Predictors of Poor Quality of Life after Primary Lower Limb Deep Venous Thrombosis: A Perspective from a Developing Nation.

Objective: We aimed to determine predictors of poor long term quality of life, using the VEINES Quality of Life (QOL) questionnaire, in patients with lower limb deep venous thrombosis (DVT). Material and Methods: This study included adult patients with primary lower limb DVT between January 2007 and December 2017. Post thrombotic syndrome (PTS) was assessed using the Villalta score and Quality of Life (QoL) by the VEINES quality of life questionnaire. Results: Our study included 125 patients, 57 (45.6%) of whom were males. The patient population's median age was 41 years (IQR: 34-47 years). The median follow up was 450 days (IQR: 390-1020 days). PTS occurred in 49 (39.2%) patients. Independent predictors of poor quality of life post DVT were progression to PTS, complete occlusion of vein, proximal (Ileofemoral) DVT, poor control of INR, poor compliance with compression stockings, severity of PTS, ileofemoral DVT and poor control of therapeutic anticoagulation. Conclusion: Predictors who are independently associated with poor quality of life post DVT are PTS, inability to maintain therapeutic anticoagulation and ileofemoral DVT.

Knowledge gain of the non-vascular surgeons after attending a course on traumatic vascular emergencies.

OBJECTIVE: To measure the effectiveness of the workshop in enhancing the knowledge and skills of the non-vascular surgeons in dealing with traumatic vascular emergencies. METHODOLOGY: It was a Quasi-experimental pre-post design study conducted at Section of Vascular Surgery, Aga Khan University Hospital, Karachi (Pakistan) in February 2019. One-day workshop was conducted to enhance the knowledge and operative skills of the non-vascular surgeons in managing traumatic vascular emergencies. A written test and course evaluation survey were used to evaluate the effectiveness of the course in achieving the desired objectives. RESULTS: Total of 21 participants attended the workshop with mean age of 29 ± 6.06 years. Majority of participants 15 (71%) were surgery residents from different subspecialties. Only 3 (14%) had prior exposure in Vascular Surgery. Mean pretest score was 11.9 ± 4.27 (59.52% ± 21.3) which improved to 16.14 ± 3.69 (81.6% ± 16.6). Gain in knowledge was measured using paired t-test and there was 21% of gain in knowledge of the participants compared between the pretest and posttest score. Overall participants found this workshop to be very useful in refining their skills and learning innovative techniques in managing vascular emergencies. CONCLUSIONS: Carefully designed workshop improves the knowledge of non-vascular surgeons in dealing with common vascular emergencies.

Safety and Efficacy of Radiofrequency Ablation for Varicose Veins: An Initial Experience from Pakistan.

OBJECTIVE: To evaluate the safety and efficacy of radiofrequency ablation (RFA) for varicose veins. STUDY DESIGN: Observational case series. PLACE AND DURATION OF STUDY: Section of Vascular Surgery, Aga Khan University Hospital, Karachi, from September 2016 to August 2018. METHODOLOGY: Data of RFA procedures performed on 40 patients were collected on a questionnaire from the medical records. It included patients' demographics, pre- and postoperative clinical, etiological, anatomical and pathological (CEAP) system score, venous clinical severity score (VCSS), procedural details and intra- or postoperative complications. Outcome measures were 'safety of the procedure, which was measured by presence of any complications; and 'efficacy of the procedure' which was measured by improvements in the CEAP and VCSS score. RESULTS: The mean age of the patients was 44.7±11.5 years. Twenty-one (52.5%) patients were women. Preoperative median VCSS [range] was 7 [2-15], which improved to 1 [0-3] (p <0.001). Preoperative median CEAP [range] was 3 [2-6] and improved to 1 [0-4] (p <0.001). One patient had recurrence and five patients (12.5%) had minor complications, which were treated conservatively. CONCLUSION: RFA in patients with symptomatic varicose veins can be performed with minimal complications. This modality is also effective in reducing the disease severity.

Rare Presentation of an Ulnar Artery Aneurysm in a Six-Month-Old Baby: Case Discussion.

Ulnar artery aneurysm cases have been rarely reported in the literature previously. A number of these cases occur in the adult population and are mostly occupational associated. In children, however, this condition is much less. Only 10 cases in children have been reported in the literature to the best of our knowledge, and the minimum age was 1 year. The etiology is mainly post-traumatic. We present a case for discussion of an ulnar artery aneurysm in a 6-month-old baby with the habit of hitting his hand against a table and the floor.

Is pelvis x-ray essential in stable trauma patients? Step towards lowering the treatment cost.

OBJECTIVE: To determine the diagnostic accuracy of clinical examination in detecting pelvic fractures in patients with blunt trauma.. METHODS: The cross-sectional prospective study was conducted at Aga Khan University Hospital, Karachi, from January to June 2015, and comprised alert, awake blunt-trauma patients. Pelvis examination findings were compared to routine pelvic X-rays. SPSS 19 was used for data analysis.. RESULTS: Of the 133 patients, 122 (92%) were males. Overall mean age was 37 ±14.2 years. There were 14 (10%) patients who were true positives with pelvic fracture diagnosis on both clinical examination and pelvic X-ray, while 14 (10%) were false negative on examination. Clinical examination missed 2 patients with evidence of fracture on X-ray and were considered false positive. Besides, 103 (77.4%) patients were true negative as both clinical exam and X-ray showed no evidence of fracture. CONCLUSION: Omitting pelvic X-ray in the recommended protocol can avoid unnecessary financial burden and reduce undesirable radiation exposure..

Developing a low budget trauma registry.

Trauma registry plays an essential role in collecting epidemiological injury data which is used in quality care improvement and research. This paper was planned toshare our experience of having developed a low-budget user-friendly trauma registry with the help of Microsoft Access. This was used because of its ease of use, quickdevelopment style, and support for relational database d esign. Var iable i nc lud ed in our registr y were demographics, description of injury, International Classification of Disease 9 Clinical Modification (ICD9- CM) external injury classification codes, date and time of arrival, length of hospital stay, referral to and from hospital, physiological assessment along with scores for assessing the injury severity. Developing a local trauma registry helped us in scrutinising our practice, and we believe that a national or regional trauma registry is the need of the hour in Pakistan. This will highlight the concerns specific to our society in providing quality trauma care.

Comparison of Upper Limb Translocated Femoral Vein and Prosthetic Arteriovenous Bridge Grafts.

Introduction Native veins are an ideal option for dialysis in a patient with chronic kidney disease (CKD) as compared to a prosthetic graft. Femoral vein (FV) translocation to the upper arm is also an alternative to a prosthetic graft as reported in the literature when all options of using the native veins of the arms are exhausted. Thus, we aimed to compare the patency of the upper limb translocated FV arteriovenous fistula (AVF) with a prosthetic arteriovenous bridge graft (AVBG). Methods It is a retrospective cohort study that was conducted in the Department of Vascular Surgery, Aga Khan University Hospital. It included adult patients who underwent either upper arm translocation of FV or prosthetic AVBG using the consecutive purposive sampling technique. There were a total of 10 patients who underwent FV translocation AVF and 20 patients who had AVBG in the upper arms. Results A total of 30 patients were included in the study. Of these 30 patients, 10 underwent FV translocation AVF and the remaining 20 had AVBG. There was a significant difference in the mean operating time of the two surgeries. The mean operating time in FV translocation was 223 (± 41.5) minutes and in those with AVBG, the mean operating time was 100 (±26.5) (p= <0.001). There was no significant difference in the total length of hospital stay in both procedures performed. The primary patency rate for FV translocation was 90% and 95% in AVBG (p=1.00). Ten percent of FV translocation had a primary failure rate compared with that of AVBG, which was 5% (p=1.00). The mean follow-up period was 61 weeks in the FV translocation group and 64 weeks in the AVG group. Conclusion There was no significant difference in both groups in terms of patency, length of hospital stay, and fewer complications were observed in the FV translocation group as compared with the AVBG group.