Vascular Surgery

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Research outputs from the Vascular Surgery team at the RD&E.


Recent Submissions

Now showing 1 - 5 of 38
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    A systematic review aggregated data and individual participant data meta-analysis of percutaneous endovascular arteriovenous fistula
    (Elsevier, 2022-10-31) Bontinis, A.; Bontinis, V.; Koutsoumpelis, A.; Wilmink, T.; Giannopoulos, A.; Rafailidis, V.; Chorti, A.; Ktenidis, K.
    OBJECTIVE: To assess the short-term and mid-term safety and efficacy of percutaneous endovascular arteriovenous fistula (pAVF) creation. METHODS: A systematic search was implemented corresponding to the PRISMA 2020 and the PRISMA for individual participant data (IPD) systematic reviews 2015. Aggregated data from the included studies were obtained and meta-analyzed regarding both the overall pAVF efficacy and the comparison of pAVF with surgical AVF (sAVF). We performed a two-stage IPD meta-analysis for studies comparing pAVF and sAVF regarding primary and secondary patency. Primary end points included primary patency, secondary patency, and functional cannulation. RESULTS: Eighteen studies with 1863 patients were included. The overall pAVF, primary patency, secondary patency, functional cannulation and abandonment rates were 54.01% (95% confidence interval [CI], 40.69-66.79), 87.27% (95% CI, 81.53-91.42), 79.94% (95% CI, 65.94-89.13), and 15.58% (95% CI, 7.77-28.79), respectively. The overall pAVF, technical success, maturation, reintervention per person-years and mean time to maturation rates were 97.08% (95% CI, 95.66-98.04), 82.13% (95% CI, 71.64-89.32), 0.80 (95% CI, 0.34-1.47), and 58 days (95% CI, 36.64-92.82), respectively. Secondary patency and pAVF abandonment rates where the only end points were WavelinQ and Ellipsys displayed statistically significant differences of 81.36% (95% CI, 76.15-85.65) versus 92.12% (95% CI, 87.94-94.93) and 32.54% (95% CI, 22.23-44.87) versus 11.13% (95% CI, 4.82-23.65). An IPD meta-analysis of hazard ratios for primary and secondary patency between pAVF and sAVF were 1.27 (95% CI, 0.61-2.67) and 1.25 (95% CI, 0.87-1.80), favoring sAVF. Statistically significant difference between pAVF and sAVF were solely depicted for steal syndrome relative risk of 5.91 (95% CI, 1.12-31.12) and wound infections relative risk of 4.19 (95% CI, 1.04-16.88). Plotting of pAVF smoothed hazard estimate displayed an upsurge in the probability of primary patency failure at 1 month after the intervention. CONCLUSIONS: Although we failed to identify statistically significant differences between pAVF and sAVF regarding any of the primary end points, pAVF displayed a decreased risk for steal syndrome and wound infection. Although both the Ellipsys and WavelinQ devices displayed satisfactory secondary patency rates, Ellipsys demonstrated a statistically significant improved rate compared with WavelinQ. Additionally, and despite the borderline statistically insignificant inferior reintervention rate displayed by WavelinQ, one in three WavelinQ pAVFs resulted in abandonment. The introduction of pAVF as a treatment modality calls for standardized definition adjustment and improvement.
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    Who should do diagnostic venous scanning?
    (Atypon, 2022-08-18) Campbell, B.; Davies, A.; Coleridge-Smith, P.
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    268 Improve Clerking of Vascular Patients at Royal Devon and Exeter (RDE) Hospital Presenting with Acute Limb Ischaemia (ALI) Using Standardized Electronic Proforma
    (Wiley, 2022-02-28) Chillarge, G.; Abouelella, Y.; Burton, H.
    Improve clerking of vascular patients at Royal Devon and Exeter (RDE) hospital presenting with acute limb ischaemia (ALI) using standardized electronic proforma.Analysis of clerking notes of patients presenting to vascular surgery with ALI over a 3-month period (March 2021 - May 2021) for documentation of vascular risk factors, smoking status, claudication, rest pain, exam findings, sensation, movement, ECG, ABPI and burgers test.A standardized electronic clerking proforma has been created using the ‘smart-phrase’ function in the ‘hyperspace Epic’ computer system at the RDE hospital.A poster has been put up in the doctor’s office and email sent out to all surgical doctors to encourage use of the new electronic clerking proforma for comprehensive initial assessment which would help vascular surgeons make early decisions especially when off-site.A total of 65 patients presented to vascular surgery during the 3-month period. Of these 20 patients presented with ‘acute limb ischaemia’. Documentation of rest pain (75%), pulses (Dorsalis paedis in 90%) and exam finding of cold feet (95%) was adequate. However, poor documentation of vascular risk factors such as previous stroke (20%) and atrial fibrillation (15%) was identified. ECG was performed on admission in only 35% patients. Examination like ABPI (10%) and Buerger's test (15%) were also inadequately documented.This audit shows inadequate clerking of vascular patients presenting with ALI. The second cycle will include further data collection post-implementation of the electronic proforma to analyse improvements in documentation of the above-mentioned factors at initial clerking.
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    Cross-cultural adaptation of the Spanish MINICHAL instrument into English for use in the United Kingdom
    (BioMed Central, 2022-03-04) Jordan, A. N.; Anning, C.; Wilkes, L.; Ball, C.; Pamphilon, N.; Clark, C. E.; Bellenger, N. G.; Shore, A. C.; Sharp, A. S. P.; Valderas, J. M.
    BACKGROUND: Hypertension is a highly prevalent condition, with optimal treatment to BP targets conferring significant gains in terms of cardiovascular outcomes. Understanding why some patients do not achieve BP targets would be enhanced through greater understanding of their health-related quality of life (HRQoL). However, the only English language disease-specific instruments for measurement of HRQoL in hypertension have not been validated in accordance with accepted standards. It is proposed that the Spanish MINICHAL instrument for the assessment of HRQoL in hypertension could be translated, adapted and validated for use in the United Kingdom. The aim of the study was therefore to complete this process. METHODS: The MINICHAL authors were contacted and the original instrument obtained. This was then translated into English by two independent English-speakers, with these versions then reconciled, before back-translation and subsequent production of a 2nd reconciled version. Thereafter, a final version was produced after cognitive debriefing, for administration and psychometric analysis in the target population of patients living in the Exeter area (Southwest UK) aged 18-80 years with treatment-naïve grade II-III hypertension, before, during and after 18 weeks' intensive treatment. RESULTS: The English-language instrument was administered to 30 individuals (median age: 58.5 years, 53% male). Psychometric analysis demonstrated a floor effect, though no ceiling effect. Internal consistency for both state of mind (StM) and somatic manifestations (SM) dimensions of the instrument were acceptable (Cronbach's alpha = 0.81 and 0.75), as was test-retest reliability (ICC = 0.717 and 0.961) and construct validity, which was measured through co-administration with the EQ-5D-5L and Bulpitt-Fletcher instruments. No significant associations were found between scores and patient characteristics known to affect HRQoL. The EQ-5D-5L instrument found an improvement in HRQoL following treatment, with the StM and SM dimensions of the English language MINICHAL trending to support this (d = 0.32 and 0.02 respectively). CONCLUSIONS: The present study details the successful English translation and validation of the MINICHAL instrument for use in individuals with hypertension. The data reported also supports an improvement in HRQoL with rapid treatment of grade II-III hypertension, a strategy which has been recommended by contemporaneous European guidelines. Trial registration ISRCTN registry number: 57475376 (assigned 25/06/2015).
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    A risk-adjusted and anatomically stratified cohort comparison study of open surgery, endovascular techniques and medical management for juxtarenal aortic aneurysms-the UK COMPlex AneurySm Study (UK-COMPASS): a study protocol
    (BMJ, 2021-11-30) Patel, S. R.; Ormesher, D. C.; Smith, S. R.; Wong, K. H. F.; Bevis, P.; Bicknell, C. D.; Boyle, J. R.; Brennan, J. A.; Campbell, B.; Cook, A.; Crosher, A. P.; Duarte, R. V.; Flett, M. M.; Gamble, C.; Jackson, R. J.; Juszczak, M. T.; Loftus, I. M.; Nordon, I. M.; Patel, J. V.; Platt, K.; Psarelli, E. E.; Rowlands, P. C.; Smyth, J. V.; Spachos, T.; Taggart, L.; Taylor, C.; Vallabhaneni, S. R.
    INTRODUCTION: In one-third of all abdominal aortic aneurysms (AAAs), the aneurysm neck is short (juxtarenal) or shows other adverse anatomical features rendering operations more complex, hazardous and expensive. Surgical options include open surgical repair and endovascular aneurysm repair (EVAR) techniques including fenestrated EVAR, EVAR with adjuncts (chimneys/endoanchors) and off-label standard EVAR. The aim of the UK COMPlex AneurySm Study (UK-COMPASS) is to answer the research question identified by the National Institute for Health Research Health Technology Assessment (NIHR HTA) Programme: 'What is the clinical and cost-effectiveness of strategies for the management of juxtarenal AAA, including fenestrated endovascular repair?' METHODS AND ANALYSIS: UK-COMPASS is a cohort study comparing clinical and cost-effectiveness of different strategies used to manage complex AAAs with stratification of physiological fitness and anatomical complexity, with statistical correction for baseline risk and indication biases. There are two data streams. First, a stream of routinely collected data from Hospital Episode Statistics and National Vascular Registry (NVR). Preoperative CT scans of all patients who underwent elective AAA repair in England between 1 November 2017 and 31 October 2019 are subjected to Corelab analysis to accurately identify and include every complex aneurysm treated. Second, a site-reported data stream regarding quality of life and treatment costs from prospectively recruited patients across England. Site recruitment also includes patients with complex aneurysms larger than 55 mm diameter in whom an operation is deferred (medical management). The primary outcome measure is perioperative all-cause mortality. Follow-up will be to a median of 5 years. ETHICS AND DISSEMINATION: The study has received full regulatory approvals from a Research Ethics Committee, the Confidentiality Advisory Group and the Health Research Authority. Data sharing agreements are in place with National Health Service Digital and the NVR. Dissemination will be via NIHR HTA reporting, peer-reviewed journals and conferences. TRIAL REGISTRATION NUMBER: ISRCTN85731188.