Modified axillary brachial plexus block: a novel technique for basilac vien superficiliziation arterio-venous fistula

To evaluate the efficacy and safety of a newly developed axillary brachial plexus anesthesia by a modified technique in basilac vien superflcialization arterio-venous fistula as a sole anesthetic agent in patients with end stage renal disease. Forty patients were studied aged [30-60yrs]. All patients with end-stage renal disease and underwent basilac vien mobilization A-Vfistula. Patients were classified into two equal groups, group A in which we tried our new modfled [open] axilary brachial plexus block and group B where traditional axillary brachial plexus block was used. Sensory and motor block were assessed at 0, 5,10, 20, 30 min and then 1 and 2 hours. Any analgesics, sedatives, and anesthetics given to the patient was recorded. In group A there was a significant increase in the number of patients with adequate sensory/motor block for surgical anesthesia [90%] while it was [60%] in group B also time of onset of sensory block was significant by shorter in group A. Total failure was [15%] in group B and [25%] had incomplete block requiring either local infiltration or general anesthesia vs no failure[0%] in group A. The modified brachial plexus block could be introduced as safe and effective new technique in blocking axillary brachial plexus. However this maneuver could be used as sole anesthetic agent selectively in patients underwent basilac vein mobilization A-V fistula

Efficacy of preoperative duplex scanning in planning for infrainguinal revascularization procedures

To evaluate safety and efficacy of preoperative duplex scanning in planning for infrainguinal revascularization procedures. Thirty patients [mean age 70 years] underwent elective DSA of lower extremity arteries at the Vascular and Endovascular Surgery unit of Perugia, Italy and were included in the study. Duplex evaluation of arterial lesions was performed for the site and degree of severity. Results were compared with DSA serving as the standard reference. Our study showed that duplex was able to determine significant lesions [either critical stenosis or occluded segments] in the femoral region with an overall sensitivity and specificity of 96.5% and 93.3% respectively and 77.7% and 99.1% as the positive predictive and negative predictive values respectively. At the popliteal region, we estimated the sensitivity and specificity as 84% and 89.2% respectively and 75% and 93.5% as the positive and negative predictive values. The overall accuracy measurements of duplex scanning at the region of leg vessels were 82.9%, and 89.4% for combined anterior and posterior tibial arteries. It seems feasible to perform infrainguinal arterial reconstructions, without preoperative angiography. Technical limitations of duplex scanning leading to inaccurate assessment of the inflow and outflow arteries, or non-visualized distal runoff arteries, should prompt angiographic evaluation

Vascular complications of diagnostic angiography via femoral artery

Vascular complications of angiographic procedures are important causes of iatrogenic morbidity. During a five-year period, thirteen patients were managed for vascular complications following angiographic procedures via the femoral artery. Eleven patients had acute limb ischemia, one had a retroperitoneal hematoma and shock and one was presented one month after catheterization with a femoral pseudoaneurysm. The management and outcome of these complications were presented and discussed. It was recommend that every clinician requesting angiography must be aware of its complications as early diagnosis is the key for successful management

Assessment of carotid artery stenosing lesions using color duplex ultrasound

The study population consisted of 646 carotid artery in 323 cases with 174/149 male/female ratio and a mean age of 54.6 +/- 3.9 years. They included cases with transient ischemic attack [TIA, 176 cases], developed stroke [CVA, 21 cases], cases with non-focal symptoms [NFS, 38 cases], cases with asymptomatic cervical bruit [CB, 58 cases] and normal volunteers [30 cases]. It was concluded that the best documented clinical indication for carotid duplex sonography is the detection of high grade stenosis in patients with TIA or stroke with good recovery. Particular attention should be paid for the study of the plaque morphology for detection of risky lesions that warrant surgical intervention. Excellent argument can be made for examination of asymptomatic persons particularly in the presence of any of the risky factors [hypertension, heart disease, smoking or diabetes]. These cases have to be scheduled for follow up duplex examination as a prophylactic measure to avoid if any future cerebral ischemic lesions is anticipated

Evaluation of proximal splenorenal shunt for the management of bleeding esophageal varices

Twenty-six patients subjected to proximal splenorenal shunt [PSRS] for the management of variceal bleeding are presented. Preoperative evaluation included thorough clinical examination, complete blood count, liver function tests, heptititis B surface antigen, parasitological examination of the stools, rectal mucosal snip for schistosomal eggs, abdominal ultrasonography with emphasis on splenic and portal veins, and upper gastrointestinal endoscopy. Postoperalively the patients were followed-up every three months for one year by repeating the previous investigations and the patency of the shunt was checked by duplex scan. The immediate operative mortality was 3.8% [2/26]. Subsequent variceal bleeding was noted in 8% of survivors [2/25], and portosystemic encephalopathy [PSE] in also 8%. Eighteen patients [69.2%] had preoperative hypersplenism While statistically significant improvement was found in blood count, no change could be detected in liver chemistries. Analysis has suggested that PSRS is an effective technique with accepted mortality and morbidity