Pub Date : 2024-04-08DOI: 10.4103/ijves.ijves_13_24
Lakshmidharan Mohan, Yadamreddy Rohit Kumar, Radhakrishnan Raju, M. Ayyappan
Extracranial carotid artery aneurysm (ECAA) is a rare condition, with varied symptoms and etiology. The current series describes the profile and treatment outcomes of those with ECCA. A record-based retrospective case study on 10 years of data from a hospital was done. Data on sociodemography including age and gender, symptoms, examination findings, radiological investigations, and management techniques were collected. A case series of 12 cases presenting with different symptoms of extracranial internal carotid artery aneurysm are discussed. Age of the participants varied from being adolescents, adults, or elderly patients. Three-fourth of the cases were males. Pulsatile swelling in the neck was the most common presentation, though asymptomatic manifestations are also present. All 12 were managed by different techniques, with surgical resection and end-to-end anastomosis being the most common type of repair. All had good outcomes following treatment. ECCA has male predominance and occurs mainly in those above 50 years of age. The most common presentation is swelling in the neck and the most common management technique is open surgical repair.
{"title":"Extracranial Carotid Artery Aneurysm: An Institutuinal Review","authors":"Lakshmidharan Mohan, Yadamreddy Rohit Kumar, Radhakrishnan Raju, M. Ayyappan","doi":"10.4103/ijves.ijves_13_24","DOIUrl":"https://doi.org/10.4103/ijves.ijves_13_24","url":null,"abstract":"\u0000 \u0000 \u0000 Extracranial carotid artery aneurysm (ECAA) is a rare condition, with varied symptoms and etiology. The current series describes the profile and treatment outcomes of those with ECCA.\u0000 \u0000 \u0000 \u0000 A record-based retrospective case study on 10 years of data from a hospital was done. Data on sociodemography including age and gender, symptoms, examination findings, radiological investigations, and management techniques were collected.\u0000 \u0000 \u0000 \u0000 A case series of 12 cases presenting with different symptoms of extracranial internal carotid artery aneurysm are discussed. Age of the participants varied from being adolescents, adults, or elderly patients. Three-fourth of the cases were males. Pulsatile swelling in the neck was the most common presentation, though asymptomatic manifestations are also present. All 12 were managed by different techniques, with surgical resection and end-to-end anastomosis being the most common type of repair. All had good outcomes following treatment.\u0000 \u0000 \u0000 \u0000 ECCA has male predominance and occurs mainly in those above 50 years of age. The most common presentation is swelling in the neck and the most common management technique is open surgical repair.\u0000","PeriodicalId":13375,"journal":{"name":"Indian Journal of Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140730468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-12DOI: 10.4103/ijves.ijves_102_23
Paresh Pai, V. Bedi, Dhanesh Kamerkar, Robbie George, Kumud M Rai, P. C. Gupta, Raghuram Sekhar, Venugopal Balaji, R. Parakh, S.R. Subramanian, Vijay Thakore, Tapish Sahu, R. Jindal
Currently, there are no guidelines or consensus recommendations on the antithrombotic management of peripheral artery disease (PAD) from an Indian perspective. In this article, we have summarized clinical practice recommendations on antithrombotic management of (i) asymptomatic chronic PAD (cPAD), (ii) symptomatic cPAD (intermittent claudication [IC] and chronic limb-threatening ischemia [CLTI]), and (iii) after revascularization (endovascular and surgical). An electronic search of the PubMed database was undertaken to identify relevant articles. Various combinations of keywords such as PAD, chronic peripheral arterial disease, asymptomatic chronic peripheral arterial disease, symptomatic chronic peripheral arterial disease, dual antiplatelet therapy, single antiplatelet therapy, dual pathway inhibition, antithrombotic, revascularization, endovascular, and surgical were used. Randomized controlled trials, case reports, practice guidelines, systematic literature reviews, and meta-analyses were screened and assessed. A roundtable meeting of experts (n = 13) was conducted to arrive at clinical practice recommendations. Experts made their decisions based on the evidence and guideline recommendations. In patients with asymptomatic cPAD and significant peripheral artery stenosis (PAS), long-term single antiplatelet therapy may be considered at the discretion of the clinician. There is no clear evidence in favor of long-term dual antiplatelet therapy in symptomatic cPAD. Experts agreed that low-dose rivaroxaban plus aspirin should be considered in patients with asymptomatic cPAD with >50% PAS and conditions such as diabetes and polyvascular disease. This combination was also suggested in patients with IC, CLTI, postendovascular (stent based/nonstent), and surgical revascularization to reduce cardiovascular and limb ischemic risk, including major amputation in the absence of high bleeding risk or other contraindications.
{"title":"Clinical Practice Recommendations for Antithrombotic Management of Peripheral Artery Disease: An Indian Perspective","authors":"Paresh Pai, V. Bedi, Dhanesh Kamerkar, Robbie George, Kumud M Rai, P. C. Gupta, Raghuram Sekhar, Venugopal Balaji, R. Parakh, S.R. Subramanian, Vijay Thakore, Tapish Sahu, R. Jindal","doi":"10.4103/ijves.ijves_102_23","DOIUrl":"https://doi.org/10.4103/ijves.ijves_102_23","url":null,"abstract":"\u0000 Currently, there are no guidelines or consensus recommendations on the antithrombotic management of peripheral artery disease (PAD) from an Indian perspective. In this article, we have summarized clinical practice recommendations on antithrombotic management of (i) asymptomatic chronic PAD (cPAD), (ii) symptomatic cPAD (intermittent claudication [IC] and chronic limb-threatening ischemia [CLTI]), and (iii) after revascularization (endovascular and surgical). An electronic search of the PubMed database was undertaken to identify relevant articles. Various combinations of keywords such as PAD, chronic peripheral arterial disease, asymptomatic chronic peripheral arterial disease, symptomatic chronic peripheral arterial disease, dual antiplatelet therapy, single antiplatelet therapy, dual pathway inhibition, antithrombotic, revascularization, endovascular, and surgical were used. Randomized controlled trials, case reports, practice guidelines, systematic literature reviews, and meta-analyses were screened and assessed. A roundtable meeting of experts (n = 13) was conducted to arrive at clinical practice recommendations. Experts made their decisions based on the evidence and guideline recommendations. In patients with asymptomatic cPAD and significant peripheral artery stenosis (PAS), long-term single antiplatelet therapy may be considered at the discretion of the clinician. There is no clear evidence in favor of long-term dual antiplatelet therapy in symptomatic cPAD. Experts agreed that low-dose rivaroxaban plus aspirin should be considered in patients with asymptomatic cPAD with >50% PAS and conditions such as diabetes and polyvascular disease. This combination was also suggested in patients with IC, CLTI, postendovascular (stent based/nonstent), and surgical revascularization to reduce cardiovascular and limb ischemic risk, including major amputation in the absence of high bleeding risk or other contraindications.","PeriodicalId":13375,"journal":{"name":"Indian Journal of Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2024-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140250533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-15DOI: 10.4103/ijves.ijves_60_23
Yuqing Niu, Shaoxian Cheng, Cheng Zhou
Abdominal aortic aneurysm (AAA) is a chronic vascular inflammation progression with a high mortality. However, intercellular communication has not been sufficiently explored in human AAA tissue. Here, we investigated available single-cell RNA sequencing data generated from human AAA. These cells were divided into 27 clusters and 6 main cell types, such as T-cells, B-cells, myeloid cells, neutrophils, endothelial cells, and fibroblasts. Immune cells were present in AAA tissues more than control. In addition, we established an intercellular communication network and observed a more pronounced enrichment of TGFB1, CCL, VEGF, IL6, and complement pathways in the AAA group compared to the control group. Together, our analyses provide beneficial insight into cell–cell communication and expand channels for the effective immunotherapy development of AAA in the future.
{"title":"Revealing the Intercellular Communication Changes of Human Abdominal Aortic Aneurysms at Single-cell Resolution","authors":"Yuqing Niu, Shaoxian Cheng, Cheng Zhou","doi":"10.4103/ijves.ijves_60_23","DOIUrl":"https://doi.org/10.4103/ijves.ijves_60_23","url":null,"abstract":"Abdominal aortic aneurysm (AAA) is a chronic vascular inflammation progression with a high mortality. However, intercellular communication has not been sufficiently explored in human AAA tissue. Here, we investigated available single-cell RNA sequencing data generated from human AAA. These cells were divided into 27 clusters and 6 main cell types, such as T-cells, B-cells, myeloid cells, neutrophils, endothelial cells, and fibroblasts. Immune cells were present in AAA tissues more than control. In addition, we established an intercellular communication network and observed a more pronounced enrichment of TGFB1, CCL, VEGF, IL6, and complement pathways in the AAA group compared to the control group. Together, our analyses provide beneficial insight into cell–cell communication and expand channels for the effective immunotherapy development of AAA in the future.","PeriodicalId":13375,"journal":{"name":"Indian Journal of Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139273479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01DOI: 10.4103/ijves.ijves_29_23
E. Stephen, A. Sharqi, Ibrahim Abdelhady, K. Wahaibi
An elderly woman presented a year after undergoing endovascular repair of her infrarenal aortic aneurysm (IRAA) with abdominal pain and hypotension. Imaging revealed a ruptured IRAA, and this was managed with banding of the aorta to correct the Type-1a endoleak and tranexamic acid postoperative. We share details and a brief review of the literature.
{"title":"Management of infrarenal aortic aneurysm rupture postendovascular stenting","authors":"E. Stephen, A. Sharqi, Ibrahim Abdelhady, K. Wahaibi","doi":"10.4103/ijves.ijves_29_23","DOIUrl":"https://doi.org/10.4103/ijves.ijves_29_23","url":null,"abstract":"An elderly woman presented a year after undergoing endovascular repair of her infrarenal aortic aneurysm (IRAA) with abdominal pain and hypotension. Imaging revealed a ruptured IRAA, and this was managed with banding of the aorta to correct the Type-1a endoleak and tranexamic acid postoperative. We share details and a brief review of the literature.","PeriodicalId":13375,"journal":{"name":"Indian Journal of Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70769247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01DOI: 10.4103/ijves.ijves_18_23
E. Stephen, HaninAl Douhani, Ibrahim Abdelhady, Hanan Maawali, Khalifa Alwahaibi
Despite the small number of reported cases of venous aneurysms, popliteal venous aneurysms (PVAs) are a potential source of venous thromboembolism (VTE) that carries significant morbidity and mortality. Recurrent VTE is a potential complication in cases of undiagnosed PVA. The knowledge of diagnosis and management of PVAs is limited among health professionals. The goal of this case report was to present the symptoms, diagnosis, and surgical management of PVA.
{"title":"Popliteal vein aneurysm – Rare cause of knee pain","authors":"E. Stephen, HaninAl Douhani, Ibrahim Abdelhady, Hanan Maawali, Khalifa Alwahaibi","doi":"10.4103/ijves.ijves_18_23","DOIUrl":"https://doi.org/10.4103/ijves.ijves_18_23","url":null,"abstract":"Despite the small number of reported cases of venous aneurysms, popliteal venous aneurysms (PVAs) are a potential source of venous thromboembolism (VTE) that carries significant morbidity and mortality. Recurrent VTE is a potential complication in cases of undiagnosed PVA. The knowledge of diagnosis and management of PVAs is limited among health professionals. The goal of this case report was to present the symptoms, diagnosis, and surgical management of PVA.","PeriodicalId":13375,"journal":{"name":"Indian Journal of Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70768724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01DOI: 10.4103/ijves.ijves_27_23
RakeshKumar Jha, A. Pushkarna, Pallavi Yerramsetty
Upper limb has rich vascular supply due to sufficient collaterals around the shoulder, elbow, and wrist joints which prevents ischemia and maintains viability of the upper limb in case of vascular injury or occlusion. There are numerous literature available, regarding the management of isolated single arterial injury in the forearm, which suggest that ligation of single artery (radial or ulnar) is safer if the companion arterial supply is intact. Hand salvage becomes more challenging when patient presents with acute hand ischemia following injury to both forearm arteries and has associated musculoskeletal injuries. We hereby report the case of a 24-year-old male who sustained glass-cut injuries to his right distal forearm resulting in both forearm arterial, nerves, flexor tendon injuries, and presented as acute hand ischemia. The patient was managed by reconstruction of radial and ulnar arteries using reverse saphenous vein graft (RSVG) along-with primary repair of median and ulnar nerves and flexor tendons. Skin and soft tissue defect was subsequently covered using antero-lateral thigh flap. The prompt and timely management of patient resulted in hand salvage with good functional outcome.
{"title":"A case of traumatic hand ischemia – Managed successfully with neurovascular and soft-tissue reconstruction","authors":"RakeshKumar Jha, A. Pushkarna, Pallavi Yerramsetty","doi":"10.4103/ijves.ijves_27_23","DOIUrl":"https://doi.org/10.4103/ijves.ijves_27_23","url":null,"abstract":"Upper limb has rich vascular supply due to sufficient collaterals around the shoulder, elbow, and wrist joints which prevents ischemia and maintains viability of the upper limb in case of vascular injury or occlusion. There are numerous literature available, regarding the management of isolated single arterial injury in the forearm, which suggest that ligation of single artery (radial or ulnar) is safer if the companion arterial supply is intact. Hand salvage becomes more challenging when patient presents with acute hand ischemia following injury to both forearm arteries and has associated musculoskeletal injuries. We hereby report the case of a 24-year-old male who sustained glass-cut injuries to his right distal forearm resulting in both forearm arterial, nerves, flexor tendon injuries, and presented as acute hand ischemia. The patient was managed by reconstruction of radial and ulnar arteries using reverse saphenous vein graft (RSVG) along-with primary repair of median and ulnar nerves and flexor tendons. Skin and soft tissue defect was subsequently covered using antero-lateral thigh flap. The prompt and timely management of patient resulted in hand salvage with good functional outcome.","PeriodicalId":13375,"journal":{"name":"Indian Journal of Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70769375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01DOI: 10.4103/ijves.ijves_37_23
Shaikat Mondal, Himel Mondal, Gujaram Marndi, J. Behera
Background: Artificial intelligence (AI), specifically ChatGPT, has the potential to revolutionize medical education by acting as an interactive virtual tutor and personalized learning assistant. It may help both teachers and students in various ways. Objective: The objective of this article is to provide practical examples of the utilization of ChatGPT for educational purposes in the context of teaching. Materials and Methods: The article presents various scenarios and applications where ChatGPT can be effectively employed by teachers. These examples are based on real-world experiences and observations, showcasing the potential of AI in enhancing educational practices. Results: The article demonstrates how ChatGPT can serve as a valuable tool for teachers in preparation of presentation slide, formulating essay-type, multiple choice, and viva questions, answering students' queries, making customized content for students according to comprehension capability, evaluation of answers, creating case vignette, plan a lesson, or create contents for blended learning. Conclusion: The findings of this article emphasize the practical implications and benefits of utilizing ChatGPT for educational purposes. Teachers who are overburdened with academic loads can take help from the program. However, teachers must use it with caution as the content created by ChatGPT may have errors or have scientific inaccuracy. Future research should focus on exploring the long-term effects and pedagogical strategies for effective implementation of ChatGPT in educational settings.
{"title":"ChatGPT for teachers: Practical examples for utilizing artificial intelligence for educational purposes","authors":"Shaikat Mondal, Himel Mondal, Gujaram Marndi, J. Behera","doi":"10.4103/ijves.ijves_37_23","DOIUrl":"https://doi.org/10.4103/ijves.ijves_37_23","url":null,"abstract":"Background: Artificial intelligence (AI), specifically ChatGPT, has the potential to revolutionize medical education by acting as an interactive virtual tutor and personalized learning assistant. It may help both teachers and students in various ways. Objective: The objective of this article is to provide practical examples of the utilization of ChatGPT for educational purposes in the context of teaching. Materials and Methods: The article presents various scenarios and applications where ChatGPT can be effectively employed by teachers. These examples are based on real-world experiences and observations, showcasing the potential of AI in enhancing educational practices. Results: The article demonstrates how ChatGPT can serve as a valuable tool for teachers in preparation of presentation slide, formulating essay-type, multiple choice, and viva questions, answering students' queries, making customized content for students according to comprehension capability, evaluation of answers, creating case vignette, plan a lesson, or create contents for blended learning. Conclusion: The findings of this article emphasize the practical implications and benefits of utilizing ChatGPT for educational purposes. Teachers who are overburdened with academic loads can take help from the program. However, teachers must use it with caution as the content created by ChatGPT may have errors or have scientific inaccuracy. Future research should focus on exploring the long-term effects and pedagogical strategies for effective implementation of ChatGPT in educational settings.","PeriodicalId":13375,"journal":{"name":"Indian Journal of Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70769012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01DOI: 10.4103/ijves.ijves_31_23
Devender Singh, Aruna Kottilliyil, M. Praveena, S. Aryala
Popliteal venous aneurysms are a rare disease of uncertain etiology that can present with serious complications, such as deep-vein thrombosis and pulmonary embolism. Ultrasound, computed tomography, and magnetic resonance imaging can be used as diagnostic tools for this condition. Early surgical repair in the form of tangential aneurysmectomy and lateral venorrhaphy of both symptomatic and asymptomatic popliteal venous aneurysms is advised since they are associated with an ill-defined possibility of pulmonary embolism and mortality, if left untreated. Herein, we present a case report of a popliteal vein aneurysm in a previously healthy 26-year-old male, presenting with pain in left knee, increased during physical activities and was successfully managed surgically.
{"title":"Popliteal vein aneurysm: A rare cause of knee pain in a young male","authors":"Devender Singh, Aruna Kottilliyil, M. Praveena, S. Aryala","doi":"10.4103/ijves.ijves_31_23","DOIUrl":"https://doi.org/10.4103/ijves.ijves_31_23","url":null,"abstract":"Popliteal venous aneurysms are a rare disease of uncertain etiology that can present with serious complications, such as deep-vein thrombosis and pulmonary embolism. Ultrasound, computed tomography, and magnetic resonance imaging can be used as diagnostic tools for this condition. Early surgical repair in the form of tangential aneurysmectomy and lateral venorrhaphy of both symptomatic and asymptomatic popliteal venous aneurysms is advised since they are associated with an ill-defined possibility of pulmonary embolism and mortality, if left untreated. Herein, we present a case report of a popliteal vein aneurysm in a previously healthy 26-year-old male, presenting with pain in left knee, increased during physical activities and was successfully managed surgically.","PeriodicalId":13375,"journal":{"name":"Indian Journal of Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70769303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01DOI: 10.4103/ijves.ijves_28_23
MayYim-Ping Wong, KeiKwong Wong
Introduction: The current commercial endovascular abdominal aortic stent grafts are designed based on the anatomical data from the Western population. Objective: To investigate the morphological features of abdominal aortic aneurysm (AAA) in a Chinese cohort and its clinical implications. Methods: It was a retrospective, observational study. The preoperative computed tomography angiogram (CTAs) of patients who underwent endovascular aortic aneurysm repair (EVAR) from January 01, 2015 to December 31, 2020, were analyzed. A predefined set of AAA morphological measurements was taken. The eligibility of EVAR with current commercially available stent grafts on the market was examined. Results: A total of 210 cases were studied. The mean AAA diameter was 64.3 mm. The mean proximal and distal neck diameters were 22.9 mm and 24.4 mm, respectively, whereas the mean neck length was 23.8 mm and the mean infra-renal angle was 51.6°. The right and left mean common iliac arteries (CIAs) diameters were 21.2 mm and 18.3 mm. The right and left mean CIA lengths were 35.7 mm and 37.3 mm. The mean external iliac artery (EIA) diameter was 8.3 mm bilaterally. Female gender was associated with significantly smaller neck diameters, smaller EIA diameters, and larger infra-renal angle. EVAR eligibility ranged from 16%–37% and was significantly lower in females. Conclusions: The majority of Chinese patients with AAA did not meet the anatomical eligibility for EVAR, with neck angulation being the major deterrent. Female patients posed an additional anatomical challenge due to larger infra-renal angle and smaller iliac access diameter. The development of low-profile angulated neck-compatible EVAR devices may expand EVAR applicability in future.
{"title":"Abdominal aortic aneurysm morphology in the Chinese population and endovascular aortic aneurysm repair eligibility","authors":"MayYim-Ping Wong, KeiKwong Wong","doi":"10.4103/ijves.ijves_28_23","DOIUrl":"https://doi.org/10.4103/ijves.ijves_28_23","url":null,"abstract":"Introduction: The current commercial endovascular abdominal aortic stent grafts are designed based on the anatomical data from the Western population. Objective: To investigate the morphological features of abdominal aortic aneurysm (AAA) in a Chinese cohort and its clinical implications. Methods: It was a retrospective, observational study. The preoperative computed tomography angiogram (CTAs) of patients who underwent endovascular aortic aneurysm repair (EVAR) from January 01, 2015 to December 31, 2020, were analyzed. A predefined set of AAA morphological measurements was taken. The eligibility of EVAR with current commercially available stent grafts on the market was examined. Results: A total of 210 cases were studied. The mean AAA diameter was 64.3 mm. The mean proximal and distal neck diameters were 22.9 mm and 24.4 mm, respectively, whereas the mean neck length was 23.8 mm and the mean infra-renal angle was 51.6°. The right and left mean common iliac arteries (CIAs) diameters were 21.2 mm and 18.3 mm. The right and left mean CIA lengths were 35.7 mm and 37.3 mm. The mean external iliac artery (EIA) diameter was 8.3 mm bilaterally. Female gender was associated with significantly smaller neck diameters, smaller EIA diameters, and larger infra-renal angle. EVAR eligibility ranged from 16%–37% and was significantly lower in females. Conclusions: The majority of Chinese patients with AAA did not meet the anatomical eligibility for EVAR, with neck angulation being the major deterrent. Female patients posed an additional anatomical challenge due to larger infra-renal angle and smaller iliac access diameter. The development of low-profile angulated neck-compatible EVAR devices may expand EVAR applicability in future.","PeriodicalId":13375,"journal":{"name":"Indian Journal of Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70769244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01DOI: 10.4103/ijves.ijves_23_23
M. Jha, P. Pawar, V. Samuel, E. Stephen, V. Bedi, K. Suresh, TN Sritharan, P. Ilayakumar, Tapish Sahu, Vijay Thakore, R. Sekhar, Sairam Subramanian, N. Sekar, Jithin Jagan, Radhakrishnan Raju, R. George
Introduction and Objective: The reported incidence of COVID-related acute limb ischemia (CRALI) ranged from 3.7% to 9.6% in the literature. We report on consolidated data of patients with CRALI from 21 centers across India, which spanned the first two waves of COVID-the period of May 2020 to June 2021. Materials and Methods: Study design: Multicenter study from May 2022 to June 2021. Retrospective analysis of prospectively collected data was done. Inclusion criteria: All patients who presented with signs and symptoms of acute limb ischemia or acute on chronic limb ischemia and who also tested positive for COVID through rapid antigen test or real time polymerase chain reaction. Results: Data for 268 patients from 21 centers across India was available for analysis. 71% were males and 85% were >45 years of age. Majority of patients (n = 191) presented with acute symptoms. Best medical management with antiplatelets and anticoagulants was the only treatment in 34% of patients. Open embolectomy was attempted in 42%, endovascular procedures in 8% and amputation as primary procedure in 14.5%. Higher grades of ischemia were associated with significantly poorer limb salvage, amputation and mortality in the immediate and 14 days follow up (P < 0.001). At 14 days 173 limbs were salvaged (64.5%). Eighty patients underwent amputations (29.8%); 26 of the 80 (32%) were minor amputations (trans-metatarsal and less), so the major amputation rate was 20.1%. Maximum number of deaths were in the group that had undergone medical management (23%), while the least number of deaths were seen in the patients that had undergone some form of intervention, open surgical (2%) or endovascular procedure (4%). Looking at 14-day outcomes, the numbers of deaths in the patients managed with medical methods increased to 30%, open surgical to 7% and endovascular procedures to 8%. Conclusion: CRALI presented both as a primary presentation or developed later during the disease. Early surgical and endovascular interventions in these patients can help in achieving decent limb salvage rates.
{"title":"COVID-related acute limb ischemia: The Indian data","authors":"M. Jha, P. Pawar, V. Samuel, E. Stephen, V. Bedi, K. Suresh, TN Sritharan, P. Ilayakumar, Tapish Sahu, Vijay Thakore, R. Sekhar, Sairam Subramanian, N. Sekar, Jithin Jagan, Radhakrishnan Raju, R. George","doi":"10.4103/ijves.ijves_23_23","DOIUrl":"https://doi.org/10.4103/ijves.ijves_23_23","url":null,"abstract":"Introduction and Objective: The reported incidence of COVID-related acute limb ischemia (CRALI) ranged from 3.7% to 9.6% in the literature. We report on consolidated data of patients with CRALI from 21 centers across India, which spanned the first two waves of COVID-the period of May 2020 to June 2021. Materials and Methods: Study design: Multicenter study from May 2022 to June 2021. Retrospective analysis of prospectively collected data was done. Inclusion criteria: All patients who presented with signs and symptoms of acute limb ischemia or acute on chronic limb ischemia and who also tested positive for COVID through rapid antigen test or real time polymerase chain reaction. Results: Data for 268 patients from 21 centers across India was available for analysis. 71% were males and 85% were >45 years of age. Majority of patients (n = 191) presented with acute symptoms. Best medical management with antiplatelets and anticoagulants was the only treatment in 34% of patients. Open embolectomy was attempted in 42%, endovascular procedures in 8% and amputation as primary procedure in 14.5%. Higher grades of ischemia were associated with significantly poorer limb salvage, amputation and mortality in the immediate and 14 days follow up (P < 0.001). At 14 days 173 limbs were salvaged (64.5%). Eighty patients underwent amputations (29.8%); 26 of the 80 (32%) were minor amputations (trans-metatarsal and less), so the major amputation rate was 20.1%. Maximum number of deaths were in the group that had undergone medical management (23%), while the least number of deaths were seen in the patients that had undergone some form of intervention, open surgical (2%) or endovascular procedure (4%). Looking at 14-day outcomes, the numbers of deaths in the patients managed with medical methods increased to 30%, open surgical to 7% and endovascular procedures to 8%. Conclusion: CRALI presented both as a primary presentation or developed later during the disease. Early surgical and endovascular interventions in these patients can help in achieving decent limb salvage rates.","PeriodicalId":13375,"journal":{"name":"Indian Journal of Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70768710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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