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   2018| April-June  | Volume 5 | Issue 2  
    Online since May 3, 2018

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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.
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The correlation of the society for vascular surgery wound, ischemia, and foot infection threatened limb classification with amputation risk and major clinical outcomes
Jessica M Mayor, Joseph L Mills
April-June 2018, 5(2):83-86
The Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) threatened limb classification more comprehensively describes the extent of limb threat in patients with chronic limb-threatening ischemia than many previous classification systems. Several centers have published 1-year amputation rates stratified by WIfI clinical stage. Stage 1 limbs have the lowest amputation risk, Stage 4 limbs have the highest, and Stages 2 and 3 have an intermediate risk. As WIfI clinical stage increases, wound healing time is longer, 1-year wound healing rate is lower, and reintervention rate, hospital costs, length of stay, and readmission rate all increase.
  3,682 198 -
Art of crafting a scientific paper for IJVES
Kalkunte R Suresh
April-June 2018, 5(2):75-82
  3,299 129 -
Acute limb ischemia secondary to popliteal artery thrombosis following total knee arthroplasty – Limb salvage by endovascular therapy
Iragavarapu Tammi Raju
April-June 2018, 5(2):115-118
Popliteal artery thrombosis is a very rare complication in total knee arthroplasty (TKA) surgery, which is more commonly caused by indirect mechanism than direct mechanism. If not treated early, it leads to limb amputation and rarely may lead to mortality. Although bypass grafting is the mainstay of treatment done in many cases, endovascular therapy is a potential alternative in acute setting for limb salvage. There are only few case reports of endovascular therapy in this setting. We report a case of acute limb ischemia due to popliteal artery thrombosis immediately after TKA which is salvaged by endovascular therapy with endoluminal thrombosuction and balloon inflation only.
  2,940 93 -
The predictive accuracy of the american college of surgeons national surgical quality improvement program surgical risk calculator in patients undergoing major vascular surgery
Alison McGill, Nigel Pinto, Jason Jenkins, Danella Favot, Murray Ogg, Nicholas Boyne, Simon Quinn, Allan Kruger, Sophie E Rowbotham
April-June 2018, 5(2):95-99
Aim: The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) Surgical Risk Calculator (SRC) was developed to estimate the rates of complications for patients undergoing a variety of surgical procedures, based on the patient's preoperative demographics and medical conditions. Its predictive ability has been evaluated in a number of studies for a variety of surgical fields. There has so far been no assessment of the SRC in patients undergoing vascular surgery. This study assesses whether the ACS NSQIP SRC can accurately predict risk of complications in patients undergoing major vascular surgery at a tertiary hospital. Methods: A retrospective review of prospectively collected data was performed on all patients who underwent an open abdominal aortic aneurysm (AAA) repair, an endovascular aneurysm repair (EVAR), or a femoral-popliteal bypass graft (FPBG) from July 2016 to April 2017. A total of 95 patients had their demographics entered into the ACS NSQIP SRC, and the predicted rates of complications were compared to the observed rates of complications. Results: Statistical analysis was performed with Brier scores and C-statistics. This analysis found the ACS NSQIP SRC accurately estimated the risk of complications with a Brier score of 0.044 for EVAR, 0.068 for open AAA repair, and 0.0752 for FPBG. The C-statistics for serious complications, any complications, and discharge to a nursing home or rehabilitation indicated the model was good at accurately predicting the risk of these outcomes. Conclusion: The ACS NSQIP SRC accurately predicts the rates of complications in patients undergoing vascular surgery.
  2,741 77 -
Outcomes of basilic vein transposition at 1 year of follow-up
Mukesh Kumar Garg, Dhruv Agarwal, Ambarish Satwik, Ajay Yadav, Sandeep Agarwal, Varinder Singh Bedi
April-June 2018, 5(2):87-91
Background: In dialysis-dependent end-stage renal disease patients, arteriovenous access (AV access) is the chief mode of hemodialysis access. Basilic vein transposition (BVT) is an alternative in patient with failed multiple AV access. The aim of the study is to assess the outcomes of BVT at 1 year of follow-up. Materials and Methods: This prospective, nonrandomized, observational study was conducted in the Department of Vascular Surgery at Sir Ganga Ram Hospital, New Delhi. Forty consenting patients with end-stage renal failure on maintenance hemodialysis having no other options utilizing superficial veins of the upper limb for AV access formation were included. All the complications, secondary interventions and patency rates were calculated at 1 year of follow-up. Statistical analysis was performed using Chi-square test, and patency rates were assessed using Kaplan–Meier survival curve. Results: Most of the patients were in the age group of 51–70 year with the mean age of 51.98 year. The mean basilic vein diameter was 2.84 mm. Fistula thrombosis was the most common complication and was seen in 17.5% cases followed by limb edema in 13% of cases. Re-interventions (fistula thrombectomy, balloon angioplasty etc.) were performed in 27.5% of the patients. The primary patency rate and secondary patency rate at 1 year of follow-up were 77.5% and 85%, respectively. Conclusions: BVT is a feasible and suitable surgical option to provide a durable and autogenous AV access to end-stage renal disease patients requiring maintenance hemodialysis.
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Management and outcomes of patients with chronic upper limb ischemia secondary to arterial thoracic outlet syndrome
Sandeep Mahapatra, Pinjala Ramakrishna, Muneer Ahmad Para, Venugopal Mustyala, Praveen Kumar Nookala
April-June 2018, 5(2):100-104
Introduction: Post stenotic dilation of the subclavian artery by cervical rib compression is generally seen in young patients with upper limb ischemia. Materials and Methods: We conducted a retrospective study on 26 consecutive patients who underwent surgical decompression for arterial thoracic outlet syndrome (aTOS) with subclavian artery repair from 2010 to 2015. Supraclavicular decompression of the thoracic outlet with cervical rib excission, scalenectomy with subclavian artery reconstruction by aneurysmorrhaphy was performed as per Scher staging of aTOS. The management and post operative outcome with regards to objective changes in the upper limb arterial pressure was studied & followed for 1 year with clinical examination, duplex scan and non invasive segmental vascular pressure. Result: The average age at presentation was 32 years, with equal gender distribution. However, symptomatic right: left aTOS at presentation was 18:8. The Scher classification system for aTOS based on subclavian artery compression identified 14 patients in stage III, 10 patients in stage II and 2 in stage I .8 out of 26 patients had digital ischemia with minor tissue loss and were managed medically by intravenous Alprostadil (Prostaglandin E1) postoperatively for 6 months .The mean above elbow pressure (AEP) before surgery has improved from 62.08±12.97 to 108.46±16.81& the below elbow pressure (BEP) has improved from 48.00±13.13 to 93.46± 32.02 . Above elbow pressure improvement is found statistically significant (p value0.037) across all Scher stages. Complete relief of vascular symptoms was seen in all patients immediately or gradually over a period of 6 months. Minor amputation was carried out in 8 patients of Scher stage 2 & 3 aTOS during follow of 6 months. Conclusion: This study finds its uniqueness in demonstrating the objective improvement of pressure with respect to different Scher stages which which is not reported in the literature.
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Complex vascular injury in a case of multiple gunshot wounds in a combat zone
Vivek Agrawal, Dhananjay Singh, Sandeep Mehrotra, Varinder Bedi
April-June 2018, 5(2):123-125
Abdominal vascular injuries are the most common cause of early death after penetrating abdominal trauma if especially associated with a chest injury and fracture of long bones. The surgical exposure and associated intraabdominal injuries may challenge the skills and judgment of even the most experienced surgeons. Rapid transportation to a trauma center, early recognition of injuries, damage control resuscitation, and early surgical intervention are critical for patient's survival.
  2,516 75 -
Collateral arterial circulation of the leg in postcatheterization iliofemoral occlusion
Vitaliy F Petrov
April-June 2018, 5(2):120-122
Seldinger's femoral puncture is a routine approach for endovascular interventions in children. It is a safe method, albeit the procedure may be complicated by iliofemoral occlusion sometimes. We report a case of a chronic postcatheterization iliofemoral occlusion and discuss patterns of arterial collateral circulation of the leg in an asymptomatic teenager.
  2,010 83 -
Intimal sarcoma of the popliteal artery presenting as popliteal artery aneurysm: A rare case report
Mukesh Kumar Garg, Ambarish Satwik, Ajay Yadav, Sandeep Agarwal, Varinder S Bedi
April-June 2018, 5(2):111-114
Intimal sarcoma is a highly aggressive and rare malignant tumor of the vascular system. We are reporting this unusual primary tumor of popliteal artery presenting as aneurysm in an infant. We report a case of an 8-month-old girl with the incidental observation of nontender and pulsatile swelling in the right popliteal fossa. An arterial duplex scan and computed tomography angiography revealed an intensely enhancing well-defined lesion (3.2 cm × 2.4 cm) of the popliteal artery suggestive of pseudoaneurysm/aneurysm. The patient underwent exploration of the popliteal artery with excision of aneurysmal sac. On histopathological examination and immunohistochemical staining, findings were suggestive of intimal sarcoma. Postoperative recovery was uneventful. At 1-year of follow-up, patient is clinically stable with no disability and any signs of recurrence or metastasis. Malignancy in peripheral arterial aneurysmal is extremely rare. More empirical evidence is yet required to make the diagnostic and therapeutic protocol to deal with this aggressive tumor of the vascular system.
  1,986 64 -
Targeted tumescent liposuction for fistula superficialization
Nitin Abrol, Santosh A Olakkengil, Shantanu Bhattacharjya
April-June 2018, 5(2):132-133
Obesity poses problem with the cannulation of arteriovenous fistula and difficulty in establishing functional autogenous access for hemodialysis. We describe a case where we used targeted tumescent liposuction to remove subcutaneous fat over the fistula.
  1,938 59 -
Management of infected brachial-axillary prosthesis for hemodialysis: Report of three cases
Hamid Jiber, Abdellatif Bouarhroum
April-June 2018, 5(2):107-110
Brachial-axillary bridge graft is an alternative to native fistula in the absence of vein access or defect of maturation. Infection of the prosthetic graft is a serious complication. It is a relatively common complication and is the second leading cause of graft loss. It should be prevented by the adoption of extreme rigor concerning monitoring of access, their care and punctures. We report three cases with different aspect clinic and therapeutic of infected brachial-axillary prosthesis for hemodialysis.
  1,878 57 -
Clinical profile of refractory intradialytic hypertension due to a giant AV fistula
Sarvepalli Partha Saradhi, Zaid Ansari, Subhash Garikipati
April-June 2018, 5(2):126-128
An arteriovenous fistula (AVF) aneurysm extending from the cubital region to the clavicle over the left arm which presented with interdialysis hypertension and high-output cardiac failure showing a reduction of blood pressure and improvement of ejection fraction after the construction of a new AVF in the other arm.
  1,832 67 -
Neo aortoiliac system repair of burkholderia cepacia infected mycotic aneurysm with impending rupture
Achintya Sharma, Pranay Pawar, Radhakrishnan Raju, MK Ayappan, Kapil Mathur
April-June 2018, 5(2):129-131
Mycotic or infected aneurysms are focal vascular dilatations from inflammation or infection that results in weakening of the blood vessel wall. It poses a high risk of complications such as aneurysm rupture, uncontrolled sepsis, and extensive para-aortic infection. We report a case of a middle-aged man with a 2-week history of fever, abdominal pain, and backache. Computed tomography angiogram was done which showed infrasaccular aneurysm with impending rupture. The patient underwent neoaortoiliac system repair which was done by harvesting bilateral superficial femoral vein. We report a case of an infected mycotic aneurysm caused by Burkholderia cepacia, a Gram-negative lactose nonfermenting bacterium which is commonly seen in livestock and has not been reported earlier.
  1,821 75 -
Robert B. Rutherford: A “teacher's teacher” the man behind the lasting legacy: The text book of vascular surgery
Devender Singh
April-June 2018, 5(2):105-106
  1,416 56 -
Expert comments on “Acute limb ischemia secondary to popliteal artery thrombosis following total knee arthroplasty – Limb salvage by endovascular therapy”
Raghunandan Motaganahalli
April-June 2018, 5(2):119-119
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