Ambarish Satwik - Academia.edu (original) (raw)

Papers by Ambarish Satwik

Oxford University PressOxford eBooks, Nov 1, 2022

BMJ Case Reports, 2021

Cervical ectopic pregnancy is an extremely rare form of ectopic pregnancy with potential risk of ... more Cervical ectopic pregnancy is an extremely rare form of ectopic pregnancy with potential risk of massive bleeding and associated morbidity. Managing this condition is challenging for clinicians due to the serious risk to patient and dilemma faced in deciding the appropriate management plan. This case report describes the role of uterine artery embolisation in managing a case of cervical ectopic pregnancy with heavy bleeding per vaginum post methotrexate treatment with falling beta human chorionic gonadotropin (HCG) levels. It highlights the unpredictable nature of this condition and need for prompt intervention in an emergency situation.

European Journal of Vascular and Endovascular Surgery, 2019

Current Medicine Research and Practice, 2020

Current Medicine Research and Practice, 2018

Indian Journal of Vascular and Endovascular Surgery, 2018

Indian Journal of Vascular and Endovascular Surgery ¦ Volume 5 ¦ Issue 1 ¦ January-March 2018 65 ... more Indian Journal of Vascular and Endovascular Surgery ¦ Volume 5 ¦ Issue 1 ¦ January-March 2018 65 failure in a young patient, who has recently undergone lumbar discectomy, is almost diagnostic of traumatic AVF. Almost 25% of these cases go undetected for up to a year due to mild symptoms, treatment of congestive symptoms with diuretics, misdiagnosis, and ignorance of this condition. The diagnosis of this condition is made by imaging, usually CTA or DSA.[5,6]

Indian Journal of Vascular and Endovascular Surgery, 2018

Current Medicine Research and Practice, 2017

Current Medicine Research and Practice, 2015

Journal of Vascular Surgery Cases, Innovations and Techniques, 2019

Duplication of the inferior vena cava (IVC) with coagulation mutations in the form of factor V Le... more Duplication of the inferior vena cava (IVC) with coagulation mutations in the form of factor V Leiden and MTHFR mutations represents an unusual subset of patients. We are reporting a case of a 43-year-old man who presented with left iliofemoral deep venous thrombosis diagnosed on duplex ultrasound scan. At the time of catheter-directed thrombolysis with prophylactic IVC filter placement, a duplicated IVC system was observed. After thrombolysis, a stenotic lesion in the left common iliac vein and IVC was stented. IVC filters were retrieved after 6 weeks. On thrombophilia profile testing at 3 months, he was also found to have factor V Leiden and MTHFR mutations. After 12 months of follow-up, the patient is asymptomatic with a patent iliocaval venous system and is receiving lifelong anticoagulation.

Indian Journal of Vascular and Endovascular Surgery

Indian Journal of Vascular and Endovascular Surgery, 2020

Introduction: Assessment of carbon dioxide (CO2) angiography for its efficacy and limitations in ... more Introduction: Assessment of carbon dioxide (CO2) angiography for its efficacy and limitations in lower limb angioplasties for chronic limb-threatening limb ischemia needs to be evaluated in detail, as the use of CO2 as a contrast agent has a distinct advantage over conventional iodinated contrast medium (ICM) in patients with borderline chronic kidney disease (CKD), with respect to nephrotoxicity caused by the later. Aims and Objectives: To study the quality of angiography images obtained with CO2 as a contrast agent and the efficacy of CO2 angiography in guiding lower limb angioplasties for critical limb ischemia. Design: This was a prospective, observational, comparative, cohort study. Study Period: September 2017–December 2018. Materials and Methods: Patients of critical limb ischemia with raised serum creatinine level (>1.49 mg/dL) who were not on the dialysis and undergoing endovascular revascularization were enrolled in the study. Hand injections were made using CO2 Angioset. Intraoperative evaluation of image quality obtained using CO2 was done by two vascular surgeons and compared with conventional contrast medium. Necessary therapeutic intervention was performed using CO2 angiography image if reliable image was acquired using the same. Results: A total of 100 patients were evaluated consisting of 176 arterial segments, out of which 145 segments required use of ICM and 31 segments were intervened using CO2 only as a contrast agent (19 superficial femoral artery, 6 common iliac artery, 2 pop artery, 3 external iliac artery, and 1 anterior tibial artery). Assessment of scores given by the observer 1 and observer 2 was performed by their comparison for the statistical significance using McNemar–Bowker test and was found to be statistically significant with P = 0.02. Kendall's Tau b coefficient is 0.74 (significant) and Cohen's kappa is 0.63 (significant). Good-quality images were seen in above the knee (ATK) segment in 39.3% and moderate in 57.8%. However, below the knee (BTK) segments received poor image quality score in majority, i.e., 82.6%. There was significant reduction observed in the total volume of ICM. No major adverse reaction/complication encountered during the procedures was observed, except pain being the most common and distressing complication. Conclusions: CO2 angiography is a very useful tool in the armamentarium of vascular surgeon, especially while performing angioplasties for peripheral arterial disease in borderline CKD patients, not on dialysis, because it not only reduces the amount of iodinated contrast used but also has good imaging ability in ATK vessels. It was fought with multiple issues while imaging BTK vessels, leading to reduction in its reliability and feasibility in that segment.

Indian Journal of Vascular and Endovascular Surgery, 2021

Thrombotic complications have been reported widely in patients with severe coronavirus disease 20... more Thrombotic complications have been reported widely in patients with severe coronavirus disease 2019 (COVID-19) infection. There has been an increasing trend of arterial thrombosis leading to significant morbidity and mortality. We report a case of a patient with COVID-19 related pneumonia who presented with acute limb ischemia.

Indian Journal of Vascular and Endovascular Surgery, 2020

Aim: The study was aimed to evaluate the role of two-dimensional (2D) perfusion angiography (PA) ... more Aim: The study was aimed to evaluate the role of two-dimensional (2D) perfusion angiography (PA) as a predictor in wound healing outcomes in patients of critical limb ischemia. Subject and Methods: It was a pilot study conducted over a period of 16 months after taking informed consent and institutional ethical clearance. The study included 40 patients of which 8 were lost to follow-up, hence the prospective data of 32 patients was collected and analyzed. Patients were subjected to endovascular intervention and 2D perfusion software was applied to the digital subtraction angiography images and its parameters were assessed. Transcutaneous oxygen tension (TcPO2) was measured pre- and postintervention and patients were closely followed up for the time taken for wound healing. Results: The median age was 62 years ranging from 30 to 85 years. Most common comorbidity was diabetes (21/32 patients). The mean Ankle–Brachial Index in the study was 0.55 and mean TcPO2 at admission was 26.5 mm o...

European Journal of Internal Medicine, 2021

An unprecedented surge in SARS-CoV-2 infections driven by the Delta variant was reported from Ind... more An unprecedented surge in SARS-CoV-2 infections driven by the Delta variant was reported from India recently[1]. The total reported new cases from its capital, New Delhi, in April and May 2021 were more than those reported in a 13-month period since the onset of the pandemic (765,117 vs 661,123)[2]. We estimated ChAdOx1 nCoV-19 effectiveness during this surge. Sir Gangaram Hospital is a tertiary care private hospital in New Delhi, having 4296 employees with equitable access to medical benefits, including investigations, medicines and hospitalization. Of these, between 16.1.21 to 30.4.21, 2716 received two doses, and 623 received a single dose of ChAdOx1-nCoV2. 927 remained unvaccinated till 30.4.21. 20 received the BBV152 vaccine or the BNT162b2 vaccine and were excluded from our analysis. We studied infection rates, moderate to severe disease rates, supplemental oxygen therapy rates and death rates in the ChAdOx1 2-doses and single-dose cohorts against the unvaccinated cohort in the period from 1.3.21 to 31.5.21. Disease severity was assigned as per the Indian Council of Medical Research guidelines[3]. Cumulative event rates were calculated using the Kaplan Meier estimator. Cox Proportional Hazard regression model was used to calculate Hazard Ratios (aHR) adjusting for age, gender, health-worker role, previous SARS-CoV-2 infections, active or retired status and comorbidities. Vaccine effectiveness was calculated as (1-aHR)x100. In total, 560 (13.1%) employees out 4276 tested positive for COVID-RTPCR between 1.3.21 to 31.5.21. Of these, 9 (1.6%) were lost to follow-up, 10 (1.8%) were asymptomatic, 458 (81.79%) had mild disease, 57 (10.2%) had moderate disease, and 26 (4.64%) had severe disease. There were six deaths totally in the study population (1.06%). Of those testing positive, 61 were hospitalized, and 499 remained in home quarantine(HQ). Notably, 57.5% of those with moderate to severe disease were in home quarantine (due to non-availability of hospital beds) and would have been missed had it not been through strict disease surveillance and follow up. Since hospitalization rates alone would not have been entirely indicative of disease severity, we did not take it as an outcome measure in our study. Marginal lowering of the incidence of symptomatic infections [12.0% (327/2716) vs 14.2% (133/937) aHR:0.76 (95%CI: 0.62-0.94)] and significant lowering of moderate to severe disease [1.2% (33/2716) vs. 3.4% (32/937); aHR: 0.35 (95% CI: 0.21-0.58)] and supplemental oxygen therapy [0.4% (11/2716) vs. 1.8% (17/937); aHR: 0.25 (95%CI: 0.11-0.58)] was observed in the 2-dose as compared to the unvaccinated cohort. This effect persisted for all events occurring beyond 14 days from dose 2. However, when analyzing for events beyond 21 days from the single dose, the incidence of symptomatic infections [12.3% (75/607) vs.

PAIRS Annual Meeting, 2018

data of the patient and obviation of hysterectomy. Gel foam hand cut pledges were the embolic age... more data of the patient and obviation of hysterectomy. Gel foam hand cut pledges were the embolic agent used. Results: Bleeder whether extravasation or pseudoaneurysm could be identified angiographically in 32 patients. In 43 patients, no definite bleeder could be identified, so bilateral uterine artery embolization was done empirically. Clinical success rate was 80% (60 patients including 31 patients with angiographically identified bleeder). Hysterectomy was needed in 15 patients after rebleeding post-UAE. No major procedural-related complications were recorded. Conclusion: Transcatheter arterial Embolization of the uterine artery is a feasible treatment option in the management of postpartum bleeding with low rates of complications. Angiographic identification of the bleeding source was associated with higher clinical success rates decreasing the need for hysterectomies.

European Journal of Vascular and Endovascular Surgery, 2022

swelling had reduced in size. Patient was discharged on anticoagulants. Computed tomography scan ... more swelling had reduced in size. Patient was discharged on anticoagulants. Computed tomography scan at 1-month follow up showed patent stent. Conclusion: Duplicated IVC can be considered as one of those rare congenital causes that predisposes to VTE. Surgeons need to be aware of such anomalies of IVC and that they may influence decision-making in patients with an acute presentation of thromboembolic disease.

swelling had reduced in size. Patient was discharged on anticoagulants. Computed tomography scan ... more swelling had reduced in size. Patient was discharged on anticoagulants. Computed tomography scan at 1-month follow up showed patent stent. Conclusion: Duplicated IVC can be considered as one of those rare congenital causes that predisposes to VTE. Surgeons need to be aware of such anomalies of IVC and that they may influence decision-making in patients with an acute presentation of thromboembolic disease.

Indian Journal of Vascular and Endovascular Surgery, 2021

A 50-year-old male diabetic, hypertensive and chronic smoker presented with complex aortic, splan... more A 50-year-old male diabetic, hypertensive and chronic smoker presented with complex aortic, splanchnic aneurysms with impending rupture of iliac artery aneurysm, underwent coiling of celiac artery, internal iliac artery, and fenestrated/chimney endovascular aortic repair. One month later, the patient landed in an emergency due to bleeding complications of common hepatic artery and gastroduodenal artery aneurysms, which were managed successfully using endovascular techniques. The mayhem of progressive nature of the disease in the patient continued as he had left lower limb ischemia due to occlusion of the iliac artery and iliac limb of the aortic graft device as he continued to smoke. All of the above sequences of events occurred over a period of 5 years. He also developed a giant aneurysm of left anterior descending of 6.8 cm diameter, which had to be repaired by open surgical technique. The patient has been followed up for 6 years since his first presentation, and he was managed successfully from all the catastrophe of events using endovascular techniques. Giant coronary artery aneurysm with previous aneurysms at multiple sites is quite unusual and rare. Currently, there is no consensus regarding the clinical characteristics, diagnostic method, and the treatment of these cases.

Oxford University PressOxford eBooks, Nov 1, 2022

BMJ Case Reports, 2021

Cervical ectopic pregnancy is an extremely rare form of ectopic pregnancy with potential risk of ... more Cervical ectopic pregnancy is an extremely rare form of ectopic pregnancy with potential risk of massive bleeding and associated morbidity. Managing this condition is challenging for clinicians due to the serious risk to patient and dilemma faced in deciding the appropriate management plan. This case report describes the role of uterine artery embolisation in managing a case of cervical ectopic pregnancy with heavy bleeding per vaginum post methotrexate treatment with falling beta human chorionic gonadotropin (HCG) levels. It highlights the unpredictable nature of this condition and need for prompt intervention in an emergency situation.

European Journal of Vascular and Endovascular Surgery, 2019

Current Medicine Research and Practice, 2020

Current Medicine Research and Practice, 2018

Indian Journal of Vascular and Endovascular Surgery, 2018

Indian Journal of Vascular and Endovascular Surgery ¦ Volume 5 ¦ Issue 1 ¦ January-March 2018 65 ... more Indian Journal of Vascular and Endovascular Surgery ¦ Volume 5 ¦ Issue 1 ¦ January-March 2018 65 failure in a young patient, who has recently undergone lumbar discectomy, is almost diagnostic of traumatic AVF. Almost 25% of these cases go undetected for up to a year due to mild symptoms, treatment of congestive symptoms with diuretics, misdiagnosis, and ignorance of this condition. The diagnosis of this condition is made by imaging, usually CTA or DSA.[5,6]

Indian Journal of Vascular and Endovascular Surgery, 2018

Current Medicine Research and Practice, 2017

Current Medicine Research and Practice, 2015

Journal of Vascular Surgery Cases, Innovations and Techniques, 2019

Duplication of the inferior vena cava (IVC) with coagulation mutations in the form of factor V Le... more Duplication of the inferior vena cava (IVC) with coagulation mutations in the form of factor V Leiden and MTHFR mutations represents an unusual subset of patients. We are reporting a case of a 43-year-old man who presented with left iliofemoral deep venous thrombosis diagnosed on duplex ultrasound scan. At the time of catheter-directed thrombolysis with prophylactic IVC filter placement, a duplicated IVC system was observed. After thrombolysis, a stenotic lesion in the left common iliac vein and IVC was stented. IVC filters were retrieved after 6 weeks. On thrombophilia profile testing at 3 months, he was also found to have factor V Leiden and MTHFR mutations. After 12 months of follow-up, the patient is asymptomatic with a patent iliocaval venous system and is receiving lifelong anticoagulation.

Indian Journal of Vascular and Endovascular Surgery

Indian Journal of Vascular and Endovascular Surgery, 2020

Introduction: Assessment of carbon dioxide (CO2) angiography for its efficacy and limitations in ... more Introduction: Assessment of carbon dioxide (CO2) angiography for its efficacy and limitations in lower limb angioplasties for chronic limb-threatening limb ischemia needs to be evaluated in detail, as the use of CO2 as a contrast agent has a distinct advantage over conventional iodinated contrast medium (ICM) in patients with borderline chronic kidney disease (CKD), with respect to nephrotoxicity caused by the later. Aims and Objectives: To study the quality of angiography images obtained with CO2 as a contrast agent and the efficacy of CO2 angiography in guiding lower limb angioplasties for critical limb ischemia. Design: This was a prospective, observational, comparative, cohort study. Study Period: September 2017–December 2018. Materials and Methods: Patients of critical limb ischemia with raised serum creatinine level (>1.49 mg/dL) who were not on the dialysis and undergoing endovascular revascularization were enrolled in the study. Hand injections were made using CO2 Angioset. Intraoperative evaluation of image quality obtained using CO2 was done by two vascular surgeons and compared with conventional contrast medium. Necessary therapeutic intervention was performed using CO2 angiography image if reliable image was acquired using the same. Results: A total of 100 patients were evaluated consisting of 176 arterial segments, out of which 145 segments required use of ICM and 31 segments were intervened using CO2 only as a contrast agent (19 superficial femoral artery, 6 common iliac artery, 2 pop artery, 3 external iliac artery, and 1 anterior tibial artery). Assessment of scores given by the observer 1 and observer 2 was performed by their comparison for the statistical significance using McNemar–Bowker test and was found to be statistically significant with P = 0.02. Kendall's Tau b coefficient is 0.74 (significant) and Cohen's kappa is 0.63 (significant). Good-quality images were seen in above the knee (ATK) segment in 39.3% and moderate in 57.8%. However, below the knee (BTK) segments received poor image quality score in majority, i.e., 82.6%. There was significant reduction observed in the total volume of ICM. No major adverse reaction/complication encountered during the procedures was observed, except pain being the most common and distressing complication. Conclusions: CO2 angiography is a very useful tool in the armamentarium of vascular surgeon, especially while performing angioplasties for peripheral arterial disease in borderline CKD patients, not on dialysis, because it not only reduces the amount of iodinated contrast used but also has good imaging ability in ATK vessels. It was fought with multiple issues while imaging BTK vessels, leading to reduction in its reliability and feasibility in that segment.

Indian Journal of Vascular and Endovascular Surgery, 2021

Thrombotic complications have been reported widely in patients with severe coronavirus disease 20... more Thrombotic complications have been reported widely in patients with severe coronavirus disease 2019 (COVID-19) infection. There has been an increasing trend of arterial thrombosis leading to significant morbidity and mortality. We report a case of a patient with COVID-19 related pneumonia who presented with acute limb ischemia.

Indian Journal of Vascular and Endovascular Surgery, 2020

Aim: The study was aimed to evaluate the role of two-dimensional (2D) perfusion angiography (PA) ... more Aim: The study was aimed to evaluate the role of two-dimensional (2D) perfusion angiography (PA) as a predictor in wound healing outcomes in patients of critical limb ischemia. Subject and Methods: It was a pilot study conducted over a period of 16 months after taking informed consent and institutional ethical clearance. The study included 40 patients of which 8 were lost to follow-up, hence the prospective data of 32 patients was collected and analyzed. Patients were subjected to endovascular intervention and 2D perfusion software was applied to the digital subtraction angiography images and its parameters were assessed. Transcutaneous oxygen tension (TcPO2) was measured pre- and postintervention and patients were closely followed up for the time taken for wound healing. Results: The median age was 62 years ranging from 30 to 85 years. Most common comorbidity was diabetes (21/32 patients). The mean Ankle–Brachial Index in the study was 0.55 and mean TcPO2 at admission was 26.5 mm o...

European Journal of Internal Medicine, 2021

An unprecedented surge in SARS-CoV-2 infections driven by the Delta variant was reported from Ind... more An unprecedented surge in SARS-CoV-2 infections driven by the Delta variant was reported from India recently[1]. The total reported new cases from its capital, New Delhi, in April and May 2021 were more than those reported in a 13-month period since the onset of the pandemic (765,117 vs 661,123)[2]. We estimated ChAdOx1 nCoV-19 effectiveness during this surge. Sir Gangaram Hospital is a tertiary care private hospital in New Delhi, having 4296 employees with equitable access to medical benefits, including investigations, medicines and hospitalization. Of these, between 16.1.21 to 30.4.21, 2716 received two doses, and 623 received a single dose of ChAdOx1-nCoV2. 927 remained unvaccinated till 30.4.21. 20 received the BBV152 vaccine or the BNT162b2 vaccine and were excluded from our analysis. We studied infection rates, moderate to severe disease rates, supplemental oxygen therapy rates and death rates in the ChAdOx1 2-doses and single-dose cohorts against the unvaccinated cohort in the period from 1.3.21 to 31.5.21. Disease severity was assigned as per the Indian Council of Medical Research guidelines[3]. Cumulative event rates were calculated using the Kaplan Meier estimator. Cox Proportional Hazard regression model was used to calculate Hazard Ratios (aHR) adjusting for age, gender, health-worker role, previous SARS-CoV-2 infections, active or retired status and comorbidities. Vaccine effectiveness was calculated as (1-aHR)x100. In total, 560 (13.1%) employees out 4276 tested positive for COVID-RTPCR between 1.3.21 to 31.5.21. Of these, 9 (1.6%) were lost to follow-up, 10 (1.8%) were asymptomatic, 458 (81.79%) had mild disease, 57 (10.2%) had moderate disease, and 26 (4.64%) had severe disease. There were six deaths totally in the study population (1.06%). Of those testing positive, 61 were hospitalized, and 499 remained in home quarantine(HQ). Notably, 57.5% of those with moderate to severe disease were in home quarantine (due to non-availability of hospital beds) and would have been missed had it not been through strict disease surveillance and follow up. Since hospitalization rates alone would not have been entirely indicative of disease severity, we did not take it as an outcome measure in our study. Marginal lowering of the incidence of symptomatic infections [12.0% (327/2716) vs 14.2% (133/937) aHR:0.76 (95%CI: 0.62-0.94)] and significant lowering of moderate to severe disease [1.2% (33/2716) vs. 3.4% (32/937); aHR: 0.35 (95% CI: 0.21-0.58)] and supplemental oxygen therapy [0.4% (11/2716) vs. 1.8% (17/937); aHR: 0.25 (95%CI: 0.11-0.58)] was observed in the 2-dose as compared to the unvaccinated cohort. This effect persisted for all events occurring beyond 14 days from dose 2. However, when analyzing for events beyond 21 days from the single dose, the incidence of symptomatic infections [12.3% (75/607) vs.

PAIRS Annual Meeting, 2018

data of the patient and obviation of hysterectomy. Gel foam hand cut pledges were the embolic age... more data of the patient and obviation of hysterectomy. Gel foam hand cut pledges were the embolic agent used. Results: Bleeder whether extravasation or pseudoaneurysm could be identified angiographically in 32 patients. In 43 patients, no definite bleeder could be identified, so bilateral uterine artery embolization was done empirically. Clinical success rate was 80% (60 patients including 31 patients with angiographically identified bleeder). Hysterectomy was needed in 15 patients after rebleeding post-UAE. No major procedural-related complications were recorded. Conclusion: Transcatheter arterial Embolization of the uterine artery is a feasible treatment option in the management of postpartum bleeding with low rates of complications. Angiographic identification of the bleeding source was associated with higher clinical success rates decreasing the need for hysterectomies.

European Journal of Vascular and Endovascular Surgery, 2022

swelling had reduced in size. Patient was discharged on anticoagulants. Computed tomography scan ... more swelling had reduced in size. Patient was discharged on anticoagulants. Computed tomography scan at 1-month follow up showed patent stent. Conclusion: Duplicated IVC can be considered as one of those rare congenital causes that predisposes to VTE. Surgeons need to be aware of such anomalies of IVC and that they may influence decision-making in patients with an acute presentation of thromboembolic disease.

swelling had reduced in size. Patient was discharged on anticoagulants. Computed tomography scan ... more swelling had reduced in size. Patient was discharged on anticoagulants. Computed tomography scan at 1-month follow up showed patent stent. Conclusion: Duplicated IVC can be considered as one of those rare congenital causes that predisposes to VTE. Surgeons need to be aware of such anomalies of IVC and that they may influence decision-making in patients with an acute presentation of thromboembolic disease.

Indian Journal of Vascular and Endovascular Surgery, 2021

A 50-year-old male diabetic, hypertensive and chronic smoker presented with complex aortic, splan... more A 50-year-old male diabetic, hypertensive and chronic smoker presented with complex aortic, splanchnic aneurysms with impending rupture of iliac artery aneurysm, underwent coiling of celiac artery, internal iliac artery, and fenestrated/chimney endovascular aortic repair. One month later, the patient landed in an emergency due to bleeding complications of common hepatic artery and gastroduodenal artery aneurysms, which were managed successfully using endovascular techniques. The mayhem of progressive nature of the disease in the patient continued as he had left lower limb ischemia due to occlusion of the iliac artery and iliac limb of the aortic graft device as he continued to smoke. All of the above sequences of events occurred over a period of 5 years. He also developed a giant aneurysm of left anterior descending of 6.8 cm diameter, which had to be repaired by open surgical technique. The patient has been followed up for 6 years since his first presentation, and he was managed successfully from all the catastrophe of events using endovascular techniques. Giant coronary artery aneurysm with previous aneurysms at multiple sites is quite unusual and rare. Currently, there is no consensus regarding the clinical characteristics, diagnostic method, and the treatment of these cases.