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Leeds, United Kingdom

Chapman S.J.,The Leeds Vascular Institute | Gough M.J.,The Leeds Vascular Institute
EJVES Extra | Year: 2012

Introduction: Several treatment options are available for primary hyperhidrosis. Selection for individual patients is influenced by symptom severity, success rates and the relative risk of compensatory hyperhidrosis. Case report: A 24-year-old female presented with a 10-year history of palmar, pedal and axillary hyperhidrosis. Following recurrent relapse after botulinum toxin (BOTOX ®) injections for axillary hyperhidrosis bilateral axillary sweat gland curettage was performed with immediate procedural success. At 6 month follow-up recurrent hyperhidrosis was reported affecting both axillae. A starch-iodine test showed a rim of persisting sweating at the periphery of both axillae. Discussion: Curettage is generally performed without specific identification of sweat gland distribution, perhaps explaining the recurrence in this patient. In contrast, a starch-iodine test is used to guide administration of BOTOX ® for hyperhidrosis. We propose pre-operative use of this technique before axillary curettage. © 2012 European Society for Vascular Surgery.

Bailey M.A.,University of Leeds | Bailey M.A.,The Leeds Vascular Institute | Charnell A.M.,University of Leeds | Griffin K.J.,University of Leeds | And 7 more authors.
Ultrasound | Year: 2011

Once detected, abdominal aortic aneurysms (AAA) are surveyed with periodic ultrasound scans until they reach an intervention threshold, based on maximal AAA size. The rate of AAA growth varies greatly between patients. There has been significant research interest in pharmacological interventions to attenuate AAA growth and a lack of good-quality evidence for surveillance scan intervals. However, studies to date have used differing methods of growth rate estimation which have been analysed together in meta-analyses. We questioned the validity of this approach and systematically reviewed the methods currently used for AAA growth estimation in the literature and considered their relative merits and limitations. We reviewed 23 studies that met our inclusion criteria, containing a total of 9769 patients and identified three methods of growth rate estimation in use: (i) a simple distance/time calculation, (ii) linear regression modelling and (iii) linear multilevel modelling. Multilevel modelling had significant advantages over the other two methods as it allowed a linear model to reflect individualized growth rates of each patient. However, all methods in use presumed AAA growth to be linear and this is not necessarily the case. Further work using models which allow for non-linear (e.g. quadratic) growth patterns is required. Consensus on a standardized model would allow valid pooling of data between centres. The UK National AAA Screening Programme will provide an important data source for ongoing work in this area.

Sun Z.D.Y.,The Leeds Vascular Institute | Bailey M.A.,The Leeds Vascular Institute | Bailey M.A.,University of Leeds | Griffin K.J.,The Leeds Vascular Institute | And 5 more authors.
Phlebology | Year: 2012

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.

Bailey M.A.,University of Leeds | Bailey M.A.,The Leeds Vascular Institute | Aggarwal R.,University of Leeds | Bridge K.I.,University of Leeds | And 11 more authors.
Journal of Thrombosis and Haemostasis | Year: 2015

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. © 2015 International Society on Thrombosis and Haemostasis.

Watkins C.E.L.,The Leeds Vascular Institute | Bailey M.A.,The Leeds Vascular Institute | Patel J.V.,The General Infirmary at Leeds | Foster N.,The General Infirmary at Leeds | And 2 more authors.
EJVES Extra | Year: 2011

Objective: We report the first case of spondylodiscitis following endovascular aneurysm repair (EVAR), without graft infection. Case report: Three weeks following elective EVAR, a 78 year old man re-presented with confusion, anorexia, fever and back pain. Escherichia coli bacteraemia was identified on blood cultures. Computer tomography angiogram and radio-labelled white cell scan excluded graft infection. Positron emission tomography revealed spondylodiscitis at T10/T11. He was treated with 6 weeks of intravenous antibiotics. At 12 months follow-up the patient was asymptomatic. Conclusion: We report spondylodiscitis as a complication of EVAR in the absence of graft infection. © 2011 European Society for Vascular Surgery.

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