Opulskis, Donatas

Introduction: Primary aortic malignancy is a very rare pathology, with only 190 cases of aortic tumors reported in the literature to date. Usually, symptoms are insidious and nonspecific, so the disease is diagnosed at an advanced stage. Objective: Here, we present a case report of a primary malignant tumor of the aorta. In our case, the diagnosis was established using computed tomography angiography (CTA) and biopsy of indeterminate masses obtained during aortography. Methods: The patient underwent surgical resection of the affected aortic segment along with a tumor. Histopathological examination revealed the diagnosis of a primary malignant tumor of the aorta - angiosarcoma. Postoperatively, patient received adjuvant chemotherapy according to the standard treatment regimen for sarcoma. Results: One month later, postoperative CT of a chest, abdomen and pelvis was performed, revealing no evidence of metastases or pathological lymph nodes in the examined areas. Conclusion: Combined surgical and systemic therapies may improve overall survival.

Objective: We present the case of a 58-year-old male patient referred to our department from a smaller facility for further evaluation and treatment strategy regarding the choice between open or endovascular surgery. The patient was diagnosed with a 6 cm asymptomatic juxtarenal aortic aneurysm and a 5 mm diameter accessory renal artery (ARA) supplying the lower half of left kidney. Further diagnostic assessments indicated that the left ARA was perfusing over 40% of the left kidney. Methods: Given the patient’s significant pre-existing medical conditions and elevated perioperative risk, the decision was made to proceed with minimally invasive endovascular surgery using a custom-made 5-branches stent graft (BEVAR). Results: In the early postoperative period, the patient reported left flank pain. A subsequent CT scan identified a partial infarction in the left kidney due to the occlusion of an early small branch from the upper left renal artery. However, laboratory results showed no significant change in renal function compared to preoperative values. The patient was discharged 6 days post-surgery, with no additional complications observed during the early postoperative period. Conclusion: This case report demonstrates that BEVAR is acceptable technique with satisfactory early postoperative outcomes for treating juxtarenal aortic aneurysms with an accessory renal artery in patients who are high-risk candidates for open repair and anatomically unsuitable for FEVAR or Ch-EVAR procedures.

Introduction Double aortic arch is the most frequent type of vascular ring malformation. The condition involves surrounded and compressed trachea and/or esophagus. Depending on the tracheal or esophageal compression, patients may experience symptoms like respiratory failure, cyanosis, asthma-like symptoms, dysphagia and other [1]. Case Presentation A 31 year-old female patient sought medical attention due to difficulty breathing during physical exercise. Over the past year she has experienced increased general weakness and reported several episodes of syncope, which she attributed to general weakness and previous pregnancy. A chest CT scan was performed for further evaluation, which revealed significant localized stenosis in the lower third of the trachea due to external compression. A CTA was performed, which revealed a dominant right aortic arch. This vascular anomaly formed a ring causing significant tracheal stenosis. Multidisciplinary Heart Team meeting concluded that surgical intervention was indicated. In the early postoperative period, the patient was presented with a markedly hoarse and weak voice. After otorhinolaryngological evaluation the partial bilateral vocal fold paralysis and laryngeal dysfunction were identified. These findings indicated the need for immediate treatment. After hospitalization period of 15 days no additional complications were observed, the patient was deemed stable and discharged from the hospital. Discussion The exact incidence of double aortic arch is generally unknown, though vascular rings are estimated to have a prevalence of about 1%. Up to 12.6% of cases present with an associated cardiac condition, such as ventricular septal defect, tetralogy of Fallot or other congenital heart defects [2]. Both endovascular and open-heart surgery is available depending on additional defects. The primary aim of the traditional open-heart surgery is the division of the vascular ring by dividing and ligating the non-dominant aortic arch [3,4,5]. Conclusions Double aortic arch is an uncommon congenital vascular malformation, especially in adulthood. It is unique for being frequently misdiagnosed in later years of life. Our case depicts the quintessence of accurate differential diagnosis, proper diagnostic methods, and timely surgical treatment to avoid possible complications.

Introduction. Endovascular aortic repair is frequently employed to treat juxtarenal aortic aneurysms, demonstrating positive early and midterm results [1]. The decision to perform endovascular surgery primarily depends on the patient's comorbidities and age. However, the presence of an accessory renal artery (ARA), which occurs in up to one-third of patients, can restrict the suitability of endovascular treatment and often requires conventional open surgical repair [2,3]. Case report. A 58-year-old male patient was referred to the Department of Vascular Surgery at St. Franziskus Hospital, Munster from a smaller facility for further evaluation and treatment tactics regarding whether to proceed with open or endovascular surgery for an asymptomatic aortic aneurysm that was detected. After conducting a duplex ultrasound scan and a CTA, it was revealed that the patient has a 6 cm juxtarenal aortic aneurysm (JAAA) and an accessory renal artery (ARA) > 5 cm on the left kidney. Because of multiple comorbidities, the patient was deemed unfit for open surgery. Moreover, because of the double left renal arteries it was decided to perform BEVAR procedure with a 5-branch custom-made stent graft with a shorter proximal sealing zone to avoid spinal cord ischemia. In the early postoperative period, the patient reported experiencing pain in the left flank. A CT scan revealed a partial infarct in the left kidney, but laboratory results indicated no significant impact on kidney function. Discussion. Juxtarenal aneurysms are primarily treated through open surgery or endovascular methods fenestrated endovascular aortic repair and chimney evar (FEVAR, Ch-EVAR). While FEVAR generally shows slightly better outcomes in terms of target vessel patency, BEVAR can be a viable alternative when the mentioned treatments are unsuitable for a patient. However, further studies are necessary to achieve satisfactory treatment outcomes. Conclusions. BEVAR seems to be a feasible option for treating juxtarenal aneurysms in patients who are not good candidates for open repair, and for whom repair FEVAR procedure is not suitable due to anatomical reasons.

Introduction. Ischemic colitis (IC) is described as an inflammation which is caused by lack of blood flow through supplying arteries to intestines. Atherosclerosis is described as a predominant cause. The condition is commonly seen for patients aged 60 to 70 years. To minimize morbidity and mortality it is critical to identify the IC early. Case report. 65-years-old women was hospitalized in the LUHS hospital Kaunas Clinics, Department of Gastroenterology due to exacerbation of Crohn’s disease. Ischemic colitis was clinically suspected. Abdomen CT scan showed celiac artery (CA) compression and superior mesenteric artery (SMA) occlusion due to atherosclerotic lesion. Patient was referred toDepartment of Vascular surgery for revascularization of these arteries. Aorto-mesenterichepatic bifurcated Dacron bypass was formed. Early postoperative period had gone without any major complications and the blood flow was restored, which was confirmed by a CTA scan. Nevertheless, the patient died of complications from sepsis. Discussion. Open surgical approach in the treatment of multiple visceral artery lesions is challenging and always requires multidisciplinary team to achieve sufficient treatment results. Conclusions. Due to the low incidence rate of CA compression with the concomitant SMA occlusion, there is a paucity of reliable data which can be followed to achieve adequate results. All cases must be assessed on an individual basis. Multidisciplinary team is necessary to achieve good treatment results.

In vivo dosimetry involves the assessment of external irradiation doses to cancer patients with the aim to ensure high precision and accuracy in dose planning and delivery during radiotherapy procedure. In vivo dosimetry can also be used for the estimation of uncertainties that may occur during radiotherapy treatment and for prevention against systematic errorsand undesirable exposure. Implementation of in vivo dosimetry during irradiation can assist in detecting of doses that exceed the limits or are insufficient to treat the cancer according to the prepared dose plan. However, the availability of the various in vivo dosimetry systems remains is limited. This is partially related to the needs for the new installations of doserecording and dose verification systems and the general belief in the usefulness of these systems in detecting patient set-up errors, as well as beam energy, treatment accessory and geometry errors. Despite of this, implementation of in vivo dosimetry systems is ongoing and is seen as a crucial part of a radiation safety system in radiotherapy department […].