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REVIEW ARTICLE
A Brief Review of High Altitude Thrombosis
RPS Gambhir, Vembu Anand, Surinder Singh Khatana, VS Bedi
October-Decenber 2014, 1(1):20-23
DOI:10.4103/0972-0820.142362  
Spontaneous vascular thrombosis may occur after a short climb or prolonged stay at high altitude (HA). Both venous and arterial thrombosis has been reported in the literature and cause significant morbidity and mortality. Diagnosis is often difficult; treatment delayed and postthrombotic sequelae disabling. Experimental evidence is limited and trials to prove thrombogenecity of HA are technically challenging to conduct. A greater understanding and awareness of its varied presentations and management is required by all those engaged in treating such patients.
  3 4,187 200
CASE REPORTS
Mycotic Aneurysm of Iliac Artery: A Rare Complication of Salmonella Infection
Sunil Joshi, Nivedita Mitta
October-Decenber 2014, 1(1):26-28
DOI:10.4103/0972-0820.142365  
Mycotic aneurysms as a result of salmonella arteritis are rare in the era of broad spectrum antibiotics. However, few cases have been reported in cases of immunosuppression, presence of cardiovascular prosthetic materials or intravenous drug addiction. Though Salmonella infections cause aortitis and aortic aneurysms in elderly patients with atherosclerosis, it is rare to have common iliac artery aneurysms in young adults. High index of suspicion and aggressive investigation is required to detect these cases as the clinical presentation may be vague. Management of mycotic aneurysms is challenging, requiring emergency surgery. We hereby present a successful management of salmonella mycotic aneurysm of iliac artery in a young adult with no atherosclerotic risk factors.
  2 2,967 80
Long-standing pseudoaneurysm of proximal brachial artery mimicking soft tissue neoplasm
Sayyed Ehtesham Hussain Naqvi, Saifullah Khalid, Mohammed Haneef Beg, Mohammed Azam Haseen, Eram Ali
April-June 2017, 4(2):66-68
DOI:10.4103/ijves.ijves_59_16  
Pseudoaneurysms of brachial artery are rare cause of upper limb mass. Their diagnosis is straightforward in the setting of a rapidly growing pulsatile soft tissue mass with bruit or distal limb ischemia. We hereby present a case of hard nonpulsatile left upper limb soft tissue mass in a 50-year-old female. Mass of 5-year duration was misdiagnosed clinically as soft tissue neoplasm and underwent trucut biopsy. The case came out to be a large pseudoaneurysm of brachial artery and was successfully excised.
  2 1,605 53
LEAD ARTICLE
Global vascular guidelines on the management of chronic limb-threatening ischemia: A brief purview
Kalkunte R Suresh
July-September 2019, 6(3):147-157
DOI:10.4103/ijves.ijves_50_19  
  2 1,748 129
ORIGINAL ARTICLES
Outcome of Ultrasound Guided Foam Sclerotherapy Treatment for Varicose Veins: Procedure is Standard and Need No Further Study
Akhilesh Kumar Maurya, Sanjay Singh, Vikas Sachdeva, Brajendra Nath, Sateesh Chandra Verma, Prashant K Gupta
July-September 2015, 2(3):96-100
DOI:10.4103/0972-0820.166933  
Objective: To study the outcomes of the ultrasound guided foam sclerotherapy (UGFS) treatment for superficial venous insufficiency. Materials and Methods: Selected patients with varicose veins were treated with UGFS using sodium tetradecyl sulfate as sclerosant and followed up to 1-year. Total 148 legs in 123 patients, 98 unilateral limbs, and 25 bilateral limbs were treated by this method. Results: Out of 148 legs saphenofemoral junction (SFJ) incompetence was found in 42 and sapheno-popliteal junction (SPJ) incompetence in 49, perforator's incompetence in 11, while combination of SFJ and perforators and SPJ and perforators in 16 and 7, respectively. Great saphenous vein varicosity was found in 58, short saphenous vein in 56 and others 34. Twenty-four limbs had recurrent varicose veins previously treated by other modalities, and 124 limbs had primary varicose veins. Fifty-two limbs were treated for complicated varicose veins (CEAP 4-6) and 96 limbs for uncomplicated varicose veins (CEAP 2-3). Early outcome was 100% success rate. No recurrences were noted at 1-year follow-up. Early complications were: Superficial skin necrosis in 4 legs (2.70%), pain at injection sites in 21 legs (14.18%), superficial thrombophlebitis in injected vein in 21 legs (14.18%), bruising in 18 legs (12.16%), superficial vein thrombosis in 10 legs (6.75%), and skin staining around injected veins in 13 legs (8.78%). Conclusion: UGFS is a safe, good, and effective treatment modality of treatment for patients with varicose veins and found to be associated with significantly less bruising and pain.
  2 3,583 156
REVIEW ARTICLES
Aortic Surgery for Patients with Connective Tissue Disorders
Michol A Cooper, James H Black
April-June 2015, 2(2):60-65
DOI:10.4103/0972-0820.161943  
Patients with connective tissue disorders have benefitted from refinements in surgical technique and progress in molecular biology research. As many patients with connective tissue disorders now enjoy a longer life expectancy, non aortic root manifestations of their conditions are becoming more commonplace and vascular surgeons are tooled to address them. In this review, we will elucidate the triage and diagnosis of patients with connective tissue disorders and advance practical treatment strategies for these challenging vascular surgery patients.
  2 4,436 97
Vascular malformations: An update on classification, clinical features, and management principles
Sumit R Kapadia, Vijay M Thakore, Hiten M Patel
October-December 2017, 4(4):152-162
DOI:10.4103/ijves.ijves_57_17  
Congenital vascular malformations are one of the most challenging subgroup of diseases treated by vascular surgeons and interventionalists. Currently, there exists a lot of misunderstandings and controversies in terminology, diagnosis, and management of patients with these problems. This review article helps doctors with a concise and current understanding of classification, clinical features, complications as well as diagnostic and therapeutic guidelines.
  2 10,347 1,071
CASE REPORTS
Intramuscular Cavernous Hemangioma of the Triceps Muscle
Anuj Rastogi, Naveen Srivastava, Varun Vijay, Saurabh Agarwal
July-September 2015, 2(3):122-124
DOI:10.4103/0972-0820.166937  
Hemangiomas are one of the commonest benign soft tissue tumors of vascular origin affecting females more than males. Deep soft tissue hemangiomas are uncommon and usually involve skeletal muscles. Intramuscular hemangiomas commonly involve muscles of the lower extremity and rarely the upper extremity. Clinical diagnosis is often missed/delayed as chronic pain and/or swelling are often the only symptoms. We present a case of intramuscular cavernous hemangioma of the triceps muscle in a young male with brief review of literature.
  1 2,607 94
Pulmonary Embolism following Radiofrequency Ablation for Varicose Vein Treated with Thrombolytic Therapy: A Case Report and Review of Literature
Palanisamy Jayakumar, Chairman Saravanan Robinson, Dhevendran Maruthupandian, Rajagopal Ganesh
July-September 2017, 4(3):132-134
DOI:10.4103/ijves.ijves_1_17  
Radiofrequency ablation (RFA) for varicose vein may have life-threatening complications such as deep vein thrombosis and pulmonary embolism (PE). Here, we reported a case report of PE following RFA, which required thrombolysis to save the patient.
  1 2,823 71
Poststab injury subclavian artery pseudoaneurysm excision
Suraj Wasudeo Nagre, KN Bhosle, Ambrish Khatod
January-March 2016, 3(1):31-32
DOI:10.4103/0972-0820.180219  
Poststab injury subclavian artery pseudoaneurysm is a rare entity with great significance because of the risk of complications such as thrombosis, rupture, gangrene, or limb loss. It should be repaired early whenever diagnosed. Our case report has a 24-year-old male patient with a history of stab injury to left supraclavicular region followed by pulsatile swelling after 2 days due to subclavian artery pseudoaneurysm. We excised the pseudoaneurysm with vein patch repair of the subclavian artery.
  1 1,710 53
A Case of Large Carotid Body Tumor: Surgical Challenge
Amitabh Jena, Gajjala Venkata Sivanath Reddy, Vinay Kadiyala, K Brinda, Rashmi Patnayak, Amit Kumar Chowhan
July-September 2016, 3(3):96-98
DOI:10.4103/0972-0820.186726  
Carotid body tumors (CBTs) are rare benign tumors, but they do have a chance of turning into malignant tumors. Hence, the earliest mode of treatment is surgical resection. The high vascularity of the tumors poses a surgical and anesthetic challenge. Hereby, we present a successfully resected case of large CBT measuring 7 cm × 6 cm. In contrast-computed tomography angiogram of the neck, the hyperdense mass was noted in the left carotid space splaying the left internal carotid artery and external carotid artery. Conventional general anesthesia with controlled ventilation technique was used in the resection of this tumor. The final histopathology report was paraganglioma. She had an uneventful perioperative period and was doing well after 18 months of follow-up.
  1 4,690 139
A Traumatic Profunda Femoris Artery Pseudoaneurysm and Literature Review
Navneel Shahi, Jim Zhong, Stephen Bradley, Peter Vowden
October-December 2016, 3(4):142-144
DOI:10.4103/0972-0820.191502  
Profunda femoris artery pseudoaneurysms (PFAPs) have been described as an iatrogenic phenomenon, principally following orthopedic procedures and open or closed trauma to the upper thigh, although remain rare. The diagnosis of PFAPs is challenging and often delayed due to the nonspecific manner of the presentation with clinical features including pain, swelling, and unexplained anemia as demonstrated in this case report of a PFAP following a stab injury to the thigh. The use of computed tomography angiography (CTA) or transcatheter angiography allows for early accurate diagnosis and treatment of vascular complications secondary to trauma, especially when there is concern of vascular injury and possible pseudoaneurysm formation in the clinical context.
  1 1,722 75
CASE SERIES
Posttraumatic Pseudoaneurysms in Hepatic Artery Branches with Endovascular N-Butyl Cyanoacrylate Embolization: Case Series
Bhavik Patel, Murali Krishnaswami, Madan Ramachandran, Francis Gnanaprakasam
April-June 2016, 3(2):62-66
DOI:10.4103/0972-0820.183639  
Posttraumatic pseudoaneurysm of hepatic artery is an uncommon complication. However, when diagnosed, they need early treatment to prevent rupture. Currently, the treatment of choice for hepatic artery pseudoaneurysm is endovascular embolization depending on the location. We present a series of 4 cases of posttraumatic intrahepatic pseudoaneurysm in branches of hepatic artery who were successfully treated with n-butyl cyanoacrylate embolization.
  1 2,177 104
EDITORIAL
People who cause the change will lead … so let us!
Kalkunte R Suresh
April-June 2017, 4(2):35-35
DOI:10.4103/ijves.ijves_18_17  
  1 1,172 81
HISTORICAL VIGNETTE
Alexis Carrel: Father of Vascular Anastomosis and Organ Transplantation
Ajay Savlania
July-September 2017, 4(3):115-117
DOI:10.4103/ijves.ijves_30_17  
  1 2,703 106
IMAGES IN VASCULAR SURGERY
Warfarin - induced Tracheobronchial Calcification
Krishnarpan Chatterjee, Chetana Sen
April-June 2015, 2(2):84-85
DOI:10.4103/0972-0820.161950  
Tracheobronchial calcification can be seen normally in the elderly. Warfarin therapy leads to calcification at an early age. We present a 35-year-old man whose chest X-ray showed prominent calcification.
  1 1,516 50
ORIGINAL ARTICLES
Predictors of Patency Following Fistulography and Percutaneous Interventions in the Treatment of Nonfunctioning Native Vascular Access
Brendan Hermenigildo Dias, Santosh Antony Olakkengil
January-March 2015, 2(1):7-11
DOI:10.4103/0972-0820.152824  
Aim: The aim was to evaluate the various factors predicting patency following fistulography and percutaneous interventions in the management of nonfunctioning native vascular access. Materials and Methods: Retrospective analysis of 61 patients with native arteriovenous fistulae (AVF) who underwent fistulography and percutaneous interventions from January 2010 to December 2013. Mean patient age was 47 (23-78) years. 69% (42 of 61) of the patients were males. 56% (34 of 61) of patients underwent elbow AVF creation, and the remaining were forearm AVFs. Median time from fistula creation to fistulography was 9 months. On fistulography, hemodynamically significant (>50%) stenosis were identified in 93% (57 of 61) of patients. Angioplasty was attempted in 88% (54 of 57) of fistulae. In 14% (8 of 54) of cases, stent was placed. Results: Technical success was achieved in 98% (53 of 54) of fistulae following angioplasty. Clinical success (ability to use the AVF for successful hemodialysis) was noted in 87% (47 of 54) of cases. About 52% (32 of 61) of the fistulae had multiple stenosis. The most common location of stenosis was the venous limb of the fistula (70%). The primary patency rates were 75.4%, 68.9%, and 30% at 3, 6 and 12 months. The secondary patency rates were 100%, 89%, and 70% at 3, 6 and 12 months. The absence of palpable thrill postprocedure was found to be a risk factor for both primary, as well as secondary patency rates. Conclusions: Our results demonstrate that fistulography and percutaneous interventions in the form of angioplasty and stenting are helpful in maintaining the patency of nonfunctioning native vascular access. We found that the most important predictor of fistula patency following percutaneous interventions is the presence of palpable thrill. Our study also showed that stent placement is effective in treating venous stenotic lesions in native arteriovenous fistula hemodialysis patients after unsatisfactory balloon dilatation.
  1 3,337 83
Brachial artery injury management: Case series
Suraj Wasudeo Nagre
January-March 2016, 3(1):7-10
DOI:10.4103/0972-0820.180200  
We performed this retrospective study to analyze our strategies for managing and surgically treating brachial artery injuries. Twenty patients with traumatic brachial artery injuries underwent surgery at our institution, from May 2013 to January 2016. Fifteen patients were male, and five were female (age range, 20-45 years; mean, 30 years). Twelve of the patients had penetrating injuries (two had stab wounds; two had window glass injuries; and eight had industrial accidents); eight had blunt trauma injuries (traffic accidents). Five patients had a peripheral nerve injury. All patients underwent Doppler ultrasonographic examination. The repair involved end-to-end anastomosis for eight injuries, reverse saphenous vein graft interpositional grafts for eight, and primary repair for four. Venous continuity was achieved in 8 of 12 patients who had major venous injuries. Nine of the twenty patients required primary fasciotomy. Follow-up showed that two of the five patients with peripheral nerve injury had apparent disabilities due to nerve injury. There were no deaths. Good results can be achieved in patients with brachial artery injuries by use of careful physical examination, Doppler ultrasonography, and vascular repair and debridement of nonviable tissues. Traumatic neurologic injury addressed expediently with nerve grafting may reduce the subsequent disability.
  1 2,302 85
Deep vein thrombosis: An experience of 25 years from north India
Sayyed Ehtesham Hussain Naqvi, Mohammed Azam Haseen, Mohammed Haneef Beg, Eram Ali, Tamkin Khan
January-March 2016, 3(1):2-6
DOI:10.4103/0972-0820.180199  
Background and Aim: Unfractionated heparin (UFH) or low-molecular-weight heparin is the treatment for established lower limb deep vein thrombosis (DVT). This study was performed to report our experience of treating the same with UFH. Patients and Methods: This was a retrospective analysis of patients with lower limb DVT managed between 1983 and 2014 at Jawaharlal Medical College, Aligarh, India. Results: This analysis included 83 males and 210 females. Mean age of patients was 34.5 ΁ 11.5 years. Most common age group involved in was 20-30 years (33.79%). Most common symptom was limb swelling (90.8%). Most common risk factor was postpartum period. Among postpartum group, primigravida was most commonly involved group. Left limb involvement was found in 195 patients (65.8%). Proximal DVT was present in 215 (73.33%) patients. In proximal patient group, 74.41% presented with more than 90% block while in distal patient group, 66.67% presented with more than 90% block of the venous system. After 3 weeks of treatment, 29.52% and 15.49% were found to have block of proximal and distal deep veins, respectively, which further declined to 1.78% and 3.45% after 6 months of presentation with continued treatment. Six patients died during the course of treatment. Conclusion: Lower limb DVT respond well to UFH, hence should be used for treatment of same with comparable results. DVT can lead to fatal pulmonary embolism and patients should be admitted till target International Normalized Ratio is achieved.
  1 2,988 195
Preceding Coil Embolization for Internal Iliac Artery Aneurysm before Open Repair
Akimasa Morisaki, Mitsuharu Hosono, Masanori Sakaguchi, Toshihiko Shibata
July-September 2016, 3(3):78-82
DOI:10.4103/0972-0820.186717  
Introduction: In the era of endovascular repair, open repair for abdominal aortic aneurysm (AAA) is still needed in the patients who had anatomical difficulties with the endovascular repair. Open repair for internal iliac artery aneurysm (IIAA) is a challenge because of the deep operating field, which is associated with high morbidity. Therefore, we performed preceding coil embolization for IIAA before open repair to control the bleeding from gluteal arteries. Materials and Methods: The present study is a retrospective case series study. Ten patients underwent preceding coil embolization for IIAA before open repair between January 2010 and August 2015. Three patients had two-stage coil embolization for bilateral IIAA. Six patients also had infrarenal AAAs. After preceding coil embolization, open repair consisting of vascular graft replacement with aneurysmectomy and closure of IIAA was undertaken. Results: The mean age was 72.5 ± 10.7 years. There were nine men and one woman. Operative time and intraoperative bleeding were 270 ± 50 min and 817 ± 671 mL, respectively. There was no postoperative mortality. Three patients developed morbidity, which consisted of paralytic ileus, pneumonia, and shower embolization caused by shaggy aorta. No recurrent IIAA, buttock claudication, and intestinal ischemia after the open repair were observed. Conclusion: Preceding coil embolization for IIAA before open repair may be an effective procedure to control the bleeding from gluteal arteries and prevent recurrent IIAA.
  1 2,146 74
An Institutional Experience of Modified Eversion Endarterectomy in the Management of Carotid Artery Stenosis
Kamran Ali Khan, Varinder Singh Bedi, Manikanda Prabhu, Sandeep Agarwal, Ajay Yadav, Ambarish Satwik
July-September 2016, 3(3):83-86
DOI:10.4103/0972-0820.186720  
Background: Carotid endarterectomy (CEA) using eversion technique has been used by vascular surgeons across the world. A simpler technique, modified eversion endarterectomy (MEE) is emerging as a promising option. Advantages are shorter clamping time, less neurological complications, and avoidance of prosthetic patch plasty. Selective shunting can be done whenever required. In the climate of carotid artery stenting versus CEA debate, one would consider this method to reduce the morbidity of CEA. Materials and Methods: This is a retrospective analysis of patients undergoing CEA at a single institution by four vascular surgeons over a period of 2½ years (January 2012–June 2014). Data were collected from computerized medical records and various parameters analyzed. Forty patients underwent MEE during the given period. The majority were symptomatic 34 (85%). Results: One patient (2.5%) required conversion to conventional endarterectomy with patch plasty because of the long length of the plaque. One patient (2.5%) had lateralizing transient ischemic attack (TIA) in the postoperative period. Two patients had hematoma of which one was returned to operating theater for evacuation. Seven patients underwent MEE along with coronary artery bypass grafting with uneventful recovery. Selective shunting was done for four patients (10%) who had a contralateral occlusive disease or poor back bleed from an internal carotid artery (ICA) on table. Average ICA cross-clamping time was 13 min. None of the patients had cerebrovascular accident/TIA in the follow-up period. Conclusions: MEE is a simpler and easier technique to perform with comparable results when compared with other conventional techniques. MEE, in our assumption, will be the technique of choice in the future for open CEA; however, larger studies with longer follow-up are required before final validation of this technique.
  1 1,887 97
Anterior Tibial Artery Pseudoaneurysm-Case Series
Velladuraichi Boologapandian, Amalopavanathan Joseph, Jeyakumar Selvapackiam, Sritharan Narayanan, Ilayakumar Paramasivam
July-September 2017, 4(3):112-114
DOI:10.4103/ijves.ijves_24_17  
Anterior tibial artery (ATA) pseudoaneurysm is a rare condition that occurs following lower extremity orthopedic intervention or after trauma. We report a series of cases of pseudoaneurysm which were treated surgically. The diagnosis was confirmed with computed tomography angiogram. Aneurysmal sac excision with ligation of ATA was performed.
  1 1,572 64
REVIEW ARTICLE
Acute mesenteric ischemia: The what, why, and when?
Edwin Stephen, Ziyab Khan Sarfaraz, Ibrahim Abdelhedy, Khalifa Al Wahaibi
January-March 2016, 3(1):24-28
DOI:10.4103/0972-0820.180211  
Acute mesenteric ischemia (AMI) is a complex clinical problem with a high mortality. The mortality associated with AMI has declined steadily over the last three decades. This is due to higher index of suspicion among clinicians, advances in radiographic diagnostic modalities, aggressive surgical approach, endovascular intervention, nutritional supplementation, and better perioperative care. Early diagnosis and prompt, effective treatment are essential to improve the clinical outcome. This article reviews the etiopathogenesis, clinical features, management, and outcomes of AMI.
  1 7,765 285
REVIEW ARTICLES
Lateral marginal vein: Have we understood its significance?
Edwin Stephen, Albert Abhinay Kota, Sunil Agarwal, Dheepak Selvaraj, Prabhu Premkumar, Sam Ponraj, Vimalin Samuel
April-June 2017, 4(2):43-45
DOI:10.4103/ijves.ijves_14_17  
The lateral marginal vein is one form of truncular venous malformation seen commonly in Klippel–Trenaunay syndrome. It is characterized by avalvulosis and presents with features of chronic venous insufficiency. As there can be associated intravascular thrombosis, there is an increased risk of venous thromboembolism and pulmonary embolism. In children, it can cause vascular bone syndrome. Surgical excision is indicated when possible to prevent complications.
  1 2,836 151
Perioperative vascular events and myocardial injury after noncardiac surgery in vascular surgery: An overview of the current emerging evidence and guidelines
Alben Sigamani
October-December 2017, 4(4):144-151
DOI:10.4103/ijves.ijves_61_17  
Vascular surgery is considered a high-risk noncardiac surgery. It is associated with an increased risk of cardiovascular events in the perioperative period. Preoperative assessment of risk using validated scales such as Revised Cardiac Risk Index, helps informing patients, surgeons, and anesthetists on the potential risk of cardiovascular events. Cardiac biomarkers, such as NT pro-brain natriuretic peptide (pro-BNP)/BNP, improve the sensitivity of these scales, in predicting potential serious perioperative cardiovascular outcomes. It is cost effective and quicker than other invasive or noninvasive procedures, usually done before any vascular surgery. Several interventions have been tested in trials for potentially preventing an event, but none have given good quality evidence for benefit, except the use of statins. Postoperatively, use of drugs to prevent a cardiovascular event has not been as effective as in the nonsurgical setting (aspirin, β-blockers, α2agonists, and angiotensin-converting-enzyme inhibitors/angiotensin receptor blockers). Monitoring of highly sensitive troponins better predicts 30-day mortality in patients undergoing any noncardiac surgery. This event is called myocardial injury after noncardiac surgery (MINS) or in short MINS. Currently, MINS is not detected in over 75% of vascular surgery patients as it is not routinely performed. As per the evidence reviewed in this article and as recommended by the Canadian Cardiovascular Society Guidelines, it is imperative we monitor all patients aged above 45 years undergoing vascular surgery. Even though there is no evidence for an effective intervention of MINS, detections help in better monitoring of the patient and initiating effective secondary prevention treatment, as indicated.
  1 1,582 83
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