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Objectives: Since 2009 the National Health Service (NHS) has been collecting patient- reported outcome measures (PROMs) following varicose vein interventions. The objective of this manuscript was to interrogate the one-year PROMs data with respect to varicose vein intervention and to discuss its potential impact on the provision of service. Methods: We interrogated the one-year PROMs data with respect to potential impact on the provision of service. Results: In total, 37,521 varicose vein operations were performed during the study period (1April 2009-30 April 2010). A total of 15,808 preoperative questionnaires were completed and returned and 12,509 were linked to Hospital Episode Statistics episodes. A total of 8127 postoperative questionnaires were completed and linked to the preoperative questionnaires. For the EuroQuol (EQ) 5D questionnaire average preoperative score across the completed data-set was 0.773. The postoperative health gain was 0.094. Fifty-three percent of patients had improved postoperative scores, 33% reported no change, while 14% reported a reduction in their postoperative EQ-5D score. Pain/discomfort was the only domain where patients reported any negative symptoms; 72% (5390) reported pain/ discomfort preoperatively and 37% (2804) postoperatively. In total, 62.6% (4685) reported no pain/discomfort following surgery A total of 7167 complete, linked and eligible data- sets were observed for the Aberdeen Varicose Vein Questionnaire (AVVQ). The average preoperative score was 18.75. The average postoperative score was 10.76. This represented a reduction in symptom scores of one-half following intervention. The lowest improvements were witnessed in patients with the lowest preoperative scores (least severe symptoms). Additional postoperative questions highlighted the improvements conferred from varicose vein surgery with 90.3% of patients reporting an improvement in their problems from varicose veins following surgery and 85% describing their operative results as excellent, very good or good. Conclusion: These data have shown variable improvements following venous interventions. PROMs are likely to have significant implications for health care in the NHS on a number of levels including provision of funding and future planning of services. [ABSTRACT FROM AUTHOR]

Venous thromboembolism (VTE) is the most common cause of preventable in-hospital mortality and all hospitalized patients should be VTE risk assessed. The VTE risk should be weighed up against risk of bleeding on an individualized basis to guide choice of prophylaxis. The most common method of mechanical thromboprophylaxis is graduated compression stockings, although others, such as intermittent pneumatic devices, are available. Stockings have the greatest benefit when used in combination with pharmacological prophylaxis. However, stockings are contraindicated in some patients, including those with stroke or peripheral arterial disease. Various options for pharmacological thromboprophylaxis are available. The most commonly used agents are the low-molecular-weight heparins, but newer orally active agents may play an increasing role in the future. [ABSTRACT FROM AUTHOR]

Venous thromboembolism (VTE) is a term including deep vein thrombosis (DVT) and pulmonary embolism (PE). Timely and accurate diagnosis of both is essential as delayed or missed diagnoses can result in death or longer term complications. Patients with suspected DVT should initially undergo a pretest probability Wells score. Depending on pretest probability Wells score they should then either proceed to two-point ultrasound scanning or D-dimer testing. Likewise, patients suspected of PE should undergo a two-level PE Wells score, and, if scored likely, a computed tomography pulmonary angiogram (CTPA), or, if there is a low pretest probability score, D-dimer testing. If positive, patients should undergo CTPA. Ventilation perfusion scanning (V/Q scan) or V/Q SPECT should be considered in place of CTPA if there is allergy to contrast media or renal impairment. [ABSTRACT FROM AUTHOR]

Post-thrombotic syndrome (PTS) can be debilitating to patients and have a major economic impact on health-care services. It arises after deep venous thrombosis (DVT) due to residual venous obstruction or valvular reflux, leading to increased venous pressure in the microcirculation. While the inflammatory process at the time of DVT may aid thrombus resolution, it may also promote destruction of venous valves. The diagnosis of PTS is principally clinical and patients typically complain of leg heaviness, swelling, pain, itching, cramps, ulcer and signs of lipodermatosclerosis. Several clinical scales or classifications have been used but it is recommended that Villalta scale is the most suitable. Risk factors for PTS include a proximal DVT and recurrent thrombosis as well as obesity and prior varicose veins. Poor quality of anticoagulation control may also be a factor. Established PTS is usually managed along the same lines as chronic venous hypertension with compression therapy and leg elevation. Surgery has only a limited role but may benefit some patients. Further trials are desperately needed to define the role of acute thrombolysis and mechanical thrombectomy, which seem to be promising treatments in the studies to date. For patients who have had a DVT more attention should be given to prescribing and using compression hosiery. [ABSTRACT FROM AUTHOR]

Objective: To assess the views of surgeons in the UK concerning the surgical management of patients with bilateral varicose veins (BVV) requiring surgery. Methods: A postal questionnaire was sent to members of the Vascular Society of Great Britain and Ireland. Questions concerned the use of BVV surgery in general, its use on day-case patients and which factors influenced decision-making in this area. Results: In all, 63% of surgeons never or only occasionally performed BVV surgery as a day case, whereas only 27% never or only occasionally performed BVV surgery on inpatients. The majority (70.2%) were not influenced by patient age or occupation (81.9%). The patient's general health was, however, a factor in decision-making for the majority (60.1%), as was the extent of the varicosities (52.8%). Other important factors were the availability of a second surgeon and a perception that there was likely to be increased morbidity with BVV surgery. Conclusions: There appears to be considerable variation between individual surgeons in the UK with regard to BVV surgery. This is manifested mainly as a reluctance to perform BVV as a day case by a significant number of surgeons. As there is no randomized trial(s) in this area, no firm guidance can be given. The issue is worthy of further study and may have significant health economic implications. [ABSTRACT FROM AUTHOR]

Mesenteric venous thrombosis is a rare condition associated with a high rate of morbidity and mortality. There have been no randomized trials, but most recent authors advocate the combination of a high clinical index of suspicion combined with noninvasive imaging with computerized tomography to make the diagnosis. When there is no evidence of perforation or peritonitis the condition is best managed conservatively with anticoagulation treatment. [ABSTRACT FROM AUTHOR]

Objective: To review current approaches to investigation and management of Paget-Schroetter syndrome (PSS). Methods: Relevant clinical studies and reports were searched for using MEDLINE and Embase databases and cross-referenced articles. Articles were extracted using keywords by the two authors independently. Principal findings: There is growing evidence of functional or positional anatomical defects, which lead to subtle intimal injury and a tendency for recurrence or poor outcome. Management of PSS remains controversial. Anticoagulation as a stand-alone treatment has lost favour. Active treatment with thrombolysis followed by consideration of thoracic decompression is recommended by most in the recent literature. Thrombolytic therapy appears to be a safe and efficacious method of establishing immediate patency of the axillary/subclavian vein. The timing and indications of decompression surgery are yet to be defined clearly. There are no randomized trials of treatment or management strategies in PSS. Conclusions: Treatment of PSS remains contentious. Most authors recommend active treatment with thrombolysis followed by thoracic decompression. Multicentre randomized trials are needed. [ABSTRACT FROM AUTHOR]

A case is described in which an atherosclerotic abdominal aortic aneurysm infected with Salmonella presented as an aortoenteric flstula and was successfully treated surgically. [ABSTRACT FROM AUTHOR]

The article presents the medical case of a 59-year-old Caucasian with recurrent panniculitis as the first clinical manifestation of acute pancreatitis secondary to cholelithiasis. The patient's medical history is described. The article notes that the case is more common with pancreatic malignancy, particularly acinous adenocarcinoma.

The article introduces the issue, which is concerned with what is known about the epidemiology, etiology, current and possible future management of chronic venous ulceration.

The article focuses on the etiology and treatment of Paget-Schroetter Syndrome or primary upper limb deep venous thrombosis. In most cases, the disease is caused by the compression and chronic damage to the subclavian vein within a narrow thoracic outlet. Thrombolytic therapy is considered as safe and efficacious method of establishing patency of the subclavian vein. Balloon angioplasty may be useful in cases of residual stenosis after surgical thoracic outlet decompression.

The author reflects on the need for further research and public awareness about primary upper limb deep vein thrombosis or Paget-Schroetter Syndrome (PSS) in Great Britain. The proposal of interventional management is designed to combat reduced quality of life resulting from long-term disability. He believes that many cases of PSS in the country were treated inappropriately.