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Öğe Amputasyon adayı diyabetik ayakların revaskülarizasyonu(Türk Kalp ve Damar Cerrahisi Derneği, 2013) Uzun, Hacı Alper; Diken, Adem İlkay; Hanedan, Onur; Çiçek, Ömer Faruk; Yalçınkaya, Adnan; Özsoy, Hakan; Taşoğlu, İrfan; Lafçı, GökhanAmaç: Bu çalışmada ileri evre distal periferik arter hastalığı olan amputasyon adayı diyabetik hastalarda uygulanan cerrahi distal revaskülarizasyon ile medikal tedavinin sonuçları karşılaştırıldı. Çalışma planı: Mart 2008 - Kasım 2010 tarihleri arasında diyabetik ayak ve kritik uzuv iskemisi nedeniyle kliniğimize başvuran 40 hasta prospektif olarak çalışmaya dahil edildi. Tüm hastalar Fontaine sınıf 4 olarak sınıflandırıldı. Hastaların 21’ine (ort. yaş 63.5 yıl) diz altı cerrahi revaskülarizasyon uygulanırken, 19’una (ort. yaş 67.9 yıl) medikal tedavi uygulandı. Medyan takip süresi 28 aydı (dağılım 16-47 ay). Hastaların klinik bulguları, amputasyon kayıtları ve greft açıklık oranları kaydedildi. Bulgular: Takip süresince cerrahi grubunda yedi hastada greft darlığı gözlendi. Cerrahi grubunda primer ve sekonder greft açıklık oranları sırasıyla %66.7 ve %80.9 idi. Ortalama uzuv kayıpsız geçen süre cerrahi grupta 42.3±2.7 ay iken medikal tedavi verilen hastalarda 31.5±4.1 ay idi. Ameliyat sonrası 12, 24 ve 30 aylık ekstremite korunması oranı sırasıyla %90.5, %85.7 ve %81 idi. Medikal tedavi verilen hastalarda ise 12 ve 24 aylık ekstremite korunması oranı sırasıyla %78.9 ve %52.6 olarak saptandı (p<0.05). Sonuç: Amputasyon adayı diyabetik hastalar distal yerleşimli periferik arter hastalığı mevcudiyetinde dahi cerrahi revaskülarizasyondan anlamlı fayda görebilirler. Cerrahi tedaviyle amputasyon oranları ve düzeyleri azaltılabilir ve uzuv kaybı olmadan zaman ve ekstremite kurtarma oranları artırılabilir.Öğe Effect of tandem lesions on haemodynamic parameters: An experimental study(Via Medica, 2017) Diken, Adem İlkay; Yalçınkaya, Adnan; Hanedan, Onur; Günertem, Orhan Eren; Demir, Emre; Erol, EmirBackground: 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. © Polskie Towarzystwo Kardiologiczne 2017.Öğe Long-term patency of autogenous saphenous veins vs. PTFE interposition graft for prosthetic hemodialysis access(Kare Publishing, 2014) Uzun, Hacı Alper; Diken, Adem İlkay; Yalçınkaya, Adnan; Hanedan, Onur; Çiçek, Ömer Faruk; Lafçı, Gökhan; Altıntaş, Garip; Çağlı, KerimObjective: 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. © 2014 by Turkish Society of Cardiology.Öğe Screening for left subclavian artery stenosis in patients undergoing coronary artery bypass graft surgery(Edizioni Minerva Medica, 2014) Diken, Adem İlkay; Altıntaş, Garip; Yalçınkaya, Adnan; Lafçı, Gökhan; Taşoğlu, İrfan; Tola, Muharrem; Hanedan, Onur; Çiçek, Ömer Faruk; Erkengel, İbrahim; Çağlı, KerimAim. Stenosis of the left subclavian artery may decrease the clinical benefit of the surgery and result in the coronarysubclavian steal syndrome. This study sought to evaluate the frequency of the subclavian artery stenosis via color Doppler ultrasonography (CDU) and determine the risk factors for subclavian artery stenosis. Methods. Three hundred and twenty consecutive patients who were referred for coronary artery bypass graft surgery were included in the study. All patients underwent subclavian artery color Doppler ultrasonographic evaluation while routine carotid artery examination was performed during the preoperative period. Patient characteristics including demographic, echocardiographic, operative, clinical and laboratory parameters were recorded. Results. Twenty-three of the 320 patients (7.18%) had stenosis of the left subclavian artery while 7 patients (2.18%) also had right subclavian artery stenosis. Age, dyslipidemia, chronic renal failure, peripheral artery disease (PAD), proximal right coronary artery (RCA) stenosis and carotid artery stenosis were all significantly associated with subclavian stenosis. In multivariate regression modeling; age, PAD, proximal RCA stenosis and carotid artery stenosis independently predicted subclavian stenosis. Conclusion. We recommend routine preoperative screening with CDU for those coronary artery bypass grafts patients at high risk for subclavian artery stenosis.Öğe Surgical strategy for moderate ischemic mitral valve regurgitation: Repair or ignore?(Carden Jennings Publishing Co. Ltd, 2014) Diken, Adem İlkay; Altıntaş, Garip; Yalçınkaya, Adnan; Lafçı, Gökhan; Hanedan, Onur; Çağlı, KerimBackground: 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.Results: Significant postoperative improvements were observed in ejection fraction and systolic diameter compared to preoperative values (P =.006 and P =.020 respectively, in the intervention group, P =.001 and P =.001 respectively, in the control group). The decrease in pulmonary artery pressure (PAP) was significant only in the intervention group (P =.001). There was a significantly marked reduction in the severity of IMR in the intervention group compared to control.Methods: 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.Conclusion: 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. © 2014 Forum Multimedia Publishing, LLC.
