Background. Splenic artery pseudoaneurysm is a rare complication of acute and chronic pancreatitis caused by an arterial wall lesion with aggressive pancreatic enzymes and followed by arrosive bleeding into pseudocyst lumen and the formation of a dense fibrous capsule prone to growth.Clinical Case Description. Patient M., 61 yo, was emergently admitted to Territorial Clinical Hospital No. 2 with a preliminary diagnosis: Chronic pancreatitis, incomplete remission. Pancreatic pseudocyst. Condition after endoscopic papillosphincterotomy, pancreatic duct stenting. Gastrointestinal haemorrhage. The patient complained of moderate persistent belting upper abdominal and left subcostal pain, nausea, general weakness, black liquid stool over last five days. Pancreonecrosis in history. Pseudocyst formation in two months, endoscopic papillosphincterotomy and pancreatic stenting in hospital, the aforementioned complaints appeared past three months. Moderate anaemia (haemoglobin 73 g/L, erythrocyte count 2.8 x 1012), hyperamylasaemia (amylase 170 U/L), no other pathology in general and biochemic blood panels. The patient was rendered urgent oesophagogastroduodenoscopy for large duodenal papilla, with no evident bleeding detected. Abdominal CT angiography revealed a haemorrhagic mass connected with splenic artery lumen in the projection of pancreatic tail. The patient was transferred to an interventional radiology room for coil embolisation of splenic artery. The postoperative period was benign, and the patient discharged on day 3 after surgery for outpatient surgical patronage. Definite clinical diagnosis: Chronic pancreatitis, incomplete remission. Splenic artery pseudoaneurysm with haemorrhage into pancreatic pseudocyst. Condition after endoscopic papillosphincterotomy, pancreatic duct stenting.Conclusion. Splenic artery pseudoaneurysm with haemorrhage into pancreatic pseudocyst is reluctant to early diagnosis due to a lacking definite clinical picture and tractable only at an interdisciplinary institution disposing with a rich diagnostic toolkit and sufficiently qualified medical personnel. Endovascular treatment is overall most effective and enables a reliable aneurysm isolation from the splenic artery basin.

Aim. Analysis of operative delivery outcomes in pregnant women with abnormal invasive placenta depending on the endovascular treatment for intraoperative haemostasis.Materials and methods. A retrospective study of operative delivery outcomes was performed in 178 patients with placental invasion using ultrasonography (US) data obtained at the Perinatal Centre of the Regional Clinic Hospital No. 2, Ministry of Health of Krasnodar Krai, in the years 2012–2018. In 2012–2014, delivery was managed without endovascular haemostasis (n = 44), and from May 2014 to December 2018 – with prophylactic balloon catheterization of common iliac arteries (n = 134). Upon intraoperative diagnosis of placental invasion, temporary balloon occlusion (TBO, n = 115) and/or uterine artery embolization (UAE, n = 33) were performed. Efficiency of endovascular methods for intraoperative haemostasis was assessed by comparing the degree of placental invasion, amount of blood loss and transfusion, frequency of hysterectomies (HE), duration of surgery, length of stay in intensive care units (ICU) and outcomes for the foetus.Results. Adoption of endovascular methods for intraoperative haemostasis allowed the blood loss (p = 0.02), haemotransfusion (p = 0.012) and HE frequency (p <0.001) to be significantly reduced. In the absence of clinical and histological manifestations of placental invasion, no difference in blood loss was detected between the groups. The amount of blood loss increased with the degree of invasion. Surgery duration in patients with TBO was signifi cantly longer (p = 0.04). No difference was detected between the groups with respect to the ICU length of stay and outcomes for the foetus.Conclusions. Establishment of endovascular haemostasis at the planned delivery of pregnant women with abnormal invasive placenta allows the blood loss and HE frequency to be reduced. Further improvement of US diagnostics of placental invasions is essential in pre-selection of patients for X-ray surgical care.

Aim. To present the first experience of a successful endovascular recanalisation and stenting of chronic post-thrombotic occlusion of the inferior vena cava and both common iliac veins in Krasnodar Krai.Methods and materials. A man, 72 years old, was admitted with the complaints of intermittent claudication, pronounced edema of both lower limbs, compaction and hyperpigmentation of the skin of the lower legs. Using ultrasound and computed tomography angiography, chronic post-thrombotic occlusion of the inferior vena cava and common iliac veins was established. The severe course of post-thrombotic syndrome (15 points on the Villalta scale) and the failure of conservative treatment were regarded as indications for performing endovascular surgery. Through puncture accesses in both common femoral veins and in the right internal jugular vein, guides were introduced through the occlusion zone, and balloon angioplasty was performed, followed by stenting of the common iliac veins and the inferior vena cava.Results. In-hospital and 4-month treatment results were analysed. The postoperative period was uneventful. The patient noted a decrease in the feeling of heaviness and edema in the lower extremities, as well as an increase in walking distance. A follow-up examination was performed following 4 months. The functional status significantly improved. The Villalta score was 4 points (absence or mild post-thrombotic syndrome). Ultrasound examination and computed tomography angiography established the patency of the stents in the inferior vena cava and in the common iliac veins.Conclusion. Endovascular recanalisation and stenting of the inferior vena cava and common iliac veins is an effective treatment for severe post-thrombotic syndrome.