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L Davidović

Publications and source records attributed to L Davidović.

At least 19 recordsLinked to original sources
PubMed2006

[Splenic artery aneurysms].

Although the third most frequent aneurysm in the abdomen, after aneurysms of the aorta and iliac arteries, and most frequent aneurisms of visceral arteries, splenic artery aneurysms are rare, but not very rare. Thanks to the new imaging techniques, first of all ultrasonography, they have been discovered with increasing frequency. We present a series of 9 splenic artery aneurysms. Seven patients were female and two male of average age 49 years (ranging from 28 to 75 years). The majority of afected women were multiparae, with average 3 children (ranging from 1 to 6). One patient had a subacute rupture, and 2 had ruptures into the splenic vein causing portal hypertension. The spleen was enlarged in 7 out of 9 patients. The average size of aneurysms was 3,2 cm (ranging from 2 to 8 cm). The preoperative diagnosis of splenic artery aneurysm was established in 6 patients while in 3 patients aneurism was accidentally found during other operations, during splenectomy in 2, and during the excision of a retroperitoneal tumour in 1 patient. Aneurysmectomy was carried out in 7 patients, while a ligation of the incoming and outcoming wessels was performed in 2 patients with arteriovenous fistula. Splenectomy was performed in 6 patients, while pancreatic tail resection, cholecystectomy and excision of the retroperitoneal tumor were performed in 3 patients. Additional resection of the abdominal aortic aneurysm with reconstruction of aortoiliac segment was performed in 2 patients. There were no mortality and the postoperative recovery was uneventful in all patients.

Adult↗
PubMed2005

[Off-pump myocardial revascularization (OPCAB) in patients with post-infarction unstabile angina, low ejection fraction and renal disfunction].

UNLABELLED: The purpose of this study is to present our experience in off-pump myocardial revascularization in patients with post-infarction unstable angina, left ventricular low ejection fraction and renal dysfunction. MATERIAL AND METHODS: From January 1998. until march 2002, at the Institute for Cardiovascular Diseases in Clinical Centre of Serbia, we have operated 20 patients with post infarction unstable angina, echocardiographicaly proved low ejection fraction (less than 30%) and renal dysfunction (Serum Creatinin 150 micrograms per liter) using this method. All patients were male and they were between 52 and 79 years old. Preoperative characteristics, surgical treatment and postoperative course are presented. RESULTS: There was no hospital mortality, as well as important morbidity. There was no worsening of the renal and myocardial function. Postoperative ICU stay was from 1 to 2 days. Postoperative hospital stay was between 3 and 7 days. CONCLUSION: Off-pump myocardial revascularization is safe and effective procedure in all patients with left ventricular low ejection fraction and renal dysfunction.

Aged↗
PubMed2005

[Early results in the surgical treatment of Crawford type IV thoracoabdominal aneurysms].

OBJECTIVE: The aim of the study was to present the outcome of surgical treatment of patients with thoracoabdominal aortic aneurysm Crawford type IV, operated on between January 2001 and April 2004. METHODS: This study included 42 subsequent patients (40 males, 2 females, age 41-76 years). All patients underwent ultrasonography, angiography, computed tomography or magnetic resonance imaging (MRI). Surgical treatment was performed under combined anaesthesia (continuous thoracic epidural analgesia and general endotracheal anaesthesia). In two patients thoracophrenolumbotomy was performed at the level of X rib, while others were operated through left lumbotomy after the extra pleural resection of XI rib. We did not perform any spinal cord protection procedures in this type of aneurysm. Reconstruction included interposition of Dacron graft in 20 patients, aortobiiliac bypass in 18, and aortobifemoral bypass in 4 patients with different varieties of visceral branches reimplantation. RESULTS: Thirty-days mortality was 31% (13 patients, two of them intraoperatively). Causes of death were: pulmonary embolism--in 1 patient; haemorrhage--in 2; myocardial infarction--in 4 (two intraoperative); acute renal failure--in 2; multisystem organ failure (MSOF)--in 4 patients. Respiratory failure dominated in all cases of MSOF. One patient with acute renal failure had paraplegia also, and that was the only case of neurological complication in whole group. All female patients (2), all patients with ruptured aneurysm (4), acute myocardial infarction (4) and acute renal failure (2) have died. Advanced age (over 70 years) and the need for extensive operative procedure with bifurcated graft use significantly influenced their mortality (p < 0.01 and p < 0.05 respectively). CONCLUSIONS: Surgical treatment of thoracoabdominal aortic aneurysm Crawford IV type was successful in 69% of our patients. There was no need for spinal cord protection measures, and extra peritoneal approach with XI rib resection under the combined anaesthesia was preferred.

Adult↗
PubMed2004

[Comparison of the influence of general and regional anesthesia on basic haemodynamic parameters during carotid endarterectomy].

Carotid endarterectomy (CEA) is a preventive operation to reduce the incidence of embolic and thrombotic cerebral stroke. CEA carries a significant perioeperartive mortality rate from stroke and myocardial infarction, which may even approach 5%. Thus, anesthetic and surgical techniques are constantly under scrutiny to try to reduce this relatively high incidence of morbidity and mortality. Anesthetic technique for CEA is divided to general (GA) and regional (RA) anesthesia, performed by cervical plexus block. The aim this study was to examine changes of basic haemodynamic parameters, which routinely fallows during CEA in condition of GA and RA. After obtaining institutional approval and informed consent, we randomized 50 patients scheduled for CEA (Tab. 1) in two groups (GA and RA). We fallow blood pressure: systolic (BPs), mean (BPm), diastolic (BPd), heart rate (HR), and RPP index at the examined patients. The examination performed in six control times: before induction of anesthesia (T1), 10 minutes after beginning of operation (T2), 5 minutes after cross clamping of arteria carotis (T3), 5 minutes after declamping arteria carotis (T4), 10 minutes (T5) and 2 hours after operation (T6). The results of study shows significant changes of blood pressure (BPs and BPm) and RPP index in T2 time in patinets undergoing GA. The changes occurred under influence of induction agent thiopental. These changes were in homeostatic range. In RA patinets, no haemodynamic changes registrated in control times. Therefore, from haemodynamic aspect RA was superior to GA.

Aged↗
PubMed2001

[The upper thoracic outlet vascular syndrome].

A 16 patients with 20 vascular TOS have been evaluated at the our Institute. Fourteen of them were female, and 2 male patients, with average age of 33.1 (18-44) years. 19 of them had congenital, and one acquired TOS after trauma at neck-shoulder region. 13 cases had arterial, and 7 venous TOS. In 10 cases a cause of TOS was cervical rib, in one scar tissue after clavicle fracture, while in 9 soft tissue anomalies. Eight cases with arterial TOS had a hand ischemia, one TIA and 5 periodical symptoms only during the arm hyperabduction. Two cases with venous TOS also had symptoms and signs during arm hyperabducrtion only, while five patients had axillary-subclavian deep venous thrombosis (DVT). All patients underwent CW-Doppler, Duplex-ultrasonographic and angiographic examination in normal position of the arm and during the hyperabduction. The four aneurysms of the subclavian artery, two poststenotic dilatation of the subclavian artery were found as well as one thrombosis of the axillary artery and 8 brachial artery embolism. The operative treatment consists from decompression and vascular procedure. A decompression procedure include 10 resections of the cervical rib, three transaxilary and 6 supraclavcular resection of the first rib, as well as one scalenectomy. A vascular procedures included 8 transbrachial thrombembolectomy and 4 resection and replacement of subclavian artery aneurysms. Four early complications were noticed: two partial pneumothorax, and two transiet medianus nerve paresis. The follow-up period was between one and six years (mean 3 years). In this period one (12.5%) late arterial occlusion was found. The vascular TOS is more rare than neurogenic, however in mostly cases requires surgical management.

Adolescent↗
PubMed1997

Popliteal artery war injuries.

The early postoperative results of 44 surgically treated popliteal arterial injuries from the Yugoslav civil war are reported. Of these patients, 41 (93%) were males and three (7%) were females, average age was 28 (range 6-45) years. Twenty patients (45%) had gunshot wounds and 24 (55%) explosive wounds. Twelve (28%) suffered isolated vascular damage, while 32 (72%) suffered concomitant bone fractures. Isolated arterial lesions were found in 24 (55%) cases, and concomitant arterial and venous lesions in 20 (45%). Twenty-four (55%) had primary reconstructions after haemostasis in the initial war hospital, and 20 (45%) secondary reconstructions after inadequate primary reconstruction in a regional war hospital. Artery procedures included 19 reverse saphenous vein graft interpositions, 10 reverse saphenous vein bypasses, 12 'in situ' saphenous vein bypasses and five lateral subcutaneous saphenous vein bypasses. The early graft patency rate was 100%, and limb salvage 72%. Major amputation was performed in 28%. Concomitant bone fractures, secondary reconstructions, secondary haemorrhage from an infected graft, and explosion wounds significantly increased the amputation rate (P < 0.01). Eleven amputations were performed after an anatomic, and only one after an extra-anatomic reconstruction (P < 0.01). The authors recommend an in situ or lateral subcutaneous reconstruction in cases of complicated popliteal artery injuries, such as concomitant bone fractures accompanied by massive soft tissue damage, and this type of reconstruction should also be used if infection is present or the procedure is delayed.

Adolescent↗
PubMed1995

[Aneurysms of the popliteal artery].

The 45 patients with popliteal artery aneurysms have been treated at the Institute for Cardiovascular Diseases from Belgrade, during the last 36 years. Four of them were women and 41 men, with average age of 61 years. The incidence of bilateral localization was 28%. The aneurysms have been presented with the rupture in 6 cases, with deep popliteal venous thrombosis in 3 cases, with sciatic nerve compression in one case, and with acute or chronic leg ischemia in 38 cases. Seven small asymptomatic aneurysms have not been operated. The primary major leg amputation had to be done in 8 cases due to irreversible ischemic changes. Any form of reconstructive procedures has been done in 48 cases (total or partial aneurysmal resection with graft interposition, an aneurysmal exclusion and bypass procedures). The autologous saphenous vein graft has been used in 42 cases, PTFE in 5 cases and Bovin solco graft in one case. Three patient died intraoperatively due to massive myocardial infarction. The early patency rate was 91%, and limb salvage 93%. The follow-up period was between 2 months to 16 years (men 3 years). The long term patency rate was 86%, and limb salvage 97%. The surgical treatment is the method of choice in case of popliteal artery aneurysm, due to good results, and possible complications.

Adult↗
PubMed1994

[Percutaneous transluminal angioplasty of the abdominal aorta using the "kissing balloon" technic].

Percutaneous transluminal angioplasty (PTA) of the distal abdominal aorta is still rarely performed procedure. Sporadic reports come from selected institutions with extensive experience in the field of PTA. Procedure is performed using so called "kissing-balloon" technique, and may be an alternative to the surgical treatment in well selected cases. We present a 45 years old woman with intermittent claudications and infrarenal abdominal aortic stenosis, treated successfully using above mentioned technique.

Angioplasty, Balloon↗
PubMed1993

The role of biphasic scintigraphy with 99mTc-HMPAO leukocytes in detection of synthetic vascular graft infections--preliminary results.

The study presents preliminary results and suggests the role of scintigraphy of synthetic vascular prosthesis by 99mTc-HMPAO labelled leukocytes for detection of graft infections. Analysis of the results obtained revealed true positive in 6, true negative in 3 and suspicious findings in 3 patients (in one of them the suspicious was confirmed on reoperation). False positive and false negative results were not obtained. Early and accurate diagnosis of occult infection of the synthetic vascular graft is of utmost importance for the prompt starting of the therapy. Due to its high sensitivity and specificity, 99mTc-HMPAO-leukocytes scintigraphy is a very useful method for the detection of graft infections.

Blood Vessel Prosthesis↗
PubMed1990

[The St. Jude biopolymeric graft in reconstruction of peripheral arteries].

The authors present their preliminary results of St. Jude Bio Polymeric graft application in the periphery arteries reconstruction. This biograft like all the previous ones (Soleo, CB.S., human umbilical veins) was introduced with the aim of creating a better substitute for autovenous Graft, which has been irreplacible ever before, especially in cases of crural reconstruction. The operated patients were classified into the II stadium of occlusive disease (claudication) and indications for surgery have been based on Doppler sonography and arteriography. In three cases crural femoro-popliteal reconstruction was carried out, because of an occlusion of the superficial femoral artery, in one case a femoro-femoro cross over bypass due to an occlusion of the iliac artery. Postoperative follow-up ranged from 6 to 12 months and the control of the graft passage by. Doppler sonography and arteriography confirmed patency of all grafts. I.e. the preliminary results are excellent.

Arterial Occlusive Diseases↗
PubMed1989

[Recurrent varices after surgical treatment].

Authors showed 240 patients with post-surgical, recidive varices. The cause of these varices were: perforators incompetentions, bad safeno-femoral deconnection, non extirpated collateral veins etc. Diagnosis of these complications is based upon Doppler and phlebographic examinations. Surgical treatment is based upon pathophysiological and pathoanatomic substrate (extirpation varices, subfascial ligature or discision perforators, etc).

Humans↗
PubMedDate not supplied

[The popliteal artery entrapment syndrome].

The authors are presenting 8 patients with 9 cases of popliteal artery entrapment syndrome. There were one female, and 7 male patients with average age of 36.4 (25-54) years. Six cases were manifested with acute, 2 with chronic foot ischemia, while one case was asymptomatic. For diagnosis a combination of Doppler sonography and transfemoral angiography, was used. Eight cases were operated using posterior, while in one medial approach to the popliteal artery. The types I and IV of the popliteal artery entrapment syndrome were found in one case, type II in two cases, type III in 4 cases, while in one case a type of syndrome had not to be identified. During the operation the resection of the anomalous muscle and reconstruction of the popliteal artery, were done in 8 cases. In one case muscle resection or arterial reconstruction, were not necessary. The early potency rate and limb salvage, were 100%, while long term potency rate after mean follow up period of 6.3 years was 83.5%. The acute or chronic foot ischemia in health, young persons without typical atherosclerotical risk factors, suggests on popliteal artery entrapment syndrome.

Adult↗
PubMedDate not supplied

[Arterial embolisms of the lower extremities].

INTRODUCTION: Embolism is one of the most frequent causes of lower limbs acute arterial occlusion [1]. Of the total number of peripheral embolism 56% of cases involve lower limbs arteries [2]. Inadequate and late treatment of the lower limbs embolism is associated with high morbidity and mortality rate. The aim of this paper was to study the aetiology of lower limbs embolism and to detect factors influencing early and late results after the operative treatment. PATIENTS AND METHODS: The study included 204 patients with 224 lower limbs embolism, treated surgically at the Institute of Cardiovascular Diseases of the Clinical Centre of Serbia in Belgrade in the period between 1993 and 1997. There were 107 (52.2%) female and 97 (47.8%) male patients. Thirty two (14.3%) patients were younger than 50 years, 64 (28.6%) were between 51 and 65, 101 (45.1%) between 66-75, while 27 patients (12.1%), were older than 75. Twenty (8.9%) patients were admitted less than 6 hours before the operation, 79 (33.3%) between 6 and 24 hours, and 125 (55.8%) more than 24 hours before the operation (Table 1). One hundred (53.6%) patients had motor and 133 (59.4%) sensor paralysis on admission. Table 2 shows arterial localization of the lower limbs embolism. The popliteal artery was involved in most cases. During the operation transfemoral arterial approach was used in 132 (58.9%) cases, while transpopliteal in 92 (41.1%) cases. Fourteen cases required bypass surgery, 43 fasciotomy, 2 intraoperative streptokinase and 4 intraoperative angiography. All patients were controlled using physical and CW Doppler ultrasonographic examinations immediately after the operation, and then one, six and 12 months, as well as every year. RESULTS: In 173 (84.4%) patients cardiac causes of embolism were found, in 8 (3.9%) noncardiac, while in 8 (3.9%) the cause could not be established. Of all cardiac causes absolute arrhythmia was most frequent. Table 3 and Table 4 show the aetiology of the lower limb embolism. The early amputation rate was 23 (10.3%) cases, while limb salvage was recorded in 174 (77.7%) patients. Of all saved limbs complete recovery was noted in 162 (72.4%) cases and peroneal nerve paresis in 12 (5.3%) cases. The early postoperative mortality rate was 27 (12.0%). Table 5 shows early results of embolectomy. The early results (limb salvage, complete recovery, rethrombosis, early reoperations, amputations rate, morbidity and mortality rate) of embolectomy were statistically significant: worse in cases when the embolus was located in the abdominal aorta and popliteal artery; in cases with a long time interval before the operation as well as in patients with sensor-motoric paralysis on admission (Tables 6-8). Of the total number of patients in 87 (56.5%) cases a late control examination was carried out. Forty nine (31.8%) patients died before the late control, while 18 (11.7%) did not come to control examination. Late recidivation of embolism was found in 3 cases. In these patients the cause could not be found, and they were treated by anticoagulant drugs.

Aged↗
PubMedDate not supplied

[Intra-arterial administration of prostaglandin E1 in occlusive arterial diseases].

The authors present their result of a two-year follow-up of 106 patients to whom an intra-arterial perfusion of prostaglandin E1 was administered, as limb salvage procedure. The patients were in the IIIrd and IVth stage of occlusive diseases by Fountain, and surgical reconstructions were not possible. All patients were divided into five groups: A--diabetic angiopathy (5), B--distal form of atherosclerosis (40), C--diabetic angiopathy and atherosclerosis (45), D--Burger disease (10) and E--adjuvant therapy in reconstruction with poor run-off (6). The Doppler sonographic and angiographic measurements were performed. After transcutaneous (16 cases), or intraoperative (90 cases) introduction of the catheter into superficial of profunda femoral artery, a continuous intraarterial administration of prostaglandin E1 was carried out in a dose of 10 nanograms/kg body weight/minute (total dosage 3000 nanograms). The patients were controlled immediately after the treatment, as well as 1, 3, 6, 12, 24 and 36 months after the treatment. In efficiency of the treatment was estimated on the following basis: elimination of rest pain, healing of trophic ulceration and demarcation of gangrenous processes. Our late results of intra-arterial administration of prostaglandin E1 proved to be a very successful limb salvage procedure. The treatment was more successful in a connections between the upper knee arterial net and pedal arterial arches were preserved.

Adult↗