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Öğe Infection Rate of Tunneled Hemodialysis Catheters(2021) Kalender, Mehmet; Ecevit, Ata Niyazi; Darçın, Osman Tansel; Karaca, Okay GüvenAim: 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.Öğe Multidisciplinary approach in “pat pat” injuries: the role of vascular surgeon(2019) Karaca, Okay Güven; Mavioğlu, İlhan; Akbaş, Mustafa Haluk; Koç, Ayşegül; Karaduman, Zekeriya Okan; Kunt, AyşegülIn Turkey, farm machinery accidents are important factors for morbidity and mortality. In Western Black sea region, a specific farming toolis used, called 'Pat Pat'. In our clinic, we operated two patients with multiple lower extremity injuries occurred due to Pat Pat machines.First case had a right Gustilo-Anderson type IIIC open tibial fracture, anterior tibial artery disruption, and a left massive soft tissue defectwith popliteal nerve and artery disruption as determined by digital subtraction angiography. The second case had a right Gustilo-Andersontype IV open proximal tibial fracture, distal femoral fracture, and popliteal artery disruption. All injuries of popliteal arteries and veinsrepaired with saphenous vein interposition. On follow up, we observed that the saphenous vein grafts were thrombosed. We suppose thatvascular injuries occurred in those cases due to both penetrating and blunt mechanisms. Repeated thrombectomy was performed, and thepatency of the grafts were achieved. Heparin infusion (1000U/hour) was administered in first postoperative 24 hours, and the patientwas followed up every hour to keep activated clotting time ?200 sec. Consequently, saphenous veins of both cases were protected fromthrombosis. In conclusion, combination of penetrating and blunt trauma causing fractures and vascular injury to lower extremities can bemanaged with coordination of orthopedic, vascular and plastic surgeons. Prompt diagnosis, early intervention, heparin infusion in first 24hours and continuing with low-molecular-weight heparin results in successful management with palpable distal pulses and limb salvage inthose challenging injuriesÖğe Pyoderma gangrenosum triggered by acute ischemia of lower extremity: A case report(Duzce University Medical School, 2019) Kalender, Mehmet; Uğur, Oğuz; Gökmengil, Hayat; Karaca, Okay Güven; Karanis, Meryem İlkay ErenPyoderma gangrenosum is a very rare condition of unclear etiology with an estimated incidence of 3 to 10 cases per million people per year. We report a case of pyoderma gangrenosum triggered by acute ischemia of lower extremity without a prior history. Seventy-seven years old female patient was admitted to the emergency department with necrosis on the anterior side of her left limb. Digital subtraction arteriography revealed total occlusion of the left common femoral artery for which thrombectomy under local anesthesia was performed successfully. The necrotic area was debrided and biopsies were obtained. Pathological examination revealed pyoderma gangrenosum and steroid treatment was began. The patient was discharged on the 10th postoperative day with prednisone 48 mg per day for the following 30 days. During the management of ischemic peripheral artery disease patients with persistent skin findings, pyoderma gangrenosum should be in the list of differential diagnoses. © 2019, Duzce University Medical School. All rights reserved.Öğe 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 AliBackground: 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.Öğe 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 TanselBackground: 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.Öğe Revascularization in Erectile Dysfunction due to Pelvic Trauma(2019) Yüksel, Alpaslan; Karaca, Okay Güven; Baba, Dursun; Şenoglu, Yusuf; Tekin, AliErectile dysfunction is defined as the inability to achieve penile erection necessary for sexualintercourse or to sustain erection sufficiently. Although the treatment options for erectiledysfunction are limited, the most common surgical treatment is penile prosthesis implantation.In addition, penile revascularization of the penis is very effective in the treatment of erectiledysfunction due to different vasculogenic reasons, especially pudendal artery occlusion, afterperineal trauma. Modified Furlow Fisher technique including anastomosis of the inferiorepigastric artery to the penile dorsal vein is a successful treatment option among therevascularization techniques. Despite invasive preliminary evaluations such as duplex Dopplerultrasound, dynamic cavernosometry, selective internal pudendal arteriography, and the longand difficult surgical procedure, it is highly effective in particularly selected young patients.Öğe Short Term Outcomes of Endarterectomy to Asymptomatic Extracranial Carotid Artery Disease(2020) Kalender, Mehmet; Uğur, Oğuz; Gökmengil, Hayat; Baysal, Ahmet Nihat; Düzyol, İpek Yakın; Parlar, Hakan; Karaca, Okay GüvenAim: Recently published papers regarding the treatment of carotid artery stenosis are incontradiction with previous trials. Some experts have argued that this evidence supports aconservative approach to carotid revascularization (carotid endarterectomy or carotid stenting)in asymptomatic patients. The objective of this study is to evaluate outcomes of carotidendarterectomy based on preoperative symptom status.Material and Methods: This retrospective study included patients underwent carotidendarterectomy to internal carotid artery between August 2008 and August 2015. Patients weredivided into two groups according to preoperative symptoms. Asymptomatic group consistedof 41 patients with no preoperative neurological symptoms, and symptomatic group of 62patients with preoperative neurological symptoms (vertigo, amaurosis fugax, transientischemic attack and ischemic stroke). Postoperatively, all patients received standard therapy inline with the recommendation of the guidelines.Results: One hundred and three patients were enrolled in this study. The mean age of patientswas 68.20±9.79 (range, 41-86) years, and 27 (26.2%) of them were female. There were nostatistically significant difference in terms of demographic characteristics between the groupsexcept risk groups; asymptomatic group had more high risk grouped patients (p=0.001).Asymptomatic group was associated with statistically significantly more postoperativemortality compared with symptomatic group (p=0.028). None of the preoperative variableswere related to postoperative stroke. In symptomatic group, postoperative stroke was seen inthe patients who had preoperative transient ischemic attack and major stroke.Conclusion: Time of surgical treatment in asymptomatic carotid artery disease should beplanned according to patients’ cardiac risk factors.Öğe Treatment of steal syndrome in patients with arteriovenous fistula: Narrowing the arterial part of anastomosis(2018) Karaca, Okay Güven; Kunt, Ayşegül; Koç, AyşegülIf primary vascular access fails, secondary and tertiary vascular accesses in the proximal sides are needed in patients undergoing hemodialysisdue to end-stage renal disease. Unfortunately, the risk of steal syndrome is higher, if the vascular access is created in the proximal sides.Although steal syndrome is rare, it is a potentially devastating complication. Herein, we present two cases of steal syndrome which wastreated by narrowing the arterial part of the anastomosis. With the anastomotic narrowing technique which we used, ischemic symptoms ofthe first case regressed completely, and wound healing was achieved after some time. Ischemic symptoms of the second case also regressedcompletely with pain relief. Arteriovenous fistulas (AVFs) of both cases were preserved, and the patients underwent hemodialysis throughthe AVFs for 40 and 21 months, respectively. We believe that narrowing the arterial part of the anastomosis under the intraoperative colorDoppler ultrasonography guidance is a simple technique which does not require the use of any foreign materials, and it may be effective inpatients with steal syndrome due to a high-flow rate and a large anastomosis, not due to peripheral arterial disease.Öğe Üst Kolda Radyobazilik Transpozisyon(2017) Karaca, Okay Güven; Sungur, Mehmet Ali; Koç, AyşegülAmaç: Hemodiyaliz için ideal giriş yolu üst ekstremitede distalden proksimale doğru olan otolog arteryovenöz fistüllerdir. Brakiyal arteri giriş arteri olarak kullanmak, özellikle steal sendromu olmak üzere komplikasyon riskini attırır. Bu çalışmada üst ekstremitede radyal arterden orijin alan radyobazilik ven transpozisyonu tekniği ile yaptığımız arteryovenöz fistüllerin sonuçlarını açıklamayı amaçladık.Gereç ve Yöntemler: Bu retrospektif çalışma, Ocak 2009 - Aralık 2012 döneminde radyobazilik transpozisyon arteryovenöz fistül yaptığımız kırk hastayı kapsamaktadır. Steal sendromu, venöz hipertansiyon ve anevrizma gibi postoperatif komplikasyonlar kaydedildi.Bulgular: Takip süresince üç hastada anevrizma gelişti. Hastaların hiçbirinde steal sendromu ve venöz hipertansiyon görülmedi. Ortalama takip süresi 28,991,57 ay idi. Bir yıllık ve iki yıllık primer açık kalma oranları sırası ile %76,6 ve %49,5 idi. Bir yıllık ve iki yıllık sekonder açık kalma oranları ise sırası ile %81,4 ve %55,6 idi.Tartışma ve Sonuç: Steal sendromu brakiyal arterden orijin alan arteryovenöz fistüllerde radyal arterden orijin alan arteryovenöz fistüllere göre daha fazla görülür. Pek çok araştırmacı komplikasyonlardan kaçınmak için giriş arteri olarak proksimal radyal arteri kullanılmıştır. Sonuçta özellikle RBAVF şeklinde yapılan bazilik ven transpozisyonunun steal sendromu açısından daha güvenli olduğunu ve patensi oranlarının da literatür ile uyumlu olduğunu düşünüyoruz. Bununla birlikte karşılaştırmalı çalışmaların gerektiğine inanıyoruz.Öğe Validation of German Aortic Valve Score in a Multi-Surgeon Single Center(Soc Brasil Cirurgia Cardiovasc, 2017) Kalender, Mehmet; Baysal, Ahmet Nihat; Karaca, Okay Güven; Boyacıoğlu, Kamil; Kayalar, NihanObjective: Risk assessment for operative mortality is mandatory for all cardiac operations. For some operation types such as aortic valve repair, EuroSCORE II overestimates the mortality rate and a new scoring system (German AV score) has been developed for a more accurate assessment of operative risk. In this study, we aimed to validate German Aortic Valve Score in our clinic in patients undergoing isolated aortic valve replacement. Methods: A total of 35 patients who underwent isolated open aortic valve replacement between 2010 and 2013 were included. Patients with concomitant procedures and transcatheter aortic valve implantation were excluded. Patients' data were collected and analyzed retrospectively. Patients' risk scores EuroSCORE II were calculated online according to criteria described by EuroSCORE taskforce, Aortic Valve Scores were also calculated. Results: The mean age of patients was 61.14 +/- 13.25 years (range 29-80 years). The number of female patients was 14 (40%) and body mass index of 25 (71.43%) patients was in range of 22-35. Mean German Aortic Valve Score was 1.05 +/- 0.96 (min: 0 max: 4.98) and mean EuroSCORE was 2.30 +/- 2.60 (min: 0.62, max: 2.30). The Aortic Valve Score scale showed better discriminative capacity (AUC 0.647, 95% CI 0.439-0.854). The goodness of fit was x(2)HL[Aortic Valve Score]= 16.63; P= 0.436). EuroSCORE II scale had shown less discriminative capacity (AUC 0.397, 95% CI 0.200-0.597). The goodness of fit was good for both scales. The goodness of fit was x(2)HL[EuroSCORE II]= 30.10; P= 0.610. Conclusion: In conclusion, German AV score applies to our population with high predictive accuracy and goodness of fit.
