An Abdominal Aortic Aneurysm (AAA) is a localized dilatation and weakening of the abdominal aorta, as it`s infrarenal part is most commonly affected by the disease. Risk of rupture: Size of the AAA is one of the strongest predictors of rupture, as aortic aneurysms above 5,5cm in diameter have a higher risk. Clinical manifestation: Most of the AAAs have no symptoms and are accidently found. Classis symptoms of ruptured AAA (rAAA) are suddenly occurring severe abdominal and/or back pain, arterial hypotension and pulsatile abdominal mass. Preoperative management: When rAAA is suspected, the patient should be consulted with a vascular surgeon as soon as possible. Aggressive fluid resuscitation should be avoided. Surgical treatment: Open surgery is usually performed via a transperitoneal approach with a midline laparotomy. Depending on the anatomy of the AAA and iliac arteries involvement an aorto-arotal or aorto-bifemoral bypass is constructed. Complications after repair of rAAA: Local - Lower limb(s) ischemia, Ischemia of the colon; Systemic - Cardiac, Pulmonary, Renal, Liver or Multiorgan failure, with 30-day mortality reaching up to 89%.CASE REPORT: Male patient, 81 years of age, with multiple concomitant diseases. He was diagnosed with AAA 4 months prior to the rupture. The maximal diameter of the AAA was 15,6cm, iliac arteries were not affected. The patient refused the suggested surgical or endovascular treatments. He presented at ER 4 months later with acute pain in the abdomen and back. Clinical status: severe pain in the abdomen, BP 96/57mmHg, Hgb 102 g/l with HCT -0.331 l/l. On the CT-angiography rupture of AAA was verified with massive retroperitoneal haematoma, occluded right renal artery and aneurysm of the left renal artery. Median laparotomy was conducted under common anaesthesia. Aneurysmal neck was clamped above renal arteries, with clamping time – 30 minutes. After reclamping aorto-bifemoral bypass was constructed. Postoperatively the patient was transferred to intensive care unit (ICU). In the course of ICU treatment, the patient was inadequate and lacked spontaneous diuresis. A temporary catheter for haemodialysis was placed and such was initiated. He was transferred in the Clinic of vascular surgery after stabilizing blood oxygen saturation. The patient was inadequate at the time of transfer, with jaundice present. The patient restored bowel passage, hepatoprotectors were administered and physiotherapy was initiated. On the 20th postoperative day, the patient had a rapid decline in the physical status, demonstrated by hypotonia, bradycardia and regardless of the reanimation, died.DISCUSSION: Ruptured aneurysm of abdominal aorta has high mortality. Despite the immediate surgical treatment and adequate substitution, the patient had lethal outcome. CONCLUSION: Ruptured abdominal aortic aneurysm has high 30-day mortality, ranging between 22,9%-65,9%. In cases of acute renal and/or liver failure following the surgical treatment and when haemodialysis is needed, mortality rate can reach up to 89%.
One of the most common complications of surgical exposures is the surgical site infection (SSI). Although it varies between different surgical profiles, it can reach up to one third of all complications. In vascular surgery patients ischemic ulcers are very common, as well as factors, compromising the immune system such as diabetes, chronic kidney disease etc. One of the main surgical exposures in vascular surgery is inguinal, providing access to the femoral artery and its bifurcation. Although it allows a wide range of reconstructions, implanting different types of prosthetic materials, stents and providing anastomosis site, it contains lymph nodes, which can contaminate the reconstruction and cause SSI with severe consequences. Patients, prone to SSI due to concomitant diseases, are threatened by sepsis, limb loss and even death, which makes prevention of those type of complications essential. Aim: To investigate etiological spectrum of microbiological isolates and their resistance against most common antimicrobials among vascular surgery patients. Materials and methods: The study is retrospective, conducted in the period 01 January 2022 – 31 March 2022. All of the samples were obtained from patients of Clinic of Vascular Surgery. After isolation of pure culture from the samples, the strains were identified by MALDI TOF MS and Vitec – 2 Compact. Antibiotic resistance was determined with Bauer-Kirby disk diffusion method. Results: From all 419 of the patients, hospitalized in the Clinic of Vascular surgery for this period, 28 isolates from 26 (6,21%) patients were obtained, of which Gram-negative were 19 (67,86%) and Gram-positive - 9 (32,14%). From Gram-negative - enterobacteria – 14 (73,68%), and non-fermenting gram-negative bacteria (NFGNB) were 5 (26,32%). Only 3 (21,43%) from all enterobacteria were extended spectrum beta-lactamases producing strains (ESBLs). No strains, resistant to carbapenems (RCP) were isolated. Five (55,55%) of the Gram-positive isolates were Staphylococcus aureus, 4 (80%) of which were methicillin resistant Staphylococcus aureus (MRSA). Two of the Gram-positive species isolated were Enterococcus faecalis, of which 1 with a high-level aminoglycoside resistance (HLAR). No Vancomycin resistant enterococci (VRE) were discovered. There were no colistin-resistant Acinetobacter baumannii and Pseudomonas aeruginosa strains. Conclusion: From all 28 isolates 8 (28,57%) were with acquired types of antimicrobial resistance. With almost one third of the isolates that are problematic in terms of antibiotic susceptibility, treatment of those patients can be challenging. Prevention of in hospital contamination with polyresistant strains, associated with medical care it is crucial for reducing the number of severe complications, decreasing of hospital stay and cost for treatment.
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