Scourge of Peripheral Artery Disease in a Low-Income-Setting: The Role of VascularSurgery

Background: Peripheral artery disease (PAD) is a progressive disorder characterized by stenosis and/or occlusion of large and medium-sized arteries, other than those that supply the heart (coronary artery disease, CAD) or the brain (cerebrovascular disease). It is increasingly becoming a challenge in developing countries owing to poverty and ignorance. Objective: To review the scourge of peripheral artery diseases in our institution in a low-income setting with a view to determining the role of a vascular surgeon. Materials and method: Over a period of 15 years (2006 to 2021), patients with documented PAD were reviewed. Data of the patients were retrieved from the record department and such data included demography, aetiology/risk factors, clinical features and investigative parameters as well as modes of treatment especially vascular surgery. Results: There were 35 patients which comprised 20 males and 15 females with male to female ratio of 4:3. Age range affected most was 71-80 years. Aetiologically, artherosclerosis was dominant. Leriche Fontaine classification used in clinical evaluation showed that type III was dominant. 6 Ps (pain, pulselessness, paralysis, paraesthesie, pallor and poikilothermia) of vascular ischemia were evident. Doppler/duplex ultrasound and computer angiography were used in diagnosis. Medical and or surgical treatments were used in patients' management. Vascular and or orthopedic surgery played significant role. Conclusion: PAD affects the lower extremities more commonly than the upper extremity vessels especially in the elderly leading to intermittent claudicationn which is the most recognized symptomatic subset of lower extremity PAD. Morbidity and mortality emanating from inadequate revascularization are burden to emerging economy like ours.

Uso do laser de 1. 470 nm para o tratamento de insuficiência venosa superficial / Use of 1, 470 nm laser for treatment of superficial venous insufficiency

Resumo Contexto Existem diversas formas de tratamento de varizes de membros inferiores. Entre elas, destaca-se o uso do laser diodo de 1.470 nm. Essa técnica proporciona aos pacientes uma cirurgia em regime ambulatorial, com retorno precoce à atividade ocupacional, bom resultado estético e baixo índice de complicações. No entanto, ainda se discute exaustivamente variáveis como comprimento de onda do laser, potência aplicada em cada área, tipo de fibra, necessidade ou não de tumescência e densidade de energia endovenosa linear. Objetivos Analisar os resultados do tratamento da insuficiência venosa superficial com laser diodo de 1.470 nm. Métodos Estudo retrospectivo, realizado em uma clínica privada de um hospital privado em Florianópolis a partir de dados colhidos prospectivamente. As amostras eram de 287 pacientes submetidos à cirurgia para tratamento da insuficiência venosa superficial com laser diodo de 1.470 nm, de janeiro de 2016 a dezembro de 2018, totalizando 358 veias safenas magnas e 84 veias safenas parvas tratadas. Resultados A taxa de oclusão total após 12 meses de cirurgia foi de 94,4%, com densidade de energia endovenosa linear média de 45,90 J/cm nas veias safenas magnas e de 96,4% com densidade de energia endovenosa linear média de 44,07 J/cm nas veias safenas parvas. Conclusões No período acompanhado, o laser diodo de 1.470 nm mostrou-se um tratamento seguro, muito efetivo e com baixas taxas de complicações (dor, edema, equimose, trombose venosa profunda e trombose induzida pelo calor endovenoso).

Abstract Background There are several ways to treat varicose veins of the lower limbs, among which use of 1470nm diode lasers stands out. This technique can be used to treat patients in outpatient settings, with early return to work, good esthetic results, and low rates of complications. However, variables such as the laser wavelength, the power administered in each area, the type of fiber, and the linear intravenous energy density (LEED) are still extensively discussed. Objectives To analyze the results of superficial venous insufficiency treatment with a 1470nm diode laser. Methods Retrospective study conducted at a private clinic in a private hospital in Florianopolis, based on a database collected prospectively. The sample comprised 287 patients who underwent surgery to treat superficial venous insufficiency with 1470nm diode laser, from January 2016 to December 2018, totaling 358 great saphenous veins (GSVs) and 84 small saphenous veins (SSVs) treated. Results The total occlusion rates after 12 months of surgery were 94.4% in the GSVs, with an average LEED of 45.90 J/cm, and 96.4% in the SSVs, with an average LEED of 44.07 J/cm. Conclusions During the follow-up period, the 1470nm diode laser proved to be a safe treatment, with great efficacy and low rates of complications (pain, edema, bruising, deep vein thrombosis, and endothermal heat-induced thrombosis - EHIT).

Therapeutic effect of transmyocardial laser revascularization [TMLR] in patients with chest pain and normal coronary angiography [cardiac syndrome X]

Patients with syndrome X coronary disease represent a heterogeneous group of patients. Medical treatment with dilators and calcium channel blockers are not very effective. We evaluated the use of transmyocardial laser revascularization [TMLR] in treating 5 patients with this syndrome. Between May 2002 to December 2005, 5 patients with cardiac syndrome X [mean age of 49.7 years] underwent TMLR. All our cases were postmenopausal women. Mean class of Canadian class of angina was 3.4. Patients were none responding to maximum medical treatment. Angiograms showed small coronary arties with a large gap between branches which corresponded with severe ischemic on Thallium scan. We used Co2 laser between 35 to 45 joules of energy and we made 20 to 30 channels on the beating heart controlled by trans-esophagus echocardiography. Our patients were followed for 2.8 years. During follow up our patients remained asymptomatic and without any need medical treatment. Mean of Canadian class of angina after intervention was 1.8. Our patients returned to full activities. TMLR is an effective treatment in patients with syndrome X and coronary insufficiency

Surgical treatment for varicose vein / 中国医学科学院学报

<p><b>OBJECTIVE</b>To explore the techniques and outcomes of the surgical treatment for varicose vein.</p><p><b>METHODS</b>Totally 2 200 patients with varicose vein received surgical treatment in our hospital from July 2000 to January 2006. The latest techniques for endovenous occlusion were used for most cases, among which 1 802 cases were treated with endovenous laser treatment (EVLT) combined with transilluminated powered phlebectomy (TIPP), 82 cases with radiofrequency endovenous occlusion (RFO) combined with TIPP, and 218 cases with limited invaginated vein stripping and foam sclerotherapy. The remaining 98 cases were treated with laser, radiofrequency or ligation for saphenous vein trunk, and with resection, electric coagulation, and transfixation for vein clusters as additional methods. Perforators were also cut and ligated as well.</p><p><b>RESULTS</b>Satisfied surgical results were obtained in all cases. The average operative time was 40 minutes (range 20-78 minutes).</p><p><b>CONCLUSIONS</b>Limited invaginated vein stripping, EVLT, and RFO can be used to treat saphenous vein reflux. Surgical resection, transfixation, electric coagulation, and sclerotherapy are reasonable options for vein cluster or tributaries. Transection and ligation of the perforators are important. TIPP is ideal for the treatment of vein clusters.</p>

Chronic effects of transmyocardial laser revascularization combined with off-pump coronary artery by pass (OPCAB) compared with OPCAB alone in patients with ischemic heart disease: a prospective multicenter follow-up study / 中华心血管病杂志

<p><b>OBJECTIVE</b>To approach the long term safety and efficacy of transmyocardial laser revascularization (TMLR, holmium: YAG) combined with off-pump coronary artery bypass (OPCAB) compared with OPCAB alone in patients with ischemic cardiac disease.</p><p><b>METHODS</b>Between 1999 and 2005, 80 patients with diffusely diseased target vessels from two centers in Beijing were enrolled to the study and randomized to receive either TMLR/OPCAB (n = 40) or OPCAB (n = 40) operation. Baseline demographics and operative characteristics were similar between groups. Follow-up (mean 3.4 +/- 1.7 years) included CCS angina class and NYHA classification assessments, 6 minutes walking test (6MWT) and echocardiography.</p><p><b>RESULTS</b>Perioperative mortality was 5% in both groups. No death occurred during follow up. At the end of follow-up, patients at both groups experienced significant improvement on angina score compared with baseline, and angina score was also significantly lower (1.21 +/- 0.42 vs. 1.57 +/- 0.87, P = 0.03) and 6MWT-distance significantly increased (518.0 +/- 65.5 m vs. 473.8 +/- 65.8m, P = 0.006) in OPCAB/TMLR group than that in the OPCAB group. Fewer patients developed recurrent severe angina and received re-CABG/PCI in OPCAB/TMLR group than that in the OPCAB (1 vs. 6 cases, P = 0.113). NYHA and LVEF were similar between the groups at the end of follow up.</p><p><b>CONCLUSION</b>Our study showed that the addition of TMLR to OPCAB is superior in improving angina and exercise tolerance, but there is no further improvement in cardiac function compared to OPCAB alone.</p>

Clinical features of idiopathic ventricular tachycardia of various types and their radiofrequency ablation therapy / 南方医科大学学报

<p><b>OBJECTIVE</b>To analyze the clinical features idiopathic ventricular tachycardia (IVT) and evaluate the effect of radiofrequency ablation therapy for their management.</p><p><b>METHODS</b>An retrospective analysis was conducted in 165 IVT patients who received radiofrequency ablation therapy. IVT was classified into 3 types according to the site of origin, namely the right ventricular outflow tract (RVOT-IVT, 86 cases), left ventricular septum (LV-IVT, 75 cases), and left Valsalva sinus (4 cases).</p><p><b>RESULTS AND CONCLUSION</b>RVOT-IVT was more frequent in female patients than in male patients (60 vs 26, M/F ratio of 0.43). In LV-IVT, male patients prevailed (54 vs 21, M/F ratio of 2.57), suggesting a gender difference in the incidence of IVT. IVT occurred mainly in young and middle-age patients. Most RVOT-IVT occurred in the third to fourth decade of life (mean 36-/+12 years), and LV-IVT occurred at a younger age than did RVOT-IVT (mean 26-/+15 years, P<0.01). Twelve-lead ECGs revealed left bundle branch block morphology in RVOT-IVT, and most of them presented with frequent premature ventricular contraction and/or non-sustained ventricular tachycardia. All the RVOT-IVT patients were successfully ablated by radiofrequency energy in pace mapping. LV-IVT patients with right bundle branch block morphology presented sustained ventricular tachycardia for most of the time, and 97% of the patients were successfully managed with radiofrequency ablation in activation mapping. Four IVT patients were characterized by atypical bundle branch block, an inferior axis, and an R/S ratio >1 in lead V3 or V2, and their tachycardia was ablated successfully in the left sinus of Valsalva using pace mapping. Radiofrequency ablation is currently an effective procedure for IVT management.</p>

Intervençäo coronaria por cateter / Coronary intervention through catheter devices

O objetivo do trabalh e definir os metodos atualmente disponives para o tratamento da aterosclerose coronaria, bem como discutir suas indicacoes com base na experiencia obtida no HCPA, iniciada em 1986. Foram feitos ate o presente 1.330 procedimentos intervencionistas, desde angioplastia classica por cateter-balao (ACTP) ate os metodos alternativos, como aterectomia coronaria direcionada (ACD), a aterectomia coronaria rotacional (Rotablator), angioplastia coronaria por laser (Excimer-Laser) e a implantacao de "Stents" coronarios

O efeito da iridectomia periférica em pacientes com glaucoma pigmentar / The effects of peripheral iridectomy on pigmentary glaucoma

Os autores analisaram o efeito da iridectomia periférica em olhos com glaucoma pigmentar. Realizaram-se dois estudos com este objetivo: o primeiro, retrospectivo, comparava olhos de pacientes com glaucoma pigmentar bilateral que haviam sido submetidos à iridectomia periférica em apenas um dos olhos. O segundo, prospectivo e randomizado, comparava olhos submetidos ou näo à iridectomia periférica. O estudo retrospectivo mostrou que os olhos submetidos à iridectomia apresentaram uma mudança significativa da configuraçäo da íris periférica, além de reduçäo da pigmentaçäo da malha trabecular e do fuso de Krukenberg. O estudo prospectivo demonstrou um estreitamento do ângulo dos olhos submetidos à iridectomia, o que foi constatado através de uso de instrumento de análise computadorizada do segmento anterior. Demonstramos pela primeira vez que a iridectomia periférica em pacientes com glaucoma pigmentar pode promover uma alteraçäo da configuraçäo angular e pode reduzir a dispersäo pigmentar. Um maior período de seguimento será necessário para avaliar os efeitos sobre a pressäo intra-ocular e a progressäo do dano glaucomatoso ao nervo ótico.

Percutaneous coronary excimer laser-assisted balloon angioplasty: successful clinical and angiographic results

Preliminary clinical experience of Xenon-chloride excimer laser coronary angioplasty has show it to be a safe and an effective means of non-surgical coronary revascularization in selected group of patients. We are reporting an application of laser excimer angioplasty in four patients with significant coronary artery disease. Two patients had left anterior descending artery disease. The first, a long proximal segmental lesion and the second, subtotal obstruction of the left anterior descending artery. The third and fourth patients had occluded circumflex and right coronary artery respectively. All patients underwent successful excimer laser angioplasty procedures assisted by subsequent balloon dilation. All had successful outcome with no mortality or significant morbidity

Percutaneous support for complex coronary angioplasty

Percutaneous transluminal coronary angioplasty is now applied to patients with unstable acute ischemic syndromes, complex coronary morphology, severe multivessel coronary artery disease and impaired left ventricular function. In order to minimize the risk during angioplasty, several coronary and systemic circulatory support approaches have been developed as adjunct to complex and high risk angioplasty. Local coronary support techniques include perfusion balloon catheter, coronary stent, directional coronary atherectomy, laser balloon angioplasty, perfluorocarbon coronary perfusion, coronary sinus retroperfusion and distal coronary hemoperfusion. Systemic circulatory supports include intraaortic balloon counterpulsation, cardiopulmonary support, hemopump and left heart partial bypass. These support devices, while associated with significant complications, may ultimately improve the safety of coronary angioplasty and allow its application to those who would otherwise not be candidates for revascularization

Arteriopatía periférica oclusiva de miembros inferiores en internados del I.N.S.S.J.P. (PAMI) República Argentina-1990 / Occlusive peripheral arteriopathy of lower extremities in patients hospitalized of the I.N.S.S.J.P. (PAMI) Republica aRGENTINA

Las arteriopatías oclusivas periféricas son importantes como causa de padecimiento crónico y por la posibilidad de llevar a la amputación y aun a la muerte. Es escasa la información epidemiológica sobre la magnitud de estas enfermedades. Para conocer su frecuencia en nuestro país y algunos factores relacionados con repercusión de la enfermedad y con la demanda de servicios de atención médica, el Centro de Investigaciones Epidemiológicas (CIE) de la Academia Nacional de Medicina de Buenos Aires, Argentina, realizó un estudio colaborativo en organizaciones dedicadas a la atención médica en los cuales se registraron y se auditan las para estudios y tratamientos especiales. Estas órdenes fueron usadas como instrumento para detectar casos. El Servicio Social para Jubilados (PAMI) elegido para el estudio, tiene una "población" de más de 3 millones de personas, de las cuales hay mayoría de mujeres. Una encuesta en las órdenes para estudios/tratamientos, durante un período de 10 meses, permitió identificar 2.679 casos, de los cuales 72 por ciento eran varones y sus edades variaban desde 21 hasta 95 años. Se hallaron 4 diagnósticos: Arterioesclerosis 58,7 por ciento, Gangrena arterioesclerótica 20,3 por ciento, Angiopatía diabética 8,8 por ciento y Gangrena diabética 12,2 por ciento. La proporción de estudios (no invasivos o invasivos) y de tratamientos (médicos o quirúrgicos) así como de algunos procedimientos especiales fueron tabulados según sexo, edad y diagnóstico. Se halló diabetes en 21,1 por ciento de los casos (18,7 por ciento en varones y 27,2 por ciento en mujeres). Las tasas de prevalencia específicas (por mil) para sexo y edad variaban en los varones desde 0,001 en edad 21-30 hasta 2,285 en edad 66-70, y en las mujeres, desde 0,022 en edad 21-30 hasta 0,618 en edad 76-80