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  1. Article ; Online: An audit of secondary prevention for peripheral arterial disease in primary care - scope for improved collaboration between vascular surgery and general practitioners.

    Foley, Megan Power / Tubassam, Muhammad / Walsh, Stewart R

    Irish journal of medical science

    2023  Volume 192, Issue 6, Page(s) 3007–3010

    Abstract: Background: Symptomatic peripheral arterial disease (PAD) is a common cause for referral from primary care to vascular surgery. Best medical therapy (BMT), encompassing anti-platelets, statins, smoking cessation, blood pressure and glycaemic control, is ...

    Abstract Background: Symptomatic peripheral arterial disease (PAD) is a common cause for referral from primary care to vascular surgery. Best medical therapy (BMT), encompassing anti-platelets, statins, smoking cessation, blood pressure and glycaemic control, is a cornerstone of PAD management. However, these easily modifiable risk factors are often left unaddressed between referral and clinic review.
    Methods: A prospective audit of electronic 'Healthlink' referrals by GPs to the vascular department for symptomatic PAD between July 2021 and June 2022 was performed. Referrals were individually reviewed for demographics, symptoms, medical history, smoking status and medications. An information leaflet on BMT was posted to all GP practices in the Soalta region as part of an educational intervention, with plans to re-audit after 6 months.
    Results: One-hundred-and-seventy referrals were analysed. The median age was 68.5 years (range 33-94) and 69% (n = 117) were male. The typical vasculopath comorbidity profile was noted. Fifty-two percent (n = 88) were referred with claudication-type pain and 25% (n = 43) with critical limb ischaemia (CLI). Twenty-eight percent (n = 33) were active smokers and 31% (n = 36) had no smoking status documented. Regarding BMT, only 34.5% (n = 40) and 52% (n = 60) were on anti-platelets and statins, respectively. Suspected CLI was not significantly associated with BMT prescription at referral (p = 0.664). Only eleven referral letters mentioned risk factor optimisation.
    Conclusions: Our first-cycle results identified significant scope for improvement in community-based risk factor modification for PAD referrals. We aim to continue supporting and educating our colleagues that effective medical management can start safely in primary care and further explore the barriers preventing this.
    MeSH term(s) Male ; Humans ; Adult ; Middle Aged ; Aged ; Aged, 80 and over ; Female ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use ; General Practitioners ; Secondary Prevention ; Peripheral Arterial Disease/prevention & control ; Peripheral Arterial Disease/surgery ; Risk Factors ; Vascular Surgical Procedures ; Primary Health Care
    Chemical Substances Hydroxymethylglutaryl-CoA Reductase Inhibitors
    Language English
    Publishing date 2023-04-26
    Publishing country Ireland
    Document type Journal Article
    ZDB-ID 390895-1
    ISSN 1863-4362 ; 0021-1265
    ISSN (online) 1863-4362
    ISSN 0021-1265
    DOI 10.1007/s11845-023-03362-1
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: A Report of Penile Mondor's Disease After Mechanochemical Ablation and Adjunct Foam Sclerotherapy of Bilateral Lower Extremity Truncal Incompetence.

    Foley, Megan Power / Westby, Daniel / Walsh, Stewart R

    Vascular and endovascular surgery

    2023  Volume 57, Issue 5, Page(s) 494–496

    Abstract: Introduction: Mondor's disease of the penis, or superficial thrombophlebitis affecting penile veins, is a rare condition. Common causes include prothombotic states, venous stasis or excessive manipulation. The literature includes one case report of ... ...

    Abstract Introduction: Mondor's disease of the penis, or superficial thrombophlebitis affecting penile veins, is a rare condition. Common causes include prothombotic states, venous stasis or excessive manipulation. The literature includes one case report of Mondor's Disease after endovenous laser ablation and foam sclerotherapy and a case series after open saphenofemoral junction ligation. However, there have been no noted cases of this rare complication after mechanochemical ablation of the GSV.
    Case details: A 50-year-old man with bilateral great saphenous venous incompetence had truncal mechanochemical ablation of both above-knee GSV segments with the Clarivein
    Conclusions: Vascular surgeons should be aware that this rare albeit self-limiting thrombotic complication can occur after endovenous mechanochemical ablation of the great saphenous vein with adjunct foam sclerotherapy, particularly as this procedure is performed very frequently. Interestingly, the majority of reported cases have occurred after bilateral interventions. The patients can be reassured that their symptoms will likely settle and the use of anti-thrombotic therapy is largely at the surgeon's discretion.
    MeSH term(s) Male ; Humans ; Middle Aged ; Sclerotherapy/adverse effects ; Sclerotherapy/methods ; Varicose Veins/diagnostic imaging ; Varicose Veins/surgery ; Treatment Outcome ; Thrombophlebitis/complications ; Laser Therapy ; Lower Extremity ; Saphenous Vein/diagnostic imaging ; Saphenous Vein/surgery ; Venous Insufficiency/diagnostic imaging ; Venous Insufficiency/surgery
    Language English
    Publishing date 2023-01-22
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 2076272-0
    ISSN 1938-9116 ; 1538-5744
    ISSN (online) 1938-9116
    ISSN 1538-5744
    DOI 10.1177/15385744231154329
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Pharmacological Thromboprophylaxis for VTE Post-Endovenous Ablation of Varicose Veins: Network Meta-Analysis.

    Westby, Daniel / Gasior, Sara / Twyford, Mark / Power Foley, Megan / Lowery, Aoife / Walsh, Stewart R

    Vascular and endovascular surgery

    2024  , Page(s) 15385744241245079

    Abstract: Objective: Endovenous ablation has revolutionized treatment of varicose vein surgery but is associated with a risk of venous thromboembolism. There is no consensus regarding anticoagulation protocols for these patients. This network meta-analysis (NMA) ... ...

    Abstract Objective: Endovenous ablation has revolutionized treatment of varicose vein surgery but is associated with a risk of venous thromboembolism. There is no consensus regarding anticoagulation protocols for these patients. This network meta-analysis (NMA) aims to identify which anticoagulant is optimal in this cohort for clot prevention with minimal risk of adverse bleeding events.
    Methods: Library databases were searched for studies where patients were treated with one or more anticoagulants following endovenous ablation for varicose veins. The methodological quality of included studies was quantified using the Risk of Bias (ROB) assessment tools. Findings were reported using the meta-analysis of observational studies in epidemiology (MOOSE) checklist. Statistical analysis was carried out using metainsight (rpackage).
    Results: Observational data on just under 1500 patients prescribed post ablation anticoagulation (Rivaroxaban, Enoxaparin, Fondaparinux) were analyzed. Patient characteristics were comparable across the cohorts. 81 thrombotic and 40 minor bleeding events occurred in total. Overall rivaroxaban is found to be superior to the other agents.
    Conclusions: This NMA indicates that prophylactic rivaroxaban is the highest ranked anticoagulant for thromboprophylaxis in patients post endovenous ablation for varicose veins, with a low risk of adverse bleeding. The choice whether to anticoagulate these patients is likely to remain at the discretion of the treating clinician.
    Language English
    Publishing date 2024-04-12
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2076272-0
    ISSN 1938-9116 ; 1538-5744
    ISSN (online) 1938-9116
    ISSN 1538-5744
    DOI 10.1177/15385744241245079
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article: Pressures, indexes and peripheral arterial disease: Time to rethink our approach?

    Westby, Daniel / Doolan, Nathalie N / Walsh, Stewart R

    Annals of the Academy of Medicine, Singapore

    2022  Volume 51, Issue 3, Page(s) 134–135

    MeSH term(s) Humans ; Peripheral Arterial Disease/epidemiology
    Language English
    Publishing date 2022-03-31
    Publishing country Singapore
    Document type Editorial ; Comment
    ZDB-ID 604527-3
    ISSN 0304-4602
    ISSN 0304-4602
    DOI 10.47102/annals-acadmedsg.202263
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Letter to the Editor Regarding "Use of Embolectomy With Local Anesthesia for Anticoagulation Failure in Radial Artery Thrombosis" by Yilmaz et al.

    Keohane, Colum R / Walsh, Stewart R

    Journal of cardiovascular pharmacology and therapeutics

    2020  Volume 26, Issue 1, Page(s) 100

    MeSH term(s) Anesthesia, Local ; Anticoagulants ; Embolectomy ; Humans ; Radial Artery ; Thrombosis
    Chemical Substances Anticoagulants
    Language English
    Publishing date 2020-08-19
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 1329372-2
    ISSN 1940-4034 ; 1074-2484
    ISSN (online) 1940-4034
    ISSN 1074-2484
    DOI 10.1177/1074248420951142
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Outcomes of a 2-Portal Endoscopic Technique for Osseous Lesions Resulting in Posterior Ankle Impingement Syndrome.

    Ling, Christopher T / Walsh, Stewart J

    The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons

    2020  Volume 59, Issue 5, Page(s) 938–941

    Abstract: Posterior ankle impingement syndrome is common in sporting populations and encompasses a range of disorders that cause posterior ankle pain during maximal forced plantarflexion. The aim of this study was to evaluate the short- and medium- to long-term ... ...

    Abstract Posterior ankle impingement syndrome is common in sporting populations and encompasses a range of disorders that cause posterior ankle pain during maximal forced plantarflexion. The aim of this study was to evaluate the short- and medium- to long-term outcomes of 2-portal endoscopic surgery for osseous lesions causing posterior ankle impingement syndrome. This was a retrospective case series analysis of all patients who underwent 2-portal endoscopic surgery at a single institution between 2005 and 2016. Visual analogue scales and selected components of the Short Form of the Revised Foot Function Index were used to assess ankle function, with the median follow-up time being 4.8 years. Of the 52 patients, 49 (94%) were able to return to their previous sport/physical activity, with the mean time taken being 5.8 months. At the completion of follow-up, the mean pain score during exercise had improved from 7.5 to 0.9 points. The mean work and sporting function scores also improved, from 5.9 to 9.6 points and 2.9 to 8.8 points, respectively. The mean score of the Short Form of the Revised Foot Function Index also improved by 77.7 points, from 84.4 to 6.7 at the completion of follow-up. There were no postoperative infections or any other major complications. This study provides strong supporting evidence for the use of hindfoot endoscopy in the treatment of posterior ankle impingement syndrome in athletes.
    MeSH term(s) Ankle ; Ankle Joint/diagnostic imaging ; Ankle Joint/surgery ; Arthroscopy ; Endoscopy ; Follow-Up Studies ; Humans ; Retrospective Studies ; Treatment Outcome
    Language English
    Publishing date 2020-05-04
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1146972-9
    ISSN 1542-2224 ; 1067-2516
    ISSN (online) 1542-2224
    ISSN 1067-2516
    DOI 10.1053/j.jfas.2020.03.013
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Case report-Vascular injury in association with posteriorly displaced medial clavicle fracture.

    Khalil, Husam / Bourchier, Russell / Walsh, Stewart

    Trauma case reports

    2021  Volume 33, Page(s) 100483

    Abstract: The primary stabiliser of the diarthrodial sterno-clavicular (SC) joint is the costo-clavicular ligament, this holds the clavicle to the first costal cartilage and the end of the first rib. The costo-clavicular and surrounding ligaments help maintain the ...

    Abstract The primary stabiliser of the diarthrodial sterno-clavicular (SC) joint is the costo-clavicular ligament, this holds the clavicle to the first costal cartilage and the end of the first rib. The costo-clavicular and surrounding ligaments help maintain the stability and strength of the SC joint. As a result, SC joint dislocations are far less common than fractures to the clavicle due to the relatively larger forces required to disrupt these ligaments. Medial physeal injuries occur when there is a fracture through the physis of a clavicle which is yet to complete the ossification process, this can often be mistaken for sterno-clavicular joint dislocation. This report looks at a case of a posteriorly displaced medial physeal fracture in an adolescent male sustained while playing rugby. We hope this case provides the reader an insight into the potentially life threatening consequences that should be considered in such presentations and highlight the importance of prompt and appropriate imaging and specialist intervention.
    Language English
    Publishing date 2021-04-21
    Publishing country Netherlands
    Document type Case Reports
    ZDB-ID 2835433-3
    ISSN 2352-6440 ; 2352-6440
    ISSN (online) 2352-6440
    ISSN 2352-6440
    DOI 10.1016/j.tcr.2021.100483
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Pulmonary Function Testing for Patients with Abdominal Aortic Aneurysm: A Combined Decision.

    Elsharkawi, Mohamed / Tawfick, Wael / Tubassam, Muhammad / Walsh, Stewart

    European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery

    2021  Volume 62, Issue 6, Page(s) 1006

    MeSH term(s) Aortic Aneurysm, Abdominal/complications ; Aortic Aneurysm, Abdominal/diagnostic imaging ; Aortic Aneurysm, Abdominal/surgery ; Elective Surgical Procedures ; Humans ; Postoperative Complications
    Language English
    Publishing date 2021-10-20
    Publishing country England
    Document type Letter ; Comment
    ZDB-ID 1225869-6
    ISSN 1532-2165 ; 1078-5884
    ISSN (online) 1532-2165
    ISSN 1078-5884
    DOI 10.1016/j.ejvs.2021.09.013
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Single-session mechanical thrombectomy for iliofemoral deep vein thrombosis using a dual mechanism of action device combining basket and rotational thrombectomy.

    Black, Stephen A / Thulasidasan, Narayanan / Benton, Lily / O'Sullivan, Gerard J / Konteva, Mariana / Petrov, Ivo S / Walsh, Stewart R / Lichtenberg, Michael

    Journal of vascular surgery. Venous and lymphatic disorders

    2024  , Page(s) 101866

    Abstract: Objective: Interventional treatments for acute iliofemoral deep vein thrombosis (DVT) remain controversial after publication of the Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis (ATTRACT) study. Interventions ... ...

    Abstract Objective: Interventional treatments for acute iliofemoral deep vein thrombosis (DVT) remain controversial after publication of the Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis (ATTRACT) study. Interventions have been shown to reduce post-thrombotic syndrome severity and improve quality of life in DVT patients, but have been accompanied by risk of major bleeding from thrombolytics. We describe thrombus removal using a novel combined basket-rotational thrombectomy device that minimizes the need for thrombolytics or repeat procedures.
    Methods: The aim of this prospective, nonrandomized, multicenter, first-in-human study of 19 patients with acute iliofemoral DVT was to evaluate the safety and performance of the Pounce venous thrombectomy system ≤12 months after treatment. The primary performance end point was defined as procedural success through achievement of Society of Interventional Radiology (SIR) grade II lysis in treated vessels with freedom from procedural adverse events. Secondary end points included venous disease severity assessments using the Villalta scale and the Venous Clinical Severity Score, patient quality-of-life measurement using the Venous Insufficiency Epidemiological and Economic Study-Quality of Life questionnaire, and calf circumference measurements taken at baseline, 24 hours, and 1 month.
    Results: The primary end point of complete or near-complete thrombus removal (Society of Interventional Radiology grade II or III) was achieved in all patients. All study device-related safety end points were met, with no major bleeding or device-related adverse events. Of the 19 patients treated, 16 (84.2%) did not receive thrombolytics during the procedure. Post-thrombotic syndrome (Villalta scale >4) was identified in 17 of 19 patients (89.5%) at baseline, 4 of 13 patients (30.8%) available for follow-up at 6 months, and 2 of 11 patients (18.2%) at 12 months. The median Venous Clinical Severity Score decreased (P < .001) from 8.5 (interquartile range [IQR], 7-10) at baseline to 4 (IQR, 2-4) at 1 month after the procedure and was similar at 6 months (2; IQR, 2-5) and 12 months (2; IQR, 1.5-3) after the procedure. The median Venous Insufficiency Epidemiological and Economic Study-Quality of Life questionnaire score improved (P < .001) by 39 from baseline (57; IQR, 53.5-74) to 1 month (96; IQR, 86-101) after the procedure, and remained high at 6 months (99; IQR, 75-103) and 12 months (98; IQR, 94.5-100). The median calf circumference decreased (P = .089) from 39 cm (IQR, 35-47.8 cm) at baseline to 36 cm (IQR, 32.5-40.5 cm) at 24 hours after the procedure and was 34.5 cm (IQR, 33.2-38.5 cm) at 1 month.
    Conclusions: The Pounce device is safe and effective for removal the of thrombus in patients with acute iliofemoral DVT. Initial results demonstrate improvements in venous disease severity and patient quality of life.
    Language English
    Publishing date 2024-03-04
    Publishing country United States
    Document type Journal Article
    ISSN 2213-3348
    ISSN (online) 2213-3348
    DOI 10.1016/j.jvsv.2024.101866
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Systematic Review and Meta-Analysis of Nonoperative Management for SVS Grade II Blunt Traumatic Aortic Injury.

    De Freitas, Simon / Joyce, Doireann / Yang, Yang / Dunphy, Kaitlyn / Walsh, Stewart / Fatima, Javairiah

    Annals of vascular surgery

    2023  Volume 98, Page(s) 220–227

    Abstract: Background: Society for Vascular Surgery (SVS) grade II blunt traumatic aortic injury is defined as intramural hematoma with or without external contour abnormality. It is uncertain whether this aortic injury pattern should be treated with endovascular ... ...

    Abstract Background: Society for Vascular Surgery (SVS) grade II blunt traumatic aortic injury is defined as intramural hematoma with or without external contour abnormality. It is uncertain whether this aortic injury pattern should be treated with endovascular stent-grafting or nonoperative measures. Since the adoption of the SVS Guidelines on endovascular repair of blunt traumatic aortic injury, the practice pattern for management of grade II injuries has been heterogenous. The objective of the study was to report natural history outcomes of grade II blunt traumatic aortic injury.
    Methods: A systematic review of published traumatic aortic injury studies was performed. Online database searches were current to November 2022. Eligible studies included data on aortic injuries that were both managed nonoperatively and classified according to the SVS 2011 Guidelines. Data points on all-cause mortality, aorta-related mortality and early aortic intervention were extracted and underwent meta-analysis. The methodology was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance.
    Results: Thirteen studies were included in the final analysis with a total of 204 cases of SVS grade II blunt traumatic aortic injury treated nonoperatively. The outcomes rates were estimated at 10.4% (95% confidence interval [CI] 6.7%-14.9%) for all-cause mortality, 2.9% (95% CI 1.1%-5.7%) for aorta-related mortality, and 3.3% (95% CI 1.4%-6.2%) for early aortic intervention. The studies included in the analysis were of fair quality with a mean Downs and Black score 15 (±1.8).
    Conclusions: Grade II blunt traumatic aortic injury follows a relatively benign course with few instances of aortic-related mortality. Death in the setting of this injury pattern is more often attributable to sequelae of multisystem trauma and not directly related to aortic injury. The current data support nonoperative management and imaging surveillance for grade II blunt traumatic aortic injury instead of endovascular repair. Longer-term effects on the aorta at the site of injury are unknown.
    MeSH term(s) Humans ; Aorta, Thoracic/surgery ; Risk Factors ; Endovascular Procedures/adverse effects ; Treatment Outcome ; Aorta/diagnostic imaging ; Aorta/injuries ; Wounds, Nonpenetrating/diagnostic imaging ; Wounds, Nonpenetrating/therapy ; Vascular System Injuries/diagnostic imaging ; Vascular System Injuries/therapy ; Retrospective Studies ; Thoracic Injuries
    Language English
    Publishing date 2023-10-06
    Publishing country Netherlands
    Document type Meta-Analysis ; Systematic Review ; Journal Article
    ZDB-ID 1027366-9
    ISSN 1615-5947 ; 0890-5096
    ISSN (online) 1615-5947
    ISSN 0890-5096
    DOI 10.1016/j.avsg.2023.07.106
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