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   2017| July-September  | Volume 4 | Issue 3  
    Online since July 31, 2017

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Antithrombotics in Vascular Surgery: Current Practice Guidelines
Amila Weerasekera, Raghvinder Pal Singh Gambhir
July-September 2017, 4(3):85-91
Pre- or post-intervention, vascular surgical patients are expected to be on one or more antithrombotic agents. Antithrombotics have played a key role in reducing cardiovascular mortality in vascular patients. There are wide variations in the practice of prescribing antithrombotic agents in vascular services. Evidence-based current practice guidelines are often not strictly followed which puts some of these patients at increased risk of bleeding complications. This paper looks at the current practice guidelines on antithrombotics.
  18,809 781 -
Alexis Carrel: Father of Vascular Anastomosis and Organ Transplantation
Ajay Savlania
July-September 2017, 4(3):115-117
  6,950 271 5
Deep Vein Thrombosis is Not Uncommon in India
Edwin Stephen, Vimalin Samuel, Sunil Agarwal, Dheepak Selvaraj, Prabhu Premkumar
July-September 2017, 4(3):92-96
Deep vein thrombosis (DVT) has for long been under-diagnosed and ignored as one of the major causes of morbidity worldwide. Knowledge of the pathology and treatment of DVT has progressed many fold over the years. Inspite of it being common, knowledge of diagnosis and treatment of this potentially fatal condition remains limited. In this review article, we look at the DVT and the available options for diagnosis and treatment.
  5,970 353 1
Pulmonary Embolism following Radiofrequency Ablation for Varicose Vein Treated with Thrombolytic Therapy: A Case Report and Review of Literature
Palanisamy Jayakumar, Chairman Saravanan Robinson, Dhevendran Maruthupandian, Rajagopal Ganesh
July-September 2017, 4(3):132-134
Radiofrequency ablation (RFA) for varicose vein may have life-threatening complications such as deep vein thrombosis and pulmonary embolism (PE). Here, we reported a case report of PE following RFA, which required thrombolysis to save the patient.
  5,142 128 1
Infected Abdominal Aortic Aneurysm with Severe Sepsis: Successful Outcome
Devender Singh, Partha Sarathy, Vamshi Krishna, Sharwari Amte
July-September 2017, 4(3):121-123
Primary infection of aorta, in absence of atherosclerosis, leading to aneurysm formation occurs in <1% of cases. Early diagnosis and surgical treatment are important to offset associated poor prognosis. A preoperative diagnosis is often missed due to nonspecific presentation. Computed tomography can confirm the diagnosis in suspected cases. Confirmation of diagnosis often warrants deviation from usual surgical techniques of management of abdominal aortic aneurysm. A case is described, of a toxic male patient, detected to have an infected aortic aneurysm with multiorgan dysfunction presented in septic shock. He could be successfully managed by an aggressive surgical and medical approach.
  4,120 116 1
Anterior Tibial Artery Pseudoaneurysm-Case Series
Velladuraichi Boologapandian, Amalopavanathan Joseph, Jeyakumar Selvapackiam, Sritharan Narayanan, Ilayakumar Paramasivam
July-September 2017, 4(3):112-114
Anterior tibial artery (ATA) pseudoaneurysm is a rare condition that occurs following lower extremity orthopedic intervention or after trauma. We report a series of cases of pseudoaneurysm which were treated surgically. The diagnosis was confirmed with computed tomography angiogram. Aneurysmal sac excision with ligation of ATA was performed.
  3,307 151 1
Assessment of Risk and Prophylaxis for Venous Thromboembolism and Adherence to the American College of Chest Physicians Recommendations during Early Days of Hospital Stay at a Tertiary Care Teaching Hospital in a Developing Country
Bijoy Kumar Panda, Vinod Kumar, Mrunal Nitin Ketkar
July-September 2017, 4(3):107-111
Aim: The aim is to assess risk and evaluate the usage of pharmacological thromboprophylaxis adhering to the American College of Chest Physicians (ACCP) recommendations for prevention of venous thromboembolism (VTE) during early days of hospital stay in critically ill and surgery patients at a tertiary care teaching hospital. Patients and Methods: A prospective study was conducted over 1 year where all patients admitted in Intensive Care Unit (ICU), and surgery wards were enrolled in the study after an informed written consent. A structured pro forma was designed, and effective risk stratification for VTE was done. Patients were followed until discharge to record any pharmacological thromboprophylaxis according to the ACCP prevention of thrombosis recommendations. Results: A total of 210 patients included in this study as per the Caprini VTE Risk Assessment tool. Of 210, 150 (60%) patients were critically ill and 60 (40%) were surgical patients with an average age of 65.3 ± 11 and 55.4 ± 12 years, respectively. Of 150 critically ill patients, 21.3% of patients were classified having moderate VTE risk, 33.3% of patients having higher and 45.3% of patients having highest VTE risks. Of 60 postsurgical patients, 13.3% of patients were categorized having moderate VTE risk, 36.6% of patients having higher and 50% of patients having highest VTE risks. Pharmacological thromboprophylaxis was administered to 35.2% of patients, of which, 46.6% and 6.6% were ICU patients and postsurgical patients, respectively. This shows underutilization of pharmacological thromboprophylaxis. Adherence to guideline recommendations (choice of drug, dose, and duration) was observed in all postsurgical patients and 33% of critically ill patients. Conclusions: Pharmacological thromboprophylaxis to higher and highest VTE risk patients was too low, particularly in both the units and very low in surgery ward. Efforts required improving patient safety practice, particularly in higher and highest risk categories.
  3,093 165 -
Anatomical Variant: Ascending Pharyngeal Artery Arising from the Extracranial Internal Carotid Artery
Chinnam Naidu Sirasapalli, T Mandapal, Subhendu Parida, Murali Belman
July-September 2017, 4(3):127-128
Ascending pharyngeal artery (APA) is a branch of the external carotid artery. Extracranial internal carotid artery (ICA) usually does not have any branches. We present here a rare case of anomalous origin of the APA from the extracranial ICA and discuss the clinical importance of this rare anatomical variant.
  2,726 146 3
Incidence and Risk Factors of Complications following Antegrade Common Femoral Artery Access
Pravin Sakharam Narkhede, Sumanthraj Kolalu, Lawish Agarwal, Vishnu Motukuru, Vivekanand , Apurva Srivastava, Dharmeshkumar Davra, Kalkunte R Suresh
July-September 2017, 4(3):103-106
Background: Bleeding and vascular complications following retrograde common femoral artery access are studied. Access site complications, their incidence, and risk factors following antegrade access remain unclear. Materials and Methods: We retrospectively analyzed 189 patients from our prospectively collected database at Jain Institute of Vascular Sciences, Bengaluru, India. All patients had antegrade femoral access and underwent femoral and popliteal artery interventions from January 2013 to December 2014. We aimed to study incidence, risk factors, length of postintervention hospital stay, and early morbidity following antegrade femoral access. Antegrade direct arterial punctures resulted in a complication rate of 14.28%, which comprised 20 ecchymosis (74.07%), 5 groin hematoma (18.51%), and 2 pseudoaneurysm (0.07%). Two patients required blood transfusion. Groin hematoma was common in females (3 vs. 2 patients) than males but had less ecchymosis (7 vs. 13 patients). Age more than 69 years, female sex, 7 Fr sheath size, direct arterial puncture by palpation, and manual compression were associated with higher incidence of complications. Complicated patients had longer hospital stay (3.52 ± 1.19 days vs 1.34 ± 0.59; range 1–7 days; P = 0.0001). Conclusion: Several factors predict access site-related complications following antegrade femoral access, notably gender, age, ultrasound guidance, sheath size, and closure device. Knowledge of these findings could be useful to determine strategies to reduce access site vascular and bleeding risk and improve outcomes.
  2,712 131 -
Simultaneous Bilateral Carotid Stenting in High-risk Patients: A Single-center Experience with Review of Literature
Lakshmi Sudha Prasanna Karanam, Sridhar Reddy Baddam, Anurag Polavarapu, Vijaya Pamidimukkala, Raghavasarma Polavarapu
July-September 2017, 4(3):97-100
Background: The aim of the present study is to determine the role of simultaneous carotid artery stenting in high-risk patients with triple vessel coronary artery disease and to determine the safety and efficacy of the procedure in these cases. Materials and Methods: The present study is a retrospective analysis of 33 patients who underwent carotid artery stenting in the same setting in our institution from 2009 to 2016. There were 22 male and 11 females with a mean age of 65 years (53–76 years). Demographic factors clinical characteristics and atherosclerosis risk factors were documented. Results: Technical success was 100% in our series. Intraprocedural and postprocedural events in the form of hypotension and bradycardia due to hemodynamic depression were seen in 11 patients. We did not encounter hyperperfusion syndrome in any of our patients. Twenty-nine patients underwent cardiac bypass surgery after 3 weeks, and 4 patients were kept on medical management for coronary artery disease. No deaths or major strokes occurred in our series. Conclusion: Simultaneous bilateral carotid artery stenting is a safe treatment option even in patients with high-risk factors and can be considered as the therapeutic option in patients with significant bilateral carotid artery disease.
  2,640 131 -
Hughes-Stovin Syndrome: An Unusual Cause for Recurrent Hemomptysis
Manoj Kumar Agarwala, Sundar Chidambaram, J Venkateshwarlu, Anil Dronamraju, Avinash Dal
July-September 2017, 4(3):129-131
A 24 year old female presented with recurrent hemoptysis and the work up revealed a large right pulmonary artery aneurysm for which she underwent endovascular intervention with relief of symptoms. Her symptoms recurred after one month and now she had left pulmonary artery aneurysm, again treated with endovascular intervention. With systemic symptoms and absence of signs of Behcets syndrome led to diagnosis of Hughes-Stovin Syndrome. She symptom free at 18 months with immunosuppression.
  2,470 94 2
The Management of Ruptured Mycotic Suprarenal Aortic Aneurysm: A Report of Successful Surgical Repair
Papa Adama Dieng, Modibo Doumbia, Adama Sawadogo, Mouhamadou Ndiaye
July-September 2017, 4(3):124-126
Ruptured suprarenal aortic aneurysms represent a huge challenge for surgeons. So far, developing endovascular procedures have failed to totally replace open repair when debranching is to be performed. The authors report their experience in the management of a ruptured mycotic aneurysm of the suprarenal aorta in a 36-year-old female patient diagnosed with active tuberculosis.
  2,420 114 -
Eight on 80-Ruptured and Intact Multiple Site Aneurysms: Aorto-Bi-Common and External Iliac, Right Popliteal and Left Femoral and Popliteal Artery Aneurysms, Sequentially Repaired Successfully in an Octogenarian
Aggarwal Vivek, Shivanesan Pitchai, Harishankar Ramachandran Nair, Madathipat Unnikrishnan
July-September 2017, 4(3):118-120
Degenerative aortic and peripheral aneurysms are well known to present in the elderly at multiple sites at varying time. Aneurysms occurring in the arteries of the lower limb are most common after aneurysms of the infrarenal aorta. A strong association exists between the presence of true aneurysms of the femoral or popliteal arteries and those of the contralateral extremity and more importantly aortoiliac domain. Consequently, the discovery of a lower extremity aneurysm mandates careful observation, evaluation, or both for associated aneurysms in the opposite limb and abdominal aorta. Traditional open surgery is used to be mandated in ruptured aneurysm in previous years, whereas endovascular therapeutic modality is a mainstay in the current practice, especially in elderly and frail patients with short life expectancy. Herein, we present a report of successful outcome following open and endovascular repair of eight aneurysms in an octogenarian at varying times under a decade.
  2,355 79 -
Antithrombotics: Do We Know Enough?
Edwin Stephen
July-September 2017, 4(3):84-84
  2,077 97 -
The Power of One
Kalkunte R Suresh
July-September 2017, 4(3):83-83
  1,936 100 -
On Bilateral Carotid Stenting by Prof. Ross Naylor: “More Questions Than Anwers”
A Ross Naylor
July-September 2017, 4(3):101-102
  1,863 85 -
On PE Following RF Ablation for of Varicose Veins by Dr. P. C. Gupta: Adequate Caution Should be Exercised to Prevent VTE
Prem Chand Gupta
July-September 2017, 4(3):135-135
  1,704 76 -