Vývoj cévní náhrady pro nízké průtoky je aktuální otázkou. Autoři představují vlastní model hledání vývoje náhrady optimálních vlastností, které vycházejí z myšlenky převzetí charakteristiky biologického modelu – veny sapheny, a naprogramování těchto vlastností do modelu konstruované náhrady. Představovaná cévní náhrada se skládá ze tří částí – nevstřebatelného scaffoldu představujícího medii a dvou vstřebatelných kolagenních vrstev – pseudointimy a pseudoadventicie. Autoři představují základní metody fyzikálního testování (inflačně-extenzní test), stejně jako další postupy, které ovlivňují konečné vlastnosti vyvíjené protézy. Mezi takové patří tvrzení kolagenu, antitrombogenní ošetření vnitřního povrchu cévní náhrady a použití metody sterilizace. Testovaný prototyp byl úspěšně ověřen implantací na ovčím modelu.

The development of a low-flow vascular prosthesis is a very topical issue. The authors present a pathway for the development of a prosthesis with optimal properties based on the idea of mimicking the characteristics of a biological model (saphenous vein graft) and programming these properties in the model of the prosthetic substitute. The vascular prosthesis presented consists of three layers – a non-absorbable scaffold representing vascular “media”, and two absorbable collagen layers – pseudointima and pseudoadventitia. The basic methods of physical testing are presented – the single axis stretch test and inflation-extension test, as well as other procedures that affect the final properties. These include collagen curing, antithrombotic treatment of the inner layer and the use of sterilization methods. The designed new graft was successfully implanted in an ovine model.

• Keywords
• cévní náhrada pro nízké průtoky, fyzikální testování,
• MeSH
• Blood Vessel Prosthesis * MeSH
• Humans MeSH
• Materials Testing MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH
• Review MeSH

We compared graft outcome between two types of a novel composite three-layer carp-collagen-coated vascular graft in low-flow conditions in a sheep model. Collagen in group A underwent more cycles of purification than in group B in order to increase the ratio between collagen and residual fat. The grafts were implanted end-to-side in both carotid arteries in sheep (14 grafts in 7 sheep in group A, 18 grafts in 9 sheep in group B) and artificially stenosed on the right side. The flow in the grafts in group A decreased from 297±118 ml/min to 158±159 ml/min (p=0.041) after placement of the artificial stenosis in group A, and from 330±164ml/min to 97±29 ml/min (p=0.0052) in group B (p=0.27 between the groups). From the five surviving animals in group A, both grafts occluded in one animal 3 and 14 days after implantation. In group B, from the six surviving animals, only one graft on the left side remained patent (p=0.0017). Histology showed degradation of the intimal layer in the center with endothelization from the periphery in group A and formation of thick fibrous intimal layer in group B. We conclude that the ratio between collagen and lipid content in the novel three-layer graft plays a critical role in its patency and structural changes in vivo.

• MeSH
• Carotid Arteries surgery   physiology   MeSH
• Blood Vessel Prosthesis MeSH
• Carps MeSH
• Collagen administration & dosage   isolation & purification   MeSH
• Sheep MeSH
• Prosthesis Design methods   trends   MeSH
• Vascular Patency physiology   MeSH
• Animals MeSH
• Check Tag
• Animals MeSH
• Publication type
• Journal Article MeSH

• MeSH
• Endarterectomy, Carotid * methods   MeSH
• Humans MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

• Publication type
• Meeting Abstract MeSH

• Publication type
• Meeting Abstract MeSH

BACKGROUND: The possibility of predicting severe compartment syndrome using simple biochemical parameters was evaluated in a single-center study of 55 patients who presented with acute femoral embolism and who were treated with open surgical embolectomy. METHODS: Parameters related to tissue damage and oxidative metabolism (i.e., lactate, bilirubin, myoglobin, uric acid, glucose, and fibrinogen) were monitored in ipsilateral femoral vein blood. RESULTS: Several statistically significant predictors of relevant compartment syndrome after surgical reperfusion were found, including lactate, uric acid, transcutaneous oxygen pressure, bilirubin, intrafascial pressure, and serum myoglobin. Glycemia and serum albumin did not significantly change over time. CONCLUSIONS: The lactate concentration in femoral vein blood sampled during surgical embolectomy can be used for the stratification of additional postoperative risk of clinically significant compartment syndrome complicating reperfusion after acute embolism of the femoral artery.

• MeSH
• Acute Disease MeSH
• Biomarkers blood   MeSH
• Time Factors MeSH
• Embolectomy adverse effects   MeSH
• Embolism diagnosis   surgery   MeSH
• Ischemia diagnosis   surgery   MeSH
• Compartment Syndromes blood   diagnosis   etiology   surgery   MeSH
• Lactic Acid blood   MeSH
• Middle Aged MeSH
• Humans MeSH
• Predictive Value of Tests MeSH
• Prognosis MeSH
• Prospective Studies MeSH
• Risk Factors MeSH
• Aged MeSH
• Femoral Vein MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

• Publication type
• Meeting Abstract MeSH

• Publication type
• Meeting Abstract MeSH

• Publication type
• Meeting Abstract MeSH

U pacientů hodláme zjistit zda existují takové biochemické markery a/nebo trend křivky intrafasciálního tlaku při poškození dolní končetiny ischemií, které by při určitých hodnotách predikovaly nutnost provedení fasciotomie postižené končetiny a podle nichž bude tedy možné správně indikovat a načasovat provedení končetinu zachraňující fasciotomie. Po kud zjistíme , že existují určité hodnoty biochemických markerů, které predikují nutnost provedení fasciotomie - pak hodláme provést další studii kdy pomocí kontrolavané reperfuze postižené postižené dolní končetiny se budeme riziko provedení fasciotomie snížit Ve studii bude postižená dolní končetina sledovaná pomocí intrafasciálních tlaků, klinického stavu, transkutánní tenze kyslíku a biochemických parametrů. Studie by mohla přinést úpravu indikace fasciotomie a tím snižit komplikace s hojením fasciotomie a přinést snížení nákládů na hospitalizaci.; We intend to identify, if there are certain levels of biochemical markers, and intrafascial and transcutaneous O2 pressure critical values of limb ischemia, which can predict the necessity of fasciotomy after reperfusion. If this study shows that there are certain markers significantly predicting a risk of faciotomy, we would like to propose another investigation to decrease a compartment syndrom clinical manifestation by so-called controlled limb reperfusion. The level of ischaemia in affected limb will be traced by intrafascial pressure and transcutaneous O2 pressure continuous monitoring and by biochemical assesment of venous blood taken from the common femoral vein This study can bring into practise a grading of limb ischaemia according objective examination, can stimulate and vindicate immediate action and decrease the cost of in-hospital stay.

• MeSH
• Acute Disease economics   therapy   MeSH
• Biomarkers MeSH
• Lower Extremity MeSH
• Embolectomy MeSH
• Fascia MeSH
• Fasciotomy MeSH
• Ischemia MeSH
• Compartment Syndromes MeSH
• Reperfusion Injury prevention & control   MeSH
• Blood Gas Monitoring, Transcutaneous MeSH

• Conspectus
• Patologie. Klinická medicína
• NML Fields
• angiologie
• ortopedie
• chirurgie
• NML Publication type
• závěrečné zprávy o řešení grantu IGA MZ ČR