BACKGROUND: An indication for selective shunting during carotid endarterectomy (CEA) is based on monitoring during a procedure. Cerebral oximetry (CO) using near-infrared spectroscopy (NIRS) may be a simple technique, but its relevance during CEA, especially with respect to cutoff values indicating shunt implantation, still needs to be elucidated. METHODS: One hundred twenty five patients underwent CEA under local anesthesia (LA) and were monitored clinically throughout the whole procedure. The patients were also monitored using bilateral NIRS probes during surgery. The NIRS values were recorded and evaluated before and after selective cross-clamping, firstly by the external carotid artery (ECA), followed by the internal carotid artery (ICA). The decrease in the ipsilateral CO values, with respect to the indication of shunting, was only analyzed after selective cross-clamping of the ICA. The decision to use an intraluminal shunt was solely based on the neurological status evaluation after ICA cross-clamping. RESULTS: One hundred five patients (85%) were stable throughout the CEA, while 20 patients (15%) clinically deteriorated during surgery. The mean drop in the CO after selective ICA clamping in clinically stable patients was 6%, while in patients with clinical deterioration, the NIRS decreased by 14.5% (p < 0.05). When the cutoff value for selective shunting was set as a 10% decrease of the ipsilateral CO after selective ICA clamping, the sensitivity of the technique was 100% and the specificity 83.0%. CONCLUSIONS: Our study showed that a 10% decrease in the ipsilateral brain tissue oximetry after selective cross-clamping the ICA provides a reliable cutoff value for selective shunting during CEA. Despite the availability of a variety of monitoring tools, the NIRS may be an easy, reliable option, especially in the scenario of acute CEA in general anesthesia.

• Klíčová slova
• Carotid endarterectomy, Cerebral oximetry, Intraluminal shunt, Neuromonitoring, Stroke,
• MeSH
• arteria carotis externa diagnostické zobrazování   chirurgie   MeSH
• arteria carotis interna diagnostické zobrazování   chirurgie   MeSH
• blízká infračervená spektroskopie MeSH
• chirurgické nástroje * MeSH
• difuzní magnetická rezonance MeSH
• karotická endarterektomie * MeSH
• konstrikce MeSH
• lidé středního věku MeSH
• lidé MeSH
• mozek diagnostické zobrazování   patofyziologie   chirurgie   MeSH
• neurochirurgické výkony * MeSH
• oxymetrie * MeSH
• prospektivní studie MeSH
• ROC křivka MeSH
• senioři nad 80 let MeSH
• senioři 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
• práce podpořená grantem MeSH

BACKGROUND: To determine impact of intraluminal-left anterior descending shunt to prevent myocardial damage in minimally invasive coronary artery bypass. METHODS: 38 patients were randomly assigned to external tournique occlusion (n = 19) or intraluminal-left anterior descending shunt group (n= 19). Blood samples for cardiac troponin T were collected at 30 minutes prior to, 6 and 24 hours after surgery. RESULTS: One patient in external tournique occlusion and two patients in intraluminal-left anterior descending shunt group were excluded from futher analysis due to preoperative cardiac troponin T level above the 99th-percentile. Postoperatively, each six patients in external tournique occlusion (33.3%) and intraluminal-left anterior descending shunt (35.3%) group were above the 99th-percentile. Two patients from each group (external tournique occlusion group 11.1% vs. intraluminal-left anterior descending shunt group 11.8%) had peak values above 10-% coeficient of variation cutoff (p = 1). There were no significant differences in between both groups at all studied timepoints. CONCLUSION: There was no protective effect of intraluminal shunting on myocardial damage compared to short-term tournique occlusion. It is upon the surgeon's discretion which method may preferrably be used to achieve a bloodless field in grafting of the non-occluded left anterior descending in minimally invasive coronary artery bypass.

• MeSH
• anastomóza chirurgická metody   MeSH
• koronární bypass metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• miniinvazivní chirurgické výkony metody   MeSH
• neparametrická statistika MeSH
• okluze terapeutická metody   MeSH
• perioperační péče MeSH
• poranění srdce prevence a kontrola   MeSH
• prospektivní studie MeSH
• senioři MeSH
• turnikety MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH

The life-saving procedures for patients in chronic renal failure (CRF) are hemodialysis (HD) or successful kidney transplantation. HD requires a properly placed and functioning vascular access, most often obtained by creating an arteriovenous fistula (AVF). The long-term patency of AVFs is limited, in addition to other factors, by the development of intimal hyperplasia and the process results in venous wall thickening and progressive fistula occlusion. Another problem is limited patency, due to the development of pseudoaneurysm, which is associated with an increased risk of thrombosis, infection and bleeding, difficult cannulation for dialysis, pain and cosmetic defects. Treatment is focused on rapidly progressing pseudoaneurysms, which can predispose to rupture, technical problems during cannulation because of pseudoaneurysm size or a growing intraluminal thrombus. Most of these patients are scheduled for pseudoaneurysm removal and new fistula construction or, occasionally, an endovascular procedure involving stent graft implantation. This paper describes a simple and inexpensive technique of managing an AVF pseudoaneurysm, i.e. aneurysmorrhaphy. To offset the weakening of the venous wall by suture following aneurysmorrhaphy, an external polyethylene terephthalate (PET) prosthesis was implanted in the vein to prevent the development of intimal hyperplasia in the de novo created AVF.

• MeSH
• arteriovenózní zkrat škodlivé účinky   metody   MeSH
• chronické selhání ledvin terapie   MeSH
• dialýza ledvin metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nepravé aneurysma etiologie   chirurgie   MeSH
• polyethyleny MeSH
• průchodnost cév MeSH
• výkony cévní chirurgie metody   MeSH
• výsledek terapie MeSH
• záchranná terapie metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• polyethyleny 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

UNLABELLED: The authors evaluate the results of 100 carotid endarterectomies in 88 patients, 70 plus years old, operated between April 1997 and December 2000. Regional anaesthesia was always used. The use of intraluminal shunt was selective (11%), on the basis of consciousness and the neurological status. Operating microscope and microsurgical technique were used in all cases. Neither 30-d morbidity nor mortality has been detected in the group. Medical morbidity has been recorded in 2 patients. CONCLUSION: Carotid microendarterectomy in regional anesthesia represents effective procedure for patients in the old age.

• MeSH
• karotická endarterektomie metody   MeSH
• lidé MeSH
• mikrochirurgie MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

A clinical series of five patients operated on for symptomatic cerebral blood flow deterioration is discussed. They presented with either hemispheral symptoms (hemiparesis, amaurosis fugax) or signs of diffuse cerebral hypoxia. In the presence of unilateral or bilateral internal carotid artery (ICA) occlusion a critical stenosis of the external carotid artery (ECA) was confirmed either by duplex ultrasound or angiography. In all these cases ECA was reconstructed by means of common vascular surgical techniques. The use of intraluminal (i.l.) shunt was mandatory. There were neither early nor late deaths in this group. In one patient a transient stroke occurred three days following standard carotid endarterectomy performed after ECA surgery on the contralateral side. After the mean follow-up of 46 months all patients remain neurologically asymptomatic. In selected cases the ECA reconstruction offers an effective and beneficial tool for surgical management of critical cerebral perfusion impairment.

• MeSH
• arteria carotis externa chirurgie   MeSH
• arteria carotis interna MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• stenóza arteria carotis diagnóza   chirurgie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• kazuistiky MeSH

BACKGROUND: In this article, we present our experience with such operations performed under local anaesthesia. METHODS: From January 1997 to November 2007, there were 387 patients operated on for asymptomatic carotid stenosis. Patient data were retrospectively evaluated. Thirty-day neurological morbidity and mortality from six different subgroups were analysed and compared. The numbers of perioperative transient ischaemic attacks, as well as surgical and other perioperative complications were also evaluated. RESULTS: Overall morbidity and mortality was 1.8% (seven patients). Stroke was noted in 1.3% (five patients). Transitory ischaemic attacks within the first 30 days were observed in 1.6% (six patients). Only those patients who had intraluminal shunt insertion were found to have significantly higher morbidity and mortality. (p = 0.000018). Myocardial infarction was observed in 0.5% (two patients), one fatal. CONCLUSION: We have achieved acceptable morbidity and mortality rates (1.8%) according to the parameters set by previous studies such as Asymptomatic Carotid Atherosclerosis Study and Asymptomatic Carotid Stenosis Trial as well as American Heart Association and European Stroke Organisation guidelines. All surgeries were done under local anaesthesia. Shunts were inserted in 22 cases (5.68%).

• MeSH
• cévní mozková příhoda etiologie   mortalita   prevence a kontrola   MeSH
• karotická endarterektomie metody   mortalita   MeSH
• lidé středního věku MeSH
• lidé MeSH
• lokální anestezie metody   mortalita   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• stenóza arteria carotis etiologie   mortalita   chirurgie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

OBJECTIVE: The clinical outcome of surgical extracranial internal carotid artery (eICA) recanalization may be adversely affected by intraoperative ischemia. Median nerve somatosensory evoked potential (SEP) amplitude correlates well with cerebral blood flow. Our study presents the value of intraoperative SEP and selective shunting in the prevention of intraoperative ischemia development during urgent eICA recanalization. METHODS: Prospective recruitment of patients with acute unilateral eICA occlusion. All underwent surgical recanalization with intraoperative monitoring of scalp median SEPs. Preoperative clinical findings, cerebral collaterals, and 3 month functional outcome were evaluated. RESULTS: The cohort consisted of 33 patients. Intraoperative SEP amplitude decreased significantly in 6 (18.2%). An intraluminal shunt was inserted twice (6.1%), surgical complications occurred in 6 (18.2%), intracerebral hemorrhage was not found. Favorable outcome 3 months after surgery according to the modified Rankin scale (mRS 0-2) was achieved in 28 (84.8%), 3 patients died (9.1%). CONCLUSIONS: Intraoperative SEP during urgent eICA recanalization seems to be beneficial. Thanks to the effective measure based on the intraoperative SEP changes, the clinical outcome in four(12.1%) could be positively affected. SIGNIFICANCE: The results suggest that selective shunting based on intraoperative median SEPs may prevent intraoperative ischemia and may improve overall outcome of urgent eICA recanalization.

• Klíčová slova
• Intraoperative monitoring, Ischemic stroke, Selective shunting, Somatosensory evoked potentials, Urgent recanalization,
• MeSH
• arteria carotis interna chirurgie   MeSH
• intraoperační neurofyziologická monitorace * MeSH
• ischemie mozku * prevence a kontrola   MeSH
• lidé MeSH
• nemoci arterie carotis * chirurgie   MeSH
• prospektivní studie MeSH
• somatosenzorické evokované potenciály fyziologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH