[Show abstract][Hide abstract] ABSTRACT: Background: In patients with chronic leg ischemia, the beneficial effect of arterial revascularization can be significantly decreased due to postoperative leg swelling. The aim of this study was to assess the effects of intermittent pneumatic compression (IPC) on skin flow normalization in patients undergoing revascularization procedures due to chronic leg ischemia. Material/Methods: We evaluated 116 patients with chronic leg ischemia. The patients were divided into groups according to the performed treatment (endovascular or surgical) and implementation of IPC postoperatively. The leg edema assessment and microcirculation flow assessment were performed pre- and postoperatively, using percutaneous O2 pressure (TcpO2), cutaneous blood perfusion (CBP) measurements, and skin flow motion assessment. Results: In patients who did not receive IPC, a decrease in CBP value was observed in the 1st postoperative assessment. Among patients receiving IPC, the CBD value increased at the 1st and 2nd postoperative measurements, especially in the surgical group. The lowest TcpO2 values were observed in by-pass surgery group without IPC postoperatively. Conclusions: The benefits of the by-pass procedure in patients with leg ischemia can be significantly reduced by postoperative edema. Among patients with postoperative leg edema, local tissue blood perfusion can be improved by the use of IPC, which can result in decreased local leg swelling, as well as improved skin blood perfusion and TcpO2.
Full-text · Article · Dec 2015 · Medical science monitor: international medical journal of experimental and clinical research
[Show abstract][Hide abstract] ABSTRACT: According to the previously performed studies, inflammation plays a crucial role in vein wall and leg tissue injury related to chronic venous insufficiency development. Sulodexide (SUL) is a balanced mixture of glycosaminoglycans with potential anticoagulant and profibrinolytic activity, protecting also endothelial cells and suppressing inflammatory reactions in various vascular disease related conditions. The goal of the present study was an evaluation of the anti-inflammatory action of SUL in patients with chronic venous disease.
The study was performed on a group of 11 patients with chronic venous disease (stage C5 according to CEAP classification). The mean age of the patients was 58.4±7.7 years, and none of them were diabetic. The patients were treated for 8 weeks with orally administered SUL (2 x 500 LSU/day). Blood samples were collected at the start and at the end of the study for measurement of MMP-9, IL-6 and monocyte chemoattractant protein-1 (MCP-1). Additionally, the effect of the obtained serum samples on the function of human venous endothelial cells (HVEC) in in vitro culture was evaluated.
After treatment with SUL, the serum concentration of MMP-9 (ng/ml) decreased from 6.50±3.48 to 5.41±1.36, p<0.05, and the concentration of IL-6 (pg/ml) decreased from 11.5±3.4 to 10.1±2.3, p<0.005. There was also a trend of decreased serum MCP-1 (pg/ml) from 31.3±23.0 before treatment to 27.1 ± 10.7 at the end. Intracellular generation of oxygen derived free radicals in HVEC maintained in in vitro culture was lower in the serum samples collected after treatment with SUL: 3.09±0.35 abs/μg prot.vs 3.63±0.32 abs/μg prot, at the start, p<0.05. Synthesis of IL-6 was lower in HVEC exposed in vitro to serum collected at the end of SUL treatment: 1.02±0.31 ng/μg cell protein vs. 1.32±0.41 ng/μg cell protein before SUL treatment. The proliferation rate of HVEC was similar in the presence of serum collected at the beginning or at the end of SUL treatment.
We conclude that treatment with SUL in patients with chronic venous disease reduces intravascular inflammation and is protective for the endothelial cells and for the extracellular matrix changes related to metalloproteinase expression.
No preview · Article · Jun 2015 · International angiology: a journal of the International Union of Angiology
[Show abstract][Hide abstract] ABSTRACT: Obstructive sleep apnea (OSA) remains one of the most common causes of resistant arterial hypertension (AH). Association between resistant hypertension and OSA was observed in numerous trials. In patients suffering from OSA resistant AH occurs in 37-56% of cases, while prevalence of OSA in group of patients suffering from resistant AH is as much as 70-85%. Presumably pathogenesis of resistant hypertension is determined by coexistence of several mechanisms. The key role in that process plays hypoxia which leads to sympathetic nervous system stimulation, activation of renin-angiotensin system, increase of oxydative stress and endothelin production. Activation of renin-angiotensin system with increase in angiotensin II and aldosterone concentrations leads to rise in peripheral vascular resistance, and in consequence increased afterload. Coexistence of OSA diminishes effectiveness of hypotensive treatment. In order to achieve blood pressure control it is necessary to use simultaneously several antihypertensive agents with different mechanism of action, including a diuretic.
No preview · Article · Jan 2015 · Nadcisnienie Tetnicze
[Show abstract][Hide abstract] ABSTRACT: Background:
Aortic cross-clamping during abdominal aortic aneurysm (AAA) open repair leads to development of ischemia-reperfusion injury. Electron paramagnetic resonance spectroscopy (EPR) spin-trapping is a valuable method of direct measurement of free radicals. The objective of the study was to evaluate the results of EPR as a direct method of free radical measurement and degree of inflammatory response in open operative treatment of patients with AAA and aorto-iliac occlusive disease (AIOD).
The study was performed on a group of 32 patients with AAA and 25 patients with AIOD scheduled for open repair. Peripheral venous blood for EPR spectroscopy and for SOD, GPx, ox-LDL, Il-6, TNF-alfa, CRP, and HO-1 were harvested. Selected parameters were established accordingly to specified EPR and immunohistochemical methods and analyzed between groups by Mann-Whitney U test and Wilcoxon matched-pairs signed-ranks test with Bonferroni correction.
Free radicals level was correlated with the time of the aortic cross-clamping after the reperfusion of he first and second leg in AAA (r=0.7; r=0.47). ox-LDL in AAA decreased 5 min after reperfusion of the first leg (32.99 U/L, range: 14.09-77.12) and 5 min after reperfusion of the second leg (26.75 U/L, range: 11.56-82.12) and 24 h after the operation (25.85 U/L, range: 14.29-49.70). HO-1 concentration increased to above the level before intervention 24 h after surgery. The activities of GPx and SOD decreased 5 min after the first-leg reperfusion in AAA. Twenty-four hours after surgery, inflammatory markers increased in AAA to CRP was 14.76 ml/l (0.23-38.55), IL-6 was 141.22 pg/ml (84.3-591.03), TNF-alfa was 6.82 pg/ml (1.76-80.01) and AIOD: CRP was 18.44 mg/l (2.56-33.14), IL-6: 184.1 pg/ml (128.46-448.03), TNF-alfa was 7.74 pg/ml (1.74-74.74).
EPR spin-trapping demonstrates temporarily elevated level of free radicals in early phase of reperfusion, leading to decrease antioxidants in AAA. Elevated free radical levels decreased 24 h after surgery due to various endogenous antioxidants and therapies.
Full-text · Article · Nov 2014 · Medical science monitor: international medical journal of experimental and clinical research
[Show abstract][Hide abstract] ABSTRACT: Aim:
Ovarian cancer (OC) is associated with a high risk of venous thromboembolism (VTE) in both, pre- and postoperative period. The aim of the study was to analyse the efficacy and the safety of an early prophylaxis with dalteparin in patients with OC qualified to surgery.
The prospective, non-randomized study was performed in the group of OC patients qualified to surgical treatment. The study group (SG) consisted of 37 patients with OC in whom thromboprophylaxis was started at the moment of qualification to the surgery (mean 16,1 days ± 11,32 SD before procedure). The control group (CG) consisted of 61 patients with OC qualified to surgery in whom thromboprophylaxis was started 12 hour before surgical treatment. The duration of postoperative prophylaxis was 4 weeks in both groups. Dalteparin 5000 U/day was used in both groups. The primary end points were occurrence of VTE and major bleeding. The patients underwent color Doppler US and D-dimer (DD) assessment at the moment of qualification for surgery, 1 day before and 7, 14, 28 days and 3 months after procedure.
The total duration of thromboprophylaxis was 45.3 ± 10.7 days in SG and 27.9 ± 3.7 days in CG (P < 0.0001). The deep venous thrombosis rate was 2,7% in SG and 16.4% in CG (P = 0.042). Neither pulmonary embolism, nor major bleeding were observed. Median preoperative DD concentration in all patients was 1700 ng/ml and was significantly higher in patients who developed postoperative DVT when compared to those who did not, 2556.8 and 1691.0 ng/mL respectively (P = 0.0009).
Prolonged preoperative thromboprophylaxis with dalteparin in patients with ovarian cancer qualified to the surgical treatment is safe, decreases the risk of thromboembolic complications. To determine indication, dosage and timing of such thromboprophylaxis in this group of patients further studies are required.
No preview · Article · Aug 2014 · International angiology: a journal of the International Union of Angiology
[Show abstract][Hide abstract] ABSTRACT: The aim of the study was to characterize the changes in the microcirculation in patients with varying severity of atherosclerotic ischaemia of the lower limbs (PAOD).
Material and methods. The study included 27 healthy subjects, 79 patients with PAOD category 0 and 1 according to the Rutherford classification, and 137 patients with PAOD category 3 and 4. The study evaluated cutaneous blood flow, flowmotion bonds, percutaneous partial pressure of oxygen and flow-mediated vasodilation.
Results. Even mild PAOD exhibits a worse systemic vascular function expressed as a reduction in the scope of flow-mediated vasodilation, and locally in TcpO2 decrease. Increase in local changes in advanced forms of PAOD were observed as further reduction in TcpO2 and a drastic reduction or exhaustion of the functional microcirculatory reserve. Among the evaluated risk factors for atherosclerosis only diabetes and smoking significantly modified perfusion, which resulted in a significant decrease in the values of vasodilation and TcpO2.
Conclusions. The study revealed the occurrence of adverse changes in microcirculation, also in patients with poorly discernible signs of limb ischaemia. It can be assumed that these may also occur in the patients who underwent a haemodynamically effective revascularization.
No preview · Article · Jan 2014 · Acta Angiologica
[Show abstract][Hide abstract] ABSTRACT: Objectives: This prospective, non-randomised study was aimed at the assessment of prevalence of thromboembolic events in vascular patients routinely receiving anti-thrombotic prophylaxis following surgical revascularisation of the lower extremities. Material and methods: This study included 105 patients operated on for aortoiliac occlusive disease. Postoperatively all patients received pharmacological antithrom-botic prophylaxis with low-molecular-weight heparin. Sonographic examination of the veins of low extremities was routinely performed three times: one day before the surgery, on the discharge day and 30 days after hospital discharge. Results: Thromboembolic complications were found in 21 patients (19.05%), including 18 patients with deep venous thrombosis and 3 with pulmonary embolism. Thromboembolic events were more prevalent in older patients (68.22 vs. 62.65 years), those with necrotic lesions of the limbs, with lower preoperative concentration of hemoglobin (7.89 vs. 8.61 mmol/l), higher of fibrinogen (455 vs. 357 mg/dl) and of platelet count (334 vs. 250 × 10 9 /l). Other risk factor comprised the number of trans-fused packed red blood cell units (3.39 vs. 1.45 units) and plasma units (1.61 vs. 0.39 units), and the length of stay in the intensive care unit (4.78 vs. 2.24 days). Conclusions: Vascular patients develop thromboembolism very often, despite pharmacological prophylaxis. Thus, routine scanning for deep vein thrombosis before hospital discharge in order to exclude thrombosis should be considered in this group. Also, an extended post-discharge thromboprophylaxis in these patients should be considered.
Full-text · Article · Jan 2014 · Przegl?d Flebologiczny
[Show abstract][Hide abstract] ABSTRACT: The increased incidence of hypertension and cardiovascular diseases in industrialized societies is associated with sodium-rich and potassium-poor diet. Potassium is the main intracellular cation of the system and is involved in formation of the rest and the action potential of nerve cells. Additionally, this element participates in maintaining the water and acid-base balance. The ability of the kidneys to retain potassium is low what is the cause of hypokalaemia in persons who consume small quantities of this element. Hypokalaemia occurs more often than hyperkalaemia. The incidence of hypokalaemia is varied and it ranges 14-20%, depending on the studied population. Patients suffering from diseases such as hypertension, heart failure, arrhythmia, diabetes and kidney failure, as well as people at risk of stroke, require special attention and monitoring in order to prevent hypokalaemia. Disturbances in potassium metabolism lead to life-threatening complications. Hypokalaemia may cause cardiac arrhythmia. In the consequence, it may cause to ventricular fibrillation. In contrast, hyperkalaemia may results in conduction disturbances, bradycardia and even asystolia. The results of numerous studies proved a protective effect of normal levels of potassium on the cardiovascular diseases, thereby reducing the risk of death. One of the main ways of prevention and good control of potassium disorders is a lifestyle change and, above all, a proper diet. In patients with cardiovascular diseases, a control of serum concentration of potassium seems to be justified. The recommended daily intake of potassium should be primarily achieved through a proper diet. In patients receiving diuretics, that lead to hypokalaemia, it is advisable to use potassium supplementation.
No preview · Article · Jan 2013 · Nadcisnienie Tetnicze
[Show abstract][Hide abstract] ABSTRACT: Background:
To compare the level of difficulty of four techniques of endovenous thermal ablation (EVTA) of the great saphenous vein and the echogenicity of the tip of the working device in vivo.
Sixty patients qualified to the EVTA of the great saphenous vein were randomly assigned to treatment with an 810-nm axial diode laser [endovenous laser ablation (EVLA) 810] with two different delivery systems: 4-F introducer, 0.018" guidewire, 22-G needle (EVLA810-1) and 4-F introducer, 0.035" guidewire, 19-G needle (EVLA810-2); a 1470-nm radial diode laser (EVLA1470); or radiofrequency ablation (RFA; ClosureFAST). The level of difficulty of four stages of the procedure-cannulation of a vein, advancement of the working part to the saphenofemoral junction (SFJ), visualization of a tip of the working part at SFJ, and difficulty of performing the ablation and delivering the planned linear energy density-was subjectively assessed. An objective comparison of visibility of working parts in ultrasonography was performed with analysis of grayscale median.
The cannulation of a distal segment of the obliterated vein was the most difficult in EVLA810-1, P = 0.015. The delivery of a working part to the SFJ was the least problematic in RFA and EVLA1470, P = 0.024. The visualization of the working tip at the SFJ was the most difficult in RFA, P = 0.028. The application of desired amount of energy was the easiest in RFA, P = 0.038. The EVLA1470 presented the best echogenicity.
Although all the examined techniques have advantages and disadvantages, EVTA with the 1470-nm diode laser with radial optic fiber seems to be the easiest.
No preview · Article · Oct 2012 · Annals of Vascular Surgery
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to establish the safety of negative pressure wound therapy (NPWT) in the treatment of acutely debrided, deep diabetic foot infections (DDFI) and to determine the value of inflammatory markers in monitoring of treatment of these infections with negative pressure wound therapy.
A group of ten patients with DDFI treated by radical surgical debridement and simultaneous NPWT was prospectively studied. During the debridement, a deep tissue sample was obtained and sent for microbiological testing. The patients were followed clinically for 10 days and NPWT dressings were changed every 2 to 3 days or sooner when indicated. The peripheral blood samples were obtained before the radical debridement and 3 and 10 days afterwards and concentrations of white blood cell, neutrophils, lymphocytes and C-reactive protein (CRP) were measured. The changes in concentration of inflammatory markers were analyzed with a Friedman test.
In all but one patient the presence of DDFI was confirmed by the culture results. At baseline, the elevated WBC and neutrophil concentrations were observed only in half of the patients while the CRP concentration was elevated in nine patients. During followup, all patients showed a favorable clinical evolution and statistically significant decrease of WBC, neutrophils and CRP (p<0.001). There were not statistically significant changes in lymphocyte count.
NPWT can be safely applied in acutely debrided DDFI. CRP seems to be the most adequate parameter for both diagnosis and monitoring of treatment of DDFI.
No preview · Article · Oct 2012 · Foot & Ankle International
[Show abstract][Hide abstract] ABSTRACT: In spite of the fact duplex Doppler ultrasonography is recognized as an scanning technique equivalent to other imaging methods for preoperative diagnostics of the lower extremity arteries, in many centres its use is limited to screening.
was to the determine usefulness of arterial duplex mapping for preoperative diagnostics in patients with peripheral artery occlusive disease (PAOD).
In 2008-2009, 103 patients with PAOD symptoms (129 limbs) were examined in a prospective, non-randomized study. DUAM was performed in all limbs, DSA in 90, CT-angio in 29, and revascularisation procedures in 116 limbs.
Problems with completing DUAM occurred in 10,1% of cases, including 1.5% of examinations of no diagnostic value. Consistency of DUAM and DSA results was found in 94.6% of cases, and consistency of DUAM results and the range of actually performed ranges was found in 97.8% of cases. Consistency of DUAM and CT-angio results was recorded in 68.0% of cases. The comparison between individual examinations and the actually performed procedures showed consistency of 96.5% for DUAM and 72.4% for CT-angio.
DUAM usefulness for detecting and defining lesions in lower extremity arteries is similar to that of DSA and CT-angio. This examination may be successfully used in preoperative diagnostics, particularly for intravascular procedures, which makes possible to reduce exposition to radiation and minimalize diagnostics costs.
No preview · Article · Jun 2012 · Polish Journal of Surgery
[Show abstract][Hide abstract] ABSTRACT: Many patients with glaucoma suffer from arterial hypertension (AH). It has been proved that both AH and low blood pressure (BP) at night are important vascular risk factors for primary open-angle glaucoma (POAG). The aims of this study were to assess the severity of pathological changes within the optic nerve and characteristics of blood flow in selected arteries of the eyeball and orbit in patients with POAG and controlled hypertension, in relation to the time of hypotensive drugs administration. Eighty-eight patients with POAG and treated, controlled hypertension were examined. The patients were divided into two subgroups, consisting of group A (n = 43), in whom hypotensive drugs were dosed only in the morning and group B (n = 45), in whom hypotensive drugs were also taken in the evening. In patients who were taking hypotensive drugs also in the evening (group B), there was a statistically significant lower mean perfusion pressure at night, a greater visual field loss and reduced amplitude of evoked potentials. Our analysis showed significantly worse changes in the parameters relating to the optic nerve in patients taking hypertensive medicines in the evening and also significantly lower perfusion pressures at night.
[Show abstract][Hide abstract] ABSTRACT: Mortality due to ruptured abdominal aortic aneurysm remains high, despite constant progress in the fields of diagnostics and treatment. According to published data, screening in selected patient populations proved effective in decreasing these adverse outcomes. The aim of the study was to determine prevalence of abdominal aortic aneurysms in male subjects over 50 years of age, inhabiting the region of Wielkopolska and bearing risk factors of atherosclerosis. The studied population included 305 men aged 52-89 years, who were examined between March 2009 and January 2010 and fulfilled at least one of the two criteria (age over 65 years and at least one risk factor for vascular complications and/or age over 50 years and family history of abdominal aortic aneurysm in immediate kin). Patient evaluation included taking medical history, measurement of the ankle-brachial index, duplex investigation of aorta and iliac arteries as well as measurement of glycaemia and lipid parameters. Aortic aneurysms of 32-93 mm in diameter were discovered in 14 patients (4.6%). In 12 subjects, only distal part of aorta was dilated, whereas in two patients the lesion encompassed both aorta and common iliac arteries. Effacement of posterior wall of aneurysm and dissection of paramural thrombi was noted in two patients who had largest aneurysms. In both these cases, angio-CT of abdomen was performed, and patients were qualified for urgent surgical intervention. Groups of healthy subjects and patients with aneurysm did not differ significantly as to age, BMI value or lipid parameters. Glycaemia in patients with aneurysms was, however, significantly higher as compared to healthy subjects. Analysis of comorbidities and cardiovascular risk factors revealed that patients with aortic aneurysms were significantly more often active smokers, had history of cerebral stroke, and were diagnosed with chronic obturative pulmonary disease or rheumatic disorders. Analysis concerning other parameters showed no significant differences between the two groups. The observed prevalence of abdominal aortic aneurysm and risk factors for its development in male inhabitants of the Wielkopolska region were similar to figures previously reported in literature. Screening performed in this study allowed detecting 14 abdominal aortic aneurysms, of which two required urgent surgical intervention. These results support therefore necessity of such screening programmes.
No preview · Article · Jan 2012 · Acta Angiologica
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to evaluate serum iron concentration and influence of this element on biomarkers of oxidative stress in patients affected by chronic venous insufficiency (CVI).
Serum iron (SI) concentration and plasma parameters of oxidant-antioxidant balance (i.e., malonyldialdehyde [MDA], uric acid [UA] concentration, and total antioxidant capacity [TAC]) were compared between 35 patients divided into appropriate groups and 23 healthy individuals.
The subgroups analysis showed that SI concentration was significantly higher only in patients with shorter duration of CVI in comparison with the control group (P = 0.013). Significant, negative correlation was found between SI concentration and duration of the disease (r = -0.422, P = 0.014), age of the patients (r = -0.542, P = 0.001) and BMI (r = -0.408, P = 0.018). Mean value of MDA concentration and TAC capacity were higher in patients with CVI in comparison with healthy individuals (P < 0.05). UA concentration was decreased, especially in CVI patients with mild clinical stage of disease and shorter CVI duration (P = 0.047; P = 0.034). There was no significant correlation found between SI concentration and the parameters of oxidant-antioxidant balance.
High concentration of MDA and low UA level in blood of CVI patients suggests that oxidative stress plays an important role in the pathogenesis of the disease. The increase in SI concentration observed in the early stage of CVI can enhance free radicals formation; however, direct evidence has not been provided by the present study.
Full-text · Article · Dec 2011 · Medical science monitor: international medical journal of experimental and clinical research