Results of surgical treatment of inferior vena cava tumor thrombi in renal cell carcinoma

INTRODUCTION

Thrombosis of inferior vena cava (IVC) is an important complication amongst oncological patients. Tumor thrombus of IVC is characteristic for patients with renal cell carcinoma, occurring in 1018%. The aim of the work is to analyze of surgical treatment in patients with cancer thrombosis of inferior vena cava in kidney cancer.

METHODS

Between 2010 and 2019 we treated 32 patients with kidney cancer complicated by thrombotic infiltration of the inferior vena cava. According to Nesbitt classification the levels of thrombotic infiltration of the inferior vena cava were: I-8 (25%), II-14 (43.8%), III-6 (18.8%), and IV-4 (12.5%). Nephrectomy with thrombectomy of the cancer thrombus in the inferior vena cava was performed in all patients. In addition to laparotomy, sternotomy was approached in 4 patients with Nesbitt IV and in 2 patients with Nesbitt III.

RESULTS

Primary suture of IVC was performed in 26 patients; angioplasty of IVC was performed in 4 patients; and resection of IVC with replacement using a polytetrafluoroethylene interposition graft was done in 2 patients. Radical surgical treatment was performed in 27 (84.3%) patients, and palliative in 5 (15.6%) patients. In the postoperative period, 1 (3.1%) patient (Nesbitt IV) died of cardiac failure during hospitalisation. Two-year survival was observed in 75% of the cases.

CONCLUSION

Tumorous infiltration of IVC is associated with a high potential for tumour embolisation to the lungs, leading to the formation of multiple metastases and spreading of the underlying disease. Postoperative comfort is improved considerably after nephrectomy of the affected kidney and removal of the tumour thrombus, including IVC resection as appropriate, and when combined with oncological treatment, the survival rate is increased significantly, as well.

Celiac axis compression syndrome - diagnostic and surgical treatment

INTRODUCTION

Celiac axis compression syndrome is one of the causes of chronic abdominal ischemia. The authors describe their experience with the surgical treatment of Dunbar syndrome in 12 patients. The purpose of the authors was a retrospective analysis of the surgical treatment of celiac axis compression syndrome.

METHOD

Between 2007 and 2016, we treated 12 patients for the celiac axis compressive syndrome. Each patient has performed abdominal sonography, CT-angiography, or angiography. The method of choice in these patients was surgical treatment. In 4 patients we resected median arcuate ligament and nerve fibers of celiac axis. In 8 patients we had to resect the stenotic or occluded celiac axis. We reconstructed the blood supply to the celiac axis by the aorto-celiac bypass, using prothetic or venous grafting or patch plastic of celiac axis stenosis.

RESULTS

There were no significant complications and deaths in the post - operative period. In one patient signs of chronic abdominal ischemia postoperatively persist.

CONCLUSION

Surgery is the method of choice of celiac axis compression syndrome. Indications for surgical reconstruction are symptomatic patients with arterial stenosis over 50%. Proper diagnosis and early surgical treatment are essential for treating chronic visceral ischemia and reducing surgical complications. Key words: celiac axis compression syndrome - chronic abdominal ischemia - resection of ligamentum median arcuate.

LIPOPROTEIN ASSOCIATED PHOSPHOLIPASE A2 AS A MARKER OF VULNERABLE ATHEROSCLEROTIC PLAQUE IN PATIENTS WITH INTERNAL CAROTID ARTERY STENOSIS

The aim of this study was to compare the concentration of inflammatory vascular markers and morphological structure of atherosclerotic plaque in symptomatic and asymptomatic patients with the stenosis of internal carotid artery (ICA). The research was carried out in 70 patients with hemodynamically significant stenosis of ICA out of which 40 (57%) were asymptomatic patients and 30 (43%) were symptomatic patients, of which 20 patients (66%) have had a stroke, or transient ischemic attack (TIA), 10 patients (33%). All the patients were indicated to carotid endarterectomy as a surgical prevention of stroke. All the patients were taken their blood for biochemical testing (T-Chol, LDL, HDL, TG, Fibrinogen, CRP and specific markers IL-4 and Lp-PLA2) early morning prior to surgery. The highest concentrations of T-Chol, LDL, HDL, CRP and Fibrinogen were measured in symptomatic patients, however, these did not feature a significant difference compared with the group of asymptomatic patients (P>0.05). Significant difference was found in IL-4 (P<0.001) and in Lp-PLA2 (P<0.001). When evaluating concentration of tracked parameters in patients with soft atherosclerotic plaque and patients with calcified atherosclerotic plaque, significant differences were found in these markers: TG (P<0.05), CRP (P<0.01), IL-4 (P<0.001) and Lp-PLA2 (P<0.001). The paper deals with higher concentrations of Lp-PLA2 in patients with a soft atherosclerotic plaque. Higher concentration of Lp-PLA2 and systemic inflammatory markers (CRP, IL-4) could be used along with ultrasonography to detect mainly asymptomatic patients who are in urgent need of surgical or endovascular treatment as a prevention of stroke.

[Malignant fibrous histiocytoma as a rare cause of acute limb ischemia]

Malignant fibrous histiocytoma (MFH) represents a rare malignant affection of heart and aorta. Its clinical presentation depends on the localisation, size, degree of invasion and metastasis. Previously, relatively few cases of acute tumour mass embolisation into the visceral and limb arterial system were described in the literature. In the present case study we describe a case of acute ischemia of both lower extremities caused by thromboembolic mass of MFH cells. According to literary sources this tumour type is characterized by poor prognosis as it was in the case of our patient.

[Leiomyoma of external iliac vein]

Authors present a case report of a patient who was diagnosed with a tumour of external iliac vein. Excision of venous wall with tumour and reconstruction of external iliac vein with venous patch was performed. Postoperative course was without complication. The patient is without complications and also without signs of recurrence in one year follow up. Tumours of venous wall are rare. They originate from vena cava inferior, less often from extremity veins. The most frequent primary tumours of vein wall are leiomyosarcomas. Secondary tumours that involve venous wall are more common than primary tumours. Primary renal carcinoma or sarcomas of retroperitoneum represent a tumour that invades vena cava inferior. The diagnosis is based on CT and MRI. Surgical resection remains the mainstay of treatment. Chronic well collateralized obstruction is not necessary to reconstruct. Vena cava inferior and iliac veins are reconstructed with PTFE graft. Extremity veins are reconstructed using venous graft from great saphenous vein. Perioperative mortality after resection of vena cava inferior and pelvic veins is up to 6.9% major morbidity up to 33% and a fiveyear survival up to 52%. Patients with infrarenal involvement of vena cava have better outcomes than patients with involvement of retrohepatal vena cava inferior.Key words: venous tumour leiomyoma of venous wall.

[Different techniques of vessel reconstruction in kidney transplantation 10-years experiences]

INTRODUCTION

The aim of the study was to analyze own results from Transplant Center Kosice, Slovak Republic.

METHODS

In total 457 patients in the end-stage renal failure were included to the kidney transplant program. Following techniques were used: arterioplasty, individual renal artery anastomosis and multiple renal arteries anastomosed on a common patch. The kidney transplant (Tx) especially requires surgical technique of a vascular anastomosis.

RESULTS

Renal transplantation has been established in Transplant Center Kosice since 1988. The arterioplasty of renal artery was performed in 102 (22.3%) and individual artery anastomosis in 25 (5.5%) patients. Multiple artery anastomosis on the patch was done in 43 (9.4%) and implantation of pole renal arteries to the main trunk performed in 34 (7.4%) cases.

CONCLUSION

Renal transplantation is a lifesaving method in end stage renal failure.

KEY WORDS

kidney transplantation - arterioplasty, cold ischemia time vascular anastomosis.

[Comparison of the results of surgical and endovascular treatment in patients with peripheral arterial disease of the lower extremities in the femoropopliteal region]

INTRODUCTION

Results of previous studies comparing bypass surgery and percutaneous transluminal angioplasty in peripheral artery disease are ambiguous. Therefore, the aim of our study was to analyse and compare the long-term results of surgical and endovascular revascularisation in patients with peripheral artery disease in the femoropopliteal region.

MATERIAL AND METHODS

255 patients with peripheral artery disease who underwent bypass surgery or percutaneous transluminal angioplasty for newly diagnosed infrainguinal lesions in the femoropopliteal region were retrospectively identified and analyzed. Clinical and technical success, primary and secondary patency, improvement of critical limb ischaemia symptoms and improvement of the claudication interval were assessed within 1 year following treatment. Secondary evaluated outcomes were complications including haematoma after intervention, the need for revascularization and need for amputation of the thigh within 1 year after the intervention. Clinical outcomes were statistically evaluated as odds ratio and confidence interval.

RESULTS

Patients were divided into two groups: the first one was formed by 93 (36.47%) patients who underwent bypass surgery, the second one consisted of 162 (63.53%) patients who underwent endovascular therapy - percutaneous transluminal angioplasty. We could not find differences in clinical and technical success, primary and secondary patency and claudication interval improvement between the treatment groups within 1 year of follow-up after the intervention. In comparison to the endovascular group, we observed a 1.85 times higher rate of clinical improvement of critical limb ischaemia symptoms after 1 year following the intervention in the bypass surgery group patients OR 1.85 (1.10-3.10), p=0.020. Multiple logistic regression analysis showed that type of intervention was the only predictor of improvement in critical limb ischemia symptoms, independently of claudication interval before intervention, age, gender, active smoking, diabetes mellitus, hypertension and ischaemic heart disease (p=0,004). The bypass surgery group had a higher incidence of haematoma due to intervention than the endovascular group OR 4.23 (1.27-14.15), p=0.019. No differences were detected between the treatment groups in the need for revascularisation or amputation of the thigh within 1 year following intervention.

CONCLUSION

The use of bypass surgery has been associated with a higher rate of clinical improvement in critical limb ischaemia symptoms after 1 year of intervention and presence of haematoma after the intervention. No differences were detected between patients with peripheral artery disease in the femoropopliteal region treated by bypass surgery or percutaneous transluminal angioplasty in clinical and technical success, primary and secondary patency, nor in the improvement of the claudication interval during 1 year of follow-up. We also could not observe differences in the need for revascularisation or amputation of the thigh within 1 year following the intervention.

Early stages of trachea healing process: (immuno/lectin) histochemical monitoring of selected markers and adhesion/growth-regulatory endogenous lectins

Tracheotomy may be associated with numerous acute and chronic complications including extensive formation of granulation tissue. The emerging functional versatility of the adhesion/growth-regulatory galectins prompted us to perform a histochemical study of wound healing using rat trachea as model. By using non-cross-reactive antibodies and the labelled tissue lectins we addressed the issue of the presence and regulation of galectin reactivity during trachea wound healing. Beside localization of high-molecular-weight keratin, wide-spectrum cytokeratin, keratins 10 and 14, α-smooth muscle actin, vimentin, fibronectin, and Sox-2, galectins -1, -2, and -3 and their reactivity profiles were measured in frozen sections of wounded and control trachea specimens 7, 14, and 28 days after trauma. A clear trend for decreased galectin-1 presence and increased reactivity for galectin-1 was revealed from day 7 to day 28. Sox-2-positive cells were present after seven days and found in the wound bed. Interestingly, several similarities were observed in comparison to skin wound healing including regulation of galectin-1 parameters.