Imperial College London

DrSarahOnida

Faculty of MedicineDepartment of Surgery & Cancer

Honorary Clinical Senior Lecturer
 
 
 
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Contact

 

+44 (0)20 3311 7317s.onida Website

 
 
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Location

 

4N 12North WingCharing Cross Campus

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Summary

 

Publications

Publication Type
Year
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142 results found

Machin M, Whittley S, Norrie J, Burgess L, Hunt BJ, Bolton L, Shalhoub J, Everington T, Gohel M, Whiteley MS, Rogers S, Onida S, Turner B, Nandhra S, Lawton R, Stephens-Boal A, Singer C, Dunbar J, Carradice D, Davies AHet al., 2024, Evaluating pharmacological THRomboprophylaxis in Individuals undergoing superficial endoVEnous treatment across NHS and private clinics in the UK: a multi-centre, assessor-blind, randomised controlled trial-THRIVE trial., BMJ Open, Vol: 14

INTRODUCTION: Endovenous therapy is the first choice management for symptomatic varicose veins in NICE guidelines, with 56-70 000 procedures performed annually in the UK. Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a known complication of endovenous therapy, occurring at a rate of up to 3.4%. Despite 73% of UK practitioners administering pharmacological thromboprophylaxis to reduce VTE, no high-quality evidence supporting this practice exists. Pharmacological thromboprophylaxis may have clinical and cost benefit in preventing VTE; however, further evidence is needed. This study aims to establish whether when endovenous therapy is undertaken: a single dose or course of pharmacological thromboprophylaxis alters the risk of VTE; pharmacological thromboprophylaxis is associated with an increased rate of bleeding events; pharmacological prophylaxis is cost effective. METHODS AND ANALYSIS: A multi-centre, assessor-blind, randomised controlled trial (RCT) will recruit 6660 participants from 40 NHS and private sites across the UK. Participants will be randomised to intervention (single dose or extended course of pharmacological thromboprophylaxis plus compression) or control (compression alone). Participants will undergo a lower limb venous duplex ultrasound scan at 21-28 days post-procedure to identify asymptomatic DVT. The duplex scan will be conducted locally by blinded assessors. Participants will be contacted remotely for follow-up at 7 days and 90 days post-procedure. The primary outcome is imaging-confirmed lower limb DVT with or without symptoms or PE with symptoms within 90 days of treatment. The main analysis will be according to the intention-to-treat principle and will compare the rates of VTE at 90 days, using a repeated measures analysis of variance, adjusting for any pre-specified strongly prognostic baseline covariates using a mixed effects logistic regression. ETHICS AND DISSEMINATION: Eth

Journal article

Gwilym B, Pallmann P, Waldron C-A, Thomas-Jones E, Milosevic S, Brookes-Howell L, Harris D, Massey I, Burton J, Stewart P, Samuel K, Jones S, Cox D, Clothier A, Prout H, Edwards A, Twine C, Bosanquet D, Vascular and Endovascular Research Network VERN, Shalhoub J, PERCEIVE study groupet al., 2024, Long term risk prediction after major lower limb amputation: 1-year results of the PERCEIVE study, BJS Open, Vol: 8, ISSN: 2474-9842

Background:Decision-making when considering major lower limb amputation is complex and requires individualized outcome estimation. It is unknown how accurate healthcare professionals or relevant outcome prediction tools are at predicting outcomes at 1-year after major lower limb amputation.Methods:An international, multicentre prospective observational study evaluating healthcare professional accuracy in predicting outcomes 1 year after major lower limb amputation and evaluation of relevant outcome prediction tools identified in a systematic search of the literature was undertaken. Observed outcomes at 1 year were compared with: healthcare professionals’ preoperative predictions of death (surgeons and anaesthetists), major lower limb amputation revision (surgeons) and ambulation (surgeons, specialist physiotherapists and vascular nurse practitioners); and probabilities calculated from relevant outcome prediction tools.Results:A total of 537 patients and 2244 healthcare professional predictions of outcomes were included. Surgeons and anaesthetists had acceptable discrimination (C-statistic = 0.715), calibration and overall performance (Brier score = 0.200) when predicting 1-year death, but performed worse when predicting major lower limb amputation revision and ambulation (C-statistics = 0.627 and 0.662 respectively). Healthcare professionals overestimated the death and major lower limb amputation revision risks. Consultants outperformed trainees, especially when predicting ambulation. Allied healthcare professionals marginally outperformed surgeons in predicting ambulation. Two outcome prediction tools (C-statistics = 0.755 and 0.717, Brier scores = 0.158 and 0.178) outperformed healthcare professionals’ discrimination, calibration and overall performance in predicting death. Two outcome prediction tools for ambulation (C-statistics = 0.688 and 0.667) marginally outperformed healthcare professionals.Conclusion:There is uncertainty in predicting 1-year ou

Journal article

Hitchman L, Gwilym B, Al-Saadi N, Birmpili P, Singh A, Machin M, Blair R, Hurndall K, Shelmerdine L, Shalhoub J, Bosanquet D, Dattani N, Saratzis A, Onida S, Benson R, Nandhra S, Ambler Get al., 2023, The Vascular and Endovascular Research Network (VERN): A multidisciplinary collaborative for vascular surgeons in training, Gefasschirurgie, Vol: 28, Pages: 434-437, ISSN: 0948-7034

The Vascular and Endovascular Research Network (VERN) was set up to promote research, to improve the treatment of vascular diseases and to improve the synthesis and dissemination of evidence. The network represents a particular form of collaboration involving trainee doctors and specialists from a wide variety of medical disciplines. It undertakes multicentre projects, which are mostly observational studies and the data collected are analysed and published in a short period of time. This form of research has several advantages including fostering collaboration between different institutes, countries and researchers with different levels of expertise. It also promotes accelerated delivery of evidence and individual professional development. The network has an executive committee that meets every 2 weeks to discuss projects and the entire committee meets every month. An appointed member of the executive committee coordinates the centres participating in projects. Although there has been some scepticism with respect to research collaboratives, raising concerns over the accountability and the contribution of authors, it is paramount that research conducted by a collaborative maintains the same scientific rigour and ethical standards as research conducted by individual academic units.

Journal article

Esposito D, Rawashdeh M, Onida S, Turner B, Machin M, Pulli R, Davies AHet al., 2023, Systematic Review and Meta-Analysis of Elective Open Conversion versus Fenestrated and Branched Endovascular Repair for Previous Non-Infected Failed Endovascular Aneurysm Repair., Eur J Vasc Endovasc Surg

OBJECTIVE: To evaluate outcomes of patients electively undergoing fenestrated and branched endovascular repair (F/B-EVAR) or open conversion for failed previous non-infected endovascular aneurysm repair (EVAR). DATA SOURCES: Embase, MEDLINE, Cochrane Library. REVIEW METHOD: The protocol was prospectively registered on PROSPERO (CRD42023404091). The review followed the PRISMA guidelines; certainty was assessed through the GRADE and quality through MINORS tools. Outcomes data were pooled separately for F/B-EVAR and open conversion. A random effects meta-analysis of proportions was conducted; heterogeneity was assessed with the I2 statistic. RESULTS: Thirty eight studies were included, for a total of 1 645 patients of whom 1 001 (60.9%) underwent an open conversion and 644 (39.1%) a F/B-EVAR. The quality of evidence was generally limited. GRADE certainty was judged low for 30 day death (in both groups) and F/B-EVAR technical success, and very low for the other outcomes. Pooled 30 day death was 2.3% (I2 33%) in the open conversion group and 2.4% (I2 0%) in the F/B-EVAR conversion group (p = .36). Technical success for F/B-EVAR was 94.1% (I2 23%). The pooled 30 day major systemic complications rate was higher in the open conversion (21.3%; I2 74%) than in the F/B-EVAR (15.7%; I2 78%) group (p = .52). At 18 months follow up, the pooled re-intervention rate was 4.5% (I2 58%) in the open conversion and 26% (I2 0%) in the F/B-EVAR group (p < .001), and overall survival was 92.5% (I2 59%) and 81.6% (I2 68%), respectively (p = .005). CONCLUSION: In the elective setting, and excluding infections, the early results of both open conversion and F/B-EVAR after failed EVAR appear satisfactory. Although open conversion presented with higher complication rates in the first 30 days after surgery, at follow up it seemed to be associated with fewer re-interventions and better survival compared with F/B-EVAR.

Journal article

Esposito D, Onida S, Turner B, Rawashdeh M, Jenkins MP, Pulli R, Davies AHet al., 2023, Systematic review and meta-analysis of outcomes after semi-conversion with graft preservation for failed endovascular aneurysm repair., J Vasc Surg

OBJECTIVE: The aim of this study was to evaluate the outcomes after semi-conversion (open conversion with graft preservation) after failed endovascular aneurysm repair (EVAR). The primary outcomes were 30-day mortality and semi-conversion failure. Secondary outcomes were 30-day major systemic complications, endoleak recurrence, reinterventions, and overall survival. METHODS: The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The protocol was prospectively registered on PROSPERO (CRD42023421153). All studies reporting the outcomes of semi-conversions for failed EVAR were eligible for inclusion. Quality assessment was performed using the Methodological Index for Non-Randomized Studies (MINORS) tool. A random effects meta-regression of proportions was conducted using the double arcsine-Tukey transformation, given the frequent zero event rate in the primary outcome. Heterogeneity was assessed with the I2 statistic. RESULTS: Eight studies were included in the review after full text screening. A total of 196 patients underwent semi-conversion at a mean time from EVAR of 47.4 months, 68.9% in an elective setting. Mean age at conversion was 78.1 years, and the main indication was isolated endoleak type II (70.1% of cases). Aortic clamping was not necessary in 92.3% of semi-conversions; the aortic sac was opened in 96.1% of cases; in 93.3% of cases, ligation/suture of one or more culprit arteries were performed; and aortic neck banding was executed in 29.2%. At 30 days from surgery, the pooled mortality and the major systemic complications rates were 5.3% (I2 = 24.9%) and 13.4% (I2 = 54.3%), respectively. At follow-up, endoleak recurred after 12.6% semi-conversions (I2 = 83.2%), and the rate of reinterventions was 7% (I2 = 50.1%); the semi-conversion failure rate was 5.5% (I2 = 54.1%), and the overall survival was 84.6% (I2 = 33.3%). CONCLUSIONS: Semi-conversions have ac

Journal article

Wang R, Tan M, Onida S, Davies AHet al., 2023, Determining the relationships between venous reflux patterns, clinical severity, and health-related quality of life, Publisher: OXFORD UNIV PRESS, ISSN: 0007-1323

Conference paper

Pruekprasert K, Simon D, Davies A, Takats Z, Onida Set al., 2023, Rapid evaporative ionisation mass spectrometry (REIMS) coupled with the hydrosurgical debridement system and the carbon dioxide surgical laser: a proof of concept study in porcine tissues, Publisher: OXFORD UNIV PRESS, Pages: III27-III27, ISSN: 0007-1323

Conference paper

Javed A, Machin M, Gwozdz A, Turner B, Onida S, Shalhoub J, Davies Aet al., 2023, Meta-analysis of lytic catheter-based intervention for acute proximal deep vein thrombosis in the reduction of post-thrombotic syndrome, Journal of Vascular Surgery: Venous and Lymphatic Disorders, ISSN: 2213-333X

Journal article

Nimura M, Lane T, Rawashdeh M, Sritharan G, Reese G, Davies Aet al., 2023, Study protocol for Neuromuscular Stimulation for Rehabilitation after general and vascular surgery - a pilot randomised clinical study, BMJ Open, Vol: 13, ISSN: 2044-6055

Objectives To investigate the acceptability and safety of neuromuscular stimulation (NMES) as an adjunct for rehabilitation after vascular and general surgery.Methods and analysis Prospective, single-centre, single-blind, parallel group, randomised controlled study. This study will be conducted in a single-centre, secondary care setting (National Healthcare Service Hospital) in the UK. All patients aged over 18 years undergoing vascular or general surgery with Rockwood Frailty Score of 3 or above on admission. Exclusion is inability or unwillingness to participate in trial, implanted electrical device, pregnancy and acute deep vein thrombosis. Target number of recruitment is 100. Participants will be randomly assigned to active NMES group (group A) or placebo NMES group (group B) prior to surgery. Participants will be blinded and asked to use the NMES device, 1–6 sessions daily (30 min per session) after surgery in addition to standard National Health Service rehabilitation care until discharge. The primary study outcomes are acceptability and safety of NMES assessed by the device satisfaction questionnaire on discharge and adverse events recorded during hospital stay. The secondary outcomes are the postoperative recovery and cost-effectiveness compared between two groups, assessed by various activity tests, mobility and independence measures and questionnaires.Ethics and dissemination Ethical approvals were provided by London-Harrow Research Ethics Committee (REC) and the 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 number NCT04784962.

Journal article

Bergner R, Onida S, Velineni R, Spagou K, Gohel MS, Bouschbacher M, Bohbot S, Shalhoub J, Holmes E, Davies AHet al., 2023, Metabolic profiling reveals changes in serum predictive of venous ulcer healing, Annals of Surgery, Vol: 277, Pages: e467-e474, ISSN: 0003-4932

Objective: The aim of this study was to identify potential biomarkers predictive of healing or failure to heal in a population with venous leg ulceration.Summary Background Data: Venous leg ulceration presents important physical, psychological, social and financial burdens. Compression therapy is the main treatment, but it can be painful and time-consuming, with significant recurrence rates. The identification of a reliable biochemical signature with the ability to identify nonhealing ulcers has important translational applications for disease prognostication, personalized health care and the development of novel therapies.Methods: Twenty-eight patients were assessed at baseline and at 20 weeks. Untargeted metabolic profiling was performed on urine, serum, and ulcer fluid, using mass spectrometry and nuclear magnetic resonance spectroscopy.Results: A differential metabolic phenotype was identified in healing (n = 15) compared to nonhealing (n = 13) venous leg ulcer patients. Analysis of the assigned metabolites found ceramide and carnitine metabolism to be relevant pathways. In this pilot study, only serum biofluids could differentiate between healing and nonhealing patients. The ratio of carnitine to ceramide was able to differentiate between healing phenotypes with 100% sensitivity, 79% specificity, and 91% accuracy.Conclusions: This study reports a metabolic signature predictive of healing in venous leg ulceration and presents potential translational applications for disease prognostication and development of targeted therapies.

Journal article

Judges D, Liu C, Onida S, Lane TRA, Davies AHet al., 2023, Left common iliac vein diameter in patients referred for lower limb venous duplex ultrasound, VASCULAR, ISSN: 1708-5381

Journal article

The Vascular and Endovascular Research Network VERN Executive Committee, Hitchman L, Birmpili P, Gwilym B, Singh A, Onida S, Blair R, Dovell G, Dattani N, Saratzis A, Bosanquet D, Shalhoub J, Ambler G, Nandhra S, Benson R, The Vascular and Endovascular Research Network VERN COVER Study Collaborativeet al., 2023, The DEFINITE Audit: a prospective audit of diabetic foot debridement in theatre, Journal of Vascular Societies Great Britain and Ireland

Journal article

Turner B, Jasionowska S, Machin M, Javed A, Gwozdz A, Shalhoub J, Onida S, Davies Aet al., 2023, Systematic review and meta-analysis of exercise therapy for venous leg ulcer healing and recurrence, Journal of vascular surgery. Venous and lymphatic disorders, Vol: 11, Pages: 219-226, ISSN: 2213-3348

Objective:National guidelines in the United Kingdom have recommended regular exercise for individuals with venous leg ulceration. However, data on the effects of exercise on ulcer healing and recurrence are sparse. In the present study, we aimed to quantify the evidence for exercise regarding venous ulcer healing with respect to the primary outcomes of the proportion of healed ulcers and rate of ulcer recurrence. The secondary outcomes were improvement in ulcer symptoms, ulcer healing time, quality of life, compliance, and adverse events reported.Methods:The review followed PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines using a registered protocol (CRD42021220925). The MEDLINE and Embase databases and Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, European Union Clinical Trials, and International Standard Randomised Controlled Trial Number registries were searched up to April 6, 2022 and included studies comparing exercise therapy and compression vs compression alone. Data for the proportion of healed ulcers were pooled using a fixed effects meta-analysis.Results:After screening 1046 reports, 7 were included, with 121 participants allocated to exercise therapy and 125 to compression alone. All the reports were of randomized controlled trials and had reported ulcer healing at 12 weeks, with a pooled relative risk of ulcer healing of 1.38 for exercise vs compression (95% confidence interval, 1.11-1.71). Only one study had reported on recurrence; thus, data pooling was not performed. No differences between exercise and usual care were demonstrated. Compliance with exercise ranged from 33% to 81%. The included studies demonstrated low enrollment and a high risk of bias. Also, most of the trials had failed to demonstrate any differences in activity completed between the intervention and control arms.Conclusions:A paucity of studies has examined leg ulcer recurrence after exercise programs, with no evidence to s

Journal article

Jasionowska S, Turner B, Machin M, Onida S, Gwozdz A, Shalhoub J, Davies Aet al., 2022, Systematic review of exercise therapy in the management of post-thrombotic syndrome, Phlebology, Vol: 37, Pages: 695-700, ISSN: 0268-3555

ObjectivesExercise improves haemodynamic parameters in patients with chronic venous disease. There is a paucity of evidence on its effect in post-thrombotic syndrome (PTS). The aim of this systematic review is to assess the impact of exercise in PTS.MethodsAdhering to PRISMA guidelines and following PROSPERO registration (CRD42021220924), MEDLINE, Cochrane Library, EMBASE database, and trial registries were searched on 19th May 2022.ResultsOne article met the inclusion criteria and a narrative synthesis was carried out. The included randomised controlled trial reported a between-group mean difference of 4.6 points (p = .027) in the VEINES-QOL score and −2.0 points (p = .14) in the Villalta score, in favour of exercise therapy. The statistical significance threshold was not reached.ConclusionData on exercise in PTS remains sparse but exercise appears to be a safe intervention. In the context of this literature, a potential future trial and outcome reporting measures are suggested.

Journal article

Gwilym BL, Pallmann P, Waldron C-A, Thomas-Jones E, Milosevic S, Brookes-Howell L, Harris D, Massey I, Burton J, Stewart P, Samuel K, Jones S, Cox D, Clothier A, Edwards A, Twine CP, Bosanquet DC, Vascular and Endovascular Research Network VERN and PERCEIVE study groupet al., 2022, Short-term risk prediction after major lower limb amputation: PERCEIVE study., Br J Surg, Vol: 109, Pages: 1300-1311

BACKGROUND: The accuracy with which healthcare professionals (HCPs) and risk prediction tools predict outcomes after major lower limb amputation (MLLA) is uncertain. The aim of this study was to evaluate the accuracy of predicting short-term (30 days after MLLA) mortality, morbidity, and revisional surgery. METHODS: The PERCEIVE (PrEdiction of Risk and Communication of outcomE following major lower limb amputation: a collaboratIVE) study was launched on 1 October 2020. It was an international multicentre study, including adults undergoing MLLA for complications of peripheral arterial disease and/or diabetes. Preoperative predictions of 30-day mortality, morbidity, and MLLA revision by surgeons and anaesthetists were recorded. Probabilities from relevant risk prediction tools were calculated. Evaluation of accuracy included measures of discrimination, calibration, and overall performance. RESULTS: Some 537 patients were included. HCPs had acceptable discrimination in predicting mortality (931 predictions; C-statistic 0.758) and MLLA revision (565 predictions; C-statistic 0.756), but were poor at predicting morbidity (980 predictions; C-statistic 0.616). They overpredicted the risk of all outcomes. All except three risk prediction tools had worse discrimination than HCPs for predicting mortality (C-statistics 0.789, 0.774, and 0.773); two of these significantly overestimated the risk compared with HCPs. SORT version 2 (the only tool incorporating HCP predictions) demonstrated better calibration and overall performance (Brier score 0.082) than HCPs. Tools predicting morbidity and MLLA revision had poor discrimination (C-statistics 0.520 and 0.679). CONCLUSION: Clinicians predicted mortality and MLLA revision well, but predicted morbidity poorly. They overestimated the risk of mortality, morbidity, and MLLA revision. Most short-term risk prediction tools had poorer discrimination or calibration than HCPs. The best method of predicting mortality was a statistical tool th

Journal article

Ambler G, Hitchman L, Benson R, Birmpili P, Blair R, Bosanquet D, Dattani N, Dovell G, Gwilym B, Hurndall K, Machin M, Nandhra S, Onida S, Shalhoub J, Singh A, Saratzis Aet al., 2022, Comment on: Collaborative research: population-based data and validation are necessary, British Journal of Surgery, Vol: 109, Pages: e111-e112, ISSN: 0007-1323

Journal article

Turner B, Machin M, Jasionowska S, Salim S, Onida S, Shalhoub J, Davies Aet al., 2022, Systematic review and meta-analysis of the additional benefit of pharmacological thromboprophylaxis for endovenous varicose vein interventions, Annals of Surgery, Vol: 278, Pages: 166-171, ISSN: 0003-4932

Objective: The primary objective of this systematic review and meta-analysis was to elucidate the rate of venous thromboembolism (VTE) following endovenous varicose vein intervention with mechanical thromboprophylaxis and additional pharmacological thromboprophylaxis, versus mechanical thromboprophylaxis alone.Summary Background Data: The VTE rate following endovenous procedures is higher than other day-case procedures and could be reduced with pharmacological thromboprophylaxis.Methods: The review followed PRISMA guidelines with a registered protocol (PROSPERO: CRD42021274963). Studies of endovenous intervention for superficial venous incompetence reporting the predefined outcomes with at least 30 patients were eligible. Data were pooled with a fixed effects model.Results: There were 221 trials included in the review (47 randomised trial arms, 105 prospective cohort studies and 69 retrospective studies). In randomised trial arms, the rate of deep venous thrombosis with additional pharmacological thromboprophylaxis was 0.52% (95% CI 0.23-1.19%) (9 studies; 1095 patients; 2 events), versus 2.26% (95% CI 1.81-2.82%) (38 studies; 6951 patients; 69 events) with mechanical thromboprophylaxis alone. The rate of pulmonary embolism in randomised trial arms with additional pharmacological thromboprophylaxis was 0.45% (95% CI 0.09-2.35) (5 studies, 460 participants, 1 event) versus 0.23% (95% CI 0.1-0.52%) (28 studies, 4834 participants, 3 events) for mechanical measures alone. The rate of EHIT grade III-IV was 0.35% (95% CI 0.09-1.40) versus 0.88% (95% CI 0.28-2.70%). There was one VTE-related mortality and one instance of major bleeding, with low rates of minor bleeding.Conclusions: There is a significant reduction in the rate of DVT with additional pharmacological thromboprophylaxis and routine prescription of anticoagulation following endovenous varicose vein intervention should be considered. VTE risk for individual study participants is heterogeneous and risk stratifica

Journal article

Shaydakov ME, Ting W, Sadek M, Aziz F, Diaz JA, Comerota AJ, Lurie F, Blebea J, Eklof BG, Lugli M, De Maeseneer MGR, Kakkos SK, Nicolaides A, Heim D, Welch HJet al., 2022, Extended anticoagulation for venous thromboembolism: A survey of the American Venous Forum and the European Venous Forum, JOURNAL OF VASCULAR SURGERY-VENOUS AND LYMPHATIC DISORDERS, Vol: 10, Pages: 1012-+, ISSN: 2213-333X

Journal article

Roy Choudhury J, Ding A, Onida S, Shalhoub J, Davies AHet al., 2022, O074 Metabolic phenotyping in diabetic foot ulceration, Annual Scientific Meeting of the Surgical-Research-Society, Publisher: OXFORD UNIV PRESS, ISSN: 0007-1323

Conference paper

Thygesen JH, Tomlinson C, Hollings S, Mizani MA, Handy A, Akbari A, Banerjee A, Cooper J, Lai AG, Li K, Mateen BA, Sattar N, Sofat R, Torralbo A, Wu H, Wood A, Sterne JAC, Pagel C, Whiteley WN, Sudlow C, Hemingway H, Denaxas Set al., 2022, COVID-19 trajectories among 57 million adults in England: a cohort study using electronic health records, LANCET DIGITAL HEALTH, Vol: 4, Pages: E542-E557

Journal article

Bootun R, Onida S, Lane T, Davies Aet al., 2022, Varicose veins, Surgery (Oxford), Vol: 40, Pages: 411-419, ISSN: 0263-9319

Varicose veins are common and have a negative impact on people's quality of life. Treatment has been shown to improve the quality of life in those affected and is endorsed by international clinical practice guidelines. In the UK, traditional techniques of saphenofemoral and saphenopopliteal junctional ligation with or without stripping have been largely superseded by minimally invasive day surgery techniques under local anaesthesia. The most performed procedures include radiofrequency ablation and endovenous laser ablation, both of which may be associated with procedural discomfort and complications relating to the use of thermal energy. More recently, novel techniques, including mechanochemical ablation and cyanoacrylate glue, have entered the clinical arena with promising results. However, newer complications are also emerging (especially for cyanoacrylate). Saphenous sparing techniques also exist, selectively disconnecting refluxing points between the superficial and deep venous systems (CHIVA) or by removing incompetent tributaries via selective phlebectomy (ASVAL). This article discusses the epidemiology, diagnosis, and management of varicose veins, including the latest endovascular and targeted open surgical techniques.

Journal article

Nandhra S, Benson RA, Vascular and Endovascular Research Network VERN COVER Study Collaborative, 2022, The persistent challenges faced by vascular surgery services during the UK coronavirus pandemic: a snapshot qualitative survey, Annals of the Royal College of Surgeons of England, Vol: 104, Pages: 385-388, ISSN: 0035-8843

INTRODUCTION: The coronavirus (COVID-19) pandemic continues to affect the NHS. The Vascular and Endovascular Research Network (VERN) COvid Vascular sERvice (COVER) study has prospectively shown the significant global impact of the COVID-19 pandemic on vascular surgery. The aim of this study is to investigate the way in which this second wave has affected surgeons' ability to treat patients with urgent vascular conditions, using contemporaneous snapshot data from 30 UK vascular centres. METHODS: This is a contemporary (18-28 January 2021) re-run of the Tier 1 COVER survey. This used closed and open questions, related to centres' provision of common vascular services, threshold for treatment, imaging, screening, staff and theatre availability, multidisciplinary team input, clinics, personal protective equipment, vaccination policies and case-backlogs. The survey was disseminated to clinicians via email. A service reduction score was calculated. RESULTS: Forty-two complete responses were received from 30 vascular centres (England, Northern Ireland, Scotland and Wales). Overall, 56.7% of units are performing only urgent procedures. The threshold for abdominal aortic aneurysm (AAA) repair has increased in the majority of UK centres (60%). One in six AAA screening programmes have stopped all screening activity: 30% having a significantly reduced programme and only half running as normal. Waiting lists are increasing for AAA, lower limb revascularisation and venous disease. CONCLUSION: Overall, these data suggest that vascular care in the NHS is facing unprecedented pressures due to COVID-19. Vascular stakeholders will have to urgently address these issues in the coming months. STUDY REGISTRATION NUMBER: ISRCTN 80453162 (registered prospectively).

Journal article

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

Journal article

Turner BRH, Jasionowska S, Machin M, Onida S, Webster C, Davies AHet al., 2022, 180Systematic Review and Meta-Analysis of Exercise Therapy for Venous Leg Ulcer Healing and Recurrence, ASiT Surgical Innovation Summit - Future Surgery Show, Publisher: OXFORD UNIV PRESS, ISSN: 0007-1323

Conference paper

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

Cruddas L, Onida S, Davies AH, 2022, Venous aneurysms: When should we intervene?, PHLEBOLOGY, Vol: 37, Pages: 3-4, ISSN: 0268-3555

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

Gimzewska M, Berthelot M, Sarai P, Geoghegan L, Onida S, Shalhoub J, Strutton P, Davies Aet al., 2022, Evaluation of a novel wireless near-infrared spectroscopy (NIRS) device in the detection of tourniquet induced ischaemia, BMJ Innovations, ISSN: 2055-8074

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Tabiri S, Kamarajah SK, Nepogodiev D, Li E, Simoes J, Sravanam S, Owusu SA, Mahama H, Agyeman YN, Arthur J, Kunfah SM, Gyamfi FE, Owusu EA, Loffler MW, Wandoh P, Bhangu A, Siaw-Acheampong K, Argus L, Chaudhry D, Dawson BE, Glasbey JC, Gujjuri RR, Jones CS, Khatri C, Keatley JM, Lawday S, Mann H, Marson EJ, Mclean KA, Picciochi M, Taylor EH, Tiwari A, Simoes JFF, Trout IM, Venn ML, Wilkin RJW, Dajti I, Gjata A, Boccalatte L, Modolo MM, Cox D, Pockney P, Townend P, Aigner F, Kronberger I, Hossain K, VanRamshorst G, Lawani I, Ataide G, Baiocchi G, Buarque I, Gohar M, Slavchev M, Agarwal A, Brar A, Martin J, Olivos M, Calvache J, Perez Rivera CJ, Hadzibegovic AD, Kopjar T, Mihanovic J, Klat J, Novysedlak R, Christensen P, El-Hussuna A, Batista S, Lincango E, Emile SH, Mengesha MG, Hailu DS, Tamiru H, Kauppila J, Arnaud A, Albertsmeiers M, Lederhuber H, Loffler M, Metallidis S, Tsoulfas G, Lorena MA, Grecinos G, Mersich T, Wettstein D, Ghosh D, Kembuan G, Brouk P, Khosravi M, Mozafari M, Adil A, Mohan HM, Zmora O, Fiore M, Gallo G, Pata F, Pellino G, Satoi S, Ayasra F, Chaar M, Fakhradiyev IR, Jamal M, Elhadi M, Gulla A, Roslani A, Martinez L, Ramos De la Medina A, Outani O, Jonker P, Kruijff S, Noltes M, Steinkamp P, van der Plas W, Ademuyiwa A, Osinaike B, Seyi-olajide J, Williams E, Pejkova S, Augestad KM, Soreide K, Al Balushi Z, Qureshi A, Sayyed R, Daraghmeh MAM, Abukhalaf S, Cukier M, Gomez H, Shu S, Vasquez X, Parreno-Sacdalan MD, Major P, Azevedo J, Cunha M, Santos I, Zarour A, Bonci E-A, Negoi I, Efetov S, Litvin A, Ntirenganya F, AlAmeer E, Radenkovic D, Xiang FKH, Hoe CM, Yong JNC, Moore R, Nhlabathi N, Colino RB, Bravo AM, Minaya-Bravo A, Jayarajah U, Wickramasinghe D, Elmujtaba M, Jebril W, Rutegard M, Sund M, Isik A, Leventoglu S, Abbott TEF, Benson R, Caruna E, Chakrabortee S, Demetriades A, Desai A, Drake TD, Edwards JG, Evans JP, Ford S, Fotopoulou C, Griffiths E, Hutchinson P, Jenkinson MD, Khan T, Knight S, Kolias A, Leung E, McKay S, Norman L, Ots Ret al., 2022, Impact of Bacillus Calmette-Guerin (BCG) vaccination on postoperative mortality in patients with perioperative SARS-CoV-2 infection, BJS Open, Vol: 5, ISSN: 2474-9842

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Shaydakov ME, Ting W, Sadek M, Aziz F, Diaz JA, Raffetto JD, Marston WA, Lal BK, Welch HJet al., 2022, Review of the current evidence for topical treatment for venous leg ulcers, JOURNAL OF VASCULAR SURGERY-VENOUS AND LYMPHATIC DISORDERS, Vol: 10, Pages: 241-+, ISSN: 2213-333X

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