1
|
Bailey DM, Rose GA, O'Donovan D, Locker D, Appadurai IR, Davies RG, Whiston RJ, Bashir M, Lewis MH, Williams IM. Retroperitoneal Compared to Transperitoneal Approach for Open Abdominal Aortic Aneurysm Repair Is Associated with Reduced Systemic Inflammation and Postoperative Morbidity. Aorta (Stamford) 2022; 10:225-234. [PMID: 36539114 PMCID: PMC9767756 DOI: 10.1055/s-0042-1749173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND In the United Kingdom, the most common surgical approach for repair of open abdominal aortic aneurysms (AAAs) is transperitoneal (TP). However, retroperitoneal (RP) approach is favored in those with more complex vascular anatomy often requiring a cross-clamp on the aorta superior to the renal arteries. This study compared these approaches in patients matched on all major demographic, comorbid, anatomic, and physiological variables. METHODS Fifty-seven patients (TP: n = 24; RP: n = 33) unsuitable for endovascular aneurysm repair underwent preoperative cardiopulmonary exercise testing prior to open AAA repair. The surgical approach undertaken was dictated by individual surgeon preference. Postoperative mortality, complications, and length of hospital stay (LoS) were recorded. Patients were further stratified according to infrarenal (IR) or suprarenal/supraceliac (SR/SC) surgical clamping. Systemic inflammation (C-reactive protein) and renal function (serum creatinine and estimated glomerular filtration rate) were recorded. RESULTS Twenty-three (96%) of TP patients only required an IR clamp compared with 12 (36%) in the RP group. Postoperative systemic inflammation was lower in RP patients (p = 0.002 vs. TP) and fewer reported pulmonary/gastrointestinal complications whereas renal impairment was more marked in those receiving SR/SC clamps (p < 0.001 vs. IR clamp). RP patients were defined by lower LoS (p = 0.001), while mid-/long-term mortality was low/comparable with TP, resulting in considerable cost savings. CONCLUSION Despite the demands of more complicated vascular anatomy, the clinical and economic benefits highlighted by these findings justify the more routine adoption of the RP approach for complex AAA repair.
Collapse
Affiliation(s)
- Damian M. Bailey
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, United Kingdom,Address for correspondence Damian Miles Bailey, PhD Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South WalesAlfred Russel Wallace Building, CF37 4ATUnited Kingdom
| | - George A. Rose
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, United Kingdom
| | - Daniel O'Donovan
- Department of Anaesthetics, University Hospital of Wales, Cardiff, United Kingdom
| | - Dafydd Locker
- Department of Vascular Surgery, University Hospital of Wales, Cardiff, United Kingdom
| | - Ian R. Appadurai
- Department of Anaesthetics, University Hospital of Wales, Cardiff, United Kingdom
| | - Richard G. Davies
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, United Kingdom,Department of Anaesthetics, University Hospital of Wales, Cardiff, United Kingdom
| | - Richard J. Whiston
- Department of Vascular Surgery, University Hospital of Wales, Cardiff, United Kingdom
| | - Mohamad Bashir
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, United Kingdom,Department of Vascular Surgery, University Hospital of Wales, Cardiff, United Kingdom
| | - Michael H. Lewis
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, United Kingdom
| | - Ian M. Williams
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, United Kingdom,Department of Vascular Surgery, University Hospital of Wales, Cardiff, United Kingdom
| |
Collapse
|
2
|
Bashir M, Tan SZCP, Jubouri M, Salahia G, Whiston RJ, White RD, Bailey DM, Williams IM. A narrative review of the surgical management of Paget-Schroetter syndrome: case series and long-term follow-up. Cardiovasc Diagn Ther 2022; 12:744-755. [DOI: 10.21037/cdt-22-158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 08/03/2022] [Indexed: 11/06/2022]
|
3
|
Mahon A, Bourantas NE, Whiston RJ. Physiological comparison of open and endovascular aneurysm repair. Br J Surg 1999; 86:1483-4. [PMID: 10617364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
|
4
|
Wertheim D, Harinath G, Melhuish JM, Williams RJ, Harding KG, Whiston RJ. In vivo pressure profiles of thigh-length graduated compression stockings. Br J Surg 1999; 86:572. [PMID: 10215842 DOI: 10.1046/j.1365-2168.1999.1100h.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
5
|
Whiston RJ, Hedges AR. Provision of a vascular service in a district general hospital. Ann R Coll Surg Engl 1996; 78:228-9. [PMID: 8944492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The effect of the appointment of a vascular interest surgeon (VIS) on the provision of a local vascular service has been analysed with regard to change in workload, over the 2.5 years before and after appointment. During the period analysed (1989-1994), there was an increase in elective vascular surgery: aorto/iliac reconstructions (11 v 58) and femoro-distal reconstructions (5 v 34). Carotid/subclavian, femorocrural and endoscopic cervical sympathectomy were introduced. There was a reduction in tertiary referrals (14 v 34). An associated increase in arteriography (196 v 280), angioplasty (38 v 74) and chemical sympathectomies (12 v 27) was observed. Major amputations, however, decreased (64 v 49). There was a decrease in emergency vascular operations performed; ruptured aneurysms (23 v 15), embolectomy (17 v 10). 50 per cent of these operations were performed by the VIS. The appointment of a vascular surgeon increases surgical, radiological and anaesthetic workload but there are still problems in the provision of a local vascular service.
Collapse
Affiliation(s)
- R J Whiston
- Department of Surgery, Princess of Wales Hospital, Mid Glamorgan
| | | |
Collapse
|
6
|
Boyce DE, Whiston RJ, Young HL. Transecting the rectum: the 'clean cut' approach. Ann R Coll Surg Engl 1996; 78:191. [PMID: 8779502 PMCID: PMC2502697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- D E Boyce
- University of Wales College of Medicine, Cardiff
| | | | | |
Collapse
|
7
|
Abstract
OBJECTIVES To determine whether the intracellular store release of Ca2+ in neutrophils from patients with rheumatoid arthritis, other joint disease and active leg ulceration was different from normal neutrophils. METHODS The release into the cytosol of Ca2+ from stores within individual neutrophils was determined using ratiometric imaging of fura2. The size of the elevated Ca2+ 'cloud' and its concentration were quantified in neutrophils from the circulation of patients with rheumatoid arthritis, other joint diseases, and leg ulcers and from the joints of those with joint disease. RESULTS In neutrophils isolated from both the synovial fluid of patients with rheumatoid arthritis and other joint conditions, and also arising from leg ulcers, the amount of the cell cytosol occupied by elevated Ca2+ was significantly increased compared with neutrophils from healthy subjects; for neutrophils from rheumatoid, non-rheumatoid joints and leg ulcers p values were 0.0006, < 0.0001, 0.016 respectively (Student's t test). There was also a significant increase in Ca2+ release from circulating neutrophils from patients with rheumatoid arthritis (p = 0.09), but not in circulating neutrophils from patients with leg ulcers or non-rheumatoid joint conditions. CONCLUSIONS It is proposed that the increased release of free Ca2+ into the cytosol of neutrophil at inflammatory sites results in increased oxidase activation.
Collapse
Affiliation(s)
- E V Davies
- Department of Surgery, University of Wales, College of Medicine, Cardiff, United Kingdom
| | | | | | | | | | | |
Collapse
|
8
|
Abstract
Neutrophil oxygen radical production was studied in 18 limbs with class 2 or 3 venous disease and compared with that of nine normal limbs. Neutrophils were isolated from arm and leg venous samples. Free radical production was determined using chemiluminescence after stimulation with the chemotactic peptide formyl-methionyl-leucyl-phenylalanine (FMLP) or the ester phorbol myristate acetate (PMA). The ratio of leg to arm luminescence was greater after FMLP stimulation in patients with venous disease (median 1.52 (95 per cent confidence interval (c.i.) 1.27-2.60)) than in controls (median 0.97 (95 per cent c.i. 0.70-1.12); P < 0.01). These changes were not observed with PMA (venous disease 1.16 (95 per cent c.i. 1.05-1.40); controls 0.95 (95 per cent c.i. 0.78-1.24)). There were fewer FMLP receptors on activated leg neutrophils (median 20.19 (95 per cent c.i. 3.58-51.42) fluorescence units) than arm neutrophils (median 36.03 (95 per cent c.i. 13.00-65.28) fluorescence units; P < 0.05), indicating an amplification of signal transduction. Intracellular calcium imaging demonstrated a larger release of calcium after stimulation of leg neutrophils (median 25.0 per cent (95 per cent c.i. 15.7-43.9 per cent)) compared with neutrophils from the arm (median 8.0 per cent (95 per cent c.i. 5.6-16.1 per cent); P = 0.04), demonstrating calcium-dependent activation. Neutrophils in patients with chronic venous disease inappropriately produce more oxygen free radical as a result of amplification of a calcium-dependent signal pathway.
Collapse
Affiliation(s)
- R J Whiston
- Wound Healing Research Unit, University Hospital of Wales, Cardiff, UK
| | | | | | | | | |
Collapse
|
9
|
Abstract
The 'trap' theory of venous ulcer formation Therapeutic touch for dermal wounds.
Collapse
Affiliation(s)
- R J Whiston
- Research fellow, Wound Healing Research Unit, Cardiff
| |
Collapse
|
10
|
Whiston RJ, Armitage NC, Wilcox D, Hardcastle JD. Hartmann's Procedure: An Appraisal. Med Chir Trans 1993; 86:205-8. [PMID: 8505728 PMCID: PMC1293950 DOI: 10.1177/014107689308600409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Ninety-seven patients underwent Hartmann's procedure between 1981 and 1986 at the University Hospital, Nottingham. Sixty-one (63%) required this operation as an emergency procedure. There was an overall mortality of 22% and the morbidity rate was 56%. Infective and cardiovascular problems accounted for 77% of all complications encountered reflecting the age and underlying condition ofthe patients requiring this procedure. Thirty patients had successful restoration of intestinal continuity, the majority of these having their original procedure performed as an emergency for benign disease. There were no immediate postoperative deaths from reanastomosis and few short- or long-term anastomotic problems, however there was again considerable postoperative morbidity.
Collapse
Affiliation(s)
- R J Whiston
- Department of Surgery, University Hospital, Nottingham
| | | | | | | |
Collapse
|
11
|
Lawrence JC, Whiston RJ, Roberts GP, Melhuish JM, Banks V. From the journals. J Wound Care 1992; 1:8-9. [PMID: 27911160 DOI: 10.12968/jowc.1992.1.2.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Donor site healing under alginate and porcine xenografts Assessing varicose veins Regulating tumour necrosis factor-α production The uses of video image analysis Pressure sores and nutrition.
Collapse
Affiliation(s)
- J C Lawrence
- Research director, Bums Research Group, Birmingham Accident Hospital, Birmingham
| | - R J Whiston
- Clinical research fellow in wound healing and vascular surgery, Wound Healing Research Unit, Cardiff
| | - G P Roberts
- Senior research officer, Wound Healing Research Unit, Cardiff
| | - J M Melhuish
- Research technician, Wound Healing Research Unit Cardiff
| | - V Banks
- Research nurse. Wound Healing Research Unit, Cardiff
| |
Collapse
|
12
|
Hopkinson I, Bale S, Whiston RJ, Gilchrist B. Reviews. J Wound Care 1992; 1:56-57. [PMID: 27911191 DOI: 10.12968/jowc.1992.1.1.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
WOUND HEALING THE MANAGEMENT OF LEG ULCERS LEG ULCERS WOUND MANAGEMENT AND DRESSINGS.
Collapse
Affiliation(s)
| | - S Bale
- HVCert director of nursing research
| | - R J Whiston
- Clinical research fellow in wound healing and vascular surgery
| | | |
Collapse
|
13
|
Affiliation(s)
- R J Whiston
- Department of Surgery, Princess of Wales Hospital, Bridgend, Mid-Glamorgan, UK
| | | | | | | |
Collapse
|
14
|
Dennison A, Whiston RJ, Rooney S, Chadderton RD, Wherry DC, Morris DL. A randomized comparison of infrared photocoagulation with bipolar diathermy for the outpatient treatment of hemorrhoids. Dis Colon Rectum 1990; 33:32-4. [PMID: 2403905 DOI: 10.1007/bf02053198] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
One hundred two patients with symptomatic hemorrhoids were randomized to receive treatment with either infrared photocoagulation (IRPC) or a bipolar diathermy probe (BD). There was no significant difference in complications, number of treatments required (IRPC 1.7 [0.9], BD 1.6 [0.8]). Third-degree hemorrhoids required more treatments than smaller piles. BD has some practical advantages over IRPC but results are similar.
Collapse
Affiliation(s)
- A Dennison
- Department of Surgery, University Hospital, Queen's Medical Centre, Nottingham, United Kingdom
| | | | | | | | | | | |
Collapse
|
15
|
Dennison AR, Whiston RJ, Rooney S, Morris DL. The management of hemorrhoids. Am J Gastroenterol 1989; 84:475-81. [PMID: 2655433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- A R Dennison
- Department of Surgery, University Hospital, Queen's Medical Center, Nottingham, England
| | | | | | | |
Collapse
|
16
|
|