Biomedical subjects

P Sedivý

Publications and source records attributed to P Sedivý.

7 recordsLinked to original sources

PubMed2006

[Postoperative re-stenosis of the carotid--A case for reoperation or endovascular management?].

The aim of this work was to assess frequency rates of re-stenoses following surgical or endovasular treatment of re-stenoses after primary endarterectomies of the carotid artery, taking into consideration concomitant disorders and the contralateral findings. Another objective was to assess differences in peroperative and postoperative complications frequency rates. The retrospective study included patients undergoing vascular surgery during a seven-year period. The study revealed that repetitive restenoses were statistically significantly (3x) more frequent in cases of the endovascular management compared to that in re-operations (p = 0.015). In the repetitive re-stenoses patients, the rate of the contralateral carotid affection was significantly higher (93.8%, p = 0.05) and also the rate of the contralateral artery obliteration was higher (43.8%, p = 0.05). The highest frequency rates of the repetitive carotid re-stenosis was in patients with a concomitant affection of the contralateral artery. Surgical management of the repetitive re-stenosis of the carotid artery following its primary surgical management showed better results than the endovascular management.

Aged↗

PubMed2005

[Allografts in the vascular surgery].

The use of allografts represents one of the therapeutic options in the treatment of vascular prosthetic infection. Close cooperation with a transplant center is unconditional for successful graft harvest and storage. Although the transplantation programme in the Czech Republic is handled in several centers across the country the use of vascular allografts is still exceptional. During multiorgan harvest procedures arterial or venous grafts have been removed and stored in antibiotic solution at 4 degrees C till implantation. Cardioplegic and short-term organ preserving solution Custodiol was used in our cohort. At the Department of Vascular Surgery of the Na Homolce Hospital in Prague fresh arterial allografts were used in 14 patients in the years 2001-2004. In all, absence of usable autologous graft was the common denominator. In ten cases previous synthetic vascular grafts were infected. Of these, critical limb ischaemia and imminent amputation due to the poor outflow tract occurred in three patients. Once, false femoral artery aneurysm infected with methicilin-resistant Staphylococcus aureus (MRSA) led to several hemorrhagic episodes. There was no early mortality but one early occlusion with subsequent major amputation. In 11 patients (79%) the procedure was uneventful at the short-term follow-up. All patients were treated with cyclosporine.

Aged↗

PubMed2004

[Bacterial aortitis].

A cohort of 14 patients with bacterial destruction of various segments of the aortic wall is presented. The Salmonella enteritidis strain was predominantly responsible. Most patients had typical history of symptomatic trias of sepsis, abdominal and/or back pain and positive blood cultures. CT scan showed pseudoaneurysm within the thoracic, subphrenic or subrenal aorta as well as acute hemorrhage in three patients. One of these was excluded from invasive treatment due to hopeless prognosis. In one patient primary aortoduodenal phistula was responsible for GI bleeding. Five patients were operated and prosthetic replacement of subrenal or iuxtarenal aortic portion together with aortorenal bypass in a couple of cases was performed. In eight patients stentgrafts (SG) of various types were deployed completed with femorofemoral crossover bypass when necessary. All patients were subject to long-standing antibiotic therapy. Two patients expired following SG insertion, all operated patients survived. Average follow-up has been 1 year (1-22 months) so far. A groin abscess was later drained in one patient. Neither CT nor isotope scanning showed persistent or recurrent infectious or hemorrhagic foci in any survivors whatsoever. The authors review and consider the doubtful indication of aortic SG deployment into the septic terrain in selected cases. Midterm results might justify its use in overly debilitated patients otherwise not eligible for radical operation due to its prohibitive risk.

Aged↗

PubMed2004

[Minilaparotomy as an access route to vascular reconstruction procedures in the aortoiliac region].

Following the example of general surgical procedures, also vascular surgery gradually minimizes the size of its surgical entrances. Miniinvasive surgical procedures significantly reduce postoperative complaints and shorten the patients recovery rates. Minilaparotomy, either a hand-assisted or a laparoscopy-assisted procedure, a procedure conducted fully via laparoscopy or thoracoscopy and a robot-assisted procedure, all of the above are contemporary options for miniinvasive procedures in the vascular surgery. The authors introduce their initial experience with the use of minilaparotomy in the aortoiliac region. From November 2002 to April 2004, 29 procedures were performed for the abdominal aortic aneurysm repair or for aortoiliac occlusive disease. In 15 cases the abdominal aortic aneurysm was managed and in 14 cases the aortoiliac occlusive disease was managed.

Aged↗

PubMed1998

[Spontaneous dissection of the left main coronary artery. Case report].

The case report of a 59 years old woman present with spontaneous dissection of the left main coronary artery including origins of its major branches is described here. The patient had emergency surgery and a triple ACEG was performed. The postoperative course was uneventful and a control angiogram proved both complete graft patency and absence of previous dissection. Six months following surgery the patient is doing well except for a minor effort dyspnea. The available literary experience with this rare and potentially fatal coronary condition is discussed in comments.

Aortic Dissection↗

PubMed1998

[A comprehensive approach to the treatment of popliteal artery aneurysms--personal experience].

UNLABELLED: During a five-year retrospective follow-up period the authors treated a group of 46 patients with the diagnosis of aneurysm of the popliteal artery (AAP). The group comprised 42 men (91%) and 4 women (9%). The mean age was 62 years. In 32 patients (69%) AAP was on both lower extremities, in the remaining 14 (31%) it was unilateral. Forty-one patients (90%) had surgery and a total of 48 AAP were operated. The remainder was treated by conservative methods (10%). The first symptoms of AAP in the investigated group were: claudication in 17%, thromboembolic complications in 46%, rupture of the AAP in 4%. An asymptomatic aneurysm was detected in 33%. RESULTS: The authors did not record any death or occlusion of the reconstruction during hospitalization. When using a vein the primary patency is 100%. When a prosthesis (PTFE) is used the results are worse but still satisfactory and the five-year secondary patency is 85%. Five patients with thromboembolic complications of AAP were successfully treated by i.a. fibrinolysis. In all exclusion of the aneurysm and revascularization of the extremity followed. In the conclusion the authors emphasize the necessity of early surgical treatment as soon as the condition is detected, before the development of thromboembolic complications of AAP. If they develop it is essential to attempt local fibrinolysis and in the second stage revascularization of the extremity, if possible by a vein.

Adult↗

PubMed1996

[Ruptured abdominal aortic aneurysm].

In the years 1990-1994, 43 patients with ruptured abdominal aortic aneurysms (RAAA) were operated on at the Department of Vascular Surgery of the Na Homolce Hospital in Prague. Men outnumbered women, average patient age was 70 years. The mean delay between onset of symptoms and hospital admission counted 27 hrs. Prior to transportation, one half to two thirds of patients went through at least two types of confirmative evaluation (CAT, ultrasound, angiography) and/or were referred via two or more hospital departments. In two thirds of patients profound shock with oligoanuria and hypotension were found. Anuria/hypotension proved to occur in a significantly lower rate in later survivors compared to later dead (11.8% vs. 23.5%: p < 0.05). Persistent hypotension during surgery together with eventual resuscitation as well as free blood found within the abdominal cavity showed up as further ominous factors. Renal failure was the leading postoperative complication (51.2%) with 27.9% of patients requiring hemodialysis after repair. Sepsis (25.6%), pneumonia (20.9%) and hemorrhage (13.9%) followed. Twenty-six patients were lost (60.5%) either within the first hours and days after surgery because of irreversible hemorrhagic shock or between the second and fourth week due to the sequels of organ failure and sepsis. In our cohort, regardless of age, sex, concomitant disease or the type of surgery, the patient's status on admission determined his/her further destiny. Urgent transfer to a specialized center going hand in hand with prompt and effective reanimation steps are the patient's only hope for survival.

Aged↗