Martin Veller

University of the Witwatersrand | wits · Department of Surgery

Purpose This study aims to ascertain the personal characteristics of a group of successful academic entrepreneurs in a South African university enterprise and the prevalent barriers and enablers to their entrepreneurial endeavour. Design/methodology/approach The authors used a Delphi process to identify and rank the characteristics, enablers, barr...

Africa is set to experience a three-fold increase in vaccine demand by 2040, yet the continent possesses few domestic capabilities for vaccine production. This lack of production capacity, heavy reliance on foreign aid, disruptions of hard-won immunization progress due to the effects of the COVID-19 pandemic, and fluctuating vaccine market dynamics...

South African guideline on the management of PAD

Aim: We aimed to determine whether the impact of aortic stiffness on atherosclerotic or small vessel end organ damage beyond brachial blood pressure depends in-part on stiffness-induced increases in central arterial pressures produced by an enhanced resistance to flow (characteristic impedance, Zc). Methods: We studied 1021 participants, 287 wit...

In response to the COVID-19 pandemic, South Africa (SA) has established a Tracing Database, collecting both aggregated and individualised mobility and locational data on COVID-19 cases and their contacts. There are compelling public health reasons for this development, since the database has the potential to assist with policy formulation and with...

It is likely that the SARS-CoV-2 pandemic will affect a large part of the world's population and will last for several years. Many critical ethical issues have arisen in the healthcare context. While response from healthcare professionals to participating in the care of patients in the era of COVID-19 has generally been positive, there have also be...

Objective: The age at which arteriosclerosis begins to contribute to events is uncertain. We determined, across the adult lifespan, the extent to which arteriosclerosis-related changes in arterial function occur in those with precipitous arterial events (stroke and critical limb ischemia). Approaches and Results: In 1082 black South Africans (356...

IMPORTANCE Peripheral arterial disease (PAD) causes significant morbidity and is an important risk factor for cardiovascular disease–related mortality. However, the burden of PAD in sub-Saharan Africa is poorly understood. OBJECTIVE To assess epidemiological and clinical reports regarding PAD from sub-Saharan Africa such that the regional epidemiol...

The book “Vital Signs: Health Security in South Africa” was published by The Brenthurst Foundation (Pty) Limited, St. Andrew’s House, 6 St Andrew’s Road, Parktown, Johannesburg, South Africa. It is written by experts with first-hand knowledge and experience offers narrative descriptions and analyses of the assessment metrics provided by the World...

The authors regret that the name of one of the co-author has been incorrectly spelt. Dr. Melina Vega de Ceniga should have been cited as “Vega de Ceniga M” The authors would like to apologise for any inconvenience caused.

The ability of carotid intima–media thickness (IMT) to predict risk beyond plaque is controversial. In 952 participants (critical limb ischemia [CLI] or stroke, n = 473; community, n = 479), we assessed whether relationships with events for IMT complement the impact of plaque in young patients depending on the extent of thrombotic versus atheroscle...

Guideline Summary: Chronic limb-threatening ischemia (CLTI) is associated with mortality, amputation, and impaired quality of life. These Global Vascular Guidelines (GVG) are focused on definition, evaluation, and management of CLTI with the goals of improving evidence-based care and highlighting critical research needs. The term CLTI is preferred...

Aim: Although chronic kidney disease (CKD) as determined from estimated glomerular filtration rate (eGFR) is recommended for risk prediction by current hypertension guidelines, the equations to derive eGFR may not perform well in black Africans. We compared whether across the adult lifespan, eGFR or CKD are as closely associated with noncardiac ar...

Background: Surgical systems are integral to successful, safe and cost effective clinical practice and must balance surgical demands on consumable items and their costs. Suture material is a key consumable resource, and was evaluated in an audit of consumable use and cost as well as the procurement systems within the South African Gauteng public h...

Stent-graft migration and type I endoleaks are associated with a higher rate of reintervention and increased mortality and morbidity. This article describes a patient presented with an infrarenal aortic stent-graft which had migrated into the aortic sac with loss of all aortic neck attachment. The acutely expanding abdominal aortic aneurysm was tre...

The common perception that the population of Southern Africa has a low incidence of vascular disease has resulted in the management of these diseases often being given a low priority. With recent improved access to health care services being made available to the often very poor and at times remote populations in this region it has however become c...

Trauma to the neck is dangerous and has a high mortality and morbidity.

Importance Peripheral arterial disease (PAD) causes significant morbidity and is an important risk factor for cardiovascular disease–related mortality. However, the burden of PAD in sub-Saharan Africa is poorly understood. Objective To assess epidemiological and clinical reports regarding PAD from sub-Saharan Africa such that the regional epidemi...

Reflective learning is considered an advanced form of learning; however, it has not been routinely incorporated into postgraduate and subspecialty educational surgical portfolios. The concept of training portfolios is not clearly understood by both trainees and teachers. Subspecialty surgical programmes rely heavily on logbooks and other forms of f...

Acute thrombosis of an infra-renal abdominal aortic aneurysm may be a life-threatening condition. We describe a case of acute thrombosis of a 3.5cm abdominal aortic aneurysm resulting in threatened lower limbs, in a high-risk surgical patient. Emergency stent graft placement was undertaken using Fluency® endoprostheses. The patient remains well at...

The internal iliac artery and cruciate anastomosis are important collateral vessels in severe aortoiliac occlusive disease. This report describes a patient with left leg rest pain due to occlusion of the left common and external iliac arteries. In addition, there was a highgrade stenosis of the right common iliac artery. Direct catheter canulation...

We present a case of endovascular management of aortic transection at the aortic bifurcation in a polytrauma patient.

Background: Blunt thoracic aortic injuries (BTAIs) remain a leading cause of death after blunt trauma. In severe injuries, thoracic endovascular aortic repair (TEVAR) has provided a less invasive alternative to conventional open repair. Objective: To report the TEVAR-related complications and uncertainties in patients who presented with traumati...

The development of vascular surgery in the 1970s as a distinct subspecialty of general surgery was based on the fact that this discipline required a subtle but real difference in approach and surgical skills, with specific requirements for training. The subsequent development of a plethora of endovascular therapies during the last two decades has a...

Introduction: The aim of this study was to determine if any patterns of infection or bacterial resistance existed in critically ill polytrauma patients admitted to the intensive care unit (ICU) at the CM Johannesburg Academic Hospital (CMJAH). Methods: This was a prospective, single-center study of patient laboratory records of 73 critically inj...

Background. The logged experience of specialist general surgical trainees has made it possible to analyse their surgical procedural exposure. Objective. To evaluate the exposure to key surgical procedures of South African (SA) trainees in general surgery from logbooks submitted to the Colleges of Medicine of South Africa (CMSA). Methods. Logbooks s...

Objectives Whether a human immunodeficiency virus (HIV)-associated vasculitis in-part accounts for occlusive large artery disease remains uncertain. We aimed to identify the histopathological features that characterize large vessel changes in HIV sero-positive as compared to sero-negative patients with critical lower limb ischemia (CLI). Materials...

: This case report describes the rare anomaly of an absent right anterior scalene muscle presenting with the symptoms and signs of the thoracic outlet syndrome. The thoracic outlet syndrome in our patient can be attributed to the absence of the right anterior scalene muscle, which resulted in the brachial plexus being in proximity to the subclavian...

Background: Primary healthcare is the foundation of a country's healthcare system. Without an efficient and cost-effective programme, the level of healthcare offered across all levels of health management is adversely affected. Objective: To analyse the effectiveness of the management of hypertension and diabetes mellitus (DM) among two distinct...

During the last 15 years, there has been a dramatic change in the management of vascular disease with a marked increase in the utilisation of endovascular techniques for occlusive and aneurysmal disease. This exponential rise in the number and complexity of minimal invasive radiological procedures has resulted in the formal separation of vascular s...

To determine whether increases in central aortic pulse pressure (PPc), but decreases in carotid-femoral pulse wave velocity (PWV) predict the presence of advanced peripheral arterial disease (PAD). Applanation tonometry and vascular ultrasound were employed to assess carotid-femoral PWV, PPc, and carotid intima media thickness (IMT) in 136 patients...

Although an increased aortic pulse wave velocity (PWV) may be employed to predict cardiovascular risk, the extent to which this may be limited by decreases in PWV in peripheral arterial disease (PAD) is uncertain. Applanation tonometry (SphygmoCor software) and vascular B-mode ultrasound were employed to assess carotid-femoral PWV and carotid intim...

Severe vascular injury after neck trauma can be present even in the absence of clinical signs. Liberal Duplex Doppler or angiography after blunt trauma when cervical vessel injuries cannot be ruled out is indicated. Associated injuries of the cervical spine, airway, and digestive tract must always be considered. Always stabilise the neck of patien...

Central aortic blood pressure (BP; BPc) predicts outcomes beyond brachial BP. In this regard, the application of a generalized transfer function (GTF) to radial pulse waves for the derivation of BPc is an easy and reproducible measurement technique. However, the use of the GTF may not be appropriate in all circumstances. Although the peak of the se...

The Study for Monitoring Antimicrobial Resistance Trends (SMART) follows trends in resistance among aerobic and facultative anaerobic gram-negative bacilli (GNB) isolated from complicated intra-abdominal infections (cIAIs) in patients around the world. During 2004-2009, three centralized clinical microbiology laboratories serving 59 private hospita...

Die HIV-Infektion äußert sich in zahlreichen omnipräsenten Manifestionen, von denen viele nur für diese Krankheit bekannt sind und die nicht durch die immunsuppressive Wirkung dieser Krankheit verursacht werden. Kein Teil des Körpers bleibt unbetroffen. Dieser Beitrag beschreibt ungewöhnliche Arterienerkrankungen, die bei HIV-infizierten Patienten...

Background: The extent to which Human Immunodeficiency Virus (HIV) is associated with increases in carotid Intima-Media Thickness (IMT) independent of conventional cardiovascular risk factors is unclear. Hence, we evaluated whether independent of conventional risk factors, an increased carotid IMT occurs in African HIV infected patients with chroni...

VASCULITIDES Occlusive arterial lesions in humans are usually caused by atherosclerosis. The primary and secondary vasculitides are rare inflammatory conditions that may also cause such ischaemia as well as occasional aneurysms. These pathologies usually present with unusual manifestations of ischaemia, but may also be the cause of common symptoms...

Paget-Schroetter syndrome or effort thrombosis is a rare condition with potentially severe consequences, affecting young and otherwise healthy athletes. Its classic clinical presentation should be rapidly identified to promote early diagnosis and treatment. This prevents recurrences and long-term complications such as persistent swelling of the aff...

Background. Bedside teaching is the core teaching strategy in the clinical study years of the medical undergraduate degree at the University of the Witwatersrand. The quality of this teaching strategy has not been formally evaluated by students as other teaching strategies have been. Method. A quantitative, descriptive study was undertaken in the f...

Medium income country such as South Africa face a dilemma on the need to offer high quality vascular surgical care in a resource constrained environment, where the vast majority of population has inadequate access to even the most basic health care provision. At the same time with rapid development in technology there is also the need to provide hi...

HIV has been widely recognised as a prothrombotic condition, with the first case reports having appeared more than 20 years ago. However, surprisingly little evidence is available regarding the mechanisms by which this disease leads to thrombosis. There is little doubt that the relationship is both multifactorial and complex. This review aims to lo...

The HIV status of surgeons, in the context of the informed consent obtained from their patients, is a contentious matter. We surveyed the views of practising surgeons in South Africa regarding aspects of HIV and its impact on surgeons. A cross-sectional survey of surgeons who were members of the Association of Surgeons of South Africa, regarding th...

Southern Africa is made up of some of the poorest countries in the world. In addition, the common perception that the population of Southern Africa has a low incidence of vascular disease has resulted in vascular surgical training being a low priority. The assumption that in the future vascular disease in Southern Africa will remain uncommon is bei...

Nonfunctional popliteal entrapment is due to embryologic maldevelopment within the popliteal fossa. Functional entrapment occurs in the apparent absence of an anatomic abnormality. Gastrocnemius hypertrophy has been associated with the latter. Both forms of entrapment may cause arterial injury and lower limb ischemia. This study assessed the attach...

South Africa is a low- to middle-income country with huge disparities in income, and a legacy of a disadvantaged majority. During the last 30 years, many of the advantaged minority found greener pastures and emigrated to first-world countries. We are left with a desperate shortage of specialists (including surgeons), particularly in the public sect...

The negative results from the ENHANCE trial of ezetimibe with regard to reduction of intima-media thickness in heterozygous familial hypercholesterolaemic patients provoked intense debate during a special session on the trial at the recent ACC meeting.

The aim of this study was to determine whether the collar graft (standard dacron graft with a customized flexible collar attached to the proximal rim) decreased anastomotic bleeding and the overall clamp time. Prospective randomised single center study. Between November 2003 and January 2006, 21 patients were treated with a collar graft and 19 with...

A pilot study to assess the feasibility and affordability of a targeted screening programme for abdominal aortic aneurysms in a group of employer-based medical schemes. Administrative database review and data extraction. Member enrolment by mail. Analysis using simple descriptive statistics. Review of international experience. Screening uptake and...

We assessed whether features of metabolic syndrome (MetSyn) were risk factors for subclinical atherosclerosis independent of previously identified determinants of cardiovascular disease in 74 patients with rheumatoid arthritis (RA). We further evaluated the clinical utility of currently recommended MetSyn definitions in the identification of RA pat...

HIV/AIDS is a manageable disease with a reasonable expectation that affected individuals might be able to experience both reduced mortality and morbidity. Within the socio-political context of the illness there has been a very strong emphasis on human rights issues, especially in relation to discrimination, which has seemingly been influenced more...

General surgery is facing a serious crisis. There has been a significant decline in the number of applicants for registrar posts and an inability to attract and retain general surgical specialists in the state sector. The Association of Surgeons of South Africa (ASSA) undertook this study to determine the extent and cause of the problem. The study...

Several factors, including comparatively low remuneration, may be responsible for the decline in applicants to general surgery. In this study, the levels of remuneration of general surgeons in the state sector were compared with other professionals in the state sector and general surgeons overseas. The study involved a combination of desk research...

The Association of Surgeons of South Africa (ASSA), because of a concern about the decline in the number of applicants for registrar posts, undertook this study into the various factors that may influence the choice of surgery as career option. The study involved a combination of desk research and structured interviews with heads of departments, sp...

To determine the association between cardiovascular (CV) risk factors and atherosclerosis in patients with rheumatoid arthritis (RA). The common carotid artery intima-media thickness (IMT) and plaque were evaluated by high resolution B-mode ultrasound in 74 consecutive patients with RA. Patients with an IMT > or = 0.60 mm and plaque were considered...

To evaluate the effects of glucocorticoids on cardiovascular (CV) risk in rheumatoid arthritis (RA). We recorded demographic, clinical, disease outcome, and treatment variables in 92 consecutive RA patients who were not taking lipid-lowering or antidiabetic medications. Fasting blood tests were taken for determination of lipids, ultra sensitive C-r...

This study evaluated endothelial dysfunction (ED) by measuring flow-mediated vasodilation (FMD) and for six months documented changes in ED, LDL-C levels and serum concentrations of inflammatory markers with high- and low-dose atorvastatin therapy. In 23 heterozygous familial hypercholesterolaemic (FH) patients, FMD, LDL-C and inflammatory markers...

As many as 10% of airline passengers travelling without prophylaxis for long distances may develop a venous thrombosis. There is, however, no evidence that economy class travellers are at increased risk of thrombosis. A suitably powered prospective study, based on the incidence of deep-vein thrombosis (DVT) reported in previous studies on long-haul...

The study compared, by a prospective, randomized method, 6 treatment options: A: Sclerotherapy; B: High-dose sclerotherapy; C: Multiple ligations; D: Stab avulsion; E: Foam-sclerotherapy; F: Surgery (ligation) followed by sclerotherapy. Results were analyzed 10 years after inclusion and initial treatment. Endpoints of the study were variations in a...

The aim of this study was to compare, in a prospective, randomized study, 6 treatment options: A: 'sclerotherapy; B: High-dose sclerotherapy; C: Multiple ligations; D: Stab avulsion; E: Foamsclerotherapy; F: Surgery (ligation) associated to sclerotherapy. Results were analyzed 10 years after inclusion and initial treatment. Endpoints of the study w...

The aim of this study was to evaluate the prevalence and incidence of venous diseases and the role of concomitant/risk factors for varicose veins (VV) or chronic venous insufficiency (CVI). The study was based in San Valentino in Central Italy and was a real whole-population study. The study included 30,000 subjects in eight villages/towns evaluate...

The aim of this study was to compare, in a prospective, randomised study, flush ligation/section of the sapheno-femoral junction (SFJ) including collaterals dissection/ligation to simple, distal (3-5 from the SFJ) long saphenous vein (LSV) ligation/section considering, after 10 years, recurrence of reflux, occurrence of new varices, lenght of obstr...

The aim of this study was to evaluate whether TTFCA (total triterpenic fraction of Centella asiatica), was effective, by modulating collagen production, in a period of 12 months, increasing the echogenicity of echolucent plaques at the femoral bifurcation. Hypoechoic atherosclerotic plaques have been found to be associated with an increased evidenc...

Adhesion of leukocytes to endothelial cells via cell adhesion molecules (CAMS) is thought to be pivotal in the initiation of atherosclerosis. As patients with familial hypercholesterolaemia (FH) are known to develop severe, premature coronary artery disease (CAD), we investigated the usefulness of soluble forms of CAMS namely vascular cellular adhe...

Over a 4-year period, antioxidant therapy (vitamin E) was compared with high-dose statin therapy in 15 patients with homozygous familial hypercholesterolemia. Carotid intima-media thickness, used as an in vivo assessment of atherosclerosis, progressed rapidly during the period of vitamin E therapy but regressed on statin therapy.

This report summarizes our experience with the popliteal entrapment syndrome in 88 limbs (48 patients) treated during a 10-year period. The study cohort consisted of a retrospective analysis of those patients who were seen with symptoms of claudication or severe ischemia by a single surgical group and in whom unequivocal evidence of popliteal entra...

This study's aim was to determine whether biochemical risk factors such as lipoprotein(a), fibrinogen, homocysteine, and insulin, as well as low-density lipoprotein (LDL) particle size, were predictive of carotid intimamedia thickness (IMT), an early marker of atherosclerosis, in subjects with familial hypercholesterolemia (FH). We also determined...

Chronic inflammation, which may be caused by a Africans. 4 Using electronmlcroscopy, elementary bodchronic infection, is similar to the early process that ies resembling chlamydial organisms were found in results in the formation of atherosclerotic plaque)The macrophages from the lipid rich core of the plaque evidence, however, that supports the hy...

This study was performed to demonstrate the value and durability of intraoperative retrograde angioplasty for stenotic lesions of the aortic arch branches at the time of carotid endarterectomy for the treatment of tandem proximal and bifurcation carotid lesions. Retrospective analysis of the clinical data. Forty-four patients were included in this...

A technique has been developed for the establishment of a state of reversible, ureteric obstruction in the primate. Ten adult males had baseline 99mTc-DTPA renogram studies. A randomly selected ureter was totally occluded and obstruction confirmed on renogram. The occlusion was reversed and subsequent renograms confirmed recovery of activity in the...