Banach-Lie groupoids and generalized inversion

We study a few basic properties of Banach-Lie groupoids and algebroids, adapting some classical results on finite dimensional Lie groupoids. As an illustration of the general theory, we show that the notion of locally transitive Banach-Lie groupoid sheds fresh light on earlier research on some infinite-dimensional manifolds associated with Banach algebras.Comment: 45 pages, too appear in J. Funct. Ana

Celiac artery compression syndrome. Mini-review

Celiac artery compression syndrome is a rare vascular disease, with incidence estimated at 0.4%. However, asymptomatic but hemodynamically significant celiac artery compression is found incidentally in 2.4–8% of the population on examination. The disease is caused by compression of the median arcuate ligament and celiac axis nerve fibers on the celiac artery, usually during expiration, and can cause symptoms of “abdominal claudication”. These symptoms include post-prandial epigastric pain, nausea, vomiting, mild weight loss and, less frequently, diarrhea, heartburn, abdominal bloating, constipation, arrhythmias and syncope. Ultrasound, computed tomography (CT), magnetic resonance (MR) and angiography are employed to diagnose celiac artery compression syndrome. Treatment of this disease is based on median arcuate ligament lysis and celiac ganglionectomy either by laparoscopic or open method, with both techniques having similar outcomes

Balloon-grab technique to bridge steep renal artery during endovascular thoracoabdominal aortic aneurysm repair: technical note

The aim of the study is to describe an endovascular manoeuvre that can help in the cannulation and stenting of difficult renal arteries in endovascular thoracoabdominal aortic aneurysm exclusion (EVAR) with a branched stent graft. Routinely, dedicated branch and target vessels are cannulated in antegrade fashion through a transaxillary approach. If renal arteries are steep, tortuous, and unfavourable, cannulation failure can preclude a successful endovascular procedure. In that situation, the guidewire slips off the artery. However, another guidewire and balloon can be introduced to the target vessel through femoral access. Expansion of an additional percutaneous transluminal angioplasty (PTA) balloon in the target vessel grabs the guidewire or catheter cannulated in typical fashion and prevents it from slipping off. At this point, a stiffer wire can be introduced, and the covered stent easily bridges the target vessel. The rest of the procedure is continued typically. Expansion of an additionally introduced balloon allows the surgeon to grab the guidewire in the renal artery, thus excluding an aneurysm during EVAR. Our early experience shows that this method is effective and durable

Application of Zenith t-Branch system in symptomatic thoracoabdominal aortic aneurysm with unfavourable anatomy — case report

Although huge improvement has been observed in endovascular repair of aneurysms involving visceral arteries, in urgent cases open repair remained a method of choice. The aim was to present a patient with symptomatic thoracoabdominal aortic aneurysm measuring 11 cm in diameter (Crawford III). Due to concomitant medication and morphology of aorta, there was neither possibility for open repair, nor for standard stent-graft implantation. We decided to apply Zenith t-Branch system, though visceral arteries anatomy haven’t met morphological criteria from instruction for use (IFU) and previous guidelines — patient had critically stenosed coeliac trunk, steep left renal artery, blood to right kidney was supplied through the thick thrombus and two extra kidney arteries to the lower pole were present. At first, balloon was placed into the right renal artery to protect it from embolization. Next, after Zenith Tx2 stent-graft deployment, t-Branch system was implanted. Through branch dedicated to coeliac trunk, left kidney artery was bridged using Advanta stents. Superior mesenteric artery and right kidney artery were bridged by appropriate branches. All bridges were reinforced by Zilver stents. Branch dedicated to left renal artery was occluded using Amplatzer plug. Postoperative recovery and 4-month follow-up was uneventful. In control computed tomography performed at third month shrinking of the sac was observed to 96 mm and low-pressure type II endoleak between coeliac trunk and additional left renal arteries has been left for further observation. Application of Zenith t-Branch is feasible and efficient method of treatment in urgent cases, even if visceral arteries anatomy is outside IFU

Stent-graft collapse after endovascular treatment of aortic dissection — case report and review of literature

Zastosowanie metody wewnątrznaczyniowej do leczenia rozwarstwień typu B stało się cenną alternatywą dla metody otwartej. Powikłania po zastosowaniu tej metody, mimo niższego odsetka występowania, stanowią ważny problem. Jednym z nich jest zapadnięcie się protezy. Celem pracy było przedstawienie przypadku zapadnięcia się stent-graftu po leczeniu wewnątrznaczyniowym z powodu rozwarstwienia oraz leczenia tego powikłania, a także podkreślenie wagi pooperacyjnej kontroli po implantacji endoprotezy. Mężczyzna 44-letni z opornym nadciśnieniem tętniczym, leczony wewnątrznaczyniowo z powodu rozwarstwienia aorty przed 6 laty, został przyjęty do kliniki z powodu bólu w klatce piersiowej i zmniejszenia dystansu chromania do około 50 metrów od roku. Tomografia komputerowa (CT) wykazała zapadnięcie się proksymalnej części stent-graftu Zenith w aorcie zstępującej i drożny kanał rzekomy rozwarstwienia. Zastosowano leczenie wewnątrznaczyniowe — wprowadzono dodatkowy stent-graft, skutecznie przywracając przepływ w kanale prawdziwym. W czasie rocznej obserwacji chory pozostał bezobjawowy, a kanał rzekomy uległ zakrzepicy. Zapadniecie się stent-graftu jest jednym z najrzadziej opisywanych powikłań występujących po leczeniu wewnątrznaczyniowym patologii aorty piersiowej. Mała krzywizna aorty, niedostateczne przyleganie protezy do jej wewnętrznej krzywizny oraz nadmierne przewymiarowanie stent-graftu są czynnikami, które mogą mieć wpływ na wystąpienie tego powikłania. Dlatego istotna jest ścisła kontrola radiologiczna po operacji. Metodą z wyboru leczenia zapadnięcia się stent-graftu powinno być postępowanie wewnątrznaczyniowe z założeniem dodatkowego stentu lub stent-graftu.Application of endovascular method for type B aortic dissection treatment is valuable option compared with open surgery. Despite the lower rate, complications in the endovascular treatment remain important issue. One of them is collapse of the prosthesis. The aim of the study was to present case of stent-graft collapse after endovascular treatment due to aortic dissection and management of this complication, and to highlight the weight of post-operative surveillance. A 44-year old male with resistant hypertension, treated due to aortic dissection 6 years ago, was admitted to Department of General, Vascular and Transplant Surgery of Warsaw Medical University, due to chest pain and decrease of claudication distance to 50 meters since last year. Computed tomography (CT) at admission revealed collapsed proximal part of Zenith stent-graft in descending aorta and fully patent false lumen of dissection. We performed endovascular treatment by additional Zenith stent-graft implantation, successfully restoring blood flow in the true lumen. In one-year observation patient remained asymptomatic and false lumen thrombosed. Stent-graft collapse is one of the rarest complications that occur after the endovascular treatment of the pathologies of thoracic aorta. Small radius of aorta, poor apposition to the inner curve of aorta and exceeding oversizing of the endograft were often reported as the etiology of the complication. Therefore strict CT surveillance is necessary due to wide spectrum of symptoms of collapsed prosthesis. Endovascular management with stent or stent-graft deployment should be first choice treatment

Aortoesophageal fistula as a complication of thoracic aorta stent graft implantation: two cases and literature review

Thoracic endovascular aortic repair (TEVAR) is a method of choice in the treatment of thoracic aorta aneurysmsand dissections. In case of a thoracoabdominal aneurysm, endovascular treatment is also being chosen moreoften, especially in patients with multimorbidity. Despite better results and less invasiveness in comparison toclassic open surgery, endovascular treatment is also associated with complications. One of the rarer and usuallyfatal complications are aortoesophageal fistula (AEF). We present two cases, in which TEVAR complicationwas AEF. Case 1 was an 87-year-old woman with a history of TEVAR 5 years earlier, who presented increasedinflammation parameters, massive gastrointestinal bleeding, and progressive anemia. Case 2 was a 66-year-oldwoman with a history of TEVAR 6 months earlier, who on admission presented medium increased inflammatorymarkers and anemia. None of the patients was qualified for surgical treatment. Both patient 1 and patient 2died during hospitalization. Diagnostic imaging plays a key role in the diagnosis of AEF. CT angiography performedin patients with AEF can show the presence of gas in the sac of aneurysm as a result of infection, a defect inthe aortic wall, or thickened esophagus with fluid level. CT angiography of the aorta combined with esophagogastroduodenoscopy(EGD) and contrast-enhanced X-ray examination of the gastrointestinal tract, enablesto confirm or exclude the diagnosis of AEF. Atypical clinical feature and increased parameters of inflammationin patients with the history of TEVAR should always suggest the presence of AEF

Urgent and emergent repair of complex aortic aneurysms using an off-the-shelf branched device

IntroductionEndovascular repair using off-the-shelf endografts is a viable solution in patients with ruptured or symptomatic complex aortic aneurysms. This analysis aimed to present the peri-operative and follow-up outcomes in urgent and emergent cases managed with the t-Branch multibranched thoracoabdominal endograft.MethodsProspectively collected data from all consecutive urgent and emergent cases managed in two aortic centers between January 1st, 2014, to November 30th, 2022, using the t-Branch device (Cook Medical Inc., Bjaeverskov, Denmark) were analyzed. Patients presenting with ruptured aortic complex aneurysms were characterized as emergent and patients with aneurysms >90 mm of diameter, or symptomatic aneurysms were characterized as urgent. Technical success, 30-day mortality, major adverse events (MAE) and spinal cord ischemia (SCI) rates were assessed.Results225 patients (36.5% females, 72.5 ± 2.8 years) were included; 73.0% were urgent. The mean aneurysm diameter was 109 ± 3.9 mm and 44.4% were type I–III TAAAs. Females (p = .03), para-renal aneurysms (p = .02) and ASA score IV (p < .001) were more common in emergent cases. Technical success was 97.8%. Thirty-day mortality and MAE rates were 17.8% and 30.6%, respectively. SCI rate was 14.7%, (4.8% paraplegia rate) with 22.2% of patients receiving prophylactic cerebrospinal drainage. Thirty-day mortality (13.3% vs. 26.7%, p = .04) and MAE (26.0% vs. 43.0%, p = .02) were more common among emergent cases while technical success (97.6% vs. 98.3%, p = .9), and SCI (13.3% vs. 18.3%, p = .4) were similar. Survival at 12-months was 83.5% (SE 5.9%) for the urgent and 77.1% (SE 8.2%) for the emergent group (log rank, p = 0.96).ConclusionT-Branch represents an effective and safe solution for the management of urgent and emergent cases with complex aortic aneurysms, with high technical success, promising early mortality and SCI rates

Evaluation of selected parameters of inflammation, coagulation system, and formation of extracellular neutrophil traps (NETs) in the perioperative period in patients undergoing endovascular treatment of thoracoabdominal aneurysm with a branched device (t-Branch)

Extracellular Neutrophils Traps (NETs) and their formation, known as NETosis, have become pivotal in the pathogenesis of aortic aneurysm development. This study investigates the NETosis markers with the assessment of selected parameters of inflammation and coagulation system in patients with thoracoabdominal aortic aneurysms in the pre-and postop period undergoing t-Branch stent-graft implantation. The study included 20 patients with thoracoabdominal aortic aneurysms. Three markers double-stranded DNA (dsDNA), single-stranded DNA (ssDNA), and citrullinated H3 histones (Cit-H3) were tested at three-time points from patients’ blood. The parameters of NETosis, inflammation, and coagulation system were examined in the preoperative period (within 24 h before surgery) and in the postoperative period (on the 3rd and 5th postoperative day). Free-circulating DNA (cfDNA) was isolated from the blood using the MagMAXTM Cell-Free DNA Extraction Kit. Double-stranded DNA (dsDNA) and single-stranded DNA (ssDNA) were then quantified using the Qubit dsDNA HS Assay Kit and the Qubit ssDNA Assay Kit. Cit-H3 concentration was determined by enzyme immunoassay ELISA (Cayman). The results revealed the significance of NETs secretion in response to the complex processes after stent-graft implantation. All NET markers increased shortly after surgery, with histones being the first to return to preoperative levels. The lack of normalization of dsDNA and ssDNA levels to preoperative levels by the last postoperative blood collection demonstrates NETs reorganization. The increase in the number of neutrophils was not related to the expansion of postoperative NETosis. The study reveals a new marker of NETosis, ssDNA, that has not been studied so far. The implantation of a stent graft in a patient with TAAA triggers an inflammatory response manifested by an increase in inflammatory parameters. One of the hallmarks of inflammation is the activation of neutrophil extracellular traps