Upper limb ischaemia - a single centre experience.

INTRODUCTION: This paper reviews the epidemiology, aetiology and management of upper limb ischaemia in a series of 8 patients presenting to a tertiary referral centre over a 4-year period and the review of the pertinent literature. MATERIALS AND METHODS: Details of patients admitted to Tan Tock Seng Hospital (TTSH) due to critical ischaemia of the upper limbs were obtained from admission summaries through the Computerised Patient Support System (CPSS) and operative notes through LOTUS. RESULTS: There were 8 patients who presented with upper limb ischaemia excluding trauma and iatrogenic causes over the last 4 years. All patients underwent embolectomy. One patient had an amputation post-embolectomy. Our short-term results were encouraging with 7 patients who were well enough to be discharged. One patient had a massive brainstem stroke and was discharged home for comfort care at the request of the family. CONCLUSION: Careful physical examination and history taking, prompt recognition of upper limb ischaemia and active approach to management in the form of embolectomy are crucial in obtaining a good outcome and reducing the risk of late disabling effects.

Isolated common femoral artery aneurysm: a case report.

INTRODUCTION: Isolated aneurysm of common femoral artery is a rare occurrence. They may mimic other common conditions like groin lymph nodes or groin hernia. CASE PRESENTATION: Here we present a case of 61-years-old Chinese gentleman who presented with a right groin lump, which was suspected to be groin hernia but turned out common femoral artery aneurysm. The aneurysm was surgically excised and a prosthetic vascular repair was done. CONCLUSION: Isolated common femoral artery aneurysms are rare and can mimic groin hernias, so one must be careful. Color Doppler is the investigation of choice. Best treatment modality is surgical excision with repair with or without graft for aneurysms > 2.5 cm.

Surgical management of infected pseudoaneurysms in intravenous drug abusers: single institution experience and a proposed algorithm.

BACKGROUND: Vascular complications from intravenous drug abuse pose significant challenges to vascular surgeons. No formalized policies have been reached on surgical management of the resultant infected pseudoaneurysm. METHODS: A retrospective review of all patients who underwent surgery for pseudoaneurysms due to chronic intravenous drug abuse from July 2005 to February 2008 was performed. RESULTS: A total of 15 patients with infected pseudoaneurysms from chronic intravenous drug abuse were operated on during the study period. The sites of involvement were restricted to the femoral (86.7%) and brachial (13.3%) areas. The drug involved was buprenorphine (Subutex) in all cases. Pain over the limb swelling (100%), pulsatility (60%), and symptoms suggestive of septicemia (46.7%) were the most common symptoms. Staphylococcus aureus was present in 93.3%. Diagnosis was achieved clinically in 26.7%, by duplex ultrasonography in 60.0%, and by computed tomography (CT) angiography in 13.3%. In the two patients with brachial pseudoaneurysms, the brachial artery was ligated in one, and a basilic vein patch was used in the other. In the 13 patients with femoral pseudoaneurysms, the pseudoaneurysm was ligated and excised in 8 (61.5%), and immediate reconstructive bypass surgery was performed in 5 (38.5%). Two patients had critical ischemia after ligation and required reconstructive bypass surgery a few weeks later. Postoperative complications included claudication, digital gangrene, localized wound infection, and rebleeding. There was no associated mortality. CONCLUSIONS: Pseudoaneurysm from intravenous drug abuse continues to pose significant challenges to surgeons worldwide, ranging from an accurate diagnosis to the choice of surgery. The aims of surgery must be to achieve adequate débridement and control infection and hemorrhage. Any associated postoperative complications must be identified and dealt with.