Objective : Venous thromboembolism (VTE) includes deep vein thrombosis (DVT) and pulmonary embolism (PE). VTE affects all races, age groups, and genders. The objective of this registry was to analyze the patient characteristics, clinical outcomes, management strategies, and temporal trends in VTE at a single center. Materials and Methods : Consecutive medical records of inpatients between January 2007 and March 2018, meeting the inclusion criteria (confirmed diagnosis of DVT by Doppler ultrasound scan and/or PE by chest computed tomography) were identified and collected. A total of 1,024 patients were reviewed. Results : Eight hundred and twelve patients with VTE were enrolled into the study; 37.4% were referrals from outside hospitals, 33.1% of the total patients had no risk factors, hence classified as unprovoked VTE and the rest of the patients had single or multiple risk factors which may have provoked the VTE, 68.8% presented with swelling and pain, and 88.5% had proximal DVT. Conclusion : VTE is no longer a rare phenomenon in the Indian population, as believed earlier. The knowledge of VTE, prophylaxis, and treatment strategies is minimal among small institutes, nursing homes, and among general practitioners who are not affiliated with teaching institutes. Therefore, educating primary care physicians/surgeons on VTE is paramount, as this would reduce the incidence of VTE in India as well as associated morbidity and mortality rates.

Background: High triglycerides (TG) and low High density Lipoproteins (HDL) are established coronary risk predctors (ratio of 3:1 being associated with definite increase in coronary risk). The TG/HDL ratio has also been established as a predictor of major cardio vascular events, insulin resistance and metabolic syndrome. However, the utility of the same in predicting worsening of peripheral vascular disease remains under-researched. Aims and Objectives: We aim at establishing TG/HDL ratio as a predictor of peripheral arterial disease in diabetic patients and to also explore the role of triglycerides and lipid lowering agents, in general, in modifying this risk. Materials and Methods: We carried out a cross sectional study enrolling Diabetes Mellitus patients with symptoms suggestive of peripheral vascular disease. We included 304 patients and analyzed their TG levels and TG/HDL ratios stratified as per age, gender and medical history. Relevant statistical analysis was carried out. Results: There was a difference in TG levels in men and women who developed serious peripheral vascular events with women having significantly elevated TG levels in comparison to men. The TG/HDL ratio was also found to be 8.06 in women and 7.88 in men. This was statistically significant in comparison to the control group. Conclusion: TG/HDL-C ratio, also known as atherogenic index, which is easily obtained by routine biochemical evaluation can be used to prognosticate incidence of peripheral arterial disease in addition to cardiovascular risk. This would serve as an easy Outpatient prognosticating and predictive factor for further assessment and patient education.

Objective: The objective of the study was to analyze and evaluate the possible factors in the long-term patency of arteriovenous (AV) access for hemodialysis (HD). Materials and Methods: This was a cross-sectional study recruiting patients from January 2019 to December 2019. All patients who have a working HD vascular access, either AV fistula (AVF) or AV graft which has been working for at least 2 years were included and collected demographic data along with other parameters such as timing of creation, interventions, dialysis sessions, and antiplatelet therapy among others. Results: We included 81 patients with AV access patent more than 2 years; 22.5% were aged >65 years, 39.6% were diabetic, 68.5% were hypertensive, and 26.1% had vascular disease. Analysis revealed that the patient factors such as current tobacco usage and side of creation and technical factors such as maturation time, number of dialysis sessions, and single-center dialysis have a significant effect on the patency of the AV access, while the factors such as past tobacco usage, diabetes, hypertension, use of jugular catheter before access creation, and cannulation technique could not establish any statistical effect on the patency of AV access. Conclusion: There is a complex interaction of factors that may affect the patency of an individual AV access. These need to be carefully considered when selecting surgical site or technique, adjuvant treatments, and follow-up protocols for AVFs.

Background To maintain the patency and longevity of arteriovenous fistula, the availability of a venous segment with adequate diameter is important. In Indian population, many chronic kidney disease patients have poor caliber veins. The study aimed to evaluate the efficacy of hydrostatic dilatation versus Primary balloon angioplasty of small caliber cephalic veins of (≤2.5 mm) preoperatively in terms of patency rate and maturation time of arteriovenous fistula. Methods Patients ( n = 80) with an end-stage renal disease requiring arteriovenous access surgery for hemodialysis with small caliber cephalic veins were randomized into two groups, i.e., hydrostatic dilatation and primary balloon angioplasty, each with 40 patients. All patients underwent a thorough clinical examination as well as duplex ultrasound vein mapping of both upper extremities. Patients were followed up for six months and primary patency, maturation time, and complications were noted. Results Immediate technical success with good palpable thrill was achieved in 97.5% of patients in the primary balloon angioplasty group and 87.5% in the hydrostatic dilatation group. The fistula maturation time in the primary balloon angioplasty group was 34.41 days and 46.18 days in the hydrostatic dilatation group. In the primary balloon angioplasty group, the primary patency of the fistula was 97.5% and 87.5% in the hydrostatic dilatation group, at six months. The arteriovenous fistula functioning rate was 77.5% in the hydrostatic dilatation group as compared to 92.5% in the primary balloon angioplasty group at six months. The incidence of surgical site infection was 5% in the primary balloon angioplasty group as compared to 10% in the hydrostatic dilatation group. Conclusion Primary balloon angioplasty of small caliber cephalic veins (≤2.5 mm) performed prior to arteriovenous fistula creation for hemodialysis is a beneficial procedure.

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