VSICON 2018 Prize Paper Abstracts

Abstract

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Export to End Note Procite Reference Manager Save my selection AbstractVSICON 2018 Prize Paper Abstracts Author Information This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. Indian Journal of Vascular and Endovascular Surgery 6(1):p 49-57, Jan–Mar 2019. | DOI: 10.4103/0972-0820.253744 Open Metrics COMPLEX BYPASSES AND FISTULAS FOR DIFFICULT HEMODIALYSIS ACCESS: A SINGLE-CENTRE EXPERIENCE Dr. Vivek Singh Background: Chronic kidney disease patients require AV access for hemodialysis. Complex bypasses and fistulas are required when all other options have exhausted. We at a single centre performed complex surgeries for AV access and studied their patency rates and procedure related complications. Objectives: To describe complex vascular access and their outcomes in 16 patients at single centre. Materials and Methods: Patients underwent basilic vein transposition bypass (n = 6), basilic to cephalic vein grafting (n = 1), AV bridge grafting (n = 4), Brachial vein transposition (n = 3), basilic vein angioplasty and redo anastomosis (n=1), GSV to CFA transposition (n=1). Postoperatively patients had bimonthly clinical examinations in which the thrill, bruit, skin, cannulation sites, and adequacy of dialysis were reviewed. The study also included graft inflow rate, vein diameter, peak systolic velocities and cardiac output were also performed. Results: There was Gd I steal syndrome in 01 patient which was managed conservatively. Patient with basilic vein angioplasty and redo-anastomosis developed pseudoaneurysm which was repaired. During the median follow-up time of 18 months, 3 patients died of causes unrelated to fistula. 02 surgical revisions were done. Primary patency rates were 90%, 85%, 68.5% respectively, at 6 months, 12 months, and 18 months; secondary patency rates were 95%, 90%, 70%. Conclusion: Complex vascular access procedures can provide patients with good hemodialysis access where the simpler procedures have exhausted. In above study an acceptable patency rates were achieved. OUTCOMES OF REVASCULARIZATION IN DE NOVO AORTIC OCCLUSIONS PRESENTING WITH LOWER LIMB MOTOR DEFICIT: A SINGLE CENTER EXPERIENCE Dr. Shubhabrata Banerjee, Dr. Praveen Krosuri, Dr. Jessicaben Shah, Dr. Mohd. Attar Azharuddin, Dr. Raghuram Sekhar Background: De novo Aortic occlusion is a rare entity with devastating consequences, ranging from functional limb loss to major amputations and even life loss. Major revascularization injuries lead to systemic sequeales like renal shutdown and myoglobinuria, rhabdomyolysis, compartment syndrome and muscle necrosis. Aims and Objective: To study the primary delay in presentation of de novo aortic occlusion and their outcomes post revascularization. Materials and Methods: Observational retrospective study of de novo aortic occlusion of patients presenting to a tertiary care hospital in Mumbai, India. Total of 11 patients over a period of 7 years. Results: Majority of patients (50%) were under the age of 60 years. More than 50% patients had no comorbidities. All patients presented >24 hrs after onset of symptoms and each patient was treated by a non vascular health faculty at onset. At presentation, all petients had some degree of motor deficit. Prompt revascularization had gratifying results with one mortality and one major amputation. Endovascular only salvage was done in one patient. Conclusion: Prompt revascularization in a case of de novo aortic occlusion has satisfying results. Perioperative hydration, Post operative renal support, ICU backup, prompt fasciotomies, nutritional support, infection control forms the pillars of immediate multimodal care. Surgical revascularization is mostly suited for patients with motor deficits, however judicious use of endovascular salvage has a role. DABIGATRAN IN POSTPARTUM LACTATING WOMEN WITH ACUTE DEEP VEIN THROMBOSIS AND ITS IMPACT ON THE BREAST FED INFANT Dr. Aadarsh Kabra Aim: To assess the utility of Dabigatran Etixilate Mesylate (Pradaxa®) in breastfeeding post partum women and to note any growth/bleeding abnormalities/GI disturbances in breast fed infants. Methods: 12 new born infants of 12 women with postpartum Acute Deep Vein thrombosis who continued to be breast fed were evaluated. All the infants were evaluated with APTT at 2 weeks after initiation of Pradaxa® to the mother. Independent assessment of all the infants was performed by a pediatrician to note for any growth/Gastrointestinal/bleeding abnormalities. The follow up ranged from 3 months to 30 months. Assessment of the metabolites of Pradaxa® in the breast milk were not done. Results: the infants did not show any GI disturbances, developmental abnormalities, bleeding diasthesis or delay in attaining growth milestones. There was no reduction in the breast milk volume as reported by the mothers. Conclusion: The use of Pradaxa® appears to be safe for breast fed infants in women with venous thromboembolic events who are still breast feeding. A PROSPECTIVE EVALUATION OF WIFI CLASSIFICATION SYSTEM IN AN INDIAN POPULATION Dr. Ankur Aggarwal, Dr. Robbie George Background: Leg ulcers, in the Indian population, are often complicated due to malnutrition, MDR infection and present commonly in advanced stage. Wound, ischemia and foot infection (WIFI) classification has been assessed across various populations for predicting treatment outcomes. This study was aimed at assessing the validity of this classification in the Indian population. Aims and Objective: To assess the validity of WIFI classification system in predicting the treatment outcomes of lower limb ulcers in Indian population. Materials and Methods: WIFI classification was used to classify 126 leg ulcer patients. All patients received standard medical and surgical care. Follow up was done at 1 week, 3 weeks, 6 weeks and 3 months and at 6 months. The treatment modalities and outcomes were correlated with the WIFI stage. Results: Our study showed increasing 6 month major adverse limb events (MALE) i.e. major amputation (p- value: 0.005) with increase in the WIFI grade. Major adverse cardiac events (MACE) and mortality were also associated with increasing WIFI grade (p value: 0.075 and 0.100 respectively). Considering the patients with ischemic foot ulcers, all MALE occurred in stage 4. Major amputation was associated with increasing WIFI grade (p value: 0.096). Conclusions: WIFI was found to be a strong predictor of worsening limb outcomes and suggestive of poor life outcomes in leg ulcer patients and is a valid score to be used in the Indian population. MODERN DAY OPEN ILIO-CAVAL SURGERY: A PERSPECTIVE Dr. Srikanthraju Siddapuram, Dr. Robbie George, Dr. Prasenjith Sutradhara Background: Open Ilio-caval surgery is a challenging part of vascular surgical practice and has undergone a change with the onset and advancement of endovascular procedures. Aims and Objectives: To review the current role of open iliocaval surgery in modern day vascular practice. Materials and Methods: A retrospective study was done at multispeciality tertiary care centre looking at all open iliocaval surgical interventions. Results: (1) 25 patients underwent open iliocaval interventions. (2) 68% of the patients were male and are mostly in 5th decade. (3) 3 patients underwent femorocaval bypass with PTFE grafts for benign iliocaval occlusive disease during initial period of surgery (2011-2012). (4) 3 patients with IVC leiomyosarcoma, underwent IVC resection with reconstruction (PTFE graft). (5) 3 patients of retroperitoneal tumor with IVC involvement underwent partial resection of wall of IVC followed by PTFE patchplasty in 2 patients and primary closure in the other patient. (6) Out of 14 patients of RCC with extension of thrombus into IVC, along with urology team nephrectomy with exploration and removal of thrombus from IVC and primary closure was done in 9 patients with no mortality. Remaining 5 patients had thrombus extending into right atrium for which CTVS team were involved, among them 2 patients died in post-operative period. Conclusion: In the current scenario the role of open IVC interventions are limited to oncological clearance with venous reconstruction as a part of multidisciplinary approach with urology and oncology teams. PACLITAXEL DRUG COATED BALLOON AND PLAIN BALLOON FOR INFRAPOPLITEAL ANGIOPLASTY: 6 MONTHS OUTCOME IN CRITICAL LIMB ISCHEMIA Dr. CPS Sravan, Dr. M Vishnu, Dr. V Vivekanand, Dr. M Sumanth Raj, Dr. Vaibhav Lende, Dr. Jain Piyush, Dr. Roshan Rodney, Dr. Hemanth Chaudhari, Dr. KR Suresh Aim: To compare the primary patency and clinical outcomes of drug coated balloon to plain balloon used for infrapopliteal angioplasty. Methods: In this prospective study, 142 patients with critical limb ischemia underwent infrapopliteal angioplasty after correction of inflow lesion. 106 and 36 patients underwent angioplasty with POBA and DCB respectively. Follow up were at 1st, 3rd and 6th month. Primary patency was a measure of significant decrease in any non invasive vascular lab measurements (ABI, TBI and TcPO2-supine and dependent). Clinical outcomes were wound healing, MACE, MALE and mortality. Results: In the POBA and DCB group, 92% and 97% were Type II diabetic (p value – 0.250), 85% and 78% in Rutherford class 6 (p value- 0.763) and 77% and 66% in WIfI stage 4 (p value 0.207) respectively. Lost to follow up were 7 patients (6.6 %) in the POBA group and 1 patient (2.7 %) in the DCB group. Primary patency for POBA and DCB groups at 1st month were 93.8% and 97% respectively (p value-0.005), at 3rd month were 81.3% and 86.7% respectively (p value-0.045) and at 6th month were 62.7% and 80.7% respectively (p value-0.011). The average duration for wound healing was 3.97 months in the POBA group and 3.52 months in the DCB group (p value- 0.114). MALE was 11% vs 8% (p value 0.209), MACE was 11% vs 22% (p value 0.106) and all cause mortality was 16% vs 17% (p value 0.930) in the POBA and DCB group respectively. Drawbacks of this study are absence of randomization, unequal sample size, single center study and multilevel disease. Conclusion: The advantage of DCBs with regard to maintaining foot perfusion at 6 months is clearly established in this study. However to observe a significant difference in other clinical parameters, a longer follow up period would be needed. CERVICAL RIB OSTEOBLASTOMA (A CASE REPORT) Dr. Singh Devender, Dr. Kilaru Harita Background: Osteochondromas are commonest benign bone tumours, they are developmental defects. Rarely, malignant transformations can occur. A few cases of osteochondramas are reported in first rib and spine, but origin in cervical rib is a very rare entity. Aims and Objectives: To report a rarest case of cervical rib osteochondroma and technical aspects involved in treatment. Materials and Methods: A 21 years female presented with numbness in right upper limb and difficulty in overhead abduction. Patient investigated with neck x ray, CT neck with angio, CT guided biopsy and PET scan. Near total excision of tumour from supraclavicular approach with claviculectomy done. Results: Post operative residual arm weakness present, with physiotherapy moderate improvement in arm function noted. Post operative CT neck showed no residual tumours. Final histopathology report-aggressive epitheloid osteochondroma. Conclusions: Paucity of data makes results difficult to compare. Complex anatomy and challenges in complete excision of tumour with acceptable morbidity is a problem. Aggressive nature of this case, prone for recurrence. Preoperative downstaging of tumour with chemotherapy and post operative radiotherapy is useful. EVALUATION OF RELATION BETWEEN GREAT SAPHENOUS VEIN DIAMETER AND BODY MASS INDEX (BMI) WITH VENOUS REFLUX Dr. Bhumika Gupta, Prof. Ramakrishna Pinjala Background: Varicose veins are the most common manifestation of Chronic Venous Disease. The estimated prevalence is between 5% and 30%, (<1% to >70%). Iincreased ambulatory venous hypertension causes swelling, pigmentation, lipodermatosclerosis, eczema, and venous ulcerations. Obesity has been identified as one of the risk factors. Duplex scanning is the preliminary diagnostic test. Venous diameter changes with valsalva maneouver significantly greater in the GSV and deep veins of CVI patients than in healthy subjects. Increased distensibility correlates with venous reflux parameters in CVI patients. Aims and Objective: To find out the relation between GSV diameter and BMI in patients with venous reflux. Materials and Methods: A prospective, cross-sectional study including 150 patients, was conducted over 1 year, in the department of Vascular surgery, NIMS, Hyderabad. Duplex scan was performed using a 10 MHz imaging probe. The SFJ was evaluated for reflux. The GSV diameters at 3 cm distal to SFJ, at mid-thigh, above knee and below knee were noted. Comparison of variables was performed using chi-square test. Results: The average diameter with BMI 20-25 were 8.15 mm, 7.94 mm, 7.28 mm and 7.12 mm. While with BMI (35-40) were- 11.27, 10.60, 9.55, and 9.01 mm. Maximum no. of patients with BMI 20-25 had grade 1 reflux (63.88%), while 75% patients were found to have grade 4 reflux with BMI of 35-40. Conclusion: There is positive relation between increase in GSV diameter and reflux at SFJ; and higher BMI and reflux grade at SFJ. Also, there is positive relationship between increase vein size and higher BMI. ROLE OF CATHETER DIRECTED THROMBOLYSIS IN PERIPHERAL ARTERIAL OCCLUSIVE DISEASE WITH NO DISTAL REFORMATION Dr. Sridhar Murugesan Background: Patients with Peripheral Arterial Occlusive Disease with no distal reformation, often end up in Amputation. Various options in management of patients with no distal reformation include Prostanoids, Pneumatic compression therapy and Thrombolysis. Aim: To study outcome following Catheter directed thrombolysis in patients with Peripheral Vascular Disease with no distal reformation. Materials and Methods: This study was conducted at Institute of Vascular Surgery, Madras Medical College. Overall 16 patients underwent catheter directed thrombolysis for Acute on Chronic Limb Ischemia during the period 2015 to 2017. Results: Mean age at presentation was 41 years (range 31 to 48 years). Mean Duration of symptoms was 18 days (range 14 to 26 days). Of total 16 patients, one was female. Smoking was a risk factor in all except the female patient. Clinical presentation at time of presentation was rutherford stage 4 and beyond. All patients underwent catheter directed thrombolysis for 48 hours. Ankle brachial index improvement was seen in all the patients. No major amputation was seen. No major bleeding complications seen. Punture site complications were present, which was managed conservatively. Pain free walking distance improved in all the patients. Conclusion: Catheter directed thrombolysis is a viable option in patients with Peripheral Vascular Disease with no distal reformation. Even though there is no recanalisation of named vessels, the collaterals are cleared of acute thrombus and helps in tiding overt the acute crisis. REVASCULARISATION IN FEMORAL EMBOLISM - CLASS III ACUTE LIMB ISCHEMIA-OUR INSTITUTIONAL EXPERIENCE Dr. M Ramya Background: Class III Acute limb ischemia (ALI) is non salvageable and amputation is the treatment of choice. We conducted a prospective study on “Revascularization in femoral embolism – class III Acute limb ischemia” in our institute of vascular surgery, RGGGH, Chennai, during period 1st August 2016 to 31st July 2018 which included 20 patients and analyzed the outcome. ´alyze the outcome following revascularization in patients with femoral embolism – class III ALI. Materials and Methods: Method of Study: Prospective study. Duration of Study: 2 years. Inclusion Criteria: (1) All patients with femoral embolism – with class III ALI (sensory loss- profound/anesthetic, muscle weakness – profound/ paralysis, Arterial and venous Doppler signals – inaudible) with age >12 years. (2) Above patients with non contracting muscles in anterolateral and deep posterior compartment with even minimal contraction in superficial posterior compartment during fasciotomy. Exclusion Criteria: (1) Patients with femoral embolism – class III ALI with skin involvement (Blebs/patches). (2) Patients with femoral embolism – class III ALI with pale, non contracting muscles in all compartments during fasciotomy. (3) Patients with femoral embolism - class III ALI with tender, tense/turgid muscles in all compartments with smoky urine. Results: Results were analyzed on the basis of Dialysis dependency, limb status, improvement in sensory/motor function, status of foot drop, fasciotomy wound healing, psychological status, amputation and mortality. Conclusion: Proper selection of patients yielded better results in functional outcome and Psychological status of the patient with less adverse effects and nil mortality. IMPACT OF WOUND ISCHEMIA AND FOOT INFECTION (WIFI) STAGE AS AN INDEPENDENT PREDICTOR OF LIMB SALVAGE IN THREATENED LIMB ISCHEMIA POST REVASCULARIZATION Dr. Vaibhav Lende, Dr. Vivekananda, Dr. CPS Sravan, Dr. Piyush Jain, Dr. Chaudhari Hemant, Dr. Rodney Roshan, Dr. KR Suresh Background: Patients presenting to Jain Institute of vascular sciences (JIVAS) with critical limb ischemia (CLI) typically have advanced disease with significant comorbidities. The Society for Vascular Surgery WIfI threatened limb classification has shown to correlate well with risk of major amputation and time to wound healing. The purpose of this study is to assess the influence of revascularization on limb salvage classified according to the WIfI stage. Methods: This is a single center prospective study done in JIVAS. All patients presenting to our hospital with CLI from June 2016 to June 2017 were enrolled and followed for minimum of six months. Wound healing and major amputation were compared for patients stratified by WIfI classification. Results: Out of 266 patients admitted with CLI, 236 patients were classified according to WIfI stage and underwent infrainguinal revascularization procedure. Three percent patients were in stage1, 20% in stage 2, 37% in stage 3 and 38% in stage 4. No significant difference noted in age, gender, procedure performed (endovascular/bypass). Diabetes (p=0.016), Hypertension (p=0.001) and smoking history (p=0.033) were more common in Stage 3 and stage 4 with significant p value. Overall major amputation rate at six months was 11.01 % with most amputations in stage 3 and 4. There were no significant difference among WIfI stages with respect to wound healing rate (p=0.238) but as the stage increases major amputations (p=0.041) rate increases significantly. Conclusion: Among patients with CLI, as the stage of the WIfI increases the rate of major amputation rises. Also in our study the wound healing rate doesn’t correlates among the WIfI stage. Further subanalysis and long duration follow up is required for more conclusive results. IMPACT OF TIBIAL ANGIOPLASTIES IN SALVAGING CRITICAL LIMBS: WHICH SUBSET OF PATIENTS BENEFITS THE MOST: AN INSTITUTIONAL EXPERIENCE Dr. Jan Sujith, Prof. N Sritharan Aim: To determine the impact of tibial angioplasty in salvaging limbs in patients with critical limb ischaemia and to identify the subset of in which it is likely to be most beneficial. Materials and Methods: Retrospective analysis of 45 patients who underwent Tibial and Peroneal angiolplasties from January 2015 to July 2018. Angioplasties were done in isolation or in conjunction with Iliac, SFA and popliteal angioplasties. A total of 38 male and 7 Female patients were included in the study. A successful outcome was defined as survival without amputation at 6 months, relief from rest pain (measured in visual analogue scale) and wound healing. Results: The median age was 61 years. 77% of the patients were diabetic and nearly a 85% percentage had disease in more than one vessel. The limb salvage rate was more than 78% and 90% of patients reported relief from rest pain. A few patients 8% (n=4) required multiple sittings of wound debridement for limb salvage. A similar number underwent amputations (major- above or below knee). Conclusion: Tibial angioplasty as a limb saving procedure has a definitive role in Diabetics and patients with multivessel disease. Despite having a low patency rate, it my aid in wound healing and thus salvage the limb. ENDOVASCULAR REPAIR OF MYCOTIC AORTIC ANEURYSMS: A CASE SERIES Dr. Rahul Agarwal, Dr. Prajna Kota, Dr. Burli Pradeep, Dr. Gnaneshwar Atturu, Dr. Prem Chand Gupta Introduction: Mycotic aortic aneurysms (MAA) an uncommon but devastating pathology. Open surgical repair is the gold standard and carries a significant in hospital mortality of 20-40%. With advances in endovascular techniques, EVAR has become an alternative treatment approach for MAA. The anxiety of leaving a foreign material in an infected field raises the debate whether EVAR for MAA should be a bridge to a definitive procedure or a permanent solution. In this series, we see the treatment outcomes of EVAR for MAA. Materials and Methods: On retrospective analysis, 4 patients underwent EVAR for MAA in our institute from May 2015 to May 2017. Early and mid-term outcomes of our subjects were analyzed and compared with standard literature. Results: The mean age of patients was 54.75 years (50-64 years), all were males. Thoracic aorta was the commonest site (75%). Symptoms included fever, pain, cough and hemoptysis. Three procedures were performed on emergency basis and one electively. E coli were isolated in one patient. The thoracic MAAs were treated with Zenith TX2 stent graft (COOK medical) and one patient required prior debranching. The abdominal MAA was treated with covered Cheatham Platinum stent. The mean hospital stay was 9.5 days (range 3 days to 25 days). All patients are on long term Ciprofloxacin and are under follow up for 38 months (range 2 to 38 months). 30-day mortality was 0% and one year and 3 year mortality was 25% (unrelated to surgery). Conclusion: EVAR is an acceptable alternative for treating MAA with low one year mortality. Prolonged antibiotic treatment could reduce risk of recurrence and need for open procedure in the midterm follow up STUMP. HEALING AFTER ABOVE KNEE AMPUTATION WITH A NON PALPABLE FEMORAL PULSE Dr. B Nishan, Dr. V Vivekananda, Dr. J Piyush, Dr. L Vaibhav, Dr. CPS Sravan, Dr. Chaudhari Hemant, Dr. H Vishal, Dr. K Siva, Dr. KR Suresh Introduction: There have been major advances in ilio-femoral revascularization procedures, inspite of which above knee amputation (AKA) is common in practice and represents a significantly morbid procedure. This study was done to evaluate the outcome of stump healing after above knee amputation in patients with a non-palpable femoral pulse. Methods: Patients with non-palpable femoral pulse who underwent AKA at JIVAS between January, 2014 and December, 2017 were evaluated retrospectively. The demographics including age, sex, comorbidities (DM/HTN/Cardiac disease/Chronic kidney disease), history of smoking, doppler signals, indication for amputation (chronic/acute limb ischemia), stump healing, re-intervention (stump debridement) and mortality were noted. Results: Data of 35 subjects was collected and analysed. The mean age of patients was 54.45+/-11.26 years, male: female ratio was 4:1. 48% (17/35) were diabetic, 45% (16/35) were hypertensive, 28% (10/35) had cardiac disease, 11% (4/35) had chronic kidney disease and 37% (13/35) were smokers. 51% (18/35) were diagnosed as chronic limb ischemia and the remaining 49% (17/35) were diagnosed as acute limb ischemia. The overall mortality rate was 20% (7/35) at 6 months. Cardiac complications were the leading cause of death (20%). Successful stump healing was accomplished in 57% (20/35) at the end of 6 months. Stump healing failure occurred in 22% (8/35) in the form of debridement. Doppler signals were noted in 51% (18/35) of which 28% (10/35) had stump healing with no debridement. Conclusion: In the current study, no single factor can accurately predict stump healing but the absence of comorbidities and presence of doppler signals may be indicative of stump healing. D-DIMER LEVELS IN PATIENTS WITH THROMBOANGITIS OBLITERANS Dr. Vimalin Samuel, Dr. Sunil Agarwal Background: Thromboangitis obliterans (TAO) is a recurring progressive segmental vasculopathy of small and medium vessels of the hands and feet. The obliterative endarteritis is thought to occur due to a mixture of thrombosis and inflammation. The diagnostic sensitivity and specificity of D-dimer as a biomarker for thrombosis in the setting of TAO has not been well studied. Aim and Objectives: The aim of our study was to study the serum D-dimer (a marker of thrombosis) in patients with TAO and compare this to normal age/ sex matched controls. Materials and Methods: A prospective case control study with sample size of 62 cases and 330 controls was carried out between April 2014 and May 2015. All patients underwent a standard diagnostic protocol including blood tests, electrocardiogram, chest X- ray and ankle brachial pressure index. Results: All 62 patients diagnosed to have TAO were males with an average age of 40 years (range 18-50 years). Medium vessel involvement was present in 85%, the reminder presented with involvement of the popliteal and femoral vessels as well. Upper limb involvement or superficial thrombophlebitis was present in 95%. The median and inter-quartile range for D-dimer values were 61ng/ml and 41-88 ng/ml in controls (n=330); 247 ng/ml and 126-477ng/ml (respectively) in cases (n=62). The D-dimer levels in cases were elevated, the difference was statistically significant (P<0.001). Conclusions: D-dimer levels are significantly elevated in patients with TAO. This indicates an underlying thrombotic process and points to its potential role as a diagnostic adjunct. It also leads us to consider a potential therapeutic benefit of anticoagulants in this disease. IS THERE ANY ROLE OF TRANSCUTANEOUS PARTIAL PRESSURE OF OXYGEN (TCPO2) IN PATIENTS WITH CHRONIC VENOUS INSUFFICIENCY? Dr. Sasank Kalipatnapu Background: Chronic venous insufficiency is an important cause of leg ulceration. Transcutaneous partial pressure of oxygen is used to determine perfusion to the skin and is used in arterial diseases. Aims and Objectives: We hypothesized that the skin changes induced by chronic venous insufficiency lead to a decrease in the perfusion of the skin. We measured the transcutaneous partial pressure of oxygen in patients with C4 to C6 disease. Materials and Methods: All patients with unilateral chronic venous disease with clinical stage 4-6 presenting to vascular surgery were included. Patients with co-existent arterial disease, active infection or autoimmune conditions were excluded. TcPO2 was measured in both diseased and normal leg in both supine and dependent positions. Results: Out of a total of 96 patients included in the study, there were 85 males and 11 females. In supine position, irrespective of the stage of advanced CVI, the mean TcPO2 in the affected limb (23.28 mm Hg) was significantly lower (p < 0.01) than the mean TcPO2 in the normal limb (32.05 mm Hg). In dependent position, the TcPO2 in the affected limb (40.50 mm Hg) was significantly lower (p < 0.01) than the TcPO2 in the non-affected limb (50.74 mm Hg). The mean TcPO2 was significantly lower in the supine position compared to dependent position both in affected & normal limb. Conclusions: In a limb affected with advanced CVI the TcPO2 is significantly lower when compared to normal, more so for C5 & C6 stage. There is a definite effect of limb positioning on TcPO2 values. This study establi