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Hakan Posacioglu

Publications and source records attributed to Hakan Posacioglu.

22 records · Page 2Linked to original sources
PubMed2002

Predictive value of conventional computed tomography in determining proximal extent of abdominal aortic aneurysms and possibility of infrarenal clamping.

The present study aimed to evaluate the diagnostic reliability of computed tomography in determining the proximal extent of abdominal aortic aneurysms and the possibility of infrarenal clamping. Preoperative computed tomographic findings, together with the operative data for 95 patients, were retrospectively analyzed in light of the operative findings. Eighty-nine (93.68%) of the patients were men and 6 (6.32%) were women, with a mean age of 66.27 +/- 18.14 years. Diagnosis of infrarenal aneurysm by computed tomography was confirmed at the time of surgery in 91 (95.79%) of 95patients. The negative-predictive value of computed tomography in detecting supra-aneurysmal renal arteries was found to be 95.79%. The specificity was 98.91%. Infrarenal cross-clamping was performed in 59 (62.11%) of 95 patients, whose aortic segments between the renal artery orifices and the proximal borders of the aneurysms had a mean length of 26.4 +/- 7.11 mm by computed tomography Suprarenal clamping was required in 36 (37.89%) of the 95 patients, whose aortic segments had a mean length of 12.7 +/- 3.48 mm. We conclude that conventional computed tomography is reasonably accurate in determining the proximal extent of abdominal aortic aneurysms. Although there is a high rate of error in determining the possibility of infrarenal clamping when no specific measurements are taken, infrarenal clamping can be planned when measurement by computed tomography shows a length of > or = 26 mm between the renal arteries and the proximal extent of the aneurysm. In patients with shorter aortic segments, suprarenal aortic clamping should be considered.

Aged↗
PubMed2002

Experience with cerebral perfusion in total aortic arch replacement.

BACKGROUND: The interruption of cerebral circulation is a major problem in the surgical repair of the aortic arch. This study was undertaken to identify the perioperative risk factors for mortality and neurological morbidity, and the outcome after total aortic arch replacement. MATERIAL/METHODS: Between June 1995 and March 2002, 23 patients (13 males) underwent total aortic arch replacement. The mean age was 61.7I9.4 years (range 35-77). All patients underwent total arch replacement with a period of hypothermic circulatory arrest (HCA). Selective cerebral perfusion was utilized as an adjunct to HCA (retrograde in 19 patients and antegrade in 4 patients). The elephant trunk technique was used in 18 patients, while proximal and middle portion of the descending aorta was also replaced in 5 patients. The patient information in our database was retrospectively reviewed. The risk factors affecting mortality and morbidity were analyzed by univariate analysis. RESULTS: The in-hospital mortality rate was 17.4%. None of the survivors developed major stroke. Temporary neurological dysfunction (TND) was seen in 5 patients. Univariate analysis revealed that excessive blood transfusion was the only factor correlated with hospital death among 18 perioperative variables (p<0.006). HCA lasting > 55 minutes and a history of hypertension were associated with the development of TND (p<0.032 and p<0.02, respectively). CONCLUSIONS: Total arch replacement can be performed with acceptable mortality and neurological morbidity. Midterm survival is excellent in hospital survivors. The duration of HCA is not associated with in-hospital mortality when selective cerebral perfusion (either antegrade or retrograde) is used as an adjunct.

Adult↗
PubMedDate not supplied

Impact of organ malperfusion on mortality and morbidity in acute type A aortic dissections.

BACKGROUND: Organ malperfusion is a serious complication of acute type A aortic dissection. Management and outcome of malperfusion has been discussed in this study. METHODS: Between November 1994 and May 2003, 118 patients with acute type A aortic dissections were operated. Fifty-seven patients (48.3%) were complicated with organ malperfusion, which is considered as group I. Seventy-three ischemic events were seen in 57 patients with organ malperfusion. Patients in group I were divided into four subgroups according to affected organ system including limb (38 events), coronary (9 events), renal (2 events), visceral (9 events), and cerebral (15 events) ischemia. Sixty-one patients without organ malperfusion constitute group II. RESULTS: The hospital mortality rate was 42.1% (24 of 57) in patients with malperfusion, 14.75% (9 of 61) in group II (p = 0.001), and 27.9% (33 of 118) in all patients. Postoperative complications such as mediastinal hemorrhage, low cardiac output, gastrointestinal system complications, acute renal failure, and multiple organ failure were higher in group I. Mesenteric and limb ischemia associated with high mortality. Multivariate analysis reveals that visceral malperfusion is the strongest predictor of postoperative mortality (odds ratio: 25.09, p = 0.000). Isolated coronary malperfusion had the lowest mortality (one patient, 16.6%) among the patients with organ malperfusion. CONCLUSIONS: Acute type A aortic dissections with organ malperfusion has higher postoperative mortality and morbidity. Immediate aortic repair is our management strategy in patients with limb, coronary, and neurological malperfusion. To reduce the extremely high mortality with mesenteric malperfusion, new strategies should be investigated such as surgical delay with interventional procedures.

Acute Disease↗