TP5.2.2 Office based endovascular radiofrequency ablation (OBEVRFA) as a standalone procedure for varicose veins

Aims The aim of this study was to identify the number of patients that required a secondary procedure for persistence/ recurrence of symptoms within 3 years of the index (OBEVRFA) procedure. Method Retrospective analysis of data collected prospectively for patients booked to have OBEVRFA in the period January 2017- January 2018 was accessed from electronic patient records. Their clinic follow letters, scans and any secondary procedures done were documented on an excel sheet. Results A total of 303 patients, were booked for an OBEVRFA of which 17 (5.6%) patients did not attend the procedure. 39 (12.8%) patients were cancelled on the day of the procedure. 247 patients (M:F 1:1.5), underwent OBEVRFA. 53 patients (21.8%), had residual veins or were symptomatic & were followed up beyond their 3 month period. 24 patients had a duplex scan which showed complete recanalization in 4, a reflux in non-treated secondary vein (Like Anterior thigh vein or duplicated Long saphenous vein) and a new perforator incompetence in others. 40 (16.1%) patients eventually underwent secondary procedures, 8 underwent classical High flush ligation and stripping with multiple stab avulsions (MSA) , 7 had a redo OBEVRFA, 3 had a redo RFA with MSA under GA, others had MSA alone and 1 had successful sclerotherapy. 3 patients were not keen for a secondary procedure. Conclusion OBEVRFA alone provides complete symptomatic relief in over 80% of patients with only 16% needing a secondary procedure. For symptomatic varicose veins from truncal reflux OBEVRFA should be the first line treatment on NHS.

A Study of Transcutaneous Oxygen Saturation by Pulse Oximetry in Symptomatic Ischaemic Lower Limb – A Cross Sectional Analytical Study in a Tertiary Care Hospital in Tirupathi

BACKGROUND Chronic arterial insufficiency (CAI) results in stenotic-occlusive disease of vascularized arterial disorders of tissues and organs. CAI of the lower extremities represents a significant medical and socio-economic problem due to a high incidence of morbidity, invalidity and mortality. METHODS A cross sectional analytical study was conducted in a group of 100 patients, admitted at the Vascular Department of the Sri Venkateshwara Ramnaraian Ruia Government General Hospital, Tirupati during the period from September 2018 to August 2019, with evident symptoms and signs of different stages of lower extremities CAI verified by ultrasonography. In patients with lower extremity disorder of tissue arterial capillaries, SpO2 was determined by pulse oximetry. CAI of the lower extremity was determined on the basis of clinical findings and colour Doppler duplex scan echo sonography results. Using the conventional method (single-gate) and colour Doppler duplex scan (multi-gate), the presence and localization of stenosis, the segmental predominance (with multisegmental forms) and the degree of progression of stenotic-occlusive lesions were verified. RESULTS Results Using pulse oximetry, depending on the of stage of lower extremities CAI, we revealed a considerable difference in the stages of functional ischemia Mean SpO2: Fontaine I – 95.50 %, Fontaine II – 92.90; in stage critical ischemia SpO2: Fontaine III – 65.00 % and Fontaine IV – 49.87 %. In 29 patients with gangrenous foot and fingers SpO2 was immeasurable and progressive decrease in SpO2 of arterial capillaries (p<0.01 between stages). CONCLUSIONS Due to the reliability and simplicity of pulse oximetry it can be a routinely used diagnostic device for patients with early determined stage of lower extremities CAI. KEYWORDS Chronic Arterial Insufficiency, SPO2, Pulse Oximetry, Ischemia

701 Combined Endovascular and Percutaneous Treatment of Traumatic Pseudoaneurysm of Profunda Femoris Artery: A Case Report

Pseudoaneurysms of the profunda femoris artery are rare complications of femoral fractures, seen especially after orthopaedic interventions for the same. We present a case of an 89-year-old Caucasian male with a left neck of femur fracture, repaired with a dynamic hip screw. He presented to us a month later with a painful swollen thigh and deep vein thrombosis. The patient underwent arterial duplex and CT angiogram scans and was found to have a pseudoaneurysm in his left profunda femoris artery, measuring 3x3x4.5cm. This was treated with balloon angioplasty and stenting. However, his stent surveillance duplex scan, a month later, showed that the pseudoaneurysm was largely thrombosed with a patent core that was being fed by a communicating vessel from the superficial femoral artery. A subsequent angiogram showed no obvious feeding vessel. The patent pseudoaneurysm was then treated by percutaneous injection of thrombin. Exclusion of the pseudoaneurysm was confirmed by a follow-up duplex scan. It is essential to treat all feeding vessels of pseudoaneurysms in the presence of a rich collateral supply. Profunda femoris false aneurysms can thus be treated entirely by endovascular/percutaneous methods and so, potentially avoid open surgery.

An “Occult” Popliteal Vein Aneurysm Causing Pulmonary Embolism

Popliteal vein aneurysm (PVAs), though uncommon, can be a cause of pulmonary emboli. They can also result in pulmonary vein embolism despite the use of anticoagulation therapy.We report the case of an otherwise fit, 64-year-old male who had a history of sudden onset of dyspnea on exercise with near syncope.A computed tomography pulmonary angiogram confirmed filling defects in the lung bases in keeping with pulmonary emboli. He was anticoagulated and a venous duplex scan revealed a fusiform suprageniculate PVA with no evidence of thrombus in the lumen. He underwent resection of the aneurysm with lateral vein patch graft repair and was placed on anticoagulation for 6 months with no recurrence after 2 years of follow-up.PVAs are rare and can either be symptomatic or asymptomatic. We advise early surgical treatment to prevent the significant morbidity and mortality associated with thromboembolization.Written consent was obtained from the patient for publication of case and use of images.

KẾT QUẢ DÀI HẠN PHẪU THUẬT CẦU NỐI ĐỘNG MẠCH CHỦ NGỰC - ĐỘNG MẠCH CẢNH - DƯỚI ĐÒN

Objectives: The complex stenosis of the branches of the aortic arch is rare, it was the challenge for vascular surgeon to manage. The purpose of thisstudy was review our experience with diagnosis and surgical treatment for complex stenosis of the branches of the aortic arch .Methods: Prospective. Eveluate the clinical characteristics of complex stenosis of the branches of the aortic arches. Diagnosis was based on Dupplex scanning, MSCT and angiography. Intrathoracic bypass was indicated for all cases. Results: From 10/1999 to 10/2011, twelve patients with complex stenosis of the branches of the aortic arch were treated in Choray hospital and Thong nhat hospital. 4 cases stenosis of the carotid and the subclavian artery; 4 cases have stenosis the branchiocephalic artery; and 4had stenosis all of the branches of the aortic arch. 10 cases admission because of chronic upper extremity ischemia. 12 cases had TIA. Takayashu’s disease affected in 6 cases, atherosclerosis was the cause of 6 patients. All patients were diagnosed by Duplex scan, MSCT and arteriography. 2 cases with 99 percent stenosis, the others were completely occluded.Upper partial sternotomy were performed in all cases.; Aorto carotido-subclavian bypass in 7 cases; Aorto bi-carotid bi-subclavian bypass were performed in 4 cases; Branchiocephalo carotid and subclavian bypass in 1 case, PTFE prothesis graft was used in 2 cases. Dacron prothesis was used in the rest .No procedure-related mortality was observed. No stroke. There are 1 wound infection, No restenosis after 12 years follow up.Conclusions: Upper partial sternotomy is a very good approach for ascending aorto carotidosubclavian bypass operation. Ascending aorto carotido subclavian bypass should be done for stenosis of multi-branches.

Venous pectoralis minor syndrome: a rare subdivision of the thoracic outlet syndrome

We analysed data of all patients who had received surgery for rare, isolated venous pectoralis minor syndrome at our tertiary institution from January 2015 to December 2018. Venous duplex scan was the preferred mode of diagnosis in all our patients. We operated on patients via a 5–6 cm deltopectoral groove incision. Ten procedures were performed on 6 patients, of whom 5 were female. The median age was 23 years (range 17–33 years). Three patients (2 female, 1 male) with bilateral pectoralis minor syndrome had separate procedures performed over a course of a few weeks. The median operating time was 22 min (range 15–95 min). Median blood loss was 20 ml (range 5–410 ml). The median hospital stay was 2 days (range 1–5 days). There was one complication in the form of a recurrence on the right side in a patient who had bilateral pectoralis minor syndrome. No other morbidities were recorded. Nine of 10 procedures (90%) were classified by patients as being satisfactory, where symptoms had partially or completely resolved. Our experience emphasizes the need for a systematic search and to maintain a high index of suspicion for venous pectoralis minor syndrome in all patients complaining of painful symptoms related to thoracic outlet syndrome. The deltopectoral groove approach is a simple and straightforward incision with a gentle learning curve.

Fístula arteriovenosa pós-cateterismo radial com repercussões cardiopulmonares

Resumo O presente artigo relata o caso de um paciente coronariopata de 86 anos submetido a cateterismo cardíaco via acesso radial à esquerda. Cerca de 16 meses após o procedimento, manifestou dispneia sem relação com esforço, associada a hipóxia noturna. Apresentava frêmito à palpação do punho esquerdo e foi diagnosticado com fístula arteriovenosa radiocefálica no punho esquerdo. Ao duplex scan apresentava alteração de padrão de onda e aumento da velocidade diastólica compatível com fístula arteriovenosa. Foi submetido a correção cirúrgica da fístula, apresentando melhora clínica e laboratorial após o procedimento. O acesso radial para cateterismo cardíaco tem sido cada vez mais utilizado, principalmente por causar complicações menos frequentes e menos deletérias em comparação ao acesso femoral. Entretanto, complicações como fístula arteriovenosa ocorrem e podem ser especialmente prejudiciais em pacientes octogenários.

Transposição da veia braquial como acesso para hemodiálise: uma alternativa ao uso de prótese sintética

Resumo Contexto Atualmente, observa-se um esforço mundial para aumento do número de acessos autógenos para hemodiálise. Objetivos Avaliar a perviedade e as complicações da transposição da veia braquial em comparação aos outros acessos autógenos para hemodiálise. Métodos Avaliação retrospectiva de 43 pacientes, com 45 procedimentos. Os pacientes que não apresentaram veias do sistema venoso superficial adequadas ao Duplex Scan pré-operatório foram submetidos à transposição da veia braquial. Esses procedimentos foram divididos em dois grupos: A: uso da veia braquial, n = 10. B: demais acessos, n = 35. Resultados Não houve diferença estatística entre os grupos no que se refere à idade, diabetes, hipertensão arterial sistêmica, dislipidemias, arteriopatias, neoplasias, estágio da doença renal, diâmetro da artéria doadora e da veia receptora, pressão arterial sistólica no membro operado, isquemia pós-operatória, formação de hematoma e infecção. Não houve diferença quanto à perviedade aos 7 dias A: 80% vs. B: 90%, p = 0,6; aos 30 dias A: 80% vs. B: 86%, p = 0,6; e aos 60 dias A: 60% vs. B: 80%, p = 0,22. Houve diferença entre os grupos quanto ao número de fístulas prévias A: 1,0 ± 0,44 vs. B: 0,6 ± 0,3, p = 0,04; e quanto ao edema em membro superior A: 20% vs. B: 0%, p = 0,04. A veia doadora menor que 3 mm esteve associada ao maior risco de oclusão precoce (RR = 8, p = 0,0125). Nesse período, não houve nenhum procedimento com o uso de prótese sintética. Conclusões A veia braquial transposta é uma alternativa à prótese sintética.

Estudo piloto comparando artéria mesentérica bovina e enxertos de politetrafluoroetileno expandido como acessos de hemodiálise não autógenos

Resumo Contexto Muitos pacientes dialíticos apresentam condições desfavoráveis para confecção de fístula arteriovenosa (FAV) nativa. A prótese vascular de politetrafluoroetileno expandido (ePTFE) é a alternativa mais utilizada, porém, sabidamente inferior àquela com veias nativas. Objetivos Pesquisar um enxerto de performance superior à do ePTFE, confrontrando seus resultados com os de FAVs confeccionadas com artéria mesentérica bovina tratada com tecnologia L-Hydro (Labcor Laboratórios®). Métodos Estudo prospectivo e controlado, composto pelo grupo controle de 10 pacientes submetidos à confecção de FAV com ePTFE (FAV ePTFE) e grupo experimental de 10 pacientes com bioprótese L-Hydro (FAV L-Hydro). Os componentes foram pareados em relação às comorbidades apresentadas. As variáveis estudadas foram: perviedades primária, primária assistida e secundária, manuseabilidade e prevalência de infecções. A performance das próteses foi avaliada por duplex scan e por consultas seriadas realizadas por profissionais de clínicas de hemodiálise. O tratamento estatístico foi o teste do qui-quadrado. Resultados Após 1 ano de seguimento pós-operatório, as taxas de perviedade secundária e primária assistida foram maiores no grupo FAV L-Hydro do que no FAV ePTFE. As intervenções para manter a perviedade da FAV foram menores no grupo FAV L-Hydro. A complicação mais comum foi trombose do enxerto, mais frequente no grupo FAV ePTFE. Apesar de os números indicarem desfechos mais favoráveis nas FAV L-Hydro, não foi possível confirmar esse achado com o tratamento estatístico aplicado. Conclusões O enxerto L-Hydro parece ser uma alternativa valiosa para FAV, pois parece necessitar de menos intervenções para manutenção da perviedade, quando comparado ao enxerto de ePTFE.