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Thromboangitis obliteransis (TAO) is a nonatherosclerotic, inflammatory, occlusive arteritis that affects small and medium-sized arteries, veins and nerves. A large proportion of patients with TAO suffer from claudication, and the ultimate condition is gangrene and limb loss if there is no treatment or the cessation of smoking. Endovascular revascularisations are performed frequently and provide acceptable results in patients who are not suitable for surgery. In this study, we aimed to show our clinical experience in patients with TAO who were treated with endovascular revascularisation.Between January 2014 and March 2020, 18 patients with lower-extremity critical limb ischaemia (CLI) underwent endovascular treatment (ET). Technical details and clinical success at follow up were documented.This study included 18 patients with lower-extremity TAO who presented with CLI and were treated with ET. The mean age of the patients was 38.8 ± 7.3 years. Fifty per cent of patients had pain at rest, 33.7% had minor tissue loss and non-healing ulcers, and 16.7% had major tissue loss on admission. The majority of lesions were located in the peroneal and tibial arteries (in/i= 13, 72.27percnt;). Two (11.1%) patients had distal superficial femoral artery occlusion concomitant with popliteal artery (PA) lesions, and three (16.7%) had PA occlusion concomitant with peroneal and tibial artery lesions. Re-establishment of antegrade flow in at least one vessel was achieved in 15 (83.3%) patients. Balloon angioplasty was performed in all patients. Plain old balloon angioplasty (POBA) was used in nine (60%) patients and drug-eluting balloon (DEB) angioplasty in six (40%). The mean duration of follow up in 15 patient who had undergone successful ET was 21.5 ± 8.1 months. The primary CLI-free rate at 12 and 24 months was 80% (66.7% in all patients). Secondary CLI-free rates at six, 12 and 24 months were 100, 93.3 and 53.3%, respectively. Patients who were active smokers during their follow up had a higher frequency of out-patient clinic consultations (ip/i= 0.03).Controversy has continued on the role of ET in the treatment of TAO. This study shows that ET of TAO had promising primary and secondary patency rates with high technical success and limb-salvage rates.

Purpose One subset of peripheral arterial disease is aortoiliac occlusive diseases (AIOD). AIOD is the term for all arterial lesions between the infrarenal distal aorta and common femoral artery. Implantation of kissing stents (KS) with covered stents (CS), bare-metal stents (BMS) is one of the endovascular treatment (ET) modalities for AIOD involving aortic bifurcation. In this study, we report the outcomes of the KS technique in infrarenal AIOD. Methods Between January 2014 and September 2017, 31 patients who underwent ET were treated with KS technique either with balloon-expandable BMS or balloon-expandable CS. Technical details, clinical success, complications, and patency at follow-up were documented. Results The majority of patients were male (77.4%), and the median age was 62 years (range, 45-78 years). All patients were classified according to the TASC II criteria. Eight patients (25.8%) were classified as TASC B. Fifteen patients (48.4%) were classified as TASC C, and 8 patients (25.8%) were classified as TASC D. These 23 patients were classified as complex AIOD group. BMS was used in 17 patients (54.8%), and CS was used in 14 patients (45.2%). Technical and clinical success was achieved in 100% of treated cases. The median follow-up was 24 months (range, 24-34 months). Primary patency rates at 12, 18, and 24 months after ET were 100%, 96.8%, and 90.3%, respectively. Conclusion We found that the KS technique has satisfying 24-month results, even in complex AIOD lesions, with high technical success and acceptable midterm patency. Key Words: Aorta, Arterial occlusive diseases, Endovascular procedures, Iliac artery, Stents.

Introduction: The minimally invasive implantation of aortic valve prosthesis via thoracotomy has numerous advantages and is comfortable, especially during the early postoperative period. Disadvantages of this method include peripheral vessel complications and groin infections. Central cannulation (direct aortic cannulation with superior vena cava cannulation) eliminates these drawbacks. In this report, we evaluated this method of treatment in patients with obesity. Methods: We retrospectively analyzed the medical records of 21 obese patients with severe aortic stenosis who underwent minimally invasive aortic valve implantation via thoracotomy and central cannulation with a bovine pericardial aortic prosthesis between 2017 and 2021. We compared these records with the medical records of 27 obese patients with severe aortic stenosis who underwent conventional aortic valve surgery. Results: Mean cross-clamp and cardiopulmonary bypass times were similar in both groups. Operating time was significantly longer in the minimally invasive group (P

Objectives The aim was to report the mid-term outcomes of Jetstream™ rotational atherectomy device in complex femoropopliteal lesions. Methods Between November 2016 and April 2018, 55 patients who were treated with rotational atherectomy and adjunctive balloon angioplasty due to complex femoropopliteal lesions were retrospectively scanned. Results Fifty-five patients who underwent endovascular treatment with rotational atherectomy for chronic total occlusive femoropopliteal lesions were included in the study. Technical success rate was 100%. The mean age was 63 (±10.5) years. The cohort included 25 (45.4%) diabetics and 45 (81.8%) current smokers. The mean length of the lesions was 20.8 ± 11.2 cm. Chronic total occlusive lesions were detected in 35 (63.6%) patients, and mixed-type steno-occlusive lesions were detected in 20 patients (36.4%). Thirty-three (60%) lesions were moderate or severely calcified. Adjunctive balloon angioplasty was performed with plain old balloon angioplasty (POBA) on 31 (56.4%) patients and with drug-coated balloon angioplasty on 24 (43.6%) patients. After adjunctive balloon angioplasty, flow limiting dissection was observed in 20 (36.3%) patients, and 17 (30.9%) patients needed stent implantation. The Kaplan–Meier analysis method estimated that the overall primary patency rates at 12 and 24 months were 81.8% and 70.9%, respectively. Overall, secondary patency rates at 12 and 24 months were 94.5% and 80%. No statistically significant differences of 24-month primary patency and secondary patency rates were found between patients treated with drug-coated balloon angioplasty and POBA as an adjunctive therapy, even though primary patency (83.3% vs. 61.3%, p = .06) and secondary patency (91.7% vs. 71%, p = .56) rates of drug-coated balloon angioplasty were slightly higher than POBA. Patients with claudication had better primary patency (90.5% vs. 58.8%, p = .001) and secondary patency (100% vs. 67.6%, p = .004) rates than patients with critical limb ischemia at 24 months. Significant differences between patients who did and did not stop smoking were found in 24-month primary patency (57% vs. 88%, p = .007) and secondary patency (67% vs. 96%, p = .007). Six patients underwent unplanned amputation. There were eight (14.5%) mortalities during follow-up. Conclusions Rotational atherectomy with adjunctive balloon angioplasty has satisfactory technical success rates and mid-term outcomes. As an adjunctive method, there was no difference between drug-coated balloon angioplasty s and POBAs. Smoking cessation is always the first-step treatment to improve mid-term patency results. Patients with critical limb ischemia have worse patency results compared to the patients with claudication.

Purpose The frequency of iatrogenic femoral artery pseudoaneurysm (FAP) diagnoses has recently increased due to the growing use of diagnostic and interventional procedures involving large diameter sheaths, as well as more potent anticoagulation procedures. In this study, we aimed to present our experience with ultrasound-guided thrombin injection (UGTI) in patients with iatrogenic FAP. Methods We studied patients with FAP who were under anticoagulant or antiplatelet therapies preoperatively, or who had received a loading dose during an interventional procedure. The outcomes of patients with FAP treated with UGTI were compared with those of patients who underwent open surgical repair for pseudoaneurysms. Results Among the 55 patients included in this study, 24 had UGTI while 31 had open surgery. The success rate was 95.8% when taking into consideration primary and secondary attempts. The mean duration of the procedure was shorter in patients with UGTI (10.1 ± 3.54 minutes) when compared with those who underwent open surgery (76.55 ± 26.74 minutes, P ≤ 0.001). In addition, the total complication frequency was significantly higher in the open surgery group (P = 0.005), as was their length of hospital stay (P < 0.001). Cost analysis showed significant differences between UGTI ($227.50 ± $82.90) and open surgery ($471.20 ± $437.60, P = 0.01). Conclusion We have found that UGTI is the safer and more effective choice of treatment in appropriate patients with FAP, as opposed to surgery.

IntroductionThe purpose of this study was to report the midterm outcomes of primary stenting of iliac arteries with additional factors which affect the outcome and to compare the results between patients with simple and complex aorta iliac occlusive disease (AOID).Material and methodsFrom January 2015 and March 2018, the study consisted of 103 lesions in 93 patients with common iliac artery (CIA) and/or external iliac artery (EIA) lesions which accompanied with severe claudication or critical limb ischemia. Balloon-expandable stents (BMS), self-expandable stents (SES) and covered stents (CS) were used to treat the lesions.ResultsLesions of 93 patients that were in CIA and/or EIA and treated with ET were included to the study (n=103). Seventy-one (68.9%) lesions were classified as simple AIOD group (TASCII A-B) while 32(31.1%) were classified as complex AIOD (TASCII C-D) group. In 72.8% of the lesions only mild calcification was detected while 27.2% lesions had moderate or severe calcification. Mean stent diameter for CIA position was 8.26±0.8mm and for EIA position was 7.52±0.8mm. Mean lesion length in patients treated with BMS were 52.5±21.0mm while SES were 63.6±28.3(p=0.03). Technical success was achieved in 101(98.1%) lesions. Significant differences in primary (93% vs 63%) and secondary (98% vs 82%) patency rates at 24 months were found between patients in simple and complex AIOD group (pConclusionsConclusion: In our study, it was found that the primary stenting in patients who had AIOD had satisfactory results with high immediate success, low complication rates and acceptable midterm outcomes.

Lipodystrophy is a group of rare disorders characterized by generalized or partial loss of adipose tissue. Diabetes secondary to lipodystrophy is hardly responsive to standard treatment modalities and may lead to microvascular and macrovascular complications (1). Diabetic foot ulcers (DFUs) are a chronic complication of diabetes and a leading cause of lower-limb loss due to amputations. DFUs are an important cause of diabetes-related mortality (2). In this observational retrospective cohort study, we report on 18 DFU episodes that developed in metreleptin-naive patients with lipodystrophy. These DFU episodes were compared with a series of DFUs ( n = 399) that occurred in a well-established cohort of patients with type 2 diabetes ( n = 290). The study was approved by the Dokuz Eylul University ethical review board. Among 206 patients with lipodystrophy registered in our national cohort, DFUs were observed in 9 of 90 subjects with diabetes (10%). Four of these patients (44.4%) had multiple DFU episodes. Six patients had generalized lipodystrophy: five congenital generalized lipodystrophy (CGL) type 1 caused by AGPAT2 p.R68X (c.202C>T), p.E229X (c.685G>T), p.K216X (c.646A>T), and p.D180PfsX5 (c.538_539delGA) variants, and one CGL type 2 caused by BSCL2 p.Q94X (c.280C>T) variant. Three patients had partial lipodystrophy: one familial partial lipodystrophy (FPLD) type 1, one FPLD type 2 caused by LMNA p.R482W (c.144C>T) variant, …

Objective The purpose of this study was to assess the clinical features of phlegmasia cerulea dolens and present the treatment outcomes with rheolytic thrombectomy device. Methods From January 2014 and March 2019, 329 patients were diagnosed and hospitalized for acute iliofemoral deep vein thrombosis, and among those patients, seven patients diagnosed with lower extremity phlegmasia cerulea dolens were consecutively enrolled. Diagnosis of phlegmasia cerulea dolens was initially made on clinical findings followed by imaging with Doppler ultrasound. The rheolytic thrombectomy device was used in all patients with a combination of catheter-directed thrombolysis as an adjunctive therapy to facilitate more rapid thrombus clearance except for one patient who had a contraindication to the use of tissue plasminogen activator. Results Seven patients (four men, three women; median age, 63 years, range 52–68 years) were included. One patient had a relative contradiction to thrombolysis due to history of coronary artery bypass graft surgery; all other patients underwent pharmaco-mechanical thrombectomy with power pulse mode. The upper limit of 480 s was completed in all patients, and this time was not exceeded to prevent hemolysis-related complications. Six Fr catheters were used in four (57.1%) patients, and 8 Fr catheters were used in three patients (42.9%). Mean thrombolytic infusion duration was 28 ± 6.2 h for patients who received tissue plasminogen activator. After catheter-directed thrombolysis, total radiological success was achieved in two patients, and partial radiologic success was achieved in five patients; however, in all seven patients, clinical success was achieved. The mean duration for complete regression of cyanosis was 18.9 ± 8.1 h. Although no patients required blood replacement, mean decreases in hemoglobin and hematocrit were 2.7 ± 1.37 g/dl and 6.42 ± 4.47%, respectively. Acute kidney injury developed in three patients (42.9%). One patient required continuous renal replacement therapy. No cardiac complication was observed. One (14.3%) patient died of ventilator-related pneumonia on postprocedural day 10. The median duration of intensive care unit stay and hospital stay were 72 h (min–max: 24–264 h) and six days (min–max: 5–33 days), respectively. Conclusion Rheolytic thrombectomy was less invasive and effective strategy for early stage phlegmasia cerulea dolens at creating rapid thrombus clearance to establish clinical success and facilitate more conservative management with catheter-directed thrombolysis.

The number of infected cases with COVID-19 increase gradually, and some of the COVID-19 patients present with concomitant cardiovascular problems that might require surgical intervention. However, we do not have sufficient evidence of optimum timing for cardiac surgery in patients with COVID-19 whose surgery cannot be postponed or who cannot be treated percutaneously. Here we discuss the management of a patient that diagnosed with COVID-19 and required urgent cardiac surgery for symptomatic moderate aortic and severe mitral valve regurgitation.

Background/aim: Cardiopulmonary bypass (CPB)-associated acute kidney injury (AKI) is a common situation and rapid diagnosis and risk classification are important in the prevention and management of AKI. Changes in serum creatinine (SCr) levels in the current consensus criteria do not allow clinicians to diagnose CPB-associated AKI until 48 h after surgery. Materials and methods: We conducted a prospective single center study involving 57 patients who underwent cardiac surgery with CBP to compare serum beta-trace protein (BTP), neutrophil gelatinase-associated lipocalin-2 (NGAL), and cystatin C (CysC) levels with SCr for early diagnosis of CPB associated AKI. We defined AKI according to KDIGO criteria. Results: AKI was diagnosed in 24 (42.1%) patients. Mean duration of postoperative intensive care unit stay was 4.79 (± 6.12) days for the AKI+ group and 2.15 (± 0.56) days for the AKI- group. The average length of hospital stay was 8.13 (± 5.75) days for the AKI+ group and 7.21 (± 3.68) days for the AKI- group, which was significantly longer in the AKI+ group (P < 0.001, P = 0.011). Unlike other biomarkers, a significant increase in postoperative CysC levels was always found in patients with AKI during follow-up when compared to patients in whom AKI did not develop (P < 0.001). Conclusion: Increase in serum CysC levels showed a significant positive correlation with increase in SCr levels. We have not seen this correlation between other biomarkers and SCr. According to our study, serum CysC was a reliable biomarker that may aid in the early detection and follow-up of AKI after cardiac surgery.

Introduction: The aim of this study was to retrospectively review patients who were diagnosed with cardiac injury and underwent an emergency surgery. Patients and Methods: Between January 2009 and December 2014, 37 patients diagnosed with cardiac injury were retrospectively evaluated. Patients were evaluated according to the demographics, mean time from admission to surgery, concurrent interventions, type and localization of cardiac injury, and preoperative mean arterial blood pressure. Results: Eight patients who suffered from cardiac arrest underwent emergency surgery by thoracotomy. On admission to emergency service (ES), 22 patients were in shock. In ES, because the hemodynamic situation of six patients worsened despite fluid therapy, they underwent surgery without performing additional tests or imaging. The localization of the injuries were the right ventricle in 19 patients, left ventricle in 15 patients, right atrium in 2 patients, and both the right and left ventricles in 1 patient. In 34 patients, the primary suturing technique was sufficient for repair but two patients were operated on using cardiopulmonary bypass. The mean time from admission to surgery was 3.16 ± 2.37 h. The mean duration of intensive care unit stay was 2.37 ± 2.1 days. On an average, 5.16 ± 4.21 units of packed erythrocyte suspension were transfused. The mortality rate was 37.83% (n= 14). Conclusion: Improvements in emergency interventions, transportation, and availability of echocardiography in the emergency departments have to be more appropriate and efficient for better outcome in the new series., Giriş: Bu çalışmada 2009-2014 yılları arasında acil serviste kardiyak yaralanma tanısı alan ve acil olarak operasyona alınan hastaları literatüre katkı sağlamak amacıyla retrospektif olarak inceledik. Hastalar ve Yöntem: Kliniğimizde Ocak 2009-Aralık 2014 tarihleri arasında acil serviste kardiyak yaralan- ma tanısı alan ve acil olarak operasyona alınan 37 hasta retrospektif olarak incelendi. Hastalar demografik özellikleri, operasyona alınma süresi, ek girişim yapılıp yapılmadığı, yaralanma şekli, kalpte yaralanan bölge, operasyon öncesi arteryel kan basınçları, operasyonun yapılma şekline göre değerlendirildi. Bulgular: Sekiz hasta acil serviste kardiyopulmoner resüsitasyon eşliğinde acil torakotomi ile ameliyata alın- dı. Yirmi iki hastada şok tablosu mevcuttu. Altı hasta sıvı tedavisine rağmen tabloda kötüleşme olması dolayı- sıyla ek tetkik beklenmeden operasyona alındı. Diğer hastalarda ise ekokardiyografi ve bilgisayarlı tomografi sonucunda kardiyak yaralanma olduğu saptanarak operasyona alındı. On dokuz hastada yaralanma sağ ventri- külde, 15 hastada sol ventrikülde, 1 hastada sağ ve sol ventrikülde, 2 hastada ise sağ atriyumdaydı. Otuz dört hastada yaralanmalar primer olarak süturasyon ile onarıldı. Bir hastada mitral kapak replasmanı, 2 hastada ise onarım kardiyopulmoner baypas altında yapıldı. Bir hastada sol internal mammarian arter yaralanması, 2 hastada femoral arter yaralanması ve 1 hastada ise vena kava inferior yaralanması vardı. Beş hastada mide ve ince bağırsak yaralanmaları olduğu için genel cerrahi ile operasyona devam edildi. Hastaların ortalama ameliyata alınma süresi 3.16 ± 2.37 saat olarak bulundu. Ortalama yoğun bakım ünitesinde yatış 2.37 ± 2.1 gün olarak hesaplandı. Hastalarda ortalama olarak 5.6 ± 4.21 ünite eritrosit süspansiyonu kullanıldı. Hastane mortalitesi 14 hasta ile %37.83 idi. Sonuç: Hastane öncesi acil müdahale ve transport imkanlarının gelişmesi, ekokardiyografinin acil servislerde ulaşılabilirliğinin artmasıyla kalp yaralanmalarının daha yüz güldürücü sonuçlarla yeni serilerde karşımıza çıkacağını umut ediyoruz.

Pseudoaneurysm of the deep femoral artery (FAP) due to penetrating trauma is less common and can be a challenging condition for surgeons. The conventional treatment strategy for FAP due to penetrating trauma is open surgical repair. With emerging technologies, less invasive techniques are being used in these patients. We report a 37-year-old male patient with delayed presentation of FAP secondary to a stab wound and treated successfully with ultrasound-guided thrombin injection.

Objective: Extremity thromboembolism is a serious cause of morbidity and mortality in cardiovascular diseases. Comparing with the lower extremity arteries, upper extremity acute arterial occlusions are rarer and constitute 15-32% of all cases. Trauma, collagen vascular diseases, malignant tumors, myxoma, subclavian artery stenosis, myocardial infarction and thromboangiitis obliterans are often identified as etiologic factors. The first option in the treatment of these patients is surgical embolectomy. Endarterectomy, patchplasty and arterial bypass operations can be counted in treatment options of chronic patients. Material and Methods: In this study, we retrospectively analyzed clinical features and prognosis of 58 patients consisting of 31 women and 27 males who were admitted to our emergency department with acute arterial embolism. Results: Mean age of our group was 67.05±17.09. Proximal brachial artery thrombosis was found in 3 patients. The other 55 patients had thrombosis in the brachial artery and its distal branches. After the diagnosis of patients in the emergency room 100 units/kg of subcutaneous enoxaparine was applied. Selective arterial embolectomy surgery was performed under local anesthesia in all patients with access from the antecubital region. Arteriotomy was closed using saphenous patch plasty technique in two patients. Compared with preoperative demographic data and thromboembolism etiology, 21 (36%) patients were diagnosed as atrial fibrillation. Those patients had not been followed and treated for atrial fibrillation. In 5 (8.6%) patients malignancy was detected as an etiologic factor. Four (6.8%) patients died during their follow-ups in the clinic, 3 (75%) of those patients had an atrial fibrillation. Conclusion: Acute peripheral arterial occlusion constitutes a significant part in emergency vascular surgery. Therefore early diagnosis and prompt surgical treatment are very important for the results. Atrial fibrillation (AF) holds an important place in upper extremity acute arterial occlusion, but other etiological factors such as malignancy is necessary to not forget. AF who has acute upper extremity arterial embolism patients with AF have higher mortality rates and the clinical management and treatment of those patients must be monitored more closely. We believe that the development of treatment modalities and further work needs to be done in order to find an appropriate treatment.

Pulmonary arterial hypertension (PAH), can be defined as mean pulmonary artery pressure (PAP) is higher than 25 mmHg during resting wheras higher than 30mmHg during exercising. Although it progresses asymptomatically for years, most frequently comes out as exertional dyspnea. Since prognosis changes depending on the reason beneath, its mortality is high if it is not treated.

Today there is a widespread use of endovascular treatment (EVT) for traumatic vascular injuries in adults, but there is lack of evidence of its use in adolescent patients with vascular injuries. With this case, we present successful EVT of 14-year-old adolescent with a right subclavian artery pseudoaneurysm (SAP) due to war injury. SAP was successfully excluded with deployment of 6×50 mm flexible, self-expanding covered nitinol stent graft (The GORE® VIABAHN® Endoprosthesis (W.L. Gore & Associates, Flagstaff, AZ)). Patient was discharged from hospital 2 days after the procedure with dual antiplatelet therapy (clopidogrel and aspirin). 3 months after discharge control DUS showed patent stent graft without any residual lesions. As a result, EVT is an alternative approach to treatment of SAP. It is safe, effective, and less invasive therapy for SAP in adults as well as in adolescents. We aim to contribute to the literature with this first case report.

Lumbar disc herniation surgery is usually performed through a posterior approach. Vascular injuries can be counted among the complications. 39 years old male patient had lower extremity pain which has started after lumbar disc herniation surgery and continued for a month. Iliac arterial pseudoaneurysm has been detected in computerized tomography. It was successfully treated with vascular surgery [Cukurova Med J 2016; 41(0.100): 5-7]

We report a 51year-old male patient admitted to our emergency department because of sudden abdominal pain, hypotension, and dyspnea. On physical examination, abdominal tenderness was observed, primarily in the lower abdomen. Hemoglobin was 8.5g/dl and hematocrit was 26%. Renal function was within normal limits. Ruptured giant left IIIAA ( diameter 11 cm ) with massive hematoma on the left side of retroperitoneal space and extensive left kidney ( diameter 26x18x20 cm ) hydronephrosis ( Figure 1a,1b ) was detected with contrast-enhanced computed tomography (CT). The patient been consulted to the urology department at the same time and decided left nephrectomy for left kidney hydronephrosis. The patient was immediately taken to operation room due to hemodynamic instability. Proximal control was obtained by percutaneous endoaortic balloon occlusion catheter. The aneurismal sac was reached after midline laparotomy (figure 2). Ligation was performed to both the proximal and distal neck of aneurismal sac. After this procedure aneursimal sac was opened and drained. Concomitantly nephrectomy was performed. The postoperative follow up was uneventful. Symptoms of ischemic colon and claudicating were not observed and renal function tests were impaired. The patient was discharged on day 7 postoperatively. At 6 months postoperative, the patient remained well.

Lomber disk hernisioperasyonu genellikle posterior yaklaşımla yapılmakta olup vasküleryaralanmalar operasyonun komplikasyonları arasında sayılabilmektedir. Sunulan 39yaşındaki olguda geçirilmiş lomber disk hernisi sonrası başlayan ve bir aydırdevam eden bacak ağrısı vardı. Yakınmaları operasyon sonrasında çıktığıöğrenilen hastada çekilen bilgisayarlı tomografi sonrasında iliak arter psödoanevrizmasıgörüldü. Olgu cerrahi olarak başarıyla tedavi edildi., Lumbar disc herniation surgery is usually performed through a posterior approach. Vascular injuries can be counted among the complications. 39 years old male patient had lower extremity pain which has started after lumbar disc herniation surgery and continued for a month. Iliac arterial pseudoaneurysm has been detected in computerized tomography. It was successfully treated with vascular surgery

1Karaman Devlet Hastanesi Kalp ve Damar Cerrahisi Kliniği; Karaman, Turkey 2International Hastanesi Kalp ve Damar Cerrahisi Kliniği, İstanbul; Turkey Bakırköy Dr Sadi Konuk Eğitim ve Araştırma Hastanesi Kalp ve Damar Cerrahi Kliniği, İstanbul, Turkey

Free-floating thrombus (FFT) of the carotid artery is an exceptional medical condition with a currently unclarified pathophysiology. Approximately 150 cases have been described and published in the literature throughout the world so far. Thus, no definite management strategies have been established yet. In this paper, a symptomatic case of an FFT inside the common carotid artery presented with a history of slurred speech, and right sided hemiplegia was reported. After the diagnosis of a mobile thrombus within the origin of the left common carotid artery, the patient was placed on anticoagulation. As the medical therapy failed, carotid thromboendarterectomy was performed.

Objective: Diabetes mellitus is recognized as a risk factor for mortality and morbidity after coronary bypass grafting. We aimed to determine the association between preoperative hemoglobin HbA1c and AF after isolated off-pump coronary bypass grafting (OPCAB). Methods: The seventy-two diabetic patients undergoing isolated off-pump coronary bypass grafting were retrospectively analyzed for AF. They were divided into; Low (4.8–5.4%), Medium (5.5–8%) and High (8.1–11.5%) groups. The three groups were compared with respect to demographic, echocardiographic, intraoperative and postoperative clinical characteristics correlation. Results: Three patients died during postoperative period. AF occurred in 12 patients (16.6%) after surgery. The incidence of postoperative AF was 15.3% in the lower, 4.4% middle and 57.1% upper group. There was statistically significant correlation between preoperative HbA1C and preoperative stroke, preoperative MI history, Left atrial (LA) size, preoperative levosimendan, preoperative clopidogrel, postoperative AF, postoperative dopamine and dobutamine use, IABP, duration of extubation time, 24-hour chest tube drainage, duration of ICU and hospital mortality. Univariate logistic regression analysis showed significant correlation between postoperative AF and variables like preoperative HbA1c levels, LVEF