• MINIMAL INVASIVE SURGICAL METHODS WITH LOCAL ANESTHESIA 

    Minimal invasive blood vessel surgery technique performed under local anesthesia is a very successful technique we have used in recent years in vascular patients. The procedure which is used to block the arteries of the heart, legs and neck prevents heart attacks, strokes and gangrene with timely intervention. It saves lives in patients where standard surgery is risky.

    Minimally invasive surgery is an operation performed under local anesthesia. It provides great advantage for elderly patients with diseases such as hypertension, diabetes, kidney diseases, chronic bronchitis, COPD and who have high anesthesia risk.

     

    We keep the patient’s consciousness open during the surgery, which shows us whether the surgery was successful or not at the time of the surgery. If we are intervening in a patient with a stroke due to a carotid artery we can see that he started to talk or move his arm and leg during the surgery. We can also observe whether a leg with gangrene can be saved or not during the surgery.

     

    STROKE SURGERY

    It was we who carried the concept of stroke surgery to the Turkish and the World agenda for the first time ever. Thus, the established opinion that an intervention after the sixth hour for the patients who have become paralyzed due to a carotid artery would not have a significant benefit has changed. The stroke surgery method that we apply can achieve success in appropriate patients in a week or 10 days and it can achieve success in others up to a month. According to the patient’s condition this success sometimes happens in the form of regaining the ability to talk and sometimes for them to stand up. In any case, we make a positive contribution to the lives of our patients whether the outcome. The same method can be applied to 100% patients with blocked carotid arteries. Another important advantage of the method is that it gives the chance of being able to intervene this narrowings in a row in patients with narrowed arteries. First, after the pass of a certain period in one narrowing (a couple of weeks or months) we become able to intervene in the narrowing on the other side. Stroke surgery is also a very important method for taking preventive measures before the patients are paralyzed. Many people can live unaware of the narrowing of their carotid artery but during this time the sickness can sometimes create symptoms such as dizziness, weakness in arms and legs, temporary speech disorder and temporary vision loss. Such complaints should never be disregarded and a carotid artery ultrasound must be applied. Therefore, this simple examination will detect the illness in the early stage and gives rise to the chance of early intervention. Whether it is 50 percent, 70 percent or 100 percent narrowness in the carotid artery, a paralysis can be prevented with the stroke surgery technique during an early stage.

    In 6 years, more than 1000 paralyzed patients were provided with a comfortable life.

    In advanced examinations, patients who are found to be suitable for surgery even if they are of advanced age (patients above 90 or 100 years of age) and even if they have multiple chronic ailments due to the fact that the process is conducted with local anesthesia by numbing the patient’s neck, they can be operated by staying away from the risks of standard surgery. During the operations performed while having a conversation with the patient we keep the consciousness of the patient active and thus like a live broadcast, we can control the returning process of the sensation lost because of the paralysis caused by the carotid artery.

    This conversation with the patient during the operation keeps them vigourous and prevents loss of consciousness. In the event of a minor impairment in consciousness, we immediately send blood to the brain with the help of a cannula and allow the patient to remain vigourous. In the meantime, we clean the insides of the vessel and close it quickly. The operation is completed between 30-50 minutes. The patient is taken directly to the normal room without intensive care and is released from the hospital after two days or three.

    DIABETIC FOOT SURGERY

    In addition to patients with paralysis due to carotid artery minimal invasive vascular surgery technique also yields successful results in situations such as diabetic foot, gangrene resulting from vascular congestion and Buerger’s disease. The method is applied with local anesthesia as in stroke surgery. We use minimal invasive vascular surgery techniques to treat patients in many different ways. In addition to diabetes, our patient group also suffers from many diseases such as kidney, blood pressure, heart and lung diseases at the same time. With this technique, we are able to keep them away from the risks of standard surgery.

    There is a combined treatment and a team in the methods we apply. The treatment is carried out by specialists such as vascular surgeon, infectious diseases doctor, endocrine doctor, plastic surgeon and cardiologist as the doctor who conducts the operation. Because these are the patients in the risk group and they also experience many problems at the same time.

    First of all, whatever the diameter of the vein, we can bypass any area that has a canal. But in diabetics, we usually have little chance of having a bypass, because in those patients, capillaries are almost completely dried out. If we can’t do this, we clean the lime within the veins with local anesthesia by opening small incisions. We also administer special drugs in the arteries. If we cannot recover them with these methods, we amputate in the same session if necessary. We’re trying to save the patient by only amputating the fingers and at worst, the heel. We benefit from hyperbaric oxygen therapy if there is an opening in those areas in the future. In the formation of tissue loss, we benefit from plastic surgeons. In an event that the plastic surgeon is not able to transfer the tissue we inject the growth hormone called epithelial growth hormone straight into the tissue.

    How many of these patients’ legs can be saved?

    All diabetic patients must be saved from the pain of getting their feet or legs cut. In many clinics and hospitals, there are patients who were said “This patient no longer has a chance. Take your patient and find a place to cut off their leg.” and we were able to save those patients. But we are not creating miracles when we are saying this. We just show a little interest in the patient, prepare the patient, and complete the missing things. Of course there are patients who go through amputation among these. The one’s we manage to save are not only our success but also the patient’s. So early diagnosis and treatment are extremely important in those patients. Every diabetic should check their foot every day. They should massage it with moisturizing cream every day whether or not there is a complaint. This provides both self-treatment and continuous control of the feet. If this happens, the amputation rates will drop or no amputation will be required. Patients caught early can be treated with the use of a simple drug treatment, simple wound care or hyperbaric oxygen therapy.

    What should be the target in amputations?

    In studies conducted between different diabetic groups abroad during the recent years it was published that diabetic foot had an amputation rate between 60 and 95. In Turkey, there is no clear information regarding the numbers. But from the statistics that we clearly know of show us that the chance for diabetics to develop diabetic foot in their life time is 15 percent. If we look at the statistics in my patient group, my amputation figure in the last 5-6 years is about 20.

    On the other hand, the number of patients in which we just amputated the fingers and saved their leg from the heel is quite high. In amputations, the target should always be able to cut as low as possible and to save the leg. We always try to push the gangrene down in diabetic patients or in leg cuts. We try to save one finger, two fingers and at worst, the heel. In amputations, the knee joint is important for us for the patient to be able to use the part of their leg below the knee. But there are such patients that they lose the leg starting from the hip and whatever you do, it does not help. At that, the job is more about saving a life than saving a leg. Sometimes there are such patients that while other centers have decided amputate the leg starting from the hip but we have managed to save the leg in question from the heel.

    What is diabetic foot?

    In diabetics, especially after neuropathy, wounds and calluses are formed on their feet after they do not feel their feet and are not able to push on them properly. These calluses turn into infections very quickly. Diabetes patients do not necessarily need to have vascular occlusion. There are diabetic patients who lose their legs from the hip even though they have an open vein. When a very serious infection occurs in this region, especially when if it becomes too late, the infection mixes with the blood thus creating a serious result that we call sepsis. Therefore, diabetic foot manifests itself by the occurrence of serious infections that are connected to neuropathy in the feet and the gangrenes which are connected to this phenomenon.

    That’s why diabetic foot problems are troubling cases. Patients can also miss the seriousness of this situation because of their lack of care and late realization. Because these patients don’t feel pain. Even if they notice, they don’t ponder on it, thinking it as a simple acronyx or a simple callus. Over time, this wound grows and turns into a serious infection. This time, when they apply to the hospital, if they did not apply to a qualified physician, antibiotic treatments based on oral use are suggested. Because it is a laborious job we can say that it is a job that is not attended to thoroughly. Diabetic foot is something that needs to be thoroughly attended. Therefore, sometimes the patient can bypass the hospital. And these patients in question usually do not have their diabetes under control and because of this the diabetes worsens the wound on their foot and the wound triggers the diabetes. And this makes the patient rot. As a result of this, he goes into sepsis and the life-critical danger begins. The patient, the patient’s relatives and the hospital as well, should be very sensitive about this issue. A simple diabetes wound can sometimes become very complicated and it can lead to the amputation of the leg. And this can lead to both social and economic losses.

     

    This is one of the most important topics regarding diabetic foot vascular surgery.

     

    It is a very important topic regarding diabetic foot vascular surgery. Even if the decision of cutting the leg has been made, the amputation procedure must be performed by a vascular surgeon. In such cases, the patient is usually referred to orthopedics. Indeed; both in the determination of the level and the amputation that is going to be made a vascular surgeon must be present and every vascular surgeon needs to know and accept this. This is important for two reasons. First, vascular surgeon sees the tissue wetting and intervenes accordingly. In orthopedics, traumatic amputation is performed via a tourniquet and blood is not seen. However, in patients whose situation is connected to vascular congestion, this procedure is in the form of intervention to vascular congestion and, if necessary, the removal of the dead part. It is made without a tourniquet and the bleeding on the cut site is observed. And according to this, the level as much as possible is tried to be drawn to the bottom. Diabetic foot policlinics, on the other hand, must be under the control of a vascular surgeon. We have diabetic foot policlinics in my control.

     

    BUERGER DISEASE

     

    Buerger’s disease is a serious disorder caused by the blockage of the small and medium-scale arteries and the vena due to smoking. The veins are clogged with an inflamed clot and the blood flow to the fingers is reduced. This vascular problem continues as long as smoking exists in your life. Over time it takes your fingers, your hands, your feet and your legs under its influence and severe inflammation occurs. These deep wounds, due to infection, gradually turn into gangrene and they cause the loss of a limb if the patient does not quit smoking. In more than one quarter of patients, the foot or legs come to the phase of being cut. Buerger’s disease manifests itself between the ages of 20 and 40. Unfortunately today, however, we see that the age range has descended to the ages 16-17. The disease which was known as male disease in general, has started to be observed in females as well during the recent years.


    It also affects the passive smoker.

    Buerger’s disease is due to smoking. However, people who are exposed to intense cigarette smoke who are called passive smokers are also at risk. Because actually this illness is an allergy related to the use of cigarettes… It’s not seen among everyone but if you have an allergic leaning, the smoking areas affect you and paves way to this disease even if you yourself are not smoking.

     

    No painkillers relieve your pain

    While this disease is more common in the feet it can also be seen in the hands. Since it holds the capillary vessels inflammated and infections usually manifest on the nails. In general, the common history of Buerger’s patients is seen as a nail extraction and subsequent lack of healing of the wound. Wounds occur under the fingernails or on the fingers. The nail develops fungus or the patient hits their foot to someplace one day and the wound on their feet never recovers. As the wounds grow, infection and bruises occur. Most of the patients have a sense of cold and numbness related to their limbs. Most of the time, the fingers are red but icy. The pain that begins with walking becomes permanent over time and unbearable pain occurs even when the patient is resting. These wounds that do not heal in any way and occur because of simple reasons gradually turn into gangrene. Patients experience pain so severe that, over time, no painkillers can alleviate their situation.

     

    The Importance of Minimally Invasive Vascular Surgery in Buerger’s Disease

     

    The most important step in the treatment of Buerger’s patients is to quit smoking. Other treatments will not help if they do not avoid smoking. They have no definite chance of recovery in medical treatments. In people who quit smoking, the risk of amputation (the cutting of tissue and limb) is very low. When smoking is not quitted the wounds do not heal, they open again and a lot of amputations may be necessary. In very few patients who have this disease the veins are suitable for bypass surgery. However, in many patients, the disease does not respond to treatment and an amputation decision is made. We apply the minimally invasive vascular surgery method which we use in vascular diseases to appropriate Buerger patients as well. We bypass the area with local anesthesia and tiny cuts. After the surgery that is approximately completed in an hour we take the patient to the normal room without having them go to the intensive care unit. We walk them the next day and release them from the hospital in two days. In some patients, there might be some losses of the limb. But we can save the limb where gangrene have been developed.

     

     If you start smoking even after 30 years, the disease will repeat.

    When we say that “stop smoking to get rid of this disease completely” we are not telling you to quit just for a while. This is a very important issue… we say, “clean it from your life style completely, forget it.” Because if you go back to your old habits after 30 years or 50 years, your old disease will come back to you as well.

     

     

    AORTIC ANEURYSM

    Aortic aneurysm is a condition in which the aneurysm in the arteries in the abdomen reach a twofold width compared to the artery itself. Since most of the time it does not show any symptoms it can lead to fatal results if a timely diagnosis and treatment is not made. It is more dangerous in patients with chronic bronchitis due to the fact that the cough creates a pressure on the stomach therefore increasing the risk of  rupture of the artery. In this case, the person may lose their life. In addition, in some romotological and connective tissue diseases, regardless of the size of the aneurysm, appropriate medical treatment following an emergency surgical intervention decision saves the patient’s life. Especially patients who have high blood pressure should undergo examination with an ultrasound, tomography or if needed,  CT angio scan. It is important to regularize these examinations after the treatment of the aortic aneurysm because it is a condition that may reoccur. Symptoms such as an abdominal pain which is not recovered, the sensation that the heart is beating in the stomach and back pain may indicate an aortic aneurysm.

        Cough can make the vein explode.

    In cases of aneurysms, treatment decisions should not be taken only by examining the size of the diameter of the vessel, but by investigating the person’s chronic diseases and lifestyle. In general, publications related to aortic aneurysms suggest follow – up with medical treatment in aneurysm up to 5 and 6.50 centimeters. The risk of explosion increases as the diameter of the vessel increases. However, in specialised patients (patients with COPD and some patients of connective tissue and rhomatology) when compared to their own artery width, even when the maximum value is two or two and a half fold, meaning a width of 4 centimeters the patient is under a risk of rupture. If the patient has complaints as well, surgery must be made immediately. There is no time to lose especially if the patient has chronic bronchitis and/or is a smoker. Because the person’s cough will increase the pressure on the abdomen it will put the artery under the risk of rupture. And this causes death. Various connective tissue and rheumatic diseases also trigger aneurysms. In rare cases such as Takayasu Vasculitis, Behçet, and Marfan Syndrome, that threaten women under 40 years of age, emergency surgery is also required.

     

    Minimally invasive surgery in aortic aneurysm

    In these surgeries where we apply many different techniques together, we reach an aneurysm zone with small cuts on the abdomen without opening the groin and we attach the new  vascular graft to the main artery. Aortic Aneurysm Surgery is one of the most difficult surgeries performed in vascular surgery. We need to complete the operation without damaging the patient, injuring the intestines, blowing the vein or paving way to a heart attack.  (tekniğin anlatımı eksikse buraya ilave edelim – yaptığımız bir vakanın haberinden faydalandım )

     

    VESSELS CAN BE OPENED WITH HYBRID METHODS

    We emphasize preventive medicine and early diagnosis on vascular health. But as far as we can see, patients do not apply to the physician before the disease progresses. This brings serious difficulties during the treatment. For approximately 10 years we have been able to open a large number of vessels with minimally invasive surgical methods in appropriate patients which in our operations by talking to the patient under local anesthesia. We have made serious progress on the part of our country in vascular surgery both for the leg veins and for the operations of the carotid artery. We have recently applied both open surgeries, angioma and stent procedures with Hybrid methods. We have seen that very complicated cases and the literally ’unopened’ can be opened with this method. This method proceeds within the framework of a personalized treatment plan. The same method is not used in all patients. In some patients, it is possible to obtain results only by surgery, some by interventional method and some by using Hybrid methods. The experienced team, experienced surgeon and the appropriate method are among the important criteria of treatment planning.

     

    VASCULAR ANOMALIES IN CHILDREN

    Frequent Vascular Anomalies in Children are called ‘Hemangioma‘ and are benign vascular anomalies. This situation is generally always omitted. Unfortunately, these vascular anomalies grow as the child grows. These can be removed at certain ages, but there are risks of recurrence. Some of them, especially the ones in the difficult regions such as the joints can restrict the comfort of child’s life. In some cases, the child cannot use the limbs, or in some cases these anomalies occur on the child’s face and may cause highly psychological problems as effecting aesthetically. Anomalies such as these usually do not operate by everyone. However, it can be treated successfully by experienced center and experienced surgeons. As mentioned above,unfortunately, recurrence rates are high in such anomalities.

     

    TREATMENTS OF VARICOSIS

     

    The expansion and the swelling of the vena is called varicosis. Varicosis are an important health problem that is usually seen in the lower parts of the legs, which is a region of the body that carries the most pressure. Varicosis patients suffer from cramps at night, itching and swelling in the legs and they go through pain when they are standing. Women’s symptoms increase during pregnancy. Therefore varicose is a serious vascular problem as well as an aesthetic problem. Both men and women should be vigilant about early diagnosis. Because varicose problems that lack precise precaution can turn into severe pain, swelling and open wounds in the feet and legs. The most serious result of varicose is the embolism that occurs with the discharge of the clot into the lungs. Given all these risks, the correct treatment of varicose is very important.

     

    • STEAM TREATMENT

    Steam treatment method is an extremely comfortable technique in varicose treatment. Under local or general anesthesia, the procedure is completed in a sterile environment in half an hour and the patient is discharged the same day. Especially in vessels with thin-diameter and curvature, its applicability provides great advantage.

    We also see the advantages of minimally invasive vascular surgery in this technique. By spraying sterile hot water vapor into the vein with the help of a tiny catheter, we burn the problematic areas. The vapor that is dispersed homogeneously in the vein has the same effect on the entire vessel wall. It is also possible to treat the veins just below the skin with this method that prevents damage to the tissues outside the vein. It is also suitable for congenital vascular anomalies. Steam treatment can also be applied to elderly patients. The transaction time is between 30 and 50 minutes. Other capillary or middle-sized varicose veins (retinal varicose veins) that are present can also be treated in the same session. After the procedure, the patient is kept under supervision for a few hours and then discharged. The person comes to the treatment on foot and can return home on foot after the treatment.


    It can be applied to everyone.

    Based on our examples and applications in Europe, we have seen that the side effects are minimal compared to other standard applications. We have seen that there is no bruising and swelling in the application area except for a few days of sensitivity. Patients need to use varicose stockings for about a month after the application. To avoid the repetition of varicose, first of all prefer a life in motion, drink plenty of water, avoid spicy and oily foods, protect yourself from the sun, prefer lightly-heeled shoes instead of flat shoes and high heels, massage your legs with cold water regularly and make sure that the legs are approximately 10 cm’s high during sleeping.

    • GLUE ADHESION METHOD

     

    Varicose is a very common vascular disease and it does not have a definitive treatment yet. Thus, many methods are being developed. However, there is not a method that will completely terminate varicose among these methods because it is a disease that can recur. Therefore, when choosing a varicose treatment or investigating varicose, the treatment should be the most comfortable one with the lowest recurrence rate. We do not prefer open surgery except in very special cases. It is both difficult to apply and the recurrence rate is high and the length of time for the patient to return their social life is long. People now want to stand up right after a surgery or practice.

     

    The person can return to his social life immediately, the process is completed in 15 minutes.

    Glue bonding is a method that has been developed in the United States and it also has FDA approval. In this method, the drug is given into the vein with the help of a battery-operated instrument. We use a small wire that is sent into the vein with the help of a catheter and do the bonding process. This method eliminates the risk of embolism, namely the risk of clot efflux. It is a very successful method especially on the veins that are under the knee and inner varicose. Other techniques are inadequate in the lower knee veins because in this area, nerve damage and nerve sensitivity are seen. Since the procedure is also done with local anesthesia, the patient can return to his / her social life immediately after the application. After the operation, patients do not become obligated to use elastic bandages or varicose stockings. The process is completed in 10-15 minutes. Varicose may increase during pregnancy. Women can benefit from this technique in the period of breastfeeding immediately after birth; it delivers no harm to the baby. The elderly can also benefit from this technique in the same way. For the patients it also provides the opportunity to be treated in summer.

     

    • FOAM SPRAYING METHOD

     

    In Turkey, we apply the foam spraying method that has been developed in the US. The method that does not require general or regional anesthesia is easy to apply and it can be applied with local anesthesia. It is completed in 15 minutes and does not require hospitalization.

    The foam spraying method is carried out by injecting medicine into the vein with the help of a battery-operated device. A small wire that is sent into the vein with the aid of a catheter which turns 360 degrees and causes damage to the walls of the vein, then we inject the foam into the vein and the vein collapses without the possibility of reopening. This method eliminates the risk of embolism, namely the risk of clot efflux. It is a very successful method especially on the veins that are under the knee and inner varicose. Other techniques are inadequate in the veins that are under the knee. Because nerve damage and nerve sensitivity are seen in this area. Although tumescent anesthesia was performed, this was not very possible to avoid. However, the foam spray method solved the problem we experienced with other techniques in this area. Since the procedure is also done with local anesthesia, the patient can return to his / her social life immediately after the application. As tumescent anesthesia is not applied, it is not seen edema or swelling after the application. The biggest problem of the employees is the time issue so they can use the method even at their lunch breaks or even at their tea breaks. The process is completed in 10-15 minutes. Anyone except those with a drug allergy can use the method. Varicose increases during pregnancy. Women can benefit from this technique in the period of breastfeeding immediately after birth; it delivers no harm to the baby. The elderly can also benefit from this technique in the same way. However, in cases where the vein is very large and that require application to both legs we avoid the application. Because we don’t want to give you an overdose. So I think this method is more appropriate for one leg.

    Advantages according to other methods.

    The laser and radiofrequency methods made a great impact when they first came out. Because they are very high energy systems, control and safety of these systems is less. In varicose veins treatment, we apply some kind of cold serum to prevent the burns that may be caused by the application by the method we call anesthetized anesthesia. This application is especially necessary in laser and radiofrequency otherwise it can cause very serious burns. Although not as deep as laser, we also apply the same method steam treatment, but steam treatment is much less effective than other methods. In the foam spraying method, there is no need for tumescent anesthesia. Particularly we can do such applications in applications from the inner wrist of the foot to the groin, but the varicose and inner varicose spilling from the outside of the foot to the popliteal fossa, laser treatment, steam treatment or radiofrequency can unfortunately create nerve damage. In that area the nerve is on a very close proximity of the vein and since the vein is a little bit more skin-deep, there can be damages, numbing and patient-wise distress. In this case, the spray method is very advantageous.

     

    SCLEROTHERAPY (NEEDLE THERAPY)

    Sclerotherapy effectively treats varicose and spider veins. It is considered the treatment of choice of varicose veins. It is basically a treatment method that allows the injection of a substance to the vein in question and thus this vein collapses and disappears by taking a form which prevents the blood to flow through it. This liquid substance can be injected in its own form or by the creation of foam. Different concentrations of drugs are used according to the diameter of varicose veins. Sclerotherapy is used in small veins and capillaries up to 0.5 mm and 0.3 mm diameter.

    Sclerotherapy is a painless procedure for the patient. Needles with a very small diameter are used. Sessions are applied once in 2 days. After sclerotherapy, it is recommended to wear elastic bandages and varicose stockings to compress the area where the injection is performed.

     

    To whom sclerotherapy is not applied?

    Over the age of 75

    With serious allergies

    Who are pregnant

    Who have related artery problems

    Obese patients

    People with rheumatic diseases

    Diabetes, heart and kidney patients

    Those with pyretic diseases

     

     

    VARICOSE IN CHILDREN

    As it is known, varicose is a disease of the veins and it occurs by a progressive expansion of the vena that carry the blood to the lungs and the heart. We define varicose in children by the absence of the vena. Varicose in children should not be compared with the appearance of standard varicose. In children, swelling on one leg is usually visible, or one leg is larger than the other and the veins are more prominent. Or both of the child’s legs and ankles are much thicker than their peers. Sometimes there is no apparent blood vessel under the skin, but there is always a difference between two legs, or both are thick. Also, if there is hemangioma, there may also be colour changes and vein anomalies resembling maps or varicose may be observed. In this case, their appearance is like the varicose seen in adults. In childhood, vascular anomalies often come to mind and the possibility of varicose is ruled out. If it’s not a vascular anomaly, we focus on the possibility of varicose. And this is usually caused by genetic predisposition. If this turns into a chronic venous insufficiency in the future for the children, it can create a life of distress. The more chronic the event, the less its rate of treatment and satisfaction becomes. The disease can become chronic due to delays in treatment, and also because of genetic predisposition. Early diagnosis and treatment are always important and useful. Care should be utmost given as the surgery may not be the option of treatment


    Standard varicose treatment is not applied in children.

    When we look at our child patients, we see that there are no congenital deep veins. The children come us with giant varicose but they are not standart varicose. If we operate their varicoses, we will disrupt the blood circulation of the children. Because the only veins that carry the venous blood to the body are the varicose veins. In varicose patients we either remove the varicose or we block the spare vein with vapour. But there’s no way we can do this in children. This is the reason why we do not say to every varicose patient, “Let’s have an open surgery!” “Or let’s destroy this vein!” This approach is not correct. As this is the case, it is obligatory to be more careful with children and to investigate whether there is an underlying genetic disorder or a vascular anomaly. Because varicose can also be the result of a vascular anomaly. This should never be forgotten. A standard varicose treatment should not be applied only by saying “this patient has varicose”. If there is a serious underlying pathology and if this is omitted, it may produce unwanted results. For this reason, they must apply to an experienced cardio vascular surgery clinic about varicose in children.

     

    • SURGERY WITH LOCAL ANESTHESIA TO THE TUMORS OF THE CAROTID ARTERY

    Carotid artery tumors, which are a rare condition can result in hoarseness,                          dyspnoea and rarely, partial paralysis because of the fact that the carotid arteries are close to the vena that lead to the brain. There are three types of carotid artery tumors. As misplaced tumors, they are classified as type 1 which we define as the simple type that is not adherent to the vein, type 2 that wraps the vein 180 degrees and type three that wraps the vein 360 degrees. Tthese type of tumors is usually benign. They must be removed because of the region they are located in  as it  is being a sensitive area  close to the tongue, vocal cords, trachea and and to the area where the carotid arteries and the vena that lead to the brain are located.  Therefore, we can describe the tumors located here as time bombs.

    Sometimes they don’t show any symptoms at all.

    In addition to hoarseness and dyspnoea, they can also cause difficulties in swallowing, a mass in the neck or a feeling of extra weight in the neck but additionally they can also progress without any symptoms. There are tumors that can grow to 15 centimeters and show no symptoms or do not show their presence at all but we can also talk about tumors of 3-4 centimeters which show themselves.  As a result, regardless of the size of the tumor, this type of tumor must be removed as per the region they are located. The otolaryngologist diagnoses the tumors of carotid arteries. Therefore, as encountering the symptoms, an otolaryngologist must be consulted immediately.

    The carotid artery tumor must be removed as soon as it is seen.

    Around the carotid artery there are the nerves that move our tongue, the nerves that move our face, the nerves that provide our voice, the brain vena, our trachea and our esophagus. When carotid artery tumors grow, they enact pressure in these regions. If you do not respond correctly to this mass on time, the mass can grow very large and suffocate the patient to death, paralyze them, create voice paralysis and create unwanted facial curvatures. For this reason, carotid artery tumors must be removed as soon as they are noticed.

    Local anesthesia minimises the risks of the surgery.

    Firstly, we routinely administer local anesthesia to patients with Type 1 and Type 2 tumors. These operations are among the first in Turkey and in the World. In the following period, we think that Type 3 patients can also participate in this. Aside from the standard risks in surgeries conducted under general anesthesia, in carotid artery tumor surgeries, there is also a risk of damage to the nerves in the face and the neck. The operation carries many risks, for example if it affects the facial nerves there is a risk of facial tension or facial paralysis. If it affects the vocal nerves, there is a risk of hoarseness and if it affects the carotid artery, there is a risk of stroke. And if a nerve injury happens accidentally, this may cost the patient’s life. In local anesthesia, as the tumor is removed, the patient becomes uncomfortable. They start to cough or feel severe pain. And we take measures accordingly. We remove the tumor without touching the nerve from above or below. In addition, another important point is that a lot of serious problems can occur in carotid artery tumors under general anesthesia. We have not encountered such problems with local anesthesia. The surgery takes approximately 1 hour. The patient is taken to the normal room without intensive care and they are discharged in a day or two.