South African Journal of Surgery - Volume 47, Issue 2, 2009
Volume 47, Issue 2, 2009
Publish or Perish revisited : letter to the editor, South African Journal of Surgery 46(2) : pp. 62 : notice of withdrawal of paperAuthor I. ChamisaSource: South African Journal of Surgery 47 (2009)More Less
Source: South African Journal of Surgery 47, pp 36 –42 (2009)More Less
Objectives. To evaluate peripheral arterial occlusive disease in HIV-infected patients regarding clinical presentation and outcome of surgical intervention.
Design. Prospective clinical survey.
Patients and methods. Routine voluntary testing for HIV / AIDS was performed in all patients presenting to our vascular unit. HIV+ patients were enrolled in a registry and followed up prospectively.
Results. We identified 154 HIV+ patients, of whom 91 (59%) presented with occlusive disease. There were 71 males and 20 females with a mean age of 44.2 years. The usual risk factors for atherosclerosis were present, but the incidence was less than reported in the classic atherosclerosis population. More than 90% of the patients presented with advanced stage vascular disease (Fontaine III/IV), which explains the high rate (31.9%) of primary amputation. Eighty-seven patients presented with lower-limb ischaemia, 2 patients with upper-limb ischaemia and 2 patients with symptomatic carotid artery stenosis. Seventy-eight procedures were performed on 72 patients, with a perioperative mortality of 6.95%. The limb salvage rate for femoro-popliteal bypassprocedures was poor (36.1%), resulting in a high incidence of secondary amputations and prolonged hospital stay. Long-term mortality for the operated patients was 20% over a mean follow-up period of 15.4 months. Hypo-albuminaemia was found to be an important predictor of outcome.
Conclusion. Patients presenting with HIV-associated peripheral arterial disease should be carefully selected for intervention, taking into consideration nutritional and immune status, stage of the vascular disease and selecting the appropriate procedure.
Author J.V. RobbsSource: South African Journal of Surgery 47, pp 44 –45 (2009)More Less
The first reported series of large-vessel aneurysms in patients with HIV infection emanated from Zimbabwe. A more comprehensive study of the pathology was reported by Nair et al. in 1999. More recently there has been some focus on occlusive large-vessel disease, with separate reports by Nair et al. and Mulaudzi et al. in 2000 and 2005, respectively.
Source: South African Journal of Surgery 47, pp 46 –53 (2009)More Less
Descriptions of the numerous manifestations of human immunodeficiency virus (HIV) infection affecting almost every organ system have abounded in recent publications. Multiple radiological, clinical and postmortem reports have recorded the cerebral, pulmonary, cardiac, renal, rheumatological and gastrointestinal pathologies in HIV-infected individuals, ranging from the bizarre to the mundane. Large-vessel HIV-related vascular manifestations have previously been reported in the surgical literature. We describe and review the manifestations of HIV-associated vasculopathy as it pertains to the cerebral, cardiovascular, mesenteric and renal circulations.
Source: South African Journal of Surgery 47, pp 54 –56 (2009)More Less
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 look at the available data and provide a concise summary of the present level of knowledge.
The future of HIV vasculopathy when our patients are on antiretroviral therapy : vascular surgery: reviewAuthor Renald BarrySource: South African Journal of Surgery 47, pp 58 –60 (2009)More Less
South Africa was one of the last countries in Africa to be affected by the HIV epidemic, but currently has one of the highest prevalences in the world. Antiretroviral therapy (ART) was recently introduced in South Africa, and as of December 2007 antiretroviral treatment coverage in this country was about 25% (UNAIDS, 2008). There is a well-documented relationship between vascular disease and HIV infection. This HIV vasculopathy may manifest as arterial aneurysms, occlusive disease or complications of hypercoagulability. The question to be asked is 'What is the future of HIV vasculopathy when our patients are on antiretroviral therapy?'
Source: South African Journal of Surgery 47, pp 62 –63 (2009)More Less
The manifestations of the HIV pandemic are manifold, affecting all organ systems. With respect to the vascular system, it is recognised that vasculitides constitute one of the less common but none the less challenging consequences of HIV infection. The HIV pandemic has also seen a dramatic increase in the prevalence of Kaposi's sarcoma and its frequently associated complication of chronic lymphoedema. When these three manifestations of HIV (Kaposi's sarcoma, lymphoedema and vasculopathy) coexist in the same limb, as in this report, unique clinical and management challenges are presented.