The minimal invasive extracorporeal circulation (MiECC) was developed as abiocompatible alternative to conventional cardiopulmonary bypass (cCPB), intending to mitigate haemodilution, lessen the systemic inflammatory response, and enhance organ protection. AQ2 Although the evidence base has grown over the past 30 years, there has been no systematic mappingof the evolution of research activity and its results. The objectives are to perform a detailed analysis of the temporal, geographical, methodological, and clinical trends within MiECC research published between 1990 and 2025. Studies involving original human clinical data (randomized controlled trials, cohort studies, observational reports, methodological or protocol papers) that reported perioperative or clinical outcomes of MiECC were included. Exclusion criteria comprised reviews, meta-analyses, editorials, letters, guidelines, animal studies, and conference abstracts lacking full text. A comprehensive search of PubMed/MEDLINE, Web of Science, Scopus, and Cochrane databases was conducted up to September 2025 to gather evidence. Reference lists of included articles and relevant reviews were also screened. Data were extracted on publication year, country, sample size, study design, surgical procedure, and reported outcomes. Two reviewers independently charted the data, and discrepancies were resolved by a third reviewer. A total of 151 studies were identified, of which 128 met eligibility criteria. Publication activity increased substantially after 2002 and peaked in 2021, with major contributions from European centres (Germany, Italy, Switzerland, Greece, and the Netherlands). Methodological/protocol papers and Randomize Controlled Trials (RCT) predominated (respectively, n = 37, n = 36). Most studies focused on coronary artery bypass grafting (CABG), while valve surgery and paediatric populations were underrepresented. Reported outcomes shifted over time: early studies emphasised transfusion and inflammatory markers, whereas more recent investigations increasingly examined renal function, neurological complications, and survival. Subgroup analyses suggested notable benefits in elderly patients, those with renal dysfunction, and individuals with low ejection fraction (EF). MiECC research has progressed from feasibility series to large multicentre trials, generating evidence for reduced transfusion requirements, attenuated inflammatory response, and better organ protection, though no clear mortality benefit has been demonstrated.

Aim: This study aimed to evaluate the effects of dexmedetomidine (Dex), commonly used during the intensive care process—particularly in the postoperative period due to its analgesic and sedative properties— on lower extremity skeletal muscle ischemia–reperfusion injury (IRI) in an experimental ruptured abdominal aortic aneurysm (RAAA) rat model. Material and Methods: Twenty-four male Sprague Dawley rats (3–4 months old; mean weight 244±32 g) were randomly allocated into three groups: SHAM, IRI, and ischemia–reperfusion injury treated with intraperitoneal 100mcg/kg dexmedetomidine (IRI&Dex). An experimental RAAA model was established in all groups. Lower extremity skeletal muscle tissues were harvested and evaluated using histopathological, immunohistochemical, and biochemical analyses. Results: Light microscopic examination revealed normal myofibrillar architecture with typical nuclei in the SHAM group, widespread necrotic myofibrils with pyknotic nuclei in the IRI group, and predominantly preserved myofibrillar structures with occasional necrosis in the IRI&Dex group. Immunohistochemical analysis demonstrated dense actin and myosin positivity in the SHAM group, a marked reduction in the IRI group, and a significant increase in the IRI&Dex group compared to the IRI group. Caspase-3 expression was normal in the SHAM group, elevated in the IRI group, and near to normal in the IRI&Dex group. Biochemical analyses showed decreased glutathione (GSH) and increased malondialdehyde (MDA) levels in the IRI group, whereas Dex treatment significantly increased GSH and reduced MDA levels compared to the IRI group. Conclusion: Histopathological, immunohistochemical, and biochemical findings indicate that dexmedetomidine markedly attenuates ischemia–reperfusion injury in lower extremity skeletal muscle in a rat model of ruptured abdominal aortic aneurysm. [Turk J Vasc Surg 2026; 35(1.000): 60-7]

ABSTRACT:In humans, body asymmetry might affect vascular asymmetry. This study aimed to examine whether there is a relationship between side asymmetry and the presence of ponticulus posticus (PP) anomaly, carotid, and vertebral artery stenosis. Retrospective analysis was done on the data files of patients with carotid and vertebral arteries who were admitted to our hospital between November 2018 and December 2022 for the presence of PP anomaly. There were 31 patients (25 males and 6 females, with a median age as 69.54 years (range 51-84 years). PP anomaly was detected in 11 of 31 patients (31.48% of cases). The correlation test showed that the presence of PP was negatively correlated with carotid stenosis on the right side, but there was no such correlation on the left. This study demonstrated that there is an innovative anatomical correlation between the PP anomaly and carotid stenosis in the adult patient cohort.

OBJECTIVE:Acute kidney injury (AKI) is one of the main causes of mortality in patients undergoing emergency surgery due to an abdominal aortic aneurysm. This study aimed to determine the potential nephroprotective characteristics of dexmedetomidine (DMD) for the establishment of a standard therapeutic method for AKI.MATERIALS AND METHODS:Thirty Spraque Dawley rats were allocated to 4 groups: control, sham, ischemia-reperfusion, and ischemia/reperfusion (I/R)+dexmedatomidine.RESULTS:Necrotic tubules, degenerative Bowman's capsule and vascular congestion were observed in the I/R group. In addition, there was an increase in tissue malondialdehyde (MDA), interleukin (IL)-1 and IL-6 levels in tubular epithelial cells. In contrast, we observed decreased tubular necrosis, IL-1, IL-6 and MDA levels in the DMD treatment group.CONCLUSIONS:DMD has a nephroprotective effect against acute kidney injury resulting from I/R, which is related to aortic occlusion used in the treatment of ruptured abdominal aortic aneurysms.

Introduction:Objective: To investigate the potential beneficial effects of resveratrol (RVT) against ischemia-reperfusion injury of myocardial tissue during surgical treatment of ruptured abdominal aortic aneurysm.Methods: Four groups were established -control, ischemia/reperfusion (I/R), sham (I/R+solvent/dimethyl sulfoxide [DMSO]), and I/R+RVT.Ruptured abdominal aortic aneurysm model was used as the experimental protocol.Results: In the I/R and I/R+DMSO groups, malondialdehyde (MDA) levels in myocardial tissue were found to be significantly increased compared to the control group.The MDA level in myocardial tissue was significantly decreased in the I/ R+RVT group compared to the I/R group.In I/R and I/R+DMSO groups, glutathione peroxidase (GSH) levels in myocardial tissue were found to be significantly decreased compared to the control group.The GSH level in the myocardial tissue was significantly increased in the I/R+RVT group compared to the I/R group.In the light microscope, isotropic and anisotropic band disorganized atypical cardiomyocytes in the I/R group and degenerative cardiomyocytes and edematous areas in the I/R+DMSO group were observed.Degenerative cardiomyocytes and edematous areas were decreased in the I/R+RVT group.When heart tissue sections incubated with cleaved caspase-3 primary antibodies were examined under the light microscope, apoptotic cardiomyocytes were present in I/R and I/R+DMSO groups.A decrease in the number of apoptotic cardiomyocytes was observed in the I/R+RVT group. Conclusion:The findings of the present study indicate that RVT exhibits protective effects against ischemia-reperfusion injury occurring in the myocardium as a distant organ as a result of abdominal aorta clamping.

Objective Despite significant improvements in interventional vascular aneurysm repair procedures and intensive care patient management, there has been no significant decrease in mortality due to ruptured abdominal aortic aneurysm. Oxidative stress is known to play a key role in secondary organ damage due to infrarenal aortic clamping. The aim of this study was to examine the potential protective effect of the alpha-2 adrenergic receptor agonist dexmedetomidine (DMT) on aortic occlusion-induced lung injury. Methods Thirty Sprague Dawley rats were allocated into control, ischemia-reperfusion (IR), and IR+DMT groups randomly. Vascular clamps were attached to the abdominal aorta in the IR and IR+DMT groups. Two-hour reperfusion was established 1 h after ischemia. The IR+DMT group received a single intraperitoneal 100 mu g dose of DMT 30 min before infrarenal abdominal aortic clamping. Results IR due to aortic occlusion led to apoptosis, widespread inflammation, alveolar septal wall thickening due to bleeding and vascular congestion were observed in both types I and II pneumocytes. Malondialdehyde levels increased while glutathione decreased. However, DMT was found to lower apoptotic pneumocytes, alveolar-septal thickness, hemorrhage, vascular congestion, and malondialdehyde levels, while glutathione levels in lung tissue increased. Conclusions This study is the first to address the effects of DMT on the lung in a ruptured abdominal aortic aneurysm model. Our findings suggest that the alpha-2 adrenergic receptor agonist DMT reduces oxidative stress and apoptosis, thus protecting against aortic occlusion-induced pulmonary injury.

OBJECTIVE:This study evaluated the effects of serratus anterior plane block (SPB) and its combination with transverse thoracic muscle plane block (TTPB) on analgesia, opioid consumption, incentive spirometry performance, and patient comfort.DESIGN:A prospective, observational study.SETTING:A university hospital.PARTICIPANTS:Adult patients scheduled for elective cardiac surgery with cardiopulmonary bypass.INTERVENTIONS:Patients who received intravenous patient-controlled analgesia only were labeled as the control group. Patients who received additional SPB were labeled as the SPB group, and patients who received additional SPB and TTPB were labeled as the SPB+TTPB group. The visual analog scores for pain (VAS), time to first analgesic requirement, total tramadol requirement, incentive spirometry values, and patient comfort indices were recorded during the first 36 postoperative hours.MEASUREMENTS AND MAIN RESULTS:From October 2020 to October 2021, data from 95 patients were analyzed. The VAS score was lower in the SPB+TTPB group at 0, 14, and 18 hours (p < 0.001, p = 0.028, p = 0.047, respectively). Time to first analgesic was longer in the SPB+TTPB group (8 hours v 0-2 hours, p = 0.001). Total tramadol consumption was similar among groups. Incentive spirometer performance was superior in the SPB+TTPB group (p < 0.001). The SPB group had similar success at 0, 14, and 18 hours.CONCLUSION:Although pain scores and opioid consumption were similar, the addition of TTPB to SPB improved pain scores during patient mobilization and incentive spirometry capacity.

Background: The aim of this study was to examine the effects on the lungs of ischemia/reperfusion injury in a ruptured abdominal aortic aneurysm model in rats and to investigate the potential protective effects of resveratrol. Methods: Thirty-two male Sprague-Dawley rats were randomly divided into four groups: control, ischemia/reperfusion, sham (ischemia/ reperfusion + solvent/dimethyl sulfoxide), and ischemia/reperfusion + resveratrol. In the groups subjected to ischemia/reperfusion, following 60-min shock to the abdominal aorta, vascular clamps were attached from the levels of the infrarenal and iliac bifurcation. A total of 60-min ischemia was applied, followed by 120-min reperfusion. In the ischemia/ reperfusion + resveratrol group, intraperitoneal 10 mg/kg resveratrol was administered 15 min before ischemia and immediately after reperfusion. Malondialdehyde, glutathione, and catalase levels were analyzed and histopathological examination of the lung tissues was performed. Results: Malondialdehyde levels increased in the ischemia/reperfusion and ischemia/reperfusion + dimethyl sulfoxide groups, compared to the control group, while catalase levels decreased, and no significant difference was observed in the glutathione levels. Malondialdehyde levels decreased with the administration of resveratrol, while glutathione levels increased, and catalase levels remained unchanged. The increased inflammation in interstitial spaces, thickening in the alveolar septal walls, increased numbers of cleaved caspase-3 apoptotic pneumocytes, and increased histopathological lung damage scores observed in the ischemia/reperfusion and ischemia/reperfusion + dimethyl sulfoxide groups improved with the application of resveratrol. Conclusion: These findings suggest that resveratrol may exhibit a protective effect in preventing acute lung injury developing due to ischemia/reperfusion in ruptured abdominal aortic aneurysm surgery by reducing oxidative damage.

Objectives: This study aims to examine the potential protective effect of the selective alpha-2 adrenergic receptor agonist dexmedetomidine (DEX) against aortic occlusion-induced myocardial injury. Patients and methods: A total of 30 rats were randomly assigned into three groups of 10 animals each as control, ischemia+reperfusion (I/Rep), and I/Rep+DEX. In the I/Rep and I/Rep+DEX groups, after the completion of the shock stage, 60-min lower torso ischemia was induced with the application of cross-clamps to the abdominal aorta, followed by 120-min reperfusion. The I/Rep+DEX group received intraperitoneal 100 µg/kg DEX 30 min before the ischemia period. Results: Malondialdehyde (MDA) levels in myocardial tissue increased with the application of I/Rep, while glutathione (GSH) levels decreased. We also observed swollen, degenerative, apoptotic cardiac myofibrils exhibiting caspase-3 positivity, widespread edematous areas, vascular congestion, and an increase in the heart damage scores. The MDA levels decreased with DEX administration, while the GSH levels increased. Degenerative, apoptotic cardiac myofibrils exhibiting loss of cytoplasm content, and vascular congestion also decreased. Conclusion: Our study results suggest that DEX may have a future role in the treatment of myocardial damage occurring due to reperfusion, following ruptured abdominal aortic aneurysm surgery. [Turk J Vasc Surg 2021; 30(2.000): 93-101]

Objectives: This study presents our long-term follow-up results of patients undergoing basilic vein superficialization and basilic vein transposition. Patients and methods: Medical records of a total of 71 patients (32 males, 39 females; mean age 56.7 years, range, 31 to 76 years) undergoing brachiobasilic arteriovenous fistula surgery for hemodialysis access between January 2010 and March 2019 were retrospectively analyzed. The patients were divided into two groups according to the type of access procedure as the basilic vein superficialization group (n=42) and basilic vein transposition group (n=29). The primary and secondary patency rates were evaluated. Results: The mean follow-up was 18.8 months. In the early postoperative period, bleeding or hematoma developed in 13, extremity edema in 11, and superficial wound site infection in four patients. Surgical methods were applied to six of 11 patients who developed fistula thrombosis during follow-up, while interventional methods were applied to five patients. Primary and secondary patency rates were 86% and 90%, respectively in the superficialization group and 76% and 90%, respectively in the transposition group. There was no statistically significant difference in the patency rates or postoperative complications between the groups. Conclusion: Owing to their low complication and high patency rates, both basilic vein superficialization and basilic vein transposition can be safely employed in patients in whom arteriovenous fistula cannot be established with the cephalic vein. [Turk J Vasc Surg 2020; 29(2.000): 78-83]

Objective: To examine the biochemical and histopathological renal effects of ischemia/reperfusion (I/R) injury using a ruptured abdominal aortic aneurysm (RAAA) model in rats and to investigate the potential protective effects of whortleberry (Vaccinium myrtillus). Methods: Thirty-two male Sprague-Dawley rats were randomly assigned into four groups - control, sham (I/R+glycerol), I/R, and I/R+whortleberry. Midline laparotomy alone was performed in the control group. Atraumatic abdominal clamps were attached under anesthesia to the abdominal aorta beneath the level of the renal artery in the groups subjected to I/R. Sixty-minute reperfusion was established one hour after ischemia. The sham group received five intraperitoneal doses of glycerol five days before I/R. The I/R+whortleberry group received a single intraperitoneal 50 mg/kg dose diluted with saline solution five days before I/R. All animals were finally euthanized by cervical dislocation following 60-min reperfusion. Results: Increases were observed in malondialdehyde (MDA) levels and tubular necrosis scores (TNS) in thin kidney tissues and in numbers of apoptotic renal tubule cells, together with a decrease in glutathione (GSH) levels, in sham and I/R groups. In contrast, we observed a decrease in MDA levels, TNS, and numbers of apoptotic renal tubule cells, and an increase in GSH levels with whortleberry treatment compared to the I/R group. Conclusion: Our findings suggest that whortleberry may be effective against acute kidney injury by reducing oxidative stress and apoptosis.

Objective: To examine the biochemical and histopathological effects of ischemia/reperfusion (I/R) injury in a ruptured abdominal aortic aneurysm (RAAA) model in rats, and to investigate the potential protective role of resveratrol. Methods: Thirty-two male Sprague-Dawley rats were randomly assigned into four groups—control, I/R, sham (I/R + solvent/dimethyl sulfoxide), and I/R + resveratrol. The control group underwent midline laparotomy only. In the other groups, infrarenal vascular clamps were attached following 60-min shock to the abdominal aorta. Ischemia was applied for 60 min followed by reperfusion for 120 min. In the I/R + resveratrol group, intraperitoneal 10 mg/kg resveratrol was administered 15 min prior to ischemia and immediately before reperfusion. The I/R + dimethyl sulfoxide group received dimethyl sulfoxide, and the I/R group was given saline solution. All animals were sacrificed by exsanguination from the carotid artery at the end of the experiment. In addition to histopathological examination of the rat kidney tissues, malondialdehyde, glutathione, catalase, and nitric oxide levels were also investigated. Results: A decrease in glutathione, catalase and nitric oxide levels, together with increases in malondialdehyde levels, numbers of apoptotic renal tubular cells, caspase-3 levels, and tubular necrosis scores, were observed in the IR and I/R + dimethyl sulfoxide groups. In contrast, resveratrol increased glutathione, catalase and nitric oxide levels in renal tissues exposed to I/R, while reducing malondialdehyde levels, apoptotic renal tubular cell numbers, caspase-3 levels, and tubular necrosis scores. Conclusion: Our findings suggest that resveratrol can be effective against I/R-related acute kidney damage developing during RAAA surgery by reducing oxidative stress and apoptosis.

Aim: In this study, we compared the clinical follow-up results and complication and success rates of patients undergoing 1470 nm wavelength endovenous laser ablation (EVLA) or radiofrequency ablation (RFA) in our clinic. Material and Methods: The records of 581 patients treated in our clinic due to clinical symptoms arising from great saphenous vein insufficiency between January 2014 and September 2018 were examined retrospectively. Three hundred fifty-seven of these patients treated with EVLA or RFA and with no deficient data were included in the study. Patients with reflux in the saphenofemoral junction lasting at least 0.5 sec, with a great saphenous vein diameter of at least 7 mm, 2 cm distal to the saphenofemoral junction, and of at least 5.5 mm at knee level, and with CEAP stage C2-C5 were scheduled for endovenous ablation. The patients were randomly distributed between the established EVLA and RFA treatment groups. Data for patients’ diagnostic and therapeutic processes were recorded and evaluated in the light of information in the literature. Results: The EVLA group consisted of 86 patients (42 male, 44 female; mean age 46 years, range 26-71), and the RFA group of 271 (113 male, 158 female; mean age 43.3 years; range 20-77). The mean follow-up time was 27.2 months. No significant differences were determined in terms of patients’ demographic data, preoperative additional diagnoses, CEAP classification values, duration of reflux, or proximal and distal great saphenous vein diameter values. Thrombophlebitis developed in 14 patients and ecchymosis/ hematoma in 32. No significant difference was observed between the groups in terms of complications. Great saphenous vein occlusion rates at Doppler ultrasonography six months after treatment were 91.8% in the EVLA group and 94% in the RFA group (p=0.46). Conclusion: Our results suggest that neither of the two endovenous ablation methods is superior to the other.

BACKGROUND:The aim of this study was to investigate the potential protective effect of whortleberry by examining the effects on heart tissue at the molecular level of ischemia-reperfusion injury caused by surgical repair of a ruptured abdominal aortic aneurysm.METHODS:Between May 2018 and February 2019, a total of 32 male Sprague-Dawley rats were randomly assigned into control, sham (ischemia-reperfusion+glycerol), ischemia-reperfusion, and ischemia-reperfusion+whortleberry groups. Hypovolemic shock was applied to the rats in the ischemia-reperfusion groups for one hour. The abdominal aorta was explored following midline laparotomy and atraumatic microvascular clamps were applied from the infrarenal level. Following one-hour ischemia, the clamps were removed, and reperfusion was established for two hours. In the sham group, intraperitoneal glycerol once daily was applied five days before surgery. In the whortleberry group, whortleberry treatment was administered via the intraperitoneal route five days before ischemia-reperfusion.RESULTS:The ischemia-reperfusion group exhibited a decrease in the glutathione levels and an increase in the malondialdehyde levels (p<0.01 and p<0.01, respectively). We also observed an increase in the caspase-3 positivity in cardiac myofibrils (p<0.01). Whortleberry administration lowered both malondialdehyde levels and numerical density of caspase-3 positive cardiac myofibrils, while increasing the heart tissue glutathione levels, compared to the ischemia-reperfusion alone group (p<0.01, p=0.011, and p=0.011, respectively).CONCLUSION:Whortleberry may be beneficial in preventing cardiac tissue damage caused by ischemia-reperfusion in the surgical repair of ruptured abdominal aortic aneurysms.

Introduction: Ischemia-associated mortality caused by aortic cross-clamps, as in ruptured abdominal aorta aneurysm surgeries, and reperfusion following their removal represent some of the main emergency conditions in cardiovascular surgery. The purpose of our study was to examine the potential protective effect of tea grape against aortic occlusion-induced lung injury using biochemical, histopathological, immunohistochemical, and quantitative analyses. Methods: Thirty-two male Sprague-Dawley rats were randomly assigned into four groups: control (healthy), glycerol + ischemia/ reperfusion (I/R) (sham), I/R, and I/R + tea grape. Results: Following aortic occlusion, we observed apoptotic pneumocytes, thickening in the alveolar wall, edematous areas in interstitial regions, and vascular congestion. We also observed an increase in pulmonary malondialdehyde (MDA) levels and decrease in pulmonary glutathione (GSH). However, tea grape reduced apoptotic pneumocytes, edema, vascular congestion, and MDA levels, while increased GSH levels in lung tissue. Conclusion: Our findings suggest that tea grape is effective against aortic occlusion-induced lung injury by reducing oxidative stress and apoptosis.

Aim: The purpose of this study was to assess the effectiveness of endovascular treatment in patients with coronary subclavian steal syndrome. Material and Methods: The archive records for six patients diagnosed with coronary subclavian steal syndrome and treated using the endovascular method between January 2012 and August 2017 were examined retrospectively. Data concerning diagnosis and treatment were recorded and evaluated in the light of the current literature. Results: All patients had undergone coronary artery bypass graft surgery at external centers a mean 5.7 years previously. Angiography revealed severe stenosis in the proximal subclavian artery in three patients and total occlusion in three. One hundred percent success was achieved in the three patients with stenosis by establishing full patency by means of a stent procedure. Full patency was also established in two of the three patients with total occlusion using the stent procedure. The symptoms of the five patients treated successfully resolved post-procedurally. No restenosis findings were encountered at clinical and Doppler ultrasonography followups. Conclusion: While surgical options predominated in the early years in the treatment of coronary subclavian steal syndrome, endovascular techniques are widely employed today. However, surgical therapeutic alternatives are still important for patients in whom success cannot be achieved with the endovascular method.

Serious problems may be encountered in arterial or venous reconstruction in cases of severe trauma and contaminated tissues. We report the use of a spiral venous graft (SVG) in a case of two-stage bypass aimed at saving first life, and then the extremity. Severe open and contaminated injury was present in the lower abdomen and pelvic region of 29-year-old woman brought to the emergency department following a traffic accident. The patient was in shock, and was taken for emergency surgery jointly with the relevant departments. Interposition bypasses with synthetic graft were performed in the first stage. The synthetic grafts were subsequently removed due to problems developing secondary to infection at subsequent follow-up, and revascularization was established with autologous grafts together with SVG. SVGs are alternative grafts in cases with contaminated tissues and requiring major vessel reconstruction. This technique can add to the therapeutic options available.