The utility of Prostar XL percutaneous vascular closure device after stent-graft implantation for infrarenal abdominal aortic aneurysms

Introduction. Over time, endovascular techniques of abdominal aortic aneurysm repair became the principal methods of treatment of this potentially fatal disease. Currently, endovascular aneurysm repair (EVAR) constitutes an effective alternative to open surgery, also in cases of aneurysm rupture. Low degree of invasiveness is the main advantage of this method. Introduction of a system enabling percutaneous stent-graft implantation appears to be the next step in the development of endovascular AAA surgery. Aim of the study is to evaluate the Prostar XL® closure device with regard to clinical effectiveness, safety, cost-effectiveness. Material and methods. The study included 100 patients (from January 2013 to December 2015) subject to endovascular abdominal aortic aneurysm repair in the infrarenal region of the aorta with the application of the Prostar Xl® closure device. Most patients were operated under epidural anaesthesia. Local anaesthesia (1% Lidocaine) was used in 36 patients due to comorbidities. A possible application of the closure system depended on a preoperative assessment of common femoral arteries using ultrasonography. Presence of atherosclerotic plaque on the anterior wall of the vessel disqualified the patient from percutaneous endovascular aneurysm repair (PEVAR). The main part of the procedure consisted of stent-graft implantation into the abdominal aortic aneurysm. In the final stage, puncture site on the anterior wall of common femoral arteries was closed using previously placed sutures of the Prostar XL system. The wound in the inguinal region was closed with a skin suture. Results. The analysis of obtained results demonstrated significantly shorter mean hospitalization times in patients treated with PEVAR compared to EVAR. Low rates and types of observed complications in the study group (PEVAR) compared to the control group (EVAR) are strongly in favour the percutaneous technique (PEVAR) of endovascular aortic abdominal aneurysm repair in the infrarenal region of the aorta, confirming its minimally invasive character

The novel minimally invasive mechano-chemical technique of the saphenous vein ablation. Our center experience: results of 24 months follow-up

Introduction: The aim of the study was to evaluate the efficacy of the endovascular ablation method of GSV//SSV superficial venous insufficiency using Flebogrif® catheter, the safety of the method, expressed in numberand quality of observed complications in 24-month observation. Material and methods: Initially, the observed group included 200 patients undergoing ablation of insufficientGSV/SSV. During 24 months of observation, this number decreased to 158, which seems to be a natural process.All patients signed the informed consent form approved by the Bioethics Committee of the Medical Universityof Lublin. Based on clinical evaluation, including ultrasound assessment, 200 patients, including 170 womenand 30 men, were admitted to the study using the adopted criteria of inclusion/exclusion. In the studied groupof patients, 172 great saphenous veins (GSV) and 28 short saphenous veins (SSV) were ablated. The treatedinefficient veins were punctured at three levels depending on the length of the segment of insufficient GSV/SSV.Each patient was treated with a compression agent in the form of a second compression class elastic stockings(20–30 mm Hg). Control visits on the basis of the accepted protocol were established in 1, 3, 6, 12, 24, 36months after the procedure. Results: During 24 months of observation, the evaluation of the Flebogrif® catheter method was based on theanalysis of results obtained in four categories: effectiveness of the method, expressed as the ratio of the numberof successfully closed veins ablated with the Flebogrif® catheter to the number of observed cases of recanalization;clinical improvement of venous insufficiency symptoms, based on the VCSS, CEAP, VAPS scale; safety ofthe method, expressed in terms of quantity and quality of observed complications; technical characteristicsof the method. The obtained results were analyzed statistically using tests for non-parametric variables. Theeffectiveness of the method based on the obtained results was 92%. A statistically significant decrease in theintensity of clinical symptoms in relation to the preoperative condition was observed. The number and quality ofthe observed complications allow considering the procedure of vein ablation with the use of Flebogrif® catheteras safe, possible to perform in ambulatory conditions. Conclusions: Effectiveness of the method of 92% in 24-month observation; good cosmetic effect; a statisticallysignificant decrease in the intensity of clinical symptoms in 24-month observation; the low incidence ofcomplications allows to consider the method safe; the method of surgery allows to perform the procedure inambulatory conditions

The influence of compression therapy on the level of inflammatory biomarkers in patients with chronic venous disease.

Chronic venous disease (CVD) is defined as any morphological and functional abnormalities of long duration manifested either by symptoms and/or signs indicating the need for investigation and/or care. The pathophysiological mechanism of CVD can be characterized by reflux, obstruction, or a combination of both, which leads to increased venous pressure. Compression therapy remains the gold standard of the conservative treatment of CVD in all stages. The possible forms of compression therapy are elastic stocking, non-elastic and elastic bandages, and intermittent pneumatic compression. Compression bandages have been proven to improve the healing of venous ulcers, in comparison with standard care without compression therapy. In the last years, inflammation has been shown to play an important role in the pathophysiology of CVD. The influence of the altered shear stress on the endothelial cells (EC) causes EC to release inflammatory molecules, chemokines, vasoactive agents, express selectins, and prothrombotic precursors such as ICAM-1, MCP-1, MIP 1β, VCAM, L-selectin, E-selectin, IL-1β, IL-4, IL-6, IL-8, IL-12p40, IL-13, G-CSF, GM-CSF, IFN-γ, TNF-α, MIP-1α. Several studies were performed to investigate the influence of compression therapy on the level of various inflammatory biomarkers in patients with CVD. In these studies level of the most inflammatory molecules, such as IL-1β, IL-6, IL-8, IL-12p40, G-CSF, GM-CSF, IFN-γ, TNF-α, VEGF, MMP 3, 8, 9 and TIMP-1 decreased after the therapy

Serumska razina za neuron specifične enolaze kao biljeg ishemijsko-reperfuzijskog oštećenja u bolesnika podvrgnutih karotidnoj endarterektomiji

In patients with atherosclerotic stenosis of the extracranial segment of internal carotid artery, surgical intervention is an effective method to prevent cerebral ischemic stroke. However, this surgical procedure may cause vascular brain damage. The aim of the study was to investigate consequential brain ischemia-reperfusion injury by measuring the cerebral specific marker, neuronspecific enolase (NSE), in serum of patients having undergone internal carotid endarterectomy (CEA). The study involved 25 patients that underwent CEA due to internal carotid artery stenosis. Blood samples were obtained from each patient on three occasions: within 24 h prior to surgery, 12 h after surgery, and 48 h after surgery. Serum NSE levels were measured by a commercially available enzymelinked immunosorbent assay. The study showed that serum NSE level was statistically significantly increased 48 h after CEA as compared with the level 12 h after surgery and the level before surgery (p0.05). Data from our study showed CEA to affect serum NSE in patients with significant internal carotid artery stenosis. Thus, serum NSE may be used as a biochemical marker of brain ischemia-reperfusion injury following CEA.Kirurška intervencija je učinkovita metoda sprječavanja ishemijskog moždanog udara u bolesnika s aterosklerotskom stenozom ekstrakranijskog dijela unutarnje karotidne arterije. Međutim, ovaj kirurški zahvat može uzrokovati oštećenje moždanog krvožilja. Cilj ovoga istraživanja bio je ispitati posljedično ishemijsko-reperfuzijsko oštećenje mozga mjerenjem za neuron specifične enolaze (neuron-specific enolase, NSE) kao specifičnog moždanog biljega u serumu bolesnika podvrgnutih endarterektomiji unutarnje karotide (internal carotid endarterectomy, CEA). Istraživanje je obuhvatilo 25 bolesnika podvrgnutih CEA zbog stenoze unutarnje karotidne arterije. Uzorci krvi uzeti su u svakog bolesnika tri puta: unutar 24 h prije operacije, 12 h nakon operacije i 48 h nakon operacije. Serumske razine NSE mjerene su komercijalnim testom ELISA. Rezultati su pokazali da je serumska razina NSE bila statistički značajno povišena 48 h nakon CEA u usporedbi s razinom izmjerenom 12 h nakon operacije, kao i u usporedbi s razinom prije operacije (p0,05). Podaci dobiveni u ovom istraživanju pokazuju da CEA utječe na razinu NSE u serumu kod bolesnika sa značajnom stenozom unutarnje karotidne arterije. Stoga bi serumska razina NSE mogla poslužiti kao biokemijski biljeg ishemijsko-reperfuzijskog oštećenja mozga nakon CEA

Stent fracture as a complication of superficial femoral artery stenting – a case report

Introduction: Peripheral artery disease (PAD) is an atherosclerotic vascular disease that results in obstruction of blood flow in the arteries other than those in the coronary circulation. PAD is often located in lower extremities, with patients presenting symptoms of intermittent claudication or critical lower limb ischemia. Angioplasty and stent implantation are often used in the treatment of PAD. Although these methods are considered as a low invasive and low risk, some factors may limit stent patency in the future. The fracture of the implanted stent may be one of these. Case report: A 68 old man, long-term smoker, with a history of chronic limb ischemia and many vascular surgeries because of PAD was admitted to the hospital with symptoms of the acute limb ischemia. Angiography showed a fracture of the stent implanted during the earlier hospitalization, with a fragment displacement to the left external iliac artery. The patient was successfully treated with catheter-directed thrombolysis. Discussion: Stent fracture is usually asymptomatic, however, it may cause complications, such as restenosis, pseudoaneurysm, perforation of the vessel, and in-stent embolism. The cumulative incidence of the femoropopliteal stent fracture varies from 2 to 65% in several studies. Incidence increases with stent length and is significantly lower in the second generation of nitinol stents, that was designed to have enhanced flexibility and durability

A new device for minimally invasive mechano-chemical method of saphenous vein ablation. Report of 12 months of follow up

Introduction. The purpose of the study was to assess the effectiveness of endovascular mechanochemicalablation of the Great Saphenous vein and the Small Saphenous vein (GSV/SSV) using the use of Flebogrif®catheter and method, based on results obtained from the analysis of 200 patients. Material and methods. 200 patients underwent mechanochemical ablation using the Flebogrif® technique,of the 200 patients, 172 patients experienced insufficiency of the GSV and 28 experienced insufficiencies ofthe SSV. Follow-up assessment was established by outpatient appointments at 1, 3, 6, and 12 months postoperatively.During each subsequent visit, the result of the procedure was evaluated with the use of ultrasound.Furthermore, the intensity of clinical manifestations was assessed with the use of VCSS, CEAP, VASP scales. Anycomplications were also noted. Results. During 12-month follow-up the number of participants decreased to 168 (152 female, 16 male).Complete closure of the vein was achieved in 154 patients (140 female, 14 male). According to adoptedcriteria, 15 cases of recanalization were detected (10 complete and 5 partial). Based on the obtained resultsthe effectiveness of the method was assessed at 92%. Conclusions. The statistical analysis of the 12-month follow-up data allowed us to conclude the following theprocedural method had 92% of effectiveness at 12-month follow-up, vein diameter was not a significant limitationfor the application of the technique, there was a low rate of serious complications, and adverse cosmetic effectwas minimal. However , the method requires further long-term follow-up to allow for a complete assessment

Prevalence and risk factors of abdominal aortic aneurysm among over 65 years old population in Lublin, Poland

Introduction: Abdominal aortic aneurysm (AAA) is a disease exceptionally well suited to screening. Ultrasound- based screening meets all criteria for a screening program according to the WHO, and there is a large evidence supporting its usefulness. Risk factors, mentioned in the available literature, associated with aneurysm formation are advanced age, male gender, tobacco smoking, hypertension, atherosclerotic disease and family or personal history of aortic aneurysms. The aim of the study was to evaluate the incidence of abdominal aortic aneurysms in the population of men and women older than 65 years, in Lublin, Poland and to identify the correlation between risk factors and the AAA incidence. Material and methods: A single-center screening study, for men and women older than 65-years was conducted in Lublin, Poland in May 2018. Patients underwent basic screening ultrasound with measurement of the diameter of abdominal aorta and iliac arteries. Each patient completed anonymous questionnaire to investigate risk factors of developing AAA. Results: 1032 patients, aged 65–91 (median age 71.37) were examined. 569 of them were women and 463 men. 27 aortic aneurysms were detected — 7 in a group of women and 20 in a group of men. The total incidence rate of AAA in our study was 2.62%; 1,23% in women and 4,32% in men. Male gender, cigarette smoking, coronary artery disease and a history of myocardial infarction all appeared to be major risk factors of AAA, with relative risk ranging from 2,75 to 4.53. The median diameter of the abdominal aorta was 19.24 mm and varied in groups of patients with different risk factors. Conclusions: The estimated prevalence of AAA in the screened population is within the range of the values reported in previous publications, however, it may confirm a trend of declining prevalence of AAA showed in some recent studies. The presented study confirms the correlation between the AAA and its major risk factors (male sex, smoking cigarettes, coronary artery disease and history of myocardial infarct) as well as a weak association between AAA and hypertension and a negative correlation with diabetes

Serum level of αII-spectrin breakdown products (SBDPs) as a potential marker of brain ischemia-reperfusion injury after carotid endarterectomy

Introduction: Stroke remains one of the main causes of morbidity and mortality worldwide. Carotid endarterectomy (CEA) reduces the incidence of ischemic stroke or death in patients with symptomatic carotid artery stenosis more effectively than pharmacological therapy alone. SBDPs (spectrin breakdown products): SBDP 120, SBDP145, and SBDP150 are the product of proteolysis of αII-spectrin (280 kDa) — an important structural component of the neuronal cytoskeleton, particularly present in axons. Increased serum level of SBDPs was previously observed in traumatic brain injury, subarachnoid hemorrhage (SAH), or brain ischemia. Material and methods: The aim of our study was to investigate changes in serum levels of SBDP120 and SBDP145 in patients undergoing uncomplicated CEA. The study included 22 patients with severe carotid artery stenosis, qualified for CEA. Blood samples were taken from the antecubital vein at three different intervals (24 h before CEA, 12 and 48 h after surgery). SBDP’s serum levels were measured by a commercially available enzyme-linked immunosorbent assay (ELISA). Results: The study showed that serum SBDP120 levels were significantly decreased 48 h after CEA when compared to the level before the surgery. SBDP145 levels were significantly decreased 12h after the procedure and then remained at a similar level 48h after CEA. Conclusions: In patients with high-grade carotid artery stenosis SBDP120 and SBDP145 serum level decreases after an uncomplicated CEA, therefore alterations from this curve may be a marker of neurological complications after the procedure. Higher SBDP levels before the procedure may represent brain damage caused by chronic ischemia

Visinin-like Protein (VLP-1) as a potential marker of brain damage after carotid endarterectomy — preliminary study

Introduction: Stroke is the second leading cause of disability and death worldwide. Carotid endarterectomy (CEA) reduces the incidence of ischemic stroke or death in patients with sympatomatic carotid artery stenosis more effectively than pharmacological therapy alone. Visinin-like protein 1 (VLP-1) is a potential marker of brain injury. An increased serum level of VLP-1 was observed in neurodegenerative diseases, ischemic stroke, and traumatic brain injury. Material and methods: The objective of the study was to report the changes in serum level concentrations of VLP-1 in patients undergoing CEA. The study group consisted of 22 patients with severe carotid artery stenosis, qualified to CEA. Serum levels of VLP-1 were measured by an enzyme-linked immunosorbent assay (ELISA) test at 24 h before CEA, 12 and 48 h after the surgery. Results: Serum VLP-1 levels were significantly reduced 48 h after CEA compared to the levels before and 12 h after surgery. Conclusions: VLP-1 serum level decreases after an uncomplicated CEA in patients with high-grade carotid artery stenosis. Alterations in this curve may be a marker of neurological events after the procedure. Higher VLP-1 baseline levels before CEA may reflect brain damage caused by chronic ischemia

Deep vein thrombosis in a 19-year-old patient with thrombophilia - description of the diagnosis and treatment

Introduction: Deep vein thrombosis (DVT) is a condition in which a blood clot forms in one of the body's deep veins, most commonly of the leg or pelvis. Before the fourth decade of life risk of DVT is low (about 1 per 10000). After the age of 45, it rises and approaches about 5 per 1000 by the age of 80. Noteworthy is the fact, that patients with a positive family history have a higher risk of DVT at a young age. Essential risk factors for developing DVT are genetic conditions or acquired thrombophilia and positive family history, but the lack of family predisposition cannot rule out the occurrence of DVT. Standard treatment method of DVT involves intravenous anticoagulation with the use of low molecular weight heparin and compression therapy. Apart from the above-mentioned methods, we can distinguish intermittent pneumatic compression, surgical embolectomy, pharmacomechanical thrombectomy, and venous stenting. Case Report: We present a case report of 19 - year old patient who was first admitted to hospital in April 2017 urgently with symptoms of pulmonary embolism which was confirmed in angio-CT. Moreover, in the Doppler ultrasound, left common iliac vein (LCIV), left external iliac vein (LEIV) and left femoral vein (LFV) thrombosis was diagnosed. During the hospitalization, genetic tests, antibody levels, and antithrombin levels were performed for thrombophilia and systemic diseases conducive to thrombosis. In October 2017 the angio-MR of the pelvis confirmed visible pressure on the LCIV, caused by the common iliac artery, which corresponds to the May-Turner syndrome. In March 2018 he was admitted to the clinic with DVT symptoms of the left lower limb such as swelling, pain, and redness. The patient underwent venous angioplasty and stent implantation for LCIV. The patient was discharged from hospital with recommendations such as compression therapy, Doppler ultrasonography and monitoring of INR. Discussion: Venous thrombosis is a multicausal disease: more than one risk factor needs to be present before thrombosis occurs. Choice of DVT treatment method is aimed at improving the quality of life of patients depending on clinical symptoms. venous stenting for an iliofemoral occlusive disease is a safe and effective method of treatment. It can be done with excellent patency rates expected in cases of idiopathic occlusion and May-Thurner syndrome. On this basis, the legitimacy of using venous stent implantation as an effective method of treatment of recurrent DVT episodes can be confirmed, which has been used in the described case