9 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΅ 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
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
Endovascular Treatment of Renal Artery Stenosis Caused by Fibromuscular Dysplasia. A Clinical Case Report
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
TREATMENT OF INTERNAL CAROTID ARTERY OCCLUSION USING PROXIMAL CEREBRAL PROTECTION DEVICE AND ITS EFFECT ON THE BLOOD PRESSURE DYNAMICS. CLINICAL CASE
In 2016, according to the Ministry of Health of the Russian Federation, about 200 thousand people died from stroke. Strokes are considered as the main cause of disability of the population, causing huge economic damage to the country. One of the most common causes of ischemic stroke is atherosclerosis of the branches of the aortic arch. The most common localization of atherosclerotic plaques is the extracranial section of the carotid arteries β bifurcation and ostium of the common carotid artery and the internal carotid artery. Recanalization of occlusion of the internal carotid artery until recently was an insoluble task for interventional surgery due to the high risk of distal embolization. The invention and use of the proximal cerebral protection device, which ensure the complete cessation of blood flow, has changed the situation. Effect of carotid revascularization on arterial hypertension, due to the effect on the baroreceptors of the carotid plexus by balloon angioplasty, which leads to a reflex decrease in arterial pressure, is an additional advantage of the endovascular technique in some cases. This effect requires further study. One also needs to pay careful attention to the diagnosis and imaging of carotid artery lesions before procedure. This clinical case is the illustration that an adequate assessment of the risk factors for intraoperative complications allows to achieve maximum results of endovascular treatment
Clinical case of retrograde endovascular recanalization of chronic coronary occlusion
Coronary chronic occlusion (CCO) occurs in ~20% of cases when coronary angiography is performed in patients with coronary artery disease. According to large observational studies and registries, it is known that most patients with CCO receive only drug therapy. Only 20-22% of patients with CCO undergo surgical myocardial revascularization. Such a low percentage can be explained by a low success rate and a large number of complications during recanalization of CCO at the development stage of endovascular surgery. The accumulation of experience and the improvement of technical equipment has significantly increased the success rate of endovascular revascularization of CCO and reduced the number of complications. More and more scientific evidence has appeared in favor of the recanalization of CCO. It is known that the myocardium in the area of the occluded artery is in ischemia. The presence of a developed system of collateral circulation allows us to ensure sufficient blood flow in the myocardium only at rest, but with a load of collateral blood supply is not enough. Recanalization of CCO can eliminate myocardial ischemia, improve systolic function of the left ventricular myocardium, increase exercise tolerance and improve the quality of life of patients
Cryoablation method for pulmonary artery sympathetic denervation in patients with pulmonary hypertension secondary to left sided heart disease: interventional technique, safety and results of the hospital phase
pulmonary artery pressure in Patients with Pulmonary Hypertension and Chronic Heart Failure.Materials and methods.Β Inclusion in the study (n=20) was based on the results of an echocardiographic study (systolic pressure in the pulmonary artery β₯35 mm Hg) and clinical assessment (NYHA β₯II FC heart failure). The procedure of pulmonary artery cryodenervation was performed at the bifurcation level of the main pulmonary trunk using single-point cryoablation catheter. The cryoablation was applied in a circular way around the pulmonary trunk at the bifurcation level, rotating the catheter tip with the pace of2 mm with temperature minus 75-80oΒ C and time 120 s at each spot. The study endpoints were the changes in systolic pulmonary artery pressure, mean pulmonary artery pressure, pulmonary vessel resistance and 6 min walking test before and immediately after procedure.Results.Β We analyzed intermediate results of sympathetic fibers cryodestruction, located in the bifurcation of main pulmonary trunk. The mean systolic pulmonary artery pressure decreased from 40 [37; 44] tΠΎ 31 [28; 35] mm Hg (p<0,05), pulmonary vessel resistance decreased from 5,6 [4,9; 6,1] tΠΎ 3,9 [3,5; 4,5] WU (p<0,05) and improvement of 6 min walking test from 287 [233; 332] to 320 [276; 348] m (p<0,05) was observed. There were no cases of early deaths and specific complications.Conclusion.Β The cryoablation pulmonary denervation is a new promising treatment in patients with pulmonary hypertension. First clinical results demonstrate the safety of this procedure. Further randomized studies are required to confirm the efficacy of PDCM. However, today we can see decrease of hemodynamic parameters and clinical improvement when using the new technique in a certain group of patients
The dynamics of blood pressure within 12 months after carotid artery stenting in patients with stenotic carotid lesions
Aim.Β To assess the dynamics of blood pressure (BP) and determine the predictors of the hypotensive effect after carotid artery stenting (CAS).Material and methods.Β The analysis included 99 patients who underwent CAS in a period of March 2014 and May 2016. Inclusion criteria: (1) the presence of 50% symptomatic or 70% asymptomatic stenosis of the carotid artery (according to NASCET criteria), (2) follow-up for at least 1 year, (3) measurement and recording of BP at four points: 24 hours before surgery, 1 hour, 24 hours and 12 months after surgery.Β Results.Β According to office measurement of BP, the average systolic/diastolic pressure was 117,11/60,75, 119,73/60,75, 134,75/70,48 mm Hg after 1 hour, one day and 12 months after the intervention, respectively. In comparison with the average numbers of BP before the intervention, 148,13/89,52 mm Hg there was a significantly significant decrease in BP levels after CAS (p<0,01). According to the results of daily monitoring of blood pressure, a statistically important decrease in blood pressure was observed after 1 year of observation (p<0,01) (136,52/76,84 compared with 145,91/87,63 before the intervention). Dissociated circle of Willis (odds ratio=10,37, 95% confidence interval, from 3,64 to 29,52; p<0,001) and the occurrence of intraoperative hypotension (odds ratio =3,62, 95% confidence interval, from 1,16 to 11,28; p<0,027) were predictors of a persistent decrease in BP after CAS.Β Conclusion.Β The obtained results indicated the need for more thorough conservative postoperative management, especially for patients with a dissociated circle of Willis. It is also necessary to achieve the target blood pressure values by individualized correction of antihypertensive therapy