Browsing by Author "Davidovic, L.B. (7006821504)"

Background: Introduction of novel procedures needs to be planned and modified according to the situation in the society. The first endovascular aortic repair (EVAR) in Serbia was performed in 2004, and this activity was routinely continued in 2007. Aim of the study is to present the problems encountered during the introduction and development of endovascular program in Serbia, and to report the early experience and mid-term results of the two main Serbian vascular centers. Methods: From March 2007 to November 2010, 1650 patients were operated due to abdominal aortic aneurysm (AAA) in the two main vascular centers in the capital of Serbia. Out of them 87 (5.27%) were treated by EVAR and are included in this Serbian bi-centric study that analyze results as well as developing process. Results: Early mortality rate was 2/87 (2.29%). In the early postoperative time and after mid-term follow-up of 17.9 months (range 2-40 months) there was no aneurysm-related death. All patients with unplanned iliac conduit procedure suffered postoperative complications and dyed. Primary technical success and assisted primary technical success were recorded in 81 (93.1%) and 86 (98.85%) patients, respectively. Initial, assisted initial, short term and mid-term clinical success were recorded in 83 (95%), 84 (96.55%), 84 (96.55%) and 81 (93.10%) patients, respectively. Conclusions: Steep learning curve is a consequence of measured and planned introduction of new procedure only in a high volume centers with previous significant experience in treatment of all vascular pathologies and complications. © Springer-Verlag 2011.

Aim. He aim of this paper was to investigate the incidence of and the indications for conversion to general anesthesia (GA) in a large single-center series of patients undergoing carotid surgery under cervical plexus block (CPB). Methods. With IRB approval we retrospectively analyzed the medical records of all patients who underwent carotid surgery under CPB from November 2007 to October 2010. Cervical plexus was blocked at both the superficial and deep levels. An intraluminal shunt was inserted in patients who demonstrated signs of inadequate cerebral perfusion upon carotid clamping (CC). Propofol was given to patients reporting pain or discomfort throughout the procedure. The primary outcomes were the number and percentage of conversions to GA as well as the indications for this intervention. The secondary outcome was the incidence of partial cervical block failure, defined as the need for supplemental propofol administration for pain relief during surgery. Results. In total, 1464 carotid surgical procedures were performed under CPB in 1305 consecutive patients during the investigated period. Conversion to GA was required in 17 (1.2%) patients. The most common reason for conversion to GA was persisting neurological deterioration upon CC and intraluminal shunt insertion, which was recorded in 8/17 (47.1%) procedures. Other indications to convert were systemic toxicity of local anesthetics, pain, general discomfort and restlessness during surgery, and acute myocardial infarction. Conclusion. Cervical plexus block for carotid surgery is associated with a low rate of conversions to GA. Neurological deterioration upon carotid clamping and local anesthetic toxicity are identified as the most common indications for such intervention.