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Critical Upper Limb Ischemia Caused by Initially Undiagnosed Thoracic Outlet Syndrome - Case Report

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Dzieciuchowicz Ł., Włodarczyk W., Oszkinis G.
Polish Journal of Surgery
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2012
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vol. 84
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issue 3
158-162
EN
A case of a progressive ischemia of the right upper extremity in a 57-year-old male caused by primarily undiagnosed compression of a subclavian artery by an accessory cervical rib is presented. Critical limb ischemia persisting for 7 years despite conservative treatment and a thrombectomy of upper extremity arteries and thoracic sympathectomy, led to a loss of three fingers and development of a non-healing ulceration of right upper extremity. Eventually a cervical rib resection together with a subclavio-brachial venous bypass graft permanently reversed the critical limb ischemia and allowed the ulceration to heal.The presented case underscores the importance of an early surgical intervention in patients with upper limb ischemia and anatomic abnormalities in a thoracic outlet.
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Treatment of Vascular Prosthesis Infections - 15 Years of Experience

80%
Kielar M., Lewczuk A., Tur W.
Polish Journal of Surgery
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2010
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vol. 82
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issue 3
130-139
EN
The aim of the study was to present the results of treatment for vascular prosthesis infections.Material and methods. From January 1993 until January 2008, 47 patients were treated at Department of General and Vascular Surgery Bródnowski Hospital due to symptomatic, late vascular graft infections. The most common local symptoms were groin abscesses, often with bleeding complications. All patients with diagnosed vascular prosthesis infections were treated operatively.Results. Fifty-three operations were performed, resulting in the regression of infection symptoms in 17 cases (63%), with 37% of cases leading to amputation. Mortality in the patients examined amounted to 37%; 46.4% of cases displayed recurrent infection. The period of hospital treatment oscillated between 12 to 221 days (av. 74 days).Conclusions. 1. Aggressive operative treatment of vascular prosthesis infections is burdened by high percentages of recurrence and amputation. 2. Less radical operative treatment techniques yield similar results. 3. A uniform protocol for diagnosed vascular prosthesis infection is currently lacking.
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The changes of plasma thrombin-antithrombin complex in the patients with peripheral arterial disease undergoing surgical revascularization

80%
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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