Atherosclerosis carotid stenosis (ACS) is one of the main causes of stroke. Unfortunately, the highest number of people go to the doctor with an advanced disease or as a result of a stroke, because carotid atherosclerosis does not cause obvious symptoms. Therefore, it is important to find a diagnostic method to detect the disease during routine tests (using blood or serum). Consequently, in this article, Raman spectroscopy was tested as a potential diagnostic method. Indeed, Raman spectra of serum collected from ACS and control patients showed decrease of Raman peak around 1520 cm(-1) and increase of peak around 3050 cm(-1) in people with ACS. Moreover in people with ACS shift of peaks originating from amides II, I and lipids vibrations were noticed in comparison with control group. Interestingly, decision tree algorithm showed that peaks at 1656 cm(-1) and 2957 cm(-1) could be a spectroscopy markers of atherosclerotic carotid stenosis. Continuing, Principal Component Analysis (PCA) clearly showed distinguishing between serum collected from ACS and control patients, while machine learning algorithms showed high value of accuracy, sensitivity and selectivity (more than 90 %). Finally, value of area under the curve of Receiver Operating Characteristic (AUC-ROC) showed value of 0.81 for Raman range between 800 cm(-1) and 1800 cm(-1) and 0.86 for 2800 cm(-1)-3000 cm(-1) range. Obtained results clearly showed possibility of Raman spectroscopy in detection of ACS from serum.

Atherosclerotic carotid stenosis (ACS) is a recognized risk factor for ischemic stroke. Currently, the gold diagnostic standard is Doppler ultrasound, the results of which do not provide certainty whether a given person should be qualified for surgery or not, because in some patients, carotid artery stenosis, for example at the level of 70 %, does not cause ischemic stroke in others yes. Therefore, there is a need for new methods that will clearly indicate the marker qualifying the patient for surgery. In this article we used Fourier Transform InfraRed Attenuated Total Reflectance (FTIR-ATR) spectra of serum collected from healthy and patients suffering from ACS, which had surgery were analyzed by machine learning and Principal Component Analysis (PCA) to determine chemical differences and spectroscopy marker of ACS. PCA demonstrated clearly differentiation between serum collected from healthy and non-healthy patients. Obtained results showed that in serum collected from ACS patients, higher absorbances of PO2-stretching symmetric, CH2 and CH3 symmetric and asymmetric and amide I vibrations were noticed than in control group. Moreover, lack of peak at 1106 cm-1 was observed in spectrum of serum from non-control group. As a result of spectral shifts analysis was found that the most important role in distinguishing between healthy and unhealthy patients is played by FTIR ranges caused by vibrations of PO2- phospholipids, amides III, II and C--O lipid vibrations. Continuing, peaks at 1636 cm- 1 and 2963 cm- 1 were proposed as a potential spectroscopy markers of ACS. Finally, accuracy of obtained results higher than 90 % suggested, that FTIR-ATR can be used as an additional diagnostic tool in ACS qualifying for surgery.

Introduction: Stroke remains the leading cause of disability and death worldwide. Carotid endarterectomy (CEA) reduces the incidence of ischemic stroke or death in patients with symptomatic carotid artery stenosis more effective than pharmacological therapy alone. Neurogranin is a potential marker of brain injury previously investigated mainly in neurodegenerative diseases (Alzheimer disease), but also in ischemic stroke and traumatic brain injury. Material and methods: The aim of the research was to investigate the changes in serum level concentrations of neurogranin in patients undergoing CEA. 22 patients with severe carotid artery stenosis underwent CEA. Serum levels of Neurogranin were measured by an enzyme-linked immunosorbent assay (ELISA) test at 24 h before CEA, 12 and 48 h after the surgery. Results: Serum neurogranin levels show a tendency to decrease after an uncomplicated CEA, however the difference is not statistically significant (p > 0.05). Conclusions: Serum neurogranin level does not significantly change after the CEA, therefore it may not be an useful marker of brain damage after the procedure. There is still need for further studies on bigger group of patients and patients with neurological complications to confirm these findings.

Introduction: Stroke remains one of the main causes of morbidity and mortality worldwide. Carotid endarterectomy (CEA) reduces the incidence of ischemic stroke or death in patients with symptomatic carotid artery stenosis more effectively than pharmacological therapy alone. SBDPs (spectrin breakdown products): SBDP 120, SBDP145, and SBDP150 are the product of proteolysis of alpha II-spectrin (280 kDa) - an important structural component of the neuronal cytoskeleton, particularly present in axons. Increased serum level of SBDPs was previously observed in traumatic brain injury, subarachnoid hemorrhage (SAH), or brain ischemia.Material and methods: The aim of our study was to investigate changes in serum levels of SBDP120 and SBDP145 in patients undergoing uncomplicated CEA. The study included 22 patients with severe carotid artery stenosis, qualified for CEA. Blood samples were taken from the antecubital vein at three different intervals (24 h before CEA, 12 and 48 h after surgery). SBDP's serum levels were measured by a commercially available enzyme-linked immunosorbent assay (ELISA).Results: The study showed that serum SBDP120 levels were significantly decreased 48 h after CEA when compared to the level before the surgery. SBDP145 levels were significantly decreased 12h after the procedure and then remained at a similar level 48h after CEA.Conclusions: In patients with high-grade carotid artery stenosis SBDP120 and SBDP145 serum level decreases after an uncomplicated CEA, therefore alterations from this curve may be a marker of neurological complications after the procedure. Higher SBDP levels before the procedure may represent brain damage caused by chronic ischemia.

Introduction: Stroke is the second leading cause of disability and death worldwide. Carotid endarterectomy (CEA) reduces the incidence of ischemic stroke or death in patients with sympatomatic carotid artery stenosis more effectively than pharmacological therapy alone. Visinin-like protein 1 (VLP-1) is a potential marker of brain injury. An increased serum level of VLP-1 was observed in neurodegenerative diseases, ischemic stroke, and traumatic brain injury. Material and methods: The objective of the study was to report the changes in serum level concentrations of VLP-1 in patients undergoing CEA. The study group consisted of 22 patients with severe carotid artery stenosis, qualified to CEA. Serum levels of VLP-1 were measured by an enzyme-linked immunosorbent assay (ELISA) test at 24 h before CEA, 12 and 48 h after the surgery. Results: Serum VLP-1 levels were significantly reduced 48 h after CEA compared to the levels before and 12 h after surgery. Conclusions: VLP-1 serum level decreases after an uncomplicated CEA in patients with high-grade carotid artery stenosis. Alterations in this curve may be a marker of neurological events after the procedure. Higher VLP-1 baseline levels before CEA may reflect brain damage caused by chronic ischemia.

Background: Klippel–Trenaunay syndrome (KTS) is characterized by a triad of symptoms; varicose veins and venous malformations (VMs), capillary malformations (port-wine stain), and soft tissue and bone hypertrophy. Herein, we retrospectively studied six patients with KTS who underwent treatment with the Flebogrif system and evaluated their outcomes. Methods: Six KTS patients aged 16–22 years who had undergone 18 non-thermal ablations using the Flebogrif system were enrolled. All patients underwent multistage foam sclerotherapy with 3% polidocanol at 3–4-week intervals. Results: Venous clinical severity score (VCSS) analysis showed improvement in the patients’ clinical condition. All patients reported a significant improvement in aesthetic outcomes. One patient presented with recanalization of ablated marginal veins during the 24-month follow-up period. Patients could return to full activity within 7–10 days after the procedure. None of the patients experienced serious systemic complications. Conclusion: The use of the Flebogrif system in treating various forms of chronic venous insufficiency, including in patients with KTS, provides a high success rate with a high closure rate.

Podręcznik przybliża w kompletny oraz nowoczesny sposób najnowszą wiedzę i aktualne trendy postępowania diagnostyczno-terapeutycznego w chirurgii. W czterech tomach zawarto najświeższe informacje wzbogacone doświadczeniem własnym Autorów – uznanych ekspertów reprezentujących praktycznie wszystkie chirurgiczne dyscypliny zabiegowe. Bogaty materiał graficzny – prawie 1200 rycin – doskonale ilustruje omawiane zagadnienia. W książce przedstawiono wiadomości z zakresu chirurgii ogólnej, chirurgii stanów nagłych, podstaw chirurgii i skojarzonego leczenia nowotworów, wybranych dziedzin chirurgii, a także zasad kompleksowego, wielospecjalistycznego postępowania diagnostyczno-terapeutycznego. Najbardziej rozbudowaną częścią publikacji są rozdziały poświęcone chirurgii układów narządów z uwzględnieniem zasad tzw. chirurgii wielonarządowej i chirurgii wisceralnej. Nowością w polskim piśmiennictwie jest poruszenie problemów przywództwa czy nabywania tzw. umiejętności nietechnicznych, w tym umiejętności kierowania zespołami chirurgów, współpracy wielodyscyplinarnej czy krytycznego postępowania diagnostyczno-terapeutycznego opartego na zasadach EBM i GCP. Autorzy dołożyli starań, aby podręcznik dobrze spełniał swoją funkcję edukacyjną w szkoleniu podyplomowym absolwentów kierunku lekarskiego oraz rezydentów realizujących szkolenie specjalizacyjne w chirurgii i jednocześnie był pomocny w codziennej praktyce klinicznej. * Fragment (epub) * Fragment (mobi)

Objective:The human acellular vessel (HAV) was evaluated for surgical bypass in a phase II study. The primary results at 24 months after implantation have been reported, and the patients will be evaluated for ≤10 years. Methods:In the present report, we have described the 6-year results of a prospective, open-label, single-treatment arm, multicenter study. Patients with advanced peripheral artery disease (PAD) requiring above-the-knee femoropopliteal bypass surgery without available autologous graft options had undergone implantation with the HAV, a bioengineered human tissue replacement blood vessel. The patients who completed the 24-month primary portion of the study will be evaluated for ≤10 years after implantation. The present mid-term analysis was performed at the 6-year milestone (72 months) for patients followed up for 24 to 72 months. Results:HAVs were implanted in 20 patients at three sites in Poland. Seven patients had discontinued the study before completing the 2-year portion of the study: four after graft occlusion had occurred and three who had died of causes deemed unrelated to the conduit, with the HAV reported as functional at their last visit. The primary results at 24 months showed primary, primary assisted, and secondary patency rates of 58%, 58%, and 74%, respectively. One vessel had developed a pseudoaneurysm deemed possibly iatrogenic; no other signs of structural failure were reported. No rejections or infections of the HAV occurred, and no patient had required amputation of the implanted limb. Of the 20 patients, 13 had completed the primary portion of the study; however, 1 patient had died shortly after 24 months. Of the remaining 12 patients, 3 died of causes unrelated to the HAV. One patient had required thrombectomy twice, with secondary patency achieved. No other interventions were recorded between 24 and 72 months. At 72 months, five patients had a patent HAV, including four patients with primary patency. For the entire study population from day 1 to month 72, the overall primary, primary assisted, and secondary patency rate estimated using Kaplan-Meier analysis was 44%, 45%, and 60% respectively, with censoring for death. No patient had experienced rejection or infection of the HAV, and no patient had required amputation of the implanted limb. Conclusions:The infection-resistant, off-the-shelf HAV could provide a durable alternative conduit in the arterial circuit setting to restore the lower extremity blood supply in patients with PAD, with remodeling into the recipient's own vessel over time. The HAV is currently being evaluated in seven clinical trials to treat PAD, vascular trauma, and as a hemodialysis access conduit.

Chronic venous disease (CVD) is defined as any morphological and functional abnormalities of long duration manifested either by symptoms and/or signs indicating the need for investigation and/or care. The pathophysiological mechanism of CVD can be characterized by reflux, obstruction, or a combination of both, which leads to increased venous pressure. Compression therapy remains the gold standard of the conservative treatment of CVD in all stages. The possible forms of compression therapy are elastic stocking, non-elastic and elastic bandages, and intermittent pneumatic compression. Compression bandages have been proven to improve the healing of venous ulcers, in comparison with standard care without compression therapy. In the last years, inflammation has been shown to play an important role in the pathophysiology of CVD. The influence of the altered shear stress on the endothelial cells (EC) causes EC to release inflammatory molecules, chemokines, vasoactive agents, express selectins, and prothrombotic precursors such as ICAM-1, MCP-1, MIP 1β, VCAM, L-selectin, E-selectin, IL-1β, IL-4, IL-6, IL-8, IL-12p40, IL-13, G-CSF, GM-CSF, IFN-γ, TNF-α, MIP-1α. Several studies were performed to investigate the influence of compression therapy on the level of various inflammatory biomarkers in patients with CVD. In these studies level of the most inflammatory molecules, such as IL-1β, IL-6, IL-8, IL-12p40, G-CSF, GM-CSF, IFN-γ, TNF-α, VEGF, MMP 3, 8, 9 and TIMP-1 decreased after the therapy.

Endovascular aneurysm repair (EVAR) is a widely accepted alternative for open surgical repair (OSR) in the treatment of an abdominal aortic aneurysm (AAA). Meta-analyses of randomized controlled trials revealed significantly lower short-term mortality after EVAR procedure than OSR. From a technical point of view, proper sizing and selection of the stent-graft is very important. Most instructions for use (IFUs) of the current endo grafts recommend 10–20% oversizing concerning the preoperative aortic diameter. It can prevent endoleaks or subsequent complications such as displacement of the leg to the abdominal aneurysmal sac. In this paper, we present a case of a 64-year-old male with a history of abdominal aortic aneurysm with concomitant common iliac artery (CIA) aneurysm. The patient underwent endovascular implantation of bifurcated stent-graft with extension to the right common iliac artery. He was admitted to the Department of Vascular Surgery due to increasing pain in the right-lower abdomen. The analysis of the imaging examination and the symptoms of an increasing lower limb ischaemia caused by deformation of the stent-graft allowed deciding for an endovascular intervention involving the implantation of the iliac side branch device (IBD). Postoperative angiography confir med the correct location of the IBD with proper blood flow. After five days the patient was discharged home.

Introduction: Flebogrif® is the youngest representative of the MOCA treatment group. Its minimally invasive nature and high effectiveness contribute to its popularity. In the presented study, its effectiveness was assessed over a 36-month follow-up. Material and methods: Observations were conducted over a 36-month period as a prospective study. Two hundred patients meeting the established inclusion criteria were enrolled in the study, including 170 women aged 18 to 87, mean age 56 years, and 30 men, age 23 to 75, mean age 46 years. The obtained numerical data were statistically analysed using tests for variables with nonparametric distribution: Wilcoxon test and Friedman’s ANOVA. The follow-up visits were scheduled as follows: baseline, 1, and 4 weeks and 3, 6, 12, 24, and 36 months. Numerical data were collected based on the assessment validation of venous clinical severity score (VCSS) and visual analogue scale (VAS). Ultrasound evaluation was performed to assess the anatomical effectiveness of the procedure. The safety of the method was assessed in terms of the severity and number of complications. Results: Based on the VCSS and VAS scale assessment, a statistically significant decrease in the intensity of clinical symptoms was observed both between monitoring visits and in relation to the baseline. One case of deep vein thrombosis (0.5%), 1 prolongated pain, 35 thrombophlebitis, and 28 discolourations (32%) were reported. The 12-month success rate dropped to 92% and remained there until 36 months. Conclusions: A high success rate of 92% was achieved, which is comparable with other methods currently used in the ablation of insufficient superficial veins. High safety of the method and low number of complications is expressed. Good cosmetic effect. A quick return to previous physical activity is an additional incentive for its use.

Introduction: Endarterectomy of the internal carotid artery (CEA) plays an important role in the prevention of cerebral ischemic stroke; however, this surgical procedure may cause neurological complications. The aim of this study was to evaluate changes in serum levels of the oxidative stress marker peroxiredoxin-1 (PRDX1) in patients undergoing CEA. Material and methods: Twenty-four patients undergoing endarterectomy for critical stenosis of the internal carotid artery participated in the study. Blood for testing was collected before CEA and twice after surgery. PRDX1 was determined by ELISA. Results: The timing of blood sampling did not affect PRDX1 levels (p > 0.05). There was no statistically significant difference in serum PRDX1 levels between male and female groups and depending on the age of the patients (p > 0.05). Conclusion: PRDX1 cannot be considered as a marker of neurological complications after CEA.

Introduction: Endarterectomy of the internal carotid artery (CEA) is a surgical procedure used to prevent cerebral ischemic stroke. Available data from previous literature indicates that CEA may lead to complications in the form of cerebral ischemia-reperfusion syndrome and oxidative stress. The aim of this study was to evaluate the serum levels of oxidative stress-related biomarkers such as 8-hydroxydeoxyguanosine (8-OHdG) and malondialdehyde (MDA) in patients who underwent CEA. Material and methods: Twenty-four patients with severe internal carotid artery stenosis participated in the study. Serum samples were taken from patients at three different times: within 24 hours preoperatively to CEA, 12 hours postoperatively, and 48 hours postoperatively. Serum 8-OHdG and MDA levels were measured using a commercially available enzyme-linked immunosorbent assay. Results: Serum 8-OHdG levels indicated statistically significant elevation 12 hours after surgery when compared to preoperative levels (p < 0.05). A further increase in the concentration of this parameter was observed 48 hours after surgery when compared to the previous measurement, however, this increase was no longer statistically significant (p = 0.05). Furthermore, serum MDA levels also indicated a statistically significant elevation 48 hours after surgery when compared to preoperative levels (p < 0.05). Conclusion: Our study showed that CEA causes an increase in blood levels of 8-OHdG and MDA, which may be related to the occurrence of oxidative stress during cerebral ischemia-reperfusion injury. Therefore, 8-OHdG and MDA may represent corresponding markers of cerebral ischemia-reperfusion complications in patients undergoing CEA.

Introduction: Internal carotid artery (ICA) stenosis in a majority is caused by atherosclerotic plaque. Symptoms of ICA stenosis manifest most likely a transient ischemic attack (TIA). The dynamics of ICA stenosis progression is unpredictable, the disease may progress quickly or slowly or remain stable for many years. The method of treatment implemented also depends on it. The task of pharmacological treatment is to reduce the progression of the disease and protect against the onset of stroke. Among the invasive methods of treating ICA stenosis, the standard procedure is endarterectomy of a carotid artery (CEA), i.e. surgical removal of atherosclerotic plaque. Another method of treatment is endovascular carotid artery stenting (CAS). CAS should be considered especially in the case of re-operated patients, also after radiotherapy and tracheostomy. CAS is a less invasive procedure, it avoids complications typical for CEA such as cranial nerve palsy or complications at the site of the wound. On the other hand, the risk of postoperative ischemic stroke is greater in the case of CAS. In recent years, the improved CAS method seems to be the implantation of dual-layered mesh-covered carotid stent systems (DLS). Case report: We present the case of a 69 old man, long-term smoker, with hypertension and coronary heart disease. In 2001 diagnosed with larynx cancer and underwent surgical laryngectomy and radiotherapy. He was admitted in scheduled mode due to symptomatic carotid artery stenosis. In USG examination there was visible stenosis of the right internal carotid artery (80%) caused by an unstable atherosclerotic plaque with irregular structure and thrombotic clots. Due to the obvious difficulties of performing endarterectomy following radiotherapy in the neck area and laryngectomy, the endovascular method has been considered. In spite of the unstable plaque, which is a contraindication to perform the endovascular procedures CAS has been decided to perform. The patient underwent implantation of a dual-layered carotid stent in the combination with proximal balloon occlusion protection with a MoMa device. After procedure arteriography confirmed the optimization of the carotid artery flow and the correct position of the stent. The treatment was carried out without complications. After a few days of hospitalization, the patient was discharged home. Discussion: The method of treatment of internal carotid artery stenosis is selected taking into consideration morphology and localization of atherosclerotic plaque, anatomical conditions and the local condition of the surgical area as well as the general condition of the patient and coexisting diseases. On the one hand, the patient underwent cervical radiotherapy and laryngectomy which are contraindications for CEA. On the other hand, an atherosclerotic plaque was unstable with the features of stratification which is a contraindication to the performance of CAS. In the described case it was decided to make implantation of dual-layered carotid stent system (DLS) connected with proximal balloon occlusion protection with a MoMa device allowed to reduce the risk of embolization.

Introduction: Abdominal aortic aneurysm (AAA) is a disease exceptionally well suited to screening. Ultrasound-based screening meets all criteria for a screening program according to the WHO, and there is a large evidence supporting its usefulness. Risk factors, mentioned in the available literature, associated with aneurysm formation are advanced age, male gender, tobacco smoking, hypertension, atherosclerotic disease and family or personal history of aortic aneurysms. The aim of the study was to evaluate the incidence of abdominal aortic aneurysms in the population of men and women older than 65 years, in Lublin, Poland and to identify the correlation between risk factors and the AAA incidence. Material and methods: A single-center screening study, for men and women older than 65-years was conducted in Lublin, Poland in May 2018. Patients underwent basic screening ultrasound with measurement of the diameter of abdominal aorta and iliac arteries. Each patient completed anonymous questionnaire to investigate risk factors of developing AAA. Results: 1032 patients, aged 65-91 (median age 71.37) were examined. 569 of them were women and 463 men. 27 aortic aneurysms were detected - 7 in a group of women and 20 in a group of men. The total incidence rate of AAA in our study was 2.62%; 1,23% in women and 4,32% in men. Male gender, cigarette smoking, coronary artery disease and a history of myocardial infarction all appeared to be major risk factors of AAA, with relative risk ranging from 2,75 to 4.53. The median diameter of the abdominal aorta was 19.24 mm and varied in groups of patients with different risk factors. Conclusions: The estimated prevalence of AAA in the screened population is within the range of the values reported in previous publications, however, it may confirm a trend of declining prevalence of AAA showed in some recent studies. The presented study confirms the correlation between the AAA and its major risk factors (male sex, smoking cigarettes, coronary artery disease and history of myocardial infarct) as well as a weak association between AAA and hypertension and a negative correlation with diabetes.

Introduction: Carotid endarterectomy (CEA) is a surgical procedure used in the prevention of ischemic stroke. However, this procedure can cause complications of ischemia-reperfusion injury to the brain. Clusterin (CLU) is a cytoprotective chaperone protein that is released from neurons in response to various neurological injuries. The objective of the study was to report the changes in serum CLU concentrations of patients undergoing CEA. Materials and methods: The study involved 25 patients with severe internal carotid artery stenosis. Serum samples were taken from patients at three different times: within 24 hours preoperatively to CEA, 12 hours postoperatively, and 48 hours postoperatively. Serum CLU concentrations were measured using a commercially available enzyme-linked immunosorbent assay. Results: When compared to concentrations preoperatively, the serum CLU concentration initially decreased during the 12 hours following CEA. However, 48 hours following the procedure there was an increase in the CLU concentration. After statistical analysis, differences were detected in serum CLU concentration between all three recorded measurements (P < 0.05). Conclusion: Data from our study indicate that serum CLU concentrations are affected after CEA. We hypothesize that serum CLU concentrations may depend on brain ischemia-reperfusion injury following this surgical procedure.

Introduction: Deep vein thrombosis (DVT) is a condition in which a blood clot forms in one of the body's deep veins, most commonly of the leg or pelvis. Before the fourth decade of life risk of DVT is low (about 1 per 10000). After the age of 45, it rises and approaches about 5 per 1000 by the age of 80. Noteworthy is the fact, that patients with a positive family history have a higher risk of DVT at a young age. Essential risk factors for developing DVT are genetic conditions or acquired thrombophilia and positive family history, but the lack of family predisposition cannot rule out the occurrence of DVT. Standard treatment method of DVT involves intravenous anticoagulation with the use of low molecular weight heparin and compression therapy. Apart from the above-mentioned methods, we can distinguish intermittent pneumatic compression, surgical embolectomy, pharmacomechanical thrombectomy, and venous stenting. Case Report: We present a case report of 19 - year old patient who was first admitted to hospital in April 2017 urgently with symptoms of pulmonary embolism which was confirmed in angio-CT. Moreover, in the Doppler ultrasound, left common iliac vein (LCIV), left external iliac vein (LEIV) and left femoral vein (LFV) thrombosis was diagnosed. During the hospitalization, genetic tests, antibody levels, and antithrombin levels were performed for thrombophilia and systemic diseases conducive to thrombosis. In October 2017 the angio-MR of the pelvis confirmed visible pressure on the LCIV, caused by the common iliac artery, which corresponds to the May-Turner syndrome. In March 2018 he was admitted to the clinic with DVT symptoms of the left lower limb such as swelling, pain, and redness. The patient underwent venous angioplasty and stent implantation for LCIV. The patient was discharged from hospital with recommendations such as compression therapy, Doppler ultrasonography and monitoring of INR. Discussion: Venous thrombosis is a multicausal disease: more than one risk factor needs to be present before thrombosis occurs. Choice of DVT treatment method is aimed at improving the quality of life of patients depending on clinical symptoms. venous stenting for an iliofemoral occlusive disease is a safe and effective method of treatment. It can be done with excellent patency rates expected in cases of idiopathic occlusion and May-Thurner syndrome. On this basis, the legitimacy of using venous stent implantation as an effective method of treatment of recurrent DVT episodes can be confirmed, which has been used in the described case.

The infection of a vascular prosthesis is potentially fatal, and its effective treatment still remains the greatest challenge for vascular surgeons. We present our initial experience using bovine pericardial vascular prostheses to replace infected aortoiliac vascular grafts. Six consecutive patients with infection of the graft were prospectively included in this study. Infection of the vascular graft was confirmed by clinical symptoms, laboratory tests and the results of computed tomography and positron emission tomography/computed tomography. In all cases, the infected aortoiliac graft was surgically removed and replaced by the bovine—pericardial BioIntegral aortic‐bifemoral prosthesis. Technical success was achieved in every case with no in‐hospital or 30 days mortality. One patient required revision of distal anastomosis due to recurrent bleeding at day four after surgery. One patient presented with upper gastrointestinal tract bleeding during the postoperative period, which was managed endoscopically. The mean hospital stay was 14 days (range 9‐19). The control CT scan performed 2 months after surgery showed significant regression of abscesses and periprosthetic inflammation. Two patients died within 32 months of follow‐up: one due to heart attack, the other due to generalized sepsis, which was correlated with the previous infection. Four patients are still in follow‐up. The BioIntegral prosthesis is patent in all four cases, with no clinical or ultrasonographic signs of infection. Our brief investigation shows that a bovine pericardial prosthesis may be a valuable option in the treatment of vascular grafts infections.

Introduction: Peripheral artery disease (PAD) is an atherosclerotic vascular disease that results in obstruction of blood flow in the arteries other than those in the coronary circulation. PAD is often located in lower extremities, with patients presenting symptoms of intermittent claudication or critical lower limb ischemia. Angioplasty and stent implantation are often used in the treatment of PAD. Although these methods are considered as a low invasive and low risk, some factors may limit stent patency in the future. The fracture of the implanted stent may be one of these. Case report: A 68 old man, long-term smoker, with a history of chronic limb ischemia and many vascular surgeries because of PAD was admitted to the hospital with symptoms of the acute limb ischemia. Angiography showed a fracture of the stent implanted during the earlier hospitalization, with a fragment displacement to the left external iliac artery. The patient was successfully treated with catheter-directed thrombolysis. Discussion: Stent fracture is usually asymptomatic, however, it may cause complications, such as restenosis, pseudoaneurysm, perforation of the vessel, and in-stent embolism. The cumulative incidence of the femoropopliteal stent fracture varies from 2 to 65% in several studies. Incidence increases with stent length and is significantly lower in the second generation of nitinol stents, that was designed to have enhanced flexibility and durability.

Introduction: The aim of the study was to evaluate the efficacy of the endovascular ablation method of GSV/ /SSV superficial venous insufficiency using Flebogrif® catheter, the safety of the method, expressed in number and quality of observed complications in 24-month observation. Material and methods: Initially, the observed group included 200 patients undergoing ablation of insufficient GSV/SSV. During 24 months of observation, this number decreased to 158, which seems to be a natural process. All patients signed the informed consent form approved by the Bioethics Committee of the Medical University of Lublin. Based on clinical evaluation, including ultrasound assessment, 200 patients, including 170 women and 30 men, were admitted to the study using the adopted criteria of inclusion/exclusion. In the studied group of patients, 172 great saphenous veins (GSV) and 28 short saphenous veins (SSV) were ablated. The treated inefficient veins were punctured at three levels depending on the length of the segment of insufficient GSV/SSV. Each patient was treated with a compression agent in the form of a second compression class elastic stockings (20–30 mm Hg). Control visits on the basis of the accepted protocol were established in 1, 3, 6, 12, 24, 36 months after the procedure. Results: During 24 months of observation, the evaluation of the Flebogrif® catheter method was based on the analysis of results obtained in four categories: effectiveness of the method, expressed as the ratio of the number of successfully closed veins ablated with the Flebogrif® catheter to the number of observed cases of recanalization; clinical improvement of venous insufficiency symptoms, based on the VCSS, CEAP, VAPS scale; safety of the method, expressed in terms of quantity and quality of observed complications; technical characteristics of the method. The obtained results were analyzed statistically using tests for non-parametric variables. The effectiveness of the method based on the obtained results was 92%. A statistically significant decrease in the intensity of clinical symptoms in relation to the preoperative condition was observed. The number and quality of the observed complications allow considering the procedure of vein ablation with the use of Flebogrif® catheter as safe, possible to perform in ambulatory conditions. Conclusions: Effectiveness of the method of 92% in 24-month observation; good cosmetic effect; a statistically significant decrease in the intensity of clinical symptoms in 24-month observation; the low incidence of complications allows to consider the method safe; the method of surgery allows to perform the procedure in ambulatory conditions.