Intraoperative Carotid Artery Injuries. Review of the literature, analysis of the material of one centre.

<b>Introduction:</b> Injuries of the carotid artery constitute a rare group of injuries. This study presents results of the treatment of 44 patients with iatrogenic carotid artery injuries for over 20 years. The patients were treated by the team of doctors of the Department of Vascular, General and Transplant Surgery in Wroclaw in the years 1997-2017 (Head of the Department Prof. Klemens Skóra, MD, and Prof. Piotr Szyber, MD, PhD - material used with permission). </br></br> <b>Aim:</b> Aims of the analysis are: to estimate the frequency of different forms of iatrogenic injuries to the common and internal carotid artery, to evaluate the results of treatment, to assess the most effective surgical method depending on the type of injury, and develop an effective preoperative, intraoperative and postoperative regimen.</br></br> <b>Discussion and results:</b> The frequency of various carotid artery injuries (blunt, acute, traffic) was constant between years, but the number of iatrogenic injuries definitely increased over time. The prognosis for patients with carotid artery injury, especially when combined with multi-organ trauma, is the gravest. Significantly better treatment results were achieved with both acute and iatrogenic injuries. This is mainly due to easier and quicker diagnosis and better conditions for assisting patients.</br></br> <b>Conclusions:</b> In iatrogenic injuries, a well-designed surgical scheme, i.e. primarily the administration of UTH and placing a temporary flow drain by the first operating team, reduces the risk of neurological complications.

Diagnosis and treatment of pelvic congestion syndrome: Single-centre experiences.

BACKGROUND: One of the underestimated causes of chronic pelvic pain (CPP) in women may be pelvic congestion syndrome (PCS) that is defined as the presence of varicose of ovarian and pelvic veins associated with chronic pain in the region of the pelvis. This pain is present longer than 6 months and intensifies with prolonged standing, coitus and menstruation. The disease constitutes a diagnostic as well as therapeutic problem, thus posing a challenge for the clinician. Transcatheter ovarian vein embolization might be a safe and effective option for PCS treatment. OBJECTIVES: The objective of this study was to evaluate the efficacy of ovarian vein embolization ovarian as a method of the PCS treatment. MATERIAL AND METHODS: Between 2002-2012, 11 embolization procedures were performed in 10 women (age range: 34-43; median age 39) with the diagnosis of PCS. One patient underwent embolization procedure twice. In 1 case the combined therapy of endovascular embolization and surgical phlebectomy of vulvar varices was performed. RESULTS: There were no major intrainterventional complications. In all the patients (100%) a significant improvement in the clinical status was noted. The procedure improved the quality of life in the patients. Three women (30%) had a mild recurrence of the symptoms at mid-term follow-up. Among 8 women who had complained of dyspareunia prior to embolization 6 patients reported complete pain relief, in other 2 cases the pain subsided partially. There was a significant decrease in the severity of symptoms associated with hemorrhoids. CONCLUSIONS: We consider embolization of insufficient ovarian veins an effective and safe way of treatment in a well-selected group of patients with PCS.

Diagnostic and Therapeutic Difficulties in Carotid Body Paragangliomas, Based on Clinical Experience and a Review of the Literature.

BACKGROUND: Paragangliomas are rare neuroendocrine tumors, representing 0.03% of all tumors. Half of them develop in the head and neck, and among these 50% are sporadic cervical tumors. OBJECTIVES: The aim of the study was to carry out an epidemiological and clinical analysis of paraganglioma patients diagnosed and treated at the authors' clinics between 1985 and 2014. MATERIAL AND METHODS: The medical data of 47 patients were analyzed. All the patients were qualified for surgery. In 43 cases (88%), simple resection of the tumor was performed, including 11 cases (22%) that additionally required vascular suturing, and 5 (10%) that required reconstruction of the internal carotid artery. Carotid vessel repair was performed by shortening the internal carotid artery in 3 cases (6%), using a saphenous vein graft in 2 cases (4%), and by creating an anastomosis between the external carotid artery and the distal portion of the internal carotid artery in one case (2%). RESULTS: In 40 cases (82%), the course of treatment was uneventful. Three patients (6%) were reoperated because of symptoms of cerebral stroke. Palsy of the hypoglossal nerve occurred in 3 cases (6%), and facial nerve palsy in 2 patients (4%). Six patients (12%) developed postoperative hematomas in the wound. In all the cases, histopathological examinations confirmed carotid paraganglioma. CONCLUSIONS: Cooperation with an otolaryngologist and vascular surgeon during surgery is recommended due to frequent damage to carotid vessels by carotid paragangliomas. Detection of the tumor in the early stages improves surgical treatment outcomes and reduces the number of complications. Regular postoperative check-ups are necessary due to possible occurrences of multiple tumors.

Surgical management of extracranial carotid artery aneurysms.

BACKGROUND: We present the methods and results of the surgical management of extracranial carotid artery aneurysms (ECCA). Postoperative complications including early and late neurological events were analysed. Correlation between reconstruction techniques and morphology of ECCA was assessed in this retrospective study. PATIENTS AND METHODS: In total, 32 reconstructions of ECCA were performed in 31 symptomatic patients with a mean age of 59.2 (range 33-84) years. The causes of ECCA were divided among atherosclerosis (n = 25; 78.1%), previous carotid endarterectomy with Dacron patch (n = 4; 12.5%), iatrogenic injury (n = 2; 6.3%) and infection (n = 1; 3.1%). In 23 cases, intervention consisted of carotid bypass. Aneurysmectomy with end-to-end suture was performed in 4 cases. Aneurysmal resection with patching was done in 2 cases and aneurysmorrhaphy without patching in another 2 cases. In 1 case, ligature of the internal carotid artery (ICA) was required. RESULTS: Technical success defined as the preservation of ICA patency was achieved in 31 cases (96.9%). There was one perioperative death due to major stroke (3.1%). Two cases of minor stroke occurred in the 30-day observation period (6.3%). Three patients had a transient hypoglossal nerve palsy that subsided spontaneously (9.4%). At a mean long-term follow-up of 68 months, there were no major or minor ipsilateral strokes or surgery-related deaths reported. In all 30 surviving patients (96.9%), long-term clinical outcomes were free from ipsilateral neurological symptoms. CONCLUSIONS: Open surgery is a relatively safe method in the therapy of ECCA. Surgical repair of ECCAs can be associated with an acceptable major stroke rate and moderate minor stroke rate. Complication-free long-term outcomes can be achieved in as many as 96.9 % of patients. Aneurysmectomy with end-to-end anastomosis or bypass surgery can be implemented during open repair of ECCA.

Deep Vein Thrombosis of the Left Lower Limb in a 12 Year-Old Female Child with Ulcerative Colitis - Case Report.

BACKGROUND: Inflammatory bowel disease includes ulcerative colitis and Crohn's disease. CASE REPORT: This case report presents a patient with ulcerative colitis, with thrombotic complication of the left common iliac vein that occurred at the age of 11, two years after diagnosis. After a year of anticoagulation and compression therapy, although exacerbations of underlying disease occurred in the first 6 months of treatment, there was no recurrence of deep venous thrombosis, partial recanalization within affected venous system has been achieved and the patient is remission of ulcerative colitis for the last six months. CONCLUSIONS: In children, thromboembolic complications occur about 7 times less often than in adults, but increases in the case of hospitalized children. In children with IBD this complication can occur independently og disease activity even in patients with any other risk factors.

[Stem and progenitor cells in biostructure of blood vessel walls]. / Komórki macierzyste i progenitorowe w biostrukturze scian naczyn krwionosnych.

Development of vascular and hematopoietic systems during organogenesis occurs at the same time. During vasculogenesis, a small part of cells does not undergo complete differentiation but stays on this level, "anchored" in tissue structures described as stem cell niches. The presence of blood vessels within tissue stem cell niches is typical and led to identification of niches and ensures that they are functioning. The three-layer biostructure of vessel walls for artery and vein, tunica: intima, media and adventitia, for a long time was defined as a mechanical barrier between vessel light and the local tissue environment. Recent findings from vascular biology studies indicate that vessel walls are dynamic biostructures, which are equipped with stem and progenitor cells, described as vascular wall-resident stem cells/progenitor cells (VW-SC/PC). Distinct zones for vessel wall harbor heterogeneous subpopulations of VW-SC/PC, which are described as "subendothelial or vasculogenic zones". Recent evidence from in vitro and in vivo studies show that prenatal activity of stem and progenitor cells is not only limited to organogenesis but also exists in postnatal life, where it is responsible for vessel wall homeostasis, remodeling and regeneration. It is believed that VW-SC/PC could be engaged in progression of vascular disorders and development of neointima. We would like to summarize current knowledge about mesenchymal and progenitor stem cell phenotype with special attention to distribution and biological properties of VW-SC/PC in biostructures of intima, media and adventitia niches. It is postulated that in the near future, niches for VW-SC/PC could be a good source of stem and progenitor cells, especially in the context of vessel tissue bioengineering as a new alternative to traditional revascularization therapies.

[Usage of hydrophilic catheters and guidewires in endovascular surgery]. / Zastosowanie prowadników i cewników hydrofilnych w chirurgii endowaskularnej.

AIM OF STUDY: The aim of this study was to evaluate the effectiveness of hydrophilic catheters and guidewires during endovascular overcoming long stenoses or occlusions of the superficial femoral and popliteal artery. MATERIAL AND METHODS: Based on 142 procedures rated the functionality of the equipment of the hydrophilic coating. The operations were performed in the years 2010-2012 in the Department of Vascular, General and Transplantation, Medical University in Wroclaw. Procedures related to recanalization or enlargement of the superficial femoral artery. Patients were divided into groups according to the Consensus TASC II depending on the length change. Each patient was assessed ankle-brachial ratio (ABI), claudication distance measured and constructed with double ultrasound imaging (USG-DD). In doubtful cases an additional study was performed with contrast computed tomography (angio-CT). The procedure was performed at the Laboratory of angiography using a angiograph Siemens Artis Zee Ceiling. Every time the contrlateral access was made, and as the first step the angiography was performed to verify type of changes in the arteries RESULTS: . A significant benefit of using hydrophilic guidewires and catheters in patients with long stenoses or occlusions. In case of long and calcified changes, hydrophilic catheters was the only option because it gave good support for hydrophilic guidewire. CONCLUSIONS: The changes in the type C and D according to the criteria for TASC II, an essential tool to achieve a positive treatment effect is the use of hydrophilic catheters and guidewires.

Evaluation of the humoral and cellular immune responses after implantation of a PTFE vascular prosthesis.

INTRODUCTION: The experiment was designed in order to determine the immunological processes that occur during the healing in synthetic vascular grafts, especially to establish the differences in the location of the complement system proteins between the proximal and distal anastomosis and the differences in the arrangement of inflammatory cells in those anastomoses. The understanding of those processes will provide a true basis for determining risk factors for complications after arterial repair procedures. MATERIAL/METHODS: The experiment was carried out on 16 dogs that underwent implantation of unilateral aorto-femoral bypass with expanded polytetrafluoroethylene (ePTFE). After 6 months all animals were euthanized to dissect the vascular grafts. Immunohistochemical assays and electron microscopic examinations were performed. RESULTS: Immunohistochemical findings in the structure of neointima between anastomoses of vascular prostheses demonstrated significant differences between humoral and cellular responses. The area of proximal anastomosis revealed the presence of fibroblasts, but no macrophages were detected. The histological structure of the proximal anastomosis indicates that inflammatory processes were ended during the prosthesis healing. The immunological response obtained in the distal anastomosis corresponded to the chronic inflammatory reaction with the presence of macrophages, myofibroblasts and deposits of complement C3. DISCUSSION: The identification of differences in the presence of macrophages and myofibroblasts and the presence of the C3 component between the anastomoses is the original achievement of the present study. In the available literature, no such significant differences have been shown so far in the humoral and cellular immune response caused by the presence of an artificial vessel in the arterial system.

[Morbidity of lower limbs obliterating atherosclerosis in the population of Opole Region]. / Zachorowalnosc na miazdzyce zarostowa tetnic konczyn dolnych w populacji Opolszczyzny.

UNLABELLED: The objective of this study was to evaluate morbidity of lower limbs obliterating atherosclerosis in the population of Opole Region. The subject of the study was the population of patients admitted and treated in the Voivodship Medical Center in Opole between 1992-1994 (1st period) and 2000-2002 (2nd period). MATERIAL AND METHODS: Material includes detailed data about 1114 patients: 387 treated between 1992-1994 and 727 treated in period 2000-2002. The analysis was made on base of documentation of the Department of General and Vascular Surgery in the Voivodeship Medical Center in Opole. Patients filled special prepared questionnaires. The completed data were intoducted to the computer database and submitted to mathematical and statistical comparative analysis with regard to both examined periods. RESULTS: The study confirmed that the major cause of chronic lower limbs ischaemia is obliterating atherosclerosis. It was found in 91% of cases in both periods. Significant increase in atherosclerosis of the lower limbs morbidity was confirmed. The most voluminous group in this study ware patients more than 65 years of age, wih elementary or elementary professional education. Significant increase in incidence was also noted in patients inhabiting rural areas and in population of women. In between 2000-2002 the percentage of patients admitted with early phase of the disease increased significantly where compared to the first period. CONCLUSIONS: Significant increase of morbidity on atherosclerosis of the lower limbs needs planning of responsible local governors in Opole Region suitable financial expend to prevent and treat this disease.

[Head and neck paraganglioma--neoplasm of nervous origin]. / Przyzwojaki glowy i szyi--nowotwory pochodzenia nerwowego.

The authors of the present paper demonstrate the head and neck paraganglioma, discuss its location, clinical picture, diagnostics and treatment. Paragangliomas are relatively rarely occurring tumors, stemming from the autonomic nervous system. Initially asymptomatic, they do not present any characteristic clinical picture during the further development. Not large size of the tumor contributes to the late diagnosis which is most regrettable due to its potential malignancy (10%). Diagnostic and therapeutic problems cause it's medication reasonable only in specialist centers. Perioperative mortality is estimated at 5 to 13%. Postoperative neurological lesions in a form of the cranial carebro-vascular failure occur in 8 to 20% of cases. A contemporary advanced angiosurgical and anesthesiologic technology allow reducing a postoperative mortality to 5% and neurological complications by 10%. During the previous years many centers carried a preoperative embolization of a tumor during angiographies. An alternative to the large tumor vessels obliteration may be a radium therapy, although several reports confirm its low radiosensitivity.

[Bilateral chemodectoma--a case report]. / Przypadek obustronnego guza klebka szyjnego.

Chemodectoma is exceptionally rarely tumor comes from the parasympathetic part of nervous system. Cases description first of all concern multiple, single tumors localized on the neck, occasionally somewhere else. Tumors expansion in internal carotid vein aperture or in ear provoke serious complications from cranial nerves paralysis to cerebellum lesion. In this paper authors present a case of bilateral chemodectoma. Surgical treatment has required--not only simple tumor excision but also internal carotid artery reimplantation.

[A value of compression therapy prophylaxis following surgery in patients suffering from chronic venous insufficiency]. / Wartosc pooperacyjnej profilaktyki kompresoterapia u chorych na przewlekla niewydolnosc zylna konczyn dolnych.

The varices of the lower limbs and its complications are very common Surgical procedure which consists of ligatur of the venous tranks or stripping of them, ligation of perforating veins are basic methods of the treatment. After surgery, veins compression prevents secondary bleeding and above all, the development or recurrence of thrombosis The purpose of this study was the assessment of graduated compression stockings in prophylaxis of varicose vein disease recurrency. The study included 120 patients who underwent phlebectomy due to varicose veins. The period of follow up lasts 3 years and has been carried out in two groups. The first one was agreed to use compression therapy following surgery. The second group did not get any physical support to their legs. Compression class I and II: calf, thigh, panty medical stockings and were used. The first group of 60 patients (102 legs) wearing medical stockings following surgery have no either subjective or objective signs of venous insufficiency in long period of time after surgery. Statistical analysis pointed out marked significance between both groups of patients p < 0.001.