Aim: In recent years endovascular treatment of symptomatic peripheral arterial disease (PAD) provides many advantages like fast application, fast recovery and low cost in many cases. And it is recommended as a primary revascularization strategy in a wide range of many PAD patients rather than surgical treatment of symptomatic peripheral arterial disease (PAD). However optimal methods of catheter-based treatment for renal insufiency patients remain controversial. Material and Method: In Yeditepe University Faculty of Medicine Hospital between 2017-2018, we performed endovascular treatment with ipsilateral popliteal artery puncture of 18 patients. Pre-op creatinin , EGFR and post-operative creatinin levels and puncture area complications were compared. Results: Primary end-point was technical success with popliteal access without any post-operative complications and low dosage contrast usage. Secondary end-point was 3 months follow-up stenosis degree. No punction area complications were notted. None of patients had any hematoma, ecchymosis or pseudoaneurisyms in puncture area. And after procedure none of patients had to have dialisysis treatment despite high level of kreatinin and low EGFR values. In third month control follow-up patients were asymptomatic and no recurren vascular disease was seen in doppler usg. Discussion: As a conclusion, balloon angioplasty performed with ipsilateral popliteal artery micro-puncture with manually low dosage opaque use, allows the shortest way to access the target lesion and it protects the kidney from opaque toxication with minimizing the amount of opaque usage for superficial femoral artery lesions. Therefore, renal protection was ensured before and after the operation without dialysis in diabetic patients with low EGFR and borderline high creatinine levels in the study group. Furthermore, the incidence of complications is lower with popliteal artery micro-puncture than femoral artery puncture.

In this article, we report a case of atrio-oesophageal fistula (AEF) which occurred after a second-generation cryoballoon intervention was utilised for refractory atrial fibrillation. On the 4th post-procedural week, the patient was admitted to a hospital owing to recurrent febrile episodes, stroke and suspicion of bacteraemia. Sepsis occurred secondary to bacteraemia. Cerebral air emboli and gas bubbles in the left ventricle and mediastinum were shown by radiological images. Emergency surgical treatment procedures were performed. Although the surgical procedure eliminated the air embolisation and drained the chest, the patient's clinical condition continued to worsen, presenting uncontrollable hemodynamic status and refractory septic shock, resulting death 24 h after the surgery.

Background. The aim of the study is to compare the current two endovenous thermal ablation methods by examining the effects on the visual analog scale (VAS) and the short form-36® quality of life index. Methods. Ninety-six patients who underwent unilateral endovenous thermal ablation of great saphenous vein were included. ClosureFast™ catheters were used in the RFA group and 1470 nm radial fiber laser catheters were used in the EVLA group. Results. The RFA group consisted of 41 patients and the EVLA group consisted of 55 patients. The preoperative baseline characteristics of both groups were similar. On the day of operation, VAS values were 2.8±1.1 in the RFA group and 3.6±1.8 in the EVLA group (p=0.02). Comparisons of short form-36 parameters in both groups showed them to be similar except the pain detected at postoperative 1st week (48.1±5.4 for RFA, 44.9±7.6 for EVLA, p=0.04). Conclusion. Results in postprocedural quality of life were found to be similar in both of the techniques. However, in terms of postoperative pain, radiofrequency ablation is still superior to the 1470 nm radial fiber laser catheters.

Background: Endovenous thermal ablation of the small saphenous vein carries a risk for sural nerve injury. Ablation above mid-calf level is recommended to avoid it. However, this strategy could not eradicate this complication. We present our results of consecutive 30 small saphenous vein thermal ablations which are performed after ultrasonographic identification of the sural nerve. Methods: We studied 26 consecutive subjects with a total of 30 limbs. Ablation was performed proximal to the risk point by a 1470-nm diode laser. Patients were asked to attend follow-up outpatient controls at 7 days, 30 days, and 180 days postoperatively. Rate of identification of the sural nerve by ultrasonography, safety of the mid-calf level as a puncture site and postoperative sural nerve damage were assessed. Results: The sural nerve identification was achieved by ultrasonography in all patients except for one. Mid-calf level as a puncture site was not safe in three (10%) extremities. None of the patients showed any evidence suggesting postoperative sural nerve damage. Conclusion: Choosing the puncture site according to the risk point may be more reasonable than general mid-calf level which is being used.

To image lower extremity arteries by CT angiography using a very low-dose intra-arterial contrast medium in patients with high risk of developing contrast-induced nephropathy (CIN).

Background: After a successful primary percutaneous transluminal coronary angioplasty (PTCA)/stent placement, performing bypass surgery to an artery with a patent stent during semiurgent coronary artery bypass grafting (CABG) surgeries may protect the patient against ischemic complications due to acute stent occlusion. This issue, however, is controversial. Loss of bypass graft function may occur in the early stages due to the competition between native flow and graft flow. In the present study, the effects of bypass surgery to an artery with a patent stent on the outcomes were investigated. Methods: Fifty nine patients who had undergone isolated CABG surgery within 6 weeks after a successful primary PTCA/stent placement were included in the study. Patients who had undergone emergency operation due to suspicion of acute stent occlusion and the redo cases were excluded in the study. Patients were divided into two groups; those with (Group P, protected) and without (Group NP; non-protected) coronary bypass to an artery with a patent stent. Preoperative, operative and postoperative data were collected retrospectively from the patient files. The need for urgent revascularization was recorded postoperatively. Mann-Whitney U test was used for the analysis of continuous variables, whereas categorical variables were analyzed either using Pearson's chisquare test or Fisher's exact test. Results: Of 59 patients, 35 underwent bypass surgery to the artery with patent stent, whereas bypass was not performed on 24 patients. It was observed that dual antiplatelet therapy had been performed on 20% of the patients in Group P and 87.5% of those in Group NP (p = 0.001). No acute ischemic change due to stent occlusion was determined in Group P, whereas it was observed in one patient in Group NP (p = 0.4). The prevalence of hospital mortality was found to be 8.6% and 8.3% in Group P and Group NP, respectively (p = 1). Conclusions: Although it was not statistically significant, it was observed that bypass surgery might have a protective effect against stent occlusion in patients who underwent bypass surgery. However, postoperative dual antiplatelet therapy substantially prevented stent occlusion in those without bypass surgery. On the other hand, stent-supported coronary circulation may be unsafe in case of discontinuation of clopidogrel therapy. Therefore, it was suggested that performing bypass surgery to an artery with a patent stent would be more reasonable in patients who underwent semi-urgent CABG surgery.

A thirty-eight-year-old male patient who suffered from 10th and 11th thoracal vertebrae fractures, paraplegia and acute traumatic aortic transection because of accidental fall was referred to our hospital. Open surgical repair carried a very high risk due to severe coexisting injuries. Transection was treated with 30x100 mm Valiant thoracic endograft, which was deployed just distal to the ostium of the left carotid artery. The patient was transferred to the neurosurgery clinic for treatment of paraplegia after an uneventful recovery. Endoyascular repair of acute transection confers substantial advantages in mortality and morbidity compared to surgical repair. However, the long-term durability of thoracic endografts remains unknown. If the long-term results are as satisfactory as the promising mid-term results, this technique may become the gold standard approach for the treatment of acute transection.

The aim of this study is to evaluate the validity of the Glasgow aneurysm score (GAS) and Hardman index in patients operated on because of ruptured abdominal aortic aneurysm (rAAA), and determining preoperative risk factors that affect in-hospital mortality. One hundred one patients operated on to repair a rAAA within the last 10 years were included. The GAS and Hardman index were calculated for each patient separately. The relation between in-hospital mortality and the Hardman index and GAS was analyzed by means of the receiver-operator characteristic (ROC) curve. Univariate and multivariate methods of analyses were used to determine preoperative risk factors. Average age was 69 ± 8, and in-hospital mortality rate was 51.5%. Analysis of the ROC curve showed that the Hardman index had an area under the curve (AUC) = 0.71 (95% confidence interval [CI], 0.593-0.800, P = 0.0002) for predicting in-hospital mortality. The GAS had an AUC = 0.77 (95% CI, 0.680-0.851, P < 0.0001). The results of multivariate analysis revealed the presence of the following preoperative risk factors: age more than 63 years (odds ratio [OR], 4.4; 95% CI, 1.17-16.49, P = 0.028); loss of consciousness (OR, 9.33; 95% CI, 1.94-44.86, P = 0.005); creatinine higher than 1.7 mg/dL (OR, 5.52; 95% CI, 1.92-15.85, P = 0.001); and pH lower than 7.31 (OR, 3.77; 95% CI, 1.18-11.99, P = 0.024). In conclusion, the Hardman index and GAS have a significant correlation with in-hospital mortality rates. Nevertheless, a high score does not necessarily correspond with a definite mortality. This is why scoring systems could not be considered as the sole criterion for choosing patients for this study. Clinical experience was still the leading factor in deciding against or in favor of surgery.

: A thirty-eight-year-old male patient who suffered from 10th and 11th thoracal vertebrae fractures, paraplegia and acute traumatic aortic transection because of accidental fall was referred to our hospital. Open surgical repair carried a very high risk due to severe coexisting injuries. Transection was treated with 30x100 mm Valiant thoracic endograft, which was deployed just distal to the ostium of the left carotid artery. The patient was transferred to the neurosurgery clinic for treatment of paraplegia after an uneventful recovery. Endovascular repair of acute transection confers substantial advantages in mortality and morbidity compared to surgical repair. However, the long-term durability of thoracic endografts remains unknown. If the long-term results are as satisfactory as the promising mid-term results, this technique may become the gold standard approach for the treatment of acute transection.

Background: Melatonin is a potent scavenger of free radicals and an antioxidant. We studied the relationship between the protective effect of melatonin against ischemia-reperfusion injury (IRI) during cardiopulmonary bypass, the plasma level of melatonin, and the time of surgery.Methods: Forty patients who were to undergo elective coronary artery bypass grafting (CABG) were divided into 2 groups, those who underwent their operations at 8 AM (group I; n = 20) and those who underwent their operations at 1 PM (group II; n = 20). The operations were carried out by the same surgical team and with the same standard surgical technique. Blood samples were collected before the operation (T(1)), when the aortic cross-clamp was removed (T(2)), and at 4 hours (T(3)) and 24 hours (T(4)) after the operation.Results: Preoperative plasma levels of melatonin were substantially higher in group I than in group II. Intraoperative and postoperative melatonin levels were also significantly higher in patients who underwent their operations in the morning. The 2 groups had similar preoperative levels of intercellular adhesion molecule 1 and interleukin 8; however, intraoperative and postoperative values were lower in group I for all samples. This difference was statistically significant for both markers. Plasma levels of lactate dehydrogenase were significantly lower in group I. The 2 groups had similar aortic cross-clamp and cardiopulmonary bypass times. Preoperative and postoperative troponin I levels were lower in group I than in group II, but these differences were not statistically significant. The 2 groups showed no significant differences in plasma creatine kinase MB levels for either preoperative or postoperative measurements.Conclusion: High plasma levels of melatonin may be directly related to low levels of IRI markers. Melatonin may have a protective effect against IRI in CABG. This effect seems to be directly correlated with the plasma levels of melatonin and inversely related with light. If melatonin protects myocardium from IRI, additional studies may be planned for the preoperative use of melatonin in patients with coronary artery disease to improve myocardial protection.

Ascending aortic aneurysm is a rare complication of Behcet's disease. A 33-year-old male patient underwent surgery for ascending aortic aneurysm that also involved the aortic root. At surgery, he had a rigid and thickened bicuspid aortic valve whose mobility was restricted. Aortic root replacement was performed with a composite graft using the Bentall procedure with the button technique. Button, proximal, and distal anastomoses were reinforced using Teflon felt strips and tissue adhesives. Postoperative echocardiographic findings were normal. Contrast-enhanced computed tomography at six months showed no signs of complications including false or true aneurysms. Histopathologic examination of the aortic tissue specimens showed lymphocytic perivasculitis consisted with Behcet's disease.

Floating thrombus in the ascending aorta is rare and its association with papillary thyroid adenocarcinoma has not been documented. We report a case of a 64-year-old man who was referred to our emergency unit because of suspected type A aortic dissection. Computerized tomographic and transthoracic echocardiographic scans revealed a floating thrombus in the aneurysmatic ascending aorta. The thrombus was removed with the dilated aorta. Although the aortic wall was macroscopically normal, histologic examination revealed metastatic papillary adenocarcinoma.

BACKGROUND:Temporary aspirin resistance can occur during the post-CABG period. If the factors causing resistance can be identified, the incidence of early graft occlusions can also be minimized.METHODS:25 elective CABG cases were enrolled in the study. The platelet count, mean platelet volume, the C-reactive protein level, lipid profile, blood urea nitrogen (BUN), and creatinine levels were identified one day before the operation and on the 1st, 5th and 10th postoperative days. Optical aggregometry was used for the evaluation of aspirin response. The patients were divided into two groups: those with aspirin resistance and those with no aspirin resistance.RESULTS:The rate of postoperative aspirin resistance was found to be 60 %. No significant difference was found when the preoperative and operative data of the two groups were compared. It was found that the rapid changes observed in the postoperative platelet counts and the C-reactive protein levels were similar.CONCLUSION:Aspirin resistance is encountered during the early postoperative period in the majority of patients undergoing CABG. None of the factors studied were found to be causative for resistance formation. Further studies are required to clarify this entity.

OBJECTIVES:Unilateral antegrade cerebral perfusion can be performed with minimal manipulations to arch arteries, but whether it provides adequate brain perfusion remains unclear. Some authors believe that this technique can be inadequate without deep hypothermia. We investigated the reliability of unilateral cerebral perfusion at 22 degrees C hypothermia and the advantages of avoiding deep hypothermia.METHODS:Study participants were 55 patients who underwent surgery with unilateral cerebral perfusion. Patients were divided into 2 groups; 18 patients underwent surgery at 16 degrees C hypothermia (group I) and 37 patients at 22 degrees C hypothermia (group II). The mean age of the patients was 59 +/- 10 years in group I and 55 +/- 14 years in group II. Supracoronary ascending aorta replacement was performed in 25 and hemiarch replacement in 15 patients. Nine patients underwent surgery for a Bentall procedure. Total arch replacement was performed in 4 patients and total thoracic aorta replacement in 2 patients.RESULTS:The hospital mortality was 11% in group I and 5.4% in group II (P = .59). Transient neurologic deficits were not detected in any of the patients. The rate of permanent neurologic deficits was 5.9% in group I and 2.8% in group II (P = .54). Although mean aortic cross-clamp and antegrade cerebral perfusion times were not significantly different, mean cardiopulmonary bypass time was longer in group I than group II (174 +/- 38 vs 142 +/- 37 minutes, P = .005). Postoperative bleeding, blood product usage, serum creatinine and hepatic enzyme level changes, inotrope usage, and arrhythmia occurrence were not different between the 2 groups. Mean mechanical ventilation time was longer in group I than group II (24 +/- 17 vs 16 +/- 6 hours, P = .02).CONCLUSIONS:Unilateral antegrade cerebral perfusion at 22 degrees C systemic hypothermia appears to be safe and reliable for brain protection. Advantages of this technique are avoidance of deep hypothermia and reduced cardiopulmonary bypass and mechanical ventilation times in patients undergoing aortic surgery.

invasive procedure and can routinely be performed off-pump by an experienced team.Following the initial feasibility studies, results are further improving: during the past two years mortality has decreased, stroke rate remains low and conversion rate to either CPB or sternotomy is low.We therefore feel that TA-AVI is an attractive therapeutic option for elderly high-risk patients with aortic stenosis.

Objective: Posterior ventricular rupture is a rare and fatal complication of mitral valve surgery. This study is designed to define the risk factors for left ventricular rupture after mitral valve replacement and, especially, to find out if posterior leaflet preservation is protective for posterior ventricular rupture. Methods: Between January 1996 and March 2007, 2560 patients underwent mitral valve replacement operation in our hospital. Risk factors for posterior ventricular rupture were studied with chi(2), and logistic regression analysis. Results: The surgery was complicated with posterior ventricular rupture in 23 (0.8%) of 2560 patients. Nineteen patients (82.6%) were female, four patients (17.4%) were mate. Mean age of the patients in this group was 60 +/- 10. Mortality rate of the patients with posterior ventricular rupture was 86% (20 patients). Twelve patients with posterior ventricular rupture were at the age of 60 and older. Age of 60 and above was found as a highly significant risk factor for posterior ventricular rupture (OR 4.53, 95% Cl 1.98-10.38, p < 0.001). Posterior leaflet was preserved in 513 patients (20%) and posterior ventricular rupture did not occur in these patients. Resection of posterior leaflet was also found as a highly significant risk factor (p = 0.008) for posterior ventricular rupture. Reoperation was performed in 372 patients and posterior ventricular rupture occurred in 7 of them. Reoperation was also found as a significant risk factor (OR 2.563, 95% Cl 1.03-6.34, p = 0.042) for posterior ventricular rupture. Conclusions: Extreme annular traction and aggressive decalcification should be avoided during mitral valve resection. Posterior leaflet of the mitral. valve should be preserved, especially in the older age group to prevent posterior ventricular rupture. (C) 2008 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

Open repair is considered the first choice for the treatment of chronic aortic transection. These patients are usually very young and they have a low risk of mortality and morbidity for surgery. However, spinal cord injury and local complications such as phrenic nerve injury and lung lacerations are still major problems in open repair, while they are very uncommon in endovascular repair. Additionally, the mid-term results of endovascular repair for aortic transections are excellent. In this paper, we present three patients with chronic transection who were treated with endovascular repair. Patients were evaluated by CT scan and were appropriate candidates for endovascular repair. Vailant thoracic endografts were used and a technically successful repair was achieved in all patients. Mid-term follow-up has been completed and there is no evidence of endoleak or stent graft migration. In conclusion, we recommend endovascular repair for chronic aortic transection in anatomically suitable patients. The long-term results will demonstrate whether it is a definitive treatment or not.