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The chronic lower limbs ischaemia is caused mainly by arteriosclerosis. After insufficient conservative treatment only the surgical intervention can salvage the limb. The revascularisation surgery can be performed by open surgery with implantation of the prosthetic bypass or by endovascular angioplasty with stent. This second method seems to be the best alternative for the patients with several concomitant systemic diseases. Nevertheless it is limited by presence of the long-distance arteriosclerotic lesions. The resolve of that problem is use of new generation of long endovascular covered stents. They can be succesfuly used in aorto-femoral and femoro-popliteal segment. Their efficiacy is simmilar to traditional prosthetic grafts.

The critical limb ischemia is diagnosed when the rest pain and/or distal necrosis or ishemic ulceration occur and last for more than two weeks. Critical limb ischemia requires immediate revascularisation due to the risk of amputation. The most common cause of this state is the arteriosclerosis located on femoropopliteal level. The surgery consists of endarterectomy or implantation of the bypass graft or the percutaneous, intravascular procedure. The best material for the graft is the autologous saphenous vein but sometimes the artificial graft should be used. Some trials have proven that the heparin-bonded polytetrafluoroethylene graft could be the best resolution for patients without possibilities of use of the autologous vein.

The Purpose: Every foreign body injected into an organism causes an inflammatory condition. Among other things leukocytes take part in it. The healing of a vascular prosthesis means gradual subsiding of an inflammatory condition. The process can be monitored with the series of scintigraphy following decrease of an area of concentrating of Technetium-labeled leukocytes. The purpose of work was an appraisal of the healing of both types of prostheses in cases of patients operated because of aneurism of abdominal aorta., Material and Methods: In three years 64 patients have been examined. They were divided into two equal groups: I-patients after (stent-graft) being implanted because of abdominal aneurysm, II-patients after aortobifemoral prosthesis being implanted of the same reason. The scintigraphy was done in 3-4 day, in 3-, 6- and 12 after a surgery. A surface of concentrating of leucocytes was counted in a computer programme which allows manual marking of a contour. The results were put through a statistical processing., Results: During a period after surgery an intensified inflammatory condition has been stated in a group of patients operated in classic way. In both groups a decreasing of an inflammatory condition has been observed. After 12 months an area of concentrating of leucocytes took up to 10 percent of initial values., Conclusions: The decreasing of an area of concentrating of leucocytes was observed independently of a type of vascular prosthesis. The higher reaction was where the classic prostheses were used. The scintigraphy shows only a cellular part of an inflammatory answer and it cannot be an independent way of a monitoring of the healing of the prostheses.

The Mallory-Weiss Syndrome is a rare complication of endoscopic examination. Upper gastrointestinal bleeding due to the Mallory-Weiss Syndrome usually stops spontaneously. The gastroscopy is an effective procedure (method) of diagnosis and treatment of the syndrome. Presented in this paper is a case of 49-year old woman with an upper gastrointestinal bleeding due to the Mallory-Weiss after biliary prosthesis removal. The choledocholithiasis was the primary reason for the initial insertion of prostheses. The cause of gastrointestinal bleeding was determined on the basis of performed gastroscopy in the early stage of prostheses removal forced by bleeding. The bleeding was effectively stopped with endoclips.

Critical lower limb ischemia is a term used to define those patients with chronic ischemic pain at rest, ulcerations or limb necrosis caused by confirmed atherosclerotic lesions of the arteries. In this paper to evaluate of the clinical usefulness of silver coated prostheses in critical lower limb ischemia was presented. The use of the vascular artificial prostheses (dacron, dacron with velour, dacron albumin coated, polytetrafluoroethylene, dacron gentamicin/ryfampicin coated) in the critical ischemia limbs threatened is her contagion. In cases of potentially threatened a contagion is indicated the use of vascular prostheses about enlarged resistance on the contagion, e.g. the silver/collagen coated prosthesis. A foundation of the use of such prostheses are antibacterial proprieties of polyester fibers salts of the silver. An aim of many works is estimation of healing of the silver prostheses of grafted in lower limb at ill with the critical ischemia where infecting of the synthetic material is extremely probable. The healing of the silver prosthesis rated is most often at the use of the scintigraphy with Technetium 99. One attends that such research will make possible the estimation of the usefulness of the vascular silver prostheses in reconstructive operations in the vascular surgery, particularly in cases threatened with the infection of used synthetic material.

Aim: The purpose of this study is to evaluate the multimodal treatment (thrombolysis, anticoagulation and surgical decompression) of subclavian-axillary vein thrombosis (Paget-Schroetter syndrome) and possibility of shortening of time of therapy., Material and Methods: In this paper 23 patients with Paget-Schroetter syndrome in Department of Vascular, General and Transplantological Surgery is presented. Thrombolysis with rt-PA, anticoagulation with heparin and intra venous angioplasty with the use intravascular stent, and operation with resection of the first rib in the treatment of subclavian vein thrombosis was used. During the follow up period the patients were divided into two groups: group I (13 patients) with traditional surgical decompression after 3-4 months (potential risk of hemorage) and group II (10 patients) with early surgical treatment (median 8 days). Long-term follow-up was obtained by chart review and asking patients to complete the DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire that was developed by the American Academy of Orthopedic Surgeons., Results: Complete revascularization with venous thrombolysis was achived in all patients. Decompresion with transaxillary resection of first rib and venous revascularization were performed in the same procedure in all patients. Statistical difference were not found in both groups. Most patients report no disability of upper limb at work and sport activity., Conclusions: Multimodal treatment of Paget-Schroetter syndrome (thrombolysis, the use of intravascular stents and early thoracic outlet decompression) can be used as a optimal of therapeutic method to subclavian vein thrombosis. The advantages of immediate surgical treatment are a promotion of rapid resumption of athletic activities.

Extra hepatic bile ducts with the gallbladder are the center place for many disease processes. In extreme cases of significant strictures of bile ducts and impairment of bile flow, obstructive jaundice occurs. There are benign and malignant biliary strictures. The treatment of obstructive jaundice depends on the removal of blockage using endoscopic and surgical methods which return the efficient bile flow to the digestive tract. The endoscopic treatment from Vater's papilla access using plastic and metal stents is the method of choice. The choice of proper prosthesis depends on the reason for biliary strictures. The plastic stents (straight, pigtail) are applied the most. Due to their low cost, easy insertion to biliary ducts and exchangeability, they are applied in benign and malignant strictures. However, metal stents (Wallstent, Diamond, Z-stent, InStent), due to the wide diameter after expansion and no possibility of removal, are applied only in malignant strictures. Endoscopic insertion of biliary endoprostheses can be burdened with complications. There have been reports of occlusion, migration with duodenal wall injury and hemorrhaging.

The abdominal aortic aneurysm is a dilatation of infrarenal part of aorta. Its ethiology is still unknown. An infection and congenital disorders of conjunctive tissue are regarded as the main risc factors. Other factors could be a perimural thrombus and elastin and colagen degradation. It's not proved that atheromatosis is a risc factor. The disease concerns mainly the old males. Not treated aneurysm grows until rupture. The aneurysms are usually asympthomatic. Majority of them are found incidentally. Ultrasonography and computed tomography are used to extended diagnosis. The open surgery or endovascular surgery are only possible ways of treatment. The aneurysm with diameter over 55 milimeters, sympthomatic or rupted is an indication for surgery. The aim of the open surgery is implantation of the vascular prosthesis into retroperitoneal space. Endovascular method consist in placement of stent-graft in the lumen of aneurysm through small incision in a peripherial vessel. Stent-graft consists of metal chassis covered by classic vascular prosthesis. This method still requires the long-term assessment.