Fresh Cold-Stored Vascular Allografts in Subgenicular Location: Our Experience with Rescue Endovascular Techniques.

BACKGROUND: Critical limb ischemia (CLI) is considered the most severe pattern of peripheral artery disease. CLI is associated with high rates of morbidity and mortality with high risk of limb amputation. In the absence of appropriate autologous grafts, unsuitability of prosthetic bypasses, and endovascular methods, fresh cold-stored venous allografts is an option. Endovascular interventional methods are essential methods for maintaining primary and secondary patency. METHODS: A single-centre retrospective analysis of 82 surgical revascularizations using allogeneic vascular grafts and rescue endovascular techniques restoring and maintaining the patency of these allogeneic revascularizations in the period between July 2005 and July 2021. RESULTS: We have performed 82 allogeneic revascularizations in 75 patients (52 reconstructions in men/63.4%/, 30 reconstructions in women/36.6%/). The median age of patients was 68 years (49 min, 87 max). We subsequently had to intervene a total of 26 bypasses. We intervened in 30 acute occluded allogeneic bypass grafts and 9 failing stenotic bypass grafts. We performed 52 angiographies. The success rate of rescue endovascular procedures in primary allogeneic reconstruction with distal anastomosis to the popliteal artery is statistically significant (P < 0.02) compared to procedures with distal anastomosis to the tibial and pedal bed. The cumulative patency (primary at time) of allogeneic reconstructions in our group was 89% after 1 month, 51.9% after 12 months, 24.2% after 3 years, 9.8% after 5 years. Limb salvage was 72.6% in 1 year, 53% in 3 years, 36.5% in 5 years, respectively. CONCLUSIONS: Cold-stored venous allografts may be used for performing below-the-knee revascularization for CLI with acceptable results, despite the poor long-term patency. Rescue endovascular techniques are an essential method for restoring or maintaining the patency of these reconstructions. These techniques have a high success rate and no other alternative.

[Minimally invasive operations in vascular surgery]. / Minimálne invazivní výkony v cévní chirurgii.

Minimally invasive surgery provides an attractive alternative compared with conventional surgical approaches and is popular with patients, particularly because of its favourable cosmetic results. Vascular surgery has taken its inspiration from general surgery and, over the past few years, has also been reducing the invasiveness of its operating methods. In addition to traditional laparoscopic techniques, we most frequently encounter the endovascular treatment of aneurysms of the thoracic and abdominal aorta and, most recently, robot-assisted surgery in the area of the abdominal aorta and pelvic arteries. Minimally invasive surgical interventions also have other advantages, including less operative trauma, a reduction in post-operative pain, shorter periods spent in the intensive care unit and overall hospitalization times, an earlier return to normal life and, finally, a reduction in total treatment costs.

[Pedal bypass occupies an irreplaceable position in the spectrum of vascular surgery interventions]. / Pedální bypass a jeho role v záchrane kriticky ischemické koncetiny.

BACKGROUND: Pedal bypass grafting has been the method of choice at Na Homolce Hospital's Vascular Surgery Department since 2008. METHODS AND RESULTS: During the period from June 2008 to December 2011, 29 pedal bypass procedures were performed in 27 patients. No perioperative mortality was recorded. Early occlusion of the graft occurred in three patients and two patients experienced delayed occlusion. Loss of the limb as a result of graft occlusion was unavoidable in two cases and one amputation had to be performed despite a patent graft. The primary patency rate for the period under review is 82.75%, and we were able to salvage the limb in 89.65% of cases. Follow-up results for our cohort are comparable with those from other centres dealing with the same problem. CONCLUSIONS: Pedal bypass has excellent early and long-term results and makes a significant contribution to reducing the number of major amputations of the lower limbs.

Pulmonary valve replacement for pacing electrodes related bacterial endocarditis.

Infective endocarditis of pulmonary valve requiring surgery is rare. We report a case of 80-year-old woman with a permanent pacemaker implanted 14 years ago. She had signs of infection resistant to antibiotic therapy, secondary cachexia, and dyspnea. Echocardiography examination revealed an infectious mass on pacing electrodes in the right atrium, right ventricular dysfunction, and pulmonary hypertension. Removal of the infected pacing system was indicated. During the operation, destruction of the pulmonary valve due to bacterial endocarditis was diagnosed. Replacement with a stented porcine valve was performed. The patient was discharged on postoperative day 20. Seven months after the operation, the patient is in a good condition.

Posterior elbow dislocation combined with subadventitial rupture of the brachial artery: interposition with the use of the autologous basilic vein.

The authors describe a relatively rare avulsion injury of the brachial artery complicating elbow dislocation in a young man, together with the relevant diagnostics and treatment. In the discussion, they deal with the symptomatology of artery injuries and available examination methods, suggesting an appropriate treatment algorithm.