Self-expandable stent placement in infrapopliteal arteries after unsuccessful angioplasty failure: one-year follow-up.

The purpose of this prospective study was to evaluate whether stent placement in infrapopliteal arteries is helpful in failed percutaneous transluminal angioplasty (PTA). Infrapopliteal PTA was performed in 70 arteries of 66 patients with chronic critical lower limb ischemia. The group comprised 55 males and 11 females, with an average age of 63.4 (range, 42-82) years. Diabetes mellitus was present in 92.4% of patients. Only the palpable anterior tibial and posterior tibial arteries were evaluated. Stents (Xpert stent; Abbot Vascular, Redwood City, CA, USA) were placed in 16 arteries where PTA was not successful (the failure was defined as residual stenosis >30% after PTA). In 54 arteries simple PTA was performed and was technically successful. Twenty-four nondilated arteries with no significant stenosis served as a comparison group. The 12-month patency rate was evaluated according to a combination of palpation and Doppler ultrasound. In all cases stent placement restored the flow in the artery immediately after unsuccessful PTA. Twelve-month follow-up showed a patency rate of 82% in the PTA group, 78% in the stent group, and 69% in the comparison group. We conclude that stent placement in the case of unsuccessful infrapopliteal PTA changed technical failure to success and restored flow in the dilated artery. At 12-month follow-up the patency rate of infrapopliteal arteries stented for PTA failure did not differ significantly either from nonstented arteries with an optimal PTA result or from a comparison group of nonintervened arteries.

[Basic epidemiologic indicators of venous diseases]. / Základní epidemiologické ukazatele zilních onemocnení.

Venous diseases are among the major causes of morbidity and mortality in The Czech Republic. The incidence of venous diseases increases rapidly with age, especially in those older than 65 years. Among discussed entities is the most important deep venous thrombosis and its complications--pulmonary embolism and postthrombotic syndrome. We discuss epidemiology of acute and chronic venous diseases in context of risk factors and offer a short outline of currently applied therapy. Then we focus on the new perspective possibilities of treatment of venous diseases especially in acute states (including local thrombolysis), on its influence of quality of life, on the progression of diseases into chronic states and on its socioeconomic consequences.

[Thromboembolic complications in the use of oral estrogen-gestagen contraceptives]. / Tromboembolické komplikace uzívání orální estrogen-gestagenní antikoncepce.

Deep vein thrombosis is a serious complication of oral contraception. The most serious complication, pulmonary embolism, could be lethal. The relative risk of thromboembolic disease is four time higher in women using oral contraception. Both the amount of estrogen and the type of gestagen can increase the relative risk of thromboembolic disease. Oral contraceptives influence procoagulants, fibrinolytic system and inhibitors of coagulation. The choice of oral contraceptive should be very careful. It is advised to use preparations with less then 50 micrograms of ethinyl-estradiol and the type of gestagen that has minimal metabolic side effects, including minimal effect on coagulation. It is not recommended to perform screening of trombophilia before prescribing oral contraception. Family history of thrombosis is indication for more detailed investigation. However in the case of positive history of thromboembolic disease use of oral contraception is contraindicated. Oral contraception users should be informed about increased risk of deep vein trombosis, and what to do to prevent deep vein thrombosis.