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Öğe Analysis of vascular trauma in terror-related civilian attacks within South-Eastern Turkey(2016) Fansa, İyad; Atay, Mehmet; Altınay, Levent; Saydam, Onur; Karatepe, Celalettin; Acıpayam, Mehmet; Lale, CemTürkiye'nin Güneydoğusu'nda meydana gelen teröre bağlı vasküler yaralanmalar ve mor-- talite göstergelerini incelemek. Gereç ve Yöntemler. Ocak 2012--Ağustos 2015 arasında teröre bağlı vasküler yaralanması olan 88 hasta (82 erkek, yaş 24418.1) bu retrospektif çalışmaya alındı. Travmatik amputasyon, yaygın doku kaybı, ciddi sinir hasarina bağlı amputasyon ve baş yaralanması olan hastalar çalışmaya alınmadı. Hastalar yaralanmanın ciddiyeti ve mekanizması, travma lokalizasyonu ve cerrahi tedavi şekillerine göre değerlendirildi. Bulgular: Kırkaltı (%52.3) hastada alt ekstremite, 19 (%21.6) hastada üst ekstremite, 13 (%14.8) hastada alt ve üst ekstremitede vasküler yaralanma vardı. Ayrıca boyun (n=3; %3.4), toraks (n=2; %2.3), abdomino--pelvik (n=5; %5.7) yaralanmalar da vardı. Yaralanmaların 23'ü (%26.1) mermi, 54'ü (%61.4) şarapnel, 11'i (%12.5) patlama sebebiyle meydana gelmişti. Hataların 38'i (%43.2) hastaneye geldiklerinde hipovolemik şoktaydı. Kırk (%45.5) hastada izole arter, 42 (%47.7) hastada arter ve ven, (%6.8) hastada sadece ven yaralanması vardı. Yirmisekiz (%31.8) hastada otojen greft, 10 (%11.4) hastada sentetik greft kullanıldı. Onsekiz (%20.5) hastada vasküler ligasyon yapıldı. Yedi (%8) hastada postoepratif akut böbrek hasarı gelişti. Yirmisekiz (%31.8) hastada yara enfeksiyonu gelişti. Çalışmamızda erken dönem mortalite oranı %18.2 (16 hasta)'dir. Hipovolemik şok (p<0.0001), akut böbrek yetmezliği (p=0.002) ve masif kan transfüzyonu (p=0.007) mortalite prediktörleridir. Sonuç: Teröre bağlı bağlı vasküler yaralanmalarda multi--disipliner yaklaşımla hipovolemik şok tedavi edilmeli, akut renal yetmezlik engellenmeli ve acil kompleks vasküler cerrahi girişimler planlanmalıdır.Öğe Aortik lezyonların endovasküler tedavisinde ilk klinik deneyimlerimiz ve kısa dönem takip sonuçlarımız(2014) Karatepe, Celalettin; Dağlı, Celalettin; Bayaroğulları, Hanefi; Akkoca, Ayşe Oğuzhan; Lale, Cem; Göksel, OnurAmaç: Çalışmamızda, kliniğimizde endovasküler aort tamiri yapılan torasik ve abdominal aort patolojilerinde ilk deneyimlerimizi ve 6 aylık sonuçlarımızı sunmayı amaçladık. Gereç ve Yöntemler: Ocak 2012-Nisan 2013 tarihleri arasında endovasküler aort tamiri yapılan 14 hasta (13 erkek, 1 kadın; ortalama yaş 68,43±9,89 yıl) retrospektif olarak incelendi. On dört hastanın 9’una abdominal endovasküler aort tamiri (EVAR), 5’ine endovasküler torakal aort tamiri (TEVAR) yapılmıştı. Tüm Olguların birinci ve 6. ay kontrol kontrastlı bilgisayarlı tomografileri değerlendirildi. Bulgular: Hastaların komorbidite sebeplerine bakıldığında birinde diabetes mellitus, 5'inde hipertansiyon, ikisinde geçirilmiş aorta koroner bypass greft operasyonu, ikisinde kronik obstruktif akciğer hastalığı, ikisinde malignite, birinde geçirilmiş batın operasyonu, ikisinde kronik böbrek yetmezliği ve 4 hastada sigara kullanımı mevcuttu. İşlemlerin tümünde başarı oranı %100 idi. İşlem sırasında major komplikasyon ve açık cerrahiye gereksinim olmadı. Hiçbir hastada greft enfeksiyonu ya da anevrizma rüptürüne bağlı ölüm gözlenmedi. Sonuç: Endovasküler aortik tamir işlemi açık cerrahi için yüksek riskli olgularda (ileri yaş, komorbidite varlığı, geçirilmiş batın operasyonu) düşük mortalite ve morbidite oranlarına sahip olması, bu hastalarda güvenli bir şekilde uygulanılabilmesi, hastanede kalış süresinin daha az olması ve daha kısa süreli anestezi kullanımının yanı sıra, yüksek teknik başarıya sahip bir yöntem olmasın nedeniyle tercih edilebilir bir uygulama haline gelmiştir. Uygun endikasyonlarda yapıldığında hastayı daha az travmatize eden, hekim açısından ise açık cerrahiye göre daha kolay ve daha az riskli ve işlem süresi kısa olan bir tedavi yöntemi olduğu kanaatindeyiz. Daha kesin sonuçlar için daha büyük serilere ve daha uzun dönem takiplere ihtiyaç duymaktayız.Öğe Böbrek yetmezlikli hastalarda doppler ultrasonografi eşliğinde hemodiyaliz amaçlı geçici kateter uygulamaları : erken ve geç dönem sonuçlar(2014) Karatepe, Celalettin; Aldemir, Mustafa; Yetim Durgun, Tülin; Akkoca Oğuzhan, Ayşe; Dağlı, CelalettinAmaç: Böbrek yetmezlikli hastalarda hemodiyaliz amaçlı geçici kateter uygulaması sık kullanılan bir yöntemdir. Makalemizde; Doppler ultrasonografi (USG) eşliğinde uygulanan hemodiyaliz amaçlı geçici kateter deneyimlerimizi sunmayı amaçladık. Gereç ve Yöntem: Kap-Damar Cerrahisi Kliniğimizde Ocak 2010-Ocak 2012 tarihleri arasında hemodiyaliz amaçlı geçici kateter uygulanan 270 hasta yaş, cinsiyet, kateter endikasyonu, uygulama yeri, çıkartılma sebepleri ve komplikasyonları açısından retrospektif olarak incelendi. Bulgular: Böbrek yetmezlikli 270 hastaya toplam 320 defa geçici hemodiyaliz kateteri takıldı. En sık giriş yeri 240 olguda sağ internal juguler vendi (İJV). 11 olguda erken dönemde, 30 olguda ise geç dönemde komplikasyon gelişti. En sık görülen komplikasyon kateter disfonksiyonu idi. Sonuç: Geçici hemodiyaliz kateterlerinin kullanımı erken ve geç dönemde yüksek komplikasyon oranları ile beraberdir. Erken dönem koplikasyonların azaltılmasında Doppler USG eşliğinde kateterizasyon önem kazanırken, geç dönem komplikasyonların azaltılmasında en önemli faktör kronik böbrek yetmezlikli hemodiyaliz gerektiren hastalarda en kısa zamanda kalıcı vasküler erişim yolunun oluşturulmasıdır.Öğe Carotid endarterectomy in the octogenarian with contralateral disease: A single center experience(2014) Goksel, Onur S.; Karatepe, Celalettin; Gok, Emre; Sayin, Omer A.; Kamber, Murat; Çinar, Bayer; Alpagut, UfukBackground: As the growing proportion of octogenarians in the ageing population may lead to a dramatic increase in cerebrovascular disease, preventing and treating stroke will be a serious challenge in the octogenarian. Objectives: We reviewed the outcome of carotid endarterectomy in the octogenarians with or without contralateral carotid stenosis or occlusion and compared the results with a similar cohort of younger age. Material and Methods: From 2005 to 2013, 142 CEAs were performed by a single surgical team on 128 patients were reviewed for early outcome in regards to hospital mortality and stroke. Results: 128 patients (111 males; mean 68.5±9.3 years-old, range 49-85) underwent CEA by the same surgical team. 14 patients had severe bilateral disease and underwent bilateral CEAs Smoking was significantly higher in the nonoctogenarians (6.2% vs. 21.8%, P<0.05). Preoperative history of transient ischemic events was the most common scenario in both octogenarians and the younger patients although preoperative transient neurologic deficits were more prominent in the non-octogenarians (50% vs. 71%, P<0.05). Contralateral carotid artery occlusion was seen in a total of 14 patients (12.5% in the octogenarians vs. 9% in the younger patients, P =0.52). Only one patient in the octogenarian group experienced a lateralizing stroke due to ipsilateral CEA in contrast to 3 patients (lateralizing stroke in 3 patients, lacunar state in one patient) in the younger patients. Conclusions: Carotid endarterectomy, despite the general perception, is a viable option for patients with CCO or bilateral disease even in the octogenarian group.Öğe Chimney grafts for a juxtarenal aneurysm in an octogenarian patient with left main coronary artery disease and symptomatic carotid stenosis : case report(2016) Göksel, Onur Selçuk; Karatepe, CelalettinJukstarenal anevrizmalı hastalarda kompleks bir açık cerrahi onarım gerekmektedir ki, bu da mortalite ve morbiditeyi artırır. Kolay uygulanabilir bir metot olarak chimney prosedürü gelişti- rilmiştir. Seksen bir yaşında, jukstarenal anevrizması, sol ana koroner arterde ciddi darlığı, unsta- bil anjinası, sol iliak arter tıkanıklığı ve semptomatik karotis arter darlığı olan bir erkek hasta sunuyoruz. Hasta acil kombine koroner ve karotis işlemlerinin ardından gerçekleştirilen sol ak- sillo-femoral bypass'ın yanısıra, aşamalı chimney greftler ve aort-uni-iliak stent-greftleme ile tedavi edildi. Hasta postoperatif 10. günde komplikasyonsuz taburcu edildi. Chimney greftler; tekniğin esnekliği, daha kısa işlem süresi, özel imal edilmesi gereken araçlara gereksinim duyulmaması ne- deniyle karmaşık vakalarda cazip bir alternatif olarak görünmektedir.Öğe The Effect of External Apple Vinegar Application on Varicosity Symptoms, Pain, and Social Appearance Anxiety: A Randomized Controlled Trial(Hindawi Ltd, 2016) Atik, Derya; Atik, Cem; Karatepe, CelalettinAim. We aimed to determine the effect of external apple vinegar application on the symptoms and social appearance anxiety of varicosity patients who were suggested conservative treatment. Method. The study was planned as an experimental, randomized, and controlled study. 120 patients were randomly selected and then were randomly allocated to either experimental or control group by simple blind random sampling method. In the collection of research data, a questionnaire questioning sociodemographic and clinical characteristics, the Visual Analog Scale (VAS) for pain, and the Social Appearance Anxiety Scale (SAAS) were used. The patients in the study group were suggested to apply apple vinegar to the area of the leg with varicosity alongside the treatment suggested by the doctor. The patients in the control group received no intervention during the study. Results. The sociodemographic and clinic characteristics of both groups were found to be similar (p > 0.05). The patients were evaluated with regard to cramps, pain, leg fatigue perception, edema, itching, pigmentation, and weight feelings in the leg, VAS, and SAAS averages in the second evaluation; the control group had a decrease in such symptoms (p > 0.05) although the decrease in the application group was higher and statistically meaningful (p < 0.05). Conclusion. We determined that the external application of apple vinegar on varicosity patients, which is a very easy application, increased the positive effects of conservative treatment.Öğe Midterm Results Following Percutaneous Rotational Thrombectomy for Acute Thrombotic Occlusions of Prosthetic Arteriovenous Access Grafts(Int College Of Surgeons, 2015) Karatepe, Celalettin; Aldemir, Mustafa; Cinar, Bayer; Onalan, Akif; Issever, Halim; Goksel, Onur S.Patent vascular access is critical for patients on regular hemodialysis. Prosthetic grafts are good alternatives when the superficial venous system is of poor quality. However, thrombosis is one of the main drawbacks of synthetic grafts, with reports of 59% to 90% patency rates for 1 year. In cases of thrombotic occlusion of prosthetic arteriovenous fistula grafts, percutaneous mechanical thrombectomy has recently gained clinical popularity as a potential alternative to surgical thrombectomy or pharmacologic thrombolysis. We reviewed our preliminary results from 30 percutaneous rotational thrombectomies performed in a total of 22 patients in the setting of acute dialysis-access prosthetic graft occlusion of the upper extremity. Among the 30 cases of acute occlusion of the arteriovenous graft, immediate success with angiographic flow restoration was observed in all patients except for 2 patients (both females; 6%), with de novo occlusion where reocclusion occurred within 12 hours despite apparent immediate angiographic patency. The mean duration between the initial presentation with acute arteriovenousgraft occlusion and the thrombectomy procedure was 27.4 +/- 12.4 hours. The mean duration of graft patency was 10.45 +/- 0.6 months. A total of 75% of the arteriovenous grafts were patent at the end of 12 months of follow-up. Female gender, diabetes mellitus, and diagnosis to intervention interval were reviewed for midterm graft failure, and the presence of diabetes mellitus yielded significance (P < 0.05). Percutaneous techniques play important roles in the treatment of failed or failing arteriovenous fistulae and grafts. Ongoing analysis of outcomes of both percutaneous and surgical intervention is necessary to continue to identify optimum treatment algorithms.Öğe A novel electrospun nano-fabric graft allows early cannulation access and reduces exposure to central venous catheters(Sage Publications Ltd, 2013) Karatepe, Celalettin; Altinay, Levent; Yetim, Tulin Durgun; Dagli, Celaleftin; Dursun, SuatPurpose: The use of tunneled central venous catheters (CVC) as vascular access for hemodialysis treatment is increasing worldwide. We present a novel polycarbonate urethane nano-fabric graft, produced by electrospinning technology, which has self-sealing features that avoid seroma formation and allow puncturing within 48 hours. The aim of this study was to assess its advantages in a setting where late referral is common. Methods: A retrospective single center study assessed 24 implanted grafts in 24 patients with maximal follow-up of 18 months; patency rates, time to first cannulation and post-operative complications were assessed. Results: Successful access was achieved in all 24 patients within 48 hours. In 50% of the patients cannulation was performed within 24 hours without increasing the complication rate. Twelve month primary and secondary patencies were 50% and 70.8%, respectively. Excluding early failures (within 30 days) because of surgical problems, 12 month primary and secondary patencies were 75% and 81.2% respectively. Complication and infection rates were 10.94 and 0.49/1000 dialysis procedures, respectively. No pseudoaneurysms or seromas were documented at 18 months. Conclusions: Early cannulation was successful in all patients with good 12-month primary and secondary patency rates, compared to data reported by others on polytetrafluoroethylene (PTFE) grafts. The infection rate was substantially lower than in tunneled CVCs. Therefore, the AVflo graft may improve the clinical status of dialysis patients by decreasing the exposure to CVCs.Öğe Results of Prompt Surgical Intervention in Hemodialysis Radiocephalic Fistula Secondary Dysfunction(Int College Of Surgeons, 2019) Fansa, Iyad; Kosem, Mesut; Karatepe, Celalettin; Sezen, Adem; Karatepe, Hilal Kuscu; Goksel, Onur SelcukRadiocephalic fistula (RCF) dysfunction is a common problem due to low maturation and patency rates of these fistulas. The most common procedure in such cases is to place a temporary catheter for the dialysis. Temporary catheter placement and undergoing dialysis with this catheter cause complications, reduce the chance for fistula, and deteriorate the quality of life. The aim of this study was to demonstrate that immediate intervention in RCF dysfunctions can increase fistula success for the patient and can reduce the need for a catheter. Furthermore, the hemodialysis treatment can continue without affecting the quality of life. A total of 295 patients who were admitted for RCF dysfunction and who underwent early surgical intervention without any catheter placement were evaluated for postoperative complications, patency rates, and rates and durations of temporary catheter use over a mean time of 47 months of follow-up (range: 4-79 months). Of the patients, 77.2% (n = 228) underwent new proximal anastomosis (NEO; the radial artery and cephalic vein were reached with an incision created proximal to the previous anastomosis), 14.2% (n = 42) underwent brachiocephalic arteriovenous fistula (AVF), 8.4% (n = 25) underwent side-to-side brachiobasilic AVF thorn super-ficialization of the basilic vein. In 88.8% (n = 262) of the patients, successful cannulations were performed within the first 24 to 48 hours without any catheter requirement or complications. Temporary catheter was used for 15.1 6 10.7 days in 11.2% (n = 33) of the patients. In RCF dysfunctions, early surgical interventions performed in the forearm and elbow provide early cannulation and thus decrease the catheter requirement, also prevent the complications of temporary catheters (infection, decreasing the fistula success, vascular injuries, etc.), increase the autogenous fistula success, and allow for the continuation of dialysis without disturbing the quality of life.Öğe Suriye’deki iç savaşta damar cerrahisi deneyimlerimiz(2014) Fansa, İyad; Karatepe, Celalettin; Acıpayam, Mehmet; Lale, CemAmaç: Suriye’de devam eden iç savaş nedeniyle hastanemize çok sayıda ateşli silah yaralanması sonucu oluşmuş vasküler yaralanmalı hasta başvurmaktadır. Biz çalışmamızda; ateşli silah yaralanması nedeniyle hastanemize başvuran vasküler yaralanmalı hastaların yaralanma bölgeleri, ek yaralanmaları, yapılan cerrahi müdahaleler ve sonuçlarının değerlendirilmesi amaçladık. Yöntemler: Çalışmaya 01.01.2012 ve 01.09.2014 tarihleri arasında Suriye iç savaşında yaralanarak hastanemize başvuran ve vasküler cerrahi müdahale yapılan 58 hasta dâhil edilmiştir. Bulgular: Başvuran 58 hastanın %5,1’i Kadın (n=3), %94,9’u Erkek (n=55) olarak tespit edilmiştir. Hastaların yaş aralığı 5–75 olup yaş ortalaması 28,61 olarak tespit edilmiştir. Hastaların % 12,1’inde (n=7) yaygın doku defektiyle birlikte olan kas-sinir-kemik yaralanması tespit edilmiş olup, bu hastalarda yapılan vasküler müdahalelere rağmen hastaların %8,6’sında (n=5) ekstremite ampute edilmiştir. Müdahale edilen 58 hastadan %15,5’i (n:9) ex olmuştur. Sonuç: Ateşli silah yaralanması ile başvuran vasküler yaralanmalı hastalarda yapılan müdahalelere rağmen, geç başvuru, ek yaralanmaların bulunması, yaralanma bölgeleri ve doku defektinin genişliği mortaliteyi etkileyen nedenlerdir.Öğe Thrombectomy with mechanical rotational catheter in a case series of six patients(2018) Karatepe, Celalettin; Altınay, Levent; Göksel, Onur S.Left superficial femoral artery occlusion was found in six patients (4 males, 2 females, mean age 65±10 years) who were admitted to the emergency department with a sudden-onset severe pain and pallor in the crural region of the left lower extremity. As the patients were high-risk patients for open surgery, thrombectomy with a mechanical rotational catheter was performed due to short operation time, and no need for a surgical incision. Complete revascularization was achieved in all patients. No evidence of restenosis was seen after six months. In conclusion, we suggest that mechanical thrombectomy with a rotational catheter is an alternative treatment in high-risk patients for open surgery.Öğe Treatment of aneurysms of hemodialysis access arteriovenous fistulas(2011) Karatepe, Celalettin; Durgun Yetim, TülinBackground: This study aims to present the results of the surgical techniques employed to repair the aneurysms which occurred in arteriovenous fistulas (AVFs) and to ensure fistula continuity. Methods: A total of 30 cases (14 males, 16 females; mean age 52 years; range 35 to 70 years) with aneurysms of 4 cm or over in AVFs for hemodialysis in Antakya State Hospital, Clinic of Cardiovascular Surgery and Mustafa Kemal University, Department of Thoracic Surgery were evaluated retrospectively. In 21 patients, the AVF was radiocephalic, and in seven it was brachiocephalic. All patients were evaluated with Doppler ultrasonography before surgery. Twenty-eight of the patients had a palpable pulsatile mass. Four of these patients additionally had coldness and hand numbness, two had hand edema and skin lacerations, and two had NHYA (New York Heart Association) degree 3-4 heart failure. The method of surgery was determined by considering the artery and vein structures of the patients. Results: All patients were discharged on the first day after surgery. No complications, such as hematoma, ischemia, wound infection, or neurological damage, were observed. The mean follow-up period after surgery was 12 months. Conclusion: Surgical repair remains the gold standard for AVF aneurysms. In our clinic, the plication method is applied to the aneurysm sac in appropriate cases. We believe that this method is effective to ensure the continuity of the fistula.Öğe 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, UfukIntroduction: 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.Öğe Video mediasitnoskopi : üniversitemizde ilk deneyimimiz(2014) Durgun Yetim, Tülin; Karatepe, Celalettin; Davran, RamazanGöğüs cerrahisi pratiğinde mediastinoskopi vazgeçilmezdir. Bu sebeple uzmanlık eğitiminde önemli bir yer tutar. Bizde kliniğimizde ilk kez videomedastinoskopiyi kullandık. Video- mediastinoskopi sırasında işlemin bütün cerrahi ekip tarafın- dan izlenmesinin yanı sıra arter ven yapılarının daha net ayırt edilmesi avantaj sağlamıştır. Bu açıdan özellikle asistan eği- timi veren hastaneler için videomediastinoskopi önerilebilir.
