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Juvenile nasopharyngeal angiofibroma-20 years of experience in endoscopic treatment

100%
Wierzbicka M., Balcerowiak A., Gawęcki W., Juszkat R., Wierzbicka M.
Polish Journal of Otolaryngology
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2021
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vol. 75
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issue 2
9-14
EN
Introduction: Juvenile nasopharyngeal angiofibroma is a rare, benign tumor; however, it shows local aggression and leads to profuse nosebleeds. Aim: The aim of the study is to present 20 years of experience in endoscopic treatment of this tumor. Material and methods: The material covers 71 patients treated in the years 1985–2019 at the Department of Otolaryngology and Laryngological Oncology in Poznań. In these patients, either the classic external approach, or the double approach – external with the use of endoscopes, or only the endoscopic approach was used. In the entire population, external surgeries were performed in 37 patients, double access in 8 and endoscopic access in 26 patients. Results: Complete resection of the tumor was achieved in 51 patients (72%). The remaining 20 patients (28%) had a residual or recurrent tumor and all of these patients underwent reoperation. Conclusions: The endoscopic approach with the use of various optics and navigation allows for the removal of not only small tumors but also much more advanced ones. Pre-operative evaluation of imaging results is extremely important to avoid incomplete tumor removal. Individual development of an operating strategy, a wide range of optics and various surgical methods, and especially endoscopic ones, are the guarantee of therapeutic success.
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Endovascular treatment of renal artery occlusion caused by aortic stentgraft migration

86%
Stanišić M. G., Majewska N., Romanowski M., Kulesza J., Juszkat R., Makałowski M., Majewski W.
Polish Journal of Surgery
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2015
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vol. 87
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issue 4
181-184
EN
Renal function impairment during interventional procedures became a real clinical problem. Contrast related nephropathy is the most common cause of renal failure, however, the procedure-related technical troubles may cause unexpected renal dysfunction.Technical failure of EVAR resulting in acute renal dysfunction is presented. The postprocedural occlusion of the right renal artery was treated in chimney technique. Early reintervention allowed the kidney preservation and renal function restoration. It is impossible to avoid all the complications following treatment of aortic aneurysm, but they can be anticipated and comprehensively treated in collaboration with other specialists.
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Endovascular Treatment of Symptomatic Stenosis of the Brachiocephalic Trunk

86%
Juszkat R., Pukacki F., Wachal K., Oszkinis G., Staniszewski R., Zieliński M., Majewski W.
Polish Journal of Surgery
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2007
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vol. 79
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issue 1
12-18
EN
The aim of the study was to present our own endovascular treatment results in cases of patients suffering from symptomatic stenosis of the brachiocephalic trunk.Material and methods. During the period between March 2000 and October 2004, 14 patients underwent angioplasty accompanied by stent implantation. The above-mentioned procedure was performed, due to critical, symptomatic stenosis of the brachiocephalic trunk. The patients were diagnosed and placed into different procedural groups based on the physical examination and radiological imaging examinations (Doppler ultrasound and DSA). The immediate and long-term results were evaluated with the physical examination and Doppler ultrasound examination performed at 3-, 6- and 12-months after the procedure.Results. In every patient, the immediate results were positive. Intraoperative DSA angiography confirmed that the artery was dilated. Preoperative clinical symptoms of cerebral and collateral circulation insufficiency in the upper extremity were limited (5/14) or totally regressed (9/14) during the postoperative period. During the intra- and postoperative period, none of the following complications were found: upper extremity arterial embolism, acute arterial thrombosis, dissection or rupture of the brachiocephalic trunk wall, or death. Patients were discharged 2 or 3 days following the procedure. Follow-up examinations confirmed proper blood flow in the brachiocephalic trunk and increased flow in the right vertebral artery. No symptoms of restenosis were found in the area of stent implantation and the stent was not dislocated.Conclusions. Angioplasty accompanied by stent implantation is a safe and efficient treatment method in the case of patients suffering from symptomatic stenosis of the brachiocephalic trunk, particularly in patients with significant operative risk. The hypothesis was confirmed by both perioperative observations and immediate, as well as, long-term patency results.
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Traumatic Injuries to Subclavian Arteries Treated with Stentgraft Implantation

86%
Juszkat R., Stanišić M., Dzieciuchowicz Ł., Staniszewski R., Pukacki F., Oszkinis G., Majewski W.
Polish Journal of Surgery
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2007
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vol. 79
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issue 1
29-35
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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Contemporary Indications and own Results of Surgical Treatment of occlusions of the initial section of the Left subclavian artery

73%
Pukacki F., Zieliński M., Oszkinis G., Juszkat R., Gabriel M., Słowiński M., Zapalski S., Majewski W.
Polish Journal of Surgery
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2010
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vol. 82
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issue 5
272-278
EN
Symptomatic occlusion of the initial section of the subclavian artery, resistant to intravascular treatment, is an indication for a surgery as it exacerbates the verterbrobasilar insufficiency and creates the risk of peripheral embolism. Reconstructive surgery fixes the reversed blood flow in the vertebral artery, alleviates neurological and limb ischemia symptoms.The aim of the study was to retrospectively evaluate the results of surgical treatment of the occlusion of the initial section of the subclavian artery using transposition or subclavian-carotid by-pass with a PTFE.Material and methods. Retrospective analysis covered 55 patients operated on between June 1996 and August 2008 for occlusion of the left subclavian artery. 39 patients underwent a subclavian artery transposition (SCT) and the remaining 16 had a subclavian-carotid by-pass (SCB) using a PTFE. Indications for surgery included ischeamic symptoms in the upper limb and impaired vertebrobasilar circulation. Clinical symptoms occurred in the following order: vertebrobasilar insufficiency and upper limb ischemia (62%), upper limb ischemia symptoms (22%), vertebrobasilar insufficiency (16%).Results. There were no early deaths (by day 30). Ischemia was lifted in 100% of the patients operated using transposition and in 93% of those with a by-pass. In the perioperative period, one patient had a bypass thrombosis, and 2 patients had a transitional brain ischemia. These incidents affected patients who underwent subclavian-carotid by-pass. In the late postoperative period, 12 patients (21.81%) died due to cardiological complications and 7 patients (12.72%) for other causes, and none of them was related to the primary surgery. All patients with transposition have maintained the primary patency, with average follow-up period of 73 months (23-138). In the group with a by-pass, occlusion occurred in 3 patients in the first follow-up month. These incidents had no effect on survival rates. For the remaining 14/16 patients from the SCB group the average primary patency was 63.4 (8-104) months.Conclusions. Subclavian-carotid transposition is a safe and effective method of upper limb revascularization. It is technically more difficult than the by-pass but ensures a better short-term and long-term result.
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