ENDOVASCULAR TREATMENT OF AN ANEURYSM OF THE SPLENIC ARTERY.

Aneurysms of the splenic artery account for about 60% of all aneurysms of visceral arteries. Most of them are asymptomatic until rupture and are discovered accidentally, usually after an imaging study. The treatment is surgical or endovascular depending on the type, location and size. We present a case of a patient with an asymptomatic, accidentally found aneurysm of the splenic artery which we successfully treated with a covered stent. The control CT-angiography on 6th month showed patent stent and totally occluded aneurysm. It is very important in cases of acute abdomen and hemorrhagic shock to think of a ruptured aneurysm. In these cases the treatment of choice is endovascular as it is mini-invasive and organ-saving.

Aorto-bifemoral revascularisation after radiation, peritonitis and colostomy.

The success of all vascular interventions depends mainly on the chosen strategy and access, especially in patients with severe co-morbidities, preceding operations or infection. In these cases the combination of retroperitoneal approach and extra-anatomical bypasses makes the revascularization possible. We present a clinical case of a patient after radiotherapy, peritonitis and colostomy with persistent pain in the lower extremities and angiographic finding of bilateral occlusion in the aorto-iliac segment. We did a right retroperitoneal aorto-femoral reconstruction and a crossover femoro-femoral bypass. It is also possible to perform visceral and renal arterial reconstructions with the retroperitoneal approach. In addition, symptomatic and ruptured aneurysms, as well as infected aortic grafts can be operated on with optimal results, without a notable increase in mortality.

Embolization of anomalous vessels in tumor formation.

Embolotherapy or embolization has rapidly developed in recent years and now represents an integral part of interventional radiology practice. Embolotherapy is defined as the percutaneous endovascular application of one or more of a variety of agents or materials to accomplish vascular occlusion. Embolization has grown dramatically in scope and complexity over the past three decades, and with this growth, there is now a need to define standards for those practicing in this field, including: appropriate training with monitoring of outcomes; provision of pre-, intra-, and postprocedure patient care; and performance of the technical aspects of the procedure. We present 58 patients from clinic of Vascular Surgery and Angiology at "St. Ekaterina" University Hospital. After four abnormal nutrition artery embolization in two consecutive procedure due to recurrences formation of adrenal tumor.

[Diagnostic criteria when establishing indications for revascularisation of profunda femoris artery].

In patients with chronic limb ischemia (CLI) the atherosclerotic process involves the aorto-iliac and/or the femoro-popliteal segment. In most cases there are steno-occlusive lesions of the superficial femoral artery but the profunda femoris artery is often spared. In 30% of the diabetic patients and in 9% of the nondiabetic there are lesions of the profunda femoris artery which are mainly ostial or can be found at the most proximal part. The revascularization of the profunda femoris artery is an important operative method especially in many cases where there is no other possibility of vascular reconstructive operation. In this paper we discuss different diagnostic tests and criteria, which we used when deciding which patients are suitable for profundoplasty--segmental pressures, angiography, Doppler triplex scan.

[Endovascular recanalisation of subclavian artery stenotic-occlusive lesions].

Recently, percutaneous transluminal angioplasty (PTA) with stent placement has gained greater acceptance for the treatment of hemodynamically significant atherosclerotic lesions involving the brachiocephalic, subclavian and vertebral vessels. PTA is performed instead of extratoracic bypass surgery, which is associated with several risks and complications. Main indications for PTA and stent include short occlusions and elderly patients with increased surgical risk. We present 4 cases with occlusion of the left subclavian artery, including 1 case ofthombosed distal anastomosis of carotid-subclavian bypass.

[Profundoplasty in patients with chronic thrombosis of the superficial femoral artery not suitable for distal revascularization].

The deep femoral artery is the main source of blood supply to the leg and foot when the superficial femoral artery is occluded. In this situation, the geometry of the trunk of the deep femoral artery represents a stenosis of 50 per cent interposed between the common femoral artery and the collateral circuit of the deep femoral artery. Intimal thickening of only 0,5 and 1,0 mm increases this anatomic stenosis to 64 and 76 per cent, respectively. Beyond the trunk, the cross-sectional area of the deep femoral artery circuit increases at each arterial division. Any reconstruction of the deep femoral artery intended to increase its inflow must extend down to at least it's first important bifurcation if it is to overcome this trunk "stenosis" and to carry out an anatomic bypass alone. This requirement explains the effectiveness of proper reconstruction of the deep femoral artery in avoiding or delaying amputation in patients with ischemic symptoms and occlusion of the superficial femoral artery who are not candidates for femoropopliteal reconstruction. In this case the absence of high grade stenosis is not a contraindication. The goal of our study was to evaluate the significance and the future perspectives of profundaplasty.

[Iatrogenic phlebothrombosis of the internal jugular vein after application of implantable central venous catheter].

We present a case report of a 56-year-old male patient diagnosed as B-cell non-Hodgkin lymphoma with iatrogenic phlebothrombosis of the right internal jugular vein after introduction of totally implantable venous catheter. He was admitted to the Clinic of Vascular Surgery at "St. Ekaterina" Hospital two weeks after the implantation complaining of pain and edema in the right cervical region, as well as ipsilateral blepharoptosis. The thrombus was removed operatively and revascularization of the vein was achieved. The patient was dismissed without clinical symptoms and with advice to continue his anticoagulant therapy. In this case we think that the most likely cause for the thrombosis of the internal jugular vein is the malposition of the catheter tip based on the observation that the device was not properly fixed to the skin and was found partly extracted. Routine heparinization proved to be insufficient for the prevention of thrombosis.