Endovascular treatment of iatrogenic arteriovenous fistula of the iliac vessel

BACKGROUND

Iatrogenic vascular injuries, due to the particular nature of such pathology, are associated with high morbidity and mortality in the postoperative period.

OBJECTIVES

The objective of this study was to present a case of non-classic approach to the therapy of iatrogenic arteriovenous fistula.

MATERIAL AND METHODS

We present a case of a 17-year old female patient admitted to the Department of Vascular, General and Oncologic Surgery (Copernicus Memorial Hospital, Łódź, Poland) due to an iatrogenic injury to the common iliac vein and artery, following neurosurgical intervention on the spine. Two weeks prior to admission, the patient underwent surgery in the Neurosurgery Clinic for herniated nucleus pulposus and lumbar spine scoliosis. The imaging diagnostic revealed the presence of a pseudoaneurysm of the right common iliac artery and arteriovenous fistula between the right common iliac vessels. The patient was qualified for endovascular treatment. Two self-expanding covered stents were successfully deployed. The clinical and radiological outcome of the procedure was good. The postoperative period was uneventful. The patient was discharged home on the 3rd postoperative day.

RESULTS

The control examinations (directly after the procedure and 6, 12, 24 and 32 months thereafter) revealed full patency of the iliac vessels, as well as no recurrence of arteriovenous fistula, nor a pseudoaneurysm of the right common iliac artery. No symptoms of either chronic limb ischaemia or venous insufficiency were observed.

CONCLUSIONS

Iatrogenic vessel injury, being a complication of neurosurgical and orthopedic surgeries, may be overlooked and remain undetected both in intraand postoperative period. Modern imaging techniques allow for an adequate diagnosis of the injury and planning the treatment of arteriovenous fistula. The endovascular procedures are the method of choice in patients with arteriovenous fistulas of iliac vessels, alternative to open surgery.

The influence of selected bariatric surgeries on glycolipid balance

The aim of this study was to compare the efficacy of two laparoscopic bariatric procedures, i.e. Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (LSG) in terms of body mass reduction and improvement in carbohydrate and lipid metabolism.

MATERIAL AND METHODS

The study group consisted of patients subjected to RYGB (Group I) and LSG (Group II) procedures. Body mass and fasting concentrations of glucose, insulin, glycated haemoglobin, total cholesterol, HDL, LDL and triglycerides were evaluated on the day preceding the surgery and 1, 3 and 6 months thereafter. BMI, HOMA-IR and HOMA-B were calculated as well.

RESULTS

The reduction of BMI, glucose, insulin, glycated haemoglobin, triglycerides levels as well as the HOMA-IR, and HOMA-B indices and increase of HDL were observed in both groups 6 months after the surgery. No reduction of both total cholesterol and LDL concentrations was obtained in both groups. The differences of the studied parameters in both groups were not statistically significant.

CONCLUSIONS

RYGB and LSG are equally effective in terms of body mass reduction, improvement of carbohydrates and lipid metabolism assessed 6 months after the surgery.

Gender-related risk factors for perioperative stroke after carotid endarterectomy in symptomatic patients

BACKGROUND

Carotid endarterectomy (CEA) is a surgical procedure used in ischemic brain stroke prevention in patients with symptomatic and asymptomatic severe carotid artery stenosis.

OBJECTIVES

This study compares perioperative stroke or death rate after carotid endarterectomy (CEA) in male and female patients, and determines risk factors for perioperative incidents in women and men.

MATERIAL AND METHODS

The outcome of surgical treatment of 269 consecutive symptomatic patients (181 men and 88 women) treated from January 2004 to August 2008 in the Department of Vascular, General and Oncologic Surgery was analyzed.

RESULTS

Perioperative stroke-death rate (within 30 days after the surgery) in women was 6.8% (6/88) and 3.3% (6/181) in men (p > 0.05). In the female group, none of the analyzed risk factors were associated with a higher risk of periprocedural incident, while in men, only hypercholesterolemia was a significant predictor of perioperative stroke (TC > 240 vs 240 vs 200-240: OR = 6.59; 95% CI: 1.12-38.97; p = 0.0375).

CONCLUSIONS

In men, hypercholesterolemia significantly increased the risk of perioperative stroke or death, while in females, none of the analyzed factors were determined as the predictors of the incident. The fact that plaque type VI by AHA was significantly more frequent in women and men more frequently were suffering from ischemic heart disease and peripheral artery occlusive disease appeared not to influence the outcome of CEA.

Neurologic and functional long-term outcome after carotid endarterectomy

BACKGROUND

The aim of this research was to assess the neurologic status of patients a year after endarterectomy with the use of National Institutes of Health Stroke Scale (NIHSS) and the degree of disability using the modified Rankin Scale (mRS) and to examine the patients' subjective evaluation of their health.

METHODS

One hundred two patients with symptomatic internal carotid artery stenosis who underwent endarterectomy and attended a 1-year follow-up examination were enrolled in the study. The material comprised 72 (70.6%) men and 30 (29.4%) women. Before the surgery, the patients' neurologic status was assessed according to the NIHSS, and their functional status was rated with the mRS. Additionally, the patients were asked to assess their life quality on a 10-point Likert scale.

RESULTS

The mean NIHSS score before the operation was 2.76 points (SD 2.47), whereas a year after it was 2.05 points (SD 1.84) (P < .0001). The NIHSS scores that improved significantly a year after endarterectomy were level of consciousness-questions and commands, motor leg, and sensory (P < .05).

CONCLUSIONS

The patients' neurologic status assessed with the NIHSS improved significantly 1 year after carotid endarterectomy mostly because of the improvement in their verbal and motor communication ability, physical condition and agility, and reduction in sensory disturbances. The observed changes in the neurologic status were reflected in the functional status and subjective life quality assessment, which appeared to be significantly better a year after the surgical treatment.