188 results on '"Davies, A.H."'
Search Results
152. The value of duplex scanning with venous occlusion in the preoperative prediction of femoro-distal vein bypass graft diameter
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Davies, A.H., primary, Magee, T.R., additional, Jones, D.R., additional, Hayward, J.K., additional, Baird, R.N., additional, and Horrocks, M., additional
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- 1991
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153. Specificity for homonymous pathways following repair of peripheral nerves with treated skeletal muscle autografts—in the primate
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Glasby, M.A., primary, Davies, A.H., additional, Gattuso, J.M., additional, and Heywood, A.J., additional
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- 1991
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154. The Role of Abdominal and Transrectal Ultrasound and Cytology in the Detection of Recurrent Bladder Tumours
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Davies, A.H., primary, Cranston, D., additional, Turner, W.H., additional, Meagher, T., additional, Mastorakou, Irene, additional, and Fellows, G.J., additional
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- 1990
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155. External-Beam Radiation for Carcinoma of the Prostate
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Davies, A.H., primary, Lydford Davis, Helen, additional, Ramarakha, P., additional, Durrant, K.D., additional, and Fellows, G.J., additional
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- 1990
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156. Randomized clinical trial of low molecular weight heparin with thigh-lenght or knee-length antiembolism stockings for patients undergoing surgery.
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Howard, A., Zaccagnini, D., Ellis, M., Williams, A., Davies, A.H., and Greenhalgh, R.M.
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CLINICAL trials ,MEDICAL protocols ,HEPARIN ,COMPRESSION stockings ,SURGERY ,ANESTHESIA ,POSTOPERATIVE care ,THROMBOSIS - Abstract
Explains that a randomized clinical trial was conducted to determine the efficacy and safety of a "blanket" protocol of low molecular weight heparin and the best length of antiembolism stocking, for every patient requiring surgery under general anesthesia. Duplex ultrasonography was used to assess the incidence of postoperative deep vein thrombosis.
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- 2004
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157. Chlamydia pneumoniae and vascular disease.
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Gibbs, R. G. J., Carey, N., and Davies, A.H.
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CHLAMYDOPHILA pneumoniae ,ATHEROSCLEROSIS ,HEART diseases - Abstract
Background There is an increasing body of evidence linking the human pathogen Chlamydia pneumoniae with atherosclerosis. Methods A Medline-based review of the literature was carried out. Results and conclusion Seroepidemiological studies have revealed the possibility that evidence of infection with C. pneumoniae and atherosclerotic disease are related. Studies on human tissue have demonstrated that evidence of the organism can be found in human atherosclerotic tissue by both direct and indirect methods significantly more often than in control vascular tissue. Using animal models it is possible to show that C. pneumoniae can be disseminated haematogenously following pulmonary infection and that it shows a tropism for atherosclerotic tissue. In vitro work has demonstrated that the organism is capable of infecting, surviving and multiplying in cells of the human vascular wall, and that it can provoke a cell-mediated cytokine response which has implications both locally and systemically. Two clinical trials of macrolide antibiotics have demonstrated that they confer increased cardiovascular protection in patients following myocardial infarction. Adequately powered trials are needed to establish the therapeutic role of antibiotics in peripheral arterial disease. [ABSTRACT FROM AUTHOR]
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- 1998
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158. CORRESPONDENCE.
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Reid, Robert, Massey, Graham, Bates, Robin, Porro, G. Bianchi, Petrillo, M., Prada, A., Godding, Edmund W., Gordon, R.R., Lask, Bryan, Waterworth, Pamela M., Lockey, Eunice, Geddes, J.S., Dewar, John A., Transbol, I., Jorgensen, F. Schonau, Lund, B., Sorensen, O.H., and Davies, A.H.
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MEDICINE ,ASTHMA treatment ,ASTHMA in children ,STEROID drugs ,ENDOSCOPY ,INDIGESTION - Abstract
Presents several letters on issues related to medicine. Treatment of asthmatic children with steroids; Importance of endoscopy in dyspepsia; Variations in urinary excretion of calcium.
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- 1975
159. Editor's Choice – Management of Chronic Venous Disease Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS)
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Writing Committee, Wittens, C., Davies, A.H., Bækgaard, N., Broholm, R., Cavezzi, A., Chastanet, S., de Wolf, M., Eggen, C., Giannoukas, A., Gohel, M., Kakkos, S., Lawson, J., Noppeney, T., Onida, S., Pittaluga, P., Thomis, S., Toonder, I., Vuylsteke, M., ESVS Guidelines Committee, Kolh, P., de Borst, G.J., Chakfé, N., Debus, S., Hinchliffe, R., Koncar, I., Lindholt, J., de Ceniga, M.V., Vermassen, F., Verzini, F., Document Reviewers, De Maeseneer, M.G., Blomgren, L., Hartung, O., Kalodiki, E., Korten, E., Lugli, M., Naylor, R., Nicolini, P., and Rosales, A.
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Stenting ,Ambulatory compression ,Laser ,AVVQ ,Venous disease ,MRV ,Endophlebectomy ,Venous malformation ,Phlebectomy ,AV fistula ,Chronic venous disease ,Sclerotherapy ,Duplex ultrasound ,Villalta ,Recurrent varicose veins ,Compression ,Radiofrequency ablation ,Phlebography ,CEAP ,VCSS ,Thermal ablation ,Plethysmography ,Wound dressings ,Non-thermal ablation ,Varicose veins ,CTV ,Vein Qol Sym ,High ligation ,Stripping - Full Text
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160. Strategic Planning in the Thomas Cook Group
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Davies, A.H.
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Travel ,Business planning -- Management ,Budget -- Methods ,Management -- Planning ,Finance -- Management ,Business ,Business, general ,Economics - Published
- 1981
161. Duplex imaging findings predict stenosis after carotid endarterectomy
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Cross, Charing, From the Department of Surgery, Westminster Medical School., Golledge, J., Cuming, R., Ellis, M., Davies, A.H., and Greenhalgh, R.M.
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Purpose: This study was performed to determine whether early duplex findings predicted restenosis after carotid endarterectomy. Methods: One hundred ninety-two symptomatic patients who underwent carotid endarterectomy were studied with color duplex imaging at 1 day and 1 week after surgery to identify minor residual disease (causing <50% stenosis), arterial kinking, and suture stricture, and to measure the external and luminal diameters of the carotid bulb and distal internal carotid artery. Patients were then observed prospectively with duplex surveillance for a median of 24 months to identify >50% restenosis. Results: Twenty-five stenoses >50% of the operated carotid artery (13%) were identified, four at 1 day (residual) and 21 at a median follow-up of 6 months (restenosis). On multiple logistic regression analysis, >50% restenosis was found to be associated with minor day-1 residual stenosis (p = 0.01) and with small luminal diameter of the distal internal carotid artery (p = 0.03) as measured 1 week after carotid endarterectomy. Life table analysis showed restenosis at 24 months to be more common for patients with below-median than patients with above-median carotid bulb external diameter (18% vs 5%, respectively; p = 0.01). Conclusions: Duplex scanning within a week of carotid endarterectomy identifies >50% residual stenosis, in addition to minor residual 25% to 50% stenosis and small carotid dimensions, which are good predictors of >50% restenosis at 6 months. (J Vasc Surg 1997;26:43-8.)
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- 1997
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162. Carotid plaque characteristics and presenting symptom
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Golledge, J., Cuming, R., Ellis, M., Davies, A.H., Greenhalgh, R.M., and Mr
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Background The importance of identifying features of carotid artery disease, in addition to degree of stenosis, which predict subsequent stroke is becoming increasingly clear. This study assessed the relationship between carotid plaque characteristics and presenting symptoms.Methods Some 285 symptomatic (transient ischaemic attack (TIA) 127, amaurosis fugax 58, transient stroke 15, established stroke 55, progressive stroke 11, crescendo TIA 19) and 65 asymptomatic patients were studied with colour-flow duplex imaging. All patients had 60-99 per cent internal carotid stenosis. Carotid plaque morphology (classified according to Gray-Weale) and plaque surface features were assessed.Results Plaque types I and II were more common in symptomatic patients (83 per cent versus 44 per cent; P<0·0001). Plaque surface was classified as smooth (34 per cent), irregular (44 per cent) or ulcerated (22 per cent). Ulceration was also more common in symptomatic patients (23 versus 14 per cent; P=0.04). In symptomatic patients there was no association between presenting symptom and plaque morphology or surface features (P=0·9 and P=0·8 respectively). On multiple regression analysis plaque morphology did not distinguish between patients who presented with stroke without warning and other symptomatic patients (who had TIA, amaurosis fugax, crescendo TIA or stroke with warning).Conclusion There was an association between echolucent type I and II carotid plaques and the presence of symptoms but not their type. Plaque morphology was not characteristic in a subgroup of patients who had stroke without warning. Further prospective study of plaque morphology in asymptomatic patients might help identify high-risk groups.
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- 1997
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163. Influence of patient-related variables on the outcome of carotid endarterectomy
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Golledge, J., Cuming, R., Beattie, D.K., Davies, A.H., and Greenhalgh, R.M.
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Purpose: Variability in outcome after carotid endarterectomy is well recognized. This study examines the importance of patient-related factors in determining outcome. Methods: Four hundred and sixty consecutive patients undergoing carotid endarterectomy for symptomatic severe (60% to 99%) internal carotid stenosis performed by one vascular surgeon have been studied prospectively. Patients were followed-up at 3, 6, 9, and 12 months and then yearly. Pre-, intra-, and perioperative details and follow-up information were entered on a database. Results: Multiple logistic regression identified a number of factors significantly associated with death and stroke. A history of crescendo transient ischemic attacks (TIAs) (p = 0.003, p = 0.0002) and being female ( p = 0.03, p = 0.0001) were associated with both perioperative death and stroke within 30 days of operation, respectively. Deaths between 1 and 36 months were associated with ischemic heart disease (p = 0.03) and diabetes ( p = 0.04), whereas stroke was associated with small internal carotid diameter ( p = 0.02). The importance of symptoms at presentation on outcome was further emphasized by life-table analysis. In 98% of patients with amaurosis fugax, only 67% of those with crescendo TIAs were alive at 18 months ( p < 0.01). The survival of patients with amaurosis was significantly better than those with TIAs ( p < 0.01), transient stroke ( p < 0.01), and progressive stroke ( p < 0.05). Similarly, postoperative stroke was significantly more common for patients with crescendo TIAs than those with amaurosis ( p < 0.01), established stroke ( p < 0.05), and TIA ( p < 0.05). Transient stroke was associated with a poor outcome, with only 66% of patients being alive at 36 months and 14% having suffered a stroke ( p < 0.05 compared with established stroke). Conclusion: Presenting symptoms significantly predict outcome after carotid endarterectomy. This should be considered both in patient selection and comparison of patient series. (J Vasc Surg 1996;24:120-6.)
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- 1996
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164. Does pressure gradient guided angioplasty improve angioplasty outcome?
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Chong, P.F.S., Mitchell, A., Barratt, N., Ellis, M., Brown, L.C., Davies, A.H., Greenhalgh, R.M., and Golledge., J.
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ANGIOPLASTY ,LIFE tables - Abstract
Examines the efficacy of pressure gradient guided angioplasty (PG-PTA). Comparison between PG-PTA and conventional angioplasty; Determinants of hemodynamic and symptomatic success; Performance of life-table analysis.
- Published
- 2001
165. Letter to Editor Re: Mehta T, Venkata Subramaniam A, Chetter I, McCollum P. Assessing the Validity and Responsiveness of Disease-specific Quality of Life Instruments in Intermittent Claudication. Eur J Vasc Endovasc Surg 2006;31:46–52
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Chong, P.F.S., Garratt, A.M., Greenhalgh, R.M., and Davies, A.H.
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- 2006
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166. Is Duplex Surveillance of Value After Leg Vein Bypass Grafting? The Principle Results of the Vein Graft Surveillance Randomized Trial (VGST)
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Davies, A.H., Howdon, A.G., and Thompson, S.G.
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- 2006
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167. CORRESPONDENCE.
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Sugarbaker, P.H., Shmookler, B., Ronnett, B.M., Chang, D., Ambrose, N.S., Guest, M., Smith, J.J., Davies, A.H., Sailer, M., Bussen, D., Debus, E.S., Fuchs, K.-H., Thiede, A., Khan, T.F. Toufeeq, Manas, D.M., and Black, J.
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LETTERS to the editor ,SURGERY ,PERIODICALS - Abstract
Presents topical correspondence from readers of the periodical 'British Journal of Surgery,' for the month of June 1999. Pseudomyxoma peritonei; Quality of life in patients with benign anorectal disorders; Anomalous pancreaticobiliary junction without congenital choledochal cyst; Association between breast and colorectal cancers.
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- 1999
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168. Nerve Growth in Cardiac Muscle
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Davies, A.H., De Souza, B.A., Glasby, M.A., Gschmeissner, S.E., and Huang, C.L.-H.
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Original Manuscripts - Abstract
The failure of reinnervation after cardiac transplantation is probably a consequence of scar formation at the suture lines. However, it must be established whether there are any intrinsic properties of the muscle that prevent reinnervation. This is examined in experimental peripheral nerve implants using cardiac muscle isografts. The results show extensive growth of regenerating axons into the implanted cardiac muscle. It is therefore unlikely that the failure of reinnervation depends upon the physical or chemical properties of the muscle itself.
- Published
- 1986
169. Do Not Forget Popliteal Venous Entrapment.
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Donnely, E., Busuttil, A., and Davies, A.H.
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- 2017
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170. Randomised Controlled Trial: Potential Benefit of a Footplate Neuromuscular Electrical Stimulation Device in Patients with Chronic Venous Disease.
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Ravikumar, R., Williams, K.J., Babber, A., Lane, T.R.A., Moore, H.M., and Davies, A.H.
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- 2017
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171. PCV94 A Cost-Effectiveness Analysis Of Interventions For Symptomatic Varicose Veins
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Marsden, G., Perry, M., Bradbury, A., Hickey, N., Kelley, K., Trender, H., Wonderling, D., and Davies, A.H.
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172. Global Management of Venous Leg Ulceration: Pre-EVRA Publication
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Heatley, F., Onida, S., and Davies, A.H.
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- 2019
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173. Metabolomics as a tool to improve decision making for the vascular surgeon – wishful thinking or a dream come true?
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Kirlikaya, B., Langridge, B., Davies, A.H., and Onida, S.
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METABOLOMICS , *METABOLITES , *PERIPHERAL vascular diseases , *VENOUS insufficiency , *THORACIC aneurysms , *DECISION making - Published
- 2019
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174. Chapter II: Diagnostic Methods.
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Cao, P., Eckstein, H.H., De Rango, P., Setacci, C., Ricco, J.-B., de Donato, G., Becker, F., Robert-Ebadi, H., Diehm, N., Schmidli, J., Teraa, M., Moll, F.L., Dick, F., Davies, A.H., Lepäntalo, M., and Apelqvist, J.
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EXTREMITIES (Anatomy) ,ISCHEMIA ,ANKLE brachial index ,CHRONIC kidney failure ,ANGIOGRAPHY ,TOMOGRAPHY - Abstract
Abstract: Non-invasive vascular studies can provide crucial information on the presence, location, and severity of critical limb ischaemia (CLI), as well as the initial assessment or treatment planning. Ankle-brachial index with Doppler ultrasound, despite limitations in diabetic and end-stage renal failure patients, is the first-line evaluation of CLI. In this group of patients, toe-brachial index measurement may better establish the diagnosis. Other non-invasive measurements, such as segmental limb pressure, continuous-wave Doppler analysis and pulse volume recording, are of limited accuracy. Transcutaneous oxygen pressure (TcPO
2 ) measurement may be of value when rest pain and ulcerations of the foot are present. Duplex ultrasound is the most important non-invasive tool in CLI patients combining haemodynamic evaluation with imaging modality. Computed tomography angiography (CTA) and magnetic resonance angiography (MRA) are the next imaging studies in the algorithm for CLI. Both CTA and MRA have been proven effective in aiding the decision-making of clinicians and accurate planning of intervention. The data acquired with CTA and MRA can be manipulated in a multiplanar and 3D fashion and can offer exquisite detail. CTA results are generally equivalent to MRA, and both compare favourably with contrast angiography. The individual use of different imaging modalities depends on local availability, experience, and costs. Contrast angiography represents the gold standard, provides detailed information about arterial anatomy, and is recommended when revascularisation is needed. [Copyright &y& Elsevier]- Published
- 2011
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175. Chapter I: Definitions, Epidemiology, Clinical Presentation and Prognosis.
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Becker, F., Robert-Ebadi, H., Ricco, J.-B., Setacci, C., Cao, P., de Donato, G., Eckstein, H.H., De Rango, P., Diehm, N., Schmidli, J., Teraa, M., Moll, F.L., Dick, F., Davies, A.H., Lepäntalo, M., and Apelqvist, J.
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EPIDEMIOLOGY ,ARTERIAL occlusions ,EXTREMITIES (Anatomy) ,VASCULAR surgery ,PROGNOSIS ,ISCHEMIA - Abstract
Abstract: The concept of chronic critical limb ischaemia (CLI) emerged late in the history of peripheral arterial occlusive disease (PAOD). The historical background and changing definitions of CLI over the last decades are important to know in order to understand why epidemiologic data are so difficult to compare between articles and over time. The prevalence of CLI is probably very high and largely underestimated, and significant differences exist between population studies and clinical series. The extremely high costs associated with management of these patients make CLI a real public health issue for the future. In the era of emerging vascular surgery in the 1950s, the initial classification of PAOD by Fontaine, with stages III and IV corresponding to CLI, was based only on clinical symptoms. Later, with increasing access to non-invasive haemodynamic measurements (ankle pressure, toe pressure), the need to prove a causal relationship between PAOD and clinical findings suggestive of CLI became a real concern, and the Rutherford classification published in 1986 included objective haemodynamic criteria. The first consensus document on CLI was published in 1991 and included clinical criteria associated with ankle and toe pressure and transcutaneous oxygen pressure (TcPO
2 ) cut-off levels <50 mmHg, <30 mmHg and <10 mmHg respectively). This rigorous definition reflects an arterial insufficiency that is so severe as to cause microcirculatory changes and compromise tissue integrity, with a high rate of major amputation and mortality. The TASC I consensus document published in 2000 used less severe pressure cut-offs (≤50–70 mmHg, ≤30–50 mmHg and ≤30–50 mmHg respectively). The thresholds for toe pressure and especially TcPO2 (which will be also included in TASC II consensus document) are however just below the lower limit of normality. It is therefore easy to infer that patients qualifying as CLI based on TASC criteria can suffer from far less severe disease than those qualifying as CLI in the initial 1991 consensus document. Furthermore, inclusion criteria of many recent interventional studies have even shifted further from the efforts of definition standardisation with objective criteria, by including patients as CLI based merely on Fontaine classification (stage III and IV) without haemodynamic criteria. The differences in the natural history of patients with CLI, including prognosis of the limb and the patient, are thus difficult to compare between studies in this context. Overall, CLI as defined by clinical and haemodynamic criteria remains a severe condition with poor prognosis, high medical costs and a major impact in terms of public health and patients'' loss of functional capacity. The major progresses in best medical therapy of arterial disease and revascularisation procedures will certainly improve the outcome of CLI patients. In the future, an effort to apply a standardised definition with clinical and objective haemodynamic criteria will be needed to better demonstrate and compare the advances in management of these patients. [Copyright &y& Elsevier]- Published
- 2011
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176. Chapter VI: Follow-up after Revascularisation.
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Dick, F., Ricco, J.-B., Davies, A.H., Cao, P., Setacci, C., de Donato, G., Becker, F., Robert-Ebadi, H., Eckstein, H.H., De Rango, P., Diehm, N., Schmidli, J., Teraa, M., Moll, F.L., Lepäntalo, M., and Apelqvist, J.
- Subjects
REVASCULARIZATION (Surgery) ,ISCHEMIA treatment ,EXTREMITIES (Anatomy) -- Surgery ,FOLLOW-up studies (Medicine) ,ANTICOAGULANTS ,MEDICAL informatics - Abstract
Abstract: Structured follow-up after revascularisation for chronic critical limb ischaemia (CLI) aims at sustained treatment success and continued best patient care. Thereby, efforts need to address three fundamental domains: (A) best medical therapy, both to protect the arterial reconstruction locally and to reduce atherosclerotic burden systemically; (B) surveillance of the arterial reconstruction; and (C) timely initiation of repeat interventions. As most CLI patients are elderly and frail, sustained resolution of CLI and preserved ambulatory capacity may decide over independent living and overall prognosis. Despite this importance, previous guidelines have largely ignored follow-up after CLI; arguably because of a striking lack of evidence and because of a widespread assumption that, in the context of CLI, efficacy of initial revascularisation will determine prognosis during the short remaining life expectancy. This chapter of the current CLI guidelines aims to challenge this disposition and to recommend evidentially best clinical practice by critically appraising available evidence in all of the above domains, including antiplatelet and antithrombotic therapy, clinical surveillance, use of duplex ultrasound, and indications for and preferred type of repeat interventions for failing and failed reconstructions. However, as corresponding studies are rarely performed among CLI patients specifically, evidence has to be consulted that derives from expanded patient populations. Therefore, most recommendations are based on extrapolations or subgroup analyses, which leads to an almost systematic degradation of their strength. Endovascular reconstruction and surgical bypass are considered separately, as are specific contexts such as diabetes or renal failure; and critical issues are highlighted throughout to inform future studies. [Copyright &y& Elsevier]
- Published
- 2011
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177. Chapter V: Diabetic Foot.
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Lepäntalo, M., Apelqvist, J., Setacci, C., Ricco, J.-B., de Donato, G., Becker, F., Robert-Ebadi, H., Cao, P., Eckstein, H.H., De Rango, P., Diehm, N., Schmidli, J., Teraa, M., Moll, F.L., Dick, F., and Davies, A.H.
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DIABETIC foot ,NEUROPATHY ,ISCHEMIA ,MICROCIRCULATION disorders ,PREDICTIVE tests ,PEOPLE with diabetes - Abstract
Abstract: Ulcerated diabetic foot is a complex problem. Ischaemia, neuropathy and infection are the three pathological components that lead to diabetic foot complications, and they frequently occur together as an aetiologic triad. Neuropathy and ischaemia are the initiating factors, most often together as neuroischaemia, whereas infection is mostly a consequence. The role of peripheral arterial disease in diabetic foot has long been underestimated as typical ischaemic symptoms are less frequent in diabetics with ischaemia than in non-diabetics. Furthermore, the healing of a neuroischaemic ulcer is hampered by microvascular dysfunction. Therefore, the threshold for revascularising neuroischaemic ulcers should be lower than that for purely ischaemic ulcers. Previous guidelines have largely ignored these specific demands related to ulcerated neuroischaemic diabetic feet. Any diabetic foot ulcer should always be considered to have vascular impairment unless otherwise proven. Early referral, non-invasive vascular testing, imaging and intervention are crucial to improve diabetic foot ulcer healing and to prevent amputation. Timing is essential, as the window of opportunity to heal the ulcer and save the leg is easily missed. This chapter underlines the paucity of data on the best way to diagnose and treat these diabetic patients. Most of the studies dealing with neuroischaemic diabetic feet are not comparable in terms of patient populations, interventions or outcome. Therefore, there is an urgent need for a paradigm shift in diabetic foot care; that is, a new approach and classification of diabetics with vascular impairment in regard to clinical practice and research. A multidisciplinary approach needs to implemented systematically with a vascular surgeon as an integrated member. New strategies must be developed and implemented for diabetic foot patients with vascular impairment, to improve healing, to speed up healing rate and to avoid amputation, irrespective of the intervention technology chosen. Focused studies on the value of predictive tests, new treatment modalities as well as selective and targeted strategies are needed. As specific data on ulcerated neuroischaemic diabetic feet are scarce, recommendations are often of low grade. [Copyright &y& Elsevier]
- Published
- 2011
- Full Text
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178. Chapter IV: Treatment of Critical Limb Ischaemia.
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Setacci, C., de Donato, G., Teraa, M., Moll, F.L., Ricco, J.-B., Becker, F., Robert-Ebadi, H., Cao, P., Eckstein, H.H., De Rango, P., Diehm, N., Schmidli, J., Dick, F., Davies, A.H., Lepäntalo, M., and Apelqvist, J.
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ISCHEMIA treatment ,EXTREMITIES (Anatomy) -- Surgery ,ARTERIAL disease treatment ,ATHEROSCLEROSIS ,COHORT analysis ,REVASCULARIZATION (Surgery) - Abstract
Abstract: Recommendations stated in the TASC II guidelines for the treatment of peripheral arterial disease (PAD) regard a heterogeneous group of patients ranging from claudicants to critical limb ischaemia (CLI) patients. However, specific considerations apply to CLI patients. An important problem regarding the majority of currently available literature that reports on revascularisation strategies for PAD is that it does not focus on CLI patients specifically and studies them as a minor part of the complete cohort. Besides the lack of data on CLI patients, studies use a variety of endpoints, and even similar endpoints are often differentially defined. These considerations result in the fact that most recommendations in this guideline are not of the highest recommendation grade. In the present chapter the treatment of CLI is not based on the TASC II classification of atherosclerotic lesions, since definitions of atherosclerotic lesions are changing along the fast development of endovascular techniques, and inter-individual differences in interpretation of the TASC classification are problematic. Therefore we propose a classification merely based on vascular area of the atherosclerotic disease and the lesion length, which is less complex and eases the interpretation. Lesions and their treatment are discussed from the aorta downwards to the infrapopliteal region. For a subset of lesions, surgical revascularisation is still the gold standard, such as in extensive aorto-iliac lesions, lesions of the common femoral artery and long lesions of the superficial femoral artery (>15 cm), especially when an applicable venous conduit is present, because of higher patency and limb salvage rates, even though the risk of complications is sometimes higher than for endovascular strategies. It is however more and more accepted that an endovascular first strategy is adapted in most iliac, superficial femoral, and in some infrapopliteal lesions. The newer endovascular techniques, i.e. drug-eluting stents and balloons, show promising results especially in infrapopliteal lesions. However, most of these results should still be confirmed in large RCTs focusing on CLI patients. At some point when there is no possibility of an endovascular nor a surgical procedure, some alternative non-reconstructive options have been proposed such as lumbar sympathectomy and spinal cord stimulation. But their effectiveness is limited especially when assessing the results on objective criteria. The additional value of cell-based therapies has still to be proven from large RCTs and should therefore still be confined to a research setting. Altogether this chapter summarises the best available evidence for the treatment of CLI, which is, from multiple perspectives, completely different from claudication. The latter also stresses the importance of well-designed RCTs focusing on CLI patients reporting standardised endpoints, both clinical as well as procedural. [Copyright &y& Elsevier]
- Published
- 2011
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179. Chapter III: Management of Cardiovascular Risk Factors and Medical Therapy.
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Diehm, N., Schmidli, J., Setacci, C., Ricco, J.-B., de Donato, G., Becker, F., Robert-Ebadi, H., Cao, P., Eckstein, H.H., De Rango, P., Teraa, M., Moll, F.L., Dick, F., Davies, A.H., Lepäntalo, M., and Apelqvist, J.
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CARDIOVASCULAR diseases risk factors ,ISCHEMIA treatment ,ATHEROSCLEROSIS ,PLATELET aggregation inhibitors ,DISEASE management ,EXTREMITIES (Anatomy) -- Surgery ,REVASCULARIZATION (Surgery) - Abstract
Abstract: Critical limb ischaemia (CLI) is a particularly severe manifestation of lower limb atherosclerosis posing a major threat to both limb and life of affected patients. Besides arterial revascularisation, risk-factor modification and administration of antiplatelet therapy is a major goal in the treatment of CLI patients. Key elements of cardiovascular risk management are smoking cessation and treatment of hyperlipidaemia with dietary modification or statins. Moreover, arterial hypertension and diabetes mellitus should be adequately treated. In CLI patients not suitable for arterial revascularisation or subsequent to unsuccessful revascularisation, parenteral prostanoids may be considered. CLI patients undergoing surgical revascularisation should be treated with beta blockers. At present, neither gene nor stem-cell therapy can be recommended outside clinical trials. Of note, walking exercise is contraindicated in CLI patients due to the risk of worsening pre-existing or causing new ischaemic wounds. CLI patients are oftentimes medically frail and exhibit significant comorbidities. Co-existing coronary heart and carotid as well as renal artery disease should be managed according to current guidelines. Considering the above-mentioned treatment goals, interdisciplinary treatment approaches for CLI patients are warranted. Aim of the present manuscript is to discuss currently existing evidence for both the management of cardiovascular risk factors and treatment of co-existing disease and to deduct specific treatment recommendations. [Copyright &y& Elsevier]
- Published
- 2011
- Full Text
- View/download PDF
180. A protocol of low molecular weight heparin and antiembolic stockings abolishes deep vein thrombosis in low and moderate-risk patients and reduces it in high-risk surgical patients.
- Author
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Howard, A., Zaccagnini, D., Williams, A., Ellis, M., Salooja, N., Davies, A.H., and Greenhalgh, R.M.
- Subjects
MEDICAL protocols ,THROMBOSIS ,HEPARIN ,COMPRESSION stockings - Abstract
Aims: In our acute university, multidisciplinary hospital we found a disparate use of thromboprophylaxis with regard to types and implementation of subcutaneous heparin and antiembolic stockings. Our goal was to investigate the efficacy and safety of a single 'blanket' thromboprophylaxis protocol of fractionated heparin combined with the best length and type of stocking given to every patient requiring surgery, under general anaesthesia. Methods: We interviewed 426 patients; 376 were randomized into three stocking groups, Medi 'Thrombexin' thigh-length, 'Thrombexin' knee-length and Kendall 'TED' thigh-length. All patients received daily fractionated heparin. Incidence of deep vein thrombosis (DVT) was assessed by duplex ultrasound. Results: No DVT occurred in the low or moderate DVT risk patients (n = 85) using this protocol. All postoperative DVT occurred in the patients from the high-risk group. Nineteen patients developed DVT from two hundred and ninety one high risk patients. DVT occurred in two patients with 'Thrombexin' thigh-length stockings and eleven with 'Thrombexin' knee-length (P < 0·05). Six patients wearing 'TED' thigh-length stockings developed DVT. Each group was statistically similar for age, gender, thromboembolic risk, surgical type and protocol compliance. One significant bleeding complication occurred. Conclusions: A single protocol employing fractionated heparin and thigh stockings for all surgical patients abolishes DVT diagnosed by duplex in low and moderaterisk patients and reduces DVT by duplex to 2% in the high-risk patients, with only one significant bleeding complication. Blanket thromboprophylaxis with fractionated heparin and good quality thigh-length stockings is safe and effective to use in all surgical patients with minimal bleeding risk. [ABSTRACT FROM AUTHOR]
- Published
- 2003
181. Evaluating quality-of-life changes in intermittent claudication.
- Author
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Chong, P.F.S., Garratt, A.M., Golledge, J., Greenhalgh, R.M., and Davies, A.H.
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QUALITY of life ,INTERMITTENT claudication ,ANGIOPLASTY - Abstract
Examines the quality of life of patients undergoing intermittent claudication (IC). Assessment of resting ankle pressure in preparation for angioplasty; Use of symptom-specific questionnaire (SSQ) to test patient responsiveness to IC; Comparison between SSQ and Walking Impairment Questionnaire.
- Published
- 2001
- Full Text
- View/download PDF
182. Evaluation of distal run-off before femorodistal bypass
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Davies, A.H., Magee, T.R., Parry, R., Horrocks, M., and Baird, R.N.
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- 1996
- Full Text
- View/download PDF
183. Carotid endarterectomy: are we under-performing?
- Author
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Davies, A.H., Wilson, Y.G., Lamont, P.M., and Baird, R.N.
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- 1995
- Full Text
- View/download PDF
184. Optimal management of asymptomatic carotid stenosis in 2021: the jury is still out. An international, multispecialty, expert review and position statement
- Author
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Ian M. Loftus, Andrew Nicolaides, Luca Saba, Pier Luigi Antignani, Mauro Silvestrini, Mateja Kaja Jezovnik, Reinoud P H Bokkers, Armando Mansilha, Christos D. Liapis, Niki Katsiki, Jasjit S. Suri, Jean-Baptiste Ricco, Michael Knoflach, Clark J. Zeebregts, Sherif Sultan, Francesco Stilo, José Fernandes e Fernandes, Felix Schlachetzki, Richard P. Cambria, Peter Gloviczki, Gaetano Lanza, Kosmas I. Paraskevas, Seemant Chaturvedi, Dimitri P. Mikhailidis, Tatjana Rundek, Pavel Poredos, Gustav Fraedrich, Jonathan Golledge, Alun H. Davies, M. Eline Kooi, Hans-Henning Eckstein, Antoine Millon, Stavros K. Kakkos, Gianluca Faggioli, George Geroulakos, Ajay Gupta, Rodolfo Pini, Peter A. Ringleb, Alan Dardik, Francesco Spinelli, Hediyeh Baradaran, Thomas S. Riles, Paraskevas K.I., Mikhailidis D.P., Antignani P.L., Baradaran H., Bokkers R.P.H., Cambria R.P., Dardik A., Davies A.H., Eckstein H.-H., Faggioli G., e Fernandes J.F., Fraedrich G., Geroulakos G., Gloviczki P., Golledge J., Gupta A., Jezovnik M.K., Kakkos S.K., Katsiki N., Knoflach M., Kooi M.E., Lanza G., Liapis C.D., Loftus I.M., Mansilha A., Millon A., Nicolaides A.N., Pini R., Poredos P., Ricco J.-B., Riles T.S., Ringleb P.A., Rundek T., Saba L., Schlachetzki F., Silvestrini M., Spinelli F., Stilo F., Sultan S., Suri J.S., Zeebregts C.J., and Chaturvedi S.
- Subjects
Male ,medicine.medical_treatment ,Carotid endarterectomy ,GUIDELINES ,DISEASE ,law.invention ,Randomized controlled trial ,Risk Factors ,law ,Stroke ,Asymptomatic carotid stenosis ,ENDARTERECTOMY ,Rehabilitation ,Fibrous cap ,ASSOCIATION ,COUNCIL ,Carotid plaque ,Plaque, Atherosclerotic ,Best medical treatment ,MEDICAL-TREATMENT ,Carotid Arteries ,ISCHEMIC-STROKE ,medicine.anatomical_structure ,Practice Guidelines as Topic ,CEREBRAL HEMODYNAMICS ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Human ,medicine.medical_specialty ,SOCIETY ,Asymptomatic ,Intervention (counseling) ,Carotid stenosis ,medicine ,Humans ,Risk factor ,RECURRENCE ,Intensive care medicine ,HEALTH-CARE PROFESSIONALS ,STROKE PREVENTION ,business.industry ,Asymptomatic carotid stenosi ,medicine.disease ,carotid ,Stenosis ,Surgery ,Neurology (clinical) ,PRIMARY PREVENTION ,business ,TASK-FORCE - Abstract
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 multispecialty position statement was to reconcile the conflicting views on the topic. A literature review was performed with a focus on data from recent studies. Several clinical and imaging high-risk features have been identified that are associated with an increased long-term ipsilateral ischemic stroke risk in patients with ACS. Such high-risk clinical/imaging features include intraplaque hemorrhage, impaired cerebrovascular reserve, carotid plaque echolucency/ulceration/ neovascularization, a lipid-rich necrotic core, a thin or ruptured fibrous cap, silent brain infarction, a contralateral transient ischemic attack/stroke episode, male patients
- Published
- 2022
185. Management of patients with asymptomatic carotid stenosis may need to be individualized: a multidisciplinary call for action
- Author
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Niki Katsiki, Francesco Stilo, Christos D. Liapis, Ian M. Loftus, Mateja K Jezovnik, Hediyeh Baradaran, Rodolfo Pini, Gaetano Lanza, Sherif Sultan, Kosmas I. Paraskevas, Seemant Chaturvedi, Dimitri P. Mikhailidis, Tatjana Rundek, José Fernandes e Fernandes, Gianluca Faggioli, Andrew Nicolaides, Luca Saba, Francesco Spinelli, Ajay Gupta, M. Eline Kooi, Stavros K. Kakkos, Pavel Poredos, Clark J. Zeebregts, Hans-Henning Eckstein, Antoine Millon, Jean-Baptiste Ricco, Alun H. Davies, Paraskevas K.I., Mikhailidis D.P., Baradaran H., Davies A.H., Eckstein H.-H., Faggioli G., E Fernandes J.F., Gupta A., Jezovnik M.K., Kakkos S.K., Katsiki N., Kooi M.E., Lanza G., Liapis C.D., Loftus I.M., Millon A., Nicolaides A.N., Poredos P., Pini R., Ricco J.-B., Rundek T., Saba L., Spinelli F., Stilo F., Sultan S., Zeebregts C.J., and Chaturvedi S.
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Life expectancy ,SCORING SYSTEM ,medicine.medical_treatment ,Review ,Carotid endarterectomy ,Stroke ,Endarterectomy ,RISK ,OUTCOMES ,medicine.diagnostic_test ,Ischemic attack ,Carotid stenosi ,ddc ,Cardiology ,SURVIVAL ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Life Sciences & Biomedicine ,Endarterectomy, carotid ,medicine.medical_specialty ,Clinical Neurology ,VASCULAR-SURGERY ,Asymptomatic ,Ischemic attack, transient ,transient ,Internal medicine ,medicine ,Carotid stenosis ,Diseases of the circulatory (Cardiovascular) system ,Patient preference ,Science & Technology ,business.industry ,STROKE PREVENTION ,ARTERY STENOSIS ,MORTALITY ,Magnetic resonance imaging ,1103 Clinical Sciences ,Vascular surgery ,medicine.disease ,Transcranial Doppler ,carotid ,Stenosis ,Life expec-tancy ,Peripheral Vascular Disease ,RC666-701 ,Cardiovascular System & Cardiology ,Neurology (clinical) ,Neurosciences & Neurology ,business ,1109 Neurosciences ,PERSONALIZED-MEDICINE - Abstract
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 or more clinical/imaging characteristics that may be associated with an increased risk of late ipsilateral stroke (e.g., silent embolic infarcts on brain computed tomography/magnetic resonance imaging, progression in the severity of ACS, a history of contralateral transient ischemic attack/stroke, microemboli detection on transcranial Doppler, etc.), provided documented perioperative stroke/death rates are 5 years. Besides these clinical/imaging characteristics, there are additional individual, ethnic/racial or social factors that should probably be evaluated in the decision process regarding the optimal management of these patients, such as individual patient needs/patient choice, patient compliance with best medical treatment, patient sex, culture, race/ethnicity, age and comorbidities, as well as improvements in imaging/operative techniques/outcomes. The present multispecialty position paper will present the rationale why the management of patients with ACS may need to be individualized.
- Published
- 2021
186. Management of patients with asymptomatic carotid stenosis may need to be individualized: A multidisciplinary call for action. Republication of J Stroke 2021;23:202-12
- Author
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Paraskevas K. I., Mikhailidis D. P., Baradaran H., Davies A. H., Eckstein H. -H., Faggioli G., Fernandes E Fernandes J., Gupta A., Jezovnik M. K., Kakkos S. K., Katsiki N., Kooi M. E., Lanza G., Liapis C. D., Loftus I. M., Millon A., Nicolaides A. N., Poredos P., Pini R., Ricco J. -B., Rundek T., Saba L., Spinelli F., Stilo F., Sultan S., Zeebregts C. J., Chaturvedi S., Paraskevas K.I., Mikhailidis D.P., Baradaran H., Davies A.H., Eckstein H.-H., Faggioli G., Fernandes E Fernandes J., Gupta A., Jezovnik M.K., Kakkos S.K., Katsiki N., Kooi M.E., Lanza G., Liapis C.D., Loftus I.M., Millon A., Nicolaides A.N., Poredos P., Pini R., Ricco J.-B., Rundek T., Saba L., Spinelli F., Stilo F., Sultan S., Zeebregts C.J., and Chaturvedi S.
- Subjects
Stroke ,Endarterectomy, Carotid ,Ischemic Attack, Transient ,Risk Factor ,Carotid Stenosi ,Human - Abstract
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 or more clinical/imaging characteristics that may be associated with an increased risk of late ipsilateral stroke (e.g. silent embolic infarcts on brain computed tomography/magnetic resonance imaging, progression in the severity of ACS, a history of contralateral transient ischemic attack/stroke, microemboli detection on transcranial Doppler, etc.), provided documented perioperative stroke/death rates are 5 years. Besides these clinical/imaging characteristics, there are additional individual, ethnic/racial or social factors that should probably be evaluated in the decision process regarding the optimal management of these patients, such as individual patient needs/patient choice, patient compliance with best medical treatment, patient sex, culture, race/ethnicity, age and comorbidities, as well as improvements in imaging/operative techniques/outcomes. The present multispecialty position paper will present the rationale why the management of patients with ACS may need to be individualized.
- Published
- 2021
187. Colour duplex in assessing the infrainguinal arteries in patients with claudication
- Author
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Davies, A.H., Willcox, J.H., Magee, T.R., Currie, I., Cole, S.E.A., Murphy, P., Lamont, P.M., and Baird, R.N.
- Published
- 1995
- Full Text
- View/download PDF
188. Risk prediction of outcome following carotid endarterectomy
- Author
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Davies, A.H., Hayward, J.K., Currie, I., Cole, S.E.A., Lopatazidis, A., Lamont, P.M., and Baird, R.N.
- Published
- 1996
- Full Text
- View/download PDF
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