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Thoracic aorta wall pathology: diagnosis, stentgraft placement, indications, strategy and procedure technique, clinical results
Novotný, Jiří ; Krajina, Antonín (advisor) ; Chochola, Miroslav (referee) ; Roček, Miloslav (referee)
Thoracic aorta wall pathology: diagnosis, stentgraft placement, indications, strategy and procedure technique, clinical results Aim. Our single-center study was designed to assess management of thoracic aorta using a stent graft in individual types of pathology. While focused on the technical success rates and efficacy of management, the study also sought to document the incidence of intra- procedural complications and to assess the rate of sac growth and endoleak incidence. Method. A total of 86 patients with thoracic aorta disease were treated using a stent graft over a period of 12 years. They were 24 women and 62 men with a mean age 58.5 years. Late CT follow-up was performed in 75 patients, 31 (36%) were lost to follow-up, most (25) patients died. The most frequent reason (50%) for treatment included size of the aneurysmal sac, with progressive sac growth accounting for 19%. Results. Complications were rare, with most serious ones including 6 cases (7%) of hemorrhage, 3 fatal cases, with the other cases (peripheral bleeding) managed by a surgeon. Primarily intractable endoleak documented by DSA was observed in 9 treated patients (10%). The most frequent CT-documented endoleak was Type I endoleak diagnosed in 18 treated patients (20%). Spontaneous endoleak regression was demonstrated in 6...
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Biomarkers, intravascular ultrasound and near-infrared spectroscopy in the assessment of vulnerable atherosclerotic plaque
Štěchovský, Cyril ; Hájek, Petr (advisor) ; Krajina, Antonín (referee) ; Kaňovský, Jan (referee)
Biomarkers, Intravascular Ultrasound and Near-Infrared Spectroscopy in the Assessment of Vulnerable Atherosclerotic Plaque Abstract The thesis describes pathophysiology of a vulnerable atherosclerotic plaque, detection of the vulnerable plaque in the stenosis of the internal carotid artery (ICA), and optimalization of carotid stenting (CAS) with near-infrared spectroscopy (NIRS) and intravascular ultrasound (IVUS) imaging. NIRS detects lipid core of the vulnerable lipid rich plaque (LRP). We demonstrated safety of NIRS-IVUS imaging during CAS. LRP was detected in one third of ICAs before CAS. Lipid signal was not correlated with plaque morphology (IVUS), biomarkers or clinical variables. CAS caused significant decrease of the lipid signal. Angiography overestimated severity of stenosis of the ICA and vastly underestimated residual stenosis after CAS. Presence of the LRP in the stenosis was neither associated with periprocedural neurological complications of CAS nor long-term adverse cardiovascular events. IVUS identified planimetric features associated with long-term restenosis or stent occlusion. After a median follow-up of 31 months, repeated NIRS-IVUS of the implanted stents showed significant expansion of the stents, diffuse neointimal hyperplasia and further reduction of the lipid signal. We assume,...
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Utilization of CTA and CTP in Middle Cerebral Artery Stroke
Cimflová, Petra ; Krajina, Antonín (advisor) ; Neuwirth, Jiří (referee) ; Procházka, Václav (referee)
Introduction: Diagnostic imaging has a crucial role in the diagnosis and therapeutic management of acute ischemic stroke (AIS). The main aim of this thesis was to further evaluate the utilization of CTA and CT perfusion (CTP) in the diagnosis and treatment decision in patients with AIS caused by the occlusion of the middle cerebral artery. Methods: Study in Chapter 2 evaluated the automatically derived CT perfusion lesion volumes (PLV) and hypoperfusion intensity ratio (HIR) with collateral score using multiphase CTA (mCTA) (Kruskal-Wallis, Wilcoxon rank-sum test and Spearman's rho correlation coefficients were calculated). In study in Chapter 3, the assessment of ischemic changes by expert reading and available automated software for non-contrast CT and CTP was compared (the sensitivity, specificity, positive and negative predictive value were calculated). In Chapter 4, the performance of StrokeSENS software tool in detection of anterior large vessel occlusions (LVO) was tested (receiver operator characteristics analysis). Study in Chapter 5 investigated whether prediction of clinical outcome and final infarct volume can be improved by collateral status assessment on time-variant color-coded mCTA (multivariable logistic regression). The aims in Chapter 6 were to determine if mCTA-derived tissue...
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Endovascular Treatment of Arteriovenous Fistula for Dialysis
Vorčák, Martin ; Krajina, Antonín (advisor) ; Peregrin, Jan (referee) ; Procházka, Václav (referee)
Endovascular treatment of arteriovenous fistula for dialysis Aim: Aim of presented retrospective study was to evaluate the primary patency of angioplasty using a drug eluting balloon (DEB) and conventional balloon (PTA) in dysfunctional dialysis fistula. Methods: 58 adult patients treated for fistula dysfunction in the period from 2015 to 2018 were enrolled based on following criteria - matured native fistula with stenosis above 50 % compared to the adjacent healthy vein. Patients with restenosis, swing point, cephalic arch, and central vein stenosis, and multiple distant stenoses were ruled out. Patients were divided into two groups according to received treatment - DEB and PTA. Primary patency of angioplasty was defined as the function of dialysis without the need for clinically driven endovascular or surgical intervention on culprit lesion during follow-up. Secondary, dialysis access patency, 12-month assisted patency, technical, clinical success, complication rate, and mortality among treated groups were evaluated. Results: Primary patency at 6 and 12 months follow up was evaluated in 25 patients in the DEB and 25 patients in the PTA group. Primary lesion and access patency were in DEB vs. PTA: 96 % vs. 76 % (p = 0,1) and 96 % vs. 72 % (p = 0,049) at 6 months, 80 % vs. 56 % (p = 0,13), 80 % vs....
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Translumbar Central Venous Hemodialysis Catheters
Jonszta, Tomáš ; Krajina, Antonín (advisor) ; Roček, Miloslav (referee) ; Michálek, Pavel (referee)
Translumbar Central Venous Hemodialysis Catheters Aim: Hemodialysis catheter translumbal placement enables high quality venous access in patients with exhausted usual venous routes. The aim of this study is to evaluate technical success of catheter insertion and long-term patency of translumbar hemodialysis catheters (TLC) and to compare the results with standard tunnelized hemodialysis catheters inserted via internal jugular vein (SC). Material and methods: Between 2010 and 2018 translumbar dialysis catheter (TLC) was inserted in 37 patients in whom occlusion of internal jugular and brachiocephalic veins precluded standard implantation route. 17 (45,9 %) men and 20 (54,1 %) women were treated with age median 64,0 years, range 41-89 years. The TLC patients were compared with standard tunnelized heamodialysis internal jugular catheter patients (SC), in whom procedures were performed in the same time period. SC was placed in 196 patients, 113 (57,7 %) men and 83 (42,3 %) women, with age median 68,5 years, range 16-91 years. Results: The total time of follow up for the TLC patients was 1-2097 days with median 673 days, while the follow up for the SC pacients was 1-2915 days with median 310 days. Technical success rate for the insertion was 97,4 % in the TLC group and 98,6 % in the SC group. Periprocedural...
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Transjugular intrahepatic portosystemic shunt: long-term patency in patients with hypercoagulation disorder
Renc, Ondřej ; Krajina, Antonín (advisor) ; Válek, Vlastimil (referee) ; Lata, Jan (referee)
Transjugular intrahepatic portosystemic shunt: long-term patency in patients with hypercoagulation disorder Aim: To retrospectively evaluate the efficacy and long-term patency of transjugular intrahepatic portosystemic shunt (TIPS) in patients with hepatic vein thrombosis due to hypercoagulation disorder. Material and method: In years 1992 - 2011, totally 38 patients with hepatic vein thrombosis resistant to medical therapy underwent TIPS creation in our department. We treated 9 males and 29 females, age 13 - 76 years (median 33 years), 6 patients were children. The underlying thrombophilic state was confirmed in 84,2 % of treated patients. The Budd-Chiari syndrome was acute in 6, subacute in 18 and chronic in 14 cases. Ascites was indication for TIPS in 31 patients, liver failure in 5 and gastrointestinal bleeding in 2 persons. All the procedures were performed in analgosedation or under general anestesia using standard technique. In 17 patients, we implanted non-covered stent or combination of non-covered and covered stents during TIPS creation, in the other 21 patients only the TIPS dedicated covered stents had been used. TIPS patency during follow-up after the procedure was based on regular ultrasonographic, clinical and laboratory examinations. In case of shunt dysfunction, a reintervention was...
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Use of TIPS Procedure for Treatment of Portal Vein Thrombosis
Čabelková, Pavla ; Krajina, Antonín (advisor) ; Urbánek, Petr (referee) ; Zeleňák, Kamil (referee)
Summary: Aim: Purpose of this study was to evaluate and to compare the treatment of patients with acute portal vein thrombosis (PVT) in a group with liver cirrhosis and in group without cirrhosis. Patients were treated with TIPS. The data in this study were collected retrospectivly and prospectivly. Methods: Patients with PVT were selected from the group of patients treated with TIPS procedure between years 2000 and 2019. Patients with chronic PVT and portal cavernoma and patients with tumorous thrombosis were excluded. Patients with acute PVT were divided into two groups - group with liver cirrhosis (LC) and group without cirrhosis. We evaluated size and localization of thrombus. In a group of patients who underwent thrombolysis (TL) for the portal vein (PV) recanalisation we evaluated amount and severity of hemorrhagic complications. We also evaluated primary patency, primary assisted patency and secondary patency of shunt. Thirty-day and 1-year mortality was observed in the group with the LC and without LC and survival was assessed in the whole group and separately in both subgroups. We used the same technique to gain access to PV in all patients. Shunt in the liver parenchyma was created using bare metal stent or stentgraft. Results: The whole group with acute PVT treated with TIPS consisted of 74...
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Translumbar Central Venous Hemodialysis Catheters
Jonszta, Tomáš ; Krajina, Antonín (advisor) ; Roček, Miloslav (referee) ; Michálek, Pavel (referee)
Translumbar Central Venous Hemodialysis Catheters Aim: Hemodialysis catheter translumbal placement enables high quality venous access in patients with exhausted usual venous routes. The aim of this study is to evaluate technical success of catheter insertion and long-term patency of translumbar hemodialysis catheters (TLC) and to compare the results with standard tunnelized hemodialysis catheters inserted via internal jugular vein (SC). Material and methods: Between 2010 and 2018 translumbar dialysis catheter (TLC) was inserted in 37 patients in whom occlusion of internal jugular and brachiocephalic veins precluded standard implantation route. 17 (45,9 %) men and 20 (54,1 %) women were treated with age median 64,0 years, range 41-89 years. The TLC patients were compared with standard tunnelized heamodialysis internal jugular catheter patients (SC), in whom procedures were performed in the same time period. SC was placed in 196 patients, 113 (57,7 %) men and 83 (42,3 %) women, with age median 68,5 years, range 16-91 years. Results: The total time of follow up for the TLC patients was 1-2097 days with median 673 days, while the follow up for the SC pacients was 1-2915 days with median 310 days. Technical success rate for the insertion was 97,4 % in the TLC group and 98,6 % in the SC group. Periprocedural...
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Multidetector row computed tonography in trauma - influence of the localization, size and density of active extravasation on subseduent clinical management
Cihlář, Filip ; Krajina, Antonín (advisor) ; Chmelová, Jana (referee) ; Köcher, Martin (referee)
Detection rate of active bleeding and number of nonoperative treatment is increasing in trauma evaluated by whole-body multi-detector row computed tomography (MDCT) imaging. The aim of the study is to evaluate a MDCT detection of the active bleeding in trauma patients. We reviewed MDCT images for the presence of active hemorrhage in our data files. The site and number of the bleeding sites was noted. The size, area, density and relative density of the hemorrhage was noted, together with the nature and size of the surrounding hemorrhage hematoma. We also evaluated clinical factors as age, sex, the Injury Severity Score (ISS), Glasgow Coma Scale (GCS), systolic blood pressure on admission (SBP), heart rate (HR), hemodynamic status of the patient (HDO) and fluid resuscitation. Results were compared with clinical follow up or intraoperative findings (nonoperative management vs. intervention, dead or alive pts. in 30 day). The authors evaluated consecutive trauma patients examined between 2004-2008 and 2010-2013 who underwent whole-body or abdominal MDCT, and were examined 967 patients. Active bleeding was detected in 128 (13,2 %) of 967 patients. A total of 183 sources of active extravasation were identified. Eighty-six (47 %) of 183 bleeding sites underwent immediate intervention - surgical or...
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