Velička, Linas

To evaluate the safety and efficacy of Total Endovenous Laser Ablation (TEVLA) in a multicenter cohort.

Įvadas ir tikslas: Šiame retrospektyviniame tyrime analizuotos paveldimos jungiamojo audinio ligos, kurios lemia aortos išsiplėtimą, atsisluoksniavimą ir kitų arterijų pažeidimus. Pacientai, turintys aortos patologiją, pagal genetinio ištyrimo rezultatą suskirstyti į patogeninių/tikėtinai patogeninių genų variantų (1 grupė, n = 20), nežinomos klinikinės reikšmės variantų (2 grupė, n = 20) ir nenustatytų patogeninių genų pokyčių (kontrolinė, n = 54) grupes. Tyrimo tikslas - įvertinti genotipo sąsajas su ligos eiga ir gydymo išeitimis, esant aortos aneurizmai ir atsisluoksniavimui. Rezultatai: Tiriamųjų kohortą sudarė 64 vyrai ir 30 moterų. Amžius tarp lyčių reikšmingai nesiskyrė (55,3 ir 57,0 metai), tačiau 1 grupės pacientai buvo jaunesni nei kontrolinės (47,5 ir 60,5 metų; p < 0,001). Amžiaus mediana iki pirmos aortos operacijos buvo 29,5 (17–40) metų 1 grupėje, 47,5 (35–56) 2 grupėje ir 51,5 (44–62) kontrolinėje. Reikšmingas skirtumas nustatytas tik tarp 1 ir kontrolinės grupių (p < 0,001). Šeiminė aortos įvykių anamnezė buvo nepriklausomai susijusi su ankstyvesne aortos intervencija (HR 2,76; 95 % PI 1,36–5,59; p = 0,005), o lytis reikšmingos įtakos neturėjo. Pakartotinės intervencijos buvo dažnesnės 1 grupėje (35,0 % vs. 14,9 %), tačiau skirtumas nepasiekė statistinio reikšmingumo (p = 0,056). Bendro išgyvenamumo analizė parodė statistiškai reikšmingą skirtumą tarp grupių (p = 0,030), tačiau dėl mažo įvykių skaičiaus (n = 3) rezultatų interpretacija yra ribota. Išvados: Patogeniniai genų variantai ir šeiminė aortos įvykių anamnezė buvo susijusi su ankstyvesne aortos intervencija. Tai pabrėžia, kad integruotas genetinių duomenų ir klinikinių veiksnių vertinimas yra svarbus tikslesniam pacientų rizikos įvertinimui ir stebėjimo bei gydymo taktikos planavimui.

Background. A significant numbers of patients undergo Carotid Endarterectomy (CEA) experience cognitive chan- ges in the early postoperative period. The middle cerebral artery (MCA) is susceptible to fluctuations in blood flow velocity (BFV) changes during carotid cross-clamping. BFV can be measured in real time using Transcranial Dopp- ler (TCD) ultrasonography. Postoperative hypoperfusion syndrome is a proven risk factor for delayed neurocognitive recovery (dNCR), intraoperative reductions in cerebral blood flow velocity may contribute to postoperative cogni- tive decline. Aim. The aim of this study was to evaluate the association between MCA BFV fluctuations and delayed neurocogni- tive recovery and identify risk factors for dNCR. Methods. 27 patients without prior neurocognitive disor- ders undergoing CEA in LUHS Hospital, Kaunas Clinics, were enrolled in the study. Adenbrooke cognitive testing was performed prior to surgery and 1 day after surgery. TCD ultrasonography was performed 1 day before surgery and during CEA. Results. 21 patients were examined; 15 (71.4%) male. Ac- cording to the ACE-III test results, patients were divided into two groups: with dNCR (dNCR group) and without dNCR (non-dNCR group). dNCR developed for seven pa- tients (33.3%). ACM BFV was consistently higher in the postoperative dNCR group, with a statistically significant difference observed before carotid cross-clamping (median [min–max]: 43.1 [11.2–75.1] vs 26.4 [11.9–40.0] cm/s; p = 0.043). No statistically significant differences were ob- served at the remaining time points (p < 0.05). Bias-re- duced logistic regression showed that preoperative cogni- tive impairment was the dominant predictor of postoperative dNCR (penalised â » +3.8). In models exclud- ing preoperative cognitive impairment, preoperative demen- tia (â » +1–4), higher pre-clamping ACM BFV (standard- ized â » +0.6), and lower end-of-surgery rSO? (â » –0.04 to –0.17 per 1% increase) showed consistent directional asso- ciations. No predictor reached statistical significance due to limited sample size. Conclusions. Postoperative dNCR occurred in one-third of patients. Higher pre-clamping MCA BFV was associated with postoperative dNCR, suggesting that altered baseline cerebrovascular haemodynamics may play a role in cogni- tive decline. Elevated pre clamping MCA BFV in carotid stenosis reflects a compensatory hyperdynamic flow from collateral circulation. dNCR was most strongly predicted by preoperative cognitive impairment. When preoperative dNCR was excluded from analysis, dementia, higher pre clamping MCA blood flow velocity, and lower end of sur- gery rScO? showed consistent but non-significant associa- tions, likely due to the limited sample size.

Introduction Abdominal aortic aneurysm (AAA) associated with a horseshoe kidney (HSK) is a rare clinical entity, reported in less than 0.12% of AAA cases, that presents significant technical challenges due to variable renal arterial anatomy and the presence of a renal isthmus overlying the aneurysm. Careful preoperative planning is essential to ensure adequate renal perfusion and to minimize perioperative complications, particularly renal dysfunction, which has been reported in complex AAA repairs involving HSK (1–3). Case Presentation A 66-year-old patient presented with abdominal pulsations lasting two months. CTA demonstrated a 74 × 73 mm fusiform pararenal AAA extending from below the superior mesenteric artery into both common iliac arteries, in association with a horseshoe kidney and atypical renal artery anatomy. Due to the short and tapered proximal neck and the complex renal arterial pattern, endovascular repair would have required a technically demanding fenestrated or hybrid approach, therefore, open surgical repair was selected. The aneurysm was repaired using a prosthetic bifurcated aorto-bi-iliac graft with suprarenal aortic cross clamping. Postoperative renal function remained preserved. The postoperative period was complicated by paralytic ileus, which was resolved with conservative management. Discussion Both open and endovascular techniques have been reported for the treatment of AAA in patients with HSK when detailed preoperative imaging is used to identify renal and accessory arteries (1–3). Endovascular repair may be limited by unfavourable aneurysm morphology, short proximal necks, and aberrant renal arteries, frequently necessitating complex fenestrated or branched techniques (1,4). Open repair, although more invasive, allows direct exposure of the aneurysm and renal vasculature and remains a reliable option in anatomically complex cases. Therefore, treatment selection should be individualized based on aneurysm characteristics, renal anatomy, and technical feasibility. Conclusions The coexistence of AAA and HSK poses unique structural challenges that demand thorough understanding of renal anatomy, and flexible surgical planning. In this case, a short proximal neck and aberrant renal arteries precluded endovascular repair, so open surgery was performed, preserving renal function.

Introduction Primary venous tumors are exceptionally rare vascular neoplasms arising from the venous wall and are often misdiagnosed as venous thrombosis or inflammatory venous disease. Fewer than a few hundred cases have been reported worldwide. Their deep anatomical location and overlapping imaging features contribute to delayed diagnosis and treatment. We present two venous tumors of differing biological behavior to highlight diagnostic pitfalls and surgical management challenges. Case Presentation Two female patients with venous tumors were surgically treated at a tertiary hospital. The first case involved a high-grade venous leiomyosarcoma of the femoral–iliac venous system, initially misdiagnosed as deep vein thrombosis. Following neoadjuvant chemoradiotherapy, radical tumor resection was performed without venous reconstruction but with iliofemoral arterial bypass using a PTFE graft; a postoperative seroma at the incision site was identified at one month follow-up. The second case described intravascular leiomyomatosis arising from the inferior vena cava with venous obstruction. Complete en bloc tumor resection with caval replacement using a PTFE graft was performed. The patient reported no early postoperative complaints; however, intermittent abdominal pain was noted at two-year follow-up and was considered possibly related to postoperative scar formation. Histopathological examination confirmed the diagnoses. Discussion These cases emphasize the diagnostic challenges of venous tumors, particularly their frequent misinterpretation as thrombotic disease. Progressive symptoms despite adequate conservative or anticoagulant therapy and atypical imaging findings should raise suspicion for venous neoplasia. Although multimodal imaging is essential, definitive diagnosis relies on histopathology. Surgical management is often complex due to vessel wall infiltration and proximity to major vascular structures. Conclusions Venous tumors should be considered in cases of atypical or treatment-resistant venous disease. Early recognition, multidisciplinary evaluation, and complete surgical resection when feasible remain crucial for optimal outcomes. Reporting rare cases contributes to improved awareness and may help refine future diagnostic and therapeutic strategies.

Background and Objectives: Median arcuate ligament syndrome (MALS), also known as Dunbar syndrome, is a vascular compression disorder. Over time, laparoscopy has become increasingly important in the treatment of MALS, gradually replacing open surgical reconstruction as the preferred first-line approach in most cases. We present nine years of experience managing patients with MALS, aiming to contribute to the evidence supporting this long-debated condition. Materials and Methods: A single-center prospective observational cohort study analysis was conducted. CT angiography was used to confirm the diagnosis of MALS in all patients. All surgical patients completed the Gastrointestinal Quality of Life Index (GIQLI) and Gastrointestinal Symptom Rating Scale (GSRS) questionnaires preoperatively and postoperatively. All the patients underwent laparoscopic decompression. Postoperative follow-up visits were scheduled at one month and three years postoperatively. Results: During the study period, 37 patients were diagnosed with MALS, of whom 11 (29.7%) were symptomatic and underwent laparoscopic decompression. The operated cohort consisted of nine women and two men (mean age 56.7 ± 10.7 years). All patients reported postprandial epigastric pain, and 63.6% experienced weight loss. Laparoscopic decompression was successfully completed in all cases without intraoperative complications. Two patients had stenting after surgery, and in two, prior to surgery. The mean operative time was 103 ± 54 min, and the mean hospital stay was 4.2 ± 2.2 days. At 3-year follow-up, 36.4% of patients reported recurrent symptoms associated with recurrent celiac trunk stenosis on CT angiography. Overall, the patients had less indigestion and less pain; however, the differences did not reach a statistically significant level. Conclusions: Laparoscopic decompression of the median arcuate ligament is a feasible and safe treatment for carefully selected patients with symptomatic MALS, offering durable symptom relief in most cases with minimal morbidity.

Kojų venų trombozė yra skirstoma į giliųjų venų trombozę (GVT) ir paviršinių venų trombozę (kitaip vadinamą paviršiniu tromboflebitu). Sergamumas kojų GVT yra 1 iš 1000 žmonių per metus [1]. Kadangi ši patologija gali komplikuotis pavojingomis būklėmis, tokiomis kaip plaučių arterijos trombinė embolija (PATE), svarbu suprasti jos rizikos veiksnius, prevencines priemones, kaip šia ligą atpažinti ir tinkamai gydyti.

A leg blood flow stimulation system comprising a closed chamber, a low-frequency acoustic vibration-exciting speakers located on sides of the chamber, an array of high-frequency vibration-exciting piezoelectric bimorph transducers located in the chamber, in the plane of the chamber corresponding to the plane of the foot, corresponding to the sole support zone below the toes and the heel support zone, where each zone includes one to three piezoelectric bimorph transducers. The leg stimulation system is designed so that a person's legs up to the knees can be placed in a closed chamber and encased in a standard type of elastic splint type system. The feet are affected by bimorph type piezoelectric transducers connected to the controller, and the lower legs are affected by acoustic vibrations thanks to the speakers installed in the side walls of the closed chamber. In this way, the pulses sent from the controller control the synchronous operation of bimorph piezoelectric transducers and acoustic speakers, which activates blood flow in the tissues of human legs and increases the efficiency of blood flow stimulation.

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.