Department Of Vascular Surgery Research Articles

Clinical Comparison of the Efficacy of Systemic Thrombolysis,Catheter-Directed Thrombolysis,and AngioJet Percutaneous Mechanical Thrombectomy in Acute Lower Extremity Deep Venous Thrombosis

Objective To compare the clinical effects of three treatment methods including systemic thrombolysis(ST),catheter-directed thrombolysis(CDT),and AngioJet percutaneous mechanical thrombectomy(PMT)in acute lower extremity deep venous thrombosis(LEDVT). Methods The data of 82 patients diagnosed with LEDVT in the Department of Vascular and Gland Surgery of the First Affiliated Hospital of Hebei North University from January 2017 to December 2020 were collected.The patients were assigned into a ST group(n=50),a CDT group(n=16),and a PMT group(n=16)according to different treatment methods.The efficacy and safety were compared among the three groups. Results Compared with that before treatment,the circumferential diameter difference of both lower limbs on days 1,2,and 3 of treatment in the ST,CDT,and PMT groups reduced(all P<0.001).The PMT group showed smaller circumferential diameter difference of lower limbs on days 1,2,and 3 of treatment than the ST group(all P<0.001)and smaller circumferential diameter difference of the lower patellar margin on day 1 of treatment than the CDT group(P<0.001).The PMT group showed higher diminution rate for swelling of the affected limb at the upper and lower edges of the patella than the ST group(P<0.001)and higher diminution rate for swelling at the upper edge of the patella than the CDT group(P=0.026).The incidence of complications after treatment showed no significant differences among the three groups(all P>0.05).The median of hospital stay in the PMT group was shorter than that in the ST and CDT groups(P=0.002,P=0.001).The PMT group had higher thrombus clearance rate than the ST group(P=0.002)and no significant difference in the thrombus clearance rate from the CDT group(P=0.361).The vascular recanalization rates in the PMT(all P<0.001)and CDT(P<0.001,P=0.002,P=0.009)groups 3,6,and 12 months after treatment were higher than those in ST group,and there were no significant differences between PMT and CDT groups(P=0.341,P=0.210,P=0.341). Conclusions ST,CDT,and PMT demonstrated significant efficacy in the treatment of LEDVT,and PMT was superior to ST and CDT in terms of circumferential diameter difference of the lower limbs,diminution rate for swelling of the affected limb,thrombus clearance rate,length of hospital stay,and long-term vascular recanalization.There was no obvious difference in safety among the three therapies.

Upper extremity arterial thrombosis, experience at the General Hospital of Mexico Dr. Eduardo Liceaga: case-series

The upper extremity arterial thrombosis has a low frequency of presentation, which is why they have been little studied and their therapeutic alternatives can be controversial with a high risk of limb loss, which represents a crucial factor in the quality of life of patients. In this investigation, cases of upper extremity arterial thrombosis are reported, evaluated and treated by the Department of angiology, vascular and endovascular surgery of the General Hospital of Mexico Dr. Eduardo Liceaga in Mexico City during the period of March 2022 to March 2023.

Is carotid web an arterial wall dysplasia? A histological series

IntroductionDescribed for 60 years under various names, the carotid web is a suspected cause of cryptogenic stroke, especially in young patients. The web creates an intraluminal protrusion that may contribute to turbulent flow and thrombus embolization into cerebral arteries. Although the carotid web has frequently been related to arterial fibrodysplasia, its natural history and pathological description remain unclear. PatientsAmong all consecutive patients admitted to the stroke unit of Sainte-Anne Hospital and referred to the vascular surgery department from January 2015 to December 2022, we retrospectively identified 9 patients with a carotid web. The surgical specimens of the 9 patients were submitted to systematic pathological analysis. ResultsThe patients with a histologically confirmed carotid web were young (median age was 42 years), prominently women (7/9), and presenting with low cardiovascular risk. Eight patients had a stroke proven by a magnetic resonance imaging, and 1 had transient monocular amaurosis. The typical pathological lesion supporting the imaging pattern of the carotid web was a focal eccentric intimal hyperplasia forming a protruding lesion characterized by a population of vascular smooth muscle cells intermingled in an abundant, most often loose extracellular matrix. Pathologically proven thrombus was observed in 4 cases. Importantly atherosclerosis was absent. ConclusionHistological features in our 9 cases strengthen carotid web characterization as a homogeneous pattern of localized intimal hyperplasia. It is a unique entity consistent with intimal fibroplasia, distinct from medial fibromuscular dysplasia and early atherosclerosis.

Embolectomy at the Time of Ligation of Femoral Vessels in Psuedoaneurysm in Intravenous Drug Addicts can save Limb

Aim: To determine the impact of embolectomy at the time of ligation of femoral artery in management of pseudoaneurysmin intravenous drug addicts Study design: Descriptive cross-sectional study Methods: This study was carried out at Vascular surgery department, CMH Lahore and included 28 patientsof intravenous drug addiction of both genders presenting in emergency of CMH Lahore with viable limb from 1st August 2021 to31st January 2023. Unsalvageable limbs at the time of presentation were excluded from the study. SPSS Version 20.0 was used for data analysis of age, sex, co-morbidities (infection), mode of presentation and outcome variables. Results: This study comprised of28 patientsadmitted through Emergency Department of CMH, Lahore. The mean age was found to be 32.16 years ±7.63 years. All patients 28(100%) were males with majority belonging to third decade of life 20(71.4%).Chronic viral infection was present in all cases. Almost half of them had hepatitis B virus infection (48%) while cases positive with hepatitis C virus and HIV infections were 37% and 15% respectively.Majority of the patients came to the hospital with bleeding from ruptured pseudoaneurysm (60.7%) and infected pulsatile swelling (32.1%), while pulsatile swelling without bleedingand wrong diagnosis were least common.Alllimbs were salvaged in first and second follow-up visits, 20 patients were lost on follow up on 12th week. Conclusion/Practical implication: Embolectomy is a very useful adjunct in the management of pseudoaneurysm of intravenous drug addicts. It should be routinely practiced in treatment of these patients to save limbs. Keywords: Embolectomy, ligation, femoral vessels, intravenous drug addicts

EXPERIENCE OF HYBRID SURGICAL TREATMENT FOR MULTILEVEL OCCLUSIVE-STENOTIC ARTERIAL LESIONS IN LOWER EXTREMITIES

Peripheral artery disease affects approximately 20% of individuals over the age of 70 and is particularly prevalent among smokers and diabetics. The increasing global prevalence of metabolic syndrome, diabetes, and smoking suggests a further rise in its occurrence. The treatment of this disease incurs significant economic costs, which are projected to continue growing. This disease is associated with high rates of disability, morbidity, and mortality. Without revascularization, 20 to 40% of patients face limb loss, and over 20% die within six months. Conservative therapies are often ineffective, leading to the surgical methods. In cases of critical limb ischemia, revascularization is performed to improve blood flow distal to stenotic or occlusive lesions. Open surgery remains the standard of care, demonstrating good limb preservation and long-term outcomes. The success of bypass procedures depends on multiple factors. The use of endovascular techniques is rapidly increasing, supported by substantial long-term data. While endovascular surgery reduces perioperative complications, choosing the appropriate instrumentation and assessing associated costs remain contentious. Method selection depends on several factors. For certain patients where open surgery is technically challenging or impractical, endovascular surgery provides a viable solution for revascularization. In such cases, revascularization of all arterial lesion levels using a combination of methods is indicated to restore limb blood supply. Isolated revascularization of a single anatomical level is often insufficient and rarely leads to the healing of trophic changes. Hybrid surgery, involving a combination of techniques during a single intervention, is a common approach. This type of surgical procedure includes endovascular correction of the iliac segment with femoral endarterectomy and/or infrainguinal bypass. Another common option is an "above knee bypass" with tibial balloon angioplasty. Surgical treatment using hybrid procedures demonstrates high technical success, good primary and secondary patency rates, limb preservation, and economic efficiency. In this article, we present two clinical cases of hybrid surgical lower extremity revascularization performed at the Department of Vascular Surgery of the M.V. Sklifosovsky Poltava Regional Clinical Hospital. These cases involve patients with stage IV peripheral artery disease (Fontaine classification) caused by an atherosclerotic process. Computed tomography with angiography and digital subtraction angiography were employed as two distinct methods for studying the vascular bed in routine patient management. The method selection was based on angiosomal targets and the suspected vascular lesions initially diagnosed. The objective of this study is to analyze the effectiveness of various hybrid surgical treatment methods for patients with critical limb ischemia resulting from multilevel occlusive-stenotic arterial lesions.

Effect of Hyaluronic Acid Iontophoresis on Healing of Chronic Venous Ulcer

Purpose: The purpose of the study is to evaluate the effect of hyaluronic acid iontophoresis on healing of chronic venous ulcer. Methods: Forty patients of both genders suffering from chronic venous ulcer in area below the knee and above the ankle with area (5-20 cm2) with less than 50% necrotic tissue participated in this study. Their ages ranged from (45 to 60) years. They were selected from Vascular Surgery Department, Al Ahrar Teaching Hospital between June 2022 and January 2023. Patients were divided randomly into 2 equal groups; each one had 20 patients. Group (A) received Hyaluronic acid iontophoresis 1 session per day, 3 sessions per week, for 4 weeks, and follow up 4 weeks after the end of the treatment. In addition to conventional, medical treatment and traditional care. Group (B) received conventional medical treatment and traditional care (ulcer cleansing, debridement, dressing, compression, medication, exercise). Measurements were done by photographic digital camera for wound Surface area (WSA) and wound volume using saline injection into a wound cavity before treatment and after 4 weeks of treatment. Results: The findings of this study indicated significant decrease in WSA and wound volume after treatment in all groups A, B (p&lt;0.001) at day 60 post treatment. There was significant decrease in ulcer surface area and ulcer volume at day 60 post treatment of study group (group A) compared with that of control group (group B) (p = 0.001).Conclusion: Hyaluronic acid iontophoresis for 6 weeks is an effective and safe adjuvant therapy in treatment of unhealed venous ulcers through accelerating wound healing, reducing Wound Surface Area (WSA) and wound volume. Keywords: Hyaluronic Acid, iontophoresis, Chronic Venous leg ulcers, Wound Healing

Radiation Exposure in Endovascular Surgery According to Complexity: Protocol for a Prospective Observational Study.

In the past decades, we have witnessed tremendous developments in endovascular surgery. Nowadays, highly complex procedures are performed by minimally invasive means. A key point is equipment improvement. Modern C-arms provide advanced imaging capabilities, facilitating endovascular navigation with an adequate open surgical environment. Nevertheless, radiation exposure remains an issue of concern. This study aims to analyze radiation used during endovascular procedures according to complexity, comparing a mobile X-ray system with a hybrid room (fixed X-ray system). This is an observational and prospective study based on a cohort of non-randomized patients treated by endovascular procedures in a Vascular Surgery department using two imaging systems. The study is planned for a 3-year duration with a recruitment period of 30 months (beginning 20 July 2021) and a 1-month follow-up period for each patient. This is the first prospective study designed to describe the radiation dose according to the complexity of the procedure. Another strength of this study is that radiologic variables are obtained directly from the C-arm and no additional measurements are required for feasibility benefit. The results from this study will help us determine the level of radiation in different endovascular procedures, in view of their complexity.

Fenestrated Endovascular Aortic Repair After Failed Endovascular Aortic Repair.

Fenestrated endovascular aortic repair (FEVAR) is technically more challenging when performed after a failing EVAR procedure (FEVAR after EVAR). This study aims to assess the technical outcome of FEVAR after EVAR and to identify factors that may influence complication rates. A retrospective observational study was conducted at a single department of vascular and endovascular surgery. The rate of FEVAR after EVAR compared to primary FEVAR is reported. Complication and primary unconnected fenestration (PUF) rates as well as survival were assessed for the FEVAR after EVAR cohort. PUF rates and operating time were also compared to all primary FEVAR patients. Patient characteristics and technical factors such as number of fenestrations or use of a steerable sheath were assessed as possible influencers on technical success when performing FEVAR after EVAR. Two hundred and nine fenestrated devices were implanted during the study period (2013 to April 2020). Thirty-five patients (16.7% of all FEVAR patients) had undergone FEVAR after EVAR and were included in the study. Overall survival at last follow-up (20.2±19.1 months) was 82.9% in FEVAR after EVAR patients. Rates of technical failure dropped significantly after 14 procedures (42.9% vs. 9.5%; p=0.03). Primary unconnected fenestrations were seen in 3 cases of FEVAR after EVAR (8.6%) and 14 of 174 primary FEVAR cases (8.0%; p>0.99). Operating time for FEVAR after EVAR was significantly higher than for primary FEVAR (301.1±110.5 minutes vs. 253.9±103.4 minutes; p=0.02). The availability of a steerable sheath was a significant predictor of reduced risk of PUFs, whereas age and gender, number of fenestrations or suprarenal fixation of the failed EVAR did not significantly influence PUF rates. Fewer technical complications were seen over the study period in FEVAR after EVAR patients. While rates of PUFs were not different from primary FEVAR, operating time was significantly longer in patients undergoing FEVAR for failed EVAR. Fenestrated EVAR can be a valuable and safe tool to treat patients with progression of aortic disease or type Ia endoleak after EVAR but may be more complex to achieve than primary FEVAR. This retrospective study assesses the technical outcome of fenestrated endovascular aortic repair (fenestrated EVAR; FEVAR) after prior EVAR. While rates of primary unconnected fenestrations were not different from primary FEVAR, operating time was significantly longer in patients undergoing FEVAR for failed EVAR. Fenestrated EVAR after prior EVAR may be technically more challenging than primary FEVAR procedures, but could be performed with equally good results in this patient cohort. FEVAR offers a feasible treatment option for patients with progression of aortic disease or type Ia endoleak after EVAR.

Blood flow restricted walking in patients suffering from intermittent claudication: a case series feasibility and safety study.

Sixteen patients with IC were recruited from two departments of vascular surgery. The BFR-W programme implied the application of a pneumatic cuff around the proximal part of the affected limb at 60% limb occlusion pressure in five intervals of 2min, four times per week for 12 weeks. Feasibility was evaluated by adherence and completion rates of the BFR-W programme. Safety was evaluated by adverse events, ankle-brachial index (ABI) at baseline and follow-up, and pain on a numerical rating scale (NRS pain) before and 2min after training sessions. Furthermore, changes in performance between baseline and follow-up were evaluated with the 30 seconds sit-to-stand test (30STS), the 6-minute walk test (6MWT) and the IC questionnaire (ICQ). Fifteen out of 16 patients completed the 12-week BFR-W programme and adherence was 92.8% (95% CI: 83.4; 100%). One adverse event unrelated to the intervention was reported causing one patient to terminate the programme 2 weeks prematurely. Mean NRS pain 2min following BFR-W was 1.8 (95% CI [1.7-2]). ABI, 30STS, 6MWT and ICQ score were improved at follow-up. BFR-W is feasible and appears to be safe in terms of completion rate, adherence to the training protocol, and adverse events in patients with IC. Further investigation of the effectiveness and safety of BFR-W compared to regular walking exercise is needed.

A Treatment Approach for Carotid Blowout Syndrome and Soft Tissue Reconstruction after Radiotherapy in Patients with Oral Cancer: A Report of 2 Cases.

This retrospective case series study aims to demonstrate a salvage technique for the treatment of carotid blow-out syndrome (CBS) in irradiated head and neck cancer patients with a vessel-depleted neck. Between October 2017 and October 2021, two patients (N = 2) with CBS were treated at our institution in a multidisciplinary approach together with the Department of Vascular Surgery. Patients were characterized based on diagnoses, treatment procedures, and the subsequent postoperative course. Surgical emergency intervention was performed in both cases. The transition zone from the common carotid artery (CCA) to the internal carotid artery (ICA) was resected and reconstructed with a xenogic (case 1) or autogenic (case 2) interposition (end-to-end anastomosis). To allow reconstruction of the vascular defect, an additional autologous vein graft was anastomosed to the interposition graft in an end-to-side technique, allowing arterial anastomosis for a free microvascular flap without re-clamping of the ICA. Because of the intraoperative ICA reconstruction, none of the patients suffered a neurological deficit. The techniques presented in the form of two case reports allow for acute bleeding control, cerebral perfusion, and the creation of a vascular anastomosis option in the vessel-depleted neck.

Management of Critical Limb Ischemia Prognostic Factors

Introduction: Critical limb ischemia (CLI) represents the most severe form of Peripheral artery disease (PAD). Its prevalence is estimated to be between 0.5% and 2.3% of the population over 40 years old. Despite its importance, epidemiological studies on CLI remain patchy. In Morocco, few studies have been carried out on this subject, and we have no epidemiological data on the morbimortality of chronic critical ischemia of the lower limbs on a national scale. Objective: The objective of our study was to evaluate the results of surgical treatment of critical limb ischemia and to identify the factors associated with the medium-term evolution. Methods: We conducted a retrospective cohort study of all patients admitted to the vascular surgery department of the Hassan II University Hospital for the management of critical ischemia of the lower limbs, who underwent revascularization surgery between 01/01/2013 and 31/12/2019. Patients who underwent a major amputation of the affected limb and those for whom the revascularization procedure was a revision were subsequently excluded. The follow-up period was 2 years and the events of major interest were the occurrence of a major limb amputation and 30-day mortality. Results: The cohort included 232 patients with critical ischemia. The mean age was 62 years with a clear male predominance of 84.5%. The most common comorbidities were diabetes (65.8%), active smoking (42.5%), and hypertension (31.2%). The majority of patients (62%) benefited from endovascular procedures. The primary technical success was 94.1%, the major amputation rate was 19.7%, and the 30-day mortality was 4.3%. In multivariate analysis, factors independently associated with a high postoperative complication rate were preoperative hyperglycemia, concomitant ischemic heart disease, female sex, young age, and intensive care unit stay. Conclusion: Our study highlights several risk factors for the occurrence of postoperative complications of CLI. These results .....

Long-term results of revascularization of the lower extremities in patients with critical ischemia and diabetes mellitus with localization of the occlusive-stenotic process in the femoral artery

Aim: to determine the most preferable tactics of surgical treatment of patients with critical ischemia of the lower extremities of atherosclerotic genesis and diabetes mellitus based on a comparison of the results of revascularizing interventions. Methods: The study involved 82 patients who were treated in the department of vascular surgery due to critical ischemia of the lower extremities as a result of atherosclerotic occlusive-stenotic lesion of the femoral arterial segment against the background of diabetes mellitus. After the diagnostic stage and preoperative preparation, the patients were divided into two groups depending on the nature of the intervention performed: endovasal revascularization or femoropopliteal autovenous bypass grafting above the knee joint gap. In the postoperative period, dynamic observation of patients was continued with a predominant assessment of the clinical status. Results: Clinically, circulatory decompensation requiring repeated intervention or amputation was observed in 9 (30 %) patients from the first group and in 13 (25 %) patients from the second. High amputation was performed in 2 (6.6 %) study participants from the endovasal revascularization group and 3 (5.7 %) from the open surgery group. Over the entire observation period, 2 (6.7 %) and 4 (7.8 %) patients died in the groups under consideration, respectively. No statistically significant differences were obtained for any of the studied parameters, however, repeated interventions were significantly more frequently performed in patients undergoing endovascular revascularization. Conclusion: When analyzing the advantages and disadvantages of endovascular and open surgery in patients with diabetes mellitus and critical ischemia, the first should be preferred due to the possibility of repeated repetition throughout the patients life. Particular attention should be paid to conservative therapy and assessment of clinical status in the late postoperative period.

Prevention of gastrointestinal bleeding in patients after endovascular surgery on the arteries of the lower extremities for critical ischemia in diabetes mellitus

Relevance: Patients with critical lower limb ischemia and diabetes mellitus are the most difficult group of patients in terms of a favorable outcome of the disease. The number of such patients increases annually. When treating these patients, it is necessary to take into account many different pathological conditions that can lead to fatal complications in the perioperative period. The purpose of the work: The aim of the work was to study methods of prevention of gastrointestinal bleeding in patients after endovascular surgery on the arteries of the lower extremities for critical ischemia in diabetes mellitus. Material and methods: The prospective study included 220 patients who were treated in the vascular surgery department of the A. A. Polyantsev General Surgery Clinic of the Volgograd State Medical University for obliterating atherosclerosis of the arteries of the lower extremities and diabetes mellitus in the period from 2017 to 2021 inclusive. All patients were diagnosed with critical ischemia of the lower extremities stage IIIIV ischemia according to the Fontaine-Pokrovsky classification. Results and discussion. The relationship between the number of painkillers taken per day to reduce pain syndrome and erosive and ulcerative lesions of the gastric mucosa and duodenum in both groups was noted. Conclusion: All patients with peripheral artery diseases accompanied by critical ischemia had endoscopic changes from gastritis to ulcerative lesions, including those complicated by bleeding, by the time they sought specialized medical care. The group at increased risk of gastrointestinal bleeding is patients with repeated reconstructions, surgical corrections of complications or amputations at various levels (from finger to hip), as well as taking anticoagulants in therapeutic dosage. Routine prevention of gastrointestinal bleeding with proton pump inhibitors is not acceptable for this group of patients.

Comparison of Patient Outcomes Before and After the Vascular Surgery Fellowship Program at Tertiary Care Hospital

Objective : To assess the outcomes in managing patients with chronic kidney disease (CKD) requiring vascular access before and after, a formal vascular surgery fellowship program (VSFP) was introduced in a tertiary care hospital in Punjab.&#x0D; Study Design : Pilot quasi-experimental study.&#x0D; Place and Duration of Study: Department of Vascular Surgery and Nephrology at Combined Military Hospital (CMH) ,Lahore Pakistan, from Feb to Oct 2020.&#x0D; Methodology: Patients meeting the inclusion criteria of ages between 20 to 70 years, either gender and undergoing dialysis due to chronic renal failure were recruited in the study. Data was collected at the initial phase when a VSFP was absent and later when it was present. Outcome variables were current dialysis access, waiting time for permanent dialysis access and failure rate about the duration of chronic renal failure.&#x0D; Results: A total of 226 patients were recruited in the study. In both pre-vascular surgery fellowship program time (pre-VSFPT) and post-vascular surgery fellowship program time (post-VSFPT), the predominant functional dialysis access at the time of the interview was arterio-venous fistula (AVF). However, they were much higher in the post-VSFPT, i.e., 46(54.1%) as compared to 96 (68.1%) (p= 0.069). In addition, in pre-VSFPT, 24 (28.2%) patients had a “Never Created” AVF status at the time of the interview as compared to 21(14.9%) in post-VSFPT, which was statistically significant.&#x0D; Conclusion: The establishment of a fellowship program not only benefits the trainee but it improves patient care significantly. This study highlights the improvement in all the benchmarks of the formation

Renal Benefits of CO2 as a Contrast Media for EVAR Procedures: New Perspectives on 1 Year Outcomes.

Endovascular aneurism repair (EVAR) is a minimally invasive alternative to open surgery for the treatment of abdominal aortic aneurysm. Iodine contrast medium (ICM) is considered the gold standard, at the high price of related nephrotoxicity and allergic reactions. Carbon dioxide (CO2) has been suggested as an alternative non-nephrotoxic contrast media agent. We aimed to evaluate the safety and the renal impact of the administration of CO2, compared with ICM in EVAR procedures. We retrospectively reviewed data of patients who underwent EVAR at the Vascular Surgery Department of the Sant'Orsola Hospital in Bologna. Estimated glomerular filtration rate (eGFR) was evaluated before intervention, immediately after and at 12 months. In total, 22 patients received CO2 and low-dose ICM (CO2 Group) and 22 received standard ICM (Control Group), matched for clinical characteristics and renal function at the time of procedure. Pre and post-operative renal function values (eGFR) were compared between the two groups: in the immediate post-operative the group treated with CO2 and low-dose ICM globally showed a slight improvement in renal function (mean eGFR +5.10%±3.2), meanwhile the group treated with standard dose of ICM presented a significant worsening of renal function compared with pre-procedure values (mean eGFR -9.65%±4). Incidence of post-contrast acute kidney injury (PC-AKI) was 9% in the CO2 group vs 27% in the Control group. At 12 months, the renal impairment was significantly greater in the ICM group than in the CO2 group (mean eGFR decrease -19.2%±11.1 and -7.40%±3.5, respectively). Administration of either CO2 alone or along with low-dose ICM showed to be safer than full-dose ICM alone, lowering the incidence of PC-AKI in patients undergoing EVAR. Unexpectedly, our study revealed also a significant worsening of renal function in patients treated with standard dose of ICM in 1-year follow-up, introducing the concept that acute renal damage caused by ICM could elicit a chronic injury process that affect long-term renal outcomes. Evaluating the safety and the renal impact of the administration of CO2, compared to Iodinate Contrast Medium, in EVAR procedures represents a first step in order to further tayloring medical procedures on patients characteristics. Our findings can guide the clinicians and surgeons in the procedures choice, not considering only the immediate effect of ICM on renal function but also the potential long-term effects.

The evolution of management of type B aortic dissection in a series of 100 consecutive cases in a tertiary center

Introduction and ObjectivesManagement of aortic dissection is rapidly evolving. The present study aims to assess paradigm shifts in type B aortic dissection (TBAD) treatment modalities and their outcomes according to clinical presentation and type of treatment. We also aim to assess the impact of endovascular technology in TBAD management in order to define organizational strategies to provide an integrated cardiovascular approach. MethodsWe performed a retrospective review with descriptive analysis of the last 100 consecutive patients with TBAD admitted to the Vascular Surgery Department of Centro Hospitalar Universitário Lisboa Norte over a 16-year period. Results were stratified according to treatment modality and stage of the disease. The study was further divided into two time periods, 2003–2010 and 2011–2019, respectively before and after the introduction of a dedicated endovascular program for aortic dissections. ResultsA total of 100 patients (83% male; mean age 60 years) were included, of whom 59 were admitted in the acute stage (50.8% with complicated dissections). The other 41 patients were admitted for chronic dissections, most of them for surgical treatment of aneurysmal degeneration. Temporal analysis demonstrated an increase in the number of patients operated for aortic dissection, mainly due to an increase in chronic patients (33.3% in 2003–2010 vs. 64.4% in 2011–2019) and a clear shift toward endovascular treatment from 2015 onward. Overall in-hospital mortality was 14% and was significantly higher in the chronic phase (acute 5.1% vs. chronic 26.8%; OR 5.30, 95% CI 1.71–16.39; p=0.003) and in patients with aneurysmal degeneration, regardless of the temporal phase. Only one death was recorded in the endovascular group. ConclusionManagement of TABD carried an overall mortality of 14% during a 16-year period, but the appropriate use of endovascular technology has substantially reduced in-hospital mortality.

Management Pattern of Chronic venous Disease in Bangladesh

Introduction: Chronic venous disease (CVD) is mostly underdiagnosed diseasewhich may progress to chronic venous insufficiency and venous ulcer thus extensive treatment. CVD may affect negatively into patient’sgood well-beingwhich can create burdens on their life and also healthcare resources. Bangladesh has very minimum awareness on CVD. Materials and Methods: This was a cross-sectional study was carried out in department of vascular surgery of National Institute of Cardiovascular disease. we randomly choose 60 patients with chonic venous disease (CVD) and evaluate their characteristics and prevalence of several types along with the management pattern. Data collection started from May 2021 for next 6 months. Results: The patients of this survey were aged between 24 to 70 years and the Mean±SD age was 43.6±12.2. 78.3% of total study population were male, 33.3% were businessman and 10% were housewife. 66.6% patients were having low socio-economic condition. C2 varicose veins were highly prevalent among the study population ( 35%) &amp; lowest prevalence of C4b lipodermatosclerosis or atrophie blanche (11.7%). Male were predominantly more prevalent to having CVD, 78.33% (n47), (p &lt;0.001). Among all the patient 68.3% patient were exposed to smoking. All the patient were managed predominantly by compression therapy mainly are of moderate pressure (66.7%,) 80% of total patients got treated by oral MPFF therapy. Conclusion: : Patients having CVD, invariably presented with the complains of heaviness of leg and unexplained leg swelling and Varicose vein were highly prevalent irrespective of sex. Compression therapy has been remained the mainstay of treatment in tertiary level hospital NICVD along with oral MPFF therapy. Medicine Today 2023 Vol.35(1): 31-33

Retrospective Analysis of Recipients after Kidney Transplantation from a Family Donor in the Lviv Regional Clinical Hospital

Introduction: Contemporary transplantology still faces many challanges, in particular due to the lack of living and inanimate donors, compared with the number of recipients; immaturity of immunodiagnostic and other diagnostic tools for the early prevention of acute rejection of graft; toxic effects and other imperfections of immunosuppressants. The Purpose: Of the work is to assess retrospectively аnalysis of recipients after kidney transplantation a family donor in the Lviv Regional Clinical Hospital. Materials and Methods: 89 medical histories of recipients undergoing in-patient treatment in the center of the kidney transplantation and chronic hemodialysis and the department of vascular surgery during the years 2008-2018 (Diagram 1) were analyzed retrospectively. 86 patients undergone one transplantation, 3 more than one. 47 (52.8%) were men and 42 (47. 2%) women. The age of the recipients ranged from 17 to 60 years. The median age of patients was 28.9 ± 1.2 years. Results: HLA-typing was performed in 38 (42.7%) pair of recipients and donors. There were 3 classical loci in 7 (18.9%) patients, 4in 15 (39.5%) recipients, and 5 in 16 (43.3%) patients. HLA matching by degree of match to 36 pairs. The crossmatch donor-recipient reaction was as follows: the absence of dead lymphocytes was observed in the 4donor-recipientpairs; 2 pairs had a dead lymphocyte count of 5%, 9pairs- 10%, 28 pairs - 15%, 45 pairs - 20% and 1 pair- 35%. Cross-matching is typically presented as negative is the 6 donor-recipient pair; indeterminate 37 pairs and positive 46 pairs.

New Pharmacological Approach to Improvement of Quality of Life of Patients after Coronary Artery Bypass Grafting through Stimulation of Neoangiogenesis

INTRODUCTION: Despite the increased volume of rendered high-tech assistance and objective improvement of the condition of the majority of operated patients, the parameters of physical activity and working capacity in this category of patients remain low.&#x0D; AIM: To study the effect of 5-oxymethyluracil with angiogenic properties on the quality of life of patients in the early and long-term period after coronary artery bypass grafting (CABG).&#x0D; MATERIALS AND METHODS: The randomized prospective study included two groups of patients: the main group (n = 87) which in the perioperative period of CABG (5 days before and 14 days after surgery), in addition to standard therapy, received the drug 5-oxymethyluracil), and the control group (n = 81) which received standard therapy. The groups were comparable in gender, age, basic clinical and functional characteristics and peculiarities of surgical intervention. The quality of life of patients was determined by the Seattle Angina Questionnaire (SAQ) before CABG surgery (upon admission to the vascular surgery department) and after surgery (after 2 months and 1618 years). There were no statistically significant differences in the preoperative parameters of quality of life in the control and main groups.&#x0D; RESULTS: In the long-term period of surgical revascularization of the myocardium (1618 years after the operation) the severity of angina according to SAQ was: in the control group 33.30 (20.00-60.00), in the main group 60.00 (33.30-70.00; р = 0.0407). Other scales of SAQ, including physical activity, stability of anginal course, satisfaction with treatment and perception of the disease, did not demonstrate any differences between the studied groups in 2 months or 1618 years after CABG.&#x0D; CONCLUSION: Perioperative use of 5-oxymethyluracil influenced the improvement of only one parameter of quality of life according to the SAQ questionnaire the severity of angina, with statistically significant differences between the groups in the long-term period of CABG (1618 years after surgery). According to SAQ questionnaire, there was no effect on the remaining parameters of the quality of life with the underlying perioperative use of the studied drug in all follow-up periods.

Outpatient treatment of truncal veins insufficiency

Abstract Introduction: Chronic venous disease is a common clinical problem with an increasing incidence that constitutes a financial burden for healthcare. Minimal invasive techniques and procedures in an outpatient basis may help decompressing the healthcare system. The aim of this study is to evaluate the effectiveness and safety of endovenous closure of the truncal veins with n butylcyanoacrylate adhesive on an outpatient basis. Methods: We treated 100 cases of venous insufficiency with endovenous NBCA glue closure of the truncal veins on an outpatient basis. Patients were usually admitted to the vascular surgery department at the time of the procedure. The surgery took place in the general operation room, under local anesthesia. We didn’t use compression stockings and patients were instructed to walk immediately after the operation. Results: There was a 100% successful obliteration of the target vein in day 0, 2weeks, 3-months and one year. The majority of patients (98%) reported improvement of the symptoms, whereas 60 patients (60%) had complete elimination of symptoms. The appearance of varicose veins improved in 96% of the cases. There were no major adverse effects observed during follow-up. A percentage of 28% presented erythema and tenderness along GSV and 15 of those patients were treated with anti-inflammatory drugs (Ibuprofen) and 5 with antibiotics (Amoxicillin-Clavulanic acid). Conclusion: Outpatient treatment of venous insufficiency with endovenous glue closure is a safe and efficient method. It increases patient satisfaction, permits rapid return to normal activities and reduces the risk of hospital transmission of infectious diseases and hospitalization costs.