KwaZulu-Natal South Africa Research Articles

Thrombectomy in HIV Related Peripheral Arterial Thrombosis: A Preliminary Report

ObjectivesTo evaluate the limb salvage rate in patients undergoing thrombectomy for HIV related peripheral arterial thrombosis. MethodsA prospective review of patients with HIV related peripheral arterial thrombosis managed at the Durban Metropolitan Vascular Service in Kwazulu-Natal South Africa over a 5-year (1998–2003) period. All patients underwent thrombectomy. ResultsTwenty-two patients (20 males) with HIV related peripheral arterial thrombosis (two upper limbs, 20 lower limbs) were included in the study. The median age was 36 years (24–46 years). All patients had rest pain and seven patients had gangrene (digital five, forefoot two). Seven patients had a short history of claudication before development of rest pain. Mean duration of symptoms was 30 days (1–120 days) with 10 patients presenting within 24h. Most patients had a good general state of health and only three had clinical evidence of HIV infection. Ten patients who presented with threatened limbs from acute arterial occlusion were subjected to thrombectomy without any diagnostic investigations. Twelve patients who did not present with critical limb ischaemia had duplex ultrasonography, which showed arterial occlusion by a thrombus with normal proximal arteries. The striking features were the normal proximal vessels and absence of distal run-off. The search for an underlying cause, echocardiography in seven patients and coagulation screening in 10 patients, was always negative.All patients were subjected to thrombectomy with an on-table angiogram and received systemic heparin intra-operatively and deltaparin post-operatively. In 20 patients, duplex ultrasonography confirmed re-thrombosis within 48h. Two patients remained with patent arteries. Most (16/20) patients who re-thrombosed required a major amputation and thrombectomy did not alter the level of amputation. The other four patients with re-thrombosis had symptomatic relief. Three patients died within 30 days of thrombectomy, all of HIV related complications. Overall the limb salvage rate was 6/22 (27%). ConclusionLimb salvage rate following thrombectomy in HIV related peripheral arterial thrombosis is very low. Duplex ultrasonography appears to be an adequate radiological diagnostic investigation for these patients.

“I am poor, I must start all over again” The impact of political violence on household economies; A case-study from KwaZulu-Natal

Abstract This paper using interview material from Mpumalanga Township, KwaZulu-Natal (South Africa) examines the relationship between political violence and household poverty. It suggests that, because of the specific nature of the violence in this area, women have been forced to take on the position of household head and thus the burden of managing poverty has fallen on them. The paper is divided into four sections: firstly it provides an overview of political violence in KwaZulu-Natal; secondly it examines how women were affected by and involved in the violence; thirdly it looks at the impact of the violence on household economies; and lastly it considers the possibilities of starting over. It concludes by suggesting that while political violence might have accelerated broader social trends, for many individual households, prior to political violence, vulnerability to poverty did not seem to be part of their trajectory.