Time filter

Source Type

Hull, United Kingdom

Shahin Y.,Peninsula Radiology Academy | Barakat H.,Academic Vascular Surgical Unit | Shrivastava V.,Royal Infirmary
Journal of Vascular and Interventional Radiology | Year: 2016

This systematic review compared outcomes between endovascular and open repair of asymptomatic popliteal artery aneurysms (PAAs). Endovascular repair was associated with increased 30-day graft occlusion (odds ratio [OR] = 3.14; 95% confidence interval [CI], 1.43-6.92) and increased 30-day reintervention (OR = 4.09; 95% CI, 2.79-6.00). The 12-month primary patency rate was significantly higher in the open repair group (hazard ratio = 1.95; 95% CI, 1.14-3.33). Endovascular repair was associated with shorter length of hospital stay (mean difference = -3 d; 95% CI, -4.09 to -1.91; P <.001). Endovascular repair is associated with inferior perioperative and postoperative outcomes compared with open repair. © 2016 SIR.

Smith G.E.,Academic Vascular Surgical Unit | Barnes R.,Academic Vascular Surgical Unit | Chetter I.C.,Academic Vascular Surgical Unit
British Journal of Surgery | Year: 2014

Background Anatomical suitability for arteriovenous fistula (AVF) formation was formerly determined by clinical examination alone. There are potential benefits from imaging to assess anatomical suitability. Existing studies examined the role of routine preoperative ultrasonography versus clinical examination alone. The role of a selective duplex ultrasound imaging policy is unknown. This study aimed to compare a policy of selective versus routine ultrasound assessment before AVF formation. Methods All patients referred for fistula formation were assessed for inclusion. Suitable patients were randomized to either routine or selective preoperative ultrasound imaging; selective imaging was performed only when clinical criteria were not met. The primary outcome measures were site of AVF formation and 30-day primary failure rate, and secondary outcome measures included the rate of complications. Results A total of 106 patients were assessed, and 94 were randomized: 47 to selective and 47 to routine duplex ultrasonography. The groups were well matched for age, co-morbidities and medications. The primary failure rate (29 per cent overall) was not significantly different between the selective and routine imaging groups: 36 per cent (14 of 39) and 21 per cent (8 of 38) respectively (P = 0·144). There were no significant differences in the sites of AVF formation or complication rates. Conclusion Routine preoperative ultrasound vessel imaging did not significantly reduce early failure rates, influence the site of AVF formation or reduce complications. If clinical evaluation detects anatomy suitable for AVF formation, duplex imaging may not be needed. Registration number: NCT01004627 (http://www.clinicaltrials.gov). No difference © 2014 BJS Society Ltd. Published by John Wiley & Sons Ltd.

Barnes R.,Academic Vascular Surgical Unit | Souroullas P.,Academic Vascular Surgical Unit | Lane R.A.,Academic Vascular Surgical Unit | Chetter I.,Academic Vascular Surgical Unit
Annals of Vascular Surgery | Year: 2014

Introduction Morbidity and mortality after lower limb amputation (LLA) remain disappointingly high. This study aimed to assess the impact of previous ipsilateral vascular intervention on outcomes after major LLA. Methods Prospective data were collected for all major LLAs performed between January 2010 and December 2011. Those who underwent a primary amputation were compared with secondary amputees to establish if previous interventions were a risk factor for morbidity and mortality. Results One hundred forty-eight patients underwent LLA during the study period; 102 were primary amputees, and 46 (31.1%) had undergone previous ipsilateral revascularization. The groups were well matched for demographics and comorbidities. Those who underwent secondary amputations were older (P = 0.016) and more likely to suffer from hypercholesterolemia (P < 0.001). Patients who had undergone a previous intervention were more likely to need revision surgery (17% vs. 4.5% P = 0.027). Previous intervention was not found to be a risk factor for more proximal amputation level (P = 0.341) or increased postoperative mortality (P = 0.782), however. Conclusions Patients who have undergone previous revascularization may be at higher risk of revision surgery. Survival after major LLA does not appear to be associated with previous revascularization attempts. © 2014 Elsevier Inc. All rights reserved.

Carradice D.,Academic Vascular Surgical Unit | Wallace T.,Academic Vascular Surgical Unit | Gohil R.,Academic Vascular Surgical Unit | Chetter I.,Academic Vascular Surgical Unit
Annals of Surgery | Year: 2014

Objective: To test the hypothesis that patients with soft tissue changes related to superficial venous insufficiency (SVI) have greater benefits from treatment than those with only symptomatic varicose veins. Background: A commonly held view is that SVI is only a minor ailment, yet randomized clinical trials (RCTs) show that treatment improves quality of life (QoL) and is cost-effective. In an effort to curb the treatment costs of this common disorder, rationing is applied in many health care systems, often limiting the reimbursement of treatment to those with soft tissue changes. Methods: This cohort study draws its data from an interventional RCT. After informed consent, consecutive patients with symptomatic unilateral SVI were randomized to receive surgical ligation and stripping or endovenous laser ablation. This analysis differentially studies the outcomes of patients with simple varicose veins (C2: n=191) and soft tissue complications (C3-4: n=76). Effectiveness outcomesmeasured up to 1 year included the following: Qol [short form 36(SF36), EuroQol, and the Aberdeen Varicose Veins Questionnaire], clinical recurrence, and the need for secondary procedures. Multivariable regression analysis was used to control for potential confounding factors. Results: Both groups saw significant improvements in QoL. All improvements were equal between groups apart from the SF36 domain of Bodily Pain, where C2 saw an improvement of 12.8 [95% confidence interval (CI):4.8-20.8] points over C3-4 participants (P = 0.002), who also suffered more recurrence [odds ratio (OR) = 2.7, 95% CI: 1.2-6.1, P = 0.022] and required more secondary procedures (OR = 4.4, 95% CI: 1.2-16.3, P = 0.028). Conclusions: This study suggests that rationing by clinical severity contradicts the evidence. Delaying treatment until the development of skin damage leads to a degree of irreversible morbidity and greater recurrence. Trial registration: NCT00759434 Clinicaltrials.gov Copyright © 2014 Lippincott Williams & Wilkins.

Discover hidden collaborations