Evolution of practices in carotid surgery: from 2006 to 2015

Carotid artery intervention or surgery is less often performed in our hospital for various reasons when compared to the more often performed coronary artery surgery and interventions.. Similarly in the last 10 years, this has not changed significantly. In addition the high dose statin therapy and best medical therapies are gaining popular in many hospital. Early initiation of best medical therapies helping the patients to prevent the next event. It is still very difficult to do carotid endarterectomy in the early window period (golden period is less than a week after indexed event TIA) due to many factors which delay the entry of the patient to the operation theatre. As the time passes the risk drops and patients also postpone it further.

An observational analysis showed stability in the number of carotid procedures performed during the period and a progressive modification of carotid surgery practices in France, in accordance with the recommendations of learned societies and major publications. We also feel that seems to be fact in many other hospitals.



Reference

Salomon du Mont, Lucie et al.. Evolution of practices in carotid surgery: observational study in France from 2006 to 2015.   Annals of Vascular Surgery , Volume 0 , Issue 0 ,

http://www.annalsofvascularsurgery.com/article/S0890-5096(17)30325-4/fulltext 

Smoking cessation rates amongst patients undergoing vascular surgery

Vascular surgeons and interventionists explain the patients and suggest them to stop smoking in the perioperative period. But some of them fail to stop smoking due to various reasons. Recurrence of the stenotic lesions and thrombosis is known to be higher in such people. In our hospital 25% of the patients stop smoking forever. 50% of patients stop smoking for some time and restart after discharge. 25% of smokers never stop smoking.

Smoking is the single most important modifiable risk factor for patients with vascular disease. A study was done in Canada with an aim to determine prevalence of smoking and cessation rates amongst patients undergoing vascular surgery.

Results  of that study - Overall 624 patients had complete follow up data. Of these, 209 (33.5%) were smokers pre-surgically. At 1 year follow up of those 209 patients who were smokers pre-op, 87 (41.6%) had stopped smoking while 122 (58.4%) had not. Patients who were male and aged >70 were more likely to be smokers pre-operatively (p=0.001 and p<0 .001="" aged="" cessation="" in="" increased="" rates="" respectively="" those="" were="">70 years (p=0.005), and in those with COPD (p=0.016). Gender was also statistically associated, with cessation rates higher in females (p=0.011).

They concluded by saying that,  more than one-third of patients who underwent surgery in a Canadian vascular center continue to smoke.  

May be, we should study the outcomes of vascular treatments after improving this difficult habit (smoking cessation) further. We should do a study targeting the smoking habit and then measuring the outcomes of the vascular procedures. The attention is needed in this direction at this hour.

Reference

McHugh, S.M. et al. Smoking cessation rates amongst patients undergoing vascular surgery in a Canadian center.  .Annals of Vascular Surgery , Volume 0 , Issue 0 ,  article in press

http://www.annalsofvascularsurgery.com/article/S0890-5096(16)31348-6/fulltext

Neuromuscular electrical stimulation for the prevention of venous thromboembolism

Methods: The Medline and Embase databases were systematically searched, adhering to PRISMA guidelines, for articles relating to electrical stimulation and thromboprophylaxis. Articles were screened according to a priori inclusion and exclusion criteria.

Results:  The search strategy identified 10 randomised controlled trials, which were used in three separate meta-analyses: five trials compared neuromuscular electrical stimulation to control, favouring neuromuscular electrical stimulation (odds ratio of deep vein thrombosis 0.29, 95% confidence interval 0.13–0.65; P = .003); three trials compared neuromuscular electrical stimulation to heparin, favouring heparin (odds ratio of deep vein thrombosis 2.00, 95% confidence interval 1.13–3.52; P = .02); three trials compared neuromuscular electrical stimulation as an adjunct to heparin versus heparin only, demonstrating no significant difference (odds ratio of deep vein thrombosis 0.33, 95% confidence interval 0.10–1.14; P = .08).

Neuromuscular electrical stimulation significantly reduces the risk of deep vein thrombosis compared to no prophylaxis. It is inferior to heparin in preventing deep vein thrombosis and there is no evidence for its use as an adjunct to heparin.

Reference:

Article first published online: June 13, 2017 DOI: https://doi.org/10.1177/0268355517710130

Raveena Ravikumar, Katherine J Williams, Adarsh Babber, Hayley M Moore, Tristan RA Lane, Joseph Shalhoub, Alun H Davies

Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, UK

Corresponding Author: Alun H Davies, Room 4E04, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK. Email: a.h.davies@imperial.ac.uk

Platinum age for rheumatology

Hi, we all should note this progress to help our patients

Diabetic foot

Infected wound after repeated
Operations

Diabetic foot

Infected

Neuro-ischemic foot

Very often people think that the Diabetic foot is always infection but they forget to recognise the underlying neuropathy as the main cause precipitating infections so the surgeons are asked to drain the pus and debride wounds. It is true that all the diabetic foot problems are complicated by infection with 1or 2 other organism.

Diet and health both are important but there is always a second opinion.

My visit to Medanta Hospital, new delhi

Hi, this is a photo taken when I was visiting Medanta hospital

Intra aortic thrombosis and peripheral arterial thrombosis in a person taking antipsychotic drugs

Fig: Angiogram films before and after therapy.

This patient was admitted with history of B/L lower limb ischemic pain ( sub acute ) while he was taking anti psychotic medications. Angiogram showed multi segmental thrombosis of the lower limb arteries. He was informed about the options - Thrombectomy and Medical therapies or combination. He opted for only medical therapies with Heparin, Prostaglandin E1 therapies. He was given monthly infections of PGE1 and antiplatelet drugs along with other antipsychotic medications. His symptoms disappeared. Now, he is able to walk freely for 2 km and after that he develops calf claudication due to the residual ischemia ( popliteal, tibial arterial residual occlusions)

Reference

http://onlinelibrary.wiley.com/doi/10.1111/pcn.12001/abstract