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Aim: Brachial artery access is an alternative approach to endovascular interventions when access to the femoral, radial, or ulnar arteries is not feasible, but it carries higher risk of periprocedural complications than other approaches, including median nerve injury. Nerve injuries can occur by direct puncture or by compression, with hematoma being the most common cause. Sometimes the compartment syndrome can accompany the direct nerve injury, masking the signs of a nerve dysfunction. Case report: We present a patient with a false aneurysm of brachial artery, surrounding soft tissue hematoma with volar arm and forearm compartment syndrome and a simultaneous median nerve intraneural hematoma caused by a direct punction. The combination of injuries occurred after brachial artery access for endovascular treatment of bilateral iliac artery steno-occlusive disease. The patient was successfully treated by fasciotomy, arterial sutures, and nerve decompression via paraneuriotomy. Conclusions: Intraneural hematoma caused by direct puncture can be masked by concomitant compartment syndrome. Emphasis should be put on prevention, early recognition, and timely surgical treatment of intraneural hematomas, especially those accompanied by fascial compartment syndrome after endovascular interventions.

The goal: To compare the results of most distal femoral bypasses in our institution with results in literature. Patients and Methods: A single centre retrospective analysis of femoral to crural and distal-leg bypass performed in University Hospital Centre Zagreb between 2014 and 2018. Results: Primary one-year patency is even a bit better in our hospital than in literature (80% vs 77% respectively) and secondary patency is in the range of the world literature (54% vs 68% respectively). Conclusion: Surgical revascularization in form of the most distal bypasses, performed in this institution observed, although reserved for a smaller number of patients, is very good and reliable method of treatment, and its results are at the level of world standards and percentages.

Introduction: Vascular Ehlers-Danlos syndrome (vEDS) is considered the most severe form of EDS because of its typical life-threatening complications in young adults: spontaneous rupture of arteries, uterus or intestine1 . The prevalence of vEDS is at least 1:200.000. It is associated with autosomal dominant mutation in COL3A1 gene, which encodes pro-alpha 1 chains of type III collagen. The median life expectancy is 48 to 51 years. The beneficial role of celiprolol in reduction of arterial complications has been described, and the mechanisms may be related to reduction of hemodynamic stress and by upregulation of collagen synthesis via transforming growth factor-β2, 3. Case report: A 26-year-old man was referred with long history of serious vascular complication. From early childhood he was prone to spontaneous bruising. At the age of 7, after minor trauma, he had a duodenal hematoma. Hemophilia was ruled out. In 2014, urgent nephrectomy was done because of spontaneous rupture of right renal artery. Calf varicose veins were treated with foam sclerotherapy in 2016. In 2017, urgent femoro- femoral bypass was performed due to spontaneous rupture of the left common iliac artery (CIA) and failure to repair extremely vulnerable CIA wall. Several months later hybrid vascular procedure was done due to spontaneous dissection of right external iliac artery. Early postoperative course was complicated by spontaneous pneumothorax. His physical appearance was also suggestive to vEDS: thin skin, characteristic facial appearance (thin lips, small chin, thin nose, prominent eyes with dark circles), small joints hypermobility. Molecular genetic testing in 2019 confirmed vEDS: our patient is heterozygous for COL3A1c.1149+2_1149+51del. His current medical therapy includes vitamin C and tolerable dose of celiprolol. For the last three years he is without new adverse vascular events. Conclusion: Accurate diagnosis, genetic consulting, avoiding high risk activities and procedures are crucial in patients with vEDS. Endovascular or surgical intervention are mainly reserved for urgent complications of arterial or organ rupture. Celiprolol, a beta blocker with a unique pharmacologic profile, demonstrated a promising role in reduction of vascular complication in vEDS.

Introduction: Klippel-Trenaunay Syndrome (KTS) is rare syndrome characterized by a presence of capillary and venous malformation, limb overgrowth, with or without lymphatic anomalies1 . KTS is related to mutations in the PIK3CA gene. Complications of KTS include clotting disorder, bleeding, lymphedema, soft tissue infection and pain. Treatment is individualized ; it may include endovascular or surgical procedures and supportive care (management of coagulopathy, infection, pain). The use of mammalian target of rapamycin (mTOR) inhibitor sirolimus shows promising results in complex vascular malformations2, 3. Case report: We present a 45 years old patient, currently living out of Croatia. Vascular malformation of the left arm was noticed a few months after his birth. During his childhood an angiography of the left arm lead to confirmation of KTS without further specific treatment. During the last 15 years he was undergoing regular hematology controls and treatment of consumptive coagulopathy as complication of KTS. In 2010 at age 35, he suffered a fracture on the left arm, but he was declared inoperable on basis of vascular malformation which extended the healing process. From 2018 further proliferation of vascular malformation was noticed on his left hemithorax. In 2020 he was presented to multidisciplinary vascular team, MR angiography was performed Unfortunately, due to extreme extension of vascular malformation with soft tissue hypertrophy and osseous deformation the patient is not suitable for any surgical or endovascular procedure. We suggested a treatment with sirolimus which is delayed due to patient’s temporary relocation. Genetic panel testing covering PIK3CA gene is in progress. Conclusion: By presenting this case, our objective is to increase the awareness of KTS, related complications and the role of sirolimus which can improve the prognosis of vascular anomalies. Additionally, we wish to emphasize the importance of multidisciplinary vs specialty focused approach in management patients with KTS.

The purpose of this case-control study was to assess the association of abdominal aortic aneurysm (AAA) in Croatian patients with four genetic polymorphisms: SNP 1166AC in the angiotensin II type 1 receptor gene (ATCase-control study conducted with 117 patients with confirmed AAA (AAAThe deletion of 287 bp in the ACE gene (allele D) was more frequently found among AAAACE I/D is associated with AAA, and 1166AC AT

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a major global health care-associated pathogen. This study sought to examine the prevalence of MRSA in patients who were admitted to a vascular surgery ward during a 3-month period. Methods: MRSA screening was accomplished through the acquisition of nasal, throat and perineal swabs. These swabs were placed in tryptic soy broth that had been supplemented with 6.5% NaCl and incubated for 24 h. The resulting isolates were subcultured on agar plates containing 5% sheep blood. The BD GeneOhm MRSA assay for screening swabs was performed in accordance with the manufacturer’s instructions. Results: A total of 58 patients were included in the study and swabs from 232 sites were obtained during the sampling period. MRSA was detected in 33 samples of 12 patients during the study period; thus, there was a 20.6% prevalence of patients who were recognized as MRSA carriers. There were discrepancies between the results of classical bacteriological screening and molecular MRSA detection methods in 8 of the patients. Conclusions: Nasal, throat and perineal MRSA screening can detect the carriage of this pathogen and allow for the timely use of appropriate infection control measures. The choice of screening techniques poses a challenge; it has been demonstrated that molecular detection methods should be performed with great sensitivity, specificity and, most importantly, speed. The cost of the PCR screening method is the only disadvantage of this approach.

Aim: The purpose on this study was to assess the association of four polymorphisms, namely SNP 1166A>C in the angiotensin II type 1 receptor gene (AT1R), SNP -1562C>T in the matrix metalloproteinase-9 gene (MMP-9), the deletion of 32 bp in the chemokine receptor 5 gene (CCR5) and the insertion/deletion of 287 bp in the angiotensin-converting enzyme gene (ACE) with abdominal aortic aneurysm in Croatian patients. Methods: Overall 234 subjects, 117 patients with confirrmed AAA (AAA+) and 117 control subjects (AAA-), were genotyped using PCR or PCR-RFLP analysis. Statistical analyses were performed using MedCalc 12.1 software. Results: The deletion of 287 bp in ACE gene (allele D) was more frequently found among AAA+ patients compared to the AAA- subjects (66.7% vs. 47.9%, p=0.0001), due to higher percentage of DD homozygotes (46.2% vs. 15.4%, pC AT1R with the size of the aneurysm, while -1562C>T MMP-9 and CCR532 polymorphism are most probably not associated with AAA in Croatian patients.

A 64-year old man with intermittent, paraumbilical pain which is lasting for 6 months, radiating to the back with no other symptoms underwent resection of the celiac trunk and superior mesenteric artery aneurysms. According to their size and location the aneurysms were not suitable for radiological embolisation or stentnig. Elective surgical procedure was performed. End-to-end anastomosis was created between the origin of the celiac trunk and splenic artery and the vascular continuity of the superior mesenteric artery was achieved using great saphenous vein interpositum. Intraoperative samples and histological findings were consistent with atherosclerosis. The patient made a good recovery and remained well after 2 years.

Methicillin-resistant Staphylococcus aureus (MRSA) is a major global health care-associated pathogen. This study sought to examine the prevalence of MRSA in patients who were admitted to a vascular surgery ward during a 3-month period.MRSA screening was accomplished through the acquisition of nasal, throat and perineal swabs. These swabs were placed in tryptic soy broth that had been supplemented with 6.5% NaCl and incubated for 24 h. The resulting isolates were subcultured on agar plates containing 5% sheep blood. The BD GeneOhm MRSA assay for screening swabs was performed in accordance with the manufacturer's instructions.A total of 58 patients were included in the study and swabs from 232 sites were obtained during the sampling period. MRSA was detected in 33 samples of 12 patients during the study period; thus, there was a 20.6% prevalence of patients who were recognized as MRSA carriers. There were discrepancies between the results of classical bacteriological screening and molecular MRSA detection methods in 8 of the patients.Nasal, throat and perineal MRSA screening can detect the carriage of this pathogen and allow for the timely use of appropriate infection control measures. The choice of screening techniques poses a challenge; it has been demonstrated that molecular detection methods should be performed with great sensitivity, specificity and, most importantly, speed. The cost of the PCR screening method is the only disadvantage of this approach.

Abdominal aortic aneurysm (AAA) is a complex genetic disorder, caused by unfavorable interplay of different genetic and environmental risk factors. The number of (GT)n repeats in the heme oxygenase-1 (HO-1) gene promoter modulates transcription of this enzyme which might have anti-inflammatory, anti-oxidant, anti-apoptotic and anti-proliferative effect. Croatian individuals, genotyped for the first time for (GT)n HO-1 polymorphism, had similar distribution of alleles and genotypes as observed in other European populations. Higher frequency of the short (S) alleles (GT less than 25) was observed in AAA patients (41.9% vs 28.2%, p=0.0026) compared to non-AAA individuals, due to the higher frequency of heterozygotes SL (54.7% vs 35.9%, p=0.0058), but not homozygotes SS (14.5% vs 10.3%, p=0.4376). SL genotype (L more than 25 GT), more often found in AAA individuals, appeared to increase risk for AAA (OR=1.72, 95% CI=1.20-2.81, p=0.009 ; after adjustment for age, sex, smoking, hypertension and hyperlipidemia: OR=1.53, 95% CI=0.90-3.09, p=0.062). Taking into consideration that our findings are contradictory to the results of the only one study performed so far on the association of (GT)n HO-1 polymorphism and AAA, further investigations are needed to clarify this relationship.