[Multivascular atherosclerosis, the Sarajevo Vascular Study]. / Polivaskularna aterosklerotska bolest, sarajevska vaskularna studija.

INTRODUCTION: We started with Sarajevo Vascular Study (SVS) in 1994 with basic aim to evaluate arterial occlusive disease (AOD) of lower extremities and investigate possible effect of amelioration of risk factors to atherosclerosis regression. In 1996 we expanded SVS to polyvascular atherosclerotic disease, asymptomatic or symptomatic atherosclerotic disease on various vascular beds i.e. lower extremity arterial occlusive disease (AOD), cerebrovascular disease (CVD), coronary artery disease (CAD). We enrolled a total of 1680 pts. in the study but this number has changed depending on war migrations, comorbidity, or paramedical reasons. Follow-up of 10 yrs. had 645 pts, and follow-up of 8 yrs. had 1035 pts. METHOD: We enrolled a total of 1680 pts, 954 pts with symptomatic disease, and 246 pts without atherosclerotic disease but with at least 3/8 multiple risk factors (MRF), and as controls 400 pts without vascular disease and less than 3 MRF. STUDY DESIGN: one center, prospective, consecutive, with evaluation of epidemiological data--gender, age, comorbidity, antropometrical data, hemodynamic data--systolic and dystolic velocities, pulsatility and resistive indices, and morphologic data. Clinical variables--gender, age, hypertension, smoking, hyperlipoproteinemia, diabetes mellitus, obesity and fibrinogen. Score of MRF was calculated as x/8. RESULTS: Out of total of 645 pts (10 yrs. follow-up) 399 pts (62%) had AOD, out of them single AOD had 295 pts (74%), and polyvascular disease 104 pts (26%). 63 (61%) pts of symptomatic group had combination of AOD + CAD, and 41 pts (39%) had AOD + CVD + CAD. In the pts with 8 yrs. follow-up (n-1035) AOD had 548 pts. (53%), single AOD had 334 pts (57%) and polyvascular had 122 pts (39%). Out of symptomatic pts. 71 (58.2%) had AOD + CAD, and 51 (41.8%) had AOD + CAD + CVD. Asymptomatic disease on the very entry period of the study was significant for both groups, p < 0.01. CONCLUSIONS: (i) we found a significant number of asymptomatic atherosclerotic changes on other vascular beds, (ii) score of MRF has correlated with polyvascular disease and with overall outcome (iii) antropomethric, haemodynamic, and morphological parameters of human blood vessels have been measured and systematically documented in Bosnia and Herzegovina.

[General outcome in critical limb ischemia in patients with arterial occlusive disease (AOD)]. / Ukupan ishod kriticne ishemije ekstremiteta kod pacijenata sa arterijskom okluzivnom bolesti (AOD).

BACKGROUND: Recent vascular studies suggests that patients with arterial occlusive disease (AOD) and with elevated score of multiple risk factors (MRF), especially diabetes mellitus, have an increased prevalence of critical limb ischaemia, increased incidence of lower limb amputations, and an overall poor outcome of their AOD. The aim of this study is to evaluate an overall outcome of AOD, Fontaine stage III and IV, and to correlate their outcome with score of MRF. METHODS: We enrolled a group of 136 patients (99 males and 37 females), with an average of 63.7 yrs and SD 12.2 all with AOD, Fontaine stage III and IV. We divided pts in three groups--pts on medicament treatment--MT group, pts for lower limb amputation--AMP group, and pts for vascular surgery. According to their clinical stage we had group in Fontaine stage III (n-48), and Fontaine IV (n-88). We followed 9 clinical variables: age, gender, tobacco, arterial hypertension, diabetes mellitus, hyperlipidaemia, level of fibrinogen, coronary ischaemic disease and cerebrovascular disease. RESULTS: In MT group we had n-91 (66.9%) with MRF score of 3.42. In Fontaine stage III we had 37 pts with MRF score of 3.89, and in Fontaine stage IV we had 54 pts with MRF score of 3.37. In AMP group we had n-23 pts (16.9%) with MRF score of 3.39, and all pts were in F IV stage. In VH group we had n-22 pts (16.1%) with MRF score of 3.1. In VH group 50% of pts were in F IV stage. In overall group (n-136) we had a significant number of Fontaine IV stage pts, p < 0.01. CONCLUSIONS: We had a high risk group of patients, with mean MRF score of 3.42, 23 pts (16.9%) were referred for lower limb amputation, and 23 pts (16.9%) for vascular surgery. MRF score correlate with overall outcome of AOD, r = 0.72, p < 0.001.