Vojko Flis | University medicdal center Maribor (original) (raw)
Papers by Vojko Flis
Obzornik zdravstvene nege
Uvod: Diabetično stopalo je skupina sindromov, pri katerih nevropatija, ishemija in infekcija pri... more Uvod: Diabetično stopalo je skupina sindromov, pri katerih nevropatija, ishemija in infekcija pripeljejo do destrukcije tkiva, končna posledica je zbolevnost, lahko pa tudi amputacija. Namen raziskave je bil ugotoviti pogostost pojava diabetičnega stopala pri pacientih s sladkorno boleznijo.Metode: V raziskavi je bila uporabljena raziskava mešanih metod. Tehnika zbiranja podatkov je bilo anketiranje 60 pacientov s sladkorno boleznijo in delno strukturiran intervju z dvema medicinskima sestrama, ki delata v diabetološki ambulanti. Kvantitativni podatki so bili analizirani z opisno in bivariatno statistiko. Kvalitativni podatki so bili analizirani s pomočjo metode analize vsebine.Rezultati: Ugotovili smo, da amputacija noge ni pogost zaplet diabetičnega stopala (U = 4,4, p = 0,217) in da ne moremo trditi, da je diabetično stopalo pogostejše pri moških kot pri ženskah (U = 0,6, p = 0,417), ter da so pacienti zelo dobro poučeni glede nege stopal in pravilne obutve.Diskusija in zaključek...
Signa Vitae - A Journal In Intensive Care And Emergency Medicine
Lemierre's syndrome is a complex and unusual clinical entity, characterized by septic thrombophle... more Lemierre's syndrome is a complex and unusual clinical entity, characterized by septic thrombophlebitis of the internal jugular vein. We present the case of a patient with Lemierre's syndrome, pulmonary embolism and propagation of an internal jugular vein thrombus retrograde to the cavernous sinus. The patient was treated with antibiotics and heparin. The importance of rapid diagnosis of the extent of the disease, in directing the otherwise somewhat controversial treatment with heparin in patients with Lemierre's syndrome, is stressed.
Radiology and Oncology
Background Recent reports have shown that patients with vascular tumour invasion who undergo conc... more Background Recent reports have shown that patients with vascular tumour invasion who undergo concurrent vascular resection can achieve long-term survival rates equivalent to those without vascular involvement requiring pancreaticoduodenectomy alone. There is no consensus about which patients benefit from the portal-superior mesenteric vein resection and there is no consensus about the best surgical technique of vessel reconstruction (resection with or without graft reconstruction). As published series are small the aim of this study was to evaluate our experience in pancreatectomies with en bloc vascular resection and reconstruction of vessels. Methods Review of database at University Clinical Centre Maribor identified 133 patients (average age 65.4 ± 8.6 years, 69 female patients) who underwent pancreatoduodenectomy between January 2006 and August 2014. Clinical data, operative results, pathological findings and postoperative outcomes were collected prospectively and analyzed. Curr...
Biomacromolecules, Jan 22, 2017
Local drug delivery systems made from nontoxic polysaccharide nanofilms have an enormous potentia... more Local drug delivery systems made from nontoxic polysaccharide nanofilms have an enormous potential in wound care. A detailed understanding of the structural, surface, physicochemical, and cytotoxic properties of such systems is crucial to design clinically efficacious materials. Herein, we fabricated polysaccharide-based nanofilms onto either a 2D model (SiO2 and Au sensors) or on nonwoven alginate 3D substrates using an alternating assembly of N,N,N-trimethylchitosan (TMC) and alginic acid (ALG) by a spin-assisted layer-by-layer (LbL) technique. These TMC/ALG multilayered nanofilms are used for a uniform encapsulation and controlled release of pentoxifylline (PTX), a potent anti-inflammatory drug for treatment of the chronic venous ulceration. We show a tailorable film growth and mass, morphology, as well as surface properties (charge, hydrophilicity, porosity) of the assembled nanofilms through control of the coating during the spin-assisted assembly. The uniform distribution of t...
Annales De Chirurgie Vasculaire, 2010
Slovenian Medical Journal, Jan 9, 2010
Izhodišča: Možganska kap (MK) je lahko nevaren zaplet operativnih posegov, ki pomembno poveča inv... more Izhodišča: Možganska kap (MK) je lahko nevaren zaplet operativnih posegov, ki pomembno poveča invalidnost bolnika, poslabša splošni izid zdravljenja in je povezana z bistveno večjo smrtnostjo in stroški zdravljenja. Pomemben dejavnik za nastanek perioperativne možganske kapi so aterosklerotične spremembe na zunajlobanjskih možganskih arterijah, pri čemer ima pomembno mesto karotidna bolezen. Karotidna bolezen predstavlja sinonim za napredovalo aterosklerozo razcepišča karotidnih arterij z zožitvijo ali zaporo zunajlobanjskega dela notranje karotidne arterije (NKA) in je pomemben dejavnik tveganja za perioperativno možgansko kap. Zadnje raziskave kažejo, da gre za zapleteno področje s številnimi protislovnimi pogledi. Pri preprečevanju in obvladovanju perioperativne MK je potreben kompleksen skupinski pristop s prilagajanjem perioperativnega vodenja bolnikov glede na njihove dejavnike tveganja in načrtovani kirurški poseg.
Slovenian Medical Journal, Jan 10, 2012
Background: Complex renal artery aneurysms (RAA) involving major branches of renal artery are dif... more Background: Complex renal artery aneurysms (RAA) involving major branches of renal artery are difficult to treat. Surgery may be associated with extensive invasiveness and morbidity in the context of major intra-abdominal surgery. Stentgrafts or selective coil embolization are contraindicated when large branches are involved in the aneurysmal sac. A case of the patient with complex renal artery aneurysm involving all major arterial branches treated with a new type of multilayer stent is described. Case report: A 56-year old woman whose right kidney had been removed five years before because of renal cell carcinoma was incidentally found to have a large (22 x 26 mm) saccular aneurysm in the main left renal artery involving all three major branches of the renal artery. Via a percutaneous femoral approach a multilayer stent was deployed without complications. Blood flow inside the sac was immediately and significantly reduced. All the renal branches remained patent. Conclusion: New multilayer fluid modulating stent concept appears to be a very useful and attractive alternative to surgery or other endovascular techniques for those RAA involving or very close to major branch vessels, especially in patients with very high risk of loosing the only viable kidney, as in our case. Razširjen povzetek Uvod: Anevrizme ledvične arterije so redke. Pojavljajo se v približno enem odstotku vseh klinično ugotovljenih anevrizem. Običajno so asimptomatske in praviloma jih odkrijemo po naključju. Indikacije o zdravljenju so protislovne. Večina zdravnikov se strinja, da je invazivno zdravljenje smiselno, ko anevrizma po premeru preseže dva centimetra, s čimer narašča tveganje za razpok, trombozo ali disekcijo. Zdravimo jih lahko kirurško ali znotrajžilno. Poseben primer so zapletene anevrizme ledvične arterije, ki zajemajo področje razcepišča poglavitnih vej za parenhim. Znotrajžilno zdravljenje z oplaščenimi opornicami ali z embolizacijo pri takih anevrizmah ni možno. Kirurško zdravljenje pa je tvegano in povezano z večjo pojavnostjo zapletov. Prikazan je primer bolnice z eno samo ledvico, ki je imela zapleteno anevrizmo leve ledvične arterije. Uporabili smo novo vrsto znotrajžilne opornice. Gre za posebno opornico, sestavljeno iz več slojev pletene mreže in brez zunanjega plašča. Posebnost opornice je njena zmožnost, da ohrani pretok krvi v tistih vejah arterije, ki jih prekrije, hkrati pa povzroči trombozo anevrizme. Prikaz primera: Oseminpetdesetletna bolnica je bila napotena iz druge ustanove, kjer je bila na običajnem kontrolnem pregledu trebušne votline z ultrazvokom. Kontrolne preglede so ji opravljali enkrat letno, saj so ji pred petimi leti odstranili desno ledvico zaradi ledvičnega karcinoma. Med pregledom so našli veliko anevrizmo v hilusu leve ledvične arterije. Napravljena je Endovascular repair of renal artery aneurysm with the multilayer stent-a short report Znotrajžilno zdravljenje anevrizme ledvične arterije z novo večslojno mrežasto žilno opornico-kratko poročilo
Introduction. Isolated superior mesenteric artery (SMA) dissection, without associated aortic dis... more Introduction. Isolated superior mesenteric artery (SMA) dissection, without associated aortic dissection, is relatively uncommon. Therefore, there are insufficient data to support a particular therapeutic option in the specific setting of isolated SMA dissection associated with thrombotic complications. Case report. In this article we describe the diagnosis and treatment of a patient who presented to the Emergency Department with the clinical picture of an acute abdomen and signs suggestive of acute occlusion of the SMA. Diagnostic studies showed an isolated SMA dissection with acute thrombotic occlusion of its main branches. The patient was successfully treated with systemic recombinant tissue plasminogen activator (rtPA) thrombolysis. To the best of our knowledge, this is the first description of a case of isolated SMA dissection associated with thrombotic occlusion of its main branches. Conclusion. In patients presenting with persistent abdominal pain and unspecific clinical findings, rare causes should be considered because of their life threatening complications. Systemic thrombolysis is a feasible technique for the treatment of isolated SMA dissection associated with thrombotic complications in the absence of bowel necrosis.
European Journal of Vascular and Endovascular Surgery, 2013
Strojniški vestnik – Journal of Mechanical Engineering, 2015
ABSTRACT
Data Revues 02992213 V24i4 S0299221310003330, Jan 31, 2011
Wiener klinische Wochenschrift, 2015
Symptomatic patients with chronic mesenteric ischemia (CMI) should be treated without much delay ... more Symptomatic patients with chronic mesenteric ischemia (CMI) should be treated without much delay because symptoms of CMI are present in 43 % patients who present with acute mesenteric ischemia. There are few reported series with large numbers of patients undergoing surgery for CMI, and many controversies persist regarding the optimal surgical treatment. These controversies include the type of surgical repair (antegrade vs. retrograde bypass), and the number of arteries that should be treated (single- vs. multiple-vessel reconstruction). It was the aim of presented study to report our experience and long-term results with single-vessel bypass grafting from infrarenal aorta to superior mesenteric artery. Patients who were admitted because of mesenteric ischemia at the surgical clinics of University Clinical Center Maribor between January 1999 and January 2009 were identified with a computerized medical data registry. Patients who underwent revascularization for CMI with retrograde synthetic aortomesenteric bypass were included in the study. Demographics, clinical characteristics, imaging, and operative data were obtained from the medical records. Significant superior mesenteric artery stenosis (> 70 % diameter stenosis) was confirmed by spiral computed angiography. All patients underwent retrograde aortomesenteric arterial bypass with synthetic bypass graft originating from the infrarenal aorta. Doppler sonography combined with color Doppler was used to evaluate disease progression in patients at 3-month interval during the first year and from then at 6-month intervals. Endpoints of the study were occlusion of graft or death by any cause. Data are presented for a cohort of 19 women and 8 men with a mean age at admission 73 years (range 56-88 years). The mean duration of follow-up was 71 months (range 1-118 months). There was one early death (4 %). Four patients died during the follow-up period, and three were lost for follow-up. None of the deaths was connected with mesenteric ischemia. During follow-up period none of the patients developed restenosis, and no occlusions were observed. There were no reinterventions. Symptom improvements were noted in 25 patients (93 %). One patient (4 %) referred to persistent pain despite successful revascularization, although during follow-up period weight gain was observed. At 71 months, freedom from recurrent symptoms, restenosis, and reinterventions was 78 % ± 13.9 %. Surgery for CMI can be safely performed with retrograde approach and single vessel anastomosis. Mortality rates and long-term survival compare favorably with other surgical approaches to treatment of CMI.
Der Unfallchirurg
At the Maribor Teaching Hospital two elderly with progressive atherosclerotic disease below the k... more At the Maribor Teaching Hospital two elderly with progressive atherosclerotic disease below the knee were treated between 1986-1992 for open fracture of ankle joint and pedal arterial trauma. The only patent atherosclerotic vessel (dorsal artery of the foot) that was disrupted was reconstructed in both cases by interposition of a part of the great and small saphenous vein in one case each. A termino-terminal anastomosis with a long, triangular patch was used, fixed with interrupted sutures. The fractures were stabilized with external fixators. Both extremities were saved.
Wiener klinische Wochenschrift
The purpose of the present paper is to analyse diagnostic and therapeutic aspects of carotid body... more The purpose of the present paper is to analyse diagnostic and therapeutic aspects of carotid body tumours. Seven patients with carotid body tumour underwent surgery at our department between 1982 and 1998. All of them had an asymptomatic cervical lateral mass. The preoperative evaluation included angiography in 7 patients, duplex scanning in 2 patients and computed tomography in one patient. Tumour excision was performed in 5. Carotid artery resection with the tumour was required in 2 patients and in both, interposition of a 5-mm polytetrafluoroethylene graft was performed. During the resection, temporary carotid shunt was required in one patient. Perioperative transcranial Doppler was used once; the use of a shunt during carotid artery resection was not required in the second case. All tumours were identified as carotid paragangliomas without evidence of malignancy. There was no mortality and no hemiplegia. After surgery, temporary cranial nerve dysfunction was noted in 2 cases. In the follow-up period of 2 to 14 years (mean, 7 years), no recurrent disease occurred. Patency of the grafts was good at 4 and 7 years after carotid artery reconstruction. We conclude that with non-invasive investigation and arteriography it is possible to obtain an early and precise diagnosis. The decision to perform simple tumour excision or additional arterial resection is based on diagnostic preoperative as well as intraoperative evaluation of the individual tumour. As demonstrated in our cases, after resection of the internal carotid artery a polytetrafluoroethylene graft may be used for carotid reconstruction. Early surgery is recommended because it minimises the risk of complications associated with large tumours.
Intraoperative transcranial Doppler monitoring of intracranial blood flow during carotid endarter... more Intraoperative transcranial Doppler monitoring of intracranial blood flow during carotid endarterectomy, surgical management of intracranial aneurysms and coronary artery bypass grafting is important because it enables recording of the flow in the middle cerebral artery in real time. An adequate blood flow through the middle cerebral artery during carotid endaterectomy allows for selective choice of intraluminal shunt as well as an operation without it, timely identification of cerebral hyperperfusion, vasospasm and hypoperfusion, and detection of cerebral microembolisms, thus minimizing postoperative neurologic complications such as cerebrovascular events or cognitive dysfunction.
Wiener klinische Wochenschrift
Although the presence of arteriovenous communications in patients with chronic venous ulcers has ... more Although the presence of arteriovenous communications in patients with chronic venous ulcers has been confirmed in several studies, their role in the pathogenesis of venous ulcers is still uncertain. They possibly do play an important role in the aetiology of chronic venous insufficiency. There is also substantial evidence to suggest that arteriovenous communications develop as a result of chronic venous hypertension. The question raised in this pilot study was whether the importance of arteriovenous shunts in the genesis of venous ulcer disease is such that their obliteration might lead to long-term healing. This clinical study was also designed to determine whether therapeutic microembolization of nutritive arterial branches to arteriovenous fistulas, found in patients with venous ulcers, facilitates healing of venous ulcers resistant to previous conservative and/or classical surgical treatment. From 1997 to 1999, 34 patients (22 women and 14 men, mean age 51.3 years) with chronic...
Vascular and Endovascular Surgery, 1995
Annals of Vascular Surgery, 2010
True aneurysms of the profunda femoris artery are extremely rare in comparison to pseudoaneurysms... more True aneurysms of the profunda femoris artery are extremely rare in comparison to pseudoaneurysms of the same artery. In most cases they are accompanied by aneurysms of the abdominal aorta or peripheral vessels. The most common reason for aneurysmic dilatation of vessels is a generalized vascular degenerative process. An isolated true aneurysm of the profunda femoris artery due to atherosclerosis is markedly unusual. These aneurysms have a high incidence of complication; therefore surgical management is mandatory for all diagnosed cases regardless of whether they are symptomatic or not. We describe a case of a 73-year-old man with a large isolated atherosclerotic aneurysm of the profunda femoris artery. He presented with an enlarging, progressively debilitating mass in his upper thigh. Ultrasound and computed tomography-angiography demonstrated a 15 x 14 cm large aneurysm of the profunda femoris artery. The patient was successfully treated by aneurysm neck ligation and sac decompression.
Obzornik zdravstvene nege
Uvod: Diabetično stopalo je skupina sindromov, pri katerih nevropatija, ishemija in infekcija pri... more Uvod: Diabetično stopalo je skupina sindromov, pri katerih nevropatija, ishemija in infekcija pripeljejo do destrukcije tkiva, končna posledica je zbolevnost, lahko pa tudi amputacija. Namen raziskave je bil ugotoviti pogostost pojava diabetičnega stopala pri pacientih s sladkorno boleznijo.Metode: V raziskavi je bila uporabljena raziskava mešanih metod. Tehnika zbiranja podatkov je bilo anketiranje 60 pacientov s sladkorno boleznijo in delno strukturiran intervju z dvema medicinskima sestrama, ki delata v diabetološki ambulanti. Kvantitativni podatki so bili analizirani z opisno in bivariatno statistiko. Kvalitativni podatki so bili analizirani s pomočjo metode analize vsebine.Rezultati: Ugotovili smo, da amputacija noge ni pogost zaplet diabetičnega stopala (U = 4,4, p = 0,217) in da ne moremo trditi, da je diabetično stopalo pogostejše pri moških kot pri ženskah (U = 0,6, p = 0,417), ter da so pacienti zelo dobro poučeni glede nege stopal in pravilne obutve.Diskusija in zaključek...
Signa Vitae - A Journal In Intensive Care And Emergency Medicine
Lemierre's syndrome is a complex and unusual clinical entity, characterized by septic thrombophle... more Lemierre's syndrome is a complex and unusual clinical entity, characterized by septic thrombophlebitis of the internal jugular vein. We present the case of a patient with Lemierre's syndrome, pulmonary embolism and propagation of an internal jugular vein thrombus retrograde to the cavernous sinus. The patient was treated with antibiotics and heparin. The importance of rapid diagnosis of the extent of the disease, in directing the otherwise somewhat controversial treatment with heparin in patients with Lemierre's syndrome, is stressed.
Radiology and Oncology
Background Recent reports have shown that patients with vascular tumour invasion who undergo conc... more Background Recent reports have shown that patients with vascular tumour invasion who undergo concurrent vascular resection can achieve long-term survival rates equivalent to those without vascular involvement requiring pancreaticoduodenectomy alone. There is no consensus about which patients benefit from the portal-superior mesenteric vein resection and there is no consensus about the best surgical technique of vessel reconstruction (resection with or without graft reconstruction). As published series are small the aim of this study was to evaluate our experience in pancreatectomies with en bloc vascular resection and reconstruction of vessels. Methods Review of database at University Clinical Centre Maribor identified 133 patients (average age 65.4 ± 8.6 years, 69 female patients) who underwent pancreatoduodenectomy between January 2006 and August 2014. Clinical data, operative results, pathological findings and postoperative outcomes were collected prospectively and analyzed. Curr...
Biomacromolecules, Jan 22, 2017
Local drug delivery systems made from nontoxic polysaccharide nanofilms have an enormous potentia... more Local drug delivery systems made from nontoxic polysaccharide nanofilms have an enormous potential in wound care. A detailed understanding of the structural, surface, physicochemical, and cytotoxic properties of such systems is crucial to design clinically efficacious materials. Herein, we fabricated polysaccharide-based nanofilms onto either a 2D model (SiO2 and Au sensors) or on nonwoven alginate 3D substrates using an alternating assembly of N,N,N-trimethylchitosan (TMC) and alginic acid (ALG) by a spin-assisted layer-by-layer (LbL) technique. These TMC/ALG multilayered nanofilms are used for a uniform encapsulation and controlled release of pentoxifylline (PTX), a potent anti-inflammatory drug for treatment of the chronic venous ulceration. We show a tailorable film growth and mass, morphology, as well as surface properties (charge, hydrophilicity, porosity) of the assembled nanofilms through control of the coating during the spin-assisted assembly. The uniform distribution of t...
Annales De Chirurgie Vasculaire, 2010
Slovenian Medical Journal, Jan 9, 2010
Izhodišča: Možganska kap (MK) je lahko nevaren zaplet operativnih posegov, ki pomembno poveča inv... more Izhodišča: Možganska kap (MK) je lahko nevaren zaplet operativnih posegov, ki pomembno poveča invalidnost bolnika, poslabša splošni izid zdravljenja in je povezana z bistveno večjo smrtnostjo in stroški zdravljenja. Pomemben dejavnik za nastanek perioperativne možganske kapi so aterosklerotične spremembe na zunajlobanjskih možganskih arterijah, pri čemer ima pomembno mesto karotidna bolezen. Karotidna bolezen predstavlja sinonim za napredovalo aterosklerozo razcepišča karotidnih arterij z zožitvijo ali zaporo zunajlobanjskega dela notranje karotidne arterije (NKA) in je pomemben dejavnik tveganja za perioperativno možgansko kap. Zadnje raziskave kažejo, da gre za zapleteno področje s številnimi protislovnimi pogledi. Pri preprečevanju in obvladovanju perioperativne MK je potreben kompleksen skupinski pristop s prilagajanjem perioperativnega vodenja bolnikov glede na njihove dejavnike tveganja in načrtovani kirurški poseg.
Slovenian Medical Journal, Jan 10, 2012
Background: Complex renal artery aneurysms (RAA) involving major branches of renal artery are dif... more Background: Complex renal artery aneurysms (RAA) involving major branches of renal artery are difficult to treat. Surgery may be associated with extensive invasiveness and morbidity in the context of major intra-abdominal surgery. Stentgrafts or selective coil embolization are contraindicated when large branches are involved in the aneurysmal sac. A case of the patient with complex renal artery aneurysm involving all major arterial branches treated with a new type of multilayer stent is described. Case report: A 56-year old woman whose right kidney had been removed five years before because of renal cell carcinoma was incidentally found to have a large (22 x 26 mm) saccular aneurysm in the main left renal artery involving all three major branches of the renal artery. Via a percutaneous femoral approach a multilayer stent was deployed without complications. Blood flow inside the sac was immediately and significantly reduced. All the renal branches remained patent. Conclusion: New multilayer fluid modulating stent concept appears to be a very useful and attractive alternative to surgery or other endovascular techniques for those RAA involving or very close to major branch vessels, especially in patients with very high risk of loosing the only viable kidney, as in our case. Razširjen povzetek Uvod: Anevrizme ledvične arterije so redke. Pojavljajo se v približno enem odstotku vseh klinično ugotovljenih anevrizem. Običajno so asimptomatske in praviloma jih odkrijemo po naključju. Indikacije o zdravljenju so protislovne. Večina zdravnikov se strinja, da je invazivno zdravljenje smiselno, ko anevrizma po premeru preseže dva centimetra, s čimer narašča tveganje za razpok, trombozo ali disekcijo. Zdravimo jih lahko kirurško ali znotrajžilno. Poseben primer so zapletene anevrizme ledvične arterije, ki zajemajo področje razcepišča poglavitnih vej za parenhim. Znotrajžilno zdravljenje z oplaščenimi opornicami ali z embolizacijo pri takih anevrizmah ni možno. Kirurško zdravljenje pa je tvegano in povezano z večjo pojavnostjo zapletov. Prikazan je primer bolnice z eno samo ledvico, ki je imela zapleteno anevrizmo leve ledvične arterije. Uporabili smo novo vrsto znotrajžilne opornice. Gre za posebno opornico, sestavljeno iz več slojev pletene mreže in brez zunanjega plašča. Posebnost opornice je njena zmožnost, da ohrani pretok krvi v tistih vejah arterije, ki jih prekrije, hkrati pa povzroči trombozo anevrizme. Prikaz primera: Oseminpetdesetletna bolnica je bila napotena iz druge ustanove, kjer je bila na običajnem kontrolnem pregledu trebušne votline z ultrazvokom. Kontrolne preglede so ji opravljali enkrat letno, saj so ji pred petimi leti odstranili desno ledvico zaradi ledvičnega karcinoma. Med pregledom so našli veliko anevrizmo v hilusu leve ledvične arterije. Napravljena je Endovascular repair of renal artery aneurysm with the multilayer stent-a short report Znotrajžilno zdravljenje anevrizme ledvične arterije z novo večslojno mrežasto žilno opornico-kratko poročilo
Introduction. Isolated superior mesenteric artery (SMA) dissection, without associated aortic dis... more Introduction. Isolated superior mesenteric artery (SMA) dissection, without associated aortic dissection, is relatively uncommon. Therefore, there are insufficient data to support a particular therapeutic option in the specific setting of isolated SMA dissection associated with thrombotic complications. Case report. In this article we describe the diagnosis and treatment of a patient who presented to the Emergency Department with the clinical picture of an acute abdomen and signs suggestive of acute occlusion of the SMA. Diagnostic studies showed an isolated SMA dissection with acute thrombotic occlusion of its main branches. The patient was successfully treated with systemic recombinant tissue plasminogen activator (rtPA) thrombolysis. To the best of our knowledge, this is the first description of a case of isolated SMA dissection associated with thrombotic occlusion of its main branches. Conclusion. In patients presenting with persistent abdominal pain and unspecific clinical findings, rare causes should be considered because of their life threatening complications. Systemic thrombolysis is a feasible technique for the treatment of isolated SMA dissection associated with thrombotic complications in the absence of bowel necrosis.
European Journal of Vascular and Endovascular Surgery, 2013
Strojniški vestnik – Journal of Mechanical Engineering, 2015
ABSTRACT
Data Revues 02992213 V24i4 S0299221310003330, Jan 31, 2011
Wiener klinische Wochenschrift, 2015
Symptomatic patients with chronic mesenteric ischemia (CMI) should be treated without much delay ... more Symptomatic patients with chronic mesenteric ischemia (CMI) should be treated without much delay because symptoms of CMI are present in 43 % patients who present with acute mesenteric ischemia. There are few reported series with large numbers of patients undergoing surgery for CMI, and many controversies persist regarding the optimal surgical treatment. These controversies include the type of surgical repair (antegrade vs. retrograde bypass), and the number of arteries that should be treated (single- vs. multiple-vessel reconstruction). It was the aim of presented study to report our experience and long-term results with single-vessel bypass grafting from infrarenal aorta to superior mesenteric artery. Patients who were admitted because of mesenteric ischemia at the surgical clinics of University Clinical Center Maribor between January 1999 and January 2009 were identified with a computerized medical data registry. Patients who underwent revascularization for CMI with retrograde synthetic aortomesenteric bypass were included in the study. Demographics, clinical characteristics, imaging, and operative data were obtained from the medical records. Significant superior mesenteric artery stenosis (> 70 % diameter stenosis) was confirmed by spiral computed angiography. All patients underwent retrograde aortomesenteric arterial bypass with synthetic bypass graft originating from the infrarenal aorta. Doppler sonography combined with color Doppler was used to evaluate disease progression in patients at 3-month interval during the first year and from then at 6-month intervals. Endpoints of the study were occlusion of graft or death by any cause. Data are presented for a cohort of 19 women and 8 men with a mean age at admission 73 years (range 56-88 years). The mean duration of follow-up was 71 months (range 1-118 months). There was one early death (4 %). Four patients died during the follow-up period, and three were lost for follow-up. None of the deaths was connected with mesenteric ischemia. During follow-up period none of the patients developed restenosis, and no occlusions were observed. There were no reinterventions. Symptom improvements were noted in 25 patients (93 %). One patient (4 %) referred to persistent pain despite successful revascularization, although during follow-up period weight gain was observed. At 71 months, freedom from recurrent symptoms, restenosis, and reinterventions was 78 % ± 13.9 %. Surgery for CMI can be safely performed with retrograde approach and single vessel anastomosis. Mortality rates and long-term survival compare favorably with other surgical approaches to treatment of CMI.
Der Unfallchirurg
At the Maribor Teaching Hospital two elderly with progressive atherosclerotic disease below the k... more At the Maribor Teaching Hospital two elderly with progressive atherosclerotic disease below the knee were treated between 1986-1992 for open fracture of ankle joint and pedal arterial trauma. The only patent atherosclerotic vessel (dorsal artery of the foot) that was disrupted was reconstructed in both cases by interposition of a part of the great and small saphenous vein in one case each. A termino-terminal anastomosis with a long, triangular patch was used, fixed with interrupted sutures. The fractures were stabilized with external fixators. Both extremities were saved.
Wiener klinische Wochenschrift
The purpose of the present paper is to analyse diagnostic and therapeutic aspects of carotid body... more The purpose of the present paper is to analyse diagnostic and therapeutic aspects of carotid body tumours. Seven patients with carotid body tumour underwent surgery at our department between 1982 and 1998. All of them had an asymptomatic cervical lateral mass. The preoperative evaluation included angiography in 7 patients, duplex scanning in 2 patients and computed tomography in one patient. Tumour excision was performed in 5. Carotid artery resection with the tumour was required in 2 patients and in both, interposition of a 5-mm polytetrafluoroethylene graft was performed. During the resection, temporary carotid shunt was required in one patient. Perioperative transcranial Doppler was used once; the use of a shunt during carotid artery resection was not required in the second case. All tumours were identified as carotid paragangliomas without evidence of malignancy. There was no mortality and no hemiplegia. After surgery, temporary cranial nerve dysfunction was noted in 2 cases. In the follow-up period of 2 to 14 years (mean, 7 years), no recurrent disease occurred. Patency of the grafts was good at 4 and 7 years after carotid artery reconstruction. We conclude that with non-invasive investigation and arteriography it is possible to obtain an early and precise diagnosis. The decision to perform simple tumour excision or additional arterial resection is based on diagnostic preoperative as well as intraoperative evaluation of the individual tumour. As demonstrated in our cases, after resection of the internal carotid artery a polytetrafluoroethylene graft may be used for carotid reconstruction. Early surgery is recommended because it minimises the risk of complications associated with large tumours.
Intraoperative transcranial Doppler monitoring of intracranial blood flow during carotid endarter... more Intraoperative transcranial Doppler monitoring of intracranial blood flow during carotid endarterectomy, surgical management of intracranial aneurysms and coronary artery bypass grafting is important because it enables recording of the flow in the middle cerebral artery in real time. An adequate blood flow through the middle cerebral artery during carotid endaterectomy allows for selective choice of intraluminal shunt as well as an operation without it, timely identification of cerebral hyperperfusion, vasospasm and hypoperfusion, and detection of cerebral microembolisms, thus minimizing postoperative neurologic complications such as cerebrovascular events or cognitive dysfunction.
Wiener klinische Wochenschrift
Although the presence of arteriovenous communications in patients with chronic venous ulcers has ... more Although the presence of arteriovenous communications in patients with chronic venous ulcers has been confirmed in several studies, their role in the pathogenesis of venous ulcers is still uncertain. They possibly do play an important role in the aetiology of chronic venous insufficiency. There is also substantial evidence to suggest that arteriovenous communications develop as a result of chronic venous hypertension. The question raised in this pilot study was whether the importance of arteriovenous shunts in the genesis of venous ulcer disease is such that their obliteration might lead to long-term healing. This clinical study was also designed to determine whether therapeutic microembolization of nutritive arterial branches to arteriovenous fistulas, found in patients with venous ulcers, facilitates healing of venous ulcers resistant to previous conservative and/or classical surgical treatment. From 1997 to 1999, 34 patients (22 women and 14 men, mean age 51.3 years) with chronic...
Vascular and Endovascular Surgery, 1995
Annals of Vascular Surgery, 2010
True aneurysms of the profunda femoris artery are extremely rare in comparison to pseudoaneurysms... more True aneurysms of the profunda femoris artery are extremely rare in comparison to pseudoaneurysms of the same artery. In most cases they are accompanied by aneurysms of the abdominal aorta or peripheral vessels. The most common reason for aneurysmic dilatation of vessels is a generalized vascular degenerative process. An isolated true aneurysm of the profunda femoris artery due to atherosclerosis is markedly unusual. These aneurysms have a high incidence of complication; therefore surgical management is mandatory for all diagnosed cases regardless of whether they are symptomatic or not. We describe a case of a 73-year-old man with a large isolated atherosclerotic aneurysm of the profunda femoris artery. He presented with an enlarging, progressively debilitating mass in his upper thigh. Ultrasound and computed tomography-angiography demonstrated a 15 x 14 cm large aneurysm of the profunda femoris artery. The patient was successfully treated by aneurysm neck ligation and sac decompression.