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C-Reactive Protein within the Wall of Large Abdominal Aortic Aneurysms; Pathophysiological Implications. A Preliminary Study

100%
Cnotliwy M., Kolasa A., Kwas A., Kazimierczak A., Wiernicki I.
Polish Journal of Surgery
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2010
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vol. 82
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issue 4
193-198
EN
The aim of the study was to evaluate the presence and distribution of C-reactive protein (CRP) at the site of the abdominal aortic aneurysm (AAA) suck to determine its potential role in AAA ruptureMaterial and methods. Samples of abdominal aortic aneurysms were obtained from 16 patients during elective surgery. These samples were taken from three places at each three levels of the aneurysmal sack: the neck, at the region of maximum diameter and above bifurcation. The cryostat sections were immunostained for CRP visualization using a specific primary mouse monoclonal anti-C-reactive protein antibody. All the specimens were analyzed morphometrically. The data was analized as the ratio of the active surface of the specimen to its total surface in percentage value.Results. No statistically significant differences between CRP concentrations were found that depended on the site of the aneurysmal sack. However, there exists an average linear correlation between CRP concentration, which is defined as the ratio of the active surface of the specimen to its total surface in percentage value, and the thickness of the adjacent thrombus (Pearson's correlation ratio; r=0.42) with statistical significance of (p<0.00001)Conclusions. The detection of C-reactive protein within the aneurismal wall is not solely sufficient to determine its role in the destruction that eventually leads to a large abdominal aortic aneurysm rupture. It is necessary then to prove an association between not only the metabolism of CRP but also the complement system activation and inflammatory cells response.
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The Role of Isolated Profundaplasty in Attempts to Lower the Level of Amputation in Critical Limb Ischemia

86%
Cnotliwy M., Szumiłowicz J., Safranow K., Petriczko W., Wiernicki I., Gutowski P.
Polish Journal of Surgery
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2007
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vol. 79
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issue 12
773-778
EN
The aim of the study was to verify the usefulness of isolated profundaplasty performed prior to amputation in attempts to salvage the knee joint in patients scheduled for the major amputation due to critical limb ischemia.Material and methods. The study enrolled 46 patients treated between January 1992 and December 2005 due to critical limb ischemia who were primarily scheduled for major amputation. Arteriography performed in all studied patients disqualified these patients from attempts to reconstruct the lower leg arteries, but simultaneously provided information on possibilities for profunda repair. A few days prior to below-knee amputation, a profundaplasty was performed. The following parameters were evaluated: the course of wound healing in the groin and tibial stump, the rate of conversion of the transtibial amputation to an above-knee amputation and patency of the deep femoral artery 12 months postoperatively.Results. One patient died within the first 30 postoperative days. Complications of wound healing in the groin requiring surgical debridement occurred in 7 patients. Early conversion to above-knee amputation was necessary in 10 cases due to lack of stump healing; this group included 6 patients with infected pedal tissue necrosis and 4 patients with reocclusion of the deep femoral artery. The cumulative proportion of survivors at 12 months with a preserved knee joint was 0.50, and that of those with a patent deep femoral artery was 0.47. No significant differences were found between profundaplasty methods regarding patency of the deep femoral artery and tibial stump healing. Similarly, no significant differences were found between diabetic and non-diabetic patients. It has been found that infection of pedal tissue necrosis had a significant negative influence on the patency of the deep femoral artery following the profundaplasty (p=0.02) and resulted in lower rates of salvage of the knee joint (p=0.0002)Conclusions. 1. In the case when other methods of vascular reconstruction are no longer possible, an isolated profundoplasty performed prior to below-knee amputation creates a chance for stump healing and salvage of the knee joint for the patients with critical limb ischemia who have no infection within the foot. 2. Pedal tissue infection in the same group of patients should constitute an indication for primary above-knee amputation.
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