Endovenous laser ablation of saphenous veins - favorable clinical results confirm theoretical advantages of the 1940nm diode laser.

INTRODUCTION: Endovenous laser ablation (EVLA) is a recognized alternative to surgical treatment of varicose veins, although an optimal laser generator and its settings still remain a matter of debate. The aim of our study was to correlate clinical results with the theoretical advantage of the 1940nm diode laser characterized by high absorption of heat in a thin layer of coagulated tissue. METHODS: From 1/2010 to 12/2021 EVLA was performed in a total of 3529 consecutive patients with varicose veins and ultrasonographically documented superficial venous reflux of lower extremities. Three types of laser were used successively with the wavelengths of 1064 nm, 1470 nm and 1940 nm, respectively. All patients were prospectively enrolled in our registry. An early postoperative followup visit was scheduled including an assessment of venous closure; additional visits were performed only in case of complications. RESULTS: The success of venous closure did not differ (p=0.054) between the three laser types and was over 98%. The catheterbased method made it possible to perform multiple ablations in one procedure the trend was 1.08, 1.31 and 1.62. In 2021 the number of ablations per patient with the laser DL Tethys 1940 nm was 1.79. With this laser it was possible to reduce the total energy applied to one half (8 W, 5080 J/cm). The postoperative course of patients treated using the 1940nm laser was smoother - no other but the early followup visit was needed in 95.6% cases (p.

Acute responses of hepatic fat content to consuming fat, glucose and fructose alone and in combination in non-obese non-diabetic individuals with non-alcoholic fatty liver disease.

We have recently demonstrated that a high-fat load can induce immediate increase in hepatic fat content (HFC) and that such an effect can be modified differently by co-administration of fructose or glucose in healthy subjects. Therefore, we addressed the question how consumption of these nutrients affects changes in HFC in subjects with non-alcoholic fatty liver disease (NAFLD). Eight male non-obese non-diabetic patients with NAFLD underwent 6 experiments each lasting 8 hours: 1. fasting, 2. high-fat load (150 g of fat (dairy cream) at time 0), 3. glucose (three doses of 50 g at 0, 2, and 4 hours), 4. high-fat load with three doses of 50 g of glucose, 5. fructose (three doses of 50 g at 0, 2, and 4 hours), 6. high-fat load with three doses of 50 g of fructose. HFC was measured using magnetic resonance spectroscopy prior to meal administration and 3 and 6 hours later. Plasma triglycerides, non-esterified fatty acids, glucose and insulin were monitored throughout each experiment. HFC increased by 10.4 ± 6.9% six hours after a high-fat load and by 15.2 ± 12.5% after high-fat load with fructose. When co-administering glucose with fat, HFC rose only transiently to return to baseline at 6 hours. Importantly, NAFLD subjects accumulated almost five times more fat in their livers than healthy subjects with normal HFC. Consumption of a high-fat load results in fat accumulation in the liver of NAFLD patients. Fat accumulation after a fat load is diminished by glucose but not fructose co-administration.

Endovenous laser ablation of saphenous vein - mid-term results confirm permanent closure and possibility to treat more lesions in one procedure.

INTRODUCTION: Endovenous Laser Ablation (EVLA) is a common alternative to surgical treatment of varicose veins. The aim of our study was to demonstrate that laser occlusion is durable, that we can treat all patients in a one day setting, even with veins >10mm in diameter, and that multiple EVLAs can be done at the same time. METHODS: In the period from 1/2017 to 12/2019 EVLA was performed in a total of 1551 consecutive patients with varicose veins and ultrasonographically documented venous reflux. The mid-term results were evaluated in a group of patients operated from 1/2017 to 6/2017 (316 pts.). We compared a risk group that consisted of patients with veins >10mm in diameter (40 pts.) with a control group (the remaining 276 pts.). Patients with veins >10mm are traditionally considered as candidates for conventional surgery. RESULTS: The catheter-based method enabled us to perform more ablations in one procedure. In 2019 we performed 1.44 EVLA procedures per patient. There was only one postoperative follow-up visit, indicating an uncomplicated postoperative course, in 87.5% of patients of the risk group. In the control group 100% of patients had only one follow-up visit including ultrasound examination, showing an uncomplicated postoperative course (p.

Clinical and (31)P magnetic resonance spectroscopy characterization of patients with critical limb ischemia before and after autologous cell therapy.

Autologous cell therapy (ACT) is a new treatment method for diabetic patients with critical limb ischemia (CLI) not eligible for standard revascularization. After intramuscular injection of bone marrow-derived mononuclear cells local arteriogenesis in the ischemic tissue occurs. Studies assessing visualization of this therapeutic vasculogenesis after ACT by novel imaging techniques are lacking. The aim of our study was to assess the effect of ACT on possible metabolic changes and perfusion of critically ischemic limbs using (31)P magnetic resonance spectroscopy ( (31)P MRS) and its possible correlation with changes of transcutaneous oxygen pressure (TcPO(2)). Twenty-one patients with diabetes and no-option CLI treated by ACT in our foot clinic over 8 years were included in the study. TcPO(2) as well as rest (phosphocreatine, adenosine triphosphate and inorganic phosphate) and dynamic (mitochondrial capacity and phosphocreatine recovery time) (31)P-MRS parameters were evaluated at baseline and 3 months after cell treatment. TcPO(2) increased significantly after 3 months compared with baseline (from 22.4±8.2 to 37.6±13.3 mm Hg, p=0.0002). Rest and dynamic (31)P MRS parameters were not significantly different after ACT in comparison with baseline values. Our study showed a significant increase of TcPO(2) on the dorsum of the foot after ACT. We did not observe any changes of rest or dynamic (31)P MRS parameters in the area of the proximal calf where the cell suspension has been injected into.

Abdominal aortic aneurysm as an IgG4-related disease.

The objectives of this study were to evaluate patients with aortic abdominal aneurysm (AAA) with regard to immunoglobulin (Ig)G4-related disease (IgG4-RD). IgG4-RD represents a recently defined condition comprised of a collection of disorders characterized by IgG4 hypergammaglobulinemia, the presence of IgG4-positive plasma cells in organs affected with fibrotic or sclerotizing changes and typical histopathological features. It was identified as a possible cause of vasculitis in large vessels. Studies have been published on a possible association between inflammatory aortic or cardiovascular disease and IgG4-RD. We examined 114 patients with AAA requiring surgery in order to identify findings which are characteristic of IgG4-RD. Aneurysm samples from seven patients showed histopathological features consistent with IgG4-RD and the presence of IgG4+ plasma cells. Only two of these seven patients showed elevated IgG4 serum levels higher 1·35 g/l. In five of the patients, the concentration of serum IgG4 was lower than 1·20 g/l, with the number of IgG4+ plasma cells being higher than 50/high-power field. These findings were consistent with AAA being a heterogeneous group of inflammatory diseases with different pathogenesis.

Gene expression in patients with abdominal aortic aneurysm - more than immunological mechanisms involved.

Abdominal aortic aneurysm (AAA) is a serious condition of unclear pathogenesis and progression. Two samples were collected from 48 patients during AAA surgery. One sample was collected from the aneurysm, the other from the aneurysm proximal neck where the tissue did not exhibit any aneurysmal changes. Subsequently, gene expression profiles using microarrays (Illumina) were compared in RNA extracted from the samples. Overall, 2,185 genes were found to be upregulated and 2,100 downregulated; from which 158 genes had a different expression with FDR<0.05 (False Discovery Rate) and FC>/=2 (Fold Change). Of this number, 115 genes were over-expressed and 43 under-expressed. The analysis of the gene list based on their biological pathways revealed that the regulation of inflammation was mediated by chemokine and cytokine signaling pathways, the integrin signaling pathway, and T and B cell activation. Moreover, a change was identified in the expression of genes involved in both intercellular and intracellular signaling systems.

Differences in muscle metabolism in patients with type I diabetes - influence of gender and nephropathy studied by (31)P MR spectroscopy.

Type I diabetes mellitus (DM1) is a complex disease with adverse effects on organs and tissues despite compensation by insulin treatment. The goal of our study was to study how kidney diseases change (31)P MR parameters of muscle metabolism in DM1 patients with respect to gender. 51 DM1 patients (19 m/14 f without and 13 m/5 f with nephropathy) and 26 (14 m/12 f) healthy volunteers were examined using (31)P magnetic resonance spectroscopy at 3T tomograph at rest, and during and after a calf muscle exercise. The exercise consisted of a six-minute plantar flexion using a pedal ergometer followed by a six-minute recovery. It is reflected by reduced relative beta-ATP and increased Pi and phosphodiester signals to phosphocreatine (PCr) at rest and prolongation of the PCr recovery time after the exercise. Measurement on healthy volunteers indicated differences between males and females in pH at the rest and after the exercise only. These differences between patients groups were not significant. We have proven that nephropathy affects the metabolism in diabetic patients and our results confirm significant difference between patients with and without nephropathy. Gender differences in pH were observed only between male and female healthy volunteers.

Influence of breathing on the measurement of lipids in the myocardium by ¹H MR spectroscopy.

The myocardium examination by MR spectroscopy is very challenging due to movements caused by the cardiac rhythm and breathing. The aim of the study was to investigate the influence of breathing on the quantitative measurement of lipid/water ratios in different groups of volunteers and different measuring protocols. We examined the lipid content of myocardium at 3T using the proton single voxel spectroscopy. Three protocols (free breathing, breath hold and the use of respiratory navigator) controlled by ECG were used for the examination of 42 adult volunteers including 14 free divers. Spectra were evaluated using jMRUI software. An average content of lipids in the healthy interventricular septum, gained by all protocols was equal to 0.6 %, which is in agreement with other published data. Based on the quality of examinations and the highest technical success, the best protocol seems to be the one containing a respiratory navigator since it is more acceptable by patients. Based on our results and the literature data we can conclude that MR spectroscopy is able to distinguish patients from controls only if their myocardial lipid content is higher than 1.6 % (mean value of lipids plus two standard deviations).

[A novel method of endovascular aneurysm sealing (EVAS) in patients with abdominal aortic aneurysm]. / Nová metoda endovaskulární výplne výdute aorty abdominální (endovascular aneurysm sealing EVAS).

INTRODUCTION: Endovascular stent graft therapy of abdominal aortic aneurysms is sometimes complicated due to unusual anatomy of the aorta and adjacent arterial regions, an irregular or short proximal neck, numerous patent branches originating from the aneurysm, or tortuous iliac arteries. Endovascular aneurysm sealing is a new method designed to overcome certain limitations of current stent grafts. METHOD: At the Department of Vascular Surgery of Na Homolce Hospital, we implanted 51 stent grafts in the subrenal aorta and iliac arteries. Most of them were regular bifurcated stent grafts. Two patients were treated with the new Nellix stent graft, in one case due to a short subrenal neck of only 13 mm, and due to a considerably conical neck in the second case. RESULTS: The post-operative course was uneventful in both patients and they were discharged on the 5th postoperative day. CT angiography after six weeks proved that the stent graft had sealed well. The polymer filled the aortic lumen completely. CONCLUSION: This new method of endovascular aneurysm sealing (EVAS) of abdominal aortic aneurysm makes it possible to treat patients whose anatomy would normally require technically complex and more expensive endovascular methods. We aim to follow long-term results of the method in larger patient cohorts.

[Arthroscopic stabilisation of acute acromioclavicular dislocation using the TighRope device]. / Artroskopická stabilizace akutní akromioklavikulární luxace implantátem TighRope.

PURPOSE OF THE STUDY: To present the TightRope (Arthrex, Naples, FL) technique and its results in the arthroscopic stabilisation of acute acromioclavicular joint (ACJ) dislocation carried out at our department. MATERIAL AND METHODS: From July 2009 till December 2010, arthroscopic stabilisation of acute ACJ dislocation was performed in 22 patients. The group consisted of 18 men and four women with an average age of 37.4 years. The Rockwood type III to type V ACJ dislocations (III, 16; IV, 1; V, 5) were indicated for surgery. The average interval between injury and surgery was 5.4 days. In all cases, a second-generation TightRope implant was inserted by the EndoButton technique joining the distal end of the clavicle and the coracoid process. The results were evaluated using the UCLA Shoulder Scale at 6 months after surgery. RESULTS: All 22 patients returned to their pre-operative activities without any restriction of shoulder motion within 5 months of surgery. The average post-operative UCLA score was 31.2 points (range, 28 to 35). Radiographic evidence of the loss of full reduction, with no effect on the clinical outcome, was recorded in four patients (18%) during post-operative rehabilitation. Of these, one had Rockwood type III, two had type IV and one had type V dislocations. One patient suffered post-operative pull-out of the implant from the coracoid; three patients showed skin wound healing by second intention above the lateral clavicle, with one requiring surgical repair under local anaesthesia. There was no neurovascular complication, intra- or postoperative fracture of the coracoid process or lateral clavicle, or deep wound infection. DISCUSSION: Arthroscopic stabilisation of acute ACJ dislocation is a minimally invasive procedure providing the coracoclavicular ligament complex with dynamic stability. In comparison with open procedures, it is less painful post-operatively, allows the patients to return early to daily activities and has a better cosmetic effect. It eliminates the necessity of removing the osteosynthetic material, as is the case in commonly used techniques such as Bosworth's method, K-wiring, osteorrhaphy or hook plate insertion. The loss of full reduction in four patients, as observed on radiographs during their rehabilitation, was not accompanied by any clinical problems and is in agreement with the findings of other authors. In our group, it occurred in Rockwood grade IV and grade V dislocations. For these, there is a possibility of using two implants in order to increase stability and prevent the loss of full reduction but this involves a higher risk of coracoid fracture, extension of operative time and higher costs. However, a loss of reduction in some patients has also been reported by the authors who have used two implants. Therefore we prefer using a single TightRope implant, particularly in acute grade III ACJ dislocations requiring surgical treatment in patients engaged in repetitive overhead activities related to sports or occupation. CONCLUSIONS: Arthroscopic stabilisation of acute ACJ dislocations using a single TightRope implant is an elegant minimally invasive method with good results in indicated cases. It proves efficient particularly in Rockwood type III injuries in patients who have to do repetitive overhead activities. Acute type IV and type V ACJ dislocations treated by this technique show a loss of full reduction on radiographs more frequently, although no effect on the clinical outcome is evident.

Endovascular treatment of infected aortic aneurysms.

OBJECTIVE: To report on the short- and long-term outcomes of patients with primary infected aortic aneurysm (IAA) treated by stent graft (SG) in two centers. MATERIAL AND METHOD: Over a period of 15 years, 32 patients with IAA underwent endovascular treatment. None had undergone previous aortic surgery. The causal relationship was gastrointestinal infection in 9 patients (28%), endovascular diagnostic/therapeutic procedures/resuscitation in 6 (19%), wound infection after previous surgeries in 5 (16%), urinary infection in 4 (13%), urology or gastroenterology procedures in 3 (9%), pancreatitis in 2 (6%), endocarditis in 1 (3%) and phlebitis in 1 (3%) patient. We implanted 11 bifurcated, 10 tubular thoracic, 4 aorto-uni-iliac, 4 tubular abdominal and 1 iliac SG. Two other surgeries were hybrid procedures. RESULTS: The etiological agent was identified in 28 (88%) patients. Twenty-six (81%) patients survived the 30-day postoperative period. Sixteen (50%) survived to 1-year follow-up and 13 (40.6%) survived to 3-year follow-up. Three patients have survived for less than 1 year and a further 3 for less than 3 years, so far. Among patients with aneurysms situated in central parts of the thoracic and infrarenal aorta there was a better death/survival ratio than among patients with a proximal or distal aneurysm location. CONCLUSION: The implantation of a SG may be an alternative to open surgery in selected groups of patients with primary IAA. Aneurysms of the central part of the thoracic or abdominal aorta have a more favorable prognosis with endovascular treatment.

A spontaneous isolated dissection of the external iliac artery in a roofer.

After two days of an intensive roofing work, a healthy professional 41-year-old roofer experienced an isolated spontaneous dissection of the external iliac artery with an acute severe ischemia of the left lower extremity. The compressed true lumen, complete thrombosis of the false lumen and an overlapping dissection at the origin of the deep femoral artery necessitated an open surgery. An urgent iliofemoral bypass was constructed and external iliac artery was excluded. Connective tissue disorders were excluded by immunology, histology and genetic tests. Spontaneous dissection of the iliac artery has frequently been described in sportsmen after an exceptional physical strain. The same mechanism may also come into question following occupational overexertion. However, connective tissue or vascular wall disorders must be taken into consideration in differential diagnosis (Fig. 1, Ref. 21).

[Radical operation of infected aortofemoral prosthesis using fresh arterial allograft: our mid-term experience]. / Radikální operace infekce cévní protézy v aortofemorální pozici s pomocí cerstvého tepenného allograftu: nase strednedobé zkusenosti.

INTRODUCTION: The mid-term experience with the use of the fresh arterial allografts in the treatment of aortic or aortofemoral prosthetic infection is presented. MATERIAL AND METHODS: Between 2001-2010 24 patients (23 with the infected graft in aortic or aortofemoral position and one with a mycotic aneurysm of the aortic bifurcation) were operated with the use of the fresh arterial allograft. Male/female ratio was 15/9, average age 65.8 (36-81) years. The gastrointestinal comorbidities dominated this cohort. The total of 70 previous vascular operations (1-9; m. 2.9/patient) were performed with the median of 5.8 years between the first and the last procedure. Seven patients had sepsis (29.2%), aortoeneteric fistula occurred in three. Various technical modifications of the aortobifemoral (13), aortounifemoral (8) bypass, aortic and aortoiliac replacement (3) were performed including the sequential distal reconstructions. The arterial allograft was used within 8-48 hours following harvest (the median cold ischemic time of 20 hours) and all patients were given cyclosporine A perioperatively. RESULTS: In-hospital mortality was 20.8% (5/24), twice caused by postoperative hemorrhage from either the aortic anastomosis or the graft necrosis. The remaining deaths were not related to the allograft itself. Two limbs, preoperatively ischemic, were amputated (8.3%). The median follow-up is 4.6 years (3 m.-8 yrs.). The three-years survival was 68.4% and the known causes of death had no relation to the allograft. The late occlusion of the graft limb occurred twice, stenoses within its course twice and three femoral anastomotic stenoses were disclosed. All were treated either surgically or by PTA/stent and the redo procedures' rate has thus reached 20.5% in the mid-term follow-up interval. One graft has shown a slight diffuse dilatation since requiring but follow-up. CONCLUSIONS: Under the conditions of the ABO compatibility tolerance and ongoing postimplantation immunosuppression the shortly ischemic arterial graft helds its anatomic structure and function and within the hostile setting of the previous infection represents a valuable alternative of the surgical treatment of the vascular prosthetic infection in the aortofemoral position or of the mycotic aneurysm.

[Changes in the true and false visceral segment lumen sizes following endovascular treatment of type B aortic dissections]. / Zmeny velikosti pravého a falesného lumen ve viscerálním segmentu po endovaskulární lécbe disekcí aorty typu B.

INTRODUCTION: The aim of the study was to assess technical success rates of endovascular procedures in acute and chronic type B aortic dissections and changes in the right (PL) and false (FL) lumen diameters in the visceral segment region during short-term and long-term follow up study periods. METHODS: From 2004 to 2009, the authors performed a prospective study, which included a total of 33 patients with acute and subacute (n = 16; 48.5%) or chronic (n = 17; 51.5%) type B dissections of the descending aorta, with dissections spreading as far as the visceral or infrarenal regions. The patients underwent successful implantations of stent grafts (SG) into the descending aorta. The study group included 7 female and 26 male subjects, at the time of the procedure, their mean age was 59 years, (34-70, the median of 56 y.o.a.). The mean follow up time was 39.3 months (8-68, the median of 41 months). During the study period, one of the patients exited due to another internal disorder, three subjects were converted to open replacements for progressing dilatation of the total diameter in the visceral or subrenal region. The true (PL) and false (FL) lumen diameters were measured at four levels: above the origin of truncus coeliacus (L 1), between the origin of truncus coeliacus and the origin of a. mesenterica superior (L 2), between the origin of a. mesenterica superior and the origin of aa. renales (L 3) and just distal to the origin of aa. renales (L 4). The measurements were performed 1 and 6 months after SG implantations and at the end of the study period. RESULTS: The primary entry was successfully sealed in all the study subjects. Significant widening of the true lumen in the region sealed by the stentgraft was recorded in all the subjects, however, the false lumen did not completely disappear in 3 (9%) patients. The false lumen was completely filled with thrombus down to the celiac trunk level (L 1) within one month in 7 (21.2%) patients, within 6 months in 14 (42.4%) subjects and by the end of the study period in 19 (58.6%) patients. The true lumen continued to enlarge at all the measured levels. The most significant enlargement was recorded at L 1 during the first postoperative month (the mean change of 5.9 mm). Furthermore, narrowing of the originally patent false lumen was observed as well, with the most significant change at L1 level during the first postoperative month (the mean change of 6.5 mm). At six months and during the whole follow up study period, further increases in the right lumen diameter and in the total aortic diameter were recorded at all the measured levels. At the same time, the false lumen diameters at all the measured levels continued to narrow, if patent at all. CONCLUSION: False lumen thrombosis along the extent of SG was recorded in 30 (91%) patients, SG filled the lumen completely and the false lumen disappeared. The true lumen expanded at all the measured visceral segment levels. The change was most significant during the first postimplantation month, and the true lumen expansions and the false lumen narrowing proceeded over the whole follow up study period, however, the progression was slower. The visceral segment true and false lumen changes will be monitored further.

[Simple method of infected vascular prosthesis removal]. / Jednoduchá metoda odstranení infikované cévní protézy.

INTRODUCTION: Removal of infected vascular prosthesis from aortofemoral or femoropopliteal positions may be technically demanding due to their strong fibrous attachment to surrounging tissues. MATERIAL AND METHODS: The authors describe a simple method of vascular prosthesis inversion and removal from the fibrous tissue using instrumentation for tunelization. DISCUSSION: The authors successfully used the method in a patient with firmly attached and thrombotized vascular prosthesis. CONCLUSION: The procedure reduced duration of the procedure and resulted in reduced traumatization of the surrounding tissue.

[Prevention of type II endoleak using postoperative coiling of the abdominal aortic aneurysm sac during stent graft implantation]. / Prevence endoleaku II. typu pomocí peroperacního coilingu vaku aneuryzmatu abdominální aorty behem implantace stentgraftu.

AIM: A prospective randomized study assessing the success rates of type II endoleak (EL) prevention, using postoperative coiling of the abdominal aortic aneurysm (AAA) sac during stent graft (SG) implantation. MATERIAL AND METHODS: From January 2008 to July 2009, 86 patients were operated for AAA using endovascular methods with bifurcation SG. The subjects were prospectively randomized into two subgroups. Group A subjects (42 subjects; 48.8%) had various numbers of coils introduced into the sac, close to the SG body. Group B (44 subjects; 51.2%) included patients without coils. Preoperative CT angiograhy (CT AG) was used to assess patency and the number of lumbal arteries (AL), a.mesenterica inferior (AMI), a. sacralis mediana (ASM) and aa. renales accessoriae (ARA), the AAA sac and the lumen size. At the end of the studied period, existence of type II EL and the AAA sac size was assessed using sonography and /or CT AG. RESULTS: Prior to the procedure, there were only minor differences in the number of source type II EL arteries (AL 3.8 vs. 3.5; AMI 0.78 vs. 0.55; ASM 0.26 vs. 0.3; ARA 0.095 vs. 0.05), preoperative AAA sac size (68.6 vs. 67.0 mm) and the lumen size (47.6 vs. 40.0 mm), the AAA sac size at the end of the studied period (63.9 vs. 62.1 mm) and its mean size change (-4.7 vs. -4.9 mm), between the Group A and B, respectively . Postoperatively, the type II EL was detected in 6 subjects in Group A (14.3%), and in 9 subjects in Group B (20.5%). At the study endpoint, the type II EL was identified in 4 subjects in Group A (9.5%), in 8 subjects in Group B (18.2%). CONCLUSION: Peroperative introduction of coils into the AAA sac is one of the options for type II EL prevention. It facilitates successful regression and disappearance of type II EL.

Infected false aneurysm caused by hematogenous dissemination of Staphylococcus aureus after the use of vaginal tampons.

The use of vaginal tampons during menstruation may be associated with the proliferation of bacteria on their uneven surface, unless the instructions for use provided by the manufacturer are followed. A healthy young woman presented with a false aneurysm of infectious origin, caused by Staphylococcus aureus, in connection with the use of vaginal tampons. The aneurysm manifested after the menstruation when tampons were used and during which the patient experienced an untreated feverish epizode. Vaginal colonies of Streptococcus and Staphylococcus are present in nearly 40% of healthy menstruating women. Staphylococcal septicemia with the subsequent appearance of an arterial infected false aneurysm in a formerly healthy woman has not yet been described in relation to the use of vaginal tampons.

[Urgent endovascular management of the thoracic aorta dissection and subsequent lower extremity ischemia]. / Akutní endovaskulární rerení disekce hrudní aorty a následné ischemie dolních koncetin.

SITUATION: Insertion of tubular stentgrafts in the management of acute type B dissection of the thoracic aorta has recently become a popular alternative to open surgeries. The classical surgical procedure in complicated dissections is associated with mortality rates of up to 50% and prolonged intensive care hospitalization. However, endovascular procedures have been associated with significantly lower morbidity and mortality rates. There is insufficient experience with the stentgraft implantation outcome concerning both the septum dissection and the lumini. CASE REVIEW: A tubular stentgraft has been implanted to a forty-nine-year-old patient with acute, type B dissection. Immediate ischemic and neurological complications, requiring reoperation and prolonged intensive care, were recorded postoperatively. The causes and the management are discussed. CONCLUSION: Endovascular management of the type B dissection is a popular, more patient-saving and healthcare professionals-saving procedure, compared to classical open surgery. Pressure changes in the true and false aortic lumen may result in rapid reduction of the organ and limb perfusion flow. These complications should be expected and must be managed urgently. Such surgeries should be performed in clinical centres with appropriate facilities.

[Postoperative re-stenosis of the carotid--A case for reoperation or endovascular management?]. / Pooperacní restenóza karotidy--reoperace nebo endovaskulární resení?

The aim of this work was to assess frequency rates of re-stenoses following surgical or endovasular treatment of re-stenoses after primary endarterectomies of the carotid artery, taking into consideration concomitant disorders and the contralateral findings. Another objective was to assess differences in peroperative and postoperative complications frequency rates. The retrospective study included patients undergoing vascular surgery during a seven-year period. The study revealed that repetitive restenoses were statistically significantly (3x) more frequent in cases of the endovascular management compared to that in re-operations (p = 0.015). In the repetitive re-stenoses patients, the rate of the contralateral carotid affection was significantly higher (93.8%, p = 0.05) and also the rate of the contralateral artery obliteration was higher (43.8%, p = 0.05). The highest frequency rates of the repetitive carotid re-stenosis was in patients with a concomitant affection of the contralateral artery. Surgical management of the repetitive re-stenosis of the carotid artery following its primary surgical management showed better results than the endovascular management.