Pub Date : 2023-11-05DOI: 10.9739/tjvs.2023.09.027
Umit Kahraman, Sedat Karaca, Karya Islamoglu, Aysen Yaprak Engin, Fatih Islamoglu
Aim: Our aim in this article is to present the mid-term results of the best preoperative and postoperative medical treatment and analgesia treatment in patients with advanced Buerger's disease who underwent saphenous patchplasty and saphenous distal bypass after endarterectomy to the popliteal artery or trifurcation area. Material and Methods: Between 2015 and 2023, we operated on 83 patients, diagnosed with Buerger's disease, who were in the chronic stage of the disease, and whose advanced imaging was performed. Preoperative, postoperative, and 1st year control evaluations were determined according to Rutherford, Fontaine classification, and Ankle-Brachial Indexes. Medical treatments of the patients were organized by the vascular surgery team and algology department. After determining the surgical approach strategy according to the imaging of the patients, saphenous patchplasty and anatomical bypass were performed. Results: The mean preoperative ankle-brachial index was 0.305, the mean postoperative ankle-brachial index was 0.644, and the mean 1-year ankle-brachial index was 0.629 in 83 patients included in the study. Statistically significant improvements were observed in the Rutherford and Fontaine classifications. (p-value < 0,001) Amputation was performed in 9.6% of patients within 1 year. Conclusion: Good clinical results and limb salvage can be achieved with a combined medical and surgical treatment approach in advancedstage patients who do not respond despite optimal medical treatment. Provided that patients quit smoking, good determination of the target surgical site, Saphenous patchplasty, and Saphenous distal bypass applied after endarterectomy in suitable patients are supported with good medical and analgesia treatment, the results will improve further.
{"title":"Mid-term results of combined medical and popliteal artery endarterectomy treatment in Buerger's disease","authors":"Umit Kahraman, Sedat Karaca, Karya Islamoglu, Aysen Yaprak Engin, Fatih Islamoglu","doi":"10.9739/tjvs.2023.09.027","DOIUrl":"https://doi.org/10.9739/tjvs.2023.09.027","url":null,"abstract":"Aim: Our aim in this article is to present the mid-term results of the best preoperative and postoperative medical treatment and analgesia treatment in patients with advanced Buerger's disease who underwent saphenous patchplasty and saphenous distal bypass after endarterectomy to the popliteal artery or trifurcation area. Material and Methods: Between 2015 and 2023, we operated on 83 patients, diagnosed with Buerger's disease, who were in the chronic stage of the disease, and whose advanced imaging was performed. Preoperative, postoperative, and 1st year control evaluations were determined according to Rutherford, Fontaine classification, and Ankle-Brachial Indexes. Medical treatments of the patients were organized by the vascular surgery team and algology department. After determining the surgical approach strategy according to the imaging of the patients, saphenous patchplasty and anatomical bypass were performed. Results: The mean preoperative ankle-brachial index was 0.305, the mean postoperative ankle-brachial index was 0.644, and the mean 1-year ankle-brachial index was 0.629 in 83 patients included in the study. Statistically significant improvements were observed in the Rutherford and Fontaine classifications. (p-value < 0,001) Amputation was performed in 9.6% of patients within 1 year. Conclusion: Good clinical results and limb salvage can be achieved with a combined medical and surgical treatment approach in advancedstage patients who do not respond despite optimal medical treatment. Provided that patients quit smoking, good determination of the target surgical site, Saphenous patchplasty, and Saphenous distal bypass applied after endarterectomy in suitable patients are supported with good medical and analgesia treatment, the results will improve further.","PeriodicalId":23982,"journal":{"name":"Turkish Journal of Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135725842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-05DOI: 10.9739/tjvs.2023.09.026
Serap Ulusoy, Hakki Zafer Iscan
Aim: Chronic Venous Ulcer (CVU) accounts for nearly 70% of all chronic leg ulcers (CLU), seriously impacting the quality of life and creating a heavy economic burden. Here, we present CVU therapy with a four-layer bandage system in 113 patients retrospectively treated by the General Surgery Chronic Wound Unit and Cardiovascular Surgery Department. Material and Methods: From January 2022 to January 2023, 113 patients with CVU were evaluated retrospectively. All patients were documented by color Doppler ultrasonography (CDUS), ulcer size, and demographics. If there were multiple ulcers, the largest one was assessed. Immobile patients and patients with an Ankle Brachial Index (ABI) of <0.7 were excluded. Debridement, exercise, venoactive drugs, and a four-layer bandage system were performed for all patients. The primary outcome was to assess the ulcer healing, and the secondary outcome was to obtain the recurrence rate and the treatment compatibility of patients. Results: The mean age of the patients was 60.73±11.3 (28-91) years and 77.9% were male. Body Mass Index (BMI) was 30.4±7.7 kg/m2 (min:18-max:51 kg/m2). The mean follow-up period was 18.82±13.4 weeks. Pseudomonas aeruginosa (38%) and Staphylococcus aureus (31.8%) were the most identified microorganisms. Four patients experienced recurrence of the CVU (3.5%). The older patients had larger ulcers than the younger patients. Female patients had larger-sized ulcers (p=0.001). Completely healed ulcers were 26.5% of the total. The four-layer compression bandage was applied 12 times for per patient. The mean healing period was 23.2±13.8 weeks. The mean healing rate was 4.17±3.78% for a week. The multivariant analysis revealed that age and pain had negatively affected the ulcer healing. Conclusion: The management of CVU is challenging and needs a multidisciplinary approach. Compression is the main goal of the treatment. Surgical or endovenous therapies may be beneficial for decreasing ulcer recurrence. For patients with slow ulcer healing, adjuvant treatment modalities such as patient education, smoking cessation, diet and lifestyle modification, and exercise should be recommended.
目的:慢性静脉溃疡(Chronic Venous Ulcer, CVU)占所有慢性腿部溃疡(Chronic leg Ulcer, CLU)的近70%，严重影响患者的生活质量，造成沉重的经济负担。在这里，我们报告了在普通外科慢性伤口科和心血管外科回顾性治疗的113例患者的四层绷带治疗。材料与方法:对2022年1月至2023年1月113例CVU患者进行回顾性分析。所有患者均通过彩色多普勒超声(CDUS)、溃疡大小和人口统计学进行记录。如果有多个溃疡，则评估最大的溃疡。不活动患者和踝关节肱指数(踝肱指数)为0.7的患者被排除在外。所有患者均行清创、运动、静脉活性药物和四层绷带系统。主要结局是评估溃疡愈合情况，次要结局是获得患者的复发率和治疗相容性。结果:患者平均年龄为60.73±11.3(28-91)岁，男性占77.9%。身体质量指数(BMI)为30.4±7.7 kg/m2(最小18-最大51 kg/m2)。平均随访时间18.82±13.4周。铜绿假单胞菌(38%)和金黄色葡萄球菌(31.8%)是鉴定最多的微生物。4例患者出现CVU复发(3.5%)。老年患者的溃疡比年轻患者大。女性患者溃疡较大(p=0.001)。溃疡完全愈合占总数的26.5%。每例患者使用四层压迫绷带12次。平均愈合时间为23.2±13.8周。平均愈合率为4.17±3.78%，一周。多变量分析显示，年龄和疼痛对溃疡愈合有负面影响。结论:CVU的治疗具有挑战性，需要多学科联合治疗。压缩是治疗的主要目标。手术或静脉内治疗可能有利于减少溃疡复发。对于溃疡愈合缓慢的患者，应推荐辅助治疗方式，如患者教育、戒烟、饮食和生活方式改变以及运动。
{"title":"The management of venous leg ulcers: Effects of four-layer bandage system","authors":"Serap Ulusoy, Hakki Zafer Iscan","doi":"10.9739/tjvs.2023.09.026","DOIUrl":"https://doi.org/10.9739/tjvs.2023.09.026","url":null,"abstract":"Aim: Chronic Venous Ulcer (CVU) accounts for nearly 70% of all chronic leg ulcers (CLU), seriously impacting the quality of life and creating a heavy economic burden. Here, we present CVU therapy with a four-layer bandage system in 113 patients retrospectively treated by the General Surgery Chronic Wound Unit and Cardiovascular Surgery Department. Material and Methods: From January 2022 to January 2023, 113 patients with CVU were evaluated retrospectively. All patients were documented by color Doppler ultrasonography (CDUS), ulcer size, and demographics. If there were multiple ulcers, the largest one was assessed. Immobile patients and patients with an Ankle Brachial Index (ABI) of <0.7 were excluded. Debridement, exercise, venoactive drugs, and a four-layer bandage system were performed for all patients. The primary outcome was to assess the ulcer healing, and the secondary outcome was to obtain the recurrence rate and the treatment compatibility of patients. Results: The mean age of the patients was 60.73±11.3 (28-91) years and 77.9% were male. Body Mass Index (BMI) was 30.4±7.7 kg/m2 (min:18-max:51 kg/m2). The mean follow-up period was 18.82±13.4 weeks. Pseudomonas aeruginosa (38%) and Staphylococcus aureus (31.8%) were the most identified microorganisms. Four patients experienced recurrence of the CVU (3.5%). The older patients had larger ulcers than the younger patients. Female patients had larger-sized ulcers (p=0.001). Completely healed ulcers were 26.5% of the total. The four-layer compression bandage was applied 12 times for per patient. The mean healing period was 23.2±13.8 weeks. The mean healing rate was 4.17±3.78% for a week. The multivariant analysis revealed that age and pain had negatively affected the ulcer healing. Conclusion: The management of CVU is challenging and needs a multidisciplinary approach. Compression is the main goal of the treatment. Surgical or endovenous therapies may be beneficial for decreasing ulcer recurrence. For patients with slow ulcer healing, adjuvant treatment modalities such as patient education, smoking cessation, diet and lifestyle modification, and exercise should be recommended.","PeriodicalId":23982,"journal":{"name":"Turkish Journal of Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135725854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-05DOI: 10.9739/tjvs.2023.09.029
Mehmet Cahit Saricaoglu, Levent Yazicioglu
Aim: Rapid artificial ventricular pacing (RAVP) is a reproducible method for rapid and reversible reduction of transvascular flow during endovascular procedures. This method has the potential to increase patient tolerance, reduce operation duration, infection risk, X-ray dose and facilitate early patient mobilisation. The aim of this study to compare the efficacy, safety and impact of RAVP and pharmacological-induced hypotension in patients who underwent thoracic endovascular aortic repair (TEVAR) procedures for aortic dissection and aneurysm. Material and Methods: This retrospective, observational, case-control study was conducted between January 2014 and December 2022. The adult patients who underwent TEVAR procedures for aortic dissection and aneurysm were enrolled in this study. Mean arterial pressure, heart rate, total operation duration, incidence of endoleak, duration of intensive care unit-hospitalization stay, and hospital mortality ratio were compared between nitroglycerin induced hypotension group and RAVP group. Results: A total of 279 patients who underwent TEVAR procedures were included in this study. The mean age of patients in this cohort was 65.6±5.7 years and 158 (56.6%) of the patients were male. Of these 279 patients, hypotension during stent-graft was achieved with nitroglycerin in 155 patients. There were no statistical differences between these two groups in terms of age, gender, body mass index, comorbidities and drugs. The blood pressure lowering effect and the heart rate during the intervention was significantly higher in RAVP. Endoleak and hospital mortality rates were similar in each group. Conclusion: RAVP is a feasible and safe method because it paves the way for agile maneuvers to maintain optimal hemodynamic conditions. Besides this, more meticulous, accurate deployment of endograft can be established with RAVP.
{"title":"Rapid artificial ventricular pacing for thoracic endovascular aortic repair","authors":"Mehmet Cahit Saricaoglu, Levent Yazicioglu","doi":"10.9739/tjvs.2023.09.029","DOIUrl":"https://doi.org/10.9739/tjvs.2023.09.029","url":null,"abstract":"Aim: Rapid artificial ventricular pacing (RAVP) is a reproducible method for rapid and reversible reduction of transvascular flow during endovascular procedures. This method has the potential to increase patient tolerance, reduce operation duration, infection risk, X-ray dose and facilitate early patient mobilisation. The aim of this study to compare the efficacy, safety and impact of RAVP and pharmacological-induced hypotension in patients who underwent thoracic endovascular aortic repair (TEVAR) procedures for aortic dissection and aneurysm. Material and Methods: This retrospective, observational, case-control study was conducted between January 2014 and December 2022. The adult patients who underwent TEVAR procedures for aortic dissection and aneurysm were enrolled in this study. Mean arterial pressure, heart rate, total operation duration, incidence of endoleak, duration of intensive care unit-hospitalization stay, and hospital mortality ratio were compared between nitroglycerin induced hypotension group and RAVP group. Results: A total of 279 patients who underwent TEVAR procedures were included in this study. The mean age of patients in this cohort was 65.6±5.7 years and 158 (56.6%) of the patients were male. Of these 279 patients, hypotension during stent-graft was achieved with nitroglycerin in 155 patients. There were no statistical differences between these two groups in terms of age, gender, body mass index, comorbidities and drugs. The blood pressure lowering effect and the heart rate during the intervention was significantly higher in RAVP. Endoleak and hospital mortality rates were similar in each group. Conclusion: RAVP is a feasible and safe method because it paves the way for agile maneuvers to maintain optimal hemodynamic conditions. Besides this, more meticulous, accurate deployment of endograft can be established with RAVP.","PeriodicalId":23982,"journal":{"name":"Turkish Journal of Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135724784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-05DOI: 10.9739/tjvs.2023.07.018
Ibrahim Cagri Kaya, Halil Ibrahim Bulut, Alper Selim Kocaoglu, Nihal Aksoy
Aim: Peripheral arterial disease (PAD) is a prevalent condition that significantly impacts quality of life and that can lead to limb amputation and thromboembolic events. Treatment options for PAD include endovascular and open surgical interventions, with the choice depending on the Trans-Atlantic inter-society consensus II (TASC II) classification. Recent evidence suggests that endovascular therapy may be feasible for complex PAD lesions, but further research is needed. Material and Methods: This retrospective cohort study included 50 patients with TASC II class C and D lesions. The procedures were conducted using a state-of-the-art angiography system, and patients received appropriate antiplatelet therapy and heparin during the intervention. Data collection was performed following ethical considerations and standardization protocols. Results: This study involved 50 patients with peripheral arterial disease, characterized by an average age of 65.0 years and a prevalence of comorbidities such as coronary artery disease, hypertension, type 2 diabetes mellitus, and tobacco use. The majority of patients presented with claudication and had lesions primarily in the femoropopliteal region. The procedures performed, primarily using drug-coated balloons, resulted in high technical success rates and favorable outcomes at 30 days, with a slight decline in primary patency rates at 6 months. Some patients required readmission due to cardiac reasons, and a small portion necessitated open surgical revascularization. Conclusion: Our findings support the use of endovascular revascularization as a safe and effective option for patients with complex lesions. Further research is needed to address challenges related to dissection and optimize outcomes in this patient population. This study contributes to the growing understanding of treatment approaches for peripheral artery disease and highlights the potential benefits of endovascular therapy.
{"title":"Endovascular revascularization of challenging anatomical lesions: Revascularization in TASC-II C and D classes: A single-centre retrospective report","authors":"Ibrahim Cagri Kaya, Halil Ibrahim Bulut, Alper Selim Kocaoglu, Nihal Aksoy","doi":"10.9739/tjvs.2023.07.018","DOIUrl":"https://doi.org/10.9739/tjvs.2023.07.018","url":null,"abstract":"Aim: Peripheral arterial disease (PAD) is a prevalent condition that significantly impacts quality of life and that can lead to limb amputation and thromboembolic events. Treatment options for PAD include endovascular and open surgical interventions, with the choice depending on the Trans-Atlantic inter-society consensus II (TASC II) classification. Recent evidence suggests that endovascular therapy may be feasible for complex PAD lesions, but further research is needed. Material and Methods: This retrospective cohort study included 50 patients with TASC II class C and D lesions. The procedures were conducted using a state-of-the-art angiography system, and patients received appropriate antiplatelet therapy and heparin during the intervention. Data collection was performed following ethical considerations and standardization protocols. Results: This study involved 50 patients with peripheral arterial disease, characterized by an average age of 65.0 years and a prevalence of comorbidities such as coronary artery disease, hypertension, type 2 diabetes mellitus, and tobacco use. The majority of patients presented with claudication and had lesions primarily in the femoropopliteal region. The procedures performed, primarily using drug-coated balloons, resulted in high technical success rates and favorable outcomes at 30 days, with a slight decline in primary patency rates at 6 months. Some patients required readmission due to cardiac reasons, and a small portion necessitated open surgical revascularization. Conclusion: Our findings support the use of endovascular revascularization as a safe and effective option for patients with complex lesions. Further research is needed to address challenges related to dissection and optimize outcomes in this patient population. This study contributes to the growing understanding of treatment approaches for peripheral artery disease and highlights the potential benefits of endovascular therapy.","PeriodicalId":23982,"journal":{"name":"Turkish Journal of Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135724783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-05DOI: 10.9739/tjvs.2023.08.023
Mehmet Ceber, Ilker Akar, Ilker Ince, Cemal Aslan, Sameh Alagha
Aim: Lower limb ischemia/reperfusion leads to distant organ dysfunction, notably affecting the lungs, resulting in respiratory failure and significant morbidity and mortality. Edaravone is a new free radical scavenger and has attracted the attention of researchers. This study aims to examine edaravone's influence on lung injury arising from lower limb ischemia-reperfusion. Material and Methods: Forty male Wistar rats were categorized into groups: Sham, Ischemia/Reperfusion (IR), Solvent, and Edaravone. The infrarenal abdominal aorta was clamped for 120 minutes and then reperfused for another 120 minutes. Edaravone was administered 30 minutes before the ischemic event. Then we analyzed serum and lung tissue samples for malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GPx), and nitric oxide (NO) levels. Furthermore, a thorough histopathological assessment was conducted. Results: In the IR group, edaravone notably reduced serum and lung MDA levels. While significant differences in serum SOD and NO levels existed between the IR and edaravone groups, similar differences were not found in the lung tissue samples. There appeared to be no significant impact of edaravone on serum and lung GPx levels. The histopathological investigation revealed that the lung injury score was significantly higher in the IR group compared to the control group, a difference mitigated by edaravone treatment. Conclusion: Our findings suggest that edaravone mitigates lower limb ischemia-reperfusion-induced lung injury, both biochemically and histopathologically. Our findings imply the potential utility of this agent in the context of acute ischemia-reperfusion injury following vascular surgery.
{"title":"The effect of Edaravone on lung injury after lower limb ischemiareperfusion in a rat model: Biochemical and histopathological insights","authors":"Mehmet Ceber, Ilker Akar, Ilker Ince, Cemal Aslan, Sameh Alagha","doi":"10.9739/tjvs.2023.08.023","DOIUrl":"https://doi.org/10.9739/tjvs.2023.08.023","url":null,"abstract":"Aim: Lower limb ischemia/reperfusion leads to distant organ dysfunction, notably affecting the lungs, resulting in respiratory failure and significant morbidity and mortality. Edaravone is a new free radical scavenger and has attracted the attention of researchers. This study aims to examine edaravone's influence on lung injury arising from lower limb ischemia-reperfusion. Material and Methods: Forty male Wistar rats were categorized into groups: Sham, Ischemia/Reperfusion (IR), Solvent, and Edaravone. The infrarenal abdominal aorta was clamped for 120 minutes and then reperfused for another 120 minutes. Edaravone was administered 30 minutes before the ischemic event. Then we analyzed serum and lung tissue samples for malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GPx), and nitric oxide (NO) levels. Furthermore, a thorough histopathological assessment was conducted. Results: In the IR group, edaravone notably reduced serum and lung MDA levels. While significant differences in serum SOD and NO levels existed between the IR and edaravone groups, similar differences were not found in the lung tissue samples. There appeared to be no significant impact of edaravone on serum and lung GPx levels. The histopathological investigation revealed that the lung injury score was significantly higher in the IR group compared to the control group, a difference mitigated by edaravone treatment. Conclusion: Our findings suggest that edaravone mitigates lower limb ischemia-reperfusion-induced lung injury, both biochemically and histopathologically. Our findings imply the potential utility of this agent in the context of acute ischemia-reperfusion injury following vascular surgery.","PeriodicalId":23982,"journal":{"name":"Turkish Journal of Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135725841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aim: The utility of thoracic endovascular aortic repair (TEVAR) in Type B Aortic dissections (TBAD) continues to advance at a growing rate. The purpose of this research was to investigate our management strategy and early-mid-term outcomes of endovascular procedures for TBAD, in a single tertiary center. Material and Methods: Sixty-six eligible TBAD patients (2 hyperacute complicated, 12 acute complicated and 52 uncomplicated) were enrolled in this single-center, retrospective cohort study between January 2016 and January 2023. The endpoints of the study were technical success, early and late morbidity and mortality, reinterventions throughout the follow-up period, as well as late open conversion. Results: Technical success was achieved in all cases. Early mortality was seen in only 3 patients (4.5%). Only patients with one hyperacute and two acute complicated TBAD (cTBAD) had early death. There was one late mortality in an acute cTBAD patient, who developed retrograde type A dissection two months after TEVAR. The median follow-up period was 26.1±13.7 months. Six reinterventions were performed for extension of dissection or covering the entries distally (9.1%). No endoleak, graft infection or migration were observed. Open surgical repair was performed; however, the patient did not survive. Conclusion: Early results of TEVAR in elective TBAD is trouble-free. Carrying the patients to the subacute phase seems to be the most suitable timing for TEVAR. Anti-stimulus and anti-hypertensive treatment with surveillance programme is mandatory for this patient cohort. Pre-emptive TEVAR has satisfactory results; however, long-term results are mandatory for further recommendations.
{"title":"Early and mid-term results of endovascular repair for type B aortic dissections: A single tertiary center experience","authors":"Gorkem Yigit, Gokay Deniz, Sabir Hasanzade, Murat Gevrek, Ayla Ece Celikten, Naim Boran Tumer, Anıl Özen, Hakki Zafer Iscan","doi":"10.9739/tjvs.2023.07.019","DOIUrl":"https://doi.org/10.9739/tjvs.2023.07.019","url":null,"abstract":"Aim: The utility of thoracic endovascular aortic repair (TEVAR) in Type B Aortic dissections (TBAD) continues to advance at a growing rate. The purpose of this research was to investigate our management strategy and early-mid-term outcomes of endovascular procedures for TBAD, in a single tertiary center. Material and Methods: Sixty-six eligible TBAD patients (2 hyperacute complicated, 12 acute complicated and 52 uncomplicated) were enrolled in this single-center, retrospective cohort study between January 2016 and January 2023. The endpoints of the study were technical success, early and late morbidity and mortality, reinterventions throughout the follow-up period, as well as late open conversion. Results: Technical success was achieved in all cases. Early mortality was seen in only 3 patients (4.5%). Only patients with one hyperacute and two acute complicated TBAD (cTBAD) had early death. There was one late mortality in an acute cTBAD patient, who developed retrograde type A dissection two months after TEVAR. The median follow-up period was 26.1±13.7 months. Six reinterventions were performed for extension of dissection or covering the entries distally (9.1%). No endoleak, graft infection or migration were observed. Open surgical repair was performed; however, the patient did not survive. Conclusion: Early results of TEVAR in elective TBAD is trouble-free. Carrying the patients to the subacute phase seems to be the most suitable timing for TEVAR. Anti-stimulus and anti-hypertensive treatment with surveillance programme is mandatory for this patient cohort. Pre-emptive TEVAR has satisfactory results; however, long-term results are mandatory for further recommendations.","PeriodicalId":23982,"journal":{"name":"Turkish Journal of Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135725851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-05DOI: 10.9739/tjvs.2023.08.022
Mehmet Cahit Saricaoglu, Evren Ozcinar
Aim: Simultaneous multilevel hybrid-based reconstructions using both endovascular and open femoral endartectomy merit the interest with the widespread adoption of these techniques by vascular surgeons. Here we presented our experience on hybrid-based approach to treat total occlusive iliofemoral lesions and study the technical success and mid-term results of combined femoral endarterectomy and endovascular treatment of iliac occlusion. Material and Methods: This retrospective single center study included patients with only total occlusion in the unilateral iliac artery. The patients underwent hybrid procedure–open femoral endarterectomy and endovascular revascularization of the external or common iliac artery- between 2016 and 2022. Statistical analysis was performed by using SPSS software version 25. Results: Totally 103 patients who underwent hybrid procedures for pervasive unilateral iliac artery occlusions were included in this study. Of the study cohort, 76% were male patients with a mean age of 74±8.7 years. Technical success rate was 89.3%. Acute myocardial infarction was the most common complication. The 30-day mortality was 7.8% (n=8) and all of them were in-hospital deaths. The survival rates of this cohort at 30 days, 6 months and 12 months were 92.2%, 88.1% and 83.7%, respectively. The primary patency at 30 days, 6 months, and 12 months were 98.1%, 96.6%, and 93.7%, respectively. Conclusion: The clinical and technical outcomes in this study suggest that the hybrid approach to pervasive iliofemoral occlusions, combining femoral endarterectomy and endovascular iliac revascularization, is an effective and applicable treatment in terms of patency rates and perioperative complications.
{"title":"Hybrid-based approach for pervasive occlusive disease of iliofemoral arteries","authors":"Mehmet Cahit Saricaoglu, Evren Ozcinar","doi":"10.9739/tjvs.2023.08.022","DOIUrl":"https://doi.org/10.9739/tjvs.2023.08.022","url":null,"abstract":"Aim: Simultaneous multilevel hybrid-based reconstructions using both endovascular and open femoral endartectomy merit the interest with the widespread adoption of these techniques by vascular surgeons. Here we presented our experience on hybrid-based approach to treat total occlusive iliofemoral lesions and study the technical success and mid-term results of combined femoral endarterectomy and endovascular treatment of iliac occlusion. Material and Methods: This retrospective single center study included patients with only total occlusion in the unilateral iliac artery. The patients underwent hybrid procedure–open femoral endarterectomy and endovascular revascularization of the external or common iliac artery- between 2016 and 2022. Statistical analysis was performed by using SPSS software version 25. Results: Totally 103 patients who underwent hybrid procedures for pervasive unilateral iliac artery occlusions were included in this study. Of the study cohort, 76% were male patients with a mean age of 74±8.7 years. Technical success rate was 89.3%. Acute myocardial infarction was the most common complication. The 30-day mortality was 7.8% (n=8) and all of them were in-hospital deaths. The survival rates of this cohort at 30 days, 6 months and 12 months were 92.2%, 88.1% and 83.7%, respectively. The primary patency at 30 days, 6 months, and 12 months were 98.1%, 96.6%, and 93.7%, respectively. Conclusion: The clinical and technical outcomes in this study suggest that the hybrid approach to pervasive iliofemoral occlusions, combining femoral endarterectomy and endovascular iliac revascularization, is an effective and applicable treatment in terms of patency rates and perioperative complications.","PeriodicalId":23982,"journal":{"name":"Turkish Journal of Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135725852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-05DOI: 10.9739/tjvs.2023.08.025
Ihsan Alur, Bilgin Emrecan
Subclavian artery aneurysm (SAA) is a rare condition seen in less than 1% of peripheral artery aneurysms. It is usually asymptomatic. However, it may become symptomatic as a result of pressure on the surrounding organs due to the progressive growth of the aneurysm. The standard treatment for SAA is surgery. In this article, we wanted to present a 63-year-old male patient who presented with the complaint of shortness of breath and was operated on with the diagnosis of Right Subclavian artery true aneurysm on thoracic CT angiography.
{"title":"Right subclavian artery true aneurysm: A rare cause of dyspnea","authors":"Ihsan Alur, Bilgin Emrecan","doi":"10.9739/tjvs.2023.08.025","DOIUrl":"https://doi.org/10.9739/tjvs.2023.08.025","url":null,"abstract":"Subclavian artery aneurysm (SAA) is a rare condition seen in less than 1% of peripheral artery aneurysms. It is usually asymptomatic. However, it may become symptomatic as a result of pressure on the surrounding organs due to the progressive growth of the aneurysm. The standard treatment for SAA is surgery. In this article, we wanted to present a 63-year-old male patient who presented with the complaint of shortness of breath and was operated on with the diagnosis of Right Subclavian artery true aneurysm on thoracic CT angiography.","PeriodicalId":23982,"journal":{"name":"Turkish Journal of Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135724934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-05DOI: 10.9739/tjvs.2023.08.020
Hakan Guven
Aim: The use of endovascular thermal and nonthermal methods in the treatment of chronic venous insufficiency has been in practice for over 10 years. The early results of these practices have been published and extensively discussed. Medium and long-term results are now being announced. In our study, we discussed the results of endovenous laser ablation and endovenous glue ablation methods, along with hemodynamic evaluations. Material and Methods: Doppler USG and Digital Photo Plethysmography were used to examine patients with chronic venous insufficiency in the C2-5 group who received endovenous ablation indication. Records of VCSS and CIVIQ-20 were obtained. Measurements were taken at 1, 3, 6, 12, 24, and 60 months. Procedural and post-procedural variables were compared, and the results were obtained for a 5-year period. Results: The demographic profiles of the groups were similar. The duration of the procedure was significantly longer in the EVLA group. Similarly, the pain during the procedure was statistically significantly higher in the EVLA group. Venous refill time and venous half-life time showed a statistically significant improvement in both groups. While there were close to 100% closure rates in both groups during the first 6 months, the rates decreased to 95.2% in EVLA and 93.5% in EVGA by the end of the fifth year. Conclusion: With 5 years of objective and subjective findings, both EVLA and EVGA are effective and reliable methods with their advantages and disadvantages. However, EVGA may be more preferred by patients because it does not require tumescent anesthesia, causes less pain, and has a shorter procedure time.
{"title":"Evaluating endovenous laser and glue ablation in the treatment of great saphenous vein insufficiency: A 5-year retrospective comparative study","authors":"Hakan Guven","doi":"10.9739/tjvs.2023.08.020","DOIUrl":"https://doi.org/10.9739/tjvs.2023.08.020","url":null,"abstract":"Aim: The use of endovascular thermal and nonthermal methods in the treatment of chronic venous insufficiency has been in practice for over 10 years. The early results of these practices have been published and extensively discussed. Medium and long-term results are now being announced. In our study, we discussed the results of endovenous laser ablation and endovenous glue ablation methods, along with hemodynamic evaluations. Material and Methods: Doppler USG and Digital Photo Plethysmography were used to examine patients with chronic venous insufficiency in the C2-5 group who received endovenous ablation indication. Records of VCSS and CIVIQ-20 were obtained. Measurements were taken at 1, 3, 6, 12, 24, and 60 months. Procedural and post-procedural variables were compared, and the results were obtained for a 5-year period. Results: The demographic profiles of the groups were similar. The duration of the procedure was significantly longer in the EVLA group. Similarly, the pain during the procedure was statistically significantly higher in the EVLA group. Venous refill time and venous half-life time showed a statistically significant improvement in both groups. While there were close to 100% closure rates in both groups during the first 6 months, the rates decreased to 95.2% in EVLA and 93.5% in EVGA by the end of the fifth year. Conclusion: With 5 years of objective and subjective findings, both EVLA and EVGA are effective and reliable methods with their advantages and disadvantages. However, EVGA may be more preferred by patients because it does not require tumescent anesthesia, causes less pain, and has a shorter procedure time.","PeriodicalId":23982,"journal":{"name":"Turkish Journal of Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135725846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aim: Vascular surgery is an important part of the multidisciplinary approach to surgical treatments, and vascular surgeons are often called on intraoperatively to provide immediate assistance to their colleagues. Our aim was to describe the extent of assistance provided during emergency intraoperative consultations at a single tertiary academic centre. Material and Methods: We reviewed the records of patients who were consulted intraoperatively in our hospital over a period of approximately 4 years (January 1, 2017-December 31, 2020) and organized the data collected. Results: 40 emergency intraoperative consultations were identified. 55% of the patients were female, with an average age of 48.83 years. The most frequently consulted subspecialty was obstetrics and gynecology (32%). Index cases were elective/nonurgent (90%), most involving tumor resection (77.5%). The primary reason for vascular consultation was revascularization (37.5%). The primary blood vessel and anatomic field of intervention were categorized. Most cases (50%) included preservation of blood flow, including primary arterial repair (20%) and ligation of the bleeding vessels (20%) in the first choice. Postoperative mean length of stay was 13 days, with a 30-day mortality of 5.1%. Conclusion: Using a wide variety of skills and techniques, vascular surgeons strive to respond to urgent open surgical consultations in various anatomical sites. Our study provides evidence to the wide range of knowledge and skills required for modern vascular surgeons and the place of the subspecialty in the core services offered in a multidisciplinary approach.
{"title":"The role of vascular surgery in intraoperative emergency consultations","authors":"A. Durmaz, A. Arıkan, S. Gur, M. Kanko","doi":"10.9739/tjvs2022.11.029","DOIUrl":"https://doi.org/10.9739/tjvs2022.11.029","url":null,"abstract":"Aim: Vascular surgery is an important part of the multidisciplinary approach to surgical treatments, and vascular surgeons are often called on intraoperatively to provide immediate assistance to their colleagues. Our aim was to describe the extent of assistance provided during emergency intraoperative consultations at a single tertiary academic centre. Material and Methods: We reviewed the records of patients who were consulted intraoperatively in our hospital over a period of approximately 4 years (January 1, 2017-December 31, 2020) and organized the data collected. Results: 40 emergency intraoperative consultations were identified. 55% of the patients were female, with an average age of 48.83 years. The most frequently consulted subspecialty was obstetrics and gynecology (32%). Index cases were elective/nonurgent (90%), most involving tumor resection (77.5%). The primary reason for vascular consultation was revascularization (37.5%). The primary blood vessel and anatomic field of intervention were categorized. Most cases (50%) included preservation of blood flow, including primary arterial repair (20%) and ligation of the bleeding vessels (20%) in the first choice. Postoperative mean length of stay was 13 days, with a 30-day mortality of 5.1%. Conclusion: Using a wide variety of skills and techniques, vascular surgeons strive to respond to urgent open surgical consultations in various anatomical sites. Our study provides evidence to the wide range of knowledge and skills required for modern vascular surgeons and the place of the subspecialty in the core services offered in a multidisciplinary approach.","PeriodicalId":23982,"journal":{"name":"Turkish Journal of Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78402098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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