Donna Angel

Microbiological profile of chronic ulcers of the lower limb: a prospective observational cohort study

Background:  The aim of the study was to determine the microbiological profile of chronic lower‐limb ulcers in a tertiary outpatient setting.

Sonographic diagnosis in iatrogenic entrapment of a femoropopliteal bypass graft

The success of duplex scanning has been well documented in many different vascular territories to diagnose arterial narrowing and occlusion. One area to which this technique has been best applied is the graft surveillance and early diagnosis of mechanical causes of graft failure. An uncommon cause of iatrogenic complication in femoropopliteal bypass grafting is popliteal artery entrapment syndrome (PAES). Developmentally, the gastrocnemius muscle arises from the calcaneus, migrating cephalad until it divides into lateral and medial heads. The lateral head attaches first to the lateral epicondyle of the femur, and the medial head attaches later to the medial epicondyle. At the time of the attachment of the medial head, the popliteal artery has already formed and is in its normal anatomic location. If the popliteal artery develops late or if the medial head migrates early, the artery is not in its normal location; instead, it is swept medially and impinged against the femur as the medial head attaches to the epicondyle. 1 A similar complication is seen when the graft is tunneled superficial to the medial head of the gastrocnemius muscle, leading to compression of the graft. 2,3 This case report describes the incidental finding of graft entrapment on angiography confirmed by duplex sonography, surgical treatment, and postoperative surveillance sonography.

Atypical leg ulcers after sclerotherapy for treatment of varicose veins: Case reports and literature review

Highlights • Varicosity treatment (related to arteriovenous malformation) results in skin ulceration.• Skin necrosis is a serious but rare complication of sclerotherapy and healing period is usually prolonged.• Wound care management vary from a non-adhesive dressing to LFUD/Surgical debridement.• Awareness of this complication is essential since atrophic/hypertrophic scars are usually unavoidable and induce psychological trauma.

Stent outcomes for infrapopliteal arterial occlusive disease.

This study aimed to determine if the different stent types used in the treatment of infrapopliteal arterial occlusive disease provide any significant advantage over one another at 6 and 12-month follow-up. Consecutive patients undergoing stenting of infrapopliteal lesions were enrolled into a non-randomised prospective registry and followed-up for 1 year. Outcome measures included binary restenosis, target lesion revascularisation, major amputation, and change in Rutherford-Becker score and ankle-brachial index (ABI). Thirty-three patients were enrolled including four patients with bilateral disease. There were 20 target vessels in the drug-eluting stent (DES) group, 13 target vessels in the balloon-expandable bare metal stent (BE-BMS) group and 14 target vessels in the self-expandable bare metal stent (SE-BMS) group. Most of the patients in the study were octogenarians except in the SE-BMS group where the mean age was 73 ± 9 years. At 12 months, seven patients had died (DES = 6, BE-BMS = 1) from cardiac and cancer-related diseases. In-stent and peri-stent binary restenosis were non-statistically different between all three groups. There was a non-statistically significant trend towards higher target vessel revascularisation in the BE-BMS group. Survival curves in all stent types demonstrated restenosis to occur within the first 6 months post-procedure. There was no significant difference in the change in Rutherford-Becker score or ABI between the groups. No major limb amputations occurred during the 12-month period. In conclusion, we did not detect a significant difference in stent performance between the different stent types used to treat infrapopliteal arterial occlusive disease. The choice of stent did not seem to affect patient survival or major amputation-free survival at 1-year follow-up.