Cerebral monitoring during carotid endarterectomy using transcranial cerebral oximetry.

OBJECTIVE: This study aimed to evaluate the outcomes of carotid endarterectomies (CEA) performed using transcranial cerebral oximetry as cerebral monitoringMETHODS: This single-center study included patients treated surgically for significant stenosis of the internal carotid artery (ICA) from January 2012 to December 2017RESULTS: Of the 654 patients, 267 were asymptomatic, and 387 were symptomatic. Eversion CEA was performed in 64.8 %, and patched conventional CEA in 35.2 % of all patients. Totally 11.4 % of all patients had a shunt inserted; all patients with the inserted shunt had the conventional pathed CEA. Severe postoperative complications occurred in 1.5 % of asymptomatic patients and 2.6 % of symptomatic patients. The stroke and death ratio in the shunted group was 2.7 %, and in the non-shunted group, 2.1 % (p = 0.7). We found no significant difference in severe postoperative complications between the shunted and non-shunted group. Further, we found the male gender (p = 0.005), coronary artery disease (p = 0.01), and ongoing smoking (p = 0.003) to be significantly associated with neurological symptoms of the ICA stenosis. We also confirmed current tobacco smoking to be significantly associated with the occurrence of postoperative stroke and death (p = 0.005)CONCLUSION: We found transcranial cerebral oximetry to be reliable in the determination of shunt insertion (Tab. 6, Ref. 26).

Results of surgical treatment of inferior vena cava tumor thrombi in renal cell carcinoma.

INTRODUCTION: Thrombosis of inferior vena cava (IVC) is an important complication amongst oncological patients. Tumor thrombus of IVC is characteristic for patients with renal cell carcinoma, occurring in 1018%. The aim of the work is to analyze of surgical treatment in patients with cancer thrombosis of inferior vena cava in kidney cancer. METHODS: Between 2010 and 2019 we treated 32 patients with kidney cancer complicated by thrombotic infiltration of the inferior vena cava. According to Nesbitt classification the levels of thrombotic infiltration of the inferior vena cava were: I-8 (25%), II-14 (43.8%), III-6 (18.8%), and IV-4 (12.5%). Nephrectomy with thrombectomy of the cancer thrombus in the inferior vena cava was performed in all patients. In addition to laparotomy, sternotomy was approached in 4 patients with Nesbitt IV and in 2 patients with Nesbitt III. RESULTS: Primary suture of IVC was performed in 26 patients; angioplasty of IVC was performed in 4 patients; and resection of IVC with replacement using a polytetrafluoroethylene interposition graft was done in 2 patients. Radical surgical treatment was performed in 27 (84.3%) patients, and palliative in 5 (15.6%) patients. In the postoperative period, 1 (3.1%) patient (Nesbitt IV) died of cardiac failure during hospitalisation. Two-year survival was observed in 75% of the cases. CONCLUSION: Tumorous infiltration of IVC is associated with a high potential for tumour embolisation to the lungs, leading to the formation of multiple metastases and spreading of the underlying disease. Postoperative comfort is improved considerably after nephrectomy of the affected kidney and removal of the tumour thrombus, including IVC resection as appropriate, and when combined with oncological treatment, the survival rate is increased significantly, as well.

Celiac axis compression syndrome - diagnostic and surgical treatment.

INTRODUCTION: Celiac axis compression syndrome is one of the causes of chronic abdominal ischemia. The authors describe their experience with the surgical treatment of Dunbar syndrome in 12 patients. The purpose of the authors was a retrospective analysis of the surgical treatment of celiac axis compression syndrome. METHOD: Between 2007 and 2016, we treated 12 patients for the celiac axis compressive syndrome. Each patient has performed abdominal sonography, CT-angiography, or angiography. The method of choice in these patients was surgical treatment. In 4 patients we resected median arcuate ligament and nerve fibers of celiac axis. In 8 patients we had to resect the stenotic or occluded celiac axis. We reconstructed the blood supply to the celiac axis by the aorto-celiac bypass, using prothetic or venous grafting or patch plastic of celiac axis stenosis. RESULTS: There were no significant complications and deaths in the post - operative period. In one patient signs of chronic abdominal ischemia postoperatively persist. CONCLUSION: Surgery is the method of choice of celiac axis compression syndrome. Indications for surgical reconstruction are symptomatic patients with arterial stenosis over 50%. Proper diagnosis and early surgical treatment are essential for treating chronic visceral ischemia and reducing surgical complications. Key words: celiac axis compression syndrome - chronic abdominal ischemia - resection of ligamentum median arcuate.

[Leiomyoma of external iliac vein]. / Leiomyóm vena iliaca externa.

Authors present a case report of a patient who was diagnosed with a tumour of external iliac vein. Excision of venous wall with tumour and reconstruction of external iliac vein with venous patch was performed. Postoperative course was without complication. The patient is without complications and also without signs of recurrence in one year follow up. Tumours of venous wall are rare. They originate from vena cava inferior, less often from extremity veins. The most frequent primary tumours of vein wall are leiomyosarcomas. Secondary tumours that involve venous wall are more common than primary tumours. Primary renal carcinoma or sarcomas of retroperitoneum represent a tumour that invades vena cava inferior. The diagnosis is based on CT and MRI. Surgical resection remains the mainstay of treatment. Chronic well collateralized obstruction is not necessary to reconstruct. Vena cava inferior and iliac veins are reconstructed with PTFE graft. Extremity veins are reconstructed using venous graft from great saphenous vein. Perioperative mortality after resection of vena cava inferior and pelvic veins is up to 6.9% major morbidity up to 33% and a fiveyear survival up to 52%. Patients with infrarenal involvement of vena cava have better outcomes than patients with involvement of retrohepatal vena cava inferior.Key words: venous tumour leiomyoma of venous wall.

FEATURES OF FORMATION OF COLLATERAL CIRCULATION IN PATIENTS WITH SUBCLAVIAN STEAL SYNDROME.

To date in patients with subclavian steal syndrome diagnosis is only grade of stenosis or localization of occlusion described. Authors recommend to take into account also type of a collateral compensation of cerebral circulation for selection of an optimal treatment The objective of the research was to study the features of formation of collateral circulation in patients with subclavian steal syndrome. The authors described changes in the direction of blood flow in the extracranial vessels of 42 patients with subclavian steal syndrome. Latent subclavian steal syndrome was detected in 26.2% of patients, transient subclavian steal syndrome was found in 54.8% of patients, and a persistent course of the disease was observed in 19.9% of patients. Symptoms of vertebrobasilar insufficiency were detected in 26.6% of patients, and combination of chronic upper extremity ischemia and vertebrobasilar insufficiency was diagnosed in 73.8% of patients. When analyzing the features of collateral circulation in 64.3% of patients the extracranial compensatory mechanism was observed being provided by three main groups of collateral hemodynamic reallocation: the occipito-vertebral hemodynamic mechanism of compensation was detected in 38.1% of cases, the thyroid compensatory mechanism was found in 16.7% of cases, and the brain stem-occipital compensatory mechanism was observed in 9.5% of cases. In 35.7% of patients the intracranial compensatory mechanism was observed being provided by two main groups of collateral hemodynamic reallocation: the vertebro-vertebral compensatory mechanism was found in 21.4% of cases and cerebrobasilar compensatory mechanism was detected in 14.3% of cases. Consideration of the features of collateral circulation in patients with subclavian steal syndrome may serve as a prognostic criterion for selecting an optimal treatment tactics.Each of compensatory mechanisms has its own hemodynamic peculiarities. The occipito- vertebral compensatory mechanism has the most positive influence on the compensationof hemodynamic failure of the vertebrobasilar basin.

[Acute arterial occlusions of the upper extremities--clinical data]. / Akútne uzávery tepien horných koncatín--nás klinický materiál.

The authors describe 30 cases of acute arterial occlusions of upper extremity during the last 10 years (1992-2001) in a group of 27 patients. In 27 cases the occlusions were caused by embolism and in 3 cases by acute thrombosis. In the group were 12 men and 18 women. The embolus was the most frequently located in brachial artery (cubital)--17 times (63%). In one case we were forced to perform amputation of left upper extremity for gangrene. Authors accentuate that early and adequate treatment lead to salvage of extremity in 80-100%.

[Review of revascularization and arterial reconstructive procedures in arteriosclerosis performed at the Hospital in Lucenec]. / Prehl'ad revaskularizacných a rekonstrukcných arteriálnych výkonov pre artériosklerózu v NsP v Lucenci.

The authors present a review of revascularisation and reconstruction operations for arteriosclerosis in a group of 2341 patients (1754 (75%) operations). Direct reconstruction operations were made 825 times (47%), indirect operations--sympathectomy 598 times (34.1%) and endovascular intervention 331 times (18.9%). Intervention vascular radiology significantly changes the indication, the strategy and the tactics of surgical treatment of arteriosclerosis and its complications.