Aim: Blunt traumatic thoracic aortic injury (BTTAI) is a catastrophic life-threatening surgical emergency and the second most common cause of death in trauma patients. We retrospectively revealed our results for endovascularly treated BTTAI with early and long-term results. Material and Methods: During January 2009 and January 2022, patients from the emergency department with diagnosed BTTAI were retrospectively revealed. 38 patients all male except two, experienced BTTAI. 5 patients had grade IV, and 21 patients had grade III aortic injuries. Results: Mean age of the patients was 41.7±12.5 years. Technical success was 100%. Early mortality was 7.9%. The mean follow-up period was 49.7±18.3 months. In the follow-up period, there were no TEVAR-related complications. Conclusion: TEVAR is the most suitable treatment for BTTAI in the modern era. Left subclavian artery (LSA) intentional coverage may be performed however surgeon modified fenestrated stent graft (SMFSG) is an effective, economic, fast, and readily available technique for LSA revascularization without additional time.

Aim: In our study, we aimed not only if CO2 is a safe and effective vascular roadmap for EVAR procedure instead of ICM but if it is a feasible opportunity for patients with hostile neck anatomy as well. Material and Methods: From January 2019 to July 2022, 42 patients with renal insufficiency had elective EVAR procedures for infrarenal abdominal aortic aneurysm in our Cardiovascular Surgery Clinic with CO2-guided DSA. Results: There were no conversions to open surgery or no need for ICM for the CO2-guided DSA. Technical success for CO2 guidance EVAR was 100% with the second shot. There was no decline in GFR values, only one patient showed transient manifestations of CIN without need for hemodialysis. Conclusion: CO2 DSA is a safe and effective technique that can guide not only the standard but endovascular procedures with a hostile neck for renal insufficiency below the diaphragm allowing virtually unlimited images. With modern automated closed systems, CO2-specific complications will be negligible if the operator has experience with the limitations and contraindications of the technique.

Aim: Postoperative bleeding related to cardiac surgery is a clinically important condition. Consequently, re-exploration and increased blood utilization lead to adverse outcomes. The aim of this pilot study was to assess the effect of a newly adapted blood conservation strategy, including heparin titration protocol along with antifibrinolytics, regarding to mediastinal bleeding, re-exploration for bleeding and blood and blood products utilization.Methods: This study included 100 patients undergoing cardiac surgery with higher risk for bleeding, such as mitral valve replacement, aortic valve replacement, ascending / arcus aortic surgery, between January 2015 and August 2016. The study group consisted of consecutive patients who underwent new protocol (heparin titration protocol + tranexamic acid). The control group consisted of patients who were administered standard dose heparin(4 mg/kg). Fifty patients in each group (with the new protocol and the standard protocol) were compared by means of amount of heparin applied, blood utilization, mediastinal drainage and rate of re-exploration.Results: Twenty-eight of the 50 study group patients (56%) received a red blood cell (RBC) transfusion for the first 24 hours. RBC transfusion ≥ 3 units was lower in the study group (34% vs 54%; p=0.044). Moreover, mediastinal drainage and blood utilization was found to be lower at the study group, however re-exploration rates remained similar.Conclusion: Based on our study results, the suggested heparin titration protocol seemed to be beneficial for reducing postoperative bleeding and blood product usage. We consider that blood utilization protocols like our heparin titration protocol should be established to reduce the need for blood transfusion in cardiac surgery.

Introduction: Endovascular aortic repair outcomes in octogenarians remain unclear. We aim to investigate whether the results for octogenarians differ from those of the younger population in elective endovascular aortic repair. Materials and Methods: From January 2013 to January 2022, 313 patients were treated with elective endovascular aortic repairs. Patient demographics and perioperative and postoperative features were obtained from the hospital database. The primary goals were to explore the early mortality rates of patients aged 80 years and older and compare them with those under 80. The secondary goal was to analyze the comorbid factors. Results: A total of 245 patients were under 80 years old, and 68 patients were 80 years and older. The early mortality rate was 2.94% in the octogenarians and 0.81% in the rest, and there was no significant difference between the two (p = 0.24). However, being 80 years and older led to a significantly lower survival probability at the five-year follow-ups. The American Society of Anesthesiologists’ score was found to help predict late mortality risk and patient selection for elective endovascular aortic repair. Conclusion: As octogenarians are fragile and sensitive to complications, patient selection, careful consideration of life expectancy, and clinical assessment are key to repair. Furthermore, age should not be an independent exclusion criterion in the endovascular aortic repair treatment decision. Keywords: Aortic Aneurysm, Abdominal; Endovascular Procedure; Octogenarians.

Amaç: Hemodiyaliz amaçlı Arteriovenöz (AV) fistül oluşturulmasında enfeksiyon ve erken trombozdan korunmak için heparin ve antibiyotiklerin preoperatif kulanım gerekliliği halen tartışılmaktadır. Bu yazıda, iki farklı nosyon retrospektif olarak karşılaştırıp bu gerekliliği tartışmaktayız. Gereç ve Yöntemler:2015-2020 yılları arasında hemodiyaliz amaçlı tüm AV fistül ameliyatlarını inceledik. 456 hastanın 242'sine herhangi bir premedikasyon uygulanmazken, diğer 214 hastaya işlem öncesi 80-100 mg/kg heparin ve 1 gr sefazolin iv verildi ve taburcu olduktan sonra antibiyotik tedavisi 1 haftaya tamamlandı. Bu iki farklı yöntemin enfeksiyon ve erken dönem açıklık oranlarını karşılaştırdık. Bulgular: Ön kol AV fistül oluşturulan hastalar heparin ve antibiyotik kullanan premedikasyon grubu ile kontrol grubu olarak gruplandırıldı. Gruplar arasında komorbit hastalıklar ve demografik veriler açısından fark yoktu. İstatistiksel olarak anlamlı olmasa da premedikasyon grubunda hematom oranları yüksek saptandı (%2, %0,9, p=0,45). Postoperatif ilk kontrolde erken açık kalma oranları ve 3 ayda diyalize ulaşan fistül oranları açısından anlamlı bir fark yoktu. Her iki grupta da fistül enfeksiyonu gözlenmedi. Sonuç: Premedikasyon olarak heparin ve antibiyotikler damar yolu girişimlerinde enfeksiyonun önlenmesine veya erken trombozu önlenmesine katkı sağlamamaktadır. AV fistül oluşturma herhangi bir antibiyotik ve heparin olmadan güvenle yapılabilir.