Twelve-month efficacy and complications of cyanoacrylate embolization compared with radiofrequency ablation for incompetent great saphenous veins.

OBJECTIVE: In this study, the clinical results of radiofrequency ablation (RFA) and n-butyl-cyanoacrylate embolization (CAE) methods were compared in the treatment of incompetent great saphenous veins (GSVs). METHODS: We analyzed retrospectively 244 patients (128 patients in the RFA group, 116 patients in the CAE group) with incompetent GSVs who were treated with RFA and CAE according to the patients' choice between June 2013 and June 2016. All patients were thoroughly examined preoperatively and at 1, 3, 6, and 12 months after the operation, and the clinical results and the quality of life were evaluated. Color Doppler ultrasound (CDUS) results were compared between two groups after the operation and at 12 months. Complete vein occlusion was defined as the success of the treatment. RESULTS: There was no significant difference between patients treated with RFA or CAE in terms of demographic and clinical features. In CDUS after operation, total occlusion was detected in the saphenous vein in both groups. At the 12-month CDUS, complete occlusion of the GSV was observed in 99.5% of the CAE group and 96.6% of the RFA group (P = .072). Skin burn, which we consider a major complication, occurred only in one patient. No other major complications were seen in either group. Severe pain, ecchymosis, and sensitivity were the most common of the side effects, and these were significantly higher in RFA group than in CAE group. Severe pain occurred in 12.5% of the RFA patients and 4.3% of the CAE patients (P = .042), ecchymosis occurred in 20.3% of the RFA patients and 12% of the CAE patients (P = .044), and sensitivity occurred in 21.9% of the RFA patients and 12.1% of the CAE patients (P = .038), respectively. CONCLUSIONS: Based on the present data, our findings suggest that CAE is as effective as RFA ablation with similar rates of successful occlusion and can be associated with less pain and fewer complications than RFA; it also may yield better patient comfort. The current results should be verified with further randomized, controlled trials with longer term follow-up and larger patient groups.

Treatment of Aortic and Iliac Artery Aneurysms with Multilayer Flow Modulator: Single Centre Experiences.

OBJECTIVE: Presenting early and midterm results of aortic and iliac artery aneurysms treated with Multilayer Flow Modulators (MFM). METHODS: We retrospectively reviewed the medical records of 23 patients (19 males and 4 females) who are admitted to our clinic between April of 2014 and February of 2016, diagnosed with thoracoabdominal aortic aneurysm and/or iliac aneurysm, and treated using MFM. The patients were followed up for the development of potential clinical presentations for 12 months. RESULTS: MFM implantation was successfully completed in all the patients. During the process, two patients developed endoleak and so they were treated with postdilatation that was performed through balloon intervention, whereby the patients fully recovered. Although a short-term ischemic cerebrovascular event occurred in one of the patients 36 hours after the MFM, the patient recuperated without any noticeable neurological sequelae. Overall, three patients died after the procedure, one of whom died in hospital three days following the intervention due to acute renal failure, while the second one lost his life at the end of the first month due to the occlusion of superior mesenteric and celiac arteries. The third patient died at the end of the third month due to acute myocardial infarction. The rest of the patients developed no complications or had no mortality at their 12-month follow-ups. CONCLUSION: MFM can be preferred as an alternative approach in the treatment of aorta and iliac artery aneurysms including major lateral branches. The present results should be confirmed with additional future studies conducted with larger patient groups for longer periods.

Effectiveness, success rates, and complications of different thoracoscopic sympathectomy techniques in patients with palmar hyperhidrosis.

BACKGROUND: This study aims to investigate the effectiveness, success and complication rates of three different video-assisted thoracoscopic sympathectomy procedures performed for the treatment of primary focal hyperhidrosis; excision, cauterization and clipping. METHODS: We retrospectively evaluated the records of 60 patients (33 males, 27 females; mean age 25.1±6.4 years; range 16 to 43 years) with primary focal hyperhidrosis and treated with videoassisted thoracoscopic sympathectomy between January 2010 and December 2013. The patients were treated bilaterally at the same session: the sympathetic chain and ganglia were excised from the spinal cord segments of T2-T4 in 20 patients (group 1), cauterized in 20 patients (group 2), and clipped in 20 patients (group 3). The procedural success and complication rates were compared among the groups. RESULTS: Sympathectomy was successfully performed in all patients. The mean operation time was found to be significantly shorter in group 2 (42.5±7.1 min) and group 3 (36.9±7.8 min), compared to group 1 (51.1±8.4 min) (p<0.05). Compensatory hyperhidrosis developed in 17 patients (28.3%) and was comparable among all groups (p<0.05). CONCLUSION: Our study results suggest that excision, cauterization, and clipping are effective and reliable in the treatment of primary focal hyperhidrosis. Based on our experience, we believe that sympathectomy with video-assisted excision may be preferable for the treatment of primary focal hyperhidrosis.

The combined use of multilayer flow modulator stent and conventional stent grafts in complex thoracoabdominal aortic aneurysms and Type 3 dissections accompanying aneurysms.

BACKGROUND: In this study, we present early and mid-term results of the combined use of multilayer flow modulator stent and conventional stent grafts in aortic aneurysms and Type B aortic dissections. METHODS: The files and computerized data of 78 patients who underwent endovascular stent graft implantation due to an aortic aneurysm and dissection in our clinic between January 2015 and December 2016 were retrospectively analyzed. Among these patients, six male patients (mean age 69.5 years; range 63 to 77 years) who were treated with multilayer flow modulator stents in combination with conventional stent grafts were included. A successful intervention was defined as the placement of the stents into the aneurysmatic region without any complications. The patients were followed for the development of any clinical events during 12 months. RESULTS: The common symptoms observed in the half of the patients were abdominal pain and back pain. One patient had claudication during walking. In all patients, the interventions were successfully completed and no mortality was observed in any patient. One of the patients developed Type 1 endoleak during the procedure; however, it was completely corrected using the aortic stent graft extension. Creatinine levels were elevated (2.1 mg/dL) in one patient on the second day of the operation. The patient did not require dialysis and the kidney functions completely returned to normal on the seventh day. No intra- or postoperative complications developed. CONCLUSION: Multilayer flow modulator stents seem to be effective and safe in the treatment of aortic aneurysms with major side branches. The combined use of stents with different stent-graft devices increase the success rate and reduce the complication rate in complex aortic aneurysms.

The effects of iloprost and alprostadil on ischemia-reperfusion injury in preventing inflammation, tissue degeneration, and apoptosis in rat skeletal muscle.

BACKGROUND/AIM: The protective effects of prostaglandin (PG) analogs on ischemia-reperfusion (I/R) have been well documented; however, comparative studies are lacking. The aim of the present study was to determine whether iloprost or alprostadil is more effective in preventing muscle I/R injury. MATERIALS AND METHODS: Thirty-two rats were divided into four groups (n = 8): sham, control, IL (I/R + iloprost), and AL (I/R + alprostadil). I/R was induced by a tourniquet in the hindlimb for 3 h/3 h. The IL and AL groups received iloprost (0.5 ng kg-1 min-1) and alprostadil (0.05 µg kg-1 min-1) during reperfusion, respectively. After 6 h, blood and muscles were collected for analyses. RESULTS: Serum TNF-α and IL-1ß levels were decreased in the IL and AL groups compared with the control group (P < 0.05), whereas IL-6 levels did not change significantly. Tissue malondialdehyde levels were significantly lower in the IL and AL groups (P < 0.05). Tissue catalase levels showed no difference. The histological damage scores and apoptosis scores were both significantly decreased in the IL and AL groups compared with the control group (P< 0.05). CONCLUSION: The present study indicated that iloprost and alprostadil attenuated I/R injury in skeletal muscle. However, no comparable difference was evident regarding the efficacies of either PG analog.