A surgical method to be reminded for the treatment of symptomatic ipsilateral central venous occlusions in patients with hemodialysis access: Axillo-axillary venous bypass case report and review of the literature.

BACKGROUND: In this case report, we present two chronic hemodialysis patients with upper extremity swelling due to central venous occlusions together with their clinical presentation, surgical management and brief review of the literature. METHODS: The first patient who was a 63-year-old female patient with a history of multiple bilateral arteriovenous fistulas (AVFs) was referred to our clinic. Physical examination demonstrated a functioning right brachio-cephalic AVF, with severe edema of the right arm, dilated venous collaterals, facial edema, and unilateral breast enlargement. In her history, multiple ipsilateral subclavian venous catheterizations were present for sustaining temporary hemodialysis access. The second patient was a 47-year-old male with a history of failed renal transplant, CABG surgery, multiple AV fistula procedures from both extremities, leg amputation caused by peripheral arterial disease, and decreased myocardial functions. He was receiving 3/7 hemodialysis and admitted to our clinic with right arm edema, accompanied by pain, stiffness, and skin hyperpigmentation symptoms ipsilateral to a functioning brachio-basilic AVF. He was not able to flex his arms, elbow, or wrist due to severe edema. RESULTS: Venography revealed right subclavian vein stenosis with patent contralateral central veins in the first patient. She underwent percutaneous transluminal angioplasty (PTA) twice with subsequent re-occlusions. After failed attempts of PTA, the patient was scheduled for axillo-axillary venous bypass in order to preserve the AV access function. In second patient, venography revealed right subclavian vein occlusion caused secondary to the subclavian venous catheters. Previous attempts for percutaneously crossing the chronic subclavian lesion failed multiple times by different centers. Hence, the patient was scheduled for axillo-axillary venous bypass surgery. CONCLUSION: In case of chronic venous occlusions, endovascular procedures may be ineffective. Since preserving the vascular access function is crucial in this particular patient population, venous bypass procedures should be kept in mind as an alternative for central venous reconstruction, before deciding on ligation and relocation of the AVF.

Atherectomy followed by drug-coated balloon angioplasty for below knee lesions in diabetic patients.

OBJECTIVE: The aim of this study was to compare the long-term outcomes of below the knee revascularization with percutaneous atherectomy followed by drug-coated balloon and revascularization with drug-coated balloon alone for symptomatic diabetic patients with peripheral arterial disease. PATIENTS AND METHODS: Between April 2015 and January 2020, total of 128 patients and 228 below the knee procedures were enrolled into this retrospective study. Sixty-five patients were treated with atherectomy followed by drug-coated balloon and 63 patients were treated solely with drug-coated balloon. RESULTS: Technical success rates were similar in the AT+DCB group and DCB group. Target lesion revascularization (TLR) was found similar in both groups at 6-month follow-up. Clinically, driven repeat endovascular and surgical limb revascularization rates were also significantly lower at 12 and 24 months. CONCLUSION: Combined usage of rotational atherectomy and drug-coated balloons for the treatment of diabetic patients with below-the knee arterial lesions and critical limb ischemia is associated with reduced long-term TLR rates and improved the long-term outcomes.

OBJETIVO: El objetivo de este estudio fue comparar los resultados a largo plazo de la revascularización por debajo de la rodilla con aterectomía percutánea seguida de balón recubierto de fármaco y revascularización con balón recubierto de fármaco solo en pacientes diabéticos sintomáticos con arteriopatía periférica. MÉTODOS: Entre abril de 2015 y enero de 2020, un total de 128 pacientes y 228 procedimientos por debajo de la rodilla se inscribieron en este estudio retrospectivo. Sesenta y cinco pacientes fueron tratados con aterectomía seguida de balón recubierto de fármaco y 63 pacientes fueron tratados únicamente con balón recubierto de fármaco. RESULTADOS: Las tasas de éxito técnico fueron similares en el grupo AT+DCB y DCB. La revascularización de la lesión diana fue similar en ambos grupos a los 6 meses de seguimiento. Las tasas de revascularización endovascular y quirúrgica de las extremidades también fueron significativamente más bajas a los 12 y 24 meses. CONCLUSIÓN: El uso combinado de aterectomía rotacional y balones recubiertos de fármaco para el tratamiento de pacientes diabéticos con lesiones arteriales por debajo de la rodilla e isquemia crítica de las extremidades se asocia con tasas reducidas de revascularización de la lesión diana a largo plazo y mejores resultados a largo plazo.

Efficiency of endovenous laser and glue ablation methods in comparison with conventional surgery for the treatment of venous ulcers.

INTRODUCTION: In this study, we aimed to investigate the efficiency of endovenous laser and glue ablation techniques and compared the results with conventional surgical stripping. PATIENTS AND METHODS: Between January 2005 and January 2020, among 3133 consecutive patients with superficial venous reflux disease receiving treatment at our institution, there were 112 consecutive patients with active venous ulcers. Patients were divided into 3 groups as receiving conventional open surgical treatment (Group 1, n: 70), endovenous glue ablation (Group 2, n: 20), and endovenous laser ablation (Group 3, n: 22). Comorbidity factors, duration and size of the ulcers, deep, perforating, and small saphenous vein disease detected with detailed Doppler ultrasonography, and duration for healing and recurrence were investigated. RESULTS: The age, gender, comorbidities, smoking, history of previous treatment, diameter of the small saphenous vein, number of refluxing perforating veins, size of the ulcer, and ulcer recurrence ratio were not significantly different between groups. There were 7 patients with bilateral disease and in total 119 legs were intervened. Mean durations for complete ulcer healing were significantly lower in Group 1 (53.28 ± 22.1 days) than Group 2 (73.7 ± 39.6 days); however, it did not differ significantly between Group 1 and Group 3 (62.59 ± 19.65 days), and Group 2 and Group 3 (p: 0.26). Ulcers recurred in 23 patients (33%) in stripping group at a mean follow up of 14.42 ± 4.6 months, in 7 patients (35%) in glue ablation group at a mean follow up of 11.97 ± 2.94 months, and in 5 patients (23%) in laser ablation group at a mean follow up of 12.66 ± 3.48 months (p > 0.05 for all). Increased body mass index, co-existence of chronic venous insufficiency, active cigarette smoking, non-compliance with physician advises and exercise and compression stockings, and depth of the ulcers were correlated with recurrence. CONCLUSION: The rationelle beyond treatment of the venous ulcers and prevention of recurrence relies on relief of the venous hypertension by interventional methods and/or compression therapy. None of the methods is superior over the others. Healing in short term without further recurrence may be achieved with successful intervention as well as good patient compliance.

Is Modified Del Nido Cardioplegia as Effective as Del Nido Cardioplegia in Patients With Isolated Coronary Artery Bypass Surgery?

OBJECTIVE: Is modified del Nido cardioplegia superior to del Nido cardioplegia in coronary artery bypass patients? MATERIAL AND METHODS: All patients underwent cardiopulmonary bypass and retrospectively were analyzed. A total of 70 patients were included in the study. Thirty-four patients who were given cold (+ 4-8C ') modified del Nido cardioplegia antegrade were evaluated. Other patients received classical del Nido cardioplegia. Hot shot warm blood cardioplegia was given to all patients before the cross-clamp was removed. The results of both groups were compared. RESULTS: There was no significant difference between cardiac arrest times in both groups. A statistically significant difference was found in the modified del Nido cardioplegia group in the working of the heart. Less fibrillation was observed in the modified del Nido cardioplegia group. No difference found between the groups, regarding myocardial preservation. No decrease in hemoglobin was observed in the modified del Nido group on the postoperative first day. CONCLUSIONS: We know that return to spontaneous sinus rhythm and fibrillation reduces ischemia-reperfusion injury. At the same time, we can see that epicardial edema was less in the modified del Nido group. We think that less anemia is an advantage of modified del Nido cardioplegia.

The revascularization of the left subclavian artery with a cross over axilloaxillary bypass for the hybrid repair of thoracic aortic aneurysms.

AIM: We present our subclavian artery revascularization experiences in the patients with thoracic aortic aneurysm who underwent hybrid repair. MATERAIL AND METHODS: Between May 2015-December 2018,4 patients underwent TEVAR procedure following axilloaxillary bypass grafting.The mean age of the patients was 72.5 ± 3.01 years.One patient was female and 3 patients were male.Patients had thoracic aortic aneurysms including the left subclavian artery or aberrant right subclavian artery. RESULTS: All patients underwent endovascular stent graft repair following axilloaxillary bypass grafting in the same day.Mortality did not occur in the perioperative period.One patient had graft infection at 8th month of the operation and the graft was removed.He was lost due to pneumonia following the operation.The control computed tomographies of the other 3 patients revealed patent grafts together with successful endovascular interventions and they have been following uneventfully a mean of 27±6.2 months (range:24-32,median:29). CONCLUSION: The risk of stroke,spinal cord ischemia, and upper extremity ischemia are found higher in the patients who underwent coverage of the left subclavian artery without revascularization.The axilloaxillary bypass grafting may be performed in the patients with high risk to prevent carotid artery manipulation and clamping during carotid-subclavian bypass with long term promising patency rates.

OBJETIVO: Presentamos nuestras experiencias de revascularización de la arteria subclavia en los pacientes con aneurisma de aorta torácica sometidos a reparación híbrida. MATERIAL Y MÉTODOS: entre mayo de 2015 y diciembre de 2018, 4 pacientes fueron sometidos a TEVAR después de un injerto de derivación axiloaxilar. La edad media de los pacientes fue 72,5 ± 3,01 años. Un paciente era mujer y 3 pacientes eran varones. Los pacientes tenían aneurismas de la aorta torácica incluyendo el arteria subclavia izquierda o arteria subclavia derecha aberrante. RESULTADOS: Todos los pacientes fueron sometidos a reparación endovascular con endoprótesis vascular en el mismo día después de un bypass axiloaxilar, no hubo mortalidad en el perioperatorio, un paciente presentó infección del injerto a los 8 meses de la operación y se retiró el injerto, se perdió por neumonía Las tomografías computarizadas de control de los otros 3 pacientes revelaron injertos permeables junto con intervenciones endovasculares exitosas y han estado siguiendo sin incidentes una media de 27 ± 6,2 meses (rango: 24-32, mediana: 29). CONCLUSIÓN: El riesgo de ictus, isquemia medular e isquemia de la extremidad superior es mayor en los pacientes sometidos a cobertura de la arteria subclavia izquierda sin revascularización; en los pacientes con alto riesgo se puede realizar un bypass axiloaxilar para prevenir la manipulación de la arteria carótida. y pinzamiento durante la derivación carótido-subclavia con tasas de permeabilidad prometedoras a largo plazo.

Ventricular septal defect closure using radial incision of the tricuspid valve for exposure: is it really necessary?

AIM: To evaluate the effects of radial incision of the tricuspid valve in patients who had undergone ventricular septal defect (VSD) closure. METHODS: Overall 173 patients were included in this study between 2012 and 2019. In 44 individuals, a tricuspid valve radial incision (TVRI) was included in the surgical process. RESULTS: There were no mortalities. The demographic data did not differ between the groups. The mean ages of the TVRI and non-TVRI groups were 2.92 ± 3.88 and 2.69 ± 2.80 years, respectively. There were no significant differences between the groups in terms of mean duration of cardiopulmonary bypass aortic cross-clamp, postoperative intubation time and intensive care unit stay. Mild tricuspid valve regurgitation was detected in only two patients in the TVRI and six patients in the non-TVRI groups. There was no tricuspid valve stenosis and all patients were in New York Heart Association functional class 1. CONCLUSION: This technique, which can facilitate exposure and closure of VSDs, did not compromise the tricuspid valve function at mid-term, therefore proving to be safe.

Thoracoabdominal Aortic Aneursym Accompanied by Leriche Syndrome in a Patient with Coronary Artery Disease: Management Strategy in a Single Case Experience.

Aneurysms and occlusive pathologies of the aorta are frequently associated with atherosclerosis; however, thoracoabdominal aortic aneurysm accompanied by Leriche syndrome is an extremely rare condition with challenging treatment strategy and without established surgical treatment protocols. In this report, we present our treatment strategy in a 64-year-old male patient with ischemic heart disease and type 5 thoracoabdominal aortic aneurysm accompanied by Leriche syndrome.

Assessment of anxiety and health-related quality of life in patients with lower extremity peripheral arterial occlusive disease.

INTRODUCTION: The aim of this study was to investigate the effect of chronic occlusive vascular disease on anxiety with adverse outcome with health-related quality of life (HRQoL). MATERIAL AND METHODS: Three hundred and thirty-five patients who were treated for peripheral arterial occlusive disease were enrolled in this study. 187 patients who had undergone percutaneous transluminal angioplasty and 148 patients who had one or more surgical revascularizations enrolled in the study. Mean age of the patients was 62.6 ±10 years. Two hundred and eighty-nine patients were male, 46 patients were female. Physical and mental domains of quality of life were measured using the 36-item Medical Outcomes Short-Form Health Survey (SF-36) self-administered questionnaire and anxiety symptoms were assessed using the Spielberger State-Trait Anxiety Inventory (STAI). At baseline 335 patients filled out the SF-36 and STAI, and 304 patients (90.7 % of the series) filled them out at 6-month follow-up. RESULTS: There was no mortality and no significant morbidity after vascular interventions in the series. Significant improvement was found in two of eight health domains. The score of social functioning increased to 60.4 from 52.6 (p < 0.03) and general health perception increased to 75.1 from 60.5 (p < 0.04) at 6-month follow-up. The two STAI sub-scores, the State Anxiety Inventory (STAI-S) and the Trait Anxiety Inventory (STAI-T) were found high (≥ 40) both preoperatively and 6 months postoperatively. Postoperatively there was no significant decrease of the levels of anxiety. CONCLUSIONS: This study suggests that the assessment of psychosocial factors, particularly the ongoing assessment of anxiety, could help in risk stratification and prediction of functional status in patients suffering from lower extremity peripheral arterial occlusive disease.

A Rare and Subtle Etiology of Chronic Oropharyngeal Pain: Isolated Internal Carotid Artery Kinking without Stenosis.

Carotid artery kinking is a frequent finding in duplex ultrasonography. However, isolated morphological changes without significant carotid stenosis are rarely symptomatic. Neck pain is a rare symptom in patients with carotid artery kinks. The vascular etiology in patients with persistent neck pain is usually overlooked. A 58-year-old female patient with chronic neck pain presented to our clinic. Following multidisciplinary team review, the symptoms were found due to the kinking of the internal carotid artery. In this report, we present the clinical presentation of the patient with the kinking of the internal carotid artery without stenosis, surgical management of the pathology, and a brief literature review.

Brief Review of Right Aortic Arch with Aberrant Left Subclavian Artery.

Development anomalies of the aortic arch and its major branches are rare congenital cardiovascular disorders. In this article, we present aberrant left subclavian artery associated with right aortic arch.

Anticoagulation strategy in patients with atrial fibrillation after carotid endarterectomy.

Aim: Carotid artery stenosis and atrial fibrillation are diseases of the aging patient population. Literature lacks precise anticoagulation treatment protocols for patients with atrial fibrillation following carotid endarterectomy. We present our experiences with anticoagulation strategy in this particular patient population. Patients and methods: Between June 2001-September 2017, 165 patients with chronic or paroxysmal atrial fibrillation out of 1594 cases from three different institutions whom received Coumadin and aspirin and required carotid endarterectomy were reviewed, respectively. Mean age was 63.4 ± 7.9 years. Male/female ratio was 102/63. There were 67 diabetic and 138 hypertensive cases. Results: Patients are followed a mean of 64.4 ± 16.9 months. Early mortality occurred in two patients due to intracranial bleeding and heart failure. Another patient was lost due to intracerebral hemorrhage and 16 other patients died due to various causes in the late follow-up. Three patients required exploration against bleeding. Conclusion: Combination of warfarin with an aim to keep the INR value between 2 and 3, and aspirin at a dosage of 100 mg per day seemed feasible and in our modest patient cohort. Further studies including multicenter larger data are warranted in order to establish a precise anticoagulation treatment protocol for patients with atrial fibrillation after carotid endarterectomy.

Factors affecting the occurrence and degree of luminal protrusion of carotid plaques after angioplasty stenting: an ex-vivo clinical study.

OBJECTIVE: To investigate possible protrusions through stent cells, and the factors affecting protrusions after carotid angioplasty and stenting (CAS). METHODS: This ex-vivo clinical study was performed between July 2010 and August 2011 at the Department of Radiology, Ege University School of Medicine, Izmir, Turkey. After approval by the Institutional Board, 15 successive carotid plaques, which were obtained intact after endarterectomies were included in the study. Plaques were placed into vascular grafts. Stent implantations and balloon angioplasties were performed. Afterwards, models were scanned with multislice CT and inner surfaces of stents were observed via fiberoptic endoscope. Protrusion measurement was carried out on endoscopic images according to a scale assuming the width of stent cell as one unit in the same level of each plaque protrusion. RESULTS: Symptomatic plaques were lighter, less calcified. Plaque weights were inversely correlated to protrusion numbers and diameters of the narrowest segments of stents. Although they did not reach to statistically significant level, plaques having high protrusion numbers were more symptomatic and less calcified. CONCLUSION: Plaque protrusions into the lumen were apparent in our ex-vivo CAS model. The main factor increasing protrusions appeared to relate to the presence of symptoms before endarterectomy.