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    A comparison of axillary blockage and local anesthesia techniques on autologous arteriovenous fistula flow rates and patient comfort in chronic hemodialysis patients
    (Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2013) Acipayam, Mehmet; Zor, Mustafa Hakan; Alfinay, Levent; Uncu, Hasan; Kara, Inci; Halici, Umit
    Background: In this article, we aim to compare the effects of axillary nerve block and local anesthesia techniques on the flow rate and patency of arteriovenous fistulas (AVF) and postoperative early-stage pain. Methods: This prospective study included 30 patients who were scheduled for brachial artery-cephalic vein AVF construction operation between the dates June 2007 and August 2009. Group 1 (n=15) consisted of axillary nerve block, group 2 (n=15) consisted of local anesthesia administered patients. The mean age of group 1 and group 2 patients were 57.8 +/- 14.0 and 54.9 +/- 16.5 respectively. There were two patients with hypertension history in both groups. Pain scores were evaluated with visual analog scale (VAS) (0-10 cm) at 2, 6th and 24th hour after the operation. Arteriovenous fistulas patency and flow rates were measured by Doppler ultrasonography (USG) at 10th months during follow-up. Results: Postoperative pain scores of 2, 6th and 24th hour in group 1 were 1.2 +/- 0.5, 2.8 +/- 0.7 and 1.9 +/- 0.4 respectively; the same values for group 2 were 3 +/- 1.3, 3 +/- 0.7 and 2 +/- 0.5 (p=0.000; p=0.480; p=0.497). The mean flow rates measured with Doppler USG after 10 months were 966.1 +/- 206.1 ml/min in group 1 and 871.6 +/- 338.3 ml/min in group 2 (p=0.513). All the AVF were patent in group 1 and group 2. Steal syndrome arised in three patients in group 2 and none in group 1 (p=0.68). There was one patient complicated with motor blockade on the same extremity, who spontaneously recovered after 24 hours in group 1. Conclusion: We conclude that axillary blockage is an effective and safe technique in AVF construction operations which has also a positive long-term effect on AVF flow rates without any critical complication.
  • Küçük Resim
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    The factors affecting the patency of arteriovenous fistulas formed for hemodialysis: evaluation of three-year experience
    (Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2013) Acipayam, Mehmet; Zor, Hakan; Yildiz, Gur Deniz; Uncu, Hasan; Cetinoglu, Mahmut; Halici, Umit; Altinay, Levent
    Background: In this study, we assessed surgical techniques used for arteriovenous (AV) fistula formed for hemodialysis and factors affecting the fistula patency in the midterm. Methods: Between April 2007 and July 2010, 530 patients (297 males, 233 females; mean age 57.3 years; range 18 to 86 years) who underwent AV fistula operation were retrospectively analyzed. The patients were divided into two groups including group 1 without AV fistula occlusion (n=411; mean age 57.6 years) and group 2 with AV fistula occlusion (n=119; mean age 56.0 years). Both groups were compared according to following variables: age, sex, diabetes, hypertension, coronary artery disease, cephalic vein and radial artery diameter, postoperative thrill existence on AV fistula and the rate of revision surgery. Results: Distribution of possible risk factors within group 1 and group 2 were as follows respectively: diabetes 82 and 49 patients, hypertension 82 and 29 patients, male sex 243 and 54 patients, coronary artery disease six patients and null, small-diameter radial artery six and four patients, small-diameter cephalic vein 16 and 11 patients, revision surgery eight and five patients, palpable postoperative thrill 377 and 100 patients. We found significant differences in the factors including sex, diabetes, cephalic vein radius and postoperative thrill between the groups (p=0.008, p=0.000, p=0.0019, p=0.0014, respectively). Conclusion: In patients with chronic renal failure, diabetes, female gender and cephalic vein diameter of <2 mm affect the patency of AV fistula adversely, while postoperative trill and male gender affect the patency of AV fistula positively.
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    A RETROSPECTIVE COMPARISON OF EARLY RESULTS OF ISOLATED CORONARY ARTERY BYPASS SURGERY IN YOUNG (<40 YEARS) AND MIDDLE AGED (40-60 YEARS) PATIENTS
    (Carbone Editore, 2015) Halici, Umit; Acipayam, Mehmet; Uncu, Hasan; Altinay, Levent; Ketenciler, Serkan; Ozsoyler, Ibrahim
    Introduction: Coronary artery disease is usually seen in middle-aged and older population. Although coronary artery disease in young patients is relatively rare compare to older population, the incidence in young people have been increasing recently. In this retrospective study, we aimed to compare the perioperative characteristics and complications of young aged (<40 years) to midlle aged (40-60 years) patients retrospectively. Materials and methods: A total of 1592 patients who underwent isolated coronary artery bypass grafting operation were included in this retrospective study. Patients were divided into two groups according to age as young aged patients (Group 1; a total of 78 patients; 64 males, 14 females, mean age 36.7 +/- 33 years) and middle-aged patients (Group 2; a total of 1514 patients; 1183 males and 331 females, mean age 51.8+/-5.2 years) and preoperative, intraoperative and postoperative parameters were compared. Results: Smoking rates in Group 1 and low molecular density cholesterol levels in Group 2 were higher but it was not statistically significant. Cardiopulmonary bypass time, cross-clamp time, incidence of reoperation, amount of drainage and number of distal anastomoses were not significantly different between groups. Also development of newly onset atrial fibrillation, use of inotropic agents, intensive care stay time, amount of fresh whole blood used, use of left internal thoracic artery and intraaortic balloon pump seen in groups were not statistically significant. The incidence of delirium and time to discharge were significantly increased in Group 2. Hospital mortality rate of Group 2 was 0.39% (6 patients) whereas there was no hospital mortality in Group 1. Conclusion: The coronary bypass grafting operation can be performed in young aged patients with similar early postoperative results as in middle aged patients group. Thus we think that age has no major effect over the early postoperative results of isolated coronary artery bypass surgery.
  • [ N/A ]
    Öğe
    A retrospective comparison of early results of isolated coronary artery bypass surgery in young (<40 years) and middle aged (40-60 years) patients
    (Acta Medica Mediterranea, 2015) Halici, Umit; Acipayam, Mehmet; Uncu, Hasan; Altinay, Levent; Ketenciler, Serkan; Ozsoyler, Ibrahim
    Introduction: Coronary artery disease is usually seen in middle-aged and older population. Although coronary artery disease in young patients is relatively rare compare to older population, the incidence in young people have been increasing recently. In this retrospective study, we aimed to compare the perioperative characteristics and complications of young aged (<40 years) to midlle aged (40-60 years) patients retrospectively. Materials and methods: A total of 1592 patients who underwent isolated coronary artery bypass grafting operation were included in this retrospective study. Patients were divided into two groups according to age as young aged patients (Group 1; a total of 78 patients; 64 males, 14 females, mean age 36.7±3.3 years) and middle-aged patients (Group 2; a total of 1514 patients; 1183 males and 331 females, mean age 51.8±5.2 years) and preoperative, intraoperative and postoperative parameters were compared. Results: Smoking rates in Group 1 and low molecular density cholesterol levels in Group 2 were higher but it was not statistically significant. Cardiopulmonary bypass time, cross-clamp time, incidence of reoperation, amount of drainage and number of distal anastomoses were not significantly different between groups. Also development of newly onset atrial fibrillation, use of inotropic agents, intensive care stay time, amount of fresh whole blood used, use of left internal thoracic artery and intraaortic balloon pump seen in groups were not statistically significant. The incidence of delirium and time to discharge were significantly increased in Group 2. Hospital mortality rate of Group 2 was 0.39% (6 patients) whereas there was no hospital mortality in Group 1. Conclusion: The coronary bypass grafting operation can be performed in young aged patients with similar early postoperative results as in middle aged patients group. Thus we think that age has no major effect over the early postoperative results of isolated coronary artery bypass surgery.