The role of intraluminal thrombus (ILT) has special attention in these studies. One of the papers... more The role of intraluminal thrombus (ILT) has special attention in these studies. One of the papers showed that asymmetrical intraluminal thrombus deposition (ATDI) has an important role in growth of the AAA. The aim of our study was to assess the asymmetrical thrombus deposition index in ruptured and symptomatic aneurysms. We collected data for 33 aneurysms, 21 (63.63%) asymptomatic and 12 (33.37%) ruptured or symptomatic. Asymmetrical thrombus deposition index (ATDI) was measured by Onis DICOM viewer software. Also, lumen's geometrical centre (LGC) was defined and ATDI was considered positive when the LGC was laid on the posterior section of the sac (meaning dominant anterior ILT distribution) and negative when it was laid on the anterior section (meaning dominant posterior ILT distribution). Maximum aneurysm diameter was 63.4mm in average (50-100mm, SD=12.89); 59.8mm in asymptomatic and 71.16mm in symptomatic or ruptured aneurysm (p=0.012). The absolute value of asymmetric thrombus deposition index was significantly higher in symptomatic/ruptured compared to asymptomatic aneurysm, 0.54 and 0.33, respectively (p=0.041), while there was no difference in frequency of positive or negative thrombus deposition (p=0.261). There was no significant correlation between maximal aneurysm size and absolute value of ATDI (p=0.505). Values of thrombus deposition index are correlating with the development of symptomatology or rupture of the AAA. This variable should be included in much wider mathematical rupture prediction model in order to have more accurate rupture risk assessment.
Background Horseshoe kidney is a well-known congenital anomaly and the most common anomaly of the... more Background Horseshoe kidney is a well-known congenital anomaly and the most common anomaly of the upper urinary tract. This condition is rarely associated with anomalous inferior vena cava (IVC). Polycystic horseshoe kidney is a very rare occurrence and however IVC anomalies common with polycistic disease are an increasingly recognized risk factor for iliofemoral deep venous thrombosis. Method We present a case of 75-year-old patient with recurrent deep vein thrombosis (DVT) of right leg as a result of compression of large horseshoe kidney cysts in double inferior vena cava. Results Large renal cyst were successful treated percutaneously punctured for the relief of compression and received injection of acidic solutions of 95% ethanol under ultrasound guidance for prevention against re-accumulation of cyst fluid. Conclusion Percutaneous aspiration with ultrasound guidance with injection of sclerosing solutions as a relatively simple procedure and can be the method of choice for treatment of renal cysts. Also, any recurrent deep vein thrombosis on lower extremity requires additional evaluation in the form of an ultrasound or multidetector computed tomography examination of the abdomen.
ObjectivesPreoperative anxiety is common and might affect surgical treatment outcomes. The aim wa... more ObjectivesPreoperative anxiety is common and might affect surgical treatment outcomes. The aim was to translate and validate the Serbian version of the Amsterdam Preoperative Anxiety and Information Scale (APAIS).MethodsFollowing translation and initial evaluation, the Serbian version (S‐APAIS) was administered to 385 patients. Internal consistency, construct validity, prognostic criteria validity, and concurrent validity between S‐APAIS and Visual Analogue Scale for Anxiety (VAS‐A) were evaluated.ResultsFactor analysis revealed two factors: APAIS‐anesthesia (items 1, 2, 3) and APAIS‐procedure (items 4, 5, 6). The whole scale, APAIS‐anesthesia, and APAIS‐procedure subscales showed an adequate level of internal consistency (Cronbach's αs: 0.787, 0.806, and 0.805, respectively). High concurrent validity was observed between APAIS‐anesthesia and VAS‐A (ρ = 0.628, p < .001). A moderate correlation was found between APAIS‐procedure and VAS‐A scale (ρ = 0.537, p < .001). At the cut‐off point of 9, the area under the curve (AUC) of APAIS‐anesthesia was 0.815 (95% CI: 0.77–0.85, p < .001). For the APAIS‐procedure, AUC was 0.772 (95% CI: 0.73–0.81, p < .001) at the cut‐off point of 8.ConclusionThe structure of S‐APAIS substantially differs from the original and allows separate measurement of anesthesia‐ and procedure‐related anxieties. S‐APAIS is a comprehensive, valid, and reliable instrument for the measurement of preoperative anxiety.
Background: Most recent publications have shown that the recombinant form of activated factor VII... more Background: Most recent publications have shown that the recombinant form of activated factor VII (rFVIIa; NovoSeven, Novo Nordisk A/S, Bagsvaerd, Denmark) induces excellent hemostasis in patients with severe intractable bleeding caused by trauma and major surgery. The purpose of this study was to determine the influence of rFVIIa on the treatment of intractable perioperative bleeding in vascular surgery when conventional hemostatic measures are inadequate. Materials and Methods: There were two groups of patients: the NovoSeven group (group N), 10 patients with ruptured abdominal aortic aneurysms (RAAAs) and 14 patients operated on due to thoracoabdominal aortic aneurysms (TAAAs); the control group (group C), 14 patients with RAAAs and 17 patients with TAAAs. All patients suffered intractable hemorrhage refractory to conventional hemostatic measures, while patients from group N were additionally treated with rFVIIa. Results: Postoperative blood loss was significantly lower in group N treated with rFVII (P < .0001). Postoperative administration of packed red blood cells, fresh frozen plasma, and platelets was lower in patients from group N, (P < .0001). Successful hemorrhage arrest was reported in 21 patients (87.5%) treated with rFVIIa, and in 9 patients (29.03%) in group C (P < .001). Thirty-day mortality in these two groups significantly differed. The mortality rate was 12.5% (3 patients) in group N and 80.65% (25 patients) in group C (P < .0001). Conclusion: Our findings suggest that rFVIIa may play a role in controlling the intractable perioperative and postoperative bleeding in surgical patients undergoing a repair of RAAAs and TAAAs. Certainly, prospective randomized trials are necessary to further confirm the efficacy and cost-effectiveness of rFVIIa in these patients.
Background The purpose of the present study is to evaluate if there is a specific relationship of... more Background The purpose of the present study is to evaluate if there is a specific relationship of the acute-phase proteins between patients with the chronic aortic occlusion (COA) and patients with diffuse aortoiliac occlusive disease (AIOD), and to investigate if there is a correlation between the acute phase proteins and the extent of disease. Methods Sixty patients with the aortoiliac occlusive disease were divided in two groups. First group consisted of thirty patients with the angiographic signs of diffuse aortoiliac occlusive disease, Leriche type III (AIOD group). Second (COA) group consisted of 30 patients characterized by either bifurcated aortic occlusion or juxtarenal aortic occlusion. Those two groups were compared according to symptomatology, ankle-brachial index (ABI) values, traditional risk factors and some acute phase proteins (high-sensitivity C-reactive protein-hs-CRP; homocysteine) taken at inclusion. Results The median serum hs-CRP was 4.85 mg/L and 15.7 mg/L in AIOD group and COA group, respectively. The difference was statistically significant (p=0.016). The mean plasma homocysteine was 21.44±11.25 mmol/L and 14.76±7.85 mmol/L in the AIOD group and COA group, respectively. Mean plasma homocysteine was significantly higher in patients with AIOD (p=0.005). Conclusions Our data demonstrate significant difference in hs-CRP and homocysteine concentrations among two variants of aortoiliac occlusive disease. In this particular pathology as COA, high hs-CRP concentration does not associate, at least with the angiographic extent of disease.
<p><b>(A)</b> variations of NSE concentrations; <b>(B)</b> variatio... more <p><b>(A)</b> variations of NSE concentrations; <b>(B)</b> variations of protein S-100B concentrations; *—P<0.01</p
Atherosclerosis is the most common cause of Aortic Arch Vessels diseases. Less common are dissect... more Atherosclerosis is the most common cause of Aortic Arch Vessels diseases. Less common are dissection, embolization, compressive syndromes of the upper thoracic outlet, and various types of arteritis (Takayasu, giant cell arteritis etc.). Left subclavicular artery is most commonly affected. Due to anatomical reasons, chronical stenosans and occlusive lesions of major arterial branches often stay asymptomatic and therefore undiagnosed for a long period of time. It is not a rare case that lesions of supraaortic branches are presented by the gangrene in certain parts of hand. Good anamnesis is of huge importance, as well as careful physical examination, which requires radial pulse palpation in normal and provoked positions. The term Thoracic Outlet Syndrome (TOS) is represented as a group of neurological and vascular syndromes on the upper extremity caused by compression on brachial plexus and subclavicular vessels by the bone or soft tissue structures which abnormally compress nerves or blood vessels exiting the thoracal cavity. The aim of this study is to remind physicians in the primary health care of the simplicity of physical diagnostics of these diseases and of the great advantage of timely consultation with a vascular surgeon.
Background: Pediatric peripheral vascular trauma carries significant risk of complications includ... more Background: Pediatric peripheral vascular trauma carries significant risk of complications including limb loss and long-term invalidity. Mechanisms and types of morphological lesions are very diverse. The objectives of this study are to present the experience of a single vascular center in the surgical approach to pediatric vascular injuries, and to analyze the main challenges related to this clinical entity. Methods: Over a period of 25 years, 17 pediatric peripheral vascular injuries were treated in our institution. Patient's age ranged between one day (newborn) and 15 years (mean: 10.7 years). There were five injuries of upper and 12 injuries of the lower extremity. Preoperative diagnosis was established by clinical examination (N.=4), ultrasonography (N.=1) and angiography (N.=12). Blunt trauma mainly caused arterial thrombosis while penetrating trauma caused arterial laceration or complete transection. Five patients had associated orthopedic injuries (29,4%). There were two posttraumatic pseudoaneurysms and two arterio-venous fistulas. Results: There was no perioperative mortality. Vascular reconstructions included arterial suture (N.=4), thrombectomy + patch angioplasty (N.=1), termino-terminal anastomosis (N.=3), venous anatomic bypass (N.=6), PTFE graft reconstruction (N.=2), and venous extra-anatomic reconstruction (N.=1). Two patients had associated venous injury demanding both arterial and venous reconstruction. In the only case of war trauma treatment ended with limb loss. Other reconstructions presented good early and long-term patency. Conclusions: Pediatric vascular injuries are extremely challenging issues. Treatment includes broad spectrum of different types of vascular reconstructions. It should be performed by vascular surgeon trained in open vascular treatment or pediatric surgeon with significant experience in vascular surgery.
Objectives: The study aimed to identify differences and compare anatomical and biomechanical feat... more Objectives: The study aimed to identify differences and compare anatomical and biomechanical features between elective and ruptured abdominal aortic aneurysms (AAAs). Methods: Data (clinical, anatomical, and biomechanical) of 98 patients with AAA, 75 (76.53%) asymptomatic (Group aAAA) and 23 (23.46%) ruptured AAA (Group rAAA), were prospectively collected and analyzed. Anatomical, morphological, and biomechanical imaging markers like peak wall stress (PWS) and rupture risk equivalent diameter (RRED), comorbid conditions, and demographics were compared between the groups. Biomechanical features were assessed by analysis of Digital Imaging and Communication in Medicine images by A4clinics (Vascops), and anatomical features were assessed by 3Surgery (Trimensio). Binary and multiple logistic regression analysis were used and adjusted for confounders. Accuracy was assessed using receiving operative characteristic (ROC) curve analysis. Results: In a multivariable model, including gender and age as confounder variables, maximal aneurysm diameter [MAD, odds ratio (OR) = 1.063], relative intraluminal thrombus (rILT, OR = 1.039), and total aneurysm volume (TAV, OR = 1.006) continued to be significant predictors of AAA rupture with PWS (OR = 1.010) and RRED (OR = 1.031). Area under the ROC curve values and correct classification (cc) for the same parameters and the model that combines MAD, TAV, and rILT were measured: MAD (0.790, cc = 75%), PWS (0.713, cc = 73%), RRED (0.717, cc = 55%), TAV (0.756, cc = 79%), rILT (0.656, cc = 60%), and MAD + TAV + rILT (0.797, cc = 82%). Conclusion: Based on our results, in addition to MAD, other important predictors of rupture that might be used during aneurysm surveillance are TAV and rILT. Biomechanical parameters (PWS, RRED) as valuable predictors should be assessed in prospective clinical trials. Similar studies on AAA smaller than 55 mm in diameter, even difficult to organize, would be of even greater clinical value.
1. Am Surg. 2011 Jan;77(1):19-21. Bilateral Isolated Axillary Aneurysms. Vasic D, Radmili O, Drag... more 1. Am Surg. 2011 Jan;77(1):19-21. Bilateral Isolated Axillary Aneurysms. Vasic D, Radmili O, Dragas M, Davidovic L, Vranes M. Vascular Surgery Clinic, Clinical Centre of Serbia, Belgrade, Serbia. PMID: 21396298 [PubMed - as supplied by publisher].
13th IEEE International Conference on BioInformatics and BioEngineering, 2013
Aneurysm rupture is a biomechanical phenomenon that occurs when the mechanical stress acting on t... more Aneurysm rupture is a biomechanical phenomenon that occurs when the mechanical stress acting on the inner wall exceeds the failure strength of the diseased aortic tissue. Besides numerous advantages in surgical and anaesthesiological management, emergency procedure leads to fatal outcome in 20-50% of those who reach hospital. Prediction of influence of dynamic blood flow on natural history of aneurysmatic disease and outcome of therapeutic procedures could contribute to treatment strategy and results. In this study we presented experimental design for estimation of the material property of real human aorta tissue from bubble inflation test. Then we investigated fluid-structure interaction of pulsatile blood flow in the specific patient threedimensional model of abdominal aortic aneurysms (AAAs). Numerical predictions of blood flow patterns and nonlinear wall stresses in AAAs are performed in compliant wall anisotropic model using the finite element method. These computational procedures together with experimental determination of the nonlinear material property could provide us more accurate assessment of aneurysm rupture risk.
We sought to analyze the early results of civil and war peripheral arterial injury treatment and ... more We sought to analyze the early results of civil and war peripheral arterial injury treatment and to identify risk factors associated with limb loss. Between 1992 and 2001, data collected retrospectively and prospectively on 413 patients with 448 peripheral arterial injuries were analyzed. Of these, there were 140 patients with war injuries and 273 patients with civil injuries. The mechanism of injury was gunshot in 40%, blunt injury in 24%, explosive trauma in 20.3%, and stabbing in 15.7% of the cases. The most frequently injured vessels were the femoral arteries (37.3%), followed by the popliteal (27.8%), axillary and brachial (23.5%), and crural arteries (6.5%). Associated injuries, which included bone, nerve, and remote injuries affecting the head, chest, or abdomen, were present in 60.8% of the cases. Surgery was carried out on all patients, with a limb salvage rate of 89.1% and a survival rate of 97.3%. In spite of a rising trend in peripheral arterial injuries, our total and delayed amputation rates remained stable. On statistical analysis, significant risk factors for amputation were found to be failed revascularization, associated injuries, secondary operation, explosive injury, war injury ( p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .01) and arterial contusion with consecutive thrombosis, popliteal artery injury, and late surgery ( p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .05). Peripheral arterial injuries, if inadequately treated, carry a high amputation rate. Explosive injuries are the most likely to lead to amputations, whereas stab injuries are the least likely to do so. The most significant independent risk factor for limb loss was failed revascularization.
The role of intraluminal thrombus (ILT) has special attention in these studies. One of the papers... more The role of intraluminal thrombus (ILT) has special attention in these studies. One of the papers showed that asymmetrical intraluminal thrombus deposition (ATDI) has an important role in growth of the AAA. The aim of our study was to assess the asymmetrical thrombus deposition index in ruptured and symptomatic aneurysms. We collected data for 33 aneurysms, 21 (63.63%) asymptomatic and 12 (33.37%) ruptured or symptomatic. Asymmetrical thrombus deposition index (ATDI) was measured by Onis DICOM viewer software. Also, lumen's geometrical centre (LGC) was defined and ATDI was considered positive when the LGC was laid on the posterior section of the sac (meaning dominant anterior ILT distribution) and negative when it was laid on the anterior section (meaning dominant posterior ILT distribution). Maximum aneurysm diameter was 63.4mm in average (50-100mm, SD=12.89); 59.8mm in asymptomatic and 71.16mm in symptomatic or ruptured aneurysm (p=0.012). The absolute value of asymmetric thrombus deposition index was significantly higher in symptomatic/ruptured compared to asymptomatic aneurysm, 0.54 and 0.33, respectively (p=0.041), while there was no difference in frequency of positive or negative thrombus deposition (p=0.261). There was no significant correlation between maximal aneurysm size and absolute value of ATDI (p=0.505). Values of thrombus deposition index are correlating with the development of symptomatology or rupture of the AAA. This variable should be included in much wider mathematical rupture prediction model in order to have more accurate rupture risk assessment.
Background Horseshoe kidney is a well-known congenital anomaly and the most common anomaly of the... more Background Horseshoe kidney is a well-known congenital anomaly and the most common anomaly of the upper urinary tract. This condition is rarely associated with anomalous inferior vena cava (IVC). Polycystic horseshoe kidney is a very rare occurrence and however IVC anomalies common with polycistic disease are an increasingly recognized risk factor for iliofemoral deep venous thrombosis. Method We present a case of 75-year-old patient with recurrent deep vein thrombosis (DVT) of right leg as a result of compression of large horseshoe kidney cysts in double inferior vena cava. Results Large renal cyst were successful treated percutaneously punctured for the relief of compression and received injection of acidic solutions of 95% ethanol under ultrasound guidance for prevention against re-accumulation of cyst fluid. Conclusion Percutaneous aspiration with ultrasound guidance with injection of sclerosing solutions as a relatively simple procedure and can be the method of choice for treatment of renal cysts. Also, any recurrent deep vein thrombosis on lower extremity requires additional evaluation in the form of an ultrasound or multidetector computed tomography examination of the abdomen.
ObjectivesPreoperative anxiety is common and might affect surgical treatment outcomes. The aim wa... more ObjectivesPreoperative anxiety is common and might affect surgical treatment outcomes. The aim was to translate and validate the Serbian version of the Amsterdam Preoperative Anxiety and Information Scale (APAIS).MethodsFollowing translation and initial evaluation, the Serbian version (S‐APAIS) was administered to 385 patients. Internal consistency, construct validity, prognostic criteria validity, and concurrent validity between S‐APAIS and Visual Analogue Scale for Anxiety (VAS‐A) were evaluated.ResultsFactor analysis revealed two factors: APAIS‐anesthesia (items 1, 2, 3) and APAIS‐procedure (items 4, 5, 6). The whole scale, APAIS‐anesthesia, and APAIS‐procedure subscales showed an adequate level of internal consistency (Cronbach's αs: 0.787, 0.806, and 0.805, respectively). High concurrent validity was observed between APAIS‐anesthesia and VAS‐A (ρ = 0.628, p < .001). A moderate correlation was found between APAIS‐procedure and VAS‐A scale (ρ = 0.537, p < .001). At the cut‐off point of 9, the area under the curve (AUC) of APAIS‐anesthesia was 0.815 (95% CI: 0.77–0.85, p < .001). For the APAIS‐procedure, AUC was 0.772 (95% CI: 0.73–0.81, p < .001) at the cut‐off point of 8.ConclusionThe structure of S‐APAIS substantially differs from the original and allows separate measurement of anesthesia‐ and procedure‐related anxieties. S‐APAIS is a comprehensive, valid, and reliable instrument for the measurement of preoperative anxiety.
Background: Most recent publications have shown that the recombinant form of activated factor VII... more Background: Most recent publications have shown that the recombinant form of activated factor VII (rFVIIa; NovoSeven, Novo Nordisk A/S, Bagsvaerd, Denmark) induces excellent hemostasis in patients with severe intractable bleeding caused by trauma and major surgery. The purpose of this study was to determine the influence of rFVIIa on the treatment of intractable perioperative bleeding in vascular surgery when conventional hemostatic measures are inadequate. Materials and Methods: There were two groups of patients: the NovoSeven group (group N), 10 patients with ruptured abdominal aortic aneurysms (RAAAs) and 14 patients operated on due to thoracoabdominal aortic aneurysms (TAAAs); the control group (group C), 14 patients with RAAAs and 17 patients with TAAAs. All patients suffered intractable hemorrhage refractory to conventional hemostatic measures, while patients from group N were additionally treated with rFVIIa. Results: Postoperative blood loss was significantly lower in group N treated with rFVII (P < .0001). Postoperative administration of packed red blood cells, fresh frozen plasma, and platelets was lower in patients from group N, (P < .0001). Successful hemorrhage arrest was reported in 21 patients (87.5%) treated with rFVIIa, and in 9 patients (29.03%) in group C (P < .001). Thirty-day mortality in these two groups significantly differed. The mortality rate was 12.5% (3 patients) in group N and 80.65% (25 patients) in group C (P < .0001). Conclusion: Our findings suggest that rFVIIa may play a role in controlling the intractable perioperative and postoperative bleeding in surgical patients undergoing a repair of RAAAs and TAAAs. Certainly, prospective randomized trials are necessary to further confirm the efficacy and cost-effectiveness of rFVIIa in these patients.
Background The purpose of the present study is to evaluate if there is a specific relationship of... more Background The purpose of the present study is to evaluate if there is a specific relationship of the acute-phase proteins between patients with the chronic aortic occlusion (COA) and patients with diffuse aortoiliac occlusive disease (AIOD), and to investigate if there is a correlation between the acute phase proteins and the extent of disease. Methods Sixty patients with the aortoiliac occlusive disease were divided in two groups. First group consisted of thirty patients with the angiographic signs of diffuse aortoiliac occlusive disease, Leriche type III (AIOD group). Second (COA) group consisted of 30 patients characterized by either bifurcated aortic occlusion or juxtarenal aortic occlusion. Those two groups were compared according to symptomatology, ankle-brachial index (ABI) values, traditional risk factors and some acute phase proteins (high-sensitivity C-reactive protein-hs-CRP; homocysteine) taken at inclusion. Results The median serum hs-CRP was 4.85 mg/L and 15.7 mg/L in AIOD group and COA group, respectively. The difference was statistically significant (p=0.016). The mean plasma homocysteine was 21.44±11.25 mmol/L and 14.76±7.85 mmol/L in the AIOD group and COA group, respectively. Mean plasma homocysteine was significantly higher in patients with AIOD (p=0.005). Conclusions Our data demonstrate significant difference in hs-CRP and homocysteine concentrations among two variants of aortoiliac occlusive disease. In this particular pathology as COA, high hs-CRP concentration does not associate, at least with the angiographic extent of disease.
<p><b>(A)</b> variations of NSE concentrations; <b>(B)</b> variatio... more <p><b>(A)</b> variations of NSE concentrations; <b>(B)</b> variations of protein S-100B concentrations; *—P<0.01</p
Atherosclerosis is the most common cause of Aortic Arch Vessels diseases. Less common are dissect... more Atherosclerosis is the most common cause of Aortic Arch Vessels diseases. Less common are dissection, embolization, compressive syndromes of the upper thoracic outlet, and various types of arteritis (Takayasu, giant cell arteritis etc.). Left subclavicular artery is most commonly affected. Due to anatomical reasons, chronical stenosans and occlusive lesions of major arterial branches often stay asymptomatic and therefore undiagnosed for a long period of time. It is not a rare case that lesions of supraaortic branches are presented by the gangrene in certain parts of hand. Good anamnesis is of huge importance, as well as careful physical examination, which requires radial pulse palpation in normal and provoked positions. The term Thoracic Outlet Syndrome (TOS) is represented as a group of neurological and vascular syndromes on the upper extremity caused by compression on brachial plexus and subclavicular vessels by the bone or soft tissue structures which abnormally compress nerves or blood vessels exiting the thoracal cavity. The aim of this study is to remind physicians in the primary health care of the simplicity of physical diagnostics of these diseases and of the great advantage of timely consultation with a vascular surgeon.
Background: Pediatric peripheral vascular trauma carries significant risk of complications includ... more Background: Pediatric peripheral vascular trauma carries significant risk of complications including limb loss and long-term invalidity. Mechanisms and types of morphological lesions are very diverse. The objectives of this study are to present the experience of a single vascular center in the surgical approach to pediatric vascular injuries, and to analyze the main challenges related to this clinical entity. Methods: Over a period of 25 years, 17 pediatric peripheral vascular injuries were treated in our institution. Patient's age ranged between one day (newborn) and 15 years (mean: 10.7 years). There were five injuries of upper and 12 injuries of the lower extremity. Preoperative diagnosis was established by clinical examination (N.=4), ultrasonography (N.=1) and angiography (N.=12). Blunt trauma mainly caused arterial thrombosis while penetrating trauma caused arterial laceration or complete transection. Five patients had associated orthopedic injuries (29,4%). There were two posttraumatic pseudoaneurysms and two arterio-venous fistulas. Results: There was no perioperative mortality. Vascular reconstructions included arterial suture (N.=4), thrombectomy + patch angioplasty (N.=1), termino-terminal anastomosis (N.=3), venous anatomic bypass (N.=6), PTFE graft reconstruction (N.=2), and venous extra-anatomic reconstruction (N.=1). Two patients had associated venous injury demanding both arterial and venous reconstruction. In the only case of war trauma treatment ended with limb loss. Other reconstructions presented good early and long-term patency. Conclusions: Pediatric vascular injuries are extremely challenging issues. Treatment includes broad spectrum of different types of vascular reconstructions. It should be performed by vascular surgeon trained in open vascular treatment or pediatric surgeon with significant experience in vascular surgery.
Objectives: The study aimed to identify differences and compare anatomical and biomechanical feat... more Objectives: The study aimed to identify differences and compare anatomical and biomechanical features between elective and ruptured abdominal aortic aneurysms (AAAs). Methods: Data (clinical, anatomical, and biomechanical) of 98 patients with AAA, 75 (76.53%) asymptomatic (Group aAAA) and 23 (23.46%) ruptured AAA (Group rAAA), were prospectively collected and analyzed. Anatomical, morphological, and biomechanical imaging markers like peak wall stress (PWS) and rupture risk equivalent diameter (RRED), comorbid conditions, and demographics were compared between the groups. Biomechanical features were assessed by analysis of Digital Imaging and Communication in Medicine images by A4clinics (Vascops), and anatomical features were assessed by 3Surgery (Trimensio). Binary and multiple logistic regression analysis were used and adjusted for confounders. Accuracy was assessed using receiving operative characteristic (ROC) curve analysis. Results: In a multivariable model, including gender and age as confounder variables, maximal aneurysm diameter [MAD, odds ratio (OR) = 1.063], relative intraluminal thrombus (rILT, OR = 1.039), and total aneurysm volume (TAV, OR = 1.006) continued to be significant predictors of AAA rupture with PWS (OR = 1.010) and RRED (OR = 1.031). Area under the ROC curve values and correct classification (cc) for the same parameters and the model that combines MAD, TAV, and rILT were measured: MAD (0.790, cc = 75%), PWS (0.713, cc = 73%), RRED (0.717, cc = 55%), TAV (0.756, cc = 79%), rILT (0.656, cc = 60%), and MAD + TAV + rILT (0.797, cc = 82%). Conclusion: Based on our results, in addition to MAD, other important predictors of rupture that might be used during aneurysm surveillance are TAV and rILT. Biomechanical parameters (PWS, RRED) as valuable predictors should be assessed in prospective clinical trials. Similar studies on AAA smaller than 55 mm in diameter, even difficult to organize, would be of even greater clinical value.
1. Am Surg. 2011 Jan;77(1):19-21. Bilateral Isolated Axillary Aneurysms. Vasic D, Radmili O, Drag... more 1. Am Surg. 2011 Jan;77(1):19-21. Bilateral Isolated Axillary Aneurysms. Vasic D, Radmili O, Dragas M, Davidovic L, Vranes M. Vascular Surgery Clinic, Clinical Centre of Serbia, Belgrade, Serbia. PMID: 21396298 [PubMed - as supplied by publisher].
13th IEEE International Conference on BioInformatics and BioEngineering, 2013
Aneurysm rupture is a biomechanical phenomenon that occurs when the mechanical stress acting on t... more Aneurysm rupture is a biomechanical phenomenon that occurs when the mechanical stress acting on the inner wall exceeds the failure strength of the diseased aortic tissue. Besides numerous advantages in surgical and anaesthesiological management, emergency procedure leads to fatal outcome in 20-50% of those who reach hospital. Prediction of influence of dynamic blood flow on natural history of aneurysmatic disease and outcome of therapeutic procedures could contribute to treatment strategy and results. In this study we presented experimental design for estimation of the material property of real human aorta tissue from bubble inflation test. Then we investigated fluid-structure interaction of pulsatile blood flow in the specific patient threedimensional model of abdominal aortic aneurysms (AAAs). Numerical predictions of blood flow patterns and nonlinear wall stresses in AAAs are performed in compliant wall anisotropic model using the finite element method. These computational procedures together with experimental determination of the nonlinear material property could provide us more accurate assessment of aneurysm rupture risk.
We sought to analyze the early results of civil and war peripheral arterial injury treatment and ... more We sought to analyze the early results of civil and war peripheral arterial injury treatment and to identify risk factors associated with limb loss. Between 1992 and 2001, data collected retrospectively and prospectively on 413 patients with 448 peripheral arterial injuries were analyzed. Of these, there were 140 patients with war injuries and 273 patients with civil injuries. The mechanism of injury was gunshot in 40%, blunt injury in 24%, explosive trauma in 20.3%, and stabbing in 15.7% of the cases. The most frequently injured vessels were the femoral arteries (37.3%), followed by the popliteal (27.8%), axillary and brachial (23.5%), and crural arteries (6.5%). Associated injuries, which included bone, nerve, and remote injuries affecting the head, chest, or abdomen, were present in 60.8% of the cases. Surgery was carried out on all patients, with a limb salvage rate of 89.1% and a survival rate of 97.3%. In spite of a rising trend in peripheral arterial injuries, our total and delayed amputation rates remained stable. On statistical analysis, significant risk factors for amputation were found to be failed revascularization, associated injuries, secondary operation, explosive injury, war injury ( p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .01) and arterial contusion with consecutive thrombosis, popliteal artery injury, and late surgery ( p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .05). Peripheral arterial injuries, if inadequately treated, carry a high amputation rate. Explosive injuries are the most likely to lead to amputations, whereas stab injuries are the least likely to do so. The most significant independent risk factor for limb loss was failed revascularization.
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Papers by Marko Dragas