Browsing by Author "Dimic, Andreja (55405165000)"

Background Left-sided inferior vena cava (LIVC) and duplicated inferior vena cava (DIVC) are rare asymptomatic congenital abnormalities. Unrecognized, these anomalies can be the source of major injuries and cause serious life-threatening bleeding complications especially during abdominal aortic surgery. Methods Retrospective data for patients with 2 major inferior vena cava (IVC) anomalies that underwent aortic surgery over a 13-year period were collected. Patient demographics, type of aortic disease and caval anomaly, surgical approach, type of aortic reconstruction associated with procedure on caval vein, postoperative complications, and in-hospital mortality were recorded. Results There were 9 patients with inferior vena cava (IVC) anomalies who underwent aortic surgery. All of them were men, with a median age of 66.2 years. Seven had an LIVC and 2 had DIVC. Five patients were operated on due to abdominal aortic aneurysm and 4 due to aortoiliac occlusive disease. In all patients, a midline transperitoneal aortic approach was performed. In 5 cases, the left IVC had to be temporarily resected and later reconstructed, and in the other 4 it was just mobilized. There were no postoperative complications except in one patient who developed deep vein thrombosis in the left calf; this was successfully treated with anticoagulant therapy. Conclusion Due to favorable results and low incidence of perioperative complications and in the absence of other associated abdominal pathology, we propose the midline transperitoneal approach with mobilization or temporary resection of LIVC. © 2016 Elsevier Inc.

Background: Symptom risk assessment in carotid artery stenosis (CAS) could be improved by parameters that reflect additional risk aspects such as chronic inflammation rate, and atherosclerotic activity on a systemic level. In light of that, we investigated the association of serum matrix metalloproteinases-2,7,9 (MMP-2,7,9), vascular cell adhesion molecule-1 (VCAM-1) and selectins-P and E with symptomatic status, stenosis degree and plaque morphology in CAS patients in order to select parameters that associate to important clinical determinants of the symptom development risk. Methods: The study included 119 CAS patients and 46 healthy subjects. Carotid arteries were examined by color flow Doppler and B-mode Duplex ultrasound. Serum parameters were assessed using commercially available enzyme-linked immunosorbent assays (ELISA). Difference was tested by Mann-Whitney U, Kruskal-Wallis and Chi-square tests, and Spearman’s correlation was tested. Results: MMP-7 and selectin-P levels were higher in CAS than in controls (p<0.001). Positive correlation with stenosis degree was found for MMP-7 (r=0.155, p=0.007), VCAM-1 (r=0.127, p=0.029) and selectin-P (r=0.269, p<0.001). MMP-7 and selectin-P were higher in subjects with Grey-Weale 2, comparing to subjects with Grey-Weale 3 plaques (p=0.036, p=0.009). Selectin-P was lower in the presence of Grey-Weale 4 than in Grey-Weale 2 (p=0.045). Conclusions: Concurrent association of MMP-7 and selectin-P with both stenosis degree and carotid plaque morphology shows the joint influence of these important determinants of symptom risk that is reflected in serum parameters. This indicates that they can supply additional information outside ultrasound CAS assessment only, and their integration in a future multiscale approach for CAS risk prediction could be beneficial. © 2025 Society of Medical Biochemists of Serbia. All rights reserved.

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Background: Diabetes mellitus increases the risk of ischaemic stroke in the general population but its impact on early outcome after the carotid endarterectomy (CEA) is controversial with conflicting results. Patients and methods: This prospective study includes 902 consecutive CEAs. Patients were divided into non-diabetic and diabetic groups and subsequently analysed. Early outcomes in terms of 30-day stroke and death rates were then analysed and compared. Results: There were 606 non-diabetic patients. Among 296 diabetic patients, 83 were insulin-dependent. The cumulative TIA/stroke rate was statistically higher in the diabetic group (2.6 vs. 5.7 %, P = 0.02). Stroke was more frequent in the diabetic group (2.0 vs. 4.4 %, P = 0.04) comparedto TIA (0.7 vs. 1.4 %, P = 0.45). Mortality was statistically more frequent in diabetic patients (0.2 vs. 1.7 %, P = 0.01). The 30-day stroke/death rate (2.6 vs. 5.7 %, P = 0.02) was also statistically higher in the diabetic group. Factors that were identified to increase risk of death and stroke in multivariate analysis were: use of insulin for blood glucose control (OR = 2.47, 95 % CI 1.61–4.68, P = 0.01), higher low-density lipoprotein cholesterol value (OR = 1.52, 95 % CI 1.15–2.22, P < 0.01), presence of coronary disease (OR = 2.04, 95 % CI 1.40–3.31, P = 0.03), peripheral artery disease (OR = 2.14, 95 % CI 1.34–3.65, P = 0.02), complicated plaque (OR = 1.77, 95 % CI 1.11–3.68, P = 0.03), contralateral carotid artery occlusion (OR = 2.37, 95 % CI 1.25–4.74, P = 0.02), shunt use (OR = 3.46, 95 % CI 1.18–7.10, P < 0.01), and among diabetic patients higher HbA1c levels (OR = 1.28, 95 % CI 1.05–1.66, P = 0.03). Clamp toleration was associated with lower risk of death and stroke rates (OR = 0.43, 95 % CI 0.23–0.76, P < 0.01). Conclusions: In our study, perioperative neurological complications and mortality were statistically higher in diabetic patients compared to non-diabetic patients during CEA. Further research will have to show whether other treatment modalities of carotid artery stenosis and better glycaemia and dyslipidaemia controlling in diabetics can reduce this risk. © 2018 Hogrefe.

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BACKGROUND: We aimed to further evaluate sex differences of perioperative and 30-day complications after carotid surgery in patients with both asymptomatic and symptomatic carotid artery stenosis. METHODS: This was a single-center prospective cohort study including 2013 consecutive patients, who were treated surgically due to extracranial carotid artery stenosis and prospectively followed. Patients who underwent carotid artery stenting and who were treated conservatively were excluded. The primary endpoints for this study were hospital stroke/transitory ischemic attack (TIA) and overall survival rates. Secondary outcomes included all other hospital adverse events, 30-day stroke/TIA, and 30-day mortality rates. RESULTS: Hospital mortality was higher in female patients with symptomatic carotid stenosis (3% vs. 0.5%, P=0.018). Bleeding requiring reintervention occurred more often in female patients with both asymptomatic (1.5% vs. 0.4%, P=0.045) and symptomatic carotid stenosis (2.4% vs. 0.2%, P=0.022). 30-day stroke/TIA and mortality rates were higher in female patients with both asymptomatic (stroke/TIA 4.4% vs. 2.5%, P=0.041; mortality 3.3% vs. 1.6%, P=0.046) and symptomatic carotid stenosis (stroke/TIA 8.3% vs. 4.2%, P=0.040; mortality 4.1% vs. 0.7%, P=0.006). After adjusting for all confounding factors, female gender remained an important predicting factor for 30-day stroke/TIA in asymptomatic (OR=1.4, 95%CI 1.0-4.7, P=0.041) and symptomatic patients (OR=1.7, 95%CI 1.1-5.3, P=0.040), as well as for 30-day all-cause mortality in patients with asymptomatic (OR=1.5, 95%CI 1.1-4.1, P=0.030) and symptomatic carotid artery disease (OR=1.2, 95%CI 1.0-5.2, P=0.048). CONCLUSIONS: Female gender is important predicting factor for stroke/TIA and all-cause mortality, both perioperative and during the first 30 days after carotid surgery. © 2023 EDIZIONI MINERVA MEDICA.

Background: Infected false aneurysms (IFA) caused by intravenous drug abuse are uncommon but challenging lesions. The best approach for the surgical management of this condition is still unknown. The aim is to present a single-center 14-year experience in the IFA treatment in intravenous drug abusers, thus providing additional data regarding the treatment options and outcome in these patients. Methods: A retrospective analysis of 32 consecutive patients with vascular injuries secondary to intravenous drug abuse, during the period from January 2004 to April 2018, was performed. Data of interest were extracted from patients’ medical history records, anesthesia charts, and database implemented in daily practice, or were obtained by personal contact. The diagnosis was set based on history, physical examination and/or color Doppler sonography, multidetector computed tomographic angiography, and digital subtraction angiography. The outcome included graft patency, limb amputation, and mortality. Results: During study period, 32 heroin abusers, predominantly males (81%), were surgically treated due to vascular injuries, with mean age of 35.2 years. The vast majority of patients have had an injury of the lower extremity blood vessels (84.3%) and the common femoral artery was the most common site of injury (59.4%). Three-quarters of patients underwent resection of the false aneurysm and ligation of the artery without reconstruction of the blood vessel. In 7 cases (21.9%), arterial reconstruction was performed with overall failure rate of 42.86%. The overall mortality rate was 6.25% and the rate of extremity salvage was 96.7%. Conclusions: The best treatment option is yet to be found, but based on the results of the present study, ligation of affected artery without revascularization seems to be an efficient, safe, and optimal treatment method, with minor risk of the extremity loss. © 2020 Elsevier Inc.