Hybrid Approach to Complex Stanford Type B Dissection: Unusual Extra-anatomical Bypass (Aorto-Celiac-Mesenteric Bypass) + Thoracic Endovascular Aortic Repair (TEVAR) + Cholecystectomy

Abstract Patients with complex Stanford type B aortic dissection are very difficult to treat. Many methods have been proposed so far in the treatment of these patients, and the emergence of hybrid techniques has made the treatment easier. In this article, we shared the extra-anatomical bypass (aorto-celiac-mesenteric bypass) + thoracic endovascular aortic repair + cholecystectomy operation technique applied to a patient with complex type B aortic dissection.

Hybrid Approach to Complex Stanford Type B Dissection: Unusual Extra-anatomical Bypass (Aorto- Celiac-Mesenteric Bypass) + Thoracic Endovascular Aortic Repair (TEVAR) + Cholecystectomy.

Patients with complex Stanford type B aortic dissection are very difficult to treat. Many methods have been proposed so far in the treatment of these patients, and the emergence of hybrid techniques has made the treatment easier. In this article, we shared the extra-anatomical bypass (aorto-celiac-mesenteric bypass) + thoracic endovascular aortic repair + cholecystectomy operation technique applied to a patient with complex type B aortic dissection.

Investigation of the arterial intima-media thickness in Behcet's disease patients without vascular complaints.

Objectives Behcet's disease is a multisystemic, inflammatory disease. Various factors have been implicated in the disease, including genetics, infections, immunoglobulins, immune complexes, antibodies, and oxidative stress. However, the underlying etiopathogenesis remains unclear. Behcet's disease can occur with or without vascular involvement. This prospective study investigated the relationship between the intima-media thickness of the major arteries, in addition to other factors affecting the disease process, in Behcet's disease without vascular involvement. Methods Twenty-four patients (average age: 38.50 ± 10.931) without vascular involvement or any vascular complaints who were diagnosed with Behcet's disease were included in the study. Sixteen healthy subjects (average age: 39.75 ± 7.793) were included as a control group. Demographic information and medical histories were recorded, and routine blood tests were performed in both groups. The intima-media thickness of the subclavian, axillary, femoral, and carotid arteries of all the participants were recorded using Doppler ultrasonography. The data were then subjected to intergroup statistical and correlation analyses. Results There were no significant differences between the arterial intima-media thickness values of the Behcet's disease patients and those of the control group ( p > 0.05). However, there was a significant difference between the neutrophil-lymphocyte ratio ( p = 0.004), low-density lipoprotein ( p = 0.007), and triglyceride ( p = 0042) levels of the two groups. Significant correlations were found between intima-media thickness and neutrophil-lymphocyte ratio levels ( p = 0.012) and the disease duration ( p = 0.030). There was also a significant correlation between the intima-media thickness of the femoral artery and disease duration ( p = 0.014). Conclusions The results showed that the duration of illness had a significant effect on arterial intima-media thickness in Behcet's disease. Blood neutrophil-lymphocyte ratio levels were also associated with increased intima-media thickness.

An evaluation of factors affecting clinical outcomes in penetrating cardiac injuries: A single center experience.

BACKGROUND: Penetrating cardiac injury (PCI) has highly mortal outcome. Therefore, management of this emergency situation is extremely important. The present study is an investigation of main factors that can affect mortality and morbidity in PCI. METHODS: Records of 112 patients who were admitted to emergency department with PCI in the last decade were evaluated retrospectively. Demographic data, initial approach, transfer duration and conditions, vital status and findings, type of injury, localization, characteristics, and type of surgical application were recorded. RESULTS: Demographic findings (age, sex, cause of injury) were not found to be significant factors affecting mortality. Early mortality (1-week observation period) occurred in 14 (12.5%) patients. Method of transfer to hospital (under medical team supervision by ambulance, or without supervision), transfer duration, initial vital findings upon arrival (blood pressure, rhythm, breathing, consciousness), operation timing (elective or emergency), and injuries to additional organs were determined to be important predictors of survival. CONCLUSION: Cardiac injury is highly mortal emergency situation. Expert medical management is important for survival. However, basic first aid measures and immediate hospital transfer are as important as expert clinical management.

Hyperbaric Oxygen Preconditioning Provides Preliminary Protection Against Doxorubicin Cardiotoxicity.

BACKGROUND: Doxorubicin (DOX) is generally recognized to have important cardiotoxic side effects. Studies are contradictory about the interaction between hyperbaric oxygen (HBO2) therapy and doxorubicin-induced cardiomyotoxicity. Recent data suggests that HBO2 therapy can lead to preconditioning of myocardium while generating oxidative stress. Herein we have investigated the effect of HBO2 therapy in a DOX-induced cardiomyocyte injury animal model. METHODS: Twenty-one rats were divided into three equal groups as follows: 1) Group 1 is a control group (without any intervention), used for evaluating the basal cardiac structures and determining the normal value of cardiacs and serum oxidative markers; 2) Group 2 is the doxorubicin group (single dose i.p. 20 mg/kg doxorubicin) for detecting the cardiotoxic and systemic effects of doxorubicin; 3) Group 3 is the doxorubicin and HBO2 group (100% oxygen at 2.5 atmospheric for 90 minutes, daily), for evaluating the effect of HBO2 in doxorubicin induced cardiotoxicity. At the end of the protocols, the hearts were harvested and blood samples (2 ml) were obtained. RESULTS: The doxorubicin treated animals (Group 2) had increased oxidative stress markers (both cardiac and serum) and severe cardiac injury as compared to the basal findings in the control group. Nevertheless, the highest cardiac oxidative stress index was detected in Group 3 (control vs. Group 3, p = 0.01). However, histological examination revealed that cardiac structures were well preserved in Group 3 when compared with Group 2. CONCLUSIONS: Our results suggest that HBO2 preconditioning appears to be protective in the doxorubicin-induced cardiotoxicity model. Future studies are required to better elucidate the basis of this preconditioning effect of HBO2.

Effects of Hyperbaric Oxygen Treatment on Renal System.

INTRODUCTION: Hyperbaric oxygen (HBO) treatment is steadily increasing as a therapeutic modality for various types of diseases. Although good clinical outcomes were reported with HBO treatment for various diseases, the multisystemic effects of this modality are still unclear. This study aimed to investigate the renal effects of HBO experimentally. MATERIALS AND METHODS: Fourteen New Zealand White rabbits were divided into 2 groups randomly as the control group and the study group. The study group received HBO treatment for 28 days (100% oxygen at 2.5 atmospheres for 90 minutes daily) and the control group was used to obtain normal renal tissue of the animal genus. After the intervention period, venous blood samples were obtained, and renal tissue samples were harvested for comparisons. RESULTS: Normal histological morphology was determined with Masson trichrome staining and periodic acid-Schiff staining in the control group. Atrophic glomerular structures, vacuolated tubule cells, and degeneration were detected in the renal samples of the study group with Masson trichrome staining. Additionally, flattening was observed on the brush borders of the proximal tubules, and tubular dilatation was visualized with periodic acid-Schiff staining. The histopathologic disruption of renal morphology was verified with detection of significantly elevated kidney function laboratory biomarkers in the study group. CONCLUSIONS: Our findings suggests that HBO has adverse effects on renal glomerulus and proximal tubules. However, the functional effects of this alteration should be investigated with further studies.

Unexpected complication of oesophagoscopy: iatrogenic aortic injury in a child.

INTRODUCTION: Oesophagoscopy is usually a safe procedure to localise and remove ingested foreign bodies, however, unexpected complications may develop during this procedure. In this case report we discuss iatrogenic aortic injury, which developed during oesophagoscopy, and its immediate treatment. CASE REPORT: A six-year-old male patient was admitted to hospital with symptoms of having ingested a foreign body. Oesophagoscopy was carried out and the foreign body was visualised at the second constriction of the oesophagus. During this procedure, profuse bleeding occurred. Subsequently, a balloon dilator was placed to control bleeding in the oesophagus. Thoracic contrast tomography revealed thoracic aortic injury. Open surgical aortic repair was immediately carried out on the patient and the oesophageal hole was primarily repaired. The patient was discharged on postoperative day 15 with a total cure. CONCLUSION: Although oesophagoscopy is a safe, easily applied method, it should be kept in mind that fatal complications may occur during the procedure. This procedure should be done in high-level medical centres, which have extra facilities for managing complications.

The relationship between fibrinogen to albumin ratio and severity of coronary artery disease in patients with STEMI.

OBJECTIVE: Previous studies show that serum fibrinogen levels are established risk factors for coronary artery disease (CAD) and that serum albumin levels are of a higher specificity and sensitivity in ST-elevation myocardial infarction (STEMI). In this study, we sought to evaluate the association between fibrinogen to albumin ratio (FAR) and the extent and severity of CAD evaluated by TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries (SYNTAX) Score (SS) in patients with STEMI. METHODS: A total of 278 patients with STEMI were included in the study. FAR was calculated using specified variables. The extent and severity of CAD were evaluated using the SS. The patients were divided into low- (SS <22) and high- (SS ≥22) risk groups. A Spearman rank correlation coefficient analysis was used for the relationship between FAR and SS. The cutoff points for sensitivity and specificity of FAR in predicting SS were estimated by performing a receiver operator characteristic curve analysis. RESULTS: There were significant differences in the mean age (P=.016), admission serum albumin (P=.041), serum fibrinogen (P<.001), FAR (P<.001), and SS risk groups. Positive correlation was detected between FAR and SS (r=0.458, P<.001). A cutoff level of >87 FAR predicted SS (sensitivity, 70%; specificity, 70%), and an area under the curve of 0.758 serum fibrinogen and albumin level was an independent predictor for SS in patients with STEMI (b=0.039; 95% confidence interval, 0.016-0.062; P=.001 and b=-6.906; 95% confidence interval, -12.284 to -1.527; P=.013, respectively). CONCLUSION: In the present study, we showed that FAR is significantly related to SS in predicting the severity of CAD in patients with STEMI.

Clinical features and patency rates of Remedy® biodegradable peripheral stents.

OBJECTIVE: The aim of this study was to investigate the midterm results of Remedy® biodegradable stents, which have recently come into use for lower-extremity arterial occlusive disease. METHODS: Sixty-five patients, who underwent surgical intervention in various cardiovascular surgery clinics throughout Turkey, were included in the study. The total number of stents used was 92. The mean age of the patients was 64.11 ± 24.13 years (20-82), and 16 (24.6%) were female. The mean number of stents per patient was 1.42, and 70.7% of the lesions were TASC type A. Patients were followed for a mean of 32 months. Sixty-five patients underwent a control examination using either digital subtraction angiography or colour Doppler ultrasonography. In-stent restenosis was defined as ≥ 50% stenosis in the stent area in asymptomatic patients. The procedure was repeated if the degree of stenosis was ≥ 70%. RESULTS: During the follow-up period, restenosis (≥50% stenosis) was observed in seven patients (10.7%). The patency rate after secondary intervention was 100%, and there was no loss of limbs in any patient. Restenosis was observed in six patients with superficial femoral artery stents, and in one patient with a popliteal arterial stent. CONCLUSION: Our experience shows that Remedy® biodegradable peripheral stents were safe and effective in our cohort of patients, with acceptable patency rates.

Pharmacomechanical thrombolysis with a rotator thrombolysis device in iliofemoral deep venous thrombosis.

OBJECTIVE: Deep venous thrombosis (DVT) is a life-threatening and morbid pathology. This study aimed to investigate the efficacy of an early thrombolysis procedure using a rotator thrombolysis device. METHODS: Sixty-seven patients with acute proximal DVT were enrolled in the study. Patients' data were recorded retrospectively. Initially, an infrarenal retrievable vena cava filter was placed through the femoral vein. Then, a rotator thrombolysis device and a thrombolytic agent injection were applied to the occluded segments of the deep veins by puncturing the popliteal vein. RESULTS: The identified reasons were trauma (43.3%), pregnancy (20.9%), undiagnosed (11.9%), major surgical operation (10.5%), immobilization (7.5%), and malignancy (5.9%). Immediate total recanalization was conducted in all patients, and the leg diameters returned to normal ranges in the early postoperative period. Hospital mortality or severe complications were not detected. CONCLUSION: New thrombolytic devices seem to reduce in-hospital mortality risks and may potentially decrease post-thrombotic morbidity.

Simple blood tests as predictive markers of disease severity and clinical condition in patients with venous insufficiency.

Chronic venous insufficiency (CVI) is a progressive inflammatory disease. Because of its inflammatory nature, several circulating markers were investigated for predicting disease progression. We aimed to investigate simple inflammatory blood markers as predictors of clinical class and disease severity in patients with CVI. Eighty patients with CVI were divided into three groups according to clinical class (grade 1, 2 and 3) and score of disease severity (mild, moderate and severe). The basic inflammatory blood markers [neutrophil, lymphocyte, mean platelet volume (MPV), white blood cell (WBC), platelet, albumin, D-dimer, fibrinogen, fibrinogen to albumin ratio, and neutrophil to lymphocyte ratio] were investigated in each group. Serum neutrophil, lymphocyte, MPV, platelet count, D-dimer and neutrophil to lymphocyte ratio levels were similar among the groups (P > 0.05). Although the serum WBC levels were significant in the clinical severity groups (P < 0.05), it was useless to separate each severity class. However, albumin, fibrinogen and the fibrinogen to albumin ratio were significant predictors of clinical class and disease severity. Especially, the fibrinogen to albumin ratio was detected as an independent indicator for a clinical class and disease severity with high sensitivity and specificity (75% sensitivity and 87.5% specificity for clinical class and 90% sensitivity and 88.3% specificity for disease severity). Serum fibrinogen and albumin levels can be useful parameters to determine clinical class and disease severity in patients with CVI. Moreover, the fibrinogen to albumin ratio is a more sensitive and specific predictor of the progression of CVI.

Protective effects of ginseng extracts and common anti-aggregant drugs on ischaemia-reperfusion injury.

OBJECTIVE: Ginseng is a traditional herbal medicinal product widely used for various types of diseases because of its cellular protective effects. Possible protective effects of ginseng were investigated in blood, cardiac and renal tissue samples and compared with common anti-aggregant agents in an animal ischaemia-reperfusion (I/R) model. METHODS: Twenty rats were equally divided into four different groups as follows: control group (I/R-induced group without drug use), group I (acetylsalicylic acid-administered group), group II (clopidogrel bisulfate-administered group), group III (ginsenoside Rb1-administered group). For the groups assigned to a medication, peripheral I/R was induced by clamping the femoral artery one week after initiation of the specified medication. After reperfusion was initiated, cardiac and renal tissues and blood samples were obtained from each rat with subsequent analysis of nitrogen oxide (NOx), malondialdehyde (MDA), paraoxonase 1 (PON1) and prolidase. RESULTS: NOx levels were similar in each group. Significant decrements were observed in serum PON1 levels in each group when compared with the control (p < 0.05). Serum MDA levels were significantly lower in groups II and III (p < 0.05). Ameliorated renal prolidase levels were detected in study groups (p < 0.05) and recovered cardiac prolidase levels were obtained in groups II and III (p < 0.05). CONCLUSION: These findings indicate that ginseng extracts may have a potential beneficial effect in I/R injury. However, more comprehensive studies are required to clarify the hypothetical cardiac, renal and systemic protective effects in reperfusion-induced oxidative damage.

Application of thoracic endovascular dissecting aneurysm repair for secondary type B aortic dissection.

Type A aortic dissection is an emergency condition that requires immediate surgery. Graft replacement of the ascending aorta is the main treatment for this disorder. However, after ascending aortic replacement, the dissection flap may progress to the distal side (to the descending aorta) and a new intimal tear may develop. In this study, we report on a 66-year-old woman who had a history of ascending aortic replacement six months earlier. She was admitted to hospital with a new onset of back pain. Computed tomography revealed a new dissection tear originating from the distal side of the subclavian artery orifice. Thoracic endovascular dissecting aneurysm repair (TEVDAR) was carried out on the patient. Additional complications were not observed in the postoperative period. Complete cure was provided and the patient was discharged on the fourth day after the operation. TEVDAR may be safe and effective in preventing progression of the aortic flap and the formation of a new intimal tear in type A aortic dissections. Optional hybrid interventions could ameliorate the outcomes in aortic dissection cases.

Investigation of possible prophylactic, renoprotective, and cardioprotective effects of thromboprophylactic drugs against ischemia-reperfusion injury.

The aim of this study was to investigate whether anticoagulant and antiaggregant agents have protective effects against oxidative damage induced by peripheral ischemia-reperfusion (I/R). Groups were created as follows: control group, I/R group (sham group), I/R plus acetylsalicylic acid (Group I), I/R+clopidogrel (Group II), I/R+rivaroxaban (Group III), I/R+bemiparin sodium (Group IV), and I/R+enoxaparin sodium (Group V). In Groups I, II, III, IV, and V, drugs were administered daily for 1 week before I/R creation. Peripheral I/R was induced in the I/R groups by clamping the right femoral artery. The rats were sacrificed 1 hour after reperfusion. Nitrogen oxide levels, malondialdehyde (MDA) levels, paraoxonase-1 (PON1) activity, and prolidase activity were evaluated in both cardiac and renal tissues. There was no significant difference in nitrogen oxide levels between the groups. However, cardiac and renal MDA were significantly higher and PON1 activity was markedly lower in the I/R groups compared with the control group (p<0.05). Although elevated prolidase activity was detected in both the cardiac and renal tissue of the I/R groups, only the sham group and Group V had significantly higher renal prolidase activity (p<0.05). Group V had significantly higher cardiac MDA, PON1, prolidase levels, and renal prolidase activity compared with the sham group (p<0.05). Significant improvement in renal MDA levels was only observed in Group III, and marked improvement was observed in the cardiac MDA levels of Group II when compared with the sham group (p<0.05). Thromboprophylactic agents appear to provide partial or prominent protection against I/R injury.

Evaluation of the vasoplegic impact of papaverine in the rat aorta.

OBJECTIVE: To identify the degree of vasoplegic affinity of papaverine to rat thoracic aortas following constriction caused by adrenalin, serotonin and potassium chloride in an in-vitro model. METHODS: The in vitro vasoplegic efficacy of papaverine against adrenalin (10(-5) M), serotonin (5HT) (10(-4) M), and KCI (60 mM) was assessed, using a rat aortic vasospasm model in an organ bath. First, aortic rings were constricted with a submaximal dose of vasoconstrictor agents. The samples were then incubated with papaverine (3 x 10(-4) M) for 20 minutes, followed by readministration of the same vasoconstrictor agents. The first vasospastic response (before papaverine incubation) and the new vasoconstrictor responses (after papaverine incubation) of the vessels were then compared. RESULTS: The vasoplegic effect of vasoconstrictor agents in decreasing order was observed as adrenalin > KCl > 5HT. This different affinity for the vasoplegic effect is considered to be a temporary impact of the drugs and the maximal inhibition of vasoconstriction was detected for the adrenalin receptor. CONCLUSION: The relevance of the macromolecules is responsible for the permanent efficacy of the drugs. Different degrees of vasoconstriction were also obtained after papaverine administration, which suggests that different responses can occur as a result of different stimulation of receptor modulators.

Values of troponin T and myoglobin predictive of non-cardiac ischemia in rats.

OBJECTIVES: Biochemical markers are important for the timely diagnosis and follow-up of ischemic events. Most of the markers have been previously studied in the context of cardiac ischemia. However, research on markers of non-cardiac events has been insufficient. Therefore, we investigated the relationship between troponin and myoglobin which are commonly used markers of cardiac ischemia, in non-cardiac ischemia. MATERIALS AND METHODS: Forty-eight rats were equally divided into six groups. Group I was the control group. Group II was the sham group and received a simple laparotomy. The superior mesenteric artery was clamped in groups III and IV in order to create mesenteric ischemia. The left femoral artery was clamped in groups V and VI in order to create peripheral ischemia. Intracardiac blood samples were taken from all groups (during the 3(rd) hour of ischemia in groups III and V and the 6(th) hour of ischemia in group IV and VI) and troponin T and myoglobin levels were measured. RESULTS: Troponin and myoglobin levels were statistically similar in groups I and II. Moreover, increments were detected for troponin and myoglobin in ischemia groups according to group I and II. Furthermore, higher troponin Tlevels were detected after three hours of mesenteric ischemia and higher myoglobin values were observed after six hours of mesenteric ischemia (P<0.05). CONCLUSION: Troponin T and myoglobin are not specific for non-cardiac ischemia, and they may be useful for detecting other ischemic events.

Diagnostic value of plasma C-type natriuretic peptide levels in determination of the duration of mesenteric ischaemia.

OBJECTIVE: Mesenteric arteries release C-type natriuretic peptide (CNP), which hyperpolarises vascular smooth muscle. We measured the levels of this peptide after inducing mesenteric ischaemia over a series of time intervals, so as to determine its predictive value in demonstrating the severity of ischaemia in a rat model. METHODS: A total of 32 rats were allocated to four groups containing eight rats each. Basal CNP reference levels were measured in the control group, which was not exposed to any intervention. In groups I, II and III, mesenteric ischaemia was induced over three, six and nine hours, respectively, and plasma CNP levels were measured afterwards. Mesenteric ischaemia was induced by clamping the superior mesenteric artery. RESULTS: In comparison with the controls (2.38 ± 0.18 pg/ml), CNP levels were relatively lower in group I (2.54 ± 0.42 pg/ml). However, significant increases in plasma CNP levels were observed over longer periods of ischaemia in group II, at 5.23 ± 0.22 pg/ml, and in group III, at 6.19 ± 0.67 pg/ml (p < 0.05). A significant direct relationship was determined between plasma CNP levels and prolonged intervals of mesenteric ischaemia (R = 0.56, p < 0.001). CONCLUSION: Measuring plasma CNP levels in patients with acute mesenteric ischaemia may be beneficial in estimating the time period over which the ischaemic injury has occurred.

The relationship between complete blood count parameters and Fontaine's Stages in patients with peripheral arterial disease.

OBJECTIVE: The aim of the present study is to evaluate whether blood count parameters differ according to the stages of Fontaine's classification and to investigate the relationship between hemogram parameters and the severity of the disease. METHOD: Eighty-two peripheral arterial disease patients were examined prospectively. Patients were classified according to the Fontaine classification system. Fifty newly diagnosed patients were included in the study. The neutrophil-to-lymphocyte ratio, mean platelet volume, and red blood cell distribution width values were recorded. RESULTS: Mean neutrophil-to-lymphocyte ratio values were found to be 3.31 ± 1.1% in Stage I, 3.11 ± 1.3% in Stage II, and 3.48 ± 1.1% in Stage III (p > 0.05). Mean platelet volume values were found to be 7.8 ± 0.6 fl (Stage I), 8.2 ± 1.0 fl (Stage II), and 9.0 ± 0.9 fl (Stage III) (p < 0.05). Red blood cell distribution width values were found to be 13.6 ± 1.0% in Stage I, 14.8 ± 1.7% in Stage II, and 15.4 ± 2.3% in Stage III, being significantly different among all three stages (p < 0.05). CONCLUSION: Both red blood cell distribution width and mean platelet volume are found to be associated with the severity of atherosclerotic disease in patients with peripheral arterial disease. This finding hypothesizes that complete blood counting parameters may serve as a beneficial and cost-effective method for monitoring atherosclerotic peripheral disease.

Investigation of the antiangiogenic behaviors of rivaroxaban and low molecular weight heparins.

Antithrombotic agents play important roles in the prophylactic and therapeutic management of many cardiovascular disorders. Therefore, many researchers have focused on developing new strategies for anticoagulation. New oral anticoagulants and factor Xa inhibitors are products of such research. Although they are identified as advantageous, there are limited data available about their multisystemic interactions. Thus, the antiangiogenic behaviors of oral factor Xa inhibitors and low molecular weight heparins (LMWHs) were investigated in this study. The chick chorioallantoic membrane (CAM) model was designed to investigate the antiangiogenic potential of new oral factor Xa inhibitors (rivaroxaban) and LMWHs (enoxaparin sodium and tinzaparin sodium). Four different molar concentrations (10, 10, 10, and 10 µmol/l) were studied for each drug. Each concentration was studied on 20 fertilized eggs. Vessel structures were evaluated under a stereoscopic microscope, and vessel formation was scaled according to previous literature. Both enoxaparin and tinzaparin sodium have increased antiangiogenic efficacy on CAM in a dose-dependent manner. However, this increased efficacy did not reach significant levels (average score < 0.5). On the contrary, while rivaroxaban showed dose-dependent antiangiogenic properties similar to enoxaparin and tinzaparin, a significant average antiangiogenic score (0.7) was detected at 10 µmol/l concentrations. New oral anticoagulants seem to be more favorable. However, their safety for the cardiovascular system needs to be clarified through microsystem studies on, for example, angiogenesis.

Diagnostic accuracy of mean platelet volume in thromboangiitis obliterans.

Thromboangiitis obliterans (TAO) affects small- and medium-sized vessels of the extremities via a non-atherosclerotic inflammatory process in the elderly. Although diagnostic criteria have been determined, only a few studies have been described in the laboratory features. Diagnostic biomarkers are important for reducing disruptions caused by TAO. The diagnostic importance of mean platelet volume (MPV) was investigated in TAO patients. Forty-four patients diagnosed with TAO (study group) and 45 healthy individuals (control group) were included in the study. The age, gender and complete blood parameters obtained via peripheral venous blood samples were compared between the two groups. A receiver operating characteristic (ROC) curve was used for determining the diagnostic accuracy of the MPV variable. All the variables were statistically similar in each group except MPV and platelet counts. MPV was significantly higher and platelet count was significantly lower in the TAO group (P< 0.05). In addition, diagnostic accuracy was measured by the area under the ROC curve (Figure 1), and MPV differs significantly (P< 0.001), with a value of 0.783 (95% CI: 0.711-0.854). This study indicates that MPV is probably an important diagnostic predictor in TAO patients. Detection of blood parameters such as platelet properties is important for meticulous care of these patients.