Objectives: In this study, we present our clinical approach to the last five-year elective infrarenal abdominal aortic aneurysm (iAAA) and our short-term results. Patients and methods: Data of a total of 333 patients (308 males, 25 females: mean age 70.6±6.6 years; range, 54 to 87 years) who were intervened with the diagnosis of an elective iAAA in Cardiovascular Surgery clinic of our hospital between January 2012 and January 2017 were retrospectively analyzed. These patients were divided into two groups as Group 1 (endovascular aneurysm repair [EVAR] group; n=187) and Group 2 (open surgery [OS] group; n=146). Results: The mean age was higher in Group 1, compared to Group 2 (p<0.001). Early postoperative mortality was 2.1% in Group 1, while it was 8.2% in Group 2 (p<0.001). While EVAR was applied to 39.4% of the patients in 2012, it became applicable to 82.3% of the patients within the last five years. Conclusion: Our study results show that EVAR is effective and safe in the early term, compared to OS. Also, high technical success in the EVAR group and lack of conversion to OS in this group indicate that the patient selection and anatomical evaluation are correct.

Objectives: This study aims to investigate whether heparin-bounded grafts are a useful alternative to autologous veins in low extremity bypasses? Patients and methods: Between January 2002 and March 2016, we retrospectively reviewed a total of 249 patients (169 males, 80 females; mean age 66.2 years; range, 55 to 73 years) who underwent above-knee femoropopliteal bypass. A heparin-bounded polytetrafluoroethylene (PTFE) graft was used in 41 patients, a standard PTFE graft in 136 patients, and a great saphenous vein graft in 72 patients. The patency rates at one, two, and third years were evaluated. Results: The patency rates at one year were the highest in the autologous vein grafts (94.3%), followed by heparin-bounded PTFE grafts (92.1%) and standard PTFE grafts (91.4%). The patency rates at two years were 88.1%, 84.3%, and 82.1% in the autologous vein grafts, heparin-bounded PTFE grafts, and standard PTFE grafts, respectively. The patency rates at three years were 86.3%, 82.1%, and 72.1% in the autologous vein grafts, heparin-bounded PTFE grafts, and standard PTFE grafts, respectively. Correlation analysis showed that coronary artery disease, chronic renal failure, diabetes mellitus, smoking, and one artery run-off were risk factors for bypass failure. Conclusion: According to our study results, autologous vein grafts are the most optimal grafts, while heparin-bounded PTFE grafts seem to be a better option than standard PTFE grafts.

Objectives: In this study, we present our experience with arteriovenous fistula (AVF) aneurysm treatment and introduce a new technique, Tan-Gor technique, for the resection of giant AVF aneurysms. Patients and methods: Between January 2011 and December 2015, a total of 48 patients (26 females, 22 males; mean age 51.5 years; range, 16 to 85 years) who were operated for either AVF aneurysms or high-flux AVFs were retrospectively analyzed. Fifty surgical procedures were performed including 40 (80%) in the left upper extremity, nine (18%) in the right upper extremity, and one (2%) in the left lower extremity. Results: Of all operations, 64% (n=32) were performed over the cephalic veins. Of these patients, 22 had aneurysmectomy and excision, six had plication, four had banding, and two had both banding and plication. Fourteen operations were performed on the basilic vein: six patients had aneurysmectomy alone, four had aneurysmectomy and graft interposition, two had plication, one had banding, and one had both banding and plication. Conclusion: Preservation of the AVFs should be the first choice in aneurysmal dilatation of AVFs. When reconstruction of the AVF is not possible and surgical aneurysmectomy is a must, this novel technique can be safely performed via excision of the vein with overlying skin to decrease complications, to reduce operational time, and to improve wound healing and cosmetic results.

Popliteal artery pseudoaneurysm (PAP) is a rare condition. They are clinically characterized by pain and swelling. Deep vein thrombosis should be considered in the differential diagnosis. Herein, we presented two cases who were admitted to our clinic with pain and swelling in left their lower extremities late following orthopedic knee surgery. Both patients had a positive Homans’ sign on physical examination. Color Doppler ultrasound, which was performed due to suspected deep vein thrombosis, revealed a giant pseudoaneurysm in the popliteal arteries in both patients.

Objectives: In this study, we present our surgical approach to small saphenous vein reflux and short-term endovenous laser ablation experiences. Patients and methods: A total of 35 patients (20 males, 15 females; mean age 43.8±14.4 years; range, 20 to 70 years) who were operated for small saphenous vein reflux in our clinic between January 2017 and October 2017 were retrospectively analyzed. Age, gender, preoperative comorbidities, diameters of the small and great saphenous veins, venous injury scores, surgical method, anesthesia techniques, and postoperative complications were evaluated. Results: The mean operated small saphenous vein diameter was 9.5±2.2 cm. Sedation analgesia (n=10, 29%) and tumescent anesthesia (n=25, 71%) were used. Endovenous laser ablation was performed to 21 patients (60%). The small saphenous vein division and partial excision were performed to 13 patients (37%). We had only one complicated operation due to catheterization failure, and we performed ultrasound-guided sclerosing agent infusion to the small saphenous vein. We also performed varicose pack excision in 19 patients (54%) and perforator vein ligation in six patients (17%) in a single session. We observed no sural nerve injury in any patient during the postoperative period. Conclusion: Today, surgical experience for small saphenous vein has been steadily increasing. Endovenous techniques are still the most optimal options for small saphenous vein surgery and can be safely used under the guidance of ultrasound to avoid complications.

Primary popliteal venous aneurysm (PVA) is a rare, but a life-threatening pathology affecting the venous system. Most of patients with PVA are asymptomatic, and pulmonary embolism may be the initial symptom. Duplex ultrasonography is an appropriate method for the diagnosis. Although management of asymptomatic PVA is still controversial, surgery is indicated in all symptomatic patients with venous aneurysms. Herein, we report a 67-year-old male patient with left PVA in whom surgical repair was performed.

Objectives: In this study, we present our surgical experience for carotid body tumors (CBT), which are rare neoplasms arising from the paraganglion cells. Patients and methods: Between January 2000 and December 2009, a total of 12 patients with CBT (4 males, 8 females; mean age 50.3±8.4 years; range, 35 to 70 years) who underwent surgical excision in our clinic were retrospectively analyzed. Magnetic resonance imaging was used for the diagnosis. The patients were evaluated in terms of clinical and operative parameters, and postoperative complications. Results: The mean follow-up was 7.5 years. One of the patients was operated bilaterally after two years. Three patients underwent endovascular embolization before surgery. As our standard procedure, the tumor was dissected from the carotid artery subadventitially, while three patients underwent internal carotid artery (ICA) revascularization due to ICA invasion. The external carotid artery (ECA) was also ligated in three patients. Lymph node dissection was performed in two patients. However, pathology result was reported as a reactive lymph node. None of the patients received radiotherapy. Left hemiplegia occurred in one patient after surgery, and the same patient died at the third year due to a non-surgical cause. No recurrences or major complications were seen during follow-up of other patients. Conclusion: The definitive treatment of KCTs which are clinically considered malignant due to their localization is surgical excision. The ICA and ECA ligation may be required in the advanced stages of tumors. However, ICA revascularization has a vital importance in these patients. In addition, utmost meticulousness is required to avoid nerve and vessel injuries during surgery. Although recurrent lesions have been reported in these patients, long-term results are satisfactory.

Ascending aortic pseudoaneurysm is a rare complication after open cardiac surgery with high mortality. Herein, we present a 47-year-old male patient in whom a pseudoaneurysm of the ascending aorta developed two years after coronary artery bypass grafting. The patient was referred to our clinic with the preliminary diagnosis of aortic dissection following transthoracic echocardiography. Based on the thoracic computed tomography angiography, coronary angiography, and ascending aortography results, the patient was diagnosed with a pseudoaneurysm of the ascending aorta and was operated urgently. The pseudoaneursym originated from the site of the cardioplegia needle entry. We performed graft interposition with a No. 26 Dacron tube graft under total circulatory arrest and deep hypothermia. Postoperative recovery was completely uneventful, and the patient was discharged on the postoperative Day 7 with full recovery. An effective and suitable surgical technique should be performed due to the risk of rupture of pseudoaneurysm and mortality in these patients.

Major vessel injury during spinal surgery is a rare, but one of the most distressing complications and it may be fatal. Prompt diagnosis and management are crucial to prevent poor outcomes. Herein, we report two cases of arterial injury during lumbar disc surgery with different presentations. Injury was detected during operation in one patient and six hours after surgery with a pseudoaneurysm formation in another patient. Both patients were treated with endovascular methods. Endovascular stent grafting offers an effective method for the treatment of aortic and iliac artery injuries.

Carotid artery pseudoaneurysms are rare vascular lesions which may occur due to trauma, tumor invasion, radiation, infection, and arteritis. They should be treated as soon as possible to prevent rupture and neurological sequelae. Behçet’s disease is one type of arteritis that typical involves medium and large vessels, causing arterial occlusive disease and aneurysm formation. Herein, we report a case of a carotid artery pseudoaneurysm and stenosis secondary to Behçet’s disease.