Diagnostic criteria for Buerger's disease: International Consensus of VAS - European Independent Foundation in Angiology/Vascular Medicine.

Buerger's disease (BD) remains a debilitating condition and early diagnosis is paramount for its effective management. Despite many published diagnostic criteria for BD, selective criteria have been utilized in different vascular centers to manage patients with BD worldwide. A recent international Delphi Consensus Study on the diagnostic criteria of BD showed that none of these published diagnostic criteria have been universally accepted as a gold standard. Apart from the presence of smoking, these published diagnostic criteria have distinct differences between them, rendering the direct comparison of patient outcomes difficult. Hence, the expert committees from the Working Group of the VAS-European Independent Foundation in Angiology/Vascular Medicine critically reviewed the findings from the Delphi study and provided practical recommendations on the diagnostic criteria for BD, facilitating its universal use. We recommend that the 'definitive' diagnosis of BD must require the presence of three features (history of smoking, typical angiographic features and typical histopathological features) and the use of a combination of major and minor criteria for the 'suspected' diagnosis of BD. The major criterion is the history of active tobacco smoking. The five minor criteria are disease onset at age less than 45 years, ischemic involvement of the lower limbs, ischemic involvement of one or both of the upper limbs, thrombophlebitis migrans and red-blue shade of purple discoloration on edematous toes or fingers. We recommend that a 'suspected' diagnosis of BD is confirmed in the presence of a major criterion plus four or more minor criteria. In the absence of the major criterion or in cases of fewer than four minor criteria, imaging and laboratory data could facilitate the diagnosis. Validation studies on the use of these major and minor criteria are underway.

Evaluation of the relationship between adjusted ischemia-modified albumin and the presence and severity of peripheral artery disease.

OBJECTIVES: Albumin undergoes structural changes under ischemia and oxidative stress, turning into ischemia-modified albumin (IMA). It has been proposed as an early biomarker for various diseases associated with ischemia. We aimed to investigate the relationship between serum IMA and peripheral artery disease (PAD) and whether it is a risk marker for the severity of PAD. METHODS: This prospective case-control study included 100 patients with lower extremity PAD and 50 volunteers without. Patients with resting pain, ulcer, and gangrene were excluded from the study. Patients with PAD included in the study were divided into two groups as mild claudication and moderate-severe claudication. Adjusted-IMA levels were calculated according to the median albumin values of the groups. The basic clinical features and laboratory findings of the participants were recorded and compared. Possible risk factors for presence and severity of PAD and IMA levels were examined by logistic regression and receiver-operating characteristic (ROC) curve analyses. RESULTS: IMA and adjusted-IMA levels were significantly higher in the PAD group (p < 0.001, p < 0.001, respectively). IMA and adjusted-IMA levels were significantly higher in PAD group 2, which had moderate-to-severe claudication and more pronounced ischemic symptoms (p < 0.001, p < 0.001, respectively). Advanced age, presence of hypertension, smoking, low albumin levels, and high adjusted-IMA levels were independent predictors of PAD. There was a negative high correlation between adjusted-IMA levels and ABI (r: -0.666, p < 0.001, Spearman's correlation). ROC curve analysis demonstrated that adjusted-IMA cut-off values of 0.802 or above could predict presence and severity of peripheral artery disease with 70% sensitivity and 78% specificity (AUC: 0.825, 95% CI: 0.758-0.893, log rank p: 0.000). CONCLUSION: We determinated that increased adjusted-IMA levels were a predictors of the presence and severity of PAD. In addition, adjusted-IMA values can be a valuable marker in the follow-up of clinical severity of PAD.

Early period results of radiofrequency ablation and cyanoacrylate embolization for great saphenous vein insufficiency.

OBJECTIVE: To evaluate the 6 months efficacy and safety of cyanoacrylate closure for the treatment of incompetent great saphenous veins (GSVs) in comparison with radiofrequency ablation (RFA). METHODS: In this multicenter, retrospective, clinical trial, 398 symptomatic subjects with incompetent GSVs were assigned to either cyanoacrylate closure or RFA. The primary endpoint, complete closure of the target GSV, was determined using duplex ultrasound examination starting from one-, three-, and six-month visits. RESULTS: All patients were followed for 6 months and there was no difference between the groups in terms of mean follow-up time. Hospital stay and return to work/activity were shorter in the cyanoacrylate ablation (CAA) group, and these differences between the groups were statistically significant. Ecchymosis was observed higher in the RFA group and was statistically significant. CONCLUSIONS: In this study, in which we examined the CAA and RFA methods, we found that both methods were effective and reliable; however, we found that patients in the CAA group had a more comfortable postoperative period and returned to work earlier.

Mitral valve repair for ischemic moderate mitral regurgitation in patients undergoing coronary artery bypass grafting.

OBJECTIVES: To investigate whether mitral valve repair (MVR) at the time of coronary artery bypass grafting (CABG) in patients with ischemic moderate mitral regurgitation (MR) and coronary artery disease could improve short- and mid-term postoperative outcomes.  METHODS: Between March 2013 and December 2015, 90 patients with moderate ischemic MR underwent first-time CABG in Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey. Out of 90 patients, 44 (48.9%) underwent combined CABG+MVR. The remaining 46 (51.1%) underwent CABG alone. Ventricular functions and effort capacities of patients in both groups were evaluated echocardiographically and clinically in the preoperative period, and in the first postoperative year.  RESULTS: Postoperative regurgitant volume changes according to preoperative values were -24.76±19 ml/beat in the combined CABG+MVR group, and -8.70±7.2 ml/beat in the CABG alone group (p=0.001). The change of vena contracta width was -3.40±0.2 mm in the combined CABG+MVR group whereas in the CABG alone -1.45±0.7 mm (p=0.019). The changes of left ventricular end-systolic volume index were -30.77±25.9 ml/m2 in the combined  CABG+MVR group and -15.6±9.4 ml/m2 in the CABG alone group (p=0.096). Ejection fraction changes in the combined CABG+MVR group was +1.51±5.3% and in the CABG alone group was +1.15±4.3%. No statistically significant difference was found between both groups (p=0.604). Preoperative  New York Heart Association  class values in the combined CABG+MVR group was 2.18±0.45, and in the CABG alone group was 2.13±0.54.  CONCLUSIONS: Moderate MR in patients undergoing CABG affects the outcome adversely and it does not reliably improve after CABG alone. Therefore, patients with ischemic moderate MR should undergo simultaneous MVR at the time of CABG.

Influence of albumin concentration in priming solution on blood viscosity under hypothermic conditions.

OBJECTIVE: Albumin is used routinely as a plasma volume expander in cardiopulmonary bypass operations. The effect of two different concentrations of albumin in Ringer's lactate on blood viscosity was explored in this study. METHODS: Ten healthy volunteers (all male) were included in the study, based on their haematocrit levels (42.6 +/- 0.96). Using a heparinised 50-ml syringe, 40 cm(3) of blood were drawn from the antecubital veins of fasting volunteers. Six ml of blood were haemodiluted with 2 ml of albumin (20%), 2 ml of Ringer's lactate containing albumin (1.3%), and 2 ml of Ringer's lactate, in order to simulate cardiopulmonary bypass conditions. Test tubes with the solutions were placed in a 15 degrees C water bath for 25 minutes. Viscosity was measured in the haemodiluted blood samples using an Ostwald viscometer. Relative viscosities of samples were assessed with SPSS software and the ANOVA test. RESULTS: The mean relative viscosity of Ringer's lactate was 4.19 (+/- 0.49), that of Ringer's lactate with 1.3% albumin was 4.30 (+/- 0.31), and of 20% albumin was 7.32 (+/- 0.71). The relative viscosity of Ringer's lactate and Ringer's lactate with 1.3% albumin were statistically similar, but that of 20% albumin was higher than the Ringer's lactate and Ringer's lactate with 1.3% albumin. CONCLUSION: Albumin is used as a plasma volume expander in priming solutions for cardiopulmonary bypass operations, but its effect on blood viscosity depends on the concentration of albumin used.