Browsing by Author "Shrestha, Uttam K"
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Publication Brachiobasilic Fistula at Manmohan Center: A Retrospective Review(Institute of Medicine, 2019) Shrestha, Kajan R; Gurung, Dinesh; Shrestha, Uttam KABSTRACT Introduction Brachiobasilic fistula (BBF) with transposition is one of methods for creating native arteriovenous fistula (AVF) for hemodialysis. This study aims to highlight the result of a BBF in a tertiary referral center and aims to improve its result. Methods This is a retrospective descriptive study conducted on the basis of data collected of patients undergoing BBF with transposition from January 2014 to December 2018 (5 years) at Manmohan Cardiothoracic Vascular and Transplant Center (MCVTC). Data regarding demographics, results and complications has been analyzed. Results Total 59 patients underwent brachiobasilic fistula performed by 3 surgeons with male to female ratio of approximately 3:2 with mean age of patient 68.78±13.77 years. Hypertension was the most common comorbidity present in 91.53% (54) of patients. Fifty six (94.92%)patient had previous undergone some sort of arteriovenous fistula creation and in 10 (16.95%) patients it was done in two stages. There were 2 immediate failures (within 1 week) and 9 early failures (before 1st dialysis) however 2 patients presented later with blocked BBF after starting dialysis. Only 31 patients could be followed up with patent BBF after 1 year of creation. About 71.19% of fistulas were able to mature and undergo dialysis by 6 week period and most common complication was bleeding from incision site in 20 patients (33.90%). Conclusion Brachiobasilic fistula is the good option for native arteriovenous fistula access for hemodialysis but it need proper selection of cases to decrease complication rates. Keywords: Brachiobasilic fistula, hemodialysis access, native arteriovenous fistulaPublication Outcome of Extracranial Carotid Pseudoaneurysm Surgery: A Retrospective Study(Institute of Medicine, 2020) Bhandari, Nikesh; Shrestha, Uttam K; Shrestha, Kajan R; Gurung, DineshABSTRACT Introduction: Extracranial carotid pseudoaneurysm (ECPA) is commonly associated with blunt or penetrating trauma and can result in thromboembolic event, cranial nerves palsies, rupture and hemorrhage. Due to the limited number of large studies, safety and efficacy of surgical and interventional management of ECPA is not well characterized. Open surgery with resection of pseudoaneurysm with end-to-end anastomosis or interposition graft is currently the preferred method of management. The aim of this study is to study the demographics, etiopathogenesis, presentation and outcome after surgical intervention of ECPA at our center. Methods: All patients who underwent surgery for carotid pseudoaneurysm form June 2012 to December 2019, at Department of Cardiothoracic and Vascular Surgery were included in this retrospective chart review study after evaluation of the hospital record book and electronic medical record. Patients who had stroke or cranial nerve injury before surgery, were excluded from this study. Results: Fifteen patients met the inclusion criteria. Male to female ratio was 11:4. Mean age of presentation was 38.17±18.98 years. All patients presented with tender and pulsatile neck swelling. Common carotid artery involvement was more common. Three patients suffered from stroke postoperatively, and all of these patients died, however, one patient with stroke died due to reasons not related to pseudoaneurysm. Two patients suffered cranial nerve injury and ten patients had no other disabling complications. Conclusion: ECPA is an uncommon but a serious disease and ischemic stroke after surgery is associated with high mortality. Keywords: Carotid, extracranial, outcome, pseudoaneurysmPublication Outcome of Carotid Endarterectomy in a Tertiary Center of Nepal: A Retrospective Study(Institute of Medicine, 2021) Kadel, Prashiddha B; Shrestha, Uttam K; Shrestha, Kajan R; Gurung, DineshABSTRACT Introduction: Carotid endarterectomy for carotid artery disease is one of the surgeries performed by vascular surgeons for carotid artery disease. The objective of this study is to describe the early and late outcome of the patient undergoing carotid endarterectomy and the association between the complication and comorbidities present previously in the patient. Methods: All patients undergoing carotid endarterectomy at Manmohan Cardiothoracic Vascular and Transplant Centre between April 2010 to April 2020 were included. The follow-up data for upto a year from medical and clinical records, telephone interview regarding the immediate and late postoperative complications in patients with and without comorbidities were investigated and compared. Results: The total study population was 42 patients. Two patients (4.7%) developed stroke, one immediately in postoperative period and the other during follow up. There were two deaths (4.7%) postoperatively due to cardiac events and three (7.14%) recurrences of carotid stenosis among whom one (2.5%) developed late stroke. Twenty six patients (61.90%) were symptomatic prior to the procedure of which 20 patients (47.61%) had brain infarct. Overall one year survival was 95.2% post procedure and overall complication rate was 7.14%. The consequence in the form of death and stroke occurred more in the patients with comorbidities (3vs1) p=0.42. Conclusion: The immediate and late postoperative complications following carotid endarterectomy were death (4.7%), stroke (4.7%), cranial nerve injury (9.5%). The most frequent cause of death was postoperative cardiac event. Though major complications occurred more frequently in patients having comorbidities, it was statistically insignificant. Keywords: Carotid artery, cerebrovascular disease, endarterectomy