BACKGROUND: Studies comparing alternative autologous vein grafts (AAVGs) to single-segment great saphenous vein (ssGSV) grafts report mixed results. The status of AAVG as first choice when ssGSV is unavailable is not unequivocal based on current evidence. Our study compares results between AAVG and ssGSV in lower extremity bypass (LEB) surgery. METHODS: A single-center retrospective cohort study involving all patients who underwent infrainguinal bypass using AAVG (arm veins, spliced arm, or arm-leg veins) and ssGSV from April 2019 to June 2023. Study endpoints were patency rates and amputation-free survival (AFS). RESULTS: There were 65 (20.8%) patients in the AAVG group, 247 (79.2%) in the ssGSV group. Chronic limb-threatening ischemia (CLTI) was the most frequent indication for surgery (AAVG 54/65, 83.1% vs. ssGSV 170/247, 68.8%), followed by acute limb ischemia (ALI) (AAVG 6/65, 9.2% vs. ssGSV 28/247, 11.3%); claudicants were presented only in the ssGSV group (AAVG 0/65, 0% vs. ssGSV 44/247, 17.8%). More redo operations occurred in AAVG than in the ssGSV group (23/65, 35.4% vs. 26/247, 10.5%; P < 0.001). Spliced vein grafts represented 87.7% (57/65) of AAVG bypasses. The median follow-up was 20.1 months for the AAVG group and 27.5 for the ssGSV group. Three-year patency rates between AAVG versus ssGSV: primary patency (PP) 59.3% ± 8.2% versus 69.2% ± 3.8%, P = 0.113; primary assisted patency (PAP) 75.2% ± 7.1% versus 73.5% ± 3.4%, P = 0.790; secondary patency (SP) 74.9% ± 7.1% versus 74.4% ± 3.4%, P = 0.667; did not display significant difference between groups nor did 3-year AFS in CLTI patients; 70.7% ± 7.9% versus 54.6% ± 4.8%; P = 0.273. CONCLUSION: AAVGs should be the first conduit choice when ssGSV is unavailable. Mid-term patency rates do not differ from those of ssGSV grafts despite higher reintervention rate.
- MeSH
- amputace MeSH
- autologní transplantace MeSH
- časové faktory MeSH
- dolní končetina * krevní zásobení MeSH
- ischemie * chirurgie patofyziologie diagnostické zobrazování MeSH
- lidé středního věku MeSH
- lidé MeSH
- okluze cévního štěpu patofyziologie etiologie chirurgie MeSH
- onemocnění periferních arterií * chirurgie patofyziologie diagnostické zobrazování mortalita MeSH
- průchodnost cév MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- transplantace cév * škodlivé účinky MeSH
- vena saphena * transplantace patofyziologie MeSH
- výsledek terapie MeSH
- záchrana končetiny MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
OBJECTIVE: The purpose of our study was to describe perioperative kinetics of procalcitonin (PCT) in patients undergoing aortic surgery, to compare the kinetics in the open abdominal aortic aneurysm (AAA) repair and aortobifemoral bypass for aortoiliac occlusive disease (AIOD), and to evaluate the ability of PCT to detect intestinal ischaemia. METHODS: A prospective non-randomized observational cohort study in 80 patients (62 men and 18 women) undergoing elective aortic surgery was performed. Serum PCT was measured at baseline and defined intraoperative and postoperative timepoints up to postoperative day 7. MRI contrast-enhanced imaging was used to detect intestinal ischaemia. RESULTS: The comparison of the AAA and AIOD cohort did not show any significant difference in PCT levels. Patients with intestinal ischaemia had higher serum PCT at multiple timepoints postoperatively. The most accurate timepoints for early diagnosis were postoperative day 3, followed by 24 h after declamping of the vascular reconstruction, and postoperative day 7. The sensitivity and negative predictive values were 100% in all mentioned timepoints. However, event at the best timepoint the specificity was 89% and the positive predictive value 43%. CONCLUSIONS: Procalcitonin levels in the postoperative period at proper timepoints might help to detect postoperative intestinal ischaemia. The limitation of this marker is its low specificity for intestinal ischaemia and low positive predictive value. The highest value of this marker is that it can rule out this complication because normal PCT levels mean that intestinal ischaemia is very unlikely.
- MeSH
- ateroskleróza * MeSH
- břicho MeSH
- ischemie diagnostické zobrazování chirurgie MeSH
- Lericheův syndrom * MeSH
- lidé MeSH
- mezenteriální ischemie * diagnostické zobrazování chirurgie MeSH
- pooperační období MeSH
- prokalcitonin MeSH
- prospektivní studie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
BACKGROUND: Critical limb ischemia (CLI) is considered the most severe pattern of peripheral artery disease. CLI is associated with high rates of morbidity and mortality with high risk of limb amputation. In the absence of appropriate autologous grafts, unsuitability of prosthetic bypasses, and endovascular methods, fresh cold-stored venous allografts is an option. Endovascular interventional methods are essential methods for maintaining primary and secondary patency. METHODS: A single-centre retrospective analysis of 82 surgical revascularizations using allogeneic vascular grafts and rescue endovascular techniques restoring and maintaining the patency of these allogeneic revascularizations in the period between July 2005 and July 2021. RESULTS: We have performed 82 allogeneic revascularizations in 75 patients (52 reconstructions in men/63.4%/, 30 reconstructions in women/36.6%/). The median age of patients was 68 years (49 min, 87 max). We subsequently had to intervene a total of 26 bypasses. We intervened in 30 acute occluded allogeneic bypass grafts and 9 failing stenotic bypass grafts. We performed 52 angiographies. The success rate of rescue endovascular procedures in primary allogeneic reconstruction with distal anastomosis to the popliteal artery is statistically significant (P < 0.02) compared to procedures with distal anastomosis to the tibial and pedal bed. The cumulative patency (primary at time) of allogeneic reconstructions in our group was 89% after 1 month, 51.9% after 12 months, 24.2% after 3 years, 9.8% after 5 years. Limb salvage was 72.6% in 1 year, 53% in 3 years, 36.5% in 5 years, respectively. CONCLUSIONS: Cold-stored venous allografts may be used for performing below-the-knee revascularization for CLI with acceptable results, despite the poor long-term patency. Rescue endovascular techniques are an essential method for restoring or maintaining the patency of these reconstructions. These techniques have a high success rate and no other alternative.
- MeSH
- alografty chirurgie MeSH
- endovaskulární výkony * škodlivé účinky MeSH
- ischemie diagnostické zobrazování chirurgie MeSH
- lidé MeSH
- onemocnění periferních arterií * diagnostické zobrazování chirurgie MeSH
- průchodnost cév MeSH
- retrospektivní studie MeSH
- senioři MeSH
- výsledek terapie MeSH
- záchrana končetiny MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Dialysis access-related distal ischaemia is a rare yet potentially rather risky complication of haemodialysis angioaccess. Timely diagnosis is crucial to target both the goals of the access team: first of all to preserve the function of the hand ideally along with angioaccess patency. Unfortunately for some patients, urgent access ligation and central vein catheter insertion would be needed to save the hand. After a first clinical examination to determine the diagnostic suspicion, the ultrasound evaluation would provide nearly all the needed information to confirm the diagnosis and to determine the most appropriate procedure to rescue the patient from distal ischaemia. In some cases, photoplethysmography would help in the differential diagnosis of other non-ischaemic causes of similar signs and symptoms. Angiography would complete the preoperative evaluation for some.Dialysis access-related distal ischaemia would be briefly reviewed, and a deep description of the ultrasound examination tools and findings would be provided for a tailored therapeutic approach.
- MeSH
- arteriovenózní zkrat * škodlivé účinky MeSH
- dialýza ledvin MeSH
- ischemie diagnostické zobrazování etiologie terapie MeSH
- lidé MeSH
- ligace MeSH
- průchodnost cév MeSH
- ruka MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Úvod: Akútna ischémia dolných končatín je väčšinou spôsobená embóliou, trombózou a traumatickými zraneniami. Samostatnú skupinu tvoria pacienti so sekundárnou akútnou ischémiou končatín k inému základnému ochoreniu. Prezentácia kazuistiky: V tomto článku popisujeme kazuistiku 72-ročnej ženy, ktorá bola hospitalizovaná na Klinike cievnej chirurgie s akútnou ischémiou dolnej končatíny. Podľa predchádzajúcej anamnézy jeden deň pred hospitalizáciou pacientka bola vyšetrená chirurgom pre bolesť brucha: bez príznakov peritonitídy. Bola realizovaná ultrazvuková diagnostika brucha, kde sa nevyskytol žiaden akútny nález; podľa laboratorných testov boli zvýšené leukocyty na 18,2 × 109/I. Nasledujúci deň pacientku doniesli na konzultáciu k cievnému chirurgovi kvôli bolesti a necitlivosti pravej dolnej končatiny. Vzhľadom na bolesť brucha a zvýšený počet leukocytov bola vykonaná v urgentnom režime CT angiografia, na základe ktorej bolo diagnostikované pneumoperitoneum a akútny uzáver artérií pravej dolnej končatiny. Vykonaná simultanná emergentná operácia: trombektómia tepien dolných končatín a laparotómia, kde bola diagnostikovaná perforácia pylorusa, difúzna peritonitída. Bohužiaľ pacientka zomrela v dôsledku hemodynamického zhoršenia a rozvoja polyorganného zlyhania na základe septického šoku. Záver: Táto kazuistika predstavuje vývoj akútnej ischémie pravej dolnej končatiny ako komplikácie difúznej peritonitídy. Septický šok spôsobil dehydratáciu pacientky, zhoršenie hemokoagulačných parametrov a rozvoj sekundárnej trombózy artérií pravej dolnej končatiny.
Background: Acute lower limb ischemia is generally caused by embolism, thrombosis, and traumatic injuries. However, patients with acute limb ischemia secondary to other underlying disease constitute a separate group. Case presentation: In this paper, we describe a case report of a 72-year-old woman, who was hospitalized with acute right lower limb ischemia to the Clinic of Vascular Surgery. According to past medical history, one day before hospitalization, the patient was examined by a surgeon for abdominal pain without signs of peritonitis. An abdominal ultrasound that did not reveal any pathology was performed; laboratory tests, that indicated an increase in white blood cell count to 18.2 × 109/L, were carried out. Next day, the patient consulted the vascular surgeon as she experienced severe right lower limb pain, numbness. Considering abdominal pain and elevated white blood cell count, there was performed emergency CT angiography that detected pneumoperitoneum and acute arterial occlusion of the right lower limb. There was performed concurrent emergency surgery: thrombectomy of the lower limb arteries and laparotomy that revealed gastrointestinal perforation, diffuse peritonitis. Unfortunately, the patient died due to hemodynamic deterioration and the development of multiple organ failure. Conclusion: This case report represents the development of acute lower limb ischemia as a complication of acute diffuse peritonitis. Septic shock resulted in the patient's dehydration, impaired blood coagulation parameters, and the development of secondary right lower extremity artery thrombosis.
- MeSH
- bolesti břicha etiologie MeSH
- CT angiografie MeSH
- dehydratace etiologie MeSH
- dolní končetina patologie MeSH
- embolie a trombóza chirurgie diagnóza MeSH
- fatální výsledek MeSH
- ischemie * chirurgie diagnostické zobrazování patologie MeSH
- laparotomie MeSH
- lidé MeSH
- multiorgánové selhání etiologie MeSH
- peptický vřed diagnóza MeSH
- peritonitida * diagnóza komplikace MeSH
- pneumoperitoneum chirurgie diagnostické zobrazování MeSH
- senioři MeSH
- septický šok MeSH
- trombektomie MeSH
- ultrasonografie MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
An unknown intense signal (Pun ) with a mean chemical shift of 5.3 ppm was observed in 31 P MR spectra from the calf muscles of patients with the diabetic foot syndrome. The aim of the study was to identify the origin of this signal and its potential as a biomarker of muscle injury. Calf muscles of 68 diabetic patients (66.3 ± 8.6 years; body mass index = 28.2 ± 4.3 kg/m2 ) and 12 age-matched healthy controls were examined by (dynamic) 31 P MRS (3 T system, 31 P/1 H coil). Phantoms (glucose-1-phosphate, Pi and PCr) were measured at pH values of 7.05 and 7.51. At rest, Pun signals with intensities higher than 50% of the Pi intensity were observed in 10 of the 68 examined diabetic subjects. We tested two hypothetical origins of the Pun signal: (1) phosphorus from phosphoesters and (2) phosphorus from extra- and intracellular alkaline phosphate pools. 2,3-diphosphoglycerate and glucose-1-phosphate are the only phosphoesters with signals in the chemical shift region close to 5.3 ppm. Both compounds can be excluded: 2,3-diphosphoglycerate due to the missing second signal component at 6.31 ppm; glucose-1-phosphate because its chemical shifts are about 0.2 ppm downfield from the Pi signal (4.9 ppm). If the Pun signal is from phosphate, it represents a pH value of 7.54 ± 0.05. Therefore, it could correspond to signals of Pi in mitochondria. However, patients with critical limb ischemia have rather few mitochondria and so the Pun signal probably originates from interstitia. Our data suggest that the increased Pun signal observed in patients with the diabetic foot syndrome is a biomarker of severe muscular damage.
- MeSH
- fantomy radiodiagnostické MeSH
- fosfor chemie MeSH
- ischemie diagnostické zobrazování MeSH
- koncentrace vodíkových iontů MeSH
- končetiny diagnostické zobrazování patologie MeSH
- lidé MeSH
- magnetická rezonanční spektroskopie * MeSH
- odpočinek MeSH
- počítačové zpracování signálu * MeSH
- senioři MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Instant Blood-Mediated Inflammatory Reaction (IBMIR) is a major cause of graft loss during pancreatic islet transplantation, leading to a low efficiency of this treatment method and significantly limiting its broader clinical use. Within the procedure, transplanted islets obstruct intrahepatic portal vein branches and consequently restrict blood supply of downstream lying liver tissue, resulting typically in ischemic necrosis. The extent of ischemic lesions is influenced by mechanical obstruction and inflammation, as well as subsequent recanalization and regeneration capacity of recipient liver tissue. Monitoring of immediate liver perfusion impairment, which is directly related to the intensity of post-transplant inflammation and thrombosis (IBMIR), is essential for improving therapeutic and preventive strategies to improve overall islet graft survival. In this study, we present a new experimental model enabling direct quantification of liver perfusion impairment after pancreatic islet transplantation using ligation of hepatic arteries followed by contrast-enhanced magnetic resonance imaging (MRI). The ligation of hepatic arteries prevents the contrast agent from circumventing the portal vein obstruction and enables to discriminate between well-perfused and non-perfused liver tissue. Here we demonstrate that the extent of liver ischemia reliably reflects the number of transplanted islets. This model represents a useful tool for in vivo monitoring of biological effect of IBMIR-alleviating interventions as well as other experiments related to liver ischemia. This technical paper introduces a novel technique and its first application in experimental animals.
- MeSH
- embolie * komplikace diagnóza MeSH
- ischemie * diagnostické zobrazování etiologie MeSH
- játra * krevní zásobení diagnostické zobrazování patologie MeSH
- krysa rodu rattus MeSH
- magnetická rezonanční angiografie metody MeSH
- přežívání štěpu MeSH
- reprodukovatelnost výsledků MeSH
- teoretické modely MeSH
- transplantace Langerhansových ostrůvků škodlivé účinky MeSH
- vena portae * MeSH
- vylepšení obrazu metody MeSH
- zvířata MeSH
- Check Tag
- krysa rodu rattus MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
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.
- MeSH
- autologní transplantace metody MeSH
- bérec diagnostické zobrazování krevní zásobení patologie MeSH
- ischemie diagnostické zobrazování metabolismus terapie MeSH
- lidé MeSH
- magnetická rezonanční spektroskopie metody MeSH
- následné studie MeSH
- radioizotopy fosforu MeSH
- transplantace kostní dřeně MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
PURPOSE: To report the results of a prospective, single-arm study to establish whether the initial treatment of acute or subacute limb ischemia (ALI and SLI, respectively) can be accomplished successfully using endovascular mechanical debulking of the target vessels to avoid the risks associated with thrombolysis and/or open surgery. MATERIALS AND METHODS: From April 2009 to April 2015, 316 consecutive patients (mean age 70.9±12 years; 184 men) with ALI (202, 63.9%) or SLI (114, 36.1%) were enrolled; the only exclusion criterion was irreversible ischemia. The ALI group included 146 (72.3%) participants with category IIb ischemia and 56 (27.7%) with category IIa. Critical limb ischemia was diagnosed in 74 (64.9%) of the 114 patients with SLI. Target occlusions of thrombotic (n=256) or embolic (n=60) origin were located in the femoropopliteal segment (n=231), prosthetic or venous femoropopliteal bypass grafts (n=75), and the aortoiliac segment (n=35). The mean occlusion length was 22.9±14.8 cm. RESULTS: The overall technical success (residual stenosis ≤30%) was 100% after debulking and adjunctive techniques (aspiration, dilation, stenting) at the level of the target lesions. No open surgical or thrombolytic modalities were necessary to bypass or recanalize the target vessels, and no death occurred in association with target occlusion therapy. Additional infrapopliteal interventions were performed in 195 (61.7%) patients (adjunctive thrombolysis in 29) to treat acute, subacute, and chronic lesions. Minor complications directly related to the debulking procedure occurred in 26 (8.2%) patients. Serious complications occurred in 11 (3.5%) patients, including hemorrhage in 8 (2.5%) patients (associated with infrapopliteal thrombolysis in 5). At 30 days, primary and secondary patency rates were 94.3% and 97.2%, respectively; mortality was 0.3% (1 fatal intracranial hemorrhage after adjunctive thrombolysis). Of 229 patients eligible for 1-year follow-up, amputation-free survival was estimated to be 87.4% in 199 patients with available data. CONCLUSION: In this all-comers study, mechanical debulking with the Rotarex alone or with adjunctive techniques is feasible as a primary therapy for occluded supratibial vessels in patients with ALI or SLI.
- MeSH
- akutní nemoc MeSH
- amputace MeSH
- časové faktory MeSH
- doba přežití bez progrese choroby MeSH
- dolní končetina krevní zásobení MeSH
- dospělí MeSH
- endovaskulární výkony * škodlivé účinky přístrojové vybavení mortalita MeSH
- ischemie diagnostické zobrazování mortalita patofyziologie terapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- onemocnění periferních arterií diagnostické zobrazování mortalita patofyziologie terapie MeSH
- prospektivní studie MeSH
- průchodnost cév MeSH
- recidiva MeSH
- rizikové faktory MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- trombektomie * škodlivé účinky přístrojové vybavení mortalita MeSH
- trombolytická terapie MeSH
- záchrana končetiny MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky MeSH
- Geografické názvy
- Česká republika MeSH
