Aneurysms of the upper limb

Fiftyone aneurysms of the upper limb were studied prospectively in a four-year period between 1986 and 1990, in the Department of Vascular Surgery of Dow Medical College and Civil Hospital, Karachi. Most of these aneurysms had resulted from penetrating trauma and the majority of patients [98%] underwent angiography and operative treatment within one year of onset. The urban setting and criminal violence were the main reasons for male preponderance [92%]. Distal subclavian and Axillary arteries were most commonly involved, revealing a pulsatile lump in the majority [80%] of the patients. Most of these vascular injuries were associated with neurological trauma [68.6%] and the resultant decrements were produced by nerve divisions [57%] and neuropathy [43%]. Excision of the aneurysm and long saphenous vein interposition graft was the commonest procedure [82%] used. Patency rate of the anastomotic conduit was 96% at six weeks. This was an excellent result. Unfortunately poor reattendance of the patients at subsequent follow-ups has resulted in a great unreliability of this patency rate. Lack of education, lack of awareness and poor compliance were the main causes of failure to reattend after such a major injury and salvage, and it is hoped that in the future more of these patients can be traced to determine the outcome of the management

Axillary aneurysm and brachial plexus lesion

A case report is described here of an axillary pseudo-aneurysm associated with brachial plexus lesion, caused by a gun shot injury. Clinical Doppler, electrophysiological and neuro-vascular reconstruction in one stage with restoration of substantial functions in the upper limb

Dorsalis pedis artery pseudoaneurysm

An unusual case report is described here, of a young man who developed a pseudoaneurysm of the left Dorsalis Pedis Artery [DPA] ten years earlier, following a blunt injury. He sustained a recent injury to the same foot following which, the lump became enlarged and painful. Doppler flow studies and angiography confirmed the diagnosis and revealed the causative ostium through which this partially thrombosed aneurysm had arisen. Successful aneurysmectomy and end-to-end LSV bypass graft surgery was followed by complete recovery

Digital vascular manifestations in SLE: a case report and review of literature for prognostic evaluation of cardiovascular manifestations in SLE

A young patient was seen at our Department of Vascular Surgery with secondary Raynaud's disease of a short duration, characterised by digital ischaemia of upper and lower limbs. Family history was positive. Investigations revealed presence of collagen disease. The most likely diagnosis was Systemic Lupus Erythematosus. The patient was treated with steroids and responded well by clinical [loss of symptoms and signs] and laboratory parameters [Falling ESR, lowered C3 and improved digital circulation on doppler flow studies]. Since the cardiovascular manifestations are prognostically important in the overall management, appropriate literature was reviewed and quoted here

Deep vein thrombosis and pulmonary embolism

Deep Vein Thrombosis [DVT] and its sequelae - Pulmonary Embolism [PE], are very important disorders which ought to be prevented actively by recognising a high risk category of patients, which should receive prophylactic treatment There are many diagnostic inadequacies with these disorders and such serious limitations often encourage empirical therapies specially if the patients are asymptomatic Major general surgery, prolonged immobility, hip arthroplasties etc. are associated with a high incidence of DVTs, as observed by the screening I-Fibrinogen uptake test and by the more specific investigations such as Venography, Pulmonary Angiography and the Lung scan. Various protocols of treatment are now popular with varied claims of success

Compressive vascular disorders of the upper limbs

This preliminary report relates to an On-going prospective study being undertaken at the Department of Vascular Surgery, Dow Medical College and Civil Hospital, Karachi. The Study is expected to yield valuable information regarding the incidence Of Occlusive vase War diseases of the upper limb relating to compressive disorders, the prevelnce of thoracic outlet syndrorm, the long term results of vascular decompression, role of adjunct cervico-dorsal sympathectomy correlation of physical signs with angiography etc. In this preliminary report some relevant physical parameters are described, as found in the patient treated, with results of surgical treatment