Serkan Burç Deşer

Genetic variants rs1994016 and rs3825807 in ADAMTS7 affect its mRNA expression in atherosclerotic occlusive peripheral arterial disease

Peripheral artery disease (PAD) is a vascular disease affecting peripheral circulation. Recently, genome‐wide association studies revealed a relationship between single nucleotide polymorphisms (SNPs) in ADAMTS7 (a disintegrin and metalloprotease with thrombospondin motif 7) and atherosclerosis. In this study, we aimed to determine ADAMTS7 expression in peripheral blood mononuclear cells (PBMCs) and the frequency of ADAMTS7 rs1994016 and rs3825807 polymorphisms in a sample of Turkish patients with PAD, and to evaluate the association of matrix metalloproteinase (MMP) levels with PAD development.

Migration of an Atrial Septal Occluder Device With Formation of Abdominal Aortic Dissection

Atrial septal defects can be closed surgically or percutaneously. However, percutaneous closure of atrial septal defects carries some risks. Embolization of the atrial septal occluder is the major adverse event. Embolization of the device into the main pulmonary artery, left atrium, right ventricle, aortic arch, descending aorta, abdominal aorta, iliac bifurcation, and iliac arteries can be seen. We report the case of a 19-year-old man with migration of an Amplatzer (St Jude Medical, St Paul, MN) atrial septal occluder into the iliac bifurcation with the development of abdominal aortic dissection 1 month after successful percutaneous closure.

Surgical treatment of posterior nutcracker syndrome presented with hyperaldosteronism

Posterior nutcracker syndrome is caused by the compression of left renal vein between the abdominal aorta and the vertebral body. Most seen symptoms are haematuria, left flank pain, abdominal pain and varicocele. The nutcracker syndrome may lead to left renal vein thrombosis due to blood congestion within compression of the vessel. Both endovascular and open surgical interventions can relieve symptoms; however, traditional surgical repair is still considered as the gold standard. Here, we present the surgical treatment of a 36-year old female with complaints of hypertension, hyperaldosteronism and diagnosed with posterior nutcracker syndrome.

Malposition of the Hemodialysis Catheter in the Persistent Left Superior Vena Cava

Persistent left superior vena cava (PLSVC) is the most common thoracic venous anomaly. The prevalence of PLSVC ranges from 0.3% to 0.5% in healthy individuals [1]. PLSVC most frequently drains into the coronary sinus, however, 8% of them drain into the left atrium. PLSVC may present with extra-, and intracardiac malformations such as atrial and ventricular septal defect. Besides that, esophageal atresia is the most common extracardiac malformation that accompanies PLSVC. It often remains asymptomatic. Temporary hemodialysis catheters are widely used in the patients with renal insufficiency who urgently need hemodialysis. The right internal jugular vein is widely used for hemodialysis access which drains into the right atrium [2]. Moreover, left internal jugular and femoral veins may be used. Malposition of hemodialysis catheter in the PLSVC may also be symptomatic or detected incidentally. Malposition of the catheter may cause serious complications such as systematic embolization, coronary sinus thrombosis, cardiac arrhythmias, thrombus, shock, angina and cardiac arrest [3].

Treatment of the Median Arcuate Ligament Syndrome in a Patient with Behcet's Disease

Compression of the celiac artery by the median arcuate ligament (MAL) and neurofibrous tissue is called MAL syndrome or Dunbars syndrome. Postprandial abdominal pain and weight loss are the main symptoms. Surgical treatment still remains the gold standard therapy. Here, we present the first case to our knowledge in which MAL syndrome accompanies Behcets disease.

Does surgical technique influence the postoperative hemodynamic disturbances and neurological outcomes in carotid endarterectomy

Abstract Introduction: The carotid endarterectomy is already well established in patients with symptomatic or asymptomatic internal carotid artery (ICA) stenosis. The aim of this study was to determine whether there is a difference in postoperative blood pressure changes, stroke rate and postoperative complications following eversion carotid endarterectomy (E-CEA) and conventional carotid endarterectomy (C-CEA). Methods: From 1 January 2010 to 31 March 2017 consecutive patients admitted to our department with symptomatic or asymptomatic ICA stenosis were included in this retrospective study. During the 7-year period, 175 CEAs were performed in 166 consecutive patients (25 females, 141 males; mean age 70.6 ± 14.4 years; range 47 to 92 years). Results: The mean operative and cross-clamping time were shorter for E-CEA (72 ± 14.3 minutes vs. 115 ± 17.4 minutes, p < .001), (22 ± 7.7 vs 34 ± 6.3, p < .001) respectively. No significant difference was noted between the groups for the occurrence of perioperative stroke (p = .501). No significant difference was noted for postoperative blood pressure difference on the 6th hour and the 24th hour after surgery between E-CEA and C-CEA (p = .130). Conclusions: E-CEA was associated with significant reduction in operative time and cross-clamping time however, increases postoperative bleeding. No difference was noted for postoperative stroke and blood pressure distortion between E-CEA and C-CEA.

Gunshot Injury to the Groin: Management of Patients with Life-Threatening Condition Gunshot Injury to the Groin

Gunshot injuries have become increasingly common in Turkey. Patients with gunshot arterial injuries to the groin admitted to the emergency department present with rapidly expanding hematoma, absent distal pulse, bruit over the artery, ischemic limb, unrecordable blood pressure, confused status, tachycardia, tachypnea, and pulsatile external bleeding (1). Prompt restoration of the circulation is mandatory to avoid death and ischemia. Although vascular injuries are not uncommon, femoral vascular injuries are the most common, accounting for approximately 70% of all peripheral vascular injuries. Vascular injuries were common during war, constituting 2%–5% of all injuries (2). Amputation rate was 50% in the World War II and reduced to less than 10% during the Vietnam War (3).

Agenesis of right and existence of left inferior vena cava associated with posterior nutcracker syndrome

Congenital agenesis of the inferior vena cava is an uncommon congenital anomaly which can be misdiagnosed. Agenesis of the inferior vena cava has an incidence of 0.0005% to 1% in the general population [1]. The most common cause of agenesis of the inferior vena cava is the failure of embryological development between the sixth and the tenth weeks of gestation. Heterotaxy syndrome is associated with congenital cardiopathy, partial anomalous pulmonary venous connection, interruption of the inferior vena cava with azygos continuation, malalignment ventricular septal defect, multiple spleens, left superior vena cava, congenital pericardial defect, intestinal malrotation and pancreatic changes [2–4]. Blood flow through the collateral veins leads to an increase in the pressure of the leg veins, which causes chronic venous insufficiency and deep venous thrombosis. As a result, venous return is achieved through the lumbar azygos vein, hemiazygos vein, ascending lumbar veins, paravertebral veins, and anterior abdominal wall veins into the superior vena cava. A 38-year-old woman diagnosed with agenesis of the inferior vena cava was admitted to us. On admission biochemical and physical examinations were normal. Computed tomography scan revealed partial agenesis of the anatomically normal right inferior vena cava above the renal veins, agenesis of right and existence of left inferior vena cava below the renal veins, associated with posterior renal nutcracker syndrome and enlargement of collateral circulation without any additional congenital cardiac, thorax and abdominal anomalies. The inferior vena cava interrupted below the right renal vein and venous blood flows directly into the left inferior vena cava; however, venous blood continues with the right inferior vena cava above the renal veins. The left renal vein courses posterior of the abdominal aorta and it was dilated due to the high flow and pressure, resulting in posterior nutcracker syndrome (Fig. 1 A–F). Due to the absence of complaints, we decided to follow up the patient with acetylsalicylic acid 100 mg/day. The patient was doing well and did not show any symptoms after 6 months of follow-up. Persistence of the left supra cardinal vein and regression of the right supracardinal vein lead to left inferior vena cava. Furthermore, the persistence of both supracardinal veins leads to double inferior vena cava. Agenesis of the inferior vena cava can be associated with polysplenia, dextrocardia, single ventricle or atrium, intestinal malrotation, pulmonary dysgenesis, renal agenesis, dextrocardia and cyanotic or a-cyanotic congenital heart diseases. Posterior nutcracker syndrome refers to the extrinsic compression of the left inferior vena cava that distorts the left renal vein flow [1]. It is usually detected incidentally, during surgery, angiography and computed tomography scans or autopsy. The most frequently observed symptoms are hematuria, left flank pain, abdominal pain, varicocele, abnormal menstruation, pelvic congestion syndrome, gonadal vein syndrome, orthostatic proteinuria and orthostatic abnormalities. Symptoms can be triggered or aggravated by physical activity, pregnancy or multiparity [5]. Left renal vein bypass, left renal vein transposition with polytetrafluoroethylene, Dacron or saphenous vein graft, medial nephropexy with excision of renal varicosities, superior mesenteric artery transposition, renal autotransplant, gonadocaval bypass and nephrectomy, wrapping of the left renal vein with ringed polytetrafluoroethylene are the surgical treatment options for posterior nutcracker syndrome [5]. However, current surgical therapy involves placement of an oversized renal vein stent with partial protrusion into the inferior vena cava to relieve stenosis and prevent stent migration. In the light of the current literature, we found only 4 cases of anomalies of the inferior vena cava presenting as nutcracker syndrome and to the best our knowledge this is the second case which consists of congenital partial agenesis of the inferior vena cava and left inferior vena cava associated with posterior nutcracker syndrome [2]. Anticoagulation/antiplatelet therapy is recommended, which would lower the risk of deep vein thrombosis and thromboembolic complications. In conclusion, clinical follow-up of the patient without complaints is recommended for these circumstances; however, surgery may be indicated in a patient with the advanced

Surgical Treatment of Inferior Pancreaticoduodenal Artery Aneurysm with Common Hepatic Artery Revascularization

Pancreaticoduodenal artery aneurysms (PDAAs) are rarely seen among the visceral artery aneurysms (<2%). PDAA is mostly asymptomatic but can be presented with abdominal pain. Embolization can be applied safely with a high success rate; however, in some conditions such as when embolization fails or accompanying celiac axis occlusion, open surgery can be performed. We report the successful management of a patient with PDAA and occlusion of the celiac axis with uneventful short- and mid-term follow-up.

Entrapped Cardiac Thrombus and Fatal Right Heart Failure due to Massive Pulmonary Emboli

The prevalence of patent foramen ovale (PFO) in the general population is 25-30%however, paradoxical embolism is rarely seen. Entrapped cardiac thrombus (impendingparadoxical embolism) is defined as embolus that project through the patent foramen ovale(PFO) thus biatrial embolism and paradoxical embolism are rarely seen in alives. Completeremoval of the thrombus by surgery reduces the risk of embolization. Emergency surgery isindicated for biatrial thrombus, entrappedcardiacthrombusandmassivePEwithhemodynamiccompromise. We present the management of a 41 year old male with entrappedcardiac thrombus and fatal right heart failure due to massive pulmonary emboli