Objectives: This study aims to investigate the efficacy of endovenous laser ablation procedure in patients with varicose veins of great and small saphenous vein accompanied by long-term venous reflux and to identify mid-term recanalization rates. Patients and methods: Between February 2010 and August 2011, endovenous laser ablation was performed in a total of 105 patients (50 males, 55 females; mean age 42 years; range, 18 to 68 years) with great or small saphenous vein reflux. Laser ablation with varicose vein excision was performed to 95 of the patients. The patients were evaluated by Doppler ultrasonography at three and six months postoperatively. Results: The mean hospital stay was one day; however, 13 patients due to spinal anesthesia-related headache, low blood pressure, and fatigue stayed longer in the hospital. None of the patients experienced operative mortality. None of the patients had hematoma or hemorrhage, while local wound infection was detected in two patients. Postoperative Doppler ultrasonography revealed that the saphenous vein reflux was continued postoperatively in five patients (4.7%) (great saphenous vein in four patients and small saphenous vein in one patient). Conclusion: Endovenous laser ablation with or without excision of the varicose veins in patients with saphenous vein insufficiency has high success rates and can be safely performed with a low mortality and morbidity risk. Although early-term results of this procedure is favorable, patients should be followed in the long-term.

Objectives: This study aims to report the outcomes of a novel non-tumescence endovenous ablation technique using the N-butyl cyanoacrylate (NBCA) in patients with varicose vein. Patients and methods: Between November 2014 and August 2017, a total of 292 patients (174 females, 118 males; mean age 42.6±17.9 years; range, 20 to 69 years) who were admitted with chronic venous insufficiency and diagnosed with saphenofemoral or small saphenous vein insufficiency by Doppler ultrasound (DUS) were included. The patients underwent endovenous ablation using the NBCA and DUS was performed before and after the procedure. The patients were evaluated using the Comprehensive Classification System for Chronic Venous Disorders (CEAP) and Venous Clinical Severity Score (VCSS). Results: The great saphenous vein was ablated in a total of 264 patients and small saphenous vein was ablated in 28 patients. The mean CEAP score was 3.3. The mean diameter of the great saphenous vein was 7.8 mm, while the mean diameter of the small saphenous vein was 6.9 mm. The patients were scheduled for follow-up visits at one week and three months after the procedure. The total occlusion rate was 97.6%, as assessed by the post-procedural DUS examination. Of the patients, 4.7% had phlebitis-like events. The mean pre-procedural VCSS score was 9.2, which decreased to 3.4 at three months after the procedure. Conclusion: Our study results show that endovenous ablation technique using the NBCA is a safe and simple method with successful results in the early period.

Objectives: This study aims to compare the success rates of two different anastomotic techniques using Doppler ultrasound (US) in patients undergoing forearm arteriovenous fistula creation surgery for hemodialysis access. Patients and methods: Between January 2010 and March 2011, 40 patients (8 males, 32 females; mean age 52.7 years; range, 28 to 63 years) who underwent the forearm arteriovenous fistula procedure due to end-stage renal disease were included in this study. The patients were divided into two groups, depending on the surgical technique employed. Group 1 included 20 patients operated using the Brescia-Cimino technique, while Group 2 included 20 patients operated using the fish-mouth technique. The diameters of the radial artery and cephalic vein were measured pre- and at postoperative Days 1, 7, and 30. The arteriovenous fistula flow rate was measured using Doppler US at postoperative Day 30. Results: The mean preoperative cephalic vein diameters were 2.48±0.4 mm in Group 1 and 2.03±0.4 mm in Group 2 (p=0.004). The mean preoperative radial artery diameters were 2.46±0.5 mm in Group 1 and 2.04±0.2 mm in Group 2 (p=0.003). The mean arteriovenous fistula flow rates at Week 4 were 547±149 mL/min in Group 1 and 745±108 mL/min in Group 2 (p<0.001). Early complication rates and surgery times were lower in the fish-mouth group. Conclusion: Fish-mouth anastomosis appears to be an efficient and safe technique for arteriovenous fistula creation with a lower complication rate and shorter operation time.

Objectives: The aim of this study is to provide a more effective and safer treatment for high-risk patient group and to shed light on the selection of the most appropriate endovascular graft for each patient. Patients and methods: Between January 2012 and January 2017, data of 63 consecutive and elective patients (60 males, 3 females; mean age: 68.2±7.2 years; range, 57 to 87 years) with the diagnosis of an infrarenal abdominal aortic aneurysm (IAAA) who were treated with AFX® (Endologix, Inc., Irvine, CA, USA - Bifurcated Endograft System) graft were retrospectively analyzed. Data of the patients were evaluated in three stages: preoperatively, intraoperatively, and postoperatively. Results: Hypertension (63.5%) and coronary artery disease (57.1%) were the most common comorbidities and 34 patients (53.9%) underwent an intervention under local anesthesia. The mean duration of the procedure was 131.3±25.4 min, the duration of the scopy was 17.8±4.0 min, and the amount of opaque used was 67.0±16.9 mL. No mortality, renal complications, and myocardial infarction were observed in any of the patients in the early postoperative period. The mean length of hospital stay was 2.3±1.4 days. No conversion to open surgery was needed in any patients. The technical success rate of the procedure was found to be 100%. Conclusion: The results of our study show that the Endologix AFX® graft is effective and safe in the short-term.

Objectives: In this study, we aimed to present our treatment modalities for carotid artery stenosis and approaches for post-treatment restenosis. Patients and methods: Between January 2003 and June 2017, 557 patients (304 males, 253 females; mean age 68.2 years; range, 54 to 82 years) who underwent an intervention due to carotid artery stenosis were retrospectively analyzed. A total of 392 patients underwent carotid artery endarterectomy (CAE), while 165 patients underwent carotid artery stenting (CAS). Of 392 patients, 34 (8.6%) underwent eversion, 188 (47.25) underwent patch closure, and 170 (43.3%) underwent primary closure. Of 165 patients undergoing CAS, 114 (69%) had a wallstent and 51 (31%) had a nitinol stent. Carotid artery restenosis (CAR) and risk of treatment modalities were evaluated in both groups. Results: A total of 29 patients (5.2%) had CAR. Of these patients, eight (4.84%) were from the CAS group, while 21 (5.35%) were from the CEA group. Of the patients undergoing primary closure, the rate of need for reintervention was 9.4% (n=16), this rate was 5.88% (n=2) in the patients undergoing eversion. In the patient group undergoing patch closure, the rate of need for reintervention was 1.59% (n=3). Twenty six patients with CAR underwent endovascular intervention, while two patients underwent surgical intervention. No mortality was observed in patients undergoing surgical intervention. Only nerve damage was seen in both patients. No mortality was observed in patients undergoing endovascular intervention due to CAR; however, one patient had major stroke. Conclusion: Gold standard treatment method in carotid artery stenosis is CAE. Endovascular treatment modalities can be a good alternative to CAE in patients with high comorbidity and high mortality risks and in case of CAR.

Objectives: In this study, we aimed to present our anticoagulant treatment strategies and experiences in patients with atrial fibrillation undergoing carotid endarterectomy. Patients and methods: Between January 2001 and April 2015, a total of 817 patients were operated due to carotid artery stenosis in our clinic. A total of 102 patients (62 females, 40 males; mean age 67.2±9.4 years; range, 41 to 87 years) with the diagnosis of atrial fibrillation were retrospectively analyzed. All patients were on warfarin and aspirin treatment. Results: One patient died in the early postoperative period due to sudden hypotension after dialysis, followed by cardiac arrest. Twelve patients died due to various reasons in the late postoperative period. Seven patients required re-exploration due to hematoma. Three patients had a neurological event characterized by hemiparesis in the early postoperative period and all of them were regressed with heparin and anti-edema therapy. Four patients had re-stenosis. Percutaneous stent graft implantation was performed in three patients. One patient was re-operated. Conclusion: Aspirin 100 mg daily combined with warfarin keeping the international normalized ratio of 2 to 3 was an appropriate treatment option for our patient group. However, further, multi-center, large-scale studies are required to establish a definite anticoagulant treatment protocol for patients with atrial fibrillation undergoing carotid endarterectomy.

A 25-year-old female patient with hereditary multiple exostosis was diagnosed with a pseudoaneurysm of the left popliteal artery. She previously underwent surgical excision of the exostoses located in the left distal femur and proximal tibia. Left leg pain occurred with swelling nine months after surgery, and radiographic examination revealed a popliteal artery pseudoaneurysm with an extensive destruction of the femur. In young patients, non-traumatic pseudoaneurysms of the distal femoral artery may be a complication of an exostosis, and those aneurysms may very rarely destruct the femur.

Lymphedema is the accumulation of interstitial fluid rich in proteins in the skin and subcutaneous tissues. A 13-year-old boy was admitted to our clinic with the complaint of edema in both lower extremities and scrotum. His medical history revealed that he was diagnosed with primary lymphedema when he was one year old. Left lower extremity and scrotal lymphatic drainage and bandaging were made. The patient was advised to wear compression stockings to his right lower extremity until the end of the treatment. At the first stage, manual lymph drainage was applied to reduce edema, and skin care and bandages were applied, while in the second stage, treatment was supported with compression stockings. A significant and rapid reduction in edema was obtained after 12 treatment sessions. When the circumference measurements before and after treatment were evaluated, an improvement was observed, particularly in the scrotum.

Peripheral artery disease (PAD) and intermittent claudication (IC) may be difficult to diagnose in elderly patients, as these patients are relatively immobile. Those elder patients without any previous history are often admitted to the emergency departments with sudden-onset critical limb ischemia (CLI) symptoms. Radiological tests in the emergency department may sometimes be suboptimal or interpreted incorrectly. Consideration of metabolic complications that may occur during the long revascularization period may also result in easier sacrifice of the extremity. A nonagenarian female patient was admitted to the emergency department with CLI, and the absence of the distal popliteal run-off was observed on computed tomography angiography. Her limb was salvaged upon a surprisingly strong intention for revascularization, as she did not give her consent for amputation. This case report highlights that the radiological findings should not always be credited, particularly in the emergency setting.

The thoracic aortic rupture in multiple trauma patients is often associated with a sudden deceleration after blunt aortic injury. Patients with blunt aortic injuries have high risks for paraplegia, stroke, and heart, kidney and respiratory failure. Thoracic endovascular aortic repair (TEVAR) enables a rapid control of bleeding and ensures rapid blood flow to the internal organs. Herein, we report a female case of a distal rupture of left subclavian artery and totally separated intimal and medial layers of the artery which was successfully treated with TEVAR procedure.

Left superficial femoral artery occlusion was found in six patients (4 males, 2 females, mean age 65±10 years) who were admitted to the emergency department with a sudden-onset severe pain and pallor in the crural region of the left lower extremity. As the patients were high-risk patients for open surgery, thrombectomy with a mechanical rotational catheter was performed due to short operation time, and no need for a surgical incision. Complete revascularization was achieved in all patients. No evidence of restenosis was seen after six months. In conclusion, we suggest that mechanical thrombectomy with a rotational catheter is an alternative treatment in high-risk patients for open surgery.