Publications
142 results found
Encarnacion S N, Onida S, Lane TR, et al., 2020, Do we need another modality for truncal vein ablation?, Phlebology, Vol: 35, Pages: 644-646, ISSN: 0268-3555
Dattani N, Shalhoub J, Nandhra S, et al., 2020, Reducing the risk of venous thromboembolism following superficial endovenous treatment: a UK and Republic of Ireland consensus study, Phlebology, Vol: 35, Pages: 706-714, ISSN: 0268-3555
ObjectivesVenous thromboembolism is a potentially fatal complication of superficial endovenous treatment. Proper risk assessment and thromboprophylaxis could mitigate this hazard; however, there are currently no evidence-based or consensus guidelines. This study surveyed UK and Republic of Ireland vascular consultants to determine areas of consensus.MethodsA 32-item survey was sent to vascular consultants via the Vascular and Endovascular Research Network (phase 1). These results generated 10 consensus statements which were redistributed (phase 2). ‘Good’ and ‘very good’ consensus were defined as endorsement/rejection of statements by >67% and >85% of respondents, respectively.ResultsForty-two consultants completed phase 1. This generated seven statements regarding risk factors mandating peri-procedural pharmacoprophylaxis and three statements regarding specific pharmacoprophylaxis regimes. Forty-seven consultants completed phase 2. Regarding venous thromboembolism risk factors mandating pharmacoprophylaxis, ‘good’ and ‘very good’ consensus was achieved for 5/7 and 2/7 statements, respectively. Regarding specific regimens, ‘very good’ consensus was achieved for 3/3 statements.ConclusionsThe main findings from this study were that there was ‘good’ or ‘very good’ consensus that patients with any of the seven surveyed risk factors should be given pharmacoprophylaxis with low-molecular-weight heparin. High-risk patients should receive one to two weeks of pharmacoprophylaxis rather than a single dose.
Benson RA, 2020, Global impact of the first coronavirus disease 2019 (COVID-19) pandemic wave on vascular services, British Journal of Surgery, Vol: 107, Pages: 1396-1400, ISSN: 0007-1323
This online structured survey has demonstrated the global impact of the COVID‐19 pandemic on vascular services. The majority of centres have documented marked reductions in operating and services provided to vascular patients. In the months during recovery from the resource restrictions imposed during the pandemic peaks, there will be a significant vascular disease burden awaiting surgeons.
Machin M, Salim S, Onida S, et al., 2020, The less invasive paradox, why carotid artery stenting is not suitable for the high-risk patient, ANNALS OF TRANSLATIONAL MEDICINE, Vol: 8, ISSN: 2305-5839
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Saghdaoui LB, Onida S, Davies AH, et al., 2020, Why nurses in primary care need to be research active: the case of venous leg ulceration., Br J Community Nurs, Vol: 25, Pages: 422-428, ISSN: 1462-4753
Venous leg ulceration (VLU) is predominantly managed in primary care by district nurses, however much of the research takes place in secondary care. This study aimed to identify to what extent nurses are involved in publishing VLU research and to ascertain how much VLU research is conducted in primary care. Three searches of literature published between 2015 and 2020 were undertaken, reviewing VLU publications on interventions, quality of life and qualitative research. Some 37% of intervention studies had one or more nurse authors, compared with 65% of quality of life studies and 86% of qualitative research publications. Of papers that providing details of recruitment, 39% of intervention and quality of life studies included primary care as a recruitment setting. Qualitative studies were more likely to recruit from primary as well as secondary care (50%). Nurses are involved in leading VLU research but are more likely to publish quality of life and qualitative research than intervention studies. The majority of nurse authors in this field are based in academic institutions. A minority of studies utilise primary care as a recruitment setting for VLU research. More must be done to enable VLU research in community settings and to promote the involvement of clinical nurses in research.
Heatley F, Onida S, Davies AH, 2020, The global management of leg ulceration: Pre early venous reflux ablation trial, Phlebology, Vol: 35, Pages: 576-582, ISSN: 0268-3555
BackgroundVarious guidelines exist worldwide for the diagnosis and management of venous leg ulcers; however, these are difficult to implement resulting in disparate treatment of patients globally.MethodAn online, 26-question survey was designed to evaluate the current global management of venous leg ulceration and was emailed globally to approximately 15,000 participants (November 2017–February 2018).ResultsOverall, 799 responses were received from 86 countries, with a 5% response rate. The respondent physicians saw a median of 10 (interquartile range 5–20) patients per month, with a median time to referral from primary to secondary care of six weeks. Of the respondents, 61% arranged an ankle brachial pressure index on first visit and 84% performed a venous duplex, with 95% prescribing compression for those in whom it was not contraindicated. Fifty-nine percent performed endovenous intervention or surgery prior to ulcer healing.ConclusionsThe survey showed a diversity of treatment pathways. The need to develop a robust, clear pathway for patients with leg ulceration is clearly required.
Langridge BJ, Onida S, Weir J, et al., 2020, Cyanoacrylate glue embolisation for varicose veins - A novel complication, Phlebology, Vol: 35, Pages: 520-523, ISSN: 0268-3555
BackgroundNon-thermal non-tumescent methods for varicose vein treatment have rapidly gained popularity in recent years due to clinical efficacy comparable to other endovenous methods, but with a superior safety and tolerability profile. Cyanoacrylate is an adhesive that rapidly polymerises during endovenous treatment to cause rapid occlusion of veins and initiate vein fibrosis.MethodCyanoacrylate glue treatment is known to cause complications such as phlebitis, cellulitis and deep vein thrombosis in rare instances. We present the first reported case of cyanoacrylate extravasation with chronic foreign body reaction in a patient nine months after initial treatment.ResultsWe discuss the aetiology of this complication, its treatment, patient outcome and its significance to both clinicians and patients.ConclusionCyanoacrylate glue embolisation can, in rare instances, lead to extravasation and chronic foreign body reaction, necessitating surgical intervention. The relative novelty of cyanoacrylate glue embolisation in the treatment of varicose veins requires clinicians to monitor for rare complications during its use in clinical practice. Patients should be aware of the rare risk of glue extravasation and foreign body reaction for fully informed consent prior to treatment.
Goodall R, Ellauzi J, Tan K, et al., 2020, A systematic review of the impact of foot-care education on self-efficacy and self-care in patients with diabetes, European Journal of Vascular and Endovascular Surgery, Vol: 60, Pages: 282-292, ISSN: 1078-5884
Objectives: Assess the evidence supporting the impact of patient foot-care education on self-efficacy, self-care behaviour and self-care knowledge in individuals with diabetes.Design: Systematic review registered prospectively on the PROSPERO database (CRD42019106171).Materials and Methods: Ovid EMBASE and MEDLINE databases were searched from 1946 to end of March 2019, using search terms related to the domains diabetic foot, patient education, self-efficacy, self-care behaviour and self-care knowledge. All included studies were prospective, randomised controlled trials that assessed foot-care education interventions in individuals with diabetes and recorded an outcome related to self-efficacy, self-care behaviour and/or self-care knowledge.Results: 13 randomised controlled trials were included, reporting on a total of 3,948 individuals. The risk of bias was high or unclear in 11 of the 13 included studies, and low in 2 studies. Both the education-interventions delivered, and the outcome assessment tools used were heterogenous across included studies: meta-analysis was therefore not performed. Eight of 11 studies identified significantly better foot self-care behaviour scores in individuals randomised to education compared with controls. Self-efficacy scores were significantly better in education groups in four of five studies reporting this primary outcome. Foot-care knowledge was significantly better in intervention versus control in three of seven studies. In general, studies assessing secondary end-points including quality of life and ulcer/amputation incidence tended not to identify significant clinical improvements.Conclusion: The available evidence is of inadequate quality to reliably conclude that foot-care education has a positive impact on foot self-care behaviour and self-efficacy in individuals with diabetes. Quality data supporting accompanying benefits on quality of life or ulcer/amputation incidence are also lacking and should be considered as an impor
Heatley F, Saghdaoui LB, Salim S, et al., 2020, UK primary care survey of venous leg ulceration management and referral - Post-EVRA trial, Phlebology, Vol: 36, Pages: 48-53, ISSN: 0268-3555
ObjectiveDetermine standards of referral and management of patients with venous leg ulceration in primary care after the release of the EVRA (A Randomized Trial of Early Endovenous Ablation in Venous Ulceration) study results.MethodsAn online questionnaire was disseminated over four months to professionals working within primary care.ResultsThe survey received 643 responses. Of respondents, 90 (14%) had heard of the EVRA trial and 51 (8%) were familiar with the results. Of those who answered the following questions, 410 (69.1%) stated that referral to a vascular specialist must be made by the General Practitioner and 13 (2.2%) reported that they would always refer patients for secondary care assessment before the publication of EVRA. Considering the EVRA results, 128 (29%) reported that they would change practice regarding referral and would experience no barriers and 198 (45%) reported that they would like to refer earlier but is not their decision. Barriers to changing practice included local referral policies, training and time restrictions, 266 (59%) had heard of the NICE guideline (CG168) and 194 (43%) were aware of the recommendations for referral to a vascular service within two weeks for patients with an open or healed ulcer.ConclusionThere is a considerable variation in local referral pathways for venous leg ulceration, and despite clinicians wanting to refer promptly, many primary care professionals are unable to. Unfortunately, the EVRA study alone may not change the overall practice, and work is needed to overcome barriers faced by primary care professionals.
Dattani N, Shalhoub J, Nandhra S, et al., 2020, Corrigendum to Reducing the risk of venous thromboembolism following superficial endovenous treatment: A UK and Republic of Ireland consensus study, Phlebology, Vol: 35, Pages: 844-844, ISSN: 0268-3555
Ding A, Onida S, Davies AH, 2020, The painful cost of cancelling surgery due toCOVID-19-can we do anything about it?, British Journal of Surgery, Vol: 107, Pages: e336-e336, ISSN: 0007-1323
Goodall R, Langridge B, Onida S, et al., 2020, Median arcuate ligament syndrome, Journal of Vascular Surgery, Vol: 71, Pages: 2170-2176, ISSN: 0741-5214
BACKGROUND: Median arcuate ligament syndrome (MALS) describes the clinical presentation associated with direct compression of the celiac artery by the median arcuate ligament. The poorly understood pathophysiologic mechanism, variable symptom severity, and unpredictable response to treatment make MALS a controversial diagnosis. METHODS: This review summarizes the literature pertaining to the pathophysiologic mechanism, presentation, diagnosis, and management of MALS. A suggested diagnostic workup and treatment algorithm are presented. RESULTS: Individuals with MALS present with signs and symptoms of foregut ischemia, including exercise-induced or postprandial epigastric pain, nausea, vomiting, and weight loss. Consideration of MALS in patients' diagnostic workup is typically delayed. Currently, no group consensus agreement as to the diagnostic criteria for MALS exists; duplex ultrasound, angiography, and gastric exercise tonometry are used in different combinations and with varying diagnostic values throughout the literature. Surgical management involves decompression of the median arcuate ligament's constriction of the celiac artery; robotic, laparoscopic, endoscopic retroperitoneal, and open surgical intervention can provide effective symptom relief, but long-term follow-up data (>5 years) are lacking. Patients treated nonoperatively appear to have worse outcomes. CONCLUSIONS: MALS is an important clinical entity with significant impact on affected individuals. Presenting symptoms, patient demographics, and radiologic signs are generally consistent, as is the short-to medium-term (<5 years) response to surgical intervention. Future prospective studies should directly compare long-term symptomatic and quality of life outcomes after nonoperative management with outcomes after open, laparoscopic, endoscopic retroperitoneal, and robotic celiac artery decompression to enable the development of evidence-based guidelines for the management of MALS.
Karia M, Onida S, Singh P, et al., 2020, Chemoprophylaxis in lower limb immobilization : A systematic review and meta-analysis, ACTA ORTHOPAEDICA BELGICA, Vol: 86, Pages: 66-73, ISSN: 0001-6462
Onida S, Davies A, 2020, Long-haul travel venous thromboembolism – an update, Phlebolymphology, ISSN: 1286-0107
Davies A, Onida S, Shalhoub J, et al., 2020, Rapid Response to: Clinical features of covid-19, BMJ: British Medical Journal, ISSN: 0959-535X
Benson RA, Forsythe R, Bosanquet D, et al., 2020, The COvid-19 vascular sERvice (COVER) study: an international vascular and endovascular research network (VERN) collaborative study Assessing the provision, practice, and outcomes of vascular surgery during the COVID-19 pandemic, European Journal of Vascular and Endovascular Surgery, ISSN: 1078-5884
Lane T, Onida S, Davies A, 2020, Comment on: Strength of public preferences for endovascular or open aortic aneurysm repair, BRITISH JOURNAL OF SURGERY, Vol: 107, Pages: 613-613, ISSN: 0007-1323
Babber A, Ravikumar R, Onida S, et al., 2020, Effect of footplate neuromuscular electrical stimulation on functional and quality‐of‐life parameters in patients with peripheral artery disease: pilot, and subsequent randomized clinical trial, British Journal of Surgery, Vol: 107, Pages: 355-363, ISSN: 0007-1323
BackgroundSupervised exercise programmes for intermittent claudication have poor access and limited compliance. Neuromuscular electrical stimulation (NMES) may be an effective alternative. A proof‐of‐concept study and RCT were conducted.MethodsIn study 1, eligible patients underwent baseline assessment; treadmill testing for initial (ICD) and maximum (MCD) claudication distance; EuroQoL Five Dimensions five‐level instrument (EQ‐5D‐5L™) and Intermittent Claudication Questionnaire (ICQ) assessment; and measurement of ultrasound haemodynamics of the superficial femoral artery. After familiarization with the NMES device, participants underwent a 30‐min session of stimulation with concomitant recording of haemodynamic measures at 15 min, and after device cessation. Measurements were repeated after 6 weeks of daily use of NMES. In study 2, consecutive patients underwent baseline assessment before online randomization to a supervised exercise programme only, or adjunctive NMES treatment for 6 weeks, followed by repeat measurements.ResultsStudy 1 (20 patients) showed a significant improvement in MCD (46 per cent; P < 0·001) and ICD (71 per cent; P < 0·001). The RCT (42 patients) showed a significant adjunctive benefit of NMES in ICD (46 per cent; P = 0·014). Improvements were seen in the ICQ (9 points; P = 0·009) and EQ‐5D‐5L™ (P = 0·007) in study 1, and there was a significant adjunctive benefit of NMES on the ICQ score in patients who did supervised exercise (11·2 points; P = 0·031). Blood volume flow and time‐adjusted mean velocity increased significantly with the device on (P < 0·050). Overall, NMES compliance exceeded 95 per cent.ConclusionFootplate NMES significantly improved walking distance in patients with intermittent claudication when used independently and also as an ad
Wittens C, Davies AH, Baekgaard N, et al., 2020, Management of Chronic Venous Disease: Clinical Practice Guidelines (vol 49, pg 678, 2015), EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, Vol: 59, Pages: 495-495, ISSN: 1078-5884
Tan MKH, Onida S, Davies AH, 2020, Response to Commentary on "The Relationship Between Vein Diameters, Clinical Severity, and Quality of Life: A Systematic Review", EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, Vol: 59, Pages: 325-325, ISSN: 1078-5884
Onida S, Tan MKH, Kafeza M, et al., 2019, Metabolic phenotyping in venous disease: The need for standardization, Journal of Proteome Research, Vol: 18, Pages: 3809-3820, ISSN: 1535-3893
Venous thromboembolism (VTE), chronic venous disease (CVD), and venous leg ulceration (VLU) are clinical manifestations of a poorly functioning venous system. Though common, much is unknown of the pathophysiology and progression of these conditions. Metabolic phenotyping has been employed to explore mechanistic pathways involved in venous disease. A systematic literature review was performed: full text, primary research articles on the applications of nuclear magnetic resonance spectroscopy (NMR) and mass spectrometry (MS) in human participants and animals were included for qualitative synthesis. Seventeen studies applying metabolic phenotyping to venous disease were identified: six on CVD, two on VLU, and nine on VTE; both animal (n = 6) and human (n = 10) experimental designs were reported, with one study including both. NMR, MS, and MS imaging were employed to characterize serum, plasma, urine, wound fluid, and tissue. Metabolites found to be upregulated in CVD included lipids, branched chain amino acids (BCAA), glutamate, taurine, lactate, and myo-inositol identified in vein tissue. Upregulated metabolites in VLU included lactate, BCAA, lysine, 3-hydroxybutyrate, and glutamate identified in wound fluid and ulcer biopsies. VTE cases were associated with reduced carnitine levels, upregulated aromatic amino acids, 3-hydroxybutyrate, BCAA, and lipids in plasma, serum, thrombus, and vein wall; kynurenine and tricarboxylic acid pathway dysfunction were reported. Future research should focus on targeted studies with internal and external validation.
Belramman A, Bootun R, Onida S, et al., 2019, ClariVein®, mechanochemical endovenous ablation: patient selection and perspective, Journal of Vascular Diagnostics and Interventions, Vol: 7, Pages: 1-8, ISSN: 2463-5618
The American Venous Forum and the National Institute for Health and Care Excellence recommend endothermal ablation (ETA) techniques as the first line treatment for superficial venous incompetence. However, these techniques require the use of tumescent anaesthesia prior to energy delivery, which may be a source of discomfort for the patient and can prolong procedure time. Recently, nonthermal, nontumescent (NTNTs) techniques such as mechanochemical ablation (MOCA) have been developed to address some of the negative aspects associated with ETA. This article reviews this technique from a patient selection and perspective point view.
Gianesini S, Obi A, Onida S, et al., 2019, Global guidelines trends and controversies in lower limb venous and lymphatic disease Narrative literature revision and experts' opinions following the vWINter international meeting in Phlebology, Lymphology & Aesthetics, 23-25 January 2019, Phlebology, Vol: 34, Pages: 4-66, ISSN: 0268-3555
Guidelines are fundamental in addressing everyday clinical indications and in reporting the current evidence-based data of related scientific investigations. At the same time, a spatial and temporal issue can limit their value. Indeed, variability in the recommendations can be found both among the same nation different scientific societies and among different nations/continents. On the other side, Garcia already published in 2014 data showing how, after three years in average, one out of five recommendations gets outdated (Martinez Garcia LM, Sanabria AJ, Garcia Alvarez E, et al. The validity of recommendations from clinical guidelines: a survival analysis. CMAJ 2014;186(16):1211–1219). The present document reports a narrative literature revision on the major international recommendations in lower limb venous and lymphatic disease management, focusing on the different countries’ guidelines, trends and controversies from all the continents, while identifying new evidence-based data potentially influencing future guidelines. World renowned experts’ opinions are also provided. The document has been written following the recorded round tables scientific discussions held at the vWINter international meeting (22–26 January 2019; Cortina d’Ampezzo, Italy) and the pre- and post-meeting literature search performed by the leading experts.
Menon D, Onida S, Davies AH, 2019, Overview of venous pathology related to repetitive axes vascular trauma in athletes, JOURNAL OF VASCULAR SURGERY-VENOUS AND LYMPHATIC DISORDERS, Vol: 7, Pages: 756-762, ISSN: 2213-333X
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Gimzewska M, Onida S, Davies A, 2019, Deep venous stenting in trauma - What is the role?, PHLEBOLOGY, ISSN: 0268-3555
Menon D, Onida S, Davies AH, 2019, Overview of arterial pathology related to repetitive trauma in athletes, JOURNAL OF VASCULAR SURGERY, Vol: 70, Pages: 641-650, ISSN: 0741-5214
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- Citations: 10
Tan M, Onida S, Davies AH, 2019, Quality of life tools reflect disease severity but can they be improved?, Phlebology, Vol: 34, Pages: 369-371, ISSN: 0268-3555
Langridge B, Goodall R, Onida S, et al., 2019, Venous thromboembolism prevention in lower limb trauma – Can we do better?, Phlebology, Vol: 34, Pages: 291-293, ISSN: 0268-3555
Tan MKH, Sutanto SA, Onida S, et al., 2019, The Relationship Between Vein Diameters, Clinical Severity, and Quality of Life: A Systematic Review, EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, Vol: 57, Pages: 851-857, ISSN: 1078-5884
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- Citations: 18
Kirlikaya B, Langridge B, Davies AH, et al., 2019, Metabolomics as a tool to improve decision making for the vascular surgeon - wishful thinking or a dream come true?, VASCULAR PHARMACOLOGY, Vol: 116, Pages: 1-3, ISSN: 1537-1891
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- Citations: 4
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