Simultaneous surgical treatment of ruptured abdominal aortic aneurysm and acute carotid occlusive disease.

Combined rupture of abdominal aortic aneurysm and acute thrombosis of internal carotid artery is extremely rare but fatal combination resulting in high mortality rate. Presented case, shows successfully performed simultaneous surgery of ruptured abdominal aortic aneurysm and acute cerebrovascular insult caused by thrombosis of carotid artery in 81 year-old male. Post operative course was uneventfull. At 24 months follow up patient was in good condition, with full neurological recovery. Simultaneous surgical treatment of acute occlusive carotid disease and ruptured abdominal aortic aneurysm (RAAA) seems to be the only life saving procedure for this rare, but very complicated condition. To our knowledge, this is the first reported successful simultaneous surgical treatment of RAAA and acute thrombosis of internal carotid artery.

Single-center prospective, randomized analysis of conventional and eversion carotid endarterectomy.

AIM: Several studies, comparing early and long-term results of the conventional carotid endarterectomy (CEA) and eversion carotid endarterectomy (EEA), were conducted for past 10 years. Nevertheless, it still remaining difficult to choose optimal endarterectomy technique. Choice yet mainly depends of experience of attending surgeon. The aim of this study was the comparison early and long-term results of the EEA and CEA. METHODS: Randomly, 103 patients were operated on in the eversion, and 98 patients in the conventional technique; 97 (48.3%) patients were asymptomatic and 104 (51.7%) had symptomatic lesions. All patients underwent preoperative cervical duplex scanning and neurological examination. The surgical procedure was carried out under general anesthesia. In cases with retrograde blood pressure less than 20 mmHg shunt was used; 78.6% of all CEA were finished up with ''patch'' angioplasty and 21.4% by primary suture. The primary outcomes were perioperative and late mortality, perioperative and late central neurological complications, a long-term survival rate and late restenosis incidence. RESULTS: The mean follow-up was 38 months. Mortality and long-term survival rate were similar in compared groups. The perioperative central neurological complications incidence were comparable in study groups (3.9% vs 12.1% , odds ratio 3.45, 95% confidence interval 1.1-11.1; P=0.029). The late restenosis incidence was significantly lower in eversion group (0.0% vs 6.1%). CONCLUSION: EEA has an advantage over the conventional procedure. The authors recommend CEA in cases when retrograde pressure indicated the use of the intraluminal shunting.

Medicamentous treatment of chronic venous insufficiency using semisynthetic diosmin--a prospective study.

INTRODUCTION: Chronic venous insufficiency (HVI) is manifested by the progressive signs of venous stasis. This disorder is treated by: compressive bandaging, medicaments, sclerotherapy, surgery, etc. AIM: Prospective study of the effects of semisynthetic diosmin (clinical signs, quality of life, local biochemical parameters) on patients with HVI to whom no other method of treatment has previously been administered. METHOD APPLIED: This prospective study analysed the presence of risk factors and personal history of 80 patients with HVI. Diagnosis of HVI was based on the clinical apperance and the color duplex scan. Each patient's clinical signs (pain, oedma, feeling of heaviness and tightness in the lower leg), quality of life (physical, social, and psychological), and CEAP stage were assessed prior to and 30 days after the treatment with Phlebodia 600. For 15 patients with unilateral varicose veins, local values of lactates and gass analysis were taken under the conditions before and following the static load, and venous control samples were taken from the healthy leg. The acquired data were processed by means of descriptive statistics, while the significance of nonparametric features was measured by Wilcoxon test. RESULTS: HVI is somewhat more frequent among females than among mails, on the left than on the right leg, and at the average age of 52.3 +/- 10.5. The patients with HVI are basicly engaged in professions with static load and have positive family history. The patients mainly started medical treatment 12.5 +/- 8.6 years after the first symptoms of the disease. Clinical improvement was recorded on the state of 65/80 patients. After the treatment numerical values of some of the clinical signs were statisticaly lower compared to the values before the administration of semisynthetic diosmin: oedema (0.94:1.50), pain (1.10:1.84), feeling of heaviness (1.20:1.96), and tightness (1.14:1.78). After the administration of the tested medication, parameters of physical, social, and psychological quality-of life were significantly improved (p<0,0001), accompanied with significantly improved (p<0,0001) CEAP stage of HVI (3.00:3.40). Local biochemical parameters had not been significantly changed. CONCLUSION: Administration of semisynthetic diosmin during 30 days results in significant improvement of clinical signs, quality of life and CEAP stage of HVI.

[Prostacyclin and pentoxifylline in the treatment of patients with inoperable occlusions of the peripheral arteries of the lower extremities]. / Primena prostaciklina i pentoksifilina u lecenju bolesnika s inoperabilnim okluzijama perifernih arterija donjih ekstremiteta

INTRODUCTION: The treatment of inoperable patients in terminal stages of chronic arterial occlusive disease is difficult and associated with high incidence of limb amputations and lethal outcomes [1]. Prostacyclin (Pgl2) is a strong vasodilator and the most potent endogenous platelet aggregation inhibitor in men [1-6]. Application of Pgl2 in such conditions is justifiable since it represents the exogenous substitution therapy [7, 8]. MATERIAL AND METHODS: An open blind study included 80 patients with inoperable peripheral arterial occlusion (Fontens stages III and IV) who were divided in two groups: Prostacyclin (PG) and Pentoxyfillyne (CG). Clinical characteristics of the groups were comparable (Table 1). Diagnosis of unreconstructable state was based on clinical and arteriographic results. Prostacyclin in the form of Epoprostenol sodium (Flolan) was used in doses of 5 ng/kg/h of continuous intravenous infusions during 24 h (9), 48 h (21) and 72 h (12). Pentoxyfillyne was also administered in continuous intravenous infusions during 24 h (2), 48 h (3) and 72 h (33) in daily dose of 300 mg. Duration of treatment was based on the subjective condition of the patients, i.e., when the patient reported the improvement the therapy was discontinued. Following the completion of infusion therapy, medicamentous therapy was initiated in all patients (Pentoxyfillyne 3 x 400 mg, Aspirin 100 mg). Routine laboratory tests (RBC, haemoglobin, haematocrit, platelet count, WBC, urea, glycaemia, Na, K, lipids, cholesterol, triglycerides), platelet aggregation (Collagen 60 mg/ml; ADP 1.5 mM/ml; RI-PA 1.5 mg/mL), BP, ABI (Doppler) indices and claudication distance were evaluated in all patients after day 1, 7 and 90 following the end of the therapy. RESULTS: The infusion treatment led to subjective reduction or elimination of pain in 52 (32 PG, 20 CG) patients during the immediate course (up to 7 days). The therapy induced no significant changes in laboratory findings, platelet count and BP during the whole follow-up period. Significant decrease in platelet aggregation was recorded 24 hours and 7 days after the initiation of the study only in PG group, while after 3 months no significant decrease in aggregation was found (Table 2). Doppler index changes in both groups were not significant. Significant improvement in claudication distance was recorded 3 months after the infusion therapy: in PG for distance under 100 m (15 patients) and more than 100 m (17 patients), in CG for distance under 100 m (22 pts). In the course of infusion therapy the following complications were recorded: blushing (3 PG), tachycardia (2 PG, 1 CG) and nausea and vomiting (1 PG, 2 CG). Deceleration or temporary discontinuation of infusion led to the improvement of condition, and thus none of the patients was withdrawn from the study. Over a three-month follow-up period 4 lethal outcomes were recorded (2 PG, 2 CG). Causes of death (diabetic nephrosclerosis and renal insufficiency, septic endocarditis, heart insufficiency, CVI) could not have been related to infusion therapy. Due to the progression of gangrene, extremity amputation on different levels was performed in 27 patients (12 PG, 15 CG) of which 15 (7 PG and 8 CG) were performed during the immediate 7-day period while the other amputations were carried out 8-90 days after the treatment. DISCUSSION: The use of prostacyclin leads to temporary and limited distant improvement in arterial flow in patients with occlusive diseases [1]. During the immediate course these effects are manifested by complete absence of pain at rest and initial demarcation of the gangrenous process [1, 4]. Doppler index values established in our series suggest that prostacyclin does not reduce vascular resistance in the major blood vessels; however, it expresses potent vasodilation, antiaggregation and disaggregation effects at the level of microcirculation flow [6, 7]. (ABSTRACT TRUNCATED)