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Wojciech Cwikiel

Publications and source records attributed to Wojciech Cwikiel.

12 recordsLinked to original sources
PubMed2003

Retroperitoneal bronchogenic cyst as a differential diagnosis of pancreatic mucinous cystic tumor.

Cystic tumors of the pancreas where a pseudocyst has not been able to be excluded has been considered potentially proliferative and pre-malignant or malignant and thus aggressive surgical approach has been advocated. Retroperitoneal cystic tumors are rare and among these bronchogenic cysts are extremely infrequent. The present paper describes a case of bronchogenic cyst in association with the pancreas in which diagnostic work-up was not able to exclude a proliferative pancreatic cystic tumor.

Adult↗
PubMed2002

Non-traumatic vascular emergencies: imaging and intervention in acute arterial conditions.

Methods of imaging and intervention in acute non-traumatic vascular arterial conditions has changed substantially during recent years. Computed tomography, MRI angiography and, more recently, intravascular ultrasonography (IVUS) have replaced to a large extent conventional diagnostic angiography. An increasing number of patients are treated by endovascular interventions and numerous new treatment methods have been evaluated. Technical development of new equipment and instruments, increasing skill of interventional radiologists and better understanding of events following interventions improve continuously results of the treatment. Radiologic diagnosis and intervention have important roles in the treatment of acute non-traumatic vascular arterial conditions.

Aortic Diseases↗
PubMed2002

Changes in the distribution of hepatic arterial blood flow following TIPS with uncovered stent and stent-graft: an experimental study.

PURPOSE: To evaluate changes in distribution of hepatic arterial blood flow in the liver following insertion of an uncovered stent and subsequently a stent-graft in the transjugular intrahepatic portosystemic shunt (TIPS) channel. METHODS: The experiments were performed in eight healthy pigs under general anesthesia. In a pilot study in one pig, scintigraphic evaluation of arterial perfusion to the liver was done before and after inflation of a balloon in the right hepatic vein. In the other pigs, outflow from the right liver vein was checked repeatedly by contrast injection through a percutaneously inserted catheter. The arterial perfusion through the liver was examined by scintigraphy, following selective injection of macro-aggregate of 99Tc m-labeled human serum albumin 99Tc m-HSA) into the hepatic artery. This examination was done before and after creation of a TIPS with an uncovered stent and subsequently after insertion of a covered stent-graft into the cranial portion of the shunt channel. RESULTS: In the pilot study changes in the arterial perfusion to the liver were easily detectable by scintigraphy. One pig died during the procedure and another pig was excluded due to dislodgement of the hepatic artery catheter. The inserted covered stent obstructed venous outflow from part of the right liver lobe. The 99Tc m-HSA activity in this part remained unchanged after TIPS creation with an uncovered stent. A reduction in activity was seen after insertion of a stent-graft (p= 0.06). CONCLUSION: The distribution of the hepatic arterial blood flow is affected by creation of a TIPS with a stent-graft, in the experimental pig model.

Animals↗
PubMed2002

Insertion of self-expandable nitinol stents without previous balloon angioplasty reduces restenosis compared with PTA prior to stenting.

PURPOSE: To compare the development of intimal hyperplasia after deployment of a self-expanding nitinol stent with and without previous percutaneous transluminal balloon angioplasty (PTA), with the results after PTA alone. METHODS: In nine healthy pigs, the iliac arteries were divided into three groups: group 1 (n = 6 arteries) was treated with PTA; group 2 n = 6) with insertion of self-expanding stents after PTA; and group 3 (n = 6) with stent insertion without previous PTA. After 8 weeks the vessels were examined with intravascular ultrasonography, histologic examination and morphometric analysis. RESULTS: Although the injury index in group 1 (0.17 +/- 0.57) was lower (p <0.05) than in group 2 (0.26 +/- 0.06) and group 3 (0.26 +/- 0.08), PTA-treated arteries showed significantly (p <0.05) reduced mean luminal gain (0.53 +/- 2.84) compared with arteries treated with PTA prior to stenting (2.58 +/- 1.38) and compared with stenting alone (4.65 +/- 5.34). Stenting after PTA resulted in a higher (p <0.05) restenosis index (2.63 +/- 1.06) compared with stenting without PTA (1.35 +/- 0.59). Group 2 also had a significantly thicker intima p <0.05) and 83% and 74% higher intima/media ratio (p <0.05) compared with groups 1 and 3, respectively. CONCLUSION: Insertion of a self-expandable nitinol stent without previous PTA results in less intimal hyperplasia than if PTA is performed prior to stenting, suggesting that direct stenting can be used in angioplasty sessions with a favorable outcome.

Alloys↗
PubMed2002

Percutaneous cystogastrostomy in patients with pancreatic pseudocysts.

OBJECTIVE: To evaluate the results of percutaneous cystogastrostomy for pancreatic pseudocysts secondary to acute or chronic pancreatitis. DESIGN: Retrospective study with prospective follow-up. SETTING: University hospital, Sweden. PATIENTS: 16 patients with symptomatic pseudocysts (10 men and 6 women, mean age 56 (36-78) years) treated during the period 1993-1999. INTERVENTION: Pseudocystogastrostomy was created under local anaesthesia and fluoroscopic control by percutaneous insertion of a double pigtail catheter. RESULTS: The underlying diagnosis was acute pancreatitis in 10 and chronic pancreatitis in 6 patients. 13 patients had one pseudocyst and 4 had 2 or more with a median diameter of 11 (5-20) cm. The procedure was successful in all but 2 patients, who were operated on. 2 patients experienced pain after the intervention that did not require specific treatment, otherwise no complications were noted. Median hospital stay was 2 days (range 1-60). The median follow-up was 45 (1-94) months. All but 2 patients had successful drainage during follow-up with resolution or regression of the pseudocyst and relief of symptoms (pain and abdominal discomfort). CONCLUSION: Pancreatic pseudocysts were treated by percutaneous cystogastrostomy with good results. Percutaneous cystogastrostomy is a safe, minimally invasive procedure that gives good results at long-term follow-up as well as in the short-term.

Acute Disease↗
PubMedDate not supplied

Stent-graft treatment of patients with acute bleeding from hepatic artery branches.

PURPOSE: To present a new treatment option in patients with acute bleeding from the hepatic artery branches. METHODS: Four male patients, 23-49 years old (mean 36.3 years), were treated for acute bleeding and subsequent transient hypotension. Bleeding episodes were secondary to hepatic artery pseudoaneurysms in two patients and surgical suture insufficiency in one patient. In the remaining patient, anastomotic leakage occurred following thrombolysis for hepatic artery thrombosis. Patients were treated by endovascular placement of one or two balloon-expandable stent-grafts, ranging from 17 to 28 mm in length. RESULTS: All procedures were carried out without serious complications. All stent-grafts were deployed in the intended position with immediate cessation of bleeding and initial preservation of satisfactory blood flow. CONCLUSIONS: Bleeding from the hepatic artery can be treated by insertion of balloon-expandable stent-grafts in the acute setting.

Acute Disease↗
PubMedDate not supplied

Acute effects of liver vein occlusion by stent-graft placed in transjugular intrahepatic portosystemic shunt channel: an experimental study.

The purpose of this study was to evaluate the effects of hepatic vein occlusion by stent-graft used in transjugular intrahepatic portosystemic shunt (TIPS). The experiments were performed in six healthy pigs under general anesthesia. Following percutaneous transhepatic implantation of a port-a-cath in the right hepatic vein, TIPS was created with a stent-graft (Viatorr; W L Gore, Flagstaff, AZ, USA). The outflow from the hepatic vein, blocked by the stent-graft was documented by injection of contrast medium and repeated injections of (99)Tc(m)-labeled human serum albumin through the port-a-cath. After 2 weeks, the outflow was re-evaluated, the pigs were sacrificed, and histopathologic examination of the liver was performed. Occlusion of the hepatic vein by a stent-graft had a short and temporary effect on the outflow. Histopathological examination from the affected liver segment showed no divergent pattern. Stent-grafts used in TIPS block the outflow from the liver vein, but do not have a prolonged circulatory effect and do not affect the liver parenchyma.

Animals↗
PubMedDate not supplied

Resolution of large azygos vein aneurysm following stent-graft shunt placement in a patient with Ehlers-Danlos syndrome type IV.

Ehlers-Danlos syndrome (EDS) type IV is a rare connective tissue disorder associated with thin-walled, friable arteries and veins predisposing patients to aneurysm formation, dissection, fistula formation, and vessel rupture. Azygos vein aneurysm is an extremely rare condition which has not been reported in association with EDS in the literature. We present a patient with EDS type IV and interrupted inferior vena cava (IVC) with azygos continuation who developed an azygos vein aneurysm. In order to decrease flow through the azygos vein and reduce the risk of aneurysm rupture, a stent-graft shunt was created from the right hepatic vein to the azygos vein via a transhepatic, retroperitoneal route. At 6 month follow-up the shunt was open and the azygos vein aneurysm had resolved.

Adult↗
PubMedDate not supplied

Conformation of adjacent self-expanding stents: a cross-sectional in vitro study.

We examined the proximal conformation of three commonly used self-expanding stents when the stents were deployed adjacent to one another in a tubular model, simulating a "kissing" stent technique. The stent pairs were evaluated by computed tomogrphy to determine the cross-sectional area excluded by the stents within the model. The mean areas associated with each stent pair were compared and significance evaluated by a t-test. A statistically significant difference was found when the area excluded by adjacent Wallstents was compared with both the Luminexx and SMART stents (p < 0.001 and p < 0.002, respectively). The difference in the area excluded and differences in conformation might play a role in the lower patencies that have been observed in "kissing" stent series.

Alloys↗
PubMedDate not supplied

Utility of stent-grafts in treatment of porto-biliary fistula.

A porto-biliary fistula causing hemobilia is a known complication of percutaneous transhepatic biliary drainage (PTBD). We present two patients with hemobilia secondary to porto-biliary fistula, treated successfully by percutaneous placement of stent-grafts. In one case, the stent-graft was placed in the bile duct, and in the other case, it was placed in the intrahepatic portal vein branch. Hemobilia stopped and there were no complications except a small area of hepatic infarction, distal to the stent-graft in the portal vein.

Arterial Occlusive Diseases↗
PubMedDate not supplied

Endovascular management of acute enteric bleeding from pancreas transplant.

Arterioenteric fistula is a rare but serious complication of enteric drained pancreas transplant, which may lead to massive gastrointestinal bleeding. We present 3 patients with failed enteric drained pancreas transplants and massive gastrointestinal bleeding secondary to arterioenteric fistula. One patient was treated by embolization and the 2 others by stent graft placement. Bleeding was successfully controlled in all cases, at follow up of 5 days, 8 months, and 12 months, respectively. One patient died 24 days after embolization, of unknown causes.

Acute Disease↗