Popliteal artery aneurysms treatments: early midterm results of the use of endovascular stent grafts

Background/aim: Popliteal artery aneurysms (PAAs) are abnormal bulgings, which account for 70% of all peripheral artery aneurysms. They are usually asymptomatic. In this study, we present our long-term results of endovascular stent grafts in the treatment of PAA in the light of literature data. Material and methods: A total of 63 legs of 63 patients with PAA, who were treated with endovascular techniques in our clinic between July 2010 and July 2019, were retrospectively analyzed. All patients underwent color Doppler ultrasound (DUS), magnetic resonance angiography (MRA), or computed tomography angiography (CTA) to identify the diameter and length of PAAs, vessel tortuosity, the presence and degree of thrombus, and diameter in the healthy landing zone and to visualize tibioperoneal vascular structures. A Viabahn stent graft was inserted in all patients. Results: 57 patients (90.5%) were males with a mean age of 76.35 ± 7 years. 24 patients (38.1%) were symptomatic, while 11 patients (17.5%) had a concomitant abdominal aortic aneurysm (AAA). The mean follow-up period was 46.05 ± 25.01 months. The primary patency rate was 79.3%. A graft thrombosis was observed in 13 patients (20.6%) during a mean follow-up period of 8.31 ± 5.91 months. The number of distal arteries was significantly lower in the patients with thrombosis than those without. Conclusions: Endovascular treatment of PAA using stentgrafts is safe in selected cases. However, it is reasonable to avoid endovascular treatment due to an increased risk for thrombosis in patients with a low number of patent distal arteries or impaired distal flow.

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.

A new percutaneous technique: N-butyl cyanoacrylate adhesive for the treatment of giant saphenous vein insufficiency.

Background We have made a retrospective evaluation of the results of the cyanoacrylate ablation technique which has recently started to be used in the treatment of giant saphenous vein insufficiency today and in which tumescent anesthesia is not required. Methods Giant saphenous vein was treated in 50 patients between September 2015 and September 2016 by using endovenous cyanoacrylate ablation. In the procedure, tumescent anesthesia and varsity socks were not used. Control duplex ultrasound evaluation was performed in the post-procedural 1st, 6th and 12th months. Venous Clinical Severity Score and Aberdeen Varicose Vein Questionnaire scores were evaluated. Results In the 50 patients who were treated, full closure was observed in giant saphenous vein in 47 (94%) patients in the 12th month control duplex ultrasound. The mean age of the patients was 46.4 (20-70) and 30 (60%) of them were female. The median Venous Clinical Severity Score scores in the 1st, 6th and 12th months were 3, 2 and 1, respectively ( p < 0.001); the median Aberdeen Varicose Vein Questionnaire scores in the 1st, 6th and 12th months were 7, 5 and 4, respectively ( p < 0.001). In the access site, two (4%) patients developed phlebitis and one (2%) developed ecchymosis. However, deep venous thrombosis, pulmonary embolism and paresthesia were not observed. Conclusion Considering the early period results in the treatment of giant saphenous vein insufficiency, cyanoacrylate ablation makes a more reliable alternative than endovenous thermal ablation methods in that it does not require tumescent anesthesia and it has a low incidence of adverse effects.

Assessment of protective effects of methylprednisolone and pheniramine maleate on reperfusion injury in kidney after distant organ ischemia: a rat model.

BACKGROUND: Ischemia/reperfusion (I/R) injury of tissues is a common problem that cardiovascular surgeons are faced with. Suppression of inflammation, which plays an important role in the pathogenesis of I/R injury, may reduce this damage. The aim of this study is to investigate the protective effects of methylprednisolone (MP)--a potent anti-inflammatory agent--and pheniramine maleate (FM)--an antihistamine that also has some anti-inflammatory effects--on reperfusion injury of kidneys developing after ischemia of the left lower extremity of rats. METHODS: Twenty-eight randomly selected male Sprague-Dawley rats weighing 320 to 370 g were divided into four groups, each consisting of seven rats. Group 1 was the control group. Group 2 was the sham group. Rats in group 3 were subjected to I/R and given FM, and rats in group 4 were subjected to I/R and given MP. A tourniquet was applied at the level of the left groin to subjects in group 2 after induction of anesthesia. One hour of ischemia was performed, and no drug was administered. In group 3, half of a total dose of 10 mg/kg FM was administered before ischemia, and the remaining half was given intraperitoneally before reperfusion. In group 4, subjects received a single dose of 50 mg/kg MP intraperitoneally in the 30th minute of ischemia. Kidneys of all subjects were removed after 24 hours. Extracted tissues were investigated regarding histological and biochemical parameters. RESULTS: Malondialdehyde--the end product of lipid peroxidation as an important indicator of I/R injury--levels were significantly lower in group 3 than in group 2 (P < 0.05). Malondialdehyde levels were also lower in group 4 than in group 2, but this difference was insignificant (P > 0.05). Superoxide dismutase and glutathione peroxidase enzyme activities were found to be significantly higher in group 3 than in group 2 (P < 0.05). However, there was no difference between group 4 and group 2 in terms of these activities. Histological examination demonstrated that both MP and FM had protective effects against I/R injury, but this effect was more potent for FM than for MP. CONCLUSIONS: FM has a protective effect against reperfusion injury in rat kidney after distant organ ischemia.

Retrosternal Deformations after Coronary Artery Bypass Surgery Using Statistical Shape Analysis.

INTRODUCTION: In this study, we aimed to evaluate the anatomical deformations of the major vascular structures in the retrosternal area caused by adhesions following coronary artery bypass grafting (CABG). METHODS: This single-center, retrospective study included a total of 40 patients with a previous CABG who were admitted to our emergency unit for any reason and underwent a contrast-enhanced chest computed tomography (patient group) and 40 patients without previous cardiac surgery (control group) between January 2018 and November 2019. The retrosternal area was compared between the groups using the statistical shape analysis method. The distance between the sternum and the ascending aorta and pulmonary artery was measured and anatomical deformations of the retrosternal area were examined. RESULTS: There was a statistically significant difference in the anatomical structures of the retrosternal area between the patient and control groups (P<0.001). The distance from the midsternal line to the highest point of the pulmonary artery was statistically significantly shorter in the patient group, compared to the control group (P=0.013). The distance from the sternum to the ascending aorta was also shorter in the patient group, although it did not reach statistical significance (P>0.05). CONCLUSIONS: Our study results showed narrowing of the retrosternal area following CABG and a shorter distance from the sternum to the pulmonary artery than the ascending aorta. Based on these findings, surgeons should be cautious about possible injuries in patients requiring cardiac surgery with repeated median sternotomy.

Comparison of pharmacomechanical and surgical interventions for thrombosed native arteriovenous fistulas.

BACKGROUND: This study aims to compare success and patency rates of pharmacomechanical thrombectomy versus open surgical thrombectomy for thrombosed native arteriovenous fistulas. METHODS: A total of 96 patients (56 males, 40 females; mean age 61±11.7 years; range, 26 to 82 years) with a thrombosed native arteriovenous fistula between January 2016 and December 2018 were retrospectively analyzed. The patients were divided into two groups as pharmacomechanical thrombectomy (n=42) and open surgical thrombectomy (n=54). Primary failure rate and primary patency rate at 6 and 12 months were recorded. RESULTS: Of 42 patients in the pharmacomechanical thrombectomy group, 41 (98%) had additional interventions, and primary failure occurred in four patients (10%). Primary failure was seen in 15 (28%) patients in the surgical group. The primary patency rates at 6 and 12 months were significantly higher in the pharmacomechanical treatment group than the surgical group (85% vs. 67% and 78% vs. 55%, respectively; p<0.05). CONCLUSION: Pharmacomechanical thrombectomy procedure yields higher primary patency rates than open surgical thrombectomy for thrombosed native arteriovenous fistula.

A retrospective comparison analysis of results of drug-coated balloon versus plain balloon angioplasty in treatment of juxta-anastomotic de novo stenosis of radiocephalic arteriovenous fistulas.

BACKGROUND: Juxta-anastomotic stenosis is a common issue of arteriovenous fistulas. We aimed to evaluate the results of percutaneous transluminal angioplasty with drug-coated balloon versus plain balloon for the treatment of juxta-anastomotic stenoses of mature but failing distal radiocephalic arteriovenous fistulas. METHODS: A total of 80 patients with a juxta-anastomotic stenosis of distal radiocephalic arteriovenous fistula in our clinic between January 2016 and September 2017 were retrospectively analyzed. Patients were divided into two groups according to the type of treatment as drug-coated balloon - percutaneous transluminal angioplasty (n = 44) and plain balloon - percutaneous transluminal angioplasty (n = 43). Intra- and post-procedural data were recorded. Target lesion primary patency rate was evaluated at 6 and 12 months. Of all patients, 48 were females and 39 were males with a mean age of 56.3 ± 10.4 (range, 24-75) years. Both groups had mature fistulas, and the mean age of fistula was 11.3 ± 9.1 months in the drug-coated balloon - percutaneous transluminal angioplasty group and 10.3 ± 8.8 months in the plain balloon - percutaneous transluminal angioplasty group (p = 0.24). RESULTS: There was no significant difference in the target lesion stenosis rate and the median lesion length between the groups. Technical and clinical success were achieved in both groups. Target lesion primary patency was similar at 6 months between the two groups (93.1% vs 81.3%, respectively; p = 0.14) but significantly higher for the drug-coated balloon - percutaneous transluminal angioplasty group at 12 months (81.8% vs 51.1%, respectively; p = 0.01). CONCLUSION: Our study results suggest that the use of drug-coated balloon combined with percutaneous transluminal angioplasty is an effective treatment for juxta-anastomotic stenoses of mature but failing distal radiocephalic arteriovenous fistulas with significantly improved target lesion primary patency rates and reduced need for juxta-anastomotic reinterventions.

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.

Surgical Treatment of Right Ventricular Rupture Caused by Total Occlusion of the Right Coronary Artery.

The rupture of the right ventricular anterior wall after myocardial infarction is a rare and life-threatening complication associated with high mortality. Early diagnosis by echocardiographic examination and successful treatment is discussed in this case report.