Okay Güven Karaca

Radiobasilic Versus Brachiobasilic Transposition on the Upper Arm to Avoid Steal Syndrome

Background Although the proximal radial artery has been reported as an alternative inflow to prevent steal syndrome, brachiobasilic fistula has been reported to be associated with steal syndrome in 10–20% of cases. We aimed to compare proximal radiobasilic arteriovenous fistula (AVF) with brachiobasilic AVFs on the upper arm in terms of steal syndrome and outcomes. Material/Method We used our institutional operative record database to identify 94 patients in whom brachiobasilic AVF (n=40) and radiobasilic AVF (n=54) were placed between January 2009 and December 2013. Postoperative complications such as steal syndrome, venous hypertension, and aneurysm were recorded. Results Steal syndrome was determined to occur less frequently in the radiobasilic AVF group (0% vs. 10%, P=0.03). The rates of other complications (bleeding, aneurysm, venous hypertension) between the 2 groups were similar, as were the patency rates. Conclusions Radiobasilic AVF was effective in reducing steal syndrome, with similar early and late outcomes.

Regional cervical plexus blockage for carotid endarterectomy in patients with cardiovascular risk factors.

BACKGROUND Carotid artery disease is not rare in cardiac patients. Patients with cardiac risk factors and carotid stenosis are prone to neurological and cardiovascular complications. With cardiac risk factors, carotid endarterectomy operation becomes challenging. Regional anesthesia is an alternative option, so we aimed to investigate the operative results of carotid endarterectomy operations under regional anesthesia in patients with cardiac risk factors. METHODS We aimed to analyze and compare outcomes of carotid endarterectomy under regional anesthesia with cardiovascular risk groups retrospectively. Between 2006 and 2014, we applied 129 carotid endarterectomy ± patch plasty to 126 patients under combined cervical plexus block anesthesia. Patients were divided into three groups (high, moderate, low) according to their cardiovascular risks. Neurological and cardiovascular events after carotid endarterectomy were compared. RESULTS Cerebrovascular accident was seen in 7 patients (5.55%) but there was no significant difference between groups (P > .05). Mortality rate was 4.76% (n = 6); it was higher in the high risk group and was not statistically significant (P = .180). Four patients required revision for bleeding (3.17%). We did not observe any postoperative surgical infection. CONCLUSION Carotid endarterectomy can be safely performed with regional cervical anesthesia in all cardiovascular risk groups. Comprehensive studies comparing general anesthesia and regional anesthesia are needed.

Validation of EuroSCORE II risk model for coronary artery bypass surgery in high-risk patients

Introduction Determining operative mortality risk is mandatory for adult cardiac surgery. Patients should be informed about the operative risk before surgery. There are some risk scoring systems that compare and standardize the results of the operations. These scoring systems needed to be updated recently, which resulted in the development of EuroSCORE II. In this study, we aimed to validate EuroSCORE II by comparing it with the original EuroSCORE risk scoring system in a group of high-risk octogenarian patients who underwent coronary artery bypass grafting (CABG). Material and methods The present study included only high-risk octogenarian patients who underwent isolated coronary artery bypass grafting in our center between January 2000 and January 2010. Redo procedures and concomitant procedures were excluded. We compared observed mortality with expected mortality predicted by EuroSCORE (logistic) and EuroSCORE II scoring systems. Results We considered 105 CABG operations performed in octogenarian patients between January 2000 and January 2010. The mean age of the patients was 81.43 ± 2.21 years (80-89 years). Thirty-nine (37.1%) of them were female. The two scales showed good discriminative capacity in the global patient sample, with the AUC (area under the curve) being higher for EuroSCORE II (AUC 0.772, 95% CI: 0.673-0.872). The goodness of fit was good for both scales. Conclusions We conclude that EuroSCORE II has better AUC (area under the ROC curve) compared to the original EuroSCORE, but both scales showed good discriminative capacity and goodness of fit in octogenarian patients undergoing isolated coronary artery bypass grafting.

Hybrid endovascular repair of thoracoabdominal aorta: early results.

BACKGROUND Thoracoabdominal aortic aneurysms (TAAA) present a significant clinical challenge, as they are complex and require invasive surgery. In an attempt to prevent considerably high mortality and morbidity in open repair, hybrid endovascular repair has been developed by many authors. In this study, we evaluated the early-term results obtained from this procedure. METHODS From November 2010 to February 2013, we performed thoracoabdominal hybrid aortic repair in 18 patients. The mean age was 68 years (12 men, 6 women). All of the patients had significant comorbidities. Follow-up computed tomography (CT) scans were performed at 1 week, 3 months, 6 months, and annually thereafter. RESULTS All patients were operated on in a staged procedure and stent graft deployment was achieved. Procedural success was achieved in all cases. All patients were discharged with complete recovery. No endoleaks weres detected in further CT examination. CONCLUSION Our results suggests that hybrid debranching and endovascular repair of extensive thoracoabdominal aneurysms represents a suitable therapeutic option to reduce the morbidity and mortality of TAAA repair, particularly in those typically considered at high risk for standard repair.

Successful Treatment of Traumatic Late Rupture of Thoracic Aorta: Case Report

trauma die at the scene of injury or before reaching the operating room.1-3 Those who survive usually have a contained aortic rupture and require mostly emergent intervention to control mediastinal hemorrhage. Actually, ruptured thoracic aortic aneurysm is more common in older patients and has a high early postoperative mortality, ranging from 24%4 to 42,1%.5 In this subgroup of elderly patients, mortality has been reported as 50% when operation was performed on the emergency basis.6 In this setting, endovascular stent grafting is a less invasive treatment for descending aortic pathologies and may be considered as an alternative to conventional surgical repair.

Surgical Therapy for Disseminated Arterial Involvement in Behcets Disease: Case Report

47 ehcet’s syndrome is a multisystemic vasculitis characterized by mucocutaneous, ocular, arthritic, vascular, and central nervous system manifestations. The prevalence is 80 to 370 cases per 100,000 population in Turkey.1 The male to female ratio is 7:1 in symptomatic forms.2 It involves all size and type of vessels including, both arterial and venous system. Venous disease is more common than arterial involvement, and prevalence may account for 14-39% and 3-5% respectively in patients with Behcet’s disease respectively.1-3 Thrombosis and/or aneurysms are observed; being predominantly false aneurysms.4 Surgical treatment is controversial due to frequent occurrence of graft occlusion and anastomotic pseudoaneurysms. Surgical Therapy for Disseminated Arterial Involvement in Behcet’s Disease: Case Report

Oral Anticoagulant Therapy May Prevent Mortality in Peripheral Vascular Surgery

ABS TRACT Objective: Atherosclerotic peripheral arterial disease is associated with an increased risk of myocardial infarction, stroke, and death from cardiovascular causes. Antiplatelet drugs protect from major cardiovascular events, but the role of oral anticoagulant agents is unclear in the prevention of cardiovascular complications in patients with peripheral arterial disease. Material and Methods: We assigned patients with peripheral arterial disease treated surgically. According to the medical treatment in postoperative and follow-up periods, the patients were divided into two groups: Anticoagulant therapy [patients receiving oral anticoagulant agents with a target international normalized ratio (INR)=2.0-3.0, n=78] and the patients not receiving oral anticoagulant agents (n=56). In both groups, medical treatment was combined with antiplatelet therapy in some patients. The primary outcome was death and secondary outcome was limb amputation. Results: A total of 134 patients were treated surgically. The mean follow-up period was 30 months. Revision due to bleeding, occlusion of the graft, embolism of non-treated arteries, myocardial infarction and stroke occurred in 6 patients receiving anticoagulant therapy (7.69%) and in 5 patients not receiving anticoagulant therapy (8.92%, p=0.48). Death and limb amputation occurred only in patients not receiving anticoagulant therapy (12.5%, p=0.02 and 5.4%, p=0.071). Conclusion: In patients with peripheral arterial disease treated surgically, the oral anticoagulant therapy may be effective for preventing death.