|Year : 2019 | Volume
| Issue : 1 | Page : 49-57
VSICON 2018 Prize Paper Abstracts
|Date of Web Publication||8-Mar-2019|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. VSICON 2018 Prize Paper Abstracts. Indian J Vasc Endovasc Surg 2019;6:49-57
| Complex Bypasses and Fistulas for Difficult Hemodialysis Access: A Single-Centre Experience|| |
Dr. Vivek Singh
Background: Chronic kidney disease patients require AV access for hemodialysis. Complex bypasses and fistulas are required when all other options have exhausted. We at a single centre performed complex surgeries for AV access and studied their patency rates and procedure related complications. Objectives: To describe complex vascular access and their outcomes in 16 patients at single centre. Materials and Methods: Patients underwent basilic vein transposition bypass (n = 6), basilic to cephalic vein grafting (n = 1), AV bridge grafting (n = 4), Brachial vein transposition (n = 3), basilic vein angioplasty and redo anastomosis (n=1), GSV to CFA transposition (n=1). Postoperatively patients had bimonthly clinical examinations in which the thrill, bruit, skin, cannulation sites, and adequacy of dialysis were reviewed. The study also included graft inflow rate, vein diameter, peak systolic velocities and cardiac output were also performed. Results: There was Gd I steal syndrome in 01 patient which was managed conservatively. Patient with basilic vein angioplasty and redo-anastomosis developed pseudoaneurysm which was repaired. During the median follow-up time of 18 months, 3 patients died of causes unrelated to fistula. 02 surgical revisions were done. Primary patency rates were 90%, 85%, 68.5% respectively, at 6 months, 12 months, and 18 months; secondary patency rates were 95%, 90%, 70%. Conclusion: Complex vascular access procedures can provide patients with good hemodialysis access where the simpler procedures have exhausted. In above study an acceptable patency rates were achieved.
| Outcomes Of Revascularization in De Novo Aortic Occlusions Presenting with Lower Limb Motor Deficit: A Single Center Experience|| |
Dr. Shubhabrata Banerjee, Dr. Praveen Krosuri, Dr. Jessicaben Shah, Dr. Mohd. Attar Azharuddin, Dr. Raghuram Sekhar
Background: De novo Aortic occlusion is a rare entity with devastating consequences, ranging from functional limb loss to major amputations and even life loss. Major revascularization injuries lead to systemic sequeales like renal shutdown and myoglobinuria, rhabdomyolysis, compartment syndrome and muscle necrosis. Aims and Objective: To study the primary delay in presentation of de novo aortic occlusion and their outcomes post revascularization. Materials and Methods: Observational retrospective study of de novo aortic occlusion of patients presenting to a tertiary care hospital in Mumbai, India. Total of 11 patients over a period of 7 years. Results: Majority of patients (50%) were under the age of 60 years. More than 50% patients had no comorbidities. All patients presented >24 hrs after onset of symptoms and each patient was treated by a non vascular health faculty at onset. At presentation, all petients had some degree of motor deficit. Prompt revascularization had gratifying results with one mortality and one major amputation. Endovascular only salvage was done in one patient. Conclusion: Prompt revascularization in a case of de novo aortic occlusion has satisfying results. Perioperative hydration, Post operative renal support, ICU backup, prompt fasciotomies, nutritional support, infection control forms the pillars of immediate multimodal care. Surgical revascularization is mostly suited for patients with motor deficits, however judicious use of endovascular salvage has a role.
| Dabigatran in Postpartum Lactating Women with Acute Deep Vein Thrombosis and Its Impact on the breast fed infant|| |
Dr. Aadarsh Kabra
Aim: To assess the utility of Dabigatran Etixilate Mesylate (Pradaxa®) in breastfeeding post partum women and to note any growth/bleeding abnormalities/GI disturbances in breast fed infants. Methods: 12 new born infants of 12 women with postpartum Acute Deep Vein thrombosis who continued to be breast fed were evaluated. All the infants were evaluated with APTT at 2 weeks after initiation of Pradaxa® to the mother. Independent assessment of all the infants was performed by a pediatrician to note for any growth/Gastrointestinal/bleeding abnormalities. The follow up ranged from 3 months to 30 months. Assessment of the metabolites of Pradaxa® in the breast milk were not done. Results: the infants did not show any GI disturbances, developmental abnormalities, bleeding diasthesis or delay in attaining growth milestones. There was no reduction in the breast milk volume as reported by the mothers. Conclusion: The use of Pradaxa® appears to be safe for breast fed infants in women with venous thromboembolic events who are still breast feeding.
| A Prospective Evaluation Of WIFI classification system in an Indian Population|| |
Dr. Ankur Aggarwal, Dr. Robbie George
Background: Leg ulcers, in the Indian population, are often complicated due to malnutrition, MDR infection and present commonly in advanced stage. Wound, ischemia and foot infection (WIFI) classification has been assessed across various populations for predicting treatment outcomes. This study was aimed at assessing the validity of this classification in the Indian population. Aims and Objective: To assess the validity of WIFI classification system in predicting the treatment outcomes of lower limb ulcers in Indian population. Materials and Methods: WIFI classification was used to classify 126 leg ulcer patients. All patients received standard medical and surgical care. Follow up was done at 1 week, 3 weeks, 6 weeks and 3 months and at 6 months. The treatment modalities and outcomes were correlated with the WIFI stage. Results: Our study showed increasing 6 month major adverse limb events (MALE) i.e. major amputation (p- value: 0.005) with increase in the WIFI grade. Major adverse cardiac events (MACE) and mortality were also associated with increasing WIFI grade (p value: 0.075 and 0.100 respectively). Considering the patients with ischemic foot ulcers, all MALE occurred in stage 4. Major amputation was associated with increasing WIFI grade (p value: 0.096). Conclusions: WIFI was found to be a strong predictor of worsening limb outcomes and suggestive of poor life outcomes in leg ulcer patients and is a valid score to be used in the Indian population.
| Modern Day Open Ilio-Caval Surgery: A Perspective|| |
Dr. Srikanthraju Siddapuram, Dr. Robbie George, Dr. Prasenjith Sutradhara
Background: Open Ilio-caval surgery is a challenging part of vascular surgical practice and has undergone a change with the onset and advancement of endovascular procedures. Aims and Objectives: To review the current role of open iliocaval surgery in modern day vascular practice. Materials and Methods: A retrospective study was done at multispeciality tertiary care centre looking at all open iliocaval surgical interventions. Results: (1) 25 patients underwent open iliocaval interventions. (2) 68% of the patients were male and are mostly in 5th decade. (3) 3 patients underwent femorocaval bypass with PTFE grafts for benign iliocaval occlusive disease during initial period of surgery (2011-2012). (4) 3 patients with IVC leiomyosarcoma, underwent IVC resection with reconstruction (PTFE graft). (5) 3 patients of retroperitoneal tumor with IVC involvement underwent partial resection of wall of IVC followed by PTFE patchplasty in 2 patients and primary closure in the other patient. (6) Out of 14 patients of RCC with extension of thrombus into IVC, along with urology team nephrectomy with exploration and removal of thrombus from IVC and primary closure was done in 9 patients with no mortality. Remaining 5 patients had thrombus extending into right atrium for which CTVS team were involved, among them 2 patients died in post-operative period. Conclusion: In the current scenario the role of open IVC interventions are limited to oncological clearance with venous reconstruction as a part of multidisciplinary approach with urology and oncology teams.
| Paclitaxel Drug Coated Balloon and Plain Balloon for Infrapopliteal Angioplasty: 6 Months Outcome in Critical Limb Ischemia|| |
Dr. CPS Sravan, Dr. M Vishnu, Dr. V Vivekanand, Dr. M Sumanth Raj, Dr. Vaibhav Lende, Dr. Jain Piyush, Dr. Roshan Rodney, Dr. Hemanth Chaudhari, Dr. KR Suresh
Aim: To compare the primary patency and clinical outcomes of drug coated balloon to plain balloon used for infrapopliteal angioplasty. Methods: In this prospective study, 142 patients with critical limb ischemia underwent infrapopliteal angioplasty after correction of inflow lesion. 106 and 36 patients underwent angioplasty with POBA and DCB respectively. Follow up were at 1st, 3rd and 6th month. Primary patency was a measure of significant decrease in any non invasive vascular lab measurements (ABI, TBI and TcPO2-supine and dependent). Clinical outcomes were wound healing, MACE, MALE and mortality. Results: In the POBA and DCB group, 92% and 97% were Type II diabetic (p value – 0.250), 85% and 78% in Rutherford class 6 (p value- 0.763) and 77% and 66% in WIfI stage 4 (p value 0.207) respectively. Lost to follow up were 7 patients (6.6 %) in the POBA group and 1 patient (2.7 %) in the DCB group. Primary patency for POBA and DCB groups at 1st month were 93.8% and 97% respectively (p value-0.005), at 3rd month were 81.3% and 86.7% respectively (p value-0.045) and at 6th month were 62.7% and 80.7% respectively (p value-0.011). The average duration for wound healing was 3.97 months in the POBA group and 3.52 months in the DCB group (p value- 0.114). MALE was 11% vs 8% (p value 0.209), MACE was 11% vs 22% (p value 0.106) and all cause mortality was 16% vs 17% (p value 0.930) in the POBA and DCB group respectively. Drawbacks of this study are absence of randomization, unequal sample size, single center study and multilevel disease. Conclusion: The advantage of DCBs with regard to maintaining foot perfusion at 6 months is clearly established in this study. However to observe a significant difference in other clinical parameters, a longer follow up period would be needed.
| Cervical Rib Osteoblastoma (A Case Report)|| |
Dr. Singh Devender, Dr. Kilaru Harita
Background: Osteochondromas are commonest benign bone tumours, they are developmental defects. Rarely, malignant transformations can occur. A few cases of osteochondramas are reported in first rib and spine, but origin in cervical rib is a very rare entity. Aims and Objectives: To report a rarest case of cervical rib osteochondroma and technical aspects involved in treatment. Materials and Methods: A 21 years female presented with numbness in right upper limb and difficulty in overhead abduction. Patient investigated with neck x ray, CT neck with angio, CT guided biopsy and PET scan. Near total excision of tumour from supraclavicular approach with claviculectomy done. Results: Post operative residual arm weakness present, with physiotherapy moderate improvement in arm function noted. Post operative CT neck showed no residual tumours. Final histopathology report-aggressive epitheloid osteochondroma. Conclusions: Paucity of data makes results difficult to compare. Complex anatomy and challenges in complete excision of tumour with acceptable morbidity is a problem. Aggressive nature of this case, prone for recurrence. Preoperative downstaging of tumour with chemotherapy and post operative radiotherapy is useful.
| Evaluation of Relation Between Great Saphenous Vein Diameter and Body Mass Index (BMI) with Venous Reflux|| |
Dr. Bhumika Gupta, Prof. Ramakrishna Pinjala
Background: Varicose veins are the most common manifestation of Chronic Venous Disease. The estimated prevalence is between 5% and 30%, (<1% to >70%). Iincreased ambulatory venous hypertension causes swelling, pigmentation, lipodermatosclerosis, eczema, and venous ulcerations. Obesity has been identified as one of the risk factors. Duplex scanning is the preliminary diagnostic test. Venous diameter changes with valsalva maneouver significantly greater in the GSV and deep veins of CVI patients than in healthy subjects. Increased distensibility correlates with venous reflux parameters in CVI patients. Aims and Objective: To find out the relation between GSV diameter and BMI in patients with venous reflux. Materials and Methods: A prospective, cross-sectional study including 150 patients, was conducted over 1 year, in the department of Vascular surgery, NIMS, Hyderabad. Duplex scan was performed using a 10 MHz imaging probe. The SFJ was evaluated for reflux. The GSV diameters at 3 cm distal to SFJ, at mid-thigh, above knee and below knee were noted. Comparison of variables was performed using chi-square test. Results: The average diameter with BMI 20-25 were 8.15 mm, 7.94 mm, 7.28 mm and 7.12 mm. While with BMI (35-40) were- 11.27, 10.60, 9.55, and 9.01 mm. Maximum no. of patients with BMI 20-25 had grade 1 reflux (63.88%), while 75% patients were found to have grade 4 reflux with BMI of 35-40. Conclusion: There is positive relation between increase in GSV diameter and reflux at SFJ; and higher BMI and reflux grade at SFJ. Also, there is positive relationship between increase vein size and higher BMI.
| Role Of Catheter Directed Thrombolysis in Peripheral Arterial Occlusive Disease with No Distal Reformation|| |
Dr. Sridhar Murugesan
Background: Patients with Peripheral Arterial Occlusive Disease with no distal reformation, often end up in Amputation. Various options in management of patients with no distal reformation include Prostanoids, Pneumatic compression therapy and Thrombolysis. Aim: To study outcome following Catheter directed thrombolysis in patients with Peripheral Vascular Disease with no distal reformation. Materials and Methods: This study was conducted at Institute of Vascular Surgery, Madras Medical College. Overall 16 patients underwent catheter directed thrombolysis for Acute on Chronic Limb Ischemia during the period 2015 to 2017. Results: Mean age at presentation was 41 years (range 31 to 48 years). Mean Duration of symptoms was 18 days (range 14 to 26 days). Of total 16 patients, one was female. Smoking was a risk factor in all except the female patient. Clinical presentation at time of presentation was rutherford stage 4 and beyond. All patients underwent catheter directed thrombolysis for 48 hours. Ankle brachial index improvement was seen in all the patients. No major amputation was seen. No major bleeding complications seen. Punture site complications were present, which was managed conservatively. Pain free walking distance improved in all the patients. Conclusion: Catheter directed thrombolysis is a viable option in patients with Peripheral Vascular Disease with no distal reformation. Even though there is no recanalisation of named vessels, the collaterals are cleared of acute thrombus and helps in tiding overt the acute crisis.
| Revascularisation in Femoral Embolism - Class III Acute Limb Ischemia-Our Institutional Experience|| |
Dr. M Ramya
Background: Class III Acute limb ischemia (ALI) is non salvageable and amputation is the treatment of choice. We conducted a prospective study on “Revascularization in femoral embolism – class III Acute limb ischemia” in our institute of vascular surgery, RGGGH, Chennai, during period 1st August 2016 to 31st July 2018 which included 20 patients and analyzed the outcome. ´alyze the outcome following revascularization in patients with femoral embolism – class III ALI. Materials and Methods: Method of Study: Prospective study. Duration of Study: 2 years. Inclusion Criteria: (1) All patients with femoral embolism – with class III ALI (sensory loss- profound/anesthetic, muscle weakness – profound/ paralysis, Arterial and venous Doppler signals – inaudible) with age >12 years. (2) Above patients with non contracting muscles in anterolateral and deep posterior compartment with even minimal contraction in superficial posterior compartment during fasciotomy. Exclusion Criteria: (1) Patients with femoral embolism – class III ALI with skin involvement (Blebs/patches). (2) Patients with femoral embolism – class III ALI with pale, non contracting muscles in all compartments during fasciotomy. (3) Patients with femoral embolism - class III ALI with tender, tense/turgid muscles in all compartments with smoky urine. Results: Results were analyzed on the basis of Dialysis dependency, limb status, improvement in sensory/motor function, status of foot drop, fasciotomy wound healing, psychological status, amputation and mortality. Conclusion: Proper selection of patients yielded better results in functional outcome and Psychological status of the patient with less adverse effects and nil mortality.
| Impact of Wound Ischemia and Foot Infection (WIFI) Stage as An Independent Predictor Of Limb Salvage in Threatened Limb Ischemia Post Revascularization|| |
Dr. Vaibhav Lende, Dr. Vivekananda, Dr. CPS Sravan, Dr. Piyush Jain, Dr. Chaudhari Hemant, Dr. Rodney Roshan, Dr. KR Suresh
Background: Patients presenting to Jain Institute of vascular sciences (JIVAS) with critical limb ischemia (CLI) typically have advanced disease with significant comorbidities. The Society for Vascular Surgery WIfI threatened limb classification has shown to correlate well with risk of major amputation and time to wound healing. The purpose of this study is to assess the influence of revascularization on limb salvage classified according to the WIfI stage. Methods: This is a single center prospective study done in JIVAS. All patients presenting to our hospital with CLI from June 2016 to June 2017 were enrolled and followed for minimum of six months. Wound healing and major amputation were compared for patients stratified by WIfI classification. Results: Out of 266 patients admitted with CLI, 236 patients were classified according to WIfI stage and underwent infrainguinal revascularization procedure. Three percent patients were in stage1, 20% in stage 2, 37% in stage 3 and 38% in stage 4. No significant difference noted in age, gender, procedure performed (endovascular/bypass). Diabetes (p=0.016), Hypertension (p=0.001) and smoking history (p=0.033) were more common in Stage 3 and stage 4 with significant p value. Overall major amputation rate at six months was 11.01 % with most amputations in stage 3 and 4. There were no significant difference among WIfI stages with respect to wound healing rate (p=0.238) but as the stage increases major amputations (p=0.041) rate increases significantly. Conclusion: Among patients with CLI, as the stage of the WIfI increases the rate of major amputation rises. Also in our study the wound healing rate doesn’t correlates among the WIfI stage. Further subanalysis and long duration follow up is required for more conclusive results.
| Impact of tibial angioplasties in Salvaging Critical Limbs: Which Subset of Patients Benefits The Most: An Institutional Experience|| |
Dr. Jan Sujith, Prof. N Sritharan
Aim: To determine the impact of tibial angioplasty in salvaging limbs in patients with critical limb ischaemia and to identify the subset of in which it is likely to be most beneficial. Materials and Methods: Retrospective analysis of 45 patients who underwent Tibial and Peroneal angiolplasties from January 2015 to July 2018. Angioplasties were done in isolation or in conjunction with Iliac, SFA and popliteal angioplasties. A total of 38 male and 7 Female patients were included in the study. A successful outcome was defined as survival without amputation at 6 months, relief from rest pain (measured in visual analogue scale) and wound healing. Results: The median age was 61 years. 77% of the patients were diabetic and nearly a 85% percentage had disease in more than one vessel. The limb salvage rate was more than 78% and 90% of patients reported relief from rest pain. A few patients 8% (n=4) required multiple sittings of wound debridement for limb salvage. A similar number underwent amputations (major- above or below knee). Conclusion: Tibial angioplasty as a limb saving procedure has a definitive role in Diabetics and patients with multivessel disease. Despite having a low patency rate, it my aid in wound healing and thus salvage the limb.
| Endovascular Repair of Mycotic Aortic Aneurysms: A Case Series|| |
Dr. Rahul Agarwal, Dr. Prajna Kota, Dr. Burli Pradeep, Dr. Gnaneshwar Atturu, Dr. Prem Chand Gupta
Introduction: Mycotic aortic aneurysms (MAA) an uncommon but devastating pathology. Open surgical repair is the gold standard and carries a significant in hospital mortality of 20-40%. With advances in endovascular techniques, EVAR has become an alternative treatment approach for MAA. The anxiety of leaving a foreign material in an infected field raises the debate whether EVAR for MAA should be a bridge to a definitive procedure or a permanent solution. In this series, we see the treatment outcomes of EVAR for MAA. Materials and Methods: On retrospective analysis, 4 patients underwent EVAR for MAA in our institute from May 2015 to May 2017. Early and mid-term outcomes of our subjects were analyzed and compared with standard literature. Results: The mean age of patients was 54.75 years (50-64 years), all were males. Thoracic aorta was the commonest site (75%). Symptoms included fever, pain, cough and hemoptysis. Three procedures were performed on emergency basis and one electively. E coli were isolated in one patient. The thoracic MAAs were treated with Zenith TX2 stent graft (COOK medical) and one patient required prior debranching. The abdominal MAA was treated with covered Cheatham Platinum stent. The mean hospital stay was 9.5 days (range 3 days to 25 days). All patients are on long term Ciprofloxacin and are under follow up for 38 months (range 2 to 38 months). 30-day mortality was 0% and one year and 3 year mortality was 25% (unrelated to surgery). Conclusion: EVAR is an acceptable alternative for treating MAA with low one year mortality. Prolonged antibiotic treatment could reduce risk of recurrence and need for open procedure in the midterm follow up STUMP.
| Healing After Above Knee Amputation with a Non Palpable Femoral Pulse|| |
Dr. B Nishan, Dr. V Vivekananda, Dr. J Piyush, Dr. L Vaibhav, Dr. CPS Sravan, Dr. Chaudhari Hemant, Dr. H Vishal, Dr. K Siva, Dr. KR Suresh
Introduction: There have been major advances in ilio-femoral revascularization procedures, inspite of which above knee amputation (AKA) is common in practice and represents a significantly morbid procedure. This study was done to evaluate the outcome of stump healing after above knee amputation in patients with a non-palpable femoral pulse. Methods: Patients with non-palpable femoral pulse who underwent AKA at JIVAS between January, 2014 and December, 2017 were evaluated retrospectively. The demographics including age, sex, comorbidities (DM/HTN/Cardiac disease/Chronic kidney disease), history of smoking, doppler signals, indication for amputation (chronic/acute limb ischemia), stump healing, re-intervention (stump debridement) and mortality were noted. Results: Data of 35 subjects was collected and analysed. The mean age of patients was 54.45+/-11.26 years, male: female ratio was 4:1. 48% (17/35) were diabetic, 45% (16/35) were hypertensive, 28% (10/35) had cardiac disease, 11% (4/35) had chronic kidney disease and 37% (13/35) were smokers. 51% (18/35) were diagnosed as chronic limb ischemia and the remaining 49% (17/35) were diagnosed as acute limb ischemia. The overall mortality rate was 20% (7/35) at 6 months. Cardiac complications were the leading cause of death (20%). Successful stump healing was accomplished in 57% (20/35) at the end of 6 months. Stump healing failure occurred in 22% (8/35) in the form of debridement. Doppler signals were noted in 51% (18/35) of which 28% (10/35) had stump healing with no debridement. Conclusion: In the current study, no single factor can accurately predict stump healing but the absence of comorbidities and presence of doppler signals may be indicative of stump healing.
| D-Dimer Levels in Patients with Thromboangitis Obliterans|| |
Dr. Vimalin Samuel, Dr. Sunil Agarwal
Background: Thromboangitis obliterans (TAO) is a recurring progressive segmental vasculopathy of small and medium vessels of the hands and feet. The obliterative endarteritis is thought to occur due to a mixture of thrombosis and inflammation. The diagnostic sensitivity and specificity of D-dimer as a biomarker for thrombosis in the setting of TAO has not been well studied. Aim and Objectives: The aim of our study was to study the serum D-dimer (a marker of thrombosis) in patients with TAO and compare this to normal age/ sex matched controls. Materials and Methods: A prospective case control study with sample size of 62 cases and 330 controls was carried out between April 2014 and May 2015. All patients underwent a standard diagnostic protocol including blood tests, electrocardiogram, chest X- ray and ankle brachial pressure index. Results: All 62 patients diagnosed to have TAO were males with an average age of 40 years (range 18-50 years). Medium vessel involvement was present in 85%, the reminder presented with involvement of the popliteal and femoral vessels as well. Upper limb involvement or superficial thrombophlebitis was present in 95%. The median and inter-quartile range for D-dimer values were 61ng/ml and 41-88 ng/ml in controls (n=330); 247 ng/ml and 126-477ng/ml (respectively) in cases (n=62). The D-dimer levels in cases were elevated, the difference was statistically significant (P<0.001). Conclusions: D-dimer levels are significantly elevated in patients with TAO. This indicates an underlying thrombotic process and points to its potential role as a diagnostic adjunct. It also leads us to consider a potential therapeutic benefit of anticoagulants in this disease.
| Is There Any Role of Transcutaneous Partial Pressure of Oxygen (TcPO2) In Patients With Chronic Venous Insufficiency?|| |
Dr. Sasank Kalipatnapu
Background: Chronic venous insufficiency is an important cause of leg ulceration. Transcutaneous partial pressure of oxygen is used to determine perfusion to the skin and is used in arterial diseases. Aims and Objectives: We hypothesized that the skin changes induced by chronic venous insufficiency lead to a decrease in the perfusion of the skin. We measured the transcutaneous partial pressure of oxygen in patients with C4 to C6 disease. Materials and Methods: All patients with unilateral chronic venous disease with clinical stage 4-6 presenting to vascular surgery were included. Patients with co-existent arterial disease, active infection or autoimmune conditions were excluded. TcPO2 was measured in both diseased and normal leg in both supine and dependent positions. Results: Out of a total of 96 patients included in the study, there were 85 males and 11 females. In supine position, irrespective of the stage of advanced CVI, the mean TcPO2 in the affected limb (23.28 mm Hg) was significantly lower (p < 0.01) than the mean TcPO2 in the normal limb (32.05 mm Hg). In dependent position, the TcPO2 in the affected limb (40.50 mm Hg) was significantly lower (p < 0.01) than the TcPO2 in the non-affected limb (50.74 mm Hg). The mean TcPO2 was significantly lower in the supine position compared to dependent position both in affected & normal limb. Conclusions: In a limb affected with advanced CVI the TcPO2 is significantly lower when compared to normal, more so for C5 & C6 stage. There is a definite effect of limb positioning on TcPO2 values. This study establishes the relevance of measuring TcPO2 in CVI as a predictor of the oxygenation status. An increase in TcPO2 following intervention could potentially be used a marker to assess the efficacy of that intervention.
| Acute Limb Ischemia-Is it Late to Intervene?|| |
Dr. Chandra Pratap Singh
Background: Patients with acute lower limb ischemia are at significant risk for both amputation and death. Rapid recognition and treatment are required to prevent limb loss and life-threatening morbidity. It has been our policy to manage patients with acute limb ischemia by heparinization, angiography, surgical embolectomy, reconstruction on patients with threatened but viable extremities and prompt amputation of nonviable limb. Aim and Objective: To study the outcome of heparinisation and surgical intervention in Acute limb ischemia. Materials and Methods: All patients of ALI presenting to tertiary care hospital during the period 01/05/16 to 30/07/18 in whom heparinisation and surgical embolectomy/revascularisation/primary amputation was done. Results: Total 37 cases of ALI were managed during this period. M: F ratio was 3:1. 48% of patients were in productive age group 30-50 yrs. 10%patients underwent fasciotomy in addition to embolectomy. Major amputation was done in 8% and minor amputation in 6%. One patient expired in post op period. Conclusion: The management of acute limb ischemia remains a surgical challenge. These patients have severe coexisting medical conditions that may limit both short-term and long-term life expectancy. Reasonable palliation and limb salvage can be anticipated with use of a policy of prompt initiation of anticoagulation, surgical embolectomy, fasciotomy, revascularization of threatened but viable limbs and primary amputation of nonviable extremities. Well began is half done, its never too late.
| Vitamin D and Its Role in Vascular Disease’S: A Prospective Study In a Tertiary Care Centre in South India|| |
Dr. Ravichandran Manoj Prabakar, Dr. SR Subrammaniyan, Dr. G Marun Raj, Dr. M Nedounsejiane
Background: Vitamin D receptors have a broad distribution in vascular smooth cells, macrophages, and lymphocytes, Vitamin D regulates the expression of a number of proteins relevant to the vessel wall. Vitamin D deficiency has been implicated as a contributory factor in the development of Peripheral arterial disease (PAD), with very few studies showing its relationship with Vascular Disease s among South Indian Population. Aims and Objectives: This study intends to assess the correlation between vitamin D levels and Vascular disease. Materials and Methods: A prospective study was planned in 100 patients attending our OPD. Cases (50) were defined as those with Vascular disease, Arterial (PAD) and Venous (CVI/CVD). Controls were other patients (50). Vitamin D and PTH levels were measured, and relevant demographic data was collected. PTH levels were asssayed to rule out Secondary HPT. Analysis was done to compare and stratify the vitamin D levels between cases and controls. Deficiency if any was classified according to Lips classification. Results: We are yet to achieve our study population of 100. 67 patients were assayed till date, Cases 32 (19 Arterial, 13 Venous), 35 Others. Deficiency was present in 50% Cases (73% Arterial, 30% Venous) and 40% controls. Deficiency was more among cases than in controls. This may show a causal relationship between the vitamin D level and Vascuar Disease. Conclusion: We found a significant association between Vitamin D deficiency and Vascular diseases, the final results are awaited. If found significant we are planning to supplement Vitamin D and assess its Functional outcome as a Phase II study.
| A Cross Sectional Study of Radiation Exposure in Patients Undergoing Endovascular Interventions|| |
Dr. Prajna Kota, Dr. Rahul Agarwal, Dr. Manjusha Sai, Dr. Burli Pradeep, Dr. Chainulu Saripalli, Dr. Prem Chand Gupta, Dr. Gnaneshwar Atturu
Background: With increase in endovascular procedures in developing countries, awareness about patient as well as surgeon radiation exposure is of paramount importance. The International Commission on Radiological protection (ICRP) has proposed guidelines for recommended dose limits for therapeutic patient exposure. Dose area product (DAP) is the amount of radiation delivered per unit tissue and it is considered as the most predictive measure of the biological sequalae of radiation exposure. Aims and Objectives: The primary objective is to analyze the DAP in various endovascular interventions and compare with standard ICRP guidelines. Secondary objective is to assess the radiation exposure times (RET). Materials and Methods: All patients who underwent endovascular procedures in our unit from February 2017 to December 2017 were included in the study. The fluoroscopic machine used was a mobile Ziehm. Data was analyzed using descriptive statistics in Microsoft Excel 2016 student version. Results: There were 325 patients including 225 males (69.2%) and 100 females (30.8%). Mean age was 57 years (13-97 years). Procedures included 156 AV access related (48%), 97 peripheral arterial interventions (29.8%), 65 central vein angioplasties (20%) and 7 lower limb vein interventions (2.2%). The mean DAP was 4565.5 cGy cm2 (110 - 33, 450 cGy cm2). The mean RET was 16 minutes (1- 56 minutes). Conclusions: Based on our observations, the DAP and maximum RET at our institute were well below the substantial radiation dose (> 50000 cGy cm2 and 60 min) proposed by the ICRP. A yearly radiation audit would benefit patients by educating the healthcare providers.
| Hybrid Procedure for Aortic Arch Aneurysms: The Jipmer Experience-Report of Two Cases|| |
Dr. Jayakrishnan Soman
Background: The management of thoracic aortic arch aneurysms is in itself surgical challenge. We have resorted to hybrid procedures for thoracic aortic aneurysms thus reducing risk of major aortic surgery on cardiopulmonary bypass. Hybrid procedure involves the debranching of aorta by the vascular surgeon and stenting of aneurysm by cardiologist on postoperative day 2. Methods: This is a report of two cases of aortic arch aneurysms managed in JIPMER by hybrid procedure. The two cases are adult males with Aortic arch and proximal DTA aneurysm with partial luminal thrombosis and Normal arch vessels. The left common carotid and subclavian was transected and end-end carotico – subclavian bypass was done. A Y graft of size 16 x 8 mm Intergard knitted type was anastomosed to the ascending aorta leaving adequate landing zone for the stent in the future. The graft was tunneled through the right pleural space and below the SVC and anastomosed to right common carotid side to side fashion and same graft was anastomosed to right subclavian in end to side fashion. The proximal ends of the right common carotid and subclavian artery below the anastomosis was clipped and ligated, thus debranched from the arch. The other limb of the Y graft was anastomosed to the common carotid part of the carotico - subclavian bypass. Both of them underwent stenting of the arch of aorta aneurysm by Cardiologist on past operative Day 2. Results and Conclusions: Many cases of aortic aneurysms are managed surgically by replacing aorta with graft and connecting arch vessels to them, many cases have long CPB time and cross clamp time and prolonged or stormy postoperative periods. In our experience of these two cases, had good recovery, and now on 6 monthly follow up.
| Percutaneous Treatment of Central Venous Obstruction in ESRD: An Institutional Experience|| |
Dr. Ashutosh Aher, Dr. Ashish Airen, Dr. Vinit Paliwal, Dr. Manju Bharat, Dr. Shrikant Ghanwat, Dr. SVR Krishna, Dr. Tapish Sahu, Dr. Virender Sheorain, Dr. Tarun Grover, Dr. Rajiv Parakh
Introduction: Central venous obstruction is a serious complication in patients undergoing hemodialysis for ESRD, often presenting with symptoms of venous hypertension. Treatment is aimed to provide symptomatic relief and to maintain hemodialysis access site patency. Aim: Describe our experience in endovascular treatment of central venous obstruction in patients undergoing hemodialysis. Materials and Methods: A total of 36 patients who presented to the Division of peripheral vascular and endovascular surgery, Medanta The Medicity with central venous obstruction, treated between July 2016 to June 2017 were included in the study: All patients underwent endovascular treatment and were analyzed prospectively for 6 months. Results: A total of 36 patients were included (21 Males and 15 females) in our study. 20 patients had total occlusions and 16 had stenotic lesions. 23 patients had superior venacava (SVC) + brachiocephalic vein (BCV) lesions, 13 patients had subclavian vein (SCV) lesions. All lesions in the SCV, BCV and SVC were primarily treated with Percutaneous Transluminal Balloon Angioplasty (PTA) and in case of significant residual stenosis/recoil, bail-out stenting was done. 26 patients underwent PTA alone and 10 patients under went PTA + stenting. All the patients were regularly followed up and at 6 months follow up - Of the 10 patients who underwent PTA+ stenting, 6 patients had complete symptomatic relief (with respect to arm swelling and venous pressures during hemodialysis). Remaining 4 patients had recurrence of arm swelling and increased venous pressures during hemodialysis. Of the remaining 26 patients who underwent PTA alone, 18 patients (70%) had good symptomatic relief. 10 (30%) patients had recurrence of symptoms. All the patients who had recurrence of symptoms (4+10= 14) underwent PTA for restenosis. Conclusion: Endovascular treatment is a safe and effective modality in treating central venous obstruction in patients with ESRD.
| Outcomes of Wire-Interwoven, Self-Expanding Nitinol Stents in Femoropoliteal Atherosclerotic Disease with Critical Limb Ischemia|| |
Dr. Manju Bharath, Dr. Vinit Paliwal, Dr. Ashish Airen, Dr. Ashutosh Aher, Dr. Shrikant Ghanwat, Dr. SVR Krishna, Dr. Tapish Sahu, Dr. Virender Sheorain, Dr. Tarun Grover, Dr. Rajiv Parakh
Background: Femoropopliteal artery travels across two joint structures (hip and knee) traversing the thigh through the muscular adductor canal, being subjected to an increased stress from bending, torsion, longitudinal and radial compression forces. Stent systems have historically been associated with high rates of stent fractures, restenosis and decreased primary patency rates. The Wire-Interwoven nitinol stent is a novel technology that is designed to withstand the unique and oppressive forces along the course of the femoropopliteal artey. Aims and Objectives: To evaluate the primary patency rates of Wire-Interwoven nitinol stents in the femoropopliteal atherosclerotic disease. Materials and Methods: 70 patients who underwent stenting with the Wire-Interwoven nitinol stent for the femoropopliteal atherosclerotic disease from January 2017 to April 2018 were included. Improvement in pain (VAS), ABI and primary patency rates were assessed over a follow-up period of six months. Results: Most patients belonged to Rutherford category 5 for limb ischemia and the majority had TASC C lesions. SFA (Superficial Femoral Artery) was the most commonly involved segment and the mean lesion length was 166.4 mm with a range of 28-290 mm. There was a statistically significant reduction in pain and ABI in all the follow up periods and overall. Primary patency rate at 6months was 82.9%. Conclusion: Stenting of the complex femoropopliteal artery lesions with the wire-interwoven stent is safe and effective and may better serve areas under extreme mechanical stress. The wire-interwoven stent has shown better patency rates and fracture-free life expectancy greater than those of other comparable platforms.
| A Comparison of Pharmacomechanical Catheter Directed Thrombolysis Vs. Anticoagulation Alone in Prevention of Post-Thrombotic Syndrome Following Acute Lower Limb Deep Vein Thrombosis|| |
Dr. Nikhil Sharma, Dr. VS Bedi, Dr. Sandeep Agarwal, Dr. Ajay Yadav, Dr. Ambarish Satwik, Dr. Apurva Srivastava
Introduction: The Post thrombotic syndrome (PTS) occurs in 20-60% of patients after acute DVT treated with anticoagulation alone. Residual thrombus after DVT leads to ambulatory venous hypertension which consequently causes PTS. Thus, evacuating the clot during DVT itself might prevent PTS-the “Open Vein Hypothesis”. Pharmacomechanical catheter directed thrombolysis (PCDT) evacuates the thrombus working on this very hypothesis. PCDT is usually performed using specialized devices which are expensive and not easily available in our country. In this study, we describe a method to perform PCDT using a commonly available and inexpensive guiding catheter in an aim to prevent PTS after DVT. Aims and Objectives: To evaluate if in acute DVT, our method of PCDT reduces the occurrence of PTS, as compared to anticoagulation alone. Design: Prospective, randomized, comparative, cohort study. Study Period: June 2016-May 2017 with one year follow up. Materials and Methods: Patients presenting with acute DVT (<3 weeks duration) who met the inclusion criteria were included in this study. They were subsequently randomized to receive either anticoagulation alone or PCDT which was performed in our vascular cath lab using a 7 Fr. guiding catheter to physically macerate and aspirate the clot with simultaneous instillation of fibrinolytic therapy (rT-PA) in the thrombus. Results: The technical success rate was 96%. The mean total dose of rT-PA used was 20.24 mg .The need for Venoplasty/Stenting was 76%. The rates of Major bleeding in the both the groups were similar at 4%. At one year follow up, following were the results [Table 1]:
Conclusions: In conclusion, our method of PCDT is safe and effective as it reduces the occurrence of PTS with preservation of valvular competence and vein patency as compared to anticoagulation alone.
| Outcomes of Drug Coated Balloon (DCB) In Arterio-Venous (A-V) Fistuloplasty for a Failing A-V Fistula for Dialysis|| |
Dr. Vinit Paliwal, Dr. Manju Bharath, Dr. Ashutosh Aher, Dr. Ashish Airen, Dr. Shrikant Ghanwat, Dr. SVR Krishna, Dr. Tapish Sahu, Dr. Virender Sheorain, Dr. Tarun Grover, Dr. Rajiv Parakh
Background: Arteriovenous fistulas (AVF) are considered the gold standard for hemodialysis access. The commonest problem with the AVF is stenosis, which can precipitate fistula occlusion. These lesions can be managed by surgical revision or endovascular intervention (fistuloplasty) of AVF. A major concern, however, is the longevity of fistuloplasty which is associated with a high recurrence rate of the stenosis and repeated interventions. Successful use of drug coated balloon in the coronary circulation led us to use DCBs in AVF stenosis. Aim and Objectives: To assess the primary patency rate of DCB Fistuloplasty at the end of six months. Materials and Methods: From Jan 2016 to Jan 2018, 76 patients who underwent DCB fistuloplasty in failing AVF were included in present study. Procedure-related complications, technical success, clinical success, adequacy of dialysis were noted. Doppler evaluation of AVF circuit was done and primary patency assessed. Results: 63.2 % of the patients had juxta-anastomotic lesion while 36.8 % of the patients had lesion in the outflow vein. Post fistuloplasty; all our cases showed 100% procedural and clinical success rate. Most common complication was fistuloplasty site haematoma. Primary patency at the end of 1, 3 and 6 months was 98.6%, 92.1% and 78.9% respectively. Conclusion: DCB fistuloplasty for failing AVF has lower rate of restenosis, leading to lesser number of interventions and improved primary patency rate at the end of six months. DCB fistuloplasty is thus a safe and effective treatment option for the treatment of failing AVF.
| Retroperitoneal Approach for Elective Open Repair of Abdominal Aortic Aneurysms: A Prospective Comparative Study with Transperitoneal Approach|| |
Dr. Harishankar Ramachandran Nair, Dr. Sreekumar Ramachandran, Dr. Shivanesan Pitchai
Background: Transperitoneal approach is the commonly practiced surgical technique for open repair of abdominal aortic aneurysm (AAA). The available literature comparing retroperitoneal (RP) and transperitoneal (TP) approach for aortic aneurysm repair show conflicting results and none has showed a clear advantage over other. Aims and Objectives: To compare 30-day outcomes, 6 months and 1 year follow up of patients undergoing elective infrarenal abdominal aortic aneurysm (AAA) repair. To assess the effectiveness and safety of both approaches with regard to mortality, complications, hospital stay, blood loss and patient-related characteristics like intraoperative outcomes, post op pain relief, return of bowel function, and early return to daily activities. Materials and Methods: All patients over 18 years of age undergoing elective AAA repair were studied over 1 year (January to December 2017). Results: A total of 34 patients were studied. Transperitoneal approach had 25 patients while retroperitoneal had 9 patients. Operative time, blood loss and need for perioperative blood transfusion were more in the retroperitoneal group. Wound infection was equal (1each) in both groups. Paralytic ileus and early return of bowel function and need for post-operative analgesics were noted to be lesser in retroperitoneal group. Abdominal wall bulge not amounting to hernia was noted in 2 patients only in retroperitoneal group. There was 1 mortality in retroperitoneal group whereas none in transperitoneal and was attributed to bleeding and hypovolemic shock. Conclusion: Retroperitoneal approach offers excellent exposure of abdominal but has a steep learning curve for the surgeon. We did not find increased pulmonary, renal and cardiac complications in retroperitoneal group unlike some studies. Once familiar, it is a great surgical technique for definitive subset of patients who have hostile abdomen (previous laparotomy, irradiated abdomen, obesity etc) and hostile necks/need suprarenal clamp.
| Upper Limb Ischemia: A Clinical Experiences of Acute and Chronic Upper Limb Ischemia in a Single Center|| |
Dr. Umesh Gheewala, Dr. KS Vinay, Dr. N Murlikrishna
Background: Upper limb ischemia is less common than lower limb ischemia, and relatively few cases have been reported. This paper reviews the epidemiology, etiology, and clinical characteristics of upper limb ischemia and analyzes the factors affecting functional sequelae after treatment. Methods: The records of 85 patients with acute and chronic upper limb ischemia who underwent treatment from January 2017 to February 2018 were retrospectively reviewed. Results: The median age was 51 years, and the number of male patients was 54. The most common etiology was embolism of cardiac origin, followed by thrombosis with secondary trauma, and the brachial artery was the most common location for a lesion causing obstruction. Computed tomography angiography was the first-line diagnostic tool in our center. 73 operations were performed, and conservative therapy was implemented in 12 cases. Twenty patients complained of functional sequelae after treatment. Functional sequelae were found to be more likely in patients with a longer duration of symptoms and higher createnine kinase levels. Conclusion: An increased duration of symptoms and higher initial serum CK levels were associated with the more frequent occurrence of functional sequelae. The prognosis of upper limb ischemia is associated with prompt and proper treatment and can also be predicted by initial createnine kinase level.
| Does The Eversion Carotid Endarterectomy Increase Postoperative Hypertension?|| |
Dr. Vineeth Kumar, Dr. Sreekumar Ramachandran, Dr. Shivanesan Pitchai
Background: The Eversion carotid endarterectomy is associated with increased incidence of postoperative hypertension because there is a high chance of baroreceptor denervation due to the longitudinal incision on the carotid bulb, which has been identified as a factor of prognostic relevance in patients with cardiovascular disease. Aims and Objective: The primary aim of this study was to determine whether hypertension in the early postoperative period is dependent on the surgical technique. The secondary aim of this study is to find out the factors that lead to the development of post-op hypertension following CEA. Materials and Methods: A prospective review of 50 patients who underwent carotid endarterectomy (CEA) from January 2017 to August 15, 2018, has been performed. The changes in blood pressure baseline during the postoperative period in Conventional carotid endarterectomy (C-CEA) and Eversion carotid endarterectomy (E-CEA) group were analyzed and compared. Postoperative hypertension was defined as an elevation of systolic pressure >180 mm Hg or >40% rise above the baseline. Results: The patients with eversion technique did not develop significantly higher blood pressure in the postoperative course compared to those operated with the standard technique. In the recovery room, the mean systolic blood pressure was 134 ± 15 mm Hg in C-CEA group versus 135 ± 13 mm Hg in S-CEA group. During the first six hours, the need for intravenous antihypertensive drugs was similar in the two groups. The dosage of preoperative antihypertensive therapy was increased in both groups without a significant statistical difference (p= 1). Conclusions: Our study shows that postoperative hypertension after carotid endarterectomy is not related to the surgical technique. Eversion CEA has the same rate of postoperative hypertension when compared to Conventional-CEA.
| Endovascular Management of Transplant Renal Artery Stenosis: A Single-Centre Study|| |
Dr. Ashwini Naveen Gangadharan
Background: Renal transplantation for various indications has been on the steady rise, and interventions to preserve graft function and integrity have been increasing. Aims and Objectives: The aim of this study was to assess the safety and efficacy of Endovascular therapy to salvage transplant kidney with diagnosed Transplant Renal Artery Stenosis (TRAS). Materials and Methods: All cases of TRAS admitted in our hospital from July 2014 to June 2017 (15 patients) were included for the study. They were followed up for 1 year with assessment of parameters including stenosis free primary transplant renal artery patency, freedom from re-intervention, graft survival, post-operative serum creatinine level, blood pressure evolution, and the number of antihypertensive drugs pre and post procedure. Results: Of the total 15 patients, mean age was 50.1 years with 66% being men. 12 patients presented with renovascular hypertension whereas 2 patients had only worsening renal function. 14 patients underwent percutaneous transluminal angioplasty with technical success of 94%. There were no periprocedural complications or deaths. Renal functions improved and stabilized in 67% of patients. Blood pressure control in patients with renovascular hypertension was significantly better. Conclusion: Endovascular salvage of renal allograft transplants is a safe and effective management technique which can be done for various indications. The maximum benefit in renal function as assessed by serum creatinine and control of blood pressure is observed in patients with worsening renal function and in the presence of reno vascular hypertension respectively.
| Hybrid Approach in Complex Aortic Aneurysms and Dissections: The Way Forward|| |
Dr. Manvendu Jha, Dr. Anand Vembu
Period of Study: Jan 2016 to Jun 2018. Summary: Twelve patients underwent Hybrid procedures from Jan 2016 till June 2018 for complex Thoracic and abdominal aortic aneurysms and Type B Aortic dissections. Five patients underwent visceral debranching with EVAR while seven patients underwent TEVAR with associated carotid subclavian bypass. Three patients had aneurysm of descending thoracic aorta while two had saccular aneurysm of the arch. Five patients had pararenal abdominal aortic aneurysm while two patients had Type B Aortic dissection. Nine patients were males and three females. Mean age of patients was 56 years. 10 patients were chronic smokers. Five patients were hypertensive and six were diabetic. Three patients had both diabetes and hypertension. Nine had COPD and four patients had associated coronary artery disease. All patients underwent the procedures under general anaesthesia with supplemented epidural in five patients. Post operatively they were managed in ICU on elective ventilation for first 24 hours. All except two patients have been followed up for one year. One patient had pancreatic collection which was managed conservatively. Follow up CT Angio was done for all patients after 03 months and one year. There was no evidence of any endoleak. We had one mortality on seventh post op day due to pneumonitis. Conclusion: Hybrid procedures are the way forward in selected patients with complex aortic aneurysms and dissections with good results, however long term follow up is required.
| IVUS Versus Venography for Diagnosis and Treatment Venous Stenotic Lesion|| |
Dr. Ashish Airen, Dr. Tapish Sahu, Dr. Virender Sheorain
Background: Multuplanar venography has traditionally been used for selecting the patients for venous stenotic lesion requiring balloon angioplasty/stenting. Recently ivus (intra vascular ultra sound) imaging has become more available. Ivus can be used along with multiplanar venography for patients with symptomatic venous disease. Ivus can help in identification and treatment of venous lesion which were missed on multiplanar venography. Aim and Objectives: To assess the change in treatment plan by use of ivus adjunct to multiplanar venography in patients of symptomatic venous disease. Methods: From December 2017 to July 2018, 10 patients presenting symptomatic venous disease underwent ivus along with multiplanar venography. Findings of multiplanar venography and ivus were noted and patients with venous lesion requiring stenting were identified. Four patients with normal venography found to have significantly decreased cross section area on ivus and were treated with balloon-plasty and stenting. Results: Four patients out of ten had change in treatment plan based on ivus fingings as compared to venography alone. There was significant clinical improvement in patients treated based on ivus findings. Technical success was 100%. No complication associated with the use of ivus. Operative time has increased by average of ten minutes. Conclusion: Intravascular ultrasound has significant role in deciding the treatment plan when used with multiplanar venography in patients of symptomatic venous disease.
| Effect of Abnormal Lipid Profile (LP) On Wound Healing in Critical Limb Ischemia Patient with Successful Infrapopliteal Angioplasty|| |
Dr. Hemant Chaudhari, Dr. Rodeny Roshan, Dr. Lende Vaibhav, Dr. CPS Sravan, Dr. Jain Piyush, Dr. B Nishan, Dr. H Vishal, Dr. Krisna Siva, Dr. M Vishnu, Dr. V Vivekananda, Dr. K Sumanthraj, Dr. KR Suresh
Aims and Objective: To study the effect of abnormal Lipid Profile on wound healing in critical limb ischemia patient with successful infrapopliteal angioplasty in a tertiary centre. Materials and Methods: In this single centre retrospective study, 231 patients were studied from March 2014 to March 2017 who underwent successful infrapopliteal angioplasty with inflow correction for critical limb ischemia. Patients with any of the high Total Cholesterol (TC)/Triglyceride (TG)/Low Density Lipoprotein (LDL) or with low High Density Lipoprotein (HDL) were included in abnormal lipid profile group. Patient with abnormal lipid profile were compared with those with normal lipid profile with respective wound healing at the end of 6 months. Patient with hybrid procedure, prior endovascular intervention were excluded from analysis. Results: Among 231 patients analysed the mean age was 66.9 ± 10.29 years. Majority were males - 83.1%. Comorbidities include all 100% were diabetic, 76.62% hypertensive, 46.32% had history ischemic heart disease and 25.54% were chronic kidney disease patient. Wound healing rate was better in patient with normal LP Vs abnormal LP (75% Vs 68.2% ), low/normal LDL Vs high LDL (69.8% Vs 69.2%), normal/high HDL Vs low HDL (76.5% Vs 66%), high TC Vs normal TC (72.7% Vs 69% ), high TG Vs normal TG (70.5% Vs 69.8%) but this observed difference was not statistically significant. Conclusions: This study highlights that wound healing in critical limb ischemia patient with successful infrapopliteal angioplasty, was not significantly affected by abnormal lipid profile.