Background: Endovenous laser ablation (EVLA) is one of the most accepted treatment options for gr... more Background: Endovenous laser ablation (EVLA) is one of the most accepted treatment options for great saphenous varicose veins. The aim of this study was to evaluate the efficacy and safety EVLA in a 12 months follow-up. Methods: Patients with symptomatic great saphenous veins (GSV) reflux were undergo EVLA. The outcome measures the efficacy and safety along the follow up period (12 months). The efficacy assessed by measuring the occlusion rate of the GSV by duplex and by measuring the improvement in the mean venous clinical severity score (VCSS) by clinical examination. The safety assessed by clinical examination to detect the complications. Results: The rate of complete occlusion in the main trunk of the great saphenous vein was 34/35 (97.1%) at 6 and 12 months. The mean VCSS scores improved significantly after the procedure at 6 and 12 months. Complications detected within 1 st week as pigmentation in 3 patients, local hematoma in one patient, and paresthesia in one patient but all complications disappeared within 6 and 12 months. Conclusions: EVLA is an effective and safe procedure for the treatment of varicose great saphenous.
ABSTRACTFoot ulcer is a major complication of diabetes mellitus and often precedes leg amputation... more ABSTRACTFoot ulcer is a major complication of diabetes mellitus and often precedes leg amputation. Among the different methods to achieve ulcer healing, the use of platelet‐rich plasma, which is rich in multiple growth factors and cytokines and may have similarities to the natural wound healing process, is gaining in popularity. A systematic review with meta‐analyses was performed to evaluate the safety and clinical effectiveness of platelet‐rich plasma for the treatment of diabetic foot ulcers compared to standard treatment or any other alternative therapy. The electronic databases Medline, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials were consulted in March 2017 with no restrictions placed on the publication date. Predefined criteria were used to determine inclusion of studies and to assess their methodologic quality. Eight randomized clinical trials and two prospective longitudinal‐observational studies with control group were included. Platelet‐rich plasma ...
Background: Critical limb ischemia (CLI) occurs due to progressive obstructive nature of atherosc... more Background: Critical limb ischemia (CLI) occurs due to progressive obstructive nature of atherosclerosis disease. Nowadays, there is widespread use of endovascular revascularization procedures for restoration of blood flow in CLI. The aim this study is evaluation of the efficacy of endovascular intervention for multilevel arterial disease in patients with critical limb ischemia.Methods: This prospective study was included CLI patients due to multilevel arterial disease who underwent endovascular revascularization between January 2016 and January 2017 in our institution. Study end points were limb salvage and wound healing. Results: The mean age of patients was (61.7±7.47) years, with 13 (61.9%) men. Eight limbs were identified as Rutherford category 4 (38.1%), ten limbs as Rutherford category 5 (47.6%), and three limbs as Rutherford category 6 (14.3%). Limb salvage rate was (90.5%) at 1 year. Wound healing rate was 80.9%.Conclusions: This study proved that endovascular revasculariz...
Background: A chronic wound can be defined as any wound that fails to heal within a reasonable pe... more Background: A chronic wound can be defined as any wound that fails to heal within a reasonable period. Platelet-rich fibrin (PRF) is a second-generation platelet concentrate. It is safe, simple, affordable and less expensive procedure in treatment of chronic wounds. Objective: This study aimed to assess safety and effectiveness of platelet-rich fibrin for treatment of chronic wounds. Patients and methods: This prospective study included 50 patients with chronic ulcer not responding to conventional therapy for at least 6 weeks, normal values blood tests especially platelet count, red blood cell count and serum albumin level. Debridement of the necrotic tissues was done using surgical and chemical debridement. The fibrin clot membrane was applied to the ulcer followed by paraffin gauze and secondary sterile dry dressing. Results: Complete wound healing occurred in 18 of 50 patients before 8th week of therapy (36%). A decrease in the mean area was observed from 7.22 ± 5.80 cm before tr...
Background Venous ulcer (VU) is a serious health problem that has no satisfactory treatment. Plat... more Background Venous ulcer (VU) is a serious health problem that has no satisfactory treatment. Platelet-rich fibrin (PRF) is one of regenerative medicines that promote wound healing by sustained release of growth factor (GF) and protein matrix for more than 7 days. Aim This study aims to evaluate the efficacy and safety of autologous leukocyte-platelet-rich fibrin (L-PRF) with venous leg ulcer. Patients and methods A randomized controlled study was conducted that included 36 patients with VUs. The eligible patients were enrolled in one of two groups (PRF and control groups) according to randomization schedule. Each group included 18 patients. The PRF group was treated with autologous L-PRF dressing, and dressing change was done once weekly. The control group was treated with conventional dressing of VU, but dressing change was done once in 2 days. Results The mean percentage of wound reduction of PRF group was found significantly higher than that of control group. There was a statistically significant difference between the PRF group and control group regarding the rate of completely healed ulcer at the fourth week for ulcer size less than 10 cm2 and at the seventh week for ulcer size more than 10 cm2. Conclusion Autologous L-PRF is effective and safe for treatment of venous leg ulcer.
Background Endovascular recanalization has become the preferred method of treatment for many pati... more Background Endovascular recanalization has become the preferred method of treatment for many patients with symptomatic femoropopliteal (FP) occlusive disease. Aim To study the efficacy of multiple level arterial angioplasty on limb salvage. Patients and methods This is a prospective, nonrandomized study that included 35 patients with critical lower limb ischemia due to multilevel arterial atherosclerotic occlusive disease treated with endovascular revascularization between August 2015 and July 2016 and followed up for 12 months. Primary outcome parameters included technical success proved by completion angiogram and distal pulse retrieval. Secondary outcome parameters included limb salvage, disappearance of the rest pain, wounds healing, and claudication distance improvement. Results Angiographically, 62.9% had both FP and infrapopliteal segment lesions while 37.1% had FP lesions only, and about 50% of our cases were Trans-Atlantic Society Consensus (TASC) II A. Technical success was recorded in 31 (88.6%) patients with failure to cross the lesion occurring in four (11.4%) patients. Cumulative limb salvage rates were 96.7, 90.3, and 80.6 at 3, 6, and 12 months, respectively. Conclusion The endovascular approach is safe and effective in the management of multilevel arterial atherosclerotic occlusive disease with high technical success rate and accepted percent of limb salvage for 1 year.
Now, it is known that one of the important pathophysiological mechanisms leading to recurrence of... more Now, it is known that one of the important pathophysiological mechanisms leading to recurrence of varicose veins after saphenofemoral junction (SFJ) ligation is postoperative neovascularisation at the level of the ligated saphenous stump. Neovascularization is detected after both primary and repeat surgery. This postoperative neovascularization at the level of the groin can be detected with duplex scanning.
Background: Endovenous laser ablation (EVLA) is one of the most accepted treatment options for gr... more Background: Endovenous laser ablation (EVLA) is one of the most accepted treatment options for great saphenous varicose veins. The aim of this study was to evaluate the efficacy and safety EVLA in a 12 months follow-up. Methods: Patients with symptomatic great saphenous veins (GSV) reflux were undergo EVLA. The outcome measures the efficacy and safety along the follow up period (12 months). The efficacy assessed by measuring the occlusion rate of the GSV by duplex and by measuring the improvement in the mean venous clinical severity score (VCSS) by clinical examination. The safety assessed by clinical examination to detect the complications. Results: The rate of complete occlusion in the main trunk of the great saphenous vein was 34/35 (97.1%) at 6 and 12 months. The mean VCSS scores improved significantly after the procedure at 6 and 12 months. Complications detected within 1 st week as pigmentation in 3 patients, local hematoma in one patient, and paresthesia in one patient but all complications disappeared within 6 and 12 months. Conclusions: EVLA is an effective and safe procedure for the treatment of varicose great saphenous.
Background: Endovenous laser ablation (EVLA) is one of the most accepted treatment options for gr... more Background: Endovenous laser ablation (EVLA) is one of the most accepted treatment options for great saphenous varicose veins. The aim of this study was to evaluate the efficacy and safety EVLA in a 12 months follow-up. Methods: Patients with symptomatic great saphenous veins (GSV) reflux were undergo EVLA. The outcome measures the efficacy and safety along the follow up period (12 months). The efficacy assessed by measuring the occlusion rate of the GSV by duplex and by measuring the improvement in the mean venous clinical severity score (VCSS) by clinical examination. The safety assessed by clinical examination to detect the complications. Results: The rate of complete occlusion in the main trunk of the great saphenous vein was 34/35 (97.1%) at 6 and 12 months. The mean VCSS scores improved significantly after the procedure at 6 and 12 months. Complications detected within 1 st week as pigmentation in 3 patients, local hematoma in one patient, and paresthesia in one patient but all complications disappeared within 6 and 12 months. Conclusions: EVLA is an effective and safe procedure for the treatment of varicose great saphenous.
ABSTRACTFoot ulcer is a major complication of diabetes mellitus and often precedes leg amputation... more ABSTRACTFoot ulcer is a major complication of diabetes mellitus and often precedes leg amputation. Among the different methods to achieve ulcer healing, the use of platelet‐rich plasma, which is rich in multiple growth factors and cytokines and may have similarities to the natural wound healing process, is gaining in popularity. A systematic review with meta‐analyses was performed to evaluate the safety and clinical effectiveness of platelet‐rich plasma for the treatment of diabetic foot ulcers compared to standard treatment or any other alternative therapy. The electronic databases Medline, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials were consulted in March 2017 with no restrictions placed on the publication date. Predefined criteria were used to determine inclusion of studies and to assess their methodologic quality. Eight randomized clinical trials and two prospective longitudinal‐observational studies with control group were included. Platelet‐rich plasma ...
Background: Critical limb ischemia (CLI) occurs due to progressive obstructive nature of atherosc... more Background: Critical limb ischemia (CLI) occurs due to progressive obstructive nature of atherosclerosis disease. Nowadays, there is widespread use of endovascular revascularization procedures for restoration of blood flow in CLI. The aim this study is evaluation of the efficacy of endovascular intervention for multilevel arterial disease in patients with critical limb ischemia.Methods: This prospective study was included CLI patients due to multilevel arterial disease who underwent endovascular revascularization between January 2016 and January 2017 in our institution. Study end points were limb salvage and wound healing. Results: The mean age of patients was (61.7±7.47) years, with 13 (61.9%) men. Eight limbs were identified as Rutherford category 4 (38.1%), ten limbs as Rutherford category 5 (47.6%), and three limbs as Rutherford category 6 (14.3%). Limb salvage rate was (90.5%) at 1 year. Wound healing rate was 80.9%.Conclusions: This study proved that endovascular revasculariz...
Background: A chronic wound can be defined as any wound that fails to heal within a reasonable pe... more Background: A chronic wound can be defined as any wound that fails to heal within a reasonable period. Platelet-rich fibrin (PRF) is a second-generation platelet concentrate. It is safe, simple, affordable and less expensive procedure in treatment of chronic wounds. Objective: This study aimed to assess safety and effectiveness of platelet-rich fibrin for treatment of chronic wounds. Patients and methods: This prospective study included 50 patients with chronic ulcer not responding to conventional therapy for at least 6 weeks, normal values blood tests especially platelet count, red blood cell count and serum albumin level. Debridement of the necrotic tissues was done using surgical and chemical debridement. The fibrin clot membrane was applied to the ulcer followed by paraffin gauze and secondary sterile dry dressing. Results: Complete wound healing occurred in 18 of 50 patients before 8th week of therapy (36%). A decrease in the mean area was observed from 7.22 ± 5.80 cm before tr...
Background Venous ulcer (VU) is a serious health problem that has no satisfactory treatment. Plat... more Background Venous ulcer (VU) is a serious health problem that has no satisfactory treatment. Platelet-rich fibrin (PRF) is one of regenerative medicines that promote wound healing by sustained release of growth factor (GF) and protein matrix for more than 7 days. Aim This study aims to evaluate the efficacy and safety of autologous leukocyte-platelet-rich fibrin (L-PRF) with venous leg ulcer. Patients and methods A randomized controlled study was conducted that included 36 patients with VUs. The eligible patients were enrolled in one of two groups (PRF and control groups) according to randomization schedule. Each group included 18 patients. The PRF group was treated with autologous L-PRF dressing, and dressing change was done once weekly. The control group was treated with conventional dressing of VU, but dressing change was done once in 2 days. Results The mean percentage of wound reduction of PRF group was found significantly higher than that of control group. There was a statistically significant difference between the PRF group and control group regarding the rate of completely healed ulcer at the fourth week for ulcer size less than 10 cm2 and at the seventh week for ulcer size more than 10 cm2. Conclusion Autologous L-PRF is effective and safe for treatment of venous leg ulcer.
Background Endovascular recanalization has become the preferred method of treatment for many pati... more Background Endovascular recanalization has become the preferred method of treatment for many patients with symptomatic femoropopliteal (FP) occlusive disease. Aim To study the efficacy of multiple level arterial angioplasty on limb salvage. Patients and methods This is a prospective, nonrandomized study that included 35 patients with critical lower limb ischemia due to multilevel arterial atherosclerotic occlusive disease treated with endovascular revascularization between August 2015 and July 2016 and followed up for 12 months. Primary outcome parameters included technical success proved by completion angiogram and distal pulse retrieval. Secondary outcome parameters included limb salvage, disappearance of the rest pain, wounds healing, and claudication distance improvement. Results Angiographically, 62.9% had both FP and infrapopliteal segment lesions while 37.1% had FP lesions only, and about 50% of our cases were Trans-Atlantic Society Consensus (TASC) II A. Technical success was recorded in 31 (88.6%) patients with failure to cross the lesion occurring in four (11.4%) patients. Cumulative limb salvage rates were 96.7, 90.3, and 80.6 at 3, 6, and 12 months, respectively. Conclusion The endovascular approach is safe and effective in the management of multilevel arterial atherosclerotic occlusive disease with high technical success rate and accepted percent of limb salvage for 1 year.
Now, it is known that one of the important pathophysiological mechanisms leading to recurrence of... more Now, it is known that one of the important pathophysiological mechanisms leading to recurrence of varicose veins after saphenofemoral junction (SFJ) ligation is postoperative neovascularisation at the level of the ligated saphenous stump. Neovascularization is detected after both primary and repeat surgery. This postoperative neovascularization at the level of the groin can be detected with duplex scanning.
Background: Endovenous laser ablation (EVLA) is one of the most accepted treatment options for gr... more Background: Endovenous laser ablation (EVLA) is one of the most accepted treatment options for great saphenous varicose veins. The aim of this study was to evaluate the efficacy and safety EVLA in a 12 months follow-up. Methods: Patients with symptomatic great saphenous veins (GSV) reflux were undergo EVLA. The outcome measures the efficacy and safety along the follow up period (12 months). The efficacy assessed by measuring the occlusion rate of the GSV by duplex and by measuring the improvement in the mean venous clinical severity score (VCSS) by clinical examination. The safety assessed by clinical examination to detect the complications. Results: The rate of complete occlusion in the main trunk of the great saphenous vein was 34/35 (97.1%) at 6 and 12 months. The mean VCSS scores improved significantly after the procedure at 6 and 12 months. Complications detected within 1 st week as pigmentation in 3 patients, local hematoma in one patient, and paresthesia in one patient but all complications disappeared within 6 and 12 months. Conclusions: EVLA is an effective and safe procedure for the treatment of varicose great saphenous.
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