Browsing by Author "Vucurevic, Bojan (58626374100)"

Peripheral arterial disease (PAD) and coronary artery disease (CAD) are manifestations of atherosclerosis, affecting a substantial proportion of the population. Despite their interrelation, the prevalence of CAD in severe PAD varies, prompting the need to understand their complex relationship. This study retrospectively analyzes prospectively collected data from a high-volume vascular center to assess CAD prevalence, risk factors, and implications for patients undergoing vascular surgery. Among 667 arterial disease patients, 19.5% underwent coronary angiography, with CAD detected in 61.5% of cases. CAD varied across vascular beds. Decision-making around preoperative coronary angiography and revascularization remains complex, with benefits for high-risk patients still being debated. In accordance with current guidelines, the routine practice of coronary revascularization preceding vascular surgery is generally discouraged. This study underscores the need for risk stratification to identify patients who might benefit from coronary revascularization prior to vascular surgery while adhering to cost-effectiveness and avoiding unnecessary and time-consuming diagnostics in the majority of patients. Patient demographics, risk factors, and clinical presentation were analyzed alongside hospital stay, mortality, and complications. The study highlights the challenges in managing patients with concurrent CAD and PAD and calls for improved protocols for treating this high-risk group. © 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.

[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.