Vascular thoracic outlet compression syndrome

The aim of this study was to describe our experience with the surgical treatment of arterial and venous thoracic outlet syndrome. This prospective study included 25 patients with vascular compression at thoracic outlet area. They were admitted to Vascular Surgery Unit, Mansoura University Hospital during the period from July 2004 to July 2007. Patients were classified into two main groups. Group I [arterial thoracic outlet syndrome, n = 16]. Group II [venous thoracic outlet syndrome, n = 9]. The operations of arterial reconstruction were worthwhile for all patients with excellent results in 11 patients [84.6%], only 2 patients [15.4%] developed early postoperative thrombosis which was managed by transbrachial thrombectomy. The success rate of surgical interference for venous non-thrombotic patients was 100% while conservative treatment of thrombotic patients showed success in 4 patients [57%] and failure in 3 patients [43%]. In patients with vascular compression, resection of the first rib, resection of cervical rib, scalenectomy and neurolysis of the brachial plexus are recommended in addition to vascular reconstruction. Our experience using the supraclauicular approach indicate that this is a safe route with good results and minimal risk to the patients health

Impact of eversion technique in carotid endarterectomy: Mansoura experience

To review our experience in eversion technique in carotid enclarterectomy in patients with carotid artery stenosis with particular attention to restenosis, occlusion, recurrent stroke or TIA. This prospective study included 12 patients with symptoms of unilateral carotid artery stenosis who were investigated, operated and followed up in Vascular Surgery Unit of Mansoura University Hospital during the period from July 2004 to January 2008. Eversion carotid endarterectomy [ECEA] was carried out for all patients. Carotid restenosis rate [>50%] during follow up was [0%] after eversion CEA at the end of the study. The cumulative stroke free survival rate was 85.7% at the end of the study. ECEA is a feasible and safe alternative technique for management of extracranial carotid stenosis, an excellent technique for handling of the kink, spiral or redundant internal carotid artery. It can be performed while patients under local or general anesthesia according to the general condition and cooperation of the patient

measurement of serum lepoprotein [a] and apolipoprotein-B be of prognostic value in patients with type II diabetes mellitus with myocardial infarction and peripheral vascular disease?

Current clinical guidelines require that five indices [total cholesterol LDL cholesterol, HDL cholesterol triglycerides and the total/ HDL cholesterol ratio] be measured or calculated to assess the lipid related risk of vascular disease. Recently, quantification of plasma Lp [a] and Apo-B was proposed as recent clinical markers that will allow better prediction of coronary and peripheral arterial disease. This study prospectively examined whether high levels of Lp [a] and Apo-B have a significant risk and prognostic value in type II diabetic patients with myocardial infarction and peripheral vascular disease. The patients included in the study were selected properly from outpatient clinics of Vascular Surgery Unit as well as Internal Medicine Department [Cardiovascular Unit], Mansoura University. The patients were divided into 4 groups: Group I [n=15]: Type II DM with no CAD and no PVD. Group II [n=15]: Type II DM with history of myocardial infarction and No PVD. Group III [n=15]: Type II DM with no history of myocardial infarction but have symptomatic PVD. Group IV [n=15]: Type II DM with history of myocardial infarction and have PVD. Patients with acute illness or taking Niacin, Estrogen replacement or antibiotics were excluded. All patients were subjected to thorough history taking, cardiovascular and peripheral vascular system evaluation including BMI, ABJ, ECG, Doppler echocardiogram as well as peripheral vascular angiography. Laboratory evaluation of our patients include assessment of diabetic state, HbAlc, standard lipid profile parameters as well as evaluation of Lp [a] and Apo-B. Serum level of Lp [a] and Apo-B showed highly statistically significant results when comparing group I with any group of type II diabetic patients complicated with either MI or PVD [P<0.001]. However, serum apo-B level was highly significant in those complicated with PVD [P<0.001], while serum Lp[a] was statistically higher in those having myo-cardial infarction [P=0.03]. Our study revealed that elevation of serum level of both Lp [a] and Apo-B were significantly correlated with occurrence of myocardial infarction and different grades of peripheral vascular insufficiency in type II diabetic individuals. However, increased serum level of Lp[a] showed higher significant prediction for occurrence of MI while, elevation of serum level of Apo-B predict more the occurrence of PVD among our patients. Evaluation of serum Lp [a] and Apo-B levels should be considered a new risk factor and of prognostic value for occurrence of vascular complications in type II diabetic patients. More population-based prospective studies are needed to answer the question definitively of whether Lp [a] and Apo-B leuels are more predictive of CAD and PVD in type II diabetic individuals than the traditional lipid parameters