Pub Date : 2022-09-01DOI: 10.4103/ijves.ijves_84_22
Harish Ayyavoo, B. Duraichi, N. Sritharan, K. Jayachander, P. Ilayakumar, S. Kumar, R. Venkatesh Babu, M. Ramya, P. Sujith
Objective: The main objective of this study was to review the clinical presentations, surgical management, and outcome of surgical procedures for arterial thoracic outlet syndrome (TOS). Methodology: This is a retrospective analysis of arterial TOS patients admitted in our department (Institute of Vascular Surgery, Madras Medical College, Chennai) from August 2012 to July 2022. Results: This study enrolled 81 patients, with mean age of 41.13 (12-65 years) and 50.61% male (41) and 49.39% female (40), associated with distal arterial lesions - 63 (77.77%), among which 50.61% - occlusion in the brachial artery (33), 24.69% in forearm arteries (15), and 24.69% in the axillary artery (15). About 95.06% of patients had cervical rib (77), 2.46% - first rib abnormality (2), 2.46% - soft-tissue compression (2), 59.25% was SCHER Stage III (48), 33.33% SCHER stage I (27), and 7.40% SCHER stage II (6). All patients had undergone a supraclavicular approach. The most common arterial lesions were subclavian artery (SCA) thrombus in 53.08% (43), occlusion in 17.28% (14), and dilatation in 29.62% (24) cases. The cervical rib excision with anterior scalenectomy in 95.06% (77), and 1st rib excision with anterior scalenectomy 2.46% (2) and soft tissue resection with anterior scalenectomy 2.46% (2) of patients. SCA intervention/reconstruction was done in 88.88% (72) of cases. Two patients had underwent above elbow amputation (2.46%) and no mortality and SCA patency was 100%. Conclusion: Cervical rib excision with anterior scalenectomy with or without thrombectomy is an effective procedure for arterial TOS cases.
{"title":"Arterial thoracic outlet syndrome - Clinical presentation, surgical management, and outcome: An institutional experience of 10-year period","authors":"Harish Ayyavoo, B. Duraichi, N. Sritharan, K. Jayachander, P. Ilayakumar, S. Kumar, R. Venkatesh Babu, M. Ramya, P. Sujith","doi":"10.4103/ijves.ijves_84_22","DOIUrl":"https://doi.org/10.4103/ijves.ijves_84_22","url":null,"abstract":"Objective: The main objective of this study was to review the clinical presentations, surgical management, and outcome of surgical procedures for arterial thoracic outlet syndrome (TOS). Methodology: This is a retrospective analysis of arterial TOS patients admitted in our department (Institute of Vascular Surgery, Madras Medical College, Chennai) from August 2012 to July 2022. Results: This study enrolled 81 patients, with mean age of 41.13 (12-65 years) and 50.61% male (41) and 49.39% female (40), associated with distal arterial lesions - 63 (77.77%), among which 50.61% - occlusion in the brachial artery (33), 24.69% in forearm arteries (15), and 24.69% in the axillary artery (15). About 95.06% of patients had cervical rib (77), 2.46% - first rib abnormality (2), 2.46% - soft-tissue compression (2), 59.25% was SCHER Stage III (48), 33.33% SCHER stage I (27), and 7.40% SCHER stage II (6). All patients had undergone a supraclavicular approach. The most common arterial lesions were subclavian artery (SCA) thrombus in 53.08% (43), occlusion in 17.28% (14), and dilatation in 29.62% (24) cases. The cervical rib excision with anterior scalenectomy in 95.06% (77), and 1st rib excision with anterior scalenectomy 2.46% (2) and soft tissue resection with anterior scalenectomy 2.46% (2) of patients. SCA intervention/reconstruction was done in 88.88% (72) of cases. Two patients had underwent above elbow amputation (2.46%) and no mortality and SCA patency was 100%. Conclusion: Cervical rib excision with anterior scalenectomy with or without thrombectomy is an effective procedure for arterial TOS cases.","PeriodicalId":13375,"journal":{"name":"Indian Journal of Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48714748","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 : 2022-09-01DOI: 10.4103/ijves.ijves_29_22
Shilpa J. Parikh, Harmi Patel, J. Shah, Sadhana Kothiya
Vascular malformation consists of a group of tumors that emerge from the vascular origin caused by vascular or lymphoproliferation. Arteriovenous malformations (AVMs) contribute high-flow, creating direct vein artery contact without regular capillary network. AVMs are present at birth or in congenital. Acquired AVMs occur later in life due to hormonal changes or trauma. AVM of the head and neck is a rare vascular anomaly but when present is persistent and progressive in nature and can represent a lethal benign disease and an incomplete resection frequently leads to recurrence of the lesion. Here, we present a series of three cases of AVM reported during 2019–2022 involving the orofacial region.
{"title":"Clinicoradiographic aspects of arteriovenous malformations involving the orofacial region: A case series","authors":"Shilpa J. Parikh, Harmi Patel, J. Shah, Sadhana Kothiya","doi":"10.4103/ijves.ijves_29_22","DOIUrl":"https://doi.org/10.4103/ijves.ijves_29_22","url":null,"abstract":"Vascular malformation consists of a group of tumors that emerge from the vascular origin caused by vascular or lymphoproliferation. Arteriovenous malformations (AVMs) contribute high-flow, creating direct vein artery contact without regular capillary network. AVMs are present at birth or in congenital. Acquired AVMs occur later in life due to hormonal changes or trauma. AVM of the head and neck is a rare vascular anomaly but when present is persistent and progressive in nature and can represent a lethal benign disease and an incomplete resection frequently leads to recurrence of the lesion. Here, we present a series of three cases of AVM reported during 2019–2022 involving the orofacial region.","PeriodicalId":13375,"journal":{"name":"Indian Journal of Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43694343","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 : 2022-09-01DOI: 10.4103/ijves.ijves_59_22
Vivek Singh, S. Rai, V. Anand, Nitu Singh
Introduction: Existing methodologies and risk stratification indices for predicting peri-operative cardiac complications in vascular surgery patient lack sufficient predictive value and therefore cannot be recommended for risk stratification. There are no Indian studies for preoperative cardiac risk scores for patients who undergo vascular and endovascular procedures. Therefore, an attempt was made to risk stratify and compare two existing cardiac risk indices (i.e., Detsky's modified cardiac risk index vs. Revised cardiac risk index [RCRI]) to predict peri-operative morbidity and mortality due to cardiac causes. The aim of this study: (a) To compare Detsky's modified cardiac risk index and RCRI to predict perioperative cardiovascular outcome in patients with peripheral vascular disease undergoing surgical intervention. (b) To predict perioperative cardiovascular outcome based on cardiac risk index in patients with peripheral vascular disease undergoing surgical intervention. Materials and Methods: This is an observational, prospective, longitudinal, controlled cohort study, which assessed 103 patients admitted at vascular centre for a period of 2 years. All patients undergoing vascular surgical procedure and evaluated by a cardiologist in the preoperative period were included in the study. Results: Eighteen patients (17.4%) had cardiac complications. The Detsky's index was found to be a satisfactory predictor of postoperative cardiac events (P < 0.001) as compared to RCRI which had a P < 0.003. There were a total of 10 mortalities (9.7%). Detsky's model and RCRI had positive predictive value (PPV) of 73.3% and 31.4%, specificity of 94.1% and 72.7%, respectively. Discussion: The overall sensitivity, specificity, PPV, negative predictive value of the Detsky's risk index, and RCRI in the prediction of cardiac events were 31.4%, 94.1%, 73.3%, 72.7% and 73.3%, 72.7%, 31.4%, 94.1%, respectively. In our study, the area under ROC for Detsky class was 0.76 versus 0.75 and superior to C statistic. However, the area under ROC for RCRI class was 0.72 versus 0.75 and inferior to C statistic. One important inference from the study was that 77.6% patients were smoker in the study group which emphasize the direct relation of peripheral vascular disease with smoking. Conclusion: The study concluded that patients with good surgical risk and profile undergoing minor vascular procedures can be operated without further testing. For other patients, the next step would be to incorporate the Detsky index. A Detsky score of 20 or more is comparable to a major clinical predictor in the American College of Cardiology/American Heart Association scheme.
{"title":"Comparative study of cardiac risk indices to predict perioperative cardiovascular outcome in patients with peripheral vascular diseases","authors":"Vivek Singh, S. Rai, V. Anand, Nitu Singh","doi":"10.4103/ijves.ijves_59_22","DOIUrl":"https://doi.org/10.4103/ijves.ijves_59_22","url":null,"abstract":"Introduction: Existing methodologies and risk stratification indices for predicting peri-operative cardiac complications in vascular surgery patient lack sufficient predictive value and therefore cannot be recommended for risk stratification. There are no Indian studies for preoperative cardiac risk scores for patients who undergo vascular and endovascular procedures. Therefore, an attempt was made to risk stratify and compare two existing cardiac risk indices (i.e., Detsky's modified cardiac risk index vs. Revised cardiac risk index [RCRI]) to predict peri-operative morbidity and mortality due to cardiac causes. The aim of this study: (a) To compare Detsky's modified cardiac risk index and RCRI to predict perioperative cardiovascular outcome in patients with peripheral vascular disease undergoing surgical intervention. (b) To predict perioperative cardiovascular outcome based on cardiac risk index in patients with peripheral vascular disease undergoing surgical intervention. Materials and Methods: This is an observational, prospective, longitudinal, controlled cohort study, which assessed 103 patients admitted at vascular centre for a period of 2 years. All patients undergoing vascular surgical procedure and evaluated by a cardiologist in the preoperative period were included in the study. Results: Eighteen patients (17.4%) had cardiac complications. The Detsky's index was found to be a satisfactory predictor of postoperative cardiac events (P < 0.001) as compared to RCRI which had a P < 0.003. There were a total of 10 mortalities (9.7%). Detsky's model and RCRI had positive predictive value (PPV) of 73.3% and 31.4%, specificity of 94.1% and 72.7%, respectively. Discussion: The overall sensitivity, specificity, PPV, negative predictive value of the Detsky's risk index, and RCRI in the prediction of cardiac events were 31.4%, 94.1%, 73.3%, 72.7% and 73.3%, 72.7%, 31.4%, 94.1%, respectively. In our study, the area under ROC for Detsky class was 0.76 versus 0.75 and superior to C statistic. However, the area under ROC for RCRI class was 0.72 versus 0.75 and inferior to C statistic. One important inference from the study was that 77.6% patients were smoker in the study group which emphasize the direct relation of peripheral vascular disease with smoking. Conclusion: The study concluded that patients with good surgical risk and profile undergoing minor vascular procedures can be operated without further testing. For other patients, the next step would be to incorporate the Detsky index. A Detsky score of 20 or more is comparable to a major clinical predictor in the American College of Cardiology/American Heart Association scheme.","PeriodicalId":13375,"journal":{"name":"Indian Journal of Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41854905","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 : 2022-09-01DOI: 10.4103/ijves.ijves_44_22
Neelamjingbha Sun, Sriram Manchikanti, A. Gupta, Shivanesan Pitchai
Posterior tibial artery (PTA) aneurysms are rare and associated with trauma and orthopedic interventions. We present a rare case of spontaneous pseudoaneurysm of the PTA, complicated with deep vein thrombosis and compartment syndrome. The patient was managed with popliteal to PTA bypass using contralateral limb reversed saphenous vein graft, and yielded good results.
{"title":"Spontaneous pseudoaneurysm of posterior tibial artery with deep vein thrombosis and compartment syndrome","authors":"Neelamjingbha Sun, Sriram Manchikanti, A. Gupta, Shivanesan Pitchai","doi":"10.4103/ijves.ijves_44_22","DOIUrl":"https://doi.org/10.4103/ijves.ijves_44_22","url":null,"abstract":"Posterior tibial artery (PTA) aneurysms are rare and associated with trauma and orthopedic interventions. We present a rare case of spontaneous pseudoaneurysm of the PTA, complicated with deep vein thrombosis and compartment syndrome. The patient was managed with popliteal to PTA bypass using contralateral limb reversed saphenous vein graft, and yielded good results.","PeriodicalId":13375,"journal":{"name":"Indian Journal of Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70769349","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 : 2022-09-01DOI: 10.4103/ijves.ijves_56_22
Devender Singh, M. Praveena, S. Aryala
True aneurysms of the digital artery are exceedingly rare, and a few cases have been reported. They form an important differential diagnosis in any patient presenting with a lump in the hand. We present a case of a 44-year-old man with a true aneurysm of the left common palmar digital artery, who underwent successful repair, following excision and end-to-end anastomosis.
{"title":"Surgical management of a true aneurysm of the digital artery","authors":"Devender Singh, M. Praveena, S. Aryala","doi":"10.4103/ijves.ijves_56_22","DOIUrl":"https://doi.org/10.4103/ijves.ijves_56_22","url":null,"abstract":"True aneurysms of the digital artery are exceedingly rare, and a few cases have been reported. They form an important differential diagnosis in any patient presenting with a lump in the hand. We present a case of a 44-year-old man with a true aneurysm of the left common palmar digital artery, who underwent successful repair, following excision and end-to-end anastomosis.","PeriodicalId":13375,"journal":{"name":"Indian Journal of Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44532532","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 : 2022-09-01DOI: 10.4103/ijves.ijves_106_22
Devender Singh, M. Praveena, S. Aryala
{"title":"First femoropopliteal bypass for a critical limb ischemia: The saga of joy and sorrow","authors":"Devender Singh, M. Praveena, S. Aryala","doi":"10.4103/ijves.ijves_106_22","DOIUrl":"https://doi.org/10.4103/ijves.ijves_106_22","url":null,"abstract":"","PeriodicalId":13375,"journal":{"name":"Indian Journal of Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49377605","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 : 2022-09-01DOI: 10.4103/ijves.ijves_94_22
S. Netam, V. Jain, Shubhkriti Agrawal, M. Rashika
Turner syndrome is one of the most common sex chromosome disorders with many anatomical abnormalities that affect physiological systems of human body. The most common cardiovascular anomalies in Turner syndrome are bicuspid aortic valve and coarctation of aorta. The venous anomalies include partial anomalous pulmonary venous return and persistent left sided Superior vena cava. Duplication of inferior vena cava (IVC) is rare in occurrence. On extensive literature search, no such case of IVC duplication in Turner syndrome is found. We, herein, report an incidental finding of IVC duplication in a known case of Turner syndrome. Any patient with Turner syndrome should be evaluated for additional venous anomalies.
{"title":"A case of duplication of inferior vena cava and turner syndrome: Is it a rare association?","authors":"S. Netam, V. Jain, Shubhkriti Agrawal, M. Rashika","doi":"10.4103/ijves.ijves_94_22","DOIUrl":"https://doi.org/10.4103/ijves.ijves_94_22","url":null,"abstract":"Turner syndrome is one of the most common sex chromosome disorders with many anatomical abnormalities that affect physiological systems of human body. The most common cardiovascular anomalies in Turner syndrome are bicuspid aortic valve and coarctation of aorta. The venous anomalies include partial anomalous pulmonary venous return and persistent left sided Superior vena cava. Duplication of inferior vena cava (IVC) is rare in occurrence. On extensive literature search, no such case of IVC duplication in Turner syndrome is found. We, herein, report an incidental finding of IVC duplication in a known case of Turner syndrome. Any patient with Turner syndrome should be evaluated for additional venous anomalies.","PeriodicalId":13375,"journal":{"name":"Indian Journal of Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45473498","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 : 2022-09-01DOI: 10.4103/ijves.ijves_42_22
Animesh Singla, Y. Cai, Krishna Kotecha, W. Mohabbat
Giant visceral artery aneurysms are uncommon. Branch vessel aneurysms, particularly of the pancreaticoduodenal territory are challenging to treat due to their location, anatomy, and access to an aneurysm. While open surgical resection is associated with significant morbidity, endovascular treatment is becoming increasingly mainstream. The utilization of coil embolization, particularly in the setting of rupture has been well described. Access and platform in these settings often involve the celiac axis. We describe unusual care of a large inferior pancreaticoduodenal aneurysm and associated retroperitoneal bleed, being fed through an ectatic superior mesenteric artery. This was associated with an occluded celiac axis. Due to the unusually large proximal and distal landing zones, a covered balloon-expandable stent was deployable with the successful exclusion of the aneurysm. This is the first reported case report of successful management of retroperitoneal rupture and associated pancreaticoduodenal aneurysm treated with a covered stent graft. This technique allowed for rapid access and exclusion of the aneurysm. In addition, it allowed the preservation of foregut flow through the collateral pathway and successfully excluded the large aneurysm.
{"title":"Giant true inferior pancreaticoduodenal artery aneurysm associated with celiac axis occlusion: A first case of successful treatment with covered balloon-expandable stent grafting using VBX","authors":"Animesh Singla, Y. Cai, Krishna Kotecha, W. Mohabbat","doi":"10.4103/ijves.ijves_42_22","DOIUrl":"https://doi.org/10.4103/ijves.ijves_42_22","url":null,"abstract":"Giant visceral artery aneurysms are uncommon. Branch vessel aneurysms, particularly of the pancreaticoduodenal territory are challenging to treat due to their location, anatomy, and access to an aneurysm. While open surgical resection is associated with significant morbidity, endovascular treatment is becoming increasingly mainstream. The utilization of coil embolization, particularly in the setting of rupture has been well described. Access and platform in these settings often involve the celiac axis. We describe unusual care of a large inferior pancreaticoduodenal aneurysm and associated retroperitoneal bleed, being fed through an ectatic superior mesenteric artery. This was associated with an occluded celiac axis. Due to the unusually large proximal and distal landing zones, a covered balloon-expandable stent was deployable with the successful exclusion of the aneurysm. This is the first reported case report of successful management of retroperitoneal rupture and associated pancreaticoduodenal aneurysm treated with a covered stent graft. This technique allowed for rapid access and exclusion of the aneurysm. In addition, it allowed the preservation of foregut flow through the collateral pathway and successfully excluded the large aneurysm.","PeriodicalId":13375,"journal":{"name":"Indian Journal of Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41285151","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 : 2022-09-01DOI: 10.4103/ijves.ijves_71_22
Deepak Sulya, Siddhanth Vairagar, B. Saichandran, Durgaprasad Rath, S. Ramsankar, M. Hemachandren, Ksp Sreevathsa
Background: We studied patients with concomitant vascular and orthopedic trauma to limbs to assess their outcome and factors that affect the outcome of the limb. Methodology: We conducted a retrospective descriptive study and data from 68 patients was collected. Factors such as demography, mode of injury, and clinical parameters such as pulses, capillary refill time (CRT), sensory-motor function, compartment syndrome, type of bone and vessel injury, and ischemia time were compared and analyzed. Results: Out of 68 patients (n = 68) with concomitant vascular and orthopedic injury included in the study, 63 (92.65%) patients were males, and the mean age in the study was 30.16 ± 16.33 years; 56 (82.35%) patients sustained road traffic accident and 12 (17.65%) patients sustained fall from height, 7 (10.29%) patients were hypertensive, and 2 (2.94%) patients had diabetes mellitus; popliteal (30 patients – 22.06%) and brachial arteries (30 patients – 22.06%) are the most (total 44.12%) followed by femoral artery (seven patients, 10.29%) and radial artery (one patient, 1.47%); sensory function was absent in 20 (29.4%) patients; CRT was more than 3 s in 49 (72.06%) patients. No mortality occurred during the hospital stay in any of the 68 patients. The overall rate of amputation in the study was 20.59% (14 amputations). Significant association of amputation rate was found with increased CRT (P = 0.01), fracture (P = 0.05), open fracture (P = 0.05), transected vessel (P = 0.017), nonextremity injury (P = 0.01), and compartment syndrome (P = 0.002). Fasciotomy was done for 49 (72.06%) patients, and no significant association was found with the amputation rate. Mangled extremity severity score (MESS) was 7 or more than 7 in 23 (33.82%) patients. All the 14 (100%) patients who required amputation in the study had a MESS of 7 or more (P = 0.01), and limb salvage index (LSI) was 6 or more in 17 patients; among the 14 patients who underwent amputation, 13 patients had an LSI of 6 or more than 6 (P = 0.01). The vascular repair was redone in 3 (21.4%) patients, excessive bleeding requiring blood transfusion happened in 2 (14.3%) patients, and hypotension occurred in 4 (28.6%) patients. Intraoperative complications were associated with an increased rate of amputations (P = 0.001). The mean ischemia time was 15 ± 6.5 h with a median of 15 h; the shortest ischemia time was 10 h, and the longest was 19 h. The mean ischemia time was 14 h in the limb salvage group and 18.5 h in the amputation group. Long ischemia time was associated with increased amputation rates (P = 0.03). There was no significant difference in time between the time of injury and presentation to the hospital, the time between presentation and surgery, and the duration of surgery between the two groups (amputated vs. salvaged). Conclusion: The extent of soft-tissue injury and ischemia time are prime determinants of outcome in cases with concomitant vascular and skeletal injury. Early diagnosis, quick re
{"title":"A descriptive study of concomitant vascular and bone injuries of the limbs in a tertiary care hospital in South India","authors":"Deepak Sulya, Siddhanth Vairagar, B. Saichandran, Durgaprasad Rath, S. Ramsankar, M. Hemachandren, Ksp Sreevathsa","doi":"10.4103/ijves.ijves_71_22","DOIUrl":"https://doi.org/10.4103/ijves.ijves_71_22","url":null,"abstract":"Background: We studied patients with concomitant vascular and orthopedic trauma to limbs to assess their outcome and factors that affect the outcome of the limb. Methodology: We conducted a retrospective descriptive study and data from 68 patients was collected. Factors such as demography, mode of injury, and clinical parameters such as pulses, capillary refill time (CRT), sensory-motor function, compartment syndrome, type of bone and vessel injury, and ischemia time were compared and analyzed. Results: Out of 68 patients (n = 68) with concomitant vascular and orthopedic injury included in the study, 63 (92.65%) patients were males, and the mean age in the study was 30.16 ± 16.33 years; 56 (82.35%) patients sustained road traffic accident and 12 (17.65%) patients sustained fall from height, 7 (10.29%) patients were hypertensive, and 2 (2.94%) patients had diabetes mellitus; popliteal (30 patients – 22.06%) and brachial arteries (30 patients – 22.06%) are the most (total 44.12%) followed by femoral artery (seven patients, 10.29%) and radial artery (one patient, 1.47%); sensory function was absent in 20 (29.4%) patients; CRT was more than 3 s in 49 (72.06%) patients. No mortality occurred during the hospital stay in any of the 68 patients. The overall rate of amputation in the study was 20.59% (14 amputations). Significant association of amputation rate was found with increased CRT (P = 0.01), fracture (P = 0.05), open fracture (P = 0.05), transected vessel (P = 0.017), nonextremity injury (P = 0.01), and compartment syndrome (P = 0.002). Fasciotomy was done for 49 (72.06%) patients, and no significant association was found with the amputation rate. Mangled extremity severity score (MESS) was 7 or more than 7 in 23 (33.82%) patients. All the 14 (100%) patients who required amputation in the study had a MESS of 7 or more (P = 0.01), and limb salvage index (LSI) was 6 or more in 17 patients; among the 14 patients who underwent amputation, 13 patients had an LSI of 6 or more than 6 (P = 0.01). The vascular repair was redone in 3 (21.4%) patients, excessive bleeding requiring blood transfusion happened in 2 (14.3%) patients, and hypotension occurred in 4 (28.6%) patients. Intraoperative complications were associated with an increased rate of amputations (P = 0.001). The mean ischemia time was 15 ± 6.5 h with a median of 15 h; the shortest ischemia time was 10 h, and the longest was 19 h. The mean ischemia time was 14 h in the limb salvage group and 18.5 h in the amputation group. Long ischemia time was associated with increased amputation rates (P = 0.03). There was no significant difference in time between the time of injury and presentation to the hospital, the time between presentation and surgery, and the duration of surgery between the two groups (amputated vs. salvaged). Conclusion: The extent of soft-tissue injury and ischemia time are prime determinants of outcome in cases with concomitant vascular and skeletal injury. Early diagnosis, quick re","PeriodicalId":13375,"journal":{"name":"Indian Journal of Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49445219","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}
Introduction and Objectives: Vascular injuries due to kite string are uncommon but are associated with significant morbidities and mortality. With the increase in the sharpness of the string, the incidence of these injuries is on the rise not only to flyer but also to the innocent other people. We present our experience as there is a relative paucity of data and literature on this subject and suggest measures to control. Methods: Between January 2016 and January 2022, six patients suffered vascular injuries due to kite string (manja) and were admitted to the vascular unit of tertiary care center. The medical histories of the patients were reviewed retrospectively and analyzed. Initial treatment included hemorrhage control by direct pressure or packing and fluid resuscitation and airway establishment by intubation (if required). Neck injuries were divided into three zones. All patients were subjected to computed tomography angiography followed by emergency exploration and repair. Results: Males are most commonly affected. The most common age group affected was 3050 years. Majority of these patients were travelling on a two wheeler. The neck was most commonly involved with primarily venous injuries. Four patients had injuries in Zone II and one patient in Zone I. One patient had a deep laceration around the ankle with vascular and significant soft-tissue injuries. The injuries were of the jugular veins, external carotid artery, trachea and tibial artery, nerve, and tendoachilles (complete tear). All the major vascular injuries were either repaired or ligated. There was no major morbidity or mortality. Conclusion: Kite flying is a popular sport in the Indian subcontinent. Vascular injuries due to sharp string can lead to grievous injuries or may be fatal. This study attempted to enlighten these dangers and emphasize that potential threats have to be understood and addressed adequately.
{"title":"Kite string vascular injuries: Management of uncommon vascular injuries with common suggestions","authors":"Devender Singh, Aruna Kottilliyil, Basavarajendra Anurshetru","doi":"10.4103/ijves.ijves_66_22","DOIUrl":"https://doi.org/10.4103/ijves.ijves_66_22","url":null,"abstract":"Introduction and Objectives: Vascular injuries due to kite string are uncommon but are associated with significant morbidities and mortality. With the increase in the sharpness of the string, the incidence of these injuries is on the rise not only to flyer but also to the innocent other people. We present our experience as there is a relative paucity of data and literature on this subject and suggest measures to control. Methods: Between January 2016 and January 2022, six patients suffered vascular injuries due to kite string (manja) and were admitted to the vascular unit of tertiary care center. The medical histories of the patients were reviewed retrospectively and analyzed. Initial treatment included hemorrhage control by direct pressure or packing and fluid resuscitation and airway establishment by intubation (if required). Neck injuries were divided into three zones. All patients were subjected to computed tomography angiography followed by emergency exploration and repair. Results: Males are most commonly affected. The most common age group affected was 3050 years. Majority of these patients were travelling on a two wheeler. The neck was most commonly involved with primarily venous injuries. Four patients had injuries in Zone II and one patient in Zone I. One patient had a deep laceration around the ankle with vascular and significant soft-tissue injuries. The injuries were of the jugular veins, external carotid artery, trachea and tibial artery, nerve, and tendoachilles (complete tear). All the major vascular injuries were either repaired or ligated. There was no major morbidity or mortality. Conclusion: Kite flying is a popular sport in the Indian subcontinent. Vascular injuries due to sharp string can lead to grievous injuries or may be fatal. This study attempted to enlighten these dangers and emphasize that potential threats have to be understood and addressed adequately.","PeriodicalId":13375,"journal":{"name":"Indian Journal of Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42438818","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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