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3 Polish Journal of Surgery

3 2009

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Own Superficial Femoral Vein Versus Silver Bonded Artificial Graft in Patients with Vascular Prosthesis Infection in Aorto-Femoral Position: Treatment Results Comparison

100%

Molski S. , Łukasiewicz A.

2009

tom 81

nr 4

165-171

Vascular prosthesis infection in aorto-femoral position presents a life-threatening complication. Two operative modalities are utilized in the authors center: own superficial femoral veins (SFVR) and silver salts bonded anatomic reconstruction (AgR).The aim of the study was comparison of the two treatment methods in terms of early and distant clinical resultsMaterial and methods. 35 patients were qualified for infected aorto-femoral graft removal. In years 2000-2004 SFVR was conducted in 19 patients and in years 2005-2007 16 patients had AgR done. These groups were compared in terms of demographic, co-morbidity, vascular reconstructions history, infection symptoms and bacterial contamination. Then treatment results analysis was performed including: operation course, mortality, postoperative morbidity, amputation rate and further observation results.Results. There were no differences in demographic and co-morbidity between the groups. First operation/clinical symptoms onset interval was significantly longer for AgR patients (8 vs 3.3 years, p=0.001). Purulent inguinal sinus was dominating infection manifestation in both groups. Swab results were similar for both groups (Gram+ species dominated in both). Analysis of course and results of operative treatment revealed that AgR operation time was shorter than SFVR (195 vs 317, p<0.001), intraoperative blood requirement was also lower for AgPR (1.6 vs 3.1, p<0.05). Postoperative death, postoperative bleeding, reinterventions and amputation rate were higher for SFVR than AgR, however differences were not significant. During follow-up no infection recurrence was observed.Conclusions. We believe that AgPR is superior comparing with SFVR for patients with infected vascular prosthesis in the aorto-femoral prosthesis. Further investigations are mandatory to confirm our results.

Outcomes of Iatrogenic Femoral Artery Lesions - Treatment Results Valuation

80%

Łukasiewicz A. , Hryncewicz W. , Rychter M. , Molski S.

2009

tom 81

nr 4

172-179

Percutaneous cardiac interventions are nowadays the most common cause of the femoral artery injury. In these cases, surgical intervention was for many years considered the treatment of choice. Satisfactory results of conservative and minimally invasive treatment has changed the state of art.The aim of the study was the analysis of treatment results in patients with iatrogenic femoral aneurysm.Material and methods. In the period of 3 years between 2004 and 2006 in 66 patients an iatrogenic, spure femoral artery aneurysm was recognized. There were 36 women and 30 men in this group. The mean age was 68.8 years. All patients were included prospectively in the study. According to aneurysm morphology, compression pliability and patient choice 45 individuals were assigned to OT group, remaining 21 were treated conservatively: US-guided compression in all patients and thrombin injection if compression failed.Results. There was one death in OT group due to underlying coronary disease and in our opinion unrelated to surgical treatment. Other major adverse events were one postoperative stroke in OT group and superficial femoral artery thrombosis in NT group. 8 patients experienced minor events and they all were operative wound complications. No other complications were observed in NT group. Post procedural stay was longer for the OT group (8.7 vs 3.8 days, p<0.05). Length of hospital stay was also significantly correlated with presence of complications (5.5 days for patients without complications and 16.9 days for the complicated cases, p<0.001). The procedure was successful in 95.2% and 100% in the groups of NT and OT respectively.Conclusions. Utilized criteria of patients' assignment to conservative and operative treatment allowed plausible treatment results. OT and complications significantly increase the length of hospitalization. It is mandatory to remember of possible thrombotic complications related to thrombin injections.

A Midgut Malrotation with Entire Small Bowel Necrosis

80%

Łukasiewicz A. , Nawrocka E. , Molski S.

2009

tom 81

nr 9

405-409

A case of previously undiagnosed midgut malrotation with bowel torsion and subsequent total small bowel necrosis in adult is described. Curative resection saved patient's life. In short discussion, diagnostic and management pitfalls of late clinical presentation of midgut malrotation are described.