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 with short interval increase over >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.

concept and and/or assembly of data; data analysis and interpretation; 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.

Background: Some of main raisons for the elderly graft occlusion after successful aortal-iliac, aortal Femoral and Femoral Distal Vein Bypass, progression of main disease, continuing bad life Habits and uncontrolled risk factors such are mostly: poor nutrition traditional or fast food, Smocking and Lacks of Walking and Physical Activity Habits. Objective: The primary objective of the study was to estimate influence of Interval Walking Training Program combine with Tribulus Terrestris, 3-5 gram of Taurine and high dose of 1800mg supplementation of ALA on primary potency and vascular treatment. Secondary goals of this study is determinate by establishing better understanding connection between ordinary vascular walking therapy 30-45 min and interval walking program combine with Tribulus Terrestris, Taurine and high dose of and ALA as secondary supplementation after surgical and endovascular treatment. Methodology: The study included 112 patients, at the Clinic of cardiovascular surgery, Clinical Center University of Sarajevo, age between 50 and 75 (50 patients surgical treated with aortic-iliac, aortic-femoral and femoral distal vein bypass with and without Linton-patch/Taylor patch-first group) and (62 endovascular Iliac treated patients (indication TASC II A and B) with and without support Tribulus Terrestris, high dose of ALA and Taurine - second group). Results: Final analysis has reveal the rehabilitation outcome in 83% patients with bypass above the knee was fully rehabilitated compared to 46,6% patients with bypass below the knee was statistically considered significant by using p value less than (p<0,05) In anamnestic history in 83% patient with amputation above the knee was documented the presence of hypertension, hyperlipidemia, nicotinismus and diabetes compared to 66,7% of patients with amputation level below the knee but there was no statistically significant difference (p>0,05). Conclusion: Interval Walking Training Program on Tribulus Terrestris, Taurine and high dose of ALA had a significantly and successfully higher bypass potency and rehabilitation prognosis compare to patients without supplementation and postsurgical physical therapy concept. It is obviously the is certain link between physical activity, life style modification and serum testosterone on primary bypass potency.

Aim: The aim of the applicative study was to estimate the increasing capability of claudications distance in Fontaine's stage IIa patients of Peripheral artery disease (PAD) with Body Mass Index (BMI) 25-34,9 kg/m2 and Ankle Brachial Index (ABI) 0,8-0,9 by comparing Stationary Bike on High Dose of Alpha-Lipoic Acid (ALA) versus Treadmill wallking program on standard Dose of Alpha-Lipoic Acid (ALA) in Exercise Therapy with life style modification. Patients and methods: This study was conducted from beginning of May, 2017 till end of May, 2018 at the Clinic for Cardiovascular Surgery Clinical Center and Department for vascular and endovascular surgery, University of Sarajevo, Special Hospital dr. Solakovic, Sarajevo and Faculty of Sport and Physical Education, University of Sarajevo. In the study included 60 male patients, age 40-55 with Peripheral Artery Disease (Ankle Brachial Index/ABI) 0,8-0,9, and Body Mass Index (BMI) 25 to 34,9 kg/m2 (30 non surgical traetment patients on standard Treadmill wallking program (control group) and research group consisting of 30 non surgical treatment patients on Stationary Bike), in stadium IIa of peripheral artery disease, with manifestation of mild claudication simptoms. For the testing of statistical significance of differences between the examinated groups parametric tests were used. The difference at a level of (p Results: Analysis shows the no statistically significantdifference between on claudication distance inStationary Bike grupsand impellers standard Treadmill wallking group (p>0,05). Conclusion: Stationary Bike Interval Training can be alternative vascular Therapy and has his on benefits but he can notentirely replace Treadmill Therapy in Patients with Peripheral Artery Disease with BMI 25-34.9kg/m2. Treadmill Rehabilitation Therapy still remain generally main strategy of the therapeutic effect on enhancement of claudication distance (Fontaine's stage II) of peripheral artery disease.

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.

AIM To assess efficacy of surgical and medical (conservative) treatment of acute exacerbation of chronic extremity ischemia by evaluating their early therapeutic outcomes in terms of mortality, extremity amputation and reamputation rate, limb salvage rate and length of hospitalization period. PATIENTS AND METHODS Patients were divided into two groups based on method used for the treatment of critical ischemia. Group A consisted of 40 patients that were subjected to surgical treatment of critical extremity ischemia during period 2004-2009. All patients were subjected to thrombectomy in local anesthesia (2% lidocaine) as initial step of treatment protocol. Urgent Seldinger angiography was performed for all patients that have undergone thrombectomy regardless of successfulness of thrombectomy. Based on angiography findings decision was made about further definitive treatment. It consisted of either using antiaggregating drugs (acetyl salicylic acid; 150 mg/day) if no significant postthrombectomy stenotic lesion was found or subjecting patients to further surgical revascularization in the form of bypass were significant stenosis or occlusion was identified. Group B consisted of 40 patients; all of them received conventional heparin anticoagulation therapy supplemented with vasoactive infusion treatment (Pentoxyohylline 300 mg/day) during period 1998-2004. On the third day of hospitalization oral anticoagulation (Sintrom) was included in the therapy protocol using dosage 2-8 mg/day in order to achieve INR 2-4, once therapeutic INR was obtained heparin was withdrawn. Study was clinical, designed as retrospective prospective and was conducted at the Clinic for vascular surgery in Sarajevo. RESULTS Mean age in group A was 66,5 years and in group B it was 65,78 years. Lenght of hospital stay in group A was 13,78 days while in group B it was 34,25 days (P value < 0,001). Limb salvage rate was 70% in group A and 17,5% in group B (P value < 0,001). In group A, nine amputations were performed (22,5%) while in group B we had to perform 38 amputations (95%), P value < 0,001. Only one reamputation was performed in group A (2,5% of patients) while in group B ten reamputations were performed (25% of patients). Mortality rate between groups was not statistically significant (P value < 0,077). CONCLUSION Surgical thrombectomy as introduction to definitive treatment of critical limb ischemia caused by atherothrombosis gives statistically superior results in comparison to conservative treatment.

Introduction: There is currently absolute increase in number of amputation being performed for peripheral vascular disease. The reasons are aging of population, high incidence of diabetes, physical inactivity, air, water and food contamination and smoking. Surgeon is required to perform amputation at lowest possible level and to ensure primary wound healing because dehiscence very often lead to reamputation on more proximal level. Beside clinical judgment as a method for determination of level of amputation, there are bunch of different methods that are currently used as objective predictors of primary amputation stump healing. We use different angiographies (DSA, CTA, and MRA). Objective of this study is to determine wheatear aforementioned angiographies are superior to clinical judgment in determination of level of amputation. Patients and methods: There were 135 patients in the study from our clinic, amputated below knee in period May 2004 – June 2007. They were separated in two groups; group of patients where clinical judgment was used in determination of the level of amputation; and group where different methods of angiography were used for determination of the level of amputation. Since we originally assumed that diabetic patients would fare a lot worse, we decided to monitor diabetics separately, also divided to groups with «clinical judgment» and angiography. All patients in the groups were matched according to age, gender and comorbidities. Results: We measured following parameters: Operative mortality, secondary wound healing, and reamputations. As shown from the study, operative mortality was the greatest in group - diabetics «clinical judgment» - 10%, and overall operative mortality was greater in groups with clinical judgment – 3.7-10%: 2-26%. Failure of primary wound healing was also more frequent in groups with clinical judgment – 30-33%: 12-13%, as well as incidence of reamputation – 18-20%: 4-5%. Discussion: Statistically significant difference in measured parameters between groups clearly indicates that angiography is reliable method for determination of the level of amputation and that it is superior to clinical judgment. Also, based on results of world studies, that were estimating reliability of other methods of determination of amputation level, we could conclude that angiography is the most reliable.

Introduction: The retroperitoneal approach for abdominal aortic and iliac reconstruction classically had been reserved for select patients with either high-risk comorbid disease or specific anatomic problems that preclude the transabdominal approach. With increasing appreciation of the physiologic, anatomic, and technical advantages of the retroperitoneal approach, the authors have expanded its use for repair of all types of aorto-iliac artery disease as well as infected aortic grafts. The objective of this article is to determine whether retroperitoneal approach for aorto-iliac surgery has greater physiologic and technical advantages than transperitoneal approach. Patients and Methods: From January 2002 to May 2006, 344 retroperitoneal aortoiliac reconstructions were performed and 2 for infected aortic grafts. On the other hand we also performed 283 transperitoneal aortic and aorto-iliac reconstructions. From total number of operated patients for aorto-iliac disease, 99 patients fulfilled criteria for entrance in the study. Beside identical operative indication (aorto-iliac disease), patients were matched according to comorbidities, age, gender, and bad habits such as smoking and alcohol abuse. Results: The mean age was 61 years with 70 men and 29 women. Overall mortality was 1% for all cases: 2% for trnasperitoneal and 0% for retroperitoneal approach. Major complications occurred in 11% of all procedures, 8% in retroperitoneal and 14% in transperitoneal approach. Over the past 4.5 years, the average length of hospital stay for uncomplicated aorto-iliac reconstructions was 5.9 days in retroperitoneal group and 6.3 days in transperitoneal group, intensive care unit stay was 1.2 days in retroperitoneal and 2.5 days in transperitoneal group, and diet was resumed by postoperative day 1 in retroperitoneal versus postoperative day 3 in transperitoneal group. Two-year graft patency was 99% for retroperitoneal and 96% for transperitoneal approach. Discussion: The retroperitoneal approach offers greater physiologic advantages than transperitoneal approach, associated with minimal disturbance of gastrointestinal and respiratory function, thereby reducing the length of intensive care unit and hospital stay.

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.

Treatment of complicated case with subclavia steal syndrome and stenosis of common iliac artery Background. The aim of this case report is to describe the realization of complex radiological minimally invasive interventional procedures at the Institute of Radiology in KCU Sarajevo during which we treated a very complicated case with the left subclavia steal syndrome and the stenosis of the left common iliac artery. Case report. The patient was 57 years old with previous history of ischemic lesions in brain, with occlusion of the left arteria carotis communis (ACC) and stenosis of the right arteria carotis interna (ACI), with dizziness and inability to look upward. The patient was treated first with subintimal recanalization and introduction of self-expandable stent into the left subclavia artery to compensate for the very wide remnant of the occluded artery. After four months of follow up with no change, our team attempted to treat stenosis of the right ACI but failed to do so and during this procedure in-stent restenosis in the left subclavia artery was noted. After less than two weeks we performed balloon dilatation of in-stent restenosis of a previously installed stent into the left subclavia artery. The patient underwent CT and CT angiography (CTA), colour Doppler ultrasonography (CDUS), MRI and MR angiography (MRA) before and after the procedures. Conclusions. A follow up and, if needed, a balloon dilation are necessary to prevent the re-occlusion of the previously treated subclavia artery with stenting.