Unilateral or bilateral cerebral perfusion in hemiarch replacement: A prospective randomized study.

BACKGROUND: We designed a prospective randomized clinical study to compare unilateral and bilateral antegrade cerebral perfusion (ACP) under moderate hypethermia in open distal aortic hemiarch replacement in ascending aortic aneurysm. METHODS: Forty-two patients were prospectively randomized into two groups; unilateral ACP to Group 1 and bilateral ACP to Group 2. Inclusion criteria were pathological aortic aneurysm in the ascending aorta and/or aortic arch, elective operation, normal preoperative carotid Doppler ultrasonography, and nonexistence of preoperative neurological event. Patients were evaluated with preoperative and postoperative biochemical blood analysis, magnetic resonance imaging (MRI), and neurological disorders. The primary endpoints were permanent neurological disorder and death. RESULTS: There were 21 patients in each group. Mean age was 56.57 ± 10.06 years in Group 1 and 50.95 ± 15.64 years in Group 2 (p = .170). No significant difference was found according to demographic data. ACP times were significantly higher in bilateral ACP (Group 1: 12.62 ± 5.04 min, Group 2: 18.23 ± 9.04 min, p = .018) whereas cross-clamp time and cardiopulmonary bypass times were not (p = .693 and p = .584 sequentially). Transient neurological disorder was found in seven patients in Group 1 and in 4 patients in Group 2 (p = .484). Postoperative MRI revealed new milimetric ischemic zones in three patients in Group 1 but none in Group 2. No permanent neurological disorder or mortality was seen. CONCLUSION: The present randomized clinical prospective study could not prove the superiority of one of the technique in cerebral protection probably because, our overall ACP time was too short.

Surgically Treated Pelvic Pain Caused by Nutcracker Syndrome and Worsened by Cockett Syndrome in a Child.

Nutcracker syndrome is rarely seen in the young. Most of the symptoms regress during follow-up. Rarely surgical intervention is necessary. This case presentation is unique for being the first case of nutcracker syndrome and coexistent Cockett syndrome that is treated with surgical intervention.

The effects of showering in 48-72 h after coronary artery bypass graft surgery through median sternotomy on wound infection, pain, comfort, and satisfaction: randomized controlled trial.

AIMS: Time of showering after surgery is still a controversial issue for surgical patients and health professionals. We evaluated the effects of showering in 48-72 h after median sternotomy on sternal wound infections, pain due to sternotomy, patient comfort, and satisfaction levels. METHODS AND RESULTS: The study was a randomized controlled clinical trial. Fifty-one patients were randomly allocated (1:1) to the shower (n = 26) or non-shower group (n = 25). The patients in the shower group (intervention group) showered in the first 48-72 h after surgery and the patients in the non-shower group (control group) were not allowed to shower until their chest tube sutures were removed. They were instructed to shower on the next day after removal of the chest tube sutures. The rate of sternal wound infections was significantly lower in the shower group (n = 2, 7.7%) than in the non-shower group patients (n = 8, 32.0%; P = 0.038). A logistic regression analysis showed that early post-operative showering was protective and significantly reduced the risk of sternal wound infections independently of other variables [odds ratio (OR): 0.177; 95% confidence interval (CI): 0.033-0.940; P = 0.042]. The pain severity score was significantly lower in the shower group patients. Also, comfort and satisfaction scores were significantly higher in this group (P < 0.05). CONCLUSION: Early showering after sternotomy was found to be protective against sternal wound infections and had a positive effect on pain, comfort, and satisfaction. TRIAL REGISTRATION: Clinical Trials.gov registration number NCT04250961 (https://clinicaltrials.gov/ct2/show/NCT04250961).

[Subclavian-carotid transposition for subclavian artery stenosis causing recurrent brachial artery embolism: case report]. / Tekrarlayan brakiyal arter embolisi olusturan subklavyen arter stenozunda subklavyo-karotid transpozisyon: Olgu sunumu.

Subclavian artery stenosis represents a relatively lower rate for upper extremity emboli source. Subclavian artery stenosis with thrombus localized distal to the stenosis was diagnosed on the arteriography of a patient who had a history of three previous brachial artery embolectomies. In this report, a case with subclavian artery stenosis causing recurrent brachial artery embolism who was successfully treated using subclavian-carotid transposition is presented.

Which is first: left anterior descending artery anastomosis or right coronary artery anastomosis in off-pump coronary artery bypass grafting?

OBJECTIVES: The sequence of the distal anastomosis for revascularization in off-pump coronary artery bypass grafting (OPCABG) surgery is under debate. The hypothesis in this study was that an analysis of cardiac markers would reveal that anastomosing the left anterior descending coronary artery (LAD) before the right coronary artery (RCA) would decrease myocardial damage in OPCABG surgery for 2-vessel disease. METHODS: Forty patients with stable angina who underwent OPCABG surgery and who had LAD and RCA lesions were randomized into 2 groups of 20 patients each. The LAD was revascularized first in group 1, and the RCA was revascularized first in group 2. Cardiac troponin I, creatine kinase (CK), and CK myocardial band (CK-MB) were measured in the 2 groups before surgery and at 8, 24, and 48 hours after surgery. RESULTS: No mortality occurred in the 2 groups. The groups were similar with respect to sex, age, durations of anastomosis of the left internal thoracic artery to the LAD and of the saphenous vein graft to the RCA, and preoperative CK, CK-MB, and troponin I levels. Postoperative CK-MB levels were significantly higher in group 2 in the eighth and 24th postoperative hours than in group 1 (P = .009 and .041, respectively). Similarly, troponin I levels were significantly higher in group 2 in the eighth, 24th, and 48th hours than in group 1 (P = .003, .003, and .006, respectively). CONCLUSIONS: Anastomosis to the LAD first in OPCABG surgery led to a slight reduction in myocardial enzyme release against the occlusion of the target vessels during anastomoses in patients with RCA and LAD stenoses.

Prosthetic valve endocarditis: A challenging complication of prosthetic valves.

BACKGROUND: This study aims to evaluate the surgical outcomes of prosthetic valve endocarditis. METHODS: A total of 21 patients (6 males, 15 females; mean age 58.9±12.6 years; range, 33 to 79 years) who were surgically treated for prosthetic valve endocarditis between January 2013 and January 2018 were retrospectively analyzed. Surgical indications included persistent fever for more than seven days after antibiotherapy, congestive heart failure refractory to medical treatment, vegetations larger than 1 cm on echocardiography, the presence of fungal endocarditis, severe valvular leak and valvular dysfunction, and staphylococcal prosthetic valve endocarditis. RESULTS: Five patients had previous aortic valve replacement and three of the aortic prostheses were re-replaced. Two patients had coexisting native mitral valve endocarditis and double valve replacement was done. Thirteen patients had previous mitral valve replacement and 12 of the mitral prostheses were re-replaced. One patient had coexisting native aortic valve endocarditis and double valve re-replacement was done. Three patients had previous aortic valve replacement + mitral valve replacement. Mitral valve endocarditis was diagnosed in two patients and these patients had only mitral valve re-replacement. The other patient had double valve endocarditis, and double valve replacement was done. The mean time from the first operation to the development of endocarditis was 7.3±5.7 years. Of five lost patients, two died from multiple organ failure, one from low cardiac output, one from pneumonia, and one from respiratory failure. CONCLUSION: Radical resection of the infected tissues is critical to achieve favorable surgical outcomes. Single valve replacement of the infected valve may be preferred in patients having previous double valve replacement. Mechanical valves or bioprostheses can be used for re-replacement procedures.

A simple and effective technique for left ventricular deairing.

OBJECTIVE: Despite careful deairing procedures, residual air has been found in the left ventricle. For this reason, we created a simple and effective left ventricular deairing technique. DESIGN: Forty patients with pure mitral valve disease were randomly divided into 2 groups. In group 1, deairing was done by filling the left atrium actively by a line coming from the aortic cannula line, and by venting from the antegrade cardioplegia line. In group 2, the air was removed by ventilating the lungs, and venting from the antegrade cardioplegia line, but not active filling of the left atrium. The patients were evaluated with transesophageal echocardiograpy during the procedure. RESULTS: According to the preoperative data, the groups were similar. After 3 minutes of deairing, 5 patients in group 2 had transesophageal echocardiographical air bubbles. In these patients, after 2 minutes, the air was removed by an active filling technique. None of the patients in group 1 had air bubbles. DISCUSSION: The technique described in this study seems to solve remaining air problems in the cardiac chambers. It can be applied easily, and it is safe and effective.

Iloprost and pentoxifylline attenuate ischemia-reperfusion injury in skeletal muscle in rabbit model.

BACKGROUND: We investigated the effects of iloprost and pentoxifylline on skeletal muscle ischemia-reperfusion injury in a rabbit model. METHODS: Forty New Zealand white rabbits were grouped into four. In Group 1, iloprost was continuously infused starting half an hour before the reperfusion following a 2-hour ischemia formed by abdominal aortic occlusion, and it was continued during the 4-hour reperfusion period. Group 2 was treated with pentoxifylline, and Group 3 received saline solution. Group 4 was the sham group. Malondialdehyde levels and edema scores in gastrocnemius muscle were evaluated. RESULTS: Edema score was significantly lower in Group 1 when compared with the control group (Group 1 vs Group 3, p=0.040; Group 2 vs Group 3, p=0.145; Group 1 vs Group 2, p=0.580). Malondialdehyde levels of the medicated groups were significantly lower when compared with the control group (Group 1: 60+/-11 nmol/g tissue, Group 2: 74+/-11 nmol/g tissue, Group 3: 95+/-10 nmol/g tissue; Group 1 vs Group 2, p=0.010; Group 1 vs Group 3, p<0.001; Group 2 vs Group 3, p<0.001; Group 1 vs Group 4, p<0.001; Group 2 vs Group 4, p<0.001; Group 3 vs Group 4: p<0.001). CONCLUSION: Acute skeletal muscle ischemia is a common problem. We are of the opinion that in the early phase of skeletal muscle ischemia, iloprost and pentoxifylline medication may reduce ischemia-reperfusion injury.

Intimal sarcoma of the pulmonary artery with retrograde extension into the pulmonic valve and right ventricle.

We describe the case of a 42-year-old man who presented with dyspnea on exertion and a history of anticoagulation therapy for what was thought to be pulmonary arterial thromboembolism. He underwent surgery for obstruction of the right ventricular outflow tract. This is a very rare case of an intimal sarcoma of the pulmonary artery, which we confirmed by pathologic studies.

[The efficacy and prognostic value of heart rate variability in 24-hour and short time recordings for determining cardiac autonomic dysfunction in congestive heart failure]. / Kalp yetersizliginde uzun ve kisa süreli kayitlarda kalp hizi degiskenliginin kardiyak otonomik disfonksiyonu belirlemede etkinligi ve prognostik degeri.

OBJECTIVE: The heart rate variability (HRV) has been used in patients with heart failure as a non-invasive method and provided neuro-cardiovascular evaluation. This study was planned to determine the efficacy and prognostic value of 24-hour and short time HRV in autonomic dysfunction in patients with congestive heart failure. METHODS: Forty-six patients with symptomatic or asymptomatic left ventricular dysfunction (ejection fraction <40%) were included to the study. In the study group, 16 patients were in NYHA class I (35%), 19 - were in NYHA class II (41%) and 11 - were in NYHA class III (24%). In the first day, HRV was evaluated from the 24-hour Holter recordings. Following day; we assessed the HRV during: (1) 10 min of supine resting, (2) 10 min of regular breathing at a frequency of 20 acts/min, and (3) 10 min of passive orthostatism after tilting 80 degrees with tilt table. RESULTS: Twenty-four hour and short time recordings of HRV showed significant decrease in long-term LF/HF24 (LF- low frequency, HF- high frequency), and short-term LF/HFsupine, LF/HFbreathing and LF/HFtilt ratios in patients with NYHA class III when compared with the patients in NYHA class I-II (p=0.0001, p=0.01, p=0.03, p=0.0001, respectively). During 446+/-186 days of follow-up, cardiovascular end-points occurred in 20 patients. In Cox multivariate analysis, significant predictors of cardiac mortality and morbidity were, reduced LF/HF ratio (HR=0.4, 95% CI 0.31-0.73, p=0.001) in the 24-hour recordings and low left ventricular ejection fraction (HR=0.9, 95% CI 0.83-0.99, p=0.03). CONCLUSION: Our study demonstrated that both of the methods were useful for assessment of cardiac autonomic dysfunction and only 24-hour recordings of HRV had a prognostic value.

Intracoronary shunt reduces postoperative troponin leaks: a prospective randomized study.

OBJECTIVE: The purpose of this study was to evaluate whether intracoronary shunt usage reduced the myocardial damage on the basis of the cardiac markers when compared with the shuntless anastomosis in off-pump coronary artery bypass grafting (OPCABG) surgery of isolated left anterior descending artery lesions. METHODS: Forty patients who had stable angina with isolated left anterior descending (LAD) coronary artery lesion undergoing OPCABG surgery were randomized into two groups. Shunt group consisted of 20 patients who had OPCABG using intracoronary shunt, whereas the shuntless group consisted of 20 patients who underwent OPCABG without using intracoronary shunt. Cardiac troponin I, CK, and CK-MB before and 24h after the surgery were assessed in the groups. RESULTS: There were no deaths in the study. The two groups were similar with respect to sex and age. Duration of LIMA-LAD anastomosis was significantly higher in the shunt group (p=0.01). There was no significant difference between the groups concerning the preoperative and postoperative CK and CK-MB levels. The preoperative troponin I levels of the groups were not different (p=0.238; NS), whereas postoperative levels of this marker was significantly higher in the shuntless group (p=0.003). CONCLUSION: Intracoronary shunt reduced the postoperative troponin I levels significantly, so it may be indicated in the patients who are thought to be susceptible to transient ischemia.

Perfusion pressure does not affect neurologic outcome in axillary artery side graft cannulation in type a aortic dissection.

OBJECTIVE: Antegrade selective cerebral perfusion (ASCP) through the right axillary is a safe and effective method for cerebral protection in aortic surgery. In the present study, we evaluated whether or not pressure control in ASCP affected the neurologic outcome. METHOD: Sixty-two patients (17 female, 45 male) with a mean age of 53.9 +/- 9.4 years (range, 23-74 years) with a diagnosis of Type A aortic dissection were operated on by using the right axillary artery side graft cannulation technique. ASCP with pressure control was used in the first 37 (59.6%) patients (group 1), whereas ASCP with flow control was used in the consecutive 25 patients (39.4%) (group 2). The groups were compared according to postoperative neurologic outcomes. RESULTS: The hospital mortality rate was 9.7% with 6 patients. The mean ASCP flows of group 1 was 663 +/- 76 mL/min and 692 +/- 51 mL/min in group 2. This difference was not statistically significant (P = .120). The neurological dysfunction rates were 2.7% in group 1 with 1 patient and 8% in group 2 with 2 patients (P = .560). CONCLUSION: In this study, we could not find a statistically significant difference in patients treated with ASCP through the right axillary applicated with pressure control versus flow control.

Aortic valve replacement in true severe aortic stenosis with low gradient and low ejection fraction.

OBJECTIVE: The results of aortic valve replacement are uncertain among patients with severe aortic stenosis, reduced left ventricular ejection fraction, and low mean transvalvular gradient. The aim of the present study was to report on 27 patients who underwent surgery for aortic stenosis with left ventricular ejection fraction

Whole-body perfusion under moderate-degree hypothermia during aortic arch repair.

INTRODUCTION: There continue to be some controversies concerning aortic arch reconstruction, especially the cerebral protection methods. We report our operative and postoperative outcomes for cases of aortic arch replacement using whole-body perfusion during aortic reconstruction under 28 degrees C moderate hypothermia. MATERIALS AND METHODS: A total of 12 patients were operated on between March 2003 and November 2005. Two of the patients were female. The mean age of the patients was 53.5 x 7.3 years (range, 42-65 years). We cannulated the right axillary artery for cerebral perfusion and the right femoral artery for body perfusion. Arch replacement was done under continuous antegrade cerebral perfusion through the right axillary artery and continuous body perfusion through the right femoral artery via intra-aortic occlusion of the proximal descending aorta with an intra-aortic occlusion catheter. Perioperative data and postoperative outcomes, blood urea nitrogen, serum creatinine, and alanin aminotransferase values were evaluated retrospectively in the patients. RESULTS: There was only 1 hospital mortality. There were no neurologic complications. Postoperative levels of blood urea nitrogen and creatinin did not show significant difference but the alanin aminotransferase levels were significantly higher in the postoperative period, which was within the normal ranges of cardiopulmonary bypass effect. DISCUSSION: Whole-body perfusion through the axillary and femoral arteries may provide more time for the surgeon and good cerebral and visceral protection, which are especially important for surgical teams in the learning curve.

Repair of post-infarct ventricular septal rupture with an infarct-exclusion technique: early results.

BACKGROUND: Ventricular septal rupture is a rare but life-threatening complication of acute myocardial infarction. The mortality rate with medical treatment is more than 90%, whereas the mortality rate after surgical repair varies between 19% and 60% in different studies. This study reviews our experience based on early closure of the septal rupture with an infarct-exclusion technique. METHODS: Eighteen consecutive patients who underwent post-infarct ventricular septal rupture operation between June 1, 2000, and November 1, 2005, were included in the study. There were 12 male and 6 female patients. Mean age was 65.72 +/- 5.21 years. All patients had echocardiography and coronary angiography before the operation. Rupture was closed with an infarct-exclusion technique in all patients. Preoperative, operative, and postoperative information were collected from patient cohorts. RESULTS: The median time from myocardial infarction to diagnosis of the ventricular septal rupture was 4.22 +/- 1.61 days. Fourteen of the patients had intra-aortic balloon pump support, and 5 had mechanic ventilator support preoperatively. Surgical repair was done 1 to 4 days after the diagnosis. Ten anterior and 8 posterior ventricular septal ruptures were found. Additional coronary artery bypass surgery was performed with a median of 1.27 +/- 0.8 grafts in 15 (83.3%) patients. The mean postoperative mechanic ventilator support time was 34.13 +/- 45.11 hours. Overall 30-day mortality was 16.7% with 3 patients. The mean intensive care unit stay was 3.3 +/- 1.6 days. Postoperative transthoracic echocardiography showed minimal residual shunts in 4 patients. CONCLUSION: Patch closure of the ventricular septal rupture with an infarct-exclusion technique provided acceptable results. Concomitant coronary artery bypass grafting might be beneficial to control additional risk of an associated coronary artery lesion. Prompt diagnosis followed by early surgical intervention is essential for patients with ventricular septal rupture.

Surgical treatment of postinfarction left ventricular pseudoaneurysms.

OBJECTIVE: Left ventricular pseudoaneurysm is a rare but serious complication of acute myocardial infarction. It is under debate whether surgical intervention is mandatory in asymptomatic patients. The aim of this report was to present our experience based on surgical treatment and midterm outcomes of patients with postinfarction left ventricular pseudoaneurysm. METHODS: Eight consecutive patients who underwent left ventricular pseudoaneurysm operation between January 1, 1995, and January 1, 2006, were included in the study. There were 5 male and 3 female patients. Mean age was 62.87 +/- 5.03 years. All patients had echocardiography and coronary angiography before the operation. Two anterior and 6 posterior pseudoaneurysms were detected. Left ventricular pseudoaneurysm was repaired with a synthetic patch by the remodeling ventriculoplasty method of Dor in all patients. Coronary revascularization was performed if necessary. Preoperative, operative, and postoperative data were collected from the patient cohorts. RESULTS: The mean duration from myocardial infarction to diagnosis of the ventricular septal rupture was 13.5 +/- 12 days. Additional coronary artery bypass surgery was performed with a median of 1.2 grafts in 5 patients (62.5%). The mean postoperative mechanic ventilator support time was 20.12 +/- 29.22 hours. Overall 30-day mortality was 12.5% with 1 patient death. The mean intensive care unit stay was 3.75 +/- 2.1 days. The late mortality rate was 12.5%. In the follow-up period (mean, 30.66 +/- 16.86 months), of the 6 patients who were alive, 5 were in New York Heart Association class I or II and 1 was in class III because of pre-existing low left ventricular ejection fraction. Transthoracic echocardiography showed good left ventricular configurations without a false aneurysm together with increases in the ejection fractions. CONCLUSION: Prompt diagnosis and early surgical intervention is essential for patients with large or expanding left ventricular pseudoaneurysms due to the high propensity of fatal rupture. Associated coronary artery bypass grafting may reduce early mortality of patients with left ventricular pseudoaneurysm by resuscitating the ischemic myocardium.

Does combination of antegrade and retrograde cardioplegia reduce coronary artery bypass grafting-related conduction defects?

BACKGROUND: Conduction disorders appearing after coronary artery bypass surgery (CABG) may have many different causes. In this study, we evaluated the postoperative conduction disorders after CABG with respect to the ante-grade blood cardioplegia and ante-grade plus continuous retrograde cardioplegia delivery methods. MATERIALS AND METHODS: This retrospective study included 1824 patients undergoing CABG between January 2001 and December 2005. There were 694 female patients (38%) and 1130 male patients (62%). Myocardial protection was done by isothermic hyperkalemic blood cardioplegia. Patents in Group 1 (n = 704) were operated on using only intermittent antegrade cardioplegia and those in group 2 (n = 1120) were operated on using the antegrade plus retrograde continuous cardioplegia. The postoperative occurrences of a new right bundle branch block, left anterior hemiblock, left posterior hemiblock, left bundle branch block, or third-degree atrioventricular block were evaluated and compared. RESULTS: Total mortality rate was 1.6% (29 patients) without significant difference between the groups. The preoperative and perioperative characteristics were statistically similar in the groups. The occurrence of conduction disorders was significantly higher in group 1 (P = .006, 55 versus 52 patients). The analysis of the patients with conduction disorders showed a significantly increased mortality rate (P < .001) in addition to a significantly increased period of intensive care unit follow-up and duration of postoperative hospitalization (P <.001). CONCLUSION: The present study demonstrated that the perioperative occurrence of conduction disorders after CABG was decreased by antegrade controlled and retrograde continuous combination cardioplegia.

Direct versus side-graft cannulation of the right axillary artery for antegrade cerebral perfusion.

Antegrade selective cerebral perfusion through the right axillary artery has proved to be a safe and effective method for cerebral protection in aortic surgery. In this study, we prospectively evaluated the techniques of direct right axillary artery cannulation (Group 1) and right axillary artery side-graft cannulation (Group 2), investigated cannulation-related complications, and determined the hemodynamic advantages and disadvantages of both cannulation techniques. Sixty-eight patients underwent surgery from April 2001 through August 2004 with the diagnoses of ascending and aortic arch aneurysms (10 patients), type A aortic dissection (56 patients), and aortic pseudoaneurysm (2 patients). There were 22 patients in Group 1 (33.4%) and 46 patients in Group 2 (67.6%). The antegrade selective cerebral perfusion flow was 500 to 700 mL/min in Group 1, whereas in Group 2 the flow was adjusted in accordance with the mean right radial arterial pressure, which was 50 mmHg. There was no significant difference between the groups in antegrade selective cerebral perfusion times, but the transient neurologic dysfunction rate (4 of 22 patients in Group 1 vs 1 of 42 in Group 2) was significantly lower in Group 2 (P =0.035). In Group 1, axillary artery dissection occurred in 2 patients (9%), and postoperative arm ischemia occurred in 1 patient (4.5%). These complications were not seen in Group 2 (P =0.031). The side-graft cannulation technique may be more acceptable because of its lower local-complication rate and because it provides pressure-controlled cerebral perfusion.

Surgical treatment of giant cardiac aneurysm with pseudoaneurysm in a colon carcinoma patient.

Left ventricular pseudoaneurysm is a rare and lethal condition associated with a high risk of rapid enlargement and rupture. It develops after transmural myocardial infarction (MI), cardiac surgery, trauma, or infection. When a left ventricular pseudoaneurysm is detected, surgical repair is recommended due to the high possibility of rupture. In this report, we present surgical treatment of a giant cardiac pseudoaneurysm that occurred after MI in a colon carcinoma patient.

Effects of endovenous laser ablation on vascular tissue: molecular genetics approach.

BACKGROUND: Endovenous laser ablation (EVLA) is a treatment option for lower extremity varicose veins. In the present study, we investigate to the genetic changes and possibility of living tissue in the saphenous vein wall after the EVLA procedure. METHODS: Eleven saphenous vein grafts were randomized in two groups: (1) 4 cm SVG segments of performed EVLA procedure in study group, (2) 4 cm segments of SVG none performed EVLA procedure in control group. SVG were taken from the remnants of distal saphenous vein grafts prepared for the bypass procedure but not used. SVG was approximately 8 cm in length and was divided into two parts 4 cm in length. One half was exposed to laser energy, while the other half of the same vein graft was untreated as a control. EVLA was performed on complete saphenous veins in the study group. Abnormal genetic changes of the SVG were observed with a Tri-Reagent method and quantified with a Nanodrop™ spectrophotometer. RESULTS: Histopathological changes indicated that the intima including the endothelium was completely necrotized in the study group. It was observed that intimal thermal-energy-induced injury did not reach the media. Histopathological examination showed that homogenous eosinophilic discoloration and coagulation necrosis characterized the laser related thermal damage as well. CONCLUSIONS: In this preliminary study, we found that living tissue remained in the SVG wall after application of laser ablation, and we also detected abnormal genetic changes in the study group compared with the control group.