dysvascular traumatized lower limbs: management and outcome

The objective of this study was to reach some recommendations to improve the surgical results of injury to the femoropopliteal axis in an area of high incidence of road traffic accidents [i.e. Saudi Arabia]. Over nearly two years period and out of 138 patients admitted to KFSH with traumatized lower limbs, 48 patients were found to have vascular injuries that needed surgical repair. The studied variables included demographics, mechanism and severity of injury quantitated by the mangled extremity severity score [MESS], detailed vascular examination, methods of repair and fasciotomies. The results showed that there were forty-two males and only six females with a mean age of 36 yeas. There were thirty-two patients with blunt trauma mainly road traffic accidents [RFA] and only 16 with penetrating trauma. In six patients, diagnosis was not evident and arteriography proved that three patients have vascular injury and the other three are free

Appraisal of El-Minia university experience in the management of complications of vascular access for hemodialysis

This thesis has demonstrated an experience with vascular access procedures performed over the past three years at El-Menia University Hospital in patients with ESRD. The complications that occurred with these procedures have been reviewed in an effort to determine how they might have been prevented and also how they could be best managed once they are encountered. Of 250 consecutive patients with ESRD who underwent vascular access surgery for hemodialysis, 88 patients developed 108 complications that required medical and /or surgical intervention. 247 patients had autogenous arteriovenous fistula and three patients had exp and ed polytetrafluoroethylene grafts. The complications included 8 hemorrhages, 18 infections, 58 thrombosis, 5 venous hypertension, 3 steal phenomena, 8 venous aneurysms and 8 arterial aneurysms. Twenty-three complications were corrected and the overall failure rate was 34%. Details of management, lessons learned and recommendations were presented

Staged amputation in diabetic infective gangrene of lower extremity

Primary wound closure with reduced rate of infection could be assured by the staged amputation technique altough it entails an additional operations. To evaluate this issue 28 patients with diabetic wet gungrene of the foot were allocated to have either a one stage amputation [group A, 13 patients] or a staged amputation [group B, 15 patients]. All patients had an intraoperative cultures from the foot and deep muscles to determine the presence of bacteria at the site of initial amputation. In group A definitive Syme, below or above-knee amputation were utilized while in group B we started with either Ray, transmetatarsal or open ankle amputation to be followed by definitive transmetatarsal, closed Syme, or below knee amputation respectively. While six patients in group A had wound complications, none of group B patients had such complications in the definitive amputation wounds. The staged amputations showed an excellent durability and none of the patients required a revision to a higher level, while in group A three patients required such a revision to a higher level. None of the group A patients had their ankle joint preserved while none of group B patients lost their knee joint. The staged amputation can be very gratifying technique that could end up with a more conservative amputation even if offered to elderly diabetic patients

Assessment of two regimens of anticoagulant therapy in acute venous thrombosis utilizing coloured duplex scan

In the present study the efficacy of two different anticoagulant regimens, one with long course heparin and the other with a short course heparin were evaluated utilizing the colored venous duplex scan in diagnosis and follow up. A total number of 64 patients with DVT were randomized into two groups. Group A [n = 32] had long course heparin and group B [n = 32] had short course heparin. Repeated duplex scan showed that despite the already started anticoagulant, some thrombi proved to be stable or regressive, while other thrombi were progressive. Follow up of the studied patients showed a significant efficacy of long course heparin in preventing and recurrent thrombosis, while one patient in group A showed recurrent thrombosis, 7 patients in group B experienced recurrent thrombosis. It was concluded that short course heparin appears to be insufficient to stop venous thrombosis when compared to the long course heparin

value of selection and comparison of two lines of treatment of primary varicose veins [using coloured duplex scan]

Rational treatment of superficial venous disease requires delineation of points of reflux. However, a considerable controversy exists over the need to strip the great saphenous vein [GSV] in treatment of primary varicose veins [PVV]. This study evaluated and compared the value of physical examination, Doppler ultrasonography and colored duplex scanning in selecting patients with PVV due to reflux of sapheno-femoral junction [SFJ]. Also, the benefit of SFJ ligation alone versus SFJ ligation plus stripping of the GSV in treatment of PVV due to reflux of SFJ, was compared. A total number of 102 limbs in 82 patients were initially evaluated, and selected group of 78 limbs in 62 patients were divided into group A [42 limbs] who had SFJ ligation plus GSV stripping and group B [36 limbs] who had SFJ ligation alone. Both physical examination and Doppler ultrasonography proved to be specific [100%], but less sensitive [52.6% and 74.3%, respectively] in diagnosing reflux of SFJ compared to duplex scanning. The postoperative follow up scans showed a significant superiority of stripping the GSV plus SFJ ligation in abolishing any residual reflux after operation

Incidence and significance of positive bacterial cultures during elective vascular surgery

Bacterial infection in vascular surgery is justifiably considered as a catastrophic complication. This study assess the incidence and significance of positive bacterial cultures in elective vascular operations. Specimens were collected in a non-selective manner from 65 patients who had 60 primary and 5 secondary surgical procedures, which included, creation of arteriovenous fistula [30], stripping of primary varicose veins [15], thromboendarterectomy [13], profundoplasty [3], femoro-popliteal bypass [2] and iliopopliteal bypass [2]. Out of the 65 patients studied, bacterial growth were evident in 11 patients in one or more of the four sample sites. The gram positive organisms constituted the main variety recovered and this included the coagulase negative staph, alpha-strept, diphtheroids, gamastrept, micrococci, and Pseudomonas in a descending manner. The results of this study documents the relatively common presence of bacteria in the vascular wall and perivascular tissue during vascular procedures and also support the contention that infectious complications do not necessarily accompany positive -cultures