Adaptation of endovascular technique of self-expandable metal esophageal stent implantation in palliative treatment of malignant dysphagia in the course of esophageal and bronchial cancers: A one-center study.

BACKGROUND: Esophageal stent implantation is an alternative for microjejunostomy or total parenteral nutrition in the palliative treatment of malignant dysphagia in the course of esophageal and advanced bronchial cancers infiltrating the esophagus. The procedure of implanting an esophageal self-expanding metal stent (SEMS) is performed with gastroscopic guidance under general anesthesia. OBJECTIVES: To analyze the efficacy and safety of a simplified technique (without gastroscopic guidance in local anesthesia) of esophageal SEMS implantation in patients with malignant dysphagia in the course of esophageal and bronchial cancers. MATERIAL AND METHODS: This is a retrospective analysis of consecutive procedures of uncovered esophageal SEMS implantation performed with a simplified adaptation of the endovascular technique (Seldinger wire) in patients with esophageal and bronchial cancers and poor performance status. The procedures were done in a single surgical center over an 8-year period in 27 patients who were referred from oncology departments with esophageal stenosis confirmed using gastroscopy and who were being treated for malignant dysphagia. The study endpoints were effectiveness (a decrease in dysphagia from grade 3 or 4 to grade 1 after the procedure) and complications related to the procedures (including restenosis and stent migration). RESULTS: In all 27 patients, the SEMS were effectively implanted, enabling enteral nutrition after the procedure. No early complications related to the procedure were observed. A single patient developed restenosis 14 days after the procedure, which required re-stenting. CONCLUSIONS: The simplified method for SEMS implantation described herein may be considered an option in the palliative treatment of patients with malignant dysphagia in the course of esophageal and bronchial cancers and poor performance status, especially in facilities with limited access to endoscopy.

Trace elements in the wall of abdominal aortic aneurysms with and without coexisting iliac artery aneurysms.

Iliac artery aneurysms (IAA) and abdominal aortic aneurysms (AAA) frequently coexist. It remains unknown whether the content of trace elements in AAA walls depends on the coexistence of IAAs. The aim of this study was to compare the content of selected trace elements in AAA walls depending on the coexistence of IAAs. The content of trace elements was assessed in samples of AAA walls harvested intraoperatively in 19 consecutive patients. In the studied group, coexisting IAAs were diagnosed in 11 out of the 19 patients with AAA. The coexistence of IAAs was associated with a slightly lower content of nickel (0.28 (0.15-0.40) vs. 0.32 (0-0.85) mg/g; p = 0.09) and a significantly higher content of cadmium (0.71 (0.26-1.17) vs. 0.25 (0.20-0.31) mg/g; p = 0.04) in AAA walls. The levels of the remaining studied elements, copper, zinc, manganese, magnesium and calcium, were comparable. The elevated levels of cadmium in the walls of AAA coexisting with IAAs may suggest an impact of the accumulation of this trace element on the greater damage of the iliac artery wall.