Evaluation of national institute for health and care excellence guidance for ruptured abdominal aortic aneurysms by emulating a hypothetical target trial.

Objective: This retrospective study evaluates the performance of UK National Institute for Health and Care Excellence (NICE) Guidelines on management of ruptured abdominal aortic aneurysms in a "real world setting" by emulating a hypothetical target trial with data from two European Aortic Centers.

Methods: Clinical data was retrospectively collected for all patients who had undergone ruptured endovascular aneurysm repair (rEVAR) and ruptured open surgical repair (rOSR). Survival analysis was performed comparing NICE compliance to usual care strategy.

New Measures, Old Conclusions: Obesity Does Not Worsen Outcomes after Elective Abdominal Aortic Aneurysm Repair.

Background:  The "obesity paradox," whereby the body mass index (BMI) mortality curve is "U-shaped," is a well-studied phenomenon in vascular surgery. However, there has been an overreliance on BMI as the measure of obesity, which has shown to poorly correlate with clinical outcomes. Robust measures such as waist-hip ratio (WHR) have been suggested as a more accurate marker reflecting central obesity.

High-Frequency Three-Dimensional Lumen Volume Ultrasound Is a Sensitive Method to Detect Early Aneurysmal Change in Elastase-Induced Murine Abdominal Aortic Aneurysm.

Objective:  The aim of this study was to investigate the reproducibility of anterior-posterior diameter (APd) and three-dimensional lumen volume (3DLV) measurements of abdominal aortic aneurysms (AAA) in a classical murine AAA model. We also compared the magnitude of change in the aortic size detected with each method of assessment.

Methods:  Periadventitial application of porcine pancreatic elastase (PPE AAA) or sham surgery was performed in two cohorts of mice.

Palliative Care Interventions for Peripheral Artery Disease: A Systematic Review and Narrative Synthesis.

Peripheral artery disease (PAD) encompasses conditions with poor outcome and severe suffering, both mentally and physically, yet utilization and research into palliative care interventions remain sparse. The purpose of this study is to identify existing evidence on palliative care intervention for chronic limb threatening ischaemia (CLTI) and abdominal aortic aneurysm (AAA). We conducted a PROSPERO-registered systematic review of studies published between 1991 and 2020 in which people with PAD received palliative care interventions and at least one patient outcome was recorded.

Systematic review of interventions to increase the use of arteriovenous fistulae and grafts in incident haemodialysis patients.

Background: Patients who commence haemodialysis (HD) through arteriovenous fistulae and grafts (AVF/G) have improved survival compared to those who do so by venous lines.

Objectives: This systematic review aims to assimilate the evidence for any strategy which increases the proportion of HD patients starting dialysis through AVF/G.

Data Sources: Medline, Embase, Cochrane Central and Scopus.

Working class role models in academic medicine - Professor Philip Quirke.

This article was migrated. The article was marked as recommended. Representation of researchers from underprivileged backgrounds in unknown in academic medicine.

Morphometric and traditional frailty assessment in transcatheter aortic valve implantation.

Objectives: Frailty is common amongst patients undergoing transcatheter aortic valve implantation (TAVI). The aim of this study was to determine the prognostic relevance of newer objective and traditional measures of frailty after TAVI.

Methods: Consecutive patients were identified from the Leeds Teaching Hospitals Trust TAVI database.

Comparison of quantity and quality of muscle as clinical prognostic markers in patients undergoing carotid endarterectomy.

Objective: The measurement of muscle area is routinely utilised in determining sarcopaenia in clinical research. However, this simple measure fails to factor in age-related morphometric changes in muscle quality such as myosteatosis. The aims of this study were to: firstly investigate the relationship between the masseter area (quantity) and density (quality), and secondly compare the prognostic clinical relevance of each parameter.

The role of cardiopulmonary exercise testing and echocardiography prior to elective endovascular aneurysm repair.

Introduction: Cardiopulmonary exercise testing (CPET) and transthoracic echocardiography (TTE) are common preparative investigations prior to elective endovascular aneurysm repair (EVAR). Whether these investigations can predict survival following EVAR and contribute to shared decision making is unknown.

Methods: Patients who underwent EVAR at a tertiary centre between June 2007 and December 2014 were identified from the National Vascular Registry.

Ten tips for foundation doctors when making inpatient referrals to surgical specialties.

Making referrals to another specialty is an underemphasised skill in the undergraduate medical curriculum. As a result, many new foundation doctors find themselves ill-equipped to make effective referrals to other specialties as part of their day-to-day responsibilities. This can often be frustrating to the foundation doctor, the specialist and contribute to critical delays in patient care.

Validation of two-dimensional vertebral body parameters in estimating patient height in elderly patients.

Objectives: Standardised comparison of abdominal muscle and adipose tissue is often utilised in morphometric clinical research. Whilst measurements are traditionally standardised against the patient's height, this may not be always practically feasible. The aim of this study was to investigate the relationship between measurements of the vertebral body and patient height.

Meta-analysis of fenestrated endovascular aneurysm repair open surgical repair of juxtarenal abdominal aortic aneurysms over the last 10 years.

Background: Juxtarenal abdominal aortic aneurysms pose a significant challenge whether managed endovascularly or by open surgery. Fenestrated endovascular aneurysm repair (FEVAR) is now well established, but few studies have compared it with open surgical repair (OSR). The aim of this systematic review was to compare short- and long-term outcomes of FEVAR and OSR for the management of juxtarenal aortic aneurysms.

Symptom relief in patients undergoing endovascular management of chronic mesenteric ischemia.

Background: Chronic mesenteric ischemia (CMI) is a rare, but potentially fatal condition, which is becoming increasingly prevalent in elderly patients. This study investigated the impact of endovascular intervention on patient symptomology and the influence of extent of mesenteric disease on patient morbidity and mortality.

Methods: All patients who underwent primary angioplasty (±stenting) to the mesenteric vessels for CMI between July 2008 to July 2017 were retrospectively identified.

Twelve Tips for Applicants from a Disadvantaged Background Considering a Career in Medicine.

This article was migrated. The article was marked as recommended. A minority of medical school entrants draw from disadvantaged backgrounds, which remain significantly under-represented within the medical workforce.

Cadaveric allograft implantation to maintain limb viability in a case of traumatic pseudoaneurysm and poor native vessels.

Infected pseudoaneurysms are a vascular emergency, necessitating urgent surgical management. Owing to the infected field, a synthetic graft may be inappropriate in patients for whom autografting is impossible. Ligation of the artery is the usual management, often leading to amputation.

Volumetric versus single slice measurements of core abdominal muscle for sarcopenia.

Objective: We investigated whether total psoas muscle area (TPMA) was representative of the total psoas muscle volume (TPMV). Secondly, we assessed whether there was a relationship between the two commonly used single slice measurements of sarcopenia, TPMA and total abdominal muscle area (TAMA).

Methods: Pre-operative CT imaging of 110 patients undergoing elective endovascular aneurysm repair were analyzed by two trained independent observers.

Twelve tips for Applying to Clinical Academic Training in the United Kingdom.

This article was migrated. The article was marked as recommended. MAW and colleagues offer their advice on applying for academic clinical training posts including the do's and don'ts.

Influence of psoas muscle area on mortality following elective abdominal aortic aneurysm repair.

Background: The effect of sarcopenia based on the total psoas muscle area (TPMA) on CT is inconclusive in patients undergoing abdominal aortic aneurysm (AAA) intervention. The aim of this prospective cohort study was to evaluate morphometric sarcopenia as a method of risk stratification in patients undergoing elective AAA intervention.

Methods: TPMA was measured on preintervention CT images of patients undergoing elective endovascular aneurysm repair (EVAR) or open aneurysm repair.

Coronary subclavian steal syndrome-is there a need for routine assessment for subclavian artery stenosis following coronary bypass surgery?

Subclavian artery stenosis (SAS) resulting in coronary subclavian steal syndrome (CSSS) is a common but under recognized pathology following coronary artery bypass surgery (CABG). Patients with SAS may be asymptomatic due to the sub-clinical diversion of blood flow from the myocardium and retrograde blood flow during catheter angiography in the left internal mammary artery (LIMA) may be the first suggestion of CSSS. The management of SAS, causing CSSS, may rarely require acute assessment and intervention.