[Czech angiology and its transformation]. / Ceská angiologie a její promeny.

Over the last 25 years, Czech angiology has changed dramatically with respect to the diseases and conditions managed by angiologists as well as available therapeutic modalities. Such developments also required substantial expansion of the extent and character of specialist knowledge required from angiologists. Angiology manages to effectively correlate a clinical profession with non-coronary endovascular therapy and this has brought about a significant improvement in treatment efficacy and comfort. Physicians thus crossed a boundary of purely conservative treatment and focus on life and organ-threatening vascular diseases. Recent years have also seen an emergence of sub-specialities ofinterventional and acute angiology. The use of diagnostic and therapeutic catheterisation enabled angiologists to contribute to the care of patients previously managed by vascular surgeons and interventional radiologists; angiologists have become important contributors to the medical care provided by comprehensive cardiovascular centres.

Markers of Chlamydia pneumoniae and human cytomegalovirus infection in patients with chronic peripheral vascular disease and their relation to inflammation, endothelial dysfunction and changes in lipid metabolism.

Our aim was to detect markers of Chlamydia pneumoniae (CPN) and human cytomegalovirus (HCMV) infection in patients with peripheral vascular occlusive disease and to follow markers of inflammation, endothelial dysfunction and lipid metabolism alteration in patients with active infection. CPN genome was detected in 9 (47.4 %) patients by at least one PCR method. Serological markers of acute CPN infection were found in 5 (26.3 %) subjects; each of them showed also positivity in at least one of the PCR methods. HCMV DNA were detected in 2 (10.5 %) patients; HCMV-specific antibodies were detected in 14 (73.7 %) subjects, however only in IgG subclass. Subjects with HCMV PCR positivity thus showed no serological markers of active HCMV infection. Laboratory findings of acute CPN infection were associated with increased plasma levels of Lp(a), triacylglycerols, atherogenic index of plasma and E-selectin (p < 0.05). No significant differences were found in the other markers, including plasma levels of total cholesterol, ferritin, homocysteine, oxidized LDL, IL-6, IL-8, IL-18, TNF-alpha, soluble forms of VCAM-1 and ICAM-1, von Willebrand factor, C-reactive protein, and plasma nitrites & nitrates. Frequent presence of chlamydial DNA in atheromatous plaques from patients with peripheral vascular disease was confirmed. HCMV DNA was detected only sporadically and with positivity in anamnestic anti-HCMV antibodies (IgG) only, indicating a rare presence of latent virus rather than active replication. Patients with laboratory markers of acute CPN infection exhibited more pronounced alterations in lipid metabolism and endothelial dysfunction.

Markedly eccentric peripheral vascular stenoses: percutaneous atherectomy with an endomyocardial biopsy device.

In 23 patients, percutaneous atherectomy was performed with an endomyocardial biopsy device in 27 eccentric stenoses of lower limb arteries. The mean percentage stenosis was reduced from 82% to 14% (P: <.001). Histopathologic examination revealed no media or adventitial tissue in the extracted particles. The technical success and complication rates were similar to those reported for conventional percutaneous transluminal angioplasty of short symmetric lesions.

[Rheological properties of blood during pulsatile pharmacomechanical and continuous local thrombolysis]. / Reologické vlastnosti krve pri pulzní farmakomechanické a lokální kontinuální trombolýze.

BACKGROUND: The aim of the work was to find out whether the controlled administration of a thrombolytic directly into the arterial occlusion could prevent formation of the systemic lytic state, which may result in distant bleeding complications. METHODS AND RESULTS: In patients subjected to pulsatile pharmacomechanical (94 patients) and local continual thrombolysis (74 patients) changes in blood and plasma viscosity, coagulation tests, fibrinogen levels and some other parameters were investigated. CONCLUSIONS: Pulsatile pharmacomechanical thrombolysis, similarly to other forms of thrombolysis, is accompanied with systemic lytic state and the risk of unwanted resorption of the hemostatic thrombosis. Urokinase administration brings about regress of systemic changes, which is similar to the use of either tested thrombolytic administration. As treatment by the continual thrombolysis takes is approximately 40 times longer, the risk of systemic lytic state and bleeding complication growths.

[The effect of heparan sulfate on percutaneous transluminal angioplasty in the vessels supplying the lower extremities]. / Vliv heparansulfátu na efekt perkutánní transluminální angioplastiky v oblasti tepen zásobujících dolní koncetiny.

BACKGROUND: The condition of patients after percutaneous transluminal angioplasty is influenced among others by the subsequent development of restenoses and reocclusions. The objective of the submitted work was to assess whether oral administration of heparan sulphate can influence the development of restenoses after percutaneous transluminal angioplasty in the pelvic and femoropopliteal region. METHODS AND RESULTS: 102 patients (78 men and 24 women, age 42-86 years) were divided into four groups. Percutaneous transluminal angioplasty was performed either on account stenosis in the aortoiliac or femoropopliteal area. (The original number was 115 patients, 13 patients were eliminated: the reasons were technical failure of the intervention procedure, reocclusion, the patient was lost from records.) As antiaggregant the patients were given acetylsalicylic acid, 250 mg/day: patients included in the heparan group were given heparan sulphate (Hemovasal, Manetti and Roberts) 100 mg/day for a period of 3 - 4 months. As compared with controls, the patients treated with heparan sulphate had within the 3 - 4 month period a significantly longer claudication distance (p < 0.05), a higher Doppler index (p < 0.05) and maximal blood flow in the feet. CONCLUSIONS: Heparan sulphate administration to patients after percutaneous transluminal angioplasty on account of stenosis of the aortoiliac or femoropopliteal area improves some angiological parameters which can suggest a slighter tendency of early restenosis.

[Electric conductivity of erythrocyte sediments and red blood cell deformability]. / Elektrická vodivost erytrocytárního sedimentu a deformabilita cervených krvinek.

BACKGROUND: To assess the deformability of erythrocytes several methods can be used. The latter investigate either the properties of single blood cell or the properties of a red cell suspension. The objective of the present study was to assess whether experimentally induced deterioration of the red cell deformability can be recorded by measurements of the electric conduction of red cell sediment. METHODS AND RESULTS: In ten patients with disorders of the circulation 10 ml blood samples were taken, mixed with a solution of sodium citrate and centrifuged at 1250 g for 10 minutes. The separated blood cells were repeatedly centrifuged and rinsed. Red cell deformability was experimentally enhanced by incubation of erythrocytes in a Ringer-albumin solution. The change of deformability was detected by viscosimetry and assessment of the electric conduction of the red cell sediment, using a conductometer Radelkis 101 OK, the temperature of the sediment being 10 degrees C. The viscosity values of red cell suspensions with a haematocrit of 0.45 were assessed at six shear rates and they were in all instances higher after incubation of red cell suspensions, as compared with the viscosity of suspensions of fresh erythrocytes. The mean value of electric conduction of the sediment with a haematocrit of 0.45 before incubation was 0.132 mS and after 24 hours incubation 0.218 mS; the difference was statistically significant (p < 0.0005). CONCLUSIONS: Deterioration of red cell deformability is associated with improved electric conduction of the red cell suspension of sediment. It is possible to use assessment of electric conduction of the red cell sediment to assess erythrocyte deformability. The method is simple and cheap, as compared with the viscosimetric method.

[Significance of hetero-collateral circulation in patients with chronic occlusion of the superficial femoral artery]. / Význam heterokolaterálního obehu u nemocných s chronickým uzáverem povrchní stehenní tepny.

The authors examined a total of 11 lower extremities in 10 patients with chronic occlusion of the superficial femoral artery (mean length of occlusion 17.2 cm) in order to compare the participation of the heterocollateral and homocollateral circulation in the maintenance of the ankle pressures assessed by the Doppler principle. Before percutaneous transluminal recanalization of the chronic occlusion of the superficial femoral artery the authors induced by means of a balloon catheter short-term occlusion of the deep femoral artery in its central portion, closely after its insertion (complete block of the heterocollateral circulation) and in the periphery of this artery (partial block of the collateral circulation). During both types of balloon occlusion the authors assessed the ankle pressures and compared them with control values, assessed before occlusion. The authors found that in their patients the heterocollateral circulation, as compared with the homocollateral one, participated substantially more in the value of the ankle pressure at rest. The importance of the heterocollateral circulation increased with the length of chronic occlusion of the superficial femoral artery. In some patients the homocollateral circulation did not participate at all in the maintenance of the ankle pressure. A drop of the ankle pressure in patients with chronic occlusion of the superficial femoral artery is also more marked in acute occlusion of the deep femoral artery in its central portion, as compared with acute occlusion in the periphery.

A thrombus in the right pulmonary artery and its follow-up using transoesophageal echocardiography.

Using transoesophageal echocardiography, the authors documented development of a right pulmonary artery thrombus in a patient with pulmonary hypertension due to chronic obstructive lung disease. This case confirms the potential of transoesophageal echocardiography in diagnosing pulmonary artery diseases.

Percutaneous transluminal angioplasty of the deep femoral artery.

Percutaneous transluminal angioplasty (PTA) of the deep femoral artery (DFA) was performed in 21 patients with chronically occluded superficial femoral artery (SFA) and a significant DFA lesion as documented by arteriography. The authors failed to pass the guidewire through the occlusion in two patients. The results do not include another patient who, while the PTA was technically successful, had to have a limb amputated because of skin lesion infection. The remaining 18 patients showed a significant increase in the ankle-arm pressure index, prolongation of the claudication interval and reported subjective improvement immediately after PTA; plethysmography performed in 14 patients revealed a significant increase in maximum foot blood flow. While the claudication intervals were found to have further significantly prolonged 6-12 months following PTA, the ankle-arm pressure index remained unchanged. There were no serious complications during and after the PTA procedure. In patients with both superficial and deep femoral artery involvement, where SFA PTA is not suitable or feasible, PTA of the DFA seems to be the method of choice. Considering its probable clinical benefits, it is appropriate to attempt it even in cases where the chances of technical success are low.

[Percutaneous transluminal coronary angioplasty. Initial clinical experience]. / Perkutánní transluminální koronární angioplastika. První klinické zkusenosti.

Percutaneous transluminal coronary angioplasty was performed in 20 patients with angina pectoris (16 patients with stable AP, class II-III., 4 patients with unstable AP) in the period of 1 year. There was single-vessel disease in all patients. Left ventricular function was normal as well in all patients. PTCA was successful in 16 patients (80%), in the remaining 4 patients coronary artery stenosis was not reached with balloon catheter. There were no death, Q-wave myocardial infarction or emergency bypass surgery. Transient ischemic changes on ECG has been found in 2 patients (10%). All patients with successful PTCA were symptomatically improved in period of 1-12 months, in one half of them this improvement was confirmed with stress ECG. Control coronary angiography was made in 2 patients until now, restenosis was not found.