Multifocal Sarcoma Mimicking Superficial Vein Thrombosis of the Leg: A Case Report.

BACKGROUND Leiomyosarcoma is a common tumor found in soft tissue. In relation to the vascular system, leiomyosarcoma appears as the most common malignancy characterized by poor prognosis. Leiomyosarcomas of the leg large vessels often occur late, and their appearance can imitate vein thrombosis with symptoms such as soft tissue swelling or mild pain, and can be misdiagnosed. Peripheral vascular leiomyosarcomas are rare. Especially leiomyosarcomas of the great saphenous vein are uncommon. The tumors develop on the media basis and grow from endovascular to exovascular order. Distant metastasis can be identified and worsen prognosis. CASE REPORT We present a case of a 61-year-old female patient with varicose vein disease complicated by recurrent superficial vein thrombosis. After 2 months of conservative treatment, while waiting for admission to the department of surgery, she developed additional symptoms. Clinical examination on the day of admission revealed several tumors along and near the great saphenous vein on the left limb below the knee. The diagnosis of leiomyosarcoma was confirmed after the surgery, involving excision of the saphenous vein, including tumors formed on its course. Preoperative clinical and ultrasound findings did not suggest malignancy. CONCLUSIONS Leiomyosarcoma of the great saphenous vein is an extraordinarily rare tumor originating from the middle layer of the vessel, mimicking unspecific symptoms and complicating and delaying diagnosis. In every case of vascular or perivascular lesions, a detailed examination and diagnosis it is required, and even unlikely clinical scenarios should be considered.

[Vascular access for hemodialysis--own experiences]. / Dostep naczyniowy do hemodializ--doswiadczenia wlasne.

AIM OF THE STUDY: We present own experiences in creation and/or reconstruction of vascular access for hemodialysis. MATERIAL AND METHODS: 91 pts (63 men, 28 female) aged 18 to 89 years, with irreversible renal failure qualified for renal replacement therapy, 47% of them with diabetic nephropathy. In years 1996-2006, 167 surgical procedures of creation or reconstruction of vascular access for hemodialysis were performed. In the qualification for surgical procedure we used clinical assessment as well as Doppler ultrasound or computed tomography angiography. RESULTS: In 3 cases from all 167 patients we performed fistula ligation due to transfer to peritoneal dialysis. In the 164 others cases we performed 18 types of different procedures among other thing: 95 first or second degree arteriovenous fistulas creation, 35 procedures of revascularisation and 34 procedures of fistula reconstruction. In our material own modification of Cimino-Brescia arteriovenous anastomosis was introduced with positive hemodynamic effects in all cases. In the discussion we stressed the necessity of selection of creation/reconstruction methods individually for every patient especially in ageing and diabetic population of patients with chronic kidney disease with many cardiovascular complications both in predialysis stage of kidney failure as well as in the course of long term dialysotheraphy. CONCLUSION: The assurance in optimal vascular access for hemodialysis is still big challenge especially in patients of advanced age. Individual approach to every case gives the chance of choice the best surgical procedures for optimal vascular access for hemodialysis.

[Asymptomatic intraperitoneal adhesions disease as the potential cause of unfeasibility of creation dialysis access to peritoneal cavity--case reports]. / Bezobjawowa choroba zrostowa otrzewnej jako potencjalna przyczyna niemozliwosci wytworzenia dostepu dializacyjnego do jamy otrzewnowej--opis przypadków.

Peritoneal dialysis is one of three, complementary methods of renal replacement therapy, including also hemodialysis and kidney transplantation. After qualification for peritoneal dialysis program special attention should be paid for creation proper dialysis access through correct implantation of peritoneal catheter. On the basis of three cases we present difficulties of Tenckhoff peritoneal catheter implantation in patients with massive peritoneal adhesions without previous surgical interventions and other risk factors for peritoneal adhesions.

Lymphatic complications after vascular interventions.

INTRODUCTION: Lymphorrhea due to classical and mini-invasive surgical interventions on femoral and popliteal arteries is a serious hindrance to patient treatment. Depending on the experience of a particular center, the incidence and frequency of this type of complication may constitute a serious clinical problem. While the level of lymphorrhea intensity and its duration result in certain foreseeable consequences, their treatment can be a time-consuming and multistep procedure. AIM: To compare different types of vascular interventions with lymphorrhea occurrence. MATERIAL AND METHODS: The authors conducted a retrospective analysis of lymphatic complications based on the material collected between 2005 and 2012 at the Department of Vascular and Endovascular Surgery of the Military Institute of Medicine in Warsaw and in the Department of Interventional Cardiology and Angiology of the Institute of Cardiology in Anin, Warsaw, in 2009-2012. RESULTS: Maintaining due thoroughness when dissecting tissues and treating the cutting line in this area with ligatures and tissue puncture are the most reliable methods of minimizing the risk of lymphatic leakage after surgical procedures performed in a classical way. The lymphatic complication under analysis is far less likely to occur when procedures are performed as planned and an endovascular technique is used - statistical significance p < 0.05. Minimally invasive and fully percutaneous procedures performed via needle puncture, including the use of the fascial closure technique to close the femoral artery, eliminate the likelihood of the occurrence of this vascular complication - statistical significance was found with p value less than 0.05. CONCLUSIONS: We concluded that in every case by minimizing the vascular approach we protected the patient against lymphatic complications.