1
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Jones AD, Waduud MA, Walker P, Stocken D, Bailey MA, Scott DJA. Meta-analysis of fenestrated endovascular aneurysm repair versus open surgical repair of juxtarenal abdominal aortic aneurysms over the last 10 years. BJS Open 2019; 3:572-584. [PMID: 31592091 PMCID: PMC6773647 DOI: 10.1002/bjs5.50178] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 04/01/2019] [Indexed: 11/12/2022] Open
Abstract
Background Juxtarenal abdominal aortic aneurysms pose a significant challenge whether managed endovascularly or by open surgery. Fenestrated endovascular aneurysm repair (FEVAR) is now well established, but few studies have compared it with open surgical repair (OSR). The aim of this systematic review was to compare short‐ and long‐term outcomes of FEVAR and OSR for the management of juxtarenal aortic aneurysms. Methods A literature search was conducted of the Ovid Medline, EMBASE and PubMed databases. Reasons for exclusion were series with fewer than 20 patients, studies published before 2007 and those concerning ruptured aneurysms. Owing to variance in definitions, the terms ‘juxta/para/suprarenal’ were used; thoracoabdominal aortic aneurysms were excluded. Primary outcomes were 30‐day/in‐hospital mortality and renal insufficiency. Secondary outcomes included major complication rates, rate of reintervention and rates of endoleak. Results Twenty‐seven studies were identified, involving 2974 patients. Study designs included 11 case series, 14 series within retrospective cohort studies, one case–control study and a single prospective non‐randomized trial. The pooled early postoperative mortality rate following FEVAR was 3·3 (95 per cent c.i. 2·0 to 5·0) per cent, compared with 4·2 (2·9 to 5·7) per cent after OSR. After FEVAR, the rate of postoperative renal insufficiency was 16·2 (10·4 to 23·0) per cent, compared with 23·8 (15·2 to 33·6) per cent after OSR. The major early complication rate following FEVAR was 23·1 (16·8 to 30·1) per cent versus 43·5 (34·4 to 52·8) per cent after OSR. The rate of late reintervention after FEVAR was higher than that after OSR: 11·1 (6·7 to 16·4) versus 2·0 (0·6 to 4·3) per cent respectively. Conclusion No significant difference was noted in 30‐day mortality; however, FEVAR was associated with significantly lower morbidity than OSR. Long‐term durability is a concern, with far higher reintervention rates after FEVAR.
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Affiliation(s)
- A D Jones
- The Leeds Vascular Institute Leeds General Infirmary Leeds UK
| | - M A Waduud
- The Leeds Vascular Institute Leeds General Infirmary Leeds UK.,The Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine University of Leeds Leeds UK
| | - P Walker
- The Leeds Vascular Institute Leeds General Infirmary Leeds UK
| | - D Stocken
- The Leeds Institute of Clinical Trials Research University of Leeds Leeds UK
| | - M A Bailey
- The Leeds Vascular Institute Leeds General Infirmary Leeds UK.,The Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine University of Leeds Leeds UK
| | - D J A Scott
- The Leeds Vascular Institute Leeds General Infirmary Leeds UK.,The Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine University of Leeds Leeds UK
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2
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Waduud MA, Wood B, Keleabetswe P, Manning J, Linton E, Drozd M, Hammond CJ, Bailey MA, Scott DJA. Influence of psoas muscle area on mortality following elective abdominal aortic aneurysm repair. Br J Surg 2019; 106:367-374. [PMID: 30706453 PMCID: PMC7938852 DOI: 10.1002/bjs.11074] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/24/2018] [Accepted: 11/05/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND The effect of sarcopenia based on the total psoas muscle area (TPMA) on CT is inconclusive in patients undergoing abdominal aortic aneurysm (AAA) intervention. The aim of this prospective cohort study was to evaluate morphometric sarcopenia as a method of risk stratification in patients undergoing elective AAA intervention. METHODS TPMA was measured on preintervention CT images of patients undergoing elective endovascular aneurysm repair (EVAR) or open aneurysm repair. Mortality was assessed in relation to preintervention TPMA using Cox regression analysis, with calculation of hazard ratios at 30 days, 1 year and 4 years. Postintervention morbidity was evaluated in terms of postintervention care, duration of hospital stay and 30-day readmission. Changes in TPMA on surveillance EVAR imaging were also evaluated. RESULTS In total, 382 patient images acquired between March 2008 and December 2016 were analysed. There were no significant intraobserver and interobserver differences in measurements of TPMA. Preintervention TPMA failed to predict morbidity and mortality at all time points. The mean(s.d.) interval between preintervention and surveillance imaging was 361·3(111·2) days. A significant reduction in TPMA was observed in men on surveillance imaging after EVAR (mean reduction 0·63(1·43) cm2 per m2 ; P < 0·001). However, this was not associated with mortality (adjusted hazard ratio 1·00, 95 per cent c.i. 0·99 to 1·01; P = 0·935). CONCLUSION TPMA is not a suitable risk stratification tool for patients undergoing effective intervention for AAA.
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Affiliation(s)
- M A Waduud
- Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - B Wood
- Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - P Keleabetswe
- Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - J Manning
- Leeds Institute for Cardiovascular and Metabolic Medicine, LIGHT Laboratories, University of Leeds, Leeds, UK
| | - E Linton
- Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - M Drozd
- Leeds Institute for Cardiovascular and Metabolic Medicine, LIGHT Laboratories, University of Leeds, Leeds, UK
| | - C J Hammond
- Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - M A Bailey
- Leeds Institute for Cardiovascular and Metabolic Medicine, LIGHT Laboratories, University of Leeds, Leeds, UK
| | - D J A Scott
- Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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3
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Jia X, Sun ZD, Patel JV, Flood K, Stocken DD, Scott DJA. Systematic review of endovascular intervention and surgery for common femoral artery atherosclerotic disease. Br J Surg 2018; 106:13-22. [DOI: 10.1002/bjs.11026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 09/05/2018] [Accepted: 09/25/2018] [Indexed: 01/09/2023]
Abstract
Abstract
Background
Endovascular intervention has emerged as a potential alternative to open surgery in treating common femoral artery (CFA) atherosclerotic disease. The aim of this systematic review was to assess the safety and efficacy of both techniques.
Methods
Thirteen electronic databases from 1980 to 3 January 2018 were searched. Study quality was assessed using the National Institute for Health and Care Excellence Interventional Procedure Programme quality assessment tool. Safety and efficacy outcome measures were analysed.
Results
Thirty-one studies reporting 813 endovascular procedures and 3835 endarterectomies were included. Only two small RCTs have been reported. The methodological quality of available studies was generally low and follow-up short. Safety endpoint assessment revealed a similar risk of wound haematoma for endovascular intervention and endarterectomy (5·5 (95 per cent c.i. 0·2 to 17·2) versus 3·9 (1·7 to 6·9) per cent respectively), a lower risk of wound infection with endovascular procedures (0 versus 5·9 (3·4 to 9·0) per cent) and a lower risk of wound lymph leakage (0 versus 5·7 (3·3 to 8·6) per cent). Efficacy endpoint assessment at 1 year identified that endovascular intervention had a lower primary patency rate than endarterectomy (78·8 (73·3 to 83·8) versus 96·0 (92·2 to 98·6) per cent respectively), a higher revascularization rate (16·0 (6·1 to 29·4) versus 5·8 (1·0 to 14·2) per cent) and a similar amputation rate (2·7 (1·2 to 4·8) versus 1·9 (0·7 to 3·8) per cent).
Conclusion
Endovascular intervention of CFA disease appears to reduce the risk of wound complications but is associated with a lower patency rate and increased rates of subsequent revascularization procedures. Standardization of the endovascular technique and quantification of the proportions of patients suitable for either technique are required.
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Affiliation(s)
- X Jia
- Leeds Vascular Institute, Leeds General Infirmary, Leeds, UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Z D Sun
- Leeds Vascular Institute, Leeds General Infirmary, Leeds, UK
| | - J V Patel
- Radiology Department, Leeds General Infirmary, Leeds, UK
| | - K Flood
- Radiology Department, Leeds General Infirmary, Leeds, UK
| | - D D Stocken
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - D J A Scott
- Leeds Vascular Institute, Leeds General Infirmary, Leeds, UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
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4
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Waduud MA, Giannoudi M, Drozd M, Malkin CJ, Patel JV, Scott DJA. Coronary subclavian steal syndrome-is there a need for routine assessment for subclavian artery stenosis following coronary bypass surgery? Oxf Med Case Reports 2018; 2018:omy102. [PMID: 30487988 PMCID: PMC6247140 DOI: 10.1093/omcr/omy102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 09/05/2018] [Accepted: 09/24/2018] [Indexed: 11/14/2022] Open
Abstract
Subclavian artery stenosis (SAS) resulting in coronary subclavian steal syndrome (CSSS) is a common but under recognized pathology following coronary artery bypass surgery (CABG). Patients with SAS may be asymptomatic due to the sub-clinical diversion of blood flow from the myocardium and retrograde blood flow during catheter angiography in the left internal mammary artery (LIMA) may be the first suggestion of CSSS. The management of SAS, causing CSSS, may rarely require acute assessment and intervention. However, full anatomical assessment of the stenosis morphology may be limited on fluoroscopy. Correction of SAS may be essential to achieve effective reperfusion therapy.
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Affiliation(s)
- M A Waduud
- Leeds Vascular Institute, Leeds General Infirmary, Leeds, UK
| | - M Giannoudi
- Leeds Vascular Institute, Leeds General Infirmary, Leeds, UK
| | - M Drozd
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - C J Malkin
- Department of Cardiology, Leeds General Infirmary, Leeds, UK
| | - J V Patel
- Leeds Vascular Institute, Leeds General Infirmary, Leeds, UK
| | - D J A Scott
- Leeds Vascular Institute, Leeds General Infirmary, Leeds, UK
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5
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Rashid ST, Haywood NJ, Yuldasheva NY, Smith J, Aziz A, Scott DJA, Kearney MT, Wheatcroft SB. Preservation of vascular endothelial repair in mice with diet-induced obesity. Obes Sci Pract 2018; 4:490-496. [PMID: 30338120 PMCID: PMC6180714 DOI: 10.1002/osp4.282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 05/15/2018] [Accepted: 05/28/2018] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Preservation of structural integrity of the endothelial monolayer and maintenance of endothelial cell function are of critical importance in preventing arterial thrombosis, restenosis and atherosclerosis. Obesity has been intimately linked with endothelial dysfunction, and reports of reduced abundance and functional impairment of circulating progenitor cells in obesity have led to the suggestion that defective endothelial repair contributes to obesity-related cardiovascular disease. METHODS C57BL/6 mice were fed a high-fat diet for either 3 or 6 months to induce obesity; metabolic phenotyping was then carried out before femoral artery wire injury was performed. Endothelial regeneration was then quantified. Mononuclear cells and myeloid angiogenic cells were cultured and characterized for pro-angiogenic properties. RESULTS No impairment of endothelial regeneration following mechanical endothelial injury in diet-induced obese mice when compared with chow-fed controls was observed, despite the induction of an adverse metabolic phenotype characterized by glucose intolerance and insulin resistance. Dietary-obese mice had increased numbers of circulating myeloid angiogenic cells, which retained normal functional properties including intact paracrine angiogenic effects. CONCLUSION Preserved endothelial regeneration despite metabolic dysregulation in dietary obese mice suggests that compensatory mechanisms mitigate the deleterious influence of insulin resistance on endothelial repair in obesity.
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Affiliation(s)
- S. T. Rashid
- Leeds Institute of Cardiovascular and Metabolic Medicine, Faculty of Medicine and HealthUniversity of LeedsLeedsUK
- Department of Vascular SurgeryManchester University NHS Foundation TrustManchesterUK
- Division of Diabetes, Endocrinology and GastroenterologyUniversity of ManchesterManchesterUK
- Manchester Academic Health Science CentreManchesterUK
| | - N. J. Haywood
- Leeds Institute of Cardiovascular and Metabolic Medicine, Faculty of Medicine and HealthUniversity of LeedsLeedsUK
| | - N. Y. Yuldasheva
- Leeds Institute of Cardiovascular and Metabolic Medicine, Faculty of Medicine and HealthUniversity of LeedsLeedsUK
| | - J. Smith
- Leeds Institute of Cardiovascular and Metabolic Medicine, Faculty of Medicine and HealthUniversity of LeedsLeedsUK
| | - A. Aziz
- Leeds Institute of Cardiovascular and Metabolic Medicine, Faculty of Medicine and HealthUniversity of LeedsLeedsUK
| | - D. J. A. Scott
- Leeds Vascular InstituteLeeds Teaching Hospitals NHS TrustLeedsUK
| | - M. T. Kearney
- Leeds Institute of Cardiovascular and Metabolic Medicine, Faculty of Medicine and HealthUniversity of LeedsLeedsUK
| | - S. B. Wheatcroft
- Leeds Institute of Cardiovascular and Metabolic Medicine, Faculty of Medicine and HealthUniversity of LeedsLeedsUK
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6
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Shiwani H, Baxter P, Taylor E, Bailey MA, Scott DJA. Modelling the growth of popliteal artery aneurysms. Br J Surg 2018; 105:1749-1752. [DOI: 10.1002/bjs.10955] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 05/03/2018] [Accepted: 06/21/2018] [Indexed: 11/09/2022]
Abstract
Abstract
Background
Popliteal artery aneurysms (PAAs) comprise up to 85 per cent of all peripheral aneurysms. Few longitudinal studies track their progression. This study aimed to track the growth of asymptomatic PAAs in a hospital-based ultrasound service, and compare models of aneurysm growth.
Methods
This retrospective single-centre cohort study included patients who had a PAA on arterial duplex ultrasound imaging of the lower limbs between 1 January 2011 and 1 January 2016. Progression of PAA size and progression to event or intervention were the primary outcome measures.
Results
Some 282 images were analysed: 47 limbs with PAA were included in a cohort of 32 patients (15 had bilateral PAAs). Twenty patients also had an abdominal aortic aneurysm (AAA). Linear multilevel modelling estimated that PAA growth was 2·4 (95 per cent c.i. 1·6 to 3·7) mm a year. Growth was estimated at 0·8 (0·1 to 1·5) mm per year in patients without an AAA and 3·5 (2·9 to 4·2) mm per year in those with a known AAA (previous open repair, previous endovascular aneurysm repair or AAA under surveillance) (P < 0·001).
Conclusion
Growth rates of PAA were heterogeneous but were optimally predicted by multilevel modelling. Patients with an existing AAA may have faster PAA progression than those without.
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Affiliation(s)
- H Shiwani
- Department of Radiology, Leeds General Infirmary, Leeds, UK
- Leeds Vascular Institute, Leeds General Infirmary, Leeds, UK
| | - P Baxter
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - E Taylor
- Department of Radiology, Leeds General Infirmary, Leeds, UK
| | - M A Bailey
- Leeds Vascular Institute, Leeds General Infirmary, Leeds, UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - D J A Scott
- Leeds Vascular Institute, Leeds General Infirmary, Leeds, UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
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7
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Bhasin N, Jones SM, Patel J, Kessel D, Robertson I, Berridge DC, Scott DJA. Internal Iliac Artery Aneurysm—A Cause of Leg Swelling and Cellulitis. J R Soc Med 2017; 97:483-4. [PMID: 15459260 PMCID: PMC1079617 DOI: 10.1177/0141076809701007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- N Bhasin
- Department of Vascular and Endovascular Surgery, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK.
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8
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Spencer SM, Trower AJ, Jia X, Scott DJA, Greenwood DC. Meta-analysis of the association between alcohol consumption and abdominal aortic aneurysm. Br J Surg 2017; 104:1756-1764. [DOI: 10.1002/bjs.10674] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 05/19/2017] [Accepted: 07/11/2017] [Indexed: 12/25/2022]
Abstract
Abstract
Background
Alcohol is a possible risk factor for abdominal aortic aneurysm (AAA), but evidence from individual studies is weak and inconsistent. Existing narrative reviews suggest the possibility of non-linear associations. The aim here was to quantify any association using a systematic literature review, followed by dose–response meta-analysis of prospective studies.
Methods
MEDLINE, Embase and Web of Science were searched systematically to January 2017 for relevant prospective studies of alcohol consumption and AAA risk. Summary estimates of highest versus lowest levels of consumption, and linear and non-linear dose–response curves were quantified using random-effects models.
Results
Eleven relevant cohorts were identified describing results from 3580 individuals with among 473 092 participants. Data were extracted from ten cohorts for meta-analyses of high versus low levels of alcohol consumption (risk ratio for AAA 0·93, 95 per cent c.i. 0·78 to 1·11; P = 0·4, I2 = 47 per cent). The linear dose–response risk ratio for AAA, derived from 11 cohorts, was 1·00 (0·97 to 1·04) per 8 g alcohol per day (P = 0·9, I2 = 73 per cent). Non-linear dose–response results showed a tick-shaped curve with lower risk up to 2 units/day, but increasing risk beyond that (P = 0·05). The increase in risk beyond 2 units/day was stronger in men than in women.
Conclusion
Although the linear dose–response analysis revealed little evidence of an association between alcohol consumption and AAA risk, a tick-shaped trend in the association was observed. This non-linear dose–response analysis revealed reduced risks for alcohol consumption below 2 units/day, masking increased risks for 2 or more units/day.
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Affiliation(s)
- S M Spencer
- Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds, UK
- Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, Leeds, UK
| | - A J Trower
- Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds, UK
- Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, Leeds, UK
| | - X Jia
- Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds, UK
- Department of Vascular Surgery, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - D J A Scott
- Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds, UK
- Department of Vascular Surgery, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - D C Greenwood
- Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds, UK
- Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, Leeds, UK
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9
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Berridge DC, Mercer KG, Thornton C, Weston MJ, Scott DJA. A Pilot Study Comparing the Use of Below-Knee and Above-Knee Graduated Stockings in Patients with Superficial Venous Incompetence. Phlebology 2016. [DOI: 10.1177/026835559901400104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Investigation of the effects of high- and low-ankle-pressure, above- and below-knee compression stockings on the haemodynamics of normal and superficially incompetent venous systems. Design: Prospective duplex study of a normal group and a venous incompetence group randomised to high- or low-pressure stockings. Setting: Vascular services of a University Hospital. Subjects: Six subjects with normal venous haemodynamics (12 limbs) and 12 patients with superficial venous incompetence (20 limbs). Methods: Subjects wore below-knee and then above-knee stockings for 1 week each. Duplex scans were performed at the outset and end of the study and on fitting and after wearing each stocking type. Main outcome measures: Duplex-derived femoral and popliteal venous velocities were measured and indexed against the initial velocity. Results: Below-knee stockings produced only minor changes. Above-knee stockings produced increased velocities in normal subjects. Similar changes were only seen with higher-pressure stockings in patients with incompetence. Conclusion: Above-knee, high-ankle-pressure stockings produce increased deep venous flow velocities.
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Affiliation(s)
- D. C. Berridge
- Department of Vascular and Endovascular Surgery, St James's and Seacroft University Hospitals NHS Trust, Leeds, UK
| | - K. G. Mercer
- Department of Vascular and Endovascular Surgery, St James's and Seacroft University Hospitals NHS Trust, Leeds, UK
| | - C. Thornton
- Department of Vascular and Endovascular Surgery, St James's and Seacroft University Hospitals NHS Trust, Leeds, UK
| | - M. J. Weston
- Department of Radiology, St James's and Seacroft University Hospitals NHS Trust, Leeds, UK
| | - D. J. A. Scott
- Department of Vascular and Endovascular Surgery, St James's and Seacroft University Hospitals NHS Trust, Leeds, UK
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10
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Bailey MA, Aggarwal R, Bridge KI, Griffin KJ, Iqbal F, Phoenix F, Purdell-Lewis J, Thomas T, Johnson AB, Ariëns RAS, Scott DJA, Ajjan RA. Aspirin therapy is associated with less compact fibrin networks and enhanced fibrinolysis in patients with abdominal aortic aneurysm. J Thromb Haemost 2015; 13:795-801. [PMID: 25660763 DOI: 10.1111/jth.12872] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Thrombotic changes in fibrin networks contribute to increased cardiovascular risk in patients with abdominal aortic aneurysm (AAA). Given that aspirin modulates the fibrin network, we aimed to determine if aspirin therapy is associated with changes in ex-vivo fibrin clot characteristics in AAA patients and also conducted an exploratory analysis of 5-year mortality in these individuals. METHODS We recruited 145 male patients, divided into controls (aortic diameter < 3 cm, n = 49), AAA not taking aspirin (AAA-Asp, n = 50) and AAA on 75 mg day(-1) aspirin (AAA+Asp, n = 46), matched for aneurysm size. Characteristics of clots made from plasma and plasma-purified fibrinogen were investigated using turbidimetric analysis, permeation studies, and confocal and electron microscopy. Plasma fibrinogen, D-dimer and inflammatory marker levels were also measured. RESULTS Maximum absorbance (MA) of plasma clots from controls was lower than that of AAA patients not on aspirin (AAA-Asp) at 0.30 ± 0.01 and 0.38 ± 0.02 au, respectively (P = 0.002), whereas aspirin-treated subjects had MA similar to controls (0.31 ± 0.02 P = 0.9). Plasma clot lysis time displayed an identical pattern at 482 ± 15, 597 ± 24 and 517 ± 27 s for control, AAA-Asp and AAA+Asp (P = 0.001 and P = 0.8). The lysis time of clots made from purified fibrinogen of AAA-Asp was longer than that of AAA+Asp patients (756 ± 47 and 592 ± 52 s, respectively; P = 0.041). Permeation studies and confocal and electron microscopy showed increased clot density in AAA-Asp compared with the AAA+Asp group. Mortality in AAA-Asp and AAA+Asp was similar, despite increased cardiovascular risk in the latter group, and both exhibited higher mortality than controls. CONCLUSION Aspirin improves fibrin clot characteristics in patients with AAA, which may have important clinical implications.
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Affiliation(s)
- M A Bailey
- Division of Cardiovascular & Diabetes Research, School of Medicine, The Leeds Institute of Cardiovascular & Metabolic Medicine, The University of Leeds, Leeds, UK; The Leeds Vascular Institute, The Leeds General Infirmary, Leeds, UK
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11
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Sohrabi S, Wheatcroft S, Barth JH, Bailey MA, Johnson A, Bridge K, Griffin K, Baxter PD, Scott DJA. Cardiovascular risk in patients with small and medium abdominal aortic aneurysms, and no history of cardiovascular disease. Br J Surg 2014; 101:1238-43. [DOI: 10.1002/bjs.9567] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 08/19/2013] [Accepted: 04/17/2014] [Indexed: 12/31/2022]
Abstract
Abstract
Background
Cardiovascular disease (CVD) is the main cause of death in people with abdominal aortic aneurysm (AAA). There is little evidence that screening for AAA reduces all-cause or cardiovascular mortality. The aim of the study was to assess whether subjects with a small or medium AAA (3·0–5·4 cm), without previous history of clinical CVD, had raised levels of CVD biomarkers or increased total mortality.
Methods
This prospective study included subjects with a small or medium AAA and controls, all without a history of clinical CVD. CVD biomarkers (high-sensitivity C-reactive protein, hs-CRP; heart-type fatty acid-binding protein, H-FABP) were measured, and survival was recorded.
Results
Of a total of 815 people, 476 with an AAA and 339 controls, a cohort of 86 with small or medium AAA (3–5·4 cm) and 158 controls, all with no clinical history of CVD, were identified. The groups were matched for age and sex. The AAA group had higher median (i.q.r.) levels of hs-CRP (2·8 (1·2–6·0) versus 1·3 (0·5–3·5) mg/l; P < 0·001) and H-FABP (4·6 (3·5–6·0) versus 4·0 (3·3–5·1) µg/l; P = 0·011) than controls. Smoking was more common in the AAA group; however, hs-CRP and H-FABP levels were not related to smoking. Mean survival was lower in the AAA group: 6·3 (95 per cent confidence interval (c·i.) 5·6 to 6·9) years versus 8·0 (7·6 to 8·1) years in controls (P < 0·001). Adjusted mortality was higher in the AAA group (hazard ratio 3·41, 95 per cent c·i. 2·11 to 9·19; P < 0·001).
Conclusion
People with small or medium AAA and no clinical symptoms of CVD have higher levels of hs-CRP and H-FABP, and higher mortality compared with controls. They should continue to receive secondary prevention against CVD.
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Affiliation(s)
- S Sohrabi
- Leeds Vascular Institute, Leeds, UK
- Leeds General Infirmary Teaching Hospital NHS Trust, Leeds, UK
- Institute for Genetics Health and Therapeutics, Multidisciplinary Cardiovascular Research Centre (MCRC), Division of Cardiovascular and Diabetes Research, University of Leeds, Leeds, UK
| | - S Wheatcroft
- Institute for Genetics Health and Therapeutics, Multidisciplinary Cardiovascular Research Centre (MCRC), Division of Cardiovascular and Diabetes Research, University of Leeds, Leeds, UK
| | - J H Barth
- Blood Sciences, Leeds General Infirmary, Leeds, UK
| | - M A Bailey
- Leeds Vascular Institute, Leeds, UK
- Leeds General Infirmary Teaching Hospital NHS Trust, Leeds, UK
- Institute for Genetics Health and Therapeutics, Multidisciplinary Cardiovascular Research Centre (MCRC), Division of Cardiovascular and Diabetes Research, University of Leeds, Leeds, UK
| | - A Johnson
- Leeds Vascular Institute, Leeds, UK
- Leeds General Infirmary Teaching Hospital NHS Trust, Leeds, UK
- Institute for Genetics Health and Therapeutics, Multidisciplinary Cardiovascular Research Centre (MCRC), Division of Cardiovascular and Diabetes Research, University of Leeds, Leeds, UK
| | - K Bridge
- Leeds Vascular Institute, Leeds, UK
- Leeds General Infirmary Teaching Hospital NHS Trust, Leeds, UK
- Institute for Genetics Health and Therapeutics, Multidisciplinary Cardiovascular Research Centre (MCRC), Division of Cardiovascular and Diabetes Research, University of Leeds, Leeds, UK
| | - K Griffin
- Leeds Vascular Institute, Leeds, UK
- Leeds General Infirmary Teaching Hospital NHS Trust, Leeds, UK
- Institute for Genetics Health and Therapeutics, Multidisciplinary Cardiovascular Research Centre (MCRC), Division of Cardiovascular and Diabetes Research, University of Leeds, Leeds, UK
| | - P D Baxter
- Leeds Centre for Epidemiology and Biostatistics, MCRC, University of Leeds, Leeds, UK
| | - D J A Scott
- Leeds Vascular Institute, Leeds, UK
- Leeds General Infirmary Teaching Hospital NHS Trust, Leeds, UK
- Institute for Genetics Health and Therapeutics, Multidisciplinary Cardiovascular Research Centre (MCRC), Division of Cardiovascular and Diabetes Research, University of Leeds, Leeds, UK
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Chandra E, Ahmadi M, Bailey MA, Griffin KJ, Berridge DC, Coughlin PA, Scott DJA. Early re-presentations and the potential role of catheter-directed thrombolysis in patients diagnosed with a lower limb deep vein thrombosis: a single-centre experience. Phlebology 2013; 28:404-8. [DOI: 10.1258/phleb.2012.012078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction Catheter-directed thrombolysis (CDT) for iliofemoral deep vein thrombosis (DVT) restores venous patency, reduces the risk of the post-thrombotic syndrome and may reduce longer term treatment costs. This study assessed the potential role of CDT in patients with DVT with regard to representation following the index event. Methods A retrospective review of all patients with a positive lower limb DVT scan. Potential suitability of each patient to undergo CDT was based on well-recognized inclusion/exclusion criteria. Results In total, 1689 patients underwent a DVT-specific lower limb venous duplex. A total of 269 were found to have a DVT. Fifty-three of these patients met the inclusion criteria for CDT (only 2 underwent CDT). Fifty-nine of the 269 patients with an index DVT re-presented to our institution with a venous thromboembolism-related clinical event. These patients were significantly younger than those who did not reattend. A higher proportion of patients who represented were deemed suitable for CDT for the index DVT compared with those who did not represent (17/59 versus 36/210; P = 0.04). Conclusion This pragmatic study highlights the fact that significant number of patients return to secondary care with actual/perceived complications following initial diagnosis and treatment of a DVT which may have been amenable to CDT.
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Affiliation(s)
- E Chandra
- Leeds Vascular Institute, Leeds General Infirmary, Leeds
| | - M Ahmadi
- Leeds Vascular Institute, Leeds General Infirmary, Leeds
| | - M A Bailey
- Leeds Vascular Institute, Leeds General Infirmary, Leeds
| | - K J Griffin
- Leeds Vascular Institute, Leeds General Infirmary, Leeds
| | - D C Berridge
- Leeds Vascular Institute, Leeds General Infirmary, Leeds
| | - P A Coughlin
- Department of Vascular Surgery, Addenbrookes Hospital, Cambridge, UK
| | - D J A Scott
- Leeds Vascular Institute, Leeds General Infirmary, Leeds
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13
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Scott DJA, Allen CJ, Honstvet CA, Hanby AM, Hammond C, Johnson AB, Perry SL, Jones PF. Lymphangiogenesis in abdominal aortic aneurysm. Br J Surg 2013; 100:895-903. [DOI: 10.1002/bjs.9128] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2013] [Indexed: 11/05/2022]
Abstract
Abstract
Background
Ongoing angiogenesis is implicated in the inflammatory environment that characterizes abdominal aortic aneurysm (AAA). Although lymphangiogenesis has been associated with chronic inflammatory conditions, it has yet to be demonstrated in AAA. The aim was to determine the presence of lymphangiogenesis and to delineate the relationship between inflammation and neovascularization in AAA tissue.
Methods
AAA samples and preoperative computed tomography images were obtained from patients undergoing elective AAA repair. Control samples were age-matched abdominal aortic tissue. Specific immunostains for blood vessels (CD31, CD105), lymphatic vessels (D2-40), vascular endothelial growth factor (VEGF) A and VEGF receptor (VEGFR) 3 allowed characterization and quantitation of vasculature.
Results
The AAA wall contained high levels of inflammatory infiltrate; microvascular densities of blood (P < 0·001) and lymphatic (P = 0·003) vessels were significantly increased in AAA samples compared with controls. Maximal AAA vascularity was observed in inflammatory areas, with vessels that stained positively for CD31 (ρ = 0·625, P = 0·017), CD105 (ρ = 0·692, P = 0·009) and D2-40 (ρ = 0·675, P = 0·008) correlating positively with the extent of inflammation. Increased VEGFR-3 and VEGF-A expression was also evident within inflammatory AAA areas.
Conclusion
These findings demonstrated lymphatic vessel involvement in end-stage AAA disease, which was associated with the degree of inflammation, and confirmed the involvement of neovascularization.
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Affiliation(s)
- D J A Scott
- Division of Cardiovascular and Diabetes Research, Leeds Institute of Genetics, Health and Therapeutics, and Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK
| | - C J Allen
- Leeds Institute of Molecular Medicine, University of Leeds, St James's University Hospital, Leeds, UK
| | - C A Honstvet
- Leeds Institute of Molecular Medicine, University of Leeds, St James's University Hospital, Leeds, UK
| | - A M Hanby
- Leeds Institute of Molecular Medicine, University of Leeds, St James's University Hospital, Leeds, UK
| | - C Hammond
- Department of Vascular Radiology, Leeds General Infirmary, Leeds, UK
| | - A B Johnson
- Division of Cardiovascular and Diabetes Research, Leeds Institute of Genetics, Health and Therapeutics, and Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK
| | - S L Perry
- Leeds Institute of Molecular Medicine, University of Leeds, St James's University Hospital, Leeds, UK
| | - P F Jones
- Leeds Institute of Molecular Medicine, University of Leeds, St James's University Hospital, Leeds, UK
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14
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Coughlin PA, Jackson D, White AD, Bailey MA, Farrow C, Scott DJA, Howell SJ. Meta-analysis of prospective trials determining the short- and mid-term effect of elective open and endovascular repair of abdominal aortic aneurysms on quality of life. Br J Surg 2012; 100:448-55. [DOI: 10.1002/bjs.9018] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2012] [Indexed: 12/27/2022]
Abstract
Abstract
Background
Repair of an abdominal aortic aneurysm (AAA) is undertaken to prevent rupture. Intervention is by either open repair (OR) or a more minimally invasive endovascular repair (EVAR). Quality-of-life (QoL) analysis is an important health outcome and a number of single studies have assessed QoL following OR and EVAR. This was a meta-analysis of published studies to assess the effect of an intervention on QoL in patients with an AAA.
Methods
A systematic literature search was undertaken for studies prospectively reporting QoL analysis in patients with an AAA undergoing elective intervention. A multivariable meta-analysis model was developed in which the outcomes were mean changes in QoL scores over time, both for all AAA repairs (OR and EVAR) and comparing OR with EVAR.
Results
Data were collated from 16 studies (14 OR, 12 EVAR). The results suggested that treating an AAA had an effect on patient-reported QoL, evident from the statistically significant changes predominantly in domains assessing physical ability and pain. QoL was affected most within the first 3 months after any form of intervention, and was more pronounced following OR. Furthermore, a deterioration in the Physical Component Summary score following an AAA repair (either OR or EVAR) was evident at 12 months after intervention.
Conclusion
Treating an AAA deleteriously affects patient-reported QoL over the first year following intervention.
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Affiliation(s)
- P A Coughlin
- Department of Vascular Surgery, Addenbrooke's Hospital, Leeds, UK
| | - D Jackson
- Medical Research Council Biostatistics Unit, Cambridge, Leeds, UK
| | | | | | - C Farrow
- Department of Anaesthesia, Leeds General Infirmary, Leeds, UK
| | | | - S J Howell
- Department of Anaesthesia, Leeds General Infirmary, Leeds, UK
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15
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Abstract
Blue toe syndrome (BTS) is an important vascular condition characterized by painful blue discoloration of one or more digits. It is frequently due to emboli and is important because of the risk of progressive ischemia and tissue loss. A 53-year-old male presented with recurrent episodes of painful blue discoloration and blistering of the skin of the right hallux. On examination, the patient was found to have a cool, blue-purple great toe; all peripheral pulses were present. The patient was investigated for coagulopathy and potential sources of emboli, but the only abnormality was significant stenosis of the dorsalis pedis artery due to extrinsic compression by the extensor hallucis brevis tendon. In the absence of any other embolic source or abnormality, we believe that this case presents a novel and potentially remediable cause of BTS and indicates the need for a careful search for an underlying lesion when common causes of BTS have been excluded.
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Affiliation(s)
- K J Griffin
- Leeds Vascular Institute, Leeds General Infirmary
| | - J Rankine
- Department of Radiology, Leeds General Infirmary, Leeds LS1 3EX, UK
| | - D Kessel
- Department of Radiology, Leeds General Infirmary, Leeds LS1 3EX, UK
| | - D C Berridge
- Leeds Vascular Institute, Leeds General Infirmary
| | - D J A Scott
- Leeds Vascular Institute, Leeds General Infirmary
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Cousins S, Griffin KJ, Bailey MA, Berridge DC, Scott DJA. Primary care trust commissioning of varicose vein intervention – is new guidance needed? Br J Hosp Med (Lond) 2012. [DOI: 10.12968/hmed.2012.73.7.409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - KJ Griffin
- The Leeds Vascular Institute at The General Infirmary at Leeds, Leeds
| | - MA Bailey
- The Leeds Vascular Institute at The General Infirmary at Leeds, Leeds
| | - DC Berridge
- The Leeds Vascular Institute at The General Infirmary at Leeds, Leeds
| | - DJA Scott
- The Leeds Vascular Institute at The General Infirmary at Leeds, Leeds
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Beales L, Wolstenhulme S, Evans JA, West R, Scott DJA. Reproducibility of ultrasound measurement of the abdominal aorta. Br J Surg 2011; 98:1517-25. [PMID: 21861264 DOI: 10.1002/bjs.7628] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2011] [Indexed: 12/22/2022]
Abstract
BACKGROUND Abdominal aortic aneurysm (AAA) screening and surveillance programmes use ultrasound imaging to measure the anteroposterior (AP) diameter of the infrarenal aorta. The aim of this study was to examine potential observer bias and variability in ultrasound measurements. METHODS Studies were identified for review via a MEDLINE database search (1966-2009). References supplied in accessed papers were also checked for potential relevance. Consistent search terminology, and inclusion and exclusion criteria were used to ensure quality of data. Nine papers were available to review. RESULTS Variation in intraobserver repeatability and interobserver reproducibility was identified. Six studies reported intraobserver repeatability coefficients for AP aortic diameter measurements of 1·6-4·4 mm. These were below the 5-mm level regarded as acceptable by the UK and USA AAA screening programmes. Five studies had interobserver reproducibility below the level of 5 mm. Four studies, however, reported poor reproducibility (range from -2 to +5·2 to -10·5 to +10·4); these differences may have had a significant clinical impact on screening and surveillance. CONCLUSION The studies used different methodologies with no standardized measurement techniques. Measurements were taken by observers from different medical disciplines of varying grade and levels of training. Standard training and formal quality assurance of ultrasound measurements are important components of an effective AAA screening programme.
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Affiliation(s)
- L Beales
- Division of Cardiovascular and Diabetes Research, University of Leeds, Leeds, UK
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19
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Foo FJ, Hammond CJ, Goldstone AR, Abuhamdiah M, Rashid ST, West RM, Nicholson AA, Scott DJA. Agreement between computed tomography and ultrasound on abdominal aortic aneurysms and implications on clinical decisions. Eur J Vasc Endovasc Surg 2011; 42:608-14. [PMID: 21852165 DOI: 10.1016/j.ejvs.2011.07.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Accepted: 07/04/2011] [Indexed: 12/23/2022]
Abstract
OBJECTIVES The United Kingdom abdominal aortic aneurysm (AAA) screening programme refers aneurysms with ultrasound (US) diameters of ≥5.5 cm to vascular services for consideration of computed tomography (CT) and intervention. We investigated the discrepancy between US and CT, implications on clinical decisions and question at which stage CT be used. DESIGN/METHODS AAA USs over 5 years were retrospectively analysed. Patients included had aneurysms measuring ≥5 cm on US with subsequent CT within 2 months (n = 123). Based on maximum US diameters, 44 patients had aneurysms between 5 and 5.4 cm (group I) and 79 patients ≥5.5 cm (group II). Results were cross-referenced. Correlation and limits of agreement were calculated. Two radiologists re-measured 44 pairs of CT/US scans and the inter-observer bias in determining discrepancies between imaging modalities calculated. RESULTS Mean difference between imaging modalities was 0.21 cm (±0.39 cm, p < 0.001). Limits of agreement were -0.55 to 0.96 cm, exceeding clinical acceptability. Mean difference was higher and significant in group I (0.39 cm, p < 0.001) compared to group II (0.10 cm, p > 0.05). Seventy-percent of group I patients had CT scans revealing diameters of ≥5.5 cm. Inter-observer bias was not significant. CONCLUSION Significant differences between imaging modalities, more in US diameters of below 5.5 cm, exist. We recommend AAAs measuring ≥5 cm on US should undergo earlier referral to a vascular service and CT.
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Affiliation(s)
- F J Foo
- Department of Vascular Surgery, Leeds Teaching Hospitals NHS Trust, UK
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20
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Sun ZDY, Bailey MA, Griffin KJ, Coughlin PA, McPherson SJ, Scott DJA. Aberrant medial sural artery causing popliteal vein entrapment syndrome. Phlebology 2011; 27:93-5. [DOI: 10.1258/phleb.2011.010099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Isolated popliteal venous entrapment is unusual and often caused by variation or aberrant origins of the gastrocnemius muscle, thickened perivenous fascia or an abnormal vascular bundle. We report a unique case of a fit and well 35-year-old man with popliteal venous entrapment after presenting to the vascular unit with symptomatic varicose veins. The cause of the entrapment was found to be an aberrant medial sural artery on operative exploration. The artery was ligated, releasing the entrapped vein. The patient made an uneventful recovery with resolution of symptoms of venous insufficiency without evidence of muscle ischaemia.
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Affiliation(s)
- Z D Y Sun
- The Leeds Vascular Institute, The General Infirmary at Leeds, Great George Street, Leeds LS1 3EX
| | - M A Bailey
- The Leeds Vascular Institute, The General Infirmary at Leeds, Great George Street, Leeds LS1 3EX
- Division of Cardiovascular and Diabetes Research, The Leeds Institute of Genetics, Health & Theraputics, The University of Leeds, Leeds LS2 9JT
| | - K J Griffin
- The Leeds Vascular Institute, The General Infirmary at Leeds, Great George Street, Leeds LS1 3EX
- Division of Cardiovascular and Diabetes Research, The Leeds Institute of Genetics, Health & Theraputics, The University of Leeds, Leeds LS2 9JT
| | - P A Coughlin
- The Leeds Vascular Institute, The General Infirmary at Leeds, Great George Street, Leeds LS1 3EX
| | - S J McPherson
- Department of Interventional Radiology, The General Infirmary at Leeds, Leeds LS1 3EX, UK
| | - D J A Scott
- The Leeds Vascular Institute, The General Infirmary at Leeds, Great George Street, Leeds LS1 3EX
- Division of Cardiovascular and Diabetes Research, The Leeds Institute of Genetics, Health & Theraputics, The University of Leeds, Leeds LS2 9JT
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21
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Bailey MA, Dunne JA, Griffin KJ, Coughlin PA, Scott DJA. Systematic review and meta-analysis of the effects of statin therapy on abdominal aortic aneurysms (Br J Surg 2011; 98: 362-353). Br J Surg 2011; 98:744-5; author reply 745. [PMID: 21462179 DOI: 10.1002/bjs.7512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Abstract
Objectives High recurrence rates following small saphenous varicose vein surgery have been reported. The aim of this study was to ascertain initial success rates following saphenopopliteal junction (SPJ) surgery using pre- and postoperative duplex scanning. Methods A prospective study was performed on patients with ultrasound-proven SPJ reflux. Patients underwent preoperative duplex skin marking and a postoperative quality assurance scan. Results Ninety procedures were performed in 88 patients. The SPJ was successfully ligated in 87 (96.7%) cases. Reflux was completely abolished in 51 (56.7%) cases, but persisted solely in the small saphenous vein (SSV) in 32.2%. Subsequently, 10 consecutive patients underwent 11 SPJ ligations with stripping of the SSV. Follow-up ultrasound scan demonstrated successful ligation of the SPJ and elimination of superficial venous reflux. Conclusion This study demonstrates that preoperative duplex SPJ marking results in a high percentage of successful ligation. Given that residual persistent reflux was avoided in patients who underwent stripping of the SSV, we propose that patients who require SPJ surgery undergo duplex marking along with specific consideration with regard to treatment of the residual SSV.
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Affiliation(s)
- A Ikponmwosa
- Leeds Vascular Institute, Leeds General Infirmary
| | - N Bhasin
- Leeds Vascular Institute, Leeds General Infirmary
| | - M J Weston
- Department of Vascular Radiology, St James's University Hospital, Leeds, UK
| | - D C Berridge
- Leeds Vascular Institute, Leeds General Infirmary
| | - D J A Scott
- Leeds Vascular Institute, Leeds General Infirmary
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23
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Shantikumar S, Ajjan R, Porter KE, Scott DJA. Diabetes and the abdominal aortic aneurysm. Eur J Vasc Endovasc Surg 2009; 39:200-7. [PMID: 19948418 DOI: 10.1016/j.ejvs.2009.10.014] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Accepted: 10/19/2009] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this review is to delineate the association between abdominal aortic aneurysms (AAAs) and diabetes mellitus. Mechanisms for the underlying association are then discussed. METHODS A systematic review of the English-language literature using PubMed, EMBASE and Cochrane databases was undertaken up to September 2009. Studies reporting appropriate prevalence data were identified and a meta-analysis performed. RESULTS Eleven studies were identified. The prevalence of diabetes mellitus in studied patients with AAA ranged from 6% to 14%. The prevalence of diabetes in control patients without AAA ranged from 17% to 36%. Pooled analysis suggested a reduced rate of diabetes amongst people with AAA compared to those without (OR 0.65, 0.60-0.70, p<0.001). CONCLUSIONS Studies so far suggest a protective role for diabetes on the development of AAA. Further research is required to demarcate the underlying mechanisms for this possible association.
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Affiliation(s)
- S Shantikumar
- Division of Cardiovascular and Diabetes Research, Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds LS2 9JT, UK
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24
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Parry DJ, Al-Barjas HS, Chappell L, Rashid T, Ariëns RAS, Scott DJA. Haemostatic and fibrinolytic factors in men with a small abdominal aortic aneurysm. Br J Surg 2009; 96:870-7. [PMID: 19591171 DOI: 10.1002/bjs.6632] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND : The presence of an abdominal aortic aneurysm (AAA) independently predicts cardiovascular disease (CVD) and its complications. Levels of plasma markers of fibrin turnover are raised in men with a large AAA (at least 5.5 cm) and predict CVD risk in healthy subjects. This study examined fibrin turnover in men with a small AAA. METHODS : Seventy-five men with a small AAA (30-55 mm) were compared with 90 controls matched for age, sex and race. Haemostatic and fibrinolytic parameters were assessed. RESULTS : Men with a small AAA had higher mean levels of fibrinogen (2.92 versus 2.59 g/l; P = 0.019), thrombin-antithrombin (TAT) complex (4.57 versus 1.89 ng/ml; P < 0.001), prothrombin F1 + 2 (1.13 versus 0.82 ng/ml; P = 0.004) and D-dimer (346.7 versus 120.2 ng/ml; P < 0.001). All markers correlated with maximum aortic diameter determined by ultrasonography. On multivariable regression the association between presence of an AAA and fibrinogen, TAT complex, prothrombin F1 + 2 and D-dimer levels remained significant after adjustment for confounding influences. CONCLUSION : Fibrin turnover was increased in these men with a small AAA, independently of concomitant CVD, conventional risk factors and inflammatory markers. Enhanced fibrin turnover may contribute to the risk of cardiac complications in this group.
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Affiliation(s)
- D J Parry
- Leeds Vascular Institute, The General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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25
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Wyld L, Weston M, Bates J, Scott DJA, Lansdown MR. Use of laparoscopic ultrasound in the pre-operative localization of adrenal tumours. MINIM INVASIV THER 2009. [DOI: 10.3109/13645709509152763] [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] [Indexed: 11/13/2022]
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26
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Balasubramaniam R, Rai R, Berridge DC, Scott DJA, Soames RW. The relationship between the saphenopopliteal junction and the common peroneal nerve: a cada-veric study. Phlebology 2009; 24:67-73. [PMID: 19299274 DOI: 10.1258/phleb.2006.006035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The variable anatomy of the short saphenous vein (SSV) and the potential failure to identify the saphenopopliteal junction (SPJ) contribute to an increased risk of damage to the common peroneal nerve (CPN) during surgical exploration. The aim of the present study was to determine the variation of the SPJ, its relationship to the CPN, and the relationship of both SPJ and CPN to defined anatomical landmarks. METHODS Measurements of the distance between the SPJ and CPN, and the defined anatomical landmarks (fibula head, lateral joint space, lateral femoral epicondyle), were undertaken on 30 cadaveric limbs following careful dissection of the popliteal fossa. RESULTS The level of SPJ termination was classified as low (below), normal (within 100 mm above) and high (more than 100 mm above), the lateral femoral epicondyle. Of the 30 limbs dissected, 70% of SPJs were normal, 23% low and 7% high. Direct measurement from the SPJ to anatomical landmarks showed a higher interquartile range (IQR) in low compared with normal terminations; however, the vertical distance from the SPJ to the fibula head showed an increase in IQR from low to normal terminations (7.1-14.2). The mean distances between the SPJ and CPN in low and normal terminations were 23.3 and 16.7 mm, respectively. Comparison of the IQR showed values very similar to low terminations having a slightly higher IQR compared with normal terminations (7.15-6.0). CONCLUSION Significant anatomic variation was observed in the termination of the SSV, with 67% located within 66 mm above the lateral femoral epicondyle. The risk of damaging the CPN during saphenopopliteal ligation may be higher for SPJs located above the lateral femoral epicondyle because of the proximity of the two structures and variability of SPJ.
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Affiliation(s)
- R Balasubramaniam
- School of Biomedical Sciences, University of Leeds, Leeds LS2 9JT, UK.
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27
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Abstract
BACKGROUND The Vascular Society of Great Britain and Ireland (VSGBI) annual meeting is a major international vascular surgery conference. Studies suggest that the percentage of presentations that result in full-text publications are a measure of the quality of the meeting. We investigated the publication outcome of abstracts presented to the VSGBI in 2001 and 2002. MATERIALS AND METHODS We retrospectively identified abstracts from the conference programmes and conducted a detailed electronic Medline and PubMed search to determine publication. We collected data regarding the study design, subject matter,publishing journal, time to publication, institution of origin, impact factors and RAE levels. RESULTS There were 63 publications from 106 abstracts (59.4%), with a median impact factor of 3.507. Prospective observational studies accounted for 20.6% of publications, with abdominal aortic aneurysms being the commonest subject matter(34.9%). The median time to publication was 12 months, with the European Journal of Vascular and Endovascular Surgery publishing 33.3% of the articles. Leicester achieved the highest number of publications and the majority of work came from centres with Research Assessment Exercise (RAE) level scores of 4, university centres accounted for 74.6% of publications. CONCLUSIONS We conclude that when compared to equivalent meetings in other specialties and geographical regions, the annual meeting of the VSGBI is of the very highest quality.
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Affiliation(s)
- N Bhasin
- Academic Unit of Molecular Vascular Medicine, The LIGHT Laboratories, University of Leeds, UK.
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Chapple KS, Parry DJ, McKenzie S, MacLennan KA, Jones P, Scott DJA. Cyclooxygenase-2 expression and its association with increased angiogenesis in human abdominal aortic aneurysms. Ann Vasc Surg 2007; 21:61-6. [PMID: 17349338 DOI: 10.1016/j.avsg.2006.10.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2006] [Revised: 09/05/2006] [Accepted: 10/19/2006] [Indexed: 11/23/2022]
Abstract
Although the mechanism whereby non-steroidal anti-inflammatory drugs may reduce abdominal aortic aneurysm (AAA) development is unknown, one potential route is via inhibition of the cyclooxygenase (COX) enzyme. Despite the fact that evidence from animal models suggests a role for the COX-2 isoform in promotion of AAA development, only very limited data exist on COX-2 expression in human AAAs. Semiquantitative immunohistochemistry for COX-2 was performed on a series of formalin-fixed, paraffin-embedded human AAAs (n = 49). Associated clinicopathological data, including the degree of inflammatory cell infiltration and neorevascularization, were obtained. COX-2 protein was detected in 46 of 49 (94%) human AAAs. Expression of COX-2 protein varied widely between AAAs. COX-2 protein localized to cells in the inflammatory infiltrate with a morphology characteristic of macrophages. COX-2 expression increased with the extent of inflammatory cell infiltration (P < 0.001) and with the degree of AAA neorevascularization (P < 0.001). Logistic regression analysis identified neorevascularization (P < 0.001) as the only significant independent predictor of COX-2 positivity in human AAAs. COX-2 protein is present at increased levels in the majority of human AAAs and is expressed by mononuclear cells in the inflammatory cell infiltrate. Promotion of angiogenesis by COX-2 may play a role in AAA development.
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Affiliation(s)
- K S Chapple
- Academic Unit of Vascular Surgery, University of Leeds, St. James's University Hospital, Leeds, UK.
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31
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Coughlin PA, Kent PJ, Berridge DC, Scott DJA, Kester RC. The PADHOC Device is a Better Guide to the Actual Incapacity Suffered by Claudicants than the Gold Standard Constant Load Treadmill Test. Eur J Vasc Endovasc Surg 2006; 32:651-6. [PMID: 16679038 DOI: 10.1016/j.ejvs.2006.03.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2006] [Accepted: 03/11/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Constant Load Treadmill Test (CLTT) is currently the primary method used to measure walking impairment in patients with peripheral vascular disease. The aim of this study was to compare the CLTT and PADHOC device as assessments of walking impairment. METHODS 55 patients with intermittent claudication underwent a CLTT and a Double Physiological Walking Test (DPWT) using the PADHOC device. Health-related quality of life was measured using the Short Form 36 and the Claudication Scale. RESULTS The initial claudication and maximum walking distance from the first part of the DPWT showed the best correlation with domains of pain and physical function. CONCLUSIONS The DPWT is more representative of the functional incapacity experienced by patients with intermittent claudication. We believe that the PADHOC is a suitable alternative to the CLTT in the assessment of this patient group.
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Affiliation(s)
- P A Coughlin
- Department of Vascular and Endovascular Surgery, St. James's University Hospital, Leeds, UK.
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Wright AP, Berridge DC, Scott DJA. Return to Work Following Varicose Vein Surgery: Influence of Type of Operation, Employment and Social Status. Eur J Vasc Endovasc Surg 2006; 31:553-7. [PMID: 16460971 DOI: 10.1016/j.ejvs.2005.05.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2004] [Accepted: 05/22/2005] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To determine factors which influence the time taken to return to work in patients undergoing varicose vein surgery. DESIGN Prospective collection of data from patients at outpatient interview. SETTING The Department of Vascular and Endovascular Surgery at a teaching hospital in the UK. PARTICIPANTS Two hundred and fifteen consecutive employed or self-employed patients attending the outpatient clinic for review following varicose vein surgery. METHODS Data was collected from patients in the outpatient clinic approximately 6 weeks following varicose vein surgery. Type of procedure, gender, occupation status, category of occupation, the incidence of complications and the time taken to return to work (RTW) was recorded. Statistics were performed using Kruskal-Wallis H, Mann-Whitney U and chi-squared analysis. RESULTS Two hundred and fifteen patients were included, 77 (36%) men and 138 (64%) women. One hundred and ninety-two (89%) were employed and 23 (11%) self-employed. One hundred and fifty-three underwent primary saphenofemoral (SFJ) surgery, 10 bilateral procedures, 23 primary saphenopopliteal surgery (SPJ), 14 redo operations, five combined SFJ and SPJ, two mid thigh perforator ligation, six phlebectomies without groin or popliteal surgery and two bilateral surgery for recurrence. There was no relationship of gender or incidence of complications to RTW. There was a significant difference (p<0.0001) between employed (median RTW 4 weeks, interquartile range 2-5 weeks) and self-employed patients (median 2 weeks, interquartile range 1-4 weeks). Occupation category did show an overall significant difference (p<0.0001) on Kruskal-Wallis H-testing. Paired Mann-Whitney U-analysis showed that this difference was between occupation class I (median RTW 2 weeks, interquartile range 1-3 weeks) and IIIN (median 3.5 weeks, interquartile range 2-5 weeks), IIIM (median 5 weeks, interquartile range 2-5 weeks), IV (median 4 weeks, interquartile range 2-6 weeks) and V (median 4 weeks interquartile range 3-6 weeks), and between class II (median 3 weeks, interquartile range 2-4 weeks) and classes IIIM, IV and V. CONCLUSIONS Employed patients and those involved in intensive manual labour are less likely to return to work early. There is no effect of gender or incidence of complications. On the basis of this study we would recommend that patients could return to work within 3 weeks of varicose veins surgery.
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Affiliation(s)
- A P Wright
- Department of Vascular and Endovascular Surgery, St James's University Hospital, Leeds LS9 7TF, UK
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Abstract
INTRODUCTION Varicose veins are a common problem and, therefore, regularly feature in the vascular bay of the MRCS clinical examination. Candidates are still being instructed to perform tests in the examination that are considered by many to be obsolete and inaccurate. Using the current cohort of vascular examiners, we aim to clarify which tests a candidate should be performing when assessing varicose veins. We also aim to assess basic surgical trainees' experience in the use of hand-held Doppler (HHD). MATERIALS AND METHODS Postal questionnaires were sent to all English College Court examiners with a declared vascular interest to gain their opinion on what tests should be used in the vascular bay to assess primary varicose veins. E-mail questionnaires were also sent to basic surgical trainees to assess their experience in the use of hand-held Doppler to assess varicose veins. RESULTS There was a 100% response rate from the examiners with 93%, 86% and 79% feeling that clinical examination, HHD examination of the SFJ and HHD examination of the SPJ, respectively, should form part of the examination of primary varicose veins in the vascular bay. Only 50% indicated the Trendelenburg test and cough impulse and 57% believed the tap test should form part of the examination of varicose veins. Of the BSTs, 53% believed they could examine varicose veins with HHD. Of the BSTs who could use HHD, 74% had held a vascular SHO post. DISCUSSION Published data and opinion show many consultant surgeons have totally abandoned the use of the Trendelenberg, cough, tap and Perthes tests and support the opinion that HHD increases the accuracy of the examination of varicose veins. This study shows the opinions of the examiners supports the evidence-based recommendations that, in the light of easily accessible HHD, the older tests are now outdated. The majority of BSTs who were able to use HHD had held a vascular SHO post (74%) but otherwise it was unlikely that the BST would be comfortable with this skill. CONCLUSIONS The Brodie-Trendelenburg (tourniquet) test, cough impulse and tap test are outdated but candidates should be aware of the principles and failings behind them. In the MRCS clinical examination, candidates should examine varicose veins by means of clinical examination and HHD as this is now accepted standard practice. To aid candidate education, the HHD technique should replace traditional clinical tests which continue to be taught in medical school and remain within the classical surgical text books.
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Affiliation(s)
- N Bhasin
- Leeds Vascular Institute, Leeds General Infirmary, Leeds, UK.
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Parry DJ, Grant PJ, Scott DJA. Fibrinolytic risk factor clustering and insulin resistance in healthy male relatives of men with intermittent claudication. Br J Surg 2006; 93:315-24. [PMID: 16498597 DOI: 10.1002/bjs.5270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 12/27/2022]
Abstract
BACKGROUND Raised fibrinolytic factors predict cardiovascular risk in healthy subjects. The aim of this study was to measure fibrinolytic factors and insulin resistance in healthy male first-degree relatives of men with intermittent claudication younger than 65 years. METHODS The study compared 165 healthy first-degree relatives with 165 age-, sex- and race-matched control subjects free from a personal or family history of premature cardiovascular disease. Primary outcome measures were plasminogen activator inhibitor 1 (PAI-1), tissue plasminogen activator (tPA) and D-dimer levels. Insulin resistance was estimated by Homeostasis Model Assessment. Clinical and biochemical risk factors were measured and subjects genotyped for the PAI-1 4G/5G polymorphism. RESULTS First-degree relatives had significantly higher mean PAI-1 (10.23 versus 7.85 ng/ml; P = 0.024), tPA (9.98 versus 8.29 ng/ml; P < 0.001) and D-dimer levels (56.6 versus 46.1 ng/ml; P = 0.004). They also had significantly higher insulin resistance (1.85 versus 1.53; P < 0.001) and clustered multiple atherogenic risk factors. On multivariate analysis the association between both tPA and D-dimer levels and relative status was independent of other variables. CONCLUSION Raised levels of PAI-1, tPA, D-dimer and estimated insulin resistance were present in the healthy male first-degree relatives of men with intermittent claudication. These data support the hypothesis of fibrinolytic risk factor clustering in this high-risk population.
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Affiliation(s)
- D J Parry
- Department of Vascular Surgery, St James's Hospital, Leeds, UK
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Abstract
BACKGROUND Natural killer (NK) cells have an emerging role in the development of chronic disease and in the direction and maintenance of inflammatory responses. Abdominal aortic aneurysms (AAA) is a chronic inflammatory disorder of unknown aetiology. The aim was to investigate whether NK cells showed altered function in patients with an AAA. METHODS The presence, phenotype and function of peripheral blood and tissue NK cells from patients with an AAA, peripheral vascular disease (PVD) and healthy age-sex-matched controls were assessed before and after surgery. RESULTS Patients with an AAA had significantly higher (P < 0.010) percentages of peripheral blood NK cells (mean (95 per cent c.i.) 23.8 (2.6) per cent) than patients with PVD (17.4 (2.9) per cent) and control subjects (16.2 (2.8) per cent). The NK cells from patients with an AAA had increased cytotoxicity on a per cell basis towards both an NK-sensitive target cell line and human aortic smooth muscle cells. Increased NK cell proportions (22.7 (3.5) per cent) and cytotoxic activity, together with higher C-reactive protein values, persisted after successful AAA repair. CONCLUSION These data support the hypothesis that increased NK cytotoxicity could be a contributing factor in the generation or potentiation of inflammation in patients with an AAA.
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Affiliation(s)
- N D Forester
- Institute of Molecular and Cellular Biology, University of Leeds, Leeds, UK
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Scott DJA. Surgery of the deep femoral artery M. P. Merlini, R. J. A. M. van Dongen and M. Dusmet (eds). 246 × 158 mm. Pp. 182. Illustrated. 1994. Berlin: Springer. DM 148.00. Br J Surg 2005. [DOI: 10.1002/bjs.1800820767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- D J A Scott
- St James's Hospital, Beckett Street, Leeds LS9 7TF, UK
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Scott DJA. A colour atlas of human anatomy. 3rd ed. R. M. H. McMinn, R. T. Hutchings, J. Pegington and P. H. Abrahms. 310 × 250 mm. Pp. 359. Illustrated. 1993. London: Wolfe. £19·95. Br J Surg 2005. [DOI: 10.1002/bjs.1800810655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- D J A Scott
- St James's University Hospital, Leeds LS9 7TF, UK
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Lamont PM, Scott DJA. The impact of shortened training times on the discipline of vascular surgery in the United Kingdom. Am J Surg 2005; 190:269-72. [PMID: 16023444 DOI: 10.1016/j.amjsurg.2005.05.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2005] [Accepted: 04/15/2005] [Indexed: 10/25/2022]
Abstract
Political initiatives and European health and safety working time regulations have combined to reduce the time available for surgical training in the United Kingdom in the future by a third. For the safety of patient care, surgeons must evolve strategies to cope with these reduced training times so that they preserve the current high level of competence exhibited by UK trainees when they attain the right to independent surgical practice recognized by appointment as a Consultant Surgeon. Such strategies include a focus on dedicated training time, the use of simulators, and a move towards progression based on satisfactory completion of a defined curriculum and competency assessment rather than the amount of time served. With insufficient time to train in every aspect of general surgery, a move towards fragmentation into its sub-specialty components seems unavoidable. Such a move offers an opportunity to re-evaluate conventional surgical training and to consider the evolution of a system-specific vascular specialist with patient-focused expertise in vascular surgery, endovascular radiology, and vascular medicine.
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Affiliation(s)
- P M Lamont
- Vascular Units, Bristol Royal Infirmary, Bristol, BS2 8HW United Kingdom.
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Haine LS, Scott DJA. Images in vascular medicine. Pseudoaneurysm as a cause of psoas spasm. Vasc Med 2005; 9:321-2. [PMID: 15678629 DOI: 10.1191/1358863x04vm564xx] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- L S Haine
- Department of Vascular Surgery, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Wadoodi A, Sapsford RJ, Patel J, Scott DJA. Images in vascular medicine. Primary aortic thrombosis as seen with transoesophageal echo and MR angiogram. Vasc Med 2005; 9:231-2. [PMID: 15675193 DOI: 10.1191/1358863x04vm547xx] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- A Wadoodi
- Department of Vascular Surgery, St James Hospital, Beckett Wing, Leeds, UK
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Mercer KG, Spark JI, Berridge DC, Kent PJ, Scott DJA. Randomized clinical trial of intraoperative autotransfusion in surgery for abdominal aortic aneurysm. Br J Surg 2004; 91:1443-8. [PMID: 15499651 DOI: 10.1002/bjs.4793] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [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: 11/09/2022]
Abstract
Abstract
Background
Perioperative homologous blood transfusion (HBT) is associated with adverse reactions and risks transmission of infection. It has also been implicated as an immunosuppressive agent. Intraoperative autotransfusion (IAT) is a potential method of autologous transfusion.
Methods
This was a single-centre randomized clinical trial of IAT in surgery for abdominal aortic aneurysm. Forty patients were randomized to IAT and 41 underwent surgery with HBT only. Patients in both groups received HBT to maintain haemoglobin levels above 8 g/dl. Transfusion requirements, and incidence of systemic inflammatory response syndrome (SIRS) and infection, were compared.
Results
Significantly fewer patients in the IAT group required HBT (21 versus 31; P = 0·038) and the median blood requirement per patient was 2 units lower (P = 0·012). There was a higher incidence of chest infection (12 versus four patients; P = 0·049) and SIRS (20 versus nine patients; P = 0·020) in the HBT group. Risk of SIRS was related to aortic cross-clamp time in the IAT group only.
Conclusion
Use of autotransfusion effectively reduced the need for HBT and was associated with a reduced incidence of postoperative SIRS and infective complications.
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Affiliation(s)
- K G Mercer
- Department of Vascular and Endovascular Surgery, Lincoln Wing, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK
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Bhasin N, Jones SM, Patel J, Kessel D, Robertson I, Berridge DC, Scott DJA. Internal iliac artery aneurysm--a cause of leg swelling and cellulitis. J R Soc Med 2004. [PMID: 15459260 DOI: 10.1258/jrsm.97.10.483] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- N Bhasin
- Department of Vascular and Endovascular Surgery, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK.
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Bhasin N, Berridge DC, Scott DJA, Miller K, Whelan PP. Penile ulcer: an unusual presentation of cholesterol emboli. Eur J Vasc Endovasc Surg 2004; 27:447-8. [PMID: 15015199 DOI: 10.1016/j.ejvs.2004.01.011] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- N Bhasin
- Department of Vascular and Endovascular Surgery, St James's University Hospital, Leeds, UK
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Surash S, Robertson I, Calvey TAJ, Kessel D, Patel J, Kent PJ, Berridge D, Scott DJA, Kester RC. An audit of out of hours interventional vascular radiology. Eur J Vasc Endovasc Surg 2003; 25:573-7. [PMID: 12787702 DOI: 10.1053/ejvs.2002.1923] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [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: 11/11/2022]
Abstract
BACKGROUND in 1996 the Royal College of Radiologists established a set of guidelines for out of hours radiology. Part of the recommendations determined that all units should regularly assess their own out of hours workload. In light of these guidelines we have audited our units interventional radiology activity. METHODS this was a retrospective study looking at the number of emergency angiograms and procedures performed over a 1-year period. Patients were identified from a vascular radiology database and case notes reviewed. RESULTS a total of 1902 patients had angiograms with 686 having further procedures. Of these, 1093 patients (57%) having 380 procedures (55%) were under the care of a consultant vascular surgeon. Of the vascular surgical patients only 17 patients (1.6%) were actually investigated out of hours (1700-0800 weekdays and at weekends). 5/17 (29%) patients received thrombolysis and 7/17 (41%) had either an angioplasty or stent. Despite being a major vascular unit only 2/17 (12%) were patients referred from outside the units own trust. Following diagnostic angiography, 13/17 (76%) of patients had an intervention performed within the first 24h. CONCLUSION in a unit performing a large number of angiograms only a small number of patients require out of hours emergency angiography and interventional vascular procedures. Our impression is that this is the result of a flexible and responsive in hour's service. At the present time extra-hospital referrals do not appear to generate large amounts of out of hours work. This level of out of hours activity has implications in the provision of vascular radiological services in the future.
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Affiliation(s)
- S Surash
- Department of Vascular Surgery, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, U.K
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Spark JI, Chetter IC, Kester RC, Scott DJA. Role of the neutrophil in the development of sepsis following abdominal aortic aneurysm surgery. Br J Surg 2002. [DOI: 10.1046/j.1365-2168.2000.01420-11.x] [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: 11/20/2022]
Abstract
Abstract
Background
There is evidence to suggest that the neutrophil (PMN) plays a critical early step in development of the ischaemia–reperfusion syndrome and sepsis. Not all patients undergoing aortic aneurysm repair develop these postoperative complications. The PMN receptor CD16 plays an important role in phagocytosis, cell-mediated cytotoxicity and the release of free radicals and proteolytic enzymes. This study determined if there is any relationship between PMN CD16 expression, phagocytosis and the development of sepsis.
Methods
Some 50 patients (39 men and 11 women, median age 70 years) who underwent elective infrarenal abdominal aortic aneurysm repair were studied. Venous blood was taken before operation, throughout surgery and for 7 days afterwards. CD16 was measured, unstimulated and following further stimulation with phorbol myrisate, lipopolysaccharide and N-formyl-methionyl-leucyl-phenylalanine using flow cytometry. Phagocytosis was measured using flow cytometry and the production of elastase using an enzyme-linked immunosorbent assay. Sepsis was defined according to the ACCP/SCCM definition.
Results
There were 36 uncomplicated operations and 14 patients with sepsis. There was no difference between the two groups in respect of nutritional, co-morbid or technical factors. In the group that developed septic complications, the level of PMN CD16 expression was significantly higher before operation (30·2 versus 10·4 mcf; P < 0·05, Mann–Whitney U test) and throughout the postoperative period. Surgery produced no change in CD16 expression in either the septic or uncomplicated group. Stimulation of the PMNs before operation caused an increase in CD16 expression in both groups. After operation, stimulation of PMNs in the septic group resulted in a fall in CD16 expression (40·8 versus 20·4 mcf; P < 0·05, Mann–Whitney U test); surgery produced no change in the level of expression in the uncomplicated group. Phagocytic ability was comparable before operation (91·2 versus 94·2 mcf), but showed a greater reduction in the septic group after operation (73·4 versus 86·2 mcf; P < 0·05, Mann–Whitney U test). Elastase concentration was also similar before operation (48 versus 49 μg l−1); after operation, there was a greater increase in the septic group (166 versus 104 μg l−1; P < 0·05, Mann–Whitney U test).
Conclusion
This study provides evidence of functional differences in PMN behaviour in patients who subsequently develop sepsis following aneurysm surgery. This difference occurs early in the postoperative course and it may be possible to identify these patients before operation.
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Spark JI, Robinson JM, Gallavin L, Gough MJ, Homer-Vanniasinkam S, Kester RC, Scott DJA. Patients with chronic critical limb ischaemia have reduced total antioxidant capacity and impaired nutritional status. Eur J Vasc Endovasc Surg 2002; 24:535-9. [PMID: 12443751 DOI: 10.1053/ejvs.2002.1755] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [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: 11/11/2022]
Abstract
INTRODUCTION it has previously been demonstrated that total antioxidant capacity (TAC) can help predict which patients undergoing femoro-distal reconstruction are susceptible to postoperative infections. AIMS the aims of this study were to examine if TAC is influenced by the nutritional state of the patient and the degree of ischaemia. PATIENTS AND METHODS thirty patients with rest pain (21 men and 9 women), with a median age of 69 years and fifteen controls (9 men and 6 women), median age of 66 years, were studied. Nutritional status was assessed using serum albumin, body mass index (BMI), maximum voluntary contraction using a hand grip dynamometer and bioelectrical impedance to determine lean body mass. Blood was also taken for total antioxidant capacity (TAC). RESULTS patients with chronic critical limb ischaemia (CCLI) had a lower TAC than controls (752 vs 1,130 micromol/l, p<0.05 Mann-Whitney U -test). There was no difference in serum albumin concentration between the CCLI group compared with controls (31 mmol/L vs 35 mmol/L, p>0.05 Mann-Whitney U-test). There was also no difference in BMI (23 vs 27, p>0.05 U-test) between the two groups. The other markers of nutrition including, maximum voluntary contractions (28.6 kg/m(2)vs 37.4 kg/m(2), p<0.05 M-W U-test), and lean body mass (3.0 vs 3.8 M-W U-test), showed a significant reduction in the vascular patients. CONCLUSION TAC is significantly reduced in patients with CCLI and this may, in part, be explained by their impaired nutritional status.
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Affiliation(s)
- J I Spark
- Department of Vascular Surgery, St James's University Hospital, Leeds, UK
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Phipp LH, Robertson I, Scott DJA. Calf vessel runoff assessment in patients undergoing femorodistal bypass. Cardiovasc Surg 2002; 10:631-9. [PMID: 12453700 DOI: 10.1016/s0967-2109(02)00078-9] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- L H Phipp
- Vascular Surgery, St James's and Seacroft University Hospitals, Beckett Street, Leeds LS9 7TF, UK
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Scott DJA. Fifty Cases of Peripheral Vascular Interventions C. J. White (ed.) 240 × 160 mm. Pp. 219. Illustrated. 2002. London: Martin Dunitz. £34.95. Br J Surg 2002. [DOI: 10.1046/j.1365-2168.2002.02170_2.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- D J A Scott
- St James's Hospital, Beckett Street, Leeds LS9 7TF, UK
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Forester ND, Parry D, Kessel D, Robertson I, Patel J, Scott DJA. Ischaemic sciatic neuropathy: an important complication of embolisation of a type II endoleak. Eur J Vasc Endovasc Surg 2002; 24:462-3. [PMID: 12435350 DOI: 10.1053/ejvs.2002.1718] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- N D Forester
- Department of Vascular Surgery, St James's University Teaching Hospital, Leeds Teaching Hospitals, Beckett Street, Leeds, LS9 7TF, UK
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Turton EPL, Scott DJA, Carding SR. Immune modulation therapy. Eur J Vasc Endovasc Surg 2002; 24:466-7; author reply 467-9. [PMID: 12440443 DOI: 10.1053/ejvs.2002.1741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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