Radiofrequency ablation of the great saphenous vein; does the choice of monopolar or bipolar catheters affect outcomes?

OBJECTIVES: Radiofrequency-based procedure is one of the leading methods of endovenous thermal ablation. The most fundamental difference with regards to currently available radiofrequency ablation systems is the way of electric current flow given to the vein wall; bipolar segmental and monopolar ablation. This study aimed to compare the monopolar ablation method with conventional bipolar segmental endovenous radiofrequency ablation method for the management of incompetent saphenous veins. METHODS: Between November 2019 and November 2021, 121 patients with incompetent varicose veins who were treated either with the F-Care/monopolar (N = 49) or ClosureFast/bipolar (N = 72) were included in the study. A single extremity of each patient with isolated great saphenous vein insufficiency was enrolled. The differences between the two groups in demographic parameters, disease severity, treated veins, peri- and postoperative complications, and treatment efficacy indicators were retrospectively evaluated. RESULTS: There was no statistically significant difference between the groups regarding demographic parameters, disease severity, and treated veins in preoperative period (p > 0,05). The average procedural time was 21.4 ± 4 minutes in the monopolar group, while it was 17.1 ± 3 minutes in the bipolar group. In both groups, the venous clinical severity scores declined significantly compared with the preoperative period, however; there was no difference between groups (p > 0,05). The occlusion rate of the saphenofemoral junction and proximal saphenous vein after 1 year was 94.1% in the bipolar group and 91.8% in the monopolar group (p = 0.4) while there was a significant difference in the occlusion rate of the shaft and distal part of the saphenous vein (93.2% in the bipolar group and 80.4% in the monopolar group, p = 0.04). Postoperative complications (bruising and skin pigmentation) were slightly higher in the bipolar group (p = 0.02, p = 0.01). CONCLUSIONS: Both systems are effective in treating the venous insufficiency of the lower extremity. Monopolar system revealed a better early postoperative course with similar occlusion rate of the proximal part of saphenous vein compared with bipolar system, however; the occlusion of the lower half of the saphenous vein was significantly lower which may negatively affect long-term occlusion rates and recurrence of the disease.

The effects of pharmacomechanical thrombectomy on novel complete blood count parameters in deep vein thrombosis: A retrospective study.

This study aimed to investigate the effects of pharmacomechanical thrombectomy on novel complete blood count parameters in deep venous thrombosis. This retrospective study included 242 patients aged >18 years who were treated for deep venous thrombosis. Patients were grouped as follows: group 1 was accepted as having interventional operations (n = 123) and group 2 was accepted as having only medical advice (n = 119). Routine complete blood count parameters, the neutrophil-to-lymphocyte ratio (NLR), and the platelet-to-lymphocyte ratio (PLR) were compared. There was no difference between the groups in terms of admission hemoglobin, hematocrit, mean platelet volume, NLR and PLR (P = .11, P = .24, P = .55, P = .93, and P = .96, respectively). In the pharmacomechanic thrombectomy group, NLR and PLR were significantly reduced after intervention when compared to the admission values (P < .001 and P < .001, respectively). However, the NLR and PLR values of medically treated patients did not differ significantly from their baseline values (P = .16 and P = .08, respectively). In this study, we effectively removed the thrombus load in blocked proximal veins using pharmacomechanical thrombectomy and observed a significant decrease in NLR and PLR, which are current, inexpensive, and accessible parameters.

Effect of tandem lesions on haemodynamic parameters: an experimental study.

BACKGROUND: The morphology and extensity of the stenotic lesion is crucial as well as the obstruction ratio. It is well known that the complexity of lesions has a direct impact on endovascular treatment (PTCA/stent); however, the arrangement of the lesions is underestimated and not well studied. AIM: We sought to evaluate the haemodynamic effects of different stenotic lesion models and arrangements in vitro. METHODS: Vascular circulation was simulated in vitro. Oxygenator, tubing set, polytetrahidroflouroethylene synthetic graft, pressure and flow rate, sensors were used to build the simulation model. Measurements of isolated short, isolated long, identical stenotic tandem short, identical stenotic tandem long, sub-critical long, and critical short lesion combinations were performed and haemodynamic parameters were recorded. RESULTS: Tandem lesions were more likely to result in critical stenosis comparing single lesions with the same obstruction ratio. This difference became more significant as the obstruction ratio was raised. Tandem long lesions also resulted in more critical stenosis than tandem short lesions. It can be claimed that tandem lesions can result in more flow restriction with reference to single lesions with the same stenotic ratio. Contrary to expectations, tandem short lesions were found to be more stenotic compared with the same degree long individual lesions. CONCLUSIONS: It is effortless to give the decision for simple, discrete and individual lesions, while the ideal decision for long and complicated lesions may remain unclear. Even if these "grey zone" lesions are considered non-critical while investigating them one by one, it must be kept in mind that the overall stenotic effect of these lesions may lead to more haemodynamic impairment.

Pentamidine in Pneumocystis jirovecii prophylaxis in heart transplant recipients.

Despite advances in transplantation techniques and the quality of post-transplantation care, opportunistic infections remain an important cause of complications. Pneumocystis jirovecii (P. jirovecii) is an opportunistic organism, represents an important cause of infections in heart transplantation patients. Almost 2% to 10% of patients undergoing cardiac transplantation have Pneumocystis pneumonia. Prophylaxis is essential after surgery. Various prophylaxis regimes had been defined in past and have different advantages. Trimethoprim/sulfamethoxazole (TMP/SMX) has a key role in prophylaxis against P. jirovecii. Generally, although TMP/SMX is well tolerated, serious side effects have also been reported during its use. Pentamidine is an alternative prophylaxis agent when TMP/SMX cannot be tolerated by the patient. Structurally, pentamidine is an aromatic diamidine compound with antiprotozoal activity. Since it is not effectively absorbed from the gastrointestinal tract, it is frequently administered via the intravenous route. Pentamidine can alternatively be administered through inhalation at a monthly dose in heart transplant recipients. Although, the efficiency and safety of this drug is well studied in other types of solid organ transplantations, there are only few data about pentamidine usage in heart transplantation. We sought to evaluate evidence-based assessment of the use of pentamidine against P. jirovecii after heart transplantation.

Coronary artery bypass grafting in the octogenarians: should we intervene, or leave them be?

OBJECTIVE: Coronary artery bypass grafting (CABG) is gradually increasing in the elderly population. We aimed to investigate the risk factors and the results of CABG along with the long term survival in patients at an age of 80 and older. METHODS: Between January 2002 and December 2011, a total of 101 consecutive patients at an age of 80 and older who underwent CABG in our hospital were included in the study. The patients were followed and the long-term survival was estimated. RESULTS: The mean age of the patients was 82.98 ± 2.27 years. Sixty-four (63.4%) were males and 37 (36.6%) were females. Emergency surgery, duration of cardiopulmonary bypass, the intensive care unit (ICU) stay, inotropic support, intra aortic balloon pulsation application, amount of erythrocyte transfusion and fresh frozen plasma transfusion and ventilation period were significantly higher in the patients who died in the hospital. The duration of cardiopulmonary bypass (CPB) was found to be an independent predictor of mortality (OR: 1.18, 95% CI 1.01-1.38, P = 0.034). The in-hospital mortality was 16.8%. Kaplan-Meier analyses revealed a survival ratio of 91.3% at one year, 82.9% at three years and 69.0% at five years. CONCLUSIONS: Patients at the age of 80 and older can be candidates for the CABG procedure bearing in mind that they may have a longer ventilation period and intensive care unit stay. The morbidity and mortality of this age group is considered within an acceptable range. Approaches to minimize CPB, or the choice of off-pump surgery, may be a preventive method to lower the incidence of mortality. Hence, CABG may be performed in this age group with a satisfactory survival ratio.

Long-term patency of autogenous saphenous veins vs. PTFE interposition graft for prosthetic hemodialysis access.

OBJECTIVE: Prosthetic vascular access is the other choice when the superficial venous system is inadequate to perform a simple radio-cephalic and brachio-cephalic fistula. METHODS: This paper reports the outcomes of a prospective cohort study of 54 patients who underwent either saphenous vein (SVI Group, n=29) or PTFE graft (PTFE Group, n=25) interposition surgery for prosthetic hemodialysis access. All patients were evaluated via color Doppler ultrasonography during preoperative course and superficial venous systems of these patients were found inadequate to perform simple radial/brachial artery-cephalic vein anastomosis. Follow-up was performed for every 6-months period. Kaplan-Meier analysis and Log Rank test was used for estimation and comparison of the patency. RESULTS: In SVI group access failure was observed in 5 of 29 patients (17.2%). In PTFE group, access failure was observed in 13 of the 25 patients (52%). Primary patency rate was 93% in 12th month and 82% in 24th month in SVI group while it was 88% in 12th month and 56% in 24th month in PTFE group. According to the Kaplan-Meier method, mean time of primary patency was significantly higher in SVI group when compared to PTFE group (33.03±1.32 months vs. 28.16±1.91 months, Log Rank chi-square value: 7.01, df:1, p=0.008). Secondary patency rate was 96% in 12th month and 93% in 24th month for SVI group while 96% in 12th month and 84% in 24th month for PTFE group. According to the Kaplan-Meier method, mean time of secondary patency was significantly higher in SVI group when compared to PTFE group (34.27±0.95 months vs. 31.16±1.40 months, Log Rank chi-square value: 7.33, df:1, p=0.007). CONCLUSION: Autologous saphenous vein can be preferably chosen as a prosthetic hemodialysis access graft due its higher primary and secondary patency, lower complication rate and cost when compared with PTFE grafts.

Surgical strategy for moderate ischemic mitral valve regurgitation: repair or ignore?

BACKGROUND: Ischemic heart disease is a significant complication of atherosclerosis. Myocardial infarction after the development of coronary artery disease can lead to a number of serious complications, including ischemic mitral regurgitation (IMR). Currently there is no consensus regarding the preferred therapeutic modality for moderately severe IMR. In this study, the postoperative outcome of concomitant coronary artery bypass (CABG) and mitral valve repair was compared with that of CABG alone in two groups of patients with moderately severe IMR. METHODS: A total of 84 patients who underwent operations for coronary artery disease and moderately severe IMR were included in the study. Preoperative demographic and clinical characteristics were recorded at the time of admission. The severity of mitral regurgitation was graded using transthoracic echocardiography and left ventriculography. RESULTS: Significant postoperative improvements were observed in ejection fraction and systolic diameter compared to preoperative values (P = .006 and P = .020 respectively, in the intervention group, P = .001 and P = .001 respectively, in the control group). The decrease in pulmonary artery pressure (PAP) was significant only in the intervention group (P = .001). There was a significantly marked reduction in the severity of IMR in the intervention group compared to control. CONCLUSION: Surgical repair of the mitral valve in conjunction with CABG for moderately severe IMR appears to be more effective than isolated CABG for certain outcome parameters, including decreased severity of mitral regurgitation and decreased pulmonary artery pressure.

The Sorin Freedom SOLO stentless tissue valve: early outcomes after aortic valve replacement.

We prospectively evaluated the hemodynamic performance of the SORIN Freedom SOLO aortic bioprosthesis, a stentless bovine pericardial valve designed for supra-annular implantation. Forty patients (mean age, 71.68 ± 5.25 yr; 29 men) with severe aortic stenosis underwent aortic valve replacement from January 2008 through August 2009. Patients were evaluated by transthoracic echocardiography and clinical examination, both preoperatively and again at 6 and 24 postoperative months. Peak and mean transvalvular gradients, end-diastolic and end-systolic diameters, interventricular septal and posterior wall thicknesses, indexed volumes of ventricular mass, degrees of aortic regurgitation, and left ventricular ejection fractions were calculated echocardiographically. The valves were implanted with single polypropylene sutures. In the early postoperative period, 1 patient (2.5%) died of multiorgan failure. The mean aortic cross-clamp time was 86.05 ± 34.2 min. Echocardiographic peak gradients were 84.54 ± 16.85 mmHg (preoperative), 29.59 ± 6.27 mmHg (6 mo postoperative), and 24.33 ± 4.67 mmHg (24 mo postoperative) (P < 0.001); left ventricular mass indices were 176.26 ± 39.98 g/m(2) (preoperative), 139.21 ± 30.1 (6 mo postoperative), and 120.51 ± 23.88 g/m(2) (24 mo postoperative) (P < 0.001). During follow-up, the maximum aortic insufficiency recorded was trace, and no valve dysfunctions were observed. Temporary thrombocytopenia was documented in all patients during early postoperative follow-up (lowest level at day 3); recovery to preoperative levels occurred by day 10. The Freedom SOLO aortic bioprosthesis is an easy-to-implant valve with excellent hemodynamic performance. The thrombocytopenia appears to be a transient laboratory finding.

Inhaled pentamidine for Pneumocystis jiroveci prophylaxis in a heart transplant recipient with allergy for trimethoprim sulfamethoxazole.

Pneumocystis jiroveci is an important cause of mortality and morbidity among heart transplant recipients. This raises the question of prophylactic treatment for this infection. Trimethoprimsulfamethoxazole is commonly used in P. jiroveci pneumonia prophylaxis with mild to severe adverse effects. We present the use of inhaled pentamidine as P. jiroveci prophylaxis in a patient with an allergy to trimethoprim sulfamethoxazole.