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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: 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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  7. Article: Vascular access device type for systemic anti-cancer therapies: a scoping review protocol.

    Duggan, Caitriona / Hernon, Orlaith / Dunne, Rosie / McInerney, Veronica / Walsh, Stewart R / Carr, Peter J

    British journal of nursing (Mark Allen Publishing)

    2023  Volume 32, Issue 7, Page(s) S18–S22

    Abstract: Introduction: Vascular access devices (VADs) are the most common invasive procedure performed in acute medicine and cancer patients undergo multiple invasive vascular access procedures. Our aim is to identify the type of evidence available regarding the ...

    Abstract Introduction: Vascular access devices (VADs) are the most common invasive procedure performed in acute medicine and cancer patients undergo multiple invasive vascular access procedures. Our aim is to identify the type of evidence available regarding the best choice of VAD for cancer patients undergoing systemic anti-cancer therapy (SACT). In this article, the authors frame the scoping review protocol used, which will systematically report all published and unpublished literature around the use of VADs for the infusion of SACT in oncology.
    Inclusion criteria: For studies to be included, they must focus on people or populations aged 18 years or older and report on vascular access in cancer patients. The concept is the variety of VAD use in cancer and reported insertion and post-insertion complications. The context surrounds the intravenous treatment of SACT whether in a cancer centre or non-cancer setting.
    Methods: The JBI scoping review methodology framework will guide the conduct of this scoping review. Electronic databases (CINAHL, Cochrane, Medline and Embase) will be searched. Grey literature sources and the reference lists of key studies will be reviewed to identify those appropriate for inclusion. No date limits will be used in the searches and studies will be limited to the English language. Two reviewers will independently screen all titles and abstracts and full-text studies for inclusion, and a third reviewer will arbitrate disagreements. All bibliographic data, study characteristics and indicators will be collected and charted using a data extraction tool.
    MeSH term(s) Humans ; Neoplasms/drug therapy ; Research Design ; Review Literature as Topic
    Language English
    Publishing date 2023-04-07
    Publishing country England
    Document type Journal Article
    ZDB-ID 1119191-0
    ISSN 0966-0461
    ISSN 0966-0461
    DOI 10.12968/bjon.2023.32.7.S18
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Editor's Choice - Systematic Review and Meta-Analysis of Lower Extremity Vascular Complications after Arterial Access for Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA): An Inevitable Concern?

    Foley, Megan Power / Walsh, Stewart R / Doolan, Nathalie / Vulliamy, Paul / McMonagle, Morgan / Aylwin, Christopher

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

    2023  Volume 66, Issue 1, Page(s) 103–118

    Abstract: Objective: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is used to temporise non-compressible torso haemorrhage. Recent data have suggested that vascular access complications secondary to REBOA placement are higher than initially ... ...

    Abstract Objective: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is used to temporise non-compressible torso haemorrhage. Recent data have suggested that vascular access complications secondary to REBOA placement are higher than initially anticipated. This updated systematic review and meta-analysis aimed to determine the pooled incidence rate of lower extremity arterial complications after REBOA.
    Data sources: PubMed, Scopus, Embase, conference abstract listings, and clinical trial registries.
    Review methods: Studies including more than five adults undergoing emergency REBOA for exsanguinating haemorrhage that reported access site complications were eligible for inclusion. A pooled meta-analysis of vascular complications was performed using the DerSimonian-Laird weights for the random effects model, presented as a Forest plot. Further meta-analyses compared the relative risk of access complications between different sheath sizes, percutaneous access techniques, and indications for REBOA. Risk of bias was assessed using the Methodological Index for Non-Randomised Studies (MINORS) tool.
    Results: No randomised controlled trials were identified, and the overall study quality was poor. Twenty-eight studies including 887 adults were identified. REBOA was performed for trauma in 713 cases. The pooled proportion rate of vascular access complications was 8.6% (95% confidence interval 4.97 - 12.97), with substantial heterogeneity (I
    Conclusion: This updated meta-analysis aimed to be as comprehensive as possible considering the poor quality of source data and high risk of bias. It suggested that lower extremity vascular complications were higher than originally suspected after REBOA. While the technical aspects did not appear to impact the safety profile, a cautious association could be drawn between REBOA use for traumatic haemorrhage and a higher risk of arterial complications.
    MeSH term(s) Balloon Occlusion ; Hemorrhage/therapy ; Humans ; Lower Extremity/physiopathology ; Cardiovascular Diseases ; Aorta
    Language English
    Publishing date 2023-02-14
    Publishing country England
    Document type Journal Article ; Meta-Analysis ; Systematic Review
    ZDB-ID 1225869-6
    ISSN 1532-2165 ; 1078-5884
    ISSN (online) 1532-2165
    ISSN 1078-5884
    DOI 10.1016/j.ejvs.2023.02.007
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Systematic review of the relationship between Hollenhorst plaques and cerebrovascular events.

    Ghoneim, Baker Moustafa / Westby, Daniel / Elsharkawi, Mohamed / Said, Marwa / Walsh, Stewart R

    Vascular

    2023  , Page(s) 17085381231163339

    Abstract: Background: Few studies have evaluated the association between asymptomatic cholesterol emboli on fundoscopy (known as Hollenhorst plaque) and the subsequent risk of stroke or death.: Aim: To evaluate the association between the presence of ... ...

    Abstract Background: Few studies have evaluated the association between asymptomatic cholesterol emboli on fundoscopy (known as Hollenhorst plaque) and the subsequent risk of stroke or death.
    Aim: To evaluate the association between the presence of asymptomatic cholesterol retinal emboli and the risk of cerebrovascular events, with assessment of the need for carotid intervention.
    Methods: PubMed, Embase, and Cochrane Library databases were searched using appropriate terms. The systematic review was conducted according to PRISMA guidelines.
    Results: Initial search revealed 43 in Medline and 46 in Embase databases. Twenty-four potentially eligible studies were included after duplicate and non-related studies were excluded based on title and abstract. Three more studies were identified from reference lists. Seventeen studies were included in the final analysis. Asymptomatic cholesterol emboli were present in 1343 patients. Approximately 17.8% (
    Conclusion: The presence of asymptomatic retinal emboli indicates a risk of a cerebrovascular event when compared to patients with no plaques seen on fundoscopy. The evidence suggests that these patients warrant referral for medical optimization of cardiovascular risk factors. Currently, there is no recommendation to support carotid endarterectomy in patients with Hollenhorst plaques, or retinal emboli, and further studies are needed to assess this.
    Language English
    Publishing date 2023-03-13
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2137151-9
    ISSN 1708-539X ; 1708-5381
    ISSN (online) 1708-539X
    ISSN 1708-5381
    DOI 10.1177/17085381231163339
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Varicose veins as a risk factor for venous thromboembolism in arthroplasty patients: Meta-analysis.

    Westby, Daniel / Ghoneim, Baker M / Nolan, Fiona / Elsharkawi, Mohamed / Maguire, Sean / Walsh, Stewart R

    Phlebology

    2023  Volume 38, Issue 3, Page(s) 150–156

    Abstract: Objective: A meta-analysis to determine if patients with varicose veins are at an increased risk of venous thromboembolism (VTE) when undergoing major lower limb arthroplasty.: Methods: Medline, Embase, and Cochrane Library databases were searched ... ...

    Abstract Objective: A meta-analysis to determine if patients with varicose veins are at an increased risk of venous thromboembolism (VTE) when undergoing major lower limb arthroplasty.
    Methods: Medline, Embase, and Cochrane Library databases were searched using appropriate terms for studies that reported post-operative VTE in patients who had lower limb arthroplasty with any history of varicose veins. 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.
    Results: A total of 129 studies were identified with 11 observational studies being eligible for inclusion. This consisted of 265,194 patients who underwent lower limb arthroplasty, 2188 of which had pre-existing varicose veins. Overall, VTE occurred in 1845 patients, and 122 cases had varicose veins present at time of arthroplasty. Meta-analysis indicates that patients undergoing lower limb arthroplasty with varicose veins are at increased risk of having a VTE, OR 2.37, 95% CI 1.54-3.63, (
    Conclusions: Varicose veins and lower limb arthroplasty are known independent risk factors for VTE. There is a paucity of data regarding the risk of VTE in patients undergoing lower limb arthroplasty who have co-existing varicose veins. This meta-analysis shows that patients with varicose veins are at an increased risk of VTE when undergoing major lower limb arthroplasty. Further studies are required in order to determine if such patients should undergo varicose vein surgery before undertaking major lower limb joint replacement.
    MeSH term(s) Humans ; Venous Thromboembolism/epidemiology ; Venous Thromboembolism/etiology ; Varicose Veins/surgery ; Varicose Veins/complications ; Risk Factors ; Arthroplasty/adverse effects ; Risk Assessment
    Language English
    Publishing date 2023-01-06
    Publishing country England
    Document type Meta-Analysis ; Journal Article
    ZDB-ID 645172-x
    ISSN 1758-1125 ; 0268-3555
    ISSN (online) 1758-1125
    ISSN 0268-3555
    DOI 10.1177/02683555221150563
    Database MEDical Literature Analysis and Retrieval System OnLINE

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