An atypical radiographic appearance of a cardiac myxoma: case report and review of the literature

Cardiac myxomas are the most common primary cardiac tumors in adults. They usually present as a solitary, solid mass in the left atrium. Their most common radiographic appearance is that of a hypodense lesion on computed tomography (CT) and inhomogeneous lesion (hypo to isointense on T1 sequences and hyperintense on T2 sequences) on magnetic resonance (MR) with some contrast enhancement. However, different patterns are recognized due to secondary changes within the tumor. We present a case of a 60-year-old man with a hypervascular myxoma. The lesion was a sessile mass located in the left atrium and rigidly attached to the interatrial septum. On CT and MR, it showed vivid contrast enhancement due to intratumoral flush of arterial blood form branches of dominant left circumflex artery and a possible fistula to the left atrium. Furthermore, we review the literature for different atypical radiographic appearances of myxomas.

Accuracy of Computed Tomography in the Assessment of Milan Criteria in Liver Transplantation for Hepatocellular Carcinoma

BACKGROUND

Despite worldwide debate on optimal selection of patients with hepatocellular carcinoma (HCC) for liver transplantation, the Milan criteria remain the benchmark for comparisons. Moreover, morphologic tumor features are universally considered important in pretransplant patient evaluation. The aim of this study was to establish the diagnostic accuracy of multiphasic computed tomography (CT) in assessing HCC burden before liver transplantation with special reference to Milan criteria fulfillment.

METHODS

This retrospective study was based on a data from 27 HCC patients after liver transplantation with available CT performed within 30 days pretransplant. CT results were compared with explant pathology with respect to Milan criteria fulfillment, tumor number, and diameter of the largest tumor.

RESULTS

Out of 19 patients within the Milan criteria on CT, 3 fell beyond the criteria on explant pathology with a gross underestimation rate of 15.8%. Out of 8 patients beyond the Milan criteria on CT, 3 were within the criteria on explant pathology with a gross overestimation rate of 37.5%. Regarding tumor number, CT was accurate only in 14 patients (51.9%), while overestimation and underestimation occurred in 5 (18.5%) and 8 (29.6%) patients, respectively. Overestimation and underestimation of largest tumor size by at least 1 cm occurred in 4 (14.8%) and 7 (25.9%) patients, respectively.

DISCUSSION

Multiphasic CT is associated with a remarkable risk of both under- and overestimation of HCC burden before transplantation. Transplant eligibility should not be solely based on CT results.

Role of 16-multidetector computerized tomography in evaluation of graft failure risk in patients with pancreatic graft thrombosis after simultaneous pancreas and kidney transplantation

BACKGROUND

Thrombosis of the pancreatic graft vessels is a common complication in patients after pancreas transplantation. The aim of this study was to evaluate the usefulness of 16-multidetector computerized tomography (16-MDCT) with volume rendering (VR) and maximum intensity projection (MIP) reconstruction as a predicting method of pancreatic graft loss after simultaneous pancreas and kidney transplantation.

METHODS

Within 6-8 days after combined kidney-pancreas transplantation, MDCT was performed in 60 patients. Secondary reconstructions were obtained with the application of VR and MIP algorithms. Vessel anastomosis, extra- and intrapancreatic arteries, venous morphology, and enhancement of graft's parenchyma were evaluated. The stenosis grade of pancreatic graft vessels and the areas of graft parenchyma malperfusion were evaluated.

RESULTS

Thrombosis of pancreatic graft vessels was recognized in 26 patients (43%), however only one-half of them required graftectomy. There were 17 cases of large vessel thrombosis and 9 cases of small intragraft vessel thrombosis. In 13 (86.6%) out of 15 recipients parenchymal malperfusion resulted in graft lost. It appeared that vessel narrowing >40% was a threshold for pancreatic graft loss with sensitivity and false positive values of 100% and 9%, respectively. For parenchyma nonenhancement >60% the sensitivity and false positive values of 100% and 0% were significantly associated with pancreatic graft loss (P < .0001).

CONCLUSIONS

Vascular occlusion of >40% and necrosis >60% of parenchymal volume correspond with pancreatic graft loss.

Treatment of early hepatic artery thrombosis after liver transplantation

INTRODUCTION

Early hepatic artery thrombosis remains one of the major causes of graft failure and mortality in liver transplant recipients. It is the most frequent severe vascular complication after orthotopic liver transplantation (OLT) accounting for >50% of all arterial complications. Most patients need to be considered for urgent liver retransplantation.

MATERIALS AND METHODS

Among 911 OLTs in 862 from 1989 to 2011, we observed 23 cases (2.6%) of acute early hepatic artery thrombosis. Seventeen patients were qualified immediately for liver retransplantation, and 6 underwent endovascular therapies, including intra-arterial heparin infusion or percutaneous transluminal angioplasty with stent placement.

RESULTS

Among patients who were assigned to early liver retransplantation, 11/17 survived with 3 succumbling due to postoperative complications, including 1 portal vein thrombosis, and 3 succumbling on the waiting list. All patients who underwent endovascular therapy survived with an excellent result obtained in 1 who underwent treatment<24 hours after arterial thrombosis. In 2 patients we achieved a satisfactory result not requiring retransplantation, but 3 patients assigned to endovascular treatment>24 hours after arterial thrombosis needed to be reassigned to liver retransplantation because of poor results of endovascular treatment.

CONCLUSIONS

Endovascular treatment efforts should be made to rescue liver grafts through urgent revascularization depending on the patient's condition and the interventional expertise at the transplant center, reserving the option of retransplantation for graft failure or severe dysfunction.

Renal artery aneurysms: presentation of five cases

We are presenting clinical characteristics, management and follow-up of five consecutive patients with renal artery aneurysm. Renal artery aneurysms are relatively uncommon, they rarely give rise to clinical manifestations and they are usually found incidentally. However with the introduction of Doppler ultrasound, computed tomography (CT) and magnetic resonance (MR) imaging, the diagnosis of renal artery aneurysms became more frequent.

Two-stage transjugular intrahepatic porta-systemic shunt for patients with cirrhosis and a high risk of portal-systemic encephalopathy patients as a bridge to orthotopic liver transplantation: a preliminary report

AIM

Placement of a transjugular intrahepatic porta-systemic shunt (TIPS) is a therapeutic option for the management of bleeding esophageal varices. However, the procedure is associated with an increased risk of portal-systemic encephalopathy (PSE). In this study, a two-stage modification of the standard TIPS technique was introduced for the management of variceal bleeding in cirrhotic patients with a high risk of PSE before liver transplantation.

METHODS

The modified procedure was applied to four patients with cirrhosis, portal hypertension, and ascites. Two had a history of encephalopathy after variceal bleeding; the other two were encephalopathic at the time of the first stage of the modified procedure. In the first stage, a 6-mm diameter intrahepatic shunt was created using a Palmaz-Schatz stent. One month later, in the second stage, the lumen of the shunt was expanded to a diameter of 10 mm.

RESULTS

Both stages of this TIPS procedure were undertaken without any associated adverse events. In particular, neither stage was followed by a deterioration of neurologic status. From completion of the second stage to undertaking orthotopic liver transplantation (a period of 2 to 6 months), no rebleeding from esophageal varices occurred.

CONCLUSIONS

A two-stage TIPS procedure to reduce portal hypertension enables a more gradual adaptation to post-TIPS hemodynamic and metabolic changes than occurs after creation of a conventional TIPS. A two-stage TIPS procedure may be the method of choice for treating bleeding from esophageal varices in patients who have a high risk of developing PSE and give them a chance for liver transplantation.

Imaging of Pancreatic Transplant Vessels and Anastomoses With 16-Row Multidetector Computed Tomography

The aim of this study was to evaluate the usefulness of 16-row multidetector computed tomography (16-MDCT) in the assessment of the potency of arterial and venous vessels in combined kidney-pancreas transplant and detection of transplant-related complications. Fifteen patients underwent a combined kidney-pancreatic transplantation. On the seventh day after the operation, we performed 16-MDCT in arterial and portal venous phase to evaluate vessels, anastomotic sites, and pancreatic parenchymal vascularization as well as peripancreatic fluid collections. We visualized the pancreatic vessels and anastomosis sites in all cases. In 12 recipients, there were no abnormal findings as regards the patency of the arterial and venous vessels and the vascularization of the pancreatic parenchyma. In two patients, complete arterial thrombosis of the body and tail pancreatic graft vessels was recognized at 2 weeks after transplantation, resulting in graft removal. Thrombi were localized in the distal part of anastomoses. None of the patients had venous thrombosis. One recipient had stenosis of the venous anastomosis. Peripancreatic fluid collections were observed in seven patients. In conclusion, 16-MDCT is an efficient method to estimate pancreatic transplant vessels, localize thrombi, and detect other transplant-related complications.

A Solution to Organ Shortage: Vascular Reconstructions for Pancreas Transplantation

Multiorgan harvesting (MOH) accounts for approximately 40% of all organ procurements in Poland. Simultaneous procurement of the pancreas and liver necessitates division of the vessels supplying both organs. Therefore, reconstruction of the pancreas vasculature is mandatory for proper function of the transplanted organ. The aim of this study was to present various methods of vascular reconstruction to prepare the pancreas for transplantation. Between January 1999 and April 2005, among 42 whole pancreas transplantations, 35 came from MOH necessitating arterial reconstruction. In 32 cases, the splenic artery (SA) and superior mesenteric artery (SMA) were sewn into a single trunk using the common iliac arterial bifurcation. Occasionally, the iliac Y-graft was unsuitable for vascular reconstruction due to atherosclerosis or iatrogenic injury. Therefore, the SA was anastomosed to the side of the SMA in two cases. In one case we utilized the brachiocephalic trunk bifurcation. Portal vein elongation employed an external iliac vein procured from the donor in all 35 cases. Good perfusion was achieved in all transplanted pancreata. During the early follow-up period, two venous and one arterial thromboses were noted. No negative effects of pancreatic vessel reconstruction were observed in postoperative graft function. Reconstruction of the pancreas vasculature did not affect the long-term function of the allograft while significantly increasing the available donor organ pool.

Simultaneous Endovascular Exclusion of Thoracic Aortic Aneurysm with Open Abdominal Aortic Aneurysm Repair

BACKGROUND

The treatment of aneurysms at multiple sites within the aorta is problematic.

METHODS

Between March 2002 and June 2003 in the Department of General, Vascular and Transplant Surgery, Medical University of Warsaw six patients with coexisting abdominal and descending thoracic aortic aneurysms underwent simultaneous open abdominal aortic aneurysm (AAA) repair and endoluminal thoracic aortic aneurysm (TAA) repair. The indication for a combined procedure was a diagnosed descending TAA and AAA with no significant risk factors for open aortic surgery or technical contraindications for endovascular treatment of TAA.

RESULTS

One patient died in the peri-operative period while the other five patients all recovered well after surgery and were discharged with both aneurysms excluded.

CONCLUSION

Endovascular treatment of TAA combined with a simultaneous open AAA repair is an efficient and relatively safe treatment modality in patients with TAA and AAA disqualified from endovascular repair. The fact that thoracotomy is not a necessity significantly lowers the complication rate in these patients.

Vascular complications after liver transplantation

Vascular complications following liver transplantation is reviewed based upon literature data and our own results. Our study conclusions are mostly based on literature data, because our center does not have the liver transplantation experience of other centers worldwide. Thus, we may conclude, that the number and character of complications does not differ from those reported by other centers. The enbloc technique used in liver harvesting minimizes the risk of arterial damage in case of vascular anomalies. Recipient retransplantation is the most effective treatment method in cases of hepatic arterial occlusion. Doppler ultrasound examinations are effective to monitor vascular blood flow in the transplanted liver.

Anatomical alteration of the vascular tree observed during living related liver transplantation

INTRODUCTION

The number of available cadaveric donor organs has reached a plateau. One current solution has been to increase number of living related liver transplantations.

MATERIAL AND METHODS

Since October 1999 in the Department of General, Transplant and Liver Surgery, Medical University of Warsaw, 40 living related liver transplantation have been carried out.

RESULTS

In 31 (77.5%) cases, a normal arterial supply was observed: the common hepatic artery arose from a celiac trunk. In two cases (5.0%), there was a partial arterial blood supply by the right accessory hepatic artery originating from the superior mesenteric artery. In two cases (5.0%), a right hepatic artery arose completely from the superior mesenteric artery (replaced artery). In one case (2.5%), a common hepatic artery originated from the superior mesenteric artery. In two cases (5.0%), an accessory left segmental artery originated from the left gastric artery. In two cases (5.0%), the function of an absent left hepatic artery was assumed by a replaced left hepatic artery originating from the left gastric artery. In two (5.0%) cases, there were two separate ducts draining the right hemiliver. There were two (5.0%) cases of an accessory duct draining segment IV, originating within the confluence of the right and left hepatic ducts. In one (2.5%) case, the common hepatic duct showed a trifurcation.

CONCLUSION

During harvesting from a living donor knowledge of anatomical variants must be used to optomize the liver graft.

The impact of experience of a transplantation center on the outcomes of orthotopic liver transplantation

The so-called learning factor has been disregarded for many years in analyzing the causes of surgical complications and post-operative mortality; it is also the case for OLT. In our center until April 2003, 209 OLT were performed in 196 patients. We evaluated the impact of experience of the transplantation team on the outcomes of liver transplantation. Thirty-four patients died (mortality rate, 16%) and 1-year survival rate, 64%. Mortality rates varied during different periods of observation due to increasing experience of the transplantation team. The causes of mortality were assessed for a series of 34 patients: it was 75% at the beginning of transplantation procedures while recent deaths have not recently exceeded 10% of cases.

[Histopathological investigation of the transjugular intrahepatic portocaval shunt (TIPS)]

The aim of the study was to investigate the histological structure of the artificial channel connecting one of the portal vein branches with the hepatic vein, as an effect of the transjugular intrahepatic portosystemic shunt (TIPS). The livers of six patients were investigated. In 4 of them recurrent variceal bleedings were an indication for TIPS, in the remaining 2 patients--intractable ascites. In all cases portal hypertension was due to liver cirrhosis. All patients were estimated as Child-Pugh group C. The period from the stent implantation to the moment of investigation ranged from 1 to 7 months. 2 livers were removed at the time of liver transplantation, 4 were procured at the autopsy. All shunts were patent and in none of the 6 cases dislocation of the stent occurred. The wall of the intrahepatic shunts was lined by a granulation tissue (pseudointima) covered with a layer of endothelial cells. No thrombosis, mechanical damage of the stent or extensive hypertrophy of pseudointima were found.

Intrahepatic portosystemic shunt in treatment of complications of portal hypertension

BACKGROUND

The aim of the paper is to present the role of transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of portal hypertension complications such as variceal bleeding and persistent ascites.

MATERIAL AND METHODS

Between June 1992 and December 2000, 56 patients with portal hypertension developed in the course of hepatic cirrhosis were qualified for TIPS. The indications for TIPS included esophageal variceal bleeding, recurrent despite endoscopic treatment (N-40), active esophageal variceal hemorrhages in which traditional methods used to stop the bleeding proved ineffective (N-8) and ascites failing to respond to high doses of diuretic agents (N-8). The studied group consisted of 30 females and 26 male patients aged from 17 to 68 (mean age 52 yrs). According to Child-Pugh surgical risk classification, 26 patients belonged to group B, and 30 to group C.

RESULTS

In 50 patients (83.5%) an intrahepatic shunt was formed and the stent(s) implanted. In 42 cases (75%), long-lasting patency of the shunt was obtained and esophageal variceal bleeding was stopped. Active esophageal variceal hemorrhages were stopped in all the cases. The remission of massive ascites and hepatorenal syndrome was obtained in 7 out of 8 patients.

CONCLUSIONS

TIPS is a non-surgical method relieving portal hypertension in patients with variceal hemorrhages recurrent despite endoscopic treatment. Very good results were also obtained in the cases with active variceal hemorrhages. TIPS has proved to be an effective method of treatment in the patients with massive ascites and hepatorenal syndrome.

Effects of the correction of renal artery stenosis on blood pressure, renal function and left ventricular morphology

The aim of this study was to evaluate the effect of renal artery stenosis (RAS) correction in hypertensive patients on 24 h SBP, 24 h DBP, creatinine clearance (GFR), urinary albumin excretion (UAE) and LV morphology and mass (LVMI). A total of 61 hypertensive patients with RAS undergoing PTRA and/or surgical treatment entered the prospective study. The final analysis was done in 44 patients (age range 45.8 +/- 16.2 years) with RAS (atherosclerosis (ASC) 31 patients, fibromuscular dysplasia (FMD) 12 patients, arteritis 1 patient) who underwent PTRA (34 patients) or surgical treatment (10 patients) and presented no Doppler signs of restenosis (or a new stenosis) during 1-year observation. The pre-interventional assessment repeated after 6 and 12 months included ABPM, GFR, UAE and echocardiography. The results were analysed in the combined group (CG) and in according aetiology. 24 h SBP and 24 h DBP decreased in all groups 6 months post-intervention and did not change further. Cure of HT was observed in 35% and 29% of ASC patients at 6 and 12 months respectively; and in 58% of FMD patients. Failure rate at 12 months was 48% in ASC against 25% in FMD. The mean GFR in CG was higher 12 months after intervention. The increase in GFR was noted in 45% of patients, the decrease in 25% of patients at 12 months. Normal values of UAE were found in 71% of patients, pre- and post-intervention alike. Mean LVMI and number of patients with LVH in CG decreased already during the initial 6 months post-intervention and did not change further. In conclusion, correction of RAS leads to cure of or improved control of hypertension in the majority of the patients with FMD, but in the ASC group in about half of cases no BP cure or improvement was seen. The renal function was improved or stable in two-thirds of patients after revascularization. Successful renal revascularization was followed by regression of LVH, which was evident within 6 months post-intervention.

[Intrahepatic portocaval shunt as a new method for treating and prevention of bleeding from esophageal varices in portal hypertension]

The aim of this study was the presentation of percutaneous transjugular intrahepatic porto-systemic shunt (TIPS) and its place among the other methods of the treatment of esophageal variceal bleedings. In the period from June 1992 to December 1997, 31 cirrhotic patients with portal hypertension and recurrent variceal bleedings were submitted for TIPS. This group consisted of 14 female and 17 male patients, their age ranging from 17 to 68 years (average 52). According to Child-Pugh classification 4 patients represented group A, 11--group B and 16--group C. Each of these patient was admitted to our Department after recurrent bleeding, resistant to typical treatment: terlipressein infusion, balloon tamponade and endoscopic sclerotherapy. In 24 patients (78%) TIPS was performed successfully. In 7 cases TIPS was performed in candidates for orthotopic liver transplantation.

CONCLUSIONS

TIPS is quite new, nearly 10 years old method for portal decompression. It is an effective and less invasive method than surgical procedures in the treatment of portal hypertension, especially in Child-Pugh group B and C patients if the sclerotherapy is not effective. It protects cirrhotic patients waiting for liver transplantation against the esophageal bleedings.

[TIPS in treatment of patients with recurrent bleeding from esophageal varices]

In the period from January 1992 to May 1997 we performed 20 procedures of percutaneous transjugular intrahepatic porto-systemic shunt (TIPS) in the patients with liver cirrhosis and recurrent variceal bleedings. This group consisted of 10 male and 10 female patients, their age ranging from 17 to 68 years (average 52). The etiology of cirrhosis was alcoholic in 8 cases, postinflammatory in 6, primary biliary in 4 and autoimmunological in 2 cases. According to Child-Pugh classification 4 patients represented group A, 10-group B and 6-group C. Each of these patient was admitted to our Department after recurrent bleeding, resistant to typical treatment: vasopressin infusion, balloon tamponade and endoscopic sclerotherapy. In 3 cases TIPS was performed in candidates for orthotopic liver transplantation.

[Transcutaneous balloon angioplasty in the treatment of subclavian steal syndrome. Characteristics of vertebral basal flow with transcranial Doppler technique]

Subclavian steal syndrome (SSS) appears when the origin of the subclavian artery (SA) is occluded or stenosed. Introduction of transcranial Doppler sonography (TCD) provided an opportunity to evaluate parameters of the blood flow in the vertebral (VA) and basilar artery (BA). Measurements of blood flow velocities performed at rest and after the brachial hyperemia test allow one to classify hemodynamic types of SSS. The aim of the study was to categorize types of steal and to compare the differences of flow patterns before and after percutaneous transluminal SA balloon angioplasty (SA-PTA). Fourty-eight patients with angiographically confirmed SSS (aged from 27 to 68 years, mean 53; 2/1 f/m ratio) were examined with 2 MHz range-gated, pulsed transcranial Doppler device (TC 2-64B EME). Both VA and BA were evaluated by the transoccipital approach at rest and during the brachial hyperemia. In 5 cases (10.4%) permanent reversal blood flow in the BA was observed (complete basilar steal). In flow in the BA blood flow was in the normal direction at rest and altered (reversed or decreased) when induced with brachial hyperemia test (transient basilar steal). In the next 14 patients (29.2%) permanently reversed VA blood flow was observed with only a slight or no alterations of the BA flow after the hyperemia test (complete vertebral steal). In the last 19 cases (39.6%) alterations of the VA blood flow without changes in BA flow were observed (latent vertebral steal). Between 1991 and 1994 twenty seven symptomatic patients with different hemodynamic types of SSS were treated with SA-PTA. TCD evaluation of VA's and BA using the hyperemia test was performed before, 3 to 7 days and 3 months after morphologically and hemodynamically successful subclavian artery balloon PTA. Normal results of vertebrobasilar examinations were obtained in 26 cases after this procedure. In one case the latent vertebral steal was detected. The 28 months mean follow-up revealed no significant changes in TCD flow patterns recorded from VA's and BA. After collecting data of about 60 patients with SSS we examined with TCD we conclude that: in patients with a hemodynamically significant SA stenosis the presence of reversed ipsilateral VA blood flow (a radiologic steal) its not a good determinant of either the presence or type of presenting symptoms and after successful PTA or recanalisation and PTA of SA in almost all cases we examined close to normal TCD recordings in BA and VA.

Endothelin-1 and neuropeptide Y plasma concentrations in renal venous blood of hypertensive patients with unilateral renal artery stenosis

The aim of the study was to investigate endothelin-1 (ET-1) and neuropeptide Y (NPY) plasma concentrations in renal venous blood of hypertensive patients with unilateral renal artery stenosis (URAS). The study was performed in 22 patients with URAS and 18 patients diagnosed as essentially hypertensive. In each subject renal arteriography and renal vein catheterisation was performed. Blood samples for ET-1, NPY and plasma renin activity (PRA) were withdrawn from renal veins and vena cava inferior, and for ET-1 and NPY from the aorta. Patients with URAS were divided in two subgroups according to the renal vein renin ratio. Both in nine patients with URAS and ratio > 1.5 and in 13 patients with URAS and ratio < 1.5, ET-1 and NPY plasma concentrations evaluated in renal venous blood of the ischaemic kidney were not different from those assessed in the contralateral side, in vena cava inferior and in the aorta. In essential hypertension, the mean ET-1 and NPY plasma concentrations of both renal veins were not different from the ET-1 and NPY plasma values assessed in renal vein of stenosed and contralateral side, vena cava and aorta of patients with URAS with and without activation of the renin system. Our study indicates that chronic ischaemia does not affect ET-1 and NPY plasma concentrations in renal venous blood of hypertensive URAS patients both with and without activation of the renin system.

[Portal vein thrombosis. Etiology, diagnosis and treatment]

The authors present 225 patients with various forms of portal system venous thrombosis (PSVT), of various origin and etiology. The largest group (120 patients) were the young people suffering from portal hypertension due to pre-hepatic venous obstruction of uncertain etiology, lasting since childhood. The next group consisted of 75 patients with liver cirrhosis coexisting with PSVT. In other cases PSVT was diagnosed as coincident with: Budd-Chiari Syndrome (8 cases), liver tumors (9 cases), chronic pancreatitis (3 cases) and polycythaemia (2 cases). In 3 cases PSCT developed postoperatively and in 5 cases after oral contraceptives. Diagnosis of coexisting PSVT deteriorates the prognosis in liver cirrhosis. The overall mortality was 16%. The course of the disease depends on extensiveness and dynamism of thrombosis, but consequently leads to the development of portal hypertension. The most effective diagnostic procedures are: CT and USG with Doppler flowmetry. Bleeding esophageal varices require either sclerotherapy or surgical treatment--decompressive shunts or "non-shunt" procedures. In the cases of recent thrombosis, without bleeding varices, thrombolytic therapy appears to be effective.

[Recanalization of occlusion of the peripheral segment of the femoral artery by the Kensey method]

The aim of the presented study was to analyse the surgical technique and results of recanalization of the peripheral segment of iliac artery with Kensey's technique. Altogether 16 patients were operated. Arterial patency was observed in 14 patients immediately after surgery. This number decreased to 11 after a 3-month follow-up. Complications in the form of perforation of the arterial wall, hemorrhage at the site of puncture and thrombotic lesions in the reconstructed arterial channel were seen in 4 cases. Authors' own experience suggests that Kensey's technique together with laser surgery are the treatment of choice in case of iliac arterial occlusion in patients, in whom classic surgery is contraindicated.