It has been previously proposed in numerous studies that chronic venous insufficiency (CVI) has similar pathogenesis to varicocele in males. Varicocele has been identified as the most common cause of infertility in men, accounting for 40% of cases. This study investigates whether varicocele screening should be conducted in patients with CVI and, if so, which patients should undergo such screening. The study included 102 adult male patients with venous insufficiency complaints who presented to the cardiovascular surgery clinic between January 2023 and June 2023. Data were prospectively collected through medical history interviews and Doppler ultrasound measurements performed by a single radiologist. The relationship between non-normally distributed measurement data of the two groups was evaluated using the Mann-Whitney U test, while the association between categorical variables was assessed using the χ2 test. ROC analysis was employed for determining predictive value. A type 1 error level of α = 0.05 was adopted. The mean left great saphenous vein (GSV) diameter of those with varicocele (6.6 ±2.3) was significantly larger compared to the mean left GSV diameter of those without varicocele (5.3 ±2.6) (p = 0.004). The area under the ROC curve for left GSV diameter was 67% (p = 0.005). When varicocele screening is performed in patients with a left GSV diameter of 5.35 cm and above, sensitivity is 71.4% and specificity is 61.2%. There is a significant association between left GSV diameter and varicocele (p = 0.004). Varicocele screening can be carried out with 71.4% sensitivity in adult male patients with a left GSV diameter of 5.35 cm and above. Both cardiovascular surgeons and radiologists can conduct varicocele screening by measuring pampiniform veins in patients with a left GSV diameter of 5.35 cm and above. This approach has the potential to reduce the incidence of varicocele and associated infertility.

The perioperative management of patients undergoing mediastinal mass operations presents a persistent challenge across multiple clinical specialties. General anesthesia administration further increases the risk of perioperative cardiorespiratory decompensation. The interdisciplinary team plays a crucial role in ensuring a safe perioperative period. However, due to the rarity and variability of mediastinal mass syndromes, specific management protocols are lacking. This review aims to outline the multitude of challenges and pitfalls encountered during perioperative management in patients with the mediastinal mass syndrome. We describe diagnostic evaluation, preoperative optimization, intraoperative considerations, and postoperative care strategies, emphasizing the paramount significance of a multidisciplinary approach and personalized treatment plans. Preoperative multidisciplinary discussions, meticulous anesthetic management, and well-established protocols for emergency situations are pivotal to ensuring patient safety. Healthcare providers involved in the care of patients with mediastinal mass syndrome must grasp these challenges and pitfalls, enabling them to deliver safe and effective perioperative management.

AMA Ilkeli E, Kocaaslan C. Agenesis of bilateral common carotid arteries in an adult. Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery. 2024;21(1):63-64. doi:10.5114/kitp.2024.138485. APA Ilkeli, E., & Kocaaslan, C. (2024). Agenesis of bilateral common carotid arteries in an adult. Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery, 21(1), 63-64. https://doi.org/10.5114/kitp.2024.138485 Chicago Ilkeli, Ekin, and Cemal Kocaaslan. 2024. "Agenesis of bilateral common carotid arteries in an adult". Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery 21 (1): 63-64. doi:10.5114/kitp.2024.138485. Harvard Ilkeli, E., and Kocaaslan, C. (2024). Agenesis of bilateral common carotid arteries in an adult. Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery, 21(1), pp.63-64. https://doi.org/10.5114/kitp.2024.138485 MLA Ilkeli, Ekin et al. "Agenesis of bilateral common carotid arteries in an adult." Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery, vol. 21, no. 1, 2024, pp. 63-64. doi:10.5114/kitp.2024.138485. Vancouver Ilkeli E, Kocaaslan C. Agenesis of bilateral common carotid arteries in an adult. Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery. 2024;21(1):63-64. doi:10.5114/kitp.2024.138485.

Post-thoracotomy air leaks remain a significant challenge in thoracic surgery. This randomized controlled trial assessed the efficacy of autologous fibrin glue in reducing air leaks following thoracotomy procedures. Conducted as a single-center, single-blind, randomized clinical trial, the study enrolled adult patients undergoing lung resection or decortication at a thoracic surgery clinic. Participants were randomly assigned to either the intervention group, receiving autologous fibrin glue application during surgery, or the control group, undergoing standard surgical procedures without glue application. Key inclusion criteria were adult patients undergoing elective thoracotomy for lung resection or decortication, while exclusion criteria included patients with severe comorbidities or contraindications to fibrin glue. A total of 40 patients were enrolled and randomized equally to the two groups. The group treated with autologous fibrin glue demonstrated a significant reduction in the duration of air leakage and chest tube drainage, along with a shorter hospital stay, compared to the control group. There were no statistically significant differences in postoperative complications between the groups. The application of autologous fibrin glue during thoracotomy procedures significantly reduces postoperative air leaks and hospitalization duration without increasing complication rates. This finding suggests a beneficial role of fibrin glue in thoracic procedures requiring lung resection or decortication.

Minimally invasive thoracic techniques often need to be converted to open thoracotomy. Thoracotomy is associated with severe postoperative pain in 50% of the patients, and this situation can be maintained for a prolonged period. Many efforts have been made to avoid this complication. We propose an easy and fast thoracotomy closure technique to avoid nerve entrapment at the time of chest closure suitable for cases of conversion to thoracotomy after a minimally invasive attempt. The proposed method effectively avoids interference with the intercostal nerve, which remains intact and restores the anatomy of the intercostal space. Efforts to decrease postoperative pain are vital. Thoracic surgeons are the principal health professionals able to deal with operative factors and postoperative pain management. We believe that the use of this easy and fast technique can facilitate excellent anatomic repositioning of the ribs alongside nerve sparing.

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Rams DJ, Bartuś K, Pawełkowska K, Myrdko T, Filip G. Intraoperative evaluation of percutaneous LARIAT left atrial appendage closure – are the adhesions present 7 years after the epicardial procedure?. Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery. 2022;19(3):164-165. doi:10.5114/kitp.2022.119769. APA Rams, D. J., Bartuś, K., Pawełkowska, K., Myrdko, T., & Filip, G. (2022). Intraoperative evaluation of percutaneous LARIAT left atrial appendage closure – are the adhesions present 7 years after the epicardial procedure?. Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery, 19(3), 164-165. https://doi.org/10.5114/kitp.2022.119769 Chicago Rams, Daniel J, Krzysztof Bartuś, Karolina Pawełkowska, Tomasz Myrdko, and Grzegorz Filip. 2022. "Intraoperative evaluation of percutaneous LARIAT left atrial appendage closure – are the adhesions present 7 years after the epicardial procedure?". Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery 19 (3): 164-165. doi:10.5114/kitp.2022.119769. Harvard Rams, D., Bartuś, K., Pawełkowska, K., Myrdko, T., and Filip, G. (2022). Intraoperative evaluation of percutaneous LARIAT left atrial appendage closure – are the adhesions present 7 years after the epicardial procedure?. Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery, 19(3), pp.164-165. https://doi.org/10.5114/kitp.2022.119769 MLA Rams, Daniel et al. "Intraoperative evaluation of percutaneous LARIAT left atrial appendage closure – are the adhesions present 7 years after the epicardial procedure?." Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery, vol. 19, no. 3, 2022, pp. 164-165. doi:10.5114/kitp.2022.119769. Vancouver Rams D, Bartuś K, Pawełkowska K, Myrdko T, Filip G. Intraoperative evaluation of percutaneous LARIAT left atrial appendage closure – are the adhesions present 7 years after the epicardial procedure?. Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery. 2022;19(3):164-165. doi:10.5114/kitp.2022.119769.

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Skevis K, Verras G, Mulita F, et al. A challenging case of pneumothorax in a COVID-19 pneumonia patient. Can fresh frozen plasma pleurodesis be an effective treatment?. Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery. 2022;19(2):105-108. doi:10.5114/kitp.2022.117744. APA Skevis, K., Verras, G., Mulita, F., Volonaki, A., Dimitriou, I., & Christodoulou, N. et al. (2022). A challenging case of pneumothorax in a COVID-19 pneumonia patient. Can fresh frozen plasma pleurodesis be an effective treatment?. Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery, 19(2), 105-108. https://doi.org/10.5114/kitp.2022.117744 Chicago Skevis, Konstantinos, Georgios-Ioannis Verras, Francesk Mulita, Aikaterini Volonaki, Ioannis Dimitriou, Nikolaos Christodoulou, and Ioannis Panagiotopoulos et al. 2022. "A challenging case of pneumothorax in a COVID-19 pneumonia patient. Can fresh frozen plasma pleurodesis be an effective treatment?". Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery 19 (2): 105-108. doi:10.5114/kitp.2022.117744. Harvard Skevis, K., Verras, G., Mulita, F., Volonaki, A., Dimitriou, I., Christodoulou, N., Panagiotopoulos, I., Tchabashvili, L., Filis, D., and Koletsis, E. (2022). A challenging case of pneumothorax in a COVID-19 pneumonia patient. Can fresh frozen plasma pleurodesis be an effective treatment?. Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery, 19(2), pp.105-108. https://doi.org/10.5114/kitp.2022.117744 MLA Skevis, Konstantinos et al. "A challenging case of pneumothorax in a COVID-19 pneumonia patient. Can fresh frozen plasma pleurodesis be an effective treatment?." Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery, vol. 19, no. 2, 2022, pp. 105-108. doi:10.5114/kitp.2022.117744. Vancouver Skevis K, Verras G, Mulita F, Volonaki A, Dimitriou I, Christodoulou N et al. A challenging case of pneumothorax in a COVID-19 pneumonia patient. Can fresh frozen plasma pleurodesis be an effective treatment?. Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery. 2022;19(2):105-108. doi:10.5114/kitp.2022.117744.

Primary aortoenteric fistula (PAEF) is a rare entity that demands high clinical suspicion and efficient management in a limited time. The evolution of interventional radiology established endovascular repair (EVAR) as an attractive option. The English literature was searched using the PubMed database with the terms "primary aortoenteric fistula", "primary aortoduodenal fistula" or "aortoduodenal fistula", and "endovascular repair" in different combinations. Studies and original articles that described the role and the outcomes of EVAR for primary aortoenteric fistula were included. Fourteen articles with a total of 15 patients with primary aortoenteric fistula who were managed with EVAR were included in our literature review. PAEF is a rare and lethal entity that everyone should be aware of. EVAR is a salvage option and a valuable weapon in our armamentarium. Is EVAR really a "bridge to surgery" or is it the birth pangs of a minimally invasive definite treatment of PAEF?

IntroductionDual antiplatelet therapy reduces the risk of cardiovascular death, myocardial infarction and recurrence of adverse ischemic events in patients affected by acute coronary syndromes, but in patients urgently needing coronary artery surgery it can increase the risk of severe perioperative bleeding complications.AimWe evaluated the impact of dual antiplatelet therapy (DAPT) based on acetylsalicylic acid plus clopidogrel or ticagrelor in patients undergoing coronary artery bypass grafting (CABG).Material and methodsThree hundred and thirty-three patients underwent coronary artery bypass grafting with DAPT discontinuation > 72 hours or 3–4 days (group A, n = 159), 48–72 hours or 2–3 days (group B, n = 126), < 24 hours or 0–1 day (group C, n = 24) prior to CABG.ResultsOperative mortality was 1.87% (group A), 0.79% (group B), absent (group C). The incidence of mediastinal re-exploration was 1.25% or 2 patients (group A), 1.59% or 2 patients (group B), 8.33% or 4 patients (group C) (p = 0.01). Group C showed postoperatively a greater incidence of a blood loss greater than 500 ml at 6 hours and a blood loss from chest tube drainages significantly higher at 6 and 24 hours (p < 0.01). Multivariate analysis showed that ongoing ticagrelor intake in group C (HR = 42.4; p = 0.02) and group C (HR = 6.9; p = 0.04) were the only independent predictors of surgical re-exploration. In group C, surgical re-exploration was 2.56% or 1/39 patients taking clopidogrel, 33.3% or 3/9 patients taking ticagrelor (p = 0.002).ConclusionsDual antiplatelet therapy ongoing until 1 day or 24 hours before CABG showed a significantly increased risk of bleeding complications in comparison with its discontinuation at 2–3 and > 3–4 days before, respectively. Major blood loss and surgical re-exploration were not associated with increased risk of operative all-cause or bleeding-related mortality. As expected, taking ticagrelor compared with clopidogrel in the short interval confers a higher risk of bleeding complications.

IntroductionMediastinitis after cardiac surgery is a rare complication, but with high morbidity and mortality.AimTo determine its risk factors and to investigate the efficacy of vacuum-assisted closure (VAC).Material and methodsNine thousand one hundred sixty cases of patients who underwent cardiac surgery during 2010–2017 were reviewed retrospectively. One hundred and twenty-seven patients, the case group, were treated by VAC. Three hundred cases with no diagnosis of mediastinitis were selected as the control group. Both groups’ clinical and demographic characteristics, preoperative variables, and postoperative follow-up parameters were compared. Factors affecting treatment were analyzed.ResultsWe found that the presence of diabetes mellitus, bilateral internal thoracic artery and intra-aortic balloon pump usage are independent risk factors for the development of mediastinitis (p < 0.05). It was found that 74% of tissue cultures were positive and the most common detected organism was Staphylococcus. It was found that many perioperative parameters had a significant effect on the duration of treatment (p < 0.05). However, regression analysis revealed that bacterial growth was the only independent variable in prolonging the treatment period.ConclusionsWe believe that the establishment of perioperative blood glucose regulation, patient selection to use bilateral internal thoracic artery grafts, and maximum attention to sepsis and antisepsis rules in patients who need mechanical support devices such as intra-aortic balloon pump, will significantly reduce the development of mediastinitis. Since we could not find an independent risk factor for the duration of VAC treatment other than culture growth, we think that VAC therapy is successful and safe in the treatment of mediastinitis and should be used more widely.