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Children older than 2 weeks undergoing the Norwood operation frequently require postoperative pulmonary vasodilatation and high inotropic support. A significant hazard of death persists through all steps of multistage palliation. Increased pulmonary vascular resistance and volume load effects, such as systemic ventricular impairment and atrioventricular valve regurgitation, are commonly evident in patients in whom treatment fails or who do not qualify to proceed to the next stage of palliation. Those patients should be closely monitored for timely referral for heart transplantation when indicated.

Sonoelastography may be superior to other US modalities in elucidating different cervical lymph node biopsy helping to distinguish benign from malignant lesions. This may replace the lymph node biopsies in the future. Moreover, its use in the follow-up of patients with cervical malignancies may reduce the number of future biopsies. Further studies with more patients may be needed for a better assessment of results.

The purpose of this study was to evaluate the efficacy of combined ipsilateral percutaneous iliac angioplasty and open infrainguinal surgical techniques for the treatment of patients with multilevel arterial occlusive disease. Combining two types of approaches in the peripheral vascular field is a less aggressive technique and may result in excellent early patency and limb salvage rates. We report our initial experience with a combined percutaneous endovascular iliac angioplasty and infrainguinal surgical reconstruction for patients with chronic lower extremity ischemia associated with multilevel arterial occlusive disease who presented with severe (disabling) lower limb claudication that significantly reduced quality of life, as well as patients with rest pain, nonhealing ulcers, and gangrene.There were 30 patients, 20 of whom had percutaneous transluminal angioplasty (PTA) only and 10 who had PTA with a stent. The infrainguinal procedures associated with each were thromboendarterectomy with vein patch angioplasty of both the common femoral artery (CFA) (12 patients), and the popliteal artery (8 patients) and a short femoropopliteal bypass for the superficial femoral artery (SFA) after recanalization of the arterial lumen using thromboendarterectomy to shorten the bypass graft (10 patients), using a reversed saphenous vein graft. The procedures were performed from July 2007 to February 2008 at the Division of Vascular and Endovascular Surgery, Al-Hussein University Hospital (Al-Azhar Faculty of Medicine, Cairo, Egypt).The study included 30 patients, 17 males and 13 females, with a mean age of 54 years (range 42-72) who underwent both combined ipsilateral percutaneous endovascular iliac angioplasty and open surgical treatment of both femoral (ie, the CFA or the SFA) and popliteal occlusive diseases. Indications were claudication that reduced quality of life after failure of conservative medical treatment in 14 patients (46.6%), critical limb ischemia in 8 patients (26.7%), and tissue loss, nonhealing ulcers, and gangrene in 8 patients (26.7%). Initial technical and hemodynamic success was achieved in 100% of cases. Clinical success was achieved in 96.7% of cases after 6 months, and clinical failure was observed in 3.3% of cases owing to occlusion of the short femoropopliteal bypass graft. Good hemodynamic results were observed in 74.9% of cases as the mean postoperative ankle-brachial index remained elevated to 1.03 +/- 0.1 and 1.07 +/- 0.12 after 3 and 6 months, respectively.Combined vascular therapy may be used effectively in patients with chronic extremity ischemia owing to multiple levels of arterial occlusion and should be performed with good results. Technical success and early patency rates are excellent. The patients' symptoms improved and resistant ischemic ulcers healed within a short period of time.

Background: Vascular trauma is one of the devastating types of injuries whether accidental or intentional. Despite this fact, there is an obvious deficiency in the educational sessions for vascular surgeons concerning the appropriate medicolegal dealing with such injuries. Aim: To report the experience of vascular limb trauma Egypt J. Forensic Sci. Appli. Toxicol.Vol 19 (1), March 2019highlighting the medicolegal and clinical findings. Methods: A 5-years retrospective study with a follow up period of 1.5 years studying the data of peripheral vascular injuries at three specialized trauma centers with special emphasize on the cause, the type, and the outcome of this trauma in relation to sociodemographic factors. Obtained data were statistically analyzed using the SPSS computer program (version 23). Results: This study included 350 trauma patients (287 males and 63 females) who presented with peripheral vascular injuries. The patients' age ranged from < 8 years to >50 years. There was a significant association between the age and the circumstances of trauma. The most encountered causative mechanisms were traffic accidents (45.7%) and firearms (21.7%).There was no significant association between outcome and age (p = 0.114) or circumstances of trauma (p = 0.208). There was a highly significant association between the outcome and the duration of hospital stay (p < 0.001). Lower limb injuries were higher in frequency than upper limb injuries (n = 286 and 123) respectively. Upper and lower limbs arterial injuries had a significantly higher frequency rate than the venous injuries. Ulnar artery and brachial vein injuries was the most frequently encountered upper limb arterial and venous trauma, while the femoral artery and the deep femoral vein were the most commonly affected lower limb vessels. Bone injuries were the most frequently accompanying injuries (44.6% of total cases). Conclusion: As any sort of injury may possess medical and lawful perspectives, medicolegal investigations have to take the crown's position when studying trauma cases, going hand in hand with the clinical aspect.

In this analysis, rFVIIa succefully reduced the chest tube bleeding and blood products transfused during severe post cardiac surgical bleeding. However, safety of rFVIIa remains unclear. Prospective controlled trials are still needed to confirm the role of rFVIIa.

Background:The aim of this study was to evaluate the technical and clinical results, following surgical treatment of iatrogenic giant femoral artery pseudoaneurysms.Methods and findings: Among 1850 patients 60 (3.25%) of them diagnosed with an iatrogenic giant femoral artery pseudoaneurysms. All patients underwent surgical repair and were followed up for one month, three month and six month respectively using Duplex ultrasound sound and/or CT angiography. There were 40 male and 20 female, aged 30-70 years (Mean age 49.06 years ± 11.03). There were 66.7 % n=40 patients presented with groin pain, pulsatile mass associated with lower extremity ischemia, infected pseudoaneurysm in 16.7% (n=10), pending ruptured pseudoaneurysm in 8.3% (n=5), and large wide pseudoaneurysm neck confirmed by Doppler ultrasound (8.3%) n=5. Primary repair was done for 30 patients; repair with vein batch angioplasty for 15 patients, interposition reversed saphenous vein graft for 10 patients, and interposition synthetic Dacron graft for 5 patients. Technical success was achieved in 100% of cases. There is neither limb loss nor intra-operative or postoperative mortality. Distal extremity ischemia was completely resolved after surgical repair. Postoperative complications included one groin wound infection, which was controlled by antibiotic treatment and debridement. Conclusion:Open surgical repair of femoral pseudoaneurysms is technically feasible, first-line treatment for iatrogenic giant femoral artery pseudoaneurysmsassociated complications.

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