Prediction of coronary vessel involvement on the basis of atherosclerosis risk factor analysis.

The prediction of coronary vessel involvement by means of noninvasive tests is one of the fundamental objectives of preventive cardiology. This review describes the current possibilities of coronary vessel involvement prediction by means of ultrasonographic examination of carotid arteries, analysis of polymorphisms in the genes encoding enzymes responsible for production of nitric oxide and carbon monoxide and assessment of levels of certain proinflammatory cytokines. In the presented work these noninvasive markers are correlated with the extent of coronary vessel involvement as assessed by coronary angiography, intravascular ultrasound and virtual histology (Fig. 5, Ref. 40).

Ischemic peripheral arterial disease and recurrent iliofemoral venous thrombosis in a 24-year-old man with antiphospholipid syndrome.

The following is a case report of a young man with antiphospholipid syndrome, present with a recurrent iliofemoral venous thrombosis and premature peripheral arterial disease. This case report highlights the high risk of recurrent thrombosis upon discontinuation of anticoagulation therapy, particularly in the presence of persistent spontaneously increased aPTT and a high antiphospholipid antibody titer. The case report also reviews the potential of endovascular treatment of iliac vein thrombosis and points out the good 24-month patency rates of stents implanted into the pelvic vein region.Key words: antiphospholipid syndrome - iliofemoral deep vein thrombosis - recurrent thrombosis - accelerated atherosclerosis - peripheral arterial disease.

[Outcomes of combined surgical and endovascular treatment of the venous thoracic outlet syndrome during 2000-2007 in the IInd Surgical Clinic of the VFN (General Faculty Hospital) and 1. LF UK (First Medical Faculty, Charles University) in Prague]. / Výsledky kombinované chirurgické a endovaskulární lécby zilního thoracic outlet syndromu v letech 2000-2007 na II. chirurgické klinice VFN a 1. LF UK v Praze.

OBJECTIVES: Between 2000-2007 we performed 31 surgical procedures for thoracic outlet syndrome, two patients underwent bilateral procedure. METHODS AND RESULTS: 26 patients had venous TOS, 4 neurovascular and 1 arterial TOS. Rib resection and scalenotomy were performed at 23 patients, rib resection, scalenotomy and deliberation at 9 patients, in one case re-operation. CONCLUSION: 76% patients were without difficulties after combined endovascular and surgical procedures.

[Bilateral leg compartment syndrome due to severe myonecrosis caused by inappropriate use of simvastatin]. / Syndrome de compression des loges bilatéral des membres inférieurs et myonécrose sévère due à l'usage inapproprié de la simvastatine.

Bilateral leg compartment syndrome due to myonecrosis caused by inappropriate use of statins is a rare but potentially fatal complication of this lipid lowering medication. We report a case of a 39-year-old woman who presented with suspicious critical lower limb ischemia. Subsequently, bilateral leg compartment syndrome and myonecrosis developed. The primary cause of myonecrosis was due to misuse of simvastatin mistaken by the patient for a weight-reducing drug. Urgent fasciotomies were performed and the patient underwent urgent renal replacement therapy with continuous hemodialysis for acute renal failure due to myoglobinuria. After this complex treatment, the patient was discharged. She almost fully recovered with only a residual paresis of the left fibular nerve. According to literature, this is a unique case of bilateral compartment syndrome and myonecrosis with acute renal failure due to statin overdose leading to acute renal failure and bilateral fasciotomy.

Autologous intra-arterial infusion of bone marrow mononuclear cells in patients with critical leg ischemia.

AIM: The injection of bone marrow mononuclear cells (BMMC) into the gastrocnemius muscle has given promising results in patients with critical limb ischemia (CLI). In this article, we have assessed whether a less invasive procedure, i.e. intravascular BMMC infusion, could be effective in this population of patients. METHODS: A total of 28 limbs in 24 patients with CLI were treated. An amount of 276-700 mL of marrow blood was harvested from posterior iliac crests and BMMC were obtained by standard procedure used for bone marrow transplantation. After performance of digital subtraction angiography, BMMC were injected laterally through a 4 Fr sheet. Primary outcome was efficacy of the procedure measured as healing of defects, frequency of high amputations and change of ischemia grade; among secondary outcomes were safety of the procedure, angiographic changes and changes in quality of life. RESULTS: One year after treatment, all patients were alive and only 2 patients have undergone high amputation. Eleven of 14 defects have healed (78%) and Fontaine grade of ischemia has changed from median grade 3.5 to median grade 2 (P<0.0001). Collateral vessel development has improved by mean 1.13 and 1.3 points on a four-point semiquantitative scale in calf and foot, respectively (P<0.0001). There were no grade III-IV adverse events. According to the SF-36 quality of life questionnaire, 1 year after the procedure patients have reported significant improvement in all measured items. CONCLUSION: Intra-arterial infusion of BMMC can lead to significant and long-lasting subjective and objective improvements in patients with CLI. The results merit validation by randomized controlled studies in patients with less critical limb ischemia.

[Endovascular treatment of acute vascular occlusions]. / Endovaskulárni lécba akutních cévních uzáveru.

Acute vascular occlusion is a medical emergency and often a life threatening situation. It is caused by embolization into local arteries, by thrombosis or by occlusion of peripheral arterial bypass grafts. Percutaneous thrombectomy and local thrombolysis represent well established techniques for the treatment of acute limb ischemia and massive deep venous thrombosis especially for ileofemoral and ileocaval occlusion. The new techniques of thrombectomy allow very effective and minimally invasive therapy of acute vascular occlusions.

[Basic epidemiologic indicators of venous diseases]. / Základní epidemiologické ukazatele zilních onemocnení.

Venous diseases are among the major causes of morbidity and mortality in The Czech Republic. The incidence of venous diseases increases rapidly with age, especially in those older than 65 years. Among discussed entities is the most important deep venous thrombosis and its complications--pulmonary embolism and postthrombotic syndrome. We discuss epidemiology of acute and chronic venous diseases in context of risk factors and offer a short outline of currently applied therapy. Then we focus on the new perspective possibilities of treatment of venous diseases especially in acute states (including local thrombolysis), on its influence of quality of life, on the progression of diseases into chronic states and on its socioeconomic consequences.

[Interventional therapy of the inferior vena cava syndrome]. / Intervencní lécba syndromu dolní duté zíly.

Interventional procedures are becoming increasingly popular in the treatment of impaired patency of deep venous system caused most often by extensive phlebothrombosis. Restoration of patency to affected venous segments while preserving the valvular function with a high degree of success in a relatively short period of time can be achieved by combination of endovascular methods such as catheter guided thrombolysis followed by percutaneous transluminal angioplasty and stenting. This approach enables not only the resolution of acute vascular complications but also the prevention of postthrombotic syndrome. This case report of a 52-year-old man with retroperitoneal fibrosis causing chronic compression of vena cava inferior further complicated by travelling associated bilateral ileofemoral thrombosis clearly demonstrates the wide ranging applications of the endovascular techniques.