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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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The role of radiographer during MR angiography
ZBĚHLÍKOVÁ, Pavla
The role of radiographer during MR angiography Objectives: The thesis and the tutorial CD provide information on the magnetic resonance angiography {--} MRA. Due to upgraded hardware and software and the non-invasive character of the examination the method is currently the most common form of the imaging of flowing blood in vessels. It is essential for a radiographer to acquire comprehensive knowledge of the basic principles and techniques of MRA. The objective of my thesis was to find out if the method can be used not only for a high-quality imaging of the arteries but also for subsequent therapeutical procedures. Methodology: The research was conducted with 106 patients (66 men and 40 women) whose lower limb arteries had been tested by MRA between 1 January and 31 December 2007 at the Multiscan RC Pardubice. I determined the number of patients who had undergone a therapeutical procedure after the MRA test (operations on arteries, percutaneous transluminal angioplastics) and assessed to what degree the MRA examination had been sufficient for the surgery. Results: In 91 % out of 46 patients indicated for therapeutical procedures the results obtained by MRA enabled other treatment or a surgical procedure. Only in 9 % patients the results obtained by MRA were not sufficient for other medical treatment and suplementary examinations such as the diagnostic digital subtraction angiography were necessary. Conclusions: MRA is a non-invasive medical diagnostic technique to visualize the blood in vessels which provide satisfactory accuracy without exposing the patient to any ionizing radiation. The results are used for other treatments. Radiographers who master the MRA techniques avoid mistakes that might devalue the test. Key words: digital subtraction angiography, magnetic resonance angiography, magnetic resonance imaging, percutaneous transluminal angioplastics, radiographer {--} radiologic technologist.
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