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Objectives: There is still a dilemma about best treatment option for patients with severe carotid and coronary artery disease. Reviving of beating heart revascularization technique and using of carotid stenting makes things even more difficult. Discussion about this subject is getting more and more profound. This is analysis of our initial experience with simultaneous carotid and off pump coronary procedures., Materials and Methods: This is retrospective analysis of 18 patients operated using this technique in a period from 2001-2003 yrs. Follow up was done by telephone interview. For survivors specially designed questionaire was fulfilled., Results: We operated total number of 18 patients with average age 60,6+/-9.32 years. Carotid recontruction was performed by eversion technique in all patients. Average number of coronary grafts was 2,67+/-0.88. During postoperative period 1 patient (5.55%) had verified perioperative infarction and 1 patient (5.55%) suffered from stroke. Average number of days in hospital was 9.95+/-4.74. During follow up period of 21 months two more patients died from cardiovascular causes. There was no need for repeat coronary angiogram or reintervention on carotid or coronary arteries., Conclusion: Simultaneous carotid and coronary operation performed on beating heart is safe and efficent method of treatment for patients with severe concomitant carotid and coronary artery disease.

During a year (1987/88) a study was performed at he Clinic of Thoracal and Vascular Surgery, supervised by Prof. dr J. Vollmar. Analysis of all cases with complications after reconstruction of the lower limbs arteries necessitating reoperation was performed. There were 56 patients in all. They were retrospectively analysed for establishing risk factors, clinical stage (by Fonstine), and time lapse from the surgery to the occurrence of complications. There were 12(21,4%), 23 (41,1%) and 21 (37,5%) of immediate, early and late complications, respectively. The following causes of complications following reconstruction of the lower limbs arteries were recorded: graft trombosis (41,1%), pseudoaneurism of anastomosis (17,8%), progressive arteriosclerosis (12,7%), proximally or distally to the operated segment. The following reoperations were applied: graft prolongation due to distal occlusion (35,7%), desobstruction of the graft and patch plasty (21,2%), partial or total replacement of the graft (17,9%), correction of the supplying vascular tree (7,1%). More than one reoperation were performed in 22 cases (39,2%) and amputation of the limb was necessitated in 4 (7,1%) cases.

Authors described operative method of subfascial discision of perforators by the use special phlebotomy for it. Intrahospital (517 legs) and long term (76 patients) was analyzed. The operation with subfascial discision of perforators has shown the best results compared with the ligature and resection these veins.

Authors showed 240 patients with post-surgical, recidive varices. The cause of these varices were: perforators incompetentions, bad safeno-femoral deconnection, non extirpated collateral veins etc. Diagnosis of these complications is based upon Doppler and phlebographic examinations. Surgical treatment is based upon pathophysiological and pathoanatomic substrate (extirpation varices, subfascial ligature or discision perforators, etc).

Authors investigated anaerobic metabolites (lactate, pyruvate), gas analyzes, pathohistological changes (light and electron microsc.) and regulatory agents in the local blood of venous ulcers. The cause of anaerobic disturbance is hypoxia and hypercapnia (hypostatic ulcers) and pathologic vasodilatation and arteriolo-venules shunts (postthrombotic ulcers). Pericapillary fibrin deposition aggravate tissue necrosis and destructions.