Karel Roztocil

Institute for Clinical and Experimental Medicine (IKEM) | IKEM · Angiology

Post-thrombotic syndrome (PTS) is a chronic venous insufficiency manifestation following an episode of deep-vein thrombosis (DVT). It is an important and frequent long-term adverse event of proximal DVT affecting 20-50% of patients. This position paper integrates data guiding clinicians in deciding PTS diagnosis, treatment and follow-up.

The objective of the present guideline is to provide evidence-based, comprehensive and optimal care recommendations for patients with atherosclerotic peripheral artery disease (PAD) of the lower limbs. The guideline is meant to aid medical personnel and patients in making decisions regarding the optimal diagnostic and therapeutic measures for patie...

The burden of vascular diseases is growing worldwide, as the population ages, prompting a call to action not only in terms of awareness but also and most urgently in recognizing the need for vascular physicians, also called angiologists. Vascular medicine views the vascular system (arteries, veins, and lymphatics) as a whole, unique, and independen...

Chronic critical lower limb ischemia (CLI) has been defined as ischemia that endangers the leg. An attempt was made to give a precise definition of CLI, based on clinical and hemodynamic data (Second European Consensus). CLI may be easily defined from a clinical point of view as rest pain of the distal foot or gangrene or ulceration. It is probably...

Background: 31P MR spectroscopy is a technique for undertaking a comprehensive evaluation of muscle metabolism. The goal of this study was to compare patients with mild and severe lower limb ischemia measured by 31P MR spectroscopy at rest and during exercise. Methods: 16 nondiabetic mild peripheral arterial occlusive disease (PAOD) patients, 23...

Background: Two point CUS (2-CUS) for the diagnosis of symptomatic proximal DVT overlooks calf vein thrombosis (CVT) overlooks calf vein thrombosis (CVT) indicating the need to repeat 2-CUS after one week, which is not cost-effective. Complete CUS (CCUS) of all deep veins from the groin to the ankle in a single procedure will pick up CVT, proximal...

Regarding the clinical diagnosis of Raynaud's phenomenon and its associated conditions, investigations and treatment are substantial, and yet no international consensus has been published regarding the medical management of patients presenting with this condition. Most knowledge on this topic derives from epidemiological surveys and observational s...

Background: -Patients with a first episode of unprovoked venous thromboembolism have a high risk of recurrence after discontinuation of the anticoagulant therapy. Extending anticoagulation reduces the risk of recurrence but is associated with increased bleeding. Sulodexide, a glycosaminoglycan, exerts antithrombotic and profibrinolytic actions, wi...

The aim was to investigate the effect of Micronised Purified Flavonoid Fraction (MPFF; Daflon® 500mg, Laboratoires Servier, France) versus placebo, on pain and quality of life (QoL) in patients with symptomatic Chronic Venous Disease (CVD). A large randomised, double-blind, placebo-controlled, parallel-group study was conducted to evaluate treatmen...

Venous and arterial disease probably share a number of common risk factors. From the pathophysiological point of view a similar triggering mechanism was proposed for atherosclerosis and venous disease: subclinical inflammation. Life-threatening thrombotic events may also go through similar pathways in both entities and the culprit is probably dysfu...

The diagnostic approach to vascular anomalies should include the distinction between vascular tumors (i.e. hemangiomas) and congential vascular malformations (CVMs). This step is based more on history and clinical examination rather than on instrumental evaluation. In children Duplex ultrasound and histology can be helpful to separate hypervasulari...

This paper is the review of the Consensus Document on Intermittent Claudication of the Central European Vascular Forum (CEVF), published in 2008, and and shared with the North Africa and Middle East Chapter of International Union of Angiology and the Mediterranean League of Angiology and Vascular Surgery. The Document presents suggestions for gener...

Peripheral arterial disease (PAD) is one of the most frequent manifestations of atherosclerosis and is associated with atherosclerosis in the coronary and carotid arteries, leading to a highly increased incidence of cardiovascular events. Major risk factors of PAD are similar to those that lead to atherosclerosis in other vascular beds. However, th...

Recently, new knowledge has been gained in the field of both chronic and acute venous disease that has an impact on the care of patients with these conditions. The incidence of chronic venous disease has been shown to be globally high, in both industrialized and developing countries. The rate of the most severe cases with an advanced stage of venou...

Sulodexide is a compound belonging to the group of glycosaminoglycans (together with heparins). In comparison with other glycosaminoglycans, sulodexide has stronger antithrombotic properties and a lower risk of bleeding, and unlike heparin, it can be administered both parenterally and orally. Multiple pharmacodynamic eff ects of the preparation hav...

Objectives: It has been demonstrated that the deleterious effect of smoking on the cardiovascular system is mediated through a decrease in protective HDL cholesterol. In addition, women are more sensitive to the negative effects of smoking, although the exact mechanism underlying this phenomenon is currently unknown. In this study, we evaluated wh...

The association between chronic venous disease (CVD) and atherosclerosis has been intensively investigated. Because data regarding cardiovascular disease in women are sparse, we evaluated the potential association between the symptoms of CVD and cardiovascular risk factors including markers of preclinical atherosclerosis in middle-aged women. A que...

Patients with claudication have a high cardiovascular risk and, foremost, require an introduction of the appropriate procedures to stop the progression of the disease and to prevent cardiovascular events as if these were patients with a coronary or cerebrovascular disease. To manage the claudication-associated complaints, surgery and endovascular r...

The MOET ICHDK (Monitoring of an Effective Therapy of Peripheral Arterial Disease, MOET PAD) project had established collaboration between general practitioners and angiologists in the area of PAD - both symptomatic and asymptomatic - across the Czech Republic and emphasised the need for comprehensive care for patients with PAD with respect to athe...

The aim of the study was to assess the regression rate of persistent echogenic masses in patients with idiopathic deep venous thrombosis (DVT) who were after initial 6 months randomized to long-term anticoagulation treatment or to discontinuation of anticoagulation. We followed 168 patients with idiopathic DVT for two years since diagnosis. After 6...

Background: The aim of this pilot study was to evaluate the success rate of percutaneous radiofrequency thermolesion in the treatment of ischemic upper limb conditions. Methods: Twenty selected patients underwent radiofrequency thermolesion of the upper thoracic sympathetic chain using controlled lesion at the level of T2 and T3. The success rate o...

This first Czech version of guidelines formulated by the working group of mentioned medical associations is based on current literature and international guidelines. They are aimed mainly on clinical medicine and on incorporation of this treatment into the health care system according to WHO recommendations. They should serve to the treatment of to...

Epidemiological data show that standard compression therapy for leg ulceration in chronic venous insufficiency (CVI) often fails to effectively improve patients' condition. This study assesses the contribution of Daflon 500 mg added to conventional therapy in the healing of hypostatic ulcers of CVI patients. Patients of about 65 years were included...

The authors present the technique of chemical lumbar sympathectomy by an anatomically new medial transdiscal approach. On a group of 80 operations they analyze the indication criteria, complications and results of this method. They compare the percutaneous technique of severing of the sympathetic nerve with the classical surgical approach. In 41 pa...

2. rozš. a přeprac. vyd.

The authors present in their paper the possibility of thoracoscopic thoracic sympathectomy as the method of choice for reoperation of the thoracic sympathetic nerve 14 years after classical surgical upper chest sympathectomy, as the original effect had receded. They mention the possibility of reoperation of the sympathetic nerve with a subsequent f...

1. Conservative therapy of critical limb ischaemia either supports the effect of revascularisation procedures (thrombolysis, PTA, surgical reconstruction) or is employed in cases where instrumental intervention is no more possible. As a longterm control programme, the conservative approach reduces the number of local and general vascular complicati...

To establish whether recurrences of varicose veins following surgery are related to their preoperative extent.

Medical therapy of CLI is only indicated in patients unsuitable for vascular reconstruction or angioplasty. The approach includes early detection of subjects at risk, observation of physiological principles of therapy and long-term control. The finding of ankle pressure < or = 50 mmHg is of particular value in early detection because of high specif...

The effect of 7-mono-hydroxyethylrutoside and its combination with acetylsalicylic acid was evaluated in a controlled clinical trial, performed in 105 patients with obliterative atherosclerosis of the lower limbs, and using non-invasive measurement of peripheral haemodynamic parameters--blood flow during reactive hyperaemia and ankle systolic blood...

The capillary filtration coefficient (CFC) in the forearm was followed in patients with essential hypertension and compared with controls, using the method of venous occlusion plethysmography and simultaneous recording of intravenous pressure in the measured segment of the extremity. Arterial blood-pressure was obtained in the contralateral arm by...

The capillary filtration coefficient (CFC) in the forearm was followed in patients with essential hypertension and compared with controls, using the method of venous occlusion plethysmography and simultaneous recording of intravenous pressure in the measured segment of the extremity. Arterial blood-pressure was obtained in the contralateral arm by...

photoplethysmographic measurements were carried out in 61 limbs with angiographically documented obliterating atherosclerosis (OA) and in 72 limbs with OA. The distance P was measured between the ascending and descending limbs of the pulse wave at the border of the upper and middle thirds of the amplitude. To standardize the measurements the P valu...

The transcapillary escape rate of albumin was studied in 24 juvenile hypertensives and in 13 controls on the basis of the radioactivities determined in the blood during 60 min after i.v. injection of human 131I-labelled albumin. In addition, the central haemodynamics of all hypertensive subjects was examined at rest and during exercise. The patient...

Capillary functions in humans can be assessed by measuring capillary filtration and capillary diffusion capacity in the extremities. Examination of these two parameters supplements each other and renders it possible to evaluate capillary function from different aspects. As an example of practical use may serve the findings in patients with oblitera...

The authors describe two types of test. Their aim was to verify the therapeutic potency of drugs used in the treatment of chronic venous disorders. The tests were carried out using both a single prescription and using successive prescriptions. The results showed that with strict clinical surveillance, phlebotropic drugs had definite therapeutic eff...

In female patients with idiopathic oedema the capillary filtration rate and capillary diffusion capacity for I-131 were studied in lower-limb muscles and subcutaneous tissue. The capillary filtration rate averaged 0.276 ml/100 ml per minute, and the capillary diffusion capacity for I-131 averaged 9.8 mol/(mol/ml) per 100 g per minute in the gastroo...

The results obtained by analysis of pulse waves by means of Fourier harmonics in healthy subjects and patients with aortic insufficiency show good agreement between input impedance of the aorta and the initial segment of the femoral bed in both groups. This means that in this region there is no marked increase in impedance, which provides a favoura...

The rate of capillary filtration after 5 minutes' ischaemia of the lower limbs was studied in man by the venous occlusive plethysmography method. The measured values were 3 times lower on an average than the control values. Comparison of the plethysmographic curves with isotope recordings after the intravenous administration of In-113m shows that v...

The rate of capillary filtration in the lower limbs after hydroxyethylrutosides administered in various doses and by different routes was studied in patients with chronic venous insufficiency. Capillary filtration rate decreased immediately after intravenous and from 55 to 85 minutes after oral administration, depending on the dose. The slow-releas...

The study was aimed at evaluating the effect of pyridinolcarbamate in patients with atherosclerosis obliterans of the lower limbs. A single intravenous administration of the drug did not induce changes in resting blood flow, but elicited a significant decline in capillary filtration rate. In a double-blind cross-over trial patients reported a signi...

With Fourier's method, the authors analyzed the pulse wave in 50 lower limbs of healthy individuals and in 78 lower limbs having obliterating arteriosclerosis previously demonstrated arteriographically. To detect the pulse wave, they employed photoplethysmography. The results obtained showed a pronounced 'damping effect' of certain amplitudes of th...

The ¹²⁵I-fibrinogen uptake test was used in rabbits after the production of thrombosis in the marginal ear vein. The uptake was very similar with thrombosis produced by irritants, thrombin as well as with inflammation without thrombosis. The ¹³¹I-albumin accumulated under these conditions to the same exten or even more than <s...

1. Capillary diffusion capacity (CDC) for 131I in gastrocnemius muscle was investigated by the tissue clearance method of Lassen (1967) in thirty-three patients with various degrees of impairment of renal function. 2. The mean CDC in uraemic patients [16·9 mol/(mol/ml)/100 g/min] was significantly higher than in the control group [7·1 mol/(mol/ml)...

The beneficial effect of hydroxyethylrutosides (HR) after oral administration for two months was shown in a double blind trial. There was a decrease in the symptoms of heavy legs, muscle cramps, tenderness; and objectively, there was a decrease in formation of edema. Further studies are needed to evaluate how long the effect lasts and what is a min...

The effects have been investigated of a single intravenous dose of 1000 mg 0-(-hydroxyethyl)-rutosides (HR), (Venoruton Zyma) on the blood flow (BF), venous distensibility (VD), capillary filtration coefficient (CFC) and capillary diffusion capacity (CDC) in 27 patients with chronic venous insufficiency, and 9 subjects without cardiovascular diseas...

We studied the effect of 0-(-hydroxyethyl)-rutosides (HR), (Venoruton, Zyma) upon resting blood flow, venous distensibility and capillary filtration coefficient in the calf in 5 women with idiopathic oedema. — During 60 min of i.v. infusion of 1000 mg HR, the value of the capillary filtration coefficient which is the measure of the size of the capi...

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1. vyd. Sborník přednášek z 11. angiologického symposia s postgraduální tematikou konaného v červnu roku 2005 ve Valticích pořádaného Českou angiologickou společností