AIMS: Data about long-term clinical outcomes of revascularization procedures, especially for autologous cell therapy (ACT), in diabetic patients with chronic limb-threatening ischaemia (CLTI) are lacking. The aim of our study was to compare the mortality and amputation rates in patients with diabetic foot ulcers (DFU) and CLTI treated by ACT with patients treated by repeated percutaneous transluminal angioplasty (re-PTA) and those treated conservatively. MATERIALS AND METHODS: One-hundred and thirty patients with DFU and CLTI (defined as transcutaneous oxygen pressure-TcPO2 <30 mmHg after unsuccessful standard revascularization) treated in our foot clinic over 9 years were enrolled in the study. Forty-five patients were treated by ACT, 43 patients underwent re-PTA, and 42 patients were treated conservatively and formed the control group. Overall survival, amputation-free survival (AFS) and major amputation rate were assessed over a 7-year follow-up period. RESULTS: Baseline demographic characteristics and comorbidities were similar between groups. However, patients in ACT and control groups had significantly worse baseline angiograms in accordance with Graziani and GLASS (infrapopliteal region) classifications than the re-PTA group (both p < 0.001), but there were no differences in baseline values of TcPO2 between groups. AFS in the ACT and re-PTA groups were significantly longer compared to control (both p < 0.001). The rate of major amputation was significantly lower in both active groups (both p < 0.001). The re-PTA group showed significantly longer overall survival compared to the control group (p < 0.001), but there was no significant difference between ACT and control groups (p = 0.063) and ACT and re-PTA groups (p = 0.081) in this parameter. CONCLUSIONS: Our study showed significantly longer AFS and lower major amputation rates in patients treated by ACT and re-PTA in contrast to patients treated conservatively. Overall survival was significantly longer only in the re-PTA group. ACT was shown to be effective in long-term limb salvage in people with no-option CLTI.

• Klíčová slova
• cellular research, clinical trial, diabetes complications, effectiveness,
• MeSH
• amputace statistika a číselné údaje   MeSH
• angioplastika * MeSH
• autologní transplantace MeSH
• buněčná a tkáňová terapie * MeSH
• chronická kritická ischemie končetin * terapie   mortalita   MeSH
• diabetická noha * terapie   mortalita   komplikace   chirurgie   MeSH
• ischemie * terapie   mortalita   MeSH
• konzervativní terapie * MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• výsledek terapie MeSH
• záchrana končetiny statistika a číselné údaje   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH

Many patients with atrial fibrillation (AF) who are in need of stroke prevention are not treated with oral anticoagulation or discontinue treatment shortly after its initiation. Despite the availability of direct oral anticoagulants (DOACs), such undertreatment has improved somewhat but is still evident. This is due to continued risks of bleeding events or ischemic strokes while on DOAC, poor treatment compliance, or aversion to anticoagulant therapy. Because of significant improvements in procedural safety over the years left atrial appendage closure (LAAC), using a catheter-based, device implantation approach, is increasingly favored for the prevention of thromboembolic events in AF patients who cannot have long-term oral anticoagulation. This article is an executive summary of a practical guide recently published by an international expert consensus group, which introduces the LAAC devices and briefly explains the implantation technique. The indications and device follow-up are more comprehensively described. This practical guide, aligned with published guideline/guidance, is aimed at those non-implanting physicians who may need to refer patients for consideration of LAAC.

• MeSH
• antikoagulancia terapeutické užití   MeSH
• cévní mozková příhoda * prevence a kontrola   etiologie   MeSH
• fibrilace síní * komplikace   terapie   diagnóza   MeSH
• konsensus MeSH
• lidé MeSH
• síňové ouško * chirurgie   MeSH
• směrnice pro lékařskou praxi jako téma MeSH
• srdeční katetrizace * škodlivé účinky   přístrojové vybavení   MeSH
• tromboembolie * prevence a kontrola   etiologie   MeSH
• uzávěr ouška levé síně MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• směrnice pro lékařskou praxi MeSH
• Názvy látek
• antikoagulancia MeSH

A more accurate descriptive and clinically useful diagnosis based upon pathophysiology for what is commonly referred to as venous outflow stenosis is inflow-outflow imbalance. In these cases, the total outflow capacity of the AV access is inadequate to handle the inflow volume (Qa) without an increase in pressure. The relative inadequacy of the access outflow capacity in comparison to Qa results in increased outflow resistance and a proportional increase in intraluminal pressure. The clinical indicators associated with venous stenosis are the resulting manifestations of this imbalance. The point at which this occurs is dependent upon variations in these two parameters-Qa and outflow resistance. The variations in these two parameters are considerable and reciprocal. Excessive Qa results in or can lead to an entire list of serious problems that adversely affect patient morbidity and mortality. Most studies dealing with AV access Qa reduction have been for the treatment of an existing condition rather than its prevention; however, prevention of disease rather than waiting for its development is an important tenet of medical practice. The resulting clinical picture of inflow-outflow imbalance is taken as an indication for corrective treatment. In the past, in most cases this has meant angioplasty to open the outflow if it is reduced; however, this clinical picture may be associated with an excessive Qa and angioplasty in these cases creates the risk for a further increase in Qa. It is the authors' opinion that access flow measurements should be a part of the evaluation of these cases prior to planning treatment. Using this information, a bimodal approach to primary treatment should be adopted involving either angioplasty for cases with a low or normal Qa or flow reduction in cases with an elevated Qa.

• Klíčová slova
• AV access flow reduction, Dialysis access, cardiac complications of AV access, excess AV access blood flow, interventional nephrology, techniques and procedures,
• MeSH
• angioplastika * škodlivé účinky   MeSH
• arteriovenózní zkrat * škodlivé účinky   MeSH
• cévní rezistence MeSH
• dialýza ledvin * MeSH
• hemodynamika * MeSH
• lidé MeSH
• okluze cévního štěpu * patofyziologie   terapie   etiologie   diagnóza   MeSH
• průchodnost cév MeSH
• regionální krevní průtok MeSH
• rizikové faktory MeSH
• rychlost toku krve MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

BACKGROUND: Chronic thromboembolic pulmonary hypertension results from mechanical obstruction of major pulmonary artery lumina with fibrotic tissue. Main treatment has been pulmonary endarterectomy, a complex surgical procedure removing vascular obstruction. However, at least 40% of patients are not candidates for pulmonary endarterectomy because of technical inoperability, comorbidities, or limited access to surgery. Balloon pulmonary angioplasty (BPA) has emerged as an interventional treatment for these patients. OBJECTIVES: The International BPA Registry (NCT03245268) was designed to investigate BPA practice across 18 established centers in the United States, Europe, and Japan. METHODS: A total of 500 patients were prospectively and consecutively enrolled between March 2018 and March 2020, with follow-up until March 2022. Of these, 484 patients were included in the analysis set. RESULTS: Regional differences were seen in patient characteristics (fewer patients with prior pulmonary endarterectomy and more elderly women in Japan) and procedural details (less medical pretreatment, more jugular access, more segments and more occlusive lesions treated per session and patient, less conscious sedation, less contrast and less radiation, shorter intervals between BPA sessions in Japan). Female sex, procedure in Europe/United States, pulmonary hypertension medications at any time, and higher baseline pulmonary vascular resistance (PVR), calculated as transpulmonary pressure gradient divided by cardiac output, emerged as independent predictors of complications during BPA. After a median of 5 (Q1-Q3: 3-6) BPA sessions per patient within a median time of 4.9 months (Q1-Q3: 1.7-11.0 months), a 15-mm Hg (38%) decrease in mPAP, a 332 dynes/s/cm-5 (57%) decrease in PVR, and a 3.2% increase in arterial saturation (medians; P < 0.001) were observed, and there were significant improvements in functional class, 6-minute walk distance, serum levels of N-terminal probrain natriuretic peptide, and Borg dyspnea index. BPA complications occurred in 11.3% of sessions and 33.9% of patients and were mostly hemoptyses. No patient died within 30 days of BPA. CONCLUSIONS: Our data are in line with previous reports on changes of clinical and hemodynamic parameters and complication rates of BPA. Centers with more experience providing BPAs were more likely to achieve a higher percentage decrease in PVR.

• Klíčová slova
• balloon pulmonary angioplasty, balloon pulmonary angioplasty outcomes, balloon pulmonary angioplasty-related complication, chronic thromboembolic pulmonary hypertension,
• MeSH
• arteria pulmonalis chirurgie   MeSH
• balónková angioplastika * metody   MeSH
• chronická nemoc MeSH
• lidé středního věku MeSH
• lidé MeSH
• plicní embolie * komplikace   chirurgie   MeSH
• plicní hypertenze * etiologie   chirurgie   terapie   patofyziologie   MeSH
• prospektivní studie MeSH
• registrace * MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• Geografické názvy
• Evropa epidemiologie   MeSH
• Japonsko epidemiologie   MeSH
• Spojené státy americké epidemiologie   MeSH

INTRODUCTION: It has been shown that general intensive care nurses are able to perform an examination of the deep venous system of the lower extremities for the diagnosis of proximal deep vein thrombosis (DVT) using a compression ultrasound test with a high degree of reliability. (Skulec et al. in Eur J Intern Med 76:130-131, 2020) Another challenge for the use of vascular point-of-care ultrasound in intensive care is the diagnosis of central venous catheter-related thrombosis. It is a common problem that is often underdiagnosed. Due to the simplicity of the examination and the possible link with nursing care of inserted central venous catheters, this may be another potential diagnostic competency for critical care nurses. METHODOLOGY: Before the start of the study, each nurse participating in the study completed a two-hour training in duplex ultrasonography and examined 5 patients under supervision. Then patients in the intensive care unit (ICU) included in the study, underwent a duplex ultrasound performed by a nurse. Within 24 h, the examination was repeated by the ICU doctor. In the case of catheter insertion into the internal jugular vein (VJI) or the subclavian vein (VSC), the jugular vein, subclavian vein, and axillary vein (VA) were examined bilaterally. When the catheter was inserted into the femoral vein (VF), the patients were subjected to a duplex ultrasound of the femoral vein and the popliteal vein (VP) of both lower limbs. The examination results of each patient were blinded until both tests were performed. Calculations were used to evaluate the reliability of the test. RESULT: A total of 160 patients aged 62.9 ± 12.3 years were included. In our sample, the prevalence of CRT was found to be 41%. The overall sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of examinations performed by general intensive care nurses were 90.8%, 97.1%, 91.8%, 96.8%, and 95.5%, respectively. CONCLUSION: The results of our study suggest that general ICU nurses are able to perform inpatient CRT duplex ultrasound with excellent specificity but only moderate sensitivity after a short, predefined training.

• Klíčová slova
• Catheter thrombosis (CRT), Duplex ultrasonography (DUS), General nurse,
• MeSH
• dospělí MeSH
• duplexní dopplerovská ultrasonografie * metody   MeSH
• jednotky intenzivní péče MeSH
• katetrizace centrálních vén * škodlivé účinky   MeSH
• klinické kompetence MeSH
• lidé středního věku MeSH
• lidé MeSH
• ošetřovatelská péče o pacienty v kritickém stavu * MeSH
• reprodukovatelnost výsledků MeSH
• senioři MeSH
• vena subclavia diagnostické zobrazování   MeSH
• venae jugulares diagnostické zobrazování   MeSH
• žilní trombóza * diagnostické zobrazování   etiologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Solitary hepatocellular carcinoma (HCC) with a diameter of 3-5 cm represents a challenging clinical entity, especially for non-surgical candidates due to comorbidities. CASE: A 74-year-old man with previous history of renal cell carcinoma presented with a new incidental solitary 5 cm liver lesion on MRI. Due to his age and a high risk for post-surgical complications, after multidisciplinary tumor board review the treatment plan consisted of percutaneous thermal segmentectomy using balloon-occluded microwave ablation (b-MWA) followed by balloon-occluded transarterial chemoembolization (b-TACE) with complete tumor necrosis, as evident in subsequent follow-up imaging. This case demonstrates that b-MWA plus b-TACE could be a safe and effective combined therapy for unresectable large HCC lesions, even for those exceeding 3 cm in size. CONCLUSION: Although the presented case is anecdotal and naturally without comparisons or control, it highlights the potential value of percutaneous thermal segmentectomy with a single session combined b-MWA followed by b-TACE for the treatment of large unresectable solitary HCC lesions.

• Klíčová slova
• balloon occluded chemoembolization, balloon occluded thermal ablation, case report, hepatocellular carcinoma,
• MeSH
• balónková okluze * MeSH
• chemoembolizace * metody   MeSH
• hepatocelulární karcinom * terapie   MeSH
• katetrizační ablace * metody   MeSH
• lidé MeSH
• mikrovlny * terapeutické užití   MeSH
• nádory jater * terapie   MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Up to one-third of patients referred for transcatheter tricuspid valve intervention (TTVI) have a transvalvular pacemaker (PPM) or implantable cardioverter-defibrillator (ICD) lead in place. Both the electrophysiology and interventional cardiology communities have been alerted to the complexity of decision-making in this situation due to potential interactions between the leads and the TTVI material, including the risk of jailing or damage to the leads. This document, commissioned by the European Heart Rhythm Association and the European Association of Percutaneous Cardiovascular Interventions of the ESC, reviews the scientific evidence to inform Heart Team discussions on the management of patients with a PPM or ICD who are scheduled for or have undergone TTVI.

• Klíčová slova
• Transcatheter tricuspid valve intervention, cardiac implantable electronic device lead, lead extraction, lead jailing, tricuspid regurgitation,
• MeSH
• chirurgická náhrada chlopně * škodlivé účinky   normy   metody   přístrojové vybavení   MeSH
• defibrilátory implantabilní * normy   MeSH
• kardiostimulátor * normy   MeSH
• konsensus MeSH
• lidé MeSH
• rizikové faktory MeSH
• srdeční katetrizace * škodlivé účinky   normy   přístrojové vybavení   MeSH
• trikuspidální chlopeň * chirurgie   patofyziologie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• směrnice pro lékařskou praxi MeSH

BACKGROUND: Current therapy for in-stent restenosis (ISR) is based on drug-eluting stents (DES) or drug-eluting balloon catheters. This prospective randomized study compared the efficacy of a novel sirolimus-eluting balloon (SEB) catheter to that of a paclitaxel-eluting balloon (PEB) catheter for the treatment of bare-metal stent (BMS-ISR) or DES-ISR. METHODS: A total of 145 patients with 158 BMS or DES-ISR lesions were randomly assigned to the treatment with either SEB or PEB. The in-segment late lumen loss at 12 months, the 12-month incidence of binary ISR, and major adverse cardiac events (cardiac death, nonfatal acute myocardial infarction, or target lesion revascularization) were compared between groups. RESULTS: The noninferiority of SEB compared with PEB in the treatment of BMS/DES-ISR with respect to late lumen loss was not demonstrated (Δlate lumen loss, -0.024 mm [95% CI, -0.277 to 0.229]; for a noninferiority margin of 0.20 mm), except in the post hoc subanalysis for the BMS-ISR group (-0.203 mm [95% CI, -0.584 to 0.178]). No significant differences in the incidence of repeated binary ISR (31.6% versus 30.4%, P=0.906) or 12-month major adverse cardiac events (31% for both; P>0.999) between the SEB and PEB groups were observed. CONCLUSIONS: The noninferiority of SEB relative to PEB in the treatment of BMS/DES-ISR with respect to late lumen loss was not confirmed. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03667313.

• Klíčová slova
• angioplasty, balloon, coronary, coronary restenosis, paclitaxel, sirolimus,
• MeSH
• balónková koronární angioplastika * škodlivé účinky   přístrojové vybavení   MeSH
• biokompatibilní potahované materiály * aplikace a dávkování   MeSH
• časové faktory MeSH
• kardiovaskulární látky aplikace a dávkování   škodlivé účinky   MeSH
• koronární angioplastika * škodlivé účinky   přístrojové vybavení   MeSH
• koronární restenóza * diagnostické zobrazování   terapie   mortalita   etiologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nemoci koronárních tepen * diagnostické zobrazování   terapie   mortalita   MeSH
• paclitaxel * aplikace a dávkování   škodlivé účinky   MeSH
• prospektivní studie MeSH
• protézy - design MeSH
• rizikové faktory MeSH
• senioři MeSH
• sirolimus * aplikace a dávkování   škodlivé účinky   MeSH
• srdeční katétry MeSH
• stenty uvolňující léky škodlivé účinky   MeSH
• stenty škodlivé účinky   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• hodnocení ekvivalence MeSH
• multicentrická studie MeSH
• srovnávací studie MeSH
• Názvy látek
• biokompatibilní potahované materiály * MeSH
• kardiovaskulární látky MeSH
• paclitaxel * MeSH
• sirolimus * MeSH

OBJECTIVES: To analyze the prevalence and severity of fetal aortic regurgitation (AR) after undergoing successful fetal aortic valvuloplasty (FAV) and to evaluate its effects on fetal circulation and left ventricular (LV) growth. METHODS: This was a retrospective review of all fetuses with critical aortic stenosis who underwent successful FAV at our center between 2010 and 2024 for whom postnatal echocardiograms were available in digital format. Fetal and postnatal echocardiographic examinations were analyzed for ventricular and valvular dimensions and characteristics, and Z-scores were calculated for middle cerebral artery (MCA) pulsatility index (PI), umbilical artery (UA) PI and cerebroplacental ratio. AR severity was classified into no/mild AR or significant (moderate/severe) AR. The balloon-to-aortic valve ratio (BVR) was calculated as the ratio between the maximum actual balloon diameter and the aortic valve (AV) annulus diameter. The primary endpoints of this study were the prevalence, severity and risk factors for fetal AR following successful FAV. RESULTS: Ninety-nine fetuses who underwent successful FAV were included. Immediate post-FAV echocardiograms showed that 87% of fetuses developed some degree of AR, including 45% of all fetuses with significant AR. BVR was significantly higher in fetuses with significant AR compared to those with no/mild AR (mean, 1.09 (95% CI, 1.06-1.12) vs 1.02 (95% CI, 0.99-1.04); P < 0.001). In a subgroup of 66/99 fetuses with available postnatal echocardiograms, the prevalence of AR decreased significantly from 86% before birth to 58% after birth (P < 0.001), with the proportion of fetuses with significant AR reducing from 47% before birth to 17% after birth (P < 0.001). In the overall cohort of fetuses, AV maximum velocity (Vmax) increased significantly from post-FAV to after birth (mean, 1.93 (95% CI, 1.75-2.11) m/s vs 3.21 (95% CI, 2.89-3.55) m/s; P < 0.001), regardless of AR severity, but Vmax after birth was lower in the significant-AR group compared with the no/mild-AR group (mean, 2.85 m/s vs 3.55 m/s; P = 0.020). Fetuses with significant AR exhibited higher relative LV length increases from immediately post-FAV to after birth than did those with no/mild AR (25% (95% CI, 16-33%) vs 14% (95% CI, 6-21%); P = 0.044), although there was no significant difference in mean LV length Z-score after birth between the two groups. FAV led to significant short-term increases in MCA-PI and UA-PI Z-scores, with greater increases observed in fetuses with significant AR. CONCLUSIONS: FAV is associated with a high prevalence of fetal AR, which lessens in severity over the course of gestation. Significant fetal AR had the largest association with greater BVR and had significant impact on fetal hemodynamics. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

• Klíčová slova
• aortic regurgitation, critical aortic stenosis, evolving hypoplastic left heart syndrome, fetal cardiac intervention, fetal circulation,
• MeSH
• aortální chlopeň diagnostické zobrazování   chirurgie   MeSH
• aortální insuficience * diagnostické zobrazování   epidemiologie   embryologie   patofyziologie   chirurgie   MeSH
• aortální stenóza * chirurgie   diagnostické zobrazování   MeSH
• balónková valvuloplastika * metody   škodlivé účinky   MeSH
• dospělí MeSH
• echokardiografie MeSH
• fetální srdce * diagnostické zobrazování   patofyziologie   MeSH
• lidé MeSH
• nemoci plodu * diagnostické zobrazování   epidemiologie   chirurgie   patofyziologie   MeSH
• prevalence MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• stupeň závažnosti nemoci MeSH
• těhotenství MeSH
• ultrasonografie prenatální metody   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: PICC is routinely inserted with assistance of ultrasonography and/or ECG navigation (RI- routine insertion). Only in a minority of patients the insertion of a PICC is difficult and fluoroscopic visualization with introduction of special guidewire is necessary for the success of the procedure (DI-difficult insertion). The aim of the study was to evaluate whether DI can be predicted and associated with a risk of complications during follow-up. METHODS: The study included patients who had a PICC insertion in 2022. The number of patients with RI and DI was recorded and the significance of selected parameters during insertion and the frequency of complications during 1 month follow-up was compared. RESULTS: About 1404 patients had successful PICC insertion in 2022, RI in 1360 (96.8%) and DI in 44 patients (3.2%). There was no significant effect of age, gender, selected vein, its size, insertion site, and tunneling on the course of PICC insertion. However the number of punctures for needle insertion was higher in DI. The complication rate during 1 month follow-up in DI was 9 (20.4%) versus 101 patients (7.4%) in RI (p = 0.002). CONCLUSION: PICC insertion was successful in both RI and DI patients. Of the analyzed parameters, the number of needle punctures was associated with DI, and complications during the 1-month follow-up were more frequently noted in the DI group.

• Klíčová slova
• ECG navigation, PICC, complications, fluoroscopy, ultrasonography,
• MeSH
• časové faktory MeSH
• centrální žilní katétry MeSH
• dialýza ledvin * MeSH
• dospělí MeSH
• hodnocení rizik MeSH
• intervenční ultrasonografie MeSH
• katetrizace centrálních vén * škodlivé účinky   přístrojové vybavení   MeSH
• lidé středního věku MeSH
• lidé MeSH
• periferní katetrizace * škodlivé účinky   přístrojové vybavení   MeSH
• punkce MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• výsledek terapie MeSH
• zaváděcí katétry MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH