In 2023, the VAS international working group on Buerger’s Disease (BD) recommended two diagnostic criteria based on a prior Delphi study: “definitive” and “suspected”. The “definitive” criteria are history of smoking, typical angiography, and typical histopathological features. All three features are mandatory to confirm a “definitive” diagnosis of BD. The conundrum is—what features should be considered typical of BD angiography? According to this review, segmental occlusion of infrapopliteal arteries, corkscrew collaterals that appear to continue the occluded arterial segment (Martorell’s sign) or bypass the segmental occlusion, absence of atherosclerotic plaque or aneurysm could differentiate BD from ASO. Hence, for “typical” BD angiography, these manifestations should certainly be considered. However, data for differentiating angiography patterns of BD from the small- and medium-sized vasculitis including Behcet’s disease, scleroderma, hepatitis associated vasculitis, and anti-phospholipid syndrome are limited. Further studies for investigating the angiography pattern in BD patients in early and late presentation of BD, particularly in the patients with long-term follow up, are highly recommended.

According to the World Health Organization, cardiovascular disease (CVD) is the leading cause of death among women worldwide, yet its magnitude is often underestimated. Biological and gender differences affect health, diagnosis, and healthcare in numerous ways. The lack of sex and gender awareness in health research and healthcare is an ongoing issue that affects not only research but also treatment and outcomes. The importance of recognizing the impacts of both sex and gender on health and of knowing the differences between the two in healthcare is beginning to gain ground. There is more appreciation of the roles that biological differences (sex) and sociocultural power structures (gender) have, and both sex and gender affect health behavior, the development of diseases, their diagnosis, management, and the long-term effects of an illness. An important issue is the knowledge and awareness of women about vascular diseases. The risk of cardiovascular events is drastically underestimated by women themselves, as well as by those around them. The purpose of this review is to draw attention to improving the medical care and treatment of women with vascular diseases.

Objective: Leg pain has long been underestimated despite being one of the most important symptoms of chronic venous disease (CVD). Studies investigating leg pain and psychosocial profile in CVD are limited. The study aimed to investigate leg pain, central sensitization, kinesiophobia, and body awareness in patients with CVD. Methods: The ninety-eight patients (80 female, 18 male) diagnosed with CVD were included in the study. The severity of leg pain was evaluated with the Visual Analog Scale (VAS). The patients were assessed with the Central Sensitization Inventory (CSI-A and B) for central sensitization-related symptoms and -positivity, the Body Awareness Questionnaire (BAQ) for body awareness, and the Tampa Kinesiophobia Scale (TKS) for kinesiophobia. The cut-off score was admitted as 41 for TKS. Results: The leg pain (mean (SD) = 4.3 +/- 2) and body awareness (mean (SD) = 82.4 +/- 22) were moderate levels in patients with CVD. Nearly half of the patients (n = 46, 46.9%) had both central sensitization positivity and elevated kinesiophobia (n = 46, 47%). The CSI was correlated with the VAS (r = 0.32, p = .001), TKS (r = 0.40, p < .001), and BAQ (r = 0.20, p = .048). Significant correlations were determined between Body Mass Index and TKS (r = 0.48, p < .001) and BAQ (r = -0.31, p = .002). Also, the patients with a TKS score >= 41-points had higher CSI-A scores (p = .002) than those with a TKS score< 41. Conclusions: Leg pain, central sensitization, and kinesiophobia are commonly seen in patients with CVD, and central sensitization seems to have a negative effect on leg pain, kinesiophobia, and body awareness. The profile beyond pain should be evaluated in detail, and various rehabilitation strategies need to be developed to manage central sensitization, interoception, kinesiophobia, and weight control in patients with CVD.

The aim of this study is to investigate the effect of a single osteopathic manuel treatment (OMT) session on femoral artery diameter and flow in patients diagnosed with (Peripheral Arterial Disease) PAD. 15 patients, diagnosed with PAD, (11 male, 4 female) were included in the study. The OMT circulation model was applied to the participants for one session. Before and after the application, femoral artery diameter and flow were evaluated by radiologist. Evaluating the diameter and flow parameters according to affected extremity, it was found that femoral artery diameter and flow values showed an increase in all patients; however, the difference was not found to be statistically significant. However, comparing diameter and flow parameters in all patients showed an increase in left and right femoral artery diameter and flow. Right femoral artery diameter parameter was found to have a statistically significant difference when compared to the parameter before the application of OMT (p=0,014). While a single session of OMT did not yield statistically significant results in artery diameter and flow in affected extremities, clinically increases were detected.

Buerger's disease (BD) remains a debilitating condition and early diagnosis is paramount for its effective management. Despite many published diagnostic criteria for BD, selective criteria have been utilized in different vascular centers to manage patients with BD worldwide. A recent international Delphi Consensus Study on the diagnostic criteria of BD showed that none of these published diagnostic criteria have been universally accepted as a gold standard. Apart from the presence of smoking, these published diagnostic criteria have distinct differences between them, rendering the direct comparison of patient outcomes difficult. Hence, the expert committees from the Working Group of the VAS-European Independent Foundation in Angiology/Vascular Medicine critically reviewed the findings from the Delphi study and provided practical recommendations on the diagnostic criteria for BD, facilitating its universal use. We recommend that the 'definitive' diagnosis of BD must require the presence of three features (history of smoking, typical angiographic features and typical histopathological features) and the use of a combination of major and minor criteria for the 'suspected' diagnosis of BD. The major criterion is the history of active tobacco smoking. The five minor criteria are disease onset at age less than 45 years, ischemic involvement of the lower limbs, ischemic involvement of one or both of the upper limbs, thrombophlebitis migrans and red-blue shade of purple discoloration on edematous toes or fingers. We recommend that a 'suspected' diagnosis of BD is confirmed in the presence of a major criterion plus four or more minor criteria. In the absence of the major criterion or in cases of fewer than four minor criteria, imaging and laboratory data could facilitate the diagnosis. Validation studies on the use of these major and minor criteria are underway.

Aim: As a mucolytic agent, Erdosteine has two sulfhydryl groups. These groups function as free radical scavengers, which has protective effects against ischemia- reperfusion (IR) injury. In this study, we aimed to observe the effects of erdosteine on skeletal muscle tissue in a rat lower extremity IR injury model. Material and Methods: A total of 18 Wistar albino rats were separated into 3 groups (n: 6); Control group (C), IR group (IR) and IR group with erdosteine (IR-E). Erdosteine administered intraperitoneally (150 mg.kg-1). Rat tissues were taken for histopathological and immunohistochemical evaluations after 2 hours of ischemia and 2 hours of reperfusion period. Results: Blood flow measurements were significantly higher in the IR-E group than in the IR group. In the IR group, endothelial caspase 3 and 8 enzyme expression was significantly higher than C and IR-E groups. Muscle caspase 3 enzyme expression was higher in the IR group than C and IR-E groups. IR and IR-E groups showed increased inflammation, vascular congestion and myositis injury levels than the C group. Also, inflammation, vascular congestion and myositis injury showed a significant decrease in the IR-E group than IR group. Discussion: As a result, erdosteine has a protective effect against skeletal tissue damage resulting from IR injury in rats. The results show the possibility of clinical administration of erdosteine for I/R injury of skeletal muscle tissue.

Background: Buerger's disease (BD) remains a debilitating condition. Despite multiple pub-lished diagnostic criteria for BD, none is universally accepted as a gold standard.Methods: We conducted a 2-round modified Delphi consensus study to establish a consensus on the diagnostic. The questionnaire included statements from several commonly used diag-nostic criteria for BD. Qualitative and quantitative analysis methods were performed. An agree-ment level of 70% was applied.Results: Twenty nine experts from 18 countries participated in this study. Overall, 75 state-ments were circulated in Round 1. Of these, 28% of statements were accepted. Following com-ments, 21 statements were recirculated in Round 2 and 90% were accepted. Although more than 90% of the experts did not agree that the diagnosis of BD can be based only on clinical manifestation, none of the nonclinical manifestations of BD were agreed as a part of the diag-nostic criteria. There was an agreement that a history of tobacco consumption in any form, not necessarily confined to the current use, should be a part of the diagnostic criteria of BD. The history of thrombophlebitis migrans, even if not present at presentation, was accepted as a clue for BD diagnosis. It was also agreed that discoloration of the toes or fingers could be included in the diagnostic criteria of BD. Experts agreed that histology results could differentiate BD from atherosclerosis obliterans and other types of vasculitis. The presence of corkscrew col -laterals on imaging and burning pain reached the agreement at the first round but not at the sec-ond. There was no consensus regarding age cut-off, the requirement of normal lipid profile, and normal blood glucose for BD diagnosis.Conclusions: The present study demonstrated discrepancies in the various published diag-nostic criteria for BD and their selective utilization in routine clinical practice worldwide. We pro-pose that all published diagnostic criteria for BD be re-evaluated for harmonization and universal use.

Purpose: In this study, the relationship between postoperative cognitive functions and serum fractalkine, Glial Fibrillar Acidic Protein (GFAP) and Cluster of differentiation 163 (CD163) levels in diabetic and non-diabetic patients after open heart surgery was evaluated. Methods and Materials: This research was planned prospectively as observational clinical study. Cognitive functions, fractalkine, GFAP and CD163 levels were evaluated with preoperative day 1 and postoperative day 7 in 44 patients. Minimental test (MM) was used to evaluate cognitive functions. Results: A positive correlation was found between preoperative CD163 concentrations and postoperative MM test scores in non-diabetic patients (r=0.536, p=0.010). There was also a positive correlation between postoperative CD163 concentrations and postoperative MM Test scores in non-diabetics (r=0.461, p=0.031). In diabetic patients, a positive correlation was found between preoperative and postoperative GFAP concentrations (r=0.792, p

Klippel-Trenaunay syndrome (KTS) is a rare congenital disease characterized by vascular malformations and tissue hypertrophy. The recommended treatment to manage the symptoms of this syndrome is based on conservative methods including complex decongestive therapy. In this article, we report a pediatric case of KTS in whom short-term CDT was applied. A decrease in pain, fatigue, lymphedema, and an improvement in the functional mobility and lower extremity endurance were achieved.

Even today thromboangiitis obliterans has disease features that remain misunderstood or underappreciated. The epidemiology, etiology and pathophysiology of the disease are still unclear. Biomarkers and disease activity markers are lacking, thus clinical assessment is difficult. We are still struggling to establish unique diagnostic, staging and treatment criteria. This is an academic-collaborative effort to describe the pathophysiology, the clinical manifestations, the diagnostic approach, and the challenges of management of patients with TAO. A systematic search for relevant studies dating from 1900 to the end of 2020 was performed on the PubMed, SCOPUS, and Science Direct databases. Given the intriguing nature of presentation of TAO, its management, to some extent is not only different in different regions of the world but also varies within the same region. Following this project, we discovered ambiguity, overlap and lack of clear-cut criteria for management of TAO. An international group of experts however came to one conclusion. They all agree that management of TAO needs a call for action for a renewed global look with multi-center studies, to update the geographical distribution of the disease and to establish a unique set of diagnostic criteria and a consensus-based guideline for best treatment based on current evidence.

These evidence-based guidelines from the Turkish Society of Cardiovascular Surgery, National Society of Vascular and Endovascular Surgery, and Phlebology Society intend to support clinicians in best decisions regarding the treatment of venous thromboembolism (VTE). The Editor was selected by the three national societies and was tasked with the recruitment of the recognized panel. All financial support was solely derived from the sponsoring societies without the direct involvement of industry or other external stakeholders. The panel prioritized clinical questions and outcomes according to their importance for clinicians in terms of VTE. The panel agreed on 42 recommendations under 15 headings for the diagnosis, initial management, secondary prevention of VTE, and treatment of recurrent VTE events. Important recommendations included the use of ultrasonography, preference for home treatment over hospital treatment for uncomplicated VTE, preference for direct oral anticoagulants (DOACs) over vitamin K antagonists for primary treatment of cancer and non-cancer-related VTE, extended or indefinite anticoagulation with DOACs in selected high-risk patients. Early catheter-directed thrombectomy was recommended in only young symptomatic patients with a diagnosis of fresh iliofemoral deep vein thrombosis.

Background: This study aims to compare the effect of different physical activity levels on pain, fatigue, and quality of life in patients with chronic venous insufficiency. Methods: Between October 2018 and February 2019, a total of 69 patients (4 males, 65 females; mean age 50 years; range, 19 to 73 years) who were diagnosed with chronic venous insufficiency and consulted for physiotherapy were included in the study. The physical activity level of the patients was determined using the International Physical Activity Questionnaire in three groups as light, moderate, or vigorous. Fatigue, pain, and QoL were assessed using the Fatigue Severity Scale, visual analog scale (during the night, activity, and rest), and Venous Insufficiency Epidemiological and Economic Study Quality/Symptom Scale, respectively. Results: Of a total of 69 patients, 17 were in the light-intensity physical activity group, 32 in the moderate-intensity physical activity group, and 20 in the vigorous-intensity physical activity group. Perceived pain during activity and fatigue were significantly different between the light- and moderate-intensity physical activity groups (p<0.05). There was no significant difference in pain, fatigue, and quality of life scores between the vigorous-intensity physical activity group and the other two groups (p>0.05). Conclusion: Our study results suggest that a moderate level of physical activity may be helpful to overcome symptoms such as pain and fatigue in patients with chronic venous insufficiency and to improve quality of life.

Background and Aim: Technological developments and enhancement of knowledge level enable heart surgery with low mortality and morbidity rates in most centers. On the other hand, hemostasis management during cardiopulmonary bypass (CPB) plays a critical role in development of postoperative complications. We aimed to compare the effects of centrifugal pump and roller pump techniques on hemostatic system during CPB. Material and Methods: One hundred patients, who underwent coronary artery bypass surgery by the same surgical team with CPB pump using either roller or centrifugal pump, at Department of Cardiovascular Surgery of Gazi University between June 2012 and June 2013 were enrolled. Patients over 40 years old and without any known immunologic, infectious or inflammatory diseases and hematological problems for the last 6 months were included. Two study groups (Group R: Roller pump group and Group C: Centrifugal pump group) were created. Platelet counts, albumin levels were measured before and after CPB (pump); the amount of blood used during CPB, total blood amount used, percentage of patients using five or more units of blood during CPB, percentage of patients who didn't receive fresh frozen plasma (FFP)or apheresis platelet concentrates were recorded. Results:The amount of blood transfused during CPB was significantly lower in Group C than in Group R (0.28 +/- 0.08 U; 0.68 +/- 0.13) (p=0.010), while the total amount of blood transfused was significantly higher in Group R compared to Group C (p<0.0001). Preoperative and postoperative platelet levels were similar between groups, but platelet levels were significantly lower in both groups compared to their preoperative levels (Group C, p<0.0001, Group R, p<0.0001). When the preoperative albumin levels were compared, the patients in Group R had higher albumin levels than in Group C, whereas postoperative albumin levels were significantly higher in Group C than Group R (p<0.0001). The percentage of patients who didn't receive blood transfusion during CPB was significantly higher in Group C (p=0.011). While the percentage of patients who didn't receive FFP transfusion was significantly higher in Group C (p=0.002), the percentage of patients who didn't receive apheresis platelet transfusion was similar. Conclusion: Our findings indicate that usage of centrifugal pump has clear superiority in terms of effects on hemostatic system during CPB when compared to roller pump. Nevertheless, we believe that our results should be supported by advanced clinical and experimental studies.

Since the first case of coronavirus disease 2019 (COVID-19) was reported at the end of 2019, this outbreak has spread to more than a million people around the world and become a pandemic. The group most affected by the outbreak with the highest mortality rate is elderly people with known vascular diseases or a high risk of developing vascular pathologies. It is evident that in this group of patients, there is a high risk of deep vein thrombosis (DVT) occurrence. In this current extraordinary era, management will be more challenging. In this article, we aimed to prepare a recommendation guide including the thromboprophylaxis and management of patients diagnosed with DVT during the COVID-19 outbreak. [Turk J Vasc Surg 2020; 29(3.000): 203-7]

Background/Aim: Although it has been thought that the complications due to non-pulsatile blood flow should decrease with the utilization of pulsatile perfusion during cardiopulmonary bypass (CPB), there is not enough literature about the probable beneficial effects on cerebral perfusion. In this study we aimed to determine whether the utilization of pulsatile or non-pulsatile CPB makes a difference on the cerebral circulation by the measurements of biochemical serum markers and the jugular bulb oxygen saturation (SjVO(2)) in addition to near-infrared spectroscopy (NIRS). Material and Methods: Eighteen patients scheduled for coronary revascularization on CPB were included in the study. After aortic clamping, non-pulsatile and pulsatile perfusion were both performed for 10-minute periods. S100 beta, adrenomedullin (ADM), NSE and SjVO(2) measurements were performed 10 minutes before anesthesia, during non-pulsatile perfusion, during pulsatile perfusion and 10 minutes after CPB. Niroxope 401 was used for NIRS measurements. Results: Fourteen patients were male (77.8 %) and four patients were female (22.2 %). The mean age was 59.06 +/- 10.40 and the mean ejection fraction was 50.67 +/- 13.39 %. There were no statistical differences between the two perfusion regimes with regard to the mean arterial blood pressures (67.26 +/- 7.01/68.71 +/- 527 mmHg) and the serum hemoglobin levels (8.64 +/- 1.32/8.51 +/- 1.29 mg/dl). The postoperative neurocognitive dysfunction rate was 27.8 % and the cerebrovascular event rate was 11.1 %. The increasing values of s100 beta during non-pulsatile perfusion were decreased significantly with pulsatile perfusion. Off-pump NSE levels and ADM levels during pulsatile perfusion and after CPB were statistically higher. There were no statistical differences between the perfusion types for NSE, SjVO(2) and NIRS measurements. Conclusion: The decrease in s100 beta levels during pulsatile perfusion is the striking point of this study. We think that there is a need for more studies with extended patient series to prove that the neurologic complications due to CPB should decrease with pulsatile perfusion.

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.

Aim: Varicose veins are the most common disorders of the lower extremities. The purpose of this study is to investigate the effect of leukocyte activation in the vein wall and apoptosis in the etiopathogenesis of varicose veins.Material and Methods:Forty-six patients with varicose veins were included in the study. High ligation with stripping with or without additional individual ligation and excision was performed for symptoms, complications or cosmetic needs. ELISA was used to measure the serum concentration of caspase-8 and caspase-9.Results: There was a statistically significant difference between the cephalic vein and saphenous vein groups (p=0.04 and p<0.0001 respectively). Conclusion: As a conclusion, the complex pathophysiology underlying varicose veins has yet to be fully defined. It is suggested that both leukocyte activation and dysregulation of apoptosis are associated with susceptibility for varicose vein formation however this argument needs further research.

Objective: The aim of this study was to evaluate the effect of dexmedetomidine (100 mu g/kg-ip) on ischemia reperfusion (IR) injury in myocard of rats.Methods: Twenty-four Wistar Albino rats were separated into four groups. There were four experimental groups (Group C (Control; n=6), Group IR (ischemia-reperfusion, n=6), Group D (Dexmedetomidine; n=6), underwent left thoracotomy and received ip dexmedetomidine without ischemia and reperfusion and Group IR-D (IR-Dexmedetomidine; n=6) was administrated 100 mu g/kg dexmedetomidine via ip route 30 minutes before ligating the left coronary artery. A small plastic snare was threaded through the ligature and placed in contact with the heart. To produce IR, a branch of the left coronary artery was occluded for 30 min followed by two hours of reperfusion. However, after the above procedure, the coronary artery was not occluded or reperfused in the control rats. At the end of the study, myocard tissue was obtained for biochemical, histochemical and immunohistochemical determination/analyses.Results: Myonecrosis, cell infiltration and edema were significantly higher in the IR group than in the C and D groups. In the IR-D group, myonecrosis, cell infiltration and edema were significantly lower than in the IR group. TBARS levels were found to be significantly higher in the IR group than in the C and D groups. TBARSlevels in the IR-D group were found to be significantly lower than in the IR group. SOD enzyme activity was found to be significantly lower in the IR group than in the C group. In the IR-D group, SOD enzyme activity was found to be significantly higherthan the IR group.Conclusion: Dexmedetomidine removed degenerative effects after ischemia reperfusion in ischemia reperfusion group and we may conclude that dexmedetomidine may have regenerative effects on IR injury.

Background: The purpose of this study was to investigate acute cardiovascular responses to manual lymphatic drainage (MLD) on different parts of the body. Materials and Methods: Thirty healthy individuals (10 women and 20 men) participated in the study voluntarily. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), respiration frequency, and oxygen saturation were measured before and after MLD was applied to different regions of the body (neck, abdomen, anastomosis, arm, and leg). HR, SBP, and DBP were measured with a sphygmomanometer (OMRON, USA) and oxygen saturation was measured with a pulse oximeter. Results: Increase in DBP was seen after abdominal drainage (p = 0.038); reduction in SBP (p = 0.002) and DBP (p = 0.004) after neck drainage; reduction in SBP (p < 0.001) and HR (p = 0.004) after arm drainage; and reduction in SBP and DBP after leg drainage. There was no change in the oxygen saturation levels of participants after MLD (p > 0.05). Conclusions: In healthy subjects, the effects of MLD were found to vary according to the region of application. This study signals that the cardiovascular effects of MLD treatment vary in different regions of the body.