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Cardioprotective abilities of procyanidins, might, at least in part, attribute to their vasodilator properties. The present study was undertaken to assess the vasorelaxant effect of procyanidin B2 on isolated human saphenous vein (HSV) and its underlying mechanisms. Procyanidin B2 relaxed phenylephrine-induced contraction of HSV rings in concentration-dependent manner. The relaxation was dependent on the presence of endothelium and was strongly affected by l-NAME, hydroxocobalamin or ODQ, the inhibitors of NO/cGMP pathway. Indomethacin significantly affected only the relaxation produced by the highest concentrations of procyanidin B2. Apamin and TRAM-34 combination, in the presence of l-NAME and indomethacin, did not additionally decreased procyanidin B2-induced relaxation. In the presence of K+ channel blockers, relaxation induced by procyanidin B2 was partially attenuated by 4-aminopyridine, significantly inhibited by glibenclamide and almost abolished by iberiotoxin. Procyanidin B2 also relaxed the contractions induced by phenylephrine or caffeine in Ca2+-free solution. Finally, nifedipine slightly, while thapsigargin strongly antagonized HSV relaxation. Our results indicate that procyanidin B2 induces endothelium-dependent relaxation of HSV, which results primarily from stimulation of NO production, as well K+ channels opening, especially BKCa, and partially KATP and KV. Regulation of the intracellular Ca2+ release and inhibition of Ca2+ influx probably contribute to procyanidin B2-induced relaxation. Keywords: Endothelium, Human saphenous vein, Procyanidin B2, Vasorelaxation, K+ channels, Ca2+ channels

New formulations and applications of hemostatic adjuncts such as fibrin sealant (FS) to support local hemostasis and sutures continue to be developed. In a pivotal, confirmatory, controlled, prospective, single-blinded, randomized, multicenter phase III clinical trial, the efficacy and safety of FS Grifols during vascular surgeries were evaluated.Patients undergoing a nonemergency, open, peripheral vascular surgical procedure with moderate arterial bleeding were recruited. In an initial preliminary part of the study, all patients were treated with FS Grifols. In a subsequent primary part, patients were randomized (2:1) to FS Grifols or manual compression (MC). The primary efficacy end point was the proportion of the primary part patients achieving hemostasis by 4 minutes after the start of treatment. Cumulative proportion and time to hemostasis were secondary efficacy end points. Safety end points (in pooled preliminary and primary parts) included adverse events (AEs), vital signs, physical assessments, clinical laboratory tests, viral markers, and immunogenicity.The primary efficacy end point was met by 76.1% of patients (83/109) for the FS Grifols group versus 22.8% of patients (13/57) for the MC group (P .001). The cumulative proportion of patients at 5, 7, and 10 minutes was 80.7%, 84.4%, and 88.1%, respectively, in the FS Grifols treatment group, and 28.1%, 35.1%, and 45.6% in the MC treatment group (P .001). The median time to hemostasis was shorter in the FS Grifols group (4 minutes vs ≥10 minutes in the MC group; P .001). The nature of AEs reported were those expected in the study patient profile. The percentage of patients experiencing treatment-emergent AEs were similar in both the FS Grifols (pooled n = 59 + 109) and MC groups (81.0% and 77.2%, respectively), most recurrent being procedural pain (34.5% and 36.8%, respectively) and pyrexia (11.3% and 10.5%, respectively).FS Grifols was superior in efficacy and similar in safety to MC as an adjunct local hemostatic agent in patients undergoing open vascular surgeries.

The aim of this paper is to determine which therapy gives best results regarding process of healing of diabetic foot ulcers among three proposed: only negative pressure wound therapy, only hyperbaric oxygen therapy, and both when used in conjunction. This bicentric prospective study included 60 patients, and they were, consecutively, assigned to one of three groups. The first group consisted of 20 patients who were treated only by hyperbaric oxygen therapy, second group consisted of 20 patients treated with combined hyperbaric oxygen and negative pressure wound therapy, and third group consisted of 20 patients who were treated only by negative pressure wound therapy. In some cases, previous revascularization of lower limb was performed and patients with poor run-off, without possibility to perform revascularization, were excluded from the study. Patients were predominantly men (56.7%) and mean age was 60.57 years. Majority of patients had ulcers of ischemic origin (45%), in 30% of cases, the reason of foot ulceration was neuropathy, and in 25% of patients, the etiology was combined. During the study, in three patients (5%), minor amputations were observed. Regarding Wagner classification of foot ulcers, most dominant was stage II (χ = 12.618, df = 4, p

Inflammation is one of the mechanisms that leads to carotid restenosis (CR). The aim of this study was to examine the influence of increased values of inflammation markers (high-sensitivity C-reactive protein [hs-CRP], C3 complement, and fibrinogen) on CR development after eversion carotid endarterectomy (CEA).A consecutive 300 patients were included in the study, in which eversion CEA was performed between March 1 and August 1, 2010. Demographic data, atherosclerosis risk factors, comorbidities, and ultrasound plaque characteristics were listed in relation to potential risk factors for CR. Serum concentrations of hs-CRP, fibrinogen, and C3 complement were taken just before surgery (6 hours); 48 hours after CEA; and during regular checkups at 1 month, 6 months, 1 year, and 2 years. An "inflammatory score" was also created, which consisted of six predictive values of inflammatory markers (hs-CRP just before and just after CEA, fibrinogen just before and just after CEA, and C3 complement just before and just after CEA) with a maximum score of 6 and a minimum score of 0. At every follow-up visit to the outpatient clinic, ultrasound assessment of the carotid artery for restenosis was done.Our results showed an increased risk of early CR within 1 year in patients with increased hs-CRP before CEA (6 hours) and increased fibrinogen 48 hours after surgery and in patients not taking aspirin after CEA. Sex was determined to be an independent predictor of CR, with female patients having a higher risk (P = .002). Male patients taking aspirin with an inflammatory score2 had an increased risk for restenosis compared with male patients with inflammatory score 2. Not taking aspirin after CEA and fibrinogen (48 hours) were the strongest predictors, and the Fisher equation incorporating these predictors was used to predict CR. A computer program was created to calculate whether the patient was at high or low risk for CR by selecting whether the patient was taking aspirin (yes or no) and whether fibrinogen was increased 48 hours after CEA (yes or no) and to display the recommended therapeutic algorithm consisting of aspirin, clopidogrel, cilostazol, and statins.Increased hs-CRP before CEA, increased fibrinogen 48 hours after CEA, and not taking aspirin were the main predictors of early CR. With the clinical implementation of the Fisher equation, it is possible to identify patients at high risk for early CR and to apply an aggressive therapeutic algorithm, finally leading to a decreased CR rate.

Dyslipidemia is the leading risk factor for the development of atherosclerosis and associated consequences, such as coronary heart disease, ischemic cerebrovascular and peripheral vascular disease. These diseases are the major cause of mortality in the world and in Europe as well, where they are responsible for around 45% of all deaths. Treatment of dyslipidemia includes the use of statins, ezetimibe, fibrates, niacin, bile acids sequestrants and omega-3 fatty acids. Although statins play the major role in dyslipidemia treatment by reducing the risk of cardiovascular (CV) events by 30%, there is a need for additional new drugs that reduce the residual risk even more. PCSK9 inhibitors, apolipoprotein B (apoB) synthesis inhibitors, MTP inhibitors and CETP inhibitors are already approved for the specific indications, or are in the advanced stages of clinical investigation. Two PCSK9 inhibitors, alirocumab and evolocumab are approved for use in combination with statins for the treatment of heterozygous familial hypercholesterolemia (FH), but also in patients with clinical atherosclerotic CV diseases who require additional low-density lipoprotein cholesterol (LDL-C) level reduction. In addition, evolocumab is approved for use in patients with homozygous FH. Mipomersen, apoB synthesis inhibitor, lomitapide, and oral MTP inhibitor are currently approved in the treatment of patients with homozygous FH as an adjunct to the maximum tolerated doses of statins and other lipid-lowering drugs. Although the new lipid-lowering agents produce significant LDL-C level reduction, more clinical studies are necessary to confirm their efficacy and safety in dyslipidemia treatment. Dislipidemije su vodeći faktor rizika za razvoj ateroskleroze i njenih posledica, kao što su koronarna bolest srca, ishemična cerebrovaskularna i periferna vaskularna bolest. Ove bolesti su glavni uzrok mortaliteta, kako u svetu tako i u Evropi, gde su odgovorne za 45% ukupne smrtnosti. Terapija dislipidemija uključuje primenu: statina, ezetimiba, fibrata, niacina, smola koje vezuju žučne kiseline i omega-3 masnih kiselina. Od pomenutih lekova, vodeću ulogu u terapiji dislipidemija imaju statini. Treba istaći da uprkos primeni statina, koji redukuju rizik od pojave kardiovaskularnih (KV) događaja za oko 30%, još uvek ostaje tzv. rezidualni rizik za nastanak KV događaja, što ukazuje da su potrebni novi lekovi koji će dalje redukovati rezidualni rizik. Novi lekovi u terapiji dislipidemija uključuju PCSK9 inhibitore, inhibitore sinteze apolipoproteina B (apoB), MTP inhibitore i CETP inhibitore, koji su ili već odobreni za primenu u određenim indikacijama, ili se nalaze u odmaklim fazama kliničkog ispitivanja. Alirokumab i evolokumab, dva PCSK9 inhibitora, odobrena su za primenu, u kombinaciji sa statinima, u terapiji heterozigotne familijarne hiperholesterolemije (FH), kao i kod bolesnika sa kliničkim aterosklerotičnim KV bolestima koji zahtevaju dodatnu redukciju nivoa lipoproteina male gustine (low-density lipoprotein cholesterol, LDL-C). Pored toga, evolokumab je odobren za primenu kod bolesnika sa homozigotnom FH. Mipomersen, inhibitor sinteze apoB, i lomitapid, oralni MTP inhibitor, su, odobreni za primenu samo kod bolesnika sa homozigotnom FH kao dodatak maksimalnoj tolerišućoj dozi statina i drugih hipolipemika. Iako novi hipolipemici značajno redukuju nivo LDL-C, neophodno je sprovesti studije, duže i sa većim brojem ispitanika, koje će potvrditi njihovu efikasnost i bezbednost i time omogućiti njihovu širu primenu u terapiji dislipidemija.

Introduction Findings from epidemiological studies indicate that polyphenols, widespread in human diet and with numerous biological activities, act cardioprotectively. Procyanidins are subclass of polyphenols with high content in commonly consumed foods and beverages, such as grapes, tea, chocolate, nuts and apples. Cardioprotective abilities of procyanidins, might, at least in part, attribute to their vasodilator properties. Purpose Because the exact mechanisms by which procyanidin B2 causes vasorelaxation are unclear, we aimed to investigate relaxant effect of procyanidin B2 on the isolated human internal mammary artery (HIMA) and its underlying mechanisms. Methods The HIMA segments were collected from patients suffering from coronary artery disease who were undergoing coronary artery bypass surgery and studied in organ bath. Results Procyanidin B2 induced strong concentration-dependent relaxation of HIMA rings pre-contracted by phenylephrine. Pretreatment with L-NAME, a NO synthase inhibitor, hydroxocobalamin, a NO scavenger, and ODQ, an inhibitor of soluble guanylate cyclase, significantly inhibited procyanidin B2-induced relaxation of HIMA, while indomethacin, a cyclooxygenase inhibitor, considerably reduced effects of low concentrations. Among K+ channel blockers, iberiotoxin, a selective blocker of large conductance Ca2+-activated K+ channels (BKCa), abolished procyanidin B2-induced relaxation, glibenclamide, a selective ATP-sensitive K+ (KATP) channel blocker, induced partial inhibition, while 4-aminopyridine, a blocker of voltage-gated K+ (KV) channels, and TRAM-34, an inhibitor of intermediate-conductance Ca2+-activated K+ (IKCa) channels, slightly reduced maximal relaxation of HIMA. Conclusion Our results demonstrate that, in HIMA, procyanidin B2 produces strong endothelium-dependent vasorelaxant effect. It seems that this relaxation is primarily the result of an increased NO synthesis and secretion by endothelial cells and partially of prostacyclin, although it involves activation of BKCa and KATP, as well as KV and IKCa channels in high concentrations of procyanidin B2. Acknowledgement/Funding The study was supported by a Scientific Research Grant (P175088) from Ministry of Science and Technology Serbia.

Purpose. To present the feasibility, safety, and efficacy of carotid endarterectomy in patients with type II internal carotid artery occlusions, including the long-term outcomes. Methods. From March 2008 to August 2015, 74 consecutive patients (48 men with a mean age of 65.1 ± 8.06 years) underwent carotid endarterectomy because of internal carotid artery (ICA) segmental occlusions. These were verified with preoperative carotid duplex scans (CDS) and CT angiography (CTA). Also, brain CT scanning was performed in all these patients. The indication for treatment was made jointly by a vascular surgeon, neurologist, and an interventional radiologist in a multidisciplinary team (MDT) context. After successful treatment, all the patients were followed-up at 1, 3, 6, and 12 months, then every 6 months thereafter. Results. The most common symptom at presentation was transient ischaemic attack (TIA) in 49 patients (66.2%), followed by stroke in the past six months in the 17 remaining patients (23%). Revascularisation of the ICA with endarterectomy techniques was performed successfully in all the patients with an average clamp time of 11.9 min. All the procedures were performed under general anaesthesia in combination with a superficial cervical block. The early complication rate was 8.1% and included two cardiac events (2.7%) (one rhythm disorder and one acute coronary syndrome), three TIAs (4.1%), and one intracerebral hemorrhage (1.3%). Only one patient with the intracerebral hemorrhage died 5 days after surgery giving a postoperative mortality of 1.3% for this series. During the follow-up period (mean 50.4 ± 31.3 months), the primary patency rates at 1, 3, 5, and 7 years were 98.4%, 94.9%, 92.9%, and 82.9%, respectively. Likewise, the survival rates were 98.7%, 96.8%, 89%, and 77.6%, respectively. Ultrasound Doppler controls during follow-up detected 8 ICA restenoses; however, only 3 of these patients required further endovascular treatment. Conclusions. Carotid endarterectomy of internal carotid artery (ICA) segmental occlusion is a safe and effective procedure associated with acceptable risk and good long-term results. Therefore, the current guidelines which do not recommend carotid endarterectomy in this patient group should be reassessed, with the requirement for ongoing large-scale randomized controlled trials to compare CEA with best medical therapy in this patient cohort.

Introduction. Infection of synthetic graft in the groin is a rare but devastating complication. When it occurs, several possibilities of treatment are available. Extra-anatomic reconstruction and in-situ implantation of new, infection resistant grafts are associated with high mortality and morbidity. Therefore, more conservative approach is needed in some cases. Negative-pressure wound therapy is one of the options in treating such patients. Objective. The aim of this study was to assess the outcome for deep groin vascular graft infection treated with negative-pressure wound therapy. Methods. Seventeen patients (19 wounds), treated for Szilagyi grade III groin infections between October 2011 and June 2014, were enrolled into this observational study. Results. Majority of the wounds (11/19) were healed by secondary intention, and the rest of the wounds (8/19) were healed by primary intention after initial negative-pressure wound therapy and graft substitution with silver-coated prostheses or autologous artery/vein implantation. No early mortality was observed. Minor bleeding was observed in one patient. Reinfection was noted in three wounds. Only one graft occlusion was noted. Late mortality was observed in three patients. Conclusion. Negative-pressure wound therapy seems to be safe for groin vascular graft infections and comfortable for both patient and surgeon. However, the rate of persistent infection is high. This technique, in our opinion, can be used as a ?bridge? from initial wound debridement to definitive wound management, when good local conditions are achieved for graft substitution, either with new synthetic graft with antimicrobial properties or autologous artery/vein. In selected cases of deep groin infections it can be used as the only therapeutic approach in wound treatment.

Introduction. An extracranial carotid artery aneurysm is a rare clinical entity with potentially debilitating consequences. Our aim is to present a case of a large internal carotid artery aneurysm combined with medial internal carotid artery (ICA) kinking successfully treated by resection with an end-to-end anastomosis. Case outline. A 34-year-old female patient was admitted to our hospital due to dizziness and frequent non-specific headaches. On admission, routine echocardiography showed an aneurysm of the atrial septum. Multislice computed tomography of the supraaortic branches showed medial kinking of the right ICA with a 15 mm aneurysm localized on the vertex of the angulation. Kinking was present on the left ICA as well, with a small aneurysm of 5 mm in diameter. The right ICA aneurysm was resected and the artery was reconstructed with an end-to-end anastomosis. The postoperative course was uneventful and the patient was symptom-free after a one-year follow-up. Conclusion. We showed that surgery of an aneurysm and kinking of the carotid artery in the medial segment of the ICA is possible and safe to perform. Detailed preoperative preparation, precise surgical technique, and short clamping time all contributed to a good final outcome.

Introduction Acute lower limb ischemia results from thrombosis or embolization of diseased native artery or previously implanted bypass graft. When this occurs, several options are available to restore blood flow: catheter-directed thrombolysis, mechanical thrombectomy or open surgery. Fundamental reasons to apply percutaneous interventions are avoiding open procedures in high risk patients, and avoiding difficult dissection through scar tissue. Case Outline A 67-year-old male was admitted at our Institution for critical limb ischemia. After performed angiography the diagnosis of occluded femoropopliteal graft was established. Occlusion was resolved by catheter-directed thrombolysis with plasmin. Culprit lesions were treated by angioplasty. Conclusion Our patient underwent a successful thrombolysis of occluded femoropopliteal graft with locally-delivered human plasmin. Uvod Ishemija donjih ekstremiteta je posledica tromboze ili embolizacije obolele nativne arterije ili implantiranog grafta. Postoji nekoliko načina lečenja ishemije: tromboliza kateterom, mehanička trombektomija i hirurško lečenje. Osnovni razlozi za primenu perkutanih intervencija jeste izbegavanje klasičnog hirurškog lečenja kod bolesnika s visokim rizikom, kao i izbegavanje preparisanja krvnog suda u ožiljku. Prikaz bolesnika Muškarac star 67 godina primljen je u bolnicu zbog kritične ishemije donjih ekstremiteta. Po učinjenoj angiografiji dijagnostikovana je tromboza femoropoplitealnog grafta. Okluzija je rešena primenom plazmina uz upotrebu intraarterijskog katetera. Stenoze koje su otkrivene posle trombolize lečene su angioplastikom. Zaključak Trombolizom uz primenu plazmina i intraarterijskog katetera uspešno je izlečena okluzija femoropoplitealnog grafta.

Introduction. Severe extremity ischemia and the presence of the “blue-toe” syndrome are rarely the first complications of the present abdominal aortic aneurysm. We report two interesting cases of this rare entity. Outline of Cases. A 61-year-old man presented with the rest pain of his toes accompanied with digital ischemia of both feet. Physical examination confirmed regular arterial pulses at lower extremities accompanied with palpable pulsate mass in the abdomen. Vascular ultrasound and multidetector tomography (MDCT) of blood vessels revealed small abdominal aortic aneurysm (37 mm in diameter), filled with the irregular, ulcerated, heterogeneous thrombotic masses. Aneurysm sac resection was performed with an aorto-bi-iliac bypass reconstruction. A week later, it was mandatory to amputate the fifth toe on the left foot because of the advanced gangrenous process. The second case was a 77-year-old woman with 7-day history of severe feet pain. Abdominal examination revealed pulsatile mass paraumbilical to the left. Performed abdominal ultrasonography and MDCT angiography confirmed coexistence of the infrarenal aortic aneurysm, 40.5 mm in diameter, covered by significant mobile mural thrombus and ulcerations. Surgical reconstruction was mandatory and patient underwent aneurysm sac resection and aortobifemoral reconstruction. Conclusion. Embolic phenomenon and peripheral embolic occlusion from the mural thrombus within the abdominal aortic aneurysm are relatively rare events, but associated with tissue loss. Thorough diagnostic examinations and prompt management are required regardless of the aneurysm size once these signs occurred.

After an acute coronary syndrome, patients remain at risk of recurrent ischemic events despite the use of antiplatelet therapy. In order to reduce the risk of recurrent ischemia in the treatment of patients with acute coronary syndromes, standard oral anticoagulants, such as vitamin K antagonists, have been introduced. These drugs have an important role in preventing stroke and systemic embolism in patients with atrial fibrillation. Vitamin K antagonists (e.g., warfarin) reduce the risk of recurrent cardio­vascular events and stroke but increase the risk of bleeding. In addition, the traditional anticoagulants have other significant drawbacks. Therefore, modulation of the coagulation process represents an important target in the development of new oral anticoagulants today. The new oral anticoagulants selectively target thrombin (dabigatran etexilate) or factor Xa (rivaroxaban, apixaban, edoxaban). Unlike traditional anticoagulants, these drugs have rapid onset of action and a relatively wide therapeutic range, do not require routine prothrombin time (PT) monitoring and have low potential for food and drug interaction. Dabigatran etexilate and rivaroxaban have been already approved in many countries for the prevention of stroke and systemic embolism in patients with atrial fibrillation. The third phase of clinical studies in which rivaroxaban was investigated in patients with acute coronary syndrome has been successfully completed. . Nakon akutnog koronarnog sindroma, kod bolesnika postoji povećan rizik od rekurentnih ishemičnih događaja, uprkos primeni antiagregacione terapije. U cilju smanjenja rizika od rekurentne ishemije, u terapiju visokorizičnih bolesnika sa akutnim koronarnim sindromom uvode se standardni oralni antikoagulansi, kao što su antagonisti vitamina K. Ovi lekovi imaju važnu ulogu u prevenciji moždanog udara i sistemskog embolizma kod bolesnika sa atrijalnom fibrilacijom. Antagonisti vitamina K (varfarin) smanjuju rizik od nastanka ponovnih kardiovaskularnih događaja i moždanog udara, ali povećavaju rizik od krvarenja. Pored toga, antagonisti vitamina K poseduju i druge, značajne nedostatke, tako da modulacija procesa koagulacije danas predstavlja značajnu metu za razvoj novih oralnih antikoagulanasa. Novi oralni antikoagulansi deluju selektivno na trombin (dabigatran eteksilat) ili na faktor koagulacije Xa (rivaroksaban, apiksaban, edoksaban). Za razliku od standardnih antikoagulanasa, imaju brz početak dejstva i relativno veliku terapijsku širinu, ne zahtevaju laboratorijsku kontrolu protrombinskog vremena (PT) i retko stupaju u interakcije sa hranom i lekovima. Dabigatran eteksilat i rivaroksaban su već registrovani u mnogim zemljama za prevenciju moždanog udara i sistemskog embolizma kod bolesnika sa atrijalnom fibrilacijom. Treća faza kliničke studije u okviru koje je ispitivan rivaroksaban kod bolesnika sa akutnim koronarnim sindromom uspešno je završena. .

Background. Complete rupture of the anterior cruciate ligament (ACL) does not represent a diagnostic problem for the standard magnetic resonance (MR) protocol of the knee. Lower accuracy of the standard MR protocol for partial rupture of the ACL can be improved by using additional, dedicated MR techniques. The study goal was to draw a comparison between sagittal-oblique MR technique of ACL imaging versus flexion MR technique of ACL imaging and, versus ACL imaging obtained with standard MR protocol of the knee. Patients and methods. In this prospective study we included 149 patients who were referred to magnetic resonance imaging (MRI) examination due to knee soft tissues trauma during 12 months period. MRI signs of ACL trauma, especially detection of partial tears, number of slices per technique showing the whole ACL, duration of applied additional protocols, and reproducibility of examination were analysed. Results. Accuracy of standard MRI protocol of the knee comparing to both additional techniques is identical in detection of a complete ACL rupture. Presentations of the partial ruptures of ACL using flexion technique and sagittaloblique technique were more sensitive (p 0.65). Sagittal-oblique technique provides a higher number of MRI slices showing the whole course of the ACL and requires a shorter scan time compared to flexion technique (p Conclusions. Both additional techniques (flexion and sagittal-oblique) are just as precise as the standard MR protocol for the evaluation of a complete rupture of the ACL, so they should be used in cases of suspicion of partial rupture of the ACL. Our study showed sagittal-oblique technique was superior, because it did not depend on patient’s ability to exactly repeat the same external rotation if standard MR protocol was used or to repeat exactly the same flexion in flexion MR technique in further MR examinations. Sagittal-oblique technique does not require the patient’s knee to be repositioned, which makes this technique faster. We propose this technique in addition to the standard MR protocol for detection of partial ACL tears.

Anticoagulants are effective agents for the prevention and treatment of thrombosis and thromboembolic complications, which represent a common cause of morbidity and mortality. Despite their clinical efficiency, traditional anticoagulants are all associated with significant drawbacks. As a result, modulation of the coagulation process represents an important target in the development of new oral and parenteral anticoagulants today. The new oral anticoagulants selectively target thrombin (ximelagatran, dabigatran etexilate) or factor Xa (rivaroxaban, apixaban, edoxaban). Unlike the traditional anticoagulants, vitamin K antagonists, these drugs have rapid onset of action and a relatively wide therapeutic range, do not require routine prothrombin time (PT) monitoring and have low potential for food and drug interaction. The new parenteral anticoagulants achieve their effects through indirect (semuloparin, idrabiotaparinux) or direct inhibition of factor Xa (otamixaban), as well as through inhibition of coagulation factor IXa (RB006). The main characteristics of these agents are a rapid onset of action and a predictable anticoagulant effect, whereby the most of them can be rapidly neutralized by an adequate antidote. Antikoagulantni lekovi su delotvorni u prevenciji i lečenju tromboze i tromboembolijskih komplikacija, koje su čest uzrok morbiditeta i mortaliteta. Ipak, uprkos kliničkoj delotvornosti, standardni antikoagulansi poseduju značajne nedostatke. Zbog toga, modulacija procesa koagulacije danas predstavlja značajnu metu za razvoj novih, oralnih i parenteralnih, antikoagulanasa. Novi oralni antikoagulansi deluju selektivno na trombin (ksimelagatran, dabigatran eteksilat) ili na faktor koagulacije Xa (rivaroksaban, apiksaban, edoksaban). Za razliku od standardnih antikoagulanasa, antagonista vitamina K, imaju brz početak dejstva i relativno veliku terapijsku širinu, ne zahtevaju laboratorijsku kontrolu protrombinskog vremena (PT), i retko stupaju u interakcije sa hranom i lekovima. Novi parenteralni antikoagulansi svoje antikoagulantno dejstvo ostvaruju indirektnom (semuloparin, idrabiotaparinuks) ili direktnom inhibicijom faktora Xa (otamiksaban), kao i inhibicijom faktora koagulacije IXa (RB006). Glavne karakteristike ovih lekova su brz početak dejstva i predvidljiv antikoagulantni efekat, a kod većine je moguće postići brzu neutralizaciju adekvatnim antidotom.

Introduction. Carotid endarterectomy is a safe and reliable surgical procedure to treat the narrowing of the internal carotid artery greater than 70%. One of the most serious complications of surgical wound after endarterectomy is an infection caused by methicillin-resistant Staphylococcus aureus (MRSA) which is accompanied with high morbidity and mortality. Case Outline. A 62-year-old woman developed a graft infection caused by MRSA after a carotid endarterectomy with synthetic graft placement. Two years after unsuccessful antibiotic and local wound treatment, we replaced the infected graft by an autologous saphenous vein conduit. Conclusion. The case suggests that only by aggressive surgical approach with replacement of infected graft a successful outcome can be achieved in such a rare but potentially fatal post-operative complication.

Introduction. Abdominal angina, also known as chronic mesenteric ischemia or intestinal angina, is a rare disease caused by intestinal flow reduction due to stenosis or occlusion of mesenteric arteries. A case of successful treatment of a patient with abdominal angina by percutaneous transuliminal angioplasty of high-grade superior mesenteric artery and coeliac trunk stenosis was presented. Case Outline. A 77-year-old male patient was admitted at our Clinic for severe postprandial abdominal pains followed by frequent diarrhoeas. Extensive gastrointestinal investigations were performed and all results were normal. Multislice computerized (MSCT) arteriography was indicated which revealed ostial celiac trunk and superior mesenteric artery subocclusion. Percutaneous transluminal angioplasty of the superior mesenteric artery and coeliac trunk was done with two stents implantation. Just a few hours following the intervention, after food ingestion, there were no abdominal pains. Six months later, the patient described a significant feeling of relief after food ingestion and no arduousness at all. Conclusion. High-grade visceral arteries stenoses in patients with intestinal ischemia symptoms can be treated by either surgical procedures or percutaneus transluminal angioplasty. In cases when a low operative risk is anticipated, surgical treatment is recommended due to a better anatomical outcome, while percutaneus angioplasty is advised to elderly patients in whom increased operative risks can be expected.

Introduction. Congenital coarctation of the thoracic aorta at the ligamentum arteriosum or the aortic arch is well recognized. But a much less common variety (0.5-2.0%) of aortic coarctation is located in the distal thoracic aorta or abdominal aorta or both and is often called 'middle aortic syndrome' or 'midaortic dysplastic syndrome'. This represents serious pathological condition and indicates multidisciplinary therapy approach. Outline of Cases. From 1996 to 2007, at the Vascular Surgery Clinic of the Institute for Cardiovascular Diseases 'Dedinje', Belgrade, three patients were treated due to abdominal aorta coarctation, two females aged 55 and 50 and a 4-year-old child. The patients were treated surgically (by-pass with a prosthetic graft and patch angioplasty) and endovascular-percutaneous transluminal angioplasty (PTA) with and without a stent. The follow-up period was 3-70 months. In the 50-year-old patient, angiography showed severe narrowing of the suprarenal segment of the abdominal aorta. Thoraco-abdominal bypass with a 16 mm dacronic tubular graft was performed. In the 4-year-old patient angiography also showed a suprarenal aorta narrowing. In the first act patch angioplasty was performed and after PTA of the visceral arteries was done on several occasions. In the 55-year-old patient, after diagnostic angiography, infrarenal aorta coarctation was registered. PTA was performed with stent placement. All patients were asymptomatic on control check-ups. Conclusion. Abdominal coarctation is a pathological disease which is seldom found in vascular surgery. Angiography is of major importance for setting the diagnosis and for the control of the results of surgical and nonsurgical treatment. The combination of surgical and endovascular treatment in our patients showed very good results in the studied period.

Introduction. Measurement of vessel stenosis using ultrasonography or magnetic resonance is still the principal method for determining the severity of carotid atherosclerosis and need for endarterectomy. Case Outline. A 56-year-old male was admitted to the Cardiovascular Institute 'Dedinje' due to a clinically asymptomatic restenosis of the operated left internal carotid artery (ICA). Angiography and magnetic resonance angiography (MRA) in previous hospitalization had revealed occluded right ICA. However, routine duplex ultrasonography revealed a highgrade restenosis (85%) of the left ICA and subocclusion of the right ICA by an ulcerated plaque (confirmed on repeated MRA). Conclusion. Selective arteriography examination could misrepresent the degree of stenosis especially in patents with the ICA that seems to be occluded. MRA is considered the method of choice for identifying pseudo-occlusions of ICA.

INTRODUCTION Inflammatory abdominal aortic aneurysm accounts for 5% to 10% of all cases of abdominal aortic aneurysm and differs from typical atherosclerotic abdominal aortic aneurysm in many important ways. Although both inflammatory and atherosclerotic abdominal aortic aneurysms most commonly affect the infrarenal portion of the abdominal aorta, patients with the inflammatory variant are younger and usually symptomatic, chiefly from back or abdominal pain. Unlike patients with atherosclerotic abdominal aortic aneurysm, most with the inflammatory variant have an elevated erythrocyte sedimentation rate or abnormalities of other serum inflammatory markers. Computed tomography and magnetic resonance imaging are both sensitive for demonstrating the cuff of soft tissue inflammation surrounding the aneurysm that is characteristic of inflammatory abdominal aortic aneurysm. Inflammatory abdominal aortic aneurysm can be primarily infected by degenaration of an infected artery (in less than 1% of cases), or can become secondary infected in the already existing aneurysm. Secondary infection of the pre-existing aneurysm has big influence on treatment choice, but is also rare. Clinically non-symptomatic infection, also known as bacterial collonisation, can be very frequent, regarding a greatly increased number of positive intraoperative findings (10-15%). Prolonged intravascular catheterization, vascular grafting, repeated punctures with large bore needles, and decreased immune defense mechanism make uraemic patients undergoing hemodialysis more likely to develop Staphylococcus aureus bacteraemia and its complications. CASE OUTLINE The case shows a gigantic inflammatory aneurysm of the abdominal aorta, localized infrarenally, which was solved successfully by resection of the aneurysm of the abdominal aorta, and interposition of Dacron tubular graft 22 mm. Bacterial examination of the aneurysmal sac was positive: methicillin-resistent Staphylococcus aureus was detected. CONCLUSION There were no postoperative complications, and the final outcome was fully satisfactory. Control CT scans after 3, 6 and 12 months were regular, with signs of regression fibrosis of the retroperitoneum.

INTRODUCTION Although the incidence is low, infection of prosthetic vascular graft bears a high incidence of serious complications including 25-75% mortality rate and 40-75% limb loss. The standard treatment of vascular graft infection consists of excision of the prosthesis, wound debridement and extraanatomic revascularization. Conservative treatment might be an option in a limited number of patients. We present three cases of surgical and conservative treatment of vascular graft infection. CASE OUTLINE Case 1: A patient developed silver-coated graft infection after femorodistal arterial reconstruction performed because of critical limb ischemia. In the early postoperative period, massive skin and subcutaneous tissue necrosis developed, with the graft being exposed. After two months of persistent debridement and wound toilette, the defect was covered with a Thiersch skin graft. Case 2: PTFE graft infection in the right groin followed reconstruction of the isolated common femoral artery aneurysm. This graft was replaced with a silver-coated graft in situ. Reinfection of the proximal end of the implanted silver-coated graft occurred and the graft was exposed. After repeated debridement and wound toilette, the exposed prosthesis was covered with granulomatous tissue, and the wound healed. Case 3: A year after anastomotic pseudoaneurysm resection in the left groin, prosthesis was exposed following wound infection. This graft was substituted with a silver-coated graft in situ. The wound healed primarily. CONCLUSION These three cases demonstrate that under some circumstances vascular prosthesis infection can be successfully treated conservatively without graft removal, and also by in situ replacement using silver-coated graft.

Introduction Transplantation is the method of choice in the treatment of terminal liver diseases with acute and structural damage of liver tissue and congenital liver diseases. Objective The aim of our study was to determine specificity and significance of vascular anastomosis in liver transplantation by postoperative evaluation of vascular anastomosis function. Method The study included 16 patients with 16 liver transplantations and one re-do liver transplantation. In all patients, preoperative angiography and postoperative duplex sonographic and angiographic evaluation of vascular anastomosis were performed. Results Preoperative angiographic evaluation did not reveal anomalies in liver blood vessels of transplant candidates. In one patient, we identified and angiographically confirmed stenosis on anastomosis of the hepatic artery on the 7th postoperative day. In another patient, we had artificial thrombosis of the hepatic artery branch due to the liver biopsy. Conclusion The successful performance of vascular anastomosis in liver transplantation is significant for adequate liver graft perfusion, good postoperative graft function and overall outcome of the liver transplantation.

Introduction. Necrotizing fasciitis is a rare, progressive bacterial infection of superficial fascia followed by secondary subcutaneous tissue necrosis. We pressented a patient with massive fulminant lifethreatening necrotising fasciitis after bellow-knee femoro-popliteal vein bypass grafting successfully treated by antibiotics, surgical debridement and final skin reconstruction using the Tierch method. Case report. A 61-year-old patient was ad-mitted to the Vascular Surgery Clinic for below-knee femoro-popliteal bypass grafting. He complained of intermittent claudication in the left leg after 50 m, ankle brachial indexes were 0.45 on the left and 1.0 on the right side. Femoropopliteal below-knee bypass grafting was done using the autologous great saphenous vein. In the very next day, initial signs of skin infection appeared including local inflammation, erythema, swelling and cellulitis restricted to saphenectomy site. These changes had rapidly spread in the following days on the deep tissue of the whole upper and lower leg, including the groin and with clinical signs of life-threatening systemic infection. Immediate surgical debridement was done followed by extensive wound packing and wide spectrum antibiotics administration for the next 33 days when final skin reconstruction by the Tierch method was performed. Interesting point is that this entire time wound swab was sterile. Conclusion. In the presented case immediate surgical debridement, wide spectrum antibiotics administration and consistent wound packing gave satisfactory results in this life-threatening systemic infection. Wound swab is not always a reliable indicator of the infection while clinical findings and surgeons’ experience are of great significance in rapid reaction to this rare surgical complication. [Projekat Ministarstva nauke Republike Srbije, br. 41002]

Introduction: The goal of modern carotid surgery is relief of symptoms, stroke prevention, improvement in quality of life, prevention of vascular dementia, and prolongation of lifetime. OBJECTIVE: The objective of this paper was to compare the outcome of carotid endarterectomy in cervical block vs. general anesthesia in patients with occluded contralateral internal carotid artery (ICA). METHOD: One hundred patients (76 male, 24 female, mean age 60.81 years) with occluded contralateral ICA were operated from 1997-2000. Neurological symptomatology, deficiency and stroke incidence were preoperatively analyzed in two groups. Duplex-scanning, angiograms and CT-scan confirmed the diagnosis. Risk factors analysis included hypertension, diabetes, lipid metabolism disorders, smoking and history of CAD, CABG and PAOD. Morbidity and mortality were used to compare the outcome of surgery in two groups. RESULTS There was no difference of age, gender and symptomatology between the groups. Paresis, TIA and dysphasia were most frequent. 70%-90% of ICA stenosis was seen in the majority of patients. Hypertension and smoking were dominant risk factors in these two groups. Eversion carotid end arterectomy was the most frequent technique used. In three cases out of nine that were operated under cervical block, the neurological symptoms developed just after clamping, so the intra-luminal shunt was placed. Postoperative morbidity was 12% and mortality was 8%. Conclusion: There was no difference of preoperative parameters, surgical technique and outcome in these two groups. Without other intraoperative monitoring, cervical block anesthesia might be an option in patients with the occlusion of the contralateral ICA. However, prospective studies involving more patients are needed.

It has been thought that the spleen is an organ without important functions, until recently. That is, why splenectomy has been the procedure of choice in a treatment of splenic diseases. Even now, when we know the functional [figure: see text] importance of the spleen, splenectomy is performed frequently, regardless of its complications. The need of spleen functions salvage, favours partial resection of the spleen as competitive in a treatment of its traumatic and benign lesions. Improvement in diagnostic procedures, surgical techniques, transfusiology and postoperative treatment, will promote it as a treatment of choice. The authors of this study have experience with 17 partial resections of the spleen for traumatic, 11 for benign lesions of the spleen, and one ectopic spleen with hypersplenism, without mortality and with insignificant complications.

Some of serious hepatic diseases with cirrhosis may be complicated by portal hypertension, splenomegaly and hypersplenism. Splenomegaly inhibits regenerative processes of the liver, and also intensifies sequestration of the cellular components of blood up to hypersplenism. Cytopenia caused by hypersplenism is aggravated by negative hepatic influence on bone marrow activity-hemathopoesis, and also by recurrent bleeding from oesophageal varices, and from the other site of gastrintestinal tract. This circle of pathologic conditions may be interrupted only by liver transplantation, until which patients are jeopardized by acute bleeding and chronic anemia. Partial resection of the spleen and splenorenal shunt may correct portal hypertension and hypersplenism, prevent gastrointestinal bleeding, and alleviate hepatic regenerative processes inhibition. In this study, 51 patients with partial resection of the spleen and splenorenal shunt, were analyzed.

Although the incidence of prosthetic infection is low (1%-6%), the consequences (limb loss or death) are dramatic for a patient, with high mortality rate (25%-75%) and limb loss in 40%-75% of cases. In case of Szilagyi's grade III infection, standard procedure consists of the excision of prosthesis and wound debridement. Alternative method is medical treatment. This is a case report of a patient with prosthetic infection of Silver-ring graft, used for femoropopliteal reconstruction, in whom an extreme skin necrosis developed in early postoperative period. This complication was successfully treated medically. After repeated debridement and wound-packing, the wound was covered using Thiersch skin graft.

Introduction. Carotid angioplasty and internal carotid artery stenting is the therapeutic method of choice in the treatment of carotid restenosis, but when it is not technically feasible (expressed tortuosity of supraaortic branches, calcifications, presence of pathological elongation of very long lesions) a redo surgery is indicated. Objective. The aim of our study was to examine the benefits and risks of redo surgery in patients with symptomatic and asymptomatic significant internal carotid artery restenosis and its impact on early and late morbidity and mortality. Methods. The study included 45 patients who were surgically treated for a hemodynamically significant internal carotid artery restenosis from January 2000 to December 2009. Surgical techniques included redo endarterectomy with direct suture, redo anderectomy with a patch plastic and resection with Dacron tubular graft interposition. The patients were followed for postoperative neurological ischemic events (transient ischemic attack (TIA), stroke), local surgical complications and lethal outcome after one month, six months, one year and after two years). Results. In the early postoperative period (up to 30 days) there were no lethal outcomes. TIA was diagnosed in four patients (8.8%), minor stroke in one patient (2.2%) and one patient (2.2%) also had cranial nerve injury. After two years two patients died (4.4%) due to fatal myocardial infarction, three patients (6.5%) had ipsilateral stroke and one patient developed graft occlusion (2%). Conclusion. In the case of symptomatic and asymptomatic carotid restenosis that cannot be treated by carotid percutaneous angioplasty, redo surgical treatment is therapeutic option with an acceptable rate of early and late postoperative complications.

A 68-year-old man presented with a history of progressively worsening dysphagia, excessive weight loss of more than 30 kg during the preceding 6 months, and retrosternal discomfort. During the previous 2 weeks, any attempt at food or liquid intake provoked vomiting. After gastroenterological evaluation and endoscopy identified pulsating extraluminal compression on the esophagus, he was referred to a vascular surgeon for further evaluation. The patient was hypertensive without any history of ischemic heart disease. A contrast-enhanced CT scan of the mediastinum (Panel A) revealed a giant fusiform aneurysm measuring approximately 10 cm in diameter which contained extensive mural thrombus. The aneurysm compressed the trachea (Panel B; arrow 1), and almost completely obliterated the esophagus (Panel B; arrow 2). CT angiography (Panel C) revealed the aneurysm of an Panel A

Introduction. Though surgical approach is common in arteriovenous (AV) fistula treatment, endovascular procedures such as stent-graft placement has become more popular in recent years. We aim to present a case of thrombosed femoral artery stent-graft which was placed one year earlier due to multiple AV fistulas following gunshot wounds. Case Outline. A 43-year-old patient was admitted to the Institute for Cardiovascular Diseases 'Dedinje', Belgrade, Serbia, for arteriography. Five years before, he had suffered from six gunshot wounds in his right leg and one year before, in the health centre in Vienna, stent-graft had been placed in the right superficial femoral artery due to multiple AV fistulas. Because of artery dilation proximal to AV fistula location, a large dimensional stent-graft had to be placed (24 mm). After admission, arteriography and Multislice CT (MSCT) angiography revealed thrombotic masses in the stent-graft with intraluminal stenosis of 50%. Extirpation of thrombosed stent-graft was performed followed by Dacron tubular graft 10 mm interposition. On the fifth postoperative day, the patient was discharged from the clinic, and after 3 months, the right leg vascularisation was well preserved. Conclusion. Large dimensional stent-graft placement in patients with mutiple AV fistulas and blood vessel dilation proximal to AV site of communication carries an increased risk of thrombotic events due to turbulent blood flow and parietal thrombosis occurrence. Though stent-graft placement can be a very useful solution in acute AV fistula treatment, the very same thrombosis should be thought of when surgical management is the only treatment choice.

INTRODUCTION Aneurysms of digital arteries are considered to be rarity. They could be true or false. False aneurysms are usually the result of penetrating trauma, while the causes of development of true aneurysms are various, such as blunt trauma, and rarely atherosclerosis, vasculitis and infection. Also, they can be idiopathic. Reviewing the literature we found 13 cases of previously described true aneurysms of digital arteries. None of them referred to the common digital artery aneurysm. CASE OUTLINE We report a case of an idiopathic true aneurysm of the common digital artery, with its clinical presentation and a corresponding multislice CT arteriogram. Surgical treatment by ligation and excision of the aneurysm was performed. CONCLUSION As mentioned above, true aneurysms of digital arteries are very rare, so they are of little clinical importance. The most common symptom of digital artery aneurysms is pain, with a tender pulsatile mass on examination. Since natural healing cannot be expected, surgical treatment of true digital artery aneurysms is recommended for pain relief and avoidance of complications which may occur and are related to the aneurysm presence. Aneurysm resection and ligation of a blood vessel can be performed. Also, artery reconstruction can be performed by primary end-to-end anastomosis or the placement of a reversed interposition vein graft.

Since antiquity, there has been a mystery about the cerebral circulation function. Scientific methods were introduced in research at the end of the nineteenth century. During the first half of the last century, the problem of occlusive carotid disease was defined and the basis for the surgical treatment of carotid disease was established. The first contemporary reconstructive surgical procedures were performed in the middle of the last century, the time when successful surgical treatment of carotid disease began. Today, carotid endarterectomy is one the most frequently performed vascular surgical procedures of all, followed by very low morbidity and mortality rates.

INTRODUCTION Hypersplenism is a common complication of portal hypertension. Cytopenia in hypersplenism is predominantly caused by splenomegaly. Distal splenorenal shunt (Warren) with partial spleen resection is an original surgical technique that regulates cytopenia by reduction of the enlarged spleen. OBJECTIVE The aim of our study was to present the advantages of distal splenorenal shunt (Warren) with partial spleen resection comparing morbidity and mortality in a group of patients treated by distal splenorenal shunt with partial spleen resection with a group of patients treated only by a distal splenorenal shunt. METHOD From 1995 to 2003, 41 patients with portal hypertension were surgically treated due to hypersplenism and oesophageal varices. The first group consisted of 20 patients (11 male, mean age 42.3 years) who were treated by distal splenorenal shunt with partial spleen resection. The second group consisted of 21 patients (13 male, mean age 49.4 years) that were treated by distal splenorenal shunt only. All patients underwent endoscopy and assessment of oesophageal varices. The size of the spleen was evaluated by ultrasound, CT or by scintigraphy. Angiography was performed in all patients. The platelet and white blood cell count and haemoglobin level were registered. Postoperatively, we noted blood transfusion, complications and total hospital stay. Follow-up period was 12 months, with first checkup after one month. RESULTS In the first group, only one patient had splenomegaly postoperatively (5%), while in the second group there were 13 patients with splenomegaly (68%). Before surgery, the mean platelet count in the first group was 51.6 +/- 18.3 x 10(9)/l, to 118.6 +/- 25.4 x 10(9)/l postoperatively. The mean platelet count in the second group was 67.6 +/- 22.8 x 10(9)/l, to 87.8 +/- 32.1 x 10(9)/l postoperatively. Concerning postoperative splenomegaly, statistically significant difference was noted between the first and the second group (p < 0.05). Comparing the postoperative platelet count between the first and second group, we found that there was a very significant statistical difference, too (p < 0.01). CONCLUSION Distal splenorenal shunt (Warren) with partial spleen resection is a very reliable surgical technique in treatment of hypersplenism and decompression of oesophageal varices caused by portal hypertension and has advantage in treatment of hypersplenism over the distal splenorenal shunt method.

2013 e47 PP098—NICORANDIL INDUCED ENDOTHELIUMINDEPENDENT RELAXATION OF ARTERIAL BYPASS GRAFT M. Marinko; A. Novakovic; I. Stojanovic; P. Milojevic; M. Jovic; D. Nenezic; N. Ugresic; V. Kanjuh; Q. Yang; and G.-W. He Department of Pharmacology, Faculty of Pharmacy, University of Belgrade; Faculty of Medicine, University of Belgrade; Institute for Cardiovascular Diseases “Dedinje”; Academy of Sciences and Arts, Belgrade, Serbia; Department of Surgery, Chinese University of Hong Kong, Hong Kong, Hong Kong; TEDA International Cardiovascular Hospital, Medical College, Nankai University, Tianjin, China; and Providence Heart & Vascular Institute, Albert Starr Academic Center, Department of Surgery, Oregon Health and Science University, Portland, Oregon Introduction: Spasm of the human internal mammary artery (HIMA) is a rare but life-threatening complication after coronary artery bypass grafting (CABG). The reversal of this vasospasm is often challenging, and the most effective therapy is not well defined. The present study was aimed to investigate vasorelaxant effect of nicorandil, K+ channel opener, on the HIMA and to define the role of different K+ channel subtypes in nicorandil action on this blood vessel. Patients (or Materials) and Methods: Discarded segments of HIMA were collected from patients undergoing CABG and studied in organ baths. HIMA rings were precontracted with phenylephrine (10 μM) followed by cumulatively adding increasing doses of nicorandil. The endothelium was removed mechanically. Results: Nicorandil (0.001 μM–300 μM) induced a concentrationdependent relaxation of HIMA rings precontracted by phenylephrine. Glibenclamide (10 μ M), a highly selective blocker of ATP-sensitive K+ (K ATP ) channels, partially inhibited relaxation of HIMA induced by nicorandil. Tetraethylammonium (TEA, 1 mM), a nonselective blocker of Ca 2+ -activated K+ (K Ca ) channels, as well as iberiotoxin (100 nM), a most selective blocker of large-conductance K Ca (BK Ca ) channels, partly antagonized relaxation of HIMA. A nonselective blocker of voltage-gated K+ (K V ) channels, 4-aminopyridine (4-AP, 0.5 mM), as well as margatoxin (10 nM), a potent inhibitor of K V 1.3 channels, did not significantly modify the nicorandil-induced relaxation of HIMA. Conclusion: The results from our study demonstrate that, in HIMA, nicorandil has a potent vasorelaxant effect which is endotheliumindependent. It seems that mechanism of this relaxation includes KATP and 4-AP-sensitive K+ channels located in the smooth muscle of HIMA. Disclosure of Interest: None declared.