False aneurysm of deep femoral artery branch following blunt trauma

Background: Pseudoaneurysms of the deep femoral artery (DFA) as a result of blunt trauma are very rare, therefore they are often not suspected. Surgery remains the treatment of choice and should be carried out electively for asymptomatic aneurysms. The stent-graft placement is another way of treatment but long-term durability of DFA stentgrafting is still unknown. Case Report: We present a case of a 20-year-old male patient with a pseudoaneurysm of DFA as a result of blunt trauma which was successfully treated with a stengraft. Conclusions: A pseudoaneurysm should be suspected in any patient presenting with an enlarging haematoma following blunt trauma. The use of stent-grafts seems to be a safe and efficient way of treatment of post traumatic DFA pseudoaneurysms and should be considered as one of treatment options

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

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

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

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

Serum microtubule associated protein tau and myelin basic protein as the potential markers of brain ischaemia-reperfusion injury in patients undergoing carotid endarterectomy

Introduction. In the prevention of ischaemic stroke the recommended surgical procedure is carotid endarterectomy (CEA). However, surgical treatment of atherosclerotic stenosis may cause neurological complications. The aim of the study was to investigate consequential brain ischaemia-reperfusion injury by measuring the cerebral specific markers, the microtubule associated protein tau (MAPt) and myelin basic protein (MBP) in the serum of patients that underwent CEA. Material and methods. This study involved 25 participants who underwent CEA due to internal carotid artery stenosis. Blood samples were taken from each patient at three different intervals; within 24 hours prior to surgery, 12 hours after the surgery, and 48 hours after the surgery. Serum MAPt and MBP levels were measured by a commercially available enzyme-linked immunosorbent assay (ELISA). Results. The study showed that serum MAPt and MBP levels were statistically significantly decreased 12 hours after CEA compared to the level before the surgery (p < 0.05), but MAPt and MBP levels were normalized 48 hours after CEA. There was statistically significant correlation in serum MAPt levels with the velocity of blood flow in the internal carotid artery 12 and 48 hours after CEA (p < 0.05). Conclusions. Data from our study showed that CEA affects serum neuromarkers levels, such as MAPt and MBP, in patients with significant internal carotid artery stenosis. MAPt and MBP levels showed characteristic time curve in patients who underwent CEA and did not experience any neurological deficit in perioperative period. Possible alterations of this time curve may potentially be an index of a neurological event occurrence.  Introduction. In the prevention of ischaemic stroke the recommended surgical procedure is carotid endarterectomy (CEA). However, surgical treatment of atherosclerotic stenosis may cause neurological complications. The aim of the study was to investigate consequential brain ischaemia-reperfusion injury by measuring the cerebral specific markers, the microtubule associated protein tau (MAPt) and myelin basic protein (MBP) in the serum of patients that underwent CEA. Material and methods. This study involved 25 participants who underwent CEA due to internal carotid artery stenosis. Blood samples were taken from each patient at three different intervals; within 24 hours prior to surgery, 12 hours after the surgery, and 48 hours after the surgery. Serum MAPt and MBP levels were measured by a commercially available enzyme-linked immunosorbent assay (ELISA). Results. The study showed that serum MAPt and MBP levels were statistically significantly decreased 12 hours after CEA compared to the level before the surgery (p < 0.05), but MAPt and MBP levels were normalized 48 hours after CEA. There was statistically significant correlation in serum MAPt levels with the velocity of blood flow in the internal carotid artery 12 and 48 hours after CEA (p < 0.05). Conclusions. Data from our study showed that CEA affects serum neuromarkers levels, such as MAPt and MBP, in patients with significant internal carotid artery stenosis. MAPt and MBP levels showed characteristic time curve in patients who underwent CEA and did not experience any neurological deficit in perioperative period. Possible alterations of this time curve may potentially be an index of a neurological event occurrence.

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

Irisin — the future of ischemic stroke therapy?

Irisin is a recently discovered hormone, synthesized mainly by the muscles. Expression of irisin and its precursor named FNDC5 was also found in the heart, kidneys, liver, pancreas, adipose tissue, and brain including cortical neurons, hippocampus, cerebellum, hypothalamus, and spinal cord. The purpose of this study is to review the latest research on the properties of the irisin and its cytoprotective effect against neuronal damage and to draw attention to its possible clinical use in the treatment of stroke. Notch pathway activity increases after ischemic damage, stimulating the repair of the affected brain area. Irisin activates the Notch pathway which inhibits the activity of microglia, secretion of inflammatory factors, and finally leads to reduction of the brain edema. Studies revealed that irisin increases levels of brain-derived neurotrophic factor (BDNF), leading to enhancement of survival and migration of the neurons, and protecting nerve cells from damage during the ischemic stroke. It was also found that irisin maintains mitochondrial integrity, reduces oxidative stress, and exerts a protective effect on the blood-brain barrier. Irisin entails a neuroprotective effect, reducing the extent of the infarcted area and the degree of brain damage. Stimulation of the irisin expression by physical activity or its exogenous administration remains the subject of research that raises hope for development of the new therapeutic options for diseases, especially ischemic stroke

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

Zastosowanie metody laserowej przepływometrii dopplerowskiej do monitorowania i oceny skuteczności zabiegu wideoskopowej sympatektomii lędźwiowej u pacjentów z pierwotnym fenomenem Raynauda i nadpotliwością

Background. The aim of the study was to apply the laser Doppler flowmetry method to monitor the course of videoscopic lumbar sympathectomy, and for objective evaluation of its short and long-term effects in patients with primary Raynaud's phenomenon and hyperhydrosis. Material and methods. Twenty-one patients were included in the study and underwent unilateral, videoassisted lumbar sympathectomy. Skin blood flow and skin temperature were monitored on the plantar surface of both feet by means of laser Doppler flowmetry. Additionally, to evaluate the reactivity of microcirculation, the test of transcutaneous electrical nerve stimulation was applied. There were 4 measurements conducted: 1 day before sympathectomy, 2 hours, 24 hours and 1 month after. During surgery, skin blood flow was monitored continuously. Results. Stimulation of sympathetic trunk evoked short-term decrease of skin blood flow. Following coagulation and segmental resection resulted in continuous elevation of blood flow values on the side of the denervated limb. The improvement in skin perfusion was stable and maintained one month after sympathectomy. The assessment of the microcirculation reactivity during transcutaneous electrical nerve stimulation showed a maximal vasodilatation in the skin of denervated extremity, pointing to the effectiveness of the procedure. Unilateral sympathectomy increased, however, not so spectacularly, skin blood flow, temperature and the level of resting vasodilatation on the contralateral, non-operated foot. This finding proves the bilateral influence of one-sided sympathectomy on the skin microcirculation, probably through the central neural control mechanisms and thermoregulatory reactions. Conclusions. Laser Doppler flowmetry is a useful and precise tool for monitoring the course of video-assisted lumbar sympathectomy. It allows a functional identification of sympathetic trunk structures and gives the possibility to objectively assess the effects of sympathectomy in patients with primary Raynaud's phenomenon and hyperhydrosis.Wstęp. Celem pracy było zastosowanie metody laserowej przepływometrii dopplerowskiej do monitorowania i oceny skuteczności zabiegu wideoskopowej sympatektomii lędźwiowej u pacjentów z pierwotnym fenomenem Raynauda i nadpotliwością. Materiał i metody. Badaniem objęto 21 chorych, u których wykonano jednostronną wideoskopową sympatektomię lędźwiową. Przepływ skórny i temperaturę skóry rejestrowano na podeszwowej powierzchni obu stóp przy użyciu laserowego dopplerowskiego przepływomierza. Do oceny reaktywności mikrokrążenia skórnego zastosowano dodatkowo test przezskórnej, elektrycznej stymulacji nerwowej. Przeprowadzono 4 pomiary: dzień przed sympatektomią, 2 godziny, 24 godziny oraz miesiąc po operacji. W trakcie operacji zmiany przepływu skórnego monitorowano w sposób ciągły. Wyniki. Drażnienie pnia współczulnego wywoływało krótkotrwały i przejściowy spadek przepływu skórnego krwi, natomiast po koagulacji i przecięciu pnia współczulnego po stronie operowanej obserwowano stałą tendencję do wzrostu perfuzji i temperatury skóry stopy. Poprawa ukrwienia skóry miała charakter trwały i utrzymywała się w miesiąc po zabiegu. Podczas oceny reaktywności mikrokrążenia skórnego w teście przezskórnej stymulacji nerwowej wykazano maksymalną wazodylatację w skórze współczulnie odnerwionej kończyny, co świadczy o skuteczności zabiegu. Jednostronna sympatektomia zwiększała również, choć w znacznie mniejszym stopniu, przepływ skórny, temperaturę skóry oraz stopień spoczynkowej wazodylatacji naczyń mikrokrążenia w stopie po stronie nieoperowanej, co wskazuje na obustronny wpływ zabiegu na obwodowe mikrokrążenie skórne, prawdopodobnie poprzez centralne mechanizmy kontroli nerwowej i reakcje termoregulacyjne. Wnioski. Laserową przepływometrię dopplerowską można uznać za precyzyjną metodę monitorowania przebiegu wideoskopowej sympatektomii lędźwiowej. Pozwala ona na czynnościową identyfikację struktur pnia współczulnego i umożliwia obiektywną ocenę skuteczności sympatektomii lędźwiowej u pacjentów z pierwotnym fenomenem Raynauda i nadpotliwością