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Introduction/Objective. The objective was to present the results and technical considerations from high-volume center when performing late open surgical conversion (LOSC) after endovascular aneurysm repair (EVAR) in ruptured abdominal aortic aneurysm (RAAA) patients. Methods. This was a single center retrospective study. LOSC was performed whenever eventual endovascular reintervention failed, was not feasible due to hostile anatomy and unavailability of specific endograft materials, or when patient was hemodynamically unstable necessitating emergent surgery. Results. All previously implanted EVARs had bimodular configuration with suprarenal fixation. Total endograft explantation was performed in 40% of patients. Hospital mortality was 20%. Both patients who died had total endograft explantation with supraceliac clamp lasting more than 30 minutes. 30-day mortality was 30%, with one more patient who died from pulmonary embolism after hospital discharge and two hospital deaths were due to myocardial infarction. Conclusion. LOSC due to RAAA after previous EVAR carries greater mortality for the patient, suggesting multifactorial impacts on the outcome. The appropriate choice of surgical method and technical success are of ultimate importance, with total graft explantation having negative impact on patient?s survival.

Visual working memory (VWM) resources are limited, placing constraints on how much visual information can be simultaneously retained. During visually guided activity, stored information can quickly become outdated, so updating mechanisms are needed to ensure the contents of memory remain relevant to current task goals. In particular, successful deallocation of resources from items that become obsolete is likely to be critical for maintaining the precision of those representations still in memory. The experiments in this study involved presenting two memory arrays of coloured disks in sequence. The appearance of the second array was a cue to replace, rehearse, or add a new colour to the colours in memory. We predicted that successful resource reallocation should result in comparable recall precision when an item was replaced or rehearsed, owing to the removal of pre-replacement features. In contrast, a failure to update WM should lead to comparable precision with a condition in which a new colour was added to memory. We identified a very small proportion (∼5%) of trials in which participants incorrectly reported a feature from the first array in place of its replacement in the second, which we interpreted as a failure to incorporate the information from the second display into memory. Once these trials were discounted, precision estimates were consistent with complete redistribution of resources in the case of updating a single item. We conclude that working memory can be efficiently updated when previous information becomes obsolete, but that this is a demanding active process that occasionally fails.

Transit time flow meter (TTFM) allows quick and accurate intraoperative graft assessment. The main study goal is to evaluate the influence of graft flow measurements on long-term clinical outcomes in patients with chronic limb-threatening ischemia (CLTI) undergoing bellow the knee (BTK) vein bypass surgery. Between January 1st, 1999 and January 1st, 2006, 976 CLTI consecutive patients underwent lower extremity bypass surgery. When applying the exclusion criteria, 249 patients were included in the final analysis. Control measurements were performed at the end of the procedure. Patients were divided according to the mean (more/less than 100 ml/min) and diastolic graft flow (more/less than 40 ml/min) values in four groups. The primary endpoints were a major adverse limb event (male) and primary graft patency. After the median follow-up of 68 months, a group with the mean graft flow below 100 ml/min and the diastolic graft flow below 40 ml/min had the highest rates of male (χ2 = 36.60, DF = 1, P

Summary: Background: Main objective of this study was to evaluate the influence of statins and/or acetylsalicylic acid on biochemical characteristics of abdominal aortic aneurysm (AAA) wall and intraluminal thrombus (ILT). Patients and methods: Fifty patients with asymptomatic infrarenal AAA were analyzed using magnetic resonance imaging on T1w sequence. Relative ILT signal intensity (SI) was determined as a ratio between ILT and psoas muscle SI. Samples containing the full ILT thickness and aneurysm wall were harvested from the anterior surface at the level of the maximal diameter. The concentration of enzymes such as matrix metalloproteinase (MMP) 9, MMP2 and neutrophil elastase (NE/ELA) were analyzed in ILT and AAA wall; while collagen type III, elastin and proteoglycan 4 were analyzed in harvested AAA wall. Oxidative stress in the AAA wall was assessed by catalase and malondialdehyde activity in tissue samples. Results: Relative ILT signal intensity (1.09 ± 0.41 vs 0.89 ± 0.21, p = 0.013) were higher in non-statin than in statin group. Patients who were taking aspirin had lower relative ILT area (0.89 ± 0.19 vs 1.13. ± 0.44, p = 0.016), and lower relative ILT signal intensity (0.85 [0.73–1.07] vs 1.01 [0.84–1.19], p = 0.021) compared to non-aspirin group. There were higher concentrations of elastin in AAA wall among patients taking both of aspirin and statins (1.21 [0.77–3.02] vs 0.78 (0.49–1.05) ng/ml, p = 0.044) than in patients who did not take both of these drugs. Conclusions: Relative ILT SI was lower in patients taking statin and aspirin. Combination of antiplatelet therapy and statins was associated with higher elastin concentrations in AAA wall.

Preoperative anxiety is associated with increased morbidity and/or mortality in surgical patients. This study investigated the incidence, predictors, and association of preoperative anxiety with postoperative complications in vascular surgery.Consecutive patients undergoing aortic, carotid, and peripheral artery surgery, under general and regional anesthesia, from February until October 2019 were included in a cross-sectional study. Anesthesiologists assessed preoperative anxiety using a validated Serbian version of the Amsterdam Preoperative Anxiety and Information Scale. Patients were divided into groups with low/high anxiety, both anesthesia- and surgery-related. Statistical analysis included multivariate linear logistic regression and point-biserial correlation.Of 402 patients interviewed, 16 were excluded and one patient refused to participate (response rate 99.7%). Out of 385 patients included (age range 39-86 years), 62.3% had previous surgery. High-level anesthesia- and surgery-related anxieties were present in 31.2 and 43.4% of patients, respectively. Independent predictors of high-level anesthesia-related anxiety were having no children (OR = 0.443, 95% CI: 0.239-0.821, p = 0.01), personal bad experiences with anesthesia (OR = 2.294, 95% CI: 1.043-5.045, p = 0.039), and time since diagnosis for ≥ 4 months (OR = 1.634, 95% CI: 1.023-5.983, p = 0.04). The female sex independently predicted high-level surgery-related preoperative anxiety (OR = 2.387, 95% CI: 1.432-3.979, p = 0.001). High-level anesthesia-related anxiety correlated with postoperative mental disorders (rSince preoperative anxiety affects the postoperative course and almost every third patient experiences anxiety preoperatively, routine screening might be recommended in vascular surgery.

The aim of this study was to examine the influence of intraluminal thrombus (ILT) volume on the level of proteolytic activity and the content of abdominal aortic aneurysm (AAA) wall.The research was designed as a cross-sectional study at the Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia in the period from April 2017 to February 2018. During this period, a total of 155 patients with asymptomatic AAA underwent open surgical treatment and 50 were included in the study based on inclusion and exclusion criteria. Before surgery, patients included in the study were examined by MRI. During the operation, samples of ILT and AAA wall were taken for biochemical analysis.A statistically significant correlation was found between the volume of the ILT and largest AAA diameter (ρ = 0.56; P 0.001). The correlation of the ILT volume on the anterior wall and the concentration of MMP-9, MMP-2 and NE/ELA in the wall did not find statistical significance. Also, no statistically significant association was found between the volume of ILT and the concentration of ECM proteins (collagen type 3, elastin, proteoglycan) in the corresponding part of the wall. The association of ILT volume with MDA was also of no statistical significance. There was a positive statistical significance found in correlation of volume of ILT and catalase activity in the wall of AAA (ρ = 0.28, P = 0.049).The volume of ILT in the aneurysmal sac seemed not to affect the level of proteolytic activity and the content of the aneurysm wall. However, a positive correlation was found between the ILT and the catalase activity. The effect of ILT on the aneurysm wall and its role in the progression of aneurysmal disease should be examined in future studies.

Summary Background Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence. Methods ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362. Findings Between Jan 15, 2008, and Dec 31, 2020, 3625 patients in 130 centres were randomly allocated, 1811 to CAS and 1814 to CEA, with good compliance, good medical therapy and a mean 5 years of follow-up. Overall, 1% had disabling stroke or death procedurally (15 allocated to CAS and 18 to CEA) and 2% had non-disabling procedural stroke (48 allocated to CAS and 29 to CEA). Kaplan-Meier estimates of 5-year non-procedural stroke were 2·5% in each group for fatal or disabling stroke, and 5·3% with CAS versus 4·5% with CEA for any stroke (rate ratio [RR] 1·16, 95% CI 0·86–1·57; p=0·33). Combining RRs for any non-procedural stroke in all CAS versus CEA trials, the RR was similar in symptomatic and asymptomatic patients (overall RR 1·11, 95% CI 0·91–1·32; p=0·21). Interpretation Serious complications are similarly uncommon after competent CAS and CEA, and the long-term effects of these two carotid artery procedures on fatal or disabling stroke are comparable. Funding UK Medical Research Council and Health Technology Assessment Programme.

Introduction We present single-institution results of types I and II hybrid procedures for aortic arch disease with 30-day and long-term results and review of the literature. Materials and methods This is a retrospective study of all patients that underwent zone 0 endografting and open bypass from ascending aorta to the arch vessels at our institution between January 2013 and 2020. The following data for the systematic review were extracted from eligible studies: 30-day/in-hospital mortality, stroke rate, spinal cord ischemia (SCI) rate, renal failure requiring dialysis, development of retrograde dissection, early ( 30 days) endoleak, and late (>30 days) mortality. Results Twelve patients underwent hybrid aortic arch treatment in our institution. The most common aortic arch pathology was degenerative aortic aneurysm. The rate of retrograde dissection and SCI was 8.33%. Regarding the literature data, a total of 768 patients undergoing types I and II hybrid aortic arch debranching procedure. The pooled rate of 30-day/in-hospital mortality was 10.96% (95% confidence interval [CI], 8.21-14.06), SCI pooled rate was 2.91% (95% CI, 1.76%-4.33%), and retrograde dissection pooled rate was 3.22% (95% CI, 1.99-4.72). Conclusion Hybrid arch techniques provide safe alternative to open repair with acceptable short- and midterm results.

BACKGROUND Acute aortic occlusion (AAO) represents potentially fatal acute vascular emergency that requires prompt diagnosis and intervention. Clinical condition of patients with AAO is frequently severely devastated when surgical intervention is questionable. Our objective was to retrospectively review our institutional experience with AAO and assess predictors of intrahospital mortality and morbidity. METHODS This is a retrospective single-center cohort study with prospectively collected data between January 1, 2005 and January 1, 2018. The total number of 28 consecutive patients with AAO were included in our analysis. Patients with acute aortic thrombosis manifested by bilateral acute limb ischemia were divided in two groups based on potential caues of AAO (embolism or in-situ thrombosis) differentiated according to condition of aortoilical segment. RESULTS We identified 28 patients with AAO. All of them underwent either aortobifemoral bypass (N.=20, 71%) or bilateral trans-femoral thrombectomy (N.=8, 29%). The overall in-hospital mortality was 36%. Factors that influenced in-hospital mortality were: paralysis (OR=4.41, 95% CI: 1.88-21.78) and higher lactate values on admission (OR=1.23, 95% CI: 1.09-1.83), postoperative development of severe acute kidney injury (OR=3.08, 95% CI: 1.42-14.66), hemodialysis (OR=10.74, 95% CI: 1.64-109.78) and bowel ischemia (OR=5.19, 95% CI: 1.58-55.63). CONCLUSIONS Paralysis, higher lactate values, development of acute kidney injury, hemodialysis and bowel ischemia are predictors of worse outcome and may be used for risk stratification of patients with acute aortic occlusion and improve counseling patients and their families about expected postoperative outcomes. Patients with embolism and malignant disease have worse outcome; however, this should be tested in future studies on larger sample.

INTRODUCTION Acute lower limb ischaemia (ALI) is the sudden onset of decreased arterial perfusion with imminent threat to limb viability. Contrast induced acute kidney injury (CI-AKI) is one of the complications that increases mortality in patients who undergo contrast imaging in coronary procedures. The goal of this study is to evaluate the impact of chronic kidney disease (CKD) and CI-AKI on long-term clinical outcomes in patients with ALI undergoing lower limb revascularisation. METHODS A total 1017 consecutive patients with acute lower limb ischaemia who were admitted between July 1, 2006, and January 1, 2017, were retrospectively reviewed. Patients who had end stage renal disease, those who had end stage heart and malignant disease and died within 7 days of limb revascularisation, and those who did not undergo angiography were excluded. Thus 546 patients were included in the final analysis. Patients were classified as with or without CKD and were then subdivided according to the presence or absence of the development of CI-AKI, defined as an increase in serum creatinine of ≥0.5 mg/dL or by ≥25% from the baseline value within the first 72 h after contrast exposure. The primary end point was all cause mortality and secondary major adverse limb event (MALE). RESULTS Both CKD and CI-AKI were associated with the highest rate of all cause mortality (chi square = 55.77, d.f. = 1, p

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.

Mortality after open repair of ruptured abdominal aortic aneurysms (RAAAs) remains high. The purpose of this study is to present the results of open RAAA treatment observing 2 different 10-year periods in a single high-volume center and to consider the possibilities of result improvement in the future.Retrospective analysis of 729 RAAA patients who were treated through 1991-2001 (229 patients, Group A) and 2002-2011 (500 patients, Group B) was performed. Variables significantly associated with mortality were defined and analyzed.Overall 30-day mortality in Group A was 53.7% (123/229 patients) with intraoperative mortality of 13.5% (31/229 patients), while in Group B it was 37.4% (187/500 patients) with intraoperative mortality of 12.4% (62/500 patients). Overall 30-day mortality was significantly lower in Group B (P = 0.012). There was no difference regarding intraoperative mortality (P = 0.797). Preoperative severe hemodynamic instability (P 0.01, P 0.001), cardiac arrest (P 0.01, P 0.001), consciousness deterioration (P 0.05, P 0.001), renal malfunction (P 0.01, P 0.001), and significant anemia (P 0.01, P 0.001) were associated with increased mortality in both A and B groups, respectively. Aortic cross-clamping level in Group A was predominantly infrarenal (68%) while in Group B it was mostly supraceliac (53%) (P 0.001). Cross-clamping time, duration of surgery, and type of aortic reconstruction had no influence on survival in Group B (P 0.05). Intraoperative hemodynamic instability (P 0.01, P 0.001), significant bleeding (P 0.05, P 0.01), and low urine output (P 0.05, P 0.001) remained parameters that favored lethal outcome in both A and B groups, respectively. Cell saving was used only in Group B. The multivariate logistic regression applied on the complete sample of patients presented several significant predictors of lethal outcome: congestive heart failure on admission (odds ratio [OR] 1.954, 95% confidence interval [CI] 1.103-3.460), intraperitoneal rupture (OR 3.009, 95% CI 1.771-5.423), aortofemoral reconstruction (OR 1.928, 95% CI 1.044-3.563), and total operative time (OR 1.005, 95% CI 1.001-1.010). Postoperative multisystem organ failure (P 0.01, P 0.001), respiratory (P 0.01, P 0.001) and renal (P 0.05, P 0.001) failure, postoperative bleeding (P 0.05), and cerebrovascular incidents (P 0.05, P 0.01) significantly increased mortality in both A and B groups.Although unselective, aggressive surgical approach in RAAA performed by teams experienced in open repair can improve patient's survival. Short admission/surgery time, supraceliac aortic cross-clamping, and the use of intraoperative cell saving are recommended.

Introduction In case of highly atherosclerotic carotid process, carotid graft replacement might be a potential solution for successful procedure. Many studies evaluated the results of vein and polytetrafluorethilen (PTFE) graft usage at the carotid bifurcation, while the experience on the Dacron graft due to extensive atherosclerotic process is missing. The aim of our study was to evaluate 30-day and long-term results of the Dacron graft on carotid artery used in patients with extensive atherosclerotic disease. Material and methods This retrospective study analysed early and long-term neurological outcome as well as Dacron graft patency in patients operated with carotid reconstruction. Early results were confirmed by follow-up clinical examination, whereas late results were assessed by follow-up clinical examination as well as duplex sonographic examination at least 1 year after the surgery. As for statistical methods we used descriptive analysis tests, Chi-square test, and logistic regression. Results Carotid graft replacement was performed in 292 patients, before endarterectomy in 155 (53.09%), or after already attempted unsuccessful eversion endarterectomy in 137 (46.91%). Nineteen (6.5%) patients had a stroke due to ipsilateral and contralateral ischaemia or haemorrhagic in 17 (5.8%), 1 (0.3%) and 1 (0.3%) patients, respectively. Significantly higher rate of strokes occurred when the graft reconstruction was used after the failure of endarterectomy (8.5% vs. 3.5%, p = 0.029). Stroke and death rate was 7.19%. Factors that increased risk of early stroke were the length of plaque in the internal carotid artery measured intraoperatively ( p = 0.025) and the surgical tactic to perform graft reconstruction after attempted extensive endarterectomy ( p = 0.029). Conclusion Low number of patients with carotid stenosis has extensive atherosclerotic process longer than 4 cm that might jeopardise eversion endarterectomy. Carotid graft replacement with Dacron graft provide early results that are comparable with other conduits; however, in such patients reconstruction should be selected individually based on surgical experience and anatomical distribution of stenotic disease. Due to high risk of stroke, only symptomatic patients with such extensive atherosclerotic disease should be operated.

Immediately after visual stimuli disappear from sight, representations of the vanished objects are thought to briefly persist in the sensory system with perceptual-level fidelity. This lingering trace of the most recent perceptual experience has been termed sensory, or iconic, memory and described as a virtually unlimited capacity store that deteriorates over a fraction of a second. Beyond this, recall relies on visual working memory (VWM) which is considered a strongly limited resource, but one which is stabilized against interference and temporal decay. Here, we systematically investigated the temporal dynamics of resource distribution and the deterioration of memory fidelity over very short intervals (0 – 1000ms). Participants viewed a set of randomly oriented stimuli and reported one of them based on a non-masking cue presented at variable delays relative to the offset of the stimuli. The target orientation was reproduced with a finger swipe on a touchpad, minimizing the opportunity for memory deterioration after the cue and providing a precise measure of response time. Contrary to previous assumptions, a robust set-size effect was observed from the moment of stimulus offset. This was followed by a rapid and then more gradual decrease of retrieval precision as the delay between stimulus and cue increased. These results were quantitatively captured by a model in which VWM fidelity is limited before the cue due to normalization of neural signal over multiple stimulus representations, but supplemented following the cue by residual activity from the sensory system. This leads to enhanced recall at the briefest delays while still being contingent on the number of stored objects. The more gradual deterioration over longer time-scales was accounted for by accumulation of random error in encoded feature values, as in previous work. These results extend a successful neurocomputational account of VWM to capture the first moments after a stimulus disappears.

Machine learning holds considerable promise for understanding complex biological processes such as vaccine responses. Capturing interindividual variability is essential to increase the statistical power necessary for building more accurate predictive models. However, available approaches have difficulty coping with incomplete datasets which is often the case when combining studies. Additionally, there are hundreds of algorithms available and no simple way to find the optimal one. Here, we developed Sequential Iterative Modelling “OverNight” or SIMON, an automated machine learning system that compares results from 128 different algorithms and is particularly suitable for datasets containing many missing values. We applied SIMON to data from five clinical studies of seasonal influenza vaccination. The results reveal previously unrecognized CD4+ and CD8+ T cell subsets strongly associated with a robust antibody response to influenza antigens. These results demonstrate that SIMON can greatly speed up the choice of analysis modalities. Hence, it is a highly useful approach for data-driven hypothesis generation from disparate clinical datasets. Our strategy could be used to gain biological insight from ever-expanding heterogeneous datasets that are publicly available.

Machine learning has the potential to identify novel biological factors underlying successful antibody responses to influenza vaccines. The first attempts have revealed a high level of complexity in establishing influenza immunity, and many different cellular and molecular components are involved. Of note is that the previously identified correlates of protection fail to account for the majority of individual responses across different age groups and influenza seasons. Challenges remain from the small sample sizes in most studies and from often limited data sets, such as transcriptomic data. Here we report the creation of a unified database, FluPRINT, to enable large-scale studies exploring the cellular and molecular underpinnings of successful antibody responses to influenza vaccines. Over 3,000 parameters were considered, including serological responses to influenza strains, serum cytokines, cell phenotypes, and cytokine stimulations. FluPRINT, facilitates the application of machine learning algorithms for data mining. The data are publicly available and represent a resource to uncover new markers and mechanisms that are important for influenza vaccine immunogenicity., Measurement(s)immune response traitTechnology Type(s)digital curationFactor Type(s)gender • race • visit_age • bmi • flu_vaccination_history • statin_use • influenza_infection_history • influenza_hospitalization • cmv_status • ebv_statusSample Characteristic - OrganismHomo sapiens Machine-accessible metadata file describing the reported data: 10.6084/m9.figshare.9902447

Negative-pressure wound therapy (NPWT) is one of the methods frequently used in wounds. The authors discuss pressure wound therapy, vascular graft infection, complex wounds in vascular surgery, and compartment syndrome after aortic surgery. Complex wounds such as laparotomy wounds, thoracolumbotomy wounds, fasciotomy wounds, pedal ulcers, and amputation stump are improved with the use of pressure wound therapy.

Introduction. Splenic artery aneurysms are potentially lethal lesions. We report two illustrative cases and discuss etiology, diagnosis and treatment of these aneurysms. Outline of Cases. Both patients, age 31 and 80 years, were biparous women. The younger woman, otherwise healthy, was referred from a local hospital 3 weeks after she underwent a left subcostal laparotomy and exploration for symptomatic abdominal mass diagnosed by CT. Angiography established the diagnosis of a large, non-ruptured splenic artery aneurysm. Elective aneurysmectomy with splenectomy was performed using the approach through the upper median laparotomy and bursa omentalis. Postoperative course was uneventful. Histopathology demonstrated cystic medial necrosis with chronic dissection. The other patient, elderly woman, presented urgently with acute abdominal pain and syncope and was diagnosed by computed tomography with a huge, ruptured splenic artery aneurysm. She underwent immediate aneurysmectomy with splenectomy using the same, above-mentioned approach. External pancreatic fistula and pancreatic pseudocyst complicated the postoperative course, requiring open pseudocyst drainage and cystojejunostomy. After a protracted hospitalization patient eventually recovered. The pathological diagnosis was atherosclerotic aneurysm. Conclusion. Splenic artery aneurysms are infrequent lesions, with varied etiology and clinical presentation. Timely diagnosis and adequate treatment prevent life-threatening rupture and lessen the risk of operative morbidity and mortality. [Projekat Ministarstva nauke Republike Srbije, br. 175008]

We present a case of successfully treated abdominal aortic aneurysm in a 24-year-old patient with Marfan syndrome. After initial physical and ultrasound examination, the multislice computed tomography (MSCT) scan revealed infrarenal aortic aneurysm of 6 cm in diameter, 10 cm long, along with slightly dilated iliac arteries. However, dimensions of aortic root, aortic arch, and descending suprarenal aorta were within normal limits. Further on, because the patient presented with signs of impending rupture, an urgent surgical intervention was performed. The patient was discharged in good general medical condition 7 days after surgery. After 6 months of follow-up, the patient's condition was satisfying and no MSCT signs of further aortic dissection/aneurysm were identified. To the best of our knowledge, a case of successful management of a patient with Marfans syndrome and truly isolated infrarenal and symptomatic abdominal aortic aneurysm has not been described in the literature before.

The volume state of dialysis patients is important in guiding the dialysis process. Volume overload in these patients is associated with inflammation. The objectives of the present study were to assess the body composition of patients on hemodialysis; to determine the concentrations of B-type natriuretic peptide (BNP) in plasma and evaluate the association of BNP concentrations with volume overload; to determine the concentrations of C-reactive protein (CRP), albumin and superoxide dismutase (SOD) activities as indicators of inflammatory or antioxidant processes. The study included 79 maintenance hemodialysis patients. Assessment of body compartments was carried out using a body composition monitor (BCM). After BCM measurements, blood samples were taken from the patients for laboratory tests. There were 40 (50.6%) volume-overloaded patients (relative overhydration15%). These patients had a higher prevalence of arterial hypertension (P0.05), significantly higher concentrations of BNP (P = 0.01), lower body mass index (P0.05) and lower fat tissue index (P0.05). There was a positive correlation between plasma BNP and CRP concentrations (ρ = 0.231; P0.05), and a negative correlation between (log) BNP and albumin (r = -0.021; P0.05), as well as (log) CRP and albumin concentrations (r = -3; P0.01). SOD activity was positively correlated with albumin concentrations (r = 0.254; P0.05). The concentrations of BNP in this study were associated with volume overload and inflammatory markers. Patients with a higher albumin concentration had higher SOD activity.

Blunt abdominal aortic injuries are extremely rare, diagnosed in less than 0.05% of all trauma admissions. Aortic injury caused by a seat belt during a car accident is often referred as "seat-belt aorta". We present a case of an 18-year-old woman, restrained back passenger involved in a vehicular collision, sustaining vertebral column and multiple rib fractures, mesenterium and colonic injury, and infrarenal aortic contusion with localized dissection and partial thrombosis.

Background Blunt injuries of the supra-aortic branches are rare entity, and majority of patients die before arrival at the hospital. Those who arrive alive require complex and fast procedure that requires sternotomy. We report 3 successfully managed cases. Case Reports We report 3 patients with injury of supra-aortic branches. One was treated urgently due to longitudinal rupture on the posterior wall of innominate artery after car accident, and another 2 had chronic false aneurysm located at the very orifice of the right subclavian and left common carotid artery. In first and second patient bypass grafting with a hand-made, Y-shaped, 8-mm Dacron graft from the ascending aorta to the right common carotid and proximal right subclavian artery were performed, whereas in last 1 bypass grafting from the ascending aorta to the cervical part of the left common carotid artery was performed. In our facility, there were no possibilities for any endovascular treatment. Conclusions When endovascular technology is not available, open surgical repair of blunt injuries of supra-aortic vessels can be performed without complications. No matter to that, endovascular and hybrid procedures should be considered whenever possible.

A 26-year-old male presented to the emergency center having been shot in the neck. Multislice computed tomography angiography revealed injury of the right internal carotid artery at level of the carotid bifurcation with hematoma and injury of right internal jugular vein. Under general anesthesia, transposition of internal carotid artery to external carotid artery, with ligation of internal jugular vein, was successfully performed. This case emphasizes the value of "old fashion" surgical treatment in modern endovascular age.

We present an interesting case of a patient with spinal cord ischemia presented with physical and angiographic findings of acute right leg ischemia 6 days after abdominal aortic aneurysm open repair. After unsuccessful transpopliteal thrombectomy, patient was treated with spinal cord drainage. Cause of this complication might be ischemic lumbal plexopathy.

Background/Aim. To promote better treatment outcome, as well as economic benefit it is very important to find out patients with simultaneous occurrence of both aortic and arterial aneurysms. The aim of this prospective study was to determine the frequency and factors affecting femoropopliteal (F-P) segment aneurysms appearance in patients with abdominal aortic aneurysms (AAA). Methods. This study included 70 patients who had underwent elective or urgent surgery of AAA from January 1, 2006 to December 31, 2007. After ultrasonographic examination of F-P segment, all the patients were divided into two groups - those with adjunctive F-P segment aneurysm (n = 20) and the group of 50 patients with no adjunctive F-P segment aneurysm. In both groups demographic characteristics (gender, age), risk factors (diabetes mellitus, elevated serum levels of cholesterol and triglycerides, arterial hypertension, smoking, obesity) and cardiovascular comorbidity (cerebrovascular desease, ischemic heart desease) were investigated. Results. Twenty (28.57%) patients who had been operated on because of AAA, had adjunctive aneurysmal desease of F-P segment. Diabetes was no statistically significantly more present among the patients who, beside AAA, had adjunctive aneurismal desease of F-P segment (?2 = 0.04; DF = 1; p > 0.05). Also, in both groups there was no statistically significant difference in gender structure (?2 = 2. 05; DF = 2; p > 0.05), age (?2 = 5. 46; DF = 1; p > 0.05), total cholesterol level (?2 = 0.89; DF = 1; p > 0.05) and triglyceride (?2 = 0.89; DF = 1; p > 0.05) levels, the presence of arterial hypertension (?2 = 1.38; DF = 2; p > 0.05), smoking (?2 = 1.74; DF = 1; p > 0.05), obesity (?2 = 1.76; DF = 1; p > 0.05) and presence of cerebrovascular desease (?2 = 2.34; DF = 1; p > 0.05). Conversly, ischemic heart desease was statistically significantly more present among the patients who, beside AAA, had adjunctive aneurismal desease of F-P segment (?2 = 5.45; DF = 1; p < 0.05). Conclusion. Twenty patients, beside AAA, had adjunctive F-P segment aneurysm. The results of this study suggest the necessity of preforming ultrasonographic examination of F-P segment in all patients with proven AAA.