[Effect of improved surgical anesthesiologic factors on the results of treatment of aneurysms of the abdominal aorta]. / Vrednovanje utjecaja poboljsanja operacijskih anestezioloskih cimbenika na rezultate lijecenja aneurizmi abdominalne aorte.

The purpose of this study was to compare the recent results of the abdominal aortic aneurysm (AAA) surgery, with the results for the patients operated ten years ago, and to identify the factors influencing the operative results. Two groups of patients were selected using a retrospective case series study. First group of patients (A) consisted of 32 cases operated in the period between 1984 and 1986, and the second group (B) consisted of those operated ten years later (from 1994 to 1996). Mortality rate, presence of risk factors, demographic data, and operative factors were analyzed and compared between the groups. The mortality rate decreased from 10.7% in period A, to 5.3% in period B for elective operations, and from 75% to 44.4% for emergency operations. The prevalence of straight graft technique in period B showed statistically significant difference compared to period A (p < 0.005). Besides, the operating time and the amount of the transfused blood between the groups differed significantly (p < 0.05). On the basis of this data, we concluded that the modifications in the operative technique, as well as the increased number of operations within the second period led to the decreased mortality rate in patients operated for AAA.

[Surgical treatment of war injuries of the veins]. / Kirursko lijecenje ratnih ozljeda vena.

Between April 1991 and December 1995, 118 patients were treated for wartime venous injuries. There were 108 (91.5%) venous injuries combined with arterial ones, and 52 (49%) with bone fractures. A total of 85 (72%) venous repairs were done and 33 (27.9%) were treated by ligation. Arteriovenous fistulas were found in 20 (16.9%) venous injuries. Venous injuries were associated with 10 (62.5%) amputations and 5 (45.4%) deaths. In the early postoperative period the authors found 15 (17.6%) thromboses of venous reconstructions.

[War injuries of the arteries]. / Ratne ozljede arterija.

The experience with military vascular injuries in the recent war in Crotia is reviewed. From April 1991 to October 1995, 197 wounded persons with 231 injuries of arteries were admitted to the University Hospital Rebro. The most common injuries were of lower extremity arteries (54.5%), and the most frequent method of repair was revascularisation with saphenous vein graft interposition. Fasciotomies were performed in 34% because of frequent associated injuries of bones (34.5%) and veins (46.7%). In 20.7% casualties pseudoaneurysms and arteriovenous fistulas were found. Postoperative thrombosis (9%) was a consequence of local infection, massive necrosis and sepsis. Amputation rate was 7.7%, and mortality 5.3%. These results are very satisfactory in comparison with the results in literature. This is a result of good organization of our war surgical service: rapid transportation of wounded persons to convenient surgical centres and high surgical skill.

Treatment of upper limb nerve war injuries associated with vascular trauma.

During a 4-year period, in the Departments of Plastic Surgery and Vascular Surgery at the Clinical Hospital Centre in Zagreb, 151 upper limb nerve injuries caused by war weapons were treated using microsurgical procedures, and 119 patients have been assessed. Among them, 44 patients with 58 nerve injuries had associated arterial injuries. It is of great importance that peripheral nerve as well as vessel injuries should be considered in all extremity war wounds. Every effort should be made to perform immediate revascularization of a damaged artery, as this is the best guarantee for long-term arterial patency. Reconstruction with autologous vein has been the method of choice for arterial war injuries. Injured peripheral nerves, at the time of vascular repair, were marked and left for secondary reconstruction. Primary repair of such injuries was contraindicated because it was impossible to determine the exact proximal and distal extent of injury. Functional results were obtained in only 44.8 per cent of cases with concomitant nerve and arterial war injuries, an outcome that could be explained by insufficient vascularization at the site of nerve repair (using both mechanisms of graft revascularization), as well as proximal levels of injury and extent of nerve damage, which resulted in long nerve defects.

Arteriovenous fistula of the internal mammary artery (combat injury): transcatheter intravascular coil occlusion.

A case of arteriovenous fistula of the left internal mammary artery occluded by Gianturco coil is reported. A 26-year-old male suffered multiple explosive injuries. Right heart failure developed postoperatively. Digital subtraction angiography demonstrated arteriovenous fistulas between the left internal mammary artery and left subclavian and innominate veins. Considering previous multiple surgical interventions and severe general condition of the patient, both arteriovenous fistulas were successfully occluded by transcatheter placement of a Gianturco coil.

[Epidural anesthesia in vascular surgery in patients with chronic obstructive lung disease]. / Epiduralna anestezija u vaskularnoj kirurgiji u bolesnika s kronicnom opstruktivnom bolesti pluca.

Epidural anaesthesia was determined in 29 patients with chronic obstructive pulmonary disease. Lidocaine 2% for vascular procedures such as embolectomy from the arteriae femoralis and arteriae poplitea was used as an anesthetic in 12 patients and 0.5% bupivacaine for aortobitemoral or femoropopliteal bypass in 17 patients. Thus possible complications in patients with obstructive chronic pulmonary disease were avoided as well as prolonged mechanical ventilation and endotracheal intubation. With the postoperative application of local anesthetic through a catheter into the epidural space, spontaneous breathing and good analgesia was achieved. Preoperatively all patients were administered bronchodilators, expetorants and they stopped smoking.

Military vascular injuries in Croatia.

A single-centre experience of military vascular injuries in the recent conflict in Yugoslavia is reviewed. From 1 April to 13 December 1991, 1020 casualties were admitted to the Surgical Clinic at the Teaching Faculty of the University in Zagreb, Croatia. A total of 120 injured blood vessels in 76 patients were treated in the department of vascular surgery. Casualties were transported to the hospital after treatment by forward surgical facilities. The transportation time ranged from 3 to 18 (mean 7) h. The most common injuries were to the popliteal artery (12.5%) and brachial veins (10.0%). After segmental resection, arterial and venous revascularization with saphenous vein graft interposition was the preferred option. Twenty-six fasciotomies were performed because of compartment syndrome. Indications for six amputations included sepsis, deep vein thrombosis and extensive myonecrosis. Concomitant bone fractures were stabilized by an external fixator in 90.4% of cases. Vascular injuries were repaired before orthopaedic stabilization. Completion arteriography was used to delineate concomitant distal lesions.

[War injuries of the blood vessels]. / Ratne ozljede krvnih zila.

In this article the authors review their personal experience with shotgun injuries to the blood vessels. To date literature demonstrates a significant difference between the military injuries to the blood vessels versus the peacetime ones in the terms of healing. Injuries from high velocity missiles as well as blast injuries produce a massive damage of the tissue, muscles, bones, nerves and blood vessels. Therefore, such injuries demand a careful and appropriate primary surgical treatment and urgent revascularization within the ischemic tolerance of the tissue.

[Surgical reconstructive treatment of blood vessels in the popliteal region]. / Operativni rekonstruktivni zahvati na krvnim zilama potkoljenice.

Severe occlusive disease frequently includes the popliteal artery and origin of the trifurcation vessels with reconstruction of one or more of the crural arteries. We made femorocrural bypass 23 times. Our indications for operation continue to be relief of pain or salvage of extremity. Of the 23 grafts during of one year period block recurred in 8 patients. Five times we made amputation and good results we had in 15 patients. In one patient we used Gore-tex prosthesis with succses in 4 month period.