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Influence of Atheromatous Lesions in the Ilio-Femoral Segment on the Occurrence of Stentgraft Thrombosis After Endovascular Treatment of an Abdominal Aortic Aneurysm

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Solonynko B., Gałązka Z., Jakimowicz T., Szmidt J.

Polish Journal of Surgery

2012

vol. 84

issue 11

551-559

Limb graft thrombosis (LGT) is one of the most frequent severe complications after endovascular repair of abdominal aortic aneurysms. The aim of the study was to assess the influence of atherosclerosis in ileo-femoral segment on the incidence of LGT as well as to analyze the methods of treatment of LGT. Material and methods. The medical records of 564 consecutive patients operated endovascularly for abdominal aortic aneurysm by means of bifurcated stentgrafts in the Department of General, Vascular and Transplantat Surgery of Medical University of Warsaw were analyzed. The minimal observation time after surgery was one year. Patients with inflammatory, ruptured and falls aneurysms as well as those with the observation period below 12 months were excluded from the study. Patients were divided into two groups: test (B) and control (K) depending on the progression of atherosclerosis in the iliac arteries. Group B included 184 patients (13 women and 171 men), with advanced atherosclerotic lesions of ilio-femoral segment, corresponding to the A - C class in the TASC classification. The remaining 380 patients (25 women and 355 men) without significant blood flow disorders in the iliac arteries, constituted the group K. The computed tomography was done in all patients with acute limb ischemia. Results. During the observation time up to 114 month, the LGT occurred in 43 (7.6%) cases: [group B - 34/184 (18.5%), group K - 9/380 (2.4%)]. The treatment of LGT included an attempt of patency restoring of the prosthesis by means of thrombolysis or thrombectomy combined with stenting. In case of failure the cross-over femoro-femoral bypass was implanted. Thrombectomy was successful in 21 of 40 cases (52.5%), the local thrombolysis was done in 5 patients and it was successful in three cases and in the remaining two patients the thrombectomy was done. In 16 of 24 patients after patency restoring of the prosthesis the angioplastics and stenting was done. In 17 cases the femoro-femoral bypass was implanted. Conclusions. The atherosclerosis in ileo-femoral segment significantly increases the risk of LGT. An attempt of patency restoring (thrombectomia or thrombolysis) combined with stenting and cross-over femoro- femoral bypass implantation in case of failure seems to be the successful method of LGT treatment.

The importance of blood flow volume in the brainsupplying arteries for the clinical management – the impact of collateral circulation

76%

Elwertowski M., Leszczyński J., Kaszczewski P., Lamparski K., Sin Yee Ho S., Gałązka Z.

Journal of Ultrasonography

2018

vol. 18

issue 73

112-119

Aim: An assessment of increased compensatory blood flow in the brain-supplying arteries in patients with significant carotid artery stenosis. Materials and methods: Doppler ultrasound was performed in 218 patients over 60 years of age to evaluate both the degree of brain-supplying artery stenosis as well as the blood flow volume balance in all vessels supplying the brain: the internal carotid artery, the external carotid artery and the vertebral artery. The control group included 94 patients with no stenosis in the extracranial segments and no neurological manifestations, in whom blood flow values were calculated (the internal carotid artery – 290 mL/min, the external carotid artery – 125 mL/min, the vertebral artery – 80 mL/min); the total mean blood flow in the brain-supplying arteries was 985 mL/min. A 33% increase in blood flow was considered compensatory. In addition to the control group, 30 patients with asymptomatic stenosis of less than 50% and 12 patients after endarterectomy with mean blood flow of 920 mL/min and 960 mL/min, as well as two groups of particular interest to us, i.e. 38 patients with no compensatory blood flow increase despite significant stenosis (>50%) with mean blood flow of 844 mL/ min and 44 patients with similar stenosis and with compensatory blood flow increase up to 1174 mL/min were included in the analysis. Results: Comparison of the two groups showed several significant differences: increased blood flow (118% vs. 86% of the norm) in patients with compensated stenosis, an increased number of asymptomatic patients (70% vs. 37%) and a threefold increase in the number of patients with occlusions (15 : 5) in the group of patients with increased blood supply to the brain. Conclusions: All potential blood-supplying vessels, including the external carotid artery, are involved in brain tissue perfusion in some of the patients with significant stenosis. Determining the degree of compensation may have an important impact on the indications for surgical treatment, which will make a valuable contribution to the current criteria (asymptomatic/ symptomatic patients).

Cel pracy: Ocena wpływu kompensacyjnego wzrostu przepływu w naczyniach dogłowowych u chorych z istotnymi zwężeniami tętnic szyjnych. Materiał i metoda: U 218 chorych powyżej 60. roku życia wykonano rozszerzone badanie ultrasonograficzne z opcją dopplera w celu oceny zarówno stopnia zwężenia naczyń dogłowowych, jak i bilansu objętości przepływu we wszystkich głównych naczyniach doprowadzających krew do mózgu: tętnicy szyjnej wewnętrznej, tętnicy szyjnej zewnętrznej i tętnicy kręgowej. Grupę kontrolną stanowiło 94 pacjentów bez zwężeń naczyń w odcinkach przedczaszkowych oraz bez objawów neurologicznych, u których obliczono normy przepływu w naczyniach (tętnica szyjna wewnętrzna – 290 ml/min, tętnica szyjna zewnętrzna – 125 ml/min, tętnica kręgowa – 80 ml/min); całkowity przepływ w naczyniach dogłowowych wynosił u nich średnio 985 ml/min. Za kompensacyjny wzrost uznano zwiększenie przepływu o 33%. Poza grupą kontrolną analizie poddano 30 pacjentów z bezobjawowymi zwężeniami poniżej 50% i 12 osób po endarterektomii ze średnimi przepływami 920 ml/min i 960 ml/min, a także dwie szczególnie interesujące nas grupy: 38 pacjentów bez kompensacyjnego wzrostu przepływu pomimo istotnych (>50%) zwężeń ze średnim przepływem 844 ml/min oraz 44 chorych z kompensacyjnym wzrostem przepływu do 1174 ml/min przy podobnych zwężeniach. Wyniki: Porównanie dwóch grup wykazało kilka istotnych różnic: większy przepływ (118% vs 86% normy) u chorych ze skompensowanymi zwężeniami, większą liczbę chorych bezobjawowych (70% vs 37%) oraz trzykrotnie więcej chorych z niedrożnościami (15 : 5) w grupie pacjentów ze zwiększonymi przepływami domózgowymi. Wnioski: Wszystkie naczynia mogące doprowadzić krew do mózgu, w tym tętnica szyjna zewnętrzna, u części chorych z istotnymi zwężeniami biorą udział w zapewnieniu perfuzji tkanki mózgowej. Określenie stopnia kompensacji może w istotny sposób wpłynąć na wskazania do leczenia zabiegowego, co stanowi cenne uzupełnienie dotychczasowych kryteriów (pacjenci bezobjawowi/objawowi).

Influence of Suprarenal Stentgraft Fixation on Renal Function in Patients After Abdominal Aortic Aneurysm Endovascular Exclusion

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Gałązka Z., Szmidt J., Rowiński O., Jakimowicz T., Nazarewski S., Grochowiecki T., Grygiel K., Wojtaszek M., Pietrasik K., Chudziński W., Pacho R.

Polish Journal of Surgery

2007

vol. 79

issue 1

4-11

Currently, there are two methods of stentgraft implantation considering patients with abdominal aortic aneurysms (AAA) undergoing endovascular repair: the suprarenal and infrarenal fixation. It has been suggested that suprarenal fixation may lead towards impaired kidney function.The aim of the study was to assess the influence of suprarenal stentgraft fixation on kidney function in patients after endovascular repair of abdominal aortic aneurysms.Material and methods. The inclusion criteria were fulfilled by 118 patients who were subjected to endovascular treatment, due to abdominal aortic aneurysms. They were consequently divided into two groups - suprarenal (NN) or infrarenal (PN) - based on the stentgraft system used. Both groups were compared on the basis of co-morbidities, operative risk (ASA score), and volume of contrast medium used intraoperatively. The creatinine concentration (cr) and creatinine clearance (Cr.cl) were assessed during the preoperative period, between the 3-rd and 7-th postoperative day, and after 3 months.Results. Increased creatinine level during the first postoperative week was observed in 12 of 118 patients (10.1%): in the suprarenal group - 7 of 66 (10.6%), and in the infrarenal group 5 of 52 (9.96%). During the 3-rd postoperative month the increase (cr > 1.5 mg/dL) was present in 3 of 118 patients (2.5%): in the suprarenal group - 2 of 66 (3.03%) and in the infrarenal group-1 of 52 (1.9%). The difference between both groups was statistically insignificant. Furthermore, there was no statistically significant difference between creatinine clearance levels considering both groups.Conclusions. In case of patients undergoing endovascular repair for AAA, implantation of a suprarenal device is a safe method, which does not significantly impair postoperative renal functioning. This increases the number of patients eligible for AAA treatment by means of stentgraft implantations.

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2 Polish Journal of Surgery

1 Journal of Ultrasonography

1 2018

1 2012

1 2007

3 Gałązka Z.

2 Jakimowicz T.

2 Szmidt J.

1 Chudziński W.

1 Elwertowski M.

1 Grochowiecki T.

1 Grygiel K.

1 Kaszczewski P.

1 Lamparski K.

1 Leszczyński J.

1 Nazarewski S.

1 Pacho R.

1 Pietrasik K.

1 Rowiński O.

1 Sin Yee Ho S.

1 Solonynko B.

1 Wojtaszek M.

Search results

Influence of Atheromatous Lesions in the Ilio-Femoral Segment on the Occurrence of Stentgraft Thrombosis After Endovascular Treatment of an Abdominal Aortic Aneurysm

The importance of blood flow volume in the brainsupplying arteries for the clinical management – the impact of collateral circulation

Influence of Suprarenal Stentgraft Fixation on Renal Function in Patients After Abdominal Aortic Aneurysm Endovascular Exclusion