Browsing by Author "Vasic, Dragan (7003336138)"

Renal transplant recipients often suffer from dyslipidemia which is one of the principal risk factors for cardiovascular disease. This study sought to determine characteristics of high-density lipoprotein (HDL) and low-density lipoprotein (LDL) particles and their associations with carotid intima-media thickness (cIMT) in a group of pediatric renal transplant recipients. We also examined the influence of immunosuppressive therapy on measured LDL and HDL particle characteristics. HDL size and subclass distribution were determined using gradient gel electrophoresis, while concentrations of small, dense LDL (sdLDL)-cholesterol (sdLDL-C) and sdLDL-apolipoprotein B (sdLDL-apoB) using heparin-magnesium precipitation method in 21 renal transplant recipients and 32 controls. Renal transplant recipients had less HDL 2b (P < 0.001), but more HDL 3a (P < 0.01) and 3b (P < 0.001) subclasses. They also had increased sdLDL-C (P < 0.01) and sdLDL-apoB (P < 0.05) levels. The proportion of the HDL 3b subclasses was a significant predictor of increased cIMT (P < 0.05). Patients treated with cyclosporine had significantly higher sdLDL-C and sdLDL-apoB concentrations (P < 0.05) when compared with those on tacrolimus therapy. Pediatric renal transplant recipients have impaired distribution of HDL and LDL particles. Changes in the proportion of small-sized HDL particles are significantly associated with cIMT. Advanced lipid testing might be useful in evaluating the effects of immunosuppressive therapy. © 2011 European Society for Organ Transplantation.

Background and Objectives: Abdominal Aortic Aneurysm (AAA) and carotid disease have medical and social significance, considering their morbidity, disability, and economic consequences. The study objectives were to determine the prevalence of asymptomatic internal carotid artery (ICA) lesions ≥70% in patients with AAA, the correlation of AAA diameter with the degree of ICA stenosis and symptoms, and the importance of preventive ultrasound checkups. Subjects and Methods: A prospective non-randomized controlled study including 740 patients, aged from 18-85 years, who were suitable for the inclusion and exclusion criteria and reported at the vascular laboratory of the Institute for Vascular and Endovascular Surgery, Clinical Center of Serbia from 1st of December 2011 to the 1st of November 2012. Results: The prevalence of asymptomatic ICA stenosis ≥70% in patients with AAA is 10.8%. Male representatives have more symptomatic ICA stenosis ≥70%. Patients with small aneurysms more often have asymptomatic ICA stenosis ≥70%. The occurrence of symptoms of carotid disease was more prevalent among patients with ICA stenosis ≥70% compared to the group with stenosis <70%. There was no correlation found between the grade of ICA stenosis with the size of AAA. Conclusion: The prevalence of asymptomatic ICA stenosis ≥70% in patients with AAA is found to be 10.8%. Male patients with ICA stenosis ≥70% more often had symptoms of carotid disease. In the smaller aneurysms, ICA stenosis ≥70% occurs frequently, but without the symptoms of carotid disease, and there was no correlation between the size of AAA and the grade of ICA stenosis. Clinical implications of ICA imaging in patients with previously diagnosed AAA is necessary. Copyright © 2013 The Korean Society of Cardiology.

COVID-19 is also manifested with hypercoagulability, pulmonary intravascular coagulation, microangiopathy, and venous thromboembolism (VTE) or arterial thrombosis. Predisposing risk factors to severe COVID-19 are male sex, underlying cardiovascular disease, or cardiovascular risk factors including noncontrolled diabetes mellitus or arterial hypertension, obesity, and advanced age. The VAS-European Independent Foundation in Angiology/Vascular Medicine draws attention to patients with vascular disease (VD) and presents an integral strategy for the management of patients with VD or cardiovascular risk factors (VD-CVR) and COVID-19. VAS recommends (1) a COVID-19-oriented primary health care network for patients with VD-CVR for identification of patients with VD-CVR in the community and patients' education for disease symptoms, use of eHealth technology, adherence to the antithrombotic and vascular regulating treatments, and (2) close medical follow-up for efficacious control of VD progression and prompt application of physical and social distancing measures in case of new epidemic waves. For patients with VD-CVR who receive home treatment for COVID-19, VAS recommends assessment for (1) disease worsening risk and prioritized hospitalization of those at high risk and (2) VTE risk assessment and thromboprophylaxis with rivaroxaban, betrixaban, or low-molecular-weight heparin (LMWH) for those at high risk. For hospitalized patients with VD-CVR and COVID-19, VAS recommends (1) routine thromboprophylaxis with weight-adjusted intermediate doses of LMWH (unless contraindication); (2) LMWH as the drug of choice over unfractionated heparin or direct oral anticoagulants for the treatment of VTE or hypercoagulability; (3) careful evaluation of the risk for disease worsening and prompt application of targeted antiviral or convalescence treatments; (4) monitoring of D-dimer for optimization of the antithrombotic treatment; and (5) evaluation of the risk of VTE before hospital discharge using the IMPROVE-D-dimer score and prolonged post-discharge thromboprophylaxis with rivaroxaban, betrixaban, or LMWH. © 2020 Georg Thieme Verlag. All rights reserved.

Background: Diabetes mellitus increases the risk of ischaemic stroke in the general population but its impact on early outcome after the carotid endarterectomy (CEA) is controversial with conflicting results. Patients and methods: This prospective study includes 902 consecutive CEAs. Patients were divided into non-diabetic and diabetic groups and subsequently analysed. Early outcomes in terms of 30-day stroke and death rates were then analysed and compared. Results: There were 606 non-diabetic patients. Among 296 diabetic patients, 83 were insulin-dependent. The cumulative TIA/stroke rate was statistically higher in the diabetic group (2.6 vs. 5.7 %, P = 0.02). Stroke was more frequent in the diabetic group (2.0 vs. 4.4 %, P = 0.04) comparedto TIA (0.7 vs. 1.4 %, P = 0.45). Mortality was statistically more frequent in diabetic patients (0.2 vs. 1.7 %, P = 0.01). The 30-day stroke/death rate (2.6 vs. 5.7 %, P = 0.02) was also statistically higher in the diabetic group. Factors that were identified to increase risk of death and stroke in multivariate analysis were: use of insulin for blood glucose control (OR = 2.47, 95 % CI 1.61–4.68, P = 0.01), higher low-density lipoprotein cholesterol value (OR = 1.52, 95 % CI 1.15–2.22, P < 0.01), presence of coronary disease (OR = 2.04, 95 % CI 1.40–3.31, P = 0.03), peripheral artery disease (OR = 2.14, 95 % CI 1.34–3.65, P = 0.02), complicated plaque (OR = 1.77, 95 % CI 1.11–3.68, P = 0.03), contralateral carotid artery occlusion (OR = 2.37, 95 % CI 1.25–4.74, P = 0.02), shunt use (OR = 3.46, 95 % CI 1.18–7.10, P < 0.01), and among diabetic patients higher HbA1c levels (OR = 1.28, 95 % CI 1.05–1.66, P = 0.03). Clamp toleration was associated with lower risk of death and stroke rates (OR = 0.43, 95 % CI 0.23–0.76, P < 0.01). Conclusions: In our study, perioperative neurological complications and mortality were statistically higher in diabetic patients compared to non-diabetic patients during CEA. Further research will have to show whether other treatment modalities of carotid artery stenosis and better glycaemia and dyslipidaemia controlling in diabetics can reduce this risk. © 2018 Hogrefe.

Background Only a few studies on the cephalic vein cutdown technique for pacemaker lead implantation in children weighingle 0kg have been reported even though the procedure is widely accepted in adults. Objective The purpose of this study was to prove that cephalic vein cutdown for pacemaker lead implantation is a reliable technique with a low incidence of complications in children weighingle 10 kg. Methods The study included 44 children weighingle 10 kg with an endocardial pacemaker. Cephalic, subclavian, and axillary vein diameters were measured by ultrasound before implantation. The measured diameters were used to select either an endocardial or epicardial surgical technique. Regular 6-month follow-up visits included pacemaker interrogation and clinical and ultrasound examinations. Results Two dual-chamber and 42 single-chamber pacemakers were implanted. Mean weight at implantation was 6.24 kg (range 2.25-10.40 kg), and mean age was 11.4 months (range 1 day-47 months). In 40 children (90.1%), the ventricular leads were implanted using the cephalic vein cutdown technique, and implantation was accomplished via the prepared right external jugular vein in 4 of the children (9.9%). The atrial leads were implanted using axillary vein puncture and external jugular vein preparations. Mean follow-up was 8.9 years (range 0-20.9 years). Only 1 pacemaker-related complication was detected (a lead fracture near the connector that was successfully resolved using a lead repair kit). Conclusion The cephalic vein cutdown technique is feasible and reliable in children weighingle 10 kg, which justifies the application of additional surgical effort in the treatment of these small patients. © 2015 Heart Rhythm Society. All rights reserved.

Aims: To determine the frequency of asymptomatic carotid artery stenosis in patients with coronary artery disease and to what degree the extent of coronary artery disease and presence of certain risk factors can be indicators of carotid artery stenosis in asymptomatic patients. Material and methods: Retrospective evaluation of consecutive patients that underwent coronary artery bypass grafting (CABG) during one year without symptoms or signs of carotid artery stenosis. The pre-operative Doppler ultrasonography in color and B-mode, using Siemens Accuson Antares machine, was used to determine the presence and the degree of carotid artery stenosis. Patients were divided according to the presence of significant (≥50%) carotid artery stenosis. The same doctor performed all examinations. Following variables were analysed: Age, gender, body mass index, hypertension, diabetes, smoking, cholesterol, triglycerides and echocardiographic variables obtained from transthoracic echocardiography - the presence of aortic wall sclerosis, aortic valve sclerosis and mitral valve calcification. Results: We have demonstrated that in 18/272 (7.1%) of patients referred to CABG with hemodynamically significant carotid artery stenosis had asymptomatic stenosis. The risk of presence of carotid artery stenosis was more significant in those older than 60 years (OR 2.58; 95% CI 0.98-6.77, p=0.047) and in patients with left main coronary artery stenosis (OR 8.92; 95% CI 3.2-24.83, p < 0.001). Other investigated variables had no significant influence (p > 0.05). Conclusion: The presence of asymptomatic carotid artery stenosis is strongly associated with the presence of left main coronary artery stenosis and with age older than 60 years. Noninvasive screening for carotid disease is reasonable in these subgroups of patients referred to CABG.

Background: Inflammation is one of the mechanisms that leads to carotid restenosis (CR). The aim of this study was to examine the influence of increased values of inflammation markers (high-sensitivity C-reactive protein [hs-CRP], C3 complement, and fibrinogen) on CR development after eversion carotid endarterectomy (CEA). Methods: A consecutive 300 patients were included in the study, in which eversion CEA was performed between March 1 and August 1, 2010. Demographic data, atherosclerosis risk factors, comorbidities, and ultrasound plaque characteristics were listed in relation to potential risk factors for CR. Serum concentrations of hs-CRP, fibrinogen, and C3 complement were taken just before surgery (6 hours); 48 hours after CEA; and during regular checkups at 1 month, 6 months, 1 year, and 2 years. An “inflammatory score” was also created, which consisted of six predictive values of inflammatory markers (hs-CRP just before and just after CEA, fibrinogen just before and just after CEA, and C3 complement just before and just after CEA) with a maximum score of 6 and a minimum score of 0. At every follow-up visit to the outpatient clinic, ultrasound assessment of the carotid artery for restenosis was done. Results: Our results showed an increased risk of early CR within 1 year in patients with increased hs-CRP before CEA (6 hours) and increased fibrinogen 48 hours after surgery and in patients not taking aspirin after CEA. Sex was determined to be an independent predictor of CR, with female patients having a higher risk (P =.002). Male patients taking aspirin with an inflammatory score >2 had an increased risk for restenosis compared with male patients with inflammatory score <2. Not taking aspirin after CEA and fibrinogen (48 hours) were the strongest predictors, and the Fisher equation incorporating these predictors was used to predict CR. A computer program was created to calculate whether the patient was at high or low risk for CR by selecting whether the patient was taking aspirin (yes or no) and whether fibrinogen was increased 48 hours after CEA (yes or no) and to display the recommended therapeutic algorithm consisting of aspirin, clopidogrel, cilostazol, and statins. Conclusions: Increased hs-CRP before CEA, increased fibrinogen 48 hours after CEA, and not taking aspirin were the main predictors of early CR. With the clinical implementation of the Fisher equation, it is possible to identify patients at high risk for early CR and to apply an aggressive therapeutic algorithm, finally leading to a decreased CR rate. © 2017 Society for Vascular Surgery

Cancer and COVID-19 are both well-established risk factors predisposing to thrombosis. Both disease entities are correlated with increased incidence of venous thrombotic events through multifaceted pathogenic mechanisms involving the interaction of cancer cells or SARS-CoV2 on the one hand and the coagulation system and endothelial cells on the other hand. Thromboprophylaxis is recommended for hospitalized patients with active cancer and high-risk outpatients with cancer receiving anticancer treatment. Universal thromboprophylaxis with a high prophylactic dose of low molecular weight heparins (LMWH) or therapeutic dose in select patients, is currently indicated for hospitalized patients with COVID-19. Also, prophylactic anticoagulation is recommended for outpatients with COVID-19 at high risk for thrombosis or disease worsening. However, whether there is an additive risk of thrombosis when a patient with cancer is infected with SARSCoV2 remains unclear. In the current review, we summarize and critically discuss the literature regarding the epidemiology of thrombotic events in patients with cancer and concomitant COVID-19, the thrombotic risk assessment, and the recommendations on thromboprophylaxis for this subgroup of patients. Current data do not support an additive thrombotic risk for patients with cancer and COVID-19. Of note, patients with cancer have less access to intensive care unit care, a setting associated with high thrombotic risk. Based on current evidence, patients with cancer and COVID-19 should be assessed with well-established risk assessment models for medically ill patients and receive thromboprophylaxis, preferentially with LMWH, according to existing recommendations. Prospective trials on well-characterized populations do not exist. © 2022 International Institute of Anticancer Research. All rights reserved.

Cancer and COVID-19 are both well-established risk factors predisposing to thrombosis. Both disease entities are correlated with increased incidence of venous thrombotic events through multifaceted pathogenic mechanisms involving the interaction of cancer cells or SARS-CoV2 on the one hand and the coagulation system and endothelial cells on the other hand. Thromboprophylaxis is recommended for hospitalized patients with active cancer and high-risk outpatients with cancer receiving anticancer treatment. Universal thromboprophylaxis with a high prophylactic dose of low molecular weight heparins (LMWH) or therapeutic dose in select patients, is currently indicated for hospitalized patients with COVID-19. Also, prophylactic anticoagulation is recommended for outpatients with COVID-19 at high risk for thrombosis or disease worsening. However, whether there is an additive risk of thrombosis when a patient with cancer is infected with SARSCoV2 remains unclear. In the current review, we summarize and critically discuss the literature regarding the epidemiology of thrombotic events in patients with cancer and concomitant COVID-19, the thrombotic risk assessment, and the recommendations on thromboprophylaxis for this subgroup of patients. Current data do not support an additive thrombotic risk for patients with cancer and COVID-19. Of note, patients with cancer have less access to intensive care unit care, a setting associated with high thrombotic risk. Based on current evidence, patients with cancer and COVID-19 should be assessed with well-established risk assessment models for medically ill patients and receive thromboprophylaxis, preferentially with LMWH, according to existing recommendations. Prospective trials on well-characterized populations do not exist. © 2022 International Institute of Anticancer Research. All rights reserved.