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Öğe An old but still valuable technique for popliteal artery stenosis: Endarterectomy via the posterior approach(Lippincott Williams & Wilkins, 2024) Huseyin, Serhat; Guclu, Orkut; Reyhancan, Adem; Yuksel, Volkan; Gurkan, Selami; Canbaz, SuatIsolated popliteal artery occlusions are rare compared with femoropopliteal occlusive diseases. Although endovascular procedures have gained importance in treatment, conventional surgery remains the gold standard. In this study, we reviewed popliteal endarterectomy and patch plasty using a posterior approach. Fourteen patients who underwent surgery for isolated popliteal artery occlusions were retrospectively examined. Patients were assessed in terms of age, sex, and risk factors, such as accompanying diseases and smoking, surgical method and anesthesia, incision type, preoperative and postoperative pulse examination, ankle-brachial indices, patency, wound infection, postoperative complications, and the treatment applied. Twelve (85.7%) patients were male, and 2 (14.3%) were female. Limb ischemia was critical (ABI < 0.7) in 11 (78.5%) patients. The average duration of postoperative hospitalization was 8 +/- 3.7 days on average, and the average length of follow-up was 17 +/- 3.4 months. Thrombosis and complications requiring secondary intervention did not develop during the early postoperative period. While the patency rate in the first 6 months of follow-up was 100%, it was 92.8% in the 1st year and 85.7% in the 2nd year. Surgical treatment with the posterior approach in isolated popliteal artery lesions is preferred by vascular surgeons as a prioritized treatment method, with a sufficient recanalization rate and low perioperative morbidity and mortality rates. Furthermore, it is promising because it does not prevent below-knee femoropopliteal bypass, which is the subsequent stage of treatment. Moreover, the great saphenous vein was protected, and the acceptable early- and mid-term results were encouraging.Öğe Body mass index as a determinant of postoperative morbidity(Cardiology Academic Press, 2013) Gürkan, Selami; Gür, Özcan; Özkaramanlı Gür, Demet; Ege, Turan; Canbaz, Suat; İşcan, ŞahinBACKGROUND: The impact of obesity on postoperative mortality and morbidity in coronary artery bypass grafting (CABG) operations is a widely studied but poorly defined topic. OBJECTIVE: To investigate the effect of body mass index (BMI) on in-hospital mortality and morbidity after isolated CABG surgery. METHODS: Prospectively collected data of a series of 1057 consecutive patients who underwent on-pump isolated CABG surgery were retrospectively analyzed. Patients were divided into five groups according to WHO BMI categorization (defined as underweight [BMI <20 kg/m(2)]; normal weight [BMI >= 20 kg/m(2) to <25 kg/m(2)]; overweight [BMI >= 25 kg/m(2) to <30 kg/m(2)]; obese, [BMI >= 30 kg/m(2) to <35 kg/m(2)]; and morbidly obese, [BMI >= 35 kg/m(2)]). RESULTS: Of 1057 patients, 13 patients (1.2%) were underweight, 298 (28.2%) were normal weight, 462 (43.7%) were overweight, 218 (20.6%) were obese and 66 (6.2%) were morbidly obese. The mean age was significantly lower in underweight patients, who were also more likely to be male. In contrast, obese and morbidly obese patients were older, and more likely to have comorbidities such as diabetes and hypertension. The incidence of postoperative bronchodilator use (P<0.001), leg wound infection (P=0.038), sternal dehiscence (P=0.039) and development of new-onset atrial fibrillation (P<0.001) was significantly higher in obese and morbidly obese groups. In contrast, postoperative prolonged ventilation (P<0.001), need for blood transfusions (P<0.001) and revision for bleeding (P=0.041), as well as gastrointestinal complications (P<0.001), were significantly higher in underweight patients. Multivariate logistic regression analysis showed that not BMI but female sex, older age and diabetes mellitis were independent risk factors for early mortality after CABG surgery. CONCLUSION: No effect of BMI on early postoperative mortality after CABG surgery could be demonstrated. However, in terms of morbidity, postoperative bleeding and revision for bleeding were increased in underweight patients while sternal dehiscence, wound infections and occurrence of atrial fibrillation were increased in obese and morbidly obese patients.Öğe Combined treatment of both arterial and deep venous thrombosis in a young adult with antiphospholipid syndrome: case report(2014) Gürkan, Selami; Gür, Özcan; Chousein-Hüseyin, Serchat-Serhat; Yüksel, Volkan; Canbaz, SuatAntifosfolipid sendromu değişik tromboembolik olaylara sebep olabilen, otoimmün hiperkoagülabilite sendromudur. Olguların %35inde pulmoner emboli ve infarktla komplike olabilen derin ven trombozu görülebilir. Hastalığın klinik görünümleri arasında; venöz ve arteriyel trombozlarla birlikte emboliler, multiorgan iskemisi ve infarktına neden olabilen küçük ve yaygın büyük damar trombozları, prematür koroner arter hastalığı, strok ve düşükler sayılabilir. Bu yazıda 25 yaşındaki genç erkek hastada görülen arteriyel ve venöz trombozu ile cerrahi ve medikal tedavi birlikteliğini sundukÖğe Continuous renal replacement therapy after cardiac surgery in patients with acute renal failure(2013) Güçlü, Orkut; Yavuz, C.; Gürkan, Selami; Yüksel, V.; Demirtaş, S.; Çalışkan, Ahmet; Canbaz, Suat; Gür, ÖzcanAim Acute renal failure is an important adverse effect of cardiopulmonary bypass that can result in high mortality or morbidity rates. It can be treated with continuous renal replacement therapy after cardiac surgery. The purpose of this study was to determine the factors associated with the mortality and incidence of acute renal failure in patients of post cardiac surgery. Methods Patients (1564) who underwent cardiac surgery between January 2007 and January 2012 and treated with continuous renal replacement therapy were included (N=40). Patients with previous renal disorders were excluded. A retrospective analysis was carried out. Results Overall, continuous renal replacement therapy was used in 40 (2.6%) patients. The mean age was 62.7±11 years. Mean duration of cardiopulmonary bypass was 166±80 min, and aorta cross-clamping time was 97±35 min. The patients' mean pretherapy creatinine level and mean creatinine level before hospital discharge were 3.3±1.1 mg/dL and 1.1±0.4 mg/dl, respectively. Thirty-day mortality was 35%. Only 6 patients required long-term renal replacement therapy. Conclusion Acute renal failure requiring hemodialysis after cardiac surgery is associated with higher mortality and morbidity and prolonged hospital stay. Early renal recovery with continuous renal replacement therapy seems to offer an evident survival benefit. Continuous renal replacement therapy may represent an important therapy and reduce mortality rates. We believe that these rates might decrease even more with detailed preoperative evaluation and meticulous postoperative care with collaborative management.Öğe In vitro effects of amiodarone on coronary artery bypass grafts(Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2015) Karaca, Okay Güven; Ege, Turan; Canbaz, Suat; Gür, Özcan; Karadağ, Çetin Hakan; Ecevit, Ata Niyazi; Kalender, MehmetBackground: This study aims to investigate the effects of amiodarone on the most commonly used grafts, internal thoracic artery (ITA), saphenous vein (SV), and radial artery (RA) in organ bath. Methods: Twenty patients (16 males, 4 females; mean ages 58.4 +/- 9.9 years; range 38 to 80 years) who underwent isolated coronary artery bypass graft (CABG) surgery between May 2008 and October 2008 were included in this study. Internal thoracic artery, saphenous vein, and radial artery grafts were harvested. Specimens were taken to laboratory in +4 degrees C Krebs solution. Specimens were suspended in 10 ml organ bath containing Krebs solution. Results: Amiodarone caused relaxation in all grafts (ITA, RA, SV) between 10(-9)-10(-3,5) M concentration in a dose dependent manner (p<0.01). Maximum relaxation rates (mean) induced by amiodarone were 78.9%, 74.9% and 66.5% for ITA, RA and SV, respectively. Conclusion: Although we did not evaluate the endothelium-independent relaxation response in this study, higher rates of relaxation response were observed with ITA grafts comparing to other grafts, and these results were compatible with literature. According to the results of this study, amiodarone-class III antiarrhythmic agent- caused vasodilation in all three grafts in vitro. Vasodilator effect of amiodarone on grafts may help to increase patency rates.Öğe Management of pericardial effusion by subxiphoidal pericardiostomy in adults(Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2012) Yüksel, Volkan; Hüseyin, Serhat; Okyay, Ahmet; Gürkan, Selami; Gür, Özcan; Canbaz, Suat; Duran, EnverBackground: We aimed to assess the effectiveness of subxiphoid pericardiostomies in the treatment of patients with pericardial effusion (PE) and to discuss the etiology for this patient population. Methods: Between January 2004 and January 2011, 148 patients (77 males, 71 females; mean age 60.1 +/- 12.3 years; range 34 to 89 years;) who underwent a subxiphoid pericardiostomy and tube drainage due to a diagnosis of PE were retrospectively analyzed. Results: Echocardiography classified PE as severe in 36 patients, moderate in 68, and mild in 44. The main causes of PE were uremia and malignancy along with idiopathic and undefined tuberculous and non-tuberculous pericarditis. A perioperative myocardial injury requiring a sternotomy occurred in two patients. A histopathological examination contributed to the diagnosis in 84.3% of the patients with malignancy. The overall 30-day mortality rate was 7% (n=11). Pericardial constriction requiring a pericardiectomy developed in two patients. Conclusion: Pericardial effusion can be an effective and quick method for managing adults with subxiphoid pericardiostomy.Öğe Surgical management of iatrogenic femoral artery pseudoaneurysms: A 10-year experience(Lithographia, 2013) Hüseyin, Serhat; Yüksel, V; Sivri, N.; Gür, Özcan; Gürkan, Selami; Canbaz, Suat; Sunar, H.Background: Vascular complications of cardiac catheterization have increased in line with increasing number of percutaneous interventions. Open repair is the standard method of treatment for true and false aneurysms of femoral artery. We report results of patients operated due to femoral artery pseudoaneurysm after cardiac catheterization. Methods: Data from 12,261 patients who underwent percutaneous intervention for cardiac catheterization between January 2003 and January 2013 were evaluated. Diagnosis of pseudoaneurysm was established mainly by doppler ultrasonography in patients with complaints of pain and hematoma at the intervention site. Pseudoaneurysms less than 2 cm in diameter were treated non-operatively and were followed up by regular ultrasonographic examination at the outpatient clinic. Pseudoaneurysms with a diameter of 2 cm or more underwent primary repair. All patients were followed up for one year. Results: We detected 55 (0.44%) patients with femoral artery pseudoaneurysm and 42 of them were operated. The mean age was 60.7 +/- 6.3 years. Thirty nine (94.5%) patients underwent elective surgery, three (5.5%) patients were operated on under emergency conditions. Operation was performed under local anesthesia in 32 patients, under local anesthesia and sedation in eight patients, and under general anesthesia in three patients. Location of the pseudoaneurysm was the superficial femoral artery in 29 (69%), the common femoral artery in nine (21.4%), and the deep femoral artery in four (9.6%) patients. No limb loss occurred, no patient died and no recurrence was detected during the follow up. Conclusions: Performing vascular reconstruction before the rupture of pseudoaneurysm is important in terms of morbidity and mortality. We concluded that surgical repair in pseudoaneurysms larger than 20 mm is safe and essential.Öğe The effect of distension pressure on endothelial injury and vasodilatation response in saphenous vein grafts: conversion of a bypass graft to a dead pipe(Termedia Publishing House Ltd, 2014) Gürkan, Selami; Gür, Özcan; Yüksel, Volkan; Tastekin, Ebru; Hüseyin, Serhat; Özkaramanlı Gür, Demet; Canbaz, SuatIntroduction: Endothelial damage caused by high pressure applied for spasm relaxation during graft preparation is one of the most plausible theories explaining early graft failure. Aim of the study: We aimed to demonstrate the extent of endothelial damage in saphenous vein grafts distended to different pressure levels by using immunohistochemical methods and in vitro tissue baths. Material and methods: Saphenous vein grafts (SVGs) of 25 patients who underwent isolated elective CABG surgery were used in this study. By using a specific mechanism, SVGs were distended to five different pressure levels for two minutes: 0 mmHg, 50 mmHg, 100 mmHg, 200 mmHg, 300 mmHg. In vitro tissue baths and immunohistochemical examinations were performed. Results: None of the grafts distended to 300 mmHg pressure were functional in the tissue bath system. The relaxation response to carbachol of SVGs distended to 0, 50, 100 and 200 mmHg was 97.87 +/- 4.47%, 98.52 +/- 3.95%, 93.78 +/- 3.64%, and 30.87 +/- 4.11%, respectively. There were no statistically significant differences in terms of relaxation responses between samples distended to 0, 50, and 100 mmHg (p = 0.490). The relaxation response of samples distended to 200 mmHg was significantly decreased (p = 0.021). The endothelia of samples distended to 0 mmHg were almost intact in CD31 staining. Endothelial cell loss occurred at all tested distension pressures at different degrees. Conclusion: In vitro and immunohistochemical studies revealed that distending an SVG used for coronary artery bypass grafting with pressures of 100 mmHg or less results in less endothelial damage and increases graft patency.
