Retrograde Versus Antegrade Approach for the Endovascular Treatment of Symptomatic Femoropopliteal Disease: Results of the 2-Year Follow Up.

OBJECTIVE: To compare the antegrade and retrograde approaches, in terms of access site complications and long-term patency in subjects undergoing EVT for symptomatic SFA or popliteal artery stenosis or occlusions. METHODS: All consecutive patients who underwent retrograde recanalization for partial stenosis or chronic total occlusion of the SFA or PA at 2 centers were enrolled in this retrospective analysis. Subjects were divided into 2 groups, according to the approach selected for EVT as antegrade approach group or retrograde approach group. The rate of primary patency, which was defined as the lack of restenosis at the target lesion, was the primary outcome measure, during the follow-up evaluations. The rate of procedural complications, including hematoma, bleeding, and distal embolism, were secondary outcome measures. RESULTS: A significant improvement occurred in ABI, following the intervention in both the antegrade approach group [0.7 (0.3 - 1.1) versus 0.85 (0.4 - 1.3), P < 0.001] and retrograde approach group [0.5 (0.3 - 1.1) versus 0.8 (0.3 - 1.3), P < .001]. The primary patency rate at the 1st, 6th, 12th and 24th months of the intervention in the antegrade approach group were 94.85%, 83.82%, 74.26%, and 66.91%, respectively. The primary patency rate at the 1st, 6th, 12th, and 24th months of the intervention in the retrograde approach group were 93.33%, 86.67%, 84.44%, and 71.11%, respectively. The groups were similar with respect to the primary patency rates. The rate of complications, including hematoma, bleeding, and distal embolization was similar in the 2 groups. CONCLUSION: Antegrade approach and retrograde approach provide a similar safety profile in the EVT of SFA and popliteal artery stenosis and occlusion. The primary patency rates at the 1st, 6th, 12th, and 24th months of follow up also were similar in the 2 groups. However, the significant difference in the lesion characteristics of the subjects undergoing retrograde or antegrade approach complicates the ability to reach a clear conclusion, regarding the superiority of one technique over the other.

Health-related quality of life after vascular surgery and endovascular treatment in subjects with critical limb ischemia.

BACKGROUND & OBJECTIVE: Revascularization of the target vessel and restoration of distal flow is critical not only to reduce mortality and morbidity but also improve health-related quality of life (HRQoL) in patients with critical limb ischemia. However, data concerning the impact of surgical bypass and percutaneous transluminal angioplasty (PTA) on HRQoL is limited. This study aimed to compare the impact of surgical bypass and PTA on HRQoL in subjects undergoing superficial femoral artery (SFA) or popliteal artery revascularization. METHODS: Seventy-one subjects who underwent successful revascularization of the SFA or popliteal artery either with surgical revascularization or PTA were enrolled in this study. Three months after revascularization, all subjects underwent ankle-brachial index (ABI) measurement, 6-minute walking test and completed the Nottingham Health Profile (NHP) questionnaire. The NHP score differences (measured at the post-procedural 3rd month) between subjects undergoing surgical or endovascular (PTA) revascularization subjects was the primary outcome measure of the study. RESULTS: Both groups experienced significant improvements in ABI and 6-minute walking distance at post-procedure three months. NHP total scores of Part I and Part II at post-procedural six months were similar in the two groups. However, social isolation [77.98 (0 - 85) vs. 22.53 (0 - 100), p=0.002] and physical abilities [78.7 (30.31 - 87.7) vs. 54.47 (0 - 100), P=0.014] domain scores of the surgical revascularization group were significantly higher than that of the endovascular treatment group. CONCLUSION: This study shows that total scores obtained from the NHP questionnaire applied three months after revascularization of SFA stenosis are similar in subjects undergoing surgical revascularization or PTA. However, the social isolation and physical abilities domains of the NHP are significantly higher in subjects receiving surgical revascularization compared to those receiving PTA.

Is hyperbaric oxygen or ozone effective in experimental endocarditis?

BACKGROUND: Infective endocarditis, a disease with high mortality and morbidity, is most commonly caused by Staphylococcus aureus; mortality and morbidity further increase in the presence of methicillin-resistant strains of S. aureus. Linezolid is the first of the oxazolidinones, a new antibiotic group that has been approved for the treatment of infections caused by gram-positive cocci. Linezolid reduces the quantity of microorganisms in vegetation to some extent; in addition, the use of hyperbaric oxygen (HBO) and ozone (O3) therapies is likely to improve targeted antibacterial effect. MATERIALS AND METHODS: Fifty-six adult male Wistar rats weighing 300-350 g were used. The subjects were divided into groups as follows: Group 1 (n = 8): control group that was not inoculated with microorganisms and was untreated; Group 2 (n = 8): control group that was inoculated with microorganisms but was untreated; Group 3 (n = 8): linezolid treatment group; Group 4 (n = 8): O3 therapy group; Group 5 (n = 8): HBO therapy group; Group 6 (n = 8): linezolid + O3 therapy group; Group 7 (n = 8): linezolid + HBO therapy group. RESULTS: In terms of reducing the number of colonies in the aortic valve, linezolid + HBO therapy was found to be the most effective treatment. Then, respectively linezolid + O3, linezolid, HBO, and O3 were found to be effective. CONCLUSIONS: We found that linezolid significantly reduced the number of bacteria in the vegetation in the experimental endocarditis model, and HBO therapy increases the effectiveness of linezolid and makes this better than O3.

Predictive value of elevated neutrophil-lymphocyte ratio for left ventricular systolic dysfunction in patients with non ST-elevated acute coronary syndrome.

OBJECTIVE: We aimed to study the predictive value of the neutrophil-lymphocyte ratio (NLR) for left ventricular systolic dysfunction (LVSD) in patients with non ST-elevated acute coronary syndrome (NST-ACS). METHODS: A total of 405 patients (mean age 62 years and 75% male) with NST-ACS were included in the study. The study population was divided into tertiles based on admission NLR values. The low, medium and high tertiles defined as NLR≤1.81 (n=135), 1.813.2 (n=135), respectively. RESULTS: The patients in the high NLR group were older (p<0.001), have higher rate of diabetes mellitus (p=0.028) and non-ST elevated myocardial infarction (NSTEMI) (p<0.001) and have lower left ventricular ejection fraction (LVEF) (p<0.001). Baseline WBC (p=0.02) and neutrophil (p<0.001) levels and NLR (p<0.001) were significantly higher, baseline hemoglobin (p=0.044), hematocrit (p=0.019) and lymphocyte (p<0.001) levels were significantly lower in the high NLR group. NLR was negatively correlated with LVEF in correlation analysis. An NLR >3.2 and age ≥70 were found to be an independent predictor of systolic dysfunction in multivariate analyses. CONCLUSION: An NLR >3.2 is a useful predictor for LVSD in patients with NST-ACS. The practice of using an NLR count on admission may be useful for identifying high-risk patients and their associated treatment methods.

Surgical management of axillosubclavian vascular injuries.

OBJECTIVE: Complex surgical exposures to upper extremity injuries required for conventional surgery correlate with a high morbidity and mortality. We present our results with conventional surgery following injuries of the subclavian and axillary vessels. METHODS: Between November 2007 and March 2012, 29 cases with subclavian-axillary vascular injury were operated. Diagnostic and treatment methods, associated organ injury, morbidity and mortality rates in these cases were respectively reviewed. RESULTS: The causes of injuries were stab wounds in 11 cases (37.9%), gunshot wounds in 9 cases (31%), iatrogenic injuries in 5 cases (17.2%) and blunt trauma 4 cases (13.7%). Eight patients (27.5%) had isolated arterial injury while 21 patients (72.4%) had coexisting organ injury (vein, bone, soft tissue, nerve). Primary repair and usage of saphenous vein were the most common surgical methods. One patient died due to myocardial infarction. (Mortality 3.4%). CONCLUSIONS: Vascular injuries of axillosubclavian are frequently associated with neurogenic, osseous and soft tissue injuries and should have early intervention. Conventional surgery remains the choice of treatment in patients with poor status and urgency.

Relationshi̇p between atrial fibrillation and coronary bypass surgery.

OBJECTIVE: Atrial fibrillation (AF) is the most common arrhythmia seen after coronary artery surgery. The purpose this study was to determine incidence of AF that develops after coronary surgery and the factors affecting its development. METHODS: Four hundred and forty eight patients who had coronary bypass surgery between February 2007 and September 2011 in the Cardiovascular Surgery Clinic were included in the study. Patients with history of chronic renal failure, redo coronary bypass surgery, valvular disease, thyroid disease, ventricular aneurysm and treatment with beta-blockers were excluded from the study of EF. RESULTS: Two hundred and ninety nine patients were male and 149 were female and their age varied between 38 and 85 and their mean age was 61±5. Surgery was performed on beating heart on 178 patients and the others were operated with cardiopulmonary bypass (CPB). Advanced age, male sex and history of hypertension was more in AF developed patient group. There was no difference between AF developed group and the other group in terms of diameter of left atrium, ejection fraction (EF), CPB time and cross clamp time. CONCLUSION: Advanced age, male sex, hypertension and prolonged P-wave duration are the factors that are associated with AF after coronary surgery. Avoidance of CPB does not decrease AF development.

Atrial septal defect repair; our early and mid-phase results.

OBJECTIVE: Atrial septal defect is one of the most commonly encountered congenital heart diseases in adults. The effect of age of the patient to the surgery is disputable. The purpose of this report was to evaluate surgical repair in patients with ASD who are operated in our clinic. METHODS: Total 40 patients were subjected to surgical repair due to ASD in Van Yuksek Ihtisas Education and Research Hospital between February 2006 and April 2009. Twenty seven of the patients were female and 13 were male, their ages differed between 8 and 71 and mean age of the patients was 33.70±14.04. RESULT: Operative mortality did not occur. Two of our patients had coronary arterial disease in addition to ASD. ASD repair was performed together with coronary bypass surgery. Closing of ASD resulted in an increase in left ventricular ejection fraction, and a decrease in pulmonary arterial pressure and cardiothoracic ratio. Recovery in the functional capacity was observed post-surgery according to NYHA. CONCLUSION: In this series, surgical results of the patients of various ages, with ASD closed were positive.

The effects of 21 and 23 milimeter aortic valve prosthesis on hemodynamic performance and functional capacity in young adults.

OBJECTIVE: Early and medium-term improvement of functional capacity and regression of left ventricular hypertrophy was evaluated in the young adult patient group following application of 21 mm or 23 mm bileaflet aortic mechanical valve prosthesis due to aortic stenosis. Methods : Twenty two patients (10 male, 12 female; mean age 27+-8.2 (19-43)) who underwent isolated aortic valve replacement due to rheumatic aortic stenosis, were included in the study. 21 mm and 23 mm bileaflet mechanical prosthesis was used respectively in eight and fourteen patients. The mean body surface area was 1.86 m(2) and 1.68 m(2) respectively in 23 mm and 21 mm prosthesis while 1.73 ±0.25 m(2) for the whole group. Functional capacity was New York Heart Association (NYHA) class II in 9 patients and class III in thirteen patients. Implantation was performed without enlarging the aortic root in all except four patients. In all patients transvalvular gradients, effective orifice area and the diameter of left ventricle were measured with transthoracic echocardiography during rest and after maximal exercise. Mean follow-up was 34±12 months (range 11-57 months). RESULTS: There were no postoperative complications or deaths. All the patients were assessed as NYHA class I with regards to functional capacity (p=0.01). Significant improvements were determined in postoperative mean transvalvular gradient (p=0.005) and left ventricular mass index (p=0.01) when compared with preoperative values. CONCLUSION: Our findings show that replacement with 21 mm and 23 mm mechanical prosthesis provides a significant improvement in regression of symptoms and increase of functional capacity in young adults in early and mid-period without increasing mortality and morbidity.

Fragmented QRS and prediction of paroxysmal atrial fibrillation episodes.

OBJECTIVE: Prior studies have demonstrated the relationship between cardiovascular diseases and fragmented QRS (fQRS). fQRS was also associated with ventricular arrhythmias. Our objective was to find out the relationship between fQRS and paroxysmal atrial fibrillation (PAF). METHOD: A total of 301 patients without overt structural heart disease were prospectively included in the study. Patients were divided in to 2 groups according to presence of fQRS. Multivariate logistic regression analysis was used to assess the predictive value of fQRS for predicting PAF. RESULTS: One hundred and three patients had fQRS. Patients with fQRS were older (53±16.8 vs 45.3±17.2, p<0.001), with larger left atrium (LA) (33.2±5.9 vs 30.1±5.9 mm, p=0.001), with thicker interventricular septum (IVS) (10.2±1.9 vs 9.5±2.3 mm, p=0.032), more diabetic (19.8 vs 10.6%, p=0.029) and have more PAF episodes (22.3 vs 4.1%, p<0.001) in comparison with patients without fQRS. fQRS was an independent predictor of detecting PAF episode (odds ratio, 9.69; 95% confidence interval, 2.46-38.15, p=0.001). Hypertension and diabetes mellitus were also predictive. CONCLUSION: The presence of fQRS independently predicted PAF episodes in holter monitoring (HM). Further studies are needed to clarify the clinical implications of this finding.

The association between serum uric acid level and heart failure and mortality in the early period of ST-elevation acute myocardial infarction.

OBJECTIVES: Uric acid (UA) is a strong marker of cardiovascular disease. Therefore, we aimed to determine the relationship between serum UA levels and cardiovascular events in patients in the early period of their acute myocardial infarction. STUDY DESIGN: This retrospective study included 586 consecutive patients with ST-elevated myocardial infarction (STEMI) who were admitted to the hospital between March 2010 and February 2012. The study population was divided into two groups; the first group included hyperuricemic patients (n=107; uric acid level >6 mg/dl in women and >7 mg/dl in men), and the second group included patients with normal UA level (n=479). Multivariate analysis was used to demonstrate the predictive value of UA levels in groups. RESULTS: Patients in the hyperuricemic group were older (median 66 years vs. 60 years, p=0.001), and the ratio of female patients was higher (35.5% vs. 16.9%, p=0.001). Patients with hyperuricemia had a significantly higher incidence of in-hospital cardiovascular mortality than the normal group (15.9% vs. 3.1%, p<0.001). Advanced heart failure (class ≥ 3) was more frequent among hyperuricemic patients (17.8% vs. 8.8%, p=0.006). Age ≥ 70 years, chest pain duration >6 hours and hyperuricemia (hazard ratio (HR): 1.83, 95% confidence interval: 1.02-3.27; p=0.041) were found to be independent predictors of advanced heart failure. Hyperuricemia was found to be an independent predictor of in-hospital cardiovascular mortality in multivariate analyses (HR: 5.32, 95% confidence interval: 2.46-11.49; p=0.001). CONCLUSION: This study showed that a high serum UA level is an independent predictor of cardiovascular mortality and morbidity during the in-hospital period of STEMI.

The safety and efficacy of pharmaco-mechanical thrombolysis in lower-extremity deep venous thrombosis.

OBJECTIVE: The aim of this study was to investigate the impact of accelerated pharmaco-mechanical thrombolysis (PMT) with low-dose second-generation urokinase for the management of cases with lower-extremity deep venous thrombosis (DVT), and to compare its efficacy in subjects with acute and subacute DVT. METHODS: Thirty-five patients with acute (< 15 days) or subacute (15-30 days) DVT who underwent PMT in a tertiary centre were enrolled in this single-arm, prospective study. Following the placement of a temporary vena cava filter, urokinase (200 000 IU) was administered into the occlusion through a multi-hole catheter for 15 to 20 minutes. Control venography was performed to assess venous flow and the rate of acute recanalisation. Percutaneous balloon dilatation and stent placement were carried out in case of a residual iliac vein stenosis of > 50%. Any residual thrombi were suctioned with an aspiration catheter. The primary outcome measures of this study were the percentages of vessel patency and PTS in the third month after PMT. RESULTS: Complete recanalisation was noted in 23 (66%) patients, while two (6%) had poor recanalisation. The rate of minor complications was 14%. None of the subjects experienced major complications, such as intracranial haemorrhage or pulmonary embolism. No mortality was recorded during the three months of follow up. Control duplex ultrasonography in the third month revealed that the target vein was patent in all subjects. None of the subjects experienced PTS during follow up. In addition, the percentage of acute complete recanalisation was significantly higher in subjects with acute DVT compared to those with subacute DVT (95 vs 27%, p < 0.001). CONCLUSION: PMT with an accelerated regimen of low-dose urokinase provided excellent efficacy in the resolution of thrombus and prevented the development of PTS in the midterm when used for the management of lower-extremity DVT.

Effects of perioperative statin treatment on postoperative atrial fibrillation and cardiac mortality in patients undergoing coronary artery bypass grafting: a propensity score analysis.

AIM: To evaluate the effect of perioperative statin treatment on postoperative atrial fibrillation and cardiac mortality in patients undergoing coronary artery bypass grafting. METHODS: A total of 1890 patients who underwent isolated coronary artery bypass were analyzed retrospectively, of which 425 patients (22.4%) older than 70 were included in the study. The demographic properties, preoperative, operative and postoperative data and other medications of these patients were recorded. Continuous preoperative and postoperative atorvastatin therapy were received by 124 (29.17%) patients; 301 (70.82%) patients were matched to a control group (no-statin group). The two groups were matched by propensity score analysis in terms of atrial fibrillation development and cardiac mortality. RESULTS: Medical history, medical treatment, cardiovascular history, and operative characteristics demonstrated significant heterogeneity in both groups. Postoperative atrial fibrillation was similar in both groups. Before propensity score matching, the percentages of patients in postoperative atrial fibrillation with respect to Atorvastain-group and No-statin-group were 13.71 and 10.3 respectively; however, those were 13.71 and 14.51 after matching. In a multivariate regression analysis, five-vessel bypass (odds ratio OR, 2.354; 95% confidence interval CI, 0.99 to 5.57) was an independent predictor of postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting. In-hospital mortality was higher in the Atorvastatin-group compared with the No-statin-group: 124 (8.9%) versus 301 (3.7%), respectively; p=0.027). CONCLUSION: Perioperative atorvastatin treatment is not found to be associated with reduced postoperative atrial fibrillation and cardiac mortality in patients undergoing isolated coronary artery bypass grafting above the age of seventy years.

Efficacy of chronic statin therapy on major cardiac events after coronary artery bypass grafting: low-dose versus high-dose.

AIM: To investigate whether chronic statin treatment after coronary artery bypass grafting (CABG) protects patients from major cardiac events and provides percutaneous coronary intervention (PCI) free survival. METHODS: A total of 232 patients with previous CABG and chronic statin therapy were selected retrospectively and were divided into two groups according to a dosage of atorvastatin per day, e. g., 20 mg or 40 mg. Groups were compared for the major cardiac events and freedom from PCI by Kaplan Meier analysis as the primary end point. Patency of grafts including left internal thoracic artery (LITA) and saphenous vein (SVG) and progression of non-grafted native vessel disease were also evaluated as secondary end points. RESULTS: Cardiac mortality, periprocedural myocardial infarction (MI), target vessel revascularization and percutaneous coronary intervention free survival were as follows: 2.9% versus 2.1% (p=1.000); 16.1% versus 21.1% (p=0.331); 56.93% versus 52.63% (p>0.005); 58.4% versus 63.2% (log-rank test; p= 0.347) in atorvastatin 20 mg and atorvastatin 40 mg groups, respectively. However, these results were not statistically significant between two groups (p>0.005). Patency of openness of grafts including LITA and SVG and progression of non-grafted native vessel disease were similar between groups (p=0.112, p=0.779, p=0.379 and p=0.663, respectively). CONCLUSION: Low-dose long-term statin treatment had similar outcomes on major cardiac events and identical rate of freedom from percutaneous coronary intervention after coronary artery bypass grafting compared with high-dose long-term statin treatment. It is better to start from low dose statin treatment after surgical interventions.

Relationship between fragmented QRS and paradoxical septal motion in coronary artery bypass graft patients.

OBJECTIVE: Paradoxical septal motion (PSM) can cause confusion in the assessment of ventricular function with scintigraphy even in the absence of ventricular septal damage and ischemia. Fragmented QRS (fQRS) is associated with various cardiac disorders. In this study, we aimed to determine the correlation between paradoxical septal motion and fQRS after coronary artery bypass grafting (CABG). METHODS: We retrospectively reviewed the hospital records showing scintigraphic images and electrocardiograms (ECG) of the patients who had undergone CABG. The patients were classified based on the evaluation of motion and thickening of the septal wall. The patients with regular thickening of the septal wall and abnormal motion were classified as PSM (+) group. The patients with normal motion and thickening of the septal wall were classified as PSM (-) group. fQRS complexes are defined as various RSR patterns either with or without Q-waves on a 12-lead resting ECG. RESULTS: PSM was found to be more common in fQRS patients (p < 0.001). PSM was seen in 91.4 % of cases with fQRS and in 79.8 % of cases without fQRS. No significant differences were found in the phase analysis parameters. A correlation was found between septal wall motion values and the presence of fQRS (r = 0.197, p = 0.012). CONCLUSION: fQRS was associated with PSM. fQRS may cause PSM in patients with CABG without left bundle branch block due to a conduction defect. PSM and fQRS are predictive of cardiac mortality. Patients diagnosed with PSM and fQRS, should be monitored closely.

Impact of elevated serum estradiol/free testosterone ratio on male varicose veins in a prospective study.

OBJECTIVE: Although some studies indicate an association between increased levels of estradiol and varicose veins in women, the role of sex hormones on varicose veins have a question mark in men. METHODS: We investigated estradiol-2/free testosterone (E2/fT) ratio relationship on varicosity in 100 male patients dividing them into two groups. Group A (n = 46) had varicose veins with endocrinological problems, especially infertility, whereas group B (n = 54) also had varicose veins but no endocrinological problems. Venous blood samples were drawn from both groups in the morning to detect the levels of serum estradiol (E2), androstenedione, dehydroepiandrostenedione sulphate and free testosterone (fT). Patient history, physical examination, colour duplex ultrasound of both limbs and classification of CEAP were performed in both groups. Serum E2/fT ratio was calculated in correspondence with CEAP classification. CEAP classification is the varicosity classification, and it is concerned about the clinical class (C), etiology (E), anatomical distribution (A) and underlying pathophysiology (P). RESULTS: E2/fT ratio was significantly higher in group A (4.18 ± 0.54) compared with group B (2.98 ± 0.36). Moreover, there is a high correlation between serum E2/fT ratio and CEAP clinical classification in group A (4) compared with group B (2). CONCLUSION: Serum E2/fT ratio is associated with varicose veins in male patients.

Can the ankle brachial pressure index (ABPI) and carotis intima media thickness (CIMT) be new early stage markers of subclinical atherosclerosis in patients with rheumatoid arthritis?

BACKGROUND: It takes years for atherosclerosis to manifest symptoms. However, it needs to be identified earlier because of the premature cardiovascular risk factors in patients with rheumatoid arthritis (RA). In this study, we aimed to investigate the effect of atherosclerosis on the ankle brachial pressure index (ABPI) and carotis intima media thickness (CIMT) in patients with RA. METHODS: RA patients attending the rheumatology clinic were examined retrospectively; then we called them for the measurements of ABPI and CIMT prospectively. Subjects were divided into four groups, as follows (Table 1): group 1 comprised RA patients with an ABPI less than 0.9; group 2 included RA patients with an ABPI between 0.9 and 1.2; group 3 was made up of RA patients with an ABPI greater than 1.2; and group 4 included patients without RA with an ABPI between 0.9 and 1.2 as a control group. Patients' demographic data were recorded. Hypertension (HT), diabetes mellitus, ABPI and CIMT measurements were taken by specialists. Duration of RA and disease scores (disease activity score-28, health assessment questionnaire score and visual assessment score) were recorded. RESULTS: The prevalence of peripheral vascular disease in patients with RA was twice as high as that in the normal population of equivalent age. Patients in group 2, with RA and normal ABPI, exhibited a significant higher mean in CIMT (mm) compared with the control group (p < 0.01), despite having normal ABPI. This confirms that these patients have a higher risk of stroke compared with the control group. Group 1's newly diagnosed HT (p < 0.01) and systolic blood pressure (SBP) values (p < 0.01) were higher and statistically significant when compared with the group 4 (control group); in addition, significant plaque levels were observed in the carotid arteries (p < 0.01). Group 3 patients had a similar history of HT and increased SBP compared with patients in group 4 (p < 0.01), and had similar characteristics to with group 1. No statistically significant differences were found between the groups in terms of inflammatory markers such as C-reactive protein and rheumatoid factor, anti-cyclic citrullinated peptide and white blood cell counts. CONCLUSION: Based on the present findings, patients with RA need to be evaluated in the early stage of the disease for subclinical peripheral artery disease using the ABPI, as well as CIMT, which is also a non-invasive technique, in terms of cerebrovascular events. Inflammatory markers exhibited no statistically significant difference. We think that the atherosclerotic process stems not only from the inflammatory effects of RA, but also perhaps from its immunological nature.

Comparison of the GRACE risk score and the TIMI risk index in predicting the extent and severity of coronary artery disease in patients with acute coronary syndrome.

OBJECTIVE: The prognostic value of the Global Registry of Acute Coronary Events (GRACE) risk score (GRS) and the Thrombolysis In Myocardial Infarction (TIMI) risk index (TRI) has been reported in coronary artery disease (CAD) patients. We aimed to evaluate the relationship between the GRS, TRI, and severity of CAD evaluated by SYNTAX score (SS) in patients with acute coronary syndrome (ACS). METHODS: Patients with ACS who were admitted to the coronary care unit of our institution were retrospectively evaluated in this study. A total of 287 patients with ACS [154 non-ST elevated ACS (NSTE-ACS), 133 ST elevated myocardial infarction (STEMI)] were included in the study. The GRS and TRI were calculated on admission using specified variables. The severity of CAD was evaluated using the SS. The patients were divided into low (GRS<109)-, intermediate (GRS 109-140)-, and high (GRS>140)-risk groups and group 1 (TRI<17), group 2 (TRI 17-26), and group 3 (TRI>26) according to GRS and TRI scores. A Pearson correlation analysis was used for the relation between GRS, TRI, and SS. RESULTS: Patients with a history of coronary artery bypass surgery, those who had missing data for calculating the GRS and TRI, and those whose systolic blood pressure (SBP) was more than 180 mm Hg or whose diastolic blood pressure (DBP) was more than 110 mm Hg were excluded from the study. Were excluded from the study. There were significant differences in mean age (p<0.001), heart rate (p<0.001), SS (p<0.001), TRI (p<0.001), rate of NSTE-ACS (p<0.001), and STEMI (p<0.001) in all patients between the risk groups. There was a positive significant correlation between the GRS and the SS (r=0.427, p<0.001), but there were no significant correlation between the TRI and SS (r=0.121, p=0.135). The area under the ROC curve value for GRS was 0.65 (95% CI: 0.56-0.74, p=0.001) in the prediction of severity of CAD. CONCLUSION: The GRS is more associated with SS than TRI in predicting the severity of CAD in patients with ACS.

Ergotamine-induced vasospastic ischemia mimicking arterial embolism: unusual case.

Ergotamine toxicity is an important and rare condition, including tachycardia, arterial spasm which occurring as a result of accidental overdosing or drug interactions. We assessed the consequences of delayed diagnosis of peripheral arterial vasoconstriction occurring after simultaneous macrolide use by a 35-year-old woman using an ergot-derived drug for migraine. Diagnosis of ergotamine intoxication begins with suspicion. Interventional radiologists and surgeons should be aware of this acute dangerous condition.

Comparison of one- and two-stage basilic vein transposition for arterio-venous fistula formation in haemodialysis patients: preliminary results.

OBJECTIVE: This study aimed to compare the results of one-and two-stage basilic vein transposition (BVT) in haemodialysis patients. METHODS: This was a non-randomised, retrospective study between January 2007 and January 2012 on 96 patients who were diagnosed with end-stage renal failure (ESRF) (54 males, 42 females; mean age 43.6 ± 14 years) and underwent one- or two-stage BVT in our clinic. All patients who were not eligible for a native radio-cephalic or brachio-cephalic arterio-venous fistula (AVF) were scheduled for one- or two-stage BVT after arterial (brachial, radial and ulnar) and venous (basilic and cephalic) Doppler ultrasonography. Patients were retrospectively divided into two groups: group 1, basilic vein diameter > 3 mm and patients who underwent one-stage BVT; and group 2, basilic vein diameter < 3 mm and patients who underwent two-stage BVT. In group 1, the basilic vein with a single incision was anastomosed to the brachial artery, followed by superficialisation. In group 2, the basilic vein was anastomosed to the brachial artery and they underwent the superficialisation procedure one month postoperatively. Fistula maturation and postoperative complications were assessed. RESULTS: The mean diameter of the basilic vein was statistically significantly higher in group 1 (3.46 ± 0.2 mm) than in group 2 (2.79 ± 0.1 mm) (p < 0.05). In terms of postoperative complications, thrombosis, haemorrhage and haematoma were significantly higher in group 1 (34, 36 and 17%, respectively) than in group 2 (23, 14 and 6%, respectively) (p < 0.05). The rate of fistula maturation was significantly lower in group 1 (66%), compared to group 2 (77%) (p < 0.05).Time to fistula maturation was significantly shorter in group 1 (mean 41 ± 14 days), compared to group 2 (mean 64 ± 28 days) (p < 0.05). CONCLUSION: Two-stage BVT was superior to one-stage BVT due to its lower rate of postoperative complications and higher fistula maturation, despite its disadvantage of late fistula use. Although the diameter of the basilic vein was larger in patients who underwent one-stage BVT, we observed that one-stage BVT was disadvantageous in terms of postoperative complications and fistula maturation.