Livedoid vasculopathy (LV) is a rare, chronic, and occlusive disease of the veins supplying the upper parts of the skin. The pathogenesis of the disease is not precisely understood, and its attacks are often unpredictable but tend to worsen during the summer. LV affects women more often. This increased risk for LV in women might be related to sex-specific physiological conditions, such as pregnancy, or a higher incidence of LV-associated conditions, such as connective tissue diseases, hypercoagulable states, and venous stasis in women. The typical clinical appearance of LV consists of three main findings: livedo racemose, atrophie blanche, and skin ulcers. The purpose of this comprehensive review was to analyze LV in all aspects and mainly focus on early diagnosis for successful clinical management with a holistic and multidisciplinary approach. A detailed history, dermatological examination, and laboratory testing are essential for a diagnosis of LV. When LV is clinically suspected, a skin biopsy should be taken to confirm the diagnosis. Another critical step is to investigate the underlying associated conditions, such as connective tissue diseases, hypercoagulable states, thrombophilia, and malignancy. Unfortunately, no associated conditions can be detected in approximately 20% of all cases (idiopathic LV) despite all efforts. The diagnosis of the disease is delayed in most patients. Thus, irreversible, permanent scars appear. Early and appropriate treatment reduces pain and prevents the development of scars and other complications. Antiplatelet drugs and anticoagulants can be preferred as the first-line treatments along with general supportive measures. Other therapeutic options might be considered in unresponsive cases. Preference for refractory cases is based on availability, clinical experience, and patient-related factors (comorbidities, age, sex, and compliance). These include anabolic steroids, intravenous immunoglobulin, hyperbaric oxygen therapy, psoralen-ultraviolet A, vasodilators, fibrinolytics, immunomodulators, and immunosuppressives.

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Occlusive lesions in the arterial endothelium are often caused by formation of intimal hyperplasia and fibrinoid necrosis. The objective of this study was to investigate the association between antiendothelial cell antibodies (AECAs) and the development of coronary artery disease (CAD) and peripheral artery disease (PAD). In this study, 94 patients with CAD or PAD and 94 healthy volunteers serving as control subjects were examined. Frozen sections of human umbilical vein endothelial cells and primate smooth muscle cells were used to detect the presence of AECAs, which were found in 52 of 94 patients (55%) and in 15 of 94 controls (16%) ( P < .001). Endothelial structure tissue damage is a major factor in arterial diseases. In the present study, a statistically significant relationship was found between AECAs and the development of CAD and PAD. The presence of AECAs has been identified as a risk factor for these diseases. According to this study, AECAs are reliable prognosticators for the development of CAD and PAD. Further studies with large numbers of serum samples are under way.

Aim: Postoperative atrial fibrillation is common after cardiac surgery and is associated with higher rates of complications and mortality. Despite the importance of postoperative atrial fibrillation, the most effective management strategy for this common surgical complication remains uncertain. The aim of this study was to evaluate the effectiveness of amiodarone and early direct current cardioversion to restore sinus rhythm in new onset postoperative atrial fibrillation. Material and Methods: This was a prospective, open-labeled randomized-controlled trial. A total of 50 patients who had new onset postoperative atrial fibrillation longer than 30 minutes were enrolled in the study; 26 patients were randomized to control group and 24 to amiodarone group. Patients in whom sinus rhythm did not return within 24 hours, then external electrical direct current cardioversion was performed for both groups. The primary endpoint of the study was a restoration of sinus rhythm at the 24th hour. Secondary endpoints needed for direct current cardioversion, success rate, sinus rhythm at discharge, sinus rhythm at 30th days and crossover rates. Results: There was a significantly higher number of patients with sinus rhythm at the 24th hour in the amiodarone group than the control group (79.2% vs. 46.2%, p=0.022). Need for direct current cardioversion (p=0.022) and crossover ratio (p=0.021) were significantly higher in control group than amiodarone group. Direct current cardioversion success rate, normal sinus rhythm at discharge and 1st month did not differ significantly between groups. Conclusion: Amiodarone therapy seems effective in restoring sinus rhythm within 24 hours and decreases the need for direct current cardioversion.

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