[Treatment of pseudoaneurysms with injection of thrombin]. / Liecba pseudoaneuryziem injekciou trombínu.

OBJECTIVES: To introduce and assess the efficacy and risks associated with a new treatment method of post-catheterization pseudoaneurysms. METHODS: Thrombin injection was indicated in patients with failure of compression therapy during 24 hours. Patients with a cavity volume < 1 cm3, with a pseudoaneurysm causing compression or haemorrhagic shock were excluded. A needle is introduced under local anaesthesia with ultrasound guidance, its tip is placed thoroughly in the centre of the cavity. Subsequently, under colour-flow mapping, thrombin solution with concentration of 1000 IU/ml is cautiously injected, which results in instantaneous thrombosis of the pseudoaneurysm cavity. RESULTS: Thrombin injection was used in 17 patients during a period of 12 months. 12 of them were women, 6 patients with valvular disease, 2 after intervention and 5 anticoagulated. The method was successful in 16 patients. In 5 of them, a small residual cavity persisted, which was not suitable for re-injection, and was closed completely after a few minutes of compression by a ultrasound transducer. There were no thrombotic complications. CONCLUSION: Although compression remains the method of choice, thrombin injection is a highly effective, quick and, with necessary precautions, safe alternative to surgical treatment of pseudoaneurysms, mainly in anticoagulated patients.

The internal mammary artery bypass--the principles of preoperative and postoperative diagnosis using colour-duplex ultrasound.

BACKGROUND: The aim of the study was the assessment of functional characteristics of the left internal mammary artery (LIMA) bypass in patients after coronary artery bypass grafting (CABG) in comparison with the native LIMA using colour-duplex ultrasound as the non-invasive diagnostic method. METHODS: We examined 303 patients after myocardial revascularization with the internal mammary artery bypass using the Hewllett Packard 2500, 5500 ultrasound units. Using the 7.5 MHz linear transducer we detected the LIMA from the left supraclavicular approach. We assessed the peak systolic velocity (PSV--cm/s), peak diastolic velocity (PDV--cm/s), end-diastolic velocity (EDV--cm/s) and we calculated the peak systolic/peak diastolic velocity ratio (SDVR) and resistance index RI (PSV-EDV/PSV). The obtained parameters were compared with the native LIMA flow characteristics of the 70 consecutive patients before CABG. RESULTS: We observed the transformation of internal mammary artery flow from the predominantly systolic high resistance type of the native LIMA, to the low resistance biphasic waveform after its use as a coronary artery graft. We detected a significant increase of diastolic flow velocities and a significant decrease of resistance and of the SDVR ratio. In dysfunctional grafts we found a decrease of diastolic flow and an increase of LIMA resistance and SDVR. CONCLUSION: The colour-duplex ultrasound is a perspective non-invasive method for the postoperative follow-up of patients with the LIMA graft. It allows the assessment of the bypass flow characteristics, functional status and patency and it could contribute to the early diagnosis of bypass failure. (Fig. 6, Tab. 4, Ref. 21.)

[The role of vascular reconstructive surgery in the treatment of cerebrovascular insufficiency]. / Miesto cievnej rekonstrukcnej chirurgie v liecbe cerebrovaskulárnej insuficiencie.

BACKGROUND: Management of cerebrovascular insufficiency (CVI) is one of the greatest medical challenges in our country. Retardation in this field has been causing serious medical and socioeconomic consequences. MAIN PURPOSE AND STARTING POINTS (OBJECTIVES): In spite of existing unfavourable conditions the authors of this paper have managed to standardize their own policy in diagnosis, surgical indications and techniques. This caused substantial improvement of their results, as well as cooperation with the neurologic clinics. In connection with the increasing numbers of operations and improved results, the authors report their recent experience in this field and compare them with the results from previous years. METHODS: The authors compare two series of patients. The first series of 65 consecutive patients surgically treated from 1st Jan. 1987 to 31st Dec. 1990 (69 operations altogether). The 2nd series of 169 consecutive patients surgically treated from January 1st 1993 to December 31st 1994 (191 operations altogether), 149 due of them were subjected to carotid endarterectomy (CEA). Mean age of the first series was 55.3 (35-73), 2nd series 59.7 years (42-86). The authors have studied participation of neurologically and angiographically unstable patients. In the first series the ratio of neurologically stable and unstable patients was 63.4:36.6%, while in the 2nd series it was 75.4:24.6%. The ratio of angiographically stable and unstable patients was in the 1st series 60.2:39.8%, while in the 2nd series it was 50.3:49.7%. In the 2nd series the authors observed also the percent age of ulcerated lesions in the carotid bifurcation and found a surprisingly high number-59.2%. RESULTS: The combined mortality-morbidity index of the first series was 11.6%, of the 2nd series 3.1%. In the first series there were two deaths (2.9%) and 6 brain infarctions. In the 2nd series four patients died from acute myocardial infarction (2.1%) and there were two cases of a perioperative brain infarction, respectively. The necessity of wound revision due to of bleeding was found in two patients (2.9%) in the first series, and in two cases (1%) in the 2nd series. CONCLUSIONS: The authors emphasize the complicated nature of these problems, the necessity to recognize the surgical indications and techniques, and protective measures to prevent serious complications. There is, in their opinion, inevitable to increase bringing the patients in need of surgical reconstruction under control. On the other hand, there is the necessity to increase the accessibility of qualified surgery in the CVI. That means in the first place to increase the number of centers able to accomplish these operations with minimal combined mortality-morbidity index. (Tab. 10, Ref. 37.).