Tomasz Brzeziński

Rare presentation of a benign smooth muscle tumour of venous wall

Deep veins thrombosis is commonly encountered in clinical practice. The reasons and risk factors are well known. Unusual conditions leading to complete obstruction of larger veins are rarely anticipated. A 34-years-old woman was treated in our hospital because of segmental thrombosis of her right common femoral vein. Color duplex Doppler revealed a solitary thrombus 5 centimeters in lengths narrowing it by 80–90%. During emergency operation a small tumour in the orifice of greater saphenous vein was found with adhering thrombus. Segmental thrombosis of large vein can be connected with an occult underlying pathology. Color duplex Doppler alone does not allow complete evaluation of such problems.

Hybrid treatment of the infected carotid-subclavian graft complicated by the septic haemorrhage

The paper presents combined method of treatment to 90-year-old female, admitted with the hemorrhage from the chronic purulent fistula in her left neck in the incision post left carotid to subclavian artery bypass in 1971. In the vascular center where she was operate on (outside of Poland) it was suggested, that she should undergo graft excision because of the possibility of graft blow and subsequent exsanguinations as the most severe complication but finally she gave up. In the new circumstances, in the face of no-indirect threat to life, there was urgent need for surgical treatment. Being aware of multiple risk factors from age, general condition and changes in local, developed the concept of radical, yet more saving, to-step procedure. At first by percutaneous means covered stents were implanted into the places of vascular anastomoses, followed by angioplasty of the narrowed origin of left subclavian artery. In the second phase, after a few days, the infected prosthesis was excised and the cavities in the arterial walls of the two arteries were provided. Before, during and after surgery targeted antibiotics were used with classic antiplatelet therapy regimen. Post-operative course was uneventful. The wound healed properly. Which currently consisting of 93 years, as for her age, she in excellent condition overall. There were no signs of infection recurrence observed.

Life Threatening Complication during Treatment of Erysipelas due to Undiagnosed Ischemia of the Calf.

Erysipelas is a superficial skin infection due to streptococci strains, which usually responds well to conservative treatment. Coexisting undiagnosed ischemia of the extremity may lead to severe complications. 57-year-old man developed large, circumflex ulceration of his right calf within two weeks before the admission after three-month treatment of erysipelas. Computer angiography showed chronic occlusion of the superficial femoral artery and the above knee popliteal artery. Rapid debridement of the wound took control over the infection. Patient required complex vascular procedure which allowed to prepare the ulcer for meshed skin grafts. Patient was discharged home on 64th hospital day with completely healed ulcer.