Five-Year Experience of Interwoven Self-Expanding Stent Implantation in Stenotic Kinking of Below the Knee Prosthetic Bypasses

PURPOSE

The purpose of this study was to evaluate the 5-year real-world results of Supera stent implantation in below the knee prosthetic bypasses (BKPBs). All the procedures were performed because of a history of recurrent thrombosis of the graft and significant stenotic kinking of the prosthesis during knee flexion. A Supera stent was implanted to prevent the next potential BKPB thrombosis.

MATERIALS AND METHODS

Fourteen patients were included in this single-center, retrospective observational cohort study. All patients underwent Supera stent implantation in infrainguinal prosthetic bypass between 2012 and 2017, due to a history of recurrent thrombosis and kinking of the prosthetic bypass.

RESULTS

Prior to Supera stent implantation procedure, all the patients had more than one episode of acute limb ischemia caused by thrombosis of the BKPB. The median number of BKPB thromboses prior to Supera stent implantation was 3 and ranged from 2 to 6. Technical success was achieved in all cases. Primary patency rates at 12, 24, 36 and 60 months were 71.4%, 57.1%, 57.1% and 14.3%, respectively. Secondary patency rates at 12, 24, 36 and 60 months were 78.6%, 64.3%, 64.3% and 35.7%, respectively. One stent fracture was reported during 60-month follow-up. Major amputation was performed in 6 patients in 5-year follow-up.

CONCLUSION

Supera stent in treatment of recurrent thrombosis of BKBP is a safe procedure with acceptable mid-term results. However, larger and comparable prospective studies are needed for broader analysis of this procedure.

Cardiac Post-Chest Radiotherapy Complications in a 50-Year-Old Patient with Hodgkin Lymphoma

Lymphomas are a group of malignant tumors that originate in the lymphatic system. It is the most common type of blood cancer. It affects the lymph nodes, spleen, bone marrow, blood, and other organs. They can be aggressive or chronic. Hodgkin lymphoma survival rate is 2 in 100,000 people. Young adults aged 20-30 and people over 50 are most often affected. The prognosis of Hodgkin's lymphoma is good, with a survival rate of up to 80 percent. Nevertheless, in 20-30 percent of patients who initially respond to treatment, the disease has a tendency to progress. The positive effect of radiotherapy (RT) on patients' survival rates has been proven in many randomized clinical trials. Although the dose of chest RT has significantly reduced over the years, we still struggle with the long-term complications of post-RT repercussions, mainly because there is no established safe dose of RT affecting the heart. Other complications include earlier onset of coronary artery disease, early and late onset of pericarditis, valve degeneration (predominantly of the left heart), calcification of the aorta and its branches, heart failure, and arrhythmias. One patient can manifest each of the abovementioned complications, as in the present case. That is why choosing the right treatment strategy is crucial.

Three-Year Real-World Outcomes of Interwoven Nitinol Supera Stent Implantation in Long and Complex Femoropopliteal Lesions

BACKGROUND

Peripheral artery disease (PAD) remains a major issue in modern societies and affects more than 200 million people around the world. Endovascular methods have been evaluated to be safe and effective in limb salvage. The Supera is able to withstand increased compression, biomechanical stress and to have higher radial force. The objective of this study is to evaluate performance, durability and 3-year patency of Supera stent implantation in severe femoropopliteal disease.

METHODS

A retrospective real-world analysis was performed with consideration of 77 patients that had a Supera stent implanted with femoropopliteal atherosclerotic disease at a single center. Among the 77 individuals, 92 Supera stents were implanted. Analysis of patients' demographics, lesions characteristics, reintervention rates and patency rates was performed.

RESULTS

The median follow-up was 33 months and ranged from 0 to 84 months. Chronic limb-threatening ischemia was observed among 43 patients. Mean lesion length was 152.8 ± 94.6 mm. Chronic total occlusions were observed in a majority of lesions. Overall, primary patency rates at 6, 12, 24 and 36 months were 85.0%, 73.6%, 59.2% and 53.2%, respectively.

CONCLUSIONS

The Supera stent is effective in the management of long and complex lesions. The results of patency rates were evaluated to be worse among lesions extending to the popliteal artery.

[Tracheal stenting in patients treated due to carcinoma of the larynx]

INTRODUCTION

Stenosis of the trachea and main bronchia can occur in patients with lung, larynx, thyroid gland, esophagus, in metastatic tumors, can be also caused by trauma and foreign bodies. Treatment in this condition can be difficult. Tracheal stenosis in patients after total removal of the larynx is relatively rare. It can be caused by recidiv tumor and inflammation processes.

AIM OF THE STUDY

Was to evaluate usefulness of stents in patient with stenosis of the trachea after total laryngectomy due to squamous cell carcinoma.

MATERIAL AND METHODS

Authors described two cases of patient after total laryngectomy. Nitinol, expandable, tracheal stents were used in both cases. Placement of the stent into the trachea was relatively simple. Patients have undergone this procedure in short general anesthesia.

RESULTS

After stenting patients exhibited dramatic improvement in their respiratory symptoms and quality of life.

CONCLUSIONS

Stents are useful in cases of tracheal stenosis and the effect is related to the reason of stenosis.

[Fatal necrotizing mediastinitis as a complication of peritonsillar abscess]

In the paper showed the case of fatal necrotizing phlegmon of the neck and descending mediastinitis in 48 year old male patient with primary peritonsillar abscess. On the base of literature it was showed the etiology, pathomechanism of the evolution of this heavy complication and surgical and pharmacological methods of its treatment. In spite of prompt wide incision and drainage of phlegmon of the neck and mediastinum and intensive treatment in intensive care unit conditions patient died in the image of septic shock and pus changes in the mediastinum, heart and lungs, what was showed on the base of post-mortum examination.