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Peripheral Pseudoaneurysms in a Third World CountryDepartment of Vascular Surgery, Dow Medical College, and Civil Hospital, Karachi, Pakistan This preliminary report of an ongoing prospective trial that began in 1986 describes 95 peripheral pseudoaneurysms excluding intracranial and cardiac aneurysms. The majority of these aneurysms were located in the upper limbs. Firearm injury was the main cause, and the author found a high incidence of concomi tant neurological lesions. Relevant investigations included Doppler flow studies, arteriography, and electrophysiologic assessment for neurologic lesions. Where neurologic involvement, such as brachial plexus (BP) lesion, was present, a rad ical one-stage neurovascular reconstruction, after excision of the aneurysm, was undertaken. This usually involved sural nerve grafting for nerve defects. Long saphenous vein (LSV) was the most common vascular conduit used, but the author has also used cephalic vein and synthetic grafts in selected cases. The early results have been very good with respect to revascularization and amelioration of symptoms, but the reattendance rate of the patients under fol low-up was very poor. Although the limited early review of the results of both vascular and nerve grafts has been very satisfactory, these findings cannot be statistically generalized. The author found lack of patient education, peer bias, and poverty to be the main reasons for the poor follow-ups and delayed refer rals. His approach has been surgically aggressive to provide reliable improve ment within a short period of time.
Vascular and Endovascular Surgery, Vol. 27, No. 4,
253-263 (1993) |
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