Dragan Totic - Academia.edu (original) (raw)
Papers by Dragan Totic
Bosnian Journal of Basic Medical Sciences, Aug 20, 2008
Venous abnormalities in lower extremities are among the most frequent disorders that aff ects gen... more Venous abnormalities in lower extremities are among the most frequent disorders that aff ects general population with signifi cant morbidity and mortality. Usually, the problem consists of a mild form of varicose veins and teleangiectasis. Treatment in this stage of disease is highly recommended since progression can lead to chronic venous insuffi ciency and chronic disability with very few eff ective treatment options. Th e most eff ective and popular treatment of varicose veins is operative treatment; specifi cally two diff erent operative procedures: method according to Myers and method according to Klapp and Smetana. We designed this study in order to determine which method is superior based on clinical parameters and patients satisfaction. Our evidence strongly support clinical superiority, as well as patient satisfaction, of Klapp and Smetana method.
PubMed, Dec 1, 2019
Background: Critical limb ischemia (CLI) represents the end stage of peripheral arterial disease ... more Background: Critical limb ischemia (CLI) represents the end stage of peripheral arterial disease (PAD). It is defined as a chronic ischemic rest pain, ulcers or gangrene, attributable to proven arterial occlusive disease. Intra-arterial digital subtraction angiography (IA DSA) still represents the gold standard for the evaluation of steno-occlusive lesions, but it has greatly been replaced with non-invasive multi-detector computed tomography angiography (MDCTA). The purpose of this prospective study was to compare diagnostic performance of MDCTA versus DSA in treatment planning in patients with CLI according to TransAtlantic Inter-Society Consensus Document on Management of Peripheral Arterial disease (TASC II). Subjects and methods: The study was designed as prospective; it was conducted from March 2014 to August 2016, and included 60 patients with symptoms of CLI, Fontaine stage III and IV. MDCTA of the peripheral arteries was performed first, followed by DSA. The lesions of aorto-iliac, femoro-popliteal and infra-popliteal regions were classified according to the TASC II guidelines, and inter-modality agreement between MDCTA and DSA was determined by using Kendall's tau-b statistics. Results: Inter-modality agreement was statistically significant in all three vascular beds, with excellent agreement >0.81 in aortoiliac and femoropopliteal regions, and a very good agreement >0.61 in infrapopliteal region. Treatment recommendations based on MDCTA findings and DSA findings were identical in 54 (90%) patients. In one patient (1.7%), CTA was not interpretable. In five patients (8.3%), CTA findings disagreed with DSA findings in regard to the preferable treatment option. Conclusion: 64-row MDCT angiography is highly competitive to DSA in evaluation of steno-occlusive disease and treatment planning in patients with critical limb ischemia.
Medicinski glasnik : official publication of the Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina, 2019
Aim To compare hospital costs of acute limb ischemia treatment in two periods of time and to show... more Aim To compare hospital costs of acute limb ischemia treatment in two periods of time and to show evidence of long-term repercussions on reducing costs during successful treatment. Methods Retrospective analysis of data obtained from 100 patients' medical history in the period 2000-2016 at the Clinic of Vascular Surgery Sarajevo: group A - 60 patients with acute limb ischemia in the period 2005-2016 and group B - 40 patients with acute limb ischemia (ALI) in the period 2000-2005. From 2000 to 2005 conservative treatment method was used, invasive diagnostic and surgical procedures were often delayed for a shorter or longer period of time. During the period from 2005 to 2016, the management model and safe practice included emergency diagnostic procedures, colour-Doppler, arteriography, emergency surgery (embolectomy by Fogharty and if necessary, vascular by-pass). Results Better health service for the patients with acute limb ischemia was offered in the period 2005-2016, which rel...
Aim To determine preferable type of treatment in our clinical circumstances by following two grou... more Aim To determine preferable type of treatment in our clinical circumstances by following two groups of patients with critical limb ischemia (CLI), who were treated endovascularly and surgically. Methods Research was carried out in the form of a prospective study of 80 patients with CLI and Trans-Atlantic Inter-Society Consensus (TASC) C or D type of arterial disease, with American Society of Anesthesiology (ASA) class III risk, who were randomly divided in two groups as per the treatment they received, surgical and endovascular. Patients were followed during 28 months using clinical examination and Duplex Ultrasound (DUS) in accordance with prescheduled control visits. Results There was a statistical difference between surgical and endovascular group in two years patency (82.5% vs. 55%; p=0.022) but it did not result in the difference in amputation free survival (AFS) (95% vs. 85%; p=0.171) or two-year freedom from major adverse limb events (MALE) (87.5 vs. 77.5; p=0.254). Also, the...
Medical Archives, 2013
Preferred graft for infragenicular bypass is autologus vein. The problem is when there is not ava... more Preferred graft for infragenicular bypass is autologus vein. The problem is when there is not available autologus vein. Literature suggest that in these situations, prosthetic graft with some form of modification of distal anastomosis with autogenic tissue is valuable adjunctive. Frequently used modifications are Miller's cuff, Taylor's patch and St. Mary's boot. Recently, there are reports on "Distal vein patch" as a form of autologus modification which, due to its simplicity and patency rate, attracted attention. The aim of this study was to evaluate benefits of this novel modification by comparing its patencies with other autologus modification of distal anastomosis. Study was performed on 60 patients, diabetics, with critical limb ischemia (CLI). Patients were divided in two groups: Group with distal vein patch modification; and group with some other form modification - control group. Patients were followed at least 22 months. We examined patency of grafts by physical examination or using Color Doppler. For statistical purposes we used KIaplan Meier analysis and curve. Significance was determined by Mann-Whitney, Fisher's exact, Pearsons chi square or Student T test as appropriate. P value less than 0,05 was considered significant. Groups were fairly matched relative to demographics, risk factors, operative intervention and distal anastomosis site. There was not statistical difference in two year primary patency between distal vein patch and control group--50% vs 53% respectivly (X2 = 0,08; p = 0,773). Also, there was not statistically significant difference in extremity survival (77% vs 77%) and patient survival between groups (89% vs 93%; X2 = 2,458; p = 0,117). This study proved equivalent patencies of infragenicular prosthetic bypasses performed using distal vein patch technique as with any other modification of distal anastomosis.
Otolaryngologic Clinics of North America, 2012
ABSTRACT This article is a concise clinical review of preoperative, intraoperative, and postopera... more ABSTRACT This article is a concise clinical review of preoperative, intraoperative, and postoperative auditory evaluation of patients with acoustic neuroma. The author describes behavioral audiometry, auditory brainstem response, and otoacoustic emissions for preoperative evaluation; auditory brainstem and direct eighth-nerve intraoperative monitoring for intraoperative evaluation; and touches on postoperative auditory assessment.
This is an Open Access article distributed under the terms of the
This is an Open Access article distributed under the terms of the
Journal of Health Sciences, 2016
Introduction: We can define extracranial carotid artery aneurysm (ECAA) as bulb dilatation greate... more Introduction: We can define extracranial carotid artery aneurysm (ECAA) as bulb dilatation greater than 200% of the diameter of the internal carotid artery (ICA) or in a case of common carotid artery (CCA) greater than 150% of the diameter. Surgical intervention is required for the treatment of this disease.Case report: This study presents an open vascular surgical procedure to resolve ECAA. We report a case of 61 years old woman with an extracranial internal carotid artery berry aneurysm, presented with a headache and dizziness when turning the head aside. Classic open surgery was performed and the lumen of berry aneurysm was separated with three clips from the lumen of ICA.Conclusions: The open surgical approach is the method of choice for the treatment of extracranial internal carotid artery pathological conditions.
Open Access Macedonian Journal of Medical Sciences
AIM: To compare hospital costs of acute deep vein thrombosis (ADVT) treatment in two periods of t... more AIM: To compare hospital costs of acute deep vein thrombosis (ADVT) treatment in two periods of time. Evidence of repercussions on reducing costs during successful treatment. Attention was given to the necessity, costs and effectiveness of diagnostic procedures, treatment and complications.METHODS: A retrospective analysis of data obtained from patients medical history in a period from 2000 to 2016. Model management and safe practice of ADVT care consisted of clinical examination, laboratory, colour Doppler and invasive diagnostics. In a treatment was used continuous infusion un-fractionated heparin for 40 patients from 2000th till 2006th and low molecular weight heparin for 40 patients from 2006th till 2016th. All patients were converted to oral anticoagulants.RESULTS: When we look at the overall picture of improving the management model, safe practices and economic rationalization, we conclude that we offer better health service for the patients with ADVT at the moment, which reli...
Medical Archives, 2017
Introduction: Atherosclerosis blood vessels, be it on extra-cranial or intra-cranial circulation,... more Introduction: Atherosclerosis blood vessels, be it on extra-cranial or intra-cranial circulation, the most common cause of incidents such as cerebro-vascular insult (ICV). Carotid endarterectomy (CEA) is a preventive operation to reduce the risk of stroke and it can be performed by eversion carotid endarterectomy (E-CEA) or a classical carotid endarterectomy (C-CEA). The aim of this study was to investigate the influence of the used techniques in basic perioperative results and the incidence of postoperative complications. Materials and Methods: It was retrospective-prospective study that involved 173 patients, with carotid stenosis, who underwent CEA, in the period of time December 2013 till December 2016. Subjects were divided into two groups in respect of technique: 90 patients were treated with E-CEA and 83 patients were treated with C-CEA. Results: Between two groups revealed a significant difference in favor of the patients from group E-CEA in the length of the surgery (92.56 ± 29.11 min.
I ntroduction: Despite the fact that the transperitoneal approach (TP) is most widely accepted ap... more I ntroduction: Despite the fact that the transperitoneal approach (TP) is most widely accepted approach to the aortic surgery because it is simple, fast, and provides good exposure of the abdominal cavity and vascular structures, lately have been increasingly advocated as an alternative retroperitoneal (RP) approach in order to avoid entering peritoneal sac, achieving lower physiological trauma and faster establishment of gastrointestinal function. Objective: The aim of this study was to compare the basic peri and postoperative results of TP and RP approaches in the surgical treatment of AIOD. Patients and Methods: The study included 114 patients with aortoiliac oc-clusive disease (AIOD) that underwent surgical treatment at the Department of Vascular Surgery, Clinical Center University of Sarajevo from January 2010 until December 2012 year. In view of the surgical technique used subjects were divided into two groups. Group A consisted of 57 patients on who had been used RP approach, and group B 57 subjects with TP used approach. Results: In patients from group A were observed significantly lower values: the length of operation (201.66 ± 43.9 minute vs. 267.36 ± 47.57 min, p <0.001), amount of postoperative drainage (56.14 ± 55.5 ml versus 130.71 ± 92.34 ml, p <0.001), length of stay in the intensive care unit (ICU) (1.10 ± 0.36 days versus 2.46 ± 1.25 days, p <0.001), time required for the restoration of gastrointestinal motil-ity (4.38 ± 5.59 versus 1.05 days ± 1.19 days, p <0.001), length of hospitalization (9.26 ± 1, 95 ± 11 days versus 1.96 days, p <0.001), costs of hospitalization (2394.98 ± BAM 346.67 versus 2933.72 ± 428.10 BAM, p <0.001). Analysis of the incidence of postoperative complications (8 vs. 7 complication complications, p>0.05) and mortality (3 versus 3, p>0.05) showed no statistically significant difference between the analyzed groups. Conclusion: RP approach in vascular reconstructive surgery in AIOD offers better postoperative results when compared to TP approach.
Bosnian Journal of Basic Medical Sciences Udruzenje Basicnih Mediciniskih Znanosti Association of Basic Medical Sciences, Sep 1, 2008
Venous abnormalities in lower extremities are among the most frequent disorders that affects gene... more Venous abnormalities in lower extremities are among the most frequent disorders that affects general population with significant morbidity and mortality. Usually, the problem consists of a mild form of varicose veins and teleangiectasis. Treatment in this stage of disease is highly recommended since progression can lead to chronic venous insufficiency and chronic disability with very few effective treatment options. The most effective and popular treatment of varicose veins is operative treatment; specifically two different operative procedures: method according to Myers and method according to Klapp and Smetana. We designed this study in order to determine which method is superior based on clinical parameters and patients satisfaction. Our evidence strongly support clinical superiority, as well as patient satisfaction, of Klapp and Smetana method.
Bosnian journal of basic medical sciences / Udruzenje basicnih mediciniskih znanosti = Association of Basic Medical Sciences
ABSTRACT
Bosnian journal of basic medical sciences / Udruzenje basicnih mediciniskih znanosti = Association of Basic Medical Sciences
Th ere is still debate whether sintethic graft (polytetrafl uoroethylene or Dacron) is equivalent... more Th ere is still debate whether sintethic graft (polytetrafl uoroethylene or Dacron) is equivalent to vein as bypass graft material for the above-knee femoropopliteal bypass. Th erefore, we performed prospective randomized trial to compare vein with polytetrafl uoroethylene/dacron for femoropopliteal bypasses with the distal anastomosis above the knee. Between January and June , femoropopliteal bypasses were performed. Th e indications for operation were severe claudication in cases, rest pain in cases, and ulceration in cases. After randomization, reversed saphenous venous bypasses and polytetrafl uoroethylene/ dacron bypasses were performed. No perioperative mortality was seen, and of the patients had minor infections of the wound, not resulting in loss of the bypass, the limb, or life. After years, of the patients had died and were lost to follow-up. Only once saphenous vein was necessary for coronary artery bypass grafting. Primary patency rates after years were , for venous bypass grafts and , for polytetrafl uoroethylene/dacron grafts (p=,). Secondary patency rates were , for vein and , for polytetrafl uoroethylene/dacron bypasses (p = ,). In the venous group, bypasses failed, leading to four new bypasses. In the polytetrafl uoroethylene group, bypasses failed, leading to reinterventions. After years of follow-up, we conclude that a bypass with saphenous vein has better patency rates at all intervals and needs fewer reoperations. Saphenous vein should be the graft material of choice for above-knee femoropopliteal bypasses and should not be preserved for reinterventions. Polytetrafl uoroethylene/dacron is an acceptable alternative if the saphenous vein is not available.
Background: Abdominal aortic rupture is a lethal event. It is estimated that 80% of the mortality... more Background: Abdominal aortic rupture is a lethal event. It is estimated that 80% of the mortality secondary to abdominal aortic aneurysm (AAA) is secondary to rupture. Surgeons would like to be able to predict with certainty which patients will survive surgical repair and return to a functional life with a minimum of complications. Objective: To analyze the multiple factors assumed to influence the outcome of operative treatment of RAAA at the Clinic for Vascular Surgery KCUS and to determine which of these factors has a significant impact on survival. Materials and methods: We performed this retrospective observation study on 49 patients treated at the Clinic for Vascular Surgery for RAAA in the period from 2004 to 2010. We compared the group of patients that survived the operation (33 patients) with the group who underwent surgery but died intraoperatively or within 30 days postoperatively (16 patients). In both groups of patients we measured and compared the period from the occurrence of symptoms until arrival, preoperative values of blood pressure, pulse, state of consciousness, diuresis, and laboratory findings such as hemoglobin, urea and creatinine, comorbidities such as cardiomyopathy, respiratory or renal failure, the duration of surgery, the duration of aortic clamping, and units of transfunded blood. Results: Operative mortality was 32.6% and intraoperative mortality was 4%. We found blood pressure less than 85/60 mmHg, hemoglobin less than 85g/l, kreatinin above 175 mmol/l, duration of operation more than 5h and duration of aortic cross clamping more than 2h as significant predictors of mortality, as well as loss of consciousness, severe cardio-myopathy and anuria on arrival. Conclusion: Currently, there is no recommendation to withhold surgery for patients with any or all of these risk factors; this decision is made on a case-by-case basis, making risk factor analysis useful mostly from the standpoint of guiding patient decisions regarding surgery and family discussions on prognosis.
Bosnian Journal of Basic Medical Sciences, Aug 20, 2008
Venous abnormalities in lower extremities are among the most frequent disorders that aff ects gen... more Venous abnormalities in lower extremities are among the most frequent disorders that aff ects general population with signifi cant morbidity and mortality. Usually, the problem consists of a mild form of varicose veins and teleangiectasis. Treatment in this stage of disease is highly recommended since progression can lead to chronic venous insuffi ciency and chronic disability with very few eff ective treatment options. Th e most eff ective and popular treatment of varicose veins is operative treatment; specifi cally two diff erent operative procedures: method according to Myers and method according to Klapp and Smetana. We designed this study in order to determine which method is superior based on clinical parameters and patients satisfaction. Our evidence strongly support clinical superiority, as well as patient satisfaction, of Klapp and Smetana method.
PubMed, Dec 1, 2019
Background: Critical limb ischemia (CLI) represents the end stage of peripheral arterial disease ... more Background: Critical limb ischemia (CLI) represents the end stage of peripheral arterial disease (PAD). It is defined as a chronic ischemic rest pain, ulcers or gangrene, attributable to proven arterial occlusive disease. Intra-arterial digital subtraction angiography (IA DSA) still represents the gold standard for the evaluation of steno-occlusive lesions, but it has greatly been replaced with non-invasive multi-detector computed tomography angiography (MDCTA). The purpose of this prospective study was to compare diagnostic performance of MDCTA versus DSA in treatment planning in patients with CLI according to TransAtlantic Inter-Society Consensus Document on Management of Peripheral Arterial disease (TASC II). Subjects and methods: The study was designed as prospective; it was conducted from March 2014 to August 2016, and included 60 patients with symptoms of CLI, Fontaine stage III and IV. MDCTA of the peripheral arteries was performed first, followed by DSA. The lesions of aorto-iliac, femoro-popliteal and infra-popliteal regions were classified according to the TASC II guidelines, and inter-modality agreement between MDCTA and DSA was determined by using Kendall's tau-b statistics. Results: Inter-modality agreement was statistically significant in all three vascular beds, with excellent agreement >0.81 in aortoiliac and femoropopliteal regions, and a very good agreement >0.61 in infrapopliteal region. Treatment recommendations based on MDCTA findings and DSA findings were identical in 54 (90%) patients. In one patient (1.7%), CTA was not interpretable. In five patients (8.3%), CTA findings disagreed with DSA findings in regard to the preferable treatment option. Conclusion: 64-row MDCT angiography is highly competitive to DSA in evaluation of steno-occlusive disease and treatment planning in patients with critical limb ischemia.
Medicinski glasnik : official publication of the Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina, 2019
Aim To compare hospital costs of acute limb ischemia treatment in two periods of time and to show... more Aim To compare hospital costs of acute limb ischemia treatment in two periods of time and to show evidence of long-term repercussions on reducing costs during successful treatment. Methods Retrospective analysis of data obtained from 100 patients' medical history in the period 2000-2016 at the Clinic of Vascular Surgery Sarajevo: group A - 60 patients with acute limb ischemia in the period 2005-2016 and group B - 40 patients with acute limb ischemia (ALI) in the period 2000-2005. From 2000 to 2005 conservative treatment method was used, invasive diagnostic and surgical procedures were often delayed for a shorter or longer period of time. During the period from 2005 to 2016, the management model and safe practice included emergency diagnostic procedures, colour-Doppler, arteriography, emergency surgery (embolectomy by Fogharty and if necessary, vascular by-pass). Results Better health service for the patients with acute limb ischemia was offered in the period 2005-2016, which rel...
Aim To determine preferable type of treatment in our clinical circumstances by following two grou... more Aim To determine preferable type of treatment in our clinical circumstances by following two groups of patients with critical limb ischemia (CLI), who were treated endovascularly and surgically. Methods Research was carried out in the form of a prospective study of 80 patients with CLI and Trans-Atlantic Inter-Society Consensus (TASC) C or D type of arterial disease, with American Society of Anesthesiology (ASA) class III risk, who were randomly divided in two groups as per the treatment they received, surgical and endovascular. Patients were followed during 28 months using clinical examination and Duplex Ultrasound (DUS) in accordance with prescheduled control visits. Results There was a statistical difference between surgical and endovascular group in two years patency (82.5% vs. 55%; p=0.022) but it did not result in the difference in amputation free survival (AFS) (95% vs. 85%; p=0.171) or two-year freedom from major adverse limb events (MALE) (87.5 vs. 77.5; p=0.254). Also, the...
Medical Archives, 2013
Preferred graft for infragenicular bypass is autologus vein. The problem is when there is not ava... more Preferred graft for infragenicular bypass is autologus vein. The problem is when there is not available autologus vein. Literature suggest that in these situations, prosthetic graft with some form of modification of distal anastomosis with autogenic tissue is valuable adjunctive. Frequently used modifications are Miller&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s cuff, Taylor&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s patch and St. Mary&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s boot. Recently, there are reports on &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;Distal vein patch&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; as a form of autologus modification which, due to its simplicity and patency rate, attracted attention. The aim of this study was to evaluate benefits of this novel modification by comparing its patencies with other autologus modification of distal anastomosis. Study was performed on 60 patients, diabetics, with critical limb ischemia (CLI). Patients were divided in two groups: Group with distal vein patch modification; and group with some other form modification - control group. Patients were followed at least 22 months. We examined patency of grafts by physical examination or using Color Doppler. For statistical purposes we used KIaplan Meier analysis and curve. Significance was determined by Mann-Whitney, Fisher&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s exact, Pearsons chi square or Student T test as appropriate. P value less than 0,05 was considered significant. Groups were fairly matched relative to demographics, risk factors, operative intervention and distal anastomosis site. There was not statistical difference in two year primary patency between distal vein patch and control group--50% vs 53% respectivly (X2 = 0,08; p = 0,773). Also, there was not statistically significant difference in extremity survival (77% vs 77%) and patient survival between groups (89% vs 93%; X2 = 2,458; p = 0,117). This study proved equivalent patencies of infragenicular prosthetic bypasses performed using distal vein patch technique as with any other modification of distal anastomosis.
Otolaryngologic Clinics of North America, 2012
ABSTRACT This article is a concise clinical review of preoperative, intraoperative, and postopera... more ABSTRACT This article is a concise clinical review of preoperative, intraoperative, and postoperative auditory evaluation of patients with acoustic neuroma. The author describes behavioral audiometry, auditory brainstem response, and otoacoustic emissions for preoperative evaluation; auditory brainstem and direct eighth-nerve intraoperative monitoring for intraoperative evaluation; and touches on postoperative auditory assessment.
This is an Open Access article distributed under the terms of the
This is an Open Access article distributed under the terms of the
Journal of Health Sciences, 2016
Introduction: We can define extracranial carotid artery aneurysm (ECAA) as bulb dilatation greate... more Introduction: We can define extracranial carotid artery aneurysm (ECAA) as bulb dilatation greater than 200% of the diameter of the internal carotid artery (ICA) or in a case of common carotid artery (CCA) greater than 150% of the diameter. Surgical intervention is required for the treatment of this disease.Case report: This study presents an open vascular surgical procedure to resolve ECAA. We report a case of 61 years old woman with an extracranial internal carotid artery berry aneurysm, presented with a headache and dizziness when turning the head aside. Classic open surgery was performed and the lumen of berry aneurysm was separated with three clips from the lumen of ICA.Conclusions: The open surgical approach is the method of choice for the treatment of extracranial internal carotid artery pathological conditions.
Open Access Macedonian Journal of Medical Sciences
AIM: To compare hospital costs of acute deep vein thrombosis (ADVT) treatment in two periods of t... more AIM: To compare hospital costs of acute deep vein thrombosis (ADVT) treatment in two periods of time. Evidence of repercussions on reducing costs during successful treatment. Attention was given to the necessity, costs and effectiveness of diagnostic procedures, treatment and complications.METHODS: A retrospective analysis of data obtained from patients medical history in a period from 2000 to 2016. Model management and safe practice of ADVT care consisted of clinical examination, laboratory, colour Doppler and invasive diagnostics. In a treatment was used continuous infusion un-fractionated heparin for 40 patients from 2000th till 2006th and low molecular weight heparin for 40 patients from 2006th till 2016th. All patients were converted to oral anticoagulants.RESULTS: When we look at the overall picture of improving the management model, safe practices and economic rationalization, we conclude that we offer better health service for the patients with ADVT at the moment, which reli...
Medical Archives, 2017
Introduction: Atherosclerosis blood vessels, be it on extra-cranial or intra-cranial circulation,... more Introduction: Atherosclerosis blood vessels, be it on extra-cranial or intra-cranial circulation, the most common cause of incidents such as cerebro-vascular insult (ICV). Carotid endarterectomy (CEA) is a preventive operation to reduce the risk of stroke and it can be performed by eversion carotid endarterectomy (E-CEA) or a classical carotid endarterectomy (C-CEA). The aim of this study was to investigate the influence of the used techniques in basic perioperative results and the incidence of postoperative complications. Materials and Methods: It was retrospective-prospective study that involved 173 patients, with carotid stenosis, who underwent CEA, in the period of time December 2013 till December 2016. Subjects were divided into two groups in respect of technique: 90 patients were treated with E-CEA and 83 patients were treated with C-CEA. Results: Between two groups revealed a significant difference in favor of the patients from group E-CEA in the length of the surgery (92.56 ± 29.11 min.
I ntroduction: Despite the fact that the transperitoneal approach (TP) is most widely accepted ap... more I ntroduction: Despite the fact that the transperitoneal approach (TP) is most widely accepted approach to the aortic surgery because it is simple, fast, and provides good exposure of the abdominal cavity and vascular structures, lately have been increasingly advocated as an alternative retroperitoneal (RP) approach in order to avoid entering peritoneal sac, achieving lower physiological trauma and faster establishment of gastrointestinal function. Objective: The aim of this study was to compare the basic peri and postoperative results of TP and RP approaches in the surgical treatment of AIOD. Patients and Methods: The study included 114 patients with aortoiliac oc-clusive disease (AIOD) that underwent surgical treatment at the Department of Vascular Surgery, Clinical Center University of Sarajevo from January 2010 until December 2012 year. In view of the surgical technique used subjects were divided into two groups. Group A consisted of 57 patients on who had been used RP approach, and group B 57 subjects with TP used approach. Results: In patients from group A were observed significantly lower values: the length of operation (201.66 ± 43.9 minute vs. 267.36 ± 47.57 min, p <0.001), amount of postoperative drainage (56.14 ± 55.5 ml versus 130.71 ± 92.34 ml, p <0.001), length of stay in the intensive care unit (ICU) (1.10 ± 0.36 days versus 2.46 ± 1.25 days, p <0.001), time required for the restoration of gastrointestinal motil-ity (4.38 ± 5.59 versus 1.05 days ± 1.19 days, p <0.001), length of hospitalization (9.26 ± 1, 95 ± 11 days versus 1.96 days, p <0.001), costs of hospitalization (2394.98 ± BAM 346.67 versus 2933.72 ± 428.10 BAM, p <0.001). Analysis of the incidence of postoperative complications (8 vs. 7 complication complications, p>0.05) and mortality (3 versus 3, p>0.05) showed no statistically significant difference between the analyzed groups. Conclusion: RP approach in vascular reconstructive surgery in AIOD offers better postoperative results when compared to TP approach.
Bosnian Journal of Basic Medical Sciences Udruzenje Basicnih Mediciniskih Znanosti Association of Basic Medical Sciences, Sep 1, 2008
Venous abnormalities in lower extremities are among the most frequent disorders that affects gene... more Venous abnormalities in lower extremities are among the most frequent disorders that affects general population with significant morbidity and mortality. Usually, the problem consists of a mild form of varicose veins and teleangiectasis. Treatment in this stage of disease is highly recommended since progression can lead to chronic venous insufficiency and chronic disability with very few effective treatment options. The most effective and popular treatment of varicose veins is operative treatment; specifically two different operative procedures: method according to Myers and method according to Klapp and Smetana. We designed this study in order to determine which method is superior based on clinical parameters and patients satisfaction. Our evidence strongly support clinical superiority, as well as patient satisfaction, of Klapp and Smetana method.
Bosnian journal of basic medical sciences / Udruzenje basicnih mediciniskih znanosti = Association of Basic Medical Sciences
ABSTRACT
Bosnian journal of basic medical sciences / Udruzenje basicnih mediciniskih znanosti = Association of Basic Medical Sciences
Th ere is still debate whether sintethic graft (polytetrafl uoroethylene or Dacron) is equivalent... more Th ere is still debate whether sintethic graft (polytetrafl uoroethylene or Dacron) is equivalent to vein as bypass graft material for the above-knee femoropopliteal bypass. Th erefore, we performed prospective randomized trial to compare vein with polytetrafl uoroethylene/dacron for femoropopliteal bypasses with the distal anastomosis above the knee. Between January and June , femoropopliteal bypasses were performed. Th e indications for operation were severe claudication in cases, rest pain in cases, and ulceration in cases. After randomization, reversed saphenous venous bypasses and polytetrafl uoroethylene/ dacron bypasses were performed. No perioperative mortality was seen, and of the patients had minor infections of the wound, not resulting in loss of the bypass, the limb, or life. After years, of the patients had died and were lost to follow-up. Only once saphenous vein was necessary for coronary artery bypass grafting. Primary patency rates after years were , for venous bypass grafts and , for polytetrafl uoroethylene/dacron grafts (p=,). Secondary patency rates were , for vein and , for polytetrafl uoroethylene/dacron bypasses (p = ,). In the venous group, bypasses failed, leading to four new bypasses. In the polytetrafl uoroethylene group, bypasses failed, leading to reinterventions. After years of follow-up, we conclude that a bypass with saphenous vein has better patency rates at all intervals and needs fewer reoperations. Saphenous vein should be the graft material of choice for above-knee femoropopliteal bypasses and should not be preserved for reinterventions. Polytetrafl uoroethylene/dacron is an acceptable alternative if the saphenous vein is not available.
Background: Abdominal aortic rupture is a lethal event. It is estimated that 80% of the mortality... more Background: Abdominal aortic rupture is a lethal event. It is estimated that 80% of the mortality secondary to abdominal aortic aneurysm (AAA) is secondary to rupture. Surgeons would like to be able to predict with certainty which patients will survive surgical repair and return to a functional life with a minimum of complications. Objective: To analyze the multiple factors assumed to influence the outcome of operative treatment of RAAA at the Clinic for Vascular Surgery KCUS and to determine which of these factors has a significant impact on survival. Materials and methods: We performed this retrospective observation study on 49 patients treated at the Clinic for Vascular Surgery for RAAA in the period from 2004 to 2010. We compared the group of patients that survived the operation (33 patients) with the group who underwent surgery but died intraoperatively or within 30 days postoperatively (16 patients). In both groups of patients we measured and compared the period from the occurrence of symptoms until arrival, preoperative values of blood pressure, pulse, state of consciousness, diuresis, and laboratory findings such as hemoglobin, urea and creatinine, comorbidities such as cardiomyopathy, respiratory or renal failure, the duration of surgery, the duration of aortic clamping, and units of transfunded blood. Results: Operative mortality was 32.6% and intraoperative mortality was 4%. We found blood pressure less than 85/60 mmHg, hemoglobin less than 85g/l, kreatinin above 175 mmol/l, duration of operation more than 5h and duration of aortic cross clamping more than 2h as significant predictors of mortality, as well as loss of consciousness, severe cardio-myopathy and anuria on arrival. Conclusion: Currently, there is no recommendation to withhold surgery for patients with any or all of these risk factors; this decision is made on a case-by-case basis, making risk factor analysis useful mostly from the standpoint of guiding patient decisions regarding surgery and family discussions on prognosis.