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P26 Plasma endothelin levels in patients with abdominal aortic aneurysms
23rd World congress of the International
Society for Cardiovascular
Surgery
or without thoracotomy was performed in 18 patients. Additional renal artery reconstruction was required in 6 and inferior mesenteric artery in 33 patients. We have used concomitant epidural spinal cord analgesia in 37 patients in operative time and postoperative period, blood autotransfusion by Cell Saver system in 24 patients, aprotinin in reducing bleeding in all patients. There was no operative mortality in group with retroperitoneal approach. The indications for extended left flank retroperitoneal approach is: multiple previons intraabdominal operations, large or inflammatory aneurysms; horsehoe kidnei, significant cardiopulmonal insufficiency, repeat aortic procedures. The analysis shows that this technique represents real progress in the surgical treatment of aneurysms.
nary heart disease and hypertension were the leading risk factors in 74 (66,7%) and 47 (42,3%) patients. The computed tomography (CT) and ultrasound imaging (USG) were used for evaluation of AAA, both in asymptomatic and symptomatic patients. Digital subtraction angiography was used only in patients with concomitant peripheral arterial occlusive disease. The elective mortality rate was 3,6%. The death rate with operations for intact symptomatic aneurysms was 20% and for ruptured AAAs was 47,2%. Mortality of symptomatic and ruptured AAA remains commonly high. The prompt, exact diagnosis and the urgent management are the main conditions for the lowering of the high mortality in these patients. The screening program in the risk groups of patients is an important factor for early detection and treatment of AAA.
P24 Treatment of Vena lava Thrombosis: Surgical Outcome P.L. GIORGETTI, E.M. BORTOLANA I/; TOLVA, P.L. VANDONE, G.F. GIUFFRIDA, S. TRIMARCHI, U. RUBERTI, Milan, Italy
P26 Plasma Endothelin Levels in Patients with Abdominal Aortic Aneurysms V. T&&A, J. VALENTA, 0. TOPOLcm, J. KOCOVA, Z. CHUDA’EEK L. PECEN, Pkefi, Czech Republic
Inferior vena cava thrombosis is generally treated with medical therapy. In selected cases when pulmonary embolism is present or impending, surgical therapy could be considered. Venous thrombectomy as a treatment of deep venous thrombosis is discussed controversial. Indication for surgical treatment is an extensive acute deep vein thrombosis with clinical symptoms of less than 7 days. Goal of therapy is prevention of pulmonary embolism and postphlebitic syndrome. When floating thrombus is diagnosticated surgical treatment must always be considered. Clinical evaluation is important to define terms for therapy. We surgically treated 36 patients for deep venous thrombosis (DVT) from Jan 1986 to Dee 1995. We evaluated time appearance of symptoms, diagnostic iter, risk factor, operatory (30 gg.) morbidity and mortality. In 17 caseswe associated ileocaval thrombectomy with positioning of DeWeese clips. All patients were dismessed with anticoagulant therapy and controlled with angiodinographic technics in a period from 3 to 24 months after surgery.
P25 Abdominal Aortic Aneurysms - Still Challenge for surgeons V. f&k4, J. VALENTA, J. Bk.EKj iv. CECHUM, J. SIMANA Between 1992 and 1996, a total of 111 patients were operated on for abdominal aortic aneurysms @AA) at the Department of Surgery, University Hospital in Plzeii, Czech Republic. The average age of patients was 67,9 years (44-91). The diameter of AAA was greater than 5 cm. Sixty (54,1%) asymptomatic patients were treated electively, 15 (13,5%) symptomatic patients underwent emergent and 36 (32,4%) patients with rupture urgent operation. The coroS16
The plasma endothelin (ET 1,2) levels were evaluated in One hundred and thirty seven patients with small ( < 5 cm), large (> 5 cm), asymptomatic and symptomatic abdominal aortic aneurysms (AAA). The average age of patients was 64,3 years (43-88). As the control group authors examined 60 patients with lower extremity ischemia and 20 patients who were hospitalised for elective hernia repair. The average age of the both groups of patients was 62,4 years (40-83). The highest plasma ET 1,2 levels were in patients with symptomatic (21,6 k 8,4 pmol/l) and large AAA (20,7 f 10,4 pmol/l). The plasma ET 1,2 levels in patients without the symptoms of atherosclerosis (hernia repair group) were 5,8 + 4,6 pmol/l and in patients with lower extremity ischemia were 18,5 + 10,3 pmol/l. Plasma ET 1,2 levels were statistically significantly higher in patients with AAA in comparison with the population without manifestation of atherosclerosis (p I 0,001). The statistical significance was also seen between plasma ET 1,2 levels in patients with small and large AAA (p I 0,05). No statistical significance was found between AAA group and group of patients with lower extremity &hernia. Plasma ET 1,2 level could be a plasma marker for AAA and lower extremity ischemia development on the basis of the progression of atherosclerosis in arterial lumen. But the further and larger studies are needed for the confirmation of such hypothesis.
P27 Is the Small Aneurysm Indication for Immediate Operation? VUKOBRATOVC: A_vRAMOVS, PFAUJ, HORVAT Z, POPOJW v VUCAJ V, Novi Sad, Yugoslavia CARDIOVASCULAR
SURGERY
SEPTEMBER
1997
Society for Cardiovascular
Surgery
or without thoracotomy was performed in 18 patients. Additional renal artery reconstruction was required in 6 and inferior mesenteric artery in 33 patients. We have used concomitant epidural spinal cord analgesia in 37 patients in operative time and postoperative period, blood autotransfusion by Cell Saver system in 24 patients, aprotinin in reducing bleeding in all patients. There was no operative mortality in group with retroperitoneal approach. The indications for extended left flank retroperitoneal approach is: multiple previons intraabdominal operations, large or inflammatory aneurysms; horsehoe kidnei, significant cardiopulmonal insufficiency, repeat aortic procedures. The analysis shows that this technique represents real progress in the surgical treatment of aneurysms.
nary heart disease and hypertension were the leading risk factors in 74 (66,7%) and 47 (42,3%) patients. The computed tomography (CT) and ultrasound imaging (USG) were used for evaluation of AAA, both in asymptomatic and symptomatic patients. Digital subtraction angiography was used only in patients with concomitant peripheral arterial occlusive disease. The elective mortality rate was 3,6%. The death rate with operations for intact symptomatic aneurysms was 20% and for ruptured AAAs was 47,2%. Mortality of symptomatic and ruptured AAA remains commonly high. The prompt, exact diagnosis and the urgent management are the main conditions for the lowering of the high mortality in these patients. The screening program in the risk groups of patients is an important factor for early detection and treatment of AAA.
P24 Treatment of Vena lava Thrombosis: Surgical Outcome P.L. GIORGETTI, E.M. BORTOLANA I/; TOLVA, P.L. VANDONE, G.F. GIUFFRIDA, S. TRIMARCHI, U. RUBERTI, Milan, Italy
P26 Plasma Endothelin Levels in Patients with Abdominal Aortic Aneurysms V. T&&A, J. VALENTA, 0. TOPOLcm, J. KOCOVA, Z. CHUDA’EEK L. PECEN, Pkefi, Czech Republic
Inferior vena cava thrombosis is generally treated with medical therapy. In selected cases when pulmonary embolism is present or impending, surgical therapy could be considered. Venous thrombectomy as a treatment of deep venous thrombosis is discussed controversial. Indication for surgical treatment is an extensive acute deep vein thrombosis with clinical symptoms of less than 7 days. Goal of therapy is prevention of pulmonary embolism and postphlebitic syndrome. When floating thrombus is diagnosticated surgical treatment must always be considered. Clinical evaluation is important to define terms for therapy. We surgically treated 36 patients for deep venous thrombosis (DVT) from Jan 1986 to Dee 1995. We evaluated time appearance of symptoms, diagnostic iter, risk factor, operatory (30 gg.) morbidity and mortality. In 17 caseswe associated ileocaval thrombectomy with positioning of DeWeese clips. All patients were dismessed with anticoagulant therapy and controlled with angiodinographic technics in a period from 3 to 24 months after surgery.
P25 Abdominal Aortic Aneurysms - Still Challenge for surgeons V. f&k4, J. VALENTA, J. Bk.EKj iv. CECHUM, J. SIMANA Between 1992 and 1996, a total of 111 patients were operated on for abdominal aortic aneurysms @AA) at the Department of Surgery, University Hospital in Plzeii, Czech Republic. The average age of patients was 67,9 years (44-91). The diameter of AAA was greater than 5 cm. Sixty (54,1%) asymptomatic patients were treated electively, 15 (13,5%) symptomatic patients underwent emergent and 36 (32,4%) patients with rupture urgent operation. The coroS16
The plasma endothelin (ET 1,2) levels were evaluated in One hundred and thirty seven patients with small ( < 5 cm), large (> 5 cm), asymptomatic and symptomatic abdominal aortic aneurysms (AAA). The average age of patients was 64,3 years (43-88). As the control group authors examined 60 patients with lower extremity ischemia and 20 patients who were hospitalised for elective hernia repair. The average age of the both groups of patients was 62,4 years (40-83). The highest plasma ET 1,2 levels were in patients with symptomatic (21,6 k 8,4 pmol/l) and large AAA (20,7 f 10,4 pmol/l). The plasma ET 1,2 levels in patients without the symptoms of atherosclerosis (hernia repair group) were 5,8 + 4,6 pmol/l and in patients with lower extremity ischemia were 18,5 + 10,3 pmol/l. Plasma ET 1,2 levels were statistically significantly higher in patients with AAA in comparison with the population without manifestation of atherosclerosis (p I 0,001). The statistical significance was also seen between plasma ET 1,2 levels in patients with small and large AAA (p I 0,05). No statistical significance was found between AAA group and group of patients with lower extremity &hernia. Plasma ET 1,2 level could be a plasma marker for AAA and lower extremity ischemia development on the basis of the progression of atherosclerosis in arterial lumen. But the further and larger studies are needed for the confirmation of such hypothesis.
P27 Is the Small Aneurysm Indication for Immediate Operation? VUKOBRATOVC: A_vRAMOVS, PFAUJ, HORVAT Z, POPOJW v VUCAJ V, Novi Sad, Yugoslavia CARDIOVASCULAR
SURGERY
SEPTEMBER
1997