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  Access statistics : Table of Contents
   2022| January-February  | Volume 9 | Issue 1  
    Online since March 23, 2022

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Retrograde tibiopedal access for chronic limb-threatening ischemia: A real-world experience report of 178 consecutive patients
Mostafa Abdelmonem, Mohammed Shahat, Mohamed G Elashry, Haitham Ali
January-February 2022, 9(1):3-10
Objective: The objective of the current study was to report single-center data concerning the efficacy, safety, and midterm outcomes of retrograde tibiopedal access, after failed antegrade attempts, for management of infrainguinal chronic total occlusions (CTOs) in patients with chronic limb-threatening ischemia (CLTI). Methods: This prospective, observational study was conducted between July 2016 and June 2019 and included 178 patients with infrainguinal CTO in whom a percutaneous tibiopedal access was attempted as a consequence of failed recanalization using an antegrade approach due to ostial lesions or failed re-entry. Results: The study reported access, crossing, and treatment success of 93.8%, 89.9%, and 88.8% of all tibiopedal access attempts, respectively. Primary, assisted primary, and secondary patency rates were 43.8% ± 3.9%, 64.2% ± 3.8%, and 71.7% ± 3.5% at 24 months, respectively. Kaplan–Meier analysis yielded an overall amputation-free survival of 71.1% ± 3.5% at 24 months. Conclusion: Retrograde tibiopedal access is an effective and safe approach as associated with high access, crossing, treatment success, and low complication rates. This approach is considered as a bailout technique during endovascular procedures in recanalization of infrainguinal CTOs, after failed antegrade attempts, in patients with CLTI.
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Evolving paradigm of hybrid repair for aortic arch pathologies
Madathipat Unnikrishnan, Sidharth Viswanathan, Shivanesan Pitchai, Ajay Savlania, Harishankar Ramachandran, Vineeth Kumar P M, Arun Mohan Mohanan, Praveen Gopalakrishnan, Kapilamoorthy T R, Prasanta Kumar Dash
January-February 2022, 9(1):11-17
Background: Critical domain of thoracic aorta, the aortic arch, is affected by diverse pathologies mandating effective yet less strenuous management to save life, preserve organ function, and provide quality of life. Conventional open repair, minimally invasive total endovascular, and hybrid aortic arch repair are therapeutic options available. We present our experience and results with hybrid arch procedures. Materials and Methods: A cohort of 75 patients who were operated upon by the senior author from 2007 to 2020 formed the basis for this report. Male: female ratio was 11:1 for this group whose age ranged from 22 to 82 years with a mean of 70. Clinical indications were degenerative aneurysm (n = 49), Stanford B aortic dissection (n = 21), residual lesion following earlier Stanford A repair (n = 4) and a solitary patient with aortic trauma. Pan-arch debranching or hemi-arch debranching was performed in nearly all along with deployment of stent-graft at Zone 0 or Zone I, respectively. Sixty-seven elective (89.3%) procedures were staged and 8 (10.7%) were synchronous on account of being emergency interventions. Postoperative follow-up was performed at 3 and 6 months and yearly. Computed tomography aortogram was done before discharge from hospital or within 1 month followed by 1 year. Results: Technical success was achieved in 97.3%. Inhospital/30-day mortality was 9.3% (7/75 patients). Neurological complications, albeit less common, were the leading cause of perioperative morbidity. No endoleaks or graft migration was encountered in follow-up. Late mortality occurred in 10.3% (7/68 patients) from 6 months to 5 years, with massive hemoptysis in three despite asymptomatic clinical status and satisfactory imaging. Two patients were lost for follow-up, while the rest 59 patients are keeping well. Conclusion: Hybrid repair of aortic arch lesions, though initially intended to compliment stressful conventional surgery, has now evolved as the primary modality in this domain. This relatively safe therapeutic option, performed in a staged setting coupled with attention to achieve a liberal proximal seal, provided excellent initial results and long-term survival.
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Has vascular surgery evolved enough to cut the umbilical cord from other related specialties? The Indian perspective
Varinder Sing Bedi
January-February 2022, 9(1):1-2
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How to conduct inferential statistics online: A brief hands-on guide for biomedical researchers
Shaikat Mondal, Swarup Saha, Himel Mondal, Rajesh De, Rabindranath Majumder, Koushik Saha
January-February 2022, 9(1):54-62
Introduction: Research data are first organized and visualized with the help of descriptive statistics. The next step is the inferential statistics. Result of the inferential statistics helps to conclude the finding. Many researchers and medical students may not have access to dedicated software for biostatistics. Aim: This study aimed to provide a guide on the conduct of common inferential statistics that can be done online. Methods: Common inferential statistical tests for both numerical data and categorical data were described in this study. All the tests were conducted online and the process is described step by step with example data. Results: The following tests were described-one-sample t-test, one-sample median test, unpaired t-test, Mann–Whitney U-test, paired t-test, Wilcoxon signed-rank test, one-way analysis of variance (ANOVA), Kruskal–Wallis test, repeated-measure ANOVA, Friedman Test, Pearson correlation test, Spearman correlation test, Binomial test, Chi-square test, Fisher's exact test, and MacNemar test. All these tests could be conducted online from a computer connected to the internet. Conclusion: We could conduct common inferential statistical tests online without any installed software. Anyone without prior data analysis knowledge may conduct the tests with example data on any internet browser. We presume that these would help the medical undergraduate and postgraduate students.
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Beneficial effects of alprostin in patients with critical limb ischemia with peripheral arterial disease: A retrospective study
Jayesh Patel, Pratiksha Shah, Fenil Gandhi
January-February 2022, 9(1):18-21
Objective: Medical management of nonre-constructible and failed reconstruction in patients with peripheral arterial disease (PAD) has limited options. The objective was to study the safety and efficacy of Alprostin in the management of patients presenting with Stages III and IV PAD. We hypothesized that administration of Alprostin will lead to an increase in the transcutaneous oximetry (TcPO2) and ankle-brachial index (ABI) values. It may also aid in decreasing limb pain, promote ulcer healing, and increase claudication distance. Materials and Methods: A retrospective study comprising 60 patients who had presented to vascular surgery with clinical features of PAD. According to the Fontaine's staging criteria, only those patients who had presented with Stages III and IV were included in the study. Patients with critical limb ischemia and nonre-constructible or failed vascular reconstruction disease, who had not improved with conservative management, and patients presenting with Stages III and IV PAD were given injection Alprostin. A total of 6 cycles (each cycle for 3 days, every month) of Alprostin were given, dose being 166.66 mcg over 5 h/day. A qualitative assessment was performed, assessing change in rest pain, claudication distance, ulcer healing, and development of complications. In addition, a quantitative assessment was performed by measuring the TcPO2 and ABI before and after the administration of Alprostin. Results: The study comprised 60 patients, out of whom 55 were male and 5 were female with a mean age of 48.98. The patients were then classified according to the Fontaine Staging, where 50 patients presented with Stage III and 10 patients presented with Stage IV PAD. After the administration of Alprostin, 100% of patients reported of decrease in pain in lower limb, 70% reported of ulcer healing, 55% reported of increase in claudication distance, and complications were only seen in 5% of the patients. TcPO2 values showed a significant rise after the administration of Alprostin, with P value being 0.001. Finally, ABI values also showed a significant improvement after the administration of Alprostin, with P value being 0.001. Conclusion: PAD is a common circulatory condition in which the narrowed arteries in the limbs reduce blood flow to the extremities, most common being lower limbs. There are several lifestyle modifications that can be made to control PAD. Alprostin is a prostaglandin E1 analog, which acts a vasodilator and inhibits platelet aggregation. It helps to reduce vascular cell adhesion molecule levels in circulation, reduces vascular inflammation, promotes ulcer healing, increases claudication distance, and reduces rate of amputation of the affected limb. Hence, it can be concluded that Alprostin has been shown to be a safe and effective drug in patients with nonre-constructible PAD.
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Utility of ankle brachial index in the diagnosis of peripheral arterial disease in a resource limited setting
Mudasir Hamid Bhat, Arshed Hussain Parry, Shadab Maqsood, Farooq Ahmad Ganie
January-February 2022, 9(1):22-26
Background: Peripheral arterial disease (PAD) constitutes a significant healthcare problem with immense health and economic implications. Owing to ill-equipped healthcare systems in poor countries the diagnosis of PAD demands the availability of a reasonably reliable and inexpensive diagnostic test. Ankle brachial index (ABI) is a simple, inexpensive office-based test for the diagnosis of PAD. The study was aimed to evaluate the reliability of ABI for the diagnosis of PAD using Doppler ultrasound (DUS) as the gold standard. Methods: The ABI of patients suspected of having lower limb PAD was measured followed by DUS examination. The sensitivity and specificity of ABI for the diagnosis of PAD was calculated by comparing it with DUS which was used as the reference or standard diagnostic test. Results: The ABI of a total of 200 limbs from 100 patients was recorded followed by DUS examination. One hundred and thirty-two limbs (66%) had PAD on DUS which was graded as mild, moderate, and severe in 45.5%, 27.2% and 30.3% respectively. Out of 132 patients who had PAD on Doppler, 96/132 (72.8%) were correctly labelled as PAD on ABI, whereas 36/132 (27.2%) received an erroneous diagnosis of normal on ABI. Conversely, only 6/60 (10%) patients who were labelled as PAD on ABI had a normal arterial system on DUS. The ABI yielded a low overall sensitivity of 72.7% and a high specificity of 90%. The sensitivity was relatively low for mild PAD (52.7%), however, for moderate and severe PAD, ABI demonstrated a high sensitivity of 88.9% and 100% respectively. Overall agreement between ABI and DUS for the diagnosis of PAD was good (k = 0.67). Conclusion: ABI demonstrated a good sensitivity and specificity for the diagnosis of PAD especially in patients with moderate-severe PAD. Combined with the advantages of ready availability, low cost, and technical feasibility the use of ABI should be maximized in routine clinical practice to clinch the diagnosis of PAD in suspected individuals.
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How to conduct descriptive statistics online: A brief hands-on guide for biomedical researchers
Himel Mondal, Sharada Mayee Swain, Shaikat Mondal
January-February 2022, 9(1):70-76
Background: Descriptive statistics is the first step of data analysis. In biomedical researches, inferential statistical tests are invariably conducted after descriptive statistical tests for getting a summary of the data. Many resource-limited settings may not have dedicated software for carrying out these tests. Aim: This article aimed to provide a brief technical guide about the conduct of descriptive statistics with visualization that can be done without any dedicated statistical software package. Methods: We searched for online tools that provide free service for the conduct of descriptive statistics. The example data were fabricated for the conduct of the test online. The visualization of the data (i.e., figures) was explained in brief, wherever necessary. Results: We described the method to graph and summarize the data using a pie chart, frequency table, stem and leaf display, histogram, frequency polygon, box plot, bar chart, stacked bar chart, line graph, dot plot, central tendency, variance, quantile-quantile plot, scatter plot, and Venn diagram. All these tests and visualization were done online without any installed dedicated software package. Conclusion: This article provides a brief technical guide for conducting common descriptive statistical tests online. Researchers in any resource-limited settings may use these services to summarize and visualize the data online from public domain websites.
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Traumatic axillary artery repair: A single center experience
Ridhika Munjal, Navnita Kisku, Subrata Pramanik, Anubhav Gupta
January-February 2022, 9(1):27-30
Introduction: Only 15%–20% of the arterial injuries of the upper limbs are due traumatic axillary artery injury. Out of all ninety four percent are due to penetrating wounds, while the remaining 6% are caused by blunt traumas. Four cases with traumatic axillary artery injury are reported here. Materials and Methods: Four patients diagnosed with traumatic axillary artery injury underwent vascular repair presented between October 2019 and September 2020 are included in this study. Results: Fifty percent of patients presented with blunt trauma, whereas 50% with penetrating injury. Only one patient had associated bone injury. Hundred per cent of the patients had absent peripheral pulsation, while 50% of patients presented with warm upper extremity and normal capillary refill time. Seventy-five percent of patients involved had trauma to 1st part of axillary artery, whereas one patient suffered trauma to 2nd part. Two incisions, i.e. supraclavicular and infraclavicular incisions were taken to take proximal control of subclavian artery in two patients with trauma to 1st part of axillary artery. Only one patient underwent vascular repair with reverse saphenous vein graft, rest all patients underwent end-to-end axillary artery repair. Twenty-five percent of patients had associated brachial plexus injury and bone injury, respectively, which were taken care off along arterial repair. Hundred percent of the patients had good vascular outcome postoperatively. Conclusion: Patients presenting with trauma to periclavicular region must be thoroughly examined for associated axillary artery injury and if diagnosed with same must undergo prompt surgical exploration and arterial repair. For good proximal control, it is advisable to go for both supraclavicular and infraclavicular incisions in case of injury to 1st part of axillary artery.
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Chronic kidney disease and anticoagulation - Quick overview and practical guide
Pranay Purushotam Pawar, Albert Abhinay Kota, Indrani Sen, Edwin Stephen, Bader Al Rawahi, Santosh Varughese, Saif Khan
January-February 2022, 9(1):40-47
Clinicians managing patients with chronic/end-stage renal disease often are challenged when it comes to anticoagulation in this subset. Unfractioned heparin and warfarin have been in use, and most multidisciplinary teams are comfortable with the drug/s either as prophylaxis or for full anticoagulation. Over the past decade, there has been an increase in the use of low-molecular-weight heparin and more recently of direct oral anticoagulants for anticoagulation. However, there is a reluctance to use these drugs for concern of increased bleeding and management of this complication in patients with renal disease. This paper shares a quick overview of coagulation in chronic/end-stage kidney disease and drugs used for anticoagulation, societal recommendations for their use, with clinical case scenarios, and a proposed management algorithm when patients have a bleed while on anticoagulation.
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Giant venous malformation of the trunk: Complications and therapeutic difficulty
Ghita Belmaati Cherkaoui, Hanane El Adak, Ayat Allah Oufkir, Adnane Benzirar, Omar El Mahi
January-February 2022, 9(1):101-104
Venous malformations (VMs) are dyssembryogenias of the venous vascular system. Giant VMs are rare but frequently associated with hemostasis disorders of variable severity. Their treatment is long and complex. The combination of several therapeutic modalities can reduce symptoms without eliminating the VM. A multidisciplinary approach is essential. A clinical case illustrates the difficulty of managing these malformations.
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Role of wound, ischemia, and foot infection scores in predicting major limb loss despite appropriate revascularization
Emmanuel Lazarus, Prabhu Premkumar, Dheepak Selvaraj, Vimalin Samuel, Albert Abhinay Kota
January-February 2022, 9(1):81-84
Background: Wound, Ischemia, and foot Infection (WIfI) scores correlate well with amputation risk in patients with peripheral vascular disease. A certain subset will eventually require a major amputation despite revascularization. These patients may be offered the option of an upfront primary amputation and early rehabilitation. We sought to assess the WIfI staging and the novel WIfI composite scoring in identifying this subgroup. Patients and Methods: Patients with lower limb peripheral vascular disease with chronic lower limb extremity wounds who underwent revascularization procedures with the intent of limb salvage were included. Retrospective data of prospectively maintained preoperative WIfI scores, details of vascular intervention and occurrence of major amputation over 1 year from April 2018 to March 2019 was collected. Follow-up data were obtained for 1 year postoperatively. Results: Hundred thirty-seven patients were included. One hundred and one underwent an endovascular procedure, 17 underwent an aortobifemoral bypass, 16 underwent an open bypass procedure, and 3 were hybrid procedures. About 16.5% (23 patients) required a major amputation despite revascularization within 6 months of intervention. The mean total component score (out of 9) in these patients who required amputation was significantly higher (7.73 vs. 5.15, P < 0.05). Higher infection score preoperatively (2.17 vs. 0.88, P < 0.05) and higher wound score (2.7 vs. 1.63, P < 0.05) were significant. Mean ischemia scores were not significantly different between the two groups (2.87 vs. 2.65). The most common cause of amputation was infection (20 out of 23 events), and most of the amputations occurred in the first 1 month following. Three patients died within the 1-year follow-up period. Conclusion: Patients with higher total WIfI scores >7, higher wound, and infection components at presentation may have poor outcomes following revascularization.
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Brief technical guide for registration of an observational study protocol
Himel Mondal, Shaikat Mondal, Amita Kumari Mahapatra
January-February 2022, 9(1):31-35
Background: Clinical trial registration is a must for the conduct of an interventional study. The registration should be in the repositories accepted by World Health Organization (WHO) and endorsed by the International Committee of Medical Journal Editors (ICMJE). These registries allow the registration of both interventional and observational studies. However, the majority of the observational studies are not registered. Aims: We aimed to find the current share of observational studies in various registries and to provide a brief technical guide on the process of registration of an observational study in the Clinical Trials Registry – India (CTRI) and in the open science framework (OSF). Methods: We searched the WHO and ICMJE websites for the list of accepted registries. The number of interventional and observational studies in those registries was collected. Then, we described the process of registration of an observational study in CTRI and OSF. Results: The highest number (83,866) of observational studies is present in ClinicalTrials.gov. However, according to percentage, the DRKS - German Clinical Trials Register has the highest percentage (31.57%) of observational studies. The CTRI has 25.33% and ClinicalTrials.gov has 21.91% observational studies. The registration of an observational study protocol is acceptable online and free of cost in the CTRI and OSF. Conclusion: It is not mandatory to register purely observational studies. However, the registration may bring transparency in scientific reporting and help to avoid publication bias towards positive results. The technical glimpse in this article would help the novice authors in registering their observational study protocol in an open repository.
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Endovascular aortic repair of mycotic abdominal aortic aneurysm with multiple systemic abscesses
Takao Miki, Satoshi Ohki, Kiyomitsu Yasuhara, Tamiyuki Obayashi
January-February 2022, 9(1):111-113
Mycotic abdominal aortic aneurysms (MAAAs) are rare, but severe aortic infection and subsequently infected aortic aneurysms can cause a lethal condition. The gold standard for treatment is resection, infected tissue debridement, and graft replacement. Despite meticulous surgical planning, the mortality rate after open surgical repair can reach 40%. Endovascular aortic repair (EVAR) is another treatment option because of its simplicity and low invasiveness. We report a case of symptomatic MAAA successfully treated with EVAR and antibiotic therapy. EVAR is valuable for postoperative physical recovery. Here, the endovascular approach was feasible, and an acceptable outcome could be obtained.
  368 13 -
Endovascular revascularization of subclavian artery occlusion: Case report and review of endovascular techniques
Hamissou Moussa Maman Roufai, Yang Jun, Song Guangfu, Yang FuYi, An Guiliang
January-February 2022, 9(1):93-96
Subclavian artery (SCA) disease is caused by stenosis or occlusion of the proximal segment of the SCA, resulting in a retrograde blood flow of the ipsilateral vertebral artery. It is rare, with a prevalence of 0.6% to 6.4% in the general population. The common cause of this disease is atherosclerosis, followed by Takayasu's arteritis. The endovascular approach is currently the first treatment option; the success rate of this approach achieved 100% reported by many authors in the case of SCA stenosis. However, the success rate of this approach is lower in the case of SCA total occlusion, and the main reason is the inability of the wire to cross the lesion. The emergent novel endovascular techniques are trying to provide an effective solution. Recently, novel endovascular methods were successfully performed and reported in the literature. Nevertheless, a small sample size limited these studies; therefore, large-scale prospective studies are needed to ascertain their feasibility, effectiveness, and safety. In this present study, we report a successful stent-assisted angioplasty and review of endovascular techniques for the SCA total occlusion.
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Retrospective validation of global limb anatomic staging system with respect to technical failures in endovascular infrainguinal revascularization for critical limb threatening ischemia
Shabnam Fathima, Sairam Subramanian
January-February 2022, 9(1):85-88
Introduction: The Global Vascular Guidelines proposed the Global limb anatomic staging system (GLASS) to overcome the shortcomings of previous multiple classification system. It grades the infrainguinal disease into three stages with a specific algorithm to score the femoropopliteal and tibial segments. We aim to retrospectively validate the GLASS staging in primary endovascular therapy with respect to immediate technical failures (ITFs). Materials and Methods: Retrospective data from November 2017 to September 2021 were collected from the existing clinical database. All patients who underwent primary infrainguinal endovascular intervention for critical limb-threatening ischemia were included in the study. The patient who had isolated infrapopliteal disease without a named tibial outflow and only inframalleolar disease were excluded. The GLASS scoring was applied to the angiographic details in the database. The ITFs from the database were compared to the predicted technical failure according to GLASS staging. Statistical analysis was done. Results: Hundred thirty-two patients were studied from clinical database. We had 13 (9.8%) ITFs. None of those in GLASS Stage I had failure. Among 26 patients in Stage II, 1 (4%) had failure, against the predicted failure rate of lesser than 20%. Among 89 patients in GLASS Stage III, only 12 (13.5%) had failures against the predicted failure rate of more than 20%. The majority of failures had occurred in higher GLASS staging. Conclusion: Higher failures in higher GLASS staging have been validated by our study. However, it is limited considering the small cohort and retrospective analysis.
  352 22 -
Primary lower-limb arterial stent infection managed with resection and In situ bovine pericardial revascularization
Thomas Lovelock, Catherine Thoo
January-February 2022, 9(1):97-100
Peripheral arterial stent infection is a rare but morbid condition. We present the case of a patient with primary stent infection of his superficial femoral artery (SFA) and popliteal artery, managed with surgical explant and in situ reconstruction using rifampicin-soaked bovine pericardial tube graft. A 69-year-old man presented with a 3-day history of left groin pain. He had had stents placed into his SFA and popliteal artery in 6 months prior. Duplex ultrasound demonstrated a pseudoaneurysm of the common femoral artery (CFA), with ying-yang flow. A computed tomography angiogram confirmed this pseudoaneurysm, which had a thick rind of nonenhancing soft tissue. Blood cultures were positive for methicillin-sensitive Staphylococcus aureus. The patient was taken to the operating theater, and the CFA, profunda femoris artery, and SFA were exposed. After heparinization and clamp control, the pseudoaneurysm was incised, which revealed that the proximal SFA had been completely eroded. All infected tissues were resected. In situ arterial reconstruction was undertaken using a rifampicin-soaked bovine pericardium tube graft. A subsequent positron emission tomography scan revealed high fluorodeoxyglucose uptake around the patients remaining distal SFA and popliteal artery stents. These were explanted in the same manner described above. There is limited evidence regarding the prevention of infection when placing peripheral arterial stents. The Society of Interventional Radiology does not recommend routine prophylactic antibiotics when placing peripheral stents. In situ reconstruction using bovine pericardium is a well-described technique in the management of aortic graft infections, but there is limited experience in its use in a peripheral setting.
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Investigation of routine blood parameters for predicting embolic risk in patients with nonvalvular atrial fibrillation
Mustafa Etli
January-February 2022, 9(1):36-39
Introduction: Nonvalvular atrial fibrillation (NV-AF) is an important risk factor for cardiac thromboembolic disorders. However, there is not an exact biomarker for evaluating risk in these patients. In this study, we aimed to investigate the routine blood test and inflammatory markers in NV-AF patients with or without embolic complications. Materials and Methods: Routine complete blood count (CBC) and a clinical biochemistry analysis of 214 NV-AF patients (151 with embolic complication and 63 without embolic complication) were recorded retrospectively. Obtained results compared between NV-AF with embolic group and NV-AF without an embolic group. Results: The most of the CBC and biochemical markers were found as similar (P > 0.05) between groups except white blood cell count, lymphocyte ratio (Lym%), neutrophil ratio (Neu%), eosinophil ratio (Eus%), neutrophil count (Neu), mean corpuscular hemoglobin concentration, blood urea nitrogen, cholesterol, low-density lipid, sodium (Na), total bilirubin, direct bilirubin, plasma iron levels, and neutrophil to lymphocyte ratio (NLR) (P < 0.05). Conclusion: The inflammatory markers, especially NLR, seem to be useful for embolic risk stratification in NVAF patients.
  356 13 -
Aggressive management of upper extremity deep venous thrombosis – A case report and systemic review
Mohammed Shahat
January-February 2022, 9(1):118-122
Upper extremity deep vein thrombosis (UEDVT) is rapidly growing health issue. The number of secondary UEDVT is outnumbering the incidence of primary deep vein thrombosis in upper limbs. Central venous catheter, malignancy is the most accused etiology for marked growth in the incidence of upper limb DVT. We are reporting a unique case for UEDVT and its management by thrombolysis in malignant patient with unique complication occurred (arteriovenous fistula) which was managed by covered stent in the artery.
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Ruptured infective pseudoaneurysm of the posterior tibial artery causing repeated bleeding in a chronic venous ulcer
Devender Singh, Shalini Aryala
January-February 2022, 9(1):105-107
Bleeding from the chronic venous ulcer is usually from underling ruptured varicosities or due to opening of arteriovenous communications. Pseudoaneurysm of the tibial arteries in the chronic venous wounds leading to bleeding is an extremely rare complication. Massive bleeding sometimes is life-threatening. We present a case of ruptured infected pseudoaneurysm of the posterior tibial artery with a chronic venous ulcer, who presented in shock with repeated episodes of bleeding.
  346 13 -
Traumatic visceral venous pseudoaneurysm: A review of reported cases over last 25 years
Vignesh Kumar, Anand Katiyar, Niladri Banerjee, Sunny Aggarwal, Suyash Singh, Harshit Agarwal
January-February 2022, 9(1):48-53
The natural history of traumatic visceral venous pseudoaneurysm (VVP) is largely unknown, and hence, there is a lack of consensus for their management. This review aims to determine the management and outcomes of these injuries. A review of the reported cases over the last 25 years was performed. Only 32 cases were found, 24 abdominal, and 8 thoracic. Traumatic abdominal VVPs were largely managed nonoperatively, while majority of traumatic thoracic VVPs underwent intervention. Hemodynamic instability was the most common cause for intervention. No uniformity was noted for follow-up imaging of these injuries.
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From hypodermoclysis to massive infiltration – Tumescent local anesthesia
Karthikeyan Sivagnanam
January-February 2022, 9(1):89-90
  322 10 -
Repair of large ruptured infected pseudoaneurysm of iliac artery with transposition of internal iliac artery after an allograft nephrectomy
Devender Singh, Shalini Aryala
January-February 2022, 9(1):91-92
Pseudoaneurysms following allograft nephrectomy are rare and associated with significant morbidity and mortality. Ruptured iliac artery pseudoaneurysm in a septic patient is a challenge to treat due to limited options. This case report highlights a novel technique of using ipsilateral internal iliac artery to repair an infected pseudoaneurysm of the iliac artery related to explanted renal transplant.
  314 13 -
How to conduct inferential statistics online (Part 2): A brief hands-on guide for biomedical researchers
Shaikat Mondal, Himel Mondal, Roopam Panda
January-February 2022, 9(1):63-69
Introduction: Researchers from developing countries may not have access to statistical software packages. However, descriptive and inferential statistical tests are to conduct to conclude the study. In a previous article (DOI: 10.4103/ijves.ijves_116_21), we described how to conduct some of the common inferential statistical tests online. This article is the second part of the series. Aim: We aimed to provide the examples of some inferential statistical tests used in clinical studies and provide step-by-step guidelines to conduct those tests online. Methods: We prepared a set of data for each statistical test. These data were used to carry out the test online and the steps are briefly described. The result of the test is presented with screenshots and text to get an idea of how to report the result in a manuscript. Results: We described the process of conduct of the following tests online – Receiver operating characteristics curve analysis, Kaplan − Meier estimate, dose-response, logistic regression, multiple linear regression, residual analysis, odd ratio, Bland − Altman plot, Cronbach's alpha, Cohen's kappa, and intraclass correlation coefficient. In addition, a method for random allocation of subjects in groups was also described. All the tests were described with example data available in a supplementary file. Conclusion: In this article, some of the inferential statistics used for clinical studies are described with example data and a step-by-step guide. Any clinician from resource-limited settings may use this guide as a reference for statistical tests. However, the tests described in this article are not a comprehensive list.
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Angioma serpiginosum: Clinico-dermoscopic histopathology correlation
Pankaj Das, Sandeep Arora, Gautam Kumar Singh, GB Prashantha, Sanghita Barui, Vikram Singh
January-February 2022, 9(1):108-110
Angioma serpiginosum (AS) is an uncommon vascular anomaly with unknown etiopathogenesis. It typically presents as asymptomatic unilateral red-colored macules and papules in linear serpiginous pattern during the first two decades of life. It most frequently affects lower limbs followed by gluteal area. We present a case of AS affecting primarily one-half of the trunk and the ipsilateral limb. The diagnosis was confirmed with dermoscopy that revealed characteristic well-defined round-to-oval red lagoons representing dilated capillaries in the papillary dermis on histopathology.
  218 16 -
Anthologies in Vascular Surgery-9

January-February 2022, 9(1):123-125
  210 23 -
Use of medial gastrocnemius muscle flap in traumatic popliteal artery injury due to posterior dislocation of knee joint
Pradeoth Mukundan Korambayil, Vinoth Kumar Dilliraj, Edwina Mary Babu, Prashanth Ambookan Varkey
January-February 2022, 9(1):77-80
Introduction: Injury to the popliteal region affects vascularity and soft tissue necrosis. The purpose of the study is to use the medial gastrocnemius muscle flap to enhance the soft tissue cover of the injured area. Materials and Methods: This retrospective study was conducted in the Department of Plastic surgery from January 2019 to December 2020. All patients admitted under the department with posterior dislocation of the knee with vascular compromise to the limb were enrolled in the study. Results: Five patients were included in the study. In all the five cases, the limb was salvaged with reverse saphenous vein graft harvested from the thigh region of the opposite limb with soft tissue cover of medial gastrocnemius muscle flap. Postoperative limb movements were satisfactory. The average duration of hospital stay was approximately 21 days. Conclusion: Usage of medial gastrocnemius flap serves an adequate soft tissue coverage in traumatic popliteal artery injury
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Rare case of large saccular pseudoaneurysm from both iliac arteries and its management by endovascular repair using kissing balloon-stent technique
Manjunath Venkataramaiah Bagur
January-February 2022, 9(1):114-117
Isolated true and false iliac artery aneurysms are rare. Cases of iliac artery pseudoaneurysm are even less common and very rarely reported in the literature. Unless interventions are done immediately by either open surgical repair or endovascular repair, the mortality rate remains very high (>50%). We present a complicated case of large saccular pseudoaneurysm from both iliac arteries undergoing a unique procedure of “kissing balloon stent” technique.
  160 15 -