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Peripheral arterial disease is common in the developed world, affecting approximately 14% to 20% of the adult population. The determination of the best method of revascularization or treatment of symptomatic peripheral arterial disease (PAD) is based upon the balance between risk of a specific intervention and the degree and durability of the improvement that can be expected from this intervention. Hybrid revascularization combines open surgery with endovascular procedures to treat multilevel vascular disease. The use of hybrid procedures permits vascular reconstruction that is less invasive than traditional surgical repair. The optimal strategy for revascularization will continue to evolve, but surgery continues to play a significant role in managing patients with PAD.

Disseminated intravascular coagulation (DIC) represents a pathological activation of coagulation (blood clotting) mechanisms that happens in response to a variety of diseases. Diseases of the blood vessels, such as aorta aneurysmal disease, could also cause local activation of coagulation. We report a case of DIC in a patient after the surgery of abdominal aorta aneurysm. 64-year-old woman was admitted to the Clinic for vascular surgery for the diagnosis and surgical treatment of abdominal aorta aneurysm. Multidetector computed tomography (MDCT) angiography verified abdominal aorta aneurysm 5.2 cm in diameter with significant aortoiliac stenosis and thereby aneurysm resection with aortobifemoral reconstruction was indicated. The operation went uneventfully but after completed reconstruction and declamping thrombosis of both limbs of Y graft was verified. Immediate bilateral thrombectomy was performed with the blood being sent for detailed analysis that revealed the presence of DIC. Regular monitoring of hemostatic parameters (coagulation factors, platelet function and rotational thromboelastometry (ROTEM)) enabled timely substitution and administration of anticoagulant therapy during and after surgery. On the 9th postoperative day the patient was discharged in good general condition. Forty days after surgery, the patient feels good with lower limbs vascularization well preserved. Early recognition of disseminated intravascular coagulation during the surgery by attending vascular surgeon, in cooperation with transfusiology center, is of great importance for well-timed detection and treatment of DIC and preventing serious and potentially lethal hemorrhagic and thrombotic complications in these patients.

Randomized Controlled Trials (RCT) comparing carotid endarterectomy (CEA) and carotid angioplasty and stenting (CAS) provide the key data in appropriate treatment of carotid atherosclerosis. Still further survey of patients' not meeting inclusion criteria or patients' unsuitable for randomization is not mentioned during the follow up and thus seriously impairing the message these trials are sending to the world medical community. The answer to this question can be obtained from specially created carotid databases (CDB) that include all patients diagnosed and treated for carotid atherosclerosis. Besides preoperative characteristics, CDB includes all the details regarding diagnostic (ultrasound, CT angiography) and interventional (CEA or CAS) procedures in each included patient. In addition to this valuable material, CDB provides very important information about the patients during the follow-up and especially the patients who were not treated by any interventional procedure (CEA or CAS). The results of further treatment and follow up of patients' unsuitable for the CEA or CAS are needed to give 'real-world' answer which of the two procedures is superior to another in the treatment of carotid atherosclerosis. Specially created carotid databases could give the answers to this specific question.

Defining standards for establishing a new vascular surgery center is very important in order to ensure its proper functioning. Multidisciplinary approach is crucial for optimal functionality of the center. Organizational and technical guidelines should be based on the experience of well-established and recognized vascular surgery centers. The aim of this paper is to highlight the basic needs and requirements for the creation of a vascular center with special emphasis on the quality of cooperation between different specialties.