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EN
The aim of the study was to compare clinical and duplex Doppler results of treatment of varicose veins with four methods of endovenous thermal ablation (EVTA).Material and methods. The results of treatment of varicose veins with 980 nm laser (EVLA980) in 67 extremities, with a radiofrequency ablation (RFA) in 43 extremities, with 810 nm laser (EVLA810) in 46 extremities and with 1470 nm laser (EVLA1470) in 15 extremities were prospectively analyzed. The data on patients' demographics, weight, stage of the venous disease, type of anesthesia, duration of the procedure, linear energy density (LED) applied, intra- and postoperative complications were collected. Thromboprophylaxis was not routinely administered. The patients were followed clinically and with duplex Doppler for 12 (1-24) months.Results. Technical success was achieved in 99% of limbs. The procedure was carried out under local anesthesia in 140 (91%) of patients. In 17 patients bilateral procedure was performed. There were one gastroenemius muscle vein thrombosis and one protruding thrombus from sapheno-femoral junction in EVLA810. No other serious complications were observed. A median LED was higher in EVLA810 than in EVLA980 and EVLA1470, 86.8 (82-94), 59.2 (45.4-74.4) and 58.8 (53-67.7) J/cm, respectively (p<0.001), though only in EVLA980 was below the intended range. Recanalization rates were 7% after EVLA980, 2% after EVLA810 and 0% after RFA and EVLA1470, p=0.14. The vein shrinking was fastest after EVLA1470. Neither neovascularization nor formation of arteriovenous fistulas was observed. Permanent saphenous nerve paresthesia occurred in two patients after RFA.Conclusions. All methods of ambulatory EVTA are safe and effective once the adequate linear energy density is applied.
EN
In this report, a 74-year old male with atypical emboli of the aortic and superior mesenteric arteries is presented. In the period preceding the occurrence of emboli, patients complained of malaise, low grade fever and weight loss. Incidentally, the patient underwent coronary artery bypass grafting two years prior to presentation. The pathologic examination of the embolus revealed the presence of typical Aspergillus spp hyphae. The presence of Aspergillus spp antigen in the patient serum was confirmed by an immunoenzymatic test. The transthoracic echocardiography did not show any signs of endocarditis or vegetations on the valves. Transesophageal echocardiography and angio-CT demonstrated lesions consistent with Aspergillus aortitis in the ascending aorta. The basic clinical features of Aspergillus aortitis and aspergillus emboli are discussed in this report.
EN
A case of a progressive ischemia of the right upper extremity in a 57-year-old male caused by primarily undiagnosed compression of a subclavian artery by an accessory cervical rib is presented. Critical limb ischemia persisting for 7 years despite conservative treatment and a thrombectomy of upper extremity arteries and thoracic sympathectomy, led to a loss of three fingers and development of a non-healing ulceration of right upper extremity. Eventually a cervical rib resection together with a subclavio-brachial venous bypass graft permanently reversed the critical limb ischemia and allowed the ulceration to heal.The presented case underscores the importance of an early surgical intervention in patients with upper limb ischemia and anatomic abnormalities in a thoracic outlet.
EN
Venous diseases, in particular varicose veins of the lower extremities, are one of the most common chronic diseases and a significant cause of morbidity in Europe and the USA. Varicose veins are considered a risk factor for deep vein thrombosis. Most patients with varicose veins have great saphenous vein ostial insufficiency and reflux of varying degrees. Standard treatment in these cases is high ligation and stripping of the great saphenous vein. This surgery, however, carries a risk of thrombotic complications. Minimally invasive procedures, which include endovenous laser ablation of the great saphenous vein, are the current world trends. This method is a relatively new treatment option for great saphenous vein reflux. The authors present the current state of knowledge on the risk of deep vein thrombosis after different surgical procedures for the treatment of varicose veins in the lower extremity. The literature analysis has led to a hypothesis that lower limb varicose vein surgeries that involve laser obliteration of the great or small saphenous veins carry a lower risk of deep vein thrombosis compared with conventional surgeries. Tumescent anaesthesia, short duration of the procedure and rapid return to physical activity may play a role in deep vein thrombosis prevention. The authors underline that thromboprophylaxis should be implemented irrespective of the method, using risk evaluation, e.g. based on the Caprini scale.
PL
Choroby układu żylnego, a zwłaszcza żylaki kończyn dolnych, są jedną z najczęstszych chorób przewlekłych, a także zasadniczym powodem chorobowości w Europie i USA. Żylaki kończyn dolnych wymieniane są także jako czynnik ryzyka zakrzepicy żył głębokich. Większość chorych z żylakami ma niewydolne ujście żyły odpiszczelowej i różnego stopnia refluks. Standardowym leczeniem w tym wypadku jest wysokie podwiązanie żyły odpiszczelowej i jej stripping. Operacja ta jest obarczona również ryzykiem wystąpienia powikłań zakrzepowych. Obecnie trend światowy stanowią operacje małoinwazyjne, do których należy wewnątrzżylna laserowa ablacja żyły odpiszczelowej. Jest ona stosunkowo nową opcją leczenia refluksu w żyle odpiszczelowej. Autorzy przedstawiają obecny stan wiedzy na temat ryzyka zakrzepicy żył głębokich w odniesieniu do różnych zabiegów operacyjnych żylaków kończyn dolnych. Po analizie piśmiennictwa światowego stawiają tezę, że operacje żylaków kończyn dolnych, w trakcie których wykonuje się obliterację laserową żyły odpiszczelowej lub odstrzałkowej, obarczone są mniejszym ryzykiem zakrzepicy żył głębokich w porównaniu z operacjami klasycznymi. Znaczenie w zapobieganiu zakrzepicy żył głębokich mogą mieć znieczulenie tumescencyjne, krótszy czas zabiegu oraz szybki powrót do normalnej aktywności fizycznej. Autorzy podkreślają jednocześnie, że profilaktykę przeciwzakrzepową należy wdrażać niezależnie od metody, stosując do określenia wskazań ocenę ryzyka wystąpienia tego typu powikłań, np. w oparciu o skalę Capriniego.
EN
In spite of the fact duplex Doppler ultrasonography is recognized as an scanning technique equivalent to other imaging methods for preoperative diagnostics of the lower extremity arteries, in many centres its use is limited to screening.The aim of the study was to the determine usefulness of arterial duplex mapping for preoperative diagnostics in patients with peripheral artery occlusive disease (PAOD)Material and methods. In 2008-2009, 103 patients with PAOD symptoms (129 limbs) were examined in a prospective, non-randomized study. DUAM was performed in all limbs, DSA in 90, CT-angio in 29, and revascularisation procedures in 116 limbs.Results. Problems with completing DUAM occurred in 10,1% of cases, including 1.5% of examinations of no diagnostic value. Consistency of DUAM and DSA results was found in 94.6% of cases, and consistency of DUAM results and the range of actually performed ranges was found in 97.8% of cases. Consistency of DUAM and CT-angio results was recorded in 68.0% of cases. The comparison between individual examinations and the actually performed procedures showed consistency of 96.5% for DUAM and 72.4% for CT-angio.Conclusions. DUAM usefulness for detecting and defining lesions in lower extremity arteries is similar to that of DSA and CT-angio. This examination may be successfully used in preoperative diagnostics, particularly for intravascular procedures, which makes possible to reduce exposition to radiation and minimalize diagnostics costs.
EN
The aim of the study was to present the experience of our centre in endovascular treatment for subclavian artery injuries.Material and methods. In the years 2000-2005, seven patients (five men and two women, aged 28 to 69 years) with traumatic injuries to their subclavian arteries were treated in the Department of General and Vascular Surgery and Department of Radiology. Four patients were diagnosed with post-traumatic aneurysms including one iatrogenic aneurysm following fixation of a fractured clavicle; one patient experienced post-traumatic injury to subclavian artery; one with iatrogenic perforation of subclavian artery with bleeding into pleural cavity; and the last one with another iatrogenic injury resulting from attempts to place a central access line following surgical, restoration of patency within subclavian and axillary arteries. All patients underwent endovascular treatment with the use of self-expanding peripheral stentgrafts (Wallgraft, Boston Scientific, USA).Results. The procedure of stentgraft implantation was successfully performed in all seven patients. In the patient with iatrogenic injury to the subclavian artery, blood extravasation around the stent was observed the next day, which required the stent to be additionally expanded with a balloon catheter. No complications during or immediately after the procedure were detected in any patient. The patient with iatrogenic injury to the subclavian artery following clavicle fracture suffered from thrombosis within the brachial artery during the third week after the procedure.Conclusions. Endovascular treatment of subclavian artery injuries with the use of peripheral stentgrafts is an efficient method that is associated with low complication rates and should be the method of choice in the treatment of subclavian artery injuries.
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