Browsing by Author "Cvetković, Slobodan (7006158672)"

Endovascular aortic/aneurysm repair (EVAR) was introduced into clinical practice at the beginning of the nineties. Its fast development had a great influence on clinicians, vascular surgeons and interventional radiologists, educational curriculums, patients, industry and medical insurance. The aim of this paper is to present the contribution of clinicians and industry to the development and advancement of endovascular aortic repair over the last 20 years. This review article presents the development of EVAR by focusing on the contribution of physicians, surgeons and interventional radiologists in the creation of the new field of vascular surgery termed hybrid vascular surgery, and also the contribution of technological advancement by a significant help of industrial representatives - engineers and their counselors. This article also analyzes studies conducted in order to compare the successfulness of EVAR with up-to-now applied open surgical repair of aortic aneurysms, and some treatment techniques of other aortic diseases. During the first two decades of its development the EVAR method was rapidly progressing and was adopted concurrently with the expansion of technology. Owing to large randomized studies, early and long-term results indicate specific complications of this method, thus influencing further technological improvement and defining risk patients groups in whom the use of the technique should be avoided. Good results are insured only in centers, specialized in vascular surgery, which have on their disposal adequate conditions for solving all complications associated with this method.

The most widespread diseases of modern man have a polygenic basis, including genetic predisposition and factors in the external environment. Such is the case with cardiovascular disease, malignancy, diabetes and so on. It should be borne in mind that risk factors usually include disorders that are themselves multifactorial, which further indicates the complexity of pathophysiological mechanisms. In the investigation of genetic factors in polygenic diseases studies are underway to determine the association with specific gene polymorphisms. Genetic or DNA polymorphisms are differences in the hereditary basis which are normally found in human populations. The human genome consists of 3×109 nucleotide (base) pairs, and it is considered that, on average, every 1000th nucleotide is polymorphic, i.e. varies between two loci or two individuals. The most common type of gene polymorphisms is the single nucleotide polymorphism (SNP). Although gene polymorphisms are an expression of normal variations in the hereditary basis, their effect on the phenotype is interesting, especially the association with proneness to certain diseases. Association studies examine the incidence of certain genetic variants, i.e. genetic polymorphisms in a group of patients, and compare it with the data of a healthy population. The results are often contradictory, so the number of polymorphisms whose role as markers of genetic predisposition has been clearly confirmed is still small. In this paper we review literature data and present experiences from our laboratory in studying genetic polymorphisms as susceptibility factors for the occurrence of thrombophilia and atherosclerosis and its clinical manifestations.

The most widespread diseases of modern man have a polygenic basis, including genetic predisposition and factors in the external environment. Such is the case with cardiovascular disease, malignancy, diabetes and so on. It should be borne in mind that risk factors usually include disorders that are themselves multifactorial, which further indicates the complexity of pathophysiological mechanisms. In the investigation of genetic factors in polygenic diseases studies are underway to determine the association with specific gene polymorphisms. Genetic or DNA polymorphisms are differences in the hereditary basis which are normally found in human populations. The human genome consists of 3×109 nucleotide (base) pairs, and it is considered that, on average, every 1000th nucleotide is polymorphic, i.e. varies between two loci or two individuals. The most common type of gene polymorphisms is the single nucleotide polymorphism (SNP). Although gene polymorphisms are an expression of normal variations in the hereditary basis, their effect on the phenotype is interesting, especially the association with proneness to certain diseases. Association studies examine the incidence of certain genetic variants, i.e. genetic polymorphisms in a group of patients, and compare it with the data of a healthy population. The results are often contradictory, so the number of polymorphisms whose role as markers of genetic predisposition has been clearly confirmed is still small. In this paper we review literature data and present experiences from our laboratory in studying genetic polymorphisms as susceptibility factors for the occurrence of thrombophilia and atherosclerosis and its clinical manifestations.

Introduction Graft infection is rightly considered one of the severest complications of vascular reconstruction. Treatment is non-standardized and associated with high mortality and morbidity rates. The choice of therapeutic modality depends upon variety of factors. One increasingly used option is in situ replacement of the infected prosthesis with the arterial allograft. Objective The aim of this prospective nonrandomized study was to evaluate the effectiveness and durability of fresh arterial allograft as in situ substitute for the infected vascular prosthesis. Methods During period of 2002-2005, 18 patients with the synthetic vascular graft infection underwent partial or complete prosthesis removal and secondary in situ reconstruction using the fresh arterial allograft, preserved under hypothermic conditions in buffered saline solution with an addition of antibiotics. Results In 14 male and 4 female patients, mean-aged 62 years, 8 aortic and 10 peripheral arterial infected prostheses werepartially or completely replaced with the allograft. Operative mortality was 27.8% and amputation rate was 22.2%. Systemic sepsis at initial presentation and highly virulent nature of causative microorganisms were identified as significant negative prognostic factors (χ2 test,p<0.05) test, p<0.05). During the long-term follow-up (mean 47 months), allograft aneurysm developed in three patients, requiring allograft explantation, followed in two cases by tertiary prosthetic reconstruction. Conclusion Substitution of the infected prosthesis with the arterial allograft could be successful if used selectively - for less virulent and localized infections of extracavitary grafts. Close follow-up is mandatory for timely diagnosis of late homograft lesions and its eventual replacement with more durable prosthetic material.

Introduction Intramural haematoma (IMH) and penetrating aortic ulcers (PAU) are the frequent cause of acute aortic syndrome that is disclosed with a rising frequency due to the development of new diagnostic methods. Different symptoms contribute to clinical misdiagnosis, while changeable locations and unpersuasive diameter can lead the radiologists to underestimate such changes. The outcome of PAU and IMH differs, and for the time being there are no data on prognostic factors. The diversity of symptoms and disease course is presented in four cases with different manifestations, treatment and outcome. Outline of Cases Two patients with IMH were treated conservatively due to the process extensiveness and its morphology. One patient had a complete restitution, while the other had progression of the disease. Other two patients with PAU were treated by surgery (stent graft implantation) according to the morphology and diameter of the aorta. Conclusion IMH and PAU should be suspected in patients with unclear clinical presentation (back and abdominal pains). Although outcome and complications of these diseases are well known, their incidence has not been fully studied. Endovascular treatment is less invasive and followed by a potentially lower rate of complications. However, usage of this method is justifiable only in patients with associated complications.

In this study we aimed to define relevant prognostic predictors for the outcome of surgical treatment of ruptured abdominal aortic aneurysms. The study included 406 consecutive patients treated between January 1991 and December 2003. There were 337 (83%) male and 69 (17%) female patients aged 67 ± 7.5 years. Fourteen (3.5%) patients had aortocaval fistula whereas 4 (0.98%) had primary aortorenteric fistula caused by aneurysm rupture into the inferior vena cava or duodenum. Reconstruction included interposition of a tube graft (215-53%), aortobiiliac bypass (134-33%), and aortobifemoral bypass (58-14.3%). Findings on admission that significantly correlated with both intraoperative (13.5%) and total operative mortality (48.3%) were systolic blood pressure <95 mmHg, low diuresis, unconsciousness, cardiac arrest, leukocytes >14 × 109/L, hematocrit <0.29%, hemoglobin <100 g/L, urea> 11 mmol/L, and creatinine >180 μmol/L. Intraoperative determinants of increased mortality were aortic cross-clamping time >47 min, duration of surgery >200 min, intraoperative blood loss >3500 mL, diuresis <400 mL, arterial systolic pressure <97.5 mmHg, and the need for aortobifemoral bypass. Respiratory complications and multisystem organ failure were significantly associated with lethal outcome in the postoperative period. Surgical treatment of ruptured abdominal aortic aneurysm was life-saving in 51.7% of patients. Variables significantly associated with mortality were unconsciousness, low systolic blood pressure, cardiac arrest, low diuresis, high urea and creatinine levels, signs of blood loss, and the need for aortobifemoral reconstruction. Short aortic cross-clamping and the total operation time, low intraoperative blood loss, and well-controlled diuresis and arterial pressure during surgery have improved survival. Therapeutic efforts should concentrate on intraoperative factors that are possible to correct, leading to better survival of these patients. © Annals of Vascular Surgery Inc.

Introduction/Objective Untreated deep vein thrombosis (DVT) is associated with a high risk of pulmonary embolism (PE), and false diagnosis of DVT results in unnecessary anticoagulant therapy, with a risk of bleeding. Accurate diagnosis of DVT and prompt therapy are essential to reduce the risk of thromboembolic complications. The aim of our study was to evaluate the sensitivity and specificity of three D-dimer tests (DD PLUS, HemosIL, and VIDAS) comparing to compression ultrasonography (CUS) examination. Methods We observed 350 patients, some with different risk factors. The patients underwent the same protocol (evaluation of the patient’s history, physical examination, and D-dimer testing), and CUS was used as a reference for all the patients. According to Wells score, the patients were divided into groups with low, moderate, and high pretest probability (PTP). Results Most of the examined patients were with moderate PTP. The CUS showed that there was the highest number of examined patients without DVT. Most of the examined patients with a positive CUS finding had proximal iliac and femoral DVT. VIDAS test was positive in the highest percentage in the group of patients with CUS-documented thrombosis. Conclusion All three D-dimer tests used in our study had similar sensitivity and specificity. However, VIDAS test had higher levels of positive and negative predictive values comparing to the others. The comparison of three D-dimer tests by an ROC curve showed that VIDAS test has the highest overall statistical accuracy of all three D-dimer tests. © 2018, Serbia Medical Society. All rights reserved.