Background: Postoperative atrial fibrillation (POAF) is the most common postoperative arrhythmia after coronary artery bypass graft (CABG) surgery. POAF is associated with an increased risk of stroke, discomfort, longer hospital stay with increased treatment costs. Aim: The aim of our study was to compare POAF prevalence after off-pump versus on-pump CABG. Materials and Methods: Our observational retrospective study included 152 patients, 121with on-pump CABG, and 31 with off-pump CABG. New-onset of POAF was observed, at the Clinic for Cardiovascular surgery, University Clinical Center Sarajevo, in the period from January 2017 to November 2017. Results: General demographics were similar. Occurrence of POAF was significant, developed in 35% of patients in on-pump CABG versus 13% of patients in off-pump CABG (p=0.013). In postoperative period there was significant difference in bleeding (p=0.0001), blood transfusion (p=0.007), vasopressor usage (p =0.003) and blood glucose level (p =0.002). There was a difference, but not significant, in low cardiac output, sepsis, need for hemodialysis and longer stay in intensive care unit. Conclusion: In our study we concluded that the off-pump CABG reduces the occurrence of POAF, which reduces post-operative complications thus shortening the length of stay in the ICU and reduces the costs of treatment.

AIM: To compare hospital costs of acute deep vein thrombosis (ADVT) treatment in two periods of time. Evidence of repercussions on reducing costs during successful treatment. Attention was given to the necessity, costs and effectiveness of diagnostic procedures, treatment and complications. METHODS: A retrospective analysis of data obtained from patients medical history in a period from 2000 to 2016. Model management and safe practice of ADVT care consisted of clinical examination, laboratory, colour Doppler and invasive diagnostics. In a treatment was used continuous infusion un-fractionated heparin for 40 patients from 2000th till 2006th and low molecular weight heparin for 40 patients from 2006th till 2016th. All patients were converted to oral anticoagulants. RESULTS: When we look at the overall picture of improving the management model, safe practices and economic rationalization, we conclude that we offer better health service for the patients with ADVT at the moment, which relies on proven medical treatment trends. While we do not forget responsibility towards a society of which depends on treatment funding. CONCLUSION: The implementation of a conceptually new model of management of ADVT did not contribute rise of the desired outcomes, but it justified the positive economic viability of introduced changes at the Clinic of Vascular surgery than the previous concept.

Blood vessel branching of the proximal femur by its scheme differs from all other major joints. This scheme changes during the individual's development, dynamically depend ing on age. Namely, the caliber, blood flow rate, and dominance of certain arteries from the entire network of blood vessels that participate in the vascular supply of the hip are not equally expressed in all stages of development. In each successive stage, blood supply is dominated by a different artery that, after a certain period of time, shifts its major role to another artery. Anastomoses between individual arteries are not constant in all stages of development, and they represent a great importance for compensatory mechanisms. The disturbance of local arterial blood vessels, at a time when they domi - nate the blood supply and affect the quality of hip development and maturation, leads to reduced perfusion, and consequently, to the lack of development, ossification, and possible osteonecrosis.

Introduction: Atherosclerosis blood vessels, be it on extra-cranial or intra-cranial circulation, the most common cause of incidents such as cerebro-vascular insult (ICV). Carotid endarterectomy (CEA) is a preventive operation to reduce the risk of stroke and it can be performed by eversion carotid endarterectomy (E-CEA) or a classical carotid endarterectomy (C-CEA). The aim of this study was to investigate the influence of the used techniques in basic perioperative results and the incidence of postoperative complications. Materials and Methods: It was retrospective-prospective study that involved 173 patients, with carotid stenosis, who underwent CEA, in the period of time December 2013 till December 2016. Subjects were divided into two groups in respect of technique: 90 patients were treated with E-CEA and 83 patients were treated with C-CEA. Results: Between two groups revealed a significant difference in favor of the patients from group E-CEA in the length of the surgery (92.56 ± 29.11 min. vs. 104.04 ± 18.01 min., P = 0.000), the time of clamping the carotid arteries (11.83 ± 1.81 min. vs. 23.69 ± 5:39 min., p = 0.000), the amount of post-operative drainage (25.33 ± 24.67 ml. vs. 36.14 ± 14:32 ml., p = 0.001), time spent in the intensive care unit (± 25.43 vs. 13:51 hours 34.54 ± 35.81 hours, p = 0.000), and the length of stay (4.60 ± 0.90 days vs. 5:42 ± 1.80 days, p = 0.001). In the patients of the group E-CEA, fewer number of individual postoperative complications without statistical significance: ICV (2.2% vs. 4.8%, p = 0.351), cardiac arrhythmia (2.2% vs. 4.8%, p = 0.351), transitory ischaemic attack (TIA) and cognitive disorder (2.2% vs. 7.2%, p = 0.117), mortality (1.1% vs. 1.2%, p = 0.954); and the total number of postoperative complications was significantly less in the same patients (7.77% vs. 18.7%, p = 0.042). Conclusion: The results of this study clearly indicate that operating techniques affects the specified monitored outcomes of vascular treatment of carotid arteries in favor of E-CEA technique. It would be ideally that the conclusions of this study contribute to broader use of E-CEA in treatment of carotid stenosis.

Introduction: Stroke is one of the largest socio medical problems of modern times. In addition to the third leading cause of death, it is the first cause of non-trauma disability. Numerous studies show a correlation of risk factors and arteriosclerotic lesions in the coronary arteries and carotid arteries. Patients and methods: Study was conducted at the Clinical Center University of Sarajevo, Clinic for Cardiology surgery, methodologically cross-sectional study and partly manipulative and clinical prevention study, conducted on a representative sample of 100 patients. The subject was divided into 2 groups, coronary and non-coronary patients. Both groups of patients underwent color Doppler of carotid arteries, medical history and laboratory analysis. Results: The results confirm the hypothesis that the critical carotid artery stenosis is more present in patients with coronary disease, while the association of risk factors has been demonstrated for diabetes, hypertension and dyslipidemia. Conclusion: Screening of carotid arteries in patients scheduled for coronary revascularization is essential. With the presence of critical stenosis of the carotid artery, surgery of carotid artery should be done before coronary revascularization. The implementation of aggressive education and prevention of risk factors for cardiovascular disease is needed.

Introduction. We report a case of a sixty-year-old man diagnosed with gluteal compartment syndrome caused by traumatic rupture of the superior gluteal artery associated with fracture of the inferior pubic ramus and blunt trauma. Case report. A patient was injured falling from a height of four meters. Signs of compartment syndrome and sciatic nerve compression developed three hours after the injury. The patient went through a computerized tomography (CT) scan procedure with contrast, which showed a hematoma in the gluteal region, but without signs of active bleeding. However, after observation and monitoring of the patient, CT angiography was performed which revealed a rupture of the superior gluteal artery. Fasciotomy and debridement were performed and the patient was diagnosed with gluteal compartment syndrome and rupture of the superior gluteal artery. Surgery resulted in a significant improvement of the patient’s condition. Conclusion. Traumatic gluteal compartment syndrome is a rare condition. Gluteal compartment syndrome should be taken into consideration in each patient with pelvic trauma and hematoma in the gluteal region whose neurological status is affected. Prompt diagnosis and fasciotomy are crucial in the treatment and fasciotomy presents the gold standard in the treatment.

Introduction: The basic principle of non-surgical fracture treatment is to restore the original anatomical position of fractured fragments by different techniques, without direct access to the bone and without further traumatizing of tissues. Intramedullary nailing is synthesis and consolidation of fracture fragments with the main goal to gain strength and permanent placement of the implants. Two techniques of intramedullary osteosynthesis are used: with dynamic or with static intramedullary nail. Dynamization include conversion of static nail by removing screws from the longest fragment. Aim: The aim of this study is to determine whether there is a difference in the speed and quality of healing of the type A and B fractures of the femur and tibia treated by static or dynamic intramedullary nails and to compare the results. Material and methods: The study was conducted at the Clinic for Orthopaedics and Traumatology, Clinical Center University Sarajevo from January 2004 to June 2009. The study was retrospective-prospective, manipulative, controlled and it was conducted on a total of 129 patients with closed fractures of the diaphysis of the femur and tibia type A and type B, with different segments of bone, regardless of sex and age structure, with the exception of children under 14 years of age. Results: Precisely there were 47 patients with femoral fractures and 82 patients with tibial fractures. The average number of weeks of healing femoral and tibial fractures was slightly in advantage of static intramedullary osteosynthesis, it was 17.08 weeks (SD=3.382). The average number of weeks of healing in 23 patients with fractures of the femur, treated by dynamic intramedullary osteosynthesis was 17.83 (SD=2.978). We can conclude that static intramedullary nailing osteosynthesis unable movements between fragments which directly stimulates bone formation and formation of minimal callus. Conclusion: Static intramedullary osteosynthesis resolve the problem of stabilizing the fracture, limb shortening and rotation of fragments.

Introduction: The aim of this study was to present the incidence of the vascular complications that had to be surgically treated during the two-year period of transfemoral cardiac catheterization procedure and to identify the risk factors associated with the complications.Methods: A retrospective two-year study of post-catheterization complications with the six-month postoperative follow-up and analysis of risk factors was done. Patients with cardiovascular diseases who underwent therapeutic or diagnostic coronary angiography in the period of 2012-2013 were included in the study. A total of 1320 patients were subjected to catheterization for coronary angiography, of which 24 had vascular complications that had to be surgically treated. Indications for operative treatment included rapid growth of pseudoaneurysm, hemorrhage, large hematoma, hemodynamic instability, failure of the targeted compression therapy.Results: Twenty-four patients experienced some kind of post-operative complication. Infection and dehiscence of surgical wound were the two most common complications. There were no fatalities. The average length of a hospitalization was 4 days. The important risk factors are gender (women more than man), obesity, concomitant use of anticoagulation therapy and antiplatelet therapy after catheterization.Conclusion: Insufficient length of the compression of the punctured place and increased risks of a pseudoaneurysm formation, such as female gender, obesity, and use of a combined anticoagulant therapy are the main causes of these complications. Late vascular complications are not uncommon.

As patients and their physicians become more demanding, the desire to make the procedures "minimally invasive" is growing constantly. In short, "minimally invasive" is a code phrase for life saving procedures which in same time disrupt our quality of life the least. Its goals include reducing incision size, decreasing surgical trauma and pain, and improving cosmesits, patient satisfaction, and recovery times. However, the most important goal of minimally invasive aortic valve surgery must be to maintain or improve the efficacy and safety of conventional aortic valve surgery. In this report we would like to present operative technique of minimally invasive aortic valve replacement (MIAVR) we use in our hospital.

UNLABELLED Article presents a rare case of posttraumatic pseudoaneurysm and A-V fistula between deep femoral artery and vein in 16 year old patient with stab wound in middle third of the lateral side of left femoral region. There were no signs of arterial injury on initial angiogram. During the observation we noticed subcutaneous bruise on the posterior side of the femoral region, and strong systolic murmur by ordinary auscultation over the involved region as a significant sign of the A-V fistula. At day 3, CT angiogram and Doppler analysis showed 4 cm sized false aneurysm combined with A-V fistula between distal portion of the deep femoral artery and vein. We made ipsilateral transfemoral catheterization and coiling of the feeding arterial branch with good immediate result, but at next Doppler checking, appearance of the same picture was disappointing. After we recognized retrograde filling through distal collateral artery, technically unsuitable for endovascular procedure, conventional surgery with posterolateral approach was indicated. An excision of the pseudoaneurysm, and ligation of the A-V fistula was done with good postoperative result. CONCLUSION Obliterative endovascular procedure is a method of choice, but sometimes can not guarantee satisfactory result. In those cases conventional surgery is recommended.

INTRODUCTION Break ankle today is becoming more frequent. There is a dilemma to operate immediately upon receipt or delayed surgical treatment for a day or two. THE AIM OF THE WORK This work aims at showing the importance of the anatomy, mechanism of injury, injury classification, diagnostic and therapeutic methods in treatment of brake ankle from our experience. MATERIAL AND METHODS In the past year in our clinic there were 30 patients treated for all types of ankle fractures, and these patients were divided in two groups. Patients of the first group are those immediately operated, and the second group were with delayed surgery. The results showed that the patients of the first group had better healing, fewer complications, better and faster rehabilitation. Second groups of patients were with complications in terms dehiscence of wounds, bad healing fracture and DVT. CONCLUSION Our results showed that better result in the treatment of ankle fractures is achieved by aggressive treatment immediately after trauma, with reconstruction of articular surface and tibiofibular syndesmosis with early rehabilitation.

PURPOSE Cerebrovascular events (CVE) are the third most common cause of death in Western countries and about 65-70% of CVE are due to atherosclerotic disease of carotid arteries. Color Doppler scanning is used to evaluate the presence, severity and type of atheromatous plaques as well as velocity parameters of carotid arteries. We performed this study to correlate data of morphological and velocity parameters with clinical variables in patients following CVE. METHODS We included total of 211 pts who had CVE, 118 females, 93 males, mean age 71.1 +/- SD 12.5 years. Out of total number of pts (n = 211) 93 pts had transient ischemic attacks (TIAs), 49 had recurrent TIAs (rTIAs), 44 had ischemic stroke (IS), and 25 had recurrent IS (rIS). As a control group we took 50 pts without CVE but with at least three multiple risk factor (MRF). Morphological parameters were; plaque composition and echogenecity. Velocity parameters were: peak-systolic velocity (PSV) and end-diastolic velocity (EDV). The following MRF were evaluated: age, gender, hypertension, tobacco smoking, hyperlipidemia (total cholesterol and LDL-cholesterol), obesity, and diabetes mellitus. Examination was performed on CCA/ICA segment. RESULTS We found significant presence of heterogeneous plaques in TIAs and rIS subgroup, p < 0.014, and borderline significance for the rTIAs and IS subgroups, p < 0.04. We found significant difference in PSV in TIAs and rTIAs subgroups vs. controls (PSV 103 cm/s vs. PSV in controls 87 cm/s, p < 0.01). Decreased EDV, below 20 cm/s, was found in all subgroups, p < 0.01, while EDV, below 16 cm/s, was found in IS and rIS subgroups. MRF score of CVE group was 4.34 vs. 3.65 in controls, p < 0.012, while MRF score in TIAs and rTIAs vs. IS and rIS subgroups was 4.34 vs. 4.51, NS, p = 0.14. We found a significant correlation (95% CI) of tobacco smoking, obesity and arterial hypertension with presence of heterogeneous plaques, p = 0.0069. Interestingly, hyperlipidemia showed no correlation with heterogeneous plaques, p = 0.027. CONCLUSIONS (i) in CVE group we found significant presence of heterogeneous plaques in TIAs and rIS subgroups, (ii) in the pts with TIAs and rTIAs events we found significant increase in PSV, (iii) EDV below 16 cm/sec was a significant single predictor of IS and rIS events, (iv) MRF score was significantly increase in the pts with CVE compared to controls, but between CVE subgroups there was no significant difference.