Introduction: We can define extracranial carotid artery aneurysm (ECAA) as bulb dilatation greater than 200% of the diameter of the internal carotid artery (ICA) or in a case of common carotid artery (CCA) greater than 150% of the diameter. Surgical intervention is required for the treatment of this disease.Case report: This study presents an open vascular surgical procedure to resolve ECAA. We report a case of 61 years old woman with an extracranial internal carotid artery berry aneurysm, presented with a headache and dizziness when turning the head aside. Classic open surgery was performed and the lumen of berry aneurysm was separated with three clips from the lumen of ICA.Conclusions: The open surgical approach is the method of choice for the treatment of extracranial internal carotid artery pathological conditions.

Introduction: Androgenic-anabolic steroids are rarely used by sportsmen who want to improve physical performance in competition sport. Despite that they are well aware of the side effects of anabolic steroids, many young athletes in Bosnia and Herzegovina without competition motivation come in temptation, trying to achieve better muscle proportion and physical performance unknowing consequence of side effects and what is hiding behind. Risk factors such as increasing of lipid levels and arterial hypertension are major factors which have important role in the Pathogenesis of atherosclerosis and are responsible for occurrence of cardiovascular disease even causing a sudden death in young athletes. Objective: The aim of the study was to estimate the frequency of misusing of androgenic anabolic steroid drugs in young recreational sportsmen without competition motivation. This study will try to estimate vascular and lipid status, analyzing the side effects of steroids in young recreational athletes under the age of 35, in Bosnia and Herzegovina. Methods: The study included 70 individuals in period of 2010 till 2015 on recreational exercising program; 35 individuals misusing androgenic anabolic steroids during the period of 5 years were compared with 35 individuals which do not use androgenic anabolic steroids. Non-invasive methods were used in all individual (clinical examination and vascular ultrasound examination of vein system). The routine of training units in both groups was approximately two hours 4-6 times per week. Results: Final analysis has reveal that in androgenic anabolic steroids group in 18 individuals or 55.7% arterial hypertension with hyperlipidemia was more represented, compared with the group without using anabolic steroids, represented by 2 individuals or 5.7% and it was statistically considered significant by using p value less than 0.05. (p<0.05). Statistically dominant population using anabolic steroids drugs are males (100%) or 35 individuals; we did not find females using anabolic steroids and that is why our research was limited to male population. Conclusion: Recreational male sportsmen are dominant androgenic anabolic steroids misusers, trying to achieve better muscle proportion and physical performance, they neglect the anabolic steroids side effects which have devastating consequence on vascular system. Benefits of misusing drugs in recreational exercising program in young sportsmen are mostly connected with development of arterial hypertension and hyperlipidemia and the variety of serious health disorders, progressing the pathogenesis of cardiovascular disease.

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.

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.

Venous abnormalities in lower extremities are among the most frequent disorders that aff ects general population with signifi cant morbidity and mortality. Usually, the problem consists of a mild form of varicose veins and teleangiectasis. Treat- ment in this stage of disease is highly recommended since progression can lead to chronic venous insuffi ciency and chronic disability with very few eff ective treat- ment options. Th e most eff ective and popular treatment of varicose veins is opera- tive treatment; specifi cally two diff erent 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.