We report a case of chronic total occlusion of the aorta with critical limb ischemia (CLI) of the lower limbs due to chronic total occlusion (CTO) of infrarenal aorta and extensive bilateral iliac disease. This case was treated by open surgical revascularization, after unsuccessful attempt of percutaneous endovascular stenting treatment. *Correspondence to: Dragan Piljic, M.D., Ph.D, Department of Cardiovascular Surgery, University Clinical Center Tuzla, Bosnia and Herzegovina, Tel: +38735303202; E-mail: dragan.piljic@dr.com Received: November 11, 2019; Accepted: November 25, 2019; Published: November 28, 2019 Case presentation A 46-year-old male, with a history of hypertension and peripheral vascular disease (including previous unsuccessful attempt endovascular stenting) was referred to our hospital for conventional open surgical treatment. The patient underwent a computed tomographic angiography, which showed complete occlusion of the infrarenal abdominal aorta, as well as both common and external iliac artery (Figure 1). He was a heavy smoker (60 cigarettes/day) and had an untreated hyperlipidemia. The operation was performed using the transperitoneal approach with limited thrombectomy through infrarenal aortotomy without transecting the aorta. The patient underwent aortic bifemoral revascularisation, with placement of a Dacron bifurcation graft of 12/6 mm. The Piljic – method was used (restricted intraoperative and postoperative fluid regime and mini-laparotomy, including surgical approach trough 8 to 10 cm paraumbilical incision. The small and large bowels were retracted to the side without being elevated out of the abdominal cavity) [1]. The patient was transfered to the intensive care unit following successful surgical repair. The patient was transfered to the department of cardiovascular surgery on the postoperative day one. Uneventful postoperative recovery resulted in hospital discharge on postoperative day four. Postoperative CTA with contrast showed a neat flow (Figure 2). Patient postoperative period has been followed up for 12 months, which ended with satisfactory general clinical and local state of both legs. Discussion In patients presenting with aortoiliac occlusive disease (AIOD), the total occlusion of the infrarenal aorta has been seen in 3 to 8.5% of cases [2]. Common causes of chronic infrarenal aortic occlusion (CIAO) include: a) atherosclerotic occlusive disease; b) middle aortic syndrome; c) Takayasu arteritis; d) fibromuscular dysplasia; e) neurofibromatosis; and f) coral reef aorta [2]. Although standardized infrarenal aortobifemoral bypass (AoBFB) remains the surgical procedure of choice for CIAO, operative decisions may proceed beyond AoBFB in complicated cases. Different therapeutic strategies include axillo-(bi) femoral bypass (AxBFB), aortoiliac endarterectomy (AIE), or hybrid procedures. AxBFB grafting usually refers to patients of high risk for aortic clamping, or patients with many comorbidities that prohibit an extensive transperitoneal procedure [3]. Surgical management Figure 1. Computed tomographic angiography showed complete occlusion of the infrarenal abdominal aorta and both common and external iliac arteries. A lateral view showed collateral blood flow from internal thoracic arteries through subcutaneous epigastric abdominal vessels to the common femoral arteries Piljic D (2019) Open Surgical Revascularization of Chronic Total Occlusion of the Infrarenal Aorta Volume 3: 2-2 Health Prim Car, 2019 doi: 10.15761/HPC.1000176 can be life-saving. Use of open surgical revascularisation can result in rapid clinical recovery and lower mortality and morbidity. Informed consent The patient provided written informed consent for publication of the figures. Declaration of conflict of interest The authors declare that there is no conflict of interest. Funding This work received no specific grant from any funding agency within public, commercial, or not-fot-profit sectors. References 1. Piljic D, Petricevic M, Piljic D, Ksela J, Robic B, et al. (2015) Restrictive versus Standard Fluid Regimen in Elective Minilaparotomy Abdominal Aortic Repair— Prospective Randomized Controlled Trial. Thorac Cardiovasc Surg 64: 296-303. 2. Shah M, Patnaik S, Sinha R, Opoku-Asare I, Chaudhry K, et al. (2017) Revascularization of Chronic Total Occlusion of the Infrarenal Aorta in a Patient with Triple Vessel Disease: Report of a Case Treated by Endovascular Approach. Case Rep Cardiol 2017: 7983748. 3. Indes JE, Pfaff MJ, Farrokhyar F, Brown H, Hashim P, et al. (2013) Clinical outcomes of 5358 patients undergoing direct open bypass or endovascular treatment for aortoiliac occlusive disease: a systematic review and meta-analysis. J Endovasc Ther 20: 443455. [Crossref] 4. Illuminati G, Calio FG, Mangialardi N, Bertagni A, Vietri F, et al. (1996) Results of axillofemoral by-passes for aorto-iliac occlusive disease. Langenbecks Arch Chir 381: 212-217. 5. Mavioglu I, Veli Dogan O, Ozeren M, Dolgun A, Yucel E (2003) Surgical management of chronic total occlusion of abdominal aorta. J Cardiovasc Surg 44: 87-93. of the totally occluded abdominal aorta is highly complex. Surgical intervention is beneficial for patients with totally occluded aorta, even if ischemic complaints are relatively mild and stable [4]. We report a case of chronic total occlusion of the aorta with critical limb ischemia (CLI) of the lower limbs due to chronic total occlusion (CTO) of infrarenal aorta and extensive bilateral iliac disease. This case was treated by open surgical revascularization, after unsuccessful attempt of percutaneous endovascular stenting treatment. Conclusion Open surgical recanalization of aortic occlusion in a patient with previously unsuccessful attempt endovascular stenting is feasible and Figure 2. Postoperative CTA with contrast showed a neat flow Copyright: ©2019 Piljic D. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

: Proper inclusion of van der Waals interactions (vdW) in ab initio calculations based on the density functional theory (DFT) is crucial to describe soft, organic, layered solids such as κ -(BEDT-TTF) 2 X . Since no consensus has been reached on the reliability of available vdW DFT functionals, most of the first principles calculations have been based on experimental crystal structure data without any structural optimization. Here, we explore optimal DFT-based schemes that account for the effects of vdW interactions on the structural and electronic band properties of three paradigmatic charge transfer salts, κ -(BEDT-TTF) 2 Cu 2 (CN) 3 , κ -(BEDT-TTF) 2 Ag 2 (CN) 3 , and κ -(BEDT-TTF) 2 Cu[N(CN) 2 ]Cl, for which a unified optimization of the structure is possible. Detailed examination of the prototype test system κ -(BEDT-TTF) 2 Cu[N(CN) 2 ]Cl shows that the optB88-vdW functional performs slightly better than the PBE-vdW and that the choice of pseudopotentials is critical to obtaining realistic results.

A unique technology of direct selective flotation is in use in flotation plant of the "Rudnik" mine in order to obtain selective lead, copper and zinc concentrates. Technological process is very sensitive to so-called "selectivity" because loss of individual metals through selective concentrates is present. Copper minerals flotation cycle is especially sensitive to selectivity and sometimes there is a higher content of lead and zinc minerals present in copper concentrate which is penalized. In this paper laboratory research results of lowering galena and zinc content in copper concentrate possibility due to extended time of cleaning are shown. All experiments were carried out on copper concentrate samples taken from the "Rudnik" flotation plant. Copper concentrate mineralogical analysis were carried out before flotation experiments.

In the CERN IT agile infrastructure (AI), Puppet, the CERN IT central messaging infrastructure (MI) and the Roger application are the key constituents handling the configuration of the machines of the computer centre. The machine configuration at any given moment depends on its declared state in Roger and Puppet ensures the actual implementation of the desired configuration by running the Puppet agent on the machine at regular intervals, typically every 90 minutes. Sometimes it is preferable that the configuration change is propagated immediately to the targeted machine, ahead of the next scheduled Puppet agent run on this machine. The particular need of handling notifications in a highly scalable manner for a large scale infrastructure has been satisfied with the implementation of the CERNMegabus architecture, based on the ActiveMQ messaging system. The design and implementation of the CERN-Megabus architecture are introduced, followed by the implementation of the Roger notification workflow. The choice of ActiveMQ is analysed and the message flow between the Roger notification producer and the CASTOR, EOS, BATCH and Load Balancing consumers are presented. The employment of predefined consumer modules in order to speed up the on-boarding of new CERN-Megabus use cases is also described.