Using vacuum in the treatment of surgical wounds complications

Background/Aim. Using vacuum in medicine has been known from long ago, however, it has not been used for the treatment of wounds. The first experiments in this field were performed by Wagner Fleischmann, University of Ulm, Ulm, West Germany, in 1993. The aim of this study was to present our clinical experience with the treatment of surgical wounds complications in vascular patients by the use of controled vacuum. Method. In a period October 2006 - December 2009 a total of 18 patients with infection and surgical wound dehiscence were treated by the use of vacuum. Vacuum was applied to wounds by placing a polyurethane sponge on them and by fixing a polyurethane foil and a sponge to the surrounding healthy skin so to completely airtight wounds. Over a foil vacuum of - 150 mmHg was applied for a 5-day period, and on the day 6 a foil and a sponge were removed. Results. In all the 18 wounds treated by the use of vacuum secondary wound closing was achieved with no complications and with a significantly shortened time period treatment. Wound infections were healed using this method and only in 2 patients antibiotics were used at the same time. Conclusion. The use of vacuum in the treatment of operative wounds complications is an easy and reliable method contributing significantly to wounds better healing

Significance of subcutaneous paratibial fasciotomy in the treatment of chronic venous ulcer

Hronični venski ulkus spada u najmasovnija oboljenja čovečanstva i predstavlja jednu od najtežih komplikacija hronične venske insuficijencije. Lečenje ulkusne bolesti spada u najkompleksnija lečenja uopšte i često je skopčano sa veoma neizvesnim uspehom. Preko 30 % pacijenata sa hroničnim venskim ulkusom se leči duže od 20 godina a oko 10 % pacijenata duže od 30 godina. Ulkus kruris čini između 57% i 80 % svih hroničnih ulceracija. Jedan venski ulkus kruris, koji pod optimalnom flebološkom terapijom ne pokazuje tendenciju zarastanja ili koji u toku 12 meseci nije zarastao, smatra se rezistentnim na terapiju. Procenjuje se da u odrasloj populaciji Srbije od hroničnog venskog ulkusa boluje 1,5 do 2,5 %, što ima veliki socialno-ekonomski značaj. U lečenju HVU stadijuma C 5-6 primenjuju se brojne metode kako konzervativne tako i operativne, shodno etiologiji i lokalnom nalazu ali postoji velika stopa recidiva kao i rezistentnost na brojne metode lečenja. Cilj disertacije je da se kroz poređenje klasičnih metoda lečenja hroničnog venskog ulkusa (HVU) bez primene subkutane paratibijalne fasciotomije (SPTF) sa klasičnim metodama lečenja HVU uz primenu SPTF, odredi značaj subkutane paratibijalne fasciotomije za lečenje HVU. U istraživanje je uključeno ukupno 100 bolesnika kod kojih je lečenje hroničnog venskog ulkusa sprovedeno klasičnim metodama lečenja tog obolenja . Prvu grupu je sačinjavalo 50 bolesnika kod kojih je klasično lečenje sprovedeno uz dodatnu primenu subkutane paratibijalne fasciotomije, a drugu grupu 50 bolesnika kod kojih je klasično lečenje sprovedeno bez primene subkutane paratibijalne fasciotomije. Perioperativno i postoperativno su kod svih praćeni prethodno postavljeni parametri, klinički tok , pojava komplikacija lečenja HVU, kao i dužina zarastanja HVU, pritisci u mišićnim odeljcima potkolenice sa ulkusom kao i vrednosti transkutanog pritiska kiseonika potkolenice sa ulkusom. Dobijeni rezultati su uz klinički aspekt, potvrdili da kod bolesnika kod kojih je klasično lečenje hroničnog venskog ulkusa sprovedeno uz primenu subkutane paratibijalne fasciotomije, dolazi do bržeg zarastanja ulkusa, da je manja stopa recidiva i da subkutana paratibijalna fasciotomija dovodi do značajnog pada pritiska u mišićnim kompartmentima i porasta transkutanog parcijalnog pritiska kiseonika. Ova studija je pokazala da je primena SPTF u lečenju HVU sigurna, pouzdana i efikasna procedura koja nije praćena komplikacijama kako intraoperativnio, tako ni postoperativno. Primena SPTF ubrzava zatvaranje ulkusa, smanjuje stopu recidiva i omogućava poboljšanje lokalne mikrocirkulacije u pogođenoj regiji čime se rešava jedan od brojnih faktora smetnje zarastanja ulkusa-hronična ishemija usled hroničnog fasciokompresivnog sindroma, popravlja se mikrocirkulacija u pogođenoj regiji, što sve ukupno povoljno utiče na njegovo zarastanje. Sam operativni akt je bezbedan, ne zahteva posebnu aparaturu niti specijalnu obuku hirurškog tima, te kao takav je primenjiv kod najvećeg broja pacijenata sa ulkus krurisom koji su kandidati za operativno lečenje.Chronic venous ulcer is one of the most widespread diseases of mankind and is one of the most serious complications of chronic venous insufficiency. Treatment of venous ulcer is one of the most complex treatment in general and is often coupled with very uncertain success. Over 30% of patients with chronic venous ulcer is treated with more than 20 years and about 10% of patients over 30 years. Venous ulcer makes between 57% and 80% of all chronic ulcers. A venous ulcer cruris, which under optimal therapy shows no tendency to heal or for 12 months is not healed, it is resistant to therapy. It is estimated that in the adult population of Serbia with chronic venous ulceration affects 1.5 to 2.5%, which is of great socio-economic importance. In the treatment of stage C 5-6 venous ulcer, there are numerous methods of conservative and operative, according to the etiology and local findings, but there is a high recurrence rate and resistance to a number of methods of treatment. The aim of the dissertation is to compare the conventional methods of treatment of chronic venous ulcers without the use of subcutaneous paratibial fasciotomy (SPTF) with conventional methods of treatment, using SPTF, determine the importance of subcutaneous paratibial fasciotomy for the treatment of chronic venous ulcer. The study included a total of 100 patients the treatment of chronic venous ulcers conducted by classical methods of treatment of this disease. The first group consisted of 50 patients in whom conventional treatment was conducted with the additional use of subcutaneous paratibial fasciotomy, a second group of 50 patients in whom conventional treatment is conducted without the use of subcutaneous paratibial fasciotomy. Perioperative and postoperative were monitored in all pre-set parameters, clinical course, occurrence of complications of treatment chronic venous ulcer and chronic venous ulcer healing length, the pressure in muscle compartments of the lower leg with ulcers as well as the value of transcutaneous oxygen pressure with a lower leg ulcer. The results obtained with the clinical aspect, confirmed that in patients in whom conventional treatment of chronic venous ulcers conducted with the use of subcutaneous paratibial fasciotomy, coming in faster healing of ulcers, the lower recurrence rate and subcutaneous paratibial fasciotomy leads to a significant drop in pressure in the muscle compartments and an increase in transcutaneous partial pressure of oxygen. This study has shown that the use SPTF for the treatment of chronic venous ulcers secure, reliable and effective procedure that is not accompanied by complications that intraoperatively, nor postoperatively. Application SPTF accelerates ulcer closure, reduces relapse rate and to improve local microcirculation in the affected region, which solves one of the many factors interfere ulcer-healing chronic ischemia due to chronic fasciokompresywe syndrome, improves the microcirculation in the affected region, the total of all its positive effect on healing . I act is operating safely, without any special apparatus or special training of the surgical team, and as such is applicable in most patients with chronic venous ulcer who are candidates for surgical treatment

Significance of subcutaneous paratibial fasciotomy in the treatment of chronic venous ulcer

Hronični venski ulkus spada u najmasovnija oboljenja čovečanstva i predstavlja jednu od najtežih komplikacija hronične venske insuficijencije. Lečenje ulkusne bolesti spada u najkompleksnija lečenja uopšte i često je skopčano sa veoma neizvesnim uspehom. Preko 30 % pacijenata sa hroničnim venskim ulkusom se leči duže od 20 godina a oko 10 % pacijenata duže od 30 godina. Ulkus kruris čini između 57% i 80 % svih hroničnih ulceracija. Jedan venski ulkus kruris, koji pod optimalnom flebološkom terapijom ne pokazuje tendenciju zarastanja ili koji u toku 12 meseci nije zarastao, smatra se rezistentnim na terapiju. Procenjuje se da u odrasloj populaciji Srbije od hroničnog venskog ulkusa boluje 1,5 do 2,5 %, što ima veliki socialno-ekonomski značaj. U lečenju HVU stadijuma C 5-6 primenjuju se brojne metode kako konzervativne tako i operativne, shodno etiologiji i lokalnom nalazu ali postoji velika stopa recidiva kao i rezistentnost na brojne metode lečenja. Cilj disertacije je da se kroz poređenje klasičnih metoda lečenja hroničnog venskog ulkusa (HVU) bez primene subkutane paratibijalne fasciotomije (SPTF) sa klasičnim metodama lečenja HVU uz primenu SPTF, odredi značaj subkutane paratibijalne fasciotomije za lečenje HVU. U istraživanje je uključeno ukupno 100 bolesnika kod kojih je lečenje hroničnog venskog ulkusa sprovedeno klasičnim metodama lečenja tog obolenja . Prvu grupu je sačinjavalo 50 bolesnika kod kojih je klasično lečenje sprovedeno uz dodatnu primenu subkutane paratibijalne fasciotomije, a drugu grupu 50 bolesnika kod kojih je klasično lečenje sprovedeno bez primene subkutane paratibijalne fasciotomije. Perioperativno i postoperativno su kod svih praćeni prethodno postavljeni parametri, klinički tok , pojava komplikacija lečenja HVU, kao i dužina zarastanja HVU, pritisci u mišićnim odeljcima potkolenice sa ulkusom kao i vrednosti transkutanog pritiska kiseonika potkolenice sa ulkusom. Dobijeni rezultati su uz klinički aspekt, potvrdili da kod bolesnika kod kojih je klasično lečenje hroničnog venskog ulkusa sprovedeno uz primenu subkutane paratibijalne fasciotomije, dolazi do bržeg zarastanja ulkusa, da je manja stopa recidiva i da subkutana paratibijalna fasciotomija dovodi do značajnog pada pritiska u mišićnim kompartmentima i porasta transkutanog parcijalnog pritiska kiseonika. Ova studija je pokazala da je primena SPTF u lečenju HVU sigurna, pouzdana i efikasna procedura koja nije praćena komplikacijama kako intraoperativnio, tako ni postoperativno. Primena SPTF ubrzava zatvaranje ulkusa, smanjuje stopu recidiva i omogućava poboljšanje lokalne mikrocirkulacije u pogođenoj regiji čime se rešava jedan od brojnih faktora smetnje zarastanja ulkusa-hronična ishemija usled hroničnog fasciokompresivnog sindroma, popravlja se mikrocirkulacija u pogođenoj regiji, što sve ukupno povoljno utiče na njegovo zarastanje. Sam operativni akt je bezbedan, ne zahteva posebnu aparaturu niti specijalnu obuku hirurškog tima, te kao takav je primenjiv kod najvećeg broja pacijenata sa ulkus krurisom koji su kandidati za operativno lečenje.Chronic venous ulcer is one of the most widespread diseases of mankind and is one of the most serious complications of chronic venous insufficiency. Treatment of venous ulcer is one of the most complex treatment in general and is often coupled with very uncertain success. Over 30% of patients with chronic venous ulcer is treated with more than 20 years and about 10% of patients over 30 years. Venous ulcer makes between 57% and 80% of all chronic ulcers. A venous ulcer cruris, which under optimal therapy shows no tendency to heal or for 12 months is not healed, it is resistant to therapy. It is estimated that in the adult population of Serbia with chronic venous ulceration affects 1.5 to 2.5%, which is of great socio-economic importance. In the treatment of stage C 5-6 venous ulcer, there are numerous methods of conservative and operative, according to the etiology and local findings, but there is a high recurrence rate and resistance to a number of methods of treatment. The aim of the dissertation is to compare the conventional methods of treatment of chronic venous ulcers without the use of subcutaneous paratibial fasciotomy (SPTF) with conventional methods of treatment, using SPTF, determine the importance of subcutaneous paratibial fasciotomy for the treatment of chronic venous ulcer. The study included a total of 100 patients the treatment of chronic venous ulcers conducted by classical methods of treatment of this disease. The first group consisted of 50 patients in whom conventional treatment was conducted with the additional use of subcutaneous paratibial fasciotomy, a second group of 50 patients in whom conventional treatment is conducted without the use of subcutaneous paratibial fasciotomy. Perioperative and postoperative were monitored in all pre-set parameters, clinical course, occurrence of complications of treatment chronic venous ulcer and chronic venous ulcer healing length, the pressure in muscle compartments of the lower leg with ulcers as well as the value of transcutaneous oxygen pressure with a lower leg ulcer. The results obtained with the clinical aspect, confirmed that in patients in whom conventional treatment of chronic venous ulcers conducted with the use of subcutaneous paratibial fasciotomy, coming in faster healing of ulcers, the lower recurrence rate and subcutaneous paratibial fasciotomy leads to a significant drop in pressure in the muscle compartments and an increase in transcutaneous partial pressure of oxygen. This study has shown that the use SPTF for the treatment of chronic venous ulcers secure, reliable and effective procedure that is not accompanied by complications that intraoperatively, nor postoperatively. Application SPTF accelerates ulcer closure, reduces relapse rate and to improve local microcirculation in the affected region, which solves one of the many factors interfere ulcer-healing chronic ischemia due to chronic fasciokompresywe syndrome, improves the microcirculation in the affected region, the total of all its positive effect on healing . I act is operating safely, without any special apparatus or special training of the surgical team, and as such is applicable in most patients with chronic venous ulcer who are candidates for surgical treatment

Significance of subcutaneous paratibial fasciotomy in the treatment of chronic venous ulcer

Hronični venski ulkus spada u najmasovnija oboljenja čovečanstva i predstavlja jednu od najtežih komplikacija hronične venske insuficijencije. Lečenje ulkusne bolesti spada u najkompleksnija lečenja uopšte i često je skopčano sa veoma neizvesnim uspehom. Preko 30 % pacijenata sa hroničnim venskim ulkusom se leči duže od 20 godina a oko 10 % pacijenata duže od 30 godina. Ulkus kruris čini između 57% i 80 % svih hroničnih ulceracija. Jedan venski ulkus kruris, koji pod optimalnom flebološkom terapijom ne pokazuje tendenciju zarastanja ili koji u toku 12 meseci nije zarastao, smatra se rezistentnim na terapiju. Procenjuje se da u odrasloj populaciji Srbije od hroničnog venskog ulkusa boluje 1,5 do 2,5 %, što ima veliki socialno-ekonomski značaj. U lečenju HVU stadijuma C 5-6 primenjuju se brojne metode kako konzervativne tako i operativne, shodno etiologiji i lokalnom nalazu ali postoji velika stopa recidiva kao i rezistentnost na brojne metode lečenja. Cilj disertacije je da se kroz poređenje klasičnih metoda lečenja hroničnog venskog ulkusa (HVU) bez primene subkutane paratibijalne fasciotomije (SPTF) sa klasičnim metodama lečenja HVU uz primenu SPTF, odredi značaj subkutane paratibijalne fasciotomije za lečenje HVU. U istraživanje je uključeno ukupno 100 bolesnika kod kojih je lečenje hroničnog venskog ulkusa sprovedeno klasičnim metodama lečenja tog obolenja . Prvu grupu je sačinjavalo 50 bolesnika kod kojih je klasično lečenje sprovedeno uz dodatnu primenu subkutane paratibijalne fasciotomije, a drugu grupu 50 bolesnika kod kojih je klasično lečenje sprovedeno bez primene subkutane paratibijalne fasciotomije. Perioperativno i postoperativno su kod svih praćeni prethodno postavljeni parametri, klinički tok , pojava komplikacija lečenja HVU, kao i dužina zarastanja HVU, pritisci u mišićnim odeljcima potkolenice sa ulkusom kao i vrednosti transkutanog pritiska kiseonika potkolenice sa ulkusom. Dobijeni rezultati su uz klinički aspekt, potvrdili da kod bolesnika kod kojih je klasično lečenje hroničnog venskog ulkusa sprovedeno uz primenu subkutane paratibijalne fasciotomije, dolazi do bržeg zarastanja ulkusa, da je manja stopa recidiva i da subkutana paratibijalna fasciotomija dovodi do značajnog pada pritiska u mišićnim kompartmentima i porasta transkutanog parcijalnog pritiska kiseonika. Ova studija je pokazala da je primena SPTF u lečenju HVU sigurna, pouzdana i efikasna procedura koja nije praćena komplikacijama kako intraoperativnio, tako ni postoperativno. Primena SPTF ubrzava zatvaranje ulkusa, smanjuje stopu recidiva i omogućava poboljšanje lokalne mikrocirkulacije u pogođenoj regiji čime se rešava jedan od brojnih faktora smetnje zarastanja ulkusa-hronična ishemija usled hroničnog fasciokompresivnog sindroma, popravlja se mikrocirkulacija u pogođenoj regiji, što sve ukupno povoljno utiče na njegovo zarastanje. Sam operativni akt je bezbedan, ne zahteva posebnu aparaturu niti specijalnu obuku hirurškog tima, te kao takav je primenjiv kod najvećeg broja pacijenata sa ulkus krurisom koji su kandidati za operativno lečenje.Chronic venous ulcer is one of the most widespread diseases of mankind and is one of the most serious complications of chronic venous insufficiency. Treatment of venous ulcer is one of the most complex treatment in general and is often coupled with very uncertain success. Over 30% of patients with chronic venous ulcer is treated with more than 20 years and about 10% of patients over 30 years. Venous ulcer makes between 57% and 80% of all chronic ulcers. A venous ulcer cruris, which under optimal therapy shows no tendency to heal or for 12 months is not healed, it is resistant to therapy. It is estimated that in the adult population of Serbia with chronic venous ulceration affects 1.5 to 2.5%, which is of great socio-economic importance. In the treatment of stage C 5-6 venous ulcer, there are numerous methods of conservative and operative, according to the etiology and local findings, but there is a high recurrence rate and resistance to a number of methods of treatment. The aim of the dissertation is to compare the conventional methods of treatment of chronic venous ulcers without the use of subcutaneous paratibial fasciotomy (SPTF) with conventional methods of treatment, using SPTF, determine the importance of subcutaneous paratibial fasciotomy for the treatment of chronic venous ulcer. The study included a total of 100 patients the treatment of chronic venous ulcers conducted by classical methods of treatment of this disease. The first group consisted of 50 patients in whom conventional treatment was conducted with the additional use of subcutaneous paratibial fasciotomy, a second group of 50 patients in whom conventional treatment is conducted without the use of subcutaneous paratibial fasciotomy. Perioperative and postoperative were monitored in all pre-set parameters, clinical course, occurrence of complications of treatment chronic venous ulcer and chronic venous ulcer healing length, the pressure in muscle compartments of the lower leg with ulcers as well as the value of transcutaneous oxygen pressure with a lower leg ulcer. The results obtained with the clinical aspect, confirmed that in patients in whom conventional treatment of chronic venous ulcers conducted with the use of subcutaneous paratibial fasciotomy, coming in faster healing of ulcers, the lower recurrence rate and subcutaneous paratibial fasciotomy leads to a significant drop in pressure in the muscle compartments and an increase in transcutaneous partial pressure of oxygen. This study has shown that the use SPTF for the treatment of chronic venous ulcers secure, reliable and effective procedure that is not accompanied by complications that intraoperatively, nor postoperatively. Application SPTF accelerates ulcer closure, reduces relapse rate and to improve local microcirculation in the affected region, which solves one of the many factors interfere ulcer-healing chronic ischemia due to chronic fasciokompresywe syndrome, improves the microcirculation in the affected region, the total of all its positive effect on healing . I act is operating safely, without any special apparatus or special training of the surgical team, and as such is applicable in most patients with chronic venous ulcer who are candidates for surgical treatment

Different techniques of vessel reconstruction during kidney transplantation

Background/Aim. Multiple renal arteries (MRAs) represent a surgical challenge by the difficulty in performing anastomoses, bleeding and stenosis. MRAs should be preserved and special attention should be paid to accessory polar arteries. All renal arteries (RAs) must be reconstructed and prepared for safe anastomosis. The paper decribed the different techniques of vessel reconstruction during kidney transplantation including important steps within recovery of organs, preparation and implantation. Methods. In a 16-year period (1996-2012) of kidney transplantation in the Military Medical Academy, Belgrade, a total of 310 living donors and 44 human cadaver kidney transplantations were performed, of which 28 (8%) kidneys had two or more RAs. Results. All the transplanted kidneys had immediate function. We repaired 20 cases of donor kidneys with 2 arteries, 4 cases with three RAs, one case with 4 RAs, one case with 4 RAs and renal vein reconstruction, one case with 3 arteries and additional polytetrafluoroethylene (PTFE) graft reconstruction, one case with transected renal artery and reconstruction with 5 cm long deceased donor external iliac artery. There were no major complications and graft failure. At a minimum of 1-year follow-up, all the patients showed normal renal function. Conclusion. Donor kidney transplantation on a contralateral side and “end-to-end” anastomosis of the renal artery to the internal iliac artery (IIA) is our standard procedure with satisfactory results. Renal artery reconstruction and anastomosis with IIA is a safe and highly efficient procedure and kidneys with MRAs are not contraindicated for transplantation. A surgical team should be fully competent to remove cadaveric abdominal organs to avoid accidental injuries of organs vessels

Ambulatory phlebectomy under tumescent local anesthesia in a kidney-transplant patient

Introduction. Tumescent local anesthesia (TLA) is widely used for ambulatory surgery. Patients with transplanted organs are on immunosuppressive therapy and with risk for organ rejection or severe infection. Case report. Saphenectomy with phlebectomy on the left leg under TLA was performed in a patient with kidney transplantation performed four years ago. A combination of 35 mg of 1% prilocaine-hydrochloride, 5 mL of 8.4% sodium bicarbonate and 500 μg of epinephrine in 460 mL of normal saline was used for TLA. Overall 750 mL of the solution was used. The patient had satisfactory postoperative analgesia and was discharged home on the same day. Blood levels of urea, creatinine, estimated glomerular filtration rate (eGFR) and tacrolimus concentration, measured preoperatively and on the second postoperative day, were in a regular range. Prilocaine blood concentrations determined on the 4th, 10th and 16th postoperative hours, were below toxic levels. Conclusion. TLA in a kidney-transplanted patient performed for saphenectomy with phlebectomy proved to be a safe and reliable anesthesia method

Visceral hybrid reconstruction of thoracoabdominal aortic aneurysm after open repair of type a aortic dissection by the Bentall procedure with the elephant trunk technique: A case report

Introduction. Reconstruction of chronic type B dissection and thoracoabdominal aortic aneurysm (TAAA) remaining after the emergency reconstruction of the ascending thoracic aorta and aortic arch for acute type A dissection represents one of the major surgical challenges. Complications of chronic type B dissection are aneurysmal formation and rupture of an aortic aneurysm with a high mortality rate. We presented a case of visceral hybrid reconstruction of TAAA secondary to chronic dissection type B after the Bentall procedure with the elephant trunk technique due to acute type A aortic dissection in a high-risk patient. Case report. A 62 year-old woman was admitted to our institution for reconstruction of Crawford type I TAAA secondary to chronic dissection. The patient had had an acute type A aortic dissection 3 years before and undergone reconstruction by the Bentall procedure with the elephant trunk technique with valve replacement. On admission the patient had coronary artery disease (myocardial infarction, two times in the past 3 years), congestive heart disease with ejection fraction of 25% and chronic obstructive pulmonary disease. On computed tomography (CT) of the aorta TAAA was revealed with a maximum diameter of 93 mm in the descending thoracic aorta secondary to chronic dissection. All the visceral arteries originated from the true lumen with exception of the celiac artery (CA), and the end of chronic dissection was below the origin of the superior mesenteric artery (SMA). The patient was operated on using surgical visceral reconstruction of the SMA, CA and the right renal artery (RRA) as the first procedure. Postoperative course was without complications. Endovascular TAAA reconstruction was performed as the second procedure one month later, when the elephant trunk was used as the proximal landing zone for the endograft, and distal landing zone was the level of origin of the RRA. Postoperatively, the patient had no neurological deficit and renal, liver function and functions of the other abdominal organs were normal. Control CT after 6 months showed full exclusion of the aneurysm from the systemic circulation without endoleak and good flow through visceral anastomosis. Conclusion. In patients with comorbidities, like in the presented case, visceral hybrid reconstruction of chronic dissection type B with TAAA could be the treatment of choice

Aortobifemoral reconstruction and renal transplantation in a patient with abdominal aortic aneurysm and occlusion of iliac arteries: A case report

Introduction. Aortoiliac occlusive disease and abdominal aortic aneurysm in patients with renal insufficiency on hemodialysis can significantly influence the success of renal transplantation. In the recent past, advanced atherosclerosis was considered as contraindication for renal transplantation. Complicated creation of vascular anastomoses and progression of occlusive or aneurysmal disease were the main reasons. Case report. We presented a 52-year-old man with a 5-year history of end-stage renal disease on haemodialysis. The patient was previously excluded from renal transplantation program because of severe aortoiliac atherosclerosis and abdominal aortic aneurysm. Resection of abdominal aortic aneurysm with occlusion of the iliac arteries and reconstruction with aortobifemoral synthetic grafts was performed and followed by cadaveric renal transplantation. Conclusion. Advanced atherosclerotic disease in aortoiliac segment requires elective vascular surgical reconstruction, as part of preparation for renal transplantation in patients with end-stage renal disease

Glycated hemoglobin (HbA1c) and thrombotic risk in polycythemia vera and essential thrombocythemia

Pismo urednik