Management of acute vascular trauma of lower limbs

Past and current military experience has contributed considerably to the advances made in the treatment of extremity vascular injuries. However, the management of arterial injuries of the lower extremity is still associated with significant rates of limb loss and functional deficits. The incidence of civilian arterial limb injuries has increased overtime due to road traffic accidents. The multi-disciplinary approach to the injured patients has produced improved limb-salvage and patient survival. 2-4% of vascular injuries need operative reconstruction. In our series, external fixation has been preferred in all cases. The advantages include requiring less operative time for immobilization, less tissue destruction, less potential for infection in contaminated wounds, and allowing daily debridement and irrigation of the wound in cases of severe soft-tissue injury. In our cases, the anticoagulant treatment was initiated in the emergency room if systemic anticoagulation was not contra-indicated [active hemorrhage, coagulopathy, and cerebral injury]. No patient complained from compartment syndrome and fasciotomy was not necessary. In addition, systemic anticoagulant therapy with low-molecular weight in prophylactic dose was started for 5 days post operative and till mobilization of the patient

Percutaneous carotid intervention in patients combined carotid and coronary artery disease

Cerebrovascular accidents [CVA] are the third leading cause of death world wide. Carotid stenosis accounts for 20% to 30% of all CVAs. Thromboembolization of the atherosclerotic stenotic carotid arteries leads to cerebrovascular strokes and transient ischemic attacks [TIAs]. By far the most common lesion found in patients with intracranial cerebral vascular disease is an atherosclerotic plaque at carotid bifurcation. Recently carotid angioplasty and stent implantation appears to be a feasible method for the treatment of carotid stenosis. To assess safety and feasibility of percutaneous intervention in the treatment of carotid artery stenosis in patients with concomitant coronary artery disease. Forty patients with concomitant coronary and carotid artery disease were enrolled in this study, their carotid lesions were managed by carotid artery stenting [CAS] and distal protection devices [filter type] were used. Twenty seven males [67.5%] and 13 females [32.5%] were enrolled in this study their age ranged from 49-82 with the mean of 64.3 years, all had ischemic heart disease and internal carotid artery [1CA] stenosis that ranged from 60 to 99% with the mean of 82.4% +/- 10.5. Optimal results were obtained in 38 patients [95%] and the procedure was incomplete in 2 patients [5%]. Mean stenosis post stenting was 6% +/- 4. In recent outcome, mortality rate was 0% while 5 patients [12.5%] developed minor strokes, and 5 patients [12.5%] developed TIAs. In 18 months follow up, 31 patients [81%] were free from major cerebro-vascular events. Coronary artery stenting [CAS] resulted in reduction of neurological symptoms and major cerebral insult and found to be feasible and safe especially in high risk patients [those with severe coronary artery disease] for surgical interventions

Duplex detected ankle Doppler velocity for the assessment of degree of peripheral ischemia

Objective: Ankle brachial index [ABI] is widely accepted for the assessment of the degree of peripheral ischemia. Duplex scan is widely used for the investigation of peripheral ischemia. Velocities are routinely measured during Duplex scan. The purpose of this study is to determine whether peak systolic velocity [PSV] of the distal tibial arteries correlates with ABI. and therefore could be used as an alternative method for the assessment of the degree of peripheral ischemia

Material and Methods: Data was prospectively collected for 20 ischemic limbs and 5 healthy volunteers. The age, gender, risk factors, duplex findings, and ABI were recorded for each patient. Duplex PSV was assessed at the most distal segment of the anterior and posterior tibial arteries. Three readings were recorded for each artery, their mean was calculated. ABI was calculated for the anterior tibial and posterior tibial arteries. A mean ABI for both tibial arteries was also calculated. Mean PSV of the anterior tibial artery was correlated with its ABI, mean PSV of the posterior tibial artery was correlated with its ABI, and mean PSV of both tibial arteries was correlated with the mean ABI of both tibial arteries

Results: PSV of the anterior tibial artery correlated well with anterior tibial ABI [r=0.8], PSV of the posterior tibial artery correlated well with posterior tibial ABI [r=0.8], and mean PSV of both tibial arteries correlated well with the mean ABI of both tibial arteries [r=0.8]. in addition 10% of patients with severe ischemia [ABI=<0.4] had mean PSV =<25, and 20% of patients with moderate ischemia [ABI =0.4 to 07] had PSV ranging from 25 to 50, and 20% of patients with mild ischemia [ABI 0.7 to 1.0] had PSV=> 50, while 45% of healthy volunteers with no ischemia [ABI => 1.0] had PSV =>75

Conclusion: These results suggest that PSV measurements at the distal tibial arteries correlate well with ABI measurements. PSV measurements can be used to assess the degree of ischemia, in particular in patients where ABI is falsely elevated due to vessel wall calcification- Dear Wassila Please complete the data in the results section, and include the P value for the correlation ratios