vascular diseasect angiography & operative treatment
DESCRIPTION
VASCULAR DISEASE CT ANGIOGRAPHY & OPERATIVE TREATMENTTRANSCRIPT
VASCULAR DISEASE CT ANGIOGRAPHY & OPERATIVE TREATMENT
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.
Variety of vascular surgical procedures are performed in special hospital for surgery Fillip II, such as: carotid artery sur-gery (thrombendaterectomy with direct suture or patch plastique, shortening of the carotid artery in symptomatic kinking etc.). Lately, 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 treatment of peripherial arterial vessels using venous, PTFE graft or thrombendaterectomy with patch plastique). Surgery of aorta: replacement of aorta ascen-dens with graft, native valve repair and reimplantation of coronary arteries (Tirone David), reconstruction of aortic root, replacement of ascendens and hemiarcus with Albograft, replacement of the thoracic, abdominal and whole aorta with reimplantation of all the branches of the aortic arch, mesenterical arteries, renal arteries as well as truncus coelliacus.
Carotid Artery Disease
Carotid endarterectomy , because of significant stenosis left carotid artery
Carotid Artery Disease
Plastic (patch) repair of the carotid artery in carotid endarterectomy, because of significant stenosis left carotid artery
Carotid Artery Disease
Operative treatement of symptomatic Kinking od right Carotid artery
Carotid Artery Disease
Plastic (patch) repair of the carotid artery in carotid endarterectomy (left), vascular graft (right) , because of bilat-eral significant stenosis
Carotid Artery Disease
Occlusion after carotid endarterectomy right, resection of right ACI and T-T anastomosis with saphenous vein (3mm)
Carotid Artery Disease
Carotid - subclavian (synthetic) bypass because of occlusion of left subclavian artery
Carotid Artery Disease
Operative treatment of giant aneyrism of left internal carotid artery and T-T anastomosis with saphenous vein
Carotid Artery Disease
Carotid endarterectomy of the carotid artery, because of occlusion of left internal carotid artery
Carotid Artery Disease
Carotid - carotid (synthetic) bypass
Abdominal aortic aneyrism
Replacement of infrarenal abdominal aorta with graft
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
FEA
TU
RE
AR
TIC
LES
by Nikola Hristov on July 30, 2009 ats.ctsnetjournals.orgDownloaded from
Aorto-Bilateral-Femoral-Bilateral-Popliteal Bypass for Leriche Syndrome With Occlusion of Both Superficial Femoral Arteries
Ann Thorac Surg 2009;88:683 DOI: 10.1016/j.athoracsur.2008.11.006
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
FEA
TU
RE
AR
TIC
LES
by Nikola Hristov on July 30, 2009 ats.ctsnetjournals.orgDownloaded from
Aortobiiliac occlusive disease Leriche Syndrome
Aorto biiliac (synthetic) bypass
Peripheral arterial occlusive disease
Femoro femoral (synthetic) bypass, bilateral femoro poplietal (synthetic)
Peripheral arterial occlusive disease
Femoro tibial (saphenous vein) autogenous bypass
Peripheral arterial occlusive disease
Popliteo tibial (saphenous vein) autogenous bypass
Peripheral arterial occlusive disease
Plastic (patch) repair of the femoral artery in femoral endarterectomy
Peripheral arterial occlusive disease
Femoro-femoral (synthetic) bypass, illiacofemoral (synthetic) bypass left
Peripheral arterial occlusive disease
Femoro poplital (synthetic) bypass left, femoro tibial autogenous bypass (saphenous vein)right
Thoracic Aortic Aneurysm
Replacement of aorta ascendens and aortic arch with graft, reimplan-tation of cephalic arteries and mec-hanical valve replacement
Thoracic Aortic Aneurysm Aorta ascendens Aneurysm
Replacement of aorta ascendens (root) with graft, native valve repair and reim-plantation of coronary arteries (Tirone David)
Thoracoabdominal Aortic Aneurysm
Replacement of thoracoabdominal aorta with graft and reimplantation of truncus coeliacus
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
DeBakey repair for type III thoracoabdominal aortic aneurysm
Eeuropena Association for CardioThoracic Surgery 35 (2009) 905
95 mm
Special Hospital for Surgical Diseases “FILIP II”bul. “Ilindenska”, 1000 Skopje, Republic of Macedonia
Tel: +389 2 3091-500, +389 2 3091-484www.cardiosurgery.com.mk