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1. Combined Treatment of Native Femoropopliteal Occlusions in Chronic Limb-Threatening Ischemia Using Atherectomy Debulking and a New Sirolimus Drug-Coated Balloon (SELUTION SLR)

Author

Joseph Sumner, Sajal Patel, Iakovos Theodoulou, Narayanan Thulasidasan, Panos Gkoutzios, Irfan Ahmed, Athanasios Saratzis, and Athanasios Diamantopoulos

Subjects
chronic limb-threatening ischemia, peripheral arterial disease, endovascular, Medical physics. Medical radiology. Nuclear medicine, R895-920
Abstract

Objective The aim of this study was to report the primary outcomes of a pilot study investigating the safety and efficacy of sirolimus drug-coated balloons (SELUTION) for endovascular postatherectomy treatment of native occluded femoropopliteal lesions in patients with chronic limb-threatening ischemia (CLTI).

Published
2024
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3. Editor's Choice – Endovascular Versus Surgical Treatment for All Comer Patients With Prosthetic Bypass Graft Occlusion: The Multicentre ENSUPRO Study

Author

Korosoglou, Grigorios, Torsello, Giovanni, Saratzis, Athanasios, Isernia, Giacomo, Kontopodis, Nikolaos, González, Teresa Martín, Jacobs, Karen, Van Herzeele, Isabelle, Zayed, Hany, Stavroulakis, Konstantinos, Argiriou, Angeliki, Konstantinou, Nikolaos, Saratzis, Nikolaos, Henriques, Mickael, Troisi, Nicola, Giordano, Antonio N., D’Oria, Mario, Fazzini, Stefano, Nasr, Bahaa, Martelli, Massimiliano, and Caradu, Caroline

Published
2024
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4. Improving cardiovascular health in patients with an abdominal aortic aneurysm: development of the cardiovascular risk reduction in patients with aneurysms (CRISP) behaviour change intervention

Author

Tom M. Withers, Colin J. Greaves, Matt J. Bown, and Athanasios Saratzis

Subjects
Abdominal aortic aneurysm, Intervention mapping, Intervention development, Medicine (General), R5-920
Abstract

Abstract Background Abdominal aortic aneurysm (AAA) is an important cardiovascular health problem. Ultrasound screening is proven to reduce AAA mortality and programmes have been implemented in some healthcare systems. Those who are identified as having a small AAA in screening enter into a surveillance programme to monitor AAA size. Individuals in AAA surveillance are at elevated risk of cardiovascular events, which is not currently addressed sufficiently. We aimed to develop a simple intervention to reduce cardiovascular risk, which could be embedded in AAA surveillance pathways. Methods Intervention mapping methods were used to co-develop the intervention with individuals with AAA, families/carers, and healthcare staff. We identified “targets for change” by synthesising research evidence and international guidelines and consulting with patients, caregivers and health service providers. We conducted a series of workshops to identify barriers to and facilitators of change and used taxonomies of behaviour change theories and techniques to match intervention strategies to each target. Further stakeholder involvement work helped refine the intervention. Results The developed intervention focusses on assessment and individually tailored discussion of risk factors, exchanging information, building motivation and action planning, followed by review of progress and problem-solving. Workbooks covering physical activity, diet, stress management, alcohol, smoking, blood pressure and mental health are provided to support behaviour change. The intervention is facilitated by trained healthcare professionals during the patient’s AAA screening appointment for the duration that they are in surveillance. Discussion The developed intervention will now be tested to assess whether it can be integrated with the current AAA screening programme. The developed intervention is a novel approach to reducing cardiovascular disease in the AAA population, it is also the first intervention which tries to do this in this population. Trial registration International Clinical Trial Registration: ISRCTN93993995.

Published
2024
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5. Using healthcare systems data for outcomes in clinical trials: issues to consider at the design stage

Author

Alice-Maria Toader, Marion K. Campbell, Jennifer K. Quint, Michael Robling, Matthew R Sydes, Joanna Thorn, Alexandra Wright-Hughes, Ly-Mee Yu, Tom. E. F. Abbott, Simon Bond, Fergus J. Caskey, Madeleine Clout, Michelle Collinson, Bethan Copsey, Gwyneth Davies, Timothy Driscoll, Carrol Gamble, Xavier L. Griffin, Thomas Hamborg, Jessica Harris, David A. Harrison, Deena Harji, Emily J. Henderson, Pip Logan, Sharon B. Love, Laura A. Magee, Alastair O’Brien, Maria Pufulete, Padmanabhan Ramnarayan, Athanasios Saratzis, Jo Smith, Ivonne Solis-Trapala, Clive Stubbs, Amanda Farrin, and Paula Williamson

Subjects
Healthcare systems data, Outcomes, Clinical trials, Routinely collected data, Data validity, Registries, Medicine (General), R5-920
Abstract

Abstract Background Healthcare system data (HSD) are increasingly used in clinical trials, augmenting or replacing traditional methods of collecting outcome data. This study, PRIMORANT, set out to identify, in the UK context, issues to be considered before the decision to use HSD for outcome data in a clinical trial is finalised, a methodological question prioritised by the clinical trials community. Methods The PRIMORANT study had three phases. First, an initial workshop was held to scope the issues faced by trialists when considering whether to use HSDs for trial outcomes. Second, a consultation exercise was undertaken with clinical trials unit (CTU) staff, trialists, methodologists, clinicians, funding panels and data providers. Third, a final discussion workshop was held, at which the results of the consultation were fed back, case studies presented, and issues considered in small breakout groups. Results Key topics included in the consultation process were the validity of outcome data, timeliness of data capture, internal pilots, data-sharing, practical issues, and decision-making. A majority of consultation respondents (n = 78, 95%) considered the development of guidance for trialists to be feasible. Guidance was developed following the discussion workshop, for the five broad areas of terminology, feasibility, internal pilots, onward data sharing, and data archiving. Conclusions We provide guidance to inform decisions about whether or not to use HSDs for outcomes, and if so, to assist trialists in working with registries and other HSD providers to improve the design and delivery of trials.

Published
2024
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6. Designing a platform/adaptive randomised controlled trial for peripheral arterial disease (PAD) – The PAEDIS international platform trial development project [version 1; peer review: 2 approved, 1 approved with reservations]

Author

Athanasios Saratzis

Subjects
Peripheral Artery Disease, PAD, randomised controlled trial, platform trial, claudication, chronic limb threatening ischaemia, eng, Medicine
Abstract

Background Peripheral artery disease (PAD) is a common health problem. There are several technologies, medications, and interventions that aim to improve or treat PAD in people with symptomatic disease. Most of these technologies, however, have been untested in high-quality randomised studies assessing effectiveness and their interactions remain unknown. We developed a proposed design for an international randomised controlled trial assessing multiple PAD treatments. Methods Over the course of 11 months (2023) several workshops and reviews of the literature took place. More specific, the proposed platform trial was designed with 44 people with PAD and 112 experts from across the world, in five work packages. The most relevant PAD treatment with unproven effectiveness were identified and key trial components as well as success criteria were defined. With input from five clinical trials units, the final format of a potential platform PAD trial in primary and secondary care was then proposed for funding. Results The proposed platform PAD randomised trial involved two major multi-arm multi-stage randomised studies, assessing PAD treatments in the community setting (1st package) and then secondary care (2nd package). The 1st package involved people with claudication and the 2nd package involves people with chronic limb threatening ischaemia (CLTI). Conclusions A platform PAD trial involves many challenges in terms of both design and delivery. The proposed design involving both people with claudication and CLTI will hopefully act as a blueprint for future work in this area.

Published
2024
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7. Cost Analysis of Target Lesion Revascularisation in Patients With Femoropopliteal In Stent Re-Stenosis or Occlusion: The COSTLY-TLR Study

Author

Uijtterhaeghen, Gilles, e Melo, Ryan Gouveia, Gianluigi, Fino, Fazzini, Stefano, Coscas, Raphael, Valdivia, Andrés Reyes, Gordillo, Sergio, Patel, Bhavisha, D'Oria, Mario, Lepidi, Sandro, Guerra Requena, Mercedes, Tsilimparis, Nikolaos, Konstantinou, Nikolaos, Troisi, Nicola, Saratzis, Athanasios, Torsello, Giovanni B., Cardona-Gloria, Yamel, Van Herzeele, Isabelle, Messeder, Sarah J., Zayed, Hany, Torsello, Giovanni F., Chisci, Emiliano, Isernia, Giacomo, and Stavroulakis, Konstantinos

Published
2024
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13. Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL)-2 Trial: Analysis of the Timing and Causes of Death in Participants Randomised to an Infrapopliteal Vein Bypass or Best Endovascular Treatment First Revascularisation Strategy

Author

Bradbury, Andrew W., Hall, Jack, Moakes, Catherine A., Popplewell, Matthew, Meecham, Lewis, Bate, Gareth R., Kelly, Lisa, Diamantopoulos, Athanasios, Ganeshan, Arul, Houlind, Kim, Malmstedt, Jonas, Patel, Jai V., Saratzis, Athanasios, and Zayed, Hany

Published
2024
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15. REPAIRS Delphi: A UK and Ireland Consensus Statement on the Management of Infected Arterial Pseudoaneurysms Secondary to Groin Injecting Drug Use

Author

Munro, Euan N., Flett, Murray M., Hussey, Keith, Wolf, Bernhard, Jamieson, Russell W., Wallace, David, Vesey, Alex T., McCaslin, James, Wong, Peng, Tenna, Adriano, Badger, Stephen, Harrison, Gareth, Ghosh, Jon, Al-Khaffaf, Haytham, Torella, Francesco, McBride, Richard, Drinkwater, Susan, Antoniou, George A., Bhasin, Neeraj, Pradhan, Aniket, Smith, George, Coughlin, Patrick, Brar, Ranjeet, Elsherif, Mohamed, Lau, Simon, Peach, George, Kulkarni, Sachin, Brooks, Marcus, Wijesinghe, Lasantha, McCune, Ken, Hopper, Neil, Cowan, Andrew, Hunter, Ian, Mittapalli, Devender, Garnham, Andrew, Jones, Steven, Rajagopalan, Sriram, Tiwari, Alok, Imray, Chris, Atwal, Amarjit, Bahia, Sandeep, Jones, Keith G., Handa, Ashok, Bowbrick, Ginny, Nordon, Ian, Button, Matthew, Rudarakanchana, Nung, D’Souza, Rovan, Tai, Nigel, Moxey, Paul, Bicknell, Colin, Gibbs, Richard, Zayed, Hany, Saratzis, Athanasios, Kannan, Ramesh, Batchelder, Andrew, Chong, Peter Lee, Rowlands, Timothy, Hildebrand, Diane, Thapar, Ankur, Chaudhuri, Arindam, Howard, Adam, Metcalfe, Matthew, Al-Jundi, Wissam, Sayer, Gabriel, Lewis, David, Sohrabi, Soroush, Woolgar, Justin, Fligelstone, Louis, Davies, Huw, Hill, Susan, Fulton, Greg, Moneley, Daragh, McDonnell, Ciaran, Martin, Zenia, Dowdall, Joseph, Tierney, Sean, Walsh, Stewart, Medani, Mekki, Gosi, Gergely, MacLeod, Caitlin S., Nagy, John, Radley, Andrew, Khan, Faisel, Rae, Nikolas, Wilson, Michael S.J., and Suttie, Stuart A.

Published
2024
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17. Study Protocol of a Prospective, Monocentric, Single-Arm Study Investigating the Correlation of Endograft Properties with Aortic Stiffness in Abdominal Aortic Aneurysm Patients Subjected to Endovascular Aortic Repair

Author

Manolis Abatzis-Papadopoulos, Konstantinos Tigkiropoulos, Spyridon Nikas, Katerina Sidiropoulou, Christina Alexou, Kyriakos Stavridis, Dimitrios Karamanos, Vasilios Kotsis, Ioannis Lazaridis, and Nikolaos Saratzis

Subjects
abdominal aortic aneurysm, pulse wave velocity, aortic compliance, aortic stiffness, endovascular aortic repair, aortic endograft, Medicine
Abstract

The number of endovascular aortic repairs (EVARs) has surpassed the number of open surgical repairs of abdominal aortic aneurysms (AAAs) worldwide. The available commercial endoprostheses are composed of materials that are stiffer than the native aortic wall. As a consequence, the implantation of stent–graft endoprostheses during EVAR increases aortic rigidity and thus aortic stiffness, resulting in a decrease in abdominal aorta compliance. EVAR has been found to have a possibly harmful effect not only on heart functions but also on other vascular beds, including kidney function, due to the decrease in aortic compliance that it causes. Aortic stiffness is measured by various hemodynamic indices like the pulse wave velocity (PWV), the central aortic pressure (CAP), and the augmentation index (AIx). In the literature, there are increasing numbers of studies investigating the properties of endografts, which are strongly related to increases in aortic stiffness. However, there is a lack of data on whether there is a correlation between the length of various endografts implanted during EVAR and the increase in the PWV, CAP, and AIx postoperatively compared to the preoperative values. The aim of this prospective, observational, monocentric, single-arm study is to investigate the correlation between endograft length and the postoperative increase in the PWV, CAP, and AIx in patients subjected to EVAR. Additionally, this study intends to identify other endograft properties related to increases in the PWV, CAP, and AIx. Other endpoints to be studied are the existence of immediate postoperative myocardial and kidney injury after EVAR. The prediction of cardiovascular events caused by endograft-related increased aortic stiffness could contribute to the improvement of various endograft properties so that the impact of endografts on the native aortic wall can be minimized.

Published
2024
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19. Preoperative assessment and optimisation prior to planned aortic aneurysm repair: a UK survey examining current practice and attitudes of vascular surgeons and vascular anaesthetists

Author

Phoebe Scarfield, Jack Ryan, Morad Sallam, Athanasios Saratzis, Adam C. Pichel, Jugdeep K. Dhesi, and Judith S. L. Partridge

Subjects
Multidisciplinary team, Preoperative assessment, Perioperative medicine, Aortic aneurysm repair, Frailty, Shared decision-making, Surgery, RD1-811
Abstract

Abstract Background The majority of those diagnosed with aortic aneurysm in the UK are older, multi-morbid patients. Decision-making as to who may benefit from intervention (open or endovascular aneurysm repair) is highly variable across the NHS (as is the mode of intervention), in part because there are no detailed guidelines or consensus on preoperative assessment. Thus, there is likely to be significant variation in the pre-operative assessment and optimisation of these patients. Methods A survey was designed to understand current practice and attitudes of vascular surgeons and vascular anaesthetists in the UK regarding preoperative assessment and optimisation of patients undergoing elective aortic aneurysm repair. The survey was reviewed and validated by an expert panel, then distributed electronically to all vascular surgical and vascular anaesthetic leads in the UK. Results Overall, the response rate was 68%. The responses were varied between surgeons and anaesthetists, with differences reported in the preoperative assessment and optimisation of patients, the approach to shared decision-making, and the perioperative pathway. Conclusions Despite initiatives such as Getting It Right First Time (GIRFT) and National Institute for Health and Care Excellence (NICE) guidelines, variation still exists between centres with some differences in opinion observed between surgeons and anaesthetists. These differences may be leading to duplication of work in the perioperative pathway, inconsistencies in how risk is assessed and communicated with consequent variation in patient care. Addressing these issues requires awareness and implementation of existing guidelines, transdisciplinary working, efficient data-driven pathways, and structured aortic aneurysm multi-disciplinary team to promote meaningful shared decision-making.

Published
2023
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20. Long-Term Effects of Acute Kidney Injury Following Endovascular Femoropopliteal Intervention: Insights From a Multicenter Trial.

Author

Katsogridakis, Emmanuel, Saha, Prakash, Diamantopoulos, Athanasios, Saratzis, Nikolaos, Davies, Robert, Zayed, Hany, Bown, Matthew J., and Saratzis, Athanasios

Abstract

Purpose: To examine the association between acute kidney injury (AKI) severity and duration with cardiovascular mortality, following endovascular treatment of femoropopliteal disease, and whether it is AKI in itself that confers an increased risk of cardiovascular mortality. Methods: A retrospective analysis of prospectively collected data obtained between 2014 and 2019 from 3 vascular centers. Renal function was followed up for a minimum of 90 days. Electronic records were queried to establish a cause of death, where applicable. Patients were excluded if unable to provide written informed consent or if presenting with acute limb ischemia. Primary outcomes were the hazard ratios for cardiovascular death (AKI patients vs no AKI; no AKI vs stage 1 AKI vs stage 3 AKI; and no AKI vs transient AKI vs established AKI). Propensity score–matched analysis was used to establish whether developing AKI, in patients with similar demographics and procedural characteristics, is associated with a higher risk of cardiovascular death. Results: Overall 239 patients developed AKI, and this was associated with an increased risk of cardiovascular mortality (hazard risk [HR]: 4.3, 95% confidence intervals [CIs]: 2.1–6.8, pairwise comparison p value=0.006]. This was dependent on the severity of the AKI stage (HR 5.4, 95% CI: 2.4–7.3, pairwise comparison p value=0.01) and duration (HR 4.2, 95% CI: 2.3–6.2, pairwise comparison p value=0.04). The propensity score–matched analysis showed that even when patients are matched for comorbidity and procedural characteristics, AKI confers an increased risk of mortality (p=0.04). Conclusions: Acute kidney injury is common after femoropopliteal endovascular therapy. It confers an increased risk of long-term cardiovascular mortality, which is still present when renal decline is transient, and highest for patients with established decline in renal function. Clinical Impact: This is the first study in the setting of peripheral arterial disease to show that acute kidney injury has an adverse effect on cardiovascular mortality, in the long-term, that is dependent on its severity, and present even when the AKI is transient. We have also shown that this difference in cardiovascular mortality becomes more pronounced from the medium-term, and thus closer follow-up of these patients is required. [ABSTRACT FROM AUTHOR]

Published
2024
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22. Global impact of the first coronavirus disease 2019 (COVID‐19) pandemic wave on vascular services

Author

Benson, Ruth A, Nandhra, Sandip, Shalhoub, Joseph, Dattani, Nikesh, Ambler, Graeme K, Banquet, David C, Bosanquet, David C, Forsythe, Rachael, Onida, Sarah, Dovell, George, Hitchman, Louise, Preece, Ryan, Saratzis, Athanasios, Imray, Chris, Johnson, Adam, Choong, Andrew, Ng, Jun Jie, Aitken, Sarah, Moss, Jana-Lee, Sudarsanam, Abhilash, Tam, Adam, Beck, Adam W, Barkat, Adel, Bajwa, Adnan, Elbasty, Ahmed, Awopetu, AI, Kodama, Akio, Rivera, Aksim G, Munoz, Alberto, Saltiel, Alberto, Russo, Alejandro, Rolls, Alex, Kafetzakis, Alexandros, Kimyaghalam, Ali, Kordzadeh, Ali, Shepherd, Amanda, Singh, Aminder, Mingoli, Andrea, Lazaris, Andreas M, Isaak, Andrej, Marin, Andres, Valdivia, Andrés Reyes, Batchelder, Andrew, Duncan, Andrew, Argyriou, Angeliki, Jaipersad, Anthony S, Freyrie, Antonio, Pereira-Neves, António, Mahomed, Anver, Isik, Arda, Jawien, Arkadiusz, Choudhry, Asad J, Sivaharan, Ashwin, Giannoukas, Athanasios, Papaioannou, Athanasios, Abbas, Ayman, Christos, Bakoyiannis, Akkaya, Bekir Bogachan, Huasen, Bella, Patrice, Bibombe, Mwipatayi, Azhar, Bilal, Keldiyorov, Boboyor, Ullery, Brant W, Pratesi, Carlo, Hinojosa, Carlos A, Bechara, Carlos F, Parra, Carolina Salinas, Alexandros, Charalabopoulos, Bezard, Charlotte, Lee, Cheong Jun, Davies, Chris, Behrendt, Christian-Alexander, Lowe, Christopher, Karkos, Christos D, Yih, Chun Ling Patricia, McDonnell, Ciarán, Ordonez, Claudia, Nesbitt, Craig, Alexander, Croo, Guglielmone, Daniel, Doherty, Daniel T, Riding, David M, Esposito, Davide, Harkin, Denis, Lui, Dennis H, and Kamal, Dhafer M

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Clinical Research, Neurodegenerative, Good Health and Well Being, COVID-19, Global Health, Health Care Surveys, Health Services Accessibility, Humans, Pandemics, Practice Patterns, Physicians', Prospective Studies, Vascular Surgical Procedures, Vascular and Endovascular Research Network (VERN) COVER study collaborative*, Medical and Health Sciences, Surgery, Clinical sciences
Abstract

This online structured survey has demonstrated the global impact of the COVID-19 pandemic on vascular services. The majority of centres have documented marked reductions in operating and services provided to vascular patients. In the months during recovery from the resource restrictions imposed during the pandemic peaks, there will be a significant vascular disease burden awaiting surgeons. One of the most affected specialties.

Published
2020

23. One-Year Outcomes of CGuard Double Mesh Stent in Carotid Artery Disease: A Systematic Review and Meta-Analysis

Author

Konstantinos Tigkiropoulos, Spyridon Nikas, Manolis Ampatzis-Papadopoulos, Katerina Sidiropoulou, Kyriakos Stavridis, Dimitrios Karamanos, Ioannis Lazaridis, and Nikolaos Saratzis

Subjects
CGuard, carotid artery stenting, carotid artery disease, dual layer mesh stents, systematic review and meta-analysis, Medicine (General), R5-920
Abstract

Background: Prospective single and multicenter studies have shown improved outcomes of patients who underwent carotid artery stenting with the novel CGuard dual-layer mesh stent at 1 year. Objectives: The aim of this study is to conduct a systematic review and meta-analysis of all published studies to assess 1-year efficacy and outcomes of CGuard in patients with carotid stenting. Methods: A systematic search was performed. All studies enrolling at least 20 patients were included in our analysis. The primary endpoints were death (all-cause, cardiovascular and ipsilateral stroke-related death) and stroke rate at 1 year. The secondary endpoint was in-stent restenosis at 1 year. Results: The final analysis included 1709 patients. The one-year all-cause mortality rate was 2.97% (39/1699, 95% CI: 1.26–6.86%, I2 = 67%, t2 = 0.3442, p < 0.01), cardiovascular-related death was 0.92% (10/1616, 95% CI: 0.35–2.39%, I2 = 34%, t2 = 0.2302, p = 0.18), and ipsilateral stroke-related death was 0.3% (1/1649, 95% CI: 0.1–0.87%, I2 = 0%, t2 = 0, p = 0.69). The one-year ipsilateral stroke rate was 1.21% (16/1649, 95% CI: 0.58–2.5%, I2 = 28%, t2 = 0.1433, p = 0.23), transient ischemic attacks (TIAs) rate was 1.78% (19/1149, 95% CI: 1.11–2.84%, I2 = 0%, t2 = 0, p = 0.69), and total composite 1-year stroke/TIA rate was 2.97% (32/1149, 95% CI: 1.84–4.77%, I2 = 0%, t2 = 0, p = 0.41). The in-stent restenosis rate at 1 year was 1.06% (13/1653, 95% CI: 0.48–2.34%, I2 = 28%, t2 = 0.2308, p = 0.22). Conclusions: This meta-analysis shows that CAS with CGuard is safe with minimal neurological adverse events and in-stent restenosis rate at 1 year.

Published
2024
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24. A vein bypass first versus a best endovascular treatment first revascularisation strategy for patients with chronic limb threatening ischaemia who required an infra-popliteal, with or without an additional more proximal infra-inguinal revascularisation procedure to restore limb perfusion (BASIL-2): an open-label, randomised, multicentre, phase 3 trial

Author

Bradbury, Andrew W, Moakes, Catherine A, Popplewell, Matthew, Meecham, Lewis, Bate, Gareth R, Kelly, Lisa, Chetter, Ian, Diamantopoulos, Athanasios, Ganeshan, Arul, Hall, Jack, Hobbs, Simon, Houlind, Kim, Jarrett, Hugh, Lockyer, Suzanne, Malmstedt, Jonas, Patel, Jai V, Patel, Smitaa, Rashid, S Tawqeer, Saratzis, Athanasios, Slinn, Gemma, Scott, D Julian A, Zayed, Hany, and Deeks, Jonathan J

Published
2023
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28. Study Protocol of a Prospective, Monocentric, Single-Arm Study Investigating the Correlation of Endograft Properties with Aortic Stiffness in Abdominal Aortic Aneurysm Patients Subjected to Endovascular Aortic Repair

Author

Abatzis-Papadopoulos, Manolis, primary, Tigkiropoulos, Konstantinos, additional, Nikas, Spyridon, additional, Sidiropoulou, Katerina, additional, Alexou, Christina, additional, Stavridis, Kyriakos, additional, Karamanos, Dimitrios, additional, Kotsis, Vasilios, additional, Lazaridis, Ioannis, additional, and Saratzis, Nikolaos, additional

Published
2024
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29. One-year outcomes following primary stenting of infrapopliteal steno-occlusive arterial disease using a non-polymer sirolimus-eluting stent: Results from a prospective single-centre cohort study

Author

Konstantinos Tigkiropoulos, Ioannis Lazaridis, Spyridon Nikas, Manolis Abatzis-Papadopoulos, Katerina Sidiropoulou, Kyriakos Stavridis, Dimitrios Karamanos, Athanasios Saratzis, and Nikolaos Saratzis

Subjects
chronic limb ischaemia, sirolimus, Cre8, stent, infrapopliteal angioplasty, Surgery, RD1-811
Abstract

BackgroundClinical outcomes using new generation drug-eluting stents designed specifically for infrapopliteal disease are not widely available, especially in comparison to paclitaxel-based therapies. This series reports 1-year outcomes in patients with diabetes and chronic limb threatening ischaemia (CLTI) undergoing angioplasty, with a sirolimus-eluting tibial stent (Cre8, Alvimedica, Turkey), evaluating the feasibility, safety, and efficacy of this new device. Outcomes were compared to matched patients undergoing infrapopliteal angioplasty using a paclitaxel-coated balloon (DCB).Patients and MethodsPatients with diabetes and CLTI requiring infrapopliteal intervention were recruited prospectively to undergo angioplasty and primary stenting using the Cre8 sirolimus-eluting stent between January 2018 and October 2020 at a single high-volume vascular centre; outcomes were compared to a group of patients with diabetes and CLTI who had undergone infrapopliteal angioplasty using a DCB. All patients were followed up for at least 12 months using a uniform protocol with duplex ultrasound and examination. The primary outcome measure was target lesion patency (

Published
2022
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30. Factors that influence the feasibility and implementation of a complex intervention to improve the treatment of peripheral arterial disease in primary and secondary care: a qualitative exploration of patient and provider perspectives

Author

Athanasios Saratzis, Vanessa Lawrence, Ruth Benson, Emma Watson, Prakash Saha, Clair Le Boutillier, and Bernadeta Bridgwood

Subjects
Medicine
Abstract

Objectives Our aim was to examine the feasibility and implementation of a complex intervention to improve the care of patients with peripheral arterial disease (the LEGS intervention) from the perspective of patients, general practitioners and secondary care clinicians.Design A qualitative study involving semistructured individual interviews with patients and providers to gain an understanding of the feasibility of the LEGS intervention as well the barriers and facilitators to implementation in secondary and primary care.Setting Primary and secondary care settings across two National Health Service Trusts.Participants Twenty-five semistructured telephone interviews were conducted with (1) patients who had received the intervention (n=11), (2) secondary care clinicians responsible for delivering the intervention (n=8) and (3) general practitioners (n=6).Analysis Data were initially analysed using inductive descriptive thematic analysis. The consolidated framework for implementation research was then used as a matrix to explore patterns in the data and to map connections between the three participant groups. Lastly, interpretive analysis allowed for refining, and a final coding frame was developed.Results Four overarching themes were identified: (1) the potential to make a difference, (2) a solution to address the gap in no man’s land, (3), prioritising and making it happen and (4) personalised information and supportive conversations for taking on the advice. The impetus for prioritising and delivering the intervention was further driven by its flexibility and adaptability to be tailored to the individual and to the environment.Conclusions The LEGS intervention can be tailored for use at early and late stages of peripheral arterial disease, provides an opportunity to meet patient needs and can be used to promote shared working across the primary–secondary care interface.

Published
2023
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32. Documenting the Recovery of Vascular Services in European Centres Following the Initial COVID-19 Pandemic Peak: Results from a Multicentre Collaborative Study

Author

Ruth A. Benson, Maria Antonella Ruffino, Sharon Chan, Patrick Coughlin, Ayoola Awopetu, Philip Stather, Tristan Lane, Dimitrios Theodosiou, Mohamed Abozeid Ahmed, Thodur Vasudevan, Mohammed Ibrahim, Faraj Al Maadany, Mohamed Eljareh, Fatimah Saad Alkhafeefi, Raphael Coscas, Ertekin Utku Ünal, Raffaele Pulli, Sergio Zacà, Domenico Angiletta, Thomas Kotsis, Magdy Moawad, Matteo Tozzi, Nikolaos Patelis, Andreas M. Lazaris, Jason Chuen, Alexander Croo, Elpiniki Tsolaki, Gladiol Zenunaj, Dhafer Kamal, Mahmoud MH. Tolba, Martin Maresch, Vipul Khetarpaul, Joseph Mills, Gaurav Gangwani, Mohamed Elahwal, Rana Khalil, Mohammed A. Azab, Anver Mahomed, Richard Whiston, Ummul Contractor, Davide Esposito, Carlo Pratesi, Elena Giacomelli, Martín Veras Troncoso, Stephane Elkouri, Flavia Gentile Johansson, Ilias Dodos, Marie Benezit, José Vidoedo, João Rocha-Neves, António Henrique Pereira-Neves, Marina Felicidade Dias-Neto, Ana Filipa Campos Jácome, Luis Loureiro, Ivone Silva, Rodrigo Garza-Herrera, Victor Canata, Charlotte Bezard, Kathryn Bowser, Jorge Felipe Tobar, Carlos Gomez Vera, Carolina Salinas Parra, Eugenia Lopez, Yvis Gadelha Serra, Juan Varela, Vanessa Rubio, Gerardo Victoria, Adam Johnson, Leigh Ann O’Banion, Ragai Makar, Tamer Ghatwary Tantawy, Martin Storck, Vincent Jongkind, Orwa falah, Olivia McBride, Arda Isik, Athanasios Papaioannou, Paulo Eduardo Ocke Reis, Umberto Marcello Bracale, Ellie Atkins, Giovanni Tinelli, Emma Scott, Lucy Wales, Ashwin Sivaharan, Georgia Priona, Craig Nesbitt, Tabitha Grainger, Lauren Shelmerdine, Patrick Chong, Adnan Bajwa, Luke Arwynck, Nancy Hadjievangelou, Ahmed Elbasty, Oscar Rubio, Michael Ricardo, Jorge H. Ulloa, Marcos Tarazona, Manuel Pabon, Georgios Pitoulias, Kevin Corless, Orestis Ioannidis, Oliver Friedrich, Isabelle Van Herzeele, Badri Vijaynagar, Tina Cohnert, Rachel Bell, Hayley Moore, Prakash Saha, Edward Gifford, Matti Laine, Adel Barkat, Christos Karkos, Lenny Suryani Binti Safri, Gabriel Buitron, Javier Del Castillo, Paul Carrera, Nilson Salinas, Rodrigo Bruno Biagioni, Sergio Benites, César Andrés Mafla, Putera Mas Pian, Pereira Albino, Ernesto Serrano, Andres Marin, Marco González, Marsha Foreroga, Alejandro Russo, Andrés Reyes, Daniel Guglielmone, Lorena Grillo, Ronald Flumignan, Francisco Gomez Palones, Pierre Galvagni Silveira, Rosnelifaizur Bin Ramely, Sara Edeiken, Ian Chetter, Lucy Green, Abhilash Sudarsanam, Oliver Lyons, Gary Lemmon, Richard Neville, Mariano Castelli, Carlos A. Hinojosa, Rubén Rodríguez Carvajal, Aksim Rivera, Peng Wong, Laura Drudi, Jeremy Perkins, Kishore Sieunarine, Doaa Attia, Mahmoud Atef, Lostoridis Eftychios, Fred Weaver, Leong Chuo Ren, Mohannad Alomari, Reda Jamjoom, Qusai Aljarrah, Ayman Abbas, Faris Alomran, Ambrish Kumar, Abdulmajeed Altoijri, Kareem T. ElSanhoury, Ahmed Alhumaid, Tamer Fekry, Raghuram Sekhar, Panagiotis Theodoridis, Theodoridis Panagiotis, Konstantinos Roditis, Paraskevi Tsiantoula, Afroditi Antoniou, Raphael Soler, Natasha Hasemaki, Efstratia Baili, Eustratia Mpaili, Bella Huasen, Tom Wallace, Andrew Duncan, Matthew Metcalfe, Kristyn Mannoia, Carlos F. Bechara, Nikolaos Tsilimparis, Nathan Aranson, David Riding, Mariano Palena, Ciarán McDonnell, Nicolas J. Mouawad, Shonda Banegas, Peter Rossi, Taohid Oshodi, Rodney Diaz, Rana Afifi, Shiva Dindyal, Ankur Thapar, Ali Kordzadeh, Gonzalo Pullas, Stephanie Lin, Chris Davies, Katy Darvall, Akio Kodama, Thushan Gooneratne, Nalaka Gunawansa, Alberto Munoz, Ng Jun Jie, Nicholas Bradley, Wissam Al-Jundi, Felicity Meyer, Cheong Lee, Martin Malina, Sophie Renton, Dennis Lui, Andrew Batchelder, Grzegorz Oszkinis, Antonio Freyrie, Jacopo Giordano, Nikolaos Saratzis, Konstantinos Tigkiropoulos, Stavridis Kyriakos, Guriy Popov, Muhammad Usman Cheema, Pierfrancesco Lapolla, Yih Chun Ling Patricia, Raed Ennab, Brant W. Ullery, Ketino Pasenidou, Jacky Tam, Gabriel Sidel, Vivek Vardhan Jayaprakash, Lisa Bennett, Simon Hardy, Emma Davies, Sara Baker, Lasantha Wijesinghe, Adam Tam, Ken McCune, Manik Chana, Chris Lowe, Aaron Goh, Katarzyna Powezka, Ioanna Kyrou, Nishath Altaf, Denis Harkin, Hannah Travers, James Cragg, Atif sharif, Tasleem Akhtar, José Antonio Chávez, Claudia Ordonez, Martin Mazzurco, Edward Choke, Imran Asghar, Virginia Summerour, Paul Dunlop, Rachel Morley, Thomas Hardy, Paul Bevis, Robert Cuff, Konstantinos Stavroulakis, Efthymios Beropoulis, Angeliki Argyriou, Ian Loftus, Bilal Azhar, Sharvil Sheth, Marco Virgilio Usai, Asad Choudhry, Kira Nicole, Emily Boyle, Doireann Joyce, Mohammed Hassan Abdelaty Hassan, Alberto Saltiel, Gert Frahm-Jensen, George Antoniou, Muhammed Elhadi, Ali Kimyaghalam, Rafael Malgor, Leigh Ann O'Banion, Diego Telve, Andrej Isaak, Jürg Schmidli, Kevin McKevitt, Tam Siddiqui, Giuseppe Asciutto, Nikolaos Floros, George Papadopoulos, Alexandros Kafetzakis, Stylianos G. Koutsias, Petroula Nana, Athanasios Giannoukas, Stavros Kakkos, Konstantinos G. Moulakakis, Natasha Shafique, Arkadiusz Jawien, Matthew Popplewell, Chris Imray, Kumar Abayasekara, Timothy Rowlands, Ganesh Kuhan, Sriram Rajagopalan, Anthony Jaipersad, Uzma Sadia, Isaac Kobe, Devender Mittapalli, Ibrahim Enemosah, Christian-Alexander Behrendt, Adam Beck, Muayyad Almudhafer, Stefano Ancetti, Donald Jacobs, Priya Jayakumar, Fatemeh Malekpour, Sherene Shalhub, Boboyor Keldiyorov, Meryl Simon, Manar Khashram, Nicole Rich, Amanda Shepherd, Lewis Meecham, and Daniel Doherty

Subjects
AAA, COVID-19, PAD, Survey, Vascular surgery, Diseases of the circulatory (Cardiovascular) system, RC666-701, Surgery, RD1-811
Abstract

Objective: To document the recovery of vascular services in Europe following the first COVID-19 pandemic peak. Methods: An online structured vascular service survey with repeated data entry between 23 March and 9 August 2020 was carried out. Unit level data were collected using repeated questionnaires addressing modifications to vascular services during the first peak (March – May 2020, “period 1”), and then again between May and June (“period 2”) and June and July 2020 (“period 3”). The duration of each period was similar. From 2 June, as reductions in cases began to be reported, centres were first asked if they were in a region still affected by rising cases, or if they had passed the peak of the first wave. These centres were asked additional questions about adaptations made to their standard pathways to permit elective surgery to resume. Results: The impact of the pandemic continued to be felt well after countries’ first peak was thought to have passed in 2020. Aneurysm screening had not returned to normal in 21.7% of centres. Carotid surgery was still offered on a case by case basis in 33.8% of centres, and only 52.9% of centres had returned to their normal aneurysm threshold for surgery. Half of centres (49.4%) believed their management of lower limb ischaemia continued to be negatively affected by the pandemic. Reduced operating theatre capacity continued in 45.5% of centres. Twenty per cent of responding centres documented a backlog of at least 20 aortic repairs. At least one negative swab and 14 days of isolation were the most common strategies used for permitting safe elective surgery to recommence. Conclusion: Centres reported a broad return of services approaching pre-pandemic “normal” by July 2020. Many introduced protocols to manage peri-operative COVID-19 risk. Backlogs in cases were reported for all major vascular surgeries.

Published
2022
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33. Documenting the Recovery of Vascular Services in European Centres Following the Initial COVID-19 Pandemic Peak: Results from a Multicentre Collaborative Study

Author

Ruffino, Maria Antonella, Chan, Sharon, Coughlin, Patrick, Awopetu, Ayoola, Stather, Philip, Lane, Tristan, Theodosiou, Dimitrios, Ahmed, Mohamed Abozeid, Vasudevan, Thodur, Ibrahim, Mohammed, Al Maadany, Faraj, Eljareh, Mohamed, Alkhafeefi, Fatimah Saad, Coscas, Raphael, Ünal, Ertekin Utku, Pulli, Raffaele, Zacà, Sergio, Angiletta, Domenico, Kotsis, Thomas, Moawad, Magdy, Tozzi, Matteo, Patelis, Nikolaos, Lazaris, Andreas M., Chuen, Jason, Croo, Alexander, Tsolaki, Elpiniki, Zenunaj, Gladiol, Kamal, Dhafer, Tolba, Mahmoud MH., Maresch, Martin, Khetarpaul, Vipul, Mills, Joseph, Gangwani, Gaurav, Elahwal, Mohamed, Khalil, Rana, Azab, Mohammed A., Mahomed, Anver, Whiston, Richard, Contractor, Ummul, Esposito, Davide, Pratesi, Carlo, Giacomelli, Elena, Troncoso, Martín Veras, Elkouri, Stephane, Johansson, Flavia Gentile, Dodos, Ilias, Benezit, Marie, Vidoedo, José, Rocha-Neves, João, Pereira-Neves, António Henrique, Dias-Neto, Marina Felicidade, Campos Jácome, Ana Filipa, Loureiro, Luis, Silva, Ivone, Garza-Herrera, Rodrigo, Canata, Victor, Bezard, Charlotte, Bowser, Kathryn, Tobar, Jorge Felipe, Vera, Carlos Gomez, Parra, Carolina Salinas, Lopez, Eugenia, Serra, Yvis Gadelha, Varela, Juan, Rubio, Vanessa, Victoria, Gerardo, Johnson, Adam, O’Banion, Leigh Ann, Makar, Ragai, Tantawy, Tamer Ghatwary, Storck, Martin, Jongkind, Vincent, falah, Orwa, McBride, Olivia, Isik, Arda, Papaioannou, Athanasios, Ocke Reis, Paulo Eduardo, Bracale, Umberto Marcello, Atkins, Ellie, Tinelli, Giovanni, Scott, Emma, Wales, Lucy, Sivaharan, Ashwin, Priona, Georgia, Nesbitt, Craig, Grainger, Tabitha, Shelmerdine, Lauren, Chong, Patrick, Bajwa, Adnan, Arwynck, Luke, Hadjievangelou, Nancy, Elbasty, Ahmed, Rubio, Oscar, Ricardo, Michael, Ulloa, Jorge H., Tarazona, Marcos, Pabon, Manuel, Pitoulias, Georgios, Corless, Kevin, Ioannidis, Orestis, Friedrich, Oliver, Van Herzeele, Isabelle, Vijaynagar, Badri, Cohnert, Tina, Bell, Rachel, Moore, Hayley, Saha, Prakash, Gifford, Edward, Laine, Matti, Barkat, Adel, Karkos, Christos, Binti Safri, Lenny Suryani, Buitron, Gabriel, Del Castillo, Javier, Carrera, Paul, Salinas, Nilson, Biagioni, Rodrigo Bruno, Benites, Sergio, Mafla, César Andrés, Pian, Putera Mas, Albino, Pereira, Serrano, Ernesto, Marin, Andres, González, Marco, Foreroga, Marsha, Russo, Alejandro, Reyes, Andrés, Guglielmone, Daniel, Grillo, Lorena, Flumignan, Ronald, Palones, Francisco Gomez, Silveira, Pierre Galvagni, Ramely, Rosnelifaizur Bin, Edeiken, Sara, Chetter, Ian, Green, Lucy, Sudarsanam, Abhilash, Lyons, Oliver, Lemmon, Gary, Neville, Richard, Castelli, Mariano, Hinojosa, Carlos A., Carvajal, Rubén Rodríguez, Rivera, Aksim, Wong, Peng, Drudi, Laura, Perkins, Jeremy, Sieunarine, Kishore, Attia, Doaa, Atef, Mahmoud, Eftychios, Lostoridis, Weaver, Fred, Ren, Leong Chuo, Alomari, Mohannad, Jamjoom, Reda, Aljarrah, Qusai, Abbas, Ayman, Alomran, Faris, Kumar, Ambrish, Altoijri, Abdulmajeed, ElSanhoury, Kareem T., Alhumaid, Ahmed, Fekry, Tamer, Sekhar, Raghuram, Theodoridis, Panagiotis, Panagiotis, Theodoridis, Roditis, Konstantinos, Tsiantoula, Paraskevi, Antoniou, Afroditi, Soler, Raphael, Hasemaki, Natasha, Baili, Efstratia, Mpaili, Eustratia, Huasen, Bella, Wallace, Tom, Duncan, Andrew, Metcalfe, Matthew, Mannoia, Kristyn, Bechara, Carlos F., Tsilimparis, Nikolaos, Aranson, Nathan, Riding, David, Palena, Mariano, McDonnell, Ciarán, Mouawad, Nicolas J., Banegas, Shonda, Rossi, Peter, Oshodi, Taohid, Diaz, Rodney, Afifi, Rana, Dindyal, Shiva, Thapar, Ankur, Kordzadeh, Ali, Pullas, Gonzalo, Lin, Stephanie, Davies, Chris, Darvall, Katy, Kodama, Akio, Gooneratne, Thushan, Gunawansa, Nalaka, Munoz, Alberto, Jie, Ng Jun, Bradley, Nicholas, Al-Jundi, Wissam, Meyer, Felicity, Lee, Cheong, Malina, Martin, Renton, Sophie, Lui, Dennis, Batchelder, Andrew, Oszkinis, Grzegorz, Freyrie, Antonio, Giordano, Jacopo, Saratzis, Nikolaos, Tigkiropoulos, Konstantinos, Kyriakos, Stavridis, Popov, Guriy, Cheema, Muhammad Usman, Lapolla, Pierfrancesco, Ling Patricia, Yih Chun, Ennab, Raed, Ullery, Brant W., Pasenidou, Ketino, Tam, Jacky, Sidel, Gabriel, Jayaprakash, Vivek Vardhan, Bennett, Lisa, Hardy, Simon, Davies, Emma, Baker, Sara, Wijesinghe, Lasantha, Tam, Adam, McCune, Ken, Chana, Manik, Lowe, Chris, Goh, Aaron, Powezka, Katarzyna, Kyrou, Ioanna, Altaf, Nishath, Harkin, Denis, Travers, Hannah, Cragg, James, sharif, Atif, Akhtar, Tasleem, Chávez, José Antonio, Ordonez, Claudia, Mazzurco, Martin, Choke, Edward, Asghar, Imran, Summerour, Virginia, Dunlop, Paul, Morley, Rachel, Hardy, Thomas, Bevis, Paul, Cuff, Robert, Stavroulakis, Konstantinos, Beropoulis, Efthymios, Argyriou, Angeliki, Loftus, Ian, Azhar, Bilal, Sheth, Sharvil, Usai, Marco Virgilio, Choudhry, Asad, Nicole, Kira, Boyle, Emily, Joyce, Doireann, Abdelaty Hassan, Mohammed Hassan, Saltiel, Alberto, Frahm-Jensen, Gert, Antoniou, George, Elhadi, Muhammed, Kimyaghalam, Ali, Malgor, Rafael, O'Banion, Leigh Ann, Telve, Diego, Isaak, Andrej, Schmidli, Jürg, McKevitt, Kevin, Siddiqui, Tam, Asciutto, Giuseppe, Floros, Nikolaos, Papadopoulos, George, Kafetzakis, Alexandros, Koutsias, Stylianos G., Nana, Petroula, Giannoukas, Athanasios, Kakkos, Stavros, Moulakakis, Konstantinos G., Shafique, Natasha, Jawien, Arkadiusz, Popplewell, Matthew, Imray, Chris, Abayasekara, Kumar, Rowlands, Timothy, Kuhan, Ganesh, Rajagopalan, Sriram, Jaipersad, Anthony, Sadia, Uzma, Kobe, Isaac, Mittapalli, Devender, Enemosah, Ibrahim, Behrendt, Christian-Alexander, Beck, Adam, Almudhafer, Muayyad, Ancetti, Stefano, Jacobs, Donald, Jayakumar, Priya, Malekpour, Fatemeh, Shalhub, Sherene, Keldiyorov, Boboyor, Simon, Meryl, Khashram, Manar, Rich, Nicole, Shepherd, Amanda, Meecham, Lewis, Doherty, Daniel, and Benson, Ruth A.

Published
2022
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34. Safety and effectiveness of the Phoenix atherectomy device for endovascular treatment of common femoral and popliteal arteries: Results of the EN-MOBILE trial.

Author

Schöfthaler, Christoph, Troisi, Nicola, Torsello, Giovanni, Jehn, Amila, Lichtenberg, Michael, Karcher, Jan C, Stavroulakis, Konstantinos, D'Oria, Mario, Saratzis, Athanasios, Zayed, Hany, Andrassy, Martin, and Korosoglou, Grigorios

Subjects
POPLITEAL artery, CHRONIC total occlusion, ENDOVASCULAR surgery, ATHERECTOMY, FEMORAL artery
Abstract

Background: This study aimed to assess the peri- and postprocedural outcomes of atherectomy-assisted endovascular treatment of the common femoral (CFA) and popliteal arteries. Methods: Phoenix atherectomy was used for the treatment of 73 and 53 de novo CFA and popliteal artery lesions, respectively, in 122 consecutive patients. Safety endpoints encompassed perforation and peripheral embolization. Postprocedural endpoints included freedom from clinically driven target lesion revascularization (CD-TLR) and clinical success (an improvement of ⩾ 2 Rutherford category [RC]). In addition, 531 patients treated for popliteal artery stenosis or occlusion without atherectomy were used as a comparator group. Results: Procedural success (residual stenosis < 30% after treatment) was 99.2%. The need for bail-out stenting was 2 (2.7%) and 3 (5.7%) in CFA and popliteal artery lesions, respectively. Only one (1.4%) embolization occurred in the CFA, which was treated by catheter aspiration. No perforations occurred. After 1.50 (IQR = 1.17–2.20) years, CD-TLR occurred in seven (9.2%) and six (14.6%) patients with CFA and popliteal artery lesions, respectively, whereas clinical success was achieved in 62 (91.2%) and 31 (75.6%), respectively. Patients treated with atherectomy and DCB in the popliteal artery after matching for baseline RC, lesion calcification, length, and the presence of chronic total occlusion, exhibited higher freedom from CD-TLR compared to the nondebulking group (HR = 3.1; 95% CI = 1.1–8.5, p = 0.03). Conclusion: Atherectomy can be used safely and is associated with low rates of bail-out stenting in CFA and popliteal arteries. CD-TLR and clinical success rates are clinically acceptable. In addition, for the popliteal artery, atherectomy combined with DCB demonstrates lower CD-TLR rates compared to a DCB alone strategy. (German Clinical Trials Register: DRKS00016708) [ABSTRACT FROM AUTHOR]

Published
2024
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35. Cost Analysis of Target Lesion Revascularisation in Patients With Femoropopliteal In Stent Re-Stenosis or Occlusion: The COSTLY-TLR Study.

Author

Saratzis, Athanasios, Torsello, Giovanni B., Cardona-Gloria, Yamel, Van Herzeele, Isabelle, Messeder, Sarah J., Zayed, Hany, Torsello, Giovanni F., Chisci, Emiliano, Isernia, Giacomo, D'Oria, Mario, and Stavroulakis, Konstantinos

Abstract

To report the cost of target lesion revascularisation procedures (TLR) for femoropopliteal peripheral artery disease (PAD) following stenting, from a healthcare payer's perspective. European multicentre study involving consecutive patients requiring femoropopliteal TLR (January 2017 – December 2021). The primary outcome was overall cost (euros) associated with a TLR procedure from presentation to discharge. Exact costs per constituent, clinical characteristics, and early outcomes were reported. This study included 482 TLR procedures (retrospectively, 13 hospitals, six countries): 56% were female, mean age was 75 ± 2 years, 61% were Rutherford class 5 or 6, 67% had Tosaka class 3 disease, and 16% had common femoral or iliac involvement. A total of 52% were hybrid procedures and 6% involved open surgery only. Technical success was 70%, 30 day mortality rate was 1%, and the 30 day major amputation rate was 4%. Most costs were for operating time during the TLR (healthcare professionals' salaries, indirect and estate costs), with a mean of: €21 917 ± €2 110 for all procedures; €23 337 ± €8 920 for open procedures; €12 903 ± €3 108 for endovascular procedures; and €22 806 ± €3 977 for hybrid procedures. In a regression analysis, procedure duration was the main parameter associated with higher overall TLR costs (coefficient, 2.77; standard error, 0.88; p <.001). The mean cost per operating minute of TLR (indirect, estate costs, all salaried staff present included) was €177 and the mean cost per night stay in hospital (outside intensive care unit) was €356. The mean cost per overnight intensive care unit stay (minimum of 8 hours per night) was €1 193. The main driver of the considerable peri-procedure costs associated with femoropopliteal TLR was procedure time. [ABSTRACT FROM AUTHOR]

Published
2024
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36. Combined Treatment of Native Femoropopliteal Occlusions in Chronic Limb-Threatening Ischemia Using Atherectomy Debulking and a New Sirolimus Drug-Coated Balloon (SELUTION SLR).

Author

Sumner, Joseph, Patel, Sajal, Theodoulou, Iakovos, Thulasidasan, Narayanan, Gkoutzios, Panos, Ahmed, Irfan, Saratzis, Athanasios, and Diamantopoulos, Athanasios

Subjects
ATHERECTOMY, RAPAMYCIN, LEG amputation, LIMB salvage, ISCHEMIA, ARTERIAL occlusions, OVERALL survival
Abstract

Objective The aim of this study was to report the primary outcomes of a pilot study investigating the safety and efficacy of sirolimus drug-coated balloons (SELUTION) for endovascular postatherectomy treatment of native occluded femoropopliteal lesions in patients with chronic limb-threatening ischemia (CLTI). Materials and Methods This study analyzes a cohort of CLTI patients with femoropopliteal artery occlusions treated with combined rotational atherectomy and postatherectomy angioplasty using the SELUTION device. The primary outcome measures were amputation-free survival (AFS) defined as time to major limb (above ankle) amputation of the index leg or death from any cause. Secondary outcome measures included technical success, overall survival, major amputation of the index leg, major adverse limb event (MALE) defined as major amputation or any further major revascularization intervention of the treated segment during the follow-up period and primary patency at 12 months. Results Between April 2021 and January 2022, nine patients (mean age: 64.0 ± 8.4, 66.7% male) with femoropopliteal occlusive lesions (mean lesion length: 141.1mm, range: 40–400) were treated with the above-combined approach. Technical success was 100%. At 12 months, the AFS was 88.9%, with one death and zero major amputations (88.9% survival and 100% limb salvage, respectively); only two patients (22.2%) suffered a MALE; primary patency was 75%. No adverse events related to the sirolimus drug-coated balloon nor to the atherectomy device were observed. Conclusion Combining sirolimus drug-coated balloon and atherectomy for treatment of femoropopliteal occlusions in CLTI patients is a safe and effective approach achieving satisfactory patency and adverse event rates. [ABSTRACT FROM AUTHOR]

Published
2024
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38. A Community and Hospital cAre Bundle to improve the medical treatment of severe cLaudIcation and critical limb iSchaemia (CHABLIS) [version 1; peer review: 2 approved]

Author

Daniel Lasserson, Clair Le Boutillier, Athanasios Saratzis, Sarah Messeder, Bernadeta Bridgwood, Emma Watson, Matthew Bown, Prakash Saha, Vanessa Lawrence, and Ruth Benson

Subjects
Peripheral Artery Disease (PAD), best medical therapy, claudication, chronic limb threatening ischaemia, eng, Medicine
Abstract

Background: Patients with peripheral artery disease (PAD) often do not receive optimal best medical therapy (BMT). Through interaction with patients and haealthcare-professionals (HCPs) we developed the LEaflet Gp letter Structured checklist (LEGS) complex clinical intervention to support HCPs provide guideline-compliant PAD BMT. Methods: This was a prospective multicentre study assessing the feasibility and fidelity of delivering the LEGS intervention in primary and secondary care over 6 months. Intervention fidelity was scored based on the proportion of intervention components used correctly at discharge, 30 days, and 6 months. Results: Overall, 129 individuals were screened and 120 took part (33% female, 74% with chronic limb threatening ischaemia; 93% recruitment rate). Of those, 118 (98% retention rate) completed follow-up. Mean intervention fidelity score at discharge (primary outcome measure) was 63% [95% Confidence Interval (CI): 39-68%, SD: 5%], exceeding the success criteria set at 60% by a panel of HCPs and patients. This, however, declined to 51% at 6 months. Eight patients (6.7%) died (all cardiovascular deaths), 4 (3.3%) had a major lower limb amputation, 12 (10%) had a cardiovascular event, and 13 (11%) were admitted due to limb ischaemia at 6 months. Incomplete lipid therapy prescriptions and LEGS intervention documents not received by primary care CHPs were the most common reasons for not complying with the LEGS intervention. Conclusion: The LEGS intervention can be delivered in PAD care pathways across different hospitals, primary, and community healthcare settings with acceptable fidelity, to streamline and improve PAD BMT short and medium term.

Published
2022
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39. Study protocol for a multicentre comparative diagnostic accuracy study of tools to establish the presence and severity of peripheral arterial disease in people with diabetes mellitus: the DM PAD study

Author

Kamlesh Khunti, Athanasios Saratzis, John Norrie, David Mark Epstein, Joseph Shalhoub, Pasha Normahani, Usman Jaffer, M Edmonds, Alun H Davies, Elizabeth Pigott, Laura Burgess, Raju Ahluwalia, Neghal Kandiyil, Sasha Smith, Trusha Coward, Tim Hartshorne, and Simon Ashwell

Subjects
Medicine
Abstract

Introduction Peripheral arterial disease (PAD) is a key risk factor for cardiovascular disease, foot ulceration and lower limb amputation in people with diabetes. Early diagnosis of PAD can enable optimisation of therapies to manage these risks. Its diagnosis is fundamental, though challenging in the context of diabetes. Although a variety of diagnostic bedside tests are available, there is no agreement as to which is the most accurate in routine clinical practice.The aim of this study is to determine the diagnostic performance of a variety of tests (audible waveform assessment, visual waveform assessment, ankle brachial pressure index (ABPI), exercise ABPI and toe brachial pressure index (TBPI)) for the diagnosis of PAD in people with diabetes as determined by a reference test (CT angiography (CTA) or magnetic resonance angiography (MRA)). In selected centres, we also aim to evaluate the performance of a new point-of-care duplex ultrasound scan (PAD-scan).Methods and analysis A prospective multicentre diagnostic accuracy study (ClinicalTrials.gov Identifier NCT05009602). We aim to recruit 730 people with diabetes from 18 centres across the UK, covering primary and secondary healthcare. Consenting participants will undergo the tests under investigation. Reference tests (CTA or MRA) will be performed within 6 weeks of the index tests. Imaging will be reported by blinded consultant radiologists at a core imaging lab, using a validated scoring system, which will also be used to categorise PAD severity. The presence of one or more arterial lesions of ≥50% stenosis, or tandem lesions with a combined value of ≥50%, will be used as the threshold for the diagnosis of PAD. The primary outcome measure of diagnostic performance will be test sensitivity.Ethics and dissemination The study has received approval from the National Research Ethics Service (NRES) (REC reference 21/PR/1221). Results will be disseminated through research presentations and papers.Trial registration number NCT05009602.

Published
2022
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42. Physical, cognitive, and mental health impacts of COVID-19 after hospitalisation (PHOSP-COVID): a UK multicentre, prospective cohort study

Author

Abel, K, Adamali, H, Adeloye, D, Adeyemi, O, Adeyemi, F, Ahmad, S, Ahmed, R, Ainsworth, M, Al-Sheklly, B, Alamoudi, A, Aljaroof, M, Allan, L, Allen, R, Alli, A, Altmann, D, Anderson, D, Andrews, M, Angyal, A, Antoniades, C, Arbane, G, Armour, C, Armstrong, N, Armstrong, L, Arnold, H, Arnold, D, Ashworth, M, Ashworth, A, Assefa-Kebede, H, Atkin, P, Atkins, H, Atkins, A, Aul, R, Avram, C, Baggott, R, Baguley, D, Baillie, J K, Bain, S, Bakali, M, Bakau, M, Baldry, E, Baldwin, D, Ballard, C, Bambrough, J, Barker, R E, Barratt, S, Barrett, F, Basire, D, Basu, N, Batterham, R, Baxendale, H, Bayes, H, Bayley, M, Beadsworth, M, Beirne, P, Bell, R, Bell, D, Berry, C, Betts, S, Bhui, K, Bishop, L, Blaikely, J, Bloomfield, C, Bloss, A, Bolger, A, Bolton, C E, Bonnington, J, Botkai, A, Bourne, M, Bourne, C, Bradley, E, Bramham, K, Brear, L, Breen, G, Breeze, J, Briggs, A, Bright, E, Brightling, C E, Brill, S, Brindle, K, Broad, L, Broome, M, Brown, J S, Brown, M, Brown, J, Brown, R, Brown, V, Brown, A, Brugha, T, Brunskill, N, Buch, M, Bularga, A, Bullmore, E, Burn, D, Burns, G, Busby, J, Buttress, A, Byrne, S, Cairns, P, Calder, P C, Calvelo, E, Card, B, Carr, L, Carson, G, Carter, P, Cavanagh, J, Chalder, T, Chalmers, J D, Chambers, R C, Channon, K, Chapman, K, Charalambou, A, Chaudhuri, N, Checkley, A, Chen, J, Chetham, L, Chilvers, E R, Chinoy, H, Chong-James, K, Choudhury, N, Choudhury, G, Chowdhury, P, Chowienczyk, P, Christie, C, Clark, D, Clark, C, Clarke, J, Clift, P, Clohisey, S, Coburn, Z, Cole, J, Coleman, C, Connell, D, Connolly, B, Connor, L, Cook, A, Cooper, B, Coupland, C, Craig, T, Crisp, P, Cristiano, D, Crooks, M G, Cross, A, Cruz, I, Cullinan, P, Daines, L, Dalton, M, Dark, P, Dasgin, J, David, A, David, C, Davies, M, Davies, G, Davies, K, Davies, F, Davies, G A, Daynes, E, De Silva, T, De Soyza, A, Deakin, B, Deans, A, Defres, S, Dell, A, Dempsey, K, Dennis, J, Dewar, A, Dharmagunawardena, R, Diar Bakerly, N, Dipper, A, Diver, S, Diwanji, S N, Dixon, M, Djukanovic, R, Dobson, H, Dobson, C, Dobson, S L, Docherty, A B, Donaldson, A, Dong, T, Dormand, N, Dougherty, A, Dowling, R, Drain, S, Dulawan, P, Dunleavy, A, Dunn, S, Easom, N, Echevarria, C, Edwards, S, Edwardson, C, Elliott, B, Elliott, A, Ellis, Y, Elmer, A, Elneima, O, Evans, R A, Evans, J, Evans, H, Evans, D, Evans, R I, Evans, R, Evans, T, Fabbri, L, Fairbairn, S, Fairman, A, Fallon, K, Faluyi, D, Favager, C, Felton, T, Finch, J, Finney, S, Fisher, H, Fletcher, S, Flockton, R, Foote, D, Ford, A, Forton, D, Francis, R, Francis, S, Francis, C, Frankel, A, Fraser, E, Free, R, French, N, Fuld, J, Furniss, J, Garner, L, Gautam, N, Geddes, J R, George, P M, George, J, Gibbons, M, Gilmour, L, Gleeson, F, Glossop, J, Glover, S, Goodman, N, Gooptu, B, Gorsuch, T, Gourlay, E, Greenhaff, P, Greenhalf, W, Greenhalgh, A, Greening, N J, Greenwood, J, Greenwood, S, Gregory, R, Grieve, D, Gummadi, M, Gupta, A, Gurram, S, Guthrie, E, Hadley, K, Haggar, A, Hainey, K, Haldar, P, Hall, I, Hall, L, Halling-Brown, M, Hamil, R, Hanley, N A, Hardwick, H E, Hardy, E, Hargadon, B, Harrington, K, Harris, V, Harrison, E M, Harrison, P, Hart, N, Harvey, A, Harvey, M, Harvie, M, Havinden-Williams, M, Hawkes, J, Hawkings, N, Haworth, J, Hayday, A, Heaney, L G, Heeney, J L, Heightman, M, Heller, S, Henderson, M, Hesselden, L, Hillman, T, Hingorani, A, Hiwot, T, Ho, L P, Hoare, A, Hoare, M, Hogarth, P, Holbourn, A, Holdsworth, L, Holgate, D, Holmes, K, Holroyd-Hind, B, Horsley, A, Hosseini, A, Hotopf, M, Houchen, L, Howard, L, Howell, A, Hufton, E, Hughes, A, Hughes, J, Hughes, R, Humphries, A, Huneke, N, Hurst, J R, Hurst, R, Husain, M, Hussell, T, Ibrahim, W, Ient, A, Ingram, L, Ismail, K, Jackson, T, Jacob, J, James, W Y, Janes, S, Jarvis, H, Jayaraman, B, Jenkins, R G, Jezzard, P, Jiwa, K, Johnson, S, Johnson, C, Johnston, D, Jolley, C, Jolley, C J, Jones, I, Jones, S, Jones, D, Jones, H, Jones, G, Jones, M, Jose, S, Kabir, T, Kaltsakas, G, Kamwa, V, Kar, P, Kausar, Z, Kelly, S, Kerr, S, Key, A L, Khan, F, Khunti, K, King, C, King, B, Kitterick, P, Klenerman, P, Knibbs, L, Knight, S, Knighton, A, Kon, O M, Kon, S, Kon, S S, Korszun, A, Kotanidis, C, Koychev, I, Kurupati, P, Kwan, J, Laing, C, Lamlum, H, Landers, G, Langenberg, C, Lasserson, D, Lawrie, A, Lea, A, Leavy, O C, Lee, D, Lee, E, Leitch, K, Lenagh, R, Lewis, K, Lewis, V, Lewis, K E, Lewis, J, Lewis-Burke, N, Light, T, Lightstone, L, Lim, L, Linford, S, Lingford-Hughes, A, Lipman, M, Liyanage, K, Lloyd, A, Logan, S, Lomas, D, Lone, N I, Loosley, R, Lord, J M, Lota, H, Lucey, A, MacGowan, G, Macharia, I, Mackay, C, Macliver, L, Madathil, S, Madzamba, G, Magee, N, Mairs, N, Majeed, N, Major, E, Malim, M, Mallison, G, Man, W, Mandal, S, Mangion, K, Mansoori, P, Marciniak, S, Mariveles, M, Marks, M, Marshall, B, Martineau, A, Maskell, N, Matila, D, Matthews, L, Mayet, J, McAdoo, S, McAllister-Williams, H, McArdle, P, McArdle, A, McAulay, D, McAuley, H J C, McAuley, D F, McCafferty, K, McCann, G P, McCauley, H, McCourt, P, Mcgarvey, L, McGinness, J, McGovern, A, McGuinness, H, McInnes, I B, McIvor, K, McIvor, E, McMahon, A, McMahon, M J, McMorrow, L, Mcnally, T, McNarry, M, McQueen, A, McShane, H, Megson, S, Meiring, J, Menzies, D, Michael, A, Michael, B D, Milligan, L, Mills, N, Mitchell, J, Mohamed, A, Molyneaux, P L, Monteiro, W, Morley, A, Morrison, L, Morriss, R, Morrow, A, Moss, A, Moss, A J, Moss, P, Mukaetova-Ladinska, E, Munawar, U, Murali, E, Murira, J, Nassa, H, Neill, P, Neubauer, S, Newby, D, Newell, H, Newton Cox, A, Nicholson, T, Nicoll, D, Nolan, C M, Noonan, M J, Novotny, P, Nunag, J, Nyaboko, J, O'Brien, L, Odell, N, Ogg, G, Olaosebikan, O, Oliver, C, Omar, Z, Openshaw, P J M, Osbourne, R, Ostermann, M, Overton, C, Oxton, J, Pacpaco, E, Paddick, S, Papineni, P, Paradowski, K, Pareek, M, Parekh, D, Parfrey, H, Pariante, C, Parker, S, Parkes, M, Parmar, J, Parvin, R, Patale, S, Patel, B, Patel, S, Patel, M, Pathmanathan, B, Pavlides, M, Pearl, J E, Peckham, D, Pendlebury, J, Peng, Y, Pennington, C, Peralta, I, Perkins, E, Peto, T, Petousi, N, Petrie, J, Pfeffer, P, Phipps, J, Pimm, J, Piper Hanley, K, Pius, R, Plein, S, Plekhanova, T, Poinasamy, K, Polgar, O, Poll, L, Porter, J C, Portukhay, S, Powell, N, Price, L, Price, D, Price, A, Price, C, Prickett, A, Quaid, S, Quigley, J, Quint, J, Qureshi, H, Rahman, N, Rahman, M, Ralser, M, Raman, B, Ramos, A, Rangeley, J, Rees, T, Regan, K, Richards, A, Richardson, M, Rivera-Ortega, P, Robertson, E, Rodgers, J, Ross, G, Rossdale, J, Rostron, A, Routen, A, Rowland, A, Rowland, M J, Rowland, J, Rowland-Jones, S L, Roy, K, Rudan, I, Russell, R, Russell, E, Sabit, R, Sage, E K, Samani, N, Samuel, R, Sapey, E, Saralaya, D, Saratzis, A, Sargeant, J, Sass, T, Sattar, N, Saunders, K, Saunders, R, Saxon, W, Sayer, A, Schwaeble, W, Scott, J, Scott, K, Selby, N, Semple, M G, Sereno, M, Shah, K, Shah, A, Shah, P, Sharma, M, Sharpe, M, Sharpe, C, Shaw, V, Sheikh, A, Shevket, K, Shikotra, A, Short, J, Siddiqui, S, Sigfrid, L, Simons, G, Simpson, J, Singapuri, A, Singh, S J, Singh, C, Singh, S, Skeemer, J, Smith, I, Smith, J, Smith, L, Smith, A, Soares, M, Southern, D, Spears, M, Spencer, L G, Speranza, F, Stadon, L, Stanel, S, Steiner, M, Stensel, D, Stern, M, Stewart, I, Stockley, J, Stone, R, Storrie, A, Storton, K, Stringer, E, Subbe, C, Sudlow, C, Suleiman, Z, Summers, C, Summersgill, C, Sutherland, D, Sykes, D L, Sykes, R, Talbot, N, Tan, A L, Taylor, C, Taylor, A, Te, A, Tedd, H, Tee, C J, Tench, H, Terry, S, Thackray-Nocera, S, Thaivalappil, F, Thickett, D, Thomas, D, Thomas, D C, Thomas, A K, Thompson, A A R, Thompson, T, Thornton, T, Thwaites, R S, Tobin, M, Toingson, G F, Tong, C, Toshner, M, Touyz, R, Tripp, K A, Tunnicliffe, E, Turner, E, Turtle, L, Turton, H, Ugwuoke, R, Upthegrove, R, Valabhji, J, Vellore, K, Wade, E, Wain, L V, Wajero, L O, Walder, S, Walker, S, Wall, E, Wallis, T, Walmsley, S, Walsh, S, Walsh, J A, Watson, L, Watson, J, Watson, E, Welch, C, Welch, H, Welsh, B, Wessely, S, West, S, Wheeler, H, Whitehead, V, Whitney, J, Whittaker, S, Whittam, B, Wild, J, Wilkins, M, Wilkinson, D, Williams, N, Williams, B, Williams, J, Williams-Howard, S A, Willicombe, M, Willis, G, Wilson, D, Wilson, I, Window, N, Witham, M, Wolf-Roberts, R, Woodhead, F, Woods, J, Wootton, D, Worsley, J, Wraith, D, Wright, L, Wright, C, Wright, S, Xie, C, Yasmin, S, Yates, T, Yip, K P, Young, B, Young, S, Young, A, Yousuf, A J, Yousuf, A, Zawia, A, Zhao, B, Zongo, O, Evans, Rachael A, McAuley, Hamish J C, Harrison, Ewen M, Shikotra, Aarti, Singapuri, Amisha, Sereno, Marco, Elneima, Omer, Docherty, Annemarie B, Lone, Nazir I, Leavy, Olivia C, Daines, Luke, Baillie, J Kenneth, Brown, Jeremy S, Chalder, Trudie, De Soyza, Anthony, Diar Bakerly, Nawar, Easom, Nicholas, Geddes, John R, Greening, Neil J, Hart, Nick, Heaney, Liam G, Heller, Simon, Howard, Luke, Hurst, John R, Jacob, Joseph, Jenkins, R Gisli, Jolley, Caroline, Kerr, Steven, Kon, Onn M, Lewis, Keir, Lord, Janet M, McCann, Gerry P, Neubauer, Stefan, Openshaw, Peter J M, Parekh, Dhruv, Pfeffer, Paul, Rahman, Najib M, Raman, Betty, Richardson, Matthew, Rowland, Matthew, Semple, Malcolm G, Shah, Ajay M, Singh, Sally J, Sheikh, Aziz, Thomas, David, Toshner, Mark, Chalmers, James D, Ho, Ling-Pei, Horsley, Alex, Marks, Michael, Poinasamy, Krisnah, Wain, Louise V, and Brightling, Christopher E

Published
2021
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43. Using healthcare systems data for outcomes in clinical trials: issues to consider at the design stage

Author

Toader, Alice-Maria, primary, Campbell, Marion K., additional, Quint, Jennifer K., additional, Robling, Michael, additional, Sydes, Matthew R, additional, Thorn, Joanna, additional, Wright-Hughes, Alexandra, additional, Yu, Ly-Mee, additional, Abbott, Tom. E. F., additional, Bond, Simon, additional, Caskey, Fergus J., additional, Clout, Madeleine, additional, Collinson, Michelle, additional, Copsey, Bethan, additional, Davies, Gwyneth, additional, Driscoll, Timothy, additional, Gamble, Carrol, additional, Griffin, Xavier L., additional, Hamborg, Thomas, additional, Harris, Jessica, additional, Harrison, David A., additional, Harji, Deena, additional, Henderson, Emily J., additional, Logan, Pip, additional, Love, Sharon B., additional, Magee, Laura A., additional, O’Brien, Alastair, additional, Pufulete, Maria, additional, Ramnarayan, Padmanabhan, additional, Saratzis, Athanasios, additional, Smith, Jo, additional, Solis-Trapala, Ivonne, additional, Stubbs, Clive, additional, Farrin, Amanda, additional, and Williamson, Paula, additional

Published
2024
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47. Central and peripheral arterial diseases in chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Author

Ademi, Zanfina, Chang, Tara I., Clark, Tim, Cooper, Chris, Criqui, Michael, de Bhailis, Áine, De Carlo, Marco, Döhner, Wolfram, Engelman, Daniel T., Fowkes, Gerry, Green, Darren, Hamdan, Allen, Heiss, Christian, Huppert, Peter, Kadian-Dodov, Daniella, Lip, Gregory Y.H., Małyszko, Jolanta, Mark, Patrick B., Miglinas, Marius, Murray, Patrick, Reid, Chris, Rochon, Paul, Ruturi, Josiah, Saratzis, Athanasios, Sarnak, Mark J., Shanahan, Cathy M., Solá, Laura, Teichgräber, Ulf, Textor, Stephen C., Toyoda, Kazunori, Yee-Moon Wang, Angela, Wong, Chris X., Johansen, Kirsten L., Garimella, Pranav S., Hicks, Caitlin W., Kalra, Philip A., Kelly, Dearbhla M., Martens, Sven, Matsushita, Kunihiro, Sarafidis, Pantelis, Sood, Manish M., Herzog, Charles A., Cheung, Michael, Jadoul, Michel, Winkelmayer, Wolfgang C., and Reinecke, Holger

Published
2021
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50. New Horizons in Peripheral Artery Disease.

Author

Houghton, John S M, Saratzis, Athanasios N, Sayers, Rob D, and Haunton, Victoria J

Subjects
*PERIPHERAL vascular disease treatment, *ISCHEMIA, *PERIPHERAL vascular diseases, *EXERCISE therapy, *FRAIL elderly, *DECISION making, *FIBRINOLYTIC agents, *ENDOVASCULAR surgery, *POLYPHARMACY, *CEREBRAL revascularization, *ATORVASTATIN, *CARDIOVASCULAR surgery, *COGNITION disorders, *PERIOPERATIVE care, *COMORBIDITY, *DISEASE risk factors, *DISEASE complications, *OLD age, PERIPHERAL vascular disease diagnosis
Abstract

Peripheral artery disease (PAD) is the lower limb manifestation of systemic atherosclerotic disease. PAD may initially present with symptoms of intermittent claudication, whilst chronic limb-threatening ischaemia (CLTI), the end stage of PAD, presents with rest pain and/or tissue loss. PAD is an age-related condition present in over 10% of those aged ≥65 in high-income countries. Guidelines regarding definition, diagnosis and staging of PAD and CLTI have been updated to reflect the changing patterns and presentations of disease given the increasing prevalence of diabetes. Recent research has changed guidelines on optimal medical therapy, with low-dose anticoagulant plus aspirin recommended in some patients. Recently published randomised trials highlight where bypass-first or endovascular-first approaches may be optimal in infra-inguinal disease. New techniques in endovascular surgery have increased minimally invasive options for ever more complex disease. Increasing recognition has been given to the complexity of patients with CLTI where a high prevalence of both frailty and cognitive impairment are present and a significant burden of multi-morbidity and polypharmacy. Despite advances in minimally invasive revascularisation techniques and reduction in amputation incidence, survival remains poor for many with CLTI. Shared decision-making is essential, and conservative management is often appropriate for older patients. There is emerging evidence of the benefit of specialist geriatric team input in the perioperative management of older patients undergoing surgery for CLTI. Recent UK guidelines now recommend screening for frailty, cognitive impairment and delirium in older vascular surgery patients as well as recommending all vascular surgery services have support and input from specialist geriatrics teams. [ABSTRACT FROM AUTHOR]

Published
2024
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