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Laloo R, Aimar K, Khanom J, Jamjoom A, Bailey M, Scott J. 547 Postoperative Outcomes Are Significantly Worse Among Patients Undergoing Repair of Ruptured Versus Unruptured Iliac Artery Aneurysms – a 10-Year Longitudinal Cohort Study. Br J Surg 2022. [DOI: 10.1093/bjs/znac269.529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Aim
The European Society for Vascular Surgery defines iliac artery aneurysms (IAA) as beyond 1.5 times its normal diameter. Common iliac arteries (CIA) beyond 1.8cm in men and 1.5cm in women are considered aneurysmal. This study aimed to assess outcomes following IAA rupture as their natural history is poorly understood and treatment recommendations based on low-level evidence.
Method
Patients with IAAs at a single vascular centre between 1st January 2010 and 31st August 2021 were identified from a prospectively collected departmental database and Caldicott-approved data collection performed. The primary outcomes included aneurysm rupture, rupture diameter, post-operative complications, 30-day, 1-year and 5-year mortality rates. Statistical analysis with SPSS® was performed using chi-squared tests.
Results
Of 203 patients included, 90.6% were men and median(IQR) age at detection was 77 (71–83). Co-morbidities included hypertension (54.2%), hyperlipidaemia (42.9%) and ischaemic heart disease (35.5%). IAA were in the CIA (85.2%), IIA (21.7%) and EIA (2.0%), mostly asymptomatic (78.8%). Overall IAA rupture rate was 7.9% with CIA (81.2%) and EIA (18.8%). Mean (SD) diameters at rupture were 4.6 (2.4)cm for CIA and 4.6 (3.0)cm for IIA. Post-operative major adverse cardiovascular events (MACE) more frequently occurred following repair of ruptured compared to unruptured IAA (33.3% vs 3.5%, p=.011). Mortality at 30-days, 1-year and 5-years postoperatively were higher following repair of ruptured vs unruptured aneurysms (88.9%, 88.9%, 100% vs 1.2%, 10.6%, 36.1% respectively).
Conclusions
Early detection and elective treatment of IAA aneurysms before they approach 4.6cm may reduce rupture risk, morbidity and mortality associated with emergency repair following rupture.
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Affiliation(s)
- R Laloo
- Leeds Teaching Hospitals Trust , Leeds , United Kingdom
| | - K Aimar
- Leeds Teaching Hospitals Trust , Leeds , United Kingdom
| | - J Khanom
- Leeds Teaching Hospitals Trust , Leeds , United Kingdom
| | - A Jamjoom
- Leeds Teaching Hospitals Trust , Leeds , United Kingdom
| | - M Bailey
- Leeds Teaching Hospitals Trust , Leeds , United Kingdom
| | - J Scott
- Leeds Teaching Hospitals Trust , Leeds , United Kingdom
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Laloo R, Aimar K, Khanom J, Jamjoom A, Bailey M, Scott J. 548 A 10-Year Longitudinal Cohort Study Assessing Growth Rates and Surveillance Intervals for Common Iliac Artery Aneurysms. Br J Surg 2022. [DOI: 10.1093/bjs/znac269.530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Aim
The European Society for Vascular Surgery defines common iliac artery (CIA) aneurysms as greater than 1.8cm in men and 1.5cm in women. Their reported growth rate is 1–4mm/year depending on their diameter. This study aimed to assess the natural history and surveillance intervals for CIA aneurysms as intervention threshold is based on low-quality evidence.
Method
Patients diagnosed with an IAA at a single vascular centre between 1st January 2010 and 31st August 2021 were identified from a prospectively collected departmental database and Caldicott-approved data collection performed. The primary outcomes included diameter-based mean aneurysm growth rates and median surveillance intervals. Statistical analysis with SPSS® was performed using chi-squared tests.
Results
Of the 203 patients included, 90.6% were men and median (IQR) age at detection was 77 (71–83). IAA were located in the CIA (85.2%), IIA (21.7%) and EIA (2.0%) with the majority being asymptomatic (78.8%). CT was most frequently used as the imaging modality for IAA surveillance (66.3%), followed by ultrasound scan (29.8%) and MRA (3.9%). Growth rate for CIA aneurysms measuring 1.0–1.9cm were -2.1mm/year, 2.0–2.9cm were 0.8mm/year, 3.0–3.9cm were 3.5mm/year, 4.0–4.9cm were 9.4mm/year, 5.0–5.9cm were 2.9mm/year and >6.0cm were 13.8mm/year. Median surveillance intervals for CIA aneurysms at 1.0–1.9cm were 12-monthly, 2.0–2.9cm were 11-monthly, 3.0–3.9cm were 5-monthly, 4.0–4.9cm were 5-monthly, 5.0–5.9cm were 5.5-monthly and >6.0cm were 14.5-monthly. Mean(SD) CIA diameter at rupture was 4.6 (2.4)cm.
Conclusions
CIA aneurysms demonstrate faster growth rates as they enlarge and may require more frequent clinical assessments, surveillance, and consideration for repair prior to rupture.
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Affiliation(s)
- R Laloo
- Leeds Teaching Hospitals Trust , Leeds , United Kingdom
| | - K Aimar
- Leeds Teaching Hospitals Trust , Leeds , United Kingdom
| | - J Khanom
- Leeds Teaching Hospitals Trust , Leeds , United Kingdom
| | - A Jamjoom
- Leeds Teaching Hospitals Trust , Leeds , United Kingdom
| | - M Bailey
- Leeds Teaching Hospitals Trust , Leeds , United Kingdom
| | - J Scott
- Leeds Teaching Hospitals Trust , Leeds , United Kingdom
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Laloo R, Gadsby G, Jauniaux B, Bailey M, Scott J. O069 Infra-inguinal bypass graft surveillance is an opportunity to optimise statin and antiplatelet therapy to reduce 12-month major amputation and mortality rates. Br J Surg 2022. [DOI: 10.1093/bjs/znac242.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Introduction
Infra-inguinal bypass graft failure within the first two postoperative years can result from stenotic lesions within the conduit and near anastomosis. This study assesses graft surveillance uptake, patency, amputation and death rates among infra-inguinal bypass surgery patients at 1, 6 and 12-months postoperatively.
Methods
Patients undergoing infra-inguinal bypass at a single vascular centre between 1st January 2018 and 31st December 2019 were identified from the prospectively collected database. Primary outcomes at 1, 6 and 12-months postoperatively included: duplex-ultrasound (DUS) surveillance uptake, patency, major amputations and death rates. Statistical analysis with SPSS® was performed using chi-squared tests and paired sample t-tests.
Results
Of the 91 patients included, 79.1% were men and median (IQR) age was 71(62–76). At 1, 6 and 12 months, DUS uptake was 74.2%, 77.5% and 73.3% respectively, primary-assisted patency rates were 88.2%, 78.8% and 65.3% respectively and secondary patency rates were 97.6%, 96.3% and 96.3% respectively. Major amputation rates at 1, 6 and 12 months were 5.4%, 8.6%, 8.6% respectively. Death rates at 1, 6 and 12 months were 3.2%, 5.4% and 10.8% respectively. Patients on statin therapy post-operatively had lower 12-month mortality than those not on statin therapy (7.7% vs 30.0%, p=.028). Major amputation rate at 12 months was lower among patients prescribed antiplatelet therapy (6.3% vs 40%, p=.008).
Conclusion
DUS graft surveillance is a vital opportunity to adequately optimise statin and antiplatelet therapy post-revascularisation to reduce 12-month major amputation and mortality rates.
Take-home message
Infra-inguinal bypass graft surveillance is an opportunity to optimise statin and antiplatelet therapy to reduce 12-month major amputation and mortality rates.
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Affiliation(s)
- R Laloo
- Leeds Teaching Hospitals Trust , Leeds. UK
| | - G Gadsby
- Leeds Teaching Hospitals Trust , Leeds. UK
| | - B Jauniaux
- Leeds Teaching Hospitals Trust , Leeds. UK
| | - M Bailey
- Leeds Teaching Hospitals Trust , Leeds. UK
| | - J Scott
- Leeds Teaching Hospitals Trust , Leeds. UK
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Davies H, Waduud M, Laloo R, Bennett M, Scott J. 456 Palliative Care Interventions for Peripheral Vascular Disease: A Systematic Review. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.1117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Objective
Identify and evaluate palliative care interventions used in peripheral vascular disease (PVD).
Background
PVD encompasses conditions with poor outcome and severe suffering, both mentally and physically, yet utilisation and research into palliative care interventions remain sparse.
Method
A systematic review of all study designs published between January 1991 and January 2020 in which people with PVD received palliative care interventions and at least one patient reported outcome was recorded.
Results
A total of eight studies involving 87037 unique patients met inclusion criteria (four cohort studies and four cross sectional studies). There were no randomised controlled studies; The small number of studies and study heterogeneity precluded meta-analysis. Only two papers recorded patient reported outcomes. Five papers found an association between palliative care and reduction in health care utilisation. Most of the studies reported that palliative care was likely underused. Only two of the studies included non-hospital patients. The methodological quality of the papers ranged from low to moderate.
Conclusions
Despite high mortality and morbidity associated with PVD, evidence of the effectiveness of palliative care in this group of patients is lacking. There are only a handful of papers on palliative care in vascular surgery and the majority are small, methodologically flawed and lack patient reported outcomes. Randomised controlled trials of palliative care interventions in patients with PVD are needed to determine optimal treatment outcomes.
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Affiliation(s)
- H Davies
- Leeds Vascular Institute, Leeds, United Kingdom
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
- University of Leeds, Leeds, United Kingdom
| | - M Waduud
- Leeds Vascular Institute, Leeds, United Kingdom
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
- University of Leeds, Leeds, United Kingdom
| | - R Laloo
- Leeds Vascular Institute, Leeds, United Kingdom
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
- University of Leeds, Leeds, United Kingdom
| | - M Bennett
- Leeds Institute of Health Science, Leeds, United Kingdom
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
- University of Leeds, Leeds, United Kingdom
| | - J Scott
- Leeds Vascular Institute, Leeds, United Kingdom
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
- University of Leeds, Leeds, United Kingdom
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Dawo S, Laloo R, Haughton S, Rangaraju M. 1183 Why Are Surgical Trainee Recruitment Rates Declining? A Cross-Sectional Study of Medical Students from Two English Medical Schools. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aim
To identify medical students’ career aspirations and describe their perceptions of pursing a surgical career at two English medical schools, in order to better understand declining surgical recruitment rates.
Method
Seventy-seven medical students consented to complete anonymous pre- and post-course questionnaires on career aspirations and promoting and deterring factors for a surgical career. Surveys were completed by medical students attending three one-day surgical revision courses organised and led by junior doctors.
Results
Seventy-seven medical students completed pre- and post-course questionnaires with a median age of 25 years (IQR 24-27). Respondents were 58.4% female and 58.7% were final year medical students. Their specialty career aspirations included medicine (27%), general practice (19.5%) and surgery (19.5%). Most students (68%) felt that time spent in the operating theatre was their most memorable surgical experience while 41.3% of students reported observing and assisting in theatres enhanced their interest in surgery. Only 20.5% of students spent extra time outside of their placements in surgery. The most common deterring factors for a surgical career included poor work-life balance (37.3%), high competition rates (28%) and a personality mismatch (12.9%) among students and surgeons.
Conclusions
One in 5 students was interested in pursuing a surgical career. Facilitating early hands-on operating theatre exposure for medical students and addressing the perceived issues with poor work-life balance may promote a career in surgery. This could help to tackle declining recruitment rates in surgical specialty training. Further research is required to determine how specific experiences at medical school, such as shadowing and mentorship, influence career choice.
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Affiliation(s)
- S Dawo
- Warwick Medical School, Coventry, United Kingdom
| | - R Laloo
- Leeds Teaching Hospital Trust, West Yorkshire, United Kingdom
| | - S Haughton
- University of Birmingham Medical School, Birmingham, United Kingdom
| | - M Rangaraju
- Warwick Medical School, Coventry, United Kingdom
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Fowler AJ, Dobbs TD, Wan YI, Laloo R, Hui S, Nepogodiev D, Bhangu A, Whitaker IS, Pearse RM, Abbott TEF. Resource requirements for reintroducing elective surgery during the COVID-19 pandemic: modelling study. Br J Surg 2021; 108:97-103. [PMID: 33640927 PMCID: PMC7799203 DOI: 10.1093/bjs/znaa012] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 07/18/2020] [Accepted: 08/31/2020] [Indexed: 12/22/2022]
Abstract
Background The COVID-19 response required the cancellation of all but the most urgent surgical procedures. The number of cancelled surgical procedures owing to Covid-19, and the reintroduction of surgical acivirt, was modelled. Methods This was a modelling study using Hospital Episode Statistics data (2014–2019). Surgical procedures were grouped into four urgency classes. Expected numbers of surgical procedures performed between 1 March 2020 and 28 February 2021 were modelled. Procedure deficit was estimated using conservative assumptions and the gradual reintroduction of elective surgery from the 1 June 2020. Costs were calculated using NHS reference costs and are reported as millions or billions of euros. Estimates are reported with 95 per cent confidence intervals. Results A total of 547 534 (95 per cent c.i. 3 318 195 to 6 250 771) patients with a pooled mean age of 53.5 years were expected to undergo surgery between 1 March 2020 and 28 February 2021. By 31 May 2020, 749 247 (513 564 to 1 077 448) surgical procedures had been cancelled. Assuming that elective surgery is reintroduced gradually, 2 328 193 (1 483 834 – 3 450 043) patients will be awaiting surgery by 28 February 2021. The cost of delayed procedures is €5.3 (3.1 to 8.0) billion. Safe delivery of surgery during the pandemic will require substantial extra resources costing €526.8 (449.3 to 633.9) million. Conclusion As a consequence of the Covid-19 pandemic, provision of elective surgery will be delayed and associated with increased healthcare costs.
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Affiliation(s)
- A J Fowler
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - T D Dobbs
- Reconstructive Surgery and Regenerative Medicine Research Group, Institute of Life Sciences, Swansea University Medical School, Swansea, UK.,Welsh Centre for Burns and Plastics, Morriston Hospital, Swansea, UK
| | - Y I Wan
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - R Laloo
- Leeds Vascular Institute, Leeds General Infirmary, Leeds, UK
| | - S Hui
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - D Nepogodiev
- NIHR Global Health Research Unit on Global Surgery, University of Birmingham, UK
| | - A Bhangu
- NIHR Global Health Research Unit on Global Surgery, University of Birmingham, UK
| | - I S Whitaker
- Reconstructive Surgery and Regenerative Medicine Research Group, Institute of Life Sciences, Swansea University Medical School, Swansea, UK.,Welsh Centre for Burns and Plastics, Morriston Hospital, Swansea, UK
| | - R M Pearse
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - T E F Abbott
- William Harvey Research Institute, Queen Mary University of London, London, UK
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Hillairet J, Chen Z, Lombard G, Delaplanche J, Vulliez K, Yang Q, Beaumont B, Calarco F, Charabot N, Kazarian F, Lamalle P, Bernard J, Bruno V, Hatchressian J, Laloo R, Mollard P, Song Y, Turq V, Volpe R. Radiofrequency and mechanical tests of silver coated CuCrZr contacts for the ITER ion cyclotron antenna. Fusion Engineering and Design 2018. [DOI: 10.1016/j.fusengdes.2018.02.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Huang P, Lethien C, Pinaud S, Brousse K, Laloo R, Turq V, Respaud M, Demortiere A, Daffos B, Taberna PL, Chaudret B, Gogotsi Y, Simon P. On-chip and freestanding elastic carbon films for micro-supercapacitors. Science 2016; 351:691-5. [DOI: 10.1126/science.aad3345] [Citation(s) in RCA: 540] [Impact Index Per Article: 67.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Bodin A, Laloo R, Abeilhou P, Guiraud L, Gauthier S, Martrou D. An energy-filtering device coupled to a quadrupole mass spectrometer for soft-landing molecular ions on surfaces with controlled energy. Rev Sci Instrum 2013; 84:095104. [PMID: 24089863 DOI: 10.1063/1.4818961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
We have developed an energy-filtering device coupled to a quadrupole mass spectrometer to deposit ionized molecules on surfaces with controlled energy in ultra high vacuum environment. Extensive numerical simulations as well as direct measurements show that the ion beam flying out of a quadrupole exhibits a high-energy tail decreasing slowly up to several hundred eV. This energy distribution renders impossible any direct soft-landing deposition of molecular ions. To remove this high-energy tail by energy filtering, a 127° electrostatic sector and a specific triplet lenses were designed and added after the last quadrupole of a triple quadrupole mass spectrometer. The results obtained with this energy-filtering device show clearly the elimination of the high-energy tail. The ion beam that impinges on the sample surface satisfies now the soft-landing criterion for molecular ions, opening new research opportunities in the numerous scientific domains involving charges adsorbed on insulating surfaces.
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Affiliation(s)
- A Bodin
- Nanosciences Group, CEMES, CNRS UPR 8011 and University Toulouse III - Paul Sabatier, 29 rue Jeanne Marvig, BP94347, F-31055 Toulouse Cedex 4, France
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