Background: Peripheral artery disease (PAD) is the most underdiagnosed, underestimated and undertreated of the atherosclerotic vascular diseases despite its poor prognosis. There may be racial or ...contextual differences in the Asia-Pacific region as to epidemiology, availability of diagnostic and therapeutic modalities, and even patient treatment response. The Asian Pacific Society of Atherosclerosis and Vascular Diseases (APSAVD) thus coordinated the development of an Asia-Pacific Consensus Statement (APCS) on the Management of PAD. Objectives: The APSAVD aimed to accomplish the following: 1) determine the applicability of the 2016 AHA/ACC guidelines on the Management of Patients with Lower Extremity Peripheral Artery Disease to the Asia-Pacific region; 2) review Asia-Pacific literature; and 3) increase the awareness of PAD. Methodology: A Steering Committee was organized to oversee development of the APCS, appoint a Technical Working Group (TWG) and Consensus Panel (CP). The TWG appraised the relevance of the 2016 AHA/ACC PAD Guideline and proposed recommendations which were reviewed by the CP using a modified Delphi technique. Results: A total of 91 recommendations were generated covering history and physical examination, diagnosis, and treatment of PAD—3 new recommendations, 31 adaptations and 57 adopted statements. This Asia-Pacific Consensus Statement on the Management of PAD constitutes the first for the Asia-Pacific Region. It is intended for use by health practitioners involved in preventing, diagnosing and treating patients with PAD and ultimately the patients and their families themselves.
Prostaglandins are potent vasoactive agents with wide variety of other actions - vasodilatation, fibrinolysis and inhibition of platelet aggregation. PGE1 was the agent used since 1973 for ...cardiovascular diseases, mainly in patients with advanced PVD. PGE1 intra venous infusion has shown to be beneficial in limb threatening ischemia, especially when reconstructive procedures are not feasible and also as an adjunct when there is residual ischemia after revascularization. The review of literature and the use of PGE1 in CLI is presented here along with our experience in NIMS.
Background & objectives: Chronic venous insufficiency (CVI) is a common clinical problem among obese patients. This study was conducted to evaluate the impact of body mass index (BMI) and associated ...morbidities such as diabetes, hypertension and hypothyroidism on venous disease clinical scores as per Clinical, Etiological, Anatomical, Pathological (CEAP) classification.
Methods: In this study, adult patients with BMI more than 30 kg/m2 with signs of CVI were evaluated clinically and by using Duplex ultrasonography of venous system. The patients with C0, C1, C2, C3 and C4, C5, C6 clinical scores in CEAP classification were grouped as lower and higher clinical scores of CVI, respectively.
Results: Of the 200 enrolled patients, 147 (73.5%) were males and were associated with higher grades of clinical scores (P=0.051). Superficial venous system was involved in 96 per cent patients and 91 per cent patients had reflux in the sapheno-femoral junction. A negative association was observed between hypertension and male gender (P=0.001). Higher BMI was associated with higher clinical scoring (P=0.053). BMI >40 kg/m2 was associated with primary aetiology (P=0.007) of CVI. There was no correlation between superficial, deep or perforator incompetence with BMI (P=0.506). Duplex-confirmed significant reflux was observed in patients with higher BMI (P=0.006). Age and BMI were positively correlated with clinical score (r=0.176; P=0.013 & r=0.140; P=0.049), respectively.
Interpretation & conclusions: Our findings indicated that elderly male patients with high BMI seemed to be at a higher risk of advanced clinical grades of CVI. The impact of comorbid conditions such as diabetes, hypertension and hypothyroidism on CVI could not reach at significance in the present study.
Introduction: Post stenotic dilation of the subclavian artery by cervical rib compression is generally seen in young patients with upper limb ischemia. Materials and Methods: We conducted a ...retrospective study on 26 consecutive patients who underwent surgical decompression for arterial thoracic outlet syndrome (aTOS) with subclavian artery repair from 2010 to 2015. Supraclavicular decompression of the thoracic outlet with cervical rib excission, scalenectomy with subclavian artery reconstruction by aneurysmorrhaphy was performed as per Scher staging of aTOS. The management and post operative outcome with regards to objective changes in the upper limb arterial pressure was studied & followed for 1 year with clinical examination, duplex scan and non invasive segmental vascular pressure. Result: The average age at presentation was 32 years, with equal gender distribution. However, symptomatic right: left aTOS at presentation was 18:8. The Scher classification system for aTOS based on subclavian artery compression identified 14 patients in stage III, 10 patients in stage II and 2 in stage I .8 out of 26 patients had digital ischemia with minor tissue loss and were managed medically by intravenous Alprostadil (Prostaglandin E1) postoperatively for 6 months .The mean above elbow pressure (AEP) before surgery has improved from 62.08±12.97 to 108.46±16.81& the below elbow pressure (BEP) has improved from 48.00±13.13 to 93.46± 32.02 . Above elbow pressure improvement is found statistically significant (p value0.037) across all Scher stages. Complete relief of vascular symptoms was seen in all patients immediately or gradually over a period of 6 months. Minor amputation was carried out in 8 patients of Scher stage 2 & 3 aTOS during follow of 6 months. Conclusion: This study finds its uniqueness in demonstrating the objective improvement of pressure with respect to different Scher stages which which is not reported in the literature.
Tumour like vascular lesions are rare. Here we report a rare case of tumor like vascular lesion from the radial artery. A pulsatile swelling in the forearm is usually diagnosed as a case of Aneurysm, ...AV fistula or highly vascular tumor. A middle aged man came to us with a painless pulsatile swelling on the lateral aspect of proximal right forearm. The ultrasound scan reported it as case of vascular tumour. Angiogram showed abnormal vascular channels, connected to the aneurysmal dialation of the proximal radial artery. Histopthological examination confirmed it as Masson’s hemangioma after excision. This is a benign condition and complete excision is curative.
A nulliparous woman aged 45 years was referred to us with painful swelling in left lower limb. She underwent laparoscopic hysterectomy for menorrhagia 12 days prior to the admission. The laparoscopic ...surgery was completed in 90 min without blood loss and blood transfusion. The size of the uterus was approximately 12 weeks. Duplex scan of the left lower limb confirmed thrombosis of the left external iliac vein, femoral vein, popliteal vein and tibial veins. On examination the laparoscopic puncture wounds healed well. She was hospitalized for initial anticoagulation with low molecular weight heparin (Enoxapain 1 mg/kg body weight twice daily) and compression bandages. Histological examination of the hysterectomy specimen was noted to be benign (Adenomyosis and cervical Leiomyoma). She responded to anticoagulation therapy and was discharged with an advice to attend the follow up clinic for long term anticoagulation advice for the next 6 months to prevent recurrent thromboembolic episodes.
Background
Fondaparinux is the first approved anticoagulant drug among factor Xa inhibitors, with proven effectiveness and safety in preventing deep vein thrombosis. However, limited data are ...available supporting the benefit-risk profile of fondaparinux vs enoxaparin in a real-world group of Indian patients with deep vein thrombosis.
Objective
To compare the effectiveness and tolerability of fondaparinux vs enoxaparin in patients with symptomatic deep vein thrombosis in a long-term real-world setting.
Methods
Data from the electronic medical records of adult patients diagnosed with deep vein thrombosis prescribed fondaparinux (
n
= 503) or enoxaparin (
n
= 508) as monotherapy were analyzed. Effectiveness was analyzed in terms of recurrence, duration, and type of deep vein thrombosis event, and tolerability as bleeding events at initial hospitalization and follow-up visits up to 3 months duration. Appropriate statistical methods were used to determine the significance (
p
< 0.05) between the two groups.
Results
The deep vein thrombosis recurrence in the fondaparinux group was non-inferior (2.78%) when compared with enoxaparin (3.76%), with a mean duration of 47 and 48 days, respectively. The number of events and mean duration of events (in days) were not significant (
p
> 0.05). Major bleeding events were higher in the enoxaparin group at 3.17% than the fondaparinux group at 2.19%, and the difference was not statistically significant (
p
> 0.05).
Conclusions
The weight-based, once-daily subcutaneous fondaparinux dose showed non-inferior effectiveness and a comparable tolerability profile when compared with the twice-daily enoxaparin dose for the management of symptomatic deep vein thrombosis.
PDF
