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  Citation statistics : Table of Contents
   2016| July-September  | Volume 3 | Issue 3  
    Online since July 25, 2016

 
 
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CASE REPORTS
A Case of Large Carotid Body Tumor: Surgical Challenge
Amitabh Jena, Gajjala Venkata Sivanath Reddy, Vinay Kadiyala, K Brinda, Rashmi Patnayak, Amit Kumar Chowhan
July-September 2016, 3(3):96-98
DOI:10.4103/0972-0820.186726  
Carotid body tumors (CBTs) are rare benign tumors, but they do have a chance of turning into malignant tumors. Hence, the earliest mode of treatment is surgical resection. The high vascularity of the tumors poses a surgical and anesthetic challenge. Hereby, we present a successfully resected case of large CBT measuring 7 cm × 6 cm. In contrast-computed tomography angiogram of the neck, the hyperdense mass was noted in the left carotid space splaying the left internal carotid artery and external carotid artery. Conventional general anesthesia with controlled ventilation technique was used in the resection of this tumor. The final histopathology report was paraganglioma. She had an uneventful perioperative period and was doing well after 18 months of follow-up.
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ORIGINAL ARTICLES
An Institutional Experience of Modified Eversion Endarterectomy in the Management of Carotid Artery Stenosis
Kamran Ali Khan, Varinder Singh Bedi, Manikanda Prabhu, Sandeep Agarwal, Ajay Yadav, Ambarish Satwik
July-September 2016, 3(3):83-86
DOI:10.4103/0972-0820.186720  
Background: Carotid endarterectomy (CEA) using eversion technique has been used by vascular surgeons across the world. A simpler technique, modified eversion endarterectomy (MEE) is emerging as a promising option. Advantages are shorter clamping time, less neurological complications, and avoidance of prosthetic patch plasty. Selective shunting can be done whenever required. In the climate of carotid artery stenting versus CEA debate, one would consider this method to reduce the morbidity of CEA. Materials and Methods: This is a retrospective analysis of patients undergoing CEA at a single institution by four vascular surgeons over a period of 2½ years (January 2012–June 2014). Data were collected from computerized medical records and various parameters analyzed. Forty patients underwent MEE during the given period. The majority were symptomatic 34 (85%). Results: One patient (2.5%) required conversion to conventional endarterectomy with patch plasty because of the long length of the plaque. One patient (2.5%) had lateralizing transient ischemic attack (TIA) in the postoperative period. Two patients had hematoma of which one was returned to operating theater for evacuation. Seven patients underwent MEE along with coronary artery bypass grafting with uneventful recovery. Selective shunting was done for four patients (10%) who had a contralateral occlusive disease or poor back bleed from an internal carotid artery (ICA) on table. Average ICA cross-clamping time was 13 min. None of the patients had cerebrovascular accident/TIA in the follow-up period. Conclusions: MEE is a simpler and easier technique to perform with comparable results when compared with other conventional techniques. MEE, in our assumption, will be the technique of choice in the future for open CEA; however, larger studies with longer follow-up are required before final validation of this technique.
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Preceding Coil Embolization for Internal Iliac Artery Aneurysm before Open Repair
Akimasa Morisaki, Mitsuharu Hosono, Masanori Sakaguchi, Toshihiko Shibata
July-September 2016, 3(3):78-82
DOI:10.4103/0972-0820.186717  
Introduction: In the era of endovascular repair, open repair for abdominal aortic aneurysm (AAA) is still needed in the patients who had anatomical difficulties with the endovascular repair. Open repair for internal iliac artery aneurysm (IIAA) is a challenge because of the deep operating field, which is associated with high morbidity. Therefore, we performed preceding coil embolization for IIAA before open repair to control the bleeding from gluteal arteries. Materials and Methods: The present study is a retrospective case series study. Ten patients underwent preceding coil embolization for IIAA before open repair between January 2010 and August 2015. Three patients had two-stage coil embolization for bilateral IIAA. Six patients also had infrarenal AAAs. After preceding coil embolization, open repair consisting of vascular graft replacement with aneurysmectomy and closure of IIAA was undertaken. Results: The mean age was 72.5 ± 10.7 years. There were nine men and one woman. Operative time and intraoperative bleeding were 270 ± 50 min and 817 ± 671 mL, respectively. There was no postoperative mortality. Three patients developed morbidity, which consisted of paralytic ileus, pneumonia, and shower embolization caused by shaggy aorta. No recurrent IIAA, buttock claudication, and intestinal ischemia after the open repair were observed. Conclusion: Preceding coil embolization for IIAA before open repair may be an effective procedure to control the bleeding from gluteal arteries and prevent recurrent IIAA.
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Carotid Body Tumors: Surgical Management and Review of Patients Over 10 Years
Gulam Nabi Lone, Adil Pervaiz Shah, Perveez Ahmad Malik, Seth Mujtaba Hussain, Ghulam Mohammad Wani
July-September 2016, 3(3):90-95
DOI:10.4103/0972-0820.186723  
Background: Carotid body tumours (CBTs) are rare but highly vascular neoplasms originating in the paraganglionic cells of the carotid bifurcation. Exact etiology of these tumors is not known. Male and female distributions are equal except at high altitude where females appear to predominate. Diagnosis of a chemodectoma usually begins with a color flow duplex scan. Magnetic resonance angiography are also useful, especially to evaluate bilateral disease. Conventional Arteriography with CT Angiography are valuable, especially in larger tumours, and are regarded as the best tools for diagnosis. The treatment of choice for carotid body tumours is surgical removal. Shamblin's classification system is used to categorize carotid body tumours based on their size and the difficulty of surgical resection. Results: It was observed that majority of the patients in this study were females numbering 35(79.45%) whereas there were 9 (20.43%) males. commonest age group involved was of patients 50 to 59 years of age. Surgery was done in all 44 (100%) patients with complete resection in 41 (93.07%) and incomplete in 3 (6.81%) patients. 10 (23%) were Shamblin grade 1, 29 (66%) grade 2 and 5 (11%) grade 3. ECA repair was done in 4 (9.08%) of patients, ICA repair in 2 (4.54%), ECA ligation in 2 (4.54%) and vascular graft was used in 1 (2.27%) of patients. 7 (15.89%) had transient cranial nerve palsy most commonly involving hypoglossal nerve. 3 (6.81%) had permanent cranial nerve palsy. In 6 (13.62%) patients there was local wound infection .There was post op stroke in 2 (4.54%) of patients. No operative mortality was seen.43 (97.61%) patients were proved to be paraganglionomas on HPE while 1 (2.27%) patients had inconclusive biopsy on Histopathological examination. Conclusion: Although rare, Carotid body tumor is still a pathology that we encounter in our experience and it should be kept in mind as a differential diagnosis for painless lateral neck masses.
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CASE REPORTS
Brachial Artery Disruption: Hyperextension of Elbow
Elamurugan Elamaran
July-September 2016, 3(3):99-100
DOI:10.4103/0972-0820.186721  
Hyperextension injury to the elbow leading to major neurovascular damage is a rare event without any bony injury or dislocation. We report a case of young male with brachial artery disruption and median nerve paresis due to hyperextension of elbow after a fall while climbing staircase.
  - 2,675 82
A Large Vascular Leiomyoma in Femoral Triangle
Bhavinder Arora
July-September 2016, 3(3):101-103
DOI:10.4103/0972-0820.186715  
Angioleiomyoma is a benign soft-tissue vascular tumor arising from the smooth muscle of the tunica media. It is more common in females. Lower extremities, particularly the lower leg and foot, are more affected. Cutaneous vessels are common site of origin. The main vessel- the femoral vein- is a rare site for the origin for a angioleiomyoma. We present a case of a large femoral triangle angioleiomyoma arising from the femoral vein. A clinical presentation, diagnosis, and radiological and histopathological findings are discussed.
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Bilateral Radial Artery Pseudoaneurysms Following Arterial Cannulation: A Rare Case Report
Devender Singh
July-September 2016, 3(3):104-106
DOI:10.4103/0972-0820.186719  
The use of arterial cannulae for blood pressure monitoring and repeated arterial blood gas sampling is increasing. The placement and maintenance of such cannulae is not without complication. To our knowledge, a case of synchronous bilateral radial artery pseudoaneurysms is a very rare presentation and only couple of cases are reported in the literature.
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Isolated Bilateral Common Iliac Artery Aneurysm
Amit Mahajan, Anil Luther, Moloti Kichu, Vikas Kumar
July-September 2016, 3(3):107-108
DOI:10.4103/0972-0820.186722  
The incidence of isolated iliac artery aneurysm is rare. We report a 78-year-old male with isolated bilateral common iliac artery and internal iliac aneurysm. Computerized tomography angiogram of the aorta revealed partially thrombosed aneurysms involving bilateral common iliac and internal arteries with mass effect. The infrarenal abdominal aorta is tortuous and ectatic. The clinical presentation and management are discussed.
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EDITORIAL
From the Desk of the Editor-in-Chief
Ramesh K Tripathi
July-September 2016, 3(3):77-77
DOI:10.4103/0972-0820.186725  
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IMAGES IN VASCULAR SURGERY
Rare Cause of Colostomy Bleeding: A Parastomal Pseudoaneurysm
Vijay Thakore, Jayesh Patel, Sumit Kapadia
July-September 2016, 3(3):109-111
DOI:10.4103/0972-0820.186724  
Patient diagnosed with rectal cancer underwent low anterior resection with protective sigmoid colostomy. He developed intractable bleeding from colostomy site on 10th post-op day. He went into haemorrhagic shock, resuscitated with massive blood transfusion. Emergent CT angio of abdomen showed a well defined, bilobed, fusiform dilated sac with smooth homogenous contrast opacification seen in the operative stomal site with a small feeding artery arising from left iliac artery? possibly an aneurysmal sac with feeding artery. The patient was successfully treated with an endovascular approach.
  - 2,126 74
LETTER TO THE EDITOR
Gangrene and Malaria
Khichar Purnaram Shubhakaran
July-September 2016, 3(3):112-112
DOI:10.4103/0972-0820.186718  
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ORIGINAL ARTICLES
Polytetrafluoroethylene Patch Closure at Venous Anastomotic Site: A Novel Technique for Arteriovenous Graft Salvage
AR Chandrashekhar, B Rajendra Prasad, Sanjay C Desai, Aniruddha Bhuiyan
July-September 2016, 3(3):87-89
DOI:10.4103/0972-0820.186716  
Introduction: The use of prosthetic arterio-venous grafts (avgs) is necessary in patients where all autogenous vein options are exhausted. This study asseses the results of PTFE patch plasty at the venous end of the access anastomosis. Materials and Methods: This is a prospective observational single centre study in a tertiary care centre for all patients with prosthetic AV graft venous anastomotic site stenosis between 2012 and 2015. Results: There were 40 patients in the study period. Presenting symptoms were primarily inadequate dialysis from AV Graft due to thrombosed graft within 14 days duration. The average age was 58.2 years and 70% were male. They underwent thrombectomy and PTFE patch closure at the venous anastomotic site due to AV graft thrombosis in upper extremity. 38.4% patients had both hypertension, Type II DM while 38.4% patients suffered from triad of hypertension, Type II DM and Hyperlipidemia. Criteria of success was based on immediate post operative bruit and next day heparin free hemodialysis from AV Graft. 37 patients who underwent the procedure had primary patency rate of 91.89% at 3 months and 59.45% at 6 months. Mean follow-up time was 8 months with average hospital stay of 3 days without post-operative complications. Conclusion: Treatment of AVG thrombosis should be performed urgently. There is no standard approach for AV graft thrombosis and surgical management must be individualized for each case. As the commonest cause of graft occlusion is at the venous anastomotic site, hence AV graft thrombectomy with eptfe patch closure can achieve better result compared to thrombectomy with primary closure or stent placement.
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