Katarzyna Pawlaczyk

Angiotensin-converting enzyme (ACE, I/D) gene polymorphism and susceptibility to abdominal aortic aneurysm or aortoiliac occlusive disease.

BACKGROUND The purpose of this study was to examine the role of polymorphism in angiotensin converting enzyme gene (ACE, I/D) in the development of abdominal aortic aneurysm (AAA) or aortoiliac occlusive disease (AIOD). MATERIALS AND METHODS We investigated 829 individuals in 4 groups: AAA (n = 133), AIOD (n = 152), control (n = 152), and a random Polish population group (n = 392). ACE I/D gene polymorphism analysis was performed by polymerase chain reaction and gel electrophoresis. The genotype distribution was in Hardy-Weinberg equilibrium. RESULTS The genotype distribution and allele frequency of ACE I/D were not significantly different between patients with AAA or AIOD and the control or the population group. Significant differences were found between the following groups: 1) hypertensive patients with AAA and normotensive patients with AAA (OR = 3.08 95% CI 1.22-7.79, P = 0.0147); 2) hypertensive patients with AAA and the population group (OR = 2.56; 95% CI 1.27-5.16, P = 0.0066). Since the majority of subjects were male, these associations were also true when only male hypertensive subjects with AAA were compared with male normotensive patients with AAA or to male population group. No relation of the ACE gene polymorphism to hypertension in the AIOD group was found. CONCLUSIONS ACE I/D gene polymorphism is not a susceptibility factor to aortoiliac occlusive disease; however it may be an important factor in the development of AAA when coexisting with hypertension.

Current options in prosthetic vascular graft infection: comparative analysis of 63 consecutive cases

PurposeThe study was conducted to compare the results of two different techniques of vascular reconstruction in patients after the removal of infected vascular prostheses.MethodsSixty-three patients with vascular prostheses infections underwent treatment. Either the infected fragments or the entire prosthesis was removed in all of the patients. Extra-anatomical grafts were implanted in 19 cases. Cryopreserved allogenic arterial grafts were applied for reconstruction in 44 patients.ResultsIn a 19-patient group with extra-anatomical grafts, two patients died (10.5%). In seven patients (36.8%) relapse symptoms of infection appeared. Primary and secondary patencies of the grafts after 3 years were 31.6% and 52.6% respectively. In a group of 44 patients with allogenic grafts no recurrence of infection was observed. Six patients died (13.6%). Primary and secondary patencies after 3 years were 63.6% and 81.8% respectively.ConclusionsThe results reveal the benefits of the allogenic arterial grafts in revascularization in patients with major vascular prostheses infections. The differences in secondary patencies of the implanted allogenic grafts indicate the necessity of an early selection of patients for the complete removal of the infected prosthesis, during a time when patients are in general good health.

Risk factors in abdominal aortic aneurysm and in Polish population aortoiliac occlusive disease and differences between them [corrected].

Abdominal aortic aneurysm (AAA) and aortoiliac occlusive disease (AIOD) are multifactorial vascular disorders caused by complex genetic and environmental factors. The purpose of this study was to define risk factors of AAA and AIOD in the Polish population and indicate differences between diseases.

Morphological and Mechanical Changes in Juxtarenal Aortic Segment and Aneurysm Before and After Open Surgical Repair of Abdominal Aortic Aneurysms

OBJECTIVE The aim of study was to assess how the ultrastructure of the wall of aortic aneurysms, sac and neck influences aortic wall distensibility and proximal dilatation 2 years after open repair. METHODS Biopsies for electron microscopy were taken from aneurysmal sac and neck of 30 patients. Patients were assessed by computed tomography (CT) and ultrasound for aneurysm diameter and distensibility (M-mode ultrasonography). RESULTS Postoperative CT of the aortic stump distinguished two groups. Group I (n = 11) with little enlargement, median 1 mm (1-3 mm) and group II (n = 19) with significant aortic enlargement, median 5.2 mm (4-12 mm). In group II, changes in elastic fibres in the aneurysm neck were comparable to, but as extreme as in the aneurysm sac. For group I, the distensibility of the aneurysmal sac was significantly lower than in the neck or at the renal arteries. For group II, the distensibility in both the neck and sac was significantly lower than at the juxtarenal segment (p = 0.01). The biopsies of group II patients showed the extensive degeneration of normal architecture, which was associated with altered wall distensibility in both the aneurysmal neck and sac. CONCLUSIONS Disorganisation and destruction of normal aortic architecture at the ultrastructural level are associated with decreasing aortic distensibility. Low aortic neck distensibility is associated with proximal aortic dilatation at 2 years postoperatively.

Intensive decongestive treatment restores ability to work in patients with advanced forms of primary and secondary lower extremity lymphoedema

Objective To show that adequate therapy for lymphoedema is able to restore ability to work. Materials and Methods The population of patients with primary lymphoedema registered in the university clinical centre diagnosed with primary or secondary lymphoedema and presumed by the national social institution as completely unable to work was selected for the retrospective analysis and divided into two groups. Group 1 consisted of 25 patients treated with a complex decongestive therapy programme daily for 3–6 weeks. The study population comprised 19 women and six men from 14 to 61 years of age (mean 31.5). In all 25 patients, complete inability to work was certified by the social institution before the treatment started. Group 2 consisted of 47 patients, 14 men and 33 women, aged from 26 to 71 years (mean 39 years) treated by so-called standard methods, who resigned from the proposed intensive treatment. In all 47 patients, complete inability to work was declared by the social institution before the treatment. Ability to work and oedema reduction were assessed by the treating physician. Results The intensive phase of treatment succeeded in 3870–15,330 mL oedema reduction in Group 1. After the end of therapy, 21 patients were able to work or study without any limitation and patients returned to their regular professional activity. Among four others, two were on welfare for at least 10 years, for another one welfare was their only income and one person was receiving a social pension. In none of the patients from group 2 was any significant oedema reduction observed. Every patient from group 2 maintained the social pension due to ineffective treatment. Conclusions Complex decongestive therapy is a very efficient form of treatment in advanced primary and secondary lymphoedema. It allows returning to work after a short period of temporary disability without the necessity of a social pension.

Effects of Intermittent Pneumatic Compression on Reduction of Postoperative Lower Extremity Edema and Normalization of Foot Microcirculation Flow in Patients Undergoing Arterial Revascularization

Background In patients with chronic leg ischemia, the beneficial effect of arterial revascularization can be significantly decreased due to postoperative leg swelling. The aim of this study was to assess the effects of intermittent pneumatic compression (IPC) on skin flow normalization in patients undergoing revascularization procedures due to chronic leg ischemia. Material/Methods We evaluated 116 patients with chronic leg ischemia. The patients were divided into groups according to the performed treatment (endovascular or surgical) and implementation of IPC postoperatively. The leg edema assessment and microcirculation flow assessment were performed pre- and postoperatively, using percutaneous O2 pressure (TcpO2), cutaneous blood perfusion (CBP) measurements, and skin flow motion assessment. Results In patients who did not receive IPC, a decrease in CBP value was observed in the 1st postoperative assessment. Among patients receiving IPC, the CBD value increased at the 1st and 2nd postoperative measurements, especially in the surgical group. The lowest TcpO2 values were observed in by-pass surgery group without IPC postoperatively. Conclusions The benefits of the by-pass procedure in patients with leg ischemia can be significantly reduced by postoperative edema. Among patients with postoperative leg edema, local tissue blood perfusion can be improved by the use of IPC, which can result in decreased local leg swelling, as well as improved skin blood perfusion and TcpO2.

The Use of Duplex Ultrasound Arterial Mapping (DUAM) and Preoperative Diagnostics in Patients with Atherosclerotic Ischaemia of Lower Extremities

UNLABELLED In spite of the fact duplex Doppler ultrasonography is recognized as an scanning technique equivalent to other imaging methods for preoperative diagnostics of the lower extremity arteries, in many centres its use is limited to screening. THE AIM OF THE STUDY was to the determine usefulness of arterial duplex mapping for preoperative diagnostics in patients with peripheral artery occlusive disease (PAOD). MATERIAL AND METHODS In 2008-2009, 103 patients with PAOD symptoms (129 limbs) were examined in a prospective, non-randomized study. DUAM was performed in all limbs, DSA in 90, CT-angio in 29, and revascularisation procedures in 116 limbs. RESULTS Problems with completing DUAM occurred in 10,1% of cases, including 1.5% of examinations of no diagnostic value. Consistency of DUAM and DSA results was found in 94.6% of cases, and consistency of DUAM results and the range of actually performed ranges was found in 97.8% of cases. Consistency of DUAM and CT-angio results was recorded in 68.0% of cases. The comparison between individual examinations and the actually performed procedures showed consistency of 96.5% for DUAM and 72.4% for CT-angio. CONCLUSIONS DUAM usefulness for detecting and defining lesions in lower extremity arteries is similar to that of DSA and CT-angio. This examination may be successfully used in preoperative diagnostics, particularly for intravascular procedures, which makes possible to reduce exposition to radiation and minimalize diagnostics costs.

Gene polymorphism -418 G/C of tissue inhibitor of metalloproteinases 2 is associated with abdominal aortic aneurysm.

OBJECTIVE The pathogenesis of abdominal aortic aneurysm (AAA) is connected with abnormal extracellular matrix remodeling, with the assistance of extracellular matrix metalloproteinases and tissue inhibitors of metalloproteinases (TIMPs). A decrease in tissue inhibitor of metalloproteinases 2 (TIMP2) gene expression was detected in AAA patients. Recently, a -418 G/C (rs8179090) polymorphism of the TIMP2 gene promoter, influencing the transcription rate of the gene, has been described. This study investigated whether the -418 G/C gene polymorphism is associated with AAA in the Polish population. METHODS The TIMP2 gene promoter polymorphism was evaluated by polymerase chain reaction, followed by restriction enzyme analysis and pyrosequencing in 128 patients affected by AAA and in 180 individuals included as references. The control group was directly matched to patients according to known risk factors for vascular diseases. RESULTS The frequency of the C allele was significantly higher in AAA patients than in the control group (odds ratio [OR], 2.516; P = .0005). The distribution of genotypes also differed significantly between the groups (CC + CG vs GG: OR, 2.906; P = .0037) or was close to being significantly different (CC vs GG + GC: OR, 2.144; P = .0501). A similar trend was observed in men but not in women. The multivariate logistic regression analysis indicated the TIMP2 gene promoter polymorphism is risk factor of AAA in the Polish population, with an adjusted OR of 4.99, when applied to a dominant inheritance model. CONCLUSIONS Our study supports the hypothesis that TIMP2 and the -418G/C polymorphism located in the promoter of the TIMP2 gene are important in AAA pathophysiology.

Duplex Doppler ultrasound examination of extremities arteries: guidelines of the Polish Society for Vascular Surgery

The duplex Doppler examination of extremities arteries is the primary diagnostic method in detecting disorders leading to lower and upper extremities blood supply disturbances. In many cases the Doppler ultrasound plays a major role in the process of qualification to the reconstructive procedures or conservative treatment, especially to the endovascular procedures. Regardless of the widespread availability and high sensitivity and specificity of this method its burdened with serious drawbacks. The most important of them are evaluation subjectivity and variety of methods determining the haemodynamic stenosis consequences. They often cause difficulties in comparing the test results carried out in different centres and to find correlations with other imaging methods results. In order to overcome these drawbacks, Polish Society for Vascular Surgery has attempted to develop recommendations for uniform methodology of extremities arteries Doppler examination. Legal terms, the manner of examination and its interpretation were presented. Proposing the way of highlights results and messages conclusion to enable the recommendations implementation of endovascular and surgical qualifications relating to surgical treatment. We hope that these recommendations will help to standardise examination techniques.

Superb Micro-vascular Imaging (SMI): a Doppler ultrasound technique with potential to identify, classify, and follow up endoleaks in patients after Endovascular Aneurysm Repair (EVAR)

PurposeThe aim of the study was to assess the effectiveness of Superb Micro-vascular Imaging (SMI) as an alternative to Contrast-Enhanced Ultrasound (CEUS) and Computed Tomography Angiography (CTA) for endoleak detection and classification in patients followed up after endovascular abdominal aortic aneurysm repair (EVAR).Materials and methodsFrom May 2015 to January 2017, 30 patients underwent post-EVAR follow-up with Color Doppler Ultrasound (CDUS), CEUS, SMI, and CTA examinations. Aneurysmal sac diameter and graft patency were evaluated; endoleaks were identified and classified. Sensitivity, specificity, and accuracy values were calculated for each of the four diagnostic methods of endoleak detection. A percentage of agreement and Cohen’s Kappa coefficient were calculated for comparison of methods in terms of endoleak identification.ResultsCTA revealed fifteen endoleaks (50%): three type Ia, nine type II, and three type III. The sensitivity of CDUS, CEUS, and SMI relative to CTA was 27%, 100%, and 100%, respectively. Specificity was 93%, 93%, and 93%, respectively. Accuracy was 60%, 97%, and 97%, respectively. There were no differences between SMI and CEUS in terms of sensitivity, specificity, or accuracy (100%, 93%, and 97%). We do not observe statistically significant differences between CTA, CEUS, and SMI concerning endoleak identification ability. The weakest method in endoleak identification was CDUS.ConclusionsThe analysis showed that SMI is effective, repeatable, and comparable with the CEUS modality in identification endoleaks after EVAR; it may be considered as a potential tool to monitor patients after EVAR implantation, especially those with renal insufficiency or with an allergy to any contrast media.