Endovenous laser ablation of saphenous veins - favorable clinical results confirm theoretical advantages of the 1940nm diode laser.

INTRODUCTION: Endovenous laser ablation (EVLA) is a recognized alternative to surgical treatment of varicose veins, although an optimal laser generator and its settings still remain a matter of debate. The aim of our study was to correlate clinical results with the theoretical advantage of the 1940nm diode laser characterized by high absorption of heat in a thin layer of coagulated tissue. METHODS: From 1/2010 to 12/2021 EVLA was performed in a total of 3529 consecutive patients with varicose veins and ultrasonographically documented superficial venous reflux of lower extremities. Three types of laser were used successively with the wavelengths of 1064 nm, 1470 nm and 1940 nm, respectively. All patients were prospectively enrolled in our registry. An early postoperative followup visit was scheduled including an assessment of venous closure; additional visits were performed only in case of complications. RESULTS: The success of venous closure did not differ (p=0.054) between the three laser types and was over 98%. The catheterbased method made it possible to perform multiple ablations in one procedure the trend was 1.08, 1.31 and 1.62. In 2021 the number of ablations per patient with the laser DL Tethys 1940 nm was 1.79. With this laser it was possible to reduce the total energy applied to one half (8 W, 5080 J/cm). The postoperative course of patients treated using the 1940nm laser was smoother - no other but the early followup visit was needed in 95.6% cases (p.

Endovenous laser ablation of saphenous vein - mid-term results confirm permanent closure and possibility to treat more lesions in one procedure.

INTRODUCTION: Endovenous Laser Ablation (EVLA) is a common alternative to surgical treatment of varicose veins. The aim of our study was to demonstrate that laser occlusion is durable, that we can treat all patients in a one day setting, even with veins >10mm in diameter, and that multiple EVLAs can be done at the same time. METHODS: In the period from 1/2017 to 12/2019 EVLA was performed in a total of 1551 consecutive patients with varicose veins and ultrasonographically documented venous reflux. The mid-term results were evaluated in a group of patients operated from 1/2017 to 6/2017 (316 pts.). We compared a risk group that consisted of patients with veins >10mm in diameter (40 pts.) with a control group (the remaining 276 pts.). Patients with veins >10mm are traditionally considered as candidates for conventional surgery. RESULTS: The catheter-based method enabled us to perform more ablations in one procedure. In 2019 we performed 1.44 EVLA procedures per patient. There was only one postoperative follow-up visit, indicating an uncomplicated postoperative course, in 87.5% of patients of the risk group. In the control group 100% of patients had only one follow-up visit including ultrasound examination, showing an uncomplicated postoperative course (p.

Catheter laser ablation of superficial veins of the lower extremities in the symptomatic treatment of venous reflux comparison of the immediate results of two types of laser.

INTRODUCTION: Catheter-Based Endovenous Laser Ablation (EVLA) is a commonly used alternative to surgical treatment of varicose veins. Recently, catheterization methods have proved to be methods of choice due to the preference of patients who value minimal invasiveness. Research of EVLA currently focuses on optimization of the procedure, which includes study of the benefits of the individual types of laser generators and the wavelengths used. In this observational study we compared our early results in a non-selected population of consecutive patients treated with two different types of lasers. METHODS: In the period from February 2010 to June 2017, EVLA was performed in a total of 1747 consecutive patients (74% were female) with venous reflux. The average vein width was 8.5 mm (525 mm). Our study sought to compare a more economical 1470nm diode laser (DL) generator (Velas 2, China) - used to operate on 630 patients - with a Nd-Yag crystal generator (Fotona - Slovenia) used in 1117 patients. All operations were performed using the same methodology, in an outpatient setting, in one specialized center. All procedures were completed in local tumescent anesthesia under peroperative ultrasound control. Postoperative sonography was performed in all patients. RESULTS: The results did not show a statistically significant difference in early closure rates (98.8% for Nd-Yag versus 99.8 for DL p-ns). Early recurrence was observed in 9 patients (15 vein segments) and managed successfully with early re-intervention and closure in all cases. The causes of incomplete closure included mainly the known risk factors (anticoagulation therapy, history of varicophlebitis). There was no correlation with larger venous diameter. In 6 patients, thrombus prolapse was observed in the deep femoral vein lumen. All cases were successfully cured after a week of low-molecular-weight heparin therapy. Only one case of low-risk pulmonary embolism was reported in a patient who failed to follow the regime recommendations. CONCLUSION: This evidence did not show a significant difference in closure reliability and the amount of complications of the endovenous laser ablation of large and small saphenous vein with a 1060nm Nd-Yag crystal compared to the more economical 1470nm diode laser generator.

A spontaneous isolated dissection of the external iliac artery in a roofer.

After two days of an intensive roofing work, a healthy professional 41-year-old roofer experienced an isolated spontaneous dissection of the external iliac artery with an acute severe ischemia of the left lower extremity. The compressed true lumen, complete thrombosis of the false lumen and an overlapping dissection at the origin of the deep femoral artery necessitated an open surgery. An urgent iliofemoral bypass was constructed and external iliac artery was excluded. Connective tissue disorders were excluded by immunology, histology and genetic tests. Spontaneous dissection of the iliac artery has frequently been described in sportsmen after an exceptional physical strain. The same mechanism may also come into question following occupational overexertion. However, connective tissue or vascular wall disorders must be taken into consideration in differential diagnosis (Fig. 1, Ref. 21).

[Current trends in the surgical management of thoracoabdominal aortic aneurysms]. / Soucasné trendy v chirurgické lécbe výdute torakoabdominální aorty.

INTRODUCTION: The authors present a group of patients, who underwent standard procedures on thoracic (TAA) and thoracoabdominal (TAAA) aortic aneurysms from 01-01-2009 to 15-09-2010. MATERIAL AND METHODS: During the above time period, a total of 29 patients were operated. The authors employed as many known organ protection procedures as possible, including reduced heparinization, mild hypothermia (32-34 degrees C), sequential aortic clamping cerebrospinal drainage, left heart bypass (a biopump) with non-ischemic canylation of the femoral artery, selective visceral blood perfusion (superior mesenteric artery and coeliac trunk) and renal arteries perfusion using cold crystallic solution. For technical reasons, monitoring of somatosensory and motor evoked potentials was used only twice. In the majority of TAAA procedures, the thoracoretroperitoneal approach was used. RESULTS: During the studied period, the overall mortality rate was 24%. In 2009, a total of 16 patients were operated, out of which 14 subjects underwent elective procedures. Two subjects underwent urgent procedures for ruptures and both of them died. In 2009, the mortality rate was 21% for planned procedures. In the following year, from January to September 15, a total of 13 patients underwent surgery, out of whom 11 underwent elective and two urgent procedures. The group's overall mortality rate was 15.4%, the mortality rate in elective surgery patients was 9% . One patient undergoing urgent surgery survived and one exited. Postoperative paraplegia was reported in one subject (3,4%), postoperative dialysis due to postoperative renal insufficiency was used in 6.9% and other postoperative complications occurred in 10,3% of the subjects. CONCLUSION: Mortality and morbidity rates in the surgical management of thoracoabdominal aortic aneurysms remain considerably high, although new procedures of organ protection help to reduce it. These highly specialized procedures require a multispecialty approach and a well- coordinated surgical team, specialized in this problematics.

[Venous interposition graft in the management of bleeding from distal anastomosis of pedal bypass]. / Zilní interponát pri resení krvácení z distální anastomózy pedálního bypassu.

The authors present a rare complication of limb revascularization using pedal bypass, disruption of the surgical wound resulting from infectious etiology with bleeding from the distal anastomosis. The wound disruption was successfully managed by venous interposition grafting. The bypass patency, as well as full functioning of the extremity, were preserved.

Symptomatic severe tricuspid insufficiency as a late complication of pulmonary balloon valvuloplasty.

The authors describe an unusual case of a young adult patient with symptomatic tricuspid valve insufficiency as a late consequence of pulmonary valve balloon dilatation in childhood. Patient was successfully treated by tricuspid valve repair with neo-chordae implantation and a ring plasty. Two years after the operation the patient, an active sportsman, is asymptomatic with trace tricuspid regurgitation on the echo examination.

[Prevention of type II endoleak using postoperative coiling of the abdominal aortic aneurysm sac during stent graft implantation]. / Prevence endoleaku II. typu pomocí peroperacního coilingu vaku aneuryzmatu abdominální aorty behem implantace stentgraftu.

AIM: A prospective randomized study assessing the success rates of type II endoleak (EL) prevention, using postoperative coiling of the abdominal aortic aneurysm (AAA) sac during stent graft (SG) implantation. MATERIAL AND METHODS: From January 2008 to July 2009, 86 patients were operated for AAA using endovascular methods with bifurcation SG. The subjects were prospectively randomized into two subgroups. Group A subjects (42 subjects; 48.8%) had various numbers of coils introduced into the sac, close to the SG body. Group B (44 subjects; 51.2%) included patients without coils. Preoperative CT angiograhy (CT AG) was used to assess patency and the number of lumbal arteries (AL), a.mesenterica inferior (AMI), a. sacralis mediana (ASM) and aa. renales accessoriae (ARA), the AAA sac and the lumen size. At the end of the studied period, existence of type II EL and the AAA sac size was assessed using sonography and /or CT AG. RESULTS: Prior to the procedure, there were only minor differences in the number of source type II EL arteries (AL 3.8 vs. 3.5; AMI 0.78 vs. 0.55; ASM 0.26 vs. 0.3; ARA 0.095 vs. 0.05), preoperative AAA sac size (68.6 vs. 67.0 mm) and the lumen size (47.6 vs. 40.0 mm), the AAA sac size at the end of the studied period (63.9 vs. 62.1 mm) and its mean size change (-4.7 vs. -4.9 mm), between the Group A and B, respectively . Postoperatively, the type II EL was detected in 6 subjects in Group A (14.3%), and in 9 subjects in Group B (20.5%). At the study endpoint, the type II EL was identified in 4 subjects in Group A (9.5%), in 8 subjects in Group B (18.2%). CONCLUSION: Peroperative introduction of coils into the AAA sac is one of the options for type II EL prevention. It facilitates successful regression and disappearance of type II EL.

[Multiple sequence revascularization of infrapopliteal arteries in the management of critically ischemic extremity]. / Vícenásobná sekvencní revaskularizace infrapopliteálních tepen pri záchrane kriticky ischemick koncetiny.

AIM OF THE STUDY: Most cases of distal bypasses closures are caused by reduced blood flow within the affected peripheral vasculature, resulting in corresponding reduction in the graft's blood supply. The authors use multiple, sequence, Y grafting and bridge grafting procedures on crural and pedal arteries, in order to improve the above hemodynamic features. Furthermore, the techniques facilitate better circulation within larger extremity regions. METHODS: From April 2007 to January 2009, the authors completed a total of 38 sequence bypass procedures. The procedures included 30 Y graft procedures with peripheral anastomoses with crural arteries, 4 Y graft procedures with peripheral anastomoses with pedal arteries and 4 bridge graft procedures. Y grafting is a technique, in which a classical distal bypass is formed, to which another bypass is attached end-to-side in an acute angle. The composite bypasses form a reversed letter Y. Its distal branches anastomose with crural or pedal arteries. Bridge grafting is a technique, where a short bypass between crural arteries is formed, using a venous graft with removed valves, allowing for a two-way flow. The distal anastomosis is attached end-to-side. All the above vascular reconstructions were indicated for critical extremity ischemia, some patients had a history of endovascular reinterventions. In the patient group, autologous veins were used in 20 reconstructions, while PTFE prostheses were used in 10 reconstructions. Clinical and sonographic examinations were performed on discharge, followed by check ups at 1,3, 6 and 12 months. RESULTS: The follow up period in patients with Y graft reconstructions was 6-20 months (mean duration of 12 months). Two patients underwent major amputation, required for bypass closures, 3 subjects exited with patent vascular reconstructions, their deaths were not related to the procedure. The authors recorded 4 bypass closures, with the main trunk patency. Primary/secondary 30-day patency rate was 90%/97%, the long-term patency rate was 93%. CONCLUSION: The vascular reconstructions results are similar to those presented in literature. In order to perform more accurate assessment of individual revascularization variants, long- term follow up studies, including randomized studies, are required.

[Popliteal artery aneurysms--acute ischemic complications]. / Výdut' podkolenní tepny--akutní ischemické komplikace.

The authors present a group of 10 patients with the diagnosis of acute ischaemia of an extremity caused by an aneurysm of the popliteal artery, during the period from 1997 till October 2002, who within a short time interval were treated by a combination of endovascular and surgical therapy. The group comprised 8 men and 2 women. The mean age was 58 years, the range 48-78 years. A bilateral aneurysm was present in 3 patients, coincidence with an aneurysm of the abdominal aorta was found in one patient. In all ten patients combined treatment was used involving local thrombolysis rtPA (Actilyse Boehringer Ingelheim) for 24-48 hours followed within 24 hours by exclusion of the aneurysm with vascular reconstruction. No death, amputation nor closure of the reconstruction was recorded during hospitalization. The medium term results suggest a 100% patency when an autologous vein was used, much poorer results are obtained when prostheses were used in particular in patients with femoropopliteal bypasses. In our opinion in acute ischaemia of the extremities as a result thrombosis of an aneurysm of the popliteal artery the application of a combination of local thrombolysis rtPA followed within a short time interval by vascular reconstruction increases the probability of saving the affected extremity and markedly reduces the necessity of amputation as compared with primary surgical treatment.

[Thoracic outlet syndrome. An atypical etiology in a typical location]. / Thoracic outlet syndrome. Netypické etiologie na typickém míste.

We have described a clinical case of 46 years old man suffering from TOS with non typical symptomatology. Diagnostic guidelines and possibilities of surgical treatment are discussed in this work.

[The in situ saphenous vein--more possibilities for vascular reconstruction?]. / Saféna in situ--rozsírení mozností zilních rekonstrukcí?

A clinical study of 47 patients with reconstruction of the large saphenous vein by the in situ technique indicates a statistically insignificant difference in the patency for venous grafts from 3 to 4 mm as compared with those above 4 mm. This confirms that the in situ technique extends the possibilities of venous reconstructions. In the author's group it extended the possibility to use a venous graft by 12.8%. The study confirms also the fundamental importance of patency of the pedal arch for long-term patency. Secondary patency of reconstructions in situ and reverse reconstructions in our department is comparable during the five-year period: 82 and 84%.