Impact of static foot disorders on the conservative treatment success in chronic venous disease patients without wounds.

OBJECTIVE: Chronic venous disease (CVD) and static foot disorders (SFDs) are prevalent conditions that commonly cause lower extremity pain. These conditions share common factors such as age and weight in their etiology. This study aimed to investigate the impact of SFDs on the treatment response of patients undergoing conservative treatment for CVD without wounds. MATERIALS AND METHODS: A retrospective evaluation was conducted on 328 patients (60 males, 268 females) with CVD. Parameters including age, gender, affected side, body mass index, Visual Analog Scale (VAS), Clinical-Etiological-Anatomical-Pathophysiological (CEAP) classification, and revised Venous Clinical Severity Score (rVCSS) were considered for evaluation. Radiological measurements of calcaneal pitch angle (CPA) were analyzed as a determinant of SFDs. RESULTS: VAS and rVCSS of the patients were evaluated before and after conservative treatment of CVD without concomitant treatment of SFDs. The presence of SFDs was associated with decreased treatment success (P < .001). Among different types of SFDs, the pes cavus group exhibited the lowest change in VAS and rVCSS scores before and after conservative CVD treatment. In contrast, the normal group demonstrated the highest improvement. Patients with a normal foot medial arch consistently achieved the best treatment outcomes compared with patients with other SFDs. CONCLUSIONS: In conclusion, SFDs affect outcomes of conservative treatment of CVD in CEAP 0 to 3 patients, with the efficacy of treatment dependent upon the severity of SFDs.

The Anti-Apoptotic Effect of Ranolazine on Cerebral Protection during Cardiopulmonary Bypass and Carotid Artery Surgery.

Background: We aimed to determine the usability of ranolazine (Rn) as a neuroprotective during cardiac surgeries and carotid artery interventions where cerebral blood flow is interrupted. Methods: Female Wistar albino rats were used. The rats were divided into 4 groups of 8 rats each. The first group (Group 1) was the control group. Group 2 underwent ischemia induction but was not treated with Rn. Group 3 received 25 mg/kg/day and Group 4 50 mg/kg/day Rn intraperitoneally, starting 3 days before ischemia induction. Bilateral carotid arteries were explored and clamped simultaneously. Ischemia was induced for 15 minutes. After 72 hours, the experimental animals were sacrificed. Results: Superoxide dismutase, alkaline phosphatase, and interleukin 6 levels were similar among the 4 groups. Acetylcholine esterase (Group 3: p = 0.007, Group 4: p = 0.002), tumor necrosis factor-alpha (Group 4: p = 0.01), and annexin V (Group 3: p = 0.001) levels were statistically significantly lower in the Rn-treated groups. Malondialdehyde (Group 3: p = 0.003, Group 4: p = 0.009), reduced glutathione (Group 4: p = 0.04), acid phosphatase (Group 3: p = 0.04), noradrenaline (Group 3: p = 0.01), and Bcl-2 (Group 4: p = 0.004) levels were significantly higher in the Rn-treated groups. Conclusions: The results of this study demonstrated the antiapoptotic effect of Rn in a brain ischemia-reperfusion model of rats receiving Rn before the procedure.

Extended length of stay after elective ascending aortic surgery and associated risk factors.

OBJECTIVE: Surgery on the ascending aorta incurs greater risk than other cardiac procedures. The primary aim of this study is to identify pre-operative and operative risk factors that play a role in extended length of stay (LOS) after elective surgery for ascending aortic aneurysms. The secondary aim is to determine post-operative outcomes associated with extended LOS. METHODS: Patients who underwent elective surgery aged >18 between January 2018 and December 2019 for ascending aortic aneurysm with or without concomitant interventions in a single heart surgery center were retrospectively identified. Patients with days of hospital stay longer than the median length made up the extended stay group. The extended stay group was compared against the rest of the patients for demographics and operative parameters, as well as post-operative outcomes. RESULTS: Patients with extended LOS were older (60.0±12.2 vs. 54.0±14.2, p=0.001) with more frequent coronary artery disease (CAD) (47.2% vs. 23.7%, p<0.001) and chronic obstructive pulmonary disease (COPD) (25.0% vs. 11.9% p=0.013). More patients in the extended LOS group required HCA for distal aortic anastomosis (43.5% vs. 17.5%, p<0.001) and cardiopulmonary bypass (CPB) durations were longer (283.1±83.9 vs. 225.3±84.2 min, p<0.001). Multivariate analysis revealed age, CAD, COPD, HCA, and CPB time as risk factors for extended LOS. Extended LOS patients had longer mechanical ventilation times (23.0±21.3 vs. 13.6±5.3 h, p<0.001), more frequently had acute renal failure (24.2% vs. 6.7%, p<0.001), reoperation for bleeding (20.7% vs. 6.7%, p=0.003), and stroke (14.3% vs. 4.3%, p=0.011). CONCLUSION: In elective surgery for ascending aortic aneurysms older age, history of COPD and CAD, longer CPB times, and HCA during surgery are associated with extended LOS. Further studies are needed to investigate the association of prolonged hospital stay with long-term outcomes, as well as the impact of operation type on hospital stay.

Factors associated with positive thrombus findings at ultrasonography in COVID-19 ward patients who underwent imaging for suspected deep vein thrombosis under prophylactic anticoagulation.

OBJECTIVE: The incidence of deep vein thrombosis (DVT) is increased in patients with coronavirus disease 2019 (COVID-19) and its presence is associated with worse outcomes. Ultrasound examination of patients with COVID-19 with a suspected DVT is challenging owing to concerns with disease transmission; the timely initiation of therapeutic anticoagulation is essential. This study aimed to identify patient factors associated with positive thrombus findings at ultrasound examination in patients with COVID-19 who underwent imaging for suspected DVT. METHODS: Patients who did not require intensive care unit treatment and who underwent ultrasound imaging for suspected DVT between March and December 2020 were included retrospectively. Patient demographics, comorbidities, modified Well's score, and d-dimer results on the day of ultrasound examination were recorded. Parameters for a higher likelihood of a positive DVT result were determined by comparing patients with confirmed DVT on ultrasound examination and patients with negative ultrasound findings. To determine a cut-off for d-dimer levels, a receiver operating characteristic curve was constructed. The sensitivity and specificity of the determined high-risk factors in the prediction of positive ultrasound results were calculated. RESULTS: A positive history for DVT (25% vs 4%; P < .001), thrombophilia (9% vs 2%; P = .048), immobilization (53% vs 23%; P = .001), and a Well's score ≥ 2 (50% vs 21%; P = .001) were more frequent in patients with DVT. The mean d-dimer levels were higher in patients with DVT (3871 ± 1805 vs 2075 ± 1543; P < .001). The presence of either thrombophilia or a d-dimer level of >2020 had a sensitivity of 93% and a specificity of 64%. The presence of either thrombophilia, a d-dimer level of >2020, or a Well's score of ≥2 had a sensitivity of 100% and a specificity of 51%. CONCLUSIONS: Patients with COVID-19 with a d-dimer of >2020, a positive history for thrombophilia, and a Well's score of ≥2 should undergo a timely ultrasound examination. The high risk of DVT should be remembered for all hospitalized patients with COVID-19.

A rare complication after coronary bypass surgery: Incisional pyoderma gangrenosum.

Pyoderma gangrenosum (PG) is a non-infectious, necrotizing, destructive skin disease which is rarely seen after cardiac surgery. This report presents a PG case after coronary bypass surgery.

The relationship between aortic calcification on chest radiograph and neurocognitive impairment after coronary artery bypass grafting.

BACKGROUND: In this study, we aimed to investigate the possible relationship between aortic calcification as detected by preoperative chest radiography and postoperative neurocognitive impairment in patients undergoing coronary artery bypass grafting. METHODS: A total of 124 patients (101 males, 23 females; mean age: 59.9±8.8 years; range, 34 to 84 years) who underwent coronary artery bypass grafting in our clinic between January 2019 and July 2019 were included. Of these patients, 35 whose preoperative chest radiography revealed aortic calcification in the aortic knuckle were included as the patient group. The control group consisted of 89 patients without aortic calcification. The patients with aortic calcification underwent additional imaging with thoracic computed tomography angiography and ascending aorta and aortic arch calcium scores were calculated. Neurocognitive dysfunction was assessed using the Standardized Mini-Mental State Examination. Postoperative delirium was evaluated by confusion assessment method in the intensive care unit. Both groups were compared for demographic, operative and postoperative data. RESULTS: Of all patients included in the study, the overall cerebrovascular event incidence was 3.2%. Although not statistically significant, the number of patients with neurocognitive decline was higher in the patient group than the control group (48.6% vs. 34.8%, respectively; p=0.157). Both Standardized Mini-Mental State Examination score decline and percentage decline were significantly higher in the patients with high aortic arch calcium scores (>2,250 AU). Carotid artery stenosis was 3.2 times higher in the patient group. In the patients with carotid artery stenosis, the aortic arch calcium scores were also higher (p=0.042). CONCLUSION: Aortic calcification detectable on chest radiography with high calcium scores may be associated with neurocognitive impairment and carotid artery stenosis in patients undergoing coronary artery bypass grafting.

Factors associated with excessive bleeding following elective on-pump coronary artery bypass grafting.

INTRODUCTION: Excessive bleeding following cardiac surgery is associated with worse outcomes. We aimed to analyze preoperative and operative factors associated with excessive bleeding in coronary artery bypass patients to better understand which patients are under increased risk. METHODS: The study was conducted as an observational study in a tertiary center for cardiac surgery by retrospective analysis of the hospital database. Patients were grouped according to chest tube output within the postoperative 24 h. Patients in the 4th percentile of chest tube output per kilogram were categorized as having excessive bleeding. Patients with excessive bleeding were compared with the other patients for preoperative and operative factors. Factors significant in univariate analysis were carried onto the multivariate analysis. RESULTS: Patients with excessive bleeding were more likely to be males (91.4% vs. 78.7%, p = .002), have lower body mass index (BMI) (27.4 vs. 29.2, p < .001), and low platelets (6.9% vs. 1.5%, p = .006). Cardiopulmonary bypass (101.8 vs. 110.9 min, p = .022) time was longer in the excessive bleeding group. Patients with excessive bleeding were more likely to have more than three vessels revascularized. Male sex, lower BMI, low platelets, and longer cardiopulmonary bypass time were independently associated with increased bleeding. CONCLUSION: Male sex, lower BMI, low platelet count, and longer cardiopulmonary bypass time are associated with extensive bleeding after elective coronary artery bypass surgery (CABG). Patients with higher bleeding risk should be identified preoperatively to account for adverse outcomes after CABG.

Transposition of brachiobasilic arteriovenous fistulas: One-stage or two-stage technique and factors affecting the early maturation.

The brachiobasilic transposition (BBT) arteriovenous fistula (AVF) is a valuable option especially for dialysis patients with previously failed vascular access. We aim to report factors affecting the maturation of BBT-AVF created with either one-stage or two-stage technique. BBT-AVF procedures between January 2015 and May 2019 by a dedicated vascular access team were investigated retrospectively. A total of 122 patients (63 males, 59 females), with 6 to 12 weeks of follow-up after the BBT-AVF procedure were included in the study. Patients of one-stage and two-stage techniques were compared for maturation rates. Patients with successful and failed maturation were compared for baseline characteristics and anatomic factors. Of 122 BBT-AVF procedures, 54 were created with the one-stage and 68 were created with the two-stage technique. The mean age of the patients was 58.2 ± 13.8, the mean brachial artery and basilic vein diameters were 3.91 ± 1.02 mm, and 3.39 ± 1.16 mm. Of 122 included patients, 88 (72.1%) had mature AVFs at follow-up. The AVF maturation rates were similar between the one- and two-stage groups (70.4% vs 73.5%; P = .699). Lower age (62.8 ± 12.5 vs 56.5 ± 13.9; P = .023) and greater brachial artery diameter (3.09 ± 0.84 mm vs 4.23 ± 1.76 mm; P < .048) were the only factors affecting the AVF maturation in univariate analysis. Gender, extremity side, diabetes mellitus, hypertension, and targeted vein diameter were not found to affect the AVF maturation (P = .301, P = .084, P = .134, P = .858, P = .127). Target artery diameter (P = .049) was the only significant factor affecting BBT-AVF maturation in multivariate analysis. One-stage and two-stage BBT-AVFs are similar in terms of maturation rates. Targeted artery diameter was the only factor important in BBT-AVF maturation in our study group. The two-stage technique can be preferred considering smaller incision size and lower complication rate in patients with suitable anatomy.

An Alternative Technique for Ascending and Arcus Aorta Repair in Case of Vascular Diameter Mismatch.

Complicated Type A intramural hematoma involving the arcus aorta requires emergency correction of the aortic arch. Surgical options include reimplantation of the brachiocephalic vessels as an island to a vascular graft, debranching aortic arch surgery, and Kazui technique. This report describes a modified technique for aortic arch repair in a patient with vascular diameter mismatch between the ascending and descending aorta, as well as an intimal tear between the brachiocephalic vessels.