vascular diseasect angiography and surgical treatment

VASCULAR DISEASECT ANGIOGRAPHY AND SURGICAL TREATMENT

SPECIAL HOSPITALFILIP VTORI

Variety of vascular surgical procedures are performed in spe-cial hospital for surgery Fillip II, such as: carotid artery surgery (thrombendaterectomy with direct suture or patch plastique, shortening of the carotid artery in symptomatic kinking etc.). Surgical treatment of acute cerebral ischemia (4 hours) has been introduced. Postoperative results has shown complete regression of neurological sings in patients with acute TIA. Operative treat-ment of peripherial arterial vessels using venous, PTFE graft or thrombendaterectomy with patch plastique). Surgery of aorta: replacement of aorta ascendens with graft, native valve repair and reimplantation of coronary arteries (Tirone David), recon-struction of aortic root, replacement of ascendens and hemiar-cus with Albograft, replacement of the thoracic, abdominal and whole aorta with reimplantation of all the branches of the aor-tic arch, mesenterical arteries, renal arteries as well as truncus coelliacus.

Academician Zan Mitrev MD (born 1961 in Shtip) cardiovascular surgeon. He finished the medical faculty in Skopje, Macedonia and surgery specialization at Rebro Clinic in Zagreb. During the specialization, he finished postgraduate studies. Several years he had worked as a cardiac surgeon in University Clinic Johan Wolfgang Goethe in Frankfurt. Two years he worked with prof. Turina in Zurich. He performs his first heart transplantation in 1997. In year 2000 he opened the first private cardiac surgery hospital in Macedonia. Several awards were granted to him regarding his work. He performed more than 10.000 cardiovascular procedures.

Operations in period 2000-2011

Cardiovascular Vascular

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Before operation After operation

Carotid Artery Disease (stenosis)

Carotid endarterectomy with direct suture (blue arrow) because of critical stenosis of left internal carotid artery. (red arrow)

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Plastic (patch) repair in carotid endarterectomy (blue arrow) because of significant stenosis (80%) of left internal carotid artery (red arrow)

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Plastic (patch) repair in carotid endarterectomy because of significant stenosis of left internal carotid artery (blue arrow) and vascular graft (red arrow) because of ostial significant stenosis of ACC and ACI (yellow arrow).

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Carotid Artery Disease (significant kinking)

Operative treatment (yellow arrow) of symptomatic Kinking righ (red arrow) and left (blue arrow) carotide artery.

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After first operation After second operationBefore operation

Carotid Artery Disease (stenosis and occlusion)

Significant stenosis of right carotid artery (yellow arrow) . Occlusion after right carotid endarterectomy (blue arrow). Resection of right ACI and T-T anastomosis with saphenous vein (3mm) (red arrow)

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Peripheral arterial occlusive disease

Carotid - subclavian (synthetic) bypass (blue arrow) because of left subclavian artery occlusion (red arrow)

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Carotid Artery Disease (carotid aneurism)

Operative treatement of giant aneurism (red arrow) of left carotid artery, T-T anastomosis with saphenous vein was performed (blue arrow)

Published in „Journal of Vascular Surgery“ August 2011, Vol. 54 Issue 2www.jvascsurg.org

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Carotid Artery Disease (occlusion)

Plastic (patch) repair in carotid endarterectomy (blue arrow) because of left internal carotid artery occlusion (red arrow)

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Carotid Artery Disease (occlusion) (оклузија)

Carotid - carotid (synthetic) bypass (blue arrow) because of left common carotid artery occlusion (red arrow)

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Aorto-Bilateral-Femoral-Bilateral-Popliteal Bypassfor Leriche Syndrome With Occlusion of BothSuperficial Femoral ArteriesZan Mitrev, MD, Lidija Veljanovska, MD, and Nikola Hristov, MDSpecial Hospital for Surgery “Filip Vtori,” Skopje, Macedonia

A 68-year-old man, who is a smoker with hypertensionand hyperlipidemia, presented in our hospital with rest

pain in both calves. His symptoms started 1 year prior withshort distance walking pain in both legs. Preoperative work updiscovered Leriche’s syndrome with occlusion of both super-ficial femoral arteries, as shown on the 64-slice computerizedtomographic scan (Fig 1). Operative treatment included aorto-bilateral femoral bypass, using 16/8 mm Dacron (Edwards

Lifesciences, Irvine, CA) Y-graft, anastomosed termino-terminal to the aorta and latero-lateral to both commonfemoral arteries. The excess 8-mm tube grafts were cut, andthe procedure continued with termino-lateral anastomosisusing an 8-mm Dacron tube graft (Edwards Lifesciences) onthe popliteal artery, then connecting the distal tube graft withthe proximal tube graft on the femoral level using termino-terminal anastomosis. The same operative steps were re-peated for the other leg. His postoperative stay was unevent-ful. He was discharged home 7 days later. A follow-up 64-slicecomputerized tomographic scan (Fig 2) of the aorto-bilateral-femoral-bilateral-popliteal bypass.

Address correspondence to Dr Hristov, PZU “Filip Vtori,” Skopje, 1000,Macedonia; e-mail: [email protected].

Fig 1. Fig 2.

© 2009 by The Society of Thoracic Surgeons Ann Thorac Surg 2009;88:683 • 0003-4975/09/$36.00Published by Elsevier Inc doi:10.1016/j.athoracsur.2008.11.006

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by Nikola Hristov on July 30, 2009 ats.ctsnetjournals.orgDownloaded from


Aorto-Bilateral-Femoral-Bilateral-Popliteal Bypassfor Leriche Syndrome With Occlusion of BothSuperficial Femoral ArteriesZan Mitrev, MD, Lidija Veljanovska, MD, and Nikola Hristov, MDSpecial Hospital for Surgery “Filip Vtori,” Skopje, Macedonia

A 68-year-old man, who is a smoker with hypertensionand hyperlipidemia, presented in our hospital with rest

pain in both calves. His symptoms started 1 year prior withshort distance walking pain in both legs. Preoperative work updiscovered Leriche’s syndrome with occlusion of both super-ficial femoral arteries, as shown on the 64-slice computerizedtomographic scan (Fig 1). Operative treatment included aorto-bilateral femoral bypass, using 16/8 mm Dacron (Edwards

Lifesciences, Irvine, CA) Y-graft, anastomosed termino-terminal to the aorta and latero-lateral to both commonfemoral arteries. The excess 8-mm tube grafts were cut, andthe procedure continued with termino-lateral anastomosisusing an 8-mm Dacron tube graft (Edwards Lifesciences) onthe popliteal artery, then connecting the distal tube graft withthe proximal tube graft on the femoral level using termino-terminal anastomosis. The same operative steps were re-peated for the other leg. His postoperative stay was unevent-ful. He was discharged home 7 days later. A follow-up 64-slicecomputerized tomographic scan (Fig 2) of the aorto-bilateral-femoral-bilateral-popliteal bypass.

Address correspondence to Dr Hristov, PZU “Filip Vtori,” Skopje, 1000,Macedonia; e-mail: [email protected].

Fig 1. Fig 2.

© 2009 by The Society of Thoracic Surgeons Ann Thorac Surg 2009;88:683 • 0003-4975/09/$36.00Published by Elsevier Inc doi:10.1016/j.athoracsur.2008.11.006

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by Nikola Hristov on July 30, 2009 ats.ctsnetjournals.orgDownloaded from

Aorto-bilateral-femoral and bilateral-femoro-popliteal bypass (blue arrow) because Lerichesyndrome with occlusion of both superficial femoral arteries (red arrow)

Published in Ann Thorac Surg 2009;88:683 DOI: 10.1016/j.athoracsur.2008.11.006

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Aorto biiliac (synthetic) bypass (blue arrow) because of syndrome Leriche (red arrow)

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Femoro - femoral (synthetic) bypass (red arrow) bilateral femoro - poplietal (blue arrow) (synthetic) bypass because of left common iliac and both femoral arteries occlusion (yellow arrow)

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Femoro - tibial (saphenous vein) autogenous bypass (blue arrow) because of right popliteal artery occlusion (red arrow)

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Popliteo - tibial (saphenous vein) autogenous bypass (blue arrow) because of left popliteal artery occlusion (red arrow)

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Plastic (patch) repair of the femoral artery in femoral endarterectomy (blue arrow), because of right femoral artery occlusion (red arrow)

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Femoro - femoral (synthetic) bypass (blue arrow) iliaco - femoro (synthetic) bypass (red arrow) because of both iliac arteries occlusion (yellow arrow)

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Left femoro – popliteal (synthetic) bypass (red arrow) because of femoral artery occlusion, right femoro -tibial (saphenous vein) autogenous bypass (blue arrow) because of femoral and popliteal artery occlusion (yellow arrow)

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Thoracic Aortic Aneurysm

Replacement of aorta ascendens and aortic arch with graft and reimplantation of cephalic arteries (blue arrow) because of aorta ascendens aneurysm and mechanical valve replacement (red arrow) (yellow arrow)

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Replacement of aorta ascendens and aortic root with graft (blue arrow) native valve repair (green arrow) and reimplantation of coronay arteries (Tirone David) (red arrow) because of aneurism of ascending aorta (yellow arrow).

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Replacement of aorta ascendens and hemiarcus with graft (blue arrow), tube graft interposition between tr. brachiocephalicus (yellow arrow) and arcus of aorta because of Disection Stanford A (green arrow) and aorta ascendens aneurysm (red arrow). Reimplantation of RCA (white arrow).

Thoracic Aortic Aneurysm and Disection Stanford A

Cardiac MRI & CT 2010 - Cannes, France - april 2010http://cannes2010.medconvent.at/

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Replacement of aorta descendens with graft (blue arrow) because of posttraumatic thoracic aortic aneurism (red arrow).

85,8mm

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Abdominal aortic aneurism

Replacement of infrarenal abdominal aorta with vascular graft (blue arrow), because of Aortic Aneurysm 10cm (red arrow)

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Thoraco abdominal Aortic Aneurysm

Replacement of thoraco abdominal aorta with graft (blue arrow) and reimplantation of truncus coeliacus (red arrow), because of thoraco abdominal aortic aneurism (yellow arrow)

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Author's personal copy

Images in cardio-thoracic surgery

DeBekay repair for type III thoracoabdominal aortic aneurysm

Zan Mitrev, Vladimir Belostotski, Lidija Veljanovska, Nikola Hristov *

Special Hospital for Surgery ‘‘Filip Vtori’’, Skopje, Macedonia

Received 30 November 2008; received in revised form 23 January 2009; accepted 29 January 2009; Available online 9 March 2009

Keywords: Aneurysm; Aortic operation

A 65-year-old man with abdominal pain, nausea andvomiting was diagnosed with thoracoabdominal aorticaneurysm, Crawford type III (Fig. 1). Immediate surgerywas performed through 6th intercostal space and retro-

peritoneally, employing DeBakey repair (Fig. 2). Followingrepair, aneurysm sac was opened, bleeding points sutured,aneurysm neck suture ligated.

www.elsevier.com/locate/ejctsEuropean Journal of Cardio-thoracic Surgery 35 (2009) 905

Fig. 2. Postoperative 64 slice computerized tomography of DeBakey typerepair for Crawford type III thoracoabdominal aortic aneurysm. Arrow 1indicating proximal end to side prosthesis implantation on distal thoracicaorta; arrow 2 implantation of the celiac trunk over short 10 mm vasculargraft on the prosthesis (arrow 8); arrow 3 implantation of the right renal arteryover short 10 mm vascular graft on the prosthesis (arrow 11); arrow 4 implan-tation of the superior mesenteric artery over short 10 mm vascular graft on theprosthesis (arrow 9); arrow 5 implantation of the left renal artery over short10 mm vascular graft on the prosthesis (arrow 10); arrow 12 end to endanastomosis between tubular and bifurcated graft; arrow 6 end to endanastomosis between prosthesis and right external iliac artery; arrow 7 endto end anastomosis between prosthesis and left external iliac artery.

Fig. 1. Preoperative 64 slice computerized tomography of Crawford type IIIthoracoabdominal aortic aneurysm, maximal diameter of 10 cm.

* Corresponding author. Address: PZU ‘Filip Vtori’, Skopje, Macedonia.Tel.: +389 2 3091500; fax: +389 2 3091499.

E-mail address: [email protected] (N. Hristov).

1010-7940/$ — see front matter # 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.doi:10.1016/j.ejcts.2009.01.048

Author's personal copy

Images in cardio-thoracic surgery

DeBekay repair for type III thoracoabdominal aortic aneurysm

Zan Mitrev, Vladimir Belostotski, Lidija Veljanovska, Nikola Hristov *

Special Hospital for Surgery ‘‘Filip Vtori’’, Skopje, Macedonia

Received 30 November 2008; received in revised form 23 January 2009; accepted 29 January 2009; Available online 9 March 2009

Keywords: Aneurysm; Aortic operation

A 65-year-old man with abdominal pain, nausea andvomiting was diagnosed with thoracoabdominal aorticaneurysm, Crawford type III (Fig. 1). Immediate surgerywas performed through 6th intercostal space and retro-

peritoneally, employing DeBakey repair (Fig. 2). Followingrepair, aneurysm sac was opened, bleeding points sutured,aneurysm neck suture ligated.

www.elsevier.com/locate/ejctsEuropean Journal of Cardio-thoracic Surgery 35 (2009) 905

Fig. 2. Postoperative 64 slice computerized tomography of DeBakey typerepair for Crawford type III thoracoabdominal aortic aneurysm. Arrow 1indicating proximal end to side prosthesis implantation on distal thoracicaorta; arrow 2 implantation of the celiac trunk over short 10 mm vasculargraft on the prosthesis (arrow 8); arrow 3 implantation of the right renal arteryover short 10 mm vascular graft on the prosthesis (arrow 11); arrow 4 implan-tation of the superior mesenteric artery over short 10 mm vascular graft on theprosthesis (arrow 9); arrow 5 implantation of the left renal artery over short10 mm vascular graft on the prosthesis (arrow 10); arrow 12 end to endanastomosis between tubular and bifurcated graft; arrow 6 end to endanastomosis between prosthesis and right external iliac artery; arrow 7 endto end anastomosis between prosthesis and left external iliac artery.

Fig. 1. Preoperative 64 slice computerized tomography of Crawford type IIIthoracoabdominal aortic aneurysm, maximal diameter of 10 cm.

* Corresponding author. Address: PZU ‘Filip Vtori’, Skopje, Macedonia.Tel.: +389 2 3091500; fax: +389 2 3091499.

E-mail address: [email protected] (N. Hristov).

1010-7940/$ — see front matter # 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.doi:10.1016/j.ejcts.2009.01.048

Published in „European Association for CardioThoracic Surgery“ 35 (2009) 905

95 mm

Thoraco abdominal Aortic Aneurysm

Repair for DeBakey - Crawford type III thoracoabdominal aortic aneurysm (red arrow) and reimplantation of visceral and renal arteries (white arrow)

bul. “Ilindenska”, 1000 Skopje, Republic of MacedoniaTel: +389 2 3091-500, +389 2 3091-484

www.cardiosurgery.com.mk

SPECIAL HOSPITALFILIP VTORI

vascular diseasect angiography and surgical treatment

Documents

blue arrow carotide

vascular graft red arrow

aci yellow arrow

direct suture blue arrow

red arrow9before operation

surgery of aorta

surgery specialization

patch plastique