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Successful management of abdominal aortocutaneous fistula following emergency endovascular aneurysm repair for aortoenteric fistula in a patient with Takayasu arteritis 1例高松动脉炎患者急诊血管内动脉瘤修复主动脉肠瘘后腹主动脉皮瘘的成功治疗
IF 0.1 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2022-09-01 DOI: 10.4103/ijves.ijves_45_22
Rahul Sima, N. Sekar, A. Gopalamurugan, A. Rajan, J. Sebastian
Aortocutaneous fistula is an extremely rare complication after aortic endograft infection. We report on the management of a patient who presented with aortocutaneous fistula following emergency endovascular aneurysm repair (EVAR) of an aortoenteric fistula (AEF). A 50-year-old female with Takayasu arteritis who had undergone thoracic endovascular aortic repair (TEVAR) for a thoracic aortic aneurysm, 23 years ago presented with a spontaneous abdominal AEF and another contained ruptured descending thoracic aortic aneurysm distal to the previous endograft. She underwent emergency bridge EVAR and redo-TEVAR. Thirteen months following EVAR, she presented with endograft infection and a spontaneous aortocutaneous fistula. She was successfully managed with an axillo-unifemoral bypass followed by EVAR endograft explantation. She was discharged on long-term antibiotics and has been symptom free for 12 months.
主动脉皮瘘是主动脉内移植物感染后极为罕见的并发症。我们报告了一名在主动脉肠瘘(AEF)的紧急血管内动脉瘤修复(EVAR)后出现主动脉皮瘘的患者的治疗。一名50岁的女性,患有大动脉炎,23年前因胸主动脉瘤接受了胸主动脉腔内修复术(TEVAR),出现自发性腹部AEF,另一例在先前的内移植物远端出现胸降主动脉瘤破裂。她接受了紧急桥接EVAR和重做TEVAR。EVAR术后13个月,她出现移植物内感染和自发性主动脉皮瘘。她成功地进行了腋窝单股旁路移植,随后进行了EVAR内移植物移植。她因长期服用抗生素而出院,12个月来一直没有任何症状。
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引用次数: 0
New classification for juxta renal aortoiliac occlusion-based on imaging for safe clamping and contemporary surgical management results 基于安全夹闭的影像学和现代手术治疗结果的肾主动脉髂旁闭塞新分类
IF 0.1 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2022-09-01 DOI: 10.4103/ijves.ijves_62_22
A. Savlania, V. Vaddavalli, Sriharsha Balraj, P. Jain, Aswitha Ravi, M. Ananthakumar, A. Behera, U. Gorsi, L. Kaman
Objectives: The objective is to decide the site of aortic clamping based on preoperative imaging and intraoperative findings and assess the outcomes on midterm follow-up in patients with juxtarenal aortoiliac occlusion (JRAIO) managed with aortic thromboendarterectomy and bypass grafting. Methods: Forty patients (39 males and one female) with JRAIO were managed with aortobifemoral bypass (ABFB). Two patients required concomitant superior mesenteric artery (SMA) bypass. The aortic clamping site was inter-renal, suprarenal, or supra-celiac, depending on the extent of thrombus relative to the renal artery and SMA ostia. We compared serum creatinine levels with renal ischemic time in the postoperative period. At the mean follow-up of 26.7 months, patients were assessed for graft patency, limb salvage, and survival rate. Results: The mean age of patients was 53.9 years, and 97.5% of patients were heavy smokers. Of the total patients, inter-renal clamping was done in 12.5%, suprarenal clamping in 70%, and supra-celiac clamping in 17.5%. Perioperative morbidity and mortality were 22.5% and 5%, respectively. Five patients with renal ischemic time ≥20 min developed acute kidney injury, showing a significant positive correlation (r = 0.465; P < 0.0001) with clamp time. Postoperative mean serum creatinine values also showed a significant difference (P = 0.0001) between <20 and ≥20 min groups. At follow-up, graft patency and limb salvage rates were 100%, and the survival rate was 97.4%. Conclusion: The risk of atheroembolic renal ischemia in ABFB for JRAIO can be lowered by good preoperative planning and safe intraoperative clamping technique, based on a simple classification for aortic clamping.
目的:目的是根据术前影像学和术中发现来确定主动脉夹闭的位置,并评估主动脉血栓内膜切除术和旁路移植术治疗的主动脉髂旁闭塞(JRAIO)患者的中期随访结果。方法:对40例JRAIO患者(男39例,女1例)采用主动脉双股旁路移植术(ABFB)进行治疗。两名患者需要同时行肠系膜上动脉(SMA)搭桥术。主动脉夹闭部位为肾间、肾上或腹腔上,这取决于血栓相对于肾动脉和SMA口的程度。我们比较了术后血清肌酸酐水平与肾缺血时间。在平均26.7个月的随访中,评估患者的移植物通畅性、肢体挽救率和生存率。结果:患者的平均年龄为53.9岁,97.5%的患者是重度吸烟者。在所有患者中,肾间夹闭术占12.5%,肾上夹闭术为70%,腹腔上夹闭手术为17.5%。围手术期发病率和死亡率分别为22.5%和5%。5例肾缺血时间≥20min的患者发生急性肾损伤,与夹闭时间呈正相关(r=0.465;P<0.0001)。术后平均血清肌酐值在<20和≥20min组之间也有显著差异(P=0.0001)。在随访中,移植物的通畅率和保肢率为100%,存活率为97.4%。结论:在主动脉夹闭的简单分类基础上,良好的术前计划和安全的术中夹闭技术可以降低JRAIO在ABFB中发生动脉粥样硬化性肾缺血的风险。
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引用次数: 0
Obscure presentation of postthrombotic syndrome 血栓形成后综合征的模糊表现
IF 0.1 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2022-09-01 DOI: 10.4103/ijves.ijves_99_22
J. Patel, Manisha Asrani, Arya Patel, Gazal Patel
Postthrombotic syndrome (PTS) will develop in 20% to 50% of patients within 1 to 2 years of symptomatic deep venous thrombosis (DVT). Limbs afflicted with PTS have more than three times the odds of having combined reflux and obstruction compared with limbs without PTS. Here, we present a case of an involvement of the right lower limb with classical features of PTS. Due to its low prevalence and similar presentations as those of chronic venous insufficiency lead to a missed diagnosis and prolonged follow up and complications of PTS. This can be prevented by employing CT venography as an early investigation modality. Here we treated the patient with open method as endovascular procedure was not successful.
血栓后综合征(PTS)将在症状性深静脉血栓形成(DVT)的1至2年内发展为20%至50%的患者。与没有PTS的肢体相比,患有PTS的四肢合并反流和阻塞的几率是没有PTS四肢的三倍多。在这里,我们提出了一个涉及右下肢的典型PTS特征的病例。由于其发病率低,表现与慢性静脉功能不全相似,导致PTS的漏诊、长期随访和并发症。这可以通过采用CT静脉造影作为早期调查模式来预防。在这里,我们用开放式方法治疗患者,因为血管内手术并不成功。
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引用次数: 0
Isolated giant infrarenal abdominal aortic aneurysm with dissection: Case report of an extremely rare entity 孤立性巨大肾下腹主动脉瘤伴夹层:一例极为罕见的实体瘤病例报告
IF 0.1 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2022-09-01 DOI: 10.4103/ijves.ijves_54_22
Divij Jayant, A. Behera, Cherring Tandup, S. Nagaraj, Saroj S. Yadav
Although abdominal aortic aneurysm (AAA) is common in the atherosclerotic aorta in the elderly, isolated AAA (IAAA) is a rare entity. Only few case reports of IAAA associated with concomitant dissection are reported in the literature. Here, we present a case of a middle-aged male who presented with abdominal pain with stable hemodynamics. Abdominal examination revealed a pulsatile mass in the left paraumbilical region. CT angiography of the abdomen revealed an isolated infrarenal AAA with dissection extending into the bilateral common iliac arteries and an eccentric partial thrombosis of the false lumen. The patient underwent successful open aneurysmorrhaphy with PTFE graft. Postoperative course was uneventful, and the patient was discharged to follow up in clinics.
尽管腹主动脉瘤(AAA)在老年人的动脉粥样硬化主动脉中很常见,但孤立性AAA(IAAA)是一种罕见的实体。文献中仅报道了少数伴有夹层的IAAA病例报告。在这里,我们介绍了一个中年男性的病例,他表现为腹痛,血流动力学稳定。腹部检查显示左侧脐旁有搏动性肿块。腹部CT血管造影术显示孤立的肾下AAA,夹层延伸至双侧髂总动脉,假腔偏心部分血栓形成。患者接受了成功的聚四氟乙烯移植开放性动脉瘤修补术。术后进展顺利,病人出院后到诊所随访。
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引用次数: 0
Work and life – A surgical challenge 工作和生活——外科手术的挑战
IF 0.1 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2022-09-01 DOI: 10.4103/ijves.ijves_3_23
R. George
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引用次数: 0
Comparing endovascular revascularization to open surgical revascularization for chronic mesenteric ischemia: A systematic review and meta-analysis 比较血管内重建术与开放手术重建术治疗慢性肠系膜缺血:一项系统回顾和荟萃分析
IF 0.1 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2022-09-01 DOI: 10.4103/ijves.ijves_93_22
Saeed S Alqahtani, Bader M Albilasi, Osama Alenzi, Saleh A Almoallem, A. Alruwaili, Mohammed Alkhaldi, A. Alruwaili, Raid Almassaeed
Although the incidence of chronic mesenteric ischemia (CMI) is uncommon, it could become life threatening. With improvements in diagnostic imaging and endovascular therapy over the past few decades, the treatment of CMI has evolved. Even though endovascular revascularization for CMI is prominent, it is unclear if the early advantages outweigh the long-term patency rates. This study conducts a systematic review and meta-analysis to present comprehensive insights into the validity of endovascular revascularization versus open revascularization as effective therapeutic modalities. Studies up to 2022 were searched in MEDLINE, Cochrane Database of Systematic Reviews, Scopus, and Embase. Additionally, references from earlier studies and review papers were manually searched for additional relevant reports. At least two authors examined all the results, making sure they fit the inclusion and exclusion criteria. In the event of disagreement, the authors were able to reach an understanding. Open revascularization is superior to endovascular approaches in maintaining vessel patency and reducing symptoms over the long term. Perioperative problems are more common in patients undergoing open procedures. Each patient's anatomy and physiology call for a different revascularization approach to be applied in treating this condition.
尽管慢性肠系膜缺血(CMI)的发生率并不常见,但它可能会危及生命。在过去的几十年里,随着诊断成像和血管内治疗的改进,CMI的治疗方法也在不断发展。尽管CMI的血管内血运重建很突出,但尚不清楚早期的优势是否大于长期的通畅率。本研究进行了系统回顾和荟萃分析,以全面了解血管内血运重建与开放式血运重建作为有效治疗模式的有效性。截至2022年的研究在MEDLINE、Cochrane系统评价数据库、Scopus和Embase中进行了检索。此外,还手动搜索了早期研究和综述论文中的参考文献,以查找其他相关报告。至少有两位作者检查了所有结果,确保它们符合纳入和排除标准。如果出现分歧,提交人能够达成谅解。在长期保持血管通畅和减少症状方面,开放式血运重建优于血管内方法。围手术期的问题在接受开放手术的患者中更为常见。每个患者的解剖学和生理学都要求采用不同的血运重建方法来治疗这种情况。
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引用次数: 0
Friedrich Trendelenburg (1844–1924): A surgeon who opened the door for venous disorders 弗里德里希·特伦德伦堡(1844–1924):一位为静脉疾病打开大门的外科医生
IF 0.1 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2022-07-01 DOI: 10.4103/ijves.ijves_118_21
Devender Singh, S. Aryala
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引用次数: 0
Delayed traumatic superficial femoral artery pseudoaneurysm and arteriovenous fistula over the left lower limb 左下肢迟发性外伤性浅股动脉假性动脉瘤及动静脉瘘
IF 0.1 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2022-07-01 DOI: 10.4103/ijves.ijves_3_22
J. Patel, Pratiksha Shah, Roshni S. K. Patel, Ravisagar Patel, Fenil Gandhi
A pseudoaneurysm is a pulsating, encapsulated hematoma in communication with a ruptured vessel (1); there is an accumulation of blood between the tunica media and tunica adventitia layers of the vessel. We report a case of a young male with complaints of swelling, skin discoloration, and a tingling sensation of the left lower limb. A peripheral angiography was performed, which revealed an arteriovenous fistula at the middle of the left superficial femoral artery. The patient underwent a left superficial femoral artery pseudoaneurysm excision and repair. In this case report, we discuss the presenting clinical features, methods of evaluation, and the management of the superficial femoral artery pseudoaneurysm accompanied with arteriovenous fistula.
假性动脉瘤是与破裂血管相通的搏动性包裹性血肿(1);血管的中膜层和外膜层之间有积血。我们报告一例年轻男性的投诉肿胀,皮肤变色,和刺痛感的左下肢。行外周血管造影,发现左股浅动脉中间有动静脉瘘。患者接受左股浅动脉假性动脉瘤切除和修复。在本病例报告中,我们讨论了股浅动脉假性动脉瘤合并动静脉瘘的临床表现、评估方法和治疗。
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引用次数: 0
Cost-effective treatment for deep-vein thrombosis in rural tertiary care hospital 农村三级医院治疗深静脉血栓的成本效益分析
IF 0.1 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2022-07-01 DOI: 10.4103/ijves.ijves_23_22
Arunkumar Arasappa, N. Kumar, M. Anto, G. Manoharan, Duraipandian Selvanathan
Objective: The aim was to compare the cost of treating deep-vein thrombosis (DVT) using unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH) among patients in rural tertiary care hospitals. Materials and Methods: A retrospective study was conducted at a Rural Tertiary Care Hospital from April 2017 to April 2019. Fifty-four patients who had symptoms of swelling of the unilateral or bilateral lower limb with or without pain were subjected to Padua prediction score and Doppler study of both lower limbs. Confirmed cases of DVT were treated with UFH or LMWH. The cost of these two treatments was compared. Results: The mean cost of heparin was 2493.33 ± 1406.27 Indian rupee (INR) in the study population. The mean cost of LMWH was 13,520 ± 9806.35 (INR) in the study population. There was a statistically significant difference between UFH and LMWH with regard to the cost of drugs (INR) for treatment (P < 0.001), which indicated that UFH was a cost-effective treatment compared to LMWH. Conclusions: The study's findings prove that UFH is a cost-effective treatment compared to LMWH in Rural Tertiary Care Hospitals for DVT. Based on the patient's affordability, the treatment decision can be made.
目的:比较农村三级医院普通肝素(UFH)和低分子肝素(LMWH)治疗深静脉血栓形成(DVT)的费用。材料和方法:2017年4月至2019年4月在一家农村三级护理医院进行回顾性研究。对54名有单侧或双侧下肢肿胀症状(伴有或不伴有疼痛)的患者进行Padua预测评分和双下肢多普勒研究。确诊的DVT病例接受UFH或LMWH治疗。比较了这两种治疗方法的成本。结果:研究人群中肝素的平均成本为2493.33±1406.27印度卢比。研究人群中低分子肝素的平均成本为13520±9806.35(INR)。UFH和LMWH在治疗药物成本(INR)方面存在统计学显著差异(P<0.001),这表明与LMWH相比,UFH是一种具有成本效益的治疗方法。结论:研究结果证明,在农村三级护理医院,与低分子肝素相比,UFH是一种具有成本效益的DVT治疗方法。根据患者的负担能力,可以做出治疗决定。
{"title":"Cost-effective treatment for deep-vein thrombosis in rural tertiary care hospital","authors":"Arunkumar Arasappa, N. Kumar, M. Anto, G. Manoharan, Duraipandian Selvanathan","doi":"10.4103/ijves.ijves_23_22","DOIUrl":"https://doi.org/10.4103/ijves.ijves_23_22","url":null,"abstract":"Objective: The aim was to compare the cost of treating deep-vein thrombosis (DVT) using unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH) among patients in rural tertiary care hospitals. Materials and Methods: A retrospective study was conducted at a Rural Tertiary Care Hospital from April 2017 to April 2019. Fifty-four patients who had symptoms of swelling of the unilateral or bilateral lower limb with or without pain were subjected to Padua prediction score and Doppler study of both lower limbs. Confirmed cases of DVT were treated with UFH or LMWH. The cost of these two treatments was compared. Results: The mean cost of heparin was 2493.33 ± 1406.27 Indian rupee (INR) in the study population. The mean cost of LMWH was 13,520 ± 9806.35 (INR) in the study population. There was a statistically significant difference between UFH and LMWH with regard to the cost of drugs (INR) for treatment (P < 0.001), which indicated that UFH was a cost-effective treatment compared to LMWH. Conclusions: The study's findings prove that UFH is a cost-effective treatment compared to LMWH in Rural Tertiary Care Hospitals for DVT. Based on the patient's affordability, the treatment decision can be made.","PeriodicalId":13375,"journal":{"name":"Indian Journal of Vascular and Endovascular Surgery","volume":"9 1","pages":"287 - 290"},"PeriodicalIF":0.1,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49648588","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}
引用次数: 0
Rule of 3 for peripheral vascular injuries 外周血管损伤的3法则
IF 0.1 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2022-07-01 DOI: 10.4103/ijves.ijves_53_22
H. Agarwal, J. James, Vignesh Kumar, Anand Katiyar
{"title":"Rule of 3 for peripheral vascular injuries","authors":"H. Agarwal, J. James, Vignesh Kumar, Anand Katiyar","doi":"10.4103/ijves.ijves_53_22","DOIUrl":"https://doi.org/10.4103/ijves.ijves_53_22","url":null,"abstract":"","PeriodicalId":13375,"journal":{"name":"Indian Journal of Vascular and Endovascular Surgery","volume":"9 1","pages":"335 - 336"},"PeriodicalIF":0.1,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45486192","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}
引用次数: 0
期刊
Indian Journal of Vascular and Endovascular Surgery
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