Hybrid vascular surgery approaches for multilevel arterial occlusive disease

BACKGROUND

The incidence of multilevel vascular occlusive disease is increased with patient age. Multilevel arterial occlusive disease cases are some of the hardest in the vascular surgical realm because of the comorbidities. In these high-risk patients inflow constrictions may limit the success of distal bypasses. At the same time the constrictions in the outflow may necessitate long bypass circuits that have less long-term patency rates.

METHODS

Our study included 38 patients with multilevel arterial occlusive disease to whom hybrid vascular approaches were applied between January 2005 and December 2011 in Şişli Florence Nightingale Hospital. The patient group had a mean age of 68.1 (48-98) and included 29 male (89%) and 9 female (11%) patients. Complaints were claudication under 100 meters of walking in 19 patients (50%), resting pain in 14 patients (36%), and disturbed tissue integrity in 5 patients (14%). Mean in-hospital stay was calculated to be 6.4 days (4-15). In one patient (2.6%), a second procedure was necessary due to graft thrombosis and this case resulted in amputation under the level of the knee. Minor toe amputations in a second session were applied to 5 patients (14%) with symptoms of foot sores. Wound infections occurred in two patients (5%) and were treated with antibiotherapy and wound care.

RESULTS

At the end of the follow-up time, extremity survival was found to be 94.1%.

CONCLUSIONS

In the treatment of multilevel peripheral arterial occlusive disease, a hybrid approach is a treatment option which is less invasive and sufficient.

Hyperhomocysteinemia in patients with arterial occlusive disease

PURPOSE

Hyperhomocysteinemia (HHCA) is defined as an independent risk factor for atherothrombotic vascular disease; therefore, screening for HHCA is recommended. However, the incidence and characteristics of HHCA in patients with vascular disease remain unclear. We conducted this study in an attempt to resolve these issues.

METHODS

This nonrandomized prospective study included 56 patients who were admitted with occlusive arterial disease (group I), and 39 control patients without occlusive arterial disease (group II). We recorded all the demographic data of both groups and collected blood samples for fasting homocysteine, vitamin B(12), and folic acid. All of the patients were followed up and the results were compared.

RESULTS

The mean concentration of homocysteine was 12.69 +/- 3.82 micromol/l in group I and 10.46 +/- 5.08 micromol/l in group II (P = 0.00048). In group I, the mean homocysteine levels for patients aged > or =70 years and those aged <70 years were 13.74 +/- 3.02 and 11.55 +/- 4.15 micromol/l, respectively (P = 0.021). There was no significant difference in mortality between the patients with HHCA and those with normal homocysteine levels during follow-up.

CONCLUSION

The incidence of hyperhomocysteinemia was higher in the patients with occlusive vascular disease than in the control patients. More evidence of the association with vitamins B(12) and folate and the benefits of homocysteine-lowering therapy is needed since we found no relationship between these vitamins and homocysteine in this study.

Cyanoacrylate for Wound Closure in Prosthetic Vascular Graft Surgery to Prevent Infections Through Contamination

PURPOSE

Prosthetic vascular graft infection (PVGI) still occurs at an unacceptably high rate, despite the many measures that have proven effective against infection. The major cause of PVGI is perioperative contamination, which usually occurs before a histological barrier is completed and may threaten graft viability. We assessed the efficacy of cyanoacrylate as a tissue adhesive and barrier against early contamination through the skin.

METHOD

A 1 x 0.5-cm Dacron graft was placed subcutaneously under sterile conditions in 16 Sprague-Dawley rats. The skin was closed with polypropylene sutures in eight rats (group A) and with N-butyl 2-cyanoacrylate in eight rats (group B). The closed incisions were then contaminated with 75 x 10(6) cfu/ml methicillin-sensitive Staphylococcus aureus. Microbiological and histopathological assessments were done 7 days later, after the rats were killed.

RESULTS

All of the graft cultures from group A (8/8) were positive for S. aureus whereas all of those from group B (0/8) were negative. This difference was significant (p < 0.001). Histological examination revealed denser inflammatory cell infiltration in group A than in group B.

CONCLUSIONS

Maintaining skin integrity after closure is of the utmost importance because contamination during the first hours of the procedure may cause PVGI. Cyanoacrylate seems to be a promising molecule not only because of its bacteriostatic effects, but also because it seals the barrier effectively and immediately.

Vascular reconstruction in Buerger's disease: is it feasible?

PURPOSE

Thromboangiitis obliterans (Buerger's disease) is a clinical syndrome characterized by segmental occlusions of the distal vessels. Although a cessation of using nicotine products usually helps, nevertheless a surgical revascularization may be needed in cases of stage III and IV limbs. Because of the distal and segmental nature of the disease, these procedures are rarely feasible. This article focuses on the feasibility of performing a vascular reconstruction in thromboangiitis obliterans.

METHODS

Thirty-six of 94 patients (38.3%) who were followed by the Peripheral Vascular Unit of Istanbul Medical Faculty were selected for revascularization and 27 of 36 (81%) patients underwent revascularization procedures.

RESULTS

During a 36-month follow-up, the patency rates at the 12th, 24th, and 36th months were 59.2%, 48%, and 33.3%, respectively. The limb salvage rate was 92.5%.

CONCLUSIONS

Since patients affected by Buerger's disease consist a group of young population who are still in their productive stages, every effort should be taken to obtain a limb salvage in the ischemic period. Although the patency rates do not seem promising, the limb salvation rate was quite satisfactory.

Separate origins of the left internal and external carotid arteries from the aortic arch: MR angiographic findings

Agenesis of the left common carotid artery with independent origins of the internal and external carotid arteries arising directly from the aortic arch is an extremely rare congenital anomaly. We present MR angiographic findings in a case with agenesis of left common carotid artery that, to our knowledge, is unique by virtue of its detection and description with MR angiography.

Interferon alfa-2a in the treatment of Behçet's disease

BACKGROUND

There is no definite treatment for Behçet's disease. New drugs are being evaluated in cases unresponsive to conventional treatment modalities.

OBJECTIVE

In this study we investigated the efficacy of interferon alfa-2a on skin lesions in 18 Behçet's disease patients who had predominantly mucocutaneous involvement.

METHODS

Eighteen patients with Behçet's disease were treated with interferon alfa-2a at 3 million IU/day in the first week (three times a week), 6 million IU/day in the second week (three times a week), 9 million IU/day in the third week and thereafter (three times a week). Interferon alfa-2a was administered subcutaneously for a total of 12 weeks.

RESULTS

At the end of the treatment the efficacy of the drug was found to be good in 9 patients and very good in 7 patients. Interferon alfa-2a is particularly effective in skin manifestations such as genital ulceration and erythema-nodosum-like lesions. It was also found to be effective in systemic manifestations such as fever, diarrhea and eye involvement.

CONCLUSION

Our results indicate that interferon alfa-2a is a promising drug in the treatment of Behçet's disease.

Free oxygen radicals in restraint-induced stress gastritis in the rat

In this experimental study, the role of free oxygen radicals (FOR) in stress gastritis (SG) was investigated in a restraint stress model for rats. Allopurinol, dimethyl sulfoxide (DMSO), and superoxide dismutase (SOD) were tested as single agents in controlled groups. The portal blood pH values, the ratio of the mucosal erosion area to the gastric mucosal area (EA/MA), the ratio of the depth of mucosal erosions to the concomitant gastric mucosal wall (ED/MD), and concentrations of malondialdehyde (MDA)--a lipid peroxidation coproduct--in the gastric mucosa were used as parameters in the experiment. The EA/MA between the treated and untreated control groups were found to have no statistically significant difference (P > 0.05). ED/MD, a crucial determinant for bleeding probability, was found to be decreased in the SOD group (P < 0.05). SOD, allopurinol, and DMSO reduced the mucosal MDA concentration to lower values than the untreated group (P < 0.05). We concluded that although FOR may not play a dominant role in stress-induced gastric lesions, SOD may be a good candidate for a clinical trial on SG prophylaxis.

A contemporary evaluation of enteric perforations in typhoid fever: analysis of 257 cases

Of the 257 typhoid enteric perforations analysed at the Departments of General and Paediatric Surgery, Ankara University Hospital, through the years 1979-1986, 74.9% were males, while the patients mean age was 35.8 years. The early signs and symptoms averaged 5.9 days. The corresponding percentages for the occurrence of abdominal pain, fever, nausea and vomiting and central nervous system disorders which constituted the clinical findings were 97.27, 51, 61.2 and 18 respectively. While the mean value for the white blood count ranged around 6600, only 61.9% of the cases had diagnostic findings in their erect abdominal roentgenograms. The standard method for the treatment of typhoid enteric perforations is still presently primary suturing of the perforated viscus and peritoneal drainage. Despite the use and misuse of a large variety of antibiotics, typhoid perforations still have a high morbidity of 74.1% and a mortality of 31.4%. Generalized peritonitis (78.4%), is considered to be to the most important cause in both situations.