Genç renal transplantlı hastada arteriyovenöz fistül kapatılması sonrası otolog sefalik ven grefti ile radiyal arter onarımı

Autogenous arteriovenous fistula at the wrist is considered as the best choice of vascular access in hemodialysis patients. In this case report, we present a young renal transplant patient who underwent autologous fistula vein interposition and closure of arteriovenous fistula to provide continuity of the radial arteryHemodiyaliz hastalarında el bileğinde açılan otolog arteriyovenöz fistül, vasküler erişim için en iyi seçenek olarak düşünülmektedir. Bu vaka sunumunda, radiyal arterin devamlılığı sağlamak için otolog fistül ven interpozisyonu yapılan ve arterivenöz fistülü kapatılan genç renal transplantlı hasta takdim edilmiştir

Short-term results of endovascular intervention with bifurcation graft in elective infrarenal abdominal aortic aneurysm

Amaç: Bu çalışmada yüksek riskli hasta grubuna daha etkin ve güvenli tedavi sunabilmek ve her hastada en uygun endovasküler greftin seçimine ışık tutabilmek amaçlandı. Hastalar ve Yöntemler: Ocak 2012 - Ocak 2017 tarihleri arasında AFX® (Endologix, Inc., Irvine, CA, USA - Bifurcated Endograft System) grefti kullanılarak tedavi edilen infrarenal abdominal aort anevrizması (İAAA) tanılı ardışık ve elektif 63 hastanın (60 erkek, 3 kadın; ort. yaş: 68.2±7.2 yıl; dağılım 57-87 yıl) verileri retrospektif olarak incelendi. Hastaların verileri ameliyat öncesi, ameliyat sırası ve ameliyat sonrası olarak üç aşamada değerlendirildi. Bulgular: Hipertansiyon (%63.5) ve koroner arter hastalığı (%57.1) en sık eşlik eden hastalıklar olup, 34 hastaya (%53.9) lokal anestezi altında girişim yapıldı. İşlem süresi ortalama 131.3±25.4 dk., skopi süresi 17.8±4.0 dk. ve kullanılan opak miktarı 67.0±16.9 mL idi. Ameliyat sonrası erken dönemde hiçbir hastada mortalite, renal komplikasyon ve miyokard enfarktüsü saptanmadı. Ortalama hastanede yatış süresi 2.3±1.4 gün idi. Hiçbir hastada açık cerrahiye dönülmedi. İşlemin teknik başarı oranı %100 olarak bulundu. Sonuç: Çalışmamızın sonuçları, Endologix AFX® greftinin erken dönemde etkin ve güvenli olduğunu göstermektedir.Objectives: The aim of this study is to provide a more effective and safer treatment for high-risk patient group and to shed light on the selection of the most appropriate endovascular graft for each patient. Patients and methods: Between January 2012 and January 2017, data of 63 consecutive and elective patients (60 males, 3 females; mean age: 68.2±7.2 years; range, 57 to 87 years) with the diagnosis of an infrarenal abdominal aortic aneurysm (IAAA) who were treated with AFX® (Endologix, Inc., Irvine, CA, USA - Bifurcated Endograft System) graft were retrospectively analyzed. Data of the patients were evaluated in three stages: preoperatively, intraoperatively, and postoperatively. Results: Hypertension (63.5%) and coronary artery disease (57.1%) were the most common comorbidities and 34 patients (53.9%) underwent an intervention under local anesthesia. The mean duration of the procedure was 131.3±25.4 min, the duration of the scopy was 17.8±4.0 min, and the amount of opaque used was 67.0±16.9 mL. No mortality, renal complications, and myocardial infarction were observed in any of the patients in the early postoperative period. The mean length of hospital stay was 2.3±1.4 days. No conversion to open surgery was needed in any patients. The technical success rate of the procedure was found to be 100%. Conclusion: The results of our study show that the Endologix AFX® graft is effective and safe in the short-term

Our clinical approach to the last five-year elective infrarenal abdominal aortic aneurysm: Short-term results

Amaç: Bu çalışmada elektif infrarenal abdominal aort anevrizmasına (iAAA) son beş yıldaki klinik yaklaşımımız ve erken dönem sonuçlarımız sunuldu.Hastalar ve Yöntemler: Hastanemizin Kalp ve Damar Cerrahisi kliniğinde Ocak 2012 - Ocak 2017 tarihleri arasında elektif iAAA tanısı ile girişim yapılan toplam 333 hastanın (308 erkek, 25 kadın; ort. yaş 70.6±6.6 yıl; dağılım, 54-87 yıl) verileri retrospektif olarak incelendi. Bu hastalar Grup 1 (endovasküler anevrizma tamiri [EVAR] grubu; n=187) ve Grup 2 (açık cerrahi [AC] grubu; n=146) olarak iki gruba ayrıldı.Bulgular: Grup 2'ye kıyasla Grup 1'in yaş ortalaması daha yüksek bulundu (p<0.001). Erken dönem ameliyat sonrası mortalite Grup 1'de %2.1 iken, Grup 2'de %8.2 olarak bulundu (p<0.001). Endovasküler girişimin 2012 yılında hastaların %39.4'üne uygulanır iken, son beş yıl içerisinde hastaların %82.3'üne uygulanır hale geldiği belirlendi.Sonuç: Çalışma sonuçlarımız EVAR'ın AC'ye kıyasla erken dönemde etkin ve güvenli olduğunu göstermektedir. Ayrıca EVAR grubunda yüksek teknik başarı ve bu grupta AC'ye geçiş olmayışı; hasta seçiminin ve anatomik değerlendirmenin doğru olduğuna işaret etmektedirObjectives: In this study, we present our clinical approach to the last five-year elective infrarenal abdominal aortic aneurysm (iAAA) and our short-term results.Patients and methods: Data of a total of 333 patients (308 males, 25 females: mean age 70.6±6.6 years; range, 54 to 87 years) who were intervened with the diagnosis of an elective iAAA in Cardiovascular Surgery clinic of our hospital between January 2012 and January 2017 were retrospectively analyzed. These patients were divided into two groups as Group 1 (endovascular aneurysm repair [EVAR] group; n=187) and Group 2 (open surgery [OS] group; n=146).Results: The mean age was higher in Group 1, compared to Group 2 (p<0.001). Early postoperative mortality was 2.1% in Group 1, while it was 8.2% in Group 2 (p<0.001). While EVAR was applied to 39.4% of the patients in 2012, it became applicable to 82.3% of the patients within the last five years.Conclusion: Our study results show that EVAR is effective and safe in the early term, compared to OS. Also, high technical success in the EVAR group and lack of conversion to OS in this group indicate that the patient selection and anatomical evaluation are correc

286 Original Investigation Diagnostic accuracy of Doppler ultrasonography for assessment of internal thoracic artery graft patency

Objective: The main purpose of this study was to assess the patency of left internal thoracic artery (LITA) graft by using color Doppler ultrasonography (CDUSG) and furthermore to determine the sensitivity and specificity of CDUSG for patency by using coronary angiography as the reference standard. Methods: This study is an observational cohort study on diagnostic accuracy that was held between August 2008 and October 2009. CDUSG was performed in 138 consecutive patients who had angina symptom or positive ischemic findings following coronary artery bypass surgery. LITA blood flow velocity at peak-systole (PSV), diastole (PDV) and end-diastole (EDV) was recorded. All patients were also assessed by coronary angiography for LITA graft patency. Statistical analysis was performed by using independent samples t-test, Mann-Whitney-U test, chisquare test and receiver operating curve analyses (ROC). Results: Seventy-eight of all patients had functional LITA grafts and 59 patients had dysfunctional LITA grafts according to CDUSG-derived parameters, whereas we cannot conclude about one patient’s LITA graft functionality. The LITA grafts were visualized angiographically in all cases. Of all 138 patients, 60 patients had dysfunctional LITA grafts after angiographic evaluation. The ROC analyses showed that PDV (AUC=0.899, 95 % CI 0.844 to 0.953; p&lt;0.001) and EDV (AUC=0.900; 95 % CI 0.847 to 0.953; p&lt;0.001) values were also strongly associated with graft functionality. We found out that CDUSG predicts LITA graft functionality with a sensitivity and specificity of 100 % and 98.4 % respectively. The accuracy of the CDUSG was calculated as 99.3%. Conclusion: CDUSG is a reliable non-invasive method for assessment of LITA graft patency. (Anadolu Kardiyol Derg 2014; 14: 286-91) Key words: blood flow velocity, coronary artery bypass grafting, internal thoracic artery, color Doppler ultrasonography, sensitivity and specificity, diagnostic accurac

Factors Affecting Recanalization in Femoropopliteal Deep Vein Thrombosis

Effects of warfarin and new-generation direct oral anticoagulants (DOACs) on thrombus resolution after the treatment of deep vein thrombosis (DVT) are still unknown. The study aimed to investigate the effects of warfarin and DOACs on thrombus resolution after DVT treatment. Methods: The study included 666 patients who were diagnosed with femoropopliteal DVT between January 2016 and January 2022 and had complete medical records without missing data. Patients with and without recanalization were added to groups 1 (n = 396) and 2 (n = 270), respectively. Ultrasonography/venous Doppler examinations of the patients during follow-up were performed by 3 radiologists. Recanalization was defined as the presence of complete flow in the femoral and popliteal veins and the absence of residual venous thrombus. Results: Among the included patients, recanalization was observed in 59.5% patients. The mean follow-up period was 23.6 ± 17.8 (range 1-72; median 17) months. There was no difference between the 2 groups in terms of the types of drugs used in the treatment ( P  = .208). Cox regression models were used to investigate the factors affecting recanalization. Analysis of the variables having significant differences between both groups revealed the low rate of recanalization in patients with coronary artery disease (odds ratio [OR], 2.3%; 95% confidence intervals [CI]: 1.6-3.4; P  < .001) and diabetes mellitus (OR, 1.5; 95% CI: 1.1-1.9; P  = .009). Conclusion: Thrombus resolution after femoropopliteal DVT is not affected by the drugs used in the treatment