Whether exercises and testosterone replacement therapy support a treatment for cardiovascular and atherosclerotic patients with iliac artery stenosis and low total testosterone and high-density lipoprotein cholesterol after endovascular procedure?

Serum levels of testosterone (ST) and high-density lipoprotein (HDL) are generally associated with atherosclerosis in male patients over 50 years with critic iliac stenosis (TASC II A and B) and cardiovascular disease with significant changes in HDL and low-density lipoprotein (LDL). In addition to the standard therapy, combined medicamentous therapy and adequate model of exercise are also important factors as medicines can improve HDL levels and primary bypass and endovascular potency impacting positively on improvement of ST or it can be the following testosterone replacement therapy (TRT) comprising cardiovascular disease prevention and vascular treatment as adjunct therapy options after endovascular and vascular surgical procedures. The aim of the study is to identify the association between HDL and ST after surgical and endovascular intervention on the iliac segment (TASCII A and B), as well as cardiovascular risk factors with modified medium activity (MET) 6 (MET), with total duration of 30–60 minutes. It also attempts to remodel a patient behavioral pattern, optimize ST levels and link them to outcomes and patency of vascular procedures on the iliac segment. Materials and methods. 108 selected male patients with cardiovascular disease combined with metabolic syndrome and critical iliac artery stenosis (TASC II A and B) were examined during 2014–2018, 4 years after invasive and minimal invasive treatment (54 patients were treated with surgical Dacron reconstruction and 54 patients – with endovascular treatment on short segment of critical iliac artery stenosis (TASC II A and B). Results. In the total population, no difference was observed in changes of constraint-induced movement therapy between the standard exercise group and the control one after 4 years from baseline. However, there was no significant interaction between the effect of exercise trainings and primary bypass potency within 4 years. Conclusions. Primary effects of endovascular procedure and Dacron bypass revascularization raise the risk of elevated testosterone levels after 4 years of group training but does not provide adequate answers to questions as to whether higher levels of ST have any major influence on primary bypass potency preventing further progression of cardiovascular disease and general symptomatic and asymptomatic atherosclerosis. However, exercise and TRT can be potential adjunctive therapeutic options for a future supporting postsurgical and endovascular illiac treatment in cardiovascular patients with low testosterone levels

Femoro-Popliteal Bypass Above Knee with Saphenous Vein vs Synthetic Graft

There is still debate whether sintethic graft (polytetrafluoroethylene or Dacron) is equivalent to vein as bypass graft material for the above-knee femoropopliteal bypass. Therefore, we performed prospective randomized trial to compare vein with polytetrafluoroethylene/dacron for femoropopliteal bypasses with the distal anastomosis above the knee. Between January 2000 and June 2003, 121 femoropopliteal bypasses were performed. The indications for operation were severe claudication in 96 cases, rest pain in 16 cases, and ulceration in 9 cases. After randomization, 60 reversed saphenous venous bypasses and 61 polytetrafluoroethylene/ dacron bypasses were performed. No perioperative mortality was seen, and 5% of the patients had minor infections of the wound, not resulting in loss of the bypass, the limb, or life. After 5 years, 37% of the patients had died and 7% were lost to follow-up. Only once saphenous vein was necessary for coronary artery bypass grafting. Primary patency rates after 5 years were 76,6% for venous bypass grafts and 59,1% for polytetrafluoroethylene/dacron grafts (p=0,035). Secondary patency rates were 83,3% for vein and 69,2% for polytetrafluoroethylene/dacron bypasses (p = 0,036). In the venous group, 10 bypasses failed, leading to four new bypasses. In the polytetrafluoroethylene group, 22 bypasses failed, leading to 12 reinterventions. After 5 years of follow-up, we conclude that a bypass with saphenous vein has better patency rates at all intervals and needs fewer reoperations. Saphenous vein should be the graft material of choice for above-knee femoropopliteal bypasses and should not be preserved for reinterventions. Polytetrafluoroethylene/dacron is an acceptable alternative if the saphenous vein is not available

Comparative Study of Operative Tretmant of Varicose Veins According to The Klapp and Smetana Method Versus Myers Method

Venous abnormalities in lower extremities are among the most frequent disorders that affects general population with significant morbidity and mortality. Usually, the problem consists of a mild form of varicose veins and teleangiectasis. Treatment in this stage of disease is highly recommended since progression can lead to chronic venous insufficiency and chronic disability with very few effective treatment options. The most effective and popular treatment of varicose veins is operative treatment; specifically two different operative procedures: method according to Myers and method according to Klapp and Smetana. We designed this study in order to determine which method is superior based on clinical parameters and patients satisfaction. Our evidence strongly support clinical superiority, as well as patient satisfaction, of Klapp and Smetana method

Femoro-Popliteal Bypass Above Knee with Saphenous Vein vs Synthetic Graft

There is still debate whether sintethic graft (polytetrafluoroethylene or Dacron) is equivalent to vein as bypass graft material for the above-knee femoropopliteal bypass. Therefore, we performed prospective randomized trial to compare vein with polytetrafluoroethylene/dacron for femoropopliteal bypasses with the distal anastomosis above the knee. Between January 2000 and June 2003, 121 femoropopliteal bypasses were performed. The indications for operation were severe claudication in 96 cases, rest pain in 16 cases, and ulceration in 9 cases. After randomization, 60 reversed saphenous venous bypasses and 61 polytetrafluoroethylene/ dacron bypasses were performed. No perioperative mortality was seen, and 5% of the patients had minor infections of the wound, not resulting in loss of the bypass, the limb, or life. After 5 years, 37% of the patients had died and 7% were lost to follow-up. Only once saphenous vein was necessary for coronary artery bypass grafting. Primary patency rates after 5 years were 76,6% for venous bypass grafts and 59,1% for polytetrafluoroethylene/dacron grafts (p=0,035). Secondary patency rates were 83,3% for vein and 69,2% for polytetrafluoroethylene/dacron bypasses (p = 0,036). In the venous group, 10 bypasses failed, leading to four new bypasses. In the polytetrafluoroethylene group, 22 bypasses failed, leading to 12 reinterventions. After 5 years of follow-up, we conclude that a bypass with saphenous vein has better patency rates at all intervals and needs fewer reoperations. Saphenous vein should be the graft material of choice for above-knee femoropopliteal bypasses and should not be preserved for reinterventions. Polytetrafluoroethylene/dacron is an acceptable alternative if the saphenous vein is not available

Outcome Comparison of Two Surgical Methods Used for the Treatment of Acute Thrombosis of Arteriovenous Fistulas: Thrombectomy Versus De Novo Creation of Arteriovenous Fistula

The aim of this study was to evaluate efficacy of two surgical methods used for the treatment of acute arteriovenous fistula (AVF) thrombosis. Twenty two out of twenty five patients that were admitted at the Clinic for vascular surgery in Sarajevo received successful surgical treatment for the salvage of acutely thromboses AVF from 2007-2009. They were included in retrospective, descriptive clinical study. Based on the type of surgical procedures performed, 22 patients were divided into two groups. The first group included 10 patients and they had successful thrombectomy of thromboses AVF while 12 patients in second group underwent de novo creation of AVF using blood vessels already exploited for construction of thromboses AVF. Patency rate of salvaged AVF in analyzed groups was compared one month and 6 months after intervention. In the postoperative follow up there was no statistically significant difference in patency rate of salvaged AVF between analyzed groups after one month, (80% vs 100%, Fisher exact test value =2,520, p= 0,195). Patency rate of salvaged AVF after six months of the follow up was significantly better in group that received de novo construction of AVF when compared to thrombectomy group (25% vs. 91%, Fisher exact test value = 1,062, p=0,002). De novo construction of AVF in case of acutely thrombosed AVF offered better patency rate of salvaged AVF when compared to surgical thrombectomy in the follow up period of six months

Outcome Comparison of Two Surgical Methods Used for the Treatment of Acute Thrombosis of Arteriovenous Fistulas: Thrombectomy Versus De Novo Creation of Arteriovenous Fistula

The aim of this study was to evaluate efficacy of two surgical methods used for the treatment of acute arteriovenous fistula (AVF) thrombosis. Twenty two out of twenty five patients that were admitted at the Clinic for vascular surgery in Sarajevo received successful surgical treatment for the salvage of acutely thromboses AVF from 2007-2009. They were included in retrospective, descriptive clinical study. Based on the type of surgical procedures performed, 22 patients were divided into two groups. The first group included 10 patients and they had successful thrombectomy of thromboses AVF while 12 patients in second group underwent de novo creation of AVF using blood vessels already exploited for construction of thromboses AVF. Patency rate of salvaged AVF in analyzed groups was compared one month and 6 months after intervention. In the postoperative follow up there was no statistically significant difference in patency rate of salvaged AVF between analyzed groups after one month, (80% vs 100%, Fisher exact test value =2,520, p= 0,195). Patency rate of salvaged AVF after six months of the follow up was significantly better in group that received de novo construction of AVF when compared to thrombectomy group (25% vs. 91%, Fisher exact test value = 1,062, p=0,002). De novo construction of AVF in case of acutely thrombosed AVF offered better patency rate of salvaged AVF when compared to surgical thrombectomy in the follow up period of six months

Дія тривалих тренувань помірної інтенсивності на мікроциркуляторні порушення та товщину інтима-медіа сонної артерії в пацієнтів після ендоваскулярного та класичного шунтування

 Research on moderate-intensity continuous training (MICT) is closely connected with primary and secondary cardiovascular protection but also can be associated with primary bypass patency and outcome of endovascular treatment for critical iliac stenosis TASC II A and B. After specific surgical or non-surgical treatment, iliac bypass or endovascular revascularization patency still depends on an individual and is still in the eye of scientific research modalities. Carotid intima-media thickness (CIMT) is an efficient surrogate parameter in detection and prediction of cerebrovascular events and potential marker of generalized atherosclerosis with prognosis of peripheral arterial disease related to prognosis of atherosclerotic coronary hemodynamic pathology.Materials and methods. A total of 139 patients were observed during 4 years of MICT. Ultrasonography of the distal part of the common carotid artery (CCA) was performed to measure CIMT before and after revascularization procedure. The bypass patency and walking distance was also studied.Results. In the total population, no difference in changes of CIMT from baseline was observed between the standard exercise group and controls in 4 years. However, there was a significant correlation between the effect of exercise training and CIMT within 4 years. CIMT was not significantly reduced in the exercise group compared with control non-diabetic patients.Conclusions. Exercise training in both groups did not significantly change carotid intima-media thickness in the four years following endovascular procedure and Dacron bypass revascularization, but significant beneficial effect of moderate-intensity continuous training on bypass patency was observed in patients with mild or without claudication symptoms as well as on subjective and objective health status. Научное исследование продолжительных тренировок умеренной интенсивности коррелирует с первичной и вторичной сердечно-сосудистой терапией, но и связано с исходом первичного обходного шунтирования и лечения эндоваскулярного подвздошного стеноза TASC II A и B. После специфического хирургического и нехирургического лечения результаты шунтирования или эндоваскулярной подвздошной реваскуляризации все еще зависят от пациента, и данные показатели актуальны для медицинских исследований. Толщина интима-медиа сонной артерии – эффективный замещающий параметр в определении и предупреждении инсульта, а также потенциальный маркер рассеянного атеросклероза с прогнозом поражения периферических артерий в связи с прогнозом коронарной атеросклеротической гемодинамической патологии.Материалы и методы. На протяжении 4 лет исследовали 139 пациентов во время длительных тренировок умеренной интенсивности. Проведена ультрасонография дальней части общей сонной артерии для измерения толщины интима медиа сонной артерии до и после реваскуляризации. Также определили проходимость шунта и дистанцию безболевой ходьбы.Результаты. У всех обследованных не наблюдали отличия в изменении толщины интима-медиа сонной артерии между стандартной и контрольной группами на протяжении 4 лет. Однако отмечена значительная взаимосвязь между действием тренировок и толщиной интима-медиа сонной артерии на протяжении 4 лет. Показатели толщины интима медиа сонной артерии незначительно уменьшились в базовой группе по сравнению с контрольной (у пациентов без диабета).Выводы. На протяжении 4 лет после эндоваскулярной процедуры и реваскуляризации дакроновым протезом тренировки, проводимые в обеих группах, незначительно изменили развитие показателя толщины интима-медиа сонной артерии, но наблюдали значительное позитивное действие продолжительных тренировок умеренной интенсивности на проходимость шунта с незначительными симптомами микроциркуляторных нарушений или их отсутствием в субъективном или объективном статусе пациента. Наукове дослідження тривалих тренувань помірної інтенсивності корелює з первинною та вторинною серцево-судинною терапією, але також пов’язане з результатом первинного обхідного шунтування та лікування ендоваскулярного здухвинного стенозу TASC II A та B. Після специфічного хірургічного та нехірургічного лікування результати шунтування або ендоваскулярної клубової реваскуляризації все ще залежать від пацієнта, і ці показники актуальні для медичних досліджень. Товщина інтима-медіа сонної артерії – ефективний заміщальний параметр у визначенні та запобіганні інсульту, а також потенційний маркер розсіяного атеросклерозу з прогнозом ураження периферичних артерій у зв’язку з прогнозом коронарної атеросклеротичної гемодинамічної патології.Матеріали та методи. Протягом 4 років дослідили 139 пацієнтів під час тривалих тренувань помірної інтенсивності. Виконали ультрасонографію дальньої частини загальної сонної артерії для вимірювання товщини інтима-медіа сонної артерії до та після реваскуляризації. Визначили прохідність шунта та дистанцію безбольової ходьби.Результати. У всіх осіб, яких дослідили, не спостерігали відмінності за зміною товщини інтима-медіа сонної артерії між стандартною та контрольною групами протягом 4 років. Однак виявили значущий взаємозв’язок між дією тренувань і товщиною інтима-медіа сонної артерії протягом 4 років. Показники товщини інтима-медіа сонної артерії несуттєво зменшилися в базовій групі порівняно з контрольною (в пацієнтів без діабету).Висновки. Протягом 4 років після ендоваскулярної процедури та реваскуляризації дакроновим протезом тренування, що відбувалися в обох групах, несуттєво змінили розвиток показника товщини інтима-медіа сонної артерії, але спостерігали значущу позитивну дію тривалих тренувань помірної інтенсивності на прохідність шунта з незначними симптомами мікроциркуляторних порушень або їхньою відсутністю в суб’єктивному чи об’єктивному статусі пацієнта.