Haris Vranic

Cost-Effectiveness Analysis of Treatment Acute Deep Vein Thrombosis in Clinic of Vascular Surgery Sarajevo

AIM: To compare hospital costs of acute deep vein thrombosis (ADVT) treatment in two periods of time. Evidence of repercussions on reducing costs during successful treatment. Attention was given to the necessity, costs and effectiveness of diagnostic procedures, treatment and complications. METHODS: A retrospective analysis of data obtained from patients medical history in a period from 2000 to 2016. Model management and safe practice of ADVT care consisted of clinical examination, laboratory, colour Doppler and invasive diagnostics. In a treatment was used continuous infusion un-fractionated heparin for 40 patients from 2000th till 2006th and low molecular weight heparin for 40 patients from 2006th till 2016th. All patients were converted to oral anticoagulants. RESULTS: When we look at the overall picture of improving the management model, safe practices and economic rationalization, we conclude that we offer better health service for the patients with ADVT at the moment, which relies on proven medical treatment trends. While we do not forget responsibility towards a society of which depends on treatment funding. CONCLUSION: The implementation of a conceptually new model of management of ADVT did not contribute rise of the desired outcomes, but it justified the positive economic viability of introduced changes at the Clinic of Vascular surgery than the previous concept.

Critical Carotid Artery Stenosis in Coronary and Non-Coronary Patients - Frequency of Risk Factors

Introduction: Stroke is one of the largest socio medical problems of modern times. In addition to the third leading cause of death, it is the first cause of non-trauma disability. Numerous studies show a correlation of risk factors and arteriosclerotic lesions in the coronary arteries and carotid arteries. Patients and methods: Study was conducted at the Clinical Center University of Sarajevo, Clinic for Cardiology surgery, methodologically cross-sectional study and partly manipulative and clinical prevention study, conducted on a representative sample of 100 patients. The subject was divided into 2 groups, coronary and non-coronary patients. Both groups of patients underwent color Doppler of carotid arteries, medical history and laboratory analysis. Results: The results confirm the hypothesis that the critical carotid artery stenosis is more present in patients with coronary disease, while the association of risk factors has been demonstrated for diabetes, hypertension and dyslipidemia. Conclusion: Screening of carotid arteries in patients scheduled for coronary revascularization is essential. With the presence of critical stenosis of the carotid artery, surgery of carotid artery should be done before coronary revascularization. The implementation of aggressive education and prevention of risk factors for cardiovascular disease is needed.

Comparison of Results Classical and Eversion Carotid Endarterectomy

Introduction: Atherosclerosis blood vessels, be it on extra-cranial or intra-cranial circulation, the most common cause of incidents such as cerebro-vascular insult (ICV). Carotid endarterectomy (CEA) is a preventive operation to reduce the risk of stroke and it can be performed by eversion carotid endarterectomy (E-CEA) or a classical carotid endarterectomy (C-CEA). The aim of this study was to investigate the influence of the used techniques in basic perioperative results and the incidence of postoperative complications. Materials and Methods: It was retrospective-prospective study that involved 173 patients, with carotid stenosis, who underwent CEA, in the period of time December 2013 till December 2016. Subjects were divided into two groups in respect of technique: 90 patients were treated with E-CEA and 83 patients were treated with C-CEA. Results: Between two groups revealed a significant difference in favor of the patients from group E-CEA in the length of the surgery (92.56 ± 29.11 min. vs. 104.04 ± 18.01 min., P = 0.000), the time of clamping the carotid arteries (11.83 ± 1.81 min. vs. 23.69 ± 5:39 min., p = 0.000), the amount of post-operative drainage (25.33 ± 24.67 ml. vs. 36.14 ± 14:32 ml., p = 0.001), time spent in the intensive care unit (± 25.43 vs. 13:51 hours 34.54 ± 35.81 hours, p = 0.000), and the length of stay (4.60 ± 0.90 days vs. 5:42 ± 1.80 days, p = 0.001). In the patients of the group E-CEA, fewer number of individual postoperative complications without statistical significance: ICV (2.2% vs. 4.8%, p = 0.351), cardiac arrhythmia (2.2% vs. 4.8%, p = 0.351), transitory ischaemic attack (TIA) and cognitive disorder (2.2% vs. 7.2%, p = 0.117), mortality (1.1% vs. 1.2%, p = 0.954); and the total number of postoperative complications was significantly less in the same patients (7.77% vs. 18.7%, p = 0.042). Conclusion: The results of this study clearly indicate that operating techniques affects the specified monitored outcomes of vascular treatment of carotid arteries in favor of E-CEA technique. It would be ideally that the conclusions of this study contribute to broader use of E-CEA in treatment of carotid stenosis.

The incidence of vascular complications after coronary angiography: evaluation of results and risk factors

Introduction: The aim of this study was to present the incidence of the vascular complications that had to be surgically treated during the two-year period of transfemoral cardiac catheterization procedure and to identify the risk factors associated with the complications.Methods: A retrospective two-year study of post-catheterization complications with the six-month postoperative follow-up and analysis of risk factors was done. Patients with cardiovascular diseases who underwent therapeutic or diagnostic coronary angiography in the period of 2012-2013 were included in the study. A total of 1320 patients were subjected to catheterization for coronary angiography, of which 24 had vascular complications that had to be surgically treated. Indications for operative treatment included rapid growth of pseudoaneurysm, hemorrhage, large hematoma, hemodynamic instability, failure of the targeted compression therapy.Results: Twenty-four patients experienced some kind of post-operative complication. Infection and dehiscence of surgical wound were the two most common complications. There were no fatalities. The average length of a hospitalization was 4 days. The important risk factors are gender (women more than man), obesity, concomitant use of anticoagulation therapy and antiplatelet therapy after catheterization.Conclusion: Insufficient length of the compression of the punctured place and increased risks of a pseudoaneurysm formation, such as female gender, obesity, and use of a combined anticoagulant therapy are the main causes of these complications. Late vascular complications are not uncommon.

Extensive Operation as One of the Solution for Patients with the Insufficient Proximal Landing Zone for TEVAR in Aortic Dissection – short term results -

Objective: In our study we wanted to showed the safety, feasibility, efficacy and way how to solve the problems of endovascular repair for aortic dissection with insufficient proximal Landing Zone. Methods: The clinical data of all the patients with insufficient proximal Landing Zone (PLZ) for endovascular repair for aortic aneurism and dissection Stanford type B for the period from October 2013 to June 2014 was prospectively reviewed. According to the classification proposed by Mitchell et al, aortic Zone 0 was involved in 3 cases, Zone 1 in 1 case, Zone 2 in 9 cases and Zone 3 in 6 cases (19 patients in total). A hybrid surgical procedure of supraortic debranching and revascularization, with direct anastomosed truncus brachiocephalicus and left common carotid artery, were performed to obtain an adequate aortic PLZ. Revascularization of the left subclavian artery was carried out on the patient with dissection Stanford type B and short PLZ 2. Results: There was no significant difference of risk factors between Zone 0, Zone 1, and Zone 2 (Table 1.), but the length of the PLZ significantly differed between groups (p<0.01) and there is no significant difference in technical and clinical success rate among the groups. Conclusion: The procedure of extending insufficient PLZ for endovascular repair for aortic arch pathology is feasible and relatively safe. The TEVAR applicability in such aortic disorders could be extended.