Treatment of patients with severe or recurrent epistaxis that is refractory to therapy is an important and relevant problem of the present-day medicine. One of the most advanced methods of this pathology treatment is endovascular embolization procedure which is usually performed through transfemoral access. Transradial vascular access has a lot advantages over the transfemoral one. The authors provided a randomized study, comparing transradial and transfemoral approaches during epistaxis embolization. Transradial access group included 12 patients, and transfemoral access group – 13 patients. The success of the procedure was 100% in both groups. The total duration of the procedure, the time needed for bleeding point catheterization, the radiation exposure and the rate of complications were comparable between the two groups. The use of the transradial access was accompanied with significant reduction of the frequency and severity of the discomfort associated with the procedure.

The authors have used for the first time transradial approach for uterine fibroid embolization. We represent a comparable analysis of transradial and transfemoral approach for uterine fibroid embolization. The major advantages of transradial approach are described.

. Background. Problems of treatment of pulmonary bleeding with the use of endovascular hemostasis bronchial arteries in patients with pulmonary hemorrhage remain the subject of intense debate and a large number of publications in medicine. This complication occurs in 7–14 % patients with various lung diseases that admit to the thoracic department. The aim of the study was to evaluate the effectiveness and use-fulness of endovascular treatment in patients with pulmonary hemorrhage. Materials and methods. Within 2012–2016 in SI “Zaitsev Institute of General and Urgent Surgery” endovascular embolization of bronchial arteries was performed in 27 patients with pulmonary hemorrhage. The age of patients ranged from 29 to 67 years, 17 of them were women and 10 men. The significant difference between men and women has been identi-fied. Endovascular embolization of bronchial arteries was performed using angiographic complex Tridoros Optimatic 1000 produced by Siemens company (Germany) and Integris Allura 12 C, produced by Phillips (Holland). Results. The compre-hensive survey of patients with pulmonary hemorrhage found that in 12 patients (44.4 %) it was caused by chronic obstructive bronchitis in 7 (25.9%) had chronic obstructive pulmonary disease, 5 (18.5 %) patients were found to have bronchiecta-sis, 2 (7.4 %) patients had community acquired pneumonia, 1 (3.7 %) patient had central lung cancer diagnosed. The high efficiency of REO at LH various etiologies, most authors noted. of bleeding in the late period after REO appeared in 2 (6%) inoperable with central lung cancer. Conclusions. Endovascular occlusion is highly effective in solving the problem to reduce pulmonary hemorrhage, it allows clarify the diagnosis due to the presence of specific angiographic signs of malignan-cy, conduct an effective endovascular hemostasis, gain time to stabilize the patient for the purpose of the planned surgery.

Среди больных с ишемической болезнью сердца (ИБС) многососудистое поражение коронарного русла встречается чаще, чем поражение одной коронарной ар-терии. Согласно статистике, от 40 до 60% эндоваскуляр-ных вмешательств выполняется у пациентов с многосо-судистым поражением коронарного русла [1, 2]. Анализ 11 рандомизированных исследований, проведенных ранее у больных с многососудистым поражением ко-ронарного русла (использовалась транслюминальная баллонная ангиопластика или стентирование с имплан-тацией голометаллических стентов), выявил преимуще-ство операций коронарного шунтирования (КШ) перед чрескожными коронарными вмешательствами (ЧКВ) в отношении снижения частоты повторных процедур реваскуляризации миокарда при одинаковых показате-лях летальности и частоты инфаркта миокарда [1—4]. Внедрение в клиническую практику в начале XXI века стентов с лекарственным покрытием открыло новые возможности в лечении этой тяжелой категории боль-ных и позволило снизить частоту повторных процедур реваскуляризации миокарда [5—10].Отдельного внимания заслуживает выбор тактики ре-васкуляризации миокарда у больных с многососудистым поражением коронарного русла, поскольку от правильно выбранного объема вмешательства зависит клинический успех эндоваскулярного лечения. В настоящее время суще-ствуют следующие основные варианты: полная, функцио-нально адекватная и неполная реваскуляризация миокарда.Впервые о тактике полной реваскуляризации мио-карда заговорили в сердечно-сосудистой хирургии, ког-да было обнаружено, что исход заболевания во многом зависит от того, насколько полной была реваскуляриза-ция коронарных артерий. Результаты первых исследова-ний показали, что больные, у которых была достигнута полная реваскуляризация коронарных артерий, имели лучшую выживаемость и более гладкое течение заболе-вания [2, 11, 12]. Тем не менее ряд авторов указывали на то, что с увеличением продолжительности наблюдения первоначальные преимущества полной реваскуляриза-ции миокарда утрачиваются [2, 4, 12]. Таким образом, возникает вопрос о необходимости стремиться к дости-жению полной реваскуляризации миокарда.

The paper is devoted to a topical problem of modern roentgenovascular surgery, i.e. endovascular embolization. The results of its application in S.P. Botkin City Clinical Hospital demonstrate high efficacy of this method for the arrest of hemorrhage and treatment of various diseases.

Long-term results of endovascular treatment of multivessel coronary artery disease by using different revascularization strategies were analyzed in 171 patients. Complete revascularization of the myocardium was performed in 63, culprit vessel revascularization in 86 and incomplete revascularization in 22 patients. The results of this study showed that strategy of complete and culprit vessel revascularization has comparable immediate and longterm results. Strategy of incomplete revascularization reduce immediate clinical success and lead to increased number of myocardial infarctions and need of coronary artery bypass surgery in the long-term follow up period.

The long-term follow-up treatment results were analyzed for 171 patients operated on the reason of multiple coronary vessels atherosclerosis. The average follow-up time was 14.85 ± 2.52 months. The complete myocardium revascularization was achieved in 63 patients; functionally adequate myocardial function was registered in 86 patients; 22 patients demonstrated noncomplete revascularization rate. Results of complete and functionally adequate revascularization were not significantly different by the myocardial infarction, repeated revascularizative manipulations and main cardio-vessel complications rates. Patients of the third group demonstrated the statistically higher rates of myocardial infarction (p=0.016) and necessity of the coronal shunting (p=0.033).

Immediate and long-term results of endovascular treatment of multivessel coronary artery disease by using different revascularization strategies were analyzed in 171 patients. Duration of follow up ranged from 12 to 18 months. Complete myocardium revascularization was performed in 63 patients, culprit vessel revascularization--in 86 pts and incomplete revascularization--in 22 pts. Results of this study showed that strategy of complete and culprit vessel revascularization in patients with multivessel coronary artery disease has comparable immediate and long-term results. Strategy of incomplete revascularization reduce immediate clinical success and lead to increased number of myocardial infarctions and needs of coronary artery bypass surgery in long-term follow-up period.