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I V Mohan

Publications and source records attributed to I V Mohan.

7 recordsLinked to original sources
PubMed2006

Endovascular popliteal aneurysm repair: are the results comparable to open surgery?

INTRODUCTION: The aim of this study was to review our experience of popliteal aneurysms using endovascular techniques. METHODS: Thirty popliteal aneurysms in 25 patients were treated over an 11-year period. Median aneurysm diameter was 26 (16-48) mm. Five were symptomatic and 25 asymptomatic. Patients were treated with the Haemobahn/Viabahn stent-graft (26), Passager (two), Aneurx (one), and PTFE homemade device (one). Data were assessed using life table analysis, and expressed as cumulative patency rates and standard error (SE). RESULTS: Median follow-up was 24 (range 1-95) months. Primary patency was 92.9% (SE 4.5%), 84.7% (SE 6.8%), 80% (SE 8.2%), 74.5% (SE 9.4%) and 74.5% (11.3%) at 1, 6, 12, 24 and 36 months, respectively. Cumulative secondary patency was 96.5% (SE 3.3%), 88.7% (SE 6.0%), 88.7% (SE 8.6%), 83.2% (SE 8.0%) and 83.2% (SE 9.8%) at 1, 6, 12, 24 and 36 months, respectively. CONCLUSION: Endovascular treatment of popliteal aneurysms in this series achieved patency rates similar to open surgery. Aneurysm repair was performed without peroperative deaths and the risks associated with open surgery.

Aged↗
PubMed2001

Risk factors for endoleak and the evidence for stent-graft oversizing in patients undergoing endovascular aneurysm repair.

OBJECTIVES: the aim of this study was to assess the relationship between patient factors, the anatomy of the proximal aneurysm neck; the type of endovascular graft; and the consequences of graft/neck size mismatch and the occurrence of proximal endoleak. Design multicentre clinical study. MATERIALS: of a total of 2194 patients, 2146 underwent successful endovascular repair of infra-renal abdominal aortic aneurysms (AAA). METHODS: endoleaks were identified by radiological imaging immediately after completion of the procedure as per study protocols. Clinical and anatomical features of AAA in patients with endoleak were compared to patients without endoleak and data were analysed using the Chi-square test. A multivariate logistic regression model was constructed by selecting variables found to be significantly associated with complications in a univariate analysis. RESULTS: intra-operative endoleak was observed in 16.7% overall, and 3.3% were noted to have proximal endoleak. Aneurysm size larger than 60 mm (p =0.004), ex-smokers ( p =0.005) and age over 75 years ( p =0.01) were independently associated with endoleak of all types. Univariate and multivariate analysis revealed correlation between proximal endoleak and (i) diameter of the aneurysm neck-proximal (D2a), middle (D2b), distal (D2c), at all levels (p <0.005); (ii) proximal aortic neck length ( p =0.0001); (iii) aortic device diameter ( p =0.0024). No correlation was identified for angulation and form of the aortic neck. A model of the frequency of proximal endoleak, in relation to the ratio of the aortic device diameter to the distal aortic neck diameter, revealed that endoleak decreased when the aortic device diameter became oversized by more than 10% and confidence intervals remained tight for up to and over 20% oversize.

Adult↗
PubMed2000

When not to operate for abdominal aortic aneurysms.

Refinement in anaesthetic and surgical techniques for repair of abdominal aortic aneurysms has significantly reduced the mortality associated with treating this condition. Endovascular techniques have further pushed back the frontiers for the treatment of aortic aneurysms, and higher risk patients are now being treated under local or regional anaesthesia. The question of when not to offer intervention is becoming more and more difficult. Age is not a bar to aneurysm surgery in a patient who is physically fit; but the risk and benefit of intervention must be carefully evaluated for each patient on an individual basis, and risk calculation must be evidence based. Contraindications to aneurysm surgery are relative and few and include: small aneurysms (<5.5 cm), a co-morbidity that increases surgical risk by >10% and a life expectancy of <1 year. Endovascular graft technology is rapidly advancing, but until the long term results of endovascular repair of aortic aneurysms are proven, the indications for intervention should be the same as for open repair.

Aortic Aneurysm, Abdominal↗
PubMed1999

Community and hospital outcome from ruptured abdominal aortic aneurysm within the catchment area of a regional vascular surgical service.

OBJECTIVE: The objective of this study was to examine patterns of referral, management, and outcome of patients with ruptured abdominal aortic aneurysm (RAAA) within the catchment area of this regional vascular unit (RVU). METHODS: Referral, management, and outcome data regarding 972 consecutive patients admitted to the hospital or certified deceased in the community because of RAAA between January 1, 1989, and December 31, 1995, were retrieved from prospectively gathered computerized national and local databases. RESULTS: Of 381 (39.2%) patients admitted to this unit, 316 (82.9%) underwent surgery, and of those, 188 (59.5%) survived. There was no significant difference in overall mortality between patients who were admitted directly to this unit (152 of 310, 49%) and those who were transferred from elsewhere (41 of 71, 58%). Surgical patients traveled significantly farther to the RVU than nonsurgical patients (P <.001), but there was no significant difference in traveling distance between surgical patients who survived and those who did not. Of 372 (38%) patients who were admitted to other units and not transferred, 24 (6.4%) underwent surgery and 14 (3.8%) survived. Of 972 patients, the overall community mortality from RAAA was 770 (79%). CONCLUSION: Transferring patients from outlying units did not appear to prejudice operative outcome in this RVU. However, less than half of all RAAA patients were transferred, and only a small minority of those not transferred underwent surgery. Although the overall community mortality from RAAA was similar to that reported in earlier studies from other regions and countries where centralization has not occurred, centralization of vascular surgical services may be associated with an inappropriately low operation and survival rate for those patients who are not transferred to the regional center. The effect of centralization on the community outcome of emergent vascular surgical conditions requires further investigation.

Aged↗
PubMed1998

Crohn's disease presenting as adenocarcinoma of the small bowel.

Crohn's adenocarcinoma of the small bowel is extremely rare. We report a patient with a 10-year history of nonspecific abdominal symptoms who was found on his first presentation to have Crohn's adenocarcinoma of the small bowel. Despite adequate surgical resection, prognosis for this condition is poor with 2-year cancer free survival of around 9%. Crohn's carcinoma should be suspected in patients with long-standing disease and those with and without excluded segments of bowel.

Adenocarcinoma↗