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Diken AI, Özyalçın S, Hafez İ, Alemdaroğlu U, Tünel HA, Hanedan O. Radiofrequency ablation of the great saphenous vein; does the choice of monopolar or bipolar catheters affect outcomes? Phlebology 2023:2683555231174997. [PMID: 37155634 DOI: 10.1177/02683555231174997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVES Radiofrequency-based procedure is one of the leading methods of endovenous thermal ablation. The most fundamental difference with regards to currently available radiofrequency ablation systems is the way of electric current flow given to the vein wall; bipolar segmental and monopolar ablation. This study aimed to compare the monopolar ablation method with conventional bipolar segmental endovenous radiofrequency ablation method for the management of incompetent saphenous veins. METHODS Between November 2019 and November 2021, 121 patients with incompetent varicose veins who were treated either with the F-Care/monopolar (N = 49) or ClosureFast/bipolar (N = 72) were included in the study. A single extremity of each patient with isolated great saphenous vein insufficiency was enrolled. The differences between the two groups in demographic parameters, disease severity, treated veins, peri- and postoperative complications, and treatment efficacy indicators were retrospectively evaluated. RESULTS There was no statistically significant difference between the groups regarding demographic parameters, disease severity, and treated veins in preoperative period (p > 0,05). The average procedural time was 21.4 ± 4 minutes in the monopolar group, while it was 17.1 ± 3 minutes in the bipolar group. In both groups, the venous clinical severity scores declined significantly compared with the preoperative period, however; there was no difference between groups (p > 0,05). The occlusion rate of the saphenofemoral junction and proximal saphenous vein after 1 year was 94.1% in the bipolar group and 91.8% in the monopolar group (p = 0.4) while there was a significant difference in the occlusion rate of the shaft and distal part of the saphenous vein (93.2% in the bipolar group and 80.4% in the monopolar group, p = 0.04). Postoperative complications (bruising and skin pigmentation) were slightly higher in the bipolar group (p = 0.02, p = 0.01). CONCLUSIONS Both systems are effective in treating the venous insufficiency of the lower extremity. Monopolar system revealed a better early postoperative course with similar occlusion rate of the proximal part of saphenous vein compared with bipolar system, however; the occlusion of the lower half of the saphenous vein was significantly lower which may negatively affect long-term occlusion rates and recurrence of the disease.
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Affiliation(s)
- Adem I Diken
- Faculty of Medicine, Department of Cardiovascular Surgery, Baskent University, Adana, Turkey
| | - Sertan Özyalçın
- Faculty of Medicine, Department of Cardiovascular Surgery, Hitit University, Corum, Turkey
| | - İzzet Hafez
- Faculty of Medicine, Department of Cardiovascular Surgery, Baskent University, Adana, Turkey
| | - Utku Alemdaroğlu
- Faculty of Medicine, Department of Cardiovascular Surgery, Baskent University, Adana, Turkey
| | - Hüseyin A Tünel
- Faculty of Medicine, Department of Cardiovascular Surgery, Baskent University, Adana, Turkey
| | - Onur Hanedan
- Department of Cardiovascular Surgery, University of Health Sciences Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Trabzon, Turkey
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Yener AÜ, Yalçinkaya A, Yener Ö, Çelik EC, Hanedan O, Çiçek MC, Çiçek ÖF. The effects of pharmacomechanical thrombectomy on novel complete blood count parameters in deep vein thrombosis: A retrospective study. Medicine (Baltimore) 2023; 102:e33008. [PMID: 36800586 PMCID: PMC9936038 DOI: 10.1097/md.0000000000033008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/27/2023] [Indexed: 02/19/2023] Open
Abstract
This study aimed to investigate the effects of pharmacomechanical thrombectomy on novel complete blood count parameters in deep venous thrombosis. This retrospective study included 242 patients aged >18 years who were treated for deep venous thrombosis. Patients were grouped as follows: group 1 was accepted as having interventional operations (n = 123) and group 2 was accepted as having only medical advice (n = 119). Routine complete blood count parameters, the neutrophil-to-lymphocyte ratio (NLR), and the platelet-to-lymphocyte ratio (PLR) were compared. There was no difference between the groups in terms of admission hemoglobin, hematocrit, mean platelet volume, NLR and PLR (P = .11, P = .24, P = .55, P = .93, and P = .96, respectively). In the pharmacomechanic thrombectomy group, NLR and PLR were significantly reduced after intervention when compared to the admission values (P < .001 and P < .001, respectively). However, the NLR and PLR values of medically treated patients did not differ significantly from their baseline values (P = .16 and P = .08, respectively). In this study, we effectively removed the thrombus load in blocked proximal veins using pharmacomechanical thrombectomy and observed a significant decrease in NLR and PLR, which are current, inexpensive, and accessible parameters.
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Affiliation(s)
- Ali Ümit Yener
- Department of Cardiovascular Surgery, University of Health Science Antalya Education and Training Hospital, Antalya, Turkey
| | - Adnan Yalçinkaya
- Department of Cardiovascular Surgery, University of Health Science Antalya Education and Training Hospital, Antalya, Turkey
| | - Özlem Yener
- Department of Radiology, Atatürk State Hospital, Antalya, Turkey
| | - Ekin Can Çelik
- Department of Cardiovascular Surgery, University of Health Science Antalya Education and Training Hospital, Antalya, Turkey
| | - Onur Hanedan
- Department of Cardiovascular Surgery, University of Health Science AhiEvran Education and Training Hospital, Trabzon, Turkey
| | | | - Ömer Faruk Çiçek
- Department of Cardiovascular Surgery, Selçuk University Faculty of Medicine, Konya, Turkey
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Diken AI, Yalçınkaya A, Hanedan O, Günertem E, Demir E, Erol E. Effect of tandem lesions on haemodynamic parameters: an experimental study. Kardiol Pol 2017; 75:1315-1323. [PMID: 28832097 DOI: 10.5603/kp.a2017.0163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 07/03/2017] [Accepted: 07/20/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND The morphology and extensity of the stenotic lesion is crucial as well as the obstruction ratio. It is well known that the complexity of lesions has a direct impact on endovascular treatment (PTCA/stent); however, the arrangement of the lesions is underestimated and not well studied. AIM We sought to evaluate the haemodynamic effects of different stenotic lesion models and arrangements in vitro. METHODS Vascular circulation was simulated in vitro. Oxygenator, tubing set, polytetrahidroflouroethylene synthetic graft, pressure and flow rate, sensors were used to build the simulation model. Measurements of isolated short, isolated long, identical stenotic tandem short, identical stenotic tandem long, sub-critical long, and critical short lesion combinations were performed and haemodynamic parameters were recorded. RESULTS Tandem lesions were more likely to result in critical stenosis comparing single lesions with the same obstruction ratio. This difference became more significant as the obstruction ratio was raised. Tandem long lesions also resulted in more critical stenosis than tandem short lesions. It can be claimed that tandem lesions can result in more flow restriction with reference to single lesions with the same stenotic ratio. Contrary to expectations, tandem short lesions were found to be more stenotic compared with the same degree long individual lesions. CONCLUSIONS It is effortless to give the decision for simple, discrete and individual lesions, while the ideal decision for long and complicated lesions may remain unclear. Even if these "grey zone" lesions are considered non-critical while investigating them one by one, it must be kept in mind that the overall stenotic effect of these lesions may lead to more haemodynamic impairment.
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Affiliation(s)
- Adem Ilkay Diken
- Hitit University Faculty of Medicine, Cardiovascular Surgery, çamlık caddesi no:2, 19000 çorum, Turkey.
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Uzun A, Diken AI, Yalçinkaya A, Hanedan O, Ciçek ÖF, Lafçi G, Altintaş G, Cağli K. Long-term patency of autogenous saphenous veins vs. PTFE interposition graft for prosthetic hemodialysis access. ACTA ACUST UNITED AC 2016; 14:542-6. [PMID: 25233501 DOI: 10.5152/akd.2014.4910] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Prosthetic vascular access is the other choice when the superficial venous system is inadequate to perform a simple radio-cephalic and brachio-cephalic fistula. METHODS This paper reports the outcomes of a prospective cohort study of 54 patients who underwent either saphenous vein (SVI Group, n=29) or PTFE graft (PTFE Group, n=25) interposition surgery for prosthetic hemodialysis access. All patients were evaluated via color Doppler ultrasonography during preoperative course and superficial venous systems of these patients were found inadequate to perform simple radial/brachial artery-cephalic vein anastomosis. Follow-up was performed for every 6-months period. Kaplan-Meier analysis and Log Rank test was used for estimation and comparison of the patency. RESULTS In SVI group access failure was observed in 5 of 29 patients (17.2%). In PTFE group, access failure was observed in 13 of the 25 patients (52%). Primary patency rate was 93% in 12th month and 82% in 24th month in SVI group while it was 88% in 12th month and 56% in 24th month in PTFE group. According to the Kaplan-Meier method, mean time of primary patency was significantly higher in SVI group when compared to PTFE group (33.03±1.32 months vs. 28.16±1.91 months, Log Rank chi-square value: 7.01, df:1, p=0.008). Secondary patency rate was 96% in 12th month and 93% in 24th month for SVI group while 96% in 12th month and 84% in 24th month for PTFE group. According to the Kaplan-Meier method, mean time of secondary patency was significantly higher in SVI group when compared to PTFE group (34.27±0.95 months vs. 31.16±1.40 months, Log Rank chi-square value: 7.33, df:1, p=0.007). CONCLUSION Autologous saphenous vein can be preferably chosen as a prosthetic hemodialysis access graft due its higher primary and secondary patency, lower complication rate and cost when compared with PTFE grafts.
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Affiliation(s)
- Alper Uzun
- Clinic of Cardiovascular Surgery, Ankara Education and Research Hospital, Ankara-Turkey.
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Diken AI, Diken OE, Hanedan O, Yılmaz S, Ecevit AN, Erol E, Yalçınkaya A. Pentamidine in Pneumocystis jirovecii prophylaxis in heart transplant recipients. World J Transplant 2016; 6:193-198. [PMID: 27011917 PMCID: PMC4801795 DOI: 10.5500/wjt.v6.i1.193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 10/21/2015] [Accepted: 12/08/2015] [Indexed: 02/05/2023] Open
Abstract
Despite advances in transplantation techniques and the quality of post-transplantation care, opportunistic infections remain an important cause of complications. Pneumocystis jirovecii (P. jirovecii) is an opportunistic organism, represents an important cause of infections in heart transplantation patients. Almost 2% to 10% of patients undergoing cardiac transplantation have Pneumocystis pneumonia. Prophylaxis is essential after surgery. Various prophylaxis regimes had been defined in past and have different advantages. Trimethoprim/sulfamethoxazole (TMP/SMX) has a key role in prophylaxis against P. jirovecii. Generally, although TMP/SMX is well tolerated, serious side effects have also been reported during its use. Pentamidine is an alternative prophylaxis agent when TMP/SMX cannot be tolerated by the patient. Structurally, pentamidine is an aromatic diamidine compound with antiprotozoal activity. Since it is not effectively absorbed from the gastrointestinal tract, it is frequently administered via the intravenous route. Pentamidine can alternatively be administered through inhalation at a monthly dose in heart transplant recipients. Although, the efficiency and safety of this drug is well studied in other types of solid organ transplantations, there are only few data about pentamidine usage in heart transplantation. We sought to evaluate evidence-based assessment of the use of pentamidine against P. jirovecii after heart transplantation.
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Diken Aİ, Altıntaş G, Yalçınkaya A, Lafçı G, Hanedan O, Çağlı K. Surgical Strategy for Moderate Ischemic Mitral Valve Regurgitation: Repair or Ignore? Heart Surg Forum 2014; 17:E201-5. [DOI: 10.1532/hsf98.2014337] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
<p><strong>Background:</strong> Ischemic heart disease is a significant complication of atherosclerosis. Myocardial infarction after the development of coronary artery disease can lead to a number of serious complications, including ischemic mitral regurgitation (IMR). Currently there is no consensus regarding the preferred therapeutic modality for moderately severe IMR. In this study, the postoperative outcome of concomitant coronary artery bypass (CABG) and mitral valve repair was compared with that of CABG alone in two groups of patients with moderately severe IMR.</p><p><strong>Methods:</strong> A total of 84 patients who underwent operations for coronary artery disease and moderately severe IMR were included in the study. Preoperative demographic and clinical characteristics were recorded at the time of admission. The severity of mitral regurgitation was graded using transthoracic echocardiography and left ventriculography.</p><p><strong>Results:</strong> Significant postoperative improvements were observed in ejection fraction and systolic diameter compared to preoperative values (<em>P</em> = .006 and <em>P</em> = .020 respectively, in the intervention group, <em>P</em> = .001 and <em>P</em> = .001 respectively, in the control group). The decrease in pulmonary artery pressure (PAP) was significant only in the intervention group (<em>P</em> = .001). There was a significantly marked reduction in the severity of IMR in the intervention group compared to control.</p><p><strong>Conclusion:</strong> Surgical repair of the mitral valve in conjunction with CABG for moderately severe IMR appears to be more effective than isolated CABG for certain outcome parameters, including decreased severity of mitral regurgitation and decreased pulmonary artery pressure.</p>
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Altintas G, Diken AI, Hanedan O, Yurdakok O, Ozyalcin S, Kucuker SA, Ozatik MA. The Sorin Freedom SOLO stentless tissue valve: early outcomes after aortic valve replacement. Tex Heart Inst J 2013; 40:50-55. [PMID: 23466929 PMCID: PMC3568268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We prospectively evaluated the hemodynamic performance of the SORIN Freedom SOLO aortic bioprosthesis, a stentless bovine pericardial valve designed for supra-annular implantation. Forty patients (mean age, 71.68 ± 5.25 yr; 29 men) with severe aortic stenosis underwent aortic valve replacement from January 2008 through August 2009. Patients were evaluated by transthoracic echocardiography and clinical examination, both preoperatively and again at 6 and 24 postoperative months. Peak and mean transvalvular gradients, end-diastolic and end-systolic diameters, interventricular septal and posterior wall thicknesses, indexed volumes of ventricular mass, degrees of aortic regurgitation, and left ventricular ejection fractions were calculated echocardiographically. The valves were implanted with single polypropylene sutures. In the early postoperative period, 1 patient (2.5%) died of multiorgan failure. The mean aortic cross-clamp time was 86.05 ± 34.2 min. Echocardiographic peak gradients were 84.54 ± 16.85 mmHg (preoperative), 29.59 ± 6.27 mmHg (6 mo postoperative), and 24.33 ± 4.67 mmHg (24 mo postoperative) (P < 0.001); left ventricular mass indices were 176.26 ± 39.98 g/m(2) (preoperative), 139.21 ± 30.1 (6 mo postoperative), and 120.51 ± 23.88 g/m(2) (24 mo postoperative) (P < 0.001). During follow-up, the maximum aortic insufficiency recorded was trace, and no valve dysfunctions were observed. Temporary thrombocytopenia was documented in all patients during early postoperative follow-up (lowest level at day 3); recovery to preoperative levels occurred by day 10. The Freedom SOLO aortic bioprosthesis is an easy-to-implant valve with excellent hemodynamic performance. The thrombocytopenia appears to be a transient laboratory finding.
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Affiliation(s)
- Garip Altintas
- Department of Cardiovascular Surgery, Turkiye Yuksek Ihtisas Hospital, 06100 Ankara, Turkey
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Altintas G, Diken AI, Diken OE, Hanedan O, Kucuker SA. Inhaled pentamidine for Pneumocystis jiroveci prophylaxis in a heart transplant recipient with allergy for trimethoprim sulfamethoxazole. EXP CLIN TRANSPLANT 2011; 9:72-73. [PMID: 21605028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Pneumocystis jiroveci is an important cause of mortality and morbidity among heart transplant recipients. This raises the question of prophylactic treatment for this infection. Trimethoprimsulfamethoxazole is commonly used in P. jiroveci pneumonia prophylaxis with mild to severe adverse effects. We present the use of inhaled pentamidine as P. jiroveci prophylaxis in a patient with an allergy to trimethoprim sulfamethoxazole.
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Affiliation(s)
- Garip Altintas
- Turkiye Yuksek Ihtisas Hospital, Department Of Cardiovascular Surgery, Ankara, Turkey
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