Vascular Department Research Articles

ОСТРЫЙ ГЕНЕРАЛИЗОВАННЫЙ ЭКЗАНТЕМАТОЗНЫЙ ПУСТУЛЕЗ: КРАТКИЙ ОБЗОР ЛИТЕРАТУРЫ И СОБСТВЕННОЕ НАБЛЮДЕНИЕ

Abstract. Introduction. Acute generalized exanthematous pustulosis is a rare cutaneous adverse drug reaction. The disease has a complex development mechanism, involving various subpopulations of T cells and monocytes, characterized by a genetically determined imbalance in IL-36 signaling. This reaction has an acute onset, a variety of clinical manifestations, and a self-limited course after drug discontinuation. Aim: Exemplifying by our own clinical observation, to present an algorithm for diagnosing and managing acute generalized exanthematous pustulosis. Material and Methods. Patient Kh., 55 years old, was hospitalized in the vascular neurology department due to ischemic stroke in the posterior circulation system, in the form of vestibulopathy, and left hemiataxia, unspecified pathogenetic subtype. Abundant itchy pustules appeared on the skin of the trunk, upper and lower extremities, weakness, lethargy, and body temperature increase up to 38–38.5ºС on the 4th day of treatment. General clinical, laboratory, and instrumental examination methods were used. Results and Discussion. Examination revealed extensive foci of edematous erythema, multiple non-follicular small pustules, an increase in the absolute number of neutrophils to 18,500 cells/μl and eosinophils to 1,250 cells/μl in the general blood test, a moderate increase in the levels of liver transaminases in the biochemical analysis, and a slight pleural effusion on the right in ultrasound. The use of the EuroSCAR scale, based on the assessment of clinical symptoms, morphology of skin lesions, and histological picture of the disease, helped set a correct diagnosis and choose a patient management approach. The patient received treatment with systemic and local glucocorticosteroids, manifesting with good positive changes. Conclusions. Using the EuroSCAR scale developed by a team of international experts helps set the diagnosis of acute generalized exanthematous pustulosis. Immediate discontinuation of the causally significant drug is a prerequisite for successful patient management. Local therapy using disinfectant solutions, topical glucocorticosteroids, and moisturizing lotions is the initial approach to managing a patient with acute generalized exanthematous pustulosis.

Results of a German nationwide survey on perioperative cardiac management in vascular surgery

Because of the lack of specific recommendations concerning cardiac risk stratification before vascular surgery, appropriate decisions remain individual. The aim of the present study was to evaluate the perioperative cardiac management in vascular surgery in Germany.MethodsThis article is based on a survey from 2018 of heads of German vascular surgical departments or units regarding their experience with perioperative cardiac management. The questionnaire asked about the experience with preoperative cardiac evaluation and its extension, awareness of perioperative myocardial ischemia, the art of postoperative monitoring and the routine use of the best medical treatment.ResultsIn total, 62% of responders agreed that perioperative myocardial ischemia is a relevant postoperative problem in their clinic after open abdominal aortic surgery, while 47% stated the same after vascular surgery (VS) like carotid endarterectomy, peripheral arterial surgery or EVAR. Preoperative cardiological evaluations are performed routinely by 87% of responders before open abdominal aortic surgery and by 42% before VS. Preoperative cardiac evaluation included cardiac echography in 92% and stress diagnostics (stress echography, stress ECG) in 38%. Routine preoperative cardiac catheterisation is performed in 4% before OAS and only 0.5% before VS. In addition, 79% of participants initiate acetylsalicylic acid routinely and 68% use statins preoperatively. The serum troponin diagnostic test in asymptomatic patients was routinely applied by 19% of responders after OAS and by 6% after VS.ConclusionPerioperative myocardial ischemia is considered a relevant problem, primarily after aortic surgery. The preoperative cardiac stress diagnostics among vascular surgeons does not seem to be sufficiently widespread. The preoperative initiation of acetylsalicylic acid and statins is not routine in 30% of hospitals.

Indicator dynamics of the “Combating Cardiovascular Diseases” regional program aimed at reducing mortality from acute coronary syndrome

Aim. To analyze the dynamics of the application of medical and organizational technologies for achieving the target reduction of mortality from acute coronary syndrome (ACS) in the region. Materials and methods. In 2018, the research covered 1 regional vascular center (RVC), 8 primary vascular departments (PVD), and 41 medical organizations (MO). In 2022, the structure of medical organizations changed to include 3 RSCs, 9 PSOs, and 39 MOs. The indicators characterizing the provision of medical care to ACS patients in the Irkutsk region were calculated and analyzed. The presence, direction, and strength of correlation between the number of deaths from ACS and the number of medical and organizational activities was studied using linear correlation analysis by the Pearson method. Results. Over time, the share of hospitalization of patients with ACS in the early stages up to 12 hours increased from 42.1% to 46.5%. The mortality rate from ACS decreased by 20.4%, primarily due to a decrease in mortality in the first 24 hours (by 28.7%). The key medical and organizational technologies that have the greatest impact on mortality rates were identified. A strong relationship (r = -0.729) was established between the number of deaths from ACS and the number of patients transferred to the regional vascular center for emergency coronoplasty; two medium-level relationships (r = -0.343) were found between the number of deaths from ACS and the number of hospitalized patients with ACS in the first 12 hours; a correlation (r = -0.415) was determined between the number of deaths from ACS and the number of hospitalized patients who underwent thrombolytic therapy. The linear regression method showed that the availability of such procedures as emergency coronoplasty and thrombolytic therapy has prognostic significance for further reduction of the expected number of deaths from ACS in the region. Conclusion. The creation of the RVC and PVD infrastructure in the region allowed the major indicators of the “Combating Cardiovascular Diseases” regional program to be achieved.

Counseling Intervention and Cardiovascular Events in People With Peripheral Artery Disease

It is unclear whether counseling to promote walking reduces the risk of major adverse cardiovascular events (MACE) in people with peripheral artery disease (PAD). To test whether a counseling intervention designed to increase walking reduced the risk of MACE in patients with PAD. The BIP trial was a randomized clinical trial, with recruitment performed between January 2015 and July 2018 and follow-up concluded in August 2023. Participants with walking impairment due to PAD from vascular departments in the Australian cities of Brisbane, Sydney, and Townsville were randomly allocated 1:1 to the intervention or control group. Data were originally analyzed in March 2024. Four brief counseling sessions aimed to help patients with the challenges of increasing physical activity. The primary outcome was the between-group difference in risk of MACE, which included myocardial infarction (MI), stroke, and cardiovascular death. The relationship between Intermittent Claudication Questionnaire (ICQ) scores, PAD Quality of Life (PADQOL) scores, and MACE was examined with Cox proportional hazard regression analyses. A total of 200 participants were included, with 102 allocated to the counseling intervention (51.0%) and 98 to the control group (49.0%).Participants were followed up for a mean (SD) duration of 3.5 (2.6) years. Median (IQR) participant age was 70 (63-76) years, and 56 of 200 participants (28.0%) were female. A total of 31 individuals had a MACE (composed of 19 MIs, 4 strokes, and 8 cardiovascular deaths). Participants allocated to the intervention were significantly less likely to have a MACE than participants in the control group (10 of 102 participants [9.8%] vs 21 of 98 [21.4%]; hazard ratio [HR], 0.43; 95% CI, 0.20-0.91; P = .03). Greater disease-specific quality of life (QOL) scores at 4 months (ICQ: HR per 1-percentage point increase, 0.97; 95% CI, 0.95-0.99; P < .001; PADQOL factor 3 [symptoms and limitations in physical functioning]: HR per 1-unit increase, 0.91; 95% CI, 0.84-0.98; P = .01) and at 12 months (ICQ: HR per 1-percentage point increase, 0.97; 95% CI, 0.95-0.99; P = .003; PADQOL factor 3: HR per 1-unit increase, 0.91; 95% CI, 0.84-0.98; P = .02) were associated with a lower risk of MACE. In analyses adjusted for ICQ or PADQOL factor 3 scores at either 4 or 12 months, allocation to the counseling intervention was no longer significantly associated with a lower risk of MACE. This post hoc exploratory analysis of the BIP randomized clinical trial suggested that the brief counseling intervention designed to increase walking may reduce the risk of MACE, possibly due to improvement in QOL. anzctr.org.au Identifier: ACTRN12614000592640.

The first experience of tele-primary vascular department to provide assistance to patients with ischemic stroke in the Krasnoyarsk territory

The first experience of tele-primary vascular department to provide assistance to patients with ischemic stroke in the Krasnoyarsk territory

Preoperative right ventricular strain as an early predictor of perioperative cardiac failure in patients undergoing mitral surgery: An exploratory study.

This study's primary purpose was to demonstrate the correlation of preoperative right ventricular free-wall longitudinal strain (RVFWLS) and pre-/postsurgical variation in strain (delta strain) with the clinical and echocardiographic diagnosis of right ventricular dysfunction. Its secondary purpose was to determine the correlation of RVFWLS and delta strain with length of stay (LOS) in the intensive care unit (ICU), ventilation days, trend of natriuretic peptide test. (NT-proBNP) and lactate in the first 48 h, incidence of acute renal failure, and 28-day mortality. Prospective observational study. Cardio-thoracic and Vascular Anaesthesia Department and ICU of the University Hospital Integrated Trust of Verona. Patients scheduled for mitral surgery. None. All clinical and transoesophageal echocardiographic (TEE) parameters were collected at baseline, before surgery (T1) and at admission in the ICU postsurgery (T2). During the postoperative period, the clinical and echocardiographic diagnoses of right, left, or biventricular dysfunction were evaluated. TEE parameters were evaluated by a cardiologist offline. The patients were divided into two subgroups according to the development of any type of ventricular dysfunction. No statistically significant differences emerged between the two groups. According to a logistic regression model, a T1-RVFWLS value of -15% appeared to predict biventricular dysfunction (sensitivity: 100%; specificity: 91.3%). No correlation between T1- or T2-RVFWLS and creatinine, hours of ventilation or ICU LOS was found. Our study introduces a new parameter that could be used in perioperative evaluations to identify patients at risk of postoperative biventricular dysfunction.

STERNAL WOUND INFECTION AFTER CARDIAC SURGERY: LOOKING FOR INTERACTIONS BETWEEN PERIOPERATIVE VARIABLES AND PATHOGEN AGENTS

Abstract Background Sternal wound infection (SWI) can be a major complication of cardiac surgery. Both the risk factors and the pathogens agents are well known today. Yet, possible interactions between perioperative variables and pathogens have not been explored. Methods Between Jan 1st, 2006 and Nov 30, 2023 (∼18 years), perioperative data of all patients undergoing cardiac operations through median sternotomy at the Cardio–Thoraco–Vascular Department of the University Hospital of Trieste, Italy, were recorded prospectically in a computed database. Every patient developing a sternal complication was followed in a dedicated outpatient clinic and, in the presence of infection, the causative pathogen was always searched for by cultural examination of tissue speciments. Different strategies of unsupervised clustering were applied to find groups of patients with similar clinical, surgical and microbiological profiles. Results Of 9,680 consecutive cardiac surgery patients, 516 (5.3%) experienced a SWI that involved superficial soft tissue in 25.6% of cases, deep soft tissue in 51%, sternal bone in 16.7%, or mediastinum in 6.8% of cases. Staphylococcus aureus, coagulase–negative Staphylococci, Enterobacteriaceae, and Pseudomonas aeruginosa were pathogens in 100 (19.4%), 158 (30.6%), 89 (17.2%) and 36 (7%) patients, respectively; other pathogens, polymicrobial and negative cultures were found in 27 (5.2%), 26 (5%) and 80 (15.5%) patients, respectively. Following statistical analyses, significant associations were found between the Pseudomonas aeruginosa etiology of SWI and some variables such as female gender (p&amp;lt;0.0001) and preoperative renal failure (p=0.008); significant associations between the Pseudomonas aeruginosa etiology were found also with more serious forms of sepsis (p=0.025), as well as with early postoperative death (p=0.02) and complications such as acute kidney injury (p=0.006), multiple transfusion (p=0.003), and prolonged mechanical ventilation (p=0.005). Conclusion For women having renal impairment and undergoing cardiac surgery through median sternotomy, in the case of SWI, the Pseudomonas aeruginosa etiology may be more frequent and a really life–threating complication.

Sex Differences in Clinical Presentation of Lower Extremity Deep Vein Thrombosis.

Background: Differences between men and women in the clinical features and extent of lower limb deep vein thrombosis (DVT) may influence DVT diagnostic algorithms involving pretest clinical probability (PTP) assessment, D-dimer, and compression ultrasonography (CUS). Aims: To assess differences in DVT clinical presentation between men and women and their effect on PTP and D-dimer. Methods: We conducted a retrospective study in outpatients referred for suspected DVT of the lower limbs to our vascular emergency department from January 2005 to December 2019. Patients underwent PTP assessment with the Wells score, D-dimer testing, and CUS. Results: More women were referred for suspected DVT than men (M/F: 1,785/2,821; F: 61.4%; p < 0.0001). Women were older than men (median age: 71 vs. 67 years; p = 0.0001), DVT was diagnosed in 436 patients (9.4%) but in more men than women (M: 210 [11.8%] vs. F: 226 [8%]; p = 0.0002), with more proximal DVT in men than women (M: 131 7.3% vs. F: 124 [4.4%]; p = 0.00021). PTP was more likely in men (355 [19.9%]) than women (455 [16.2%]) (p = 0.0011); more men had swelling in the entire limb, increased calf circumference by >3 cm compared with the contralateral limb, and pitting edema, than women. D-dimer levels (available in 65% of patients) were more frequently positive in women with DVT than in men (94.6% vs. 85.7%; p = 0.016). However, a positive D-dimer and/or likely PTP was similarly frequent in men (92%) and women (96%) with DVT. Conclusions: More women than men are referred for suspected DVT, and men have a higher prevalence of proximal DVT. However, current algorithms for DVT diagnosis perform similarly in men and in women.

An Anatomic Classification Scheme for Surgical Planning of Renal Artery Aneurysms

Purpose: Renal artery aneurysm (RAA) is a rare disease. This study proposed and evaluated a new classification for RAA to assist in surgical decision-making. Materials and Methods: Single-center data of 105 patients with RAAs from the vascular department of vascular surgery were collected retrospectively. A new classification scheme was proposed. Type I aneurysms arise from the main trunk, accessory branch, or first-order branches away from any bifurcation. Type II aneurysms arise from the first bifurcation with narrow necks (defined as dome-to-neck ratio &gt;2) or from intralobular branches. Type III aneurysms with a wide neck arise from the first bifurcation and affect 2 or more branches that cannot be sacrificed without significant infarction of the kidney. Results: There was 50 (47.62%) type I, 33 (31.43%) type II, and 22 (20.95%) type III aneurysms. The classification assigned endovascular repair as first-line treatment (for type I or II), while open techniques were conducted if anatomically suitable (for type III). A kappa level of 0.752 was achieved by the classification compared with a level of 0.579 from the classic Rundback classification. Technical primary success was achieved in 100% and 96.05%, and symptoms were completely resolved in 100% and 84.85%, while hypertension was relieved in 84.21% and 72.92% of patients receiving open surgery or endovascular repair, respectively. No significant difference was observed for perioperative or long-term complications among the 3 classification types. Conclusion: The new classification proved to be a convenient and effective method for facilitating choice of intervention for RAAs. Clinical Impact This study proposed and evaluated a new classification scheme for renal artery aneurysms, which proved to be a convenient and effective method for facilitating surgical decision-making. Coil embolization was the first-line treatment if suitable, while aneurysm resection and reconstruction with vein graft were conducted for some complex lesions. The safety and efficacy of both open and endovascular methods were validated.

FibroScan as a surveillance marker post-cavopulmonary anastomosis for single-ventricle physiology.

Single-ventricle physiology encompasses a group of congenital cardiac malformations with only one functional ventricle. The Fontan procedure is the final palliation of this pathway and has its complications. One of these is Fontan-associated liver disease (FALD). It is known that all patients with Fontan will have FALD, due to the physiology of the Fontan circuit, and only the severity will vary. The pathophysiology of hepatic damage in FALD is unique and not easily detectable by routine non-invasive investigations. Therefore, this study is aimed to identify if FibroScan can be used as a surveillance marker to detect and assess the progression of FALD. Patients who attended the Cardiothoracic and Vascular Surgery Outpatient Department (OPD) for follow-up post-cavopulmonary anastomosis (bidirectional Glenn and Fontan) were enrolled in this study. They underwent routine examinations and tests, and in addition a FibroScan was performed. FibroScan showed that the liver stiffness measurement (LSM) was increased in all patients who had undergone Fontan and a couple of patients who had undergone bidirectional (BD) Glenn. The LSM was 12.29 (± 3.59) kPa in patients post-Fontan and 6.64 (± 4.24) kPa in patients post-BD Glenn. This raised LSM was not associated with a parallel rise in liver enzymes or other laboratory markers associated with liver function. This emphasizes the suitability of FibroScan as an early and non-invasive surveillance tool for monitoring the progression of hepatic venous congestion and FALD. We have found that LSM via FibroScan can effectively be a surveillance or screening test for FALD. Serial FibroScans can be used to monitor the progress of liver disease. Raised LSM may also have a role in predicting the morbidity for completion of Fontan post-BD Glenn operation. Large-scale studies are needed to validate our findings.

Efficacy and pharmacoeconomic advantages of Fufang Huangbai Fluid hydropathic compress in diabetic foot infections: a comparative clinical study with antimicrobial calcium alginate wound dressing.

Objective: To compare the intervention effects and pharmacoeconomic advantages of Fufang Huangbai Fluid (FFHB) hydropathic compress versus Antimicrobial Calcium Alginate Wound Dressing (ACAWD) in the treatment of diabetic foot infections (DFI). Methods: Patients with DF who were hospitalized in the peripheral vascular Department of Dongzhimen Hospital of Beijing University of Chinese Medicine from December 2020 to February 2022 and met the inclusion and excluding criteria were allocated into the experimental group and control group through minimization randomization. The experimental group was treated with FFHB hydropathic compress for 2weeks, while the control group was treated with ACAWD for the same duration. The wound healing of both groups was monitored for 1month post-discharge. Clinical data from all eligible patients were collected, and differences in various indices between cohorts were analyzed. Results: 22 in the experimental group (including two fell off) and 20 in the control group. After the treatment, the negative rate of wound culture in the experimental group was 30% and that in the control group was 10%, There was no significant difference in the negative rate of wound culture and change trend of minimum inhibitory concentration (MIC) value of drug sensitivity (p > 0.05). The infection control rate of the experimental group was 60%, and that of the control group was 25%. The difference between the two groups was statistically significant (χ2 = 5.013, p = 0.025). The median wound healing rate of the experimental group was 34.4% and that of the control group was 33.3%. There was no significant difference between the two groups (p > 0.05). During the follow-up 1month later, the wound healing rate in the experimental group was higher, and the difference was statistically significant (p = 0.047). Pharmacoeconomic evaluations indicated that the experimental group had greater cost-effectiveness compared to the control group. Conclusion: In the preliminary study, FFHB demonstrated comparable pathogenic and clinical efficacy to ACAWD in the treatment of mild DF infection, and exhibited superior pharmacoeconomic advantages. With the aid of infection control, the wound healing rate in the FFHB group showed notable improvement. Nevertheless, due to the limited sample size, larger-scale studies are warranted to further validate these findings. Clinical Trial Registration: (https://www.chictr.org.cn/showproj.aspx?proj=66175), identifier (ChiCTR2000041443).

Outcomes of Portal Vein Tumour Thrombosis [PVTT] with Or Without Anticoagulation In 13 Patients Following in Vascular Department, Ttsh, Singapore

1.1. Aim: To look at the clinical outcomes in portal vein tumour thrombosis [PVTT] with or without anticoagulation. 1.2. Method: This study was approved by ethics committee. Patients following up in Vascular department were recruited with retrospective analysis from 2011 to 2016. Patients were classified into 3 groups: Portal vein thrombosis [PVT] with cirrhosis, malignancy, and infections. The biggest group was PVT with malignancy also known as portal vein tumour thrombosis [PVTT]. This group was analysed in this study. Statistical analysis was done with frequency, means, and percentages were calculated. Outcome measures were defined as clot resolution with or without anticoagulation, bleeding, recurrence, death. 1.3. Results: Out of 30 patients of PVT, 13 patients of PVTT were analysed in this study. They were primary hepatocellular carcinoma [HCC] in 4 and secondary HCC in 9 patients. Mean age was 66.8 years [range of 47-91 years]. There were 6 [46.2%] males and 7 [53.8%] females with ethnicity Chinese in 11 [84.6%], 2 [6.7%] Malay, other races 1 [7.7%]. Six patients received anticoagulation and 7 did not receive anticoagulation. 1.Of 6 patients who received anticoagulation, there was complete resolution of thrombus in 1 [16.7%], partial resolution in 0 [0.0%], no resolution in 5 [83.3%]. There was bleeding in 1 [16.7%], there was no recurrence and 4 [66.7%] died during the period of follow-up. 2.Of 7 patients who did not receive anticoagulation, there was complete resolution of thrombus in 0 [0.0%], partial resolution in 0 [0.0%], no resolution in 7 [100%]. There was bleeding in 0 [0.0%], there was recurrence in 0 [0.0%] and 4 [57.1%] died during the period of follow-up 1.4. Conclusion: Anticoagulation is of marginal benefit in terms of mortality in patient with PVTT. The rate of recurrence is similar in patients with or without anticoagulation, however, PVTT patients with anticoagulation is associated with increased risk of bleeding.

СПЕЦИАЛИЗИРОВАННАЯ МЕДИЦИНСКАЯ ПОМОЩЬ ПАЦИЕНТАМ С СЕРДЕЧНО-СОСУДИСТЫМИ ЗАБОЛЕВАНИЯМИ: ОТДЕЛЬНЫЕ АСПЕКТЫ

Significance. Diseases of the circulatory system are a class of diseases of high social importance and a reservoir for reducing mortality and increasing life expectancy, primarily through improving specialized medical care for working-age patients. The purpose of this study is to assess the results of improving specialized medical care for cardiovascular patients under the federal project “Fight against cardiovascular diseases”. Material and Methods. The analysis is based on data from statistical collections of the Federal Research Institute for Health Organization and Informatics of the Ministry of Health of the Russian Federation, and was focused on evaluating target and actual indicators of the federal project “Fight against cardiovascular diseases”. The content analysis of normative legal documents regulating provision of medical care to patients with cardiovascular diseases has been undertaken. Results. Results of the federal project implemented from October 1st, 2018 to December 31st, 2023, are as follows: 374 regional vascular centers and primary vascular departments were re-equipped (retrofitted); more than 310,000 therapeutic X-ray endovascular interventions were performed; 95.5% of patients who underwent through major cardiovascular surgery are provided with free medications; more than 70% of patients with a high risk of acute cardiovascular event are under medical follow-up and received medical care; hospital mortality from myocardial infarction is under 10%, and hospital mortality from acute cerebrovascular accidents is under16.2%. The standardized mortality rate from diseases of the circulatory system in Russia as a whole decreased by 6.0% in 2022 compared to 2018 and equaled to 408.8 per 100,000population. Conclusion. Implementation of the federal project “Fight against cardiovascular diseases” has made it possible to increase effectiveness of specialized medical care delivery in the Russian Federation primarily due to improved material and technical resources of health care facilities. Coverage of cardiovascular patients with quality clinical follow-up is a hard-to-implement component of the overall process of care delivery to such patients, requiring on-going improvements in the implementation approaches. Progress towards this target is the lowest. In order to achieve quality results in reducing morbidity and mortality from cardiovascular diseases, it is important to timely improve the regulatory framework rather than only develop the resource component.

Ischemic stroke in men 18-50 years of age

To evaluate the main modifiable risk factors for ischemic stroke (IS) and features of the course in atherothrombotic, cardioembolic, and lacunar subtypes of IS in men aged 18-50 years. The study included 125 men (the mean age was 42.6±5.3 years) who were admitted to the Vascular department before the COVID-19 pandemic and survived for the first 30 days after IS. Information on patients' baseline characteristics, traditional vascular risk factors, and lifestyle risk factors was systematically collected. Neuroimaging, ultrasound and laboratory tests were performed. Atherothrombotic subtype was identified in 60 patients, lacunar subtype in 46 patients and cardioembolic subtype in 19 patients. In the group as a whole, major risk factors included arterial hypertension (83.2%), dyslipidemia (50.4%), smoking (67.2%), alcohol consumption (29.6%), obesity (16.8%), heart rhythm disorders (12%), and diabetes mellitus (8%). The study revealed the main risk factors, the frequency of which differed depending on the stroke subtype and the age of the patients.

Implementation of a varicose vein module added to Swedvasc, the Swedish National Registry for vascular surgery.

The addition of a varicose veins (VV) module to the existing Swedish National Registry for Vascular Surgery (Swedvasc) and its impact on quality of care were evaluated. Vascular departments and private VV clinics were invited to enter data from 2016. Registrations were approximately 10,000 yearly but dropped to 5390 in 2022 when a fee was introduced for private clinics due to reduced funding. 88% more interventions were reported to Swedvasc 2020 than to the National Board of Health and Welfare. Regions differed in interventions per 100,000 inhabitants/year from 21 to 233 and in preoperative CEAP C4-6 from 30.8%-90.4%. Follow-up was 9.4%. These data contributed to the decision to prioritize the patient group for national guidelines and pathways of care, which will be monitored by Swedvasc. A national VV registry with high coverage is possible and can contribute to national quality of care. The main challenge is funding.

WTP8.2 How the healthcare system fails to provide continued care for patients

Abstract Aims In the current climate of dissatisfaction with the healthcare system due to oversaturation of outpatient services that has left around 7 million people waiting to be seen for the first time, we wanted to evaluate the number of post-surgical patients who have failed to receive appropriate follow-up. Methods We retrospectively looked at all patients admitted under the vascular department at a tertiary centre hospital over a 3-month period. We excluded the following patients from our data collection: 1. Those who passed away in hospital. 2. Those who did not require follow-up after discharge. We looked at the Electronic Patient Records (EPR) to identify if they had been given a follow-up appointment. Results A total of 127 of the 150 patients admitted in the 3 month study period were advised a follow-up in their Electric discharge notifications (EDNs). Of these, 83 patients were admitted electively and 44 as emergencies. For a follow-up appointment to be booked there are two steps: For the elective admissions, 88% had follow-up booked compared to 86% for the emergency admissions. Conclusions Our study shows that the failure to follow up rate was 12-14% despite a dual notification method. This can have an adverse impact on both the quality and continuity of patient care. The system still continues to fail the patients.

WTP8.3 Failing to record consent discussions on clinical records leaves us vulnerable

Abstract Aims Documenting informed consent discussions in patient clinical records is a mandatory requirement by the General Medical Council (GMC). This study aimed to evaluate the adherence to that mandate. Methods We looked at GMC and Royal College of Surgeon’s guidance on consent and its documentation in patients’ records. The recommendations are: We retrospectively looked at the Electronic Patient Record (EPR) of patients admitted for surgery under the Vascular department at a tertiary centre over 3 months. We excluded patients who passed away prior to surgery or needed Consent form 4. Results 136 out of 150 patients admitted for surgery during the study period met the inclusion criteria. Of these, 90 were admitted electively and 46 as emergencies. We found evidence of consent discussion for only 60% (n-54) of the elective admissions and for 59% (n-27) of emergency admissions, through clinic letters or ward entries. For the remaining, there was no recorded EPR documentation of the consenting discussion though all had a consent form signed. Conclusions Although GMC and Royal College of surgeons have clear guidance regarding documentation of consent in patients’ notes, this is often not followed in clinical practice. This leaves the trusts open to future litigation.

Retrospective analysis of cases of transient global amnesia admitted to the hospital

Introduction. Transient global amnesia (TGA) is a clinical syndrome, the main clinical manifestation of which is sudden development of anterograde and retrograde amnesia, lasting not more than 24 hours, without other general cerebral or focal neurological symptoms.The aim of the work was to reveal the peculiarities of clinical manifestations and data of additional methods of examination of patients with TGA syndrome referred to the primary vascular department with suspected acute cerebral circulation disorder (ACCD).Materials and methods. The study included 16 patients with transient global amnesia diagnosed according to the diagnostic criteria of Hodges and Warlow (1990). All patients underwent a detailed neurological and general medical examination. Electrocardiography, multispiral computer tomography of the head, echocardiography, ultrasound duplex scanning of the main arteries of the head and neck, laboratory examination (lipid spectrum) were performed. The Brief Mental Status Rating Scale was used to assess cognitive impairment.Results. The majority of patients had elevated blood pressure (BP). The leading trigger factor of transient global amnesia was stress. The duration of amnesia ranged from 1.5 to 5 hours. There was a significant impairment of short-term memory. On the first and second days of hospitalization, 50% of patients had normal cognitive functions on a brief mental status assessment scale, but by the 5th−7th day only 12.5 % of patients had abnormalities. Ultrasound markers of atherosclerosis in the form of intima-media complex thickening and dyslipidemia were found in 6 patients. Signs of left ventricular hypertrophy were found in the majority of patients. Discussion TGA is a relatively rare condition and an understudied syndrome. Due to its suddenness of clinical manifestation, TGA requires differential diagnostics with acute cerebral circulatory disorders, epilepsy, acute hypertensive encephalopathy and psychogenic amnesia.Conclusion. The clinical features of TGA identified in the patients were a history of arterial hypertension, elevated BP during an episode of TGA. The leading provoking factor was stress. TGA episode occurred predominantly in the first half of the day. The majority of patients had complaints of headache on admission. Cognitive disorders detected in patients on the first and second days of the disease quickly regressed to normal. Left ventricular hypertrophy was detected in most patients.

Trans-Arterial Chemoembolization for the Treatment of Hepatocellular Carcinoma: A Single Tertiary Care Institute Experience

Introduction: Trans-arterial chemoembolization (TACE) is a mainstay therapeutic option indicated in early-stage non- resectable hepatocellular carcinoma (HCC) and has been shown to be associated with survival improvements. This study aimed to evaluate the radiological and clinical response of those who underwent TACE. Aims &amp; Objectives: We aimed to evaluate the radiological and clinical response in patients who underwent Trans- arterial chemoembolization. Place and Duration of Study: This study was conducted in the Vascular Interventional Radiology Department, Dow Institute of Radiology, Dow University of Health Sciences, Ojha Campus Karachi for a period of 18 months between January 2021 and June 2022. Material &amp; Methods: HCC patients (n=181) who underwent TACE as their primary treatment at Dow Hospital Ojha Campus Karachi between January 1st, 2021, and June 30th, 2022 were included. Inclusion criteria followed the Barcelona Clinic Liver Cancer (BCLC) and Child-Pugh staging systems. Tumor response was evaluated using “modified Response Evaluation Criteria in Solid Tumors (mRECIST)”, and patients were categorized into complete response (CR) or partial response (PR) groups. The study compared background, clinico-laboratory, and radiological features between these groups, including HCC sizes and CT scan findings before and after TACE. The retrieved data was entered and analyzed using SPSS version.21. Results: Of the total 118 patients, 51.70% showed CR to the TACE, while PR was noted in 48.30%. Age, sex, viral hepatitis, and co-morbids showed no intergroup differences. However, Child-Pugh stage and BCLC were significantly associated with tumor response. Similarly, laboratory parameters revealed significant mean differences between the two groups (p&lt;0.001), except international normalized ratio and alanine transaminase. Those who had achieved CR had a mean number of tumor less than that of PR. Similarly, tumor size significantly decreased post-TACE (p&lt;0.0001). Moreover, arterial-phase enhancement and portal venous and delayed phases washout tumors before TACE were reported in 76.30%. Over half of the patients had no residual tumor tissue after TACE. Tumors with arterial-phase enhancement and portal venous and delayed phases washout were highly susceptible to TACE.Furthermore, Child-Pugh classA had a greater estimated mean survival than class B (p&lt;0.001). Conclusion: Over half of the patients showed complete response to the TACE. BCLC staging (B), Child-Pugh (stage A), and small tumors had a favourable effect on the radiological and clinical response in the early-stages of HCC. Tumors with an arterial-phase enhancement and portal venous and delayed phases washout were more susceptible to TACE.

Patient experiences of closed-incision negative pressure therapy on groin incisions after discharge following peripheral arterial surgery: A qualitative study

BackgroundClosed-incision negative pressure therapy may lower the risk of surgical site infections in patients after peripheral arterial surgery. AimTo explore patient experience of negative pressure therapy applied to groin incisions after discharge following peripheral arterial surgery, and to study their perception and attitudes toward the self-care information sheet they received at the vascular department. MethodsA qualitative study underpinned by Gadamer's philosophical hermeneutics was conducted semi-structured interviews by telephone around day seven after therapy ended with ten participants. All had received self-care information sheet at the discharge and been home with closed-incision negative pressure therapy for 3-6 days. The participants had open peripheral arterial surgery in the groin in form of femoral thromboendarterectomy. Kvale and Brinkmann's research guided the data collection, analysis, and interpretation. FindingsPatients found themselves coping with an unfamiliar situation after peripheral arterial surgery and the need arose to conceal the pump and tubing that were part of their incision treatment to protect their self-image. Their treatment became a constant companion, with some patients viewing the equipment as an extension of their bodies and others feeling its impact on activities of daily living. Patients perceived the treatment as providing reassurance, albeit with constraints, leading to feelings of manageability and an increasing sense of control. They viewed the written information as informative but with room for improvement. ConclusionsPatient experiences of closed-incision negative pressure therapy on groin incisions after discharge following peripheral arterial surgery showed that they perceived it as safe and manageable. Patients need support, however, in learning how to hide the treatment and to expand their own involvement and improve self-care. The study found that patient involvement and individually tailored information is essential to facilitating a healthy transition from hospital to self-care at home and that written information must be improved further.