[Endovascular treatment of blunt thoracic aortic injuries]. / Tompa trauma okozta mellkasi aortasérülések endovascularis ellátása.

INTRODUCTION: A new era has begun in the last two decades with the advent of endovascular methods in the therapy of blunt thoracic aorta injuries. Our experiences with the endovascular interventions of blunt aortic trauma in the Cardiovascular Center of Semmelweis University are summarised here. METHODS: We included those patients who underwent endovascular intervention due to blunt aortic trauma in a university hospital between 1998 and 2014. The statistical analysis was performed with the use of Excel. RESULTS: 41 patients were selected from our database. There were 34 males, the average age was 47 years (±17 years). Among the 41 patients 15 underwent an acute procedure (12 ruptures) and 26 patients received delayed treatment (in 4 cases due to growing of the pseudoaneurysm). There was only one early postoperative death. Late mortality was 22.5% and 7.5% was related to the aortic injury. CONCLUSION: Our late mortality and complication rates were similar to other studies, which reinforces international experiences. In the cases when delayed treatment is feasible, the patient can be stabilized and the CTA images can be analyzed for precise stentgraft planning. The treatment of blunt thoracic aorta injured patients should take place in specialized centers capable of such endovascular interventions.

[Arterial thrombolysis in the lower extremity in vascular surgical practice]. / Alsó végtagi artériás thrombolysis az érsebszeti gyakorlatban.

The acute arterial thrombosis of the lower limb is dangerous not only for the limb, but it can cause life-threatening situation as well. That is why it is important to use different therapeutical modalities as the catheter guided intraarterial thrombolysis, which can reduce the surgical risks. All the drugs used for lysis now days are plasminogen activators. Due to the results of different studies the most appropriate drugs for optimal thrombolysis are the urokinase, the tissue-plasminogen activators and their recombinant forms. There are two major studies dealing with the effect of the different fibrinolytic drugs in comparison of the results of randomly operated patients. Both of these studies (STILE, TOPAS) determined a nearly same efficacy of both methods, operative or thrombolytic (approximately 70% amputation-free survival). Significant difference was observed in relation of occlusion of a native artery or a graft: better results could be obtained with surgery in case of arterial occlusion and conversely, it was in favor for thrombolysis if a graft was occluded. It must be noted that the thrombolysis has to be followed with endovascular or open surgical procedures in most of the cases. On the basis of our experiences and the data of literature we suggest after individual decision thrombolysis in case of graft occlusion, and surgery in case of arterial occlusion as first choice.

Angioplasty of the innominate artery in 89 patients: experience over 19 years.

PURPOSE: To assess retrospectively the success of percutaneous transluminal angioplasty (PTA) in treating innominate artery stenoses and occlusions in a large series of patients with long-term follow-up results. METHODS: In symptomatic (upper limb claudication, transient ischemic attack, vertebrobasilar insufficiency) patients with high-degree (>60%) stenosis, innominate artery PTA was performed. Long-term follow-up was undertaken by blood pressure measurements on both arms as well as subclavian, right common carotid and right vertebral duplex scan. RESULTS: Between 1981 and 1999, the primary success rate of 89 innominate artery PTA (84 stenoses, 5 occlusions) was 96.4%. Complications included one left occipital lobe infarction (2%), two puncture-site thromboses (3%) and four transient ischemic attacks (6%). Two patients with restenosis were successfully treated with re-PTA. Cumulative primary patency was 98 +/- 2% at 6 months, 93 +/- 4% at 16-117 months; secondary patency was 100% at 6 months, 98 +/- 2% at 12-117 months. Sixty-one percent of the patients became symptomless, 32% improved, 7% showed no improvement. CONCLUSION: Angioplasty of the innominate artery has been proven to be safe and effective on a large series of patients. For innominate artery stenosis and short occlusion, PTA should be the treatment of choice.