Background The optimal treatment of high‐risk pulmonary embolism (PE) with cardiac arrest is still controversial although various treatment approaches have been developed and improved. Here, we present a serie of patients with high‐risk PE showing hemodynamic collapse, who were successfully treated with extracorporeal membrane oxygenation (ECMO) as an adjunct to EKOS™ acoustic pulse thrombolysis (APT). Methods From April 2016 to June 2020, 29 patients with high‐risk PE with cardiac arrest were retrospectively included. The mean age was 55.3 ± 9.2 years. A total of 12 (41.3%) patients were female. All patients had cardiac arrest, either as an initial presentation or in‐hospital after presentation. All patients exhibited acute symptoms, computed tomography evidence of large thrombus burden, and severe right ventricular dysfunction. Primary outcome was all‐cause 30‐day mortality. Results Twenty‐two patients survived to hospital discharge, with a mean intensive care unit stay of 9.9 ± 1.6 days (range: 7–22 days) and mean length of hospital stay of 23.7 ± 8.5 days (range: 11–44 days). Six patients died from refractory shock. Ninety‐day mortality was 24.1% (7/29). The Mean ECMO duration was 3.5 ± 1.1 days and the mean RV/LV ratio decreased from 1.31 ± 0.17 to 0.92 ± 0.11 in patients who survived to discharge. The mean tissue plasminogen activator dose for survivor patients was 20.5 ± 1.6 mg. Conclusion Patients with high‐risk pulmonary embolism who suffer a cardiac arrest have high morbidity and mortality. APT complemented by ECMO could be a successful treatment option for the patients who have high‐risk PE with circulatory collapse.

Bu çalışmada, kateter aracılı ultrasonla hızlandırılmış tromboliz ile tedavi edilen derin ven trombozlu hastaların işlem sonrası semptomları ve ultrasonografik sonuçları değerlendirildi. Ça lış m a pla nı: Ocak 2012-Mayıs 2013 tarihleri arasında derin ven trombozu tanısı olan toplam 41 hasta (20 erkek, 21 kadın; ort. yaş 63.9; dağılım 19.9±21.9 yıl) çalışmaya dahil edildi. Hastalar akut, subakut ve kronik olarak üç gruba ayrıldı. Akut grupta 15 hasta (%36.6), subakut grupta 21 hasta (%51.2) ve kronik grupta beş hasta (%12.2) vardı. Tüm olgularda tromboze ekstremitede Doppler ultrasonografi eşliğinde popliteal ven yoluyla kateter aracılı ultrasonla hızlandırılmış tromboliz (EKOS ®) uygulandı. Venografi yapıldı ve trombüs boyu doğrulandı. Hastalar işlem sonrası varfarin ile antikoagüle edildi ve antiemboli çorabı verildi. Hastaların işlem öncesi ve işlem sonrası birinci ay, altıncı ay ve birinci yıl Doppler ultrason sonuçları, semptom değişimleri ve bacak çap farkları istatistiksel olarak değerlendirildi. Bul gu lar: Bir hastada eşlik eden pulmoner emboli saptandı. Akut ve subakut gruplarındaki hastalarda istatistiksel olarak anlamlı semptomatik düzelme ve bacak çaplarında azalma saptandı. Kronik gruptaki hastalarda semptomatik düzelme ve rekanalizasyon artışı saptandı. Tedavi süresince mortalite veya kanama komplikasyonu olmadı. So nuç:Bulgularımıza göre, kateter aracılı ultrasonla hızlandırılmış tromboliz derin ven trombozu için riskli hasta grubunda bile güvenilir ve etkin bir tedavi olabilir. Anah tar söz cük ler: Kateter aracılı ultrasonla hızlandırılmış tromboliz; derin ven trombozu; endovenöz lokal trombolitik tedavi. Background: This study aims to evaluate the post-intervention symptoms and ultrasonographic results of patients with deep vein thrombosis who were treated with catheter-directed ultrasoundaccelerated thrombolysis. Methods: Forty-one patients (20 males, 21 females; mean age 63.9 years; range 19.9±21.9 years) who diagnosed with deep vein thrombosis between January 2012 and May 2013 were included in this study. Patients were divided into three groups as acute, subacute and chronic. Acute group included 15 patients (36.6%), subacute group included 21 patients (51.2%), and chronic group included five patients (12.2%). All cases were administered catheter-directed ultrasound-accelerated thrombolysis (EKOS ®) in the thrombosed extremity via the popliteal vein under Doppler ultrasonography. Venography was applied and thrombus length was confirmed. After the intervention, patients were anticoagulated with warfarin, and given anti-embolism stockings. Patients' Doppler ultrasound results for pre-intervention, and one month, six months, and one year after intervention, symptom changes, and leg diameter differences were statistically evaluated. Results: Concomitant pulmonary embolism was detected in one patient. Statistically significant symptomatic improvement and reduced leg diameters were detected in patients in the acute and subacute groups. Symptomatic improvement and increased recanalization were dete...

Objectives:The aim of the present study was to compare preoperative / postoperative ventricular functions of patients with ventricular dysfunction who were planned for coronary artery bypass grafting (CABG) using echocardiography and angiography, and to evaluate whether there was a significant improvement in ventricular function. Methods: This prospective study included 30 patients with poor ventricular function who had undergone CABG at the Cardiovascular Surgery Clinics of Bursa Yüksek Ihtisas Hospital. The patients' ventricular functions were compared preoperatively and postoperatively at the 2 nd , 6 th and 12 th months. Results: Of the patients, 28 were males, and the mean age was 60.1 ± 8 years (range 39-71). In these cases, functional capacity improved within the early postoperative period, and global ventricular functions improved within the postoperative first year. The improvement in ejection fraction results was statistically significant at 6 months and 12 months (p < 0.05). A significant decrease was observed in left ventricular enddiastolic pressures within one year (p < 0.001). For the performance score, improvement was significant from the 2nd month (p < 0.05). Conclusions: Our findings show that CABG improves ventricular function in terms of EF, PS, LVEDP and NYHA classification. In conclusion, we consider that CABG is a significantly effective option in patients with poor ventricular function.

Objective: Ablation of N-butyl cyanoacrylate (NBCA) and endovenous laser ablation (EVLA) are two important techniques used in the treatment of venous insufficiency. The aim of this study is to compare the results of EVLA and NBCA methods in the treatment of saphenous vein insufficiency. Method: 739 patients with saphenous vein insufficiency who were followed up between 2013 and 2018 and treated with NBCA (350 patients) and EVLA (389 patients) applications were included in the study. Pre-procedure, during, post-procedure and follow-up data of the patients were collected and compared retrospectively. Results: In the group using NBCA technique; mean age was 46.09±6.12 years, mean age was 48.08±6.11 years in the EVLA technique group. The mean ablated vein length was 32.97-65.83 cm in the NBCA group and 30.65-67.25 cm in the EVLA group. The mean procedure time was 7 minutes in the NBCA group and 18 minutes in the EVLA group. The 12-month total occlusion rates in the NBCA and EVLA groups were 98.8% and 97.6%, respectively. In both the NBCA and EVLA groups, the post-procedure Venous Clinical Severity Score (VCSS) was significantly reduced with no difference between the groups. When NBCA treatment was compared with EVLA treatment, it was seen that there may be fewer side effects after NBCA treatment. Conclusion: When the treatment success rates, application times, complication rates and venous clinical severity scoring results in the data obtained in our study were evaluated, it was thought that the NBCA method was as successful and reliable as the EVLA method. In conclusion; It has been suggested that the vascular closure system with NBCA is a fast and effective treatment method in the treatment of saphenous vein insufficiency, as it does not require tumescent anesthesia, does not require compression stockings, and does not have the risk of paresthesia, burn scars or pigmentation.

Currently, the only widely accepted indication for interventional treatment in cases of pulmonary embolism is hemodynamic instability or cardiogenic shock. However, the presence of a right-heart thrombus along with a pulmonary embolism is a poor prognostic indicator, and catheter-directed thrombolysis with the use of thrombolytic agents should also be considered in this circumstance. Optimal management of right heart thrombus and high-risk pulmonary embolism is still uncertain. Herein, we present the case of an 81-year-old woman who presented at our hospital after progressive dyspnea and a syncopal event. The transthoracic echocardiography showed massive bilateral pulmonary, right ventricular, and mobile atrial thrombus and also right-sided enlargement. The patient was successfully treated with acoustic pulse thrombolysis using the EKOS EkoSonic system and echocardiography revealed complete resolution of her right-heart thrombus and her high-risk pulmonary embolism 2 days later.