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Publications (793)
Introduction: Postthrombotic syndrome (PTS) describes a condition arising after an acute deep venous thrombosis (DVT) that is characterised by leg heaviness, discomfort, and recurrent venous ulceration. Venous disease is associated with significant morbidity and impairment of mobility due to pain, infection, and oedema.
Report: We present a patient...
Introduction: Carotid webs (CaW) are non-atherosclerotic fibrous bands which present as shelf-like linear intraluminal filling defects at the carotid bulb or internal carotid artery. They are a known cause of cryptogenic strokes. Current management includes medical, interventional (stenting) and surgical approaches.
Aims: The aim of this review was...
Introduction: Superficial endovenous intervention is the recommended treatment for symptomatic varicose veins. However, venous thromboembolism (VTE) remains a known complication. Guidelines, including those from the National Institute for Health and Care Excellence (NICE) and European Society for Vascular Surgery (ESVS), are largely opinion-based a...
Peripheral arterial disease (PAD) affects over 236 million people globally, with endovascular treatment as the predominant mode of revascularization. While pre-procedural lesion assessment typically relies on non-invasive Doppler measurement, invasive physiological assessment offers a promising approach to guide lesion selection and provide real-ti...
Background
Venous leg ulcers (VLUs) cause significant impairment to patients’ quality of life (QoL) and up to 30% do not heal at 6 months. Decellularized dermis (DCD) allografts have been shown to be effective in improving healing rates of diabetic foot ulcers in RCTs. The DAVE RCT aimed to determine whether DCD is an effective, safe, and cost-effe...
Natural Language Processing (NLP) has the potential to revolutionise clinical research utilising Electronic Health Records (EHR) through the automated analysis of unstructured free text. Despite this potential, relatively few applications have entered real-world clinical practice. This paper aims to introduce the whole pipeline of NLP methodologies...
Introduction
Venous leg ulcers (VLU) are the most severe manifestation of venous insufficiency and carry a poor prognosis because of delayed healing and recurrent ulceration. Pentoxifylline (PTX) is an example of a vasoactive medication that can be used alongside compression therapy to help improve ulcer healing rates. A previous review highlighted...
Objectives
Evaluation of the literature assessing the use of thermography, a non-invasive imaging modality that detects pathological temperature variation, in recognising superficial venous insufficiency (SVI).
Methods
A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideli...
Surgical inpatients are at increased risk of venous thromboembolism (VTE). Current national guidelines recommend a combination of pharmacological (chemoprophylaxis) and mechanical thromboprophylaxis to reduce VTE risk. For most patients, mechanical thromboprophylaxis is provided via application of graduated compression stockings (GCS). This editori...
Background
Inadvertent intra-arterial injection of sclerosants is an uncommon adverse event of both ultrasound-guided and direct vision sclerotherapy. This complication can result in significant tissue or limb loss and significant long-term morbidity.
Objectives
To provide recommendations for diagnosis and immediate management of an unintentional...
Objective
Patients with chronic venous disease (CVD) can present with different underlying hemodynamic abnormalities affecting the deep, superficial, and perforator veins. This review explores the relationship between reflux patterns, extent of venous reflux, and clinical manifestations of CVD.
Methods
The Medline and EMBASE databases were searche...
Objective
To review the current approaches to the diagnosis of Post-Thrombotic Syndrome (PTS) and to evaluate the potential need for a diagnostic tool.
Method
Medical specialists were invited to participate in an online survey of their current approaches to the diagnosis and management of PTS, including the use of scoring systems, diagnostic imagi...
Objective
There is increasing recognition that health systems need to measure and improve the value of patient care by measuring outcomes. Chronic pelvic pain secondary to pelvic venous insufficiency can have a significant impact on the quality of life (QOL) of women affected. Despite growing recognition, pelvic venous disorders (PeVDs), an importa...
Objective: To assess a potential efficacy signal, safety and feasibility of neuromuscular electrical stimulation (NMES) therapy as an adjunct to standard care in patients with diabetic sensorimotor polyneuropathy (DSPN). Methods: In this single-centre, prospective, cohort, proof-of-concept study, 25 patients with DSPN consented to at least one dail...
Dysregulated lipid metabolism is implicated in the pathophysiology of a range of kidney diseases. The specific mechanisms through which lipotoxicity contributes to acute kidney injury (AKI) remain poorly understood. Herein we review the cardinal features of lipotoxic injury in ischemic kidney injury; lipid accumulation and mitochondrial lipotoxicit...
Introduction
Endovenous therapy is the first choice management for symptomatic varicose veins in NICE guidelines, with 56–70 000 procedures performed annually in the UK. Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a known complication of endovenous therapy, occurring at a rate of up to 3.4%. De...
Venous thromboembolism (VTE), notably deep venous thrombosis (DVT), represents a significant cardiovascular disease with high morbidity from post-thrombotic syndrome (PTS). Recent advancements in early thrombus removal technologies have prompted randomized controlled trials (RCT) to assess their efficacy and safety, particularly for iliofemoral DVT...
Introduction:
The aim of this systematic review was to identify the evidence in the literature for limb salvage with the introduction of duplex surveillance.
Methods:
A systematic review and meta-analysis was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines (PRISMA) methodology for all studies whi...
Objective
The evidence for post-foam sclerotherapy compression stockings for varicose veins is limited. Thus, we examined the effects of post-procedural compression stockings on varicose vein patients undergoing foam sclerotherapy.
Methods
The CONFETTI study was a prospective, single-center, randomized controlled trial. Patients with foam scleroth...
Introduction: It remains unclear whether patients undergoing endovenous thermal ablation (EVTA) for superficial venous incompetence (SVI) should receive pharmacological thromboprophylaxis. A survey was conducted to assess current thromboprophylaxis practices across the UK in patients undergoing EVTA for SVI. Methods: To examine the thromboprophylax...
Vascular compression syndromes, including median arcuate ligament syndrome (MALS) and nutcracker syndrome (NCS), are poorly understood and frequently delayed diagnoses. This case describes a young adult female presenting with chronic vomiting, abdominal pain and weight loss, with dependence on nasogastric feeding. Subsequent to her gastrointestinal...
Objective
This systematic review and meta-analysis compares the rate of venous thromboembolism (VTE) in surgical inpatients with pharmacological thromboprophylaxis and additional graduated compression stockings (GCS) versus pharmacological thromboprophylaxis alone.
Summary Background Data
Surgical inpatients have elevated VTE risk; recent studies...
Methods
This was an open, multicentre, randomized controlled trial. Patients with intermittent claudication attending vascular surgery outpatient clinics were randomized (1:1) to receive either neuromuscular electrical stimulation (NMES) or not in addition to local standard care available at study centres (best medical therapy alone or plus supervi...
Background
Peripheral arterial disease is common and associated with increased cardiovascular morbidity and mortality. While patients with peripheral arterial disease are known to benefit from supervised exercise therapy, it is not always available. Neuromuscular electrical stimulation devices may offer a similar benefit. A randomised controlled tr...
Aims
To describe hypertension-related cardiovascular magnetic resonance (CMR) phenotypes in the UK Biobank considering variations across patient populations.
Methods and results
We studied 39 095 (51.5% women, mean age: 63.9 ± 7.7 years, 38.6% hypertensive) participants with CMR data available. Hypertension status was ascertained through health re...
Objective:
Post-thrombotic syndrome (PTS) is a common complication of deep vein thrombosis (DVT) that can result in significant morbidity for the patient with detrimental impact on their quality of life. Evidence supporting lytic catheter-based interventions (LCBI) undertaken for early thrombus reduction in acute proximal DVT for the prevention of...
Background:
Sclerotherapy is a non-invasive procedure commonly used to treat superficial venous disease, vascular malformations and other ectatic vascular lesions. While extremely rare, sclerotherapy may be complicated by serious adverse events.
Objectives:
To categorise contraindications to sclerotherapy based on the available scientific eviden...
Introduction
Diabetic foot ulceration (DFU) is a common and challenging complication of diabetes. Risk stratification can guide further management. We aim to evaluate the prognostic performance of bedside tests used for peripheral arterial disease (PAD) diagnosis to predict DFU healing.
Research design and methods
Testing for Arterial Disease in D...
Objectives
To investigate the acceptability and safety of neuromuscular stimulation (NMES) as an adjunct for rehabilitation after vascular and general surgery.
Methods and analysis
Prospective, single-centre, single-blind, parallel group, randomised controlled study. This study will be conducted in a single-centre, secondary care setting (National...
Introduction: Following acute iliofemoral deep vein thrombosis (DVT), early thrombus removal may reduce the risk of subsequent post-thrombotic syndrome (PTS). For those with established chronic venous disease (CVD) secondary to obstructing iliac vein lesions, venoplasty and venous stenting can be used to restore patency. Currently, these interventi...
Introduction
Peripheral arterial disease (PAD) is a key risk factor for cardiovascular disease, foot ulceration and lower limb amputation in people with diabetes. Early diagnosis of PAD can enable optimisation of therapies to manage these risks. Its diagnosis is fundamental, though challenging in the context of diabetes. Although a variety of diagn...
International evidence-based guidelines recommend preoperative duplex ultrasound mapping in the assessment of chronic venous disease, and concurrent ultrasound imaging to guide superficial endovenous interventions such as endovenous laser ablation, radiofrequency ablation, cyanoacrylate adhesive closure, and sclerotherapy (ultrasound-guided sclerot...
Objectives:
To identify the rate of post-thrombotic syndrome (PTS) after isolated distal deep venous thrombosis (IDDVT) by performing a meta-analysis of the rate of PTS across randomised and observational studies.
Data sources:
MEDLINE, Embase, the Cochrane Controlled Trials Register, Clinicaltrials.gov, European Union Clinical Trials, Internati...
Objective:
The primary objective of this systematic review and meta-analysis was to elucidate the rate of venous thromboembolism (VTE) following endovenous varicose vein intervention with mechanical thromboprophylaxis and additional pharmacological thromboprophylaxis, versus mechanical thromboprophylaxis alone.
Summary background data:
The VTE r...
Objective
National guidelines in the United Kingdom recommend regular exercise for individuals with venous leg ulceration, yet data for the effect of exercise on ulcer healing and recurrence are sparse. This study aimed to quantify the evidence for exercise in venous ulcer healing with respect to the primary outcomes of proportion of healed ulcers...
Objectives
The aim of this study was to investigate whether symptomatic atherosclerotic vascular disease (SAVD) was associated with graft survival in primary kidney transplant recipients.
Summary background data
Recipient atherosclerotic vascular disease is associated with increased mortality rates amongst renal transplant patients. However, its r...
Objectives
Exercise improves haemodynamic parameters in patients with chronic venous disease. There is a paucity of evidence on its effect in post-thrombotic syndrome (PTS). The aim of this systematic review is to assess the impact of exercise in PTS.
Methods
Adhering to PRISMA guidelines and following PROSPERO registration (CRD42021220924), MEDLI...
Background
Current guidelines do not recommend screening for asymptomatic carotid artery stenosis (AsxCS). The rationale behind this recommendation is that detection of AsxCS may lead to an unnecessary carotid intervention. In contrast, screening for abdominal aortic aneurysms is strongly recommended.
Methods
A critical analysis of the literature...
International evidence-based guidelines recommend preoperative duplex ultrasound mapping in the assessment of chronic venous disease (CVD), and concurrent ultrasound imaging to guide superficial endovenous interventions such as endovenous laser ablation (EVLA), radiofrequency ablation (RFA), cyanoacrylate adhesive closure (CAC) and sclerotherapy (u...
Introduction
Diabetic foot ulceration is a devasting complication of diabetes contributing to significant morbidity. Delayed wound healing leads to limb loss and associated stress, anxiety and depression. Apart from systemic inflammatory markers and qualitative assessment of the ulcers, there is no molecular biomarker that can help prognosticate th...
Introduction
Varicose veins are prevalent throughout the UK population, affecting a third of adults. Various treatments exist and must be validated by rigorous testing. Randomised control trials (RCTs) are the accepted gold standard in the hierarchy of evidence, comparing the effectiveness of interventions. Poor recruitment is common among surgical...
A systematic review and meta-analysis of the pooled rate of VTE after endovenous intervention for varicose. vein surgery. The study demonstrates the rate of DVT is x4 lower in pooled randomised controlled trial arms with additional anticoagulation, as compared to compression therapy alone.
Varicose veins are common and have a negative impact on people's quality of life. Treatment has been shown to improve the quality of life in those affected and is endorsed by international clinical practice guidelines. In the UK, traditional techniques of saphenofemoral and saphenopopliteal junctional ligation with or without stripping have been la...
Recomendación 1.1: Compresión después de ablación térmica o escisión de venas safenas. Cuando sea posible, sugerimos que se debe usar compresión (medias elásticas o vendaje) después de procedimientos quirúrgicos o térmicos, para eliminar venas varicosas. [GRADO 2; NIVEL DE EVIDENCIA - C] Recomendación 1.2:Dosis de compresión posterior a ablación té...
International guidelines strongly recommend statins alone or in combination with other lipid-lowering agents to lower low-density lipoprotein cholesterol (LDL-C) levels for patients with asymptomatic/symptomatic carotid stenosis (AsxCS/SCS). Lowering LDL-C levels is associated with significant reductions in transient ischemic attack, stroke, cardio...
Objectives
This study aims to examine uptake and dissemination of a National Institute for Health Research (NIHR) Health Technology Assessment (HTA)–funded trial – Graduated compression as an Adjunct to Pharmaco-thromboprophylaxis in Surgery (GAPS) (project number: 14/140/61) amongst health professionals in the UK. This study aims to evaluate the i...
Despite the publication of several national/international guidelines, the optimal management of patients with asymptomatic carotid stenosis (AsxCS) remains controversial. This article compares 3 recently released guidelines (the 2020 German–Austrian, the 2021 European Stroke Organization [ESO], and the 2021 Society for Vascular Surgery [SVS] guidel...
Importance:
Endovenous thermal ablations (ETAs) are recommended as first-line treatment for truncal vein reflux, have a short recovery time, and are cost-effective. However, ETAs are associated with discomfort during tumescent anesthesia infiltration. To minimize discomfort, nonthermal, nontumescent ablation techniques had emerged in the form of m...
Objectives
Venous stenting of the lower extremities has grown in popularity and is now considered a key component of the primary treatment strategy for the management of pathologically obstructive or stenotic lesions of the deep venous system. This review aims to provide an overview of the role of venous stenting in the management of chronic condit...
Aim
National guidelines recommend regular exercise for individuals with venous leg ulceration, yet data for the effect of exercise on ulcer healing and recurrence are sparse. This study aimed to quantify the evidence for exercise in venous ulcer healing with the primary outcomes of proportion of healed ulcers and rate of ulcer recurrence. Secondary...
Compression encompasses a range of therapies used to provide an externally applied graduated pressure greater at the ankle than the knee aiming to improve venous function and decrease lower limb swelling (Lim and Davies, Graduated compression stockings [Internet], 2020). Graduated compression stockings are elastic stockings that exert the greatest...
Lymphoedema is estimated to affect up to 15% of the global population. Patients with this “forgotten vascular disease” often fail to receive the complex comprehensive multidisciplinary care they need, leading to reduced health-related quality of life (HRQoL). This chapter focuses on the literature regarding the impact of lower limb lymphoedema on p...
Objectives
The recommendations of international guidelines for the management of asymptomatic carotid stenosis (ACS) often vary considerably and extend from a conservative approach with risk factor modification and best medical treatment (BMT) alone, to a more aggressive approach with a carotid intervention plus BMT. The aim of the current multispe...
Objectives:
The recommendations of international guidelines for the management of asymptomatic carotid stenosis (ACS) often vary considerably and extend from a conservative approach with risk factor modification and best medical treatment (BMT) alone, to a more aggressive approach with a carotid intervention plus BMT. The aim of the current multis...
Objective
Nickel allergy is common; endovascular specialists are often confronted with nickel allergic patients ahead of the implantation of endovascular devices, many of which are nickel-containing. Our aim was to elucidate whether nickel hypersensitivity is significantly associated with worse or adverse outcomes after placement of a nickel-contai...
Web-based health care content has emerged as a primary source for patients to access health information without direct guidance from health care providers. The benefit of this approach is dependent on the ability of patients to access engaging high-quality information, but significant variability in the quality of web-based information often forces...
Objective
Pelvic venous reflux (PVR) can present with symptoms such as chronic pelvic pain (CPP), dysmenorrhoea, and dyspareunia, resulting in reduced quality of life amongst those affected. Percutaneous coil embolisation (CE) is a common intervention for PVR, however the efficacy and safety of its use in isolation has yet to be reviewed.
Methods...
Objective
To analyze the effectiveness and cost-effectiveness of technologies for treatment of varicose veins over 5 years - conservative care (CONS), surgery (HL/S), ultrasound guided foam sclerotherapy (UGFS), endovenous laser ablation (EVLA), and radiofrequency ablation (RFA), mechanochemical ablation (MOCA) and cyanoacrylate glue occlusion (CAE...
Introduction
A number of factors have reportedly been associated with venous leg ulceration (VLU) however many of these remain disputed. UK Biobank (UKB) is an electronic dataset that provides in-depth detail on the lives of its participants. The aim of this research is to utilise UKB to understand factors associated with VLU.
Methods
Participants...
The optimal management of patients with asymptomatic carotid stenosis (ACS) is the subject of extensive debate. According to the 2017 European Society for Vascular Surgery guidelines, carotid endarterectomy should (Class IIa; Level of Evidence: B) or carotid artery stenting may be considered (Class IIb; Level of Evidence: B) in the presence of one...
Objective:
The aim of this study was to identify potential biomarkers predictive of healing or failure to heal in a population with venous leg ulceration.
Summary background data:
Venous leg ulceration presents important physical, psychological, social and financial burdens. Compression therapy is the main treatment, but it can be painful and ti...
The optimal management of patients with asymptomatic carotid stenosis (ACS) is the subject of extensive debate. According to the 2017 European Society for Vascular Surgery guidelines, carotid endarterectomy should (Class IIa; Level of Evidence: B) or carotid artery stenting may be considered (Class IIb; Level of Evidence: B) in the presence of one...
