Role of infra-popliteal balloon angioplasty in the management of critical limb ischemia

The purpose of this study was to evaluate the patency rate and effectiveness of the percuatanous trans-luminal angioplasty [PTA] as a primary therapy for infra-popliteal occlusive disease. Twenty patients had angioplasty for Critical lower limb ischemia due to infra-popliteal disease between May 2005 - May 2007. We collected data on patient demography, symptoms, as will as pre and post procedure ankle - brachial pressure index [ABI] and angiographic findings. Thirteen men and 7 women had a mean age of 62 years. Risk factors included smoking in 70%, diabetes in 60%, hypertension in 40%, and end -stage renal disease in 1%. The indication for intervention were persistent rest pain in 50%, foot ulcer 30% and gangrene of foot or toes 20%. Immediate results were good in 19 patients with one case of technical failure .Three patients had restenosis at mean period of 7 months. There was one major and three minor amputations. Average follow up was11.2 months. The mean post procedural increase in ABI was 0.29. PTA of the infra-popliteal vessels has low morbiditiy, high success rate, and acceptable patency rate

Retrievable IVC filter insertion for temporary protection in patients at high risk of pulmonary embolism

Purpose: The aim of this study was to assess the efficacy and safety of retrievable vena caval filters in preventing pulmonary embolism in high risk group of patients when filter indications were transient

Patients and methods: Twenty Allen square stent retrievable filters [SSF] were temporary inserted in 20 patients [8 males and 12 females, median age 41 years] who at transient high risk of pulmonary embolism [PE]. The patients were referred to the vscular surgery department. El Housein hospital during the period from July 2004 to July 2005. All filters were reviewed for deployment or retrievial complications as migration, dislodgment, tilting malposition or thrombosis inside the filter. The filters were retrieved from 2 days to 2 weeks from their insertion. All patients were reviewed for PE either clinically or radiologically [plain x ray chest, ventilation/perfusion scan or CT scan] in suspected cases

Results: All patients were proven to have DVT [100 %] either of lower limbs veins in 17 patients[85%] or of pelvic veins in 3 patients[15 %].The patients were referred from general surgery [8], obstetric and gynecology [6], and from vascular clinic [6]. The main temporary filter indication was thrombolysis therapy [60%]. Transfemoral insertion was done in 15 patient [75%], and transjugular insertion was done in 5 patients [25 %]. The average filter time was 5.4 days. The main filter problem was filter thrombosis [2 patients]. All filters were retrieved safely except one was left as permanent filter because of thrombosis. Two patients died during follow up becauses of causes other than PE

Conclusion: The square stent filter is easy to place and to retrieve, is stable after placement, and has a high efficacy for trapping emboli and excellent protection against PE

Foam treatment for varicose veins; efficacy and safety

To demonstrate the efficacy and safety of foam sclerotherapy in the treatment of varicose veins measured against patient satisfaction, symptom relief, clinical examination and duptex scanning. From October 2004 to October 2005, 100 legs with varicose veins treated with ultrasound guided sclerosing foam prepared according to Tessari method by mixing Ethanolamine Oleate [E.O] with air using 2 disposable syrings and a three way tap producing a high-quality micro foam.Every patient was studied with clinical examination and duplex scanning before and after the treatment with a mean follow up of 12 months. An average of 8 ml of E.O. 5% foam were required to close incompetent varicose veins. Thirty percent of legs required a second treatment at the 3rd month of follow up. All patients felt that their legs had treated successfully with resolution of all symptoms in 85% and resolution of all varicosities in 92%. Foam sclerotherapy is safe and effective therapy in treating varicose veins with high patient satisfaction and improvement in quality of life