Percutaneous transluminal angioplasty and stenting of carotid arteries: Early results

INTRODUCTION Treatment of carotid stenosis could be surgical: eversion endarterectomy, conventional endarterectomy and patch-plasty, resection with graft interposition and bypass procedure or, in the past few years, carotid artery angioplasty (PTA) with stent implantation. OBJECTIVE The aim of this study is to present early results of carotid artery angioplasty and stenting, as well as to identify indications for this procedure. METHOD Twenty-three patients with stenosis of internal carotid artery were included in the prospective study which was performed in the period from July 2006 to July 2007. For PTA and stenting of the carotid artery we used Balloon dilatation catheter Ultra-softTM SV and Carotid WallstentTM MonorailTM. During the procedure, brain protection by embolic protection system Filter Wire EZ was essentially performed. Descriptive statistical methods were performed to present and describe the patient characteristics, risk factors and results. RESULTS 23 patients were examined. In four (17.39%) cases there was asymptomatic, while in 19 (82.61%) there was symptomatic homodynamic significant stenosis of the internal carotid artery. Four of these 19 patients (17.39%) had late restenosis following carotid endarterectomy, four (17.39%) important respiratory failure, and 11 (47.83%) important heart disease. Patients were followed up for the first 30 postopertive days. In that period, there were no mortality and no needs for surgical conversions. In one case (4.35%), residual stenosis of 30% remained. Two patients (8.70%) had TIA and one (4.35%) had CVI. CONCLUSION Main indications for PTA and stenting of carotid arteries are: surgically inaccessible lesions (at or above C2; or subclavial); radiation-induced carotid stenosis; prior ispilateral radical neck dissection; prior carotid endarterectomy (restenosis), severe cardiac and pulmonary conditions. Limitations and contraindications to carotid angioplasty and stentning include: significant peripheral occlusive diseases; unfavorable aortic arch anatomy; severe tortuosity of the common and internal carotid artery; severely calcified stenosis, lesions containing fresh thrombus; stenosis longer than 2 cm; critical (>99%) stenosis; associated carotid artery aneurysm; contrast-related issues and severe aortic valve stenosis

Компаративни прглед здравствених ефеката комерцијално узгајане гљиве Agaricus bisporus и самоникле врсте гливе Ganoderma resinaceum

The health promoting effects of hot water extracts obtained from fruiting bodies of the commercially cultivated mushroom Agaricus bisporus (AbHW) and the wild-growing mushroom Ganoderma resinaceum (GrHW) originating from northern Serbia are presented in this research. These abilities were compared in vitro by the prevention of lipid peroxidation (LPx) in a linoleic acid model system, inhibition of the angiotension converting I enzyme (ACE) that could help in the maintenance of a normal blood pressure level and strengthening the ability of the central cholinergic neuron by inhibiting the activity of acetylcholinesterase (AChE). Cytotoxic activities were observed towards selected human malignant (HeLa and K562) cell lines and normal- -human peripheral blood mononuclear cells (PBMC). GrHW contains higher phenolics (5.9 g (100 g)-1), inhibition of LPx (EC50 = 1.07 mg mL-1), ACE (IC50 = 0.54 mg mL-1) and AChE (IC50 = 0.37 mg mL-1), and exhibited a significant selectivity in the antitumour action against HeLa (IC50 = 0.14 mg mL-1) and K562 (IC50 = 0.11 mg mL-1) cells. AbHW contained higher total protein (6.4 g (100 g)-1), carbohydrate (75.4 g (100 g)-1) and β-glucan (55.1 g (100 g)-1) contents and induced significant proliferation of healthy PBMC from 152–116 % in the concentration range of 0.047–0.187 mg mL-1. The difference in the biological activity of the extracts provides guidance on their use as functional food.У овоме раду поређен је здраствени ефекaт врелих водених екстраката добијених из плодоносних тела комерцијално узгајане јестиве гљиве Agaricus bisporus (AbHW) и самоникле врсте гљиве Ganoderma resinaceum (GrHW) из региона северне Србије. Здраствени ефекат је поређен in vitro превенцијом липидне пероксидације (LPx) у модел систему линолеинске киселине, инхибицијом ангиотензин конвертујућег ензима (ACE) који има улогу у одржавању нормалног нивоа крвног притиска и јачањем способности централних холинергичких неурона инхибицијом активности ацетилхолинестеразе (AChE). Цитотоксична активност је праћена на хуманим ћелијама тумора грлића материц (HeLa) и ћелијама хроничне мијелоидне леукемије (K562), као и на здравим мононуклеарним ћелијама периферног крвотока (PBMC). GrHW је показао већи садржај фенолних компоненти (5,9 g (100 g)-1), већу способност инхибиције LPx (EC50 = 1,07 mg mL-1), ACE (IC50 = 0,54 mg mL-1) и AChE (IC50 = 0,37 mg mL-1); показао је већу селективност у антитуморском дејству према HeLa (IC50 = 0,14 mg mL-1) и K562 (IC50 = 0,11 mg mL-1) ћелијама. AbHW је показао већи укупни садржај протеина (6,4 g (100 g)-1), угљених хидрата (75,4 g (100 g)-1) и β-глукана (55,1 g (100 g)-1) и значајно je стимулисао пролиферацију PBMC ћелија од 152–116 % у распону концентрација од 0,046–0,187 mg mL-1. Разлика у биолошкој активности екстраката даје смернице у њиховој примени као функционалнe хранe

Factors influencing early results of femoro-femoral crossover bypass

Introduction. Femoro-femoral crossover bypass is an extraanatomic reconstruction used for revascularization of lower limb with contralatateral femoral artery as an inflow vessel, and the graft placed in the suprapubic region. We perform this procedure when anatomic reconstruction is not possible or is contraindicated. Objective. To analyze the influence of different risk factors on early patency of femoro-femoral crossover bypass. Methods. This retrospective study analyzed the results of 88 femoro-femoral bypass grafting during an 11-year period. There were 66 (75%) males and 22 (25%) females of average age 64.93 years (42-79 years). In 76 patients the operations were performed due to critical limb ischemia. Revascularization was urgent in 12 patients, while 76 patients were elective. Dacron prosthesis was used in 81 patients, while PTFE was used in 7 patients. Statistical analysis was made by logistic regression. Results. During hospitalisation the graft remained patent in 82 patients, and graft thrombosis occurred in 6 patients. Limb salvage rate was 90.91%. Early morbidity rate (within the first post-operative month) was 13.64%, while early mortality rate was 4.55%. Using logistic regression we established that early graft patency was statistically more significant in males (p<0.05). Age (p=0.07) and hypertension (p=0.08) appeared to be predicting influence of the graft patency on the border of the accepted statistical significance level. Conclusion. Femoro-femoral crossover bypass is a good alternative for revascularization in high risk patients for standard anatomic reconstructions due to comorbid conditions or local problems

Portal hypertension caused by postoperative superior mesenteric arteriovenous fistula

Introduction. Arteriovenous fistula of the superior mesenteric blood vessels is a rare complicaton in abdominal surgery. Case report. We presented a 49-year-old man with cramplike abdominal pain, abdominal distension and weight loss symptoms, with a history of previous small bowel resection and right colectomy, due to Crohn disease, 16 years ago. Clinical examination revealed a paraumbilical pulsation with systolic murmur and thrill. Ultrasonography and computed tomography revealed cystic dilatation of the superior mesenteric vein, hepatomegaly and ascites. Upper endoscopy revealed grade I esophageal varices with portal hypertensive gastropathy. The diagnosis of arteriovenous fistula between superior mesenteric artery and vein was confirmed by angiogram of the superior mesenteric vessels and resection of the fistula was performed. Control examination after nine months showed no signs of portal hypertension. Conclusion. Early diagnosis and treatment of mesenteric blood vessel arteriovenous fistula prevents portal hypertension development and its complications

Obturator or "lateral" bypass in the management of infected vascular prostheses at the groin

The infection of the previously implanted vascular graft at the groin, is associated with great mortality and morbidity rate [1]. The authors present a retrospective study in which they analyzed management of infected vascular prostheses at the groin, using obturator bypass in 26 cases, and "lateral" bypass in 15 cases. The indications for obturator bypass reconstructions included: 20 infections of aorto-femoral grafts, two infected pse udoaneurysms in the groin after RTA of the superficial femoral artery, and 4 infections of iliac-femoral grafts. The indications for lateral bypass reconstructions were: infections after aorto-femoral reconstructions - 8 cases; infection after femora-popliteal reconstructions - 4 cases; infection after iliac-femoral reconstruction - 2 patients, and one infected pseudoaneurysm in the groin after RTA of the superficial femoral artery. In 3 subjects obturator bypass was performed using extraperitoneal approach while in other 23 patients transperitoneal approach was done by donor's artery. The obturator bypass was performed using a PTFE graft in 3 cases and Dacron graft in 23. The donor's artery used for obturator bypass was a noninfected proximal part of aortofemoral graft in 20 cases, and iliac artery in 6 patients. The superfical femoral artery was recipient artery for obturator bypass in 3 cases, deep femoral artery in one case, and above the knee popliteal artery in 22 cases (Figure 1). In two patients transperitoenal approach to donors artery for "lateral" bypass has been used, and in 13 cases extraperitoneal. The proximal noninfected part of aorto femoral graft was used as a donor's artery for lateral bypass in 8 patients, while common iliac artery in 7 subjects. In 5 cases recon structions were performed using PTFE grafts, in 3 using autologous saphenous vein grafts, and in 7 using Dacron grafts. The recipient artery for "lateral" bypass was deep femoral in 8 cases, superficial femoral in three patients and above the knee popliteal artery in 4 subjects. After both types of reconstruction, extirpation of infected grafts from the groin was performed (Figure 2). The control examination was performed using physical and Doppler ultrasonographic examinations, one, 3, 6, 12 months, and then every year after the operation. In cases with suspected graft infection or thrombosis, control angography was also performed. One intraoperative perforation of the urinary bladder has been done accidentally during obturator bypass reconstruction. The mean follow-up period for patients with obturator bypasses was 2.3 years, while 2.1 years for patients with "lateral" bypasses. Comparing with "lateral" bypass, obturator bypass showed statistically significant lower (p < 0.05) 30- day mortality and early graft infection rate, as well as statistically significant better early and total limb salvage rate. There were no statistically significant differences (p > 0.05) between obturator and "lateral" bypass procedures having in mind, late graft infection rate, as well as early and late graft patency (Figures 3 and 4). In cases with infected vascular prostheses in the groin, the authors recommend obturator bypass comparing with "lateral" bypass

Surgical treatment of abdominal tumors closely related to major blood vessels

INTRODUCTION Radical operative treatment of abdominal tumors closely related to major blood vessels often demands complex vascular procedures. OBJECTIVE The aim of this paper was to present elementary principles and results of the complex procedures, based on 46 patients operated on at the Institute for Cardiovascular Diseases, Clinical Centre of Serbia, Belgrade, from January 1999 to July 2006. METHOD Primary localization of the tumor was the kidney in 14 patients, the suprarenal gland in 2, the retroperitoneum in 23 and the testis in 7 patients. Histologically, the most frequent were the following: renal carcinoma in 14 patients, teratoma in 7, liposarcoma in 5, fibrosarcoma and lymphoma in 3 patients. The tumor compressed abdominal aorta occurred in 3 cases, vena cava inferior in 5 and both the abdominal aorta and vena cava inferior in 11 cases. In 4 cases the tumor infiltrated the abdominal aorta, in 11 the vena cava inferior and in 8 both of them. In two patients, the tumor compressed the vena cava inferior and infiltrated the aorta; in two patients the aorta was compressed and the vena cava was infiltrated. In three cases only the exploration was performed due to multiple abdominal organ infiltration. The ex tempore biopsy showed the type of tumor in which the radical surgical treatment did not improve the prognosis. In 20 cases of tumor compression, subadventitional excision was performed. In 23 cases of infiltration, the tumor excision and vascular reconstruction had to be performed. Intraoperative blood cell saving and autotransfusion were applied in 27 patients. RESULTS The lethal outcome happened in 3 (6.5%) patients during hospitalization. In other patients all reconstructed blood vessels were patent during the postoperative hospitalization period. CONCLUSION Treatment of the abdominal tumors closely related to major blood vessels must be interdisciplinary, considering diagnostics, operability estimation and additional measures. Tumor reduction cannot improve long term prognosis, and has no major impact on life quality. There have been not many papers that analyze the long term results after such complex operations proving their appropriateness