Ocena pierwszego polskiego stentu "Neptun" w leczeniu zmian miażdżycowych tętnic biodrowych

Background: Angioplasty of occluded iliac arteries connected with stent implantation demonstrated the high technical efficacy and good clinical effect of the stent. The patency of iliac vessel stents 12 months after their implantation ranged between 86 and 99%, depending on the author cited. The aim of the study was to determine the safety and clinical efficacy of iliac artery angioplasty following the implantation of the Polish stent Neptun, manufactured by Balton. Material/Methods: The study group comprised 56 patients aged between 39 and 83 years diagnosed with stenosis or iliac artery occlusion, subjected to implantation of 75 stents. The patients were directed towards intravascular procedures on the basis of their medical history as well as clinical and imaging examinations, including Doppler ultrasound and DSA angiography. Clinical symptoms were based on Fontaine's classification, evaluated before the procedure and three days after. Considering the similar time intervals, the ankle-brachial index (ABI) was evaluated. Distant results were determined on the basis of clinical examinations in addition to the ABI estimation performed during the follow-up visit 12 months after the procedure. Thirty-seven patients required single stents, while in 9 subjects both iliac arteries were subjected to stenting, including the abdominal aortic bifurcation. In six patients, stents were implanted to both iliac arteries, the aortic bifurcation excluded. Four patients were subjected to the implantation of two stents, involving one of the iliac arteries. Results: In all patients a positive technical and clinical effect was obtained. Improvement according to Fontaine's classification was observed in the whole study group of patients (evaluation undertaken three days after the procedure). The mean ankle-brachial index on admission was 0.62±0.17. After angioplasty, this index significantly increased (p<0.01) to 0.87±0.19. After the one-year observation period the AB index decreased to 0.82±0.18 (p=NS). Ultrasonographic control comprised 49 patients with 65 implanted stents. Complete vessel patency was confirmed in 60 (92.3%) 12 months after stent implantation. Conclusions: Based on this evaluation, Neptun stents are safe, their technical and clinical efficacy amounting to 100% during the perioperative period. The stents assure good visualization during implantation. Their patency after the one-year observation period proved to be high, being comparable to other previously used stents. Further investigations are required, involving a longer follow-up period

Percutaneous direct thrombin injection with hydrodissection to manage type II endoleak after endovascular abdominal aortic aneurysm repair

Type II endoleak is the most common complication after endovascular abdominal aortic aneurysm repair (EVAR). The management remains controversial. We present a case in which endoleak was successfully treated by direct percutaneous thrombin injection with hydrodissection. This method seems to be a safe and feasible alternative method for treatment of type II endoleak

Successful retrieval of a hydrophilic guidewire coating

Background: We present two cases of endovascular retrieval of a hydrophilic guidewire coating, which was stripped off against the needle during coronary angiography. Case report: The first coating was 43 centimeters long and it was located at the course of external iliac artery, common femoral artery and its bifurcation and along the deep femoral artery. In the second case, the foreign body was a couple of centimeters long and located in the proximal part of the deep femoral artery. The coating was captured and successfully retrieved in both cases using 0.009" intermingling guidewires, advanced from the contralateral side in so-called cross-over way. Conclusions: Percutaneous retrieval techniques of endovascular foreign bodies are very effective and safe. Physicians performing endovascular procedures should be familiar with these retrieval techniques

Successful coronary stent retrieval from the renal artery

Coronary stent loss and its migration is one of complications of percutaneous coronary interventions (PCI). We present a case of successful retrieval of a coronary stent which moved initially to the left renal artery. Subsequently the stent was lost again and migrated to the left deep femoral artery, while an attempt was made at its retrieval with a snare loop from the renal artery. Successful retrieval was finally performed through right femoral access by the so-called &#8220;cross-over&#8221; method. (Cardiol J 2007; 14: 87&#8211;90

Endovascular therapy of arteriovenous malformation in a male patient with severe post-coital pelvic pain

Purpose: Congenital pelvic arteriovenous malformations (AVMs) are high-flow vascular lesions consisting of abnormal shunts between arteries and veins within a nidus. The rare presentation and extensive network of vasculature contributes to the difficulty in effective treatment. Optimal therapeutic options are determined based on the clinical presentation, the location of the lesion, and possible complications. Case report: A 24-year-old male patient with a history of recurrent pain following sexual intercourse presented with complaints of intense pelvic pain radiating to the perineal area. Computed tomography angiography (CTA) revealed a large venous aneurysm as an outflow vein of a right-sided pelvic AVM. Embolisation of the outflow veins was established along with direct percutaneous delivery of fibre coils and thrombin to the venous aneurysm of the AVM. With recurring symptoms and AVM recanalisation on angiography, another direct puncture and placement of pushable coils was made. Total AVM occlusion was achieved with no recanalisation on follow-up digital subtraction angiography (DSA), and the patient remained asymptomatic. Conclusions: Endovascular embolisation of the nidus area may result in a complete occlusion of an AVM. Therefore, a thorough understanding of the vascular anatomy of the AVM is essential in choosing an effective embolisation strategy and to minimise the risk of possible complications

Upper extremity deep vein thrombosis: pathogenesis and treatment

Upper extremity deep vein thrombosis (UEDVT) may be the first manifestation of venous thoracic outlet syndrome(VTOS). It primarily affects young, physically active people. The clinical findings depend on the degreeof obstruction of the subclavian vein. Correct diagnosis — aided by various imaging modalities — as well asrapid initiation of local thrombolytic therapy, surgical decompression of the thoracic outlet (when indicationsare present), and the immediate initiation of anticoagulation therapy aim at successfully restoring the patient’squality of life

Coexistence of Renal Artery Aneurysm and Stenosis in The Course of Arterial Hypertension - Case Report

Jedną z najczęstszych przyczyn nadciśnienia tętniczego wtórnego jest zwężenie tętnicy nerkowej. Rolę zwężenia w patogenezie nadciśnienia tętniczego dobrze poznano i udowodniono. Inną, rzadką patologią tętnicy nerkowej jest tętniak. Opinie na temat jego roli w patogenezie nadciśnienia tętniczego są podzielone i zagadnienie to wymaga szerszych badań. W pracy przedstawiono przypadek 31-letniej pacjentki hospitalizowanej z powodu nadciśnienia tętniczego opornego na leczenie farmakologiczne. W trakcie diagnostyki obrazowej u chorej stwierdzono współistnienie w obrębie tętnicy nerkowej zwężenia oraz tętniaka. Wykonano przezskórną angioplastykę wewnątrznaczyniową istniejącego zwężenia. Tętniaka ze względu na rozmiary nie zakwalifikowano do leczenia zabiegowego. Po zabiegu wartości ciśnienia tętniczego znacznie zmniejszyły się, przy jednoczesnej redukcji leczenia farmakologicznego.Stenosis of renal artery is the one of most frequent reasons of secondary arterial hypertension. The role of stenosis in arterial hypertension patogenesis is well known and proved. Other rare pathology in renal artery is an aneurysm. Investigators differ in their opinions about the role of aneurysm in patogenesis of arterial hypertension and it reqire extensive studies. In this publication we described a case of 31 years old woman hospitalized with refractory arterial hypertension. Radiological examinations revealed coegsisting renal artery aneurysm and stenosis. Transcutaneus intra-arterial angioplasty of stenosis was performed. The aneurysm was not qualified to treatment becouse of its size. After surgery the blood pressure was considerably lower and pharmacological treatment was also significant reduced

Patient exposure to X-ray radiation during abdominal aorta and lower limb digital subtraction angiography

Background: The main aim of this study was to find out what is the risk caused by ionizing radiation during digital subtraction angiography (DSA) for abdominal aorta and lower limb examinations. Material\Methods: The study is based on a large group of patient data subjected to a complex analysis of fluoroscopy time, exposure time, air kerma values, and dose-area product (DAP). Measurements were performed on 449 patients with intra-arterial (IA DSA) contrast administration. Results and Median DAP value for fluoroscopy was 5.4 Gy-cm2 and for exposure 51.7 Gy-cm2. On exposure the patients received 94% of the total DAP although this examination takes only 0.1% of the total examination time. For this reason, small changes in the exposure time may result in a considerable reduction in the radiation received by the patient. There was good correlation between DAP values and the fluoroscopy time (r=0.78), while the correlation between DAP and the exposure time was much poorer (r=0.39). It was also found that gender was a differentiating factor neither both fluoroscopy (F[1, 449]=0.01, p>0.05) nor exposure time (F[1, 449]=0.42, p>0.05)

Wewnątrznaczyniowe leczenie tętniaków naczyń mózgowych przy użyciu spirali odczepianych hydraulicznie

Background: Authors analysed results of endovascular treatment using platinum hydraulically detachable coils in ruptured and unruptured cerebral aneurysms. The aim of the study was to evaluate the efficacy of the presented method and safety of the treatment for patients with cerebral aneurysms. Material/Methods: Authors describe a clinical analysis in a group of 129 patients with 153 cerebral aneurysms treated with endovascular embolization in Department of Neurosurgery and Neurotraumatology of University of Medical Sciences in Poznań, Poland. 116 patients were hospitalized with a history of subarachnoidal hemorrhage, while 13 patients were without previous onset of bleeding. In bled group the clinical condition was assessed according to Hunt-Hess's scale. All patients were treated using Balt (MDS Pression) hydraulically detachable coils system. Based on angiographic examination results one evaluated the anatomical conditions of the aneurysm, its size, and relationship of the aneurysmal sac to its neck. Considering 116 patients with ruptured aneurysms, endovascular embolization within 72 hours was performed in 70 cases, in case of 46 patients the procedure was delayed. Results: Complete occlusion of the lumen of the aneurysmal sac was achieved in 126 (82.3%) patients, while incomplete occlusion in 27 (17.7%). The efficacy of embolization was connected with the size and morphology of the aneurysm, as well as the relationship of the neck to the aneurysmal sac. Complete embolization was obtained specially in case of small aneurysms and those with a narrow neck. Conclusions: Authors proof justness of transarterial embolisation as a highly effective first choice procedure of aneurismal sack exclusion from cerebral circulation