17.	Yogev Y. Visser G. H.A. Obesity, gestational diabetes and pregnancy outcome. Semin Fetal Neonatal Med 2009; 14: 77-84.
18.	Carpenter MW, Couston DR, Mestman JH. Pregnancy complicated by gestational diebetes. In: Diabetes in women. Phidelphia: Lippincott Williams & Wükins; 2004.
19.	Pajntar M, Novak-Antolič Ž et al. Nosečnost in vodenje poroda. Ljubljana: Cankarjeva založba; 2004.
20.	Gartner LM, Morton J, Lawrence RA, Naylor AJ, O'Hare D et al. Breastfeeding and the use of human mük. Pediatrics 2005; 115: 496-506.
21.	Owen CG, Martin RM, Whincup PH, Smith GD, Cook DG. Does breastfeeding influence risk of type 2 diabetes in later life? A quantitative analysis of published evidence. Am J Clin Nutr 2006; 84:
1043-54.
22.	Gouver E, Papanas N, Hatzitolios AI, Maltezos E. Breastfeeding and Diabetes. Curr Diabetes Rev
2011; 7: 135-42.
23.	Simeoni U, Barker D.J. Offspring of diabetic pregnancy: Long-term outcomes. Semin Fetal Neonatal Med 2009; 14: 119-24.
24.	Buchanan TA. Pancreatic B-cell defects in gesta-tional diabetes: implications for the pathogenesis and prevention of type 2 diabetes. J Clin Endoci-nol Metab 2011; 86: 989-993.
25.	Jovanovic L, Knopp RH, Brown Z et al. Declining insulin requirement in the first trimester of diabetic pregnancy. Diabetes Care 2001; 24: 1130-36.
26.	Hawthorne G. Maternal complications in diabetic pregnancy. Best Pract Res Clin Obstet Gynaecol
2011; 25: 77-90.
27.	Ray JG, O'Brien TE, Chan WS. Preconception care and the risk of congenital anomalies in the offspring of women with diabetes mellitus: a me-ta-analysis. QJM 2001; 94: 435-44.
28.	Murphy HR, Roland JM, Skinner TC, Simmons D, Gurnell E, Morrish NJ, et al. Effectiveness of a regional prepregnancy care program in women with type 1 and type 2 diabetes: benefits beyond glycemic control. Diabetes Care 2010; 33: 2514-20.
29.	Guideline Development Group. Management of diabetes from preconception to the postnatal period: summary of NICE guidance. BMJ 2008; 336:
714-7.
30.	IDF Clinical Guidelines Task Force: Global Guideline on Pregnancy and Diabetes. Brussels: International Diabetes Federation; 2009. Dosegljivo na: http://www.idf.org/webdata/docs/Pregnan-cy_EN_RTP.pdf.
31.	Pollex EK, Feig DS, Lubetsky A, Yip PM, Koren G. Insulin glargine safety in pregnancy: a tran-splacental transfer study. Diabetes Care 2010; 33:
29-33.
32.	Kovo M, Wainstein J, Matas Z, Haroutiunian S, Hoffman A, Golan A. Placental transfer of the insulin analog glargine in the ex vivo perfused placental cotyledon model. Endocr Res 2011; 36:
19-24.
33.	Pantalone KM, Faiman C, Olansky L. Insulin glar-gine use during pregnancy. Endocr Pract 2011; 17:
448-55.
34.	Priloga1. Povzetek glavnih značilnosti Zdravil. Dosegljivo na: http://www.ema.europa.eu/docs/ sl_SI/document_library/EPAR_Product_Infor-mation/human/000284/WC500036082.pdf.
35.	Mathiesen ER, Damm P, Jovanovic L, McCance DR, Thyregod C, Jensen ABet al. Basal insulin analogues in diabetic pregnancy: a literature review and baseline results of a randomised, controlled trial in type 1 diabetes. Diabetes Metab Res Rev2011; 27: 543-51.
36.	Priloga1. Povzetek glavnih zdravil. Dosegljivo na: http://www.ema.europa.eu/docs/sl_SI/docu-ment_library/EPAR_-_Product_Information/hu-man/000528/WC500036662.pdf
37.	Gough SC. A review of human and analogue insulin trials. Diabetes Res Clin Pract 2007; 77: 1-15.
38.	Murphy HR, Rayman G, Lewis K, Kelly S, Johal B, Duffield K. Effectiveness of continuous glucose monitoring in pregnant women with diabetes: randomised clinical trial. BMJ 2008; 337: a1680.
39.	Kurkinen-Räty M, Koivisto M, Jouppila P. Preterm delivery for maternal or fetal indications:maternal morbidity, neonatal outcome and late sequelae in infants. BJOG 2000; 107: 648-55.
40.	Gyamfi-Bannerman C, Fuchs KM, Young OM, et al. Nonspontaneous late preterm birth: etiology and outcomes. Am J Obstet Gynecol 2011; 205:
456.e1-6.
41.	Rasmussen MJ, Firth R, Foley M, Stronge JM.The timing of deliveryin diabetic pregnancy: a 10-year review. Aust N Z J Obstet Gynaecol 1992; 32: 313-7.
42.	ACOG Committee on Practice Bulletins. ACOG Practice Bulletin. Clinical Management Guidelines for Obstetrician-Gynecologists. Pregestatio-nal diabetes mellitus. Obstet Gynecol 2005; 105: 675-85.
43.	Kurjak A, Chervenak Frank A. Textbook of Perinatal Medicine. Informa UK Ltd UK 2006 Second Edition 1348-58.
44.	Krajnc M, Zavratnik A, Čokolič M. Nosečnostna sladkorna bolezen. Med Mes 2008; 4: 30-36.
45.	Štotl I, Medvešček M, Zaletel Vrtovec J. Obravnava oseb z velikim tveganjem za sladkorno bolezen tipa 2. In: Slovenske smernice za klinično obravnavo sladkorne bolezni tipa 2 pri odraslih osebah. Dosegljivo na: http://www.endodiab.si/ dotAsset/7144.pdf.
klinični PRIMER/case report
Endovascular repair of renal artery aneurysm with the multilayer stent - a short report
ZnotraJžiLno zdravljenje anevrizme Ledvične arterije z novo večsLojno mrežasto žiLno opornico - kratko poročilo
Vojko FLis,1 Jože MateLa,2 SiLva Breznik,2 MicheL Henry3
1	Department of Vascular Surgery, University Medical Centre Maribor, Ljubljanska 5,2000 Maribor, Slovenia
2	Department of Radiology, University Medical Centre Maribor, Ljubljanska 5,2000 Maribor, Slovenia
3	Polyclinique des Essey, Cabinet de Cardiologie, 80, rue Raymond Poincare, 54000 Nancy, France
Korespondenca/ Correspondence:
doc. dr. Vojko FLis, dr. med., Department of VascuLar Surgery, University MedicaL Centre Maribor, LjubLjanska 5, 2000 Maribor, SLovenia
Ključne besede:
anevrizma Ledvične arterije, znotrajžiLno zdravLjenje, večpLastna znotrajžiLna opornica
Key words:
renaL artery aneurysm, endovascuLar treatment, muLtiLayer endovascuLar stent
Abstract
Background: Complex renal artery aneurysms (RAA) involving major branches of renal artery are difficult to treat. Surgery may be associated with extensive invasiveness and morbidity in the context of major intra-abdominal surgery. Stentgrafts or selective coil embolization are contra-indicated when large branches are involved in the aneurysmal sac. A case of the patient with complex renal artery aneurysm involving all major arterial branches treated with a new type of multilayer stent is described.
Case report: A 56-year old woman whose right kidney had been removed five years before because of renal cell carcinoma was incidentally found to have a large (22 x 26 mm) saccular an-eurysm in the main left renal artery involving all three major branches of the renal artery. Via a percutaneous femoral approach a multilayer stent was deployed without complications. Blood flow inside the sac was immediately and significantly reduced. All the renal branches remained patent.
Conclusion: New multilayer fluid modulating stent concept appears to be a very useful and attractive alternative to surgery or other endo-vascular techniques for those RAA involving or very close to major branch vessels, especially in patients with very high risk of loosing the only viable kidney, as in our case.
Razširjen povzetek
Uvod: Anevrizme ledvične arterije so redke. Pojavljajo se v približno enem odstotku vseh klinično ugotovljenih anevrizem. Običajno so asimptomatske in praviloma jih odkrijemo po naključju. Indikacije o zdravljenju so protislovne. Večina zdravnikov se strinja, da je invazivno zdravljenje smiselno, ko anevrizma po premeru preseže dva centimetra, s čimer narašča tveganje za razpok, trombozo ali disekcijo. Zdravimo jih lahko kirurško ali znotrajžilno. Poseben primer so zapletene anevrizme ledvične arterije, ki zajemajo področje razcepišča poglavitnih vej za pa-renhim. Znotrajžilno zdravljenje z oplaščenimi opornicami ali z embolizacijo pri takih anevriz-mah ni možno. Kirurško zdravljenje pa je tvegano in povezano z večjo pojavnostjo zapletov. Prikazan je primer bolnice z eno samo ledvico, ki je imela zapleteno anevrizmo leve ledvične arterije. Uporabili smo novo vrsto znotrajžilne opornice. Gre za posebno opornico, sestavljeno iz več slojev pletene mreže in brez zunanjega plašča. Posebnost opornice je njena zmožnost, da ohrani pretok krvi v tistih vejah arterije, ki jih prekrije, hkrati pa povzroči trombozo anevrizme.
Prikaz primera: Oseminpetdesetletna bolnica je bila napotena iz druge ustanove, kjer je bila na običajnem kontrolnem pregledu trebušne votline z ultrazvokom. Kontrolne preglede so ji opravljali enkrat letno, saj so ji pred petimi leti odstranili desno ledvico zaradi ledvičnega kar-cinoma. Med pregledom so našli veliko anevriz-mo v hilusu leve ledvične arterije. Napravljena je
Citirajte kot/Cite as:
Zdrav Vestn 2012; 81: 753-8
PrispeLo: 7. dec. 2011, Sprejeto: 7. mar. 2012
bila CT preiskava s kontrastom, ki je ultrazvočni izvid potrdila. Najdena je bila velika anevrizma (22 x 26 mm) na razcepišču glavne veje leve ledvične arterije. Iz anevrizme so izhajale tri veje za ledvični parenhim. Zdravljenje z oplaščeno znotrajžilno opornico ni bilo možno. Prav tako ni bila možna embolizacija. Kirurški poseg je bil ocenjen kot tvegan predvsem zaradi zarastlin po prvi operaciji. Bolnici smo predstavili vse možnosti zdravljenja, tudi možnost z vstavitvijo nove vrste večslojne mrežaste žilne opornice. Privolila je v vstavitev nove vrste opornice. Tri dni pred posegom je pričela dobivati klopidrogel (75mg/dan). Poseg je bil opravljen v lokalni omami skozi desno skupno stegensko arterijo. Med in po posegu ni bilo zapletov. Opornica je ane-
vrizmo izključila iz krvotoka in pri tem ohranila odprte vse arterijske veje za parenhim. Bolnica je bila iz bolnišnice odpuščena dan po posegu. Mesec in šest mesecev po posegu kontrolna CT preiskava kaže popolno izključitev anevrizme iz krvotoka, laboratorijske preiskave pa kažejo normalno ledvično funkcijo.
Zaključek: Nova vrsta mrežaste večslojne žilne opornice, ki lahko ohrani prehodne tudi tise arterijske veje, ki jih prekriva, je videti izvrstna alternativa kirurškemu zdravljenju zapletenih anevrizem ledvične arterije, še posebej v primerih, ko je tveganje invazivnega zdravljena visoko, tako kot pri predstavljeni bolnici z eno samo ledvico.
introduction
Renal artery aneurysms (RAA) are relatively rare occurrence in contemporary clinical practice. They have an estimated incidence from 01-1 %,i'2 although the trend for more widespread investigation of the renal arteries with noninvasive methods has in some series resulted in an incidence up to 10 %.3'4 In most cases the clinical relevance of the aneurysm is uncertain, as patients have no symptoms directly related to the aneurysm. Some patients may present with arterial hypertension, renal ischemia, hema-turia, or flank pain, but the cause-and effect relationship is hard to establish.^-® The natural history of RAA is poorly documented.^'^ RAA are usually incidentally detected in patients during various diagnostic procedures. Although rupture is not common, the risk of RAA rupture is significantly increased in pregnancy and polyarteritis nodosa (PAN) and is also related to the aneurysm size.®'^ The accepted indications for RAA treatment include symptomatic patients, women who are pregnant, or those contemplating pregnancy, PAN, and enlarging lesions.^'®'® Most physicians would advocate invasive treatment when the aneurysm is larger than 2 cm or causing renal compromise.^'^ Treatment of RAA involves surgical repair and endovascular techniques, depending on the size of RAA, morphologic characteristics of aneurysm and its location along the renal artery.4-7 Endovascular treatment of renal
artery aneurysms was initially introduced for patients at a high risk with significant comorbidities or aneurysms of parenchymal branches with difficult surgical access. Yet, the high technical success with low procedural morbidity and mortality rates has made this approach the treatment of choice for most RAA in many centers. i"'" However, for complex RAA located at the renal artery bifurcation, and for those involving distal branches, open surgical repair by in situ or ex vivo repair respectively, was suggested to be the gold standard of treatment.^'®'®'!^ But a new type of multilayer self-expanding stent technology has been developed that may offer an endovascular alternative in complex RAA where stent-grafts or em-bolotherapy could not be applied.^^ Stent--grafts are contraindicated when large branches must be covered, such as in our patient. The fluid modulating multilayer stent is a new technology that allows treatment of RAA without the risk of branch occlusion or renal infarction.^^
Case presentation
A 56-year old woman was referred from another hospital. Her right kidney had been removed because of renal carcinoma five years before. During regular follow-up examination with ultrasound a large left renal artery aneurysm was detected. Ultrasound showed slightly enlarged left kidney with normal shape, no signs of hydronephrosis
Figure 1: 3D CTA
reconstruction of the abdominal aorta and Left renaL artery before endovascuLar treatment. The right renaL artery is absent after removaL of the right kidney years ago because of renaL ceLL carcinoma. Arrow is denoting the aneurysm of the Left renaL artery.
and normal echotexture. Interlobar artery resistance index was below 0.7. On admission, the patient was asymptomatic. She was taking medications for high blood pressure for five years (angiotensin-converting enzyme inhibitor ramipril and diuretic hydro-chlorothiazide). Her average blood pressure during hospital stay before invasive treatment was 160/100 mmHg. Her serum urea and creatinine levels were normal. Her glo-merular filtration rate calculated by MDRD equation was 71 ml/min.^^ The urine test showed no blood, protein or bacteria in her urine. CTA examination confirmed a large saccular aneurysm of the left hilum of the kidney (Fig. 1). On digital subtraction angiography the aneurysm measured 2.3 x 2.7 cm (Fig. 2). Three large terminal branches were involved in the aneurysm, which precluded the use of stent-graft or coils (Fig. 1 and 2). Surgical procedure was considered to be associated with high risks due to adhesions from the previous surgery. The option of an endovascular procedure with a new stent was explained to the patient, who con-
sented to the procedure. Three days prior to procedure the patient started taking clopi-dogrel (75 mg/dl).
Under local anesthesia, the right common femoral artery was catheterized and 5000 units of heparin were given intra-ar-terially. The left renal artery was selectively catheterized with a 7čF RDC guiding catheter (Cordis, Warren, NJ, USA). An angio-gram confirmed the size and location of the aneurysm. A stiff 0.018-inch guidewire (Boston Scientific, Natick, MA, USA) was placed in the left renal artery. Over this wire, a 6x30 mm Multilayer stent (Cardiatis, Isnes, Belgium) protected by a 6-F delivery catheter was advanced and easily deployed across the neck of aneurysm, covering the main renal artery trunk and medium renal artery. All the branches remained intact (Fig. 3). The patient was discharged the next day with instruction to continue taking clopido-grel for 1 month and the acetylsalicylic acid indefinitely. At discharge, the patient's renal function was normal. Her glomerular filtration rate calculated by MDRD equation was
Figure 2: Digital subtraction angiography of the left renal artery. renal artery aneurysm measures 22 x 26 mm along its long axes.
Figure 3: angiography immediately after new multilayer endovascular stent placement. aneurysm is excluded from the blood flow and all distal branches are patent.
83 ml/min. The urine test showed no blood, protein or bacteria in her urine.
After one month, the control CTA showed shrinkage of the aneurysmal sac. All major renal artery branches remained patent (Fig. 4). The patient remained in excellent condition, with normal blood pressure (130/60 mmHg) and renal function and no anthypertensive medication.
Discussion
There is controversy regarding the indications for repair of RAA, but may include risk of rupture, rapid growth, hypertension, hematuria, dissection and symptomatic disease.4'5'8-11 Our patient met multiple indications for repair of her renal artery ane-urysm. She was hypertonic and it was considered that there was a significant risk for rupture. Primarily, the patient was left with only one viable kidney and the diameter of
aneurysm exceeded two centimeters. The risk of loosing the remaining kidney due to rupture of RAA could not be neglected. The second indication for repair was blood pressure control.5 Henke and coworkers suggested that patients who had successful repair of aneurysm had improved blood pressure control compared to controls.
For complex RAA located at the renal artery bifurcation, such as in our patient, and for those involving distal branches, open surgical repair by in situ or ex vivo repair respectively, was suggested to be the gold standard of treatment.5'8'9 However, the open surgical approach for complex RAA is associated with extensive invasiveness and morbidity due to major intra-abdomi-nal surgery.5 In complex lesions, intentional nephrectomy occurs in up to 20 "/o of cases and unplanned nephrectomy in 5 % of cases.® In an effort to reduce invasiveness and morbidity associated with open surgical RAA repair, the laparoscopic and robot-assisted laparoscopic approach has been proposed as a possible alternative.8 Minimally invasive robot-assisted laparoscopic surgery has been applied recently in the field of vascular surgery to reduce operative trauma and to improve the technical limitations of classic laparoscopy.8 However, even with robotic system the total operation time with patient under general anesthesia exceeds 300 minutes and during the procedure surgeon is not able to work without total warm renal ischemia thus increasing the risk of procedure.8
Among endovascular techniques, stents represent a possible alternative to surgical repair of visceral aneurysms because they allow for organ flow preservation with minimal tissue trauma and warm ischemia time.4'10'11 The current use of stents was restricted to RAA involving the main renal artery trunk, with edges located at least 15 mm away from the renal bifurcation and renal ostium.4'10'11'15 Stent-grafts, selective coil embolization, stent-assisted coiling or use of liquid embolic agents are contraindicated when large branches are involved in aneuri-smal sac, such as in our patient.^'i"'"
The recent advent of a new type of stent offered a potential endovascular alternative to manage RAA involving one or more
Figure 4: 3D CTA one
month after multilayer stent placement. There is no blood leakage into the aneurismal sac and all renal branches are patent.
branching vessels.^^ The fluid modulating multilayer stent has been available in Europe since 2006, and the first successful use in humans was reported for popliteal ane-urysm in 2007.1® The main advantage of three dimensional multilayer stent is that it reduces flow velocity and vortex into the sac, while improving laminar flow in the main artery and the surrounding vital branches. Without collateral branch, the multilayer stent eliminates the damaging flow vortex pressure and redirects its flow along the wall in the same directions as the systemic pressure leading to a physiological organized thrombus. If there is collateral branch, the multilayer stent laminates the flow in the aneurysm and the branch, directs the flow to the branch, and thus increased flow in the branch leads to a progressive collapse of the aneurismal wall. One of the major advantages of the multilayer stent is suggested to be its effect on collateral branches. Placed in front of collateral branches, a multilayer stent laminates the flow in these collaterals and improves the inflow into collateral circulation, keeping different size collateral arteries patent. All of these characteristics may help to reduce the shear stress on the
diseased arterial wall and increase the formation of an organized thrombus in aneu-rismal sac.i^'i®
Tests on animals have shown a significant difference in the flow to collaterals before and after implanting a multilayer stent. Better flow circulation in the branches was observed after a multilayer stent had been placed. All explants after one month showed that flow in the collaterals was maintained regardless of the size of the branch. This sustained permeability is associated with the fact that the multilayer stent, unlike classical stents, becomes lined with endothelium except in the area of collaterals.i^
To date only few cases of renal or visceral aneurysms treated with this new stent have been reported. Henry and coworkers first reported successful exclusion of a large renal artery aneurysm and also suggested its application for peripheral aneurysms.i^ Bal-dieri and coworkers excluded a large hepatic aneurysm and Carrafiello and coworkers successfully treated a patient with celiac trunk aneurysm.16'17
To date Henry and coworkers have treated more than 32 patients with new multilayer stent.i8 There were no short- and medium-term complications. In 30-month follow up all the side branches remained patent. All aneurysms thrombosed with diameter reduction in some patients.^®
Conclusion
A new concept of stent, the multilayer stent without any covering was developed to treat aneurysms. First midterm results show that this new technology could be a very useful and attractive alternative to surgery or other endovascular techniques for those RAA involving or situated very close to major branch vessels, especially in patients with very high risk of loosing the only viable kidney, as in our case.
Conflict of interests
Michel Henry is consultant for Cardiatis, producer of new multilayer stents. The other authors have no commercial, proprietary, or financial interest in any products connected with Cardiatis.
Literature
1.	Stanley JC, Rhodes RL, Gewertz BL, Chang CY, Walter JF, Fry WJ. Renal artery aneurysms, significance of microaneurysms exclusive of dissections and fibrodysplastic mural dilatations. Arch Surg 1975; 110: 1327-33.
2.	Henriksson C, Bjorkerud S, Nilson AE, Pettersen S. Natural history of renal artery aneurysm elucidated by repeated angiography and pathoanato-mic studies. Eur Urol 1985; 11: 244-8.
3.	Browne RF, Riordan EO, Roberts JA, Ridgway JP, Woodrow G, Gough M, et al. Renal artery aneurysms: diagnosis and surveillance with 3D contrast-enhanced magnetic resonance angiography. Eur J Radiol 2004; 14: 1807-12.
4.	Abath C, Andrade G, Cavalcani D, Brito N, Marques R. Complex renal artery aneurysm: liquids or coils? Tech Vasc Interv Radiol 2007; 10:
299-307.
5.	Henke PK, Cardneau JD, Welling 3rd TH, Upc-hurch Jr GR, Wakefield TW, Jacobs LA, et al. Renal artery aneurysms: a 35 years clinical experience with 252 aneurysms in 168 patients. Ann Surg
2001; 234: 454-62.
6.	Ufberg JW, McNeil B, Swisher L. Ruptured renal artery aneurysm: an uncommon cause of acute abdominal pain. J Emerg Med 2003; 25: 35-8.
7.	Soliman KB, Shawky Y, Abbas MM et al. Ruptured renal artery aneurysm during pregnancy, a clinical dilemma. BMC Urolog 2006; 31; 6-22.
8.	Giulianotti PC, Bianco FM, Addeo P, Lombardi A, Coratti A, Sbrana F. Robot-assisted laparoscopic repair of renal artery aneurysms. J Vasc Surg 2010;
51: 842-9.
9.	English WP, Pearce JD, Craven TE, Wilson DB, Edwards MS, Ayerdi J et al. Surgical management of renal artery aneurysms. J Vasc Surg 2004; 40:
53-60.
10.	Etezadi V, Gandhi TR, Benenati JF, Rochon P, Gordon M, Benenati MJ, et al. Endovascular treatment of visceral and renal artery aneurysms. J Vasc Interv Radiol 2011; 22: 1246-1253.
11.	Chimpiri AR, Natarajan B. Renal vascular lesions: diagnosis and endovascular management. Semin Intervent Radiol 2009; 26: 253-261.
12.	Flis V, Štirn B, Breznik S. Anevrizma ledvične ar-terije-kratko poročilo. Med Mes 2005; 1: 11-14.
13.	Henry M, Polydorou A, Frid N, Gruffaz P, Cavet A, Herny I, et al. Treatment of renal artery ane-urysm with the multilayer stent. J Endovasc Ther 2008; 15: 231-236.
14.	Stoves J, Lindley EJ, Barnfield MC, Burniston MT, Newstead CG. MDRD equation estimates of glo-merular filtration rate in potential kidney donors and renal transplant recipients with impaired graft function. Nephrol Dial Transplant 2002; 17: 2036-7.
15.	Lederman RJ, Mendelsohn FO, Santos R, Phlips HR, Stack RS, Crowley JJ. Primary renal artery stenting: characteristics and outcomes after 363 procedures. Am Heart J 2001; 142: 314-23.
16.	Carrafiello G, Rivolta N, Annoni M, Fontana F, Piffaretti G. Endovascular repair opf celiac trunk aneurysm with a new multilayer stent. J Vasc Surg 2011; 54: 1148-50.
17.	Balderi A, Antonietti A, Pedrazzini F, Ferro L, Le-otta L, Peano E, et al. Treatment of hepatic artery aneurysm by endovascular exclusion using the multilayer Cardiatis stent. Cardiovasc Interv Ra-diol 2010: 33; 1282-6.
18.	Henry M, Benjelloun A, Henry I. New developments in endovascular technologies. In: Pore-doš P, Ježovnik KM eds. 20th European chapter congress of the international union of angiology. Book of abstracts; 2011 Oct 6-8; Ljubljana, Slovenija. Ljubljana: Slovene medical association; 2011.
in memoriam
prim. Marjan Veber, dr. med.
(1924-2012)
V aprilu 2012 je primarij Marjan Veber, dr. med., specialist šolske higiene dopolnil 88 let. V avgustu 2012, v času šolskih počitnic, pa je ugasnilo življenje enega prvih šolskih zdravnikov v Sloveniji.
Rojen je bil v Celju, kjer je tudi zaključil osnovno šolo in gimnazijo. Druga svetovna vojna je za nekaj časa prekinila primarijevo študijsko pot. Po končani vojni leta 1945 se je vpisal na Medicinsko fakulteto v Ljubljani in jo leta 1951 zaključil.
Kot zdravnik ja začel službeno pot v bolnišnici Celje na internem oddelku in na pe-diatriji. Od leta 1953 dalje pa je svoje delo, znanje in izkušnje posvetil šolskim otrokom in mladostnikom. Mnogo let kasneje je večkrat v pogovorih poudaril, da se nikoli ne bi odločil kako drugače kot za pot šolskega zdravnika.
Od vsega začetka svojega dela kot šolski zdravnik je sodeloval s Službo za zdravstveno varstvo šolskih otrok in mladine na Republiškem zavodu za zdravstveno varstvo (sedanjem Inštitutu za varovanje zdravja RS). Bil je dejaven član Republiškega strokovnega kolegija za šolsko medicino od njegove ustanovitve. Aktivno je sodeloval na kongresih, tudi na 1. slovenskem kongresu sekcije za šolsko in visokošolsko medicino leta 1994, na strokovnih srečanjih Sekcije za šolsko in visokošolsko medicine pri SZD.
Vedno je imel vodilno vlogo na področju zdravstvenega varstva otrok in mladostnikov na celjskem področju. Uvedel je preventivne ambulante. V okvirju Dispanzerja za šolske otroke je vpeljal okulistično, ORL, ortopedsko in zobozdravstveno ambulanto. V tem obdobju so otroci in mladostniki imeli takojšen dostop do ustreznega zdravljenja pri specialistih. To dejstvo je vedno rad zapisal v svoja poročila in članke. Uvedel je sistematične preglede učencev šol v takratnem celjskem okraju. Vpeljal je terapevtsko telovadbo za otroke s težjimi anomalijami telesne drže in okvarami hrbtenice in telovadbo za astmatike. Prevzel je naloge sanitarne inšpekcije za šolsko higieno.
V svoji ambulanti je kar nekaj časa posvetil zdravljenju nočne enureze pri šolarjih.
Na celjskem je imel predavanja za starše, učitelje in zdravstvene delavce.
Leta 1988 je dobil naziv primarij. V starosti 65 let se je upokojil. Stik s šolarji in mladostniki pa je ohranil še dolgo po sedemdesetem letu starosti. Njegov moto je bil, da lahko vsak sam največ naredi za svoje zdravje. Ni videl ozdravitve samo v medika-mentnem zdravljenju, ampak predvsem v umirjenem, zdravem načinu življenja. Vo-lontersko je vodil avtogene treninge za posamezne starostne skupine šolajočih se otrok v našem dispanzerju. Tako je ohranjal stik z nami. V zdravljenju psihosomatskih stanj in bolezni je videl uspeh šolske medicine.
Ostajajo lepi spomini na čase, ko je kot predstojnik dispanzerja in kasneje kot mentor številnim otrokom in mladostnikom pri avtogenem treningu vedno z žarom in zaupanjem v šolsko medicino orisal čar in pomen tega dela.
Naj zaključim z njegovimi besedami, ki jih je zapisal v Zdravstvenem vestniku ob 70-letnici šolske zdravstvene službe v Celju: »Kljub vsemu obstaja upanje, da navdaja pristojne zavest, da so otroci naše bogastvo in narodova perspektiva. Če je tako, potem lahko mirno zremo v prihodnost.«
Ksenija Goste, dr. med., spec. šolske medicine vodja šolskega dispanzerja v ZD Celje in tajnica Sekcije za šolsko in visokošolsko medicino pri SZD
asis. dr. Mojca Juričič, dr. med., spec. šolske medicine in spec. higiene predsednica Sekcije za šolsko in visokošolsko medicino pri SZD