Difficult Neck in Endovascular Aneurysm Repair (EVAR)

Endovascular approach in abdominal aortic aneurysm (AAA) treatment (EVAR) became the treatment of choice for most patients suffering from that disease. However, a successful endovascular therapy of the AAA depends on some key anatomical and morphological factors highly influencing the procedure outcome. Among them, the most important feature is the anatomical situation in the aneurysm neck. The definitions of the terms “hostile neck” and “difficult neck” are explained in order to present unfavorable conditions in the landing zone of most commercially available stent graft models. In this chapter, a description of various criteria of the difficult neck and their basic features and shapes as well was presented. Also, the most popular methods of solving that clinical problem were outlined. At the end, an overall (APPROACH) strategy in the treatment of a hostile neck patient is described

Vascular Trauma

Trauma is a leading cause of death and disability in young adults in developed countries with the high impact on future patient quality of life and productivity. The traumatic injury of the vessels is one of the most dangerous types of injury, requiring a fast and reliable diagnosis and, in vast majority of cases, immediate surgical treatment. In this chapter, the authors describe various types of vascular injuries according to injury types and locations. The prehospital care algorithms in patients with vascular trauma are proposed with the emphasis on bleeding control techniques and transportation technique to the nearest hospital. In the next subsection, the various peripheral vascular injuries of specific body areas are described. The truncal vessel trauma is discussed in the next subsection, focusing on fast diagnosis and decision on surgery. In the last subsection, a problem of iatrogenic vascular injury is described due to a rapid increase of minimally invasive techniques in which a vascular injury, as a complication of therapy, may occur

Peripheral vessel false aneurysm obliteration by intraluminal thrombin injection - case report and review of the literature

W wyniku rozwoju procedur diagnostycznych i terapeutycznych związanych z cewnikowaniem naczyń obwodowych notuje się coraz częstsze występowanie tętniaków rzekomych. Dotychczasowe leczenie z wyboru stanowił zabieg operacyjny lub ucisk pseudotętniaka pod kontrolą ultrasonografii. Przedstawiono przypadek 61-letniej pacjentki z pseudotętniakiem tętnicy udowej, będącym powikłaniem koronarografii, u której wykrzepienie pseudotętniaka uzyskano poprzez przezskórną podaż trombiny do jego wnętrza pod kontrolą USG. Iniekcja trombiny pod kontrolą badania USG stanowi obiecującą, małoinwazyjną metodę w leczeniu jatrogennych tętniaków rzekomych.The more frequent occurrence of peripheral vessel false aneurysms as a result of diagnostic and therapeutic procedures’ development is observed. Until recently, the treatment of choice was surgery or ultrasound-guided compression. A case of pseudoaneurysm of the femoral artery, arising as a complication of coronarography, was reported in a 61-year-old woman. False aneurysm was occluded by percutaneous ultrasound-guided thrombin injection directly into the aneurysm sac. Ultrasound-guided thrombin injection is a promising, minimally invasive technique for the treatment of iatrogenic pseudoaneurysms

Fat embolism syndrome case in woman presenting with a multiple injury following a traffic accident successfully treated using interdisciplinary approach - case report

BACKGROUND: A potential complication of extensive injuries is an episode of fat embolism, also referred to as fat embolism syndrome. The main causes of fat embolism include long bone and pelvic fractures. Symptoms of fat embolism may also develop after elective orthopedic surgery, removal of subcutaneous fat tissue, multiple rib fractures, acute pancreatitis, or parenteral nutrition with fat-containing products.Most of the possible clinical signs are non-specific. The triad of clinical signs including gas exchange disorders in the lungs, central nervous system disorders, and bloody petechiae on the skin makes fat embolism syndrome diagnosis much easier. However, the final diagnosis is based on meeting one large criterion, four small criteria, and one laboratory criterion in accordance with Gurd’s assumptions. METHODS: Manuscript description a case of 44-year-old woman with a multiple injury following a traffic accident. Computed tomography revealed a extensive head injury, numerous fractures of ribs, transverse processes of thoracic vertebrae and right scapula. As a result of the injuries developed full-blown fat embolism syndrome. CONCLUSIONS: This case highlights the importance of appropriate knowledge of the pathomechanism and clinical presentation of fat embolism syndrome and interdisciplinary therapeutic team approach. A quick correct diagnosis is crucial to improve treatment results. Access to laboratory and imaging tests considerably facilitates the diagnostic process, which should be followed by optimal therapeutic management. The lack of a golden standard of treatment necessitates a flexible and interdisciplinary therapeutic approach

Type I endoleak occurrence following stent-graft implantation in the therapy of the infrarenal abdominal aortic aneurysm. Case report

W pracy przedstawiono przypadek chorej pierwotnie leczonej endowaskularnie z powodu podnerkowego tętniaka aorty brzusznej. W wykonanych po 3 miesiącach badaniach kontrolnych (angio-TK, aortografia) u chorej wykryto przeciek okołoprotezowy typu I a. Przeciek leczono w znieczuleniu miejscowym za pomocą implantacji kolejnego prostego stent-graftu, którym pokryto nieszczelność, i skutecznie wyłączono z krążenia worek tętniaka.In the routine 3-month follow-up examination (angio-CT, aortography) in female patient who underwent the endovascular treatment of the infrarenal abdominal aortic aneurysm endoleak type I a was revealed. The endoluminal treatment of the endoleak was performed by means of the another stent-graft implantation, which covered the leak and effectively stopped the blood flow into the aneurysm sack