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Background Extremity vascular injuries represent 50–70% of all injuries treated during wars. Hence, our objectives are to elaborate the challenges of vascular war injuries and to clarify their mechanisms, pattern, effectiveness of management and outcomes during war in Jazan. Patients and methods This is a descriptive study of patients with war-related vascular injuries treated in King Fahd Teaching Hospital during the war in Jazan (Saudi Arabia) from February 2016 to May 2016. The study included age, mechanism of injury, site of vascular injury, pattern of repair, and clinical outcome. Results This study included 56 patients with a mean age of 37 years. All patients were men (100%); four (7.1%) patients were civilians; 23 (41%) patients presented with blast injuries; and 33 (59%) patients presented with gunshot injuries. There were 40 (71.4%) arterial injuries, 16 (28.6%) venous injuries, and seven combined injuries (arterial and venous). Repair was done in 37 patients and ligation in 19 patients. Primary amputation was done in eight patients and secondary amputation in one patient. Conclusion Management of vascular injuries during wars presents a unique challenge to surgeons; standard vascular technical repair remains the gold standard management in vitally stable patients; primary extremity amputation is a lifesaving procedure in unstable patients with other life-threatening injuries. [ABSTRACT FROM AUTHOR]

Background and objective Endovenous laser ablation (EVLA) of the great saphenous vein (GSV) is much more used as an alternative method of treatment instead of conventional surgery procedures. EVLA is thought to decrease postoperative morbidity with rapid recovery and early return to daily activity. The goal of this study was to compare the effectiveness, postoperative pain, complications, and patient satisfaction following either EVLA or conventional surgery for varicose veins of the lower limbs. Patients and methods This is a retrospective study that was conducted on 50 consecutive patients/60 limbs (10 bilateral and 40 unilateral) presented to Kasr Al Aini Hospitals, Cairo University and Asir Central Hospital Saudi Arabia from January 2015 to January 2018 with truncal varicose veins involving GSV. Patients were divided into two groups: group I (30 limbs) who underwent conventional surgery in the form of high ligation and striping and group II (30 limbs) who underwent EVLA. Results The EVLT group was associated with good patient satisfaction with early return to daily activities and work. Pain, paresthesia, ecchymosis, hematoma were significantly higher in group II (P<0.05), with low rate of recurrence in both groups with no statistically significant difference between both groups. Conclusion Both EVLT and conventional surgery techniques were performed well as regards efficacy with low rate of recurrence for incompetent GSV. Less postoperative pain and complications were observed with EVLT as compared with conventional surgery such as ecchymosis, hematoma, superficial thrombophlebitis, and paresthesia. [ABSTRACT FROM AUTHOR]

Background With the great advancement of endovascular intervention in the management of both chronic and acute peripheral vascular disease, the need for open surgical intervention has markedly decreased over the past decade; however, in certain cases, a simple surgical intervention remains the only hope for limb saving. In this study, the authors presented a review for the effect of one of the oldest surgical vascular procedures, which is 'profundoplasty' and the authors focused on its role and outcome in cases presented with threatened limb with no distal runoff to the foot. Patients and methods This is a retrospective study conducted on 18 cases presented with 20 threatened limbs with no distal runoff and managed with either isolated profundoplasty or combined with other procedures in the period between May 2016 and May 2018 at the Vascular Surgery Department of Kasr Al Aini with the limb salvage as the end point. Results The study included 18 male patients with mean age of 50 years presented with 20 threatened limbs: 10 patients presented with critical limb ischemia classified according to Rutherford classification between class 4 and 6, and eight patients with 10 delayed acute limb ischemia category IIb (two patients presented with bilateral lower limb affection). Technical success was 100%; two cases of critical limb ischemia ended up with unilateral below-knee amputation, with limb salvage rate of 90%. Conclusion Profundoplasty remains a very effective procedure in the management of lower limb ischemia either acute or chronic, especially when other options cannot be performed and the case seems to be hopeless. [ABSTRACT FROM AUTHOR]

Background: Peripheral artery disease (PAD) is 3 to 4fold higher in diabetic patients, with concomitant coronary and chronic kidney disease and increased risk of complications particularly contrast-induced nephropathy (CIN) after traditional fluoroscopically guided endovascular interventions. The aim of this study was to compare the safety, accuracy of diagnosis and feasibility of automated CO2-DSA with standard Contrast-DSA in the evaluation of PAD. Methods: Prospective, single-center study to report our early experience in 50 Limbs of diabetic CLI patients with chronic kidney disease using automated carbon dioxide angiography (ACDA) during the endovascular treatment and to evaluate its diagnostic accuracy vs Contrast DSA. Results: Mean age was 62.76 ± 11.34 y, lesion distribution 36 (72%) patients with superficial femoral artery block, 10 (20%) patients with Infra popliteal disease, 4 (8%) patients aortoiliac disease. The primary efficacy endpoint was achieved in all patients. No statistically significant Increase in Serum creatinine pre and post CO2 injection in exclusive cases 35(70%) and added contrast cases15 (30%) with statistically significant Increase in ABPI pre and post CO2 Angioplasty and highest amount of CO2 volume was given in SFA block cases. 10(71.4%) cases of Below knee and 4(28.6%) cases of SFA angioplasty had added 5 ml of iodinated contrast, follow up over 6 months. Conclusions: ACDA can be utilized to guide PAD interventions, significantly decreasing to small volumes of contrast when needed (if not eliminating) the need to use iodinated contrast in patients with contrast allergies or compromised renal function at baseline. [ABSTRACT FROM AUTHOR]