24 research outputs found
ΠΠ½Π΄ΠΎΠ²Π°ΡΠΊΡΠ»ΡΡΠ½ΠΎΠ΅ Π»Π΅ΡΠ΅Π½ΠΈΠ΅ ΠΎΡΡΡΠΎΠ³ΠΎ ΡΡΠΎΠΌΠ±ΠΎΠ·Π° ΡΠΈΠ±ΠΈΠΎΠΏΠ΅ΡΠΎΠ½Π΅Π°Π»ΡΠ½ΠΎΠ³ΠΎ ΡΡΠ²ΠΎΠ»Π°. ΠΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΠΉ ΡΠ»ΡΡΠ°ΠΉ
Introduction. Acute limb ischemia is a severe disorder caused by a sharp drop in the arterial perfusion of the limb. It carries a threat to the limbβs function and viability. The issue of early recognition of acute limb ischemia in surgery is both important and difficult. The current guidelines recommend that patients with acute limb ischemia when the limb is viable should be urgently examined and treated. Restoring the blood flow in patients with acute limb ischemia is aΒ priority, since a significant reduction in arterial perfusion can lead to limb amputation and life-threatening complications. In acute limb ischemia different treatment methods can be used, both open surgery and endovascular procedures. The treatment strategy depends on the localisation, duration of ischemia, neurological deficit, concomitant diseases and risks associated with treatment and its results. Endovascular procedures on the arteries of the lower leg are most often indicated to save a limb. Endovascular procedures on the arteries of the lower leg are indicated more often in patients with critical limb ischemia. Endovascular procedures when the condition is primary demonstrate good outcomes and high efficiency on the arteries of the lower extremities at all levels of the lesion.Materials and methods. This paper presents a clinical case of a successful endovascular procedure performed for the treatment of acute thrombosis of the arteries of the lower leg. Three stents were implanted, with a good angiographically confirmed outcome.Conclusion. Endovascular balloon angioplasty with stenting of the tibioperoneal trunk can result in good outcomes in patients with acute thrombosis of the arteries of the lower leg.ΠΠ²Π΅Π΄Π΅Π½ΠΈΠ΅. ΠΡΡΡΠ°Ρ ΠΈΡΠ΅ΠΌΠΈΡ ΠΊΠΎΠ½Π΅ΡΠ½ΠΎΡΡΠΈ (ΠΠΠ)Β β ΡΡΠΆΠ΅Π»ΠΎΠ΅ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠ΅, Π² ΠΎΡΠ½ΠΎΠ²Π΅ ΠΊΠΎΡΠΎΡΠΎΠ³ΠΎ Π»Π΅ΠΆΠΈΡ ΡΠ΅Π·ΠΊΠΎΠ΅ ΡΠΌΠ΅Π½ΡΡΠ΅Π½ΠΈΠ΅ Π°ΡΡΠ΅ΡΠΈΠ°Π»ΡΠ½ΠΎΠΉ ΠΏΠ΅ΡΡΡΠ·ΠΈΠΈ ΠΊΠΎΠ½Π΅ΡΠ½ΠΎΡΡΠΈ, ΡΠΎΠ·Π΄Π°ΡΡΠ΅Π΅ ΠΏΠΎΡΠ΅Π½ΡΠΈΠ°Π»ΡΠ½ΡΡ ΡΠ³ΡΠΎΠ·Ρ Π΅Π΅ ΡΡΠ½ΠΊΡΠΈΠΎΠ½Π°Π»ΡΠ½ΠΎΡΡΠΈ ΠΈ ΠΆΠΈΠ·Π½Π΅ΡΠΏΠΎΡΠΎΠ±Π½ΠΎΡΡΠΈ. ΠΡΠΎΠ±Π»Π΅ΠΌΠ° ΡΠ²ΠΎΠ΅Π²ΡΠ΅ΠΌΠ΅Π½Π½ΠΎΠ³ΠΎ ΡΠ°ΡΠΏΠΎΠ·Π½Π°Π²Π°Π½ΠΈΡ ΠΎΡΡΡΠΎΠΉ ΠΈΡΠ΅ΠΌΠΈΠΈ ΠΊΠΎΠ½Π΅ΡΠ½ΠΎΡΡΠΈ ΡΠ²Π»ΡΠ΅ΡΡΡ ΠΎΠ΄Π½ΠΎΠ²ΡΠ΅ΠΌΠ΅Π½Π½ΠΎ Π²Π°ΠΆΠ½ΠΎΠΉ ΠΈ ΡΠ»ΠΎΠΆΠ½ΠΎΠΉ Π² Ρ
ΠΈΡΡΡΠ³ΠΈΠΈ. Π‘ΠΎΠ³Π»Π°ΡΠ½ΠΎ ΡΠΎΠ²ΡΠ΅ΠΌΠ΅Π½Π½ΡΠΌ ΡΠ΅ΠΊΠΎΠΌΠ΅Π½Π΄Π°ΡΠΈΡΠΌ, ΠΏΠ°ΡΠΈΠ΅Π½ΡΡ Ρ ΠΎΡΡΡΠΎΠΉ ΠΈΡΠ΅ΠΌΠΈΠ΅ΠΉ ΠΊΠΎΠ½Π΅ΡΠ½ΠΎΡΡΠΈ ΠΈ ΡΠΎΡ
ΡΠ°Π½Π΅Π½Π½ΠΎΠΉ Π΅Π΅ ΠΆΠΈΠ·Π½Π΅ΡΠΏΠΎΡΠΎΠ±Π½ΠΎΡΡΡΡ Π΄ΠΎΠ»ΠΆΠ½Ρ Π±ΡΡΡ ΡΠΊΡΡΡΠ΅Π½Π½ΠΎ ΠΎΠ±ΡΠ»Π΅Π΄ΠΎΠ²Π°Π½Ρ ΠΈ ΠΏΡΠΎΠ»Π΅ΡΠ΅Π½Ρ. ΠΠΎΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΈΠ΅ ΠΊΡΠΎΠ²ΠΎΡΠΎΠΊΠ° ΠΏΡΠΈ ΠΠΠ ΡΠ²Π»ΡΠ΅ΡΡΡ ΠΏΡΠΈΠΎΡΠΈΡΠ΅ΡΠ½ΠΎΠΉ Π·Π°Π΄Π°ΡΠ΅ΠΉ, ΡΠ°ΠΊ ΠΊΠ°ΠΊ Π·Π½Π°ΡΠΈΡΠ΅Π»ΡΠ½ΠΎΠ΅ ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΠ΅ Π°ΡΡΠ΅ΡΠΈΠ°Π»ΡΠ½ΠΎΠΉ ΠΏΠ΅ΡΡΡΠ·ΠΈΠΈ ΠΌΠΎΠΆΠ΅Ρ ΠΏΡΠΈΠ²Π΅ΡΡΠΈ ΠΊ Π°ΠΌΠΏΡΡΠ°ΡΠΈΠΈ ΠΊΠΎΠ½Π΅ΡΠ½ΠΎΡΡΠΈ ΠΈ ΡΠ³ΡΠΎΠΆΠ°ΡΡΠΈΠΌ ΠΆΠΈΠ·Π½ΠΈ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΡΠΌ. ΠΡΠΈ ΠΎΡΡΡΠΎΠΉ ΠΈΡΠ΅ΠΌΠΈΠΈ ΠΊΠΎΠ½Π΅ΡΠ½ΠΎΡΡΠΈ ΠΌΠΎΠ³ΡΡ ΠΏΡΠΈΠΌΠ΅Π½ΡΡΡΡΡ ΡΠ°Π·Π½ΡΠ΅ ΠΌΠ΅ΡΠΎΠ΄Ρ Π»Π΅ΡΠ΅Π½ΠΈΡΒ β ΠΊΠ°ΠΊ ΠΎΡΠΊΡΡΡΠ°Ρ Ρ
ΠΈΡΡΡΠ³ΠΈΡ, ΡΠ°ΠΊ ΠΈ ΡΠ½Π΄ΠΎΠ²Π°ΡΠΊΡΠ»ΡΡΠ½Π°Ρ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΡ. Π’Π°ΠΊΡΠΈΠΊΠ° Π»Π΅ΡΠ΅Π½ΠΈΡ Π±ΡΠ΄Π΅Ρ ΠΎΠΏΡΠ΅Π΄Π΅Π»ΡΡΡΡΡ Π½Π° ΠΎΡΠ½ΠΎΠ²Π°Π½ΠΈΠΈ Π»ΠΎΠΊΠ°Π»ΠΈΠ·Π°ΡΠΈΠΈ, ΠΏΡΠΎΠ΄ΠΎΠ»ΠΆΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΠΈ ΠΈΡΠ΅ΠΌΠΈΠΈ, Π½Π΅Π²ΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π΄Π΅ΡΠΈΡΠΈΡΠ°, ΡΠΎΠΏΡΡΡΡΠ²ΡΡΡΠΈΡ
Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠΉ ΠΈ ΡΠ²ΡΠ·Π°Π½Π½ΡΡ
Ρ Π»Π΅ΡΠ΅Π½ΠΈΠ΅ΠΌ ΡΠΈΡΠΊΠΎΠ² ΠΈ Π΅Π³ΠΎ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠΎΠ². ΠΠ½Π΄ΠΎΠ²Π°ΡΠΊΡΠ»ΡΡΠ½ΡΠ΅ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΈ Π½Π° Π°ΡΡΠ΅ΡΠΈΡΡ
Π³ΠΎΠ»Π΅Π½ΠΈ ΡΠ°ΡΠ΅ Π²ΡΠ΅Π³ΠΎ ΠΏΠΎΠΊΠ°Π·Π°Π½Ρ Π΄Π»Ρ ΡΠΏΠ°ΡΠ΅Π½ΠΈΡ ΠΊΠΎΠ½Π΅ΡΠ½ΠΎΡΡΠΈ. Π£Π²Π΅Π»ΠΈΡΠΈΠ²Π°Π΅ΡΡΡ ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²ΠΎ ΡΠ΅ΠΊΠΎΠΌΠ΅Π½Π΄Π°ΡΠΈΠΉ Π² ΠΏΠΎΠ»ΡΠ·Ρ ΡΠ½Π΄ΠΎΠ²Π°ΡΠΊΡΠ»ΡΡΠ½ΠΎΠΉ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΈ Π½Π° Π°ΡΡΠ΅ΡΠΈΡΡ
Π³ΠΎΠ»Π΅Π½ΠΈ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ
Ρ ΠΊΡΠΈΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΈΡΠ΅ΠΌΠΈΠ΅ΠΉ ΠΊΠΎΠ½Π΅ΡΠ½ΠΎΡΡΠΈ. ΠΠ½Π΄ΠΎΠ²Π°ΡΠΊΡΠ»ΡΡΠ½ΡΠ΅ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΈ ΠΏΡΠΈ ΠΏΠ΅ΡΠ²ΠΈΡΠ½ΠΎΠΌ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠΈ ΠΏΠΎΠΊΠ°Π·ΡΠ²Π°ΡΡ Ρ
ΠΎΡΠΎΡΠΈΠΉ ΡΠ΅Π·ΡΠ»ΡΡΠ°Ρ ΠΈ Π²ΡΡΠΎΠΊΡΡ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΡ Π½Π° Π°ΡΡΠ΅ΡΠΈΡΡ
Π½ΠΈΠΆΠ½ΠΈΡ
ΠΊΠΎΠ½Π΅ΡΠ½ΠΎΡΡΠ΅ΠΉ Π½Π° Π²ΡΠ΅Ρ
ΡΡΠΎΠ²Π½ΡΡ
ΠΏΠΎΡΠ°ΠΆΠ΅Π½ΠΈΡ.ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. Π ΡΡΠ°ΡΡΠ΅ ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»Π΅Π½ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΠΉ ΡΠ»ΡΡΠ°ΠΉ ΡΡΠΏΠ΅ΡΠ½ΠΎΠ³ΠΎ ΡΠ½Π΄ΠΎΠ²Π°ΡΠΊΡΠ»ΡΡΠ½ΠΎΠ³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ ΠΎΡΡΡΠΎΠ³ΠΎ ΡΡΠΎΠΌΠ±ΠΎΠ·Π° Π°ΡΡΠ΅ΡΠΈΠΉ Π³ΠΎΠ»Π΅Π½ΠΈ. Π Ρ
ΠΎΠ΄Π΅ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠ²Π½ΠΎΠ³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ Π±ΡΠ»ΠΈ ΠΈΠΌΠΏΠ»Π°Π½ΡΠΈΡΠΎΠ²Π°Π½Ρ ΡΡΠΈ ΡΡΠ΅Π½ΡΠ° Ρ Ρ
ΠΎΡΠΎΡΠΈΠΌ Π°Π½Π³ΠΈΠΎΠ³ΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΠΌ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠΎΠΌ.ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. ΠΠ½Π΄ΠΎΠ²Π°ΡΠΊΡΠ»ΡΡΠ½Π°Ρ Π±Π°Π»Π»ΠΎΠ½Π½Π°Ρ Π°Π½Π³ΠΈΠΎΠΏΠ»Π°ΡΡΠΈΠΊΠ° ΡΠΎ ΡΡΠ΅Π½ΡΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ ΡΠΈΠ±ΠΈΠΎΠΏΠ΅ΡΠΎΠ½Π΅Π°Π»ΡΠ½ΠΎΠ³ΠΎ ΡΡΠ²ΠΎΠ»Π° ΠΌΠΎΠΆΠ΅Ρ ΡΡΠΏΠ΅ΡΠ½ΠΎ ΠΏΡΠΈΠΌΠ΅Π½ΡΡΡΡΡ Π² ΡΠ»ΡΡΠ°Π΅ ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΎΡΡΡΠΎΠ³ΠΎ ΡΡΠΎΠΌΠ±ΠΎΠ·Π° Π°ΡΡΠ΅ΡΠΈΠΉ Π½ΠΈΠΆΠ½ΠΈΡ
ΠΊΠΎΠ½Π΅ΡΠ½ΠΎΡΡΠ΅ΠΉ
ΠΠ½Π΄ΠΎΠ²Π°ΡΠΊΡΠ»ΡΡΠ½ΠΎΠ΅ Π»Π΅ΡΠ΅Π½ΠΈΠ΅ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° Ρ ΠΌΠ½ΠΎΠ³ΠΎΡΠΎΡΡΠ΄ΠΈΡΡΡΠΌ ΠΏΠΎΡΠ°ΠΆΠ΅Π½ΠΈΠ΅ΠΌ Π² ΡΠΎΡΠ΅ΡΠ°Π½ΠΈΠΈ Ρ Ρ ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΎΠΊΠΊΠ»ΡΠ·ΠΈΠ΅ΠΉ ΠΏΡΠ°Π²ΠΎΠΉ ΠΊΠΎΡΠΎΠ½Π°ΡΠ½ΠΎΠΉ Π°ΡΡΠ΅ΡΠΈΠΈ
Introduction. Coronary hagiography revealed 70%-prevalence of multivessel coronary lesions. Chronic coronary occlusion (CCO) occurs in approximately 20 % of patients with coronary heart disease. Endovascular recanalization of CCO is associated with technical difficulties and the risk of complications. In this regard, patients with CCO rarely undergo revascularization, which leads to incomplete myocardial revascularization.Materials and methods. Patient M., male, 64, was hospitalized at the National Medical Research Center for Therapy and Preventive Medicine in February 2020 with a diagnosis of CHD. Stable angina, FC III, multivessel coronary lesions. The recanalization of chronic occlusion of the right coronary artery was performed at the first stage. During the next stage of revascularization of the left main coronary artery, an acute occlusion of the circumflex artery occurred. Despite the acute occlusion, no ischemic dynamics wasm reported on the electrocardiogram, there were no complaints, hemodynamics was stable. Ischemic events did not occur due to the formed network of collaterals out of the system of the right coronary artery. This allowed the complication to be corrected without consequences for the patient. Results and discussion. Thanks to the accumulated experience and advanced technologies, the success rate of recanalization has reached 90β95 %, and complications are not more common than in cases of stenting of non-occlusive lesions. The conducted studies have proved that successful recanalization of CCO improves the patientβs clinical and functional status, intracardiac hemodynamics and quality of life.Conclusion. The clinical case given above clearly demonstrates the need for endovascular revascularization of CCO. The formed collateral network ensured blood flow in the area of acute occlusion and prevented the development of ischemia and myocardial infarction.ΠΠ²Π΅Π΄Π΅Π½ΠΈΠ΅. Π Π°ΡΠΏΡΠΎΡΡΡΠ°Π½Π΅Π½Π½ΠΎΡΡΡ ΠΌΠ½ΠΎΠ³ΠΎΡΠΎΡΡΠ΄ΠΈΡΡΠΎΠ³ΠΎ ΠΏΠΎΡΠ°ΠΆΠ΅Π½ΠΈΡ ΠΊΠΎΡΠΎΠ½Π°ΡΠ½ΠΎΠ³ΠΎ ΡΡΡΠ»Π° Π΄ΠΎΡΡΠΈΠ³Π°Π΅Ρ 70 % ΠΏΠΎ Π΄Π°Π½Π½ΡΠΌ ΠΊΠΎΡΠΎΠ½Π°ΡΠ½ΠΎΠΉ Π°Π³ΠΈΠΎΠ³ΡΠ°ΡΠΈΠΈ. Π₯ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠ°Ρ ΠΎΠΊΠΊΠ»ΡΠ·ΠΈΡ ΠΊΠΎΡΠΎΠ½Π°ΡΠ½ΠΎΠΉ Π°ΡΡΠ΅ΡΠΈΠΈ (Π₯ΠΠΠ) Π²ΡΡΡΠ΅ΡΠ°Π΅ΡΡΡ ΠΏΡΠΈΠΌΠ΅ΡΠ½ΠΎ Π² 20 % ΡΠ»ΡΡΠ°Π΅Π² Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΈΡΠ΅ΠΌΠΈΡΠ΅ΡΠΊΠΎΠΉ Π±ΠΎΠ»Π΅Π·Π½ΡΡ ΡΠ΅ΡΠ΄ΡΠ°. ΠΠ½Π΄ΠΎΠ²Π°ΡΠΊΡΠ»ΡΡΠ½Π°Ρ ΡΠ΅ΠΊΠ°Π½Π°Π»ΠΈΠ·Π°ΡΠΈΡ Π₯ΠΠΠ ΡΠΎΠΏΡΡΠΆΠ΅Π½Π° Ρ ΡΠ΅Ρ
Π½ΠΈΡΠ΅ΡΠΊΠΈΠΌΠΈ ΡΠ»ΠΎΠΆΠ½ΠΎΡΡΡΠΌΠΈ ΠΈ ΡΠΈΡΠΊΠΎΠΌ ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ. Π ΡΠ²ΡΠ·ΠΈ Ρ ΡΡΠΈΠΌ ΠΏΠ°ΡΠΈΠ΅Π½ΡΡ Ρ Π₯ΠΠΠ ΡΠ΅Π΄ΠΊΠΎ ΠΏΠΎΠ΄Π²Π΅ΡΠ³Π°ΡΡΡΡ ΡΠ΅Π²Π°ΡΠΊΡΠ»ΡΡΠΈΠ·Π°ΡΠΈΠΈ, ΡΡΠΎ ΠΏΡΠΈΠ²ΠΎΠ΄ΠΈΡ ΠΊ Π½Π΅ΠΏΠΎΠ»Π½ΠΎΠΉ ΡΠ΅Π²Π°ΡΠΊΡΠ»ΡΡΠΈΠ·Π°ΡΠΈΠΈ ΠΌΠΈΠΎΠΊΠ°ΡΠ΄Π°.ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. ΠΠ°ΡΠΈΠ΅Π½Ρ Π., ΠΌΡΠΆΡΠΈΠ½Π°, 64 Π³ΠΎΠ΄Π°, Π½Π°Ρ
ΠΎΠ΄ΠΈΠ»ΡΡ Π½Π° ΡΡΠ°ΡΠΈΠΎΠ½Π°ΡΠ½ΠΎΠΌ Π»Π΅ΡΠ΅Π½ΠΈΠΈ Π² Π€ΠΠΠ£ Β«ΠΠΠΠ¦ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ ΠΈ ΠΏΡΠΎΡΠΈΠ»Π°ΠΊΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΒ» Π² ΡΠ΅Π²ΡΠ°Π»Π΅ 2020 Π³ΠΎΠ΄Π° Ρ Π΄ΠΈΠ°Π³Π½ΠΎΠ·ΠΎΠΌ: ΠΠΠ‘. Π‘ΡΠ΅Π½ΠΎΠΊΠ°ΡΠ΄ΠΈΡ Π½Π°ΠΏΡΡΠΆΠ΅Π½ΠΈΡ, III ΡΡΠ½ΠΊΡΠΈΠΎΠ½Π°Π»ΡΠ½ΡΠΉ ΠΊΠ»Π°ΡΡ. ΠΠ½ΠΎΠ³ΠΎΡΠΎΡΡΠ΄ΠΈΡΡΠΎΠ΅ ΠΏΠΎΡΠ°ΠΆΠ΅Π½ΠΈΠ΅ ΠΊΠΎΡΠΎΠ½Π°ΡΠ½ΡΡ
Π°ΡΡΠ΅ΡΠΈΠΉ. ΠΠ΅ΡΠ²ΡΠΌ ΡΡΠ°ΠΏΠΎΠΌ ΠΏΠ°ΡΠΈΠ΅Π½ΡΡ Π²ΡΠΏΠΎΠ»Π½Π΅Π½Π° ΡΠ΅ΠΊΠ°Π½Π°Π»ΠΈΠ·Π°ΡΠΈΡ Ρ
ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΎΠΊΠΊΠ»ΡΠ·ΠΈΠΈ ΠΏΡΠ°Π²ΠΎΠΉ ΠΊΠΎΡΠΎΠ½Π°ΡΠ½ΠΎΠΉ Π°ΡΡΠ΅ΡΠΈΠΈ. ΠΠΎ Π²ΡΠ΅ΠΌΡ ΡΠ»Π΅Π΄ΡΡΡΠ΅Π³ΠΎ ΡΡΠ°ΠΏΠ° ΡΠ΅Π²Π°ΡΠΊΡΠ»ΡΡΠΈΠ·Π°ΡΠΈΠΈ ΠΎΡΠ½ΠΎΠ²Π½ΠΎΠ³ΠΎ ΡΡΠ²ΠΎΠ»Π° Π»Π΅Π²ΠΎΠΉ ΠΊΠΎΡΠΎΠ½Π°ΡΠ½ΠΎΠΉ Π°ΡΡΠ΅ΡΠΈΠΈ Π²ΠΎΠ·Π½ΠΈΠΊΠ»Π° ΠΎΡΡΡΠ°Ρ ΠΎΠΊΠΊΠ»ΡΠ·ΠΈΡ ΠΎΠ³ΠΈΠ±Π°ΡΡΠ΅ΠΉ Π°ΡΡΠ΅ΡΠΈΠΈ. ΠΠ΅ΡΠΌΠΎΡΡΡ Π½Π° ΠΎΡΡΡΡΡ ΠΎΠΊΠΊΠ»ΡΠ·ΠΈΡ, ΠΈΡΠ΅ΠΌΠΈΡΠ΅ΡΠΊΠ°Ρ Π΄ΠΈΠ½Π°ΠΌΠΈΠΊΠ° Π½Π° ΡΠ»Π΅ΠΊΡΡΠΎΠΊΠ°ΡΠ΄ΠΈΠΎΠ³ΡΠ°ΠΌΠΌΠ΅ Π½Π΅ ΠΎΡΠΌΠ΅ΡΠ°Π»Π°ΡΡ, ΠΆΠ°Π»ΠΎΠ± Π½Π΅ Π±ΡΠ»ΠΎ, Π³Π΅ΠΌΠΎΠ΄ΠΈΠ½Π°ΠΌΠΈΠΊΠ° Π±ΡΠ»Π° ΡΡΠ°Π±ΠΈΠ»ΡΠ½ΠΎΠΉ. ΠΡΠ΅ΠΌΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΏΡΠΎΡΠ²Π»Π΅Π½ΠΈΡ Π½Π΅ Π²ΠΎΠ·Π½ΠΈΠΊΠ»ΠΈ Π±Π»Π°Π³ΠΎΠ΄Π°ΡΡ ΡΡΠΎΡΠΌΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠΉ ΡΠ΅ΡΠΈ ΠΊΠΎΠ»Π»Π°ΡΠ΅ΡΠ°Π»Π΅ΠΉ ΠΈΠ· ΡΠΈΡΡΠ΅ΠΌΡ ΠΏΡΠ°Π²ΠΎΠΉ ΠΊΠΎΡΠΎΠ½Π°ΡΠ½ΠΎΠΉ Π°ΡΡΠ΅ΡΠΈΠΈ. ΠΡΠΎ ΠΏΠΎΠ·Π²ΠΎΠ»ΠΈΠ»ΠΎ Π±Π΅Π· ΠΏΠΎΡΠ»Π΅Π΄ΡΡΠ²ΠΈΠΉ Π΄Π»Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° ΡΠΊΠΎΡΡΠ΅ΠΊΡΠΈΡΠΎΠ²Π°ΡΡ ΡΠ»ΠΎΠΆΠΈΠ²ΡΠ΅Π΅ΡΡ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠ΅.Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ ΠΈ ΠΎΠ±ΡΡΠΆΠ΄Π΅Π½ΠΈΠ΅. ΠΠ»Π°Π³ΠΎΠ΄Π°ΡΡ Π½Π°ΠΊΠΎΠΏΠ»Π΅Π½Π½ΠΎΠΌΡ ΠΎΠΏΡΡΡ ΠΈ ΡΠ°Π·Π²ΠΈΡΠΈΡ ΡΠ΅Ρ
Π½ΠΎΠ»ΠΎΠ³ΠΈΠΉ ΡΠ°ΡΡΠΎΡΠ° ΡΡΠΏΠ΅ΡΠ½ΠΎΠΉ ΡΠ΅ΠΊΠ°Π½Π°Π»ΠΈΠ·Π°ΡΠΈΠΈ Π₯ΠΠΠ Π΄ΠΎΡΡΠΈΠ³Π»Π° 90β95 %, Π° ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΡ Π²ΠΎΠ·Π½ΠΈΠΊΠ°ΡΡ Π½Π΅ ΡΠ°ΡΠ΅, ΡΠ΅ΠΌ ΠΏΡΠΈ ΡΡΠ΅Π½ΡΠΈΡΠΎΠ²Π°Π½ΠΈΠΈ Π½Π΅ΠΎΠΊΠΊΠ»ΡΠ·ΠΈΡΡΡΡΠΈΡ
ΠΏΠΎΡΠ°ΠΆΠ΅Π½ΠΈΠΉ. ΠΡΠΎΠ²Π΅Π΄Π΅Π½Π½ΡΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ ΠΏΠΎΠΊΠ°Π·Π°Π»ΠΈ, ΡΡΠΎ ΡΡΠΏΠ΅ΡΠ½Π°Ρ ΡΠ΅ΠΊΠ°Π½Π°Π»ΠΈΠ·Π°ΡΠΈΡ Π₯ΠΠΠ ΡΠΏΠΎΡΠΎΠ±ΡΡΠ²ΡΠ΅Ρ ΡΠ»ΡΡΡΠ΅Π½ΠΈΡ ΠΊΠ»ΠΈΠ½ΠΈΠΊΠΎ-ΡΡΠ½ΠΊΡΠΈΠΎΠ½Π°Π»ΡΠ½ΠΎΠ³ΠΎ ΡΡΠ°ΡΡΡΠ° ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°, ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Π΅ΠΉ Π²Π½ΡΡΡΠΈΡΠ΅ΡΠ΄Π΅ΡΠ½ΠΎΠΉ Π³Π΅ΠΌΠΎΠ΄ΠΈΠ½Π°ΠΌΠΈΠΊΠΈ ΠΈ ΠΊΠ°ΡΠ΅ΡΡΠ²Π° ΠΆΠΈΠ·Π½ΠΈ.ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. ΠΡΠΈΠ²Π΅Π΄Π΅Π½Π½ΡΠΉ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΠΉ ΠΏΡΠΈΠΌΠ΅Ρ Π½Π°Π³Π»ΡΠ΄Π½ΠΎ ΠΏΠΎΠΊΠ°Π·ΡΠ²Π°Π΅Ρ Π½Π΅ΠΎΠ±Ρ
ΠΎΠ΄ΠΈΠΌΠΎΡΡΡ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΡ ΡΠ½Π΄ΠΎΠ²Π°ΡΠΊΡΠ»ΡΡΠ½ΠΎΠΉ ΡΠ΅Π²Π°ΡΠΊΡΠ»ΡΡΠΈΠ·Π°ΡΠΈΠΈ Π₯ΠΠΠ. Π‘ΡΠΎΡΠΌΠΈΡΠΎΠ²Π°Π½Π½Π°Ρ ΠΊΠΎΠ»Π»Π°ΡΠ΅ΡΠ°Π»ΡΠ½Π°Ρ ΡΠ΅ΡΡ ΠΎΠ±Π΅ΡΠΏΠ΅ΡΠΈΠ»Π° ΠΊΡΠΎΠ²ΠΎΡΠΎΠΊ Π² Π·ΠΎΠ½Π΅ ΠΎΡΡΡΠΎΠΉ ΠΎΠΊΠΊΠ»ΡΠ·ΠΈΠΈ ΠΈ ΠΏΡΠ΅Π΄ΡΠΏΡΠ΅Π΄ΠΈΠ»Π° ΡΠ°Π·Π²ΠΈΡΠΈΠ΅ ΠΈΡΠ΅ΠΌΠΈΠΈ ΠΈ ΠΈΠ½ΡΠ°ΡΠΊΡΠ° ΠΌΠΈΠΎΠΊΠ°ΡΠ΄Π°
ΠΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΠΉ ΡΠ»ΡΡΠ°ΠΉ ΡΡΠ΅Π½ΡΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΠΊΠΎΡΠΎΠ½Π°ΡΠ½ΠΎΠΉ Π°ΡΡΠ΅ΡΠΈΠΈ ΠΏΠΎΠ΄ ΠΊΠΎΠ½ΡΡΠΎΠ»Π΅ΠΌ ΠΠ‘Π£ΠΠ Ρ Π±ΠΎΠ»ΡΠ½ΠΎΠ³ΠΎ Ρ Ρ ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΏΠΎΡΠ΅ΡΠ½ΠΎΠΉ Π½Π΅Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎΡΡΡΡ
Introduction. An expanding number of indications for PCI in patients with coronary heart disease and severe concomitant pathology are accompanied by a growing number of patients with chronic renal failure. Contrast-induced nephropathy (CIN) is recognized as a severe complication, aggravating the course of the underlying disease, and, moreover, reducing the life expectancy of the patients. Modern intravascular imaging technologies are widely implemented in real clinical practice of endovascular surgery. In the context of increasing number of PCI performed in patients with severe concomitant pathology, the IVUS-guidance will improve the quality of stenting, and, importantly, lessen the risks of CIN due to the reduction in contrast volume. Materials and methods. The paper presents a clinical case of IVUSguided stenting of the right coronary artery without contrast agent in a patient with chronic kidney disease and the following diagnosis: βCoronary heart disease. Effort angina, class III (dyspnea as anginal equivalent). Balloon angioplasty and stenting of circumflex artery and LAD. Hyperlipidemia 2a. Atherosclerosis of the aorta, brachiocephalic and coronary arteries. Stage 3 hypertension. Controlled Hypertension. Level IV CVD risk. Type 2 diabetes mellitus. Target glycated hemoglobin is less than 7.5%. Grade 2 obesity, exogenous-constitutional. Renal microlithiasis. CKD stage 4 (GFR 29 ml/min/1.73m2). Cerebrovascular disease. Chronic cerebral ischemia.β Results and discussion. In the described clinical case, a complete myocardial revascularization was achieved using IVUS-guidance and minimal amount of contrast agent in a patient with severe CKD. The advantage of minimally invasive endovascular interventions in a complex category of patients, demonstrated by the case, implies expanded possibilities for providing high-tech care to patients with significant limitations in the use of contrast agents due to severe CKD with a high risk of CIN. Conclusion. Today, an increasing number of X-ray operating rooms in Russia are equipped with intravascular technologies, ensuring their wider use. The skills and knowledge in using IVUS imply rare application of contrast agents, thereby lessening the risk of CKD and, as a consequence, improving the prognosis of patients with reduced renal function and high risk of CKD.ΠΠ²Π΅Π΄Π΅Π½ΠΈΠ΅. Π ΡΡΠ»ΠΎΠ²ΠΈΡΡ
ΡΠ°ΡΡΠΈΡΠ΅Π½ΠΈΡ ΠΏΠΎΠΊΠ°Π·Π°Π½ΠΈΠΉ ΠΊ Π§ΠΠ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ
ΠΈΡΠ΅ΠΌΠΈΡΠ΅ΡΠΊΠΎΠΉ Π±ΠΎΠ»Π΅Π·Π½ΡΡ ΡΠ΅ΡΠ΄ΡΠ° Ρ ΡΡΠΆΠ΅Π»ΠΎΠΉ ΡΠΎΠΏΡΡΡΡΠ²ΡΡΡΠ΅ΠΉ ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΠ΅ΠΉ ΡΠ°ΡΡΠ΅Ρ ΡΠΈΡΠ»ΠΎ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ Ρ
ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΏΠΎΡΠ΅ΡΠ½ΠΎΠΉ Π½Π΅Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎΡΡΡΡ. ΠΠΠ ΡΠ²Π»ΡΠ΅ΡΡΡ ΠΎΠ΄Π½ΠΈΠΌ ΠΈΠ· Π³ΡΠΎΠ·Π½ΡΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ, ΡΡΠΎ Π½Π΅ ΡΠΎΠ»ΡΠΊΠΎ ΡΡΡΠ³ΡΠ±Π»ΡΠ΅Ρ ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ ΠΎΡΠ½ΠΎΠ²Π½ΠΎΠ³ΠΎ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ, Π½ΠΎ ΠΈ ΡΠΌΠ΅Π½ΡΡΠ°Π΅Ρ ΠΏΡΠΎΠ΄ΠΎΠ»ΠΆΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡ ΠΆΠΈΠ·Π½ΠΈ Π±ΠΎΠ»ΡΠ½ΠΎΠ³ΠΎ. Π‘ΠΎΠ²ΡΠ΅ΠΌΠ΅Π½Π½ΡΠ΅ ΠΌΠ΅ΡΠΎΠ΄Ρ Π²Π½ΡΡΡΠΈΡΠΎΡΡΠ΄ΠΈΡΡΠΎΠΉ Π²ΠΈΠ·ΡΠ°Π»ΠΈΠ·Π°ΡΠΈΠΈ ΡΠΈΡΠΎΠΊΠΎ Π²Π½Π΅Π΄ΡΡΡΡΡΡ Π² ΡΠ΅Π°Π»ΡΠ½ΡΡ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΡΡ ΠΏΡΠ°ΠΊΡΠΈΠΊΡ ΡΠ½Π΄ΠΎΠ²Π°ΡΠΊΡΠ»ΡΡΠ½ΠΎΠΉ Ρ
ΠΈΡΡΡΠ³ΠΈΠΈ. Π ΡΡΠ»ΠΎΠ²ΠΈΡΡ
ΡΠ°ΡΡΡΡΠ΅Π³ΠΎ ΡΠΈΡΠ»Π° Π²ΡΠΏΠΎΠ»Π½ΡΠ΅ΠΌΡΡ
Π§ΠΠ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ
Ρ ΡΡΠΆΠ΅Π»ΠΎΠΉ ΡΠΎΠΏΡΡΡΡΠ²ΡΡΡΠ΅ΠΉ ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΠ΅ΠΉ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ ΠΠ‘Π£ΠΠ ΡΠ»ΡΡΡΠΈΡ Π½Π΅ ΡΠΎΠ»ΡΠΊΠΎ ΠΊΠ°ΡΠ΅ΡΡΠ²ΠΎ Π²ΡΠΏΠΎΠ»Π½ΡΠ΅ΠΌΡΡ
ΡΡΠ΅Π½ΡΠΈΡΠΎΠ²Π°Π½ΠΈΠΉ, Π½ΠΎ ΠΈ ΡΠ½ΠΈΠ·ΠΈΡ ΡΠΈΡΠΊΠΈ ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΠΠ Π²Π²ΠΈΠ΄Ρ ΡΠΌΠ΅Π½ΡΡΠ΅Π½ΠΈΡ ΠΎΠ±ΡΠ΅ΠΌΠ° Π²Π²ΠΎΠ΄ΠΈΠΌΠΎΠ³ΠΎ ΠΊΠΎΠ½ΡΡΠ°ΡΡΠ°. ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. ΠΡΠΈΠ²ΠΎΠ΄ΠΈΠΌ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΠΉ ΡΠ»ΡΡΠ°ΠΉ ΡΡΠ΅Π½ΡΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΠΏΡΠ°Π²ΠΎΠΉ ΠΊΠΎΡΠΎΠ½Π°ΡΠ½ΠΎΠΉ Π°ΡΡΠ΅ΡΠΈΠΈ Π±Π΅Π· ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΡ ΠΊΠΎΠ½ΡΡΠ°ΡΡΠ½ΠΎΠ³ΠΎ Π²Π΅ΡΠ΅ΡΡΠ²Π° ΠΏΠΎΠ΄ ΠΊΠΎΠ½ΡΡΠΎΠ»Π΅ΠΌ ΠΠ‘Π£ΠΠ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΊΠΈ Ρ Ρ
ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ Π±ΠΎΠ»Π΅Π·Π½ΡΡ ΠΏΠΎΡΠ΅ΠΊ ΠΈ Π΄ΠΈΠ°Π³Π½ΠΎΠ·ΠΎΠΌ: ΠΡΠ΅ΠΌΠΈΡΠ΅ΡΠΊΠ°Ρ Π±ΠΎΠ»Π΅Π·Π½Ρ ΡΠ΅ΡΠ΄ΡΠ°. Π‘ΡΠ΅Π½ΠΎΠΊΠ°ΡΠ΄ΠΈΡ Π½Π°ΠΏΡΡΠΆΠ΅Π½ΠΈΡ, III ΡΡΠ½ΠΊΡΠΈΠΎΠ½Π°Π»ΡΠ½ΡΠΉ ΠΊΠ»Π°ΡΡ (ΠΎΠ΄ΡΡΠΊΠ° ΠΊΠ°ΠΊ ΡΠΊΠ²ΠΈΠ²Π°Π»Π΅Π½Ρ). ΠΠ°Π»Π»ΠΎΠ½Π½Π°Ρ Π°Π½Π³ΠΈΠΎΠΏΠ»Π°ΡΡΠΈΠΊΠ° ΠΈ ΡΡΠ΅Π½ΡΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ ΠΠ ΠΈ ΠΠΠΠ. ΠΠΈΠΏΠ΅ΡΠ»ΠΈΠΏΠΈΠ΄Π΅ΠΌΠΈΡ 2 Π°. ΠΡΠ΅ΡΠΎΡΠΊΠ»Π΅ΡΠΎΠ· Π°ΠΎΡΡΡ, Π±ΡΠ°Ρ
ΠΈΠΎΡΠ΅ΡΠ°Π»ΡΠ½ΡΡ
ΠΈ ΠΊΠΎΡΠΎΠ½Π°ΡΠ½ΡΡ
Π°ΡΡΠ΅ΡΠΈΠΉ. ΠΠΈΠΏΠ΅ΡΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠ°Ρ Π±ΠΎΠ»Π΅Π·Π½Ρ III ΡΡΠ°Π΄ΠΈΠΈ. ΠΠΎΠ½ΡΡΠΎΠ»ΠΈΡΡΠ΅ΠΌΠ°Ρ Π°ΡΡΠ΅ΡΠΈΠ°Π»ΡΠ½Π°Ρ Π³ΠΈΠΏΠ΅ΡΡΠ΅Π½Π·ΠΈΡ. Π ΠΈΡΠΊ Π‘Π‘Π IV. Π‘Π°Ρ
Π°ΡΠ½ΡΠΉ Π΄ΠΈΠ°Π±Π΅Ρ 2 ΡΠΈΠΏΠ°. Π¦Π΅Π»Π΅Π²ΠΎΠΉ ΡΡΠΎΠ²Π΅Π½Ρ Π³Π»ΠΈΠΊΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠ³ΠΎ Π³Π΅ΠΌΠΎΠ³Π»ΠΎΠ±ΠΈΠ½Π° ΠΌΠ΅Π½Π΅Π΅ 7,5 %. ΠΠΆΠΈΡΠ΅Π½ΠΈΠ΅ 2 ΡΡΠ΅ΠΏΠ΅Π½ΠΈ, ΡΠΊΠ·ΠΎΠ³Π΅Π½Π½ΠΎ-ΠΊΠΎΠ½ΡΡΠΈΡΡΡΠΈΠΎΠ½Π°Π»ΡΠ½ΠΎΠ΅. ΠΠΈΠΊΡΠΎΠ»ΠΈΡΡ ΠΏΠΎΡΠ΅ΠΊ. Π₯ΠΠ 4 ΡΡΠ°Π΄ΠΈΡ (Π‘ΠΠ€ 29 ΠΌΠ»/ΠΌΠΈΠ½/1,73 ΠΌ 2). Π¦Π΅ΡΠ΅Π±ΡΠΎΠ²Π°ΡΠΊΡΠ»ΡΡΠ½Π°Ρ Π±ΠΎΠ»Π΅Π·Π½Ρ. Π₯ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠ°Ρ ΠΈΡΠ΅ΠΌΠΈΡ Π³ΠΎΠ»ΠΎΠ²Π½ΠΎΠ³ΠΎ ΠΌΠΎΠ·Π³Π°. Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ ΠΈ ΠΎΠ±ΡΡΠΆΠ΄Π΅Π½ΠΈΠ΅. Π ΠΎΠΏΠΈΡΠ°Π½Π½ΠΎΠΌ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΌ ΡΠ»ΡΡΠ°Π΅ ΡΠ΄Π°Π»ΠΎΡΡ Π΄ΠΎΠ±ΠΈΡΡΡΡ ΠΏΠΎΠ»Π½ΠΎΠΉ ΡΠ΅Π²Π°ΡΠΊΡΠ»ΡΡΠΈΠ·Π°ΡΠΈΠΈ ΠΌΠΈΠΎΠΊΠ°ΡΠ΄Π° ΠΏΠΎΠ΄ ΠΊΠΎΠ½ΡΡΠΎΠ»Π΅ΠΌ ΠΠ‘Π£ΠΠ Ρ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ ΠΌΠΈΠ½ΠΈΠΌΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²Π° ΠΊΠΎΠ½ΡΡΠ°ΡΡΠ½ΠΎΠ³ΠΎ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠ° Ρ Π±ΠΎΠ»ΡΠ½ΠΎΠ³ΠΎ Ρ ΡΡΠΆΠ΅Π»ΠΎΠΉ Π₯ΠΠ ΠΠ°Π½Π½ΡΠΉ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΠΉ ΠΏΡΠΈΠΌΠ΅Ρ Π΄Π΅ΠΌΠΎΠ½ΡΡΡΠΈΡΡΠ΅Ρ ΠΏΡΠ΅ΠΈΠΌΡΡΠ΅ΡΡΠ²ΠΎ ΠΌΠ°Π»ΠΎΠΈΠ½Π²Π°Π·ΠΈΠ²Π½ΡΡ
ΡΠ½Π΄ΠΎΠ²Π°ΡΠΊΡΠ»ΡΡΠ½ΡΡ
Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ² Ρ ΡΠ»ΠΎΠΆΠ½ΠΎΠΉ ΠΊΠ°ΡΠ΅Π³ΠΎΡΠΈΠΈ Π±ΠΎΠ»ΡΠ½ΡΡ
, ΠΊΠΎΡΠΎΡΡΠ΅ ΠΏΠΎΠ·Π²ΠΎΠ»ΡΡ ΡΠ°ΡΡΠΈΡΠΈΡΡ Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΠΈ ΠΎΠΊΠ°Π·Π°Π½ΠΈΡ Π²ΡΡΠΎΠΊΠΎΡΠ΅Ρ
Π½ΠΎΠ»ΠΎΠ³ΠΈΡΠ½ΠΎΠΉ ΠΏΠΎΠΌΠΎΡΠΈ Π±ΠΎΠ»ΡΠ½ΡΠΌ, ΠΈΠΌΠ΅ΡΡΠΈΠΌ Π·Π½Π°ΡΠΈΡΠ΅Π»ΡΠ½ΡΠ΅ ΠΎΠ³ΡΠ°Π½ΠΈΡΠ΅Π½ΠΈΡ Π² ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠΈ ΠΊΠΎΠ½ΡΡΠ°ΡΡΠ½ΡΡ
ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠΎΠ² Π²Π²ΠΈΠ΄Ρ ΡΡΠΆΠ΅Π»ΠΎΠΉ Π₯ΠΠ Ρ Π²ΡΡΠΎΠΊΠΈΠΌ ΡΠΈΡΠΊΠΎΠΌ ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΠΠ. ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. ΠΠ° ΡΠ΅Π³ΠΎΠ΄Π½ΡΡΠ½ΠΈΠΉ Π΄Π΅Π½Ρ Π²ΡΠ΅ Π±ΠΎΠ»ΡΡΠ΅Π΅ ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²ΠΎ ΡΠ΅Π½ΡΠ³Π΅Π½ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΡΡ
ΡΡΡΠ°Π½Ρ ΠΎΡΠ½Π°ΡΠ΅Π½Ρ Π²Π½ΡΡΡΠΈΡΠΎΡΡΠ΄ΠΈΡΡΡΠΌΠΈ ΠΌΠΎΠ΄Π°Π»ΡΠ½ΠΎΡΡΡΠΌΠΈ, ΡΡΠΎ, Π±Π΅Π·ΡΡΠ»ΠΎΠ²Π½ΠΎ, ΠΏΡΠΈΠ²Π΅Π΄Π΅Ρ ΠΊ Π±ΠΎΠ»Π΅Π΅ ΡΠΈΡΠΎΠΊΠΎΠΌΡ ΠΈΡ
ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΡ. ΠΠ°Π²ΡΠΊΠΈ ΠΈ Π·Π½Π°Π½ΠΈΡ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΡ ΠΠ‘Π£ΠΠ ΠΏΠΎΠ·Π²ΠΎΠ»ΡΡ Π² ΠΌΠ΅Π½ΡΡΠ΅ΠΌ ΠΎΠ±ΡΠ΅ΠΌΠ΅ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°ΡΡ Π ΠΠ, ΡΡΠΎ ΠΏΡΠΈΠ²Π΅Π΄Π΅Ρ ΠΊ ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΡ ΡΠΈΡΠΊΠ° ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΠΠ ΠΈ, ΠΊΠ°ΠΊ ΡΠ»Π΅Π΄ΡΡΠ²ΠΈΠ΅, ΡΠ»ΡΡΡΠ΅Π½ΠΈΡ ΠΏΡΠΎΠ³Π½ΠΎΠ·Π° ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΡΠΎ ΡΠ½ΠΈΠΆΠ΅Π½Π½ΠΎΠΉ ΡΡΠ½ΠΊΡΠΈΠ΅ΠΉ ΠΏΠΎΡΠ΅ΠΊ ΠΈ Π²ΡΡΠΎΠΊΠΈΠΌ ΡΠΈΡΠΊΠΎΠΌ ΠΠΠ
ΠΠ½Π΄ΠΎΠ²Π°ΡΠΊΡΠ»ΡΡΠ½ΠΎΠ΅ Π»Π΅ΡΠ΅Π½ΠΈΠ΅ ΡΡΠ΅Π½ΠΎΠ·Π° ΠΏΠΎΡΠ΅ΡΠ½ΠΎΠΉ Π°ΡΡΠ΅ΡΠΈΠΈ, Π²ΡΠ·Π²Π°Π½Π½ΠΎΠ³ΠΎ ΡΠΈΠ±ΡΠΎΠΌΡΡΠΊΡΠ»ΡΡΠ½ΠΎΠΉ Π΄ΠΈΡΠΏΠ»Π°Π·ΠΈΠ΅ΠΉ. ΠΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΠΉ ΡΠ»ΡΡΠ°ΠΉ
Introduction. Fibromuscular dysplasia (FMD) is an idiopathic, non-atherosclerotic, non-inflammatory disease of arteries. Careful research into this disorder showed that FMD has been found in every arterial bed in the body; the most common arteries affected are renal arteries and extracranial sections of carotid and vertebral arteries. The clinical presentation is determined by the localization of the vasculature affected and the stenosis severity. Today FMD is a very rare disease with the incidence of 4 per 1000 people. The diagnosis today is difficult and may take a long time. According to the latest European Society of Cardiology guidelines renal artery balloon angioplasty is indicated for patients with FMD; if a good angiographic result is achieved (no dissection, TIMI 3 flow) no renal artery stenting required. The treatment success depends on the early diagnosis.Materials and Methods. This paper presents a clinical case of renal artery stenosis caused by fibromuscular dysplasia that was treated successfully with balloon angioplasty without stenting.Results and discussion. Protracted process of diagnosing this disease may result in deteriorating quality of life and poor outcomes such as difficult-to-control hypertension and its sequelae, TIA, stroke, aneurism dissection or rupture. It is worth pointing out that FMD diagnosis may be incidental when imaging is performed for other reasons, or when there is a systolic murmur at arteries in an asymptomatic patient who does not have classic atherosclerosis risk factors. According to the latest guidelines endovascular treatment is indicated for patients with FMD to manage the hypertension; this has proven very effective in improving quality of life.ΠΠ²Π΅Π΄Π΅Π½ΠΈΠ΅. Π€ΠΈΠ±ΡΠΎΠΌΡΡΠΊΡΠ»ΡΡΠ½Π°Ρ Π΄ΠΈΡΠΏΠ»Π°Π·ΠΈΡ (Π€ΠΠ)Β β ΠΈΠ΄ΠΈΠΎΠΏΠ°ΡΠΈΡΠ΅ΡΠΊΠΎΠ΅, Π½Π΅ Π°ΡΠ΅ΡΠΎΡΠΊΠ»Π΅ΡΠΎΡΠΈΡΠ΅ΡΠΊΠΎΠ΅, Π½Π΅ Π²ΠΎΡΠΏΠ°Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎΠ΅ ΠΏΠΎΡΠ°ΠΆΠ΅Π½ΠΈΠ΅ Π°ΡΡΠ΅ΡΠΈΠΉ. Π’ΡΠ°ΡΠ΅Π»ΡΠ½ΠΎΠ΅ ΠΈΠ·ΡΡΠ΅Π½ΠΈΠ΅ Π΄Π°Π½Π½ΠΎΠΉ ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΠΈ ΠΏΠΎΠΊΠ°Π·Π°Π»ΠΎ, ΡΡΠΎ ΠΏΡΠΈ Π€ΠΠ ΠΏΠΎΡΠ°ΠΆΠ°ΡΡΡΡ Π²ΡΠ΅ ΡΠΎΡΡΠ΄ΠΈΡΡΡΠ΅ ΡΡΡΠ»Π°, Π½Π°ΠΈΠ±ΠΎΠ»Π΅Π΅ ΡΠ°ΡΠ΅ Π²ΡΡΡΠ΅ΡΠ°Π΅ΠΌΡΠ΅Β β ΡΡΠΎ ΠΏΠΎΡΠ΅ΡΠ½ΡΠ΅ Π°ΡΡΠ΅ΡΠΈΠΈ ΠΈ ΡΠΊΡΡΡΠ°ΠΊΡΠ°Π½ΠΈΠ°Π»ΡΠ½ΡΠ΅ ΠΎΡΠ΄Π΅Π»Ρ ΡΠΎΠ½Π½ΡΡ
ΠΈ ΠΏΠΎΠ·Π²ΠΎΠ½ΠΎΡΠ½ΡΡ
Π°ΡΡΠ΅ΡΠΈΠΉ. ΠΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠ°Ρ ΠΊΠ°ΡΡΠΈΠ½Π° Π€ΠΠ ΠΎΠΏΡΠ΅Π΄Π΅Π»ΡΠ΅ΡΡΡ Π»ΠΎΠΊΠ°Π»ΠΈΠ·Π°ΡΠΈΠ΅ΠΉ ΠΏΠΎΡΠ°ΠΆΠ΅Π½Π½ΠΎΠ³ΠΎ ΡΠΎΡΡΠ΄ΠΈΡΡΠΎΠ³ΠΎ Π±Π°ΡΡΠ΅ΠΉΠ½Π° ΠΈΒ ΡΡΠΆΠ΅ΡΡΡΡ ΡΡΠ΅Π½ΠΎΠ·Π°. ΠΠ° ΡΠ΅Π³ΠΎΠ΄Π½ΡΡΠ½ΠΈΠΉ Π΄Π΅Π½Ρ Π€ΠΠ ΡΠ²Π»ΡΠ΅ΡΡΡ Π²Π΅ΡΡΠΌΠ° ΡΠ΅Π΄ΠΊΠΈΠΌ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠ΅ΠΌ. ΠΠ³ΠΎ ΡΠ°ΡΠΏΡΠΎΡΡΡΠ°Π½Π΅Π½Π½ΠΎΡΡΡ ΠΏΡΠΈΠΌΠ΅ΡΠ½ΠΎ 4 Π½Π° 1000 ΡΠ΅Π»ΠΎΠ²Π΅ΠΊ. Π‘Π²ΠΎΠ΅Π²ΡΠ΅ΠΌΠ΅Π½Π½Π°Ρ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠ° Π·Π°ΡΡΡΠ΄Π½Π΅Π½Π°, ΠΈ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΈΠΉ ΠΏΠΎΠΈΡΠΊ ΠΌΠΎΠΆΠ΅Ρ Π·Π°Π½ΡΡΡ ΠΌΠ½ΠΎΠ³ΠΎ Π²ΡΠ΅ΠΌΠ΅Π½ΠΈ. Π‘ΠΎΠ³Π»Π°ΡΠ½ΠΎ ΠΏΠΎΡΠ»Π΅Π΄Π½ΠΈΠΌ ΡΠ΅ΠΊΠΎΠΌΠ΅Π½Π΄Π°ΡΠΈΡΠΌ ΠΠ²ΡΠΎΠΏΠ΅ΠΉΡΠΊΠΎΠΉ Π°ΡΡΠΎΡΠΈΠ°ΡΠΈΠΈ ΠΊΠ°ΡΠ΄ΠΈΠΎΠ»ΠΎΠ³ΠΎΠ² ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°ΠΌ Ρ Π€ΠΠ ΠΏΠΎΠΊΠ°Π·Π°Π½Π° Π±Π°Π»Π»ΠΎΠ½Π½Π°Ρ Π°Π½Π³ΠΈΠΎΠΏΠ»Π°ΡΡΠΈΠΊΠ° ΠΏΠΎΡΠ΅ΡΠ½ΠΎΠΉ Π°ΡΡΠ΅ΡΠΈΠΈ, ΠΏΡΠΈ Ρ
ΠΎΡΠΎΡΠ΅ΠΌ Π°Π½Π³ΠΈΠΎΠ³ΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΎΠΌ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠ΅ (ΠΎΡΡΡΡΡΡΠ²ΠΈΠ΅ Π΄ΠΈΡΡΠ΅ΠΊΡΠΈΠΈ, ΠΊΡΠΎΠ²ΠΎΡΠΎΠΊ TIMI 3) Π±Π΅Π· ΠΈΠΌΠΏΠ»Π°Π½ΡΠ°ΡΠΈΠΈ ΡΡΠ΅Π½ΡΠ° Π² ΠΏΠΎΡΠ΅ΡΠ½ΡΡ Π°ΡΡΠ΅ΡΠΈΡ. Π£ΡΠΏΠ΅Ρ
Π»Π΅ΡΠ΅Π½ΠΈΡ Π·Π°Π²ΠΈΡΠΈΡ ΠΎΡΒ ΡΠ°Π½Π½Π΅ΠΉ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ. ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. Π ΡΡΠ°ΡΡΠ΅ ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»Π΅Π½ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΠΉ ΡΠ»ΡΡΠ°ΠΉ ΡΡΠΏΠ΅ΡΠ½ΠΎΠ³ΠΎ ΡΠ½Π΄ΠΎΠ²Π°ΡΠΊΡΠ»ΡΡΠ½ΠΎΠ³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ ΡΡΠ΅Π½ΠΎΠ·Π° ΠΏΠΎΡΠ΅ΡΠ½ΠΎΠΉ Π°ΡΡΠ΅ΡΠΈΠΈ, Π²ΡΠ·Π²Π°Π½Π½ΠΎΠ³ΠΎ ΡΠΈΠ±ΡΠΎΠΌΡΡΠΊΡΠ»ΡΡΠ½ΠΎΠΉ Π΄ΠΈΡΠΏΠ»Π°Π·ΠΈΠ΅ΠΉ, ΠΏΡΠΈ ΠΏΠΎΠΌΠΎΡΠΈ Π±Π°Π»Π»ΠΎΠ½Π½ΠΎΠΉ Π°Π½Π³ΠΈΠΎΠΏΠ»Π°ΡΡΠΈΠΊΠΈ Π±Π΅Π· ΡΡΠ΅Π½ΡΠΈΡΠΎΠ²Π°Π½ΠΈΡ.Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ ΠΈ ΠΎΠ±ΡΡΠΆΠ΄Π΅Π½ΠΈΠ΅. ΠΠ»ΠΈΡΠ΅Π»ΡΠ½Π°Ρ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠ° Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ ΠΌΠΎΠΆΠ΅Ρ ΠΏΡΠΈΠ²Π΅ΡΡΠΈ ΠΊ ΡΡ
ΡΠ΄ΡΠ΅Π½ΠΈΡ ΠΊΠ°ΡΠ΅ΡΡΠ²Π° ΠΆΠΈΠ·Π½ΠΈ ΠΈ Π½Π΅Π±Π»Π°Π³ΠΎΠΏΡΠΈΡΡΠ½ΡΠΌ ΠΈΡΡ
ΠΎΠ΄Π°ΠΌ, ΡΠ°ΠΊΠΈΠΌ ΠΊΠ°ΠΊ ΠΏΠ»ΠΎΡ
ΠΎ ΠΊΠΎΠ½ΡΡΠΎΠ»ΠΈΡΡΠ΅ΠΌΠ°Ρ Π³ΠΈΠΏΠ΅ΡΡΠ΅Π½Π·ΠΈΡ ΠΈ Π΅Π΅ ΠΏΠΎΡΠ»Π΅Π΄ΡΡΠ²ΠΈΡ, Π’ΠΠ, ΠΈΠ½ΡΡΠ»ΡΡ, Π΄ΠΈΡΡΠ΅ΠΊΡΠΈΡ ΠΈΠ»ΠΈ ΡΠ°Π·ΡΡΠ² Π°Π½Π΅Π²ΡΠΈΠ·ΠΌΡ. Π‘Π»Π΅Π΄ΡΠ΅Ρ ΠΎΡΠΌΠ΅ΡΠΈΡΡ, ΡΡΠΎ Π€ΠΠ ΠΌΠΎΠΆΠ΅Ρ Π±ΡΡΡ ΠΎΠ±Π½Π°ΡΡΠΆΠ΅Π½Π° ΡΠ»ΡΡΠ°ΠΉΠ½ΠΎ, ΠΊΠΎΠ³Π΄Π° Π²ΠΈΠ·ΡΠ°Π»ΠΈΠ·Π°ΡΠΈΡ Π²ΡΠΏΠΎΠ»Π½ΡΠ΅ΡΡΡ ΠΏΠΎ Π΄ΡΡΠ³ΠΈΠΌ ΠΏΡΠΈΡΠΈΠ½Π°ΠΌ ΠΈΠ»ΠΈ ΠΊΠΎΠ³Π΄Π° ΡΠ»ΡΡΠ΅Π½ ΡΠΈΡΡΠΎΠ»ΠΈΡΠ΅ΡΠΊΠΈΠΉ ΡΡΠΌ ΠΏΡΠΈ Π°ΡΡΠΊΡΠ»ΡΡΠ°ΡΠΈΠΈ Π°ΡΡΠ΅ΡΠΈΠΉ Ρ Π±Π΅ΡΡΠΈΠΌΠΏΡΠΎΠΌΠ½ΠΎΠ³ΠΎ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° Π±Π΅Π· ΠΊΠ»Π°ΡΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΡΠ°ΠΊΡΠΎΡΠΎΠ² ΡΠΈΡΠΊΠ° Π°ΡΠ΅ΡΠΎΡΠΊΠ»Π΅ΡΠΎΠ·Π°. ΠΠΎ ΡΠΎΠ²ΡΠ΅ΠΌΠ΅Π½Π½ΡΠΌ ΡΠ΅ΠΊΠΎΠΌΠ΅Π½Π΄Π°ΡΠΈΡΠΌ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°ΠΌ ΡΠΎ ΡΡΠ΅Π½ΠΎΠ·ΠΎΠΌ ΠΏΠΎΡΠ΅ΡΠ½ΡΡ
Π°ΡΡΠ΅ΡΠΈΠΉ ΠΏΡΠΈ Π€ΠΠ Π΄Π»Ρ Π»Π΅ΡΠ΅Π½ΠΈΡ Π³ΠΈΠΏΠ΅ΡΡΠΎΠ½ΠΈΠΈ ΠΏΠΎΠΊΠ°Π·Π°Π½ΠΎ ΡΠ½Π΄ΠΎΠ²Π°ΡΠΊΡΠ»ΡΡΠ½ΠΎΠ΅ Π»Π΅ΡΠ΅Π½ΠΈΠ΅, ΠΊΠΎΡΠΎΡΠΎΠ΅ Π΄Π°Π΅Ρ Ρ
ΠΎΡΠΎΡΠΈΠΉ ΡΡΡΠ΅ΠΊΡ Π² ΡΠ»ΡΡΡΠ΅Π½ΠΈΠΈ ΠΊΠ°ΡΠ΅ΡΡΠ²Π° ΠΆΠΈΠ·Π½ΠΈ.ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. ΠΠ½Π΄ΠΎΠ²Π°ΡΠΊΡΠ»ΡΡΠ½Π°Ρ Π±Π°Π»Π»ΠΎΠ½Π½Π°Ρ Π°Π½Π³ΠΈΠΎΠΏΠ»Π°ΡΡΠΈΠΊΠ° ΠΏΠΎΡΠ΅ΡΠ½ΠΎΠΉ Π°ΡΡΠ΅ΡΠΈΠΈ ΠΌΠΎΠΆΠ΅Ρ ΡΡΠΏΠ΅ΡΠ½ΠΎ ΠΏΡΠΈΠΌΠ΅Π½ΡΡΡΡΡ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΡΠΈΠ±ΡΠΎΠΌΡΡΠΊΡΠ»ΡΡΠ½ΠΎΠΉ Π΄ΠΈΡΠΏΠ»Π°Π·ΠΈΠ΅ΠΉ
ΠΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠ΅ Π² Ρ ΠΎΠ΄Π΅ ΡΠ½Π΄ΠΎΠ²Π°ΡΠΊΡΠ»ΡΡΠ½ΠΎΠ³ΠΎ Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ²Π°: ΠΎΡΡΡΠ°Ρ ΠΈΡΠ΅ΠΌΠΈΡ Π½ΠΈΠΆΠ½Π΅ΠΉ ΠΊΠΎΠ½Π΅ΡΠ½ΠΎΡΡΠΈ Π² ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠ΅ ΡΠΏΠΈΡΠ°Π»Π΅Π²ΠΈΠ΄Π½ΠΎΠΉ Π΄ΠΈΡΡΠ΅ΠΊΡΠΈΠΈ ΠΏΡΠΈ Π°Π½ΡΠ΅Π³ΡΠ°Π΄Π½ΠΎΠΉ ΠΏΡΠ½ΠΊΡΠΈΠΈ Π»Π΅Π²ΠΎΠΉ ΠΎΠ±ΡΠ΅ΠΉ Π±Π΅Π΄ΡΠ΅Π½Π½ΠΎΠΉ Π°ΡΡΠ΅ΡΠΈΠΈ
Introduction. Over the past decade, endovascular interventions have become widely used in patients with obliterating atherosclerosis of lower extremity arteries. This is due to the low-trauma nature of the methodology, various technological achievements in the improvement of instruments and the accumulation of operational experience. However, despite all the successes achieved, no intervention is without its complications. In the case of endovascular interventions, complications are most commonly associated with the site of arterial access. One of the most widely-used arterial approaches is retrograde femoral access. However, if an intervention is planned on the femoropopliteal arterial segment, the antegrade femoral approach is generally the method of choice. Among the advantages of antegrade access can be noted the shorter path to the site, better toolkit support and a shorter operation duration. One of the main complications involved in antegrade access is the development of dissection. Although this complication occurs in less than 1% of cases, it carries a threat of critical ischemia of the lower limbs, which may require emergency open surgery up to and including emergency limb amputation.Materials and methods. The paper presents a clinical case of successful treatment of iatrogenic spiral dissection, which occurred following antegrade vascular access. During surgical treatment of this complication, stents were implanted throughout the dissection to βpressβ the exfoliated layer of the intima.Results. The study presents a case of iatrogenic spiral dissection after antegrade femoral puncture followed by successful endovascular treatment of this complication.Conclusion. Endovascular balloon angioplasty and stenting can be successfully used when iatrogenic dissection develops following antegrade puncture of the right femoral artery, allowing classic βopenβ surgical intervention to be avoided.ΠΠ²Π΅Π΄Π΅Π½ΠΈΠ΅. ΠΠ° ΠΏΠΎΡΠ»Π΅Π΄Π½Π΅Π΅ Π΄Π΅ΡΡΡΠΈΠ»Π΅ΡΠΈΠ΅ ΡΠ½Π΄ΠΎΠ²Π°ΡΠΊΡΠ»ΡΡΠ½ΡΠ΅ Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ²Π° ΡΡΠ°Π»ΠΈ ΡΠΈΡΠΎΠΊΠΎ ΠΏΡΠΈΠΌΠ΅Π½ΡΡΡΡΡ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΎΠ±Π»ΠΈΡΠ΅ΡΠΈΡΡΡΡΠΈΠΌ Π°ΡΠ΅ΡΠΎΡΠΊΠ»Π΅ΡΠΎΠ·ΠΎΠΌ Π°ΡΡΠ΅ΡΠΈΠΉ Π½ΠΈΠΆΠ½ΠΈΡ
ΠΊΠΎΠ½Π΅ΡΠ½ΠΎΡΡΠ΅ΠΉ. ΠΡΠΎΠΌΡ ΡΠΏΠΎΡΠΎΠ±ΡΡΠ²ΠΎΠ²Π°Π»ΠΈ ΠΌΠ°Π»Π°Ρ ΡΡΠ°Π²ΠΌΠ°ΡΠΈΡΠ½ΠΎΡΡΡ ΠΌΠ΅ΡΠΎΠ΄ΠΈΠΊΠΈ, Π΄ΠΎΡΡΠΈΠΆΠ΅Π½ΠΈΡ Π½Π°ΡΠΊΠΈ ΠΈ ΡΠ΅Ρ
Π½ΠΈΠΊΠΈ Π² ΡΡΠΎΠ²Π΅ΡΡΠ΅Π½ΡΡΠ²ΠΎΠ²Π°Π½ΠΈΠΈ ΠΈΠ½ΡΡΡΡΠΌΠ΅Π½ΡΠ°ΡΠΈΡ ΠΈ Π½Π°ΠΊΠΎΠΏΠ»Π΅Π½ΠΈΠ΅ ΠΎΠΏΡΡΠ° ΠΎΠΏΠ΅ΡΠ°ΡΠΎΡΠΎΠ². ΠΠ΅ΡΠΌΠΎΡΡΡ Π½Π° Π²ΡΠ΅ Π΄ΠΎΡΡΠΈΠ³Π½ΡΡΡΠ΅ ΡΡΠΏΠ΅Ρ
ΠΈ, Ρ Π»ΡΠ±ΠΎΠ³ΠΎ Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ²Π° Π΅ΡΡΡ ΡΠ²ΠΎΠΈ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΡ. ΠΡΠΈ ΡΠ½Π΄ΠΎΠ²Π°ΡΠΊΡΠ»ΡΡΠ½ΡΡ
Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ²Π°Ρ
Π½Π°ΠΈΠ±ΠΎΠ»Π΅Π΅ ΡΠ°ΡΡΠΎ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΡ ΡΠ²ΡΠ·Π°Π½Ρ Ρ ΠΌΠ΅ΡΡΠΎΠΌ Π°ΡΡΠ΅ΡΠΈΠ°Π»ΡΠ½ΠΎΠ³ΠΎ Π΄ΠΎΡΡΡΠΏΠ°. ΠΠ΄Π½ΠΈΠΌ ΠΈΠ· ΡΠ°ΡΠΏΡΠΎΡΡΡΠ°Π½Π΅Π½Π½ΡΡ
Π°ΡΡΠ΅ΡΠΈΠ°Π»ΡΠ½ΡΡ
Π΄ΠΎΡΡΡΠΏΠΎΠ² ΡΠ»ΡΠΆΠΈΡ ΡΠ΅ΡΡΠΎΠ³ΡΠ°Π΄Π½ΡΠΉ Π±Π΅Π΄ΡΠ΅Π½Π½ΡΠΉ Π΄ΠΎΡΡΡΠΏ. ΠΠ΄Π½Π°ΠΊΠΎ Π΅ΡΠ»ΠΈ ΠΏΠ»Π°Π½ΠΈΡΡΠ΅ΡΡΡ Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ²ΠΎ Π½Π° Π±Π΅Π΄ΡΠ΅Π½Π½ΠΎ-ΠΏΠΎΠ΄ΠΊΠΎΠ»Π΅Π½Π½ΠΎΠΌ Π°ΡΡΠ΅ΡΠΈΠ°Π»ΡΠ½ΠΎΠΌ ΡΠ΅Π³ΠΌΠ΅Π½ΡΠ΅, ΠΌΠ΅ΡΠΎΠ΄ΠΎΠΌ Π²ΡΠ±ΠΎΡΠ° ΡΠ»ΡΠΆΠΈΡ Π°Π½ΡΠ΅Π³ΡΠ°Π΄Π½ΡΠΉ Π±Π΅Π΄ΡΠ΅Π½Π½ΡΠΉ Π΄ΠΎΡΡΡΠΏ. ΠΠ· ΠΏΡΠ΅ΠΈΠΌΡΡΠ΅ΡΡΠ² Π°Π½ΡΠ΅Π³ΡΠ°Π΄Π½ΠΎΠ³ΠΎ Π΄ΠΎΡΡΡΠΏΠ° ΠΌΠΎΠΆΠ½ΠΎ ΠΎΡΠΌΠ΅ΡΠΈΡΡ Π±ΠΎΠ»Π΅Π΅ ΠΊΠΎΡΠΎΡΠΊΠΈΠΉ ΠΏΡΡΡ Π΄ΠΎ ΠΏΠΎΡΠ°ΠΆΠ΅Π½ΠΈΡ, Π»ΡΡΡΡΡ ΠΏΠΎΠ΄Π΄Π΅ΡΠΆΠΊΡ ΠΈΠ½ΡΡΡΡΠΌΠ΅Π½ΡΠ°ΡΠΈΡ ΠΈ ΡΠΎΠΊΡΠ°ΡΠ΅Π½ΠΈΠ΅ Π΄Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΠΈ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΈ. ΠΠ΄Π½ΠΈΠΌ ΠΈΠ· ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ Π°Π½ΡΠ΅Π³ΡΠ°Π΄Π½ΠΎΠ³ΠΎ Π΄ΠΎΡΡΡΠΏΠ° ΡΠ²Π»ΡΠ΅ΡΡΡ ΡΠ°Π·Π²ΠΈΡΠΈΠ΅ Π΄ΠΈΡΡΠ΅ΠΊΡΠΈΠΈ. ΠΠ°Π½Π½ΠΎΠ΅ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠ΅ Π²ΠΎΠ·Π½ΠΈΠΊΠ°Π΅Ρ ΠΌΠ΅Π½Π΅Π΅ ΡΠ΅ΠΌ Π² 1 % ΡΠ»ΡΡΠ°Π΅Π², Π½ΠΎ ΡΠ°ΠΈΡ Π² ΡΠ΅Π±Π΅ ΡΠ³ΡΠΎΠ·Ρ ΠΊΡΠΈΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΈΡΠ΅ΠΌΠΈΠΈ Π½ΠΈΠΆΠ½Π΅ΠΉ ΠΊΠΎΠ½Π΅ΡΠ½ΠΎΡΡΠΈ, ΡΡΠΎ ΠΌΠΎΠΆΠ΅Ρ ΠΏΠΎΡΡΠ΅Π±ΠΎΠ²Π°ΡΡ ΡΠΊΡΡΡΠ΅Π½Π½ΠΎΠΉ ΠΎΡΠΊΡΡΡΠΎΠΉ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΈ, Π²ΠΏΠ»ΠΎΡΡ Π΄ΠΎ ΡΠΊΡΡΡΠ΅Π½Π½ΠΎΠΉ Π°ΠΌΠΏΡΡΠ°ΡΠΈΠΈ ΠΊΠΎΠ½Π΅ΡΠ½ΠΎΡΡΠΈ.ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. Π Π΄Π°Π½Π½ΠΎΠΉ ΡΠ°Π±ΠΎΡΠ΅ ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»Π΅Π½ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΠΉ ΡΠ»ΡΡΠ°ΠΉ ΡΡΠΏΠ΅ΡΠ½ΠΎΠ³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ ΡΡΡΠΎΠ³Π΅Π½Π½ΠΎΠΉ ΡΠΏΠΈΡΠ°Π»Π΅Π²ΠΈΠ΄Π½ΠΎΠΉ Π΄ΠΈΡΡΠ΅ΠΊΡΠΈΠΈ, Π²ΠΎΠ·Π½ΠΈΠΊΡΠ΅ΠΉ ΠΏΠΎΡΠ»Π΅ Π°Π½ΡΠ΅Π³ΡΠ°Π΄Π½ΠΎΠ³ΠΎ ΡΠΎΡΡΠ΄ΠΈΡΡΠΎΠ³ΠΎ Π΄ΠΎΡΡΡΠΏΠ°. Π Ρ
ΠΎΠ΄Π΅ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠ²Π½ΠΎΠ³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ Π΄Π°Π½Π½ΠΎΠ³ΠΎ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΡ ΠΏΠΎΡΠ»Π΅Π΄ΠΎΠ²Π°ΡΠ΅Π»ΡΠ½ΠΎ Π±ΡΠ»ΠΈ ΠΈΠΌΠΏΠ»Π°Π½ΡΠΈΡΠΎΠ²Π°Π½Ρ ΡΡΠ΅Π½ΡΡ Π½Π° Π²ΡΠ΅ΠΌ ΠΏΡΠΎΡΡΠΆΠ΅Π½ΠΈΠΈ Π΄ΠΈΡΡΠ΅ΠΊΡΠΈΠΈ, ΡΡΠΎΠ±Ρ Β«ΠΏΡΠΈΠΆΠ°ΡΡΒ» ΠΎΡΡΠ»ΠΎΠΈΠ²ΡΠΈΠΉΡΡ ΡΠ»ΠΎΠΉ ΠΈΠ½ΡΠΈΠΌΡ.Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. Π ΡΠ°Π±ΠΎΡΠ΅ ΠΏΠΎΠΊΠ°Π·Π°Π½ ΡΠ»ΡΡΠ°ΠΉ ΡΡΡΠΎΠ³Π΅Π½Π½ΠΎΠΉ ΡΠΏΠΈΡΠ°Π»Π΅Π²ΠΈΠ΄Π½ΠΎΠΉ Π΄ΠΈΡΡΠ΅ΠΊΡΠΈΠΈ ΠΏΠΎΡΠ»Π΅ Π°Π½ΡΠ΅Π³ΡΠ°Π΄Π½ΠΎΠΉ Π±Π΅Π΄ΡΠ΅Π½Π½ΠΎΠΉ ΠΏΡΠ½ΠΊΡΠΈΠΈ Ρ ΠΏΠΎΡΠ»Π΅Π΄ΡΡΡΠΈΠΌ ΡΡΠΏΠ΅ΡΠ½ΡΠΌ ΡΠ½Π΄ΠΎΠ²Π°ΡΠΊΡΠ»ΡΡΠ½ΡΠΌ Π»Π΅ΡΠ΅Π½ΠΈΠ΅ΠΌ Π΄Π°Π½Π½ΠΎΠ³ΠΎ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΡ.ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. ΠΠ½Π΄ΠΎΠ²Π°ΡΠΊΡΠ»ΡΡΠ½Π°Ρ Π±Π°Π»Π»ΠΎΠ½Π½Π°Ρ Π°Π½Π³ΠΈΠΎΠΏΠ»Π°ΡΡΠΈΠΊΠ° ΠΈ ΡΡΠ΅Π½ΡΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ ΠΌΠΎΠ³ΡΡ ΡΡΠΏΠ΅ΡΠ½ΠΎ ΠΏΡΠΈΠΌΠ΅Π½ΡΡΡΡΡ Π² ΡΠ»ΡΡΠ°Π΅ ΡΠ°Π·Π²ΠΈΡΠΈΡ ΡΡΡΠΎΠ³Π΅Π½Π½ΠΎΠΉ Π΄ΠΈΡΡΠ΅ΠΊΡΠΈΠΈ ΠΏΠΎΡΠ»Π΅ Π°Π½ΡΠ΅Π³ΡΠ°Π΄Π½ΠΎΠΉ ΠΏΡΠ½ΠΊΡΠΈΠΈ ΠΏΡΠ°Π²ΠΎΠΉ Π±Π΅Π΄ΡΠ΅Π½Π½ΠΎΠΉ Π°ΡΡΠ΅ΡΠΈΠΈ ΠΈ ΠΏΠΎΠΌΠΎΡΡ ΠΈΠ·Π±Π΅ΠΆΠ°ΡΡ ΠΊΠ»Π°ΡΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Β«ΠΎΡΠΊΡΡΡΠΎΠ³ΠΎΒ» ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠ²Π½ΠΎΠ³ΠΎ Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ²Π°
STENTING OF "UNPROTECTED" LEFT MAIN CORONARY ARTERY WITH CONCOMITANT PROXIMAL CHRONIC OCCLUSION OF THE RIGHT CORONARY ARTERY
Stenosis of the left main coronary artery (LMCA) is the most formidable atherosclerotic coronary artery disease due to its importance. The prognosis in patients with significant hemodynamic lesion of LMCA is unfavorable and associated with high mortality. LMCA disease is an absolute indication for myocardial revascularization with the highest class of recommendation and level of the evidences. This article provides a clinical case of balloon angioplasty with stenting of "unprotected" LMCA with concomitant proximal occlusion of the right coronary artery
Endovascular Treatment of Acute Tibioperoneal Trunk Thrombosis. A Clinical Case Report
Introduction. Acute limb ischemia is a severe disorder caused by a sharp drop in the arterial perfusion of the limb. It carries a threat to the limbβs function and viability. The issue of early recognition of acute limb ischemia in surgery is both important and difficult. The current guidelines recommend that patients with acute limb ischemia when the limb is viable should be urgently examined and treated. Restoring the blood flow in patients with acute limb ischemia is aΒ priority, since a significant reduction in arterial perfusion can lead to limb amputation and life-threatening complications. In acute limb ischemia different treatment methods can be used, both open surgery and endovascular procedures. The treatment strategy depends on the localisation, duration of ischemia, neurological deficit, concomitant diseases and risks associated with treatment and its results. Endovascular procedures on the arteries of the lower leg are most often indicated to save a limb. Endovascular procedures on the arteries of the lower leg are indicated more often in patients with critical limb ischemia. Endovascular procedures when the condition is primary demonstrate good outcomes and high efficiency on the arteries of the lower extremities at all levels of the lesion.Materials and methods. This paper presents a clinical case of a successful endovascular procedure performed for the treatment of acute thrombosis of the arteries of the lower leg. Three stents were implanted, with a good angiographically confirmed outcome.Conclusion. Endovascular balloon angioplasty with stenting of the tibioperoneal trunk can result in good outcomes in patients with acute thrombosis of the arteries of the lower leg
Radiomorphological changes of the coronary artery in patients with coronary artery disease with recurrent angina in the first year after angioplasty and stenting of multi-vessel lesions
Aim. To study the radiomorphological changes in coronary arteries (CA) and their contribution to the recurrence of angina pectoris in patients in the first year after angioplasty and stenting of multi-vessel lesions of CA; to identify factors contributing to the progression of atherosclerosis in poorly modified segments of CA after percutaneous coronary intervention (PCI). Material and methods. The study included 102 patients. Multivariate analysis with assessment of clinical risk factors, radiomorphology of the CA before and after PCI, analysis of the technique of the operation to identify factors contributing to the progression of atherosclerosis in the slightly altered segments of CA.Results. Restenosis of the coronary arteries was observed in 43 cases when the stent was implanted BMS (bare-metal stent). Diabetes mellitus, hypertension, dyslipidemia, chronic heart failure, obesity, smoking did not affect the development of restenosis. Hypertension increased the risk of progression of atherosclerosis in the source hemodynamically insignificant stenosis of the right coronary artery (RCA) and left circumflex artery (LCX), peripheral atherosclerosis was associated with progression of atherosclerosis of the left anterior descending artery (LAD). The diabetes mellitus, obesity, smoking did not significantly affect the progression of atherosclerosis in the proximal segments. Performing techniques of βdeep intubationβ of guide catheters to the left coronary artery (LCA) led to the progression of stenosis growth in the proximal segments of permanent residence. The use of more than one wire and angulation of LCX divergence of more than 90 degrees significantly leads to the progression of atherosclerosis in the proximal segments of LCX. Performing pre-dilatation of proximal segments without subsequent stent coating led to the development of stenosis in LAD, RCA and LCX. Extended calcined lesions are associated with the progression of atherosclerosis in the proximal segments. The use of an extension cord catheter did not affect the progression of atherosclerosis in the proximal segments.Conclusion. Along with stent restenosis, provoking factors of the βiatrogenicβ process in the proximal segments may be a combination of aggressive manipulations during PCI, the complexity of the radiomorphology of coronary arteries. The analysis of the use of new endovascular less traumatic technologies (the use of an extension cord catheter) reduces the risk of βiatrogenicβ damage to the intima and the progression of atherosclerosis
Clinical case of iatrogenic accelerated atherosclerosis as a cause of relapse of angina pectoris in a patient with ischemic heart disease in the first year after angioplasty and stenting of multi-vessels lesions coronary arteries
Assessment of the proportion of iatrogenic intima lesion of the coronary artery in the structure of recurrence of coronary syndrome after angioplasty and stenting is an insufficiently studied issue. Considering the continuously increasing number of percutaneous coronary intervention procedures, an increase in the degree of technical complexity (especially in multivessel coronary artery disease involving proximal segments in the atherosclerotic process), the study of this topic seems topical and practically meaningful. In clinical practice, aggressive methods of carrying out the endovascular procedure (deep intubation of the conductor catheter, the use of an extension of the conductor catheter, etc.) increasingly lead to the progression of atherosclerosis in the proximal segments of the coronary arteries, especially in the presence of their initial lesion
Endovascular myocardial revascularization in patients with multivessel coronary artery disease with chronic total occlusion and high surgical risk
The main reasonΒ for incomplete myocardial revascularization is the presence of chronic coronary total occlusion (CTO), which is detected in every fourth patient during coronary angiography. At the same time, a generally accepted approach Β to the treatment of CTO has not yet been developed.Aim. To assess the rationale of complete myocardial revascularization in patients with multivessel coronary artery disease Β (CAD) with chronic total occlusion and high surgical risk.Material and methods. This retrospective, Β open-label, Β non-randomized clinical trial was carried out included 180 patients multivessel CAD and CTO. The patients Β underwent endovascular Β surgery for complete myocardial revascularization. Depending on the success of surgery, the patients were divided into groups of complete and incomplete myocardial revascularization. Endpoints were death, acute coronary syndrome, re-revascularization after 1-year follow-up. Left ventricular (LV) contractility and clinical status Β of patients Β in the study groups after 1 year of observation was assessed.Results. The median follow-up was 12,1 months. The successful Β rate of revascularization was 79,4%. The incidence of main composite endpoint in the group of complete myocardial revascularization was 5,59%, while in the group of incomplete revascularizations β 21,6% (p=0,005).Conclusion. The study showedΒ that low incidence Β of intraoperative complications and a high successful Β rate of revascularization are characteristic of complete myocardial revascularization in patients at high surgical risk with multivessel CAD and CTO. Complete myocardial revascularization leads to a significant decrease in the incidence of major coronary events