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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.


Dunne J.A.,University of Leeds | Bailey M.A.,University of Leeds | Bailey M.A.,The Leeds Vascular Institute | Griffin K.J.,University of Leeds | And 6 more authors.
Current Vascular Pharmacology | Year: 2014

Background: In the era of Abdominal Aortic Aneurysm (AAA) screening, pharmacotherapies to attenuate AAA growth are sought. HMG Co-A reductase inhibitors (statins) have pleiotropic actions independent of their lipid lowering effects and have been suggested as potential treatment for small AAAs. We systematically review the clinical evidence for this effect. Methods: Medline, EMBASE and the Cochrane Central Register of Controlled Trials (1950-2011) were searched for studies reporting data on the role of statin therapy on AAA growth rate. No language restrictions were placed on the search. References of retrieved articles and pertinent journals were hand searched. Included studies were reviewed by 2 independent observers. The search retrieved 164 papers, 100 were irrelevant based on their title, 47 were reviews and 1 was a letter. 8 studies were excluded based on review of their abstract leaving 8 for inclusion in the study. Results: Eight observational clinical studies with a total of 4,466 patients were reviewed. Four studies demonstrated reduced AAA expansion in statin users while 4 studies failed to demonstrate this effect. The method of determining AAA growth rates varied significantly between the studies and the ability of many studies to control for misclassification bias was poor. Conclusions: The claim that statins attenuate AAA growth remains questionable. Further prospective studies with stringent identification and verification of statin usage and a standardised method of estimating AAA growth rates are required. Statin type and dose also merit consideration. © 2014 Bentham Science Publishers.


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.


Davies J.M.,University of Leeds | Bailey M.A.,University of Leeds | Bailey M.A.,The Leeds Vascular Institute | Griffin K.J.,University of Leeds | And 3 more authors.
Vascular | Year: 2012

Pulse wave velocity (PWV) is a known indicator of arterial stiffness and cardiovascular risk. We critically evaluated the evidence supporting the four main non-invasive devices available to assess it: Complior, SphygmoCor, Arteriograph and Vicorder. PubMed and Medline databases (1960 2011) were searched to identify studies reporting carotid femoral PWV in humans using one or more of the four devices. Of the 183 articles retrieved, 43 met inclusion criteria. The Arteriograph device demonstrated least variance but had poor agreement with the other devices. Undisputable reference values for PWV need to be established and internationally agreed, and a standardized method for superficial distance measurement generated to reduce variability. Further studies comparing all four devices with invasive assessment are necessary. © The Author(s), 2012.


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.


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.


PubMed | The Leeds Vascular Institute
Type: | Journal: Journal of medical case reports | Year: 2010

The rate of abdominal aortic aneurysm expansion is related to multiple factors. There is some evidence that inflammation can accelerate aneurysm expansion. However, the association between pulmonary sepsis and rapid abdominal aortic aneurysm expansion is rarely reported.Here we present a case of a rapidly expanding abdominal aortic aneurysm in a 68-year-old Caucasian man with a concomitant lower respiratory tract infection and systemic sepsis requiring intensive monitoring and urgent endovascular intervention. Our patient had an uncomplicated post-operative recovery and a follow-up computed tomography scan at one month demonstrated no evidence of an endoleak.This case highlights the potential association between pulmonary sepsis and rapid abdominal aortic aneurysm expansion. In such cases, a policy of frequent monitoring should be adopted to identify those patients requiring definitive management.


PubMed | The Leeds Vascular Institute
Type: Case Reports | Journal: 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.


PubMed | The Leeds Vascular Institute
Type: Evaluation Studies | Journal: Journal of diabetes and its complications | Year: 2012

Digital toe amputation is a relatively minor surgical procedure but there is a historical view that it is the first stage in a predictable clinical course leading to eventual limb loss. There is a paucity of contemporaneous data on the long-term outcomes of patients undergoing toe amputation. We aim to study the experience from our institution, focussing on the risk factors for progression to future limb loss, by conducting a retrospective review of our practice.Sixty-three patients undergoing toe amputation within our institution were identified and the clinical notes retrospectively reviewed. A database of vascular risk factors and co-morbidity was constructed and correlation with future limb loss was analysed with Chi-squared testing and a logistic regression model.Sixty-three patients with a mean age of 69 (IQR 62-76.5) years were identified. Thirty-five (55.6%) of these patients went on to have a further surgical amputation; 22 major amputations (16 below-knee and 6 above-knee amputations) and 23 minor amputations were performed in total. Forty three (68.3%) patients had diabetes and 31 (49.2%) patients had one or more revascularisation procedures undertaken. There was a significant correlation between patients who did not have diabetes and future limb loss (Chi-squared=4.31, p=0.038), however no other identified risk factor predicted the need for major amputation.Toe amputation is a significant predictor of future limb loss. Our study identified that patients with diabetes are significantly less likely to progress to further limb loss than those with the disease. We hypothesise that this difference is due to the more intensive, multi-disciplinary foot care follow-up that diabetic patients receive. These results highlight the significance of toe amputation and contribute to the evidence for a more intensive out-patient service for these high risk patients.

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