The prevalence of DVT in critically ill patients in a Thai surgical ICU was approximately 10.5%. Further research is needed to evaluate the risks and benefits of venous thromboprophylaxis in Thai patients.

Vascular Pythiosis caused by Pythium insiodiosum rarely involves carotid artery. A case of concealed ruptured pseudoaneurysm of the carotid artery with neck abscesses, and cerebral septic emboli is described. Patient presented with large pulsatile neck mass that failed to response to surgery, antifungals and immunotherapeutic vaccine. Residual unresectable disease leads to death in the patient. Pythiosis should be considered as a differential diagnosis of head and neck infection.

BackgroundBiologic prosthesis (BP) has been reported as a safe alternative to polytetrafluoroethylene (PTFE) in vascular reconstruction. However, efficacy of BP remains controversial. We, therefore, conducted a systematic review to summarize previous available evidences comparing the BP and PTFE in terms of clinical outcomes.Materials and methodsA literature search of the MEDLINE and Scopus was performed to identify comparative studies reporting outcomes of BP, PTFE, and/or autologous veins graft (VG) in vascular access for hemodialysis or femoropopliteal bypass. The outcome of interest was graft patency. Two reviewers independently extracted data. Meta-analysis with a random-effect model was applied to pool a risk ratio (RR) across studies.ResultsAmong 584 articles identified, 11 studies (4 randomized controlled trials (RCT) and 7 cohorts) comprising 2627 patients were eligible for pooling. Seven studies compared BP with PTFE and 3 studies compared PTFE with VG. Among BP vs PTFE, pooling based on 3 RCTs yielded the pooled RR of 1.54 (95% CI: 1.10, 2.16), indicating 54% higher graft patency in VG than PTFE. Adding the 7 cohorts in this pooling yield similar results with the pooled RR of 1.29 (95% CI: 1.15, 1.45). The pooled RR of graft patency for BP vs VG was 0.74 (95% CI, 0.55, 1.00), indicating 26% lower graft patency in BP than VG.ConclusionsOur first meta-analysis indicated that the biosynthetic prosthesis might be benefit over PTFE by increasing graft patency. An updated meta-analysis or a large scale randomized control trial is required to confirm this benefit.

Angiosarcoma is a rare complication of both functioning and nonfunctioning fistulas. It is an aggressive soft tissue sarcoma arising from vascular or lymphatic endothelial cells. We report a case of angiosarcoma from a nonfunctional fistula in a kidney transplantation patient receiving immunosuppressive drugs. The patient had presented with arm pain mimicking a thrombosed arteriovenous fistula.

A male patient presenting with a refluxing calf perforator was treated after unsuccessful surgery and sclerotherapy. Nine pulses were delivered at a mean power of 45 W. No anesthesia was performed. The perforator was occluded acutely, and this result persisted at 3 months. A male patient presenting with a refluxing GSV and active ulcer was treated after surgery. Thirty-nine pulses were delivered with a mean power of 38 W. Tumescent anesthesia was performed. The vein was occluded acutely, and this result persisted at 3 months. The ulcer was healed at 3 months.Conclusions: In this first study using HIFU, the preliminary results are encouraging and show that HIFU could become a credible alternative method. In future studies, more cases and longer follow-up will be needed.

Introduction: Venous thromboembolism (VTE) in surgical patients is a preventable cause of hospital death. In previous studies, the prevalence of VTE decreased after implementing a prophylactic protocol. Because of the low rate of VTE prophylaxis in Thailand, we studied the outcomes after the implementation of a VTE prophylactic protocol in our hospital. Methods: A retrospective cohort single-center study was conducted from November 2019 to November 2020 in the Department of Surgery. We established the VTE prophylactic protocol using a multidisciplinary team approach and the Caprini score risk assessment model. The outcomes were the incidence of symptomatic VTE, VTE-related death, risk factors, and safety. Results: In total, 6983 patients were admitted to the surgical department during the study period. After excluding patients with current VTE and missing data, 4579 patients were enrolled in this study, and 1579 (34.5%) patients at high risk for VTE were identified. The use of pharmacological prophylaxis, mechanical prophylaxis, and early ambulation in the entire cohort was lower than that in high-risk patients (7.99%, 19.81%, and 21.56% vs. 15.77%, 31.10%, and 46.55%, respectively). In the comparison of before and after implementation, the prevalence of symptomatic VTE and 30-day mortality of VTE decreased from 1.20% to 0.37% and from 0.11% to 0.02%, respectively. No major bleeding occurred. Conclusions: After protocol implementation, the prevalence of symptomatic VTE and VTE-related death decreased. The VTE prophylaxis was safe. We highly recommended using a multidisciplinary team approach VTE prophylaxis in high-risk surgical patients. Highlights

Methods: After deployment of two parallel main body stent grafts into the descending aorta through the femoral arteries, we cannulated the superior mesenteric artery and celiac trunk through one of the contralateral limbs and bilateral renal arteries through the other contralateral limb of the main body stent from bilateral axillary arteries. Two covered stents for the superior mesenteric artery and celiac trunk were deployed and were kept parallel at the top of the contralateral limb. The renal arteries were preserved similarly. The remaining two ipsilateral limbs were extended to bilateral common iliac arteries.Results: Final angiography and postoperative 6-month imaging followup in our three patients showed good results (Fig 2).Conclusions: Our hexapus technique is feasible in treatment of thoracoabdominal aortic aneurysm if the patient is too fragile to receive open repair or no commercial fenestrated or branched stent graft is available.

Purpose: Forearm loop arteriovenous grafts (AVGs) are an effective way to grant permanent vascular access in end-stage renal disease patients undergoing hemodialysis. A common postoperative complication with this procedure is forearm swelling. Distal vein ligation is believed to reduce postoperative venous hypertension and forearm swelling. There have been no previous randomized controlled trials comparing the efficacy of AVGs with and without distal vein ligation. Methods: A pilot study was performed as a randomized controlled trial. End-stage renal disease patients who required AVG construction were recruited and randomly assigned to either the distal vein ligation group or the nondistal vein ligation group. Forearm swelling, graft patency, and graft thrombosis were recorded and compared. Results: The nonligation and ligation groups consisted of 30 and 31 patients, respectively. Forearm swelling at both the proximal and distal areas was nonsignificantly higher in the nonligation group than in the ligation group. The success rate of cannulation of the graft was 77% in both groups. The first cannulation time was somewhat shorter in the ligation group than in the nonligation group (57 vs 63 days; P = .282). There was no difference in graft thrombosis between the 2 groups (8 and 6 patients, respectively, in the nonligation and ligation groups). Conclusions: AVGs can be performed with or without distal vein ligation.