Adherence to massive transfusion protocol in major vascular surgery

Abstract

s / International Journal of Surgery 11 (2013) 686e745 744 ABSTRACTS 1359: ADHERENCE TO MASSIVE TRANSFUSION PROTOCOL IN MAJOR VASCULAR SURGERY Reza Arsalani Zadeh, Marion Wood, John Abraham. University Hospital Morecambe Bay, Lancaster, UK. Introduction: Emergency vascular surgery often requires massive transfusion. Haemostatic transfusion protocols have shown to decrease mortality in trauma. Similar approach may be necessary in vascular surgery. Aims / Methods: The aim of this audit was to assess the adherence to local massive transfusion protocols in vascular surgery. All patient undergoing any form of vascular surgery requiring massive transfusion (>6 units) in 2011 were included in this audit. Results: Total of 20 patients required massive transfusion.(age: 74.9 8.1yrs, M:F1⁄415: 5). Median time from receiving sample to issue of RBC, usage of RBC and to issue of FFP were 00:55, 1:32 and 1:40min respectively. A total of 185 RBC were used. (median 8(4-32)). A total equivalent of 94 units were used with cell salvage (median 2(2-21)). A total of 117 FFP(median 4) and 23 units of platelet(median 2) were used. Total wastage was 14 FFPs and 3 platelets. Mean RBC: plasma ratio was 1.57. A post transfusion platelet count of>100 was achieved in only two patients. Conclusion: Timing of availability of blood products and RBC:plasma transfusion ratio was acceptable. However, pre-emptive use of platelet should be encouraged. Increase awareness of all heath staff about the presence of transfusion protocols is necessary. 1368: ASIT-ROULEAUX CLUB PRIZE WINNER: FASCIAL SHEATH CLOSURE FOLLOWING PERCUTANEOUS ENDOVASCULAR ANEURYSM REPAIR: CURRENT EVIDENCE FOR PRACTICE Sophie Howell , Kirtan Patel , Vamsee Bhrugubanda , Andrew Choong . 1 Imperial College School of Medicine, London, UK; Outer North West London Regional Vascular Unit, Northwick Park Hospital, London, UK. Purpose: Fascial sheath closure(FSC) is an alternative to closure devices for artery closure following percutaneous endovascular aneurysm repair(PEVAR). We present a systematic review and pooled data synthesis of FSC following PEVAR. Methods: Review methods were according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis(PRISMA) guidelines. Published literature from five electronic databases was searched. Studied outcomes included pathology treated, number of attempted fascial sheath closures, primary technical success for closure, re-intervention rates and causes, length of follow up Results: 4 studies representing 315 patients were eligible for analysis. The mean patient age was 64.5 with a male to female ratio of 6:1. 75.5% of patients had FSC for PEVAR. The remainder had FSC for a percutaneous endovascular treatment of fenestrated, thoracic, dissection or iliac pathologies. 441 fascial sheath closures were attempted. Primary success was 89.8%. The most common complications requiring intervention within 24 hours were bleeding(6.8%) and thrombosis(2.5%). The majority of late complications were managed conservatively(3.9%). Conclusion: Fascial sheath closure has good primary technical success and is associated with a low re-intervention rate. In these times of austerity, perhaps this should be considered as a good alternative to the use of more expensive closure devices in PEVAR. 1384: OMNIFLOW BIOSYNTHETIC GRAFTS: CURRENT EVIDENCE FOR USE IN HAEMODIALYSIS Vamsee Bhrugubanda , Sophie Howell , Kirtan Patel , Andrew Choong . Outer North West London Regional Vascular Unit, Northwick Park Hospital, Middlesex, UK; 2 Imperial College School of Medicine, London, UK. Background: Omniflow is a biosynthetic vascular prosthesis and is indicated when a primary arterio-venous fistula cannot be created. We present a systematic review on its use in access for haemodialysis. Methods: Review methods were according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis(PRISMA) guidelines. Literature from five electronic databases was searched. Studied outcomes included graft type created, time on dialysis, co-morbidities, primary and secondary patency, rescue procedures for thrombosis and time to first puncture. Results: 3 studies were identified with 112 patients eligible for analysis. This encompassed 128 procedures from 1992-2008. The mean age was 64.3. 56.3% of patients had a forearm loop fistula, 23.4% forearm straight fistula and 20.3% thigh loop fistula. 49.2% required rescue procedures for thrombosis. Graft infection rate was 1.6%. There was no limb loss and only 10.9% demonstrated post-implantation stenoses. Primary patency was 63% and 46.3% at 12 and 24 months respectively. Conclusions: In patients where a primary arterio-venous fistula cannot be created, Omniflow represents a viable alternative to other prosthetics and may confer benefit as a biosynthetic prosthesis particularly in terms of infection resistance. This represents the available data on Omniflow but does not include improvements(Omniflow II), which may demonstrate improved results. 1429: LONG-TERM CLINICAL OUTCOMES FOLLOWING LOWER LIMB ARTERIAL ANGIOPLASTY James Glasbey , Gareth Morris-Stiff , David Bosanquet , Medhat Moawad , Gareth Davies , Eryl Hicks , Colin Davies , Michael Lewis . Department of Surgery, Royal Glamorgan Hospital, Ynysmaerdy, Llantristant, UK; Department of Radiology, Royal Glamorgan Hospital, Ynysmaerdy, Llantristant, UK; Cardiff University School of Medicine,