Major #amputations can be disabling and despressing. This sketch is for Jess, a cancer survivor, who’s, in her own words, been “showing cancer who’s boss “. Simple measures in #diabetes makes all the difference. read more:
AJLyon Cardiovascular Health Newsletter 2019 is out now!
WORRIED ABOUT YOUR ARTERIES??
Here is our specialist simple advice that can make a huge difference to the healthiness of your arteries!
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Vascular Newsletter 2018
Using nanotechnology and Math in treating patients with stroke
Nanotechnology is the manipulation of matter on an atomic, molecular, and supramolecular scale. It is the engineering of functional systems at the molecular level. A typical carbon-carbon bond lengths, or the spacing between these atoms in a molecule, are in the range 0.12–0.15 nm. A DNA double-helix has a diameter around 2 nm.
Ischaemic stroke occurs when a large-enough clot blocks one or more main arteries in the brain. The clot, at the molecular level, is composed of cells (red cells, white cells, platelets) attached together with bridges of protein called fibrin.
Currently, we use different drugs (tPA, etc) to break down those bridges and allow the blood to flow again into the brain. The problem is that this drug needs to be delivered to the area via a catheter, and that the same drug is able to dissolve good clots that usually form to repair damages in the artery wall.
Our team at ASPH, Royal Holloway University of London, and Imperial College London are exploring completely new ways of delivering this action without the after mentioned issues. This is a very exciting opportunity that emerged from joining forces between scientists and surgeons and we believe we will be able to change completely the way this therapy is delivered. Just watch the space..
New Public Talk on Swollen Legs, Leg Ulcer, Cold Feet, etc.?
Want to update your knowledge on modern treatment for Swollen Legs, Leg Ulcer, Cold Feet, etc.?
Then join our power review education talk series ..
On Saturday 25th Nov 2017, at 19:00-20:30
During this session we will talk about:
– Grey’s anatomy in 5 minutes©
– Modern understanding of leg swelling and leg ulcers.
– A simple system for leg assessment
– Prevention better than cure: is it possible?
– Complementary and alternative therapies in vascular leg diseases.
– Benefit from a One-stop clinics..
– Current treatment options; how effective? When to advise and NOT to advise?
– Live surgery … vein surgery, bypass, aortic aneurysm repair ..
– Question and Answer …
For more details, please contact Libby on email:
libby@ajlyon.co.uk
Bleeding following surgery on the carotid artery: the ‘second phase management’ concept!
#VascularSurgeon #GP
Surgery to treat a severely diseased carotid artery is a relatively safe operation in almost 90-95% of patients. The remaining 5-10% will be at risk of death or stroke if their immediate postoperative complications are not treated promptly and effectively. The three most common examples of such second-phase complications include ‘malignant’ hypertension, significant bleeding, and a flap-related or hypoperfusion-related intraoperative stroke. The management of such complications, or what we can call the ‘second-phase management concept’ can save a further 8-9% of patients’ life, leaving 1-2% to havea rather ‘unavoidable’ serious complications (stroke or death).
Postoperative bleeding occurs in 1-4.5% of patients. The UK national audit on carotid surgery has shown that bleeding occurred in 3.4% of cases, of which 2.5% returned to theatre. This resulted in 0-0.1% contribution to death or stroke, reflecting the efficiency of managing such complications in experienced hands of UK surgeons. Bleeding occurs more commonly due to a slipping of the surgical knot from a vein branch, especially following a strong cough (Valsalva manoeuvre). It can also occur from the dissection surfaces due to an excessive effect of anticoagulation medications (see newest guidelines on anticoagulation here). Finally, the bleeding can originate directly from the artery due to stitch-line bleeding or a rupture of the artery wall or the patch.
Cases from the author’s experience:
Over the last 10 years of vascular experience, first as a specialist registrar then as a consultant surgeon, the author has attended few cases of bleeding post carotid surgery; almost all of them were treated promptly and recovered successfully from a rather immediate life-threatening condition. One case was a carotid surgery performed in a tertiary referral centre, whereby the bleeding occurred immediately upon waking the patient up from general anaesthetic. The surgeon (one of the most experienced in the world) was still scrubbed up when the drain suddenly filled up with fresh blood. The surgeon opened the wound up instantly to find a ruptured back wall of the carotid artery. He controlled the proximal then distal bleeding and re-inserted the shunt. He then used a jump graft to repair the artery.
The second case occurred following resection of a carotid body tumour. The raw area was oozing significantly in the postoperative period. Nevertheless, the patient didn’t need to go back to theatre. The third case was a patient who has been on warfarin for atrial fibrillation and developed a classical TIA due to a severe stenosis in his right common carotid artery. He was put on aspirin and clopidogrel by the stroke team. One week later, he underwent a carotid endarterectomy after stopping the warfarin and the clopidogrel for 48h. The surface was oozing significantly intraoperatively and he required the use of different haemostatic agents (bioglue, fibrillar, etc.). These were enough to stop the bleeding and recover the patient. However, upon reintroducing therapeutic clexan 48h postoperatively, the patient developed expanding haematoma. He was taken immediately to operating theatre where stitch lines and raw surfaces were found to be significantly oozing. More importantly, the trachea was significantly deviated and oedematous. The bleeding was stopped and the patient required admission to ITU and 48h intubation. He recovered following that with no further evidence of active bleeding.
Take home message: don’t be fearful of Vascular complications; they do and they will occur! Instead, be ready to take further actions to save the patients who will only make a successful recovery if a prompt and wise decision had been made by the operating surgeon.
Cardiovascular Health Chat .. is now live
We are please to announce that our ASK YOUR QUESTIONS is now active and live .. please feel free to send your questions through. Our reply time is impressively quick!
Reducing blood pressure’further’ is certainly healthier..
Ref: BMJ JUNE 2017
A large study (meta analysis) on over 140000 patients and published in JAMA cardiology had shown significant benefits of further reducing blood pressure below the usual targets
This applies to patients with vascular diseases who are at special rush of heart attacks