Minimally invasive organ-preserving endovideosurgical technologies and the use of X-ray endovascular catheter interventions at the stages of evacuation of the wounded | Ukrainian Medical Journal

Kravchenko R.Yu.,Luzan O.M.,Ivaschyk Ya.I.

Main
Publications
Minimally invasive organ-preserving endovideosurgical technologies and the use of X-ray endovascular catheter interventions at the stages of evacuation of the wounded

Minimally invasive organ-preserving endovideosurgical technologies and the use of X-ray endovascular catheter interventions at the stages of evacuation of the wounded

March 14, 2025

УДК: 616-001

DOI: 10.32471/umj.1680-3051.264015

Keywords :

combined treatment,

endovascular technologies,

intra-arterial embolization,

mine-blast trauma,

minimally invasive technologies,

pulmonary hemorrhage

Specialities :

Surgery

Resume

A clinical case of a 34-year-old patient with pulmonary hemorrhage caused by lung damage due to mine-explosive trauma combined with thoracoabdominal trauma and gunshot shrapnel wound of the left lung is presented. The patient’s condition was characterized by a number of complications, namely, rib fracture, left-sided hemothorax, and damage to the diaphragmatic surface of the spleen. The patient’s serious condition required the provision of proper medical care and, above all, the selection of an effective method for stopping pulmonary hemorrhage. The patient underwent an angiographic examination, which made it possible to determine the source of bleeding. Using a contrast agent (tomohexol 350), areas of hypervascularization of the lung tissue with impaired architectonics were detected, and a site of contrast agent extravasation was detected. After the angiographic examination, a minimally invasive method of endovascular treatment was performed – radiogenic endovascular embolization of the bronchial arteries. The effectiveness of the operation was confirmed angiographically. The implementation of X-ray endovascular embolization of the bronchial arteries made it possible to achieve stable hemostasis and contributed to the stabilization of the patient’s condition and further positive dynamics of recovery. This method is the method of choice for stopping pulmonary hemorrhages of various intensity and etiology. X-ray endovascular embolization of the bronchial arteries is the method of choice in the treatment of massive pulmonary hemorrhages that occur in bronchitis, tuberculosis, bronchiectasis, lung cancer, etc. Despite the fact that this method of endovascular treatment is preferred in the above diseases, its capabilities in combat lung trauma have not been studied previously. Therefore, this clinical case confirms the high effectiveness of the specified method of treating pulmonary hemorrhage due to shrapnel injury to the lungs. As a result, it was possible to achieve stable hemostasis and stabilize the patient’s condition. Accordingly, X-ray endovascular embolization of bronchial arteries can be recommended as the method of choice for stopping bleeding due to combat lung injury.

References

1. Герасимчук П.О., Осадчук Д.В., Фіра Д.Б., Павлишин А.В. (2023) Відеолапароскопія при закритій травмі живота з пошкодженням печінки та селезінки. Хірургія дитячого віку, 2(79): 44–49.
2. Сухомлин М.П. (2024) Медицина невідкладних станів, Т. 20, ДУ «Інститут загальної та невідкладної хірургії ім. В.Т. Зайцева НАМН України», Харків.
3. Бойко В.В., Бунін Ю.В., Верба А.В. та ін. (2023) Лікування поранених з бойовими ушкодженнями грудей. Київ, Харків, 236 с.
4. Хоменко І.П., Гетьман В.Г., Гуменюк К.В. та ін. (2021) Відеоторакоскопічні технології при бойових пораненнях та травмах грудної клітки. Метод. рекоменд., Київ, Одеса, Вид-во Людмила, 63 с.
5. Чаплик В., Олійник П., Цегельський А. (ред.) (2015) Невідкладна військова хірургія: присвячується військовим лікарям. Українське видання. 4-те вид. Львів, Наутілус, 504 с.
6. Abdelshafy A.A., Nagy M.E., Elshinawi M.E. et al. (2020) Role of laparoscopy in blunt abdominal trauma a comparative prospective cohort study between laparoscopy and laparotomy in patients with blunt abdominal trauma. Egypt. J. Surg., 39(4): 926–931. doi: 10.4103/ejs.ejs11720.
7. Авдосьєв Ю., Бойко В.В., Белозеров И.В. (2022) Ангіографія та рентгенендоваскулярна хірургія внутрішніх і зовнішніх кровотеч. с. 164–173.
8. Худа М., Грубнік В., Севергін В., Дубенко Д. (2023) Малоінвазивні методи лікування легеневих кровотеч. Укр. наук.-мед. молодіж. журн., 139(2): 32–39. doi.org/10.32345/USMYJ.2(139).2023.32-39.
9. Chen J., Chen L.A., Liang Z.X. et al. (2014) Immediate and long-term results of bronchial artery embolization for hemoptysis due to benign versus malignantpulmonary diseases. Am. J. Med. Sci., 348(3): 204–209. doi.org/10.32345/USMYJ.2(139).2023.32-39.
10. Fernando H.C., Stein M., Benfield J.R., Link D.P. (1998) Role of bronchial artery embolization in the management of hemoptysis. Arch. Surg., 133(8): 862–866. doi.org/10.1001/archsurg.133.8.862.
11. Fruchter O., Schneer S., Rusanov V. et al. (2015) Bronchial artery embolization for massive hemoptysis: long-term follow-up. Asian Cardiovasc. Thorac. Ann., 23(1): 55–60. doi.org/10.1177/0218492314544310.
12. Temel U. (2020) Bronchial artery embolization, an increasingly used method for hemoptysis;treatment and avoidance Bronchial artery embolization for hemoptysis management. SiSli Etfal Hastan Tip Bulteni Med. Bull. Sisli Hosp. doi.org/10.14744/ semb.2020.68870.
13. Zeiler J., Idell S., Norwood S. (2020) Hemothorax: a review of the literature. Clin. Pulm. Med., 27(1): 1–12.
14. Kakkar A., Kochhar L.K. (2000) Missile injuries of face and neck: our experience. Indian J. Otolaryngol. Head Neck Surg., 52(4): 334–339. doi.org.10.1007/ BF02991472.
15. Ongom P.A., Kijjambu S.C., Jombwe J. (2014) Atypical gunshot injury to the right side of the face with the bullet lodged in the carotid sheath: a case report. J. Med. Case Rep., 8: 29. doi.org/10.1186/1752-1947-8-29.
16. Champion H.R., Copes W.S., Sacco W.J. et al. (1990) The major trauma outcome study: establishing national norms for trauma care. J. Trauma., 30(11): 1356–1365.
17. Худа М., Грубнік В. (2023) Опис клінічного випадку зупинки рецидивуючої легеневоїкровотечі внаслідок вогнепального бойового пораненняза допомогою рентгенендоваскулярної емболізації бронхіальних артерій. Curr. Asp. Military Med., 30(2): 194–203. DOI: 10.327/2310-4910-2023-30-2-18.