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1. Documenting the Recovery of Vascular Services in European Centres Following the Initial COVID-19 Pandemic Peak: Results from a Multicentre Collaborative Study

Author

Ruffino, M. A., Chan, S., Coughlin, P., Awopetu, A., Stather, P., Lane, T., Theodosiou, D., Ahmed, M. A., Vasudevan, T., Ibrahim, M., Al Maadany, F., Eljareh, M., Alkhafeefi, F. S., Coscas, R., Unal, E. U., Pulli, R., Zaca, S., Angiletta, D., Kotsis, T., Moawad, M., Tozzi, M., Patelis, N., Lazaris, A. M., Chuen, J., Croo, A., Tsolaki, E., Zenunaj, G., Kamal, D., Tolba, M. M., Maresch, M., Khetarpaul, V., Mills, J., Gangwani, G., Elahwal, M., Khalil, R., Azab, M. A., Mahomed, A., Whiston, R., Contractor, U., Esposito, D., Pratesi, C., Giacomelli, E., Troncoso, M. V., Elkouri, S., Johansson, F. G., Dodos, I., Benezit, M., Vidoedo, J., Rocha-Neves, J., Pereira-Neves, A. H., Dias-Neto, M. F., Campos Jacome, A. F., Loureiro, L., Silva, I., Garza-Herrera, R., Canata, V., Bezard, C., Bowser, K., Tobar, J. F., Vera, C. G., Parra, C. S., Lopez, E., Serra, Y. G., Varela, J., Rubio, V., Victoria, G., Johnson, A., O'Banion, L. A., Makar, R., Tantawy, T. G., Storck, M., Jongkind, V., Falah, O., Mcbride, O., Isik, A., Papaioannou, A., Ocke Reis, P. E., Bracale, U. M., Atkins, E., Tinelli, Giovanni, Scott, E., Wales, L., Sivaharan, A., Priona, G., Nesbitt, C., Grainger, T., Shelmerdine, L., Chong, P., Bajwa, A., Arwynck, L., Hadjievangelou, N., Elbasty, A., Rubio, O., Ricardo, M., Ulloa, J. H., Tarazona, M., Pabon, M., Pitoulias, G., Corless, K., Ioannidis, O., Friedrich, O., Van Herzeele, I., Vijaynagar, B., Cohnert, T., Bell, R., Moore, H., Saha, P., Gifford, E., Laine, M., Barkat, A., Karkos, C., Binti Safri, L. S., Buitron, G., Del Castillo, J., Carrera, P., Salinas, N., Biagioni, R. B., Benites, S., Mafla, C. A., Pian, P. M., Albino, P., Serrano, E., Marin, A., Gonzalez, M., Foreroga, M., Russo, A., Reyes, A., Guglielmone, D., Grillo, L., Flumignan, R., Palones, F. G., Silveira, P. G., Ramely, R. B., Edeiken, S., Chetter, I., Green, L., Sudarsanam, A., Lyons, O., Lemmon, G., Neville, R., Castelli, M., Hinojosa, C. A., Carvajal, R. R., Rivera, A., Wong, P., Drudi, L., Perkins, J., Sieunarine, K., Attia, D., Atef, M., Eftychios, L., Weaver, F., Ren, L. C., Alomari, M., Jamjoom, R., Aljarrah, Q., Abbas, A., Alomran, F., Kumar, A., Altoijri, A., Elsanhoury, K. T., Alhumaid, A., Fekry, T., Sekhar, R., Theodoridis, P., Panagiotis, T., Roditis, K., Tsiantoula, P., Antoniou, A., Soler, R., Hasemaki, N., Baili, E., Mpaili, E., Huasen, B., Wallace, T., Duncan, A., Metcalfe, M., Mannoia, K., Bechara, C. F., Tsilimparis, N., Aranson, N., Riding, D., Palena, M., Mcdonnell, C., Mouawad, N. J., Banegas, S., Rossi, P., Oshodi, T., Diaz, R., Afifi, R., Dindyal, S., Thapar, A., Kordzadeh, A., Pullas, G., Lin, S., Davies, C., Darvall, K., Kodama, A., Gooneratne, T., Gunawansa, N., Munoz, A., Jie, N. J., Bradley, N., Al-Jundi, W., Meyer, F., Lee, C., Malina, M., Renton, S., Lui, D., Batchelder, A., Oszkinis, G., Freyrie, A., Giordano, J., Saratzis, N., Tigkiropoulos, K., Kyriakos, S., Popov, G., Cheema, M. U., Lapolla, P., Ling Patricia, Y. C., Ennab, R., Ullery, B. W., Pasenidou, K., Tam, J., Sidel, G., Jayaprakash, V. V., Bennett, L., Hardy, S., Davies, E., Baker, S., Wijesinghe, L., Tam, A., Mccune, K., Chana, M., Lowe, C., Goh, A., Powezka, K., Kyrou, I., Altaf, N., Harkin, D., Travers, H., Cragg, J., Sharif, A., Akhtar, T., Chavez, J. A., Ordonez, C., Mazzurco, M., Choke, E., Asghar, I., Summerour, V., Dunlop, P., Morley, R., Hardy, T., Bevis, P., Cuff, R., Stavroulakis, K., Beropoulis, E., Argyriou, A., Loftus, I., Azhar, B., Sheth, S., Usai, M. V., Choudhry, A., Nicole, K., Boyle, E., Joyce, D., Abdelaty Hassan, M. H., Saltiel, A., Frahm-Jensen, G., Antoniou, G., Elhadi, M., Kimyaghalam, A., Malgor, R., Telve, D., Isaak, A., Schmidli, J., Mckevitt, K., Siddiqui, T., Asciutto, G., Floros, N., Papadopoulos, G., Kafetzakis, A., Koutsias, S. G., Nana, P., Giannoukas, A., Kakkos, S., Moulakakis, K. G., Shafique, N., Jawien, A., Popplewell, M., Imray, C., Abayasekara, K., Rowlands, T., Kuhan, G., Rajagopalan, S., Jaipersad, A., Sadia, U., Kobe, I., Mittapalli, D., Enemosah, I., Behrendt, C. -A., Beck, A., Almudhafer, M., Ancetti, S., Jacobs, D., Jayakumar, P., Malekpour, F., Shalhub, S., Keldiyorov, B., Simon, M., Khashram, M., Rich, N., Shepherd, A., Meecham, L., Doherty, D., Benson, R. A., Tinelli G. (ORCID:0000-0002-2212-3226), Ruffino, M. A., Chan, S., Coughlin, P., Awopetu, A., Stather, P., Lane, T., Theodosiou, D., Ahmed, M. A., Vasudevan, T., Ibrahim, M., Al Maadany, F., Eljareh, M., Alkhafeefi, F. S., Coscas, R., Unal, E. U., Pulli, R., Zaca, S., Angiletta, D., Kotsis, T., Moawad, M., Tozzi, M., Patelis, N., Lazaris, A. M., Chuen, J., Croo, A., Tsolaki, E., Zenunaj, G., Kamal, D., Tolba, M. M., Maresch, M., Khetarpaul, V., Mills, J., Gangwani, G., Elahwal, M., Khalil, R., Azab, M. A., Mahomed, A., Whiston, R., Contractor, U., Esposito, D., Pratesi, C., Giacomelli, E., Troncoso, M. V., Elkouri, S., Johansson, F. G., Dodos, I., Benezit, M., Vidoedo, J., Rocha-Neves, J., Pereira-Neves, A. H., Dias-Neto, M. F., Campos Jacome, A. F., Loureiro, L., Silva, I., Garza-Herrera, R., Canata, V., Bezard, C., Bowser, K., Tobar, J. F., Vera, C. G., Parra, C. S., Lopez, E., Serra, Y. G., Varela, J., Rubio, V., Victoria, G., Johnson, A., O'Banion, L. A., Makar, R., Tantawy, T. G., Storck, M., Jongkind, V., Falah, O., Mcbride, O., Isik, A., Papaioannou, A., Ocke Reis, P. E., Bracale, U. M., Atkins, E., Tinelli, Giovanni, Scott, E., Wales, L., Sivaharan, A., Priona, G., Nesbitt, C., Grainger, T., Shelmerdine, L., Chong, P., Bajwa, A., Arwynck, L., Hadjievangelou, N., Elbasty, A., Rubio, O., Ricardo, M., Ulloa, J. H., Tarazona, M., Pabon, M., Pitoulias, G., Corless, K., Ioannidis, O., Friedrich, O., Van Herzeele, I., Vijaynagar, B., Cohnert, T., Bell, R., Moore, H., Saha, P., Gifford, E., Laine, M., Barkat, A., Karkos, C., Binti Safri, L. S., Buitron, G., Del Castillo, J., Carrera, P., Salinas, N., Biagioni, R. B., Benites, S., Mafla, C. A., Pian, P. M., Albino, P., Serrano, E., Marin, A., Gonzalez, M., Foreroga, M., Russo, A., Reyes, A., Guglielmone, D., Grillo, L., Flumignan, R., Palones, F. G., Silveira, P. G., Ramely, R. B., Edeiken, S., Chetter, I., Green, L., Sudarsanam, A., Lyons, O., Lemmon, G., Neville, R., Castelli, M., Hinojosa, C. A., Carvajal, R. R., Rivera, A., Wong, P., Drudi, L., Perkins, J., Sieunarine, K., Attia, D., Atef, M., Eftychios, L., Weaver, F., Ren, L. C., Alomari, M., Jamjoom, R., Aljarrah, Q., Abbas, A., Alomran, F., Kumar, A., Altoijri, A., Elsanhoury, K. T., Alhumaid, A., Fekry, T., Sekhar, R., Theodoridis, P., Panagiotis, T., Roditis, K., Tsiantoula, P., Antoniou, A., Soler, R., Hasemaki, N., Baili, E., Mpaili, E., Huasen, B., Wallace, T., Duncan, A., Metcalfe, M., Mannoia, K., Bechara, C. F., Tsilimparis, N., Aranson, N., Riding, D., Palena, M., Mcdonnell, C., Mouawad, N. J., Banegas, S., Rossi, P., Oshodi, T., Diaz, R., Afifi, R., Dindyal, S., Thapar, A., Kordzadeh, A., Pullas, G., Lin, S., Davies, C., Darvall, K., Kodama, A., Gooneratne, T., Gunawansa, N., Munoz, A., Jie, N. J., Bradley, N., Al-Jundi, W., Meyer, F., Lee, C., Malina, M., Renton, S., Lui, D., Batchelder, A., Oszkinis, G., Freyrie, A., Giordano, J., Saratzis, N., Tigkiropoulos, K., Kyriakos, S., Popov, G., Cheema, M. U., Lapolla, P., Ling Patricia, Y. C., Ennab, R., Ullery, B. W., Pasenidou, K., Tam, J., Sidel, G., Jayaprakash, V. V., Bennett, L., Hardy, S., Davies, E., Baker, S., Wijesinghe, L., Tam, A., Mccune, K., Chana, M., Lowe, C., Goh, A., Powezka, K., Kyrou, I., Altaf, N., Harkin, D., Travers, H., Cragg, J., Sharif, A., Akhtar, T., Chavez, J. A., Ordonez, C., Mazzurco, M., Choke, E., Asghar, I., Summerour, V., Dunlop, P., Morley, R., Hardy, T., Bevis, P., Cuff, R., Stavroulakis, K., Beropoulis, E., Argyriou, A., Loftus, I., Azhar, B., Sheth, S., Usai, M. V., Choudhry, A., Nicole, K., Boyle, E., Joyce, D., Abdelaty Hassan, M. H., Saltiel, A., Frahm-Jensen, G., Antoniou, G., Elhadi, M., Kimyaghalam, A., Malgor, R., Telve, D., Isaak, A., Schmidli, J., Mckevitt, K., Siddiqui, T., Asciutto, G., Floros, N., Papadopoulos, G., Kafetzakis, A., Koutsias, S. G., Nana, P., Giannoukas, A., Kakkos, S., Moulakakis, K. G., Shafique, N., Jawien, A., Popplewell, M., Imray, C., Abayasekara, K., Rowlands, T., Kuhan, G., Rajagopalan, S., Jaipersad, A., Sadia, U., Kobe, I., Mittapalli, D., Enemosah, I., Behrendt, C. -A., Beck, A., Almudhafer, M., Ancetti, S., Jacobs, D., Jayakumar, P., Malekpour, F., Shalhub, S., Keldiyorov, B., Simon, M., Khashram, M., Rich, N., Shepherd, A., Meecham, L., Doherty, D., Benson, R. A., and Tinelli G. (ORCID:0000-0002-2212-3226)

Abstract

Objective: To document the recovery of vascular services in Europe following the first COVID-19 pandemic peak. Methods: An online structured vascular service survey with repeated data entry between 23 March and 9 August 2020 was carried out. Unit level data were collected using repeated questionnaires addressing modifications to vascular services during the first peak (March – May 2020, “period 1”), and then again between May and June (“period 2”) and June and July 2020 (“period 3”). The duration of each period was similar. From 2 June, as reductions in cases began to be reported, centres were first asked if they were in a region still affected by rising cases, or if they had passed the peak of the first wave. These centres were asked additional questions about adaptations made to their standard pathways to permit elective surgery to resume. Results: The impact of the pandemic continued to be felt well after countries’ first peak was thought to have passed in 2020. Aneurysm screening had not returned to normal in 21.7% of centres. Carotid surgery was still offered on a case by case basis in 33.8% of centres, and only 52.9% of centres had returned to their normal aneurysm threshold for surgery. Half of centres (49.4%) believed their management of lower limb ischaemia continued to be negatively affected by the pandemic. Reduced operating theatre capacity continued in 45.5% of centres. Twenty per cent of responding centres documented a backlog of at least 20 aortic repairs. At least one negative swab and 14 days of isolation were the most common strategies used for permitting safe elective surgery to recommence. Conclusion: Centres reported a broad return of services approaching pre-pandemic “normal” by July 2020. Many introduced protocols to manage peri-operative COVID-19 risk. Backlogs in cases were reported for all major vascular surgeries.

Published
2022

7. Global impact of the first coronavirus disease 2019 (COVID-19) pandemic wave on vascular services

Author

Benson, R. A., Sudarsanam, A., Tam, A., Beck, A. W., Barkat, A., Bajwa, A., Elbasty, A., Awopetu, A. I., Kodama, A., Rivera, A. G., Munoz, A., Saltiel, A., Russo, A., Rolls, A., Kafetzakis, A., Kimyaghalam, A., Kordzadeh, A., Shepherd, A., Singh, A., Mingoli, A., Lazaris, A. M., Isaak, A., Marin, A., Valdivia, A. R., Batchelder, A., Duncan, A., Argyriou, A., Jaipersad, A. S., Freyrie, A., Pereira-Neves, A., Mahomed, A., Isik, A., Jawien, A., Choudhry, A. J., Sivaharan, A., Giannoukas, A., Papaioannou, A., Saratzis, A., Abbas, A., Christos, B., Akkaya, B. B., Huasen, B., Patrice, B., Mwipatayi, Azhar, B., Keldiyorov, B., Ullery, B. W., Pratesi, C., Hinojosa, C. A., Bechara, C. F., Parra, C. S., Alexandros, C., Bezard, C., Lee, C. J., Davies, C., Behrendt, C. -A., Lowe, C., Karkos, C. D., Yih, C. L. P., Mcdonnell, C., Ordonez, C., Nesbitt, C., Alexander, C., Guglielmone, D., Doherty, D. T., Riding, D. M., Esposito, D., Harkin, D., Lui, D. H., Kamal, D. M., Telve, D., Theodosiou, D., Angiletta, D., Jacobs, D., Choke, E., Gifford, E. D., Beropoulis, E., Lostoridis, E., Atkins, E., Giacomelli, E., Tsolaki, E., Davies, E., Scott, E., Katsogridakis, E., Serrano, E., Unal, E. U., Lopez, E., Mpaili, E., Minelli, Fabrizio, Malekpour, F., Mousa, F., Meyer, F., Tobar, F., Filipa, J., Johansson, F. G., Weaver, F., Proano, G. A. B., Sidel, G., Kuhan, G., Lemmon, G., Antoniou, G. A., Papadopoulos, G., Pitoulias, G., Sotirios, G., Victoria, G., Frahm-Jensen, G., Tinelli, Giovanni, Asciutto, G., Zenunaj, G., Eduardo, G. V. C., Pullas, G., Oszkinis, G., Popov, G., Iscan, H. Z., Travers, H. C., Barakat, H., Mavioglu, H. L., Chetter, I., Loftus, I., Dodos, I., Asghar, I., Van Herzeele, I., Giordano, J., Cragg, J., Chuen, J., Orrego, J. D. C., Perkins, J., Rocha-Neves, J., Ulloa, J. H., Chavez, J. A., Vidoedo, J., Faraj, J., Mills, J., Varela, J., Ng, J. J., Schmidli, J., Kiriaki, K., Powezka, K., Bowser, K., Darvall, K., Mccune, K., Pasenidou, K., Corless, K., Mckevitt, K., Long, K. N., Moulakakis, K. G., Roditis, K., Stavroulakis, K., Tigkiropoulos, K., Mannoia, K., Abayasekara, K., Jayakumar, L., Wijesinghe, L., Drudi, L., Shelmerdine, L., O'Banion, L. A., Meecham, L., Bennett, L. F., Grillo, L., Green, L., Wales, L., Loureiro, L., Palena, L. M., Tolba, M. M. H., Khashram, M., Chana, M., Pabon, M., Gonzalez, M., Usai, M. V., Tarazona, M., Ruffino, M. A., Castelli, M., Benezit, M., Dias-Neto, M., Malina, M., Maresch, M., Mazzurco, M., Storck, M., Troncoso, M. V., Popplewell, M., Tozzi, M., Metcalfe, M., Laine, M., Rawhi, M., Ricardo, M., Goh, M. A., Ahmed, M. A., Ibrahim, M., Alomari, M., Almudhafer, M., Elhadi, M., Gunawansa, N., Hadjievangelou, N., Hasemaki, N., Shafique, N., Aranson, N., Bradley, N., Mouawad, N. J., Rich, N. C., Floros, N., Patelis, N., Saratzis, N., Tsilimparis, N., Salinas, N., Altaf, N., Friedrich, O., Lyons, O., Mcbride, O. M. B., Ioannidis, O., Falah, O., Theodoridis, P., Sapienza, P., Tsiantoula, P., Chong, P., Coughlin, P., Bevis, P., Carrera, P., Dunlop, P., Wong, P. F., Albino, P., Rossi, P., Nana, P., Stather, P. W., Lapolla, P., Silveira, P. G., Saha, P., Somaiya, P., Pian, P. M., Morley, R. L., Bell, R., Ennab, R. M., Malgor, R., Pulli, R., Makar, R., Sekhar, R., Afifi, R., Coscas, R., Soler, R., Cuff, R. F., Diaz, R., Biagioni, R., Ramely, R. B., Carvajal, R. R., Jhajj, S., Edeiken, S., Benites, S., Zaca, S., Paravastu, S., Chan, S., Sheth, S., Shalhub, S., Dindyal, S., Banegas, S., Hardy, S., Sica, Simona, Tam, S. C., Premnath, S., Renton, S., Rajagopalan, S., Kyriakos, S., Kakkos, S., Ancetti, S., Elkouri, S., Lin, S., Cheng, S. W. K., Koutsias, S. G., Grainger, T., Fekry, T., Tantawy, T. G., Siddiqui, T., Oshodi, T., Akhtar, T., Hardy, T. J., Kotsis, T., Gooneratne, T., Rowlands, T., Cohnert, T. U., Wallace, T., Lane, T. R. A., Bracale, U. M., Cheema, U., Sadia, U., Rubio, V., Canata, V., Jongkind, V., Khetarpaul, V., Summerour, V., Dorigo, W., Al-Jundi, W., Luo, X., Tshomba, Yamume, Serra, Y. G., Minelli F., Tinelli G. (ORCID:0000-0002-2212-3226), Sica S., Tshomba Y. (ORCID:0000-0001-7304-7553), Benson, R. A., Sudarsanam, A., Tam, A., Beck, A. W., Barkat, A., Bajwa, A., Elbasty, A., Awopetu, A. I., Kodama, A., Rivera, A. G., Munoz, A., Saltiel, A., Russo, A., Rolls, A., Kafetzakis, A., Kimyaghalam, A., Kordzadeh, A., Shepherd, A., Singh, A., Mingoli, A., Lazaris, A. M., Isaak, A., Marin, A., Valdivia, A. R., Batchelder, A., Duncan, A., Argyriou, A., Jaipersad, A. S., Freyrie, A., Pereira-Neves, A., Mahomed, A., Isik, A., Jawien, A., Choudhry, A. J., Sivaharan, A., Giannoukas, A., Papaioannou, A., Saratzis, A., Abbas, A., Christos, B., Akkaya, B. B., Huasen, B., Patrice, B., Mwipatayi, Azhar, B., Keldiyorov, B., Ullery, B. W., Pratesi, C., Hinojosa, C. A., Bechara, C. F., Parra, C. S., Alexandros, C., Bezard, C., Lee, C. J., Davies, C., Behrendt, C. -A., Lowe, C., Karkos, C. D., Yih, C. L. P., Mcdonnell, C., Ordonez, C., Nesbitt, C., Alexander, C., Guglielmone, D., Doherty, D. T., Riding, D. M., Esposito, D., Harkin, D., Lui, D. H., Kamal, D. M., Telve, D., Theodosiou, D., Angiletta, D., Jacobs, D., Choke, E., Gifford, E. D., Beropoulis, E., Lostoridis, E., Atkins, E., Giacomelli, E., Tsolaki, E., Davies, E., Scott, E., Katsogridakis, E., Serrano, E., Unal, E. U., Lopez, E., Mpaili, E., Minelli, Fabrizio, Malekpour, F., Mousa, F., Meyer, F., Tobar, F., Filipa, J., Johansson, F. G., Weaver, F., Proano, G. A. B., Sidel, G., Kuhan, G., Lemmon, G., Antoniou, G. A., Papadopoulos, G., Pitoulias, G., Sotirios, G., Victoria, G., Frahm-Jensen, G., Tinelli, Giovanni, Asciutto, G., Zenunaj, G., Eduardo, G. V. C., Pullas, G., Oszkinis, G., Popov, G., Iscan, H. Z., Travers, H. C., Barakat, H., Mavioglu, H. L., Chetter, I., Loftus, I., Dodos, I., Asghar, I., Van Herzeele, I., Giordano, J., Cragg, J., Chuen, J., Orrego, J. D. C., Perkins, J., Rocha-Neves, J., Ulloa, J. H., Chavez, J. A., Vidoedo, J., Faraj, J., Mills, J., Varela, J., Ng, J. J., Schmidli, J., Kiriaki, K., Powezka, K., Bowser, K., Darvall, K., Mccune, K., Pasenidou, K., Corless, K., Mckevitt, K., Long, K. N., Moulakakis, K. G., Roditis, K., Stavroulakis, K., Tigkiropoulos, K., Mannoia, K., Abayasekara, K., Jayakumar, L., Wijesinghe, L., Drudi, L., Shelmerdine, L., O'Banion, L. A., Meecham, L., Bennett, L. F., Grillo, L., Green, L., Wales, L., Loureiro, L., Palena, L. M., Tolba, M. M. H., Khashram, M., Chana, M., Pabon, M., Gonzalez, M., Usai, M. V., Tarazona, M., Ruffino, M. A., Castelli, M., Benezit, M., Dias-Neto, M., Malina, M., Maresch, M., Mazzurco, M., Storck, M., Troncoso, M. V., Popplewell, M., Tozzi, M., Metcalfe, M., Laine, M., Rawhi, M., Ricardo, M., Goh, M. A., Ahmed, M. A., Ibrahim, M., Alomari, M., Almudhafer, M., Elhadi, M., Gunawansa, N., Hadjievangelou, N., Hasemaki, N., Shafique, N., Aranson, N., Bradley, N., Mouawad, N. J., Rich, N. C., Floros, N., Patelis, N., Saratzis, N., Tsilimparis, N., Salinas, N., Altaf, N., Friedrich, O., Lyons, O., Mcbride, O. M. B., Ioannidis, O., Falah, O., Theodoridis, P., Sapienza, P., Tsiantoula, P., Chong, P., Coughlin, P., Bevis, P., Carrera, P., Dunlop, P., Wong, P. F., Albino, P., Rossi, P., Nana, P., Stather, P. W., Lapolla, P., Silveira, P. G., Saha, P., Somaiya, P., Pian, P. M., Morley, R. L., Bell, R., Ennab, R. M., Malgor, R., Pulli, R., Makar, R., Sekhar, R., Afifi, R., Coscas, R., Soler, R., Cuff, R. F., Diaz, R., Biagioni, R., Ramely, R. B., Carvajal, R. R., Jhajj, S., Edeiken, S., Benites, S., Zaca, S., Paravastu, S., Chan, S., Sheth, S., Shalhub, S., Dindyal, S., Banegas, S., Hardy, S., Sica, Simona, Tam, S. C., Premnath, S., Renton, S., Rajagopalan, S., Kyriakos, S., Kakkos, S., Ancetti, S., Elkouri, S., Lin, S., Cheng, S. W. K., Koutsias, S. G., Grainger, T., Fekry, T., Tantawy, T. G., Siddiqui, T., Oshodi, T., Akhtar, T., Hardy, T. J., Kotsis, T., Gooneratne, T., Rowlands, T., Cohnert, T. U., Wallace, T., Lane, T. R. A., Bracale, U. M., Cheema, U., Sadia, U., Rubio, V., Canata, V., Jongkind, V., Khetarpaul, V., Summerour, V., Dorigo, W., Al-Jundi, W., Luo, X., Tshomba, Yamume, Serra, Y. G., Minelli F., Tinelli G. (ORCID:0000-0002-2212-3226), Sica S., and Tshomba Y. (ORCID:0000-0001-7304-7553)

Abstract

This online structured survey has demonstrated the global impact of the COVID-19 pandemic on vascular services. The majority of centres have documented marked reductions in operating and services provided to vascular patients. In the months during recovery from the resource restrictions imposed during the pandemic peaks, there will be a significant vascular disease burden awaiting surgeons. One of the most affected specialties

Published
2020

8. Cost-effectiveness analysis of a randomized clinical trial of early versus deferred endovenous ablation of superficial venous reflux in patients with venous ulceration

Author

Epstein, D M, primary, Gohel, M S, additional, Heatley, F, additional, Liu, X, additional, Bradbury, A, additional, Bulbulia, R, additional, Cullum, N, additional, Nyamekye, I, additional, Poskitt, K R, additional, Renton, S, additional, Warwick, J, additional, Davies, A H, additional, Read, D, additional, Hargreaves, S, additional, Dhillon, K, additional, Anwar, M, additional, Liddle, A, additional, Brown, H, additional, Mercer, K, additional, Gill, F, additional, Liu, A, additional, Jepson, W, additional, Wormwell, A, additional, Rafferty, H, additional, Kaur, R, additional, Solomon, E, additional, Sritharan, K, additional, Velineni, R, additional, Lim, C S, additional, Busuttil, A, additional, Bootun, R, additional, Bicknell, C, additional, Jenkins, M, additional, Lane, T, additional, Serjeant, E, additional, Poskitt, K, additional, Waldron, J, additional, Wolfrey, G, additional, Slim, F, additional, Davies, C, additional, Emerson, L, additional, Grasty, M, additional, Whyman, M, additional, Wakeley, C, additional, Cooper, A, additional, Clapp, J, additional, Hogg, N, additional, Howard, J, additional, Dyer, J, additional, Lyes, S, additional, Teemul, D, additional, Harvey, K, additional, Pride, M, additional, Kindon, A, additional, Price, H, additional, Flemming, L, additional, Birch, G, additional, Holmes, H, additional, Weston, J, additional, Joseph, T, additional, Eiffel, R, additional, Ojimba, T, additional, Wilson, T, additional, Hodgson, A, additional, Robinson, L, additional, Todhunter, J, additional, Heagarty, D, additional, Mckeane, A, additional, McCarthy, R, additional, Barwell, J, additional, Northcott, C, additional, Elstone, A, additional, West, C, additional, Chong, P, additional, Gerrard, D, additional, Croucher, A, additional, Levy, S, additional, Martin, C, additional, Craig, T, additional, Carradice, D, additional, Firth, A, additional, Clarke, E, additional, Oswald, A, additional, Sinclair, J, additional, Chetter, I, additional, El-Sheikha, J, additional, Nandhra, S, additional, Leung, C, additional, Scott, J, additional, Dewhirst, N, additional, Woods, J, additional, Russell, D, additional, Darwood, R, additional, Troxler, M, additional, Thackeray, J, additional, Bell, D, additional, Watson, D, additional, Williamson, L, additional, Coulston, J, additional, Eyers, P, additional, Darvall, K, additional, Hunter, I, additional, Stewart, A, additional, Moss, A, additional, Rewbury, J, additional, Adams, C, additional, Vickery, L, additional, Foote, L, additional, Durman, H, additional, Venn, F, additional, Hill, P, additional, James, K, additional, Luxton, F, additional, Greenwell, D, additional, Roberts, K, additional, Mitchell, S, additional, Tate, M, additional, Mills, H, additional, Garnham, A, additional, Hobbs, S, additional, McIntosh, D, additional, Green, M, additional, Collins, K, additional, Rankin, J, additional, Poulton, P, additional, Isgar, V, additional, Trivedi, M, additional, Kafeza, M, additional, Parsapour, S, additional, Moore, H, additional, Najem, M, additional, Connarty, S, additional, Albon, H, additional, Lloyd, C, additional, Trant, J, additional, Vohra, R, additional, McCormack, J, additional, Marshall, J, additional, Hardy, V, additional, Rogoveanu, R, additional, Goff, W, additional, Gidda, R, additional, Merotra, S, additional, Shiralkar, S, additional, Jayatunga, A, additional, Pathak, R, additional, Rehman, A, additional, Randhawa, K, additional, Lewis, J, additional, Fullwood, S, additional, Jennings, S, additional, Cole, S, additional, Wall, M, additional, Ranaboldo, C, additional, Hulin, S, additional, Clarke, C, additional, Fennelly, R, additional, Cooper, R, additional, Boyes, R, additional, Draper, C, additional, Harris, L, additional, Mead, D, additional, Kelly, L, additional, Bate, G, additional, Davies, H, additional, Popplewell, M, additional, Claridge, M, additional, Gannon, M, additional, Khaira, H, additional, Scriven, M, additional, Wilmink, T, additional, Adam, D, additional, Nasr, H, additional, Dodd, D, additional, Nawaz, S, additional, Humphreys, J, additional, Barnes, M, additional, Sorrell, J, additional, Swift, D, additional, Phillips, P, additional, Trender, H, additional, Fenwick, N, additional, Rittoo, D, additional, Baker, S, additional, Mitchell, R, additional, Andrews, S, additional, Williams, S, additional, Stephenson, J, additional, Holloway, S, additional, Hayes, W, additional, Day, J, additional, Clayton, C, additional, Harding, D, additional, Thompson, A, additional, Gibson, A, additional, Murphy, Z, additional, and Smith, T, additional

Published
2019
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16. Documenting the Recovery of Vascular Services in European Centres Following the Initial COVID-19 Pandemic Peak: Results from a Multicentre Collaborative Study

Author

Ruth A. Benson, Maria Antonella Ruffino, Sharon Chan, Patrick Coughlin, Ayoola Awopetu, Philip Stather, Tristan Lane, Dimitrios Theodosiou, Mohamed Abozeid Ahmed, Thodur Vasudevan, Mohammed Ibrahim, Faraj Al Maadany, Mohamed Eljareh, Fatimah Saad Alkhafeefi, Raphael Coscas, Ertekin Utku Ünal, Raffaele Pulli, Sergio Zacà, Domenico Angiletta, Thomas Kotsis, Magdy Moawad, Matteo Tozzi, Nikolaos Patelis, Andreas M. Lazaris, Jason Chuen, Alexander Croo, Elpiniki Tsolaki, Gladiol Zenunaj, Dhafer Kamal, Mahmoud MH. Tolba, Martin Maresch, Vipul Khetarpaul, Joseph Mills, Gaurav Gangwani, Mohamed Elahwal, Rana Khalil, Mohammed A. Azab, Anver Mahomed, Richard Whiston, Ummul Contractor, Davide Esposito, Carlo Pratesi, Elena Giacomelli, Martín Veras Troncoso, Stephane Elkouri, Flavia Gentile Johansson, Ilias Dodos, Marie Benezit, José Vidoedo, João Rocha-Neves, António Henrique Pereira-Neves, Marina Felicidade Dias-Neto, Ana Filipa Campos Jácome, Luis Loureiro, Ivone Silva, Rodrigo Garza-Herrera, Victor Canata, Charlotte Bezard, Kathryn Bowser, Jorge Felipe Tobar, Carlos Gomez Vera, Carolina Salinas Parra, Eugenia Lopez, Yvis Gadelha Serra, Juan Varela, Vanessa Rubio, Gerardo Victoria, Adam Johnson, Leigh Ann O’Banion, Ragai Makar, Tamer Ghatwary Tantawy, Martin Storck, Vincent Jongkind, Orwa falah, Olivia McBride, Arda Isik, Athanasios Papaioannou, Paulo Eduardo Ocke Reis, Umberto Marcello Bracale, Ellie Atkins, Giovanni Tinelli, Emma Scott, Lucy Wales, Ashwin Sivaharan, Georgia Priona, Craig Nesbitt, Tabitha Grainger, Lauren Shelmerdine, Patrick Chong, Adnan Bajwa, Luke Arwynck, Nancy Hadjievangelou, Ahmed Elbasty, Oscar Rubio, Michael Ricardo, Jorge H. Ulloa, Marcos Tarazona, Manuel Pabon, Georgios Pitoulias, Kevin Corless, Orestis Ioannidis, Oliver Friedrich, Isabelle Van Herzeele, Badri Vijaynagar, Tina Cohnert, Rachel Bell, Hayley Moore, Prakash Saha, Edward Gifford, Matti Laine, Adel Barkat, Christos Karkos, Lenny Suryani Binti Safri, Gabriel Buitron, Javier Del Castillo, Paul Carrera, Nilson Salinas, Rodrigo Bruno Biagioni, Sergio Benites, César Andrés Mafla, Putera Mas Pian, Pereira Albino, Ernesto Serrano, Andres Marin, Marco González, Marsha Foreroga, Alejandro Russo, Andrés Reyes, Daniel Guglielmone, Lorena Grillo, Ronald Flumignan, Francisco Gomez Palones, Pierre Galvagni Silveira, Rosnelifaizur Bin Ramely, Sara Edeiken, Ian Chetter, Lucy Green, Abhilash Sudarsanam, Oliver Lyons, Gary Lemmon, Richard Neville, Mariano Castelli, Carlos A. Hinojosa, Rubén Rodríguez Carvajal, Aksim Rivera, Peng Wong, Laura Drudi, Jeremy Perkins, Kishore Sieunarine, Doaa Attia, Mahmoud Atef, Lostoridis Eftychios, Fred Weaver, Leong Chuo Ren, Mohannad Alomari, Reda Jamjoom, Qusai Aljarrah, Ayman Abbas, Faris Alomran, Ambrish Kumar, Abdulmajeed Altoijri, Kareem T. ElSanhoury, Ahmed Alhumaid, Tamer Fekry, Raghuram Sekhar, Panagiotis Theodoridis, Theodoridis Panagiotis, Konstantinos Roditis, Paraskevi Tsiantoula, Afroditi Antoniou, Raphael Soler, Natasha Hasemaki, Efstratia Baili, Eustratia Mpaili, Bella Huasen, Tom Wallace, Andrew Duncan, Matthew Metcalfe, Kristyn Mannoia, Carlos F. Bechara, Nikolaos Tsilimparis, Nathan Aranson, David Riding, Mariano Palena, Ciarán McDonnell, Nicolas J. Mouawad, Shonda Banegas, Peter Rossi, Taohid Oshodi, Rodney Diaz, Rana Afifi, Shiva Dindyal, Ankur Thapar, Ali Kordzadeh, Gonzalo Pullas, Stephanie Lin, Chris Davies, Katy Darvall, Akio Kodama, Thushan Gooneratne, Nalaka Gunawansa, Alberto Munoz, Ng Jun Jie, Nicholas Bradley, Wissam Al-Jundi, Felicity Meyer, Cheong Lee, Martin Malina, Sophie Renton, Dennis Lui, Andrew Batchelder, Grzegorz Oszkinis, Antonio Freyrie, Jacopo Giordano, Nikolaos Saratzis, Konstantinos Tigkiropoulos, Stavridis Kyriakos, Guriy Popov, Muhammad Usman Cheema, Pierfrancesco Lapolla, Yih Chun Ling Patricia, Raed Ennab, Brant W. Ullery, Ketino Pasenidou, Jacky Tam, Gabriel Sidel, Vivek Vardhan Jayaprakash, Lisa Bennett, Simon Hardy, Emma Davies, Sara Baker, Lasantha Wijesinghe, Adam Tam, Ken McCune, Manik Chana, Chris Lowe, Aaron Goh, Katarzyna Powezka, Ioanna Kyrou, Nishath Altaf, Denis Harkin, Hannah Travers, James Cragg, Atif sharif, Tasleem Akhtar, José Antonio Chávez, Claudia Ordonez, Martin Mazzurco, Edward Choke, Imran Asghar, Virginia Summerour, Paul Dunlop, Rachel Morley, Thomas Hardy, Paul Bevis, Robert Cuff, Konstantinos Stavroulakis, Efthymios Beropoulis, Angeliki Argyriou, Ian Loftus, Bilal Azhar, Sharvil Sheth, Marco Virgilio Usai, Asad Choudhry, Kira Nicole, Emily Boyle, Doireann Joyce, Mohammed Hassan Abdelaty Hassan, Alberto Saltiel, Gert Frahm-Jensen, George Antoniou, Muhammed Elhadi, Ali Kimyaghalam, Rafael Malgor, Leigh Ann O'Banion, Diego Telve, Andrej Isaak, Jürg Schmidli, Kevin McKevitt, Tam Siddiqui, Giuseppe Asciutto, Nikolaos Floros, George Papadopoulos, Alexandros Kafetzakis, Stylianos G. Koutsias, Petroula Nana, Athanasios Giannoukas, Stavros Kakkos, Konstantinos G. Moulakakis, Natasha Shafique, Arkadiusz Jawien, Matthew Popplewell, Chris Imray, Kumar Abayasekara, Timothy Rowlands, Ganesh Kuhan, Sriram Rajagopalan, Anthony Jaipersad, Uzma Sadia, Isaac Kobe, Devender Mittapalli, Ibrahim Enemosah, Christian-Alexander Behrendt, Adam Beck, Muayyad Almudhafer, Stefano Ancetti, Donald Jacobs, Priya Jayakumar, Fatemeh Malekpour, Sherene Shalhub, Boboyor Keldiyorov, Meryl Simon, Manar Khashram, Nicole Rich, Amanda Shepherd, Lewis Meecham, Daniel Doherty, Surgery, ACS - Atherosclerosis & ischemic syndromes, ACS - Microcirculation, Benson, Ruth A, Bracale, Umberto Marcello, Ruffino M.A., Chan S., Coughlin P., Awopetu A., Stather P., Lane T., Theodosiou D., Ahmed M.A., Vasudevan T., Ibrahim M., Al Maadany F., Eljareh M., Alkhafeefi F.S., Coscas R., Unal E.U., Pulli R., Zaca S., Angiletta D., Kotsis T., Moawad M., Tozzi M., Patelis N., Lazaris A.M., Chuen J., Croo A., Tsolaki E., Zenunaj G., Kamal D., Tolba M.M., Maresch M., Khetarpaul V., Mills J., Gangwani G., Elahwal M., Khalil R., Azab M.A., Mahomed A., Whiston R., Contractor U., Esposito D., Pratesi C., Giacomelli E., Troncoso M.V., Elkouri S., Johansson F.G., Dodos I., Benezit M., Vidoedo J., Rocha-Neves J., Pereira-Neves A.H., Dias-Neto M.F., Campos Jacome A.F., Loureiro L., Silva I., Garza-Herrera R., Canata V., Bezard C., Bowser K., Tobar J.F., Vera C.G., Parra C.S., Lopez E., Serra Y.G., Varela J., Rubio V., Victoria G., Johnson A., O'Banion L.A., Makar R., Tantawy T.G., Storck M., Jongkind V., falah O., McBride O., Isik A., Papaioannou A., Ocke Reis P.E., Bracale U.M., Atkins E., Tinelli G., Scott E., Wales L., Sivaharan A., Priona G., Nesbitt C., Grainger T., Shelmerdine L., Chong P., Bajwa A., Arwynck L., Hadjievangelou N., Elbasty A., Rubio O., Ricardo M., Ulloa J.H., Tarazona M., Pabon M., Pitoulias G., Corless K., Ioannidis O., Friedrich O., Van Herzeele I., Vijaynagar B., Cohnert T., Bell R., Moore H., Saha P., Gifford E., Laine M., Barkat A., Karkos C., Binti Safri L.S., Buitron G., Del Castillo J., Carrera P., Salinas N., Biagioni R.B., Benites S., Mafla C.A., Pian P.M., Albino P., Serrano E., Marin A., Gonzalez M., Foreroga M., Russo A., Reyes A., Guglielmone D., Grillo L., Flumignan R., Palones F.G., Silveira P.G., Ramely R.B., Edeiken S., Chetter I., Green L., Sudarsanam A., Lyons O., Lemmon G., Neville R., Castelli M., Hinojosa C.A., Carvajal R.R., Rivera A., Wong P., Drudi L., Perkins J., Sieunarine K., Attia D., Atef M., Eftychios L., Weaver F., Ren L.C., Alomari M., Jamjoom R., Aljarrah Q., Abbas A., Alomran F., Kumar A., Altoijri A., ElSanhoury K.T., Alhumaid A., Fekry T., Sekhar R., Theodoridis P., Panagiotis T., Roditis K., Tsiantoula P., Antoniou A., Soler R., Hasemaki N., Baili E., Mpaili E., Huasen B., Wallace T., Duncan A., Metcalfe M., Mannoia K., Bechara C.F., Tsilimparis N., Aranson N., Riding D., Palena M., McDonnell C., Mouawad N.J., Banegas S., Rossi P., Oshodi T., Diaz R., Afifi R., Dindyal S., Thapar A., Kordzadeh A., Pullas G., Lin S., Davies C., Darvall K., Kodama A., Gooneratne T., Gunawansa N., Munoz A., Jie N.J., Bradley N., Al-Jundi W., Meyer F., Lee C., Malina M., Renton S., Lui D., Batchelder A., Oszkinis G., Freyrie A., Giordano J., Saratzis N., Tigkiropoulos K., Kyriakos S., Popov G., Cheema M.U., Lapolla P., Ling Patricia Y.C., Ennab R., Ullery B.W., Pasenidou K., Tam J., Sidel G., Jayaprakash V.V., Bennett L., Hardy S., Davies E., Baker S., Wijesinghe L., Tam A., McCune K., Chana M., Lowe C., Goh A., Powezka K., Kyrou I., Altaf N., Harkin D., Travers H., Cragg J., sharif A., Akhtar T., Chavez J.A., Ordonez C., Mazzurco M., Choke E., Asghar I., Summerour V., Dunlop P., Morley R., Hardy T., Bevis P., Cuff R., Stavroulakis K., Beropoulis E., Argyriou A., Loftus I., Azhar B., Sheth S., Usai M.V., Choudhry A., Nicole K., Boyle E., Joyce D., Abdelaty Hassan M.H., Saltiel A., Frahm-Jensen G., Antoniou G., Elhadi M., Kimyaghalam A., Malgor R., Telve D., Isaak A., Schmidli J., McKevitt K., Siddiqui T., Asciutto G., Floros N., Papadopoulos G., Kafetzakis A., Koutsias S.G., Nana P., Giannoukas A., Kakkos S., Moulakakis K.G., Shafique N., Jawien A., Popplewell M., Imray C., Abayasekara K., Rowlands T., Kuhan G., Rajagopalan S., Jaipersad A., Sadia U., Kobe I., Mittapalli D., Enemosah I., Behrendt C.-A., Beck A., Almudhafer M., Ancetti S., Jacobs D., Jayakumar P., Malekpour F., Shalhub S., Keldiyorov B., Simon M., Khashram M., Rich N., Shepherd A., Meecham L., Doherty D., and Benson R.A.

Subjects
Vascular surgery, Peripheral artery disease, Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE, Abdominal aortic aneurysm, COVID-19, 610 Medicine & health, Surgery, AAA, Cardiology and Cardiovascular Medicine, Survey, Settore MED/22 - CHIRURGIA VASCOLARE, PAD
Abstract

OBJECTIVE To document the recovery of vascular services in Europe following the first COVID-19 pandemic peak. METHODS An online structured vascular service survey with repeated data entry between 23 March and 9 August 2020 was carried out. Unit level data were collected using repeated questionnaires addressing modifications to vascular services during the first peak (March - May 2020, "period 1"), and then again between May and June ("period 2") and June and July 2020 ("period 3"). The duration of each period was similar. From 2 June, as reductions in cases began to be reported, centres were first asked if they were in a region still affected by rising cases, or if they had passed the peak of the first wave. These centres were asked additional questions about adaptations made to their standard pathways to permit elective surgery to resume. RESULTS The impact of the pandemic continued to be felt well after countries' first peak was thought to have passed in 2020. Aneurysm screening had not returned to normal in 21.7% of centres. Carotid surgery was still offered on a case by case basis in 33.8% of centres, and only 52.9% of centres had returned to their normal aneurysm threshold for surgery. Half of centres (49.4%) believed their management of lower limb ischaemia continued to be negatively affected by the pandemic. Reduced operating theatre capacity continued in 45.5% of centres. Twenty per cent of responding centres documented a backlog of at least 20 aortic repairs. At least one negative swab and 14 days of isolation were the most common strategies used for permitting safe elective surgery to recommence. CONCLUSION Centres reported a broad return of services approaching pre-pandemic "normal" by July 2020. Many introduced protocols to manage peri-operative COVID-19 risk. Backlogs in cases were reported for all major vascular surgeries.

Published
2022
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18. Service user and community clinician design of a partially virtual diabetic service improves access to care and education and reduces amputation incidence.

Author

Watt A, Beacham A, Palmer-Mann L, Williams A, White J, Brown R, Williams E, Richards G, White L, Budge P, Darvall K, Bond E, and Paisey R

Subjects
Amputation, Surgical, Health Services Accessibility, Humans, Incidence, State Medicine, Diabetes Mellitus epidemiology, Diabetes Mellitus therapy, Diabetic Foot epidemiology, Diabetic Foot therapy
Abstract

Introduction: Design of an integrated diabetes service based on needs of service users (persons living with diabetes) and community clinicians in a semirural low-income health district of the UK., Research Design and Methods: One hundred and eighty-five service users engaged through public meetings, questionnaires and focus groups. General practice staff contributed views through workshops and questionnaires. Analysis of feedback indicated service user needs for better access to education, dietary advice and foot care. General practice staff endorsed these views and requested regular access to secondary care in the community. Seven hundred persons registered with diabetes attended eight well-being events in the community. From 2017 virtual practice multidisciplinary patient reviews, virtual referral of foot cases and non-face-to-face helplines were developed. A National Health Service (NHS) approved 'App' and web-based personalized education support for those recently diagnosed with diabetes was introduced., Results: Engagement in education for those recently diagnosed with diabetes increased from 5% to 71%. Weight and hemoglobin A1c (HbA1c) levels before and 6 months after starting the program were 99.4±25 and 95.5±24.2 kg and 59.3±16 and 54.8±12.9 mmol/mol, respectively, p=0.00003 and 0.003. Of those engaging at well-being events, 44 had missed regular follow-up. One hundred and seventy-five cases were reviewed virtually with practice staff by the secondary care team avoiding referral to the hospital diabetic clinic. One hundred and seventy-six referrals were made to the virtual multidisciplinary diabetic foot team clinic. Major amputation incidence declined from 13 to 3 major procedures/10 000 per annum and minor amputation from 26 to 18/10 000. Percentage bed day occupancy by persons with diabetes fell significantly in the district general hospital., Conclusions: Integrated community-based diabetes care delivery has been achieved with partially virtual reviews. Patient education, secondary care in the community, access to dietetic advice and foot care outcomes have all improved., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Published
2021
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19. Impact of UK NICE clinical guidelines 168 on referrals to a specialist academic leg ulcer service.

Author

Davies HO, Popplewell M, Bate G, Kelly L, Darvall K, and Bradbury AW

Subjects
Adult, Aged, Aged, 80 and over, Bandages, Female, Humans, Male, Middle Aged, United Kingdom, Vascular Surgical Procedures, Wound Healing, Young Adult, Cardiology standards, Leg Ulcer therapy, Practice Guidelines as Topic, Referral and Consultation, Varicose Ulcer therapy
Abstract

Background Leg ulcers are a common cause of morbidity and disability and result in significant health and social care expenditure. The UK National Institute for Health and Care Excellence (NICE) Clinical Guideline (CG)168, published in July 2013, sought to improve care of patients with leg ulcers, recommending that patients with a break in the skin below the knee that had not healed within two weeks be referred to a specialist vascular service for diagnosis and management. Aim Determine the impact of CG168 on referrals to a leg ulcer service. Methods Patients referred with leg ulceration during an 18-month period prior to CG168 (January 2012-June 2013) and an 18-month period commencing six months after (January 2014-June 2015) publication of CG168 were compared. Results There was a two-fold increase in referrals (181 patients, 220 legs vs. 385 patients, 453 legs) but no change in mean age, gender or median-duration of ulcer at referral (16.6 vs. 16.2 weeks). Mean-time from referral to specialist appointment increased (4.8 vs. 6 weeks, p = 0.0001), as did legs with superficial venous insufficiency (SVI) (36% vs. 44%, p = 0.05). There was a trend towards more SVI endovenous interventions (32% vs. 39%, p = 0.271) with an increase in endothermal (2 vs. 32 legs, p = 0.001) but no change in sclerotherapy (24 vs. 51 legs) treatments. In both groups, 62% legs had compression. There was a reduction in legs treated conservatively with simple dressings (26% vs. 15%, p = 0.0006). Conclusions Since CG168, there has been a considerable increase in leg ulcer referrals. However, patients are still not referred until ulceration has been present for many months. Although many ulcers are multi-factorial and the mainstay of treatment remains compression, there has been an increase in SVI endovenous intervention. Further efforts are required to persuade community practitioners to refer patients earlier, to educate patients and encourage further investment in chronically underfunded leg ulcer services.

Published
2018
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20. The impact of 2013 UK NICE guidelines on the management of varicose veins at the Heart of England NHS Foundation Trust, Birmingham, UK.

Author

Davies HO, Popplewell M, Bate G, Kelly L, Darvall K, and Bradbury AW

Subjects
Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Practice Guidelines as Topic, Prospective Studies, United Kingdom epidemiology, Varicose Veins epidemiology, Databases, Factual, Varicose Veins therapy
Abstract

Objective: Although varicose veins are a common cause of morbidity, the UK National Health Service and private medical insurers have previously sought to ration their treatment in a non-evidence based manner in order to limit health-care expenditure and reimbursement. In July 2013, the UK National Institute for Health and Care Excellence published new national Clinical Guidelines (CG168) to promote evidence-based commissioning and management of varicose veins. The aim of this study was to evaluate the impact of CG168 on the referral and management of varicose veins at the Heart of England NHS Foundation Trust, Birmingham, UK., Methods: Interrogation of a prospectively gathered database, provided by the Heart of England NHS Foundation Trust Performance Unit, of patients undergoing interventions for varicose veins since 1 January 2012. Patients treated before (group 1) and after (group 2) publication of CG168 were compared., Results: There were 253 patients, 286 legs (48% male, mean (range) age 54 (20-91) years) treated in group 1, and 417 patients, 452 legs, (46% male, mean (range) age 54 (14-90) years) treated in group 2, an increase of 65%. CG168 was associated with a significant reduction in the use of surgery (131 patients (52%) group 1 vs. 127 patients (30%) group 2, p = 0.0003, χ(2)), no change in endothermal ablation (30 patients (12%) group 1 vs. 45 patients (11%) group 2), a significant increase in ultrasound-guided foam sclerotherapy (92 patients (36%) group 1 and 245 patients (59%) group 2, p = 0.0001, χ(2)) and an increase in treatment for C2/3 disease (53% group 1 and 65.2% group 2, p = 0.0022, χ(2))., Conclusions: Publication of National Institute for Health and Care Excellence CG168 has been associated with a significant increase (65%) in the number of patients treated, referral at an earlier (CEAP C) stage and increased use of endovenous treatment. CG 168 has been highly effective in improving access to, and quality of care, for varicose veins at Heart of England NHS Foundation Trust., (© The Author(s) 2015.)

Published
2016
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21. Venous symptoms: the SYM Vein Consensus statement developed under the auspices of the European Venous Forum.

Author

Perrin M, Eklof B, VAN Rij A, Labropoulos N, Vasquez M, Nicolaides A, Blattler W, Bouhassira D, Bouskela E, Carpentier P, Darvall K, DE Maeseneer M, Flour M, Guex JJ, Hamel-Desnos C, Kakkos S, Launois R, Lugli M, Maleti O, Mansilha A, NEGLéN P, Rabe E, and Shaydakov E

Subjects
Chronic Disease, Consensus, Humans, Predictive Value of Tests, Severity of Illness Index, Varicose Veins diagnosis, Varicose Veins physiopathology, Venous Insufficiency diagnosis, Venous Insufficiency physiopathology, Terminology as Topic, Varicose Veins classification, Venous Insufficiency classification
Published
2016

22. A review of randomised controlled trials comparing ultrasound-guided foam sclerotherapy with endothermal ablation for the treatment of great saphenous varicose veins.

Author

Davies HO, Popplewell M, Darvall K, Bate G, and Bradbury AW

Subjects
Female, Humans, Male, Randomized Controlled Trials as Topic, Endovascular Procedures methods, Sclerotherapy methods, Ultrasonography methods, Varicose Veins diagnostic imaging, Varicose Veins therapy
Abstract

Objective: The last 10 years have seen the introduction into everyday clinical practice of a wide range of novel non-surgical treatments for varicose veins. In July 2013, the UK National Institute for Health and Care Excellence recommended the following treatment hierarchy for varicose veins: endothermal ablation, ultrasound-guided foam sclerotherapy, surgery and compression hosiery. The aim of this paper is to review the randomised controlled trials that have compared endothermal ablation and ultrasound-guided foam sclerotherapy to determine if the level 1 evidence base still supports an "endothermal ablation first" strategy for the treatment of varicose veins., Methods: A PubMed and OVID literature search (until 31 January 2015) was performed and randomised controlled trials comparing endothermal ablation and ultrasound-guided foam sclerotherapy were obtained., Results: Although anatomical success appeared higher with endothermal ablation than ultrasound-guided foam sclerotherapy, clinical success and patient-reported outcomes measures were similar. Morbidity and complication rates were very low and not significantly different between endothermal ablation and ultrasound-guided foam sclerotherapy. Ultrasound-guided foam sclerotherapy was consistently less expensive that endothermal ablation., Conclusions: All endovenous modalities appear to be successful and have a role in modern day practice. Although further work is required to optimise ultrasound-guided foam sclerotherapy technique to maximise anatomical success and minimise retreatment, the present level 1 evidence base shows there is no significant difference in clinical important outcomes between ultrasound-guided foam sclerotherapy and endothermal ablation. As ultrasound-guided foam sclerotherapy is less expensive, it is likely to be a more cost-effective option in most patients in most healthcare settings. Strict adherence to the treatment hierarchy recommended by National Institute for Health and Care Excellence seems unjustified., (© The Author(s) 2015.)

Published
2016
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23. Generic health-related quality of life is significantly worse in varicose vein patients with lower limb symptoms independent of CEAP clinical grade.

Author

Darvall KA, Bate GR, Adam DJ, and Bradbury AW

Subjects
Aged, Chronic Disease, Cost of Illness, England, Female, Health Care Rationing, Humans, Linear Models, Male, Mental Health, Middle Aged, Patient Selection, Predictive Value of Tests, Prognosis, Risk Assessment, Risk Factors, Severity of Illness Index, State Medicine, Varicose Veins complications, Varicose Veins physiopathology, Varicose Veins psychology, Varicose Veins therapy, Quality of Life, Surveys and Questionnaires, Varicose Veins diagnosis
Abstract

Objectives: To determine the relationship between lower limb symptoms and generic health-related quality of life (HRQL) in patients with varicose veins (VV)., Methods: 284 patients on the waiting list for VV treatment completed the Short Form-12 (SF12) and a questionnaire asking about the presence of lower limb symptoms commonly attributed to venous disease (pain or ache, itching, tingling, cramp, restless legs, a feeling of swelling, and heaviness)., Results: Median age was 57 years (interquartile range 45-67); 100 (35%) were male, and 182 (64%) had CEAP clinical grade 2 or 3 disease. Jonckheere-Terpstra test for trend revealed that both physical (P < .0005) and mental (P = .001) HRQL worsened as the reported number of symptoms increased. Patients reporting tingling (P = .016, Mann-Whitney U test), cramp (P = .001), restless legs (P < .0005), swelling (P < .0005), and heaviness (P < .0005) had a significantly worse physical HRQL than those who did not. Mental HRQL was also significantly worse in patients with tingling (P = .010), cramp (P = .008), restless legs (P = .040), swelling (P = .001), and heaviness (P = .035). These significant relationships remained, and pain was also correlated with worse physical HRQL (P = .011), when linear regression was performed to control for CEAP clinical grade, age and sex., Conclusions: Physical and mental HRQL is significantly worse in VV patients with lower limb symptoms irrespective of the clinical stage of disease. This observation confirms that VV are not primarily a cosmetic problem and that NHS rationing of treatment to those with CEAP C4-6 disease excludes many patients who would benefit from intervention in terms of HRQL. Generic HRQL instruments also allow comparison with interventions for other chronic conditions., (Copyright © 2012 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.)

Published
2012
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24. Duplex ultrasound outcomes following ultrasound-guided foam sclerotherapy of symptomatic recurrent great saphenous varicose veins.

Author

Darvall KA, Bate GR, Adam DJ, Silverman SH, and Bradbury AW

Subjects
Adult, Aged, Aged, 80 and over, England, Female, Humans, Male, Middle Aged, Recurrence, Retreatment, Time Factors, Treatment Outcome, Varicose Veins diagnostic imaging, Saphenous Vein diagnostic imaging, Sclerosing Solutions therapeutic use, Sclerotherapy methods, Sodium Tetradecyl Sulfate therapeutic use, Ultrasonography, Doppler, Duplex, Ultrasonography, Interventional, Varicose Veins therapy
Abstract

Objectives: To describe duplex ultrasound (DUS) outcomes 12 months following ultrasound-guided foam sclerotherapy (UGFS) of recurrent great saphenous varicose veins (GSVV)., Methods: A consecutive series of UK National Health Service patients underwent serial DUS examinations following UGFS with 3% sodium tetradecyl sulphate for symptomatic recurrent GSVV., Results: 91 treated legs (CEAP C(2/3) 58, C(4) 21, C(5) 8, C(6) 4) belonging to 73 patients (24 male) of median age 58 (range 32-86) years were enrolled between November 2004 and May 2007. The median volume of foam used was 8 (range 4-14) ml. Above-knee (AK) and below-knee (BK) GSV reflux was present in 88 (97%) and 80 (88%) legs respectively prior to treatment. AK and BK-GSV reflux was completely eradicated by a single session of UGFS in 86 (98%) and 74 (93%) legs respectively; and by two sessions of UGFS in 88 (100%) and 77 (97%) legs respectively. In those legs where GSV reflux had been eradicated, recanalisation occurred in 7/78 (9%) AK and 8/68 (12%) BK-GSV segments after 12 months follow-up. Retreatment, where undertaken, with a single UGFS session effectively eradicated all GSV reflux in all cases of recanalisation., Discussion: A single session of UGFS can eradicate reflux in the AK and BK-GSV in over 93% of patients with symptomatic recurrent GSVV. Re-recurrence at 12 months is superior to that reported after redo GSV surgery, similar to that observed following other minimally-invasive techniques and, when it occurs, is effectively and simply treated by a single further session of UGFS., (Copyright © 2011 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.)

Published
2011
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25. Healing and recurrence rates following ultrasound-guided foam sclerotherapy of superficial venous reflux in patients with chronic venous ulceration.

Author

Pang KH, Bate GR, Darvall KA, Adam DJ, and Bradbury AW

Subjects
Aged, Chronic Disease, Databases as Topic, England, Female, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Prospective Studies, Recurrence, Time Factors, Treatment Outcome, Varicose Ulcer diagnostic imaging, Varicose Ulcer pathology, Venous Insufficiency diagnostic imaging, Venous Insufficiency pathology, Sclerosing Solutions therapeutic use, Sclerotherapy, Ultrasonography, Interventional, Varicose Ulcer therapy, Venous Insufficiency therapy, Wound Healing
Abstract

Objectives: To determine healing and recurrence rates following ultrasound-guided foam sclerotherapy (UGFS) of superficial venous reflux (SVR) in patients with healed (clinical, etiologic, anatomic and pathophysiologic (CEAP) classification, C5) and open (C6) chronic venous ulceration (CVU)., Methods: Between 1 March 2005 and 31 December 2009, 130 consecutive patients (132 limbs, 49 CEAP C5, 83 C6) of median age 70 (interquartile range (IQR) 56-76) years underwent UGFS as part of their treatment for CVU., Results: The median (IQR) follow-up time was 16 (12-32) months. One C6 patient moved abroad 1 week after UGFS and was lost to follow-up. Healing was observed in 67/82 (82%) remaining C6 patients at a median (IQR) of 1 (1-2) month following their first UGFS treatment. In 49 limbs originally treated for C5 disease, and in 67 limbs treated for C6 that healed following UGFS, there were five recurrent ulcers during the follow-up period, giving a 4.9% Kaplan-Meier estimate of recurrence at 2 years. In legs treated for C6 and C5 disease, the median (IQR) ulcer-free periods were 22 (IQR 9-32) and 14 (IQR 8-36) months, respectively., Discussion: Healing rates following UGFS for CVU are comparable to those reported after surgery but recurrence may be lower. UGFS is a safe, clinically effective and, thus, highly attractive minimally invasive alternative to surgery in patients with C5 and C6 disease., (Copyright © 2010. Published by Elsevier Ltd.)

Published
2010
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26. Duplex ultrasound outcomes following ultrasound-guided foam sclerotherapy of symptomatic primary great saphenous varicose veins.

Author

Darvall KA, Bate GR, Adam DJ, Silverman SH, and Bradbury AW

Subjects
Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Treatment Outcome, Saphenous Vein diagnostic imaging, Sclerosing Solutions therapeutic use, Sclerotherapy methods, Sodium Tetradecyl Sulfate therapeutic use, Ultrasonography, Doppler, Duplex, Ultrasonography, Interventional, Varicose Veins diagnostic imaging, Varicose Veins therapy
Abstract

Objectives: To describe duplex ultrasound (DUS) outcomes 12 months following ultrasound-guided foam sclerotherapy (UGFS) of primary great saphenous varicose veins (GSVV)., Methods: A consecutive series of UK National Health Service patients underwent serial DUS examinations following UGFS with 3% sodium tetradecyl sulphate for symptomatic primary GSVV., Results: 344 treated legs (CEAP C(2/3) 237, C(4) 72, C(5) 14, C(6) 21) belonging to 278 patients (103 male) of median age 57 (range 21-89) years were enrolled between November 2004 and May 2007. The median volume of foam used was 10 (range 2-16) ml. Above-knee (AK) and below-knee (BK) GSV reflux was present in 333 (96.8%) and 308 (89.5%) legs respectively prior to treatment. AK and BK-GSV reflux was completely eradicated by a single session of UGFS in 323 (97.0%) and 294 (95.5%) legs respectively; and by two sessions of UGFS in 329 (98.8%) and 304 (98.7%) legs respectively. In those legs where GSV reflux had been eradicated, recanalisation occurred in 18/286 (6.3%) AK and 23/259 (8.9%) BK-GSV segments after 12 months follow-up., Conclusions: A single session of UGFS can eradicate reflux in the AK and BK-GSV in over 95% of patients with symptomatic primary GSVV. Recanalisation at 12 months is superior to that reported after surgery and similar to that observed following other minimally invasive techniques., (Copyright © 2010 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.)

Published
2010
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27. The incidence of raised procoagulant factors and hyperhomocysteinaemia in Chinese patients with chronic venous insufficiency.

Author

Darvall KA, Sam RC, Adam DJ, Silverman SH, Fegan CD, and Bradbury AW

Subjects
Adult, Aged, Aged, 80 and over, Asian People statistics & numerical data, Chronic Disease, Comorbidity, Factor IX analysis, Factor VIII analysis, Factor XI analysis, Female, Homocysteine blood, Hong Kong epidemiology, Humans, Hyperhomocysteinemia blood, Male, Middle Aged, United Kingdom epidemiology, White People statistics & numerical data, Blood Coagulation Factors analysis, Hyperhomocysteinemia ethnology, Venous Insufficiency ethnology, Venous Thromboembolism ethnology
Abstract

Background: For reasons that are poorly understood, there appear to be differences in the prevalence of chronic venous insufficiency (CVI) and venous thromboembolism between Caucasians and Asians., Objectives: To compare levels of procoagulant factors and homocysteine (Hcy) in Hong Kong (HK) Chinese and United Kingdom (UK) Caucasian populations of patients with CVI (patients of CEAP clinical stages C4 - C6)., Methods: HK Chinese and UK Caucasian patients with CEAP clinical grade 4-6 venous disease were enrolled. Patients with conditions known to be associated with thrombophilia (TP) were excluded. UK and HK patients were matched by gender, age (within 5 years) and by CEAP clinical grade. All subjects underwent clinical examination, venous duplex ultrasound, and measurement of Hcy and factors (F) VIII, IX and XI., Results: 63 Patients were enrolled in each group: Mean age 64y (HK group); 67y (UK group). 37% were female; 19% had active venous ulceration. One-third of patients in each group had deep venous reflux. High Hcy, FIX and FXI were significantly more common in the UK group. Multiple TP was more common in the UK group: raised levels of >or=2 factors in 26 vs. 14 patients (P = 0.022, chi(2)). Median Hcy (14.3 vs. 10.8 micromol/L; P < 0.0005, Wilcoxon signed rank [WSR]), FIX (131 vs. 115%; P = 0.048), and FXI (114 vs. 97%; P = 0.002) were significantly higher in the UK group. There was no significant difference in FVIII levels., Conclusions: Raised procoagulant factors were more common in Caucasians compared with Chinese patients with CVI in this study. As with the inherited thrombophilias, the pattern of raised procoagulant factors in Chinese patients appears to differ from that in Caucasians., (Copyright (c) 2010 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.)

Published
2010
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28. Photoplethysmographic venous refilling times following ultrasound guided foam sclerotherapy for symptomatic superficial venous reflux: relationship with clinical outcomes.

Author

Darvall KA, Sam RC, Bate GR, Adam DJ, Silverman SH, and Bradbury AW

Subjects
Adult, Aged, Female, Humans, Lower Extremity blood supply, Male, Middle Aged, Sclerosing Solutions therapeutic use, Severity of Illness Index, Treatment Outcome, Ultrasonography, Doppler, Duplex, Ultrasonography, Interventional, Varicose Veins diagnostic imaging, Venous Insufficiency diagnostic imaging, Venous Insufficiency physiopathology, Venous Insufficiency therapy, Young Adult, Photoplethysmography, Sclerotherapy methods, Varicose Veins physiopathology, Varicose Veins therapy
Abstract

Introduction: Digital photoplethysmography (PPG) provides an inexpensive, reproducible, quantitative, non-invasive assessment of lower limb venous function., Aim: To examine the relationship between venous refilling time (VRT) and severity of venous disease, and also between changes in VRT and symptomatic improvement after ultrasound guided foam sclerotherapy (UGFS) for symptomatic superficial venous reflux (SVR)., Methods: Prior to and 6 months after UGFS, 246 patients (317 limbs) completed a symptom questionnaire, underwent duplex ultrasonography and clinical assessment, and VRT measurement by digital PPG. Health related quality of life (HRQL) questionnaires were also completed., Results: Median VRT improved from 11 to 31 s (P < 0.0005, Wilcoxon Signed Ranks). Abnormal VRT (<20 s) correlated well with the presence of SVR on duplex (sensitivity 75%, specificity 94%). Pre-treatment there was a significant relationship between reducing VRT and increasing CEAP clinical grade (P < 0.0005, chi(2)), extent of SVR on duplex (P < 0.0005) and a non-significant relationship with overall increasing symptom severity (P = 0.097). Relief of all symptoms was more likely when there was normalisation of VRT after treatment (80% vs. 65%, P < 0.0005, chi(2)). Pre-treatment VRT correlated with both generic physical (r = 0.428, P = 0.002) and disease-specific (r = -0.413, P = 0.003, Spearman's rank) HRQL., Conclusions: UGFS for SVR improves VRT measured by digital PPG and that improvement correlates with symptom relief., (Copyright (c) 2010 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.)

Published
2010
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29. Ultrasound-guided foam sclerotherapy for the treatment of chronic venous ulceration: a preliminary study.

Author

Darvall KA, Bate GR, Adam DJ, Silverman SH, and Bradbury AW

Subjects
Adult, Aged, Aged, 80 and over, Chronic Disease, Combined Modality Therapy, Female, Humans, Male, Middle Aged, Pilot Projects, Prospective Studies, Recurrence, Severity of Illness Index, Stockings, Compression, Time Factors, Treatment Outcome, Ultrasonography, Doppler, Duplex, Varicose Ulcer diagnostic imaging, Varicose Ulcer physiopathology, Wound Healing, Young Adult, Sclerotherapy, Ultrasonography, Interventional, Varicose Ulcer therapy
Abstract

Objectives: When compared to compression therapy alone, surgical correction of superficial venous reflux (SVR) reduces recurrence but does not appear to increase healing of chronic venous ulceration (CVU). The role of ultrasound-guided foam sclerotherapy (UGFS) of SVR as part of the treatment of CVU remains uncertain. The aim of this study is to describe CVU healing and recurrence rates after UGFS and to relate these outcomes to patterns of pre- and post-intervention venous reflux., Methods: A prospective study of 27 consecutive patients (28 legs) of median age 69 (interquartile range 54-79) years undergoing UGFS for SVR in addition to compression for treatment of CVU of median duration 12 (IQR 6-23) months. Prior to and 1, 6, and 12 months after treatment patients underwent clinical and duplex assessment., Results: 8 limbs (29%) had deep and superficial venous reflux, and 20 limbs had SVR alone. There was a history of DVT in 4 limbs, and 4 patients were on warfarin. No limbs had significant arterial disease and all received post-UGFS compression. Median volume of (3% STD) foam used was 8 (range 2-14) ml. 1, 3 and 6 months after UGFS, 22 (79%), 27 (96%) and 27 (96%) CVU had healed. At 12 months, 25 ulcers remained healed, 2 ulcers had recurred; one patient had died from carcinomatosis., Discussion: Following UGFS as an adjunct to compression, 96% of CVU healed within 3 months and only 2 healed ulcers (7%) had recurred at 12 months. UGFS appears to be an attractive minimally-invasive alternative to surgery to treat SVR in patients with CVU, especially the elderly and frail.

Published
2009
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30. Patients' expectations before and satisfaction after ultrasound guided foam sclerotherapy for varicose veins.

Author

Darvall KA, Bate GR, Sam RC, Adam DJ, Silverman SH, and Bradbury AW

Subjects
Adult, Aged, Female, Humans, Interpersonal Relations, Life Style, Male, Middle Aged, Quality of Life, Surveys and Questionnaires, Treatment Outcome, Varicose Veins complications, Varicose Veins diagnostic imaging, Health Knowledge, Attitudes, Practice, Patient Satisfaction, Sclerosing Solutions therapeutic use, Sclerotherapy methods, Ultrasonography, Interventional, Varicose Veins therapy
Abstract

Objectives: Ultrasound guided foam sclerotherapy (UGFS) is a minimally invasive treatment for varicose veins (VV) whose clinical and cost-effectiveness remains incompletely defined. The aim of the current study was to examine patients' expectations before and satisfaction after UGFS for VV in terms of relief of lower limb symptoms, improvement in appearance, and beneficial effect on life-style., Methods: A consecutive series of 351 patients (464 limbs) undergoing UGFS for VV completed questionnaires one week prior to and six months after treatment., Results: Pre and post-treatment response rates were 80%; 60% returned both questionnaires. Virtually all patients were expecting improvement in lower limb symptoms; these were exceeded in a third. Most patients expected cosmetic improvement and these were largely met. Two-thirds of patients expected significant life-style (clothes, work, social) benefits and outcomes were slightly less than expected. A quarter expected improvement in their interpersonal relationships. This benefit was greater than expected occurring in one-third of patients. Overall, a quarter of patients had their expectations exceeded and 10% (appearance and relationships) to 25% (clothing, work and social and leisure activities) were left with unmet expectations., Discussion: When specifically asked most patients admit to having a wide range of expectations in relation to their VV treatment, many of them probably unanticipated by the clinician. However, present data indicate that UGFS is usually able to meet, and often exceeds, these physical and psychosocial needs and expectations. UGFS is, therefore, a highly effective treatment for VV from the patients' perspective.

Published
2009
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31. Chronic venous disease in a cohort of healthy UK Asian men.

Author

Sam RC, Hobbs SD, Darvall KA, Rehman A, Adam DJ, Silverman SH, and Bradbury AW

Subjects
Adult, Age Distribution, Aged, Blood Flow Velocity physiology, Humans, Life Style, Male, Middle Aged, Photoplethysmography, Prevalence, Prospective Studies, Risk Factors, Ultrasonography, United Kingdom epidemiology, Varicose Veins diagnostic imaging, Varicose Veins physiopathology, Asian People, Varicose Veins ethnology
Abstract

Objectives: This group has previously reported that UK Asians are significantly less likely to undergo surgery for lower limb venous disease than age and sex matched Caucasians. The aim of the present study was to estimate the prevalence of lower limb chronic venous disease (CVD) in the UK Asian male population., Design: A prospective, epidemiological survey., Materials and Methods: 100 unselected Asian men attending a local Mosque were assessed for the evidence of lower limb CVD, involving the collection of data on history and clinical signs and objective assessments of venous pathophysiology using lower limb venous ultrasonography and venous photoplethysmography (PPG)., Results: On clinical examination, 80 limbs (in 50 subjects) had clinical evidence of CVD, the majority of cases consisting of varicose veins (CEAP C2). No limbs had either healed or active ulceration (C5/6), and only 2 limbs had thread veins (C1). Eight subjects had had previous venous surgery. The venous refill time (vRT) measured by PPG was lower in limbs with CVD. On venous ultrasound, reflux was present in 73/200 limbs, affecting primarily the GSV system, with only 7 limbs having deep venous reflux., Conclusions: Present data strongly suggest that the low rates of superficial venous surgery in UK Asians is not because they are inherently less likely to develop CVD.

Published
2007
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32. Obesity and thrombosis.

Author

Darvall KA, Sam RC, Silverman SH, Bradbury AW, and Adam DJ

Subjects
Adiponectin blood, Global Health, Humans, Leptin blood, Morbidity trends, Obesity blood, Risk Factors, Thrombosis epidemiology, Obesity complications, Thrombosis etiology
Abstract

Objectives: To describe the pathophysiological mechanisms by which obesity increases the propensity to thrombosis, the leading cause of death in the Western World, with particular emphasis on the role of inflammation, oxidative stress, dyslipidaemia, insulin resistance and the coagulation cascade., Design: Review article., Materials and Methods: Medline (1966-2005) and Cochrane library review of literature examining the relationship between obesity and thrombosis. Search terms included obesity, overweight, body mass index, thrombosis, cardiovascular disease, venous thromboembolism, peripheral arterial disease, and coronary heart disease., Results: Obesity is an important and growing public health issue that is estimated to affect more than half of the UK adult population. Obesity, in particular central (visceral) obesity, is associated with significant, and largely preventable, morbidity and mortality including an increased incidence and prevalence of arterial and venous thrombotic events. The various mechanisms by which obesity may cause thrombosis include: the actions of so-called adipocytokines from adipose tissue, e.g. leptin and adiponectin; increased activity of the coagulation cascade and decreased activity of the fibrinolytic cascade; increased inflammation; increased oxidative stress and endothelial dysfunction; and disturbances of lipids and glucose tolerance in association with the metabolic syndrome., Conclusions: Obesity appears to be associated with thrombosis via several mechanisms. These pro-thrombotic factors are all improved by weight loss.

Published
2007
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