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Krzysztof Bojakowski and Piotr Andziak

Operative Treatment of Septic Hemorrhage Due to Dialysis Arterio-Venous Fistula

The number of hemodialyzed patients in western countries is growing consistently. Septic complications of vascular access obtained with artificial prostheses are a significant therapeutic problem. Septic bleeding from infected arterio-venous fistula is a life-threatening condition.

The aim of the study was to evaluate the results of treatment for septic bleeding from arterio-venous fistula. Data was gathered at the General, Vascular Department at Central Clinical Hospital Ministry of Internal Affairs.

Material and methods. Between January 12004 and December 31, 2008, we noticed septic bleeding caused by infectious complications of dialysis fistula in 6 of 348 patients who underwent operation for arterio-venous fistula.

Results. All of the patients with septic bleeding had arm fistula due to the employment of vascular prostheses. Successful dialysis fistula reconstruction was performed in 5 of 6 patients. Reconstruction of the brachial artery was carried out in the sixth patient. In all cases, we used segments of autogenous saphenous vein as reconstructive material. Patients with septic bleeding were significantly more likely to have undergone a vascular access operation or fistula reconstruction, in comparison to the group of non-septic patients.

Conclusions. The highest risk of septic bleeding as a result of dialysis fistula infection is observed in patients with fistulas preformed with vascular prosthetic grafts. Patients operated due to septic bleeding have the possibility to maintain existing vascular access for dialysis. Our results indicate that the best material for infected dialysis fistula reconstruction is autogenous saphenous vein.

Open access

Joanna Wiśniewska-Goryń, Ewa Gorczyca-Wiśniewska, Tomasz Goryń, Piotr Andziak and Marek Durlik

Treatment of Vascular Complications After Kidney Transplantation

The aim of the study was to determine the frequency of occurrence and treatment methods of early vascular complications after kidney transplantation.

Material and methods. A retrospective analysis comprised of 245 patients subjected to kidney transplantation during the period between 1998 and 2006 in our department. Of these, 236 patients received organs from deceased donors, while nine patients received organs from living donors. The occurrence of vascular complications and the diagnostic and treatment methods used were determined for each patient. Patients operated on during the period between 1998 and 2001 were compared to those operated on between 2002 and 2006.

Results. Twenty-two patients presented with vascular complications after kidney transplantation. The following were observed: bleeding (6.1%), anastomotic stenosis (1.2%), renal vein thrombosis (0.81%), renal artery thrombosis (0.4%), and false aneurysm of the renal artery (0.4%). Nineteen patients underwent surgery, and two required intravascular procedures while one was subjected to conservative treatment. Good treatment results were obtained in 17 patients, while five patients had the transplanted kidney removed.

Seventy-eight transplantations were performed in the first four years (1998-2001). In that period, vascular complications occurred in 13 patients (17%). During the following four years (2002-2006) we transplanted 167 patients, and vascular complications were observed in nine patients (5%). Statistical analysis showed a significant reduction (p=0.004-test chi2) in the number of vascular complications during the latter period.

Conclusions. As surgeons gain experience treating transplant recipients, the number of vascular complications decreases. Diagnostics and treatment depends on the early visualization of complications by means of Doppler ultrasound and angio-MRI examinations. The use of intravascular techniques could be an effective and safe therapeutic method in the case of vascular complications.

Open access

Adam Mazurkiewicz, Piotr Andziak, Maciej Sybilski, Mirosław Nowicki, Maciej Dratwicki, Krzysztof Braun, Marcin Zdzienicki and Jerzy Walecki

Analysis of Early and Distant Results Following Endovascular Repair of the Descending and Abdominal Aorta

The aim of the study was to analyze early and distant results following thoracic descending and abdominal aorta stentgraft implantations.

Material and methods. During the period between 2000 and 2006, 20 stentgrafts were implanted into the thoracic descending aorta and 114 into the abdominal aorta.

Results. The initial technical success was obtained in 85.71% of cases considering the descending aorta and 89.47% in case of the abdominal aorta. The initial clinical success was obtained in 85.71% and 84.21%, respectively. In 5% of descending aortic operations the branching of the left subclavian artery was covered. Early mortality in case of descending aortic operations amounted 4.76%, while that after abdominal aortic operations - 0.88%. After the implantation of abdominal aortic stentgrafts, 2.63% of early conversions were performed because of aneurysmal rupture, and 1.75% of distant conversions, due to prosthesis inflammation. After abdominal aortic operations, 2.63% of patients required reconstructive operations, due to arterial injury at the site of the approach. After the implantation of descending aortic stentgrafts, early type 1 endoleaks were observed in 10% of cases. After the implantation of abdominal aortic stentgrafts, primary endoleaks were observed in 11.4% of cases: type 1 - 7.02%, type 2 - 3.51%, type 3 - 0.88%. Following the implantation of abdominal aortic stentgrafts, 1.75% of patient's demonstrated symptoms of colon ischemia, while 0.88% - kidney ischemia. After abdominal aortic operations secondary endoleaks were observed in 7.01% of cases: type 1 - 2.63%, type 2 - 1.75%, type 3 - 2.63%.

Conclusions. 1. The implantation of stentgrafts is a safe and effective method considering the treatment of descending aortic injuries, dissections and ruptures. 2. The implantation of stentgrafts enables to obtain satisfactory results in the treatment of abdominal aortic aneurysms, considering high-risk patients. 3. The significant number of complications and their heterogenity might be responsible for the limited indications towards stentgraft implantations. The above-mentioned method should be performed in case of patients, where classical operations are connected with an increased risk of complications.

Open access

Marek Krawczyk, Jerzy Wordliczek, Antoni Czupryna, Jan Dobrogowski, Marek Dobosz, Wojciech Gaszyński, Piotr Andziak, Hanna Misiołek and Adam Dziki