BACKGROUND: Coronary artery bypass grafting (CABG) is a common cardiac surgery. Manufacturing small-diameter (2-5 mm) vascular grafts for CABG is important for patients who lack first-choice autologous arterial, or venous conduits. Ovine and porcine common carotid arteries (CCAs) are used as large animal models for in vivo testing of newly developed tissue-engineered arterial grafts. It is unknown to what extent these models are interchangeable and whether the left and right arteries of the same subjects can be used as experimental controls. Therefore, we compared the microscopic structure of paired left and right ovine and porcine CCAs in the proximodistal direction and compared these animal model samples to samples of human coronary arteries (CAs) and human internal thoracic arteries (ITAs). METHODS: We compared the histological composition of whole CCAs of sheep (n = 22 animals) with whole porcine CCAs (n = 21), segments of human CAs (n = 21), and human ITAs (n = 21). Using unbiased sampling and stereological methods, we quantified the fractions of elastin, total collagen, type I collagen, type III collagen, smooth muscle actin (SMA) and chondroitin sulfate (CS) A, B, and C. We also quantified the densities and distributions of nuclear profiles, nervi vasorum and vasa vasorum as well as the thickness of the intima-media and total wall thickness. RESULTS: The differences between the paired samples of left and right CCAs in sheep were substantially greater than the differences in laterality in porcine CCAs. The right ovine CCAs had a smaller fraction of elastin (p < 0.001), greater fraction of SMA (p < 0.01), and greater intima-media thickness (p < 0.001) than the paired left side CCAs. In pigs, the right CCAs had a greater fraction of elastin (p < 0.05) and a greater density of vasa vasorum in the media (p < 0.001) than the left-side CCAs. The fractions of elastin and CS decreased and the fraction of SMA increased in the proximodistal direction in both the ovine (p < 0.001) and porcine (p < 0.001) CCAs. Ovine CCAs had a muscular phenotype along their entire length, but porcine CCAs were elastic-type arteries in the proximal segments but muscular type arteries in middle and distal segments. The CCAs of both animals differed from the human CAs and ITAs in most parameters, but the ovine CCAs had a comparable fraction of elastin and CS to human ITAs. CONCLUSIONS: From a histological point of view, ovine and porcine CCAs were not equivalent in most quantitative parameters to human CAs and ITAs. Left and right ovine CCAs did not have the same histological composition, which is limiting for their mutual equivalence as sham-operated controls in experiments. These differences should be taken into account when designing and interpreting experiments using these models in cardiac surgery. The complete morphometric data obtained by quantitative evaluation of arterial segments were provided to facilitate the power analysis necessary for justification of the minimum number of samples when planning further experiments. The middle or distal segments of ovine and porcine CCAs remain the most realistic and the best characterized large animal models for testing artificial arterial CABG conduits.

• Klíčová slova
• Carotid arteries, Coronary arteries, Coronary artery bypass grafting, Internal thoracic arteries, Pig, Sheep, Stereology,
• MeSH
• arteriae carotides chirurgie   MeSH
• intimomediální šíře tepenné stěny * MeSH
• koronární bypass metody   MeSH
• lidé MeSH
• mamární tepny * MeSH
• modely u zvířat MeSH
• ovce MeSH
• prasata MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH

A case is reported of a 40-year-old woman clinically diagnosed as moyamoya disease with associated fibromuscular dysplasia of intrapulmonary bronchial arteries incidentally revealed during autoptic examination. Moyamoya disease represents an idiopathic noninflammatory and nonatherosclerotic arterio-occlusive process of intracranial arteries. Prolonged brain ischemia leads to formation of tiny and fragile collaterals. Clinically, patients with moyamoya angiopathy commonly present with severe neurological symptoms caused by brain infarction or hemorrhage. Histologically, the steno-occlusive process is based on fibrocellular thickening of intima and intimal smooth muscle cell proliferation. In the literature, extracranial arterial involvement, i.e. fibromuscular dysplasia of renal or pulmonary arteries, has been described in several cases of moyamoya disease. Our aim is to show a unique case of moyamoya disease associated with fibromuscular dysplasia affecting an uncommon site.

• Klíčová slova
• Bronchial artery, Fibromuscular dysplasia, Moyamoya disease,
• MeSH
• arteriae bronchiales patologie   MeSH
• arteriae carotides diagnostické zobrazování   patologie   chirurgie   MeSH
• arteriae cerebrales diagnostické zobrazování   patologie   chirurgie   MeSH
• biopsie MeSH
• digitální subtrakční angiografie MeSH
• dospělí MeSH
• fatální výsledek MeSH
• fibromuskulární dysplazie komplikace   patologie   MeSH
• lidé MeSH
• moyamoya nemoc komplikace   diagnostické zobrazování   patologie   chirurgie   MeSH
• mozková angiografie MeSH
• pitva MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

BACKGROUND: Using animal models in experimental medicine requires mapping of their anatomical variability. Porcine common carotid arteries (CCA) are often preferred for the preclinical testing of vascular grafts due to their anatomical and physiological similarity to human small-diameter arteries. Comparing the microscopic structure of animal model organs to their human counterparts reveals the benefits and limitations of translational medicine. METHODS: Using quantitative histology and stereology, we performed an extensive mapping of the regional proximodistal differences in the fractions of elastin, collagen, and smooth muscle actin as well as the intima-media and wall thicknesses among 404 segments (every 1 cm) of porcine CCAs collected from male and female pigs (n = 21). We also compared the microscopic structure of porcine CCAs with segments of human coronary arteries and one of the preferred arterial conduits used for the coronary artery bypass grafting (CABG), namely, the internal thoracic artery (ITA) (n = 21 human cadavers). RESULTS: The results showed that the histological structure of left and right porcine CCA can be considered equivalent, provided that gross anatomical variations of the regular branching patterns are excluded. The proximal elastic carotid (51.2% elastin, 4.2% collagen, and 37.2% actin) transitioned to more muscular middle segments (23.5% elastin, 4.9% collagen, 54.3% actin) at the range of 2-3 centimeters and then to even more muscular distal segments (17.2% elastin, 4.9% collagen, 64.0% actin). The resulting morphometric data set shows the biological variability of the artery and is made available for biomechanical modeling and for performing a power analysis and calculating the minimum number of samples per group when planning further experiments with this widely used large animal model. CONCLUSIONS: Comparison of porcine carotids with human coronary arteries and ITA revealed the benefits and the limitations of using porcine CCAs as a valid model for testing bioengineered small-diameter CABG vascular conduits. Morphometry of human coronary arteries and ITA provided more realistic data for tailoring multilayered artificial vascular prostheses and the ranges of values within which the conduits should be tested in the future. Despite their limitations, porcine CCAs remain a widely used and well-characterized large animal model that is available for a variety of experiments in vascular surgery.

• Klíčová slova
• Bypass grafting, Cardiac surgery, Carotid artery, Coronary arteries, Internal thoracic artery, Pig, Stereology,
• MeSH
• arteriae carotides anatomie a histologie   chirurgie   MeSH
• cévní protézy * klasifikace   normy   MeSH
• imunohistochemie MeSH
• koronární bypass metody   MeSH
• lidé MeSH
• modely u zvířat MeSH
• mrtvola MeSH
• pilotní projekty MeSH
• prasata MeSH
• srdce anatomie a histologie   MeSH
• tkáňové inženýrství MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články 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
• arteriae carotides fyziologie   chirurgie   MeSH
• cévní protézy trendy   MeSH
• kapři MeSH
• kolagen aplikace a dávkování   izolace a purifikace   MeSH
• ovce MeSH
• protézy - design metody   trendy   MeSH
• průchodnost cév fyziologie   MeSH
• zvířata MeSH
• Check Tag
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• kolagen MeSH

BACKGROUND: Intraoperative use of the intraluminal shunt may reduce the risk of a stroke by reducing cerebral blood flow compromise, but it may also increase the risk of atherosclerotic arterial wall damage with subsequent stroke during carotid endarterectomy (CEA). There is still no evidence to support routine or selective shunting. MATERIAL AND METHODS: A total of 754 CEAs were performed in a prospective study from 2005 to 2011 at our department. All procedures were done under regional anesthesia with selective carotid artery shunting according to neurologic status after internal carotid artery clamping. Magnetic resonance (MR) evaluation of brain parenchyma using diffusion-weighed imaging (DWI) sequence was performed upon hospital admission and 24 hours after the surgical procedure. Acute new MR DWI lesions were evaluated according to the classification published by Szabo et al. A routine neurologic evaluation was recorded as well. RESULTS: The intraluminal shunt was used in 46 of 754 patients (6.1%). A new ischemic lesion was detected in 45 patients (6%). Most of these lesions were neurologically asymptomatic (80%). A new lesion on MR DWI in the subgroup of shunted patients was detected in 15 cases (32.6%) and in the subgroup of nonshunted patients in 30 cases (4.2%). Most of these lesions were due to embolization or hypoperfusion during shunt insertion. CONCLUSION: Use of the intraluminal shunt was the most important risk factor for the new MR DWI lesion in the entire group of CEAs. Results support the strategy of a selective use of intraluminal shunts.

• MeSH
• arteriae carotides patologie   chirurgie   MeSH
• cévní mozková příhoda etiologie   MeSH
• difuzní magnetická rezonance * MeSH
• karotická endarterektomie škodlivé účinky   metody   MeSH
• lidé MeSH
• předoperační období MeSH
• prognóza MeSH
• rizikové faktory MeSH
• stenóza arteria carotis patologie   chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVES: Sleep apnea is associated with advanced atherosclerosis. This study was focused on sleep breathing in patients with hemodynamically significant carotid stenosis, currently free from clinical symptoms. DESIGN AND SETTINGS: 17 patients with carotid artery stenosis of 70% and more in the absence of actual neurological symptoms indicated for non-acute endarterectomy, and 17 age- and sex-matched controls were examined using sleep polygraphy. 12 patients had a follow-up sleep polygraphy a month after the surgery. RESULTS: The criteria of obstructive sleep apnea (OSA) were met by 4 patients prior to operation, by 2 patients after the operation, and by 2 control subjects. The pre-surgery apnea/hypopnea index (AHI) was 14 (+/-SD=17.0), post-surgery 8.3 (+/-9.0) and in the controls 6.7(+/-6.7). The pre-surgery oxygen desaturation index was 20.1 (+/-17.7), post-surgery 15.0 (+/-12.0) and in the controls 11.6 (+/-6.1). A comparison between the pre-surgery results seen in the patients and in controls after adjustment for BMI revealed no significant difference. The only significant difference between the pre-surgery and post-surgery values was found in the AHI (P=0.045). CONCLUSION: According to this study there exists an association between carotid stenosis and OSA, however this association is explainable by a higher BMI. The study also found a tendency toward OSA alleviation in response to endarterectomy.

• MeSH
• arteriae carotides patologie   chirurgie   MeSH
• incidence MeSH
• index tělesné hmotnosti MeSH
• komorbidita MeSH
• krk anatomie a histologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• obstrukční spánková apnoe komplikace   epidemiologie   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• stenóza arteria carotis komplikace   epidemiologie   chirurgie   MeSH
• studie případů a kontrol 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
• práce podpořená grantem MeSH

Poly(2-hydroxyethyl methacrylate) (PHEMA) embolization particles with enhanced haemostatic properties were prepared by bulk or suspension polymerisation of 2-hydroxyethyl methacrylate (HEMA) followed by particle soaking in ethamsylate solution. The particles accelerated thrombus formation as evidenced by blood analysis of rabbits with implanted emboli. Usefulness of both spherical and cylindrical PHEMA particles with enhanced haemostatic effect was demonstrated on the embolization of arterial anastomosis, fistulas of the lower extremity and abdominal cavity, haemangioma and arteriovenous malformation of the head of several children.

• MeSH
• arteriae carotides patologie   chirurgie   MeSH
• biomimetické materiály terapeutické užití   MeSH
• dítě MeSH
• hemokoagulace fyziologie   MeSH
• hemostáza chirurgická metody   MeSH
• králíci MeSH
• lidé MeSH
• ligace MeSH
• mladiství MeSH
• PEG-DMA hydrogel terapeutické užití   MeSH
• permeabilita MeSH
• polyhydroxyethylmethakrylát terapeutické užití   MeSH
• pooperační krvácení etiologie   terapie   MeSH
• poréznost MeSH
• předškolní dítě MeSH
• terapeutická embolizace metody   MeSH
• výkony cévní chirurgie škodlivé účinky   metody   MeSH
• výsledek terapie MeSH
• zvířata MeSH
• Check Tag
• dítě MeSH
• králíci MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• hodnotící studie MeSH
• kazuistiky MeSH
• práce podpořená grantem MeSH
• Názvy látek
• PEG-DMA hydrogel MeSH
• polyhydroxyethylmethakrylát MeSH

BACKGROUND: Experience with Intraoperative monitoring using neurophysiological and haemodynamic indices in 500 operations for carotid endarterectomy is reported. METHODS: Transcranial Doppler technique (TCD), electroencephalogram (EEG) and bilateral median somatosensory evoked potentials (SEP) were performed. Latency and amplitude of SEP, spectral analysis of EEG signal and blood flow velocity in the medial cerebral artery (MCA) were continuously measured. FINDINGS: After two consecutive drops of N20/P25 complex of more than 50%, a warning was given, and when the decrease continued, an the alarm raised. Abnormal EEG changes, if any, appeared after a significant decrease in the N20/P25 amplitude. A mean blood flow velocity drop below 40% of the reference value after cross clamping was rated as a significant warning event.A warning as a result of a decrease in N20/P25 amplitude occurred in 80 operations (16.0%), after an spectral edge frequency decrease in 2 cases (0.4%) and after a V(mean) decrease in 21 cases (4.2%). False negative results were experienced in 2 patients (0.4%). A shunt was inserted in 2.8% of the operations. The overall mortality/morbidity rate was 2.4%. CONCLUSION: A decrease of more than 50% in the amplitude of the thalamocortical somatosensory evoked potential complex N20/P25 proved to be the most reliable warning of danger of ischaemia during carotid endarterectomy.

• MeSH
• arteriae carotides diagnostické zobrazování   patofyziologie   chirurgie   MeSH
• celková anestezie normy   MeSH
• dospělí MeSH
• elektroencefalografie metody   normy   MeSH
• karotická endarterektomie metody   mortalita   normy   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mozek krevní zásobení   patofyziologie   MeSH
• mozková hypoxie a ischemie etiologie   patofyziologie   prevence a kontrola   MeSH
• mozkový krevní oběh fyziologie   MeSH
• peroperační komplikace etiologie   patofyziologie   prevence a kontrola   MeSH
• peroperační monitorování metody   normy   trendy   MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• somatosenzorické evokované potenciály fyziologie   MeSH
• stenóza arteria carotis chirurgie   MeSH
• ultrasonografie dopplerovská transkraniální metody   normy   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

The objective of the paper is to summarize hitherto assembled experience of the department with the application of new approaches to reconstruction operations of the extracranial circulation with emphasis on its most important part, i.e. the carotid circulation. The main feature of this approach is an effort to increase the safety of the operation for the patient at risk which implies among others extension of indications for reconstruction surgery.

• MeSH
• arteriae carotides chirurgie   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• pooperační komplikace MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

Arterial spasms developing during microsurgical vascular anastomoses can be a difficult problem. We have been using specially developed spherical dilators in clinical practice to remove spasm that do not respond to the application of warm saline with lidocain. Dilating the spastic segment of the vessel two or three times with the instrument will usually relieve the spasm. Experimental testing of the method on the rat carotid artery has shown that using the dilator three times causes only moderate damage to the endothelium, which is largely overcome within one week. Thrombosis of the dilated artery was never seen in experimental studies and clinical use.

• MeSH
• anastomóza chirurgická přístrojové vybavení   MeSH
• anestetika lokální terapeutické užití   MeSH
• arteriae carotides účinky léků   patofyziologie   chirurgie   MeSH
• cévní endotel zranění   patologie   MeSH
• chlorid sodný MeSH
• design vybavení MeSH
• dilatace přístrojové vybavení   MeSH
• krysa rodu Rattus MeSH
• lidokain terapeutické užití   MeSH
• mikrochirurgie přístrojové vybavení   MeSH
• peroperační komplikace terapie   MeSH
• vazodilatancia terapeutické užití   MeSH
• vazokonstrikce účinky léků   fyziologie   MeSH
• zvířata MeSH
• Check Tag
• krysa rodu Rattus MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• anestetika lokální MeSH
• chlorid sodný MeSH
• lidokain MeSH
• vazodilatancia MeSH