Our surgeons became pioneers in rare technique endovascular surgery

Last week Tyumen Cardiology Research Center vascular surgeons first in the Tyumen region used rare endovascular techniques in complicated clinical case.

Vasiliy Mihaylovich Migalko is 61 years old. He has come from Nadym to Tyumen Cardiology Research Center for examination and treatment almost every year for the past 7 years. Vasiliy Mihaylovich used to suffer from chronic coronary heart disease due to total occlusion of one of the main coronary arteries. This is a severe artery lesion – it is completely blocked by an atherosclerotic plaque. The patient underwent coronary artery bypass grafting in 2002: venous graft was “sewn” to his occluded artery in order to blood could flow along the artery bypassing the lesion area. However, venous graft was not ready to high blood pressure, therefore it wears out quickly and gets destroyed - over time atherosclerosis develops and plaque grows.

Last year our surgeons found out that the patient` venous graft was significantly destroyed. Thus, the stent implantation surgery was carried out – a perforated small stent widened the plaque. On that patient` visit, the most obvious plaque degenerative changes were identified during examination – areas of thrombosis had already appeared. On the 7^th of November, Stanislav Sapozhnikov and Viktor Bukhvalov, surgeons of X-ray endovascular methods of diagnostics and treatment applied complicated procedure of treatment – retrograde recanalization of coronary artery chronic total occlusion.

“We identified the high risk in patient stratified by the patient risk complexity scale, - explained Stanislav Sapozhnikov. – After a consillium we decided to carry out a standard procedure, but during the surgery understood that it would not be possible. The surgery was complicated with a big age of an occlusion period, bypass grafting in medical history and existence of confirmed myocardial ischemia in patient – the heart had a nutrient deficiency.”

Because of this, surgeons decided to change tactics immediately at the surgical table. “There was no other solution as patient` prognosis without occlusion recanalization was unfavourable. Medical assistance had to be provided. That is why we did not go as usually through the artery, because the occlusion area was quite extended and could not be recanalized by standard technique, but continued retrograde intervention. We got access via bypass graft by using long introducer with the system of microcatheters and got out via left coronary artery and the introducer got outside, it means we almost held the patient` heart in both hands with help of one introducer without incisions. It gave us an opportunity to perform balloon dilatation and stenting coronary artery successfully, completely restored blood flow, its original state.” – shared Sapozhnikov S.

The surgery lasted three hours. “I was undoubtedly nervous, shared Migalko V., - I did not even tell my relatives in order they did not worry. I saw that it was arduous for surgeons at the surgery, it was hard going, and there were many motions. I was lying but they were standing for three hours. They were talking to me, begging to endure for a little, when I got pain, then this pain was gone. They are really good! They came to visit me in an intensive-care unit. They have made great achievement. It is important for me now to recover completely.”

This technique is rarely applied and considered as a top of success in invasive cardiology. Our surgeons of the Department of X-ray Surgical Methods for Diagnostics and Treatment #1 are communicating with colleagues from Novosibirsk National Research Medical Center by Academician E.N. Meshalkin, which is the leader of endovascular methods application in Russian Federation. Founders of chronic occlusion retrograde recanalization are physicians from Japan. Japanese surgeons were the ones who have had great experience: they know how to restore a blood flow in nearly all vessels.

This year our specialists have started to use Japanese introducers for vascular surgery, which are considered to be the most up-to-date. So, due to premium material of device and of course professionalism and surgical skills of our specialists, we have managed to save the patient`s life.