Approach to peripheral arterial disease in the elderly

The prevalence of peripheral arterial disease, which usually develops on the basis of atherosclerosis and develops as a result of chronic arterial occlusive pathology, increases with age. Peripheral artery disease in the elderly patient population may be asymptomatic due to restrictive conditions associated with immobilization. Concurrent cerebrovascular disease and coronary artery disease risk and mortality rates are higher in elderly patients with peripheral artery disease. The life expectancy in patients with peripheral arterial disease is worse than in prostate cancer patients. Leading risk factors include advanced age, smoking, diabetes mellitus, hypertension, hyperlipidemia, hyperhomocysteinemia and hypothyroidism. The most important physical examination component is the palpation of the entire peripheral pulses. The cases in which the ankle-brachial systolic pressure index measurement for clinical diagnosis is below 0.9 are defined as peripheral arterial disease. It is aimed to completely correct or improve the existing clinical symptoms and to increase the survival rates of the patients. The existing risk factors are modified as the first step of the treatment. Smoking cessation, treatment of hypertension primarily with angiotensin-converting enzyme inhibitors, lowering of hemoglobin A1c levels below 7%, anti-hyperlipidemic treatment primarily with statin, antiaggregant therapy primarily with clopidogrel, cilostazol therapy, good foot care, controlled exercise program, if necessary, interventional or operational revascularization, amputation in the presence of irreversible effects are the main treatment components. Indications for major revascularization include the presence of resting pain in the limb and / or open and long-lasting unhealed wound in the extremity and / or severe complaints of intermittant claudication that will result in limitation in daily activities. It should not be forgotten that, all the clinical decisions to be taken in the treatment of elderly patients with peripheral arterial disease are determined by the patient's physical condition, current clinical condition and the expectation level of the patient

Coronary Artery and Mitral Valve Surgery in Takayasu's Arteritis: A Case Report

Concomitant coronary artery disease and mitral valve disease are rare in Takayasu's Arteritis. Our patient had Takayasu's Arteritis diagnosed 9 years ago. She had an inferior myocardial infarction and double stent implantation 8 months ago. She was admitted to the hospital for chest pain, and 3 vessel diseases were diagnosed with significant mitral regurgitation due to anterior leaflet prolapse. In this report, we present perioperative management of our patient who underwent coronary artery bypass grafting and mitral valve replacement

How ideal is pulmonary autograft for mitral valve replacement?

Although significant progress has been achieved in heart surgery since the first successful valve replacement performed in the year 1960, some problems regarding mechanical and bioprosthetic valves still persist. Towards 2000s, pulmonary autografts came to the fore again for mitral valve replacement. These results have been promising for the long-term. However, early-period complications are frequently observed in these operations that are technically challenging and require considerable experience. For these reasons, pulmonary autografts are not applicable for extensive usage; instead they are a good alternative to be used in selected cases (patients in whom use of warfarin is not practical and extended durability of valve is desired)

The reliability of estimated glomerular filtration rate in coronary artery bypass grafting

Background: In this study, we investigated the reliability of the estimated creatinine clearance and glomerular filtration rate in patients undergoing on-pump coronary artery bypass grafting

A useful cannulation strategy to facilitate re-warming during total arch replacement

"Distal-first" surgical technique with antegrade cerebral perfusion and early re-warming is a secure and comfortable method for aortic arch replacement. By using this technique, we can minimize total circulatory arrest and hypothermic periods. Cerebral morbidities can be reduced by antegrade cerebral perfusion which is achieved via both axillary cannulation and balloon-catheters. Distal organ, cerebral, and renal morbidities can be minimized by early femoral arterial perfusion and early re-warming that is re-started immediately after distal anastomosis is performed

The Reliability of the Use of Serum Neutrophil Gelatinase-Associated Lipocalin Levels in the Assessment of Renal Functions after Coronary Artery Bypass Grafting

Objective. Evaluation of perioperative renal function is very important for early diagnosis and treatment of acute kidney injury after coronary artery bypass grafting. Serum creatinine levels, creatinine clearance, and estimated glomerular filtration rates used in determination of postoperative kidney injury can lead to late detection. Therefore, it is necessary to make a diagnosis earlier in clinical practice and to search for a reliable method. The reliability of the use of serum neutrophil gelatinase-associated lipocalin levels in close follow-up of renal function was evaluated in patients with coronary artery bypass grafting under cardiopulmonary bypass in our study. Patients and Methods. A total of 40 patients who underwent coronary artery bypass grafting under cardiopulmonary bypass between September 2009 and February 2010 were included in the study. The reliability of the postoperative 1st day plasma neutrophil gelatinase-associated lipocalin (Triage (R) NGAL Device; Biosite Inc.) measurements was evaluated in kidney injury developed in the first 5 days after operation that was detected using the Risk-Injury-Failure-Loss-End stage criteria. Results. Ten (25%) women and 30 (75%) male patients were included in the study. The average age is 59 +/- 8.6 years. Kidney injury according to Risk-Injury-Failure-Loss-End stage criteria developed in 8 patients (20%). For 150 ng/mL cutoff value of postoperative plasma neutrophil gelatinase-associated lipocalin levels, the area under the receiver-operating characteristic curve was 0.965. Neutrophil gelatinase-associated lipocalins sensitivity, specificity, and negative and positive predictive values were 100%, 93.8%, 100%, and 80%, respectively. Conclusion. It has been determined that plasma neutrophil gelatinase-associated lipocalin levels can be reliably used for early diagnosis of kidney dysfunction in patients undergoing coronary artery bypass grafting

The dose-related effects of Dexmedetomidine on renal functions and serum neutrophil gelatinase-associated lipocalin values after coronary artery bypass grafting: a randomized, triple-blind, placebo-controlled study

OBJECTIVES: Acute kidney failure after coronary artery bypass grafting (CABG) is a serious complication that increases morbidity and mortality rates. Early detection and prevention of this complication are very important. A novel biomarker named neutrophil gelatinaseassociated lipocalin (NGAL) can play an important role in early diagnosis of acute kidney injury. Recent studies on the favourable effects of Dexmedetomidine on cardiac surgery have been published. The aim of this study is to investigate whether there is a dose-dependent positive effect of Dexmedetomidine on neutrophil gelatinase-associated lipocalin levels and renal functions when used after CABG