On Pump Beating Heart Coronary Artery Surgery in Patients Requiring Urgent Revascularization.

BACKGROUND: When acute coronary syndrome patients necessitate immediate revascularization, heart-on-pump coronary artery bypass grafting may be regarded as a viable substitute for conventional on-pump surgery. Our clinical experience and initial outcomes of heart-on-pump coronary surgery in patients with acute coronary syndrome are detailed in this article. METHOD: This research endeavor was a retrospective analysis that spanned the years March 2011 to August 2023. The sample size comprised 2816 patients who had undergone coronary artery surgery. During this period, the same surgical team performed coronary artery bypass surgery on 411 of these patients, who underwent beating heart surgery while on cardiopulmonary bypass support and without cardioplegic arrest; this was done under emergency conditions. RESULT: 9.3 ± 2.2 hours elapsed between the initiation of acute myocardial infarction and the commencement of coronary artery bypass grafting (CABG). A mean of 4.0 grafts was applied (2.2 ± 1.1). Mortality in hospitals was calculated for sixteen patients. Following surgery, twenty-six patients developed an inadequate cardiac output syndrome. Despite having renal dysfunction, none of the eight individuals needed hemodialysis. The mean duration of stay in intensive care was 3.2 (2.2 ± 1.1) days, while the mean length of hospitalization was 9.2 (4.3 ± 2.4) days. CONCLUSION: We believe that for high-risk patients with multivascular coronary artery disease who require an emergency coronary artery bypass graft, on-pump beating heart revascularization could be a viable option.

Severe Aortic Thrombosis in the Early Period after COVID-19: Two Cases.

A total occlusion of the aorta is a rare condition; however, while rare, it has a very high mortality rate. Coronavirus disease 2019 (COVID-19) poses serious health problems, including vascular problems. Inflammatory changes produced by viral infections can cause serious disturbances in the coagulation system. Although cases showing a marked increase in thrombotic activity in the venous system have been presented, thrombosis in the arterial system, especially in the aorta, has rarely been reported. Here, we present 2 patients admitted to our hospital with an acute aortic thrombosis.

The Effect of Aspirin as an Irreversible COX1 Inhibitor in Preventing Non-Valvular Atrial Fibrillation After Coronary Bypass Surgery.

BACKGROUND: We investigated whether the use of aspirin (irreversible COX1 inhibitor) in the preoperative period may prevent non-valvular atrial fibrillation, which is the most common rhythm problem in the postoperative period. Non-valvular atrial fibrillation after coronary surgery may lead to an increase in hospital costs due to excessive drug use and long-term hospitalization. METHODS: More than 1000 coronary artery bypass grafting operations were performed between January 2011 to and Nov 2018. The 572 patients were included in this study. Patients were divided into two groups as medication (n=292) and medication-free group (n=280). In the medication group, while patients received aspirin (300 mg daily) therapy (up to 5 days) before the operation, the other group did not receive any anti-aggregan treatment. The patients were followed up for the occurrence of atrial fibrillation from the early postoperative period up to 3 months. RESULTS: While non-valvular atrial fibrillation was developed in 16 patients (5,5 %) in medication group, this rate was 24,3 % with 68 patients in medication-free group 3 month after operation (P < .05). In addition to the intensive care unit and hospital stay, there was a significant difference between the groups in terms of hospital costs (P < .05). CONCLUSIONS: According to the results of our study, we found that the aspirin used in preoperative period may prevent non-valvular atrial fibrillation in the postoperative period. In relation to these results, we found that hospital stay and hospital expenses decreased.

Ablation therapy with cyanoacrylate glue and laser for refluxing great saphenous veins - a prospective randomised study.

Background: Endovenous cyanoacrylate ablation is a new technique for the treatment of clinically symptomatic venous insufficiency. The results of a prospective comparative study of cyanoacrylate glue versus endovenous laser ablation for the management of incompetent great saphenous veins are presented. Patients and methods: A total of 400 subjects were treated with cyanoacrylate ablation or endovenous laser ablation between April 2014 and April 2016. The preprocedural, procedural, postprocedural, and follow-up data were recorded and compared. Results: There were 208 procedures in cyanoacrylate ablation group (CAA) and 204 in endovenous laser ablation group (EVLA). Operative time was 13 ± 3.4 minutes in the CAA and 31.7 ± 8.8 minutes in the EVLA (< 0.001). All procedures in both groups were successful, and the target vein segments were fully occluded at the end of the procedure. Periprocedural pain was less in the CAA (< 0.001). Enduration, ecchymosis, and paresthesia rates were significantly higher in the EVLA (< 0.001). The mean length of follow-up was 14 months (range 10-16). The 3, 6 and 12 months closure rates were 97.4%, 95.6%, and 94.1% for EVLA and 98.6%, 97.1% and 96.6% for CAA respectively. In both groups, the Venous Clinical Severity Score and Chronic Venous Insufficiency Quality of Life Questionnaire with declined significantly with no difference between groups. Conclusions: Management of incompetent great saphenous veins both endovenous cyanoacrylate ablation and laser ablation results in high occlusion rates. Endovenous cyanoacrylate ablation technique is fast and simple with low periprocedural pain that does not require tumescent anesthesia and compression stockings.

More Successful Results with Less Energy in Endovenous Laser Ablation Treatment: Long-term Comparison of Bare-tip Fiber 980 nm Laser and Radial-tip Fiber 1470 nm Laser Application.

BACKGROUND: Varices and venous insufficiency are common and serious health problems in the general population which affect the quality of life. Endothermal treatment of the great saphenous vein has become the first line of treatment for superficial venous reflux, and the endovenous laser ablation (EVLA) method has been widely accepted all over the world. In this method, ablation is provided by a laser fiber inserted into the lumen of the vein. Initially, the fibers were 810 nm, but today the fibers are usually 940, 980, or 1470 nm. METHODS: The study included 400 patients (419 procedures) who were diagnosed with venous insufficiency and underwent 980 and 1470 nm EVLA. Patients were followed up for 48 months. A 980-nm bare-tip laser catheter in Group A and a 1470-nm radial-tip laser catheter in Group B were inserted until they were 2 cm below the saphenofemoral junction. An EVLA catheter was drawn slowly at the rate of 1-3 cm/sec (2.08 ± 0.6). The energy applied to the saphenous vein was 60-120 J/cm (84.65 ± 13.03) and 45-120 J/cm (76.95 ± 15.06) in Group A and Group B, respectively (P < 0.001), with 15 W in the continuous mode. Follow-up visits included a physical examination and Doppler ultrasonography performed at the following time points: day 1, week 1, and months 1, 6, 12, 24, 36, and 48. Saphenous vein occlusion rates and postprocedure saphenous vein diameters were evaluated at each follow-up visit. Pain levels were evaluated using the Wong-Baker FACES® pain scale (0-10). Postoperative complications were recorded. RESULTS: Group A (980 nm laser) consisted of 200 patients with a mean age of 37.84 ± 12.2 years. Group B (1470 nm laser) consisted of 200 patients with a mean age of 38.38 ± 12.1 years. The mean duration of the procedure was 32.2 ± 9.7 min in Group A and 31.7 ± 8.8 min in Group B, respectively (P = 0.47). Induration, ecchymosis, and paresthesia rates were significantly higher in the bare-tip laser group. The most important complication, deep vein thrombosis, was observed in 4 patients in Group A. Recanalization rates were found to be increased by prolonged follow-up periods. At the 48-month follow-up, this rate was 15.9% in Group A and 8.3% in Group B (P = 0.017). This rate showed that the 1470-nm wavelength laser treatment was more successful in Group B than in Group A over the long term. CONCLUSIONS: Both the 980 and 1470 nm wavelength laser-assisted EVLA procedures appear to be effective in treating saphenous vein insufficiency. The 1470-nm radial-tip fiber is preferred due to lower energy levels, lower complication rates, early return to daily life, and the successful long-term occlusion rate.

N-butyl cyanoacrylate in the treatment of venous insufficiency--the effect of embolisation with ablative polymerisation.

BACKGROUND: The primary objective of this multicentre prospective observational study was to evaluate the early results of a new non-thermal embolisation method using N-butyl cyanoacrylate in venous insufficiency. PATIENTS AND METHODS: A total of 181 patients with a varicose vein diagnosis were treated with the VariClose: Vein Sealing Systems at four different centres. The protocol included physical and colour Doppler ultrasonography examination, venous clinical severity score and quality of life assessment before and after the procedure on days 1 and 7 and at months 1, 3 and 6. Clinical recovery was evaluated by comparing the venous clinical severity score and the quality of life assessment before and after the procedure. RESULTS: In total, 215 embolisation procedures were successfully completed on 181 patients (110 female) with a mean age of 37.6 ± 13.2 years (range 18-72 years). The 215 procedures consisted of 25 bilateral applications on 206 great saphenous veins and 9 small saphenous veins. The average pre-interventional diameter of great saphenous veins was 6.5 ± 1.4 mm (4.3-14 mm), and the mean diameter of small saphenous veins was 5.2 ± 1.3 mm (3.8-8.6 mm). The average length of the sealed vein segments was 31.6 ± 6.1 cm (23-70 cm), and the average N-butyl cyanoacrylate usage for the patient was 0.9 ml (0.7-2.1 ml). The procedural occlusion rate was 100%. Post-operative pain was observed in 11 patients (6.1%), and thrombophlebitis was observed in 1 patient (0.5%). No total recanalisation was observed. Five (2.7%) partial recanalisations were observed at the 6 month follow-up. The 6 month total occlusion rate was 97.2%. CONCLUSIONS: This new tumescent-free non-thermal embolisation method can be applied safely with high success rates.

Surgical removal of guidewire entrapped within stent struts during percutaneous coronary angioplasty.

There has been a growing trend toward percutaneous coronary angioplasty for complex coronary artery lesions. Stent or guidewire break off or trapping within the coronary artery lumen is a rare complication, but it may have fatal consequences. In such cases, the entrapped device may be removed by either percutaneous route or surgical exploration. Here, we report a patient with guidewire entrapment within the struts of the intracoronary stent during primary percutaneous coronary angioplasty, which necessitated surgical removal and subsequent coronary artery bypass grafting (CABG).

Pharmacomechanical thrombectomy for acute symptomatic lower extremity deep venous thrombosis.

BACKGROUND: The purpose of this study was to evaluate the efficacy and safety of pharmacomechanical thrombectomy performed by using a rotational thrombectomy device for the treatment of deep vein thrombosis. METHODS: Between April 2012 and November 2014, 17 patients with acute deep vein thrombosis underwent pharmacomechanical thrombolysis. The thrombectomy device was used in a single-session technique for patients with lower-extremity deep vein thrombosis. After the procedure, the effect of thrombolysis was evaluated in 3 grades venographically. Grade I showed lysis of under 50%, and grade III showed complete lysis. RESULTS: Ten patients (58.8%) had an iliofemoral thrombosis and 7 (41.2%) had a femoropopliteal venous thrombosis. At the end of the pharmacomechanical thrombectomy procedure, 12 patients (70%) had complete (grade III) thrombus resolution. Grade I and II lysis were noted in 2 (12%) and 3 (18%) patients, respectively. Additionally, four (23.5%) required an additional lytic infusion as a result of residual thrombi. The overall grade III, II, and I thrombus resolution rates, including the supplemental thrombolysis, were 82.2% (n = 14), 12% (n = 2), and 5.8% (n = 1), respectively. There was no mortality. CONCLUSION: Based on the present data, use of the Cleaner thrombectomy device may prove to be a safe and feasible single-session pharmacomechanical thrombectomy method for the treatment of acute deep vein thrombosis. To prove the effectiveness of this type treatment, a more extensive large-scale studies are needed.

Acute Mitral Valve Dysfunction Due to Escape of Prosthetic Mechanical Leaflet and Peripheral Leaftlet Embolization.

BACKGROUND: Leaflet escape of prosthetic valve is rare but potentially life threatening. Early diagnosis is essential on account of avoiding mortality, and emergency surgical correction is compulsory. This complication has previously been reported for both monoleaflet and bileaflet valve models. METHODS: A 30-year-old man who had undergone mitral valve replacement with a bileaflet valve 8 years prior at another center was admitted with acute-onset with cardiogenic shock as an emergency case. Transthoracic echocardiograms showed acute-starting severe mitral regurgitation associated with prosthetic mitral valve. There was a suspicious finding of a single prosthetic mitral leaflet. But the problem related with the valve wasn't specifically determined. The patient underwent emergent surgery for replacement of the damaged prosthetic valves immediately. There was no tissue impingement and thrombosis, one of the two leaflets was absent, and there were no signs of endocarditis or pannus formation in the prosthetic valve. The missing leaflet could not be found within the cardiac cavity. The abdominal fluoroscopic study and plain radiography were unable to detect the escaped leaflet during surgery. The damaged valve was removed and a replacement 29 mm bileaflet mechanical valve was inserted by right lateral thoracotomy. RESULTS: After post-operative week one, the abdominal computed tomography scan and the ultrasound showed the escaped leaflet in the left femoral artery. Fifteen days after the surgery the escaped leaflet was removed safely from the left femoral artery and the patient made a complete recovery. CONCLUSION: The escaped leaflet showed a fracture of one of the pivot systems caused by structural failure. Early cardiac surgery should be applied because of life-threatening problems.

Pharmacomechanical thrombolysis of symptomatic acute and subacute deep vein thrombosis with a rotational thrombectomy device.

PURPOSE: To retrospectively evaluate the efficacy and safety of pharmacomechanical thrombolysis (PMT) with the use of a rotational thrombectomy device for symptomatic deep vein thrombosis (DVT). MATERIALS AND METHODS: Between July 2012 and August 2013, 41 patients with acute or subacute DVT underwent PMT. The Cleaner thrombectomy device was used in a single-session technique for patients with lower-extremity DVT. Based on contrast venography, the extent of lysis was graded from I (< 50%) to III (complete). RESULTS: Sixteen patients (39.0%) had a femoropopliteal thrombosis and 25 (61.0%) had an iliofemoral venous thrombosis. The mean duration of symptoms was 11.0 days (range, 3-25 d). The mean quantity of tissue plasminogen activator was 20.7 mg (range, 10-50), and the mean duration of the procedure was 74.3 minutes (range, 30-240 min). At the end of the PMT procedure, 29 patients (70.7%) had complete (grade III) thrombus resolution. Grade I and II lysis were noted in one (2.4%) and 11 (26.8%) patients, respectively. Thirty-eight of the 41 patients were treated with PMT in a single session, and three (7.3%) required an additional lytic infusion as a result of residual thrombi. The overall grade III, II, and I thrombus resolution rates, including the supplemental thrombolysis, were 73.2% (n = 30), 22.0% (n = 9), and 4.9% (n = 2), respectively. There was no mortality. CONCLUSIONS: Use of the Cleaner thrombectomy device is a promising alternative to current treatment modalities for the management of DVT in a single session of PMT.

The Surgical Treatment of Carotid Body Tumor as Well as the Prevention and Management of Complications.

The carotid body tumor (CBT) is a rare paraganglioma neoplasm that often occurs in the head and neck anatomical region. Carotid angiography continues to be widely regarded as the preferred diagnostic method for this particular malignancy. Surgical intervention has been widely acknowledged as the primary approach for managing CBTs. However, the resection of CBTs poses significant technical challenges due to its specific anatomical position. To mitigate the incidence of intraoperative and postoperative challenges, we have conducted a comprehensive review of both domestic and international literature to consolidate the surgical approach and strategies for preventing and managing complications associated with this particular tumor.

Comparison of Del Nido (a different application) and crystalloid blood cardioplegia on arrhythmia and early results.

BACKGROUND: The results of the use of del-Nido(DN) solution using a different method or crystalloid blood cardioplegia in coronary bypass patients were compared. We aimed to investigate the effects on intraoperative and postoperative arrhythmias, arrhythmia durations and early results. METHODS: The study included 175 patients using crystalloid blood cardioplegia (Group 1) and 150 patients using DN solution(Group 2). In the DN group, 75% of the calculated plegia dose was given first. the remaining part was applied by giving from grafts. Intraoperative/postoperative data were compared. RESULTS: There was no significant difference between the groups in terms of demographic characteristics. Preop troponin level was similar.(p = 0.190) However, there was a statistical difference between the postoperative 6th hour.(p = 0.001) There was no difference in troponin values at the postoperative 24th hour. (p = 0.631) Spontaneous rhythm occurred at the cardiopulmonary by pass (CPB) weaning stage in most of the patients in Group 2 (95.3%). Although the need for temporary pacing was less in Group 2, it was not significant.(p = 0.282) No patient required permanent pacing. CPB duration, cross clamp times and intraoperative glucose levels, intensive care follow-up times and hospitalization times were found to be shorter in Group 2. Although the postoperative atrial fibrillation frequency was similar (p = 0.261), the time to return to sinus was lower in Group 2.(p = 0.001). CONCLUSION: The use of DN cardioplegia solution provides significant positive contributions to avoid arrhythmias compared to crystalloid blood cardioplegia. DN solution applied with this method may contribute to reducing the anxieties associated with its use in isolated coronary artery bypass surgery.

Is administration of preoperative angiotensin-converting enzyme inhibitors important for renal protection after cardiac surgery?

OBJECTIVE: There are various reasons for renal dysfunction after cardiac surgery; however, activation of the renin-angiotensin system has an important role following cardiac surgery. We investigated the effect of preoperative angiotensin-converting enzyme (ACE) inhibitors on renal functions after cardiovascular surgery. MATERIAL-METHODS: Three hundred sixty-six patients awaiting elective cardiac surgery were allocated to two groups, namely the treatment group, comprising the ACE inhibitor group (n = 186), and the control group, which was without ACE inhibitor (n = 180). The renal parameters [blood urea nitrogen, creatinine, creatinine clearance, and glomerular filtration rate (GFR)] and the need for dialysis were evaluated associated with renal functions between the two groups in the postoperative period. RESULTS: After cardiac surgery, renal dysfunction requiring dialysis developed in 11 (3.8%) patients in the control group patients. There was no required dialysis in the treatment group (p < 0.05). As an indicator of renal dysfunction, the increase in creatinine and blood urea nitrogen levels and the decrease in GFR and creatinine clearance were higher in the control group (p < 0.05). The multivariate analysis indicated that therapy with ACE inhibitors was found to decrease the incidence of postoperative renal dysfunction (odds ratio, 1.07; 95% confidence interval, 0.45-2.50; p < 0.05). The other independent predictors were age, preoperative intra-aortic blood pump, hypertension, diabetes mellitus, and a left ventricular ejection fraction below 0.40. CONCLUSION: Preoperative therapy with ACE inhibitors has an influence on renal functions. This study demonstrates that administration of ACE inhibitors provides better renal protection after cardiac surgery.

The relationship between arteriovenous fistula success and inflammation.

BACKGROUND: Arteriovenous fistula (AVF) is the most important vascular access method for hemodialysis (HD). In this study, the relationship between AVF success and inflammation in patients who had HD due to end-stage renal failure (ESRF) was investigated. MATERIAL AND METHOD: In the study, a total of 658 patients, who started HD for ESRF, were evaluated retrospectively. A total of 386 patients were included in this study. The demographic data and C-reactive protein, albumin and fibrinogen levels were investigated in patients with recognized success AVF. RESULTS: In total 311 patients with successful AVF and 75 unsuccessful AVFs were found. In unsuccessful AVF group the average low albumin level, high C-reactive protein and fibrinogen levels were found to be statistically meaningful when compared with successful AVF group (p < 0.001, p < 0.001, p < 0.001). CONCLUSION: As a result, we think that the evaluation of inflammation before creating AVF in HD patients is very important for increasing the success of AVF.

On-pump beating-heart versus conventional coronary artery bypass grafting for revascularization in patients with severe left ventricular dysfunction: early outcomes.

BACKGROUND: We sought to evaluate the effects of on-pump beating-heart versus conventional coronary artery bypass grafting techniques requiring cardioplegic arrest in patients with coronary artery disease with left ventricular dysfunction. METHODS: We report the early outcomes associated with survival, morbidity and improvement of left ventricular function in patients with low ejection fraction who underwent coronary artery bypass grafting between August 2009 and June 2012. Patients were separated into 2 groups: group I underwent conventional coronary artery bypass grafting and group II underwent an on-pump beating-heart technique without cardioplegic arrest. RESULTS: In all, 131 patients underwent coronary artery bypass grafting: 66 in group I and 65 in group II. Left ventricular ejection fraction was 26.6% ± 3.5% in group I and 27.7% ± 4.7% in group II. Left ventricular end diastolic diameter was 65.6 ± 3.6 mm in group I and 64.1 ± 3.2 mm in group II. There was a significant reduction in mortality in the conventional and on-pump beating-heart groups (p < 0.001). Perioperative myocardial infarction and low cardiac output syndrome were higher in group I than group II (both p < 0.05). Improvement of left ventricular function after the surgical procedure was better in group II than group I. CONCLUSION: The on-pump beating-heart technique is the preferred method for myocardial revascularization in patients with left ventricular dysfunction. This technique may be an acceptable alternative to the conventional technique owing to lower postoperative mortality and morbidity.

CONTEXTE: Nous avons voulu comparer les effets du pontage coronarien sur coeur battant sous CEC (circulation extracorporelle) et ceux du pontage coronarien classique exigeant un arrêt cardioplégique chez des patients atteints de coronaropathie et de dysfonction ventriculaire gauche. MÉTHODES: Nous faisons état des premiers résultats aux plans de la survie, de la morbidité et de l'amélioration de la fonction ventriculaire gauche chez des patients qui avaient une fraction d'éjection faible et qui ont reçu un pontage coronarien entre août 2009 et juin 2012. Les patients ont été répartis en 2 groupes : le groupe I a été soumis à la technique de pontage coronarien classique et le groupe II a été soumis à la technique à coeur battant sous CEC sans arrêt cardioplégique. RÉSULTATS: En tout, 131 patients ont reçu un pontage coronarien : 66 dans le groupe I et 65 dans le groupe II. La fraction d'éjection ventriculaire gauche était de 26,6 % ± 3,5 % dans le groupe I et de 27,7 % ± 4,7 % dans le groupe II. Le diamètre télédiastolique ventriculaire gauche était de 65,6 ± 3,6 mm dans le groupe I et de 64,1 ± 3,2 mm dans le groupe II. On a noté une réduction significative de la mortalité dans les groupes soumis à l'intervention classique et à l'intervention à coeur battant sous CEC (p < 0,001). L'infarctus du myocarde peropératoire et le syndrome de faible débit cardiaque ont été plus fréquents dans le groupe I que dans le groupe II (tous deux p < 0,05). L'amélioration de la fonction ventriculaire gauche après l'intervention chirurgicale a été plus marquée dans le groupe II que dans le groupe I. CONCLUSION: La technique à coeur battant sous CEC est la méthode préférée de revascularisation myocardique chez les patients atteints d'une dysfonction ventriculaire gauche. Cette technique peut être une solution de rechange acceptable à la technique classique en raison des taux de mortalité et de morbidité postopératoires plus faibles qui y sont associés.

SARS-CoV-2 infection-associated thoraco-abdomino-iliac thrombosis in a patient without cardiac and systemic co-morbidity.

Acute pulmonary damage and vascular coagulopathy occur frequently in patients with severe acute respiratory syndrome coronavirus 2 infection in relation to coronavirus disease (COVID-19). The inflammatory process accompanying the infection and excessive coagulation state is one of the most important causes of patient death. The COVID-19 pandemic remains a major challenge for healthcare systems and millions of patients worldwide. In this report, we present a complicated case of COVID-19 associated with lung disease and aortic thrombosis.

Comparison of flowmeter (transit time flow measurement) values for graft flow in three different surgical methods for isolated coronary artery bypass surgery.

BACKGROUND: Graft patency is the most important factor in coronary artery bypass surgery. This study aimed to compare the relationship between three different surgical methods and transit time flow measurement (TTFM), which is used to detect technical problems in anastomoses performed during coronary artery bypass graft operations and to correct them if necessary. METHODS: A total of 110 patients undergoing isolated coronary artery bypass surgery were analysed. Of these patients, 48 were operated on by inducing cardiopulmonary arrest (group 1), 33 were operated on without inducing cardiac arrest (group 2) during cardiopulmonary bypass surgery, and 29 underwent surgery on the off-pump beating heart (group 3). TTFMs were performed on all the patients' grafts. Additional surgical intervention requirements, the need for intra-operative and postoperative inotropic support, and all postoperative follow-up data were compared. RESULTS: In total, 110 patients were measured for 301 grafts. Due to insufficient measurements performed on these patients, additional surgical intervention was performed on five grafts in group 1, five grafts in group 2, and seven grafts in group 3. These interventions enabled a normal flow rate to be achieved. The number of grafts that required revision was highest in group 3. There was no difference between the groups in terms of demographic data, EuroSCORE II, preoperative ejection fraction, postoperative complications and mortality rate. CONCLUSION: TTFM is important for detecting technical problems in grafts. We believe that all surgical methods can be applied more safely by controlling graft flow.

Giant Right Coronary Artery Aneurysm in a Patient With Multiple Coronary Artery Aneurysmatic Dilatations.

One kind of coronary artery disease that is uncommon is coronary artery aneurysm (CAA). According to angiographic reports, the incidence of coronary artery aneurysms ranges from 1.5% to 4.9%, with a higher frequency in men. A patient with both coronary heart disease and an aneurysm in the right coronary artery (RCA) underwent a successful simultaneous coronary bypass together with an aneurysmal reconstruction procedure.

An experience of arteriovenous fistulas created for hemodialysis in the largest health center in eastern Turkey.

BACKGROUND: The aim of the study was to evaluated the primary and secondary (after reoperation) patency rates and some effect factors in fistula patency for hemodialysis patients. MATERIAL AND METHODS: Over a 10-year period, 1529 arteriovenous fistulas (AVFs) were fashioned in 1003 (611 males, 392 females; median age range 7-72) patients using the native vascular tissue and prosthetic graft material. We also evaluated the effects of various factors in fistula patency and primary and secondary patency rates in AVF patients. RESULTS: The primary patencies of fistulas in this series were 72%, 64%, 51%, 41%, and 26%, and secondary patencies were 79%, 70%, 56%, 46%, and 33% at 6 months, 1, 2, 4, and 6 years, respectively. There was no statistically significant difference between the primary and secondary patencies (p = 0.082) in the 6-year follow-up. Factors affecting the patency of fistulas were diabetes mellitus (p < 0.005), hypertension (p < 0.005), and smoking habits (p < 0.005). CONCLUSION: Even if shown to be not statistically significant, successful surgical revision after fistula occlusion improves secondary patency with potential benefits in terms of patient morbidity. Besides, the AVF patency was shortened in chronic renal-insufficiency patients with diabetes mellitus, hypertension, and smoking habits.

Analysis of risk factors for amputation in 822 cases with acute arterial emboli.

BACKGROUND: We retrospectively examined the records of 822 patients who underwent a total of 901 operations for acute peripheral arterial occlusion of the upper or lower extremities between 1999 and 2009. We analyzed the effects of atherosclerotic structure, the time of admission to hospital, and re-embolectomies on amputation in the early postoperative period. METHODS: There were 466 (56.7%) men and 356 (43.3%) women. The time of admission to hospital was in the range of 58 hours. There were lower extremity emboli in 683 (83%). Bypass procedures were done in 27 (3.3%) patients. Fasciotomy, patchplasty, and endarterectomy were made in 19 (2.3%), 9 (1.1%), and 7 (0.8%) patients, respectively. RESULTS: Early revision (re-embolectomy) was performed in 77 (9.3%) patients. Amputation was performed in 112 (13.6%) patients. Delay after six hours from the onset of complaints and re-embolectomies increased the risk of amputation and rates. CONCLUSION: If the embolectomy, which is a rapid and easy technique for treatment of acute arterial emboli, is performed by experienced surgeons without delay, the complications associated with the emboli may be prevented. Otherwise, delayed operation and repeated re-embolizations in acute arterial play important roles in morbidity.