Year 2020 Vol. 28 No 4

GENARAL & SPECIAL SURGERY

E.V. MUSHENKO 1, 2, YU.V. AVDOSYEV 1, O.M. TYSHCHENKO 1, R.M. SMACHYLO 1, 2, YU.V. IVANONA 2

SURGICAL TREATMENT OF VISCERAL PSEUDOANEURYSMS

V.T. Zaycev Institute of general and urgent surgery of NAMS of Ukraine 1,
Kharkov National Medical University 2, Kharkov,
Ukraine

Objective. Optimization of surgical treatment of visceral pseudoaneurysms (PA) by means of using individualized treatment tactics and combined methods for their surgical treatment.
Methods. The treatment results of patients (n=35) with visceral PA are presented in the article. Localization of PA in the splenic artery was detected in 20 patients (57.2%), in the common hepatic artery in 8 patients (22.8%), in the superior or inferior pancreatoduodenal artery in 5 cases (14.3%), in the superior mesenteric artery in 2 cases (5.7%). The asymptomatic course of PA was observed in 17 patients (48.6%), while the remaining 18 patients (51.4%) had a symptomatic course of the disease. Diagnostics of PA localization included traditional methods of medical visualization and angiography, which is used as a diagnostic and treatment procedure.
Results. Complete technical success after endovascular therapy was achieved in 20 patients (57.1%), partial in 15 cases (42.9%), that required the use of combined interventions. The reasons of technical failure of X-ray operations were associated with the impossibility of intravascular access to the damaged artery or arteries or access to the neck of the PA, the doubt about the organ blood supply that the damaged artery after its endovascular occlusion supports, and with the large size of the PA. Partial success in this case was considered to be a decrease of the intensity of bleeding or temporary hemostasis, which made it possible to perform the intervention from the traditional approach. Morbidity rate was 34.3% (20 patients). Severe complications were identified in 6 patients (17.1%). Mortality rate was 11.4%.
Conclusion. Endovascular interventions should be considered as an option for the first line surgical treatment of patients with visceral PA. In case of technical failure or partial technical success, the combined surgical aid with using of X-ray endosurgical treatment and traditional surgical intervention are required to achieve acceptable results of treatment of these patients.

Keywords: visceral pseudoaneurysms, hemorrhage, interventional radiology, angiography, endovascular treatment, combined operations
p. 387-395 of the original issue
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Address for correspondence:
61018, Ukraine,
Kharkov, Balakirev str., 1,
V.T. Zaycev Institute of General
and Urgent Surgery of NAMS of Ukraine,
the Department of the Hepatic
and Bile Ducts Surgery,
Tel.: +380 67 575-63-75,
e-mail: dr.mushenko@gmail.com,
Mushenko Evgreny V.
Information about the authors:
Mushenko Evgrene V., PhD, Senior Researcher of the Department of the Hepatic and Bile Ducts Surgery, V.T. Zaycev Institute of General and Urgent Surgery of NAMS of Ukraine, Assistant of the Surgery Department No1, Kharkov National Medical University, Kharkov, Ukraine.
https://orcid.org/0000-0003-0244-3289
Avdosyev Yury V., MD, Head of the X-ray Surgical Department, V.T. Zaycev Institute of General and Urgent Surgery of NAMS of Ukraine, Kharkov, Ukraine.
http://orcid.org/0000-0002-2677-4464
Tyshchenko Olexander M., MD, Professor, Senior Researcher of the Department of the Hepatic and Bile Ducts Surgery, V.T. Zaycev Institute of General and Urgent Surgery of NAMS of Ukraine, Kharkov, Ukraine.
https://orcid.org/0000-0002-3894-1100
Smachylo Rostislav M., MD, Professor, Head of the Department of the Hepatic and Bile Ducts Surgery, V.T. Zaycev Institute of General and Urgent Surgery of NAMS of Ukraine, Professor of the Surgery Department No1, Kharkov National Medical University, Kharkov, Ukraine.
https://orcid.org/0000-0003-1237-0255
Ivanona Yulia V., MD, Professor of the Surgery Department No1, Kharkov National Medical University, Kharkov, Ukraine.
https://orcid.org/0000-0001-8773-6827
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