Late aneurysm rupture after endovascular abdominal aneurysm repair.

OBJECTIVES: The goal of endovascular repair is to protect the patient from aneurysm rupture. Careful surveillance should be performed postoperatively in order to select patients with aneurysm growth and, therefore, the highest rupture risk. The aim of the study was to present our experience with aneurysm rupture in long-term follow-up after endovascular abdominal aneurysm repair. METHODS: Between 1998 and 2006, 445 patients with abdominal aortic aneurysms were treated endovasculary in our Department. All patients were followed-up postoperatively according to the EUROSTAR protocol, with a CT scan performed postoperatively in the 3rd, 6th and 12th month and annually thereafter with good compliance. Because of this we had the opportunity for early treatment of complications, especially endoleaks which may cause aneurysm growth and subsequent rupture. RESULTS: In three presented patients aneurysm rupture occurred in the late follow-up period after endovascular treatment. In all cases open aneurysmectomy was performed without any major complications. We also analyzed the reason for the rupture: in all cases it was due to endoleak type I, that was not present during postoperative CT-scans. The mechanism of its recurrence was proximal cuff migration 29 months after endovascular aneurysm treatment in the first patient. In the second case endoleak type I appeared 32 months postoperatively due to aneurysm lengthening, what could have been the consequence of persistent, small endoleak type II. In the third case the reason of aneurysm rupture was late endoleak type I due to migration of proximal seal of the stentgraft. CONCLUSIONS: Although the risk of aneurysm rupture after EVAR is low, all patients treated endovascularly should be routinely monitored, in order to select cases with potential endoleaks or stentgraft migration which may lead to fatal complications. When rupture occurs open aneurysmectomy is feasible, although it requires careful management in these high-risk patients.

A retrospective study of steroid elimination in simultaneous pancreas and preemptive kidney transplant (Sppre-Ktx) recipients.

OBJECTIVES: The feasibility and timing of corticosteroid elimination and its impact on lipid metabolism in simultaneous pancreas and preemptive kidney transplantation were examined. MATERIAL AND METHODS: A retrospective study was conducted on 14 recipients of pancreas and preemptive kidney grafts transplanted form April 2003 to March 2004. All recipients received ATG induction. Tacrolimus (Tac) was administered according to trough concentration 8-15 ng/ml. Mycophenolate mofetil (MMF) was administered at doses of 2 g per day with subsequent dosage adjustment based on tolerability. All recipients received corticosteroids with subsequent dose tapering. Total cholesterol and triglyceride levels before transplantation and after steroid withdrawal were assessed. RESULTS: One year recipient survival rate was 100%. Cumulative one year panaceas and kidney survival rates were: 85% and 100%, respectively. After transplantation of fasting glycemia and HbAIC were normalized. Serum creatinine decreased from 4.35 +/- 1.61 mg/dl before transplantation to 1.1 + 0.25 mg/dl after surgery (p < 0.05). Corticosteroids were eliminated between the 2nd and 16th month (mean 6 months) after transplantation. Cholesterol and triglyceride levels were wiyhin normal range, in addition significantly decreased after transplantation and steroid withdrawal, from 194.5 +/- 35.6 mg/dl to 162.4 +/- 36.8 mg/dl and 142.5 +/- 65 94.8 +/- 42.5 mg/dl, respectively (p < 0.05). CONCLUSIONS: It is possible to eliminate steroids 6 months after transplantation using immunossupression based on MMF and Tac. Withdrawal of steroids could be partially contributed to the normalization of lipid metabolism.

The comparison of treatment results of type 1 diabetes mellitus complicated by end-stage diabetic nephropathy in patients undergoing simultaneous pancreas and pre-emptive kidney transplantation (SPPkTx) and patients enrolled into the dialysis program--a cohort study.

OBJECTIVE: A cohort study was conducted to compare treatment of patients with type 1 diabetes mellitus and end-stage diabetic nephropathy. PATIENTS AND METHODS: 47 type 1 diabetic patients required renal replacement therapy in years: 2001-2005 were enrolled. Simultaneous pancreas and preemptive kidney transplant (sppktx) was performed in 18 (group I). Group II consisted of 29 patients who entered dialysis program. Survival rate for patients from both groups was estimated. Transplanted organ function was evaluated for group II. Lipid profile and its correlation with thickness of carotid media was assessed. Impact of sppktx on diabetic retinopathy was investigated. Cost and life quality were compared between groups. RESULTS: Two-year cumulative recipient survival rate for group I and II was 100% and 96%, respectively. One-year cumulative survival rate for transplanted pancreas was 88% and for kidney grafts 94%. In group I cholesterol and triglyceride level before transplantation were: 207 +/- 38 mg/dl and 133 +/- 65 mg/dl and decreased after transplantation to 155 +/- 20 mg/dl and 78 +/- 25 mg/dl, respectively (p < 0.05). No difference of carotid media thickness was observed between groups. Stabilization of retinopathy was observed in 91.6% non-blind recipients. During the first year of the follow-up the costs of transplantation doubled those of dialysis therapy but in the second year the costs of dialysis exceeded the costs required for transplanted patients. CONCLUSION: Despite of major surgery and introduction of immunosuppression in group I, results did not differ significantly between groups during a two-year follow-up. After sppktx, stabilization of the carotid media was slower than the normalization of lipids. At the second year, transplantation is less expensive than dialysis.