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    Multistage Hybrid Treatment of Aortic Aneurysm and Management of Postoperative Complications: A Case Report
    (Macedonian Academy of Sciences and Arts/Walter de Gruyter GmbH, 2025-06-01)
    Shokarovski, Marjan
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    Mehmedovic, Nadica
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    Grazhdani, Sonja
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    Grueva, Elena
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    The Frozen Elephant Trunk (FET) is a surgical procedure developed for simultaneous repair of the aortic arch and the proximal descending thoracic aorta. Experience has shown its technical feasibility and good clinical results, although complications remain possible. Case Presentation: A 66-year-old male presented for evaluation due to findings from computed tomography angiography of aneurysms in the ascending aorta, aortic arch, and abdominal aorta. The patient had a history of a quadruple coronary artery bypass graft (CABG) and placement of two stents in the descending thoracic aorta, which were improperly aligned, thrombosed, and further complicated the case. The patient underwent surgery involving sternotomy to perform the FET procedure, replacing the ascending aorta and aortic arch and placing a stent graft in the proximal descending thoracic aorta. Simultaneously, two coronary artery bypass grafts were performed. Postoperatively, the patient was stable, and the intervention outcome was satisfactory. Subsequently, endovascular treatment was carried out on the remaining thoracic aorta and abdominal blood vessels. However, respiratory failure necessitated the placement of stent grafts in the left main bronchus on two occasions. Despite extensive efforts, the patient succumbed to respiratory insufficiency. Conclusion: Timely intervention and a multidisciplinary approach played a key role in addressing complications, although the patient ultimately experienced a fatal outcome due to multiorgan failure.
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    AORTIC DISSECTION: OFTEN NEGLECTED DIFFERENTIAL DIAGNOSIS IN EMERGENCY AMBULANCE SERVICES
    (MIT University Skopje, 2024-03)
    Furnadjiski, Atanas
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    Antova, I
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    Abazi, A
    Introduction: Aortic dissection is a rupture of the aortal medial layer produced by intramural hemorrhage that leads in a separation of the aortic wall layers, forming a false and true lumen with or without communication and is highly lethal. It causes a variety of symptoms, which can be discrete and subacute, or chronic, and is frequently misdiagnosed. Aim: This case report aims to present a case of a rare, subtle manifestation of transient ischemic attack caused by an aortic dissection. Case report: A 76-year-old man came to the Emergency Medical Service complaining of recent back and left shoulder pain accompanied by discomfort, as well as left-sided tingling of the face, arm, and leg, along with left hand weakness, that had occurred multiple times in the previous five days and lasted three to four minutes. On admission, he was clinically stable and had normal vital signs, without any neurological deficit. The ECG examination revealed RBBB without ST segment abnormalities. The anamnestic and hetero-anamnestic data were completely consistent with a cerebrovascular transient ischemic attack that occurred three days prior. After reevaluating the patient clinical status that was unchanged, he experienced temporary weakness, sweating, and dizziness revealed by shifting from supine to straight position, which was instantly relieved by kneeling down on the floor. The patient was immediately referred to secondary care. While a CT of the brain revealed normal findings, the CT angiography of the aorta showed an infrarenal aneurismatic dilatation with a 4cm wide flap indicative of impending aortal dissection. The patient was promptly referred to a tertiary care for further examination and medical care. Conclusion: Aortal dissection can easily go undetected in the Emergency Medical Services due to its pleomorphic clinical presentation, which oscillates between acute hemodynamic shocks to subtle, often undetectable symptomatology. Awareness of aortic dissection as differential diagnosis should be promptly lifted to a higher order thinking.
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    D DIMERS - A POWERFUL TOOL IN THE DIAGNOSIS OF AORTIC DISSECTION
    (Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R.N. Macedonia, 2023)
    Jovanoski, Marko
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    Nikolovski, Robert
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    Petkovski, D.
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    Introduction: Acute aortic syndrome is one of the most life threatening cardivascular conditions besides acute coronary syndrome and pulmonary embolism. Fifty percent of all the patients with aortic dissection do not survive for surgery or other therapeutic procedure to be performed and they experience a lethal end. D dimers although are a marker with a low specificity and sensitivity they can help us and guide us to make the right diagnosis. Aim: Using d dimers to raise the suspicion for acute aortic dissection and using the triple chest pain CT angiography protocol to confirm the right diagnosis. Case report: This series of case reports are about a few patients that presented in the emergency department with either a chest or back pain which was radiating to different body regions (including the lumbal region and the abdominal area). As these symptoms can sometime overlap and manifest as different acute cardiovascular syndromes, which can lead to increased morbidity and mortality, a CT angiography was performed after the regular noninvasive, low cost echocardiography was done to potentially find a possible diagnosis and show us the right diagnostic path. D dimers were also examined in all of the patients and increased level was found in all of the above mentioned. Aortic dissection (Stanford A or B ) was the final diagnosis in all of them, every single patient requiring a different therapeutic approach. Conclusion: D dimers in combination with a good clinical examination can be a perfect tool to raise the suspicion for acute aortic syndrome and after performing a triple chest pain protocol with CT angiography we can confirm and treat the diagnosis which requested a hospital admission.
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    Atypical presentation of type A aortic dissection: a case report
    (2015-10)
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    Otljanska, M
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    Kostov, I
    Background: Aortic dissection typically presents with severe chest or back pain. Lower limb ischemia occurs in less than 10 % of cases of type A aortic dissection. Isolated distal limb ischemia as the first sign of dissection is very rare.1-3 Case report: A 75-year-old man with history of uncontrolled hypertension and smoking was admitted to our hospital with sudden onset of lower extremities pain. During exertion patient felt transient mild chest pain. He was asymptomatic few hours till onset of sharp pain in his left leg. He was admitted in our hospital with persisting symptoms and sings of critical distal limb ischemia. There was significant systolic blood pressure difference. Troponin T was negative, but other cardiac biomarkers were highly elevated. Transthoracic echocardiography detected aortic root dilatation, mild regurgitation and aortic arch intimal flap. CT angiography was performed and type A aortic dissection, with doubled lumen was detected from ascending aorta to aortic bifurcation. Supra-aortic vessels were not involved and no repercussion on celiac, renal or mesenteric artery flow was detected. Thrombus in left iliac artery with involvement of left external iliac artery could explain signs of distal limb ischemia. Patient was referred to cardiovascular center but unfortunately he died immediately after transfer to surgical institution. Discussion and Conclusions: Aortic dissection is an emergency that, unless it is quickly identified, almost regularly results in death, especially in presence of atypical or rare symptoms. Suddenonset of lower limb pain or signs of critical ischemia could be the signs of acute aortic disease and should be carefully investigated.