Background and Objectives: Leadless pacemakers provide an innovative alternative to traditional transvenous pacemakers for managing cardiac arrhythmias. The objective of this systematic review is to conduct a meta-analysis comparing acute complication and mortality rates associated with leadless pacemakers versus transvenous pacemaker placements using national-level data. Specifically, we aim to summarize the current evidence and calculate pooled odds ratios for acute overall complications, acute device-related complications, and acute mortality to assess the early safety outcomes of leadless pacemaker placement relative to traditional transvenous pacemakers. Materials and Methods: A systematic search of PubMed, Scopus, ScienceDirect, and Google Scholar was conducted by two independent researchers using a predefined search protocol. The search included articles published up to 10 October 2024, without limits on review depth. Studies were included if they provided national-level data comparing leadless pacemaker and traditional pacemaker recipients in terms of acute mortality, acute overall complications, and acute device-related complications. Outcomes were pooled to calculate odds ratios using a random-effects model in RStudio (version 2024.12.1+563). Results: A total of five studies met the eligibility criteria. The pooled odds ratio for acute mortality was 2.03 (95% CI: 0.65–6.34, I² = 99%; p < 0.01), for acute overall complications was 1.08 (95% CI: 0.45–2.61, I² = 99%; p < 0.01), and for acute device-related complications was 1.02 (95% CI: 0.23–4.44, I² = 99%; p < 0.01). Conclusions: The reviewed studies suggest that leadless pacemakers offer a promising alternative to transvenous pacemakers, offering a comparable short-term safety profile. Ongoing technological advancements may further enhance their applicability in clinical practice.

Relevance: Pelvic venous congestion syndrome (PVCS) is a chronic and often underdiagnosed vascular disorder in women of reproductive age, primarily manifested by persistent pelvic pain. Impaired venous outflow, characterized by reflux and dilatation of ovarian and pelvic veins, is considered the primary mechanism. Endovascular embolization has emerged as a safe, minimally invasive treatment that provides significant symptom relief. The study aimed to evaluate the efficacy and safety of endovascular ovarian vein embolization in women diagnosed with pelvic venous congestion syndrome. Materials and Methods: A retrospective analysis included 17 women (18–50 years) with clinically and radiologically confirmed PVCS who underwent ovarian vein embolization at the Syzganov National Scientific Center of Surgery (Almaty, Kazakhstan) in 2023–2024. Diagnosis was based on Doppler ultrasound, CT venography, and catheter-based phlebography. Embolization was performed using coils and sclerosing agents. Pain intensity was evaluated by the Visual Analog Pain Scale (VAPS) before and after surgery (Day 1, Day 3, 1 month, 3 months). Statistical analysis was performed using the Wilcoxon signed-rank test, with p < 0.05 considered significant. The article also presents a clinical case of PVCS with pelvic varicose vein disease. Results: Ovarian vein reflux (Hiromura grade II-III) was detected in 88.2% of patients, predominantly on the left side. VAPS scores decreased from a median of 6.0 (IQR 5-7) preoperatively to 2.0 (IQR 1-3) at 3 months (p < 0.001). No major peri- or post-procedural complications occurred. Three women (17.6%) required re-embolization due to contralateral reflux. Overall, 82.4% of patients reported partial or complete symptom resolution. Conclusions: Endovascular ovarian vein embolization is a safe and effective treatment for PVCS, resulting in long-term reductions in pelvic pain and improvements in quality of life. Integration of multidisciplinary diagnostic criteria and SVP classification may further optimize patient selection and outcomes.

Increasement in the diameter of the thoracic aorta ≥ 50% of the norm of 40 mm in men and 34 mm in women (99 percentile) is considered to be an aneurysmal expansion. The risk of rupture is proportional to the size of the aneurysm and is associated with the development of fatal complications. Diagnosis is usually verified by computed tomographic angiography (CTA), magnetic resonance angiography (MRA), or transesophageal echocardiogram. Treatment consists of endovascular stent graft placement or open surgery in combination with optimal medical therapy. The article presents the experience of treating a patient with a dissecting aneurysm of the thoracic aorta type IIIB according to DeBakey using a stent graft modified by a doctor “on table” by forming a fenestration modeled after the anatomy of the left subclavian artery orifice. The aim of the work was to evaluate the short-term and medium-term results and prognosis of treatment using the technique of endovascular prosthesis with a modified graft. Such modifications on the table or in situ make it possible to model the prosthesis according to the variant of the anatomy of a particular patient, which allows optimizing the apposition of the prosthesis, eliminating additional stages of complex surgical treatment, reducing the undesirable effects of standard approaches, including preliminary endovascular occlusion of the left subclavian artery and/or the formation of a carotid-subclavian shunt, reduce the time of stationary observation. The use of the described technique will reduce the radicalness of surgical treatment of patients with dissecting aneurysms and increase economic efficiency. This technique is a promising direction in the development of endovascular and surgery and requires further study to assess long-term results and prognosis in a large number of patients.

Congenital portosystemic shunt, also known as Abernethy malformation, is a rare vascular anomaly in which portal venous blood partially or completely bypasses the liver and enters the systemic circulation. This condition can lead to severe complications such as hepatopulmonary syndrome, hepatic encephalopathy, hypoxemia, and hyperammonemia. This article presents the first clinically confirmed and successfully treated case of Abernethy type II malformation in a child in Kazakhstan, who developed severe hepatopulmonary syndrome. A detailed description is provided of the diagnostic algorithm, angiographic evaluation, the endovascular intervention technique, and the patient’s clinical course over a five-year follow-up period. Shunt closure resulted in marked clinical improvement, including normalization of oxygen saturation (from 60% to 98%), reduction in blood ammonia levels, increased exercise tolerance, and enhanced quality of life.The findings support the effectiveness of an individualized, stepwise approach in the management of type II CPSS. The importance of early recognition of this condition is emphasized, particularly in pediatric patients presenting with unexplained cyanosis, hypoxemia, or signs of hepatic dysfunction. Endovascular techniques, due to their minimally invasive nature and high clinical efficacy, represent an optimal therapeutic strategy in pediatric practice.

Background/Objectives: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia worldwide, with inflammatory cytokines increasingly implicated in its development, persistence, and post-ablation recurrence. However, prospective perioperative cytokine data from Central Asia are lacking. The objective of the study is to evaluate temporal changes in inflammatory cytokines in AF patients undergoing catheter ablation and assess differences by AF type and recurrence status. Methods: In this prospective observational study conducted at the Syzganov National Scientific Center of Surgery, Almaty, Kazakhstan, 166 AF patients (mean age 66.1 ± 8.2 years; 57.8% male) were enrolled. Serum cytokines were measured using ELISA at baseline, immediately postablation, and at 6 months. Temporal changes were analysed using Friedman and Wilcoxon signed-rank tests, while between-group comparisons used Mann–Whitney U and Kruskal–Wallis tests. Results: IL-1β, IL-6, and IL-17A showed significant temporal changes (all p < 0.001). IL-6 increased immediately after ablation (0.088 to 0.122 pg/mL) before decreasing below baseline at 6 months (0.079 pg/mL). IL-17A progressively declined across all time points (0.073, 0.069, and 0.048 pg/mL). At 6 months, IL-1α levels were higher in primary versus recurrent AF (0.079 vs. 0.067 pg/mL; p = 0.047). Baseline IL-1β and IL-28A differed across AF subtypes (p = 0.040 and p = 0.014). No pre-operative cytokine independently predicted recurrence. Conclusions: AF ablation is associated with distinct cytokine trajectories, particularly for IL-1β, IL-6, and IL-17A. Cytokine profiles vary by AF type and recurrence, highlighting the potential role of immune monitoring in AF management. These findings should be regarded as exploratory and hypothesis-generating.

Background. Pulmonary vein isolation is the cornerstone of catheter-based treatment for atrial fibrillation. Cryoballoon ablation offers an effective and reproducible method for pulmonary vein isolation, yet recurrence of arrhythmias remains a challenge. Despite advances in catheter technologies, the role of altered pulmonary vein anatomy as a factor for atrial fibrillation recurrence is poorly studied. Materials and Methods. This prospective study included 465 patients with paroxysmal atrial fibrillation who underwent cryoballoon ablation. Pulmonary vein and left atrial anatomy were evaluated using multislice computed tomography. Patients were followed for 24–48 months to assess atrial fibrillation recurrence and anatomical risk factors. Cox proportional hazard modeling and Kaplan-Meier analysis were used to evaluate predictors of arrhythmia recurrence. Results. Complete Pulmonary vein isolation was achieved in all patients. During follow-up, 38% of patients experienced atrial fibrillation recurrence. Patients with altered pulmonary vein anatomy, particularly a left common pulmonary vein and additional pulmonary veins, showed a higher rate of recurrence. Cox regression analysis identified left atrial volume index >50 mL/m² and pathological pulmonary vein anatomy as independent risk factors for atrial fibrillation recurrence. Conclusion. Altered pulmonary vein anatomy is a significant risk factor for atrial fibrillation recurrence following cryoballoon ablation. Comprehensive imaging of the left atrial and pulmonary vein using multislice computed tomography can improve patient selection, reducing the recurrence risk and improving long-term outcomes.