Journal of Cardiovascular Medicine and Surgery

Angina pectoris is defined as substernal chest pain, pressure, or discomfort that is typically exacerbated by exertion and/or emotional stress, lasts greater than 30 to 60 seconds, and is relieved by rest and nitroglycerin. There are approximately 10 million people in the United States who have angina, and there are over 500000 cases diagnosed per year. Several studies now show that angina itself is a predictor of major adverse cardiac events. In addition, angina is a serious morbidity that impedes quality of life and should be treated. In the United States, pharmacologic therapy for angina includes β-blockers, nitrates, calcium channel blockers, and the late sodium current blocker ranolazine. In other countries, additional pharmacologic agents include trimetazidine, ivabradine, nicorandil, fasudil, and others. Revascularization is indicated in certain high-risk individuals and also has been shown to improve angina.

Introduction: Pseudo aneurysms occur due to injury to arterial wall. Due to sustained arterial pressure, blood dissects into the tissues around the damaged artery and forms a perfused sac that communicates with the arterial lumen. The perfused sac contains media or adventitia or simply soft tissue structures surrounding the injured vessel. Material and Methods: We analysed 32 patients who underwent surgical AVF takedown after formation of pseudo aneurysm at our centre over a period of 3 years between September 2018 to September 2021. Results: 32 patients (26 males and 6 females) underwent takedown of AVF during this 3 years period. 22 (84.62%) had fistula on their left arm as compared to 4 (15.38%) having fistula on their right arm. 21 (80.76%) were brachiocephalic fistulas while the remaining 5 (19.24%) were radio cephalic. 25 (78.12%) presented as pseudo aneurysms with a risk of impending rupture, while 7 (21.88%) presented with aneurysmal rupture. 14 (43.75%) underwent the procedure under axillary block, 18 (56.25%) were operated under local anaesthesia and minimal sedation. Mean operative time was 75.72 ± 24.27 min. 26 (81.25%) underwent excision of aneurysm with ligation of proximal and distal end of arteries while 6 (18.75%) underwent arterial reconstruction with venous interposition grafting. Mean duration of hospital stay was 3.4 days with a maximum of 7.2 days. 6 of our patients had post op wound infection. All patients had good distal pulsations in the postoperative period. Conclusion: Pseudo aneurysms pose threat to both limb and life. Planning is necessary for properly managing these patients. Though surgical excision of aneurysm with reconstruction of vessel has remained definite treatment for impending and ruptured Pseudo aneurysms, however in our experience most of our patients didn’t need reconstruction as collaterals had already formed and no patient had post operative ischemia after proximal and distal ligation of artery along with excision of aneurismal tissue.

The application of “negative pressure” has evolved to a cornerstone in the treatment of acute and chronic wounds in almost all specialties. Continuous Intermittent, and cyclic are the three types of Negative pressure Wound Therapy (NPWT). The cyclic NPWT system is similar to the intermittent mode in terms of using the same maximal sub-atmospheric pressure, but the pressure never reaches zero in the cyclic mode. The study assesses the role of cyclical Negative pressure wound therapy in adult burn wound healing.