[Effects of infrainguinal bypasses on long-term patency in pelvic procedures--the significance of hybrid procedures]. / Vliv infrainguinálních bypassu na dlouhodobou pruchodnost pánevních intervencí--význam hybridních výkonu.

OBJECTIVE: The hitherto published data did not provide clear answer to whether the adjustment of poor runoff through infrainguinal by-pass can improve long-term patency of iliac interventions in patients with multiple-stage arterial lesion. Our intent was to respond to this question. MATERIAL AND METHODS: In the period since 1st January 2003 until 31st May 2005 we evaluated two groups of revascularized patients with similar angiographic affection of the iliac and femoropopliteal arteries and statistically comparable input parameters. In the first group incorporating 38 procedures the vascular surgeon performed hybrid intervention (group 1)--one-step iliac intervention with infrainguinal ipsilateral bypass, in the second group incorporating 43 patients angioradiologist performed single percutaneous iliac intervention in catheterization laboratory (group 2). RESULTS: Observation median was 71 months (60-86). Three-year primary patency of iliac interventions was 83% in the hybrid group (group 1) and 72% in single angioplasty group (group 2). Five-year patency was 77% in group 1 and 69% in group 2. In secondary patency the three-year and five-year patency was 94% in group 1 and 83% in group 2. Statistically we did not prove that poor infrainguinal runoff is negative factor of primary patency of iliac intervention (K-M, log rank test, p = 0.58628), as well as secondary patency (p = 0.11474). CONCLUSION: From the long-term perspective it is not possible to consider poor runoff to be independent risk factor of patency of iliac intervention. Infrainguinal bypass within the hybrid procedures shall not improve the results of iliac intervention.

[Major vascular injuries in laparoscopic operations]. / Velká cévní poranení u laparoskopických operací.

The authors present three case-histories of major vascular injuries during laparoscopic operations. Subsequently they discuss causes and possible prevention of these rare but serious complications.

[Treatment of occlusions of deep femoral artery prostheses with a venous patch: the Bartos method of reoperation]. / Desobliterace protézy a hluboké stehenní tepny se zilní záplatou: reoperace podle Bartose.

The author deals with the approach to a thrombosis of an aorto-femoral prothesis. The principle of the operation, described by the author as Bartos reoperation involves retrograde desobliteration of the prothesis and open desobliteration of the a. profunda femoris with a venous patch. It is implemented from one incision in the groin. The procedure is simple and feasible even in the majority of risk patients.

[Reconstruction of the femoro-popliteal and peripheral portion in saphenous insufficiency]. / Náhradní rekonstrukce femoropopliteálního a periferního úseku pri nedostatku safény.

Implantation of a venous bypass is the best method of infraarticular and crural reconstructions. In 30%, however, a suitable saphenous vein is not available. If on account of severe ischemia revascularization is necessary, an alternative method must be selected. From a total number of 326 peripheral reconstructions with a distal anastomosis into the distal popliteal artery or crural artery the authors had to use instead of a long venous bypass a subsidiary reconstruction in 145 patients (44.6%). The authors implanted composite venous bypasses in 36 patients (24%), in 93 patients (64%) they combined a venous bypass with desobliteration of the superficial femoral artery and in 16 patients (11%) with an artificial prosthesis. For the end-to-end anastomosis of the prosthesis and vein the authors suggested a plastic operation by means of a venous patch which makes a short anastomosis possible with a smooth transit from a wide prosthesis into a narrow vein. The authors assume that in future ever more frequently the combination prosthesis and vein in the shape of a jump bypass will be preferred to other reconstructive methods, as it is relatively simple and rapid. Their hitherto assembled experience with this methods is favourable.

[Surgical treatment of post-traumatic thrombosis of the inferior vena cava]. / Chirurgická lécba poúrazové trombózy dolní duté zíly.

A 49-year-old man contracted a fracture of the 8th and 9th rib on the right side and developed after this injury thrombosis of the inferior vena cava in the renal and suprarenal portion and of both renal veins manifested clinically as nephrotic syndrome of obscure aetiology. Only detailed cavographic and CT examination revealed this thrombosis. Caval thrombectomy was performed according to Spencer's method because of concurrent phlebothrombosis of the left lower extremity. The patient is in a satisfactory condition with permanent Pelentan medication.

[Chemical lumbar sympathectomy]. / Chemická bederní sympatektomie.

After an account of historical facts the authors describe the technique of chemical lumbar sympathectomy. A 7.5% phenol solution in glycerol was used (7.5 ml). At the Surgical Clinic of the Institute for Postgraduate Medical Training of the Regional Hospital with Policlinic in Ostrava chemical lumbar sympathectomy was performed in 22 patients. No complications were observed during operation and during the postoperative period and in all patients the effect was favourable.

[Iatrogenic injuries of the abdominal aorta during surgery of intervertebral disks of the lumbar vertebrae]. / Iatrogenní poranení brisní aorty pri operacích meziobratlové ploténky bederních obratlu.

The authors present the case-histories of two successfully treated patients following injury of the infrarenal part of the abdominal aorta. The injury occurred during extirpation of sequestra of discs of lumbar vertebrae. Some problems of the tactics of surgical treatment are discussed.

[Arteriovenous shunt--a prerequisite for long-term hemodialysis therapy]. / Arteriovenózní shunt--nezbytná podmínka dlouhodobého hemodialyzacního lécení.

The authors give an account of the experience of their department with the establishment of arteriovenous fistulae during the preparation of patients for a dialyzation transplantation programme. In the course of 13 years a total of 685 a-v shunts were made. The results in 60 patients are evaluated in detail. These patients were treated in 1989 in the chronic dialyzation programme of the Ostrava dialyzation unit, focused on long-term patency of the fistulae. The cumulative patency of shunts up to one year is 83.3%, the long-term patency is 73.3%.

[Personal experience with the use of acute isovolemic hemodilution in vascular surgery]. / Nase zkusenosti s uzitím akutní izovolemické hemodiluce v cévní chirurgii.

The authors present their eight-year experience with acute isovolaemic haemodilution during operations on blood vessels in the aorto-femoro-popliteal region. They remind of basic physiological findings, present actual results, and based on their experience and data in the literature, they formulate the main principles of indications and implementation of haemodilution.

[The role of computer tomography in the diagnosis of aneurysms of the abdominal aorta]. / Uloha computerové tomografie v diagnostice aneurysmatu abdominální aorty.

The advantages of computer tomography are obvious. They include the non-invasive character of examination, the detection of aneurysms with a small diameter and the opportunity to check them systematically. Computer tomography is in the authors' opinion most effective in the differential diagnosis and for the assessment of the character of aneurysms--stable or unstable, and in particular in the diagnosis of initial stages of ruptures.

Significance of pedal arch for femoropopliteal vein bypass patency.

There are different opinions about the usefulness of preoperative arteriography. Therefore we resolved to show its importance for the distal runoff evaluation as well as for the indication and results of femoropopliteal vein bypasses. There were controlled 149 patients 1-5 years after femoropopliteal vein bypass implantations. Seventy six vein bypasses proved to be patent and seventy three were closed. The findings of preoperative arteriographies visualizating the whole arterial periphery, including the pedal arch arteries, were compared in both groups of patients. It was proved that the evaluation of the distal runoff by means of preoperative arteriography may be reliable and correct under condition of tibial and pedal arch arteries visualization. According to our experience, the preoperative arteriography can be performed in such a way to fulfil this indispensable condition. In rare case of preoperative arteriography repeated failure, it is the peroperative prebypass arteriography, which always is successful. In evaluating the distal runoff, there must be taken into consideration the whole arterial complex: tibial + pedal arch arteries. The patency of pedal arch seems to be more important than the number of patent tibial arteries. According to preoperative arteriographic findings, there is possible to distinguish three main types of distal runoff: (1) Sufficient runoff: whole pedal arch and 1-3 tibial arteries patent; (2) satisfactory runoff: partial pedal arch patency and 1-3 tibial arteries patent; (3) Unsufficient runoff: total pedal arch obliterations and 1-3 tibial arteries patency.

[Significance of the pedal arch for patency of femoropopliteal bypasses]. / Význam pedálního oblouku pro pruchodnost femoropopliteálních bypassu.

The authors pay attention to the evaluation of drainage in indications of femoropopliteal reconstructions with regard to the patency of the peripheral circulation. Based on comparison of preoperative arteriographic findings regarding the patency of venous femoropopliteal bypasses in 149 operated patients the authors were able to confirm their previous assumption that when evaluating the drainage it is necessary to take into consideration not only the number of patent arteries on the leg but also the patency of their continuation in the area of the sole where they form the plantar arch. When evaluating the drainage it is thus necessary to evaluate the patency of the entire complex: arteries of the leg+plantar arch. From this ensues the authors' demand to use in indications of femoropopliteal reconstructions as a basis arteriography which visualizes the entire peripheral arterial circulation incl. the plantar arch.