Wyniki wyszukiwania - Biblioteka Nauki

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New Method of Forced Implantation of Permanent Catheters for Hemodialysis into Critically Stenosed or Occluded Central Veins

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Przywara S. , Iłżecki M. , Terlecki P. , Zubilewicz T.

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2015

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tom 86

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nr 9

405-409

EN

The aim of the study was to report a novel technique of forced implantation of catheters for hemodialysis into critically stenosed or occluded central veins, without preceding angioplasty or stenting. Material and methods. Sixteen patients with central venous occlusive disease, requiring urgent hemodialysis underwent this procedure. Catheterization of stenosis - occlusion was initially performed with soft guidewire, subsequently exchanged to stiff guidewire. Forced insertion of dilators, peel-off sheath throughout the stenosis or occlusion and finally implantation of the catheter completed the procedure. Our technique does not require pre-procedural angioplasty or stent deployment. Results. In all patients postoperative hemodialysis was managed with satisfactory adequacy. No early or late complications related to the procedure occurred. We did not observe any clinically significant aggravation of symptoms of central vein stenosis or occlusion. Complications, not-related to the procedure included one, late skin entry site infection and one, late catheter thrombosis. These were managed without the necessity of catheter exchange. Conclusions. Our technique of forced implantation of catheters for hemodialysis into critically stenosed or occluded central veins without previous balloon predilatation or stenting is simple and diminishes the total cost of the procedure. Provides quick vascular access for hemodialysis in life threatening situations.

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The Impact of Nissen-Rossetti Fundoplication on the Perfusion in Microcirculation of the Gastric Fundus

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Przywara S. , Wallner G. , Dąbrowski A. , Skoczylas T. , Wroński J. , Michalak K. , Zymon R.

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2007

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tom 79

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nr 9

581-586

EN

The aim of the study was to investigate the impact of Nissen-Rossetti fundoplication on the blood flow in the microcirculation of the gastric fundus.Material and methods. Eight patients undergoing Nissen-Rossetti fundoplication were included in the study. Perfusion in the gastric fundus was measured intraoperatively with laser Doppler flowmetry. An adhesive, flat, silicon probe was attached to the serosa in the same anatomical location during every measurement. Microcirculatory blood flow was recorded before and after fundoplication without ligation and division of the short gastric vessels.Results. In each patient, fundoplication led to increases in resting perfusion. Hyperperfusion was evoked by two mechanisms: increase in average blood flow and increase in vasomotion's amplitude and frequency.Conclusions. Fundoplication constitutes a new distribution of blood flow in the microcirculation of the gastric fundus, irrespective of its indication as a treatment of reflux disease or a supplement to cardiomyotomy in patients with achalasia. The procedure, when correctly performed, leads to local reactive hyperemia. Decreases in fundal perfusion suggest that the fundoplication wrap was created under excessive tension and may lead to dysphagia and local ischemia with consequences on motility of the lower esophagus. Thus, the assessment of change in perfusion of the gastric fundus after fundoplication might be a valuable tool in the routine quality control for appropriate performance of the fundoplication wrap.

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Efficacy Evaluation Of Bio Trombina ® 400 In Mini Mall Y Invasive Treatment of Complications (Pseudoaneurysms), After Venipuncture for Diagnostic Purposes. Authors’ Own Experience – Case Study of 38 Patients

75%

Iłżecki M. , Zubilewicz T. , Przywara S. , Wojtak A. , Kęsik J. J. , Olejniczak-Nowakowska M. , Terlecki P.

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2015

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tom 86

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nr 8

359-363

EN

Common use of venipuncture on upper and lower limbs for diagnostic purposes (such as coronarography or arteriography), and also during the course of treatment (angioplasty), very often bares a complication in the form of pseudoaneurysms. According to various reports, the incidence of pseudoaneurysms ranges from 0.005% to 0.5% of all vascular procedures requiring arterial cannulation (Common Femoral Artery, Brachial Artery, Radial Artery). The use of Bio Trombina® 400 in the embolization of pseudoaneurysms allows minimally invasive and effective treatment. The aim of the study was to evaluate the efficacy of pseudoaneurysm embolization with the use of Trombina 400, authors’ own experience. Material and methods. In the years 2011 - 2013, the authors of this study performed 38 vascular interventional procedures involving pseudoaneurysms as complications of venipuncture in upper and lower limbs for diagnostic and treatment purposes. All procedures involved the direct injection of thrombin into the chamber of the pseudoaneurysm under the guidance of USG Doppler (6.2 MHz linear head). 34 cases presented single chamber pseudoaneurysms while 4 cases involved multi- chamber pseudoaneurysms, which required several thrombin reinjections (Bio Trombina® 400) into each of the chambers. Pseudoaneurysm maximum size of 4 cm was set as an inclusion criterion for the embolization procedure. Furthermore, all pseudoaneurysms with a significantly wide tract in transverse dimensions were treated as an exclusion criterion because of high risk of the peripheral arteries embolization. Results. Initial success was observed in 36 patients (94.73%) in the first day after the procedure, 1 patient (2.63%) underwent thrombin reinjection procedure in the second day after the first embolization. Another patient (2.63%) underwent an open procedure in which the Common Femoral Artery was accessed, the clot evacuated, and CFA was sutured with continuous suture Prolene 6-0. Conclusions. 1. Embolization of pseudoaneurysms with USG Doppler-guided thrombin injection is an effective course of treatment for complications of cannulation. 2. The safety of pseudoaneurysm embolization depends on a surgeon’s experience. It is also crucial to keep in mind the inclusion and exclusion criteria for this type of procedure (the size of a pseudoaneurysm, the width of its base). 3. Furthermore, its cost effectiveness and short hospitalization period make pseudoaneurysm embolization an effective and valuable alternative to the classic approach.