Journal of vascular surgery
-
Strategies to improve outcomes for patients with ruptured abdominal aortic aneurysm (rAAA) are becoming more evident. The aging population, however, continues to make the decision to intervene often difficult, especially given that traditional risk models do not reflect issues of aging and frailty. This study aimed to integrate measures of function alongside comorbidity- and frailty-specific factors to determine outcome. ⋯ This novel rAAA model incorporating function and comorbidity offers good predictive power for mortality. It is quick to calculate and may ultimately become helpful for both counseling and selection of patients and comparative audit at a time when outcome in patients with rAAA increasingly comes under the spotlight.
-
Review Meta Analysis
A systematic review and meta-analysis of tests to predict wound healing in diabetic foot.
This systematic review summarized the evidence on noninvasive screening tests for the prediction of wound healing and the risk of amputation in diabetic foot ulcers. ⋯ Several tests may predict wound healing in the setting of diabetic foot ulcer; however, most of the available evidence evaluates only TcPo2 and ABI. The overall quality of the evidence is low, and further research is needed to provide higher quality comparative effectiveness evidence.
-
Randomized Controlled Trial Comparative Study
Five-year follow-up of a randomized, controlled trial comparing saphenofemoral ligation and stripping of the great saphenous vein with endovenous laser ablation (980 nm) using local tumescent anesthesia.
The objective of this study was to compare the long-term results (groin-related recurrence, great saphenous vein [GSV] occlusion rate, Clinical class, Etiology, Anatomy, and Pathophysiology [CEAP] staging, and quality of life [QoL]) after the treatment of a GSV incompetence by saphenofemoral ligation and stripping (SFL/S) with endovenous laser ablation bare fiber, 980 nm (EVLA). ⋯ At the 5-year follow-up, a significantly higher varicose vein recurrence rate originated at the SFJ region after EVLA compared with SFL/S. There were no differences in the relief of venous symptoms, CEAP staging, or general QoL between the groups.
-
Diabetes mellitus continues to grow in global prevalence and to consume an increasing amount of health care resources. One of the key areas of morbidity associated with diabetes is the diabetic foot. To improve the care of patients with diabetic foot and to provide an evidence-based multidisciplinary management approach, the Society for Vascular Surgery in collaboration with the American Podiatric Medical Association and the Society for Vascular Medicine developed this clinical practice guideline. ⋯ Whereas these guidelines have addressed five key areas in the care of DFUs, they do not cover all the aspects of this complex condition. Going forward as future evidence accumulates, we plan to update our recommendations accordingly.
-
After its introduction in six pilot centers in 2009, the National Abdominal Aortic Aneurysm Screening Programme (NAAASP) is now established across the United Kingdom, demonstrating significant benefit in terms of fewer emergency surgeries and reduced 30-day surgical mortality. However, according to publication of data on annual screened abdominal aortic aneurysm (AAA) detection, a lower incidence than predicted in the original screening trials has been found. In this audit we assessed features and risk factors of men found to have a positive scan result in the southwest London AAA screening program, to determine screening yield for subgroups of populations and assess the case for a more targeted screening program. ⋯ Within southwest London, AAA was most strongly associated with being white-British, a previous or current smoker, and known hypertension. Targeted education in patient groups with identified risk factors for AAA should be considered to improve screening yield without excluding any subgroup from the screening program. This could draw on resources released by unused scans because of lower than predicted prevalence. AAA diagnosis should be seen as an opportunity to address the increased all-cause mortality associated with aortic aneurysmal disease.