Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is associated not only with respiratory illness but also with profound vascular and coagulation disturbances. Long COVID (LC) is characterized by persistent symptoms such as fatigue, dyspnea, cognitive impairment, and palpitations. Mechanistically, SARS-CoV-2 induces direct endothelial injury, promotes a pro-inflammatory cytokine milieu, and activates platelets, leading to immunothrombosis and impaired fibrinolysis. Consequently, patients exhibit microthrombosis, elevated plasma D-dimer, fibrinogen dysregulation, and persistent hypercoagulability. Clinically, this translates into an increased risk of venous thromboembolism, including deep vein thrombosis and pulmonary embolism, as well as arterial thrombotic events such as myocardial infarction and stroke, which may persist months after acute infection. Understanding the interplay between endothelial injury, inflammation, and coagulation is crucial for risk stratification and the development of preventive and therapeutic strategies. We conducted a systematic narrative review of the literature, including human clinical and mechanistic studies identified through PubMed, Scopus and Web of Science up to 30 September 2025. This review synthesizes current evidence on vascular complications in LC, highlighting endothelial dysfunction as a central pathophysiological nexus linking the acute phase of SARS-CoV-2 infection with chronic LC manifestations.

Background: Venous leg ulcers (VLUs) are a common chronic wound condition susceptible to infection by various bacterial species. Understanding bacterial presence and antibiotic sensitivity is crucial for effective treatment. Methodsː Medical records of 60 patients diagnosed with the C6 chronic venous insufficiency stage were analyzed retrospectively. The patients were divided into an active recurrent VLU group (33 cases) and a first-onset active VLU group (27 cases). Bacterial identification, antibiotic sensitivity, and laboratory markers were assessed. Resultsː Pseudomonas aeruginosa was the most prevalent bacterial species in both the study (72.72%) and control (37.03%) groups, along with other common bacteria such as Proteus mirabilis, Enterococcus sp., Staphylococcus aureus, Acinetobacter baumannii, Klebsiella spp., and Escherichia coli. Furthermore, uncommon bacteria, including Providencia rettgeri, Group B Streptococcus, and Salmonella Paratyphi B, and a fungal infection with Candida albicans, were identified only in the study group, while Morganella morganii was found exclusively in the control group. Pseudomonas aeruginosa showed significant sensitivity to several antibiotics, particularly Amikacin and Meropenem. Nonspecific laboratory markers, such as CRP, fibrinogen, ESR, WBC, CK, neutrophils, and lymphocytes, revealed statistically significant differences between groups, indicating their potential as biomarkers for monitoring recurrent VLUs. Conclusionsː These results highlight the need for comprehensive diagnostic approaches to effectively manage VLU infections and improve patient outcomes. Further research is warranted to explore factors influencing the presence of uncommon bacteria and to develop targeted interventions for VLU management.

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.

Introduction Screening of males over 65 years of age for abdominal aortic aneurysm (AAA) has been proved effective in some countries. The incidence of AAA in Serbian population has not been evaluated yet. The aim of the study was to assess the ratio between elective and urgently operated patients with AAA and to estimate hospital incidence of treated AAA based on the population of 100 000 inhabitants. Methods Data were obtained from Vascular surgery registry - Serbvasc which has been created by 17 institutions. Data containing demographic characteristics were obtained from the publication of the Statistical office of the Republic of Serbia. For statistical analysis, the methods of descriptive statistics were used and the values were expressed per 100 000 inhabitants. Results During the year 2021, 422 operations were performed in 7 hospitals due to asymptomatic, symptomatic and ruptured AAA in 323 (76,54%), 37(8,76%) and 62 (14,69%) patients, respectively. Hospital incidence of electively operated AAA is 8,06 cases per 100 000 inhabitants, whereas the incidence of operated ruptured AAA is 1,55 cases per 100 000 inhabitants. Overall hospital incidence of all operatively treated AAA is 10,53 cases per 100 000 inhabitants. Out of the total number of operated patients with AAA, 134 (31,75%) were younger than 65 years, while 22 (35%) out of 62 patients treated for rAAA, where younger than 65 years. Conclusion The incidence of operatively treated elective AAA is lower than the values reported in literature, while the rate of ruptured AAA is more than twice as high as the rate reported by recent papers. One third of treated patients were younger than 65 years. The most efficient strategy for reducing the number of urgently treated AAA is the implementation of screening for AAA in groups with higher risk.

Background/Objectives: Coronary artery disease (CAD) is highly prevalent in patients undergoing vascular surgery and is a major determinant of postoperative morbidity and mortality. Preoperative anemia is a well-recognized risk factor for adverse outcomes, including major adverse cardiac events (MACEs), but its independent impact in patients with CAD undergoing abdominal aortic aneurysm (AAA) repair remains unclear. Methods: We conducted a retrospective cohort study of 410 consecutive patients undergoing open AAA repair at a tertiary vascular center between 2023 and 2025. Preoperative anemia was defined as hemoglobin < 130 g/L and significant CAD as ≥70% luminal narrowing for non-left main disease or ≥50% for left main disease. The primary outcome was MACE (cardiovascular death, myocardial infarction, or stroke) during hospitalization. Baseline covariates included age, sex, diabetes mellitus (DM), chronic kidney disease (CKD), congestive heart failure (CHF), peripheral artery disease (PAD), and other relevant comorbidities. Multivariable logistic regression models were used to evaluate associations of anemia, CAD, and their interaction with MACE. Additionally, a composite risk group was created to examine MACE rates across mutually exclusive subgroups. Results: Among 410 patients, 314 (76.6%) had CAD and 116 (28.3%) had preoperative anemia. Overall, 67 patients (16.3%) experienced MACE. In the reduced model including only anemia and CAD, anemia remained a strong independent predictor of a MACE (OR 4.46, 95% CI 2.57–7.72, p < 0.001), and CAD was also independently associated (OR 2.20, 95% CI 1.00–4.72, p = 0.044). In the full multivariable model adjusting for DM, CHF, CKD, PAD, and age, anemia was the strongest predictor (OR 4.53, 95% CI 2.49–8.26, p < 0.001), while CAD showed a borderline association (OR 2.07, 95% CI 0.94–4.57, p = 0.071). Interaction analysis indicated no statistically significant modification in risk by the combination of anemia and CAD. The composite risk group variable was omitted due to collinearity with its components. Conclusions: Preoperative anemia, particularly in patients with CAD, is a significant and independent predictor of major adverse cardiac events following open AAA repair. These findings support the importance of early identification and correction of anemia before surgery to improve perioperative cardiac outcomes in this high-risk population.

Introduction: Major adverse cardiac events (MACE) are the primary cause of morbidity and mortality in patients undergoing vascular surgical procedures. This is why it is essential to understand the relationship between coronary artery disease and peripheral arterial disease. In this paper, we aimed to determine predictors and risk factors related to the occurrence of MACE in patients undergoing vascular surgery for peripheral arterial disease. Material and Methods: This is a retrospective study of 310 in-hospital patients treated at a high-volume vascular centre. The outcome was classified through the three-point MACE (myocardial infarction, stroke and cardiovascular mortality). Results: We found that the majority of initial MACE happened in patients with aortobifemoral bypass surgery compared to other types of reconstruction (p=0.009). No significant correlation was established between the procedures performed and the short-term primary outcome. In the initial period, MACE was detected in 14 (5.8%) patients. Among them, six (1.9%) experienced a myocardial infarction (MI), three (1%) had a stroke, and five (1.6%) died within the first 30 days. All deaths were linked to cardiac ischemia, which ultimately culminated in cardiogenic shock and subsequent death. Short term MACE was observed in 2 (0.6%) patients both of whom had an MI. Conclusion: Major vascular surgery in patients with coronary artery disease is a highly morbid procedure and perioperative MACE places them at a significantly high risk of mortality. Early detection of coronary heart disease and preoperative optimization can play a major role in reducing the risk of MACE.