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Mechanisms causing cytoplasmic sequestration andinactivation of the tumor suppressor p53 are currently investigated only in vertebrate models, which are expensive to maintain and highly regulated. We use leukemic hemocytes from the softshell clam, Mya arenaria, both in vivo and in vitro, to investigate cytoplasmic anchoring of p53 family member proteins by mortalin (mot-2). Clam mot-2 displays

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.

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.