Kassem, H. H., M. F. Elmahdy, E. B. Ewis, and S. G. Mahdy, "Incidence and predictors of post-catheterization femoral artery pseudoaneurysms", The Egyptian Heart Journal, vol. 65, issue 3, pp. 213-221, 2013. pseudoaneurysm.pdf
Elmahdy, M. F., S. G. Mahdy, E. Baligh Ewiss, K. Said, H. H. Kassem, and W. Ammar, "Value of duplex scanning in differentiating embolic from thrombotic arterial occlusion in acute limb ischemia.", Cardiovascular revascularization medicine : including molecular interventions, vol. 11, issue 4, pp. 223-6, 2010 Oct-Dec. Abstract

BACKGROUND: Management of acute limb ischemia (ALI) is largely based on the etiology of arterial occlusion (embolic vs. thrombotic). To our knowledge, the ability of duplex scanning to differentiate embolic from thrombotic occlusion has not been previously reported.

PURPOSE: To determine the ability of duplex scanning to differentiate embolic from thrombotic acute arterial occlusion.

METHODS: We prospectively recruited 97 patients (50.3 ± 19.7 years; 55% males) with 107 nontraumatic ALI in native arteries. All patients underwent surgical revascularization. Preoperative duplex scan detected arterial occlusion in the following arteries: iliac (11), femoral (38), popliteal (38), infrapopliteal (3), subclavian (3), axillary (1), brachial (9), and forearm arteries (4). We measured the arterial diameters at the site of occlusion (d(occl)) and at the corresponding contralateral healthy side (d(CONTRA)). The difference (Δ) between the two diameters was calculated as d(OCCL)-d(CONTRA). Duplex scan was also used to assess the state of the arterial wall whether healthy or atherosclerotic and the presence of calcification or collaterals. According to surgical findings, limbs were classified into embolic (E group=55 limbs) and thrombotic (T group=52 limbs) groups.

RESULTS: Both groups were comparable regarding age, diabetes, hypertension, smoking, atrial fibrillation, and time of presentation. The status of arterial wall at the site of occlusion and presence of calcification or collaterals were all similar in both groups. Δ in the E group was 0.95 ± 0.92 mm vs. -0.13 ± 1.02 mm in the T group (P<.001). A value of ≥ 0.5 mm for Δ had 85% sensitivity and 76% specificity for the diagnosis of embolic occlusion (CI 0.72-0.90, P<.001), whereas a value of less than -0.5 mm for Δ had 85% sensitivity and 76% specificity for thrombotic occlusion (CI 0.72-0.90, P<.001).

CONCLUSION: In acute arterial occlusion, ≥ 0.5 mm dilatation or diminution in the occluded artery diameter is a useful duplex sign for diagnosing embolic or thrombotic occlusion, respectively.

Elmahdy, M. F., S. Abdelsalam, M. Donya, A. ELFaramawy, K. Said, J. Miro, and M. Yacoub, "Closure of a large pulmonary arterio-venous fistula with Amplatzer vascular plug I.", European heart journal cardiovascular Imaging, vol. 13, issue 10, pp. 881, 2012 Oct.
Elmahdy, M. F., and D. Antoniucci, "ARCTIC: Additional proof against antiplatelet adjusted therapy.", Global cardiology science & practice, vol. 2013, issue 2, pp. 130-2, 2013.
Elmahdy, M. F., and D. Antoniucci, "TRIOLOGY ACS: No benefit/No harm.", Global cardiology science & practice, vol. 2013, issue 2, pp. 133-5, 2013.
Samaan, A. A., H. Hosny, M. Donia, M. F. Elmahdy, and C. van Doorn, "Successful repair of obstructed pulmonary venous confluence by the descending aorta in a 43-year-old patient: pre- and post-operative images.", European heart journal cardiovascular Imaging, vol. 14, issue 6, pp. 525, 2013 Jun.
Elmahdy, M. F., H. H. Kassem, E. B. Ewis, and S. G. Mahdy, "Comparison between ultrasound-guided compression and para-aneurysmal saline injection in the treatment of postcatheterization femoral artery pseudoaneurysms.", The American journal of cardiology, vol. 113, issue 5, pp. 871-6, 2014 Mar 01. Abstract

Management of postcatheterization femoral artery pseudoaneurysm (FAP) is problematic. Ultrasound-guided compression (UGC) is painful and cumbersome. Thrombin injection is costly and may cause thromboembolism. Ultrasound-guided para-aneurysmal saline injection (PASI) has been described but was never compared against other treatment methods of FAP. We aimed at comparing the success rate and complications of PASI versus UGC. We randomly assigned 80 patients with postcatheterization FAPs to either UGC (40 patients) or PASI (40 patients). We compared the 2 procedures regarding successful obliteration of the FAP, incidence of vasovagal attacks, procedure time, discontinuation of antiplatelet and/or anticoagulants, and the Doppler waveform in the ipsilateral pedal arteries at the end of the procedure. There was no significant difference between patients in both groups regarding clinical and vascular duplex data. The mean durations of UGC and PASI procedures were 58.14 ± 28.45 and 30.33 ± 8.56 minutes, respectively (p = 0.045). Vasovagal attacks were reported in 10 (25%) and 2 patients (5%) treated with UGC and PASI, respectively (p = 0.05). All patients in both groups had triphasic Doppler waveform in the infrapopliteal arteries before and after the procedure. The primary and final success rates were 75%, 92.5%, 87.5%, and 95% for UGC and PASI, respectively (p = 0.43). In successfully treated patients, there was no reperfusion of the FAP in the follow-up studies (days 1 and 7) in both groups. In conclusion, ultrasound-guided PASI is an effective method for the treatment of FAP. Compared with UGC, PASI is faster, less likely to cause vasovagal reactions, and can be more convenient to patients and physicians.

Elmahdy, M. F., "TASTE: To aspirate, or not to aspirate, remains a question.", Global cardiology science & practice, vol. 2014, issue 1, pp. 37-9, 2014.
Abdelsalam, G. G., H. Saad, M. Donia, H. Elnady, and M. F. Elmahdy, "Atypical site and size of atrial myxoma.", Cardiovascular revascularization medicine : including molecular interventions, vol. 16, issue 2, pp. 129-30, 2015 Mar.
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