same time, the morphological changes that occur in uterine tissues in operated UL patients after performing the UAE are not studied. The aim was to study the peculiarities of pathomorphological changes in uterine tumors and tissues in operated UL patients complicated by uterine bleeding after performing UAE. Material and methods. The results of morphological changes appearing in tumors and tissues of the uterus in 39 operated UL patients, who were used for stopping uterine bleeding, were analyzed. Results. After applying different types of embolizing agents in macroscopic study of the uterus, signs of ischemia of its tissues were revealed, and the most pronounced disorders were detected in the UL nodes. Morphologically it was established that UAE microemboli resulted in vessel occlusion with increasing thrombosis in their distal sections. UAE was not accompanied by occlusal occlusion of the arteries and resulted in small-scale necrosis of the tumor with complete regeneration of the endometrium. Conclusions. The results of the morphological study showed that after the UAE was performed, the myomatous nodes underwent dystrophic, necrobiotic and necrotic changes. Depending on the nature of occlusion of the uterine arteries, various variants of necrosis (scale and completeness of the process) developed in the tumor tissue, which was aseptic in nature.

Individual features of the blood supply to the uterus and ovaries in 20-25% of cases cause failures in endovascular treatment of patients with uterine leiomyoma (ULM) and are forced to return to traditional surgical methods. The purpose of the study is to assess the possibilities of preventing iatrogenic complications of endovascular treatment of ULM through the use of separating occlusion of the uterine arteries, taking into account the characteristics of the blood supply to the uterus and ovaries. Materials and methods. The work is based on the analysis of the results. X-ray endovascular occlusion of the uterine arteries for ULM performed in 88 women aged 34-46 years (mean age 38.8 ± 2.5 years). The patients were divided into 2 groups: the 1st group comprised 65 patients without visible uterine-ovarian interarterial anastomoses. They performed standard embolization of the uterine arteries (EUA) using spherical PVA microemboli (COOK, USA), Embosphere (Merit Medical, USA) with a diameter of 500-700 microns. The second group consisted of 23 patients in whom utero-ovarian inter-arterial anastomoses were detected. In patients of this group, EUAs were produced with Embox cylindrical emboli (Plastis-M, Russia) with a length of 10 mm and a diameter of 500-700 μm, which occlude only the bed of the uterine arteries and are not capable of to overcome utero-ovarian inter-arterial anastomoses. In the 2nd group of EUA patients wore the character of occlusion, separating the uterine and ovarian arteries. The original EUA protocol was applied, which includes, in addition to the standard stages of selective arteriography of the uterine arteries, performing preliminary abdominal aortography to visualize the ovarian arteries and pelvic arteriography to assess pelvic vascular anatomy and identify utero-ovarian interarterial anastomoses. The results of the study. A total angiographic examination of the ovarian and uterine arteries, including a review angiography of the infrarenal section and bifurcation of the aorta, ileal vessels. In 23 (26.1%) patients with angiographic examination, uterine-ovarian arterio-arterial anastomoses. In 13 patients (56.5% of the detected anastomoses), these were type 1 anastomoses. In 10 patients (43.5% of the detected anastomoses), type 3 anastomoses were detected. Endovascular occlusion of the uterine arteries was performed in all patients. In 5 (7.69%) patients from the 1st group after EUA, amenorrhea occurred. In contrast, in all 23 patients from the 2nd group in the postembolization period, no observation of ovarian function was observed in any of the observations. Conclusion. For endovascular treatment of ULM in the presence of pronounced utero-ovarian interarterial anastomoses, the method of separating uterine artery occlusion is a safe and effective way to prevent ischemic damage to the ovaries.

The paper describes the first experience with endovascular embolization of artery of kidney graft irreversibly lost its function in fifteen years after transplantation, during preoperative preparation of patient to nefrotransplantatectomy. The purpose of the study – to show the effectiveness of the artery rentgenendovascular embolization of the artery of kidney transplant before the nefrotransplantatektomy as a method of preventing massive intraoperative bleeding and related complications. An angiography and the rentgenendovascular embolization of the artery of kidney transplant executed on the day of surgery allowed us to remove nefrotransplantat without any technical difficulties. The total intraoperative blood loss did not exceed 50 ml.

Проанализированы результаты лечения 65 больных лейомиомой матки (ЛМ) разных размеров, поступивших с обильным маточным кровотечением. Всем больным был выполнен эндоваскулярный гемостаз путем проведения эмболизации маточных артерий (ЭМА). Изучены клинические особенности течения заболевания после выполнения ЭМА при разных размерах опухоли. Отмечена недостаточно высокая эффективность ЭМА при сочетанном поражении матки ЛМ и аденомиозом.

The results of treatment of 65 patients with uterine leiomyoma (LM) of various sizes received with abundant uterine bleeding are analyzed. All patients underwent endovascular haemostasis by performing uterine artery embolization (EMA). The clinical features of the course of the disease after performing EMA at different tumor sizes were studied. The insufficiently high efficiency of EMA at combined defeat of uterus LM and adenomyosis is noted.

OBJECTIVES. A timely and accurate diagnosis of acute aortic disease is a prerequisite for a successful surgical treatment. Medical imaging techniques vary in their diagnostic capacity.PURPOSE. The purpose was to assess the current role of endovascular techniques among other diagnostic and treatment modalities for patients with an acute aortic pathology.MATERIAL AND METHODS. The results of endovascular diagnostic investigations performed in 472 patients with aortic pathology have been reviewed.RESULTS. Detection of aorta pathology made 89.6% for aortic aneurysms, 14.1% for aneurysm ruptures, 93.1% for aortic dissection, and 100% for aortic injury. Dissections extended to the aortic branches were identified completely in 41.2 % of cases, and partially indentified in 17.6 %. Endovascular examinations allowed a more accurate evaluation of the aortic branches. Angiography measurements did not reflect an exact size of the aneurysm.CONCLUSION. The angiography is less sensitive method than bolus contrast-enhanced CT and Doppler ultra­sonography and thus should be used only in the cases of suspected aortic-visceral fistulae, to assess the involvement of the aortic branches, the coronary arteryies, and the arteries contributing to spine perfusion, and also in the cases of suspected aortic injury in equivocal CT findings. Angiography should be used at the final stage of the diagnostic work-up in unclear cases and becomes more commonly considered as an endovascular surgical technique for stent-graft implantation, including that in the cases of acute aortic pathology.

The article presents the issues of application of endovascular mini-invasive method - uterine artery embolization (UAE) in the treatment of patients with uterine leiomyoma (UL). Reflected controversial aspects of the use of UAE depending on the location and size of fibroids. Presented testimony and contraindications for UAE in patients with UL, technical difficulties and complications that arise in its implementation.

The results of radiation diagnostic techniques were analyzed in 29 patients with aortic aneurysmal ruptures with formation of aortic anastomoses. The examination and treatment of 362 patients with abdominal aortic aneurysmal ruptures revealed that 23 (6.35%) patients had anastomoses (aortocaval (n = 15), aortoduodenal (n = 6), aortogastric (n = 1), and aortoureteral (n = 1)). Six patients were observed to have secondary aortointestinal anastomoses occurring after reconstructive vascular surgery. In one patient, abdominal aortic aneurysmal rupture first led to the formation of a primary aortoduodenal anastomosis and some time after surgery a secondary aortointestinal fistula emerged. One out of 113 patients with aortic dissecting aortic aneurysms had an aortopulmonary fistula. Ultrasonography, computed tomography, and angiography were performed in 27, 19, and 14 patients, respectively. Radiation diagnostic techniques revealed fistulas in 9 (31%) out of the 29 patients. The diagnosis of aortic anastomoses presents challenges.

Embolization of internal iliac and uterine arteries is one of the surgical treatments for hemorrhages that complicate the course of uterine myoma, cancer diseases and medical treatment-unresponsive conditions. Endovascular hemostasis was performed in 24 patients. The causes of hemorrhage were uterine myoma with intramural or submucous nodal location in 15 patients, cancer of the uterus corpus in 6 patients, cancer of the uterus cervix in 2, and uterine sarcoma with tumor grown in the adjacent organs in 1. In all cases, free Gianturco-type spirals were used for embolization of internal iliac and ulterine arteries. For better visualization and superselective catheterization of uterine arteries, a study was performed in the right or light oblique projections at an angle of 20-25 degrees. After embolization of iliac and uterine arteries, hemostasis was attained in all patients. At the same time there were no complications. Thus, embolization of uterine arteries is a safe and highly effective alternative to radical surgical intervention in patients with acute gynecological disease complicated by bleeding, which provides effective hemostasis and permits either avoidance of surgical intervention or a significant reduction in the volume of intraoperative blood loss.

Four hundred and forty seven patients with aneurysms of the abdominal aorta (AAA), including 238 patients with aneurysmal rupture, were admitted to the Research Institute of Emergency Care in 1990 to 2000. The results of studies in 225 patients (ultrasonography in 197, computed tomography in 59, and angiography in 104), including 155 patients with aneurysmal rupture were analyzed. Computed tomography (CT) has proved to be the most accurate technique in the detection and estimation of the size of aneurysms, as well as in the identification of ruptures (83.9%) and inferior to angiography (AG) in the study of involvement of the branches of the abdominal aorta. Ultrasound study (US) ranks below CT in its accuracy (US detects ruptures in 67.8%); however, US surpasses CT and AS in screening, particularly valuable at an admission unit and an intensive care unit, which permits repeated studies. AG has turned out to be the most valid method in identifying the involvement of renal and iliac arteries in aneurysm and in detecting aortocaval anastomoses; yet it is inferior to US and CT (the former revealed rupture and dissection in 18.6% of cases) in solving other diagnostic tasks. Based on the analysis, the optimal sequence of studies in the patients is US, CT, and AG.

The radio-angiographic features of coronary blood flow were studied in 119 patients in the first 24 hours of a macrofocal myocardial infarction. In 100 (84%) patients with recognized occlusion of the coronary artery responsible for the infarction the semeiotics of the occluding coronary thrombosis is described, and the characteristics of the residual stenoses after intracoronary thrombolysis were studied. In more than 60% of cases the radiographic features of these stenoses were found to be similar to those of primarily revealed stenoses responsible for infarction of the coronary arteries in degree, form, and the presence of mural thrombus. The mechanism of the formation of these stenoses was of a common character--lysis of the occluding thrombus, which was medicinal in the first case and spontaneous in the second. Medicinal thrombolysis is an analogue of the natural physiological mechanism--spontaneous coronary thrombolysis. It was established that the process of medicinal lysis of the coronary thrombus, a mural thrombus among others, is fully completed by the end of the second day of myocardial infarction. The obtained information makes it possible to formulate some principles of radiologically-guided intravascular treatment of patients with myocardial infarction.

Myocardial infarction area and left-ventricular myocardial contractility, determined by sectoral scanning, and exercise tolerance were assessed in 47 myocardial infarction patients with isolated coronary arterial lesions. The area under myocardial infarction was shown to be dependent on the site of the atherosclerotic process rather than the degree of stenosis in patients with isolated coronary arterial lesions. A relationship was established between the incidence of complications developing in the acute phase of infarction and the degree of stenosis. The disease was complicated more frequently in patients with coronary arterial occlusion as compared to those with severe coronary-arterial stenosis. High stress tolerance, irrespective of the site of myocardial infarction, is an evidence of great functional potentials in this category of patients.

Hemorrhagic myocardial infarction (HMI) has certain angiographic features that make it possible to diagnose it during the patient's life. HMI angiographic criteria are hypervascularization of an infarction zone in the late arterial phase, an intense contrast of an infarction zone in the parenchymal phase, extravasation of a contrast medium in an infarction zone in the venous phase of coronarography lasting for a long time, and slow discharge of a contrast medium from the distal vascular channel of an infarction zone. HMI characteristic features require thorough phase-by-phase angiographic investigation of the coronary arteries in all MI patients, especially in young ones and those after intracoronary thrombolytic therapy. The detected morphological spasm of microcirculatory vessels and veins disturbing the blood outflow from an infarction zone, noticeable hemorrhages in its interstice prove to be the morphological substantiation of HMI angiographic signs.