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Dive into the research topics where Prabhu Premkumar is active.

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Featured researches published by Prabhu Premkumar.


Journal of Endovascular Therapy | 2013

A novel cautery instrument for on-site fenestration of aortic stent-grafts: a feasibility study of 18 patients.

Edwin Stephen; George Joseph; Indrani Sen; Sujith Thomas Chacko; Prabhu Premkumar; Lijo Varghese; Dheepak Selvaraj

Purpose To report the bench-top evaluation and initial clinical use of an instrument for onsite fenestration of aortic stent-grafts. Methods A stainless steel thermal cautery instrument was designed to create circular stent-graft fenestrations from 3 to 10 mm in diameter. Three operators independently bench-tested the instrument on thoracic stent-graft samples to evaluate size, shape, location, and quality of fenestrations created. For clinical use, on-site fenestration was performed 2 days before the endovascular procedure in a sterile room without access to supplemental oxygen. A fenestrator 1 or 2 mm smaller in diameter than the target vessel was used; the edges of the fenestrations were strengthened using flexible radiopaque nitinol wire. The aortic stent-graft was then re-sheathed and sterilized for added safety. Eighteen patients (17 men; mean age 51 years, range 18–80) with a variety of thoracic and juxtarenal pathologies were treated using Zenith TX2, Valiant Captivia, Zenith AAA, and Endurant stent-grafts modified in this manner. Results After successful bench testing, the instrument was used to create 34 fenestrations in aortic stent-grafts deployed in the 18 patients. Size and location of fenestrations obtained were as desired. Subsequent catheterization of the fenestration/target vessel and covered stent deployment were successfully achieved in 31 (91%) fenestrations; 2 fenestrations had type III endoleaks and 1 fenestration was unused. There was no perioperative mortality, stroke, embolization, vessel dissection, renal failure, or graft infection. Follow-up to 1 year in the majority of patients has revealed no new fenestration-related problems. Conclusion This simple-to-use instrument makes on-site creation of aortic stent-graft fenestrations easy, accurate, and precise. The instrument is inexpensive, robust, and easily sterilized.


Journal of Endovascular Therapy | 2016

Externalized Guidewires to Facilitate Fenestrated Endograft Deployment in the Aortic Arch

George Joseph; Prabhu Premkumar; Viji Samuel Thomson; Mithun J. Varghese; Dheepak Selvaraj; Raj Sahajanandan

Purpose: To describe a precannulated fenestrated endograft system utilizing externalized guidewires to facilitate aortic arch endovascular repair and to report its use in 2 patients with challenging anatomy. Technique: For distal arch repair, a fenestration for the left subclavian artery (LSA) is made onsite in a standard thoracic endograft tailored to the patient anatomy; it is precannulated with a nitinol guidewire (NGw), which is passed from the femoral artery and externalized from the left brachial artery prior to endograft delivery system introduction over a parallel stiff guidewire. Steps are then taken to remove guidewire intertwining, prevent NGw wrapping around the delivery system, and orient the LSA fenestration superiorly when the delivery system moves into the arch. Gentle traction on the ends of the NGw during endograft deployment facilitates proper fenestration alignment. A covered stent is deployed in the LSA fenestration. The technique is illustrated in a patient with congenital coarctation of the aorta and descending aortic aneurysm. For total arch repair, endograft fenestrations are made for all 3 arch branches; the left common carotid artery (LCCA) and LSA fenestrations are each cannulated with NGws, which travel together from the femoral artery, pass through a LSA snare loop, and are exteriorized from the LCCA. After endograft deployment, the innominate artery fenestration is separately cannulated using right brachial access. Placement of a parallel externalized hydrophilic guidewire passing through the LCCA fenestration (but not the LSA snare loop) and removal of the LCCA fenestration NGw allows exteriorization of the LSA fenestration NGw from the left brachial artery by pulling the LSA snare. Covered stents are deployed in all 3 fenestrations. The technique is presented in a patient with type B aortic dissection. Conclusion: Use of the precannulated fenestrated endograft system described is feasible and has the potential to make aortic arch endovascular repair simpler, more reliable, and safer.


Indian Journal of Vascular and Endovascular Surgery | 2018

Venous thoracic outlet syndrome: A short review

Dheepak Selvaraj; Edwin Stephen; AlbertAbhinay Kota; Vimalin Samuel; Prabhu Premkumar; Sunil Agarwal

Venous thoracic outlet obstruction can be either primary or secondary. Effort-induced thrombosis of the upper limb ranges from 1% to 4% of all venous thrombosis has been the focus of discussion in many an international and national journal recently because of an increase in the number of cases being seen, diagnosed, and treated. In this paper, we discuss an overview of the problem and our management approach based on available evidence and share the experience gained from treating patients with effort-induced axillary-subclavian thrombosis or Paget—von Schroetter syndrome, as it is otherwise called.


Indian Journal of Vascular and Endovascular Surgery | 2018

Management of klippel-trenaunay syndrome from a single center in India: Experience shared

Edwin Stephen; Prabhu Premkumar; JoelMathew John; AlbertAbhinay Kota; Vimalin Samuel; Dheepak Selvaraj; Sunil Agarwal

India with a population of about 1.3 billion and diverse cultures holds within its large land mass an encyclopedia of medical cases, several un/underdiagnosed. Klippel-Trenaunay syndrome (KTS) is one such condition. Over the years, as the understanding of our team increased about the condition, we were able to share the same with our colleagues across the institution and publish the brief article. This resulted in an increased referral pattern from within the institution and across the country. At our institution, we managed 127 cases of KTS between October 2009 and December 2017. In this article, we share our experience about managing the cases, lessons learnt, and the challenges we face.


Anz Journal of Surgery | 2018

Arterial thoracic outlet syndrome in Klippel-Feil syndrome.

Darpanarayan Hazra; Indrani Sen; Dheepak Selvaraj; Prabhu Premkumar; Sunil Agarwal

Anomalous first or cervical ribs are present in 0.7% of the general population. Thirty per cent of cervical ribs are complete. Although mostly asymptomatic, these are the most common cause of compression of the subclavian vessels producing an arterial thoracic outlet syndrome (A-TOS). Neurogenic (brachial plexus compression; N-TOS) and venous (subclavian or axillary vein compression) can also occur. Klippel–Feil syndrome (KFS), a complex skeletal and visceral dysplasia syndrome, is associated with cervical ribs in as many as 30% of patients. However, reports of thoracic outlet syndrome in these patients are rare. We present a case and review of arterial TOS in KFS. A 42-year-old man presented with right upper limb claudication and digital emboli (Fig. 1, panel A1). He did not use tobacco or have diabetes, dyslipidaemia or hypertension. Palpation of the neck revealed a bony mass in the posterior triangle with prominent arterial pulsations in the supraclavicular fossa. The radial and ulnar pulses were not palpable. Electrocardiogram was normal. X-ray revealed a complete cervical rib (Fig. 1, panel A2); A-TOS was diagnosed. Computed tomography angiogram diagnosed anomalies of the cervical spine and subclavian artery. There were eight cervical vertebrae with partial fusion of C2, C3. The transitional vertebra (C7) had bilateral complete bony ribs (Fig. 1, panel A3). The subclavian artery had a focal narrowing at the bifurcation of the right brachiocephalic trunk with a post-stenotic dilatation after crossing the anomalous rib (Fig. 2). He did not have a significant family history, low hairline, short neck or limitation of neck movement (classical features of KFS) but had other skeletal anomalies (lumbar ribs) confirming the diagnosis of KFS (Table 1). He underwent excision of the cervical rib with arterial reconstruction by a supraclavicular approach (Fig. 2). As can be seen on the images, the innominate bifurcation was readily accessible using this approach. Following the procedure, the patient was started on aspirin (75 mg daily). KFS has an incidence of one in 40 000. Maurice Klippel and Andre Feil described and classified it into three types (I–III) based on the degree of spinal fusion. Sporadic form or syndromic association with multiple other skeletal, renal, auditory, visual, genitourinary, cardiovascular and neurological abnormalities is described. The classic triad (low hairline, short neck, limitation of neck movement) is no longer diagnostic, as it is present only in 40%. Clarke reclassified KFS into four types based on inheritance, other anomalies and the level of anterior fusion (Table 1). Presentation varies – some are detected incidentally, others present with osteoarthritis or enthesopathies of the cervical spine, spinal canal stenosis, cord compression or symptoms secondary to visceral anomalies. N-TOS in KFS is reported. This is the first report of a KFS patient presenting with arterial TOS. One other patient had episodic colour change suggestive of Raynaud’s but the primary diagnosis was N-TOS. Anomalous first ribs, fibrocartilaginous bands, clavicular fractures or enlarged C7 transverse processes structures are the other causes of extrinsic compression. The clinical presentation is typical; patients complain of upper limb arterial symptoms with a palpable rib and prominent subclavian pulsation in the neck. Diagnosis is confirmed by a plain neck X-ray (anteroposterior view), followed by arterial imaging. This can detect the changes associated with chronic subclavian arterial compression: post-stenotic dilatation, aneurysmal change, localized intimal damage, embolization or thrombosis. Operative management is mandatory in symptomatic patients. This usually involves resection of the offending rib with arterial


Indian Journal of Vascular and Endovascular Surgery | 2017

Deep Vein Thrombosis is Not Uncommon in India

Edwin Stephen; Vimalin Samuel; Sunil Agarwal; Dheepak Selvaraj; Prabhu Premkumar

Deep vein thrombosis (DVT) has for long been under-diagnosed and ignored as one of the major causes of morbidity worldwide. Knowledge of the pathology and treatment of DVT has progressed many fold over the years. Inspite of it being common, knowledge of diagnosis and treatment of this potentially fatal condition remains limited. In this review article, we look at the DVT and the available options for diagnosis and treatment.


Indian Journal of Vascular and Endovascular Surgery | 2016

Endovascular Management of Primary Aortoenteric Fistulae

Albert Abhinay Kota; Andrew Dheepak Selvaraj; Prabhu Premkumar; Sam Ponraj; Sunil Agarwal

Primary aortoenteric fistula (AEF) is a rare clinical entity which is life-threatening. Early diagnosis and prompt treatment play a crucial role in the management. Minimally invasive approaches such as endovascular treatment are newer options in treatment. We describe three patients with primary AEF successfully managed with endovascular treatment. The presentation of primary AEF may be acute, with an exsanguinating unstable patient who would be unfit to undergo a major laparotomy. In such instances, endovascular treatment can be used as the initial option to control the bleeding. Endovascular treatment is a valuable treatment option to control bleeding when the morbidity of open repair is high.


Journal of Vascular Surgery Cases and Innovative Techniques | 2015

Nonhemophiliac musculoskeletal pseudotumor

Indrani Sen; Dheepak Selvaraj; Prabhu Premkumar; Sunil Agarwal

A 24-year-old man presented with impending ulceration of a large thigh swelling which appeared after minor trauma. Imaging revealed a large well-encapsulated lesion with no vascularity. He was diagnosed to have a pseudotumor and underwent successful excision of the mass under blood and cryoprecipitate cover. The unusual presentation was suspected to be secondary to a transient drug-induced factor XIII deficiency because the result of the final coagulation study was normal.


Indian Journal of Vascular and Endovascular Surgery | 2015

Mycotic Aneurysm: Case Series

Albert Abhinay Kota; Indrani Sen; Andrew Dheepak Selvaraj; Prabhu Premkumar; Sam Ponraj; Sunil Agarwal

Mycotic aneurysms are rare and usually occur secondary to embolization of septic foci. Early diagnosis is the crucial. They have high risk of rupture/complications and can pose a difficult management challenge especially in an acute setting. We describe the management of four patients with mycotic aneurysms in our case series.


European Journal of Vascular and Endovascular Surgery | 2009

Venous Thrombo-embolism in India

A.D. Lee; Edwin Stephen; Sunil Agarwal; Prabhu Premkumar

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Sunil Agarwal

Christian Medical College

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Edwin Stephen

Christian Medical College

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Indrani Sen

Christian Medical College

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Vimalin Samuel

Christian Medical College

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Sam Ponraj

Christian Medical College

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George Joseph

Christian Medical College

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A.D. Lee

Christian Medical College

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