[Changes in topography of the popliteal artery in patients with rheumatoid arthritis depending on the degree of contracture according to angiographic data]. / Izmenenie topografii podkolennoi arterii u bol'nykh revmatoidnym artritom v zavisimosti ot stepeni kontraktury po dannym angiografii.

The paper is devoted to the first results of studies on abnormalities in the topography of vessels of the knee joint in rheumatoid arthritis (RA) and to potentialities of digital subtraction angiography (DSA) in differential diagnosis of degree of severity of the vascular system in the joint. Knowing the arrangement of arteries (their positions) we can prevent complications like vascular traumata, loss of blood in surgical treatment of contractures, what is of particular importance in hormone-dependent patients presenting with hypervascularization of the knee joint. DSA is an objective method of diagnosis of abnormalities in the topography of vessels of knee joints in RA patients, permitting the different diagnosis to be established concerning degrees of severity of the vascular system in the joint.

Endovascular embolization of the hepatolienal vessels in the treatment of portal hypertension.

PURPOSE: to study the characteristics and variants of changes in the structure of celiac trunk and portal vein pool vessels, to define the tactics of most effective use of endovascular interventions in the treatment of portal hypertension. MATERIAL AND METHODS: the immediate and long-term results of angiographic studies and endovascular interventions are analyzed in 329 patients with portal hypertension induced by liver cirrhosis. The compensated stage of portal hypertension was identified in 62, subcompensated in 93 and decompensated in 174 patients. The patients underwent embolization of the splenic, left gastric and gastro-omental arteries, varices of the esophagus and cardial part of the stomach. In the long-term period, appropriate corrective medical endovascular interventions were performed in the event of the identification of recanalization of the previously embolized vessels and occurrence of the collateral pathways. RESULTS: after embolization of the splenic artery the positive shifts in blood readings, reduction of the splenic size, and abatement of ascites were revealed in the majority of cases. In the long-term period, the efficacy of the procedure diminished as a result of restoration of the lumen of the previously embolized vessels or development of the collaterals which demanded repeat endovascular intervention. The hospital lethality among patients with portal hypertension who had been provided endovascular interventions because of esophageal bleeding accounted for 29.8%, with the incidence of early recurrences being equal to 4.8%. The best results were obtained in a group of patients who had undergone embolization of bleeding gastroesophageal varices coupled with occlusion of the splenic artery for decompression and intraportal infusion therapy.

[Choice of approach for transhepatic endovascular and biliary procedures]. / Vybor dostupa dlia vypol'neniia chrespechenochnykh éndovaskuliarnykh i éndobiliarnykh vmeshatel'stv.

Results of diagnostic and therapeutic transhepatic procedures in 185 patients with portal hypertension and 292 patients with obstructive jaundice are analyzed. Optimal angles for introduction of instruments, optimal intercost and the most convenient for manipulation biliovascular structures of the liver were determined. These principles permitted to reduce the failure rate in endovasculary procedures from 10.5 to 3.8%, in endobiliary--from 13.2 to 0.97%.

[Embolization of splenic artery in children with portal hypertension]. / Embolizatsiia selezenochnoi arterii pri portal'noi gipertenzii u detei.

This study examined the results of embolization of the splenic artery (ESA) in 30 children (age ranged from 5 to 14 years) with portal hypertension. Effectiveness of ESA was evaluated by a decrease in spleen size, hypersplenism, disappearance of esophageal varices and improvement in blood count. The results show that chronic embolization of the splenic artery in children is relatively safe and effective surgical treatment for portal hypertension. It lessens portal hypertension, reduces and in some cases eliminates hypersplenism and splenomegaly. Furthermore, being pathogenically sound it may be operation of choice in treatment of chronic hepatitis with portal hypertension and is well tolerated by children.

[Puncture of liver cystic masses and abscesses]. / Punktsionnoe lechenie polostnykh obrazovanii i abstsessov pecheni.

The results of punctional treatment of cavital masses and abscesses of the liver in 58 patients are analysed. In 33 patients sanation was carried out according to traditional method, including local application of broad spectrum antibiotics; in 25 patients the solution of sodium-hypochlorite was used for treatment. Control group consisted of 38 patients, who underwent open surgical procedure. The application of the developed method of punctional treatment with the use of electrolyze solution of sodium hypochlorite provides the possibility to increase the terms of temperature normalization and cleansing and elimination of cavity 1.5 times comparing to traditional method of treatment, to decrease the number of complications and lethality, to reduce the duration of postoperation period 1.5-2 times comparing to the patients in whom traditional method of treatment was used, and 2-2.5 times comparing to the patients, who underwent operation.

[Complications of transcutaneous transhepatic endovascular interventions in patients with portal hypertension]. / Oslozhneniia chreskozhnykh chrespechenochnykh éndovaskuliarnykh vmeshatel'stv u bol'nykh portal'noi gipertenziei.

Results of endovasal treatment of 196 patients with portal hypertension and its complications are analysed. The total rate of complications is 23.4%, the most serious of them were intraabdominal bleeding (2.5%), portal vein thrombosis (2.1%). The rate of mortality, related to the complications of transhepatic procedures, was 2.5%. The majority of the complications were specific to the character of the disease: liver cirrhosis, ascites, high portal pressure, coagulating system disorders.