Therapeutic efficacy of vacuum-assisted-closure therapy in the treatment of lymphatic complications following peripheral vascular interventions and surgeries.

OBJECTIVES: Lymphatic complications, lymphocele and lymphorrhea being the leading, are generally encountered after vascular interventions and surgeries. The present study aimed to evaluate the outcomes of vacuum-assisted-closure (VAC) therapy, which we frequently prefer as the first-choice treatment for such complications. MATERIALS AND METHODS: Among patients undergoing peripheral vascular intervention or surgery between January 2008 and February 2012, the medical files of 21 patients who received VAC therapy or other treatment due to symptomatic lymphatic complications were retrospectively analyzed and the results were discussed. RESULTS: Group I consisted of 10 patients (three with lymphocele and seven with lymphorrhea) who underwent VAC therapy as the first-choice treatment, Group II consisted of 11 patients of which 7 patients received various therapies before VAC therapy and 4 patients received other treatments alone. The patients who received VAC therapy as the primary therapy demonstrated more rapid wound healing, early drainage control, and shorter hospital stay. The mean hospital medical cost was €1038 (range, €739-1826) for the patients who primarily underwent VAC therapy; it was calculated to be €2137 (range, €1610-3130) for the other patients (p=0.001). CONCLUSION: In addition to its safety and good clinical outcomes, VAC therapy also has economic advantages and should be the primary method for the treatment of lymphatic complications.

Cineangiographic intraoperative evaluation of venous grafts during coronary bypass surgery.

BACKGROUND AND OBJECTIVE: Evaluation of graft patency is an important component of coronary bypass surgery. In the present study, intraoperative cineangiography was performed in a cardiovascular hybrid operating room to evaluate anastomosis quality and patency of coronary venous grafts. METHOD: This prospective study evaluated coronary bypass grafts in 34 patients between January 2012 and June 2012. Radiopaque material was administered into the grafts through a vessel cannula before the proximal anastomosis. Then, cineangiographic images were obtained using a mobile C-arm cineangiography system. The myocardial perfusion scintigraphy (MPS) of the patients was compared between preoperative and first month postoperative periods to assess graft function. RESULTS: The localization of the grafts in the target vessel, structural status of the grafts, anastomosis line, and availability of the target vessel were easily evaluated. Angiographic defects were detected in two grafts (3%, n = 60) in two patients (6%, n = 34). Staining was observed in the distal myocardial segments of the saphenous vein grafts following the administration of radiopaque material. The procedure took eight minutes, on average (range, 5-14 minutes), and a mean of 15 mL (range, 10-35 mL) of opaque material was used. None of the patients developed intraoperative myocardial infarction, postoperative complications, or contrast material-induced renal failure. No mortality was observed. The distal myocardial segments of saphenous vein grafts were detected to be perfused 92% normally, 5% reversibly defective, and 3% irreversibly defective with postoperative MPS controls. CONCLUSION: Cineangiographic graft evaluation in a hybrid operating room is a practical, safe, noninvasive, easily available, and easily applicable method.

A rare complication: aorta-cutaneous fistula with abundant bleeding.

Pseudoaneurysm and aorto-cutaneous fistula following surgical procedures of the aorta are rare complications with potentially catastrophic results that require rapid diagnosis and urgent surgical treatment. We performed a successful life-saving operation using hypothermic circulatory arrest with femoral artery and vein cannulation. The patient had undergone open heart surgery in our clinic twice, and there was active and abundant bleeding from aorta-cutaneous fistula that occured 5 years after the last surgery.

Tetraplegia after coronary artery bypass surgery in a patient with cervical herniation.

Tetraplegia is a rare complication after coronary artery bypass surgery. The authors present a case of tetraplegia after uncomplicated coronary artery bypass surgery because of cervical disc herniation. No distinct abnormality was found in the preoperative neurologic examination although the postoperative cervical magnetic resonance imaging revealed a huge hernia at C5-C6 level presenting with tetraplegia. Surgical decompression was performed on the second postoperative day of bypass surgery, and neurologic deficits gradually improved.

An approach to cultural adaptation and validation: the Intermittent Claudication Questionnaire.

The objective of this study was to perform a cultural adaptation and define the validity of the Turkish version of the Intermittent Claudication Questionnaire (ICQ) in order to provide a practical instrument for the evaluation of the impact of intermittent claudication (IC) on patients' quality of life and response to therapy. A standard 'forward-backward' translation method was used to translate the questionnaire into Turkish. Reliability was assessed by internal consistency of the questionnaire reporting Cronbach's alpha coefficient, test-retest reliability that was assessed with the intraclass correlation between instrument scores over time and with the Spearman-Brown coefficient as a variant of split-half reliability. Validity was examined by correlation of the ICQ with the scores of the SF-36 and its eight domains. Eighty-four patients (mean age, 60.7 +/- 7.3 years; male, 57%) were given the ICQ and a final completion rate of 98.8% (83 patients) was reached. The mean total ICQ score was 39.1 +/- 21.8 (SD) (0-100) for the first application of the questionnaire. Thirty patients out of the eligible 83 completed the questionnaire at two time points with a 1-day interval. For the retest, the total ICQ score was 40.6 +/- 26.1 (4.7-97.2). The total SF-36 score of all the study patients was 33.8 +/- 20.7 (3.0-81.0). Cronbach's alpha was 0.95; the Spearman-Brown coefficient was 0.92; and the intraclass correlation coefficient for the two measurements was 0.91. For the total score and for the scores of domains except the emotional role domain, the correlations were high and all the correlations were statistically significant. In conclusion, the Turkish version of the ICQ, which is a disease-specific, self-administered, and practical instrument, is reliable and valid. We recommend its use to assess the effect of IC on the quality of life of patients in clinical trials and in daily clinical practice.

Perioperative type I aortic dissection during conventional coronary artery bypass surgery: risk factors and management.

OBJECTIVES: Perioperative iatrogenic type I aortic dissection (PIAD) is a rare but potentially fatal complication of conventional coronary artery bypass surgery (CCABG). Prompt recognition and repair of PIAD may significantly improve outcomes. METHODS: We reviewed the hospital records of patients with PIAD occurring as a complication of CCABG at Siyami Ersek Thoracic and Cardiovascular Surgery Center from January 2001 through June 2007. During this period, 10,130 CCABG were performed and 21 patients (0.20%) with PIAD were identified. We compared variables for these 21 patients with 603 patients without PIAD (control group). RESULTS: PIAD occurred intraoperatively in 19 patients (90%) and during the early postoperative period (first 6 hours) in 2 patients (10%) who underwent CCABG. Dissections were noticed after removal of the aortic crossclamp in 11 patients, during aortic cannulation in 3 patients, and after removal of the partial-occlusion clamp in 5 patients. Patients with and without PIAD differed significantly in regard to sex (P = .05), history of hypertension (P = .001), and history of severe concomitant peripheral arterial disease (PAD) (P = .001). The diameter of the aorta was significantly wider in patients with PIAD. (3.83 +/- 0.9 vs 2.93 +/- 0.46 cm, P = .019). The occurrence of high cardiopulmonary bypass (CPB) pressure (>==120 mmHg) was significantly higher in the PIAD patients than the non-PIAD patients (28.6% vs 3.3%, P = .0001). Seven PIAD patients (33.3%) died preoperatively and 3 (14.2%) died postoperatively. CONCLUSION: PIAD is frequently fatal. Risk factors for PIAD during or after CCABG include female sex, history of PAD and hypertension, increased aortic diameter, and high CPB pressure.

Myocardial injury during off-pump surgery. The effect of intraoperative risk factors.

OBJECTIVE: To achieve better outcomes, the degree of myocardial injury due to off-pump coronary artery bypass surgery (OPCAB) must be reduced. We studied the factors that render patients scheduled for OPCAB vulnerable to myocardial injury, using troponin T (cTnT) as a marker of myocardial injury. METHODS: We prospectively investigated 123 patients being operated by a group of surgeons with off-pump technique between January 2001 and June 2006 in Siyami Ersek Thoracic and Cardiovascular Surgery Center. Myocardial injury occurring during surgery was assessed by post-operative cTnT measurement. Then, the relation between intraoperative factors and postoperative cTnT release were statistically evaluated. RESULTS: Blood samples for cTnT measurement were taken from all patients before operation, immediately after arrival at the intensive care unit, then at 6, 12, and 24 hours after distal revascularization. When regarding the intraoperative risk factors, we found that the heart rate, blood pressure and anastomosis time are the main determinant of myocardial cell injury occurring during OPCAB surgery. CONCLUSION: Although aortic cross-clamp and cardioplegic arrest were not used in off-pump myocardial revascularization, the ischemic myocardial cell destruction was also inevitable in off-pump technique. Therefore, management of heart rate and myocardial contractility was desirable not only for precise anastomosis but also for myocardial protection during OPCAB surgery.