Browsing by Author "Marjanović, Ivan (36928024700)"

Introduction. Aortoiliac occlusive disease and abdominal aortic aneurysm in patients with renal insufficiency on hemodialysis can significantly influence the success of renal transplantation. In the recent past, advanced atherosclerosis was considered as contraindication for renal transplantation. Complicated creation of vascular anastomoses and progression of occlusive or aneurysmal disease were the main reasons. Case report. We presented a 52-year-old man with a 5-year history of end-stage renal disease on haemodialysis. The patient was previously excluded from renal transplantation program because of severe aortoiliac atherosclerosis and abdominal aortic aneurysm. Resection of abdominal aortic aneurysm with occlusion of the iliac arteries and reconstruction with aortobifemoral synthetic grafts was performed and followed by cadaveric renal transplantation. Conclusion. Advanced atherosclerotic disease in aortoiliac segment requires elective vascular surgical reconstruction, as part of preparation for renal transplantation in patients with end-stage renal disease. © 2016, Institut za Vojnomedicinske Naucne Informacije/Documentaciju. All rights reserved.

Background/Aim. Popliteal artery aneurysm (PAA) is the most common peripheral artery aneurysm and the second most common aneurysm following abdominal aortic aneurysm (AAA). Still, its incidence is rare, and treatment is non-standardized. The collection of data in a multicenter registry could improve the diagnosis and treatment of PAA. SerbVasc is a newly established data collection collaboration among vascular centers in Serbia. The aim of this study was to present common surgical practices in the diagnosis and treatment of patients with PAA in hospitals in Serbia. Methods. Vascular centers in Serbia that accepted the invitation collected data retrospectively concerning patients operated on for PAA from 2012 to 2018. Data regarding symptoms, preoperative diagnostics, vascular and endovascular techniques, and postoperative results were collected. This data set was submitted to the VASCUNET international project of PAA for data analysis between the countries. The same data set was used for a detailed analysis of the contemporary treatment of PAA in six hospitals in Serbia: University Clinical Center of Serbia, “Dedinje” Cardiovascular Institute, Military Medical Academy, University Clinical Center Novi Sad, University Clinical Center Niš, and General Hospital Užice. Results. From 2012 to 2018, in six hospitals in Serbia, data for 342 procedures on treating PAA were collected for 329 (96.2%) men and only 13 (3.8%) women. The incidence of PAA repair was 6.8 operations per million inhabitants a year. The mean age of patients was 64.34 years (ranging from 29 to 87). A total of 223 (65.8%) elective procedures were performed. Amputation and hospital survival were considered the main outcomes. Thrombosis was recorded in 110 (32.5%) patients as a cause for surgery, and rupture was recorded in 5 patients. The mean diameter of the aneurysm was 35.3 mm, and a slightly larger diameter was recorded in ruptured aneurysms – 43.8 mm on average. Both synthetic and vein grafts were used in elective and urgent procedures equally. Endovascular procedures were performed in 6 (1.8%) cases. Conclusion. This study confirms the importance of registry-based collection of data and their analysis. It showed that the national incidence of PAA in Serbia is low and that well-organized, even institution-based, screening algorithms should improve identifying such patients and increase the number of electively treated PAA. Educating vascular surgeons to use the posterior approach could improve vascular healthcare. © 2023 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Introduction/Aim. The disturbances in hemostasis are often in open surgical repair (OR) and endovascular repair (EVAR) of an abdominal aortic aneurysm (AAA). These changes may influence the perioperative and early postoperative period inducing serious complications. The aim of this study was to compare the impact of OR and EVAR of AAA on clot quality assessed by rotational thromboelastometry (ROTEM®) tests. Methods. The study included 40 patients who underwent elective AAA surgery and were devided into two groups (the OR and the EVAR group – 20 patients in each group). The ROTEM ® test was performed in 4 points: point 1 – 10 min before starting anesthesia in both groups; point 2 – 10 min after aortic clapming in the OR group and 10 min after the stent-graft trunk release in the EVAR group; point 3 – 10 min after the releasing of aortic clamp in the OR group and 10 min after stentgraft placement and releasing the femoral clamp in the EVAR group; point 4 – one hour after the procedure in both groups. Three ROTEM® tests were performed as: extrinsically activated assay with tissue factor (EXTEM), intrinsically activated test using kaolin (INTEM), and extrinsically activated test with tissue factor and the platelet inhibitor cytochalasin D (FIBTEM). All tests included the assessment of the maximum clot firmness (MCF) and the platelet component of clot strength was presented as maximal clot elasticity (MCE). Results. No significant difference in age, gender and diameter of AAA between groups was found. The time required for the procedure was significantly longer and loss of blood was greater in the OR group than in the EVAR group (p < 0.001). The significant deviation of MCF values in EXTEM test was found mainly in the point 3 (p ≤ 0.004) with significant difference between groups (p < 0.001). A significant difference of MCF values in INTEM test between groups was found in the points 3 and 4 (p < 0.001), which were dose-dependent by heparin sulfate. The MCF values in FIBTEM test were more prominent in the OR group than in the EVAR group without significant difference. The significant changes of MCF values in the FIBTEM test were found during time in both groups (p < 0.001). The values of MCE were lower in both groups, but without significant changes and difference between groups (p = 0.105). Conclusion. The disorders of hemostatic parameters assessed by ROTEM® tests are present in both the OR and the EVAR groups being more prominent in OR of AAA. Vigilant monitoring of hemostatic parameters evaluated by ROTEM® tests could help in administration of the adequate and target therapy in patients who underwent EVAR or OR of AAA. © 2016, Institut za Vojnomedicinske Naucne Informacije/Documentaciju. All rights reserved.