Percutaneous inferior vena cava filters 3 years experience

This is a retrospective study of 22 patients in whom a Titanium Greenfield Vena Cava filter was placed, between 1992 and 1994. Indications for placement were mainly for patients with deep venous thrombosis or pulmonary embolism with either anticoagulant failure or contraindication. Several technical difficulties and complications are described along with the suggestion about how best to avoid them. A comparison between this type of filter and the stainless steel model is described and showed the superiority of the titanium model. Mortality rate was 4.5% [1 case], and on long term follow up 1 case had recurrence of pulmonary embolism and no cases showed signs of venous stasis or vena cava occlusion. It was concluded that, the use of the titanium filter compares favorably with reports in the literature and is improving as experience is gained. Careful estimation of the cost benefits of using this device is needed as indication for it's use and confidence of the physician increases

Bronchial artery injuries: a civilian experience with 27 cases

Between January 1989 and January 1992, 27 cases with brachial artery injury were operated upon at Ain Shams University Hospitals. Penetrating trauma was the predominant cause. In 14 patients, there was associated median and/or ulnar nerve injury. In 5 patients, there was associated bone injury. In 20 patients, a reversed saphenous vein graft was inserted to restore arterial continuity. In 4 patients, end to end anastomosis was possible. An interposition reversed basilic vein graft was used in one patient, lateral suturing in one patient and an axillary-brachial saphenous vein bypass was performed in one patient. No single amputation was required. However, the functional disability resulting from associated nerve injury was pronounced. Nerve repair was not accomplished on emergency basis in this study. Intra-operative angiography was employed to detect associated distal vascular injury in the forearm. The mortality rate was zero per cent as associated distant injuries were not serious

In-situ saphenous vein graft for management of critical ischemia of the lower limb

Over the last two years, 48 patients with critical chronic ischemia of the lower limbs were treated in the Surgery Department, Ain-Shams University by in situ saphenous vein graft. Additional profundoplasty was done in 12 cases. Early graft thrombosis occurred in three cases, for whom thrombectomy was done under local anesthesia. Late graft failure occurred in 12 cases. Four of these were not symptomatic. Such cases had profundoplasty in addition to the in situ saphenous vein graft. In the remaining 8 occlusions, above-knee amputation was required in 4 cases either because of extensive gangrene or because of failure of the redo of the revascularization by the use of goretex grafts. Thirty-three patients had satisfactory results. Follow up for 1-28 months showed graft patency and freedom from symptoms. Two patients died after hospital discharge, one of them succumbed following a cardiovascular accident. The great advantage of the in situ saphenous vein graft is the feasibility of doing arterial reconstruction at the level of more distal limb arteries as a limb salvage procedure