Search

Background: The aim of this study was to examine the influence of intraluminal thrombus (ILT) volume on the level of proteolytic activity and the content of abdominal aortic aneurysm (AAA) wall., Methods: The research was designed as a cross-sectional study at the Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia in the period from April 2017 to February 2018. During this period, a total of 155 patients with asymptomatic AAA underwent open surgical treatment and 50 were included in the study based on inclusion and exclusion criteria. Before surgery, patients included in the study were examined by MRI. During the operation, samples of ILT and AAA wall were taken for biochemical analysis., Results: A statistically significant correlation was found between the volume of the ILT and largest AAA diameter (ρ = 0.56; P < 0.001). The correlation of the ILT volume on the anterior wall and the concentration of MMP-9, MMP-2 and NE/ELA in the wall did not find statistical significance. Also, no statistically significant association was found between the volume of ILT and the concentration of ECM proteins (collagen type 3, elastin, proteoglycan) in the corresponding part of the wall. The association of ILT volume with MDA was also of no statistical significance. There was a positive statistical significance found in correlation of volume of ILT and catalase activity in the wall of AAA (ρ = 0.28, P = 0.049)., Conclusions: The volume of ILT in the aneurysmal sac seemed not to affect the level of proteolytic activity and the content of the aneurysm wall. However, a positive correlation was found between the ILT and the catalase activity. The effect of ILT on the aneurysm wall and its role in the progression of aneurysmal disease should be examined in future studies., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: The aim of this paper is to report our single-center experience in the open surgical treatment of acute spontaneous infrarenal isolated abdominal aortic dissection (siIAAD)., Methods: This was a single center retrospective study. Between January 2015 and 2020 ten patients were treated due to acute siIAAD with open surgery. There were no patients treated for chronic siIAAD in this time period. Patients who had concomitant thoracic aortic involvement were excluded from this report., Results: The group consisted of 7 male and 3 female patients. History of hypertension was present in nine patients and six were active smokers. The abdominal/back pain was described in 9 patients, two had acute limb ischemia and three had aortic rupture. Median dissection length was 91 mm (65.7 - 106), median distance from the lowest renal artery was 30 mm (20.7 - 49.3) and median abdominal aortic diameter was 58.5 mm (32.5 - 66.2). Supracoeliac clamp was used in three cases with a ruptured aorta and suprarenal in two patients. The mean duration of proximal clamping time was 24.3 ± 7.49 min. One patient died of postoperative acute myocardial infarction, one suffered nonfatal pulmonary embolism and one had deep venous thrombosis. No aortic-related deaths and/or reinterventions occurred during the median follow-up of 32 months., Conclusions: Acute siIAAD is a rare event which affects mostly male smokers with hypertension. Open surgery is a technically demanding procedure with acceptable complication rates and should be performed in specialized high-volume centers for the treatment of aortic disease. Future efforts to establish a multicenter registry to evaluate the prevalence of the disease and treatment options could provide better and more comprehensive guidelines for the treatment of acute siIAAAD., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: Infected false aneurysms (IFA) caused by intravenous drug abuse are uncommon but challenging lesions. The best approach for the surgical management of this condition is still unknown. The aim is to present a single-center 14-year experience in the IFA treatment in intravenous drug abusers, thus providing additional data regarding the treatment options and outcome in these patients., Methods: A retrospective analysis of 32 consecutive patients with vascular injuries secondary to intravenous drug abuse, during the period from January 2004 to April 2018, was performed. Data of interest were extracted from patients' medical history records, anesthesia charts, and database implemented in daily practice, or were obtained by personal contact. The diagnosis was set based on history, physical examination and/or color Doppler sonography, multidetector computed tomographic angiography, and digital subtraction angiography. The outcome included graft patency, limb amputation, and mortality., Results: During study period, 32 heroin abusers, predominantly males (81%), were surgically treated due to vascular injuries, with mean age of 35.2 years. The vast majority of patients have had an injury of the lower extremity blood vessels (84.3%) and the common femoral artery was the most common site of injury (59.4%). Three-quarters of patients underwent resection of the false aneurysm and ligation of the artery without reconstruction of the blood vessel. In 7 cases (21.9%), arterial reconstruction was performed with overall failure rate of 42.86%. The overall mortality rate was 6.25% and the rate of extremity salvage was 96.7%., Conclusions: The best treatment option is yet to be found, but based on the results of the present study, ligation of affected artery without revascularization seems to be an efficient, safe, and optimal treatment method, with minor risk of the extremity loss., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Primary aorto-appendicular fistulas are extremely rare in clinical practice, and there are only 3 such cases reported in the available literature. The aim of this study is to present the case of a 68-year-old female patient with primary aorto-appendicular fistula accompanied by infected penetrating aortic ulcer (PAU). At the time of her hospital admission, the patient did not demonstrate any typical symptoms. Multidetector computed tomography imaging of aorta was performed during an additional preoperative examination and the PAU of the infrarenal aortic segment was detected. Other pathological changes were not found. The intraoperative findings confirmed the presence of the PAU firmly attached to the appendix and surrounding signs of inflammation. Appendectomy and partial resection of the PAU were performed, along with aortic reconstruction, using a Dacron tube graft and right renal artery reattachment. During the postoperative period, there were no complications, and the patient was discharged on the 10th postoperative day. Control medical examination and color duplex ultrasonography were performed 18 months after the surgery and they provided satisfactory results., (Copyright © 2019 Elsevier Inc. All rights reserved.)

We present a case of successfully treated abdominal aortic aneurysm in a 24-year-old patient with Marfan syndrome. After initial physical and ultrasound examination, the multislice computed tomography (MSCT) scan revealed infrarenal aortic aneurysm of 6 cm in diameter, 10 cm long, along with slightly dilated iliac arteries. However, dimensions of aortic root, aortic arch, and descending suprarenal aorta were within normal limits. Further on, because the patient presented with signs of impending rupture, an urgent surgical intervention was performed. The patient was discharged in good general medical condition 7 days after surgery. After 6 months of follow-up, the patient's condition was satisfying and no MSCT signs of further aortic dissection/aneurysm were identified. To the best of our knowledge, a case of successful management of a patient with Marfans syndrome and truly isolated infrarenal and symptomatic abdominal aortic aneurysm has not been described in the literature before., (Copyright © 2019 Elsevier Inc. All rights reserved.)

The case report describes our first experience of "diffusion-weighted whole-body imaging with background body signal suppression" (DWIBS) application for disease activity assessment in a young female patient with Takayasu arteritis (TA). Despite the normal level of inflammatory markers, clinical signs of disease recurrence were present. In our case, DWIBS did not only help to identify the disease recurrence in the patient with false-negative inflammatory markers but also revealed new foci involved in the TA process. DWIBS can be a potentially new imaging method, useful during the follow-up in patients with TA., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: The aim of this study is to compare the pattern of intraluminal thrombus (ILT) deposition in diameter-matched ruptured and nonruptured abdominal aortic aneurysms (AAAs)., Methods: We performed a single-center, retrospective study. Ruptured AAAs were collected during 24 months. Diameter-matched intact lesions were randomly selected in a 2:1 ratio and served as controls. ILT cross-sectional area, relative area, maximum thickness, and asymmetric distribution were recorded at the site of maximum aneurysm size and compared between groups. Moreover, additional comparisons were performed inside the group of ruptured AAAs, between the site of maximum size and the site of rupture., Results: Fifteen ruptured cases were compared with 30 nonruptured cases. ILT relative area (37.5% vs. 73.5%, P = 0.004) and maximum thickness (14.5 vs. 28 mm, P= 0.0017) were significantly reduced among ruptured compared to intact AAAs. The latter group presented mostly an anterior eccentric ILT deposition, while the former presented a more symmetrical pattern. The site of rupture was located at the site of maximum size in only 2 cases. In general, ILT was reduced at the site of rupture compared to the site of maximum aneurysm size in ruptured cases but differences did not reach statistical significance., Conclusions: In similar sized AAAs, ILT is reduced in ruptured compared to nonruptured cases., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Blunt abdominal aortic injuries are extremely rare, diagnosed in less than 0.05% of all trauma admissions. Aortic injury caused by a seat belt during a car accident is often referred as "seat-belt aorta". We present a case of an 18-year-old woman, restrained back passenger involved in a vehicular collision, sustaining vertebral column and multiple rib fractures, mesenterium and colonic injury, and infrarenal aortic contusion with localized dissection and partial thrombosis., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: The aim was to evaluate the causes of thoracic endovascular aortic repair (TEVAR) failure and conversion to open surgery (COS) in a vascular center with high-volume open surgery and low-volume TEVAR procedures., Methods: A total of 8 patients (6 men; mean age, 55.14 years) underwent COS after TEVAR. The indications for COS, intraoperative strategy, and early postoperative and mid-follow-up results were analyzed., Results: The indications for COS were persistent proximal type I endoleak with progressive aneurysm enlargement in 2 patients, type III endoleak in 1 patient, progressive aneurysm enlargement with no endoleak in 1 patient, stent-graft migration in 2 patients, secondary aortoesophageal fistula in 1 patient, secondary aortoesophageal and aortobronchial fistula in 1 patient, and distal progression of the aneurysmal disease in 2 patients. In all but one patient, thoracic stent grafts were explanted, and replacement with a Dacron graft was performed using left partial cardiopulmonary bypass. In the remaining patients with disconnection of the distal component and unfavorable anatomy, the proximal stent graft was recycled, and the Dacron prosthesis was sewn to it. Patients with secondary aortobronchial and aortoesophageal fistulas required additional bronchial and esophageal repair. The in-hospital mortality rate was 50% (4 patients). Four (50%) patients were followed up between 7 and 24 months (mean, 16.75 months) without mortality., Conclusions: COS after TEVAR has a high mortality rate, and endovascular techniques should be considered as the first line of treatment. Those procedures should be performed by surgeons experienced in open repair which one might expect to be a challenging problem in the era of endovascular therapy., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Both, open and endovascular, procedures are related to higher complication rate in abdominal aortic aneurysm (AAA) with shorter neck. Previous study showed that long-neck AAA might have lower risk of rupture. Estimation of biomechanical forces in AAA improves rupture risk assessment. The aim of this study was to compare morphological features and biomechanical forces in the short- and long-neck AAA with threshold of 15 mm., Methods: Digital Imaging and Communication in Medicine images of 64 aneurysms were prospectively collected and analyzed in a case-control study. Using commercially available software, Peak wall Stress (PWS) and Rupture Risk Equivalent Diameter (RRED) were determined. Difference between the maximal aneurysm diameter (MAD) and RRED was calculated and expressed as an absolute and relative (percentage of the MAD) value. In addition, volume of intraluminal thrombus (ILT) was calculated and expressed relative to AAA volume., Results: Study included 64 AAA divided in group with long (36, 56.25%), and short (28, 43.75%) neck. There was no correlation between neck length and MAD, PWS, and RRED (P = 0.646, P = 0.421, and P = 0.405, respectively). Relative ILT volume was greater in the short-neck aneurysms (P = 0.033). Relative difference between RRED and MAD was -4% and -14.8% in short- and long-neck aneurysms, respectively (P = 0.029). The difference between RRED and MAD was positive in 14/28 patients (50%) with short neck and in 6/35 patients (17.14%) with long neck (P = 0.011)., Conclusions: Based on our biomechanical analysis, in AAA with neck longer than 15 mm rupture risk might be lower than the risk estimated by its diameter. It might be explained with lower relative volume of ILT., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Aortoesophageal (AEF) and aortobronchial fistula (ABF) after thoracic endovascular aortic repair (TEVAR) are rare complications with catastrophic consequences without treatment. In this case report, we presented a patient with AEF and ABF after TEVAR successfully treated with endograft explantation and replaced by Dacron graft followed by esophagectomy and left principal bronchus repairing. We report a patient with AEF and ABF after TEVAR who was evaluated due to dysphagia and chest pain followed by hematemesis and hemoptysis. Endoscopic examination revealed lesion of the esophageal wall with chronic abscess formation and stent-graft protrusion into the cavity. Patient was operated on with extracorporeal circulation. AEF and ABF were confirmed intraoperatively. Endograft was explanted and in situ reconstruction of thoracic aorta was carried out with tubular Dacron 22-mm prosthesis wrapped with omental flap. After aortic reconstruction, esophageal mucosal stripping was performed with cervical esophagostomy, pyloromyotomy, and Stamm-Kader gastrostomy for nutrition. In addition, omentoplasty of the defect in the left principal bronchus was performed. To re-establish peroral food intake esophagocoloplasty was carried out 8 months after previous surgery utilizing transversosplenic segment of the colon and retrosternal route. In very selective cases, stent-graft explantation and in situ reconstruction with Dacron graft covered by omental flap followed by esophagectomy and bronchus repairing permit adequate debridement reducing the risk of mediastinitis and graft infection and allow a safe esophageal reconstruction in a second procedure., (Copyright © 2017 Elsevier Inc. All rights reserved.)

The clinical spectrum of internal carotid artery occlusion ranges from being a completely asymptomatic occlusion to a devastating stroke or death. The prevalence of asymptomatic internal carotid artery occlusion is unknown, particularly for bilateral occlusion. The distal branches of the external carotid artery anastomose with distal branches of the internal carotid artery provide important sources of collateral circulation to the brain. Stenosis of the external carotid artery with ipsilateral/bilateral internal occlusion may result in ischemic sequelae. Coiling or kinking of the vertebral artery is a rare morphological entity that is infrequently reported because it remains asymptomatic and has no clinical relevance. Currently, there is little evidence to support management strategies for this disease entity and no official recommendations for asymptomatic bilateral carotid artery occlusion. We present a case of a 62-year-old female with asymptomatic bilateral internal carotid artery occlusion, bilateral external carotid artery stenoses, and bilateral kinking of the vertebral artery at the V2 segment, who has been successfully managed conservatively for over 5 years. An individualized approach to management of patients with bilateral internal carotid artery occlusion, especially in combination with external carotid artery stenosis and elongation malformations of the vertebral artery is key to a successful strategy., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Exertional leg pain includes a broad range of conditions induced by different vascular, musculoskeletal, and neurological disorders. We report a case with isolated popliteal artery dissection as a cause of a transient acute lower limb ischemia. We report a patient with popliteal artery dissection which occurred during squatting exercise. After initial signs of transient acute limb ischemia, physical and ultrasound examination pointed to entrampment syndrome as a likely cause. However, digital subtraction angiography showed possible dissection of popliteal artery, which was confirmed intraoperatively. Popliteal artery was resected and reversed saphenous vein bypass was performed. Isolated popliteal artery dissection in professional athletes is a rare entity, which can be manifested with exertional leg pain. Clinical findings can sometimes be similar to those of popliteal entrapment syndrome. Clinical suspicion and timely patient referral to a vascular specialist are crucial for optimal treatment of this limb-threatening condition., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: The surgical tactics in cases of abdominal aortic aneurysms (AAA) and intra-abdominal malignancy are not uniform in the literature and are still a matter of debate. In this case report, we present a patient with coexisting AAA and primary liver cancer managed by simultaneous open AAA repair and liver resection After laparotomy and intraoperative liver ultrasonography that confirmed resectability of the tumor, aneurysm repair was performed with aorto-aortic tube grafting after interrenal cross-clamping Radiofrequency-assisted liver transection was performed to complete an anterior anatomic resection of liver segments VI and VII. The postoperative course was uneventful and the patient was discharged on a postoperative day 10., Methods: This was prospective follow up of one patient., Results: The patient is free from disease at 18-month follow-up., Conclusions: The best treatment strategy for patients with AAA and malignant disease is still not clearly defined. Strategy selection is made individually according to the risk of rupture of AAA, general condition of the patient, experience of the teams that should perform the procedure and estimated life expectancy after resection of malignant disease., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Left-sided inferior vena cava (LIVC) and duplicated inferior vena cava (DIVC) are rare asymptomatic congenital abnormalities. Unrecognized, these anomalies can be the source of major injuries and cause serious life-threatening bleeding complications especially during abdominal aortic surgery., Methods: Retrospective data for patients with 2 major inferior vena cava (IVC) anomalies that underwent aortic surgery over a 13-year period were collected. Patient demographics, type of aortic disease and caval anomaly, surgical approach, type of aortic reconstruction associated with procedure on caval vein, postoperative complications, and in-hospital mortality were recorded., Results: There were 9 patients with inferior vena cava (IVC) anomalies who underwent aortic surgery. All of them were men, with a median age of 66.2 years. Seven had an LIVC and 2 had DIVC. Five patients were operated on due to abdominal aortic aneurysm and 4 due to aortoiliac occlusive disease. In all patients, a midline transperitoneal aortic approach was performed. In 5 cases, the left IVC had to be temporarily resected and later reconstructed, and in the other 4 it was just mobilized. There were no postoperative complications except in one patient who developed deep vein thrombosis in the left calf; this was successfully treated with anticoagulant therapy., Conclusion: Due to favorable results and low incidence of perioperative complications and in the absence of other associated abdominal pathology, we propose the midline transperitoneal approach with mobilization or temporary resection of LIVC., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Although both internal iliac arteries were saved during operation, the patient developed paraplegia immediately after aortoiliac reconstruction due to the spinal cord ischemia. We report a successfully treated immediate postoperative paraplegia by performing second operation and creating bypass from the bifurcated Dacron graft to the previously detected nonpaired huge lumbar artery., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Blunt injuries of the supra-aortic branches are rare entity, and majority of patients die before arrival at the hospital. Those who arrive alive require complex and fast procedure that requires sternotomy. We report 3 successfully managed cases., Case Reports: We report 3 patients with injury of supra-aortic branches. One was treated urgently due to longitudinal rupture on the posterior wall of innominate artery after car accident, and another 2 had chronic false aneurysm located at the very orifice of the right subclavian and left common carotid artery. In first and second patient bypass grafting with a hand-made, Y-shaped, 8-mm Dacron graft from the ascending aorta to the right common carotid and proximal right subclavian artery were performed, whereas in last 1 bypass grafting from the ascending aorta to the cervical part of the left common carotid artery was performed. In our facility, there were no possibilities for any endovascular treatment., Conclusions: When endovascular technology is not available, open surgical repair of blunt injuries of supra-aortic vessels can be performed without complications. No matter to that, endovascular and hybrid procedures should be considered whenever possible., (Copyright © 2016 Elsevier Inc. All rights reserved.)

We report an unusual case of aneurysm of the left common iliac vein and thrombus formation in inferior vena cava associated with Parkes Weber syndrome (PWS). In addition to many already known clinical signs which determine PWS, common iliac vein aneurysm formation together with inferior vena cava thrombus present a new clinical feature and new challenges in treatment strategy of these patients., (Copyright © 2015 Elsevier Inc. All rights reserved.)

We present the case of a 65-year-old male patient with aortoiliac aneurysm associated with a congenital left pelvic kidney vascularized by left common iliac artery and right malposition kidney vascularized by 2 aberrant arteries, which sprout from the aneurysm. In addition, the patient had right iliacofemoral vein thrombosis caused by right iliac artery aneurysm compression. We faced the challenge of treating the patient while preserving renal function., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: To investigate the results after carotid endarterectomy performed for asymptomatic carotid stenosis (ACS) in a single high-volume center and define the factors that increase perioperative stroke and mortality rate., Methods: This observational study that analyzes prospectively collected data includes 1,567 patients with ACS operated in the period between 2007 and 2012., Results: Most patients were male, 1,037 (66.18%), with mean age of 63.6 years. Perioperative death rate was 0.38%. The most frequent causes of death were stroke and myocardial infarction. The total perioperative stroke/transient ischemic attack rate was 2.81%. Logistic regression analysis confirmed that females (P = 0.028) and obese (P = 0.060) patients have higher risk of perioperative stroke after surgical repair of ACS with odds ratio (OR) of 2.008 and 2.342. The early mortality was significantly higher in candidates for coroanary artery bypass grafting (P = 0.018). Stroke and mortality are related to obesity and ischemic heart disease with OR of 2.407 and 2.097, respectively., Conclusions: According to our results, female and obese patients are prone to stroke after carotid endarterectomy. Further study of the effects of female gender and obesity on surgical outcomes is warranted before medical therapy is considered the preferred treatment for these patients., (Copyright © 2015 Elsevier Inc. All rights reserved.)

A 63-year-old woman patient was presented with 3 visceral artery aneurysms, which were identified accidentally at nuclear magnetic resonance imaging carried out because of small mass in the left adrenal gland, which was suspected by ultrasound. Computed tomography (CT) examination was indicated and showed fusiform aneurysm on splenic artery, saccular aneurysm of right renal artery, and saccular aneurysm of left segmental renal artery. Also, she experienced hypertension, cardiomyopathy, thyroid gland strum with normal hormone levels, osteoporosis, and rheumatoid arthritis. The patient was treated by open conventional surgery followed by end-to-end anastomosis reconstructions firstly of the right renal and then splenic artery. In 5 days, the patient was released from hospital in good condition. Control CT examination in 9 months did not show enlargement of remaining aneurysm. Histopathology confirmed just typical aneurysm degeneration based on atherosclerosis., (Copyright © 2015 Elsevier Inc. All rights reserved.)

We present an interesting case of a patient with spinal cord ischemia presented with physical and angiographic findings of acute right leg ischemia 6 days after abdominal aortic aneurysm open repair. After unsuccessful transpopliteal thrombectomy, patient was treated with spinal cord drainage. Cause of this complication might be ischemic lumbal plexopathy., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: The increased number of carotid endarterectomies performed worldwide in recent years is associated with a greater need for carotid restenosis evaluation. Carotid restenosis rate ranges from 0.6% to 3.6% in symptomatic patients and from 8.8% to 19% in asymptomatic patients. Carotid angioplasty and stenting is a preferable therapeutic choice for carotid restenosis treatment, but whenever it is not technically feasible (tortuosities of supra-aortic branches, calcifications, pathological elongation, or very extensive lesions), redo surgical treatment is indicated. The aim of our study was to examine outcome of redo surgical treatment in patients with symptomatic and asymptomatic carotid restenosis, in whom carotid angioplasty could not be done, and its impact on early and late morbidity and mortality., Methods: The study included 52 patients who were surgically treated for significant carotid restenosis from January 2000 to December 2008 in two high-volume vascular surgery university clinics. Surgical techniques included redo eversion endarterectomy, standard endarterectomy with Dacron patch closure, and Dacron tubular graft interposition. The patients were followed for significant events (transient ischemic attack, stroke, cranial nerve injuries, surgical site hematoma, the occurrence of carotid re-restenosis, or occlusion), and mortality after 1 month, 6 months, 1 year, and annually afterward., Results: In the early postoperative period (within 30 days), there were no lethal outcomes. Transient ischemic attack was diagnosed in four patients (7.6%), minor stroke in two patients (3.8%), and cranial nerve injury in four patients (7.6%). After 4 years, three patients died (5.7%), two due to a fatal myocardial infarction (3.8%) and one after a major stroke (1.9%); four patients (7.6%) had ipsilateral stroke; and graft occlusion was verified in one patient (1.9%)., Conclusion: Carotid angioplasty might be a primary option for carotid restenosis treatment, but whenever it cannot be performed, redo surgical treatment is indicated, owing to its acceptable rate of early and late postoperative complications., (Copyright © 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.)

Background: We sought to prospectively evaluate clinical effects of eversion carotid endarterectomy (ECEA) versus best medical treatment of symptomatic patients with near total internal carotid artery (ICA) occlusion., Methods: From January 2003 to December 2006, a total of 309 recently (within 12 months) symptomatic patients with near total ICA occlusion who were eligible for surgery were identified in our institution. Patients were nonrandomly divided into group A (259 patients), who underwent ECEA surgery, and group B (50 patients), who refused surgery. Patients in group B received the best medical treatment based on the opinion of the attending vascular surgeon and/or angiologist. Patients were followed for ipsilateral stroke, transient ischemic accident, and neurologic mortality for 12 months., Results: There were no intraoperative and perioperative deaths and strokes in patients who were subjected to surgery. TIA was noted in 4 (1.5%) of these patients. There were no differences between the groups with respect to medications on discharge. Cumulative 12 month incidence of TIA, ipsilateral stroke and neurologic mortality was lower in patients who underwent ECEA than in patients on medical therapy (13 [5%] versus 12 [24%], p < 0.001; 4 [1.5%] versus 7 [14%], p < 0.001; and 4 [1.5%] versus 4 [8%], p = 0.034, respectively). Restenosis of the operated ICA was noted in 7 (3%) patients, and progression of near to total occlusion was seen in 15 (37%) patients in group B., Conclusion: Our data indicate that recently (within 12 months) symptomatic patients with near total ICA occlusion who underwent ECEA have lower incidence of TIA, ipsilateral stroke, and neurologic death during follow-up than medically treated patients. It appears that, at least in high-volume centers, ECEA should be favored over medical treatment for the management of these patients., (Copyright 2009 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.)