Understanding the Tibial-Pedal Arterial Anatomy: Practical Points for Current Clinical Presentations

peer reviewedThe lower extremity arterial vasculature encompasses a balanced, tapering distribution closely related to the muscular compartments of the leg and foot. From the main ilio-femoral inflow to further remote capillary vessels, a harmonious pyramid of gradually tapering limb perfusion is created. This impressive vascular system is structured into several ranks of tapering vessels that correspond with angiosomes in the lower extremities. Each of these levels expresses unique anatomic features when threatened by atherosclerotic ischemic disease. As atherosclerosis progressively worsens, the vascular anatomy, including the tibio-pedal trunks, foot arches, and collateral distributions, continuously provides coordinated support and dynamic adaptations in regional perfusion of the foot, in accordance with various endogenous and exogenous factors. Critical limb ischemia (CLI) involves characteristic infragenicular patterns of arterial disease and related compensatory flow paths that are useful for interventionists to acknowledge and understand. The present article briefly reviews the main anatomical features describing infra-popliteal arterial vasculature with, and without, ischemic impairment, in accordance with practical clinical issues encountered in daily practice

Patient-reported outcome, perception and satisfaction after laparoscopic cholecystectomy in Kigali, Rwanda.

peer reviewed[en] BACKGROUND: Laparoscopic surgery is the gold standard for many abdominal surgeries. Laparoscopic programs in low- and middle-income countries (LMICs) and in sub-Saharan Africa face many constraints, although its use is safe, feasible, and clinically beneficial. The authors assessed patient-reported outcomes and the experience of patients operated on at the University Teaching Hospital of Kigali (CHUK). METHODS: This is a retrospective cross-sectional study combining medical data from medical files and information collected from telephone calls to 288 patients who underwent laparoscopic cholecystectomy at CHUK from January 2015 to December 2020. RESULTS: Among 446 laparoscopic surgeries performed at CHUK over 6 years, cholecystectomies accounted for 64.6 % of cases (288/446). Postoperative complications and mortality after laparoscopic cholecystectomy were low, respectively 1.7 % and 0.7 %, while the median length of stay was 3 days. About 74 % of surveyed patients had never heard of laparoscopic surgery prior to their procedure. Knowledge of laparoscopic surgery was associated with patient education level (p 90 % of patients consider laparoscopic surgery as the best surgical approach in Rwanda, and for this reason they declared to be ready to promote this new technology despite its higher cost. However, patients reported some weaknesses and made recommendations for improving public awareness of laparoscopy and its benefits, patient-provider relationships, training of surgical workforce, laparoscopic equipment, and infrastructure. CONCLUSION: Laparoscopic cholecystectomy can be performed with a low rate of postoperative complications in a resource-limited setting like Rwanda. Patient satisfaction was high, but efforts should be made to improve public awareness of laparoscopic surgery, improve surgical capacity, laparoscopic equipment, and infrastructure

Prospective, randomized clinical trial of laparoscopic totally extraperitoneal inguinal hernia repair using conventional versus custom-made (mosquito) mesh performed in Cameroon: a short-term outcomes.

Adverse economic conditions often prevent the widespread implementation of modern surgical techniques in third world countries such as in Sub-Sahara Africa.info:eu-repo/semantics/publishe