OBJECTIVES: Acute intestinal ischemia is a severe complication of abdominal aortic surgery that is difficult to diagnose early and therefore to treat adequately and timely. In this study the perioperative kinetics of d-lactate and ischemia-modified albumin (IMA) are described and the predictive value of these markers for the early diagnosis of acute intestinal ischemia is assessed. DESIGN & METHODS: This non-randomised, single-centre cohort study enrolled 50 patients with abdominal aortic aneurysm (AAA) and 30 patients with aortoiliac occlusive disease (AOID). Serum d-lactate and IMA were assessed pre-, intra-, and postoperatively at eight defined time points. RESULTS: The highest serum d-lactate was at 6 h after complete declamping of the vascular graft. The highest predictive power of d-lactate was at 3 h after complete declamping (AUC 0.857). IMA was found to be higher in the AAA group in ischemic patients 10 min after complete declamping than in the AOID group. The highest predictive values of IMA were at 1 h after aortic cross-clamping (AUC 0.758) and 3 and 6 h after complete declamping (0.745 and 0.721, respectively). Moreover, the multivariate model with both markers at 3 h after complete declamping improved the detection of intestinal ischemia (AUC 0.894). CONCLUSIONS: Serum levels of IMA and d-lactate seem to be influential predictive markers for postoperative intestinal ischemia, especially after 3 h from complete declamping of vascular reconstruction.

• MeSH
• aneurysma břišní aorty * chirurgie   komplikace   MeSH
• biologické markery MeSH
• ischemie diagnóza   etiologie   MeSH
• kohortové studie MeSH
• kyselina mléčná * MeSH
• lidé MeSH
• sérový albumin MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články 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

• Publikační typ
• abstrakt z konference MeSH

Background: The acute phase of the COVID-19 pandemic requires a redefinition of healthcare system to increase the number of available intensive care units for COVID-19 patients. This leads to the postponement of elective surgeries including the treatment of abdominal aortic aneurysm (AAA). The probabilistic rupture risk index (PRRI) recently showed its advantage over the diameter criterion in AAA rupture risk assessment. Its major improvement is in increased specificity and yet has the same sensitivity as the maximal diameter criterion. The objective of this study was to test the clinical applicability of the PRRI method in a quasi-prospective patient cohort study. Methods: Nineteen patients (fourteen males, five females) with intact AAA who were postponed due to COVID-19 pandemic were included in this study. The PRRI was calculated at the baseline via finite element method models. If a case was diagnosed as high risk (PRRI > 3%), the patient was offered priority in AAA intervention. Cases were followed until 10 September 2021 and a number of false positive and false negative cases were recorded. Results: Each case was assessed within 3 days. Priority in intervention was offered to two patients with high PRRI. There were four false positive cases and no false negative cases classified by PRRI. In three cases, the follow-up was very short to reach any conclusion. Conclusions: Integrating PRRI into clinical workflow is possible. Longitudinal validation of PRRI did not fail and may significantly decrease the false positive rate in AAA treatment.

• Publikační typ
• časopisecké články MeSH

Úvod: Aneuryzma abdominální aorty (AAA) je poměrně častý a závažný stav v cévní chirurgii. Diagnostika, indikační proces a léčebný postup se opírají o guidelines, dle kterých je zákrok indikován při průměru AAA nad 55 mm. Tento přístup však není ve všech případech zcela dostačující, a proto je naší snahou vytvoření moderního diagnostického nástroje s využitím počítačové modelace a analýzy napětí cévní stěny. Metody: Na projektu spolupracujeme již deset let s inženýry z VUT Brno a VŠB Ostrava. V první, experimentální fázi projektu byl vytvořen návrh analytického nástroje, který umožňuje výpočet napětí cévní stěny AAA pomocí metody konečných prvků z běžně dostupných CT snímků, tento primární model byl v průběhu let upraven a výrazně zpřesněn na základě mechanických a histologických testů vzorků AAA získaných v průběhu otevřené resekce. Do výpočtů jsou navíc zapojeny i další konkrétní údaje, jako jsou tlak krve, pohlaví a materiálové charakteristiky. Výsledky: Účinnost metody byla ověřena nejprve pomocí pseudoprospektivní studie s jasnou převahou analýzy napětí cévní stěny nad parametrem maximálního průměru. Metoda byla poprvé zapojena do praxe v průběhu restrikcí spojených s pandemií covid-19, kdy jsme byli na základě analýzy schopni určit, které AAA snese odklad a u kterých je riziko ruptury vysoké a je třeba provést intervenci navzdory restrikcím. Metoda dosáhla 100 % senzitivy a specificity, výrazně lepší ve srovnání s přístupem maximálního průměru. Závěr: Metoda analýzy napětí cévní stěny AAA se zdá být významně přesnější než klasický indikační přístup založený pouze na maximálním průměru a umožňuje stanovení léčby na základě specifických parametrů daného pacienta.

Introduction: Abdominal aortic aneurysm (AAA) is a relatively frequent and serious condition in vascular surgery. The diagnostic and indication process and its treatment are driven by the guidelines which dictate an intervention when the maximum AAA diameter is more than 55 mm. Nevertheless, this approach is not fully sufficient in all AAA cases and thus we have been seeking to develop a modern diagnostic tool using computer modeling and vascular wall stress analysis. Methods: The project has been ongoing in cooperation with engineers from VUT Brno (Brno University of Technology) and VŠB Ostrava (Technical University of Ostrava) for ten years. The design of the analytical tool was created during the first, experimental period of the project; this tool is able to assess vascular wall stress from regular CT scans using the finite element method. This primary model was gradually altered and its precision was increased considerably in the course of the years using data from mechanical and histological tests of AAA wall specimens harvested during open repairs. Additionally, other patient specific data are included in the analysis such as blood pressure, gender and material characteristics. Results: The effectiveness of the method was evaluated in a pseudo-prospective study, showing clear superiority of the vascular wall stress analysis over the maximum diameter approach. The method was used in clinical practice for the first time during restrictions due to the COVID-19 pandemic; based on the analysis we were able to assess which AAA cases can be postponed and which had a high risk of rupture and an intervention was required despite the restrictions. The method achieved 100% sensitivity, and its specificity was also much better compared to the maximum diameter approach. Conclusion: The vascular wall stress analysis of AAA seems to be much more precise than the classic indication approach based only on the maximum diameter, and it can be used to determine the therapy based on patient specific parameters.

• Klíčová slova
• indikační proces, napětí cévní stěny,
• MeSH
• aneurysma břišní aorty * chirurgie   diagnostické zobrazování   MeSH
• aorta abdominalis chirurgie   MeSH
• COVID-19 * MeSH
• lidé MeSH
• mechanický stres MeSH
• pandemie MeSH
• prospektivní studie MeSH
• ruptura aorty patologie   MeSH
• stupeň závažnosti nemoci MeSH
• určení vhodnosti pacienta MeSH
• výběr pacientů MeSH
• Check Tag
• lidé MeSH

Úvod. Ischemická choroba dolních končetin (ICHDKK) je chronické onemocnění, které může vést k výraznému omezení kvality života pacientů. I když úspěšná revaskularizace je pilířem léčby ICHDKK, tak v některých případech není indikována anebo vůbec možná. Takoví pacienti jsou odkázáni na konzervativní terapii, mezi kterou patří i léčba pomocí sulodexidu. Cíl. V této retrospektivní studii jsme vyhodnotili efekt nově nasazeného sulodexidu u pacientů s klaudikačními bolestmi a u pacientů s chronickou končetinu ohrožující ischemií (CLTI). Metodika. V průběhu tří let byl sulodexid nově nasazen u 34 pacientů s klaudikacemi a u 38 pacientů s CLTI, u kterých nebylo indikováno nebo nebylo možné provedení revaskularizace. Stav pacientů byl hodnocen po 4 a 8 měsících, hodnocené parametry byly klaudikační interval, Rutherfordova klasifikace a přítomnost CLTI. Výsledky. V obou skupinách byl pozorován celkově pozitivní efekt léčby. Ve skupině klaudikantů došlo k prodloužení průměru klaudikačního intervalu ze 144 m na začátku terapie na 376 m po čtyřech měsících a 430 m po osmi měsících. Ve druhé skupině začínalo všech 38 pacientů s příznaky CLTI, po čtyřech měsících zůstaly projevy CLTI u šesti pacientů a po osmi měsících u dalších tří. Závěr Po nasazení sulodexidu jsme zaznamenali významné zlepšení stavu jak u pacientů s klaudikačními bolestmi, tak i u pacientů s CLTI. Efekt sulodexidu na pacienty s CLTI nebyl zatím dostatečně popsán v žádných literárních zdrojích. Dle našeho pozorování se použití sulodexidu zdá být účinnou terapií u pacientů s ICHDKK, a to i ve stadiu CLTI.

Introduction. Critical limb ischaemia (CLI) is a chronic disease that can lead to a significant reduction in the patients' quality of life. Although successful revascularisation is a pillar of CLI treatment, in some cases it is not indicated or possible at all. Such patients rely on conservative therapy, which includes sulodexide treatment. Objective. In this retrospective study, we evaluated the effect of newly introduced sulodexide in patients with claudication pain and in patients with chronic limb-threatening ischaemia (CLTI). Methodology. Over a three-year period, sulodexide was newly used in 34 patients with claudication and in 38 patients with CLTI in whom revascularisation was not indicated or possible. The condition of the patients was evaluated after four and eight months, the evaluated parameters were claudication interval, Rutherford's classification and the presence of CLTI. Results. An overall positive effect of the treatment was observed in both groups. In the group of claudication patients, the average claudication interval increased from 144 m at the beginning of therapy to 376 m after four months and 430 m after eight months. In the second group, all 38 patients began with symptoms of CLTI, after four months CLTI symptoms remained in six patients and after eight months in another three. Conclusion. After the use of sulodexide, we observed a significant improvement in both patients with claudication pain and patients with CLTI. The effect of sulodexide on patients with CLTI has not been sufficiently described in any literature. According to our observations, the use of sulodexide appears to be an effective therapy in patients with CLI, even in the CLTI stage.

• Klíčová slova
• Sulodexid,
• MeSH
• glykosaminoglykany aplikace a dávkování   farmakologie   MeSH
• intermitentní klaudikace * diagnóza   farmakoterapie   klasifikace   MeSH
• kvalita života MeSH
• lidé MeSH
• onemocnění periferních arterií diagnostické zobrazování   farmakoterapie   MeSH
• retrospektivní studie MeSH
• stupeň závažnosti nemoci MeSH
• vředy dolních končetin etiologie   farmakoterapie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH

BACKGROUND: Postoperative intestinal ischemia is a severe complication in abdominal aortic surgery. Early diagnosis is needed for adequate and timely treatment. We studied the postoperative kinetics of l-lactate in vascular patients to assess its value as a marker for early postoperative intestinal ischemia detection. MATERIAL AND METHODS: We performed a prospective non-randomized single-center observational cohort study in eighty elective patients, fifty operated on for abdominal aortic aneurysm (AAA) and thirty for aortoiliac occlusive disease (AIOD). Serum l-lactate was measured preoperatively, intraoperatively, and postoperatively at defined timepoints up to postoperative day 7. Intestinal ischemia was detected using MRI enterocolography. We have used univariate logistic regression and receiver operating characteristics curves for the evaluation of marker accuracy. RESULTS: We recorded 6 cases of postoperative intestinal ischemia (7.5%), five non-transmural and one transmural. Two patients died because of this complication (mortality 33%). The comparison of AAA and AIOD cohorts showed a significant difference in l-lactate levels at one intraoperative timepoint, which was attributable to procedure differences. The only preoperative factor associated with higher l-lactate levels at some timepoints was chronic kidney disease. Patients suffering postoperative intestinal ischemia had elevated serum l-lactate levels at multiple timepoints. The most accurate timepoint for diagnosis was 24 h after the declamping of the vascular reconstruction (DC24H), the second was 10 min after declamping. Sensitivity, specificity, positive and negative predictive values at timepoint DC24H were 100%, 82%, 32%, and 100%, respectively. CONCLUSION: Serum l-lactate levels might help in the early detection of postoperative intestinal ischemia after aortic surgery if proper timepoints are used. Cutoff values need to be established in large-scale prospective studies.

• MeSH
• aneurysma břišní aorty * diagnostické zobrazování   chirurgie   MeSH
• ischemie etiologie   chirurgie   MeSH
• kinetika MeSH
• laktáty MeSH
• lidé MeSH
• pooperační komplikace * etiologie   MeSH
• prospektivní studie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH

BACKGROUND AND OBJECTIVE: Estimating patient specific annual risk of rupture of abdominal aortic aneurysm (AAA) is currently based only on population. More accurate knowledge based on patient specific data would allow surgical treatment of only those AAAs with significant risk of rupture. This would be beneficial for both patients and health care system. METHODS: A methodology for estimating annual risk of rupture (EARR) of abdominal aortic aneurysms (AAA) that utilizes Bayesian statistics, mechanics and patient-specific blood pressure monitoring data is proposed. EARR estimation takes into consideration, peak wall stress in AAA computed by patient-specific finite element modeling, the probability distributions of wall thickness, wall strength, systolic blood pressure and the period of time that the patient is known to have already survived with the intact AAA. Initial testing of proposed approach was performed on fifteen patients with intact AAA (mean maximal diameter 51mm±8mm). They were equipped with a pressure holter and their blood pressure was recorded over 24 hours. Then, we calculated EARR values for four possible scenarios - without considering any days of survival prior identification of AAA at computed tomography scans (EARR_0), considering past survival of 30 (EARR_30), 90 (EARR_90) and 180 days (EARR_180). Finally, effect of patient-specific blood pressure variability was analyzed. RESULTS: Consideration of past survival does indeed significantly improve predictions of future risk: EARR_30 (1.04%± 0.87%), EARR_90 (0.67%± 0.56%) and EARR_180 (0.47%± 0.39%) which are unrealistically high otherwise (EARR_0 5.02%± 5.24%). Finally, EARR values were observed to vary by an order as a consequence of blood pressure variability and by factor of two as a consequence of neglected growth. CONCLUSIONS: Methodology for computing annual risk of rupture of AAA was developed for the first time. Sensitivity analyses showed respecting patient specific blood pressure is important factor and should be included in the AAA rupture risk assessment. Obtained EARR values were generally low and in good agreement with confirmed survival time of investigated patients so proposed method should be further clinically validated.

• MeSH
• aneurysma břišní aorty * diagnostické zobrazování   MeSH
• Bayesova věta MeSH
• hodnocení rizik MeSH
• lidé MeSH
• mechanický stres MeSH
• modely kardiovaskulární MeSH
• počítačová rentgenová tomografie MeSH
• počítačové modelování podle konkrétního pacienta MeSH
• rizikové faktory MeSH
• ruptura aorty * diagnostické zobrazování   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: Biomechanical rupture risk assessment of abdominal aortic aneurysm (AAA) requires information about failure properties of aneurysmal tissue. There are large differences between reported values. Among others, studies vary in using either axially or circumferentially oriented samples. This study investigates the effect of sample orientation on failure properties. METHODS: Aneurysmal tissues from 45 patients (11 females) were harvested during open AAA repair, cut into uniaxial samples (90) and tested mechanically within 3 h. If possible, the samples were cut in both axial (49 samples) and circumferential (41 samples) directions. Wall thickness, First Piola-Kirchhoff strength Pult and ultimate tension Tult were recorded. Influence of sample orientation and other clinical parameters were investigated using non parametric tests. RESULTS: Medians of Pult (values 1100 kPa for circumferential vs. 715 kPa for axial direction, p < 10-4) and Tult (17.4 N/cm in circumferential vs. 11.2 N/cm in axial direction, p < 10-4) were significantly higher in circumferential direction. For paired data, the median of difference was 411 kPa (p < 10-3) in Pult and 7.4 N/cm (p < 10-4) in Tult in favor of circumferential direction. CONCLUSIONS: In this first study of anisotropy in AAA wall failure properties using paired comparisons, the strength in circumferential orientation was found to be higher than in axial orientation.

• MeSH
• aneurysma břišní aorty * MeSH
• anizotropie MeSH
• biomechanika MeSH
• hodnocení rizik MeSH
• lidé MeSH
• mechanický stres MeSH
• ruptura aorty * MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

• Klíčová slova
• WOBENZYM,
• MeSH
• diabetická noha farmakoterapie   MeSH
• enzymoterapie * metody   MeSH
• hojení ran * účinky léků   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH