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  Citation statistics : Table of Contents
   2018| July-September  | Volume 5 | Issue 3  
    Online since August 8, 2018

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Management of klippel-trenaunay syndrome from a single center in India: Experience shared
Prabhu Premkumar, Edwin Stephen, Joel Mathew John, Albert Abhinay Kota, Vimalin Samuel, Dheepak Selvaraj, Sunil Agarwal
July-September 2018, 5(3):149-153
India with a population of about 1.3 billion and diverse cultures holds within its large land mass an encyclopedia of medical cases, several un/underdiagnosed. Klippel-Trenaunay syndrome (KTS) is one such condition. Over the years, as the understanding of our team increased about the condition, we were able to share the same with our colleagues across the institution and publish the brief article. This resulted in an increased referral pattern from within the institution and across the country. At our institution, we managed 127 cases of KTS between October 2009 and December 2017. In this article, we share our experience about managing the cases, lessons learnt, and the challenges we face.
  3 6,461 206
Leiomyosarcoma of infrarenal inferior vena cava: A single institution experience and review of literature
Achintya Sharma, MK Ayappan, Radhakrishnan Raju, Kapil Mathur, Pranay Pawar
July-September 2018, 5(3):203-207
We report three cases of primary leiomyosarcoma (LMS) of inferior vena cava (IVC). Vascular LMSs are rare tumors, arising most frequently from IVC. These tumors have a female predominance. Their diagnosis is often challenging, as patients may present with nonspecific complaints such as dyspnea, malaise, weight loss, abdominal pain, or back pain, preceding the diagnosis by several years. LMS of the IVC most frequently occurs in the middle segment. The final diagnosis can be made by an ultrasound or computed tomography-guided biopsy. Due to limited experience with this disease, optimal management of IVC LMS is unknown. Curative surgical resection remains the current treatment of choice for primary LMS of IVC. Neoadjuvant therapy may be given to downsize the tumor and increase resectability rates. Nonetheless, there is no proven role for adjuvant therapy, and recurrence is common. We, hereby, report three cases of this rare entity with emphasis on management.
  2 3,060 103
Story of warfarin: From rat poison to lifesaving drug
Sreekumar Ramachandran, Shivanesan Pitchai
July-September 2018, 5(3):174-175
  2 11,251 811
How to choose title and keywords for manuscript according to medical subject headings
Himel Mondal, Shaikat Mondal, Sarika Mondal
July-September 2018, 5(3):141-144
Background: Title and keywords are the two most important parts of a manuscript. The words or phrases used in the title or keywords should be selected wisely for a wider dissemination of the article. Medical Subject Headings (MeSH) terms are used to index article in MEDLINE/PubMed. Hence, choosing the title and keywords according to MeSH would be a better choice for authors. Aim: The aim of this article was to provide a technical guide for selecting words and phrases for title and keywords of an article according to MeSH terms. Methods: The most frequently used words in a manuscript can be identified by the help of word cloud technique. We showed an example of making a word cloud from the text of a manuscript. The method of searching MeSH terms in a manuscript text was shown with an example. Writing title and keywords with amalgamation of these two methods was described. Conclusion: This tutorial showed the use of two freely available tools on the World Wide Web (word cloud and MeSH on demand) for choosing title and keywords for a manuscript. This brief description would help authors in wider dissemination of research knowledge to the targeted audience.
  2 19,744 783
A rare complication after blood donation: Brachial artery pseudoaneurysm
Lokesh Shekher Jaiswal, Tanveer Khan, Narendra Pandit
July-September 2018, 5(3):201-202
Pseudoaneurysm of brachial artery following whole blood donation is a very rare complication due to inadvertent arterial puncture. There are only a few cases reported in literature. Here, we describe this rare event in a young male whole blood donor presenting 2 months after blood donation with pulsatile swelling in the right antecubital fossa and paresthesia of hand. He was successfully managed with surgical intervention.
  1 36,272 161
Why, how, and where to publish?
Edwin Stephen
July-September 2018, 5(3):139-140
  1 2,178 91
Management of free-floating thrombus in the arch of the aorta in a case of upper limb ischemia
Devender Singh
July-September 2018, 5(3):176-178
Floating thrombus in a nonaneurysmal and nonatherosclerotic arch of the aorta is an extremely rare event with potential catastrophic complications. There is a risk of both systemic and cerebral embolization. We present a case of floating thrombus in the arch of the aorta who presented with left upper limb advanced ischemia. Confirmation of the diagnosis was done by computed tomography angiogram. His upper limb symptoms were relieved with thrombectomy, supported by medical line of treatment. For floating thrombus in the arch of the aorta, he was started on aggressive anticoagulation therapy, and there was significant resolution after 4 weeks and complete resolution after 3 months of the treatment. We report our experience with a very rare condition and make a proposal for therapeutic interventions.
  - 3,064 107
Extravascular endoconduit for compromised access route in patients with ruptured thoracic aortic aneurysm
Akimasa Morisaki, Sohgawa Etsuji, Murakami Takashi, Shibata Toshihiko
July-September 2018, 5(3):179-181
Some patients who undergo thoracic endovascular repair (TEVAR) for a thoracic aortic aneurysm have a compromised or unfavorable access route that requires additional intervention or another access route approach. We experienced a case involving an 80-year-old woman who developed a ruptured thoracic aortic aneurysm with an unfavorable access route characterized by a narrow external artery and severe atherosclerosis. She was severely frail due to a history of fractures and extensive intestinal resection for necrosis of the intestine. Although we planned to perform TEVAR following establishment of an internal endoconduit (IEC) of the common and external iliac arteries, the stent graft sheath did not pass IEC. We resolved the issue of the unfavorable access route with extravascular deployment of a stent graft following establishment of IEC (so-called extravascular endoconduit technique).
  - 2,165 57
Endovascular management of postthrombotic ilio-iliac arteriovenous fistula with occluded common iliac vein: A case report and literature review
C P S Sravan, Vivek Anand, S Indushekar, Sumanth Raj, Vaibhav Lende, Dharmesh Davra, Piyushkumar Jain, S Roshan Rodney, Hemant Chaudhari, M Vishnu, KR Suresh
July-September 2018, 5(3):182-185
Chronic venous hypertension as a result of May—Thurner syndrome (MTS) and subsequent venous thrombosis is a frequently observed clinical condition. However, a postthrombotic arteriovenous fistula (AVF) is a phenomenon not reported commonly. Such conditions have been treated surgically and by endovascular approach — embolization or stenting. We present a case of concomitant MTS and pelvic AVF in a patient with recurrent deep vein thrombosis, who also had lumbar laminectomy in the past, resulting in massive and debilitating left lower extremity edema and bleeding varices in the left lateral thigh, which was successfully treated with the placement of stent graft/stent in both arterial and venous systems.
  - 2,490 66
Endovascular management of inflammatory superior mesenteric artery aneurysm: A case report and review of literature
Vaibhav Pralhad Lende, Vivekananda , C P S Sravan, P Jain, D Davra, H Chaudhari, R Rodney, V Motukuru, K Sumanth Raj, KR Suresh
July-September 2018, 5(3):187-190
Superior mesenteric artery aneurysm (SMAA) is a rare clinical entity which can present with a wide spectrum of symptoms. It is associated with a high risk of rupture, morbidity, and mortality. Variable clinical manifestations often lead to misdiagnosis and improper therapies with high mortality ranging from 8.5% to 25%. We present a case of a 60-year-old male patient who presented with abdominal pain and a palpable pulsatile mass in the right hypochondriac and epigastric regions. He was diagnosed to have a large SMAA which was treated successfully with stent grafts.
  - 2,311 72
Successful embolectomy for an acute mesenteric ischemia following acute myocardial infarction in a patient with chronic atrial fibrillation
Abdellah Rezziki, H Alzaarir, O Anane, T Abutayf, A Benzirar, O Elmahi
July-September 2018, 5(3):191-194
Acute mesenteric ischemia (AMI) is a rare vascular disorder that carries a fatal prognosis. Common risk factors for superior mesenteric artery embolism include arrhythmia and myocardial infarction that was both associated in our patient. Early diagnosis and aggressive therapy can prevent bowel infarction and improve survival rates and thus outcomes since it carries a fatal prognosis. We report a case of AMI in a 79-year-old woman with a history of chronic atrial fibrillation and following recent myocardial infarction.
  - 2,650 73
Infected double graft explantation in graft enteric erosion
Ashutosh Pandey, Abhinay Reddy, Harjeet Singh, Ujjwal Gorsi, Ajay Savlania
July-September 2018, 5(3):195-197
Aortoenteric fistula (AEF) is an uncommon entity with high morbidity and mortality associated with it. Primary AEF can occur in the presence of aortic aneurysm but it is less common as compared to the secondary type, which is associated with the presence of prosthetic graft used for repair of aortic aneurysm or aortic bypass for occlusive disease. Multiple strategies have been described in the literature which needs to be individualized to each patient. This patient had undergone aortobifemoral bypass twice in the past, which makes anatomy hostile, followed by graft infection and graft enteric (jejunum) erosion leading to very challenging case to treat. The patient was managed in two stages, first axillobifemoral bypass followed by explantation of two grafts. He is doing fine at >12 months of follow-up.
  - 2,503 70
Secondary aortoenteric fistula: Review of a case and literature
Sandeep Raj Pandey, Sheorain Virender, Grover Tarun, Parakh Rajiv
July-September 2018, 5(3):198-200
The objective of this study was to assess early diagnosis and management of hematemesis in patients who have a history of aortic reconstructive surgery. A 70-year-old male presented with complaints of active hematemesis and melena for 2 days at the emergency room. He gave a history of aortobifemoral bypass for bilateral iliac arterial occlusive disease 9 years ago. Urgent computed tomography (CT) angiography was suggestive of large aortic anastomotic pseudoaneurysm with aortoenteric fistula (AEF). Urgent endovascular repair of pseudoaneurysm with right femoral artery to left femoral artery crossover with ligation of left femoral artery, left common iliac artery, and left graft limb was done. The patient did well after the surgical management. Routine follow-up was done. Repeat CT angiography was done. No any major complication was encountered. Secondary AEF is a life-threatening complication of abdominal aortic reconstruction. The clinical manifestation of the AEF is always hematemesis. Treatment of the disease is urgent hybrid surgical intervention.
  - 2,082 75
Comments on endovascular management of postthrombotic ilio-iliac arteriovenous fistula with occluded common iliac vein: A case report and literature review
Seshadri Raju
July-September 2018, 5(3):186-186
  - 1,650 66
Venous thoracic outlet syndrome: A short review
Edwin Stephen, Albert Abhinay Kota, Dheepak Selvaraj, Vimalin Samuel, Prabhu Premkumar, Sunil Agarwal
July-September 2018, 5(3):168-173
Venous thoracic outlet obstruction can be either primary or secondary. Effort-induced thrombosis of the upper limb ranges from 1% to 4% of all venous thrombosis has been the focus of discussion in many an international and national journal recently because of an increase in the number of cases being seen, diagnosed, and treated. In this paper, we discuss an overview of the problem and our management approach based on available evidence and share the experience gained from treating patients with effort-induced axillary-subclavian thrombosis or Paget—von Schroetter syndrome, as it is otherwise called.
  - 6,230 191
Pilgrim's progress
Kalkunte R Suresh
July-September 2018, 5(3):137-138
  - 2,172 80
Intimal sarcoma of the popliteal artery presenting as popliteal artery aneurysm: A rare case report
Mahmood Dhahir Al-Mendalawi
July-September 2018, 5(3):208-208
  - 1,590 54
Can pre and postoperative vein diameter and postoperative flow velocities influence the patency of vascular access in hemodialysis patients?
Venu Manne, Vedamurthy Reddy Pogula, Mallikarjuna Reddy Nalubolu, Vijayabhaskar Reddy Gouru, Ranadheer Byram, Sudeep Bodduluri
July-September 2018, 5(3):145-148
Introduction: All end-stage renal disease patients have to undergo renal replacement therapy or renal transplantation. Patients require vascular access for hemodialysis. Autologous arteriovenous fistula (AVF) is the gold standard to maintain vascular access for hemodialysis. Methods: This is a prospective study. A total of 187 patients were evaluated in this study. Correlation with pre- and postoperative vein diameter and flow velocities on the outcomes of the AVFs was studied. Pre- and postoperative vein diameter and postoperative flow velocities were measured on the 1st-postoperative day in vein and across anastomosis using duplex Doppler study. Results: Flow velocities across the anastomosis and the vein were significant in both radiocephalic (RC) and brachiocephalic (BC) group. P = 0.010 and 0.013 for RC and 0.046 and 0.004 for the BC group, respectively. Increase in the postoperative vein diameter between functioning and nonfunctioning group was significant, with P = 0.029 in the BC group. Flow velocities in vein and across anastomosis between functioning and failure group were significant in brachiobasilic (BB) fistulas with P = 0.0220 and 0.0143, respectively. Increase in the postoperative vein diameter between functioning and nonfunctioning group is not significant, with P = 0.446. Conclusion: The increase in vein diameter after anastomosis predicts the success of fistula in BC AVF. Flow velocities in vein and across anastomosis have strong prediction in RC, BC, and BB AVF.
  - 3,843 151
Assessment of preprocedure difference in the supine and dependent transcutaneous tissue oxygenation to prognosticate pain relief, following chemical lumbar sympathectomy for critical limb ischemia in thromboangiitis obliterans
Jonathan Sadhu Reddipogu, Indrani Sen, Lakshmanan Jeyaseelan, Shyamkumar Nidugala Keshava, Edwin Stephen, Sunil Agarwal
July-September 2018, 5(3):154-159
Context: Chemical lumbar sympathectomy (CLS) is performed in thromboangiitis obliterans (TAO) for relief of rest pain. Interruption of sympathetic innervation causes improvement in tissue oxygenation and is reflected in transcutaneous partial pressure of oxygen (TcPo2). There is very little data available to guide patient selection for CLS. Aims: The primary objective was to assess if preprocedure difference in TcPo2measured in supine and dependent positions on the foot correlated with relief of rest pain. The secondary objectives were to measure postprocedure TcPo2on the foot and assess preprocedure predictors of rest pain relief following sympathectomy. Settings and Design: Prospective observational study in patients undergoing CLS for TAO carried out from October 2009 to August 2014 in the Vascular Surgery Unit at Christian Medical College, Vellore. Subjects and Methods: Patients diagnosed to have TAO based on Shionoya's criteria, who were planned for a sympathectomy for rest pain, were included in the study. Statistical Analysis Used: Outcomes were compared using Mann—Whitney U-test and Wilcoxon signed-rank test. Data were entered and analyzed using SPSS 16.0 software. Results: There was a significant reduction of pain after sympathectomy (P < 0.001). There was a significant increase in TcPo2, supine to dependent position, independently before and after sympathectomy (P < 0.001). However, preprocedure difference in supine and dependent TcPo2did not correlate with the change in pain scores following sympathectomy. Conclusions: CLS provides relief of rest pain in TAO by improving tissue oxygenation. Preprocedure difference in the supine and dependent TcPo2did not correlate with pain relief.
  - 2,474 84
Results of intralesional injection of n-butyl cyanoacrylate (NBCA) and fibrin glue in hemangioma and low flow vascular malformations
Pawan Agarwal, Anand Sharma, D Sharma
July-September 2018, 5(3):160-164
Background and Objectives: Complete surgical excision of vascular anomalies is technically difficult and seldom possible, prompting interest in other treatment options, especially sclerotherapy. We decided to study the results of intralesional injection of n-butyl cyanoacrylate (NBCA) and autologous fibrin glue (FG) in hemangiomata and vascular malformations (VMs). Materials and Methods: This prospective study was conducted in fifty consecutive patients of hemangioma and VMs. Frequency of injections was decided according to size and injections were given at the interval of 4 days to complete the treatment in 30 days. Postinjection reduction in size of the lesion was assessed. Lesions which did not disappear or those having complications were taken for surgery and amount of blood loss during excision was estimated. Results: In NBCA group, the mean reduction in size of hemangioma and low flow VM was 63.85%—73.3%; in FG Group, it was 51.9%—53.80%, respectively. In FG group, the mean blood loss was 37.5 ml for a mean size of 3.6 cm2 hemangioma and 79.55 ml for low flow VM with a mean size of lesion 2.23 cm2. In NBCA group, the mean blood loss was 37.5 ml for mean size of 4.4 cm2 hemangioma and 37.5 ml with a mean size of 3.55 cm2 low flow VM. Conclusion: Repeated intralesional injections of NBCA and FG in hemangioma and VMs are associated with significant reduction in size and blood loss during excision. Small vascular lesions (<2 cm) disappeared completely, and excision of remaining lesions becomes technically easy.
  - 2,815 109
Endovascular management of peripheral congenital arteriovenous malformation and arteriovenous fistula in Nepal
Sandeep Raj Pandey
July-September 2018, 5(3):165-167
Introduction: The management of peripheral arteriovenous malformations (AVMs) and arteriovenous fistula (AVF) remains challenging in Nepal due to their unpredictable behavior and high recurrence rate. Materials and Methods: This report describes cases of peripheral AVM and AVF. We report the case of a 20-year-old male with AVMs draining from a superficial femoral artery (SFA) with multiple feeders on the left lower thigh who underwent embolization of SFA feeders. Other case was a 60-year-old female with very high-flow AV fistula from the inferior gluteal artery with large venous varix of draining vein who underwent coil embolization of nidus followed by glue embolization. Results: Both patients got relieved of pain and significantly decreased mass n pulsation. The outcome was satisfactory without complication. Conclusion: Treatment for peripheral AVM and AVF is a challenge due to their unpredictable behavior. There is a wide plethora of embolic agents, each with its particular characteristics that makes it ideal for certain situations. Familiarity with these and their modes of use and action can help in selecting the correct agent depending on the goal of embolization.
  - 2,716 80