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Acute Mesenteric Ischemia: a Disease Still Challenging Surgeons
(Springer India, 2022) Beyaz, Metin Onur; Demir, Ibrahim; Omeroglu, Sinan; Ata, Emin Can
Acute mesenteric ischemia is a medical emergency that has a high incidence of morbidity and mortality. The most effective way to reduce its consequences is to establish early diagnosis and revascularization. Here, we aimed to present our management and outcome. In this case series analysis, patients with acute mesenteric ischemia were examined from January 2013 to September 2018. Thromboembolectomy was applied by using a 2-3 French sized Fogarty catheter until the superior mesenteric artery flow was restored. Endarterectomy and saphenous vein patchplasty were preferred in atherosclerotic arteries. Nineteen patients were examined. Hypertension (63.2%) and atrial fibrillation (57.9%) were the most common seen comorbid factors. After embolectomy, arterial pulsation came back in 17 (89.5%) patients. Two patients had saphenous vein bypass due to the severe atherosclerosis of the mesenteric artery. Seven (36.8%) patients died on early postoperative period. Multiorgan failure developed in 2 (10.5%) patients. The survival rate was 42.1% in 46 SD17.3 months follow-up. Acute mesenteric ischemia has high mortality and morbidity because of the local and systemic effects of comorbid diseases and intestinal ischemia. The main goals of treatment should be maintaining body auto-regulation, establishing revascularization of the ischemic intestine and removing necrotic tissues.
Addition of the duration of ST segment depression to Duke treadmill score for diagnostic accuracy of exercise electrocardiography to predict obstructive coronary artery disease
(Taylor & Francis Ltd, 2022) Caglar, Fatma Nihan Turhan; Gok, Gulay; Oztimer, Gulsum; Katkat, Fahrettin; Karakozak, Dilay; Oztas, Didem Melis; Beyaz, Metin Onur
Introduction Exercise electrocardiography (EET) is a safe and cost-effective method to predict the presence, prognosis, and severity of coronary artery disease (CAD). Various score models have been developed to increase predictive power of EET. In this study, we aimed to evaluate whether adding ST depression duration could have an effect on increasing the value of Duke treadmill score (DTS) in predicting obstructive CAD. Methods In this single centred, cross-sectional study, we evaluated a total of 258 patients who presented with a complaint of chest pain and undergone coronary angiogram in result of a positive EET. DTS was calculated for all the patients. The new score-revised DTS- was calculated by adding total ST depression time to classical DS parameters. We compared area under the curve (AUC) of DTS and revised DTS by Delongi method. Results Mean age of the group was 58.43 +/- 9.37, and 37.2% (n = 96) were female. Mean total ST-depression duration was 171.72 +/- 91.43 msec in normal artery group,241.54 +/- 118.11 msec in non-obstructive CAD group, and 281.26 +/- 113.64 in obstructive CAD group.ST-depression duration in both exercise and recovery, and total ST depression duration were significantly higher in obstructive CAD group than non-obstructive and normal artery groups (p = 0.024, p = 0.01, p < 0.01, and p < 0.01, respectively). Revised DTS had significantly higher predictive value of obstructive CAD compared to classical DS (AUC (95%CI): 0.744 vs. 0.626, p < 0.001). The AUC of DS was significantly lower than the new score (z-score:3.274, p = 0.011). Conclusion In conclusion, adding ST depression duration to DTS calculation is increasing the discriminative value of DTS to predict obstructive CAD. Benefits of EET within the context of the management of CAD is well-known, hence, it is clear that physicians may use revised DTS.
Carotid artery plaque structure in the context of symptomatic/asymptomatic nature of carotid artery stenosis
(Czech Soc Cardiology & Czech Soc Cardiovascular Surgery, 2021) Oztas, Didem Melis; Bilen, Bukem Tanoren; Sener, Leyla Turker; Beyaz, Metin Onur; Ulukan, Mustafa Ozer; Unal, Orcun; Unlu, Mehmet Burcin
Objective: In this paper, we examined the relationship between atherosclerotic plaque characteristics and symptomatic carotid artery disease. Material and methods: Twenty-two patients who underwent carotid endarterectomy were enrolled into the study. Thirteen patients were male and remaining 9 patients were female. The mean age was 60.2 +/- 9.6 years. The carotid artery stenosis ranged between 75% and 99%. Eight patients were asymptomatic and remaining 14 patients were symptomatic. Ten patients suffered stroke. One of them had recurrent transient ischemic attacks, 4 patients had dizziness, and one of them had amaurosis fugax. The extracted plaques were evaluated by scanning acoustic microscopy (SAM) and micro-computerized tomography (micro-CT). Results: Smaller acoustic impedance values that reveal collagen-rich plaque formation were detected in patients who had stroke, while higher acoustic impedance values that reveal calcium-rich plaque formation were detected in the asymptomatic patients' plaques. Conclusions: Determination of plaque characteristics with modern radiographic techniques, rather than relying on the degree of stenosis in patients with carotid artery disease, may be helpful to discriminate patients requiring intervention.
Carotid artery screening in asymptomatic individuals of different ethnic origins
(Czech Soc Cardiology & Czech Soc Cardiovascular Surgery, 2022) Beyaz, Metin Onur; Onalan, Mehmet Akif; Oztas, Didem Melis; Ugurlucan, Murat
Background and aims: Certain chronic conditions such as hypertension, diabetes mellitus (DM), hyperchole-sterolemia, and smoking were well defined as a risk factor for carotid stenosis. However, the development of carotid stenosis in different ethnic groups has not been researched adequately. This study aims to evaluate the carotid artery stenosis in patients of different ethnic origins. Methods: This prospective study included 246 (61.2%) Turkish natives and 153 (39.8%) Syrian immigrants, and carried out during March and September 2018 in Istanbul. All of the 399 participants were between the age of 50 and 65 years, and have at least one of the risk factors of hypertension, hyperlipidemia, DM, obesity, heavy socio-economic stress, and smoking. Patients were examined for bilateral carotid arterial system with Doppler ultrasound. Results: The mean age of the patients were 54.2 +/- 7.2, and there were 50.4% of women. Hypertension was the foremost risk factor of both groups (41.1% vs. 47.7%, p = 0.596). Smoking was higher among Turkish natives (p = 0.022). Hyperlipidemia, DM, and stress were similar between the groups (p >0.05). The overweight and obesity rates were also similar among Turkish natives and Syrian immigrants (p = 0.071 and p = 0.279). Patients with mild (<50%), moderate (50-70%) and severe (>70%) carotid stenosis were 332 (83.2%), 33 (8.3%) and 34 (8.6%). No statistical significance was found between the two ethnic groups in terms of the severity of carotid stenosis (p >0.05). Conclusion: Syrian immigrants and Turkish natives have a similar rate of moderate and severe carotid artery stenosis. It can be explained by racial similarity and having a similar risk factor.
The Effect of Renin-Angiotensin Blockers on COVID-19 Related Mortality: A Tertiary Center's Experience
(Czech Soc Cardiology & Czech Soc Cardiovascular Surgery, 2022) Oflar, Ersan; Koyuncu, Atilla; Alp, Murat Erdem; Karaosmanogul, Hayat Kumbasar; Unal, Orcun; Beyaz, Metin Onur; Oztas, Didem Melis
Background: The first reports on coronaviruse disease 2019 (COVID-19) revealed an exaggerated mortality rate in hypertensive patients. In this regard, concerns about angiotensin-converting enzyme (ACE) inhibitors' and angiotensin-receptor blockers' (ARBs) have been aroused. Our aim in this study was to evaluate the potential bad outcome effect of hypertension and anti-hypertensive therapy on COVID-19. Methods: 183 patients with polymerase-chain-reaction (PCR)-proven COVID-19, who were admitted to our hospital and consulted to cardiology department between 15th of March and 15th of April 2020 were inclu-ded. Data were recruited from hospital records. Results: Thirty-two out of 183 patients with COVID-19 died in hospital. Hypertension incidence was not sta-tistically different between patients who survived and died (76 [50.3%] vs 19 [59.4%, p = 0.352]). Although the usage rate of ACEI were similar among groups, ARB usage rate was significantly higher in patients who died than survived (11 [34.4%] vs 23 [15.2%], p = 0.011). Binary regression analysis showed an association between ARBs and mortality (OR: 0.032, 95% CI 1.045-2.623, p = 0.032). Conclusion: Our study confirmed previous concerns regarding a potential harmful effects of ARBs on COVID-19 related mortality.
Efficiency of Prophylactic Ablation of the Tributary Venous Pathways Draining Around the Saphenofemoral Junction to Decrease the Rate of Future Varicose Vein and Symptoms Occurence
(Elsevier Science Inc, 2021) Ulukan, Mustafa Ozer; Karakaya, Atalay; Erkanli, Korhan; Beyaz, Metin Onur; Oztas, Didem Melis; Ugurlucan, Murat
Background: There are various other collaterals draining into the venous system around the saphenofemoral junction in addition to the great saphenous vein. We aimed to determine the efficiency of prophylactic ablation of tributary veins in long term varicose vein and symptom recurrence. Methods: Two hundred and sixty-three consecutive patients whom underwent radiofrequency ablation therapy for the treatment of superficial venous reflux disease were investigated. There were 129 patients who received isolated great saphenous vein ablation (Group A) where as 134 patients underwent ablation of the other tributary veins in addition to the great saphenous vein (Group B) between June 2015 and January 2017. The tributary superficial veins; refluxing and/or not refluxing, draining into the saphenofemoral junction were selectively catheterized and ablated in Group B. Patients are followed at least 1 year after the procedures regulary and researched for recurrence of varciose veins and symptoms. Results: Gender, mean age, body mass index, diameter of the great saphenous veins, small saphenous vein disease, and grade of deep venous insufficiency did not differ significantly between the two groups. The mean number of tributary veins were similar in both groups (n: 1.9 +/- 0.4 in Group A vs. n: 1.8 +/- 0.7 in Group B) which were detected preoperatively as well as during the procedure. The mean number of ablated tributary venous pathways could be 1.4 +/- 0.6 in Group B. During the follow up period symptoms related with varicose veins recurred in 19 patients in Group A where as in 7 patients in Group B ( P < 0.05). Three of these symptomatic patients in Group B were the ones in whom the tributary pathways could not be catheterized ablated where as 14 patients in Group A were diagnosed with newly refluxing tributary pathways. All the symptomatic patients in both groups were managed medically and/or with additional interventions. Conclusion: The absence of any fascial unsheathing and the parietal weakness are suggestive of a lower resistance of the tributary veins wall, so collapse and size of veins make it more complex to catheterization regarding to great saphenous vein. Ablation of the tributary superficial venous pathways during the treatment of great saphenous vein reflux disease decreased the rate of recurrence of superficial venous reflux disease and patients symtoms in our modest cohort.
Fistulized Pseudoaneurysm Associated with Hypothenar Hammer Syndrome to the Skin in a 12-Year-Old Patient: A Case Report
(Korean Soc Vascular Surgery, 2023) Beyaz, Metin Onur; Kaya, Sefer; Demir, Ibrahim
In this case, we present a condition where the extension of the hamate hook in the Guyon canal can damage the ulnar artery or its branches, leading to the development of an aneurysm or pseudoaneurysm. The patient, a 12-year-old female, presented to our clinic with a complaint of an uncontrolled palm lump that has been growing for several months and began to bleed in a pulsatile manner after trauma. She was an amateur volleyball player who trained twice weekly for two hours. Color Doppler ultrasound examination revealed a 1.1x0.8 cm pseudoaneurysm in a branch of the ulnar artery. Aneurysmectomy and primary repair were performed. Timely diagnosis and treatment planning are crucial for ulnar artery pseudoaneurysms or aneurysms to prevent ischemic events in a later period.
Follow-up Results of Endovascular Aneurysm Repair Following Abdominal Visceral Debranching
(Soc Brasil Cirurgia Cardiovasc, 2022) Oztas, Didem Melis; Ugurlucan, Murat; Sayin, Omer Ali; Ekiz, Feza; Onal, Yilmaz; Beyaz, Metin Onur; Umutlu, Muzaffer
Introduction: The aim of this study is to present a series of six cases with thoracoabdominal aneurysm treated with hybrid technique in our center. Methods: Between May 2015 and December 2018, the data of six patients with thoracoabdominal aneurysms and various comorbidities who underwent visceral debranching followed by endovascular aortic aneurysm repair were reviewed retrospectively. Results: Patients' mean age was 65.3 +/- 19.6 years. All of them were male. Comorbidities were old age, congestive heart failure, coronary artery disease, chronic obstructive pulmonary disease, previous surgical interventions, and/or esophageal hemangioma. Except for one patient who underwent coronary artery bypass grafting (inflow was taken from ascending aorta), debranching was performed from the right iliac artery. Debranching of four visceral arteries (superior mesenteric artery, celiac trunk, and bilateral renal right arteries) was performed in three patients, of three visceral arteries (superior mesenteric artery, celiac trunk, right renal artery) was performed in one, and of two visceral arteries (superior mesenteric artery, celiac trunk) was performed in two patients. Great saphenous vein and 6-mm polytetrafluoroethylene grafts were used in one and five patients, respectively, for debranching. Endovascular aneurysm repair was performed following debranching procedures as soon as the patients were stabilized. In total, three patients died at the early, mid, and long-term follow-up due to multiorgan failure, pneumonia, and unknown reasons. Conclusion: Hybrid repair of thoracoabdominal aneurysms may be an alternative to fenestrated or branched endovascular stent grafts in patients with increased risk factors for open surgical thoracoabdominal aneurysm repair; however, the procedure requires experience and care.
Identifying the optimal monopolar electrocautery output power in pedicular internal thoracic artery harvesting: 20 or 40 watts?
(Clinics Cardive Publ Pty Ltd, 2022) Ata, Emin Can; Senturk, Gozde Erkanli; Saygi, Halil Ibrahim; Ulukan, Mustafa Ozer; Ugurlucan, Murat; Erkanli, Korhan; Beyaz, Metin Onur
Background: Monopolar electrocautery is an important tool for harvesting the pedicular internal thoracic artery (ITA) in cardiac surgery. The different power outputs of cautery may affect graft integrity and long-term patency. This study aimed to identify the optimal threshold of electrocautery power for ITA harvest. Methods: This prospective study included 30 patients who underwent elective coronary artery bypass surgery at the Medipol Mega University Hospital. The ITA was harvested by monopolar electrocautery after a median sternotomy. The output of cautery was adjusted at 20 W in group A and 40 W in group B. Three to 4 cm of a distal ITA sample from each patient was examined under a light microscope by two independent pathologists. Results: The ITA harvest time was longer in group A (21.2 +/- 7.5 vs 10.3 +/- 8.1 min, p < 0.001) than in group B. ITA free flow was similar in the two groups (43.6 +/- 48.7 vs 51.7 +/- 45.0 ml/min, p = 0.762). Mild to moderate injury in the endothelial and sub-endothelial sample was more frequent in the low-cautery group (p = 0.0037). Conclusion: ITA endothelial integrity was found to be better preserved with 40W electrocautery. Moreover, 20W of monop-olar electrocautery may not be safe in pedicular ITA harvesting.
Increased CRP/albumin ratio is associated with superficial venous reflux disease and varicose vein formation
(Czech Soc Cardiology & Czech Soc Cardiovascular Surgery, 2021) Unal, Orcun; Oztas, Didem Melis; Beyaz, Metin Onur; Erdinc, Ibrahim; Meric, Mert; Ulukan, Mustafa Ozer; Karakaya, Atalay
Background: It has been recently postulated that inflammation may have an effect on varicose vein development and prognosis, besides increased venous pressure. CRP/albumin (CAR) is a novel inflammatory marker associated with poor prognosis in a various group of patients. Our aim in this study was to investigate the relation between varicose greater saphenous vein (VSM) diameter and CAR. Methods: A total of 150 patients with patients VSM insufficiency (Group 1, n: 114) and normal VSM (n: 36) were included in the study. The diameter of the VSM was measured with B-mode ultrasound, and reflux was quantified based on valve closure time using Doppler spectral tracings. Blood samples were taken during recruitment. The CAR value is determined by dividing the serum CRP level to the albumin level. Results: There were 21 (18.4%) males and 93 (81.5%) females in Group 1 and 7 males and 29 females in Group 2. Mean age of the patients were similar in both groups (48.02 +/- 12.20 years in Group 1 vs. 44.9 +/- 8.92 years in Group 2, p = 0.44). Mean BMI of the patients did not differ significantly (Group 1: 26.4 +/- 3.7 kg/m2 vs. Group 2: 25.7 +/- 4.2 kg/m2, p = 0.13). The mean diameter of VSM was measured 5.70 +/- 0.29 mm in Group 1 whereas 3.21 +/- 0.34 mm in Group 2 (p = 0.0023). Mean CRP and albumin values in Group 1 were 6.18 +/- 4.99 mg/L and 4.45 +/- 0.27 g/dL whereas 4.25 +/- 2.46 mg/L and 6.18 +/- 1.14 g/dL in Group 2, respectively (p value for CRP = 0.049, p value for albumin = 0.074). CRP/albumin was 1.28 +/- 1.34 in Group 1 and 1.11 +/- 1.21 in Group 2, which was not statistically significant (p = 0.58). There was a positive moderately strong correlation between VSM diameter and CRP/albumin ratio as well as superficial venous reflux disease (r: 0.48). Conclusion: CRP/albumin ratio is associated with increased incidence of varicose veins and increased diame-ter of greater saphenous vein; hence, superficial venous reflux disease. The findings support the hypothesis that systemic inflammation may play a role in varicose vein disease.
Is Surgery the Only Fate of the Patient with Leriche Syndrome ? Our Endovascular Therapy Results Early Follow-Up Outcomes
(Forum Multimedia Publishing, Llc, 2022) Beyaz, Metin Onur; Urfali, Senem; Kaya, Sefer; Oruc, Dilan; Fansa, Iyad
Aim: In this research, we aimed to present early follow-up results of the endovascular treatment in patients with Leriche syndrome at our single center.Methods and materials: Between October 2020 and January 2022, 14 patients with Leriche syndrome (12 men, two women) who underwent endovascular treatment at our center retrospectively were evaluated. Before the treatment, the ankle-brachial index (ABI) was found 0.50 +/- 0.11 on the right leg and 0.45 +/- 0.09 on the left leg.Results: All of the patients with Leriche syndrome applied to our clinic for the first time. In five patients, the fully occluded lesion length was over 3 cm (ranging between 3.5-7.2 cm), hence they were treated with aortic and bilat-eral iliac bare metallic stents. Although in one patient, the aortic occluding lesion was below 3 cm; it was treated with a bare aortic and bilateral bare iliac stent application because the lesion in the aorta was too calcific. In eight patients, the lesion length was less than 3 cm, bilateral iliac metal bare stents were applied in a kissing stent way.Conclusion: Endovascular therapy for chronic aorto-iliac occlusive disease has an early high technical success with pri-mary and secondary patency rates. Especially in patients with high risk factors, it may be considered as a good alternative to conventional surgery.
Low Oxygen Saturation Following Total Correction in a Patient with Tetralogy of Fallot and Persistant Left Superior Caval Vein-How Did We Diagnose and Manage?
(Czech Soc Cardiology & Czech Soc Cardiovascular Surgery, 2022) Basunlu, Mehmet Turan; Coban, Senay; Sari, Gizem; Saritas, Turkay; Erdem, Abdullah; Oztas, Didem Melis; Beyaz, Metin Onur
Association of tetralogy of Fallot (TOF) with the other intracardiac pathologies such as atrial septal defect (ASD), atrioventricular canal defect or persistent left superior vena cava (PLSVC), absent pulmonary valve are well known pathologies. The associated pathologies require specific attention during surgical treatment. In this manuscript, we present management of a four-month-old girl who was diagnosed with TOF and PLSVC but the diagnosis of unroofed coronary sinus was missed in her. Association of unroofed coronary sinus with TOF is a very rare variant of TOF pathology.
Management of Nonocclusive Mesenteric Ischemia in Patients with Cardiac Failure
(Forum Multimedia Publishing, Llc, 2022) Omeroglu, Sinan; Tanal, Mert; Beyaz, Metin Onur; Guven, Onur; Demir, Ibrahim; Gurbulak, Esin Kabul; Demir, Uygar
Aim: This study aimed to evaluate the surgical procedures, outcomes, and prognostic factors in patients with ischemic heart disease who were operated on due to nonocclusive mesenteric ischemia (NOMI). Material and methods: This research contains all patients diagnosed with congestive heart failure and NOMI between January 2011 to January 2020. The patients who had angiography or CT that showed occlusion of more than 50% in any of the main branches of the mesenteric artery or patients who presented with symptoms in correlation with a total occlusion were excluded from the study. Patients who underwent coronary heart surgery but were not diagnosed with congestive heart failure and those with atrial fibrillation also were excluded from the study. Patients divided into two groups, according to a medical database. Results: A significant difference was found between the surviving and non-survivor groups in minutes, in terms of median time to segmenter intestinal resection (P = 0.042). Conclusion: An early diagnosis and surgical segmental intestinal resection before peritonitis worsens can be the key to better prognosis for NOMI patients.
Preliminary Results of a New Illuminated Radiofrequency Ablation Catheter for the Treatment of Great Saphenous Vein Reflux Disease
(Sage Publications Inc, 2022) Beyaz, Metin Onur; Oztas, Didem Melis; Ulukan, Mustafa Ozer; Arslan, Hasan Murat; Unal, Orcun; Ugurlucan, Murat
Introduction: In the current study, we present single surgeon experience of a new radiofrequency ablation system, the catheter, and the device. Patients and Methods: The new system, which comprises a generator and an intervally illuminated radiofrequency ablation catheter, was used for the treatment of 272 consecutive patients with chronic venous insufficiency of the great saphenous vein between November 2017 and October 2018. Mean age of the patients was 53.40 +/- 11.91 years. Mean saphenous vein diameter was 8.51 +/- 2.45 mm. Bilateral great saphenous vein reflux disease was present in 19% (51 cases) of the patients. At the end of the procedure, the closure of the great saphenous vein was confirmed with Doppler ultrasonography. Results: Procedures could be successfully performed in all, except 1 obese (BMI> 30 kg/m(2)) male patient. At the 3rd month, outpatient clinic follow-up control Doppler USG revealed successful ablation of the treated great saphenous vein in 260 patients (96%), whereas in 12 cases (4%), there was continuing reflux. The diameters of the saphenous veins in these patients ranged between 6.9 mm and 19.5 (mean: 10.68 +/- 3.41) mm. Ten patients could be treated successfully with ablation with the same device controlled both at the interventional section as well as on the 3rd month outpatient clinic follow-up. The remaining patients underwent high ligation of the great saphenous vein. Paresthesia occurred in 1 patient and had been permanent. Hematoma occurred in a male patient and resolved spontaneously. Conclusion: Preliminary results of our new radiofrequency ablation device with illumination guidance for the treatment of great saphenous vein reflux disease indicated successful results with enhanced physician utilization, comfort, and reliability.
Servikal blok altında karotis endarterektomi operasyonu sonuçlarımız: Anadolu’da bir merkezde ilk uygulama
(2022) Beyaz, Metin Onur; Urfalı, Senem; Kaya, Sefer; Oruç, Dilan; Çömez, Mehmet Selim; Hakimoğlu, Sedat; Koyuncu, Onur
Amaç: Karotis endarterektomi operasyonu genel anestezi ile uygulanabildiği gibi, bölgesel uygulanabilen; servikal rejyonel blok, lokal-rejyonel kombine anestezi ya da lokal infiltrasyon anestezisi altında yapılabilir. Bu çalışmada rejyonel blok uygulaması ile karotis endarterektomi uygulama deneyimlerimizi sunmayı amaçlıyoruz. \rYöntem: Eylül 2020- Ocak 2022 tarihleri arasında karotis arterine endarterektomi operasyonu yapılan 61 hastanın cerrahi sonrası 30 gün süreyle erken dönem sonuçları retrospektif irdelenmiştir. Hastalara ait yaş, cinsiyet, risk faktörleri, şant kullanımı, operasyon süresi, nörolojik olaylar, mortalite ve morbidite değerlendirilmiştir.\rBulgular: Toplam 61 hastanın verileri retrospektif olarak incelenmiştir. Hastalardan 15’i kadın, 46’sı erkekti. Ortalama yaş 61.6±9.1 (48-88) yıl olarak hesaplandı. Semptomatik hasta sayısı 51 idi. 10 hasta asemptomatik olup stenoz derecesi %70’in üzerindeydi. 11 hastada her iki tarafa endarterektomi uygulandı. Toplam olarak 72 karotis endarterektomi operasyonu gerçekleştirildi.\rOrtalama işlem süresi 77.6±19.7 dakika, karotis klemp süresi 29.4±11.5 dakika olarak hesaplandı. Taburcu edilen hiçbir hastada postoperatif ilk ay içinde majör nörolojik olay, kanama, enfeksiyon ya da ölüm ile karşılaşılmadı. \rSonuç: Karotis endarterektomi operasyonu artan tecrübe ile birlikte rejyonel servikal blok altında güvenle gerçekleştirilebilir.
Surgical Treatment of Asymptomatic Popliteal Artery Aneurysms and Mid-term Outcome
(Springer India, 2021) Beyaz, Metin Onur; Ata, Emin Can; Demir, Ibrahim; Onalan, Mehmet Akif; Sayin, Omer Ali
Popliteal artery aneurysm (PAA) is a rare condition with an incidence ranging from 0.8 to 2.8%; however, it constitutes approximately 70-85% of all peripheral artery aneurysms. It is asymptomatic in the majority of cases but can cause pain and edema due to venous and neuronal compression. The most severe complication is limb lost due to thromboembolic event. Although surgical treatment left its place to endovascular treatment in the 1990s, surgical treatment still maintains its importance in preventing complications. Here, we aim to report our experience and results of the surgical management of popliteal aneurysms in this study. In this retrospective study, a total of 21 patients who were operated on due to popliteal artery aneurysm between October 2017 and January 2020 were analyzed. Patients with pseudoaneurysm and those who are infected and complicated were excluded from our study. The mean age was 63.3 +/- 9.6; females were 17 (81%). Mean follow-up was 19 +/- 8 months. More than two risk factors were found in 14 (66.7%) patients. Aneurysmectomy was performed successfully in all patients. Autologous saphenous vein graft was used in 11 (52.4%), whereas 6-mm polytetrafluoroethylene (PTFE) graft was preferred in 10 (47.6%) patients. During the follow-up period, limb loss rates were 16.7% and 83.3%, respectively. The difference was statistically significant (p < 0.05). No relation was found between the aneurysm diameter and postoperative graft occlusion. Limb loss rate was high in popliteal aneurysm repair using PTFE graft due to graft occlusion; saphenous vein graft is more superior in terms of mid-term graft patency.
Thermal ablation, nonthermal ablation and surgical striping applications: 1-year single center early results
(2022) Beyaz, Metin Onur; Urfalı, Senem; Koyuncu, Onur; Fansa, İyad
Objective: Starting from the 1990’s minimally invasive methods such as endovenous laser ablation (EVLA), radiofrequency ablation (RFA), and ultrasound-guided foam sclerotherapy (UGFS) developed. Method: This study includes a total of 136 patients (81 women/55 men), of whom 22 (10 women/12 men) were treated with classic surgical stripping, 54 (32 women/22 men) with thermal ablation and 60 (39 women/21 men) with non-thermal ablation. Results: Twenty-two patients (10 women/12 men) were treated with surgical stripping. In one female patient a hematoma arose in the medial crural region postoperatively. A radiofrequency catheter (ThermoBLOCK TM) was used in the thermal ablation procedures in 54 patients (32 female/22 male). While permanent paresthesia occurred in one female patient after the procedure, temporary paresthesia occurred in 3 male patients postoperatively. Non-thermal ablation was performed in 60 patients (39 female/21 male). Even through a severe burning sensation was present in 6 patients (5 female/1 male) during the procedure, this symptom was only transient. In one of the patients, deep venous thrombosis (DVT) occurred at the level of the popliteal vein postoperatively at the sixth day. Conclusion: Even if thermal and non-thermal ablation and surgical procedures have the same pain decreasing rates, hematomas and a longer hospital stay are more frequent in surgical procedures.
Vascular Tumors of the Neck in Adults: 10-Year Experience in a Tertiary Center
(Forum Multimedia Publishing, Llc, 2020) Goksel, Onur S.; Gok, Emre; Karatepe, Celalettin; Sarilar, Cagla Canbay; Onalan, Mehmet Akif; Beyaz, Metin Onur; Alpagut, Ufuk
Introduction: The diagnosis and management of vascular lesions of the neck is a challenging task that requires a multidisciplinary approach. This retrospective study assesses the single center experience of vascular tumors of the neck. Materials and methods: Patients diagnosed with a vascular tumor and/or a mass in close proximity to the carotid artery were identified from our records over a 10-year period. The demographic characteristics, clinical features, surgical approach, and outcomes were reviewed. Results: Surgical excision of 17 vascular lesions were performed in 16 patients with a mean age of 51.56 +/- 17.35 years at the time of operation. Intra- and/or postoperative clinical and histological assessment revealed unilateral glomus caroticum (N = 11), glomus vagale (N = 2), bilateral glomus caroticum (N = 1), cavernous hemangioma (N = 1), and carotid sheath tumor (N = 1). In three patients, internal carotid artery, common carotid artery and vagal nerve were sacrificed to facilitate complete tumor excision. During the follow-up period, no tumor recurrences were observed, and the morbidity and mortality were minimal. Conclusion: Preoperative evaluation concerning the size, extent, and anatomical relationships of the tumor thoroughly should be investigated. Multidisciplinary approach involving vascular surgery, otolaryngology, and radiology is preferred to treat these patients for better outcomes. Preoperative embolization in selected cases may decrease estimated blood loss and operative time.

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