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    A comparison of two different management plans for patients requiring both carotid endarterectomy and coronary artery bypass grafting
    (Clinics Cardive Publ Pty Ltd, 2021) Ecevit, Ata Niyazi; Karaca, Okay Guven; Kalender, Mehmet; Bekmezci, Murat; Sungur, Mehmet Ali; Darcin, Osman Tansel
    Background: Carotid endarterectomy (CEA) is a prophylactic operation that is used to mitigate the risk of stroke caused by embolism of atherosclerotic plaques in the carotid bifurcation. Previously, the large, multicentre, randomised, controlled GALA study found no significant differences in clinical outcomes between patients treated using general or local anaesthesia. While this study provided important insights into disease outcomes based on treatment modalities, it did not answer questions regarding the safety of CEA under local anaesthesia in patients at high risk for cardiovascular complications. Here, we examined the use of two different management plans in patients requiring both carotid endarterectomy and coronary artery bypass grafting (CABG), in terms of their effects on hospital mortality. Methods: Thirty-four patients consecutively operated on in our cardiovascular department were included in this analysis. The patients were divided into two groups based on the anaesthetic management plan. The first group consisted of patients who underwent CEA and CABG under general anaesthesia in the same session (GA group); the second group consisted of patients who initially underwent CEA under cervical block anaesthesia followed by CABG under general anaesthesia in a separate session (CB-GA group). These two groups were compared in terms of postoperative complications and hospital mortality. Results: The incidence of postoperative myocardial infarction was higher in the CB-GA group, with four patients experiencing postoperative myocardial infarction, compared to no patients in the GA group. Conclusion: For patients requiring CEA and CABG, performing both operations under general anaesthesia in the same session was safer than initially performing CEA under cervical block anaesthesia followed by CABG under general anaesthesia.
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    Cost-effectiveness analysis of radiobasilic and brachiobasilic arteriovenous fistulas in hemodialysis patients
    (Wiley, 2021) Sungur, Mehmet Ali; Karaca, Okay Guven; Ecevit, Ata Niyazi
    We evaluated the cost and efficacy of radiobasilic and brachiobasilic arteriovenous fistula (AVF) methods in terms of forearm autogenous arteriovenous access in hemodialysis patients. We used a decision tree to compare the cost-effectiveness of proximal radiobasilic AVF (pRBAVF) and brachiobasilic AVF (BBAVF), considering the mean direct medical costs and patency rates. The overall mean cost of pRBAVF per patient (1767.59 Turkish lira [TL]) was lower than that of BBAVF (1877.99 TL). Also, the mean patency duration per patient was higher for pRBAVF (25.72 months) than BBAVF (20.21 months). The incremental cost-effectiveness ratio (ICER) showed that pRBAVF was 20.04-fold more effective than BBAVF. The monthly ICERs also favored pRBAVF, which was less costly and more effective. The pRBAVF provided clinical and economic benefits for hemodialysis patients requiring forearm autogenous arteriovenous access. pRBAVF was more effective in terms of patency than BBAVF, and was also less expensive.
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    An Eligible Surgical Repair Technique for Bland-White-Garland Syndrome
    (2020) Uysalel, Mustafa Adnan; Eyileten, Zeynep; Arıcı, Burcu; Ecevit, Ata Niyazi; Kaya, Bülent; Yaman, Nur Dikmen
    Anomalous origin of left coronary artery from pulmonary artery (ALCAPA) is an uncommonbut major congenital cardiac anomaly, which was firstly defined in 1866. Multiple surgicaltechniques intend to compose 2-coronary artery system, including direct reimplantation of leftcoronary artery to aorta and coronary artery bypass grafting procedures. Left coronary arteryseldomly rises from non-facing pulmonary sinus, where direct reimplantation is technicallyquite difficult for surgical correction because of long distance from native aorta. In this casereport, a surgical technique option of reconstructing left coronary artery, arising from nonfacing sinus which we turned to aorta with a tunnel created from autologous pulmonary arterywall, was presented.
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    Infection Rate of Tunneled Hemodialysis Catheters
    (2021) Kalender, Mehmet; Ecevit, Ata Niyazi; Darçın, Osman Tansel; Karaca, Okay Güven
    Aim: Tunneled hemodialysis catheters are frequently used for hemodialysis patients andprovide temporary venous access. However, it causes complications such as catheter-relatedinfection, pneumothorax and hematoma. In this study, we aimed to evaluate the infections,complications and catheter patency rates that developed after the use of tunnel cathetersconnected to three different access routes.Material and Methods: A total of 145 patients who underwent hemodialysis due to chronicrenal failure and who were placed on permanent hemodialysis catheter were included. In thisstudy, jugular vein route was used as the first choice for the dialysis access route, when otheraccess routes were needed due to complications and infection, femoral vein route was thesecond choice, while subclavian vein route was the third choice.Results: The femoral vein group had the highest infection rate and the lowest patency rate(both p<0.001). The infection rate at the end of one year was 65.3%, 95.6%, and 64.0% for thejugular vein, femoral vein and subclavian vein, respectively. At the end of one year, patencyrates for the jugular vein, subclavian vein and femoral vein were 57.3%, 6.7%, and 32.0%,respectively.Conclusion: Although the jugular vein is the first choice for venous entry in hemodialysispatients, femoral and subclavian veins are also used. In this study, the jugular vein was the bestoption in terms of patency rate and infection. The femoral vein, on the other hand, had theworst patency rate and was also the access route with the highest infection rate.
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    Radiobasilic Versus Brachiobasilic Transposition on the Upper Arm to Avoid Steal Syndrome
    (Int Scientific Information, Inc, 2015) Karaca, Okay Güven; Baysal, Ahmet Nihat; Ecevit, Ata Niyazi; Kalender, Mehmet; Darçın, Osman Tansel; Sungur, Mehmet Ali
    Background: Although the proximal radial artery has been reported as an alternative inflow to prevent steal syndrome, brachiobasilic fistula has been reported to be associated with steal syndrome in 10-20% of cases. We aimed to compare proximal radiobasilic arteriovenous fistula (AVF) with brachiobasilic AVFs on the upper arm in terms of steal syndrome and outcomes. Material/Method: We used our institutional operative record database to identify 94 patients in whom brachiobasilic AVF (n=40) and radiobasilic AVF (n=54) were placed between January 2009 and December 2013. Postoperative complications such as steal syndrome, venous hypertension, and aneurysm were recorded. Results: Steal syndrome was determined to occur less frequently in the radiobasilic AVF group (0% vs. 10%, P=0.03). The rates of other complications (bleeding, aneurysm, venous hypertension) between the 2 groups were similar, as were the patency rates. Conclusions: Radiobasilic AVF was effective in reducing steal syndrome, with similar early and late outcomes.
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    Regional Cervical Plexus Blockage for Carotid Endarterectomy in Patients with Cardiovascular Risk Factors
    (Forum Multimedia Publishing, Llc, 2015) Taşar, Mehmet; Kalender, Mehmet; Karaca, Okay Güven; Ecevit, Ata Niyazi; Salihi, Salih; Adademir, Taylan; Darçın, Osman Tansel
    Background: Carotid artery disease is not rare in cardiac patients. Patients with cardiac risk factors and carotid stenosis are prone to neurological and cardiovascular complications. With cardiac risk factors, carotid endarterectomy operation becomes challenging. Regional anesthesia is an alternative option, so we aimed to investigate the operative results of carotid endarterectomy operations under regional anesthesia in patients with cardiac risk factors. Methods: We aimed to analyze and compare outcomes of carotid endarterectomy under regional anesthesia with cardiovascular risk groups retrospectively. Between 2006 and 2014, we applied 129 carotid endarterectomy +/- patch plasty to 126 patients under combined cervical plexus block anesthesia. Patients were divided into three groups (high, moderate, low) according to their cardiovascular risks. Neurological and cardiovascular events after carotid endarterectomy were compared. Results: Cerebrovascular accident was seen in 7 patients (5.55%) but there was no significant difference between groups (P > .05). Mortality rate was 4.76% (n = 6); it was higher in the high risk group and was not statistically significant (P = .180). Four patients required revision for bleeding (3.17%). We did not observe any postoperative surgical infection. Conclusion: Carotid endarterectomy can be safely performed with regional cervical anesthesia in all cardiovascular risk groups. Comprehensive studies comparing general anesthesia and regional anesthesia are needed.