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The changes of plasma thrombin-antithrombin complex in the patients with peripheral arterial disease undergoing surgical revascularization

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Kęsik J. J., Wroński J., Feldo M., Terlecki P., Zubilewicz T.
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vol. 85
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issue 11
638-643
EN
In patients with severe lower limb ischemia the coagulation and fibrinolytic systems have been found to be activated preoperatively. The aim of the study was to evaluate the changes of TAT level as a selected coagulation factor, before, during and after surgical revascularization and the analysis of the impact of coexisting diseases on the coagulation during the procedure. Material and methods. 50 patients with PAOD, in Fontaine stages IIb to IV (29 men and 21 women; median age 65.8 years, ASA II/III) undergoing elective surgical revascularization were studied. Two groups of patients were compared: 20 undergoing reconstruction on aorto-femoral and 30 on femoropopliteal level. Blood samples were collected 5 times: 24 hours before the operation; intraoperatively after artery exposure; after heparin administration and clamping; after reperfusion and -24 hours postoperatively. Results. Elevated values of TAT (10.5 g/l ±7.1) were found before the operation. The elevated value of TAT increased intraoperatively (25.1 g/l ±44.58; p<0.001) (norm 1-4.1 g/l) and maintaining higher levels after the surgery. The significant correlations between plasma level of TAT and ischemia degree were found. Also the correlation between intraoperative increase of TAT and the duration of surgery was noticed. No significant differences between two analysed groups were observed. Conclusions. The results indicate the activation of coagulation and prothrombotic state in the patients with advanced arteriosclerosis. During the surgical revascularisation permanent increase of activation of blood coagulation was observed. This activation depends on duration of the procedure and maintains increased one-day after the operation. Our findings may explain the unexpected occurrence of early thrombotic complications after technically successful vascular reconstructions.
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The new era in the treatment of deep vein occlusion

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Kęsik J. J., Terlecki P., Feldo M., Pietura R., Zubilewicz T.
Polish Journal of Public Health
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2015
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vol. 125
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issue 1
36-38
EN
A non-invasive, conservative treatment has been a standard in treating acute and chronic deep vein thrombosis. This treatment turned out to be ineffective, particularly in the hip area. Also, it was demonstrated that it does not influence the frequency of manifestations of post-thrombotic syndrome. Previous attempts to surgically reconstruct deep veins, unlike arteries reconstruction, yielded no positive results and also increased hemorrhagic and embolic complications. Currently, already in the period of the acute thrombosis of deep veins, the methods of early re-canalization, both with the application of targeted thrombolisis, as well as of pharmacomechanical methods, are applied. Thanks to a wide array of image examination methods applied in pre-operational and intra-operational diagnostics optimum, it is possible to plan a revascularising treatment in the sick individuals suffering from the already developed manifestations of the post-thrombotic syndrome. The development of endovascular methods, made possible thanks both to the surgeons’ experience in the re-canalization field, as well as constant improvements of stents dedicated to the venous system, allowed for effective use of these techniques in curing the occlusion of deep veins. It was the case with the arterial system and works here as well. Applying the hybrid proceeding, combining opened techniques and endovascular ones, works very well in selected cases.
3
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Efficacy Evaluation Of Bio Trombina ® 400 In Mini Mall Y Invasive Treatment of Complications (Pseudoaneurysms), After Venipuncture for Diagnostic Purposes. Authors’ Own Experience – Case Study of 38 Patients

86%
Iłżecki M., Zubilewicz T., Przywara S., Wojtak A., Kęsik J. J., Olejniczak-Nowakowska M., Terlecki P.
Polish Journal of Surgery
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2015
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vol. 86
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issue 8
359-363
EN
Common use of venipuncture on upper and lower limbs for diagnostic purposes (such as coronarography or arteriography), and also during the course of treatment (angioplasty), very often bares a complication in the form of pseudoaneurysms. According to various reports, the incidence of pseudoaneurysms ranges from 0.005% to 0.5% of all vascular procedures requiring arterial cannulation (Common Femoral Artery, Brachial Artery, Radial Artery). The use of Bio Trombina® 400 in the embolization of pseudoaneurysms allows minimally invasive and effective treatment. The aim of the study was to evaluate the efficacy of pseudoaneurysm embolization with the use of Trombina 400, authors’ own experience. Material and methods. In the years 2011 - 2013, the authors of this study performed 38 vascular interventional procedures involving pseudoaneurysms as complications of venipuncture in upper and lower limbs for diagnostic and treatment purposes. All procedures involved the direct injection of thrombin into the chamber of the pseudoaneurysm under the guidance of USG Doppler (6.2 MHz linear head). 34 cases presented single chamber pseudoaneurysms while 4 cases involved multi- chamber pseudoaneurysms, which required several thrombin reinjections (Bio Trombina® 400) into each of the chambers. Pseudoaneurysm maximum size of 4 cm was set as an inclusion criterion for the embolization procedure. Furthermore, all pseudoaneurysms with a significantly wide tract in transverse dimensions were treated as an exclusion criterion because of high risk of the peripheral arteries embolization. Results. Initial success was observed in 36 patients (94.73%) in the first day after the procedure, 1 patient (2.63%) underwent thrombin reinjection procedure in the second day after the first embolization. Another patient (2.63%) underwent an open procedure in which the Common Femoral Artery was accessed, the clot evacuated, and CFA was sutured with continuous suture Prolene 6-0. Conclusions. 1. Embolization of pseudoaneurysms with USG Doppler-guided thrombin injection is an effective course of treatment for complications of cannulation. 2. The safety of pseudoaneurysm embolization depends on a surgeon’s experience. It is also crucial to keep in mind the inclusion and exclusion criteria for this type of procedure (the size of a pseudoaneurysm, the width of its base). 3. Furthermore, its cost effectiveness and short hospitalization period make pseudoaneurysm embolization an effective and valuable alternative to the classic approach.
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