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A rare complication after blood donation: Brachial artery pseudoaneurysm
Lokesh Shekher Jaiswal, Tanveer Khan, Narendra Pandit
July-September 2018, 5(3):201-202
Pseudoaneurysm of brachial artery following whole blood donation is a very rare complication due to inadvertent arterial puncture. There are only a few cases reported in literature. Here, we describe this rare event in a young male whole blood donor presenting 2 months after blood donation with pulsatile swelling in the right antecubital fossa and paresthesia of hand. He was successfully managed with surgical intervention.
  13,946 71 1
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
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.
  12,584 1,232 4
Antithrombotics in Vascular Surgery: Current Practice Guidelines
Amila Weerasekera, Raghvinder Pal Singh Gambhir
July-September 2017, 4(3):85-91
Pre- or post-intervention, vascular surgical patients are expected to be on one or more antithrombotic agents. Antithrombotics have played a key role in reducing cardiovascular mortality in vascular patients. There are wide variations in the practice of prescribing antithrombotic agents in vascular services. Evidence-based current practice guidelines are often not strictly followed which puts some of these patients at increased risk of bleeding complications. This paper looks at the current practice guidelines on antithrombotics.
  11,058 402 -
Intravenous infusion of prostaglandin E1 therapy in extremity ischemia
Pinjala Ramakrishna
April-June 2017, 4(2):38-42
Prostaglandins are potent vasoactive agents with wide variety of other actions - vasodilatation, fibrinolysis and inhibition of platelet aggregation. PGE1 was the agent used since 1973 for cardiovascular diseases, mainly in patients with advanced PVD. PGE1 intra venous infusion has shown to be beneficial in limb threatening ischemia, especially when reconstructive procedures are not feasible and also as an adjunct when there is residual ischemia after revascularization. The review of literature and the use of PGE1 in CLI is presented here along with our experience in NIMS.
  10,382 462 -
How to choose title and keywords for manuscript according to medical subject headings
Himel Mondal, Shaikat Mondal, Sarika Mondal
July-September 2018, 5(3):141-144
Background: Title and keywords are the two most important parts of a manuscript. The words or phrases used in the title or keywords should be selected wisely for a wider dissemination of the article. Medical Subject Headings (MeSH) terms are used to index article in MEDLINE/PubMed. Hence, choosing the title and keywords according to MeSH would be a better choice for authors. Aim: The aim of this article was to provide a technical guide for selecting words and phrases for title and keywords of an article according to MeSH terms. Methods: The most frequently used words in a manuscript can be identified by the help of word cloud technique. We showed an example of making a word cloud from the text of a manuscript. The method of searching MeSH terms in a manuscript text was shown with an example. Writing title and keywords with amalgamation of these two methods was described. Conclusion: This tutorial showed the use of two freely available tools on the World Wide Web (word cloud and MeSH on demand) for choosing title and keywords for a manuscript. This brief description would help authors in wider dissemination of research knowledge to the targeted audience.
  10,289 406 1
The current overview of pelvic congestion syndrome and pelvic vein reflux
Mark S Whiteley
October-December 2018, 5(4):227-233
  9,372 217 -
Prediction of saphenofemoral junction incompetence by measurement of great saphenous vein size at the level of femoral condyle
Robin Man Karmacharya, Bibushan Kalu Shrestha, Bikesh Shrestha
April-June 2018, 5(2):92-94
Introduction: Doppler ultrasonography (USG) is the primary modality for diagnosis of superficial venous reflux caused by incompetence of venous valves of the great saphenous vein (GSV) and usually associated with competence of saphenofemoral junction (SFJ). This study is done to know the cutoff value in size of GSV that safely predicts this junction incompetence. Methods: All varicose vein patients during the study period of January–December 2016 were included in the study. The cases underwent Doppler USG of GSV using Siemens Acuson P500 to identify GSV. The diameter of GSV was measured at the level of femoral condyle in standing position and these were compared with SFJ incompetence. Contralateral limbs which were apparently normal were taken as control limbs if there is no evidence of reflux in SFJ. Results: There were 147 patients with 16 cases (9.81%) where bilateral limb was involved making total cases as 163 limbs and controls as 131 limbs. The mean GSV diameter in disease group was 6.05 mm and in control group was 3.19 mm with P < 0.05. Receiver operating characteristic (ROC) curve of size of GSV at the level of knee and prediction of SFJ incompetence had the ideal curve depicting use of some cutoff value. The point with both best sensitivity and specificity lied on 4.95 mm with sensitivity of 82% and specificity of 83%. Conclusion: We recommend 5 mm as the cutoff value for diameter of GSV at the level of femoral condyle which successfully predicts SFJ incompetence.
  8,942 171 -
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
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.
  8,406 300 1
Risk Factors and Saphenofemoral Junction in Varicose Veins
Kshitij Manerikar, Arjinder Pal Singh Bawa, Abhilash Kumar Pithwa, Gurjit Singh, Harshwardhan Shrotri, Somnath Gooptu
October-December 2015, 2(4):134-138
Introduction: Varicose veins (VVs) are dilated, tortuous, subcutaneous veins. It is common condition causing substantial morbidity. Prevalence of VVs ranges between 5% and 30% in the adult population. Surgery is one of the common modality of its treatment. A complete knowledge about anatomical variation at saphenofemoral junction (SFJ) and variations in tributaries of great saphenous vein (GSV) is important while dealing with such patients effectively. It will help in reducing chances of recurrences and complications. Methods: A prospective non-randomized study of fifty patients was carried out in our hospital between May 2014 and May 2015. Diagnosis was established by clinical examination and supplemented with venous duplex ultrasound study. Patients were subjected to trendelenburg's operation, stripping of GSV with hook phlebectomy of affected perforators. Results: A total of fifty patients were studied in this study, in which tobacco chewing was the most common associated risk factor with primary VVs, and it was observed in 46% of patients. Amongst them, twenty patients were obese with body mass index of more than 25 kg/m 2 . Location of SFJ was a mean of 2.24 ± 0.55 cm inferior and 3.77 ± 0.61 cm lateral to the pubic tubercle on duplex ultrasound and 2.35 ± 0.42 cm inferior and 3.73 ± 0.58 cm lateral intraoperatively, both of which had nonsignificant P value. The number of tributaries varied from 2 to 6 at the first 5 cm from SFJ. There were two and six tributaries in one patient each whereas three tributaries were observed in 42% patients. The most frequent consistent branch was a superficial inferior epigastric vein, seen in 98% of patients. The least frequent branch was posterior accessory saphenous vein, seen only in 2% of patients. The external pudendal artery was crossing SFJ anteriorly in 38% and posteriorly in 56%, and it was not identified in remaining 4% patients. Conclusion: Our study showed the nonsignificant difference in Duplex ultrasound and intraoperative finding of SFJ location with respect to pubic tubercle; hence, one can plan a precise incision with the help of duplex ultrasound marking preoperatively. One must look for all tributaries for ligation which will prevent recurrence of varicose vein as variation in numbers and location of tributaries was remarkable in our study.
  6,822 108 -
Nontraumatic acute limb ischemia – presentation, evaluation, and management
Bhavin L Ram, Robbie K George
October-December 2017, 4(4):192-197
Nontraumatic acute limb ischemia (ALI) may cause significant morbidity and death if not addressed in time and need to be promptly recognized and treated. Perfusion should be thoroughly assessed using available multiple methods, and patients should be considered for revascularization (endovascular or open surgery) to restore blood perfusion as soon as possible. Underlying conditions, which caused ALI, need to be assessed and treated accordingly.
  5,921 313 -
How I Do it: Fenestrated Endovascular Aneurysm Repair?
SR Vallabhaneni
October-Decenber 2014, 1(1):16-19
A proportion of abdominal aortic aneurysms is anatomically unsuitable for endovascular repair using standard stent-grafts, due to the absence of an adequate infrarenal neck. Fenestrated endovascular repair has been developed for use in such patients and has become well-established over the last decade. This article aims to provide an overview of the principles and technique of implanting a fenestrated endovascular aneurysm repair.
  5,549 111 -
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
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.
  5,341 149 2
Ultrasound assessment of pelvic venous reflux
Angie M White, Judy M Holdstock
October-December 2018, 5(4):234-243
  5,189 170 1
Descending Thoracic Aorto-bifemoral Bypass for Aortoiliac Occlusive Disease
Anil Sharma, Mohit Sharma, Sunil Dixit, Neeraj Sharma, Omeshwar Sharma
January-March 2015, 2(1):12-15
Introduction: Complete obstruction of the abdominal aorta at the renal artery level is a difficult surgical problem. Methods: From August 2010 to January 2014, descending thoracic aorta to femoral artery bypass grafting was used to re-vascularize the lower limbs of the patients in our center. We analysedd our results Results: Primary indication was lack of a suitable site for aortic clamping. Average duration of surgery was 2.5-4.5 h, and blood loss was 100-400 mL. We use BARD®, IMPRA® expanded polytetrafluoroethylene vascular graft for thoraco-bifemoral bypass surgery. There was one mortality due to myocardial infarction. Major morbidities were graft occlusion in one patient that was managed by embolectomy and ascites in another patient, managed conservatively. Conclusion: Thoracic aorta to femoral artery bypass is a simple extra anatomic bypass technique, which can be used in case of difficulty to use abdominal aorta for lower limb re-vascularization.
  5,172 173 -
Aortic Surgery for Patients with Connective Tissue Disorders
Michol A Cooper, James H Black
April-June 2015, 2(2):60-65
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.
  5,080 102 2
A Brief Review of High Altitude Thrombosis
RPS Gambhir, Vembu Anand, Surinder Singh Khatana, VS Bedi
October-Decenber 2014, 1(1):20-23
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.
  4,794 221 4
Brachiocephalic Arteriovenous Fistula through the Median Antecubital Vein for Hemodialysis
Elamaran Elamurugan, R Hemachandar
April-June 2016, 3(2):49-52
Purpose: An option for patients who are unsuitable for radiocephalic fistula is brachiocephalic (BC) fistula. In such patients, we exploited the venous interconnections in the cubital fossa for median antecubital vein (MAV)-BC arteriovenous fistula (AVF) creation. In this article, we describe our experience in the creation of such technical variant of the BC fistula AVF, its success, and associated complications. Materials and Methods: A retrospective review of such AVF created between September 2014 and August 2015 was done. The data collected included demographics, comorbidities, basic disease, operative details, patency, complications, and mortality. Results: A total of 68 vascular access surgeries were done which included 26 (38.2%) BC AVF using the MAV. The mean cephalic vein diameter and mean flow rate were 7.18 mm and 1415 ml/min, respectively, 2 months after fistula creation. The primary and secondary failure rates were 3.87% and 7.69%, respectively. Complications included aneurysm (7.69%), edema (19.23%), hematoma (11.53%), and wound infection (2.5%). Conclusion: Using reverse flow in the MAV is a safe and simple way to perform BC AVF before brachiobasilic AVF and grafts.
  4,772 127 -
Management for Carotid Body Tumors: A Single Center Experience
Devender Singh, R Jaydip, Rajani
October-Decenber 2014, 1(1):8-11
Introduction: The carotid body tumor is a rare neoplasm that has generated much literature over the last century, and for which continued controversy exists regarding natural history, biologic behavior, proper technique of excision, and the risk of morbidity and mortality. Methods: The present study reviewed a 7-year experience of managing carotid body paraganglioma between 2007 and 2013. There were 10 consecutive patients aged between 18 and 50 years, and median follow-up was 5-year. Preoperative information was derived from spiral computed tomography (CT) scanning, magnetic resonance imaging, color Doppler imaging (CDI), and four-vessel digital subtraction arteriography. Results: In five patients, the tumor excision was attempted before they were referred to our tertiary care hospital. Two patients had bilateral tumors. Four patients had preoperative embolization, and blood loss was minimal, and excision was relatively easier in them. There was difficulty in deglutition (nasal and laryngeal regurgitation) in three patients with large tumors. Conclusion: Surgical planning and prediction of peri-operative complications can be obtained by digital subtraction angiography, spiral CT angiography, and CDI. The peri-operative blood loss can be reduced by preoperative embolisation.
  4,695 137 -
Applicability of wells' criteria for diagnosis of deep vein thrombosis in lower extremities at Dhulikhel hospital, Kathmandu university hospital
Robin Man Karmacharya, Hemanta Batajoo, Yagya Ratna Shakya, Sumita Pradhan
October-December 2017, 4(4):173-175
Introduction: Deep vein thrombosis (DVT) is the presence of thrombus in deep venous system, commonly encountered in lower extremities. P. S. Wells was one of the pioneers to diagnose DVT without relying on imaging methods and using the clinical criteria for patient management. Methods: All the patients with clinical suspicion of DVT in lower extremities (new onset edema, pain) visiting the Outpatient Department or Emergency Department of Dhulikhel Hospital between September 2012 and August 2016 were included in the study. The patients were asked/examined for knowing all the points in Wells' criteria. Confirmation of the diagnosis was done by color Doppler ultrasonography on the same day by a radiologist. The patients were categorized into three groups as ≥3 as high probability, 1–2 as moderate probability, and <0 as low probability. Results: There were 68 patients with a history suggestive of DVT. Doppler ultrasonography being considered as gold standard for diagnosis confirmed 65 cases as DVT (95.6%) on the 1st day and remaining 3 cases were confirmed on the 3rd day in repeat Doppler ultrasonography. Mean age was 55.5 years (range: 34–75, standard deviation [SD] 11.3 years). Mean days of history was 3 days (range 1–10 days, SD 2.2 days). Pitting edema was present in 95.6% of cases which was the most common clinical characteristic in patients with DVT. This was followed by swelling of entire leg (67.6%), followed by localized tenderness along the distribution of deep venous system (64.7%). In 51 cases (75%), Wells' score was ≥3 (high probability), while in 14 cases (20.6), it was 1–2 (moderate probability) and in 3 cases (4.4%) it was <0 (low probability). In terms of positive Wells' score (≥2), there were 55 cases (80.9%). Conclusion: Wells' scoring can be used for diagnosis of DVT in lower extremities, but for further accuracy, it needs to be reconfirmed by Doppler ultrasonography.
  4,688 103 -
A Brief Review of Deep Vein Thrombosis in Pediatric Patients
Abhijit S Nair, Subodh Kamtikar
July-September 2015, 2(3):101-104
Deep vein thrombosis (DVT) that develops in a hospitalized pediatric patient can has serious consequences. Prophylactic strategies with unfractionated or low molecular weight is not practised in children like it is practised by clinicians in adults. It is important to identify high-risk pediatric patient who has risk factors for developing DVT, so as to prevent in-hospital morbidity, mortality and increased hospital stay.
  4,399 277 -
Carotid Body Tumors: Surgical Management and Review of Patients Over 10 Years
Gulam Nabi Lone, Adil Pervaiz Shah, Perveez Ahmad Malik, Seth Mujtaba Hussain, Ghulam Mohammad Wani
July-September 2016, 3(3):90-95
Background: Carotid body tumours (CBTs) are rare but highly vascular neoplasms originating in the paraganglionic cells of the carotid bifurcation. Exact etiology of these tumors is not known. Male and female distributions are equal except at high altitude where females appear to predominate. Diagnosis of a chemodectoma usually begins with a color flow duplex scan. Magnetic resonance angiography are also useful, especially to evaluate bilateral disease. Conventional Arteriography with CT Angiography are valuable, especially in larger tumours, and are regarded as the best tools for diagnosis. The treatment of choice for carotid body tumours is surgical removal. Shamblin's classification system is used to categorize carotid body tumours based on their size and the difficulty of surgical resection. Results: It was observed that majority of the patients in this study were females numbering 35(79.45%) whereas there were 9 (20.43%) males. commonest age group involved was of patients 50 to 59 years of age. Surgery was done in all 44 (100%) patients with complete resection in 41 (93.07%) and incomplete in 3 (6.81%) patients. 10 (23%) were Shamblin grade 1, 29 (66%) grade 2 and 5 (11%) grade 3. ECA repair was done in 4 (9.08%) of patients, ICA repair in 2 (4.54%), ECA ligation in 2 (4.54%) and vascular graft was used in 1 (2.27%) of patients. 7 (15.89%) had transient cranial nerve palsy most commonly involving hypoglossal nerve. 3 (6.81%) had permanent cranial nerve palsy. In 6 (13.62%) patients there was local wound infection .There was post op stroke in 2 (4.54%) of patients. No operative mortality was seen.43 (97.61%) patients were proved to be paraganglionomas on HPE while 1 (2.27%) patients had inconclusive biopsy on Histopathological examination. Conclusion: Although rare, Carotid body tumor is still a pathology that we encounter in our experience and it should be kept in mind as a differential diagnosis for painless lateral neck masses.
  4,398 180 -
History of Aortic Surgery in India
Himanshu Verma, Kumud Rai, S Rao Vallabhaneni, Ramesh Tripathi
July-September 2015, 2(3):105-111
  4,408 150 -
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
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.
  3,982 167 2
Management of klippel-trenaunay syndrome from a single center in India: Experience shared
Prabhu Premkumar, Edwin Stephen, Joel Mathew John, Albert Abhinay Kota, Vimalin Samuel, Dheepak Selvaraj, Sunil Agarwal
July-September 2018, 5(3):149-153
India with a population of about 1.3 billion and diverse cultures holds within its large land mass an encyclopedia of medical cases, several un/underdiagnosed. Klippel-Trenaunay syndrome (KTS) is one such condition. Over the years, as the understanding of our team increased about the condition, we were able to share the same with our colleagues across the institution and publish the brief article. This resulted in an increased referral pattern from within the institution and across the country. At our institution, we managed 127 cases of KTS between October 2009 and December 2017. In this article, we share our experience about managing the cases, lessons learnt, and the challenges we face.
  4,001 139 2
Management of Vascular Trauma: A Single Center Experience
Dheeraj Sharma, Gaurav Goyal, Abhinav Singh, Anula Sisodia, Sanjeev Devgarha, Rajendra Mohan Mathur
October-Decenber 2014, 1(1):3-7
Introduction: This was a retrospective study of the experience with extremity vascular trauma at a tertiary level referral center in North India. The objective of this study was to analyze the cause of injury, surgical approach, outcome, and complications in patients with vascular trauma operated from 2003 to 2013. Materials and Methods: A retrospective analysis of records of patients who were operated for peripheral vascular injuries in the last 10 years (November 2003 to November 2013) was done. Diagnosis was made by physical examination and hand Doppler alone or in combination with computed tomography angiography. There were 3948 patients; primary vascular repair was carried out where possible; if not possible an interposition vein graft was placed. Patients with isolated venous trauma or unsalvageable lower extremity injury requiring primary amputation were excluded from the study. Results: Of 3948 patients, 3347 were male (84.78%), and 601 were females (15.22%); their ages range was 5-80 years. Mean duration of the presentation was 11 h after the injury. Road traffic accidents were the most common cause of injury: 67% in those with penetrating trauma and 58% in those with blunt trauma. The incidence of concomitant orthopedic injuries was very high in our patients (73.6%). The most common injured artery was the brachial artery (36.4%), followed by the popliteal (30.4%) and femoral artery (21.7%). Primary repair was performed in 58.3%, interposition vein grafts in 41.4%. Majority of patients had a good outcome-78% had functional, viable limbs. About 13% had a nonfunctional, but viable limb; the secondary amputation rate was 9%. Conclusion: Early diagnosis and treatment of vascular injuries is crucial for saving the patient's limb and life. Our study is the largest study from a single center in India/South West Asia: Increased awareness is required to ensure that patients identified to have a vascular injury are transferred to a specialist vascular surgery center at the earliest. Vascular injuries require immediate localization and surgical intervention. Prompt and decisive management maximizes patient survival and limb salvage- and as we demonstrate, this is possible even in patients with delayed presentation or when early ischemic changes are present. Protocols must be established in the management of associated injuries to avoid delay.
  3,828 199 -