Valerija Mosenko

Vilnius University

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Tomas Baltrūnas

Vilnius University

Artūras Mackevičius

Vilnius University

AŠ

Audrius Širvinskas

Vilnius University

Austėja Račytė

Vilnius University

Giedrius Ledas

Vilnius University

Kęstutis Ručinskas

Vilnius University

Gediminas Vaitėnas

Vilnius University

Arminas Skrebūnas

Vilnius University

Saulius Lukoševičius

Lithuanian University of Health Sciences

Vilius Dambrauskas

Kaunas University of Technology

Cooperative Institutions

Vilnius University

Vilnius University Hospital Santariskiu Klinikos

John Paul II Hospital

Jagiellonian University

Institute of Cardiology

Kaunas University of Technology

Cardiovascular Center Frankfurt

ASL Roma

Hospital Clínico San Carlos

University Hospital of Basel

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Measurement of Revascularization Effect Using Near Infrared Spectroscopy in Below the Knee Arteries

Reviews in Cardiovascular Medicine (2022)

Tomas Baltrūnas Gabija Pikturnaitė Austėja Račytė Vaida Baltrūnienė Valerija Mosenko

Objectives: Current methods evaluating tissue ischemia are based mainly on evaluating blood flow and not tissue perfusion. However, diabetes mainly affects small vessels and blood flow evaluation is insufficient. The aim of the trial was to evaluate the feasibility of NIRS in measuring perfusion changes during chronic total occlusion (CTO) revascularization in below the knee (BTK) arteries. Methods and Material: A prospective observational study was performed. During the endovascular revascularization procedure, tissue oxygenation changes were measured using three NIRS sensors. Postoperative angiographies and 30 days wound healing was evaluated. Results: The study enrolled 30 patients with chronic limb threatening ischemia, occluded below the knee arteries, Rutherford 5. Mean age 74.7 ± 11.2 years, 16 (53%) of the patients had diabetes mellitus, 10 (33%) had end-stage renal disease. A statistically significant NIRS rSO2 increase was observed on sensors near the wound after the revascularization, p = 0.001. Thirty days follow-up visits included 27 patients, because 3 patients had died. Comparing good wound healing group with poor wound healing group intraoperative NIRS rSO2 increase difference was statistically significant, p = 0.017. Conclusions: The study confirmed tissue perfusion increase could be detected using NIRS during revascularization of below the knee arteries. An intraoperative increase of NIRS rSO2 proved to predict wound healing results.

Critical limb ischemia

10.31083/j.rcm2309299

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Citations (1)

A Bleeding Uretero-Arterial Fistula: Open Repair After Unsuccessful Endovascular Treatment

Vascular and Endovascular Surgery (2020)

Karolis Tijunaitis Valerija Mosenko Tomas Baltrūnas

Uretero-arterial fistula (UAF) poses major challenges in management and diagnosis due to the rarity of this condition and associated high morbidity/mortality rates.We describe a case of a UAF associated with previous aorto-biiliac grafting, ureteric stenting and right nephrectomy because of chronic pielonephritis and complicated by surgical site infection. This case illustrates a very complex pathology, with a challenging diagnosis and multiple treatment options.A 72 year-old woman was referred to Vilnius Vascular Unit for open UAF repair. The patient had a history of open abdominal aortic aneurysm repair using a bifurcated graft 25 years ago. The right ureter was injured during the operation and a rigid indwelling ureteric stent was inserted. Six months prior to referral, she underwent a right nephrectomy due to a chronic pyelonephritis, complicated by surgical site infection, which was still present at the time of admission. Initial CTA demonstrated bilateral iliac aneurysms, but no signs of UAF. A further CTA revealed a UAF between the right ureteral stump and the right common iliac artery (CIA) para-anastomotic aneurysm. After unsuccessful attempts to embolize the UAF using both coils and glue, the patient was referred to Vilnius Vascular Unit for open repair. Left axillo-bifemoral bypass reconstruction was performed followed by UAF repair and bifurcated graft explantation. Follow-up after 2 years showed no recurrence of haematuria, good function of the remaining kidney and patent axillo-bifemoral bypass with no signs of infection around the prosthetic aortic stump.Uretero-arterial fistula is a uncommon condition in everyday clinical practice. The rarity of this condition may lead to delayed or missed diagnosis which can result in life-threating consequences. A multidisciplinary approach involving urologists, vascular surgeon and radiologist are crucial to both the diagnosis and managment of this rare entity.

Stoma (medicine)

10.1177/1538574420953964

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Low rates of restenosis in primary lateral carotid artery endarterectomy

Medicni perspektivi (2020)

Artūras Mackevičius Valerija Mosenko Kęstutis Laurikėnas Agnese Sataviciute Tomas Baltrūnas

Carotid artery endarterectomy (CAE) is a treatment of choice for symptomatic and asymptomatic high-grade carotid stenosis, showing great results in reducing stroke morbidity. The optimal technique of the arterial closure is, however, still under discussion, with both patch angioplasty and primary closure having numerous advantages and pitfalls. The definite evidence is still lacking. The aim of this study was to evaluate the results of the modified primary closure technique during CEA. Incidence of restenosis more than 8 months after the surgery was measured. A retrospective observational study to evaluate modified primary internal carotid artery closure was conducted in Republican Vilnius University Hospital from January 1st, 2014 to December 31st, 2018. The patients were enrolled in the trial during their routine follow-up by their surgeon. During the visit, after an informed consent was signed, a qualified investigator performed carotid duplex ultrasound scan, documenting the restenosis rates. Patients also filled in the comorbidity assessment questionnaire, which included their smoking habits, history of hypertension and their adherence to antihypertensive medication as well as cholesterol levels and statin therapy, additional related comorbidities. Out of 342 patients that underwent CAE with primary closure in the Republican Vilnius university hospital from 2014 to 2018, 42 patients were identified as deceased, therefore a follow-up was impossible. Out of planned 150 (50%) consequently selected patients, 125 gave an informed consent to be enrolled into the study. Out of those 6 pre-occlusions were established during the review of the patient medical data and therefore were excluded from the study. In general, we analyzed the data of 119 patients and 125 CAE with a modified primary suture closure. The mean follow-up time was 35.78 months (SE 0.992; SD 11,046). At the time of a follow up, 3 (2,4%) carotid artery occlusions were identified and promptly evaluated. Restenosis rates varied: 5,6% of patients had low grade (<50%), 5,6% had moderate grade (50-69%) and 1,6% had high grade (70-99%) stenosis. The modified lateral CAE with primary closure technique, used in our hospital’s contemporary practice has shown to be a promising alternative to the classical primary suture, due to reduced restenosis rates. More prospective and randomized studies are needed to evaluate this technique in comparison to other CAE closure techniques.

Stroke

Endarterectomy

Medical record

10.26641/2307-0404.2020.3.214818

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Circle of Willis Configuration and Thrombus Localization Impact on Ischemic Stroke Patient Outcomes: A Systematic Review

Medicina (2023)

Audrius Širvinskas Givi Lengvenis Giedrius Ledas Valerija Mosenko Saulius Lukoševičius

Background and Objectives: The published literature highlights the fact that the integrity of the Circle of Willis has a direct impact on stroke outcome, especially in cases of distal internal carotid T occlusion. The aim of this study was to review the available data on the Circle of Willis configuration and thrombus location impact on patient outcome in cases of ischemic stroke. Materials and Methods: A systematic search according to PRISMA guidelines was performed in PubMed, Cochrane, and EMBASE databases to identify studies investigating the influence of Circle of Willis variants on ischemic stroke outcomes published up to March 2023. The manuscripts were reviewed by three researchers separately and scored on the quality of the research using the MINORS criteria. Results: After screening 157 manuscripts, 11 studies (n = 4643) were included. Circle of Willis integrity plays a vital role in stroke outcome, especially when T-form occlusions are present. Despite this, in the event of M1 occlusion Circle of Willis configuration does not play an important role. In cases of distal internal carotid artery occlusion, the presence of a fully developed contralateral A1 segment and anterior communicating artery is essential for a favorable stroke outcome. Conclusions: The preserved integrity of the Circle of Willis has great significance for collateral flow in the event of ischemic stroke and helps patients to achieve more favorable outcomes, as it determines the affected brain territory. The clinical outcome of the ischemic stroke appears to be significantly better if only one artery territory is affected, compared to two or more.

Circle of Willis

Stroke

Anterior cerebral artery

10.3390/medicina59122115

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Citations (2)

Enterocutaneous Fistula: Open Repair after Unsuccessful Stenting—A Case Report

Medicina (2022)

Valerija Mosenko Saulius Jurevičius Audrius Šileikis

Enterocutaneous fistula (ECF) is an abnormal connection between the gastrointestinal tract and the skin; by some estimates, it represents 88.2% of all fistulae. It can either develop spontaneously due to underlying malignancy, inflammatory bowel disease, radiation exposure, or, more commonly, as a complication of gastrointestinal surgery. A 75-year-old woman was treated for a small bowel enterocutaneous fistula that developed after laparoscopic cholecystectomy using a HANAROSTENT self-expanding metal stent (SEMS) to cover the fistula. Seven months later, the patient was discharged. For the following 2 years, the patient refused the reconstructive surgery until stent obstruction occurred. After optimizing the patient's nutritional status, laparotomy and small bowel resection were performed successfully. The use of SEMS in fistulas of the lower gastrointestinal tract is a heavily debated and fairly under-researched topic, especially in the context of enterocutaneous fistulas. No international guidelines officially recommend using SEMS in the small bowel ECF.

Enterocutaneous Fistula

Bowel resection

10.3390/medicina58020223

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Citations (1)

Abdominal Aortic Aneurysm Diameter versus Volume: A Systematic Review

Biomedicines (2023)

Gediminas Vaitėnas Valerija Mosenko Austėja Račytė Karolis Medelis Arminas Skrebūnas

Recently, AAA volume measurement has been proposed as a potentially valuable surveillance method in situations when diameter measurement might fail. Objective: The aim of this systematic review was to analyze the results of previous studies comparing AAA diameter and volume measurements. Methods: A systematic search in PubMed, Cochrane, and EMBASE databases was performed to identify studies investigating the use of diameter and volume measurements in AAA diagnosis and prognosis in English, German, and Russian, published until December 2022. The manuscripts were reviewed by three researchers and scored on the quality of the research using MINORS criteria. Results: After screening 752 manuscripts, 19 studies (n = 1690) were included. The majority (n = 17) of the manuscripts appeared to favor volume. It is, however, important to highlight the heterogeneity of methodologies and lack of standardized protocol for measuring both volume and diameter in the included studies, which hindered the interpretation of the results. Conclusions: The clinical relevance of abdominal aortic aneurysm volume measurement is still unclear, although studies show favorable and promising results for volumetric changes in AAA, especially in follow-up after EVAR.

10.3390/biomedicines11030941

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A multi-center study of the MicroNET-covered stent in consecutive patients with acute carotid-related stroke: SAFEGUARD-STROKE

Advances in Interventional Cardiology (2024)

Łukasz Tekieli A. V. Afanasiev Maciej Mazgaj Vladimir Borodetsky Kolja Sievert

AMA Tekieli L, Afanasjev A, Mazgaj M, et al. A multi-center study of the MicroNET-covered stent in consecutive patients with acute carotid-related stroke: SAFEGUARD-STROKE. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej. 2024;20(2):172-193. doi:10.5114/aic.2024.140963. APA Tekieli, L., Afanasjev, A., Mazgaj, M., Borodetsky, V., Sievert, K., & Ruzsa, Z. et al. (2024). A multi-center study of the MicroNET-covered stent in consecutive patients with acute carotid-related stroke: SAFEGUARD-STROKE. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej, 20(2), 172-193. https://doi.org/10.5114/aic.2024.140963 Chicago Tekieli, Lukasz, Andrej Afanasjev, Maciej Mazgaj, Vladimir Borodetsky, Kolja Sievert, Zoltan Ruzsa, and Magdalena Knapik et al. 2024. "A multi-center study of the MicroNET-covered stent in consecutive patients with acute carotid-related stroke: SAFEGUARD-STROKE". Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej 20 (2): 172-193. doi:10.5114/aic.2024.140963. Harvard Tekieli, L., Afanasjev, A., Mazgaj, M., Borodetsky, V., Sievert, K., Ruzsa, Z., Knapik, M., Širvinskas, A., Mazurek, A., Dzierwa, K., Sanczuk, T., Mosenko, V., Urbanczyk-Zawadzka, M., Trystula, M., Paluszek, P., Wiewiorka, L., Stefaniak, J., Pieniazek, P., Slautaitė, I., Kwiatkowski, T., Mackevičius, A., Teitcher, M., Sievert, H., Q. Grunwald, I., and Musialek, P. (2024). A multi-center study of the MicroNET-covered stent in consecutive patients with acute carotid-related stroke: SAFEGUARD-STROKE. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej, 20(2), pp.172-193. https://doi.org/10.5114/aic.2024.140963 MLA Tekieli, Lukasz et al. "A multi-center study of the MicroNET-covered stent in consecutive patients with acute carotid-related stroke: SAFEGUARD-STROKE." Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej, vol. 20, no. 2, 2024, pp. 172-193. doi:10.5114/aic.2024.140963. Vancouver Tekieli L, Afanasjev A, Mazgaj M, Borodetsky V, Sievert K, Ruzsa Z et al. A multi-center study of the MicroNET-covered stent in consecutive patients with acute carotid-related stroke: SAFEGUARD-STROKE. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej. 2024;20(2):172-193. doi:10.5114/aic.2024.140963.

Safeguard

Stroke

Acute stroke

Center (category theory)

10.5114/aic.2024.140963

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Citations (4)

Association of Narrow Anterior Communicating Artery or Contralateral A1 Segment with Poor Outcomes After Mechanical Thrombectomy

Medicina (2024)

Audrius Širvinskas Giedrius Ledas Rūta Levulienė Jurgita Markevičiūtė Valerija Mosenko

Contralateral A1 and AComA aplasia/hypoplasia are critically important in distal ICA T occlusion as the protective collateral blood supply from the circle of Willis via the anterior communicating artery is compromised. Although the terms aplasia/hypoplasia are used broadly in the literature, the need for concrete measurements and data on their clinical significance is apparent. Features of the individual anatomy of the circle of Willis may determine patient outcomes. We aim to determine the cut-off values of contralateral A1 and AComA segments that determine worse outcomes for patients with acute ischemic stroke with T occlusion of the terminal internal carotid artery.

Anterior cerebral artery

Association (psychology)

Anterior communicating artery

10.3390/medicina60111749

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The use of near-infrared spectroscopy in the diagnosis of peripheral artery disease: A systematic review

Vascular (2021)

Tomas Baltrūnas Valerija Mosenko Artūras Mackevičius Vilius Dambrauskas Ingrida Ašakienė

Background Peripheral arterial disease is a stenosis or occlusion of peripheral arteries that results in compromised blood flow and muscle ischemia. The available diagnostic methods are mostly used to measure and visualize blood flow and are not useful in the evaluation of perfusion, especially in diabetic patients, which is now considered to be a research priority by most of the vascular societies around the world as this is still a relatively poorly studied phenomenon. Objective The aim of this review is to explore the clinical significance of muscle tissue oxygenation monitoring in lower-extremity peripheral artery disease diagnosis using the near-infrared spectroscopy method. Methods A systematic search in PubMed, CINAHL, and Cochrane databases was performed to identify clinical near-infrared spectroscopy (NIRS) studies in English and Russian, published until September 2019, involving muscle tissue oxygenation in peripheral arterial disease (PAD). The manuscripts were reviewed by two researchers independently and scored on the quality of the research using MINORS criteria. Results After screening 443 manuscripts, 23 studies ( n = 1580) were included. NIRS-evaluated recovery time seems to be more accurate than ankle-brachial index in diabetic patients to differentiate between moderate and severe claudication. Consistent findings across all the included studies showed that both the oxygenation and deoxygenation rates as well as the recovery times varied from patient to patient and therefore were not suitable for standardization. Conclusions The clinical relevance of routine use of NIRS to diagnose PAD is unproven; therefore, its use is not currently part of standard-of-care for patients with PAD since the absolute values seem to vary significantly, depending on the outside conditions. More data need to be provided on the possible use of NIRS monitoring intraoperatively where the conditions can be more controlled.

10.1177/17085381211025174

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Citations (13)