Is Surgery the Only Fate of the Patient with Leriche Syndrome? Our Endovascular Therapy Results Early Follow-Up Outcomes.

AIM: In this research, we aimed to present early follow-up results of the endovascular treatment in patients with Leriche syndrome at our single center. METHODS AND MATERIALS: Between October 2020 and January 2022, 14 patients with Leriche syndrome (12 men, two women) who underwent endovascular treatment at our center retrospectively were evaluated. Before the treatment, the ankle-brachial index (ABI) was found 0.50 ± 0.11 on the right leg and 0.45 ± 0.09 on the left leg. RESULTS: All of the patients with Leriche syndrome applied to our clinic for the first time. In five patients, the fully occluded lesion length was over 3 cm (ranging between 3.5-7.2 cm), hence they were treated with aortic and bilateral iliac bare metallic stents. Although in one patient, the aortic occluding lesion was below 3 cm; it was treated with a bare aortic and bilateral bare iliac stent application because the lesion in the aorta was too calcific. In eight patients, the lesion length was less than 3 cm, bilateral iliac metal bare stents were applied in a kissing stent way. CONCLUSION: Endovascular therapy for chronic aorto-iliac occlusive disease has an early high technical success with primary and secondary patency rates. Especially in patients with high risk factors, it may be considered as a good alternative to conventional surgery.

The beneficial effects of tadalafil on renal ischemia-reperfusion injury in rats.

Acute renal failure due to ischemia-reperfusion (I/R) injury is a common complication in cardiovascular surgery. We determined the influence of tadalafil on renal injury in a renal I/R model in rats. For this purpose, 21 male Wistar albino rats were separated into 3 groups: sham, placebo and tadalafil. A right nephrectomy was performed, and the left renal pedicles were occluded for 60 min and reperfused for 60 min in the placebo and tadalafil groups. A single dose of tadalafil (10 mg/kg) through an orogastric tube was administered to the tadalafil group. Tubular atrophy with acute inflammation in renal histology, total oxidant status (TOS) and total antioxidant status (TAS) were determined in tissue homogenates. Compared to the tadalafil group, tubular atrophy and acute inflammation was significant in the placebo group. TAS levels were significantly higher in the tadalafil group compared to the placebo (p = 0.01) and sham groups (p = 0.04). While TOS levels were significantly higher in the placebo group (p = 0.03), tadalafil did not significantly alter the TOS levels. The beneficial effects of tadalafil can be attributed to its protective effects on renal tubular cells and inhibition of leukocyte infiltration in renal tissue. We think that tadalafil treatment has an important role in reducing renal injury resulting from renal I/R.

Early outcomes of radial artery use in all-arterial grafting of the coronary arteries in patients 65 years and older.

We retrospectively evaluated early clinical results of coronary revascularization using none but arterial grafts in patients aged 65 years and older. The cases of 449 consecutive patients who had undergone isolated myocardial revascularization were divided into 2 groups: the arterial conduit group (n=107) received a left internal mammary artery (LIMA) graft and 1 or both radial arteries (RAs), while the mixed-conduit group (n=342) received a LIMA graft and 1 or more saphenous vein grafts (SVGs), with or without an RA. There was no significant difference between the groups' rates of mortality. The arterial conduit group had a significantly shorter overall postoperative hospital stay than did the mixed-conduit group (mean, 6.6 +/- 0.9 vs 7.2 +/- 5 days; P=0.04). Linear regression analysis revealed that the presence of hypertension (beta=0.13; 95% confidence interval [CI], 0.054-0.759; P=0.02) and high EuroSCORE (beta=0.24; 95% CI, 0.053-0.283; P=0.004) were the major predicting factors for long hospital stay. Graft-harvest-site infection was statistically more frequent in the mixed-conduit group than in the arterial conduit group (6.4% vs 0, respectively; P=0.007). Angiography was performed postoperatively (mean, 24.9 +/- 16.3 mo; range, 11-65 mo) in 21 patients. In these patients, all LIMA grafts were patent, as were 86.9% of the SVGs and 90.9% of the RA grafts. Myocardial revascularization using all arterial grafts (at least 50% RAs) in patients aged 65 years and older is safe and reliable, produces short-term results equal to those of saphenous vein grafting, and can reduce graft-harvest-site infections.

Left sinus of Valsalva aneurysm with rupture into the right atrium.

Herein, we present the echocardiographic diagnosis of a case of left sinus of Valsalva aneurysm with rupture into the right atrium.

Risk factors for stroke following coronary artery bypass operations.

BACKGROUND: Although the overall complication rates have been decreased significantly in recent years, stroke rates still remain high in patients undergoing coronary bypass operations. This study is designed to evaluate the risk factors for stroke in patients who had undergone coronary artery bypass surgery in an 8-year period in our clinic. METHODS: Between 1995 and 2003, 8547 coronary artery operations under cardiopulmonary bypass were performed. Retrospective analysis of the patient files revealed that 75 (0.9%) patients had stroke in the early postoperative period. RESULTS: Mean age of these patients was 62.3 +/- 9.5 years, and 54 (72%) were males. Stroke rate was 1.2% between 1995 and 1998 and this was significantly higher from the stroke rate (0.7%) of the period 1998 to 2003 (p = 0.03). Major technical differences between these two periods were the routine application of preoperative carotid arteries Doppler evaluation and intraoperative epiaortic echocardiography after 1998. Higher age (p = 0.000), female sex (p = 0.005), smoking (p = 0.03), presence of diabetes mellitus (p = 0.01), hypertension (p = 0.008), and left main coronary artery disease (p = 0.001), carotid surgery (p = 0.000), and peripheral vascular disease (p = 0.049) were identified as important risk factors in univariate analysis for stroke development. Higher age (p = 0.000; OR = 21.38), left main coronary artery disease (p = 0.007; OR = 7.26), peripheral vascular disease (p = 0.050; OR = 3.08), and operation date before 1998 (p = 0.012; OR = 6.33) were identified as important risk factors in logistic regression analysis. According to intraoperative epiaortic ultrasonography, operative strategy was changed in 9% of patients. Thirty-seven (49.3%) of the stroke patients died. Female sex (p = 0.023; OR = 5.18) and preoperative hypertension (p = 0.045; OR = 4.03) were observed as significant risk factors for mortality after stroke. CONCLUSION: Development of stroke is one of the major reasons of mortality after coronary artery bypass operations. It is essential to take all the measures to prevent this complication, especially in patients with known risk factors. Evaluation of carotid arteries prior to operation and application of routine intraoperative epiaortic echocardiography may in part eliminate stroke.

Does diltiazem inhibit the inflammatory response in cardiopulmonary bypass?

BACKGROUND: The objective of our study was to investigate the anti-inflammatory effect and inhibiting action of diltiazem, a calcium channel blocking agent, on the systemic inflammatory response seen after cardiopulmonary bypass (CPB) in humans, in a controlled prospective study. MATERIAL/METHODS: Two groups of 15 candidates for coronary artery bypass graft were enrolled in the study. In the study group, 1 g/kg/min of diltiazem was infused during cardiopulmonary bypass, while the control group received saline. Interleukin-6 and 10 (IL-6, IL-10) levels were measured from systemic arterial blood at five time points. RESULTS: The levels of IL-6, a marker of the severity of systemic inflammation, were significantly higher in the control group at the end of CPB and 3 hours later. At the end of CPB, the mean IL-6 level in the control group was significantly higher than in the diltiazem group (p=0.015), and at 3 hours after CPB the difference was even greater (p=0.002). The levels of IL-10, an anti-inflammatory cytokine that limits the effects of pro-inflammatory cytokines, were higher in the control group, but not statistically significant at any time point. CONCLUSIONS: Diltiazem inhibits the release of the pro-inflammatory cytokine IL-6, which is strong evidence for its anti-inflammatory effect. It is clinically important to inhibit the inflammation that takes place during CPB and the inflammation of myocardium encountered after ischemia-reperfusion, since these effect the clinical status of the patient after CPB, as well as myocardial functions.