Clinical outcomes of extended endovascular recanalization of 16 consecutive Buerger's disease patients.

OBJECTIVE: Buerger's disease is one of the worst diseases causing peripheral artery occlusions (especially lower extremity) with increased morbidity and mortality. Endovascular treatment of the diseased arteries gains preference over bypass surgery nowadays. Here, we aimed to present the clinical outcomes of 16 consecutive Buerger's disease patients underwent extended endovascular recanalization which is a new technique to restore direct blood flow to at least one foot artery, with the performance of angioplasty for each tibial and foot artery obstructions. METHODS: A total of 16 consecutive patients with confirmed diagnosis of Buerger's disease that percutaneously treated in our center between February 2014 and March 2018 were included in the study. The mean age of the patients was 44.25 ± 4.28 ranging from 36 to 50 years. After physical examination and complementary diagnostic tests, performance of extended angioplasty for occluded arteries was intended to restore direct blood flow to at least one of the blow-the-knee arteries. RESULTS: A successful extended endovascular treatment was performed in 20 of 22 limbs, achieving a technical success of 91%. All patients were successfully discharged without any complication. Mean follow-up duration was 21.43 ± 7.08 months. Reintervention was performed in one patient and minor amputation was needed in one of the failed limbs. Limb salvage rate was 100%. A significant difference was observed based on Rutherford classification, ankle brachial index, direct blood flow to foot, presence of ulcer and rest pain when compared before and after the intervention. CONCLUSION: We showed successful extended endovascular recanalization of Buerger's disease patients with a high technical success rate and sustained clinical improvement. Extended endovascular recanalization could be a therapeutic option in Buerger's disease patients, since they are not good candidates for surgery.

The relationship between serum bilirubin concentration and coronary artery ectasia.

INTRODUCTION: The pathophysiology of coronary artery ectasia (CAE) has not been clearly identified, although multiple abnormalities including arteritis, endothelial dysfunction, and atherothrombosis have been reported. Several studies have demonstrated that higher serum bilirubin inhibits the inflammation and proliferation of vascular smooth muscle cells; also there is a relationship between serum bilirubin and cardiovascular disease. However, the relationship between bilirubin and CAE is still unknown. AIM: We compared serum bilirubin concentration between CAE patients and controls. MATERIAL AND METHODS: This study included 50 CAE patients (20 male, mean age: 60.26 ±10.6 years) and 30 control persons (10 male, mean age: 57.86 ±11.6 years). These participants underwent concurrent routine biochemical tests and leukocyte count, hemoglobin, hematocrit and platelet count in whole blood. These parameters were compared between groups. RESULTS: No statistically significant difference was found between the two groups in terms of basic characteristics. Total, direct and indirect serum bilirubin levels were significantly lower among persons with CAE patients than controls (0.37 ±0.4 vs. 0.71 ±0.6 and 0.13 ±0.1 vs. 0.27 ±0.2 and 0.24 ±0.2 vs. 0.43 ±0.4 mg/dl; all p<0.001, respectively). CONCLUSIONS: Our study revealed a relationship between serum bilirubin and CAE.

The relationship between vitamin D deficiency and coronary artery ectasia.

INTRODUCTION: The pathophysiology of coronary artery ectasia (CAE) has not been clearly identified although multiple abnormalities including arteritis, endothelial dysfunction, and atherothrombosis have been reported. The role of vitamin D deficiency suggests cardiovascular diseases such as coronary artery disease, heart failure, and hypertension. Vitamin D deficiency activates the renin-angiotensin-aldosterone system, which affects the cardiovascular system. For this reason, it could be suggested that there is a relationship between vitamin D deficiency and CAE. AIM: We aimed to compare the 25-OH vitamin D levels of CAE patients with those of controls. MATERIAL AND METHODS: This study included 50 CAE patients (20 male, mean age: 60.26 ±10.6 years) and 30 controls (10 males, mean age: 57.86 ±11.6 years). Along with routine tests, 25 OH vitamin D and parathormone (PTH) levels were analysed. Twenty-five OH vitamin D and PTH levels were compared. RESULTS: No statistically significant difference was found between the two groups in terms of basic characteristics. The average PTH level of the group of patients with CAE was higher than the average PTH level of the controls (97.8 ±46.3 pg/ml vs. 59.1 ±23.7 pg/ml; p < 0.001). The average 25 OH vitamin D level of the group of the patients with CAE was lower than the average 25 OH vitamin D level of the control group (18.9 ±8.5 ng/ml vs. 31.3 ±11.2 ng/ml; p < 0.001). CONCLUSIONS: An association between CAE and vitamin D deficiency was found in our study.

Relationship between serum bilirubin concentration and nondipper hypertension.

BACKGROUND: Although nondipper hypertension has been associated with increased cardiovascular morbidity and mortality, the relationship between bilirubin levels and nondipper hypertension remains unclear. Several studies have demonstrated that higher serum bilirubin levels inhibit inflammation and the proliferation of vascular smooth muscle cells, which may suggest a relationship between serum bilirubin levels and cardiovascular disease. The aim of this study was to compare serum bilirubin levels between dipper and nondipper hypertensive patients. METHODS: The present study included 80 hypertensive patients who were stratified into two groups: 50 dipper patients (mean [± SD] age 51.5 ± 8 years; 29 male) and 30 nondipper patients (mean age 50.6 ± 5.4 years; 17 male). All patients underwent 24 h ambulatory blood pressure monitoring. RESULTS: No statistically significant differences were found between the two groups in terms of basic characteristics. Total, direct and indirect serum bilirubin levels were significantly lower among individuals with nondipper hypertension compared with patients with dipper hypertension (0.78 ± 0.6 mg/dL versus 0.42 ± 0.32 mg/dL; and 0.29 ± 0.1 mg/dL versus 0.18 ± 0.05 mg/dL; and 0.48 ± 0.52 mg/dL versus 0.25 ± 0.22 mg/dL, respectively; all P<0.001). Additionally, leukocyte counts were higher in patients with nondipper hypertension. CONCLUSION: The present study revealed a potential relationship between lower serum bilirubin levels and a nondipping pattern in hypertensive patients.

The Relationship Between Blood Monocyte Count and Coronary Artery Ectasia.

BACKGROUND: The pathophysiology of coronary artery ectasia (CAE) has not been clearly identified, although multiple abnormalities including arteritis, endothelial dysfunction, and atherothrombosis have been reported. It is known that monocytes play an important role in inflammation, atherosclerosis and cardiovascular disease. We aimed to compare the numbers of monocyte counts of the CAE patients versus controls. METHOD: This study included 84 CAE patients (40 male, mean age 55.4 ± 9.7 years) and 30 controls (10 male, mean age 57.86 ± 11.6 years). Concurrent routine biochemical tests and neutrophil, lymphocyte, monocyte count and mean platelet volume (MPV) on whole blood count were performed for these participants. These parameters were compared between groups. RESULTS: Baseline characteristics of the study groups were comparable. CAE patients had a higher MPV value and monocyte count than controls (8.8 ± 0.2 vs. 6.2 ± 1.6 fL and 732 ± 88 vs. 321 ± 75 cell/µL; both P < 0.001, respectively). CONCLUSION: As a result, our study revealed a relationship between monocyte count and MPV in patients with CAE.

The Relationship Between Plasma Eosinophil Count and Coronary Artery Ectasia.

BACKGROUND: The pathophysiology of coronary artery ectasia (CAE) has not been clearly identified, although multiple abnormalities including arteritis, endothelial dysfunction, and atherothrombosis have been reported. It is known that eosinophils play an important role in inflammation and thrombosis. Also vascular anomalies such as aneurysm have been noted in patients with hypereosinophilic syndromes. We aimed to compare the numbers of eosinophil counts of the patients CAE versus controls. METHODS: This study included 50 CAE patients (20 male, mean age 60.26 ± 10.6 years) and 30 control person (10 male, mean age 57.86 ± 11.6 years). These participants were performed concurrent routine biochemical tests and neutrophil, lymphocyte, eosinophil count and mean platelet volume (MPV) on whole blood count. These parameters were compared between groups. RESULTS: Baseline characteristics of the study groups were comparable. CAE patients had a higher MPV value, eosinophil, neutrophil lymphocyte ratio (NLR) than controls (8.5 ± 1 vs 76.2 ± 1.6 fl and 0.198 ± 0.14 vs 0.093 ± 0.058 and 3.0 ± 2.5vs 1.14 ± 0.9; P < 0.001, 0.002 and 0.028 respectively). CONCLUSION: As a result, our study revealed a relationship between eosinophil count, NLR and MPV in patients with CAE.