Efficacy and safety of urgent carotid endarterectomy in patients with acute ischemic stroke.

INTRODUCTION: Acute symptomatic occlusion of the internal carotid artery (ICA) is associated with unfavorable prognosis. However, no clear definition of its optimal treatment exists. The aim of this study was to evaluate the efficacy and risks of urgent carotid endarterectomy (CEA) in patients with ischemic stroke due to acute extracranial ICA occlusion. METHODS: A retrospective analysis was performed of all consecutive patients undergoing urgent CEA for acute extracranial ICA occlusion during the period from July 2014 to June 2021. The primary outcome was functional independence at three months defined as modified Rankin Scale (mRS) score 2. Secondary outcomes included the severity of the neurological deficit at the time of discharge and its comparison with the preoperative condition as assessed using the National Institutes of Health Stroke Scale (NIHSS), the incidence of symptomatic intracerebral hemorrhage (ICH), and 30-day periprocedural mortality. RESULTS: During the study period, a total of 42 urgent CEAs were performed for acute extracranial ICA occlusions. The median preoperative NIHSS score was 7 (interquartile range [IQR] 5-13). The median time interval between the onset of symptoms and surgery was 290 minutes (IQR 235-340). Technical success rate of urgent CEA was 97.6% (41 patients). The median NIHSS at the time of hospital discharge was 2 (IQR 3-7; p.

Aneurysm of pancreaticoduodenal arcade caused by medial arcuate ligament syndrome - case report and review of literature.

INTRODUCTION: Visceral artery aneurysms are rare vascular pathologies. They are usually incidental findings during the examination for other reasons. The most common clinical symptoms are nonspecific abdominal pain and bleeding caused by their rupture, with a severe clinical presentation. Aneurysms of pancreaticoduodenal arcade are more common in patients with well-developed collateral circulation due to the coeliac trunk stenosis or occlusion. CASE REPORT: In this case report the authors present a rare case of a patient with incidental finding of pancreaticoduodenal arcade aneurysm in the setting of severe stenosis of coeliac trunk origin caused by medial arcuate ligament compression. The diameter of the aneurysm was 40 mm and endovascular treatment was not possible because of unfavorable anatomical setting. The patient was successfully treated with resection of the aneurysm and the division of medial arcuate ligament during one surgery. CONCLUSION: There is no correlation between the diameter and the risk of rupture of the pancreaticoduodenal arcade aneurysm. Because of high morbidity and mortality of their rupture, most authors recommend active treatment of these aneurysms. The necessity to treat truncus coeliacus stenosis or occlusion remains a controversial issue.

Combined endovascular and surgical treatment of symptomatic tandem occlusion of common carotid artery and middle cerebral artery - case repor.

INTRODUCTION: Cerebrovascular events are among the most common causes of invalidity or death. The aim of treatment in acute cerebral ischemia is to restore the blood flow before irreversible necrosis of brain tissue and persistent neurologic deficit occur. Pharmacological, endovascular and surgical methods are employed in the treatment of these patients. CASE REPORT: The authors present a case report of a 56-year-old woman with acute cerebral ischemia caused by tandem occlusion of the left common carotid artery and the M1 segment of middle cerebral artery. In the initial phase the patient was treated by intravenous thrombolysis with minimal success. Common carotid artery was occluded and mechanical extraction of embolus was successfully performed through direct carotid bifurcation puncture. Almost complete regression of neurologic deficit occurred after the endovascular recanalization. Occluded common carotid stump and bifurcation was considered as a source of embolization and therefore, to prevent further cerebrovascular event, a subclavian-carotid bypass was performed on the 15th day after the stroke. CONCLUSION: In the reported patient with symptomatic tandem occlusion of common carotid artery and the M1 part of middle cerebral artery, recanalization of cerebral artery was attained by the combination of pharmacological and endovascular method. Consequent subclavian-to-carotid bypass was performed in tertiary prevention of further cerebrovascular event.

[Femoropopliteal deep vein thrombosis and popliteal artery pseudoaneurysm as a complication of multiple hereditary osteochondromatosis]. / Femoropopliteální zilní trombóza a pseudoaneuryzma popliteální tepny jako komplikace mnohocetné hereditární osteochondromatózy.

Osteochondromas (exostoses) are the most common benign bone tumours. In most cases, osteochondroma occurs as a solitary lesion. Hereditary multiple osteochondromatosis is an autosomal dominant disorder manifested by multiple exostoses most commonly located at the metaphyses of long bones, the iliac crest, the ribs, the vertebral borders, and scapulas. Vascular complications of multiple osteochondromatosis are very rare, most frequently affecting the popliteal artery. The authors report the case of a 27-year-old female patient with hereditary multiple osteochondromatosis that was complicated by femoropopliteal deep vein thrombosis and giant popliteal artery pseudoaneurysm.

[Popliteal artery entrapment syndrome]. / Entrapment syndrom podkolenní tepny.

Popliteal artery entrapment syndrome is a rare cause of lower limb ischaemia. It is caused by an abnormal relationship between popliteal artery and its surrounding musculotendineous structures (anatomic entrapment). Functional popliteal entrapment is characterized by normal anatomic relationships within popliteal fossa. The true incidence is unknown, it usually affects young patients, typically men, and is clinically presented with symptoms of calf claudication, calf cramping, coldness and paresthesia. CT angiography and MR angiography have become an imaging technique of choice. The mainstay surgical procedure is popliteal artery release. In cases of popliteal artery damage autologous saphenous vein bypass grafting offers the best long-term results. Authors on the basis of two case reports describe the clinical course, diagnosis and surgical technique used in the treatment of patients with advanced popliteal artery entrapmentsyndrome.

Prognostic value of various intracranial pathologies in traumatic brain injury.

OBJECTIVE: Various intracranial pathologies in traumatic brain injury (TBI) can help to predict patient outcomes. These pathologies can be categorised using the Marshall Classification or the Abbreviated Injury Scale (AIS) dictionary or can be described through traditional descriptive terms such as subarachnoid haemorrhage (SAH), subdural haemorrhage (SDH), epidural haemorrhage (EDH) etc. The purpose of this study is to assess the prognostic value of AIS scores, the Marshall Classification and various intracranial pathologies in TBI. METHODS: A dataset of 802 TBI patients in the Trauma Audit and Research Network (TARN) database was analysed using logistic regression. First, a baseline model was constructed with age, Glasgow Coma Scale (GCS), pupillary reactivity, cause of injury and presence/absence of extracranial injury as predictors and survival at discharge as the outcome. Subsequently, AIS score, the Marshall Classification and various intracranial pathologies such as haemorrhage, SAH or brain swelling were added in order to assess the relative predictive strength of each variable and also to assess the improvement in the performance of the model. RESULTS: Various AIS scores or Marshal classes did not appear to significantly affect the outcome. Among traditional descriptive terms, only brain stem injury and brain swelling significantly influenced outcome [odds ratios for survival: 0.17 (95% confidence interval [CI]; 0.08-0.40) and 0.48 (95% CI; 0.29-0.80), respectively]. Neither haemorrhage nor its subtypes, such as SAH, SDH and EDH, were significantly associated with outcome. Adding AIS scores, the Marshall Classification and various intracranial pathologies to the prognostic models resulted in an almost equal increase in the predictive performance of the baseline model. CONCLUSIONS: In this relatively recent dataset, each of the brain injury classification systems enhanced equally the performance of an early mortality prediction model in traumatic brain injury patients. The significant effect of brain swelling and brain stem injury on the outcome in comparison to injuries such as SAH suggests the need to improve therapeutic approaches to patients who have sustained these injuries.

A modified radiofrequency-assisted approach to right hemihepatectomy.

AIMS: To evaluate a modified radiofrequency-assisted approach to right hemihepatectomy. METHODS: Following a bilateral subcostal incision and intraoperative ultrasonography, the liver was mobilized in the standard manner, and a cholecystectomy was performed. The portal vein was isolated, encircled, and ligated. After demarcating the liver parenchyma, coagulation necrosis was achieved using a radiofrequency-assisted device along the line demarcated for transecting the liver parenchyma. The actual transection of the liver parenchyma and the right portal vein was done using a surgical scalpel along the radiofrequency-coagulated line. The right hepatic vein was coagulated using the radiofrequency sealer or by stitching in the resection plane. The hepatic artery was not dissected and was sealed together with the bile ducts in the resection plane using the radiofrequency instrument. The hepatic vein was not divided. RESULTS: Between July 2005 and July 2006, a total of 49 liver resections were performed in our unit. Of these, the radiofrequency-assisted technique was used in 33 cases with metastatic disease; 14 of these cases had right hemihepatectomies, including 2 repeat resections. The mean operation time was 180min (range, 120-240min), and the average blood transfusion was 0.14U (range, 0-2U). Postoperatively, there was no morbidity, such as bleeding, infection, or biliary fistula, related to the liver resection technique, and no patients died as a result of surgery. In 8 out of the 14 right hemihepatectomies, a right-sided pleural effusion was observed; 3 of them required evacuation. CONCLUSION: This paper describes a modified radiofrequency-assisted hemihepatectomy, which allows one to obtain control of the portal blood flow going into the resected part of liver. The modified approach appears to be simple and safe.

[Radiofrequency assisted liver resection in non-cirhotic liver. Initial clinical experience]. / Radiofrekvencne asistovaná resekce v necirhotických játrech. První klinické zkusenosti.

AIM OF THE STUDY: To evaluate the radiofrequency assisted liver resection using Habib sealer (RITA Medical System, Inc., Mountain View, CA). METHODS: The operation time, liver transection time, transfusion units used, and postoperative complications were recorded in a prospective way. RESULTS: 22 liver resections were performed between July 2005 and December 2005, 15 of them were done using radiofrequency technique. Twelve anatomical resections and three non-anatomical resections were performed in total. The mean operation time equalled 155 (120-240) minutes. An average of 0.6 (0-4) transfusion units was used. In 13 of the 15 operations, which represent 86% of the patients, no transfusions were used. Postoperatively, no major bleeding from the resection plane was noted and no biliary fistula was observed. CONCLUSIONS: Radiofrequncy assisted liver resection is a safe technique with the major benefit of minimal perioperative blood lost.

[Intraoperative enteroscopy--personal experience from 1995 to 2002]. / Intraoperacní enteroskopie--vlastní zkusenosti z období 1995-2002.

Authors present their experience with the intraoperative enteroscopy method--an invasive technique of small bowel examination. It is performed under narcosis at an operating theatre (i.e. in co-operation with surgeon and anaesthesiologist). The endoscopy-performing physician becomes one of the members of the operating team. The advantage of the method is the possibility to examine of the whole small intestine and to solve immediately the pathological findings by endoscopic or surgical intervention. The examination is invasive and the correct indication is mandatory. Authors report their results of 18 intraoperative panendoscopies of small intestine.

Intrahepatic portal vein branches after extrahepatic portal vein occlusion. Experimental study.

BACKGROUND/AIMS: Prehepatic portal hypertension caused by extrahepatic portal vein occlusion is a situation in which hepatocytes are not damaged by disease despite the fact that portal blood is unable to reach them due to portal vein occlusion. We explored the patency of intrahepatic portal vein branches after extrahepatic portal vein occlusion for the possibility of revascularization by splenoportal shunt. METHODOLOGY: Prehepatic portal hypertension was induced in 8 mini-pigs by external compression of the portal vein with a device consisting of an inflatable silicone balloon mounted on a silicone cuff and attached to a subcutaneous chamber. Another device consisting of cannula and a subcutaneous chamber was placed into the splenic vein for portal pressure monitoring and portal venograms. Both devices were placed during laparotomy with their chambers positioned subcutaneously. Portal vein compression was initiated one week later and was accomplished in two steps. Extrahepatic portal vein occlusion and the patency of intrahepatic portal vein branches were confirmed by direct portal venography. Alteration of the intrahepatic portal bed was examined at necropsy after 4 weeks, checking for the presence of occlusion or thrombosis. RESULTS: Portal vein occlusion was achieved in 5 animals, while severe stenosis was demonstrated in the remaining three. Portal venograms demonstrated patency of the lobar portal vein branches filled by hepatopetal collaterals around the occluded portal vein. All intrahepatic branches were free of thrombus at gross examination. CONCLUSIONS: In the absence of the hepatic parenchymal disease, lobar intrahepatic portal vein branches remain patent despite truncal portal vein occlusion and are supplied by rapidly developed hepatopetal collaterals.

[The spiral Z-stent with a knit dacron coating in endoluminal therapy of aneurysms of the abdominal aorta]. / Spirální Z stent potazený dacronovým úpletem v endoluminální terapii aneuryzmatu brisní aorty.

The authors present their own experience with construction, experimental testing and clinical application of endoluminal grafts. In the first part of the project, a new selfexpandable stentgraft was constructed on the basis of spiral Z stent. Spiral Z stent was covered by ultrathin polyester sleeve. Next, stentgraft was tested on animal model of abdominal aortic aneurysm. On the basis of experimental results endoluminal grafting of AAA was started in Czech Republic.

A feasibility study of roquinimex (Linomide) and alpha interferon in patients with advanced malignant melanoma or renal carcinoma.

Thirty-one patients with advanced renal carcinoma or malignant melanoma were treated in the first feasibility study of alpha-interferon (Roferon) and the new oral immunomodulating agent, Linomide. Linomide 5 mg or 10 mg p.o. daily was given for 2 weeks; alpha-interferon was then added at 3 MU s.c. three times weekly, escalating in each patient by 3 MU per week, if tolerable, up to 12 MJ. The combination was poorly tolerated with nausea, vomiting, somnolence and myalgia commonly reported. Adverse events accounted for treatment withdrawal in ten patients and contributed to withdrawal in four other patients. Treatment with Linomide alone in the first 2 weeks led to a significant increase in white blood cells, neutrophils and platelets. When alpha-interferon was added, the platelet count decreased significantly over the following 6 weeks. Nineteen patients had white cell phenotype and function measured. After 2 weeks of 5 mg Linomide, a transient but significant decrease in the absolute number of activated T-helper cells (CD4+DR+) was observed. No changes in natural killer (NK) cell number or activity were observed. Twenty-two patients were evaluable for response. One with metastatic renal cell carcinoma had a complete response and six had stable disease. This study does not support the use of the combination because significant toxicity was seen without the anticipated immunological benefits.

Dissection of the infrarenal aorta treated by stent graft placement.

Aortic dissection is primarily localized in the thoracic aorta. Dissection of the abdominal aorta is exceedingly rare, especially in the absence of a blunt abdominal trauma. Two cases of a primarily infrarenal aortic dissection were diagnosed by US, CT and angiography. The patients were treated by stent graft placement. The stent grafts were introduced via a femoral arteriotomy through the introducer sheath and were placed so that they occluded entry and reentry of aortic dissection. The stent graft placement caused total obliteration of a false channel of the dissection immediately after endoprosthesis deployment. The patients were followed-up by CT and angiography at 16 and 3 months after surgery without complication.

Juxtarenal aortic aneurysm associated with a horseshoe kidney. Transfemoral endoluminal repair.

Horseshoe kidney complicates aortic aneurysm surgery in 1 of 200 cases. A patient with asymptomatic juxtarenal aortic aneurysm associated with a horseshoe kidney was successfully treated by stent graft placement. The kidney was supplied by 4 renal arteries. The proximal uncovered part of the stent graft was anchored across the origin of 1 renal artery. Another renal artery, arising from the aneurysmal sac, was occluded by the covered part of the stent graft. A kidney infarction developed postoperatively, which did not affect renal function or blood pressure. The patient was discharged from the hospital in good condition. Follow-up computed tomography and angiography confirmed a satisfactory result of the endovascular treatment.

Juxtarenal aortic aneurysm: endoluminal transfemoral repair?

Endoluminal transfemoral repair of an abdominal aortic aneurysm by a stent graft placement requires a segment of the nondilated infrarenal aorta of at least 15 mm long for safe stent graft attachment. The possibility of endoluminal treatment of a juxtarenal abdominal aortic aneurysm with partially covered spiral Z stent was assessed in experiment and in three clinical cases. In the experiment, the noncovered spiral Z stent was placed into the abdominal aorta, across the origins of renal arteries and mesenteric arteries, in six dogs. In the clinical cases, a partially covered stent graft was attached in 3 patients with the juxtarenal abdominal aortic aneurysm (of the group of 12 patients with abdominal aortic aneurysm). The stent grafts were attached with proximal uncovered parts across the origins of the renal arteries. In experiment, the renal artery occlusions or stenoses were not observed 36 months after stent placement, and in clinic, 3 patients with the juxtarenal aortic aneurysm were successfully treated by stent graft placement. There were no signs of flow impairment into the renal arteries 14 months after stent graft implantation. This approach can possibly expand the indications for endoluminal grafting in the treatment of juxtarenal aortic aneurysms in patients who are at high risk for surgery.

[Endovascular treatment of abdominal aortic aneurysms. Morphology of aneurysms as one of the deciding indicating factors]. / Endovaskulární lécba aneuryzmat abdominální aorty. Morfologie aneuryzmatu jeden z rozhodujících momentu v indikaci.

Endovascular treatment of aneurysms of the abdominal aorta is based on intravascular bridging of the aneurysm using of an endovascular prosthesis. The prosthesis must be safely anchored above and below the sac of the aneurysm in the non-dilated artery. Therefore the indication of endovascular treatment depends on the morphology of the aneurysm. The objective of the work was to analyse the morphology of the aneurysm with regard to the possibility of endovascular treatment. The morphology of the aneurysm was evaluated with regard to the angiographic examination and examination by computed tomography. The following parameters were investigated: diameter and length of the proximal and distal neck, diameter of the sac in two planes, diameter and tortousity of the iliac arteries, tortousity of the infrarenal aorta. A total of 70 patients with aneurysms of the abdominal aorta were examined. The patients were divided into three groups according to the morphology of the aneurysm. I. infrarenal aneurysms not affecting common iliac artery (n = 20) 28.5%, II. infrarenal aneurysms affecting common iliac artery (n = 38) 54.2%, III. juxtarenal aneurysms regardless of the affection of common iliac arteries (n = 12) 17.1%. Of the total of 70 examined patients 24 (34.2%) with infrarenal aneurysm and 6 (8.57%) with juxtarenal aneurysm were suitable for endovascular treatment.

[Polyester-covered spiral Z stent. Initial clinical experience with endovascular treatment of aortic aneurysms]. / Polyesterom pot'ahovaný spirálový Z stent. Prvé klinické skúsenosti s endovaskulárnou liecbou aneuryzmy aorty.

The authors present their initial clinical experience with endovascular treatment of an aneurysm of the abdominal aorta using of a polyester covered spiral Z stent. Since May 1995 they treated by the endoluminal route 13 patients with aneurysms of the abdominal aorta and 1 patient with thoracic aneurysm. In patients with a subrenal aneurysm (n = 10) the stent graft was anchored below renal arteries origins. In patients with a juxtarenal aneurysm (n = 3) the stent graft was anchored across the renal arteries origins. All patients were followed up by angiography, computed tomography and ultrasonography. In one patient with a subrenal aneurysm dislocation of the stent graft during implantation occurred. In the remaining patients it proved possible to exclude the aneurysm successfully. One patient with an juxtarenal aneurysm died 6 days after surgery. The cause of death was not associated with the aneurysm or surgery. In patients with juxtarenal aneurysms the authors did not observe changes of renal functions or occlusion of the renal artery in the course of 12 months.

[Endoluminal grafts in the therapy of aneurysms of the abdominal aorta. Experimental results]. / Endoluminálny graft v terapii aneuryzmy brusnej aorty. Experimentálne výsledky.

In 1991 a new method of treatment of aneurysms of the abdominal aorta was published. The method is based on bridging the sac of the aneurysm by an endoluminal graft. The graft is a stent provided with a special vascular prosthesis. The endoprosthesis is inserted by means of a catheter from arteriotomy of the common femoral artery. The objective of the submitted work was to test the possibility to use a polyester covered spiral Z stent in the treatment of aneurysms of the abdominal aorta. For experiments six dogs were used weighing 12-18 kg. In the experimental animals an artificial aneurysm of the abdominal aorta was induced. Then the authors interposed surgically into the subrenal section of the abdominal aorta a special polyester knitted prosthesis imitating the shape of the aneurysm. Two weeks after surgery angiography of the abdominal aorta was performed. After angiography the authors introduced from arteriotomy of the superficial femoral artery an endoluminal graft into the artificial aneurysm. The graft bridged the aneurysm on the inside and this led to thrombosis of the sac of the aneurysm. The state of the graft and aneurysm was checked sonographically and angiographically. The graft was successfully used in all experimental animals. Angiographic check-up examinations revealed that application of the graft led to immediate exclusion of the sac of the aneurysm. In two experimental animals the graft was inserted in an excessively cranial position. It did not bridge the aneurysm throughout its length. Reflux of blood in the distal part persisted and filled the residual cavity of the sac of the aneurysm.(ABSTRACT TRUNCATED AT 250 WORDS)

[A new approach to modelling prehepatic portal hypertension. Preliminary experimental results]. / Nový prístup k modelovaniu prehepatálnej portálnej hypertenzie. Predbezné výsledky v experimente.

The generally used model of prehepatic portal hypertension is based on stenosis of the portal vein closely before it enters the hepatic parenchyma. The modelling is performed in the open abdominal cavity, which distorts the subsequent development of the modelled disease. The objective of the presented work was to elaborate a new approach to modelling of PPH where the rise of pressure in the portal vein will be separated from the surgery and the pressure in the portal circulation will rise gradually. Equipment for external compression of the portal vein was used in sic minipigs. The equipment comprised an inflatable balloon fitted to a silicone clamp. The balloon was connected by means of a polyurethane catheter to a chamber (ELLA Port CS). The compression set was attached before operation to the portal vein. The second cannula attached to the chamber (ELLA Port CS) was inserted into the lienal vein. Seven days after surgery the authors began to model portal hypertension percutaneously without laparotomy by inflating the balloon inserted into the portal vein. The value of the portal pressure seven days after the onset of modelling was 17.69 +/- 0.76 mm Hg, as compared with 9.0 +/- 1.3 mm Hg before modelling was started. In all experimental animals prehepatic portal hypertension was induced, as was proved angiographically and by direct assessment of the portal pressure.

[Partial ileal bypass in the treatment of hyperlipidemia]. / Cástecný ileální bypass v lécbe hyperlipidémie.

The hyperlipidemia may be influenced with both the conservative and surgical management. Starting from 1987, authors use Buchwald's (1963) partial ileal bypass method. They report on their experience with 16-membered total of patients. In majority of patients, the PIB was auxiliary operation mostly in relation with vascular reconstructive surgery. No lethality case or serious complication has been stated. All patients showed the substantial decrease in cholesterol and triglyceride levels, these being normalized in majority of patients. Authors are discussing PIB indications. The suggestion is made that this is the most effective of known measures in attempt to achieve a continual decrease in lipids without the serious discomfort for a patient.