[Aneurysm of an anomalous common celiac-mesenteric trunk]. / Aneuryzma anomálního spolecného céliakomezenterického trunku.

The authors describe the successful surgical treatment of a very rare aneurysm of the common coeliacomesenteric trunk in a 68-year-old woman. They mention the symptoms, diagnostic procedure and possibilities of surgical treatment of aneurysms of visceral branches of the abdominal aorta.

[Aneurysms of the abdominal aorta]. / Aneuryzma abdominální aorty.

The authors present the experience of the Plzen department with treatment of aneurysms of the abdominal aorta (AAA) during the last five-year period (1992-1996) when they operated a total of 111 AAA in patients with an average age of 67.9 years (44-91 years). The number of symptomatic AAA was 15 (13.5%), 36 ruptures (32.4%). The most frequent risk factor was ischemic heart disease (IHD) in 74 (66.7%) and hypertension in 47 (42.3%) of the patients. Within 30 days after surgery two asymptomatic patients died (3.9%) and three (20%) with symptomatic AAA. The most frequent cause of death was acute myocardial infarction (AIM) in four (80%). Of 36 patients with rupture of AAA 17 (47.2%) died. A statistically significant factor for death of patients with rupture of the AAA was sever shock (blood pressure < 40 mm Hg) before surgery (p < 0.01), blood in the abdominal cavity (p < 0.01) and hypertension in the patient's case history (p < 0.05). Aimed screening of AAA in patients of risk groups and early elective surgery are important for reducing the incidence of ruptures of AAA. A patient with rupture of the AAA needs surgery urgently and unnecessary examination (CT, USG) frequently causes delay and reduces the patient's chance of survival.

[Dysphagia lusoria]. / Dysphagia lusoria.

In a 44-year-old female patient with dysphagia persisting for 30 years it was found that the cause of the complaints was an abnormal insertion of the right subclavian artery (arteria lusoria). After simple severing of the artery without reconstruction dysphagia disappeared, the right upper extremity is not ischaemic and does not handicap the patient. So far symptoms of the steal syndrome did not develop.

[Unusual injuries of the abdominal aorta]. / Neobvyklé poranení brisní aorty.

A 23-year-old patient was admitted after a car accident with multiple fractures of the extremities, contusion of the brain and a sonographically confirmed haematoma in the retroperitoneum. After 24 hours laparotomy was indicated on account of suddenly developed hypotension. On operation a haemoperitoneum was found and an extensive haematoma in the retroperitoneum, the cause of which was injury of the abdominal aorta due to rupture of the lower mesenteric and lumbar artery. The authors demonstrate the not quite typical picture of an injury of a major artery and recommended early angiography.

[Arterial "crossover" reconstruction in ischemic disease of the lower extremities]. / Tepenné rekonstrukce typu "crossover" u ischemické choroby dolních koncetin.

The authors present a group of 20 patients where in the course of a 15-year period (1978-1992) a crossover bypass was made to save a lower extremity with advanced ischaemia. Based on their own experience which they compare with results of physicians abroad they submit an analysis of indications for this type of extra-anatomical reconstruction. In the authors' opinion crossover bypasses have their place in reconstruction surgery of the arteries of the lower extremities if they are perceived as extra-anatomical reconstructions and thus are subjects to strict criteria for indication.

[Arterial injuries of the upper extremities]. / Poranení tepen horních koncetin.

At the Department of Surgery in Pilsen in 1982-1991 a total of 26 patients with upper extremity vascular injuries was treated. Brachial artery was injured most commonly (50%). The direct trauma was responsible for 88.5% injuries, indirect injury was recorded in 11.5% cases only. The incidence of concomitant injuries of the vein, nerve or bone was 73.1%. Approximately one third of arterial injuries was caused by criminal offences. The vascular reconstruction was performed in all 26 patients. The overall patency rate was 84.6%, the amputation rate was 3.8%. One patient with polytrauma died of sepsis (3.8%). The authors give a comprehensive review of the causes, diagnosis and treatment of vascular injuries of the upper extremities.

[Extra-anatomic bypasses in reconstructive vascular surgery in the lower extremities]. / Extraanatomické bypassy v rekonstrukcní chirurgii tepen dolních koncetin.

Extra-anatomic Bypass was used in 36 patients for limb salvage at the Department of Surgery, University Hospital in Pilsen in a period of almost eleven years (1th January 1981-1th November 1991) constituting 8.2% of all vascular reconstructions. Amputation rate was 22.2% and mortality rate 8.3% (without direct connection with reconstruction). Extra-anatomic reconstruction was used in such cases only where the anatomic bypass was excluded for general or local causes.

[Incidence of aneurysms of the abdominal aorta in the Czechoslovak population and possibilities of its detection]. / Výskyt aneurysmatu abdominální aorty v nasí populaci a moznosti jeho depistáze.

A significant increase not only in the number of operations for AAA but also in the incidence of autopsy findings of AAA from 1.5 per cent to 4.5 per cent has been observed during the last 20 years. Ultrasound screening of the abdominal aorta in patients examined for other reasons revealed asymptomatic dilatation of the infrarenal aorta to more than 4 cm in 3.8 per cent of men older than 60 years. AAA should be actively searched for at every physical and ultrasound examination of the abdomen in men over 60 years of age.

[Aneurysms of the peripheral arteries]. / Aneurysmata periferních tepen.

The authors discuss the problem of the right peripheral arterial aneurysm. In 1985-1989, five patients with peripheral arterial aneurysm were operated on at the surgical department, teaching hospital. Plzen. The paper gives an account of each case pointing to the specific features of this particular part of vascular surgery. Further, the authors describe the etiology, diagnostics and treatment of the disease.

[Secondary access routes for hemodialysis]. / Sekundární prístupové cesty pro hemodialýzu.

During the period of 1970-1985 375 arteriovenous fistulae were constructed in 248 dialyzed patients. The number of fistulae needed for long-term dialysis was significantly higher in women. Five-year cumulative patency rates were significantly better in the first fistulae than in the second, third or following fistulae. The best long-term patency rates were achieved in radiocephalic fistulae. Of all secondary vascular access procedures saphenous vein grafts proved to be the most reliable.

[Symptomatic aneurysms of the abdominal aorta]. / Symptomatická aneurysmata brisní aorty.

In the years 1981-1985 21 patients were operated upon for symptomatic abdominal aortic aneurysms. Atypical symptoms such as acute pancreatitis, weight loss, blood in the stool or urine, incorrect interpretation of abdominal pain and physical examination findings caused erroneous initial diagnosis and delay in referring the patient to surgical treatment in nine cases. Long history prior to admission was noted even in patients with ruptured aneurysms; mortality in these patients was high, 66%. Best results were achieved with aneurysm resection; indirect aneurysm occlusion in combination with axillofemoral bypass attempted in two patients was not successful.

Vascular surgery in the treatment of impotence; its present possibilities and prospects.

Five years ago we reported on a technique of direct arterial anastomosis with the cavernous bodies of the penis. At that time we expressed the hypothesis that in some cases impotence could be the result of organic changes in the arterial bed supplying the cavernous bodies. A histological study was therefore performed on postmortem material and a new arteriographic technique - phalloarteriography - was developed to visualize the internal pudendal artery, the penile artery and its branches. Bilateral examination carried out in 132 patients with erectile impotence established stenosis or occlusion of these arteries or aplasia of the deep penile artery in most of them. Stenoses or occlusions were either of traumatic (after pelvic fracture) or sclerotic origin in middle aged and older patients or were related to diabetes. In more than 20% of patients with occlusions in the arterial bed plastic induration of the penis (Peyronie's disease) was found. Phalloarteriography has become the basic technique of surgical indication and approach. Revascularization procedures consisted of anastomosis of the inferior epigastric artery to the dorsal penile artery or directly to the cavernous bodies. The results attained in the first 54 patients confirmed the vasculogenic origin of their impotence. The development of phalloarteriography and revascularization procedures contribute to surgical management of impotence and extend the use of vascular surgery.