Aim of study: Aim of this study is to defi ne an entity of unruptured symptomatic AAA, to examine... more Aim of study: Aim of this study is to defi ne an entity of unruptured symptomatic AAA, to examine the infl uence of timing of the surgical treatment and to analyze the results of the treatment of unruptured symptomatic AAA in acute expansion. Materials and method: The study is designed as retrospective analysis of 390 operatively treated patients in the last fi ve years at the Clinics of Vascular Surgery in Novi Sad. All patients were grouped into four categories: elective operative surgical treatment, surgical treatment 24 hours after the admission through the Department of Urgent Surgery with an urgent CT diagnosis (in fi rst 2 hours), surgical treatment within 24 hours since the admission through the Department of Urgent Surgery with an urgent CT diagnosis (in fi rst 2 hours) and immediate surgical treatment of ruptured AAA. Results: In the period from Jan 1, 2005 to Dec 31, 2009, 390 patients with AAA were operatively treated. 89 patients had ruptured AAA, 52 were operated 24 hours after the urgent admission, 18 patients were operated in the fi rst 24 hours after the urgent admission and 231 patients were planned for elective surgery. Mortality rates between the groups were asfollows: elective surgery-5.1 %, patients operated 24 hours after the urgent admission 7.2 %, patients operated in the fi rst 24 hours after the urgent admission 23 %, and patients who had ruptured AAA 34 %. Conclusion: Considering the obtained data, it can be concluded that the treatment of unruptured symptomatic AAA is related to a higher risk of postoperative mortality in relation to an elective surgery. Moreover, surgical treatment in the fi rst 24 hours after the urgent admission of unruptured symptomatic AAA has higher rate of mortality and morbidity compared to surgical treatment 24 hours after the urgent admission of the patients, so we can conclude that the early (semi) elective surgery is a method of choice for the treatment of unruptured symptomatic AAA in acute expansion (Tab. 2, Fig. 2, Ref. 21).
Extracranial internal carotid artery aneurysms are rare manifestations 1,2 but have the potential... more Extracranial internal carotid artery aneurysms are rare manifestations 1,2 but have the potential for a fatal complication as result of embolization, rupture, and local compression. We describe a 62-year-old obese woman with a history of hypertension, hyperlipidemia, and moderate mitral and aortic valve regurgitation. She had sustained a stroke 4 years earlier that had completely resolved. She presented in our hospital with a pulsating cervical mass. A 64-slice computed angiography of the carotid artery and circle of Willis was performed (Cover, A). The diagnosis of giant aneurysm of the extracranial left internal carotid artery was confirmed, with dimensions of 6 ϫ 6 cm, bulging toward the outside. Kinking with significant stenosis of the right internal carotid artery was also discovered. The patient was placed under general anesthesia, and immediate surgery was performed on the left side, with aneurysm dissection from the surrounding structures and complete aneurysm resection. This was followed by autologous saphenous vein graft interposition between the distal extracranial part of left internal carotid artery and the left common carotid artery (Video, online only). After the uneventful operation, the patient was extubated 3 hours later, with no neurologic complications. Postoperative 64-slice computed angiography (B and C) showed excellent repair. The patient was discharged home the next day, and her 6-month follow-up examination was normal.
Introduction. This research has been aimed at determining whether incomplete Circle of Willis in ... more Introduction. This research has been aimed at determining whether incomplete Circle of Willis in patients with significant extracranial carotid stenosis is associated with a higher incidence of neurological symptomatology and/or ischemic cerebral lesions. Material and Methods. The research was conducted as a prospective study which comprised 211 patients who underwent surgical treatment of extracranial carotid disease at the Department of Vascular Surgery in Novi Sad and 102 patients in the control group. Each patient underwent preoperative magnetic resonance imaging and magnetic resonance angiography with visualization of cerebral parenchyma, extracranial and intracranial cerebral circulation. Assessment of Circle of Willis morphology was performed by 3D time-of-flight magnetic resonance angiogram sequence analysis. The patients were divided into two groups: group I - the patients with complete Circle of Willis and group II - the patients with incomplete Circle of Willis i.e. with ...
Introduction. Due to the ever-present lack of kidney transplant grafts, more and more organs obta... more Introduction. Due to the ever-present lack of kidney transplant grafts, more and more organs obtained from the so-called ?marginal donors? group are accepted, which can provide suboptimal effect of transplantation, depending on their characteristics and/or implantation techniques. Case report. We presented a case with successful variation of kidney position with modified approach of kidney transplantation from an infant to an adult female patient with normal postoperative recovery. Urethral anastomosis was performed without antireflux procedure and this has not led to the development of reflux disease at an early stage. Conclusion. The position of a pair of kidneys proved to be satisfactory despite the growth of the kidney to the expected size and relatively small pelvis. There were no problems with venous stasis and kidney function from the very beginning was good.
Accepted papers are articles in press that have gone through due peer review process and have bee... more Accepted papers are articles in press that have gone through due peer review process and have been accepted for publication by the Editorial Board of the Serbian Archives of Medicine. They have not yet been copy-edited and/or formatted in the publication house style, and the text may be changed before the final publication. Although accepted papers do not yet have all the accompanying bibliographic details available, they can already be cited using the year of online publication and the DOI, as follows: the author’s last name and initial of the first name, article title, journal title, online first publication month and year, and the DOI; e.g.: Petrović P, Jovanović J. The title of the article. Srp Arh Celok Lek. Online First, February 2017. When the final article is assigned to volumes/issues of the journal, the Article in Press version will be removed and the final version will appear in the associated published volumes/issues of the journal. The date the article was made availabl...
This study examined 191 patients with 'reversed' and 99 patients with 'in situ' femoro-popliteal ... more This study examined 191 patients with 'reversed' and 99 patients with 'in situ' femoro-popliteal bypass technique. There were 85 diabetic patients (44.5%) in the group with 'reversed' bypass, and 43 patients (43.43%) in the 'in situ' group. There were 152 (79.68%) smokers in the 'reversed' bypass group, and 80 (80.8%) in the 'in situ' group. The graft patency was confirmed immediately after operation using CW Doppler and then followed up after 1, 6, l2 months and annually thereafter. The statistical analysis was performed using Pearsons chisquare test, Fischer's test and 'Life table' statistic methods. The patients were followed from 3 to 10 yr after surgery. 'In situ' bypass showed better patency than the 'reversed' bypass technique but only in the second and tenth follow-up year (PϽ0.05). Also, 'in situ' bypass proved to be better than 'reversed' only in patients with one patent crural artery (PϽ0.01). Diabetes and preoperative smoking did not significantly affect late patency regarding this technique (P>0.05). However, continuous smoking after the operation significantly decreased late patency rate in both groups of patients (PϽ0.01). There was no significant difference in the early thrombectomy rate between groups with 'reversed' and 'in situ' bypasses (P>0.05). The early thrombectomy, however, significantly reduced late patency rate in both groups (PϽ0.01). Therefore we suggest 'in situ' bypass in cases with poor run off, small-calibre vein and 'long' bypass. Also, we consider important more frequent physical and Doppler ultrasonographic control in patients who had early thrombectomy.
Introduction. It has been established that infrainguinal occlusive disease, type III peripheral o... more Introduction. It has been established that infrainguinal occlusive disease, type III peripheral obliterative arterial disease (POAD), is more common in diabetics than in non-diabetics. It is presumeable that after surgical treatment of this arterial segment diabetics develop more complications and higher mortality rate than nondiabetics. The aim of this study was to analyze the results of reconstructive surgical treatment of diabetic and non-diabetic patients with type III PAOD. Material and Methods. In the period 1999-2003, 118 patients with Type III PAOD underwent surgery at the Vascular Surgery Clinic in Novi Sad. They were divided into two groups: group I included 51 nondiabetic patients, and group II 67 diabetic patients. Subgroups were formed based on the clinical status. Differences were established in IVa, (46 diabetics and 4 non-diabetics) and IVb stage (11 diabetic and 30 non-diabetic patients). Results. Statistical data analysis using X2 test showed a statistical differen...
Introduction. Acute critical lower limb ischemia refers to the state of severely impaired vitalit... more Introduction. Acute critical lower limb ischemia refers to the state of severely impaired vitality of lower limbs due to acute occlusion of arterial blood vessel by a thrombus or emboli. Surgical revascularization in the first 6-12 hours after the onset of symptoms gives the best results. However, a high mortality rate and probability of limb loss make this problem more debatable, and can be related with associated diseases. Material and Methods. This research included 95 patients who had been operated within the first 12 hours after the onset of symptoms of critical limb ischemia. We collected the following data: age and sex of patients, etiology of limb ischemia, type of operation, associated diseases and outcome of treatment. Results and Discussion. Most of the patients were 70 to 80 years old, both sexes being equally represented. There was significantly more arterial embolism (70%) than thrombosis on the prior arterial lesion. Most of the embolizations were treated with Fogarty...
An aneurysm has been defined as a permanent local dilatation of the diameter of an artery by at l... more An aneurysm has been defined as a permanent local dilatation of the diameter of an artery by at least 50% of its normal value. A splenic artery aneurysm is most frequently a visceral artery aneurysm and clinically it is usually asymptomatic but potentially life-threatening at the same time, with the incidence of its rupturing being 2-10% and then the mortality rate ranges from 20 to 36%. A 51-year-old female patient was admitted to the Department of Vascular and Transplantation Surgery in Novi Sad having been found to have a big splenic artery aneurysm during the ultrasound examination of her abdomen after cholecystectomy. The additional diagnostic procedure - computerized tomography of the abdomen with i.v contrast subtraction angiography-confirmed the splenic artery aneurysm to have the diameter of 5 cm and therefore the elective surgical treatment was indicated after the preoperative preparation and risk assessment. The aneurysm was exposed through Chevron incision, and the detai...
Background/Aim. A certain percentage of patients with asymptomatic carotid stenosis have an unsta... more Background/Aim. A certain percentage of patients with asymptomatic carotid stenosis have an unstable carotid plaque. For these patients it is possible to register by modern imaging methods the existence of lesions of the brain parenchyma - the silent brain infarction. These patients have a greater risk of ischemic stroke. The aim of this study was to analyze the connection between the morphology of atherosclerotic carotid plaque in patients with asymptomatic carotid stenosis and the manifestation of silent brain infarction, and to analyze the influence of risk factors for cardiovascular diseases on the occurrence of silent brain infarction and the morphology of carotid plaque. Methods. This retrospective study included patients who had been operated for high grade (> 70%) extracranial atherosclerotic carotid stenosis at the Clinic for Vascular and Transplantation Surgery of the Clinical Center of Vojvodina over a period of 5 years. The patients analyzed had no clinical manifestat...
An intra-operative cell salvage machine, commonly known as a "cell saver", aspirates, w... more An intra-operative cell salvage machine, commonly known as a "cell saver", aspirates, washes, and filters patient's blood during an operation so that the blood can be returned to the patient's circulation instead of being discarded. This procedure could significantly reduce the risks related to the use of allogeneic blood and blood products in surgery. The aim of this study was to analyse the influence of intra-operative cell salvage on reducing the need for allogeneic blood in patients with asymptomatic infrarenal abdominal aortic aneurysm undergoing elective repair of the aneurysm. We retrospectively collected data from the clinical records of patients who underwent elective infrarenal abdominal aortic aneurysm repair. Two groups were formed: the "cell saver" group, in which intra-operative cell salvage was used, and the control group, in which a cell saver was not used. Thirty patients underwent abdominal aortic aneurysm repair with the use of a cell s...
Introduction. An arteriovenous fistula (AVF) is an abnormal connection between an artery and a ve... more Introduction. An arteriovenous fistula (AVF) is an abnormal connection between an artery and a vein which may result from traumatic injury or may occur as congenital abnormality. Stent graft repair through arteriovenous fistula could lead to complications. Case report. Endovascular stent graft repair in a 23-year-old patient with posttraumatic superficial femoral arteriovenous fistula was performed to cover a fistula. During the procedure the device migrated through the fistula into the femoral vein. Due to eventual risk of migration to the heart, a prompt decision was made to fix the stent graft with three puncture needles in the common femoral vein region under fluoroscopy guidance. The vascular surgeon was called to perform open surgery. Conclusions. The presented way of treating this rare complication in an extreme and uncommon situation is very efficient, safe and inexpensive.
Drowning is a leading preventable cause of unintentional morbidity and mortality. The dominant pa... more Drowning is a leading preventable cause of unintentional morbidity and mortality. The dominant pathophysiological mechanism of drowning includes the development of acute hypoxia. The rescue procedure of a drowning person includes careful pulling the victim out of the water, examination, maintenance of the airways passable and urgent transfer to hospital. The first and most important treatment option of a drowning victim is the provision of ventilation which increases the chances of survival. As soon as the unresponsive victim is removed from the water, the lay rescuer should immediately begin chest compressions and provide cycles of ventilations and compressions. Some recent investigations have revealed that exterior compression of the chest is a necessary measure even in a situation when bystanders cannot provide airway. It is recommended to train bystanders to provide basic life support and apply automated external defibrillator in a drowning person whenever indicated and as early...
A certain percentage of patients with asymptomatic carotid stenosis have an unstable carotid plaq... more A certain percentage of patients with asymptomatic carotid stenosis have an unstable carotid plaque. For these patients it is possible to register the existence of lesions of the brain parenchyma - the silent brain infarction. These patients have a greater risk of ischemic stroke by modern imaging methods. The aim of this study was to analyze the connection between the morphology of atherosclerotic carotid plaque in patients with asymptomatic carotid stenosis and the manifestation of silent brain infarction, and to analyze the influence of risk factors for cardiovascular diseases on the occurrence of silent brain infarction and the morphology of carotid plaque. This retrospective study included patients who had been operated for high grade (> 70%) extracranial atherosclerotic carotid stenosis at the Clinic for Vascular and Transplantation Surgery of the Clinical Center of Vojvodina over a period of 5 tears. The patients analyzed had no clinical manifestation of cerebrovascular insufficiency of the carotid artery territory up to the time of operation. The classification of carotid plaque morphology was carried out according to the Gray-Weale classification, after which all the types were subcategorized into two groups: stable and unstable. Brain lesions were verified using preoperative imaging of the brain parenchyma by magnetic resonance. We analyzed ipsilateral lesions of the size > or = 3 mm. Out of 201 patients 78% had stable plaque and 22% unstable one. Unstable plaque was prevalent in the male patients (male/female ratio = 24.8% : 17.8%), but without a statistically significant difference (p > 0.05). The risk factors (hypertension, nicotinism, hyperlipoproteinemia, and diabetes mellitus) showed no statistically significant impact on carotid plaque morphology and the occurrence of silent brain infarction. Silent brain infarction was detected in 30.8% of the patients. Unstable carotid plaque was found in a larger percentage of patients with silent brain infarction (36.4% : 29.3%) but without a significant statistical difference (p > 0.05). Even though silent brain infarction is more frequent in patients with unstable plaque of carotid bifurication, the difference is of no statistical significance. The effects of the number and type of risk factors bear no statistical significance on the incidence of morphological asymptomatic carotid plaque.
Acute critical lower limb ischemia refers to the state of severely impaired vitality of lower lim... more Acute critical lower limb ischemia refers to the state of severely impaired vitality of lower limbs due to acute occlusion of arterial blood vessel by a thrombus or emboli. Surgical revascularization in the first 6-12 hours after the onset of symptoms gives the best results. However, a high mortality rate and probability of limb loss make this problem more debatable, and can be related with associated diseases. This research included 95 patients who had been operated within the first 12 hours after the onset of symptoms of critical limb ischemia We collected the following data: age and sex of patients, etiology of limb ischemia, type of operation, associated diseases and outcome of treatment. Most of the patients were 70 to 80 years old, both sexes being equally represented. There was significantly more arterial embolism (70%) than thrombosis on the prior arterial lesion. Most of the embolizations were treated with Fogarty balloon catheter embolectomy (98%); however, a great number ofarterial thrombosis demanded more complex "inflow" and "outflow" ensuring procedures such as thromboendarterectomy and bypass (33%). The performed surgical procedures showed no statistical differences when final outcome was analyzed. Amputation had to be performed in about 3% of the patients and all of them were diabetics. Mortality rate in this research was 10.5% and 7/10 with this outcome had severe form of chronic myocardiopathy and metabolic decompensation. Acute critical lower limb ischemia should be treated surgically as soon as possible. Negative outcomes are associated with comorbidity and general condition of the patient.
Sazetak -Aneurizma je po definiciji trajno lokalno prosirenje dijametra arterije za 50% od uobica... more Sazetak -Aneurizma je po definiciji trajno lokalno prosirenje dijametra arterije za 50% od uobicajenog dijametra posmatrane arterije. Aneurizma slezinske. tj, splenicne arterije (a. splenica) naicesca je visceralna arterijska aneurizma. Klinicki je najcesce asimptornatska, ali istovrerneno potencijalno zivotno ugrozavajuca, sa incidencijorn ruptuiranja 2-10%; u tom slucaju stopa mortaliteta krece se 20-36%. Pacijentkinja stara 51 godinu primljcna je na Kliniku za vaskularnu i transplantaeionu hirurgiju u Novorri Sadu nakon detekeije vel ike aneurizrne a. splenicae prilikom ultrasonografskog pregleda abdomena nakon holecistektomije. Dodatnom dijagnostikom -kompjuterizovanorn tomografijom abdomena sa i. v kontrastom digitalnom suptrakcionom angiografijorn potvrdena je aneurizma a. splenicae precnika 5 em, te je nakon preoperativne pripreme i procene rizika. indikovano elektivno operativno hirursko lecenje. Primenjen je hirurski pristup prosirenom levom supkostalnom incizijom po Chevronu, a detaljna hirurska eksploracija sledi otvaranjem omentalne burze. Nakon verifikacije istanjenog zida aneurizme sledi aneurizmektomija i rekonstrukcija a. splenicae termino-terminalnom anastomozom. Intraoperativno uzete su biopsije jetre i aneurizmatske vrece. Patohistoloski nalaz potvrduje aterosklerotsku etiologiju aneurizme, a kako postoperativni tok protice uredno, bolesniea se otpusta na dalje kucno lecenje osmi postoperativni dan. Kljucne reei: Aneurizma: Slezinska arterija; Dijagnoza: Elektivne hirurske procedure: Zen ski pol: Srednjc god inc Summary -An aneurysm has been defined as a permanent local dilatation ofthe diameter ofan artery by at least 5()% of its normal value. A splenic artery aneurysm is most frequently a visceral artery aneurysm and clinically it is usually asymptomatic but potentially life-threatening at the same time. with the incidence of its rupturing being 2-1()% and then the mortality rate rangesfrom 2() to 36%. A 5 J-year-old female patient was admitted to the Department of Vascular and Transplantation Surgery in Novi Sad having been found to have a big splenic artery aneurysm during the ultrasound examination of her abdomen after cholecystectomy. The additional diagnostic procedure -computerized tomography of the abdomen with i. v contrast subtraction angiography -confirmed the splenic artery aneurysm to have the diameter of5 em and therefore the elective surgical treatment was indicated after the preoperative preparation and risk assessment. The aneurysm was exposed through Chevron incision, and the detailed surgical exploration was done after the omental bursa had been opened. The aneurysmectomy and the reconstruction of the splenic artery by the termino-terminal anastomosis were performed after the weakening of the wall had been verified. The biopsies of the liver and the aneurysmal sac were done during the surgery. The pathohistologicalfinding confirmed the atherosclerotic etiology ofthe aneurysm. Since the postoperative course was normal, the patient 1vaS discharged on the eighth postoperative day.
True aneurysms of the extracranial internal carotid artery are rare lesions. Surgical treatment i... more True aneurysms of the extracranial internal carotid artery are rare lesions. Surgical treatment is considered to be the best therapeutic option. However, the use of the intraluminal shunt remains controversial. We reported a case of a giant extracranial internal carotid artery aneurysm treated by reconstructive surgery. A 76-year-old woman was referred with a pulsatile mass inside her mouth, associated with dizziness and dysarthria. There was no history of cerebrovascular symptoms, neck pain, or cervical trauma. A magnetic resonance scan showed a 45 mm aneurysm of the internal carotid artery (ICA), and kinking of ICA. Angiography demonstrated a saccular ICA aneurysm, with a lengthening and tortuosity of the ICA. The aneurysm and the carotid artery branches were easily exposed through a standard anterior cervical incision. After resection of the aneurysm, a Javid shunt was inserted between the common and internal carotid arteries, and end-to-end repair of ICA was easily performed due to ICA redundancy. The aneurysm was of atherosclerotic origin. Four months after the operation, the patient showed a complete recovery from peripheral neurological deficit. Our results show that surgical reconstruction is a satisfactory therapeutic choice in the management of extracranial carotid artery aneurysms in order to avoid rupture, thromboembolism and cerebrovascular insufficiency. To date, there has been little experience with endoluminal exclusion techniques and the long-term effectiveness is still uncertain.
Aim of study: Aim of this study is to defi ne an entity of unruptured symptomatic AAA, to examine... more Aim of study: Aim of this study is to defi ne an entity of unruptured symptomatic AAA, to examine the infl uence of timing of the surgical treatment and to analyze the results of the treatment of unruptured symptomatic AAA in acute expansion. Materials and method: The study is designed as retrospective analysis of 390 operatively treated patients in the last fi ve years at the Clinics of Vascular Surgery in Novi Sad. All patients were grouped into four categories: elective operative surgical treatment, surgical treatment 24 hours after the admission through the Department of Urgent Surgery with an urgent CT diagnosis (in fi rst 2 hours), surgical treatment within 24 hours since the admission through the Department of Urgent Surgery with an urgent CT diagnosis (in fi rst 2 hours) and immediate surgical treatment of ruptured AAA. Results: In the period from Jan 1, 2005 to Dec 31, 2009, 390 patients with AAA were operatively treated. 89 patients had ruptured AAA, 52 were operated 24 hours after the urgent admission, 18 patients were operated in the fi rst 24 hours after the urgent admission and 231 patients were planned for elective surgery. Mortality rates between the groups were asfollows: elective surgery-5.1 %, patients operated 24 hours after the urgent admission 7.2 %, patients operated in the fi rst 24 hours after the urgent admission 23 %, and patients who had ruptured AAA 34 %. Conclusion: Considering the obtained data, it can be concluded that the treatment of unruptured symptomatic AAA is related to a higher risk of postoperative mortality in relation to an elective surgery. Moreover, surgical treatment in the fi rst 24 hours after the urgent admission of unruptured symptomatic AAA has higher rate of mortality and morbidity compared to surgical treatment 24 hours after the urgent admission of the patients, so we can conclude that the early (semi) elective surgery is a method of choice for the treatment of unruptured symptomatic AAA in acute expansion (Tab. 2, Fig. 2, Ref. 21).
Extracranial internal carotid artery aneurysms are rare manifestations 1,2 but have the potential... more Extracranial internal carotid artery aneurysms are rare manifestations 1,2 but have the potential for a fatal complication as result of embolization, rupture, and local compression. We describe a 62-year-old obese woman with a history of hypertension, hyperlipidemia, and moderate mitral and aortic valve regurgitation. She had sustained a stroke 4 years earlier that had completely resolved. She presented in our hospital with a pulsating cervical mass. A 64-slice computed angiography of the carotid artery and circle of Willis was performed (Cover, A). The diagnosis of giant aneurysm of the extracranial left internal carotid artery was confirmed, with dimensions of 6 ϫ 6 cm, bulging toward the outside. Kinking with significant stenosis of the right internal carotid artery was also discovered. The patient was placed under general anesthesia, and immediate surgery was performed on the left side, with aneurysm dissection from the surrounding structures and complete aneurysm resection. This was followed by autologous saphenous vein graft interposition between the distal extracranial part of left internal carotid artery and the left common carotid artery (Video, online only). After the uneventful operation, the patient was extubated 3 hours later, with no neurologic complications. Postoperative 64-slice computed angiography (B and C) showed excellent repair. The patient was discharged home the next day, and her 6-month follow-up examination was normal.
Introduction. This research has been aimed at determining whether incomplete Circle of Willis in ... more Introduction. This research has been aimed at determining whether incomplete Circle of Willis in patients with significant extracranial carotid stenosis is associated with a higher incidence of neurological symptomatology and/or ischemic cerebral lesions. Material and Methods. The research was conducted as a prospective study which comprised 211 patients who underwent surgical treatment of extracranial carotid disease at the Department of Vascular Surgery in Novi Sad and 102 patients in the control group. Each patient underwent preoperative magnetic resonance imaging and magnetic resonance angiography with visualization of cerebral parenchyma, extracranial and intracranial cerebral circulation. Assessment of Circle of Willis morphology was performed by 3D time-of-flight magnetic resonance angiogram sequence analysis. The patients were divided into two groups: group I - the patients with complete Circle of Willis and group II - the patients with incomplete Circle of Willis i.e. with ...
Introduction. Due to the ever-present lack of kidney transplant grafts, more and more organs obta... more Introduction. Due to the ever-present lack of kidney transplant grafts, more and more organs obtained from the so-called ?marginal donors? group are accepted, which can provide suboptimal effect of transplantation, depending on their characteristics and/or implantation techniques. Case report. We presented a case with successful variation of kidney position with modified approach of kidney transplantation from an infant to an adult female patient with normal postoperative recovery. Urethral anastomosis was performed without antireflux procedure and this has not led to the development of reflux disease at an early stage. Conclusion. The position of a pair of kidneys proved to be satisfactory despite the growth of the kidney to the expected size and relatively small pelvis. There were no problems with venous stasis and kidney function from the very beginning was good.
Accepted papers are articles in press that have gone through due peer review process and have bee... more Accepted papers are articles in press that have gone through due peer review process and have been accepted for publication by the Editorial Board of the Serbian Archives of Medicine. They have not yet been copy-edited and/or formatted in the publication house style, and the text may be changed before the final publication. Although accepted papers do not yet have all the accompanying bibliographic details available, they can already be cited using the year of online publication and the DOI, as follows: the author’s last name and initial of the first name, article title, journal title, online first publication month and year, and the DOI; e.g.: Petrović P, Jovanović J. The title of the article. Srp Arh Celok Lek. Online First, February 2017. When the final article is assigned to volumes/issues of the journal, the Article in Press version will be removed and the final version will appear in the associated published volumes/issues of the journal. The date the article was made availabl...
This study examined 191 patients with 'reversed' and 99 patients with 'in situ' femoro-popliteal ... more This study examined 191 patients with 'reversed' and 99 patients with 'in situ' femoro-popliteal bypass technique. There were 85 diabetic patients (44.5%) in the group with 'reversed' bypass, and 43 patients (43.43%) in the 'in situ' group. There were 152 (79.68%) smokers in the 'reversed' bypass group, and 80 (80.8%) in the 'in situ' group. The graft patency was confirmed immediately after operation using CW Doppler and then followed up after 1, 6, l2 months and annually thereafter. The statistical analysis was performed using Pearsons chisquare test, Fischer's test and 'Life table' statistic methods. The patients were followed from 3 to 10 yr after surgery. 'In situ' bypass showed better patency than the 'reversed' bypass technique but only in the second and tenth follow-up year (PϽ0.05). Also, 'in situ' bypass proved to be better than 'reversed' only in patients with one patent crural artery (PϽ0.01). Diabetes and preoperative smoking did not significantly affect late patency regarding this technique (P>0.05). However, continuous smoking after the operation significantly decreased late patency rate in both groups of patients (PϽ0.01). There was no significant difference in the early thrombectomy rate between groups with 'reversed' and 'in situ' bypasses (P>0.05). The early thrombectomy, however, significantly reduced late patency rate in both groups (PϽ0.01). Therefore we suggest 'in situ' bypass in cases with poor run off, small-calibre vein and 'long' bypass. Also, we consider important more frequent physical and Doppler ultrasonographic control in patients who had early thrombectomy.
Introduction. It has been established that infrainguinal occlusive disease, type III peripheral o... more Introduction. It has been established that infrainguinal occlusive disease, type III peripheral obliterative arterial disease (POAD), is more common in diabetics than in non-diabetics. It is presumeable that after surgical treatment of this arterial segment diabetics develop more complications and higher mortality rate than nondiabetics. The aim of this study was to analyze the results of reconstructive surgical treatment of diabetic and non-diabetic patients with type III PAOD. Material and Methods. In the period 1999-2003, 118 patients with Type III PAOD underwent surgery at the Vascular Surgery Clinic in Novi Sad. They were divided into two groups: group I included 51 nondiabetic patients, and group II 67 diabetic patients. Subgroups were formed based on the clinical status. Differences were established in IVa, (46 diabetics and 4 non-diabetics) and IVb stage (11 diabetic and 30 non-diabetic patients). Results. Statistical data analysis using X2 test showed a statistical differen...
Introduction. Acute critical lower limb ischemia refers to the state of severely impaired vitalit... more Introduction. Acute critical lower limb ischemia refers to the state of severely impaired vitality of lower limbs due to acute occlusion of arterial blood vessel by a thrombus or emboli. Surgical revascularization in the first 6-12 hours after the onset of symptoms gives the best results. However, a high mortality rate and probability of limb loss make this problem more debatable, and can be related with associated diseases. Material and Methods. This research included 95 patients who had been operated within the first 12 hours after the onset of symptoms of critical limb ischemia. We collected the following data: age and sex of patients, etiology of limb ischemia, type of operation, associated diseases and outcome of treatment. Results and Discussion. Most of the patients were 70 to 80 years old, both sexes being equally represented. There was significantly more arterial embolism (70%) than thrombosis on the prior arterial lesion. Most of the embolizations were treated with Fogarty...
An aneurysm has been defined as a permanent local dilatation of the diameter of an artery by at l... more An aneurysm has been defined as a permanent local dilatation of the diameter of an artery by at least 50% of its normal value. A splenic artery aneurysm is most frequently a visceral artery aneurysm and clinically it is usually asymptomatic but potentially life-threatening at the same time, with the incidence of its rupturing being 2-10% and then the mortality rate ranges from 20 to 36%. A 51-year-old female patient was admitted to the Department of Vascular and Transplantation Surgery in Novi Sad having been found to have a big splenic artery aneurysm during the ultrasound examination of her abdomen after cholecystectomy. The additional diagnostic procedure - computerized tomography of the abdomen with i.v contrast subtraction angiography-confirmed the splenic artery aneurysm to have the diameter of 5 cm and therefore the elective surgical treatment was indicated after the preoperative preparation and risk assessment. The aneurysm was exposed through Chevron incision, and the detai...
Background/Aim. A certain percentage of patients with asymptomatic carotid stenosis have an unsta... more Background/Aim. A certain percentage of patients with asymptomatic carotid stenosis have an unstable carotid plaque. For these patients it is possible to register by modern imaging methods the existence of lesions of the brain parenchyma - the silent brain infarction. These patients have a greater risk of ischemic stroke. The aim of this study was to analyze the connection between the morphology of atherosclerotic carotid plaque in patients with asymptomatic carotid stenosis and the manifestation of silent brain infarction, and to analyze the influence of risk factors for cardiovascular diseases on the occurrence of silent brain infarction and the morphology of carotid plaque. Methods. This retrospective study included patients who had been operated for high grade (> 70%) extracranial atherosclerotic carotid stenosis at the Clinic for Vascular and Transplantation Surgery of the Clinical Center of Vojvodina over a period of 5 years. The patients analyzed had no clinical manifestat...
An intra-operative cell salvage machine, commonly known as a "cell saver", aspirates, w... more An intra-operative cell salvage machine, commonly known as a "cell saver", aspirates, washes, and filters patient's blood during an operation so that the blood can be returned to the patient's circulation instead of being discarded. This procedure could significantly reduce the risks related to the use of allogeneic blood and blood products in surgery. The aim of this study was to analyse the influence of intra-operative cell salvage on reducing the need for allogeneic blood in patients with asymptomatic infrarenal abdominal aortic aneurysm undergoing elective repair of the aneurysm. We retrospectively collected data from the clinical records of patients who underwent elective infrarenal abdominal aortic aneurysm repair. Two groups were formed: the "cell saver" group, in which intra-operative cell salvage was used, and the control group, in which a cell saver was not used. Thirty patients underwent abdominal aortic aneurysm repair with the use of a cell s...
Introduction. An arteriovenous fistula (AVF) is an abnormal connection between an artery and a ve... more Introduction. An arteriovenous fistula (AVF) is an abnormal connection between an artery and a vein which may result from traumatic injury or may occur as congenital abnormality. Stent graft repair through arteriovenous fistula could lead to complications. Case report. Endovascular stent graft repair in a 23-year-old patient with posttraumatic superficial femoral arteriovenous fistula was performed to cover a fistula. During the procedure the device migrated through the fistula into the femoral vein. Due to eventual risk of migration to the heart, a prompt decision was made to fix the stent graft with three puncture needles in the common femoral vein region under fluoroscopy guidance. The vascular surgeon was called to perform open surgery. Conclusions. The presented way of treating this rare complication in an extreme and uncommon situation is very efficient, safe and inexpensive.
Drowning is a leading preventable cause of unintentional morbidity and mortality. The dominant pa... more Drowning is a leading preventable cause of unintentional morbidity and mortality. The dominant pathophysiological mechanism of drowning includes the development of acute hypoxia. The rescue procedure of a drowning person includes careful pulling the victim out of the water, examination, maintenance of the airways passable and urgent transfer to hospital. The first and most important treatment option of a drowning victim is the provision of ventilation which increases the chances of survival. As soon as the unresponsive victim is removed from the water, the lay rescuer should immediately begin chest compressions and provide cycles of ventilations and compressions. Some recent investigations have revealed that exterior compression of the chest is a necessary measure even in a situation when bystanders cannot provide airway. It is recommended to train bystanders to provide basic life support and apply automated external defibrillator in a drowning person whenever indicated and as early...
A certain percentage of patients with asymptomatic carotid stenosis have an unstable carotid plaq... more A certain percentage of patients with asymptomatic carotid stenosis have an unstable carotid plaque. For these patients it is possible to register the existence of lesions of the brain parenchyma - the silent brain infarction. These patients have a greater risk of ischemic stroke by modern imaging methods. The aim of this study was to analyze the connection between the morphology of atherosclerotic carotid plaque in patients with asymptomatic carotid stenosis and the manifestation of silent brain infarction, and to analyze the influence of risk factors for cardiovascular diseases on the occurrence of silent brain infarction and the morphology of carotid plaque. This retrospective study included patients who had been operated for high grade (> 70%) extracranial atherosclerotic carotid stenosis at the Clinic for Vascular and Transplantation Surgery of the Clinical Center of Vojvodina over a period of 5 tears. The patients analyzed had no clinical manifestation of cerebrovascular insufficiency of the carotid artery territory up to the time of operation. The classification of carotid plaque morphology was carried out according to the Gray-Weale classification, after which all the types were subcategorized into two groups: stable and unstable. Brain lesions were verified using preoperative imaging of the brain parenchyma by magnetic resonance. We analyzed ipsilateral lesions of the size > or = 3 mm. Out of 201 patients 78% had stable plaque and 22% unstable one. Unstable plaque was prevalent in the male patients (male/female ratio = 24.8% : 17.8%), but without a statistically significant difference (p > 0.05). The risk factors (hypertension, nicotinism, hyperlipoproteinemia, and diabetes mellitus) showed no statistically significant impact on carotid plaque morphology and the occurrence of silent brain infarction. Silent brain infarction was detected in 30.8% of the patients. Unstable carotid plaque was found in a larger percentage of patients with silent brain infarction (36.4% : 29.3%) but without a significant statistical difference (p > 0.05). Even though silent brain infarction is more frequent in patients with unstable plaque of carotid bifurication, the difference is of no statistical significance. The effects of the number and type of risk factors bear no statistical significance on the incidence of morphological asymptomatic carotid plaque.
Acute critical lower limb ischemia refers to the state of severely impaired vitality of lower lim... more Acute critical lower limb ischemia refers to the state of severely impaired vitality of lower limbs due to acute occlusion of arterial blood vessel by a thrombus or emboli. Surgical revascularization in the first 6-12 hours after the onset of symptoms gives the best results. However, a high mortality rate and probability of limb loss make this problem more debatable, and can be related with associated diseases. This research included 95 patients who had been operated within the first 12 hours after the onset of symptoms of critical limb ischemia We collected the following data: age and sex of patients, etiology of limb ischemia, type of operation, associated diseases and outcome of treatment. Most of the patients were 70 to 80 years old, both sexes being equally represented. There was significantly more arterial embolism (70%) than thrombosis on the prior arterial lesion. Most of the embolizations were treated with Fogarty balloon catheter embolectomy (98%); however, a great number ofarterial thrombosis demanded more complex "inflow" and "outflow" ensuring procedures such as thromboendarterectomy and bypass (33%). The performed surgical procedures showed no statistical differences when final outcome was analyzed. Amputation had to be performed in about 3% of the patients and all of them were diabetics. Mortality rate in this research was 10.5% and 7/10 with this outcome had severe form of chronic myocardiopathy and metabolic decompensation. Acute critical lower limb ischemia should be treated surgically as soon as possible. Negative outcomes are associated with comorbidity and general condition of the patient.
Sazetak -Aneurizma je po definiciji trajno lokalno prosirenje dijametra arterije za 50% od uobica... more Sazetak -Aneurizma je po definiciji trajno lokalno prosirenje dijametra arterije za 50% od uobicajenog dijametra posmatrane arterije. Aneurizma slezinske. tj, splenicne arterije (a. splenica) naicesca je visceralna arterijska aneurizma. Klinicki je najcesce asimptornatska, ali istovrerneno potencijalno zivotno ugrozavajuca, sa incidencijorn ruptuiranja 2-10%; u tom slucaju stopa mortaliteta krece se 20-36%. Pacijentkinja stara 51 godinu primljcna je na Kliniku za vaskularnu i transplantaeionu hirurgiju u Novorri Sadu nakon detekeije vel ike aneurizrne a. splenicae prilikom ultrasonografskog pregleda abdomena nakon holecistektomije. Dodatnom dijagnostikom -kompjuterizovanorn tomografijom abdomena sa i. v kontrastom digitalnom suptrakcionom angiografijorn potvrdena je aneurizma a. splenicae precnika 5 em, te je nakon preoperativne pripreme i procene rizika. indikovano elektivno operativno hirursko lecenje. Primenjen je hirurski pristup prosirenom levom supkostalnom incizijom po Chevronu, a detaljna hirurska eksploracija sledi otvaranjem omentalne burze. Nakon verifikacije istanjenog zida aneurizme sledi aneurizmektomija i rekonstrukcija a. splenicae termino-terminalnom anastomozom. Intraoperativno uzete su biopsije jetre i aneurizmatske vrece. Patohistoloski nalaz potvrduje aterosklerotsku etiologiju aneurizme, a kako postoperativni tok protice uredno, bolesniea se otpusta na dalje kucno lecenje osmi postoperativni dan. Kljucne reei: Aneurizma: Slezinska arterija; Dijagnoza: Elektivne hirurske procedure: Zen ski pol: Srednjc god inc Summary -An aneurysm has been defined as a permanent local dilatation ofthe diameter ofan artery by at least 5()% of its normal value. A splenic artery aneurysm is most frequently a visceral artery aneurysm and clinically it is usually asymptomatic but potentially life-threatening at the same time. with the incidence of its rupturing being 2-1()% and then the mortality rate rangesfrom 2() to 36%. A 5 J-year-old female patient was admitted to the Department of Vascular and Transplantation Surgery in Novi Sad having been found to have a big splenic artery aneurysm during the ultrasound examination of her abdomen after cholecystectomy. The additional diagnostic procedure -computerized tomography of the abdomen with i. v contrast subtraction angiography -confirmed the splenic artery aneurysm to have the diameter of5 em and therefore the elective surgical treatment was indicated after the preoperative preparation and risk assessment. The aneurysm was exposed through Chevron incision, and the detailed surgical exploration was done after the omental bursa had been opened. The aneurysmectomy and the reconstruction of the splenic artery by the termino-terminal anastomosis were performed after the weakening of the wall had been verified. The biopsies of the liver and the aneurysmal sac were done during the surgery. The pathohistologicalfinding confirmed the atherosclerotic etiology ofthe aneurysm. Since the postoperative course was normal, the patient 1vaS discharged on the eighth postoperative day.
True aneurysms of the extracranial internal carotid artery are rare lesions. Surgical treatment i... more True aneurysms of the extracranial internal carotid artery are rare lesions. Surgical treatment is considered to be the best therapeutic option. However, the use of the intraluminal shunt remains controversial. We reported a case of a giant extracranial internal carotid artery aneurysm treated by reconstructive surgery. A 76-year-old woman was referred with a pulsatile mass inside her mouth, associated with dizziness and dysarthria. There was no history of cerebrovascular symptoms, neck pain, or cervical trauma. A magnetic resonance scan showed a 45 mm aneurysm of the internal carotid artery (ICA), and kinking of ICA. Angiography demonstrated a saccular ICA aneurysm, with a lengthening and tortuosity of the ICA. The aneurysm and the carotid artery branches were easily exposed through a standard anterior cervical incision. After resection of the aneurysm, a Javid shunt was inserted between the common and internal carotid arteries, and end-to-end repair of ICA was easily performed due to ICA redundancy. The aneurysm was of atherosclerotic origin. Four months after the operation, the patient showed a complete recovery from peripheral neurological deficit. Our results show that surgical reconstruction is a satisfactory therapeutic choice in the management of extracranial carotid artery aneurysms in order to avoid rupture, thromboembolism and cerebrovascular insufficiency. To date, there has been little experience with endoluminal exclusion techniques and the long-term effectiveness is still uncertain.
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