Providing of a highly specialized medical care for servicemen of the Armed Forces of Ukraine by roentgen-endovascular interventional methods
DOI:
https://doi.org/10.14739/2310-1210.2021.3.223139Keywords:
endovascular surgery, minimally invasive interventions, military personnel, acute coronary syndrome, embolization, revascularizationAbstract
Aim: to provide high-quality and full-fledged minimally invasive highly specialized medical care by X-ray endovascular methods, according to modern world standards, for the Armed Forces of Ukraine on all territories of the country and direct participants of combat operations in the context of Joint Forces Operation (JFO) in certain parts of Donetsk and Luhansk regions.
Materials and methods. The provision of minimally invasive highly specialized medical care by X-ray endovascular techniques for servicemen of the Armed Forces of Ukraine in the conditions of JFO in certain parts of Luhansk and Donetsk regions and the National Military Medical Clinical Center of Kyiv (NMMCC) in critical internal bleedings, pathology and injuries of the main vessels, acute cardiovascular pathology over a period of 2018–2020 was analyzed: 1038 diagnostic coronary interventions to servicemen with acute coronary syndrome, 346 stenting of coronary arteries in an emergency, 36 – angioplasty of coronary arteries. A total of 296 interventions for pathology of the peripheral vascular system including combat trauma were performed. Transcatheter arterial embolization was performed for 100 patients with internal bleeding. An emergency care mechanism was implemented for patients with acute coronary syndrome in the Joint Forces Operation in certain parts of Donetsk and Luhansk regions.
Results. The implementation of these methods of highly specialized care in the Armed Forces of Ukraine allowed to realize the standards of emergency care for acute coronary syndrome, the average time of “door – balloon” was 100 minutes (CI 95 %, 98–103 minutes, P < 0.05). In the conditions of JFO, care for patients with acute coronary syndrome, the interval “door – balloon” takes time from 2 to 12 hours (CI 95 %, 5.5–6.5 hours, P < 0.05), fatalities were absent. At transcatheter arterial embolization, technical success of arterial occlusion was 100 %. In the treatment of main vessels, the length of hospital stay after endovascular interventions was 1–18 days (CI 95 %, 1.96–2.51 days, P < 0.05). The main complications were postpuncture hematoma – 4.73 %, acute occlusion after intervention within 24 hours – 2.36 %, pseudoaneurysm – 0.68 %. Effective recanalization of the main blood flow was achieved in 262 cases (88.51 %).
Conclusions. The implementation of X-ray endovascular techniques into the medical service of the Armed Forces of Ukraine allowed for providing high-quality highly specialized medical care directly to participants of Joint Forces Operation in certain parts of Donetsk and Luhansk regions in the shortest possible time.
References
Ministry of Health of Ukraine. (2017, September 28). Pro zatverdzhennia Poriadku orhanizatsii nadannia medychnoi dopomohy ta hospitalizatsii patsiientiv z hostrym koronarnym syndromom z elevatsiieiu sehmenta ST bryhadamy ekstrenoi medychnoi dopomohy [On Approval of the Procedure for Providing Medical Care and Hospitalization of Patients with ST-segment Elevation Acute Coronary Syndrome by Medical Emergency Teams (No. 1181)]. https://zakon.rada.gov.ua/laws/show/z1290-17#Text
Lüscher, T. F. (2019). Myocardial revascularization: guideline-based therapy today. European Heart Journal, 40(2), 75-78. https://doi.org/10.1093/eurheartj/ehy901
Laine, L., & Jensen, D. M. (2012). Management of Patients With Ulcer Bleeding. American Journal of Gastroenterology, 107(3), 345-360. https://doi.org/10.1038/ajg.2011.480
Barkun, A. N., Bardou, M., Kuipers, E. J., Sung, J., Hunt, R. H., Martel, M., Sinclair, P., & International Consensus Upper Gastrointestinal Bleeding Conference Group. (2010). International Consensus Recommendations on the Management of Patients With Nonvariceal Upper Gastrointestinal Bleeding. Annals of Internal Medicine, 152(2), 101-113. https://doi.org/10.7326/0003-4819-152-2-201001190-00009
Beggs, A. D., Dilworth, M. P., Powell, S. L., Atherton, H., & Griffiths, E. A. (2014). A systematic review of transarterial embolization versus emergency surgery in treatment of major nonvariceal upper gastrointestinal bleeding. Clinical and Experimental Gastroenterology, 7, 93-104. https://doi.org/10.2147/CEG.S56725
Yang, J., Zhang, X. H., Huang, Y. H., Chen, B., Xu, J. B., Chen, C. Q., Cai, S. R., Zhan, W. H., He, Y. L., & Ma, J. P. (2016). Diagnosis and Treatment of Abdominal Arterial Bleeding After Radical Gastrectomy: a Retrospective Analysis of 1875 Consecutive Resections for Gastric Cancer. Journal of Gastrointestinal Surgery, 20(3), 510-520. https://doi.org/10.1007/s11605-015-3049-z
Park, S., Shin, J. H., Gwon, D. I., Kim, H. J., Sung, K. B., Yoon, H. K., Ko, G. Y., & Ko, H. K. (2017). Transcatheter Arterial Embolization for Gastrointestinal Bleeding Associated with Gastric Carcinoma: Prognostic Factors Predicting Successful Hemostasis and Survival. Journal of Vascular and Interventional Radiology, 28(7), 1012-1021. https://doi.org/10.1016/j.jvir.2017.03.017
Barbato, E., Noc, M., Baumbach, A., Dudek, D., Bunc, M., Skalidis, E., Banning, A., Legutko, J., Witt, N., Pan, M., Tilsted, H. H., Nef, H., Tarantini, G., Kazakiewicz, D., Huculeci, R., Cook, S., Magdy, A., Desmet, W., Cayla, G., Vinereanu, D., … Haude, M. (2020). Mapping interventional cardiology in Europe: the European Association of Percutaneous Cardiovascular Interventions (EAPCI) Atlas Project. European Heart Journal, 41(27), 2579-2588. https://doi.org/10.1093/eurheartj/ehaa475
Dudek, D., Siudak, Z., Grygier, M., Araszkiewicz, A., Dąbrowski, M., Kusa, J., Hawranek, M., Huczek, Z., Kralisz, P., Roleder, T., Wojakowski, W., Parma, R., Malinowski, K. P., & Bartuś, S. (2020). Interventional cardiology in Poland in 2019. Summary report of the Association of Cardiovascular Interventions of the Polish Cardiac Society (AISN PTK) and Jagiellonian University Medical College. Postępy w Kardiologii Interwencyjnej, 16(2), 123-126. https://doi.org/10.5114/aic.2020.96054
Lüsebrink, E., Massberg, S., & Orban, M. (2020). Ten things ICU specialists need to know about new valvular procedures in interventional cardiology. Intensive Care Medicine, 46(1), 102-106. https://doi.org/10.1007/s00134-019-05824-6
Wolff, G., Lin, Y., Quade, J., Bader, S., Kosejian, L., Brockmeyer, M., Karathanos, A., Parco, C., Krieger, T., Heinen, Y., Perings, S., Albert, A., Icks, A., Kelm, M., & Schulze, V. (2020). Validation of National Cardiovascular Data Registry risk models for mortality, bleeding and acute kidney injury in interventional cardiology at a German Heart Center. Clinical Research in Cardiology, 109(2), 235-245. https://doi.org/10.1007/s00392-019-01506-x
Gabr, A. M., Li, N., Schenning, R. C., Elbarbary, A., Anderson, J. C., Kaufman, J. A., & Farsad, K. (2020). Diagnostic and Interventional Radiology Case Volume and Education in the Age of Pandemics: Impact Analysis and Potential Future Directions. Academic Radiology, 27(10), 1481-1488. https://doi.org/10.1016/j.acra.2020.07.014
American College of Cardiology, American Heart Association, & Canadian Cardiovascular Society. (2004). ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction. Circulation, 110(9), e82-e292. https://doi.org/10.1161/circ.110.9.e82
Zhang, L., Wang, J., Jiang, J., & Shen, J. (2020). The Role of Interventional Radiology in the Management of Late Postpancreaticoduodenectomy Hemorrhage. BioMed Research International, 2020, Article 8851950. https://doi.org/10.1155/2020/8851950
Sakai, N., Yoshitomi, H., Furukawa, K., Takayashiki, T., Kuboki, S., Takano, S., Suzuki, D., Kagawa, S., Mishima, T., Nakadai, E., & Ohtsuka, M. (2020). Outcome of interventional radiology for delayed postoperative hemorrhage in hepatobiliary and pancreatic surgery. Journal of Gastroenterology and Hepatology, 35(12), 2264-2272. https://doi.org/10.1111/jgh.15140
Yevich, S. M. (2020) Interventional Radiology Procedures in Critically Ill Cancer Patients. In J. Nates & K. Price (Eds.), Oncologic Critical Care (pp. 1597-1608). Springer, Cham. https://doi.org/10.1007/978-3-319-74588-6_136
Gralnek, I. M., Neeman, Z., & Strate, L. L. (2017). Acute Lower Gastrointestinal Bleeding. The New England Journal of Medicine, 376(11), 1054-1063. https://doi.org/10.1056/NEJMcp1603455
Oakland, K., Chadwick, G., East, J. E., Guy, R., Humphries, A., Jairath, V., McPherson, S., Metzner, M., Morris, A. J., Murphy, M. F., Tham, T., Uberoi, R., Veitch, A. M., Wheeler, J., Regan, C., & Hoare, J. (2019). Diagnosis and management of acute lower gastrointestinal bleeding: guidelines from the British Society of Gastroenterology. Gut, 68(5), 776-789. https://doi.org/10.1136/gutjnl-2018-317807
Aboyans, V., Ricco, J. B., Bartelink, M., Björck, M., Brodmann, M., Cohnert, T., Collet, J. P., Czerny, M., De Carlo, M., Debus, S., Espinola-Klein, C., Kahan, T., Kownator, S., Mazzolai, L., Naylor, A. R., Roffi, M., Röther, J., Sprynger, M., Tendera, M., Tepe, G., … ESC Scientific Document Group. (2018). 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries Endorsed by: the European Stroke Organization (ESO) The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). European Heart Journal, 39(9), 763-816. https://doi.org/10.1093/eurheartj/ehx095
Downloads
Published
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)
