Use of Intralesional and Perilesional Human Recombinant Epidermal Growth Factor (hrEGF) in the Local Treatment of Venous Ulcer - Review Article - Expert Recommendation.

Venous Ulcers (VU) represent 60-80% of all leg ulcers and are the final stage of the disease secondary to venous hypertension or valve insufficiency. Conventional treatment that focuses on its etiological factors continues to be the gold standard; however, 30% of ulcers do not heal with this treatment; thus, it has been seen that the use of growth factor can be used as an adjuvant for this pathology. A literature review was carried out to evaluate the evidence from systematic reviews, meta-analyses, case studies, and quantitative studies that respond to the objective of this analysis review in the different databases with specific inclusion criteria with publications between 2002 and 2022, initially finding the topical application of the factor and later, more recently, the intralesional and perilesional application, the latter being an alternative treatment for this type of pathology and generating some recommendations for using the Factor.

Open resection for a large iatrogenic radial artery pseudoaneurysm. Case report.

INTRODUCTION AND IMPORTANCE: We present the case in which a large symptomatic pseudoaneurysm (PSA), 6 × 5 cm, with one year of evolution on the path of the right radial artery (RRA) appeared after its punction and cannulation for performing cardiac catheterism in an atrial fibrillation (AF) indefinite anticoagulated patient. Diagnosis and surgical planning were consolidated only by using color duplex ultrasound (CDU), contrasted images were not indicated. The open surgical management was performed during a short-time supraclavicular blockade of peripheral nerves without stopping nor bridging anticoagulant therapy. Complete excision of the deforming mass with no blood loss, decompression of the adjacent structures and direct closure of the arterial defect without compromising of its lumen and path were also achieved. CASE PRESENTATION: A 74-year-old, Hispanic male patient and former smoker underwent coronary catheterization for thoracic typical pain. One year after, he is admitted for move restrictive pain in distal right forearm and hand paresthesia related to a rapidly growing right radial artery PSA of 6 cm in diameter where the indefinite anticoagulation, indicated for chronic AF, confers a risk of major bleeding. After clinic and exclusive CDU assessing, the patient granted us written authorization for performing an open surgery. One year follow up showed an asymptomatic patient with no RRA residual lesions. CLINICAL DISCUSSION: Although contrasted are the preferred diagnosis methods when arterial issues are suspected especially angiography since, when indicated, the endovascular treatment may be performed immediately after diagnosis. The CDU performed with a high-sensitivity transducer is the image of choice for an immediate differential diagnosis (Meola et al., 2021 [1]). In addition, it allowed us to see both, the particular PSA inside structure and the patency of ipsilateral ulnar artery, necessary details to propose the successful open surgical treatment finally conducted. CONCLUSION: Vascular and trauma surgeons should be trained to ensure the correct diagnosis based on preexisting medical conditions, clinical findings and those provided by CDU in order to offer an appropriate and definitive management to peripheral vascular iatrogenic lesions with potential bleeding risk, especially in anticoagulated patients. Since large limb deforming PSAs are recommended to be excided through open access, they should also be trained to perform it without additional risks nor sequelae. Since the number of AF patients is increasing worldwide, main aspects on anticoagulation therapy have to be taught to every surgical team.

Gunshot-related giant brachial artery pseudoaneurysm: Case report.

Pseudoaneurysms are late and rare complications in the upper limbs due to penetrating vascular trauma. Although endovascular management is offered as the ideal approach, there are some anatomical conditions to consider surgical treatment. An 18-year-old patient was admitted into our hospital two months later after suffering a single gunshot on the left arm. The arteriography showed loss of most of the branchial artery (BA) course, which was replaced by an unusual 14 ∗ 10 cm pseudoaneurysm. The increasing deformity within the anterior compartment of the arm generated neuropathic and ischemic symptoms (NIS) that were resolved after the drainage and reconstruction of BA. An autologous, ipsilateral basilic vein (BV) graft was used for this purpose. After 26 months, the normal hemodynamic conditions of the treated limb allowed the patient to remain asymptomatic.