Witold Woźniak

The effectiveness of anticellulite treatment using tripolar radiofrequency monitored by classic and high-frequency ultrasound

Background  Cellulite affects nearly 85% of the female population. Given the size of the phenomenon, we are continuously looking for effective ways to reduce cellulite. Reliable monitoring of anticellulite treatment remains a problem.

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.

The removal of post-sclerotherapy pigmentation following sclerotherapy alone or in combination with crossectomy.

BACKGROUND Sclerotherapy is a widely used method for the obliteration of blood vessels. Hyperpigmentation is a frequent complication that results from haemosiderin (FeO) accumulation. Hyperpigmentation and changes in the skin can be observed with ultrasound. OBJECTIVE The aim of this study was to evaluate the efficacy of hyperpigmentation elimination using an intense pulse light generator (IPL) equipped with radio waves (RF) under ultrasonography (US) control. METHODS Twenty-one women with permanent hyperpigmentation (after sclerotherapy or crossectomy combined with sclerotherapy) underwent a hyperpigmentation eliminating therapy with the use of IPL + RF and were monitored by using US. The thicknesses of the dermis and the subcutaneous tissue as well as the echogenicities of each layer were assessed. RESULTS As a result of the therapy, a complete regression of hyperpigmentation was achieved in 90.48% of the women, and in 9.52% of the women, the therapy led to a reduction in hyperpigmentation but did not cause its complete disappearance. An increase in dermal echogenicity and a decrease in subcutaneous tissue echogenicity were observed, but there was no change in their thicknesses. After the therapy, the ultrasound images of areas of previous hyperpigmentation corresponded with images that were characteristic of healthy skin. CONCLUSION IPL + RF therapy is effective for eliminating permanent skin hyperpigmentation after sclerotherapy. US is also useful in this therapeutic method.

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.

Electron microscopy study of a vascular prosthesis destructed in vivo reveals fractures in Dacron fibers

The genuine destruction of a synthetic prosthesis wall, as a late complication of vascular surgery, is extremely rare. We report a case of a 64-year-old male who had his 12-year-old femoropopliteal synthetic graft explanted due to two large pseudoaneurysms in the middle section of the graft. Microscopic evaluation demonstrated the areas of focal thinning along the entire prosthesis wall, with “foreign body” type reaction in the adjacent connective tissue. Transmission electron microscopy showed longitudinal fractures of Dacron fibers interposed with cellular structures, suggesting that destruction must have taken place significantly earlier. The problems of limited graft durability and graft surveillance are discussed.

Lipoma removal using a high-frequency ultrasound-guided injection of a Class III CE-marked device-Empirical findings

Lipomas are very common benign neoplasms, which constitute 99% of all adipose‐derived tumors. Main treatment option includes surgical excision, which is unacceptable for a number of patients seeking ways to improve esthetic appearance of their skin. Therefore, alternative treatment options are being sought.

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.

The Effect of Local Platelet Rich Plasma Therapy on the Composition of Bacterial Flora in Chronic Venous Leg Ulcer

Microbial colonisation of chronic venous ulcers and synergism between bacterial species slow down the healing process. The study aimed at performing qualitative analysis of microbial flora in venous leg ulcers treated with platelet rich plasma (PRP). Twenty two women and twelve men aged 47-90 years were treated with PRP at our department between 2012 and 2015. Ulcer cultures collected before and after PRP therapy yielded 83 and 110 microbial isolates, respectively, of Gram positive, Gram negative bacteria and candida. Pseudomonas aueruginosa and Staphylococcus aureus were the most common pre- and post-treatment isolates. PRP therapy and increased the variety of microbial flora.

Thrombin obliteration of subclavian artery aneurysm with intravascular balloon protection

A rare case of a 56-year-old man with posttraumatic false aneurysm of the right subclavian artery is presented. He was admitted to hospital due to pain in the shoulder. The diagnosis was made upon ultrasonography and computed tomography (CT) results. With ultrasound guidance, the aneurysm was punctured and injected with bovine thrombin (Biotrombina 400u, Biomed). During the injection, the aneurysm neck was occluded by an endovascular balloon placed in the subclavian artery. Complete aneurysm embolisation was confirmed by ultrasound and CT studies. The postoperative course was complicated by Horners syndrome which resolved completely within 3 weeks. The procedure technique is described in detail.