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

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Background: The purpose of this paper is to examine and assess the outcomes following open repair in 39 patients who experienced aorto-caval fistula (ACF) resulting from the spontaneous rupture of an abdominal aortic aneurysm (AAA). Methods: We reviewed the clinical records of all patients surgically treated with open repair for ACF at the Clinic for Vascular and Endovascular Surgery of the Serbian Clinical Center in Belgrade, Serbia, from January 2012 to February 2023. All of the patients in this series were consecutive and had aorto-caval fistula from AAA. No patients were excluded from the procedure due to the life-threatening nature of the state. A follow-up assessment was performed during the follow-up examination or by telephone interview with the patient or a family member. Results: All patients were male, with mean age 67.4±8.3 years (range: 52-83 years). The 30-day mortality rate in our cohort was 35.9%, with three (7.7%) intraoperative deaths, and 11 deaths in the postoperative period (28.2%). A total of 25 patients out of 39 (64.1%) in the original cohort have survived the surgery and the postoperative period and were followed-up for a total of 67.1 person-years. The mean follow-up was 3.7±2.2 years (range 0.25-8.4 years). Two patients (8.0%) died during the follow-up, 16 patients (64.0%) survived, and seven (28.0%) were lost to follow-up. The long-term mortality rate in the cohort that survived the postoperative period was 3.0/100 person-years. Conclusions: ACF caused by spontaneous AAA rupture into the inferior caval vein or iliac veins is a relatively rare, life-threatening condition which requires prompt treatment. An exact preoperative diagnosis is essential for perioperative strategy. As the comparison of our results with the results from contemporary literature indicates, wherever possible endovascular repair should be considered since it results might be superior to open repair. © 2024 EDIZIONI MINERVA MEDICA.

BACKGROUND: The purpose of this study was to assess the clinical presentation and contemporary management of arterial thoracic outlet syndrome (TOS) in high-volume referral center. METHODS: We conducted a retrospective review of a prospectively maintained database of patients with TOS of any etiology between January 1st 1990 and 2021. Supra-, or combined supra-/infraclavicular approaches have been used for decompression/vascular reconstructions. The group was divided into two equal time periods: period 1 (1990-2006, N.=27) and period 2 (2006-2021, N.=36). RESULTS: Sixty-three consecutive patients underwent surgical treatment due to arterial TOS. Period 2 had more patients who were asymptomatic (N.=16, 44.4% vs. N.=0, 0%, P<0.001) and those presenting with critical hand ischemia (N.=12, 33.3% vs. N.=0, 0%, P=0.01), while acute limb ischemia was more common in period 1 (N.=16, 59.2% vs. N.=5, 13.9%, P<0.001). SA compression without lesion was more common in period 2 (N.=16, 44.4% vs. N.=0, 0%, P<0.001), while SA intimal damage with mural thrombus formation was more common in the period 1 (N.=12, 44.4% vs. N.=1, 2.7%, P<0.001). Decompression as an isolated procedure was performed in 25.4% (N.=16) of all asymptomatic patients, while combined decompressive and vascular procedure in 71.4% (N.=45) of patients. The most common postoperative complication was pneumothorax (N.=7, 11.1%). CONCLUSIONS: The supraclavicular approach with its modifications provides adequate decompression and allows also repair or reconstruction of the SA, as well as complete additional revascularization of the upper extremity without the need for further patient repositioning. While treatment methods and early outcomes have not changed significantly over time, there has been a trend towards different clinical and SA pathomorphological presentation.

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Carotid endarterectomy (CEA) is the main procedure in carotid surgery, as well as the most frequent vascular procedure. Two techniques of CEA are available: eversion and conventional plus patch angioplasty. Eversion CEA is anatomic procedure that reduces ischemic and total operative time. Simultaneous correction of the joined carotid kinking and coiling is possible, easy and safe, while the usage of patch is excluded. Thanks to oblique shape of anastomosis, eversion CEA is associated with low risk of long-term restenosis. The false anastomotic aneurysms occurrence is very rare, almost impossible after eversion CEA. However, the usage of carotid shunt during eversion CEA is not always simple, while proximal or distal extension of the carotid plaque can make eversion CEA more difficult and risky. Eversion CEA should be the first choice in carotid surgery. Conventional CEA is indicated in cases when carotid plaque is extended more than usual, as well as, if the usage of carotid shunt is necessary. © 2020 The Korean Neurosurgical Society.

Carotid endarterectomy (CEA) is the main procedure in carotid surgery, as well as the most frequent vascular procedure. Two techniques of CEA are available: eversion and conventional plus patch angioplasty. Eversion CEA is anatomic procedure that reduces ischemic and total operative time. Simultaneous correction of the joined carotid kinking and coiling is possible, easy and safe, while the usage of patch is excluded. Thanks to oblique shape of anastomosis, eversion CEA is associated with low risk of long-term restenosis. The false anastomotic aneurysms occurrence is very rare, almost impossible after eversion CEA. However, the usage of carotid shunt during eversion CEA is not always simple, while proximal or distal extension of the carotid plaque can make eversion CEA more difficult and risky. Eversion CEA should be the first choice in carotid surgery. Conventional CEA is indicated in cases when carotid plaque is extended more than usual, as well as, if the usage of carotid shunt is necessary. © 2020 The Korean Neurosurgical Society.

Background: The purpose of this study was to analyze the incidence, clinical presentation, diagnosis, and treatment of false traumatic aneurysms and arteriovenous fistulas as well as the outcomes of the patients. Methods: A retrospective, 16-year survey has been conducted regarding the cases of patients who underwent surgery for false traumatic aneurysms (FTA) of arteries and traumatic arteriovenous fistulas (TAVF). Patients with iatrogenic AV fistulas and iatrogenic false aneurysms were excluded from the study. There were 36 patients with TAVF and 47 with FTA. In all, 73 (87.95%) were male, and 10 (12.05%) were female, with an average age of 36.93 years (13-82 years). Results: In 25 (29.76%) cases TAVF and FTA appeared combat-related, and 59 (70.24%) were in noncombatants. The average of all intervals between the injury and surgery was 919. 8 days (1 day to 41 years) for FTA and 396.6 days (1 day to 9 years) for TAVF. Most of the patients in both groups were surgically treated during the first 30 days after injury. One patient died on the fourth postoperative day. There were two early complications. The early patency rate was 83.34%, and limb salvage was 100%. There were no recurrent AV fistulas that required additional operations. Conclusions: Because of their history of severe complications, FTA and TAV fistulas require prompt treatment. The treatment is simpler if there is only a short interval between the injury and the operation. Surgical endovascular repair is mostly indicated. © 2011 Société Internationale de Chirurgie.

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BaCKgrouNd: accumulated endovascular aneurysm repair (eVar) procedures will increase number of patients requiring conversion to open repair of abdominal aortic aneurysms (aaa). in most cases, patients undergo late open surgical conversion (losC), many months, or years, after initial eVar. The aim of this study is to analyze results of losC after eVar in elective and urgent setting, including presenting features, surgical techniques, as well as to review the clinical outcomes and their predictors. MeThods: retrospective review of all consecutive patients undergoing losC after eVar was performed at three distinct, high volume, vascular centers. Patients that required primary conversion within 30 days after eVar have not been included in this study. Between January 1st 2010 and January 1st 2017 total of 31 consecutive patients were treated. losC were performed either in elective or in urgent setting, thus dividing patients in two groups. Primary outcome was 30-day mortality and secondary postoperative complications resulTs: losC rate after eVar was 4.51%. Most common indication for losC was type i endoleak (N.=20, 64.51%). all patients that presented with ruptured AAA had some form of endoleak (type I endoleak was present in five from six cases). Most common site for aortic cross-clamping was infrarenal (51.61%). stent-graft was removed completely in 18 patients (58.06%) and partially in 13 (41.93%). 30-day mortality rate was 16.12% (5 patients) and most common cause of death was myocardial infarction (60%). following univariate factors were isolated as predictors for 30-day mortality: preoperative coronary artery disease, chronic obstructive pulmonary disease, urgent losC, prolonged time until losC, ruptured aaa, supraceliac clamp, higher number of red blood cell transfusion, postoperative myocardial infarction, and prolonged intubation (more than 48 hours). CoNClusioNs: losC seems to be safe and effective procedure when preformed in elective manner. on the other side, urgent losC after eVar is associated with very high postoperative mortality and morbidity. endoleak remains the main indication for open conversion. further studies are necessary to standardize timing and treatment options for failing eVar. © 2018 EDIZIONI MINERVA MEDICA.

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: Ruptured abdominal aortic aneurysms (RAAA) with concomitant horseshoe kidney (HK) present a unique challenge at the time of repair. The aim of this article was to propose the most rationale strategy during open repair (OR) of RAAAin the presence of HK. METHODS: We identified and analyzed all patients treated at the clinic due to RAAA and HK. An extensive search was performed on all articles published up to August of 2017 describing open and endovascular repair of RAAAwith concomitant horseshoe kidney. The following data were extracted and analyzed: patient number, number of renal arteries, Crawford classification of horseshoe kidney vascularization, type of aortic reconstruction, management with renal arteries, 30-day kidney failure and outcome. RESULTS: Transperitoneal approach followed by supraceliac aortic cross clamping without the division of the renal isthmus occurred in all our six cases. Four of them required additional procedures with accessory renal arteries after aortic replacement. Three of patients (50%) died during the first 30 postoperative days, while one developed transitory renal insufficiency. The renal isthmus was preserved in 43.90% and divided in 46.34% of cases. Crawford type I of HK vascularization was presented in 21.95% of cases, type II also in 39.02%, while the type III in 19.51% of cases. In 46.33% of cases a procedure with renal arteries was necessary. In 26.82% accessory renal arteries were ligated, while in 19.51% preserved (reattachment or aorto-renal bypass). Thirty-day mortality was 21.95%, while the incidence of postoperative renal failure was also 21.95%. There was not significant correlation between the renal artery ligation and the postoperative renal failure (r=-0.81, P=0.59). CONCLUSIONS: Transperitoneal approach should be preferred during urgent ORof RAAAwith concomitant HK. Asupraceliac aortic cross clamping and the placement of occlusive Fogarty catheters into both iliac arteries are recommended for proximal and distal bleeding control. Preservation of accessory renal arteries that are larger than 3 mm in diameter or supply more than 30% of renal parenchima is recommended. The division of the renal isthmus should be avoided if vascularized. It seems that renal arteries could be covered in emergency EVARwithout any implications on postoperative kidney function, allowing broader aplication of endovascular treatment for thesse patients. © 2018 EDIZIONI MINERVAMEDICA.

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Objective: Screening for abdominal aortic aneurysm (AAA) is recommended in high risk populations based on local conditions. Differences in lifestyle and risk factors between countries with different income status make risk stratification based on geographic location necessary. The majority of epidemiological studies on AAA have reported data from high income countries. The aim of this study was to explore the prevalence and risk factors for AAA in an upper middle income country in Eastern Europe. Methods: A pilot screening project for AAA, supported by a mass media campaign, was conducted in 2023 in seven cities in Serbia. Ultrasound evaluation of the abdominal aorta was performed by a registered vascular surgeon on individuals who agreed to participate. Participants who attended screening completed a questionnaire on demographic and clinical information. To assess risk factors for AAA, univariable logistic regression analysis was performed to compute the odds ratio (OR) with 95% confidence interval (CI). Multivariable logistic regression was subsequently performed with adjustments for sex, age, family history of AAA, and other relevant factors. Results: A total of 4 046 participants (51.2% male and 48.8% female; mean age 68.8 ± 7.6 years) responded to the campaign. An aneurysm was found in 195 (4.8%) screened individuals (8.2% of men and 1.3% of women). In males aged 50 – 64 years, the prevalence of AAA was 5.4%. Male sex, older age, family history of AAA, being a smoker or ex-smoker, being overweight, and alcohol consumption were predictors of AAA in the univariable analysis. After adjustments in the multivariable analysis, male sex (OR 8.04, 95% CI 4.87 – 13.28), older age (OR 1.04, 95% CI 1.02 – 1.07), positive family history (OR 2.47, 95% CI 1.61 – 3.78), smoker status (OR 3.10, 95% CI 2.10 – 4.59), ex-smoker status (OR 2.13, 95% CI 1.39 – 3.27), and being overweight (OR 1.85, 95% CI 1.25 – 2.74) were independent risk factors for AAA. Conclusion: The prevalence of AAA has not been reduced in all countries, and screening strategies might be changed based on local epidemiological data. The results of this pilot study underline the importance of exploring the prevalence of AAA in populations with a high prevalence of smoking. © 2024

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At the beginning of the second decade of the 20th century, Serbian surgeon V. Soubbotich reported his experience regarding treatment of vascular injuries from the Balkan Wars (1912-13). At the end of the 20th century, the former Yugoslavia experienced civil war, closely followed by the North Atlantic Treaty Organisation (NATO) bombing of Serbia. As a result of these unpleasant facts, the author’s generation of vascular surgeons had the opportunity to treat a significant number of vascular injuries. In the absence of national registers, the most reliable data related to vascular injuries in Serbia can be found in the database of the Clinic for Vascular and Endovascular Surgery of the Serbian Clinical Center. This database contains records from patients with 590 peripheral arterial injuries sustained between 1992 and 2001. Of these injuries, 140 were war-related and 273 occurred in the civilian settings. During the 2002-18 (“peacetime”) period, an additional number of 870 vascular injuries was included in the register. These data revealed that the treatment of vascular injury in the region of the Western Balkans is associated with two main problems. The first one is inefficient transportation of the injured; the second is the lack of qualified vascular surgeons. The result is a significant number of redo procedures, usually followed by decreased functionality of the extremity. In the majority of cases with vascular injuries, open surgical repair is the most common option. On the other hand, in most developed countries, residents and young vascular surgeons do not have sufficient experience in the conventional treatment of vascular trauma; for this reason additional education and training in open vascular surgery is still needed. Young vascular surgeons and residents in Serbia do not lack this training. © 2022 Elsevier Inc.