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    Evaluation of clinical results of esmarch bandage application in giant saphenous vein closure during endovenous glue ablation
    (Clinics Cardive Publ Pty Ltd, 2024) Karahan, Oguz; Akkaya, Ozgur; Aydogan, Eyup
    Background: In recent years, the endovenous technique has been presented as a good alternative to surgery in the treatment of patients with lower extremity varicose veins. However, its effectiveness in very advanced saphenous vein diameters is controversial. In this study, we investigated the results of an endovenous glue ablation closure system applied with an esmarch bandage in saphenous veins with very large diameters. Methods: Eighty-nine patients who were operated on for varicose veins were divided into three groups according to their saphenous vein diameters: less than 10 mm (group 1), between 10 and 15 mm (group 2), and larger than 15 mm (group 3). Endovenous closure was performed with n-butyl cyanoacrylate in all patients. An esmarch bandage was applied during the procedure to all patients, except for the group with a diameter of less than 10 mm. This group underwent the standard procedure. All patients were followed up for six months after the procedure and postoperative symptoms, complications and closure rates were recorded. Results: There was complete closure of all veins in the first month postoperatively. While no thrombophlebitis was observed in group 3, thrombophlebitis was detected in two patients in groups 1 and 2. In the third month, minimal saphenofemoral reflux was observed in two (4.2%) patients in group 1 and in one (4.3%) in group 2. In the sixth month, minimal saphenofemoral reflux was detected in three (6.3%) patients in group 1 and in one (4.3%) in group 2. No residual leakage was observed in group 3 (p = 0.001). In all groups, the severity score regressed significantly in the postoperative sixth month. However, the most significant symptomatic regression was observed in group 3, which had the largest saphenous diameters and we used an esmarch bandage during closure (p = 0.000).Conclusion: Our findings support the idea that the application of an esmarch bandage during endovenous closure improves clinical outcomes, especially in saphenous veins with larger diameters.
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    Mitral annular plane systolic excursion (MAPSE) as a predictor of atrial fibrillation development after coronary artery bypass surgery
    (Aepress Sro, 2024) Koseoglu, Cemal; Oncel, Can Ramazan; Dagasan, Goksel; Coner, Ali; Akkaya, Ozgur; Keykubat, Alanya Alaaddin
    OBJECTIVE: To predict the possibility of postoperative atrial fibrillation (AF) with mitral annular plane systolic excursion (MAPSE) measurement, which is a cheap, reproducible echocardiographic method and to monitor these patients more closely and to evaluate them more effectively postoperatively. MATERIAL AND METHODS: 247 patients scheduled for coronary artery bypass surgery were evaluated and 200 patients were included in the study. The enrolled patients were classified into the two groups according to the occurrence of postoperative AF or maintained sinus rhythm after coronary artery bypass surgery (normal sinus rhythm [NSR] group vs. AF group).The clinical and demographic data of all the patients were recorded on admission. Two-dimensional transthoracic echocardiography (TTE) was performed prior to elective surgery. RESULTS: Postoperative new onset AF occurred in 37 (18.5%) patients. In the multivariate logistic regression analysis carried out after the formation of the model based on the parameters related to AF development, the relationships with white blood cell count, LAd and MAPSE were observed to be prevalent. When MAPSE, which is a parameter used to predict the development of postoperative atrial fibrillation, was compared in the ROC analysis, the area under the curve was found to be 0.831, 95% CI lower-95% CI upper (0.761-0.901) (p<0.001). The distinguishing MAPSE value in predicting postoperative atrial fibrillation development was found to be 11.6 (sensitivity: 90%, specificity: 81%). CONCLUSIONS: We showed that MAPSE could play a role in determining postoperative atrial fibrillation development after coronary artery bypass surgery (Tab. 2, Fig. 2, Ref. 28). Text in PDF www.elis.sk
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    Pain Management During and After Carotid Endarterectomy Cases Performed with Regional and İnfiltration (Tumescent) Anesthesia
    (Dubai Iranian Hosp, 2025) Akkaya, Ozgur; Aydogan, Eyup
    Background and Objectives: Previous studies have discussed the advantages of different anesthesia techniques in carotid artery surgery. However, there is not enough data comparing local anesthesia and block techniques. In this retrospective study, pain management during and after carotid endarterectomy cases is performed with regional and infiltration (tumescent) anesthesia. Methods: Endarterectomy cases performed in our clinic between 2022 and 2023 were examined. The patient's age, gender, comorbidities, type of anesthesia (infiltration anesthesia, deep cervical plexus block), and postoperative pain levels of the patients were evaluated. Results: Body Mass Index (BMI) means of patients were statistically significant and higher in cervical block patients compared to infiltration patients (P < 0.05) Operation pain was significantly correlated with BMI ( r = 0.346 ; r < 0.01 ) and medicine usage ( r = - 0.252 ; P < 0.05 ) Pain after 24h was significantly correlated with operation duration ( r = - 0.296 ; P < 0.05 ) and medicine ( r = - 0.286 ; P < 0.05 ) The effect of medicine on operation pain was insignificant multivariate level (P > 0.05) , whereas the effect of BMI was significant ( B = 0.055 ; P < 0.05 ) with controlling anesthesia type. Pain level according to BMI was significant with 0.717 Area Under Curve (AUC) value meaning 71.7% pain predictive value of BMI. Patients having a BMI over 22.85 had high pain with 93.2% positive predictive and 42.9% negative predictive level. Effects of medicine and operation duration on VAS after 24 hours were insignificant at the univariate level (P > 0.05) Conclusion: Although there is no medical justification, retrospectively, cervical block was preferred more in patients with high BMI. High BMI predicts intraoperative pain, suggesting tailored analgesia for obese patients. Further researches are needed to understand cervical block preference for higher BMI and its effects on operation pain.
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    Predicting Postoperative Atrial Fibrillation Using HARMS2-AF Score
    (Kare Publ, 2024) Oncel, Can Ramazan; Koseoglu, Cemal; Dagasan, Goksel; Coner, Ali; Ayhan, Selcuk; Akkaya, Ozgur; Karahan, Oguz
    Background Postoperative atrial fibrillation (POAF) remains a common complication after cardiac surgery. The ability to accurately identify patients at risk through previous risk scores is limited. This study aimed to evaluate the new HARMS(2)-AF risk score to predict POAF after coronary artery bypass grafting (CABG) surgery. Methods In this retrospective cohort study, we included 265 patients undergoing CABG surgery from 2022-2023. Data were obtained from the medical files of the patients and hospital records. Each patient was assigned a HARMS(2)-AF risk score. A univariate and multivariate regression analyses were done to analyze independent predictors of POAF. Results Of 265 patients, 49 had postoperative atrial fibrillation. HARMS(2)-AF score was significantly higher in patients with POAF. Age, sleep apnea, left atrial diameter (LAd), and HARMS(2)-AF score were independently associated with POAF. A HARMS(2)-AF score >= 4.5 predicted POAF with 91% sensitivity and 64% specificity (AUC = 0.787, 95% CI = 0.731-0.842, P < .001). Conclusion The HARMS(2)-AF score is a strong predictor of atrial fibrillation (AF) development after isolated CABG surgery. It can be used as a novel stratification tool to estimate AF after cardiac surgery.
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    Sex-Specific Impact of Inflammation and Nutritional Indices on AVF Blood Flow and Maturation: A Retrospective Analysis
    (Mdpi, 2025) Akkaya, Ozgur; Arslan, Umit
    Background: Arteriovenous fistula (AVF) failure rates are consistently higher in females, although the underlying mechanisms remain incompletely understood. Inflammatory processes play a key role in AVF remodeling and venous arterialization, yet their influence may differ by sex. This study aimed to evaluate the impact of inflammatory indices on AVF blood flow and maturation, with a focus on sex-specific differences. Methods: This retrospective analytical study included 110 patients (50 females, 60 males) undergoing initial surgical AVF creation. Postoperative assessments occurred at the fourth and sixth weeks. Patients demonstrating insufficient maturation (blood flow < 600 mL/min) at the fourth week were re-evaluated after two weeks without any intervening procedures or additional interventions. Results: Intraoperative Transit-Time Flow Measurement (TTFM) revealed significantly higher median AVF blood flow in males compared to females (289 mL/min vs. 200 mL/min; p < 0.001). Doppler ultrasonography (DUS) findings confirmed these sex-related differences, demonstrating consistently lower blood flow rates in female patients. An elevated neutrophil-to-lymphocyte ratio (NLR) was associated with approximately a 31% reduction in AVF blood flow among females, whereas an increased C-reactive protein-to-albumin ratio (CrA) correlated with an approximate 9% decline. In males, an elevated systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI) were significantly associated with decreased AVF blood flow. Conversely, a higher prognostic nutritional index (PNI) positively correlated with AVF blood flow in both sexes. Risk factors associated with inadequate AVF maturation (<600 mL/min at sixth week) included female sex, advanced age, obesity, smoking, anemia, low vitamin D levels, and elevated inflammatory indices (NLR, SII, and SIRI). Conclusions: Inflammatory and nutritional indices derived from routine laboratory tests may assist in estimating AVF maturation likelihood. While DUS reliably assesses AVF blood flow, complementary evaluation methods may be required to assess the broader vascular status. Further research is needed to clarify sex-specific inflammatory mechanisms influencing AVF outcomes and to guide individualized management strategies.
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    The effects on clinical outcomes of administering medications together or separately in prolonged dual antiplatelet therapy after peripheral revascularisation
    (Clinics Cardive Publ Pty Ltd, 2024) Akkaya, Ozgur; Karahan, Oguz
    Background: In the current guidelines, dual antiplatelet therapy [acetylsalicylic acid (ASA) + clopidogrel] is recommended for at least three months after peripheral iliac stenting. In this study, we investigated the effect on clinical outcomes of adding ASA in different doses and at different times after Methods: Seventy-one patients were administered dual antiplatelet therapy after successful iliac stenting. Group 1, consisting of 40 patients, was given 75 mg of clopidogrel plus 75 mg of ASA in a single dose in the morning. In group 2, separate doses of 75 mg of clopidogrel (in the morning) and 81 mg of 1 x 1 ASA (in the evening) were started in 31 patients after the procedure were recorded. resulting in reduced haemoglobin levels (p = 0.038). dose of ASA.