Fevzi Çakmak Mah. Akınsel Sok. No:1 Tepebaşı Eskişehir
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Cardiovascular surgery is surgical procedures performed on the heart and vessels by surgeons specialized in this field. Cardiovascular diseases are among the important causes of death in Turkey and in the world. With advances in medicine, these diseases can now be diagnosed early for anyone who has regular checkups.
Private Gürlife Hospital's experienced cardiac anesthesia team and intensive care units equipped with advanced life support devices contribute significantly to the success rate of surgeries and allow patients to spend the postoperative period more comfortably.
The services provided in the Department of Cardiovascular Surgery are as follows:
EXAMPLES OF CLINICAL PRACTICES
1.ETS (Endoscopic thoracic sympathectomy) = VATS (Videothoracoscopic thoracal sympathectomy)
It is an endoscopic surgery performed under general anesthesia in hand and arm excessive sweating (Hyperhidrosis), buerger's disease involving the arms and Raynaud's disease. Two 1 cm incisions are made on the chest to be applied and the chest cavity is entered with thin pencil-sized thoracars. The chest cavity is observed on the screen with the camera apparatus through one of the thoracar. The lung is extinguished with gas and there is a thoracal sympathetic chain on the thoracal vertebrae. The parts that constrict the arteries of the hand and arm, and the parts related to sweating are resected with instruments inserted from the other thoracar or by cauterization. Thus, sweating in the hand, arm and armpit disappears, and the patient may even have to use a moisturizer. Wounds of patients with buggers with wounds on their fingers begin to heal with the expansion of capillaries. The hands and fingers of patients with Raynaud's become noticeably warm and their complaints improve. The patient is discharged on the same day or 1 day later.
2. VARICOSE TREATMENT
Before deciding on the treatment of varicose veins, a good clinical examination should be performed by the Cardiovascular Surgeon and the physical examination should be completed with Venous Doppler USG (vascular ultrasound), which will definitely be performed by the Radiology Specialist. With this examination, old or new clot and obstruction, stenosis, deficiencies in venous valves, backflow rate of blood, pressure and vein diameters can be measured in deep and superficial veins. The relevant Specialist Physician tries to make the best decision for the patient in the light of this information.
Sclerotherapy (needle treatment), foam sclerotherapy, skin laser, radiofrequency and thermocoagulation methods can sometimes be applied individually, or sometimes both together, to patients with capillary varicose veins (= telangiectasia) with normal deep and superficial veins and no leakage from intravenous valves. 2-4 mm slightly raised from the skin. Patients with bluish, greenish-appearing reticular varices in the diameter of the patient should be treated with sclerotherapy and foam sclerotherapy if their vascular ultrasound is normal. In sclerotherapy, a chemical agent containing polidocanol is usually administered into varicose veins with very fine-tipped insulin needles or butterfly sets in different concentrations depending on the diameter of the vessel, and the vessel is visibly sclerosed and disappears. If we mix this liquid chemical agent with air, foam it and use it, the name of the process is foam sclerotherapy. We give priority to varicose stockings if the leakage time and saphenous vein (superficial main vein) diameter is not equal to or more than 0.5 sec- 5.5 mm in patients whose contaminated blood is escaping back due to gravity and varicose veins occur on the leg skin surfaces due to valve insufficiency. . Except for regular use of compression stockings to patients at this stage; We recommend that they avoid heat, hot baths in the bath, sand baths and sunbathing in the sea, do not wear tight clothing and high heels, take frequent breaks on long journeys, and move their ankles if they cannot. We can also give venotonic medications to those who have complaints despite following these recommendations. We keep these patients under control and regularly (such as 6 months to 1 year) when there is an increase in their measurable pathologies with vascular ultrasound, we bring other treatments to the agenda.
Nowadays, we primarily recommend new methods when the vein diameters and leakage times in the valves increase. The most preferred of these are intravenous methods applied by inserting a needle into the vein of the superficial saphenous vein with a guide wire through the needle hole and sending a catheter over it. Endovenous laser ablation, endovenous radiofrequency (RF) ablation and endovenous cyanoacrylate adhesion methods are the most popular and are also known as non-surgical varicose veins treatment. In these methods, with spinal or local anesthesia, the saphenous vein with venous insufficiency is punctured with a seldinger needle in the inner part of the lower knee region, and the hole in the needle is a guide wire is sent and a sheat is inserted into the vein and a catheter is sent through the sheat and a deep and superficial vein close to the groin area is 2 cm. fixed to the distance. In the laser process, a region that emits laser energy at the end of this catheter is a region that emits radio waves at the end of the catheter in the radiofrequency process, and the catheters are connected to the main devices. Laser or RF energy that will be given into the vein with these devices will produce high heat, so 200-300 cc is applied around the catheterized vessel so that the surrounding tissues are not damaged. Tumescent anesthesia is applied with cold medicated serum until the heat energy is withdrawn from the catheter tip slowly or automatically to the pedestrian. After the procedure, the blood flow is stopped in this vein, which is burned, cauterized, and the inner wall is destroyed in a controlled manner, and the vein is left in place and canceled.
The newest method, which has been used in our country for the last 5-6 years and has become more and more preferred, is the bonding-glue method. In this method, the catheter placed in the vein is a hole inside the catheter and a catheter with holes on the edges. This liquid substance, whose chemical name is N-methyl cyanoacrylate and has been used in various treatments in the human body for years, is a strong adhesive like Japanese glue, compatible with the body, with the help of a trigger device like a gun attached to the back of the catheter, while the catheter is slowly withdrawn into the vein. given and 3 seconds following administration. When pressure is applied inside, the intravascular will be stuck together and the blood circulation in it will be stopped. Thus, with these 3 methods, this vein with high pressure and high pressure is canceled, and the branched and enlarged varicose veins originating from this vein disappear.
In cases where the vein to be placed catheter is very curved, there are very common varicose veins or the diameter of the saphenous vein is very large, the classical surgical method should be applied. The branches of the saphenous vein, located near the junction with the deep vein, are tied, cut, and a wire called a stripper is inserted into the saphenous vein, and this wire is removed from the vein with a small incision made from the lower knee area. The upper and lower connections are cut and connected, the wire is pulled and taken out with the vein. Marked varicose veins are also removed by pulling out through the mini incisions made.
The purpose of the treatment of varicose veins and venous insufficiency is to purify the person from varicose veins, to reduce the venous pressure and to save the varicose stockings. In the past, attempts for varicose veins and venous insufficiency were avoided in patients with deep vein insufficiency and varicose wounds. In recent years, no matter how much we can reduce the venous pressure in the legs, the purpose of profit has come to the fore, and these methods have been applied to all patients with varicose veins and venous insufficiency. Over time, with these interventions performed in patients with chronic venous insufficiency, even in patients with venous ulcers, it was observed that complaints and symptoms regressed, and even venous wounds healed, and these methods were added to the treatment protocols, provided that they continue to use compression stockings or elastic bandages.
Surgical (surgical) varicose vein treatments include large-small saphenous vein varisectomy + stripping, varicose pake excision, high (high) ligation, perforating vein ligation, venous valve transfer, valve repair and SEPS (subfascial endoscopic perforating surgery).
In the treatment of varicose veins and venous insufficiency, non-surgical or surgical treatments can be applied individually according to the indication, or two or three can be applied together.