Vaskulárna medicína ABSTRAKTY jún 2013, Tatranská Lomnica, Vysoké Tatry. ISSN

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1 Vaskulárna medicína S ISSN ABSTRAKTY XXI. Slovenský angiologický kongres spojený so 6. kurzom Central European Vascular Forum The 21 st Slovak Angiological Congress joint with the 6th Educational Course of Central European Vascular Forum jún 2013, Tatranská Lomnica, Vysoké Tatry

2 2 Informácie Vaskulárna medicína Suplement 3 Samostatne nepredajná príloha. Citačný index: Vask. med. Supl. Vychádza ako príloha časopisu Vaskulárna medicína. Časopis je indexovaný v Bibliographia Medica Slovaca (BMS). Citácie sú spracované v CiBaMed. Spracovala spoločnosť SOLEN, s. r. o., vydavateľ časopisu Vaskulárna medicína Adresa redakcie: SOLEN, s. r. o., Lovinského 16, Bratislava, solen@solen.sk Redaktorka: Magdaléna Žiaková, ziakova@solen.sk Obchodné oddelenie: Ing. Monika Liedlová, liedlova@solen.sk Grafická úprava a sadzba: Ján Kopčok, kopcok@solen.sk Vydavateľ nenesie zodpovednosť za údaje a názory autorov jednotlivých článkov či inzerátov. Za obsahovú správnosť príspevkov zodpovedajú autori. Reprodukcia obsahu je povolená len s priamym súhlasom redakcie. ISSN Vaskulárna medicína Suplement ; 5(S3)

3 Informácie 3 XXI. Slovenský angiologický kongres spojený so 6. kurzom Central European Vascular Forum pod záštitou Ing. Jána Mokoša, primátora mesta Vysoké Tatry a Spectabilis Prof. MUDr. Petra Labaša, CSc. dekana Lekárskej fakulty Univerzity Komenského v Bratislave The 21 st Slovak Angiological Congress joint with the 6th Educational Course of Central European Vascular Forum under the auspices of Ing. Ján Mokoš the Mayor of Vysoké Tatry and Spectabilis prof. MUDr. Peter Labaš, PhD. the Dean of the Medical Faculty Comenius University in Bratislava Usporiadateľ (Organizer): Slovenská angiologická spoločnosť Slovenskej lekárskej spoločnosti (S.A.S. SLS) + Central European Vascular Forum Miesto konania (Congress venue): Hotel SOREA TITRIS Odborár, TATRANSKÁ LOMNICA, Vysoké Tatry, Slovak republic, sorea@titris.sk Dátum (Date): ; 5(S3) Vaskulárna medicína Suplement 3

4 4 Odborný program STREDA WEDNESDAY Veľká sála (Lecture hall A) Prednáškový blok č. 1 (Scientific Session No 1) HOJENIE RÁN (WOUND HEALING) Prednáškový blok organizovaný v spolupráci so Slovenskou spoločnosťou pre liečenie rán SLS Predsedníctvo: E. Ambrózy (Bratislava) M. Čambal (Bratislava) J. Koller (Bratislava) 1. Proces hojenia rán patofyziologické a klinické aspekty (Pathophysiological and clinical aspects of the wound healing process) J. Koller, M. Huťan, T. Kopal, D. Karasová, E. Huľo, Klinika popálenín a rekonštrukčnej chirurgie LF UK a UNB, Bratislava 2. Druhy debridementu a ich význam v manažmente rany (Methods of debridement and their importance in wound management) M. Čambal, M. Huťan, T. Kopal, J. Koller, D. Karasová, E. Huľo, I. chirurgická klinika LF UK a UNB, Bratislava 3. Inflamačná a granulačná fáza hojenia rán, patofyziologia a manažment (Inflammation and granulation phase of wound healing, patophysiology and management) M. Huťan, M. Čambal, T. Kopal, J. Koller, D. Karasová, E. Huľo, II. chirurgická klinika LF UK a UNB, Bratislava 4. Re-epitelizácia rán a možnosti jej podpory u dlhodobo sa nehojacich kožných defektov (Re-epithelization of the wounds and possibilities of its enhancement in long-term non-healing skin defects) E. Huľo, D. Karasová, M. Čambal, M. Huťan, T. Kopal, J. Koller, L. Strelka, M. Vojtko, Chirurgická klinika JLF UK a UN, Martin 5. Kontaktné alergie u pacientov s vredom predkolenia (Contact alergies in patients with leg ulcers) T. Kopal, M. Čambal, M. Huťan, J. Koller, D. Karasová, E. Huľo, Kožné oddelenie NsP, Považská Bystrica 6. Diferenciálna diagnostika a liečba kožných vaskulitíd problém stále aktuálny (Differential diagnostics and therapy of cutaneous vasculitis a topical issue) H. Zelenková, DOST, Svidník 7. Ulcus cruris mixtum (Ulcus cruris mixtum) E. Ambrózy, II. interná klinika LF UK a UNB, Bratislava Kávová prestávka Prednáškový blok č. 2 (Scientific Session No 2) BLOK MLADÝCH ANGIOLÓGOV (SESSION OF YOUNG ANGIOLOGISTS) Predsedníctvo: J. Maďarič (Bratislava) V. Štvrtinová (Bratislava) 8. Súčasné trendy v manažmente pacientov s aneuryzmou artéria poplitea (Current strategies in management of patients with popliteal artery aneurysm) K. Vavrovičová, J. Tomka, R. Bažík, T. Dulka, E. Marton, I. Vulev, Klinika cievnej chirurgie a Oddelenie diagnostickej a intervenčnej rádiológie, NÚSCH, Bratislava 9. Manažment pacientov s CLI v rokoch 2001 a 2010 retrospektívna analýza aký je dopad rozvoja endovaskulárnej liečby na prognózu pacienta s CLI? (Managment of patients with CLI between 2001 and 2010 retrospective analysis) M. Širila, I. Litvin, O. Herman, Angiologické oddelenie VÚSCH, Košice, Rádiologické oddelenie FN Trenčín a Interné oddelenie FN, Trenčín Vaskulárna medicína Suplement ; 5(S3)

5 Odborný program Karotický stenting u pacientov pred neodkladnou kardiochirurgickou operáciou (Carotid artery stenting prior to urgent cardiac surgery) K. Kmeťková, SÚSCCH, Banská Bystrica 11. Odstrániteľné kaválne filtre indikácie implantácie a klinické sledovanie (Retrievable vena cava filters indications and clinical monitoring) M. Šumaj, J. Maďarič, Interné odd., FN Trenčín a Odd. kardiológie a angiológie, NÚSCH Bratislava 12. Nízke TSH redukuje výskyt venózneho tromboembolizmu (Low TSH reduces the events of venous thromboembolism) M. Nagyová, T. Petrovič, Z. Zelinková, T. Koller, J. Payer, V. interná klinika LF UK a UNB, Bratislava Prednáškový blok č. 3 (Scientific Session No 3) Blok pracovnej skupiny Intervenčnej angiológie S.A.S. (Session of the Working Group of Interventional Angiology of S.A.S) NOVÉ POSTUPY V ENDOVASKU- LÁRNEJ LIEČBE KKI (NEW METHODS IN THE ENDOVASCULAR TREATMENT OF CLI) Predsedníctvo: Ľ. Špak (Košice) I. Vulev (Bratislava) 13. DEB (liečivom poťahované balóny) v liečbe kritickej končatinovej ischémie (DEB in treatment of CLI) M. Vozár, J. Sivák, K. Kmeťková, I. Striežová, Oddelenie rádiológie a Oddelenie kardiológie SÚSCCH, Banská Bystrica 15. Aterektómia v liečbe končatinovej ischémie (Aterectomy in the treatment of limb ischemia) I. Vulev, Odd. diagnostickej a intervenčnej rádiológie, NÚSCH, Bratislava 16. Antitrombotická liečba u pacientov po periférnych vaskulárnych intervenciách (Antithrombotic treatment in patients after peripheral vascular interventions) J. Maďarič, Oddelenie kardiológie a angiológie, NÚSCH, Bratislava Plenárne zasadnutie S.A.S. SLS (Plenary assembly of the members of the Slovak Angiological Society) Program: 1. V. Štvrtinová: Slovenská angiológia v roku 2013 Voľby do výboru S.A.S. SLS na roky E. Ambrózy: Správa o činnosti S.A.S. SLS za obdobie október 2012 jún 2013 Správa o finančnom hospodárení S.A.S. SLS za rok A. Mistrík: Správa hlavného odborníka MZ SR pre angiológiu 4. O. Bzdúchová: Správa dozornej rady 14. DES liečivom poťahované stenty v liečbe končatinovej ischémie (DES drug eluting stents in the treatment of limb ischemia) Ľ. Špak, Oddelenie angiológie, VÚSCH, Košice ; 5(S3) Vaskulárna medicína Suplement 3

6 6 Odborný program STREDA WEDNESDAY Malá sála Lecture hall B Zasadnutie výboru S.A.S. SLS (Meeting of the S.A.S. executive committee) Prednáškový blok č. 4 (Scientific Session No 4) AKÚTNA KONČATINOVÁ ISCHÉMIA (ACUTE LIMB ISCHAEMIA) Predsedníctvo: A. Mistrík (Bratislava) Ľ. Špak (Košice) 17. Akútna končatinová ischémia definícia, diagnostika, algoritmy terapie (Acute limb ischemia definition, diagnostic, terapeutic algorithm) M. Širila, Angiologické oddelenie Kardiologickej kliniky, VÚSCH, Košice 18. Lokálna trombolytická liečba akútnej končatinovej ischémie (Acute limb ischemia treated with local thrombolytic therapy) Š. Pataky, Ľ. Špak, Angiologické oddelenie Kardiologickej kliniky, VÚSCH, Košice 19. Mechanická trombektómia (Mechanical thrombectomy) M. Moščovič, Angiologické odd. kliniky kardiológie, VÚSCH, Košice 20. Úloha farmakomechanickej trombektómie v liečbe aktútnej končatinovej ischémie (Role of pharmacomechanical thrombectomy in the treatment of acute limb ischemia) T. Balázs, I. Vulev, R. Bažík, A. Klepanec, Oddelenie diagnostickej a intervenčnej rádiológie, NÚSCH, Bratislava Prednáškový blok č. 5 (Scientific Session No 5) CHOROBY TEPIEN (ARTERIAL DISEASES) Predsedníctvo: J. Kmec (Košice) S. Oravec (Bratislava) P. Wohlfahrt (Praha) 21. Karotická intimo-mediálna hrúbka a indexy arteriálnej tuhosti ako prediktívne ukazovatele vzniku infarktu myokardu a cerebrálneho infarktu (Carotid intima-media thickness and indices of arterial stiffness as the predictors of myocardial infarction and cerebral infarction) L. Danihel, D. Bartko, Z. Gombošová, Ústav medicínskych vied, neurovied a vojenského zdravotníctva, Ústredná vojenská nemocnica fakultná nemocnica SNP, Ružomberok 22. Aortic stiffness and carotid flow pulsatility in stroke survivors P. Wohlfahrt, Thomayerova nemocnice, IKEM, Praha, Česká republika 23. Stimulácia baroreceptorov podporuje NOdependentnú vazodilatáciu, možné uplatnenie pri diabete a kardiovaskulárnych ochoreniach (Baroreceptor stimulation enhanced NOdependent vascular dilation a new treatment for diabetic and cardiovascular conditions) J. Gmitrov, The National Institute of Public Health, Tokyo, Japan; Všeobecná nemocnica Pro Vitae n. o.; Gelnica, NsP Krompachy 24. Migračná pozícia lipoproteínu (a) v spektre sérových lipoproteínov, identifikovaná systémom Lipoprint LDL (Migration position of Lipoprotein (a) in lipoprotein spectrum of serum lipoproteins identified by Lipoprint LDL system) S. Oravec, M. Kučera, P. Sabaka, E. Dostal, II. interná klinika LF UK a UNB, Bratislava a Krankenanstalten Labor Dr. Dostal, Vienna, Austria Vaskulárna medicína Suplement ; 5(S3)

7 Odborný program Vaskulitídy ako zriedkavá príčina claudicatio intermittens (Vasculitides as a rare cause of intermittent claudication) Z. Celecová, B. Krahulec, D. Ližičárová, Ľ. Gašpar, V. Štvrtinová, II. interná klinika LF UK a UNB, Bratislava Kávová prestávka ŠTVRTOK THURSDAY Veľká sála (Lecture hall A) Prednáškový blok č. 6 (Scientific Session No 6) ARTÉRIOVÁ HYPERTENZIA (ARTERIAL HYPERTENSION) Predsedníctvo: J. Maďarič (Bratislava) T. Ostrowski (Warsaw) E. Szabóová (Košice) 26. Špecifiká liečby artériovej hypertenzie u chorých a ochoreniami periférnych artérií (Specifications of hypertension treatment in patients with peripheral artery diseases) E. Szabóová, M. Bavoľárová, M. Pavúková, D. Kmecová, D. Holoubek, IV. interná klinika, LF UPJŠ, V. interná klinika LF UPJŠ, Angiologická ambulancia Angiocare a Kardiologická klinika VÚSCH, Košice 27. Rádiofrekvenčná renálna sympatiková denervácia u pacientov s rezistentnou artériovou hypertenziou 3-mesačné sledovanie (Radiofrequency renal sympathetic denervation in patients with resistant hypertension 3-months follow-up results) J. Maďarič, M. Tóth, T. Urlandová, D. Hladíková, J. Margitfalviová, L. Fľak, J. Mikuláš, E. Drangová, L. Postulková, A. Mistrík, P. Chnupa, I. Vulev, Oddelenie kardiológie a angiológie, NÚSCH, Bratislava 28. Long-term results of percutaneous angioplasty of the renal artery, according to recent multicenter studies (ASTRAL & CORAL) A. Kosicki, T. Ostrowski, A. Kulesza, M. Szostek, M. Skórski, M. Januszewicz, O. Rowiński, Medical University of Warsaw, Department of General and Thoracic Surgery and II Department of Radiology, Warsaw, Poland 29. Systémové vaskulitídy vzácne príčiny renovaskulárnej hypertenzie (Systemic vasculitides a rare cause of renovascular hypertension) E. Hirnerová, M. Kučera, Z. Celecová, K. Podolinská, V. Štvrtinová, II. interná klinika UN a LF UK Bratislava a I. rádiologická klinika UN a LF UK, Bratislava 30. Ovplyvnenie vaskulárneho rizika a kontrola tlaku krvi u pacientov s periférnym artériovým ochorením dolných končatín (Vascular Risk Treatment and Blood Pressure Control in Patients with Peripheral Arterial Disease of Lower Extremity) D. Čelovská, Z. Celecová, K. Letková, E. Ambrózy, V. Štvrtinová, II. interná klinika, LF UK a UNB, Bratislava 31. Benfotiamín a endotelová dysfunkcia (Benfotiamine and endothelial dysfunction) E. Ambrózy, II. interná klinika LF UK a UNB, Bratislava Kávová prestávka ; 5(S3) Vaskulárna medicína Suplement 3

8 8 Odborný program Prednáškový blok č. 7 (Scientific Session No 7) CHRONICKÉ ŽILOVÉ OCHORENIE (CHRONIC VENOUS DISEASE) Podporené edukačným grantom spoločnosti SERVIER Predsedníctvo: Z. Rybak (Wroclaw) V. Štvrtinová (Bratislava) F. Žernovický jr. (Bratislava) 32. Optimal management of CVD: place of MPFF as drug in the latest international guidelines Z. Rybak, Departmant of Experimental Surgery and Biomaterials Research, Wroclaw, Poland 33. Bolesť končatín u pacientov s CHVO (Extremities pain in patients with CVD) V. Štvrtinová, S. Štvrtina, II. interná klinika a Ústav patologickej anatómie, Univerzita Komenského, Lekárska fakulta, Bratislava 34. Čo vieme ponúknuť pacientovi s kmeňovou varikozitou v roku 2013? (What can we offer to the patient with trunk varicosis in the year 2013?) F. Žernovický jr, E. Marton, K. Žernovická, K. Kanáliková, J. Tomka, V. Šefránek, Klinika cievnej chirurgie NÚSCH a ANGIO privátna angiochirurgická ambulancia, Bratislava Slávnostné otvorenie kongresu (Official opening ceremony) Príhovory hostí (Welcome greetings) J. Kmec, K. Roztočil: Spomienka na MUDr. Alexandra SCHIRGERA prvého československého profesora na Mayo Clinic Klavírny koncert (Jozef Hollý) Obedová prestávka Prednáškový blok č. 8 (Scientific Session No 8) CHOROBY AORTY a TEPIEN (AORTIC AND ARTERIAL DISEASES) Predsedníctvo: M. Holomáň (Bratislava) P. Poredos (Ljubljana) M. Szostek (Warsaw) V. Šefránek (Bratislava) 35. Nové trendy v kardiochirurgii (New trends in cardiac surgery) M. Holomáň, Klinika srdcovej chirurgie, NÚSCH, Bratislava 36. One center experience with endovascular treatment of thoracic aorta dissection type B M. M. Szostek, W. Jakuczun, R. Pogorzelski, T. Ostrowski, M. Szostek, General and Thoracic Surgery Dept. Warsaw Medical University, Warsaw, Poland 37. How to defect vulnerable atherosclerotic lesions and its clinical relevance P. Poredos, Dept. of Vascular Diseases, University Medical Centre, Ljubljana, Slovenia 38. AAA naše výsledky za posledných 5 rokov (AAA our results in the last 5 years) V. Sihotský, M. Frankovičová, M. Kubíková, Klinika cievnej chirurgie, VÚSCH, Košice 39. Naše najnovšie skúsenosti v karotickej chirurgii (Our recent experience in carotid surgery) V. Šefránek, J. Tomka, Z. Zita, T. Dulka, Klinika cievnej chirurgie NÚSCH, Bratislava 40. Dlouhodobé výsledky trombektomie Rotarexem u akutních a subakutních uzávěrů periferních tepen a bypassů (Long-term results after Rotarex thrombectomy of acute and subacute occlusions of peripheral arteries and bypasses) F. Staněk, R. Ouhrabková, D. Procházka, Radiodiagnostické oddělení, Oblastní nemocnice Kladno, Česká republika Vaskulárna medicína Suplement ; 5(S3)

9 Odborný program Prednáškový blok č. 9 (Scientific Session No 9) AKTUALIZÁCIA HNMH V MANAŽMENTE VTE (ACTUALIZATION OF LMWH IN THE MANAGEMENT OF VTE) Podporené edukačným grantom spoločnosti SANOFI Predsedníctvo: M. Hulíková (Košice) I. Vacula (Bratislava) 41. Končí sa éra HNMH v profylaxii a terapii VTE? (Is this really the end of the period of LMWHs in prophylaxis and therapy of VTE?) I. Vacula, II. interná klinika LF UK a UNB, Bratislava 42. Éra HNMH nekončí (The era of LMWHs is not over yet) M. Hulíková, Centrum hemostázy a trombózy, HemoMedika, Košice Kávová prestávka Prednáškový blok č. 10 (Scientific Session No 10) TREATMENT WITH SULODEXID (LIEČBA SO SULODEXIDOM) Podporené edukačným grantom spoločnosti ALFA-WASSERMANN Predsedníctvo: G. M. Andreozzi (Padua) V. Štvrtinová (Bratislava) 43. Sulodexide, an old drug with renewed evidences and interests. G. M. Andreozzi, Angiology Care Unit University Hospital of Padua, Italy 44. Skúsenosti s liečbou angiologických pacientov sulodexidom v SR (Experience with sulodexide treatment of vascular patients in Slovak republic) A. Džupina, Alian, Bardejov Prednáškový blok č. 11 (Scientific Session No 11) MINIINVAZÍVNA CHIRURGIA VARIXOV (MINIINVASIVE SURGERY OF VARICOSE VEINS) Predsedníctvo: I. Bihari (Budapest) S. Kašpar (Hradec Králové) 45. Recurrence of varicose veins after laser surgery I. Bihari, ABC Clinic, Budapešť, Hungary 46. Eleven years experience with endovenous laser in single center S. Kašpar, Flebocentrum, Hradec Králové, Česká republika 47. FOAM inhanced ablation of GSV new posibility in endovenous surgery (Penou potencovaná radiofrekvenčná ablácia nový rozmer endovenóznej chirurgie varixov) F. Žernovický jr, E. Marton, K. Žernovická, K. Kanáliková, J. Tomka, V. Šefránek, Klinika cievnej chirurgie NÚSCH a ANGIO privátna angiochirurgická ambulancia, Bratislava 48. Our experiens with endovenous laser treatmant of varicous veins Z. Rybak, Departmant of Experimental Surgery and Biomaterials Research, Wroclaw, Poland Kávová prestávka ; 5(S3) Vaskulárna medicína Suplement 3

10 10 Odborný program Prednáškový blok č. 12 (Scientific Session No 12) VYBUDOVANÁ skúsenosť a budúcnosť nových perorálnych antikoagulancií (ESTABLISHED experience and the future of new oral anticoagulants) Podporené edukačným grantom spoločnosti Boehringer-Ingelheim Predsedníctvo: M. Hulíková (Košice) G. Kaliská (Banská Bystrica) 49. Čo sa zmenilo v antikoagulačnej liečbe na Slovensku za posledný rok? (What has changed in anticoagulation therapy within the last year in Slovakia?) G. Kaliská, oddelenie Kardiológie, SÚSCCH, Banská Bystrica 50. Aké sú možnosti absolútnej minimalizácie rizika krvácania u pacientov liečených novými antikoagulanciami? (What are the options in absolute minimalization of the risk of bleeding at patients treated with new anticoagulants?) M. Hulíková, Centrum hemostázy a trombózy, HemoMedika, Košice 51. Sú nové per os antikoagulanciá budúcnosťou v liečbe VTE? (Are the new oral anticoagulants the future in VTE treatment?) I. Vacula, II. interná klinika LF UK a UNB, Bratislava Prednáškový blok č. 13 (Scientific Session No 13) LIEČBA HŽT (TREATMENT OF DVT) Podporené edukačným grantom spoločnosti GSK Predsedníctvo: V. Štvrtinová (Bratislava) M. Hulíková (Košice) 52. Manažment pacienta s extenzívnou hlbokou venóznou trombózou dolných končatín (Management of patient with extensive deep venous thrombosis of lower extremities) J. Maďarič, Oddelenie kardiológie a angiológie NÚSCH, Bratislava 53. Monitorovanie antikoagulačnej liečby (Anticoagulant therapy monitoring) M. Hulíková, Centrum hemostázy a trombózy, HemoMedika, Košice 54. VTE v onkológii princípy profylaxie a liečby (VTE in oncology prophylaxis and treatment principles) I. Vacula, II. interná klinika LF UK, Bratislava a VASA-CARE, Trnava 55. Budúcnosť liečby HŽT (The Future of DVT treatment) A. Džupina, ALIAN, Bardejov ŠTVRTOK THURSDAY Malá sála Lecture hall B Prednáškový blok č. 14 (Scientific Session No 14) CHOROBY ŽÍL I (VENOUS DISEASES I) Predsedníctvo: M. Frankovičová (Košice) J. Mazuch (Martin) T. Petrovič (Bratislava) 56. Kongenitálne vaskulárne malformácie a chronická venózna insuficiencia (Congenital vascular malformations and chronic venous insufficiency) J. Mazuch, D. Mištuna, E. Huľo, J. Mazuchová, Chirurgická klinika a Ústav biológie JLF UK, Martin Vaskulárna medicína Suplement ; 5(S3)

11 Odborný program Úspešné podanie trombolytickej liečby pri masívnej pľúcnej embólii (Successfull administration of thrombolytic therapy due to massive pulmonary embolism) A. Dokupilová, P. Vahala, P. Poliačik, J. Hasilla, Kardiologická klinika FN, Nitra a Fakulta sociálnych vecí a zdravotnictva UKF, Nitra 58. Antikoagulačná liečba po epizóde krvácania (Anticoagulant therapy after an episode of bleeding) T. Petrovič, V. interná klinika LF UK a UNB, Nemocnica Ružinov, Bratislava 59. May-Thurnerov syndróm ako zriedkavá príčina častého stavu kazuistika) (May- Thurner syndrome as a rare cause of an often condition case report) L. Farkašová, L. Špak, Z. Tormová, M. Moščovič, Angiologické oddelenie Kardiologickej kliniky VÚSCH, Košice 60. Hirudoterapia stále aktuálna liečba (Hirudotherapy still current treatment) V. Slezák, P. Takáč, H. Galátová, B. Mareková, University Hospital of the Merciful Brothers, Bratislava, Institute of Zoology, Slovak Academy of Sciences, Bratislava 61. Výživové a zdravotné tvrdenia (Nutrition and health claims) J. Lučanský, Bratislava Kávová prestávka Prednáškový blok č. 15 (Scientific Session No 15) SEKCIA SESTIER (NURSES SESSION) Predsedníctvo: M. Fülleová (Bratislava) M. Krištofová (Košice) J. Machalová (Banská Bystrica) 62. Psychosociálne problémy pacientov so syndrómom diabetickej nohy (Psychosocial problems of patients with diabetic foot syndrome) M. Fülleová, II. interná klinika LF UK a UNB, Bratislava 63. Manažment starostlivosti o pacienta s intraarteriálnou trombolýzou (Management of care for patients with intra-arterial thrombolysis) J. Machalová, Z. Kvasnová, M. Pálková, II. chirurgická klinika, Oddelenie cievnej chirurgie, FNsP F. D. Roosevelta, Banská Bystrica 64. Kvalita života pacientov s cerebrovaskulárnou insuficienciou (Quality of life in patients with cerebrovascular insufficiency) I. Wintnerová, H. Tabačáková, Cievna chirurgická amb. FNsP J. A. Reimana, Prešov 65. Súčasné možnosti liečby končatinovej ischémie a následná ošetrovateľská starostlivosť (Current treatment options for limb ischemia and subsequent nursing care) M. Krištofová, T. Valková, Angiologická jednotka VÚSCH, Košice 66. Ošetrovateľská starostlivosť o pacientov po amputácii dolnej končatiny (Nursing care about patients after leg amputation) Z. Kišová-Gažová, E. Palaghyová, II. interná klinika LF UK a UNB, Bratislava 67. Funkčná diagnostika kardiovaskulárnych ochorení (Functional diagnostic of cardiovascular diseases) E. Palaghyová, Z. Kišová-Gažová, II. interná klinika LF UK a UNB, Bratislava 68. Špecifiká ošetrovateľskej starostlivosti pri vybraných intervenčných výkonoch na angiologickej jednotke (Specifics of nursing care in selected interventional procedures for Angiology Unit) I. Rónayová, Klinika kardiológie angiologická jednotka VÚSCH, Košice ; 5(S3) Vaskulárna medicína Suplement 3

12 12 Odborný program 69. Proces indikácie pacienta s rezistentnou artériovou hypertenziou na rádiofrekvenčnú renálnu sympatikovú denerváciu: ambulantný manažment (Process of indication of radiofrequency renal sympathetic denervation in patients with resistant hypertension: outpatients management) D. Dergnovichová, M. Hnilicová, T. Paráková, A. Mistrík, I. Vulev, J, Maďarič, Angiologická ambulancia, NÚSCH, Bratislava Kávová prestávka Prednáškový blok č. 16 (Scientific Session No 16) FILOZOFICKO-HISTORICKÝ BLOK (PHILOSOFICAL AND HISTORICAL SESSION) Predsedníctvo: M. Cachovan (Luneburg) V. Štvrtinová (Bratislava) F. Žernovický (Bratislava) 70. O hudbe, o vode, o človeku (About music, about water, about man) J. Štvrtina, Bratislava 71. Dnešný človek a klinický výskum (Modern man and clinical research) V. Štvrtinová, II. interná klinika LF UK a UNB, Bratislava 72. Armand Trousseau link between thrombosis and cancer K. Dostálová, T. Eckhardt, P. Palacka, Š. Moricová, L. Maheľová, I. Elalamy, Faculty of Public Health, Slovak Medical University, Bratislava, Department of Occupational Medicine and Toxicology, Faculty of Medicine, Comenius university, Univesity Hospital, Bratislava Service d Hématologie Biologique, Hôpital Tenon, Pierre-and-Marie-Curie University, Paris, France 73. História liečby ulcus cruris (History of ulcus cruris treatment) F. Žernovický, ANGIO privátna angiochirurgická ambulancia, Bratislava Banket ANGIO 2013 PIATOK FRIDAY Veľká sála (Lecture hall A) Prednáškový blok č. 17 (Scientific Session No 17) DIAGNOSTICKÉ POSTUPY (DIAGNOSTIC PROCEDURES) Predsedníctvo: R. Avram (Timisoara) K. Dostálová (Bratislava) 74. Budúci angiológovia by mali začať s prevenciou DNJZ bez zbytočného meškania (Angiologists to Be Have to Start prevention of Occupational overuse syndrome without delay) L. Maheľová, K. Dostálová, Š. Moricová, I. Bátora, L. Kukučková, KPLaT UNB, Fakulta verejného zdravotníctva SZU a ODCH, Bratislava 75. Neinvazívne možnosti cievneho zobrazenia pred revaskularizačnou liečbou u pacientov s periférnym artériovým ochorením (Non-invasive vascular imaging before revascularization therapy in patients with peripheral arterial disease) M. Malík, P. Lesný, V. Javorka, M. Mižičková, J. Bilický, S. Bodíková, Rádiologická klinika LF UK, SZU a UNB a IV. interná klinika LF UK a UNB, Bratislava Vaskulárna medicína Suplement ; 5(S3)

13 Odborný program Investigation of uni/bilateral lower limb edema with venous ultrasound F. Parv, R. Avram, M. Tudoran, M. Balint, I. Avram, L. Vasiluta, F. Gadalean, University of Medicine and Pharmacy Victor Babes, Emergency County Hospital No.1, Timisoara, Romania 77. Chemical thoracic sympathectomy. Indications and results. Single centre experience. T. Ostrowski, A. Kosicki, M. Szostek, M. Osęka, M. Szostek, M. Skórski, M. Pawłowska, A. Kański, Medical University of Warsaw, Department of General and Thoracic Surgery and II. Department of Anesthesia and Intensive Care, Warsaw, Poland Prednáškový blok č. 18 (Scientific Session No 18) NOVÉ možnosti liečby venózneho tromboembolizmu rivaroxabanom (NOVEL means for VTE treatment WITH rivaroxaban) Podporené edukačným grantom spoločnosti Bayer Predsedníctvo: J. Beyer-Westendorf (Dresden) I. Šimková (Bratislava) V. Štvrtinová (Bratislava) 78. Moderná liečba VTE od injekcií k tabletkám (Up do date VTE treatment from injections to tablets) V. Štvrtinová, II. interná klinika LF UK a UNB, Bratislava 79. Up to date manažment pľúcnej embólie ( Up to date management of pulmonary embolism) I. Šimková, Klinika kardiológie a angiológie LF SZU a NÚSCH, Bratislava 80. Practical aspects of and clinical experience with oral VTE treatment (Praktické otázky a skúsenosti s perorálnou liečbou venózneho tromboembolizmu) J. Beyer-Westendorf, Division of Thrombosis Research and Vascular Medicine, Dresden University Clinic, Dresden, Germany Kávová prestávka Prednáškový blok č.19 (Scientific Session No 19) DIAGNOSTICS AND TREATMENT IN VASCULAR MEDICINE (DIAGNOSTIKA A LIEČBA VO VASKULÁRNEJ MEDICÍNE) Predsedníctvo: C. Allegra (Rome) R. Martini (Padua) K. Roztočil (Praha) H. Partsch (Vienna) Zs. Pecsvarady (Kistarcsa) 81. Nové konsensy a doporučené postupy pro cévní onemocnení (New consensus and guidelines for vascular diseases) K. Roztočil, Odd. periferní cirkulace IKEM, Praha, Česká republika 82. Biophisics of Microcirculation C. Allegra, Dept. of Angiology, S. Giovanni Hospital, Rome, Italy 83. Intermittent claudication and exercise programs G. M. Andreozzi, R. Martini, A. Leone, Angiology Care Unit University Hospital of Padua and Vascular Rehabilitation Unit of Rehabilitation Clinic Casa di Cura Carmide Catania, Italy 84. Study to predict the effect of prostanoid treatment in CLI (ILOCRITERIA study) Zs. Pecsvarady, Flór Ferenc Teaching Hospital, Kistarcsa, Hungary ; 5(S3) Vaskulárna medicína Suplement 3

14 14 Odborný program 85. Skin microcirculation assesment in peripheral arterial disease R. Martini, Angiology Care Unit, University Hospital of Padua, University of Padua, Italy 86. Compression for the management of venous leg ulcers H. Partsch, Emeritus Professor of Dermatology, Medical University of Vienna, Austria 87. Leg ulcers of non-venous origin F. Žernovický, ANGIO privátna angiochirurgická ambulancia, Bratislava Obedová prestávka Prednáškový blok č. 20 (Scientific Session No 21) LIEČBA HEMOROIDOV (Hemorrhoid treatment) Podporené edukačným grantom spoločnosti Teva Predsedníctvo: E. Ambrózy (Bratislava) M. Rác (Nitra) 88. Konzervatívna liečba hemoroidov preparátom Diosminol micro (Conservative treatment of haemorrhoids with preparation Diosminol micro) J. Beláček, Chirurgická klinika, Fakultná nemocnica, Bratislava 89. Terapeutický profil escínu a jeho postavenie v liečbe chronickej žilovej nedostatočnosti (Therapeutic profile of aescin and its place in treatment of chronic venous insufficiency) M. Rác, Oddelenie klinickej farmakológie, Interná klinika, Fakultná nemocnica, Nitra Prednáškový blok č. 21 (Scientific Session No 21) VTE (VTE ) Predsedníctvo: P. L. Antignani (Rome) I. Elalamy (Paris) J. J. Michiels (Rotterdam) I. Vacula (Bratislava) 90. Venous thrombosis, right ventricular dysfunction and angiographic index-interrelations and prognostic value in pulmonary embolism R. Avram, M. Balint, F. Parv, T. Ciocarlie, I. Avram, VD Moga, University of Medicine and Pharmacy Victor Babes Timisoara, Cardiology and Surgery Department I, Emergency County Hospital Timisoara, Romania 91. Does exist a consensus on treatment of distal vein thrombosis? P. L. Antignani, Dept. of Angiology, S. Giovanni Hospital, Rome, Italy 92. Treatment of venous thromboembolism in patients with cancer I. Elalamy, Service d Hématologie Biologique, Hôpital Tenon, Pierre-and-Marie-Curie University, Paris, France 93. Classification of Acute Deep Vein Thrombosis (DVT), risk factors for (DVT) Recurrence, and management of the Post-Thrombotic Syndrome (PTS): bridging the gap between DVT and PTS. J. J. Michiels, J. Barth, W. Moosdorff, M. De Maeseneer, M. Neumann, Goodheart Institute, Bloodcoagulation & Vascular Medicine Science Center, Primary Care Medicine Medical Diagnostic Center, Rijnmond, and Department of Dermatology, Section Phlebology, Erasmus University Medical Center, Rotterdam, The Netherlands 94. Compression ultrasonography, clinical score, thrombosis risk factors and D-dimer test for evidence based Diagnosis and Management of Deep Vaskulárna medicína Suplement ; 5(S3)

15 Odborný program 15 Vein Thrombosis and Alternative Diagnoses in the primary care setting and outpatient wards J. J. Michiels, J. M. Michiels, W. Moosdorff, J. Barth, Goodheart Institute, Bloodcoagulation & Vascular Medicine Science Center, and Proimary Care Medicine, Medical Diagnostic Center, Rijnmond, Rotterdam, The Netherlands 95. Safe exclusion of deep vein thrombosis (DVT) by ultrasonography and ELISA D-dimer testing: a prospective study in 1330 patients with suspected DVT in the primary care setting J. D. Barth, W. Moosdorff, H. Maasland, J. M. Michiels, M. U. Lao, J. J. Michiels, Primary Care Medicine, Medical Diagnostic Center, Rijnmond, Rotterdam and Department of Primary Care Medicine, Leiden University Medical Center, Leiden and Goodheart Institute, Bloodcoagulation & Vascular Medicine Science Center, Rotterdam, The Netherlands 96. VTE in pregnancy and puerperium new registry in CEVF countries the proposal. (REVTECE REgistry of VTE in Central Europe) I. Vacula, II. interná klinika LF UK, Bratislava; VASA- CARE, s.r.o., Trnava Prehliadka zámku v Strážkach Guided Tour of Strážky Castle PIATOK FRIDAY Malá sála Lecture hall B Posterová sekcia (Poster Session) Predsedníctvo: J. Bulas (Bratislava) E. Bojdová (Nitra) 97. Septické plicní embolizace (Septic pulmonary embolism) P. Vahala, P. Poliačik, J. Hasilla, Kardiologická klinika FN, Nitra a Fakulta sociálnych vecí a zdravotníctva UKF, Nitra 98. Hormonálna antikoncepcia z pohľadu kardiológa (Point of view of cardiologist on the hormonal contraception) B. Ivan, P. Vahala, P. Koiš, P. Poliačik, J. Hasilla, Kardiologická klinika FN, Nitra a Fakulta sociálnych vecí a zdravotníctva UKF, Nitra 99. Subfebríllie signál cievnej katastrofy (Low-grade fever a warning sign of vascular catastrophe) K. Bírová, P. Vahala, J. Hasilla, J. Galko, Kardiologická klinika FN, Nitra a Fakulta sociálnych vecí a zdravotníctva UKF, Nitra 100. Phlegmasia coerulea dolens bilaterálne kazuistika (Bilateral phlegmasia coerulea case report) R. Necpal, L. Žúdelová, J. Tomka, V. Šefránek, Klinika cievnej chirurgie NÚSCH, Bratislava 101. Vaskuloprotektívne účinky amlodipínu u hypertenzie (Vasculoprotective effects of amlodipine in hypertension) J. Bulas, M. Potočárová, J. Murín, A. Reptová, I. interná klinika LF UK a UNB, Bratislava 102. Larválna debridementová terapia bioterapeutická metóda na liečenie vredov predkolenia a iných chronických rán (Maggot debridement therapy the biotherapeutic method for healing of leg ulcers and other chronic wounds) P. Takáč, M. Čambal, V. Slezák, J. Majtán, Oddelenie Molekulárnej a aplikovanej zoológie Ústav zoológie, SAV, I. chirurgická klinika, Univerzitná klinika, Nemocnica Staré mesto a Cievno-chirurgická ambulancia, Univerzitná nemocnica s poliklinikou, Milosrdní bratia, Bratislava ; 5(S3) Vaskulárna medicína Suplement 3

16 16 Odborný program 103. Slovenský medovicový med v liečbe vredov predkolenia (Slovak honeydew honey for treatment of the lower leg ulcers) V. Slezák, P. Takáč, J. Majtán, University Hospital of the Merciful Brothers and Institute of Zoology SAV, Bratislava 104. Dynamics of distal arterial filling pressures (TBI) and capillary filling pressures of lower extremities in patients with diabetes mellitus, observed for PAD, in one and five year follow-up M. Frič, R. Jurga, Angiologická ambulancia, Nemocničná a. s, Malacky a Ekonomická fakulta, Košice Schôdza výboru Central European Vascular Forum Meeting of the CENTRAL EUROPEAN VASCULAR FORUM Committee Prednáškový blok č. 22 (Scientific Session No 22) BLOK LYMFOLOGICKEJ SEKCIE S.A.S. SLS (SESSION OF THE LYMPHOLOGIC SECTION OF S.A.S. SMA) Predsedníctvo: A. Džupina (Bardejov) E. Husarovičová (Bratislava) 107. Význam kineziológie po operácii prsníka (The importance of kinesiology after breast surgery) E. Husarovičová, V. Machová, Fyziatricko-rehabilitačné oddelenie, Národný onkologický ústav, Bratislava 108. Životný štýl a hlavné zásady liečby lymfedému (The lifestyle and main principles by lymphoedema disease) M. Poláková, J. Polák, Fyziatricko-rehabilitačné oddelenie, Národný onkologický ústav, Bratislava SOBOTA SATURDAY Veľká sála (Lecture hall A) ŠKOLA ULTRAZVUKOVEJ DIAGNOSTIKY (SCHOOL OF ULTRASOUND DIAGNOSTICS) Racionálny prístup k diagnostike a liečbe hlbokej a povrchovej žilovej trombózy (... aj o tom, čo sa nám nezdá na posledných odporučeniach ACCP) D. Musil, Olomouc, Česká republika a F. Žernovický jr, Bratislava, Slovenská republika 105. Prístup k edému nôh nejasnej etiológie (Approach to Leg Edema of Unclear Etiology) E. Ambrózy, II. interná klinika LF UK a UNB, Bratislava 106. Význam kompresívnej terapie v lymfológii (The importance of compression therapy in lymphology) A. Džupina, M. Džupinová, Alian, Bardejov Vaskulárna medicína Suplement ; 5(S3)

17 Abstrakty Proces hojenia rán patofyziologické a klinické aspekty (Pathophysiological and clinical aspects of the wound healing process) Koller J 5, Huťan M 2, Kopal T 4, Karasová D 1, Huľo E 1, Čambal M 2 1 Chirurgická klinika JLF UK a UN Martin, 2 I. chirurgická klinika LF UK a UN Bratislava, 3 II. chirurgická klinika LF UK a UN Bratislava, 4 Kožné oddelenie NsP Považská Bystrica, 5 Klinika popálenín a rekonštrukčnej chirurgie UN Bratislava Úvod: Poznatky o mechanizmoch hojenia rán ako aj o patofyziológii a klinickom prístupe k rôznym druhom rán dosiahli v posledných desaťtročiach významné pokroky. Každá rana po svojom vzniku spúšťa organizovanú kaskádu bunkových a biochemických udalostí, ktoré prebiehajú v určitých a predpovedateľných následnostiach a súvislostiach. Tieto javy voláme súborne proces hojenia. Hojenie rán teda predstavuje kontinuálny sled signálov a odpovedí pri ktorých epiteliálne, endoteliálne, zápalové bunky, trombocyty a fibroblasty sa krátkodobo spolu zoskupia mimo svojich obvyklých domén, dochádza k ich interakcii, obnoveniu vzájomnej disciplíny a nakoniec k návratu k ich pôvodným činnostiam (Hunt 1990). Materiál a metodika: Poznáme tri základné typy hojenia rán : normálne postnatálne hojenie, patologické hojenie a fetálne hojenie. Normálne hojenie môže mať dvojaké kvalitatívne odlišné východiská. Regenerácia znamená úplnú obnovu pôvodných štruktúr a funkcií. Reparácia je neúplná obnova štruktúr a funkcií s výsledkom vytvorenia jazvy. Patologické hojenie je modifikovaný typ hojenia kvôli pridruženým ochoreniam alebo iných faktorom, ktoré môžu ovplyvniť hojenie, ako sú diabetes, malignity, autoimúnne choroby, ateroskleróza, poruchy imunity, stavy po rádioterapii a po podávaní určitých skupín liekov a pod. Výsledkom býva spomalenie, respektíve predĺženie hojenia, alebo aj úplné zastavenie procesu hojenia v ktorejkoľvek fáze s výsledkom dlhodobo otvorených chronických rán. Kvôli lepšiemu porozumeniu týchto procesov a javov Hunt (1990) logicky opísal jednotlivé fázy procesu hojenia nasledovne: koagulácia a zápal, angiogenéza, fibroplázia, depozícia matrixu, epitelizácia, kontrakcia a remodelácia. Tieto budú opísané detailnejšie. Súhrn: Hojenie rán je komplexný problém, ktorý môže byť ovplyvnený celým radom ako externých (infekcia, topická terapia, krytie rán a ich uzavretie, starostlivosťou o rany) tak aj interných (vek pacienta, celkový a nutričný stav, komorbidity, pridružené poranenia a pod.) faktorov. Všetci odborníci, ktorí sa starajú o rany, by mali mať tieto faktory na pamäti, aby mohli zvoliť optimálny individuálny terapeutický prístup ku každému pacientovi. Introduction: Both the knowledge of wound healing mechanisms and the knowledge of pathophysiology and clinical approach to different wound types have done a considerable progress in the last few decades. Each wounding triggers an organized cascade of cellular and biochemical events, which then progress in certain and predictable consequences and relations. These events are called wound healing process. Wound healing in fact represents a continuous row of signals and responses where epithelial, endothelial, inflammatory cells, trombocytes and fibroblasts gather temporarily outside of their usual domains interact together, and then they resume their original discipline and activities (Hunt 1990) ; 5(S3) Vaskulárna medicína Suplement 3

18 18 Abstrakty Material and Methods: There are three basic types of wound healing: normal postnatal healing, pathological healing, and fetal healing. There are two qualitatively different outcomes of the normal postnatal healing process. Regeneration means complete renewal of original structure and functions. Reparation means incomplete renewal of the structure and function resulting in scar formation. Pathological healing is a modified type of healing due to concommitant systemic diseases, such as diabetes, malignancies, autoimmune diseases, atherosclerosis, immunity disturbances, radiotherapy, medications etc. The result is prolonged healing time, or stopping of the healing process in any phase, which reults in longterm open chronic wounds. For better understanding of all these processes and events Hunt (1990) introduced a logical description of particular phases of the healing process as follows: coagulation and inflammation, angiogeneseis, fibroplasia, matrix deposition, epithelialization, contracion, remodelling. They will be described in details. Summary: Wound healing is a complex problem which can be influenced by a wide range of both external (infection, topical therapy, wound coverage/closure materials, wound care) and internal (patient age, general and nutritional status, co-morbidies, concommitant injuries etc) factors. All the professionals, who take care of the wounds, should be aware of these factors in order to select the best individual therapeutic approach for each patient. 1. Hunt TK. Basic principles of wound healing. J Trauma 1990; 30(Suppl12): S123 S Druhy debridementu a ich význam v manažmente rany (Methods of debridement and their importance in wound management) Čambal M 2, Huťan M 3, Kopal T 4, Koller J 5, Karasová D 1, Huľo E 1 1 Chirurgická klinika JLF UK a UN Martin, 2 I. chirurgická klinika LF UK a UN Bratislava, 3 I. chirurgická klinika LF UK a UN Bratislava, 4 Kožné oddelenie NsP Považská Bystrica, 5 Klinika popálenín a rekonštrukčnej chirurgie UN Bratislava Debridement rany je definovaný ako odstránenie cudzieho materiálu a mŕtveho kontaminovaného tkaniva z (alebo priliehajúceho k) traumatickej alebo infikovanej lézii za účelom obnaženia zdravého tkaniva. Môže tiež zahŕňať odstránenie cudzieho materiálu, ktorý uviazol v rane. V literatúre je opísaných mnoho metód debridementu chronických rán: chirurgický a ostrý debridement, a v posledných rokoch si získavajú narastajúcu pozornosť i ďalšie spôsoby ako larválna terapia, mechanické spôsoby debridementu, enzymatický či autolytický debridement. Debridement tiež môžeme rozdeliť na selektívny a neselektívny. Definitívny výber metódy debridementu závisí od snahy docieliť veľmi rýchle, bezpečné a nebolestivé zhojenie rany. Správny výber metódy debridementu hrá kľúčovú úlohu v liečbe chronickej, nehojacej sa rany. Práca poskytuje prehľad základných metód debridementu a ich charakteristiku, výhody a nevýhody ich použitia. Debridement of the wound is defined as the removal of foreign material and dead, contaminated tissue from a (or adjacent to) traumatic or infected lesion, aimed at exposure of the healthy Vaskulárna medicína Suplement ; 5(S3)

19 Abstrakty 19 tissue. It may also include the removal of foreign material trapped in the wound. In the literature there are described many methods of debridement of chronic wounds: surgical and sharp debridement, but in recent years non-surgical methods are gaining increasing attention: maggot therapy, mechanical debridement, enzymatic and autolytic debridement. Debridement can also be divided according to the method used on selective and nonselective. The final choice of debridement method is based on the effort to achieve very fast, safe and painless wound healing. The correct choice of debridement method is the key role of the doctors treating chronic, non-healing wound. This paper is offering a review of main debridement types, their characteristics, advantages and disadvantages of their use. 3. Inflamačná a granulačná fáza hojenia rán, patofyziológia a manažment (Inflammation and granulation phase of wound healing, patophysiology and management) Huťan M 1, Čambal M 2, Kopal T 3, Koller J 4, Karasová D 5, Huľo E 5 1 II. chirurgická klinika LF UK a UNB, Bratislava, 2 I. chirurgická klinika LF UK a UNB, Bratislava, 3 Kožné oddelenie NsP Považská Bystrica, 4 Klinika popálenín a rekonštrukčnej chirurgie LF UK a UNB, Bratislava, 5 Chirurgická klinika JLF UK a UN Martin Inflamačná fáza je základnou fázou hojenia rán, ktorá prichádza po primárnom inzulte. Je charakteristická endogénnym a exogénnym zápalom na podklade prieniku polymorfonukleárnych leukocytov do rany ako následok chemoatrakcie PDGF AB (Platelet Derived Growth Factor AB) a TGF-β1 (Transforming Growth Factor beta 1) z agregovaných trombocytov. Následne ranu prestupujú makrofágy, ktoré ju pripravujú na druhú fázu hojenia (granulačnú fázu). Počas tejto je rana rekonštruovaná a vyplnená granulačným tkanivom na báze fibroproliferácie a angiogenézy ako dôsledok produkcie TGF (Transforming Growth Factor), FGW (Fibroblast Growth Factor) a VEGF (Vascular Endothelial Growth Factor) makrofágmi. Manažment uvedených dvoch fáz sa nesie v zmysle koncepcie TIME (Tissue, Infection, Moisture, Edges). V prvom rade je potrebné zhodnotenie mikrobiálnej nálože a jej dopad na ranu. Je nutné odlíšiť kolonizáciu a kritickú kolonizáciu od infekcie (s alebo bez systémovej odpovede) a započať potrebnú liečbu (systémovú alebo lokálnu). Systémová antibotikoterapia je zvyčajne nutná iba pri výskyte sepsy. Lokálne antiseptické prostriedky sa rôznia od derivátov jódu (jód povidonium), chlorhexidínu a striebra. Je možné využitie hyperosmolárnych vlastností niektorých produktov (med). Uvedené sa indikujú pri infikovaných ranách, pri ranách, kde infekciu predpokladáme alebo kde by infekcia rany mala vážny dopad na stav (rany, končatiny, pacienta). Zhodnotenie stavu vlhkosti rany a výber techniky hojenia rany (gázová, vlhká terapia rán MWT, NPWT negative pressure wound therapy) ako aj špecifického produktu (polyuretánová pena, alginát, hydrokoloid, etc.) má vplyv na aktivitu MMP (matrixmetaloproteáz) a rýchlosť hojenia rany. Základné techniky v zmysle gázových preväzov majú množstvo obmedzení a nástrah. Vlhká terapia rán sa skladá ; 5(S3) Vaskulárna medicína Suplement 3

20 20 Abstrakty z niekoľkých materiálových línií, pričom najčastejšie sa používajú polyuretánové peny, algináty, superabsorpčné polyméry (SAP) a hydrokoloidy. Tieto regulujú vlhkosť v rane a zabezpečujú ideálnu vlhkosť pre optimálne hojenie. NPWT sa indikuje u komplikovaných a chronických rán. Uvedenú lokálnu liečbe je nutné aplikovať v rámci komplexnej liečby spolu so systémovou liečbou podkladových ochorení pacienta. Autori v prednáške objasňujú patofyziologické vzťahy a princípy inflamačnej a zápalovej fázy hojenia rany a možnosti ich ovplyvnenia za pomoci moderných techník. Inflammation phase is a crucial phase of wound healing, that comes after initial injury. It is characterized by endogenous or exogenous inflammation on basis of inflow of neutrophils as a consequence of chemoattraction of PDGF AB (Platelet Derived Growth Factor AB) and TGF-β1 (Transforming Growth Factor beta 1) from agreggated platelets and subsequent infiltration of wound with macrophages, that prepare wound for the second phase of wound healing (granulation phase). With production of TGF (Transforming Growth Factor), FGW (Fibroblast Growth Factor), VEGF (Vascular Endothelial Growth Factor) and PDGF BB the wound is being reconstructed by fibroproliferation and angiogenesis. Management of these two phases according to TIME concept (Tissue, Infection, Moisture, Edges) is lined with assessment of microbiological burden and its impact on the wound. Colonization and critical colonization has to be diferentiated from infection (with or without systemic impact), with appropriate measures (local or systemic) taken. Systemic antibiotic therapy is rarely required unless sepsis occurs. Local antimicrobial dresings range from iodine products (povidonium iodine), chlorhexidine or silver compounds. Hyperosmotic properties of some products might also be used (honey). These are usualy applied in wounds with infection, or where infection is highly predicted, or where infection wound have severe impact. Similarly, evaluation of moisture level and selection of appropriate wound healing technique (wet-to-dry, moist wound therapy (MWT), negative pressure wound therapy (NPWT)) and specific product types (polyurethane foam, alginate, hydrocolloid, etc.) have their impact on activity of MMPs (matrixmetaloproteases) and tendency of wound to heal. Basic therapeutic technique using gauze (wet-to-dry) has many limitations and dangers. Moist wound healing has several product lines, of these polyuretan foams, alginates, superabsorption polymers (SAP) and hydrocolloids are used most. These regulate the moisture level of the wound and provide ideal moisture level for optimal healing. NPWT is generally applied in complicated or chronic wounds. Such local treatment has to be carried out together with complex systemic therapy of the patient. Authors in their contribution explain the patophysiological principles of inflammation and granulation phase of wound healing and possibilities of management with modern techniques. 4. Re-epitelizácia rán a možnosti jej podpory u dlhodobo sa nehojacich kožných defektov (Re-epithelization of the wounds and possibilities of its enhancement in long-term nonhealing skin defects) Vaskulárna medicína Suplement ; 5(S3)

21 Abstrakty 21 Huľo E 1, Karasová D 1, Čambal M 2, Huťan M 3, Kopal T 4, Koller J 5, Strelka Ľ 1, Vojtko M 1 1 Chirurgická klinika JLF UK a UN Martin, 2 I. chirurgická klinika LF UK a UN Bratislava, 3 II. chirurgická klinika LF UK a UN Bratislava, 4 Kožné oddelenie NsP Považská Bystrica, 5 Klinika popálenín a rekonštrukčnej chirurgie UN Bratislava Proces re-epitelizácie začína počas niekoľkých hodín od vzniku poranenia kože. V priebehu tohto procesu migrujú epidermálne bunky za prítomnosti epidermálneho rastového faktoru (EGF) a transformujúceho rastového faktoru (TGF-β) z okrajov rany centrálne, až do úplnej obnovy kožného povrchu. Migrácia epidermálnych buniek je uľahčovaná tvorbou plazmínu a kolagenázy, ktoré napomáhajú pri odstraňovaní fibrínových krvných zrazenín a poškodenej strómy. Na tomto procese sa taktiež podieľajú folikulárne kmeňové bunky nachádzajúce sa vo vlasových folikuloch, čo vysvetľuje, prečo je re-epitelizácia narušená v hlbokých ranách, kde je epitel adnex čiastočne alebo úplne zničený. Nové epidermálne tkanivo je odlišné od neporanenej epidermis. Príčinou je neschopnosť procesu re-epitelizácie vytvárať hrebeňové výbežky v epidermis a regenerovať epitel adnex. Re-epitelizácia teda predstavuje reparačnú odpoveď na poranenie. Pri nedostatočnom hojení neadekvátna re-epitelizácia vedie k predĺženému a nekompletnému hojeniu dlhodobo sa nehojacim (chronickým) ranám. Keďže je koža ideálnou náhradou v liečbe kožných strát, uzatvorenie rany pacientov s chronickou ranou tak môže byť úspešne dosiahnuté pomocou kožných transplantátov. Prekrytie rany kožou je u týchto pacientov podstatou liečby kožných defektov a ich komplikácií. Autori preberajú patofyziológiu re-epitelizácie, históriu použitia kožných transplantátov a možnosti a techniky použitia autológnych, allogénnych a xenograft štepov. Kľúčové slová: autológne kožné transplantáty, allograft, xenograft, štepy plnej hrúbky kože, štepy čiastočnej hrúbky kože, re-epitelizácia, dlhodobo sa nehojaca rana, kožný defekt. The process of re-epithelization begins within hours of skin injury. During this process, epidermal cells in the presence of epidermal growth factor (EGF) and transforming growth factor beta (TGF-β) migrate from the wound edges inwards until the epidermal surface is completely restored. Migration of epidermal cells is facilitated by the production of plasmin and collagenase which assist in the removal of fibrin clots and damaged stroma. Follicular stem cells residing in hair follicles also participate in this process, which explains why re-epithelization is impaired in deep wounds, where adnexal epithelium is partially or fully destroyed. New epidermal tissue is different from uninjured epidermis. This is due to the inability of the re-epithelization process to form rete ridges and to regenerate adnexal epithelium. Re-epithelization represents a reparation response to injury. In deficient healing an inadequate re-epithelization leads to prolonged and incomplete healing long-term non-healing (chronic) wounds. Whereas skin itself is the ideal replacement for treatment of skin-loss, therefore wound closure in patients with chronic wounds can be successfully accomplished using skin grafts. Wound coverage in these patients is essential to treat the skin loss and its complications. Authors discuss pathophysiology of re-epithelization, history of skin graft use and ; 5(S3) Vaskulárna medicína Suplement 3

22 22 Abstrakty the possibilities and techniques of autograft, allograft and xenograft usage. Key words: autologous skin graft, allograft, xenograft, full thickness skin graft, split thickness skin graft, re-epithelization, long-term non-healing wound, chronic wound, skin defect. 5. Kontaktné alergie u pacientov s vredom predkolenia (Contact alergies in patients with leg ulcers) Kopal T 4, Čambal M 2, Huťan M 3, Koller J 5, Karasová D 1, Huľo E 1 1 Chirurgická klinika JLF UK a UN Martin, 2 I. chirurgická klinika LF UK a UN Bratislava, 3 II. chirurgická klinika LF UK a UN Bratislava, 4 Kožné oddelenie NsP Považská Bystrica, 5 Klinika popálenín a rekonštrukčnej chirurgie UN Bratislava Kontaktná precitlivenosť je časným javom u pacientov s chronickými ranami. Vzniká často v dôsledku opakovanej expozície alergénom buď pri samoošetrení alebo aj v dôsledku kontaktu s liečivými lokálnymi prípravkami, ktoré indikuje lekár. Najčastešie kontaktnými alergénmi u týchto pacientov býva lanolín, bežné sú parabény a neomycín. Ojedinelá ale problematická je precitlivenosť na kortikoidy. Mimoriadne dôležité je odlíšenie kontaktného ekzému od infecie kože a iných príčin jej zápalu. Podozrenie na kontaktnú precitlivenosť možno stanoviť na základe klinického vyšetrenia. Diagnózu potvrdzujeme epikutánnym testovaním. Contact allergy is a frequent phenomenon in patients with chronic wounds. It is based upon repeated contact with allergens contained in topical medicaments applied either by patient at home or by physician. Most frequent allergens are lanolin followed by parabenes and neomycin. Troublesome may be allergy to topical corticoid preparations. Crucial is the ability to tell the difference among contact allergic eczema and other inflammatory conditions of the skin, e.g. the infection. The suspicion may be established by clinical finding, the diagnose is to be proven by skin testing. 6. Diferenciálna diagnostika a liečba kožných vaskulitíd problém stále aktuálny (Differential diagnostics and therapy of cutaneous vasculitis a topical issue) Zelenková H DOST Svidník Vasculitis allergica relatívne častá dermatóza postihujúca obidve pohlavia. Podstatou vzniku chorobných zmien je ukladanie cirkulujúcich imunokomplexov do stien chorobných venúl. Najčastejšie antigény lieky (PNC, sulfónamidy, inzulín a iné), antigény vírusov, baktérií, potravín, helmintov, nádorov, autoantigény a pod. Klinicky sa rozlišuje niekoľko typov, ktoré sa môžu vzájomne prelínať hemoragický, hemoragicko- -nekrotický, papulonekrotický, polymorfný nodulárny, urtikariálny. V liečbe sa celkovo podávajú kortikoidy, sulfóny, antihistaminiká. Je možná aj aplikácia cyklosporínu A. Problémom najmä pre pacienta je, pokiaľ je jeho ochorenie nesprávne diagnostikované a roky je vykonávaná napríklad liečba ulcus cruris venosum, samozrejme, bez adekvátnej terapeutickej odozvy. Na úskalia diferenciálnej diagnostiky je poukazované v prípade prezentovaných pacientov. Allergic vasculitis is a relatively common diagnosis affecting both genders. The condition is Vaskulárna medicína Suplement ; 5(S3)

23 Abstrakty 23 caused by circulating immunocomplexes deposited in small vessels. Most common antigens include drugs (PNC, sulphonamides, insulin, and others), virus antigens, bacterial antigens, foodstuff, helmints, tumour antigens, auto-antigens, and so on. Clinically we distinguish between several types of allergic vasculitis, which may occur simultaneously hemorrhagic, hemorrhagic-necrotic, pappulo-necrotic, polymorphous, nodular, or urticarial. The therapy includes systemic corticoids, sulphones, and antihistamine drugs. Cyclosporine A is also an option. What remains a problem especially for the patient is a situation where the condition is misdiagnosed and treated for years for example as a lower leg venous ulcer without any therapeutic response. The case reports document the bottlenecks in the differential diagnostics of this condition. 8. Súčasné trendy v manažmente pacientov s aneuryzmou artéria poplitea (Current strategies in management of patients with popliteal artery aneurysm) Vavrovičová K 1, Tomka J 1, Bažík R 2, Dulka T 1, Marton E 1, Vulev I 2 1 Klinika cievnej chirurgie, 2 Oddelenie diagnostickej a intervenčnej rádiológie, NÚSCH, a.s., Bratislava, Slovakia Úvod: Aneuryzmy zákolennej tepny (a. poplitea) patria medzi najčastejšie sa vyskytujúce aneuryzmy v oblasti periférneho arteriálneho riečiska dolných končatín. Takmer výlučne bývajú prítomné u mužov, a to najmä v 6 decéniu veku. Z etiologického hľadiska väčšina aneuryziem vzniká v dôsledku degeneratívnych aterosklerotických zmien. Len asi v jednej pätine prípadov je etiológia rozdielna (trauma, infekcia, ochorenia spojivového tkaniva, kongenitálne, geneticky podmienené ochorenia). Medzi najčastejšie klinické príznaky prítomnosti aneuryzmy artéria poplitea patria prejavy v dôsledku tromboembolických komplikácií. Medzi základné diagnostické metódy patria, popri anamnéze a fyzikálnom vyšetrení, predovšetkým rôzne metódy zobrazovacích vyšetrení. Liečba aneuryziem popliteálnej artérie je konzervatívna, operačná alebo endovaskulárna. Na riešenie sú indikované predovšetkým symptomatické aneuryzmy s rozmerom 2 cm. Preventívne výkony u asymptomatických pacientov s aneuryzmami popliteálnej artérie sú predmetom diskusie. Charakteristika súboru: Autori opisujú sledovanie pacientov hospitalizovaných na Klinike cievnej chirurgie alebo Oddelení invazívnej angiológie NÚSCH a. s., Bratislave počas 10-ročného obdobia (od do ). Retrospektívne sme hodnotili výsledky manažmentu a liečby 69 pacientov (66 mužov a 3 žien) s aneuryzmami artéria poplitea. U pacientov sa vyskytlo celkovo 78 aneuryziem zákolennej tepny. Priemerný vek pacientov bol 63,5 roka (od 39 rokov do 83 rokov). Analýza súboru a výsledky: Hodnotili sme výskyt komorbidít a prítomnosti jednotlivých rizikových faktorov u týchto pacientov. Desať pacientov bolo riešených konzervatívne, u 14 bola zvolená endovaskulárna liečba a 54 z nich sa podrobilo chirurgickej liečbe. V práci sme hodnotili prítomnosť klinických príznakov v skupine intervenovaných pacientov (n=68), ako aj výskyt komplikácií pri zvolenej terapii. Záver: Voľba terapie (endovaskulárna vs. operačná) vyžaduje individuálne posúdenie ; 5(S3) Vaskulárna medicína Suplement 3

24 24 Abstrakty prínosov a rizík u konkrétneho pacienta. V emergentných situáciach, lokálna intra-arteriálna trombolytická liečba, spolu s použitím endovaskulárnych alebo operačných techník predstavujú metódy umožňujúce reperfúziu a zvrátenie ischémie so záchranou končatiny. Výber vhodnej metódy a postupu pri liečbe závisí na závažnosti ischémie. Medikamentózna terapia je dôležitou súčasťou celkovej starostlivosti. Manažment pacientov s aneuryzmami zákolennej tepny vyžaduje multidisciplinárny prístup. Pacienti by mali byť odosielaní, liečení a následne sledovaní na špecializovaných vaskulárnych pracoviskách. Kľúčové slová: aneuryzma popliteálnej artérie, symptómy, diagnostika, ultrazvukové vyšetrenie, endovaskulárna liečba, chirurgická liečba, emergentný výkon, manažment, multidisciplinárny prístup. Introduction: Popliteal artery aneurysm is one of the most common lower limb arterial aneurysm. It almost exclusively affects male population. Incidence as well as prevalence increases with age, with the highest occurence in 6th decade. The majority of popliteal artery aneurysms are due to atherosclerotic disease. Only one fifth have different etiology (trauma, infection, connective tissue diseases, congenital genetic factors etc.). The main clinical symptoms are results of tromboembolic episodes. Principal diagnostic methods, beside patient s history and physical examination, represent different imaging modalities. Therapy of popliteal artery aneurysm is conservative, endovascular or surgical. Treated should be symtomatic aneurysm with diameter 2 cm. Preventive intervention for asymptomatic aneurysm is still issue of vascular expert discussion. Methods: A retrospective follow-up study was conducted in two departments in one of tertiary vascular centre (National Institute of Cardiovascular Diseases) in Bratiskava, Slovakia. From 2002 until 2011, data were collected through a search in the hospital patient databases. Popliteal artery aneurysm was identfied and evaluated in 69 patients (66 men and 3 women), Mean age of patients was 63,5 years (from 39 to 83 years). The total number of popliteal artery aneurysms identified and treated was 78. Evaluations and results: Evaluated were patients comorbidities and risk factors. In 10 cases patients were managed conservatively, while in other 68 popliteal artery aneurysm were treated either endovascularely (n=14) or surgicaly (n=54). In the group of patients udegoing surgery or endovascular intervention, clinical symptoms, method of repair, as well as results and type of complications were evaluated. Conclusion: Decision for some therapeutic option (surgery or endovascular) should be based on individual evaluation of advances and disadvantages in particular patient case. In emergency cases, local intra-arterial thrombolysis, together with endovascular or surgical techniques is methods that help to provide reperfusion, stop progresion of ischaemia and generally increase the chance for preservation of imb perfusion. Choice of therapeutical method and course of treatment (managment of patient) should be based on severity of ischemia. Pharmacological therapy is important part of global patient care. Managment of patients with popliteal artery aneurysm demands multidisciplinary approach. Patients should be viewed, treated and inf important later followed- -up in tertiary vascular centres. Vaskulárna medicína Suplement ; 5(S3)

25 Abstrakty 25 Clue words: popliteal artery aneurysm, symptoms, diagnosis, ultrasound and other imaging modalities, endovascular treatment, surgery, emergency, management, multi-disciplinary approach. 9. Manažment pacientov s CLI v rokoch 2001 a 2010 retrospektívna analýza Aký je dopad rozvoja endovaskulárnej liečby na prognózu pacienta s CLI? (Managment of patients with CLI between 2001 and 2010 retrospective analysis) Širila M¹, Litvin I², Herman O³ ¹Angiologické oddelenie, VÚSCH, a. s. Košice, ²Rádiologické oddelenie, FN Trenčín, ³Interné oddelenie, FN Trenčín Kritická končatinová ischémia (KKI) je najmalígnejšou formou periférneho artériového ochorenia. Je závažným celospoločenským problémom výrazne zhoršujúcim tak kvalitu života (vysoké riziko amputácie), ako aj prognózu pacienta v zmysle smrti na kardiovaskulárne ochorenia. Vzhľadom na zvyšujúcu sa prevalenciu diabetes mellitus a iných rizikových faktorov aterosklerózy (fajčenie, obezita, arteriálna hypertenzia, hyperlipoproteinémia), ktoré sú hlavnými determinantami vzniku a rozvoja KKI, možno predpokladať zvyšujúci sa trend jej výskytu. Správnou diagnostikou a liečbou zabránime invalidizácii pacienta a znížime ostatné komplikácie vrátane úmrtia na kardiovaskulárne príhody. Táto práca sa zaoberá porovnaním liečby pacientov s KKI v rokoch 2001 a 2010 a jej vplyvom na výskyt vysokej amputácie. Kľúčové slová: kritická končatinová ischémia, amputácia, stenting, bypass. Critical limb ischemia is the most malignant form of the peripheral arterial disease. It is the serious all-society problem, which is really debasing the quality of life (high risk of amputation) as well as patient prognosis in terms of death on cardiovascular diseases. Regarding the increasing prevalence of diabetes mellitus and other atherosclerosis risk factors (smoking, obesity, arterial hypertension, hyperlipoproteinemia), which are the main determinants of the creation and expansion of critical limb ischemia it is possible to expect the increasing trend of appearance. With the right diagnosis and treatment we avoid patient invalidization and reduce the risk of the other complications including death on cardiovascular diseases. In this work I compare treatment of patients with CLI in the years 2001 and 2010 and its effect on appearance of high amputation. Key words: critical limb ischemia, amputation, stenting, bypass. 10. Karotický stenting u pacientov pred neodkladnou kardiochirurgickou operáciou (Carotid artery stenting prior to urgent cardiac surgery) Kmeťková K SÚSCCH, a.s., Banská Bystrica Ateroskleróza ako generalizovaný proces u pacientov nezriedka vedie k súčasnému postihnutiu viacerých artériových riečisk. Ak ide o závažné postihnutie karotického riečiska u pacientov, ktorých zdravotný stav vyžaduje neodkladnú chirurgickú koronárnu revaskularizáciu alebo operačné riešenie chlopňovej chyby, ; 5(S3) Vaskulárna medicína Suplement 3

26 26 Abstrakty zvyšuje sa u týchto pacientov riziko perioperačnej ischemickej cievnej mozgovej príhody. Neexistuje univerzálne riešenie ako postupovať v takýchto prípadoch. Situáciu je u každého pacienta potrebné posudzovať individuálne. Jednou z možností riešenia u vysoko rizikových pacientov je simultánny hybridný revaskularizačný výkon (karotický stenting, aorto-koronárny bypass), ktorého úspešnosť potvrdili výsledky štúdie SHARP. Autori prezentujú súbor 57 pacientov, u ktorých bol na našom pracovisku indikovaný simultánny hybridný revaskularizačný výkon pre súčasné závažné postihnutie koronárnych a karotických tepien. 11. Odstrániteľné kaválne filtre indikácie implantácie a klinické sledovanie (Retrievable vena cava filters indications and clinical monitoring) Šumaj M¹, Maďarič J² ¹Interné odd., FN Trenčín, ²Odd. kardiológie a angiológie, NÚSCH Bratislava Odstrániteľné kaválne filtre sú vhodnou alternatívou permanentých ako aj dočasných kaválnych filtrov pre možnosť ich dlhodobého ponechania v mieste implantácie, ako aj ich extrakcie v prípade neprítomnosti dlhodobého rizika pľúcnej embólie (PE). Cieľom práce je analýza indikácií implantácie reponibilných kaválnych filtrov (VCF) u pacientov s venóznym tromboembolizmom (VTE) a zhodnotenie klinického stavu pacientov po ich implantácii v dlhodobom sledovaní. Retrospektívne bolo analyzovaných 17 pacientov, ktorí boli v rokoch hospitalizovaní na NÚSCH, a. s., s cieľom implantácie VCF ako prevencie PE. Zhodnotené a referované budú absolútne a relatívne indikácie implantácie, prežívanie pacientov, výskyt PE a recidívy hlbokej venóznej trombózy (HVT) v sledovanom období, časový interval do eventuálnej extrakcie VCF, komplikácie, ako aj spôsob a dĺžka antikoagulačnej liečby v sledovanej skupine pacientov. Reponibilné kaválne filtre sú pri dodržaní správnych indikácií dôležitou súčasťou manažmentu u vybraných rizikových pacientov s HVT, kde sú účinnou prevenciou PE. 12. Nízke TSH redukuje výskyt venózneho tromboembolizmu (Low TSH reduces the events of venous thromboembolism) Nagyová M, Petrovič T, Zelinková Z, Koller T, Payer J V. interná klinika LF UK a UNB, Bratislava Background/Introduction: Various changes in the coagulation-fibrinolytic system have been described in patients with an excess or deficiency of thyroid hormones. These coagulation-fibrinolytic disorders range from subclinical laboratory abnormalities to more rarely life-threatening hemorrhages or thrombotic events. According to the literature, overt hypothyroidism appears to be associated with a bleeding tendency; hyperthyroidism emerged to have an increased risk of thrombotic events. In opposite, a large clinical study showed an incresed risk of venous thromboembolism in patient with hypothyreoidism, but not hyperthyreoidism. Aim of the study: To assess the relative contribution of thyroid function to the risk of venous thromboembolism (VTE). Vaskulárna medicína Suplement ; 5(S3)

27 Abstrakty 27 Patients and Methods: First, in the period from January 2009 till August 2012, all consecutive patients admitted to the internal ward with clinical suspicion of VTE were included. The suspicion was based on the symptoms and signs of deep vein thrombosis and pulmonary embolism. To confirm the diagnosis of suspected pulmonary embolism we used CTpulmoangiography, and for detection of deep vein thrombosis Doppler ultrasound. Pacients were divided into 3 groups according totsh: pacient with hypothyreoidism (TSH > 5 miu/l), euthyreoidism (TSH miu/l) and hyperthyreoidism (TSH < 0.5 miu/l). Second, patients treated for hyperthyroidism were recruited from the endocrinology outpatient clinical of one academic hospital. These patients were interviewed and their self-reported rate of VTE events was recorded. Results: In total 205 patients with suspicion of VTE were included (84 males/121 females, mean age was 66.7 years). VTE was confirmed in 98 pts (58%). The proportion of patients with VTE was significantly reduced in the group of patients with hyperthyroidism (33% with VTE vs. 58% in both, euthyroid and hypothyroid group, respectively; p=0.042). In the group of euthyroid patients, the average TSH was significantly higher in patients with VTE compared with patients without VTE ( ± vs ± , p=0.017). In addition, the overall rate of VTE among outpatients with hyperthyroidism was assessed. None of the 62 (14 males/ 48 females; mean age 52 years), interviewed patients suffered from VTE in the past. Conclusion: Low TSH seems to reduce the events of venous thromboembolism. Results from our clinical research were in line with findings from the clinical study conducted on large number of pacient. Nevertheless, further observational and studies might be needed to provide more definitive information on the clinical relevance of this association. 17. Akútna končatinová ischémia definícia, diagnostika, algoritmy terapie (Acute limb ischemia definition, diagnostic, terapeutic algorithm) Širila M. Angiologické oddelenie Kardiologickej kliniky, VÚSCH, Košice Akútna končatinová ischémia (AKI) je stav, kedy dochádza k náhlemu poklesu toku krvi do končatiny. Ohrozuje pacienta na živote (metabolickým rozvratom) alebo stratoukončatiny. Mala by byť považovaná za emergentnú situáciu. Mechanizmus vzniku AKI možeme rozdeliť do dvoch kategórií: embolizácia a lokálna obštrukcia. Najčastejšou príčinou embolizačnej príhody je fibrilácia predsiení. Lokálna obštrukcia vzniká následkom ruptúry nestabilného aterosklerotického plátu. Kombináciou oboch môže byť aneuryzma artérie (spôsobuje embolizácie do periférie alebo uzáveru cievy trombotizáciou). Klinický nález závisí od rýchlosti vzniku uzáveru (prípadne preexistujúcich kolaterál) a anatomickej lokalizácie. Štádium ochorenia sa určuje podľa Rutherfordovej klasifikácie pre AKI. Pre ovplyvnenie prognózy pacienta je dôležitá rýchla a presná diagnostika, ktorá rozhodne o výbere správnej liečebnej modality (endovaskulárna verzus chirurgická liečba) ; 5(S3) Vaskulárna medicína Suplement 3

28 28 Abstrakty Acute limb ischemia occurs when blood flow to a limb is suddenly decreased. It threatens patient life (with a metabolic failure) or limb loses. It should be considered as a true medical emergency. The mechanism of origin can be divided into two broad categories: embolism and local obstruction. The most common origin of embolisation is atrial fibrilation. The local obstruction it cause by a disruption of instabil aterosclerotic plaque. The combination of both modalitis can be arterial aneurysm (it leads to peripherial embolisation or obstruction of the vessel). The clinical finds depends on the rapidity of vessel obstruction (or preexisting collaterals) and on anatomical localization. Grading is done with the Rutherford classification for acute limb ischemia. Exact diagnostic and optimal theraputic strategy (endovascular versus surgical) are crucial for final positive therapeutic outcome. 18. Lokálna trombolytická liečba akútnej končatinovej ischémie (Acute limb ischemia treated with local thrombolytic therapy) Pataky Š, Špak Ľ Angiologické oddelenie Kardiologickej kliniky, VÚSCH, Košice Akútna končatinová ischémia je definovaná ako náhly pokles alebo zhoršenie prietoku krvi končatinou, ktoré predstavuje hrozbu pre jej životaschopnosť. Príčinou jej vzniku môže byť trombóza, prípadne embólia natívnej tepny, alebo bypassu. Lokálna, kontinuálna, katétrom usmernená intra-arteriálna trombolýza je bežne zaužívanou alternatívou chirurgickej liečby akútnej končatinovej ischémie. Na základe celosvetových štúdii je lokálna trombolýza odporúčaná v liečbe akútnej končatinovej ischémie do štrnástich dní od začatia symptómov. Na našom pracovisku sme hodnotili výsledky perkutánnej lokálnej kontinuálnej trombolytickej liečby pacientov v období medzi májom 2008 a decembrom 2012, kedy sme rekombinantným tkanivovým aktivátorom plazminogénu vykonali 200 arteriálnych trombolýz (71,9 % mužov, 28,1 % žien). Liečba trombolýzou, ako primárna terapeutická stratégia viedla k úspešnej záchrane končatiny v 94 % prípadov. Lokálna trombolytická liečba je úspešná a menej invazívna terapeutická metodika akútnej končatinovej ischémie. Acute limb ischemia occurs due to a sudden decrease in the blood flow to a limb, resulting in a potential threat to the viability of the extremity. Reason for the onset of acute limb ischemia can be thrombosis or embolism to the native artery or a bypass graft. Local, continual, catheter directed intra arterial thrombolysis is a widely use alternative to the surgical treatment in the management of the acute limb ischemia. Local thrombolytic therapy is a recommended treatment option in the first fourteen days after onset of symptoms of acute limb ischemia, according to the available studies. We evaluated the results of percutaneous local continual thrombolytic therapy performed in our hospital between May 2008 and December Between this period we treated 200 patients with r-tpa (71% male, 28.1% female). Treatment of acute limb ischemia with thrombolytic therapy resulted in limb salvage in 94% of cases. Local thrombolythic therapy is a less invasive and successful therapeutic option in the management of acute limb ischemia. Vaskulárna medicína Suplement ; 5(S3)

29 Abstrakty Mechanická trombektómia (Mechanical thrombectomy) Moščovič M Angiologické odd. kliniky kardiológie, VÚSCH, Košice Mechanická trombektómia je jednou z dostupných možností liečby akútnej a subakútnej končatinovej ischémie hlavne v oblasti pod bifurkáciou femorálnej artérie. V mnohých prípadoch umožňuje priame odstránenie zrazeniny v snahe čo najrýchlešej revaskularizácie. V mnohých prípadoch umožňuje vyhnúť sa zdĺhavým a opakovaným výkonom. Nutná je znalosť viacerých dostupných techník a prístrojov od aspiračných katétrov až po mechanické systémy. Mechanická trombektómia nezaručuje úspešnosť v každej situácii. Na dosiahnutie čo najlepších možných výsledkov je nutná kombinácia rôznych techník. Sľubné výsledky metodiky by mali byť v budúcnosti potvrdené aj väčšími randomizovanými štúdiami. Mechanical thrombectomy is a feasible way for acute and subacute thrombosis in arteries mainly below the femoral bifurcation. In most instances it allows the straight-forward removal of the clot material, allows rapid revascularization. Also avoids lengthy procedures with repeat re-checks in most instances. It requires knowledge of a variety of different devices from aspiration catheters to mechanical systems. Full success in every situation is not guaranteed. Combination of different techniques and cooperation between different specialities is required to achieve the best possible results. Promising results should lead to larger, randomised studies. 20. Úloha farmakomechanickej trombektómie v liečbe aktútnej končatinovej ischémie (Role of pharmacomechanical thrombectomy in the treatment of acute limb ischemia) Balázs T, Vulev I, Bažík R, Klepanec A Oddelenie diagnostickej a intervenčnej rádiológie NÚSCH, Bratislava Akútna končatinová ischémia (ALI) je potencionálne život ohrozujúci stav zapríčinený náhlym obmedzením prietoku krvi do ohrozenej končatiny. Najčastejšou príčinou ALI je aterotrombóza (85 %), kým oklúzia tepny na embolizačnom podklade vzniká v 15 % prípadov. Správnou diagnostikou a rýchlym terapeutickým zásahom vieme výrazne znížiť morbiditu, mieru amputácii a v konečnom dôsledku aj mortalitu. Najdôležitejšiu úlohu hrá v liečbe ALI časové okno a práve pre tento fakt sa postupne zavádzajú nové miniinvazívne endovaskulárne intervenčné techniky s cieľom primárneho spriechodnenia postihnutého tepenného riečiska, obnoviť krvé zásobenie končatiny a súčasne aj skrátiť množstvo periprocedurálne podaných trombolytík s cieľom znížiť riziko hemoragických príhod, ktoré sú nežiadcim vedľajším účinkom pri klasickej katétrom usmernenej trombolýze. Klasickú formu perkutánnej mechanickej trombektómie (aspirácia, trombosukcia) postupne dopĺňajú nové technológie, pomocou ktorých dochádza k macerácii, fragmentácii a ku evakuácii zrazenín s cievneho lúmenu. Mechanické perkutánne zariadenia pracujú na princípe mikrofragmentácie trombu, ďalej na hydrodynamickom princípe. Najúčinnejšou formou podľa našich skúseností je kombinácia mechanickej trombektómie a farmakologickej trombolýzy, tzv. farmakomechanická trombektómia ; 5(S3) Vaskulárna medicína Suplement 3

30 30 Abstrakty (PMT). Počas činnosti tohto zariadenia dochádza ku pulzno-sprejovej aplikácii trombolytika a súčasne aj k narúšaniu integrity samotného trombu. Týmto spôsobom dochádza k efektívnejšiemu rozrušeniu trombov a ich následnej extrakcii. Vysokou rýchlosťou podávané trombolytikum vytvára podtlak, pomocou ktorého sú následne fragmentované čiastočky trombu odsaté. Ďalšou nespornou výhodou je výrazne redukovaný čas pôsobenia trombolytika s jeho minimálnym, resp. žiadnym systémovým účinkom, teda dostupným aj u rizikových pacientov, u ktorých je klasická kontinuálna trombolýza kontraindikovaná (čerstvé postpartálne obdobie, čerstvé hemoragické mozgové príhody, resp. pooperačné stavy a traumy). Treba spomenúť výrazný benefit PMT z hľadiska redukcie času nutného pobytu na monitorovanom lôžku počas podávania trombolytika, redukcie počtu kontrolných angiografií a v možnosti kombinácie s ostatnými terapeutickými modalitami. 21. Karotická intimo-mediálna hrúbka a indexy arteriálnej tuhosti ako prediktívne ukazovatele vzniku infarktu myokardu a cerebrálneho infarktu (Carotid intima-media thickness and indices of arterial stiffness as the predictors of myocardial infarction and cerebral infarction) Danihel D, Bartko D, Gombošová Z Ústav medicínskych vied, neurovied a vojenského zdravotníctva, Ústredná vojenská nemocnica fakultná nemocnica SNP, Ružomberok Introduction: My research work is a part of a project of the European Union named New markers of the onset and time-course of cerebral infarction. The study, which I take part in, is a component of this project. The name of this study is Lipoprotein-associated Phospholipase A2 (LP-PLA2) may predict future cardiovascular events in patients with coronary heart disease (CHD) and ischemic cerebral stroke (ics), relationship with intima-media thickness (IMT), arterial stiffness and plaque characteristics. We are trying to find a correlation between LP-PL2 and IMT and indices of arterial stiffness in patients with ics, CHD and arterial hypertension (AH). The task of a radiologist in this study is the assessment of IMT on common carotid artery by ultrasonography as predictive indicator of myocardial infarction (MI) and cerebral infarction (CI). Although aplanation tonometry is a physiologic method of measurement of regional arterial stiffness on aorta, radiologist can use it as another opportunity to diagnose early stage of the atherosclerosis in phase of endothelial dysfunction with measurement of augmentation index (Alx) and in phase of functional changes with measurement of pulse wave velocity (PWV) The aplanation tonometry is used by world known and respected institutions which publish their outcomes in journals with impact factor more than 20 (Neurology). According to the guidelines of the European Society of Hypertension from 2007, the value of IMT more than 0.9 mm and of PWV more than 12 m/s is recognized as subclinical organ damage in hypertensive patients. This opinion was confirmed by The Fifth Task Joint Force of the European Society of Cardiology an Other Societies on Cardiovascular Disease Prevention in Clinical Practice and published in European Guidelines on cardiovascular disease Vaskulárna medicína Suplement ; 5(S3)

31 Abstrakty 31 prevention in clinical practice in According to the guidelines ofthe American College of Cardiology and the American Heart Association from 2010, the enlargement of IMT about 0.1 mm increases relative risk (risk in young people adapt for age of 60 years) of fatal or non-fatal cardiovascular events about 15 %. A study named Aortic Pressure Augmentation Predicts Adverse Cardiovascular Events in Patients With Established Coronary Artery Disease was published on Hypertension journal of AHA in 2005, in which the increase of risk of cardiovascular event when Alx rises about 10% was estimated about 28% by Cox regression method. The work of whole team is prospective, multidisciplinary and multicetrical study, my work is cross-sectional corfirmative study preliminarily. Aim of the study: To assess and confirm carotid intima-media thickness and indices of arterial stiffness as the predictors of myocardial infarction and cerebral infarction. Materials and methods: I examine four patient groups. There are patients with CI in the first group and with CHD in the second group and with AH in the third group and healthy people in the fourth group. In all groups I measure IMT common carotid artery on both sides by ultrasonography using radio-frequency data analysis and augmentation index (Alx) and pulse wave velocity (PWV) on one side (mostly right) by aplanation tonometry. Alx and PWV are parameters of regional aortic stiffness. It is important to measure IMT on both sides to compare side differences in patients on the side with cerebral ischaemia and on healthy side. The measurement of Alx and PWV is not side dependent, because Alx and PWV are parameters of aortic stiffness, but they are not parameters of cerebral circulation (carotid stiffness). Alx and PWX are measured on right side mostly. If this is not possible (shunt for dialysis on right wrist or forearm, amputated upper or lower right limb), they are measured on left side. In some cases the values from measurement of Alx and PWV are not evaluable; it is in case of aortal stenosis, Raynaud s phenomenon, A-V block of 2nd and 3rd degree, atrial fibrillation and flutter and in presence of pacemaker. Results: From January 2011 to April 2013 I have examined 436 subjects (200 men and 236 women) totally, 170 patients (85 men and 85 women) in group with CI, 86 patients (27 men and 59 women) in group with CHD, 124 patients (57 men and 67 women) in group with AH and 56 subjects (31 men and 25 women) in control group. Measured values will be processed statistically with tabular calculator Microsoft Excel 2007 and statistical software STATISTICA Base Cz ver. 10 using Whitney U test. Conclusion: Preliminary results document substantial changes of IMT and aortic stiffness not only in group with CI, but also in group with CHD and AH. The measurement of IMT, Alx and PWV is a useful method of assessment of cardiovascular and cerebrovascular risk. IMT, Alx and PWV have significant prognostic power to point out patients with increased risk of onset of cardiovascular and cerebrovascular diseases including increased mortality. Key words: arterial stiffness, augmentation index, pulse wave velocity, intima-media thickness. This study is supported by the grant of European Union ITMS ; 5(S3) Vaskulárna medicína Suplement 3

32 32 Abstrakty 22. Aortic stiffness and carotid flow pulsatility in stroke survivors Wohlfahrt P Thomayerova nemocnice; IKEM, Praha, Česká republika Background and Purpose: Aortic stiffness is increased in lacunar stroke. The precise mechanism linking aortic stiffness and symptomatic lacunar stroke is not well understood. The aim Figure 1. Differences in aortic pulse wave velocity (Panel A) and carotid resistive index (Panel B) between ischemic stroke subtypes. Panel A Panel B LAA large artery atherosclerosis; CAEM cardioembolism, data are adjusted for age, sex, MAP, hypertension, diabetes, BMI, total and LDL cholesterol and glycaemia of this study was to access the association between aortic stiffness, carotid flow pulsatility and stroke etiology. Methods: Consecutive patients hospitalized at Thomayer Hospital for their first-ever ischemic stroke were examined. The subtype of ischemic stroke was classified using the Causative Classification of Stroke System. Carotid-femoral pulse wave velocity (PWV), as a parameter of aortic stiffness, was measured using a SphygmoCor device. Common carotid flow pulsatility expressed as resistive index (RI) was measured using ultrasound. Results: In 174 patients (mean age 66.7±9.6 years, 64% of men), PWV was higher in patients with lacunar stroke as compared with patients with large artery atherosclerosis (13.11 ± 2.74 vs ± 1.87 m/s, p). 23. Stimulácia baroreceptorov podporuje NO-dependentnú vazodilatáciu, možné uplatnenie pri diabete a kardiovaskulárnych ochoreniach (Baroreceptor stimulation enhanced NO-dependent vascular dilation a new treatment for diabetic and cardiovascular conditions) Gmitrov J The National Institute of Public Health, Tokyo, Japan; Všeobecná nemocnica Pro Vitae n.o.; Gelnica, NsP Krompachy Objectives: Increasing evidence suggests nitric oxide (NO) deficit and baroreflex dysfunction to be characteristic for diabetic and cardiovascular conditions even in preclinical stages of the disease. We studied sodium nitroprusside Vaskulárna medicína Suplement ; 5(S3)

33 Abstrakty 33 (a spontaneous NO donor) microvascular vasodilatatory effect in conjunction with arterial baroreflex sensitivity (BRS) after sinocarotid baroreceptor magnetic stimulation with potential implementation in diabetic and cardiovascular conditions. Methods: Mean femoral artery blood pressure (BP), heart rate (HR), and ear lobe skin microcirculatory blood flow, measured by microphotoelectric plethysmogram (MPPG), were simultaneously recorded in conscious rabbits before and after 40-min local exposure of the sinocarotid baroreceptors to 350 mt intensity static magnetic field (SMF), generated by Nd- Fe-B alloy magnets (n=14) or sham magnets (n=10, controls). Baroreflex sensitivity was estimated from HR/MAP response to intravenous bolus injections of sodium nitroprusside and phenylephrine. Results: The microvascular vasodilatory response due to the same dose bolus injections of nitroprusside strikingly increased after SMF exposure. SMF-inducedsignificant increase in BRS inversely correlated with significant decrease in phenylephrine BP ramps (p=0.016) and positively with significant increase in microcirculatory blood flow (p=0.009). Conclusion: A larger vasodilatory effect of a sodium nitroprusside (NO-donor) on the background of increased arterial baroreflex sensitivity suggests augmentation of the baroreflex capacity support NO-dependent vasodilation to be a new physiological mechanism of the blood pressure buffering and microcirculatory control. Sinocarotid baroreceptor magnetic stimulation should be tested in a range of important cardiovascular conditions associated with diabetes such as arterial hypertension, coronary heart disease and heart failure where NO deficit and sympathovagal imbalance, that result from a loss of baroreflex control over autonomic activity, increases the risk of morbidity and mortality substantially. Key words: static magnetic field, baroreflex sensitivity, blood pressure buffering, microcirculation, diabetes. 24. Migračná pozícia lipoproteínu(a) v spektre sérových lipoproteínov, identifikovaná systémom Lipoprint LDL (Migration position of Lipoprotein(a) in lipoprotein spectrum of serum lipoproteins identified by Lipoprint LDL system) Oravec S 1, Kučera M 1, Sabaka P 1, Dostal E interná klinika LF UK UNB Bratislava, Slovensko 2 Krankenanstalten Dr. Dostal, Viedeň, Rakúsko Ūvod: Lipoproteín(a) [Lp(a)], predstavuje nezávislý faktor rozvoja kardio-vaskulárnych ochorení. Jeho koncentrácia v sére nad hodnotu 0,3 g/l zvyšuje riziko vzniku atero-trombózy periférnych ciev, ale aj náhlej ischémie mozgu. Osoby, ktoré majú súčasne vyššiu hladinu celkového cholesterolu aj lipoproteínu(a) v sére, sú ohrození vznikom kardio-vaskulárnej alebo cerebro-vaskulárnej príhody oproti osobám s normálnymi hladinami lipoproteínov, tro-násobne. Cieľom štúdie bolo určiť migračné miesto Lp(a) v lipoproteínovom spektre pri elektroforéze lipoproteínov na PAG a či častice lipoproteínu (a) rôznej koncentrácie a rôznej veľkosti nemigrujú na rôznych migračných pozíciách ; 5(S3) Vaskulárna medicína Suplement 3

34 34 Abstrakty Pacienti a metódy: Bolo vyšetrených 175 osôb so zvýšenou koncentráciou lipoproteínu (a) v sére, ktoré boli rozdelené na dve podskupiny: Skupina (n=98), kde hodnoty Lp(a) boli v rozmedzí 0,3 0,8 g/l; Skupina (n=77) s hodnotami Lp(a) vyššími než 0,8 g/l. Kontrolnú skupinu zdravých probandov tvorilo 128 osôb s hodnotami Lp(a) v sére nižšími než 0.3 g/l. Analýza lipidov a lipoproteínov: V sére sa vyšetrila koncentrácia celkového cholesterolu, triacylglycerolov enzymatickou metódou (Roche SRN) a lipoproteínu(a) nefelometrickou metódou (Roche SRN). Lipoprotreínové spektrum sa vyšetrilo Lipoprint LDL Systémom (Quantimetrix corp. USA). Súbory sa vyhodnotili štatisticky nepárovým Studentovým t-testom. Signifikantné rozdiely porovnávaných hodnôt sa akceptovali pri p< 0,05. Výsledky: V štúdii sa zistilo, že koncentráci IDL2 a IDL3, v skupinách so zvýšenými hodnotami Lp(a) v sére je oproti kontrolnej skupine štatisticky signifikantne vyššia: 0,49 vs 0,43 mmol/l (p<0,005) pre IDL2 subpopuláciu a 0,62 vs. 0,49 mmol/l (p<0,0001) pre IDL3 subpopuláciu. Záver: IDL2 a IDL3 predstavujú frakciu lipoproteínov séra, kde počas elektroforézy lipoproteínov na PAG (Lipoprint System LDL), migruje lipoproteín(a). Štúdia nepotvrdila rôzne migračné pozície pre častice lipoproteínu(a) rôznej veľkosti. Introduction: Lipoprotein (a) [(Lp(a)] represents an independent factor for the cardio- -vascular diseases development. The serum concentration of Lp(a) higher than 0.3 g/l increases the risk of athero-thrombosis of peripheral vessels and a brain stroke event. The individuals with increased levels of lipoprotein (a) and contemporarily increased cholesterol level in serum are at increased risk of the inception of cardiovascular or cerebrovascular event even 3-times. The aim of the study was to learn the migration position of Lp(a) in lipoprotein spectrum during a lipoprotein electrophoresis on PAG and if the lipoprotein (a) particles of different serum concentration and different size do not migrate in different positions of the lipoprotein spectrum. Patients and methods: In 175 individuals with increased serum concentration of lipoprotein(a) a lipoprotein profile analysis was performed. They were divided into two groups: Subgroup (n=98) with the Lp(a) concentration in the range between g/l; Subgroup with the Lp(a) concentration over 0.8 g/l.the control group of healthy subjects consisted from 128 persons who had the Lp(a) concentration in serum lower than 0.3 g/l. Lipid and lipoproteins analysis: Total cholesterol and triglycerides in serum were analysed by an enzymatic method CHOD PAP (Roche Diagnostics, FRG) and lipoprotein (a) was analysed by an immuno-nephelometric method (Roche Diagnostics, FRG). For the analysis of lipoproteins an innovated electrophoresis method on polyacrylamide gel (PAG) Lipoprint LDL System (Quantimetrix corp. USA), was used. The results were evaluated statistically by an impair Students test. Results: The study found out, that the concentration of IDL2 and IDL3 subpopulations in both subgroups with increased serum Lp(a) are significantly increased, compared to the control group: 0.49 vs 0.43 mmol/l (p<0.005) for IDL2 and 0.62 vs 0.49 mmol/l (p<0.0001) for IDL3 subpopulations. Conclusion: IDL2 and IDL3 subpopulations represent the lipoprotein fractions, where during Vaskulárna medicína Suplement ; 5(S3)

35 Abstrakty 35 an electrophoretic analysis of serum lipoproteins on polyacrylamide gel migrates Lp(a). The study did not confirm the different migration positions for the Lp(a) particles of different size. 25. Vaskulitídy ako zriedkavá príčina claudicatio intermittens (Vasculitides as a rare cause of intermittent claudication) Celecová Z, Krahulec B, Ližičárová D, Gašpar Ľ, Štvrtinová V II. interná klinika LF UK a UNB Bratislava Intermittent claudication of the lower extremities is a common symptom described in older patients with atherosclerotic peripheral arterial disease. Peripheral arterial disease due to atherosclerosis is known to be associated with a higher risk of myocardial infarction, stroke and all-cause mortality. However, if intermittent claudication appears in a younger group of patients or older patients in absence of traditional risk factors for atherosclerosis such as smoking, dyslipidemia, arterial hypertension and diabetes mellitus other causes than atherosclerosis must be considered. These conditions include vasculitides, fibromuscular dysplasia, cystic adventitial disease, excentric vascular compression by tumor, popliteal artery entrapment syndrome, trauma or dissection. Vasculitides present a heterogenous group of disorders characterized by inflammatory destruction of blood vessels. Although often not a leading symptom intermittent claudication could be a part of a clinical picture in giant-cell arteritis, Takayasu s arteritis, Buerger s disease, polyarteritis nodosa or Behçet disease. Limb claudication is usually of rapid onset, progressive and bilateral. Each of the mentioned vasculitides is specific in ethiology and clinical manifestation with a variable prognosis for the patient. Increased awareness of the presence of different causes of limb claudication and their early diagnosis with a prompt initiation of appropriate treatment may help to avoid clinical progression that can lead to vascular surgery or even limb loss. Key words: intermittent claudication, giant- -cell vasculitides, variable clinical picture. 26. Špecifiká liečby artériovej hypertenzie u chorých a ochoreniami periférnych artérií (Specifications of hypertension treatment in patients with peripheral artery diseases) Szabóová E¹, Bavoľárová M², Pavúková M¹, Kmecová D³, Holoubek D 4 ¹IV. interná klinika, Faculty of Medicine, PJ Šafárik University in Košice ²V. interná klinika Faculty of Medicine, PJ Šafárik University in Košice ³Angiologická ambulancia, Angiocare sro. Košice 4 Kardiologická klinika VÚSCH Košice Artériová hypertenzia, významný rizikový faktor kardiovaskulárnych ochorení (KV) ochorení, je často prítomná aj u chorých s ochoreniami periférnych artérií (PAO), u ktorých jej manažment má isté špecifiká. V prehľadovej prednáške autori analyzujú možnosti liečby artériovej hypertenzie u týchto chorých. Zdôrazňujú význam zdravého životného štýlu, ale aj nutnosť farmakoterapie so zreteľom na jej začatie, dosiahnutie cieľových hodnôt krvného tlaku pomocou hlavných skupín antihypertenzív v monoterapii alebo v kombinácii ako i na celodennú efektivitu ; 5(S3) Vaskulárna medicína Suplement 3

36 36 Abstrakty zvoleného antihypertenzíva. Správny liečebný postup redukciou KV rizika zlepšuje prognózu chorých. Arterial hypertension, a major risk factor for cardiovascular (CV) disease is often present even in patients with peripheral arterial disease (PAD), in which its management has certain peculiarities. In the review authors analyze the possibility of hypertension treatment in these patients. They stress the importance of a healthy lifestyle, but also a need for drug therapy with regard to its initiation, achieving target blood pressure by major groups of antihypertensive drugs as monotherapy or in combination, as well as all- -day efficiency of selected antihypertensives. Adequate management by reducing cardiovascular risk improves the prognosis of patients. 27. Rádiofrekvenčná renálna sympatiková denervácia u pacientov s rezistentnou artériovou hypertenziou 3-mesačné sledovanie (Radiofrequency renal sympathetic denervation in patients with resistant hypertension 3 months follow-up results) Maďarič J, Tóth M, Urlandová T, Hladíková D, Margitfalviová J, Fľak L, Mikuláš J, Drangová E, Postulková L, Mistrík A, Chnupa P, Vulev I Oddelenie kardiológie a angiológie, NÚSCH, Bratislava Cieľ: Cieľom práce bolo zhodnotenie bezpečnosti a efektivity perkutánnej rádiofrekvenčnej renálnej sympatikovej denervácie (RDN) u pacientov s rezistentnou artériovou hypertenziou (AH) v krátkodobom sledovaní. Metódy: Z 22 kandidátov s nedostatočne kontrolovanou AH na 3 kombinačnej antihypertenzívnej liečbe vrátane diuretika sme v období od 3/2012 do 3/2013 indikovali 10 pacientov (vek 55±11 rokov, M:F 7:3) s rezistentnou AH (priemerný ambulantný krvný tlak 188/112 mmhg s priemerným počtom antihypertenzív 7±1) na realizáciu RDN. Výkon bol uskutočnený v analgosedácii transfemorálnym perkutánnym prístupom s použitím RDN Symplicity katétra (Medtronic). Analyzované boli zmeny hodnôt ambulantného krvného tlaku (TK) a 24-hodinového TK monitoringu (ABPM) 1 a 3 mesiace po RDN (9 pacientov), ako aj výskyt komplikácií. Ako RDN responderi boli definovaní pacienti s poklesom ambulantného systolického TK o 10 mmhg. Výsledky: U žiadneho z intervenovaných pacientov sme nezaznamenali v periprocedurálnom období, ako aj v 3-mesačnom sledovaní výskyt celkových alebo lokálnych komplikácií. Všetci pacienti dobre tolerovali ablačný výkon, nedošlo k zmene renálnej filtrácie, nezaznamenali sme výskyt renálnej stenózy pri kontrolnej CT angiografii 3 mesiace po RDN. Priemerný počet ablácii na jednu renálnu artériu bol 5,5±0,9, priemerná dĺžka výkonu 41 minút. Mesiac ako aj 3 mesiace po výkone došlo k významnému poklesu hodnôt TK v ambulantnom prostredí, ako aj počas 24 hod. ABPM.. Respondermi RDN 3 mesiace po výkone boli 7 z 9 pacientov (78 %). Záver: Rádiofrekvenčná renálna sympatiková denervácia je bezpečná metóda, ktorá v krátkodobom sledovaní významne znižuje hodnoty TK u pacientov s rezistentnou AH. Doterajšie skúsenosti so zavádzanou metodikou poukazujú na potrebu správnej selekcie pacientov vhodných na toto intervenčné riešenie. Vaskulárna medicína Suplement ; 5(S3)

37 Abstrakty Long-term results of percutaneous angioplasty of the renal artery, according to recent multicenter studies ( ASTRAL & CORAL) Kosicki A, Ostrowski T, Kulesza A, Szostek M, Skórski M, Januszewicz M, Rowiński O Medical University of Warsaw, Department of General and Thoracic Surgery and II Department of Radiology, Warsaw, Poland Aim: Evaluation of immediate and long-term results of renal artery angioplasty by means of reduction in blood pressure and by means of improving the renal function. Material and methods: In Department of General and Thoracic Surgery of Warsaw Medical University between years , 180 patients (90 women and 90 men) with renal hypertension were treated. Diagnosis was based upon Doppler ultrasound examinations, angiograms and blood pressure measurements. The number of anti-hypertensive medications used and biochemical parameters of renal function were estimated. 205 primary renal angioplasties were performed. Results: In 90.6% (163 patients) a good immediate results were achieved. After five years, good results were noted in 61%. 61 patients remained in long-term follow up (up to 24 years). The results were analyzed respecting the primary cause of renal artery stenosis and upon what the influence on renal function had renal artery angioplasty. Results are compared with the ones obtained by ASTRAL trial and preliminary results of CORAL trial. Conclusions: 1. A safe and effective method of treatment for renovascular hypertension is percutaneous transluminal renal artery angioplasty (PTRA). After successful PTRA patients achieve better hypertension control and are less likely to develop renal failure. 2. Better clinical results after the procedure, were observed in patients where atherosclerosis was responsible for renal artery stenosis, compared to those where fibromuscular dysplasia was the cause. Several re-do procedures do not diminish hypertension and renal insufficiency, good long term results were observed. 3. According to our almost 30 year experience with treatment of renovascular disease, effectual and safety modality such as renal artery angioplasty makes it a good choice. 29. Systémové vaskulitídy vzácne príčiny renovaskulárnej hypertenzie (Systemic vasculitides a rare cause of renovascular hypertension) Hirnerová E¹, Kučera M¹, Celecová Z¹, Podolinská K², Štvrtinová V¹ ¹II. interná klinika UN a LF UK Bratislava, ²I. rádiologická klinika UN a LF UK, Bratislava Renovascular hypertension (RVH) is quite a common type of secondary hypertension which is often associated with an extremely high blood pressure as well as with a resistance to antihypertensive treatment. It is defined as an elevation of systemic blood pressure as a result of either partial or complete occlusion of one or both renal arteries or their branches. Stenosis of renal arteries can be caused by various pathological causes, the most common of them are atherosclerosis and fibromuscular dysplasia. In ; 5(S3) Vaskulárna medicína Suplement 3

38 38 Abstrakty our clinical practice we can encounter even less common causes of RVH, systemic vasculitides present one of these rare clinical entities. Systemic vasculitides present a heterogenous group of disorders often of unknown etiology that is characterized by inflammation and necrosis of blood vessel wall. Medium and large vessel vasculitides are those that can potentially lead to RVH. In Takayasu s arteritis RVH is the most common presentation of the disease in adults as well as in children, medium sized arteritis such as classic form of polyarteritis nodosa or Kawasaki disease less commonly present with RVH. Pathogenesis of hypertension in vasculitides is probably more complex; apart from stenosis of renal arteries other mechanisms play a role as well, such as e.g. lower elasticity of the vessel wall. Not adequately treated RVH negatively affects prognosis of the patients as it leads to serious often life-threatening comlications. It is though the most common form of secondary hypertension with a possibility of causal treatment. In comparison to the other causes of RVH treatment of the patients with systemic vasculitides requires often special guidelines apart from medical treatment of the hypertension or eventual revascularisation therapy it is often necessary to start a treatment with imunosuppresive drugs. It is therefore very important to differentiate these rare diseases from the other causes of RVH in our clinical practice and start the appropriate diagnostics and treatment. 30. Ovplyvnenie vaskulárneho rizika a kontrola tlaku krvi u pacientov s periférnym artériovým ochorením dolných končatín (Vascular Risk Treatment and Blood Pressure Control in Patients with Peripheral Arterial Disease of Lower Extremity) Čelovská D, Celecová Z, Letková K, Ambrózy E, Štvrtinová V II. interná klinika, LF UK a UNB, Bratislava Objective: Peripheral arterial disease (PAD) of lower extremity is predominantly a manifestation of atherothrombotic process in which arterial hypertension plays an important role in initation as well as progression of the disease. Effective blood pressure control and global cardiovascular risk treatment are underestimated in clinical practice despite significantly increased cardio-cerbro-vascular mortality and morbidity in symptomatic and even in asymptomatic PAD patients. The aim of the present study was to determine risk factor, blood pressure profile in PAD patients and describe global cardiovascular risk treatment. Method: Observational and descriptive study was carried out in 120 hospitalized patients not for vascular disease primary (59 M/61 F, 73±12 years of age). PAD was determined by an ankle brachial index (ABI) < 0,9 and blood pressure control by 24 hour blood pressure monitoring in all patients. Patients with critical limb ischaemia were excluded. Results: Profile of symptomatic and asymptomatic (55%) PAD patients with ABI < 0,9 was: high blood pressure 89,2%, diabetes mellitus 83,3%, lipid disorders 72,5%, smoking 35,8 %, creatinine clearence < 60 ml/min 40% and all components of metabolic syndrome (NCEP-ATP III) in 36,6% of patients. 24-hour blood pressure was 145/85 mmhg, 65.8% of non-dippers. Lipid-lowering agents were present in 53%, ACE- inhibitors in 44% and antiplatelet therapy in 74% patients. Vaskulárna medicína Suplement ; 5(S3)

39 Abstrakty 39 Conclusions: There is a high prevalence of asymptomatic PAD patients that can be detected by an ABI. In PAD patients is commonly systolic hypertension associated with a high pulse pressure and non-dipping pattern. Global vascular risk treatment in high risk PAD patients is underestimated. Key words: peripheral arterial disease of lower extremity, arterial hypertension, cardiovascular risk. 33. Bolesť končatín u pacientov s CHVO (Extremities pain in patients with CVD) Štvrtinová V, Štvrtina S II. interná klinika a Ústav patologickej anatómie, Univerzita Komenského, Lekárska fakulta, Bratislava Najfascinujúcejším novým poznatkom posledných dvoch troch desaťročí je skutočnosť, že chronické venózne ochorenie (CHVO) možno považovať za chronické zápalové ochorenie. V posledných rokoch sa nahromadili nezvratné dôkazy o tom, že zápal zohráva dôležitú úlohu ako pri vzniku jednotlivých typov kŕčových žíl, tak aj pri zhoršovaní klinického priebehu ochorenia, pri vzniku subjektívnych symptómov, opuchu, trofických kožných zmien a vredu predkolenia. Práve účasťou chronicky pôsobiacich zápalových mechanizmov sa pravdepodobne dá vysvetliť aj fakt, že vo vyvinutých, industrializovaných krajinách je výskyt CHVO niekoľkokrát vyšší ako u primitívnych národov Afriky či Oceánie. Zápalové procesy zohrávajú významnú úlohu aj pri vzniku bolesti u pacientov s CHVO. Niektoré prozápalové mediátory, ktoré sa lokálne uvoľňujú predovšetkým v dôsledku hypoxie, môžu aktivovať nociceptory lokalizované v žilovej stene (medzi endotelovými bunkami a hladkými svalmi medie), ako aj v perivenóznom spojivovom tkanive. Pocit bolesti je v konečnom dôsledku sprostredkovaný najmä uvoľnením oxidu dusnatého NO, pretože v experimente sa potvrdili zvýšené koncentrácie NO v krvi odobratej zo skrytej žily (vena saphena) pacientov so závažnými klinickými štádiami CHVO. Zdá sa, že hypoxia je skutočne najdôležitejším spúšťačom bolesti žilového pôvodu a je možné, že mnohé bolestivé vnemy u pacientov s CHVO sú spôsobené intermitentne prítomnou či zhoršujúcou sa hypoxiou, napr. na konci namáhavého dňa, po niekoľkohodinovom stoji či sede alebo v určitých fázach menštruačného cyklu. Nedávne výskumy ukázali, že mediátory zápalu uvoľňované po interakcii endotelových buniek a leukocytov v skorých štádiách CHVO aktivujú nemyelínové C-vlákna (C-nociceptory), ktoré sa nachádzajú v cievnej stene a sú zodpovedné za bolesť. Zistenie, že C-nociceptory sú prevažne umiestnené vo vonkajšej časti medie a nie v blízkosti endotelu boli do istej miery prekvapením. C-vlákna zasahujú aj do spojivového tkaniva perivenózneho priestoru v oblasti mikrocirkulácie. Mediátory zápalu sa uvoľňujú v mikrocirkulácii, kde dochádza ku kontaktu zápalových mediátorov s nociceptormi často ešte skôr, ako dokážame vidieť zmeny na úrovni makrocirkulácie. Takto sa dá vysvetliť skutočnosť, že bolesť sa u niektorých jedincov objavuje už v klinickom štádiu C0 (podľa CEAP klasifikácie CHVO). Interakcia leukocytov a endotelových buniek kapilár indukuje uvoľňovanie mediátorov zápalu, čo vysvetľuje vzájomný vzťah medzi bolesťou žíl a mikrocirkuláciou. Skoré začatie ; 5(S3) Vaskulárna medicína Suplement 3

40 40 Abstrakty liečby zamerané na zabránenie rozvoja zápalu žíl by tak mohlo nielen zmierniť bolesť, ale aj znížiť riziko vzniku pokročilých klinických štádií a komplikácii CHVO. Detailnejšie spoznanie úlohy zápalu pri vzniku a rozvoji CHVO nám otvára dvere k lepšiemu porozumenie etiopatogenézy ochorenia, ale zároveň je kľúčom k účinnejšej liečbe a prevencii tohto rozšíreného ochorenia. 36. One center experience with endovascular treatment of thoracic aorta dissection type B Szostek MM, Jakuczun W, Pogorzelski R, Ostrowski T, Szostek M General and Thoracic Surgery Dept. Warsaw Medical University, Warsaw, Poland Introduction: Uncontrolled arterial hypertension combined with genetic disorders of arterial wall may provide to aortic dissection. Concers in majority cases man, belove 60 years of age, rather seldom coexist with atherosclerosis. Dissection of the aorta causes acute ischemia of the viscera or limbs. Groving of the false lumen created dissecting aneurysm with twicefold often tendency to rupture than true aneurysm with higher mortality rate. Material and method: In in General and Thoracic Dept 469 patients were operated due to aortic diseases. In 175 patients dissection type B according to Stanford classification were diagnosed, in 90 cases acute dissection, lasting less than 14 days. In all patients dissection was accompanying by hypertension. At the time of admission Angio-CT was performed. Patiens who presented symptoms despite conservative treatment and blood pressure stabilisation were qualified to the operation. The treatment of choice was endovascular operation using stent-graft. In majority cases patients were operated under spinal anaesthesia. Surgical access was performed via clasically opened common femoral artery. During the procedure the most importand moment was proper canal identyfication. Technical succes was achieved in all cases. Results: In follow up, most of complications we observed were: acute ischemia of the leg, retrograde dissection in arch, endoleak most commonly type IB and stent-graft migration Conclusion: Indication for operation is symptomatic acute or chronic dissection and dissection aneurysm. Endovascular treatment of aortic dissection is a method of choice with significant low mortality rate than classical operation. All patients should be carefully follow-up. 38. AAA naše výsledky za posledných 5 rokov (AAA our results in the last 5 years) Sihotský V, Frankovičová M, Kubíková M Klinika cievnej chirurgie, VÚSCH, Košice Na Klinike cievnej chirurgie VÚSCH, a. s., bolo za posledných 5 rokov zoperovaných 124 aneuryziem v aortoiliakálnej oblasti. V 47 prípadoch bola vykonaná urgentná operácia pre ruptúru aneuryzmy abdominálnej aorty a 77 pacientov bolo zoperovaných v elektívnom režime. Na rekonštrukciu sme použili aortoaortálne interpozitum alebo aortobifemorálny bypass. Perioperačná mortalita bola u pacientov s ruptúrou AAA pod 60 % a pod 5 % u pacientov operovaných elektívne. Chirurgické riešenie považujeme za štandardný postup u pacientov s normálnym alebo stredným operačným rizikom. Vaskulárna medicína Suplement ; 5(S3)

41 Abstrakty Naše najnovšie skúsenosti v karotickej chirurgii (Our recent experience in carotid surgery) Šefránek V, Tomka J, Zita Z, Dulka T Klinika cievnej chirurgie NÚSCH, Bratislava Introduction: Carotid surgery has been accomplished for more than 60 years and during this time exposed to a hectic evolution, which changed approach in indications, surgical strategies and technique, and results of treatment, as well. Carotid surgery is recently vigorously influenced by the boom of the endovascular treatment. Main goal of all carotid interventions has been the prevention of ischaemic cerebral attacks. Objective of our presentation is an evaluation of our 2-years experience in carotid surgery since to Methods: We have evaluated retrospectively results of 519 operations (358 eversion endarterectomies, 63 convencional CEA with patch-plasty, 5 interpositions, 89 ICA kinking corrections, 2 ECA angioplasties, 2 subclaviocarotid bypasses). Results: 1 pacient died, 22 pacients were revised bacause of compressive wound haematoma, in 10 cases had a significant neurologic event, in 5 cases TIA, 3 pacients had nerve laesions. In 7 cases we have recorded early recurrent ICA stenoses, all of them solved by an endovascular procedure (CAS). 1 pacient had overcome a perioperative MI (NSTEMI). Combined morbidity/ mortality of this cohort was 2.1%. Discussion: Recently we can assess an increase of number of endovascular interventions (CAS) and slight decrease of open surgery. In our department we have been favouring eversion endarterectomies using locoregional anesthesia. From overall number of 426 open carotid endarterectomies there were 358 eversion CEA (84%) and 68 convencional CEA (16 %). Advantage of the eversion technique in our hands is shorter surgery time, decreased morbidity and mortality, decreased number of recurrent stenoses, shorter ICU stay and hospitalization length. Conclusion: Recently we can assess vigorous changes in carotid surgery. Overall number of open operations has slightly decresed contemporarily with the increase of endovascular procedures. Indications have been precised according to the international guidelines. Number of eversion endarterectomies using locoregional anesthesia has increased and our results have been better. 40. Dlouhodobé výsledky trombektomie Rotarexem u akutních a subakutních uzávěrů periferních tepen a bypassů (Long-term results after Rotarex thrombectomy of acute and subacute occlusions of peripheral arteries and bypasses) Staněk F, Ouhrabková R, Procházka D Radiodiagnostické oddělení, Oblastní nemocnice Kladno, Česká republika Mechanical thrombectomy using the Rotarex catheter represents an equivalent alternative to intraarterial thrombolysis in the treatment of acute and subacute occlusions of mainly infrainguinal peripheral arteries and bypasses. This method has a high primary success rate and a low rate of complications. However, less is known about the long-term results. We have performed 101 procedures using the Rotarex catheter in patients with acute and subacute occlusions of ; 5(S3) Vaskulárna medicína Suplement 3

42 42 Abstrakty peripheral arteries and bypasses. The primary success was achieved in 94 %. Patients were followed-up at six month intervals. Apart from a medical history and physical examination, the patients underwent ankle/brachial pressure index determination and duplex scanning of the intervened segment. Significant restenosis (over 50 %) was considered if the peak systolic velocity ratio was greater than 2.0. Cumulative patency rates were assessed using the life-table analysis and were as follows: 65% after 6 months, 54% after 12 months, 43% after 18 months, 40% after 24 months, 37% after 30, 36 and 42 months and 32 % after 48 months. In cases of recurrent limb ischemia during follow-up it was possible to perform a new successful intervention and the late reocclusion led only exceptionally to limb amputation. On comparing the data from the literature, the most of studies dealing with the Rotarex thrombectomy report the results of follow-up lasting only 18 months or even less. This includes also important trials involving thrombolysis. 41. Končí sa éra HNMH v profylaxii a terapii VTE? (Is this really the end of the period of LMWHs in prophylaxis and therapy of VTE?) Vacula I II. interná klinika LF UK a UNB, Bratislava Úvod: Príchod nových perorálnych antikoagulancií (NOA) je určite jedným z najväčších prelomov v profylaxii a najmä v liečbe VTE. Nadvláda warfarínu v liečbe VTE by skutočne mohla byť minulosťou. Doterajšie štúdie s NOA však neadresujú niektoré otázky začiatku liečby VTE u pacientov s klinickým podozrením na malignitu ako aj samotnú liečbu a sekundárnu prevenciu VTE u tejto skupiny pacientov. Problematický zatiaľ ostáva aj režim pri plánovaní niektorých terapeutických a diagnostických zákrokov s biopsiou tkanív, kde chýbajú skúsenosti s NOA. Situácia v tromboprofylaxii je ešte komplikovanejšia a zatiaľ čo v ortopédii dokázali NOA istý benefit v porovnaní s LMWH a najmä warfarínom, u nechirurgických pacientov takéto dôkazy účinnosti a bezpečnosti chýbajú. Identifikácia pacienta pre NOA/LMWH: Obe základné klinické štúdie (EINSTEIN, RECOVER) sledujúce efektivitu NOA v liečbe VTE sú porovnaním s warfarinom. Dabigatran aj rivaroxaban dokázali non inferioritu ako aj porovnateľnú bezpečnosť s warfarinom. V oboch štúdiách boli zaradení aj pacienti s aktívnym malígnym ochorením ale tvorili len relatívne malý zlomok celkového počtu pacientov. Zatiaľ čo LMWH dokázali svoje výhody v porovnaní s warfarínom u podskupiny onkologických pacientov, podobné dôkazy pre NOA zatiaľ nemáme k dispozícii. Okrem sekundárnej profylaxie VTE, nevyriešené ostávajú zatiaľ aj dlhodobé dopady liečby VTE pomocou NOA, ako je napr. efektivita samotnej rekanalizácie, protekcia chlopní a ochrana pred vznikom potrombotického syndrómu. Veľmi dôležité bude tiež dokázať dlhodobú bezpečnosť liečby u pacientov s recidivujúcou VTE príhodou. Zdá sa, že medikamentózna profylaxia u hospitalizovaných pacientov s akútnym rizikovým ochorením na nechirurgických oddeleniach tiež zatiaľ zostane doménou LMWH. Rivaroxaban a apixaban (štúdie MAGELLAN, ADOPT) síce dokázali non inferioritu v porovnaní s LMWH, avšak pri dlhšom podávaní za cenu zvýšenia krvácivých komplikácií. Tým sa ich benefit stráca v porovnaní Vaskulárna medicína Suplement ; 5(S3)

43 Abstrakty 43 s LMWH stráca. Zostáva tiež vyriešiť otázku úvodu liečby VTE, ktorá je často spojená s potrebou diagnostických vyšetrení s biopsiami, kde zatiaľ nie je dostatok skúseností s možnosťami prerušenia/premostenia liečby NOA. Záver: NOA (rivaroxaban, apixaban, dabigatran...) sa ukazujú ako veľmi nádejné lieky s dobrou budúcnosťou, ktoré snáď rýchlo nahradia warfarín vo väčšine jeho indikácií. Napriek tomu, stále existujú pomerne veľké skupiny pacientov, ktorí dokázateľne môžu profitovať z výberu LMWH v profylaxii/liečbe VTE. 54. VTE v onkológii princípy profylaxie a liečby (VTE in oncology prophylaxis and treatment principles) Vacula I II. interná klinika LF UK, Bratislava a VASA-CARE, Trnava Úvod: Armand Trousseau, internista v Hôtel- Dieu, opísal v r trombózu u pacienta s malignitou a naviac, prisúdil náchylnosť na VTE zmenám v koagulácii a nie lokálnym vplyvom nádoru. V r spozoroval spontánnu flebitídu na svojej ľavej ruke a predpokladal viscerálnu malignitu. O pár mesiacov zomrel na karcinóm pankreasu. Venózny tromboembolizmus (VTE) je častou komplikáciou nádorových ochorení, ktorá skracuje predpokladanú dĺžku života a významne zhoršuje kvalitu života onkologických pacientov. Princípy primárnej tromboprofylaxie VTE u pacientov s malignitou: zvažovanie pomeru risk/benefit je u pacientov s malignitou sťažené odhadom možného krvácania zo samotného nádoru, resp. tkanív poškodených nádorovým rastom. Napriek tomu, aktívne onkologické ochorenie u hospitalizovaného pacienta je indikáciou ku profylaktickej dávke LMWH počas hospitalizácie. Výnimku tvoria len pacienti prijatí pre krvácivé komplikácie a aj tu je potrebné zhodnotiť rozsah krvácania a možnosti jeho ovplyvnenia. U ambulantných pacientov sa prikláňame k podaniu tromboprofylaktickej dávky LMWH len v prípade liečby lenalidomidom/talidomidom s chemoterapiou resp. dexametazónom u pacientov s mnohopočetným myelómom. Princípy liečby a sekundárnej prevencie VTE u pacientov s malignitou: medikamentózna liečba VTE príhody u onkologického pacienta sa začína plnou antikoagulačnou dávkou LMWH, ktorá je dokázateľne účinnejšia v porovnaní s perorálnymi antikoagulanciami u tejto skupiny pacientov. Liečba má trvať 3 6 mesiacov, zväčša však práve 6 mesiacov za kontroly krvného obrazu a klinického stavu, CUS (kompresívna ultrasonografia) sa odporúča o 4 6 týždňov, 3 a 6 mesiacov po začiatku liečby. Najvýznamnejšie dôkazy účinnosti a bezpečnosti majú nadroparín a dalteparín. Veľmi neisté je ďalšie predĺženie liečby nad hranicu 6 mesiacov, pričom u každého pacienta s pokračujúcou liečbou pre aktívne onkologické ochorenie zvažujeme predĺženie liečby, resp. jej konverziu na tromboprofylaktickú dávku počas celej doby aktívnej liečby. Ukončenie/ pokračovanie v tromboprofylaxii však závisí aj od ďalších faktorov ako sú stav výživy, celková pohyblivosť pacienta, bolesti limitujúce kvalitu života a pohybu, atď. Onkologické ochorenie sa nezriedka mení na chronické ochorenie, čo podmieńuje potrebu opakovaného prehodnotenia pomeru risk/benefit indikovanej medikamentóznej tromboprofylaxie ; 5(S3) Vaskulárna medicína Suplement 3

44 44 Abstrakty Záver: Napriek dobre známemu zvýšenému riziku VTE u onkologických pacientov, tromboprofylaxia sa najmä na interných oddeleniach nepodáva v dostatočnej miere. Azda hlavnou príčinou tohto javu sú obavy z krvácania, ktoré sú nezriedka málo opodstatnené. Najproblematickejšou oblasťou liečby je ukončenie podávania LMWH. Odhad rizika recidívy VTE je veľmi náročný a vyžaduje často opakované prešetrenie pacienta pred definitívnym ukončením liečby. 56. Kongenitálne vaskulárne malformácie a chronická venózna insuficiencia (Congenital vascular malformations and chronic venous insufficiency) Mazuch J¹, Mištuna D¹, Huľo E¹, Mazuchová J² ¹Chirurgická klinika JLF UK Martin, ²Ústav biológie biológie JLF UK Martin Congenital vascular malformations (CVM) or angiodysplasias are rare complex lesions of malformated vessels, which are the result of abnormal development of vascular system and its stoppage during embryogenesis (4th-10th week). Vascular malformations should be distinguished from hemangiomas. Hemangiomas are benign tumors showing proliferative activity of endothelial cells. All other congenital vascular lesions which do not show proliferation of endothelial cells belong to CVM. Based on Hamburg classification, CVM are classified into 5 groups in dependency on predominat vascular component: arterial, venous, aterio-venous (A-V shunts), lymphatic and combined. It is important to clinically describe and differentiate dominant abnormalities, which may affect venous, arterial, lymphatic system or a combination of them. According to that CVM are divided into: 1. monovalent, affecting only one vascular component, 2. polyvalent, at least two vascular components (arterio-venous event. veno-lymphatic) is affected. Although CVM etiology is still unknown, it is certain that the development stops during embryogenesis (4th to 10th week). However there was described a genetic abnormality: a specific mutation of chromosome 21, affecting the tyrosine kinase receptor TIE2. A gene for familial venous anomaly is located on chromosome1p21 p22. Research continues on the level of molecular biology and genetics. From clinical and angiological point of view it is important to identify those angiodysplasias and their various forms, which can be treated and so at least partially influence and improve the quality of life of affected patients. Especially those venous marformations are considered, where signs of chronic venous insufficiency (CVI) and arterio-venous fistulas are dominating and which are manifested as congenital varicose veins of the lower extremities. These include varicose veins at A-V fistulas, at Weber and Klippel-Trenaunay syndrome. Then there are various hemangiomas and malformations, which require broad cooperation of different specialists and multidisciplinary approach. The authors demonstrate their own clinical case of CVM type of Klippel-Trenaunay and Weber syndrome and a variety of types of hemangiomas affecting mainly the young generation, which were solved mainly surgically. Vaskulárna medicína Suplement ; 5(S3)

45 Abstrakty Úspešné podanie trombolytickej liečby pri masívnej pľúcnej embólii (Successfull administration of thrombolytic therapy due to massive pulmonary embolism) Dokupilová A, Vahala P, Poliačik P, Hasilla J Kardiologická klinika FN, Nitra a Fakulta sociálnych vecí a zdravotnictva UKF, Nitra Introduction: The principal criteria for categorizing PE as massive are arterial hypotension and cardiogenic shock. Arterial hypotension is defined as a systolic arterial pressure <90 mm Hg or a drop in systolic arterial pressure of at least 40 mm Hg for at least 15 minutes. Early mortality in patients with massive PE is at least 15%, and the degree of hemodynamic compromise is the most powerful predictor of in-hospital death. Pulmonary embolism has an annual incidence of 60 to 70 per persons within the general population. In massive pulmonary embolism, 10% to 15% of patients present with syncope, which results from obstruction of the Figure 1: ECG on admission typical S1Q3T3 pattern pulmonary outflow tract by embolic material. Pressure increases within the right ventricle, causing dilatation and dysfunction. This imaging technique echocardiography is not diagnostic for pulmonary embolism, but evidence of right ventricular hypocontractility and dysfunction is seen in 95% of patients who are in unstable condition. This test is useful in differentiating between massive pulmonary embolism and other causes of hemodynamic compromise. A pattern of acute right ventricular strain is highly suggestive of pulmonary embolism but is present in only 20% of the cases. This pattern is evidenced by an S wave in lead I, a Q wave in lead III, and a T-wave inversion in lead III. Patients in stable condition are treated with anticoagulation alone, but thrombolytics are the treatment of choice in hemodynamically unstable patients. Case report: Patient J. V. was admitted to our Department in October/November years old patient without internal disorders, but his sister was treated by coumarine due to deep venous thrombosis. He was being treated by GP ; 5(S3) Vaskulárna medicína Suplement 3

46 46 Abstrakty for coughing with claritromycine. There was no improvement, so he has visited his GP 4 days later. The diagnosis of PE was suspected when he suffered sudden onset of syncope and hypotension, followed by arterial oxygen desaturation, tachycardia, tachypnea and cyanosis. The ECG had typically pattern of sinus tachycardia, an S1Q3T3 pattern, T-wave inversions. Echocardiography showed an extremely dilated right ventricle with septal flattening. Patient was immediatelly transferred to ICU and started a treatment with a preffered fibrinolytic agent- alteplase as a 100- mg continuous 2-hour infusion. This treatment caused improvement of clinically condition, his blood pressure normalised as well as oxygenation. Tachypnea and cyanosis disappeared. Fibrinolytic agent was followed by a continuous intravenous heparin infusion. Patient underwent endoscopy of gastrointestinal tract and urology without pathologic findings. Nowadays is using coumarine, regularly INR measurement is performing. Conclusion: Massive pulmonary embolism in the setting of syncope and cardiac arrest is often fatal if not rapidly diagnosed. The patient s cardiopulmonary status before the embolic event is a predictor of morbidity and mortality. Although systemic fibrinolysis is not worth the risk in all patients with acute PE, it is recommended as standard, first-line treatment in patients with massive PE. In an overview of the 5 randomized controlled trials that included patients with massive PE, fibrinolysis reduced the risk of death or recurrent PE by 55%. In our case report we reported a successfull using of fibrinolytic therapy due to massive pulmonary embolism. 58. Antikoagulačná liečba po epizóde krvácania (Anticoagulant therapy after an episode of bleeding) Petrovič T V. interná klinika LF UK a UNB, Nemocnica Ružinov, Bratislava In the past years we witness the increased intake of anticoagulant therapy, mainly vitamin K antagonists. The most common and feared complication of anticoagulant therapy is the risk of bleeding. The increased intake of such therapy is associated with the increased risk of bleeding mainly the most life threatening gastrointestinal and intracerebral. The problem consists in optimal duration of anticoagulant therapy in particular in patients with high risk and strong indication. The authors analysed the literature and considerations onto the optimal duration of anticoagulant therapy after gastrointestinal and intracerebral bleeding referring to the current recommendations. Current data may support the continuation of anticoagulant therapy (in particular after intracranial bleeding) in patients with high risk of thrombosis. 59. May-Thurnerov syndróm ako zriedkavá príčina častého stavu kazuistika (May-Thurner syndrome as a rare cause of an often condition case report) Farkašová L, Špak L, Tormová Z, Moščovič M Angiologické oddelenie Kardiologickej kliniky VÚSCH, Košice Šesťdesiatsedemročný muž, diabetik, hypertonik prijatý na naše oddelenie pre 1- dňový opuch ĽDK s utrazvukovým nálezom Vaskulárna medicína Suplement ; 5(S3)

47 Abstrakty 47 panvovej trombózy. Ultrasonografické vyšetrenie abdomenu bolo bez signifikantnej patológie. Anamnesticky bez známeho onkologického ochorenia. Zrealizované flebografické vyšetrenie s nálezom trombózy vena iliaca communis a vena iliaca externa (VIC, VIE) l. sin. Vykonaná mechanická trombektómia systémom Aspirex, pred výkonom implantovaný kaválny filter do dolnej dutej žily. Po endovaskulárnej intervencii došlo k demaskovaniu May-Thurnerovho syndrómu, preto následne do VIC l. sin. implantovaný stent. O mesiac bola u pacienta realizovaná extrakcia kaválneho filtra a dokumentovaný dobrý efekt intervencie. May-Thurnerov syndróm (MTS) je anatomický variant, ktorého príčinou je kompresia ľavej spoločnej panvovej žily pravou spoločnou panvovou tepnou proti driekovým stavcom. Podľa retrospektívnej analýzy z roku 2004 je prevalencia MTS %. Napriek tomuto udávanému výskytu MTS je klinická prevalencia hlbokej žilovej trombózy (HŽT) asociovanej s MTS podľa údajov 2 3 %, pričom častejšie sa vyskytuje u žien medzi druhou a štvrtou dekádou. Diabetici sú z hľadiska vzniku HŽT rizikovejší, pričom sa opisuje častejší výskyt HŽT a pľúcnej embólie (PE) u žien diabetičiek. Podľa metaanalýzy zahŕňajúcej pacientov (70 % žien), majú diabetici 1,5 násobne vyššie riziko HŽT a event. PE v porovnaní s pacientmi nediabetikmi. Endovaskulárna liečba iliofemorálnej HŽT je moderná terapeutická invazívna metóda, ktorej cieľom je invazívne odstránenie trombu. Skorým prínosom je prevencia PE a neskorým pozitívnym efektom je prevencia potrombotického syndrómu. Hlavnými výhodami endovaskulárnych intervencií pri HŽT je rýchle odstránenie trombov, s rýchlym spriechodním cirkulácie, skrátenie času celého výkonu, zníženie rizika krvácavých komplikácií, skrátenie času intenzívneho monitorovania pacienta, ako aj skrátenie celkovej dĺžky hospitalizácie. 67 year old man with diabetes, hypertension was admitted to our department with a 1-day history of swelling of left lower extremity with ultrasound finding of iliac thrombosis. The result of abdominal ultrasound examination was unremarkable. The patient had no prior cancer history. Lower extremity phlebography revealed thrombus in the left common iliac vein and external iliac vein. A mechanical thrombectomy was performed using an Aspirex system, vena cava filter was implanted before thrombectomy. After endovascular intervention May-Thurner syndrome was unmasked, therefore stent was placed across the stenotic area in the left common iliac vein. A month later the vena cava filter was removed and good effect of intervention was documented. May-Thurner syndrome (MTS) is an anatomical variant in which the right common iliac artery overlies and compresses the left common iliac vein against the lumbar spine. According to retrospective analysis in 2004 the prevalence of MTS is 22-24%. Despite of the reported incidence of MTS the clinical prevalence of deep vein thrombosis (DVT) associated with MTS is recorded in only 2% to 3% of all lower extremity DVTs; and is more common in women between the second and fourth decade. Patients with diabetes may be more likely to develop DVT; increased incidence of DVT and pulmonary embolism (PE) is reported in women with diabetes. According to a meta-analysis involving 63,552 patients (70% women), diabetics have 1.5 times higher risk of DVT and PE compared to ; 5(S3) Vaskulárna medicína Suplement 3

48 48 Abstrakty non-diabetic patients. Iliofemoral endovascular treatment of DVT is a modern therapeutic invasive method, with target of invasive removal of thrombus. The prevention of PE is first positive effect after treatment and the prevention of post-thrombotic syndrome as positive effect subsequently. The main advantages of endovascular interventions of DVT is the rapid removal of thrombus with rapid circulation relief, reducing of time of the performance, reducing the risk of complications related with bleeding, shortening of intensive patient monitoring as well as shortening the duration of hospitalization. 60. Hirudoterapia stále aktuálna liečba (Hirudotherapy still current treatment) Slezák V¹, Takáč P², ³, Galátová H², Mareková B¹ ¹University Hospital of the Merciful Brothers, Bratislava, Slovakia,²Scientica, s. r. o, Bratislava, Slovakia, ³Institute of Zoology, Slovak Academy of Sciences, Bratislava, Slovakia Hirudotherapy treatment using leeches one of the oldest methods of biotherapeutic. Hirudotherapy peaked in the late 18th and beginning of the 19th century, when used in Europe annually tens of millions of leeches for medicinal purposes. Opinions varied on the medicinal leech and the condition persists to this day. While a considerable part of the medical community considers medicinal leech for leftover past, which has a place in modern medicine, another part shows the extreme amount of pharmacologically active substances present in the saliva of leeches. To this day, was isolated more than twenty different pharmacological agents especially Hirudin in the saliva of leeches. The authors in their work submitted patients treated in outpatient vascular care standard therapeutic procedures with Hirudotherapy. Patients were divided into files (CVI, Postthrombotic syndrome, UCV, Acute inflammation). Preliminary results show the benefit of combination therapy improvement of subjective symptoms and objective criteria. The authors based on literature data and their experience recommend combination therapy indicated in indicated cases. This work had been funded by the Operational Program of Research and Development and cofinanced with the European Fund for Regional Development (EFRD). Grant: ITMS : Research and development of new biotherapeutic methods and its application in some illnesses treatment. DK 61. Výživové a zdravotné tvrdenia (Nutrition and health claims) Lučanský J Bratislava V dnešnej dobe stále viac potravín obsahuje označenia s výživovými a zdravotnými výrokmi, ktoré nám poskytujú hlbšie poznatky o nakupovaných výrobkoch. Tieto informácie nám pomáhajú pri pochopení, ako rôzne potraviny prospievajú nášmu zdraviu a kvalite života a pri zostavovaní vyváženej stravy. Od 1. júla 2007 platí v EÚ nariadenie Európskeho parlamentu a Rady (ES) č. 1924/2006 z 20. decembra 2006 o výživových a zdravotných tvrdeniach o potravinách. Je to prvý príspevok špeciálnych legislatívnych opatrení k tejto problematike. Nariadenie sa vzťahuje Vaskulárna medicína Suplement ; 5(S3)

49 Abstrakty 49 na každé zdravotné a nutričné tvrdenie uvedené na potravinách a nápojoch určených na ľudskú výživu a uvádzaných do obchodnej siete členských krajín EÚ, vrátane komerčnej komunikácie, všeobecnej inzercie a reklamnej kampane. Vzťahuje sa aj na potraviny na osobitné výživové účely a výživové doplnky. V Európe sa povinnosť uvádzať výživové informácie vzťahuje iba na výrobky, ktoré sprevádza tvrdenie o výživových alebo zdravotných účinkoch. Výživové tvrdenia/zdravotné tvrdenia: Prvá otázka klasifikácie sa týka tvrdenia obsahuje (názov živiny alebo inej látky). Zatiaľ čo tvrdenie obsahuje je obvykle výživovým tvrdením, v niektorých prípadoch sa používanie výrazu obsahuje v tvrdení vzťahuje na skupinu látok s osobitným funkčným účinkom. V takýchto prípadoch sú tvrdenia obsahuje zdravotným tvrdením a musia byť príslušne schválené. Zdravotné tvrdenie je každé tvrdenie, ktoré udáva, naznačuje alebo vyvoláva dojem, že existuje súvislosť medzi kategóriou potravín, potravinou alebo jednou z jej zložiek a zdravím. Tvrdenie o znížení rizika ochorenia je každé zdravotné tvrdenie, ktoré udáva, naznačuje alebo vyvoláva dojem, že konzumácia nejakej kategórie potravín, potraviny alebo jednej z jej zložiek vo významnej miere znižuje rizikový faktor výskytu ochorenia u ľudí. Tvrdenie sa vzťahuje na: normálnu telesnú funkciu; rizikový faktor ochorenia, bez uvedenia, naznačenia alebo vyvolávania dojmu jeho zníženia. Príklad: udržiava (vymenovanie normálnych vitálnych telesných funkcií ) zníženie rizikového faktora ochorenia, s alebo bez spomenutia názvu ochorenia Príklad: znižuje (pomenovanie rizikového faktora). Ako výnimky boli povolené niektoré zdravotné tvrdenia. Lieky versus výživové doplnky: Kvalita liečiv, ktoré obsahujú lieky je deklarovaná v liekopise. Liekopis je záväzná norma. Ak je určitá molekula zaradená do liekopisu, znamená to, že bola skúšaná predklinicky aj klinicky. Ak je výrobca držiteľom licencie SVP (GMP), prípravky, ktoré prepúšťa, majú analytický certifikát, ktorý potvrdzuje kvalitu prípravku. To znamená, že všetky zložky nachádzajúce sa napr. v tablete prešli kontrolou kvality. Ak predmetom výroby podobného alebo zhodného prípravku s obsahom rovnakej molekuly alebo viac molekúl je viac výrobcov, ich výrobky sú rovnakej kvality. Predmetom diskusie v ostatnom čase sú tzv. generické prípravky, pri ktorých sa často spochybňuje účinnosť voči originálnym. Ak predklinické a klinické účinky konkrétnej molekuly boli preukázané, v literatúre publikované, sú verejne dostupné, platia pre všetkých výrobcov. Tvrdenie, že originálny prípravok je lepší ako iné prípravky s obsahom rovnakých zložiek neobstojí, pretože zakaždým ide o potvrdenie účinku konkrétnych molekúl alebo ich zmesí. Ak prípravok bol zaradený medzi lieky a neskôr presunutý medzi doplnky výživy, nemení sa nič na požiadavkách na jeho kvalitu. Nowadays more and more foods contain indications of nutrition and health statements, which provide us with a deeper understanding of the purchased products. This information helps us in understanding how different foods are beneficial to our health and quality of life, and to compile a balanced diet. From 1 July 2007 applies in the EU of the European Parliament and Council Regulation (EC) No. 1924/2006 of 20 December 2006 on nutrition and health claims made on foods. This is the first post of special legislative measures in this regard. The Regulation applies to any health and nutritional claim made on foods and beverages for human ; 5(S3) Vaskulárna medicína Suplement 3

50 50 Abstrakty consumption and put into commercial network of EU Member States, including commercial communications, general advertising and promotional campaigns. It also applies to foods for particular nutritional uses and food supplements. In Europe, the obligation to indicate the nutritional information applies only for products which accompany the statement on nutrition and health effects. Nutrition claims / health claims: A first question concerns the classification of the claim contains (name of the nutrient or other substance). While the claim includes is usually nutrition claim, in some cases, use of the term comprises in the claims refers to a group of substances with a specific functional effects. In such cases, the claim includes health claim and must be appropriately validated. Health claim means any claim that states, suggests or implies that a relationship exists between a food category, a food or one of its constituents and health. Reduction of disease risk means any health claim that states, suggests or implies that the consumption of a food category, a food or one of its constituents significantly reduces a risk factor for disease in humans. Argument applies for: Normal body function; A risk factor for the disease, without indicating an indication or creating the impression of a reduction. Example: maintain (the appointment of normal vital bodily functions) reduction of disease risk factor with or without mentioning the name of the disease. Example: reduces (naming risk factor). As some exceptions were permitted health claims. Drugs versus nutritional supplements: The quality of medicines containing drugs is declared in the pharmacopoeia. Pharmacopoeia is an obligatory norm. Whenever a molecule is included in the Pharmacopoeia, it means that it has been tested preclinical and clinical. If the manufacturer is licensed GMP (GMP), preparations have admitted certificate of analysis, which confirms the quality of the product. This means that all the elements contained, for example into the tablet, passed quality control. If the subject of manufacturing an identical or similar product containing the same molecule or molecules are more and more manufacturers, their products are of equal quality. Subject of discussion in recent times are so called generic preparations which are often questions the efficacy against the original. If preclinical and clinical effects of specific molecules have been shown in published literature, publicly available, apply to all producers. Claim that the original product is better than other formulations containing the same ingredients does not hold, because every time a view to confirming the effect of specific molecules or mixtures thereof. If the product has been ranked among the drugs and later transferred between nutritional supplements, it does not change anything on the requirements for quality. 62. Psychosociálne problémy pacientov so syndrómom diabetickej nohy (Psychosocial problems of patients with diabetic foot syndrome) Fülleová M II. interná klinika LF UK a UNB, Bratislava Syndróm diabetickej nohy je najzávažnejšia, výrazne stresogénna, invalidizujúca, až život ohrozujúca komplikácia diabetes mellitus. Prináša so sebou celú škálu emocionálneho rozrušenia a zlej kvality života. Ulcerácie na nohách diabetikov a amputácie zapríčiňujú nielen fyzické dysfunkcie, ale významne zasiahnu aj psychiku pacienta. Vyvolávajú sebaľútosť, zníženú sebaúctu, zmenu postavenia v rodine, frustráciu, úzkosť, depresie, znížené sebavedomie Vaskulárna medicína Suplement ; 5(S3)

51 Abstrakty 51 a sociálnu izoláciu. Spracovanie záťaže a akceptácia ochorenia prebieha v niekoľkých fázach a je ovplyvnená viacerými faktormi. Medzi ne patrí vek, intelekt, inteligencia, sociálne postavenie pacienta a rodiny. Liečba diabetes mellitus a syndrómu diabetickej nohy vyžaduje multidisciplinárny prístup. Spoluúčasť klinického psychológa a sociálnej sestry pomáha pri zabezpečovaní optimálneho psychického a sociálneho stavu pacienta a je ovplyvnená individuálnymi hodnotami a kvalitami sestier, lekárov, pacientov, rodinných príslušníkov, ako i tvorcami zdravotníckej legislatívy. Kľúčové slová: syndróm diabetickej nohy, psychika pacienta, spracovanie záťaže, akceptácia ochorenia, psychológ, sociálna sestra. 63. Manažment starostlivosti o pacienta s intraarteriálnou trombolýzou (Management of care for patients with intra-arterial thrombolysis) Machalová J, Kvasnová Z, Pálková M II. chirurgická klinika, Oddelenie cievnej chirurgie, FNsP F. D. Roosevelta, Banská Bystrica Intraarteriálna trombolýza je invazívna metóda používaná na rozpustenie akútneho uzáveru tepien krvnou zrazeninou. Najčastejšími indikáciami sú v tepnovom systéme uzávery ciev dolných končatín alebo bypassov po chirurgických operáciách.cieľom tejto invazívnej liečebnej metódy je čo najrýchlejšie rozpustiť krvnú zrazeninu, ktorá upcháva postihnutú tepnu a obnovenie krvného prietoku v postihnutej oblasti. Základným princípom terapie je zavedenie katétra do uzáveru tepny s priamou aplikáciou trombolytika. Katéter sa zavádza pod angiografickou kontrolou. Liečba trvá hodín a ukončujeme ju pri rekanalizácii uzáveru, pri krvácavých komplikáciách alebo pri zlyhaní trombolýzy, keď nie je prítomný žiadny efekt. Odhalené organické lézie sú potom odstránené PVI, stentingom alebo je indikovaná chirurgická revaskularizácia. Prednáška je zameraná na starostlivosť o pacienta pred, počas a po zákroku, ako aj na možné komplikácie trombolýzy. 64. Kvalita života pacientov s cerebrovaskulárnou insuficienciou (Quality of life in patients with cerebrovascular insufficiency) Wintnerová I, Tabačáková H Cievna chirurgická amb. FNsP J. A. Reimana, Prešov Cerebrovaskulárna insuficiencia (CVI) je po ischemickej chorobe srdca druhou najčastejšou príčinou mortality a morbidity na Slovensku. Práca oboznamuje o kvalite života a zdravia všeobecne, v ošetrovateľstve a kvalite života pacientov s týmto ochorením. Praktická časť obsahuje prieskum zameraný na zisťovanie kvality života pacientov s CVI. Prieskum bol realizovaný od január 2012 do januára 2013 formou dotazníka. Prieskumnú vzorku tvorilo 77 respondentov, ktorí boli v tomto období ošetrení na ambulancii cievnej chirurgie vo FNsP J. A. Reimana v Prešove. Z prieskumnej štúdie vyplynulo, že toto ochorenie výrazne ovplyvňuje kvalitu života, obmedzuje pacientov v bežných denných činnostiach, aktivitách a záľubách, hlavne pri progresii ochorenia, pri celkovom zlom zdravotnom stave a u pacientov vo vyššom veku. Kľúčové slová: cerebrovaskulárna insuficiencia, kvalita života, pacient, sestra, prieskum ; 5(S3) Vaskulárna medicína Suplement 3

52 52 Abstrakty 65. Súčasné možnosti liečby končatinovej ischémie a následná ošetrovateľská starostlivosť (Current treatment options for limb ischemia and subsequent nursing care) Krištofová M, Valková T Angiologická jednotka VÚSCH, Košice Končatinová ischémia je v súčasnosti častou príčinou postihnutia dolných končatín. Včasná diagnostika a liečba zlepšuje kvalitu života jednotlivcov.v súčasnosti sa preferuje intervenčná liečba. Cieľom práce je opis ošetrovateľských aktivít sestry pred intervenčným výkonom a po ňom. Na našom oddelení sú hospitalizovaní pacienti s končatinovou ischémiou, pre intervenčné riešenie a následnú ošetrovateľskú starostlivosť. Touto témou poukazujeme na špecifiká ošetrovateľskej starostlivosti pri končatinovej ischémii. 68. Špecifiká ošetrovateľskej starostlivosti pri vybraných intervenčných výkonoch na angiologickej jednotke (Specifics of nursing care in selected interventional procedures for Angiology Unit) Rónayová I Klinika kardiológie angiologická jednotka VÚSCH, Košice Angiologické oddelenie je najmladším oddelením VÚSCH, a. s. Zaoberá sa diagnostikou a liečbou pacientov s ochoreniami tepien a žíl. Na intervenčnej sále sa realizuje široké spektrum vaskulárnych intervencií na extrakraniálnom mozgovom riečisku, renálnych a iných viscerálnych tepnách, a špecializované výkony na najväčšej tepne aorte, na jej hrudnej a abdominálne časti. Prudký rozvoj tejto endovaskulárnej terapie umožňuje riešenie mnohých ochorení tepien i žíl bez nutnosti operácie. Pacienti profitujú z progresívnej koncepcie oddelenia, keď diagnostické aj intervenčné výkony vykonávajú samotní angiológovia a špecifickú ošetrovateľskú starostlivosť realizujú vysoko erudované sestry. Pacienti sú hospitalizovaní na angiologickej jednotke intenzívnej starostlivosti. Tu im je poskytnutá špecifická starostlivosť: príprava pred samotným výkonom, ale aj starostlivosť po výkone, so svojimi špecifickými úlohami s dôrazom na edukáciu. Cieľom práce je špecifická starostlivosť u pacientov pri výkonoch na extrakraniálnych mozgových tepnách implantácii stentu do karotického riečišťa, intervenciách na obličkových tepnách. U pacientov so žilovou trombózou, ktorým je aplikovaná trombolytická liečba. Najzaujímavejším intervenčným výkonom je endovaskulárna implantácia stentgraftu pri ochoreniach aorty. 69. Proces indikácie pacienta s rezistentnou artériovou hypertenziou na rádiofrekvenčnú renálnu sympatikovú denerváciu: ambulantný manažment (Process of indication of radiofrequency renal sympathetic denervation in patients with resistant hypertension: outpatients management) Dergnovichová D, Hnilicová M, Paráková T, Mistrík A, Vulev I, Maďarič J Angiologická ambulancia NÚSCH, Bratislava Cieľ: Cieľom práce je opísať proces indikácie perkutánnej rádiofrekvenčnej renálnej sympatikovej denervácie (RDN) u pacientov s rezistentnou artériovou hypertenziou (AH) v rámci ambulantného manažmentu. Vaskulárna medicína Suplement ; 5(S3)

53 Abstrakty 53 Metódy: V období od 3/2012 do 3/2013 sme na Angiologickej ambulancii vyšetrili 22 špecialistami poukázaných kandidátov s nedostatočne kontrolovanou AH na 3 kombinačnej antihypertenzívnej liečbe vrátane diuretika s cieľom zváženia indikácie RDN. Pred rozhodnutím o indikácii výkonu každý pacient absolvuje 3 ambulannté návštevy, počas ktorých je pri každej návšteve zmeraný krvný tlak (TK) na oboch horných končatinách, počas prvej návštevy zhodnotená anamnéza, zaznamenané EKG, realizovaná farebná duplexná sonografia (CDUS) renálnych artérií (RA) a v prípade potreby upravená antihypertenzná liečba. V prípade potvrdenia suspekcie na rezistentnú AH absolvuje pacient o 2 3 týždne druhú návštevu s realizáciou 24-hodinového ambulantného TK monitoringu (ABPM), krvných odberov, transtorakálnu echokardiografiu a CT RA a nadobličiek. Počas tretej návštevy v ambulancii sa hodnotia výsledky uvedených vyšetrení vrátane prinesených výsledkov endokrinologického vyšetrenia a v prípade potvrdenia rezistentnej AH a vylúčenia sekundárnej formy AH ako aj významnejšej renálnej insuficiencie je indikovaná RDN a pacient objednaný na hospitalizáciu. Pacienti po RDN absolvujú ambulantnú kontrolu týždeň po výkone, následne 1, 3, 6, 9 a 12 mesiacov po RDN s kontrolou TK vrátane 24 hod. ABPM (3, 6, 9, 12 mesiacov po RDN), krvných odberov, CDUS kontrolu RA týždeň, mesiac, 6 a 12 mesiacov po RDN a CT angiografickú kontrolu RA 3 mesiace po RDN. Výsledky: Z 22 kandidátov na RDN spĺňalo kritériá na realizáciu RDN 11 pacientov (50 %). Všetci pacienti dôsledne dodržiavali stanovený harmonogram ambulantných kontrol, rozpis odporúčanej medikamentóznej liečby a adekvátny zaznamenávali hodnoty domáceho monitoringu TK. U pacientov po RDN bola v 3 prípadoch nedostatočná realizácia režimových opatrení na redukciu hmotnosti. U žiadneho z intervenovaných pacientov sme nezaznamenali výskyt celkových alebo lokálnych komplikácií po RDN. Záver: Rádiofrekvenčná renálna sympatiková denervácia je nová intervenčná metóda liečby rezistentnej AH, ktorá si vyžaduje správny výber vhodných pacientov, ako aj ich následné dôsledné sledovanie, k čomu sú nevyhnutné pravidelné špecificky zameraná ambulantné vyšetrenia. 72. Armand Trousseau link between thrombosis and cancer Dostálová K 1, Eckhardt T 2, Palacka P 3, Moricová Š 1, Maheľová L 4, Elalamy I 5 1 Faculty of Public Health, Slovak Medical University, Bratislava, 2 Faculty of Medicine, Slovak Medical University, Bratislava, 3 Department of Medical Oncology, Medical Faculty, Comenius University and National Cancer Institut, Bratislava, Slovakia, 4 Department of Occupational Medicine and Toxicology, Faculty of Medicine, Comenius University, University Hospital, Bratislava, 5 Service d Hématologie Biologique, Hôpital Tenon, UMPC-ER2 Paris A close interaction exists between venous thromboembolic disease and cancer. Tumor progression is associated with an activation of coagulation and fibrinoformation which are both implicated in cancer proliferation and metastasis dissemination. It is believed that Armand Trousseau was the first to notice this link that is connecting thrombosis and cancer a man who was very ; 5(S3) Vaskulárna medicína Suplement 3

54 54 Abstrakty gifted in means of admirably using his potential. Trousseau, famous for his delicate behaviour, elegance in teaching and intellectual force was also known for his swift memory that emphasised all his advantages. His personality corresponded with his tall, handsome posture, regular features and educated, elegant look. Trousseau is a true example of a man of a keen mind. From his young age, he participated in various competitions including rhetoric and philosophy. The range of his interests was wide and he was active in many areas of medicine such as epidemiology, infectious diseases, otorhinolaryngology (editing a book entitled A Practical Treatise on Laryngeal Phthisis, Chronic Laryngitis, and Diseases of the Voice ), pathology and public health. His journeys led him to the Gibraltar area to investigate Yellow Fever. Later, he became the head of the Department of Internal Medicine at Hôtel-Dieu Hospital in Paris. As a leader of the French renaissance in treating diseases, Trousseau assisted in developing new therapeutic methods of acute obstructive laryngitis diphtheria. He was the first to come up with the thoracentesis procedure and he managed to refine tracheotomy. A large number of diseases fully curable now were a serious problem in the time of Trousseau. During the devastating epidemic of cholera in March 1832, Trousseau s four patients died in the same bed in Hôtel-Dieu in seven hours due to this appalling disease as Trousseau himself characterised this disease. We can safely call him a visionary who was excellent at hospital bedside of his patients as well as at the front of a huge auditorium full of students and among whom many became his followers. His life affected lives of people surrounding him. His son Georges became a physician, and his grandson Henri Armand became an ophtalmologist as well. Figure 1. Armand Trousseau ( ) Trousseau was a friend of Victor Hugo and Eugène Delacroix. He did not limit himself in medicine. Thanks to his ability to carefully watch and listen, he identified the relation between cancer and thrombosis. In a case of patient suffering from abdominal pain and mild leg oedema, he said: Gentlemen, this oedema is different from that one caused by feverish albuminuria, it is different because it is caused by venous obliteration that results in phlegmasia alba dolens. (Phlegmasia alba dolens. In: Trousseau A (ed). Clinique médicale de l Hôtel-Dieu de Paris. Ballière Paris p ) Two years later he noticed similar signs on himself and instantly knew what his diagnosis was. He said to his students: I am lost, phlebitis which manifested this night will let no one to question the nature of my disease. He experienced his own observations concerning the relationship between thrombosis and cancer. The memory of Trousseau s effort exists in a great form one of the legendary trinity of French hospitals carries his name. In another of the three hospitals Tenon, The Department of Thrombosis and Haemostasis works with the same enthusiasm and attitude as Trousseau did. Part of their research includes paraneoplastic thromboembolic disease as one of the first potential sign of malignancy. Everyone should be aware about the potential acquired hypercoagulable state induced by cancer and be a great profiler such as Trousseau. Vaskulárna medicína Suplement ; 5(S3)

55 Abstrakty Budúci angiológovia by mali začať s prevenciou DNJZ bez zbytočného meškania (Angiologists to Be Have to Start prevention of Occupational overuse syndrome without delay) Maheľová L¹, Dostálová K², Moricová Š², Bátora I¹, Kukučková L³ ¹KPLaT, UNB, ²Fakulta verejného zdravotníctva, SZU, ³ODCH Bratislava OOS belongs to the top of occupational diseases in most countries of the European Union as well. Since 1997 in the Slovak Republic the largest part of occupational diseases (over 30%) has represented the disease of occupational overuse syndrome (OOS). 162 cases of OOS (i.e. 43,4%) of the total 373 occupational diseases cases were reported in 2011 in the Slovak Republic. The occupational overuse syndrome affects the structure of limbs bones, joints, tendons, nerves. It is caused by different work activities without the necessary time to recover. The most common OOS include carpal tunnel syndrome, impingement syndrome, ulnar or radial epicondylitis. Sonographers today are working more efficiently, serving considerably more patients per day. Ultrasound exams require a peculiar type of muscle effort on the part of the sonographer. More than 80% sonographers are scanning in pain, 40% sonographers label their pain as severe and 20% of these professionals eventually experience a career-ending injury. On average, within 5 years of entering the profession, sonographers experience pain while scanning. Color-duplex sonography is the most important technique in angiology using every day. OOS in angiologists is potentiated by the work with the display unit (writing). The most important thing is prevention. Angiologists to be have to start with prevention of Figure. The image on the left illustrates injury- -producing work postures. The image on the right shows a more proper work position. OOS from the first days of preparation. Preventive step is in particular reform working conditions so as not to overuse the upper extremities and the spine. Good ergonomic design must be an integral part of the equipment. Risk of injury can be minimized by careful use of following principles: decreasing the duration of static posture, decreasing hand-grip pressure, minimizing awkward postures, increasing tissue tolerances through exercise and adequate rest. Upper-body exercises can be effective with either light free weights or the use of resistance equipment. Some of sports (volleyball, golf, handball, tennis) in particular may reinforce origin of overuse syndrome. Very important is to realize individual physical givenness. Then arrange professional and leisure time activity the way preventing OOS and preserving working capacity for the whole life. 75. Neinvazívne možnosti cievneho zobrazenia pred revaskularizačnou liečbou u pacientov s periférnym artériovým ochorením (Noninvasive vascular imaging before revascularization therapy in patients with peripheral arterial disease) ; 5(S3) Vaskulárna medicína Suplement 3

56 56 Abstrakty Malík M, Lesný P, Javorka V, Mižičková M, Bilický J, Bodíková S Rádiologická klinika LF UK, SZU a UNB a IV. interná klinika LF UK a UNB, Bratislava V prípade plánovania endovaskulárnej alebo chirurgickej revaskularizácie u pacientov s periférnym artériovým ochorením je vždy indikované zobrazovacie vyšetrenie. Presná anatomická lokalizácia, rozsah, morfológia a hemodynamická závažnosť lézii arteriálneho systému umožňujú rozhodnutie o vhodnej revaskularizačnej metóde. CT a MR angiografia sa stali neoddeliteľnou súčasťou indikačnej škály vyšetrení pri PAO. Pomocou nich je dnes v mnohých situáciách možné diagnostikovať a lokalizovať lézie, zároveň posúdiť ich závažnosť a navrhnúť vhodnú stratégiu liečby. Farbou kódovaná duplexná sonografia môže mať v rukách skúseného špecialistu vysokú diagnostickú hodnotu, na podklade ktorej sú možné aj rozhodnutia o ďaľšej invazívnej liečbe, v praxi sa však používa často selektívne na presnú morfologickú a hemodynamickú charakteristiku lézií s ohľadom na ich vhodnosť na endovaskulárnu liečbu. Je metódou voľby pri kontinuálnom sledovaní pacientov po endovaskulárnej a cievnochirurgickej intervencii. Pri výbere najvhodnejšej zobrazovacej metódy je potrebné zohľadniť kontraindikácie, riziká, klinický stav a predpokladaný rozsah postihnutia u konkrétneho pacienta. Výber ovplyvňuje aj ich lokálna dostupnosť a tiež skúsenosti konkrétneho pracoviska s jednotlivými zobrazovacími modalitami. Zavedenie postkontrastnej MRA do rutinnej diagnostiky a rýchly technický rozvoj CT multidetektorových systémov posunuli tieto metódy kvalitatívne ďalej a v súčasnosti sú v mnohých prípadoch schopné konkurovať invazívnej DSA. Techniky MRA ako paralelné zobrazovanie, time-resolved MRA ako aj zobrazenie tepien bez použitia kontrastnej látky zvýšili jej diagnostickú hodnotu natoľko, že dnes táto metóda ponúka pre pacienta bezpečnejšiu a menej zaťažujúcu alternatívu v porovnaní s CTA vyšetrením. Invazívna DSA tak zostáva v zálohe pre nejasné prípady a najmä pre cielené endovaskulárne revaskularizačné výkony. V prezentácii sú zhrnuté súčasné možnosti, úskalia a naše skúsenosti s neinvazívnym zobrazením artériového systému pred plánovaním revaskularizačnej liečby. When planning endovascular or surgical revascularization in patients with peripheral arterial disease, imaging is always indicated. To make a decision about the mostappropriate method of revascularization, information about exact anatomical location, extent, morphology, and hemodynamic severity of arterial lesions is essential. CT and MR angiography has become an integral part of examination tests used in peripheral arterial disease. In most patients, these methods can help diagnose and localize lesions while at the same time assess their severity and suggest appropriate treatment strategy. In the hands of an experienced specialist, color-coded sonography may have a high diagnostic value, on the basis of which decisions on subsequent invasive treatment are possible. Most often, it is used selectively for precise morphologic and hemodynamic characterizations of lesions with respect to their suitability for endovascular treatment. It is the method of choice for follow up patient assessments after endovascular or surgical treatment. To select the most appropriate imaging technique, we need to take into account contraindications, risks, expected extent of the Vaskulárna medicína Suplement ; 5(S3)

57 Abstrakty 57 disease, as well as clinical conditionof the particular patient. Technique selection is also affected by its local availability and departament s experience. The introduction of contrast-enhanced MRA into routine diagnostics and rapid technological development of multidetector CT systems have made these methods competitive with invasive DSA. Due to techniques such as parallel imaging, time-resolved MRA, and vessel imaging without contrast medium, MR angiography offers the patient a safer and less burdensome alternative compared to the CT angiography. Invasive DSA can be reserved for cases when non-invasive imaging is unsatisfactory and for targeted endovascular procedures. Our presentation summarizes current possibilities, pitfalls, and our experience with non-invasive imaging before revascularization therapy. 76. Investigation of uni/bilateral lower limb edema with venous ultrasound Parv F, Avram R, Tudoran M, Balint M, Avram I, Vasiluta L, Gadalean F University of Medicine and Pharmacy Victor Babes, Emergency County Hospital No.1, Timisoara, Romania Introduction: Lower limb edema may be the result of multiple causes, both systemic and local; the main mechanisms are: decreased oncotic pressure, increased hydrostatic pressure, increased capillary permeability, lymphatic obstruction, inflammation and hypercoagulability. Also, the prognosis and quality of life in patients with edema are extremely variable. Venous ultrasound is a useful tool in the detection of some causes of edema. Purpose: The study aims to identify diagnostic features of uni / bilateral lower limb edema with venous ultrasound. Material and methods: Of 306 patients adressed for venous ultrasonography in our clinic we selected 145 patients who had uni / bilateral lower limb edema. We noted demographic characteristics and main sonographic criteria of chronic venous disease (reflux at sapheno-femoral junction, duration of reflux, perforator veins, deep vein thrombosis) on the basis of which we could confirm the diagnosis of chronic venous disease. Were excluded patients with documented chronic saline fluid retention (ex.congestive heart failure, liver cirrhosis, kidney disease). Results: Of 80 patients with unilateral edema (50% women) with mean age ± years, 13 patients (16%) had venous insufficiency elements: reflux with mean duration 2.1 ± 0.87 seconds, dilated perforating veins in 10 (38%) patients, varicosis in 12 (15%) of patients; 22 (27%) were classified in CEAP class 3 and 9 (11%) in CEAP class 5. Other 42 (52%) patients had deep venous thrombosis: in femoral vein (14%), popliteal vein (19%) and calf veins (44%). 21 (26%) had concomitant pulmonary embolism. In 25 (31%) patients in whom venous ultrasound was normal were established as causes of edema: trauma surgery (12), hematoma (3) Baker cyst (4), tumor (2), compressive lymphadenopathy (1), reflexsimpatodistrophy (1), cellulitis (2). Of 65 patients with bilateral edema (49% women) with mean age ± years we identified elements of ultrasound venous insufficiency in 48 (74%) of patients: reflux with average length of 3.66 ± 1.87 seconds, dilated perforating veins in 11 (17%), varices in 17 (26%) of patients and ; 5(S3) Vaskulárna medicína Suplement 3

58 58 Abstrakty deep vein thrombosis in 7 (10%). In 7 (11%) of patients in whom venous ultrasound was normal were identified as causes of edema: hypoalbuminemia (4), hormonal (2) compression pelvic lymphadenopathy (1). Conclusions: Venous ultrasonography is a non-invasive method able to exclude significant acute or chronic venous pathology as the cause of uni / bilateral leg edema and help in documentation of other processes generating local edema. 77. Chemical thoracic sympathectomy. Indications and results. Single centre experience. Ostrowski T, Kosicki A, Szostek M, Osęka M, Szostek M, Skórski M, Pawłowska M, Kański A Medical University of Warsaw, Department of General and Thoracic Surgery and II., Department of Anesthesia and Intensive Care, Warsaw, Poland Aim: Presentation of experience in the treatment of the upper limbs ischemia and vasomotoric changes by means of chemical sympathectomy. Materials: In the years in the Department of General and Thoracic Surgery, Warsaw Medical University 81 patients underwent chemical sympathectomy. Main indication for applying this procedure was Raynaud syndrome (in 35 cases), in 26 cases distal distal upper limb ischemia due to arterial occlusion, in 7 hyperactive hands sweating, in 12 Buerger disease and in one patient Takaysu arteritis. Methods: The principle of this method is neurolysis of a sympathic thoracic ganglion with specific indication to Th2. This procedure was based upon application of neurolytic substance (4ml of 96% ethilic alcohol) to the paravertebral area at the level of the 2nd thoracic vertebrae under X-ray control. 36 patients had bilateral sympathectomy and 45 unilateral procedures were applied (total 117 sympathectomies). Results: Very good results were stated in 56 upper limbs (47.9%), good in 52 (44,4%). In 9 (7.7%) cases no changes in ischemia were notified. In patients who presented to control, significant improvement was stated in 47 among 76 treated upper limbs (61.8%). Conclusions: 1. Thoracic chemical sympathectomy is an effective, cheap and low rate of complications method of treatment for ischemic changes in upper limbs. 2. Low invasive character and repeability maches it, the method of choice in this pathology. 83. Intermittent claudication and exercise programs Andreozzi GM, Martini R, Leone A Angiology Care Unit University Hospital of Padua and Vascular Rehabilitation Unit of Rehabilitation Clinic Casa di Cura Carmide Catania, Italy Physical training is universally recognized as the most effective means to improve walking capacity of patients with intermittent claudication (IC). Despite its effectiveness and its recommendation in guidelines its application remains infrequent and with a range of protocols and results unacceptable for other therapeutic tools. This review focus several operative aspects, still debated. Vaskulárna medicína Suplement ; 5(S3)

59 Abstrakty 59 Type of Exercise and Cardio-Vascular effects. The main cardiovascular effects of physical training are the improvements of endothelial function, increase of NO synthase and prostacyclin, reduction of inflammation, enhancement of muscle metabolism, improve blood rheology and likely neoangiogenesis. During the years power exercise or endurance exercise have been proposed. The power exercises, also called strength exercise, focus the stimulation of the suffering muscle, which in the intermittent claudication means the muscles downstream of the arterial stenosis or obstruction. This strategy derives from physiatric of neurological rehabilitation and is based on the theory of re-commitment of the loss function to new neurons. On the contrary, the endurance exercises involve all the muscles of the limb. A study carried-out by our group in the 80s demonstrated the superiority of endurance exercise than power. In fact, the pathophysiology of IC does not involve a motor neuron dysfunction, but the discrepancy between the oxygen required by muscle activity and oxygen provided by the reduced local arterial inflow. These results have been confirmed by larger study in On the other hand, we must not forget that the muscle of the claudicant patients has a severe reduction of fast glycolytic fibers 2B that compromises the result of the exercise of power. Training methods. The literature distinguishes between the advised physical training (training carried out independently by the patient following the advice and instruction gave by experienced medical staff) and supervised physical training (training carried out under the supervision of well skilled doctors and nurses). All comparative studies showed significantly higher effectiveness of supervised than advised training; however the last one remains more effective than absence of physical acivity. These findings suggest an early advised training program in patients with mild IC, and reserve the supervised program for patients with moderate or severe IC, in which the risk of local worsening of the disease is significantly higher. However, before providing suggestions for the advised program it is always better carry-on a cycle of supervised training, adapting the following phases to the own clinical response of the patient. Duration and costs. Most of the literature suggests a pattern of three sessions a week (every other day) for 3-6 months, with an estimated cost between ten and forty thousand U.S. $, depending on the mode of training, advised or supervised. In Italy the cost of the controlled training for the CI varies depending on how it is delivered. A recent study carried out in Northern Italy (Lombardia) reported the efficacy of a protocol of four weeks (two sessions per day), with improvement of 132% in initial claudication distance and 87% in the absolute claudication distance, with an estimated cost of between 4,626 and 3,811. Realising the training as in-patient day-hospital, the cost is per day in Sicily, while in Veneto amounts to per day for the first 13 days, plus for each additional day. So, considering the six-month protocols described in the literature the costs would thus be 16, to 10, in Sicily and Veneto. Our proposed short-course protocol has a cost of 4, to 3, in Sicily and Veneto, with an average cost per gained meter of (40.64 for the moderate claudication and for the severe claudication) ; 5(S3) Vaskulárna medicína Suplement 3

60 60 Abstrakty Frequency of Training Cycles. The few data available in the literature indicate that the benefits of supervised exercise training on walking capacity are long-lasting until at least six months after the end of training, especially if the patient continues to do regular physical activity outside of cycles controlled training. Several years ago, our group demonstrated that the gain in walking capacity remained stable up to six months and that further training cycles undertaken in this period did not further improve the performance. The Consensus Document on the Management of the Intermittent Claudication of the Central European Vascular Forum suggests that the claudicant patient with stable parameters in two subsequent controls is monitored once a year (mild claudication), every six months (moderate claudication) or every three months (severe claudication) by measuring the ABI pressure index and the walkink ability (six minute walking test). After the training cycle, the patient is advised to verify the walking ability each month and contact the vascular specialist in case of worsening. 84. Study to predict the effect of prostanoid treatment in CLI ( ILOCRITERIA study) Pecsvarady Zs Flór Ferenc Teaching Hospital, Kistarcsa, Hungary Chronic critical leg ischemia (CLI) is a serious condition with a high amputation rate. If interventional radiology procedure or reconstructive surgery is not possible, the prostanoid treatment is the only possibity to save the leg. This treatment is expensive and takes long time (weeks) hospitalisation without knowing the possible effect of the treatment. To give a better sort and also long-turn prediction of this treatment what is not really available at the moment according to the literature we have designed a non-interventional study (NIS) for the patients who are not suitable for any other vascular procedure just for amputation using TCPO2 functional and kinetic tests to determine the best tool among them for a more effective prediction what is important either in ethical or financial viewpoint. We are treating the patients 3 weeks according to the manual of the ilomedin medication using 6 hour infusion based on the weight and the tolerance of the patients. In the meantime tissue oxigenation of the leg in supine, elevation, and dependency pozition, after oxigen inhalation and during the first hour of the ilomedin infusion are measured. In the same visit ABI, pain scale, SF36 questionaer are performed. The patients are controlled baseline, one week, before discharged from the hospital, 3, 6, 12 month with the same fashion. Our ongoing study started in September 2011 and the planned 130 patients were enrolled at the end of 2012 in 10 Hungarian centers. The preliminary data of this study will be presented. 85. Skin microcirculation assesment in peripheral arterial disease Martini R Unità Operativa Complessa di Angiologia, Azienda Ospedale Università di Padova Italy The evaluation of the cutaneous microcirculation has been revealed in recent years a fundamental parameter for the evaluation of the patient with peripheral arterial disease. Currently Vaskulárna medicína Suplement ; 5(S3)

61 Abstrakty 61 are used the Laser Doppler (LD), transcutaneous pressure of oxygen (TcpO2). Particularly the LD has proven useful in the evaluation of the skin l Flowmotion and also for the evaluation of toe pressure and the tissue pressure, for the diagnosis of critical limb ischemia. The TcpO2 has had more success than LD not only in the definition of critical ischemia of the lower limbs but also in the prediction of healing of skin lesions in patients with and without critical limb ischemia. Both methods explore the cutaneous microcirculation non-invasively, and are easy to use thanks to special softwares that help the clinician interpretation of data. 86. Compression for the management of venous leg ulcers Partsch H Emeritus Professor of Dermatology, Medical University of Vienna, Austria Gravity is the reason why most wounds are localized on the lower extremities. Therefore compression therapy will stay the basic principle in managing all sorts of leg ulcers also in the future. In many so-called real life studies the healing rates of venous leg ulcers is still reported to be less than fifty present after twelve weeks. As shown by several trials this situation can be dramatically improved by choosing adequate compression materials applied with adequate pressure. The additional use of pressure pumps in combination with conventional compression is a promising tool especially in patients with restricted mobility. New ways of self-management have been developed in the last years. The main obstacle to better ulcer healing in the community is not the lack of good material but the lack of information and training of medical staff and patients. Based on several dose finding experiments measuring compression pressure and its effect on venous hemodynamics an optimal pressure range for different compression products could be evaluated. Methods used included Duplex and MRI, measurement of venous pressure in a dorsal foot vein and of the ejection fraction of the calf pump. Concerning better information also some basic understanding of the pathophysiology and differential diagnosis of leg ulcers is essential. Accurate diagnosis of the underlying vascular pathology may lead to a more targeted treatment in addition to compression aiming to heal the actual ulceration and to prevent recurrence. If no clear clinical improvement can be achieved by proper compression in some weeks the diagnosis of a purely venous ulcer needs to be reassessed (Doppler examination, biopsy, blood testing etc.). Reflux abolition by endovenous procedures may prevent recurrence of venous ulcers even without ongoing life-long compression. 87. Leg ulcers of non-venous origin Žernovický F ANGIO privátna angiochirurgická ambulancia, Bratislava % of leg ulcers are of venous origin. The rest of them has a very different etiology: ischemic, vasculitic, lymphostatic, neoplastic, neuropathic, traumatic, infectious and other dermatologic lesions. In authors material were 429 leg ulcers, venous 381, ischemic 4, mixed 20, vasculitic 14, lymphatic 5, malignant 5. Results: from 381 venous leg ulcers healed 344 (90,2%), lost from evidence were ; 5(S3) Vaskulárna medicína Suplement 3

62 62 Abstrakty (9,1%), and there were 32 (8,3%) recurrences. From 24 ischemic and mixed 21 (87,5%) healed, lost from evidence were 3 (12,5%). From 14 vasculitic healed 12 (85,7%), 2 (14,2%) did not heal. From 5 lymphatic healed 4 (80%), recurred 1 (20%). From 5 malignant healed 3 (60%), 1 (20%) was lost from evidence and 1 (20%) died. As we can see, leg ulcers are not only venous. It is essential to differentiate them according to their origin and establish the appropriate treatment: venous ulcers with compression, ischemic by revascularisation, vasculitic by moderate compression (in some cases corticoids necessary), lymphatic ulcers need very strong compression and malignant ulcers require radical exscision and lymphadenectomy respectively. 88. Konzervatívna liečba hemoroidov preparátom Diosminol micro (Conservative treatment of haemorrhoids with preparation Diosminol micro) Beláček J Chirurgická klinika, Fakultná nemocnica, Bratislava Autori udávajú súbor 84 pacientov, ktorých liečili preparátom Diosminol M; 73 % pacientov bolo vo veku medzi rokov. V priebehu roka 2012 ich sledovali v cievnych alebo v chirurgických ambulanciách. Indikáciou na liečbu Diosminolom boli bolesti, zápal alebo komplikácie hemoroidov. Analyzovali parametre ako výtok, svrbenie, opuch, zápal, prolaps a krvácanie. Zlepšenie v priebehu 1 týždňa pozorovali u 50 % pacientov s opuchom a svrbením a u 45 % pacientov so zápalom a krvácaním. 89. Terapeutický profil escínu a jeho postavenie v liečbe chronickej žilovej nedostatočnosti (Therapeutic profile of aescin and its place in treatment of chronic venous insufficiency) Rác M Oddelenie klinickej farmakológie, Interná klinika, Fakultná nemocnica, Nitra Bioflavonoidy predstavujú v armamentáriu liečby chronických venóznych ochorení dôležitú terapeutickú modalitu. Ide o liečivá prírodného pôvodu, často viac komponentné. Escín je jedným z najdlhšie používaných predstaviteľov skupiny prírodných venofarmák. Predstavuje zmes látok izolovaných zo semena pagaštanu konského. Má významný protizápalový a protiedémový efekt. Výrazne znižuje permeabilitu kapilár. Má tiež venotonický efekt. Tieto základné vlastnosti ho predurčujú k použitiu v liečbe symptomatických ochorení v príčinnom vzťahu k chronickej žilovej nedostatočnosti. 90. Venous thrombosis, right ventricular dysfunction and angiographic index interrelations and prognostic value in pulmonary embolism Avram R 1, Balint M 1, Parv F 1, Ciocarlie T 1, Avram I 2, Moga VD 1, University of Medicine and Pharmacy Victor Babes Timisoara, Romania, 1 Cardiology Department, Emergency County Hospital Timisoara, Romania, 2 Surgery Department I, Emergency County Hospital Timisoara, Romania Pulmonary embolism (PE) is still a leading cause of death and also together with deep vein Vaskulárna medicína Suplement ; 5(S3)

63 Abstrakty 63 thrombosis, is a common finding at necropsy in non-diagnosticated PE patients. Clinical severity confirmed by the CT angiography, impairment of the right ventricle (RV) and lower limb vein ultrasound examination have a diagnostic and probably complementary prognostic value. We selected from our clinical casuistry a total of 38 patients, 20 women and 18 men aged years with pulmonary embolism in the absence of other cardiovascular or respiratory diseases. We noted clinical and electrocardiographic data, echocardiographic right ventricular dysfunction, dimensions, tricuspid regurgitation, pulmonary pressure, angiographic index by Qanadli method and vein ultrasound. The follow of patients was done on an average period of 45 days. Only in 18 patients we were able to record clear correlations. 8 patients with severe clinical presentation and angiographic index over 10 had impaired ventricular function, pulmonary pressure > 50 mmhg, 10 patients with venous dilation ultrasound and angiographic index under 10 showed no signs of abnormal echocardiographic RV. In evolution right ventricular function recovered in 18 patients in 7-14 days, in days in 10 patients followed by improvement in ECG and also of thrombosis resolution in venous ultrasonography. Persistence of venous thrombosis in ultrasound was recorded for 3 months in 6 patients without right ventricular dysfunction and in 4 patients with right ventricular enlargement. Conclusions: Mean resolution in venous thrombosis and RV dysfunction increased progressively by 3 month. Right ventricular enlargement and dysfunction is high sensitivity for diagnostic and prognostic criteria, but ultrasound documented thrombosis evolves more slowly. Persistent venous thrombosis even after reducing other disease criteria suggests the need for repetition of the ultrasound exploration, but also the echocardiography. 91. Does exist a consensus on treatment of distal vein thrombosis? Antignani PL Dept. of Angiology, S. Giovanni Hospital, Rome, Italy The distal vein thrombosis is a special disease poorly studied and actually without consensus on the diagnostic evaluation and on the necessary treatment. Sometimes this disease has a good prognosis, but it can extend to proximal veins and it can progress to pulmonary embolism, especially in its bilateral presentation. The natural history of this disease is poorly documented and there is no consensus on the necessity of screening and treating patients presented with isolated distal deep vein thrombosis (DVT). Some investigators recommended routine administration of oral anticoagulants; others recommended serial ultrasound scan (at 1 and at 4 10 days, mean 1 week) and administered oral anticoagulant only if thrombosis is extended to proximal veins. This debate is due to the balance between the risk of the anticoagulation and the risk of thrombosis complications. Bleeding is a possible complication in postoperative patients and in elderly patients, so it is unnecessary if the risk of pulmonary embolism is not very high. Rationale for distal vein thrombosis treatment is based on its possibility of proximal progression (10 20%) and risk of pulmonary embolism, ; 5(S3) Vaskulárna medicína Suplement 3

64 64 Abstrakty reported recently as proximal thrombosis, up to 24.6%. The majority of thrombus progression, during the treatment period, was observed in patients with unprovoked idiopatic DVT (ID- DVT). These results support the usefulness of a prolonged treatment in un provoked ID-DVT. The Italian Society for the Study of Haemostasis and Thrombosis (SISET) recommends anticoagulant therapy for 6 weeks, while the American College of Chest Physician suggests 3 months. These recommendations apply equally to patients with proximal vein thrombosis and to patients with symptomatic distal vein thrombosis: low molecular weight heparin is used as an acute treatment and long-term anticoagulant therapy to prevent the high frequency (15 20%) of symptomatic extension of thrombosis and/or recurrent venous thromboembolism. Recently, TICT study has evaluated the efficacy and safety of ambulatory treatment of symptomatic distal vein thrombosis, based on the use of low molecular weight heparin (LMWH). The results are progression of proximal venous thrombosis that occurred in 4.6% of patients; not major bleeding, 1.16% cases or minor bleeding. Patients with idiopatic thrombosis have more complications or thrombosis progression to proximal veins (87.5 % of patients with idiopatic thrombosis). The authors conclude that these patients have to be treated at full dosage for a longer period after an acute event. The last ACCP guide lines suggest serial imaging of the deep veins for 2 weeks over initial anticoagulation for patients with acute distal DVT of the leg without severe symptoms or risk factors for extension (grade2c); initial anticoagulation over serial imaging of deep veins are suggested in the case of severe symptoms or risk factors for extension (grade2c).treatment with anticoagulation for 3 months over treatment of shorter period (grade 2C) and treatment for 3 months over treatment of a longer time-limited period (grade1b) or extended therapy (grade1b regardless of bleeding risk) are suggested for patients with an isolated distal DVT of the leg provoked by surgery or by non-surgical transient risk factor. Treatment with anticoagulation for at least 3 months over treatment of a shorter duration (grade1b) is to be reserved for patients with unprovoked DVT of the leg (isolated distal or proximal); the leg should be evaluated after 3 months of treatment for the risk benefit ratio of extended therapy. A plausible strategy to minimize the bleeding risk of over treatment is administration of limited courses of anticoagulation (i.e.short durations and/or reduced dosages in combination with follow-up ultrasound to adjust treatment parameters according to thrombus regression). If no regression occurs after 4 weeks of anticoagulation the full 3-month treatment course may be given. Reduced dosages may include half therapeutic or even prophylactic regimens of LMWH. 1. Parisi R, Visona A, Camporese G, Verlato F, Lessiani G, Antignani PL, Palareti G. Isolated distal deep vein thrombosis: efficacy and safety of a protocol of treatment. Treatment of Isolated Calf Thrombosis (TICT) Study. Int Angiol 2009; 28: Lautz TB, Abbas F, Walsh SJ, Chow C, Amaranto DJ, Wang E, Blackburn D, Pearce WH, Kibbe MR. Isolated gastrocnemius and soleal vein thrombosis: should these patients receive therapeutic anticoagulation? Ann Surg 2010; 251: Palareti G., Schellong S. Isolated distal deep vein thrombosis: what we know and what we are doing. J Thromb Haemost 2012; 10: Antignani PL, Aluigi L. The calf vein thrombosis. Reviews in Vascular Medicine 2013;1(1):1-4. Vaskulárna medicína Suplement ; 5(S3)

65 Abstrakty Treatment of venous thromboembolism in patients with cancer Elalamy I Service d Hématologie Biologique, Hôpital Tenon, Pierre-and-Marie-Curie University, Paris, France Despite that the complex and natural relationship between cancer and thrombosis was established since the middle of the 19th century and that thrombosis is the second cause of death in cancer patients, 70% of patients with a high thrombotic risk do not receive any adapted prophylaxis. The weak awareness of such acquired hypercoagulable state and the lacks of implementation of evidence-based recommendations are obvious in the medical community. The main refrains from this prescription are the fear of bleeding, the absence of systematic thrombosis risk stratification, economical and organizational barriers. Different scoring systems are proposed, but none was validated for global risk determination in so various clinical and therapeutic contexts. Most of the scientific societies have published their own recommendations showing also a significant heterogeneity. Through the impulsion of the Groupe Francophone Thrombose et Cancer, a consensual document has been recently published with international recommendations for thrombosis management in cancer patients. Low Molecular Weight Heparins are the first line drugs and the spearhead of this strategy. In France, we suggested practical algorithms to help all physicians in their decision with a contextualized and simplified manner. The improvement of such recommendations application requires various conditions: first, to be validated by each health system based on the local possibilities, second, to be reinforced by regular therapeutic educational programs and, third, to implement a multidisciplinary approach through particular dialogue meetings determining the optimal management of fragile patients with a recognized high risk of thrombosis. 93. Classification of Acute Deep Vein Thrombosis (DVT), risk factors for (DVT) Recurrence, and management of the Post-Thrombotic Syndrome (PTS): bridging the gap between DVT and PTS Michiels JJ, Barth J, Moosdorff W, De Maeseneer M, Neumann M Goodheart Institute, Bloodcoagulation & Vascular Medicine Science Center, Primary Care Medicine Medical Diagnostic Center, Rijnmond, and Department of Dermatology, Section Phlebology, Erasmus University Medical Center, Rotterdam, The Netherlands About one third to half of patients with deep vein thrombosis (DVT) develops various degrees of post-thrombotic syndrome (PTS) within 1 to 5 years post-dvt. DVT recurs in about 20% to 30% within 5 years and is a main cause of PTS. The Clinical-Etiology-Anatomic-Pathophysiologic (CEAP) classification is most objective to detect mild, moderate and severe PTS at time point beyond one year post-dvt. For the assessment of PTS development within the first months to one year post-dvt the combined Villalta and Brandjes scoring systems seems to be most sensitive.. None of the PTS classifications do evaluate the degree of DVT symptom disappearance ; 5(S3) Vaskulárna medicína Suplement 3

66 66 Abstrakty Duplex ultrasound sonography (DUS) is mandatory at time of DVT diagnosis and during the first year at 0, 1, 3, 6, 9 and 12 months post-dvt to document DVT extension, the degree of recanalisation, residual vein thrombosis (RVT) or obstruction (RVO) and the appearance of reflux.the occurrence of PTS and DVT recurrence depend on the location and extend of DVT, on risk factors on DVT recurrence and the duration of anticoagulation. DVT patients are currently recommended to wear medical elastic stockings for 2 years to reduce the incidence of PTS from 50% to 25%. Complete recanalization of leg veins and no appearance of reflux at 3 to 6 months post-dvt in half of the DVT patients is predicted to be associated with no recurrence of DVT and no appearance of PTS obviating the need of continuation of anticoagulation and wearing medical elastic stockings (MECS) at 6 to 9 months post-dvt. The appearance of reflux due to valve destruction is related to delayed recanalization and the degree of RVT or RVO at 9 to 12 months post-dvt. The presence of reflux and/or obstruction in symptomatic PTS in about one fourth to one third at time point of 1 year post-dvt patients predict the need of prolonged anticoagulation on top of MECS to prevent DVT recurrence. To test this concept we designed a prospective management study to bridge the gap between DVT and PTS. We here propose that a clinical examination for the assessment of PTS by DUS should be performed in routine clinical practice at 3 to 6 months, one year separates post-dvt patients in4 groups: 1. complete recanalization, and no reflux at 6 months post-dvt, anticoagulation and MECS can be discontinued. 2. No PTS with reflux of the deep venous system and PTS, anticoagulation and wearing MECS and anticoagulation should be continued until re-evaluation at 1 year. 3 and 4 PTS with reflux and incomplete recanalization or obstruction are candidates for long-term anticoagulation and MECS for at least 2 years to prevent DVT recurrence PTS. A large scale prospective study is warranted to fine-tune and prove this concept. 94. Compression ultrasonography, clinical score, thrombosis risk factors and D-dimer test for evidence based Diagnosis and Management of Deep Vein Thrombosis and Alternative Diagnoses in the primary care setting and outpatient wards Michiels JJ, Michiels JM, Moosdorff W, Barth J Goodheart Institute, Bloodcoagulation & Vascular Medicine Science Center, and Proimary Care Medicine, Medical Diagnostic Center, Rijnmond, Rotterdam, the Netherlands Deep vein thrombosis (DVT) has an annual incidence of 0.2% in the urban population. The incidence of DVT is 1.8 per 1000 persons-years at age 65 to 69 years and 3.1 per 1000 persons years at age 85 to 89 years. First episodes of DVT are in two-thirds of cases elicited by risk factors, including varicose veins, cancer, pregnancy/postpartum, oral contraceptives below the age of 50 years, immobility or surgery. Pain and tenderness in the calf and popliteal fossa may occur resulting from other conditions labeled as alternative diagnosis (AD) including Baker s cyst, ruptured Baker s cyst, torn plantaris tendon, hematoma, or Vaskulárna medicína Suplement ; 5(S3)

67 Abstrakty 67 muscle tears or pulls. Due to its invasive nature phlebography has not become a routine tes for DVT diagnosis and exclusion, and has been replaced by compression ultrasonography (CUS). The requirement for a safe diagnostic strategy of deep vein thrombosis (DVT) should be based on an objective post-test incidence of venous thromboembolism (VTE) of less than 0.1% with a negative predictive value for exclusion of DVT of 99.99% during 3 months follow-up. Modification of the Wells score by elimination of the minus 2 points for AD is mandatory and will improve clinical score assessment for DVT suspicion in the primary care and outpatient medical diagnostic setting. Repeated CUS alone is not cost-effective enough to rule in or out DVT. Complete CUS (CCUS) does pick up alternative diagnoses (AD) like Bakers cyste, muscle hematomas, old DVT, and superficial vein thrombosis (SVT) and other alternative diagnoses with a negative CCUS include leg edema, varices erysipelas are easily picked up by physical examination. The combination of low clinical score and a negative D-dimer test is not sensitive enough for safe exclusion of DVT in routine clinical practice. The sequential use of CUS followed by dimer testing and modified clinical score assessment is a proper objective diagnostic algorithm that can safely and effectively exclude and diagnose both DVT and alternative diagnoses (AD) in patients with suspected DVT. About 10 to 30% of patients with DVT develop overt post-thrombotic syndrome (PTS) at one year post-dvt. DVT has a recurrence rate of about 20% to 30% after 5 years, but the rate varies depending on the presence of risk factors and prolonged anticoagulation if indicated (78-82). Risk stratification using CCUS for reflux and Dimer studies are recommended to assess the duration to wear medical elastic stockings and anticoagulation for the prevention DVT recurrence as the best option to reduce the incidence of PTS. 95. Safe exclusion of deep vein thrombosis (DVT) by ultrasonography and ELISA D-dimer testing: a prospective study in 1330 patients with suspected DVT in the primary care setting Barth JD 1, Moosdorff W 1, Maasland H 1, Michiels JM 2, Lao MU 1, Michiels JJ 1,3 Primary Care Medicine, Medical 1 Diagnostic Center, Rijnmond, Rotterdam, 2 Department of Primary Care Medicine, Leiden University Medical Center, Leiden, 3 Goodheart Institute, Bloodcoagulation & Vascular Medicine Science Center, Rotterdam, The Netherlands Introduction: A negative compression ultrasonography (CUS) excludes deep vein thrombosis (DVT) with a negative predictive value (NPV) of 97 to 98% indicating the need to repeat CUS within one week. A normal rapid ELISA D-dimer test (VIDASR) excludes DVT with a sensitivity and NPV of 99% irrespective of clinical score. The incidence of DVT after a negative CUS and ELISA dimer level above 500 ng/ml is predicted to be increased (4 to 5%) indicating the need to repeat CUS. To test this strategy we performed a prospective study in 1330 consecutive outpatients with suspected DVT in the primary care setting. Methods: A negative CUS and a rapid ELISA D-dimer test (VIDASR) of <500 ng/l exclude DVT ; 5(S3) Vaskulárna medicína Suplement 3

68 68 Abstrakty A negative CUS with a D-dimer result above 500 ng/l was followed by a second CUS within one week. Patients with DVT on a 1st or 2nd CUS were treated with low molecular weight heparin followed by vitamin K antagonist. Results: Out of 1330 with suspected DVT a 1st CUS was negative in 1059 and positive for DVT in 271: 20.3%. In 384 with a normal ELISA D-dimer (<500ng/mL) the CUS was true negative in 382 and false negative on CUS in 2, indicating a sensitivity of 99.52%, a NPV of 99.48%, and a specificty of 36% irrespective of clinical score. A 2nd CUS was indicated in 675, performed in 641 patients and proved to be positive in 26 (4.0%), indicating a NPV of 96% after a 1st negative CUS. The overall prevalence of DVT after a 1st or 2nd CUS was 297 of 1330 (22.3%): 18% proximal DVT and 2.4% distal DVT. The NPV of a negative 1st CUS and a rapid ELISA D-dimer test (VIDASR) of less than 1000 ng/ml was 99.1% at a specificty of 66.9% irrespective of clinical score. The prevalences of DVT at increasing D-dimer cut of levels of 0 to 500, 500 to 1000, 1000 to 1500, and above 1500 ng/ml were 0.5%, 6.3%, 15.1% and 47.4% respectively irrespective of clinical score. At time of a negative 1st CUS for DVT in 1059 outpatients, the CUS was positive for the following alternative diagnoses: Bakers cyste, muscle hematoma or old DVT in 62 (5.8%), superficial vein thrombosis (SVT) without DVT in 78 (7.4%), and leg edema or varices in 17%. Repeated CUS was positive in 6% of SVT. Discussion: A 1st CUS detected a significant number of alternative diagnoses in patients with suspected DVT in the primary care setting. A 1st CUS and an ELISA D-dimer of <1000 ng/ml excluded DVT with a sensitivity of 99.1% irrespective of clinical score. The combination of a 1st negative CUS and a normal ELISA test (<500 ng/ml) irrespective of clinical score, and the combination of low clinical score (asymptomatic for DVT), a normal 1st CUS and an ELISA D-dimer test of <1000 ng/ml is predicted to safely exclude DVT with a sensitivity of 99.99% and a NPV of 99.99% without the need of repeated CUS testing in two-third of outpatients with suspected DVT. This strategy is predicted to be cost-effective by reduction of repeated CUS by 67%, and has been evaluated in a prospective study of more than 2000 outpatients with suspected DVT in our primary care setting (manuscript in preparation). 96. VTE in pregnancy and puerperium new registry in CEVF countries the proposal (REVTECE REgistry of VTE in Central Europe) Vacula I II. interná klinika LF UK, Bratislava; VASA- CARE, Trnava Background: Venous thromboembolism (VTE) occurs rarely during pregnancy, but is still one of the most threatening complications of pregnancy and puerperium. As the health and life of the mother and child is seriously in danger, immediate diagnostic procedures and therapy are indicated. There are no reliable well designed clinical studies involving pregnant women and almost the only source of information remains registries. Proposal: Central European Venous Forum (CEVF) is an organisation with aims to gather vascular specialists from Central Europe and support their research and educational activities. A project like International registry is a motivation for joining our community. With contribution to this common project, vascular specialists from our countries could begin a closer cooperation Vaskulárna medicína Suplement ; 5(S3)

69 Abstrakty 69 with results as common publications or exchangeable study residence etc. Organisation, time Schedule: In Slovakia, registry of VTE will involve close cooperation between vascular specialists and gynecologists. As every woman diagnosed VTE in pregnancy and puerperium should be addmitted to hospital, we (Slovak Angiological Society (SAS) and Slovak Society of Gynecology and Obstetrics (SSGO) will ask every hospital to send the woman after dissmission to the closest angiologist. The instruction with the address and phone contact of the angiologist will be posted to every chief doctor of the gynecology ward. Every private gynecologist will also receive an information letter concerning the project. The project will be introduced on national congresses of SAS and SSGO. In the whole Slovakia, there are just about 30 angiological ambulancies and thus, it is very unlikely, that we will miss a single patient. The angiologist will be responsible for the further treatment of VTE as well as for the registry. We will ask all most important Pharmaceutical Companies producing LMWH for their support (GSK, Pfizer and Sanofi-Aventis). The registry can be operated from Masaryk University in Brno (as we have very good experiencies with the registry of SVT) and the direct link on the registry will be placed on the official websites of SAS and CEVF. The project has to be prepared until December 2013 and will be send to Ethical Commette for evaluation and agreement. The international coordination of the project will be realized by national coordinators and their communication with the principal international coordinator. Conclusion: The project of common registry depends on identification of possible problems and their solutions. Now, this project is opened for discussion. 97. Septické plicní embolizace (Septic pulmonary embolism) Vahala P, Poliačik P, Hasilla J Kardiologická klinika FN, Nitra a Fakulta sociálnych vecí a zdravotníctva UKF, Nitra Introduction: Septic pulmonary embolisms in young people lead to suspicion of abuse of intravenous drugs. These patients are often and repeatedly treated as outpatients by antibiotics due to their pulmonary symptomatology with temperatures under the disguise of recurrent bronchopneumonia with gradual development of abscesses. The right diagnosis and treatment is established only after being sent to the echocardiographic examination in the specialized clinic. Materials and Methods: 182 infective endocardites were diagnosed and treated by the authors from 1996 to cases (17.6%) of endocarditis were located in the right heart. These right-sided endocardites were evaluated by the authors from the diagnostic and treatment course of the disease. Results: Pulmonary symptoms of septic pulmonary embolism varied from clinically silent cases to massive lung lesions with the development of respiratory insufficiency requiring mechanical ventilation. The chest X-rays showed effusions, infiltrates, small abscesses and extensive abscesses 10 cm x 10 cm. Staphylococcus aureus and Streptococcus were the most common pathogens proved in the blood cultures. Sources of the septic pulmonary embolism (vegetation) were in the following locations: 1. tricuspid valve (intravenous drug users, patients with Crohn\ s disease), 2. infected pacing systems, 3. in the foramen ovale a large saddle vegetation blowing in both cardiac atria, ; 5(S3) Vaskulárna medicína Suplement 3

70 70 Abstrakty (young man taking anabolic drugs), 4. vegetation hanging from the Eustachian valve in the right atrium, 5. septic thrombophlebitis. Diagnostic latency was 2 months. Response to treatment was favorable. Nobody died. Recidivism and relapses are common. Surgical extraction was proved necessary due to recurrent infections of the pacing systems. Also, vegetation in the foramen ovale required resection; subsequently the suture of the foramen ovale was executed. Conclusion/Discussion: Echocardiography possesses crucial and irreplaceable role in the diagnosis of septic pulmonary embolism. This must be performed in the cardiologic center with sufficient know-how and experience; where there is sufficient practice with the diagnosis and treatment for these patients (more than 12 diagnosed and treated patients with infective endocarditis per year). Otherwise, extremely valuable time can be wasted by the validation of the diagnosis, ineffective and untargeted treatment and delayed reactions to the occurrence of complications. 98. Hormonálna antikoncepcia z pohľadu kardiológa (Point of view of cardiologist on the hormonal contraception) Ivan B, Vahala P, Koiš P, Poliačik P, Hasilla J Kardiologická klinika FN, Nitra a Fakulta sociálnych vecí a zdravotníctva UKF, Nitra Introduction: Every medical treatment may have, under certain circumstances, serious side effects. One should not take medication, unless completely necessary. Moreover, hormonal contraception is not a medicinal substance. Currently, the medicine is too complex. Doctors are highly specialized in their field of expertise and from the perspective of their expertise and experience they see some facts that may not be visible to the other specialists. Hormonal contraceptives are detected by cardiologist primarily through venous thromboembolism among adolescent teenagers and young women. Material and Methods: Out of the total 1,500 in clinic hospitalizations per year, there are patients with venous thromboembolic events. Adolescents and young women ages are a substantial part (app. 50%) of those with thromboembolic events. The most common reason for hospitalization ages up to 30 is due to the venous thromboembolic events. Diagnostic process, the severity of events, and the incidence of risk factors were evaluated by authors on their own group of 61 female patients. Results: The authors present a wide range of pulmonary embolism in young women ranging from fatal events and life-threatening pulmonary embolism to small, clinically silent embolisms, proven only by positive findings on CT angiography. Most cases (56%) have an echocardiographically detected right ventricular dilatation or signs of pulmonary hypertension (50% were hemodynamically stable, 10% unstable). Positive troponin (48%) is the clear evidence of the severity. Creation of slow healing pulmonary infarctions was identified as the complication in 10% of the cases. The thoracic drainage of large pleural effusion in one 24 year old female became necessary due to the development of pleural syndrome. Thrombosis of the deep venous system was diagnosed by duplex ultrasonography in 47% of patients. Pelvic compression syndrome was found in three patients, with the Vaskulárna medicína Suplement ; 5(S3)

71 Abstrakty 71 necessity of invasive solutions, including the application of several stents. One patient was diagnosed with a compression syndrome of the upper limb after strenuous physical activity (house painting). Hormonal contraception was used by all patients. The additional risks factors seen are as follows: active smoking (80%), factor V Leiden mutation (18%), hyperhomocysteinemia (5%), antiphospholipid syndrome (3 x), inactivity (travel thrombosis - jet leg), small injuries with subsequent fixation and without fixation of limbs, infection with insufficient drinking regime, sedentary work, unusual exertion and cancer treatment (1x). Three adolescents with hormonal contraception were admitted for suspected pulmonary embolism and diagnosed with primary pulmonary hypertension. Discussion: Prior to introducing the hormonal contraception to young women, the careful detection of risk factors, including a detailed family history is required. If the family history is insufficient and/or information gathered from adolescents and family members are incomplete, doctors cannot avoid using special tests to exclude thrombophilic states in the prevention of sudden death. However, some women in this group had a negative family history and positive results for congenital factor V Leiden mutation. Some women in the group were provided with insufficient information on possible side effects; they were not informed of the need for discontinuation of their contraceptive due to immobilization or discontinuing their contraceptive four weeks before any surgery. Every woman taking hormonal contraception, sent to the cardiology clinic for vague cardiorespiratory problems, requires termination using of hormonal contraceptives and a detailed examination including thrombophilic states. Thus we can help to avoid sudden death of young women taking hormonal contraception. 99. Subfebríllie signál cievnej katastrofy (Low-grade fever a warning sign of vascular catastrophe) Bírová K¹, Vahala P¹, Hasilla J¹, Galko J² ¹Kardiologická klinika FN Nitra, FSVaZ Univerzita Konštantína filozofa v Nitre,²Vascular surgery ward FN Nitra Introduction: Signs of infection in patients with prosthetic material represent a significant diagnostic and therapeutic challenge. At our cardiology department, we most commonly deal with patients with prosthetic heart valve, history of valve repair, or permanent pacemaker implantation. Occasionally we face the problem of infection signs in patients with history of vascular surgical reconstruction using prosthetic aortic graft. Population and methods: Between 2009 and 2013 we had three cases of unexplained lowgrade fever in patients with history of aortic-femoral vascular reconstruction of abdominal aortic aneurysm using prosthetic graft. Clinical examination, computed tomography (CT), labelled white blood cells scintigraphy and blood cultures were our diagnostic modalities of choice. Results: Two patients were admitted because of intermittent recurrent fever following termination of antibiotic treatment. First patient (60 years old) had a history of a vascular surgical reconstruction of abdominal aortic aneurysm with aortic-bifemoral bypass 4 weeks before the admission. Blood cultures at the time of admission showed a multi-resistant, beta lactamase and ; 5(S3) Vaskulárna medicína Suplement 3

72 72 Abstrakty cepholosporinase producing species of Klebsiella pneumonia. Labelled leucocytes scan confirmed small localized infection at the proximal end of deteriorated, with loss of consciousness and acute rectal bleeding. Emergent surgical revision revealed aortic-duodenal fistula and graft infection. The infected graft was explanted, duodenum sutured and a new axillary-bifemoral bypass graft implanted. One month later, the patient was discharged to home in stable clinical condition. Second patient (58 years old), with a history aortic-femoral bypass graft surgery 3 bronchopneumonia at his local surgery. Because of persisting intermittent fevers despite the antibiotic treatment he was referred for an echocardiogram which revealed significant mitral regurgitation without obvious vegetations on trans-thoracic scan. Several blood cultures showed viridians streptococci and corynebacteria. Labelled leucocytes nuclear scan confirmed aortic-femoral prosthetic graft infection. We gave him a diagnosis of prosthesis infection complicated with infective endocarditis. He underwent an urgent vascular surgical reconstruction procedure, but on the 14th post-operative day he died due to multi-organ failure. Third, 74-year old patient, with a history of recent aortic-femoral bypass operation, was admitted because of recurrent gastrointestinal bleed, with gastrofibroscopy repeatedly showing D3 duodenal bleeding. Computed tomography and nuclear scintigraphy were negative in terms of prosthesis infection. CT angiography revealed large leaking pseudoaneurysm in the area of distal anastomosis of the left graft branch, with prosthesis-duodenal fistula. The pseudoaneurysm was successfully covered with a stent-graft and one month later, fully clinically recovered, he was discharged to home. Conclusion: Our case reports illustrate the diagnostic and therapeutic challenge of non- -specific symptoms in the context of previous prosthetic surgery. Recurrent fevers or repeated, initially mild gastrointestinal bleed can direct the patients to internal medicine or cardiology departments. Despite blood culture guided antibiotic treatment, the prosthetic graft infection progresses and can result in aortic-enteral fistula and life-threatening bleeding. Successful diagnosis of these complications requires high level of clinical suspicion, especially if they are not a part of your everyday clinical practice Phlegmasia coerulea dolens bilaterálne kazuistika (Bilateral phlegmasia coerulea case report) Necpal R, Žúdelová L, Tomka T, Šefránek V Klinika cievnej chirurgie NÚSCH, Bratislava Autori prezentujú kazuistiku 53-ročného pacienta akútne riešeného na ich pracovisku s nálezom obojstrannej phlegmasia coerulea dolens s ťažkým senzomotorickým deficitom na oboch DK a šokovým stavom. Príčinou bol rozsiahly nádor retroperitonea, ktorý kompletne obturoval VCI a následne došlo k trombóze iliackých, femorálnych a končatinových žíl. Pri urgentnej operácii zrealizovali venóznu trombektómiu hlbokých žíl dolných končatín. Pri náleze nepriechodnej VCI zavzatej v nádore bol súčasne zrealizovaný venózny bypas medzi VFC bilaterálne a VCI. Pooperačný priebeh komplikovaný polyurickou formou akútneho renálneho zlyhania a nutnosťou vazopresorickej liečby. Postupne došlo k normalizácii stavu. Napriek antikoagulačnej liečbe došlo v priebehu Vaskulárna medicína Suplement ; 5(S3)

73 Abstrakty 73 niekoľkých týždňov k postupnému uzáveru rekonštrukcie, ale bez klinického zhoršenia. Pacient absolvoval orchiektómiu (histol. nález: seminóm T3N3M0 S2, št. IIIa/IIIb ) s následnou chemoterapiou; 24 mesiacov po operácii je pacient v remisii onkologického ochorenia, v klinickom obraze sú prítomné len mierne perimaleolárne opuchy a zvýraznená venózna kresba na brušnej stene Vaskuloprotektívne účinky amlodipínu pri hypertenzii (Vasculoprotective effects of amlodipine in hypertension) Bulas J, Potočárová M, Murín J, Reptová A I. interná klinika LF UK a UNB, Bratislava Vascular protection is an important goal of antihypertensive therapy. Many studies devoted their effort to find some advantageous properties of cardiovascular drugs frequently used in clinical practice. Calcium channel blockers (CCB) are very effective and frequently used in the therapy of hypertension. Amlodipine is the newest one among them and has very beneficial effects reaching beyond the lowering blood pressure only. As an antihypertensive drug it belongs into the group of third generation dihydropyridine derivatives of L-type calcium channel blockers with pronounced selective vasodilatatory effect. It has an exceptionally long half-life of excretion (30 to 50 hours) with achieving the maximal hemodynamic effect after 7 days from starting the therapy. Smooth muscle relaxation and remodelling of resistant arterioles decreases not only brachial blood pressure, but also decreases the stiffness of arteries and aortic pulse wave velocity and thus the central systolic blood pressure due to lowering the amplitudes of initial pulse pressure waves and also the amplitudes of reflected pressure waves from the periphery. This increases the effectivity of left ventricular work, improves its blood supply during the diastole and contributes to the prevention of cardiovascular events. The favorable contribution of amlodipine to the treatment of hypertension results not only from the lowering of blood pressure per se, but further from the supression of blood pressure variability which is known as another parameter increasing the cardiovascular risk. Amlodipine acts also on nondihydropyridine calcium channels, has vasculoprotective effects mediated through antiproliferative effect on vascular smooth muscle and extracellular matrix, has antiatherogenic and antioxidative effects in the vessel wall. Its vasodilatative effect is amplified by stimulation of NO release from endothel. Effects non-related to the L-type voltage-dependent calcium channels are called pleiotropic effects of amlodipine, adding more benefits to its advantageuos clinical profile. The combination of amlodipine with angiotensine converting enzyme inhibitors (ACEI) or angiotensine II receptor blockers (ARB) is considered as the most effective antihypertensive therapy in reducing the cardiovascular risk. When combined with statin it favourably affects the regulation of vascular smooth muscle proliferation, apoptosis and metalloproteinases production and increases the stability of atheromatous plaques. The preservation of vascular wall should be a target of complex antihypertensive therapy going beyond the simple blood pressure lowering. Key words: amlodipine, vascular wall protection, calcium channel blockers, aortic stiffness, central systolic blood pressure, antihypertensive therapy, cardiovascular risk ; 5(S3) Vaskulárna medicína Suplement 3

74 74 Abstrakty 102. Larválna debridementová terapia bioterapeutická metóda na liečenie vredov predkolenia a iných chronických rán (Maggot debridement therapy the biotherapeutic method for healing of leg ulcers and other chronic wounds) Takac P¹, Čambal M², Slezák V³, Majtán J¹, Takáč P 4 ¹Oddelenie Molekulárnej a aplikovanej zoológie Ústav zoológie, SAV, ²I. chirurgická klinika, Univerzitná klinika, Nem. Staré mesto, ³Cievno-chirurgická ambulancia, Univerzitná nemocnica s poliklinikou, Milosrdní bratia, 4 SCIENTICA, s. r. o. The maggot debridement therapy is a modern biotherapeutic method based on the use of necrophagous flies to treat chronic non- -healing wounds. In last two decades, maggot debridement therapy became routinely used therapeutic method and thousands of patients over the world had benefit of its healing power. In Slovakia, maggot debridement therapy was successfully used for the first time in August 2003 at the Medical Faculty Hospital in Bratislava to clean persisting wound of patient suffering by diabetes. Sterile larvae of blowfly Lucilia sericata were prepared by the Institute of Zoology, Slovak Academy of Sciences. A year later, non-profit organization MEDALT was established with the aim to develop biotherapeutic methods and to introduce these methods in clinical praxis in Slovakia. The research and introduction of maggot debridement therapy was supported by European Social Foundation through the project running in Tens of lectures for medical experts and common public as well as media presentations were organized. Thanks to these activities, maggot debridement therapy is routinely used in hospitals over the country. Since 2010 research in the field of larval therapy is provided by the company SCIENTICA, s.r.o., which received the grant from Operational Program of Research and Development of European Union. In the frame of this project, modern laboratory for production and research of sterile larvae was developed. The application of larval therapy is carried out in two ways: By straight application of Lucillia sericata larvae in wounds two layered dressing is used to prevent larvae escape. The bottom layer (cage layer) is fixed to the intact skin surrounding the wound. Its purpose is to keep maggots in the wound and to protect surrounding skin from aggressive maggot s juice side effects. We use colostomy pads Coloplast. The second layer is chiffon, which is attached by a special disperse glue (developed in the Institute of Polymers, SAS, Bratislava) to the bottom layer. This layer allows maggots to breathe oxygen and to drain out liquefied necrotic tissue and wound secretion. One day old sterile larvae are applied under plastered chiffon. Top layer is dry gauze which is usually placed over the cage layer to absorb the liquefied necrotic tissue. Only this layer is regularly (every 4-6 hours) changed by the nursing staff. Biobag application. Biobag is our challenge. Simuntaneously we are designing a new biobag for maggot debridement therapy. By using biobags we didn t notice any larvae escape. The application, removal and disposal are simple and practical. We can recommend this way of maggot s application direct into the Vaskulárna medicína Suplement ; 5(S3)

75 Abstrakty 75 wound. Maggot debridement therapy is a safe, reliable, cost-saving and very effectivemethod in management of chronic non-healing wounds. This work had been funded by the Operational Program of Research and Development and co-financed with the European Fund for Regional Development (EFRD). Grant: ITMS : Research and development of new biotherapeutic methods and its application in some illnesses treatment Slovenský medovicový med v liečbe vredov predkolenia (Slovak honeydew honey for treatment of the lower leg ulcers) Slezák V¹, Takáč P², Majtán J² ¹University Hospital of the Merciful Brothers, ²Institute of Zoology SAS Honey has been used as a traditional medicine for centuries by different cultures for the treatment of various disorders. However, not all honeys exhibit equal antimicrobial potency and only a few of them meet the criteria for clinical usage. The aim of the study was to show that honeydew honey produced in Slovakia has a strong potential to be another medical-grade honey. We evaluated clinical efficacy of sterilized honey in the treatment of the lower leg ulcers in 15 patients. We found that leg ulcers were completely healed after 4 weeks treatment with sterile honeydew honey in most patients. Honey also reduced inflammation, pain and induration of affected region. Honey was well tolerated in most patients; however, two patients discontinued the participation in the study due to intolerance of honey treatment. Based on our clinical data we believe that Slovak honeydew honey is an ideal and cheap antibacterial and wound healing agent that meets all attributes to become a medical-grade honey. This work had been funded by the Operational Program of Research and Development and co- -financed with the European Fund for Regional Development (EFRD). Grant: ITMS : Research and development of new biotherapeutic methods and its application in some illnesses treatment. This work was also supported by the Slovak Research and Development Agency under contract No. APVV ; 5(S3) Vaskulárna medicína Suplement 3

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