Delays to Revascularisation and Outcomes of Non-elective Admissions for Chronic Limb Threatening Ischaemia: a UK Population Based Cohort Study.

Objective: Major amputation and death are significant outcomes after lower limb revascularisation for chronic limb threatening ischaemia (CLTI), but there is limited evidence on their association with the timing of revascularisation. The aim of this study was to examine the relationship between time from non-elective admission to revascularisation and one year outcomes for patients with CLTI.

Methods: This was an observational, population based cohort study of patients aged ≥ 50 years with CLTI admitted non-electively for infra-inguinal revascularisation procedures in English NHS hospitals from January 2017 to December 2019 recorded in the Hospital Episode Statistics database.

Illness Trajectories After Revascularization in Patients With Peripheral Artery Disease: A Unified Approach to Understanding the Risk of Major Amputation and Death.

Background: The aim of this study was to investigate the illness trajectories of patients with peripheral artery disease (PAD) after revascularization and estimate the independent risks of major amputation and death (from any cause) and their interaction.

Methods: Data from Hospital Episode Statistics Admitted Patient Care were used to identify patients (≥50 years of age) who underwent lower limb revascularization for PAD in England from April 2013 to March 2020. A Markov illness-death model was developed to describe patterns of survival after the initial lower limb revascularization, if and when patients experienced major amputation, and survival after amputation.

Patient experience of the process to diagnosis of chronic limb-threatening ischaemia: A qualitative study.

Introduction: Delays exist at each stage of the chronic limb-threatening ischaemia (CLTI) care pathway, but there is little known about patient factors influencing delay to diagnosis of CLTI. This study explores the experiences and perceptions of patients recently diagnosed with CLTI.

Methods: A qualitative interview study was conducted.

Documentary analysis of national and international guidance for community clinicians referring patients with suspected chronic limb-threatening ischaemia.

Background: Delayed referral of patients with chronic limb-threatening ischaemia (CLTI) from the community to vascular services may increase risk of amputation due to delayed revascularisation. Lack of appropriate guidance for clinicians in the community may contribute to this problem. This documentary analysis investigated referral guidance available to primary care clinicians.

Understanding delays in chronic limb-threatening ischaemia care: Application of the theoretical domains framework to identify factors affecting primary care clinicians' referral behaviours.

Introduction: Patients in the community with suspected Chronic limb-threatening ischaemia (CLTI) should be urgently referred to vascular services for investigation and management. The Theoretical Domains Framework (TDF) allows identification of influences on health professional behaviour in order to inform future interventions. Here, the TDF is used to explore primary care clinicians' behaviours with regards to recognition and referral of CLTI.

The symptom to assessment pathway for suspected chronic limb-threatening ischaemia (CLTI) affects quality of care: a process mapping exercise.

Background: Delays in the pathway from first symptom to treatment of chronic limb-threatening ischaemia (CLTI) are associated with worse mortality and limb loss outcomes. This study examined the processes used by vascular services to provide urgent care to patients with suspected CLTI referred from the community.

Methods: Vascular surgery units from various regions in England were invited to participate in a process mapping exercise.

Hospital clinicians' perceptions and experiences of care pathways for chronic limb-threatening ischaemia: a qualitative study.

Background: Chronic limb-threatening ischaemia (CLTI) is a condition associated with significant risks of lower limb loss and mortality, which increase with delays in management. Guidance recommends urgent referral and assessment, but delays are evident at every stage of the CLTI patient pathway. This study uses qualitative methods to explore hospital clinicians' experiences and perceptions of the existing CLTI pathway.

Raised BMI is associated with fewer Type I endoleaks in patients treated with the Gore Excluder device: data from the Global Registry for Endovascular Aortic Treatment (GREAT).

Background: Obesity is increasing in prevalence globally and within the cohort of vascular surgical patients, leading to poorer outcomes. There are few data on endoleak as a complication of AAA surgery in obese patients. The aim of this study was to use large scale registry data from the Global Registry for Endovascular Aortic Treatment (GREAT) to interrogate any relationship between obesity and endoleak following endovascular aneurysm repair (EVAR) using a Gore Excluder device (W.

Outcomes after minor lower limb amputation for peripheral arterial disease and diabetes: population-based cohort study.

Background: Patients with diabetes and peripheral arterial disease are at increased risk of minor amputation. The aim of study was to assess the rate of re-amputations and death after an initial minor amputation, and to identify associated risk factors.

Methods: Data on all patients aged 40 years and over with diabetes and/or peripheral arterial disease, who underwent minor amputation between January 2014 and December 2018, were extracted from Hospital Episode Statistics.

The Impact of Pre-Operative Anaemia on One Year Amputation Free Survival and Re-Admissions in Patients Undergoing Vascular Surgery for Peripheral Arterial Disease: a National Vascular Registry Study.

Objective: Anaemia is common among patients undergoing surgery, but its association with post-operative outcomes in patients with peripheral arterial disease (PAD) is unclear. The aim of this observational population based study was to examine the association between pre-operative anaemia and one year outcomes after surgical revascularisation for PAD.

Methods: This study used data from the National Vascular Registry, linked with an administrative database (Hospital Episode Statistics), to identify patients who underwent open surgical lower limb revascularisation for PAD in English NHS hospitals between January 2016 and December 2019.

Effectiveness of quality improvement collaboratives in UK surgical settings and barriers and facilitators influencing their implementation: a systematic review and evidence synthesis.

Background: High-quality surgical care is vital to deliver the excellent outcomes patients deserve following surgical treatment. Quality improvement collaboratives (QICs) are based on a multicentre model for improving healthcare. They are increasingly used but their effectiveness in the context of surgical services is unclear.

Editor's Choice - Outcomes of Surgery for Patients with Peripheral Arterial Disease During the COVID-19 Pandemic in the United Kingdom: A Population Based Study.

Objective: There is limited information on changes in the patterns of care and outcomes for patients who had vascular procedures after the first wave of the COVID-19 pandemic. The aim of this population based study was to examine the patterns of care and outcomes for vascular lower limb procedures in the UK during the COVID-19 pandemic.

Methods: Lower limb revascularisations and major amputations performed from January 2019 to April 2021 in the UK and entered in the National Vascular Registry were included in the study.

Evaluation of the ICD-10 system in coding revascularisation procedures in patients with peripheral arterial disease in England: A retrospective cohort study using national administrative and clinical databases.

Background: Many studies evaluating care in hospitals in England use the Hospital Episode Statistics (HES) administrative database. The aim of this study was to explore whether the International Classification of Diseases 10th Revision (ICD-10) system used by HES supported the evaluation of care received by patients with peripheral arterial disease (PAD) who had revascularisation.

Methods: This retrospective cohort study used records on patients who had revascularisation for PAD between 1st January 2017 and 31st December 2019 in England, collected prospectively in the National Vascular Registry (NVR) and linked to HES.

Arterial embolization of metal-on-metal hip arthroplasty-related pseudotumor material causing acute limb ischemia.

We have described a complication of a pseudotumor secondary to metal-on-metal hip arthroplasty. The patient experienced acute limb ischemia after pseudotumor material had invaded and stenosed the external iliac artery and embolized distally. Multiple vascular surgery procedures were performed to revascularize the limb.

Vascular surgery trainee retention in the UK: how many leave and why? A survey of trainee and Training Programme Directors' perceptions.

Background: It is currently not known how many trainees leave vascular surgery, and their reasons for doing so are unclear. This paper is the first to publish the number of UK trainees leaving the training programme and interrogates their reasons for doing so.

Methods: An email survey was distributed to current and recent Training Programme Directors (TPDs) to quantify the number of trainees resigning between 2013 and 2019.

Smartphone learning as an adjunct to vascular teaching - a pilot project.

Background: M-learning is education using personal mobile electronic devices. Given the prevalence of these in society and amongst healthcare professionals, we aimed to assess their use and feasibility in improving the educational programme of a single vascular institution.

Methods: A weekly vascular departmental teaching programme was initiated with registrars giving 30-min presentations on a defined book chapter.

Is management of complex abdominal aortic aneurysms consistent? A questionnaire-based survey.

Background: Complex abdominal aortic aneurysm (AAA) is a relatively common presentation to the vascular specialist. Despite this there is little consensus on how to manage the often comorbid group of patients. Recent advances in endovascular technology have led to the availability of multiple devices, many of which could be used to treat the same aneurysm.

Is the management of complex abdominal aortic aneurysms consistent across the UK? A questionnaire-based survey.

Background: Our objective was to quantify variability across the UK in the management of a complex abdominal aortic aneurysm (AAA).

Methods: An online survey was emailed to all members of the Vascular Society for Great Britain and Ireland. The survey presented a vignette of a 63-year-old woman with significant respiratory co-morbidity whose computed tomographic (CT) angiogram demonstrated a 54 mm AAA with a short (7 mm) proximal neck but no other adverse morphological features for a standard or complex endovascular aneurysm repair (EVAR).