[The cost of surgical and endovascular treatment of abdominal aortic aneurysm - a retrospective comparative study]. / Náklady na chirurgickú a endovaskulárnu liecbu aneuryzmy brusnej aorty - retrospektívna komparatívna stúdia.

INTRODUCTION: A comparison of the costs of a surgery and an endovascular treatment of abdominal aortic aneurysms (AAA) for the General Health Insurance Company (VsZP) in 2009-2010. MATERIAL AND METHODS: Between 2009 and 2010, VsZP paid for treatment of 211 patients with AAA with an average age of 69 years (range: 41-91 years). Out of these, 174 patients underwent surgical treatment and 37 patients were treated by endovascular means. In both groups, we observed a total cost of treatment, payment for hospitalization (UH) and separately charged material (ZM), the cost of blood and reimbursement for CT (computer tomography) examinations and the patient age. For statistical comparison, we used the nonparametric Mann-Whitney U test, the limit of statistical significance was <0.01. The data were processed and compared by means of contingency tables in MS Excel and then statistically processed in the program StatSoft, Inc.. (2011). STATISTICA (data analysis software system), version 10th www.statsoft.com. RESULTS: The total two-year costs of VsZP for the treatment of AAA were € 1 212 188 - out of which 37% were represented by the OR costs (open repair) and 63% for EVAR (endovascular aneurysm repair) (p <0.01). In terms of the ZM use (p <0.01), and the use of CT examinations (p <0.01), EVAR is cost demanding. OR is cost demanding in terms of the blood consumption levels (p <0.01). The average total cost per admission was € 21,038 for EVAR and € 2,493 for OR, representing only 12% of the total EVAR costs. The age of patients has no impact on the costs (p> 0.01). The decisive impact on the total costs is represented by ZM, which presents 90 % of costs of EVAR method and 44% of OR method. CONCLUSION: OR and EVAR are effective modalities for the treatment of AAA. EVAR is a minimally invasive method, but the treatment costs are more than 8 times higher than the costs of surgical treatment. In terms of the VsZP cost control for the treatment of AAA, there must be clearly defined explicit indication criteria for EVAR. In terms of the costs for the treatment of AAA with "good risk" patients and those cases where there are no local obstacles for the surgical treatment (eg, colostoma, hostile abdomen, ren arcuatus and other), the surgical therapy is a "gold" standard. The health insurance company is a crucial regulator of the system of payment for provided medical care. The development of medical technology and the financial burden, on one hand, and the limited and scarce resources, on the other hand, are a source of "tension" between the health care providers and the regulators (insurance, Ministry of Health). One way to slow the "opening of the scissors" is to establish clear rules for the entry of new technologies into clinical practice, clearly defined costs (COI - cost of illness), and the usefulness and cost-effectiveness (CEA - cost-effectiveness analysis, ICER - incremental cost-effectiveness ratio, QALY - quality-adjusted life year). Despite the fact that it has beenmore than 20 years after the "velvet revolution", implementing the principles of health economics and health technology into practice has been managed in a rather weak way. The comparison of the costs of treatment is applicable in many areas of clinical medicine, and in the case of well-defined data it can be a source for the determination of ICER, CEA and QALYs. Key words: abdominal aortic aneurysms - surgery and endovascular treatment - costs.

[Clinical significance of venoplasties in infragenicular prosthetic bypass grafts]. / Klinický význam zilovej plastiky distálnej anastomózy pri infragenikulárnych protetických bypassoch.

AIMS: Analysis of medium-term patency of prosthetic infragenicular bypass grafts with venoplasty of distal anastomosis and evaluation of venoplasties in patients with critical limb ischemia. STUDY DESIGN: A single centre, retrospective, non-randomised study. METHODS AND RESULTS: In 1998-2005, 42 patients with critical limb ischemias were surgically managed at our clinic using infragenicular prosthetic bypass graft implantation with distal anastomosis venoplasty. 3 types of plasty were employed: Linton's, St. Mary's boot and Taylor's plasty. Mean follow-up period was 25 months and primary functionality was 69%. Long-term functionality (over 5 years) was 35% and limb salvage rate was 38%. Functionality was assessed using life table analysis. 19% of patients exited during the follow-up period. In up to 30% patients, thrombolytic therapy was indicated for late bypass occlusion with a success rate of 63%. CONCLUSION: Prosthetic crural bypass is a relevant alternative to proximal level limb amputation. Venoplasty of distal anastomosis increases volume of the anastomosis and compensates for incongruencies of the graft and recipient vein lumen. Based on our experience, not a type of venoplasty, but a fact of increasing the anastomosis volume is most important. Whenever crural reconstructions are indicated, patient's quality of life, expected survival period, degree of patient's independence prior to surgery and patient's compliance must be considered.

[Arthroscopy of the ankle joint--A rare cause of a pseudoaneurysm of the dorsalis pedis artery--A case review]. / Artroskopia clenkového klbu--zriedkavá prícina pseudoaneuryzmy pedalnej artérie--case report.

The arthroscopy is an attractive method for the diagnosing and treatment of injured joint structures in contemporary sport medicine. Vascular complications of this technique are very rare but generally extremely dangerous for the extremity salvage. We describe a rare case of the pedal artery pseudo aneurysm after ankle arthroscopy and the treatment of this complication.

[Post-catheterization pseudoaneurysm of the femoral artery--an unusual cause of femoral vein thrombosis--case report and review of the literature]. / Postkatetrizacná pseudoaneuryzma femorálnej tepny--nezvyklá prícina femorálnej zilnej trombózy--kazuistika a prehlad literatúry.

Invasive diagnostic procedures cause considerable increase of local arterial complications. Common femoral artery represents the most frequently used access artery. Our short report describes indications for treatment and treatment modalities of postcathterization false aneurysms with review of the literature. We present a case report of the patient with iliofemoral venous thrombosis related to external compression due to postcathterization false arterial aneurysm.

[Recent patho-biochemical view of ischemia-reperfusion injury]. / Súcasný patobiochemický pohl'ad na ischemicko-reperfúzne poskodenie tkaniva.

Ischemia-reperfusion injury (IRI) in patients with limb ischaemia remains still a topical problem and it is a subject of research. Some degree of tissue injury is expressed in each patient, regardless of type of ischaemia (acute or chronic). The difference is stated in extent of injury and in clinical relevance. In our article we provide current theoretical view of IRI and possibilities to influence it.

[The influence of chloroquine on some biochemical and hematological parameters in patients with critical limb ischemia]. / Vplyv chlorochinu na niektoré biochemické a hematologické parametre u pacientov s kritickou koncatinovou ischémiou.

CLI represents a major medical and social problem. The incidence is increasing and currently it was estimated 500-1000 per 1 million inhabitants. We carried out a clinical study (2000-2004) concerning monitoring of some hematological and biochemical markers during reperfusion in patients with CLI. The subject of our interest included possibilities to influence PMNL elastase by medical means and neutrophil-lymphocyte ratio which is considered a reliable and simple parameter to assess severity of clinical conditions.

[Cystic degeneration of the adventitia of the popliteal artery--case report]. / Cystická degenerácia adventície a. poplitea--case report.

Cystic adventitial disease (CAD) is a rare diagnosis with a higher number of the patients in recent years. The article gives a brief of the pathology and etiolopathogenesis of adventitial cystic disease and two case reports of the patients with CAD of the popliteal artery treated in our department between 1997 and 2001. Successful results are achieved only with surgical treatment.

[Regional biochemical and hematologic changes in patients after revascularization of the lower extremities in ischemia of the extremities]. / Regionálne biochemické a hematologické zmeny u pacientov po revaskularizácii dolných koncatín pre koncatinovú ischémiu.

INTRODUCTION: Surgical treatment of PAOD is related to iatrogenic ischaemia caused by arterial clamping and ischaemia which is result of natural development of the disease. The pathway of skeletal muscle reperfusion injury is complex and one of the most important factors related to injury is endothelial damage. The expected reason of endothelial damage is increased production of oxygen free radicals by prematurely activated PMN (polymorphonuclear) leukocytes (direct injury). Non-specific tissue injury is related to releasing of PMN elastase. Endothelial dysfunction, hypercoagulable state and microcirculation stasis are responsible for indirect injury and no-reflow fenomena. STUDY DESIGN: Observational pilot study. METHODS: 10 patients underwent surgery because of PAOD (all suffering from critical limb ischaemia). During reperfusion period in defined intervals following parameters were measured (samples were taken from ipsilateral femoral vein): PMN elastase, lactate, total antioxidant status, malondialdehyd, minerals, acid-base balance, blood count, APTT, prothrombin time, fibrinogen and HTI (heparin tolerance index). RESULTS: Patients with PAOD are threatened by hypercoagulable state with its clinical and surgical consequences. Maximal grade of local acidosis is reached 2 hours from the beginning of reperfusion. Tissue damage is expressed by maximum activity of PMN elastase 18-24 hours during reperfusion and represents non-specific tissue damage. Low total antioxidant status reveals high sensibility to oxygen free radicals. MDA does not achieve the pathological range in observed series. CONCLUSION: Our results confirmed inevitable importance of prevention of hypercoagulability, oxygen free radical tissue damage and PMN elastase activation to avoid of non-specific tissue damage.

[The popliteal artery entrapment syndrome--personal experience]. / Entrapment syndróm popliteálnej artérie--nase skúsenosti.

OBJECTIVE: In a retrospective study we analyze 5 patients with popliteal artery entrapment syndrome who were treated since 1999 to 2000 in our department. METHODS AND RESULTS: 5 patients were found to have popliteal vascular entrapment during a two-year period. From the total number of 5 patients, we performed surgery in 3 patients (5 operations). One patient rejected proposed surgical therapy, in another case the morphological lesion of the popliteal artery was not suitable for revascularisation. 3 patients underwent interposition of the diseased popliteal artery using a venous graft from a dorsal approach. Twice the decompression (myotomy) of the medial head of gastrocnemius muscle was sufficient. The study group is included in our follow up programme (median follow up 12.8 months, range from 3 to 24 months), primary and long term patency has been 100%. RESULTS: On the basis of our experience, we advice total replacement of the diseased popliteal artery. A dorsal approach (Hamming's "S" shaped incision) with interposition of the popliteal artery with autogenous venous graft, end to end anastomosis on both sides, seems to be the optimal solution. In case, the arterial wall is not irreversibly changed, surgical decompression (myotomy) is sufficient to prevent the development of symptomatic disease, also using the dorsal approach.

Diagnostic importance of magnetic resonance angiography in arterial reconstructive surgery.

Magnetic resonance angiography (MRA) permits the non-invasive visualisation of blood flow in arteries and veins. It has an enormous potential in imaging of various vascular pathologies and it has been establishing itself as a reliable alternative to widespread contrast X-ray methods explaining morphology of vascular system. This advanced and safe diagnostic method is very rarely used in the clinical practice of vascular surgeons in Slovak republic. The aim of this report is to outline a clinical importance of MRA for arterial reconstructive surgery, its advantages, limitation as an imagine technique and its practical application in different anatomical areas of the human body which are related to operative activity of vascular surgeons. It is intended for briefly comparing MRA with other vascular imagine techniques more common used in clinical practice of our surgical and vascular surgery departments and outpatient clinics.

[Surgical treatment of abdominal aortic aneurysms in severe ischemic coronary disease]. / Operacná liecba aneuryziem abdominálnej aorty pri závaznej ischemickej chorobe srdca.

BACKGROUND: The abdominal aortic aneurysm (AAA) is one of the most serious problems of vascular surgery and general medicine, as well. Endovascular methods of treatment have been developing very rapidly, however, the conventional treatment of the AAA still predominates. The results of operative treatment have been influenced besides the delayed diagnostics of the AAA resulting in a high rate of ruptured AAA by the high comorbidity of the AAA patients population. The accentuation of the proper preoperative and perioperative management of patients could therefore significantly influence the results of the surgery. MAIN PURPOSE AND STARTING POINTS: Striking difference between the mortality of elective and emergent surgery of AAA has been unchanged despite the intensive effort of many centers. One of the main factors of mortality is the concomitant serious coronary heart disease (CHD), predominantly the acute myocardial infarction (MI). The paper analyses the possibilities to improve the results of AAA surgery by means of the patients selection and effective preparation before the elective surgery. The risk factors and concomitant diseases of patients suffering from the AAA, the elective and emergent surgery ratio and the operative mortality are referred. The results of surgical treatment before and after accepting the modern CHD management algorithm are compared. METHODS: The present study is a retrospective analysis of the data of 343 consecutive patients with AAA operated on during the 20-years period from 1 January 1979 to 31 December 1998. The 1st group of 249 patients operated on during the 18-years period from 1. January 1979 to 31 December 1996 was not subjected to special attention concerning the CHD and was compared with the 2nd group of 93 patients operated on from 1 January 1997 to 31 December 1998. In this group of patients special attention was focused on the improvement of surgical techniques, intensive care and comprehensive diagnostics, evaluation and proper management of the concomitant CHD. RESULTS: The mortality rate of the elective surgery in the 1st group was 5.5%, in the 2nd group decreased to 3.6%, the difference was not statistically significant. Evident improvement of the results was apparent in emergency operations for ruptured AAA. The mortality rate in the 1st group of 76% dropped to 40% in the 2nd group (p < 0.05). The improved policy in the management has lead to statistically significant decrease of the MI incidence in the perioperative period (87.2% to 28.5%, p < 0.001). CONCLUSION: The improved diagnostics, selection of patients with special concern to the CHD and management of the patients before surgery, improved surgical techniques and intensive care lead to evident improvement of the results in the surgical management of the AAA. This fact is confirmed by improved results of the 2nd group of patients because of improved CHD management algorithm. (Tab. 5, Fig. 1, Ref. 35.)