Axillary Vein Valve transfer for CVI:An Intraoperative Video

Chronic venous insufficiency is a difficult clinical problem to tackle.Different treatment modalities are in vogue for the same.In desperate situations wherein the patient has non healing large painful venous ulcer/ulcers with gross incompetence in the deep venous system vein valve transfer is attempted to give relief to the patient esp.in old cases of DVT wherein the insitu valves are beyond repair.We did a similar case and recorded it.Kindly have a look.

PERIPHERAL STENT REMOVAL :A CHALLENGE

(PICTURE OF THE STENTS REMOVED)
The advent of stents has revolutionised vascular and endovascular surgery .More and more vascular procedures are now carried out in the cath lab with peripheral stenting ruling the roost.A veritable deluge of change has been seen in the approach to endovascular work.Elemental and vital questions arise as to who is entitled to be an endovascular surgeon?How does one acquire this entitlement?Who is entitled to enter it?The interests of the new specialty often conflict with the aspirations of other fields and therefore the tussle.Cardiologists without saying consider endovascular surgery to be their birth right(Atleast it appears that way)inspite of the fact that the anatomical knowledge of the vascular system they carry is dismal.Not only that, to confuse and complicate the issue further we now have radiologists who claim themselves to be the best interventionists.

There is a reason for me to be highlighting the above mentioned facts.We had a patient recently with a chronic occlusion of the left iliac artery involving the common and external iliac arteries extending till the femoral.Unfortunately this guy landed up with the cardiologist who as usual felt the vessel was stentable.There he goes and he ends up rupturing the iliac vessel with the patient in shock.A Vascular Surgeon probably is only required to deal with the final eventuality.We took him up and what do we see?Peripheral stents three in number extending from left common iliac till the proximal superficial femoral vessel going across the femoral bifurcation/Profunda(Almost 25cms in length).We had no other option than to remove the stents and then do a unilateral ilio-femoral bypass.

Removing a stent is hardly ever attempted and poses challenge to the operating surgeon as it is badly stuck to the vessel wall.

ITS GOOD TO BE AGGRESSIVE BUT IT SHOULD NOT BE A CASE OF MISPLACED AGGRESSION.ITS TIME OUR DEAR FRIENDS(READ CARDIOLOGISTS)LEARN WHAT VASCULAR SURGERY IS ALL ABOUT.