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Outcomes of Iatrogenic Femoral Artery Lesions - Treatment Results Valuation

100%
Łukasiewicz A., Hryncewicz W., Rychter M., Molski S.
Polish Journal of Surgery
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2009
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vol. 81
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issue 4
172-179
EN
Percutaneous cardiac interventions are nowadays the most common cause of the femoral artery injury. In these cases, surgical intervention was for many years considered the treatment of choice. Satisfactory results of conservative and minimally invasive treatment has changed the state of art.The aim of the study was the analysis of treatment results in patients with iatrogenic femoral aneurysm.Material and methods. In the period of 3 years between 2004 and 2006 in 66 patients an iatrogenic, spure femoral artery aneurysm was recognized. There were 36 women and 30 men in this group. The mean age was 68.8 years. All patients were included prospectively in the study. According to aneurysm morphology, compression pliability and patient choice 45 individuals were assigned to OT group, remaining 21 were treated conservatively: US-guided compression in all patients and thrombin injection if compression failed.Results. There was one death in OT group due to underlying coronary disease and in our opinion unrelated to surgical treatment. Other major adverse events were one postoperative stroke in OT group and superficial femoral artery thrombosis in NT group. 8 patients experienced minor events and they all were operative wound complications. No other complications were observed in NT group. Post procedural stay was longer for the OT group (8.7 vs 3.8 days, p<0.05). Length of hospital stay was also significantly correlated with presence of complications (5.5 days for patients without complications and 16.9 days for the complicated cases, p<0.001). The procedure was successful in 95.2% and 100% in the groups of NT and OT respectively.Conclusions. Utilized criteria of patients' assignment to conservative and operative treatment allowed plausible treatment results. OT and complications significantly increase the length of hospitalization. It is mandatory to remember of possible thrombotic complications related to thrombin injections.
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Frequency of Deep Vein Thrombosis in Immobilized Patients after Spinal Cord Injury and Severe Brain Trauma

76%
Mackiewicz-Milewska M., Lach-Inszczak S., Hryncewicz W., Pilecki S., Hagner W., Dymek G., Szymkuć I.
Polish Journal of Surgery
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2009
|
vol. 81
|
issue 4
180-185
EN
Patients after spinal cord injury, severe brain trauma and cerebral stroke (ischemic or hemorrhagic) are often immobilized in bed or wheelchair for months or even years. One of the main risk factor for deep vein thrombosis is just prolonged immobilization.The aim of the study was to evaluate the frequency of symptomatic and asymptomatic thrombosis among immobilized patients because of severe brain damage and spinal cord injury.Material and methods. The study included 59 patients with tetra or paraparesis after severe brain damage or spinal cord injury, hospitalized in the University Hospital in Bydgoszcz in the Department of Rehabilitation over the period 2007-2008. All of them had lower extremities duplex-scan ultrasound as a screening examination and D-dimer testing.Results. Thrombosis was confirmed in nine patients (15% of all examined) and two patients (23%) in his group were of asymptomatic. 77% of diagnosed patients had only low extremities edema. Full symptomatic thrombosis with low extremities edema, increased warmness and redness were observed in 22% of patients.Conclusions. It is advisable to make periodical lower extremities venous system examination to exclude deep vein thrombosis. The risk of missed diagnosis in this group of patients is connected with increased percentage of embolism complications during the rehabilitation process. In patients after spinal cord injury, there are indications to examine the patients' venous system periodically.
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