Browsing by Author "Cvetić, Vladimir (57189236266)"

Introduction Anomalies of the middle cerebral artery (MCA) are very rare. “Rete MCA,” “twig-like MCA” (T-MCA), “aplastic MCA,” “unfused MCA,” and others are all synonyms for unilateral embryological anomaly of the M1 segment of the MCA, where, due to an unknown cause, fusion of primordial arteries of the M1 segment did not happen. As a result, the M1 segment of the affected side consists of a mesh of small arteries from which arise normal perforators and cortical branches. Moyamoya disease, moyamoya-like syndrome, atherosclerotic steno-occlusive disease, vasculitis, and dissection of the MCA should be considered in differential diagnosis. Case outline We present a 60-year-old female patient with twig-like left MCA, incidentally diagnosed due to persistent headaches six days prior to admission. Non-contrast computed tomography head examination was without peculiarities. Computed tomography angiography showed a network of small vessels in place of the left M1 segment, bridging internal carotid artery terminus with branches of the MCA bifurcation and giving rise to lenticulostriate arteries. Fourteen months later, on physical examina-tion, the patient was in good general condition, without a neurological deficit, with occasional episodes of headache no stronger than 3–4/10 on the visual analogue scale. Conclusion We report a patient with extremely rare variation of the M1 segment of the left MCA, incidentally diagnosed due to headaches. © 2021, Serbia Medical Society. All rights reserved.

Background/Aim. Open thoracoabdominal aortic aneurysm (ThAAAs) repair is a challenging mission. Total endovascular approach is performed at selected institutions in developing countries, however these are not generalizable. Hybrid procedures offer an alternative approach. The aim of this study was to present our results of the ThAAA hybrid treatment and a literature review. Methods. This is a retrospective study of all patients that underwent the hybrid ThAAA repair at our institution between January 2011 and January 2018. Hybrid ThAAA repair was done as a two-staged procedure – open visceral debranching followed by stent-graft placement (TEVAR). The following data from eligible studies were extracted and analyzed: first author, publication year, patient sample, 30-day/in-hospital mortality, permanent paraplegia rate, presence of endoleaks and graft patency after the follow-up period, overall survival and mean follow-up period. Results. Seven patients underwent the hybrid ThAAA repair at our institution. Neither intra-operative death nor technical failure due to TEVAR was observed. Mean follow-up rate after discharge was 51.71 months [95% confidence interval (CI): 14.67–88.74 months]. At the time of the follow-up, all bypasses were patent and no prosthesis migration was documented. After one year, a case of type Ib endoleak was identified and treated successfully. Twenty-five studies were eligible for the literature review. Primary technical success was 91.69% (95% CI: 85.34–97.24%). Mean percentage of permanent paraplegia was 5.27% (95% CI: 3.55–7.01%). Visceral graft patency during the mean follow-up of 27.54 months (95% CI: 17.41–37.66 months) was 94.5% (95% CI: 92.5–96.5%). Mean pooled percentage rate of overall endoleaks during the follow-up period was 16.72% (95% CI: 11.15–22.29%). Analysis revealed 15.32% (95% CI: 11.04–19.61%) of 30-day/in-hospital mortality and 65.98% (95% CI: 58.15– 73.81%) of overall survival after the follow-up period. Conclusion. Although thought as less invasive, the hybrid ThAAA repair is still associated with a considerable morbidity and mortality. © 2019, Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Background/Aim. A phenomenon of subclavian steal is caused by occlusion or stenosis of the proximal subclavian artery with subsequent retrograde filling of the subclavian artery via the ipsilateral vertebral artery. The aim of this research was to compare surgical method [carotid-subclavian bypass grafts (CSBG)] and endovascular methods [percutaneous transluminal angioplasty (PTA) and stenting of subclavian artery] from the aspect of immediate and long-term results. Methods. Thirty patients [16 (53.33%) males], of average age between 60.1 ± 8.25 years were treated with CSBG and compared with a group of forty patients [18 (45%) males], of the average age between 57.75 ± 6.15 years treated by PTA and stenting of subclavian artery. Immediate and long-term results were determined clinically and confirmed by Doppler pressures and duplex ultrasound/angiography. All patients were followed-up after 1, 6 and 12 months post-procedure, and annually thereafter. Results. The average follow-up for both groups was 22.37 ± 11.95 months. There were 2 (6.67%) procedural complications in the CSBG group (transient ischemic attack in 2 patients) and 3 (7.5%) ones in the PTA/stent group (dissection and distal embolization in one patient and puncture site hematoma in one patient). Systolic blood pressure difference between the two brachial arteries in CSBG group was: 42.6 ± 14.5 mmHg vs 4.75 ± 12.94 mmHg (p < 0.05). In the PTA/stent group it was: 41.2 ± 15.35 mmHg vs 3.58 ± 5.83 mmHg (p < 0.05). Long-term success was 93.33% in the CSBG group and 92.5% in the PTA/stent group (p > 0.05). Conclusions. Both, the CSBG and PTA/stenting of subclavian artery are safe, efficacious and durable procedures. They have similar immediate and long-term results. PTA and stenting are the methods of choice for high grade stenosis, near total occlusions and segment occlusions of subclavian artery. CSBG is indicated in case of diffuse occlusive lesions and when the PTA and stenting do not succeed or cause complications. © 2017, Inst. Sci. inf., Univ. Defence in Belgrade. All Rights Reserved.