Background Few data were documented about risk factors for lower limb varicose veins (LLVV) among Egyptian population. Identifying modifiable risk factors is crucial to plan for prevention. The current research aims to study the epidemiological, life style, and occupational factors associated with LLVV in a sample of Egyptian population. Methods A case control study was adopted. Cases with LLVV (n = 150) were compared with controls (n = 150). Data was collected using an interview questionnaire and clinical assessment. Data was analyzed using the univariate and multivariate logistic regression analyses. Results According to multivariate analysis among all participants (n = 300), the odds of LLVV was 59.8 times greater for those who frequently lift heavy objects (95% CI = 6.01, 584.36) and 6.95 times higher for those who drink < 5 cups of water/day (95% CI = 2.78, 17.33). Moreover, it was 4.27 times greater for those who infrequently/never consume fiber-rich foods (95% CI = 1.95, 9.37) and 3.65 times greater for those who stand > 4 h/day (95% CI = 1.63, 8.17). Additionally, odds of LLVV was 3.34 times greater for those who report irregular defecation habit (95% CI = 1.68, 6.60), and 2.86 times higher for those who sleep < 8 h/day (95% CI = 1.14, 7.16), and 2.53 times higher for smokers compared with ex-smokers/non-smokers (95% CI = 1.15, 5.58). In addition, a standing posture at work was an independent predictor of LLVV among ever employed participants (n = 234) in the current study (OR = 3.10; 95% CI = 1.02, 9.38). Conclusions This study highlighted seven modifiable independent predictors of LLVV mostly related to the life style, namely, frequent lifting of heavy objects, drinking < 5 cups of water/day, infrequent/no consumption of fiber-rich food, standing more than 4 h/day, irregular defecation habit, sleeping less than 8 h/day, and smoking. These findings provide a basis to design an evidence-based low-cost strategy for prevention of LLVV among Egyptian population.

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Was to study the results of open surgical reconstruction of huge abdominal aortic aneurysms (HAAAs) & their complications. Patients and methods: Twenty eight patients with huge abdominal aortic aneurysms were studied in the period from October 2012-March 2015. The diagnosis was done by: history, clinical examination, various imaging which included: Duplex Ultrasound, CTA, MRA, DSA & Mid-stream aortography. Open aortic reconstruction was done by using Bifurcated graft (Collagen coated or PTFE ) or aneurysmorrhaphy in two cases of mycotic saccular aneurysms. Results: The age incidence ranged from 45-78 years with a mean of 64 years. Male sex was predominant than female sex with M:F ratio 6:1. There was a history of Diabetes mellitus, smoking, hypertension, hypercholesterolaemia, obesity, myocardial infarction (seven cases) & renal impairment (two cases). The most common presentation of AAAs were abdominal pain, back pain, pulsating abdominal mass & acute abdomen (in two leaking AAAs). The size of the aneurysm (diameter) ranged between 12-22 cm with a mean of 16 cm, the size was measured by Duplex Ultrasound & CTA. Postoperative Morbidity: lower limb ischemia due to arterial thrombosis was present in two cases & distal embolization in two cases, thrombectomy & embolectomy were done respectively & successfully except one big toe amputated after embolectomy. Myocardial infarction occurred in four cases, two of them died. Another two cases developed uraemia, one of them died. Leaking abdominal aortic aneurysms occurred in two cases, one of them died. The overall all mortality rate within thirty postoperative days was four cases (14.3%), no intraoperative mortality. Conclusion: The morbidity & mortality rates were proportional with increase in size of the aneurysm & increase with the presence of preoperative cardiac, renal dysfunction & risk factors.

Background: Renovascular hypertension is the commonest form of secondary hypertension. It occurs in less than 5 % of all hypertensive population. There are two forms of renovascular hypertension: Atherosclerotic and fibromuscular dysplasia. Renovascular hypertension is suspected when it develops suddenly in patients under 30 or over 55 years of age, or abruptly worsen in any patient. The aim was to evaluate the indications of surgical treatment of "renovascular hypertension". Methods: Twenty cases with renovascular hypertension were included. The main investigations were: Laboratory studies, Duplex ultrasound, Intravenous pyelogram, CT angiography, aortography and selective renal angiography. Indications for surgery were : complex disease of the renal artery, aneurysm, accessory renal arteries, fibromuscular dysplasia and partial damaged of one kidney. Also, atherosclerotic stenosis of the renal arteries and complete kidney damage. Results : According to the etiology, 20 patients were divided into two groups : Group 1(Below 30 years)(Fibromuscular dysplasia group)which included 14 patients, (100.0%) were females, their age ranged from 18 to years with the mean±SD (24.7±3.5).Group 2(Above55 years)(Atherosclerotic group) which included 6 patients, their age ranged from 55 to 68 years with the mean±SD(62 ±4.1), 5(83.3%)were males and 1(16.7%) was female. Renal artery bypass graft was done for 15 cases, endarterectomy in 2 cases, endarterectomy with patch graft in two cases and nephrectomy in one case. Control of hypertension was successful in 17 cases, partial control of 2 cases, while the blood pressure still high in case of nephrectomy. No mortality in both groups within 6 months follow up period. Conclusions : Surgical treatment for renovascular hypertension is mandatory for complex disease of the renal artery, aneurysms and failure of endovascular procedures. Nephrectomy is the treatment of choice for damaged kidney.

Background: Subclavian artery aneurysms (SAAs) are uncommon aneurysms.SAA is potentially serious disease due to complications. Objective: to evaluate the surgical treatment of SAAs and its complications. Methods: Fifteen patients with SAAs: 13 patients (86.67%) had extrathoracic (ET) aneurysms and two patients (13.33%) had intrathoracic (IT) aneurysms. Thoracic outlet syndrome (TOS) was presented in 8 patients (53.33%), while, atherosclerosis was presented in 7patients (46.67%). Laboratory & radiological studies were done. All patients were treated surgically. Results: In 13 patients with extrathoracic aneurysms, a supraclavicular approach to the subclavian artery was used in (6/13, 46.15%), supraclavicular and infraclavicular approach was used in (7/13, 53.85%) cases. After excision of the aneurysm, graft interposition using (PTFE) and saphenous vein graft bypass were done in (6/13, 46.15% & 5/13 , 38.46 %) patients respectively. In two patients (2/13, 15.38 %), aneurysmal excision and end to end anastomosis were done. While in two patients with intrathoracic aneurysms, a combined left thoracotomy and supraclavicular approach was used. Common carotid-subclavian bypass using Dacron graft was done. In (6/8, 75 %) of patients with TOS, decompression was performed before arterial reconstruction. In three (37.50 %) patients with cervical rib, the cervical rib was resected. In three patients (37.50 % ) with scalene syndrome, scalenectomy of the scalenus anterior muscle was done. In two patients (2/8, 25 %) with brachial artery embolism, embolectomy was done. Conclusions: Early intervention was needed, especially in distal SAAs, because of the risk of thrombo-embolic complications. Open repair is sill the gold standard intervention for SAA.