Angiology & Vascular Surgery
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2021 ◽  
Vol 6 (3) ◽  
pp. 1-4
Author(s):  
Fakhry A ◽  

Introduction: Deep Vein Thrombosis (DVT) after varicose vein surgery is well recognized. Less well documented is Endovenous Heat-Induced Thrombosis (EHIT), thrombus extension into a deep vein after superficial venous thermo ablation. There is no current agreement on the routine use of thromboprophylaxis in patients undergoing varicose vein surgery. more data on the incidence of VTE, and the need for postoperative thromboprophylaxis are necessary to formulate evidence-based clinical guidelines. Aim of the study: Comparison of the use of Caprini's Saphenous Ablation Scores versus Standard Caprini’s Score for the prophylaxis of VTE in EVLA. Patients & Methods: 60 patients admitted to Royal Vascular Center, Alexandria - Egypt. From Jan. 1st, 2021, to June 30th 2021 divided in 3 groups. - Group A) Treated by ablation of Great saphenous vein and received VTE prophylaxis according to Caprini’s Saphenous Ablation Scores Fig 1-A & B -Group B) Treated by ablation of Great saphenous vein and received VTE prophylaxis according to Standard Caprini’s Risk Assessment Score for VTE Fig 2-A&B - C) Treated by ablation of Great saphenous vein without VTE prophylaxis Ablation was done using radial 1480 YAG laser fibers and Post-operative Duplex was done one day, 3 month and one-year. Results: Age: 35.6+0.2, 34.3+0.5 and 37.6+0.09 years in the 3 groups M/F: 6/14, 8/12 and 7/13. In group A) all patients showed absent reflux post operatively and in all follow up visits. Duplex examination revealed significant reflux in the great saphenous veins in all patients and ranged from 0.7:0.9 Sec. and mean duration 0.7+0.09 Sec. Vein diameter ranged from (0.6: 0.9,X+0.76 CM.) in group A), (0.6: 0.8,X+0.7 CM.) in group B) , (0.5: 0.8,X+0.65 CM.) in group C) According to Caprini’s saphenous score 14 patients 70% were classified as low risk, 4 patients 20% were of moderate risk and 2 patients 10% of high-risk in Group A, while applying standard Caprini’s Score in group B patients revealed: 6 patients 30% were of moderate risk and 14 patients 70% of high risk in Group B ) . 3 patients developed superficial thrombophlebitis 15% and one patient 5% developed left calf DVT in Group C, while no VTE events were shown in both A&B Groups Significant drop in CVSS in patients in the three groups. Conclusion: Risk assessment of patients undergoing varicose veins ablation should be done and applying Caprini’s saphenous score as a better alternative to Standard Caprini’s score for VTE prophylaxis and is considered a safe and cost-effective tool in VTE prevention in these patients.


2021 ◽  
Vol 6 (3) ◽  
pp. 1-7
Author(s):  
Francesco De Santis ◽  

Background: The aim of this report is to describe and discuss a unique case of acute lower limb ischemia presented in a recovered COVID-19 patient treated via percutaneous mechanical thrombectomy and catheter directed thrombolysis. Starting from this singular case a wide literature review regarding COVID-19-related thrombo-embolic complications has been accomplished. Methods: A 47-year-old male was admitted to the emergency unit with acute lower limb ischemia three weeks after testing positive for COVID-19. He had been isolated at home because of minor COVID-19-related symptoms. Angio-CT-imaging showed a segmental occlusion of the common iliac artery coupled with retro-articular popliteal artery and leg vessels thrombosis. The patient was first unsuccessfully submitted to trans-femoral iliac thrombo-embolectomy. Results: Instead of peripheral limb vessel re-thromboembolectomy, a percutaneous mechanical thrombectomy coupled with leg vessel catheter direct thrombolysis was performed. The completion angiography showed the recanalization of the popliteal artery and leg vessels as far as the ankle but with a reduced forefoot vascularization. The fibrinolytic treatment was continued for 8 hours post-operatively. A compartment syndrome complicated the early post-operative course. There was a progressive recovery of ischemic symptoms and at 6-month follow-up, peripheral pulses were palpable with an almost complete normalization of foot and toe perfusion and motility. Conclusion: Acute lower limb ischemia following COVID-19-related arterial thrombo-embolic events represents a severe complication of COVID-19 infection and may result in a high rate of revascularization failure. In these cases, Percutaneous Mechanical thrombectomy coupled with catheter directed thrombolysis might represent a less traumatic and more selective approach.


2021 ◽  
Vol 6 (2) ◽  
pp. 1-4
Author(s):  
Velthuis PJ

Most popular fillers in cosmetic medicine are hyaluronic acid based. These comprise over 90% of the market and come with the advantage to be soluble in case of complications. Other fillers are contained in the group of bio-stimulatory fillers. They exert a secondary volumizing effect by provoking a low-grade inflammatory response that produces extra collagen. Examples are calcium-hydroxyapatite and L-poly-lactid acid. Finally autologous fat is being used as a filling substance (lipofilling). The gravest complications with fillers are intravascular injections. In particular when injected in arteries fillers can block blood flow and lead to skin necrosis or vison loss in case the material occludes the Central Retinal Artery (CRAO). Two opposing theories about the nature of arterial occlusion exist. One based on Ian Taylor idea of choke anastomoses assume vasoconstriction induced by the filler, both of the primary offended artery and its anastomosing vasosomes. In this case resolving the hyaluronic acid filler with the enzyme hyaluronidase at the primary occluding location would suffice. This is done under ultrasound guidance. The other theory assumes displacement of parts of the filler to end arterioles. Then, the whole affected area has to be flooded with large dosages of hyaluronidase. Obstructions with fillers based on other materials cannot be resolved. It seems logical to prevent intra-arterial filler injection by duplex sonography detection of the course of arteries prior to injection. Ultrasound has additional advantages for cosmetic doctors such as recognizing remains of previously injected filler. It also can give feedback on a physician’s ability to inject filler in the correct subdermal location.


2021 ◽  
Vol 6 (2) ◽  
pp. 1-4
Author(s):  
Lawrence E Greiten ◽  

Heterotaxy is an abnormal arrangement of viscera across the left-right axis of the body often associated with a variety of complex cardiac lesions. We present a case of left isomeric heterotaxy, a right aortic arch, and a left brachiocephalic artery arising from a left ductus arteriosus.


2021 ◽  
Vol 6 (2) ◽  
pp. 1-5
Author(s):  
Ulf Thorsten Zierau ◽  

Oxygen multi-step therapy for Varicose Veins: Oxygen as an energy carrier, all mechanisms in the human organism during growth, its maintenance and its physical and mental activity require energy. This becomes particularly clear to the patient during cardiac work, breathing work in the lungs, skeletal muscles and intellectual work. The pathology of the microcirculation in the capillaries depends largely on the oxygen partial pressure and on the blood pressure in the supplying arteries and the high pressure in the draining veins.


2021 ◽  
Vol 6 (2) ◽  
pp. 1-4
Author(s):  
Richard F Neville ◽  

Critical limb ischemia carries risk of significant morbidity and mortality and revascularization is particularly challenging in patients with tibial and pedal arterial disease. Recent advances in both endovascular therapies and open revascularization techniques have expanded our ability to treat patients with below the knee disease who may otherwise be subject to amputation. This commentary briefly reflects on emerging endovascular and open revascularization techniques for limb salvage in complex below knee arterial disease in order to raise awareness and minimize primary amputation without attempts at these “state of the art” modalities.


2021 ◽  
Vol 6 (2) ◽  
pp. 1-5
Author(s):  
David Shavelle ◽  

Background: Evaluating the severity of peripheral artery lesions is challenging. Image-based blood flow modeling from peripheral Computed Tomographic Angiography (pCTA) may provide a non-invasive method to determine the hemodynamic significance of lesions. This pilot study evaluates the performance of pCTA-based blood flow modeling in diagnosing functionally significant peripheral lesions in comparison with Digital Subtraction Angiography (DSA). Methods: Ten patients undergoing DSA and pCTA were included. The peripheral arteries were divided into 8 segments per extremity and stenosis severity was graded by visual estimation from DSA. Each segment was graded 0 to IV (normal, mildly-stenotic, moderately-stenotic, severely-stenotic, occluded) or non-evaluable. Independent from DSA review, a Resting Pressure Drop (RPD) and an Exercise Pressure Drop (ExPD) for each segment was calculated from pCTA-based blood flow modeling. A functionally significant (FS) lesion was defined as grade III or IV by DSA and RPD > 5 mmHg from pCTA-based modeling. Analysis was repeated with an ExPD > 20 mmHg. Sensitivity, specificity and accuracy were calculated for RPD > 5 mmHg and ExPD > 20 mmHg using DSA as the standard. Results: Mean age was 52±16 years, 4 patients were male, 8 patients presented with critical limb ischemia, mean ankle brachial index was 0.60±0.29, and 66 arterial segments were available for both assessment methods. Twenty-two segments had FS lesions by DSA. Using an RPD > 5 mmHg, sensitivity was 80%, specificity was 85% and accuracy was 79%. Using an ExPD > 20 mmHg, sensitivity was 84%, specificity was 89% and accuracy was 88%. Conclusion: Use of a resting pressure drop > 5 mmHg and an exercise pressure drop > 20 mmHg, measured by blood flow modeling from CT angiography, can accurately identify functionally significant stenosis in patients with peripheral vascular disease. This information motivates the need for a larger-scale prospective imaging trial to further validate this novel non-invasive approach.


2021 ◽  
Vol 6 (2) ◽  
pp. 1-4
Author(s):  
Supatcha Prasertcharoensuk ◽  

The most common technical concern in Endovascular Aneurysm Repair (EVAR) is the proximal landing zone of stent. Sandwich technique is the effective procedure to preserve internal iliac blood flow. This case report describes using this procedure for successful EVAR in patient with juxtarenal abdominal aortic aneurysm.


2021 ◽  
Vol 6 (1) ◽  
pp. 1-5
Author(s):  
Ayman M Fakhry ◽  

Background: Thrombus formation and extension to femoral or popliteal veins and pulmonary embolism may be though as a complication of EVLT in varicose veins treatment we aimed to study the thermal energy effect of the procedure under standardized conditions on biochemical markers of platelets and endothelium activities. Patients and methods: 25 patients admitted to vascular surgery dept. of Alexandria armed forces hospital with varicose veins and GSV. reflux and all treated by endovenous laser ablation during: 1/1/2018_12/31/2018. Venous blood samples were taken from iliofemoral and antecubital veins, before during and one day after surgery of P-selectin, soluble thrombomodulin, fibrin degradation products and D-dime Results: There was no immediate rise of P-selectin and s TM in neither iliofemoral nor antecubital veins, where FDPs D-dimer was significantly elevated post operatively in the two regions. Conclusion: 1480 pulsed mode diode laser doesn’t induce measurable endothelial and platelets activation in iliofemoral region during endovenous ablation of varicose veins.


2021 ◽  
Vol 6 (1) ◽  
pp. 1-4
Author(s):  
Javier Rodriguez-Padilla ◽  

Purpose: We present an unpublished case of bilateral carotid injury due to radiation-induced treated by endovascular therapy using double embolic protection device as a novel technique. Methods: Extracranial carotid artery pseudoaneurysm is a rare condition among head and neck cancer patients treated with radio therapy. We report a case of pseudoaneurysm in the right Common Carotid Artery (CCA) and critical stenosis in the left CCA. A 72 years-old patient laryngeal cancer treated with laryngectomy and radiotherapy 26 years before admission. He presented to us complaining of right neck pain and right hemispheric TIA symptoms. Results: Performed ultrasonography and magnetic resonance angiography revealed right Common Carotid Artery (CCA) pseudoaneurysm (size:13x25 mm) and critical stenosis in the left CCA. Endovascular treatment was performed in bilateral carotid artery using covered stent in pseudoaneurysms in the right CCA and uncovered stent due critical stenosis in the left CCA using double embolic protection device. Both procedures showed successful exclusion of the pseudoaneurysm and widely patent artery. Conclusion: Endovascular treatment in injury artery radiation-induced is safe and effective approach with low rate complications. The combined use of proximal cerebral protection devices and distal filter protection could decrease the rate of cerebral embolization procedure related.


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