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Öğe A rare and subtle etiology of chronic oropharyngeal pain: isolated Internal carotid artery kinking without stenosis(Elsevier, 2020) Öztaş, Didem Melis; Meriç, Mert; Başaran, Bora; Erdinç, İbrahim; Özgür, Eren; Umutlu, Muzaffer Reha; Ünal, Orçun; Beyaz, Metin Onur; Ulukan, Mustafa Özer; Sencer, Serra; Alpagut, Ufuk; U?urlucan, MuratCarotid artery kinking is a frequent finding in duplex ultrasonography. However, isolated morphological changes without significant carotid stenosis are rarely symptomatic. Neck pain is a rare symptom in patients with carotid artery kinks. The vascular etiology in patients with persistent neck pain is usually overlooked. A 58-year-old female patient with chronic neck pain presented to our clinic. Following multidisciplinary team review, the symptoms were found due to the kinking of the internal carotid artery. In this report, we present the clinical presentation of the patient with the kinking of the internal carotid artery without stenosis, surgical management of the pathology, and a brief literature review.Öğe A surgical technique for ascending aorta, aortic arch and descending aorta replacement without cross-clamp, circulatory arrest or hypothermia(Cambridge University Press, 2020) Uğurlucan, Murat; Yıldız, Yahya; Ulukan, Mustafa Özer; Öztaş, Didem Melis; Beyaz, Metin Onur; Canata, Emin; Çoban, Şenay; Ünal, Orçun; Erkanlı, Korhan; Türko?lu, HalilTreatment of the aneurysms comprising the aortic arch is challenging. Surgical reconstruction usually requires aortic cross-clamping, cardiac arrest, and even deep hypothermia for a bloodless field. In this report, we present our surgical technique providing normothermic ascending aorta, aortic arch, and proximal descending aorta replacement with selective cannulation and perfusion of the whole body.Öğe 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) Turhan Çağlar, Fatma Nihan; Gök, Gülay; Öztimer, Gülsüm; Katkat, Fahrettin; Karakozak, Dilay; Öztaş, Didem Melis; Beyaz, Metin Onur; Uğurlucan, MuratIntroduction 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.Öğe Anxiety and health-related quality of life after cardiac surgery(Termedia Publishing House Ltd., 2020) Güzelhan, Yalçın; Uğurlucan, Murat; Öztaş, Didem Melis; Beyaz, Metin Onur; Ünal, Orçun; Bektaş, Nilüfer; Conkbayır, Cenk; Alpagut, Ufuk; Bozbuğa, NilgünIntroduction: The aim of this study was to investigate the effect of elective cardiac surgery on health-related quality of life (HRQoL). Material and methods: One hundred and eight (35 women and 73 men, mean age 62.3 ±12.7 years) patients undergoing open heart surgery were enrolled in the study. Physical and mental domains of quality of life were measured using the 36-item Medical Outcomes Short-Form Health Survey (SF-36) self-administered questionnaire, and anxiety symptoms were assessed using the Spielberger State-Trait Anxiety Inventory (STAI). At baseline 108 patients filled out the SF-36 and STAI, and 102 patients at 6-month follow-up. Results: It was found that there was significant improvement in three out of eight health domains: physical functioning (p < 0.02), role physical (p < 0.01), and social functioning (p < 0.04), at 6-month follow-up. The two STAI sub-scores: the State Anxiety Inventory and the Trait Anxiety Inventory were found to be high (? 40) both preoperatively and 6 months postoperatively. Postoperatively there was not any statistically significant decrease in the levels of anxiety. Conclusions: This study suggests that the assessment of psychosocial factors, particularly the ongoing assessment of anxiety, could help in risk stratification and prediction of functional status and HRQoL in patients after cardiovascular surgery. Furthermore, the assessment of preoperative well-being should be integrated in routine care in order to identify and support patients with higher levels of anxiety.Öğe Brief review of right aortic arch with aberrant left subclavian artery(Thieme Medical Publishers, Inc., 2019) Öztaş, Didem Melis; Umutlu, Muzaffer; Ertan, Melike; Beyaz, Metin Onur; Badem, Serdar; Erdinç, İbrahim; Ulukan, Mustafa Özer; Ünal, Orçun; Conkbayır, Cenk; Alpagut, Ufuk; Uğurlucan, MuratDevelopment anomalies of the aortic arch and its major branches are rare congenitalcardiovascular disorders. In this article, we present aberrant left subclavian arteryassociated with right aortic arch.Öğe Cardioprotective effects of erythropoietin in diabetic rats determined by CD34 and vascular endothelial growth factor levels(Termedia Publishing House Ltd., 2020) Öztaş, Didem Melis; Meriç, Mert; Beyaz, Metin Onur; Önalan, Mehmet Akif; Sönmez, Kıvılcım; Öter, Kerem; Ziyade, Sedat; Ömer, Beyhan; Alpagut, Ufuk; Uğurlucan, MuratIntroduction: In this study, the effects of diabetes mellitus on the cardiovascular system were investigated by assessing the stem cell levels in serum and heart and compared with the normal population. Additionally, efficacy of erythropoietin, which is known to increase stem cells, was studied in diabetic rats.Material and methods: Twenty-five male Sprague Dawley rats were divided into three groups as a control group (group 1), diabetic group (group 2) and erythropoietin induced diabetic group (group 3). A diabetes model was created with streptozocin. In group 3 rats received 3000 U/kg of erythropoietin. At the end of 1 month blood reticulocyte levels, degree of tissue fibrosis and immunohistochemical assessment of reliable stem cell markers, CD34 and vascular endothelial growth factor (VEGF), were analyzed.Results: The increase in the blood glucose levels resulted in a significant decrease in reticulocyte levels in group 2. The increase in blood glucose levels resulted in a statistically significant increase in tissue level of fibrosis, CD34 and VEGF. When the rats in groups 1 and 2 were compared, the fibrosis, CD34 and VEGF levels were found to increase significantly. When group 2 and group 3 were compared, the amount of fibrosis was lower and the levels of CD34 and VEGF were significantly higher in group 3 than group 2.Conclusions: The results of our study indicated that the amount of CD34 and VEGF which function in cellular protection and tissue regeneration may be enhanced with safely applicable erythropoietin leading to increase in reticulocyte levels in serum, and CD34 and VEGF levels in right atrium, right ventricle, left atrium, and left ventricle as a protective mechanism in diabetic rats.Öğe Carotid artery plaque structure in the context of symptomatic/asymptomatic nature of carotid artery stenosis(Czech Society of Cardiology and Czech Society for Cardiovascular Surgery, 2021) Öztaş, Didem Melis; Tanören Bilen, Bukem; Türker Şener, Leyla; Beyaz, Metin Onur; Ulukan, Mustafa Özer; Ünal, Orçun; Ünlü, Mehmet Burçin; Reis, Paulo Eduardo Ocke; Uğurlucan, MuratObjective: 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.Öğe Carotid artery screening in asymptomatic individuals of different ethnic origins(Czech Society of Cardiology Z.S, 2022) Beyaz, Metin Onur; Önalan, Mehmet Akif; Öztaş, Didem Melis; Uğurlucan, MuratBackground 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.Öğe Çocukluk çağı damar yaralanmalarında cerrahi tedavi tecrübelerimiz(Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş., 2020) Beyaz, Metin Onur; Öztaş, Didem Melis; Vuran, Alican; U?urlucan, MuratAmaç: Çocuklarda vasküler yaralanmalar, uzun dönemde ekstremitede gelişim bozukluğu gibi ciddi komplikasyonlara neden olabileceğinden ayrı bir öneme sahiptir. Biz bu yazıda çocukluk çağı vasküler yaralanmalarında uyguladığımız tedavi yöntemlerini ve sonuçlarını paylaşmayı amaçladık. Gereç ve Yöntemler: Çocukluk çağı vasküler yaralanma nedeni ile opere edilen 32 hasta retrospektif olarak incelendi. Hastaların 30 (%93,75)’u erkek, 2 (%6,25)’si kadındı. Ortalama yaş 11,2 idi. On sekiz (%56,2) hastada kesici-delici alet yaralanması, 9 (%28,1) hastada ateşli silah yaralanması ve 5 (%15,6) hastada travmaya sekonder yaralanma mevcuttu. Revaskülarizasyon tekniği olarak üst ekstremite arteriyel yaralanması ile başvuran 3 hastada uç uca tamir tekniği, 1 hastada otolog ven ile “patch” plasti, 2 hastada otolog ven interpozisyonu uygulandı. Alt ekstremite yaralanmalarında ise 18 hastada uç uca tamir, 4 hastada ven interpozisyonu, 2 hastada venöz “patch” plasti ve 2 hastada primer onarım uygulandı. Bulgular: Radiyal artere primer tamir uygulanan bir hastada, 1. ayda iskemi oluşturmayan oklüzyon gelişti. Alt ekstremitede venöz “patch” plasti ve primer onarım yapılan birer olguda, psödoanevrizma gelişti. İzole popliteal arter yaralanması olan ve uç uca tamir uygulanan bir olguda, 1. ayda popliteal vende derin venöz tromboz saptandı ve medikal tedavi düzenlendi. Uyuşturucu madde kullanım öyküsüne sahip bir hastada, yara yeri enfeksiyonu gözlendi. Sonuç: Çocukluk çağında artan arteriyel yaralanmalar, ilk planda en doğru ameliyat yöntemi ve gereklilik hâlinde en doğru greft seçimi ile revaskülarize edilmeli, özellikle erken çocuk yaş grubunda büyüme ve gelişmenin devam ettiği göz ardı edilmemelidir.Öğe Comparison of atherectomy, drug-eluting balloon, and combined treatment efficiency by near infrared spectroscopy(Publicaciones Permanyer, 2021) Beyaz, Metin Onur; Demir, İbrahim; Ulukan, Mustafa ÖzerAtherosclerosis is a systemic pathology involving the entire vascular system. Smoking, hyperlipidemia, diabetes mellitus, advanced age, and hypertension are known risk factors for the development of atherosclerosis. Surgical treatment in peripheral arterial disease (PAD) has been replaced by endovascular treatment options in recent years due to mortality and morbidity. In our study, we aimed to present the effectiveness of atherectomy, drug-eluting balloon, and combined therapy with values determined by near-infrared spectroscopy (NIRS) in patients they have atherosclerotic PAD. Materials and methods: Patients with intermittent claudication or critical leg ischemia (Rutherford class 3 or more) have been viewed in the study. There were 30 male and 9 female patients. Patients were followed up before, at the 1st h after and at the 3rd month after the procedure, with simultaneous ankle-brachial pressure index (ABPI), walking distance measurements, and measurement of tissue oxygenation by NIRS method. Results: When patients with similar post-operative ABPI measurements were evaluated with NIRS, venous oxygenation was observed higher in patients used treatment methods combined with atherectomy. According to these results, we thought that treatment methods combined with atherectomy have increased microcirculation and collateral circulation more than other methods.Öğe Comparison of fentanil and remifentanil for coronary artery surgery with low ejection fraction(Termedia Publishing House Ltd., 2020) Baddal, Nükhet; Conkbayır, Cenk; Erdemli, Özcan; Karadeniz, Ümit; Tezcan, Büşra; Öztaş, Didem Melis; Beyaz, Metin Onur; Uğurlucan, Murat; Yıldız, Yahya; Yavaş, SonerIntroduction: In this study, we evaluated patient response and haemodynamic parameters in patients with low ejection fraction undergoing coronary bypass surgery with either fentanil or remifentanil in conjunction with etomidate.Material and methods: We evaluated 30 cases of coronary artery surgery, which were divided into two treatment groups (n = 15 each). In group F (fentanil group), the following regimen was employed for anaesthesia induction: 1 mg/kg lidocaine, 0.3 mg/kg etomidate, and, following a 1 µg/kg 60 s bolus dose of fentanil, a 0.1 µg/kg/min fentanil infusion was initiated, after which 0.6 mg/kg rocuronium was administered. In group R (remifentanil group), the following regimen was employed for anaesthesia induction: 1 mg/kg lidocaine, 0.3 mg/kg etomidate and, following a 1 µg/kg 60 s bolus dose of remifentanil, a 0.1 µg/kg/min remifentanil infusion was initiated, after which 0.6 mg/kg rocuronium was administered. Systolic artery pressure, diastolic artery pressure, mean arterial pressure, heart rate, SPO2 (saturation), cardiac output, stroke volume variance, central venous pressure, and systemic vascular resistance values were recorded for all study patients at five minutes before anaesthetic induction (T1), immediately following induction (T2), and immediately following intubation (T3).Results: The demographic values obtained for both groups were similar. We found that remifentanil use was associated with decreased cardiac output and increased fluctuations in both heart rate and mean values of arterial pressure.Conclusions: Although many studies have demonstrated remifentanil to be as safe as fentanil when titrated to an appropriate dose, our study suggests that fentanil may be a more appropriate choice during the induction of anaesthesia in patients with a low ejection fraction.Öğe Comparison of the apoptotic effects of topically applied papaverine, diltiazem, and nitroprusside to internal thoracic artery(Sociedade Brasileira de Cirurgia Cardiovascular, 2020) Ünal, Orçun; Ulukan, Mustafa Özer; Bakuy, Vedat; Kaytaz, Behiye; Artan, Sevilhan; Aral, Erinç; Öztaş, Didem Melis; Beyaz, Metin Onur; Uğurlucan, Murat; Sevin, BehçetObjective: To detect and to compare the apoptotic effects of intraoperatively topically applied diltiazem, papaverine, and nitroprusside.Methods: Internal thoracic artery segments of ten patients were obtained during coronary bypass grafting surgery. Each internal thoracic artery segment was divided into four pieces and immersed into four different solutions containing separately saline (Group S), diltiazem (Group D), papaverine (Group P), and nitroprusside (Group N). Each segment was examined with both hematoxylin-eosin and the terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL) method in order to determine and quantify apoptosis.Results: Apoptotic cells were counted in 50 microscopic areas of each segment. No significant difference was observed among the four groups according to hematoxylin-eosin staining. However, the TUNEL method revealed a significant increase in mean apoptotic cells in the diltiazem group when compared with the other three groups (Group S=4.25 +/- 1.4; Group D=13.31 +/- 2.8; Group N=9.48 +/- 2.09; Group P=10.75 +/- 2.37). The differences between groups were significant (P=0.0001). No difference was observed between the samples of the diabetic and non-diabetic patients in any of the study groups.Conclusion: The benefit of topically applied vasodilator drugs must outweigh the potential adverse effects. In terms of apoptosis, diltiazem was found to have the most deleterious effects on internal thoracic artery graft segments. Of the analyzed medical agents, nitroprusside was found to have the least apoptotic activity, followed by papaverine. Diabetes did not have significant effect on the occurrence of apoptosis in left internal thoracic artery grafts.Öğe Congenital cardiac interventions during the peak phase of COVID-19 pandemics in the country in a pandemics hospital in Istanbul(Cambridge University Press, 2020) Uğurlucan, Murat; Yıldız, Yahya; Öztaş, Didem Melis; Çoban, Şenay; Beyaz, Metin Onur; Sarı, Gizem; Ulukan, Mustafa Özer; Karakaya, Atalay; Vatansever, Binay; Erkanlı, Korhan; Meriç, Mert; Ünal, Orçun; Demirkol, Demet; Yozgat, Yılmaz; Sarıtaş, Türkay; Erdem, Abdullah; Akdeniz, Celal; Türkoğlu, HalilIntroduction: In this report, we aim to present our algorithm and results of patients with congenital cardiac disorders who underwent surgical or interventional procedures during the peak phase of the pandemics in our country. Patients and methods: The first COVID-19 case was diagnosed in Turkey on 11 March, 2020, and the peak phase seemed to end by the end of April. All the patients whom were referred, treated, or previously operated but still at the hospital during the peak phase of COVID-19 pandemics in the country were included into this retrospective study. Patient's diagnosis, interventions, adverse events, and early post-procedural courses were studied. Results: Thirty-one patients with various diagnoses of congenital cardiovascular disorders were retrospectively reviewed. Ages of the patients ranged between 2 days and 16 years. Seventeen cases were males and 14 cases were females. Elective cases were postponed. Priority was given to interventional procedures, and five cases were treated percutaneously. Palliative procedures were preferred in patients whom presumably would require long hospital stay. Corrective procedures were not hesitated in prioritised stable patients. Mortality occurred in one patient. Eight patients out of 151 ICU admissions were diagnosed with COVID-19, and they were transferred to COVID-19 ICU immediately. Three nurses whom also took care of the paediatric cases became infected with SARS-CoV-2; however, the children did not catch the disease. Conclusion: Mandatory and emergent congenital cardiac percutaneous and surgical procedures may be performed with similar postoperative risks as there are no pandemics with meticulous care and preventive measures.Öğe Coronary arteries arising from single coronary ostium: A case report(NLM (Medline), 2019) Conkbayır, Cenk; Çoşkun, U?ur; Öztaş, Didem Melis; Beyaz, Metin Onur; Meriç, Mert; U?urlucan, MuratAdvanced diagnostic systems and healthcare screening programs enabled increased diagnosis of congenital cardiovascular anomalies, including variations in coronary arteries. Single coronary artery is a rare congenital cardiovascular malformation in which all three main coronary arteries originate from a single coronary trunk. In this report, we present a patient with single coronary ostium giving rise to the left and right coronary artery systems, which was diagnosed incidentally with coronary computerized tomography and confirmed with conventional angiography.Öğe Current strategies for the management of anomalous origin of coronary arteries from the pulmonary artery(NLM (Medline), 2021) Beyaz, Metin Onur; Çoban, Şenay; Ulukan, Mustafa Özer; Do?an, Mehmet Sait; Erol, Cengiz; Sarıtaş, Türkay; Erdem, Abdullah; Akdeniz, Celal; U?urlucan, Murat; Akçevin, Atıf; Türko?lu, HalilINTRODUCTION: The coronary arteries, which have to originate from the aorta, may sometimes rise from the pulmonary artery. This study evaluated clinical and diagnostic findings, treatment methods, and follow up of cases with anomalous coronary arteries arising from the pulmonary artery. PATIENTS AND METHODS: Eight patients with the diagnosis of anomalous left coronary artery from the pulmonary artery (ALCAPA) (N = 6) and anomalous right coronary artery from the pulmonary artery (ARCAPA) (N = 2), between January 2014 and January 2020 from a single center university hospital, were included in the study. Data from patients' demographic characteristics, electrocardiography, echocardiography, angiographic findings, operation, hospitalization, and follow up were evaluated. RESULTS: The study included eight patients (six females and two males) - six patients with ALCAPA and two with ARCAPA. The ages of the patients ranged between 3-135 (average: 53.25) months. The median body weight was calculated as 17.4 kg. Severe mitral valve insufficiency was detected in two patients and two other patients had a moderate degree of mitral insufficiency on echocardiography. Ejection fractions ranged between 16-74%. One patient had perimembranous malalignment large ventricular septal defect with pulmonary stenosis. Operative techniques were Takeuchi procedure (three patients), direct implantation (four patients), and left internal thoracic artery to left main coronary artery bypass (one patient). Mechanical cardiac support was not required in the postoperative period. Mortality did not occur. Mitral insufficiency and ejection fractions improved following correction of the coronary anatomy. CONCLUSION: It is important to diagnose the ALCAPA or ARCAPA, where the coronary artery originates from the pulmonary artery. Patients should be treated before congestive heart failure and fatal complications occur. Surgical correction should be planned regardless of symptom status, even though some of patients reach adulthood with an increased number of collaterals.Öğe Effects of diosmin-hesperidin and low pressure compression stocking combination in superficial venous insufficiency(2021) Beyaz, Metin Onur; Ata, Emin CanAim: The main aim of the study is to investigate the efficacy and patient tolerance of Daflon 1000mg/day and low-pressure compression stocking combination in the treatment of superficial venous insufficiency. Materials and Methods: This prospective study included 112 patients diagnosed with superficial venous insufficiency and reflux in saphenofemoral junction during March 2018 and 2019 at our center. All the patients received 1000 mg micronized purified flavonoid fractions containing 90% diosmin-10% hesperidin and low-pressure venous compression stockings (15-20 mmHg) throughout the study. Patients superficial, perforator, and deep venous systems were evaluated by Doppler US at the beginning and average of 5.3 ± 3.7 months after treatment. Results: A total of 99 (88.4%) patients out of 112 eligible patients completed the investigation. The mean age was 41±12.6, the female was 66 (58.9%), the mean follow-up was 5.3±3.7 months. Pre-treatment and post-treatment diameters of SFJ were 6.27±2.9 and 5.68±1.8 mm, respectively, this was statistically significant (P=0.033). All of the patients have SFJ reflux initially, after the treatment, patients with SFJ reflux were decreased to 44 (44.4%), this was also statistically significant (P<0.001, OR:0.004, 95% CI: 0.0002-0.07). We also found significant improvement in grade III and grade IV reflux (P<0.05) after treatment. The symptomatic patients decreased from 63 to 16 after treatment, this was statistically severely significant (P<0.001, OR:0.11, 95% CI: 0.056-0.216). During the follow-up period, 6 (5.4%) patients were worsened and underwent surgical intervention, this was not statistically significant (P=0.076). Conclusion: Daflon 1000mg/day with a combination of low- pressure CS well tolerates by venous insufficiency patients. Six months of continuous application may reduce the reflux of SFJ and VSM, and causes marked symptomatic relief.Öğe Efficacy of rotational atherectomy followed by drug-coated balloon angioplasty for the treatment of femoropopliteal lesions-comparison with sole drug-coated balloon revascularization: Two-year outcomes(Elsevier Inc., 2021) Rodoplu, Orhan; Öztaş, Didem Melis; Meriç, Mert; Beyaz, Metin Onur; Ulukan, Mustafa Özer; Yıldız, Cenk Eray; Ünal, Orçun; Uğurlucan, MuratBackground: We aimed to evaluate the results of the combined use of rotational atherectomy (RA) followed by drug-coated balloon (DCB) treatment against DCB angioplasty alone in patients who had significantly calcified and symptomatic femoropopliteal peripheral arterial disease. Methods: Patients presented to the clinic with symptoms of chronic limb ischemia of femoropopliteal segment such as moderate or severe claudication and rest pain, who received endovascular therapy between January 2016 and January 2018 in our hospital comprised the study cohort and investigated, retrospectively. Patients with minor or major tissue loss were excluded from the study. We evaluated the effect of RA system followed by DCB with DCB alone in 121 patients and a total of 226 significantly calcified and symptomatic femoropopliteal lesions. Fifty-eight patients and 112 (49.5%) lesions were treated with RA + DCB, whereas 63 patients and 114 (50.5%) lesions were treated with DCB only. The mean age was 61.2 ± 9.7 years. Primary patency is evaluated with duplex ultrasound/angiography at 6, 12, and 24 months and with angiography on 12 and 24 months. Patients were followed up for 24 months to assign clinically driven target lesion revascularization (TLR). Overall survival rates were 96.5% (56/58) in RA + DCB group and 93.6% (59/63) in DCB alone group both at one-year and two-year follow-up. Amputation-free survival rates of RA + DCB and DCB-only groups are 96.5% (56/58) to 87.3% (55/63) at one year, and 94.8% (55/58) to 82.5% (52/63) at two years, respectively. Results: Baseline characteristics of groups were similar. The lesions were longer in the RA + DCB group than the DCB alone group (14.4 ± 5.2 cm vs. 10.2 ± 3.1 cm; P = 0.05). The technical success rate in the RA + DCB group was superior to that of DCB-only group (95.4% vs. 84.8%, P = 0.006). The 12-month and 24-month patency rates with angiography in the RA-DCB group were similar to those in the DCB-only group (85.7% vs. 74.6% and 73.2% vs. 62.7%, respectively). The rates of bailout stenting were significantly lower among patients treated with RA + DCB (n = 3; 5.1% vs. n = 13; 20.6%, P < 0.001). The rates of flow-limiting dissections and vessel recoils after procedures were significantly in RA + DCB group (n = 2; 3.4% vs. n = 8; 12.6%, P < 0.001) than DCB only (n = 1; 1.7% vs. n = 4; 6.3%, P < 0.002). The freedom from TLR rate was significantly increased in the RA + DCB group at 12 months (95.2% vs. 76.3%, P = 0.002) and 24 months (93.4% vs. 63.7%, P = 0.002). The mean ankle brachial index at discharge in the RA-DCB group improved by 0.35 ± 0.24, and in the DCB-only group, it was 0.30 ± 0.23 (P = 0.683). Conclusions: Combined use of RA and DCB treatment is an effective, safe, and durable method for the treatment of the complex femoropopliteal lesions. Combination of RA and DCB angioplasty reveals increased technical success, fewer flow-limiting dissections, significantly reduced TLR, and bailout stenting rates compared with sole DCB angioplasty.Öğe 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 Özer; Karakaya, Atalay; Erkanlı, Korhan; Beyaz, Metin Onur; Öztaş, Didem Melis; Uğurlucan, MuratBackground: 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.Öğe Evaluation of chronic inflammation in the aetiology of venous insufficiency by investigating cytomegalovirus DNA(Termedia Publishing House Ltd, 2022) Beyaz, Metin Onur; Bozkurt, Emre; Önalan, Mehmet Akif; Öztaş, Didem Melis; Meriç, Mert; Ulukan, Mustafa Özer; Coşkun, Uğur; Uğurlucan, MuratIntroduction: Lower extremity venous insufficiency is a significant health problem with economic and sociological consequences, lowering the quality of life, and sometimes leading to serious complications. The aim of this study is to evaluate the cytomegalovirus (CMV) effect on chronic inflammation in the aetiology of chronic venous insufficiency. Material and methods: Between November 2017 and August 2018, 468 patients who underwent radio-frequency ablation therapy and phlebectomy were included in the study. PCR analyses for CMV DNA were performed on the venous tissue samples. Patients with post-thrombotic syndrome were excluded from the study. After ethical approval, the relationship between the presence of CMV DNA, gender, body mass index, and bilaterality of chronic venous insufficiency were investigated. Results: When the relationship between CMV DNA and gender or body mass index was examined, a significant relationship was not detected. But when the patients with bilateral chronic venous insufficiency and patients with unilateral chronic venous insufficiency were compared regarding CMV DNA positivity, the patients with bilateral chronic venous insufficiency had significantly higher CMV DNA positivity (p = 0.002). Also, the incidence of venous ulcers in the CMV DNA exposed group was significantly higher. Conclusions: In the literature there are many studies showing that CMV triggers atherosclerosis, but there is no study in which CMV directly produces chronic venous insufficiency. The high rates of positivity suggest that CMV, which is the basis of chronic inflammation, may be a significant factor in the aetiology of chronic venous insufficiency.Öğe Follow-up results of aortic arch cervical debranching performed with the help of a temporary crossover external carotid artery bypass for cerebral protection followed by endovascular thoracic aortic aneurysm repair(Oxford University Press, 2020) Öztaş, Didem Melis; Uğurlucan, Murat; Beyaz, Metin Onur; Ulukan, Mustafa Özer; Ünal, Orçun; Önal, Yılmaz; Umutlu, Muzaffer; Acunaş, Bülent; Alpagut, UfukOBJECTIVES: Treating aortic arch aneurysms with conventional open surgical and endovascular stent graft procedures is challenging due to the complex anatomy of the arch and the arteries arising from it that nourish the brain. Cerebral protection is of the utmost importance during the treatment of thoracic aneurysms involving the aortic arch.METHODS: Between May 2014 and November 2018, 7 patients with thoracic aortic aneurysms involving the aortic arch who underwent aortic arch cervical debranching with our technique were reviewed retrospectively. Because all the patients being considered for conventional surgical aortic arch replacement had serious comorbidities, they were selected to receive hybrid therapy. The mean age of the patients was 71.2 +/- 9.4 years. One patient was a woman and 6 patients were men. One patient was given general anaesthesia; the remaining 6 patients had a regional block. A crossover temporary bypass was performed between the external carotid arteries with a 6-mm polytetrafluoroethylene graft for cerebral protection in all patients. Thoracic endovascular aortic repair (TEVAR) was successfully performed in all patients except 1 following debranching.RESULTS: Neurological complications did not occur during the procedures. Patients were followed for a mean of 18.3 +/- 4.9 months. One female patient died of exacerbating chronic obstructive pulmonary disease within the first follow-up year. Three other patients died: 1 died of natural causes; 1 died of pneumonia followed by multiorgan failure; and 1 died of myocardial infarction during the mid-term follow-up period. The remaining patients are still being followed and are event free.CONCLUSIONS: Endovascular treatment of thoracic aortic diseases involving the aortic arch is facilitated when the aortic arch is debranched. Our cerebral protection method with a temporary crossover bypass between the external carotid arteries provides continuous pulsatile blood flow to the brain; hence, neurologically, it is a reliable procedure. The follow-up results of the patients who underwent aortic arch cervical debranching followed by TEVAR depended on their comorbidities.
