Experience of peripheral lesion treatment in developing world

I’m not sure we can call India a developing world; the definition is controversial here. Nevertheless, in a country where private practice is most common, this is how people are perceiving new technologies … Very interesting reflection … 

Endocascupaf today Aug 2015 /India:
http://evtoday.com/2015/08/india

What to do for anaemic patient prepared for fempop bypass in few days?

The outcome is significantly different (poor) for anaemic patient:

A META-ANALYSIS (BJS 2015) showed the following: (DOI: 10.1002/bjs.9861)

  • Anaemia was associated with increased mortality (OR 2·90, 2·30 to 3·68; I2 = 97 per cent; P < 0·001), acute kidney injury (OR 3·75, 2·95 to 4·76; I2 = 60 per cent; P < 0·001) and infection (OR 1·93, 1·17 to 3·18; I2 = 99 per cent; P = 0·01). 
  • Among cardiac surgical patients, anaemia was associated with stroke (OR 1·28, 1·06 to 1·55; I2 = 0 per cent; P = 0·009) but not myocardial infarction (OR 1·11, 0·68 to 1·82; I2 = 13 per cent; P = 0·67). 
  • Anaemia was associated with an increased incidence of red cell transfusion (OR 5·04, 4·12 to 6·17; I2 = 96 per cent; P < 0·001). Similar findings were observed in the cardiac and non-cardiac subgroups.


THEREFORE, the following recommendations applies to anaemic patients undergoing an operation: (DOI: 10.1002/bjs.9898) 

  • Both anaemia and blood transfusion are independently associated with adverse outcomes. 
  • Functional iron deficiency (iron restriction due to increased levels of hepcidin) is the most common cause of preoperative anaemia, and should be treated with intravenous iron. 
  • Intraoperative blood loss can be reduced with antifibrinolytic drugs such as tranexamic acid, and cell salvage should be used. 
  • A restrictive transfusion practice should be the standard of care after surgery.

Femoral aneurysm – to treat or not to treat

ref:

2014 Feb;59(2):343-9. doi: 10.1016/j.jvs.2013.08.090.

The current management of isolated degenerative femoral artery aneurysms is too aggressive for their natural history.

http://www.ncbi.nlm.nih.gov/pubmed/24461859

This series is large enough to provide an excellent natural history analysis of the femoral artery aneurysm.

Abstract

BACKGROUND:

Previous studies have combined anastomotic, catheter-induced, and atherosclerotic isolated femoral artery aneurysms (FAAs) to achieve adequate numbers for analysis and have recommended repair of asymptomatic FAAs with diameters ≥2.5 cm and all symptomatic FAAs. This study evaluated the contemporary management of isolated FAAs.

METHODS:

Patients with FAAs were evaluated using a standardized, prospectively maintained database by a research consortium.

RESULTS:

From 2002 to 2012, 236 FAAs were identified in 182 patients (mean age, 72 years; male-to-female ratio, 16:1) at eight institutions. The mean nonoperative mean diameter was 2.8 ± 0.7 cm, and the operative diameter was 3.3 ± 1.5 cm. FAA location was the common femoral artery in 191, superficial femoral artery (SFA) in 34, and profunda femoris artery in 11. Synchronous aneurysms (mean, 1.7 per patient) occurred in the aorta (n = 113), in the iliac (n = 109), popliteal (n = 86), and hypogastric (n = 56) arteries, and in the contralateral common femoral artery (n = 34), SFA (n = 9), and profunda femoris artery (n = 2). Of the aneurysms repaired, 66% were asymptomatic; other indications for repair were claudication (18%), local pain (8%), nerve compression (3%), rupture (2%), acute thrombosis (1%), and rest pain (0.5%). Acute aneurysm-related complications (rupture, thrombosis, embolus) were associated (P < .05) with FAA diameter >4 cm and intraluminal thrombus, but not location. Mean diameter of asymptomatic aneurysms that developed acute complications was 5.7 ± 1.3 cm for rupture, 4 ± 1.1 cm for thrombosis, and 3.5 cm for embolus. Repair was by interposition or bypass graft in 177 FAAs and by endovascular repair in three SFA aneurysms. Two perioperative deaths, of myocardial infarction and multisystem organ failure, occurred at 30 days. Operative complications included wound infection (6%), seroma (3%), and bleeding (2%). No amputations occurred through 5 years in the operative or nonoperative groups. Survival in operated-on patients was 99% (n = 138) at 3 months, 92% at 1 year, and 81% (n = 20) at 5 years.

CONCLUSIONS:

This largest study of isolated FAAs demonstrates that (1) acute complications did not occur in FAAs ≤3.5 cm, repair criteria of asymptomatic FAAs should be changed to >3.5 cm, and chronic intraluminal thrombus should reduce the threshold for repair, and that (2) current indications for symptomatic FAA repair result in low morbidity and should remain unchanged.
Copyright © 2014. Published by Mosby, Inc.