Description

Heart and vascular diseases

 Cardiac surgery has been performed in the world since the
1950s. With the developing technology and experience, surgeries are
performed with very high success rates. After these success rates were
achieved, a search for innovation in cardiac surgery was started.

The aim was to operate patients through smaller
incisions, shorten the duration of hospital stay and enable them to return to
daily life faster. In addition, the increase in success rates has enabled
more risky and complex surgeries to be performed.

What is varicose veins?

 Varicose veins are called varicose veins when the
superficial veins in our legs become enlarged, elongated, and become folded and
swollen from the skin. Healthy leg veins have lids that open and close to
help return blood to the heart. With damage to the valves, the blood
returning function to the heart is partially lost. With the ponding that
occurs as a result, the veins fold, swell and become swollen from the
skin. This formation, which becomes puffy, is called varicose
veins. The presence of this condition in the deep veins in the inner parts
of the legs is known as deep venous insufficiency (internal varicose
veins). Signs of varicose disease; enlarged veins, pain and swelling
in the legs, a feeling of heaviness and fatigue in the legs, skin discoloration
and sores. Varicose veins are found in 50% of people between the ages of
20 and 70 in the society. As the age progresses, the risk of varicose
veins increases. It is more likely to be seen in women. Age, Gender,
Frequent pregnancy, Obesity, Family history, Standing professions, many factors
contribute to the presence of venous insufficiency.

Deep venous insufficiency

It is known as the ‘inner heir’ among the people. In
the main veins running close to the bone in the innermost part of the leg,
swelling and pain are seen in the leg as a result of blood flowing backwards
into the leg. Over time, thickening, darkening and sores can be seen in
the skin around the ankle.

In the superficial veins in the legs, blood flows not
towards the heart, but towards the back, resulting in enlargement of the veins,
swelling of the skin and folds.

Capillary varices

It is a thin vein enlargement on the skin that is usually
purple or red in color. They may occur with insufficiency in deep or
superficial veins, or they may only be found at the skin level.

Grading Varicose Veins Disease

Grade 1:  Thin varicose veins 1-3 mm in diameter

Grade 2:  True varicose veins over 4 mm in diameter

Grade 3:  Leg swelling

Grade 4:  Brown-black changes in the skin

Grade 5:  Skin changes and a healed wound around the ankle

Grade 6:  Open wound (almost always on the inside of the ankle)

Intravascular Laser Application

During the procedure, a needle is inserted into the vein
first. Then, under the guidance of the Doppler ultrasound device, the
leading wire is placed in the appropriate place in the vein. Pain relief
solution is injected around the vein, and then the laser light is used to burn
the vein from the inside. In the same session, varicose packs, which
cannot be burned with laser, are puffy from the skin and palpable, are removed
from millimetric incisions. This method has significant
advantages. First of all, it can be performed under local
anesthesia. The procedure takes an average of 30 minutes to 1 hour, and
after resting for 1-2 hours, the patient is sent home on foot. After the
procedure, there is no need for any restriction in the movements. The patient
should wear compression stockings for 2-3 weeks. Tens of thousands of
patients are treated with this method every year in the USA and Europe. The success
rate is 95% -98%.

Intravascular Radiofrequency:

It is based on the principle of burning the vein from the
inside with high temperature by sending high frequency radio waves to a
catheter placed in the vein. With this method, the vein heats, shrinks and ultimately
closes. In this procedure, it can be applied under local anesthesia such
as laser. The needle is entered into the vein. The catheter is advanced in the
vein with the help of ultrasound. In the new catheters of the
radiofrequency method, the catheter is pulled down by giving energy for 20
seconds for every 7 cm. In this way, the burning process takes 3-5
minutes. The total processing time is between 30 minutes and 1 hour. Then the
leg is wrapped with elastic bandage. After 1-2 hours of rest, the patient goes
home. 1 day later, he is told to wear compression stockings. must
wear. The success rate is higher than laser 98.-100%.

Conservative Treatment (medical therapy)

It includes medication and compression (compression
stockings) treatment. It does not cure varicose disease, but it stops its
progression and reduces the patient’s complaints.

Sclerotherapy (needle therapy):

It is the occlusion of the vein by injecting a substance
with very fine needles into the varicose veins in the leg. There may be a
slight pain at the injection site. It does not require anesthesia and
surgery. It is not recommended for medium and large vessels as the chance
of success is low. It can be used on varicose veins with a diameter of 1-3
mm. After the procedure, the patient returns to his / her daily life. The leg
is wrapped with an elastic bandage for 1 day. After that, compression stockings
are worn for 2-4 weeks. Bruising, pain and redness may occur in the
leg. Symptoms regress in a short time. Allergic reaction to the drug may
rarely develop. The interval between sessions is at least 2 days.

Mechanism of action:  It provides closure of
the vessel by initiating a kind of inflammatory reaction by irritating the cell
layer on the inner surface of the vessel.

Side Effects: It is  very rare. Allergic
reaction to the drug can be seen. Painful redness may occur as a result of the
leakage of the blood or the drug outside the vein. Then sometimes a dark color
change may remain. Sometimes the color change may disappear after
years. Another problem, although rare, may be a clot in the vein. It may
take time to disappear. Success rate: 70-90%, sometimes its effectiveness
can be seen weeks later.

Foam Sclerotherapy

The foamy drug is obtained by mixing the conventionally
used drug with air. This ensures longer contact of the drug with the vascular
surface and increases the effectiveness of the drug. Also, it is more reliable
because less drug is used. After the procedure, the leg is wrapped with an
elastic bandage for 1 day, as in sclerotherapy. The patient returns to his
daily life after the procedure. After the procedure, compression stockings are
worn. Side effects are the formation of clots in the vein or deeper veins,
discoloration, sometimes scarring, bruising and pain.

Surgery: The  aim here is to remove the
varicose veins seen from the outside, as well as to eliminate the insufficiency
that causes high pressure in the veins and almost always caused by the valves
in the groin area. Small incisions are made in the groin and below the
knee area by numbing the waist or under general anesthesia. The patient vein is
removed with a special wire that is advanced through the incisions. If there
are other varicose veins on the leg, the vein is removed with a special hook from
the millimetric incisions made. After 1 day, elastic bandage is opened and
compression stockings are put on. The patient is discharged.

Complications: It may be complications related to
anesthesia or may be due to surgery. Bleeding, infection, bruising, pain, loss
of sensation around the ankle and knee, varicose veins (15-20%).

Varicose ulcer and stem cell therapy

Venous ulcer is a wound usually opened around the ankle
and leg due to insufficiency in the leg veins. It is also known as
varicose wound among the people. Treatment is difficult and takes time. We
have shortened the place of long-lasting treatment with hyperbaric oxygen with
stem cell therapy. The blood taken from the patient is separated by a special
method. The part rich in root cells is applied to the injured area. Thus, the
speed of wound healing increases 5 times. current also increases. There is
no need for hospitalization during treatment. The procedure is repeated
for several sessions. The sessions are performed with 1 week intervals.
Meanwhile, the patient wears compression stockings. It doesn’t have any
side effects. The results are pretty good.