Intra-aneurysm sac pressure measurement using a thin pressure wire during endovascular aneurysm repair

BACKGROUND

An endoleak is a typical complication of endovascular aneurysm repair (EVAR). It is characterized by persistent blood flow between a stent graft and the aneurysm sac. Usually, it can be visualized during primary EVAR, but in many cases, this remains impossible. Therefore, other methods of endoleak assessment are urgently needed. The measurement of aneurysm sac pressure (ASP) seems to be a promising direction of research in this area.

OBJECTIVES

We aimed to evaluate the safety and efficacy of a new method for invasive pressure measurement inside the abdominal aortic aneurysm (AAA) during EVAR. We also assessed a correlation between pressure values and early angiographic occurrence of an endoleak after the procedure.

MATERIAL AND METHODS

A total of 20 patients with AAA were included in this experimental prospective study. During EVAR, systolic, diastolic and mean pressure values were recorded both for ASP and aortic pressure (AP) before procedure, after stent graft opening and after final stent graft ballooning.

RESULTS

The measurements were successfully obtained in all participants without any complications. There were no significant differences between all ASP and AP before procedure. After the procedure, blood pressure significantly decreased in the aneurysm sac but not in the aorta. Systolic ASP was significantly lower than systolic AP both after stent graft opening (80.4 ±20.9 mm Hg compared to 110.7 ±21.6 mm Hg, p < 0.01) and after its balloon post-dilatation (65.6 ±26.1 mm Hg compared to 107.4 ±22.1 mm Hg, p < 0.001). Diastolic ASP decreased significantly in comparison to diastolic AP only after stent graft ballooning (48.0 ±14.6 mm Hg compared to 56.4 ±13.6 mm Hg, p < 0.05).

CONCLUSIONS

Our study confirmed that the novel method for the measurement of ASP during EVAR, using a thin pressure wire, is feasible and safe.

Distinct Chemokine Dynamics in Early Postoperative Period after Open and Robotic Colorectal Surgery

Stress response to robot-assisted colorectal surgery is largely unknown. Therefore, we conducted a prospective comparative nonrandomized study evaluating the perioperative dynamics of chemokines: IL-8/CXCL8, MCP-1/CCL2, MIP-1α/CCL3, MIP-1β/CCL4, RANTES/CCL5, and eotaxin-1/CCL11 in 61 colorectal cancer patients following open colorectal surgery (OCS) or robot-assisted surgery (RACS) in reference to clinical data. Postoperative IL-8 and MCP-1 increase was reduced in RACS with a magnitude of blood loss, length of surgery, and concomitant up-regulation of IL-6 and TNFα as its independent predictors. RANTES at 8 h dropped in RACS and RANTES, and MIP1α/β at 24 h were more elevated in RACS than OCS. IL-8 and MCP-1 at 72 h remained higher in patients subsequently developing surgical site infections, in whom a 2.6- and 2.5-fold increase was observed. IL-8 up-regulation at 24 h in patients undergoing open procedure was predictive of anastomotic leak (AL; 94% accuracy). Changes in MCP-1 and RANTES were predictive of delayed restoration of bowel function. Chemokines behave differently depending on procedure. A robot-assisted approach may be beneficial in terms of chemokine dynamics by favoring Th1 immunity and attenuated angiogenic potential and postoperative ileus. Monitoring chemokine dynamics may prove useful for predicting adverse clinical events. Attenuated chemokine up-regulation results from less severe blood loss and diminished inflammatory response.

Septic Shock in the Course of Liver Absces Rescued with Percutaneous Drainage - A Literature Review and Case Report

This study presented a septic shock occurring with striking speed during the percutaneous drainage of a large abscess of the liver in an 18-year-old female patient after an appendectomy performed 3 months earlier using the laparoscopic method because of its phlegmonous and gangraenosus inflammation. The post-operative course was complicated by increased suppuration in places after removal of the trocars. After including the intravenous antibiotic therapy and under the USG control, the percutaneous drainage of the abscess was performed. While withdrawing the guide of the drainage catheter set, the symptoms of septic shock occurred. The pharmacological treatment was applied with continuation of the antibiotic therapy till a negative result of microbiological tests was obtained and the normalization of life parameters. The patient was not qualified for treatment in the ICU. She was discharged in a generally good condition after 24 days of hospitalization. In the case of this patient, the drain covered with the content of the abscess may have contact with the adjacent tiny blood vessels, which may have contributed to the systemic inflammatory response syndrome that was linked with fast-developing sceptic shock.

Exceptionally rare cause of a total stomach resection

The first-ever case of a 54-year-old woman who overdosed on non-steroidal anti-inflammatory drugs in an attempt at suicide. Before that incident, she had not been treated for coexisting diseases such as rheumatoid arthritis or depression. At the time of admission to the General Surgery Department, the patient reported pains in the epigastric region with accompanying nausea and vomiting with mucous content as well as the inability to ingest food orally. Despite parenteral and enteral feeding, the patient exhibited a drop in body mass. The histopathologic examination of a sample taken from the stomach during gastroscopy showed some non-specific necrotic and inflammatory masses with granulation. Intraoperatively, a very small, infiltrated stomach with an initial section of duodenum was identified. A total stomach resection together with the reconstruction of digestive tract continuity was performed using the Roux-Y method. Histopathologic examination of the stomach revealed a deep, chronic and exacerbated inflammatory condition with an extensive ulceration over the entire length of the stomach, reaching up to the pylorus. Additionally, numerous lymphatic glands with inflammatory reaction changes were observed.