Nerijus Misonis

Management of Bleeding Pseudoaneurysms in Complicated Pancreatitis

Background: Haemorrhage from pseudoaneurysms in patients with pancreatic diseases is a rare but life-threatening condition requiring timely and accurate diagnosis as well as adequate treatment. Patients and Methods: This article reviews retrospectively the data on 38 patients treated in our clinic for bleeding peri/intrapancreatic pseudoaneurysms in the period from 1995 to 2008. Results: Transcatheter angiography was performed for 23 and spiral computed tomography (CT) angiography for 22 patients resulting in accurate diagnosis of pseudoaneurysm in 78.3 and 90.9%, respectively. Transcatheter embolization was successfully performed in 11 patients (61.1%). 26 patients (68.4%) underwent pancreas resection, and 6 (15.8%) underwent arterial ligation with pseudocyst drainage. Recurrent bleeding occurred in 2 cases (7.7%) following pancreas resection, and in 2 cases (33.3%) after arterial ligation and pseudocyst drainage. Conclusions: Spiral CT angiography is considered to be the most accurate diagnostic method in determining peri/intrapancreatic pseudoaneurysms. Transcatheter angiography does not provide information in all cases, and pseudoaneurysm embolization is not always possible. It is recommended as temporary means of arresting haemorrhage before pancreas resection and as final means of management in cases where the pancreas is not irreversibly changed due to inflammation.

EFFECT OF RENAL SYMPATHETIC DENERVATION ON CARDIAC SYMPATHETIC NERVE ACTIVITY ASSESSED WITH IODINE 123 METAIODOBENZYLGUANIDINE SCINTIGRAPHY

The objective of the present study was to investigate the effect of renal sympathetic denervation (RSD) in patients with resistant hypertension and RSD effect on cardiac sympathetic nerve activity. It is known that abnormally activated sympathetic and altered parasympathetic tone is associated with

Early ischemic brain lesions after carotid angioplasty and stenting on diffusion-weighted magnetic resonance imaging study

Summary Aim: The aim of the paper is to evaluate the appearance of the new early ischemic lesions in the brain after carotid angioplasty and stenting on diffusion-weighted magnetic resonance imaging, and their relationship with clinical and procedural factors. Methods: Carotid artery stenting (CAS) procedures performed by a single interventional cardiologist in years November 2006 to January 2013 were evaluated retrospectively. In total, 227 procedures for 211 patients (mean age 69.8 ± 8.5 years) were performed, from which 171 (75.3%) for male and 56 (24.7%) for female patients. Seventy-two (34.1%) patients had symptomatic stenosis of carotid artery. The following protection systems to avoid the distal microembolism were used during the CAS: (1) Filters: FilterWire EZ (Boston Scientific Corporation); Emboshield NAV (Abbott Vascular); SpideRX (EV3); Defender (Medtronic); FiberNet Filter (Invatec-Medtronic); (2) Occlusion MoMa Baloon System (Invatec-Medtronic). Acute ischemic damages of the brain before and after CAS procedure were diagnosed using magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) sequences. Sixty-five (30.8%) patients underwent MRI test. Exact and asymptomatic χ2 criteria were applied for testing the hypothesis of inter-dependency of the symptoms. Results: Forty-six (70.8%) patients had new ischemic foci in the brain on MRI DWI after CAS procedures. Among those patients, focal damage of the brain was diagnosed in 36 (78.3%) cases; linear damage of the brain - in 9 (19.6%) patients; ipsilateral damage of the brain - in 37 (80.4%) patients; bilateral damage of the brain - in 16 (34.8%) patients, 38 (82.6%) patients were diagnosed with forebrain damage; 4 (8.7%) patients were diagnosed with damage of brainstem; 5 (10.9%) patients were diagnosed with cerebellum damage. Clinical symptoms of brain damage were diagnosed only for 2 (4.3%) patients. Focal damage of the brain was significantly less frequent only for aortic arch type 1, if compared with aortic arch type 2 and 3: 64.3%, 93.3% and 100.0%, respectively (p < 0.05). Focal damage of the brain occurred least in patients (28.6%) with Emboshield NAV protection type, if compared to other types of protection (71.4-100.0%). Linear >10mmbrain damage was less frequent when using FilterWire EZ, Emboshield NAV and SpideRX protection type. Ipsilateral ischemic brain damage also occurred less frequent when using Emboshield NAV protection type; bilateral damage occurred less frequent when using FilterWire EZ, Emboshield NAV and SpideRX protection type. Ischemic forebrain damage was also diagnosed less often in patients for whom protection type FilterWire EZ and Emboshield NAV was applied. Conclusions: Most frequent findings by MRI after CAS procedures were focal, ipsilateral and forebrain damage (about 80%), but less than 5% patients had clinical symptoms. In the case of aorta arch type 1 focal ischemic damage of the brain was significantly less frequent, then in aortic arch type 2 and 3. The localization and extent of brain damage was associated with the type of protection systems that have been used.

Classic Dissection of Thoracic Aorta Complicated by Ascending Aortic Intramural Hematoma: Promt Diagnosis and Successful Endovascular Repair

We reported a case of 68-year-old man, with a previous history of hypertension. Patient was admitted to our institution for evaluation of a severe, constant, tearing anterior chest pain radiated to the neck with suspicion of acute aortic dissection. A multidetector computed tomography scan of thorax and abdomen demonstrated a dissection starting from the middle part of aortic arch and extending downward to the descending aorta till the middle part of the thoracic aorta. The dissection was classified as Stanford A, De Bakey I. Surgical treatment of patient was started with bypass graft from the right common carotid artery to the left common carotid with subsequent revascularization of left subclavian artery. Lower parts of above-mentioned arteries were ligated. At the second stage an emergent prosthetic stent-graft was placed distally from the truncus brachiocephalicus up to the proximal part of the descending aorta. We reported a case report to present diagnostic and possible interventional treatment for patient with acute aortic type A dissection.