Search

Introduction. The aim of this study was to report our preliminary results regarding the use of the repositionable self-expanding nitinol stent in a cohort of patients with femoro-popliteal artery occlusion/stenosis. Material and methods. The study groups consisted a total of 8 patients (10 extremities) between 47 and 70 years of age who presented with typical symptoms of intermittent claudication and/or critical limb ischaemia (Fontaine stage II-IV) and underwent primary elective superficial femoral artery percutaneous transluminal angioplasty and/or stenting using a Jaguar repositionable self-expanding nitinol stent in the dates of 2013-2015. Information for patency at 6th month after the stenting procedure was obtained. Results. The mean operation time was 38.56 ± 26.40 minutes. No patients had procedure-related stent fracture, distal thromboembolism, haematoma, femoral pseudoaneurysm or stent occlusion. At 6-month follow- -up, at least one categorical improvement was observed in 7 patients (87.5% of intent-to-treat population). Conclusions. The Jaguar self-expanding nitinol stent has several technical advantages, and its use was associated with a low risk of complications. Further study is warranted to establish its superiority in providing good long-term patency. [ABSTRACT FROM AUTHOR]

Introduction. Critical limb ischaemia (CLI) is an advanced phase of chronic lower extremity ischaemia linked to increased mortality, decreased quality of life, and the risk of leg amputation. The aim of this study was to determine factors affecting the risk of leg amputation among patients with CLI treated endovascularly as a first approach. Material and methods. Of 118 patients treated endovascularly, 32 (27%) had a leg amputated. Their clinical data were analysed retrospectively. Results. Patients who had a leg amputated initially had a higher Rutherford class, were older, and had a greater prevalence of comorbidities. In multivariate analysis, amputation-free survival was shortened by a history of dyslipidaemia, female gender, blood creatinine concentration, the need for target lesion revascularization, smoking habit, Rutherford class, and leukocyte blood count. Whereas, the factors which decreased the risk of leg amputation were: use of statins, the number of previous interventions, and blood LDL cholesterol concentration. Angiographic classification of lesion severity did not affect endovascular procedure outcome. Conclusions. The risk of major amputation following endovascular treatment in patients with CLI was associated with a number of characteristics, mainly: atherosclerosis risk factors and necrosis advancement, and the number of reinterventions. To avoid endangering patients and the unnecessary utilization of resources, it would seem to be worth performing large studies to determine a risk stratification scoring system for patients with CLI, which could enable the qualification of risk-adjusted patients for endovascular or surgical revascularization or for primary leg amputation. [ABSTRACT FROM AUTHOR]

Background. The aim of this paper was the assessment of the effectiveness of concurrent endovascular angioplasty with stenting and classic "open" surgery in patients in poor general condition with numerous cardiovascular and respiratory risk factors, during one year of observation. Material and methods. The study group consisted of 43 persons (68.2% men and 31.8% women, with an average age of 63.7 years), selected from 56 patients operated on in our clinic in 2007, in which simultaneous surgery with use of "C" arm was carried out. All operations were performed in elective mode. During initial evaluation of all patients, the ankle brachial pressure index (ABPI) was measured and for assessment of intermittent claudication distance -- walking test was perforated with a runway velocity 3.4 km/h. if possible (patients with resting pains were excluded). All patients were qualified for surgery by a cardiologist; their average EF was 41.3%. The frequency of ca-morbidities in this group was: ischaemic heart disease 58%, previous myocardial infarction 16%, previous CABG or PTCA 12%, diabetes 33%, chronic kidney disease 7%, cerebral vascular diseases 47%, arrhythmia 14%, and hypertension 67%. According to these ca-morbidities, patients were qualified by an anaesthesiologist to A SA groups as follows: ASA I -- 5%, ASA II 43%, ASA II/III -- 16%, ASA III -- 30% and ASA IV -- 9% The patients were operated on under local anaesthesia. In all of them endovascular angioplasty with or without stenting of the iliac artery was done and then, after improving arterial low, the classic operation was performed -- outflow angioplasty of common femoral and deep femoral artery or femoropopliteal bypass, as needed. If there was not satisfactory arterial flow to the ischaemic extremity, and concurrent stenosis of opposite iliac artery was present, endovascular dilation of this artery ("flow donor") was performed and next non anatomical suprapubic crossover femorofemoral bypass was corned out. The average duration of a single operation was I h 48 min. Results. Of the 43 operations performed, in I case (2.3%) it was necessary to make an intraoperative change to the classic technique; on iliofemoral bypass was corned out in the first case because of a breakage of the external iliac artery during balloon angioplasty. In 2 cases (3.5%) scheduled amputation was performed, at shin level in I case (1.7%) and at forefoot level in I case (1.7%). All patients were discharged in good general condition and with considerable improvement of perfusion in the operated leg, with a recommendation of taking oral antiplatelet and hypolipaemic medications. During postoperative follow up in 43 patients, ankle-brachial pressure index (ABPI) was measured and walking test on a running track was performed. The overage objective preoperative distance of claudication was 49.09 m, and during the postoperative year it increased to an average of 358.38 m; in patients with critical ischaemia the resting and nocturnal pain has withdrawn, and the distance of claudication has increased to an average of l2O m. The average value of ABPI in the whole group before surgery was 0.315, and at the end of first postoperative year it has increased to 0.87. Conclusions. Early results of the study show the great effectiveness of hybrid surgery, especially in patients with numerous co morbidities limiting the possibilities of "open" revascularisation. In one year of observation, it has been shown that the obtained postoperative improvement of blood supply in the operated extremity is maintained at a constant satisfactory level, and that the clinical effect of this treatment was good. [ABSTRACT FROM AUTHOR]

Background. The aim of this paper was the assessment of the effectiveness of concurrent endovascular angioplasty with stenting and classic "open" surgery in patients in poor general condition with numerous cardiovascular and respiratory risk factors, during one year of observation. Material and methods. The study group consisted of 43 persons (68.2% men and 31.8% women, with an average age of 63.7 years), selected from 56 patients operated on in our clinic in 2007, in which simultaneous surgery with use of "C" arm was carried out. All operations were performed in elective mode. During initial evaluation of all patients, the ankle brachial pressure index (ABPI) was measured and for assessment of intermittent claudication distance -- walking test was perforated with a runway velocity 3.4 km/h. if possible (patients with resting pains were excluded). All patients were qualified for surgery by a cardiologist; their average EF was 41.3%. The frequency of ca-morbidities in this group was: ischaemic heart disease 58%, previous myocardial infarction 16%, previous CABG or PTCA 12%, diabetes 33%, chronic kidney disease 7%, cerebral vascular diseases 47%, arrhythmia 14%, and hypertension 67%. According to these ca-morbidities, patients were qualified by an anaesthesiologist to A SA groups as follows: ASA I -- 5%, ASA II 43%, ASA II/III -- 16%, ASA III -- 30% and ASA IV -- 9% The patients were operated on under local anaesthesia. In all of them endovascular angioplasty with or without stenting of the iliac artery was done and then, after improving arterial low, the classic operation was performed -- outflow angioplasty of common femoral and deep femoral artery or femoropopliteal bypass, as needed. If there was not satisfactory arterial flow to the ischaemic extremity, and concurrent stenosis of opposite iliac artery was present, endovascular dilation of this artery ("flow donor") was performed and next non anatomical suprapubic crossover femorofemoral bypass was corned out. The average duration of a single operation was I h 48 min. Results. Of the 43 operations performed, in I case (2.3%) it was necessary to make an intraoperative change to the classic technique; on iliofemoral bypass was corned out in the first case because of a breakage of the external iliac artery during balloon angioplasty. In 2 cases (3.5%) scheduled amputation was performed, at shin level in I case (1.7%) and at forefoot level in I case (1.7%). All patients were discharged in good general condition and with considerable improvement of perfusion in the operated leg, with a recommendation of taking oral antiplatelet and hypolipaemic medications. During postoperative follow up in 43 patients, ankle-brachial pressure index (ABPI) was measured and walking test on a running track was performed. The overage objective preoperative distance of claudication was 49.09 m, and during the postoperative year it increased to an average of 358.38 m; in patients with critical ischaemia the resting and nocturnal pain has withdrawn, and the distance of claudication has increased to an average of l2O m. The average value of ABPI in the whole group before surgery was 0.315, and at the end of first postoperative year it has increased to 0.87. Conclusions. Early results of the study show the great effectiveness of hybrid surgery, especially in patients with numerous co morbidities limiting the possibilities of "open" revascularisation. In one year of observation, it has been shown that the obtained postoperative improvement of blood supply in the operated extremity is maintained at a constant satisfactory level, and that the clinical effect of this treatment was good. [ABSTRACT FROM AUTHOR]

Background. In 2003 we started investigations concerning the possibility of using new techniques, including bone-marrow cell implantation, in the therapy of critical leg ischaemia. Safety procedures, scheme of work and inclusion and exclusion criteria were established during the first faze in collaboration with various local departments and laboratories. Material and methods. Inclusion criteria consisted of critical leg ischaemia, no possibility of surgical operation, no effective 2 months conservative treatment or the possibility of limb amputation in the following months. Exclusive criteria included causes of ischaemia other than atherosclerosis, absence of consent, need for urgent amputation, cancer or poor general condition. After acquiring conscious consent, patients were randomized into two groups: conventional therapy (control group) (n = 15), and those treated with bone marrow cells (n = 14). Standard bone marrow collection was performed as early as the first operation (usually about 8 a.m.) under general anaesthesia. Material was then prepared filtration and concentration in a separator -- using standard procedure. Morphology and measurement of the amount of nuclear cells and CD34 cells were perforated as well as microbiological examination. This material, including progenitor cells, was injected using two methods about 46 hours after bone marrow aspiration. In every case it involved several intramuscular injections into the ischemic limb (thigh and leg). In 4 cases we performed intravascular placement of progenitors using arteriography (in the distal pan near the occluded part of the axial limb artery). Results. Observation was based on several parameters: vital parameters (blood pressure, heart rate, respiratory rate, temperature) measured every day during hospitalisation; ankle/brachial index (ABI), ulcerations or pedal necrosis documented by photography and subjective parameters: feeling of pain (VAS), self care (WHO scale) measured 1, 3 and 6 months after our procedure. Baseline angiography was performed in every case. Control angiography followed bone marrow collection after 3 months in 5 cases. No changes in angiograms were detected. Endpoints were: amputation (10) and death (no observations). In case of amputation, material was histologically examined and signs of angiogenesis (mostly new vein formation) were detected. In the group treated by stem cell implantation we reached greater subjective improvement in 12 cases compared to 7 in the control group; healing of ulcers in 8 cases (complete in 5 cases) compared to 3 cases in the control group. Amputations were performed in 3 patients in the index group compared to 7 in the control group. Conclusions. We think that implantation of patients' bone-morrow progenitor cells in cases of critical leg ischaemia is safe and is a prospective therapeutic method. [ABSTRACT FROM AUTHOR]

Zastosowanie czynników proangiogennych w celu wywołania efektu leczniczego u chorych z krytycznym niedokrwieniem kończyn dolnych (CLI) może stać się obiecującym sposobem leczenia, zwłaszcza osób niekwalifikujących się do leczenia chirurgicznego czy wewnątrznaczyniowego. W bezpośrednim zastosowaniu substancji stymulujących angiogenezę lub genów kodujących te substancje na modelach zwierzęcych wykazano skuteczność takiego postępowania. W licznych doniesieniach z pierwszych prób klinicznego zastosowania substancji stymulujących angiogenezę wskazuje się na zmniejszenie dolegliwości wiążących się z CLI, w tym wydłużenie dystansu chromania. Wyniki te zobiektywizowano poprzez badania przepływowe i obrazowe. Wstępna ocena wyników badań klinicznych I i II fazy daje podstawy do pozytywnej oceny proponowanego leczenia u osób wyłączonych z innych sposobów terpaii CLI. W niniejszej pracy przedstawiono najczęściej stosowane w badaniach doświadczalnych i klinicznych czynniki wzrostu stymulujące angiogenezę pod kątem ich praktycznego wykorzystania klinicznego. [ABSTRACT FROM AUTHOR]