An Assessment of the Potential Benefits of Video Consultation in the Emergency Department: Mixed Methods Study.

Background: District general hospital emergency departments may refer patients to a tertiary center depending on the information available to a generalist clinician in discussion with a specialist team. If there is uncertainty, the lowest-risk strategy is often to transfer the patient. Video consultation allowing the specialist team to see and talk to the patient and local clinician while still in the emergency department could improve decision-making for patient transfer.

Day of surgery: the impact on patient length of stay in a tertiary vascular unit.

Background: Our hypothesis was that patients undergoing surgery earlier in the week would have better access to physiotherapy and other discharge services after surgery and, as a result, would have a shorter length of hospital stay compared with patients undergoing surgery later in the week. This study aimed to assess whether there is a significant difference in postoperative length of hospital stay between the groups with secondary assessment by operation subtype.

Methods: We identified all patients admitted for vascular surgery in 2015 from a prospectively collected database and divided the week into Monday to Wednesday and Thursday to Friday.

The effects of foam sclerotherapy on ulcer healing: a single-centre prospective study.

Introduction: This prospective study of foam sclerotherapy for varicose veins aimed to determine the outcomes of treatment including ulcer healing and complication rates in our unit. Data were collected prospectively over a 10-year period and maintained on a database by our vascular sciences unit, which performed the planning and post-treatment venous duplex scans. Patients undergoing treatment due to venous ulceration were identified from this database.

Quantification of carotid plaque lipid content with magnetic resonance T2 mapping in patients undergoing carotid endarterectomy.

Background And Purpose: Techniques to stratify subgroups of patients with asymptomatic carotid artery disease are urgently needed to guide decisions on optimal treatment. Reliance on estimates of % luminal stenosis has not been effective, perhaps because that approach entirely disregards potentially important information on the pathological process in the wall of the artery.

Methods: Since plaque lipid is a key determinant of plaque behaviour we used a newly validated, high-sensitivity T2-mapping MR technique for a systematic survey of the quantity and distribution of plaque lipid in patients undergoing endarterectomy.

Quantification of Lipid-Rich Core in Carotid Atherosclerosis Using Magnetic Resonance T Mapping: Relation to Clinical Presentation.

Objectives: The aim of this study was to: 1) provide tissue validation of quantitative T mapping to measure plaque lipid content; and 2) investigate whether this technique could discern differences in plaque characteristics between symptom-related and non-symptom-related carotid plaques.

Background: Noninvasive plaque lipid quantification is appealing both for stratification in treatment selection and as a possible predictor of future plaque rupture. However, current cardiovascular magnetic resonance (CMR) methods are insensitive, require a coalesced mass of lipid core, and rely on multicontrast acquisition with contrast media and extensive post-processing.

Population-Based Study of Incidence, Risk Factors, Outcome, and Prognosis of Ischemic Peripheral Arterial Events: Implications for Prevention.

Background: There are few published data on the incidence and long-term outcomes of critical limb ischemia, acute limb ischemia, or acute visceral ischemia with which to inform health service planning, to monitor prevention, and to enable risk prediction.

Methods And Results: In a prospective population-based study (Oxfordshire, UK; 2002-2012), we determined the incidence and outcome of all acute peripheral arterial events in a population of 92,728. Risk factors were assessed by comparison with the underlying population.

Between a rock and a hard place.

The authors present the case of a patient who presented with acute coronary syndrome requiring percutaneous coronary intervention. He was incidentally diagnosed with a large abdominal abdominal aortic aneurysm which developed acute inflammatory features with rapid sac expansion and imminent rupture. This short report aims to highlight several dilemma that confronted us during the management of this patient.

Audit of anticoagulation after embolectomy for acute ischaemia.

Introduction: Intravenous unfractionated heparin (UFH) is routinely used in patients after arterial embolectomy. Achieving and maintaining therapeutic levels requires a co-ordinated approach which may be difficult for busy junior doctors and laboratories. There is no current evidence regarding the use of subcutaneous low molecular weight heparin (LMWH) as an alternative.

The difficult venous ulcer: case series of 177 ulcers referred for vascular surgical opinion following failure of conservative management.

Venous leg ulcers are common, chronic, debilitating, and expensive. Evidence supports use of compression bandaging, with superficial venous surgery in selected cases, but these interventions frequently fail to achieve healing. We describe a series of 152 consecutive referrals from a nurse-led specialist dermatology clinic to a vascular surgical service; a group posing particularly challenging problems.

Should we train the trainers? Results of a randomized trial.

Background: The development of efficient training methods in surgery is increasingly important. The effectiveness of training trainers is unclear. This study was designed to determine the effect on their trainees' performance of instructing trainers in a specific cognitive training method.

Is arteriovenous shunting involved in the development of varicosities? A study of the intraluminal pressure and oxygen content in varicose veins.

Objectives: Arteriovenous (AV) shunting has been postulated as the underlying cause of varicose veins. The aim of this study was to analyse pressure and oxygen content in primary varicose veins in order to determine evidence of arterial shunting.

Methods: Thirty-nine patients with varicose veins underwent cannulation of varicosities.

Endogenous heparin activity is decreased in peripheral arterial occlusive disease.

Background: Naturally occurring heparin-like activity in the form of endogenous heparin and heparin sulfate proteoglycans has been shown in normal human plasma. Exogenous low-dose heparin improves pain-free walking distance and maximum walking distance in peripheral arterial occlusive disease (PAOD). Is reduced endogenous heparin activity responsible for some of the problems found in PAOD? This study compared heparin-like activity in patients with PAOD with that in healthy subjects and explored its relationship to disease severity.

External validity of a mortality prediction model in patients after open abdominal aortic aneurysm repair using multi-level methodology.

Objectives: Evaluation of the prognostic ability of the APACHE-AAA model in an independent group of post-operative (open) Abdominal Aortic Aneurysm (AAA) patients.

Methods: The model was applied to predict in-hospital mortality in 541 patients (325 elective and 216 emergencies; 489 from Oxford; 52 from Lewisham). Multi-level modelling was used to adjust for both the local structure and process of care and patient case-mix.

Fast track open aortic surgery: reduced post operative stay with a goal directed pathway.

Objective: Open aortic aneurysm repair is traditionally associated with an extended hospital stay. The aim of this study was to examine the feasibility of reducing post-operative stay through the implementation of a fast-track, goal directed, clinical pathway for elective open aortic surgery.

Methods: A fast-track clinical pathway for aortic surgery was introduced in a regional vascular unit in September 2005.

An e-Health approach to managing vascular surgical patients.

The objective of this study was to investigate an e-health approach to managing patients presenting with vascular-type symptoms. A pilot study of a prospective cohort of patients referred from a single general practitioner practice of 5700 patients using electronic referral, assessment by a practice nurse, and teleconferencing facilities as an adjunct to normal referral and management practice was designed and conducted. Thirty-eight patients aged 30-93 years old (median 72 years) were enrolled in the study between March 2001 and July 2004.

Comparison of mortality prediction models after open abdominal aortic aneurysm repair.

Objectives: Comparison of the accuracy of prediction of contemporary mortality prediction models after open Abdominal Aortic Aneurysm (AAA) surgery.

Methods: Post-operative data were collected from AAA patients from 2 UK Intensive Care Units (ICU). POSSUM and VBHOM based models were compared to the APACHE-AAA model which was able to adjust for the hospital-related effect on outcome.

Thromboelastographic changes following nonionic contrast medium injection during transfemoral angiography in patients with peripheral arterial occlusive disease.

Background/purpose: Patients with peripheral arterial occlusive disease (PAOD) are known to be systemically hypercoagulable and there is concern that exposing them to contrast media during angiography may exacerbate that thrombotic tendency. Many in vitro studies in which blood is exposed to contrast media suggest that nonionic contrast medium (NICM) has a weaker anticoagulant effect than ionic contrast medium (ICM) and some studies suggest that NICM can lead to activation of coagulation thus increasing the risk of thrombotic events where it is employed. We have looked at the changes in coagulation adjacent to the site of contrast injection/potential angioplasty to determine the magnitude of change locally.

Informed prognosis [corrected] after abdominal aortic aneurysm repair using predictive modeling techniques [corrected].

Objective: To identify the best method for the prediction of postoperative mortality in individual abdominal aortic aneurysm surgery (AAA) patients by comparing statistical modelling with artificial neural networks' (ANN) and clinicians' estimates.

Methods: An observational multicenter study was conducted of prospectively collected postoperative Acute Physiology and Chronic Health Evaluation II data for a 9-year period from 24 intensive care units (ICU) in the Thames region of the United Kingdom. The study cohort consisted of 1205 elective and 546 emergency AAA patients.

Quantification of mortality risk after abdominal aortic aneurysm repair.

Background: The study was designed to evaluate the Acute Physiology And Chronic Health Evaluation (APACHE) II risk scoring system in abdominal aortic aneurysm (AAA) surgery. The aim was to create an APACHE-based risk stratification model for postoperative death.

Methods: Prospective postoperative APACHE II data were collected from patients undergoing AAA repair over a 9-year interval from 24 intensive care units (ICUs) in the Thames region.

The use of telemedicine in the management of vascular surgical referrals.

We have performed a feasibility study of telemedicine as an alternative to conventional outpatient appointments for the making of diagnostic and management decisions for patients referred for vascular surgery. Twenty-two sequential patients referred by a single general practice to a vascular centre were offered a telemedicine clinic appointment as an alternative to a conventional hospital outpatient appointment. A referral pro forma and digital photograph (where appropriate) were transmitted in advance of the videoconference.

Preoperative duplex on admission prevents unnecessary carotid surgery.

Objectives: Our unit policy is to duplex on admission all patients undergoing carotid endarterectomy to confirm patency. The aim of this study was to evaluate whether this had led to avoidance of unnecessary carotid surgery in a significant number of patients.

Methods: Over a 7-year period from January 1997 to December 2003, a total of 475 patients were scheduled for carotid endarterectomy.

Histological correlates of carotid plaque surface morphology on lumen contrast imaging.

Background: Carotid angiographic plaque surface morphology is a powerful risk factor for stroke and systemic vascular risk. However, the underlying pathology is unclear, and a better understanding is required both to evaluate other forms of carotid imaging and to develop new treatments. Previous studies comparing angiographic plaque surface morphology with pathology have been small and unblinded, and the vast majority assessed only the crude macroscopic appearance of the plaque.

Changes in blood coagulability as it traverses the ischemic limb.

Objective: We undertook this study to determine whether changes in blood coagulability associated with peripheral arterial occlusive disease are due to contact with the atherosclerotic arterial wall or passage through distal ischemic tissue.

Methods: Thirty patients with peripheral arterial occlusive disease undergoing angiography participated in the study. Ankle-brachial pressure index was recorded before intervention.

Duplex ultrasonography predicts safety of radial artery harvest in the presence of an abnormal Allen test.

Background: The Allen test is commonly used to assess collateral hand circulation before radial artery harvest for coronary artery bypass grafting. However there is no consensus as to whether an abnormal Allen test is an absolute or relative contraindication to radial artery harvesting. We assessed the safety of harvesting the radial artery using arterial duplex ultrasonography in patients with an abnormal Allen test.