Browsing by Author "Kratovska, Aina"

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    Endoscopic hemostasis followed by preventive transarterial embolization in high-risk patients with bleeding peptic ulcer : 5-year experience
    (2019-09-10) Kaminskis, Aleksejs; Ivanova, Patricija; Kratovska, Aina; Ponomarjova, Sanita; Ptašņuka, Margarita; Demičevs, Jevgenijs; Demičeva, Renate; Boka, Viesturs; Pupelis, Guntars
    Background: Upper gastrointestinal bleeding (UGIB) due to peptic ulcer disease is one of the leading causes of death in patients with non-variceal bleeding, resulting in up to 10% mortality rate, and the patient group at high risk of rebleeding (Forrest IA, IB, and IIA) often requires additional therapy after endoscopic hemostasis. Preventive transarterial embolization (P-TAE) after endoscopic hemostasis was introduced in our institution in 2014. The aim of the study is an assessment of the intermediate results of P-TAE following primary endoscopic hemostasis in patients with serious comorbid conditions and high risk of rebleeding. Methods: During the period from 2014 to 2018, a total of 399 patients referred to our institution with a bleeding peptic ulcer, classified as type Forrest IA, IB, or IIA with the Rockall score ≥ 5, after endoscopic hemostasis was prospectively included in two groups-P-TAE group and control group, where endoscopy alone (EA) was performed. The P-TAE patients underwent flow-reducing left gastric artery or gastroduodenal artery embolization according to the ulcer type. The rebleeding rate, complications, frequency of surgical interventions, transfused packed red blood cells (PRBC), amount of fresh frozen plasma (FFP), and mortality rate were analyzed. Results: From 738 patients with a bleeding peptic ulcer, 399 were at high risk for rebleeding after endoscopic hemostasis. From this cohort, 58 patients underwent P-TAE, and 341 were allocated to the EA. A significantly lower rebleeding rate was observed in the P-TAE group, 3.4% vs. 16.2% in the EA group; p = 0.005. The need for surgical intervention reached 10.3% vs. 20.6% in the P-TAE and EA groups accordingly; p = 0.065. Patients that underwent P-TAE required less FFP, 1.3 unit vs. 2.6 units in EA; p = 0.0001. The mortality rate was similar in groups with a tendency to decrease in the P-TAE group, 5.7% vs. 8.5% in EA; p = 0.417. Conclusion: P-TAE is a feasible and safe procedure, and it may reduce the rebleeding rate and the need for surgical intervention in patients with a bleeding peptic ulcer when the rebleeding risk remains high after primary endoscopic hemostasis.
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    Preoperative Lateralization and Diagnostic Value of Selective Bilateral Internal Jugular Venous Sampling in Primary Hyperparathyroidism : Single-Center Experience
    (2024-03) Solodjankina, Anastasija; Kratovska, Aina; Ponomarjova, Sanita; Ivanova, Patricija; Mohammadian, Reza; Department of Radiology
    Background and Objectives: Primary hyperparathyroidism (pHPT) is a common endocrine disorder caused by excessive production of parathyroid hormone (PTH) leading to elevated calcium levels. Diagnosis is primarily based on biochemical evaluation, and surgery is the curative treatment. Imaging techniques like ultrasound and Tc-99m Sestamibi scintigraphy are used for localization, but selective Internal Jugular Venous (SVS) becomes valuable in cases of inconclusive or conflicting results. This study evaluated the diagnostic efficacy of SVS for localizing parathyroid adenomas in cases where non-invasive radiological diagnostic methods yielded inconclusive results or negative findings despite clinical symptoms suggestive of pHPT. Materials and Methods: In this retrospective study, a total of 28 patients diagnosed with pHPT underwent SVS at a tertiary center known for receiving referrals from 2017 to 2022. The diagnoses were confirmed through biochemical analysis. The SVS results in 22 patients were compared with non-invasive imaging methods, including ultrasound, scintigraphy, and computed tomography with/without contrast material. SVS was indicated when at least two non-invasive diagnostic procedures failed to clearly localize the parathyroid glands or provided ambiguous results. Results: SVS demonstrated higher sensitivity for localizing parathyroid adenomas compared to non-invasive imaging methods, accurately lateralizing the adenoma in 68.18% of cases. Among the SVS findings, 31.8% of patients had negative results, with 9.1% not having clinically proven parathyroid adenoma, while 22.7% had false negative SVS findings but were later confirmed to have adenoma during surgery. Ultrasound correctly identified the location in 45.45% of cases, CT in 27.27%, and scintigraphy in 40.9%. Conclusions: SVS is a valuable diagnostic tool for accurately localizing parathyroid adenomas in patients with inconclusive non-invasive imaging results. It aids in targeted surgical interventions, contributing to improved management and treatment outcomes in primary hyperparathyroidism.
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    Preventive transarterial embolization in upper nonvariceal gastrointestinal bleeding
    (2017-01-13) Kaminskis, Aleksejs; Kratovska, Aina; Ponomarjova, Sanita; Tolstova, Anna; Mukans, Maksims; Stabiņa, Solvita; Gailums, Raivis; Bernšteins, Andrejs; Ivanova, Patricija; Boka, Viesturs; Pupelis, Guntars
    Background: Transarterial embolization (TAE) is a therapeutic option for patients with a high risk of recurrent bleeding after endoscopic haemostasis. The aim of our prospective study was a preliminary assessment of the safety, efficacy, and clinical outcomes following preventive TAE in patients with non-variceal acute upper gastrointestinal bleeding (NVUGIB) with a high risk of recurrent bleeding after endoscopic haemostasis. Methods: Preventive visceral angiography and TAE were performed after endoscopic haemostasis on patients with NVUGIB who were at a high risk of recurrent bleeding (PE+ group). The comparison group consisted of similar patients who only underwent endoscopic haemostasis, without preventive TAE (PE- group). The technical success of preventive TAE, the completeness of haemostasis, the incidence of rebleeding and the need for surgical intervention and the main outcomes were compared between the groups. Results: The PE+ group consisted of 25 patients, and the PE- group of 50 patients, similar in age (median age 66 vs. 63 years), gender and comorbid conditions. The ulcer size at endoscopy was not significantly different (median of 152 mm vs. 127 mm). The most frequent were Forest II type ulcers, 44% in both groups. The distribution of the Forest grade was even. The median haemoglobin on admission was 8, 2 g/dl vs. 8,7 g/dl, p = 0,482, erythrocyte count was 2,7 × 1012/L vs. 2,9 × 1012/L, p = 0,727. The shock index and Rockall scores were similar, as well as and transfusion - on average, four units of packed red blood cells for the majority of patients in both groups, however, significantly more fresh frozen plasma was transfused in the PE- group, p = 0,013. The rebleeding rate was similar, while surgical treatment was needed notably more often in the PE- group, 8% vs. 35% accordingly, p = 0,012. The median ICU stay was 3 days, hospital stay - 6 days vs. 9 days, p = 0.079. The overall mortality reached 20%; in the PE+ group it was 4%, not reaching a statistically significant difference. Conclusion: Preventive TAE is a feasible, safe and effective minimally invasive type of haemostasis decreasing the risk of repeated bleeding and preparing the patient for the definitive surgical intervention when indicated.
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    The role of intraoperative 2D foot perfusion during percutaneous infrainguinal angioplasty in patients with critical limb ischemia
    (2021) Kratovska, Aina; Zdanovskis, Nauris; Zaiceva, Veronika; Ponomarjova, Sanita; Ivanova, Patrīcija; Rīga Stradiņš University
    Background. Critical limb ischemia (CLI) is an end stage of peripheral arterial disease. Percutaneous transluminal angioplasty (PTA) has gained a mainstream position in treatment of CLI. Frequently, multilevel hemodynamically significant atherosclerotic lesions are detected during PTA in patients with CLI. Therefore, intraoperative decision of intervention level and amount has to be undertaken based on macrovascular images acquired during intraoperative digital subtraction angiography (DSA) analysed by eye. Intraoperative 2D foot perfusion angiography (2DFPA) is a novel post-processing tool integrated in newest generation DSA equipment. It offers an objective quantitative analysis of different flow and contrast density parameters within region of interest (ROI). Consequently, it might become an additional objective intraoperative tool in estimation of operation volume. Aim. To establish basic protocol for 2DFPA in Riga East University Hospital and perform pilot evaluation of the parameters acquired during 2DFPA. Methods. In this case, the control study performed during June to November of 2020, and included 7 patients with CLI and intraoperative 2DFPA. 2DFPA performed through antegrade 6F 23 cm sheath in superficial femoral artery with automated injection volume/rate 15 ml/6 ml/s and fixed position of the foot during procedure. Following pre-intervention and post-intervention perfusion parameters analysed in whole foot ROI: arrival time (AT), time-to-peak (TTP), area under the curve (AuC), peak density (PD); Results. The mean age – 71.5 (54–85) years, 4 males, 3 females. CLI Rutherford class V in all patients. One patient excluded due to foot movements during procedure and noncomparable 2DFPA results. 3 patients underwent PTA of superficial femoral artery, 3 patients – infrageniculate PTA. In 4 PTA procedures defined by operator as successful based on DSA, the following 2DFPA parameters were acquired: decrease of AT and TTP, and increase of PD and AuC was found corresponding with good technical result. 2DFPA showed no improvement of parameters in one PTA defined by operator as successful and in one PTA defined by operator as not successful. Conclusion. 2DFPA is an easy and safe intraoperative analysis tool to be applied, although adaptation of protocol and patient positioning is required. Acquisition of intraoperative perfusion parameters pre- and post-treatment might serve as a marker for operation volume, if the desired perfusion goals are not achieved. Following larger scale trials have to be conducted to establish specific perfusion value ranges as treatment end-points. Medicina (Kaunas) 2021;57(Supplement 1):200 201Medicina (Kaunas) 2021;57(Supplement 1) The role of Transcranial Doppler sonography for neuromonitoring in cardiac surgery with cardiopulmonary bypass Mackevics Davis1, Leibuss Roberts2,3, Oss Elvijs2, Kalejs Martins2,3, Strike Eva2,3, Stradins Peteris2,3 1University of Latvia, Faculty of Medicine, Riga, Latvia 2Riga Stradiņš University, Faculty of Medicine, Riga, Latvia3Pauls Stradiņš Clinical University Hospital, Riga, Latvia Background. In patients undergoing cardiac surgery with cardiopulmonary bypass (CPB), blood pressure (BP) excursions outside the limits of cerebral autoregulation are associated with organ and brain dysfunction. The use of TCD has been reported in intraoperative monitoring of cerebral blood flow and air emboli by providing instant visual feedback. Individualized mean arterial pressure (MAP) management targeted to optimize cerebral autoregulation by TCD might provide a more neuroprotective approach to patient care during CPB than standardized BP management. Aim. The study aimed to analyse MAP excursions during non-pulsatile CPB effects on cerebral blood flow parameters and primary postoperative outcomes. As well as identify possible other factors affecting TCD. Methods. 50 elective cardiac surgeries with CBP performed in a University Clinical Hospital. The right and left middle cerebral artery blood flow velocity was assessed using TCD and analysed for spectrum. Measurement intervals: after anaesthesia induction, 15 minutes after aortic cross-clamping, and 15 minutes after CBP. The average pulsatility index (PI), time-averaged peak velocity (TAPV), resistance index (RI), end-diastolic velocity (EDV), peak systolic velocity (PSV) were recorded and compared. Results and discussion. A total of 50 patients were included. The mean age 64.76 (42–81) years; CPB 101.14 (54–184) minutes; Ejection fraction 52.50 (20–72); Body mass index 29.08 (19.48–44.41); Diabetes occurred in 38 patients; Pulmonary arterial hypertension (PAH) I occurred in 18 patients, 21 patients – PAH II; Blood transfusions were performed in 22 patients; Catecholamines was required in 21 patients; Patients who stayed longer in the ICU had more comorbidities – nine patients stayed in the ICU for 9–65 days (median 4.64). MAP during CPB was 66.18 (50–80). The blood transfusion rate showed no significant differences. Hematocrit was decreased postoperatively (mean 29) compared to preoperative values (mean 37.7); during CPB 25.6. CPB during cardiac surgery has been demonstrated to cause alterations of the cerebral blood flow. RI was affected by gender (p=0.08), type of operation (p=0.09) and CHF (p=0.08); PI was affected by gender (p=0.02), diabetes (p=0.06) and PAH (p=0.02); PSV was affected by presence of diabetes (p=0.04), PAH (p=0.006), heart rate (p=0.04), TAPV (p=0.05); Conclusion. TCD method can be considered for multimodal neuromonitoring in cardiac surgery. TCD can be a useful guiding instrument for adequate hemodynamic parameters, confirming the adequacy of cerebral perfusion strategy or the need for its optimization. Acknowledgements. The authors declare the absence of conflict of interest. Medicina (Kaunas) 2021;57(Supplement 1):201 202Medicina (Kaunas) 2021;57(Supplement 1) Evaluation of STEMI caused by the atherosclerotic disorder of the specific coronary artery Rėkus Algirdas1, Jaruševičius Gediminas2, Aldujeli Ali2 1Lithuanian University of Health Sciences, Faculty of Medicine, Kaunas, Lithuania 2 Lithuanian University of Health Sciences, Department of Cardiology, Kaunas, Lithuania Background. ST-elevation myocardial infarction (STEMI) is an acute condition best treated by percutaneous coronary artery (CA) intervention. This retrospective study attempted to assess the association between STEMI caused by CA and disease risk factors, studies conducted and treatment data. Aim. To evaluate the connections between CA and of STEMI – experienced patients’ data of those admitted to the Lithuanian University of Health Sciences Department of Cardiology. Methods. A retrospective single-centre study was conducted of 745 STEMI patients. Patients were divided into four groups, depending on CA induced STEMI: right coronary artery (RCA), left main artery (LM), left anterior descending (LAD), left circumflex (LCx). Gender, age, history of smoking, diabetes mellitus (DM), obesity, arterial hypertension (AH), TIMI flow before and after reperfusion, total number, length and diameters of stents used, initial laboratory tests: haemoglobin, glucose, creatinine, troponin I (TnI), potassium, leukocytes, total (TC), high (HDC) and low (LDC) – density cholesterol, triglyceride levels (TG) and mortality were evaluated. Chi-square test, Student’s t-test, independent – samples Kruskal- Wallis test, ANOVA were used for analysis. The value of p≤0.05 was considered statistically significant. Results. The study evaluated 756 STEMI patients. No statistical significance was found between the CA and data: gender (p=0.217), age (p=0.466), smoking (p=0.378), DM (p=0.296), obesity (p=0.095), AH (p=0.194), TIMI flow before (p=0.173) and after intervention (p=0.488), number of stents used (p=0.629), initial laboratory tests: glucose (p=0.690), creatinine (p=0.156), TnI (p=0.808), potassium (p=0.185), leukocytes (p=0.912), TC (p=0.217), LDC (p=0.187), TG (p=0.4) and mortality (p=0.461). The statistical significance of the following data was determined: the total length of stents used in RCA was longer than LCx (p=0.03), the total diameter of the stents used in LAD was larger than RCA (p=0.02), the initial haemoglobin concentration was lower in LAD than RCA (p=0.02), HDC was found to be higher in LAD than in RCA (p=0.004). Conclusion. For the RCA, longer stents were used in general than the LCx, but the total stents’ diameter for the LAD was larger than in case of the RCA. The haemoglobin concentration was lower in the LAD than in the RCA. HDC was found in higher concentration among LAD than the RCA. Medicina (Kaunas) 2021;57(Supplement 1):202 203Medicina (Kaunas) 2021;57(Supplement 1) Platelet activity and its correlation with inflammation and cell count readings in chronic heart failure patients with reduced ejection fraction Mongirdienė Aušra1, Laukaitienė Jolanta1,2, Skipskis Vilius3 1Lithuanian University of Health Sciences, Institution Department of Biochemistry, Kaunas, Lithuania 2Lithuanian University of Health Sciences, Cardiology Clinic, University Hospital, Kaunas, Lithuania 3Lithuanian University of Health Sciences, Institute of Cardiology, Laboratory of Molecular Cardiology, Kaunas, Lithuania Background. There has been an increasing interest in the role of inflammation in thrombosis complications in chronic heart failure (HF) patients. The incidence of thrombosis in HF is shown to be the highest in patients classified as NYHA IV. It is stated that inflammation is regulated by platelet-induced activation of blood leukocytes. Aim. The objective of the current study was to compare the platelet and cell count readings in chronic HF with reduced ejection fraction (HFrEF) patients according to NYHA functional class and to evaluate the correlation between those readings. Methods. Total of 185 patients were examined in complete blood cell count, platelet aggregation, C reactive protein (CRP), NT-proBNP, cortisol, fibrinogen concentration. Results. Mean platelet volume (MPV) increased with deterioration of a patient’s state (p<0.005). Lymphocyte count and percent were the lowest in NYHA IV group (p<0.005). Neutrophil percent and count, monocyte percent and count were the highest (p<0.045) in NYHA IV. ADP and ADR-induced platelet aggregation was higher in NYHA III group compared to NYHA II and I group (p<0.023). NYHA functional class correlated with MPV (r=0.311, p=0.0001), lymphocyte count (r=-0.186, p=0.026), monocyte count (p=0.172, p=0.041), and percent (r=0.212, p=0.011). CRP concentration correlated with NT-proBNP (r=0.203, p=0.005). MPV correlated with fibrinogen concentration (r=0.244, p=0.004). Neutrophil count correlated with fibrinogen concentration (r=0.308, p=0.0001), evening cortisol concentration (r=0.256, p=0.009), and CRP (r=0.378, p=0.0001). Lymphocyte percent correlated with fibrinogen concentration (r=-0.174, p=0.03), CRP (r=-0.220, p=0.028), and evening cortisol concentration (r=-0.246, p=0.012). Monocyte percent correlated with fibrinogen concentration (r=0.175, p=0.03). Monocyte count correlated with morning cortisol, fibrinogen concentration (r=0.279, p=0.004 and r=0.315, p=0.0001, respectively) and CRP (r=0.315, p=0.0001). Conclusion. 1) MPV could be considered as additional reading reflecting patient’s condition; use of MPV identifying patients at risk of hypercoagulable state should be evaluated in more extensive studies; 2) increasing neutrophil and monocyte count could indicate a higher inflammatory state in chronic HFrEF. Acknowledgements. The authors declare the absence of conflict of interest. No outside funding has been received for the current study. Medicina (Kaunas) 2021;57(Supplement 1):203
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    Spontaneous isolated superior mesenteric artery dissection : A case report and brief analysis
    (2023-09) Kratovska, Aina; Ponomarjova, Sanita; Ivanova, Patricija; Ligers, Arturs; Mohammadian, Reza; Department of Radiology
    This case report describes the clinical presentation, diagnostic approach, and treatment strategies for a 58-year-old male patient diagnosed with spontaneous isolated superior mesenteric artery dissection (SISMAD). The patient presented with suddenonset abdominal pain and was diagnosed with SISMAD using computed tomography angiography (CTA). SISMAD is a rare but potentially serious condition that can lead to bowel ischemia and other complications. Management options include surgery, endovascular therapy and conservative management with anticoagulation and close observation. The patient was managed conservatively with antiplatelet therapy and close follow-up. During hospitalization, he received antiplatelet therapy and was closely monitored for signs of bowel ischemia or other complications. The patients' symptoms gradually improved over time, and he was eventually discharged on oral mono- antiagreggation therapy. Clinical follow-up showed a significant symptimatic improvement. Conservative management with antiplatelet therapy was chosen due to the absence of bowel ischemia signs and overall stable clinical condition of patient. This report emphasizes the importance of prompt recognition and management of SISMAD to prevent potentially life-threatening complications. Conservative management with antiplatelet therapy can be a safe and effective treatment option for SISMAD, especially in cases without evidence of bowel ischemia or other complications.