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Diagnostics of pathological changes in vascular system and innovative methods of interventional therapy
Novák, Matěj ; Lambert, Lukáš (advisor) ; Křivánek, Jiří (referee) ; Cihlář, Filip (referee)
Purpose. The objective of the first study was to compare the results of primary patency of failing dialysis arterio-venous fistulas and grafts when using drug-coated balloon catheters in comparison with simple balloon catheters. The aim of the second study was to quantify perfusion changes on CT pulmonary angiography (CTPA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Methods. In the first study, a total of 76 patients were randomized to the study - 38 patients were treated with percutaneous transluminal angioplasty using a drug-coated balloon catheter, and 38 patients were treated with percutaneous transluminal angioplasty using a simple balloon catheter. Follow-up DSAs were performed at 3, 6, 9, and 12 months after baseline intervention. In the second study, CTPA in 58 patients with CTEPH were evaluated. The volume of the hypoperfused part of the lungs was measured using density thresholding in semi-automatically segmented lung volume and compared with hemodynamic parameters from catheterization. Results. In the first study, the primary patency in the PTA group with a drug-coated balloon catheter versus the PTA group with a simple balloon catheter was 86.7 ± 5.6% vs. 74.2 ± 7.4% at 3 months, 52.8 ± 8.4% vs. 25.6 ± 7.9% at 6 months, 21.8 ± 8.1% vs. 11.0 ± 5.9% at 9...
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Patency of dialysis fistulas in patients undergoing vascular interventional procedures.
Kaván, Jan ; Lambert, Lukáš (advisor) ; Chochola, Miroslav (referee) ; Beran, Jan (referee)
Purpose. The primary objective was to compare primary and secondary patency, number of percutaneous transluminal angioplasty (PTA) interventions and cost-effectiveness among PTA, deployment of a stent, or a stent graft in the treatment of failing arteriovenous dialysis grafts. The secondary objective was to compare the residual diameter at the site of dialysis shunt stenosis using sonography and digital subtraction angiography (DSA). Methods. Sixty patients were randomly assigned to either PTA, placement of a stent or stent graft. Follow-up angiography was scheduled at 3, 6, and 12 months or when requested by the physician. Residual diameter of a dialysis shunt stenosis was measured in 20 patients with significant stenosis by ultrasonography and on an angiogram from DSA. Results. During a median follow-up of 22.4 months patients with PTA, stent, or stent graft required 3.1±1.7, 2.5±1.7, or 1.7±2.1 (P=0.031) secondary PTA interventions. The primary patency rates were 0%, 18%, and 65% at 12 months and 0%, 18%, and 37% at 24 months in the PTA, stent, and stent graft group respectively (P<0.0001). The cost of the procedures was €7,900±€3,300 in PTA group, €8,500±€4,500 in stent group, and €7,500±€6,200 in stent graft group (P=0.45). The mean residual diameter measured by ultrasonography and DSA was...
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Percutaneous transluminal angioplasty of extracranial carotid arteries in comparison with the operating solution stenoses
VESELÁ, Lenka
My bachelor thesis "Percutaneous Transluminal Angioplasty of Intracranial Carotid Arteries Compared with Surgical Treatment of Stenoses" is divided into two parts.Theoretical part, is based on analysis of available sources containing publications and articles concerning with anatomy, radiological technologies, angelology, neurosurgery and neurology.The treatment is interdisciplinary.The choice of correct treatment plan is important. We must take account of patient's overall condition with his comorbidities and anticipated life expectancy. There is also discussed cerebrovascular reserve which has to be considered. It is worth mentioning that in the Nemocnice České Budějovice, a. s. České Budějovice Hospital is in collaboration with the University Illinois Center in Chicago a NOVA examination done.Patients with exhausted cerebrovascular reserve and patients with symptomatic stenoses are indicated to intervetional treatment (percutaneous transluminal angioplasty) or surgical (carotic endartectomy).My bachelor thesis was created with two objectives. The first one was comparison of economic aspects of the individual treatment methods.After analysis of the accessible materials were approximately quantified expenses on each method using DRG system. Results show that interventional procedure is more expensive. It is caused by costs of disposable intervetional radiology instrumentation. At surgical method are used cheaper instruments.Second objective was comparison of individual procedures performance in relation to resocialization. It was compared the hospitalization period and the period for which it is possible to return to work. It is necessary to compare similar patients, i.d. patients with no complications after angioplasty and patients with no complications after endarterectomy. Results show that duration of hospitalization is comparable.Time after which is patient able to return to work is very individual. The time depends on type and content of the work. It could be said that after interventional procedure is minimal traumatization and painfulness, so that patients can return back without complications into work soon after discharge. In the conclusion, it has to be said that quantification of expenses was not optimal. Professional community in cooperation with National Reference Centre tries to redress methodology for reporting and subsequent payment performances by insurance companies.On the subject of comparing carotid stenting and endarterectomy in terms of appropriate indications, safety performance and profit performance of the patient, there were several studies. One also takes place contemporary. There was not proved that one of the treatment modalities were clearly better.
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