The effects of a large arteriovenous fistula (AVF) on pulmonary perfusion remains to be elucidated. We aimed to study, for the first time, the real-time acute effects of a large AVF on regional distribution of pulmonary perfusion in a novel porcine model. Ten healthy swine under general anesthesia were studied. AVF was created by the connection of femoral artery and femoral vein using high-diameter perfusion cannulas. The AVF was closed and after 30 min of stabilization the first values were recorded. The fistula was then opened, and new data were collected after reaching stable state. Continuous hemodynamic monitoring was performed throughout the protocol. The following functional images were analyzed by electrical impedance tomography (EIT): perfusion and ventilation distributions. We found an increased cardiac output and right ventricular work, which was strongly correlated to an increased pulmonary artery mean pressure (r=0.878, P=0.001). The ventral/dorsal ratio of pulmonary perfusion decreased from 1.9+/-1.0 to 1.5+/-0.7 (P=0.025). The percentage of total pulmonary blood flow through the dorsal lung region increased from 38.6+/-11.7 to 42.2+/-10.4 (P=0.016). In conclusion, we have used EIT for the first time for studying the acute effects of a large AVF on regional distribution of pulmonary perfusion in a novel porcine model. In this new experimental model of hyperkinetic circulation caused by AVF, we documented an increased percentage of total pulmonary blood flow through the dorsal lung region and a more homogeneous perfusion distribution. Key words Arteriovenous fistula, Hyperkinetic circulation, Tissue perfusion, Animal model, Pulmonary blood flow.

• MeSH
• arteria pulmonalis diagnostické zobrazování   patofyziologie   MeSH
• arteriovenózní píštěl patofyziologie   diagnostické zobrazování   MeSH
• arteriovenózní zkrat MeSH
• plíce krevní zásobení   diagnostické zobrazování   MeSH
• plicní oběh * fyziologie   MeSH
• prasata MeSH
• vena femoralis diagnostické zobrazování   MeSH
• zvířata MeSH
• Check Tag
• ženské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH

The authors present their contribution to the improvement of methods suitable for the detection of the freezing and thawing damage of cells of cryopreserved venous grafts used for lower limb revascularization procedures. They studied the post-thaw viability of cells of the wall of cryopreserved venous grafts (CVG) immediately after thawing and after 24 and 48 h culture at +37 °C in two groups of six CVG selected randomly for slow thawing in the refrigerator and rapid thawing in a water bath at +37 °C. The grafts were collected from multi-organ and tissue brain-dead donors, cryopreserved, and stored in a liquid nitrogen vapor phase for five years. The viability was assessed from tissue slices obtained by perpendicular and longitudinal cuts of the thawed graft samples using in situ staining with fluorescence vital dyes. The mean and median immediate post-thaw viability values above 70% were found in using both thawing protocols and both types of cutting. The statistically significant decline in viability after the 48-h culture was observed only when using the slow thawing protocol and perpendicular cutting. The possible explanation might be the "solution effect damage" during slow thawing, which caused a gentle reduction in the graft cellularity. The possible influence of this phenomenon on the immunogenicity of CVG should be the subject of further investigations.

• Klíčová slova
• Thawing method, cell viability, confocal microscopy, cryopreservation, fluorescence vital dyes, vascular allograft,
• MeSH
• alografty diagnostické zobrazování   účinky léků   MeSH
• apoptóza účinky léků   MeSH
• dárci tkání MeSH
• dimethylsulfoxid farmakologie   MeSH
• fluorescenční barviva * MeSH
• konfokální mikroskopie metody   MeSH
• kryoprezervace metody   MeSH
• kryoprotektivní látky farmakologie   MeSH
• lidé MeSH
• optické zobrazování metody   MeSH
• transplantace cév metody   MeSH
• vena femoralis diagnostické zobrazování   účinky léků   MeSH
• vena saphena diagnostické zobrazování   účinky léků   MeSH
• viabilita buněk účinky léků   MeSH
• zmrazování * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• dimethylsulfoxid MeSH
• fluorescenční barviva * MeSH
• kryoprotektivní látky MeSH

BACKGROUND: The study was initiated following the observation of complete recanalization of thrombus in subjects with DVT treated with rivaroxaban after 1-2 weeks. The aim of this observational retrospective study was to evaluate clinically and by means of echo color Duplex, the fibrinolytic effect of rivaroxaban in patients with recent and previous DVT. To accomplish this two populations of patients were evaluated. METHODS: Group 1 was comprised of 31 patients (ranging in age 52-73 years) with popliteal-femoral DVT (12 months ago) treated with standard anticoagulant therapy. In these patients, we found a complete superficial femoral recanalization and partial recanalization of the popliteal vein (30% of residual thrombus). The patients had normal creatinine clearance and liver function. The patients were switched from warfarin to rivaroxaban due to a lack of compliance with warfarin therapy. Group 2 was comprised of 22 patients (ranging in age 65-82 years) with previous popliteal-femoral DVT and documented complete common femoral veins recanalization who presented with a recent superficial femoral vein re-thrombosis (1 week before). The patients had normal creatinine clearance and liver function. The patients switched from warfarin to rivaroxaban due to a lack of compliance with warfarin therapy. RESULTS: In group 1, all patients exhibited the complete recanalization of the popliteal veins after 4 weeks of rivaroxaban therapy. In group 2, all patients exhibited the complete recanalization of the popliteal veins after 4 weeks, and the complete recanalization of the acute re-thrombosis of the superficial femoral veins after 2 weeks of rivaroxaban therapy. No adverse events for both groups were observed. CONCLUSIONS: Our results suggest that rivaroxaban could have a pro-fibrinolytic effect not only on recent thrombus but also on organized thrombus that results in a complete recanalization of affected veins. It is proposed that this lytic effect will preserve venous valve structure and lead to a reduction of incidence of post-thrombotic syndrome in rivaroxaban treated patients.

• MeSH
• duplexní dopplerovská ultrasonografie MeSH
• inhibitory faktoru Xa terapeutické užití   MeSH
• lidé středního věku MeSH
• lidé MeSH
• posttrombotický syndrom prevence a kontrola   MeSH
• rivaroxaban terapeutické užití   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• trombolytická terapie MeSH
• vena femoralis diagnostické zobrazování   MeSH
• vena poplitea diagnostické zobrazování   MeSH
• výsledek terapie MeSH
• žilní trombóza diagnostické zobrazování   farmakoterapie   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
• pozorovací studie MeSH
• Názvy látek
• inhibitory faktoru Xa MeSH
• rivaroxaban MeSH

AIMS: Complications of catheter ablation for atrial fibrillation (AF) are frequently related to vascular access. We hypothesized that ultrasound-guided (USG) venipuncture may facilitate the procedure and reduce complication rates. METHODS AND RESULTS: We conducted a multicentre, randomized trial in patients undergoing catheter ablation for AF on uninterrupted anticoagulation therapy. The study enrolled consecutive 320 patients (age: 63 ± 8 years; male: 62%) and were randomized to USG or conventional venipuncture in 1:1 fashion. It was prematurely terminated due to substantially lower-than-expected complication rates, which doubled the population size needed to maintain statistical power. While the complication rates did not differ between two study arms (0.6% vs. 1.9%, P = 0.62), intra-procedural outcome measures were in favour of the USG approach (puncture time, 288 vs. 369 s, P < 0.001; first pass success, 74% vs. 20%, P < 0.001; extra puncture attempts 0.5 vs. 2.1, P < 0.001; inadvertent arterial puncture 0.07 vs. 0.25, P < 0.001; unsuccessful cannulation 0.6% vs. 14%, P < 0.001). Though these measures varied between trainees (49% of procedures) and expert operators, between-arm differences (except for unsuccessful cannulation) were comparably significant in favour of USG approach for both subgroups. CONCLUSIONS: Ultrasound-guided puncture of femoral veins was associated with preferable intra-procedural outcomes, though the major complication rates were not reduced. Both trainees and expert operators benefited from the USG strategy. (www.clinicaltrials.gov ID: NCT02834221).

• MeSH
• časové faktory MeSH
• fibrilace síní diagnóza   patofyziologie   chirurgie   MeSH
• intervenční ultrasonografie * MeSH
• katetrizační ablace * škodlivé účinky   MeSH
• lidé středního věku MeSH
• lidé MeSH
• periferní katetrizace škodlivé účinky   metody   MeSH
• pooperační komplikace etiologie   MeSH
• předčasné ukončení klinických zkoušek MeSH
• punkce MeSH
• rizikové faktory MeSH
• senioři MeSH
• vena femoralis diagnostické zobrazování   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
• randomizované kontrolované studie MeSH
• srovnávací studie MeSH
• Geografické názvy
• Česká republika MeSH
• Japonsko MeSH

AIM: Residual thrombotic occlusion (RTO) after deep vein thrombosis (DVT) is considered as a risk factor of recurrent venous thromboembolism (VTE). We searched for risk factors associated with RTO after proximal DVT at the lower extremities. METHODS: Using compression ultrasound, we evaluated the presence of RTO at 6 months after DVT (RTO defined as a residual thrombus occupying, at maximum compressibility, >/=20% of the vein lumen before compression). RESULTS: We examined 126 Czech patients: mean age 57.5 years; 50.0% women, 68.3% femoral location of DVT (otherwise popliteal), RTO found in 45.2%. While accounting for covariates, in the whole population, RTO was significantly associated with following factors: (OR; 95% confidence limit; p value): male sex (2.01; 1.27-3.19; P=0.003), femoral location (2.76; 1.59-4.78; P=0.0003). In women, but not in men, an association was demonstrated for: concurrent pulmonary embolism (PE) (18.51; 1.85-185.7; P=0.0131), diabetes mellitus (4.62; 1.38-15.51; P=0.0133) and statin use (0.11; 0.02-0.62; P=0.0125). In contrast, in men RTO was associated with an unprovoked DVT (2.6; 1.26-5.34; P=0.0094). CONCLUSION: In the whole study population, male sex and femoral location of DVT were positively associated with RTO. In women, concurrent PE and diabetes mellitus were risk factors for RTO, while the use of statins was a protective factor. There was a positive association between RTO and unprovoked DVT in men. These findings deserve further evaluation in a larger study.

• MeSH
• časové faktory MeSH
• diabetes mellitus epidemiologie   MeSH
• dolní končetina krevní zásobení   MeSH
• dospělí MeSH
• hodnocení rizik MeSH
• lidé středního věku MeSH
• lidé MeSH
• logistické modely MeSH
• mladý dospělý MeSH
• odds ratio MeSH
• plicní embolie epidemiologie   MeSH
• recidiva MeSH
• rizikové faktory MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• sexuální faktory MeSH
• statiny terapeutické užití   MeSH
• ultrasonografie MeSH
• vena femoralis * diagnostické zobrazování   MeSH
• vena poplitea * diagnostické zobrazování   MeSH
• žilní tromboembolie diagnostické zobrazování   epidemiologie   MeSH
• žilní trombóza diagnostické zobrazování   epidemiologie   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
• Geografické názvy
• Česká republika epidemiologie   MeSH
• Názvy látek
• statiny MeSH

BACKGROUND: The aim of the study was to assess the regression rate of persistent echogenic masses in patients with idiopathic deep venous thrombosis (DVT) who were after initial 6 months randomized to long-term anticoagulation treatment or to discontinuation of anticoagulation. PATIENTS AND METHODS: We followed 168 patients with idiopathic DVT for two years since diagnosis. After 6 months of standard therapy (heparin/LMWH, warfarin with target INR 2-3) we randomized patients with persistent echogenic masses of over 20% of venous diameter to either discontinuation of warfarin or to continuation of warfarin for another 6 months. We evaluated the size of thrombotic masses with duplex ultrasound. RESULTS: After 6 months of standard therapy complete regression was observed in 69 patients while in 99 patients echogenic masses persisted, with 71 patients maintaining an obstruction of at least 20% of venous cross-sectional area. 52 patients were randomized. 27 patients continued warfarin therapy and in 25 patients warfarin was discontinued. After discontinuation of warfarin a further trend to regression was seen in both groups. A significant difference in regression of thrombotic masses between the 6th and 12th month of follow up was seen in patients continuing to receive warfarin, both within the popliteal vein (2.81 +/- 1.56 vs. 2.10 +/- 1.67 mm, p < 0.05) and the femoral vein (3.95 +/- 2.74 vs. 2.30 +/- 1.34 mm, p < 0.05). CONCLUSIONS: After 6 months of DVT treatment persistent echogenic masses can be found in almost two thirds of patients. Even after discontinuation of anticoagulation treatment echogenic masses further regress. However, the rate of regression in patients with deep venous thrombosis between the 6th and 12th month was greater in patients randomized to continue warfarin during this period than in patients without anticoagulation.

• MeSH
• antikoagulancia aplikace a dávkování   MeSH
• časové faktory MeSH
• duplexní dopplerovská ultrasonografie MeSH
• hemokoagulace účinky léků   MeSH
• heparin nízkomolekulární aplikace a dávkování   MeSH
• INR MeSH
• lidé středního věku MeSH
• lidé MeSH
• recidiva MeSH
• rozvrh dávkování léků MeSH
• senioři MeSH
• stupeň závažnosti nemoci MeSH
• vena femoralis diagnostické zobrazování   účinky léků   MeSH
• vena poplitea diagnostické zobrazování   účinky léků   MeSH
• výsledek terapie MeSH
• warfarin aplikace a dávkování   MeSH
• žilní trombóza krev   diagnostické zobrazování   farmakoterapie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH
• Názvy látek
• antikoagulancia MeSH
• heparin nízkomolekulární MeSH
• warfarin MeSH

A primary survey study involving a set of 113 lower limbs of 66 patients was focused on the prevalence of additional front great saphenous vein (AFGSV) and the measurement of the distance between its start in the great saphenous vein (GSV) and the saphenofemoral junction (SFJ), the measurement of the distance between the passage of AFGSV through the saphenous fascia and its start in GSV, and compared the width of AFGSV anechogenous lumen with the calibre of GSV. The prevalence of AFGSV in the observed set was 42.5%. Reflux was proved in 6 AFGSVs (12.5%). The width of the AFGSV anechogenous lumen was on an average 0.29 cm (M 0.26 cm, SD +/- 0.15 cm), and the width of GSV anechogenous lumen measured on lower limbs with simultaneous occurrence of AFGSV was 0.38 cm (M 0.38 cm, SD +/- 0.11 cm) on an average. Comparison of the anechogenous lumen width of the two veins showed a statistically significant difference (p < 0,001). AFGSV in the observed set of lower limbs started in VS at an average distance of 0.8 cm from the saphenofemoral junction (M 0.8 cm, SD +/- 0.46 cm). The minimum start point distance was 0.1 cm, the maximum was 1.84 cm. In 3 cases (6.3%), AFGSV started directly in the common femoral vein (v. femoralis communis), which was the place where also the saphenous vein begins. The distance between the passage of AFGSV through saphenous fascia to upper subcutaneous layers and the start of the vein in GSV was on an average 13.2 cm (M 14.5 cm, SD +/- 6.5 cm). The maximum distance between the passage of AFGSV through saphenous fascia and the start of the vein in GSV was 4 cm, the maximum distance being 30 cm.

• MeSH
• dolní končetina krevní zásobení   diagnostické zobrazování   MeSH
• duplexní dopplerovská ultrasonografie MeSH
• lidé středního věku MeSH
• lidé MeSH
• vena femoralis diagnostické zobrazování   MeSH
• vena saphena abnormality   diagnostické zobrazování   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

In a 38-year-old female patient during surgery of a femoral hernia by the crural approach injury-two stitches of the femoral vein occurred which was not noticed during surgery. After surgery a haematoma developed in the wound from lacerarion of the venous wall. The haematoma was evacuated and the wound healed secondarily. From the first postoperative day swelling of the thigh and foreknee. This finding called after some time for a duplex sonographic and phlebographic examination. Stenosis of the femoral vein, 35 mm in length, and with a 3 mm diameter of the vein was found. Three months after injury of the vein re-operation was performed. During the latter the stitches which stenotized the vein were released and a partial resection of the inguinal ligament was made. Shortly after surgery the oedema receded and the stenosis dilated to a diameter of 8 mm. At present the patient has no complaints.

• MeSH
• dospělí MeSH
• femorální hernie chirurgie   MeSH
• lidé MeSH
• peroperační komplikace * MeSH
• radiografie MeSH
• stenóza MeSH
• vena femoralis diagnostické zobrazování   zranění   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

• MeSH
• barevná diluční technika * MeSH
• dospělí MeSH
• hlavice femuru fyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• radiografie MeSH
• senioři MeSH
• vena femoralis diagnostické zobrazování   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• akutní nemoc MeSH
• antiflogistika aplikace a dávkování   terapeutické užití   MeSH
• časové faktory MeSH
• diatrizoát aplikace a dávkování   MeSH
• ethylbiskumacetát terapeutické užití   MeSH
• fenylbutazon aplikace a dávkování   terapeutické užití   MeSH
• fibrinolýza účinky léků   MeSH
• flebografie * MeSH
• heparin aplikace a dávkování   terapeutické užití   MeSH
• injekce intravenózní MeSH
• kombinovaná farmakoterapie MeSH
• lidé středního věku MeSH
• lidé MeSH
• streptokinasa aplikace a dávkování   terapeutické užití   MeSH
• tibie krevní zásobení   MeSH
• tromboflebitida diagnostické zobrazování   farmakoterapie   MeSH
• vena femoralis diagnostické zobrazování   MeSH
• vena iliaca diagnostické zobrazování   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH
• Názvy látek
• antiflogistika MeSH
• diatrizoát MeSH
• ethylbiskumacetát MeSH
• fenylbutazon MeSH
• heparin MeSH
• streptokinasa MeSH