Cerebral monitoring during carotid endarterectomy using transcranial cerebral oximetry.

OBJECTIVE: This study aimed to evaluate the outcomes of carotid endarterectomies (CEA) performed using transcranial cerebral oximetry as cerebral monitoringMETHODS: This single-center study included patients treated surgically for significant stenosis of the internal carotid artery (ICA) from January 2012 to December 2017RESULTS: Of the 654 patients, 267 were asymptomatic, and 387 were symptomatic. Eversion CEA was performed in 64.8 %, and patched conventional CEA in 35.2 % of all patients. Totally 11.4 % of all patients had a shunt inserted; all patients with the inserted shunt had the conventional pathed CEA. Severe postoperative complications occurred in 1.5 % of asymptomatic patients and 2.6 % of symptomatic patients. The stroke and death ratio in the shunted group was 2.7 %, and in the non-shunted group, 2.1 % (p = 0.7). We found no significant difference in severe postoperative complications between the shunted and non-shunted group. Further, we found the male gender (p = 0.005), coronary artery disease (p = 0.01), and ongoing smoking (p = 0.003) to be significantly associated with neurological symptoms of the ICA stenosis. We also confirmed current tobacco smoking to be significantly associated with the occurrence of postoperative stroke and death (p = 0.005)CONCLUSION: We found transcranial cerebral oximetry to be reliable in the determination of shunt insertion (Tab. 6, Ref. 26).

Results of surgical treatment of inferior vena cava tumor thrombi in renal cell carcinoma.

INTRODUCTION: Thrombosis of inferior vena cava (IVC) is an important complication amongst oncological patients. Tumor thrombus of IVC is characteristic for patients with renal cell carcinoma, occurring in 1018%. The aim of the work is to analyze of surgical treatment in patients with cancer thrombosis of inferior vena cava in kidney cancer. METHODS: Between 2010 and 2019 we treated 32 patients with kidney cancer complicated by thrombotic infiltration of the inferior vena cava. According to Nesbitt classification the levels of thrombotic infiltration of the inferior vena cava were: I-8 (25%), II-14 (43.8%), III-6 (18.8%), and IV-4 (12.5%). Nephrectomy with thrombectomy of the cancer thrombus in the inferior vena cava was performed in all patients. In addition to laparotomy, sternotomy was approached in 4 patients with Nesbitt IV and in 2 patients with Nesbitt III. RESULTS: Primary suture of IVC was performed in 26 patients; angioplasty of IVC was performed in 4 patients; and resection of IVC with replacement using a polytetrafluoroethylene interposition graft was done in 2 patients. Radical surgical treatment was performed in 27 (84.3%) patients, and palliative in 5 (15.6%) patients. In the postoperative period, 1 (3.1%) patient (Nesbitt IV) died of cardiac failure during hospitalisation. Two-year survival was observed in 75% of the cases. CONCLUSION: Tumorous infiltration of IVC is associated with a high potential for tumour embolisation to the lungs, leading to the formation of multiple metastases and spreading of the underlying disease. Postoperative comfort is improved considerably after nephrectomy of the affected kidney and removal of the tumour thrombus, including IVC resection as appropriate, and when combined with oncological treatment, the survival rate is increased significantly, as well.

Celiac axis compression syndrome - diagnostic and surgical treatment.

INTRODUCTION: Celiac axis compression syndrome is one of the causes of chronic abdominal ischemia. The authors describe their experience with the surgical treatment of Dunbar syndrome in 12 patients. The purpose of the authors was a retrospective analysis of the surgical treatment of celiac axis compression syndrome. METHOD: Between 2007 and 2016, we treated 12 patients for the celiac axis compressive syndrome. Each patient has performed abdominal sonography, CT-angiography, or angiography. The method of choice in these patients was surgical treatment. In 4 patients we resected median arcuate ligament and nerve fibers of celiac axis. In 8 patients we had to resect the stenotic or occluded celiac axis. We reconstructed the blood supply to the celiac axis by the aorto-celiac bypass, using prothetic or venous grafting or patch plastic of celiac axis stenosis. RESULTS: There were no significant complications and deaths in the post - operative period. In one patient signs of chronic abdominal ischemia postoperatively persist. CONCLUSION: Surgery is the method of choice of celiac axis compression syndrome. Indications for surgical reconstruction are symptomatic patients with arterial stenosis over 50%. Proper diagnosis and early surgical treatment are essential for treating chronic visceral ischemia and reducing surgical complications. Key words: celiac axis compression syndrome - chronic abdominal ischemia - resection of ligamentum median arcuate.

Humoral predictors of ankle-brachial index in patients with peripheral arterial disease and controls.

INTRODUCTION: Peripheral arterial disease (PAD) is a common condition due to atherosclerosis with high prevalence in population over 55 years. Although its pathophysiology is well recognized, the role of inflammatory markers is still not fully known. OBJECTIVES: The aim of the study was to assess the relation of C-reactive protein (CRP), tumor necrosis factors-alpha (TNF-alpha) and interleukin-6 (IL-6) to ankle-brachial index (ABI) and metabolic variables in patients with PAD. The second aim was to find the most significant humoral predictor of ABI. PATIENTS AND METHODS: The study groups consisted of 55 patients (36 men and 19 women) diagnosed with PAD (age 63.65 ± 6.11 years) and 34 control subjects (7 men, 27 women) of average age 59.88 ± 6.10 years with ABI > 0.9. Blood samples were analyzed for glycaemia, lipid profile and inflammatory markers (CRP, TNF-alpha and IL-6). RESULTS: A significantly higher serum total cholesterol (p = 0.04), triglycerides (p = 0.005) and lower HDL cholesterol (p < 0.0001) were found in the PAD group as compared to controls. Patients with PAD had significantly higher serum glucose (p = 0.008), CRP (p = 0.0044), IL-6 (p < 0.0001) and TNF-α (p < 0.0001) in comparison to controls. In a multiple linear regression analysis among variables log IL-6 and log HDL cholesterol were most significantly related to ABI (LW 4.75 for log IL-6, LW 4.016 for log HDL cholesterol, respectively, p < 0.01) in all subjects. CONCLUSIONS: We conclude that among traditional and humoral risk factors IL-6 is the strongest predictor of ABI. HDL cholesterol is also significant and strong predictor of decreased ABI and could be a potential biomarker of PAD in patients using lipid lowering drugs (Tab. 1, Ref. 31).

The impact of the angioplasty of the renal artery and cold ischemia time in kidney transplantation on graft function.

The aim of this study was to analyze the benefit of the patients after renal transplantation with an assessment of the significance of different surgical techniques in patients with renal transplantation (not only from the dead but also the living donors) with multiple arteries. 457 patients with end stage renal disease (ESRD) in the treatment using the extracorporeal elimination method (haemodialysis, or peritoneal dialysis), who in the period from 2005 to 2015 had a kidney transplant were included in our retrospective study. Our results confirm that the patients after kidney transplantation with cold ischemia time more than 12 hours have 2.5 times higher risk of delayed onset, possibly failure of graft function compared to those with cold ischemia time less than 12 hours. This confirms our experience that the best option for the patient to achieve a stable graft function with long-term perspective is cold ischemia time of less than 12 hours and the realisation of renal artery angioplasty. In this case, the risk of delayed onset of transplanted kidney function or graft failure decreases 4.5 times compared to the respondents with cold ischemia time more than 12 hours without carrying out arterial angioplasty (Tab. 1, Fig. 4, Ref. 16).

[Malignant fibrous histiocytoma as a rare cause of acute limb ischemia]. / Malígny fibrózny histiocytóm ako raritná prícina akútnej koncatinovej ischémie.

Malignant fibrous histiocytoma (MFH) represents a rare malignant affection of heart and aorta. Its clinical presentation depends on the localisation, size, degree of invasion and metastasis. Previously, relatively few cases of acute tumour mass embolisation into the visceral and limb arterial system were described in the literature. In the present case study we describe a case of acute ischemia of both lower extremities caused by thromboembolic mass of MFH cells. According to literary sources this tumour type is characterized by poor prognosis as it was in the case of our patient.

[Leiomyoma of external iliac vein]. / Leiomyóm vena iliaca externa.

Authors present a case report of a patient who was diagnosed with a tumour of external iliac vein. Excision of venous wall with tumour and reconstruction of external iliac vein with venous patch was performed. Postoperative course was without complication. The patient is without complications and also without signs of recurrence in one year follow up. Tumours of venous wall are rare. They originate from vena cava inferior, less often from extremity veins. The most frequent primary tumours of vein wall are leiomyosarcomas. Secondary tumours that involve venous wall are more common than primary tumours. Primary renal carcinoma or sarcomas of retroperitoneum represent a tumour that invades vena cava inferior. The diagnosis is based on CT and MRI. Surgical resection remains the mainstay of treatment. Chronic well collateralized obstruction is not necessary to reconstruct. Vena cava inferior and iliac veins are reconstructed with PTFE graft. Extremity veins are reconstructed using venous graft from great saphenous vein. Perioperative mortality after resection of vena cava inferior and pelvic veins is up to 6.9% major morbidity up to 33% and a fiveyear survival up to 52%. Patients with infrarenal involvement of vena cava have better outcomes than patients with involvement of retrohepatal vena cava inferior.Key words: venous tumour leiomyoma of venous wall.

LIPOPROTEIN ASSOCIATED PHOSPHOLIPASE A2 AS A MARKER OF VULNERABLE ATHEROSCLEROTIC PLAQUE IN PATIENTS WITH INTERNAL CAROTID ARTERY STENOSIS.

The aim of this study was to compare the concentration of inflammatory vascular markers and morphological structure of atherosclerotic plaque in symptomatic and asymptomatic patients with the stenosis of internal carotid artery (ICA). The research was carried out in 70 patients with hemodynamically significant stenosis of ICA out of which 40 (57%) were asymptomatic patients and 30 (43%) were symptomatic patients, of which 20 patients (66%) have had a stroke, or transient ischemic attack (TIA), 10 patients (33%). All the patients were indicated to carotid endarterectomy as a surgical prevention of stroke. All the patients were taken their blood for biochemical testing (T-Chol, LDL, HDL, TG, Fibrinogen, CRP and specific markers IL-4 and Lp-PLA2) early morning prior to surgery. The highest concentrations of T-Chol, LDL, HDL, CRP and Fibrinogen were measured in symptomatic patients, however, these did not feature a significant difference compared with the group of asymptomatic patients (P>0.05). Significant difference was found in IL-4 (P<0.001) and in Lp-PLA2 (P<0.001). When evaluating concentration of tracked parameters in patients with soft atherosclerotic plaque and patients with calcified atherosclerotic plaque, significant differences were found in these markers: TG (P<0.05), CRP (P<0.01), IL-4 (P<0.001) and Lp-PLA2 (P<0.001). The paper deals with higher concentrations of Lp-PLA2 in patients with a soft atherosclerotic plaque. Higher concentration of Lp-PLA2 and systemic inflammatory markers (CRP, IL-4) could be used along with ultrasonography to detect mainly asymptomatic patients who are in urgent need of surgical or endovascular treatment as a prevention of stroke.

Patients with Klippel-Trenaunay syndrome.

Klippel-Trenaunay syndrome is the most frequent systemic venous angiodysplasia. It is characterized by cutaneous capillary malformations - naevus flammeus, excessive growth of soft and bone tissue, venous and lymphatic malformations. Investigative methods include: clinical examinations, venography as the evidence of dysplastic changes of superficial and / or deep venous system, the Moyne obstruction and venous insufficiency perforator. Treatment is conservative, related to that of chronic venous disease. The surgery is aimed at removing the varices and insufficient perforators (Fig. 9, Ref. 8).

[Different techniques of vessel reconstruction in kidney transplantation 10-years experiences]. / Cievne plastiky a úpravy ciev u pacientov pri transplantácii obliciek v 10 rocnom sledovaní.

INTRODUCTION: The aim of the study was to analyze own results from Transplant Center Kosice, Slovak Republic. METHODS: In total 457 patients in the end-stage renal failure were included to the kidney transplant program. Following techniques were used: arterioplasty, individual renal artery anastomosis and multiple renal arteries anastomosed on a common patch. The kidney transplant (Tx) especially requires surgical technique of a vascular anastomosis. RESULTS: Renal transplantation has been established in Transplant Center Kosice since 1988. The arterioplasty of renal artery was performed in 102 (22.3%) and individual artery anastomosis in 25 (5.5%) patients. Multiple artery anastomosis on the patch was done in 43 (9.4%) and implantation of pole renal arteries to the main trunk performed in 34 (7.4%) cases. CONCLUSION: Renal transplantation is a lifesaving method in end stage renal failure. KEY WORDS: kidney transplantation - arterioplasty, cold ischemia time vascular anastomosis.

[EXTRAANATOMIC ARTERIAL RECONSTRUCTION IN PATIENTS WITH ATEROSCLEROTIC AFFECTION OF THE AORTAL ARCH BRANCHES].

Own experience of extraanatomical reconstruction, made for atherosclerotic affection of the aortal arch branches, was analyzed. A subclavian artery (SA) transposition into common carotid artery (CCA) was conducted for symptomatic subtotal stenosis or occlusion of the SA I segment. While extension of atherosclerotic process beyond boundaries of the SA I segment or technical difficulties a carotid-subclavian shunting was preferred. Carotid-carotid shunting was applied in necessity of revascularization of extracranial arteries before endovascular implantation of a stent-graft down to aortal arch with closure of the left CCA branching. The authors consider extraanatomic reconstruction the method of choice in the patients surgical treatment for central atherosclerotic affection of the aortal arch branches, when possibilities of endovascular revascularization methods are exhausted, and this guarantees good and satisfactory results in 91.7% of them.

[Comparison of the results of surgical and endovascular treatment in patients with peripheral arterial disease of the lower extremities in the femoropopliteal region]. / Porovnanie výsledkov pouzitia chirurgickej a endovaskulárnej liecby u pacientov s periférnym artériovým ochorením dolných koncatín vo femoropopliteálnej oblasti.

INTRODUCTION: Results of previous studies comparing bypass surgery and percutaneous transluminal angioplasty in peripheral artery disease are ambiguous. Therefore, the aim of our study was to analyse and compare the long-term results of surgical and endovascular revascularisation in patients with peripheral artery disease in the femoropopliteal region. MATERIAL AND METHODS: 255 patients with peripheral artery disease who underwent bypass surgery or percutaneous transluminal angioplasty for newly diagnosed infrainguinal lesions in the femoropopliteal region were retrospectively identified and analyzed. Clinical and technical success, primary and secondary patency, improvement of critical limb ischaemia symptoms and improvement of the claudication interval were assessed within 1 year following treatment. Secondary evaluated outcomes were complications including haematoma after intervention, the need for revascularization and need for amputation of the thigh within 1 year after the intervention. Clinical outcomes were statistically evaluated as odds ratio and confidence interval. RESULTS: Patients were divided into two groups: the first one was formed by 93 (36.47%) patients who underwent bypass surgery, the second one consisted of 162 (63.53%) patients who underwent endovascular therapy - percutaneous transluminal angioplasty. We could not find differences in clinical and technical success, primary and secondary patency and claudication interval improvement between the treatment groups within 1 year of follow-up after the intervention. In comparison to the endovascular group, we observed a 1.85 times higher rate of clinical improvement of critical limb ischaemia symptoms after 1 year following the intervention in the bypass surgery group patients OR 1.85 (1.10-3.10), p=0.020. Multiple logistic regression analysis showed that type of intervention was the only predictor of improvement in critical limb ischemia symptoms, independently of claudication interval before intervention, age, gender, active smoking, diabetes mellitus, hypertension and ischaemic heart disease (p=0,004). The bypass surgery group had a higher incidence of haematoma due to intervention than the endovascular group OR 4.23 (1.27-14.15), p=0.019. No differences were detected between the treatment groups in the need for revascularisation or amputation of the thigh within 1 year following intervention. CONCLUSION: The use of bypass surgery has been associated with a higher rate of clinical improvement in critical limb ischaemia symptoms after 1 year of intervention and presence of haematoma after the intervention. No differences were detected between patients with peripheral artery disease in the femoropopliteal region treated by bypass surgery or percutaneous transluminal angioplasty in clinical and technical success, primary and secondary patency, nor in the improvement of the claudication interval during 1 year of follow-up. We also could not observe differences in the need for revascularisation or amputation of the thigh within 1 year following the intervention.

Early stages of trachea healing process: (immuno/lectin) histochemical monitoring of selected markers and adhesion/growth-regulatory endogenous lectins.

Tracheotomy may be associated with numerous acute and chronic complications including extensive formation of granulation tissue. The emerging functional versatility of the adhesion/growth-regulatory galectins prompted us to perform a histochemical study of wound healing using rat trachea as model. By using non-cross-reactive antibodies and the labelled tissue lectins we addressed the issue of the presence and regulation of galectin reactivity during trachea wound healing. Beside localization of high-molecular-weight keratin, wide-spectrum cytokeratin, keratins 10 and 14, α-smooth muscle actin, vimentin, fibronectin, and Sox-2, galectins -1, -2, and -3 and their reactivity profiles were measured in frozen sections of wounded and control trachea specimens 7, 14, and 28 days after trauma. A clear trend for decreased galectin-1 presence and increased reactivity for galectin-1 was revealed from day 7 to day 28. Sox-2-positive cells were present after seven days and found in the wound bed. Interestingly, several similarities were observed in comparison to skin wound healing including regulation of galectin-1 parameters.

Anatomical study of blood supply to the spinal cord in the rabbit.

STUDY DESIGN: The study was carried out in rabbit. OBJECTIVE: To investigate the arterial blood supply of the spinal cord in rabbit as model in experimental spinal cord ischemia surgery. SETTING: The study was carried out in the Department of Anatomy, Histology and Physiology, University of Veterinary Medicine and Pharmacy in Kosice, Slovak Republic. METHODS: The study was carried out on 10 adult New Zealand white rabbits. We prepared corrosion casts of arterial system of spinal cord. Batson's corrosion casting kit no. 17 was used as a casting medium. RESULTS: The presence of branches entering arteria spinalis ventralis in the thoracic region was observed in 71% of the cases on the left side and in 29% on the right side. In the lumbar region, left-sided branches were observed in 52% of the cases and right-sided in 48% of the cases. The artery of Adamkiewicz was present in 50% of the cases as left-sided and in 50% as right-sided. CONCLUSION: Documenting the anatomical variations in spinal cord blood supply in the rabbit will aid in the planning of future experimental studies and determining the clinical relevance on such studies.

[Superficial thrombophlebitis--diagnostics and treatment]. / Povrchová tromboflebitída--diagnostika a liecba.

Superficial thrombophlebitis (ST) is a common disease, usually considered benign. However, the practice of systemic duplex ultrasonography has revealed a large number of deep-vein thromboses concomitant with ST. In contrast with extensive information on the management of deep vein thrombosis, little is known about the most appropriate treatment of the ST. Systematic duplex ultrasonography investigation has been proposed in the initial management of ST, to detect the presence of any underlying deep vein thrombosis. Because ST may extend into the deep venous system and potentially engender pulmonary embolism, treatment with low-molecular-weight-heparins might be the best choice. In our work diagnostic and therapeutic procedures for ST, proposed by Slovak angiological society, Slovak society for vascular surgeons, Slovak dermatological society, Slovak society for haemostasis and thrombosis, Slovak surgical society and Slovak internistic society are discussed.

[A patient with popliteal artery entrapment syndrome and with infectious endocarditis (a case review)]. / Pacient s entrapment syndrómom a. poplitea a infekcnou endokarditídou (kazuistika).

Popliteal artery entrapment syndrome is severe problem of young, athletic men, at the age of 20-40. The syndrome releases compression of popliteal artery by medial part of the gastrocnemius muscle. It can be hereditary, or disruption of muscles tentacle. The traumatisation of vessels wall may cause stenosis, obturation or aneurysm.

[Gastrointestinal surgical complications after kidney transplantation]. / Gastrointestinálne chirurgické komplikácie po transplantácii oblicky.

BACKGROUND AND OBJECTIVE: Clinical spectrum of gastrointestinal (GI) complication in renal transplant recipients ranges from nonspecific signs of abdominal discomfort to life-threatening surgical emergencies. The manifestation of such complications is modified by antirejection therapy with resulting risk of diagnostic and therapeutic error. The present study analyses the incidence of serious GI complications after renal transplantation and their treatment. METHODS: Retrospective analysis in a university transplant center in years 1988-2000. There was 239 renal transplants performed in 234 patients (age 42 +/- 14). Male to female ratio was 140.99. Polycystic kidney disease patients comprised 9% (n = 22). RESULTS: Five serious GI complications resulting in death were recorded (2x upper GI bleed, 1x acute pancreatitis, 1x bowel obstruction in sclerotizing peritonitis, 1x diffuse purulent peritonitis of unknown origin). There was no case of diverticulitis. The average time onset of lethal GI complication was 2.8 +/- 1.4 years after renal transplantation. There was no statistically significant relation to underlying diagnosis of renal failure, warm and cold ischemia time, and time elapsed after transplantation. CONCLUSION: GI complications have increased incidence in patients after renal transplantation. The incidence of complications has no relationship to underlying diagnosis of renal failure, warm and cold ischemia time, and time elapsed after transplantation. Patients involved in transplant program should be carefully followed and thoroughly examined with any new GI symptomatology. Further studies are necessary to evaluate potential of pre-transplant screening programs.

Vascular complications in reconstructive and replantation surgery.

Authors deal with the causes of complications in reconstructive and replantation surgery of the hand. The most common complications are of vascular origin. Early revision, removal of all devitalized tissue and autoplastics of arteries and veins combined with ATB treatment contribute to their successful management. (Fig. 7, Ref. 6.)

[Reconstructive operations in our clinical data]. / Rekonstrukcné operácie v nasom klinickom materiáli.

The authors present the results of reconstructive vascular operations performed during the period from 1990 to 1994. According to the criteria of the European Vascular Surgery Council the lowest patency was recorded in the distal type of femoropopliteal bypasses in the lower extremities. They emphasize the necessity to apply the "Graft Surveillance Programme" in vascular consultation centre. (Tab. 2, Ref. 7.).

Microvascular treatment of impotence.

Occlusion and/or stenosis of arteries supplying the penis was the cause of erectile impotence in 11 patients. They were chosen from 124 patients who were assessed by a multidisciplinary team for impotence. Indirect revascularization of the corpora cavernosa was performed by anastomosing the inferior epigastric artery to the deep dorsal penile vein. This arterialized vein was, in turn, anastomosed side to side to one of the corpora cavernosa. In seven patients the anastomosis remained patent. There was one documented thrombosis. Three patients were unavailable for Doppler examination but are known to have achieved erection. The indirect revascularization of the corpora cavernosa appears to be an acceptable surgical treatment of vasculogenic impotence.