Changes in flow-mediated dilatation in patients with femoropopliteal occlusion receiving conservative and invasive treatment.

BACKGROUND: Although the beneficial effect of revascularisation on reduction of local clinical ischaemic symptoms has been well established, its effect on systemic vascular endothelial function has not been fully explained yet. AIM: To determine changes in endothelium-dependent flow-mediated dilatation in patients with unilateral femoropopliteal occlusion receiving medical and surgical treatment. METHODS: Seventy-nine patients with symptomatic atherosclerotic ischaemia of lower extremities, treated with endovascular procedures, with femoropopliteal graft, or receiving conservative treatment (21-day controlled treadmill training) were enrolled in the study. Ankle brachial pressure index (ABPI), skin blood flow on the feet, and flow-mediated dilatation (FMD) of brachial arteries were measured in each patient at baseline and after 90 days of follow-up. RESULTS: The ABPI, vasomotion in the myogenic frequency band, and FMD increased significantly in surgical patients. In patients after femoropopliteal bypass a significant increase of vasomotion in the endothelial frequency band was also observed. In patients receiving conservative treatment (treadmill training), vasomotion in the myogenic frequency band increased whereas the FMD remained unchanged. CONCLUSIONS: It seems that surgical treatment may contribute to reducing the risk of cardiovascular complications in patients with advanced peripheral artery disease, as a result of improving the systemic vascular endothelial function. Limiting treatment to just treadmill training increases pain-free walking distance but does not improve systemic vascular endothelial function.

Isolated internal carotid artery dissection in a long-distance runner.

We present a case of internal carotid artery dissection (ICAD) in the precranial segment, which caused binocular visual impairment in a 49-year-old man during a marathon race. The incident lasted 3 h, after which the symptoms resolved. Imaging tests showed internal carotid artery dissection. No ophthalmologic changes were identified. After 6 weeks of ineffective non-invasive treatment the patient underwent vascular surgery - stent implantation into the damaged artery. Detailed diagnostic tests and adequate treatment allowed us to achieve a good clinical result. Upon the suspicion of ICAD it is recommended to extend standard Doppler ultrasound performed with a linear transducer and evaluate the proximal segment of the internal carotid artery with a curved transducer as well.

The Application of Negative Pressure Wound Therapy with Installation in Diabetic Foot Associated with Phlegmon.

The negative pressure wound therapy in the treatment of diabetic foot ulcers was used successfully for many years. In the case of complications associated with infection by this type of wound treatment to give very good results. From many years of sustained research on a device that could combine the advantages of the negative pressure wound therapy and drainage flow. Finally, in the last year, the first V.A.C. Ulta (KCI, USA) devices were included to the Polish hospital departments. In this paper we present a case of a patient of successfully using a negative pressure wound therapy with installation via a set of V.A.C. Ulta in the ischemic diabetic foot syndrome complicated by phlegmon and tissue necrosis. The patient was treated in stages. In first stage was performed angioplasty of critically stenosis of the superficial femoral artery segment. Secondly, the resection of the necrotic bone revised fingers and forefoot was conducted, and in the third step the negative pressure wound therapy with installation was used. Finally, the wound was closed by the intermediate thickness skin graft. The total duration of treatment was 21 days. The patient in good general condition with a completely healed wound was discharged. Currently, after the supply with orthopedic equipment, patient regained full mobility.

Diagnosis and treatment of a patient with type IV endoleak as a late complication after endovascular aneurysm repair.

Type IV endoleak is a very rare complication observed after implantation of aortobiiliac stent grafts. The difficult diagnosis of type IV endoleak leads to the application of many imaging methods in the diagnostic process. We present a case report of a patient who underwent implantation of an aortobiiliac stent graft in 2004. After surgery, the size of the aneurysm sac was monitored continually in the subsequent imaging studies. Progression of the aneurysm sac volume was detected in 2009. In a short period of time, the diameter of the aneurysm increased from 100 to 140 mm. Angio-computed tomography and angiography did not reveal the location of the endoleak. The attempt at localization and endovascular closure of the source of the endoleak failed. It was decided to treat the patient surgically. Intraoperatively, the source of the endoleak was visualized, and the endoleak was closed with surgical sutures.

Abdominal aorta aneurysm: Case report of high radiation dose during stent-graft implantation.

This study is a case report regarding a possible problem of high radiation dose during stent-graft implantation. Before deciding on how to treat an aneurysm (stent grafting or traditional surgery), possible complications such as difficult anatomical conditions and diseases of the aorta and iliac arteries should be considered to avoid potentially high doses of radiation. In case of this patient, it was very difficult to introduce a guidewire through the contralateral limb into the body of the graft due to tortuosity and kinking of iliac arteries. Because of the long duration of the procedure (68 min), the patient was exposed to a very high radiation dose (4.37 Gy) and DAP (1760.3 Gy cm(2)).