bluuebunny/crossref_metadata_2025_split huggingface dataset:
O062 Acquired carotid-jugular fistulas following carotid endarterectomy: a narrative review
Authors: Narroway H , Bourke B , Tchen A 
Published: November 2022

Abstract

Introduction
Acquired arterio-venous fistulas (AVF) involving the carotid artery are most commonly the result of trauma and catheterisation of the neck vessels. Left untreated, carotid-jugular fistulas (CJF) may precipitate ischaemic neurological symptoms due to thromboembolism or shunting of blood through the AVF.

Methods
A literature review was performed to determine the incidence and outcomes of acquired carotid-jugular AVFs following carotid endarterectomy (CEA). Electronic searches were performed using three databases, PubMed, EMBASE, and Google Scholar.

Results
Three case studies met inclusion criteria for analysis. The first case occurred 4-months following a left CEA. CT-angiography and duplex ultrasound identified a pseudoaneurysm arising from the proximal internal carotid artery. A CJF was identified on re-intervention and carotid ligation was performed following unsuccessful attempts to repair the defect. The patient has ongoing mild dysphonia with no other complications at 18 months follow-up. The second case occurred 6 years following right CEA. Catheter angiography revealed an AVF between the right external carotid artery (ECA) and internal jugular vein, treated with coil embolization. The patient made complete neurological recovery and had no further complications at 2 years follow-up. The third case occurred 4 years following right CEA. Catheter angiography identified fistulisation between the lingual branch of the right ECA and right retromandibular vein, treated with transarterial particle embolization. The patient made a complete neurological recovery.

Conclusion
Carotid-jugular AVFs are rare following CEA. This review proposes that carotid-jugular AVFs may be amenable to both open and endovascular intervention with durable outcomes. Proceduralists should be cognisant of this complication.

Take-home message
Carotid-jugular arteriovenous fistulas are rare following carotid endarterectomy and may be amenable to both open and endovascular intervention with durable outcomes.
O063 Use of MRSA screening to discontinue teicoplanin on a tertiary vascular surgical firm
Authors: Deans K , Kansagra A , Chokkarapu P , Curtis S 
Published: November 2022

Abstract

Introduction
The aim of this study was to determine whether the implementation of new educational
interventions could reduce the use of teicoplanin in Diabetic Foot Infections (DFI) on a Vascular surgical firm and prevent potential toxicity. Local trust guidelines state that DFI should be treated with piperacillin-tazobactam and teicoplanin. Following a groin/nasal swab, teicoplanin can then be withdrawn if the patient has a negative screen for MRSA (methicillin-resistant Staphylococcus aureus).

Methods
Interventions were undertaken to reduce overuse of teicoplanin. These consisted of Ward Pharmacist teaching, updating the Vascular Doctor Handbook and sending an email to the Ward Juniors explaining current antibiotic guidelines. Alongside these interventions was the pre-existing weekly microbiology Consultant-led ward rounds. Teicoplanin prescribing was compared in patient groups identified pre (n=44) and post intervention (n=36). Inclusion criteria were diabetes/ prediabetes, no allergies to penicillin or teicoplanin and no prosthetic material grafts in situ.

Results
The mean number of excess doses of teicoplanin decreased from 4.84 (pre-intervention) to 1.00 (post-intervention). Largest excess doses received by one patient was reduced from 11 to 6. One 400 mg teicoplanin vial costs £9.30, resulting in an average saving of £35.71 per patient.

Conclusion
The described interventions reduced the number of excess teicoplanin doses for DFI on the Vascular firm. This resulted in a more cost-effective practice, drug administration rounds becoming more time efficient and resulting in less waste thus facilitating more sustainable practice. Future research could further explore the impact on sustainability by calculating carbon emissions of antibiotic usage on the ward.

Take-home message
Educational interventions have helped reduce excess use of teicoplanin in Diabetic Foot Infections for patients under the care of a vascular surgical firm. This has led to a reduction in time and expenses, thus promoting a more sustainable practice.
O064 Early follow-up quality of life and mental health of patients with congenital vascular malformations cared for in a multi-disciplinary specialist center
Authors: Pang C , Nisbet R , Gibson M , Evans N , Khalifa M , Papadopoulou A , Tsui J , Hamilton G , Brookes J , Lim CS 
Published: November 2022

Abstract

Introduction
To evaluate the early follow-up quality of life (QoL), pain and mental health of patients with congenital vascular malformation (CVM) receiving care by a single multi-disciplinary specialist centre

Methods
All patients with CVM who received care (supportive treatment only, open surgery, targeted pharmacological therapy, embolosclerotherapy), and had follow-up, between 1 February 2018 and 31 January 2020 were included. The health-related QoL, pain, and mental health were assessed with validated questionnaires: SF-36, VAS-P and HADS. The CVM were categorized into types – low-flow (LFVM) and high-flow (HFVM), and anatomical locations. Paired t-test was used for all analyses. Differences were considered significant at P&lt;0.05.

Results
110 patients (85 LFVM and 25 HFVM) with a mean age of 36.9 years were included. Significant improvement was found in the bodily pain domain of SF-36 and VAS-P (both P = 0.01) in all patients. However, only patients with HFVM reported significant improvement in the bodily pain domain of SF-36 (P=0.002) and VAS-P (P = 0.02). Patients who received supportive treatment only reported significant improvement in mental health (P=0.004) and social functioning (P=0.03) domains of SF-36. Meanwhile, patients treated with embolosclerotherapy reported significant improvement only in VAS-P (P=0.02). Patients who received targeted pharmacological therapy reported no significant early changes.

Conclusion
The effects of care on early follow-up QoL, pain and mental health of patients with CVM were heterogenous. Future research is required to understand the various factors that affect the QoL and mental health of these patients, as well as the holistic approaches to manage them.

Take-home message
The effects of care on early follow-up QoL, pain and mental health of patients with CVM were heterogenous. Future research is required to understand the various factors that affect the QoL and mental health of these patients, as well as the holistic approaches to manage them.
O066 Postoperative outcomes are significantly worse among patients undergoing repair of ruptured versus unruptured iliac artery aneurysms – a 10-year longitudinal cohort study
Authors: Laloo R , Aimar K , Khanom J , Bailey M , Scott J 
Published: November 2022

Abstract

Introduction
European Society for Vascular Surgery defines iliac artery aneurysms (IAA) as beyond 1.5 times its normal diameter. Common iliac arteries (CIA) beyond 1.8cm in men and 1.5cm in women are considered aneurysmal. This study assessed outcomes following IAA rupture as their natural history is poorly understood with recommendations based on low-level evidence.

Methods
Patients with IAAs at a single vascular centre between 1st January 2010 and 31st August 2021 were identified from a prospectively collected departmental database and Caldicott-approved data
collection performed. The primary outcomes included aneurysm rupture, rupture diameter, postoperative complications, 30-day, 1-year and 5-year mortality rates. Statistical analysis with SPSS® was performed using chi-squared tests.

Results
Of 203 patients included, 90.6% were men and median (IQR) age at detection was 77(71–83). Comorbidities included hypertension (54.2%), hyperlipidaemia (42.9%) and ischaemic heart disease (35.5%). IAA were in the CIA (85.2%), IIA (21.7%) and EIA (2.0%), mostly asymptomatic (78.8%). Overall IAA rupture rate was 7.9% with CIA (81.2%) and EIA (18.8%). Mean (SD) diameters at rupture were 4.6 (2.4) cm for CIA and 4.6 (3.0) cm for IIA. Post-operative major adverse cardiovascular events more frequently occurred following repair of ruptured compared to unruptured IAA (33.3% vs 3.5%, p=.011). Mortality at 30-days, 1-year and 5-years postoperatively were higher following repair of ruptured vs unruptured aneurysms (88.9%, 88.9%, 100% vs 1.2%, 10.6%, 36.1% respectively).

Conclusion
Early detection and elective treatment of IAA aneurysms before they approach 4.6cm may reduce rupture risk, morbidity and mortality associated with emergency repair following rupture.

Take-home message
Postoperative outcomes are significantly worse among patients undergoing repair of ruptured versus unruptured iliac artery aneurysms.
O068 EVAR Gore salvage fabric technique (ARAFAT) to salvage evar fabric fatigue and graft failure
Authors: Sultan S , Acharya Y , Hynes N 
Published: November 2022

Abstract

Introduction
EVAR GORE SalvAge Fabric Technique (ARAFAT) is an innovative management protocol to seal material graft failure due to type IIIb endoleak (EL) in patients who are mainly at high risk for open conversion. We aim to discuss ARAFAT, an innovative management protocol to seal material graft failure due to type IIIb endoleak (EL).

Methods
We employed ARAFAT in patients following type IIIb EL to salvage previous EVAR with a polyester-based stent graft. The ARAFAT principle relies on the use of polytetrafluoroethylene (PTFE) and the realignment of the polyester stent graft for sealing the microleaks and aortic sac hygroma, resulted due to polyester filtration. First, an oversized EXCLUDER® aortic cuff (GORE®, Flagstaff, Arizona, USA) is deployed into the previously implanted polyester-based stent graft. This is followed by simultaneous deployment of an EXCLUDER® iliac extension, as necessary, in double barrel configuration from the main cuff. A minimum of 2 cm of a distal seal zone is provided to promote stability.

Results
ARAFAT was employed in 18 patients (mean age 80 ± 6.86 years; 77% male). The average size of the aortic sac that underwent re-intervention was 6.68 ± 2.13 cm. All the patients had primary technical success. There was no peri-operative mortality. The average follow-up was 35.6 ± 6.24 months.

Conclusion
We successfully employed the ARAFAT technique as a fully functioning protocol to overcome apparent challenges in managing material fatigue graft failure EL in high-risk patients.

Take-home message
EVAR GORE Salvage Fabric Technique (ARAFAT) technique could be successfully employed as a fully functioning protocol to overcome apparent challenges in managing material fatigue graft failure EL in high-risk patients.
O069 Infra-inguinal bypass graft surveillance is an opportunity to optimise statin and antiplatelet therapy to reduce 12-month major amputation and mortality rates
Authors: Laloo R , Gadsby G , Jauniaux B , Bailey M , Scott J 
Published: November 2022

Abstract

Introduction
Infra-inguinal bypass graft failure within the first two postoperative years can result from stenotic lesions within the conduit and near anastomosis. This study assesses graft surveillance uptake, patency, amputation and death rates among infra-inguinal bypass surgery patients at 1, 6 and 12-months postoperatively.

Methods
Patients undergoing infra-inguinal bypass at a single vascular centre between 1st January 2018 and 31st December 2019 were identified from the prospectively collected database. Primary outcomes at 1, 6 and 12-months postoperatively included: duplex-ultrasound (DUS) surveillance uptake, patency, major amputations and death rates. Statistical analysis with SPSS® was performed using chi-squared tests and paired sample t-tests.

Results
Of the 91 patients included, 79.1% were men and median (IQR) age was 71(62–76). At 1, 6 and 12 months, DUS uptake was 74.2%, 77.5% and 73.3% respectively, primary-assisted patency rates were 88.2%, 78.8% and 65.3% respectively and secondary patency rates were 97.6%, 96.3% and 96.3% respectively. Major amputation rates at 1, 6 and 12 months were 5.4%, 8.6%, 8.6% respectively. Death rates at 1, 6 and 12 months were 3.2%, 5.4% and 10.8% respectively. Patients on statin therapy post-operatively had lower 12-month mortality than those not on statin therapy (7.7% vs 30.0%, p=.028). Major amputation rate at 12 months was lower among patients prescribed antiplatelet therapy (6.3% vs 40%, p=.008).

Conclusion
DUS graft surveillance is a vital opportunity to adequately optimise statin and antiplatelet therapy post-revascularisation to reduce 12-month major amputation and mortality rates.

Take-home message
Infra-inguinal bypass graft surveillance is an opportunity to optimise statin and antiplatelet therapy to reduce 12-month major amputation and mortality rates.
O071 An innovative prone contrast enhancement computed tomography angiography (PASHA) protocol to diagnose concealed endoleak and aortic sac hygroma
Authors: Sultan S , Acharya Y , Hynes N 
Published: November 2022

Abstract

Introduction
Standard 4-phase supine computed tomography angiography (CTA) scans are unable to detect smaller fabric tear (&lt; 1–2 mm) following EVAR, which are erroneously interpreted as type IV or V endoleak (EL). Here, we propose a novel diagnostic technique, ‘Prone contrASt enhanced computed tomography Angiography’ (PASHA)' that uses time-resolved four-phase CTA protocol to detect and classify concealed ELs.

Methods
We employed PASHA protocol in 46 patients after continuous sac expansion following primary EVAR where the standard 4-phase CTA could not identify the EL source. PASHA protocol uses a prone position during standard 4-phase CTA, which displaces the aorta anteriorly by approximately 5 mm, shortening the anterior cortex distance and allowing fluid transudation due to gravity with maximal EL enhancements.

Results
The average numbers of CT scans performed before diagnosing EL with PASHA protocol were 3.4 ±1.5 (range: 1–6). PASHA protocol demonstrated EL in all 46 cases that the standard supine 4-phase CTA could not identify. PASHA protocol effectively enhanced the degree of contrast infiltration into the aortic sac in all the patients.

Conclusion
PASHA is a multi-phase positional CTA technique that enhances the degree of contrast infiltration into the aortic sac when micro-leaks are present, increasing the EL detection rate following EVAR and strategically mapping successful future intervention.

Take-home message
Prone contrASt enHanced computed tomography Angiography (PASHA) is a multi-phase positional computed tomography angiography (CTA) technique that enhances the degree of contrast infiltration into the aortic sac when micro-leaks are present. PASHA increases the endoleak (EL) detection rate following endovascular aneurysm repair (EVAR) and strategically maps successful future interventions.
O072 A 10-year longitudinal cohort study assessing growth rates and surveillance intervals for common iliac artery aneurysms
Authors: Laloo R , Aimar K , Khanom J , Bailey M , Scott J 
Published: November 2022

Abstract

Introduction
European Society for Vascular Surgery defines common iliac artery (CIA) aneurysms as greater than 1.8cm in men and 1.5cm in women. Reported growth rate is 1–4mm/year depending on their diameter. This study assessed the natural history and surveillance intervals for CIA aneurysms as intervention threshold is based on low-quality evidence.

Methods
Patients with an IAA at a single vascular centre between 1st January 2010 and 31st August 2021 were identified from a prospectively collected departmental database and Caldicott-approved data collection performed. The primary outcomes included diameter-based mean aneurysm growth rates and median surveillance intervals. Statistical analysis with SPSS® was performed using chi squared tests.

Results
Of 203 patients included, 90.6% were men and median (IQR) age at detection was 77(71–83). IAA were located in the CIA (85.2%), IIA (21.7%) and EIA (2.0%) with the majority being asymptomatic (78.8%). CT was most frequently used as the imaging modality for IAA surveillance (66.3%), followed by ultrasound scan (29.8%) and MRA (3.9%). Growth rate for CIA aneurysms measuring 1.0–1.9cm were -2.1mm/year, 2.0–2.9cm were 0.8mm/year, 3.0–3.9cm were 3.5mm/year, 4.0–4.9cm were 9.4mm/year, 5.0–5.9cm were 2.9mm/year and &gt;6.0cm were 13.8mm/year. Median surveillance intervals for CIA aneurysms at 1.0–1.9cm were 12-monthly, 2.0–2.9cm were 11-monthly, 3.0–3.9cm were 5-monthly, 4.0–4.9cm were 5-monthly, 5.0–5.9cm were 5.5-monthly and &gt;6.0cm were 14.5-monthly. Mean (SD) CIA diameter at rupture was 4.6 (2.4)cm.

Conclusion
CIA aneurysms demonstrate faster growth rates as they enlarge and may require more frequent clinical assessments, surveillance and consideration for repair prior to rupture.

Take-home message
CIA aneurysms demonstrate faster growth rates as they enlarge and may require more frequent clinical assessments, surveillance and consideration for repair prior to rupture.
O075 Antithrombotic therapy for aortic and peripheral artery aneurysms: a systematic review and meta-analysis
Authors: Wong KHF , Zlatanovic P , Bosanquet DC , Aboyans V , Saratzis A , Kakkos SK , Hinchliffe RJ , Twine CP 
Published: November 2022

Abstract

Introduction
The role of antithrombotic agents in aneurysm progression and outcomes following surgical or endovascular intervention is unclear.

Methods
A systematic review and meta-analysis was performed. Medline, Embase, and CENTRAL databases were searched. Randomised-controlled trials and observational studies investigating the effect of antithrombotic therapy on clinical outcomes for patients with aortic or extracranial peripheral arterial aneurysms were included. Aneurysm growth rate, major adverse cardiovascular or limb events, mortality, endoleaks, re-intervention rates, and other outcomes were captured.

Results
Fifty-seven studies involving 121,451 patients were included (26 antiplatelets, 12 anticoagulants, 16 any antithrombotic agent(s), 2 intra-operative heparin). Aspirin reduced growth rates of aortic aneurysms under surveillance (mean difference -0.9mm/y, 95%CI -1.74 to -0.07, p=0.03; GRADE certainty: moderate). For aortic aneurysms undergoing intervention, anti-thrombotics increased 30-day mortality (odds ratio [OR] 2.30, 95%CI 1.51 to 3.51, p&lt;0.001; GRADE certainty: moderate). Antiplatelets reduced long-term all-cause mortality (hazard ratio [HR] 0.84, 95%CI 0.76 to 0.92, p&lt;0.001; GRADE certainty: moderate), whilst anticoagulants increased this risk (HR 1.64, 95%CI 1.14 to 2.37, p=0.008; GRADE certainty: very low). Anticoagulants increased incidence of endoleaks under 3 years, and re-intervention rates (p&lt;0.05 for all). Antithrombotic agents did not significantly affect rupture rates in aortic aneurysms. Meta-analysis was not possible for ruptured aneurysms and popliteal aneurysms.

Conclusion
There is moderate quality evidence that aspirin reduces aneurysm growth rates. Antiplatelet agents reduced all-cause mortality in aneurysms after intervention; whilst anticoagulants increased this risk, along with endoleaks and re-interventions. Well-designed trials are required to determine therapeutic benefits of antithrombotic agents for patients with aneurysms.

Take-home message
Antiplatelets may have a role in reducing aneurysm growth rates and all-cause mortality; whilst anticoagulants are associated with increased mortality, endoleaks, and re-interventions. Well-designed trials are required to determine therapeutic benefits of antithrombotic agents for patients with aneurysms.
O076 Long term outcomes of “Christmas tree” banding for the treatment of dialysis access related steal syndrome: a thirteen-year experience with the technique
Authors: Ravindhran B , Totty JP , Carradice D , Chetter IC , Smith GE 
Published: November 2022

Abstract

Introduction
High flowrates in arterio-venous fistulas (AVF) and the associated distal arterial insufficiency can cause Dialysis-Access related Steal Syndrome (DASS). Various techniques including ligation, banding, and bypass with interval-ligation have been advocated to treat this difficult problem with varying success. We present the long-term outcomes following a novel banding technique.

Methods
46 patients in this prospective cohort-study from 2008–2021 underwent an adjustable banding procedure using a PTFE patch shaped with one slit-end and saw-tooth edges (resulting in a ‘‘Christmas tree’’ pattern) to provide a ratchet mechanism to progressively constrict the draining vein. Real-time finger perfusion pressure monitoring allowed an optimal compromise between distal extremity and AVF perfusion. Comparisons between groups were measured and survival curves were obtained using the Kaplan-Meier method based on the log-rank test to calculate the thrombosis-free survival.

Results
63%(n=29) presented with constant pain and 24%(n=11) presented with tissue loss due to steal syndrome. Post-intervention patency was 100%,97.7%,95%,86% and 72% at 30 days, 60 days, 180 days, 1 year and 3 years, respectively. Complete resolution of symptoms was achieved in 74%(n=34) of patients and 11%(n=5) reported partial response needing no further intervention. We also observed that pre-procedure finger pressures of 41mmHg or below was highly specific for “true” steal-syndrome and these patients were more likely to completely respond to banding (p=0.016). The overall mean thrombosis free survival was seen to be 1844±168 days.

Conclusion
This adjustable dynamic method of AVF banding demonstrates a sustained efficacy in patients with DASS in the long term with a very low risk of patency loss.

Take-home message
The described adjustable dynamic method of AVF banding under local anaesthesia demonstrates a sustained efficacy in patients with DASS in the long term with a very low risk of patency loss.