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Ghoneim B, Nash C, Akmenkalne L, Cremen S, Canning C, Colgan MP, O'Neill S, Martin Z, Madhavan P, O'Callaghan A. Staged treatment for pancreaticoduodenal artery aneurysm with coeliac artery revascularisation: Case report and systematic review. Vascular 2024; 32:162-178. [PMID: 36071691 DOI: 10.1177/17085381221124991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite being rare, pancreaticoduodenal artery aneurysms (PDAAs) carry a risk of rupture of up to 50% and are frequently associated with coeliac artery occlusion. METHODS PubMed and Embase databases were searched using appropriate terms. The systematic review was conducted according to PRISMA guidelines. RESULTS We present the case of a 2 cm pancreaticoduodenal artery aneurysm pre-operative angiography demonstrated that the coeliac artery was occluded and the pancreaticoduodenal artery was providing collateral blood supply to the liver. Treatment was a staged hybrid intervention inclusive of an aorto-hepatic bypass using a 6 mm graft, followed by coil embolisation of the aneurysm. We also present a systematic review of the management of PDAAs. Two hundred and ninety-two publications were identified initially with 81 publications included in the final review. Of the 258 peripancreatic aneurysms included, 175 (61%) were associated with coeliac artery disease either occlusion or stenosis. Abdominal pain was the main presentation in 158 cases. Rupture occurred in 111 (40%) of patients with only ten (3.8%) cases being unstable on presentation. Fifty (18%) cases were detected incidentally while investigating another pathology. Over half the cases (n=141/54.6%) were treated by trans arterial embolisation (TAE) alone, while 37 cases had open surgery only. Twenty-one cases needed TAE and a coeliac stent. Seventeen cases underwent hybrid treatment (open and endovascular). Sixteen cases were treated conservatively and in 26 cases, treatment was not specified. CONCLUSION PDAAs are commonly associated with coeliac artery disease. The most common presentation is pain followed by rupture. The scarcity of literature about true peripancreatic artery aneurysms associated with CA occlusive disease makes it difficult to assess the natural history or the appropriate treatment. Revascularisation of hepatic artery is better done with bypass in setting of median arcuate ligament compression and occluded celiac trunk.
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Affiliation(s)
- Baker Ghoneim
- Department of Vascular Surgery, St James Hospital, Dublin, Ireland
| | - Connor Nash
- Department of Vascular Surgery, St James Hospital, Dublin, Ireland
| | - Liga Akmenkalne
- Department of Vascular Surgery, St James Hospital, Dublin, Ireland
| | - Sinead Cremen
- Department of Vascular Surgery, St James Hospital, Dublin, Ireland
| | - Catriona Canning
- Department of Vascular Surgery, St James Hospital, Dublin, Ireland
| | - Mary P Colgan
- Department of Vascular Surgery, St James Hospital, Dublin, Ireland
| | - Sean O'Neill
- Department of Vascular Surgery, St James Hospital, Dublin, Ireland
| | - Zenia Martin
- Department of Vascular Surgery, St James Hospital, Dublin, Ireland
| | - Prakash Madhavan
- Department of Vascular Surgery, St James Hospital, Dublin, Ireland
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Said M, Ghoneim B, Jones J, Tawfick W. The effects of sedentary behaviour on patients with peripheral arterial Disease: A systematic review. Prev Med Rep 2023; 36:102424. [PMID: 37810263 PMCID: PMC10556819 DOI: 10.1016/j.pmedr.2023.102424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/28/2023] [Accepted: 09/14/2023] [Indexed: 10/10/2023] Open
Abstract
Sedentary behavior has recently emerged as a risk factor for cardiometabolic diseases. The objective of this review was to assess the relationship between sedentary behavior and peripheral arterial disease (PAD). Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, we performed an electronic search across databases including Cochrane Central Register of Controlled Trials, Embase, MEDLINE (Ovid), CINHAL and PubMed to identify studies focusing on sedentary behavior and PAD. A total of 678 records fulfilled eligibility; 166 duplicates were removed, 487 were excluded at the title and abstract level and 15 studies were excluded at the full article level. Thus, our review comprised 10 studies of 20,064 patients with mean age 67.4 years. The average sedentary time was 544.9 min/day. The current review findings indicate that patients with PAD exhibited prolonged periods of sedentary behavior. Furthermore, sedentary behavior among patients with PAD was associated with lower survival rates. The included studies also reported varied outcomes regarding walking distance with some showing an association between reduced sedentary behavior and increased total walking distance. A randomized controlled trial in this review highlighted that reducing sedentary time among patients with PAD improved walking distance. Therefore, the connection between sedentary behavior and PAD seems to be bidirectional. Sedentary time could contribute to PAD development, and PAD-related symptoms may lead to prolonged sedentary behavior. A call for research investigating the link between PAD and sedentary time. Additionally, intervention studies are needed to target the reduction of sedentary time in patients with PAD.
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Affiliation(s)
- Marwa Said
- School of Medicine, University of Galway, Ireland
| | | | - Jennifer Jones
- School of Medicine, University of Galway, Ireland
- National Institute for Prevention and Cardiovascular Health, Ireland
| | - Wael Tawfick
- School of Medicine, University of Galway, Ireland
- National Institute for Prevention and Cardiovascular Health, Ireland
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Abstract
OBJECTIVES Few studies have reported on the safety and durability of adipose-derived stem cells (ADSCs) to support healing in patients with venous leg ulcers (VLU). To establish if there is any evidence to support ADSC use in VLU patients, a systematic review was conducted. METHODS A systematic review was conducted following the PRISMA guidelines. PubMed and Embase databases were searched for relevant papers. References from retrieved papers were reviewed to identify any extra eligible studies. RESULTS After duplicate removal, 950 papers were screened for eligibility of which 932 were excluded based on title and abstract. Four papers were included in the final analysis (one randomised study and three non-randomised studies). 66 patients in total received ADSCs for VLU treatment. The only randomised paper reported 6-month healing rates of 75% with ADSCs compared to 50% in controls. 100% healing was achieved in one study. The remaining 2 studies reported 25% and 58% healing; however, they included patients with relatively large VLUs. Pain scores decreased after ADSCs application where reported. No serious procedure related complications were reported. CONCLUSION ADSCs may enhance ulcer healing in patients with chronic VLU and appears safe based on initial reports. Large, randomised trials are needed to definitively establish the technique's role in VLU patients.
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Affiliation(s)
- Mohamed Elsharkawi
- Department of Vascular Surgery, University College Hospital Galway, Galway, Ireland
| | - Baker Ghoneim
- Department of Vascular Surgery, University College Hospital Galway, Galway, Ireland
- Department of Vascular Surgery, Cairo University Hospital, Cairo, Egypt
| | - Daniel Westby
- Department of Vascular Surgery, University College Hospital Galway, Galway, Ireland
| | - Deirdre Jones
- Department of Plastic Surgery, University College Hospital Galway, Galway, Ireland
| | - Wael Tawfick
- Department of Vascular Surgery, University College Hospital Galway, Galway, Ireland
| | - Stewart R Walsh
- Department of Vascular Surgery, University College Hospital Galway, Galway, Ireland
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Elsharkawi M, Ghoneim B, O'Sullivan M, Lowery AJ, Westby D, Tawfick W, Walsh SR. Role of Adipose Derived Stem Cells in Patients with Diabetic Foot Ulcers: Systematic Review and Meta-Analysis of Randomised Controlled Trials. INT J LOW EXTR WOUND 2023:15347346231174554. [PMID: 37170536 DOI: 10.1177/15347346231174554] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Few studies to date have investigated the role of adipose derived stem cells (ADSCs) in patients with diabetic foot ulcers (DFU). We aimed to conduct a systematic search of the literature to explore the available evidence behind ADSCs application in patients with DFU to establish if it has any added benefit regarding healing rate and healing time in this cohort of patients. The PubMed and Embase databases were searched for eligible studies. Only randomised controlled trials which investigated the impact of ADSCs alone on the healing of DFU were considered eligible and were included for the review. Reported healing rates, time to healing and procedure related complications were collected and analysed. The initial search resulted in 160 papers. Following duplicate removal, 131 papers were screened for eligibility. Only four trials met the study criteria and were included for the final review and analysis. 97 out of 189 patients who were included in the four studies received ADSCs for treatment of DFU whereas the remaining 92 patients received standard measures (control). The median participant age was 62, predominantly male (72.5%). Complete healing was achieved in 83.5% (n = 81) of patients in the ADSC group compared to 52% (n = 48) for patients in the control group at 12 months (OR = 4.8, 95%CI = 2.25 to 10.24, P < 0.0001). Mean healing time in the ADSC group ranged from 31 to 85 days whereas mean healing time in the control group ranged from 42 to 85 days (Pooled weighted mean difference = -10.832856, 95%CI = -22.44 to 0.77, P = 0.0673). No significant procedure related complications were reported in either group. The use of ADSCs in patients with DFU appears to demonstrate improved healing rates. The procedure of ADSC harvest and administration appears to be safe based on the initial reports. Large, randomised trials are needed to establish its role in patients with diabetic foot wounds.
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Affiliation(s)
- Mohamed Elsharkawi
- Department of Vascular Surgery, Galway University Hospital, Galway, Ireland
| | - Baker Ghoneim
- Department of Vascular Surgery, Galway University Hospital, Galway, Ireland
- Department of Vascular Surgery, Cairo University Hospital, Egypt
| | - Miriam O'Sullivan
- Department of Vascular Surgery, Galway University Hospital, Galway, Ireland
| | - Aoife J Lowery
- Discipline of Surgery, University of Galway, Galway, Ireland
| | - Daniel Westby
- Department of Vascular Surgery, Galway University Hospital, Galway, Ireland
| | - Wael Tawfick
- Department of Vascular Surgery, Galway University Hospital, Galway, Ireland
| | - Stewart R Walsh
- Department of Vascular Surgery, Galway University Hospital, Galway, Ireland
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Westby D, Ghoneim B, Elsharkawi M, Nolan F, Walsh SR. Systematic Review and Meta-Analysis of Venous Thromboembolism in Patients Undergoing Hip or Knee Arthroplasty with Pre-Existing Varicose Veins. Eur J Vasc Endovasc Surg 2022. [DOI: 10.1016/j.ejvs.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Elsharkawi M, Ghoneim B, Elsherif M, Sultan S. Bilateral external carotid artery stenting in symptomatic patient with complete occlusion of both internal carotid arteries. Clin Case Rep 2021; 9:540-542. [PMID: 33489211 PMCID: PMC7813021 DOI: 10.1002/ccr3.3577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 10/19/2020] [Accepted: 11/03/2020] [Indexed: 11/08/2022] Open
Abstract
Completely occluded ICA should not always turn a symptomatic patient down for surgical intervention especially if medical treatment fails. Where bilateral ECA intervention is required, endovascular approach should be considered if feasible.
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Affiliation(s)
- Mohamed Elsharkawi
- Department of Vascular & Endovascular SurgeryGalway University HospitalNational University of IrelandGalwayIreland
| | - Baker Ghoneim
- Department of Vascular & Endovascular SurgeryGalway University HospitalNational University of IrelandGalwayIreland
| | - Mohamed Elsherif
- Department of Vascular & Endovascular SurgeryGalway University HospitalNational University of IrelandGalwayIreland
| | - Sherif Sultan
- Department of Vascular & Endovascular SurgeryGalway University HospitalNational University of IrelandGalwayIreland
- Department of Vascular and Endovascular SurgeryGalway ClinicGalwayIreland
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Ghoneim B, Elsherif M, Elsharkawi M, Acharya Y, Hynes N, Tawfick W, Sultan S. Outcomes of Unibody Bifurcated Endograft and Aortobifemoral Bypass for Aortoiliac Occlusive Disease. Vasc Specialist Int 2020; 36:216-223. [PMID: 33361542 PMCID: PMC7790696 DOI: 10.5758/vsi.200051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/01/2020] [Accepted: 11/23/2020] [Indexed: 11/20/2022] Open
Abstract
Purpose We compared the outcomes between the total endovascular approach using a unibody bifurcated aortoiliac endograft and the gold standard aortobifemoral bypass (ABF) surgery for the management of extensive aortoiliac occlusive disease (AIOD). Methods Materials and This retrospective observational study compared the outcomes of endovascular technique with unibody bifurcated endograft (UBE) using the Endologix AFX unibody stent-graft and a standard surgical approach (ABF) in the management of AIOD based on patient records in Western Vascular Institute, Galway University Hospital, National University of Ireland. Procedural details and outcomes were documented to compare both groups. Results From January 2002 to December 2018, 67 patients underwent AIOD (20 UBE and 47 ABF). Both the ABF and UBE groups showed 100% immediate clinical and technical successes without 30-day mortality. There were no statistical differences in the overall survival and sustained clinical improvement between the bypass and the UBE groups; however, statistically significant differences were observed in 3-year freedom from re-intervention and amputation-free survival. Furthermore, the mean length of the intensive care unit (ICU) stay was significantly lower in the UBE group than that in the ABF group (0.75 days vs. 3.1 days, P=0.001). Conclusion Total endovascular reconstruction of AIOD is an alternative to invasive bypass procedures, with a shorter ICU stay.
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Affiliation(s)
- Baker Ghoneim
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, Galway University Hospital, Galway, Ireland.,Department of Vascular Surgery, Cairo University Hospitals, Cairo, Egypt
| | - Mohamed Elsherif
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, Galway University Hospital, Galway, Ireland
| | - Mohamed Elsharkawi
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, Galway University Hospital, Galway, Ireland
| | - Yogesh Acharya
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, Galway University Hospital, Galway, Ireland.,Department of Vascular surgery, Galway Clinic, Galway, Ireland
| | - Niamh Hynes
- Department of Vascular surgery, Galway Clinic, Galway, Ireland
| | - Wael Tawfick
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, Galway University Hospital, Galway, Ireland
| | - Sherif Sultan
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, Galway University Hospital, Galway, Ireland.,Department of Vascular surgery, Galway Clinic, Galway, Ireland
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Ghoneim B, Nasser M, Elwan HO. Outcome of angioplasty of occluded arteriovenous fistula for hemodialysis: single center experience. Ital J Vasc Endovasc Surg 2019. [DOI: 10.23736/s1824-4777.18.01376-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ghoneim B, Hafez BA, Aboollo MF, Karmota AG, Elwan HO. Outcome of endovascular stent grafting versus open surgical repair in traumatic thoracic aortic injury. Ital J Vasc Endovasc Surg 2019. [DOI: 10.23736/s1824-4777.18.01374-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ghoneim B, Younis S, Elmahdy H, Elwan H, Khairy H. Endovascular intervention in flush superficial femoral artery occlusive disease: challenges and outcome. Ital J Vasc Endovasc Surg 2019. [DOI: 10.23736/s1824-4777.18.01368-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ghoneim B, Canning P, Hynes N, Tawfick W, Sultan S. AAN 5. Internal Iliac Artery Sacrifice During Endovascular Aneurysm Repair. J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2018.08.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Ghoneim B, ElSherif M, Sharkawi ME, Hynes N, Tawfick W, Canning P, Sultan S. LEO 1. Total Endovascular Management of Aortoiliac Occlusive Disease. J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2018.08.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ghoneim B, Eldaly W, Elwan H, Taha A. Endovascular Management of Flush Common Iliac Artery Occlusive Disease: Challenges and Solutions. Int J Angiol 2017; 26:20-26. [PMID: 28255211 DOI: 10.1055/s-0036-1584902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
The aim of this study was to assess the difficulties met with possible recommendations in management of flush common iliac artery occlusive disease (FCIAOD). This a prospective study assessing FCIAOD along the period of 24 months. We defined FCIAOD as more than 90% occlusion of diameter of common iliac artery (CIA) with less than 2 mm patent iliac stump from its origin from the abdominal aorta. Our study included 51 cases. Technical success was achieved in 47 patients (92%); 82.5% of cases were done via two accesses (65% of cases were done using bilateral femoral). Primary stenting was done in all cases. Sixty-eight percent of cases were treated by unilateral stents (81.3% of them were done using self-expandable) and 32% of cases were treated by kissing stents (50% using self-expandable). Prestent dilatation was selectively used in 77% of cases. Follow-up (12 months) revealed primary patency of 82.5% and secondary patency was 98% with no amputation done. Mortality rate was 4%. Endovascular treatment provides a successful option for the management of FCIAOD with a technical success rate of 92%, the option of selective use of prestent dilatation. FCIAOD does not preclude the use of unilateral stent in CIA, which can be completed to kissing stents if needed.
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Affiliation(s)
- Baker Ghoneim
- Vascular Surgery Unit, Cairo University, Giza, Egypt
| | - Walied Eldaly
- Vascular Surgery Unit, Cairo University, Giza, Egypt
| | - Hussein Elwan
- Vascular Surgery Unit, Cairo University, Giza, Egypt
| | - Ahmed Taha
- Vascular Surgery Unit, Cairo University, Giza, Egypt
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Ghoneim B, Elwan H, Eldaly W, Khairy H, Taha A, Gad A. Management of critical lower limb ischemia in endovascular era: experience from 511 patients. Int J Angiol 2014; 23:197-206. [PMID: 25317033 PMCID: PMC4172447 DOI: 10.1055/s-0034-1382825] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
This study aims at the assessment of the achievability of the endovascular treatment of patients with critical limb ischemia (CLI) and the role of bypass in such patient. This is a prospective study conducted on patients with chronic atherosclerotic critical lower limb ischemia presenting to us over a period of 3 years. Patients presenting with nonsalvageable limbs requiring primary major amputation and nonatherosclerotic causes of CLI were excluded. Endovascular treatment was the first choice modality of treatment in revascularization of all patients. Open surgery was offered selectively for patient whom endovascular failed or complicated and for long TransAtlantic Inter-Society Consensus (TASC) II lesions in fit patients. This study included 511 cases of CLI, and the mean age was 64.5 years. Patients with Rutherford IV, V, and VI were 19.25, 60.5, and 19.25%, respectively. The TASC II aortoiliac lesions were as follows: A, B, C, and D in 33.7, 12,15.7, and 38.6%, respectively, and infrainguinal lesions were A, B, C, and D in 3.7, 19, 35.4, and 68.3%, respectively. A total of 78.3% of patients were treated by endovascular totally, while 16% were treated by surgery from the start, 3.7% of endovascular cases were converted to open surgery after failure of endovascular treatment, and 2% was offered hybrid treatment. Crossing of lesions by subintimal and intraluminal was 12.5 and 87.5%, respectively. Technical success in endovascular was 94%; however, we could successfully revascularize 96.8% of all CLI presented in this study by either surgery or endovascular. On 24 months follow-up, primary patency, secondary patency, and limb salvage by percutaneous transluminal angioplasty are 77.8, 84.7, and 90.7%, respectively. Revascularization by endovascular achieves high technical success and limb salvage in CLI, hence should be considered as preferred choice of treatment. However, both endovascular and surgery should not be counteracting each other and using both can revascularize 96.6% of CLI.
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Affiliation(s)
- Baker Ghoneim
- Vascular Surgery Unit, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Hussein Elwan
- Vascular Surgery Unit, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Waleed Eldaly
- Vascular Surgery Unit, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Hussein Khairy
- Vascular Surgery Unit, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Ahmad Taha
- Vascular Surgery Unit, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Amr Gad
- Vascular Surgery Unit, Faculty of Medicine, Cairo University, Giza, Egypt
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