Objective Buerger’s disease is one of the worst diseases causing peripheral artery occlusions (especially lower extremity) with increased morbidity and mortality. Endovascular treatment of the diseased arteries gains preference over bypass surgery nowadays. Here, we aimed to present the clinical outcomes of 16 consecutive Buerger’s disease patients underwent extended endovascular recanalization which is a new technique to restore direct blood flow to at least one foot artery, with the performance of angioplasty for each tibial and foot artery obstructions. Methods A total of 16 consecutive patients with confirmed diagnosis of Buerger’s disease that percutaneously treated in our center between February 2014 and March 2018 were included in the study. The mean age of the patients was 44.25 ± 4.28 ranging from 36 to 50 years. After physical examination and complementary diagnostic tests, performance of extended angioplasty for occluded arteries was intended to restore direct blood flow to at least one of the blow-the-knee arteries. Results A successful extended endovascular treatment was performed in 20 of 22 limbs, achieving a technical success of 91%. All patients were successfully discharged without any complication. Mean follow-up duration was 21.43 ± 7.08 months. Reintervention was performed in one patient and minor amputation was needed in one of the failed limbs. Limb salvage rate was 100%. A significant difference was observed based on Rutherford classification, ankle brachial index, direct blood flow to foot, presence of ulcer and rest pain when compared before and after the intervention. Conclusion We showed successful extended endovascular recanalization of Buerger’s disease patients with a high technical success rate and sustained clinical improvement. Extended endovascular recanalization could be a therapeutic option in Buerger’s disease patients, since they are not good candidates for surgery.

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The risk of paraplegia associated with thoracic aortic cross-clamping is high even when various methods of spinal cord protection are used. In this study prostacyclin 12 (PGI2) was selected as an agent to reduce the spinal cord injury because of its vasodilator, antiaggregant, and cytoprotective properties.Twelve dogs underwent sixty-minute aortic occlusion. Six dogs received PGI2 whereas the other 6 did not (controls). PG12 administration was started at a rate of 5 ng/kg/minute five minutes before aortic occlusion. This dosage was increased to 25 ng/kg/minute during aortic occlusion. PGI2 at a dosage of 5 ng/kg/minute was maintained for a period of five minutes after the aortic occlusion was released.Three dogs in the control group were paraplegic. There were no paraplegic dogs in the PGI2 group. Distal aortic perfusion pressure was 31 ±6 mmHg in the PGI2 group and 22 ±3 in the control group (P < 0.008).As a result of this study the authors conclude that PGI2 is a valuable agent for decreasing the risk of spinal cord injury during thoracic aortic cross-clamping lasting sixty minutes.

Brachial artery cannulation is technically simple and less time consuming, thus suitable even for emergency cases. With an acceptable risk of local complications, we recommend routine use of upper brachial cannulation for antegrade cerebral perfusion.

We report preoperative and early postoperative findings of 286 coronary bypass patients operated between 1988 and 1998 who had endarterectomy and/or patchplasty to the right coronary artery. In this retrospective study there were 61 cases with only saphenous vein patchplasty to the right coronary artery (patch group), 57 patients who underwent endarterectomy and patchplasty (open-patch group), and 229 patients having closed endarterectomy to the right coronary artery (closed group). A group of 150 patients having a saphenous vein graft to the right coronary artery without endarterectomy were chosen as a control group. Gender, age, family history, smoking history, diabetes, hyperlipidemia, hypertension, nature of the angina, severity of the coronary artery disease, left ventricular functions, preoperative rhythm, and electrocardiographic patterns were evaluated for their effect on early mortality among groups. No significant difference was detected. Positive inotropic and mechanical support need was higher in the closed group at the end of the operation and in the intensive care unit. Duration of cardiopulmonary bypass and clamp time was higher in the open-patch group. Atrial fibrillation in the early postoperative period was more frequent in the patch and closed groups. Complete atrioventricular block development and the need for a pacemaker were higher in the open-patch and closed groups. Non-Q wave myocardial infarction was more frequent in the closed group. Mortality rates were higher in the open-patch and closed groups. We conclude that endarterectomy to right coronary artery should be avoided if possible, and patchplasty with saphenous vein should be preferred.