Pub Date : 2022-07-01DOI: 10.4103/ijves.ijves_5_22
M. Prabhakaran, H. Mahapatra, N. Kaur, Amandeep Singh, S. Patil, Abhisek Gautam, A. Kumari
End-stage kidney disease (ESKD) patients who were on maintenance hemodialysis require a stable, permanent vascular access as a lifeline. Venous mapping during prearteriovenous fistula (AVF) construction does not include central vein assessment. The guidelines on angiographic assessment of central veins during pre-AVF construction are yet to be streamlined. Moreover, during COVID pandemic, assess difficulty in catheterization laboratory and interventional radiology created devastating situation. We report 15 ESKD cases of central venous stenosis presented during the COVID pandemic time from February 2020 to July 2021. Patients' basic details were collected and initial clinical examination findings were recorded; they were subjected to Doppler and fistulogram. After the combined decision of nephrologist, interventional cardiologist, and vascular surgeon, the management (fistula closure/repair) was planned. Of 15 patients, 13 were males. Basic disease is chronic glomerulonephritis in 9, diabetic nephropathy in 4, and chronic interstitial nephritis in 2. Average number of central vein cannulation prior to AVF creation was 2.6. The median time to the development of symptoms after fistula creation was 13 months. Major initial symptoms were swelling of the upper limb in 4, dilatation of outflow veins in 5, swelling and dilatation in 2, poor flow during dialysis in 3, and dilatation of neck and chest vein in 1. Arm elevation test was positive in most of the cases. On Doppler assessment, dilated veins (>12 mm) with high outflow (>2000 ml/min) in 5, 4 patients showed low flow (<400 ml/min), and six patients showed normal findings. In fistulogram, the common location of stenosis/thrombosis was brachiocephalic vein (BV) in 5 and subclavian vein (SC) in 3, BV vein + SC vein in 4, and superior vena cava in 3. Out of 15, 3 underwent balloon dilatation, 7 underwent fistula closure, 1 no intervention done, 3 lost to follow-up, and 1 expired. This is the first case series of central vein stenosis (CVS) brought in light during COVID pandemic. CVS is a serious issue, which might result in permanent vascular access failure. Further study is needed on impact of previous central vein catheterization leading to stenosis and role of pre-AVF creation angiographic assessment to avoid this type of devastating AVF complication.
{"title":"Central vein stenosis in hemodialysis patients during COVID pandemic: A case series analysis","authors":"M. Prabhakaran, H. Mahapatra, N. Kaur, Amandeep Singh, S. Patil, Abhisek Gautam, A. Kumari","doi":"10.4103/ijves.ijves_5_22","DOIUrl":"https://doi.org/10.4103/ijves.ijves_5_22","url":null,"abstract":"End-stage kidney disease (ESKD) patients who were on maintenance hemodialysis require a stable, permanent vascular access as a lifeline. Venous mapping during prearteriovenous fistula (AVF) construction does not include central vein assessment. The guidelines on angiographic assessment of central veins during pre-AVF construction are yet to be streamlined. Moreover, during COVID pandemic, assess difficulty in catheterization laboratory and interventional radiology created devastating situation. We report 15 ESKD cases of central venous stenosis presented during the COVID pandemic time from February 2020 to July 2021. Patients' basic details were collected and initial clinical examination findings were recorded; they were subjected to Doppler and fistulogram. After the combined decision of nephrologist, interventional cardiologist, and vascular surgeon, the management (fistula closure/repair) was planned. Of 15 patients, 13 were males. Basic disease is chronic glomerulonephritis in 9, diabetic nephropathy in 4, and chronic interstitial nephritis in 2. Average number of central vein cannulation prior to AVF creation was 2.6. The median time to the development of symptoms after fistula creation was 13 months. Major initial symptoms were swelling of the upper limb in 4, dilatation of outflow veins in 5, swelling and dilatation in 2, poor flow during dialysis in 3, and dilatation of neck and chest vein in 1. Arm elevation test was positive in most of the cases. On Doppler assessment, dilated veins (>12 mm) with high outflow (>2000 ml/min) in 5, 4 patients showed low flow (<400 ml/min), and six patients showed normal findings. In fistulogram, the common location of stenosis/thrombosis was brachiocephalic vein (BV) in 5 and subclavian vein (SC) in 3, BV vein + SC vein in 4, and superior vena cava in 3. Out of 15, 3 underwent balloon dilatation, 7 underwent fistula closure, 1 no intervention done, 3 lost to follow-up, and 1 expired. This is the first case series of central vein stenosis (CVS) brought in light during COVID pandemic. CVS is a serious issue, which might result in permanent vascular access failure. Further study is needed on impact of previous central vein catheterization leading to stenosis and role of pre-AVF creation angiographic assessment to avoid this type of devastating AVF complication.","PeriodicalId":13375,"journal":{"name":"Indian Journal of Vascular and Endovascular Surgery","volume":"9 1","pages":"309 - 312"},"PeriodicalIF":0.1,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42024054","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 : 2022-07-01DOI: 10.4103/ijves.ijves_86_21
K. Abuji, A. Savlania, Deepak Kumar, L. Kaman, U. Gorsi, Cherring Tandup
COVID-19 pandemic has affected everyone globally in every walk of life. A rise in the number of patients afflicted with thromboembolic complications of COVID-19 is being reported, both venous and arterial. Elective vascular surgery has been stopped entirely at our institute. However, both COVID-19-positive and negative patients continued to require emergent vascular surgery even during the pandemic. We are reporting a case of COVID-positive, ruptured abdominal aortic aneurysm (AAA) who was successfully managed at our hospital. The principles of open repair of ruptured AAA remained same, with a few special considerations. We did not find any report on open repair of ruptured AAA in COVID-19-positive patient. On search at Medline, we found two cases of ruptured AAA, which were successfully managed with endovascular aneurysm repair (EVAR).
{"title":"COVID-19-positive ruptured abdominal aortic aneurysm successfully managed by open surgical repair and review of literature","authors":"K. Abuji, A. Savlania, Deepak Kumar, L. Kaman, U. Gorsi, Cherring Tandup","doi":"10.4103/ijves.ijves_86_21","DOIUrl":"https://doi.org/10.4103/ijves.ijves_86_21","url":null,"abstract":"COVID-19 pandemic has affected everyone globally in every walk of life. A rise in the number of patients afflicted with thromboembolic complications of COVID-19 is being reported, both venous and arterial. Elective vascular surgery has been stopped entirely at our institute. However, both COVID-19-positive and negative patients continued to require emergent vascular surgery even during the pandemic. We are reporting a case of COVID-positive, ruptured abdominal aortic aneurysm (AAA) who was successfully managed at our hospital. The principles of open repair of ruptured AAA remained same, with a few special considerations. We did not find any report on open repair of ruptured AAA in COVID-19-positive patient. On search at Medline, we found two cases of ruptured AAA, which were successfully managed with endovascular aneurysm repair (EVAR).","PeriodicalId":13375,"journal":{"name":"Indian Journal of Vascular and Endovascular Surgery","volume":"9 1","pages":"322 - 325"},"PeriodicalIF":0.1,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46449896","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 : 2022-07-01DOI: 10.4103/ijves.ijves_97_22
K. Suresh
{"title":"Pandemic of PAD/CLTI across the globe “A surgeon's skills are measured by the way he handles blood vessels” Sir William Halstead","authors":"K. Suresh","doi":"10.4103/ijves.ijves_97_22","DOIUrl":"https://doi.org/10.4103/ijves.ijves_97_22","url":null,"abstract":"","PeriodicalId":13375,"journal":{"name":"Indian Journal of Vascular and Endovascular Surgery","volume":"9 1","pages":"273 - 276"},"PeriodicalIF":0.1,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41712660","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 : 2022-07-01DOI: 10.4103/ijves.ijves_1_22
A. Pandey, Neelamjingbha Sun, Sriram Manchikanti, Shivanesan Pitchai
We describe an unusual presentation where a patient referred for ruptured abdominal aortic aneurysm was detected to have a concurrent colonic growth with perforation and localized spillage. Aneurysm repair was done with neoaortoiliac system reconstruction and Hartmann's procedure was done. This case report describes the management of a rare intraoperative challenge.
{"title":"Ruptured mycotic abdominal aortic aneurysm with perforated colonic malignancy – “Quadruple Jeopardy”","authors":"A. Pandey, Neelamjingbha Sun, Sriram Manchikanti, Shivanesan Pitchai","doi":"10.4103/ijves.ijves_1_22","DOIUrl":"https://doi.org/10.4103/ijves.ijves_1_22","url":null,"abstract":"We describe an unusual presentation where a patient referred for ruptured abdominal aortic aneurysm was detected to have a concurrent colonic growth with perforation and localized spillage. Aneurysm repair was done with neoaortoiliac system reconstruction and Hartmann's procedure was done. This case report describes the management of a rare intraoperative challenge.","PeriodicalId":13375,"journal":{"name":"Indian Journal of Vascular and Endovascular Surgery","volume":"9 1","pages":"326 - 328"},"PeriodicalIF":0.1,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42387196","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 : 2022-07-01DOI: 10.4103/ijves.ijves_35_22
M. Akhtar, Agam Goel, Sartaj Guroo, S. Rabbani, S. Alim, M. Haseen, Areeb Abbasi
Objectives: The objective was to study the role of propranolol in decreasing the size and severity of hemangioma. Materials and Methods: This study was conducted in JNMC, AMU, Aligarh, India, on 100 patients who were divided according to their age group among infants (0–1 year), children (1–14 years), and adults (>14 years). Intracavitary hemangioma was diagnosed with ultrasonography/magnetic resonance imaging scan. Treatment with oral propranolol was started after ruling out any contraindication to therapy. The patients were assessed according to the Hemangioma Activity and Severity Index (HASI) at the start and at the end of treatment. The treatment outcome and side effects were recorded. Results: Among the total patients studied, there were more number of adult patients in this study, most of them were male. There were more number of patients of extracutaneous hemangioma, most of which were intra-abdominal. The difference of location of hemangioma and age group was observed, with intra-abdominal hemangiomas being more common in adult patients and cutaneous hemangioma being more common in infant and pediatric age group. The propranolol therapy was effective in all age groups, with mean HASI being reduced significantly between start and end of treatment at 16 weeks (P = 0.001). There was regression in a good number of patients with partial regression in 55% of patients and complete regression in 32.5% of patients. Minor side effects of hypoglycemia, palpitation, and episodic bradycardia were observed in very few patients. Conclusions: Propranolol is effective in reducing the size and severity of hemangiomas among all age group of patients without causing any severe side effect.
{"title":"Effect of propranolol in cutaneous and intracavitary hemangiomas","authors":"M. Akhtar, Agam Goel, Sartaj Guroo, S. Rabbani, S. Alim, M. Haseen, Areeb Abbasi","doi":"10.4103/ijves.ijves_35_22","DOIUrl":"https://doi.org/10.4103/ijves.ijves_35_22","url":null,"abstract":"Objectives: The objective was to study the role of propranolol in decreasing the size and severity of hemangioma. Materials and Methods: This study was conducted in JNMC, AMU, Aligarh, India, on 100 patients who were divided according to their age group among infants (0–1 year), children (1–14 years), and adults (>14 years). Intracavitary hemangioma was diagnosed with ultrasonography/magnetic resonance imaging scan. Treatment with oral propranolol was started after ruling out any contraindication to therapy. The patients were assessed according to the Hemangioma Activity and Severity Index (HASI) at the start and at the end of treatment. The treatment outcome and side effects were recorded. Results: Among the total patients studied, there were more number of adult patients in this study, most of them were male. There were more number of patients of extracutaneous hemangioma, most of which were intra-abdominal. The difference of location of hemangioma and age group was observed, with intra-abdominal hemangiomas being more common in adult patients and cutaneous hemangioma being more common in infant and pediatric age group. The propranolol therapy was effective in all age groups, with mean HASI being reduced significantly between start and end of treatment at 16 weeks (P = 0.001). There was regression in a good number of patients with partial regression in 55% of patients and complete regression in 32.5% of patients. Minor side effects of hypoglycemia, palpitation, and episodic bradycardia were observed in very few patients. Conclusions: Propranolol is effective in reducing the size and severity of hemangiomas among all age group of patients without causing any severe side effect.","PeriodicalId":13375,"journal":{"name":"Indian Journal of Vascular and Endovascular Surgery","volume":"9 1","pages":"291 - 295"},"PeriodicalIF":0.1,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46810750","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 : 2022-07-01DOI: 10.4103/ijves.ijves_37_22
S. Balaji, C. Robinson, S. Yalamuru, Sabarish Kumar, Adharshkumar Maruthupandian, Syed Ahmed, M. Bharat Arun, Ruru Ray
Purpose: The most common cause of mortality in patients undergoing open surgical repair for aortoiliac disease is from cardiac complications. As there is a paucity of literature about the surgical outcomes in patients with compromised cardiac status, this study was undertaken to study the perioperative outcomes of open surgical repair for aortoiliac occlusive disease in patients with poor cardiac status. Methodology: A retrospective study was carried out from January 2017 to December 2020. Patients with aortoiliac occlusive disease based on computed tomography angiographic findings with poor cardiac reserve (ejection fraction ≤40% on echocardiography) were included in the study. The primary endpoints were perioperative complications which included intraoperative hemodynamic complications and early postoperative complications. Results: During 2017–2020, a total of 44 patients with aortoiliac occlusive disease (AIOD) with erectile function ≤40% underwent open surgical repair. Of these, 25 (57%) patients had infrarenal aortoiliac involvement and 19 (43%) had juxtarenal aortoiliac involvement. In our study of open surgical repair for juxtarenal and infrarenal aortoiliac occlusive disease in patients with poor cardiac status, intraoperative hemodynamic complications were noted in 26 (59%) patients, early postoperative complications were noted in 11 (25%), and mortality rate was 4.5%. Conclusion: Even though AIOD patients with poor cardiac status are at high operative risk than patients with normal cardiac status, open surgical repair with in-line bypass can be considered as a suitable option in these patients, especially where facilities for appropriate intraoperative monitoring and management are available.
{"title":"Perioperative outcomes of open surgical repair for juxtarenal and infrarenal aortoiliac occlusive disease in patients with poor cardiac status","authors":"S. Balaji, C. Robinson, S. Yalamuru, Sabarish Kumar, Adharshkumar Maruthupandian, Syed Ahmed, M. Bharat Arun, Ruru Ray","doi":"10.4103/ijves.ijves_37_22","DOIUrl":"https://doi.org/10.4103/ijves.ijves_37_22","url":null,"abstract":"Purpose: The most common cause of mortality in patients undergoing open surgical repair for aortoiliac disease is from cardiac complications. As there is a paucity of literature about the surgical outcomes in patients with compromised cardiac status, this study was undertaken to study the perioperative outcomes of open surgical repair for aortoiliac occlusive disease in patients with poor cardiac status. Methodology: A retrospective study was carried out from January 2017 to December 2020. Patients with aortoiliac occlusive disease based on computed tomography angiographic findings with poor cardiac reserve (ejection fraction ≤40% on echocardiography) were included in the study. The primary endpoints were perioperative complications which included intraoperative hemodynamic complications and early postoperative complications. Results: During 2017–2020, a total of 44 patients with aortoiliac occlusive disease (AIOD) with erectile function ≤40% underwent open surgical repair. Of these, 25 (57%) patients had infrarenal aortoiliac involvement and 19 (43%) had juxtarenal aortoiliac involvement. In our study of open surgical repair for juxtarenal and infrarenal aortoiliac occlusive disease in patients with poor cardiac status, intraoperative hemodynamic complications were noted in 26 (59%) patients, early postoperative complications were noted in 11 (25%), and mortality rate was 4.5%. Conclusion: Even though AIOD patients with poor cardiac status are at high operative risk than patients with normal cardiac status, open surgical repair with in-line bypass can be considered as a suitable option in these patients, especially where facilities for appropriate intraoperative monitoring and management are available.","PeriodicalId":13375,"journal":{"name":"Indian Journal of Vascular and Endovascular Surgery","volume":"9 1","pages":"296 - 301"},"PeriodicalIF":0.1,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49608807","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 : 2022-07-01DOI: 10.4103/ijves.ijves_41_22
A. Patkar, Sumanshi Singh, Neha Kalwadia, Rishabh Gadhavi, R. Sekhar
The exponential rise in diabetes in India has led to a steady rise in end-stage renal disease patients requiring renal replacement therapy (RRT). Affordability and access to centers providing RRT and maintenance of functioning upper extremity vascular access for prolonged periods remain a challenge. Frequently facing no upper extremity access situations, we decided to reassess the feasibility of lower extremity vascular access. A retrospective study was carried out evaluating data from January 2009 to March 2022 including patients with a graft tunneled in the thigh (lower superficial femoral artery end to side to terminal great saphenous vein end to end). Totally 26 cases were studied with respect to age, sex, body mass index, comorbidities, difficulty in cannulation, complications, graft dysfunction, and patency rates. Follow-up was a dynamic ongoing process without a fixed endpoint. Graft dysfunction was seen in seven of 26 patients (26.92%), with a primary patency rate of 88.46% (23/26) at 1 year. Twelve subjects died during the study period, however, all had a functioning lower limb arteriovenous graft (AVG). Lack of surgical training, fear of complications, and absence of team approach in decision-making are some reasons why lower extremity permanent dialysis access is infrequently used. However, in view of increased survival on dialysis, advancing age of the dialysis population, associated comorbidities, and multiple access failures, lower limb AVGs may be considered a feasible access modality with acceptable patency rates and minimal complications.
{"title":"Lower limb dialysis grafts: Are they really that bad?","authors":"A. Patkar, Sumanshi Singh, Neha Kalwadia, Rishabh Gadhavi, R. Sekhar","doi":"10.4103/ijves.ijves_41_22","DOIUrl":"https://doi.org/10.4103/ijves.ijves_41_22","url":null,"abstract":"The exponential rise in diabetes in India has led to a steady rise in end-stage renal disease patients requiring renal replacement therapy (RRT). Affordability and access to centers providing RRT and maintenance of functioning upper extremity vascular access for prolonged periods remain a challenge. Frequently facing no upper extremity access situations, we decided to reassess the feasibility of lower extremity vascular access. A retrospective study was carried out evaluating data from January 2009 to March 2022 including patients with a graft tunneled in the thigh (lower superficial femoral artery end to side to terminal great saphenous vein end to end). Totally 26 cases were studied with respect to age, sex, body mass index, comorbidities, difficulty in cannulation, complications, graft dysfunction, and patency rates. Follow-up was a dynamic ongoing process without a fixed endpoint. Graft dysfunction was seen in seven of 26 patients (26.92%), with a primary patency rate of 88.46% (23/26) at 1 year. Twelve subjects died during the study period, however, all had a functioning lower limb arteriovenous graft (AVG). Lack of surgical training, fear of complications, and absence of team approach in decision-making are some reasons why lower extremity permanent dialysis access is infrequently used. However, in view of increased survival on dialysis, advancing age of the dialysis population, associated comorbidities, and multiple access failures, lower limb AVGs may be considered a feasible access modality with acceptable patency rates and minimal complications.","PeriodicalId":13375,"journal":{"name":"Indian Journal of Vascular and Endovascular Surgery","volume":"9 1","pages":"281 - 286"},"PeriodicalIF":0.1,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46741808","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 : 2022-07-01DOI: 10.4103/ijves.ijves_7_22
K. Sivagnanam
Postimplantation syndrome following endovascular aneurysm repair (EVAR) is a known entity which presents within the 1st week of EVAR. The symptoms include fever, leukocytosis, and elevated C-reactive protein. Although the pathogenesis is unknown, it resolves within a 5 days. This case report involves elaborating on delayed onset inflammatory response in the 3rd week following EVAR when the patient developed thrombocytopenia which went as low as 55,000/μL. It resolved gradually with supportive measures and systemic steroids.
{"title":"Systemic inflammatory response and delayed thrombocytopenia following endovascular aneurysm repair for abdominal aortic aneurysm","authors":"K. Sivagnanam","doi":"10.4103/ijves.ijves_7_22","DOIUrl":"https://doi.org/10.4103/ijves.ijves_7_22","url":null,"abstract":"Postimplantation syndrome following endovascular aneurysm repair (EVAR) is a known entity which presents within the 1st week of EVAR. The symptoms include fever, leukocytosis, and elevated C-reactive protein. Although the pathogenesis is unknown, it resolves within a 5 days. This case report involves elaborating on delayed onset inflammatory response in the 3rd week following EVAR when the patient developed thrombocytopenia which went as low as 55,000/μL. It resolved gradually with supportive measures and systemic steroids.","PeriodicalId":13375,"journal":{"name":"Indian Journal of Vascular and Endovascular Surgery","volume":"9 1","pages":"329 - 330"},"PeriodicalIF":0.1,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47747801","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 : 2022-07-01DOI: 10.4103/ijves.ijves_47_22
R. Agarwal, Viswanath Atreyapurapu, Pritee Sharma, Vamsikrishna Yerramsetty, Chainulu Saripalli, K. Reddy, G. Atturu, P. Gupta
Introduction: A surge in the number of patients with acute limb ischemia (ALI) was seen during the first and second waves of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. This has been ascribed to the hypercoagulable state seen in COVID infections. The aim of this study is to report our experience and outcomes of ALI associated with SARS-CoV-2 infection. Materials and Methods: It was a single-center observational retrospective study from a prospectively maintained database of patients with SARS-CoV-2 infection presenting with ALI between July 2020 and December 2020 with 1-year follow-up. Results: Thirty-nine acutely ischemic limbs were treated in 32 patients including three upper limbs. The mean age of patients was 55.75 (range: 27–80). There were 23 (71.87%) males and 9 (28.12%) females. Majority of the limbs were in Class IIB of ALI, whereas 20.51% had irreversible ischemia. Of the 39 affected limbs in 32 patients, 22 limbs were revascularized, 9 had primary amputation, and 8 were managed conservatively with anticoagulation. The overall limb salvage was 26 out of 39 limbs (66.7%), whereas it was 81.8% for the limbs that had an intervention. The overall mortality was 9.4%. There was no further limb loss or mortality during 1-year follow-up. Interestingly, 15 patients did not have any symptoms suggestive of SARS-CoV-2 infection other than ALI. The severity of COVID infection did not correlate with the severity of ALI. Conclusion: COVID-19 infection can be associated with arterial thrombosis and ALI, which, if treated early with appropriate intervention, can result in a satisfactory limb salvage rate. Prophylactic anticoagulation in COVID-19-infected patients may not prevent arterial thrombosis, and the clinical severity of the COVID-19 infection is not a predictor of arterial thrombosis.
{"title":"COVID-19 and clotting: A wave of acute limb ischemia","authors":"R. Agarwal, Viswanath Atreyapurapu, Pritee Sharma, Vamsikrishna Yerramsetty, Chainulu Saripalli, K. Reddy, G. Atturu, P. Gupta","doi":"10.4103/ijves.ijves_47_22","DOIUrl":"https://doi.org/10.4103/ijves.ijves_47_22","url":null,"abstract":"Introduction: A surge in the number of patients with acute limb ischemia (ALI) was seen during the first and second waves of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. This has been ascribed to the hypercoagulable state seen in COVID infections. The aim of this study is to report our experience and outcomes of ALI associated with SARS-CoV-2 infection. Materials and Methods: It was a single-center observational retrospective study from a prospectively maintained database of patients with SARS-CoV-2 infection presenting with ALI between July 2020 and December 2020 with 1-year follow-up. Results: Thirty-nine acutely ischemic limbs were treated in 32 patients including three upper limbs. The mean age of patients was 55.75 (range: 27–80). There were 23 (71.87%) males and 9 (28.12%) females. Majority of the limbs were in Class IIB of ALI, whereas 20.51% had irreversible ischemia. Of the 39 affected limbs in 32 patients, 22 limbs were revascularized, 9 had primary amputation, and 8 were managed conservatively with anticoagulation. The overall limb salvage was 26 out of 39 limbs (66.7%), whereas it was 81.8% for the limbs that had an intervention. The overall mortality was 9.4%. There was no further limb loss or mortality during 1-year follow-up. Interestingly, 15 patients did not have any symptoms suggestive of SARS-CoV-2 infection other than ALI. The severity of COVID infection did not correlate with the severity of ALI. Conclusion: COVID-19 infection can be associated with arterial thrombosis and ALI, which, if treated early with appropriate intervention, can result in a satisfactory limb salvage rate. Prophylactic anticoagulation in COVID-19-infected patients may not prevent arterial thrombosis, and the clinical severity of the COVID-19 infection is not a predictor of arterial thrombosis.","PeriodicalId":13375,"journal":{"name":"Indian Journal of Vascular and Endovascular Surgery","volume":"9 1","pages":"302 - 306"},"PeriodicalIF":0.1,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70769026","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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