ABSTRACT
lntravenous drug abuse can lead to vascular complications, most frequent of which is pseudoaneurysm. These pseudoaneurysms [false aneurysms] are prone to rupture, leading to profuse hemorrhage and death. To evaluate pseudoaneurysms in intravenous drug addicts for the site, mode of presentation, management and outcome. Descriptive study. Surgical unit I, Combined Military Hospital, Rawalpindi. Surgical unit 2, Combined Military Hospital, Lahore. January 2006 to September 2010. All cases of pseudoaneurysms in intravenous drug addicts who presented to a single vascular surgeon, between 1st January 2006 and 30 th September 2010, were evaluated for site, mode of presentation, treatment and the outcome. Surgical procedures included excision of pseudoaneurysm with interpositioning of graft, repair of vascular rent, ligation of vessel and debridement. All cases were referred to psychiatrist for management of drug addiction. Total 12 cases of pseudoaneurysms due to IV drug abuse were included in our study. Arteries affected included 9[75%] common femoral arteries [CFA]. ln 3[25%] cases, both common femoral artery and vein were involved with arteriovenous fistula between them. There was 1[8.3%] pseudoaneurysm each of external iliac artery, superficial femoral artery and brachial artery. Nine cases [75%] presented with recurrent hemorrhage from a swelling while in 3[25%] cases there was swelling with no history of hemorrhage. ln 7[58.3%] cases, repair/grafting, while in 5[41.6%] cases ligation and debridement was done. There was seroma formation in 1[8.3%] case after excision and grafting. ln none of the cases, in which artery was ligated, critical limb ischaemia occurred. Common femoral artery is the most frequent site of pseudoaneurysms in lV drug abuse. ln those cases where vascular reconstruction is not possible due to extensive skin necrosis or infection, ligation of affected vessel is not only a life saving procedure but a safe option also.
ABSTRACT
To determine the frequency of intra-operative hypotension following induction of Anesthesia in patients continuing their routine dose of angiotensin system inhibitor therapy before surgery. Cross-sectional study. Department of Anaesthesiology, Combined Military Hospital, Quetta. One year from 20-08-2010 to 19-08-2011. Total 92 hypertensive patients were included in this study. Diagnostic criteria for patients was those cases receiving ACEI/ARA therapy for at least 3 months with admission preoperative arterial blood pressure of >150/90mmHg. Mean age of the patients was 47.70 +/- 8.47 years. Out of 92 patients, 38 patients [41.3%] were male while remaining 54 patients [58.7%] were female. Distribution of cases by hypotension after induction of anesthesia shows, hypotension at 30 minute in 55 patients [59.8%] and hypotension at 60 minute in 37 patients [40.2%]. Out of 55 hypotensive patients [at 30 minute] 17 patients [30.9%] had mild hypotension, 32 patients [58.2%] had moderate hypotension and 6 patients [10.9%] had severe hypotension. Out of 37 hypotensive patients [at 60 minute] 8 patients [21.6%] had mild hypotension, 25 patients [67.6%] had moderate hypotension and 4 patients [10.8%] had severe hypotension. Hypertensive patients continuing their routine angiotensin system inhibitors therapy [<10 hr preoperative] have a variable risk of developing moderate hypotension within 30 minutes after induction. This moderate hypotension proved to be of little clinical significance as it responded to conventional therapy