Browsing by Author "Banzic, Igor (36518108700)"

We present an interesting case of a patient with spinal cord ischemia presented with physical and angiographic findings of acute right leg ischemia 6 days after abdominal aortic aneurysm open repair. After unsuccessful transpopliteal thrombectomy, patient was treated with spinal cord drainage. Cause of this complication might be ischemic lumbal plexopathy. © 2014 Elsevier Inc. All rights reserved.

Background To present outcomes following an operative approach of extracranial carotid artery aneurysm (ECAAs) based on anatomic types and associated kinks. Methods This study represents retrospective analysis of anatomic type based approach to operative repair of 84 patients with ECAA from 1994 to 2011, 28 (33.3%) with associated kinking. Patients were followed for neurological ischemic events, hematoma, cranial nerve injury, myocardial infarction, neurological, and overall mortality. The results are presented as early, within 30 days after the surgery, and long term during the follow-up. Results In the early postoperative period, there were no strokes or mortalities, cranial nerve injury rate was 2.4% while 1 patient had myocardial infarction (1.2%). During the follow-up, 4 patients (4.8%) had stroke, out of which 2 patients died (2.3%), while overall mortality was 4.6%. The average 5-year survival rate was 96 ± 3%. Conclusion Excellent outcomes can be obtained with surgical repair of ECAA, which should be tailored to the anatomic types and presence of kinks. © 2014 Elsevier Inc. All rights reserved.

[No abstract available]

Significant type 3 endoleak as a defect in the graft material, especially associated with endograft rupture, is a rare complication. A 68-year-old male patient with aortic plaque rupture was treated with endovascular graft placement. The patient was readmitted two years later with severe abdominal pain, a large retroperitoneal hematoma and contrast extravasation below the location where the aortic plaque had presented. Before an aortic infrarenal cuff could be placed during a control angiography, a large graft hole and a significant type 3 endoleak were observed. The sharp aortic plaque may have been responsible for the endograft tear. © 2015 Wiley Periodicals, Inc.

Introduction: Acute aortic type III dissection is one of the most catastrophic events, with in-hospital mortality ranging between 10% and 12%. The majority of patients are treated medically, but complicated dissections, which represent 15% to 20% of cases, require surgical or thoracic endovascular aortic repair (TEVAR). For the best outcomes adequate blood transfusion support is required. Interest in the relationship between blood type and vascular disease has been established. The aim of our study is to evaluate distribution of blood groups among patients with acute aortic type III dissection and to identify any kind of relationship between blood type and patient's survival. Material and methods: From January 2005 to December 2014, 115 patients with acute aortic type III dissection were enrolled at the Clinic of Vascular and Endovascular Surgery in Belgrade, Serbia and retrospectively analyzed. Patients were separated into two groups. The examination group consisted of patients with a lethal outcome, and the control group consisted of patients who survived. Results: The analysis of the blood groups and RhD typing between groups did not reveal a statistically significant difference (p = 0.220). Conclusions: Our results indicated no difference between different blood groups and RhD typing with respect to in-hospital mortality of patients with acute aortic dissection type III. Copyright © 2016 Termedia & Banach.

Although both internal iliac arteries were saved during operation, the patient developed paraplegia immediately after aortoiliac reconstruction due to the spinal cord ischemia. We report a successfully treated immediate postoperative paraplegia by performing second operation and creating bypass from the bifurcated Dacron graft to the previously detected nonpaired huge lumbar artery. © 2016 Elsevier Inc.

Background To investigate the results after carotid endarterectomy performed for asymptomatic carotid stenosis (ACS) in a single high-volume center and define the factors that increase perioperative stroke and mortality rate. Methods This observational study that analyzes prospectively collected data includes 1,567 patients with ACS operated in the period between 2007 and 2012. Results Most patients were male, 1,037 (66.18%), with mean age of 63.6 years. Perioperative death rate was 0.38%. The most frequent causes of death were stroke and myocardial infarction. The total perioperative stroke/transient ischemic attack rate was 2.81%. Logistic regression analysis confirmed that females (P = 0.028) and obese (P = 0.060) patients have higher risk of perioperative stroke after surgical repair of ACS with odds ratio (OR) of 2.008 and 2.342. The early mortality was significantly higher in candidates for coroanary artery bypass grafting (P = 0.018). Stroke and mortality are related to obesity and ischemic heart disease with OR of 2.407 and 2.097, respectively. Conclusions According to our results, female and obese patients are prone to stroke after carotid endarterectomy. Further study of the effects of female gender and obesity on surgical outcomes is warranted before medical therapy is considered the preferred treatment for these patients. © 2015 Elsevier Inc. All rights reserved.

Objective: To assess results of open repair (OR) of AAA in a single high volume center. Methods: We analyzed prospectively collected data of 450 patients who underwent elective OR of AAA at the Clinic for Vascular and Endovascular Surgery of the Serbian Clinical Centre in the period between January 2013 and September 2014. Results: Postoperative death occurred in seven patients (1. 55%) during the first 30 postoperative days. The mortality was caused by: uncontrolled bleeding-1, acute myocardial infarction-1, ischemic colitis-2, MOFS-2, sepsis due to infection and dehiscence of laparotomy wound-1. Coronary artery disease (OR 3.89; CI 0.85–17.7; p = 0.0058), postoperative acute myocardial infarction (OR 29.9; CI 2.56–334.95; p = 0.0053), chronic renal failure (OR 7.5; CI 1.35–8.5; p = 0.0073), colonic necrosis (OR 88.2; CI 4.77–1629.69; p = 0.0026), occlusion of the both hypogastric arteries and the inability to preserve at least one hypogastric artery (OR 17.4; CI 1.99–178.33; p = 0.0230), aortobifemoral reconstruction (OR 9.06; CI 1.76–46.49; p = 0.016), significant perioperative bleeding (>2 L) (OR 7.32; CI 1.31–10.79; p = 0.0001), hostile abdomen (OR 5.25; CI 1.3–21.1; p = 0.0055), inflammatory aneurysm (OR 13.99; CI 2.88–65.09; p = 0.0002), supraceliac aortic cross-clamping (OR 18.7; CI 3.8–90.6; p = 0.0003), prolonged aortic cross-clamping (>60 min) (OR 14.25; CI 2.75–64.5; p = 0.0003), the intraoperative hypotension (OR 6.61; CI 0.71–61.07; p = 0.0545), the prolonged operation (>240 min) (OR 8.66; CI 0.91–81.56; p = 0.0585) and complete dehiscence of the laparotomy (OR 44.1; CI 3.39–572.78; p = 0.0396) increased the 30-day mortality in our study. Conclusions: Early mortality after open repair of AAA in high volume center might be very low due to experienced multidisciplinary team. Centralized open aortic surgery might be solution for effective treatment of patients with unsuitable anatomy or for young patients with long life expectancy. © 2016, Société Internationale de Chirurgie.

Background Blunt injuries of the supra-aortic branches are rare entity, and majority of patients die before arrival at the hospital. Those who arrive alive require complex and fast procedure that requires sternotomy. We report 3 successfully managed cases. Case Reports We report 3 patients with injury of supra-aortic branches. One was treated urgently due to longitudinal rupture on the posterior wall of innominate artery after car accident, and another 2 had chronic false aneurysm located at the very orifice of the right subclavian and left common carotid artery. In first and second patient bypass grafting with a hand-made, Y-shaped, 8-mm Dacron graft from the ascending aorta to the right common carotid and proximal right subclavian artery were performed, whereas in last 1 bypass grafting from the ascending aorta to the cervical part of the left common carotid artery was performed. In our facility, there were no possibilities for any endovascular treatment. Conclusions When endovascular technology is not available, open surgical repair of blunt injuries of supra-aortic vessels can be performed without complications. No matter to that, endovascular and hybrid procedures should be considered whenever possible. © 2016 Elsevier Inc.

Objectives: Parkes Weber syndrome is a congenital vascular malformation which consists of capillary malformation, venous malformation, lymphatic malformation, and arteriovenous malformation. Although Parkes Weber syndrome is a clinically distinctive entity with serious complications, it is still frequently misdiagnosed as Klippel–Trenaunay syndrome that consists of the triad capillary malformation, venous malformation, and lymphatic malformation. Methods: We performed a systematic review investigating clinical, diagnostic, and treatment modalities of Parkes Weber syndrome (PubMed/MEDLINE, Embase, and Cochrane databases). Thirty-six publications (48 patients) fulfilled the eligibility criteria. Results: The median age of patients was 23 years (IQR, 8–32), and 24 (50.0%) were males. Lower extremity was affected in 42 (87.5%) and upper extremity in 6 (12.5%) patients; 15 (31.3%) patients developed high-output heart failure; 12 (25.0%) patients had chronic venous ulcerations, whereas 4 (8.3%) manifested distal arterial ischemia. The spinal arteriovenous malformations were reported in six (12.5%) patients and coexistence of aneurysmatic disease in five (10.4%) patients. The most frequently utilized invasive treatments were embotherapy followed by amputation and surgical arteriovenous malformation resection, and occasionally stent-graft implantation. All modalities showed clinical improvement. However, long follow-up and outcome remained unclear. Conclusion: A diagnosis of Parkes Weber syndrome should be made on the presence of capillary malformation, venous malformation, lymphatic malformation, and arteriovenous malformation (as main defect) in overgrowth extremity. Arteriovenous malformation presents the criterion for distinguishing Parkes Weber syndrome from Klippel-Trenaunay syndrome, which is substantial for treatment strategy. The primary management goal should be patient's quality of life improvement and complication reduction. Embolization alone/combined with surgical resection targeting occlusion or removal of arteriovenous malformation “nidus” reliably leads to clinical improvement. © 2016, © The Author(s) 2016.

Background: The aim of this paper was to present single centre experience in the treatment of extra cranial carotid artery aneurysms (eCCa) and to analyze results discussing different treatment modalities. MeThods: The study analyzed 60 patients with 62 eCCa treated surgically at the Clinic for vascular and endovascular surgery, serbian Clinical Center (Belgrade) in the period between 1985 and 2013. Treatment strategy was individually selected and demographic, morphologic, intraoperative and postoperative data were collected. resulTs: Thirty-day operative mortality was 3.3% and completely stroke related. Besides two fatal strokes one additional was registered making total number of 3 (4.8%) postoperative strokes. only one (1.6%) early graft thrombosis has been found. The 30-day-patency rate was 98.4%. during the same period seven local complications were found: three (4.8%) hemorrhage and four (6.4%) cranial nerves injuries. in all cases of hemorrhage successful re-intervention was performed without any consequences. Cranial nerves injuries included transient contusions of hypoglossal (2) and superior laryngeal nerve (2). ConClusions: The etiology, location, and morphology of an eCCa are determining selection of appropriate therapy. large or tortuous aneurysms, as well as aneurysms involving common carotid or proximal internal carotid artery, are also absolutely indicated to open surgical therapy. Aneurysms which involve the distal internal carotid artery and false anastomotic aneurysms are best managed with endovascular techniques. The ligature is indicated for the treatment of external carotid aneurysms, mycotic aneurysms with local infection and in ruptured eCCa with uncontrolled bleeding. © 2016 Edizioni Minerva Medica.

Background: One of the rare forms of abdominal aortic aneurysm (AAA) rupture is the rupture into great abdominal veins such as the inferior vein cava (IVC), the iliac veins, or the left renal vein, with the formation of direct or indirect aorto-caval fistula (ACF). The purpose of the present study was to summarize 20 years of experience at a single referral center for vascular surgery in a developing country, and to discuss the clinical presentation, diagnosis, treatment options, and outcome of patients with spontaneous aorto-venous fistulas (AVF) caused by ruptured aortic aneurysms. Materials and methods: Retrospective database review identified 50 patients treated in our institution for aorto-venous fistulas (AVF) caused by spontaneous AAA rupture in the 20 years 1991-2010. Pulsating abdominal mass and low back pain were the leading symptoms on admission in our patients. Signs of shock, congestive heart failure, or pelvic and lower extremity venous hypertension were present in 48%, 26%, and 75% of the patients, respectively. Diagnosis of AVF was based on physical examination, duplex ultrasonography, conventional angiography, or multislice computed tomography (MSCT). In 40% of the patients the presence of AVF has not been recognized before surgery. All patients were treated with open surgery. Results: After proximal and distal bleeding control the fistula was closed with direct suture (92%) or patch angioplasty (8%). Aortic reconstruction followed with tubular (22%) or bifurcated (78%) synthetic graft. Six (12%) patients died. The causes of death were excessive intraoperative blood loss, myocardial infarction, left colon gangrene and multiple organ failure. Conclusions: Spontaneous AVFs caused by aneurysmal rupture are not uncommon, and they require prompt surgical or endovascular treatment. Routine use of multislice CT in patients with acute aortic syndrome is probably the best way to the correct diagnosis of aorto-venous fistulas and planning of the optimal treatment. © 2011 Société Internationale de Chirurgie.

We report an unusual case of aneurysm of the left common iliac vein and thrombus formation in inferior vena cava associated with Parkes Weber syndrome (PWS). In addition to many already known clinical signs which determine PWS, common iliac vein aneurysm formation together with inferior vena cava thrombus present a new clinical feature and new challenges in treatment strategy of these patients. © 2015 Elsevier Inc. All rights reserved.