Vikram Puttaswamy’s research while affiliated with Royal Berkshire NHS Foundation Trust and other places

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Publications (32)


5-years patency results of Zilver PTX on the femoro-popliteal arterial segment: A Northern Sydney experience
  • Article

November 2024

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6 Reads

Vascular

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Naomi Anning

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Raleene Gatmaitan

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[...]

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Vikram Puttaswamy

Background The burden of peripheral arterial disease is increasing. Treatment of femoro-popliteal lesions remains challenging despite novel endovascular devices. Drug-eluting stents suppress post-treatment inflammation and reducing neo-intimal hyperplasia to reduce in-stent restenosis. Methods A multi-centre retrospective 5-years longitudinal study was undertaken to evaluate freedom from clinically driven target limb revascularisation (FF CD-TLR) and patency of Zilver PTX stents in treating symptomatic femoro-popliteal stenotic lesions. Kaplan–Meier survival curves were used to demonstrate FF CD-TLR, primary, primary assisted and secondary patency. Results There were 148 patients and 183 lesions treated with a mean age of 80.3 years and 52% males. The all-cause 5-years mortality was 25%. FF CD-TLR yearly patencies to 5 years were 81%, 67%, 62%, 57% and 52%, respectively, with significantly poorer outcomes for in-stent restenosis, longer stent lengths and lesions at the femoro-popliteal junction. Primary patencies were 63%, 47%, 40%, 34% and 24%, assisted primary patencies were 90%, 75%, 68%, 59% and 48% and secondary patencies were 96%, 94%, 94%, 92% and 92%. Major adverse limb events were 5% at 1-year and cumulative at 5-years was 16%. Discussion The clinical outcomes in this study population are comparable to recent publications with smaller cohorts. Our study confirms Zilver PTX has very good primary patency over 5 years with no discernible effect on all-cause mortality in an elderly cohort with particularly long treated lesions. Our results are similar to those seen in younger patients with shorter lesions. Nonetheless, longer lesions required more reinterventions to maintain patency. Conclusion Zilver PTX is a safe and durable drug-eluting stent when utilised in the management of femoro-popliteal stenotic lesions with good long-term patency and limited need for re-intervention.


(A) Angiography of the left L4 lumbar artery via a right DCIA approach; (B) Coil embolisation of the left L4 lumbar and type II endoleak; (C) No persistent type II endoleak filling following coil embolisation of the right L4 lumbar artery.
(A) Angiographic view of the directional catheter in the CFA near the DCIA ostium; (B) Antegrade flow in the DCIA from the CFA; (C) View of the microcatheter traversing the DCIA to access the endoleak.
Patient Demographics and Procedural Details.
Transarterial Embolisation of Abdominal Aortic Type II Endoleaks Accessed via the Deep Circumflex Iliac Artery: A Case Series and Literature Review
  • Literature Review
  • Publisher preview available

October 2024

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9 Reads

We report our technique and experience treating 3 patients with native abdominal aortic aneurysm (AAA) sac expansion following EVAR, who were managed with transarterial embolisation via the deep circumflex iliac artery (DCIA). In this case series, we demonstrate that transarterial embolisation via the DCIA is a feasible and safe treatment option. The DCIA should be routinely interrogated with angiography as not only a cause of possible Type II endoleak, but also to identify a potential access route to the abdominal aortic sac for interventional treatment.

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Intra‐operative duplex ultrasound scanning in renal transplantation: protocol and service requirements

March 2024

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45 Reads

Intra‐operative duplex ultrasound in renal transplantation was first described in 1998 and whilst reported in problematic cases, there are few reports of its routine use and no current published protocols. Since 2013, we have used intra‐operative ultrasound in all renal transplants. The formal protocol used since August 2020 is presented as a reference document for other transplant centres. A Canon Aplio 800 ultrasound system with an i22LH8 hockey‐stick transducer is used to image the renal cortex and major vessels, and an i8CX1 matrix transducer to image the graft during and after fascial closure. These transducers are fully sterilised with Sterrad and no sheathing of transducers is required. The transplant surgeon scans within the sterile field with the sonographer guiding imaging and adjusting machine settings. Ultrasound findings are discussed between team members including any requirement for interventions. Ultrasound is performed at three stages of the operation: Stage 1: after clamp release identifying issues of graft vascularity including otherwise unrecognised major vessel and anastomotic abnormalities. Stage 2: following ureteric implantation identifying compromised perfusion due to graft rotation or vessel kinking. Stage 3: after fascial closure identifying compromised perfusion due to external compression. Post‐operative scanning, including assessment of the collecting system and bladder, is performed routinely on days 1, 3, 7 and 30. The intervention is effective with no early graft losses or peri‐operative vascular thromboses. The requirements for service provision are significant including the availability of additional transducers, and sonographers with expertise in intra‐operative scanning able to attend after‐hours for extended periods.


Is There a Role for Heli-FX Endoanchors in Treating Type 1B Common Iliac Artery Endoleaks?

October 2023

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49 Reads

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1 Citation

Objectives The management of type 1B endoleaks following endovascular aortic aneurysm repair (EVAR) can be challenging. The Heli-FX Endoanchor system effectively treats proximal type 1A endoleaks but has not been used for type 1B common iliac artery endoleaks. This study demonstrates that it is both safe and effective in being used in the common iliac artery (CIA) limb of an EVAR. Methods A retrospective review of patients identified through coding and medical records was performed to extract information on demographics, aneurysmal features, operative features, and postoperative outcomes. This was then collated and analysed thoroughly and compared to existing research. Results Four patients with six type 1B CIA endoleaks were treated with Heli-FX Endoanchors in the CIA limbs of EVAR grafts. There was 100% technical success rate with complete exclusion of the endoleaks at 6 months. With mean follow up of 714 days, there were no Endoanchor-specific complications. One patient required explantation of the aortic endograft due to contralateral limb fracture, where it was found that an Endoanchor had penetrated the common iliac vein, requiring primary closure. Conclusions Heli-FX Endoanchors were effective within this cohort of patients, though key risks were identified. Adjacent anatomy to the CIA must be considered, which also have nearly half the arterial thickness compared to the aorta. Pre-operative planning is essential given the theoretical risk of placing Endoanchors.


A sex-based analysis of 5-year outcomes following stenting for the treatment of aorto-iliac occlusive disease

August 2023

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29 Reads

Vascular

Objectives: The aim of this study was to evaluate the impact of sex on mid-term outcomes following stenting for aorto-iliac occlusive disease (AIOD). Methods: The Covered versus Balloon Expandable Stent Trial (COBEST) compared the safety and efficacy of the covered stent (CS) with those of the bare metal stent (BMS) in the treatment of hemodynamically significant AIOD. It was identified that CS provided a significant benefit. The primary endpoint of our analysis was the rate of primary patency 5 years following stenting for AIOD (inclusive of both CS and BMS) in both sexes. Results: Of the 168 lesions treated, 103 (61%) were present in men and 65 (39%) were present in women. Of the concomitant comorbidities, diabetes mellitus was significantly more common in women (17.5% vs 41.5%, p = .006). Although chronic limb threatening ischemia (CLTI) at the time of intervention was more common in women, the difference was not significant (16.5% vs 24.6%, p = .395). Sex was not associated with the primary patency rate (male; 0.70, 95% confidence interval [CI]: 0.23-2.19, p = .543). When considering both male sex and the utilization of BMS, no significant impact was found on the primary patency rate (hazard ratio [HR]: 3.43, 95% CI: 0.69-17.10, p = .133). All-cause mortality at 60 months was 22.6% in men compared to 19.4% in women (p = .695). Conclusions: No significant difference was identified in the primary patency rate between the sexes. Further investigation is warranted to ascertain whether sex-specific interventional guidelines are required in this regard.


Citations (5)


... Perfusion study with intraoperative Duplex ultrasound performed by an expert radiologist has been proposed. Thebridge L et al. [17] described the routine use in 331 consecutive patients. 24 of these patients required correction of the anastomosis, 9 before performing the ultrasound. ...

Reference:

Protocol description and initial experience in kidney graft perfusion using infrared thermography
Early Outcomes in Renal Transplantation With Routine Intraoperative Duplex Ultrasound
  • Citing Article
  • March 2023

Transplantation Proceedings

... The patient's cardiovascular profile, including hypertension and (Hypertrophic Non-Obstructive Cardiomyopathy) HNCM, complicates the clinical picture, with hypertension likely playing a central role in the malignant left MCA stroke [28,29]. However, the use of labetalol and nicardipine for blood pressure management was effective, but persistent high diastolic pressure suggests hypertension control difficulties, possibly linked to HNCM and other cardiovascular abnormalities [30,31]. ...

An unusual case of malignant hypertension causing stroke in a young adult

Annals of Vascular Surgery

... Помимо этого на ИР влияют показатели центральной гемодинамики и возраст реципиента. Многими исследованиями также доказана значимость ИР как одного из ранних предикторов отсроченной функции почечного трансплантата [10][11][12]. ...

Systematic review of intra‐operative duplex scanning during renal transplantation
  • Citing Article
  • February 2022

Australasian Journal of Ultrasound in Medicine

... For FCD, the patient walked on a 100-foot indoor track, and the claudication distance where the patient preferred to stop walking was assessed 15 . FCD has a reliability of 0.959 for assessing individuals with intermittent claudication 16 . The VascuQol-6 questionnaire evaluated patients with symptomatic PAD to assess their diseasespecific Qol. ...

Protocol for the Stimulating β 3 -Adrenergic Receptors for Peripheral Artery Disease (STAR-PAD) trial: A double-blinded, randomised, placebo-controlled study evaluating the effects of mirabegron on functional performance in patients with peripheral arterial disease

BMJ Open

... This could potentially result in hyperfiltration glomerulosclerosis, leading to CKD, and altered renal hemodynamics can potentially contribute to progressive CKD development. Third, commonly used medications for amputation patients include renally eliminated medications, such as adjuvant analgesics and nonsteroidal anti-inflammatory drugs during the surgical intervention and postoperatively for pain control, or anticoagulants to prevent venous thromboembolism [23,24]. Furthermore, amputation patients undergo more frequent contrast CT scans or angiography than the general population, which may lead to contrast-induced nephropathy [25]. ...

Primary prophylaxis for venous thromboembolism in people undergoing major amputation of the lower extremity
  • Citing Article
  • July 2020

Cochrane Database of Systematic Reviews