Kazimierz Kordecki

Changes in the Fibrinolytic System during Angiography with Ionic and with Nonionic Contrast Media

RATIONALE AND OBJECTIVES The purpose of the study was to evaluate and compare changes in some parameters of the fibrinolytic system caused by the use of ionic and nonionic contrast media during angiography in certain groups of patients. MATERIALS AND METHODS Angiographic diagnostic procedures were performed in 126 patients (male and female) clinically suspected of having kidney cancer (38 patients), arteriosclerotic occlusive disease of lower extremities (44 patients), or dissection of cerebral artery (44 patients). The control group included 12 patients with clinical symptoms of the disease in whom angiographic examination excluded the presence of cerebral artery dissection or kidney cancer. Patients were randomly assigned to receive either an ionic (diatrizoate sodium) or a nonionic (iopromide) contrast medium. Immediately before and 30 minutes after administration, venous blood samples were obtained to determine select parameters of the hemostatic system. RESULTS There were no significant differences in the fibrinolytic parameters within the control group after contrast medium administration. The nonionic contrast medium (iopromide) caused a decrease in fibrinolytic activity in the patients, unlike the controls, which was particularly pronounced among the patients undergoing renal angiography. CONCLUSION The use of contrast media in some groups of patients led to transient changes in the fibrinolytic system. These results indicate that ionic contrast media should be used during angiographic procedures in patients at increased risk for thrombotic complications.

Vertebroplasty of Cervical Vertebra

Summary Background The first vertebroplasty was performed by Harve Deramond in France in 1984 due to a hemangioma of cervical vertebral body. Procedure technique consisted of inserting a needle through the bony palate of the oral cavity. Bone cement injected under pressure not only fills the areas of bone loss. The heat released in the process of crystallization causes denaturation of pathological tissue proteins (metastasis) and disrupts blood supply (hemangiomas). The aim of this study was to evaluate the method of treatment from anterolateral access. Material/Methods In the years 2007–2012 the procedure was performed in 6 men and 9 women aged from 42 to 71 years (mean age: 56.3 years). In 10 cases the reason for vertebroplasty was the vertebral hemangioma, in another 4 – pathological vertebral fractures due to metastases, and in one case – multiple myeloma. Procedures were performed from anterolateral access, under local anesthesia, under x-ray guidance (fluoroscopy). Bone needle was inserted into the vertebral body, followed by injection of PMMA cement. Results In 100% cases pain relief was observed immediately after the procedure and beneficial therapeutic effect was obtained. No life-threatening complications and clinical symptoms were observed. Average length hospital stay amounted to 2.9 days. Conclusions Cervical spine vertebroplasty from anterolateral access seems to be a safe, effective and beneficial method of treatment. It reduces the risk of infection in comparison to the transoral method.

Palliative embolization of hemorrhages in extensive head and neck tumors.

Summary Background: A lot has changed in terms of intervention technique, indications and embolic agents since Duggan introduced embolization to management of postraumatic epistaxis in 1970. Embolization is used in treatment of spontaneous and traumatic epistaxis, palliative tumors and vascular defects, as well as vascularized tumors and juvenile nasopharyngeal angiofibromas. The possibility of simultaneous visualization of pathology and implementation of therapy is one of its greatest advantages. Material/Methods: Authors analyzed the efficacy of selective embolization treatment of haemorrhage in advanced head and neck tumors. Seventy-six patients with such tumors treated at the Department of Otolaryngology in Bialystok between1999 and 2011 were examined. Results: Embolization of bleeding vessel within the tumor was effective (hemorrhage was stopped) in 65 patients (86%). Although the method is highly efficient, it is still associated with complications. Fourteen patients suffered from headaches that lasted for several days and six from face edema. Rebleeding was rare. Unfortunately, there was one case of hemiparesis. Conclusions: We conclude that superselective endovascular treatment deserves to be considered alongside standard options for the palliative or preoperative management of acute hemorrhage from advanced head and neck cancers.

Diagnostyka ultrasonograficzna i wewnątrznaczyniowe udrożnienie tętnicy po embolizacji tętniaka mózgu powikłanej zakrzepem tętnicy szyjnej wewnętrznej

Streszczenie Powiklania zatorowo-zakrzepowe po leczeniu wewnątrznaczyniowym tetniakow mozgu stanowią zagrozenie zycia, ale wciąz leczone są najcześciej zachowawczo. Rzadko stosowaną alternatywą jest interwencja wewnątrznaczyniowa, ktorej skutecznośc ściśle zalezy od czasu jej przeprowadzenia. Niniejszy opis przypadku podkreśla uzytecznośc przezczaszkowej ultrasonografii z kolorowym obrazowaniem przeplywu krwi w szybkim rozpoznaniu roznicowym oraz skutecznośc natychmiastowej interwencji drogą wewnątrznaczyniową. U 50-letniej chorej po zabiegu ponownej embolizacji tetniaka tetnicy szyjnej wewnetrznej doszlo do wystąpienia objawow neurologicznych. Badanie dopplerowskie wykazalo zmniejszenie predkości przeplywu krwi w tetnicy środkowej mozgu, a angiografia – prawie calkowitą niedroznośc tetnicy szyjnej wewnetrznej. Podano heparyne, wykonano pilną trombektomie drogą wewnątrznaczyniową i zalozono do naczynia stent, uzyskując ustąpienie objawow. Przezczaszkowa ultrasonografia dopplerowska z kolorowym obrazowaniem przeplywu krwi pozwala szybko rozpoznac powiklania po embolizacji tetniakow mozgu związane z zaburzeniem przeplywu krwi w naczyniach wewnątrzczaszkowych. Umozliwia to szybką i skuteczną interwencje wewnątrznaczyniową w przypadku powiklan zatorowo-zakrzepowych.Thromboembolism after brain aneurysm embolization involves high morbidity/mortality and its conservative treatment is still a standard policy. We report the practical utility of transcranial colour-coded Doppler sonography (TCCS) in the early diagnosis and effectiveness of prompt intravascular intervention in the treatment of this condition. A 50-year-old woman developed acute neurological deficit after intravascular re-embolization of a brain aneurysm. Severely decreased blood flow velocity in the middle cerebral artery was revealed with TCCS and angiography confirmed nearly complete occlusion of the carotid artery. After heparin administration, intravascular thrombectomy was performed at the same session with implantation of a stent. The symptoms faded away within hours and the patient recovered fully. Prompt intravascular intervention could be a valuable and efficient alternative in the treatment of thromboembolism after embolization of cerebral aneurysm. TCCS enables early differential diagnosis of this potentially devastating sequel.

Ocena skuteczności leczenia endowaskularnego zwężeń i niedrożności tętnicy biodrowej wspólnej oraz zewnętrznej przy użyciu stentu samorozprężalnego Jaguar SM

Summary The goal of this work was to assess the effectiveness of endovascular treatment of common and external iliac artery stenosis/occlusion classified according to TASC using a self-expanding stent Jaguar SM. The study group included 95 patients (61 men and 34 women) who underwent treatment for stenosis or occlusion of lower limb arteries at the Department of Radiology of the University Hospital in Bialystok and the Diagnostic Radiology Department of the Central Clinical Hospital of the Ministry of Interior (MSWiA) in Warsaw between 2005 and 2007. All arterial lesions were of atherosclerotic etiology. The shortest stenotic fragment was 10 mm long and the longest occluded arterial fragment did not exceed 90 mm. Morphological classification of iliac artery lesions in treated patients was performed according to TASC II classification and included 10 patients with type A, 39 cases of type B, 36 with type C and 10 patients with type D lesions. Endovascular procedure failed to restore flow in five patients with TASC type D lesions, who were later referred for surgery. One patient suffered a complication – vessel perforation during predilatation, and had a stentgraft implanted. In 95% of patients stents were expanded using a balloon after implantation. Good results were achieved in practically all patients who underwent stent implantation. Patients were subjected to follow-up clinical and imaging evaluation during next 1–24 months. Success rate of the performed procedures as well as in a 30-day observation period was 100% in case of stenosis and 80% in case of vessel occlusion. A follow-up after 12 and 24 months showed patency of treated vessels in 84% and 76% of patients, respectively.