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Purpose: To report the results of a prospective, single-arm study to establish whether the initial treatment of acute or subacute limb ischemia (ALI and SLI, respectively) can be accomplished successfully using endovascular mechanical debulking of the target vessels to avoid the risks associated with thrombolysis and/or open surgery. Materials and Methods: From April 2009 to April 2015, 316 consecutive patients (mean age 70.9±12 years; 184 men) with ALI (202, 63.9%) or SLI (114, 36.1%) were enrolled; the only exclusion criterion was irreversible ischemia. The ALI group included 146 (72.3%) participants with category IIb ischemia and 56 (27.7%) with category IIa. Critical limb ischemia was diagnosed in 74 (64.9%) of the 114 patients with SLI. Target occlusions of thrombotic (n=256) or embolic (n=60) origin were located in the femoropopliteal segment (n=231), prosthetic or venous femoropopliteal bypass grafts (n=75), and the aortoiliac segment (n=35). The mean occlusion length was 22.9±14.8 cm. Results: The overall technical success (residual stenosis ≤30%) was 100% after debulking and adjunctive techniques (aspiration, dilation, stenting) at the level of the target lesions. No open surgical or thrombolytic modalities were necessary to bypass or recanalize the target vessels, and no death occurred in association with target occlusion therapy. Additional infrapopliteal interventions were performed in 195 (61.7%) patients (adjunctive thrombolysis in 29) to treat acute, subacute, and chronic lesions. Minor complications directly related to the debulking procedure occurred in 26 (8.2%) patients. Serious complications occurred in 11 (3.5%) patients, including hemorrhage in 8 (2.5%) patients (associated with infrapopliteal thrombolysis in 5). At 30 days, primary and secondary patency rates were 94.3% and 97.2%, respectively; mortality was 0.3% (1 fatal intracranial hemorrhage after adjunctive thrombolysis). Of 229 patients eligible for 1-year follow-up, amputation-free survival was estimated to be 87.4% in 199 patients with available data. Conclusion: In this all-comers study, mechanical debulking with the Rotarex alone or with adjunctive techniques is feasible as a primary therapy for occluded supratibial vessels in patients with ALI or SLI.

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Summary. We have evaluated the effect of successful pancreatic and kidney transplantation on autonomic neuropathy in nine Type 1 (insulin-dependent) diabetic subjects. Cardiovascular reflex tests were performed before and at 6-24 months after transplantation. A control group of ten Type I diabetic patients after kidney grafting only was examined at the same time periods. For base-line comparisons results of the tests in ten healthy subjects were used. Advanced autonomic neuropathy was present in both groups of transplant recipients and no significant changes in test results could be found at post-transplant evaluation. Lack of autonomic nerve function improvement was confirmed in seven patients of the pancreatic and kidney transplantation group who were examined again after 2-4 years. Irreversible structural autonomic nerve damage is probably present in uraemic pancreatic transplantation candidates.

We have demonstrated a potential advantage of the sutureless Symmetry Aortic Connector System as a suitable approach that affords minimal access. Video-assisted multivessel revascularization through a left anterior small thoracotomy approach with an automated mechanical anastomosis device is particularly useful in patients undergoing coronary artery bypass reoperations or those at risk of poor sternal healing or infection. This approach seems to be a safe alternative to standard median sternotomy.

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Falešné aneuryzma-pseudoaneuryzma (PSA)-levé komory se vytvoří, pokud se ruptura srdeční stěny překryje a ohraničí perikardem ve vak, který dále komunikuje úzkým krčkem s dutinou levé komory. (1) Patogeneze vzniku ruptury srdeční stěny je komplexní proces ovlivněný řadou faktorů. (2) Pokud se vyvine PSA, jde o tenkostěnný útvar tvořený perikardem a organizovaným hematomem bez endokardu či myokardu, na rozdíl od pravého aneuryzmatu. (3) Jeho výskyt je vzácný, prevalence neznámá a prognóza vážná. Diagnostickým zlatým standardem byla ventrikulografie (diagnostická přesnost ≥ 85 %). (4) V současné době se dává přednost magnetické rezonanci (MR) a echokardiografii (ECHO). (5) V praxi se obvykle