Early surgical and vascular complications after open repairs of aortoiliac aneurysms.

INTRODUCTION: The surgical procedures due to aortoiliac aneurysm (AAA) represent the most demanding procedures in conventional vascular surgery. This is due, among other things, to the relatively frequent systemic and surgical complications in polymorbid and often urgently operated patients. Surgical and vascular complications after resections of aortoiliac aneurysms are relatively common, and reintervention due to these complications is reported to range around 14%. METHOD: Retrospective clinical study of a group of patients undergoing surgical management for aortoiliac aneurysms in the period from 1 January 2010 to 31 December 2017 at the Department of Vascular and Plastic Surgery of Pardubice Hospital NPK. RESULTS: In a group of 240 patients (205 males, 35 females), mortality reached a total of 10.4%, with mortality in elective cases 3.4% and 31.1% in urgent procedures (37.5% in AAA rupture). Overall, in the elective group, we recorded a total of 29 (16.2%) surgical and/or vascular complications with the necessity of 16 (8.9%) surgical, endovascular or combined interventions. In the emergency group, these complications were recorded 30 times (49%) with the need for intervention in 19 cases (31.1% of emergency procedures). CONCLUSION: Open surgical procedures on AAA are accompanied by a high incidence of systemic and surgical and/or vascular complications. These patients therefore require high attention and quality of intensive care in the postoperative period, focusing on early diagnosis and subsequent treatment of these complications. Key words: aortoiliac aneurysm surgical complications - bleeding limb ischemia abdominal compartment syndrome.

[Vacuum-assisted closure as a treatment modality for infrainguinal vascular prosthetic graft infection: our experience and take-home message]. / Vakuová drenáz jako varianta terapie infektu cévní infrainguinální protetické rekonstrukce - zkusenosti z naseho pracoviste a shrnutí problematiky.

INTRODUCTION: Infection of the prosthetic graft represents one of the biggest challenges for practising vascular surgeons. The patient is jeopardized with possible future limb loss or, in the most serious cases, even death due to this complication. The incidence in the infrainguinal area amounts to a maximum of 6% of all arterial surgical procedures. MATERIAL AND METHODS: Between January 2010 and December 2011, the authors performed a total of 689 vascular surgical reconstructions, of which 311 were performed in the infrainguinal area where 7 cases (2.25%) of graft infection occurred. RESULTS: None of the patients died or lost a limb due to this complication. Two patients with an infected infrainguinal prosthetic graft were successfully treated with vacuum-assisted closure (VAC) system. CONCLUSION: The prosthetic vascular graft infection is the most feared complication in vascular surgery. The generally recognized principles of the traditional surgical approach are well-known and widely accepted. However, in selected cases of infrainguinal vascular prosthetic infection, both the affected limb and the patent graft may be saved and successfully treated with the use of vacuum-assisted closure.

[The complication of a periproctal abscess--Fournièr's gangrene or necrotizing fasciitis? A case report]. / Komplikace periproktálního abscesu--Fournièrova gangréna nebo nekrotizující fasciitida? Kazuistika.

INTRODUCTION: Periproctal abscess is a routine diagnosis of everyday surgical practice. Fournièr's gangrene with progress to the sepsis is one of the most serious complication of this disease. CASE REPORT: The authors present a case review of fulminant surgical infection run as a Fournièr's gangrene and a necrotizig fasciitis of a right lower limb and body with the progress of severe septic status, which started on the strength of a contusion with formation of a periproctal absceding haematoma. A patienthood led to the long-term intensive care with a necessity of multiple surgeries and with subsequent rehabilitative care. This case is rare by the origin of thus extensive infection of soft tissue and its illustration of the heftiness of the patient's treatment with such a disease. CONCLUSION: Fournièr's gangrene and necrotizing fasciitis are loaded by a high-grade of mortality. It is one of the most serious surgical infection, which ends by death frequently. The therapy is primarily surgical, but it cannot be sufficient without aggressive intensive care of a patient.

[A six-year experience with endovenous laser in the treatment of lower extremity varices]. / Sest let zkuseností s endovenózním laserem v terapii varixu dolních kon etin.

AIMS: Endovascular techniques of saphenous ablation are the miniinvasive alternatives of the radical surgical treatment. This study summarizes our own clinical experience with endovenous laser. MATERIAL AND METHODS: During 6 year period we performed in total 723 endovenous laser procedures of trunk varicose veins of lower extremities in 630 patients. Every patient was preoperatively examined clinically and with color duplex machine. Primary varicose veins were operated on in 664 cases, in 59 cases the procedure was performed in recurrent varicose veins with reflux in the residual saphenous trunk. Post-operative follow-up (clinical and duplex ultrasound) was performed after 5 days and 1 month, 6 months and yearly thereafter. The results were evaluated by comparison of CEAP clinical class and quality of life (QoL) pre- and post-operatively, by the percentage of recanalizations and also using Kaplan-Meier life-table method. RESULTS: No thrombosis, nor pulmonary embolism were diagnosed in the post-operative period; from the whole cohort of 723 laser procedures, the postoperative data were available during different time periods in 718 cases (99.3%). Saphenous occlusion was verified in 97.3% after 1 month, non-occlusion or early reopening was seen in 2.7%. In total, 44 non-occluded trunk veins were found during the whole follow-up period (1-72 months, mean 15 months) which represents the final occlusion result of 93.9%. With stronger Kaplan-Meier analysis, we reached 88.9% occlusion rate during the follow-up period of 6 years. Cox regression analysis of factors influencing non-occlusion and early or late recanalisation of saphenous vein found 2 factors with statistical importance: energy per centimeter of vein length (p = 0.04) and laser power (p = 0.04). Cumulative rate of occlusions in 72 months horizon is significantly higher (94%) in patients treated with more than 50 J/cm compared to less than 50 J/cm (87%), log-rank test 0.039. When comparing the influence of laser power on the quality of saphenous occlusion, the treshold of 13W was set arbitrary based on median values in occluded and non-occluded cohorts and using the Kaplan-Meier survival method, the results of the treatment with power less than 13W and more than 13W were analysed. Using the power values less than 13W, the results were significantly better (p = 0.031) compared to power values of 13 W or more. Mean clinical CEAP classification improved from 2.22 (before operation) to 0.24 (1 month after) and 0.48 (last visit) and also QoL was significantly better in laser group compared to traditional surgery group (p < 0.001). The sick leave was also significantly shorter in the laser group ( median 0 days) compared to traditional group (median 40 days), p < 0.01. CONCLUSIONS: The results of endovenous laser ablation of varicose veins depend mainly on meticulous pre-operative ultrasound examination and sufficient technical parameters of the therapy. The present study supports the concept of "slow heating" during the endovenous laser treatment of varicose veins to achieve sufficient energy per centimetre of the vein and the optimal clinical outcome.

Dose reduction in computed tomography by attenuation-based on-line modulation of tube current: evaluation of six anatomical regions.

This study investigated the potential of attenuation-based on-line modulation of tube current to reduce the dose of computed tomography (in milliamperes) without loss in image quality. The dose can be reduced for non-circular patient cross-sections by reducing the tube current at the angular positions at which the diameter through the patient diameter is smallest. We investigated a new technical approach with attenuation-based on-line modulation of tube current. Computed tomographic projection data were analyzed to determine the optimal milliampere values for each projection angle in real time, instead of performing prior measurements with localizer radiographs. We compared image quality, noise pattern, and dose for standard scans and for scans with attenuation-based on-line modulation of tube current in a group of 30 radiation therapy patients. Six different anatomical regions were examined: head, shoulder, thorax, abdomen, pelvis, and extremities (knee). Image quality was evaluated by four radiologists in a blinded fashion. We found the dose to be reduced typically by 15-50 %. In general, no deterioration in image quality was observed. Thus the dose in computed tomography be reduced substantially by technical measures without sacrificing image quality. Attenuation-based on-line modulation of tube current is an efficient and practical means for this.