Aims/IntroductionWe devised a simple implementable color‐coded etiological key survey based on six significant categories to screen and manage all diabetic foot patients. The study results were analyzed to verify the impact of this survey.Materials and MethodsFirst we carried out a retrospective internal survey of all diabetic patients that presented to us during the period from January 2004 to January 2007. We used this analysis to develop the color‐coded etiological survey, and applied it to analyze patients prospectively for 5 years from May 2007 to May 2012. Out of 4,102 diabetic foot patients, 739 patients were referred by other medical facilities for major amputation as a result of the severity of their foot lesions. This group was then subjected to further analysis to study the value and impact of the survey on amputation‐free limb survival.ResultsBlood quality abnormalities were most prevalent followed by peripheral occlusive diseases, whereas tissue loss was the least. After the completion of the assessment process, management was implemented according to the defined protocol based on the lesions’ characteristics. The primary end‐point of major amputation‐free limb survival was achieved in 72.5% of patients, with an average hospital stay of 13.3 days. Statistical analysis of the etiological keys showed a significant impact of tissue loss, and previous foot surgery as a poor predictor of limb loss.ConclusionWe conclude that the implementation of the color‐coded etiological key survey can provide efficient and effective service to diabetic foot victims with comparable outcomes to dedicated diabetic foot clinics.

A trans-ascending aorta through-and-through guidewire is a feasible adjunct that can be added to the endovascular armamentarium when transcardiac or transbrachial approaches are impossible or ineffective.

Introduction: Vascular malformations are localized defects in vascular morphogenesis that are believed to be caused by dysfunction in embryogenesis and vasculogenesis. However, with the development of new vessel sealing devices, surgical removal of the vascular malformations can be safely undertaken. The aim of this study was to test the feasibility of vessel sealing devices in the complete excision of vascular malformations. Methods: We retrospectively analyzed medical records of all patients with vascular malformation who underwent a surgical excision of vascular malformations at our institution from January 2015 to June 2018. All patients were followed up after 1 week; 1, 3, 6 months; and 1 year. Results: We assessed 14 patients with vascular malformation (median age, 21 years; malformation: arteriovenous, n = 5; venous, n = 7; lymphatic, n = 1; and combined, n = 1). These vascular malformations were localized in the right lower (n = 5) and left upper (n = 3) limbs, right upper limb (n = 2), head and neck (n = 3), and chest wall (n = 1). Using vessel sealing instruments, the nidus in AVM was excised, and complete excision of vascular malformations was achieved without depriving the skin of dermal blood supply. One patient died three weeks later due to secondary hemorrhage. Complication related to gangrenous skin over the patella was healed by vacuum-assisted closure therapy. Post-excision MRI after 18 months suggested recurrence in one patient. Conclusion: The use of vessel sealing devices was found to be feasible, for surgical excision of vascular malformations. However, further evidence from larger studies, prefereably randomized controlled trials, is required to support the routine use of these devices. Highlights:

Summary: Background: The aim of this study is to evaluate perioperative as well as long-term outcomes in patients operated with carotid endarterectomy (CEA) or stenting (CAS) due to symptomatic or asymptomatic high-grade restenosis of the internal carotid artery (ICA). Patients and methods: In a retrospective analysis of our electronic database including 2980 patients who underwent carotid endarterectomy or stenting due to a symptomatic or asymptomatic high-grade stenosis of the ICA, between 2000 and 2016, we enrolled 111 patients with recurrent ICA stenosis. Results: An ipsilateral 2nd time restenosis (> 80 % in the asymptomatic and > 50 % in the symptomatic patients according to NASCET criteria) of ICA was detected in 13 patients (12 %); 3 of them were symptomatic. These patients were managed with either CEA (n = 5/38 %) or CAS (n = 8/62 %) with no perioperative stroke or death. The stroke-free survival rates at 2 and 8 years for CEA were 98 % and 98 % versus 100 % and 100 % for CAS respectively (P = .271). The type of the initial procedure (patch, CAS or interposition) did not play any significant role for the development of a 2nd time restenosis (P = .841). Conclusions: Redo-CEA/CAS seem to have similar results as primary procedures (as reported in the literature) with favorable periprocedural and long-term outcomes.

No abstract