Vascular Surgery

Success story 1

Master Gowrishankar 16year boy resident of thiruppur , presented with c/o severe pain abdomen for 2 years, which was Intermittent and dull aching.

H/o fever 2 months back, associated with increase in severity and frequency of abdominal pain,he had no history of trauma. Upon examination his abdomen was Soft, with diffuse tenderness and a firm pulsatile mass of size 5 x 7 cm palpable in the epigastrium with tenderness to deep palpation. No visible gastric peristalsis&. No movements on respiration. No scars/ dilated veins were present over abdomen

He was evaluated with CT Angiogram which showed -Large fusiform aneurysm of celiac trunk measuring 4.5 X 2.6 X 3.1 cm with hepatic artery and splenic artery reformation from branches of SMA. Multiple collaterals from SMA and IMA joins with reformatted Common Hepatic Artery and splenic artery trunk.

After obtaining informed consent from parents and fitness for surgery he was taken up for laparotomy + aortic aneurysm excision with dacron patch closure of aorta,procedure was uneventful.Postoperatively, he was extubated on POD 2 and started on sips of fluid on POD 3. He was ambulated and his wounds were found to be healthy on daily dressings and got discharged on POD10

This procedure Saved life from catastrophic bleeding.The cost of surgery in private hospital is 5-6 lakhs.This procedure was done free of cost under CMCHIS scheme.This was first of its kind in Government hospital ,chennai

Success story 2

MR DHARMARAJ ,65 year Gentleman ,a recently diagnosed hypertensive ,known hypothyroid ,chronic smoker and alcoholic presented with c/o severe abdominal pain poorly localized to epigastrium for 2 months, which was aggravated for the past 2 weeks .Upon examination he was found to have a soft, non-tender, pulsatile abdominal mass measuring around 7x6 cm in epigastric region. Margins are ill-defined. Upper extent could not be identified. No guarding/ rigidity. No bruit present in Bilateral renal angles. Lower limb examination was apparently normal

He was evaluated by CT aortogram which showed saccular aneurysm 6.5x 4.3x 5.2 cm arising from right lateral and anterior wall of descending thoracic aorta (extending from D11 to L1 vertebra),with No major vessels seen arising from the aneurysm

He was planned for TEVAR ,after obtaining surgical fitness . He underwent TEVAR using VACTAM Covered stent graft device (PROXIMAL DIA-34MM/DISTAL DIAMETER-31MM/LENGTH-150MM),procedure was uneventful with no endoleaks and was discharged on POD 3 . He is under regular follow up and doing well

Success story 3

Mr.ASHOK ,59 year old school teacher,a known diabetic and hypertensive and coronary artery disease with post CABG ,resident of Chennai ,presented with complaints of severe pain abdomen poorly localized to hypogastrium which was of sudden onset and severe in intensity radiating to both flanks for 2 months .He had haematemesis about 50 ml ,two episodes.On examination abdomen was soft ,non tender with a pulsatile abdominal mass measuring 7x6 cm in periumbilical region with poorly defined margins .

CT angiogram was taken which showed saccular aneurysm 6.5x 4.3x 5.2 cm arising from right lateral and anterior wall of descending thoracic aorta (extending from D11 to L1 vertebra). No major vessels seen arising from the aneurysm. After proper work up and obtaining fitness ,he was planned for EVAR done on 22/09/2022.

ENDURANT IIS Device used.procedure was uneventful ,patient performed well in the post operative period and discharged in satisfactory condition with normal distal pulses

Success story 4

MR.VENKATESAN/39/M- RESIDENT OF CHENGALPATTU ,Presented with c/o swelling over the Left side of neck which he noticed 1 week before . & he had severe pain over swelling-past 1 week duration associated with sudden increase in size of swelling over past 10days.He had a history of blunt trauma -6 months back(?assault),and recurrent trauma to LT side of neck – 10 days back (self fall over the metal rod/lamp post under alcohol influence).He has difficulty in swallowing and mild voice change.

Upon examination,there was a 7 x 5 cm swelling over LT side of neck below the angle of mandible in- anterior triangle of neck,which is pulsatile & tender swelling,Firm in consistency/smooth surface/irregular borders & No palpable thrill,Lower border of swelling can be made out & Bruit was present on auscultation over the swelling.

• On ultrasound of neck Neck of sac-3mm,Proximal CCA – 6.1mm, Distal CCA at aneurysm level – 5.3mm was noted
• CT Angiogram showed SACCULAR ANEURSYM measuring 5.9 x 4.2 x 5.5 c 1cm below carotid bifurcation
• Neck of sac—3.5 mm
• After obtaining informed consent and fitness for surgery ,he was taken up for LEFT Common Carotid Artery stenting using COVERA 7X 60MM stent via Right Femoral Access .Procedure was uneventful ,there was no leak post stent deployment and no thrill on palpation (Date of surgery-29/11/2022)

Success story 5

ABHINAYA 13 year girl ,resident of Mayiladudurai, a K/c/o SLE with vasculitis/secondary APLA/Renovascular hypertension /Hypothyroidism- diagnosed in JIPMER 1 ½ months back was admitted with complaints of Bilateral lower limb pain and discoloration of bilateral forefoot. She was diagnosed to have Bilateral fempop disease/right tibial disease/left tibial occlusion /bilateral CLI. She was started on IV antibiotics, Inj LMWH, statins, antihypertensive medications ,thyroxine. Rheumatology call over given and was started on Steroids, HCQ, MMF. Regular review obtained; drugs titrated as per their advice. Nephrology call over given in view of renovascular hypertension advices followed, regular review opinions sought. Ophthalmology call over given and fundus examination done. Initially managed conservatively and waited for line of demarcation. Inj. prostaglandin infusion was given. Cardiology and thoracic medicine opinion sought and advices followed. Pain clinic anesthesia consultation done and advices followed. After obtaining Anesthesia fitness she underwent Left midfoot amputation on 07/01/2023. Postoperatively managed with antibiotics, analgesics, daily dressings, blood transfusion and other supportive measures. She underwent right forefoot amputation on 21/01/2023. Daily wound care and dressings done. Plastic surgery opinion sought and planned for SSG for raw area on left midfoot stump. After anesthesia fitness underwent left midfoot raw area SSG (01/02/2023). Serial review and graft monitoring, dressings done by plastic surgery. OBGY opiniontaken in view of amenorrhea and advices followed. Patient improved symptomatically and hence she was discharged in satisfactory condition

Success story 6

Mrs kalamalini,27 years lady ,known hypertensive and recently diagnosed CAD presented with c/o abdominal pain and distension x 1 week. Upon examination she was found to have a pulsatile mass over epigastrium extending to left hypochondrium,with tenderness .

She was evaluated by CT angiogram which showed, 9x8.5x6cm aneurysm extending just below celiac axis to infra renal level. Left kidney atrophic, Celiac origin, IMA-normal, SMA origin from aneurysm. In view of her raised inflammatory markers ,pulse steroid therapy was given .

After getting informed consent and fitness for surgery she was taken up for ENDOANEURYSMORHAPHY + RT RENAL ARTERY + SMA DACRON GRAFT BYPASS on 25/02/23,procedure was eventful . Distal pulses in the limbs were palpable. Her central venous catheter and abdominal drain were removed on POD 4 and was ambulated and tolerating normal diet. She was managed with regular wound dressings. Abdominal wound was healthy and Was discharged on POD 11.

Success story 7

Mr.Srinivasn 50year Gentleman ,Resident of Chennai,known Coronary Artery Disease presented with c/o abdominal pain localized to mesogastrium for 3 days associated with alternating loose stools and constipation for 1 week, he had melena 3 episodes , and has post prandial angina for past 4 months .

Upon examination his abdomen was Soft, tenderness+, Rebound tenderness+ all quadrants, Bowel sounds present .He was evaluated by CT angiogram which showed “Short segment complete occlusion of SMA trunk from its origin with reformation of its distal trunk and its branches through collaterals”.After obtaining informed consent and fitness for surgery he was taken up for - RETROGRADE AORTO-MESENTRIC BYPASS (INFRA-RENAL AORTA-SMA PTFE GRAFT REPAIR).

Procedure was uneventful ,patient recovered well in the post-operative period and started on Liquid diet o POD 3, & on solid diet on POD 5, he tolerated well, passed stools and was symptomatically better and discharged satisfactorily .