Introduction: Low concentration of free testosterone and low serum testosterone levels are associated in males patients with metabolic syndrome and cardiovascular disease and in some cases in connection with critic iliac stenosis and also in most cases with lack of physical activity. Exercise can be also important factor to improve primary bypass and endovascular potency and general health benefits after surigal and endovascular treatment in patients with critical ishemia over 75% of lumen obstruction of short liiac artery segment have positive impact on improvemt of generely Testosterone Levels. Subjects and Methods: 72 selected Patients with Cardiovascular Disease with Metabolic Syndrome and Critic Iliac Artery Stenosis (TASC II A and B) were observed in period 3 years between ferbruary 2015 and ferbruary 2018. In focus was 1 year potency after invasive and minimalinvasive tertmant (45 patients treated with surgical dacron reconstruction and 25 patients with endovascular tretmant of short segment critical iliac artery stenosis (TASC II A and B). Results: In the total population no difference in changes of CIMT from baseline was observed between the standard exercise group and controls. However, there was no significant interaction between the effect of exercise training and primary bypass potency during 1 year. Conclusion: Primary potency of Endovascular procedure and Dacron bypass revascularization after 1 year in exercise training group significantly rise of testosterone levels higher but still not therapy adequate. With potential optimization testosterone therapy levels we can answer of the question. Is any major influence on primary bypass potency and are higher levels of free testosterone are preventing further progressing of cardiovascular disease and generel symptomatic and asymptomatic atherosclerosis?

Serum levels of testosterone (ST) and high-density lipoprotein (HDL) are generally associated with atherosclerosis in male patients over 50 years with critic iliac stenosis (TASC II A and B) and cardiovascular disease with significant changes in HDL and low-density lipoprotein (LDL). In addition to the standard therapy, combined medicamentous therapy and adequate model of exercise are also important factors as medicines can improve HDL levels and primary bypass and endovascular potency impacting positively on improvement of ST or it can be the following testosterone replacement therapy (TRT) comprising cardiovascular disease prevention and vascular treatment as adjunct therapy options after endovascular and vascular surgical procedures. The aim of the study is to identify the association between HDL and ST after surgical and endovascular intervention on the iliac segment (TASCII A and B), as well as cardiovascular risk factors with modified medium activity (MET) <6 with short interval increase over >6 (MET), with total duration of 30–60 minutes. It also attempts to remodel a patient behavioral pattern, optimize ST levels and link them to outcomes and patency of vascular procedures on the iliac segment. Materials and methods. 108 selected male patients with cardiovascular disease combined with metabolic syndrome and critical iliac artery stenosis (TASC II A and B) were examined during 2014–2018, 4 years after invasive and minimal invasive treatment (54 patients were treated with surgical Dacron reconstruction and 54 patients – with endovascular treatment on short segment of critical iliac artery stenosis (TASC II A and B). Results. In the total population, no difference was observed in changes of constraint-induced movement therapy between the standard exercise group and the control one after 4 years from baseline. However, there was no significant interaction between the effect of exercise trainings and primary bypass potency within 4 years. Conclusions. Primary effects of endovascular procedure and Dacron bypass revascularization raise the risk of elevated testosterone levels after 4 years of group training but does not provide adequate answers to questions as to whether higher levels of ST have any major influence on primary bypass potency preventing further progression of cardiovascular disease and general symptomatic and asymptomatic atherosclerosis. However, exercise and TRT can be potential adjunctive therapeutic options for a future supporting postsurgical and endovascular illiac treatment in cardiovascular patients with low testosterone levels.