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During the last two decades, superficial venous surgery has experienced an unprecedented boom. Traditional surgical procedures (crossectomy and stripping) are now being replaced to a greater or lesser extent by new less invasive endovenous methods. Our aim is to provide an up-todate review of all available endovenous techniques (laser, radiofrequency, steam, mechanochemical ablation and venous glue) describing the indications, the technique and mechanism of action, and the results. In experienced hands, all endovenous techniques are safe and effective, with long-term results comparable to conventional surgical procedures.

Objectives Several plaque and lesion characteristics have been associated with an increased risk for procedural stroke during or shortly after carotid artery stenting (CAS). While technical advancements in stent design and cerebral protection devices (CPD) may help reduce the procedural stroke risk, and anatomy remains important, tailoring stenting procedures according to plaque and lesion characteristics might be a useful strategy in reducing stroke associated with CAS. In this descriptive report of the ongoing Asymptomatic Carotid Surgery Trial-2 (ACST-2), it was assessed whether choice for stent and use or type of CPD was influenced by plaque and lesion characteristics. Materials and methods Trial patients who underwent CAS between 2008 and 2015 were included in this study. Chi-square statistics were used to study the effects of plaque echolucency, ipsilateral preocclusive disease (90–99%), and contralateral high-grade stenosis (>50%) or occlusion of the carotid artery on interventionalists' choice for stent and CPD. Differences in treatment preference between specialties were also analysed. Results In this study, 831 patients from 88 ACST-2 centres were included. Almost all procedures were performed by either interventional radiologists (50%) or vascular surgeons (45%). Plaque echolucency, ipsilateral preocclusive disease (90–99%), and significant contralateral stenosis (>50%) or occlusion did not affect the choice of stent or either the use of cerebral protection and type of CPD employed (i.e., filter/flow reversal). Vascular surgeons used a CPD significantly more often than interventional radiologists (98.6% vs. 76.3%; p < .001), but this choice did not appear to be dependent on patient characteristics. Conclusions In ACST-2, plaque characteristics and severity of stenosis did not primarily determine interventionalists' choice of stent or use or type of CPD, suggesting that other factors, such as vascular anatomy or personal and centre preference, may be more important. Stent and CPD use was highly heterogeneous among participating European centres.

The measurement of transcutaneous oxygen pressure (TcpO2) is a non-invasive method to quantify skin oxygenation at capillary level and their nutritive ability needed to heal the ischemic defect. TcpO2 pressure values below 30 mm Hg are specific for critical limb ischemia and predict complicated healing. The purpose of this study was to verify the cut-off pressure in patient unable to undergo vascular reconstruction, and to verify the possibility of using this method to evaluate the effectiveness of vascular reconstructive surgery.The group included 52 patients (35 men and 17 women). The mean age of patients in the group was 66.5 years (max. 85, min. 44).In our group of patients we confirmed that the TcpO2 values of successfully healed ischemic wounds were equal or greater than 30 mm Hg (mean TcpO2 value at the dorsum of the foot was 37.0 mm Hg ± 9.5 mm Hg), compared to the group of unsuccessfully healed patients whose values were lower (mean TcpO2 value at the dorsum of the foot was 9.0 mm Hg ± 5.3 mm Hg).TcpO2 is a suitable method in predicting the healing of ischemic defects and any possible need for surgical or endovascular revascularization. Thanks to its non-invasive nature and undemanding measurement, it surely helps to make better decisions in choosing the therapeutic procedure needed to heal the defect.

Perigraft seroma is quite a rare complication that may occur after implantation of Dacron or expanded polytetrafluoroethylene (ePTFE) vascular grafts. We report a case of a 54-year-old patient with perigraft seroma around an axillofemoral bypass (ePTFE graft). Definitive treatment involved the explantation of this extraanatomic bypass with perigraft seroma and the implantation of an aortobiiliac bypass using vascular prosthesis made of a different material. Based on published studies, therapeutic options for this complication are discussed. No guidelines or recommendations are available. In conclusion, the approach to perigraft seroma treatment remains strictly individual. Vascular graft replacement using grafts made of different material seems to be the best option in the case of recurring perigraft seroma, where less invasive procedures were not successful.

Infection is a serious complication in vascular reconstructive surgery. When the entire graft is infected, its excision and subsequent replacement is the only option of treatment. In case of localised graft infection in the groin, the vascular reconstruction can be saved using negative-pressure wound therapy (NPWT).Retrospective study design was used to evaluate the efficiency of NPWT in the treatment of infected inguinal wounds following arterial reconstructive surgery. The assessments included demographic patient characteristics, causative agents, type of reconstruction and NPWT outcome. Wound infection was graded based on the Szilagyi classification. Patients were followed-up for 12 months after the therapy. Complete wound healing, retained graft patency, and no clinical signs or laboratory evidence of infection were regarded as successful results of treatment.Between 2009 and 2012, 20 patients with deep groin infection (Szilagyi II and III) following arterial reconstructive surgery were treated by NPWT. The patient group included 12 men and 8 women; mean age was 68.1 years. Nine patients underwent aorto-femoral arterial reconstructions (with vascular prosthesis in 8 cases), and surgery below the inguinal ligament was done in 11 patients (with vascular prosthesis in 7 cases). Of the 20 patients, early infection within 30 days of surgery was recorded in 17 (85%) patients; Szilagyi grade III groin infection with exposed prosthetic graft was found in 5 (25 %) patients (infection: early, 4; late, 1). The causative agents isolated from the wound included Staphylococcus aureus (n=8), Pseudomonas aeruginosa (n=5) and Escherichia coli (n=5). Mean NPWT duration was 12.7 days. Wound healing was achieved in 17 patients (success rate, 85 %). Patients with early Szilagyi II infection showed the best outcomes (92.3%).Localised wound infection in the groin after arterial surgery is a serious complication of arterial reconstruction procedures. In eligible patients, such an infection can be treated conservatively using NPWT. The method is most efficient in the management of early infections. Wounds infected with P. aeruginosa or those with suture line exposure require special treatment. Long-term follow-up is necessary due to the risk of recurrent infection.

The negative pressure wound therapy (NPWT) is an effective local treatment method of many non-healing wounds. NPWT is routinely used for inpatient treatment in the Czech Republic; however, no clinical data is available for systematic outpatient treatment.The prospective non-randomized study was used to compare the clinical impact and cost-effectiveness of diabetic leg-ulcer and foot-ulcer negative pressure treatment in outpatient and inpatient settings. The aim of the study was to assess the effectiveness of outpatient NPWT on the basis of wound bed evaluation, to detect and quantify pre-expected reductions in the total costs of the therapy, and to compare the efficacy of both treatment options. Enrolled subjects included inpatients (n=36, NPWT systems RENASYS GO or PICO) and outpatients (n=28, PICO system). NPWT was concluded when the wound bed had been totally covered by granulation tissue, or when serious health problems occurred. We monitored the ulcer area, wound bed trait, number of NPWT dressing changes, length of NPWT, intensity of pain (VAS scale), presence of complications, and treatment costs.We found comparable clinical efficacy of outpatient (n=28)/inpatient (n=36; statistically non-significant differences in healing of ulcers verified based on wound bed development and reduction of ulcer areas in time) NPWT, the same risk of complications associated with NPWT (statistically non-significant differences in the function of both technologies and in complications developed during follow-up) as well as similar long-term results (statistically non-significant differences in the count of amputations). The total costs for outpatient wound treatment were statistically significantly lower (EUR 600 versus EUR 1300, p=0.001), and so were the average one-day-NPWT costs (EUR 30 versus EUR 120, p=0.001).We demonstrated that outpatient diabetic-foot-ulcer NPWT provided the same clinical efficiency as inpatient NPWT, while outpatient NPWT was less expensive, less painful and better tolerated than inpatient NPWT.

Il lavoro di ricerca è stato sviluppato dal CESIT nell'ambito di un progetto finanziato dal MIUR mirante ad un duplice obiettivo. Il primo volto ad indagare il tema dei processi di acquisto delle organizzazioni. Il secondo, di carattere empirico, ha analizzato i processi di acquisto degli esercenti ferroviari regionali europei. Il lavoro di ricerca è durato circa due anno ed ha coinvolto decine di imprese ferroviarie europee.

Infection represents a serious complication in vascular surgery. The average of 2-3% of reconstructions are involved. The article offers a review of current diagnosis and treatment of infection after vascular reconstruction. Emphasis is put on early diagnosis and its impact on prognosis of patients. We summarize the practical potential of surgical treatment. The situation is illustrated by our results from the years 2004-2006. During the last 3 years 19 patients were operated on for infection of the arterial reconstruction (15 ways aorto-femoral and 4 ways femoro-popliteal bypass). The main agent was Staphylococcus aureus (9 patients, i.e. 47.4%). In most cases explantation of the whole infected reconstruction was performed (13 patients). The early mortality rate is 26.3%. Amputation was necessary in 6 patients (i.e. 31.5%). Our results are fully comparable to those from other centres of vascular surgery.

The authors present the case of a subadventitial rupture of the popliteal artery and devastating injury to the crural arteries due to a crush injury to the proximal shank. The arterial injury was treated by urgent popliteo-pedal bypass grafting. Besides the surgical procedure, the authors also discuss revascularisation syndrome. The subadventitial rupture of the popliteal artery is a serious condition associated with a risk of high amputation.

Using retrospective analysis, we sought to investigate the incidence, risk factors and therapeutic outcomes of ischemic colitis in patients after surgical and endovascular repair of abdominal aortic aneurysms (AAA).The complete inpatient and outpatient medical records of all patients undergoing surgical or endovascular AAA repair in our Department from January 2005 to December 2009 were retrospectively reviewed. We selected all patients who had developed an acute or chronic form of postoperative large or small bowel ischemia. We carried out data analysis and focused on determining the incidence and risk factors of this complication and the outcomes of its treatment.Two hundred and seven AAA repairs were performed in the 2nd Department of Surgery of St. Anne's University Hospital in Brno and the Faculty of Medicine of Masaryk University in Brno during the studied period. This number includes endovascular AAA repairs (13 patients; 6.3%) as well as one robot-assisted operation, and also the whole clinical spectrum of AAA manifestations, from non-symptomatic forms to ruptured aneurysm forms. The rest of the patients underwent open operation. Bowel ischemia developed in a total of 11 patients (5.3 %), who all underwent open AAA repair. Six of these patients presented with non-ruptured AAA and the remaining 5 with ruptured AAA. In 3 patients, bowel ischemia was diagnosed with a delay of several months from the original revascularization operation in the clinical form of postischemic stricture of the large bowel (2 patients) or postischemic colitis (1 patient). 8 patients were diagnosed with acute ischemic colitis affecting an isolated segment of the small bowel in one patient, extended segments of the large bowel (descending colon + sigmoid colon + rectum) in 2 patients, and typically the descending and sigmoid colon in 5 patients. None of the three patients with late manifestation of ischemic colitis died. Of the 8 patients with acute presentation, resection of the ischemic bowel +/- the rectum was performed in 6 patients. 3 of them died and 3 survived the operation and have been followed up in our outpatient department. 2 patients with acute manifestation did not undergo bowel resection. Both of them died. The overall mortality of all patients with ischemic colitis was 45.5% (5 patients out of 11 died) in our study. When considering only patients suffering from the acute form of ischemic colitis, the mortality rate in our studied cohort amounts to 62.5% (5 patients out of 8 died).Bowel ischemia after AAA repair remains to be a serious complication. Besides the acute form of ischemic colitis, its possible late clinical manifestation in the form of postischemic stricture of the large bowel or postischemic large bowel colitis must also be kept in mind when following up patients. The analysis of our patient's data shows that conditions requiring the use of vasopressors and an increased need of transfusions (more than 7 units of packed red blood cells) intraoperatively represent important predictors of colon ischemia after AAA repair.

Thrombolytic therapy is a method of solution of thrombotic arterial occlusions of limbs using the physiological process of fibrinolysis. The severity of limb ischemia is the crucial for therapy. If immediate recanalization of arterial system is necessary than primarily surgical teratment is chosen.The arterial closures in infrainguinal localization are indicated for thrombolysis. Especially occlusions of crural vessels and the closures of previous vascular reconstruction (bypass) are indicated. The methods of local intra-arterial thrombolysis with application of recombinant tissue plasminogen activator, (rt-PA Actilyse) through catheter introduced into the level of thrombotic occlusion by Seldinger's Metod are used in our department.The authors present retrospectively analyzed set of 51 patients (12 women and 39 men aged 33 to 85 years) with acute arterial occlusion solved with thrombolytic therapy in the period 02/2007 - 03/2010. Complete recanalization was achieved in 43 cases (patients) (84%), high amputation of limbs was performed in 3 cases (5.9%).

The objective of the study was to evaluate the results of the robot-assisted laparoscopic aortoiliofemoral reconstructions in a group of 45 patients.The procedure is performed using three surgical techniques--conventional for the dissection of the vessels in the groin and distal anastomosis creation; laparoscopic for the dissection of the abdominal aorta and robotic for the proximal anastomosis creation. Between May 2006 and May 2010 we operated on 45 patients (37 males, 8 females) at a mean age of 57 years for aortoiliac occlusive disease using robot-assisted laparoscopic approach. We assessed the perioperative and hospitalization data.We created 21 aortobifemoral, 22 aortofemoral and 2 iliofemoral bypasses. The median time of the proximal anastomosis creation was 23 minutes (range 18 to 50 minutes), median clamping time was 60 minutes (range 40 to 95 minutes), median total operating time was 295 minutes (range 180 to 475 minutes). The median estimated blood loss was 265 ml (range 50 to 1200 ml). The median ICU stay was 2 days (range 1 to 8 days). During the follow-up period (median 19 months; range 2 to 50 months), we observed 3 early occlusions (6.7%)--all due to an insufficient outflow. All occlusions were resolved by the extension of reconstructions. No renal, cardiac or pulmonary complications were observed. The 30-day mortality was 0%. Late complications: port-site hernia (2.2%). The secondary patency was 100%.The da Vinci robotic system allows a precise vascular anastomosis creation and blood loss minimization. The achieved results (clamping time, anastomosis time) are fully comparable to conventional vascular surgery. The robotic system eliminates the technical limitations of laparoscopic aortic anastomosis creation. Robot-assisted laparoscopic aortoiliofemoral bypass grafting seems a safe method with a low complication rate.

The authors evaluate a group of 110 patients to whom a pedal bypass was implanted in the period from October 2000 to July 2009. In all cases the limb was at risk of high amputation and the possibilities of endovascular and conservative therapy were exhausted. No patient died during the procedure, early postoperative mortality was 1.8%. During the follow-up (average, 30 +/- 26.4 months; range, 1.2-91.2 months) 21 bypass occlusions occurred, of which in 8 cases bypass patency was restored by an early intervention. In the reference period the cumulative probability of primary and secondary patency of pedal bypasses is 67.2% and 69.5%, the cumulative probability of limb salvage by pedal bypass surgery is 78.0%. A part of the study is a statistical evaluation of the data and findings of how the primary and secondary patency of pedal bypasses and the probability of limb salvage are influenced by diabetes mellitus.

Replanting the inferior mesentery artery during infrarenal aortic aneurysm repair is a measure which might prevent development of colon ischemia under certain circumstances. These circumstances and patients who would benefit from this procedure are not well defined.64-year old man underwent an elective operation on infrarenal AAA at our institution in December 2009. From preoperative CT angiography we knew about the accessory right renal artery branching directly from AAA and bilateral occlusion of hypogastric arteries. We performed open resection of AAA with implantation of a bifurcated graft. Proximal anastomosis was situated below renal arteries, distal anastomoses were bilaterally constructed on external illiac arteries. The accessory right renal artery was anastomosed into the right limb of the graft and IMA was replanted into the body of the graft. Postoperative recovery of the patient was uneventful. His follow-ups 3 and 6 months after the operation have been showing good clinical state of the patient, absence of abdominal complaints and normal levels of urea and creatinine. CT angiography which was performed 3 months after the operation discovered an occlusion of the reimplanted IMA, but patent replanted accessory right renal artery.Assessment of collateral circulation of large intestine during infrarenal AAA repair is influenced by many preoperative and intraoperative factors. Most surgeons judge the adequacy of the collateral circulation by IMA backbleeding combined with inspection of sigmoid colon after restoring aortic flow. There have been numerous attempts to replace this subjective approach with more objective methods like intraoperative colon mucosal saturation measurement, laser Doppler flowmetry, IMA stump pressures, photophletyzmographic technique. Even though these methods describe conditions when a collateral circulation of rectosigmoid is inadequate after IMA ligature, they are unable to fully eliminate the occurrence of colon ischemia because of its multifactorial nature. Solving the problem of collateral circulation of the large intestine represents only a part of the obstacle presented by colon ischemia after infrarenal AAA repair.IMA replantation during infrarenal AAA repair does not fully prevent an occurance of colon ischemia. On the other side, this moneuver does not increase perioperative morbidity, nor prolongs an operation significantly. Our policy is to replant IMA whenever we thing the circulation of large intestine is under threat or in borderline situations.

Mycotic aneurysm of the abdominal aorta is a rare, but potentially lethal disorder because of the risk of rupture. It presents a permanent problem in vascular surgery. Despite recent advances in endovascular procedures, one of the available surgical interventions generally remains the method of choice. The authors present the case of a patient with a ruptured mycotic aneurysm of the abdominal aorta who urgently underwent aorto-biiliac reconstruction by an autologous superficial femoral vein graft. The patient's post-operative condition with the absence of complications is in agreement with the good results achieved with this technique by surgeons abroad, and gives support to the notion that this approach is superior to other surgical treatments of mycotic aneurysms.

The authors present their experience with treatment of 74 patients operated on for hepatocellular carcinoma. Resection could be performed only in 44 patients. In 19 cases, a catheter for regional chemotherapy was implanted. Tumor destruction with alcohol was performed 4 times and radiofrequency thermal ablation 5 times either as a single intervention or in addition to the resection. Liver cirrhosis was verified by histology in 29 operated patients. Hospital mortality: 2 operated patients. Median survival after the liver resection: 42 months, mean survival: 72 months. The importance of preoperative indocyanine green elimination test for the exact determination of functional capacity of the liver and the priority of radical resection as compared to the other treatment modalities are emphasized (Tab. 2, Ref. 12). Full Text (Free, PDF) www.bmj.sk.

Vascular prosthesis infection is a serious diagnostic and therapeutic problem. Timely diagnosis and adequate treatment are essential for the patient's future condition. We present a case report of a 60-year-old man with aortobifemoral prosthesis infection and with an aortoduodenal fistula. The prosthesis infection was confirmed by fluorodeoxyglucose positron emission tomography. Urgent surgery was indicated due to massive gastrointestinal bleeding. Because of lower limb Ischaemia after removal of the infected bifurcation prosthesis, an implantation of an axillobifemoral bypass was performed in a one stage procedure. 8 months after the surgery, the patient is in good condition without walking limitation.

The aim of this article is to summarize our experience in operations for subclavian steal syndrome. We recommend anaesthesia with preservation of patient's consciousness and mobility, and we prefer transposition of arteries to prosthesis implantation. The main characteristic of this approaches is an attempt to increase safety of operation. A feasible procedure is suggested also in the case of reconstruction occlusion: the axillo-axillary bypass. (Fig. 6, Ref. 3.)

In 2000 to 2002, we carried out "pedal" arterial reconstructions in 30 patients, performing a distal anastomosis to the dorsal pedal artery (47%) or the posterior tibial artery (53%). All patients suffered from critical ischemia of the lower extremity; 26 (86.7%) had gangrene or foot defect and 21 (70%) had diabetes mellitus. They all had atherosclerotic obliteration of the crural arteries and only a graft bypass of this segment offered good prospects for limb salvage. In 16.7% of the patients, previous percutaneous transluminar angioplasty had failed to treat the condition. Preoperative angiographic findings were unsatisfactory in the majority of patients because in 23 patients (76.7%) the plantar arch was not shown and, in 13 patients (43.3%), neither the plantar arch nor any of the pedal arteries were visualised. During 36 months of follow-up, one patient died (3.3%) and three had bypass graft occlusion (10%). Of these, one patient underwent early thrombectomy, which resulted in long-term graft patency and limb salvage. A further patient had the limb saved although occlusion occurred after the defect had healed. In the third patient, however, bypass occlusion eventually led to high amputation of the leg. The results were evaluated by Kaplan Meier analysis. At 36 months, cumulative probabilities were 87% and 90% for primary and secondary patency, respectively; cumulative probability for limb salvage was 93%. Our results are in agreement with those from major specialised foreign centres and support the view that patients with critical ischemia and unsatisfactory angiographic findings (obliteration of crural arteries) are indicated for pedal artery inspection with subsequent vascular reconstruction.

Diabetic foot syndrome in patients with atherosclerotic angiopathy of the crural arteries frequently develops in critical ischaemia and gangrene. Revascularization then may be the only approach to limb salvage. In the ongoing decade, pedal bypass grafting has become the method of choice for treatment of the most severe forms of chronic critical leg ischaemia caused by obliteration of the crural arteries. However, in patients in whom angiographic findings are favourable (short stenosis of the crural artery and the presence of suitable distal outflow arteries), percutaneous transluminal angioplasty (PTA), with stent placement, if indicated, is preferred. In multisegmental or diffuse disease or when PTA is associated with complications (occlusion or dissection) with subsequent limb ischaemia, bypass surgery is the method of treatment. In this study, the group of 30 patients undergoing bypass grafting showed 90% patency of the pedal bypasses at 12-month follow-up; in 18 patients treated by PTA, the patency of crural arteries at 6 months after angioplasty was 78%. Since either method has its advantage and disadvantages, an individual approach to each patient is recommended. In decision-making on the basis of angiographic findings, PTA is not confronted with pedal bypass grafting but the two methods are regarded as complementary in treatment of patients with crural artery disease.

Chronic venous insufficiency (CVI) of lower limbs is one of the most widespread diseases occurring in developed countries worldwide. Literature data concerning its prevalence and incidence differ depending on evaluation criteria or on the definition of CVI. By comparing the available epidemiological literature published in the last decade, the authors point out the fact that the disunity in evaluation criteria of CVI is the weakness of all comparative studies. In spite of this, it is evident that, in addition to age and sex, the main risk factors of CVI include also the influence of working environment, genetic influences and geographic factors. Solely the acceptance of a unified classification of CVI and multinational collaborative studies could bring new information on epidemiology, etiology, prevention and therapy of this chronic disease, as in the case of coronary heart diseases in the past. (Tab. 1, Fig. 2, Ref 19.).

In the investigated group 300 patients were operated for a thyropathy mostly struma nodosa, tumours were proved in 69 cases; 38 of them were carcinomas of various extent and 3 of them were combined with Hashinoto's lymphomatous goitre. The overwhelming majority of the carcinomas were papillary carcinomas (22 cases). The incidence of papillary carcinoma in Hashimoto's goitre was about 8%; this fact calls for more attention to autoaggressive thyroiditis both in examination of surgical material, and during autopsies in middle-aged women, where this thyroiditis is often clinically silent. Our results suggest an increase in the incidence of carcinoma in Hashimoto's goitre and the generally accepted rarity of this coincidence is questioned. We recorded also a lower incidence of medullary carcinoma than the worldwide average and a more frequent incidence of mixed-type carcinoma.

The authors present a case of a patient with a progredient moist gangrene of the right foot. In this patient, amputation of the lower limb was indicated because of an unfavourable angiographic finding, after unsuccessful conservative treatment. With regard to the fact, that the patient had undergone amputation of the other lower limb in the crus, revision of the posterior tibial artery was decided. Preoperative angiography did not confirm the previous unfavourable angiographic finding. After the implantation of a distal crural venous bypass (posterior tibial artery--supramalleolar part), healing of the extremity occurred in a relatively short time period. The authors agree with the opinion that distal crural and pedal bypasses cannot be always indicated on the basis of routinely performed angiography. Revision of crural arteries and possible preoperative angiography can change the situation and lead to the salvage of the limb.

The authors present the results of a retrospective study concerning 96 patients with an abdominal aortic aneurysm rupture who underwent surgery in the 2nd Department of Surgery in Brno in the time period from 1989 to 1999. In 30 cases (31.2%) there was an isolated retroperitoneal rupture, 66 patients (68.8%) also had haemoperitoneum. The mean age of the patients was 74 years and the male/female ratio was 76 (79.2%): 20 (20.8%). Twelve patients (40%) did not survive the retroperitoneal rupture, and 34 patients (51.5%) did not survive the intraabdominal rupture. Total mortality in the study group was 47.9%. The type of the rupture and the size of the haematoma that is in correlation with the time of diagnosis and operation, are among the most decisive prognostic factors. Patients with a small haematoma show higher survival rates. In large retroperitoneal haematomas accompanied by a haemorrhagic shock, the mortality was about 40% in the presented study group, in intraabdominal ruptures the mortality rate increases to values over 50%. The results are in accordance with foreign literature data, and the authors agree with the opinion that haemodynamically unstable patients with suspected abdominal aortic aneurysm rupture should be, after necessary preparations, urgently operated without complementary examinations.

Vascular collagen prosthesis of RaK type (collagen-impregnated knitted prosthesis) made by Výzkumný ústav pletarský (Research Institute of Hosiery) in Brno was introduced into clinical practice in 1990. In comparison with previous type, the collagen-impregnated prosthesis has had a number of advantages and thus it gets into the interests of vascular surgeons. The report presented has given the results of clinical evaluating study carried out at the IInd Clinic of Surgery, Faculty of Medicine, Masaryk University, Brno according to the methods of EN 540 European Norm Proposal for clinical studies. The results obtained from evaluating a set of 107 patients created for this study (besides others, long-term patency of 90.7%, or 0.9% incidence of infection of the vascular prosthesis of Szilagyi III type) have shown that nowadays we have at disposal a very good, reliable and economically acceptable vascular prosthesis of our provenience.

The authors present the experience of their department with resections of the liver. Their main attention is focused on indications and the technique of operation. During the period from 1981 to April 1990 at the Surgical Clinic in Brno 50 resections of the liver were made. Thirty patients with benign diseases were operated and 18 patients with malignant diseases. The group comprised only those resections where at least one liver segment was removed. In two patients re-resection on account of a tumour relapse was performed. For arrest of haemorrhage from the resection area the authors recommend in addition to careful surgical treatment also the use of fibrin glue.

In the morning a healthy 40 years old female had a successful spinal anesthetic with bupivacaine 1% 10 mg for hemorrhoidectomy followed by a second injection at midnight for severe pain. The second traumatic injection caused a conus medullaris/cauda equina lesion discovered by MRI 45 days later. The contribution of hyperbaric bupivacaine dosage and pencil point needle is discussed.