Common iliac artery aneurysm: Management issues in the era of endovascular treatment

Common iliac artery aneurysm (CIAA) is rare. It only constitutes about 2% of all abdominal aneurysms. CIAA develops silently with typical presentation of hemorrhagic shock after rupture, which carries a very high perioperative mortality. Atypical presentation includes unilateral lower limb weakness, pain and swelling. These symptoms should alert clinicians to the differential diagnosis of iliac artery aneurysm. Early detection and investigations are paramount since immediate intervention can considerably improve the outcome. We will highlight 3 cases of symptomatic common iliac artery aneurysm with different treatment modalities. The options of management, including literature review regarding open and endovascular treatment will be highlighte

Outcome of core out fistulectomy and the ligation of anal fistula tract: a single center experience in Malaysia

Fistula-in-ano is a benign anorectal disease which always poses a big dilemma to the surgeons because of their significant recurrent rate following surgery. Materials and Methods: A cross-sectional study involving 42 patients undergoing core out fistulectomy in the Hospital Tengku Ampuan Afzan, Kuantan, Pahang, Malaysia were included in this study. Demographic data of patients were assessed. Endoanal ultrasound (EAUS) was done prior to the surgery to determine types of fistula and classified using Park’s classification. Follow up was made post-operatively at 4th week, 2nd month, 3rd month, 4th month, 5th month and 6th month to look for the duration of healing or recurrence. Results: 5 out of 42 patients were lost to follow up leaving 37 patients available for the analysis. Mean age of the patient was 38.4 (13.8) years old. Transphincteric and intersphincteric type of fistula accounted for 54.5% and 40.1%, respectively. 62.2% (n=23) of patients achieved primary healing after the procedure. The mean for healing duration was 3.7 (3.1) months. Recurrence of the disease was seen only in 37.8% (n=14) of the patients. Conclusions: Even though we managed to achieve significant success rate cumulatively, recurrence of fistula still impose a significant challenge toward patient’s management. Therefore, further prospective study with a bigger sample size is recommended to look into this method to reduce recurrence of fistula

Primary patency rate of Arteriovenous Fistula (AVF) and factors affecting its patency among Malaysian

The purpose of this study was to compare the maturity and patency rate of AVF being created at our centre in comparison to those being published elsewhere in the world. We are also analyzing different factors identified previously that may have affected this maturity and patency rate. This is an observational cross sectional study including all patients underwent AVF creation between 1st of January 2013 to 31st December 2013. We analysed non-modifiable factors including age, gender, presence of diabetes, presence of peripheral vascular disease and venous and artery diameter, and modifiable factors including smoking status, BMI index, anti-platelets and statin therapy and the site and side of AVF created, against the maturity and patency rate using a multi variates analysis. Our maturity rate at 6 weeks is 89% and patency rate at 6 months is 61% and at 12 months is 57%. Although there was a positive trends towards a better maturity rate in those who were treated with statin and with a bigger venous diameter, this was not statistically significant and these trends fail to sustain towards patency rates at both 6 and 12 months. In conclusion, our centre’s autologous AVF creation has been equally successful in comparison to other published results worldwide. Our study population failed to show any relationship between some known risk factors that has been shown by earlier study to have an effect on autologous AVF maturity and patenc