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: Varicose veins are a frequent vascular issue. Radiofrequency ablation (RFA) and Endo-venous laser ablation (EVLA) are endo-venous treatments for varicose veins. Endo-venous therapy demonstrated superior outcomes than standard high ligation and stripping in terms of pain, quality of life, healing, and recurrence. The RFA and ELA surpass vein stripping in morbidity, outcome, and neovascularization (recurrence), which is attributed for greater recurrence rates. Aim: We aim to compare between using of radio frequency ablation and endo-venous laser ablation in the treatment of primary lower limb varicose veins as regard to complications, treatment failure,recurrence. Methods: This prospective randomized controlled study was conducted in the vascular surgery department at Al-Azhar university hospitals (Al-Hussein and Sayed Galal), in the period from September 2020 to June 2022 (20 months). The study included 50 patients, males were 22(44%) while females were 28(56%), Presented by primary varicose veins. Results: In EVLA group Recanalization of short-segment occlusion was done in 4 patients, Recanalization of long-segment occlusion was done in 2 patients and recurrent varicose veins happened in 5 patients.
Background: Arteriovenous fistula (AVF) is a significant procedure for patient in need of hemodialysis. Failure of maturation due to stenosis is a challenge that needs further intervention. Endovascular treatment allows salvaging these fistulae. Aim of the work: To identify the anatomical causes of maturation failure and to assess immediate and long-term clinical effects of PTA of non-mature native (AVF) caused by outflow stenosis using currently available endovascular techniques. Material and Methods: This study was performed on forty patients complaining of stenosis of primary AVF. The mean age is 60.5. Patients were followed-up every two weeks for the first 2 months, then every month for 6 months post-intervention clinically and radiologically. Collected data includes patient's demographics, cause of renal failure, characters of primary AVF, and variables of endovascular intervention, primary patency, and recurrence of stenosis. Results: AVF type was either brachiocephalic (57.5%), brachiobasilic (32.5%) or radiocephalic (10.0%). Fistulography revealed peripheral venous stenosis in 18 patients (45.0%), central venous stenosis in 14 patients (35.0%), and juxta-anastomotic stenosis in 8 patients (20%). Our technical success was achieved in 87.5% of cases; the patency rate was 91.0% in a month, 86.0% in 3 months, and 80.0% in 6 months. Complications were reported in 10 cases. The recurrence was reported in 7 patients (17.5% of cases). Conclusions: Endovascular salvage of failing A-V fistulas with PTA and Stenting is safe and effective. It is associated with high success rates, low complication rates, and rendering the immediate reuse of the failing shunt.
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