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Background Occlusive lesions of superficial femoral artery (SFA) in endovascular candidate patients are treated with balloon angioplasty with or without stenting. Recently, introduction of drug-coated balloon (DCB) angioplasty as a superior treatment option to plain balloon (PB) has been challenging. Objective The purpose of this study was to compare the effectiveness of DCB versus PB angioplasty in chronic lower extremity ischemia patients. Patients and methods In this clinical trial, 2 groups were matched at baseline; among 68 patients with peripheral artery disease, 23 patients were treated by DCB and 45 by PB. They were followed up for 6 months. Our findings of ABI, Rutherford and WIFI class changes, mortality, limb amputation, re-intervention and primary patency (PP) were collected and analyzed in comparative fashion between 2 groups. Results Mean patients age was 68.5 years (77.9% male). At 6 months, the increase in ABI in DCB was 0.37 and in PB was 0.32 (P>0.05). Mean decrease in Rutherford class in DCB and PB were 2.56, 2.28 (P>0.05). Mean decrease in WIFI class in DCB and PB were 1.48, 1.11 (P>0.05). In DCB group, 1 (4.3%) limb amputation, 3 (13%) re-interventions and no mortality with 87% PP were seen. In PB group, 2 (4.4%) limb amputation, 7 (15.6%) re-interventions, 1 (2.2%) mortality with 84.4% PP were seen. Conclusion Treatment of occlusive lesions of SFA with DCB probably may leads to improvement in ABI, Rutherford and WIFI class, higher pp and lower rate of re-interventions. Since Rutherford class and pp in DCB group have improved during 6 months compared to 1 month follow up (in our study), this improvement seems to be more significant statistically in longer term of follow up. more...

Background: Access to arteries is one of the most appropriate approaches for helping chronic kidney diseases. Objectives: The aim of the present study was to evaluate the survey method of vascular surgery on the onset of ischemic limb syndrome following vascular access in dialysis patients. Methods: In this cross-sectional study, the population study was patients with end-stage renal disease (ESRD) referring to Ahvaz Golestan Hospital in 2018. Control of limbs temperature and comparison with the other side, before and after surgery, feeling cold by the patient, control of organs pulse and comparison with the other side, pain of organs comparing to the other side, pain during the dialysis, paresthesia, and movement failure and during dialysis, and organs atrophy-ulcer were measured. Results: In the present study, 294 patients, including 139 women (46.94%) and 156 men (53.06%), were studied. Ischemic steal syndrome (ISS) was observed in 20 patients, that 13 cases of them had benefited from fistula approach and 7 patients used graft approach. The most common observed ISS was related to brachiocephalic fistula approach (AVF-Brachiocephalic) and then graft in arm. In non-steal syndrome group, brachiocephalic fistula (AVF-Brachiocephalic) had the most common application. In the present study, there was no significant correlation between access method and underlying diseases of high blood pressure, diabetes, and cardiac ischemic diseases. Conclusions: One of the most important results of the present study was the highest existence of steal syndrome in brachiocephalic approach, which is confirmed by other studies. more...

This study was done to assess the risk factors associated with diabetic foot ulcer-free survival in patients with diabetes.Based on a prospective cohort study, ADFC (Ahvaz Diabetic Foot Cohort) study, carried out in a university hospital, all of the patients with diabetes were followed up for new diabetic foot ulcer (DFU). The time of ulcer development was final outcome during two years in the present study. To analyze the data, the variables were first evaluated by univariate analysis. Subsequently variables with P value0.2 were tested in multivariate analysis, using backward elimination multiple Cox regression.From among 605 eligible patients of ADFC study, 566 patients without foot ulcer were included for a 2- years follow-up. Thirty subjects (5.3%) developed DFU during the study course none of whom underwent amputation. The DFU-free survival rate was 0.945 over two years of follow-up. In final multivariate Cox regression analysis, the variables which remained in the model and had a statistically significant relationship with time to develop foot ulcer were: dyslipidemia, history of DFU or amputation, nephropathy callus formation in the feet and diabetes duration. Foot deformity and patients' training about self-care of their feet were statistically borderline significant.The DFU-free survival rate was 0.945 over two years of follow-up. In this study, independent risk factors associated with ulcer-free survival in diabetic foot patients were dyslipidemia, prior history of DFU or amputation, diabetic nephropathy, callus formation in the feet and diabetes duration. more...

Introduction: Chronic Kidney Disease (CKD) is a global health problem which is growing in prevalence. Hemodialysis is the most common treatment for end-stage renal disease (ESRD) which requires a permanent vascular access. Vascular accesses should have a good patency and low complication. Objectives: The present study aimed to compare side-to-side (STS) versus end-to-side (ETS) methods in antecubital arteriovenous fistulas in dialysis patients. Patients and Methods: In this randomized, single-blind clinical trial, 100 ESRD patients who scheduled for hemodialysis were divided into two groups. STS arteriovenous anastomosis was employed in one group and in the other, the ETS approach was conducted. Follow ups were done after 1, 8, and 24 weeks to detect fistula maturation and immediate or delayed complications. Results: The STS anastomosis group demonstrated higher rates of delayed maturation, vascular aneurism, and venous hypertension syndrome than ETS anastomosis group. The ETS group, however, showed higher rates of venous thrombosis and vascular stenosis. Overall, the rate of complications was 24% and 8% for STS and ETS anastomosis group respectively (P =0.03). Conclusion: In comparison, ETS arteriovenous fistulas involve less complications than STS method in ESRD patients. However, more thrombosis and stenosis detected by ETS method. ETS arteriovenous fistulas had less delayed maturation, aneurism, venous hypertension and overall complications than STS approach. ETS arteriovenous fistulas contributes to establishing a more stable connection to hemodialysis machine to conduct a more effective hemodialysis. more...

Central venous cannulation (CVC) is required for management of critically ill and hemodialysis patients which has different complications in conventional procedure. The aim of this study was to compare the outcomes and complication of central venous cannulation using both conventional and ultrasound guide. A randomized controlled trial study of 336 recently hospitalized hemodialysis patients was conducted (168 in intervention group and 168 in control group). CVC was done by an ultrasound machine in intervention group that the needle was inserted perpendicular to the skin under visualization on the US screen while CVC was performed by the conventional landmark approach in the other group. The time for insertion, attempts required, and complications were measured in both groups. Data were analyzed with ANOVA Repeated Measure. In intervention group 22 patients (13.09) required more than one attempt, while in the control group 75 patients (44.6) required more than one attempt. Statistically this difference was significant (P.V = 0.000). In the control group, arterial puncture was happened in 10 patients (5.9), and hematoma in 5 patient (2.9), while were 2 patients (1.1) and 1 patients (0.59) in the ultrasound group respectively (P.V = 0.04 and P.V = 0.05). The results of our study showed that USG approach took lesser time, required lesser attempts, and had lower incidence of complications for cannulation of the internal jugular vein. more...

Aims The aim of this study was to evaluate the prevalence of diabetic foot ulcer and its related risk factors. Materials and methods In this descriptive cross-sectional study, 605 patients with diabetes were evaluated in July 2014. A checklist was used to obtain demographic data, diabetes related data, past medical history, and physical examination data. Results The prevalence of diabetic foot ulcer was 6.4% (95% CI: 4.64–8.73). Seventeen cases of them were female (4.9%). In univariate analysis, the following variables had statistically significant relationship with DFU prevalence: diabetes duration, educational level, 10 g monofilament sensation, Ankle Brachial Index (ABI) and Body Mass Index (BMI). Patients' age, glycemic control and smoking did not show any significant relationship with DFU. After logistic regression analysis, the patients with decreased 10 g monofilament sensation had DFU more than patients with normal sensation (OR = 8.84, 95% CI: 3.5–22.3). Abnormal ABI increased the odds of DFU (OR = 5.6, 95% CI: 1.3–24.18). The DFU prevalence in patients with diabetes duration of 11–20 years, was more than patients with ≤5 years (OR = 3.8, 95% CI: 1.33–10.8).The odds of DFU development in educated patients compared with illiterate patients was 0.27(95% CI: 0.12–0.57). BMI had a significant relationship with DFU prevalence. The odds in overweight patients was 0.259(95% CI: 0.108–0.623) and in obese patients was 0.263 (95% CI: 0.1–0.687). Conclusion The prevalence of DFU was 6.4% in this study. Final associated risk factors of DFU were decreased 10 g monofilament sensation, abnormal ABI, diabetes duration, educational level and BMI. more...

We aimed to determine the pattern of drug use and the affective demographic factors in addicts in self-referred drug rehabilitation centers in Khuzestan province.It was a cross-sectional descriptive and analytic study which has done on 4400 addicts in self-referred drug rehabilitation centers in Khuzestan province from March 2014 to March 2015. The collected data were analyzed in SPSS version 22 software. Mean and standard deviation were calculated for continuous variables and the frequency and percentage frequency were calculated for nominal and classified variables, and also t-test, χ2 and ANOVA were used to examine the relationships between variables. The level of significance was considered less than 0.05.Finding has shown that 97.5% were male. The average age of subjects was 38.21 ±10.52. Most consumable drug in these people was opium (50.6%) and the main way of drug use was smoking (69.4%). In terms of motivation of using drug, in men were enjoyment and in women family problems had the highest relative percentage. The majority of subjects (67.2%) had a history of drug abandonment. The reason of referring to rehabilitation centers for treatment, types of using drug and the number of drug using, was significant difference between males and females (p0.05).The results have shown that it is necessary to consider some issues including of provincial drug policy and increasing awareness at different levels of society and making appropriate cultural and sports spaces in order to achieve the primary preventive goals.Określenie długoterminowych wzorców używania narkotyków i wpływających na nie czynników demograficznych u osób uzależnionych, dobrowolnie leczonych w ośrodkach leczenia uzależnień w prowincji Chuzestan.Zastosowano metodę badań przekrojowych, opisowych i analitycznych, którymi objęto 4400 osób uzależnionych, dobrowolnie przebywających w ośrodkach leczenia uzależnień w prowincji Chuzestan w okresie od marca 2014 r. do marca 2015 r. Zebrane dane poddano analizie za pomocą programu komputerowego SPSS w wersji 22. Odchylenia średnie i standardowe wyliczono dla zmiennych ciągłych, natomiast częstotliwość i częstotliwość procentową obliczano dla zmiennych nominalnych i klasyfikacyjnych. Do ustalenia relacji pomiędzy zmiennymi zastosowano testy t, χ2 oraz ANOVA. Poziom istotności określono na poziomie poniżej 0,05.Ustalono, że 97,5% osób badanych stanowili mężczyźni. Średni wiek badanych wynosił 38,21 ±10,52 roku. Najczęściej zażywanym narkotykiem było opium (50,6%), a głównym sposobem jego przyjmowania – palenie (69,4%). Najczęstszą motywacją do sięgnięcia po narkotyki była przyjemność (wśród mężczyzn) oraz problemy rodzinne (wśród kobiet). Większość badanych (67,2%) już wcześniej odstawiała narkotyki. Pomiędzy grupą mężczyzn a grupą kobiet stwierdzono statystycznie istotne (p0,05) różnice w zakresie powodów zgłoszenia się do ośrodka leczenia, sposobów stosowania narkotyków oraz częstotliwości ich zażywania.Uzyskane wyniki wskazują, że w celu osiągnięcia głównych celów profilaktycznych konieczne jest uwzględnienie wielu czynników, takich jak miejscowe przepisy dotyczące narkotyków, podnoszenie świadomości w poszczególnych warstwach społeczeństwa oraz zapewnienie odpowiedniej infrastruktury kulturalnej i sportowej. more...

Despite significant advances in the treatment of diabetic foot ulcers and below-the-knee critical ischemia, there are ongoing efforts to achieve a method with low complication, high success rate and persistence of long-term effects.was to examine the outcome of angioplasty in patients with below-the-knee critical ischemia referred to Hospital.. This semi-experimental study conducted on diabetics patients treated with PTA (Percutaneous transluminal angioplasty) with critical ischemia of lower limbs referred to Sina Hospital. After discharge, the patients were followed weekly for the first month and then monthly up to 12 months. The procedure short-term effects were examined through evaluation of wound healing as well as patients' recovery and pain relief, after one month. Given the distribution type, parametric and non-parametric test were used to compare the results before and after treatment. Pearson's correlation coefficient was used to determine the correlation between variables.. Twenty four patients participated in this study. The mean ankle-brachial index (ABI) at baseline was 0.55±0.17. A month after angioplasty, the index increased statistically significant to 0.93±0.16. The mean health score expressed by the patients at baseline was 5.48±1.39. A month after angioplasty, it was significantly increased (6.32±1.24). The mean pain score before enrollment was 6.68±2.52 (according to VAS scale). There was a significant decrease over time (3.45±1.13). The overall mean score of all patients at Rutherford Classification was 3.88±0.63 at baseline. During the 1st month and 6th month follow-up, it was changed to Class 0 that was statistically significant in the first month.. This study represents the mid-term outcomes of PTA. Although PTA treatment was associated with improved pain scores, satisfaction with health, classification of limb ischemia and diabetic foot ulcers, the effects only remain short-term and mid-term. However, long-term efficacy of PTA needs to be investigated further. more...

Avoidance of hand ischemia in the construction of prosthetic access for hemodialysis in diabetics that have no suitable vein for arteriovenous fistula is appreciated. Taper type may be an appropriately matched conduit to prevent its occurrence. This is a prospective controlled trial of 38 selected diabetics requiring hemodialysis, who were referred to our clinic during a period of 6 months. The aim of the study was to evaluate the efficacy of tapered grafts in preventing distal hand hypoperfusion and determining its most likely contributors. In 18 intervening cases, taper 4 mm × 7 mm and in twenty cases (control group), standard 6 mm polytetrafluoroethylene as straight Brachial-Axillary access was used. Graft flow rates, artery and vein diameters, and mean arterial pressure were included for evaluation. Within the control group, 11 patients (55%) (7 cases Grade 1, 3 Grade 2, 1 Grade 3) and in intervening group, 2 cases (11%) (Grade 1, Grade 3) developed Steal syndrome. There was no significant difference in the mean flow rates (P = 0.82). Increased risk of distal hypoperfusion was observed in the control group when flow rates were more than 1000 ml/min. Arterial diameters (P = 0.011) and mean arterial pressure (P = 0.05) were found to be important contributing factors. Taper grafts causes reduced incidence of distal hand hypoperfusion. When artery diameter was more...

Aim of the study was to comparison between internal jugular vs. subclavian vein cuffed tunnel catheter placement for dialysis. Material and methods Cases who required central venous catheter for dialysis were included in this study. Forty cases were included in this study and divided to two groups. Catheters were placed randomly in internal jugular vein or subclavian. Patients were followed for 6 months. Early and late complications of catheter's placement were recorded. Analysis was done using Spss ver 13.0 (Chicago, IL, USA). Results There were no significant differences between subclavian and internal jugular vein regarding occurrence of infection resulted in extraction or treatment. Also there were no significant differences regarding occurrence of thrombosis resulted in extraction or treatment. Failure rate was significantly higher in cases with internal jugular vein catheter compared to cases with subclavian vein catheter (p=0.04). Conclusion Failure rate was significantly higher in cases with internal jugular vein catheter compared to subclavian cathether. Subclavian catheter is more appropriate route for catheter placement. more...

This study describes two cases of cervical sympathetic schwannoma operated at department of vascular surgery and review the literature to clarify the demographic, diagnostic, and therapeutic features of these rare lesions for the first time. Two 32- and 59-year-old ladies both presenting with a painless cervical mass were referred to our service with the initial diagnosis of carotid body tumor. At the operation, mobile masses which could be easily dissected from the surrounding arteries and veins, except for the cervical sympathetic trunk were observed. Micro-surgical techniques helped us with removing the lesions with saving the sympathetic trunk in both cases. No permanent deficits were observed post-operatively in patients. Angiographic studies can provide the only pre-operative clues to diagnose a sympathetic schwannoma. Total removal of the lesion at the expense of sacrificing the sympathetic nerve is associated with minimal neurologic deficits which are well tolerated by the patient. more...

Background: Flow-mediated dilation (FMD) in terms of blood pressure is impaired and it seems that exercise training can improve it. The present study intended to compare flow-mediated dilation in patients with hypertension and normotensive people and examine the effect of exercise on it. Methods: In this semi-experimental study, 12 normotensive and 24 hypertensive middle-aged men (age: 49.66 ± 2.80 years, height: 174.16 ± 4.66 cm, weight: 81.08 ± 12.65 kg) were selected using convenience sampling method. Patients were randomly divided to equal groups; 12 for control (age: 52.08 ± 2.53 years, height: 173.75 ± 5.81 cm, weight: 80.08 ± 8.26 kg) and 12 for interval aerobic training (age: 50.50 ± 2.91 years, height: 173.4 ± 4.69 cm, weight: 85.2 ± 13.6 kg). The training included 12 weeks of treadmill interval aerobic running with 50 and 80% heart rate reserve for 2 and 1 minute, respectively, three times a week for totally 12 minutes each session. Each week, 3 minutes to 6th week and then, every two weeks, 3 minutes added to the training time. So that, training in the last two weeks was 36 minutes. Blood pressure and flow-mediated dilation were taken before and after the training period. The distribution normality of data was assessed using Shapiro-Wilk test. Findings: Independent t-test showed that flow-mediated dilation was lower in patients than in normotensive subjects (t = 4.469, P < 0.001). The analysis of variance with repeated measures showed that the training significantly reduced systolic blood pressure (F = 7.059, P = 0.015) and increased flow-mediated dilation (F = 13.63, P = 0.001). Conclusion: It seems that, flow-mediated dilation in patients with hypertension is impaired and these patients can do aerobic interval training to relieve pressure and improve endothelial function. more...