Diagnosis and treatment of peripheral arterial disease in diabetic patients with a foot ulcer. A progress report of the International Working Group on the Diabetic Foot.

The International Working Group on the Diabetic Foot (IWDGF) has produced in 2011 a guideline on the diagnosis and treatment of peripheral arterial disease in patients with diabetes and a foot ulcer. This document, together with a systematic review that provided the background information on management, was produced by a multidisciplinary working group of experts in the field and was endorsed by the IWDGF. This progress report is based on these two documents and earlier consensus texts of the IWDGF on the diagnosis and management of diabetic foot ulcers.

A systematic review of the effectiveness of revascularization of the ulcerated foot in patients with diabetes and peripheral arterial disease.

In several large recent observational studies, peripheral arterial disease (PAD) was present in up to 50% of the patients with a diabetic foot ulcer and was an independent risk factor for amputation. The International Working Group on the Diabetic Foot therefore established a multidisciplinary working group to evaluate the effectiveness of revascularization of the ulcerated foot in patients with diabetes and PAD. A systematic search was performed for therapies to revascularize the ulcerated foot in patients with diabetes and PAD from 1980-June 2010.

A systematic review of interventions to enhance the healing of chronic ulcers of the foot in diabetes.

The outcome of management of diabetic foot ulcers is poor, and there is continuing uncertainty concerning optimal approaches to management. It was for these reasons that in 2006 the International Working Group of the Diabetic Foot (IWGDF) working group on wound healing undertook a systematic review of the evidence to inform protocols for routine care and to highlight areas which should be considered for further study. The same working group has now updated this review by considering papers on the interventions to improve the healing of chronic ulcers published between December 2006 and June 2010.

Measures of health-related quality of life in diabetes-related foot disease: a systematic review.

Aims/hypothesis: Patient-reported outcome measures (PROMs) are increasingly used as key performance indicators in chronic illness. We sought to review the value of these tools in assessing health-related quality of life (HRQOL) in patients with diabetes-related foot disease and identify the impact of each foot problem on life quality.

Methods: A systematic review of literature on HRQOL PROMs in diabetes-related foot disease was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines.

Endofibrosis and kinking of the iliac arteries in athletes: a systematic review.

Introduction: Kinking and endofibrosis of the iliac arteries are uncommon and poorly recognized conditions affecting young endurance athletes. Deformation or progressive stenosis of the iliac artery may reduce blood flow to the lower limb and adversely affect performance. The aim of this review was to examine the existing literature relating to these flow-limiting phenomena and identify a clear, unifying strategy for the assessment and management of affected patients.

A systematic review of protocols for the three-dimensional morphologic assessment of abdominal aortic aneurysms using computed tomographic angiography.

The morphology of infrarenal abdominal aortic aneurysms (AAAs) directly influences the perioperative outcome and long-term durability of endovascular aneurysm repair. A variety of methods have been proposed for the characterization of AAA morphology using reconstructed three-dimensional (3D) computed tomography (CT) images. At present, there is lack of consensus as to which of these methods is most applicable to clinical practice or research.

Popliteal entrapment syndrome.

Introduction: Popliteal entrapment syndrome (PES) is a rare but important cause of intermittent claudication in young people. Controversy exists about optimal strategies for diagnosis and management, particularly for variants such as functional popliteal entrapment. The aim of this review was to systematically catalog the published English-language literature on PES and to determine if evidence-based guidelines for management could be formulated.

A prospective double-blind randomized controlled trial of radiofrequency versus laser treatment of the great saphenous vein in patients with varicose veins.

Background: Endovenous ablation of varicose veins using radiofrequency ablation (RFA) and endovenous laser therapy (EVLT) has reported advantages over traditional open surgical treatment. There is little evidence comparing the efficacy and patient-reported outcomes between the 2 endovenous solutions. This study compares the RFA and EVLT strategies in a prospective double-blind clinical trial.

First-year results of a national abdominal aortic aneurysm screening programme in a single centre.

Background: The UK Multicentre Aneurysm Screening Study (MASS) demonstrated reduced mortality from screening for abdominal aortic aneurysm (AAA). As a result, the National Health Service AAA Screening Programme was introduced in England. This study reports the results from an early-implementation screening centre.

A systematic review of mid-term outcomes of thoracic endovascular repair (TEVAR) of chronic type B aortic dissection.

Objective And Design: The role of Thoracic Endovascular Repair (TEVAR) in chronic type B aortic dissection remains controversial and its mid-term success as an alternative to open repair or best medical therapy remains unknown. The aim of the present study was to provide a systematic review of mid-term outcomes of TEVAR for chronic type B aortic dissection.

Materials And Methods: Medline, trial registries, conference proceedings and article reference lists from 1950 to January 2011 were searched to identify case series reporting mid-term outcomes of TEVAR in chronic type B dissection.

Patient-reported symptoms are independent of disease severity in patients with primary varicose veins.

The objective of this paper is to explore patterns of incompetence and disease distribution in patients with chronic venous disorders and to correlate this with CEAP (Clinical, Etiologic, Anatomic and Pathologic) classification and presenting symptoms to determine which features of chronic venous disorder (CVD) could be used to guide a patient pathway for referral and treatment. Consecutive patients attending a one-stop venous clinic at a university teaching hospital were recruited over a 12-month period. Patients were clinically assessed, assigned CEAP scores, duplex-scanned and categorized.

Heterogeneity in surveillance after endovascular aneurysm repair in the UK.

Objectives: Surveillance after Endovascular Aneurysm Repair (EVAR) is considered mandatory, but the optimal regimen remains controversial. The aim of the present study was to report the nature of routine post-EVAR surveillance protocols in the UK, in order to identify the degree of variation in national practice and from the manufacturer's instructions for use (IFU).

Methods: A telephone survey was administered to 41 centres with 10 years' experience in EVAR to identify their standard surveillance protocol after EVAR.

Comparative proteomics reveals a systemic vulnerability in the vasculature of patients with abdominal aortic aneurysms.

Introduction: Abdominal aortic aneurysms (AAA) are associated with inflammation, apoptosis, and matrix degradation. AAA tissue represents the end stage of disease, limiting its utility in identification of factors culpable for initiation of aneurysm development. Recent evidence suggests that AAAs are a local representation of a systemic disease of the vasculature.

Trends and outcomes after surgical lower limb revascularization in England.

Background: The aim was to analyse contemporary data on the number of surgical revascularization procedures performed each year in England, and their outcome.

Methods: Hospital Episode Statistics and Office for National Statistics data were used to quantify numbers and identify factors associated with outcome after all femoropopliteal and femorodistal bypass procedures performed between 2002 and 2006. Outcome measures were repeat bypass, major amputation, death and a composite measure.

The fate of patients referred to a specialist vascular unit with large infra-renal abdominal aortic aneurysms over a two-year period.

Introduction: The basic premise in managing patients with abdominal aortic aneurysms (AAA) must be to reduce overall mortality from the disease. Operative mortality is widely reported, but data on patients deemed unsuitable for repair are scarce. The purpose of the present study was to report the fate of patients referred with AAA, to define the proportion deemed unsuitable for surgery and to investigate the reasons for conservative treatment.

Curious chiral cases of caddisfly larvae: handed behavior, asymmetric forms, evolutionary history.

Studies of right-left asymmetries have yielded valuable insights into the mechanisms of both development and evolution. Larvae from several groups of caddisflies (Trichoptera) build portable asymmetrical cases within which they live. In nearly all species that build spiral-walled tubular cases, the direction of wall coiling is random (equal numbers of dextral and sinistral cases within species) whereas in all species that build helicospiral, snail-like cases the direction of coiling is exclusively dextral.

A standardized aortic aneurysm model for the assessment of endovascular stent-graft technology.

Reliable models of aortic aneurysms are required to test endovascular stent-graft technology prior to human use. We describe the creation of a standardized prosthetic aneurysm in an ovine model to assess endovascular technology. In an adult ovine model under general anesthesia, a polyester sphere measuring 6 cm across was sutured onto the infrarenal aorta following aortotomy.

Deficiencies in venous experience in UK vascular trainees: a survey of Rouleaux Club members.

Objective: The aim of this study was to evaluate the training experience of current UK vascular trainees in the modern management of venous disease.

Method: A web-based questionnaire of the 145 members of the Rouleaux Club (www.rouleauxclub.

Should the role of EVAR be re-evaluated in light of the 10 year results of EVAR-1?

EVAR-1 published its 10 year results in 2010. The principal finding of the study was that the endovascular group (EVR) had a significant reduction in early aneurysm related mortality compared to open surgery (OR), but the benefit was lost by the end of the study (adjusted hazard ratio [HR], 0.92; 95% confidence interval [CI] 0.