Protection from renal injury with popliteal artery micro-puncture and minimized radiographic contrast use with critical SFA lesions, low EGFR, and high creatinine levels
Süha Sadullah Özdilek1, Fatma Ferda Kartufan3, Soner Sanioğlu2, Hakan Öntaş4, Kayıhan Kara5, Halit Yerebakan2
1 Department of Cardiovascular Surgery, Sakarya Research and Training Hospital, Sakarya, 2 Department of Cardiovascular Surgery, Yeditepe Univesity Hospital, Ataşehir, Istanbul, 3 Department of Anesthesia and Intensive Care, Yeditepe Univesity Hospital, Ataşehir, Istanbul, 4 Department of Cardiovascular Surgery, Balıkesir Atatürk City Hospital, Balıkesir, 5 Department of Internal Medicine, Turkish Ministry of Defence, Turkish Naval Forces Command Primary Health Center, Çankaya, Ankara, Turkey
Aim: In recent years endovascular treatment of symptomatic peripheral arterial disease (PAD) provides many advantages like fast application, fast recovery and low cost in many cases. And it is recommended as a primary revascularization strategy in a wide range of many PAD patients rather than surgical treatment of symptomatic peripheral arterial disease (PAD). However optimal methods of catheter-based treatment for renal insufiency patients remain controversial. Material and Method: In Yeditepe University Faculty of Medicine Hospital between 2017-2018, we performed endovascular treatment with ipsilateral popliteal artery puncture of 18 patients. Pre-op creatinin , EGFR and post-operative creatinin levels and puncture area complications were compared. Results: Primary end-point was technical success with popliteal access without any post-operative complications and low dosage contrast usage. Secondary end-point was 3 months follow-up stenosis degree. No punction area complications were notted. None of patients had any hematoma, ecchymosis or pseudoaneurisyms in puncture area. And after procedure none of patients had to have dialisysis treatment despite high level of kreatinin and low EGFR values. In third month control follow-up patients were asymptomatic and no recurren vascular disease was seen in doppler usg. Discussion: As a conclusion, balloon angioplasty performed with ipsilateral popliteal ar- tery micro-puncture with manually low dosage opaque use, allows the shortest way to access the target lesion and it protects the kidney from opaque toxication with minimizing the amount of opaque usage for superficial femoral artery lesions. Therefore, renal protection was ensured before and after the operation without dialysis in diabetic patients with low EGFR and borderline high creatinine levels in the study group. Furthermore, the incidence of complications is lower with popliteal artery micro-puncture than femoral artery puncture.
Renal Insuffiency; Popliteal Artery Micro-Puncture; Endovascular Treatment; Drug Eluting Balloon; Symptomatic Peripheral Artery Disease
Corresponding Author: Halit Yerebakan, Yeditepe University Hospital Cardiovascular Surgery Department, İçerenköy Mah. Hastane Sok. No:4,4/1 Ataşehir, İstanbul, Turkey. GSM: +905332719284 • F.: +90 2164693796 • E-Mail: firstname.lastname@example.org • ORCID ID: 0000-0001-9476-3145
How to Cite: Süha Sadullah Özdilek, Fatma Ferda Kartufan, Soner Sanioğlu, Hakan Öntaş, Kayıhan Kara, Halit Yerebakan. Protection from renal injury with popliteal artery micro-puncture and minimized radiographic contrast use with critical SFA lesions, low EGFR, and high creatinine levels. Eu Clin Anal Med 2019;7(2): 18-22.
Intraoperatively Taken and Used Autologous Blood Transfusion; A Cost-Effective and Beneficial Way of Blood Transfusion in Cardiac Surgery: A Retrospective Clinical Trial
Fatma Ferda Kartufan1, Kenan Abdurrahman Kara2
1 Department of Anesthesia and Intensive Care, 2 Department of Cardiovascular Surgery, Yeditepe Univesity Hospital, Ataşehir, Istanbul, Turkey
Aim: In recent years autologous blood transfusion (ABT) seems to be more beneficial than allograft blood trans- fusion in coronary artery bypass, major vascular surgery and other surgeries that have increased elective blood transfusion risk. This current retrospective controlled study aimed to show that the intraoperatively taken and transfused ABT (iABT) is practical, beneficial and cost-effective. Material and Method: Cardiac surgery patients were investigated from January 2017 to November 2018. Fifty-eight patients’ clinical data were investigated. During the process; the cross-clamp time and the extracorporeal perfusion time, volume of blood loss, blood transfusions needed were investigated. During the intensive care unit hospitalization extubation, ICU hospital- ization time, the volume of blood loss, blood transfusions needed were examined. Also, total hospitalization time, the total volume of blood loss, total blood transfusions required, 30 days of mortality and one year of mortality were investigated. Results: Fifty-eight patients’ (23 female and 35 male) clinical data were investigated. ICU time was significantly shorter than the patients who were not transfused with iABT (p<0.05). Intraoperative, ICU stay, and total blood loss were significantly lower than who were not transfused with the iABT(p<0.05). Discussion: This current study showed that the iABT is more beneficial than allograft blood and blood products transfusions. The iABT is related to less blood loss in operation and during the ICU stay, causing decreased risk of complica- tions. According to less blood loss, fewer blood products transfusion is also a cost-effective benefit.
Autologous Blood Transfusion; Cardiac Surgery; Preoperative Autologous Blood Donation; ICU; Restrictive Trans- fusion
Corresponding Author: Kenan Abdurrahman Kara, Department of Cardiovascular Surgery, Yeditepe University Hospital, İçerenköy Mah. Hastane Sok. No:4,4/1 Ataşehir, İstanbul, Turkey. GSM: +905300655225 • F.: +90 2164693796 • E-Mail: email@example.com
ORCID ID: 0000-0003-1295-7689
How to Cite: Fatma Ferda Kartufan, Kenan Abdurrahman Kara. Intraoperatively Taken and Used Autologous Blood Transfusion; A Cost-Effective and Beneficial Way of Blood Transfusion in Cardiac Surgery: A Retrospective Clinical Trial. Eu Clin Anal Med 2019;7(2): 13-7.