VASCULAR DISEASECT ANGIOGRAPHY AND SURGICAL TREATMENT

SPECIAL HOSPITAL

FILIP VTORI

VA SC UL AR DISEASE

CT ANGIOGRAPHY AND SURGICAL 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 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 treatment 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), 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.

Operations in period 2000-2011

Cardiovascular

Vascular

Carotid Artery Disease (stenosis) Before operation

After operation

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

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Carotid Artery Disease (stenosis) Before operation

After operation

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

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Carotid Artery Disease (stenosis) Before operation

After operation

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) Before operation

After operation

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

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Carotid Artery Disease (stenosis and occlusion) Before operation

After first operation

After second operation

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 Before operation

After operation

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

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Carotid Artery Disease (carotid aneurism) Before operation

After operation

Operative treatement of giant aneurism (red arrow) of left carotid artery, T-T anastomosis with saphenous vein was performed (blue arrow) 10

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

Carotid Artery Disease (occlusion) Before operation

After operation

Plastic (patch) repair in carotid endarterectomy (blue arrow) because of left internal carotid artery occlusion (red arrow) 11

Carotid Artery Disease (occlusion) (оклузија) Before operation

After operation

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

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Lidija Veljanovska, MD, and Nikola MDHristov, MD Mitrev, MD, Lidija Veljanovska, MD, Hristov, and Nikola

y “Filip Vtori,” Skopje, Macedonia Hospital for Surgery “Filip Vtori,”disease Skopje, Macedonia Peripheral arterial occlusive

After operation

Before operation

Aorto-bilateral-femoral and bilateral-femoro-popliteal bypass (blue arrow) because Leriche syndrome with occlusion of both superficial femoral arteries (red arrow) Fig 1.

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

Fig 2.

Fig 2.

Lifesciences, Irvine, CA) 13Y-graftt Lifesciences, Irvine, CA) Y-graft, anastomosed terminal the aorta and latero terminal to the aorta andtolatero-lateral to both

Peripheral arterial occlusive disease Before operation

After operation

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

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Peripheral arterial occlusive disease Before operation

After operation

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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Peripheral arterial occlusive disease Before operation

After operation

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

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Peripheral arterial occlusive disease Before operation

After operation

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

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Peripheral arterial occlusive disease Before operation

After operation

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

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Peripheral arterial occlusive disease Before operation

After operation

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

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Peripheral arterial occlusive disease Before operation

After operation

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 Before operation

After operation

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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Thoracic Aortic Aneurysm Before operation

After operation

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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Thoracic Aortic Aneurysm and Disection Stanford A Before operation

After operation

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).

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

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Thoracic Aortic Aneurysm Before operation

After operation

85,8mm

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

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Abdominal aortic aneurism Before operation

After operation

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 Before operation

After operation

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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diagnosed with thoracoabdominal aortic wford type III (Fig. 1). Immediate surgery Thoraco abdominal Aortic Aneurysm d through 6th intercostal space and retro-

repair, aneury aneurysm neck

After operation

Before operation

95 mm

Fig. 2. Postoperat e 64 tomography Crawford type 2. - Postoperative 64 slice computerized tomography Repair computerized for Fig. DeBakey Crawford type III of thoracoabdominal aorticIIIaneurysm (red arrow) and of pe III slice repair for Crawfo ofmaximal visceral anddiameter renal arteriesof(white arrow) aortic reimplantation aneurysm, 10 cm. repair for Crawford type III thoracoabdominal aortic aneur indicating proxima indicating proximal end to side prosthesis implantation on aorta; arrow 2 im aorta; arrow 2 implantation of the celiac trunk graftover on theshort prosth1 Published in „European Association for CardioThoracic Surgery“ 35 (2009) 905 27 graft on the prosthesis (arrow 8); arrow 3 implantation of10 the rigv over short mm

SPECIAL HOSPITAL

FILIP VTORI

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