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).

[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.

[EXTRAANATOMIC ARTERIAL RECONSTRUCTION IN PATIENTS WITH ATEROSCLEROTIC AFFECTION OF THE AORTAL ARCH BRANCHES].

Own experience of extraanatomical reconstruction, made for atherosclerotic affection of the aortal arch branches, was analyzed. A subclavian artery (SA) transposition into common carotid artery (CCA) was conducted for symptomatic subtotal stenosis or occlusion of the SA I segment. While extension of atherosclerotic process beyond boundaries of the SA I segment or technical difficulties a carotid-subclavian shunting was preferred. Carotid-carotid shunting was applied in necessity of revascularization of extracranial arteries before endovascular implantation of a stent-graft down to aortal arch with closure of the left CCA branching. The authors consider extraanatomic reconstruction the method of choice in the patients surgical treatment for central atherosclerotic affection of the aortal arch branches, when possibilities of endovascular revascularization methods are exhausted, and this guarantees good and satisfactory results in 91.7% of them.

[Surgical prevention of acute stroke in atherosclerotic carotid stenosis].

The results of carotid endarterectomy performed in 687 patients for the symptomatic and asymptomatic carotid stenosis. Operation in most patients was performed under general anesthesia with intraoperative transcranial oximetry monitoring. Early good and satisfactory postoperative results in patients with symptomatic atherosclerotic carotid stenosis were 95.9% in asymptomatic and 97.2% in symptomatic patients. Hemodynamically significant restenosis over 50% of chink in 3 years follow-up was found in 3.4% patients. Eversion endarterectomy application permite to reduce the duration of the operation. Transcranial oximetry application during surgery helps to realise best surgical tactics and is helpful on decision to use or not an intraoperative shunt.

[Endovascular treatment of carotid artery stenosis with cerebral protection: 5-year experience]. / Endovaskulární lécba stenóz karotických tepen s pouzitím cerebrální protekce: petileté zkusenosti.

BACKGROUND: Percutaneous transluminal angioplasty and stenting with cerebral protection is a minimally invasive method for carotid artery stenosis treatment, which may be an alternative to surgical endarterectomy. The aim of our study is to evaluate results of endovascular treatment in patients at high risk of endarterectomy. PATIENTS AND METHODS: Between years 2001-2006, 210 carotid artery stenoses in 204 patients were treated in our department. Fourty seven percent of patients suffered from symptomatic stenosis, asymptomatic stenosis was proved in 53% of patients. All asymptomatic patients had stenosis more than 70% measured according to NASCET, mostly with contralateral carotid artery occlusion. RESULTS: The procedure was technically successful in 99% of patients, mortality was 0.49%. Periprocedural embolic complications based on transient ischemic attack were observed in 2.39% of patients, symptoms of minor stroke in 0.47% and symptoms of major stroke in 0.47% of patients. The mortality and disabled morbidity rate in the whole group was 0.96%. One hundred and fifty three patients (73%) were followed up, during this time, 7 patients (3.9%) developed hemodynamically significant restenosis. CONCLUSION: Endovascular carotid artery stenosis treatment with cerebral protection seems to be a safe method of treatment with acceptable short-term results. However, long-term follow-up is needed to get enough data about safety and effectiveness of this method compared to endarterectomy and best medical therapy.

[Reconstructive operations in our clinical data]. / Rekonstrukcné operácie v nasom klinickom materiáli.

The authors present the results of reconstructive vascular operations performed during the period from 1990 to 1994. According to the criteria of the European Vascular Surgery Council the lowest patency was recorded in the distal type of femoropopliteal bypasses in the lower extremities. They emphasize the necessity to apply the "Graft Surveillance Programme" in vascular consultation centre. (Tab. 2, Ref. 7.).

Urinary excretion of zinc and magnesium in malignant melanoma.

As zinc is the dominant trace element of melanin pigmentation, its urinary excretion was studied in 63 patients with malignant melanoma and also in groups of carcinoma patients and normal subjects. For comparison, magnesium excretion was also measured. As the melanoma progressed, the zinc excretion increased, but there was no correlation between the magnesium excretion and the stage of melanoma. There were no significant differences in excretion of either metal between the groups of treated melanoma patients, normal individuals, or the carcinoma patients.