[Retrospective analysis of short-term and mid-term results of percutaneous endovascular repair in patients with abdominal aortic aneurysm]. / Retrospektívna analýza krátkodobých a strednodobých výsledkov perkutánnej endovaskulárnej liecby pacientov s aneuryzmou abdominálnej aorty.

INTRODUCTION: Endovascular abdominal aortic aneurysm repair (EVAR) is a modern and, compared to conventional open surgery, less invasive therapeutic strategy with short-term lower morbidity and mortality. The aim of our retrospective analysis was the assessment of safety, technical success, short-term and mid-term results of elective patients scheduled for total percutaneous EVAR implantation (PEVAR). MATERIAL AND METHODS: One hundred and sixteen consecutive patients (M:F 104:12, age 71±9 years, maximum AAA diameter 60±14mm) underwent elective PEVAR between January 2009 and August 2012. All the patients were treated under local anaesthesia by total percutaneous approach via femoral access. The immediate technical success of stentgraft implantation as well as the presence of 30-day and 1-year complications and the need of reintervention rate were assessed. RESULTS: In 115/116 patients (99.1%),immediate technical success of the procedure was recorded, with no need of conversion to open surgery; in 1 patient (0.9%) the performance technically failed due to unfavourable arterial anatomy. The mortality in 30-day follow-up was 2.6% (3 patients), during 1-year follow-up it amounted to 8.6% (10 patients), without causal relationship with stentgraft implantation. Overall event-free survival was 85% (98/116) without serious complications (mortality, MI, stroke, reintervention, severe ischemic complication) in the one-year follow-up period. CONCLUSION: Endovascular AAA repair is a safe and feasible method with low mortality and acceptable complication rate in patients scheduled for EVAR implantation. Percutaneous approach allows for the extension of indications also for the highest-risk group of polymorbid patients. Technical feasibility and adequate periprocedural management are essential for further reduction in adverse events after PEVAR.

Endovascular treatment of internal carotid and vertebral artery aneurysms using a novel pericardium covered stent.

Intracranial aneurysm is a fairly common (often asymptomatic) condition. Subarachnoid hemorrhage associated with aneurysmal rupture is a potentially lethal event with a mortality rate as high as 50 percent and a high rate of disability among those who survive the initial hemorrhage, such that recently published guidelines support treatment of intracerebral aneurysms. The current treatment options include surgical clipping and endovascular treatment, but these are not without significant problems. Despite the trend toward endovascular treatment the rate of recurrence and complications is high. Current published evidence of the use of covered stent is limited to stents covered with polytetrafluoroethylene. It is now recognized that mammalian extracellular matrix represents an excellent scaffold material suitable for many therapeutic applications and glutaraldehyde treated pericardium has been widely used for many years due to its desirable features such as low immunogenicity and durability. This report describes the first published experience with the Aneugraft Pericardium Covered Stent (ITGI Medical, OR Akiva, Israel) in the treatment of internal carotid and vertebral artery aneurysms in three patients. In all three cases, the implantation of this novel device has resulted in successful closure of aneurysms.

Vascular complications after renal transplantation.

BACKGROUND: Vascular complications in renal transplant recipients are uncommon but important causes of graft dysfunction and graft loss after kidney transplantation. OBJECTIVES: To document vascular complications that occurred following kidney transplantations in order to assess the incidence of these complications at our center as well as to identify possible treatment approach. METHODS: 103 kidney transplantations were performed in the period from 1 January 2008 to 31 December 2009. All patients after kidney transplantation underwent ultrasound examination (included colour Doppler flow and duplex Doppler ultrasound) immediately after surgery--especially in condition of anuria, then regularly according to an internal schedule and always in patients with worsened graft function. RESULTS: We detected renal vein thrombosis in 3 cases (2.9%), artery thrombosis in 4 cases (3.9%), one time intrarenal pseudoaneurysm (1%) and renal artery stenosis in 10 patients (9.7%). There was no extrarenal pseudoaneurysm or arteriovenous fistula in our group of patients. CONCLUSION: The incidence of vascular complications in our department correlates with the incidence of these complications referred in literature. We confirmed the importance of established immediate diagnosis and fast intervention once the diagnosis of vascular complication is established (Fig. 8, Ref. 12). Full Text in free PDF www.bmj.sk.

[Successfully combined management of the abberant retroesophageal arteria subcalvia dextra aneurysm (arteria lusoria)]. / Uspesné kombinované riesenie aneuryzmy aberantnej retroezofageálne prebiehajúcej arteria subclavia dextra (arteria lusoria). Kazuistika.

INTRODUCTION: Aberrant right subclavian artery arising from the distal part of the aortic arch and passing behind the oesophagus (arteria lusoria) is a rare congenital vascular anomaly, it is the 4th most common aortic arch anomaly. At the site of the orifice there is the Kommerell's diverticulum, which is the locus minoris resistentiae with the possible arise of the aortic aneurysm. Aneurysmatic dilatation of the anomalous artery and of the aorta may be the cause of distal embolism or rupture. Less frequently there is also the possibility of aortic dissection or traumatic rupture. CASE REPORT: 54-old man with a symptomatic aberrant aneurysmatic dilated right subclavian artery (arteria lusoria) and an anerurysmatic dilatation of the Kommerell's diverticulum was indicated to staged combined management. Firstly we performed open surgical debranching of two supraaortic trunks (both subclavian arteries). Thereafter we excluded the orifice of the aberrant artery with the Kommerell's diverticulum by use of the endovascular techniques. There have been no complications during the perioperative period and the effect of surgery was optimal. DISCUSSION: It is generally accepted that the presence of aneurysm of the aberrant right subclavian artery is an indication for surgery, whether symptomatic or not. The conventional surgery is usually staged. Firstly there is a carotid-subclavian bypass or transposition on the right side and thereafter a transthoracic resection of the Kommerell's diverticulum and aortic angioplasty. The combined management with supraaortic revascularization followed with the stentgraft exclusion of the aneurysm is a sophisticated alternative. CONCLUSION: Experiences with the combined treatment published in the literature and ours are excellent, this technique is miniinvasive with a low complication rate. In our opinion it is the management of choice.