Role of vascular endothelial growth factor in inducing production of angiopoetin-1 - in vivo study in Fisher rats.

The aim of the study was to investigate how an intramuscular injection of plasmids with genes coding various pro-angiogenic factors: angiopoetin-1 (ANGPT1), vascular endothelial growth factor (VEGF165) and hepatic growth factor (HGF), influences the production of ANGPT1. 40 Healthy Fisher rats received i.m. injections containing plasmids encoding pro-angiogenic genes in thigh muscles. They were divided into four equal groups. The first group received the plANGPT1 plasmid and the second group- the pIRES/ANGPT1/VEGF165 bicistronic plasmid. The pIRES/VEGF165/HGF bicistronic plasmid was administered to the third group and an empty plasmid (control group) to the fourth group. The animals were euthanized after 12 weeks. In each group, the number of vessels stained with the anti-ANGPT1 antibody was assessed under an optical microscope. The anti-ANGPT1 antibodies stained the vessels in all the groups. There were on average 14.1 ±2.3 vessels in the the plANGPT1 group, 32.5 ±10.5 in the pl/RESANGPT1/VEGF group and 30.8 ±13.3 in the plRES/HGV/VEGF group. There were on average 7.3 ±2.3 stained vessels (p < 0.0001) in the control group . The VEGF plays a role in the induction of the production of ANGPT1. The administration of plasmids only encoding ANGPT1 does not induce its production.

[Methods of Reduction of Warm Ischemic Time in Kidney Transplantation and Their Role of Early and Late Outcomes].

Kidney is the organ transplanted most often. An increase in the number of expanded criteria donors (ECD) has been observed for years, and consequently the condition of transplanted organs worsened. In recent years, the possibility to recover organs from donors after cardiac death (DCD) became legally available in Poland, which will result in the increase of donors. Every DCD donor is at the same time ECD donor. One of the most important challenges the transplantology has to face is the improvement of the quality of transplanted organs. In this study the available data on the reduction of warm ischemic time (WIT) on transplanted kidney has been presented. WIT may influence early and late outcome of kidney allograft. Long WIT increases the risk of delayed graft function (DGF). DGF occurs more often in transplanted kidneys from DCD. One of the main reasons for that is the fact that DCD have longer WIT compared to donors after brain death (DBD). So-called WIT II appearing during vascular anastomosis in kidney transplantation may be reduced by various techniques. The model of clear sterilized polyethylene bag developed by the authors has been presented. The construction of the bag, consisting of three compartments, allow to safely perform vascular anastomosis while keeping the temperature of the transplanted kidney low. The article describes as well other techniques used to decrease WIT II. The effect of anastomosis time on allograft outcome is still not well researched. The article presents the newest information regarding the influence of WIT on graft and patient survival.

[Stem and progenitor cells in biostructure of blood vessel walls]. / Komórki macierzyste i progenitorowe w biostrukturze scian naczyn krwionosnych.

Development of vascular and hematopoietic systems during organogenesis occurs at the same time. During vasculogenesis, a small part of cells does not undergo complete differentiation but stays on this level, "anchored" in tissue structures described as stem cell niches. The presence of blood vessels within tissue stem cell niches is typical and led to identification of niches and ensures that they are functioning. The three-layer biostructure of vessel walls for artery and vein, tunica: intima, media and adventitia, for a long time was defined as a mechanical barrier between vessel light and the local tissue environment. Recent findings from vascular biology studies indicate that vessel walls are dynamic biostructures, which are equipped with stem and progenitor cells, described as vascular wall-resident stem cells/progenitor cells (VW-SC/PC). Distinct zones for vessel wall harbor heterogeneous subpopulations of VW-SC/PC, which are described as "subendothelial or vasculogenic zones". Recent evidence from in vitro and in vivo studies show that prenatal activity of stem and progenitor cells is not only limited to organogenesis but also exists in postnatal life, where it is responsible for vessel wall homeostasis, remodeling and regeneration. It is believed that VW-SC/PC could be engaged in progression of vascular disorders and development of neointima. We would like to summarize current knowledge about mesenchymal and progenitor stem cell phenotype with special attention to distribution and biological properties of VW-SC/PC in biostructures of intima, media and adventitia niches. It is postulated that in the near future, niches for VW-SC/PC could be a good source of stem and progenitor cells, especially in the context of vessel tissue bioengineering as a new alternative to traditional revascularization therapies.

Evaluation of the humoral and cellular immune responses after implantation of a PTFE vascular prosthesis.

INTRODUCTION: The experiment was designed in order to determine the immunological processes that occur during the healing in synthetic vascular grafts, especially to establish the differences in the location of the complement system proteins between the proximal and distal anastomosis and the differences in the arrangement of inflammatory cells in those anastomoses. The understanding of those processes will provide a true basis for determining risk factors for complications after arterial repair procedures. MATERIAL/METHODS: The experiment was carried out on 16 dogs that underwent implantation of unilateral aorto-femoral bypass with expanded polytetrafluoroethylene (ePTFE). After 6 months all animals were euthanized to dissect the vascular grafts. Immunohistochemical assays and electron microscopic examinations were performed. RESULTS: Immunohistochemical findings in the structure of neointima between anastomoses of vascular prostheses demonstrated significant differences between humoral and cellular responses. The area of proximal anastomosis revealed the presence of fibroblasts, but no macrophages were detected. The histological structure of the proximal anastomosis indicates that inflammatory processes were ended during the prosthesis healing. The immunological response obtained in the distal anastomosis corresponded to the chronic inflammatory reaction with the presence of macrophages, myofibroblasts and deposits of complement C3. DISCUSSION: The identification of differences in the presence of macrophages and myofibroblasts and the presence of the C3 component between the anastomoses is the original achievement of the present study. In the available literature, no such significant differences have been shown so far in the humoral and cellular immune response caused by the presence of an artificial vessel in the arterial system.

[Modern treatment of rupturted abdominal aortic aneurysms with the use of synthetic endovascular prostheses]. / Leczenie peknietych tetniaków aorty brzusznej z uzyciem syntetycznych protez wewnatrznaczyniowych.

AIM OF STUDY: We analyzed the case of two patients with ruptured aortic aneurysm treated with the usage of the endowascular method. MATERIALS AND METHODS: Treatment of ruptured abdominal aortic aneurysms is burdened with a high mortality rate during the perioperative period. The implantation of forked stent-grafts and uni-grafts significantly reduced the mortality rate in this group of patients. Usage of this treatment requires the hybrid operating room. An essential element is to have the appropriate amount of equipment available to find a suitable intravascular prostheses. Uni-grafts are a good alternative for smaller divisions and for physicians with less experience in endovascular surgery. CONCLUSION: Endowascular procedures have a great chance to became a golden treatment standard.

[The usefulness of the polymeric "double J" catheter in ureteropelvic junction stenting after laparoscopic pyeloplasty]. / Skutecznosc szynowania polaczeniamiedniczkowo-moczowodowego polimerowym cewnikiem "double J" u chorych poddanych laparoskopowej pyeloplastyce.

OBJECTIVES: The aim of the study was to evaluate both the effectiveness of ureteropelvic junction stenting with the use of a polymeric "double J" stent after laparoscopic pyeloplasty, as well as intra- and postoperative complications of the procedure. MATERIAL AND METHODS: From October 2001 to November 2010 laparoscopic pyeloplasty was performer in 150 patients with primary UPJO. In all cases an attempt has been made to insert the stent into the operated kidney before the operation. All but one operations were performed using a transperitoneal approach. Anderson-Hynes pyeloplasty was carried out in 85 cases, Y-V plasty in 61 cases and Fenger plasty in 2 patients. Open conversion was performer in two cases. RESULTS: In 13 cases the complications observed in the postoperastive period were connected with the polymeric stent. In 12 patients the obstruction of the stent lead to massive urinary leakage and in 3 cases from this group urinoma developed. Urinoma was also observed in a patient, who was left without stenting because of the difficulties in inserting the stent to the operated kidney. In 10 cases the stent was successfully replaced but in 3 cases the placement of a percutaneous nephrostomy tube was necessary. It was left in place for 3 weeks. CONCLUSIONS: Our data indicate, that the stent obstruction is the main cause of postoperative complications in patients after laparoscopic pyeloplasty. So far no better method of upper urinary tract drainage after laparoscopic pyeloplasty has been worked out. Experimenting with various types of stents has been of no avail.

[Usage of hydrophilic catheters and guidewires in endovascular surgery]. / Zastosowanie prowadników i cewników hydrofilnych w chirurgii endowaskularnej.

AIM OF STUDY: The aim of this study was to evaluate the effectiveness of hydrophilic catheters and guidewires during endovascular overcoming long stenoses or occlusions of the superficial femoral and popliteal artery. MATERIAL AND METHODS: Based on 142 procedures rated the functionality of the equipment of the hydrophilic coating. The operations were performed in the years 2010-2012 in the Department of Vascular, General and Transplantation, Medical University in Wroclaw. Procedures related to recanalization or enlargement of the superficial femoral artery. Patients were divided into groups according to the Consensus TASC II depending on the length change. Each patient was assessed ankle-brachial ratio (ABI), claudication distance measured and constructed with double ultrasound imaging (USG-DD). In doubtful cases an additional study was performed with contrast computed tomography (angio-CT). The procedure was performed at the Laboratory of angiography using a angiograph Siemens Artis Zee Ceiling. Every time the contrlateral access was made, and as the first step the angiography was performed to verify type of changes in the arteries RESULTS: . A significant benefit of using hydrophilic guidewires and catheters in patients with long stenoses or occlusions. In case of long and calcified changes, hydrophilic catheters was the only option because it gave good support for hydrophilic guidewire. CONCLUSIONS: The changes in the type C and D according to the criteria for TASC II, an essential tool to achieve a positive treatment effect is the use of hydrophilic catheters and guidewires.

[The treatment of aorto-duodenal fistula with the use of the endovascular prosthesis]. / Zaopatrzenie przetoki aortalno-dwunastniczej z uzyciem protezy wewnatrznaczyniowej--opis przypadku.

One of the most common and serious complications after implantation of aortic or aorto-femoral prosthesis are aortoduodenal fistula. Secondary aorto-duodenal fistula is the most commonly observed form of a fistula between the abdominal aorta and gastrointestinal tract. 76 years old male with infected vascular prosthesis was admitted to Clinic with syndroms of active bleeding from aorto-duodenal fistula. Because of general condition, patient was qualified to endovascular procedure, and a new stentgraft was implanted. After the procedure patient was treated with antibiotic compatible with inoculation from blood and he did not gave agreement for further surgical operations. He lived next 28 months and died because of lung cancer.

[The use of polymeric Hem-o-lock clips in laparoscopic radical nephrectomy]. / Zastosowanie polimerowych klipsów Hem-o-lock w laparoskopowej nefrektomii radykalnej.

OBJECTIVES: The aim of the study was to evaluate the usefulness and cost-effectiveness of polymeric Hem-o-lock clips during laparoscopic nephrectomy. The intra- and postoperative complications of the operation were assessed too. MATERIAL AND METHODS: From April 2011 through November 2011, 19 laparoscopic radical nephrectomies were performed. A preferred method to secure the renal vein was the use of polymeric Hem-o-lock clips. The renal artery was clipped by titanium clips. In five patients an Endo-GIA stapler was used to secure the renal pedicle. All procedures were carried out using a transperitoneal access. The perioperative data were analyzed retrospectively. RESULTS: No intraoperative complications associated with the use of Hem-o-lock clips were observed. The mean procedure time was 202 min. The average blood loss during the operation was 480 ml. No bleeding in the postoperative period was observed. The mean abdominal drain output was 65 ml per day. The mean time to drain removal was 3 days. The average hospital stay was 5-6 days. CONCLUSIONS: Using the polymeric Hem-o-lock clips is a safe, relatively easy and cheep way to close the renal vein during laparoscopic radical nephrectomy.

[The treatment of dissected thoraco-abdominal aorta aneurysm with the use hybrid procedure]. / Zaopatrzenie tetniaka aorty piersiowo-brzusznej przy uzyciu procedur hybrydowych.

AIM OF STUDY: We analyzed the case of a patient treated in Vascular Surgery Department with the use of the hybrid procedure with a good results. MATERIALS AND METHODS: Acute cases of dissected aortic aneurysm are commonly known as an immediate danger of human live and determinate a big challenge for physicians. The collaboration of classic and endovascular methods (hybrid procedures) gives much more chances to improve patient's survival and resumption to normal life activity. Endovascular procedures are limiting the operation shock, improving recovery time. That means rising the chances of survival so advanced surgical procedure. CONCLUSION: Hybrid procedures are a modern technic that gives good results.

The inflammatory cells in vascular graft anastomosis an electron microscopy study.

UNLABELLED: In order to determine the processes arising during the healing in vascular grafts the following experiment was desinged in 16 dogs. MATERIAL AND METHODS: The animals underwent implantation of unilateral bypass aorto-femoral (straight prosthesis from politetrafluoroethylrne--PTFE). After the 6 months all the animals sacrificed and vascular grafts were dissected and exam in electron microscopy. RESULTS: There were significant differences in the histological findings in structure of neoitima between the proximal and distal anastomoses vascular prostheses. There were evidence of presence of fibroblasts but not macrophages in proximal anastomoses The histological structure of the proximal anastomoses indicates that inflammatory processes was ended during the prosthesis healing. There were presence of macrophages and myofibroblasts, some in the active secretion of collagen in distal anastomoses. CONCLUSIONS: Theses images of vascular anastomoses of artery with politerafluoroeth-ylene prosthesis corresponds to the chronic inflammatory reaction in distal anastomoses.

[The operations of the abdominal hernias with the use propylene material in patients operated due to abdominal aortic aneurysm]. / Stosowanie siatek propylenowych w operacjach przepuklin brzusznych u chorych, operowanych z powodu tetniaka aorty brzusznej.

The correlation between abdominal hernias and aortic aneurysm has been well documented in literature. The pathophysiology of aneurysm and hernia formation is seen within the abnormal collagen metabolism, resulting in extracellular matrix defects. This study presents a group of 8 men in the age of 36 to 78 years old (average 63, 5 years old) who underwent both an operation for the aneurysm and for the abdominal hernia. Of the reported 8 patients, 7 had postoperative hernias, where 4 of the cases there were recurrent postoperative hernias. The remaining patient had an inguinal hernia. In 7 cases patients underwent an abdominal aortic aneurysm (AAA) operation and in one case a hepatic artery aneurysm endovascular operation was performed. Due to the fact that postoperative hernias are an immense problem, especially within the group of patient with collagen defects, the area of research and improvement of the materials that are used in prosthetic hernia surgery today needs to progress. This study also presents a short review of the various types of prosthetic materials used in the production of hernial meshes. This is to emphasize the necessity of improving operational techniques to minimize the risk of herniation, especially within a group of patients with collagen defects.

[The use of vascular prothesis Gore Viabahn in the managment of the lower limbs ischemia]. / Zastosowanie protezy Gore Viabahn w leczeniu przewleklego niedokrwienia konczyn dolnych.

The chronic lower limbs ischaemia is caused mainly by arteriosclerosis. After insufficient conservative treatment only the surgical intervention can salvage the limb. The revascularisation surgery can be performed by open surgery with implantation of the prosthetic bypass or by endovascular angioplasty with stent. This second method seems to be the best alternative for the patients with several concomitant systemic diseases. Nevertheless it is limited by presence of the long-distance arteriosclerotic lesions. The resolve of that problem is use of new generation of long endovascular covered stents. They can be succesfuly used in aorto-femoral and femoro-popliteal segment. Their efficiacy is simmilar to traditional prosthetic grafts.

[The use of dacron Quatro-furcate prosthesis and PTFE-stentgraft in the treatment of thoraco-abdominal aneurysm]. / Zastosowanie dakronowej rozgalezionej protezy naczyniowej oraz politetrafluoroetylenowej protezy wewnatrznaczyniowej w leczeniu hybrydowym piersiowo-brzusznego tetniaka aorty.

In the work a case of patient with thoracoabdominal aneurysm in area of subclavian artery was presented. The patient was previously operated on because of abdominal aneurysm. There was a risk of death when performing classic surgical treatment. In the presented situation hybrid operation was performed. In the first stage the inflow of the blood to blood-vessels with the use quarto-bifurcation dacron with collagen vascular prosthesis was reconstructed and in the second stage stentgraft was implanted. The patient's survival during seven years long observation was reached owing to the fact that hybrid operation was performed.

The heparin-bonded ePTFE grafts in revascularisation of the lower limbs.

The critical limb ischemia is diagnosed when the rest pain and/or distal necrosis or ishemic ulceration occur and last for more than two weeks. Critical limb ischemia requires immediate revascularisation due to the risk of amputation. The most common cause of this state is the arteriosclerosis located on femoropopliteal level. The surgery consists of endarterectomy or implantation of the bypass graft or the percutaneous, intravascular procedure. The best material for the graft is the autologous saphenous vein but sometimes the artificial graft should be used. Some trials have proven that the heparin-bonded polytetrafluoroethylene graft could be the best resolution for patients without possibilities of use of the autologous vein.

[The use of the heparin-bonded ePTFE grafts for needs of the hemodialysis]. / Zastosowanie protez naczyniowych politetrafluoroetylenowych pokrytych heparyna dla potrzeb hemodializy.

Chronic dialysis in case of patients with extreme renal insufficiency frequently leads to loss of vascular access for hemodialysis. The only alternative for such patients is a transplantation of a kidney. The time of expectation may extend because of many reasons and a patient requires permanent and systematic dialysis. Then there is no option of maintaining a permanent access to dialysis but to artery-arterial by-pass with the usage of vascular prosthesis as an access to dialysis. Recent researches recommend prostheses covered with heparin. Such prosthesis are less of thrombosis and they curb processes connected to the height of the number of cells. At the same time they retain their patency for longer, especially in region of anastomosis. It permits to lengthen time of dialysis and also time of expectation for a kidney transplant. Our experiences are confirmed by other authors' observations and they also prove usefulness of heparin bonded prosthesis Propaten for producing artery-arterial by-pass as the only alternative of treating patients with chronic renal insufficiency in cases of whom all possibilities of vascular access for hemodialysis were depleted.

[The use of the dacron net in the externa tightening of the endoleak type I, after the stengraft implantation in the abdominal aorta aneurysm]. / Zastosowanie siatki dakronowej w zewnetrznym uszczelnieniu przecieku typu I, po wszczepieniu protezy wewnatrznaczyniowej w tetniaka aorty brzusznej.

Implantation of the vascular prosthesis below renal artery when the neck of the aneurysm is short, carries the risk of the appearance of the endoleak type I. At such patients one ought to make allowance for with the necessity of the single-stage or two-stage-supply of the endoleak with banding method that is to say with the tightening of the neck of the aneurysm on the stentgraft with the open method. This method consisting in to the compression of the neck of the aneurysm on stentgraft at the use of ribbons or the wide belt from the dacron net. In this paper one represented 3 patients operated with banding method. In the face the massive endoleak type I and the threat of the ruptum of the aneurysm one decided on the realization of the surgical correction with the open method with banding.

[The use of politetrafluoroethylene stent-graft and vena cava filter in the endovascular treatment of ruptured abdominal aortic aneurysm with aortocaval fistula]. / Zastosowanie politetrafluoroetylenowej protezy wewnatrznaczyniowej i filtra zyly glównej dolnej w leczeniu peknietego tetniaka aorty brzusznej do tyly czczej dolnej.

We report on a the endovascular treatment of ruptured abdominal aortic aneurysm with aortocaval fistula. The stent-graft was placed with the patient under general anaesthesia, and the abdominal aorta aneurysm was successfully treated. To prevent pulmonary embolism vena cava filter was deployed before the implantation of the sten-graft. The aneurysm was excluded and no endoleak or communication between the aorta and inferior vena cava was seen on computed tomographic imaging at the 3-month evaluation. Endovascular treatment offers an attractive therapeutic alternative to open repair in case of aortocaval fistula.

[Synthetic endovascular prostheses in the treatment of the aortic dissection]. / Syntetyczne protezy wewnatrznaczyniowe stosowane w leczeniu rozwarstwienia aorty.

Endovascular technique using endovascular prostheses called stent-grafts offers less invasive new method of the aortic dissection. Assessment of endovascular aortic dissection type B treatment effectiveness, complications and mortality frequency associated with this technique. Among 33 patients (24 men -- 73% and 9 women -- 27%, aged 19-76 years (average [+/- SD]. Underwent endovascular stent-grafts implantation procedures using 3 types of grafts: Zenith (2 prostheses -- 13,3%), Talent (11 prostheses -- 73,3%) and Valiant (2 prostheses --13,3%). The diameter of proximal end of stent-graft ranged from 34 to 42 mm (mean 37,6 +/- 3,44 mm), length -- from 130 to 230 mm (mean 183,6 +/- 37,42 mm). Endovascular technique is promising strategy of aortic dissection type B treatment. Stent-graft application faces up to general aspiration to minimize extension and traumatization of surgical procedures, to reduce peri- and postoperative complications, decrease hospitalization and convalescence period. Endovascular technique is the only available method that interferes in the elementary mechanism of the aortic dissection pathogenesis. Through the initiation of natural repair process (thrombosis of the false lumen), as a result of coverage of the primary entry tear, ensures remodeling and stabilization of the aortic wall.

[The use of a synthetic vascular artificial prosthesis or arterial homograft in cases of patients with the arteriosclerosis and terminal insufficiency of kidney cured by the kidney transplantation]. / Stosowanie syntetycznej protezy naczyniowej lub homograftu tetniczego u chorych z miazdzyca i terminalna niewydolnoscia nerek leczonych przeszczepem nerki.

Arterial transplantations were practiced in the vascular surgery since the beginning of her formation but without successes in the distant observation. Transplantation of a kidney is a routine conduct in the treatment of the decadent incapacity of a kidney. The dissertation concerns a use of arterial allografts kept using a method of a cold ischaemia in the protective liquid or synthetic vascular dacron artificial limbs or PTFE used as arterial foot-bridges at patients with the atherosclerotic obstruction aortal-pelvic, treated with the kidney transplantation. The arterial transplant is created from the aorta, arteria iliacas common and externa, femoral arteries common and superficial. A tissue material is kept using the method of the cold ischaemia and practical as the aortal foot-bridge-femoral or aortal-two-femoral at classified earlier patients being subjecteds to transfusion. The other way of a transplantation of a kidney at patients with the arteriosclerosis is the realization earlier or one-temporarily the vascular foot-bridge with use of the synthetic artificial limb. It seems that vascular artificial limbs about enlarged resistance on the contagion should be used in such a case. Sonographic examinations with duplex doppler and angiography are performed in all cases. The analysis of such cures can make a creation of the most profitable algorithm of the conduct possible in cases of patients suffering from ischaemia of lower limbs and requiring a transplantation of a kidney because of its incapacity.