AMAÇ: Hemodiyaliz hastalarındaki yaşam beklentisi ve hayat kalitesi vasküler erişim yolunun efektif olarak kullanılabilmesi ile doğru orantılıdır. Arteriyovenöz fistülde(AVF) oluşan komplikasyonlar morbidite ile ilişkilidir. Çalışmamızda, kronik böbrek yetmezliği hastalarında arteriyovenöz fistüllerin bölgelerine dikkat ederek akut ve kronik patensi oranlarını ve cerrahi tedavi sonuçlarını değerlendirmeyi amaçladık.GEREÇ VE YÖNTEM: 2019 Ocak ve 2020 Ocak tarihleri arasında 121 hastada retrospektif olarak hemodiyaliz için dominant olmayan üst ekstremitelerinden açılan vasküler akses amacıyla kullanılan 152 adet AVF’i değerlendirdik.BULGULAR: Cimino-Brescia 68 (%44,7), brakiosefalik 62 (%40,7), brakiobazilik 22 (%14,4) AVF operasyonları uyguladık. Akut dönem komplikasyon 18 AVF’de (%11,8), geç dönem olgunlaşamama ve komplikasyon gelişmesi 11 AVF’de(%7,1) saptanmıştır. Distal fistül akut komplikasyonları %21, proksimal fistül akut komplikasyonları %12 saptanmış ve istatistiksel açıdan anlamlı olarak daha yüksek bulunmuştur (p<0.05). Geç dönemde, proksimalde açılan AVF’lerin ve distalde açılan AVF’lerin başarısız olma oranları arasında istatistiksel fark saptanmadı (p>0.05). Açılan AVF’lerin 29(%18,8)’inde komplikasyon geliştiği saptandı.SONUÇ: Ekstremitenin distalinde oluşturulan AVF‘lerin proksimal lokalizasyonlara açılanlara göre başarılı olma oranlarını daha az olarak saptadık; ancak brakial bölgenin ilerideki dönemlerde kullanılması suretiyle korumak amacıyla öncelikli olarak distal bölgelere açılan AVF uygulamaları ilk tercih olmalıdır.
The objective of this study is to report our experience with surgical revision of dialysis access-induced ischemia syndrome.Between January 2005 and July 2013, 1254 patients underwent arteriovenous fistula operation, and 86 of them [53 males, mean age: 55 ± 25 (range: 25 to 75) years; 33 females, mean age: 50 ± 20 (range: 30 to 70) years] subsequently developed steal syndrome. These patients were treated with arterial pressure-controlled polytetrafluoroethylene banding or constriction with polypropylene suturing technique. Patients were followed in the outpatient clinic at regular intervals.Symptoms were not relieved during the first 15 days in 4 patients; therefore, reintervention was performed. Thrombosis occurred in one patient after reintervention. No early or late complications were detected in other patients, and fistulae were suitable for hemodialysis. Patency rates at 6 and 12 months were 96% and 92%, respectively, and thrombosis rates were 7% and 9%. There was no hospital mortality in our study, but one patient died from unrelated causes and two other patients quit follow-up after 6 months.We think that arterial pressure-controlled surgical revision is an effective and safe technique in patients with fistula-related hand ischemia.
We sought to evaluate the effects of on-pump beating-heart versus conventional coronary artery bypass grafting techniques requiring cardioplegic arrest in patients with coronary artery disease with left ventricular dysfunction.We report the early outcomes associated with survival, morbidity and improvement of left ventricular function in patients with low ejection fraction who underwent coronary artery bypass grafting between August 2009 and June 2012. Patients were separated into 2 groups: group I underwent conventional coronary artery bypass grafting and group II underwent an on-pump beating-heart technique without cardioplegic arrest.In all, 131 patients underwent coronary artery bypass grafting: 66 in group I and 65 in group II. Left ventricular ejection fraction was 26.6% ± 3.5% in group I and 27.7% ± 4.7% in group II. Left ventricular end diastolic diameter was 65.6 ± 3.6 mm in group I and 64.1 ± 3.2 mm in group II. There was a significant reduction in mortality in the conventional and on-pump beating-heart groups (p < 0.001). Perioperative myocardial infarction and low cardiac output syndrome were higher in group I than group II (both p < 0.05). Improvement of left ventricular function after the surgical procedure was better in group II than group I.The on-pump beating-heart technique is the preferred method for myocardial revascularization in patients with left ventricular dysfunction. This technique may be an acceptable alternative to the conventional technique owing to lower postoperative mortality and morbidity.Nous avons voulu comparer les effets du pontage coronarien sur coeur battant sous CEC (circulation extracorporelle) et ceux du pontage coronarien classique exigeant un arrêt cardioplégique chez des patients atteints de coronaropathie et de dysfonction ventriculaire gauche.Nous faisons état des premiers résultats aux plans de la survie, de la morbidité et de l’amélioration de la fonction ventriculaire gauche chez des patients qui avaient une fraction d’éjection faible et qui ont reçu un pontage coronarien entre août 2009 et juin 2012. Les patients ont été répartis en 2 groupes : le groupe I a été soumis à la technique de pontage coronarien classique et le groupe II a été soumis à la technique à coeur battant sous CEC sans arrêt cardioplégique.En tout, 131 patients ont reçu un pontage coronarien : 66 dans le groupe I et 65 dans le groupe II. La fraction d’éjection ventriculaire gauche était de 26,6 % ± 3,5 % dans le groupe I et de 27,7 % ± 4,7 % dans le groupe II. Le diamètre télédiastolique ventriculaire gauche était de 65,6 ± 3,6 mm dans le groupe I et de 64,1 ± 3,2 mm dans le groupe II. On a noté une réduction significative de la mortalité dans les groupes soumis à l’intervention classique et à l’intervention à coeur battant sous CEC (p < 0,001). L’infarctus du myocarde peropératoire et le syndrome de faible débit cardiaque ont été plus fréquents dans le groupe I que dans le groupe II (tous deux p < 0,05). L’amélioration de la fonction ventriculaire gauche après l’intervention chirurgicale a été plus marquée dans le groupe II que dans le groupe I.La technique à coeur battant sous CEC est la méthode préférée de revascularisation myocardique chez les patients atteints d’une dysfonction ventriculaire gauche. Cette technique peut être une solution de rechange acceptable à la technique classique en raison des taux de mortalité et de morbidité postopératoires plus faibles qui y sont associés.
Amaç: Bu çalışmanın amacı, izole Vena Safena Parva stripingi sonrasında orta basınçlı elastik kompresyon çorabı kullanılmasının etkinliğini araştırmaktır
The primary objective of this multicentre prospective observational study was to evaluate the early results of a new non-thermal embolisation method using N-butyl cyanoacrylate in venous insufficiency.A total of 181 patients with a varicose vein diagnosis were treated with the VariClose: Vein Sealing Systems at four different centres. The protocol included physical and colour Doppler ultrasonography examination, venous clinical severity score and quality of life assessment before and after the procedure on days 1 and 7 and at months 1, 3 and 6. Clinical recovery was evaluated by comparing the venous clinical severity score and the quality of life assessment before and after the procedure.In total, 215 embolisation procedures were successfully completed on 181 patients (110 female) with a mean age of 37.6 ± 13.2 years (range 18-72 years). The 215 procedures consisted of 25 bilateral applications on 206 great saphenous veins and 9 small saphenous veins. The average pre-interventional diameter of great saphenous veins was 6.5 ± 1.4 mm (4.3-14 mm), and the mean diameter of small saphenous veins was 5.2 ± 1.3 mm (3.8-8.6 mm). The average length of the sealed vein segments was 31.6 ± 6.1 cm (23-70 cm), and the average N-butyl cyanoacrylate usage for the patient was 0.9 ml (0.7-2.1 ml). The procedural occlusion rate was 100%. Post-operative pain was observed in 11 patients (6.1%), and thrombophlebitis was observed in 1 patient (0.5%). No total recanalisation was observed. Five (2.7%) partial recanalisations were observed at the 6 month follow-up. The 6 month total occlusion rate was 97.2%.This new tumescent-free non-thermal embolisation method can be applied safely with high success rates.
<strong>Background:</strong> Leaflet escape of prosthetic valve is rare but potentially life threatening. Early diagnosis is essential on account of avoiding mortality, and emergency surgical correction is compulsory. This complication has previously been reported for both monoleaflet and bileaflet valve models. <br /><strong>Methods:</strong> A 30-year-old man who had undergone mitral valve replacement with a bileaflet valve 8 years prior at another center was admitted with acute-onset with cardiogenic shock as an emergency case. Transthoracic echocardiograms showed acute-starting severe mitral regurgitation associated with prosthetic mitral valve. There was a suspicious finding of a single prosthetic mitral leaflet. But the problem related with the valve wasn’t specifically determined. The patient underwent emergent surgery for replacement of the damaged prosthetic valves immediately. There was no tissue impingement and thrombosis, one of the two leaflets was absent, and there were no signs of endocarditis or pannus formation in the prosthetic valve. The missing leaflet could not be found within the cardiac cavity. The abdominal fluoroscopic study and plain radiography were unable to detect the escaped leaflet during surgery. The damaged valve was removed and a replacement 29 mm bileaflet mechanical valve was inserted by right lateral thoracotomy. <br /><strong>Results:</strong> After post-operative week one, the abdominal computed tomography scan and the ultrasound showed the escaped leaflet in the left femoral artery. Fifteen days after the surgery the escaped leaflet was removed safely from the left femoral artery and the patient made a complete recovery. <br /><strong>Conclusion:</strong> The escaped leaflet showed a fracture of one of the pivot systems caused by structural failure. Early cardiac surgery should be applied because of life-threatening problems.
The study aimed to examine whether alpha-1-antitrypsin (AAT), an inhibitor of leukocyte esterase(LE), which damages the venous vessel wall, has a protective effect against chronic venous disease(CVD), and to examine the relationship between AAT levels and disease severity.Patients admitted with varicose vein disease and having reflux flow lasting longer than 0.5 s as determined by Doppler ultrasound were included. The informed consents were taken, and blood samples were obtained for complete blood count, C-reactive protein (CRP) level, and AAT level following anamnesis and physical examination. Clinical Etiologic Anatomic Pathologic (CEAP) classification was used to assess disease severity, and patients were divided into CEAP 1-5 groups accordingly.A total of 87 patients were included in the study. There was no statistically significant difference between the groups in body weight, red blood cell counts, platelet counts, or neutrophil counts (p = 0.117, p = 0.932, p = 0.177, and p = 0.177, respectively).CRP and AAT levels were higher in patients with a CEAP clinical score of 5 compared to the other groups (p = 0.018, and p = 0.020, respectively). AAT levels were similar in the CEAP 1-3 group and decreased in the CEAP-4 group but increased again in the CEAP-5 group. The AAT level was 1.62 ± 0.3 g/L in the CEAP-1 group, 1.61 ± 0.21 g/L in the CEAP-2 group, 1.61 ± 0.27 g/L in the CEAP-3 group, 1.48 ± 0.28 g/L in the CEAP-4 group, and 1.94 ± 0.39 g/L in the CEAP-5 group. CRP levels and platelet counts were observed to affect AAT levels (p = 0.10, p = 0.017, respectively).We believe that our hypothesis that low AAT levels play a role in the etiopathogenesis of CVD has been partially validated, at least in the CEAP-4 group. However, we believe that increased AAT levels in the CEAP-5 group may be a reactive increase in increased LE levels due to higher CRP levels of this group.
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