The Egyptian Journal of Hospital Medicine, Apr 1, 2023
Background: Vascular access is critical for hemodialysis (HD) patients. Traditional catheter inse... more Background: Vascular access is critical for hemodialysis (HD) patients. Traditional catheter insertion techniques rely on anatomical landmarks, which correlated with higher failures and increased rates of complications. The procedure's efficacy and safety could be optimized by utilizing real-time ultrasound guidance during HD central venous catheter placement. Objective: The aim of the current study was to evaluate the effectiveness and safety of ultrasound-guided permanent internal jugular vein (IJV) catheterization in serving hemodialysis patients. Patients and methods: A total of 150 patients suffering from end-stage renal disease (ESRD) who had ultrasonography (US)-guided IJV permanent HD catheters implanted in our university hospital, from March 2015 to March 2016 were recruited. Patients were examined for their catheter insertion site, technical success, operative time, number of needle punctures, and procedure-related complications. Patients who have had multiple catheter insertions, prior catheterization challenges, poor compliance, obesity, bony deformity, and coagulation disorders were considered high-operative risks. Results: All patients experienced the technical success of the 150 catheters, and 62 (41.3%) were placed in high-risk patients. The first-attempt success rate was 89.8% for the normal-risk group and 72.5% for the high-risk group (P=0.006). IJV cannulation took less time in the normal-risk group compared to the high-risk group (21.2±0.09 minutes vs 35.4±0.11 minutes, P<0.001). No serious complications were reported. Only 4 (6.4%) patients experienced arterial puncture in the high-risk group. Conclusion: A low complication rate and a high success rate are associated with the US-guided placement of a catheter into the IJV, even in the high-risk group.
Purpose: For patients with a failed forearm autogenous fistula (AF) and an exhausted cephalic vei... more Purpose: For patients with a failed forearm autogenous fistula (AF) and an exhausted cephalic vein, there is controversy about whether a brachial basilic AF with transposition or an arteriovenous prosthetic bridging graft (BG) must be the second vascular access option. This work measured and compared these two modalities according to patency rates, complications, and revisions. Patients and methods: A retrospective study of 104 cases that had either a brachial basilic AF (72) or an Arteriovenous BG (32). Technical success, operative complications, procedurerelated mortality, maturation time, functional primary, secondary, and overall patency rates were all assessed. Results: Technical success was obtained in all participants. No procedure-linked mortality. Maturation time for BGs was significantly shorter than AFs. The complication rate was significantly higher in BGs than in AFs. The most prevalent complication was access thrombosis. The functional primary patency rate was signific...
Background: Iliac arteries are commonly affected by occlusive atherosclerotic disease, leading to... more Background: Iliac arteries are commonly affected by occlusive atherosclerotic disease, leading to arterial insufficiency and lower extremity symptoms. Atherosclerosis in the iliac region often coexists with pathologies below the inguinal ligament. Aims: This study aimed to compare the effectiveness of unilateral common iliac artery stenting versus bilateral kissing stents in terms of clinical and technical success for treating unilateral common iliac artery ostial lesions. Method: A prospective study (October 2022-April 2023) that included 40 patients randomly assigned to two groups. Group A received bilateral kissing stents, while group B underwent unilateral common iliac artery stenting. Clinical evaluation, technical success, and complications were assessed over six months. Results: Technical success rate was 100 % in groups A and B, six months primary patency rate in group A was 95% had patent stent with good inflow while 5% had claudication at 100 M, treated by a balloon expandable stent. While in group B, 85% had patent stent with good inflow while 5% had claudication at 100 M, treated by balloon expandable stent, 5% had renal failure, congested heart failure and died, and 5% neglected medication. DFI occurred, sepsis and AKA was done as a lifesaving. Conclusion: Unilateral common iliac artery stenting demonstrated comparable clinical outcomes, technical success, and complication rates to bilateral kissing stents. It provides a safe and effective alternative for treating unilateral common iliac artery ostial lesions.
New Frontiers in Medicine and Medical Research Vol. 3, 2021
Cellulitis is a non-necrotizing inflammation of the skin and subcutaneous tissues that usually re... more Cellulitis is a non-necrotizing inflammation of the skin and subcutaneous tissues that usually results from an acute infection. The gram-negative bacillus Pseudomonas aeruginosa causes a wide range of clinical illnesses. It is, however, most commonly linked to a hospital-acquired illness. We describe a case report of a 45-year-old Saudi man who developed vesiculous bullae, scaling, and sloughing of the overlying skin after initially experiencing redness and heat in the mid-right lower thigh. Though it was not a common suspect bacteria, Pseudomonas aeruginosa was detected from the case. It's possible that it's the result of a community-acquired infection.Patient was treated conservatively with intravenous antibiotics and local hygiene treatments such as Vaseline (bactigrass) dressing and topical antibiotics.Patient improved and discharged with complete resolution of cellulitis. Objectives: Describe the pathophysiology of community-acquired infections. Review the laboratory te...
Background: Vascular access is critical for hemodialysis (HD) patients. Traditional catheter inse... more Background: Vascular access is critical for hemodialysis (HD) patients. Traditional catheter insertion techniques rely on anatomical landmarks, which correlated with higher failures and increased rates of complications. The procedure's efficacy and safety could be optimized by utilizing real-time ultrasound guidance during HD central venous catheter placement. Objective: The aim of the current study was to evaluate the effectiveness and safety of ultrasound-guided permanent internal jugular vein (IJV) catheterization in serving hemodialysis patients. Patients and methods: A total of 150 patients suffering from end-stage renal disease (ESRD) who had ultrasonography (US)-guided IJV permanent HD catheters implanted in our university hospital, from March 2015 to March 2016 were recruited. Patients were examined for their catheter insertion site, technical success, operative time, number of needle punctures, and procedure-related complications. Patients who have had multiple catheter insertions, prior catheterization challenges, poor compliance, obesity, bony deformity, and coagulation disorders were considered high-operative risks. Results: All patients experienced the technical success of the 150 catheters, and 62 (41.3%) were placed in high-risk patients. The first-attempt success rate was 89.8% for the normal-risk group and 72.5% for the high-risk group (P=0.006). IJV cannulation took less time in the normal-risk group compared to the high-risk group (21.2±0.09 minutes vs 35.4±0.11 minutes, P<0.001). No serious complications were reported. Only 4 (6.4%) patients experienced arterial puncture in the high-risk group. Conclusion: A low complication rate and a high success rate are associated with the US-guided placement of a catheter into the IJV, even in the high-risk group.
The mangled extremity severity score (MESS) was established 28 years ago to decide performing an ... more The mangled extremity severity score (MESS) was established 28 years ago to decide performing an amputation in cases of limb trauma. It assigns points for 4 aspects of the injury: the extent of soft tissue and skeletal injury, limb ischemia and ischemic duration, shock, and age. A score of 7 or higher indicates that primary amputation is required. Thirty-one patients with MESS scores of 7 to 8 underwent limb salvage surgeries, with 13 limbs being saved and 18 limbs being amputated. Upper extremities trauma had a salvage rate of 62.5%, whereas lower extremity trauma had a salvage rate of 20%. MESS is not a sensitive predictor of amputation in upper limb trauma, but it is useful in lower limb injuries.
The term cellulitis is commonly used to indicate a nonnecrotizing inflammation of the skin and su... more The term cellulitis is commonly used to indicate a nonnecrotizing inflammation of the skin and subcutaneous tissues, usually from acute infection. Pseudomonas aeruginosa is a gram-negative bacillus that causes wide spectrum clinical infections. However, it is most frequently associated with hospital-acquired infection. Authors are presenting a case report of 45 years old Saudi male who presented initially with redness and hotness in the mid of right lower leg gradually increased with development of vesiculous bullae, scaling and sloughing of overlying skin. Pseudomonas aeruginosa was identified from the case, though it was not a usual suspected organism. It might be due to community-acquired infection. Patient was treated conservatively with I/V antibiotic and local hygienic methods including dressing with vaseline (bactigrass) and topical antibiotics. Patient improved and discharged with complete resolution of cellulitis
Purpose: The aim of the study was to evaluate the results of percutaneous transluminal angioplast... more Purpose: The aim of the study was to evaluate the results of percutaneous transluminal angioplasty (PTA) of femoropopliteal arteries in patients with critical lower limb ischemia; Materials and methods: From June 2006 till May 2008, 40 patients underwent 40 PTA procedures, 18 were of the superficial femoral artery (SFA), 7 of the popliteal artery, 9 of both arteries and 6 of the common femoral artery (CFA). Twenty-nine procedures were performed for treatment of stenoses and 11 for occlusion. The patients were monitored clinically with non-invasive hemodynamic studies. Results: The technical success rate was 97.5%. Overall primary patency rates at 24 months were 67.5%. Primary patency rates in limbs with occlusion were 45.5% compared with 75.9 in limbs with stenoses. Two major amputations were performed. The overall survival rate was 95%. Conclusion: The 2 years results of femoropopliteal PTA performed for treatment of CLI seemed to be near the results of infrainguinal bypass graftin...
The Egyptian Journal of Hospital Medicine, Apr 1, 2023
Background: Vascular access is critical for hemodialysis (HD) patients. Traditional catheter inse... more Background: Vascular access is critical for hemodialysis (HD) patients. Traditional catheter insertion techniques rely on anatomical landmarks, which correlated with higher failures and increased rates of complications. The procedure's efficacy and safety could be optimized by utilizing real-time ultrasound guidance during HD central venous catheter placement. Objective: The aim of the current study was to evaluate the effectiveness and safety of ultrasound-guided permanent internal jugular vein (IJV) catheterization in serving hemodialysis patients. Patients and methods: A total of 150 patients suffering from end-stage renal disease (ESRD) who had ultrasonography (US)-guided IJV permanent HD catheters implanted in our university hospital, from March 2015 to March 2016 were recruited. Patients were examined for their catheter insertion site, technical success, operative time, number of needle punctures, and procedure-related complications. Patients who have had multiple catheter insertions, prior catheterization challenges, poor compliance, obesity, bony deformity, and coagulation disorders were considered high-operative risks. Results: All patients experienced the technical success of the 150 catheters, and 62 (41.3%) were placed in high-risk patients. The first-attempt success rate was 89.8% for the normal-risk group and 72.5% for the high-risk group (P=0.006). IJV cannulation took less time in the normal-risk group compared to the high-risk group (21.2±0.09 minutes vs 35.4±0.11 minutes, P<0.001). No serious complications were reported. Only 4 (6.4%) patients experienced arterial puncture in the high-risk group. Conclusion: A low complication rate and a high success rate are associated with the US-guided placement of a catheter into the IJV, even in the high-risk group.
Purpose: For patients with a failed forearm autogenous fistula (AF) and an exhausted cephalic vei... more Purpose: For patients with a failed forearm autogenous fistula (AF) and an exhausted cephalic vein, there is controversy about whether a brachial basilic AF with transposition or an arteriovenous prosthetic bridging graft (BG) must be the second vascular access option. This work measured and compared these two modalities according to patency rates, complications, and revisions. Patients and methods: A retrospective study of 104 cases that had either a brachial basilic AF (72) or an Arteriovenous BG (32). Technical success, operative complications, procedurerelated mortality, maturation time, functional primary, secondary, and overall patency rates were all assessed. Results: Technical success was obtained in all participants. No procedure-linked mortality. Maturation time for BGs was significantly shorter than AFs. The complication rate was significantly higher in BGs than in AFs. The most prevalent complication was access thrombosis. The functional primary patency rate was signific...
Background: Iliac arteries are commonly affected by occlusive atherosclerotic disease, leading to... more Background: Iliac arteries are commonly affected by occlusive atherosclerotic disease, leading to arterial insufficiency and lower extremity symptoms. Atherosclerosis in the iliac region often coexists with pathologies below the inguinal ligament. Aims: This study aimed to compare the effectiveness of unilateral common iliac artery stenting versus bilateral kissing stents in terms of clinical and technical success for treating unilateral common iliac artery ostial lesions. Method: A prospective study (October 2022-April 2023) that included 40 patients randomly assigned to two groups. Group A received bilateral kissing stents, while group B underwent unilateral common iliac artery stenting. Clinical evaluation, technical success, and complications were assessed over six months. Results: Technical success rate was 100 % in groups A and B, six months primary patency rate in group A was 95% had patent stent with good inflow while 5% had claudication at 100 M, treated by a balloon expandable stent. While in group B, 85% had patent stent with good inflow while 5% had claudication at 100 M, treated by balloon expandable stent, 5% had renal failure, congested heart failure and died, and 5% neglected medication. DFI occurred, sepsis and AKA was done as a lifesaving. Conclusion: Unilateral common iliac artery stenting demonstrated comparable clinical outcomes, technical success, and complication rates to bilateral kissing stents. It provides a safe and effective alternative for treating unilateral common iliac artery ostial lesions.
New Frontiers in Medicine and Medical Research Vol. 3, 2021
Cellulitis is a non-necrotizing inflammation of the skin and subcutaneous tissues that usually re... more Cellulitis is a non-necrotizing inflammation of the skin and subcutaneous tissues that usually results from an acute infection. The gram-negative bacillus Pseudomonas aeruginosa causes a wide range of clinical illnesses. It is, however, most commonly linked to a hospital-acquired illness. We describe a case report of a 45-year-old Saudi man who developed vesiculous bullae, scaling, and sloughing of the overlying skin after initially experiencing redness and heat in the mid-right lower thigh. Though it was not a common suspect bacteria, Pseudomonas aeruginosa was detected from the case. It's possible that it's the result of a community-acquired infection.Patient was treated conservatively with intravenous antibiotics and local hygiene treatments such as Vaseline (bactigrass) dressing and topical antibiotics.Patient improved and discharged with complete resolution of cellulitis. Objectives: Describe the pathophysiology of community-acquired infections. Review the laboratory te...
Background: Vascular access is critical for hemodialysis (HD) patients. Traditional catheter inse... more Background: Vascular access is critical for hemodialysis (HD) patients. Traditional catheter insertion techniques rely on anatomical landmarks, which correlated with higher failures and increased rates of complications. The procedure's efficacy and safety could be optimized by utilizing real-time ultrasound guidance during HD central venous catheter placement. Objective: The aim of the current study was to evaluate the effectiveness and safety of ultrasound-guided permanent internal jugular vein (IJV) catheterization in serving hemodialysis patients. Patients and methods: A total of 150 patients suffering from end-stage renal disease (ESRD) who had ultrasonography (US)-guided IJV permanent HD catheters implanted in our university hospital, from March 2015 to March 2016 were recruited. Patients were examined for their catheter insertion site, technical success, operative time, number of needle punctures, and procedure-related complications. Patients who have had multiple catheter insertions, prior catheterization challenges, poor compliance, obesity, bony deformity, and coagulation disorders were considered high-operative risks. Results: All patients experienced the technical success of the 150 catheters, and 62 (41.3%) were placed in high-risk patients. The first-attempt success rate was 89.8% for the normal-risk group and 72.5% for the high-risk group (P=0.006). IJV cannulation took less time in the normal-risk group compared to the high-risk group (21.2±0.09 minutes vs 35.4±0.11 minutes, P<0.001). No serious complications were reported. Only 4 (6.4%) patients experienced arterial puncture in the high-risk group. Conclusion: A low complication rate and a high success rate are associated with the US-guided placement of a catheter into the IJV, even in the high-risk group.
The mangled extremity severity score (MESS) was established 28 years ago to decide performing an ... more The mangled extremity severity score (MESS) was established 28 years ago to decide performing an amputation in cases of limb trauma. It assigns points for 4 aspects of the injury: the extent of soft tissue and skeletal injury, limb ischemia and ischemic duration, shock, and age. A score of 7 or higher indicates that primary amputation is required. Thirty-one patients with MESS scores of 7 to 8 underwent limb salvage surgeries, with 13 limbs being saved and 18 limbs being amputated. Upper extremities trauma had a salvage rate of 62.5%, whereas lower extremity trauma had a salvage rate of 20%. MESS is not a sensitive predictor of amputation in upper limb trauma, but it is useful in lower limb injuries.
The term cellulitis is commonly used to indicate a nonnecrotizing inflammation of the skin and su... more The term cellulitis is commonly used to indicate a nonnecrotizing inflammation of the skin and subcutaneous tissues, usually from acute infection. Pseudomonas aeruginosa is a gram-negative bacillus that causes wide spectrum clinical infections. However, it is most frequently associated with hospital-acquired infection. Authors are presenting a case report of 45 years old Saudi male who presented initially with redness and hotness in the mid of right lower leg gradually increased with development of vesiculous bullae, scaling and sloughing of overlying skin. Pseudomonas aeruginosa was identified from the case, though it was not a usual suspected organism. It might be due to community-acquired infection. Patient was treated conservatively with I/V antibiotic and local hygienic methods including dressing with vaseline (bactigrass) and topical antibiotics. Patient improved and discharged with complete resolution of cellulitis
Purpose: The aim of the study was to evaluate the results of percutaneous transluminal angioplast... more Purpose: The aim of the study was to evaluate the results of percutaneous transluminal angioplasty (PTA) of femoropopliteal arteries in patients with critical lower limb ischemia; Materials and methods: From June 2006 till May 2008, 40 patients underwent 40 PTA procedures, 18 were of the superficial femoral artery (SFA), 7 of the popliteal artery, 9 of both arteries and 6 of the common femoral artery (CFA). Twenty-nine procedures were performed for treatment of stenoses and 11 for occlusion. The patients were monitored clinically with non-invasive hemodynamic studies. Results: The technical success rate was 97.5%. Overall primary patency rates at 24 months were 67.5%. Primary patency rates in limbs with occlusion were 45.5% compared with 75.9 in limbs with stenoses. Two major amputations were performed. The overall survival rate was 95%. Conclusion: The 2 years results of femoropopliteal PTA performed for treatment of CLI seemed to be near the results of infrainguinal bypass graftin...
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