A Retrospective Follow-Up Study To Show The Effectiveness Of Booster Dose Of Foam Sclerotherapy Session At 3rd And 6th Months In Preventing The Recurrence Of Varicose Veins.

BACKGROUND: Injection sclerotherapy administration is known to cause a decreased recurrence of varicose vein disease. This research aimed to investigate the recurrence of varicose vein disease after giving booster doses of injection sclerotherapy. The booster doses were given at 3rd and 6th months. METHODS: One hundred and fifty patients participated and all patient's included ages 30-70 in the category of 'low risk' patients. The patients were both males and females. Patients participating in the study were counselled appropriately and written consent was taken from them. Moreover, the patients selected were volunteers and agreed to be part of the study. Patients who were above 70 years of age, those who were at a high-risk due to some co-morbidities (high-risk patients), patients not willing to be part of the study, those allergic to drugs being used including sclerosant and people with any known psychiatric illness or cardiac arrhythmias, deep venous thrombosis patients, patients having arteriovenous malformation/venous ulcers were all excluded. If the patient was pregnant, the gynaecology team was taken on board and the procedure was carried out. Every procedure was carried out under the direct supervision of the supervisor. Booster dose sessions of Foam Sclerotherapy were held at 3rd and 6th months of the study time. Their effectiveness was observed and documentation was carried out. RESULTS: Since it was a procedure that could be done in the OPD, there was no need for specialized anaesthesia care. It is of significant notice that when a patient of varicose veins was given a booster intravenous sclerosant injection at 3rd and 6th month of treatment, chances of recurrence decreased to 50%.

Double Stab Excision Arteriotomy-A Novel Technique For A Better Outcome.

BACKGROUND: This study was carried out to introduce a new technique of excision arteriotomy and to compare it with standard excision arteriotomy in terms of achieving desired size, shape and margins with minimal technical problems. METHODS: This was a comparative study carried out at the Vascular Surgery Unit of Combined Military Hospital Peshawar between January and September 2022. A total of 150 patients of chronic renal failure undergoing Arteriovenous access fulfilling the inclusion criteria were enrolled in our study. The patients were randomized into two groups, 75 in each group: Group A consisted of patients who underwent Conventional excision arteriotomy and Group B underwent Double Stab excision Arteriotomy. The endpoint of the study was to achieve an appropriate arteriotomy of the desired size and shape by having regular margins without intimal dissection during its formation or otherwise inappropriate arteriotomy if any of the criteria is not met. RESULTS: Among the total 150 patients included in our study, Ages ranged between 30-60 years and a mean age of 52.5 years. There were 82 (54.66%) males and 68 (45.33%) females with a male-to-female ratio of 1.2:1. In group A (Conventional Excision arteriotomy) there were 30 (40%) inappropriate arteriotomies and 45 (60%) appropriate arteriotomies. Among the total 30(40%) inappropriate arteriotomies in group A, larger than desired size arteriotomies were 10 cases (33.33%) followed by smaller than desired size arteriotomies; 6 (20%), irregular margins 9 (30%), intimal dissection 3(10%) & lateral tear 2 (6.66%) respectively. In group B of double stab excision arteriotomies, appropriate arteriotomies were achieved in 69 (92%) while the rest had inappropriate arteriotomies in 6 (8%). Among the total 6 (8%) inappropriate arteriotomies in group B, larger than desired size arteriotomies were 2 (33.33%), smaller than desired size arteriotomy; 1 (16.66%), irregular margins 1 (16.66%), intimal dissection;2 (33.33%) & no lateral tear respectively. CONCLUSIONS: This study concluded that the Double stab excision arteriotomy technique is superior to the conventional excision arteriotomy technique. The advantages of our technique are; its reliability with a short learning curve and can be performed precisely and safely.

Evaluation Of Normal Diameter Of Infra-Renal Aorta In A Pakistani Population Using Contrast-Enhanced Computed Tomography.

BACKGROUND: It is a common observation that the aortic size of Pakistani population is relatively less as compared to western population. Till now there is no study which has measured the dimensions of abdominal aorta in local population.The standard diameter of an artery across the body is critical for clinicians to recognize when an artery has become aneurysmal. This study aims to present the results of a local population's normal diameter of an infrarenal aorta and how it varies by age, gender, weight, height, body mass index (BMI) and body surface area (BSA). METHODS: This cross-sectional observational study was conducted in Vascular Surgery Department, at Combined Military Hospital (CMH), Peshawar, from July 2020 to November 2021.Participants in the study included all patients who underwent a contrast-enhanced computed tomography (CT) scan of the abdomen for any reason other than cardiovascular disease.The infrarenal abdominal aorta's mean internal diameter (anteroposterior and transverse diameter) was assessed. SPSS v 23 was used to analyze the data and present it as frequency and percentages. The Pearson correlation coefficient assessed the correlation between aortic diameters, weight, height, BMI, and BSA. RESULTS: Recruitment of a total of 250 patients was done in this study. Males were 194 (77.6%), while the rest were female patients. The patients' mean age was 39.6±12.8 years. The mean anteroposterior (AP) diameter of the infrarenal aorta was 16.13±2.32 mm. The mean transverse diameter (TD) was 15.96±2.34 mm. The infrarenal diameter of the aorta was smaller in women when compared to men, and the calibre of the aorta increased with the increasing age of the patients. There was a statistically significant positive relationship between their age and the average diameter of the infrarenal aorta (p<0.001) among both men and women. CONCLUSIONS: Clinicians and vascular surgeons will benefit from the findings in diagnosing and treating abdominal aortic aneurysms. Hence, thoughtful consideration should be made before formulating intervention protocols.

Posterior Aneurysmorrhaphy & Lateralization Of Aneurysmal Fistula Vein: A Modification Of Existing Aneurysmectomy Techniques.

BACKGROUND: To present a new modification of aneurysmectomy technique for the management of aneurysmal fistula vein. This cross-sectional study was carried out at Vascular Surgery department, Combined Military Hospital Rawalpindi from 1st October 2014 to 30th December 2018. METHODS: This modified aneurysmectomy procedure was performed in 20 patients. Massive diffuse venous dilatation of vein, necrosis of overlying skin, reduction in the cannulation area and pain were the indications of surgery. Revision was performed by rotating the mobilized vein to 180°, excising redundant vein, reducing diameter, repairing venotomy posteriorly and placing the vein in a mobilized skin flap over the fascia of biceps muscle away from skin suture line, to facilitate subsequent cannulation and post puncture haemostasis. The rationale of this modification was to prevent damage to the usual anteriorly placed suture line during needle insertion for haemodialysis. The data were analysed by using SPSS version 25.0. RESULTS: The mean age of patients was 45.45±14.75 years with a range of 12-65 years. Sixteen patients (80.0%) were having brachiocephalic fistula while 4 patients (20.0%) had radio cephalic fistula. The mean time of reuse of AVF after vein Aneurysmectomy was 24.55±5.3 days with half of the patients having reuse of AVF after 3 weeks. Three (15%) patients developed hematoma while 2 (10%) patients developed skin necrosis. Fifteen (75%) patients had no surgery related complications after procedure. CONCLUSIONS: Posterior suturing and lateralization of aneurysmal vein under mobilized skin flap is a safe, effective and easy to learn modification of aneurysmectomy procedure for the management of aneurysmal dilatation of fistula vein.

Outcome Of Embolectomy In Patients Presenting Late With Acute Limb Ischemia.

BACKGROUND: UThe aim of this study is to share our experience regarding outcome of embolectomy in the patients presenting late with acute limb ischemia. It was a cross sectional descriptive study, conducted at CMH Rawalpindi from January 2016 to December 2017. METHODS: All those patients having non-traumatic acute limb ischemia presenting between 6 to 72 hours of the onset of symptoms with viable affected limb were included. Their data was analysed for demography, involved limb, time of embolectomy, fasciotomy, re embolectomy, amputations, reperfusion injuries and death. The patients presenting later than 72 hours, irreversible Ischemia and limb ischemia secondary to trauma or graft occlusion of previous Bypass surgery were excluded from the study.. RESULTS: A total of 49 (36 males and 13 females) patients were included in the study. Thirty-three (67.3%) patients underwent embolectomy for lower while 16 (32.6%) for upper limb ischemia. Ten (20.4%) patients had fasciotomy while 7 (14.2%) patients underwent re embolectomy. In 5 (10.2%) patients vascular bypass had to be done. Seven (14.2%) patients underwent minor amputations while 5 (10.2%) had major limb amputations. Two (4%) patients died of reperfusion injury. Overall 42 (85.7%) limbs were salvaged. CONCLUSIONS: Embolectomy is effective in late presenting acute limb ischemia with viable extremity and should be offered to these patients.

Popliteal artery entrapment syndrome.

Popliteal artery entrapment syndrome is an uncommon cause of intermittent claudication in young athletic persons. A 32 years old soldier presented with 14 months history of intermittent claudication. On the basis of history, physical examination and angiographic findings a diagnosis of popliteal artery entrapment was made. Exploration revealed a fibrous band tightly compressing popliteal artery and irreversibly damaged popliteal artery. Short saphenous vein graft was used to bypass the occluded segment of popliteal artery. This led to complete resolution of symptoms and continuation of active service.