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   2018| January-March  | Volume 5 | Issue 1  
    Online since January 31, 2018

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Expert commentary on “asymptomatic carotid stenosis” less is more!
A Ross Naylor
January-March 2018, 5(1):6-8
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Analysis of risk factors and complications in postpartum lower extremity deep vein thrombosis patients at a single center
Piyushkumar Jain, M Vishnu, Vaibhav Lende, Dharmesh Davra, C P S Sravan, Pravin Narkhede, Vivekanand , Sumanthraj , KR Giirija, KR Suresh
January-March 2018, 5(1):22-25
Objective: The objective of this study is to elucidate circumstances surrounding postpartum patients with lower extremity deep vein thrombosis (DVT) including demographics, risk factors, comorbidities, clinical presentation, and outcomes presenting to our tertiary care center. Introduction: Postpartum is a period of increased risk of venous thromboembolism (VTE). Several risk factors such as previous history of VTE, increased maternal age, varicose veins, mode of delivery, and family history of VTE have been suggested, but data supporting these are inconsistent. In this study, we have described circumstances surrounding postpartum lower extremity DVT including demographics, risk factors, comorbidities, and clinical presentation. Materials and Methods: In this retrospective study, all women with lower extremity duplex confirmed DVT during postpartum period, presented at Jain Institute of Vascular Sciences (JIVAS), Bengaluru, from January 2010 to December 2016 were enrolled. Baseline characteristics recorded were age of the patient, index lower extremity involved, segment of the vein involved and comorbidities. Risk factor evaluated were mode of delivery, history of varicose veins, previous history of thrombophilia, VTE, abortions/miscarriages, and tobacco use. Complications and treatments received in the hospital were documented. Results: Postpartum DVT was seen in 42 out of 1276 DVT patients (497 female patients) treated at JIVAS. The average age was 25.57 ± 5.73 years and left side (29 [69.04%]) being more commonly involved. Risk factors associated in patients were anemia 16 (38.09%), postlower segment cesarean section (LSCS) delivery 16 (38.09%) while tobacco use was seen in 2 (4.76%) patients, and varicose vein in 1 (2.38%). There were no patients with history of VTE, abortions, or thrombophilia. None of the patients had symptomatic pulmonary embolism (PE). All patients were treated with low-molecular-weight heparin and bridged to Vitamin K antagonists. Conclusion: The most common risk factors were anemia and post-LSCS delivery. There was no incidence of symptomatic PE or mortality.
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Autologous platelet-rich plasma for treatment of ischemic ulcers in buerger's disease: A pilot study with short-term results
Dhananjaya Sharma, Pawan Agarwal, Sharad Jain, Reena Kothari
January-March 2018, 5(1):14-20
Background: Many treatment modalities are available for the treatment of ischemic ulcers in Buerger's disease (thromboangiitis obliterans [TAO]). Objectives: The objective of the study was to evaluate the efficacy and clinical outcome of autologous platelet-rich plasma (PRP) for the treatment of ischemic ulcers in TAO patients. Methods: This prospective observational study was conducted on selected TAO patients who underwent autologous PRP treatment in surgery department of a teaching hospital in Central India. Diagnosis of TAO was made on clinical grounds and Color Doppler study. Autologous PRP was injected subcutaneously around the area of ulcer on day 0 and then on the 5th and 10th day. Results were noted on day 1, day 5, day 10, and on day 15. Outcome monitored was improvement in pain (using visual analog scale) and healing of ischemic ulcers. Results: All 14 patients were males, chronic smokers, and most of the patients were in the 4th decade of life. All had involvement of lower limbs; one had upper limb ischemia as well. All patients had ischemic ulcers. Pain relief, as measured with visual analog scale score, was good; most of the patients had 50% relief within 24 h of injecting PRP, which persisted/continued to improve on days 5, 10, and 15. Similarly, ulcer healing showed improvement on days 5, 10, and 15. Conclusions: PRP can provide efficient treatment for pain and healing of ischemic ulcers in TAO patients.
  1,902 113 -
Surgical management of acute aortic occlusion: A single-center experience
Duvuru Ram, Hemachandren Munuswamy, Karthik Panchanatheeswaran, Sreevathsa Prasad, Padmanabhan Ramsankar, Bathal Vedagiri Sai Chandran
January-March 2018, 5(1):26-28
Objective: Acute aortic occlusion (AAO) is an uncommon vascular emergency with a high mortality rate of 25%–80%. The management relies heavily on the timely presentation, early recognition, and prompt institution of appropriate treatment to decrease the morbidity and mortality. The objective of this study was to analyze the results of aortic thrombectomy for AAO in our center. Patients and Methods: This retrospective study included ten consecutive patients from November 2014 to July 2015 who presented to the Emergency Department of our hospital with features of AAO. The intraoperative and postoperative data were recorded, and the patients were followed up for 30 months. Results: Of the total of 10 patients, 6 were male. The age range was between 21 and 60 years. Three patients had an identifiable embolic source. The shortest duration of presentation was 12 h while the longest duration was 1 week. Only one patient presented with pain abdomen and vomiting whereas the rest presented with features suggestive of lower-limb ischemia. The mean duration of ischemia and presentation to hospital was 3.33 days in case of embolic etiology while it was 2.64 days in case of thrombotic etiology. We had two postoperative mortalities. Conclusion: AAO though rare has a favorable prognosis irrespective of the duration of presentation depending on the severity of ischemia and end-organ dysfunction at the time of presentation. It also has decreased morbidity and mortality with appropriate and timely treatment. Aortic thrombectomy (infrarenal, suprarenal, or thoracic aorta) is a safe and cost-effective management with less morbidity and mortality.
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Management of vascular injury in counter insurgency area: A single-center study
Vivek Agrawal, Varinder Singh Bedi, Vembu Anand, Mukesh Kumar Garg
January-March 2018, 5(1):29-34
Background: Vascular trauma can threaten both limb as well as life of the patient. Combat-related vascular injuries are different from civilian vascular injuries in terms of epidemiology, mechanism, pathophysiology, and outcome. Combat or military trauma is generally penetrating trauma (high energy weapons). Difficult evacuation and transportation from the battle field complicates the vascular injury and its outcome. Materials and Methods: This is a single-center, prospective, observational study conducted at a service hospital in Jammu and Kashmir. Twenty-five patients with mean age 25.76 years (18–43 years) who underwent vascular intervention for trauma from December 2013 to November 2016 were included. Data pertaining to vascular injury regarding to site of injury, associated injuries, type of vascular repair, outcome, and complications were recorded and analyzed. Results: Five hundred and eighty trauma patients were admitted during the study period with 4.3% of the patients having vascular injury. All the patients were males and most of them were in the second or third decade of life. The mean time interval between the trauma and arrival to the hospital was 7 h. Lower extremity was the most common site of trauma (52%) of the patients followed by upper extremity. In 56% of the patients, vessels were repaired with reverse saphenous vein graft harvested from the uninjured limb. Two patients (8%) had secondary amputation and one patient (4%) died due to sepsis. Conclusion: Expeditious evacuation, quick transfer, early diagnosis and management including advanced endovascular care are essential for the limb salvage and survival of the serving soldiers.
  1,515 114 -
Iatrogenic lower limb ischemia in children with congenital cardiac disease
Bhavin L Ram, S Rajesh, Robbie K George
January-March 2018, 5(1):36-40
Aim: To report our experience of the management of peripheral artery cannulation-induced limb ischemia in neonates, infants, and children (<5 years). Materials and Methods: Children <5 years old with peripheral ischemia who had undergone cardiac surgery or intervention who were referred to the vascular surgery service from March 2013 to June 2014 were included prospectively. All patients were assessed at referral and during follow-up clinically and with arterial duplex imaging. Follow-up included clinical review and arterial duplex at 1 week and clinical follow-up thereafter. Results: Twenty-six children (14 males, 12 females) with a median age of 21 months were assessed. This included three neonates with a median age of 10 days (range 3–26) and 12 infants with a median age of 5.5 months (range 3–11 months). Referral to the vascular service was initiated on the basis of a combination of absent pulses (46.2%), pregangrenous changes (34.6%), and cold limbs (19.2%). Thirteen (50%) patients had limb ischemia postarterial line insertion, while all other patients presented with limb ischemia postarterial sheath insertion. Median duration for limb ischemia postarterial line was 6 days while it was 3 h for sheath. All patients were treated with intravenous heparin infusion, antiplatelet, and supportive care. No patient required any surgical intervention. On mean follow-up of 11 months, no patient had any complication or limb loss or any further progression of pregangrene. Out of 26, five patients (19.2%) died, four due to underlying cardiac disease, and one due to septicemia, which were not directly related to limb ischemia. Conclusion: In our experience, anticoagulation, antiplatelets, and supportive care are very effective in the management of iatrogenic femoral artery-associated ischemia in young children, infants, and neonates.
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Endovascular management of aortic endograft occlusion
Mukesh Kumar Garg, Varinder Singh Bedi, Ajay Yadav, Sandeep Agarwal, Ambarish Satwik
January-March 2018, 5(1):60-62
Endovascular aortic repair is becoming the standard of care for abdominal aortic aneurysm. Despite aorta being a high flow system, there is still a definite risk of endograft occlusion. Management of occluded aortic endograft is highly controversial. Successful endovascular relining in aortic endograft occlusion is a technically demanding and forthcoming secondary intervention, not been studied extensively. We are reporting a case of aortic endograft thrombosis in a morbidly obese, 64-year-old gentleman with multiple comorbidities presenting with lifestyle-limiting claudication. The patient had a history of abdominal aortic aneurysm repair with aorto-uni-iliac device and femorofemoral bypass. The patient was managed by relining of aortic endograft with graft thrombectomy and snorkeling of the left renal artery. Postoperative course was uneventful. After 1 year of follow-up, the patient is free of symptoms with patent endograft. More empirical evidence is yet required to make the standard guidelines for the management of aortic endograft occlusion.
  1,478 43 -
Hemodialysis access in a patient with severe hemophilia: Technical challenges
Murali Manivannan, Amalorpavanathan Joseph, Subrammaniyan S Rathinavel, Elancheralathan Kalyanaraman, PS Balakumar, Ilayakumar Paramasivam, B Velladuraichi, Devarajan Ilangovan, Prathap Kumar Sudalaiyandi, Jayanth Vijayakumar, Krishna Muralidharan
January-March 2018, 5(1):56-59
A case report on the challenges in establishing hemodialysis access for a hemophiliac with factor VIII inhibitors. A 23-year-old male patient, a known case of congenital Hemophilia A for 6 months of age, presented with recurrent hemarthroses, uncontrolled hypertension, and azotemia; on evaluation, he was diagnosed to be suffering from chronic kidney disease. He was on factor VIII supplementation for hemophilia and was recently diagnosed with factor VIII inhibitors as he was becoming refractory to treatment. The hemodialysis access for this patient is technically challenging as the patient has blood dyscrasia. Herein discussing the choices we had in this patient and challenges faced by us in securing the hemodialysis access.
  1,389 44 -
Minimally invasive management of renal artery pseudoaneurysm following robotic nephron-sparing surgery: Report of two cases and review of literature
Shahzad S Bulsara, Govind Prasad, Manjubharath , Vinit Paliwal, Tapish Sahu, Virender Sheorain, Tarun Grover, Rajiv Parakh
January-March 2018, 5(1):44-49
Partial nephrectomy (PN) either done open, laparoscopic, or robotic is associated with the complication of renal artery pseudoaneurysm (RAP), which is rare but can have grave prognosis. Minimally invasive intervention using endovascular techniques can safely treat this problem with minimal morbidity. We present here two cases of RAP following robotic PN. The first case was a 78-year male patient who underwent robotic PN 3 months prior for a 55 mm × 53 mm clear cell carcinoma of the left lower renal pole. On his 3-month follow-up computerized tomography (CT), he was incidentally diagnosed with a 48 mm × 40 mm × 36 mm well-defined pseudoaneurysm with supply from the lower polar accessory renal artery. The second case was a 42-year male patient who had undergone a robotic PN for a 3.5 cm renal mass. On day 24 postsurgery, he developed hematuria and evaluation with renal CT angiography showed two pseudoaneurysms of approximately 8–9 mm each; associated with a hematoma extending from the mid pole of the left kidney to the tail of the pancreas. We managed to successfully embolize the RAPs endovascularly in both the patients; case one with glue and case two with coils. Both patients were discharged on the next day with no side effects, complications, or morbidity. RAP post-PN; though rare, is a dreaded complication that one should be aware of and be able to treat it timely. Knowing how to managing these situations with minimally invasive techniques should be a part of the armamentarium of all endovascular specialists.
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Notre journal Va-T-Il dans la bonne direction?
Kalkunte R Suresh
January-March 2018, 5(1):1-3
  1,326 62 -
Iatrogenic arteriovenous fistula after lumbar disc surgery: Case reports and review of literature
Pranay Pawar, Achintya Sharma, Radhakrishnan Raju, MK Ayyappan
January-March 2018, 5(1):63-65
Iatrogenic arteriovenous fistulas (AVF) after intervertebral disc surgery are rare. The presentation can be varied from potentially fatal to those, which present years after the index surgery with features of, deep vein thrombosis, leg edema, and cardiac failure. The history and physical findings can be indicative of an AVF and the diagnosis is confirmed by computed tomography (CT) CT angiogram (CTA) or digital subtraction angiogram (DSA). Open surgery and endovascular approach can be both used for the treatment of this condition, both with good results, although the endovascular approach is associated with minimal morbidity.
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VSI secretary's report 2017
RC Sreekumar
January-March 2018, 5(1):12-13
  1,284 43 -
President's address- VSICON 2017
T Vidyasagaran
January-March 2018, 5(1):9-11
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Contribution of a vascular surgeon in the era of terrorism and war-related trauma: An Indian perspective
Varinder Singh Bedi
January-March 2018, 5(1):4-5
  1,199 66 -
Endovascular treatment of a complex broad neck bifurcation aneurysm at peripheral center by pconus stent: A new neck bridging device
Rupinder Singh, Kavita Vani, Gaurav Goel, Anshu Mahajan
January-March 2018, 5(1):53-55
Endovascular treatment of wide-necked aneurysms is a challenge in itself, especially, if branches are incorporated in the neck or base of the aneurysm. The problem is greater if the availability of technical resources and expertise is limited. Difficult endovascular treatment options in such cases include the use of double balloon remodeling and bilateral intracranial stents with associated higher complication rates. However, with availability of a new neck bridging device, treatment of such aneurysms is becoming relatively easy. We present a case of the ruptured basilar top aneurysm with incorporated bilateral posterior cerebral artery origins treated with pCONus stent-assisted coiling. We intend to draw the attention of neurointerventionists to newly available neck bridging device which has lower thrombogenicity than stents, require a shorter learning curve, are compatible with routine delivery catheters, can be deployed quickly and can be performed even on a single plane digital subtraction angiography equipment with minimal expertise.
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A real dilemma: Management of multiple mycotic visceral aneurysms revealing severe endocarditis
Zahira Zouizra, Gaël Biaou, Mouhcine El Mardouli, Rachid El Haouati, Drissi Boumzebra
January-March 2018, 5(1):50-52
We present a case of endocarditis, which manifested as an acute-onset of abdominal pain, due to multiple mycotic visceral aneurysms in a 31-year-old man. We initially thought that the pain had a surgical visceral aetiology. However, following a computed tomography scan of the abdomen, he was subsequently found, to have multiple mycotic visceral aneurysms including: two aneurysms in two branches of the superior mesenteric artery; two mycotic aneurysms in the left renal artery associated with bilateral renal and splenic infarcts. Further investigations confirmed that the symptoms were related to mutilated mitral and aortic valves with a high risk of embolization. Our case highlights the surgical priority between repairing the life-threatening multiple aneurysms and the mitral and aortic valves that caused an endocarditis. First, we repaired the mycotic aneurysms by ligation and/or excision. This was then followed by replacement of the aortic and mitral valves. The patient recovered remarkably well.
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Expert comments on “autologous platelet-rich plasma for treatment of ischemic ulcers in buerger's disease”
Yiewfah Fong
January-March 2018, 5(1):20-21
  1,062 59 -
Charles Dotter M.D.
Ambarish Satwik
January-March 2018, 5(1):42-43
  1,039 39 -
VSICON 2017 prize paper abstracts

January-March 2018, 5(1):67-71
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Expert comments on “Iatrogenic lower limb ischaemia in children with congenital cardiac disease”
George Hamilton
January-March 2018, 5(1):40-41
  885 43 -
Expert comments on “management of vascular injury in counter insurgency area: A single center study”
W Darrin Clouse
January-March 2018, 5(1):34-35
  888 35 -
Expert comments on “iatrogenic arteriovenous fistula after lumbar disc surgery: Case reports and review of literature”
Ambarish Satwik
January-March 2018, 5(1):65-66
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