Department Of Vascular Surgery Research Articles

WalkingPad protocol: a randomized clinical trial of behavioral and motivational intervention added to smartphone-enabled supervised home-based exercise in patients with peripheral arterial disease and intermittent claudication

BackgroundPhysical exercise is a first-line treatment for peripheral arterial disease (PAD) and intermittent claudication (IC) reducing pain and increasing the distances walked. Home-based exercise therapy (HBET) has the advantage of reaching a higher number of patients and increasing adherence to physical exercise as it is performed in the patient’s residential area and does not have the time, cost, and access restrictions of supervised exercise therapy (SET) implemented in a clinical setting. Even so, rates of adherence to physical exercise are relatively low, and therefore, m-health tools are promising in increasing motivation to behavior change and adherence to physical exercise. A built-in virtual assistant is a patient-focused tool available in a mobile interface, providing a variety of functions including health education, motivation, and implementation of behavior change techniques.MethodsThis is a single-center, prospective, three-arm, single-blind, randomized, controlled, superior clinical trial with stratified and blocked random allocation. Three hundred participants with PAD and IC will be recruited from an Angiology and Vascular Surgery Department, Centro Hospitalar Universitário Porto (CHUPorto), Porto, Portugal. All patients will receive the same medical care recommended by current guidelines. Participants in all three groups will receive a personalized prescription for an HBET program and a behavioral change and motivational intervention. Participants in experimental groups 1 and 2 will receive a smartphone with the WalkingPad app to monitor exercise sessions. Experimental group 2 WalkingPad app will have a built-in virtual assistant that will promote behavioral change and provide motivational support. Participants allocated to the active control group will not receive the m-health tool, but a practice diary to encourage monitoring. The program will last for 6 months with three evaluation moments (baseline, 3, and 6 months). The primary outcome will be the change in distances walked (maximal and pain-free) from baseline to 3 and 6 months. Secondary outcomes will be changes in quality of life, patients’ perception of resistance, and walking speed.DiscussionThis study will allow measuring the effectiveness of an m-health tool in increasing motivation for behavior change and adherence to an HBET program in patients with PAD. The superiority of experimental group 2 in the primary and secondary outcomes will indicate that the virtual assistant is effective for motivating behavioral change and encouraging the practice and adherence to physical exercise. The use of m-health tools and virtual health assistants can potentially fill a gap in the access and quality of health services and information, reducing the burden on the health system and promoting self-management and self-care in chronic illness.Trial registrationClinicalTrials.govNCT04749732. Registered on 10 February 2021

REHABILITATION OF PATIENTS AFTER CARDIAC SURGERY

Background. Patients undergoing cardiac surgery are under a high risk of post-operative reductions in respiratory muscle strength and pulmonary function as well as lowered functional capacity. In-hospital physical inactivity and inappropriate rehabilitation increases the chances for development of these complications and affects patients’ future independence in daily routine. Cardiac rehabilitation is crucial in preventing complications and assisting the early function recovery. However, despite the evidences for its benefits and strong guideline recommendations, the uptake of cardiac rehabilitation remains poor. Objective. this study is aimed at promotion of cardiac rehabilitation and sharing successful experience of using it. Methods. Post-surgical treatment and rehabilitation of 387 patients with cardiovascular pathology in the Department of Vascular and Cardiac Surgery of Municipal Non-Commercial Enterprise “Ternopil Regional Clinical Hospital” of Ternopil Regional Council has been analysed. Results. The experience of successful post-surgical treatment and rehabilitation allowed establishing the basic approaches to perioperative management of patients with cardiovascular surgical pathology. Key principles include minimized ICU stay and artificial ventilation time, early verticalization and beginning of physical activities, early removed drainage tubes, tracheobronchial tree drainage, nutritional balance, lymphatic drainage massage, application of elastic jersey on the lower extremities, early transferring to the surgery ward and returning to the regular daily activities, circumstantial health education, complex work of a multidisciplinary team. Conclusions. This set of rehabilitation measures helps prevent complications after cardiac surgery as well as provide a faster patient’s daily routine.

Stratification of predictors of major amputation versus limb salvage in Egyptian patients with critical limb ischemia

Aim of the study: To determine major predictors for limb salvage (or major amputation) in chronic limb threatening ischemia (CLTI) in Egyptian people. Design: Pilot study, observational analytical study. Patients and Methods: This study was conducted on 224 cases in the Department of Vascular Surgery in Kasr Al-Ainy Hospital – Cairo University between March 2018 to February 2019. The clinical, radiological and operative variables were collected and detect patients who need major amputation in 30 days and verify predictors of limb salvage, which was subjected to univariate analysis in order to determine the most important factors of failure of limb salvage. Results: The TLC, total CK, serum urea level and incomplete foot arch are independent factors directly proportional to the possibility of major amputation. Open interventions and presence of inline distal runoff enter the foot are independent factors inversely proportional to the possibility of major amputation. Anemia and active cardiac condition are risk factors for major amputation. Conclusion: We obtained factors that predict the limb salvage by using of univariate and multivariate analysis. These factors can help the practitioners to predict the limb salvage and guides the consumption of health care resources and personnel.

Patency and Complications of Arterio-venous Fistula Created in Pre- and Post-dialysis Settings.

To determine the difference in patency and complication rates of arterio-venous fistula (AVF) constructed in pre-dialysis versus post-dialysis settings. Descriptive study. The Department of Vascular Surgery, Shifa International Hospital, Islamabad from January 2014 to August 2020. Computerised record of 726 patients, who had undergone vascular access surgery for haemodialysis, was collected. Patients were divided into two groups according to those who had undergone AVF surgery: a) prior to the commencement; or b) after the commencement of haemodialysis. Primary and secondary patency rates were determined clinically by using duplex scans. Complications and suitability of AV fistula were assessed in both the groups. Data was collected and analysed using SPSS version 25, considering p-value of less than 0.05 as statistically significant. Early fistula failure was significantly higher in post-dialysis group compared with pre-dialysis group, while primary patency was higher in pre-dialysis (78.2%) group comparing with post-dialysis (66.1%) group. Secondary patency was 88.9% and 75.8% in pre- and post-dialysis groups, respectively. Early dialysis suitability failure rates were 12.2% and 15.1%; and late suitability failure rates were 7.9% and 16.1% in the pre- and post-dialysis groups, respectively. Higher rates of complications like maturation failure, low flow AVF, stenosis, thrombosis, venous hypertension, AV aneurysm, and infections were encountered in post-dialysis group compared to pre-dialysis group. Surgical creation of AVF three months prior to commencement of haemodialysis is advantageous in terms of patient outcomes and healthcare resources. However, a multidisciplinary approach and timely referral of patients to a vascular clinic further enhances the outcome with respect to the suitability of vascular access for dialysis. Arterio-venous fistula, Dialysis, Patency, Complications, Suitability.

Relationship of the Low-Density Lipoprotein Cholesterol/High-Density Lipoprotein Cholesterol Ratio with a Vulnerable Plaque in Patients with Severe Carotid Artery Stenosis: A Case-Control Study in the Han Chinese Population.

Carotid plaque is often an important factor in ischemic stroke after it changes from stable to vulnerable, and low-density lipoprotein cholesterol (LDL-c) and high-density lipoprotein cholesterol (HDL-c) are associated with plaque vulnerability. We aimed to investigate whether the LDL-c/HDL-c ratio, an easily available and novel biomarker, is associated with vulnerable plaques and enhances the warning effect on vulnerability compared to LDL-c or HDL-c alone. We conducted a retrospective study of 187 patients with severe CAS admitted to the Department of Vascular Surgery at the Nanjing Drum Tower Hospital from January 2019 to July 2021. They were divided into a stable plaque group and a vulnerable plaque group according to carotid ultrasonography, carotid angiography (CTA), and plaque pathology. Baseline information was collected and compared between the two groups. Correlation analysis was used to determine the degree of correlation between clinical variables. Univariate and multifactor logistic regression analyses were used to examine independent risk factors for vulnerable plaque in patients with severe CAS. Receiver operating characteristic (ROC) curves were used to assess the capacity of LDL-c/HDL-c to predict the occurrence of vulnerable plaque. The age of the vulnerable plaque group was 68.12 ± 8.90 years, with 85 males (89.91%); the age of the stable plaque group was 68.77 ± 8.43 years, with 70 males (89.74%). Multivariate logistic regression analysis showed that LDL-c/HDL-c, smoking and diabetes were independent risk factors for vulnerable plaque (all P <0.05). The risk of vulnerable plaque was 4.78-fold greater in the highest LDL-c/HDL-c quartile (≥ 2.63) than in the lowest quartile (≤ 1.31) (P-trend <0.001), and the area under the ROC curve for LDL-c/HDL-c (AUC=0.681, P <0.001) was higher than that for LDL-c and HDL-c. LDL-c/HDL-c, smoking and diabetes were independent risk factors for vulnerable plaque in patients with severe CAS, and LDL-c/HDL-c had a higher predictive value for the presence of vulnerable plaque compared with other lipid parameters.

Сложности диагностики расслоения аорты в реальной клинической практике

INTRODUCTION: The clinical presentation of aortic dissection (AD) is diverse. Along with the classic signs, there are many “masks” that create difficulties in differential diagnosis with diseases having similar symptoms. The difficulties in the diagnosis of AD include rare incidence of the pathology, atypism of the clinical symptoms which can be interpreted as ischemic heart disease, hypertensive crisis, pulmonary embolism, aortic heart disease, neurological pathology, acute surgical pathology, renal colic. In the reported cases, there were symptoms that should have put the doctor on the alert for AD. So, in the first case there were an acute onset with a sharp rise in blood pressure, unusual irradiation of anginal pain to the lumbar region, asymmetry of the pulse and blood pressure on the extremities, development of gangrene of the right leg. In the second case, the symptomatology of degenerative-dystrophic lesion of the spine prevailed, for which the appropriate treatment was given for ten days. Symptoms suggestive of AD: expansion of the abdominal aorta on magnetic resonance imaging of the spine that could suggest involvement of the thoracic aorta in the pathological process, the presence of anemia. The third case — symptomatically classic variant of AD: severe anginal status, pulse and blood pressure asymmetry. Such symptoms as nausea, vomiting, diarrhea, and most importantly, short duration of the observation, did not permit to make a correct diagnosis on admission. In all clinical observations, the analysis of complaints, history, physical and instrumental data ultimately permitted to diagnose AD. CONCLUSION: For the timely diagnosis of AD, it is important to use available methods of instrumental diagnostics, from routine to high-tech ones. Before routing a patient to the department of vascular surgery, it is necessary to provide medical care aimed at slowing down AD, stabilization of hemodynamics, and anesthesia.

The experience of specialized medical care by vascular surgeons in the COVID-19 pandemic

Introduction. The aim of the study was to analyze the provision of specialized medical care by vascular surgeons during the COVID-19 pandemic on the example of the Sverdlovsk Regional Clinical Hospital No. 1.Materials and methods. A retrospective analysis of the activities of vascular surgeons of Sverdlovsk Regional Clinical Hospital No. 1 in 2020 was conducted. In addition, an assessment was given of the organization of measures aimed at reducing nosocomial infection and the spread of a new coronavirus infection.Results. The number of outpatient visits to a vascular surgeon in 2020 decreased by about 10%, and the number of hospitalizations to the vascular surgery department decreased by more than a third compared to previous years. But in 2020, the number of consultations of a vascular surgeon with the use of telemedicine technologies increased almost 2 times. In the vast majority of cases, patients with abdominal aortic aneurysm underwent endovascular prosthetics, which significantly reduced the time spent in the hospital and minimized the risks of nosocomial infection with COVID-19. The preoperative preparation included: computed tomography of the lungs and determination of coronavirus RNA (SARS-CoV-2) by PCR. In addition, on the day of hospitalization, it was mandatory to conduct: thorough collection of an epidemiological history and characteristic complaints, thermometry. Also, in order to prevent the spread of a new coronavirus infection, isolators for temporary stay of patients with suspected COVID-19 were organized in the emergency room and hospital departments.Conclusions. All organizational measures at the Sverdlovsk Regional Clinical Hospital No. 1 have made it possible to minimize the risk of nosocomial infection and the spread of COVID-19, thereby ensuring continuous work on the provision of planned and emergency specialized medical care.

Beliefs about Pain Control in Patients after Abdominal Aortic Aneurysm Surgery-A Preliminary Study.

Introduction: Pain-control beliefs significantly influence the perception of disease and, therefore, may influence the treatment outcomes of surgical patients. The sense of control is related to the sense of agency and the ability to influence one’s own life and environment. This construct may be external or internal. The belief that pain control depends on internal or external factors can depend on many variables. This may be influenced by socio-demographic and clinical characteristics, as well as the source and cause of pain. The aim of the study was the assessment of the relationship between the intensity of postoperative pain and beliefs about pain control in patients after AAA surgery and assessment of the relationship between socio-demographic and clinical variables and beliefs about pain control in patients after AAA surgery. Materials and Methods: The research material consisted of 42 patients aged 57 to 85, hospitalized at the Department of Cardiac Surgery and Vascular Surgery of the University Clinical Center in Gdańsk. The research was conducted from March to September 2020. The study uses a survey technique based on a standardized research tool: the Polish version of the BPCQ (The Beliefs about Pain Control Questionnaire), the NRS (Numerical Rating Scale), and the author’s own questionnaire that allows for the collection of socio-demographic data. Results: The highest intensity of pain was observed in subjects with ruptured AAA H (2) = 6.19; p < 0.05 and subjects who underwent classic surgery Z = −2.95; p < 0.05 (non-parametric Mann–Whitney U test). Subjects with ruptured aneurysms are less convinced about the influence of internal factors on pain control H (2) = 5.26; p < 0.05. The respondents’ conviction about the influence of doctors on pain control increased together with their age, rHO = 0.38, p < 0.05. Conclusion: Pain intensity after surgery did not significantly correlate with beliefs about pain control. Patients with ruptured AAA are less convinced about the influence of internal factors on pain control. With age, patients have more confidence in their doctors than in themselves to control their pain.

Angiosome-Guided Endovascular Revascularization for Treatment of Diabetic Foot Ulcers with Peripheral Artery Disease

Because diabetic foot ulcers (DFUs) are difficult to heal and cause huge economic losses to the society, accelerating their healing has become extremely important. The purpose of this study was to evaluate the effect of revascularization based on the angiosome concept on DFU. Between January 2018 and July 2020, 112 consecutive legs with DFUs, in 111 patients who were discharged from the vascular surgery department of our hospital were retrospectively evaluated. The legs were assigned to two groups depending on whether direct arterial flow to the foot ulcer based on the angiosome concept was achieved. Comparisons of the ulcer healing rate, mean time to ulcer healing, major amputation rate, survival rate, and major amputation-free survival rate between the angiosome direct revascularization (DR) and angiosome indirect revascularization (IR) groups were performed. DR was achieved in 71 legs (63%) compared with IR in 41 legs. The ulcer healing rate (70.4% in the DR group versus 34.1% in the IR group, P<0.01), the mean time to ulcer healing (7.01±4.26months versus 10.09±3.24months, P<0.01), the survival rate (90.1 vs. 53.7%, P<0.01), and the major amputation-free survival rate (81.7 vs. 48.8%, P<0.01) were significantly higher in the DR group than in the IR group. Undergoing DR did not significantly reduce the major amputations rate compared to IR (13.4 and 34.1%, respectively, P=0.15), but there might be a trend. In multivariate models, DR remained a significant predictor for ulcer healing (HR, 7.07; 95% confidence interval (CI), 6.54-7.60, P<0.01). Opening multiple infrapopliteal arteries in the DR group compared with restoring only one infrapopliteal artery did not significantly improve the ulcer healing rate (P=0.59), the mean time to ulcer healing (P=0.70), major amputation rate (P=0.83), the survival rate (P=0.31), and the major amputation-free survival rate (P=0.40). Attaining a direct arterial flow based on the angiosome concept may be important for ulcer healing, survival, and amputation-free survival in diabetic foot patients. Opening multiple infrapopliteal arteries in DR patients may not improve the ulcer healing, survival, major amputation or amputation-free survival compared with single DR vessel patency.

Clinical and Economic Impact of COVID-19 in Vascular Surgery at a Tertiary University “Hub” Hospital of Italy

BackgroundSince the first cases of a novel respiratory disease were reported in December 2019, coronavirus disease (COVID-19) Emergency State (Cov-ES) caused a worldwide outbreak requiring a complete reorganization of the healthcare system and new management of its personnel; aim of this study was to analyze the clinical and financial impact of Cov-ES in the Department of Vascular Surgery at a Tertiary University “Hub” Hospital in northeast Italy.MethodsDifferences in clinical practice according to Diagnostic Related Group (DRG) and International Statistical Classification of Diseases (ICD) and Related Health Problems and the financial impact of Cov-ES were considered. Vascular procedures performed between March 2019 and December 2019 (Prepandemic) were compared to those performed in the period March–December 2020 (Pandemic). Prepandemic and pandemic reimbursements of all vascular activities and the top 3 vascular diagnoses were evaluated.ResultsPrepandemic versus pandemic era documented a decrease of vascular consultations performed (2,882 vs. 2,270, −21.2%). The number of total vascular procedures decreased from 997 to 797 (−20.1%) with a higher reduction observed in outpatient surgical activities (247 to 136, −45.0%, P = 0.0005) rather than inpatient surgical activities (750 vs. 661, 11.9%, P = 0.02). Length of hospital stay (LOS) increased from 3.3 ± 2.7 days in prepandemic to 5.3 ± 3.9 in the pandemic era (P = 0.004). Among patients with limb-threatening ischemia, the rate of major limb amputation was higher in the pandemic (3.3% vs. 5.4%, respectively, P = 0.02), and a higher rate of elective hospitalization procedures was performed as urgent/emerging setting after clinical deterioration (2.8 % vs. 6.4%, P = 0.0002). According to DRG classification, an increase of “complicated” limb-threatening ischemia (DRG 554) and aortic aneurysm (DRG 110) was observed prepandemic to pandemic (+84.2% and +25.0%, respectively). Total reimbursement for vascular activities between pandemic versus prepandemic was 4,646,108€ vs. 5,054,398€, respectively (−8.0%). Management of “complicated” limb-threatening ischemia (DRG 554) and aortic aneurysm (DRG 110) required a higher clinical and financial support that was translated into higher economic reimbursement during the pandemic (273,035€ vs. 150,005€, +82.0% and 749,250€ vs. 603,680€, +24.1%, respectively).ConclusionsDuring the pandemic, the main resources were employed for the treatment of limb-threatening ischemia, aortic aneurysm, and carotid stenosis. Inpatient activities documented an increase in major limb amputation and LOS. An increased reimbursement for each vascular procedure and for all “complicated” diagnoses revealed that the more serious and resource-demanding pathology occurred in this period.

390 Assessing the Standard of Operative Notes Within a Vascular Surgery Department: An Audit Cycle

Abstract Aim Both the General Medical Council and Royal College of Surgeons of England’s (RCSEng) ‘Good Surgical Practice’ state that all clinical documentation must be recorded clearly, accurately, and legibly. The operative note is not just a means of communicating post-operative plans but can also be used for medico-legal purposes. The aim of this audit cycle was to ascertain how well the operative notes within a Vascular Surgery department adhered to the guidelines devised by RCSEng. Method 40 operative notes were analysed prospectively against the criteria stated in the ‘Good Surgical Practice'. The surgeons were made aware of the initial results via a departmental meeting. Using the Plan-Study-Do-Act (PDSA) model, we studied the pre-existing operative note template and created an aide-memoire highlighting the criteria with poor compliance. This was placed in all the vascular theatres. A re-audit was then undertaken 2 months after. Results In the first audit, we noted good compliance in areas that were included in the pre-existing template such as date (97.5%), name of operator (97.5%), name of anaesthetist (100%), operative procedure (100%), and closure technique (95%). Areas in need for improvement included time (0%), anticipated blood loss (2.5%) and elective/emergency procedure (10%). The second cycle demonstrated improvements (100% compliance) in most parameters. Documentation of time, elective/emergency procedure, and legibility showed minimal improvement. Conclusions This audit highlighted the importance of greater awareness of the expected standard of note documentation. Implementation of proformas and electronic documentation can effectively circumvent issues related to variability and legibility, and ultimately improve patient safety.

348 The New Normal? – a Survey of Patients’ and Clinicians’ Satisfaction of Remote Consultations During the COVID-19 Pandemic

Abstract Aim Remote consultations (RC) were implemented during the COVID-19 pandemic with the aim of preventing transmission of the virus. We conducted a survey to assess patients’ and clinicians’ satisfaction of RC. Method Two online surveys were created for patient and clinician feedback, and each recorded a cohorts' opinions on various aspects of RC. The surveys were distributed to Urology, General and Vascular surgery departments at three NHS trusts. Patient feedback was collected over the phone, whilst clinicians completed the survey online. Results Overall, responses from 99 patients and 22 clinicians were collected. 89.9% of patients were either ‘satisfied or very satisfied’ with RC, compared to 77.2% of clinicians who practiced RC. 93.9 % of patients felt they were able to discuss all their concerns during their RC. However, outside of the COVID-19 setting 50% of patients and 59.1% of clinicians would prefer face to face consultations. Both cohorts reported adherence to social distancing and convenience as key advantages of RC; furthermore 68.2% of clinicians thought RC were economically beneficial. 100% of clinicians felt the inability to examine patients was a disadvantage of RC and 33.8% of patients agreed with this. Conclusions The majority of feedback from patients and clinicians was positive for RC. However, in future approximately 55% of both cohorts would prefer face to face consultations. Looking forward, we believe RC can form a part of routine practice in selected groups of patients, where it could potentially save time and money without compromising patient or clinician satisfaction.

Research on adherence of elder patients with cardiovascular diseases to surgical treatment and assessment of the endovascular treatment clinical efficacy

Background. Patients with cardiovascular diseases (CVD) older than 70 years have low adherence to surgical treatment.&#x0D; Aim. To investigate the adherence of elder patients with CVD to surgical treatment and evaluate the effectiveness of endovascular care.&#x0D; Material and methods. In 20162020 on the basis of the vascular surgery department of the Central Clinical Hospital Russian Railways-Medicine (Moscow) and the Peoples' Friendship University of Russia standardized clinical interviewing of patients with surgical CVD (n=422, average age 76.117.2 years) was conducted. Patients were considered adherent to surgical treatment if more than in 90% of cases they agreed to undergo cardiovascular surgery. Endovascular operations were performed (100%). Evaluation of the endovascular treatment effectiveness was carried out according to the following criteria: reducing the degree of ischemia, the duration of hospital treatment, the frequency of hospitalizations during the year caused by the CVD progression, and two-year survival. The duration of patients supervision was 24 months. We compared the results of the years 20162017 (the period of mainly conservative treatment, group A, n=106) and the years 20182019 (the period of high surgical activity for CVD, group B, n=422 which included 106 patients from group A). Differences between the compared indicators were considered significant at p 0.05.&#x0D; Results. The adherence of patients over 70 years old to surgical CVD treatment was 99.5% if endovascular technology was suggested. The priority usage of endovascular care contributed to the growth of surgical activity in the vascular surgery department from 7 to 98.9% (p=0.0015), as well as high immediate and long-term (24 months) clinical efficiency (100 and 88%), and two-year survival of patients up to 100% (group B). The average duration of hospitalization for endovascular treatment was 5.10.11 days, for conservative treatment it was 8.43.6 days (p=0.02). The average number of hospitalizations per year for patients in group A was 3.1 times, in group B 1.6 times (p=0.0028).&#x0D; Conclusion. Endovascular care for CVD curing is an effective method of surgical treatment and promotes adherence of elder patients to surgical treatment.

One-year Outcomes After Implementation Of A Ruptured Abdominal Aortic Aneurysm Protocol

OBJECTIVE Societal guidelines recommend protocol establishment for patients with ruptured abdominal aortic aneurysms (rAAA), but few reports exist. We describe 1-year outcomes after implementing a rAAA protocol and a survey of team member perceptions. METHODS This was a multi-hospital single healthcare network pre-post investigation (2017-2020) where a single quaternary university hospital (QUH) receives rAAA transfers. Protocol activation engages a multidisciplinary team including vascular surgery, anesthesia, operating room (OR) and emergency department (ED) staff, and was implemented in Feb 2020. Patients are routed from the helipad to the OR or ED for expedited management. Primary outcomes were time from QUH arrival to OR and 30-day mortality. Post-protocol outcomes were compared to historical controls (2017-2019). As a qualitative adjunct, we conducted a survey examining perceptions among participants at 1-year post implementation. Results: 88 patients with rAAA presented during our study period (42 pre; 46 post). Protocol activation occurred in 32 (70%) of post-protocol patients. Presenting characteristics were similar between groups (Table 1). QUH arrival time to OR was lower for the post protocol cohort compared to historical controls (pre 88.9±78.5; post 24.6±28.4 minutes; p<0.01). 30-day mortality did not differ significantly between groups (pre N=17(40%); post N=13(41%); P=.8). Most survey participants believed the protocol improved safety (65%) and care efficiency (63%). Almost all (89%) would want the protocol activated for a family member (Table 2). CONCLUSIONS rAAA protocol implementation reduced OR arrival time and improved patient safety and efficiency perspectives among staff. Protocol development should be considered at centers with high volumes of rAAA. Societal guidelines recommend protocol establishment for patients with ruptured abdominal aortic aneurysms (rAAA), but few reports exist. We describe 1-year outcomes after implementing a rAAA protocol and a survey of team member perceptions. This was a multi-hospital single healthcare network pre-post investigation (2017-2020) where a single quaternary university hospital (QUH) receives rAAA transfers. Protocol activation engages a multidisciplinary team including vascular surgery, anesthesia, operating room (OR) and emergency department (ED) staff, and was implemented in Feb 2020. Patients are routed from the helipad to the OR or ED for expedited management. Primary outcomes were time from QUH arrival to OR and 30-day mortality. Post-protocol outcomes were compared to historical controls (2017-2019). As a qualitative adjunct, we conducted a survey examining perceptions among participants at 1-year post implementation. Results: 88 patients with rAAA presented during our study period (42 pre; 46 post). Protocol activation occurred in 32 (70%) of post-protocol patients. Presenting characteristics were similar between groups (Table 1). QUH arrival time to OR was lower for the post protocol cohort compared to historical controls (pre 88.9±78.5; post 24.6±28.4 minutes; p<0.01). 30-day mortality did not differ significantly between groups (pre N=17(40%); post N=13(41%); P=.8). Most survey participants believed the protocol improved safety (65%) and care efficiency (63%). Almost all (89%) would want the protocol activated for a family member (Table 2). rAAA protocol implementation reduced OR arrival time and improved patient safety and efficiency perspectives among staff. Protocol development should be considered at centers with high volumes of rAAA.

Thirty Years of No-Touch Saphenous Vein Harvesting: A Timely Jubilee Gift

Thirty Years of No-Touch Saphenous Vein Harvesting: A Timely Jubilee Gift

Coronary Artery Bypass Grafting among Patients Undergoing Cardiac Surgery in a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

Among all cardiac surgeries, coronary artery bypass graft is frequently performed and is expected to improve the quality of life in patients with coronary artery disease. This study aimed to look at the prevalence of the patients undergoing coronary artery bypass grafting among cardiac surgery cases at a tertiary care hospital. This was a descriptive cross-sectional study conducted at the Cardio-Thoracic and Vascular Surgery department of a tertiary care hospital among 92 patients who underwent cardiac surgery. Participants were enrolled after the ethical clearance from the Institutional Review Committee (Reference number: 574/2019). Epidemiological characters, functional New York Heart Association classification, and left ventricular function were evaluated. Data were entered in Microsoft Excel 2010 and analyzed using Statistical Package for the Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. The prevalence of coronary artery bypass graft in patients undergoing cardiac surgery was 49 (53.2%) (43.0-63.4 at 95% Confidence Interval). The mean age of 49 patients was 58.87 years. Hypertension 43 (88%), Dyslipidemia 34 (69%) and Type 2 Diabetes Mellitus 25 (51%) were major comorbidities. The mean preoperative and postoperative ejection fraction was 48.2±10.5% and 52.6±6.0% respectively. The preoperative median New York Heart Association class was 3 whereas the post-operative class was 1. Mortality was seen in one (2.04%) patient. The prevalence of coronary artery bypass graft in the patient undergoing cardiac surgery was lower than noted in other studies.

Effect of COVID-19 on the Cardiothoracic and Vascular Surgery Procedures Mix at a Tertiary Care Hospital.

ObjectiveTo assess the effect of the COVID-19 pandemic on the cardiothoracic and vascular surgery procedures volume at a tertiary care hospital.Materials & MethodsThis cross-sectional retrospective study was carried out at a tertiary care hospital's Cardiothoracic and Vascular Surgery department. All the four-year surgical procedures data were reviewed from August 2017 to August 2021. After extracting data from the hospital database software, a databank was generated in SPSS version 24.0. Average cases per month were calculated, and the data were stratified into three groups, Pre-COVID, COVID, and Post-COVID. Tables and charts were generated for the representation of data.ResultsThe total number of patients that underwent cardiovascular and thoracic procedures during the years 2017-2021 were 3,624, with male predominance (71.5%). Procedures were divided into Pre-COVID (68.5%), COVID (15.2%) and Post-COVID (16.3%) groups. Coronary Artery Bypass Grafting (CABG) was the most common procedure throughout the study duration (56.8%) and during the COVID-19 pandemic (29 procedures/month). Congenital Heart Surgeries (16.6%) and Valvular surgeries (11.5%) were next on the list. However, congenital heart surgeries were most affected during the pandemic (16 to 5 procedures/month). The average number of surgeries per month peaked at 2017 (135 procedures/month) and after that declined to its low of 46/month during the COVID-19 pandemic (The year 2020).ConclusionCardiothoracic and Vascular Surgeries have significantly decreased during the COVID-19 pandemic, especially the Coronary Artery Bypass (CABG) and Congenital Heart Surgeries. CABG procedures, however, remained the highest performed surgery even during the pandemic due to their emergent nature. Thoracic, vascular, and combined surgeries have stayed almost constant. The year 2020 (COVID-19 year) saw the lowest number of surgeries performed per month. An uprising trend in the number of surgical procedures is seen in the post-pandemic time (2021).

Thromboembolism after COVID 19 – our experience with 6 cases.

Background: The 2020 year was different. WHO announced a global pandemic and till now we have over 2 million fatality rate. The SARS CoV-2 virus causes acute respiratory viral infection and is associated with a wide range of complications.&#x0D; Aim: In this article we are representing six patients with deep venous and arterial thrombosis after Covid-19 and their treatment.&#x0D; Materials and Methods: The patients were treated successively by the Department of Vascular Surgery and the Department of Burns, Plastic, Reconstructive and Aesthetic Surgery of the "St. George" University Hospital, Medical University Plovdiv, Bulgaria.&#x0D; Results: Some of them were treated conservatively and others surgically. The localizations were upper and lower extremity and the hard palate. Amputation of the affected limb, soft tissue defects and conservative treatment was required. The arterial thrombosis were more than venous ones. All the patients were stable at discharge.&#x0D; Conclusion: After COVID-19 complications include Thrombotic events – Acute Limb Ischemia (ALI), Venous Thromboembolism (VTE), Pulmonary Embolism (PE), Disseminated Intravascular Coagulopathy (DIC) Syndrome. Thromboprophylaxis is very important. It dependent on the severity of the infection, the underlying causes and the course of treatment.&#x0D;

Anaerobes in cardiac infections: A decade experience from the tertiary care center

PurposeAnaerobic infections are common yet life-threatening. They are being recovered from all sites of the body, including the cardiovascular system. This study was aimed to determine the retrospective analysis on the isolation of anaerobes in cardiovascular samples received for a decade-long duration. It helps in knowing the frequency of isolation of anaerobic causes of cardiovascular infection. MethodsAll cardiovascular samples from the department of Cardio-thoracic vascular surgery from January 2010 to December 2020 were studied. ResultsOf 601 samples received, predominant samples were vegetations and valvular tissues of 258, followed by 98 samples of pericardial tissues, 92 samples of embolus, 90 samples of blood and post-operative collections, and 63 excised aneurysms and vascular grafts. Of the total, 15 samples grew anaerobes where Clostridium species were the predominant isolates. Clostridioides difficile was isolated in 2 samples. ConclusionsAnaerobes in cardiovascular samples are uncommon yet form a significant cause of morbidity and mortality. Most infections are from the contiguous spread, penetrating trauma, and hematogenous causing endocarditis or valvular infections. These conditions and samples form the seat of infectious focus and clinical suspicion towards the anaerobic cause of these conditions, especially in conventional routine culture-negative samples. Timely diagnosis of anaerobic infections plays a vital role in the good prognostic outcome of patients undergoing cardiothoracic and vascular surgery.

Improving Code Status Documentation Rates Using Communication Skills Training in Vascular Surgery: A Quality Improvement Initiative.

Introduction: Code status discussions are poorly understood by patients and variably performed by admitting providers, yet they are used as a quality metric. Surgical specialties, such as Vascular Surgery, admit patients with urgent and life-threatening illness. Surgical trainees are less likely to receive communication skills interventions when compared with nonsurgical specialties. Without a documented code status, nurses and physicians lack guidance on patient preference in the case of cardiopulmonary arrest and may deliver unwanted measures, which may also result in poor outcomes. Methods: We conducted a before-after Plan-Do-Study-Act quality improvement project between May 2018 and May 2019. A needs assessment included baseline code status documentation rates for the Vascular Surgery department admissions. A communication skills training (CST) and documentation intervention was provided to all Vascular Surgery trainees and advance practice providers (APPs). Departmental e-mails were sent over the 12-month intervention period, which demonstrated the code status documentation rates and served as reminders to document code status. Results: A total of 29 vascular surgery trainees and APPs received the intervention. At completion of the intervention, learners reported increased comfort initiating a code status discussion, making a recommendation for cardiopulmonary resuscitation (CPR) status, and having a strategy to discuss code status. A total of 2762 patient admissions were reviewed, with 1562 patient admissions occurring during the 12-month intervention period. The average code status documentation rate for the three months before the intervention was 7.8%. At the end of the 12-month intervention, documentation rates were 44.9% and 6 months after completion of the study period, average rates remained 45.2%. There was no change in admission rates during the study period. Discussion: CST and regular reminders increased vascular surgery residents' and APPs' comfort in engaging in code status discussions. After intervention, documentation of code status discussions increased with persistence up to six months after the intervention.