OBJECTIVE:To evaluate the mid-term results of endovascular revascularization of the lower extremities through primary retrograde distal approach. MATERIAL AND METHODS:We prospectively analyzed the mid-term results of 74 endovascular surgeries via primary retrograde distal approach in 69 patients with lower extremity ischemia. Mean age of patients was 68.6±8.9 years. Men prevailed (66.2%); 50% of patients suffered from diabetes mellitus. In 70.3% of cases, the indication for intervention was ischemic ulcerative-necrotic defects of the foot. Revascularization through anterior tibial artery was the most common (63.5%). Angiosomal artery was catheterized in 59.6% of cases; the only patent lower leg vessel - in 25.7% of cases. Antegrade recanalization of "adjacent" tibial artery via distal approach was performed in 40.5% of cases. RESULTS:Distal access was successful in all cases. Retrograde revascularization (restoration of blood flow to the foot through at least one tibial artery) was successful in 91.9% of cases. Conversion to antegrade intervention was necessary in 8.1% of cases. Recanalization of adjacent tibial artery was successful in 100% of cases. Direct revascularization of the affected angiosome was performed in 76.9% of patients with foot tissue necrosis, indirect revascularization through collaterals - in 23.1% of cases. Access-related morbidity was 8.1%, all complications were local in nature. Most of them (83.3%) regressed without loss of arterial patency. Freedom from limb amputation and thrombosis of access-related artery within two years was 87.0% and 88.1%, respectively. Occlusion of access-related artery immediately before amputation was observed only in 1 case. CONCLUSION:Endovascular revascularization through primary retrograde distal access is effective and safe. Freedom from limb amputation and thrombosis of access-related artery within two years is high.

According to the Department of ambulance organization of the I. I. Dzhanelidze Research Institute of Joint Venture in the structure of the “acute abdomen” UGDB takes 4th place in 2021. Transcatheter arterial embolization (TAE) is an alternative to palliative surgical interventions when conservative treatment of ulcerative bleeding using endoscopic hemostasis methods is ineffective, especially in patients with a high risk of surgery and an unfavorable outcome. The aim of the work is to evaluate its role in improving the results of treatment of patients with UGDB who underwent TAE in an ambulance hospital in order to prevent recurrence of bleeding, to assess its role in improving the results of treatment of this category of patients. Materials and methods. The analysis of the results of treatment of 30 patients with UGDB who were on inpatient treatment at the I. I. Dzhanelidze Research Institute of SP from 2018 to 2021, the use of TAE is an alternative to open palliative surgery. As a result of the conducted examination, it was found that the use of endovascular hemostasis in order to prevent recurrence of bleeding in a group of somatically severe patients with UGDB is advisable.

OBJECTIVE To evaluate safety and feasibility of transradial approach for neuroendovascular procedures and to familiarize neurosurgeons and neuroradiologists with the capabilities and limitations of this approach, as well as technical features influencing its effectiveness. MATERIAL AND METHODS A retrospective analysis was performed in 270 patients who underwent transradial neuroendovascular procedures between January 2015 and December 2019. Diagnostic and surgical interventions were performed in 203 (75.2%) and 67 (24.8%) patients, respectively. The authors comprehensively describe catheterization technique and choosing the instrument for effective and safe transradial access. RESULTS The right vertebral and both common carotid arteries were the most accessible for selective catheterization (100% of cases). The left common carotid artery was catheterized in all cases, the left internal carotid artery - only in 92% of cases. If catheterization of the left vertebral artery was necessary, we used the left-sided radial approach. Conversion to femoral approach was required in 2.6% of cases for the left internal carotid artery disease (n=7). Radial artery occlusion occurred in 3.7% of cases (n=10) and was asymptomatic in all cases. We present a video clip (https://youtu.be/3wZ6O8u-lpk) devoted to various surgical interventions through radial approach. CONCLUSION Radial approach is safe and feasible and may be used for neuroendovascular procedures.

OBJECTIVE:To improve treatment outcomes in victims with kidney damage following blunt and stab abdominal trauma by using of minimally invasive methods of diagnosis and treatment.MATERIAL AND METHODS:About 1.2-3.5% of all victims arrived to the Dzhanelidze St. Petersburg Research Institute for Emergency Care have kidney injuries. We analyzed the results of treatment of 117 patients with isolated and combined blunt and stab abdominal injuries. The retrospective (2014-2017) group included 62 victims, and the prospective (2018-2021) group enrolled 55 patients who were treated according to the new algorithm. This algorithm included non-surgical and minimally invasive management for patients with systolic blood pressure >90 mm Hg after contrast-enhanced CT. Angiography with selective embolization was required for ongoing bleeding. We analyzed incidence of open interventions, organ-sparing procedures, complications, duration of treatment and mortality. Between-group differences were assessed using the χ2 test and Student's test.RESULTS:In both groups, kidney damage in most victims with abdominal trauma was due to road accident and catatrauma. Most patients had combined abdominal injuries, mainly in combination with head and chest lesions. Severity of injuries and clinical condition were similar in both groups. In the retrospective group, there were 9 laparotomies with nephrectomy. Nephrorraphy was performed in 8 cases, kidney vessel suture - in 4 patietns. In the prospective group, nephrectomy was performed in 3 patients with unstable hemodynamics and injuries AAST grade V. Nephrorraphy was performed in 4 victims. In one case, vascular suture was applied for tangential vein damage. All laparoscopies in both groups were diagnostic without nephrectomy. We used non-surgical treatment in 34 patients of the prospective group. One patient underwent angiography and selective embolization of renal artery branches. There were no significant between-group differences in the incidence of infectious and non-infectious complications. Mortality rate was 30.6% (n=19) and 27.3% (n=15) in the retrospective and prospective groups, respectively.CONCLUSION:The proposed algorithm for kidney injury made it possible to reduce the incidence of laparoscopies and laparotomies by 2 times, preserve the damaged kidney in 94.5% of cases and avoid invasive treatment in 62% of victims.

OBJECTIVE:To develop a method for early (24 hrs after intervention) prognosis of functional outcome at discharge in patients after endovascular thrombectomy (EVT) in anterior cerebral circulation based on NIHSS.MATERIAL AND METHODS:A retrospective analysis of endovascular treatment in 362 acute stroke patients (189 men, 173 women, median age 69 years) with anterior circulation large vessel occlusion was performed in the regional vascular centers of St. Petersburg.RESULTS:The original scale (S10-10) developed for prognosis of functional outcome at discharge is based on total scores on 3 patterns: NIHSS 24 hrs after EVT (10 and less - 1, greater than 10 - 2), NIHSS improvement 24 hrs (greater than 10 - 0, 1-10 - 1, 0 and less - 2), older than 78 yr - 1. According to the total score, 5 grades are determined: 1 (good, mRs 0-2 75%, mRs 3-5 25%, mRs 6 0%), 2 (favorable, mRs 0-2 66%, mRs 3-5 26%, mRs 6 8%), 3 (unfavorable, mRs 0-2 14%, mRs 3-5 68%, mRs 6 18%), 4 (unfavorable with high mortality, mRs 0-2 1%, mRs 3-5 52%, mRs 6 47%), 5 (highly negative, mRs 0-2 0%, mRs 3-5 16%, mRs 6 84%). S10-10 greater than 2 indicates unfavorable prognosis. The scale allows accurate prognosis of functional outcome at discharge (AUC 0.89; AUC 0.84 in a validation cohort) and length of in-patient staying and time to death for S10-10 greater than 2.CONCLUSION:Accurate prognosis of functional outcome at discharge can be done 24 hrs after EVT in anterior cerebral circulation based on the widely used neurological scale (NIHSS) taking into account patient age.

OBJECTIVE:To evaluate safety and technical efficiency of primary retrograde distal access for endovascular interventions in patients with lower limb ischemia.MATERIAL AND METHODS:A prospective analysis included 25 endovascular procedures via primary retrograde distal access in 23 patients with chronic obliterating diseases of lower limb arteries. Occlusive lesion of femoral-popliteal segment was observed in 68% of cases, occlusion of at least one tibial artery was also found in 68% of cases. In 44% of cases, occlusive lesion was localized at several levels. Percutaneous intervention via anterior tibial artery or dorsalis pedis artery was performed in 68% of cases, posterior tibial artery - 24% of cases, peroneal artery - 8% of cases. We used 2 accesses in 92% of cases (the main one for intervention and additional one for angiography). In 8% of cases, intervention was carried out through a single access. Angiosome artery was punctured in 65% of cases. The only patent tibial vessel was used in 20% of cases. In 24% of cases, we performed antegrade recanalization of 'adjacent' tibial artery via distal access.RESULTS:Primary retrograde distal access was successfully performed in 100% of cases. Retrograde revascularization was not successful in all cases (successful recanalization rate 96%, retrograde intervention rate - 92%). Femoral access was performed in 8% of cases. Antegrade blood flow through at least one tibial artery was restored in all cases. Direct revascularization of the affected angiosome was performed in 15 patients with foot necrosis, indirect revascularization through collaterals - in 5 patients. Local complications of surgical access occurred in 12% of cases.CONCLUSION:Endovascular revascularization via primary retrograde distal access was technically effective in most cases. There were no complications with systemic consequences.

Представлен случай успешной эндоваскулярной механической тромбэктомии, выполненной первичным ретроградным дистальным доступом у пациентки с внутристентовым подострым тромбозом бедренноподколенного сегмента. Обоснован выбор тактики и описаны особенности эндоваскулярной реваскуляризации.

The Objective was to assess and improve the treatment results of victims with spleen injury in blunt abdominal trauma by using high-tech minimally invasive methods of diagnosis and treatment.Methods and materials. The article analyzed the results of treatment of 86 patients with isolated and combined blunt spleen injuries who received conventional surgery, and 52 similar patients who were treated in accordance with the new algorithm. This algorithm included conventional splenectomy for unstable hemodynamics and non-operative and minimally invasive management for stable hemodynamics after MSCT. In the absence of CT signs of ongoing bleeding, non-operative management was performed, if ongoing bleeding signs were detected, angiography with selective angioembolization was performed.Results. In both groups, most of the victims with blunt spleen injury were admitted to the trauma center after traffic accidents and catatraumas. There were no statistically significant differences in the injury severity (ISS, Tsibin scales), and the condition severity (VPH-SP). The tactics of non-operative and minimally invasive management was applied in 31 patients of the prospective group with stable hemodynamics. Non-operative management was performed on 16 patients of the prospective group. Four patients of this group underwent angiography and selective embolization of the branches of the splenic artery. In the retrospective group, there was a greater number of local complications compared to the prospective group (p=0.006). The decrease in the number of visceral and generalized complications was statistically insignificant (p>0.05). In the retrospective group, 21 victims died. Of these, 12 patients died from severe combined trauma and massive blood loss during the first 24 hours. In the prospective group, the total number of deaths was 10 patients. Of these, 6 died from polytrauma with acute massive blood loss, 1 – from severe traumatic brain injury, 1 – from PE, 2 – from sepsis. In the prospective group, among the patients with stable hemodynamics who had conservative treatment of abdominal trauma, 2 deaths were observed in the long-term period due to severe traumatic brain injury and PE.Conclusion. Organ-preserving management was carried out in 26 of 52 (50 %) patients, the number of performed diagnostic laparocenteses was reduced by 50.6 %, laparoscopies – by 16.5 %, laparotomies – by 60.7 %, the duration of inpatient treatment of surviving patients was more than for 7 days, mortality – by 5.2 %.

The article describes a case of successful treatment of the rupture of aortic aneurysm by the endovascular method. Patient P., 71 years old, was hospitalized in a multidisciplinary hospital with a diagnosis of acute cerebral circulation disorder. The patient was examined in the intensive care unit. Signs of neurological symptoms regressed. Spiral computed tomography of the chest organs was performed with suspected pulmonary embolism, the results of which revealed an aneurysm of the descending thoracic aorta, complicated by a rupture with the formation of a right-sided hemothorax. The patient underwent endoprosthesis of the thoracic aorta with stent graft. After 2 days, thoracoscopic sanitation, drainage of the right pleural cavity was performed. The postoperative period proceeded without peculiarities. The patient was discharged on the 12th day in satisfactory condition. At control examination in 1, 6, 12 months, the long-term steady positive result was noted. Endovascular methods minimize the risk of postoperative complications, contributing to a favorable outcome of the disease.

Middle meningeal artery embolization as primary method for treatment of chronic subdural hematomas became more popular in past decade. There are few large case series (>150 patients) and literature reviews characterizing advantages and drawbacks of endovascular treatment and technical features of surgeries. In this manuscript, the authors report 11 patients with chronic subdural hematoma scheduled for middle meningeal artery embolization and review the literature data on this issue.

OBJECTIVE:Based on a retrospective analysis, to evaluate technical results and functional outcomes at discharge after endovascular thrombectomy (EVT) in anterior circulation out of 6-hours «therapeutic window» in patients with stroke.MATERIAL AND METHODS:The retrospective analysis of EVT in 594 acute stroke patients (303 male, 291 female, median age 69 years) with the anterior circulation large vessel occlusion was performed. EVT was carried out before 6 hrs in 550, later in 44 patients. Time to artery puncture was defined as a cut point. Patients were included in the study if they met the criterion for 0-6 hours «therapeutic window».RESULTS:No significant differences in functional outcomes at discharge assessed with the Rankin scale (mRs 0-2 29.8% and 20.5% p<0.19; mRs 3-5 38.7% and 38.6% p<0.99; mRs 6 31.5% and 40.9% p<0.2) and the rates of intracranial haemorrhage, haemorrhagic transformation and symptomatic haemorrhagic transformation (4% and 0% p<0.17; 20.9% and 29.5% p<0.49; 10.1% and 11.4% p<0.78) were observed in patients exposed to EVT before 6 hrs and later.CONCLUSION:EVT in anterior circulation stroke over 6 hrs «therapeutic window» based on the criterion for 0-6 hrs provides comparable functional outcomes at discharge without the increase in the frequency of intracranial haemorrhages, haemorrhagic and symptomatic haemorrhagic transformations.

The study objective is to present a clinical case of using transradial access for embolization of an aneurysm of the basilar artery (BA) bifurcation. Materials and methods. A patient, 67 years old, sought medical help at the I.I. Dzhanelidze Saint Petersburg Research Institute of Emergency Medicine complaining of headaches. Computed angiography of the brain had shown a large aneurysm of the BA with an absolutely wide neck. Embolization of the aneurysm using stent assistance (Y-stenting) was performed with access through the radial artery. The results were compared to data from scientific literature (about 16 cases).Results. Aneurysm embolization level was II or IIIb per the modified Raymond–Roy classification was performed. No complications were observed, blood flow in the radial artery was preserved. The patient was released on day 2 after the surgery. No signs of blood flow through the aneurysm were observed during control selective cerebral angiography 12 months later. According to literature data, transradial access is preferable only with pathology of the vertebrobasilar system, especially if standard access is impossible to form due to atherosclerotic damage of the femoral artery, angling of the aortic arch, and pathological vessel tortuosity.Conclusion. Routine use of transradial access in surgery of pathologies of the cerebral flow is not justifiable. But in some cases, this alternative access can be more effective and safer compared to the standard access. The main advantages of this access are reduced rate of complications of arterial access and possibility of early patient activization.

The article describes the clinical experience of treatment of the victim using minimally invasive methods such as angiography and embolization. The applied treatment tactics made it possible to preserve the damaged parenchymal organ of the abdominal cavity and avoid performing other more traumatic surgical interventions (laparoscopy, laparotomy).

AIM:To assess technical results and close functional outcomes of acute ischemic stroke (AIS) in patients treated with endovascular thrombecomy (ET) in regional vascular centers (RVC) of St-Petersburg.MATERIAL AND METHODS:Retrospective analysis of 183 patients with AIS, including 143 patients with AIS due to a large intracranial vessel occlusion in anterior (AC) and 25 patients in posterior cerebral (PC) circulation, 15 with isolated extracranial carotid occlusion treated in 6 RVC in 2017 was performed. All patients underwent ET.RESULTS AND CONCLUSION:Effective reperfusion (mTICI 2b-3) was achieved in 71.5% (71.3% AC, 72% PC). On discharge, 35,7% patients had good (mRs 0-2) functional outcome (37.1% AC, 28% PC). The incidence of symptomatic intracranial hemorrhage (according to ECASS II criteria) was 10.7% (9.1% AC, 20% PC), the mortality was 29.2% (22.4% AC, 68% PC).). The results of our study show the possibility of effective and safe application of ET in patients with AIS in the anterior and posterior cerebral circulation in regional vascular centers of St.-Petersburg.

. Background and Purpose. Associations between clinical presentation of brain arteriovenous malformations (AVMs) and their angioarchitecture have been described. This study aims to identify significant factors related to the initial hemorrhagic event through multivariate statistical methodology. Methods. The authors studied the initial clinical presentation of 257 consecutive patients with brain AVMs. Angiographic features present at that time, such as location, size, and blood supply, were recorded following a standard protocol and associated, through multivariate analysis techniques, with type of presentation. Conclusions. For initial hemorrhagic presentation, deep location, а small size AVM, a small number of afferents, deep venous drainage and presence of intranidal aneurysms were significant associated factors.