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Edin Herceglija

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We present a case of catheter induced pseudoaneurysm of femoral artery and postprocedural course. This type of complications occurs in 2% to 8% patients after interventional procedures via trans femoral access and and has overall trend of increase due to significant number of this procedures in diagnostic and interventional cardiology. A 74-year-old female was admitted to Vascular department complaining of severe pain in her left groin. On physical examination, there was a femoral mass palpable but non-pulsatile in her left groin. Color Doppler documented the presence of femoral pseudoaneurysm as well as "to-and-fro" flow pattern on the pseudoaneurysm neck. CT arteriogram showed pseudoaneurysm with mostly thrombosed cavity, diameter of 85 x 27 mm. We concluded for further surgical repair.

Treatment of complicated case with subclavia steal syndrome and stenosis of common iliac artery Background. The aim of this case report is to describe the realization of complex radiological minimally invasive interventional procedures at the Institute of Radiology in KCU Sarajevo during which we treated a very complicated case with the left subclavia steal syndrome and the stenosis of the left common iliac artery. Case report. The patient was 57 years old with previous history of ischemic lesions in brain, with occlusion of the left arteria carotis communis (ACC) and stenosis of the right arteria carotis interna (ACI), with dizziness and inability to look upward. The patient was treated first with subintimal recanalization and introduction of self-expandable stent into the left subclavia artery to compensate for the very wide remnant of the occluded artery. After four months of follow up with no change, our team attempted to treat stenosis of the right ACI but failed to do so and during this procedure in-stent restenosis in the left subclavia artery was noted. After less than two weeks we performed balloon dilatation of in-stent restenosis of a previously installed stent into the left subclavia artery. The patient underwent CT and CT angiography (CTA), colour Doppler ultrasonography (CDUS), MRI and MR angiography (MRA) before and after the procedures. Conclusions. A follow up and, if needed, a balloon dilation are necessary to prevent the re-occlusion of the previously treated subclavia artery with stenting.

E. Solaković, N. Rustempašić, Edin Herceglija, Vesna Djurovic-Sarajlic, Sandi Solakovic, F. Memić

Objective: Comparison of detection and determination of critical carotid stenosis between two radiological methods: color doppler ultrasound and Seldinger angiography. Methods: This is retrospective study that has included 64 patients that were hospitalized at the Clinic for Vascular surgery, Clinical Centre of University of Sarajevo, from 2006-2008.. 43 patients had carortid artery stenosis from 50-99%, all patients confirmed of having carotid stenosis greater than 60% were subjected to Seldinger angiography. Results confirming critical stenosis of both methods were compared. Degree of carotid stenosis with color doppler was determined on basis of peak systolic velocity and in the case of angiography stenosis was determined by measuring stenotic segment with milimeter tape and comparing it to diameter of normal segment. Results: according to color doppler investigation 32/43 patients had critical carotid stenosis ≥70% . In case of Seldinger angiogram ratio of positive cases was 37/43. In 86% of cases critical stenosis was confirmed by both methods. 5 angiograms showed greater degree of carotid stenosis than color doppler investigation. Out of 2 complete occlussions of internal carotid artery detected by color doppler only one was confirmed by Seldinger angiography, the other was described as stenosis of very high degree.. Discussion: Compatibility of successfull recognition of critical carotid stenosis for both methods is 86%, that figure does not deviate significantly from results pointed out by other studies where compatibility was reported to be 91%. Conclusion: Both methods should be combined in order to make sound indication for operative treatment since beside having segmental stenosis of carotid artery, imperative for carrying out succsseful operation is regular appearance of distal portion of internal carotid artery that is best visualised by one of available angiographies.

E. Solaković, N. Rustempašić, Edin Herceglija, Vesna Djurovic-Sarajlic, Sandi Solakovic, Fuad Memic

INTRODUCTION Preoperative evaluation of patients with aneurysm of abdominal aorta includes CT angiography. Stenotic changes of iliac arteries greater than 50% imply consideration of aorto-femoral reconstruction in order to avoid upcoming occlusion of iliac arteries in the near future. AIM Comparison of detection of arterial stenotic changes between CT and Seldinger angiographies that are > or = 50% in aorto-iliaco femoral region. METHODS AND PATIENTS This is a retrospective descriptive study that included 73 patients diagnosed with AAA from 2006-2008. Both CT and Seldinger angiography were performed on 43 patients, while 30 patients were evaluated only with CT angiography. RESULTS out of 43 patients that were evaluated with both CT and Seldinger angiography, 30 of them were males and 13 were females. Stenotic changes > or = 50% detected by CT are as follows: aortic bifurcation -9.3% of patients, common iliac artery-11.62% of patients, internal iliac artery -46.51% of patients, external iliac artery 25.58% of patients and 4.6% of patients in case od common femoral artery. Seldinger angiography detected stenotic changes > or = 50% as follows: aortic bifurcation -16.27% of patients, common iliac artery -16.27% of patients, internal iliac artery -60.46% of patients, external iliac artery 32.55% of patients and 9.3% of stenotic changes at the level of common femoral artery. CONCLUSION Seldinger angiography detected more stenotic changes of iliac artery segment in comparison to CT angiography and in that aspect every suspicion of potential stenotic change in iliac artery segment should be additionally evaluated by Seldinger angiogram in case of patients with AAA.

Edin Herceglija, Suad Jaganjac, E. Avdagić, Vesna Sarajelic-Djurovic, Sanela Vesnic

SUMMARY After surgical anesthesia came during the first decades of the 20th Century celiac plexus block gain huge importance in the interventions within management of pain therapy. Modification of the already existing techniques, innovations in pharmacology, progress in assistance of radiology methods and permanent development of methodology placed this method at the important place in the intervention radiology. Percutaneous neurolysis of the celiac plexus controlled by CT is rather simple, cheap and safe palliative procedure which eliminates or reduces intensive pain in patients with malignant changes. Intervention radiology, together with the pharmacological therapy, neurostimulation techniques and neurosurgical procedures can play and plays an important role in management of pain and improvement of life quality in patients with malignant processes in the upper abdomen. In article we will present experiences in application of this method at the Institute for radiology of the Clinical Center of

Suad Jaganjac, Vesna Sarajlić-Durović, Amela Duherić, Edin Herceglija, D. Bulja, L. Lincender

INTRODUCTION In advanced stage of renal carcinoma especially in right kidney because of proximity of inferior vena cava in most centers preoperative embolization of kidney is performed in purpose of facilitating surgery and reducing pre- and postoperative complications. In certain number of patients with indication for inoperability, complete embolization is performed in order.to prevent complications like bleeding. After intervention, surgical nephrectomy can be performed. In patients with the absolute contraindication for the surgical treatment, embolization represents the treatment of choice. MATERIAL AND METHODS Material for period of 7 years in Elbeck-Schoen Klinik and CCUS is presented in this paper. There were 72 patients, age range 3 to 92 years old, treated with 77 performed embolizations. Embolization was performed with PVA particles in order of achieving capillary embolization, while the principal trunk of renal artery was occluded with one or more coils until complete occlusion occurred. RESULTS Patients were divided in two groups: group A consisted of patients with preoperatively performed embolization, and to patients in group B embolization was performed as form of palliative care. In all patients in group A procedure was a success, and in one patient from group B procedure was needed to be repeated several times. DISCUSSION AND CONCLUSION As it is known from medical history first embolization was performed by Almgard in 1973 with purpose in providing safer surgical treatment to patient. Nowadays, this procedure got its widespread use in interventional radiology. Our experiences indicate successfulness of this procedure in most cases in preoperative management as well as in palliative treatment of patient. Postembolization syndrome occurred in all patients after intervention has been performed, and was successfully treated with symptomatic therapy. More severe complications were sporadic. In conclusion it might be said that embolization of inoperative tumors may increase both survival rate and quality of patients life.

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