Simulator training on pulsatile vascular models significantly improves surgical skills and the quality of carotid patch plasty.

Objective: Vascular surgeons perform numerous highly sophisticated and delicate procedures. Due to restrictions in training time and the advent of endovascular techniques, new concepts including alternative environments for training and assessment of surgical skills are required. Over the past decade, training on simulators and synthetic models has become more sophisticated and lifelike.

Remodelling of vascular (surgical) services in the UK.

The last few years have seen major changes in the delivery of vascular services in the UK. An increasingly elderly population with greater expectations from their medical services has challenged established methods. It also became apparent that outcomes for low volume, high risk index vascular interventions such as abdominal aortic aneurysm repair were poor in the UK compared to the rest of Europe.

Skeletal muscle adaptation in response to supervised exercise training for intermittent claudication.

Objectives: There is evidence that the improvement following supervised exercise for claudication results from skeletal muscle adaptation. The myosin heavy chain (MHC) determines muscle fibre type and therefore efficiency. Immunohistochemical analysis has failed to take account of hybrid MHC expression within myofibres.

Calf muscle oxygen saturation and the effects of supervised exercise training for intermittent claudication.

Objective: The mechanisms underlying the symptomatic improvement witnessed as a result of exercise training in intermittent claudication remain unclear. There is no reproducible evidence to support increased limb blood flow resulting from neovascularization. Changes in oxygenation of active muscles as a result of blood redistribution are hypothesized but unproven.

Intravenous leiomyomatosis with intracardiac extension: first reported case in Australia.

Intravenous leiomyomatosis (IVL) with cardiac extension is a rare uterine tumour. We present an unusual case of uterine leiomyoma that progressed along the inferior vena cava into the right atrium. Complete one stage removal of the tumour was performed using cardiopulmonary bypass and circulatory arrest.

Local versus systemic mechanisms underlying supervised exercise training for intermittent claudication.

The mechanisms by which exercise training improves intermittent claudication remain unclear. In this article, the effects of local and systemic physiological factors on improved exercise tolerance after a supervised exercise program in claudicants are investigated. A total of 60 patients were randomized to 3 months of supervised exercise followed by 3 months of unsupervised exercise, or to exercise advice alone (control).

Exercise training for claudication.

Exercise advice is a well established component of the conservative management of intermittent claudication. Supervised programmes of exercise remain relatively uncommon and are provided mainly in secondary care. This review outlines the evidence for the effectiveness of different exercise regimens and the relative benefits of exercise therapy, where comparisons have been made with medical therapy, angioplasty and surgery.

Spontaneous resolution of carotid stenosis--a case for routine preoperative duplex ultrasound.

Spontaneous resolution of carotid stenosis has not been previously reported in the context of preoperative duplex ultrasound scanning, although it has been described as a recognizable phenomenon in the past. We report a case in whom significant carotid stenosis was noted at the time of listing for surgery on both duplex ultrasound and MRA. On preoperative imaging there was resolution of the lesion and surgery was avoided.

The impact of shortened training times on the discipline of vascular surgery in the United Kingdom.

Political initiatives and European health and safety working time regulations have combined to reduce the time available for surgical training in the United Kingdom in the future by a third. For the safety of patient care, surgeons must evolve strategies to cope with these reduced training times so that they preserve the current high level of competence exhibited by UK trainees when they attain the right to independent surgical practice recognized by appointment as a Consultant Surgeon. Such strategies include a focus on dedicated training time, the use of simulators, and a move towards progression based on satisfactory completion of a defined curriculum and competency assessment rather than the amount of time served.

The effect of acute normovolaemic haemodilution on the inflammatory response and clinical outcome in abdominal aortic aneurysm repair--results of a pilot trial.

Objectives: To determine the effect of acute normovolaemic haemodilution (ANH) on the inflammatory response and clinical outcome in elective open abdominal aortic aneurysm (AAA) repair.

Design: Randomised controlled clinical trial.

Methods: Thirty-six patients were randomised to undergo ANH or act as controls.

Haemodilutional effect of standard fluid management limits the effectiveness of acute normovolaemic haemodilution in AAA surgery--results of a pilot trial.

Objective: To evaluate the impact of standard fluid management on the effectiveness of ANH as a blood conservation method in elective open AAA repair.

Design: Prospective randomised controlled study.

Methods: Thirty-four patients undergoing elective AAA repair were randomised to have ANH (16) or act as controls (18).

Reoperation for neurological complications following carotid endarterectomy.

Background: There remains a dilemma whether or not to re-explore the carotid artery when a neurological complication occurs after carotid endarterectomy. This study reviewed the indications for, findings and clinical outcomes following re-exploration.

Methods: Patients who experienced transient or permanent neurological events following carotid endarterectomy were identified from a prospectively compiled computerized database.

Risk factor documentation in elective and emergency vascular surgical admissions.

Objectives: this study investigates current practice of risk factor documentation in a vascular unit and compares variations in risk factor assessment between elective and emergency admissions.

Methods: one hundred and forty-four patients who underwent vascular surgical intervention for atherosclerotic disease during the year 2000 were retrospectively identified from computerised database. Case note review collated demographic details, data on risk factor assessment and the nature of surgery.

Pre-operative hand-held Doppler run-off score can be used to stratify risk prior to infra-inguinal bypass surgery.

Objectives: to investigate the relationship between calf vessel run-off assessed by hand-held Doppler, graft patency and patient survival following infra-inguinal graft surgery.

Design: prospective cohort study of 258 consecutive patients undergoing infra-inguinal bypass grafts in one centre between 1995-99.

Materials And Methods: ankle Doppler auditory waveform characteristics were documented for patients considered for infra-inguinal bypass grafting.

A randomised, double blind, placebo-controlled study to determine the efficacy of immune modulation therapy in the treatment of patients suffering from peripheral arterial occlusive disease with intermittent claudication.

Objectives: this study examined the effect of immune modulation therapy (IMT) on claudication distances.

Materials And Methods: a double-blind placebo controlled trial was performed on patients with disabling intermittent claudication with randomisation stratified for short and long distance IC. For IMT, following exposure to UV light, oxidisation and 42.

The effect of acute normovolaemic haemodilution on blood transfusion requirements in abdominal aortic aneurysm repair.

Objective: to evaluate the impact of acute normovolaemic haemodilution (ANH) on the blood transfusion requirements in elective abdominal aortic aneurysm (AAA) repair in a single vascular unit.

Methods: thirty-two patients underwent ANH during elective AAA repair between 1992 and 1997. The operation was performed by the same surgeon/anaesthetist team in 75% of cases.

The systemic effects of intermittent claudication are reversed by angioplasty.

Introduction: exercise in patients with intermittent claudication causes systemic effects, the consequences of which are unknown. This study investigates whether successful PTA reverses the systemic effects.

Patients And Methods: ten patients with IC were recruited prior to PTA.

The association of platelet-derived growth factor receptor expression, plaque morphology and histological features with symptoms in carotid atherosclerosis.

Platelet-derived growth factor may influence smooth muscle cell migration and proliferation and, therefore, carotid plaque composition and stenosis. Platelet-derived growth factor receptor expression and histological features were compared in carotid plaques from symptomatic and asymptomatic patients. Immunocytochemistry and histology determined platelet-derived growth factor-alpha and -beta receptor expression, white blood cell infiltration, smooth muscle cell, elastin, cholesterol, collagen and intraplaque haemorrhage in carotid artery plaques removed at surgery or the post-mortem.

Vascular surgical society of great britain and ireland: angioplasty reverses the systemic effects of exercise in intermittent claudication.

BACKGROUND: The choice between exercise training and percutaneous transluminal angioplasty (PTA) in the treatment of intermittent claudication (IC) remains controversial. Exercise is known to induce systemic effects in claudicants. This study aimed to determine whether such systemic effects are reversed by PTA.

Vascular surgical society of great britain and ireland: systemic effects of exercise in claudicants are associated with neutrophil activation.

BACKGROUND: Claudication induces potentially harmful systemic effects which may be mediated through free radicals and neutrophil activation. This study examined the impact of these mechanisms on renal tubular function. METHODS: Flow cytometry was used to determine CD11b expression by neutrophils and monocytes, and expression of P selectin (CD62P) by platelets, in 16 patients with intermittent claudication and eight matched controls before and at intervals after exercise.