Publications
869 results found
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.
Smith S, Normahani P, Lane T, et 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.
Paraskevas K, Gloviczki P, Antignani PL, et al., 2022, Benefits and drawbacks of statins and non-statin lipid lowering agents in carotid artery disease, PROGRESS IN CARDIOVASCULAR DISEASES, Vol: 73, Pages: 41-47, ISSN: 0033-0620
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- Citations: 3
Belramman A, Bootun R, Tang TY, et 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, JAMA Surgery, Vol: 157, Pages: 395-404, ISSN: 2168-6262
Importance Endovenous thermal ablations (ETAs) are recommended as first-line treatment for truncal vein reflux, have a short recovery time, and are cost-effective. However, ETAs are associated with discomfort during tumescent anesthesia infiltration. To minimize discomfort, nonthermal, nontumescent ablation techniques had emerged in the form of mechanochemical ablation (MOCA) and cyanoacrylate adhesive injection (CAE).Objective To assess pain scores immediately after truncal ablation using a 100-mm visual analog scale and 10-point number scale to compare pain-related outcomes following mechanochemical ablation vs cyanoacrylate adhesive treatment.Design, Setting, and Participants The Multicenter Randomized II Clinical Trial Comparing Mechanochemical Ablation vs Cyanoacrylate Adhesive for the Treatment of Primary Truncal Saphenous Veins Incompetence study was a prospective multicenter randomized clinical trial conducted at 3 sites between November 2017 and January 2020. Inclusion criteria were primary great or small saphenous varicose veins; exclusion criteria included recurrent varicose veins, current deep venous thrombosis, or serious arterial disease. There were 392 participants screened, 225 were excluded, and 167 participants underwent randomization. Four participants did not receive allocated intervention and were included in the intention-to-treat analysis. Follow-up took place at 2 weeks, and 3, 6, and 12 months.Interventions Patients with primary truncal vein incompetence were randomized to receive either MOCA or CAE.Main Outcomes and Measures The primary outcome measure was pain score immediately after completing truncal ablation using a 100-mm visual analog scale (VAS) and a 10-point number scale. Secondary outcome measures included degree of ecchymosis, occlusion rates, clinical severity, and generic and disease-specific quality of life (QoL) scores.Results Of 167 study participants, 99 (59.3%) were women, and the mean (SD) age was 56 (15.8) years. O
Racaru S, Saghdaoui LB, Choudhury JR, et 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
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- Citations: 4
Taha M, Busuttil A, Bootun R, et 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.
Paraskevas K, Mikhailidis DP, Antignani PL, et 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
Epstein D, Bootun R, Diop M, et 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.
Geoghegan L, Onida S, Davies AH, 2022, The use of venous-specific preference based measures in health economic evaluation: comparing apples and pears?, Phlebology, Vol: 37, Pages: 84-85, ISSN: 0268-3555
Machin M, Younan H-C, Guéroult A, et 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
Paraskevas KI, Mikhailidis DP, Baradaran H, et al., 2022, The burden of carotid-related strokes, ANNALS OF TRANSLATIONAL MEDICINE, Vol: 10, ISSN: 2305-5839
Cruddas L, Onida S, Davies AH, 2022, Venous aneurysms: When should we intervene?, PHLEBOLOGY, Vol: 37, Pages: 3-4, ISSN: 0268-3555
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- Citations: 2
Tan K, Salim S, Machin M, et 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.
Gimzewska M, Berthelot M, Sarai P, et al., 2022, Evaluation of a novel wireless near-infrared spectroscopy (NIRS) device in the detection of tourniquet induced ischaemia, BMJ Innovations, ISSN: 2055-8074
Otunla A, Shanmugarajah K, Madariaga M, et 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.
Belramman A, Bootun R, Tang TY, et 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
Tan MKH, Davies AH, 2022, Quality of Life in Lower Limb Lymphoedema Patients, Approach to Lower Limb Oedema, Pages: 337-348, ISBN: 9789811662058
Lymphoedema is estimated to affect up to 15% of the global population. Patients with this “forgotten vascular disease” often fail to receive the complex comprehensive multidisciplinary care they need, leading to reduced health-related quality of life (HRQoL). This chapter focuses on the literature regarding the impact of lower limb lymphoedema on patients’ HRQoL. While there is increasing focus on lymphoedema as a research subject, the quality of the literature available over the last 10 years is variable, especially when considering the specific topic of HRQoL in this patient population. Lymphoedema, including both primary and secondary types, has a significant negative impact on HRQoL. Quantifiable decreases in HRQoL have been recorded in all the studies included in this review; notably, primary lymphoedema patients appear to have physical HRQoL impairments that are less severe compared to those with secondary lymphoedema. Psychological HRQoL may be related to patients’ coping ability, with primary lymphoedema patients having no significant differences in psychological scores when compared to population norms. Further trials are required to compare the impact of conservative and surgical interventions on patients’ HRQoL and to determine target populations to maximise HRQoL benefits.
Shan LL, Saxena A, Davies AH, 2022, Quality of Life and Patient Reported Outcome Measures Following Percutaneous Aortic Intervention for Aortic Aneurysms and Dissection, Patient Reported Outcomes and Quality of Life in Cardiovascular Interventions, Pages: 267-299, ISBN: 9783031098147
Endovascular intervention is commonly used in aortic aneurysms and dissections with appropriate anatomy. The most common procedures are abdominal endovascular aortic repair (EVAR) and thoracic endovascular aortic repair (TEVAR). Quality of life (QOL) and patient reports outcomes measures (PROMS) are increasingly recognised as key aspects of outcomes assessment. QOL and PROMS facilitate shared clinical decision making and patient-centred care as well as helping to improve quality and safety. Understanding QOL outcomes is especially important where prophylactic EVAR or TEVAR are performed in asymptomatic patients who may otherwise have never experienced a detriment to their QOL from the disease process. This chapter provides an outline of the QOL instruments and PROMS used in endovascular aortic intervention and summarises the outcomes. The lack of evidence in specific areas is also highlighted with guidelines provided for further research.
Shan LL, Saxena A, Davies AH, 2022, Quality of Life and Patient Reported Outcome Measures Following Carotid Artery Intervention, Patient Reported Outcomes and Quality of Life in Cardiovascular Interventions, Pages: 249-265, ISBN: 9783031098147
Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are the currently recognised methods of carotid artery intervention in the setting of atherosclerotic disease. Quality of life (QOL) and patient reported outcomes measures (PROMS) are increasingly recognised as key aspects of postoperative outcomes assessment. In addition, they facilitate shared clinical decision making and patient-centred care as well as helping to improve quality and safety. Understanding QOL outcomes is especially important in prophylactic procedures such as CEA and CAS which may be performed in asymptomatic patients as well. This chapter provides an outline of the commonly used QOL instruments and PROMS in carotid intervention and summarises the QOL findings. However, there are significant limitations of the literature that are identified and discussed in order to provide a platform for future studies.
Taha M, Busuttil A, Bootun R, et 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.
Machin M, Thapar A, Davies AH, 2022, Compression Stockings, Approach to Lower Limb Oedema, Pages: 159-178, ISBN: 9789811662058
Compression encompasses a range of therapies used to provide an externally applied graduated pressure greater at the ankle than the knee aiming to improve venous function and decrease lower limb swelling (Lim and Davies, Graduated compression stockings [Internet], 2020). Graduated compression stockings are elastic stockings that exert the greatest degree of compression at the ankle, with the degree of compression gradually decreasing up the garment (Lim and Davies, Graduated compression stockings [Internet], 2020). The indications for graduated compression stockings include symptom relief in post-thrombotic syndrome, chronic venous disease, lipedema, and lymphedema. Investigational studies into the use of stockings to prevent post-thrombotic syndrome are underway.
Paraskevas KI, Mikhailidis DP, Baradaran H, et 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
Paraskevas KI, Mikhailidis DP, Antignani PL, et al., 2022, 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
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- Citations: 15
Sutanto SA, Tan M, Onida S, et 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.
Tan M, Davies AH, 2022, Is compression necessary after endovenous thermal ablation of varicose veins? Clarifying a (com)pressing matter, PHLEBOLYMPHOLOGY, Vol: 29, Pages: 27-33, ISSN: 1286-0107
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
Paraskevas KI, Mikhailidis DP, Baradaran H, et 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.
Salim S, Machin M, Patterson BO, et al., 2021, Global Epidemiology of Chronic Venous Disease <i>A Systematic Review With Pooled Prevalence Analysis</i>, ANNALS OF SURGERY, Vol: 274, Pages: 971-976, ISSN: 0003-4932
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Bootun R, Belramman A, Bolton-Saghdaoui L, et 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
Goodall R, Salciccioli JD, Davies AH, et 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.
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