Erdinc Eroglu

Serum concentration of procoagulant, endothelial and oxidative stress markers in early primary varicose veins

Abstract Objective Endothelial disorders of the veins are considered to play a role in the pathogenesis of primary varicose veins and oxidative stress is implicated in these disorders. With this aim, we investigated vascular endothelial marker levels and the effect of endothelial damage on coagulation parameters and vasodilator substances to determine metabolic markers of oxidative stress in patients with varicose veins and vascular endothelial damage caused by oxidative stress. Methods We investigated the levels of malondialdehyde (MDA), protein C, protein S, fibrinogen, von Willebrand factor (vWf), tissue plasminogen activator (tPA), vascular endothelial growth factor (VEGF), interleukin-6 (IL-6), interleukin-12 (IL-12) and nitric oxide (NO) in the blood taken from the brachial vein of 25 patients with primary varicose veins (study group) and compared the results with 25 healthy volunteers (control group). We also investigated the urinary levels of prostaglandin I2 (PGI2) in the study group and compared the results with the control group. Results There was no statistically significant difference between the study group and the control group with respect to the plasma levels of MDA, protein C, fibrinogen, tPA, IL-6, NO and urinary levels of PGI2. But plasma levels of protein S, vWf, VEGF and IL-12 were found to be statistically significantly higher in the study group than in the control group. Conclusions Although the systemically measured levels of protein S, vWf, VEGF and IL-12 were found to be higher in patients of primary varicose veins, levels of protein C, fibrinogen, homocysteine and PGI2 were not found to be statistically significant. No systemic increased oxidative stress seems to be related to the early stages of chronic venous insufficiency. Further studies are warranted for understanding the role of molecules such as NO, oxidative stress parameters and cytokines.

A new non-tumescent endovenous ablation method for varicose vein treatment: Early results of N-butyl cyanoacrylate (VariClose®)

Objective This report aims to present the early results of a retrospective study of the use of N-butyl cyanoacrylate (VariClose®)-based non-tumescent endovenous ablation for the treatment of patients with varicose veins. Method One hundred and eighty patients with varicose veins due to incompetent saphenous veins were treated with the VariClose® endovenous ablation method between May 2014 and November 2014. The patient sample consisted of 86 men and 94 women, with a mean age of 47.7 ± 11.7 years. The patients had a great saphenous vein diameter greater than 5.5 mm and a small saphenous vein diameter greater than 4 mm in conjunction with reflux for more than 0.5 s. Patients with varicose veins were evaluated with venous duplex examination, Clinical, Etiological, Anatomical and Pathophysiological classification (CEAP), and their Venous Clinical Severity Scores were recorded. Results The median CEAP score of patients was three, and the saphenous vein diameters were between 5.5 and 14 mm (mean of 7.7 ± 2.1 mm). A percutaneous entry was made under local anesthesia to the great saphenous vein in 169 patients and to the small saphenous vein in 11 patients. Duplex examination immediately after the procedure showed closure of the treated vein in 100% of the treated segment. No complications were observed. The mean follow-up time was 5.5 months (ranging from three to seven months). Recanalization was not observed in any of the patients during follow-up. The average Venous Clinical Severity Scores was 10.2 before the procedure and decreased to 3.9 after three months (p < 0.001). Conclusion The application of N-butyl cyanoacrylate (VariClose®) is an effective method for treating varicose veins; it yielded a high endovenous closure rate, with no need for tumescent anesthesia. However, long-term results are currently unknown.

Mid-term results in the treatment of varicose veins with N-butyl cyanoacrylate

Aim To present mid-term results of patients with varicose veins treated with N-butyl cyanoacrylate (VariClose®), a nontumescent endovenous ablation technique. Patients and method Endovenous ablation was performed on 180 patients with saphenous vein incompetence between May and October 2014. One hundred sixty-eight subjects capable of being followed-up for 30 months were included. Patients’ pre- and postoperative data were recorded. Results Procedures were performed on the great saphenous vein in 159 patients and on the small saphenous vein in nine patients. Saphenous vein diameters ranged between 5.5 mm and 14 mm. Full ablation was achieved in all patients following the procedure. No complications were encountered. Patients were monitored for 30 months. Ablation rates were 100% at the 3rd month, 98.3% at the 6th month, 96.6% at 1 year, and 94.1% at 30 months. Mean venous clinical severity score was 10.2 before procedures, decreasing to 3.9 at 3 months, 4.2 at 6 months, 2.9 at 12 months, and 2.7 at 30 months (p = 0.000). Conclusion Due to its high success rate, absence of complications, no tumescent anesthesia requirement and high patient satisfaction, endovenous ablation with N-butyl cyanoacrylate is a good method. However, long-term follow-up results are now needed.

Comparison of Endovenous Laser and Radiofrequency Ablation in Treating Varicose Veins in the Same Patient

Purpose: To compare endovenous laser ablation (EVLA) and radiofrequency venous ablation (RFA) in different legs in the same patients with venous insufficiency. Methods: Sixty patients with bilateral saphenous vein insufficiency were included. Endovenous laser ablation or RFA was applied to one of the patient’s legs and the remaining procedure, RFA or EVLA, to the other leg. Results: Minor complications in EVLA and RFA were hyperemia at 20.7% and 31.0%, ecchymosis at 31.0% and 51.7% and edema at 27.6% and 65.5%, respectively. The rate of recanalization was 6.8% in the RFA group. No recanalization was observed in the EVLA group. The level of patients satisfied with EVLA was 51.7%, compared to 31.0% for RFA, while 17.2% of patients were satisfied with both the procedures. Times to return to daily activity were 0.9 days in the EVLA group and 1.3 days in the RFA group. Conclusion: The EVLA procedure may be superior to RFA in certain respects.

Which prosthesis is more resistant to vascular graft infection: polytetrafluoroethylene or Omniflow II biosynthetic grafts?

PurposeThe aim of this study was to determine whether polytetrafluoroethylene grafts or Omniflow II biosynthetic grafts are more resistant to infection caused by Staphylococcus aureus.MethodsSixty rats were divided into six groups. In Groups 1A, 1B and 1C, a polytetrafluoroethylene graft was implanted in each rat, and, in Groups 2A, 2B and 2C, a biosynthetic graft was implanted in each rat. Staphylococcus aureus was inoculated into Groups 1B, 1C, 2B and 2C, and the rats in Groups 1C and 2C were treated with teicoplanin. One week later, the rats were euthanized, the grafts were removed and a microbiological count was performed. A histopathological examination was subsequently carried out, and the C-reactive protein, prealbumin and leukocyte levels were investigated.ResultsThere were no significant differences in the C-reactive protein, prealbumin and leukocyte levels. The differences in the results of the microbiological evaluations between the groups were significant. The quantitative culture results showed no bacterial growth in Groups 1A, 1C and 2A. The number of bacteria in Group 1B was statistically lower than that in Group 2B. When the groups receiving treatment were compared, Group 2C had bacterial growth, whereas Group 1C did not. The histopathological examinations showed similar results.ConclusionsOmniflow II grafts are more susceptible to infection than polytetrafluoroethylene grafts.

Efficacy of Linezolid, Teicoplanin, and Vancomycin in Prevention of an Experimental Polytetrafluoroethylene Graft Infection Model caused by Methicillin-Resistant Staphylococcus aureus

Background The aim of this study was to evaluate the effectiveness of linezolid, teicoplanin, and vancomycin in prevention of prosthetic vascular graft infections in a vascular graft infection model. Material/Methods Fifty rats were divided into 5 groups. A polytetrafluoroethylene graft was implanted on the back of each rat. Methicillin-resistant Staphylococcus aureus (MRSA) strain was inoculated into all rats except Group 1. Group 2 was not given any treatment, Group 3 received linezolid, Group 4 received vancomycin, and Group 5 received teicoplanin. The grafts were removed for microbiological and histological examinations on the 7th day. In addition, C-reactive protein and prealbumin levels and leukocyte counts in obtained blood specimens were determined. Results Group 1 did not have infection. Group 2 had bacteria 5.7×104 CFU/cm2. Group 3 and Group 4 had less bacterial growth. Group 5 had no bacterial growth. The number of bacteria was significantly higher in Group 2 than in the other experimental groups and the control group (p<0.001). Although there was no bacterial growth in Group 5, it did not significantly differ from Group 3 and Group 4. Group 2 had a significantly higher CRP level and leukocyte count and a significantly lower prealbumin level than the other groups. Conclusions Linezolid, teicoplanin, and vancomycin are effective in prevention of prosthetic vascular graft infections.

Clinical and Subclinical Varicocele Incidence in Patients With Primary Varicose Veins Requiring Surgery

BACKGROUND The purpose of this study was to analyze the incidence of clinical and subclinical varicocele in patients with primary varicose veins requiring surgery. METHODS A total of 100 patients with primary varicose veins requiring surgery were evaluated. Clinical varicocele was found in each patient through physical examination. Each patient was also evaluated with ultrasound because of evidence of subclinical varicocele. RESULTS Among the patients with varicose veins, 28 had no clinical sign of varicocele, whereas the remaining 72 had varicocele with different clinical levels (72%). Doppler ultrasound revealed that 32 patients had no reflux flow, whereas the other 68 had different grades of reflux flow (68%). CONCLUSIONS Clinical or subclinical varicocele may be highly present in patients with severe venous disease. However, these types of varicoceles do not cause infertility in most patients. Nevertheless, infertility may occur in subsequent years, especially in young patients who have venous disease and undergo surgery, and they should be aware of this condition.

East Mediterranean Experiences in TEVAR

While there are numerous diseases of the thoracic aorta, the two most commonly encountered clinical conditions are dissection and aneurysms. Classic surgical treatment of these conditions is difficult for patients because of its high mortality and morbidity rates, as well as being tiring and laborious for the surgeon. Endovascular methods are therefore becoming increasingly popular in the treatment of these diseases. It was reported that rates of 30-day and in-hospital mortality, stroke, permanent dialysis, and permanent paraparesis and paraplegia were 4.7%, 2.1%, 0.5%, and 0.5% respectively for thoracic aortic aneurysms. Otherwise thoracic endovascular aneurysm repair (TEVAR) had similar immediate and delayed motor deficits and early mortality but lower dialysis, respiratory failure, and intensive care unit stay compared to open surgical repair. Early mortality after TEVAR was lower in septuagenarians, glomerular filtration rate of less than 60 mL/min, chronic obstructive pulmonary disease, defined as target population that had fourfold mortality reduction attributable to TEVAR. One study comparing open surgery and endovascular therapy in thoracic aorta dissections reported mortality rates of 26.6% and 13.1%, respectively, in thoracoabdominal dissection and of 16.9% and 9.5%, respectively, in thoracic dissection. That study also reported significantly higher morbidity rates, including cardiac, respiratory, and genitourinary complications, hemorrhage, and acute renal failure, in patients undergoing open repair. We also attach particular importance to endovascular interventions in thoracic aorta pathologies in our clinic. Endovascular interventions were performed on 18 patients at the Kahramanmaras Sutcu Imam University Faculty of Medicine, Cardiovascular Surgery Department in 2012-2018. Aneurysm was present in seven of these (six thoracoabdominal and one thoracic), dissection in nine, and aortic tear in two. TEVAR was applied to patients with dissection, aortic tear, and thoracic aorta aneurysm, while patients with thoracoabdominal aortic aneurysm received multilayer stent implantation.

A Rare Clinical Case: Giant Splenic Artery Aneurysm and Its Successful Endovascular Treatment

Objectives The true giant splenic artery aneurysms are extremely rare and can be fatal. Although surgical approach has been the standard of care in the past, endovascular methods gained more importance in recent years. Background We describe a case with true giant splenic artery aneurysm, treated with endovascular approach. Methods A 68-year-old female patient with abdominal pain admitted to our clinic had true splenic artery aneurysm (14 × 10 × 9 cm). We decided on endovascular treatment using vascular plug and the treatment was performed successfully. Conclusions Due to high mortality and morbidity in open surgery, endovascular treatment of giant splenic artery aneurysm is a better treatment option.