Surgical Treatment Options for Buerger's Disease (Experience with 315 Cases in Iran).

Background: Buerger's disease (thromboangiitis obliterans) may be a rare peripheral vascular disease that sometimes affects young male smokers. This study presents surgical treatment options for 315 Buerger's patients during a period of 18 years from 2002 to 2020. Methods: In this cross-sectional study, 315 newly diagnosed Buerger patients in a period of 18 years (by Census sampling) were evaluated. Data included age, sex, cigarette smoking status, clinical presentation, the affected limb (right or left, upper or lower extremities), and the performed therapeutic procedures such as angiography of limb arteries, amputation, sympathectomy, and vascular bypass surgery, which were collected in a data sheet. Vascular reconstruction was done if there were suitable inflow and outflow arteries. Sympathectomy was performed for the patients who were unsuitable for revascularization. All analyzes were performed using SPSSV.18 software package (SPSS Inc., Chicago, IL). Data are presented as frequency, mean ± variance (SD). Results: The mean age of patients was 42.6±9 years old, ranging from (26-75). There were 309 (98.1%) males and 6 (1.9%) females. The most common symptom was ulcer 252 (80%), and the most commonly involved arteries were the dorsal pedis (N=231; 73.4%) and posterior tibialis (N=225; 71.5%). Vascular bypass surgery, sympathectomy, and amputation were performed for patients who met surgical indications. Aortofemoral (N=9) and femoropopliteal (N=24) bypass procedures were done in 2.8% and 7.6% of patients respectively. Of nine patients who underwent aorto-femoral bypass procedure, 6 cases presented with leg claudication, 3 with an ulcer, and 3 with the Raynaud phenomenon. The digital loss rate was 9.6% (N=9) in toes and 1% (N=3) in fingers. Conclusion: As most of the Buerger patients have multi arterial involvement, bypass surgery or sympathectomy can't help treat these patients more than cigarette smoking or pharmaceutical therapy.

Cost-Effectiveness of Endovascular Versus Open Repair of Abdominal Aortic Aneurysm: A Systematic Review.

PURPOSE: Abdominal aortic aneurysm (AAA) is a life-threatening condition which, in the absence of increasing diameter or rupture, often remains asymptomatic, and a diameter greater than 5.5 cm requires elective surgical repair. This study aimed to evaluate the cost-effectiveness of endovascular repair (EVAR) versus open surgical repair (OSR) in patients with AAA through a systematic review of published health economics studies. METHODS: Using a systematic review method, an electronic search was conducted for cost-effectiveness studies published on AAA (both in English and Persian) on PubMed, Embase, ISI/Web of Science (WoS), SCOPUS, Global Health databases, and the national databases of Iran from 1990 to 2020 including the keywords "cost-effectiveness", "endovascular", "open surgical", and "abdominal aortic aneurysms". The quality of the studies was assessed using the Quality of Health Economic Studies (QHES) checklist. RESULTS: In total, 958 studies were found, of which 16 were eligible for further study. All studies were conducted in developed countries, and quality-adjusted life years (QALY) and life years (LY) were used to measure the outcomes. According to the QHES checklist, most studies were of good quality. In European countries and Canada, EVAR has not been cost-effective, while most studies in the United States regard this technique as a cost-effective intervention. For example, incremental cost-effectiveness ratio (ICER) values ranged from $14,252.12 to $34,446.37 per QALY in the USA, while ICER was €116,600.40 per QALY in Portugal. CONCLUSION: According to the results, the EVAR technique has been more cost-effective than OSR for high-risk patients, but the need for continuous follow-up, increased costs, and re-intervention over the long term and for low-risk patients has reduced the cost-effectiveness of this method. As the health systems vary among different countries (i.e. quality of care, cost of devices, etc.), and due to the heterogeneity of studies in terms of the follow-up period, time horizon, and threshold, all of which are inherent features of economic evaluation, generalizing the results should be done with much caution, and policymaking must be based on national evidence.

Cost-effectiveness of a population-based AAA screening program for men over 65 years old in Iran.

BACKGROUND: Screening program tend to recognized patients in their early stage and consequently improve health outcomes. Cost-effectiveness of the abdominal aortic aneurysm (AAA) screening program has been scarcely studied in developing countries. We sought to evaluate the cost-effectiveness of a screening program for the abdominal aortic aneurysm (AAA) in men aged over 65 years in Iran. METHODS: A Markov cohort model with 11 mutually exclusive health statuses was used to evaluate the cost-effectiveness of a population-based AAA screening program compared with a no-screening strategy. Transitions between the health statuses were simulated by using 3-month cycles. Data for disease transition probabilities and quality of life outcomes were obtained from published literature, and costs were calculated based on the price of medical services in Iran and the examination of the patients' medical records. The outcomes were life-years gained, the quality-adjusted life-year (QALY), costs, and the incremental cost-effectiveness ratio (ICER). The analysis was conducted for a lifetime horizon from the payer's perspective. Costs and effects were discounted at an annual rate of 3%. Uncertainty surrounding the model inputs was tested with deterministic and probabilistic sensitivity analyses. RESULTS: The mean incremental cost of the AAA screening strategy compared with the no-screening strategy was $140 and the mean incremental QALY gain was 0.025 QALY, resulting in an ICER of $5566 ($14,656 PPP) per QALY gained. At a willingness-to-pay of 1 gross domestic product (GDP) per capita ($5628) per QALY gained, the probability of the cost-effectiveness of AAA screening was about 50%. However, at a willingness-to-pay of twice the GDP per capita per QALY gained, there was about a 95% probability for the AAA screening program to be cost-effective in Iran. CONCLUSIONS: The results of this study showed that at a willingness-to-pay of 1 GDP per capita per QALY gained, a 1-time AAA screening program for men aged over 65 years could not be cost-effective. Nevertheless, at a willingness-to-pay of twice the GDP per capita per QALY gained, the AAA screening program could be cost-effective in Iran. Further, AAA screening in high-risk groups could be cost-effective at a willingness-to-pay of 1 GDP per capita per QALY gained.

Venoplasty and stenting in post-thrombotic syndrome and non-thrombotic iliac vein lesion.

Introduction: Venous outflow obstruction is a common condition among patients with chronic venous insufficiency. Endovascular treatment is favourable over open surgery. This study aimed to assess stent patency and clinical outcome in venous outflow obstruction of lower limbs, and also to compare it between post-thrombotic syndrome and non-thrombotic iliac vein lesions.Material and methods: The study was a historical cohort study. Patients with chronic deep venous insufficiency referred to our tertiary referral centre who underwent venoplasty were recruited. Patients were divided into two groups: non-thrombotic-iliac-vein-lesions and post-thrombotic syndrome. Stent patency rate, clinical improvement and risk factors were evaluated during a six-months course after venoplasty.Results: One-hundred-sixty-four patients were included. Six-months primary, assisted primary and secondary patency rates were 98.86%, 100% and100% in the non-thrombotic-iliac-vein-lesions group and 88%, 93% and 96% in the post thrombotic syndrome groups (p-value = .005, p-value = .02, and p-value = .09, respectively). Pain, claudication and edema were the most common symptoms in both groups and significantly improved after six months. Early thrombosis in the PTS group was more common (9 vs. 1, P value = .007).Conclusion: Percutaneous stenting in patients with venous outflow obstruction is safe and effective with a high patency rate and significant decrease in clinical score in both post-thrombotic syndrome and non-thrombotic-iliac-vein lesions groups.

Modeling and optimization of nonylphenol removal from contaminated water media using a magnetic recoverable composite by artificial neural networks.

Herein, activated carbon impregnated iron oxide nanoparticles (Fe3O4/AC) were synthesized to determine their potentials for the adsorption of nonylphenol (NP) in aqueous solution with different experimental variables, namely the pH of the solution, contact time, adsorbent dosage and the initial NP concentration. Additionally, an artificial neural network system was used to find the relative importance of each of the aforementioned input variables on NP adsorption efficiency. Experimental findings indicated that the optimum solution pH for NP adsorption was 3.0. The equilibrium time of the adsorption process was 30 min. According to the results of isotherm and kinetic studies, among all applied models, the Liu and pseudo-first-order models showed the best fit with the experimental data. The pH of the solution, compared to other input variables, had the maximum impacts on NP adsorption efficiency. Under optimum conditions, the adsorption percentage decreased insignificantly from 99.6 to 92.6% after the fifth cycle. Also, the adsorption efficiencies of 70.7, 73.5 and 67.3% were observed for river water, tap water and wastewater effluent, respectively. Ultimately, from the findings of this study, it can be postulated that Fe3O4/AC nanoparticles can be recommended as a promising and novel adsorbent to remove NP from polluted groundwater.

Health risk assessment of heavy metal intake due to fish consumption in the Sistan region, Iran.

The heavy metal (Pb, Cd, Cr, and Ni) content of a fish species consumed by the Sistan population and its associated health risk factors were investigated. The mean concentrations of Pb, Cd, and Cr were slightly higher than the standard levels. The Ni content of fish was below the maximum guideline proposed by the US Food and Drug Administration (USFDA). The average estimated weekly intake was significantly below the provisional tolerable intake based on the FAO and WHO standards for all studied metals. The target hazard quotients (THQ) of all metals were below 1, showing an absence of health hazard for the population of Sistan. The combined target hazard quotient for the considered metals was 26.94 × 10-3. The cancer risk factor for Pb (1.57 × 10-7) was below the acceptable lifetime carcinogenic risk (10-5). The results of this study reveal an almost safe level of Pb, Cd, Cr, and Ni contents in the fish consumed by the Sistan population. Graphical abstract ᅟ.

A comprehensive study on venous endovascular management and stenting in deep veins occlusion and stenosis: A review study.

Background: Patients with deep venous disease can be classified into two distinct categories: those with disease resulting from known deep vein thrombosis (DVT), which may subsequently lead to post-thrombotic syndrome (PTS), and those with disease caused by compressive factors or non-thrombotic iliac vein lesions (NIVL). The major factor causing the symptoms in patients with PTS and NIVL is venous hypertension which happens due to venous stenosis or venous obstruction. Nowadays Venous stenting offers a noninvasive approach for treatment of NIVL and PTS demonstrating high patency rate. Methods: We comprehensively reviewed relevant published papers from 2008 to 2023 that surveyed various influencing factors including the site of occlusion and etiology of occlusions, proper diagnostic imaging, ideal characteristics of venous stents, different dedicated venous stents, pre-operative, concomitant, and post-operative interventions and factors that challenge stenting in both PTS and NIVL patients. The papers were identified by searching the keywords "venous stenting", "PTS", "NIVL", "occlusion", and "stenosis" in PubMed central library MEDLINE and Google Scholar. Results: Patency rates, post-stent complications, and relevant data according to the patient's quality of life were included and analyzed from 476 identified studies. There is no validated protocol and guideline for using stents in patients with PTS and NIVL. Conclusion: As there is no validated protocol and guideline for using stents in patients with PTS and NIVL, our study may provide comprehensive information to assist researchers interested in writing the protocol and give them insight.

Aorto-uni-iliac stent grafts without crossover fem-fem bypass for treatment of abdominal aortic aneurysms: A report of two cases.

INTRODUCTION AND IMPORTANCE: Arterial aneurysm is a serious condition caused by weakened arterial walls. Aorto-uni-iliac (AUI) and femorofemoral bypass are safe and effective options for managing abdominal aortic aneurysm (AAA). However, fem-fem bypass leads to longer surgical procedures and introduces additional risks such as graft infection, occlusion, wound complications, and peripheral vascular problems. This report highlights two successful cases of AAA management using the AUI approach without the need for fem-fem bypass. CASE PRESENTATION: Two male patients, both aged about 70, presented at our medical facility complaining of abdominal pain. Investigations unveiled an approximately 10-cm AAA that was previously undetected. Subsequently, we performed an elective AUI procedure without fem-fem bypass, marking the first instance of this technique being employed in Iran successfully. CLINICAL DISCUSSION: The placement of an AUI stent graft is generally less technically demanding compared to that of a standard bifurcated graft, especially when anatomical constraints are severe, making the latter difficult or even impossible to deploy. Beside the longer duration of stent deployment, sometimes we encounter contralateral complications to cannulate the main body. The AUI is typically used in emergency situations or when the distal aorta's internal diameter is small. The femoral-femoral bypass is advised in nearly all circumstances. CONCLUSION: AUI stent grafts are still a viable option for treatments of AAA, especially in cases of severe aortoiliac occlusive disease or comorbidities. AUI without crossover bypass is a viable option in the patients who have stenosis of contralateral iliac artery.

Cost-effectiveness analysis of endovascular versus open repair in patients with abdominal aortic aneurysm in Iran: a cross-sectional study.

OBJECTIVES: Abdominal aortic aneurysm (AAA) is one of the most important cardiovascular diseases, especially in the elderly. People with this disease are at risk of rupture of the abdominal aorta and death. The present study was conducted with the aim of analyzing the cost-effectiveness of endovascular repair compared to open surgery in AAA patients in Iran. METHODS: A Markov chain model was developed based on the use of endovascular repair and open surgery. The base-case patient was defined as a 65-year-old man presenting with AAA diameter greater than 5 cm. The determination of costs was from the perspective of the public sector provider. QALY was used to calculate the effectiveness. Incremental cost-effectiveness ratio (ICER) and TreeAge software were used for cost-effectiveness analysis. The follow-up period was 10 years and the willingness to pay (WTP) was determined as three times the Gross domestic product (GDP) per capita. RESULT: At the end of year 10, the endovascular aneurysm repair (EVAR) strategy gained 1 318 313 559 Iranian Rial (IRR) (67 885.29$) in cost and 3.57 QALYs in effectiveness. In contrast, the use of the open surgery repair (OSR) strategy gained 1 186 761 858 IRR (61 111.16$) in cost and 3·32 QALYs in effectiveness. The incremental cost-effectiveness ratio, comparing EVAR versus OSR, was 53, 346, 3757 IRR (178.36$) per QALYs, which is lower than the proposed WTP, indicating that EVAR is more expensive and more effective. Based on the Monte Carlo simulation test, EVAR is the preferred strategy in 58.6% of the population. CONCLUSION: Endovascular repair has a relative superiority compared to open surgery, and the probability of the effectiveness of endovascular repair compared to open surgery does not change with increasing willingness to pay.

Emergent method for management of splenic artery aneurysms rupture: A case report.

INTRODUCTION AND IMPORTANCE: Although endovascular therapy is becoming more used for the treatment of splenic artery aneurysms (SAAs) instead of open surgery, there is limited information available on the emergent hybrid approach, selectively. We present our experience of hybrid therapy using an emergent endovascular balloon for inflow control and open resection. CASE PRESENTATION: A 34-year-old woman was brought to the emergency room after it was reported that she had a pseudoaneurysm in her splenic artery at a different medical facility. The patient was hemodynamically stable. Then we underwent a combination of endovascular and open procedures, using balloon proximal control and open aneurysm resection. She was discharged from hospital on the fifth postoperative day after the operation. CLINICAL DISCUSSION: There is no agreement on how to treat SAA patients. Endovascular procedures such as endovascular intervention are also being used, minimizing the risks of surgery and shortening the patient's hospital stay, but complications remain. We propose to try SAA's emergency hybrid strategy operation with a good prognosis and fewer complications. CONCLUSION: It seems that, compared to open surgery alone when endovascular procedures were impossible, elective hybrid procedures are more secure and efficient in stable patients and could make the operation easier without more dissection for proximal control of splenic artery.

Plasma levels of homocysteine in Buerger's sufferers and healthy heavy smokers and non-smokers.

BACKGROUND: Our aim of this study was to evaluate the possible association between homocysteine levels and Buerger's disease in a case-control study. METHODS: 25 patients with Buerger's disease based on Shionoya's clinical criteria, and 25 heavy smokers along with 25 healthy non-smokers (control) were recruited for this study. All groups were matched for age. Plasma homocysteine levels were measured in each patient and then compared between the three groups. RESULTS: The mean plasma concentration of homocysteine was 16.88 mmol/L in the Buerger sufferers; as for the smoker (group 2) and control (group 3) groups, the level was as low as 13.89 and 13.56 mmol/L, respectively. CONCLUSIONS: Patients with thromboangiitis obliterans, especially those with a progressive course, benefit from the hyperhomocysteinemia screening test.

Calf arteriovenous malformation presenting as an iliac artery aneurysm: A case report.

INTRODUCTION AND IMPORTANCE: Arteriovenous malformations (AVMs) are abnormal connections between arteries and veins. Common signs of AVMs include a pulsating mass, pain, ulceration, bleeding, and tissue necrosis. This case report discusses a rare presentation of an iliac artery aneurysm in a patient with an extensive calf AVM. CASE PRESENTATION: A 35-year-old male presented with a pulsatile mass in the abdomen, along with symptoms of chronic venous insufficiency in the lower limb. He had undergone multiple surgeries for varicose veins in the past. Initially, external iliac artery aneurysm was diagnosed. Further assessment revealed the presence of an AVM in the calf. After multiple unsuccessful endovascular interventions, amputation was recommended. However, the patient opted for conservative management. CLINICAL DISCUSSION: AVMs are vascular malformations that are present from birth. Angiography is considered the gold standard for confirming the diagnosis of AVMs. As there is no consensus on the best treatment for AVMs, a multidisciplinary approach is recommended on a case-by-case basis. Delaying treatment can lead to serious complications and increase morbidity and mortality. Treating extensive AVMs that involve the entire extremity can be particularly challenging and often result in poor outcomes. CONCLUSION: The presence of varicose veins at a young age may indicate an underlying AVM. AVM can manifest in various ways, including arterial aneurysms. In severe cases, extensive AVMs may require limb amputation when other treatments fail.

Cardiovascular foreign body retrieval and its management algorithm.

Application of central venous catheters become more common however a rare complication, embolization, can occur which lead to high mortality rate. Therefore, cardiovascular foreign bodies should be immediately remove with a safe and effective method and algorithm. So, we investigate the results of cardiovascular foreign body retrieval in our center based on a designed algorithm. In this case series study, patients who had cardiovascular foreign body embolization were managed by our algorithm. Our approach was based on the time duration of foreign body embolization in cardiovascular system and also its location. If the embolization time was less than 48 h, based on the location of foreign body, insertion site would be right femoral or jugular vein. If the time of foreign body embolization was more than 48 h, echocardiography should be done to assess thrombosis around foreign body. Retrieval was done with snare technique in all patients. Over 12 patients, 9 patient had port catheter foreign body in SVC and atrium, 1 patient had port catheter in atrium, 1 patient had port catheter in pulmonary artery and 1 patient had hemodialysis catheter in inferior vena cava (IVC) and atrium. Foreign body retrieval was successful in all 11 patient. The IVC and atrium were the common site of port catheter fragments. According to our experience, we organize a useful algorithm for retrieval of cardiovascular foreign body based on time of embolization and its location.

Endovascular management of post PCNL vascular injuries.

Although percutaneous nephrolithotomy (PCNL) is a gold standard treatment of large kidney stones, vascular injuries like pseudoaneurysm (PA) and arteriovenous fistula (AVF) may occur due to renal punctures. These endovascular complications need urgent intervention to be diagnosed and managed early. In this case series, 14 patients who had hematuria after PCNL were managed by using angiography to identify the vascular pathology. Among them, we identified 10 patients with PA and 4 patients with AVF, 1 patient with both subscapular hematoma and PA. Angiographic embolization was done successfully in all patients. Based on our results, in cases with peripheral parenchymal damage, PA was common and in cases with hilar damage, AVF was common. No other complication and rebleeding was detected after embolization. Based on our study, angiography can be used as a safe and effective method to detect and treat vascular injuries immediately and successfully.

Simple Separate Sutures Versus Continuous Sutures on Hepatic Artery Anastomosis in Liver Transplant: A Prospective Study.

OBJECTIVES: Liver transplant is the definitive treatment for liver failure of various causes. There are various operation methods, of which the conventional approach is most frequently performed. In the conventional technique, 4 anastomoses are required, and different subtleties in these techniques are known to cause different rates of complications. We assessed the outcome of a simple separate (ie, interrupted) suture technique compared with a the continuous suture technique in 194 patients. MATERIALS AND METHODS: There were 194 patients included in this single-center, controlled study. The exclusion criteria were patients who died during the surgical procedure and patients with incomplete medical records. The data recorded were age, sex, past medical history of liver disease, tobacco use, comorbidities, and whetherthe livertransplant was for the first time or retransplant. All patients included in this study were recipients of liver transplants from deceased donors. The patients were categorized as those who received either simple sutures (n = 16) or continuous sutures (n = 178). The continuous suture operations were performed first, and the simple suture operations were performed at a later time (ie, the 2 groups were temporally separated). The results included the duration of surgery, hepatic artery thrombosis rate, hepatic artery stenosis rate, 2-year survival, and further complications. RESULTS: No evidence of hepatic artery thrombosis or hepatic artery stenosis was observed in the study groups. The duration of surgery was equal in both groups. The 2-year mortality rate was significantly higher in the simple suture group. CONCLUSIONS: The continuous suture method seems to be accompanied by a similar duration of operation and rate of complications compared with the simple suture process.

Light-based solution for the dominating set problem.

In this paper, an optical solution for the dominating set problem is provided. The solution is based on long ribbon-shaped optical filters, on which some operations can be optically applied efficiently. The provided solution requires polynomial time, exponential length of filters, and exponential number of photons to solve the dominating set problem. The provided solution is implemented experimentally using lithographic sheets, on a graph with six vertices, to find all dominating sets with two vertices.

Endovascular reconstruction of aortoiliac occlusive disease in a case with claudication and an ectopic pelvic kidney.

INTRODUCTION AND IMPORTANCE: Ectopic kidney is a rare anomaly with an incidence of about 1 in 2500 birth in the population. Concurrency of pelvic kidney and iliac occlusion is rare, and the treatment is challenging because the pelvic kidney is associated with an atypical blood supply. CASE PRESENTATION: We reported a 68-year-old man with aortoiliac stenosis, right pelvic kidney, and high-risk cardiovascular comorbidities. He presented with the right lower extremity claudication that has been present for four years. Computed tomography angiograms showed total occlusion of right common and external iliac arteries. CLINICAL DISCUSSION: The old method for treating iliac artery stenosis is open surgery, which needs cross-clamping of the aorta. During this procedure, the chance of renal thrombosis and ischemia is high. Thus, the patient underwent an endovascular angioplasty that was done successfully for the patient without any disturbances in kidney function. CONCLUSION: Traditional treatment of iliac artery stenosis, especially in patients with high-risk cardiovascular comorbidities, may be associated with complications. Endovascular intervention is a safe and effective approach for treating aortoiliac occlusion in patients with ectopic pelvic kidneys. More research and case series are needed to review the results and compare the success rate of this method versus open surgery.

Surgical Repair Outcomes of Inflammatory and Degenerative Abdominal Aortic Aneurysms.

Inflammatory abdominal aortic aneurysm (IAAA) is characterised by thick aortic wall, with perianeurysmal fibrosis extending to adjacent organs. This study aimed to determine the early surgical outcomes of 10 IAAAs and compare the risk factors, perioperative complications, and 30-day mortality of these patients to 50 degenerative AAAs (dAAA), who underwent open repair in Sina Hospital, Tehran, Iran. The study was conducted from 2011 to 2019. IAAA patients were followed for 22.7 ± 3.8 months. The frequency of IAAA was 4.9%. All IAAA patients were males and smokers. There was no statistical difference in preoperative risk factors (age, smoking, hypertension, chronic kidney disease, ischemic heart disease, chronic obstructive pulmonary disease), operation time, blood loss, postoperative complications between dAAA and IAAA patients. The thirty-day mortality rate of open surgeries in degenerative and inflammatory cases was 8% (N=4) and 10% (N=1), respectively. Open repair with proximal/and/or distal clamping, avoids severe adhesiolysis, procedure-related morbidity, and 30-day perioperative mortality. Key Words: Inflammatory abdominal aortic aneurysm, Open surgery, Mortality, Outcome, Degenerative aortic aneurysm.

Firework-related injuries in Tehran's Persian Wednesday Eve Festival (Chaharshanbe Soori).

BACKGROUND: Fireworks are the leading cause of injuries such as burns and amputations during the Persian Wednesday Eve Festival (Chaharshanbeh Soori). OBJECTIVES: This study was designed to explore the age of the high-risk population, the type of fireworks most frequently causing injury, the pattern of injury, and the frequency of permanent disabilities. METHODS: This cohort study was performed by Tehran Emergency Medical Services at different medical centers all around Tehran, Iran, in individuals referred due to firework-related injuries during 1 month surrounding the festival in the year 2007. The following information was extracted from the patients' medical records: demographic data, the type of fireworks causing injury, the pattern and severity of the injury, the pre-hospital and hospital care provided for the patient, and the patient's condition at the time of discharge. In addition, information on the severity of the remaining disability was recorded 8 months after the injury. RESULTS: There were 197 patients enrolled in the study with a mean age of 20.94 ± 11.31 years; the majority of them were male. Fuse-detonated noisemakers and homemade grenades were the most frequent causes of injury. Hand injury was reported in 39.8% of the cases. Amputation and long-term disability were found in 6 and 12 cases, respectively. None of the patients died during the study period. CONCLUSION: The fireworks used during a Chaharshanbe Soori ceremony were responsible for a considerable number of injuries to different parts of the body, and some of them led to permanent disabilities.

Management of huge splenic artery aneurysm with new hybrid procedure including endovascular and open surgical approach: Case series.

INTRODUCTION: Splenic artery aneurysms (SAAs) account for more than half of all visceral artery aneurysms. Small SAAs are usually asymptomatic, but giant aneurysms are more likely to cause symptoms and result in life-threatening complications; these aneurysms treatment can be challenging. Splenic artery aneurysms treatment includes laparotomy, laparoscopy, or endovascular techniques. CASE PRESENTATION: This case series reports the details of successful management of three patients with huge splenic artery aneurysms who underwent hybrid surgery, endovascular inflow control with a balloon, and open aneurysm resection. DISCUSSION: Although endovascular treatment options are increasingly favored, only selected aneurysms are suitable for these procedures, as marked tortuosity of the artery or SAA in the proximal splenic artery may not be suitable for endovascular management. CONCLUSION: Open surgery escorted by endovascular techniques can be considered an ideal treatment of SAA in the proximal region of the splenic artery.