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   Table of Contents - Current issue
Coverpage
October-December 2018
Volume 5 | Issue 4
Page Nos. 213-302

Online since Tuesday, December 11, 2018

Accessed 5,880 times.

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EDITORIAL  

Evidence-based medicine …… Or is it? Highly accessed article p. 213
Kalkunte R Suresh
DOI:10.4103/ijves.ijves_79_18  
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EXPERT COMMENT Top

Caring for the orphan children of vascular surgery p. 217
Robbie George
DOI:10.4103/ijves.ijves_81_18  
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REVIEW ARTICLES Top

Advances and controversies in the contemporary management of chronic lymphedema p. 219
Monika Lecomte Gloviczki, Peter Gloviczki
DOI:10.4103/ijves.ijves_85_18  
The lymphatic system is essential for normal body function, as its role is to recover fluid passed to the interstitial tissue from capillaries and to carry it back to the systemic circulation. This review presents briefly the magnitude of the problem first and then focuses on recent key advances and controversies in contemporary management. Lymphedema touches millions of individuals and generates considerable financial burden for the healthcare system. This frequently debilitating disease requires lifelong treatments in most of the cases. Lymphedema can be significantly improved with comprehensive management including always decongestive physiotherapy, compression pumps, and garments. Drug therapy and surgical treatment are optional. Surgical interventions can be reconstructive or excisional. Therapeutic strategies often combine several methods and should be adapted to each patient. At all times, the patient's values and quality of life should be considered. Although nonperfect and in majority of cases noncurative, the therapeutic options are available and they are efficient. Future research efforts should bring better solutions and will improve patients' evaluation and management.
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The current overview of pelvic congestion syndrome and pelvic vein reflux Highly accessed article p. 227
Mark S Whiteley
DOI:10.4103/ijves.ijves_82_18  
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Ultrasound assessment of pelvic venous reflux p. 234
Angie M White, Judy M Holdstock
DOI:10.4103/ijves.ijves_84_18  
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Pelvic congestion syndrome: A review of the treatment of symptomatic venous insufficiency in the ovarian and internal iliac veins by catheter-directed embolization p. 244
Previn Diwakar
DOI:10.4103/ijves.ijves_83_18  
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ORIGINAL ARTICLES Top

Sine-wave technique to superficialize a deep arteriovenous fistula and mini review of the techniques to deal with deep-seated arteriovenous fistula p. 253
Pallab Chatterjee, Ajay Kumar Dabas
DOI:10.4103/ijves.ijves_47_18  
Context: Deep-seated arteriovenous fistula (AVF) poses a problem for cannulation. Sine-wave technique is described as a superficialization technique. A mini review of techniques of superficialization is presented. Aims: The aim of the study was to describe a technique of superficialization for deep-seated AVF. Settings and Design: This study was a descriptive study. Subjects and Methods: We describe “Sine-Wave” technique of superficializing the deep-seated AVF for easy cannulation. Statistical Analysis Used: Not applicable. Results: Sine-wave technique is an easily performed technique for superficializing the deep-seated AVF with good result. Conclusions: There are various techniques advocated to overcome the difficult cannulation in deep-seated AVF. However, all have certain potential shortcomings. Sine-wave technique of superficializing a deep-seated AVF easily overcomes these shortcomings.
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Decongestive lymphatic therapy in postfilarial lymphedema: A prospective study p. 259
Amish Jayantilal Gohil, Sreekar Harinatha, A Dheepak Selvaraj, Andrew Babu, P Tyagraj, Ashish Kumar Gupta
DOI:10.4103/ijves.ijves_57_18  
Context: In a filariasis endemic country like India, the need for an effective and consistent treatment for filarial lymphedema has long been recognized. In this study, we set out to evaluate decongestive lymphatic therapy (DLT) for postfilarial lymphedema. Aims: The aims of this study are to determine the efficacy of DLT in the management of postfilarial lymphedema of extremities. Settings and Design: This is one prospective study from April 1, 2010, to March 30, 2011 included twenty patients with the diagnosis of lymphedema of the extremities. After the Institutional Review Board approval, consent was taken. Subjects and Methods: Patients with unilateral postfilarial lymphedema were included in the study. Exclusion Criteria: (1) Other forms of lymphedema, (2) Clinical evidence of local infection, (3) Severe cardiac disease, (4) Uncontrolled hypertension, (5) Malignancy. The clinical profile of the patient was recorded and was noted. Limb circumferences were measured at axial intervals of 10 cm for the entire limb length. Each segment's volume was calculated with the truncated cone formula H × (C2 + Cc + c2)/12 Π, H = height, C = circumference at the top of the cone, c = circumference at the base of the cone. Total limb volume was acquired by adding the segments. Patients were subjected to daily DLT which included manual lymphatic drainage, low-stretch compression bandaging, and skin care and exercises and volume reduction measured. The patients were followed up for 1 year. Statistical Analysis Used: Spearman's rank correlation coefficient, one sample t-test, Mann–Whitney U-test. Results: The mean reduction in the volume of the affected limb was 63.12% with standard deviation of 11.38 and P < 0.001. Long-term therapeutic benefits were maintained through self-massage, self-bandaging, exercise, and consistent use of compressive garments. The average volume of the affected limb at presentation was 10067.45 ml ± 3768.42. After DLT, the average volume was 7860.4 ml ± 2617.36. The average volume after 1-year follow-up was 8109.3 ml ± 2438.4. There was no correlation between the severity of pretreatment limb volume and the extent of reduction after DLT. No complications were seen during the course of the study. Conclusions: DLT is an effective and safe modality for the treatment of lymphedema of the extremities. It has wide applicability, especially in postfilarial lymphedema.
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Manual lymphatic drainage in chronic venous disease: A forgotten weapon in our armory p. 266
Vimalin Samuel, Prabhu Premkumar, Dheepak Selvaraj, Albert Abhinay Kota, Joel Mathew John, Edwin Stephen
DOI:10.4103/ijves.ijves_58_18  
Objectives: The objective of this study is to evaluate the effect of manual lymphatic drainage (MLD) on venous flow and its effect on wound healing in patients with advanced chronic venous insufficiency (CVI). Design: This was a prospective nonrandomized cross-sectional study. Setting: Participants were assessed from a group of patients presenting to a vascular clinic at a tertiary care center, in South India. Participants: Thirty-eight patients with the venous ulcers were enrolled in this study. Intervention: MLD was applied by a certified physical therapist to the lower limb following a standard protocol. The patient and the caregiver were also educated on methods of MLD so as to carry on the treatment in a home-based setting. Main Outcome Measurements: Subjective analysis of symptom relief and ulcer healing were analyzed at 1 week and at 6 months. Results: There was a significant improvement in patient symptoms with respect to ulcer healing and reduction of edema. Conclusions: MLD is an important adjunct in the treatment of advanced CVI.
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Google search: A simple and free tool to detect plagiarism p. 270
Shaikat Mondal, Himel Mondal
DOI:10.4103/ijves.ijves_60_18  
Context: A manuscript should be devoid of plagiarism to get it published in a journal. Hence, checking plagiarism is an essential part of the publication. There are paid and free service providers who help in checking plagiarism of articles. Free service providers allow a user to search limited number of words per day. Aim: The aim of the study was to describe a method of checking plagiarism which is free, and there is no limit on the words that can be searched for plagiarism. Methods: A manuscript can be checked for text plagiarism with the help of Google “exact word or phrase” search. To do this, the user (i.e., author, reviewer, and editor) has to copy the portion of text and search it on Google with the text in quotes. This commands Google to search for the exact words and phrases in exact order. If search results are shown by Google with the exact sentence, it may be copied, unintentionally plagiarized, or a very common sentence. Conclusion: The method of searching plagiarism with the help of Google “exact word or phrase” search can be used by authors, reviewers, and editors to check duplicate content present in the manuscript. However, this method has limitations. It may not be capable of detecting an inadequately paraphrased sentence. Hence, its usage should be adapted with caution.
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CONTINUE MEDICAL EDUCATION Top

How to approach a patient with peripheral arterial disease p. 274
Sritharan Narayanan, Velladuraichi Boologapandian
DOI:10.4103/ijves.ijves_51_18  
Peripheral Arterial Disease (PAD) is defined as chronic atherosclerotic disease of the lower limbs. Patients with lower extremity PAD present with wide spectrum of symptoms ranging from asymptomatic to minor exertoinal leg pain, significant walking impairment and ulceration or gangrene. The first step in decision making for the treatment of PAD is to confirm PAD with history, physical examination and non invasive vascular laboratory tests. Decision making regarding revascularization is based on symptom status and patient comorbidities. Treatment strategies for intermittent claudication is medical management and for critical limb ischemia is revascularization in the form of either endovascular or surgical management to avoid amputation.
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EDITORIAL ANNEXURE Top

How to approach a patient with peripheral arterial disease p. 281
Kalkunte R Suresh
DOI:10.4103/ijves.ijves_78_18  
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HISTORICAL VIGNETTE Top

The beginning of endovascular aortic aneurysm repair p. 283
Sairam Subramanian
DOI:10.4103/ijves.ijves_77_18  
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CASE REPORTS Top

Palpable thoracoabdominal aortic aneurysm through the chest wall: A late and ominous presentation p. 286
Harishankar Ramachandran Nair, Shivanesan Pitchai, Sreekumar Ramachandran
DOI:10.4103/ijves.ijves_35_18  
Thoracoabdominal/thoracic aortic aneurysm is often diagnosed incidentally while evaluating for dyspnea or atypical chest pain of long duration. Late presentation in various forms such as palpable pulsatile swelling in this patient is quite rare and fatal and foreruns impending rupture. We present a 53-year-old female who presented with acute-onset left-sided chest and back pain with swelling on the left side of the chest wall for 2 weeks. She was evaluated with chest X-ray which showed mediastinal widening and computed tomography scan thorax showed a large thoracic aortic aneurysm protruding out through seventh intercostal space onto the chest wall. She underwent open repair of aneurysm and was doing well at 6 months of follow-up. Thoracic aortic aneurysm mandates early diagnosis and prompt treatment as delay in the same leads to fatal rupture. Open surgical repair is the treatment of choice in large aneurysms causing significant compressive symptoms and imminent rupture.
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A rare case of symptomatic true aneurysm of posterior tibial artery p. 289
Devender Singh
DOI:10.4103/ijves.ijves_44_18  
Aneurysms of the infrapopliteal region are uncommon. Of them, true aneurysms are very rare and that of the posterior tibial artery (PTA) are extremely rare. We present a case of a 25-year-old female presented with a pulsatile mass behind the right medial malleolus for 1-year duration. Arterial duplex and angiogram revealed a true saccular aneurysm of the PTA. The aneurysm was resected, and the PTA was reconstructed with a reverse saphenous vein graft.
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Open repair of an abdominal aortic aneurysm in a patient with congenital renal vascular anomalies p. 292
Vineeth Kumar, Shivanesan Pitchai, Sreekumar Ramachandran, Harishankar Ramachandran Nair
DOI:10.4103/ijves.ijves_48_18  
Purpose: The renal vasculature is unique in such a way that each artery behaves as an end artery. The amount of renal damage that can occur by sacrificing these arteries are so unpredictable. The presence of aberrant or accessory renal arteries makes open repair of the abdominal aortic aneurysm (AAA) technically more challenging than conventional surgery. Here, we describe various techniques used to preserve the renal vasculature and prevent renal ischemia during surgery. Methods: We present a case of saccular AAA with low lying right kidney with an aberrant renal artery arising from neck and an accessory renal artery arising from the body of the aneurysm. We performed an open repair of the aneurysm, during which we did inter-renal clamping and renal perfusion with renoplegia solution using Pruitt-Inahara shunt. Conclusions: Interrenal clamping and administration of optimal renoplegia solution through shunt are very useful adjuncts to prevent renal ischemia during open repair of AAA with congenital renal vascular anomalies. Pruitt-Inahara Shunt, classically described in carotid endarterectomy, can be used in AAA surgeries for administering renoplegia.
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Improving pulmonary perfusion in a child with Takayasu's arteritis p. 295
Bhavin L Ram, Robbie K George, Aruna Bhat
DOI:10.4103/ijves.ijves_43_18  
Takayasu's arteritis (TA) is a form of granulomatous arteritis of unknown etiology, which frequently involves pulmonary artery (PA) also. Here, we describe a report of a 14-year-old boy with TA and disabling pulmonary compromise, who was treated by PA angioplasty and stenting. The fact that he showed such a dramatic response to therapy suggests that it might be appropriate to consider improving pulmonary perfusion not only for pulmonary artery hypertension but also for its respiratory benefits.
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Late infection of endovascular aneurysm repair stent graft by Mycobacterium tuberculosis p. 299
Surendran Rajendran, V Balaji, Bhaskar Venkatachalapathy, Ram Gopalakrishnan
DOI:10.4103/ijves.ijves_45_18  
We report a case of infection by Mycobacterium tuberculosis in an endovascular aneurysm repair stent graft placed 4 years earlier for an abdominal aortic aneurysm. Tuberculous infection of aortic stents or grafts is not reported but should be considered in tuberculosis endemic countries in patients with suspected stent infections and negative blood cultures.
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LETTER TO EDITOR Top

Optimal therapy for venous thoracic outlet syndrome p. 302
Yasser Ali Kamal
DOI:10.4103/ijves.ijves_75_18  
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