Vascular Surgery

Sanjay Singh has expertise and passion in vascular and endovascular surgery. He has done complex aortic endovascular fellowship and is a vascular consultant working in United Kingdom. His open and contextual surgical techniques are based on researched and practiced models which help create new pathways for innovation. He has achieved this aptitude after years of experience in research and teaching in University hospitals and institutions. The ever-responsive and adapting field of endovascular surgery has improved the survival rates of high risk patients.

Mycotic abdominal aortic aneurysm (MAAA) is a rare but life-threatening condition with an incidence of about 0.65-2% of all aortic aneurysms. MAAA have poor prognosis as they have tendency to grow rapidly and rupture and the patients often have severe comorbidities and coexisting septic conditions. Conventional surgical treatment is open surgery but is associated with high morbidity and mortality and can be very demanding or even impossible. Endovascular aneurysm repair (EVAR) is a less invasive but controversial alternative to conventional open repair of MAAA. A major disadvantage of EVAR is that the infected tissue, including the aneurysm itself, is not resected, which may facilitate reinfection, recurrent sepsis, and infection of the endoprosthesis. Methodology: Three cases of MAAA are described; all treated with endovascular stent graft with variable configurations (2 cases treated with EVAR and 1 with surgeon modified Fenestrated EVAR). The clinical diagnosis of MAAA, was made by clinical presentation, results of hematologic tests and culture, and CT findings. All cases grew streptococcus pneumoniae on blood culture. All patients underwent successful placement of stent grafts for their aneurysms. All patients were given antibiotics preoperatively and postoperatively, initially with broad-spectrum antibiotics intravenously and later, when discharged from the hospital, oral treatment guided by culture results, when available. Antibiotic therapy was administered after consultation with infectious disease specialists. No 30-day postoperative mortality was observed. Conclusion: Our short- term review shows that repair of MAAA can be accomplished with endovascular repair. This may be a safer alternative to open repair particularly in patients who are not suitable for conventional open repair

Assem is a junior cosultant vascular surgeon in Matarya Teaching Hospital ;Cairo;Egypt.one of the big vascular centres in Egypt.\r\nHe has a fair experience in both open and endovascular procedures.MSC.MRCS .& M.D\r\n

Objective;; to evaluate the efficiency of the hemodialysis catheter in the femoral tunnel as durable access for patients with hemodialysis.\r\nIntroduction; Vascular access (VA) continues to be the keystone in cases requiring hemodialysis (HD). When the choices of arterial venous fistula, grafts, and thoracic central catheters are depleted, the case\'s life becomes at risk. The extra options are limited to transplantation, peritoneal dialysis, insertion of the trans lumbar and femoral catheter. The Last may, in lots of cases, be the best choice. We present our experience at the Matarya Teaching Hospital with 17 cases where all vascular accesses was depleted and no transplant or peritoneal dialysis could be performed. Therefore, we chose the femoral tunnel catheter (FTC) as VA durable and unique. The median follow-up period was 10 months (2-14 months). The median age of cases was 55 (40-70) years. In ten cases, a Permcath (Hickman access system, BARD) and the other seven are inserted (DURAFLOW, from AngioDynamics). All cases received warfarin after passing LMWH to prevent thrombosis of the catheter. All catheters were functional for 2 months. The mean blood flow was 230 ml / min (200-260 ml / min). Two cases died at 5 and 12 months respectively with a functional catheter due to causes not directly related to the FTC. In a patient, the site of the catheter was changed to 5 months due to an accidental catheter slipping. A catheter has been changed because the flow has become inadequate after 8 months. No patient had deep vein thrombosis. In one patient, the catheter was operated for 14 months after insertion.\r\nWe conclude that the femoral catheter in the tunnel is a stable option in cases with depleted VA.\r\n