Comparison of standard balloon and drug-coated balloon angioplasty in patients with the below-the-knee peripheral artery disease

SUMMARY OBJECTIVE: The objective of this study was to compare the interventions of percutaneous transluminal drug-coated balloon angioplasty (DCB PTA) and standard PTA in the treatment of patients with the below-the-knee peripheral artery disease (BTK PAD). METHODS: Overall, 196 patients (113 males and 83 females; mean age: 63.56±11.94 years; 45-83 years) were treated with PTA for BTK PAD between June 2014 and March 2019. RESULT: Standard PTA (group 1; 96 patients) and DCB PTA (group 2; 100 patients) results were analyzed and compared retrospectively. No statistically significant difference was found between the mean ages of group 1 and 2 patients (p=0.371, p>0.05). Demographic and clinical data were compared and no any statistically significant differences was found between the two groups. Comparing in terms of the iliac lesion, there was no statistically significant difference between the two groups. However, a statistically significant difference was found between the two groups in terms of frequency of popliteal lesions (p=0.001; p<0.05). There was not a statistically significant difference between the two groups in terms of other lesions. In addition, limb salvage rates were 82.0% (18 amputations) and 65.6% (33 amputations) in the drug-release balloon group and the naked balloon group, at the end of 1 year, respectively. No distal embolism, limb-threatening ischemia, and mortality were observed in any patients. CONCLUSIONS: Based on this study, patients in the DCB group had significantly higher rates of primary patency as compared with the other patients.

Cardiac and extra-cardiac pathologies in patients with acute arterial occlusion

SUMMARY OBJECTIVE: We aimed to investigate cardiac and extra-cardiac pathologies in patients who were operated for acute arterial occlusion. METHODS: Between March 2010 and March 2018, a total of 120 patients who underwent surgical treatment for acute arterial occlusion were included in this retrospective study. RESULTS: 84 (70%) and 27 (22. 5%) of the patients had cardiac and extra-cardiac pathologies, respectively. In 9 (7. 5%) of the cases, no reason for arterial occlusion could be found. Pure atrial fibrillation was found in 39 (32. 5%) patients. Atrial fibrillation and cardiac valvular pathologies were detected in 45 patients (37. 5%). Among those with a cardiac valvular pathology, 9 patients (7. 5%) had pure mitral stenosis, 21 patients (17. 5%) had moderate to advanced mitral stenosis with tricuspid regurgitation, 9 patients (7. 5%) had 20-30 mitral regurgitation with 30 tricuspid regurgitation, 3 patients (2. 5%) had moderate mitral stenosis, 30-40 tricuspid regurgitation and 20-30 aortic stenosis, and 3 patients (2. 5%) had 30 mitral regurgitation, 10- 20 tricuspid regurgitation, calcific moderate aortic stenosis, and coronary artery disease. Among those 27 patients with an extra-cardiac pathology, 21 patients (22. 5%) had peripheral artery disease, 3 patients (2.5%) had an abdominal aortic aneurysm, and 3 patients (2. 5%) had Behçet's Disease. CONCLUSION: Cardiac and extra-cardiac pathologies should be kept in mind in patients with acute arterial occlusion. Thus, detected pathologies could be treated, and the development of additional peripheral emboli could be prevented.

RESUMO OBJETIVO: O objetivo do estudo é investigar patologias cardíacas e extracardíacas em pacientes operados por oclusão arterial aguda. MÉTODOS: Entre março de 2010 e março de 2018, um total de 120 pacientes submetidos a tratamento cirúrgico para oclusão arterial aguda foram incluídos neste estudo retrospectivo. RESULTADOS: Dos pacientes incluídos, 84 (70%) e 27 (22.5%) apresentavam, respectivamente, patologias cardíacas e extracardíacas. Em 9 (7.5%) dos casos, nenhuma cause para a oclusão arterial foi encontrada. Fibrilação atrial isolada foi encontrada em 39 (32.5%) pacientes. Fibrilação atrial e valvopatias cardíacas foram detectadas em 45 pacientes (37.5%). Entre aqueles com valvopatias cardíacas, 9 (7.5%) tinham estenose mitral isolada, 21 (17. 5%) tinham estenose mitral moderada a avançada com regurgitação tricúspide, 9 (7. 5%) tinham 2°-3° de regurgitação mitral com 3o regurgitação tricúspide, 3 (2. 5%) tinham estenose mitral moderada, 3°-4° regurgitação tricúspide e 2°-3° estenose aórtica, e 3 (2.5%) tinham 3o mitral, 1°- 2° regurgitação tricúspide moderada, estenose aórtica moderada calcificada e doença coronariana. Entre os 27 pacientes com patologia extracardíaca, 21 (22.5%) tinham doença arterial periférica, 3 (2,5%) tinham aneurisma da aorta abdominal, e 3 (2.5%) tinham Doença de Behçet. CONCLUSÃO: Patologias cardíacas e extracardíacas devem ser consideradas em pacientes com oclusão arterial aguda. Assim, patologias detectadas podem ser tratadas e o desenvolvimento de trombos periféricos adicionais pode ser evitado.

Evaluation of liquid or foam sclerotherapy in small varicose veins (ceap c1) with venous clinical severity score

SUMMARY OBJECTIVE: We aimed to evaluate the efficacy of liquid or foam sclerotherapy of varicose veins using venous clinical severity scores and possible complications. METHODS: A total of 318 patients (268 females, 50 males) who were treated with liquid or foam sclerotherapy between January 2012 and December 2012 were included in this study. RESULTS: Skin necrosis was observed in only 6 patients (1. 8%), thrombophlebitis in 10 patients (3. 1%), and hyperpigmentation in 18 patients (5. 6%) in this study group. The mean venous clinical severity score was calculated as: pain score, 1. 23 ± 0.88; varicose vein score,1.85 ± 0. 8; edema score, 0.64 ± 0.77). Pain and edema decreased at the control examination, 1 month after completion of sclerotherapy sessions. Varicose veins completely disappeared after sclerotherapy. While the decrease in edema in the foam sclerotherapy group was significantly less (P<0.001), the decline in pain showed an increasing trend (P=0.069). While skin necrosis did not develop after foam sclerotherapy, rates of pigmentation and local thrombophlebitis were similar (P>0.05). CONCLUSION: In conclusion, we observed that both sclerotherapy methods are effective with a low rate of complications, alleviating the complaints of patients with small varicose veins, and providing considerable improvement in venous clinical severity scores.

RESUMO OBJETIVO: Nosso objetivo foi avaliar a eficácia de líquido ou espuma na escleroterapia de varizes por meio de escores de gravidade clínica venosa e possíveis complicações. MÉTODOS: Um total de 318 pacientes (268 do sexo feminino, 50 do sexo masculino) tratados com escleroterapia com espuma ou líquido entre janeiro de 2012 e dezembro de 2012 foi incluído neste estudo. RESULTADOS: Necrose da pele foi observada em apenas seis pacientes (1,8%), tromboflebite em dez pacientes (3,1%) e hiperpigmentação em 18 pacientes (5,6%) neste grupo de estudo. A média do escore de gravidade clínica venosa foi calculado como: dor pontuação 1,23±0,88, veia varicosa pontuação 1,85±0,8, edema pontuação 0,64±0,77. Dor e edema reduzido no exame de controle um mês após a conclusão das sessões de escleroterapia. Varizes desapareceram completamente após a escleroterapia. Enquanto a diminuição do edema no grupo de escleroterapia com espuma foi significativamente menor (P<0,001), o decréscimo do nível de dor mostrou uma tendência a ser maior (P=0,069). Ainda que necrose da pele não tenha se desenvolvido após escleroterapia com espuma, as taxas de pigmentação e tromboflebite local foram semelhantes (P>0,05). CONCLUSÃO: Observou-se que ambos os métodos de escleroterapia são eficazes, com baixa taxa de complicações, aliviando as queixas de pacientes com varizes pequenas, e proporcionando uma melhora considerável nos escores de gravidade clínica venosa.

Clinical correlation of biopsy results in patients with temporal arteritis

Summary Objective: Temporal arteritis is systemic vasculitis of medium and large sized vessels. The lowest incidence rates were reported in Turkey, Japan and Israel. We aimed to investigate the results of patients with biopsy-proven temporal arteritis and those classified according to the American College of Rheumatology criteria from a low-incidence region for temporal arteritis. The results of our study are noteworthy, since there is limited data on pathologic diagnosis of temporal arteritis in Turkey. Method: We studied the medical records, laboratory findings such as erythrocyte sedimentation rate and C-reactive protein levels, biopsy results, and postoperative complications of all the patients operated for temporal artery biopsy at our clinic. We used the computerized laboratory registry that keeps all records of 42 consecutive temporal artery biopsy results from January 2011 to December 2016. Results: The mean age was 66±12.5 years. The most common manifestations on admission were temporal headache, optic neuritis and jaw claudication, respectively. Temporal artery biopsy results confirmed tempoal arteritis in eight out of 42 (19%) patients. There was no statistically significant difference between biopsy-positive and biopsy-negative groups in terms of sex, age, erythrocyte sedimentation rate, C-reactive protein and biopsy length. Conclusion: We were not able to find a correlation between the analysis of biopsy results and clinical evaluation of patients with temporal arteritis. We suggest that diagnosis of temporal arteritis depends on clinical suspicion. Laboratory examination results may not be helpful in accurate diagnosis of tempoal arteritis.