Sunil Agarwal

Christian Medical College Vellore, Velluru, Tamil Nādu, India

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Publications (27)22.13 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Inflammatory carotid pseudotumor is a rare differential of a unilateral neck swelling in the carotid triangle. A 48-year-old man presented with a firm non-tender gradually progressive left neck swelling for five months. Computed tomography angiogram revealed a mass encasing the common carotid. Patient underwent excision; histopathology was reported as inflammatory pseudotumor. Patient had a recurrence after eight months. Steroids were prescribed with which the swelling resolved, patient remained recurrence free at two-year follow-up.
    Vascular 03/2013; · 0.86 Impact Factor
  • Indrani Sen, Edwin Stephen, Sunil Agarwal
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    ABSTRACT: Aortoiliac arterial occlusive (AIOD) disease is common in India. The clinical presentation and etiology are different than in the West. Intervention is frequently required for advanced lower extremity ischemia, but the results have not been systemically evaluated. We studied the clinical profile and midterm results of patients undergoing aortobifemoral bypass for AIOD at a tertiary care center in south India. Clinical data of patients undergoing aortobifemoral bypass for AIOD over a 6-year period from January 1, 2005 to December 31, 2010 were retrospectively analyzed. Clinical presentation and factors affecting outcome were evaluated. Graft patency and mortality were included as study end points. Ninety-nine patients (mean age, 52 years) with AIOD who underwent aortobifemoral bypass were included. Etiology included atherosclerosis in 79 patients, thromboangiitis obliterans in 15, Takayasu's arteritis in two, and hematological conditions in 3. Smoking (82%), hypertension (40%), and diabetes (30%) were the most common risk factors; ischemic heart disease (4%), obesity (2%), and dyslipidemia (3%) were rare. Eighty-one percent of patients presented with critical limb ischemia. Mean duration of symptoms was 22 months (range, 4 months to 9 years). Concomitant infrainguinal arterial occlusive disease was identified in 81%, but intervened upon in only 2%. In-hospital mortality was 3%. Causes of death included myocardial infarction in two and colon ischemia in one. Major morbidity included nonfatal myocardial infarction (3%), pneumonia/atelectasis (5%), and renal dysfunction (2%). Groin wound complications occurred in 20%, seroma/lymph leak in 13%, infection in 7%, and anastomotic hemorrhage in 2%. Multidrug-resistant and polymicrobial infections were common. Early graft thrombosis (30 days) occurred in 15 patients; 8 of 11 reintervened grafts were salvaged. Four more grafts thrombosed during a mean follow-up of 2 years (range, 0-5 years) and two became infected. Overall study major limb loss rate was 10% (primary, 2%; secondary, 8%). Delayed presentation and smoking were more common in patients developing complications. There was no significant difference in overall complication rates between patients with thromboangiitis obliterans and atherosclerosis (P = .66). Despite earlier age at presentation, atherosclerosis remains the predominant etiology of aortoiliac arterial occlusive disease in Indian patients. Results of open revascularization are comparable to those in the Western literature. Thromboangiitis obliterans is the underlying pathology in a minority of patients with no significant difference in operative outcome. Patients frequently present late with critical limb ischemia, but this does not affect outcome.
    Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 02/2013; 57(2 Suppl):20S-5S. · 3.52 Impact Factor
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    ABSTRACT: Carotid body tumors are considered rare. However, there has been an increase in the number of these tumors managed at our center in recent years. Delayed presentation with large tumors is common. We studied the clinical profile, interventions, and outcomes of these tumors and assessed the factors influencing operative neurological morbidity and recurrence. This retrospective study was conducted at the Christian Medical College in Vellore, a tertiary care center in south India. We analyzed the inpatient and outpatient records of patients diagnosed to have carotid body tumors undergoing excision from January 1, 2005 to December 31, 2011. Patients diagnosed to have vagal paragangliomas were excluded. Thirty-four of 48 tumors were excised from 32 patients (11 female, 21 male). Average age at presentation was 38.2 years, and three patients had familial bilateral tumors. All patients presented with a painless neck mass. There were 27 Shamblin group III, six Shamblin group II, and one Shamblin group I tumor. Eleven Shamblin group II/III tumors were associated with transient cranial nerve palsy or paresis (32.3%). Two Shamblin group III tumors were associated with perioperative stroke (5.8%). Preoperative embolization was done in 17 tumors, 12 of which were associated with neurological complications (two stroke, nine nerve palsy, one hemianopia). One patient underwent thrombolysis for a middle cerebral artery thrombus and recovered completely on follow-up, and another with a capsuloganglionic infarct managed conservatively had minimal persistent disability. Three patients had persistent nerve palsy (8.8%). Although complications were more common in patients with higher Shamblin group tumors, the difference was not statistically significant. The overall rate of neurological complications is higher with tumors of higher Shamblin groups. Preoperative embolization was not effective in reducing neurological complications. The rates of postoperative stroke and permanent cranial nerve palsy after resection of large tumors are acceptable.
    Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 02/2013; 57(2 Suppl):64S-8S. · 3.52 Impact Factor
  • Indian Journal of Thoracic and Cardiovascular Surgery 01/2013; 29(4).
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    ABSTRACT: Objective: To describe a family with hereditary paraganglioma due to a disease-causing mutation in the SDHD gene.Methods: We present the clinical findings, diagnostic test results, treatment, and genetic test results in a family with hereditary paraganglioma.Results: Three siblings with bilateral carotid body tumors presented at different time points and with varied clinical presentations. While the proband, a 20-year-old man, was not hypertensive and had normal urinary metanephrine and normetanephrine levels, his sister and brother had a more severe clinical picture, with hypertension in both and elevated normetanephrine levels in his brother (his brother had pheochromocytoma and 2 intra-abdominal paragangliomas). Mean age at presentation was 24 years. A 4-base pair frameshift mutation, c.337-340delGACT, was detected in exon 4 of the SDHD gene in all 3 patients.Conclusion: This is the first report of the c.337-340delGACT mutation being associated with hereditary paraganglioma; this report emphasizes the need to screen all at-risk first-degree relatives for the disease-causing SDHD mutation once it has been identified in an affected family member.
    Endocrine Practice 03/2012; 18(5):e106-10. · 2.49 Impact Factor
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    ABSTRACT: Numerous studies have compared the accuracy of color Doppler (CD) with that of digital subtraction angiography (DSA) in the diagnosis of peripheral arterial disease (PAD). However, only a few have looked at the influence of these diagnostic tests on the treatment decision in PAD. This study evaluated the differences in treatment decisions that were based on CD and with those based on DSA findings. Findings from CD and DSA studies obtained in 40 patients were entered on line diagrams by two radiologists working separately. These were randomized and sent to three experienced clinicians - two vascular surgeons and one interventional radiologist. The treatment decisions of the clinicians based on each proforma were collected and analyzed to look for the degree of agreement between Doppler-based and DSA-based decisions. There was fair to moderate agreement between CD-based and DSA-based decisions for all three clinicians, with some improvement in agreement with the addition of clinical data. The vascular surgeons showed better agreement with each other on treatment decisions compared to the interventional radiologist who showed a fair-to-moderate level of agreement with the vascular surgeons, which did not significantly change with the addition of clinical data. There is a fair to moderate agreement between treatment decisions based on CD findings and those based on DSA findings. We conclude that CD along with clinical data is sufficient to make decisions in the treatment of PAD.
    The Indian journal of radiology and imaging 10/2011; 21(4):294-7.
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    ABSTRACT: Doppler evaluation of lower limb veins was performed to evaluate the pattern of involvement of various sites of incompetence in Indian patients with varicose veins. A prospective Doppler study of 100 consecutive limbs in patients who presented with varicose veins to the vascular surgery department of a tertiary care hospital in India. The Clinico-Etiological Anatomical and Pathological (CEAP) classification was applied for assessment. Doppler evaluation of both superficial and deep venous system of the lower limbs was performed. The data of various sites of reflux was analysed to find the patterns of venous involvement in the affected patients. Superficial venous reflux was seen in all the patients. Deep venous reflux was seen in 50% of the lower limbs examined. Doppler is a simple non-invasive test, and is well tolerated by the patients. Deep venous reflux is common in Indian population, though it rarely occurs in isolation, and is usually associated with superficial reflux.
    Indian Journal of Surgery 04/2011; 73(2):125-30. · 0.09 Impact Factor
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    ABSTRACT: To standardise the preoperative marking of incompetent perforators and saphenopopliteal junction on Doppler with evaluation of "T" technique. A prospective study including 54 consecutive patients (61 lower limbs) who underwent surgery for varicose veins in 2003 and 2004 were included for preoperative marking. "T" technique is a technique of Doppler marking of an incompetent perforator, long limb of the T representing the course of the superficial vein and the junction of the T representing the site of perforator entering the deep fascia. Surgical correlation was done. The overall surgical detection rate of incompetent perforators was 199 / 220(90.5%); detection of the saphenopopliteal junction was 100%. The "T" technique of Doppler marking was found to be easy to perform and aided intraoperative detection.
    Indian Journal of Surgery 01/2011; 73(1):37-9. · 0.09 Impact Factor
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    ABSTRACT: Objective To identify and compare the existence of similar and other risk factors in the perspective of an Indian population.
    Asian Pacific Journal of Tropical Medicine 01/2010; 3(5):407-409. · 0.50 Impact Factor
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    ABSTRACT: A 22-year-old woman presented with a 3-month history of a pulsatile swelling in the right supraclavicular region. A CT angiogram revealed an aneurysm arising from the distal right subclavian artery. At surgery, the subclavian artery was almost entirely replaced by a well-vascularized tumor mass. The vascular tumor along with the native vessel was excised and replaced with a vascular prosthesis. Biopsy was suggestive of an epithelioid hemangioma (EH). In conclusion, an EH is a rare vascular tumor. The presence of vascular hyperplasia with plump endothelial cells protruding into the lumen is the most important discriminator in establishing the diagnosis of EH. Vascular neoplasms presenting as aneurysms should be considered, especially if other etiologies can be excluded.
    Vascular Medicine 11/2009; 14(4):377-9. · 1.62 Impact Factor
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    ABSTRACT: Surgery is considered to be the treatment of choice for vascular injuries caused by trauma. However, endovascular techniques are emerging as an alternative means of treatment. In this article, we describe three patients with posttraumatic arteriovenous fistulae in different body regions that were managed using endovascular techniques. Each case had its unique set of associated problems requiring innovative methods and a multidisciplinary approach. While the short-term results are encouraging, long-term follow-up of posttraumatic arteriovenous fistulae that have been treated with endovascular techniques is still required.
    CardioVascular and Interventional Radiology 08/2009; 32(5):1042-52. · 2.09 Impact Factor
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    ABSTRACT: Venous thromboembolism (VTE) is a common and potentially life threatening condition. It continues to be under diagnosed and undertreated. Awareness among Indians regarding this potentially life-threatening disease is low. Contrary to earlier belief, the incidence of VTE in Asia and India is comparable to that in Western countries. The risk of VTE is especially high in hospitalized patients, in a majority of whom it is clinically silent. It is one of the commonest causes of unplanned readmission and preventable death. In the United States, it is responsible for more deaths than accidents. Thromboprophylaxis is highly effective in reducing the incidence of VTE without any increase in clinically significant bleeding. It is worth emphasizing that prevention of VTE is much easier and cheaper than its treatment.
    Indian Journal of Urology 02/2009; 25(1):11-6.
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    ABSTRACT: Henoch The aim of the study was to evaluate the efficacy of preoperative embolization in the management of carotid body tumours. Of the 15 patients admitted to the Department of Vascular Surgery (General Surgery Unit II), Christian Medical College, Vellore, from January 1st 2002 to December 31st 2006 for management of carotid body tumours, 4 patients underwent preoperative embolization and were grouped together. Of the remaining 9 patients who underwent surgical excision, there were 5 with comparable tumour size and these were grouped together into the control group. Surgical outcome of both the groups were compared in terms of operating time, intraoperative blood loss, nerve injury, postoperative morbidity and mortality. There was statistically significant reduction in blood loss and duration of surgery in patients who underwent preoperative embolization. In conclusion, the preoperative embolization is effective in the management of Shamblin type III carotid body tumours.
    Central European Journal of Medicine 01/2009; 4(3):337-339. · 0.26 Impact Factor
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    ABSTRACT: We present two cases of segmental arterial mediolysis, which can present with dissecting aneurysms or thrombosis of the visceral branches of the abdominal aorta. Segmental arterial mediolysis (SAM) causes ischemic bowel disease and has characteristic CT and angiographic features.
    Indian Journal of Gastroenterology 01/2009; 28(2):72-3.
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    ABSTRACT: Venous aneurysms are not often recognised nor given importance due to the more serious and challenging nature of their arterial counterpart. They are uncommon entities that generally present as a painless swelling, can be accurately diagnosed by duplex venous scanning and are completely cured by surgical excision. We present a short report of 14 cases treated at a tertiary care centre in India over seven years from June 2001 to June 2008, to increase awareness of this easily treatable condition.
    Central European Journal of Medicine 11/2008; 3(4):503-504. · 0.26 Impact Factor
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    J Rajinikanth, Edwin Stephen, Sunil Agarwal
    Canadian journal of surgery. Journal canadien de chirurgie 11/2008; 51(5):E113-4. · 1.63 Impact Factor
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    ABSTRACT: Acute limb ischaemia is threatening to both limb and life. There is little information about this disease entity from India. We did a retrospective analysis of the clinical profile of patients presenting with non-traumatic acute limb ischaemia to our department (a tertiary care centre in India) from January 1998 to December 2007. The demography, risk factors, time taken to present to the emergency from the onset of symptoms, time taken to administer the first dose of heparin upon arrival to the emergency, primary interventions and outcomes in terms of amputation rates and in-hospital mortality were studied. The mean (SD) age of the 84 patients was 48.9 (14.3) years. Only one patient died (1.2%) and 24 patients had an amputation (28.6%). Among the predisposing risk factors a significant association was found between smoking and the rate of amputation. Early presentation to emergency and early administration of heparin was associated with lower amputation rates though this did not achieve statistical significance. Acute limb ischaemia is a catastrophic event. Smoking is a risk factor associated with poorer outcomes. Early arrival to the emergency and early administration of heparin was associated with lower amputation rates.
    The National medical journal of India 01/2008; 21(6):284-7. · 0.91 Impact Factor
  • Arvind Dhas Lee, Sunil Agarwal, David Sadhu
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    ABSTRACT: Severely symptomatic arterial insufficiency of an upper limb not suitable for revascularization is a difficult condition to manage. Thoracoscopic sympathectomy (TS) can be an effective procedure in this setting. Our experience with 18 consecutive thoracoscopic sympathectomy (TS) procedures over a period of 7 years has been reviewed. Indications, operative technique, complications, and outcome of surgery are analyzed. We performed 18 TS procedures on 17 patients during this period. There were no deaths. One patient had intraoperative hemorrhage necessitating conversion to open thoracotomy. Mean postoperative hospital stay was 2.3 days. Follow-up ranged from 6 to 72 months. All patients demonstrated clinical benefit from the procedure. Thoracoscopic sympathectomy is a useful option in patients with severely symptomatic hand and digital ischemia from occlusive small arterial disease like thromboangitis obliterans.
    World Journal of Surgery 10/2006; 30(9):1644-7. · 2.23 Impact Factor
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    ABSTRACT: An acute inguinoscrotal swelling appearing during the course of acute pancreatitis is rare. There are only three case reports of this in the English literature. We report a case of right inguinoscrotal swelling appearing during an attack of acute pancreatitis. A correct diagnosis and appropriate management will prevent unnecessary surgical intervention.
    JOP: Journal of the pancreas 10/2004; 5(5):357-9.
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    ABSTRACT: Thoracic Outlet Syndrome (TOS) refers to compression of the neurovascular structures in the region between the scalene muscles and the first rib, or by anatomical abnormalities such as cervical rib, fibrous bands and other variations in the scalene musculature. Our experience with 63 consecutive operations for TOS, over a period of 10 years, has been reviewed. Preoperative symptoms and signs, investigations, surgery done, complications and the outcome of surgery are analysed. A total of 60 patients underwent 63 operations for decompression of TOS. All the 63 first ribs, were excised by the transaxillary approach. In seven patients (16%), a combined transaxillary and supraclavicular approach was used. There was no operative mortality in this series. The operative complications included pneumothorax in four patients (6.3%), which was treated by insertion of chest drain, and lower brachial plexus neuropraxia in two patients (3%), which improved with conservative management. The mean duration of postoperative hospital stay was 3.6 days. At 12 months following surgery, 56 patients (93%) had complete or partial relief of symptoms and only four patients (6.6%) had no relief of symptoms. The results of the present study confirm that transaxillary excision of the first rib is a surgical procedure associated with very low morbidity and excellent relief of symptoms. It can therefore be offered as an early option for patients with thoracic outlet syndrome. It may be combined with the supraclavicular approach if exposure of the subclavian artery is required for vascular reconstruction.
    ANZ Journal of Surgery 07/2004; 74(6):450-4. · 1.50 Impact Factor