Publications by authors named "Ian Chetter"

Background: Surgical site infections (SSIs) pose a significant challenge to healthcare systems by elevating patient morbidity and mortality and driving up financial costs. Preoperative skin preparation is crucial for preventing SSIs; however, certain traditional methods of hair removal have been found to increase the risk of SSI development. Mechanical epilation and waxing constitute two relatively explored methods of hair removal, which may hold potential to accelerate wound healing due to the activation of stem cells within hair follicles.

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Article Synopsis
  • - The study evaluates the 10-year outcomes of two treatments for varicose veins: surgical ligation and stripping vs. endovenous laser ablation (EVLA), showing both improve quality of life (QoL).
  • - At the 10-year mark, EVLA had a lower clinical recurrence rate (37% vs. 59%) and showed significantly better QoL scores in areas like bodily pain and general health compared to surgery.
  • - Overall, while both treatments are effective long-term, EVLA provides superior clinical and QoL outcomes for patients with symptomatic varicose veins.
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Introduction: The combination of intermittent claudication (IC), cardiometabolic multimorbidity (CMM), and sarcopenia is associated with worse outcomes than IC alone. This study aimed to identify whether the completion of supervised exercise therapy (SET) attenuates these adverse outcomes in patients with combined IC, sarcopenia, and CMM.

Methods: This registry review included consecutive IC patients with concomitant CMM and sarcopenia, who were referred for SET from 2014 to 2017.

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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.

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Surgical site infections (SSIs) following major lower limb amputation (MLLA) in vascular patients are a major source of morbidity. The objective of this systematic review was to determine the incidence of SSI following MLLA in vascular patients. This review was prospectively registered with the International Prospective Register of Systematic Reviews (CRD42023460645).

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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.

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Importance: Intermittent lower limb claudication limits function and quality of life. Supervised exercise programs are not readily available, and a noninvasive alternative is needed.

Objective: To assess extracorporeal corporeal shockwave therapy in improving quality of life in patients with claudication.

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Article Synopsis
  • Surgical site infections (SSI) are prevalent in healthcare, often due to barriers like limited access, lack of awareness, and poor wound monitoring; telemedicine can enhance early detection and follow-up after surgery.
  • This study analyzed the implementation of telemedicine for postoperative follow-up in patients after lower limb vascular surgeries, evaluating its effectiveness through remote assessments and carbon footprint impact.
  • Results indicated that telemedicine significantly reduced patient travel distance and carbon emissions, supporting its role in achieving the NHS Net-Zero goal by 2045 while maintaining quality care.
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Background: Guidelines recommend cardiovascular risk reduction and supervised exercise therapy as the first line of treatment in intermittent claudication, but implementation challenges and poor patient compliance lead to significant variation in management and therefore outcomes. The development of a precise risk stratification tool is proposed through a machine-learning algorithm that aims to provide personalized outcome predictions for different management strategies.

Methods: Feature selection was performed using the least absolute shrinkage and selection operator method.

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Article Synopsis
  • A new high-intensity interval training (HIIT) program for patients with intermittent claudication (IC) was found to be feasible and beneficial, prompting researchers to gather patient feedback for further development.
  • Semi-structured interviews were conducted with patients who either completed the program, declined participation, or discontinued early; the analysis revealed three main themes: personal reflections, barriers and facilitators, and perceived benefits of the program.
  • Participants who completed the HIIT program reported positive experiences and health improvements, highlighting the need for program adjustments to address logistical and motivational challenges, which supports the idea of conducting further research through a larger randomized controlled trial.
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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.

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Objective: This study aimed to explore the long term outcomes of patients with intermittent claudication (IC) who completed supervised exercise therapy (SET) vs. those who declined or prematurely discontinued SET, focusing on the incidence of chronic limb threatening ischaemia (CLTI), revascularisation, major adverse limb events (MALE), and major adverse cardiovascular events (MACE).

Methods: A retrospective registry analysis of consecutive patients with IC who were referred for SET between March 2015 and August 2016 and followed up for a minimum of five years.

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Negative pressure wound therapy (NPWT) has significantly advanced wound care and continues to find new applications. Its effects at a molecular level however, remain a subject of debate. The aim of this systematic review is to summarize the current evidence regarding the molecular mechanisms of action of NPWT.

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Methods: This was an open, multicentre, randomized controlled trial. Patients with intermittent claudication attending vascular surgery outpatient clinics were randomized (1:1) to receive either neuromuscular electrical stimulation (NMES) or not in addition to local standard care available at study centres (best medical therapy alone or plus supervised exercise therapy (SET)). The objective of this trial was to investigate the clinical efficacy of an NMES device in addition to local standard care in improving walking distances in patients with claudication.

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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.

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Objective: A preoperative supervised exercise program (SEP) improves cardiorespiratory fitness and perioperative outcomes for patients undergoing elective abdominal aortic aneurysm (AAA) repair. The aim of this study was to assess the effect of a preoperative SEP on long-term survival of these patients. A secondary aim was to consider long-term changes in cardiorespiratory fitness and quality of life.

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Background: Venous leg ulcers (VLUs) are a serious manifestation of chronic venous disease affecting up to 3% of the adult population. This typically recalcitrant and recurring condition significantly impairs quality of life, and its treatment places a heavy financial burden upon healthcare systems. The longstanding mainstay treatment for VLUs is compression therapy.

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Surgical site infection (SSI) is common following arterial surgery involving a groin incision. There is a lack of evidence regarding interventions to prevent groin wound SSI, therefore, a survey of vascular clinicians was undertaken to assess current opinion and practice, equipoise and feasibility of a randomised controlled trial (RCT). Participants at the Vascular Society of Great Britain and Ireland 2021 Annual Scientific Meeting were surveyed regarding three separate interventions designed to prevent SSI in the groin; impregnated incise drapes, diakylcarbomoyl chloride dressings and antibiotic impregnated collagen sponges.

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Background: The European Association of Endoscopic Surgery (EAES) is a surgical society who promotes the development and expansion of minimally invasive surgery to surgeons and surgical trainees. It does so through its activities in education, training, and research. The EAES research committee aims to promote the highest quality clinical research in endoscopic and minimally invasive surgery.

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Article Synopsis
  • A study explored the feasibility of a 6-week high-intensity interval training (HIIT) program as an alternative to standard supervised exercise programs (SEPs) for patients with intermittent claudication (IC).
  • Out of 280 screened patients, 40 were recruited, and 31 (78%) completed the HIIT program, indicating high adherence and no serious adverse events.
  • Results showed improvements in maximum walking distance and physical health scores, suggesting that HIIT is a tolerable, potentially safe, and effective option for patients with IC, warranting further research.
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Background: Minimally invasive (MI) surgery has revolutionised surgery, becoming the standard of care in many countries around the globe. Observed benefits over traditional open surgery include reduced pain, shorter hospital stay, and decreased recovery time. Gastrointestinal surgery in particular was an early adaptor to both laparoscopic and robotic surgery.

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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.

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Background: Chronic limb-threatening ischaemia is the severest manifestation of peripheral arterial disease and presents with ischaemic pain at rest or tissue loss (ulceration, gangrene, or both), or both. We compared the effectiveness of a vein bypass first with a best endovascular treatment first revascularisation strategy in terms of preventing major amputation and death in patients with chronic limb threatening ischaemia who required an infra-popliteal, with or without an additional more proximal infra-inguinal, revascularisation procedure to restore limb perfusion.

Methods: Bypass versus Angioplasty for Severe Ischaemia of the Leg (BASIL)-2 was an open-label, pragmatic, multicentre, phase 3, randomised trial done at 41 vascular surgery units in the UK (n=39), Sweden (n=1), and Denmark (n=1).

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