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Rodway A, Giltinan C, Dehghan-Nayeri A, Santos A, Stafford M, Whyte MB, Allan C, Field B, Clark J, Pazos Casal F, Pankhania A, Loosemore T, Heiss C. Impact of COVID-19 on angioplasty service and outcome of patients treated for critical limb ischaemia. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2030] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Peripheral artery disease (PAD) is a major challenge worldwide and endovascular revascularization is an important component of treatment that is affected by COVID-19 restrictions.
Purpose
Here, we evaluated the impact of COVID-19 restriction on angioplasty service and outcome of patients undergoing lower limb angioplasty.
Methods
Consecutive patients undergoing endovascular revascularisation between August 2018-March 2021 in a UK district general hospital were analysed retrospectively. Indications for angioplasty of all patients were discussed and agreed upon in multi-disciplinary teams. We compared time from referral to angioplasty, patient and procedural characteristics, technical success, peri-procedural complications, and outcome (wound healing, major amputation, target lesion revascularization, death) in patients treated 'before' and after February 2020 (“during COVID-19”).
Results
One hundred nineteen patients were treated 'before' (92% critical limb ischaemia [CLI]; 60% diabetes mellitus) and 72 were treated 'during COVID-19' (96% CLI; 61% diabetes mellitus). While the total monthly number of patients treated did not change, the number of outpatients treated as day cases increased (40% to 72%) and overnight stays for social reasons decreased (16% to 10%). Treatment of hospitalized patients decreased from 44% to 18%. The percentage of outpatients treated at <14 days after referral increased from 39% to 63% and hospitalized patients treated <5 days from 47% to 54%. Neither COVID-19 nor time to procedure affected wound healing (p(log Rank) = 0.451; median time to healing 168±25 days) and amputation free survival (p(log Rank) = 0.924; median survival 368±30 days) in all CLI patients significantly. However, amputation-free survival was significantly worse in hospitalized as compared to outpatients (p(log Rank) <0.001; median survival 155±20 vs 368±30 days) with similar wound healing in those that survived (p(log Rank) = 0.340; median time to wound healing 168±25 days). Of note, the known causes of death were sepsis (32%), pneumonia (18%), COVID pneumonia (18%), cardiac (16%) and stroke (8%).
Conclusions
Adapting to COVID-19 restriction we maintained a safe and effective angioplasty service while shortening waiting times. Very high mortality rates in patients after hospitalization indicated that CLI need to be treated much earlier and more aggressively to avoid disease progression requiring hospitalization.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Rodway
- Surrey and Sussex Healthcare NHS Trust, Vascular Department, Redhill, United Kingdom
| | - C Giltinan
- University of Surrey, Guildford, United Kingdom
| | | | - A Santos
- University of Surrey, Guildford, United Kingdom
| | - M Stafford
- Surrey and Sussex Healthcare NHS Trust, Vascular Department, Redhill, United Kingdom
| | - M B Whyte
- University of Surrey, Guildford, United Kingdom
| | - C Allan
- Surrey and Sussex Healthcare NHS Trust, Vascular Department, Redhill, United Kingdom
| | - B Field
- Surrey and Sussex Healthcare NHS Trust, Vascular Department, Redhill, United Kingdom
| | - J Clark
- Surrey and Sussex Healthcare NHS Trust, Vascular Department, Redhill, United Kingdom
| | - F Pazos Casal
- Surrey and Sussex Healthcare NHS Trust, Vascular Department, Redhill, United Kingdom
| | - A Pankhania
- Surrey and Sussex Healthcare NHS Trust, Vascular Department, Redhill, United Kingdom
| | - T Loosemore
- Surrey and Sussex Healthcare NHS Trust, Vascular Department, Redhill, United Kingdom
| | - C Heiss
- University of Surrey, Guildford, United Kingdom
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Ambler G, Boyle J, Cousins C, Hayes P, Metha T, See T, Varty K, Winterbottom A, Adam D, Bradbury A, Clarke M, Jackson R, Rose J, Sharif A, Wealleans V, Williams R, Wilson L, Wyatt M, Ahmed I, Bell R, Carrell T, Gkoutzios P, Sabharwal T, Salter R, Waltham M, Bicknell C, Bourke P, Cheshire N, Franklin I, James A, Jenkins M, Tyrrell M, Wilkins C, Bown M, Choke E, McCarthy M, Sayers R, Tamberaja A, Farquharson F, Serracino-Inglott F, Davis M, Hamilton G, Brennan J, Canavati R, Fisher R, McWilliams R, Naik J, Vallabhaneni S, Hardman J, Black S, Hinchliffe R, Holt P, Loftus I, Loosemore T, Morgan R, Thompson M, Agu O, Bishop C, Boardley D, Cross J, Hague J, Harris P, Ivancev K, Raja J, Richards T, Simring D, Fisher A, Smith D, Copeland G. Early Results of Fenestrated Endovascular Repair of Juxtarenal Aortic Aneurysms in the United Kingdom. Circulation 2012; 125:2707-15. [PMID: 22665884 DOI: 10.1161/circulationaha.111.070334] [Citation(s) in RCA: 129] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | | | - T. Metha
- Addenbrooke's Hospital, Cambridge
| | - T.C. See
- Addenbrooke's Hospital, Cambridge
| | - K. Varty
- Addenbrooke's Hospital, Cambridge
| | | | - D.J. Adam
- Birmingham Heartlands Hospital, Birmingham
| | | | | | | | - J.D. Rose
- Freeman Hospital, Newcastle upon Tyne
| | - A. Sharif
- Freeman Hospital, Newcastle upon Tyne
| | | | | | - L. Wilson
- Freeman Hospital, Newcastle upon Tyne
| | | | - I. Ahmed
- Guy's & St. Thomas' Hospital, London
| | - R.E. Bell
- Guy's & St. Thomas' Hospital, London
| | | | | | | | - R. Salter
- Guy's & St. Thomas' Hospital, London
| | | | | | | | | | | | - A. James
- Imperial College Hospitals, London
| | | | | | | | - M. Bown
- Leicester Royal Infirmary, Leicester
| | - E. Choke
- Leicester Royal Infirmary, Leicester
| | | | - R. Sayers
- Leicester Royal Infirmary, Leicester
| | | | | | | | | | | | | | - R. Canavati
- Royal Liverpool University Hospital, Liverpool
| | - R.K. Fisher
- Royal Liverpool University Hospital, Liverpool
| | | | - J.B. Naik
- Royal Liverpool University Hospital, Liverpool
| | | | | | | | | | - P. Holt
- St. George's Hospital, London
| | | | | | | | | | - O. Agu
- University College London Hospital, London
| | - C. Bishop
- University College London Hospital, London
| | | | - J. Cross
- University College London Hospital, London
| | - J. Hague
- University College London Hospital, London
| | | | - K. Ivancev
- University College London Hospital, London
| | - J. Raja
- University College London Hospital, London
| | | | - D. Simring
- University College London Hospital, London
| | - A.C. Fisher
- Globalstar on-line database IT support, University of Liverpool, Liverpool
| | - D. Smith
- Globalstar on-line database IT support, University of Liverpool, Liverpool
| | - G.P. Copeland
- POSSUM advice, Warrington General Hospital, Warrington
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Metcalfe M, Brownrigg J, Black S, Loosemore T, Loftus I, Thompson M. Unselected Percutaneous Access with Large Vessel Closure for Endovascular Aortic Surgery: Experience and Predictors of Technical Success. J Vasc Surg 2012. [DOI: 10.1016/j.jvs.2012.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Metcalfe M, Brownrigg J, Black S, Loosemore T, Loftus I, Thompson M. Unselected Percutaneous Access with Large Vessel Closure for Endovascular Aortic Surgery: Experience and Predictors of Technical Success. Eur J Vasc Endovasc Surg 2012; 43:378-81. [DOI: 10.1016/j.ejvs.2011.12.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Accepted: 12/22/2011] [Indexed: 12/17/2022]
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Munneke G, Loosemore T, Smith J, Thompson M, Morgan R, Belli AM. Pseudoaneurysm after aortic coarctation repair presenting with an aortobronchial fistula successfully treated with an aortic stent graft. Clin Radiol 2006; 61:104-8. [PMID: 16356824 DOI: 10.1016/j.crad.2005.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2005] [Revised: 07/04/2005] [Accepted: 07/07/2005] [Indexed: 11/21/2022]
Affiliation(s)
- G Munneke
- Department of Interventional Radiology, St George's Hospital, London, UK.
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Sayed S, Choke E, Helme S, Dawson J, Morgan R, Belli A, Loosemore T, Thompson MM. Endovascular stent graft repair of mycotic aneurysms of the thoracic aorta. J Cardiovasc Surg (Torino) 2005; 46:155-61. [PMID: 15793495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Traditional open surgical repair for mycotic aneurysms of the thoracic aorta is associated with significant morbidity and mortality. Endovascular repair has been reported as an alternative treatment in patients with mycotic thoracic aneurysms. This article reports our experience of endovascular stent graft placement in three patients with mycotic aneurysms of the thoracic aorta and compares the results with similar reports on the literature.
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Affiliation(s)
- S Sayed
- Department of Vascular Surgery, St George's Hospital, London, UK
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Tomlinson MA, Anjum A, Loosemore T. Retroperitoneal haematoma. Eur J Vasc Endovasc Surg 2000; 19:558-9. [PMID: 10896449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Tomlinson MA, Beese R, Banwell M, Loosemore T, Buckenham TM, Dormandy JA. Sequential retroperitoneal venous hemorrhage and embolism of an angio-seal puncture closure device complicating iliac artery angioplasty. J Endovasc Surg 1999; 6:264-9. [PMID: 10495155 DOI: 10.1583/1074-6218(1999)006<0264:srvhae>2.0.co;2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To present a case of iatrogenic puncture closure device embolization complicating surgery for retroperitoneal hemorrhage (RPH) secondary to angioplasty-induced common iliac vein trauma. METHODS AND RESULTS A 78-year-old woman with rest pain underwent successful kissing balloon dilation of her aortoiliac bifurcation for a calcified ostial stenosis of the left common iliac artery. Hemostatic puncture closure devices (Angio-Seal) were used to secure both femoral punctures. A right-sided retroperitoneal hematoma developed, and during surgical exploration of the right groin, the Angio-Seal device was removed. The only bleeding site found was the external iliac artery puncture and it was repaired. She again became hypovolemic 18 hours later and was returned to surgery, where bilateral groin explorations and laparotomy by the vascular surgical team found a tear in the left common iliac vein. After repair, the patient was stable for 48 hours when the left leg became critically ischemic. Angiography detected a new high-grade stenosis in the left profunda femoris artery; embolectomy retrieved a footplate from the left puncture closure device. The patient died 11 days later from multiorgan failure. CONCLUSIONS RPH should be considered early as an occult cause of hypovolemic shock developing soon after even technically straightforward iliac angioplasty. Interventionists should be aware that using the Angio-Seal device risks acute limb ischemia if footplate embolization occurs.
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Affiliation(s)
- M A Tomlinson
- Department of Vascular Surgery, St. George's Hospital, London, United Kingdom
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Kelly M, Potter K, Nassef A, Jacob S, Loosemore T, Dormandy J, Taylor R. Vascular surgical society of great britain and ireland: review of out-of-hours vascular procedures in a tertiary vascular unit. Br J Surg 1999; 86:703. [PMID: 10361337 DOI: 10.1046/j.1365-2168.1999.0703b.x] [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: 11/20/2022]
Abstract
BACKGROUND: The aim of this study was to review out-of-hours vascular procedures in a tertiary vascular unit. METHODS: The vascular emergencies that presented outside normal working hours (17. 00 to 08.00 hours) in a vascular unit between January and June 1998 were reviewed. Only cases considered to be life or limb threatening and requiring urgent surgical or radiological intervention were assessed. RESULTS: The Table shows that a significant number of vascular emergencies was performed out of hours in one unit. This was, in part, due to an increase in the number of tertiary referrals, which represented 57 per cent of all emergency procedures. Reasons for the tertiary referrals were: no consultant vascular surgeon on call (33 per cent), no consultant interventional radiologist on call (26 per cent), lack of intensive care beds (30 per cent) and complex procedure (11 per cent). The overall mortality rate of patients referred in this period was 15 per cent. The unit has three consultant vascular surgeons, two consultant interventional radio- logists and one vascular specialist registrar. CONCLUSION: The significant increase in out-of-hours vascular emergencies, both surgical and radiological, has placed an enormous demand on senior members of the team. In addition, it has had a significant impact on the unit's elective admissions and waiting lists, in particular those for routine general surgery. To support the growth in complex emergency referrals, senior vascular fellows in both vascular surgery and radiology have been appointed and proposals are underway to restructure local vascular services.
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Affiliation(s)
- M Kelly
- St George's Hospital, London, UK
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Crawley F, Clifton A, Buckenham T, Loosemore T, Taylor RS, Brown MM. Comparison of hemodynamic cerebral ischemia and microembolic signals detected during carotid endarterectomy and carotid angioplasty. Stroke 1997; 28:2460-4. [PMID: 9412633 DOI: 10.1161/01.str.28.12.2460] [Citation(s) in RCA: 118] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE There has been concern about carotid percutaneous transluminal angioplasty (PTA) carrying a greater risk of cerebral ischemia than carotid endarterectomy. We set out to compare cerebral hemodynamics and microembolization during carotid PTA and CEA. METHODS We used transcranial Doppler to monitor the middle cerebral artery of 28 patients undergoing carotid PTA (n = 14) or carotid endarterectomy (CEA) with a shunt (n = 14). Each period during which the internal carotid artery was occluded by PTA balloon or by clamp when the shunt was not in place was timed. Individual periods were summated to give a total occlusion time. Ischemic time was defined as the period for which mean middle cerebral artery velocity fell to a third or less of baseline. Microembolic signals were counted during each procedure. RESULTS CEA resulted in significantly longer individual and total occlusion time than PTA (mean individual occlusion time, seconds), CEA, 168 +/- 51; PTA, 20 +/- 7; P < .001; mean total occlusion time; CEA, 337 +/- 70; PTA, 26 +/- 10; P < .001. Ischemic time was also significantly longer during CEA than during PTA (CEA, 165 +/- 40; PTA, 17 +/- 5; P = .001). There were significantly more microembolic signals during PTA than during CEA (mean number of microembolic signals during CEA, 52 +/- 64; during PTA, 202 +/- 119; P = .001). There was no correlation between any of the parameters measured and periprocedural stroke, which occurred in one patient in each group. CONCLUSION PTA results in less hemodynamic ischemia but more cerebral microembolism than CEA. In this small series, however, it is not possible to comment on the relations between ischemic time, microembolism, and stroke.
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Affiliation(s)
- F Crawley
- Division of Clinical Neuroscience, St George's Hospital Medical School, London, UK
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Affiliation(s)
- H Souka
- St. George's Hospital, London, United Kingdom
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12
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Asimakopoulos G, Loosemore T, Bowyer RC, McKee G, Giddings AE. A regional study of thyroidectomy: surgical pathology suggests scope to improve quality and reduce cost. Ann R Coll Surg Engl 1995; 77:425-30. [PMID: 8540661 PMCID: PMC2502468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
This study of thyroid histopathological data from hospitals in the South West Thames region was undertaken to assess current practice and the scope for improvement. Over a 6 month period, 186 thyroid operations were performed on 179 patients at eight hospitals serving almost 1.7 million people. The frequency of thyroidectomy in different hospitals varied from 13 to 35 per 100,000 per year and 6.4% of the operations were second thyroidectomies. Benign multinodular goitre was the most common histological finding (34%). A benign solitary nodule was found in 36% and malignancy in 8.4% of the specimens. Correlation of histological analysis and type of operation suggested that a variety of operations were performed for the same pathological condition and that some operations were diagnostic procedures only. Overall, 63 of the 186 operations (34%) might have been avoided by a firm preoperative diagnosis. Only 67 thyroid fine needle aspiration biopsies (FNAC) were performed at the eight hospitals during the study period. Only 15 (8%) of the patients who underwent thyroid operation had been investigated by FNAC. Reduction in thyroid surgery through more widespread use of FNAC could result in savings of 100,000 pounds per million population per year. Regional activity data show that more than 50 surgeons currently undertake a workload of less than 500 thyroidectomies each year. Increased subspecialisation may be required to reduce costs and raise standards.
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Affiliation(s)
- G Asimakopoulos
- Department of Surgery, Royal Surrey County Hospital, Guildford
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Loh A, Loosemore T, Taylor RS. Technique for laparoscopic appendicectomy. Br J Surg 1992; 79:1386-7. [PMID: 1486452 DOI: 10.1002/bjs.1800791256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Nash G, Loosemore T, Thomas P, Dormandy J. Effects of acute Trental infusion on white blood cell rheology in patients with critical leg ischaemia. Clin Hemorheol Microcirc 1991. [DOI: 10.3233/ch-1991-11508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- G.B. Nash
- Department of Haematology, The Medical School University of Birmingham, Birmingham B15 2TJ, UK
| | - T. Loosemore
- Departments of Haematology and of Surgery, St. George's Hospital, London SW17 ORE, UK
| | - P.R.S. Thomas
- Departments of Haematology and of Surgery, St. George's Hospital, London SW17 ORE, UK
| | - J.A. Dormandy
- Departments of Haematology and of Surgery, St. George's Hospital, London SW17 ORE, UK
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