INTRODUCTION: Aneurysm formation is a complication of the use of arteriovenous fistulas, and symptomatic aneurysms require surgical treatment. The optimum treatment is aneurysmorrhaphy, because this salvages the function of the fistula. Aneurysmorrhaphy outcomes may be improved by implanting an external prosthesis over the repaired aneurysm. This study aimed to compare aneurysmorrhaphy performed with and without an external prosthesis. MATERIALS AND METHODS: This was a multicenter, randomized, prospective non-blinded study. Patients with symptomatic aneurysms of arteriovenous fistulas were recruited between February 2018 and September 2022. Recruited patients were assigned randomly to undergoing aneurysmorrhaphy with or without an external prosthesis. The study compared patency and aneurysm recurrence rates at 1-year follow-up. RESULTS: Forty-six patients underwent aneurysmorrhaphy with an external prosthesis and fifty-five underwent aneurysmorrhaphy without an external prosthesis. There were no differences in patient and aneurysm characteristics between the two groups. At 1 year follow-up, the patency rates were 86% for aneurysmorrhaphy with external prosthesis and 80% for aneurysmorrhaphy without external prosthesis (p = 0.87). Aneurysm recurrences occurred in 2 patients (4.3%) who underwent aneurysmorrhaphy with external prosthesis and in 6 patients (10.9%) who underwent aneurysmorrhaphy without external prosthesis (p = 0.114). CONCLUSION: There was no statistically significant difference in primary patency rates and aneurysm recurrence between patients treated with aneurysmorrhaphy with and without external prosthetic support.

• Klíčová slova
• Arteriovenous fistula aneurysms, aneurysmorrhaphy, arteriovenous fistula complication,
• Publikační typ
• časopisecké články MeSH

Pancreaticoduodenal artery aneurysms are rare visceral artery aneurysms that may be associated with stenosis of the coeliac trunk. We present a case of a 48-year-old woman with a symptomatic aneurysm of the inferior pancreaticoduodenal artery caused by occlusion of the coeliac trunk due to median arcuate ligament syndrome. The patient was treated with an aorto-hepatic bypass and excision of the aneurysm. We discuss the case and the complexities and controversies in the treatment of this disease.

• Klíčová slova
• Dunbar syndrome, Sutton-Kadir syndrome, aorto-hepatic bypass, median arcuate ligament syndrome, pancreaticoduodenal aneurysm,
• MeSH
• aneurysma * diagnostické zobrazování   etiologie   chirurgie   MeSH
• arteria coeliaca diagnostické zobrazování   chirurgie   MeSH
• arteria mesenterica superior MeSH
• lidé středního věku MeSH
• lidé MeSH
• pankreas * chirurgie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

BACKGROUND: One of the three commercially available cyanoacrylate venous glues used for the treatment of saphenous vein insufficiency is the VariClose® vein sealing system. Previous studies have documented a high rate of occlusion and minimal postoperative complications. The aim of this study was to compare occlusion rates and clinical outcomes of endovenous laser treatment with the VariClose® vein sealing system in the treatment of truncal vein insufficiency. PATIENTS AND METHODS: Retrospective non-randomized single center study with prospectively collected data comparing endovenous laser treatment and VariClose® procedures between April 2018 and November 2019. RESULTS: VariClose® was used in 27 patients (30 veins) and endovenous laser treatment in 42 patients (51 veins). The occlusion rate at one, three, and six months were 96%, 85%, and 65% for VariClose® procedures and 100%, 100%, and 97% for endovenous laser treatment procedures (p = 0.01), respectively. Reduction of VCSS scores before treatment and at the last postoperative follow-up visit in the VariClose® group dropped by an average of 1.8 ± 1.6 and in the endovenous laser treatment by an average of 3.3 ± 2.9 (p = 0.01). CONCLUSION: VariClose® vein sealing system is inferior to endovenous laser treatment as a treatment option for varicose veins as it has a higher recanalization rate.

• Klíčová slova
• Cyanoacrylate ablation, VariClose®, endovenous laser, varicose vein, venous insufficiency,
• MeSH
• laserová terapie * škodlivé účinky   metody   MeSH
• lidé MeSH
• retrospektivní studie MeSH
• varixy * diagnostické zobrazování   chirurgie   MeSH
• vena saphena diagnostické zobrazování   chirurgie   MeSH
• výsledek terapie MeSH
• žilní insuficience * diagnostické zobrazování   chirurgie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVES: The aim of this study was to assess occlusion rates of saphenous veins treated with the VariClose vein sealing system. METHODS: A retrospective analysis including a total of 64 patients from four centres from the Czech Republic. Occlusion was defined as a non-compressible vein with absence of flow with exception to the first 3 cm from the saphenofemoral or saphenopopliteal junction on duplex ultrasound. RESULTS: In 64 patients a total of 79 veins were treated. Technical success of the procedure was achieved in 74 (94%) of cases. The mean follow-up was 5.5 months. The closure rates calculated by the Kaplan-Meier method at 1, 3, 6 and 12 months were 94%, 85%, 69% and 36%, respectively, and there were no significant differences between centers. The average difference in VCSS score before and after the procedure was 1.8. CONCLUSIONS: The present study demonstrated surprisingly worse occlusion rates than the current literature.

• Klíčová slova
• Cyanoacrylate, VariClose®, varicose vein, venous insufficiency,
• MeSH
• lidé MeSH
• retrospektivní studie MeSH
• varixy * diagnostické zobrazování   chirurgie   MeSH
• vena saphena diagnostické zobrazování   chirurgie   MeSH
• výsledek terapie MeSH
• žilní insuficience * diagnostické zobrazování   terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

A large tumorous mass completely surrounding and compressing the coeliac trunk was identified on computed tomography in a young woman with a six-month history of progressive abdominal pain. The tumor was excised along with the coeliac trunk and the proximal parts of its branches. The hepatic artery was reconstructed with an aorto-hepatic autogenous bypass. Postoperatively the patient had neurogenic diarrhea, which subsided on medical treatment. Seven months after surgery the patient is in a good state of health and living a normal life.

• Klíčová slova
• aorto-hepatic bypass, coeliac trunk, ganglioneuroma, oncovascular surgery,
• MeSH
• arteria coeliaca diagnostické zobrazování   patologie   chirurgie   MeSH
• arteria hepatica diagnostické zobrazování   patologie   chirurgie   MeSH
• disekce MeSH
• dospělí MeSH
• ganglioneurom diagnostické zobrazování   patologie   chirurgie   MeSH
• lidé MeSH
• ligace MeSH
• vena saphena transplantace   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

• MeSH
• alografty * MeSH
• aneurysma patologie   chirurgie   MeSH
• homologní transplantace * metody   MeSH
• lidé MeSH
• senioři MeSH
• takrolimus farmakologie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Názvy látek
• takrolimus MeSH

OBJECTIVE: Aneurysms arising from arteriovenous fistulae are a common finding among dialysed patients and pose a risk of acute bleeding. The aim of this study was to perform a systematic review and meta-analysis evaluating the surgical options for the treatment of aneurysmal arteriovenous fistulae. METHODS: A systematic review and meta-analysis of articles published between January 1973 and March 2019 describing the surgical treatment of arteriovenous fistulae aneurysms. RESULTS: A total of 794 records were identified. After duplicate and low quality studies were removed, 72 full text articles were reviewed and from these 13 were included in the meta-analysis. The total number of patients was 597. Aneurysms were located in the upper arm in 289 (59%) cases and the smallest diameter of a treated aneurysm was 15 mm. The most frequent indication for treatment was bleeding prevention in 513 (86%) cases. Aneurysmorrhaphy was the surgical method of choice in all 13 studies. The pooled primary patency at 12 months was 82% (95% CI 69%-90%, 12 studies, I2 = 84%, p < .01). The 12 month primary patency rates were similar for aneurysmorrhaphy with external prosthetic reinforcement (85%, 95% CI 71%-93%, two studies, I2 = 0%, p = .33) and aneurysmorrhaphy performed using a stapler (74%, 95% CI 61%-83%, four studies, I2 = 0%, p = .48) and without a stapler (82%, 95% CI 60%-94%, six studies, I2 = 92%, p < .01). CONCLUSION: Aneurysmorraphy of arteriovenous fistulae is a procedure with acceptable short and long term results, with a low complication and aneurysm recurrence rate.

• Klíčová slova
• aneurysm, arteriovenous fistula, haemodialysis, pseudoaneurysm, vascular access,
• MeSH
• aneurysma chirurgie   MeSH
• arteriovenózní zkrat * škodlivé účinky   MeSH
• čas MeSH
• dialýza ledvin * škodlivé účinky   MeSH
• horní končetina krevní zásobení   chirurgie   MeSH
• lidé MeSH
• průchodnost cév fyziologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH
• systematický přehled MeSH

• MeSH
• arteriovenózní píštěl * MeSH
• chronické selhání ledvin * MeSH
• dialýza ledvin MeSH
• lidé MeSH
• srdce MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• komentáře MeSH

In patients with end-stage renal disease, excessive blood flow through an arteriovenous fistula (AVF) may lead to volume overload-induced cardiac remodeling and heart failure. It is unclear which patients with hyperfunctional AVF may benefit from AVF reduction or ligation. The indication for the procedure is often based on AVF flow. Because cardiac remodeling is driven by increased venous return, which is equivalent to cardiac output, we hypothesized that an elevated cardiac index (CI) might better identify subjects with reverse remodeling after AVF reduction. Thirty patients (age 52±12 years, 73% male) with AVF flow ⩾1.5 l min(-1) underwent comprehensive echocardiographic evaluations before and after AVF reduction. At baseline, 16 patients had a normal CI (2.5-3.8 l min(-1) m(-2)) and 14 had a high CI (4.0-6.0 l min(-1) m(-2)). A left ventricular end-diastolic diameter decrease after operation was predicted by elevated baseline CI (P<0.01), but not elevated AVF flow (P=0.07). There was a significant decrease in CI, left ventricular mass, left atrial and right ventricular diameter and pulmonary systolic pressure in the high CI group but not in the normal CI group. After AVF reduction, systemic vascular resistance decreased in the normal CI group, whereas it did not change in the high CI group. In conclusion, reduction of high-flow AVF leads to reverse cardiac remodeling but only in patients with elevated CI. The variability of the response of systemic vascular resistance to AVF flow may explain this observation. Increased CI but not increased AVF flow may better determine candidates for AVF reduction.

• MeSH
• arteriovenózní píštěl diagnostické zobrazování   patofyziologie   MeSH
• chronické selhání ledvin diagnostické zobrazování   patofyziologie   terapie   MeSH
• dialýza ledvin MeSH
• dospělí MeSH
• echokardiografie MeSH
• lidé středního věku MeSH
• lidé MeSH
• remodelace komor fyziologie   MeSH
• senioři MeSH
• srdce diagnostické zobrazování   patofyziologie   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: Organ shortage leads to the increased use of expanded-criteria donor (ECD) kidneys, which contribute to a higher risk of delayed graft function (DGF) after transplantation. The aim of this study was to determine factors that may better predict the risk of DGF. METHODS: Histologic assessments of donor renal biopsy were used with other clinical variables to predict the risk of DGF after kidney transplantation. The total Banff score equaled the sum of interstitial fibrosis (CI), tubular atrophy, arteriolar hyaline thickening, fibrous intimal thickening (CV), and fraction of sclerotized glomeruli. RESULTS: In total, 126 of 344 patients developed DGF after kidney transplantation. The histologic score for CI, tubular atrophy, and CV and the total Banff score were increased in patients with DGF. Only CI and CV were independent predictors of DGF (P<0.01). A CIV score (CI+CV; odds ratio, 2.68; 95% confidence interval, 1.55-4.66; P<0.001) was superior to the combination of the total Banff score (odds ratio, 1.48; 95% confidence interval, 0.85-2.55; P=NS). A CIV score≥1, donor age more than 51 years, and anoxia donor brain injury were associated with the highest risk of DGF. A CIV<1 identified a subgroup of ECDs at a lower risk of DGF comparable with standard-criteria donors (29.3% vs. 28.4%). CONCLUSIONS: Composite CIV score better identifies ECD kidneys with a lower risk of developing DGF. Morphologic evaluation of ECD kidneys and donor characteristics may improve kidney allocation.

• MeSH
• biopsie MeSH
• dárci tkání zásobování a distribuce   MeSH
• dospělí MeSH
• fibróza MeSH
• hodnocení rizik MeSH
• ledviny patologie   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• lineární modely MeSH
• logistické modely MeSH
• mladiství MeSH
• mladý dospělý MeSH
• multivariační analýza MeSH
• nefrektomie * MeSH
• odds ratio MeSH
• opožděný nástup funkce štěpu etiologie   prevence a kontrola   MeSH
• prediktivní hodnota testů MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• senioři MeSH
• transplantace ledvin škodlivé účinky   metody   MeSH
• výběr dárců metody   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH