Background: Intravenous drug abuse can lead to vascular complications, most frequent of which is pseudoaneurysm. Thesepseudoaneurysms (false aneurysms) are prone to rupture, leading to profuse hemorrhage and death. Objective: To evaluatepseudoaneurysms in intravenous drug addicts for the site, mode of presentation, management and outcome. Design: Descriptive study.Place and duration of study: Surgical unit I, Combined Military Hospital, Rawalpindi. Surgical unit 2, Combined Military Hospital, Lahore.January 2006 to September 2010. Subjects and methods: All cases of pseudoaneurysms in intravenous drug addicts who presented to asingle vascular surgeon, between 1st January 2006 and 30th September 2010, were evaluated for site, mode of presentation, treatment andthe outcome. Surgical procedures included excision of pseudoaneurysm with interpositioning of graft, repair of vascular rent, ligation of vesseland debridement. All cases were referred to psychiatrist for management of drug addiction. Results: Total 12 cases of pseudoaneurysms dueto IV drug abuse were included in our study. Arteries affected included 9(75%) common femoral arteries (CFA). In 3(25%) cases, both commonfemoral artery and vein were involved with arteriovenous fistula between them. There was 1(8.3%) pseudoaneurysm each of external iliacartery, superficial femoral artery and brachial artery. Nine cases (75%) presented with recurrent hemorrhage from a swelling while in 3(25%)cases there was swelling with no history of hemorrhage. In 7(58.3%) cases, repair/grafting, while in 5(41.6%) cases ligation and debridementwas done. There was seroma formation in 1(8.3%) case after excision and grafting. In none of the cases, in which artery was ligated, critical limbischaemia occurred. Conclusions: Common femoral artery is the most frequent site of pseudoaneurysms in IV drug abuse. In those caseswhere vascular reconstruction is not possible due to extensive skin necrosis or infection, ligation of affected vessel is not only a life savingprocedure but a safe option also.
Aim: To compare the limb salvage rate in early versus late presenting patients of Rutherford class IIB acute lower extremity ischemia undergoing revascularization. Study Design: Comparative/observational study Place and duration of study: Department of Surgery, CMH Peshawar from January 2019 to March 2021 Methodology: Twenty eight patients of both genders with ages 20 to 70 years presented with Rutherford class IIB acute lower limb ischemia were enrolled in this study. Patients were divided into two groups. Group I (presented after 6 hours of onset of symptoms) consisted of 20 patients and group II (presented within 6 hours of onset of symptoms) consisted of 8 patients. All the patients underwent femoral embolectomy. Limb salvage rate between both groups was examined at postoperative 3rd month. Data was analyzed by SPSS 24.0. P-value <0.05 was taken as significant. Results: There were 16(80%) male and 4(20%) females with mean age 50.52±11.74 years in group I, in group II 6(75%) were male and 2(25%) were females with mean age 50.08±10.94 years. No significant difference was observed between both groups regarding age and gender with p-value >0.05. In group I, limb salvage found in 19(95%) patients while in group II limb salvage found in 5(62.5%) patients, a significant difference was observed regarding limb salvage rate between both groups (p-value <0.05). Mortality rate was high in group II (delayed presentation) as compared to group I (12.5% Vs 0%) with p-value <0.05. Conclusion: The limb salvage rate was high in early presenting patients than late presenting patients with a significant difference. 30 days mortality rate and amputation rate were significantly high in delayed presentation as compared to early presented cases. Keywords: Acute lower limb ischemia, revascularization, limb salvage
Background: It is a common observation that the aortic size of Pakistani population is relatively less as compared to western population. Till now there is no study which has measured the dimensions of abdominal aorta in local population.The standard diameter of an artery across the body is critical for clinicians to recognize when an artery has become aneurysmal. This study aims to present the results of a local population's normal diameter of an infrarenal aorta and how it varies by age, gender, weight, height, body mass index (BMI) and body surface area (BSA). Methods: This cross-sectional observational study was conducted in Vascular Surgery Department, at Combined Military Hospital (CMH), Peshawar, from July 2020 to November 2021.Participants in the study included all patients who underwent a contrast-enhanced computed tomography (CT) scan of the abdomen for any reason other than cardiovascular disease.The infrarenal abdominal aorta's mean internal diameter (anteroposterior and transverse diameter) was assessed. SPSS v 23 was used to analyze the data and present it as frequency and percentages. The Pearson correlation coefficient assessed the correlation between aortic diameters, weight, height, BMI, and BSA. Result: Recruitment of a total of 250 patients was done in this study. Males were 194 (77.6%), while the rest were female patients. The patients' mean age was 39.6±12.8 years. The mean anteroposterior (AP) diameter of the infrarenal aorta was 16.13±2.32 mm. The mean transverse diameter (TD) was 15.96±2.34 mm. The infrarenal diameter of the aorta was smaller in women when compared to men, and the calibre of the aorta increased with the increasing age of the patients. There was a statistically significant positive relationship between their age and the average diameter of the infrarenal aorta (p<0.001) among both men and women. Conclusion: Clinicians and vascular surgeons will benefit from the findings in diagnosing and treating abdominal aortic aneurysms. Hence, thoughtful consideration should be made before formulating intervention protocols.
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