Comparison of Endovenous Laser and Radiofrequency Ablation in Treating Varices in the Same Patient.

Introduction: To compare endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) in different legs in the same individual in patients with venous insufficiency. Methods: Sixty patients with bilateral saphenous vein insufficiency were included. EVLA or RFA was applied to one of the patient's legs and RFA or EVLA to the other leg. Results: EVLA and RFA complications were hyperemia at 20.7% and 31.0%, ecchymosis at 31.0% and 51.7% and edema at 27.6% and 65.5%, respectively. The rate of recanalization was 6.8% in the RFA group. No recanalization was observed in EVLA group. The level of patients satisfied with EVLA was 51.7%, compared to 31.0% for RFA, while 17.2% of patients were satisfied with both procedures. Times to return to daily activity were 0.9 days in the EVLA group and 1.3 days in the RFA group. Conclusion: EVLA procedure may be superior to RFA in certain respects.

A new non-tumescent endovenous ablation method for varicose vein treatment: Early results of N-butyl cyanoacrylate (VariClose®).

Objective This report aims to present the early results of a retrospective study of the use of N-butyl cyanoacrylate (VariClose®)-based non-tumescent endovenous ablation for the treatment of patients with varicose veins. Method One hundred and eighty patients with varicose veins due to incompetent saphenous veins were treated with the VariClose® endovenous ablation method between May 2014 and November 2014. The patient sample consisted of 86 men and 94 women, with a mean age of 47.7 ± 11.7 years. The patients had a great saphenous vein diameter greater than 5.5 mm and a small saphenous vein diameter greater than 4 mm in conjunction with reflux for more than 0.5 s. Patients with varicose veins were evaluated with venous duplex examination, Clinical, Etiological, Anatomical and Pathophysiological classification (CEAP), and their Venous Clinical Severity Scores were recorded. Results The median CEAP score of patients was three, and the saphenous vein diameters were between 5.5 and 14 mm (mean of 7.7 ± 2.1 mm). A percutaneous entry was made under local anesthesia to the great saphenous vein in 169 patients and to the small saphenous vein in 11 patients. Duplex examination immediately after the procedure showed closure of the treated vein in 100% of the treated segment. No complications were observed. The mean follow-up time was 5.5 months (ranging from three to seven months). Recanalization was not observed in any of the patients during follow-up. The average Venous Clinical Severity Scores was 10.2 before the procedure and decreased to 3.9 after three months (p < 0.001). Conclusion The application of N-butyl cyanoacrylate (VariClose®) is an effective method for treating varicose veins; it yielded a high endovenous closure rate, with no need for tumescent anesthesia. However, long-term results are currently unknown.

Comparison of Endovenous Laser and Radiofrequency Ablation in Treating Varicose Veins in the Same Patient.

PURPOSE: To compare endovenous laser ablation (EVLA) and radiofrequency venous ablation (RFA) in different legs in the same patients with venous insufficiency. METHODS: Sixty patients with bilateral saphenous vein insufficiency were included. Endovenous laser ablation or RFA was applied to one of the patient's legs and the remaining procedure, RFA or EVLA, to the other leg. RESULTS: Minor complications in EVLA and RFA were hyperemia at 20.7% and 31.0%, ecchymosis at 31.0% and 51.7% and edema at 27.6% and 65.5%, respectively. The rate of recanalization was 6.8% in the RFA group. No recanalization was observed in the EVLA group. The level of patients satisfied with EVLA was 51.7%, compared to 31.0% for RFA, while 17.2% of patients were satisfied with both the procedures. Times to return to daily activity were 0.9 days in the EVLA group and 1.3 days in the RFA group. CONCLUSION: The EVLA procedure may be superior to RFA in certain respects.

Which prosthesis is more resistant to vascular graft infection: polytetrafluoroethylene or Omniflow II biosynthetic grafts?

PURPOSE: The aim of this study was to determine whether polytetrafluoroethylene grafts or Omniflow II biosynthetic grafts are more resistant to infection caused by Staphylococcus aureus. METHODS: Sixty rats were divided into six groups. In Groups 1A, 1B and 1C, a polytetrafluoroethylene graft was implanted in each rat, and, in Groups 2A, 2B and 2C, a biosynthetic graft was implanted in each rat. Staphylococcus aureus was inoculated into Groups 1B, 1C, 2B and 2C, and the rats in Groups 1C and 2C were treated with teicoplanin. One week later, the rats were euthanized, the grafts were removed and a microbiological count was performed. A histopathological examination was subsequently carried out, and the C-reactive protein, prealbumin and leukocyte levels were investigated. RESULTS: There were no significant differences in the C-reactive protein, prealbumin and leukocyte levels. The differences in the results of the microbiological evaluations between the groups were significant. The quantitative culture results showed no bacterial growth in Groups 1A, 1C and 2A. The number of bacteria in Group 1B was statistically lower than that in Group 2B. When the groups receiving treatment were compared, Group 2C had bacterial growth, whereas Group 1C did not. The histopathological examinations showed similar results. CONCLUSIONS: Omniflow II grafts are more susceptible to infection than polytetrafluoroethylene grafts.

Evaluation of left atrial mechanical function and atrial conduction abnormalities in Maras powder (smokeless tobacco) users and smokers.

OBJECTIVE: In Turkey, a type of smokeless tobacco called Maras powder (MP) is widely used in the south-eastern region. Smokeless tobacco is found in preparations for chewing and for absorption by the nasal and oral mucosae. The purpose of this study was to investigate whether MP damages intra- and inter-atrial conduction delay and left atrial (LA) mechanical function as much as cigarette smoking. METHOD: A total of 150 chronic MP users (50 males, 32.5 ± 5.4 years), smokers (50 males, 32.1 ± 6.0 years) and controls (50 males, 30.1 ± 5.8 years) were included in the study. LA volumes were measured echocardiographically according to the biplane area-length method. Atrial electromechanical coupling was measured with tissue Doppler imaging and LA mechanical function parameters were calculated. RESULTS: The LA passive emptying fraction was significantly decreased and LA active emptying volume (LAAEV) was significantly increased in the MP group (p = 0.012 and p = 0.024, respectively), and the LA active emptying fraction (LAAEF) was significantly increased in the smokers (p = 0.003). There was a positive correlation between the amount of MP used and smoking (pack years) with LAAEV and LAAEF (r = 0.26, p = 0.009 and r = 0.25, p = 0.013, respectively). Lateral atrial electromechanical intervals (PA) were significantly higher in MP users, and the septal mitral PA was statistically higher in the smokers (p = 0.05 and p = 0.04, respectively). CONCLUSION: We suggest that atrial electromechanical coupling intervals were prolonged and LA mechanical function was impaired in MP users and smokers, but there was no significant difference between the MP users and smokers. These findings may be markers of subclinical cardiac involvement and tendency for atrial fibrillation.

A Comparison of 1,470-nm Endovenous Laser Ablation and Radiofrequency Ablation in the Treatment of Great Saphenous Veins 10 mm or More in Size.

BACKGROUND: To compare 1,470-nm endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) in the treatment of patients with great saphenous vein diameters of 10 mm or more. METHODS: One hundred twenty consecutive patients presenting to the cardiovascular surgery department with a great saphenous vein diameter exceeding 10 mm at the saphenofemoral junction between January and December 2013 were included in the study. The first randomly selected 60 patients (group 1) received 1,470-nm EVLA and the other 60 patients (group 2) received RFA. Patients were assessed on the second day, the first week, and the first, third, and sixth months. Major and minor complications were recorded. RESULTS: Minor complications in EVLA and RFA were hyperemia at 20% and 30% (P = 0.50), ecchymosis at 16.7% and 48.3% (P = 0.02), and edema at 40.0% and 65.5% (P < 0.08), respectively. No major complication was observed in any patient. Recanalization developed during monitoring in 3 patients in the RFA group, a rate of 5%. No recanalization was observed in the EVLA group. Success rates in the EVLA and RFA groups were 100% and 95%, respectively. Mean time to return to daily activity was 0.7 days in the EVLA group and 1.4 days in the RFA group (P < 0.006), whereas mean time to return to work was 1.8 days in the EVLA group and 2.2 days in the RFA group (P < 0.07). There was no statistically significant difference between the groups in terms of pain during the procedure or postoperatively. Less pain was reported in the EVLA during both (P < 0.02). CONCLUSIONS: EVLA using a 1,470-nm radial fiber is superior to RFA in the treatment of saphenous veins larger than 10 mm in diameter.

Efficacy of linezolid, teicoplanin, and vancomycin in prevention of an experimental polytetrafluoroethylene graft infection model caused by methicillin-resistant Staphylococcus aureus.

BACKGROUND: The aim of this study was to evaluate the effectiveness of linezolid, teicoplanin, and vancomycin in prevention of prosthetic vascular graft infections in a vascular graft infection model. MATERIAL AND METHODS: Fifty rats were divided into 5 groups. A polytetrafluoroethylene graft was implanted on the back of each rat. Methicillin-resistant Staphylococcus aureus (MRSA) strain was inoculated into all rats except Group 1. Group 2 was not given any treatment, Group 3 received linezolid, Group 4 received vancomycin, and Group 5 received teicoplanin. The grafts were removed for microbiological and histological examinations on the 7th day. In addition, C-reactive protein and prealbumin levels and leukocyte counts in obtained blood specimens were determined. RESULTS: Group 1 did not have infection. Group 2 had bacteria 5.7 × 10(4) CFU/cm(2). Group 3 and Group 4 had less bacterial growth. Group 5 had no bacterial growth. The number of bacteria was significantly higher in Group 2 than in the other experimental groups and the control group (p<0.001). Although there was no bacterial growth in Group 5, it did not significantly differ from Group 3 and Group 4. Group 2 had a significantly higher CRP level and leukocyte count and a significantly lower prealbumin level than the other groups. CONCLUSIONS: Linezolid, teicoplanin, and vancomycin are effective in prevention of prosthetic vascular graft infections.

Evaluation of Tp-e interval and Tp-e/QT ratio in patients with ankylosing spondylitis.

OBJECTIVES: Ankylosing spondylitis (AS) is a chronic multi-systemic inflammatory rheumatic disorder. Several studies have suggested that the interval from the peak to the end of the electrocardiographic T wave (Tp-e) may correspond to the transmural dispersion of repolarization and that increased Tp-e interval and Tp-e/QT ratio are associated with malignant ventricular arrhythmias. The aim of this study was to evaluate ventricular repolarization by using Tp-e interval and Tp-e/QT ratio in patients with AS, and to assess the relation with inflammation. METHODS: Sixty-two patients with AS and 50 controls were included. Tp-e interval and Tp-e/QT ratio were measured from a 12-lead electrocardiogram, and the Tp-e interval corrected for heart rate. The plasma level of high sensitive C-reactive protein (hsCRP) was measured. These parameters were compared between groups. RESULTS: In electrocardiographic parameters analysis, QT dispersion (QTd) and corrected QTd were significantly increased in AS patients compared to the controls (31.7 ± 9.6 vs 28.2 ± 7.4 and 35.8 ± 11.5 vs 30.6 ± 7.9 ms, P = 0.03 and P = 0.007, respectively). cTp-e interval and Tp-e/QT ratio were also significantly higher in AS patients (92.1 ± 10.2 vs 75.8 ± 8.4 and 0.22 ± 0.02 vs 0.19 ± 0.02 ms, all P values <0.001). cTp-e interval and Tp-e/QT ratio were significantly correlated with hsCRP (r = 0.63, P < 0.001 and r = 0.49, P < 0.001, respectively). CONCLUSIONS: Our study revealed that Tp-e interval and Tp-e/QT ratio were increased in AS patients. These electrocardiographic ventricular repolarization indexes were significantly correlated with the plasma level of hsCRP.

Predictive value of aortic knob width for postoperative atrial fibrillation in coronary artery bypass surgery.

OBJECTIVE: The aim of our study was determine whether aortic knob width (AKW) is associated with the development of atrial fibrillation (AF) after isolated coronary artery bypass surgery (CABG). METHODS: In this retrospective observational cohort study, we evaluated 135 patients without hemodynamically significant valvular problems. AKW was measured on chest X-ray by digital system. Multiple logistic regression analysis was used to find independent associates of postoperative AF (POAF). The diagnostic value of AKW was assessed using ROC analysis. RESULTS: POAF occurred in 43 (31.8%) of all patients. The age, AKW, left atrial (LA) diameter and C-reactive protein (CRP) were significantly higher in patients with POAF than without POAF (67.2 ± 8.6 vs 61.3 ± 9.8 years, p=0.004; 45.6 ± 5.8 vs 36.1 ± 3.8 mm, p<0.001; 37.9 ± 3.5 vs 35.8 ± 3.1mm, p=0.002 and 10.6 ± 8.5 vs 5.6 ± 6.5 mg/L, p=0.001 respectively). Multiple logistic regression analysis demonstrated that AKW, LA diameter and CRP were independently associated with POAF (OR=4.527, 95% CI=1.315 -15.588, p=0.017; OR=2.834, 95% CI=1.091-7.360, p=0.032 and OR=1.300, 95% CI=1.038-1.628, p=0.022 respectively). ROC analysis has demonstrated that aortic knob of 36.5 mm constitutes the cut-off value for the occurrence of POAF with 84.4% sensitivity and 64.6% specificity (AUC=0.84, 95% CI=0.75-0.94, p<0.001). CONCLUSION: We have demonstrated a significant association between the AKW and AF development after isolated CABG. PA chest radiography is a cheap and readily available clinical tool and it can be examined easily by every cardiovascular surgeons.

Usefulness of the mean platelet volume for predicting new-onset atrial fibrillation after isolated coronary artery bypass grafting.

Postoperative atrial fibrillation (AF) is a common complication of coronary artery bypass grafting (CABG). The mean platelet volume (MPV) is an important marker of platelet activity and is associated with cardiovascular risk factors. We investigated whether the MPV is associated with the development of AF after CABG. This study included 208 patients undergoing elective isolated CABG. We evaluated the standard preoperative 12-lead electrocardiograph (ECG) recorded at a paper speed of 25 mm/s obtained for each patient from our hospital records before surgery. All study patients underwent standard CABG requiring cardiopulmonary bypass without concurrent valvular surgery. Forty-three patients were excluded. After CABG, all patients were monitored by telemetry and 12-lead ECGs. AF was defined using the established Society of Thoracic Surgeons definition. Postoperative AF occurred in 38 (22%) patients. The hemoglobin and platelet and leukocyte counts were similar in the groups with and without AF. However, the MPV and neutrophil/lymphocyte ratio were significantly higher in the AF group (8.9 [1.4] vs. 7.9 [1.2], p < 0.001 and 3.2 ± 1.9 vs. 2.6 ± 1.2, p = 0.005, respectively). In addition, the C-reactive protein (CRP) levels were significantly higher in the AF group (8.9 [19.6] vs. 5.3 [8.7], p = 0.025). Multivariate logistic regression analysis showed that MPV and CRP were independent predictors of postoperative AF (odds ratio [OR] 2.564, 95% confidence interval [CI] 1.326-4.958, p = 0.005; OR 1.055, 95% CI 1.000-1.114, p = 0.050, respectively). Our results show that increased platelet activity is associated with the development of AF after CABG.

Effects of smokeless tobacco (Maras powder) use on carotid intima media thickness.

BACKGROUND: The aim of this study was to investigate the effects of smokeless tobacco (Maras powder, Nicotiana rustica Linn) on carotid intima media thickness. MATERIAL/METHODS: The study included 32 Maras powder users presenting to our Family Medicine outpatient clinic and 30 non-users of Maras powder as a control group. Carotid intima media thickness was measured by duplex ultrasonography. RESULTS: The mean age of the Maras powder users was 45.4±11.3 years and the mean age of the control group was 46.3+11.6 years. All the participants were male. The mean duration of Maras powder use was 27.3±11.6 years. Carotid intima media thickness was 0.73±0.20 mm in the Maras powder users and 0.49±0.14 mm in the controls. It was significantly higher in the Maras powder users (p<0.001). Blood pressure measured before Maras powder use in Maras powder users was similar to that measured in the control group (p>0.05). Systolic blood pressure and diastolic blood pressure values were also similar between MP users before using Maras powder and controls (p>0.05). Systolic blood pressures were 136.6±12.4 mmHg and 109.7±9.7 mmHg after 30-60 minutes using Maras powder in the Maras powder users and in the controls, respectively. Diastolic blood pressures were 87.2±6.1 mmHg and 62.8±8.1 mmHg after 30-60 minutes using Maras powder in the Maras powder users and the controls, respectively. Both systolic and diastolic blood pressures after 30-60 minutes using Maras powder were significantly higher in the Maras powder users (p<0.001). Carotid intima media thickness was significantly correlated with systolic blood pressure (r=0.613, p<0.001) and diastolic blood pressure (r=0.612, p<0.001). CONCLUSIONS: Carotid intima media thickness was higher in Maras powder users than in nonusers of the powder. Increased carotid intima media thickness can be associated with an immediate increase in systolic and diastolic blood pressures. Therefore, attempts to increase public awareness about smoking should also be directed towards prevention of Maras powder use.

Evaluation of Tp-e interval and Tp-e/QT ratio in patients with ankylosing spondylitis.

OBJECTIVES: Ankylosing spondylitis (AS) is a chronic multi-systemic inflammatory rheumatic disorder. Several studies have suggested that the interval from the peak to the end of the electrocardiographic T wave (Tp-e) may correspond to the transmural dispersion of repolarization and that increased Tp-e interval and Tp-e/QT ratio are associated with malignant ventricular arrhythmias. The aim of this study was to evaluate ventricular repolarization by using Tp-e interval and Tp-e/QT ratio in patients with AS, and to assess the relation with inflammation. METHODS: Sixty-two patients with AS and 50 controls were included. Tp-e interval and Tp-e/QT ratio were measured from a 12-lead electrocardiogram, and the Tp-e interval corrected for heart rate. The plasma level of high sensitive C-reactive protein (hsCRP) was measured. These parameters were compared between groups. RESULTS: In electrocardiographic parameters analysis, QT dispersion (QTd) and corrected QTd were significantly increased in AS patients compared to the controls (31.7 ± 9.6 vs 28.2 ± 7.4 and 35.8 ± 11.5 vs 30.6 ± 7.9 ms, P = 0.03 and P = 0.007, respectively). cTp-e interval and Tp-e/QT ratio were also significantly higher in AS patients (92.1 ± 10.2 vs 75.8 ± 8.4 and 0.22 ± 0.02 vs 0.19 ± 0.02 ms, all P values <0.001). cTp-e interval and Tp-e/QT ratio were significantly correlated with hsCRP (r = 0.63, P < 0.001 and r = 0.49, P < 0.001, respectively). CONCLUSIONS: Our study revealed that Tp-e interval and Tp-e/QT ratio were increased in AS patients. These electrocardiographic ventricular repolarization indexes were significantly correlated with the plasma level of hsCRP.

A rare complication of endovenous laser ablation: intravascular laser catheter breakage.

During endovenous laser ablation, which is performed as an alternative to surgery for the treatment of superficial venous insufficiency of lower extremity and associated varicose veins, it was realised that the distal end of the catheter protecting the fibre sheared off; the retained catheter fragment in the saphenous vein was removed by a mini incision. Herein, we aim to present a rare complication of endovenous laser ablation.

Infective endocarditis developing serious multiple complications.

A 20-year-old female patient with no history of heart disease presented to the hospital with high fever, cough and sputum. On the third day of hospitalisation, left facial paralysis developed and cranial revealed an infarct in the right frontoparietotemporal lobe. Transthoracic echocardiography revealed 1.5 × 2 cm-sized vegetation on the mitral valve and severe mitral regurgitation. On the 11th day of hospitalisation, multiple emboli were shown to be present in the left iliac artery. Since the patient had recurrent septic emboli despite 3 weeks of treatment, a surgical intervention was planned. The vegetation was removed and the mitral valve was replaced by mechanical prostheses. During the postoperative period, acute renal failure developed in the patient. The treatment was completed in 6 weeks with full recovery. This case confirms that infective endocarditis may present with various clinical situations, and that a high index of suspicion and surgical intervention, in addition to aggressive antibiotic therapy, is lifesaving.

Right coronary artery originating from left anterior descending artery: a case report.

Right Coronary Artery (RCA) originating from left anterior descending artery is a very rare congenital coronary artery anomaly. A 66-year-old man presented with hypertension and complaints of exertional chest pain. The angiography was performed. Aortic root angiography showed no coronary ostium originating from the right sinus of valsalva. Right coronary artery was visualized as anomalously originating from the midportion of left anterior descending artery. Severe stenosis were seen in ostium of anomalous right coronary artery, in midportion of left anterior descending and in midportion of circumflex artery. The patient was referred for coronary artery bypass grafting. The patient underwent coronary artery bypass surgery for three vessels. He was discharged home on postoperative day 7 without any complication. His echocardiogram on follow-up visit revealed good biventricular function.