Browsing by Author "Pesic, Slobodan (58525670300)"

Background: Peripheral arterial disease (PAD) and diabetes are the major causes of lower extremity amputations (LEAs) worldwide. Morbidity and mortality in patients with LEAs are high with an associated significant burden on the global health system. The aim of this article is to report the overall morbidity and mortality rates after major and minor LEAs from the Serbian Vascular Registry (SerbVasc), with an analysis of predictive factors that influenced adverse outcomes. Materials and methods: SerbVasc was created in 2019 as a part of the Vascunet collaboration that is aiming to include all vascular procedures from 21 hospitals in Serbia. Prevalence of diabetes among patients with LEAs, previous revascularization procedures, the degree and the type of foot infection and tissue loss, and overall morbidity and mortality rates were analyzed, with a special reference to mortality predictors. Results: In the period from January 2020 to December 2022, data on 702 patients with LEAs were extracted from the SerbVasc registry, mean age of 69.06±10.63 years. Major LEAs were performed in 59%, while minor LEAs in 41% of patients. Diabetes was seen in 65.1% of the patients, with 44% of them being on insulin therapy. Before LEA, only 20.3% of patients had previous peripheral revascularization. Soft tissue infection, irreversible acute ischemia, and Fontaine III and IV grade ischemia were the most common causes of above-the-knee amputations while diabetic foot was the most common cause of transphalangeal and toe amputations. The infection rate was 3.7%, the re-amputation rate was 5.7%, and the overall mortality rate was 6.9%, with intrahospital mortality in patients with above-the-knee amputation of 11.1%. The most significant intrahospital mortality predictors were age >65 years (p<0.001), chronic kidney disease (CKD) (p<0.001), ischemic heart disease (IHD) (p=0.001), previous myocardial revascularization (p=0.017), emergency type of admission (p<0.001), not using aspirin (p=0.041), using previous anticoagulation therapy (p=0.003), and postoperative complications (p<0.001). Conclusions: The main predictors of increased mortality after LEAs from the SerbVasc registry are age >65 years, CKD, IHD, previous myocardial revascularization, emergency type of admission, not using aspirin, using previous anticoagulation therapy, and postoperative complications. Taking into account high mortality rates after LEAs and a small proportion of previous peripheral revascularization, the work should be done on early diagnosis and timely treatment of PAD hopefully leading to decreased number of LEAs and overall mortality. Clinical Impact: Mortality after lower limb amputation from the SerbVasc register is high. A small number of previously revascularized patients is of particular clinical importance, bearing in mind that the main reasons for above-the-knee amputations were irreversible ischemia, Fontaine III and Fontaine IV grade ischemia. Lack of diagnostics procedures and late recognition of patients with PAD, led to subsequent threating limb ischemia and increased amputation rates. The work should be done on early diagnosis and timely treatment of PAD in Serbia, hopefully leading to an increased number of PAD procedures, decreased number of LEAs, and lower overall mortality. © The Author(s) 2023.

Background: The management of mitral regurgitation during aortic valve replacement remains a complex question. Secondary mitral regurgitation often improves post-aortic valve replacement without mitral valve surgery, but residual mitral regurgitation can significantly affect long-term outcomes. This study investigates the natural history of mitral regurgitation following isolated aortic valve replacement and identifies prognostic factors for persistent mitral regurgitation. Methods: A retrospective study was conducted on 108 patients who underwent isolated aortic valve replacement. Patients were categorized based on mitral regurgitation improvement. Additionally, patients were divided into patient-prosthesis mismatch and non-patient-prosthesis mismatch groups based on the aortic prosthesis. Preoperative and postoperative echocardiographic data were analyzed. Results: In total, 63% of patients showed mitral regurgitation improvement. The improved functional MR group showed significant reductions in peak and mean transvalvular pressure gradients. In contrast, the patient-prosthesis mismatch group had persistent mitral regurgitation improvement in 59.2% of patients. The non-patient-prosthesis mismatch group exhibited significant structural improvements and a reduction in mitral regurgitation severity in 68.6% of patients. Conclusions: The study shows that aortic valve replacement could significantly improve MR when patient-prosthesis mismatch is avoided. This approach maximizes hemodynamic outcomes, mitigates the risk of residual or worsening mitral regurgitation, and potentially reduces the need for additional mitral valve interventions. © 2024 by the authors.

Colic artery aneurysms (CAA) are among the rarest visceral artery aneurysms that carry a significant risk of rupture with a high mortality rate. Concomitant occlusive disease of the mesenteric arteries can significantly alter the type of treatment undertaken (open or endovascular). We present the case of a 68-year-old woman with a visceral artery aneurysm that was discovered coincidently during a routine ultrasound examination. The patient reported no abdominal or back pain or any symptoms associated with mesenteric ischemia. Computed tomography angiography showed a near total occlusion of the celiac trunk, segmental complete occlusion of the superior mesenteric artery, and a middle colic artery (MCA) aneurysm measuring 22 mm in diameter. Complete resection of the MCA aneurysm was performed, with subsequent reconstruction by end-to-end anastomosis. There is no clear evidence to support indications for intervention according to aneurysm size in asymptomatic patients with CAA. Endovascular occlusion of the proximal and distal arterial segments is often considered a first-line approach, which was inappropriate in our case. Open surgical reconstruction was mandatory to preserve collateral circulation and avoid bowel ischemia in circumstances of occlusive mesenteric artery disease. We decided not to treat the stenotic lesions of the mesenteric arteries, given the absence of mesenteric ischemia symptoms. © Indian Association of Cardiovascular-Thoracic Surgeons 2025.

[No abstract available]

Subclavian artery aneurysm (SAA) is a rare and potentially life and limb-threatening disease. Fibromuscular dysplasia (FMD) is an idiopathic, segmental, non-atherosclerotic and non-inflammatory disease of the musculature of arterial walls, leading to stenosis of small- and medium-sized arteries. We are presenting a case of surgical treatment of SAA due to FMD with compression symptoms. A 63-year-old woman was admitted due to an 18-mm right SAA. She complained of constant pain in the right shoulder. Due to the significant compression symptoms, risk of rupture, embolization and thrombosis, surgical treatment was indicated. The aneurysm was isolated through the supraclavicular incision and resected with subsequent subclavian artery (SA) reconstruction. Histopathological findings showed FMD, with thickened intima and fibroplasia of the subintimal layer of the arterial wall and luminal nodular formation as a striking feature, with tunica media being atrophic and replaced by fibrous tissue. The postoperative course was uneventful, and after 6 months, the patient was doing well with SA flow well preserved and no more pain in the right shoulder. SAA due to FMD is rare. Surgical treatment in such cases is the preferable treatment option over endovascular, due to the relief of aneurysmal sac compression symptoms on surrounding nerves and structures. In the case of isolated subclavian artery pseudoaneurysm, one should suspect that the cause could be FMD. © Indian Association of Cardiovascular-Thoracic Surgeons 2024.