Transmetatarsal amputation (TMA) for peripheral vascular disease has the reputation of being an operation with a poor outcome. This retrospective study reviewed a 3-year consecutive series of TMA in diabetic and nondiabetic patients. All amputations performed for peripheral vascular disease at Groote Schuur Hospital from January 1999 to December 2002 were reviewed. Data were obtained from hospital records and operating theatre books. The following groups were defined for the purpose of this retrospective study: group 1, TMAs performed in diabetic patients; group 2, TMAs done in nondiabetic patients. Altogether, 43 TMAs were performed: 27 in group 1 and 16 in group 2. Perioperative mortality rates were 7% and 4%, respectively. Overall, the healing rate was 67%: 62% (17/27) in group 1 and 75% (12/16) in group 2. The median times to healing were 8 months in group 1 and 7 months in group 2. Toe pressure and the presence of advanced tibioperoneal disease influenced the outcome of TMA in diabetic patients. Transmetatarsal amputation with a healed stump provided our patients with good mobility. Prediction of healing after operation is unreliable. There was no statistical difference in outcome in diabetic (group 1) versus nondiabetic (group 2) patients.

Despite the paucity of long-term, durable data, stent graft repair has emerged as a safe and feasible alternative to open repair of trauma-related subclavian and axillary vascular injuries (SAVIs). Surgical treatment is often attended by high morbidity and mortality rates (5-30%). [1,2] Indeed, some have suggested that stent graft repair should be considered as first-line treatment for trauma-related SAVIs. Peripheral stent grafting evolved as a complementary treatment strategy since 2008 at Groote Schuur Hospital, Cape Town, for select patients with vascular trauma. Methods All patients considered endosuitable were counselled about the procedure, and the need for diligent follow-up was emphasised. Consent was obtained from all patients. The procedure was performed either in an interventional angio suite under local anaesthesia or in the operating theatre (OR) under general anaesthesia. Estimation of stent graft diameter and length was obtained from preoperative imaging modalities that included catheter angiography, duplex ultrasound (DUS) or computed tomography angiography (CTA). A range of stent grafts of different diameters and lengths was available at the time of the procedure. Access for deployment was obtained via percutaneous or 'cut-down' (femoral or brachial) approaches. When using femoral access, long systems were utilised (guidewires; balloon and stent catheters; long, appropriately sized sheaths). Heparin was given prior to lesion crossing and stent graft deployment in all cases. We maintained the habit of balloon moulding, a requirement for some older-generation

Introduction Ankle/brachial indices are inaccurate in the presence of calcification, and physicians may rely on the measurement of digital pressures. As the population continues to age and with the escalation in type 2 diabetes, the importance of, and reliance on, toe pressure measurements will increase. The aim of this study was to assess the reproducibility of toe pressure measurements in a single vascular laboratory. Methods Repeated ankle/brachial indices and toe pressures were measured in 20 patients (10 with known peripheral vascular disease and 10 with aneurysmal or carotid artery disease but no history of PVD), and 10 control patients. Three measurements were made 48 hours apart. All measurements were made by a single vascular technologist. Reproducibility was assessed by the use of the repeatability coefficient and the intraclass correlation coefficient. Results Ankle/brachial indices ranged from 0.36 to 2.4, toe pressures from 18 mmHg to 173 mmHg, and toe/brachial indices from 0.11 to 1.1. The repeatability coefficient showed no significant difference between measurements ( p > 0.1) and the intraclass correlation coefficient estimates showed high agreement between repeated measurements (0.77–0.99). Bland-Altman plots indicated that the observer variability was equally distributed across the range of pressure measurements. Conclusion These results confirm the intraobserver reproducibility of toe pressure measurements; however, further work is required to demonstrate inter-observer reproducibility.