Crystallized phenol application is a good alternative to the modified Limberg flap procedure and other surgical procedures, because it has several advantages such as being a minimally invasive procedure performed under local anesthesia with higher success rate after multiple applications, decreased length of stay in hospital, and minimal scar tissue formation.

Background: In this study, we aimed to compare the results of endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) in patients with lower extremity venous insufficiency due to great saphenous vein (GSV) reflux on efficiency, patient comfort and postoperative morbidity. Methods: Endovascular approach in treatment of GSV insufficiency was performed in 283 patients between 2011 and 2014 at our clinic. In group 1, EVLA was performed on 149 patients (42 male, 107 female; mean age 46.90 ± 11.43) and in group 2, RFA was performed on 134 patients (41 male, 93 female; mean age 47.02 ± 12.58). The results were compared in terms of local pain, ecchymosis, paresthesia, venous clinic severity score (VCSS), length of GSV that process performed, efficiency and Clinical Etiology Anatomy Pathophysiology (CEAP) classification data. Results: GSV diameter at saphenofemoral junction level was 10.65 ± 3.72 mm and 11.29 ± 3.78 mm in group 1 and 2, respectively. Length of GSV that process performed was 38.97 ± 6.88 cm in group 1 and 41.83 ± 4.82 cm in group 2. Postoperatively burn, pulmonary embolism (PE) and deep venous thrombosis (DVT) were not observed in both groups. Postoperative complications in group 1 were hematoma formation in 2 (1.3%) patients, ecchymosis in 13 (8.7%) patients, edema in 21 (14.1%) patients and paresthesia in 10 (6.7%) patients. Postoperative complications in group 2 were hematoma formation in 1 (0.7%) patient, ecchymosis in 8 (6%) patients, edema in 12 (9%) patients and paresthesia in 6 (4.5%) patients. The efficiency of the process was 96.6% in EVLA group and 98.5% in RFA group. Conclusion: We conclude that both RFA and 1470 nm radial fiber EVLA procedures are effective and reliable techniques in treatment of GSV insufficiency. No significant difference was found between two techniques in terms of efficiency and postoperative morbidity.

CorrespondenceA 75 year old man was referred to our clinic with acute right leg ischemia that developed after interventional angiography was performed for treating left femoral artery pseudoaneurysm. Three months earlier, he had undergone coronary angiography via the left femoral artery, following which he suffered from left groin pain and swelling. Contrast computed tomography revealed a pseudoaneurysm of the left femoral artery, extending to the iliac artery, and bilateral peripheral arterial occlusive lesions (Figure 1). Angiography was repeated at our clinic via the left groin just below the pseudoaneurysm. There was an occlusion of the common iliac artery due to arterial dissection (Figure 2). After diagnostic angiography, a "cross-over" vascular sheath was inserted into the right common iliac artery. Then, the distal part of the right iliac artery was catheterized, a 0.035-inch guidewire was inserted, and an 8 x 60 mm self-expandable stent was mounted into the left external artery. In control angiography, the right external iliac artery and distal fl ow were visualized (Figure 3). Just after percutaneous intervention, the left femoral artery pseudoaneurysm was repaired via groin incision, and femoropopliteal bypass was performed with an 8 mm polytetrafl uoroethylene graft at the same side. As a result, the iatrogenic pseudoaneurysm of the left iliac artery and dissection of the right iliac artery were both repaired with hybrid approach.

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Background: Thyroidectomy for giant goiter is a surgical challenge due to distorted and displaced anatomy. The aim of this study is to evaluate the relationship between giant goiter and its operative complications. Material and Methods: A retrospective multicenter study of consecutive patients who had thyroid surgery was conducted, including 639 patients who undergone thyroidectomy in State hospital at Van and Corlu city-Turkey. Seven cases had giant goiter in the patients. Total thyroidectomy was performed all patients. Results: All patients were women. The mean weight of glands removed was 689 gr in giant goiter's patients. Two operative complications had happened; right site injury of the external branch of the superior laryngeal nerve had happened to one patient; hypocalcemia was happened to another one patient. In those two patients previously were operated partial thyroidectomy. Conclusions: Thyroidectomy for a massively enlarged goiter is technically challenging. The predominant operative complications were related to previously operate and the thyroid gland due to distorted and displaced anatomy. The surgical approach to such cases requires carefully preoperative evaluation and planning. Especially, using of intraoperative nerve monitoring is to be useful in these difficult cases which previously had undergone surgery.