ABSTRACT
Objective: To delineate pattern of peripheral vascular disease [PAD] [upper or lower limb vessels] among troops and their families in the Armed Forces. Study Design: Cross sectional descriptive study. Place and Duration of Study: Armed Forces Institute of Cardiology [AFIC] and National Institute of Heart Diseases [NIHD] Rawalpindi and Combined Military Hospital [CMH] Rawalpindi over a 3 year period, from Aug 2012 to Aug 2015
Material and Methods: All serving and retired army personnel and their families were included in the study. Method of sampling was non probability convenience sampling. The total number of patients was 156. All referrals were from CMH vascular surgery department. All arteriograms were performed on Siemens angiography equipment without facility of DSA [digital subtraction angiography]. The lesions were placed in one of the following categories: normal category in whom either the vessels were normal or minimally diseased without any flow limitation, short and long segment stenoses, and short and long segment occlusions and diffusely diseased vessels. The arteriogram of infra inguinal region was divided into femoropopliteal segment and infra popliteal segment. SPSS version 14 was used to calculate the frequency and percentage of various disease patterns
Results: The pattern of peripheral vascular disease was divided in the lower limb in infra inguinal region into femoropopliteal disease and infra popliteal disease. The predominant pattern of disease in the femoro popliteal segment was long segment occlusion and the disease pattern in the infra popliteal segment was diffuse disease of the involved vessels. The predominant pattern of disease in upper limb was long segment blockage
Conclusion: Peripheral vascular disease among soldiers and families show advanced disease pattern at presentation
ABSTRACT
Objective: To analyze errors in primary treatment of vascular injuries and delayed presentations of missed vascular injuries as a surrogate indicator of need for improved vascular surgical training of upcoming general surgeons
Materials and methods: This retrospective observational study was carried out at vascular surgery department of two tertiary care hospitals of Armed Forces from Jan 2012 to June 2017. Hospital records of all patients with vascular trauma were analyzed for presence of pitfalls in primary treatment and delayed presentation of missed vascular injuries which resulted in redo surgeries or adverse outcomes
Results: Out of 256 patients with vascular injury sequel 41 had either a problem in primary treatment or presented with delayed complications of missed injuries. The omissions can be divided into: missed injuries [24/41], technical errors in initial repair [12/24], reperfusion of mangled Extremity [3/41] and non availability of a surgeon capable of undertaking vascular repair. The commonest operative fault was failure to debride the vessel adequately and vascular repair under tension. The commonest primary assessment problem was failure to timely appreciate hard signs of vascular injury
Conclusion: With better training and emphasizing the need of thorough clinical examination outcome of vascular trauma can be improved
ABSTRACT
Objective: To share five year experience and a half years with emphasis on some technical aspects which will help those managing such cases
Study Design: Descriptive case series
Place and Duration of Study: Combined Military Hospital Rawalpindi, from Jul 2010 to Dec 2015
Material and Methods: All cases of CBT presenting to our department from Jul 2010 to Dec 2015 were included in the study and analyzed
Results: A total of 13 patients were treated at our institute in the last 5 and half years. Average age of patients was 38.5 years with a range of 22-55 years. Male to female ratio was 1:6.5. Mean interval between symptoms onset and presentation was 38.7 +/- 16 months. None of the tumors were bilateral or malignant. Two patients had type I tumor [15 percent], seven patients had tumor of type II [54 percent] and four [31 percent] patients underwent resection for type III tumor. Type I and Type II tumor was removed by simple excision. Three cases of type III tumor were managed by excision, use of temporary shunt and followed by reconstruction of internal carotid artery. One of the type III tumor was excised with ligation of internal carotid artery. There was no mortality or stroke, three patients with type III tumors had transient dysphagia; One of them had marginal mandibular nerve palsy as well. We used bipolar diathermy in all cases, Harmonic TM Scalpel [Ethicon Endo-Surgery] in three cases and LigaSureTM [Covidien Ltd, Dublin Republic of Ireland] in three cases. Use of newer energy sources made dissection less bloody, quick and easier
Conclusion: CBT are rare tumors. Surgical excision should be carefully planned and executed with the help of modern energy sources to avoid any serious complications
ABSTRACT
Objective: To share experience of presentation and management of carotid artery injuries in tertiary care Hospitals Rawalpindi, Lahore and Quetta
Study Design: Cross sectional descriptive study
Place and Duration of Study: Combined Military Hospital Rawalpindi Lahore and Quetta, from Jun 2005 to Jul 2014
Material and Methods: The data of demography, mode of presentation, associated injuries and surgical procedures performed in the patients with penetrating neck injuries were collected and analyzed descriptively
Results: All 32 patients were male. Age ranged from 18 to 52 years [mean: 30.7 +/- 7.1 years]. Time of presentation to vascular surgeon ranged from 1 to 52 hours [mean: 4.4 +/- 2.3 hours]. Sixteen cases [50 Percent] resulted from shrapnel injuries. Thirteen patients [40.6 Percent] had bullet injuries and in three [9.3 Percent], stab wounds. In only 6 cases [18.7 Percent] carotid injury was confirmed on angiography preoperatively. Common carotid artery [CCA] was the most frequently injured artery in 15 cases [46.8 Percent]. There were 6 cases [18.7 Percent] of External carotid artery [ECA], 4 [12.5 Percent] cases of internal carotid artery [ICA] and 1 case [3.1 Percent] of injury to the carotid bifurcation. Two cases [6.2 Percent] had both ICA and ECA injuries. Four patients [12.5 Percent] had no carotid artery injury on surgical exploration
Conclusion: Surgical exploration of neck penetrating injuries on the basis of hard signs and platysmal penetration was found a safe procedure especially in patients who had history of hemodynamic instability