Maciej Zieliński

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.

Traumatic Inferior Gluteal Artery Aneurysm Managed with Emergency Transcatheter Thrombin Injection

Pseudoaneurysms of the inferior gluteal artery (IGA) are rare and are often caused by trauma. Treatment options vary and include surgery, ultrasound-guided percutaneous thrombin injection, and endovascular procedures such as stent-graft placement, coil embolization, and glue injection. We report a 70-year-old male who presented to the hospital after a road accident with a posttraumatic pseudoaneurysm that was treated by endovascular thrombin embolization. To the best of our knowledge, this is the first reported case of inferior gluteal artery false aneurysm treated by this method.

Utility of Measurements of Abdominal Perfusion Pressure as a Measure of Isovolemic Status and Intestinal Perfusion in Patients with Ruptured Aortic Aneurysm

UNLABELLED Ruptured abdominal aorta aneurysm of ten results in intraabdominal hypertension (IAH). When IAH exceeds 20 mm Hg, intestinal ischemia can result that is a common cause of severe postoperative complications, including death. THE AIM OF THE STUDY was to evaluate utility of measurement of abdominal perfusion pressure (APP) to estimate intestinal perfusion and isovolemic status in patients undergoing surgical treatment for ruptured abdominal aorta aneurysm. MATERIAL AND METHODS A group of 40 patients of either sex, aged 47-93 years (average age 70 ± 10) was treated at an Intensive Care Unit after surgical reconstruction of abdominal aorta due to ruptured aortic aneurysm. The study was prospective. The following were measured: parameters of intraabdominal pressure (intraabdominal pressure - IAP, abdominal perfusion pressure - APP); parameters of intestinal perfusion - tonometric (intramucosal gastric carbon dioxide partial pressure PgCO(2), intramucosal-arterial difference in carbon dioxide partial pressure - Pg-aCO(2)); hemodynamic parameters (mean arterial pressure - MAP, central venous pressure - CVP). RESULTS A statistically significant correlation was demonstrated between parameters of visceral perfusion and abdominal perfusion pressure. Pearson correlation coefficient for APP/PgCO(2) and APP/Pg-aCO(2) was negative and was -0.4664 and -0.3498, respectively. CONCLUSIONS Abdominal perfusion pressure is an useful parameter in the evaluation of intestinal perfusion in IAH patients after surgical treatment of ruptured aortic aneurysm. MAP reflects current physiological body reserves at a critical stage of the disease, informing about possibility to provide visceral perfusion and indirectly, about adequacy of fluid replacement therapy. In intraabdominal hypertension, CVP is falsely elevated, making it of low utility in the evaluation of volemic status and intestinal perfusion.

The forearm basilic vein looped transposition fistula as a tertiary option for upper limb vascular access

Introduction: The forearm basilic vein can serve as an option for haemodialysis access but may not be possible in cases where the wrist arteries are unsuitable. In this setting, the forearm basilic vein can be used in a looped transposition with a brachial artery anastomosis. Aims: The aims of this study were to assess the outcome of forearm basilic vein looped transposition as an option for vascular access. Material and methods: Data from January 2007 to December 2010 were prospectively collected and analysed. Outcome measures were operative success, complications, maturation and primary and secondary patency following 5 years of follow-up. Results: From a total of 583 patients receiving autologous vascular access for haemodialysis, 24 (4.1%) underwent a forearm basilic vein looped transposition. The median age was 60 years (range, 27–80 years), with a slight male predominance (13 male:11 female). Mean follow-up was 34 months (1–60 months). Two patients died and other three were transplanted with subsequent fistula closure. All procedures were successful (100%); however, maturation failure occurred in one case (4.2%). No serious perioperative complications were observed. In two cases, we observed late false aneurysm formation requiring intervention. Primary patency at 1, 2, 3 and 5 years was the following: 77%, 62%, 21% and 10%, whereas secondary patency was the following: 81%, 71%, 61% and 32%, respectively. Conclusion: Autologous forearm basilic vein looped transposition is an effective surgical procedure for the creation of access for haemodialysis. This may be a useful option in patients with compromised peripheral arterial diameter or flow and should be considered in patients with a suitable forearm basilic vein.

Single Fascicle Graft Repair Model

Extensive trauma can lead to the peripheral nerve transection injury. Further reconstruction can be done with the use of the best method: end-to-end coaptation, if this will not cause tension of the approximated trunks. Larger nerve gaps resulted from tissue loss or degeneration, require additional material for the reconstruction. Ideal material acceptable for nerve engraftment is autologous nerve, however the sources of it are limited. Despite well-established method of full-thickness cable-nerve grafting there is still need for research to improve results of functional nerve restoration following grafting, as well as to increase the amount of neural tissue material suitable for reconstruction.

Changes in flow-mediated dilatation in patients with femoropopliteal occlusion receiving conservative and invasive treatment.

BACKGROUND Although the beneficial effect of revascularisation on reduction of local clinical ischaemic symptoms has been well established, its effect on systemic vascular endothelial function has not been fully explained yet. AIM To determine changes in endothelium-dependent flow-mediated dilatation in patients with unilateral femoropopliteal occlusion receiving medical and surgical treatment. METHODS Seventy-nine patients with symptomatic atherosclerotic ischaemia of lower extremities, treated with endovascular procedures, with femoropopliteal graft, or receiving conservative treatment (21-day controlled treadmill training) were enrolled in the study. Ankle brachial pressure index (ABPI), skin blood flow on the feet, and flow-mediated dilatation (FMD) of brachial arteries were measured in each patient at baseline and after 90 days of follow-up. RESULTS The ABPI, vasomotion in the myogenic frequency band, and FMD increased significantly in surgical patients. In patients after femoropopliteal bypass a significant increase of vasomotion in the endothelial frequency band was also observed. In patients receiving conservative treatment (treadmill training), vasomotion in the myogenic frequency band increased whereas the FMD remained unchanged. CONCLUSIONS It seems that surgical treatment may contribute to reducing the risk of cardiovascular complications in patients with advanced peripheral artery disease, as a result of improving the systemic vascular endothelial function. Limiting treatment to just treadmill training increases pain-free walking distance but does not improve systemic vascular endothelial function.