Piotr Ciostek

Complications and Failure of Endovenous Laser Ablation and Radiofrequency Ablation Procedures in Patients With Lower Extremity Varicose Veins in a 5-Year Follow-Up

Introduction: Thermal ablation techniques have gradually replaced Babcock procedure in varicose vein treatment. Aim: A comparative quantitative–qualitative analysis of complications and failure of endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) in a 5-year follow-up. Materials and Methods: One hundred ten adult participants with varicose veins clinical grade C2 to C6, treated for isolated great saphenous vein (GSV) or small saphenous vein (SSV) insufficiency in a single lower extremity in 2009 to 2010, were enrolled and subdivided into EVLA (n = 56) and RFA (n = 54) groups. Both groups were compared for demography, disease stage, affected veins, perioperative, and postoperative complications as well as treatment efficacy. Results: The perioperative and postoperative complications were statistically insignificant. Treatment efficacy, expressed as the number of participants with recurrent varicosity and recanalization, was comparable in both groups. The clinically significant recanalization rate was 3.6% and 5.6% in EVLA and RFA groups, respectively. Conclusion: Endovenous laser ablation and RFA for the management of lower extremity varicose vein offer comparable efficacy and safety in a 5-year follow-up.

Assessment of the efficacy and safety of steam vein sclerosis as compared to classic surgery in lower extremity varicose vein management

Introduction For the last 10 years, endovenous thermal ablation methods have gradually predominated over the classic Babcock procedure in varicose vein treatment. Steam vein sclerosis is the newest thermal ablation technique. Aim To assess the efficacy and safety of steam vein sclerosis as compared to the Babcock procedure in lower extremity varicose vein treatment. Material and methods One hundred and two adult subjects with varicose veins of clinical grade C2 to C6 according to the CEAP classification, treated with varicose vein surgery between 2010 and 2012, were enrolled in the study. These were subdivided into two groups: the study group of 52 patients treated with endovenous steam vein sclerosis and the control group of 50 patients treated with the Babcock procedure. A single lower extremity with isolated great or small saphenous vein insufficiency was operated on in each subject. The groups were compared for demography, disease severity, involved veins, potential perioperative and postoperative complications, as well as treatment efficacy based on the VCSS score reduction. Results There were no statistically significant differences between the groups in terms of demography, disease severity, involved veins, or perioperative and postoperative complications. The treatment efficacy of both methods, assessed based on the recurrence rate and the quantitative VCSS score reduction, was similar. Clinically significant recanalisation was observed in 1 (1.9%) patient in the study group. Conclusions The efficacy and safety analysis shows that steam vein sclerosis is a safe, simple method which can be recommended as effective varicose vein treatment.

Implantation of a new enteral stent in obstructive colorectal cancer using interventional radiology in patients over 70 years of age.

Introduction Colorectal cancer is the second leading cause of death due to cancer in Poland. The traditional approach to treat patients included a surgical procedure. Irrespective of the surgical method being used, surgical treatment of malignant colorectal obstruction is associated with prolonged hospitalisation, and the postoperative mortality rate is approximately 5–11%. Due to these problems, more interest has been shown in less invasive methods. Prosthesis implantation is a leading endoscopic method used currently in palliative or preoperative treatment. Aim To compare the results of implantation of traditional stents with the results of implantation of an own stent using minimally invasive methods. Material and methods Left-sided colon obstruction due to cancer was an indication for transplantation. All patients were aged over 70 years and had serious concomitant diseases. The control group included 50 patients with colorectal cancer who received traditional stents in the period 2009–2011. Our stent covers only the internal length of a tumour. It is not equipped with anti-migration flares. To minimize the risk of migration it has a system of hooks that are responsible for permanent anchorage of the stent within the tumour mass. Results Implantation technical and clinical success defined as effective decompression of intestinal obstruction was 100% in both groups. There were 2 cases of stent migration in the control group. Conclusions It is possible to achieve a secure surgical anastomosis after intestinal decompression. Stent implantation is fast and safe thanks to the positioning system that was used. The use of labelled hooks is a secure anti-migration solution.

Role of plasma growth factor in the healing of chronic ulcers of the lower legs and foot due to ischaemia in diabetic patients

Introduction It has been demonstrated that plasma growth factor (PGF) responsible for proliferation of smooth muscle cells and fibroblasts significantly shortens treatment duration. Aim To determine the role of human growth factor in the healing of ulcers due to ischaemic diabetic foot syndrome (DFS) following previous angioplasty of the blood vessels of the lower leg and foot. Material and methods The study group included 50 patients with ischaemic diabetic foot complicated by lower leg ulcers in which angioplasty of the stenotic arteries in the distal lower leg and foot was performed. It has been assumed that the area of the ulcer cannot exceed 5 cm2. Following surgical debridement, each patient received platelet-rich plasma in the form of dressings applied on an ulcer, followed by hydrocolloid dressings. Each dressing was replaced after 10 days, and this procedure was repeated after 20 and 30 days of treatment. The control group included 50 patients with ischaemic diabetic foot complicated by an ulcer up to 5 cm2. Angioplasty of the lower leg arteries was also performed in this group. However, after surgical debridement, wounds were covered with hydrocolloid dressings. Results After 3 months of combined treatment, all wounds in the study group healed whereas in the control group, only wounds of the smallest size healed. Conclusions Combined treatment of ulcers due to ischaemic DFS with endovascular procedures to re-establish blood flow to the vessels and dressings with autologous platelet-rich plasma significantly shortens the healing time.

Multiple orifices are better than single in the endoscopic treatment of pancreatic pseudocysts

BACKGROUND/AIMS The aim of this study was to compare the surgical drainage of large, symptomatic pancreatic cysts (>5 cm) with single- and multi-channel endoscopic drainage. MATERIALS AND METHODS In the period 2005-2010, we treated 112 patients with post-inflammatory pancreatic cysts. Thirty-six patients underwent surgical internal drainage. The remaining group of patients was treated endoscopically. In 28 of them, drainage was performed by anastomosing the cyst to the gastrointestinal tract using a single pig tail drain and then widening the channel to a diameter of 15 mm. Forty-eight patients underwent multi-channel cystic drainage. It consisted of connecting the cyst to the stomach and/or duodenum using at least 3 drains. Each connection was widened to a minimum diameter of 15 mm to ensure free drainage of the morphotic elements of the cyst. Each procedure was preceded by abdominal computed tomography to determine the exact location of the cyst in relation to the gastrointestinal tract and a Doppler ultrasound scan to determine the location of the blood vessels modeling on its surface. RESULTS In 48 patients with multi-channel drainage, there was no obstruction of the anastomosis, and cysts closed within 4 months. The drains were removed after about 3 months. The created channels were patent for about 3-4 weeks, which was enough to completely close the cyst. CONCLUSION Multi-channel endoscopic anastomosis of pancreatic cyst to the gastrointestinal tract is a very effective method for drainage of large post-inflammatory pancreatic cysts, comparable in terms of effectiveness with the surgical method but less invasive.

Susceptibility of Vascular Implants to Colonization in vitro by Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus faecalis and Pseudomonas aeruginosa

We compared association of Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa and Enterococcus faecalis with nine vascular implants after co-culture. Vascular implants were composed of various materials such as warp knitted polyester (with or without gelatin and silver ions), expanded polytetrafluoroethylene and biological materials - surface treated porcine pericardial patch and Omniflow II. The lowest overall number of associated bacteria was detected for polytetrafluoroethylene implants and porcine pericardial patch. The highest overall number of associated bacteria was detected for Omniflow II implant. The major source of variation, i.e. primary factor influencing colonization, is the implant type (56.22%), bacterial species is responsible for only 1.81%, and interaction of those two factors - 13.09% of variation.

The Usefulness of Biosynthetic Vascular Graft Omniflow II and Autologous Veins for the Treatment of Massive Infection of Dacron Vascular Graft with Enterococcus faecalis HLAR

Infections of vascular grafts are the most severe complications in vascular surgery. We present the case of a 73-year-old male with infection of a dacron prosthesis with a strain of Enterococcus faecalis. The patient was treated with replacement of a full prosthesis with a combined graft constructed from Biosynthetic Vascular graft Omniflow and autologous veins. This graft is recommended for implantation in patients with a higher risk of infection. Our case is one of the first reported usage of this kind of graft in the aortic region and in a 2 years observation period no recurrence of infection was observed.

Using our own developed stent in the palliative treatment of obstruction in the left half of the colon due to ovarian cancer

OBJECTIVES An assessment of implantation efficacy and safety of self-developed self-expanding stent in patients with an ovarian cancer induced by intestinal obstruction. MATERIAL AND METHODS The study of the stenting efficacy and safety was realized prospectively. The group consisted of 13 patients with left half colon obstruction due to an inoperable metastatic ovarian carcinoma. All the patients had a histopathologically diagnosed ovarian carcinoma and were treated in the past both surgically and systemically. Stenting was preceded by a Computed Tomography (CT) scan confirming and locating the obstruction. Patients with a multilevel intestinal obstruction were disqualified. RESULTS Nine stents were implanted in the rectosigmoid; 4 stents were implanted in an externally compressed rectum. One migration of implanted stent was observed. In one case 2 stents were implanted due to an insufficient coverage of the stricture. The decompression of the obstruction of the gastrointestinal tract was achieved in 11 patients (85%). CONCLUSIONS 1) The implantation of our own developed, self-expanding stent is effective and safe. 2) The implantation of the stent in patients with an inoperable ovarian cancer causing an obstruction of the gastrointestinal tract is an effective procedure limiting postoperative complications and improving life comfort by avoiding stoma.

The Use of Interventional Radiology Techniques in the Treatment of Pancreatic Fistula.

One of the complications of pancreatic disease is the formation of pancreatic fistulae. The presence of fistula leads to body wasting and cachexia. The standard treatment is intubation of the Wirsung duct and in cases where there are no improvements the next proposed form of treatment is surgery. The aim of the study was to evaluate the efficacy of pancreatic fistula closure using interventional radiology techniques. In 2009 to 2014, 46 patients diagnosed with pancreatic fistula were treated with interventional radiology techniques. Treatment consisted of vascular coil implanted at the entry of the fistula and then sealed with tissue glue adhesive during endoscopic procedure. Technical success of vascular coil implantation and the use of tissue glue adhesive were reported in all patients. Pancreatic fistula recurred in 7 patients (15.2%). The latter group of patients underwent statistical analysis to determine what the risk factors in recurring pancreatic fistulas were. The results indicate a significant relationship between etiology of the fistula and treatment effect. In conclusion: (1) the use of interventional radiology methods in the closure of pancreatic fistula is an effective and safe procedure; and (2) the recurrence of fistula is dependent on the etiology and often occurs after surgery or trauma.

Results of Endoscopic and Surgical Fistula Treatment in Esophagointestinal Anastomosis After Gastrectomy.

Introduction: Intestinal fistulas occur in 4% to 8% of cases of upper gastrointestinal tract surgery. Until now, this type of surgery has been the standard for treating fistulas in esophagointestinal anastomosis. The use of stents and hemoclips is still controversial, but an increasing number of publications have been presenting good results with this type of treatment. Objective: The objective of the study was to investigate the outcome of endoscopic and surgical treatment of fistulas in esophagointestinal anastomosis after gastrectomy. Materials and Methods: Fistulas in esophagointestinal anastomoses were observed in 23 patients (4.8%) over an 18-year period. The indications for endoscopic treatment were small (<50 mL/d) and large (>50 mL/d) fistulas in patients with no symptoms of peritonitis or abscess, who were treated with implantation of a covered stent. Surgical intervention was carried out for large fistulas that resulted in peritonitis and complicated gangrene of margins and/or abscesses. Results: Four subjects were treated endoscopically with hemoclips, resulting in 50% technical and clinical success. We implanted stents in 12 patients. Technical success was achieved in all patients; yet, permanent closure of the fistula was reported in 8 subjects (66%). Thirty-three percent of patients were operated upon for fistulas. We reported 4 deaths in this group. Conclusions: The use of hemoclips in the treatment of small fistulas and of self-expandable covered stents in the treatment of medium and large fistulas is an effective method that shortens the hospitalization period and accelerates the introduction of oral nutrition while reducing the number of fatal complications.