Cardiac Stress in High-Risk Patients Undergoing Major Endovascular Surgery-Focus on Diastolic Function.

OBJECTIVES: The purpose of this study was to determine the relationship between the changes in diastolic function and their association with cardiac biomarkers in the perioperative period in patients undergoing complex endovascular aortic repair. DESIGN: Prospective observational study. SETTING: Single-center academic hospital, central teaching hospital in Warsaw, Poland. PARTICIPANTS: The study comprised 27 high-risk patients scheduled for elective endovascular repair of aortic aneurysm. INTERVENTIONS: Complex endovascular procedure using branched endograft of the thoracoabdominal aorta. Branches of the stent grafts included renal arteries, the superior mesenteric artery, and the celiac trunk. MEASUREMENTS AND MAIN RESULTS: The primary outcome was to evaluate changes in diastolic function parameters assessed with transthoracic echocardiography at two and 24 hours postoperatively. The major secondary outcomes were changes in N-terminal pro-B-type natriuretic peptide (NT-proBNP) and troponin I concentrations, systolic function parameters, hemodynamic parameters at two and 24 hours, length of hospital stay, and 30-day mortality. There was a reduction in e' wave velocity on both the septal and lateral sides at two hours compared with the baseline (p = 0.041 and p = 0.05, respectively). There was an increase in both NT-proBNP and troponin I concentrations after surgery (p = 0.002 and p = 0.034, respectively), with troponin I peaking two hours after surgery and NT-proBNP peaking 24 hours after surgery. CONCLUSIONS: Patients undergoing a branched endovascular aortic repair of a thoracoabdominal aortic aneurysm experience a cardiac insult that manifests with deterioration in diastolic parameters and concomitant increases of troponin and NT-proBNP concentrations. Additional large-scale prospective studies are required to confirm this phenomenon.

Usefulness of Modified Dindo-Clavien Scale to Evaluate the Correlation Between the Severity of Surgical Complications and Complications Related to the Renal and Pancreatic Grafts After Simultaneous Kidney and Pancreas Transplantation.

OBJECTIVE: Simultaneous pancreas and kidney transplantation (spktx) is the multiorgan transplantation. Thus various complications originated from transplanted organs and the complications that are not directly related to pancreatic or renal grafts could be developed at the same recipient. AIM: The aim of this study is to explore whether there is a correlation between the severity of complications originated from transplanted pancreas, transplanted kidney and general surgical complication developed at the same spktx recipient. METHODS: Complications which developed among 112 spktx recipients were divided into three groups: related to the pancreatic graft (PTXc), to the renal graft (KTXc) and the general surgical complication (GNc). Severity of postoperative complications using modified Dindo-Clavien scale recipients was evaluated for each group. The correlation of severity of coexisting complications from different complication groups was analyzed. RESULTS: There were 22 recipients who developed the coexistence of complication between different complication groups. Complication originated from two and three complication groups developed 15 (68.2%) and 7 (31.8%) patients, respectively. There was not found correlation of the complication severity between: KTXc and GNc group, GNc and PTXc group, KTXc and PTXc group. The correlation (r = 0.84) of complication severity in recipients who developed concurrently complication from transplanted kidney, transplanted pancreas and general surgery complication was found. CONCLUSION: The modified Dindo-Clavien scale is an useful methodology for the correlation description of complication severity in complex multiorgan transplantation such is spktx, especially when the complications originated from different, potentially independent from the pathophysiological point of view, sources.

Surgical Complications Not Related to the Renal and Pancreatic Grafts After Simultaneous Kidney and Pancreas Transplantation.

BACKGROUND: Simultaneous pancreas and kidney transplantation (SPKTx) is the most commonly performed multiorgan transplantation procedure worldwide. Transplanted organs are the main source of complication; however, some postoperative complications are not directly related to the pancreatic or renal grafts. The goal of this study was to evaluate the prevalence, type, and severity of postoperative complications not related to transplanted kidney or pancreas among SPKTx recipients. METHODS: Complications unrelated to transplanted pancreas and kidneys among 112 SPKTx recipients were analyzed. The cumulative freedom from general surgical complications was assessed, and it was compared with cumulative freedom from complications related to kidney and pancreatic grafts. Severity of complications was classified according to a modified Clavien-Dindo scale. RESULTS: The general surgery complication rate was 22.2%. Cumulative freedom from general surgical complications at days 60 and 90 after transplantation was 0.89 and 0.87, respectively. Cumulative freedom from general surgical complications was comparable with cumulative freedom from complications related to kidney grafts but significantly higher than cumulative freedom from complications related to pancreatic grafts (log-rank test, P < .001). The rates for grades of severity II, IIIa, IIIb, and IVb were 19.4%, 9.7%, 64.5%, and 6.4%, respectively. The most frequent cause of complications was intra-abdominal hematoma or abscess (25.8%). CONCLUSIONS: The general surgical complication rate was comparable to the rate of complications originating from the renal grafts but significantly lower than the complication rate related to the transplanted pancreas. The incidence of general surgical complications could be defined as moderate, and the severity of this type of complication was low.

Multivariate analysis of complications after simultaneous pancreas and kidney transplantation.

OBJECTIVE: Identification of factors that have an impact on postoperative complications after simultaneous pancreas and kidney transplantation (SPKTx) could help overcome limitations of this kind of treatment. METHODS: Postoperative complications among 112 SPKTx recipients were divided into 3 groups: related to transplanted pancreas (n = 66), related to transplanted kidney (n = 23) and general surgical complications (n = 31) 120 refers to complications among 112 recipients. According to the modified Clavien-Dindo scale, complications were classified according to their severity for each group. Risk factors for complication development related to donor, recipient, surgical technique, and immunosuppression were included to establish the multivariable model using logistic regression. RESULTS: Multiple regression analysis showed the following independent factors influenced mortal complications due to transplanted pancreas: age of donor (OR, 1.07; P < .04), duration of vascular pancreas anastomosis above 35 minutes (OR, 3.94; P < .04) and duration of recipient dialysis above 24 months before transplantation (OR, 0.14; P < .01). Area under receiver operating characteristic curve for this model was 0.8. CONCLUSION: To improve results, the following modification of identified risk factors should be assumed: selection of donor in term of age, shortening of the second warm ischemia time, and adjustment of the waiting list to avoid prolongation of recipient dialysis before SPKTx.

Quality of pancreatic transplant program assessment using a risk-adjusted cumulative sum chart: experience from a single, small center.

BACKGROUND: The high rate of complication after pancreas transplantation not only had an impact on recipient quality of life and survival but also had significant financial implications. Thus, monitoring transplant center performance was crucial to indentifying changes in clinical practice that result in quality deterioration. OBJECTIVE: To evaluate retrospectively the quality of the single, small pancreatic transplant program and to establish prospective monitoring of the center using risk-adjusted cumulative sum (CUSUM). METHODOLOGY: From 1988 to 2014, 119 simultaneous pancreas and the kidney transplantations (SPKTx) were performed. The program was divided into 3 eras, based on surgical technique and immunosuppression. Analyses of the 15 fatal outcomes due to complication from pancreatic graft were performed. The risk model was developed using multivariable logistic regression analysis based on retrospective data of 112 SPKTx recipients. The risk-adjusted 1-sided CUSUM chart was plotted for retrospective and prospective events. The upper control limit was set to 2. RESULTS: There were 2 main causes of death: multiorgan failure (73.3%; 11/15) and septic hemorrhage (26.7%; 4/15). Quality analysis using the CUSUM chart revealed that the process was not homogeneous; however, no significant signal of program deterioration was obtained and the performance of the whole program was within the settled control limit. CONCLUSION: For a single pancreatic transplant center. The risk-adjusted CUSUM chart was a useful tool for quality program assessment. It could support decision making during traditional surgical morbidity and mortality conferences. For small transplant centers, increasing the sensitivity of the CUSUM method by lowering the upper control limit should be considered. However, an individual assessment approach of the for particular centers is recommended.

Early complications related to the transplanted kidney after simultaneous pancreas and kidney transplantation.

OBJECTIVE: Simultaneous pancreas and kidney transplantation (SPKTx) is the most often performed multiorgan transplantation. The main source of complication is transplanted pancreas; as a result, early complications related to kidney transplant are rarely assessed. The aim of this study was to evaluate prevalence, types, and severity of postoperative complications due to kidney graft among the simultaneous pancreas and kidney recipients. METHODS: Complications related to transplanted kidney among 112 SPKTx recipients were analyzed. The indication for SPKTx was end-stage diabetic nephropathy due to long-lasting diabetes type 1. The cumulative survival rates for kidney graft function and cumulative freedom from complication on days 60 and 90 after transplantation were assessed. Severity of complications was classified according to the modified Dindo-Clavien scale. RESULTS: The 12-month cumulative survival rate for kidney graft was 0.91. Cumulative freedom from complication on the 60th day after transplantation was 0.84. The rates for II, IIIA, IIIB, IVA, and IVB severity grades were: 34.9%, 4.3%, 26.1%, 26.1%, and 8.6%, respectively. Acute tubular necrosis and rejection were the most frequent (43.4%) cause of complication. The most frequent reasons for graft nephrectomy were infections (2/7; 28.6%) and vascular thrombosis due to atherosclerosis of recipient iliac arteries (2/7; 28.6%). The most severe (IVB) complications were caused by fungal infection. CONCLUSION: Rate and severity of complications due to renal graft after SPKTx was low; however, to prevent the most serious ones reduction of fungal infection was necessary.

Surgical complications related to transplanted pancreas after simultaneous pancreas and kidney transplantation.

OBJECTIVE: Simultaneous pancreas and kidney transplantation (SPTKx) is characterized by the high rate and variability of postoperative complications, which could be a limitation of this treatment. The aim of this study was to evaluate prevalence, types, and severity of postoperative complications due to pancreas graft among the simultaneous pancreas and kidney recipients. METHODS: Postoperative complications related to transplanted pancreas among 112 SPTKx recipients were analyzed. The cumulative survival rates for pancreas graft function and cumulative freedom from complication on day 60 after transplantation were assessed. Severity of complications was classified according to a modified Clavien-Dindo scale. RESULTS: The 12-month cumulative survival rate for pancreatic graft was 0.74. Cumulative freedom from complication on the 60th day after transplantation was 0.57. The rates for II, IIIA, IIIB, IVA, and IVB severity grades were 10,6%, 4,5%, 19,7%, 44%, and 21,2%, respectively. The most severe (IVB) transplanted pancreas complications were due to graft inflammation, infection, pancreatic abscess, and local or diffuse necrosis. The most frequent reason for graft pancreatectomy was vascular thrombosis 35.9% (14/39). The mortality rate after graft pancreatectomy was significantly lower for vascular thrombosis than for infection (0/14 vs 11/25; P < .05). CONCLUSION: Reducing vascular thrombosis could preserve graft function rate. Preventing graft inflammation and infection would reduce mortality.

Is severe atherosclerosis in the aortoiliac region a contraindication for kidney transplantation?

BACKGROUND: Atherosclerosis is common in end-stage renal disease patients on dialysis. However, it has previously been considered to be a relative contraindication to kidney transplantation. Currently, patients with extended indications are accepted onto the waiting list, including those with severe atherosclerosis. These patients require vascular procedures before or during kidney transplantation. The aim of this study was to present our experience with vascular reconstruction before kidney transplantation. MATERIAL AND METHODS: Twelve atherosclerotic, uremic patients referred to be candidates for kidney transplantation were refused because of occlusive lesions of the iliac arteries or the distal aorta. The 10 males and 2 females had an age range of 45 to 68 years. Preoperative assessments consisted of a Doppler ultrasound and an angio computed tomography scan. The reconstructions were performed with aorto-biliac, aorto-bifemoral, or ilio-femoral dacron grafts in 7, 4, and 1 patient, respectively, under general anesthesia. RESULTS: There were no major postoperative complications; the patients were discharged and placed on a special waiting list. Eight patients received kidney allografts, including one living-related transplantation. All procedures were performed with arterial anastomosis of the transplanted kidney to the side of the prosthesis. No patient developed signs of arterial graft infection. In the postoperative period, there were no arterial or transplanted kidney-related complications, except for delayed graft function in four cases. The remaining four patients are still on the waiting list. CONCLUSION: In end-stage renal disease patients with severe atherosclerosis in the aortoiliac region, vascular reconstruction allows kidney transplantation.

Influence of simultaneous pancreas and preemptive kidney transplantation on severity of postoperative complications.

BACKGROUND: Simultaneous pancreas and preemptive kidney transplantation (SPpreKT) seems to be the optimal treatment for the patients with diabetes type 1 who are progressing to end-stage renal disease. On the other hand, surgical complications with a high rate of relaparatomy are a limiting factor in pancreas transplantation. OBJECTIVE: Comparison of severity of surgical complications was performed between a group of preemptive (SPpreKT group) and nonpreemptive recipients of SPKT (SPKT group). METHODS: Between 1988 and 2010, we performed 112 SPKTs including 25 preemptive recipients (22.3%). The SPKT Group included 87 recipients (77.7%). The severity of complications was classified according to a modified Clavien scale: grade I, no complication; grade II, drug therapy; grade IIIA, invasive intervention not requiring general anesthesia; grade IIIB, invasive intervention requiring general anesthesia; grade IVA, graft failure; and grade IVB, death. RESULTS: Among the SPpreKT group, 64% of recipients were free from postoperative complications compared with 40.3% of the SPKT group (P<.01). Among the SPKT group, 52 recipients (59.7%) developed 58 postoperative complications, including 15 (17.3%) deaths due to graft pancreatitis (80%) or pancreatic fistula (20%). Among the SPpreKT group, 9 recipients developed 9 complications. None of the preemptively transplanted group subjects experienced a lethal complication. Among the SPpreKT group, the most severe complication was graft pancreatitis leading to graft removal in 2 recipients. CONCLUSIONS: Recipients of preemptive SPKT developed significantly fewer postoperative complications, especially deaths. However the rates of mild (II, IIIA) and moderate (IIIB) complications as well as graft failures (IVA) were similar to the nonpreemptive group.

Vascular access for haemodialysis in patients with central vein thrombosis.

OBJECTIVES: Dialysis-dependent patients often have central venous drainage complications. In patients with functioning arm arteriovenous fistula, this may result in venous hypertension, arm oedema and vascular access failure. Percutaneous angioplasty and stent implantation might be inadequate to resolve these issues. In these cases, new access can potentially be created with anastomosis to the subclavian vein, iliac vein or vena cava or by making a veno-venous graft to bypass the thrombosis. The aim of this study was to assess the utility of unusual bypasses in vascular access in patients with the central vein thrombosis. MATERIALS: A total of 49 patients were treated. The mean number of previous vascular access surgery procedures was 7.6 (3-17). We performed 19 axillo-iliac, 14 axillo-axillary bypasses and 16 conduits from the arm fistula to the jugular (nine conduits) or subclavian (seven conduits) vein for haemodialysis purposes. RESULTS: All fistulas except one were used for haemodialysis. One patient died before the first use of the fistula. At 12 months, the primary, primary assisted and secondary patency rates were 85.4%, 89.6% and 95.8%, respectively. The follow-up period ranged from 1 to 84 months. CONCLUSION: Unusual grafts are an efficient option as a permanent vascular access for haemodialysis purposes in patients with central vein occlusion.

Influence of the primary disease on rehabilitation results in the early postoperative period in patients after orthotopic liver transplantation.

BACKGROUND: Rehabilitation after orthotropic liver transplantation (OLT) is a difficult clinical problem due to severe comorbidities and complications. We evaluated the rehabilitation progress in the early postoperative period of patients after OLT depending on the reason for liver transplantation. MATERIALS AND METHODS: We retrospectively evaluated 309 OLT recipients transplanted between 2003 and 2006, including 161 women and 148 men. We analyzed the results of early postoperative rehabilitation measured by the time to full, active, erection upright after surgery. We divided the patients into 5 groups due to etiology of liver failure: group A (n = 89; mean age, 46.7 years) consisted of patients with liver cirrhosis due to hepatitis B, C, or both; group B (n = 70; mean age, 43.8 years) included patients with primary biliary cirrhosis and primary sclerosing cholangitis; group C (n = 44; mean age, 46 years) conprised patients with postalcoholic liver cirrhosis; group D (n = 23; mean age, 29.7 years) had experienced acute or subacute liver failure; and group E (n = 83; mean age, 37.4 years) had other reasons of liver failure. All patients were included in an identical rehabilitation program. RESULTS: The mean time to full, active, erection upright was dependent on the reason for liver failure. The best result was observed in groups A and E (4.51 and 4.6 days, respectively), medium in groups B and C (5.3 and 5.02, respectively), and worst in group D (8.5 days). The differences between groups A, E, and D were significant. CONCLUSION: The best results were obtained in groups A and E, where full, active, erection upright was achieved at 4.51 and 4.60 days respectively, and worst in group D, where it was achieved on day 8.50. These results need to be taken into account in planning the rehabilitation process for OLT patients. When analyzing the correlation between full, active, erection upright and primary diseases, one of the factors contributing to the delay needs to be assumed to be the inability to develop compensating mechanisms in the cases of acute and subacute hepatic failures, resulting from the sudden development of the disease.

Usefulness of 16-row multidetector computed tomography with volume rendering and maximum intensity projection reconstruction as a monitor pancreatic graft vessel patency during the early postoperative period.

Thrombosis of the pancreatic graft vessels is the most common complication after transplantation. It leads to loss of 5% to 8% of grafts during the early postoperative period. The aims of this study were to evaluate the usefulness of 16-row multidetector computed tomography (16-MDCT) with volume rendering (VR) and maximum intensity projection (MIP) reconstruction to monitor pancreatic graft vessel patency during the early postoperative period and the efficacy of a heparin infusion as a treatment for graft thrombosis. Among 40 consecutive simultaneous pancreas-kidney transplant recipients, 16-MDCT was performed at 6 to 8 days after the operation. Secondary reconstructions were obtained with VR and MIP algorithms to evaluate the morphology and patency of the extra- and intrapancreatic arteries and veins. In cases of thrombosis, every patient was treated with an infusion of unfractionated heparin. In 15 recipients, thrombosis of the large vessels was detected by 16-MDCT. Heparin infusions saved five pancreatic grafts (5/15; 33.3%), but the other 10 pancreatic grafts were removed. In another four recipients (4/40; 10%) the thrombi were localized only in small intrapancreatic vessels. Treatment with heparin infusion was successful in 3/4 (75%) cases with patent vessels upon control computed tomography examination. We compared the efficacy of heparin treatment depending on the diameter of the thrombosed vessel, observing a significant difference (5/15 vs 3/4; P < .01; chi-square). 16-MDCT with secondary reconstruction by application of VR and MIP algorithms was an efficient method to visualize not only large pancreatic graft arteries and veins but also intrapancreatic parenchymal vessels. In cases of thrombosis of small intrapancreatic vessels, unfractionated heparin infusion significantly decreased graft loss.

Influence of pancreas and kidney transplant function on recipient survival.

The aim of this study was to evaluate long-term survival after simultaneous pancreas and kidney (SPK) transplantation in relation to function of both grafts. Among 67 recipients who received SPK transplants between 1988 and 2004, 35 had follow-up longer than 18 months, and were divided into: group I (n = 20), recipients with good function of both grafts; group II (n = 7), patients who had lost transplanted pancreas but had still good kidney graft function; group III (n = 8), patients who had lost both grafts. Comparison of survival rates and analysis of the reason of mortality among groups was performed. The cumulative survival rate was significantly higher in group I than in group III (after 3, 5, 10 years: 100%, 100%, 80% vs 75%, 50%, 37%, respectively). Cumulative survival rate for group II after 3, 5, 10 years was 100%, 100%, 33%, respectively. There were no significant differences in survival rates between groups I and II and between groups II and III. In group I deaths for cardiovascular event and for leukemia were noted. In group II deaths due to cardiovascular event and sepsis were observed. In group III all patients died due to cardiovascular events and the mean time from loss of pancreas and kidney graft function to death was: 75 +/- 51 months (range from 19 to 142), and 49 +/- 26 months (range 19 to 99), respectively. Good pancreas and kidney graft functions prevent death due to cardiovascular event.

Imaging of pancreatic transplant vessels and anastomoses with 16-row multidetector computed tomography.

The aim of this study was to evaluate the usefulness of 16-row multidetector computed tomography (16-MDCT) in the assessment of the potency of arterial and venous vessels in combined kidney-pancreas transplant and detection of transplant-related complications. Fifteen patients underwent a combined kidney-pancreatic transplantation. On the seventh day after the operation, we performed 16-MDCT in arterial and portal venous phase to evaluate vessels, anastomotic sites, and pancreatic parenchymal vascularization as well as peripancreatic fluid collections. We visualized the pancreatic vessels and anastomosis sites in all cases. In 12 recipients, there were no abnormal findings as regards the patency of the arterial and venous vessels and the vascularization of the pancreatic parenchyma. In two patients, complete arterial thrombosis of the body and tail pancreatic graft vessels was recognized at 2 weeks after transplantation, resulting in graft removal. Thrombi were localized in the distal part of anastomoses. None of the patients had venous thrombosis. One recipient had stenosis of the venous anastomosis. Peripancreatic fluid collections were observed in seven patients. In conclusion, 16-MDCT is an efficient method to estimate pancreatic transplant vessels, localize thrombi, and detect other transplant-related complications.

A solution to organ shortage: vascular reconstructions for pancreas transplantation.

Multiorgan harvesting (MOH) accounts for approximately 40% of all organ procurements in Poland. Simultaneous procurement of the pancreas and liver necessitates division of the vessels supplying both organs. Therefore, reconstruction of the pancreas vasculature is mandatory for proper function of the transplanted organ. The aim of this study was to present various methods of vascular reconstruction to prepare the pancreas for transplantation. Between January 1999 and April 2005, among 42 whole pancreas transplantations, 35 came from MOH necessitating arterial reconstruction. In 32 cases, the splenic artery (SA) and superior mesenteric artery (SMA) were sewn into a single trunk using the common iliac arterial bifurcation. Occasionally, the iliac Y-graft was unsuitable for vascular reconstruction due to atherosclerosis or iatrogenic injury. Therefore, the SA was anastomosed to the side of the SMA in two cases. In one case we utilized the brachiocephalic trunk bifurcation. Portal vein elongation employed an external iliac vein procured from the donor in all 35 cases. Good perfusion was achieved in all transplanted pancreata. During the early follow-up period, two venous and one arterial thromboses were noted. No negative effects of pancreatic vessel reconstruction were observed in postoperative graft function. Reconstruction of the pancreas vasculature did not affect the long-term function of the allograft while significantly increasing the available donor organ pool.

Proinsulinemia in simultaneous pancreas and kidney transplant recipients.

It has been shown that lipid profiles do not differ between pancreas recipients with systemic and portal venous anastomosis. However, it is unclear whether venous drainage from the transplanted pancreas has an impact on recipient atherogenesis and if other factors should be considered. Increased concentration of proinsulin correlates with tachycardia and other risk factors for ischemic heart disease. The aim of this study was to compare proinsulin levels in different types of pancreatic graft venous drainage. Twenty-four simultaneous pancreas and kidney transplantation (SPK) recipients with systemic venous drainage (group S, n = 12) and portal venous drainage (group P, n = 12) under identical immunosuppressive treatment were prospectively observed during 24 months. Following transplantation, only recipients with normoglycemia, normal HbA1c, and normal serum creatine were evaluated. Proinsulin was assessed in fasting state; after glucagon stimulation (Delta-proinsulin), and during oral 75-g glucose tolerance test twice: between 3 and 6 months and 12 to 24 months posttransplantation. All SPK patients had higher proinsulin concentration in fasting state compared with age-matched healthy controls. After stimulation, proinsulin level did not significantly differ between groups; the type of the pancreas venous anastomosis did not change the release of proinsulin and should not have impact on cardiovascular risk factors.

Duodenal patch and sphincterotomy: modification of an old technique to prevent graft pancreatitis.

The aim of this study was to preliminarily evaluate the duodenal patch technique combined with open sphincterotomy in terms of prevention of graft pancreatitis. From April 2003 to March 2005, 17 simultaneous pancreas and kidney transplantations were performed using this technique. All recipients are alive with good renal transplant function. Directly after sphincterotomy in 16 pancreatic grafts a good outflow of clear pancreatic juice and a lessening of graft tenseness were observed during surgery. In two transplants an additional sphincterotomy of the Santorini duct sphincter was necessary. In one recipient no pancreatic juice secretion was observed and insulin independence was not obtained. This graft was explanted shortly afterward. In 13 recipients no graft pancreatic or peripancreatic fluid collection requiring intervention was observed. Of the three recipients who developed graft pancreatitis, two required graft pancreatectomy. In conclusion, Sphincterotomy facilitates pancreatic juice outflow by reducing intraoperative graft edema, which could lead to subsequent inflammation. Further studies on the factors inducing graft pancreatitis are necessary to eliminate this severe complication.

Simultaneous endovascular exclusion of thoracic aortic aneurysm with open abdominal aortic aneurysm repair.

BACKGROUND: The treatment of aneurysms at multiple sites within the aorta is problematic. METHODS: Between March 2002 and June 2003 in the Department of General, Vascular and Transplant Surgery, Medical University of Warsaw six patients with coexisting abdominal and descending thoracic aortic aneurysms underwent simultaneous open abdominal aortic aneurysm (AAA) repair and endoluminal thoracic aortic aneurysm (TAA) repair. The indication for a combined procedure was a diagnosed descending TAA and AAA with no significant risk factors for open aortic surgery or technical contraindications for endovascular treatment of TAA. RESULTS: One patient died in the peri-operative period while the other five patients all recovered well after surgery and were discharged with both aneurysms excluded. CONCLUSION: Endovascular treatment of TAA combined with a simultaneous open AAA repair is an efficient and relatively safe treatment modality in patients with TAA and AAA disqualified from endovascular repair. The fact that thoracotomy is not a necessity significantly lowers the complication rate in these patients.

Do high levels of serum triglycerides in pancreas graft recipients before transplantation promote graft pancreatitis?

OBJECTIVE: Graft pancreatitis is a serious complication following pancreas transplantation. The aim of this study was to evaluate the influence of pretransplant serum lipid levels on the development of graft pancreatitis among patients undergoing simultaneous pancreas and kidney transplantation (spkTx). METHODS: We reviewed data from spkTx patients engrafted between 1999 and 2002. Group 1 consisted of 10 recipients with well-established pancreas and kidney graft function without postoperative pancreatitis; group 2 5 spkTx recipients who developed fatal graft pancreatitis in the first posttransplant month. The lipid parameters evaluated within 1 hour before transplantation and after hemodialysis included total cholesterol, HDL, LDL, VLDL, triglicerides and apoproteins A and B. RESULTS: Triglycerides, apoprotein B and VLDL were significantly increased just before transplantation among patients who developed fatal pancreatitis compared to those patients with good graft function. CONCLUSION: Recipient hypertriglyceridemia promotes graft pancreatitis in previously injured pancreatic graft.