The effects of pharmacomechanical thrombectomy on novel complete blood count parameters in deep vein thrombosis: A retrospective study.

This study aimed to investigate the effects of pharmacomechanical thrombectomy on novel complete blood count parameters in deep venous thrombosis. This retrospective study included 242 patients aged >18 years who were treated for deep venous thrombosis. Patients were grouped as follows: group 1 was accepted as having interventional operations (n = 123) and group 2 was accepted as having only medical advice (n = 119). Routine complete blood count parameters, the neutrophil-to-lymphocyte ratio (NLR), and the platelet-to-lymphocyte ratio (PLR) were compared. There was no difference between the groups in terms of admission hemoglobin, hematocrit, mean platelet volume, NLR and PLR (P = .11, P = .24, P = .55, P = .93, and P = .96, respectively). In the pharmacomechanic thrombectomy group, NLR and PLR were significantly reduced after intervention when compared to the admission values (P < .001 and P < .001, respectively). However, the NLR and PLR values of medically treated patients did not differ significantly from their baseline values (P = .16 and P = .08, respectively). In this study, we effectively removed the thrombus load in blocked proximal veins using pharmacomechanical thrombectomy and observed a significant decrease in NLR and PLR, which are current, inexpensive, and accessible parameters.

Prognostic nutritional index predicts in-hospital mortality in patients with acute Stanford type A aortic dissection.

BACKGROUND: Acute Stanford type A aortic dissection (ATAAD) is a life-threatening medical emergency. The aim of this study was to investigate the clinical significance of the prognostic nutritional index (PNI) as a novel inflammatory marker for ATAAD patients undergoing surgical repair. METHODS: We retrospectively examined the medical records of 151 ATAAD patients who treated surgically. Patients were divided into two groups (survival and death) and these groups were compared with respect to clinical and laboratory parameters. The PNI was calculated as 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (per mm3). Logistic regression analyses were performed to identify the risk factors of in-hospital mortality. RESULTS: The mean age of the study cohort was 61 ± 12 years, 99 (65.6%) were males, and 35 (23.2%) patients died during the hospital stay. The PNI levels were significantly lower in death group compared with survival group (32.80 ± 4.90 vs. 37.94 ± 5.42, p < 0.001). Multivariate analysis showed that the PNI (OR: 0.795, p = 0.005), age (odds ratio [OR]: 1.085, p = 0.034), operating time (OR: 1.660, p = 0.042), and D-dimer (OR: 1.002, p = 0.001) independently predicted in-hospital mortality. The calculated cutoff value of the PNI was 33.01. CONCLUSION: Lower PNI values are independently associated with in-hospital mortality in ATAAD. The PNI may be a useful tool for predicting the early mortality of ATAAD patients after surgical repair.

Successful long-term limb salvage using cephalic and small saphenous vein grafts: A case report.

In this case report, we present a patient scheduled for operation due to critical leg ischemia in whom a bilateral great saphenous vein (GSV) had already been used during previous cardiac and peripheral vascular surgeries. The patient underwent femorofemoral crossover bypass from left to right with a small saphenous vein and right femoropopliteal bypass with cephalic vein (CV) during the same session. Distal pulses became palpable, and symptoms regressed dramatically following the operation. A control computed tomographic angiography scan revealed no signs of graft stenosis 32 months after the surgery. Despite the recent advances in synthetic graft materials, small saphenous and CVs should be remembered as alternative long-standing conduits in the absence of the GSV.

A comparison of three tricuspid annuloplasty techniques: Suture, ring, and band.

BACKGROUND: This study aims to compare three different tricuspid annuloplasty techniques using suture, ring, and band. METHODS: Between January 2010 and December 2015, a total of 231 consecutive patients (78 males, 153 females; mean age 50.3±15.9 years; range, 34 to 66 years) who underwent tricuspid valve annuloplasty using three different techniques were retrospectively analyzed. Tricuspid valve r epair w as p erformed w ith d e Vega a nnuloplasty t echnique (n=62, 26.8%), flexible ring (n=76, 32.9%) or Teflon strip (n=93, 40.3%). Postoperative data including vital signs, echocardiographic reports, functional status, and the rate of re-do surgeries were recorded. RESULTS: Cardiopulmonary bypass times were statistically significantly shorter in the de Vega annuloplasty group (p<0.001). There was no significant difference among the groups in terms of the in-hospital mortality. Late postoperative tricuspid regurgitation grades, systolic pulmonary artery pressure, and right atrial diameters showed significant improvements, compared to baseline, in ring and strip annuloplasty groups. CONCLUSION: Our study results demonstrate that suture-based approaches should be avoided. Instead of performing routine tricuspid ring annuloplasty, Teflon strip annuloplasty may be considered an alternative method in most cases, particularly due to controversy in selection of true ring size and high cost of this surgical material in the real-life setting.

Comparison of cutaneous nerve injury and vessel disruption complications following saphenous vein stripping using big or small olive heads.

OBJECTIVE: To compare the nerve injury and vessel disruption complicaitons in patients undergoing saphenous vein stripping using olive heads of different sizes. METHODS: Big olive heads were used in group A (n=50) and small olive heads were used in group B (n=50) from the ankle to the groin; in group C (n=50), the vein was stripped in two sections; in an upward fashion by stripping the distal portion from the ankle to the level of the knee using small olive heads and by stripping the proximal portion from the knee to the level of the groin using big olive heads. RESULTS: Six months after the operation, nerve injury symptoms were identified in 26%, 4%, 6% of patients in groups A, B, and C respectively. Vessel disruption occurred 2% in group A, 32% in group B, and 4% in group C. Both vessel disruption and nerve injury complications of group C were significantly lower than group A and B (p<0.001). CONCLUSION: Saphenous stripping using big olive heads for the proximal portion from the groin down to the level of the knee and using small olive heads for the distal portion from the knee to the level of the ankle is the alternative method which results in minimal nerve injury and vessel disruption.

Successful Treatment of Secondary Aortoenteric Fistula with a Special Graft.

Aortoenteric fistula is an uncommon but life-threatening cause of gastrointestinal blood loss. We report a case of a 70-year-old man who presented to the emergency department with an episode of melena and infection in the left inguinal region. Diagnosis of secondary aortoenteric fistula was made between the left limb of the aortobifemoral graft and the descending colon. We performed excision of the infected graft and in situ silver acetate coating of prosthetic vascular graft replacement (aortoleft femoral) on the patient. This study reports a rare type of secondary aortoenteric fistula to the left colon, and it describes an unusual and successful surgical treatment. Antimicrobial coating of prosthetic vascular grafts may be a good alternative in the presence of graft infection associated with aortoenteric fistula because in situ grafts may carry an increased risk of reinfection.

Groin Swelling in a Four-Year-Old Boy: Primary Great Saphenous Vein Aneurysm.

Primary venous aneurysm, especially in pediatric population, is a very rare clinical entity. We report a case of primary great saphenous vein aneurysm in a 4-year-old boy. He was initially suspected of suffering from inguinal hernia because the soft mass was detected at the inguinal region when the patient was in the standing position, but color Doppler ultrasonography demonstrated the swelling to be a great saphenous vein aneurysm. We decided that surgery was the best option because of potential risk for thromboembolism.

U-vein compressor improves early haemodynamic outcomes in radiocephalic arterio-venous fistulae in under 2-mm superficial veins.

AIM: In this study, we sought to determine the early postoperative results of arterio-venous fistulae (AVF) created by U-vein compressors with veins between 1.5 and 2 mm in size. METHODS: Pre-operative venous mapping was done. The fistula tract was marked at 0-, 4-, 8- and 12-cm points; 0 cm was the estimated point where the anastomosis would be done. With Doppler ultrasonography, transverse diameters in the estimated fistula tract were measured at the 0-, 4-, 8- and 12-cm points. A superficial vein that would be used as the fistula tract was dilated using U-vein compressors. In the first postoperative hour, the flow in the anastomosis, and the transverse diameter of the fistula tract at the 0-, 4-, 8- and 12-cm points were measured by Doppler ultrasonography. RESULTS: Forty patients were included in the study. U-vein compressors were used for 20 patients. Postoperative expansion of vein diameters and postoperative flow velocities were found to be statistically significantly different in patients where a U-vein compressor had been used (p < 0.001). CONCLUSION: We present a technique to dilate veins that are between 1.5 and 2 mm in diameter, which are generally accepted as poor vessels to create radiocephalic arteriovenous fistulae.

Protective role of heparin in the injury of the liver and kidney on the experimental model of ischemia/reperfusion.

BACKGROUND: Surgery of thoracoabdominal aortic aneurysms (TAAA) is associated with high incidence of serious complications. Ischemia/reperfusion (I/R) injury may be responsible for these complications. We investigated the effect of degree of anticoagulation on remote organ I/R injuries and whether heparin is protective against I/R injury in addition to its anticoagulant properties. METHODS: Spraque Dawley rats were used to determine both liver and kidney concentrations of HSP-70,IL-6, MPO in four groups: ischemic control (operation with cross-clamping and intraperitoneal administration of 0.9% saline, n = 7), sham (operation without cross-clamping, n = 7), heparin (ACT level about 200), and high dose heparin (ACT level up to 600). Histological analyses of the organs were performed. RESULTS: Histopathological evaluation of kidney presented significant differences between groups with regards to the cytoplasmic vacuole formation, hemorrhage, tubular cell degeneration and tubular dilatation while heparinized group had best results. The kidney MPO and HSP-70 levels significantly decreased (p < 0.05), but IL-6 level was not significant (p > 0.05) in heparinized group when compared to ischemic control group. No statistically significant intergroup differences were detected in the tissue samples of liver. Immunohistochemical markers of the liver were compared and no statistically significant difference was found among the groups. CONCLUSION: Heparin is an important anticoagulation agent in TAAA surgical procedures but the use of higher levels of heparin in the present study revealed no beneficial effects. Bleeding complications is much less when heparin is used in the real-world clinical practice as ACT levels of 200.

Surgical removal of an atrial septal occluder device embolized to the main pulmonary artery.

Percutaneous closure of atrial septal defects in adults has emerged as an alternative to surgery. We report a sequela of such closure in a 16-year-old boy: embolization of the atrial septal defect occluder into the main pulmonary artery when the patient experienced an episode of intense coughing immediately after device deployment. We removed the device surgically and closed the atrial septal defect in a standard manner, with an autologous pericardial patch.