Analysis of Predictive Factors Influencing Early Patency in Adult Autogenous Arterio Venous Accesses

Abstract: Arteriovenous(AV

Iatrogenic vascular injuries: An institutional experience

Introduction: Iatrogenic vascular injuries are emergency referrals to the vascular surgeon. They can lead to prolonged hospitalization, higher cost, limb loss, mortality, and litigation. Aim: The aim of this study is to analyze the referral patterns and outcomes of iatrogenic vascular injuries managed in our institution from 2008 to 2013. Materials and Methods: Patients with iatrogenic vascular injuries referred to the vascular surgery department of our institution from July 2008 to Sep 2013 were included in this study. Those with isolated injury to superficial venous system were excluded from the study. Data were collected from a prospectively maintained database and analyzed with respect to patient characteristics, mode and type of vascular injury, intervention, and outcomes. Results: The incidence of iatrogenic vascular injuries was progressively on the rise year on year during the study period. The incidence was most common in the age group of 31–45 years contributing about 30%. The incidence was more in males (65%). A significant number of iatrogenic vascular injuries occurred in pediatric population (25%). The most common mode of iatrogenic vascular injuries in children was due to intravascular injections and it accounted for 50% of amputations. There was no difference in the incidence among medical and surgical specialties. Conclusion: Iatrogenic vascular injuries appear to progress day by day. Early and proper management can be a limb or life-saving. Late referral ended up in limb or life loss. Thorough knowledge of anatomy and image-guided interventions can be a preventive measure of iatrogenic vascular injuries

Regulating Microvascular Free Flaps Reconstruction in “Schobinger Stage 4” Arteriovenous Malformations of Face

Objectives Arteriovenous malformations (AVMs) are high-flow, aggressive lesions that cause systemic effects and may pose a risk to life. These lesions are difficult to treat as they have a tendency to recur aggressively after excision or embolization. So, it requires a regulating free flap with robust vascular flow averting the postexcisional ischemia-induced collateralization, parasitization, and recruitment of neovessels from the surrounding mesenchyme—a phenomenon precipitating and perpetuating the recurrence of AVM. Materials and Methods Sixteen patients (12 males and 4 females) with AVMs Schobinger type 4 involving face were treated from March 2015 to March 2021 with various free flaps: three free rectus abdominis flaps, one free radial forearm flap, and twelve free anterolateral thigh flaps were used for reconstruction following the wide local excision of Schobinger type 4 facial AVM. The records of these patients were analyzed retrospectively. The average follow-up period was 18.5 months. The functional and aesthetic outcomes were analyzed with institutional assessment scores. Results The average size of the flap harvested was 113.43 cm2. Fourteen patients (87.5%) had good-to-excellent score (p = 0.035) with institutional aesthetic and functional assessment system. The remaining two patients (12.5%) had only fair results. There was no recurrence (0%) in the free flap group versus 64% recurrence in the pedicled flap and skin grafting groups (p = 0.035). Conclusion Free flaps with their robust and homogenized blood supply provide a good avenue for void filling and an excellent regulating effect in inhibiting any locoregional recurrences of AVM

Hemodialysis access in a patient with severe hemophilia: Technical challenges

A case report on the challenges in establishing hemodialysis access for a hemophiliac with factor VIII inhibitors. A 23-year-old male patient, a known case of congenital Hemophilia A for 6 months of age, presented with recurrent hemarthroses, uncontrolled hypertension, and azotemia; on evaluation, he was diagnosed to be suffering from chronic kidney disease. He was on factor VIII supplementation for hemophilia and was recently diagnosed with factor VIII inhibitors as he was becoming refractory to treatment. The hemodialysis access for this patient is technically challenging as the patient has blood dyscrasia. Herein discussing the choices we had in this patient and challenges faced by us in securing the hemodialysis access

COVID-related acute limb ischemia: The Indian data

Introduction and Objective: The reported incidence of COVID-related acute limb ischemia (CRALI) ranged from 3.7% to 9.6% in the literature. We report on consolidated data of patients with CRALI from 21 centers across India, which spanned the first two waves of COVID-the period of May 2020 to June 2021. Materials and Methods: Study design: Multicenter study from May 2022 to June 2021. Retrospective analysis of prospectively collected data was done. Inclusion criteria: All patients who presented with signs and symptoms of acute limb ischemia or acute on chronic limb ischemia and who also tested positive for COVID through rapid antigen test or real time polymerase chain reaction. Results: Data for 268 patients from 21 centers across India was available for analysis. 71% were males and 85% were >45 years of age. Majority of patients (n = 191) presented with acute symptoms. Best medical management with antiplatelets and anticoagulants was the only treatment in 34% of patients. Open embolectomy was attempted in 42%, endovascular procedures in 8% and amputation as primary procedure in 14.5%. Higher grades of ischemia were associated with significantly poorer limb salvage, amputation and mortality in the immediate and 14 days follow up (P < 0.001). At 14 days 173 limbs were salvaged (64.5%). Eighty patients underwent amputations (29.8%); 26 of the 80 (32%) were minor amputations (trans-metatarsal and less), so the major amputation rate was 20.1%. Maximum number of deaths were in the group that had undergone medical management (23%), while the least number of deaths were seen in the patients that had undergone some form of intervention, open surgical (2%) or endovascular procedure (4%). Looking at 14-day outcomes, the numbers of deaths in the patients managed with medical methods increased to 30%, open surgical to 7% and endovascular procedures to 8%. Conclusion: CRALI presented both as a primary presentation or developed later during the disease. Early surgical and endovascular interventions in these patients can help in achieving decent limb salvage rates