Extracranial Carotid Artery Aneurysm: Optimal Treatment Approach –
I have put the following tool to easily calculate the risk of performing AAA surgery, based on GAS, VBHOM, and vPOSSUM. I have also added a new self-designed interesting monogram, a rupture index tool, that I found fascinating in calculating the risk of rupture in patients with AAA.
NICE has made it clear that it is time to change the attitude and offer endothermic/foam/and even surgery for patients who are likely to be struggling with their varicose veins permanently BEFORE going into the compression hosiery option.
This is what they stated, and this is what I used recently in a letter to the GP requesting for funding (the outcome of which is not known yet!):
“Historically surgery and compression therapy were the only treatments available to people with varicose veins, but in recent years other treatments including endothermal ablation and ultrasound-guided foam sclerotherapy have been developed. These newer therapies are less invasive than surgery, promote faster recovery and need shorter hospital stays.
- endothermal ablation (in which the veins are closed off using heat)
- or, if endothermal ablation is unsuitable, a treatment called ultrasound-guided foam sclerotherapy (in which the veins are closed off using a chemical foam)
- or, if both endothermal ablation and ultrasound-guided foam sclerotherapy are unsuitable, surgery to remove the varicose veins.
They should only be offered compression hosiery (stockings designed to improve blood flow by squeezing the legs) as a permanent treatment if none of the other treatments are suitable for them.
The following topics and depth of vascular knowledge have to be delivered during your ward rounds; its up to you to design how and over what time you are delivering them.
- Basic vascular anatomy and surface anatomy: the tree; origin; branches; access and important structures; essential landmarks
- Basic history and physical examination of the six types of vascular diseases: ICs (with emphasise on risk factors and exercises/smoking); CIL (with emphasis on definitions and correlation to pressures); AAA (with emphasis on acute presentation and decision making); VVs (with emphasis on classification and severity); and diabetic foot (with emphasis on changes in skin, muscles, bones, deformities, nerves, and circulations).
- Core vascular ultrasound scan / waves/ resistance/ eABPIs/ pitfalls/
- Core pathophysiology – atherosclerosis (stages; endothelium; effect of statin; combination of organ effect) – aneurysmal disease – varicose veins – CILs – diabetic foot – see MRCS presentation
- Core principles of biomechanics in diabetic foot. – see biomechanics presentation
- Vascular Facts and Figures
- Basic techniques in vascular surgery:
- CORE VIDEOS
- EXPOSURE: aorta; iliac; femoral; popliteal; foot; carotid; subclavian; axillary; brachial;
- PROCEDURES –
- LEVEL OF COMPETENCY I would expect from a vascular trainee (with different levels of course):