[Venous aneurysm as a therapeutic problem: various management strategies in selected patients: our experience]. / Venöses Aneurysma als therapeutisches Problem. Behandlungsmöglichkeiten. Die Vorgehensweise bei den gewählten Kranken - unsere Erfahrung.

Venous system aneurysms appear relatively rarely, and are even more rarely diagnosed, especially if asymptomatic. In the material of our clinic we provide a variety of practices in three patients with venous aneurysms depending on the location, symptoms and main disease. In some patients the occurrence of pulmonary embolism is the first symptom of venous aneurysms, having influence on the selection of further diagnostics, conservative treatment, as well as on endovascular or operating procedure. The proper diagnosis of a venous aneurysm takes place in case of doubling or tripling of the diameter of the basic dimension of the lumen, often with the presence of thrombotic material. Asymptomatic venous aneurysms are usually detected during routine pre-operative diagnosis also including duplex-Doppler studies. In the presence of pulmonary embolism positive angio-CT and scintigraphy raise the suspicion of venous aneurysm unless any other reason is apparent. There is no standard treatment of venous aneurysms. This has to do with the relatively low epidemiology, diversity of location, difficulties in determining the proper primary and secondary aetiology, anatomy and coexisting diseases. Despite the many unknowns a few issues should be considered before appropriate treatment is undertaken. Undoubtedly, the shape itself, the location and size of the aneurysm with the presence or not of thrombotic material are of great value in evaluating the risk of complications, including possibly lethal pulmonary embolism, local symptoms of venous hypertension and possible complications of surgery. In this paper we present 3 patients treated for venous aneurysms located in different regions: popliteal vein, brachial vein and iliac internal vein.

Successful revascularisation of a thrombosed renal artery aneurysm in a young man with solitary kidney and history of severe hypertension.

Case report of a 18-year-old patient with long lasting hypertension, who developed acute renal failure, in course of an antihypertensive therapy modification, backgrounded by undiagnosed aneurysm of the solitary kidney renal artery. The acute renal function decrease was caused by single dose of ACE inhibitor causing an equivalent drop in serum ACE activity. Aneurysm excision followed by implantation of a venous bypass normalized restored renal function and blood pressure for over 24 months of observation.

Dissecting aneurysm of the thoracic aorta in a patient with nephrotic syndrome and brucellosis.

We report the case of a 61-year-old man with nephrotic syndrome due to glomerulonephritis and chronic brucellosis complicated by dissecting aortic aneurysm. The patient worked as a veterinarian and was diagnosed for chronic but non-active brucellosis with positive serum test for Brucella melitensis in the past. Administration of cyclosporine in combination with low dose prednisone resulted at least in proteinuria reduction and partial remission for 3 years. Dissecting aortic aneurysm was treated by insertion of a stent-graft, that resulted in canalization of blood flow and retraction of aneurysm wall later in the course in our patient.

[Long-term results of operative treatment of the vertebro-basilar syndrome]. / Langzeitergebnisse der operativen Behandlung des vertebrobasilären Syndroms.

In case of changes occurring within the extracranial sections of the common and internal carotid artery the operative procedure has become a generally accepted surgical method. Another reason of brain ischemia is the vertebro-basilar insufficiency caused by external pressure on the vertebral artery in a channel formed by transverse processes of cervical vertebrae. The author presents the clinical experience with 54 cases that have been treated surgically from 1994 to 2003 due to the above mentioned reasons. In all patients an anastomosis between the distal vertebral artery and external carotid artery gave good or very good results.

Iatrogenic injuries of the carotid arteries.

BACKGROUND: Iatrogenic trauma of the carotid artery (CA) is a dangerous intraoperative complication, especially during oncological and endocrinological procedures. In these cases massive hemorrhage and severe neurological complications may occur. The outcome of reconstructive procedures is often fatal because of the long delay of surgery after the injuries occuring in non-vascular centers. PATIENTS AND METHODS: In this paper 22 cases of iatrogenic CA trauma will be presented, operated in the period of 1980-2003. Different methods of operation were performed according to the extent of trauma and anatomical changes. RESULTS: In spite of emergency help two patients died. In three cases cerebral stroke was observed. Additionally peripheral nervous damages were noted. CONCLUSIONS: Iatrogenic CA trauma is one of the most dangerous vascular injuries, connected with hemorrhage and neurological complications. We recommend intravenous administration of 5000 units unfractionated Heparin, anatomical artery preparation, then shunt inserting. Autogenous material should be used if possible. For reconstruction of the initial part of internal carotid artery the transposition of the external carotid artery is useful.

[Injuries of carotid arteries]. / Karotisverletzungen.

Carotid artery injuries reveal as a specific and relatively small group of vascular trauma. Hemorrhage from vessels of this diameter and flow (10 % of cardiac output) has predominantly a fatal end or shows severe neurological sequelae. Cut and stab wounds represent the majority of carotid injuries, often associated with venous damage. Blunt trauma and fractures of the skull basis are uncommon causes. We present 43 cases of carotid injuries operated upon as emergency service (in the majority outside of our hospital). The number of postoperative surgical and neurological complications was moderate.

Influence of hypercholesterolemia and acute graft rejection on chronic nephropathy development in renal transplant recipients.

Graft endothelial lesions resulting from acute rejection may be sustained by concomitant hypercholesterolemia, thus increasing the risk of chronic graft failure. The present study was undertaken to examine the influence of hypercholesterolemia and acute graft rejection (AGR) episodes on graft function and graft loss due to chronic nephropathy. A cohort of 336 patients transplanted between 1993 and 2000 having graft function at 12 months after transplantation were examined. Immunosuppressive therapy consisted of CsA, azathioprine, and corticosteroids in 90% with 10% of patients receiving mycophenolate mofetil in place of azathioprine. During the first year after transplantation, AGR occurred in 134 (39.8%) and hypercholesterolemia (6.2 mmol/L) in 132 (39.2%) of patients. The population was divided into four groups according to AGR occurrence and cholesterol concentrations during the first year after transplantation for analysis of serum creatinine concentrations and graft loss at 5 years of follow-up. Patients with AGR irrespective of cholesterol levels displayed significantly higher creatinine concentrations. Graft loss in these patients increased over twofold compared to the remaining groups. Patients without hypercholesterolemia and AGR showed normal creatinine concentrations and low graft loss rates during 5 years of follow-up.

[Erection disorders after implantation of aorto-bifemoral prosthesis]. / Zaburzenia erekcji po wszczepieniu protezy aortalno-dwuudowej.

In this paper we present sexual complications occurring after implantation of vascular aorto-bifemoral prosthesis. We have sent an inquiry to 1236 men, who were operated in Vascular Department of Medical Academy in Wroclaw in years 1983-1997. We received 659 answers. Additionally 302 patients were examined. We noticed disorders of erection after vascular operation in 350 cases. In 29 cases erection reappeared after operation. Only 112 patients declared correct ejaculation and 137 men have satisfied sexual life. This results present problem of postoperative ischaemia of minor pelvis and trauma to neural plexus of bifurcation of aorta. In cases of younger sexually active men, who need revascularisation of lower extremities by implantation of vascular aortobifemoral prosthesis we suggest endarterectomy of hypogastric artery and/or implantation this artery to prosthesis.

[Buttock claudication as the dominant symptom of atherosclerosis: a case report]. / Chromanie posladkowe jako dominujacy objaw miazdzycy zarostowej tetnic--opis przypadku.

Buttock claudication is rather rare symptom of atherosclerosis. Authors presented a case of 61 year old patient in whom buttock claudication was only one symptom. The patient was surgically treated (endarterectomy of iliac internal artery with ilico-femoral bypass) with excellent result. Authors pointed out necessity of restoration of blood flow through internal iliac artery as a prevention or treatment in buttock claudication.

[Vertebro-basilar insufficiency syndrome: preoperational diagnosis]. / Zespól kregowo-podstawny--diagnostyka przedoperacyjna.

Indications for surgery of vertebro-basilar insufficiency are: stenosis or occlusion due to atherosclerosis. The initial parts of carotid, subclavian arteries or brachiocephalic trunk one must frequent involved. From the other hand arterial compression on vertebral arteries (diskopathies or osteopathies) leads to symptoms of cerebral ischaemia. In diagnosis very important are history of disease, physical examination and neurologic assessment. Additional procedures consisted of: color Doppler-scan, transcranial Doppler, cerebral CT-scan and angiography. By-pass of stenotic or occlusive segment of artery is procedure of choice in this disease.

[Clinical evaluation of a polyester vascular prosthesis impregnated with albumins from material of the Vascular Surgical Clinic AM in Wroclaw in the years 1994-1997. Introductory report]. / Ocena kliniczna poliestrowej impregnowanej albuminami protezy naczyniowej w materiale Kliniki Chirurgii Naczyniowej AM we Wroclawiu w latach 1994-1997. Doniesienie wstepne.

The aim of this work was clinical evaluation of impregnated (albumins) prostheses of Polish production. Those prostheses were compared with polyester knitted vascular prostheses. We evaluated a group of 48 patients to whom prostheses covered with albumins were implanted and 52 patients to whom nonimpregnated prosthesis was implanted in 1994-1997. The prostheses were implanted in aortofemoral segment. The achieved results prove the good quality of the impregnated prosthesis and its high value for vascular reconstructive surgery.