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Introduction. An abdominal aortic aneurysm is a permanent focal dilation of the blood vessel wall to about 1.5 times larger than the normal diameter. Clinically, it may be divided into symptomatic and asymptomatic. It is still discussed whether patients with symptomatic non-ruptured abdominal aortic aneurysm benefit more from emergency or delayed surgical treatment. The aim of the study was to evaluate the results of the symptomatic non-ruptured aneurysms in regard to the diameter of ruptured and non-ruptured symptomatic aneurysms and the impact of the time elapsed from admission to surgery on its outcome. Material and Methods. The retrospective study included all 133 patients who underwent surgery due to symptomatic non-ruptured or ruptured abdominal aortic aneurysm at the Clinic of Vascular and Endovascular Surgery during the previous 3 years. Results. Out of a total of 133 patients, 75.19% underwent surgery in the first 24 hours after admission, while the rest 24.81% of patients were operated later. Intraoperative complications were recorded only in patients with ruptured aneurysms, 4% had cardiac arrest and 1.5% of patients had fatal outcome. The in-hospital mortality was 16.67% in patients with non-ruptured aneurysm of the abdominal aorta operated in the first 24 hours, and 9.91% in patients who were operated after 24 hours after admission. Conclusion. Early elective surgery is a method of choice in the treatment of symptomatic non-ruptured aneurysm of the abdominal aorta. However, surgical treatment in the first 24 hours is associated with a higher mortality rate than surgery after 24 hours after admission. Also, there is no statistically significant difference in the diameter of ruptured and non-ruptured symptomatic aneurysms, but the average size of the aneurysm diameter is higher in ruptured than in non-ruptured aneurysms, which confirms the fact that the increase in diameter increases the risk of aneurysm rupture.

Introduction. An aneurysm is a localized, permanent dilation of an arterial blood vessel with a diameter greater than 50% of the usual diameter for that aortic segment. It is treated with endovascular stent graft placement or open surgery. Endovascular stent grafting of the abdominal aorta has become popular as an elective treatment. but one of the complications is increased aneurysm diameter that may lead to rupture. Case Series. This case series reviews open reconstructive surgery of ruptured abdominal aortic aneurysms in three patients treated with endovascular repair. The diameter of the aneurysm increased due to endoleak or stent graft migration, leading to rupture. Due to the inability to extract the stent graft in two patients, the graft was transversely cut at the proximal part, where upper anastomosis was created using a Dacron graft prosthesis. Conclusion. Regular annual controls for the rest of patients lives are of great importance in order to avoid fatal complications after endovascular aneurysm repair. One of the methods after the abdominal aortic rupture after endovascular stent graft treatment that significantly shortens the duration of the surgery and gives a more stable upper anastomosis, is transverse stent graft cut in the proximal part. Complete prevention remains a challenge because a rupture may occur even if the abnormalities are not evident. The ultimate goal is to increase the survival rate after the ruptured abdominal aortic aneurysm.

Introduction. This research has been aimed at determining whether incomplete Circle of Willis in patients with significant extracranial carotid stenosis is associated with a higher incidence of neurological symptomatology and/or ischemic cerebral lesions. Material and Methods. The research was conducted as a prospective study which comprised 211 patients who underwent surgical treatment of extracranial carotid disease at the Department of Vascular Surgery in Novi Sad and 102 patients in the control group. Each patient underwent preoperative magnetic resonance imaging and magnetic resonance angiography with visualization of cerebral parenchyma, extracranial and intracranial cerebral circulation. Assessment of Circle of Willis morphology was performed by 3D time-of-flight magnetic resonance angiogram sequence analysis. The patients were divided into two groups: group I - the patients with complete Circle of Willis and group II - the patients with incomplete Circle of Willis i.e. with the disruption of anterior and/or ipsilateral posterior circulation - regarding the side of significant carotid stenosis. Results. Out of 211 patients who were operated during a two-year period, 133 had the complete Circle of Willis, while 78 patients had the incomplete Circle of Willis. Out of 111 patients with symptomatic carotid disease or silent cerebral infarction, 52.5% (58) had the complete Circle of Willis and 47.5% (53) had the incomplete Circle of Willis. It was shown to be statistically different (P = 0.0146) in relation with the asymptomatic group of patients (100), where the frequency of the complete Circle of Willis was 75% (75) while the insufficiency of anterior or ipsilateral posterior collateralization was found in 25% (25). In the control group there were significantly fewer cases of developed collateral flow and the complete Circle of Willis (41%) compared to the operated patients with extracranial carotid stenosis (63%) (P = 0.0003). Conclusion. Incompleteness of Circle of Willis is associated with more frequent occurrence of neurological symptomatology or ischemic lesions of brain parenchyma in operated patients with significant extracranial carotid stenosis. The control group without extracranial carotid stenosis had less developed collaterals of Circle of Willis compared to extracranial carotid patients.

Introduction. Due to the ever-present lack of kidney transplant grafts, more and more organs obtained from the so-called ?marginal donors? group are accepted, which can provide suboptimal effect of transplantation, depending on their characteristics and/or implantation techniques. Case report. We presented a case with successful variation of kidney position with modified approach of kidney transplantation from an infant to an adult female patient with normal postoperative recovery. Urethral anastomosis was performed without antireflux procedure and this has not led to the development of reflux disease at an early stage. Conclusion. The position of a pair of kidneys proved to be satisfactory despite the growth of the kidney to the expected size and relatively small pelvis. There were no problems with venous stasis and kidney function from the very beginning was good.

Background/Aim. A certain percentage of patients with asymptomatic carotid stenosis have an unstable carotid plaque. For these patients it is possible to register by modern imaging methods the existence of lesions of the brain parenchyma - the silent brain infarction. These patients have a greater risk of ischemic stroke. The aim of this study was to analyze the connection between the morphology of atherosclerotic carotid plaque in patients with asymptomatic carotid stenosis and the manifestation of silent brain infarction, and to analyze the influence of risk factors for cardiovascular diseases on the occurrence of silent brain infarction and the morphology of carotid plaque. Methods. This retrospective study included patients who had been operated for high grade (> 70%) extracranial atherosclerotic carotid stenosis at the Clinic for Vascular and Transplantation Surgery of the Clinical Center of Vojvodina over a period of 5 years. The patients analyzed had no clinical manifestation of cerebrovascular insufficiency of the carotid artery territory up to the time of operation. The classification of carotid plaque morphology was carried out according to the Gray-Weale classification, after which all the types were subcategorized into two groups: stable and unstable. Brain lesions were verified using preoperative imaging of the brain parenchyma by magnetic resonance. We analyzed ipsilateral lesions of the size > or = 3 mm. Results. Out of a 201 patients 78% had stable plaque and 22% unstable one. Unstable plaque was prevalent in the male patients (male/female ratio = 24.8% : 17.8%), but without a statistically significant difference (p > 0.05). The risk factors (hypertension, nicotinism, hyperlipoproteinemia, and diabetes mellitus) showed no statistically significant impact on carotid plaque morphology and the occurrence of silent brain infarction. Silent brain infarction was detected in 30.8% of the patients. Unstable carotid plaque was found in a larger percentage of patients with silent brain infarction (36.4% : 29.3%) but without a significant statistical difference (p > 0.05). Conclusions. Even though silent brain infarction is more frequent in patients with unstable plaque of carotid bifurication, the difference is of no statistical significance. The effects of the number and type of risk factors bear no statistical significance on the incidence of morphological asymptomatic carotid plaque.

Introduction. Streptococcal toxic shock syndrome is now recognized as a toxin-mediated, multisystem illness. It is characterized by an early onset of shock with multiorgan failure and continues to be associated with high morbidity and mortality, caused by group A Streptococcus pyogenes. The symptoms for staphylococcal and streptococcal toxic shock syndrome are similar. Streptococcal toxic shock syndrome was not well described until 1993, when children who had suffered from varicella presented roughly 2-4 weeks later with a clinical syndrome highly suggestive of toxic shock syndrome. Characteristics, complications and therapy. It is characterized by a sudden onset of fever, chills, vomiting, diarrhea, muscle aches and rash. It can rapidly progress to severe and intractable hypotension and multisystem dysfunction. Almost every organ system can be involved. Complications of streptococcal toxic shock syndrome may include kidney failure, liver failure and even death. Crystalloids and inotropic agents are used to treat the hypovolemic shock aggressively, with close monitoring of the patient’s mean arterial pressure and central venous pressure. An immediate and aggressive management of hypovolemic shock is essential in streptococcal toxic shock syndrome. Targeted antibiotics are indicated; penicillin or a betalactam antibiotic is used for treating group A streptococci, and clindamycin has emerged as a key portion of the standard treatment.

Introduction. True aneurysms of the extracranial internal carotid artery are rare lesions. Surgical treatment is considered to be the best therapeutic option. However, the use of the intraluminal shunt remains controversial. Case report. We reported a case of a giant extracranial internal carotid artery aneurysm treated by reconstructive surgery. A 76-year-old woman was referred with a pulsatile mass inside her mouth, associated with dizziness and dysarthria. There was no history of cerebrovascular symptoms, neck pain, or cervical trauma. A magnetic resonance scan showed a 45 mm aneurysm of the internal carotid artery (ICA), and kinking of ICA. Angiography demonstrated a saccular ICA aneurysm, with a lengthening and tortuosity of the ICA. The aneurysm and the carotid artery branches were easily exposed through a standard anterior cervical incision. After resection of the aneurysm, a Javid shunt was inserted between the common and internal carotid arteries, and end-to-end repair of ICA was easily performed due to ICA redundancy. The aneurysm was of atherosclerotic origin. Four months after the operation, the patient showed a complete recovery from peripheral neurological deficit. Discussion. Our results show that surgical reconstruction is a satisfactory therapeutic choice in the management of extracranial carotid artery aneurysms in order to avoid rupture, thromboembolism and cerebrovascular insufficiency. To date, there has been little experience with endoluminal exclusion techniques and the long-term effectiveness is still uncertain. .

Introduction. Infrainguinal arterial reconstruction is a procedure with two main types of autologous venous grafts: reversed-vein bypass grafting, and the in situ bypass grafting. Both techniques have advantages and disadvantages, and the aim of this study was to compare the results of each technique. Material and methods. In the period from 1999 to 2003, 118 patients with infrainguinal arterial occlusive disease (IAOD) undenvent reconstruction surgery at the Vascular and Transplantation Surgery Clinic in Novi Sad. 141 reconstruction procedures were performed using the autologous great saphenous vein. The patients were divided into two groups: group I included 72 patients with "in situ " by?pass grafts and group II included 46 with 55 "reversed" bypass grafts. The postoperative function was evaluated by using a pocket-sized Doppler sonography, and by assessment of the postoperative increase in API in regard to preoperative values. Results. Statistical analysis of the investigated groups of patients and X2 showed that there were no statistically significant differences in postoperative patency, complication rate and number of salvaged limbs. Conclusion. We can conclude that both investigated reconstruction techniques have advantages and minor disadvantages: they are applicable, safe and reliable and each has a specific range of indications. .

Introduction. Acute critical lower limb ischemia refers to the state of severely impaired vitality of lower limbs due to acute occlusion of arterial blood vessel by a thrombus or emboli. Surgical revascularization in the first 6-12 hours after the onset of symptoms gives the best results. However, a high mortality rate and probability of limb loss make this problem more debatable, and can be related with associated diseases. Material and Methods. This research included 95 patients who had been operated within the first 12 hours after the onset of symptoms of critical limb ischemia. We collected the following data: age and sex of patients, etiology of limb ischemia, type of operation, associated diseases and outcome of treatment. Results and Discussion. Most of the patients were 70 to 80 years old, both sexes being equally represented. There was significantly more arterial embolism (70%) than thrombosis on the prior arterial lesion. Most of the embolizations were treated with Fogarty balloon catheter embolectomy (98%); however, a great number of arterial thrombosis demanded more complex ”inflow” and ”outflow” ensuring procedures such as thromboendarterectomy and bypass (33%). The performed surgical procedures showed no statistical differences when final outcome was analyzed. Amputation had to be performed in about 3% of the patients and all of them were diabetics. Mortality rate in this research was 10.5% and 7/10 with this outcome had severe form of chronic myocardiopathy and metabolic decompensation. Conclusion. Acute critical lower limb ischemia should be treated surgically as soon as possible. Negative outcomes are associated with comorbidity and general condition of the patient.

An aneurysm has been defined as a permanent local dilatation of the diameter of an artery by at least 50% of its normal value. A splenic artery aneurysm is most frequently a visceral artery aneurysm and clinically it is usually asymptomatic but potentially life-threatening at the same time, with the incidence of its rupturing being 2-10% and then the mortality rate ranges from 20 to 36%. A 51-year-old female patient was admitted to the Department of Vascular and Transplantation Surgery in Novi Sad having been found to have a big splenic artery aneurysm during the ultrasound examination of her abdomen after cholecystectomy. The additional diagnostic procedure - computerized tomography of the abdomen with i.v contrast subtraction angiography-confirmed the splenic artery aneurysm to have the diameter of 5 cm and therefore the elective surgical treatment was indicated after the preoperative preparation and risk assessment. The aneurysm was exposed through Chevron incision, and the detailed surgical exploration was done after the omental bursa had been opened. The aneurysmectomy and the reconstruction of the splenic artery by the termino-terminal anastomosis were performed after the weakening of the wall had been verified. The biopsies of the liver and the aneurysmal sac were done during the surgery. The pathohistological finding confirmed the atherosclerotic etiology of the aneurysm. Since the postoperative course was normal, the patient was discharged on the eighth postoperative day.

Introduction. It has been established that infrainguinal occlusive disease, type III peripheral obliterative arterial disease (POAD), is more common in diabetics than in non-diabetics. It is presumeable that after surgical treatment of this arterial segment diabetics develop more complications and higher mortality rate than nondiabetics. The aim of this study was to analyze the results of reconstructive surgical treatment of diabetic and non-diabetic patients with type III PAOD. Material and Methods. In the period 1999-2003, 118 patients with Type III PAOD underwent surgery at the Vascular Surgery Clinic in Novi Sad. They were divided into two groups: group I included 51 nondiabetic patients, and group II 67 diabetic patients. Subgroups were formed based on the clinical status. Differences were established in IVa, (46 diabetics and 4 non-diabetics) and IVb stage (11 diabetic and 30 non-diabetic patients). Results. Statistical data analysis using X2 test showed a statistical difference in complications rates, number of salvaged limbs and finally, in the mortality rates between diabetic and non-diabetic patients. Conclusion. Diabetic patients presented with significantly more trophic skin lesions (IVa stage). The overall complication rate was significantly higher in diabetics, as well as the amputation rate. Finally, the mortality rate was also significantly higher in diabetics than in nondiabetic patients. .

The reduction in incidence of major amputation for diabetes is an accepted target of health care, but the extent to which this is being achieved is unclear (1). Assessment of the published literature is made especially difficult by the effect of population selection and by a rapid increase in the prevalence of known diabetes in most countries. For the most meaningful results, it follows that data should be derived from unselected and circumscribed populations and should be expressed in terms of the number in the community with diabetes …