Introduction: Arteriovenous fistula is the most common vascular access for patients requiringhemodialysis, but it is not always possible or practical hence cuffed tunneled dialysis cathetercomes into play. The aim of the study was to determine the outcome of cuffed tunneled dialysiscatheter used for hemodialysis at a teaching hospital. Methods: A descriptive cross-sectional study was conducted between January 2014 and December2019 on 103 chronic dialysis patients with end-stage renal disease presenting to a tertiary carehospital. Ethical approval was received from the institutional review board (2/(6-11) E2/076/77).Whole sampling was done. Data entry and analysis were done in Microsoft Excel 10. Results: The study included 103 patients with 117 cuffed tunneled dialysis catheters placed forhemodialysis. On assessing the outcome of the catheters, the primary and secondary patencyrates of the catheters were 5.85±4.87 and 1.21±3.77 months. Thirty-one (30.1%) patients requiredone intervention, and 11 (10.68%) catheters required 3 or more interventions to maintain patency.Eighteen (17.48%) patients presented with catheter dysfunction while in 11 (10.68%) cases, thecatheter was kinked or malpositioned at the notch. In one patient, procedure was abandoned dueto severe bleeding and in 2 (1.94%) patients dialysis catheters could not be negotiated into the rightatrium and left in brachiocephalic junction. Conclusions: Cuffed tunneled dialysis catheter is effective for maintenance hemodialysis in patientswith the end-stage renal disease if used with proper care during dialysis even in our setup. Theresults and outcomes of the procedure are at par with standards.
Introduction Carotid endarterectomy for carotid artery disease is one of the surgeries performed by vascular surgeons for carotid artery disease. The objective of this study is to describe the early and late outcome of the patient undergoing carotid endarterectomy and the association between the complication and comorbidities present previously in the patient. MethodsAll patients undergoing carotid endarterectomy at Manmohan Cardiothoracic Vascular and Transplant Centre between April 2010 to April 2020 were included. The follow-up data for upto a year from medical and clinical records, telephone interview regarding the immediate and late postoperative complications in patients with and without comorbidities were investigated and compared. ResultsThe total study population was 42 patients. Two patients (4.7%) developed stroke, one immediately in postoperative period and the other during follow up. There were two deaths (4.7%) postoperatively due to cardiac events and three (7.14%) recurrences of carotid stenosis among whom one (2.5%) developed late stroke. Twenty six patients (61.90%) were symptomatic prior to the procedure of which 20 patients (47.61%) had brain infarct. Overall one year survival was 95.2% post procedure and overall complication rate was 7.14%. The consequence in the form of death and stroke occurred more in the patients with comorbidities (3vs1) p=0.42. ConclusionThe immediate and late postoperative complications following carotid endarterectomy were death (4.7%), stroke (4.7%), cranial nerve injury (9.5%). The most frequent cause of death was postoperative cardiac event. Though major complications occurred more frequently in patients having comorbidities, it was statistically insignificant.
Introduction: Brachiobasilic fistula (BBF) with transposition is one of methods for creating native arteriovenous fistula (AVF) for hemodialysis. This study aims to highlight the result of a BBF in a tertiary referral center and aims to improve its result. Methods: This is a retrospective descriptive study conducted on the basis of data collected of patients undergoing BBF with transposition from January 2014 to December 2018 (5 years) at Manmohan Cardiothoracic Vascular and Transplant Center (MCVTC). Data regarding demographics, results and complications has been analyzed. Results: Total 59 patients underwent brachiobasilic fistula performed by 3 surgeons with male to female ratio of approximately 3:2 with mean age of patient 68.78±13.77 years. Hypertension was the most common comorbidity present in 91.53% (54) of patients. Fifty six (94.92%) patient had previous undergone some sort of arteriovenous fistula creation and in 10 (16.95%) patients it was done in two stages. There were 2 immediate failures (within 1 week) and 9 early failures (before 1st dialysis) however 2 patients presented later with blocked BBF after starting dialysis. Only 31 patients could be followed up with patent BBF after 1 year of creation. About 71.19% of fistulas were able to mature and undergo dialysis by 6 week period and most common complication was bleeding from incision site in 20 patients (33.90%). Conclusion: Brachiobasilic fistula is the good option for native arteriovenous fistula access for hemodialysis but it need proper selection of cases to decrease complication rates.
Aorto-esophageal fistula is a life-threatening condition, accounting for a small number of cases of upper gastrointestinal bleeding where patients present with one or more features of Chiari’s triad. We present the case of a 43-year-old woman, referred to us with symptoms of central chest pain, sudden onset dysphagia followed by massive hemoptysis. She was diagnosed with an aorto-esophageal fistula due to a ruptured thoracic aortic aneurysm and rushed for an emergency endovascular thoracic aortic stent and feeding jejunostomy with intravenous antibiotics and supportive care. After 6 weeks of surgery, the patient was re-evaluated to plan for an esophageal stent if required. The purpose of this presentation is to make the surgical fraternity aware of the gravity of this disease and novel techniques to manage it.
<p><strong>Background:</strong> Bronchiectasis is the permanent dilatation of the bronchi due to destruction of bronchial wall. Bronchiectasis still remains a serious problem in developing countries despite of modern medical facilities.</p><p><strong>Objectives:</strong> This study aims to demonstrate our surgical experience for bronchiectasis and analyze the risk factors related with the surgery outcome.</p><p><strong>Methods:</strong> Hospital based analyses of 39 patients were done who were underwent surgery for bronchiectasis and were on follow up in National Institute of Diseases of Chest hospital (NIDCH) in September 2014 to February 2015 were included in this study. All 39 patients had surgery for the bronchiectasis in the period of January 2014 to December 2014.</p><p><strong>Results:</strong> The mean age of the patients were 22.2 years. Twenty four patients were females and 15 were male. Symptoms were recurrent infection with cough, copious sputum in all patients and hemoptysis in 31 patients. The etiology was recurrent childhood infection in 17 patients, pneumonia in 11 patients, PTB in 6 patients, Aspiration in 2 patients, foreign body obstruction in 1 patient, and unknown etiology in 2 patients. Chest x-ray, CT scan and rigid bronchoscope were done for all patients. Bronchiectasis was left-sided in 17 patients. It was mainly confined to the lower lobes either alone in 9 patients and in conjunction with middle lobe or lingual in 8 patients. Indications for resection were failure of conservative therapy in 22 patients, hemoptysis in 8 patients, destroyed lung in 9 patients. Surgery was lobectomy in 24 patients, Bilobectomy in 5 patients, and pneumonectomy in 10 patients. Complications occurred in 10 patients with no operative mortality. Thirty four patients had relief of their preoperative symptoms after surgery in follow up periods.</p><p><strong>Conclusions:</strong> Surgical resection for bronchiectasis should be reserved for patients with localised disease who have failed medical management and have persistent symptoms that negatively affect their quality of life.</p>
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