Aortoiliac atherosclerosis is frequently encountered in renal failure patients waiting for renal transplantation. Staged or simultaneous surgical repair of aortoiliac lesions with renal transplantation is possible at reasonable risk. Arterial reconstruction is most commonly performed using an artificial prosthesis. Another option is the use of a fresh or preserved arterial allograft. In our institute, about 180 cadaveric transplantations are performed each year. Over the past 2 years, three patients with chronic renal failure and obliterative disease of the abdominal aorta and iliac arteries underwent aortofemoral bypass using a fresh arterial allograft combined with kidney transplantation from the same donor. The procedures as well as the postoperative course were uneventful. There was an immediate development of function of the renal transplant. Combined arterial reconstruction and transplantation, managing both conditions at a time, is convenient for the patient mainly because it means undergoing only one general anesthesia during one hospitalization. Moreover, the risk of infection of the vascular prosthesis is somewhat reduced. Disadvantages are that the availability of the arterial allograft is dependent on a suitable donor and the limited body of experience with the behavior of the arterial allograft in patients with chronic immunosuppression.

• MeSH
• arteria femoralis chirurgie   MeSH
• arteriální okluzní nemoci komplikace   chirurgie   MeSH
• arteriovenózní zkrat * MeSH
• chronické selhání ledvin komplikace   chirurgie   MeSH
• dospělí MeSH
• homologní transplantace MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• transplantace ledvin metody   MeSH
• vena femoralis chirurgie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Replacing an infected vascular prosthetic conduit with an allograft is a possible solution of this complication given the low recurrence of infection. It is most commonly utilized for cases where the use of autologous tissue is not an option. We present the case of a 70-year-old patient who had undergone repeated vascular reconstructions in the right lower limb. He was admitted to our department due to a progressively growing mass in the right groin and subsequently placed on the waiting list for a fresh allograft. The patient had the infected false aneurysm and prosthetic material of the femoral bifurcation replaced with an arterial allograft. The previous femoral popliteal autovenous bypass graft was reimplanted into the allograft. There were signs of sepsis during the operation; however, the blood culture was negative. Cultures from neither the wound nor the drain revealed the presence of any bacteria. The patient was discharged on the seventh post-operative day with prophylactic antibiotics. An early followup confirmed that there were no signs of recurrent infection and that the reconstruction remained patent. Seven and half months after the surgery, the femoral popliteal bypass graft became occluded and a conservative approach was chosen. A small thrombosed false aneurysm of the graft was revealed two years after the surgery due to transient non-compliance of the patient to immunosuppression therapy. It was treated conservatively. Two and a half years after the surgery, the allograft still remains open and the limb is preserved.

• Klíčová slova
• allograft, blood vessel prosthesis, infection,
• MeSH
• alografty chirurgie   MeSH
• arteria femoralis chirurgie   MeSH
• arterie transplantace   MeSH
• cévní protézy škodlivé účinky   MeSH
• cévy - implantace protéz * MeSH
• infekce spojené s protézou * chirurgie   mikrobiologie   MeSH
• lidé MeSH
• nepravé aneurysma * chirurgie   komplikace   MeSH
• reoperace škodlivé účinky   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Critical limb ischemia in patients with diabetes at the organ complication stage represents a considerable challenge in vascular medicine. Because of the complexity of the disease and the often symmetric involvement of both lower limbs, a discrepancy between suitable vascular conduit availability and the actual requirement can occur: notably, the prevalence of multilevel and diffuse arterial disease often limits the possibilities of endovascular treatment, and, in surgical cases, frequently prohibits the effective use of prosthetic material. In our patient with bilateral critical limb ischemia and previous coronary artery bypass graft followed by cardiac transplantation, only one great saphenous vein remained available. That was used in its entirety to salvage one limb as a sequential femorocrural bypass. A similar surgical procedure with a fresh arterial allograft retrieved from a deceased donor was performed on the other extremity . ABO compatibility as well as the chronic immunosuppressive therapy in a heart transplant recipient may have contributed to the favorable long-term clinical outcome of the allogeneic arterial reconstruction.

• MeSH
• arteria femoralis patofyziologie   chirurgie   MeSH
• arterie transplantace   MeSH
• časové faktory MeSH
• diabetické angiopatie etiologie   patofyziologie   chirurgie   MeSH
• dolní končetina krevní zásobení   MeSH
• homologní transplantace MeSH
• imunosupresiva aplikace a dávkování   MeSH
• ischemie etiologie   patofyziologie   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční angiografie MeSH
• onemocnění periferních arterií etiologie   patofyziologie   chirurgie   MeSH
• průchodnost cév * MeSH
• transplantace cév * MeSH
• transplantace srdce * MeSH
• vena saphena transplantace   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Názvy látek
• imunosupresiva MeSH

AIMS: The aim of this trial was to use intravascular ultrasound (IVUS) to determine whether cardiac allograft vasculopathy (CAV) starts progressing during the first year after heart transplantation (HTx). METHODS: We retrospectively analyzed 51 patients (11 women) who received heart transplants in our center between January 2010 and September 2013 and underwent coronary angiography as well as IVUS examination one month and one year after HTx. Patients with proven calcification and fibrotic plates in the IVUS examination one month after HTx constituted a group with defined donor-transmitted atherosclerosis (DTA). In patients without DTA, measurements of maximal intimal thickening (MIT) were made in two predetermined locations. RESULTS: Eight of the 51 patients had DTA, while 43 did not. These were divided based on maximal intimal thickness (MIT) into a group with MIT < 0.5 mm (27) and MIT ≥ 0.5 mm (16). No patient with MIT < 0.5 mm developed allograft vasculopathy within one year after HTx. CAV developed in three patients (P = 0.045) out of the 16 patients with MIT ≥ 0.5. In patients with DTA, a statistically significant deterioration in percent area stenosis (PAS) occurred in both artery sections (P = 0.01). CONCLUSION: Our trial showed that CAV progresses during the first year after HTx significantly more frequently in patients with DTA and MIT ≥ 0.5 mm. It is essential in these patients to implement an IVUS control examination one year after transplantation. The results can lead to a change in treatment strategy to prevent further progress of the disease.

• Klíčová slova
• IVUS examination, allograft vasculopathy, heart transplantation,
• MeSH
• alografty krevní zásobení   diagnostické zobrazování   MeSH
• časové faktory MeSH
• dárci tkání MeSH
• dospělí MeSH
• homologní transplantace MeSH
• intervenční ultrasonografie MeSH
• koronární angiografie metody   MeSH
• koronární stenóza diagnostické zobrazování   etiologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nemoci koronárních tepen komplikace   diagnostické zobrazování   MeSH
• okluze cévního štěpu diagnostické zobrazování   etiologie   MeSH
• pooperační péče metody   MeSH
• progrese nemoci MeSH
• transplantace srdce * MeSH
• tunica intima diagnostické zobrazování   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH
• práce podpořená grantem MeSH

BACKGROUND: Vascular allotransplantations are performed worldwide in selected patients suffering from vascular prosthesis infection or critical limb ischemia. Either fresh or cryopreserved vascular allograft may be used. OBJECTIVES: In various points, we address several aspects (allograft procurement, cryopreservation and transplantation technique) of the program of vascular allotransplantations in the Czech Republic. MATERIAL AND METHODS: Vascular grafts retrieval has been done within multiorgan harvests using no-touch technique. Very short time of cold ischemia is achieved due to close cooperation with Tissue Establishment where the following processing of cryopreservation is performed. Meeting all necessary quality criteria is a prerequisity for releasing grafts for clinical application. Standardized thawing protocol and surgical handling aims to minimize microfractures before implantation. RESULTS: Based on experimental and clinical work, the first validation of cryopreserved arterial and venous grafts for clinical use was performed between 2011 and 2013 in the Czech Republic. The developement of storage of vascular tissue in banks was stimulated in 2000-2010 by the issue of EU directives and national harmonized norms, aimed at assurance of high quality and safety of cells and tissues used for transplantations in humans. CONCLUSIONS: There are several crucial moments affecting final quality, including graft retrieval within a multiorgan harvest, short ischemic time, cryopreservation and thawing technique used. The recommended surgical handling during implantation may also affect results and graft-related complications.

• Klíčová slova
• cryopreservation, cryopreserved vascular allograft transplantation, graft procurement, operative procedures, tissue banking,
• MeSH
• alografty MeSH
• cévní protézy * MeSH
• cévy fyziologie   transplantace   MeSH
• homologní transplantace metody   MeSH
• kryoprezervace * metody   MeSH
• lidé MeSH
• tkáňové banky MeSH
• transplantace cév metody   MeSH
• získávání tkání a orgánů * statistika a číselné údaje   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

• MeSH
• alografty MeSH
• aortální aneurysma chirurgie   MeSH
• cévní protézy škodlivé účinky   MeSH
• infekce spojené s protézou chirurgie   MeSH
• lidé MeSH
• senioři MeSH
• stenty škodlivé účinky   MeSH
• transplantace cév škodlivé účinky   metody   MeSH
• výkony cévní chirurgie metody   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

BACKGROUND: Uterus transplantation is a complex, multi-step experimental procedure used for the treatment of uterus absence or uterus anomaly that prevents embryo implantation or pregnancy completion. METHOD: To date, only 51 uterus transplants worldwide had been performed. When simplified, it is vascularized composite allograft transplantation. While it is still an experimental procedure with encouraging results for the future, there are still many issues that have to be clarified. The most serious complications of uterus transplantation are graft rejection or grafts vascular failure. RESULTS: So far, no reference to the atherosclerotic arterial infiltration of the uterus arteries was suggested and studied as one of the main causes of graft's failure. CONCLUSION: In this review we summarized current knowledge and possible role of uterus arterial damage, including atherosclerotic changes on the graft's survival.

• MeSH
• arteria uterina * MeSH
• ateroskleróza etiologie   MeSH
• lidé MeSH
• oxid dusnatý metabolismus   MeSH
• remodelace cév MeSH
• tunica intima metabolismus   MeSH
• uterus krevní zásobení   transplantace   MeSH
• vaskularizovaná kompozitní alotransplantace škodlivé účinky   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• systematický přehled MeSH
• Názvy látek
• oxid dusnatý MeSH

BACKGROUND: There is conflicting evidence on the role of acetylsalicylic acid (ASA) use in the development of cardiac allograft vasculopathy (CAV). METHODS: A nationwide prospective two-center study investigated changes in the coronary artery vasculature by highly automated 3-D optical coherence tomography (OCT) analysis at 1 month and 12 months after heart transplant (HTx). The influence of ASA use on coronary artery microvascular changes was analyzed in the overall study cohort and after propensity score matching for selected clinical CAV risk factors. RESULTS: In total, 175 patients (mean age 52 ± 12 years, 79% male) were recruited. During the 1-year follow-up, both intimal and media thickness progressed, with ASA having no effect on its progression. However, detailed OCT analysis revealed that ASA use was associated with a lower increase in lipid plaque (LP) burden (p = .013), while it did not affect the other observed pathologies. Propensity score matching of 120 patients (60 patient pairs) showed similar results, with ASA use associated with lower progression of LPs (p = .002), while having no impact on layered fibrotic plaque (p = .224), calcification (p = .231), macrophage infiltration (p = .197), or the absolute coronary artery risk score (p = .277). According to Kaplan-Meier analysis, ASA use was not associated with a significant difference in survival (p = .699) CONCLUSION: This study showed a benefit of early ASA use after HTx on LP progression. However, ASA use did not have any impact on the progression of other OCT-observed pathologies or long-term survival.

• Klíčová slova
• OCT, acetylsalicylic acid, cardiac allograft vasculopathy, lipid plaque,
• MeSH
• alografty patologie   MeSH
• aterosklerotický plát * komplikace   MeSH
• dospělí MeSH
• koronární angiografie MeSH
• lidé středního věku MeSH
• lidé MeSH
• nemoci koronárních tepen * etiologie   MeSH
• optická koherentní tomografie škodlivé účinky   metody   MeSH
• prospektivní studie MeSH
• transplantace srdce * škodlivé účinky   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Research Support, N.I.H., Extramural MeSH

Despite the wide choice of commercial heart valve prostheses, cryopreserved semilunar allograft heart valves (C-AHV) are required, and successfully transplanted in selected groups of patients. The expiration limit (EL) criteria have not been defined yet. Most Tissue Establishments (TE) use the EL of 5 years. From physiological, functional, and surgical point of view, the morphology and mechanical properties of aortic and pulmonary roots represent basic features limiting the EL of C-AHV. The aim of this work was to review methods of AHV tissue structural analysis and mechanical testing from the perspective of suitability for EL validation studies. Microscopic structure analysis of great arterial wall and semilunar leaflets tissue should clearly demonstrate cells as well as the extracellular matrix components by highly reproducible and specific histological staining procedures. Quantitative morphometry using stereological grids has proved to be effective, as the exact statistics was feasible. From mechanical testing methods, tensile test was the most suitable. Young's moduli of elasticity, ultimate stress and strain were shown to represent most important AHV tissue mechanical characteristics, suitable for exact statistical analysis. C-AHV are prepared by many different protocols, so as each TE has to work out own EL for C-AHV.

• Klíčová slova
• Cryopreservation, Expiration limit, Heart valve allograft, Mechanical measurements, Quantitative microscopy, Tissue banking,
• MeSH
• alografty MeSH
• aorta MeSH
• aortální chlopeň * chirurgie   MeSH
• kryoprezervace * MeSH
• lidé MeSH
• modul pružnosti MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

• MeSH
• aneurysma břišní aorty chirurgie   MeSH
• arterie transplantace   MeSH
• homologní transplantace MeSH
• lidé středního věku MeSH
• lidé MeSH
• transplantace ledvin * MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH