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  1. Article ; Online: Impact of great saphenous vein ablation on healing and recurrence of venous leg ulcers in patients with post-thrombotic syndrome: A retrospective comparative study.

    Bishara, Rashad A / Gaweesh, Ahmed / Taha, Wassila / Tolba, Mahmoud M / Shalhoub, Joseph

    Journal of vascular surgery. Venous and lymphatic disorders

    2024  Volume 12, Issue 3, Page(s) 101859

    Abstract: Background: The optimal treatment approach for patients with active venous leg ulcers (VLUs) and post-thrombotic syndrome (PTS) associated with great saphenous vein (GSV) reflux remains unclear. To address this gap, we retrospectively compared the ... ...

    Abstract Background: The optimal treatment approach for patients with active venous leg ulcers (VLUs) and post-thrombotic syndrome (PTS) associated with great saphenous vein (GSV) reflux remains unclear. To address this gap, we retrospectively compared the outcomes of patients with post-thrombotic VLU with an intact GSV vs those with a stripped or ablated GSV.
    Methods: We retrospectively analyzed data from 48 patients with active VLUs and documented PTS, who were treated at a single center between January 2018 and December 2022. Clinical information, including ulcer photographs, was recorded in a prospectively maintained digital database at the initial and follow-up visits. Two patient groups-group A (with an intact GSV) and group B (with a stripped or ablated GSV)-were compared in terms of time to complete healing, proportion of ulcers achieving complete healing, and ulcer recurrence during the follow-up period.
    Results: There were no significant differences in age, gender, initial ulcer size, or ulcer duration between the two groups. All included patients had femoropopliteal post-thrombotic changes. Group A had significantly more completely healed ulcers (33 of 34 ulcers, 97%) compared with group B (10 of 14 ulcers, 71%) (P = .008). Group A also exhibited a significantly shorter time to complete ulcer healing (median: 42.5 days, interquartile range [IQR]: 65) compared with group B (median: 161 days, IQR: 530.5) (P = .0177), with a greater probability of ulcer healing (P = .0084). Long-term follow-up data were available for 45 of 48 patients (93.7%), with a mean duration of 39.6 months (range: 5.7-67.4 months). The proportion of ulcers that failed to heal or recurred during the follow-up period was significantly lower in group A (9 of 32 ulcers, 27%) compared with group B (11 of 13 ulcers, 85%) (P = .0009). In addition, in a subgroup analysis, patients with an intact but refluxing GSV (12 of 34) had a significantly shorter time to heal (median: 34 days, IQR: 57.25) (P = .0242), with a greater probability of ulcer healing (P = .0091) and significantly fewer recurrences (2 of 12, 16%) (P = .006) compared with group B.
    Conclusions: Our findings suggest that removal of the GSV through stripping or ablation in patients with post-thrombotic deep venous systems affecting the femoropopliteal segment may result in delayed ulcer healing and increased ulcer recurrence. Patients with an intact GSV had better outcomes, even when the refluxing GSV was left untreated. These findings emphasize the potential impact of GSV treatment on the management of VLUs in individuals with PTS. Further investigation is needed to validate these results and explore alternative therapeutic strategies to optimize outcomes for this patient population.
    MeSH term(s) Humans ; Ulcer ; Retrospective Studies ; Saphenous Vein/surgery ; Treatment Outcome ; Varicose Ulcer/therapy ; Postthrombotic Syndrome ; Venous Insufficiency/surgery ; Recurrence
    Language English
    Publishing date 2024-03-04
    Publishing country United States
    Document type Journal Article
    ISSN 2213-3348
    ISSN (online) 2213-3348
    DOI 10.1016/j.jvsv.2024.101859
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  2. Thesis ; Online: Sediment Dynamics in Alluvial Rivers Used as a Resource for Land-Building

    Gaweesh, Ahmed Moustafa

    2014  

    Abstract: There is a dire need to use sediment from alluvial rivers to sustain and create new marsh land and sustain barrier islands and ridges. Coastal Louisiana is a prime example where wetland loss rates are one of the highest nationwide. This study focuses on ... ...

    Abstract There is a dire need to use sediment from alluvial rivers to sustain and create new marsh land and sustain barrier islands and ridges. Coastal Louisiana is a prime example where wetland loss rates are one of the highest nationwide. This study focuses on investigating the sediment dynamics of the Lower Mississippi River, specifically the temporal and spatial variability of the sediment concentration as well as the sediment size characteristics. The objectives of this study are: to analyze and quantify the impact of diversion design parameters on the efficiency of sediment capture, to analyze the hydrodynamic and morphological patterns at sand bar borrow areas and to quantify the infill spatial and temporal patterns of these dredged pits. The investigation was performed using a morphodynamic numerical tool (Delft3D). The Louisiana 2012 State Master Plan identified two viable mechanisms to build land: sediment diversions and dedicated dredging. The morphodynamic model was parameterized and validated using historical and recent field observations. The model was used to examine three different parameters hypothesized as key design parameters that govern the sediment capture efficiency of sediment diversions: the alignment angle, invert elevation and diversion size. Diverted sediment loads and the sediment concentration ratio were used to assess the efficiency achieved to the corresponding change in design. Implications of choosing the designs on construction and efficiency was discussed. The model was also used to investigate the riverside morphological response to a number of parameters for dredging lateral sand bars. Detailed analyses were carried out for the hydrodynamics at the dredge pit and its implications on the morphological development. Sensitivity analysis of hydrodynamic and sediment transport parameters examined the morphological response within the dredge pit. Findings put emphasis on data collection requirements and helped form future recommendations for predictive modeling of dredged sandbar infill. The study is concluded with an economic assessment for the impact of land-building mechanisms on the riverside in correlation to waterborne economy.
    Keywords Civil engineering|Systems science
    Subject code 550
    Language ENG
    Publishing date 2014-01-01 00:00:01.0
    Publisher University of Louisiana at Lafayette
    Publishing country us
    Document type Thesis ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Predictors of Limb Outcome Following Arterial Ligation of Infected Femoral Pseudoaneurysms in Drug Abusers.

    Elahwal, Mohamed / Gaweesh, Ahmed Sherif / Elemam, Ali / Moustafa, Sameh

    Annals of vascular surgery

    2019  Volume 65, Page(s) 130–136

    Abstract: Background: We aimed to study variables affecting limb outcome following ligation of infected femoral pseudoaneurysms in intravenous drug abusers (IVDA)in the emergency setting and to propose an algorithm for management.: Design: Prospective study.!## ...

    Abstract Background: We aimed to study variables affecting limb outcome following ligation of infected femoral pseudoaneurysms in intravenous drug abusers (IVDA)in the emergency setting and to propose an algorithm for management.
    Design: Prospective study.
    Methods: We studied short-term outcomes of 26 IVDA presenting with infected femoral pseudoaneurysms who underwent arterial ligation, hematoma evacuation, and debridement. Long-term results pertaining to limb functionality were unfeasible, as all patients were lost to follow-up. We aimed to study the potential predictors that might impact limb outcome in the emergency setting, namely: 1) mode of presentation (impending versus ruptured), 2) site of arterial ligation (above versus below inguinal ligament), 3) presence or absence of pedal Doppler flow post-ligation, and 4) ankle brachial pressure index (ABI) pre- and post-ligation.
    Results: Arterial ligation without revascularization was done in 19 (73.1%) of our patients, requiring no further intervention for limb salvage during their hospital stay. Four patients (15.4%) required iliopopliteal bypass, and 3 patients (11.5%) required major amputations (2 hip disarticulations and one above-knee amputation). In total, 23 limbs (88.5%) were salvaged. Proximal arterial ligation was done below the inguinal ligament (common femoral artery) in 21 patients (80.8%), while in the remaining 5 patients (19.2%), higher ligation was done above the inguinal ligament (external iliac artery). All 19 patients who were compensated had pedal Doppler flow post-ligation, and 18 of them had arterial ligation done below the inguinal ligament. The mean preoperative ABI (±SD) was 0.87 ± 0.34, and the mean postoperative ABI (±SD) was 0.37 ± 0.27. The mean change in ABI (±SD) was 0.50 ± 0.32.
    Conclusions: Arterial ligation with local debridement alone is a safe procedure and would have salvaged 73.1% of limbs in this study. However, implementing a selective approach for post-ligation revascularization and our proposed algorithm increased limb salvage rate to 88.5%. The detection of pedal Doppler flow after ligation can stratify patients in whom urgent revascularization might not be required for limb salvage. Additionally, all efforts should be made to ligate the femoral artery below the inguinal ligament to preserve important juxta-inguinal collateral branches.
    MeSH term(s) Adult ; Algorithms ; Amputation ; Aneurysm, False/diagnostic imaging ; Aneurysm, False/microbiology ; Aneurysm, False/physiopathology ; Aneurysm, False/surgery ; Aneurysm, Infected/diagnostic imaging ; Aneurysm, Infected/microbiology ; Aneurysm, Infected/physiopathology ; Aneurysm, Infected/surgery ; Clinical Decision-Making ; Debridement/adverse effects ; Decision Support Techniques ; Drug Users ; Female ; Femoral Artery/diagnostic imaging ; Femoral Artery/physiopathology ; Femoral Artery/surgery ; Humans ; Ligation ; Limb Salvage ; Male ; Regional Blood Flow ; Retrospective Studies ; Risk Factors ; Substance Abuse, Intravenous/complications ; Time Factors ; Treatment Outcome ; Vascular Grafting/adverse effects
    Language English
    Publishing date 2019-11-06
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 1027366-9
    ISSN 1615-5947 ; 0890-5096
    ISSN (online) 1615-5947
    ISSN 0890-5096
    DOI 10.1016/j.avsg.2019.11.003
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    Zs.A 2882: Show issues Location:
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    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (2.OG)
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  4. Article ; Online: Impeded venous drainage: novel view of chronic venous disease pathophysiology.

    Gaweesh, Ahmed S

    Medical hypotheses

    2009  Volume 73, Issue 4, Page(s) 548–552

    Abstract: Venous valve incompetence role as the primary pathology occurring in patients with chronic venous diseases (CVD) has long been exaggerated. Management strategies based on the current pathophysiological concepts are far from perfect. A novel concept is ... ...

    Abstract Venous valve incompetence role as the primary pathology occurring in patients with chronic venous diseases (CVD) has long been exaggerated. Management strategies based on the current pathophysiological concepts are far from perfect. A novel concept is introduced describing the importance of patency of axial venous system with "Pressure gradient model" providing the venous system architecture required for efficient venous drainage. The roles of calf muscle pump, perforators and venous valves according to the novel concept are described. Impeded venous drainage (IVD) plays the key role in the pathophysiology of CVD. Management of CVD should be directed to correction of IVD instead of correction or ablation of valve incompetence.
    MeSH term(s) Blood Flow Velocity ; Blood Pressure ; Chronic Disease ; Humans ; Models, Cardiovascular ; Muscle Contraction ; Muscle, Skeletal/blood supply ; Muscle, Skeletal/physiopathology ; Stockings, Compression ; Venous Thrombosis/physiopathology ; Venous Thrombosis/prevention & control
    Language English
    Publishing date 2009-10
    Publishing country United States
    Document type Journal Article
    ZDB-ID 193145-3
    ISSN 1532-2777 ; 0306-9877
    ISSN (online) 1532-2777
    ISSN 0306-9877
    DOI 10.1016/j.mehy.2009.05.046
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 1132: Show issues Location:
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  5. Article ; Online: Popliteal venous aneurysms and iliac vein compression: a possible association.

    Gaweesh, Ahmed S / Kayed, Mohamed H / Gaweesh, Tamer Y / Shata, Aly

    Phlebology

    2014  Volume 29, Issue 6, Page(s) 386–389

    Abstract: Popliteal venous aneurysms have always been linked to death from pulmonary embolism. Incidental finding of an asymptomatic popliteal venous aneurysm during duplex scan performed for patients with chronic venous disease is increasingly diagnosed but the ... ...

    Abstract Popliteal venous aneurysms have always been linked to death from pulmonary embolism. Incidental finding of an asymptomatic popliteal venous aneurysm during duplex scan performed for patients with chronic venous disease is increasingly diagnosed but the relation between popliteal venous aneurysms and chronic venous disease remains unknown. We report the incidental finding of three asymptomatic popliteal venous aneurysms associated with iliac vein compression in patients with chronic venous disease who had undergone computed tomography venography with direct pedal contrast injection. An association between popliteal venous aneurysms and iliac vein compression is postulated.
    MeSH term(s) Adult ; Aneurysm/complications ; Aneurysm/diagnostic imaging ; Chronic Disease ; Constriction, Pathologic/diagnostic imaging ; Humans ; Iliac Vein/diagnostic imaging ; Male ; Middle Aged ; Phlebography ; Popliteal Vein/diagnostic imaging ; Pulmonary Embolism/diagnostic imaging ; Pulmonary Embolism/etiology
    Language English
    Publishing date 2014-07
    Publishing country England
    Document type Clinical Trial ; Journal Article
    ZDB-ID 645172-x
    ISSN 1758-1125 ; 0268-3555
    ISSN (online) 1758-1125
    ISSN 0268-3555
    DOI 10.1177/0268355513486781
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    Zs.A 2538: Show issues Location:
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