Clinical outcomes after angioplasty and/or stent placement in patients with illac occlusive disease

Introduction: iliac angioplasty represents an important skill for the cardiovascular interventionist to master, not only to relieve patients lower extremity symptoms, but also to preserve vascular access for what may be lifesaving cardiovascular therapies such as coronary angioplasty or intra aortic balloon counter pulsation

Aim of the work: to evaluate the preliminary results of angioplasty in management of chronic iliac occlusive disease in Nasr City Insurance Hospital in 32 months

Patients and methods: a prospective study was done in 9-patients presented to Nasr City Insurance Hospital during the period between Nov. 2000 to May 2003 complaining of intermittent claudication [77.8%], rest pain [33.3%] and/or peripheral ulcer and gangrene [66.6%]. Angioplasty was an intermediate stage before surgery in 5-patients [55.6%] changing surgery from a major one [from the aorta] to a simpler one from the femoral artery] to a diffusely diseased peripheral vessels

Results: a successful angioplasty was done for all cases [7-right and 2-left iliac arteries]. PTA was enough with good results in 6-patients. PTA balloon dilatations and stenting was done for 3-patients. We considered our angioplasty procedure is technically successful if the residual stenosis is lower than 30% of the reference diameter. Follow up: Post intervention period passed smoothly in 7patients hut unfortunately, 2 patients died during follow up. NO mortality was related to the procedure. Patient [No.1] died 23 days after angioplasty due to septicemia and secondary infection after fern-pop. Bypass. The second patients [No.4] died 6-days after angioplasty due to AMI

Conclusion: angioplasty has the following advantages: -Lower initial procedure related morbidity and mortality. -No need for general an aesthesia. -Shorter hospital stay, and less trauma

Evaluation of surgical complications of living renal transplantation: a study of 40 cases

This study was conducted to review a preliminary surgical experience in 40 cases of living renal transplantation. The age of the patients was 37.3 years and male to female ratio was 7:3. The mean total ischemic time was 37.2 +/- 2.0 minutes. One case died three days postoperatively due to pulmonary embolism, three cases developed mild lymphocele and three cases developed urinary leakage. There was no single case of renal artery or vein thrombosis and two cases developed rupture kidney due to rejection. During the follow up, one case developed renal artery stenosis and another case developed ureteral stricture, all these complications were treated successfully. Comparing the results with other published results in specialized centers for renal transplantation, it was found that the study results are convenient and encouraging to continue and trying to find out the etiological causes for any surgical complication to minimize these complications and to get the best possible results

Quantitative assessment of rehabilitation results in peripheral arterial disease

Peripheral arterial disease [PAD] patients are commonly classified on the basis of subjective evaluations of pain and fatigue. It could he important to have, at least, an objective measurement ofJƒtigue for better evaluation of muscle performance and exercise tolerance in such patients as well as for serial quantitative assessment of different vascular rehabilitation programs designed for claudications. Median frequency [MDF] analysis has been recently used to monitor electromyo graphic [EMG] power spectrum shift toward lower frequencies due to muscle fati gue. Twenty-five PAD patients and ten control subjects matched for age and sex were studied. Surface EMO was recorded over the medial gastrocnemius muscle along 40 seconds at maximal voluntaty contraction. The median frequency of the electromyoraphic power spectrum was calculated in the first 10 seconds [TO] and the last 10 seconds [T1]. Change from TO to T1 was statistically calculated and considered as the fatigue index [FI]. EMG reassessment was done for the patients' group after completing a physical training program. Significantly lower initial Ti values, compared with initial TO, were found in both the PAD and the control groups. A highly significant difference was documented regarding all the initial MDF parameters between the patient and control groups. Moreover, a highly significant difference was recorded between the initial and the post-rehabilitation FI in the patients' group. EMG frequency analysis can be considered an easy, painless, practical and reproducible method which has a high degree of precision and accuracy in providing objective information on the muscle performance and fatigue in PAD patients

Preliminary experience in endovascular management of renal artery stenosis

From June 1997 to March 2001, 22 patients [14 males and 8 females with mean age 45.2 years] underwent 28 percutaneous transluminal renal angioplasties [PTRA] and stenting. Stenting was done in 13 cases only [direct stenting in five of them]. Fifteen patients underwent treatment for renovascular hypertension, 5 patients for renal impairment and only 2 cases to prevent kidney loss from change of renal artery stenosis to total occlusion. Femoral approach was used in 20 cases and brachial approach was used in 2 cases only. Complications occurred in 5 cases included hematoma at the puncture site in one case, perinephric hematoma in one case, deterioration in kidney function in one, acute renal thrombosis in one and death due to massive myocardial infraction in one case. Renovascular hypertension was cured in 5 cases, improved in 7 cases, no change in 2 cases and became more worse in one case. Regular clinical, laboratory investigations and duplex follow up was done on all patients for a period between 3 months and 24 months [average 18 months]. Restenosis occurred in 4 cases. Another PTRA and stenting was done in 3 cases. Nonsignificant stenosis occurred in one case and needed only follow-up

Brachio-infraclavicular axillary interposition graft as a successful tertiary vascular access procedure for hemodialysis

This study describes experience with brachio-axillary interposition graft for hemodialysis as a successful tertiary vascular access procedure. The purpose of the study is to assess the role of this procedure in the dialysis access algorithm. Between May [1995] and March [2000], fourteen grafts were placed in 14 patients, with exhausted venous arm sites. No significant post-operative complications occurred, the secondary patency rate after 1 and 2 years was 85.7% and 77% respectively, which were much better than conventional arm bridge fistula 50-70% after one year, Really, this procedure opened the closed doors infront of those miserable patients with chronic renal failure and exhausted all venous arm sites and good enough that the proposed two main problems with this procedure which were heart failure and steal phenomena did not occur with a significant importance. No single case of heart failure occurred in this series also, steal phenomena occurred only in one case with mild degree that there was no need for intervention, So, it might prove reasonable to use this graft earlier in an effort to eliminate the painful, costly and inconvenient multiple revisions frequently required with more conventional grafts

Occult malignancy in patients with idiopathic deep venous thrombosis

The relationship between deep venous thrombosis [DVT] and malignancy has long been recognized and documented, patients diagnosed with malignancy are clearly at risk for the development of venous thromboembolism and conversely some patients with deep venous thrombosis have subsequently been discovered to harbor an occult malignancy. This is a prospective study of 51 DVT patients who presented to Ain Shams University Hospitals between January 1997 and December 2000. These patients were chosen out of 188 DVT cases because of absence of any major thrombotic risk factor, their ages were over 40 years, and non were previously diagnosed with any form of malignancy. All patients were screened for any signs of occult cancer, which included careful history taking, thorough physical examination, laboratory screening including tumor markers, and abdominal ultrasonographic examinations. After the first level of screening; suspicious cases were subjected to the second level of specific laboratory, radiological, or endoscopic tests to reach a final diagnosis. Malignant neoplasms were detected in 11 cases [21.5%]. Carcino-embryonic antigen [CEA] and endoscopy were key in diagnosing 2 cases of early colon cancer and 2 cases of adenomatous colonic polypi. Cystoscopy followed by biopsy detected 2 cases of early urinary bladder cancer, and high levels prostate specific antigen, transrectal ultrasound and biopsy were used to diagnose cancer prostate in one patient. Biopsy of palpable axillary and cervical lymph nodes attracted our attention to one case of cancer breast, and one case of non-Hodgkin lymphoma. Oncofeotal proteins and scrotal ultrasound led to diagnosing one case of early testicular tumor. Computerized tomography scans of the abdomen discovered one case of cancer body of the pancreas. The most striking finding was that most of these cases were in the early stages of malignancy. These findings underscore the importance of screening for occult malignancy in idiopathic DVT patients especially in the elderly population and regardless of the cost, since we are sometimes rewarded by finding cancer at an early stage, giving the patient the best chance for survival