Imperial College London

Professor Alun H Davies, MA,DM,DSc,FRCS,FHEA,FEBVS,FACPh

Faculty of MedicineDepartment of Surgery & Cancer

Professor of Vascular Surgery
 
 
 
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Contact

 

+44 (0)20 3311 7309a.h.davies

 
 
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Location

 

4E04 EastEast WingCharing Cross Campus

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Summary

 

Publications

Publication Type
Year
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805 results found

Campbell B, Davies A, Coleridge-Smith P, 2022, Who should do diagnostic venous scanning?, PHLEBOLOGY, ISSN: 0268-3555

Journal article

Smith S, Normahani P, Lane T, Hohenschurz-Schmidt D, Oliver N, Davies AHet al., 2022, Prevention and management strategies for diabetic neuropathy, Life, Vol: 12, Pages: 1185-1185, ISSN: 2075-1729

Diabetic neuropathy (DN) is a common complication of diabetes that is becoming an increasing concern as the prevalence of diabetes rapidly rises. There are several types of DN, but the most prevalent and studied type is distal symmetrical polyneuropathy, which is the focus of this review and is simply referred to as DN. It can lead to a wide range of sensorimotor and psychosocial symptoms and is a major risk factor for diabetic foot ulceration and Charcot neuropathic osteoarthropathy, which are associated with high rates of lower limb amputation and mortality. The prevention and management of DN are thus critical, and clinical guidelines recommend several strategies for these based on the best available evidence. This article aims to provide a narrative review of DN prevention and management strategies by discussing these guidelines and the evidence that supports them. First, the epidemiology and diverse clinical manifestations of DN are summarized. Then, prevention strategies such as glycemic control, lifestyle modifications and footcare are discussed, as well as the importance of early diagnosis. Finally, neuropathic pain management strategies and promising novel therapies under investigation such as neuromodulation devices and nutraceuticals are reviewed.

Journal article

Lawton R, Shalhoub J, Davies A, 2022, Implementation of the graduated compression as an adjunct to pharmaco-thromboprophylaxis in surgery (GAPS) trial results across the UK, Phlebology, Vol: 37, Pages: 540-542, ISSN: 0268-3555

ObjectivesTo examine uptake and dissemination of a National Institute for Health Research (NIHR) Health Technology Assessment (HTA) funded trial- Graduated compression as an Adjunct to Pharmaco-thromboprophylaxis in Surgery (GAPS) (project number: 14/140/61) amongst health professionals in the UK. To evaluate the impact of the trial on venous thromboembolism (VTE) prevention policies 7 months after publication.MethodA 12-question online survey emailed to 2750 individuals via several vascular societies, 34 VTE Exemplar Centre leads and 1 charity over a 3-month period.ResultsIn total, 250 responses were received; a 9.1% response rate. Over half of all respondents (52.4%) had read the GAPS trial results prior to completing the survey. Precisely, 77.1% said their hospital had not yet made changes or did not intend to make changes to local hospital VTE policy based on the GAPS trial.ConclusionsFindings must be interpreted in the context of the low response rate. Further in-depth interviews would aid understanding of barriers to implementing change.

Journal article

Lawton R, Hunt B, Norrie J, Shalhoub J, Thapar A, Davies Aet al., 2022, Compression Hosiery to Avoid Post-Thrombotic Syndrome (CHAPS) Trial, European Journal of Vascular and Endovascular Surgery, ISSN: 1078-5884

Journal article

Smith S, Normahani P, Lane T, Hohenschurz-Schmidt D, Oliver N, Davies AHet al., 2022, Pathogenesis of distal symmetrical polyneuropathy in diabetes, Life, Vol: 12, Pages: 1-16, ISSN: 2075-1729

Distal symmetrical polyneuropathy (DSPN) is a serious complication of diabetes associated with significant disability and mortality. Although more than 50% of people with diabetes develop DSPN, its pathogenesis is still relatively unknown. This lack of understanding has limited the development of novel disease-modifying therapies and left the reasons for failed therapies uncertain, which is critical given that current management strategies often fail to achieve long-term efficacy. In this article, the pathogenesis of DSPN is reviewed, covering pathogenic changes in the peripheral nervous system, microvasculature and central nervous system (CNS). Furthermore, the successes and limitations of current therapies are discussed, and potential therapeutic targets are proposed. Recent findings on its pathogenesis have called the definition of DSPN into question and transformed the disease model, paving the way for new research prospects.

Journal article

Paraskevas KI, Gloviczki P, Antignani PL, Comerota AJ, Dardik A, Davies AH, Eckstein H-H, Faggioli G, Fernandes E Fernandes J, Fraedrich G, Geroulakos G, Golledge J, Gupta A, Gurevich VS, Jawien A, Jezovnik MK, Kakkos SK, Knoflach M, Lanza G, Liapis CD, Loftus IM, Mansilha A, Nicolaides AN, Pini R, Poredos P, Proczka RM, Ricco J-B, Rundek T, Saba L, Schlachetzki F, Silvestrini M, Spinelli F, Stilo F, Suri JS, Svetlikov AV, Zeebregts CJ, Chaturvedi S, Veith FJ, Mikhailidis DPet al., 2022, Benefits and drawbacks of statins and non-statin lipid lowering agents in carotid artery disease., Prog Cardiovasc Dis, Vol: 73, Pages: 41-47

International guidelines strongly recommend statins alone or in combination with other lipid-lowering agents to lower low-density lipoprotein cholesterol (LDL-C) levels for patients with asymptomatic/symptomatic carotid stenosis (AsxCS/SCS). Lowering LDL-C levels is associated with significant reductions in transient ischemic attack, stroke, cardiovascular (CV) event and death rates. The aim of this multi-disciplinary overview is to summarize the benefits and risks associated with lowering LDL-C with statins or non-statin medications for Asx/SCS patients. The cerebrovascular and CV beneficial effects associated with statins, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors and other non-statin lipid-lowering agents (e.g. fibrates, ezetimibe) are reviewed. The use of statins and PCSK9 inhibitors is associated with several beneficial effects for Asx/SCS patients, including carotid plaque stabilization and reduction of stroke rates. Ezetimibe and fibrates are associated with smaller reductions in stroke rates. The side-effects resulting from statin and PCSK9 inhibitor use are also highlighted. The benefits associated with lowering LDL-C with statins or non-statin lipid lowering agents (e.g. PCSK9 inhibitors) outweigh the risks and potential side-effects. Irrespective of their LDL-C levels, all Asx/SCS patients should receive high-dose statin treatment±ezetimibe or PCSK9 inhibitors for reduction not only of LDL-C levels, but also of stroke, cardiovascular mortality and coronary event rates.

Journal article

Shan LL, Wang J, Westcott MJ, Tew M, Davies AH, Choong PFet al., 2022, A Systematic Review of Cost-Utility Analyses in Chronic Limb-Threatening Ischemia., Ann Vasc Surg

BACKGROUND: To review and describe the available literature on cost-utility analysis of revascularization and non-revascularization treatment approaches in chronic limb-threatening ischemia. METHODS: A systematic review was performed on cost-utility analysis studies evaluating revascularization (open surgery or endovascular), major lower extremity amputation, or conservative management in adult chronic limb-threatening ischemia patients. Six bibliographic databases and online registries were searched for English language articles up to August 2021. The outcome for cost-utility analysis was quality-adjusted in life years. Procedures were compared using incremental cost-effectiveness ratios which were converted to 2021 United States dollars. Study reporting quality was assessed using the 2022 Consolidated Health Economic Evaluation Reporting Standards statement. The study was registered in International Prospective Register of Systematic Reviews (CRD42021273602). RESULTS: Three trial-based and five model-based studies were included for review. Studies met between 14/28 and 20/28 criteria of the Consolidated Health Economic Evaluation Reporting Standards CHEERS statement. Only one study was written according to standardized reporting guidelines. Most studies evaluated infrainguinal disease, and adopted a health care provider perspective. There was a large variation in the incremental cost-effectiveness ratios presented across studies. Open surgical revascularization (incremental cost-effectiveness ratios: $3,678, $58,828, and $72,937), endovascular revascularization (incremental cost-effectiveness ratios: $52,036, $125,329, and $149,123), and mixed open or endovascular revascularization (incremental cost-effectiveness ratio: $8,094) maybe more cost-effective than conservative management. CONCLUSIONS: The application of cost-utility analyses in chronic limb-threatening ischemia is in its infancy. Revascularization in infrainguinal disease may be favored over major lower

Journal article

Racaru S, Saghdaoui LB, Choudhury JR, Wells M, Davies AHet al., 2022, Offloading treatment in people with diabetic foot disease: A systematic scoping review on adherence to foot offloading, DIABETES & METABOLIC SYNDROME-CLINICAL RESEARCH & REVIEWS, Vol: 16, ISSN: 1871-4021

Journal article

Paraskevas K, Mikhailidis DP, Antignani PL, Ascher E, Baradaran H, Bokkers RPH, Cambria RP, Comerota AJ, Dardik A, Davies AH, Eckstein H-H, Faggioli G, Fernandes JFE, Fraedrich G, Geroulakos G, Gloviczki P, Golledge J, Gupta A, Jezovnik MK, Kakkos SK, Katsiki N, Knoflach M, Kooi ME, Lanza G, Lavenson GS, Liapis CD, Loftus IM, Mansilha A, Millon A, Nicolaides AN, Pini R, Poredos P, Proczka RM, Ricco J-B, Riles TS, Ringleb PA, Rundek T, Saba L, Schlachetzki F, Silvestrini M, Spinelli F, Stilo F, Sultan S, Suri JS, Svetlikov A, Zeebregts CJ, Chaturvedi Set al., 2022, Comparison of Recent Practice Guidelines for the Management of Patients With Asymptomatic Carotid Stenosis, ANGIOLOGY, ISSN: 0003-3197

Journal article

Belramman A, Bootun R, Tang TY, Lane TRA, Davies AHet al., 2022, Pain Outcomes Following Mechanochemical Ablation vs Cyanoacrylate Adhesive for the Treatment of Primary Truncal Saphenous Vein Incompetence The MOCCA Randomized Clinical Trial, JAMA SURGERY, Vol: 157, Pages: 395-404, ISSN: 2168-6254

Journal article

Taha M, Busuttil A, Bootun R, Thabet B, Badawy A, Hassan H, Shalhoub J, Davies Aet al., 2022, Clinical outcomes and overview of dedicated venous stents for management of chronic iliocaval and femoral deep venous disease, Vascular, Vol: 30, Pages: 320-330, ISSN: 0967-2109

ObjectivesVenous stenting of the lower extremities has grown in popularity and is now considered a key component of the primary treatment strategy for the management of pathologically obstructive or stenotic lesions of the deep venous system. This review aims to provide an overview of the role of venous stenting in the management of chronic conditions affecting the deep venous system of the lower limbs.MethodsAn overview of venous stents design and current role of stenting procedure in individuals presenting with Chronic Venous Insufficiency (CVI) and presenting the current trials of dedicated venous stenting in management of chronic deep venous lesions. This review provides a focused insight on venous stent design, physical properties and the available dedicated venous stents selected studies with their related patency outcome based on selective literature search of the PubMed database and Cochrane library.ConclusionsDedicated venous stent technology is advancing at a rapid pace alongside the increased undertaking of endovascular deep venous stent reconstruction in the management of iliocaval vein pathologies. The ideal design(s) for venous stents remain unknown, although it is hoped that the presence of new dedicated venous stents in clinical practice will allow the generation of experience and data to advance our understanding in this area.

Journal article

Paraskevas K, Mikhailidis DP, Antignani PL, Baradaran H, Bokkers RPH, Cambria RP, Dardik A, Davies AH, Eckstein H-H, Faggioli G, Fernandes JFE, Fraedrich G, Geroulakos G, Gloviczki P, Golledge J, Gupta A, Jezovnik MK, Kakkos SK, Katsiki N, Knoflach M, Kooi ME, Lanza G, Liapis CD, Loftus IM, Mansilha A, Millon A, Nicolaides AN, Pini R, Poredos P, Ricco J-B, Riles TS, Ringleb PA, Rundek T, Saba L, Schlachetzki F, Silvestrini M, Spinelli F, Stilo F, Sultan S, Suri JS, Zeebregts CJ, Chaturvedi Set al., 2022, Optimal management of asymptomatic carotid stenosis in 2021: the jury is still out. An international, multispecialty, expert review and position statement, INTERNATIONAL ANGIOLOGY, Vol: 41, Pages: 158-169, ISSN: 0392-9590

Journal article

Epstein D, Bootun R, Diop M, Ortega-Ortega M, Lane TRA, Davies AHet al., 2022, Cost-effectiveness analysis of current varicose veins treatments, Journal of vascular surgery. Venous and lymphatic disorders, Vol: 10, Pages: 504-513.e7, ISSN: 2213-3348

OBJECTIVE: To analyze the effectiveness and cost-effectiveness of technologies for treatment of varicose veins over 5 years - conservative care (CONS), surgery (HL/S), ultrasound guided foam sclerotherapy (UGFS), endovenous laser ablation (EVLA), and radiofrequency ablation (RFA), mechanochemical ablation (MOCA) and cyanoacrylate glue occlusion (CAE). METHODS: A systematic review was updated and used to construct a Markov decision model. Outcomes were re-intervention on the truncal vein, re-treatment of residual varicosities and quality-adjusted life years (QALY) and costs over five years. RESULTS: UGFS has a significantly greater re-intervention rate than other procedures, while there is no significant difference between the other procedures. The cost per QALY of EVLA versus UGFS in our base-case model is £16966 ($23700) per QALY, which is considered cost-effective in the UK. RFA, MOCA and CAE have greater procedure costs than EVLA with no evidence of greater benefit for patients. CONCLUSIONS: EVLA is the most cost-effective therapeutic option, with RFA a close second, in adult patients requiring treatment in the upper leg for incompetence of the GSV. MOCA, UGFS, CAE, CONS and HL/S are not cost-effective at current prices in the UK National Health Service. MOCA and CAE appear promising but further evidence on effectiveness, re-interventions and health-related quality of life is needed, as well as how cost-effectiveness may vary across settings and reimbursement systems.

Journal article

Machin M, Younan H-C, Guéroult A, Shalhoub J, Onida S, Davies Aet al., 2022, Systematic review of inframalleolar endovascular interventions and rates of limb salvage, wound healing, restenosis, rest pain, reintervention and complications, Vascular, Vol: 30, Pages: 105-114, ISSN: 0967-2109

ObjectivesPeripheral artery disease is estimated to affect 237 million individuals worldwide. Critical limb ischaemia, also known as chronic limb threatening ischaemia is a consequence of the progression of peripheral artery disease which occurs in ∼21% of patients over a five-year period. The aim of this systematic review is to assess the use of additional below-the-ankle angioplasty in comparison to the use of above-the-ankle angioplasty alone, and the subsequent rates of amputation, wound healing, restenosis, rest pain, reintervention and complications.MethodsThis systematic review was undertaken in accordance with PRISMA guidelines following a registered protocol (CRD42019154893). Online databases were searched using a search strategy of 20 keywords. Included articles reported the outcome for inframalleolar (pedal artery, pedal arch, plantar arteries) angioplasty with additional proximal angioplasty in comparison to proximal angioplasty alone. GRADE assessment was applied to assess the quality of the evidence.ResultsAfter screening 1089 articles, 10 articles met the inclusion criteria. Comparative performance assessment of below-the-ankle with above-the-ankle versus above-the-ankle angioplasty alone was undertaken in 3 articles, with the remaining 7 articles reporting outcomes of below-the-ankle with above-the-ankle angioplasty with no distinct comparator group. Significant decrease in major lower limb amputation at the last follow-up in the below-the-ankle group when compared with the above-the-ankle angioplasty alone group was observed in a single study (3.45% vs. 14.9%, p < 0.05). Improved wound healing rate at follow-up in the below-the-ankle group versus above-the-ankle angioplasty alone group was also reported in a single study (59.3% vs. 38.1%, p < 0.05). Subsequent rate of amputation after below-the-ankle angioplasty has been estimated as 23.5%.ConclusionTo date, there is a lack of studies assessing inframalleolar in

Journal article

Lane T, Nimura M, Rawashdeh M, Sritharan G, Reese G, Davies Aet al., 2022, Study protocol for Neuromuscular Stimulation for Rehabilitation after general and vascular surgery - a pilot randomised clinical study, BMJ Open, ISSN: 2044-6055

Introduction:Rehabilitation after surgery is important to achieve an optimal surgical outcome. However, recovery training offered by practitioners is limited due to resource constrain, and this may prolong hospital stay and increase bed costs. Neuromuscular Electrical Stimulation (NMES) is safe, low cost and user-friendly technology which may fulfil this role.Methods and analysis:This is a prospective single-centre randomised clinical trial. Patients undergoing vascular or general surgery will be randomised to either the standard rehabilitation and active NMES device group (group A) or the standard rehabilitation and placebo NMES device group (Group B). They will be asked to use the device after surgery until discharge. The primary outcomes are the acceptability and safety of NMES as an adjunct for rehabilitation. The secondary outcomes are postoperative recovery levels in activity, frailty, independence and QoL levels. The total target recruitment is 100 patients.Ethics and Dissemination:Ethical approvals were provided by London-Harrow Research Ethics Committee (REC) and Health Research Authority (HRA), Ref: 21/PR/0250. Findings will be published in a peer-reviewed journal and presented at national and international conferences.Trial registration:ClinicalTrials.gov ID: NCT04784962, Registered on 5 March 2021.

Journal article

Tan K, Salim S, Machin M, Geroult A, Onida S, Lane T, Davies Aet al., 2022, Abdominal aortic aneurysm clinical practice guidelines: a methodological assessment using the AGREE II instrument, BMJ Open, Vol: 12, Pages: 1-9, ISSN: 2044-6055

Objectives: Abdominal aortic aneurysm (AAA) clinical practice guidelines (CPGs) provide evidence-based information on patient management; however, methodological differences exist in the development of CPGs. This study examines the methodological quality of AAA CPGs using a validated assessment tool. Design: Medline, EMBASE and online CPG databases were searched from 1946 to 31st October 2021. Full-text, English language, evidence-based AAA CPGs were included. Consensus-based CPGs, summaries of CPGs or CPGs which were only available upon purchase were excluded. Five reviewers assessed their quality using the Appraisal of Guidelines for Research and Evaluation II instrument. An overall guideline assessment scaled score of ≥80% was considered as the threshold to recommend CPG use in clinical practice.Results: Seven CPGs were identified. Scores showed good inter-reviewer reliability (ICC 0.943, 95% CI 0.915-0.964). On average, CPGs performed adequately with mean scaled scores of over 50% in all domains. However, between CPGs, significant methodological heterogeneity was observed in all domains. Four CPGs scored ≥80% (European Society of Cardiology, the Society of Vascular Surgery, the European Society of Vascular Surgery, and the National Institute of Health and Care Excellence), supporting their use in clinical practice.Conclusions: Four CPGs were considered of adequate methodological quality to recommend their use in clinical practice; nonetheless, these still showed areas for improvement, potentially through performing economic analysis and trial application of recommendations. A structured approach employing validated CPG creation tools should be used to improve rigour of AAA CPGs. Future work should also evaluate recommendation accuracy using validated appraisal tools.

Journal article

Otunla A, Shanmugarajah K, Madariaga M, Davies AH, Shalhoub Jet al., 2022, Chronic rejection and atherosclerosis in post-transplant cardiovascular mortality: two sides of the same coin, Heart Lung and Circulation, Vol: 31, Pages: 162-166, ISSN: 1443-9506

Post-transplant cardiovascular disease (CVD) is the single most common cause of death in solid organ transplant recipients. The prevailing school of thought is that post-transplant CVD is driven by the same underlying atherosclerotic processes as the CVD of aging seen in the general population. This is reflected in current management strategies, which focus on the minimisation of traditional cardiovascular risk factors. In this article, we argue that atherosclerosis is not the sole aetiology of post-transplant CVD. Instead, chronic rejection drives post-transplant CVD through an antibody-mediated systemic vasculopathy termed systemic accelerated arteriosclerosis (SAA). SAA is fundamentally distinct from atherosclerosis, associated with unique histology, pathophysiology and risk factors. In order to effectively manage post-transplant CVD, SAA needs to be addressed in current management strategies through revised risk factor minimisation and use of immunomodulatory pharmaceuticals.

Journal article

Belramman A, Bootun R, Tang TY, Lane TRA, Davies AHet al., 2022, Pain outcomes in a multicentre randomised clinical trial comparing MechanOChemical ablation versus CyanoAcrylate Adhesive for the treatment of primary truncal saphenous veins incompetence A Randomised Clinical Trial, JAMA Surgery, ISSN: 2168-6254

Importance Endovenous thermal ablations (ETAs) are recommended as first-line treatment of truncal vein reflux and have a short recovery time and are cost-effective. However, ETAs are associated with discomfort during tumescent anesthesia infiltration. To minimise discomfort, non-thermal, non tumescent ablation techniques, in the form of mechanochemical ablation (MOCA) and cyanoacrylate adhesive injection (CAE), have emerged. ObjectiveTo assess pain score immediately after truncal ablation using 100-mm Visual Analogue Scale and 10-point number scale. Design, Setting, and Participants The MOCCA study was a prospective, multicentre, randomised clinical trial, conducted at three sites between November 2017 and January 2020. There were 392 participants screened, 225 were excluded, and 167 participants underwent randomisation. Four participants did not receive allocated intervention and were included in the intention to treat analysis. Patients were reviewed at 2 weeks, and at 3, 6, and 12 months. Interventions Patients with primary truncal vein incompetence were randomised to receive either MOCA or CAE Main Outcomes and Measures Primary outcome measure was pain score immediately after completing truncal ablation using 100- mm Visual Analogue Scale (VAS) and 10-point number scale. Secondary outcome measures included degree of ecchymosis; occlusion rates, clinical severity, generic and disease specific quality of life (QoL) scores. Results 60% were women with mean age 56 years. 92.8% of truncal veins treated were GSV. Demographic data and baseline status was comparable. 47% underwent adjunctive treatment ofvaricosities. Overall median maximum pain score after truncal treatment was 23mm on VAS and 3 5 on number scale. There was no difference in pain measured by VAS (MOCA 24mm vs CAE 20mm, p = .230) or number scale (MOCA 4, vs CAE 3, p = .179). Both groups demonstrated significant and comparable improvement in clinical severity, generic and disease specific QoL scores, and c

Journal article

Paraskevas KI, Mikhailidis DP, Baradaran H, Davies AH, Eckstein H-H, Faggioli G, Fernandes e Fernandes J, Gupta A, Jezovnik MK, Kakkos SK, Katsiki N, Kooi ME, Lanza G, Liapis CD, Loftus IM, Millon A, Nicolaides AN, Poredos P, Pini R, Ricco J-B, Rundek T, Saba L, Spinelli F, Stilo F, Sultan S, Zeebregts CJ, Chaturvedi Set al., 2022, Optimal Management of Asymptomatic Carotid Stenosis: Counterbalancing the Benefits with the Potential Risks, JOURNAL OF STROKE, Vol: 24, Pages: 163-165, ISSN: 2287-6391

Journal article

Taha M, Busuttil A, Bootun R, Thabet B, Badawy A, Hassan H, Shalhoub J, Davies Aet al., 2022, A clinical guide to deep venous stenting for chronic iliofemoral venous obstruction, Journal of vascular surgery. Venous and lymphatic disorders, Vol: 10, Pages: 258-266.e1, ISSN: 2213-3348

BackgroundAn increase in endovenous interventions for deep venous pathologies has been observed. This article aims to provide an overview of the role of venous stenting in the management of chronic conditions affecting the deep venous system of the lower limbs, with a focus on intervention relating to the vena cava and iliofemoral venous segments.MethodsAn overview of the literature on the minimally invasive venous stenting procedures that are being increasingly used in the management of chronic conditions affecting the deep venous system of the lower limbs.ResultsWe discuss key areas of interest to a venous specialist practicing in this area, including diagnostic imaging in chronic deep venous disease, with a focus on the use of intravascular ultrasound examination in this context; the treatment of chronic venous outflow obstruction, including the rationale and structural indications for stenting, current guidance regarding stent placement, and fundamental points to consider during decision-making (endophlebectomy and stenting, stenting across the inguinal ligament, optimal sizing of venous stents, extension of venous stenting to beyond the common femoral vein confluence, the role of thrombolysis useful in chronic venous disease, and arteriovenous fistulae); outcomes and initial reports of stenting; and the future of venous stents.ConclusionsDeep venous stenting has become a key treatment option for chronic (thrombotic or nonthrombotic) obstructive venous disease. Dedicated venous stents and intravascular ultrasound examination represent important technological advances in the minimally invasive treatment of symptomatic chronic deep venous obstruction, which previously required open surgical reconstruction.

Journal article

Sutanto SA, Tan M, Onida S, Davies AHet al., 2022, A systematic review on isolated coil embolization for pelvic venous reflux, Journal of vascular surgery. Venous and lymphatic disorders, Vol: 10, Pages: 224-232.e9, ISSN: 2213-3348

OBJECTIVE: Pelvic venous reflux (PVR) can present with symptoms such as chronic pelvic pain, dysmenorrhea, and dyspareunia, resulting in a decreased quality of life among those affected. Percutaneous coil embolization (CE) is a common intervention for PVR; however, the efficacy and safety of its use in isolation has yet to be reviewed. METHODS: The MEDLINE and EMBASE databases were systematically searched from 1990 to July 20, 2020, for studies reporting on adult patients undergoing isolated CE for PVR. Articles not in English, case reports, studies reporting on pediatric patients, and studies not performing isolated CE were excluded. Search, review, and data extraction were performed by two independent reviewers (S.S. and M.T.). Changes in pain before and after CE was evaluated through a pooled analysis of visual analogue scale scores in seven studies. RESULTS: A total of 970 patients (range, 3-218, 100% female) undergoing isolated ovarian vein or mixed veins embolization from 20 studies were included. Pooled analysis revealed mean improvements of 5.47 points (95% CI, 4.77-6.16) on the visual analogue scale. Common symptoms such as urinary urgency and dyspareunia reported significant improvements of 78-100% and 60-89.5% respectively. Complications were rare, with coil migration (n = 19) being the most common. Recurrence rates differed based on the varying symptoms and studies, with recurrence in pain 1-2 years after CE ranging from 5.9-25%. Two randomized controlled trials revealed improved clinical outcomes with CE as compared with vascular plugs and hysterectomy. CONCLUSIONS: The current data suggests that isolated CE is technically effective and can result in clinical improvement among patients with PVR. However, further trials are required to ascertain its long-term effects.

Journal article

Salim S, Machin M, Patterson BO, Onida S, Davies AHet al., 2021, Global Epidemiology of Chronic Venous Disease A Systematic Review With Pooled Prevalence Analysis, ANNALS OF SURGERY, Vol: 274, Pages: 971-976, ISSN: 0003-4932

Journal article

Khatri A, Davies A, Shalhoub J, 2021, Mechanical prophylaxis for venous thromboembolism prevention in obese individuals, Phlebology, Vol: 36, Pages: 768-770, ISSN: 0268-3555

Journal article

Paraskevas KI, Mikhailidis DP, Baradaran H, Davies AH, Eckstein H-H, Faggioli G, Fernandes E Fernandes J, Gupta A, Jezovnik MK, Kakkos SK, Katsiki N, Kooi ME, Lanza G, Liapis CD, Loftus IM, Millon A, Nicolaides AN, Poredos P, Pini R, Ricco J-B, Rundek T, Saba L, Spinelli F, Stilo F, Sultan S, Zeebregts CJ, Chaturvedi Set al., 2021, Management of patients with asymptomatic carotid stenosis may need to be individualized: a multidisciplinary call for action. Republication of J Stroke 2021;23:202-212., Int Angiol, Vol: 40, Pages: 487-496

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 <3% and the patient's life expectancy is >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.

Journal article

Bootun R, Belramman A, Bolton-Saghdaoui L, Lane TRA, Riga C, Davies AHet al., 2021, Randomized controlled trial of compression after endovenous thermal ablation of varicose veins (COMETA Trial), Journal of Vascular Surgery, Vol: 9, Pages: 103-104, ISSN: 0741-5214

Journal article

Paraskevas KI, Mikhailidis DP, Antignani PL, Baradaran H, Bokkers RPH, Cambria RP, Dardik A, Davies AH, Eckstein H-H, Faggioli G, Fernandes e Fernande J, Fraedrich G, Geroulakos G, Gloviczki P, Golledge J, Jezovnik MK, Kakkos SK, Katsiki N, Knoflach M, Kooi ME, Lanza G, Liapis CD, Loftus IM, Mansilha A, Millon A, Nicolaides AN, Pini R, Poredos P, Ricco J-B, Riles TS, Ringleb PA, Rundek T, Saba L, Schlachetzki F, Silvestrini M, Spinelli F, Stilo F, Sultan S, Suri JS, Zeebregts CJ, Chaturvedi Set al., 2021, Optimal Management of Asymptomatic Carotid Stenosis in 2021: The Jury is Still Out. An International, Multispecialty, Expert Review and Position Statement, JOURNAL OF STROKE & CEREBROVASCULAR DISEASES, Vol: 31, ISSN: 1052-3057

Journal article

Goodall R, Salciccioli JD, Davies AH, Marshall D, Shalhoub Jet al., 2021, Trends in peripheral arterial disease incidence and mortality in EU15+ countries 1990-2017., European Journal of Preventive Cardiology, Vol: 28, Pages: 1201-1213, ISSN: 2047-4873

AIMS: The aim was to assess trends in peripheral arterial disease (PAD) incidence and mortality rates in European Union(15+) countries between 1990 and 2017. METHODS AND RESULTS: This observational study used data obtained from the 2017 Global Burden of Disease study. Age-standardised mortality and incidence rates from PAD were extracted from the Global Health Data Exchange for EU15+ countries for the years 1990-2017. Trends were analysed using Joinpoint regression analysis. Between 1990 and 2017, the incidence of PAD decreased in all 19 EU15+ countries for females, and in 18 of 19 countries for males. Increasing PAD incidence was observed only for males in the United States (+1.4%). In 2017, the highest incidence rates were observed in Denmark and the United States for males (213.6 and 202.3 per 100,000, respectively) and in the United States and Canada for females (194.8 and 171.1 per 100,000, respectively). There was a concomitant overall trend for increasing age-standardised mortality rates in all EU15+ countries for females, and in 16 of 19 EU15+ countries for males between 1990 and 2017. Italy (-25.1%), Portugal (-1.9%) and Sweden (-0.6%) were the only countries with reducing PAD mortality rates in males. The largest increases in mortality rates were observed in the United Kingdom (males +140.4%, females +158.0%) and the United States (males +125.7%, females +131.2%). CONCLUSIONS: We identify shifting burden of PAD in EU15+ countries, with increasing mortality rates despite reducing incidence. Strong evidence supports goal-directed medical therapy in reducing PAD mortality - population-wide strategies to improve compliance to optimal goal-directed medical therapy are warranted.

Journal article

Gueroult A, Al-Balah A, Shalhoub J, Davies Aet al., 2021, Nickel hypersensitivity and endovascular devices: a systematic review and meta-analysis, Heart, ISSN: 1355-6037

Objective Nickel allergy is common; endovascular specialists are often confronted with nickel allergic patients ahead of the implantation of endovascular devices, many of which are nickel-containing. Our aim was to elucidate whether nickel hypersensitivity is significantly associated with worse or adverse outcomes after placement of a nickel-containing endovascular device.Methods Inclusion criteria were: endovascular and transcatheter procedures for coronary, structural heart, neurovascular and peripheral vascular pathology involving nickel-allergic patients. All adverse outcomes were included as defined by included studies. A systematic review and meta-analysis were undertaken using a random-effects model. Searches of MEDLINE and EMBASE were conducted for articles published 1947–2019.Results 190 records were identified, 78 articles were included for qualitative synthesis and 15 met criteria for meta-analysis. Patch-test confirmed nickel allergy was associated with an increased risk of adverse outcomes following implantation of a nickel-containing endovascular device (n=14 articles, 1740 patients; OR 2.61, 95% CI 1.41 to 4.85). This finding further was observed in coronary (n=12 articles, 1624 patients; OR 1.94, 95% CI 1.16 to 3.23) and structural heart subgroups (n=2 articles, 83 patients; OR 52.28, 95% CI 1.31 to 2079.14), but not in the neurovascular subgroup (n=1 article, 33 patients; OR 3.04, 95% CI 0.59 to 15.72) or with a patient-reported history of nickel allergy (n=2 articles, 207 patients; OR 2.14, 95% CI 0.23 to 19.70).Conclusions Patch-tested nickel allergy is associated with an increased risk of adverse outcomes following endovascular device implantation and alternative treatment options should be considered. Specialists faced with patients’ self-reporting nickel allergy should consider proceeding to diagnostic patch-testing.

Journal article

Guni A, Normahani P, Davies A, Jaffer Uet al., 2021, Harnessing machine learning to personalize web-based health care content, Journal of Medical Internet Research, Vol: 23, ISSN: 1438-8871

Web-based health care content has emerged as a primary source for patients to access health information without direct guidance from health care providers. The benefit of this approach is dependent on the ability of patients to access engaging high-quality information, but significant variability in the quality of web-based information often forces patients to navigate large quantities of inaccurate, incomplete, irrelevant, or inaccessible content. Personalization positions the patient at the center of health care models by considering their needs, preferences, goals, and values. However, the traditional methods used thus far in health care to determine the factors of high-quality content for a particular user are insufficient. Machine learning (ML) uses algorithms to process and uncover patterns within large volumes of data to develop predictive models that automatically improve over time. The health care sector has lagged behind other industries in implementing ML to analyze user and content features, which can automate personalized content recommendations on a mass scale. With the advent of big data in health care, which builds comprehensive patient profiles drawn from several disparate sources, ML can be used to integrate structured and unstructured data from users and content to deliver content that is predicted to be effective and engaging for patients. This enables patients to engage in their health and support education, self-management, and positive behavior change as well as to enhance clinical outcomes.

Journal article

Khatri A, Machin M, Vijay A, Salim S, Shalhoub J, Davies Aet al., 2021, A Review of current and future antithrombotic strategies in surgical patients–leaving the graduated compression stockings behind?, Journal of Clinical Medicine, Vol: 10, ISSN: 2077-0383

Venous thromboembolism (VTE) remains an important consideration within surgery, with recent evidence looking to refine clinical guidance. This review provides a contemporary update of existing clinical evidence for antithrombotic regimens for surgical patients, providing future directions for prophylaxis regimens and research. For moderate to high VTE risk patients, existing evidence supports the use of heparins for prophylaxis. Direct oral anticoagulants (DOACs) have been validated within orthopaedic surgery, although there remain few completed randomised controlled trials in other surgical specialties. Recent trials have also cast doubt on the efficacy of mechanical prophylaxis, especially when adjuvant to pharmacological prophylaxis. Despite the ongoing uncertainty in higher VTE risk patients, there remains a lack of evidence for mechanical prophylaxis in low VTE risk patients, with a recent systematic search failing to identify high-quality evidence. Future research on rigorously developed and validated risk assessment models will allow the better stratification of patients for clinical and academic use. Mechanical prophylaxis’ role in modern practice remains uncertain, requiring high-quality trials to investigate select populations in which it may hold benefit and to explore whether intermittent pneumatic compression is more effective. The validation of DOACs and aspirin in wider specialties may permit pharmacological thromboprophylactic regimens that are easier to administer.

Journal article

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