Biomedical subjects
Publications and source records attributed to Petr Utíkal.
The authors describe a promising abdominal aortic aneurysm treatment--a combined endovascular/surgical approach--used in two cases of aneurysm taking the aortic visceral branches region.
The paper deals with pharmacotherapeutical approaches to decreasing hematocrit in order to improve macro and microcirculation in arteries of lower limbs of type 2 diabetes patients. The study included 37 patients with diabetic angiopathy, all of whom had inoperable changes to arteries. In order to decrease hematocrit and cause haemodilution, we used 10 % solution of hydroxyethyl starch. Indications for inclusion in the study were carried out in close cooperation with a vascular surgeon. We applied hydroxyethyl starch according to a predetermined scheme. Using normovolemic and hypervolemic haemodilution, we decreased hematocrit to 0.41-0.42. Patients underwent a treadmill examination at the beginning of the study and then repeatedly during the course of study, when we measured the claudication distance to quantify, the effects of decreased hematocrit. The results show that the effect is most pronounced after 6 weeks, when hematocrit fell from a baseline of 0.435 to 0.421 (p < 0.01) and claudication distance increased to 51% (also significant). On average the claudication distance rose from 55.7 m to 84.6 m (p < 0.01). In the following weeks (after the sixth week of the study), the studied parameters changed only insignificantly (p > 0.05).
The authors describe surgical treatment for high risk patients with abdominal aortic aneurysms of complicated morphology for standard endovascular repair. This was achieved by combining endovascular stent-grafting for aneurysmal sac exclusion with conventional vascular surgical procedures.
PURPOSE: Evaluation of 6-year results of abdominal aortic aneurysm (AAA) treatment by Ella stent-grafts with regard to safety and effectivity in relation to morphology of the aneurysm. METHODS: From a group of 172 patients with AAA, in whom elective endovascular treatment was considered, 120 of them (69.8%) were found to be suitable for this type of therapy. The bifurcated type of stent-graft was implanted in 97 patients, uniiliacal type in 19 patients and only four patients were found to be suitable for tubular type of stent-graft. Additional necessary procedures (internal iliac artery occlusion or contralateral common iliac artery occlusion in a group of patients with uniiliacal type of stent-graft) were performed surgically during the stent-graft implantation. CT and US controls were performed at 3, 6 and 12 months after implantation, later every 12 months. RESULTS: Primary technical success was achieved in 109 of the 120 patients (91%). Primary endoleak was recorded in 11 patients (primary endoleak type Ia in seven patients, type Ib in three patients and type IIIa in one patient). Assisted technical success after reintervention or spontaneous seal was 98.3%. Surgical conversion was indicated in two patients (1.7%). Perioperative mortality rate was 3.3%. Total average follow-up period was 20.7 months (range from 2 to 60 months). In nine patients (7.5%) secondary endoleak type II was found at control CT or US, in three patients partial thrombosis of the stent-graft was found. There was no aneurysm rupture during follow-up. CONCLUSION: Treatment of AAA with Ella stent-graft system is effective and safe. Bifurcated stent-graft is the most frequently used type. Uniiliacal type of stent-graft is used by us only in cases of complicated morphology.
The function of an arteriovenous (av) fistula for haemodialysis may be complicated by manifestation of peripheral venous hypertension, which results from the arterial blood flow through the venous system into the periphery of the upper extremity. Its development is most typically caused by a proximal forearm av-fistula, as, in addition to the desirable arterialisation of the subcutaneous venous system of the arm, arterialisation of the venous system of the forearm and the hand may occur and possibly promote the development of venous hypertension, which may in the extreme result in gangrene of the fingers. Awareness of these problems as well as of the necessity of their surgical solution is essential for doctors dealing with haemodialysis.
The authors describe femoral - internal iliac bypass creation to remove ischemic complications in aortoiliac aneurysm endovascular repair. Based on a good experience with bypass in 6 patients they recommend its preventive indication when both internal iliac arteries are overstented.
The authors describe the method of surgical aortic banding for better stent-graft fixation in cases of problematic aortic neck in the endovascular infrarenal aneurysms repair.
The authors describe their indication tactics for AAA elective treatment. Based on one-month morbidity and mortality they evaluate the results obtained in the past six years and compare the methods of open surgery, endovascular repair and combined strategy in AAAs elective repair.
The authors describe their own initial experience with saphenoperitoneal modification of the peritoneovenous shunt in intractable ascites solution. Their findings with this easy type of permanent ascites drainage using the "patient's own resources" are puzzling.
The authors describe treatment possibility for AAA with renal arteries arising from aneurysmal sac in high operating risk patients. They combined endovascular stent-grafting for aneurysmal sac exclusion and classical vascular surgical iliacrenal bypass for revascularisation of excluded renal arteries.
OBJECTIVE: Evaluation of long-term results of percutaneous treatment of central vein stenoses or occlusions in patients with haemodialysis shunt. MATERIALS AND METHODS: In 26 patients with haemodialysis shunts and confirmed central vein stenosis or occlusion, 28 primary percutaneous transluminal angioplasties (PTA) and 5 repeated PTAs (re-PTA) were performed; in three patients a stent was implanted - primary in one patient and due to early restenosis after PTA in two patients. To maintain stent patency, 10 re-PTA were performed. RESULTS: The technical success rate of primary interventions was 96 % (100 % in stenoses and 50 % in occlusions). Primary post-PTA patency rate was 70 % at 3 months, 60 % at 6 months and 30 % at 12 months. CONCLUSION: PTA with possible stent implantation is a first-choice method in the treatment of stenoses and occlusions of the central venous system. Despite the relatively frequent re-interventions, endovascular treatment is capable to preserve long-term function of the dialysis shunt.
The authors emphasize the need for the investigation of the central venous system prior to the insertion of an avfistula, this they consider to be of utmost importance in patients with anamnesis of central vessel access. After the av-fistula is inserted, an unrecognized obstacle (stenosis or thrombosis) may result in the occurrence of venous hypertension and hypofunction, this may lead to av-fistula malfunction.
Variceal bleeding is a clinical emergency that may be difficult to treat in some patients, especially those with prehepatic portal hypertension, failed sclerotherapy, and with contraindications to transjugular intrahepatic portosystemic shunt. In such patients there are few remaining options. The authors refer to three patients for whom the modified Sugiura procedure was the only remaining option for the treatment of variceal bleeding. Two of them had pre-hepatic portal hypertension, and one had hepatic cirrhosis, and in all, other standard treatment options and failed. The modified Sugiura devascularization and esophageal transection was performed without operative or postoperative complications and in the follow-up, (mean: 4.2 years), there was no recurrence of variceal bleeding. The authors recommend the modified Sugiura procedure as safe and effective for patients in whom other treatment options for variceal bleeding have failed.