Outcome of pseudoaneurysm repair: a single tertiary center experience in Pahang, Malaysia

Introduction: Symptomatic arterial pseudoaneurysm is not an uncommon emergent vascular case presenting to a tertiary hospital. These are mainly associated with infection, iatrogenic puncture or trauma. The resultant morbidity, limb loss and mortality present a challenge to the surgeons managing these cases. Materials and method: We retrospectively reviewed all case notes of all pseudoaneurysm repair done at our centre from Jan 2015 to May 2017. Results: A total of 20 cases were treated surgically, with majority 16(80%) had ligation of the affected arteries. The rest were managed with reconstruction of the arteries with synthetic graft. In 7 patients (35%), the aetiology was identified as iatrogenic intravenous drug injection. Staphylococcus aureus remained the main causative organism with Treponema Pallidum and Burkholderia pseudomallei as the other organisms identified in the cultures. Our 3 patients with graft reconstruction had long term oral antibiotics upon discharge. Conclusion: Majority of pseudoaneurysms presented to our center results in ligation of the artery. Repair of mycotic aneurysm needs careful consideration as graft infection remains a lethal complication and no consensus is available regarding the duration of post-operative antibiotic cover

Banding for access related ischaemia: Our experience in Kuantan, Malaysia

We reviewed our result of banding procedures for steal syndrome identied from theatre lists and cross referenced with the theatre log book. We performed 8 banding procedures in 8 patients, between June 2012 and April 2014. All presented with grade II–III steal syndrome. Complete symptoms resolution and salvage access occurred in all cases except in 1 patient. We concluded, employing banding as a flow limiting procedure has been a success in dealing with access related ischaemia

Early result: randomized controlled trial of treatment for intermittent claudication

Objective: To compare angioplasty (PTA), supervised exercise (SEP) and PTA + SEP in the treatment of intermittent claudication (IC) due to femoro-popliteal disease Methods: Over a 6 years period, 178 patients (108 men, median age 70 years) with angioplastiable femoro-popliteal lesions were randomized to: PTA, SEP or PTA + SEP. Patients were assessed prior to and at 1 & 3 month post treatment. ISCVS outcome criteria (Ankle pressures, treadmill walking distances) and Quality of Life (QoL) questionnaires (SF36 and VascuQoL) were analysed. Results: All groups were well matched at baseline. 21 patients withdrew. Intra group analysis: All groups demonstrated significant clinical and QoL improvements (Friedman test, p < 0·05). SEP (59 patients, 8 withdrew) – 62·7% of patients (n = 32) improved following treatment [20 mild, 9 moderate, 3 marked], 27·4% (n = 14) no improvement and 9·8% (n = 5) deteriorated. PTA (60 patients, 3 withdrew) – 66·6% of patients (n = 38) improved following treatment [19mild, 10 moderate, 9 marked], 22·8% (n = 13) no improvement and 10·5% (n = 6) deteriorated. PTA + SEP (59 patients, 10 withdrew) – 81·6% of patients (n = 40) improved following treatment. [10 mild, 17 moderate, 13 marked], 14·2%% (n = 7) no improvement and 4·0% (n = 2) deteriorated Inter group Analysis: PTA + SEP produce a much greater improvement in clinical outcome measures than PTA or SEP alone, but there was no significant Q0L advantage (Kruskal Wallis test, p > 0·05). Conclusion: SEP should be the primary treatment for the patients with claudication and PTA should be supplemented by a SEP

Early outcomes from a randomized, controlled trial of supervised exercise, angioplasty, and combined therapy in intermittent claudication

BACKGROUND: To compare angioplasty (PTA), supervised exercise (SEP) and PTA + SEP in the treatment of intermittent claudication (IC) due to femoropopliteal disease. METHODS: Over a 6-year period, 178 patients (108 men; median age, 70 years) with femoropopliteal lesions suitable for angioplasty were randomized to PTA, SEP, or PTA + SEP. Patients were assessed prior to and at 1 and 3 months post treatment. ISCVS outcome criteria (ankle pressures, treadmill walking distances) and quality of life (QoL) questionnaires (SF-36 and VascuQoL) were analyzed. RESULTS: All groups were well matched at baseline. Twenty-one patients withdrew. Results are as follows: Intragroup analysis: All groups demonstrated significant clinical and QoL improvements (Friedman test, p 0.05). CONCLUSION: SEP should be the primary treatment for the patients with claudication and PTA should be supplemented by an SEP