A New Method for Determining the Level of the Carotid Artery Bifurcation.

Exact localization of the bifurcation of the common carotid artery using skin surface landmarks is important for various diagnostic and therapeutic purposes, including emergency cases. Traditional methods have confirmed their accuracy in only a certain percentage of cases and there are inconsistencies among various publications. The cervical computed tomography-angiographic examinations for any diagnostic purpose between June 2017 and December, 2017 in the authors' hospital were examined. Measurements were performed for (MT-CB) and (MT-SE) distances and the results were recorded [MT = The tip of the mastoid process; CB = common carotid artery bifurcation; SE = sternal extremity of the clavicle]. Cervical computed tomography angiography was found in the records of 91 patients in the 6-month period between June 2017 and December 2017. After exclusion criteria were applied, a total of 116 carotid bifurcation levels on the right and left sides were measured in 58 patients. The mean MT-CB distance was 6.29 ±â€Š0.9 cm (range: 2.9-8.4 cm). The mean distance between MT and SE was 15.3 ±â€Š1.7 cm (range: 9.9-19.0 cm). The (MT-CB): (MT-SE) ratios ranged from 29% to 51% with a mean of 41 ±â€Š4.2% (95% CI: 39.88%-42.10%) and a median of 41.1% (P < 0.05) (Kolmogorov-Smirnov test). The distance ratio values did not change significantly according to age and gender (respectively P = 0.341, P = 0.093). These results show that the CB is usually located at two-fifths of the distance from the mastoid tip to the sternal extremity of the clavicle and closer to the mastoid tip.

Single-center retrospective review of early outcomes of radiofrequency ablation versus cyanoacrylate ablation of isolated great saphenous vein insufficiency.

OBJECTIVE: Data comparing radiofrequency ablation (RFA) with cyanoacrylate closure (CAC) treatment of isolated great saphenous vein (GSV) insufficiency are limited. In this study, we present our early outcomes of RFA vs CAC for the treatment of GSV insufficiency. METHODS: Between March 2015 and February 2017, a total of 159 patients underwent CAC (n = 75) or RFA (n = 84) for treatment of GSV insufficiency by a single surgeon. Medical data of the patients were retrieved from the institutional database and retrospectively analyzed. All patients underwent lower extremity venous color duplex ultrasound examination. The Venous Clinical Severity Score and Aberdeen Varicose Vein Questionnaire were used. Total closure rates of the GSV with RFA or CAC were recorded at 1 month, 6 months, and 12 months. Procedure-related adverse events and quality of life of the patients were also evaluated. RESULTS: The mean age was 46.33 ± 14.40 years in the CAC group and 48.09 ± 13.25 years in the RFA group (P = .4). The mean treated saphenous vein diameter was 7 mm in the CAC group and 7.25 mm in the RFA group (P = .07). The length of treated venous segment was 30 cm in both the CAC and RFA groups (P = .66). The mean duration of operation was 25 minutes in the CAC group and 35 minutes in the RFA group (P < .001). The incidence of adverse events was higher in the RFA group (P < .05). At 1 month, 6 months, and 12 months of follow-up, there was no statistically significant difference in the total closure rates between the CAC and RFA groups. There was no significant difference in the Venous Clinical Severity Score and Aberdeen Varicose Vein Questionnaire score between the groups (P > .05). CONCLUSIONS: Our study results suggest that both RFA and CAC are effective in closure of the target GSV. Although the incidence of tumescent anesthesia-related and procedure-related complications is higher with the RFA technique, both techniques can be used safely with similar success rate and patient satisfaction.

Consequence of Ischemic Stroke after Coronary Surgery with Cardiopulmonary Bypass According to Stroke Subtypes.

INTRODUCTION: The aim of this study was to determine the outcomes of patients developing ischemic stroke after coronary artery bypass grafting (CABG). METHODS: From March 2012 to January 2017, 5380 consecutive patients undergoing elective coronary surgery were analyzed. Ninety-five patients who developed ischemic strokes after on-pump coronary surgery were included in the study, retrospectively. The cohort was divided into four subgroups [total anterior circulation infarction (TACI), partial anterior circulation infarction (PACI), posterior circulation infarction (POCI), and lacunar infarction (LACI)] according to the Oxfordshire Community Stroke Project (OCSP) classification. The primary endpoints were in-hospital mortality, total mortality, and survival analysis over an average of 30 months of follow-up. The secondary endpoints were the extent of disability and dependency according to modified Rankin Scale (mRS). RESULTS: The incidence of stroke was 1.76% (n=95). The median age was 62.03±10.06 years and 68 (71.6%) patients were male. The groups were as follows: TACI (n=17, 17.9%), PACI (n=47, 49.5%), POCI (n=20, 21.1%), and LACI (n=11, 11.6%). Twenty-eight (29.5%) patients died in hospital and 34 (35.8%) deaths occurred. The overall mortality rate of the TACI group was significantly higher than that of the LACI group (64.7% vs. 27.3%, P=0.041). The mean mRS score of the TACI group was significantly higher than that of the other groups (P=0.003). CONCLUSION: Patients in the TACI group had higher in-hospital and cumulative mortality rates and higher mRS scores. We believe that use of the OCSP classification and the mRS may render it possible to predict the outcomes of stroke after coronary surgery.