AVOID THAT STROKE :ACT TIMELY

DON’T BE A VICTIM

A stroke is a term used to describe a cerebrovascular accident.It results either from a rupture of a blood vessel in the brain or else from a blockage of the blood vessel that supplies the brain leading to brain damage.The former causes damage by producing bleeding around the brain cells(hemorrhage)or else can damage the brain cells due to lack of blood supply(infarct) leading to permanent disability like speech defect,weakness of limb etc. (As shown in the pictures)
Strokes are the third commonest cause of death after cancer and heart ailments.These can be prevented and if brought in time to the concerned doctor can be treated as well.

WHAT ARE THE RISK FACTORS FOR STROKE?

The common causes are
Ageing
Smoking
Blood pressure
Diabetes
Obesity
High fat content in the blood

Many people experience transient weakness of any limb or momentary visual impairment.These episodes in medical terminology are called transient ischemic attacks.Please don’t take them lightly as this may be the first indication of a stroke to happen.These symptoms may wane off in 24 hours giving a false sense of security to the patient.
One must be thoroughly investigated especially a Doppler test of the carotid vessels become mandatory.In many instances the carotid Doppler shows significant obstruction in these patients.If neglected it can ultimately lead to total paralysis or death.Such patients should see their vascular surgeon at the earliest .This is because if carotid obstruction is operated timely,a major stroke can be prevented.

Even if you had a stroke earlier with minimal disability you can still be a candidate for carotid surgery to prevent further strokes.

PERITONEOVENOUS SHUNT WITH FEMORAL VEIN FOR INTRACTABLE ASCITES-SOMETHING UNIQUE

Intractable ascites is a very common symptomatology which our internists come across in their daily practice.Its a difficult situation to deal with more so for the fact that the general health of the patient is not great and the renal parameters are also deranged in most of the cases along with the ongoing hepatic problem(Hepatorenal syndrome).These patients frequent their doctors for ascitic tap or else for hepatic encephalopathy and related issues.Surgeons have tried various treatment modalities including venovenous shunts with variable results.These procedures have their own benefits and pitfalls.

In older times LeVeen shunt was used aggressively for intractable ascites but has been replaced by the Denever shunt .Using foreign material has always been dicey as the chance of infection is relatively high more so in these immunocompromised patients with the shunt placed subcutaneously.This issue has been of perennial concern for the attending surgeons and has led to the birth of biological grafts wherein saphenous vein is attached to the rent created in peritoneum for ascitic fluid drainage.Few small series of this mode of treatment modality are available on the net for one and all to see.

We report to you a unique case of intratractable ascites in a 65 years old male who was not a case for TIPS or other traditional VenoVenous shunts for multiple reasons and was referred to me for a possible peritoneovenous shunt.I went through the literature available on net and realized that the probable cause for the occlusion of the saphenous shunt was the small caliber of the vein.So we tried something unique in this case which probably has never been attempted anywhere before in a case like this.We harvested the SUPERFICIAL FEMORAL VEIN from the thigh and anastomosed the proximal end of it to the rent in the peritoneum for ascitic fluid drainage.We found the caliber of the saphenous vein to be small intraoperatively though we never intended to use it otherwise also.

No doubt this is a palliative surgery intended to give better quality of life but till it serves its purpose its worth it.

PALMA PROCEDURE FOR VENOUS CLAUDICATION:IS IT FORGOTTEN

Venous surgeries in our modern day scenario are more or less limited to surgery of the varicose veins.This paradigm shift probably comes from the very fact that different vascular surgery centres have given different results regarding venous surgeries over a period of time.Unfortunately these indifferent surgical results also stem from the fact that the choice of patients was not appropriate and venous surgery was in its infancy.All said and done,venous surgery is here to stay provided we stick to the basic rules of vascular surgery,know basics of venous heamodynamics and pathophysiology and institute timely treatment to the patients.An example to quote is the fresh revival of interest in venous thrombectomies in acute cases especially after the work presented by Germans in different vascular conferences.

We present to you a unique case of a 21 year old young man who came to us with ‘May Turner Syndrome’ which subsequently led to thrombosis of his common and external iliac vein.This patient came with swelling of the left leg and thigh for the last three years and had a recurrent ulcer at his medial ankle region.He was on acitrom for the last almost 3 years but to no avail.He had significant venous claudication and was practically handicapped for life so to speak.We were left with a difficult situation to deal with.A convetional venogram was done which was suggestive of the above mentionted findings.We tried opening the left iliac vein by endovascular methods inspite of me not a keen follower of this methodology and as expected, it did not work.

PALMA procedure was done in him wherein the Great Saphenous Vein was harvested from the right thigh and anastomosed to his left Common Femoral Vein through a crossover procedure thereby restoring the drainage of the left limb through the saphenous vein via Right Iliac Vein.Its almost eight weeks now from the day of surgery and the patient is doing ok.His venous ulcer has healed and the swelling on the leg has reduced remarkably.The patient is on tab.acitrom and compression stockings.I don’t know for how long would this work for him but one thing is for sure i.e its not going to add a great deal to his morbidity.

This procedure is unique for many reasons.One we were never ever taught as to what extra can be done other than routine stuff in patients suffering from CVI resulting from iliac vein thrombosis .Secondly we never came across much of papers presented in National vascular surgery conferences catering to venous diseases other than the usual papers on laser surgery for varicosities.I think its time we have more of venous conferences wherein all these issues are addressed in interactive sessions without any prejudice or else we need to switch back to our standard textbooks for answers for books to me ‘never lie’.