Patrik Tosenovsky - Academia.edu (original) (raw)
Papers by Patrik Tosenovsky
AACN Clinical Issues: Advanced Practice in Acute and Critical Care, 1995
Diabetes is the leading cause of end-stage renal disease in the United States. Combined kidney an... more Diabetes is the leading cause of end-stage renal disease in the United States. Combined kidney and pancreas transplantation is a safe and effective treatment option for diabetic nephropathy. During the past decade, pancreas transplants had improved outcomes as a result of improvements in pancreas recovery and preservation, the surgical procedure, immunosuppressive regimens, and immunologic monitoring. Current 1-year patient and graft survival rates are 90% and 80%, respectively, and evidence is accumulating that improvements occur in microvascular and neuropathic complications as well. Successful outcomes of kidney and pancreas transplantation are due in large part to careful nursing assessment, diagnosis, intervention, teaching, and discharge planning.
PubMed, 2001
The authors present the results of 100 pancreatico-duodenal grafts placed extraperitoneally with ... more The authors present the results of 100 pancreatico-duodenal grafts placed extraperitoneally with the bladder drainage. The onset of pancreatic graft function was immediate in all cases and the patients became insulin free. Despite the extraperitoneal graft placement the incidence of surgical complications was low. The only exception was slightly impaired wound healing. The Authors claim that this surgical technique allows the elimination of intraperitoneal infection and easy performance of the graft biopsy.
Vascular and Endovascular Surgery, Mar 8, 2023
Introduction Congenital malformations of the inferior vena cava are rare and remain an under reco... more Introduction Congenital malformations of the inferior vena cava are rare and remain an under recognised cause of spontaneous deep venous thrombosis (DVT). The purpose of this case report is to highlight the rare occurrence of a concomitant iliac vein aneurysm and the feasibility of endovascular reconstruction in the presence of extensive iliocaval thrombus burden, especially in cases where other treatment modalities have been unsuccessful. Report This is the report of a 25-year-old male who presented with acute onset left lower limb pain/swelling secondary to extensive iliocaval DVT. This was due to multiple abnormalities of the venous system including hypoplasia of the IVC with aneurysmal dilatation of the iliac veins. He failed an initial management strategy of anticoagulation and thrombolysis but subsequently underwent endovascular reconstruction of the iliocaval system via venoplasty and stenting. Complete symptom resolution and venous patency, including resolution of venous aneurysmal disease, were maintained at twelve-month follow-up. Discussion Reduction of the iliac vein diameter so early after successful reconstruction suggests that the iliac venous aneurysm was secondary to significant venous hypertension, and that if the obstruction causing it is treated, the vein can return to a normal vessel diameter.
Interní medicína pro praxi, Dec 13, 2005
PubMed, Apr 1, 2009
A brief content of American College of Chest Physicians Venous thromboembolism prophylaxis guidel... more A brief content of American College of Chest Physicians Venous thromboembolism prophylaxis guidelines for surgical specialties published in 2008 and selection of significant studies and corresponding references is provided thus a reader has easily accessible review and literature.
PubMed, Jun 1, 1997
The authors report on their experience with lower limb revascularization using the in-situ saphen... more The authors report on their experience with lower limb revascularization using the in-situ saphenous vein bypass grafting in four patients with angioscopically assisted valvulotomy. They describe the surgical technique employed and outcome of the procedure. The discussion section examines the pros and cons of the technique of in-situ saphenous vein bypass with angioscopically assisted valvulotomy (ISB + AV) compared with the standard technique of reversed bypass (RVB).
PubMed, Mar 1, 2004
Fresh arterial grafts obtained during multi-organ excisions widen a spectrum of treatment possibi... more Fresh arterial grafts obtained during multi-organ excisions widen a spectrum of treatment possibilities for obliterating arterial disorders of low extremities or for the abdominal aortic aneurysm in patients waiting for organ transplantation. Between the year 1998 and the end of the year 2002, our work-team performed parallel reconstructions of the abdominal aorta using fresh grafts and cadaverous kidney transplantations in a group of five patients. The simultaneous surgical treatment of the both disorders during a single hospitalization as well as a considerable decrease of the artificial blood vessel prosthesis infection risk during chronic imunosuppression, represent the biggest advantage of this method. On the other hand, the risk of possible surgical complications is increased in these patients. During the operation and postoperation period, our four patients suffered from no serious complications. In case of one patient, ischemic colitis occurred which required surgical revision and subtotal colectomy. In this article, the authors describe the postoperation course of the patient condition with the above complication, which required a close cooperation of surgeons, anesthesiologists and nephrologists, in full detail.
Interní medicína pro praxi, Dec 13, 2005
PubMed, Jul 1, 1997
The number of combined transplantations of the pancreas and kidney in type I diabetics with chron... more The number of combined transplantations of the pancreas and kidney in type I diabetics with chronic renal failure is increasing every year. The authors present their experience with a new technique of duodenocystostomy during this transplantation. The use of a circular stapler to create the duodenocystoanastomosis can hasten the surgical procedure and reduce at the same time the risk of development of a pancreatic fistula.
Annals of Vascular Surgery, Aug 1, 2019
Aim of the study was to assess results of interventions for iliocaval obstruction or compression ... more Aim of the study was to assess results of interventions for iliocaval obstruction or compression in patient with acute and chronic venous disease. Methods: Patients with chronic venous insufficiency (CVI) C3-C6 (CEAP classification) and acute DVT were assessed by ultrasound scan, CT, venography and/or IVUS, and if an obstruction in their iliocaval or iliofemoral segments were confirmed, they underwent venoplasty and stenting. Acute DVT cases were treated with pharmaco-mechanical and/or catheter-directed thrombolysis and residual obstruction was then stented. Results: 118 consecutive limbs were treated between October 2011 and December 2017. Thirty-two limbs had an active ulcer (27%), 27 limbs had healed ulcer or advanced skin changes (23%), 39 limbs had swelling with or without other symptoms of CVI (33%), 15 limbs had acute symptomatic DVT (13%), and the residual 5 iliac vein cases were causing pelvic congestion syndrome (4%). Patency rates of the stents in acute cases were 84.6%, 76.9%, 76.9%, and in chronic cases (combined thrombotic and non-thrombotic) 93,1%, 91% and 89.9% in 3, 6 and 12 months, respectively. A relief of symptoms was achieved in 81.5 % of limbs at some stage during the first 12 months (most of them within the first 3 months), although at the end of this period only 59.3% remained free of symptoms. There was no limb loss, and no mortality within 30 days from the intervention. Conclusion: Iliocaval and iliofemoral venoplasty and stenting in both acute and chronic obstruction cases can be performed safely with good patency rates and reasonable improvement of symptoms of CVI.
PubMed, Aug 1, 2000
A formerly established theory on obliteration of diabetic foot arteries was dismissed. In the las... more A formerly established theory on obliteration of diabetic foot arteries was dismissed. In the last decade, diabetic foot revascularization using so called very distal bypass has became a routine procedure. The reconstructions are undertaken in patients with chronic critical limb ischemia. This paper presents our initial experience with this, not yet widely used, operative technique in 16 patients who had a total of 14 pedal bypass procedures performed. The parameters we monitored included the 3-, 6-, and 12-month patency rates, defect healing, and limb salvage rates. The primary and secondary patency rates were 64.3% and 78.6% at 3 months; 55.5% and 66.7% at 6 months; and 50% and 75% at one year, respectively. The overall limb salvage rate for the above periods was 92.9%. All defects healed following successful revascularization using pedal bypass. In patients where bypass could not be established, limb salvage was accomplished in one in three cases only.
Transplantation Proceedings, Mar 1, 1998
Journal of clinical & experimental dermatology research, Jan 28, 2017
PubMed, Nov 1, 2001
The authors present their results of the treatment of diabetic foot critical ischemia by means of... more The authors present their results of the treatment of diabetic foot critical ischemia by means of surgical revascularisation together with minor amputation or debridement. They discuss the causes of higher amputations and re-amputations in revascularised ischemic diabetic lower limbs and presents patency rates in different types of peripheral arterial bypasses. The authors evaluated 81 diabetic feet with chronic critical ischemia, where they performed 50 arterial bypass procedures in the 50 limbs (13 femoropopliteal, 13 femorodistal, 19 pedal bypasses and 5 aorto/ilicofemoral or extraanatomical bypasses). 41 minor amputations or debridements (82%), 6 minor re-amputations (12%) was performed in the group of 50 revascularised limbs. The primary patency rates, secondary patency rates and limb salvage was achieved 92%, 92% and 92% in femoropopliteal bypass, 91%, 91% and 92% in femorodistal bypass, 78%, 83% and 84% in pedal bypass, respectively. The average follow-up time was 11.4 months. 6 minor re-amputations (12%) and 5 high amputations was necessary to perform in the group of 50 revascularised lower limbs. The main cause of re-amputation and high amputation was continuing ischemia. 30 day mortality rate was 0%, 30 day morbidity rate was 8% (myocardial infarction and pulmonary embolism).
PubMed, 2002
Aim: The aim of this retrospective analysis was assessment of both patency and limb salvage rates... more Aim: The aim of this retrospective analysis was assessment of both patency and limb salvage rates of diabetic ischemic feet which underwent pedal bypass surgery within the period of 3 years. Material and methods: Authors evaluated 50 critically ischemic diabetic feet where the pedal bypass was indicated for limb salvage. Total 41 pedal bypasses were performed and median follow-up was 16.7 months (1-39). The free muscle transfer were performed either in one session with or subsequently after the pedal bypass surgery in six limbs. Results: Authors achieved 61% and 76% graft patency and limb salvage rates, respectively, within the median 16.7 months follow-up. All successfully revascularised feet healed up within the median period of 3 months postoperatively. No patient died within 30 days postoperatively. Conclusion: We conclude, that pedal bypass is safe procedure with acceptable limb salvage rate in the medium-term follow-up. Surgeons can markedly extend an indication criterions for limb salvage by exploiting of this technique.
Phlebology, Apr 20, 2022
Background Iliocaval stenting is widely used for treatment of symptomatic iliocaval obstruction. ... more Background Iliocaval stenting is widely used for treatment of symptomatic iliocaval obstruction. The aim of our study was to compare quality of life before and after iliocaval stenting. Method Prospectively collected data using CIVIQ20 questionnaire, Venous Clinical Severity Score (rVCSS) and Villalta-Prandoni score (VP) of patients following iliocaval stenting for non-thrombotic and post-thrombotic venous obstruction were analysed. Result One hundred and one limbs (87 patients) were stented between May 2017 and May 2019. Baseline CIVIQ20 median value was 50 (34–66); 1 month after surgery CIVIQ20 value was 36 (26–58) and the scores then remained steady for the rest of the first year. Both rVCSS and VP scores decrease by 3.09 (95% CI: 2.39, 3.89; p < .001) and 5.21 (95% CI: 4.14, 6.48; p < .001) units, respectively, throughout the first year. Conclusion Quality of life of patients with iliocaval obstruction significantly improves after successful percutaneous reconstruction. Severity of symptoms measured by rVCSS and VP scores decreases.
Annals of Vascular Surgery, May 1, 2021
OBJECTIVE We describe the case of lower limb unilateral swelling due to a cystic mass (Adventitia... more OBJECTIVE We describe the case of lower limb unilateral swelling due to a cystic mass (Adventitial Cystic Disease, ACD) compressing on the common femoral vein. This was misdiagnosed as a deep vein thrombosis on both CT venography and Doppler ultrasound. METHOD We describe the diagnostic pathways and surgical excision of this venous adventitial cyst of the femoral vein. CONCLUSION Venous adventitial cysts are a rare occurrence and diagnosis remains difficult. It often presents clinically as a DVT. Suspicions should be raised should symptoms persist despite appropriate DVT management. Surgical management include endovascular, minimally invasive procedures and complete evacuation of the mucoid cyst with excision of the cystic wall.
European Journal of Vascular and Endovascular Surgery, Apr 1, 2010
This publication describes a hybrid endovascular and open surgical approach to treating a large a... more This publication describes a hybrid endovascular and open surgical approach to treating a large aneurysm of an aberrant right subclavian artery (Kommerell's diverticulum). A 76-year old man presented with dysphagia lusoria due to a 3.5 Â 3.0 cm aneurysm involving an aberrant right subclavian artery. The patient was treated by a thoracic aortic endograft, left subclavian artery de-branching (by its transposition to the left common carotid artery) and right subclavian artery revascularisation. This approach avoids the requirement for a thoracotomy or sternotomy needed with open surgical repair. At a 6 months follow-up assessment the aneurysm was shown to be thrombosed with no evidence of endoleak.
AACN Clinical Issues: Advanced Practice in Acute and Critical Care, 1995
Diabetes is the leading cause of end-stage renal disease in the United States. Combined kidney an... more Diabetes is the leading cause of end-stage renal disease in the United States. Combined kidney and pancreas transplantation is a safe and effective treatment option for diabetic nephropathy. During the past decade, pancreas transplants had improved outcomes as a result of improvements in pancreas recovery and preservation, the surgical procedure, immunosuppressive regimens, and immunologic monitoring. Current 1-year patient and graft survival rates are 90% and 80%, respectively, and evidence is accumulating that improvements occur in microvascular and neuropathic complications as well. Successful outcomes of kidney and pancreas transplantation are due in large part to careful nursing assessment, diagnosis, intervention, teaching, and discharge planning.
PubMed, 2001
The authors present the results of 100 pancreatico-duodenal grafts placed extraperitoneally with ... more The authors present the results of 100 pancreatico-duodenal grafts placed extraperitoneally with the bladder drainage. The onset of pancreatic graft function was immediate in all cases and the patients became insulin free. Despite the extraperitoneal graft placement the incidence of surgical complications was low. The only exception was slightly impaired wound healing. The Authors claim that this surgical technique allows the elimination of intraperitoneal infection and easy performance of the graft biopsy.
Vascular and Endovascular Surgery, Mar 8, 2023
Introduction Congenital malformations of the inferior vena cava are rare and remain an under reco... more Introduction Congenital malformations of the inferior vena cava are rare and remain an under recognised cause of spontaneous deep venous thrombosis (DVT). The purpose of this case report is to highlight the rare occurrence of a concomitant iliac vein aneurysm and the feasibility of endovascular reconstruction in the presence of extensive iliocaval thrombus burden, especially in cases where other treatment modalities have been unsuccessful. Report This is the report of a 25-year-old male who presented with acute onset left lower limb pain/swelling secondary to extensive iliocaval DVT. This was due to multiple abnormalities of the venous system including hypoplasia of the IVC with aneurysmal dilatation of the iliac veins. He failed an initial management strategy of anticoagulation and thrombolysis but subsequently underwent endovascular reconstruction of the iliocaval system via venoplasty and stenting. Complete symptom resolution and venous patency, including resolution of venous aneurysmal disease, were maintained at twelve-month follow-up. Discussion Reduction of the iliac vein diameter so early after successful reconstruction suggests that the iliac venous aneurysm was secondary to significant venous hypertension, and that if the obstruction causing it is treated, the vein can return to a normal vessel diameter.
Interní medicína pro praxi, Dec 13, 2005
PubMed, Apr 1, 2009
A brief content of American College of Chest Physicians Venous thromboembolism prophylaxis guidel... more A brief content of American College of Chest Physicians Venous thromboembolism prophylaxis guidelines for surgical specialties published in 2008 and selection of significant studies and corresponding references is provided thus a reader has easily accessible review and literature.
PubMed, Jun 1, 1997
The authors report on their experience with lower limb revascularization using the in-situ saphen... more The authors report on their experience with lower limb revascularization using the in-situ saphenous vein bypass grafting in four patients with angioscopically assisted valvulotomy. They describe the surgical technique employed and outcome of the procedure. The discussion section examines the pros and cons of the technique of in-situ saphenous vein bypass with angioscopically assisted valvulotomy (ISB + AV) compared with the standard technique of reversed bypass (RVB).
PubMed, Mar 1, 2004
Fresh arterial grafts obtained during multi-organ excisions widen a spectrum of treatment possibi... more Fresh arterial grafts obtained during multi-organ excisions widen a spectrum of treatment possibilities for obliterating arterial disorders of low extremities or for the abdominal aortic aneurysm in patients waiting for organ transplantation. Between the year 1998 and the end of the year 2002, our work-team performed parallel reconstructions of the abdominal aorta using fresh grafts and cadaverous kidney transplantations in a group of five patients. The simultaneous surgical treatment of the both disorders during a single hospitalization as well as a considerable decrease of the artificial blood vessel prosthesis infection risk during chronic imunosuppression, represent the biggest advantage of this method. On the other hand, the risk of possible surgical complications is increased in these patients. During the operation and postoperation period, our four patients suffered from no serious complications. In case of one patient, ischemic colitis occurred which required surgical revision and subtotal colectomy. In this article, the authors describe the postoperation course of the patient condition with the above complication, which required a close cooperation of surgeons, anesthesiologists and nephrologists, in full detail.
Interní medicína pro praxi, Dec 13, 2005
PubMed, Jul 1, 1997
The number of combined transplantations of the pancreas and kidney in type I diabetics with chron... more The number of combined transplantations of the pancreas and kidney in type I diabetics with chronic renal failure is increasing every year. The authors present their experience with a new technique of duodenocystostomy during this transplantation. The use of a circular stapler to create the duodenocystoanastomosis can hasten the surgical procedure and reduce at the same time the risk of development of a pancreatic fistula.
Annals of Vascular Surgery, Aug 1, 2019
Aim of the study was to assess results of interventions for iliocaval obstruction or compression ... more Aim of the study was to assess results of interventions for iliocaval obstruction or compression in patient with acute and chronic venous disease. Methods: Patients with chronic venous insufficiency (CVI) C3-C6 (CEAP classification) and acute DVT were assessed by ultrasound scan, CT, venography and/or IVUS, and if an obstruction in their iliocaval or iliofemoral segments were confirmed, they underwent venoplasty and stenting. Acute DVT cases were treated with pharmaco-mechanical and/or catheter-directed thrombolysis and residual obstruction was then stented. Results: 118 consecutive limbs were treated between October 2011 and December 2017. Thirty-two limbs had an active ulcer (27%), 27 limbs had healed ulcer or advanced skin changes (23%), 39 limbs had swelling with or without other symptoms of CVI (33%), 15 limbs had acute symptomatic DVT (13%), and the residual 5 iliac vein cases were causing pelvic congestion syndrome (4%). Patency rates of the stents in acute cases were 84.6%, 76.9%, 76.9%, and in chronic cases (combined thrombotic and non-thrombotic) 93,1%, 91% and 89.9% in 3, 6 and 12 months, respectively. A relief of symptoms was achieved in 81.5 % of limbs at some stage during the first 12 months (most of them within the first 3 months), although at the end of this period only 59.3% remained free of symptoms. There was no limb loss, and no mortality within 30 days from the intervention. Conclusion: Iliocaval and iliofemoral venoplasty and stenting in both acute and chronic obstruction cases can be performed safely with good patency rates and reasonable improvement of symptoms of CVI.
PubMed, Aug 1, 2000
A formerly established theory on obliteration of diabetic foot arteries was dismissed. In the las... more A formerly established theory on obliteration of diabetic foot arteries was dismissed. In the last decade, diabetic foot revascularization using so called very distal bypass has became a routine procedure. The reconstructions are undertaken in patients with chronic critical limb ischemia. This paper presents our initial experience with this, not yet widely used, operative technique in 16 patients who had a total of 14 pedal bypass procedures performed. The parameters we monitored included the 3-, 6-, and 12-month patency rates, defect healing, and limb salvage rates. The primary and secondary patency rates were 64.3% and 78.6% at 3 months; 55.5% and 66.7% at 6 months; and 50% and 75% at one year, respectively. The overall limb salvage rate for the above periods was 92.9%. All defects healed following successful revascularization using pedal bypass. In patients where bypass could not be established, limb salvage was accomplished in one in three cases only.
Transplantation Proceedings, Mar 1, 1998
Journal of clinical & experimental dermatology research, Jan 28, 2017
PubMed, Nov 1, 2001
The authors present their results of the treatment of diabetic foot critical ischemia by means of... more The authors present their results of the treatment of diabetic foot critical ischemia by means of surgical revascularisation together with minor amputation or debridement. They discuss the causes of higher amputations and re-amputations in revascularised ischemic diabetic lower limbs and presents patency rates in different types of peripheral arterial bypasses. The authors evaluated 81 diabetic feet with chronic critical ischemia, where they performed 50 arterial bypass procedures in the 50 limbs (13 femoropopliteal, 13 femorodistal, 19 pedal bypasses and 5 aorto/ilicofemoral or extraanatomical bypasses). 41 minor amputations or debridements (82%), 6 minor re-amputations (12%) was performed in the group of 50 revascularised limbs. The primary patency rates, secondary patency rates and limb salvage was achieved 92%, 92% and 92% in femoropopliteal bypass, 91%, 91% and 92% in femorodistal bypass, 78%, 83% and 84% in pedal bypass, respectively. The average follow-up time was 11.4 months. 6 minor re-amputations (12%) and 5 high amputations was necessary to perform in the group of 50 revascularised lower limbs. The main cause of re-amputation and high amputation was continuing ischemia. 30 day mortality rate was 0%, 30 day morbidity rate was 8% (myocardial infarction and pulmonary embolism).
PubMed, 2002
Aim: The aim of this retrospective analysis was assessment of both patency and limb salvage rates... more Aim: The aim of this retrospective analysis was assessment of both patency and limb salvage rates of diabetic ischemic feet which underwent pedal bypass surgery within the period of 3 years. Material and methods: Authors evaluated 50 critically ischemic diabetic feet where the pedal bypass was indicated for limb salvage. Total 41 pedal bypasses were performed and median follow-up was 16.7 months (1-39). The free muscle transfer were performed either in one session with or subsequently after the pedal bypass surgery in six limbs. Results: Authors achieved 61% and 76% graft patency and limb salvage rates, respectively, within the median 16.7 months follow-up. All successfully revascularised feet healed up within the median period of 3 months postoperatively. No patient died within 30 days postoperatively. Conclusion: We conclude, that pedal bypass is safe procedure with acceptable limb salvage rate in the medium-term follow-up. Surgeons can markedly extend an indication criterions for limb salvage by exploiting of this technique.
Phlebology, Apr 20, 2022
Background Iliocaval stenting is widely used for treatment of symptomatic iliocaval obstruction. ... more Background Iliocaval stenting is widely used for treatment of symptomatic iliocaval obstruction. The aim of our study was to compare quality of life before and after iliocaval stenting. Method Prospectively collected data using CIVIQ20 questionnaire, Venous Clinical Severity Score (rVCSS) and Villalta-Prandoni score (VP) of patients following iliocaval stenting for non-thrombotic and post-thrombotic venous obstruction were analysed. Result One hundred and one limbs (87 patients) were stented between May 2017 and May 2019. Baseline CIVIQ20 median value was 50 (34–66); 1 month after surgery CIVIQ20 value was 36 (26–58) and the scores then remained steady for the rest of the first year. Both rVCSS and VP scores decrease by 3.09 (95% CI: 2.39, 3.89; p < .001) and 5.21 (95% CI: 4.14, 6.48; p < .001) units, respectively, throughout the first year. Conclusion Quality of life of patients with iliocaval obstruction significantly improves after successful percutaneous reconstruction. Severity of symptoms measured by rVCSS and VP scores decreases.
Annals of Vascular Surgery, May 1, 2021
OBJECTIVE We describe the case of lower limb unilateral swelling due to a cystic mass (Adventitia... more OBJECTIVE We describe the case of lower limb unilateral swelling due to a cystic mass (Adventitial Cystic Disease, ACD) compressing on the common femoral vein. This was misdiagnosed as a deep vein thrombosis on both CT venography and Doppler ultrasound. METHOD We describe the diagnostic pathways and surgical excision of this venous adventitial cyst of the femoral vein. CONCLUSION Venous adventitial cysts are a rare occurrence and diagnosis remains difficult. It often presents clinically as a DVT. Suspicions should be raised should symptoms persist despite appropriate DVT management. Surgical management include endovascular, minimally invasive procedures and complete evacuation of the mucoid cyst with excision of the cystic wall.
European Journal of Vascular and Endovascular Surgery, Apr 1, 2010
This publication describes a hybrid endovascular and open surgical approach to treating a large a... more This publication describes a hybrid endovascular and open surgical approach to treating a large aneurysm of an aberrant right subclavian artery (Kommerell's diverticulum). A 76-year old man presented with dysphagia lusoria due to a 3.5 Â 3.0 cm aneurysm involving an aberrant right subclavian artery. The patient was treated by a thoracic aortic endograft, left subclavian artery de-branching (by its transposition to the left common carotid artery) and right subclavian artery revascularisation. This approach avoids the requirement for a thoracotomy or sternotomy needed with open surgical repair. At a 6 months follow-up assessment the aneurysm was shown to be thrombosed with no evidence of endoleak.