Pub Date : 2023-08-31DOI: 10.54522/jvsgbi.2023.089
I Chetter
Welcome to the August 2023 edition of the Journal of Vascular Societies Great Britain and Ireland (JVSGBI) which contains two highly topical editorials, four excellent original research articles, and two case reports.
{"title":"Editor’s foreword","authors":"I Chetter","doi":"10.54522/jvsgbi.2023.089","DOIUrl":"https://doi.org/10.54522/jvsgbi.2023.089","url":null,"abstract":"Welcome to the August 2023 edition of the Journal of Vascular Societies Great Britain and Ireland (JVSGBI) which contains two highly topical editorials, four excellent original research articles, and two case reports.","PeriodicalId":489502,"journal":{"name":"Journal of Vascular Societies Great Britain & Ireland","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135890502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-31DOI: 10.54522/jvsgbi.2023.088
JVSGBI is owned by the Vascular Society for Great Britain and Ireland (VSGBI), for all affiliated societies and the wider vascular community. Here’s the latest news from each society
{"title":"Updates from the Vascular Societies","authors":"","doi":"10.54522/jvsgbi.2023.088","DOIUrl":"https://doi.org/10.54522/jvsgbi.2023.088","url":null,"abstract":"JVSGBI is owned by the Vascular Society for Great Britain and Ireland (VSGBI), for all affiliated societies and the wider vascular community. Here’s the latest news from each society","PeriodicalId":489502,"journal":{"name":"Journal of Vascular Societies Great Britain & Ireland","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135890500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.54522/jvsgbi.2023.093
KW Fung, M Szybka, T Lane, S Kreckler
Objective: Non-attendance for National Abdominal Aortic Aneurysm Screening Program (NAAASP) screening scans results in a lost opportunity to improve public health and has financial implications for the healthcare system as a whole. This study aimed to assess the spatio-temporal distribution of the ‘did-not-attend’ (DNA) rate and identify high-risk geographical areas and associated risk factors for future policy making and allocation of healthcare resources. Methods: This was a retrospective spatio-temporal analysis of non-attendance to the NAAASP in Cambridgeshire, Peterborough and West Suffolk from 2018 to 2022. With the data from the national AAA screening system, Screening Management and Referral Tracking (SMaRT), the DNA rate was established for each postcode district and compared with the overall DNA rate. Using the number of ‘non-attenders’ in each postcode district, optimised hotspot analysis was performed to identify hotspots of non-attendance for each year between 2018 and 2022. Multiple logistic regression was used to investigate the association between degree of deprivation and non-attendance. Results: Overall, 6,364 of 23,957 people (26.6%) being called for screening did not attend from 2018 to 2022. Optimised hotspot analysis identified eight statistically significant hotspots of non-attendance. Postcode districts PE10 (n=8, 80%), PE1 (n=433, 44.5%), CB4 (n=331, 40.2%), CB3 (n=114, 36.7%) and CB1 (n=320, 35.8%) were identified as areas with statistically significantly higher DNA rates. PE1, CB1, CB3 and CB4 were high-risk areas with both high DNA rates and high numbers of non-attenders. A consistent spatial pattern of hotspots was observed while there was a significant drop in the DNA rate in 2020/21. While degree of deprivation was closely linked to non-attendance in Peterborough, the link was less obvious in Cambridge with little socioeconomic deprivation. Conclusion: PE1, CB1, CB3 and CB4 were identified as high-risk postcodes. These areas comprise 12.6% of the total screened population. The degree of deprivation is found to be a major contributing factor to non-attendance. Focusing resources to try and improve attendance in these cohorts should be a more cost-effective approach than targeting the population as a whole. Future research is needed to explore the risk factors associated with high non-attendance in these postcode districts in order to identify actions to improve uptake and access to the screening services.
{"title":"Spatio-temporal analysis of non-attendance for the National Abdominal Aortic Aneurysm Screening Program in Cambridgeshire, Peterborough and West Suffolk region between 2018 and 2022 and its link to socioeconomic deprivation","authors":"KW Fung, M Szybka, T Lane, S Kreckler","doi":"10.54522/jvsgbi.2023.093","DOIUrl":"https://doi.org/10.54522/jvsgbi.2023.093","url":null,"abstract":"Objective: Non-attendance for National Abdominal Aortic Aneurysm Screening Program (NAAASP) screening scans results in a lost opportunity to improve public health and has financial implications for the healthcare system as a whole. This study aimed to assess the spatio-temporal distribution of the ‘did-not-attend’ (DNA) rate and identify high-risk geographical areas and associated risk factors for future policy making and allocation of healthcare resources. Methods: This was a retrospective spatio-temporal analysis of non-attendance to the NAAASP in Cambridgeshire, Peterborough and West Suffolk from 2018 to 2022. With the data from the national AAA screening system, Screening Management and Referral Tracking (SMaRT), the DNA rate was established for each postcode district and compared with the overall DNA rate. Using the number of ‘non-attenders’ in each postcode district, optimised hotspot analysis was performed to identify hotspots of non-attendance for each year between 2018 and 2022. Multiple logistic regression was used to investigate the association between degree of deprivation and non-attendance. Results: Overall, 6,364 of 23,957 people (26.6%) being called for screening did not attend from 2018 to 2022. Optimised hotspot analysis identified eight statistically significant hotspots of non-attendance. Postcode districts PE10 (n=8, 80%), PE1 (n=433, 44.5%), CB4 (n=331, 40.2%), CB3 (n=114, 36.7%) and CB1 (n=320, 35.8%) were identified as areas with statistically significantly higher DNA rates. PE1, CB1, CB3 and CB4 were high-risk areas with both high DNA rates and high numbers of non-attenders. A consistent spatial pattern of hotspots was observed while there was a significant drop in the DNA rate in 2020/21. While degree of deprivation was closely linked to non-attendance in Peterborough, the link was less obvious in Cambridge with little socioeconomic deprivation. Conclusion: PE1, CB1, CB3 and CB4 were identified as high-risk postcodes. These areas comprise 12.6% of the total screened population. The degree of deprivation is found to be a major contributing factor to non-attendance. Focusing resources to try and improve attendance in these cohorts should be a more cost-effective approach than targeting the population as a whole. Future research is needed to explore the risk factors associated with high non-attendance in these postcode districts in order to identify actions to improve uptake and access to the screening services.","PeriodicalId":489502,"journal":{"name":"Journal of Vascular Societies Great Britain & Ireland","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135550076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.54522/jvsgbi.2023.092
E Chan, S Pathmanathan, J Sultan
Peripheral arterial disease (PAD) has been recognised as a healthcare burden affecting up to 5.56% of the global population over 25 years of age.1 Intermittent claudication (IC) is often debilitating and results in reduced physical activity which is associated with increased cardiovascular disease and all-cause mortality.2,3 Early identification and management of PAD is essential to improve symptoms and prevent a downward trajectory towards limb loss. Supervised exercise therapy (SET) is the widely recommended first-line treatment for IC. Despite the benefits of SET, uptake and adherence rates are recognised to be poor.4 The reasons for poor SET compliance are multifactorial and include time constraints, travelling distance, personal, financial and institutional barriers.5 To overcome these barriers, alternative methods for delivering SET need to be explored.
{"title":"Supervised exercise therapy apps for claudication","authors":"E Chan, S Pathmanathan, J Sultan","doi":"10.54522/jvsgbi.2023.092","DOIUrl":"https://doi.org/10.54522/jvsgbi.2023.092","url":null,"abstract":"Peripheral arterial disease (PAD) has been recognised as a healthcare burden affecting up to 5.56% of the global population over 25 years of age.1 Intermittent claudication (IC) is often debilitating and results in reduced physical activity which is associated with increased cardiovascular disease and all-cause mortality.2,3 Early identification and management of PAD is essential to improve symptoms and prevent a downward trajectory towards limb loss. Supervised exercise therapy (SET) is the widely recommended first-line treatment for IC. Despite the benefits of SET, uptake and adherence rates are recognised to be poor.4 The reasons for poor SET compliance are multifactorial and include time constraints, travelling distance, personal, financial and institutional barriers.5 To overcome these barriers, alternative methods for delivering SET need to be explored.","PeriodicalId":489502,"journal":{"name":"Journal of Vascular Societies Great Britain & Ireland","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135838183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.54522/jvsgbi.2023.094
C Bishop, T El-Sayad, B Baljer, E Buckley, J Convill, G Rowlands, R Bell, S Nandhra
Introduction: Research has suggested a relationship between health literacy, socioeconomic status and health-related outcomes. The aim of the study was to study the association between health literacy, socioeconomic status and outcomes following infra-inguinal bypass surgery for chronic limb-threatening ischaemia (CLTI). Methods: Patients with CLTI undergoing lower limb surgical bypass graft operations between January 2016 and December 2018 were included in a cross-sectional observational study. The HLS19-Q12 questionnaire categorised participant’s health literacy as inadequate, problematic, sufficient or excellent. Socioeconomic status was assessed using the Index of Multiple Deprivation (IMD). Primary outcomes were major lower limb amputation (MLLA) and adverse cardiovascular events. Secondary outcomes included length of hospital stay, and early postoperative complications including pneumonia, surgical site and graft infection. Kaplan–Meier survival curves were used to compare health literacy and amputation, and Cox proportional regression analysis was conducted to identify differences in limb loss risk against health literacy and social deprivation levels. Results: The study consisted of 50 patients with an average age of 70±8.7 years. The participants’ levels of health literacy were classified as inadequate (28%), problematic (38%), sufficient (24%) or excellent (10%). Approximately 40% of the patients lived in the most deprived areas. While all health literacy groups had similar postoperative outcomes, low health literacy was connected with lower socioeconomic status (r=0.308, p=0.029). IMD (p=0.017, HR 0.502 (95% CI 0.285 to 0.883)) and haemoglobin (p=0.001, HR 0.919 (95% CI 0.872 to 0.968)) were significant predictors of MLLA. Conclusion: Patients with lower health literacy are more likely to face higher levels of social deprivation, which may predict amputation following bypass surgery. Enhancing health literacy could play a role in reducing health disparities caused by social deprivation, thereby potentially addressing a vascular James Lind Alliance priority.
研究表明，健康素养、社会经济地位和健康相关结果之间存在关系。本研究的目的是研究健康素养、社会经济地位和腹股沟下旁路手术治疗慢性肢体威胁性缺血(CLTI)后预后之间的关系。方法:将2016年1月至2018年12月期间接受下肢搭桥手术的CLTI患者纳入一项横断面观察研究。HLS19-Q12问卷将参与者的健康素养分为不足、有问题、充分或优秀。使用多重剥夺指数(IMD)评估社会经济地位。主要结局是严重下肢截肢(MLLA)和不良心血管事件。次要结局包括住院时间和早期术后并发症，包括肺炎、手术部位和移植物感染。Kaplan-Meier生存曲线用于比较健康素养和截肢，并进行Cox比例回归分析，以确定健康素养和社会剥夺水平在肢体丧失风险方面的差异。结果:纳入50例患者，平均年龄70±8.7岁。参与者的健康素养水平分为不足(28%)、有问题(38%)、充分(24%)和优秀(10%)。大约40%的患者生活在最贫困的地区。虽然所有健康素养组的术后结果相似，但低健康素养与较低的社会经济地位相关(r=0.308, p=0.029)。IMD (p=0.017, HR 0.502 (95% CI 0.285 ~ 0.883))和血红蛋白(p=0.001, HR 0.919 (95% CI 0.872 ~ 0.968))是MLLA的显著预测因子。结论:健康素养较低的患者更有可能面临较高程度的社会剥夺，这可能预示着搭桥手术后的截肢。提高卫生知识素养可以在减少社会剥夺造成的健康差距方面发挥作用，从而有可能解决詹姆斯·林德联盟的血管优先事项。
{"title":"Effect of health literacy and socioeconomic deprivation on outcomes after lower limb surgical revascularisation for chronic limb-threatening ischaemia: the HeaLTHI study","authors":"C Bishop, T El-Sayad, B Baljer, E Buckley, J Convill, G Rowlands, R Bell, S Nandhra","doi":"10.54522/jvsgbi.2023.094","DOIUrl":"https://doi.org/10.54522/jvsgbi.2023.094","url":null,"abstract":"Introduction: Research has suggested a relationship between health literacy, socioeconomic status and health-related outcomes. The aim of the study was to study the association between health literacy, socioeconomic status and outcomes following infra-inguinal bypass surgery for chronic limb-threatening ischaemia (CLTI). Methods: Patients with CLTI undergoing lower limb surgical bypass graft operations between January 2016 and December 2018 were included in a cross-sectional observational study. The HLS19-Q12 questionnaire categorised participant’s health literacy as inadequate, problematic, sufficient or excellent. Socioeconomic status was assessed using the Index of Multiple Deprivation (IMD). Primary outcomes were major lower limb amputation (MLLA) and adverse cardiovascular events. Secondary outcomes included length of hospital stay, and early postoperative complications including pneumonia, surgical site and graft infection. Kaplan–Meier survival curves were used to compare health literacy and amputation, and Cox proportional regression analysis was conducted to identify differences in limb loss risk against health literacy and social deprivation levels. Results: The study consisted of 50 patients with an average age of 70±8.7 years. The participants’ levels of health literacy were classified as inadequate (28%), problematic (38%), sufficient (24%) or excellent (10%). Approximately 40% of the patients lived in the most deprived areas. While all health literacy groups had similar postoperative outcomes, low health literacy was connected with lower socioeconomic status (r=0.308, p=0.029). IMD (p=0.017, HR 0.502 (95% CI 0.285 to 0.883)) and haemoglobin (p=0.001, HR 0.919 (95% CI 0.872 to 0.968)) were significant predictors of MLLA. Conclusion: Patients with lower health literacy are more likely to face higher levels of social deprivation, which may predict amputation following bypass surgery. Enhancing health literacy could play a role in reducing health disparities caused by social deprivation, thereby potentially addressing a vascular James Lind Alliance priority.","PeriodicalId":489502,"journal":{"name":"Journal of Vascular Societies Great Britain & Ireland","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135704360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.54522/jvsgbi.2023.096
S Whittley, M Machin, L Burgess, S Onida, D Carradice, AH Davies
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 thromboprophylaxis practices of clinicians performing EVTA for SVI in the UK, an online survey was developed using the Qualtrics online survey tool. The survey link was circulated via email to members of the multidisciplinary collaborative Vascular and Endovascular Research Network (VERN) and promoted through social media. The primary focus of the survey was to gather information regarding venous thromboembolism (VTE) prophylaxis during EVTA for SVI. Results: A total of 32 vascular surgeons and one vascular nurse specialist based in the UK participated in the survey. All respondents reported routine prescription of compression therapy in the immediate postoperative period. Of all the respondents, 67% (n=22) reported routine prescription of pharmacological thromboprophylaxis during the peri-procedural period. Extended prophylaxis was routinely offered by 15% (n=5) of all respondents. Among those who provided extended prophylaxis, the majority (80%, n=4) used low molecular weight heparin (LMWH), while 20% (n=1) opted for a direct-acting oral anticoagulant (DOAC). Conclusion: The findings from this survey indicate that a significant proportion of patients undergoing EVTA for SVI routinely receive pharmacological thromboprophylaxis, with a single perioperative dose of LMWH being the prevailing practice. However, there is a notable lack of robust high-quality evidence to substantiate this practice. Grade A evidence is required to assess the potential benefit of pharmacological thromboprophylaxis in the context of EVTA to guide the development of clinically relevant guidelines. Should pharmacological thromboprophylaxis prove to offer no additional benefit for this specific patient population, this could result in cost savings for the NHS and enable patients to avoid unwanted side effects associated with anticoagulation therapy.
{"title":"Thromboprophylaxis strategies in patients undergoing endovenous thermal ablation: a UK survey","authors":"S Whittley, M Machin, L Burgess, S Onida, D Carradice, AH Davies","doi":"10.54522/jvsgbi.2023.096","DOIUrl":"https://doi.org/10.54522/jvsgbi.2023.096","url":null,"abstract":"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 thromboprophylaxis practices of clinicians performing EVTA for SVI in the UK, an online survey was developed using the Qualtrics online survey tool. The survey link was circulated via email to members of the multidisciplinary collaborative Vascular and Endovascular Research Network (VERN) and promoted through social media. The primary focus of the survey was to gather information regarding venous thromboembolism (VTE) prophylaxis during EVTA for SVI. Results: A total of 32 vascular surgeons and one vascular nurse specialist based in the UK participated in the survey. All respondents reported routine prescription of compression therapy in the immediate postoperative period. Of all the respondents, 67% (n=22) reported routine prescription of pharmacological thromboprophylaxis during the peri-procedural period. Extended prophylaxis was routinely offered by 15% (n=5) of all respondents. Among those who provided extended prophylaxis, the majority (80%, n=4) used low molecular weight heparin (LMWH), while 20% (n=1) opted for a direct-acting oral anticoagulant (DOAC). Conclusion: The findings from this survey indicate that a significant proportion of patients undergoing EVTA for SVI routinely receive pharmacological thromboprophylaxis, with a single perioperative dose of LMWH being the prevailing practice. However, there is a notable lack of robust high-quality evidence to substantiate this practice. Grade A evidence is required to assess the potential benefit of pharmacological thromboprophylaxis in the context of EVTA to guide the development of clinically relevant guidelines. Should pharmacological thromboprophylaxis prove to offer no additional benefit for this specific patient population, this could result in cost savings for the NHS and enable patients to avoid unwanted side effects associated with anticoagulation therapy.","PeriodicalId":489502,"journal":{"name":"Journal of Vascular Societies Great Britain & Ireland","volume":"69 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135704359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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