[Role of the homograft bypass in extremity inferior's reconstructions]. / Homograftok szerepe az alsó végtagi érrekonstrukciókban.

INTRODUCTION: Vascular homografts are used for limb salvage in cases of graft infection after previous reconstructive vascular surgery or inadequate autologous veins. During multi-organ donation the thoracic aorta segment, aortic bifurcation, iliac arteries, femoral arteries, popliteal arteries, femoral veins and greater saphenous veins can be harvested. Our aim was to optimize the use of homografts by analyzing the results of previous procedures. METHODS: The patient information was processed retrospectively, using the clinical computer system. 162 procedures were performed on 144 patients between 2007 and 2014. The short- and long-term patency, hemorrhagic complication rate, amputation rate and mortality was examined in our study. The location, graft type and length of cryopreservation were taken into consideration. Aortoiliac and femoropopliteal reconstructions with arterial and venous homografts were examined. RESULTS: The mean age of the patients was 63.6 ± 10.7 years, the mean follow-up period was 36 ± 28 months. The primary patency rates at the postoperative 1, 3 and 6 months were 83.7%, 75.0% and 63.4%. In this study the arterial and deep venous homografts had better primary patency rates compared to the superficial venous homografts: at the postoperative 1, 3, 6 months the arterial homograft results were 85.6%, 78.6% and 74.3%, the greater saphenous vein homograft results were 81.4%, 70.4% and 47.7% in the same intervals. CONCLUSION: The reconstructive surgical procedures in septic area mean serious challenge for the vascular surgeons. The AB0 compatibility of the graft and the recipient did not result better long-term outcomes compared to the non-compatible grafts. According to our data the ideal choice of homogenous graft is an arterial homograft which was not cryopreserved longer than 6 months.

Acute type A aortic dissection complicated by aortic stent graft collapse.

A 57-year-old man complaining of chest pain presented with signs of lower limb ischemia 1 year after implantation of a stent graft at the aortoiliac bifurcation. A computed tomography scan revealed the presence of a type A aortic dissection and complete collapse of the stent graft by bulging of the false lumen. The patient underwent emergency surgical reconstruction of the aortic root and arch, which allowed reexpansion of the previously collapsed stent graft. Stenting of residual stenoses distal to the stent graft and of an occluded left renal artery was also successful.

[Aortoenteric fistula to the sigmoid colon complicated with entero-grafto-cutaneous fistula]. / Aortoenteralis fistula ritka formája--sigmoideo-grafto-cutan fistula.

We report a case of a 62-year-old man who presented to the emergency department with acute rectal bleeding. The patient had previous aortoiliac surgery with the utilization of an aorto-bifemoral vascular graft. Diagnosis of secondary aortoenteric fistula was made between the aortoiliac graft and sigmoid colon. This fistula had an entero-cutaneous component. After exploratory laparotomy resection of the sigma, extirpation of the entero-cutaneous fistula, excision of the graft, oversewing of the aortic stump, and extra-anatomical crossover bypass were successfully performed. This study reports a rare type of secondary aortoenteric fistula to the sigmoid colon complicated with an entero-grafto-cutaneous component and it describes an unusual and successful surgical treatment.

Secondary iliac-enteric fistula to the sigmoid colon complicated with entero-grafto-cutaneous fistula.

We report the case of a 67-year-old man who was admitted to our department with acute rectal bleeding. The patient had had previous aortoiliac surgery with the utilization of an aortobifemoral vascular prosthesis. Diagnosis of aortoenteric fistula was made between the distal suture line of the right graft leg and the sigmoid colon. This fistula had an enterocutaneous component. After exploratory laparotomy, primary resection of the sigmoid colon, exstirpation of the enterocutaneous fistula, excision of the right graft leg and extraanatomical crossover bypass were successfully performed. This study reports a rare type of aorto/ilac-enteric fistula to the left colon complicated with an entero-grafto-cutaneous component and describes an unusual and successful surgical treatment method.

[Bilateral internal carotid aneurysms]. / Bilateralis carotis interna aneurysma.

The authors discuss the treatment of five patients with bilateral carotid aneurysms and review the relevant literature. During the preoperative workup duplex scan, angiography and CT scan were obtained. The diameter of the aneurysms was in the range from 9 to 40 mm. Treatment plans were largely individualized. Two patients had bilateral and two had unilateral reconstructions carried out with end-to-end anastomosis. One patient was treated conservatively. In one case, a staged approach was chosen due to multiple aneurysms. As a postoperative complication, a reversible stroke was detected in one patient. All patients were followed up (between 3 to 14 years) by six monthly duplex scans. The authors suggest surgical treatment for carotid aneurysms with a diameter above 15 mm, increasing size, thrombotic plaques or neurological sings in order to avoid high risk complications (compression, rupture, embolisation).

[Arterial thrombolysis in the lower extremity in vascular surgical practice]. / Alsó végtagi artériás thrombolysis az érsebszeti gyakorlatban.

The acute arterial thrombosis of the lower limb is dangerous not only for the limb, but it can cause life-threatening situation as well. That is why it is important to use different therapeutical modalities as the catheter guided intraarterial thrombolysis, which can reduce the surgical risks. All the drugs used for lysis now days are plasminogen activators. Due to the results of different studies the most appropriate drugs for optimal thrombolysis are the urokinase, the tissue-plasminogen activators and their recombinant forms. There are two major studies dealing with the effect of the different fibrinolytic drugs in comparison of the results of randomly operated patients. Both of these studies (STILE, TOPAS) determined a nearly same efficacy of both methods, operative or thrombolytic (approximately 70% amputation-free survival). Significant difference was observed in relation of occlusion of a native artery or a graft: better results could be obtained with surgery in case of arterial occlusion and conversely, it was in favor for thrombolysis if a graft was occluded. It must be noted that the thrombolysis has to be followed with endovascular or open surgical procedures in most of the cases. On the basis of our experiences and the data of literature we suggest after individual decision thrombolysis in case of graft occlusion, and surgery in case of arterial occlusion as first choice.

[Analysis of vascular complications of IABP therapy in open-heart surgery patients 1999-2004]. / Szívmuitött betegek intraaortikus ballonpumpa kezelése során kialakult vaszkuláris szövodményeinek elemzése (1999-2004).

Intraaortic balloon pump (IABP) is being used in cardiac surgery in an increased ratio. IABP therapy involves considerable risk, mainly vascular complications, postoperative bleeding and infection can represent danger. Between 1999 and 2004 out of 4443 open heart surgery operations we have performed intraaortic balloon pump treatment in case of 75 patients. The mean age was 64 years, 23 patients had diabetes mellitus, 47 patients had hypertension, 20 patients had peripheral vascular disease as well. We performed IABP therapy most frequently during isolated coronary bypass operations (42 cases), but also combined operations (implantation of valve prosthesis + coronary bypass) represent a significant part (implantation of aortic valve prosthesis + CABG: 5 cases, implantation of mitral valve prosthesis + CABG: 8 cases). Vascular complications occurred in 10 cases--13.3%--out of 75 patients, including 7 fatal ones. Three cases are due to the IABP treatment itself: Crush syndrome was developed leading to the loss of the patient. Applying the multiple logistic regression model we have examined the effect of the following factors on the occurrence of vascular complications: gender, age, body surface, accompanying diseases (hypertension, diabetes, peripheral vascular disease), the method and timing of insertion. Peripheral vascular disease (p < 0.005) and hypertension (p = 0.01) represent independent risk factors regarding the occurrence of complications. Having performed chi-square test we have not identified significant correlations between mortality and vascular complications. In case of prevailing peripheral vascular disease, the application of alternative insertion techniques--via the ascending aorta, the axillary artery--are recommended.

[Takayasu's arteritis; rare disease with special considerations]. / Takayasu arteritis; ritka kókép, különleges megfontolások.

Takayasu's arteritis is a chronic, non-specific inflammation of unknown aetiology, involving the aorta and its main branches. The authors describe the aetiology, pathomechanism, characteristic symptoms and a series of diagnostic criteria. Classifications used in previous decades and nowadays are listed. The therapy--considering the main principles--is individual, and it can be a combination of medical and surgical treatment or percutaneous angioplasty. Takayasu's arteritis is a rare disease in the western countries. There can not be found a specific examination to diagnose it. Mainly in the case of young female patients with inflammation of unknown origin for early diagnosis, it is essential to consider this particular disease.

[Secondary aorto-enteral fistula--material of 22 years and literature review]. / Szekunder aorto-enteralis fisztulák--22 év anyaga és irodalmi áttekintés.

INTRODUCTION: Aorto-enteral fistula is a pathological communication between the aorta and the bowel lumen. In its secondary form is a dreaded, often fatal complication of the aorto-iliac operations. METHODS: We report 34 secondary fistulas, a great number of patients treated in the last 22 years. One can rarely find such a number in the literature. RESULTS: The incidence of secondary fistulas is 0.42% following aorto-iliac operations. We give a detailed description of diagnostics. We prefer in situ solutions (graft change, aorto-aortic interposition, iliac desobliteration, homograft or deep venous bypass, aorto-bifemoral bypass) to extra-anatomical bypasses. We emphasize the importance of the postoperative care, and the necessity of adequate antibiotic therapy. CONCLUSION: Despite improved operations and intensive care mortality is still high (55.88%). We find that prevention is of great importance.