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Visceral artery aneurysms are rare findings in the practice of vascular surgeons. Their inaccessibility to physical examination, asymptomatic nature in many cases, but also an inherent risk of rupture that can be life threatening, make them a complex diagnostic and therapeutic problem. By presenting a case report of a ruptured common hepatic artery aneurysm the authors summarize basic characteristics of these aneurysms, as well as diagnostic and treatment options.

Introduction: Vascular graft infection is a rare but serious complication in vascular surgery, associated with high morbidity and mortality. Early diagnosis of vascular graft infection is important for proper and timely surgical and antibiotic treatment that improves the outcome. The tactic and techniques of surgical treatment of vascular graft infection have changed over the last two decades, and this trend can also be observed in our retrospective study., Methods: We evaluated a group of patients with prosthetic vascular reconstructions performed at the Department of Surgery, University Hospital in Pilsen in the period of 2003-2021 using retrospective analysis. In the analyzed 19-year period, 23 infected vascular grafts were managed out of a total of 2090 performed peripheral bypasses, and 27 infected vascular grafts were managed out of a total set of 1940 central reconstructions., Results: The incidence of peripheral vascular graft infections at our Department of Surgery in the period of 2003-2021 reached 1.1% with the early mortality rate of 8.7%; 1.4% central vascular graft infections occurred in the same time period with 33% early mortality., Conclusion: The results of our retrospective study are comparable virtually in all parameters with the experience of other departments. Consistently, our department switched to in situ replacements for explanted vascular grafts and we can confirm good experience with silver impregnated grafts.

Introduction: Vascular graft infection is a life threatening situation with significant morbidity and mortality. Bacterial graft infection can lead to false aneurysms, bleeding and sepsis. There are a lot of risky situations where grafts can become infected. It is therefore highly desirable to have a vascular graft that is resistant to infection. In this retrospective clinical study, a silver-impregnated vascular graft was evaluated in various indications., Methods: Our study included a total of 71 patients who received a silver-impregnated vascular graft during the period from 2013 to 2018. Patients had an aortoiliac localization of vascular graft in 61 cases (86%), and a peripheral localization on the lower limbs in 10 cases (14%). Indications for the use of these special vascular grafts were trophic lesions or gangrene in the lower limbs in 24 cases (34%), suspicious mycotic abdominal aortic aneurysm (mAAA) in 4 cases (5.5%), salmonela aortitis or aneurysms in 4 cases (5.5%), infection of the previous vascular graft in 11 cases (15.5%), other infections in 12 cases (17%), AAA rupture in 10 cases (14%) and other reasons (pre-transplant condition, multiple trauma, graft-enteric fistula) in 6 cases (8.5%). Thirty-day mortality, morbidity, the need for reintervention and amputation, primary and secondary graft patency, and finally the presence of a proven vascular graft infection were evaluated., Results: The 30-day mortality was 19.7%, and morbidity was 42.2%. The primary patency of the vascular graft was 91.5%. Reoperation was necessary in 10 cases (14%) and amputation was necessary in 10 cases (14%). The median length of hospital stay was 13 days and the mean follow-up period was 48 ± 9 months. During the follow-up period, six patients (8.5%) died from reasons unrelated to surgery or without any relation to the vascular graft. Secondary patency after one year was 88%. Infection of the silver graft was observed in three patients (4.2%)., Conclusions: Based on our results, the silver graft is a very suitable alternative for solving infectious, or potentially infectious, situations in vascular surgery. In particular, in urgent or acute cases, a silver graft is often the only option.

Background/aim: As the population ages, there are increasing findings of coincidental diseases such as abdominal aortic aneurysm (AAA) and intra-abdominal, retroperitoneal malignancy. The aim of this study was to propose an optimal treatment procedure for these patients., Patients and Methods: Over a twenty-year-period, surgery was performed on a total of 1,098 patients with AAA and 32 (2.9%) patients with AAA and intra-abdominal, retroperitoneal malignancy: 18 renal, 6 colorectal carcinomas, 3 carcinomas of the small intestine, 3 primary liver tumours, 1 stomach carcinoma and 1 teratoma. The median age of patients was 72.5 years, there were 20 men (62.5%) and 12 women (37.5%). A one-stage procedure was performed on 19 patients (59.4%), and a two-stage procedure on 13 (40.6%) patients., Results: The average time of hospitalization was 12.4±6.9 days (median=11.0 days) for one-stage procedure, for a two-stage procedure 21.3±9.3 days (median=20.0 days), p=0.0045. Seven patients (21.9%) died within 30 days after the operation. All the deaths were in the group of one-stage procedures (p=0.0252). The 1-, 3- and 5-year overall survival for patients following one-stage and twostage procedures was 61.0/56.3/51.5% and 89.0/79.9/53.0% respectively (p=0.1199)., Conclusion: Symptomatic disease must be resolved first. Two-stage procedures are the method of choice and offer better short-term results compared to one-stage procedures., (Copyright© 2021, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background: Accumulated endovascular aneurysm repair (EVAR) procedures will increase number of patients requiring conversion to open repair of abdominal aortic aneurysms (AAA). In most cases, patients undergo late open surgical conversion (LOSC), many months, or years, after initial EVAR. The aim of this study is to analyze results of LOSC after EVAR in elective and urgent setting, including presenting features, surgical techniques, as well as to review the clinical outcomes and their predictors., Methods: Retrospective review of all consecutive patients undergoing LOSC after EVAR was performed at three distinct, high volume, vascular centers. Patients that required primary conversion within 30 days after EVAR have not been included in this study. Between January 1st 2010 and January 1st 2017 total of 31 consecutive patients were treated. LOSC were performed either in elective or in urgent setting, thus dividing patients in two groups. Primary outcome was 30-day mortality and secondary postoperative complications., Results: LOSC rate after EVAR was 4.51%. Most common indication for LOSC was type I endoleak (N.=20, 64.51%). All patients that presented with ruptured AAA had some form of endoleak (type I endoleak was present in five from six cases). Most common site for aortic cross-clamping was infrarenal (51.61%). Stent-graft was removed completely in 18 patients (58.06%) and partially in 13 (41.93%). 30-day mortality rate was 16.12% (5 patients) and most common cause of death was myocardial infarction (60%). Following univariate factors were isolated as predictors for 30-day mortality: preoperative coronary artery disease, chronic obstructive pulmonary disease, urgent LOSC, prolonged time until LOSC, ruptured AAA, supraceliac clamp, higher number of red blood cell transfusion, postoperative myocardial infarction, and prolonged intubation (more than 48 hours)., Conclusions: LOSC seems to be safe and effective procedure when preformed in elective manner. On the other side, urgent LOSC after EVAR is associated with very high postoperative mortality and morbidity. Endoleak remains the main indication for open conversion. Further studies are necessary to standardize timing and treatment options for failing EVAR.

Aorto-caval fistula can be associated with abdominal aortic aneurysm. The fistula can manifest with nonspecific symptoms. The rupture of abdominal aortic aneurysm is one of the leading symptoms. The symptoms and the necessity of treatment are related to these acute conditions. This article describes the case of a 78 years old man with a huge abdominal aortic aneurysm and aorto-caval fistula that was presented with a sudden onset of abdominal pain, dyspnoea, hypotension and cardiac insufficiency with an acute cor pulmonale. Urgent surgery was performed - aneurysm resection with transaortic suture of the fistula and aortic replacement using a Dacron graft. Resuscitation and defibrillation were needed during the surgery due to fibrillation cardiac arrest, which were successful. The post-operative period was complicated with a persisting consciousness disorder of the patient and persisting myocardial ischaemia, resulting in the patients death 3 weeks after the surgery. The aim of this report is to point out the severity of this condition, the various treatment options of this uncommon disease with an uncertain prognosis, and also the importance of a multidisciplinary approach, essential in the entire treatment process as well as in the primary diagnosis.

Pain increased the number of free radicals in the body. Previously, we studied changes mainly in oxygen and nitroxide free radicals and described these changes relative to the lipids and saccharides. In this article we focus on changes relative to proteins. Assessment of AGE products (advanced glycation end-products) was carried out by measuring fluorescence. Patients were divided into two groups: 15 patients with acute pain and 17 patients with chronic pain. Acute pain was associated with a variety of surgical procedures and patients were examined before and after surgical procedures. The group of patients with chronic pain suffered from various types of chronic pain, but mainly back pain. In patients with acute pain, total protein (TP) decreased after surgery, as did the level of AGE and the AGE/TP ratio. Nonetheless, post-operative pain increased. In patients with chronic pain, neither total protein, AGE, or AGE/TP changed, despite significant pain relief being reported after treatment. Changes in proteins, as biochemical markers, before and after pain treatment did not show any significant changes. In patients with acute pain, the recorded changes only lasted for 3-5 days after the operation. While in chronic pain, there were no significant changes at all. The assumption that changes in proteins, as biomarkers, would have the same importance as changes in lipids and saccharides was not proven.

Introduction: Cardiovascular disorders and their complications are the leading causes of death all over the world. The number of patients with critical limb ischemia and in risk of amputation is increasing together with increased incidence of cardiovascular diseases. In comparison with comparable population, the prognosis of patients after limb amputation is much worse. In case with no possible revascularisation, stem cell therapy offers a possible option for limb salvage., Methods: We collected relevant informations from published and accessible studies available on internet database Pubmed in period of 2007-2017. The key words stem cell and critical limb ischemia were used., Conclusion: Available informations show promising results in the use of stem cells in the treatment of no-option limb ischemia. Multicenter randomized clinical trials and unified recommendations and guidelines are needed to accept this method as available option for treatment. This article is presenting a short rewiev of circumstancies and conditions of this evolving method of treatment. Key words: stem cell - limb ischemia.

Introduction: At most vascular surgery departments, transperitoneal approach predominates in resections of the aortic aneurysms. For difficult reconstructions of the aorta in the visceral segment, a left flank retroperitoneal approach is used most frequently., Method: The authors retrospectively evaluate the left retroperitoneal approach in the management of abdominal aortic aneurysms during a 10-year period. From the total number of 445 operated patients, the left-sided retroperitoneal approach was used in 23 cases., Result: All operated patients survived. Average hospital stay was 10 days in the case of elective operations., Conclusion: Based on favorable results, the authors confirm that left-sided retroperitoneal approach is rightly considered as a choice in the technically demanding reconstruction of the aorta in the visceral segment.Key words: aortic aneurysm visceral segment of the aorta retroperitoneal approach.

Popliteal vein aneurysm is a rare disease of the lower limb venous system. Massive pulmonary embolism may be a clinically serious presentation of the disease. The authors present surgical management of the popliteal vein aneurysm in two case reports.Key words: popliteal vein aneurysm surgical management.

Introduction: Kidney procurement from donors after circulatory death (DCD) is an important part of worldwide transplantation programmes. The first kidney transplantation from DCD was successfully performed in the Czech Republic in 2002., Method: Forty four kidneys from DCD were procured in the Transplant Centre of Pilsen between 2002 and 2015. We used the technique of "in situ" procurement with the double balloon triple lumen catheter and 510 minutes of the no-touch interval. The method of pulsatile hypothermic perfusion was used to test the viability of the kidneys. Twenty eight recipients with mean age 51.1 (2673) years were transplanted. Sixteen (57.1%) kidneys were from the 2nd, 8 (28.6%) from the 3rd and 4 (14.3%) from the 4th category according to the Maastricht criteria., Results: 30-day mortality and morbidity rates were 0 and 10.7% i. e.14.3% respectively (N=4). Primary non-function was presented in 2 (7.1%), and delayed graft function in 5 (17.9%) cases. One, five and ten years of recipient and graft survival rates were 100%, 86.4% and 76.7%; and 92.9%, 69.6% and 61.9%, respectively. The long-term results are fully comparable with kidneys transplanted from donors after brain death., Conclusion: DCD are an important source for kidney transplantation. Kidney transplantation from DCD is a logistically, economically and personally demanding method with very good long-term results., Key Words: donors after circulatory death - kidney transplantation - results.

Introduction: Renal carcinoma (RC) is present in 0.1-3% of patients with abdominal aortic aneurysm (AAA). There are several options for surgical solution as regards the type and timing of the procedure. The authors discuss the simultaneous AAA resection and radical nephrectomy as a treatment option., Material and Methods: 1168 patients with AAA including 19 (1.6%) with asymptomatic AAA (diameter >50mm) and RC (average diameter 74.3 mm) indicated for radical nephrectomy were operated on in the last 20 years (between 5/1994 and 5/2014). The average age of the patients was 72.8 years (5585). Pre-operatively, sixteen patients were classified as ASA II, three as ASA III. Unilateral nephrectomy was performed in 18 and bilateral nephrectomy in one patient. One-stage AAA resection (1x endovascular aneurysm repair) with nephrectomy was performed in all patients., Results: Two patients with ASA III classification died within 30 days postoperatively due to acute myocardial infarction and multiorgan failure. In the other patients, the simultaneous procedure was without any complications. Four patients died within two years after the operation due to generalized RC, the others have survived in the interval of one and twelve years after the procedure., Conclusion: Simultaneous procedure does not represent increased operation load for patients with good health status. Nevertheless, the type of procedure should be optimised for each individual patient with regard to his or her general health status, life expectancy, disease symptomatology, the diameter of the RC and the anatomical conditions of AAA.

Unlabelled: Infection of the aorta is rare but potentially very dangerous. Under normal circumstances the aorta is very resistant to infections. Following some afflictions, the infection can pass to the aorta from blood or the surrounding tissues. The authors present their 5-year experience with therapy of various types of infections of the abdominal aorta., Methods: In the 5-year period between January 2008 and December 2012, the Surgical Clinic of the University Hospital in Pilsen treated 17 patients with acute infection of the abdominal aorta. They included 9 males and 8 females. The mean age was 73.05 years (58-90). The most common pathogens were Salmonella (7), Staphylococcus aureus (2), Klebsiella pneumoniae (1), Listeria monocytogenes (1), and Candida albicans (1). Two cases included mixed bacteria and no infectious agent was cultured in three cases. In 14 cases (82.6%) we decided on an open surgical solution, i.e., resection of the affected abdominal aorta, extensive debridement, and vascular reconstruction. In all of these 14 cases we decided on in situ reconstruction. Twelve cases were treated using silver-impregnated prostheses. An antibiotic impregnated graft was used in one case and fresh aortic allograft in one case. In one case (5.9%) we decided on an endovascular solution, i.e., insertion of a bifurcation stent graft and prolonged antibiotic therapy. In two cases (11.8%) we decided on conservative treatment, as both patients refused any surgical therapy., Results: Morbidity was 47.2% (8 patients). In one case we had to perform reoperation of a patient on the 15th postoperative day to evacuate the postoperative hematoma. The 30-day mortality was 5.9% (1 patient). The hospital mortality was 11.8% (2 patients). One patient died on the 42nd postoperative day due to multiorgan failure following resection of perforated aortitis. During follow-up (average 3.5 years), we had no case of infection or thrombosis of the vascular prosthesis., Conclusion: Patients with mycotic aneurysms or acute aortitides face a high risk of death. One can legitimately expect an increase of "aortic infections" to parallel the increase of immunocompromised individuals. Surgical procedures for infectious aortitis are always demanding and require excellent interdisciplinary cooperation, but, as this experience shows, can lead to midterm survival.

Purposes: A ruptured AAA (rAAA) is a common cause of death in males over 60 years of age, and the global mortality from rAAA exceeds 80 %. The pathological processes occurring in the wall of the developing AAA are still unclear. The potential pathophysiological mechanisms underlying aortic aneurysms have been examined by many studies using immunohistochemistry and were, therefore, targeted at specific, preselected protein antigens., Methods: We collected samples of tissue from anterior wall of an aneurysm sac from 15 patients indicated for AAA resection (group A) during the period from 2010 to 2011. These samples were subjected to a proteomic analysis. In addition, we collected control samples of identical aortic tissue from 10 heart-beating deceased organ donors (group B)., Results: A total of 417 differentially expressed protein fractions were identified, 18 of which were only detected in the healthy controls, while 85 were specific for aneurysm tissue and 314 were detectable in both groups. In 175 protein fractions, the gel-derived spot volumes differed significantly between aneurismal and healthy aortic tissue., Conclusions: We found a significant difference in the proteome of the AAA tissue and non-dilated aortic tissue. We demonstrated that the AAA proteome is considerably richer and more varied than the healthy and atherosclerotic aorta. We believe that our results clearly demonstrate a completely different etiopathogenesis of atherosclerosis and aneurismal disease.

Purpose: There is much interest in all factors that influence the etiopathogenesis of abdominal aortic aneurysm (AAA) rupture. Apart from the well-established factors such as arterial hypertension, smoking, age, and genetic predisposition, less common factors that may play a role in the mechanism of the rupture are the subject of much discussion. These include atmospheric conditions, temperature, and atmospheric pressure. We conducted this study to investigate the effects of the absolute value of atmospheric pressure and its changes on the frequency of AAA rupture., Methods: We retrospectively examined 54 patients who underwent treatment for a ruptured AAA at the Clinic of Surgery in the University Hospital in Pilsen between 1 January 2005 and 31 December 2009. We collected data on the atmospheric pressure in this period from the Czech Hydrometeorological Institute in Pilsen., Results: We did not find a significant difference in atmospheric pressure values between the days when the rupture occurred versus the other days (p < 0.5888). Moreover, we did not find significant changes in the atmospheric pressure during the 48 h preceding the rupture (Student's test p < 0.4434) versus the day of rupture or in the mean atmospheric pressure in that month., Conclusion: These findings suggest that atmospheric pressure and its changes do not affect the pathogenesis of AAA rupture.

Aim: Observational studies in human patients and animal experiments suggested that statins have a potential in slowing the growth of small abdominal aortic aneurysms (AAA). Our aim was to quantify histological postoperative changes of AAA in porcine experimental model of AAA with and without administration of atorvastatin., Methods: The AAA was induced by intraaortic infusion of porcine pancreatic elastase and subrenal application of plastic cuff. The AAA statin group (N.=14) received atorvastatin 1 mg/kg daily for 28 days, the other AAA group (N.=13) did not. The aortic diameter was measured by ultrasonography. Aortic samples were described using eleven quantitative histological parameters and compared with healthy aortae., Results: There was no difference in aortic diameter between the AAA with statin when compared to AAA without statin. Administration of atorvastatin led to a better postoperative histological condition of the aortic elastin network, preservation of contractile phenotype of vascular smooth muscle, a higher density of vasa vasorum, it prevented thickening of intima and media. The increase in wall thickness in AAA without atorvastatin has not been accompanied by a proportional increase in number of vasa vasorum., Conclusion: The effects of atorvastatin seem to prevent the histopathological progression of AAA.

Introduction: Leriche's syndrome is defined as atherosclerotic occlusion of the infrarenal aorta and/or the iliac axis. It is associated with claudications or critical limb ischaemia and erectile dysfunction in men., Material and Methods: Twenty patients with Leriche's syndrome were operated on at the Department of Surgery, University Hospital in Pilsen between 2008 and 2012. There were 6 women and 14 men of average age 60.3 years (41-76 years). Three patients were in group C and 17 in group D according to the Trans-Atlantic Inter-Society Classification IIb (TASC IIb). Fifteen patients suffered from chronic claudication or rest pain, five patients had acute limb ischaemic symptomatology. Aortobifemoral bypass with subsequent anti-aggregation therapy was the only treatment option., Results: Primary 30-day patency was 100%. 30-day postoperative mortality was 5% (one patient died of acute myocardial infarction). Two patients died in two and four years after the reconstruction (10%) due to cerebral ischaemia and bronchopneumonia. Only one extremity amputation was performed within the five-year interval after vascular reconstruction. All aortobifemoral reconstructions were patent in two months to five years after the operation. We had to manage only one false aneurysm in the groin three years after the aortobifemoral reconstruction., Conclusion: Aortobifemoral bypass is a method of choice for the treatment of Leriche's syndrome. Endovascular treatment is suitable for patients with severe comorbidities.

Primary aortoduodenal fistula is very rare acute abdomen with high mortality. Serious problem is often late diagnosis. Authors present case report from their University Hospital. Diagnosis and therapy options are discussed. Key words:primary aortoduodenal fistula - late diagnosis.

Objective: Abdominal aortic aneurysm (AAA) is a serious disease due to its covert nature, relatively high prevalence and fatal prognosis in the case of rupture. To obtain new insights into AAA pathogenesis, we examined the relationships between histopathology, multiplex in vitro immunoassay data, diameter and symptomatology., Methods: In a prospective, non-randomised study, we evaluated samples from 6 normal infrarenal aortae and 65 AAA patients (65 walls, 55 thrombi). The AAA patients were either asymptomatic (n = 44), symptomatic (n = 7) or with ruptured AAA (n = 14). The AAA diameter was classified as small (<5 cm, n = 18), medium (5-7 cm, n = 26) and large (>7 cm, n = 21). We quantified the histopathology of the AAA wall and the adjacent thrombus. We assessed the expression of proteins in the same samples., Results: Asymptomatic AAAs had walls with more abundant inflammatory infiltrates, lower amounts of PAI-1, a higher number of tPA-positive elements, a tendency towards decreased collagen content, whereas the adjacent thrombi had a greater concentration of VCAM-1 and MMP-2 when compared with symptomatic AAAs. Compared with the aneurysmatic aorta, the normal aorta contained less collagen and more elastin, actin, desmin and PAI-1-positive elements; in addition, it was more vascular. Medium-sized AAAs were the most actin and vimentin rich, and large AAAs were the most vascular., Conclusion: Our results show that asymptomatic AAA walls often have more potentially deleterious histopathological alterations than symptomatic AAA walls. This result indicates that a progression from an asymptomatic AAA to rupture can be expected and screening patients who are at risk of rupture could be beneficial., (Copyright © 2012 S. Karger AG, Basel.)

Introduction: The incidence of prosthetic vascular graft infections in the aortofemoral region is reported at 0.6-3%. These complications are burdened with a high mortality of up to 50% and an amputation rate of up to 20%. The aim of our study was to give a complex view on the diagnostic and treatment possibilities of these serious complications of reconstructive vascular surgery., Material and Methods: Prosthetic bypass grafts were performed in 1088 patients in the aortofemoral region between 2001-2011 at the Department of Surgery, Teaching Hospital and the Faculty of Medicine, Charles University, in Pilsen. 24 (2.2%) patients suffered from graft infection at various time intervals after primary vascular reconstruction. Clinical examination, computed tomography and positron emission tomography were the main diagnostic methods of vascular graft infection. "In situ" reconstructions dominated over extra-anatomic reconstructions. When the infection involved only the peripheral part of the prosthetic graft, a more conservative approach - local debridement and drainage - was used., Results: The mortality of the patients was 20.8%, high amputation rate 12.5%, and morbidity rate 58.3%, respectively. The average time of hospitalization in surviving patients was 46.5 days. Primary 30-day patency rate in "in situ" and extra-anatomic reconstructions was 100 and 60%, respectively., Conclusion: Prosthetic vascular graft infections in the aortofemoral region require tailored multidisciplinary treatment approach in vascular centres. "In situ" reconstructions are the method of first choice. A more conservative approach in infections involving only the peripheral part of the vascular reconstruction has a positive treatment effect.

Introduction: Thoracic aortic injury (TAI) is burdened with high mortality (80-90%). The diagnostic and therapeutic algorithm has changed radically over the last couple of years. The authors present their experience with diagnosis and treatment of TAI at the University Hospital Trauma Centre., Material and Methods: 24 TAIs were evaluated in a retrospective study, in 20 (83.3%) cases they were part of a polytrauma. The average age of the patients was 39.4 years (20-67). Traffic accidents formed the majority of TAIs (87.5%). Multi-detector computed tomography was used as a basic examination to detect TAI. Thoracic endovascular aortic repair (TEVAR) was the treatment of choice in 21 and open surgery in 3 injured patients., Results: The 30-day postoperative mortality was 12.5%, in one case it was associated with TEVAR. 30-day morbidity was 37.5% (circulatory instability, respiratory insufficiency, bronchopneumonia, type I endoleak)., Conclusion: MDCT and TEVAR are currently the methods of first choice in the diagnosis and treatment of TAI. TAI requires a highly specialized multidisciplinary approach within Trauma Centres providing complex cardiovascular services.

Introduction: The aim of our work was to influence growth and histological changes in the wall of an experimentally induced aneurysm of the abdominal aorta in a large laboratory animal (domestic pig) by administering atorvastatin (3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitor)., Material and Methods: Within the scope of the above mentioned experimental work, we compared the growth rate of the aneurysm between the group influenced by statin administration (n=14) and the group without any pharmacological treatment (n=13). We also compared histological changes in the structure of the aortic wall in both groups with aneurysm and the wall of the aorta without aneurysm (n=6)., Results: During the 4-week follow-up, we did not prove a statistically significant difference in the growth rate of aneurysms between the above mentioned groups. The histological structure of the aneurysm walls, however, differed between the two groups. The structure of the wall in the group of animals influenced by statin administration resembled the structure of the aortic wall without aneurysm., Conclusion: The results presented demonstrate that statins do influence the composition of the aortic wall. In our opinion, the administration of statins could lead to changes resulting in a more stable aneurysmatic wall. We believe that patients with smaller aneurysms who are not indicated for surgery or endovascular treatment could be treated with statins. Stabilization of the aneurysmal wall could slow down the growth of the aneurysm and prevent its rupture.

Purpose of the Study: The aim of this retrospective study is to present our experience with the management of injuries to the vascular system at the Trauma Centre, University Hospital in Plzeň. We show the most frequent mechanisms of injury, diagnostic pitfalls, therapeutic options and evaluate both the short-term and long-term results of surgical treatment and interventional radiology procedures., Material and Methods: We evaluated a group of patients with a serious vascular injury who were treated at the Traima Centre during the five-year period from January 2006 to December 2010. The group included 82 patients, 59 men and 23 women, with the average age of 34.5 years. We assessed the success rate of vascular reconstruction, primary and secondary graft patency and mortality and morbidity rates. Recovery of function in the injured extremities and return of the patient to normal daily activities were considered the most important parameters. In 28 patients (34%) vascular injury was due to polytrauma, in nine (11%) it was part of a combined injury, and 45 patients (55 %) sustained monotrauma. Most of the patients (68; 83%) were managed surgically. The most frequent procedures included direct suture of a lesion, resection and replacement of an injured artery or bypass grafting. In 13 patients we used interventional radiology procedures (in most cases it was for thoracic endovascular aortic repair). In one patient we were able to use a conservative treatment., Results: The 30-day mortality rate was 8.5%, i.e., seven patients died of polytrauma. The morbidity rate was 35% (29 patients). The most frequent complications included respiratory failure in polytrauma (13%), transient leg/arm swelling (6%) and wound infection (4%). Primary and secondary graft patencies were 100% and 95.5%, respectively. Vascular reconstruction failed in three patients and, in two of them, we had to carry out limb amputation., Conclusions: From the viewpoint of vascular surgery, even very serious injuries of upper and lower extremities can be managed, if possible associated injuries of the skeletal and nerve structures allow for it. The key to success is good co-operation of the orthopaedic trauma surgeon, vascular surgeon and neurosurgeon.

The paper summarizes the latest research on the abdominal aorta aneurysm etiopathogenesis and compares normal aorta morphology with changes in the aortic aneurysm wall. The role of risk factors, especially hemodynamic and genetic, is discussed in detail. Special attention is paid to inflammatory processes including cytokines and matrix degrading proteases that contribute to the development of aneurysm. The role of thrombus and the current results of research into biomarkers indicating the risks and progression of the disease are analysed. Finally, a review of pharmacomodulation of the aortic aneurysm using statins, antibiotics, antihypertensive and nonsteroidal antiinflammatory drugs is presented.

Background: Despite the fact that abdominal aortic aneurysm (AAA) is asymptomatic in the vast majority of cases, sudden rupture with a fatal outcome may still occur. Early planned resection or endovascular aneurysm repair of small AAAs may help prevent a rupture, but both methods are associated with significant mortality. The aim of our study was to determine AAA wall distensibility and to compare it with distensibility of the "healthy" aorta of the same patient., Methods: We evaluated 12 patients with AAA, mean age of 65 years, 10 men and 2 women. The mean diameter of the aneurysm was 5.95 cm., Results: We did not find any correlation between aneurysm diameter and any of the following parameters: (1) distensibility of AAA wall (p = 0.8119), (2) distensibility of AAA lumen (p = 0.1262), and (3) distensibility of normal aorta (p = 0.9828). We proved by use of the Wilcoxon test that distensibility of the wall of the normal aorta is significantly greater than distensibility of the AAA wall (p = 0.0141). A significant difference between distensibility of the AAA wall and AAA lumen was proved (p = 0.0221) also by use of the Wilcoxon test. Distensibility of the AAA wall is significantly lower. Despite the proved significant differences between distensibility of the AAA wall and normal aorta, values of AAA wall distensibility nearly reached values of distensibility of the normal aorta above the AAA in some particular cases; the value was even higher in one case. We observed this phenomenon in four patients of our small population, two of them suffering from rapidly increasing aneurysm., Conclusion: In our opinion, electrocardiography-synchronized computed tomographic angiography may contribute to diagnostics in the future. Lumen distensibility is significantly higher than distensibility of the wall. The thrombus acts in this respect as a buffer, thus inhibiting the effect of pulse waves on the wall. From a mechanical point of view, the thrombus rather acts protectively against the risk of rupture. Distensibility assessment could be another fragment of the diagnostic algorithm and decision making on intervention., (Copyright © 2011 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.)

Introduction: Inflammation within the abdominal aortic wall is generally considered a very significant ethiopathogenic factor in the development of abdominal aortic aneurysms. Proinflammatory cytokines are important mediators of inflammation within the abdominal aortic wall., Aim: The aim of the study was to research, whether plasmatic levels of certain proinflammatory cytokines, which can commonly be evaluated (TNFalpha, IL-1, -2, -6 a -8), play a significant role in the development of AAA., Method: The prospective non-randomized study included 345 patients with AAAs. The patients were assigned to 5 subgroups based on their symptoms and AAA diameters. The first subgroup included patients with symptomatic AAAs, including AAA ruptures (N = 69), the second subgroup included subjects with asymptomatic AAAs (N = 276) with AAA diameters up to 5 cm (N = 72), the third subgroup included 5 cm (N = 72), the fourth included 5-8 cm (N = 192) and the fifth subgroup included subjects with AAA diameters of more than 8 cm (N = 81). The mean age of patients was 74.1 +/- 7.8 years (56-84 y.o.a.). The male to female ratio was 5:1. The control group included 30 healthy volunteer subjects of similar age and male to female rates, who had no clinical signs of arterial disorders. Plasmatic levels of cytokines were evaluated from venous blood samples using ELISA (Bender, Austria) testing. Statistical assessment of the results was performed using ANOVA and Wilcoxon tests with Spearman's correlation. P values < 0.05 were considered significant., Results: Plasmatic concentrations of proinflammatory cytokines were found to be statistically significantly higher in patients with AAAs compared to those in healthy volunteers. Plasmatic IL8 levels were significantly decreasing proportionally to decreasing AAA diameters (p < 0.05). TNFalpha levels were found to be significantly low in symptomatic patients with AAA ruptures (p < 0.05)., Conclusion: The study confirmed the significance of proinflammatory cytokines levels monitoring in AAA patients. The authors showed that, for instance IL8 activity and to a certain extent TNFalpha activity, is the highest in small and developing AAAs. These findings would be significant for customized medication therapy aimed at blocking the effects of these factors on the inflammatory process within the AAA wall.

Carotid trauma is always very serious. Post-traumatic carotid dissection is rather rare and can be diagnosed late. Authors present a case report of post-traumatic bilateral carotid dissection and its spontaneous recovery. Symptoms, diagnosis, and treatment are discussed., (Copyright © 2010. Published by Elsevier Inc.)

Bowel intussusception in adulthood is relatively rare. It is the cause of bowel movement disorders in around 1-5% of cases. In contrast to intussusception in childhood, where the cause is usually unclear, in adulthood the unequivocal causes are known in 70-90% of cases. These predominantly include benign tumours of the small intestine. The authors describe 2 case reports, where small bowel intussusception was the cause of the bowel movement disorder and non-specific abdominal pain. This clinical entity must be kept in mind as the possible cause of non-specific abdominal pain in adulthood. If a malignancy is suspected, then the rules of oncological surgery should be followed.

Objective: To evaluate the single center experience in the treatment of patients with AAA., Methods: 586 patients undergoing open resection (OR) and EVAR (2000-2009). The average age was 72.2 +/- 7.7 years. AAA diameter was 8.3 cm (range 5.0-13.1 cm). 451 (76.9%) patients had asymptomatic AAA, 135 (23.1%) RAAA. 448 patients (76.5%) suffered from various co-morbidities. 430 (73.4 %) OR, 156 (26.6%) EVAR and 52 (8.9%) one staged procedure (for concomitant diseases) was performed., Results: 30 days mortality rate of elective OR and EVAR was 6.2, resp. 2.9% (n.s.) versus 36.6% of RAAA (p < 0.0001). 30 days mortality rate of one staged and single procedure was 19.5, resp. 3.6% (p < 0.0001). 30 days morbidity rate was in the whole group 52.1% (80.7% in RAAA x 43.4% in asymptomatic AAA - p < 0.0001), in one-stage procedures 60.8% x 51.1% in single procedures - n.s., 45.1% in OR x 39.0% in EVAR - n.s. Redo procedures were significantly higher in EVAR x OR in the long-term period after primary procedure. 1-, 3-, 5-, and 8 years survival of patients with asymptomatic AAA and RAAA was 91.6, 85.9, 81.1 and 73.6%, resp. 54.9, 48.9, 45.9 and 43.5 years (p < 0.0001). 1-, 3-, and 5 years patients survival with single versus one staged procedures was 85.5, 80.5 and 71.0% versus 71.1, 68.0 and 74.6% (n.s.). 1-, 3-, and 5- years patients survival after OR or EVAR was 91.2, 87.1 and 80.6%, resp. 90.7, 79.9 and 74.6 % (n.s.). The significant influence on patients long-term survival had RAAA, age of patients, postoperative complications and one stage procedures., Conclusion: High percentage of polymorbidity was the cause of the significant 30 days postoperative mortality of patients after OR. EVAR and OR have similar long-term results. One staged procedures should be used very carefully in selected patients due to the higher mortality rate and worse long-term patients survival.

Aim: Examination of tumour markers conducive to follow up of the patients with colorectal carcinoma., Material and Methods: The tumour markers were examined in the population of patients with primarily established and histologically verified colorectal adenocarcinoma., Results: The resection therapy resulted in the decrease in post-operative CEA levels. There were no changes in pre- and post-operative CA 19-9 levels; unlike with post-operative TPS levels having been significantly increased, probably due to reparation processes resulting from the surgery. It can be concluded that pre- and post-operative CEA levels are the most suitable markers to check the effect of surgery. With a 95%-specificity for the establishment of recidives, the highest sensitivity was reached with TPS (83%); the sensitivities of the classical tumour markers CEA and CA 19-9 were significantly lower (41% and 25%, respectively). The results should be interpreted with caution due to a small number of relapses regarding a short follow up and rather local-regional character of the recidives., Conclusion: However, TPS seems to be a promising marker for the follow up of the patients with colorectal carcinoma. Thus, an ideal combination seems to be that of CEA and TPS.

This case report of 62 year old woman observed and treated in Vascular surgery Dpt. of University Hospital in Pilsen because of small bowel obstruction may be an example of a malignant disease, which can occur after using immunosuppressive drugs. The reason of the obstruction was strangulation of the small bowel in a peritoneal defect, which was made arteficialy as a treatment of posttransplant lymf-collection. We found signs of malignant disease in peritoneal cavity during the operation, that was verified by biopsy. The patient did not suffer from malignant disease before the transplantation. The origin of malignancy was probably ovarian tumor.

Introduction: Prolonged air leak (prolonged air leak - PAL, an air leak for over 7 postoperative days) is a common complication following lung resections. It extends the period of thoracic drainage, duration of hospitalization, increases postoperative morbidity rates and the cost of the treatment., Methodology: The retrospective study included a group of 256 subjects with lung lobectomies, performed during 2002-2007, where active thoracic drainage was introduced postoperatively. The following parametres were assessed: gender, age, preoperative FEV1/FVC values, intraoperative detection of pleural adhesions, missing interlobar fissures (due to stapler resections), presence of distinct bullae, number of removed mediastinal lymph nodes, lobectomy types (upper vs. lower), use of staplers and insufficient lung inflation of 2cm, detectable on x-ray on the day of the procedure., Results: PAL was recorded in 26 (10.1%) of the subjects and their thoracic drain was left in place for 8-34 days (the mean of 15.9 days). In 7 subjects, the active thoracic drainage was replaced by a passive one (on the 14.4th postoperative day, on average, the range: postoperative Day 11 to postoperative Day 22). In seven subjects, the drain's position was changed, and in a single subject, reoperation for PAL was required. In particular, the following subjects are more likely to develop PAL: patients with FEV1/FVC of 80% (p-value = 0.0066; odds ratio = 3.494), where stapler resections of interlobar fissures are required (p-value = 0.0118; odds ratio = 3.070) and males (p-value = 0.0471; odds ratio = 3.200)., Conclusion: In patients, predisposed to develop PAL, saving techniques to optimalize surgical procedures, as well as approaches to optimalize their postoperative care, including early replacement of the active thoracic drainage for the passive method, should be employed.

Background: The incidence of liver injury is increasing steadily because of serious injuries resulting mainly from traffic accidents. The aim of the study was to evaluate the results of the University Trauma Center, with consideration of the present diagnostic and therapeutic possibilities for liver injuries., Methods: Between January 1st 2000 and April 1st 2006 a total of 132 patients with various degrees of liver injury were admitted to the Trauma Center, University Hospital in Pilsen. 76 injured patients (57.6%) were treated conservatively, and only 56 (42.4%) received surgical treatment, with a total of 87 operations performed., Results: 10 patients with polytrauma (7.6%) died of hemorrhagic shock (group Moore IV-VI). Six injured patients (4.5%) had a complicated course during their hospitalization. The average period of hospitalization was 17 days (1-69 days)., Conclusion: The mortality and morbidity of patients with liver injury are comparable in the group presented here with the results of other large trauma centers. If compared with previous years, there has been a considerable decrease in mortality from this serious injury. At present the basic diagnostic means in liver injury are as follows: "bed-side" ultrasonography, spiral computed tomography, and in more complicated injuries magnetic resonance, angiography, or endoscopic retrograde cholangiography. In terms of therapeutic tactics conservative methods prevail in haemodynamically stable patients, irrespective of the degree of liver injury. The surgical policy applies "damage control surgery", where during the initial surgery life-saving and non-time-demanding procedures are the target (e.g. liver tamponade), correcting hypothermia, haemocoagulation and metabolic acidosis. Only after stabilization of the injured patient other definitive procedures are possible (Tab. 2, Ref. 16). Full Text (Free, PDF) www.bmj.sk.

Background: This prospective non-randomized single center study evaluated the predictive significance of various factors to the treatment outcomes of the prosthetic vascular graft infections., Methods: 46 patients with the prosthetic vascular graft infection underwent the treatment. The prosthesis extirpation was performed in 37 cases. The extra-anatomical reconstruction was implanted in 18 and the in situ reconstruction in 12 patients. In 9 patients, only local treatment was applied. The influence of the preoperative factors (patient's age, type of primary procedure, type of infection, positive hemoculture, diabetes mellitus, comorbidity, C-reactive protein, leucocytosis, repeated interventions) on the result of the treatment was evaluated with the multivariate analysis., Results: On the 30 day, the postoperative mortality was 23.9%. One and three years after the treatment, 72.1 and 57.8% of patients, respectively, survived. C-reactive protein above 90 mg/l (Wilcoxon test p<0.02, Log-rank test p<0.01), and leucocytosis >13 x 10(9)/l (Wilcoxon test p<0.0001, Log-rank test p<0.0004) were significant factors for patients morbidity and mortality. There were no preoperative factors with a statistically significant cut-off value which should be important for the long-term graft patency., Conclusion: C-reactive protein and leucocytosis are simple preoperative predictive markers of the treatment results of the prosthetic vascular graft infections. An early and aggressive diagnostic and therapeutic procedure is recommended in patients with the pre-operative levels of CRP higher than 90 mg/l and leucocytosis of 13 x 10(9)/l (Tab. 5, Fig. 3, Ref. 30). Full Text (Free, PDF) www.bmj.sk.

The authors present a rare case of a 92- year old female patient with obstruction of the small intestine with adhesions between intestinal loops and a spontaneously separated gall bladder, located amongst them. The finding was successfully managed using lesion of the adhesions and removal of the gall bladder. No intestinal resection was required. No similar case has been reported, according to the literature data available to the authors.

Aim: The aim is to specify contemporary diagnostic and therapeutic procedures of liver injuries., Methodology: The authors present a trial group of 117 patients with various stages of liver injuries hospitalized at the Traumacentrum Surgical Department of the Faculty Hospital in Plzen from 1.1.2000 to 31.9.2005. 61 injured (52.1%) were treated conservatively, 56 (47.9%) surgically, who underwent 87 procedures, in total., Results: 10 polytrauma patients exited (8.5%) from a haemorrhagic shock (group Moore IV-VI). Six subjects (5.1%) had complications on hospitalization. Average hospitalization lasted 18 days (1-69 days)., Conclusion: The basic diagnostic tools in liver injuries include "bed side" ultrasonography, spiral computer tomography, in more complicated traumas also MRI, angiography or endoscopic retrograde cholangiography. As a treatment strategy, conservative methods prevail in haemodynamically stable patients, regardless of the liver injury stage. The objective of the surgical management is to provide "damage control surgery", i.e. the first procedure is aimed at life-saving, no time-demanding surgical procedures (e.g. liver tamponade), management of hypothermia, haemocoagulation and metabolic acidosis.