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Cuffed-tunneled hemodialysis catheter is a reliable and effective alternative treatment option in the cases where all the peripheral vascular access points become useless for operative procedures or reinterventions. In addition, imaging methods have become more important to identify or prevent possible complications during or after catheter insertion. In this article, we report two rare cases to emphasize the importance of fluoroscopy and venography in determination and treatment of catheter-related complications and dysfunctions.

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BackgroundWe aimed to investigate the preoperative, operative, and postoperative factors affecting intra-aortic balloon pump (IABP) insertion in patients undergoing isolated on-pump coronary artery bypass grafting (CABG). We also investigated factors affecting morbidity, mortality, and survival in patients with IABP support.MethodsBetween January 2002 and December 2009, 1,657 patients underwent isolated CABG in İzmir Katip Celebi University Atatürk Training and Research Hospital. The number of patients requiring support with IABP was 134 (8.1%).ResultsIn a multivariate logistic regression analysis, prolonged cardiopulmonary bypass time and prolonged operation time were independent predictive factors of IABP insertion. The postoperative mortality rate was 35.8% and 1% in patients with and without IABP support, respectively (p=0.000). Postoperative renal insufficiency, prolonged ventilatory support, and postoperative atrial fibrillation were independent predictive factors of postoperative mortality in patients with IABP support. The mean follow-up time was 38.55±22.70 months and 48.78±25.20 months in patients with and without IABP support, respectively. The follow-up mortality rate was 3% (n=4) and 5.3% (n=78) in patients with and without IABP support, respectively.ConclusionThe patients with IABP support had a higher postoperative mortality rate and a longer length of intensive care unit and hospital stay. The mid-term survival was good for patients surviving the early postoperative period.

Objective Acute aortic thrombosis and floating aortailiac thrombus are infrequent clinical conditions with high morbidity and mortality rates. It was observed that; SARS-CoV-2 coronavirus disease (Covid-19) caused a hyperinflammation and hyperimmune state and these conditions can result in a hypercoagulation and eventually thrombotic events might occur. Methods Here we presented two covid-19 positive patients with rare aortic thrombotic events. Results Two patients underwent emergent diagnostic tests including computerized tomographic angiography. Total aortic thrombosis just below the renal arising point was evaluated in one patient, and aortic floating thrombus was evaluated in other patient. But despite initial medical therapies, the clinical conditions of the cases worsened and both patients died while on medical therapy before planned surgical intervention applied. Conclusions Covid-19 is not only the disease of lungs and inflammatory system also the disease of coagulation and vascular system. Aortic thrombosis is rare and must be kept in mind in Covid-19 patients with peripheral circulation impairment.

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This study aims to investigate the predictive value of platelet/neutrophil ratio (PNR) as a marker for postoperative atrial fibrillation (POAF) in addition to neutrophil/lymphocyte (NLR) and platelet/lymphocyte (PLR) measured in the preoperative period in patients who underwent coronary artery bypass grafting (CABG). Patients and methods:The data of a total of 122 patients (89 males, 33 females; mean age 63.2±9.19, range, 41 to 86 years) who underwent isolated CABG in our clinic and had no prior atrial fibrillation history between May 2018 and February 2020 were reviewed retrospectively. The patients were divided into two groups as those with and without POAF. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated.Results: Postoperative atrial fibrillation was detected in 36 of 122 patients. A significant difference was found in lymphocyte count (p=0.043), NLR (p=0.01), and PNR (p=0.048) in the patients who developed POAF. In the univariate logistic regression model, NLR was found to be an independent predictor for POAF development with 75% sensitivity, 53% specificity, 61.5% PPV, 67.9% NPV, and 64% accuracy (AUC: 0.646, p=0.01). In the POAF patients, the ROC analysis was performed to determine the diagnostic value of the PNR; however, no significant results were obtained. Conclusion:Our study results show an independent association between baseline NLR and POAF after CABG surgery.

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