Background Endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) of primary varicose vein are thought to minimize postoperative morbidity and reduce work loss compared with the conventional surgical procedure. Aim of the Work to determine, whether endovenous ablation (radiofrequency and laser) have any advantages or disadvantages in comparison with conventional surgery, in the treatment of primary varicose vein. Patients and Methods this is a prospective randomized study. Thirty Patients presented at Vascular Outpatient Clinic for management of chronic venous insufficiency. All patients underwent clinical examination and duplex ultrasonography. Ten (10) patients were treated with ligation and stripping of the GSV or SSV. Ten (10) patients were treated with Radiofrequency ablation. Ten (10) patients were treated with endovenous laser ablation. The study was conducted at Ain Shams University Hospitals and Helwan University Hospitals. The study took place from September 2017 to June 2018. Results Compared with conventional surgery, endovenous ablation methods reduce postoperative discomfort and pain, with a lower complication rate after treatment for avoidance of a groin incision and dissection at the saphenofemoral confluence. Cosmetic demands are also better satisfied. However, risks of EVLA and RFA remain in terms of recanalization and neoreflux via junctional tributaries. Conclusion RFA and EVLA are minimally invasive procedures. Their potential early benefits, by avoiding groin dissection and GSV stripping, have been confirmed by the findings from this trial. Current evidence based on randomized trials consistently demonstrates significant early benefits after RFA and EVLA in suitable patients with varicose veins.
Background portal vein thrombosis (PVT) is a common complication of end-stage liver disease with an incidence of 0.6–16% in patients with well-compensated disease (1–3), increasing up to 35% in cirrhotic patients with hepatocellular carcinoma. Aim of the Work the aim of the study is to compare between thrombectomy of PVT using vascular clamps “eversion” & manual technique “modified eversion” during liver transplantation regarding operative time, degree of blood loss, portal vein rethrombosis, and post-operative complications. Patients and Methods This is a retrospective cohort study to compare between thrombectomy of PVT using vascular clamps “eversion” & manual technique “modified eversion” during liver transplantation regarding operative time, degree of blood loss, portal vein rethrombosis & post-operative complications. The study was conducted as retrospective study of 33 adult patients who underwent LDLT at Ain Shams Specialized Hospital, Ain Shams University, Cairo, Egypt, between January 2016 and July 2018. Results the mean child score was 9.55 and the median hospital stay was 12 days. Based on review manager statics program, the PVT recurrence was non-significant (P = 0.295, Test value: 1.096). However, the blood loss was significant (p < 0.029, test value: -2.186) and the surgical time was significant (p = 0.013, test value: 2.633). Conclusion portal vein thrombosis (PVT) represents a significant technical challenge in liver transplantation and for many years was considered a relative contraindication. While advances in surgical techniques, axial imaging, and alternative inflow reconstruction options have made liver transplantation possible in transplant candidates with PVT.
Background Portal vein thrombosis (PVT) is a common complication in terminal-stage liver disease. Its incidence in liver transplantation (LT) ranges from 2.1% to 26%. In the past, PVT was considered an absolute contraindication for LT, especially due to the technical difficulty involved. Nonetheless, since the mid-1980s, with the introduction of new surgical techniques, PVT is no longer considered an absolute contraindication in a larger percentage of patients. Aim of the Work to show the effect of preoperative portal vein thrombosis with its different extension degree on both patient and graft survival post living donor liver transplantation. Patients and Methods This retrospective cohort study was conducted on all the patients who performed living donor liver transplantation during the period from January 2010 till June 2017 at Ain Shams centre for organ transplantation (ASCOT). Our study included 240 cases who performed right lobe LDLT in that time interval and fulfilled the required data and time interval follow up. Those 240 cases were classified into 2 groups: group A Patients without preoprative PVT (200); group B Patients with pre-operative PVT. (40). Results 1-year patients survival rates of patients with and without PVT were 75% vs. 85%. t 2-year patients survival rates of patients with and without PVT 75% vs. 84%. 1-year graft survival rates of patients with and without PVT were 75% vs. 84%; that 2-year graft survival rates of patients with and without PVT: 65% vs. 77%. Conclusion P.V.T not only makes the surgery more difficult and complex but it also affects the outcome of LT. However Further studies should be done taking in consideration different degree of extension of the thrombus as it has crucial effect on the outcome of the liver transplantation.
Background Deep venous thrombosis (DVT) refers to the formation of one or more blood clots in one of the body’s large veins, most commonly in the lower limbs. The clot can cause partial or complete blocking of circulation in the vein, which in some patients leads to pain, swelling, tenderness, discolouration of the skin that is warm to touch. Aim of the Work Compare the effect of direct Oral Anticoagulant (Rivaroxaban) versus Antivitamin K (warfarin) in treatment of lower limb Deep Venous Thrombosis. Patients and Methods Type of study: prospective single blinded randomized study, study setting: was conducted at Kobri Elkobba hospitals, study period: 6 months, study population: Eligible all patients above 18 years had femoropopliteal vein thrombosis, confirmed with duplex ultrasound scanning and D-dimer test and qualified under the inclusion and exclusion criteria of the study. Results Our study shows that Rivaroxaban alone is as effective as standard therapy, with similar safety, for the treatment of acute DVT and in preventing recurrence and has low risk of bleeding. There was statistically significant increase in INR monitoring during 6 months in warfarin group than Rivaroxaban group with p-value < 0.001. This because warfarin has many drug and food interaction. There's no response in treatment out come after 3 months duplex as the study was on patient of femoro popliteal DVT, however there were clinical improvement in both groups. Complete recanalization with normal augmentation by muscle compression occurred in all Rivaroxaban patients compared to 5% were partially compressible with incomplete recanalization in warfarin group after 6 months of treatment. Conclusion We concluded in patients with unprovoked VTE, rivaroxaban has the potential to reduce both the risk of major bleeding and recurrent VTE compared to warfarin. And there’s no need for adjusting the dose and INR monitoring, and Rivaroxaban has no food nor drug interactions.
Acute cellular rejection occurred in 7 cases (8%).-Ischemia reperfusion injury occurred in 3 cases (3.6%).-Multivariate analysis of factors of hyperbilirubinemia revealed that recipient gender, actual graft recipient weight ratio (GRWR) less than one, multiple hepatic venous anastomosis, acute cellular rejection & duct to duct biliary reconstruction were independent risk factors.-Incidence of hyperbilirubinemia in the perioperative period decreases patient survival as 53 cases (63%) of patients who had developed hyperbilirubinemia, eventually died. Conclusion: Hyperbilirubinemia post-LDLTx indicates poor survival outcome. Avoidance of steatotic grafts, small for size & GRWR <1 improves the incidence of early post-LDLTx Jaundice.
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