Browsing by Author "Firat, Ali"

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An Alternative Treatment of Stump Occlusion of the Superficial Femoral Artery with Percutaneous Direct Puncture Followed by Antegrade Recanalization
(2020) Igus, Behlul; Firat, Ali; 0000-0003-4874-8141; 0000-0003-3296-7227; 31732420; AAN-1040-2021
Introduction: The purpose of the study was to evaluate the efficacy and safety of the "percutaneous direct puncture of occluded superficial femoral artery (SFA)" technique for recanalization of SFA, after failure of antegrade recanalization in patients with limited access to retrograde popliteal and crural arteries. Material and methods: Between April 2014 and November 2017, 10 patients with CLI (Critical limb ischemia) underwent endovascular recanalization with direct percutaneous puncture of occluded SFA after failed antegrade recanalization. All patients had a long segment (39,9 +/- 2.8 cm) occluded SFA without stump causing failed antegrade recanalization with a cannulated guidewire in the SFA origin. After unsuccessful attempts with the antegrade approach, the retrograde direct puncture technique of the occluded SFA was performed and followed by antegrade recanalization. Patients were followed up clinically with Doppler ultrasonography and according to the Rutherford scale at 1, 3, 6 and 12 months after discharge. Results: Technical success was achieved in 8/10 patients (80%).The mean follow-up period was 25,1 +/- 9,6 months. One patient underwent major amputation, resulting in 90% limb salvage rate at 12 and 24 months. Amputation-free survival estimated by Kaplan-Meier analysis was 60% at 12 and 24 months. Primary patency rates were 62.5% at 12 and 24 months and secondary patency rates were 87.5% at 12 and 24 months. Conclusion: Treatment of SFA occlusions without a stump in CLI patients via the percutaneous direct puncture of occluded SFA approach improved technical success and clinical recovery, especially in cases unsuitable for conventional antegrade and retrograde approaches. (c) 2020 Elsevier Inc. All rights reserved.
Endovascular Recanalization of Thromboangiitis Obliterans (Buerger's Disease) in Twenty-Eight Consecutive Patients and Combined Antegrade-Retrograde Intervention in Eight Patients
(2019) Firat, Ali; Igus, Behlul; 0000-0003-3296-7227; 30834476
PurposeThe aim of the study was to evaluate the technical success of the procedure and the clinical efficacy of treatment in patients with thromboangiitis obliterans (TAO) (Buerger's disease) based on a change in the Rutherford classification.Materials and MethodsA total of 28 consecutive patients (26 males, 2 females, mean age 43.35.32years) underwent endovascular recanalization with a diagnosis of TAO, between April 2015 and July 2018. After unsuccessful attempts using the antegrade approach, retrograde approaches were used in 8 patients under ultrasound guidance. Clinical follow-up was routinely performed at 1-month, 3-month, 6-month, and 1-year intervals.ResultsA total of 28 TAO patients underwent 40 procedures in 32 limbs. Technical success was achieved in 28 of the 32 limbs (87.5%). In total, 45 of 59 (76.2%) below the knee arteries were treated successfully. One major amputation was performed, providing a 96.8% rate for limb salvage both at 12 and 24months. Amputation-free survival estimated by Kaplan-Meier analysis was 84% at 12 and 24months. Primary patency rates at 12, 24, and 36months were 84%, 78%, and 75%, respectively. Secondary patency rates were 87.5% both at 12 and 24months.Conclusionp id=ParEndovascular treatment is a technically feasible and potentially effective treatment modality for Buerger's disease. Combined antegrade and retrograde interventions in TAO patients may improve technical success and clinical recovery, especially in cases where the antegrade approach has failed.
Endovascular Treatment of Intracranial Aneursyms with Flow Diverter Stents
(2020) Igus, Behlul; Selcuk, Hakan; Kara, Batuhan; Firat, Ali; Salik, Aysun Erbahceci; 0000-0003-4874-8141; AAN-1040-2021
Objective: We aimed to present the treatment and follow-up results of 41 patients who were treated for intracranial aneurysm with flow diverter stents. Method: Forty-one patients (Age range 27-68 years) were treated with the flow- diverting devices during January 2010 and January 2014. Aneurysms ranged in size from small to large (1-30 mm) and include wide-necked aneurysms, multiple, saccular, blister, dissecan, fusiform and recurrent intracranial aneurysms. Control skull X-Ray Graphy was typically performed at 1, 3 and 6 months after treatment. A follow-up digital subtraction angiogram (DSA) was performed first day, 6 and 12 months after treatment. Conclusions: Complete angiographic occlusion was achieved in 36 patients (88%) at follow-up digital subtraction angiogram. Two transient morbidities and one permanent morbidity occurred due to stent thrombosis. There was no mortality observed. Flow diverter stents are an effective tool in the treatment of large wide neck, high growth rates, and technical problematic aneurysms to treat with conventional endovascular methods.
Endovascular Treatment of Superficial Femoral Artery Ostial Occlusions and Outcomes of Unexpected Postprocedural Deep Femoral Artery Occlusion
(2023) Igus, Behlul; Firat, Ali
Introduction: This study aimed to demonstrate different revascularization approaches to superficial femoral artery (SFA) ostial occlusion and to evaluate the outcomes of unexpected deep femoral artery (DFA) occlusion encountered during the endovascular treatment (EVT). Materials and Methods: This retrospective study included 56 patients diagnosed with ostial SFA occlusion between March 2014 and December 2019. Patients were divided into two groups: the percutaneous transluminal balloon angioplasty (PTA) group, which included 32 patients treated with PTA, and the stent group, which included 24 patients treated with stents. The preferred access site was the contralateral femoral approach, and in 20 patients, access was performed with the popliteal artery (n: 13), pedal arteries (n: 4), and retrograde occluded SFA (n: 3). Results: Technical success was 100%. In the PTA group and stent group, primary patencies were 81%, 75%; 62%, 66%; and 56%, 58% and secondary patencies were 92%, 90%; 64%, 63%; and 50%, 54% at 6, 12, and 24 months, respectively, with no significant differences determined between the groups (P = 0.943 and P = 0.640 by log-rank). DFA occlusion occurred in 8 patients during the EVT. Rutherford score was a statistically significant decrease in both the groups (Wilcoxon signed-rank test, P = 0.010). Conclusion: Even in challenging SFA ostial lesions, using several different approaches has high success rates in EVT. This study showed no significant difference in PTA and stenting patency rates. Accidentally, DFA occlusion may be encountered, in which case revascularization of the SFA is the priority, even if the procedure ends with occluded DFA. A patent SFA and good distal flow will be sufficient for foot perfusion in DFA's occluded patients.
Evaluation of Prostatic Artery Embolization Efficiency in Benign Prostatic Hyperplasia Patients with High Comorbidity
(2018) Duman, Enes; Yildirim, Ismail Okan; Firat, Ali; Celik, Huseyin; Sarac, Kaya
Objective: The purpose of this study was to evaluate efficacy outcomes following prostate artery embolization (PAE) for the treatment of benign prostatic hyperplasia (BPH) patients with high comorbidity. Materials and Methods: This retrospective study included 22 patients treated with PAE from May 2015 to June 2017. Patients with Charlson comorbidity index >= 2, International Prostate Symptom Score (IPSS) >12, prostate specific antigen (PSA) levels <4 ng/mL or between 4 and 10 ng/mL with negative prostate biopsy and total prostate volume (TPV) >90 cm(3) were included. Total PSA, maximum flow rate (Q(max)), TPV, IPSS, post-voiding residual (PVR) values were recorded in all patients in the urology clinic before PAE and at 3 and 6 months after PAE. Results: The average patient age was 73.86 +/- 6.25 years and operative time was 80 minutes (range, 60-120 min). Pre-PAE and 6-month post-PAE values were: IPSS: 25.18 +/- 6.75 an d 11.27 +/- 3.29 (p<0.05), Q(max): 8.31 +/- 3.12 and 17.22 +/- 3.23 (p<0.05), PVR: 87.9 +/- 19.25 and 25.86 +/- 7.72 (p<0.05), TPV: 134.45 +/- 57.56 and 86 +/- 15.4 (p<0.05), and PSA: 3.89 +/- 1.26 and 2.11 +/- 1.06 (p<0.05). Embolization was performed unilaterally due to atherosclerosis and strictures in the internal iliac artery branches in 2 patients. After the procedure, 2 patients experienced transient hematuria which did not require bladder irrigation, 1 patient had acute urinary retention due to dysuria, and 1 patient had transient hematospermia. Conclusion: PAE may be an alternative treatment method in BPH patients with high comorbidity.