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Deprivation and supervised exercise for intermittent claudication
Introduction Intermittent claudication is ischaemic muscle pain resulting from impeded arterial blood flow that is precipitated by exercise and relieved by rest. It is thought to have a prevalence of up to 10%.1 National and international guidelines recommend supervised exercise, in conjunction with risk modification through lifestyle changes and best medical therapy, as first-line management…
How do you solve the problem of aortic dissection?
“The tragedies of life are largely arterial” – Sir William Osler1 Every vascular surgeon can remember stories of patients with aortic dissection having thrombolysis for a presumed myocardial infarction, or a V/Q scan and full anticoagulation for a likely pulmonary embolus. My most memorable story is of an international sports coach who developed tearing intrascapular…
Research priorities in diabetic foot disease
Introduction Diabetic foot disease is among a number of serious complications of diabetes mellitus.1 In the UK there are over 7,000 diabetes-related lower limb amputations each year.2 Diabetic foot ulceration (DFU) precedes diabetes-related lower limb amputations in 80% of cases, with studies reporting a prevalence of DFUs as between 1%3 and 2%4 in people living…
A survey of surgical site infection prevention practice in UK vascular surgery
Introduction Surgical site infections (SSI) are a common complication following vascular surgery, with significant detrimental effects for patients and healthcare providers.1 Reported SSI rates vary, but may be as high as 40%.2 This high rate is due to vascular surgical patients often being elderly, smokers and diabetics, frequently having multiple long-term conditions. Undesirable physical sequelae…
The future of exercise therapy for people with intermittent claudication?
National Institute for Health and Care Excellence (NICE) guideline 147 recommends supervised exercise therapy (SET) for all patients with intermittent claudication, consisting of 2 hours of SET per week for a 3-month period.1 This is supported by good evidence from Cochrane reviews2,3 that SET shows improvement in mean walking performance compared with home-based exercise and…
Ilio-mesenteric bypass for chronic mesenteric ischaemia where prior endovascular treatment has failed: a case series
Abstract Background: Symptomatic chronic mesenteric ischaemia is a rare but debilitating disease, and its diagnosis is often delayed by the time taken to rule out underlying malignancy or other abdominal pathology. Once diagnosed, definitive revascularisation should not be delayed to avoid future bowel infarction. There is no consensus on the best treatment option, but most…
Research priorities for vascular wounds: results of the Vascular Society GBI/James Lind Alliance Priority Setting Process
Background In the UK, approximately 3.8 million people live with a wound at an estimated cost of £8.3 billion per year to the NHS, with this figure expected to rise in the future.1,2 Additionally, complications like delayed healing, infection and deterioration of other comorbidities are known to have a detrimental impact on patients’ quality of…
Does the level of encouragement affect 6-minute walk test performance in patients with intermittent claudication? A protocol for a randomised multicentre controlled trial
Introduction Peripheral artery disease (PAD) is characterised by atherosclerotic lesions of the arteries in the lower limbs, resulting in a reduction of blood flow.1 Globally, it is estimated that 236 million people are living with PAD, with the number of cases increasing by 24% from 2000 to 2010.2,3 A classic symptom of PAD is intermittent…
