Manzoor Abbas

Deep venous valve reconstruction for non-healing leg ulcers: techniques and results.

Background:  The purpose of the present paper was to report clinical and imaging results of a 5 year experience of deep venous valve surgery with evaluation of end‐points at 2 year follow up for the management of non‐healing venous leg ulcers in 137 patients.

Popliteal artery injury: Royal Perth experience and literature review

Background:  Popliteal artery injury is uncommon but poses a significant challenge in Australian trauma care. Blunt trauma and knee dislocations appear to be associated with higher amputation rates. The aim of the present study was to review the authors’ experience with this condition and discuss the best approach to investigation and management.

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.

PULSATING VARICOSE VEINS!! THE DIAGNOSIS LIES IN THE HEART

Right heart failure is associated with increased systemic venous pressure, which can be diagnosed clinically with the findings of elevated jugular venous pressure, pulsatile liver and distinctive cardiac murmurs (precordial systolic). Severe tricuspid regurgitation (TR) has occasionally been known to lead to marked pulsation of varicose veins. We report three cases that were referred to the vascular clinic of Royal Perth Hospital in which the patients involved had unilateral (right leg) varicose veins and chronic venous ulcers. On clinical examination all three patients had pulsations along the course of the varicose long saphenous vein up to the mid calf. The main differential diagnosis was arterio‐venous malformation, which was excluded by compression of the sapheno‐femoral junction and demonstrating absence of pulsation in the long saphenous vein. A venous duplex scan showed a grossly incompetent sapheno‐femoral junction with abnormal wave forms. Two of the cases were managed conservatively with compression dressing. The option of sapheno‐femoral junction ligation was reserved in one patient who had unsettling cellulitis and oedema of the lower limb in spite of compression dressing and optimal conservative management. All three patients had improvement in ulcer size at 3‐month follow up with compression therapy. This article highlights that in cases of right heart failure the venous pressures can be felt as low as the mid calf level and that can be a cause of the venous ulcers. There should be a high suspicion of right heart failure in patients with late onset venous insufficiency.

Late stent-graft migration secondary to separation of the uncovered segment from the main body of a Zenith endoluminal graft.

Purpose: To report a case of type I endoleak secondary to complete disruption of the sutures uniting the uncovered and covered segments of a bifurcated Zenith endoluminal graft, causing displacement and distal migration of the graft main body. Case Report: A 76-year-old man had successful exclusion of an abdominal aortic aneurysm with a Zenith endoluminal graft in 1999. He continued to do well until the 4-year surveillance imaging [computed tomography (CT) and plain abdominal radiography] showed device migration and proximal endoleak, with consequent expansion of the aneurysm. A proximal extension stent-graft was inserted with good seal. The 1-month follow-up CT angiogram showed reduced aneurysm size and no evidence of any leak. Conclusion: This case shows that the failure of an endoluminal graft occurs at weak points in the construction of the graft, reinforcing the need for long-term surveillance. If detected promptly, such events can often be treated by another endovascular procedure.

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.

Sonographic Evaluation of Chronic Venous Insufficiency in Right Heart Failure

Clinical and sonographic findings of three octogenarian patients with recent-onset venous insufficiency with venous ulcer were evaluated with clinical examination and venous duplex scanning. The venous duplex findings in the affected lower limb of patients with right heart failure showed phasic flow in the long saphenous vein. The phasic flow was traced back up to the inferior vena cava and the hepatic veins. Echocardiogram confirmed marked tricuspid regurgitation. Clinically, a simple compression of the sapheno-femoral junction showed an absence of pulsation in the long saphenous veins, giving clinical confirmation that venous backflow caused the pulsation in the limb veins. Right heart failure in patients with late-onset venous insufficiency and venous ulcer should be suspected. Sonography complemented with clinical examination is the key to the proper evaluation and management of chronic venous insufficiency with right heart failure.

Transplantation of Crossed Fused Renal Ectopia

Crossed fused renal ectopia is a type of congenital fused anomaly of the kidney. This type of kidney, when encountered, can be used as a donor organ to provide useful solution to the critical shortage of available organs for transplantation.