Publications
142 results found
Machin M, Salim S, Onida S, et al., 2019, Venous thromboembolism risk assessment tools: Do we need a consensus?, Phlebology, Pages: 268355519828863-268355519828863
Onida S, Lane TRA, Bootun R, et al., 2019, Varicose veins and their management, Surgery (United Kingdom), Vol: 37, Pages: 73-80, ISSN: 0263-9319
Varicose veins are common and affect a significant proportion of the UK population. They negatively impact on patients’ quality of life and are an important cause of morbidity. 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techniques of saphenofemoral and saphenopopliteal junctional ligation with or without stripping have been largely superseded by minimally invasive, day surgery techniques under local anaesthesia.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 commonly performed include radiofrequency ablation and endovenous laser ablation, both endothermal techniques 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. 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.
Goodall R, Langridge B, Onida S, et al., 2019, Current status of non-invasive perfusion assessment in individuals with diabetic foot ulceration, Journal of Vascular Surgery, Vol: 69, Pages: 315-317, ISSN: 0741-5214
Tan MKH, Luo R, Onida S, et al., 2019, Venous Leg Ulcer Clinical Practice Guidelines: What is AGREEd?, EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, Vol: 57, Pages: 121-129, ISSN: 1078-5884
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Tan MKH, Onida S, Laffan M, et al., 2018, Thrombophilia in non-thrombotic chronic venous disease of the lower limb - a systematic review, British Journal of Haematology, Vol: 183, Pages: 703-716, ISSN: 1365-2141
Chronic venous disease (CVD) represents a significant healthcare burden. Thrombophilia is proposed as a risk factor, particularly for post‐thrombotic CVD. A systematic review was performed to determine the relationship between thrombophilia and non‐thrombotic CVD. MEDLINE® and Embase® databases were searched from 1946 up to March 2018. Case‐control studies, cohort studies or randomised clinical trials reporting on thrombophilias in non‐thrombotic lower limb CVD in adult patients were included. Non‐English and post‐thrombotic syndrome studies were excluded. Study selection and data extraction were performed by two reviewers. Fifteen studies were included, reporting on 916 cases and 1261 controls. Studies largely focused on venous ulceration and investigated multiple haemostatic factors. An association between thrombophilia and non‐thrombotic CVD was identified, with greater prevalence and factor concentration alteration reported in patients compared to controls. Concomitant thrombophilia presence was associated with earlier CVD onset. Relationship strength varied, with commoner aetiologies showing clearer correlation than rarer ones. Thrombophilia is associated with non‐thrombotic CVD but the mechanism is unclear and causation cannot be determined. Future research should focus on prospective studies with larger populations and identify adjunct therapies targeting thrombophilia.
Staniszewska A, Onida S, Davies AH, 2018, Compression therapy for uncomplicated varicose veins - Too little for too much?, Phlebology, Pages: 268355518781432-268355518781432
Clark SL, Onida S, Davies A, 2018, Long-haul travel and venous thrombosis: what is the evidence?, Phlebology, Vol: 33, Pages: 295-297, ISSN: 0268-3555
Epstein D, Onida S, Bootun R, et al., 2018, Cost-Effectiveness of Current and Emerging Treatments of Varicose Veins, Value in Health, ISSN: 1098-3015
© 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Objectives: To analyze the cost-effectiveness of current technologies (conservative care [CONS], high-ligation surgery [HL/S], ultrasound-guided foam sclerotherapy [UGFS], endovenous laser ablation [EVLA], and radiofrequency ablation [RFA]) and emerging technologies (mechanochemical ablation [MOCA] and cyanoacrylate glue occlusion [CAE]) for treatment of varicose veins over 5 years. Methods: A Markov decision model was constructed. Effectiveness was measured by re-intervention on the truncal vein, re-treatment of residual varicosities, and quality-adjusted life-years (QALYs) over 5 years. Model inputs were estimated from systematic review, the UK National Health Service unit costs, and manufacturers’ list prices. Univariate and probabilistic sensitivity analyses were undertaken. Results: CONS has the lowest overall cost and quality of life per person over 5 years; HL/S, EVLA, RFA, and MOCA have on average similar costs and effectiveness; and CAE has the highest overall cost but is no more effective than other therapies. The incremental cost per QALY of RFA versus CONS was £5,148/QALY. Time to return to work or normal activities was significantly longer after HL/S than after other procedures. Conclusions: At a threshold of £20,000/QALY, RFA was the treatment with highest median rank for net benefit, with MOCA second, EVLA third, HL/S fourth, CAE fifth, and CONS and UGFS sixth. Further evidence on effectiveness and health-related quality of life for MOCA and CAE is needed. At current prices, CAE is not a cost-effective option because it is costlier but has not been shown to be more effective than other options.
Manley LR, Onida S, Davies AH, 2018, A SYSTEMATIC REVIEW OF PERIPHERAL BLOOD BIOMARKERS IN PRIMARY CHRONIC VENOUS DISEASE, Annual Meeting of the Society-of-Academic-and-Research-Surgery (SARS), Publisher: WILEY, Pages: 11-11, ISSN: 0007-1323
Grant Y, Onida S, Dharmarajah B, et al., 2018, Exercise-induced median arcuate ligament syndrome in athletes, JOURNAL OF SPORTS MEDICINE AND PHYSICAL FITNESS, Vol: 58, Pages: 193-195, ISSN: 0022-4707
Stather P, Mascara F, on Behalf of the Vascular and Endovascular Research Network VERN, 2017, Cardiovascular risk reduction in referrals to outpatient vascular clinics, Annals of The Royal College of Surgeons of England, Vol: 100, Pages: 194-198, ISSN: 0035-8843
IntroductionPatients with peripheral arterial disease (PAD), aneurysmal disease (AD) or carotid atherosclerosis are at high cardiovascular risk, necessitating secondary cardiovascular protection. The aim of this study was to determine compliance with cardiovascular risk reduction guidelines in new patients referred to vascular clinics.MethodsA multicentre collaborative national observational audit of new patients referred to eight tertiary general vascular clinics over a three-month period in England and Wales was conducted by the Vascular and Endovascular Research Network (VERN). Referral letters, case notes and investigations were reviewed by local investigators, and data analysed by VERN.ResultsA total of 656 patients were included in the study: 73.2% had PAD, 23.2% had AD and 3.7% had carotid atherosclerosis. A third (37.5%) were current smokers, two-thirds (61.7%) were on antiplatelet therapy and two-thirds (61.5%) were on statin therapy. Smoking was more prevalent in the PAD cohort (PAD 41.4%, AD 27.5%, p=0.003). However, more PAD patients were on antiplatelet therapy (PAD 63.9%, AD 53.3%, p=0.024). Both antiplatelet and statin prescription significantly increased with the number of cardiovascular risk factors. Patients with a previous cardiac or cerebrovascular history were more likely to have stopped smoking, and to be on antiplatelet and statin therapy (p<0.0001 for each). Overall, 47.3% of patients were on both antiplatelet and statin therapy, and 28.9% were on antiplatelet and statin therapy and not smoking.ConclusionsThis study highlights deficiencies in cardiovascular risk minimisation in patients with established vascular disease. Patients with concomitant cardiac or cerebrovascular disease were more likely to be on best medical therapy.
Onida S, Karia M, Bootun R, et al., 2017, VTE Risk Assessment Scoring in Day Surgery Patients: US and UK Perspectives on Risk Stratification, Vascular Annual Meeting of the Society-for-Vascular-Surgery, Publisher: MOSBY-ELSEVIER, Pages: 129S-129S, ISSN: 0741-5214
Onida S, Clark S, Davies AH, 2017, Travel-Related Deep Venous Thrombosis in the Context of Endovenous Ablation: What Is the Evidence?, Vascular Annual Meeting of the Society-for-Vascular-Surgery, Publisher: MOSBY-ELSEVIER, Pages: 129S-130S, ISSN: 0741-5214
Bootun R, Epstein D, Onida S, et al., 2017, Cost-Effectiveness of Current and Emerging Treatments of Varicose Veins, 2017 Vascular Annual Meeting, Publisher: ELSEVIER, Pages: 128S-128S, ISSN: 0741-5214
Bootun R, Epstein D, onida, et al., 2017, Effectiveness of treatments of varicose veins: systematic review and evidence synthesis, Society for Academic and Research Surgery, Publisher: Wiley, Pages: 28-28, ISSN: 1365-2168
BackgroundNovel methods of varicose vein treatment have been introduced in the past few years with the expectation that they might be more advantageous than conventional procedures. A systematic review and network meta-analysis was conducted comparing the effectiveness of current treatment (conservative care, surgery, ultrasound guided foam sclerotherapy (UGFS), endovenous laser ablation (EVLA), and radiofrequency ablation (RFA)) to emerging technologies (mechanochemical ablation (MOCA) and cyanoacrylate glue occlusion (CAE)).MethodsA systematic review of the literature was undertaken with evidence from randomised controlled trials (RCTs) collected for current technologies. However, because of a paucity of randomised studies, evidence for the newer endovenous ablation procedures was obtained from non-randomised studies in a secondary analysis. Outcomes measured were re-intervention on the truncal vein and re-treatment for residual varicosities.ResultsThirty-three RCTs and a further ten non-randomised studies evaluating MOCA or CAE were analysed. Thirteen RCTs and three non-randomised studies reported on re-interventions and re-treatments. The rate of re-interventions was found to be similar between EVLA, RFA and surgery. The rate of re-intervention after MOCA appears lower than UGFS (incidence rate ratio MOCA v UGFS 0.395) and greater than surgery (incidence rate ratio MOCA v surgery 1.378). ConclusionThis is the first systematic review that has conducted a meta-analysis of re-intervention and retreatment. The high attrition rate is the main risk of bias identified in the RCTs. Further, high quality studies comparing MOCA and CAE to other modalities are needed to establish truncal re-intervention rates and rate of re-treatment of residual varicosities.
Bootun R, Onida S, Lane, et al., 2017, Pilot study of the use of cyanoacrylate in the treatment of varicose veins, Society for Academic and Research Surgery (SARS), Publisher: Wiley, Pages: 46-47, ISSN: 1365-2168
BackgroundThe treatment of varicose vein disease has changed significantly over the past decade. Endovenous ablation, especially using thermal methods, has become the new norm. However, it is often associated with patient discomfort during tumescent infiltration and the ablative procedure. The non-thermal, non-tumescent (NTNT) techniques are believed to be more advantageous as they eliminate these potential adverse events. In this study, the use of a new cyanoacrylate compound (Variclose vein sealing system, Biolas®, Ankara, Turkey) is assessed.MethodPatients with symptomatic varicose veins were invited to have their truncal saphenous incompetence treated using the new cyanoacrylate glue. Intraoperatively, their level of discomfort was assessed. Patients also had their clinical status and quality of life assessed at baseline and at 1 month post-operatively. ResultsSeventeen patients (20 limbs) were recruited. The mean age was 54 years. Eighty-five percent of limbs were reviewed at the 30-day follow-up. The mean baseline VCSS was 3.6 (±2.5), which improved to 2.4 (±3) at the 30-day point. Improvements were also noted in both the generic and specific quality of life scores. The median maximum pain score using a VAS was 34mm and 33mm for average pain. The complete/proximal occlusion rate at 30 days was 88%.ConclusionsThese preliminary results suggest that endovenous ablation using cyanoacrylate is safe and results in quality of life improvements similar to that seen in studies evaluating thermal techniques along with a low degree of intra-operative pain. Larger comparative studies are, however, required to confirm its effectiveness.
Mursia FM, Busuttil A, Onida S, et al., 2017, A systematic review on anticoagulation following deep venous stenting, BRITISH JOURNAL OF SURGERY, Vol: 104, Pages: 48-48, ISSN: 0007-1323
Sinha Y, Busuttil A, Onida S, et al., 2017, A systematic review into quality of life following endovenous interventions for varicose veins, BRITISH JOURNAL OF SURGERY, Vol: 104, Pages: 56-56, ISSN: 0007-1323
Bootun R, Epstein D, Onida S, et al., 2017, Effectiveness of treatments of varicose veins: systematic review and evidence synthesis, Publisher: WILEY, Pages: 28-28, ISSN: 0007-1323
Bootun R, Onida S, Lane TRA, et al., 2017, Pilot study of the use of cyanoacrylate in the treatment of varicose veins, Annual Meeting of the Society-of-Academic-and-Research-Surgery (SARS), Publisher: Wiley, Pages: 46-47, ISSN: 1365-2168
Sinha Y, Onida S, Davies AH, 2017, The relationship between duplex detected superficial venous incompetence and quality of life in symptomatic and asymptomatic populations, Annual Meeting of the Society-of-Academic-and-Research-Surgery (SARS), Publisher: WILEY, Pages: 47-47, ISSN: 0007-1323
Ananthan K, Onida S, Davies AH, 2017, Nutcracker Syndrome: An Update on Current Diagnostic Criteria and Management Guidelines, EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, Vol: 53, Pages: 886-894, ISSN: 1078-5884
Onida S, Lane TRA, Davies AH, 2017, Clinical presentation and assessment of patients with venous disease, Handbook of Venous and Lymphatic Disorders: Guidelines of the American Venous Forum: Fourth Edition, Pages: 361-370, ISBN: 9781498724401
Grant Y, Onida S, Davies A, 2017, Genetics in chronic venous disease., Phlebology, Vol: 32, Pages: 3-5
Chronic venous disease is highly prevalent in the Western world, with varicose veins being the most common form of clinical manifestation. With recent developments in sequencing technology, clinicians and geneticists alike are embarking on a journey to identify and unravel the genetic candidates of chronic venous disease. There is now currently substantial evidence to suggest the presence of genetic influences in the aetiology and pathology of venous disease. Despite this, the precise nature and profile of the genes involved in chronic venous disease remain a poorly understood entity. Moreover, it is strikingly apparent that the majority of venous genetic studies conducted over the past decade do not adhere to fundamental research principles. The emergence of high-throughput genotyping platforms permits a more systematic search for inherited components of venous disease. Pursuing a genome-wide frontier has the potential to reveal novel critical metabolic pathways and explain the genetic susceptibility of chronic venous disease. An expedited knowledge of the genetic factors in the aetiology of venous disease may translate into better prevention or treatment, which would benefit patients suffering from its clinical sequelae. Researchers should be urged to foster collaborative links and design a genome-wide case-control association study as an international consortium to provide a statistically robust paradigm in the field of chronic venous disease genetics. This will carry promise for clinically relevant progress and represent a first step towards better understanding of the genetics of chronic venous disease aetiology.
Wittens C, Davies AH, BÆkgaard N, et al., 2017, Editor's choice - Management of chronic venous diseases: Clinical treatment guidelines of the European Society for Vascular Surgery (ESVS), European Journal of Vascular and Endovascular Surgery, Vol: 29, Pages: 44-45, ISSN: 1078-5884
Hameed M, Onida S, Davies AH, 2016, What is pathological May-Thurner syndrome?, Phlebology, ISSN: 1433-3031
Karia M, Onida S, Davies AH, 2016, A Comparison of Caprini and Department of Health Venous Thromboembolism Risk Scores in Urological Patients, International Surgical Congress of the Association-of-Surgeons-of-Great-Britain-and-Ireland, Publisher: WILEY-BLACKWELL, Pages: 13-13, ISSN: 0007-1323
Maccatrozzo S, Onida S, Davies AH, 2016, Guidelines on venous ulceration: A mess., Phlebology, ISSN: 0268-3555
Zappadu S, Onida S, Davies AH, et al., 2016, The role of quality of life tools in superficial venous disease, Reviews in Vascular Medicine, Vol: 4-5, Pages: 17-22, ISSN: 2212-0211
Superficial venous disease (SVD) is a common condition in the Western world, with recognized, negative effects on mood and quality of life (QoL) in those affected. Numerous tools exist to assess QoL in patients with SVD. The aim of this article is to review the literature on the role of QoL assessment tools in this disease group, describing the most commonly used instruments and their relevance, assessing the relationship between clinical and functional assessment tools, delineating the correlation among physician and patient reports and discussing the importance of translation.
Onida S, Bootun R, Grant Y, et al., 2016, Venous thromboembolism risk assessment prior to superficial venous disease intervention - what's the score?, Annual Meeting of the Society of Academic and Research Surgery (SARS), Publisher: Wiley, Pages: 44-44, ISSN: 1365-2168
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