Source: BJS Feb 2017
This study from Manchester health economics looked at measures for anxiety and depression vs probability of wound complication following up replacement, knee replacement and hernia repair. Moderate anxiety and depression are associated with higher (x1.2) and longer hospital stay (0.19).
It’s very interesting… Yours support to patients, especially those not quite psychologically comfortable can make a difference to your surgical outcomes..
Source CX 2017
Primary patency is significantly better with open but not secondary ones.
There are risk factors that make endo prone to failure ..
Source: CX 2017
108 Pts had veClose vs 114 had RFA
No difference in pain even without tumescent in adhesive. Less bruising found in adhesive vs RFA.
Complete occlusion 99% in adhesive vs 94% in 3 months, then after 33 months 91% in RFA vs 94% in adhesives
Quality of life is not different however.
Results presented by Kathleen Gibson from Bellevue USA
Source: CX 2017
This Trial showed that using stockings for one week following thermal ablation of veins have better outcome in general.
Source: Charing Cross vasc symposium April2017
This trial was presented only and not published yet; but the results shown shows more bleeding (1.6% vs 0.3% in control) and more bleeding episodes (4.5% vs 1.7% in control). No fatal consequences noted.
Long term results: 46.7% from interventional arm had post thrombotic syndrome vs 48.2% in control
Both iliofemoral and fenoropopliteal DVTs were included.
Type: Randomized multicenter trial – FinnMesh Study.
Three groups were randomised: glue fixation vs. self-gripping mesh vs. suture fixation of mesh in Lichtenstein hernia repair
The duration of surgery was different: 34 min with glue, 32 min with self-gripping, and 38 min with sutured mesh (P<0⋅001). The postoperative pain, pain killer requirement, complication rate or quality of life were not different.
Ann Surg 2015; 262: 714–720.
Level of Evidence: randomised controlled trial.
A 126 procedures were included. The primary patency at 3 months improved when patients have had the procedure done under brachial plexus block, compared to local anaesthesia alone (84% vs. 62%, P=0⋅005).
Lancet 2016; 388: 1067–1074.
Level of evidence: Randomised, double-blind, placebo-controlled trial
Intravenous dexmedetomidine given to patients over 65 in the first 24 hours who are admitted to ITU following a major surgery can significantly reduce the risk of delirium (9% vs 23%, P<0⋅0001)
Lancet 2016; 388: 1893–1902.
Ref. Circumstances Cardiovascular Interv Nov 2016
This study allows us, as vascular surgeons, to conclude .. as it is not exactly applicable in a direct manner.
The objective of this study was to assess the efficacy of sealing intermediate nonobstructive coronary saphenous veingraft (SVG) lesions with drug-eluting stents (DES; paclitaxel- or everolimus-eluting stents) for reducing major adverse cardiac events (MACE).
This was a randomized controlled multicenter clinical trial that enrolled patients with a previous coronary artery bypass graft who had developed at least 1 intermediate nonobstructive SVG lesion (30%-60% diameter stenosis by visual estimation). Patients were randomized (1:1) to DES implantation (SVG-DES) or medical treatment (SVG-MT) of the target SVG lesion. The primary efficacy outcome was the first occurrence of MACE defined as the composite of cardiac death, myocardial infarction, or coronary revascularization related to the target SVG during the duration of follow-up (minimum of 2 years). Secondary efficacy outcomes included MACE related to the target SVG lesion and overall MACE. A total of 125 patients (mean age 70±9 years, 87% men) were included, with a mean time from coronary artery bypass graft of 12±5 years. Sixty and 65 patients were allocated to the SVG-DES and SVG-MT groups, respectively. There were no events related to the target SVG at 30 days. After a median follow-up of 3.4 (interquartile range: 2.8-3.9) years, the MACE rate related to the target SVG was not significantly different in the 2 groups (SVG-DES: 15.0%, SVG-MT: 20.0%; hazard ratio, 0.65; 95% confidence interval, 0.23-1.53; P=0.33). There were no significant differences between groups in MACE related to the target SVG lesion (SVG-DES: 10.0%, SVG-MT: 16.9%; hazard ratio, 0.53; 95% confidence interval, 0.20-1.43; P=0.21) or global MACE (SVG-DES: 36.7%, SVG-MT: 44.6%; hazard ratio, 0.73; 95% confidence interval, 0.42-1.27; P=0.26).
Sealing intermediate nonobstructive SVG lesions with DES was safe but was not associated with a significant reduction of cardiac events at 3-year follow-up.
Reflections from ‘know yourself’ – consultant interview preparation course
Vascular surgery is distinct in four main aspects when compared to almost all other branches of surgery:
It is not therefore surprising that this branch of surgery:
Well .. not everyone is convinced though. This is what Br J Cardiol 2009;16:299–302 has to say:
We undertook a seven-year in-depth review of all reported obituaries of medical practitioners in the BMJ to assess the age and disease distribution of mortality of medical practitioners in order to identify relationships between mortality and discipline, ethnicity and other demographic factors. In total, 3,342 obituaries reported in the BMJ from January 1997 to December 2004 were reviewed.
The majority of obituaries were of male doctors. Doctors who qualified in the developed world appeared to live longer (mean age at death of 78 years) than those who qualified in Asia (mean age at death of 70 years). White-European doctors lived significantly longer than doctors from other ethnic groups. There was no significant difference in longevity between doctors working in the primary care sector and those in the secondary care sector. An eighth (12.5%) of doctors died between the ages of 60 and 70 years and, of these, nearly half died between the ages of 61 and 65 years. There were significantly more suicides and accidental deaths in Accident and Emergency (A&E) doctors compared with other specialties.
