Endovascular embolization in the treatment of complications of portal hypertension

Abstract

Introduction. Portal hypertension is the cause of the development of varicose veins of the esophagus with subsequent bulging of the veins into its internal lumen; hydroperitoneum; stagnant phenomena in the pool of vessels of the abdominal cavity, with a violation of the blood circulation of the corresponding organs. The aim of the study. Improvement and study of the clinical effectiveness of endovascular embolization methods in portal hypertension. Materials and methods. The study was conducted in the period from 2007 to 2022 on the basis of the Odesa Regional Clinical Hospital. 173 patients aged 34 to 78 who suffered from liver cirrhosis took part in the study. Patients were divided into three groups depending on the severity of liver cirrhosis using the Child-Pugh classification: A – 14 patients, B – 151 patients, C – 8 patients. Endovascular interventions were applied to 152 patients. Catheterization was performed through the right femoral artery according to Seldigner. Embolization of the splenic artery was carried out acutely or chronically, thanks to the introduction and/or spiral of the Gianturco type and/or paralonov emboli with a diameter of 2 mm. Results and discussion. The authors used endovascular embolization of the splenic and left gastric arteries in combination with endoscopic hemostasis in the complex treatment of 73 patients with complications of portal hypertension. After analyzing the results of the treatment, it was found that the combination of embolization of the splenic and left gastric arteries with endoscopic interventions on varicose veins of the esophagus has high clinical effectiveness, prolongs the life of patients and improves its quality. It was established that "chronic" embolization is much better compared to "acute", which is related to the absence of a pronounced pain syndrome. Conclusions. The proposed method allows to reduce the risk of bleeding in case of rupture of the esophageal veins, increases the percentage of survival of patients.