Deep Venous Thrombosis after Arterial Surgery a Literature Review

AbstractObjectiveTo quantify the risk of DVT in arterial surgery, and to assess the need for prophylaxis.MethodsA search was carried out through Medline, Embase and Cochrane databases to identify published studies on DVT in arterial surgery. To quantify the risk of DVT both randomised and prospective non-randomised studies were included for analysis. However, to assess the need for prophylaxis only randomised controlled trials were considered.ResultsTwenty three prospective studies that evaluated DVT in arterial surgery were identified. Ten reported data about DVT in aortic surgery, seven studies evaluated DVT in general vascular surgery, three studied DVT in infra-inguinal vascular surgery and three studied DVT incidence in patients after limb amputations.ConclusionThere is a wide variation in the reported incidence of DVT in arterial surgery (2%–24%). This is mostly due to the diversity of screening methods used and the inclusion or exclusion of below knee DVT.There is insufficient evidence to make a valid conclusion regarding the routine use of anticoagulants prophylaxis in arterial surgery. However, until such evidence becomes available, DVT prophylaxis in patients undergoing arterial surgery will continue to be guided by evidence gained from studies of general surgical patients

REPAIRS Delphi: A UK and Ireland Consensus Statement on the Management of Infected Arterial Pseudoaneurysms Secondary to Groin Injecting Drug Use

\ua9 2024 The Author(s)Objective: Consensus guidelines on the optimal management of infected arterial pseudoaneurysms secondary to groin injecting drug use are lacking. This pathology is a problem in the UK and globally, yet operative management options remain contentious. This study was designed to establish consensus to promote better management of these patients, drawing on the expert experience of those in a location with a high prevalence of illicit drug use. Methods: A three round modified Delphi was undertaken, systematically surveying consultant vascular surgeons in the UK and Ireland using an online platform. Seventy five vascular surgery units were invited to participate, with one consultant providing the unit consensus practice. Round one responses were thematically analysed to generate statements for round two. These statements were evaluated by participants using a five point Likert scale. Consensus was achieved at a threshold of 70% or more agreement or disagreement. Those statements not reaching consensus were assessed and modified for round three. The results of the Delphi process constituted the consensus statement. Results: Round one received 64 (86%) responses, round two 59 (79%) responses, and round three 62 (83%) responses; 73 (97%) of 75 units contributed. Round two comprised 150 statements and round three 24 statements. Ninety one statements achieved consensus agreement and 15 consensus disagreement. The Delphi statements covered sequential management of these patients from diagnosis and imaging, antibiotics and microbiology, surgical approach, wound management, follow up, and additional considerations. Pre-operative imaging achieved consensus agreement (97%), with computerised tomography angiography being the modality of choice (97%). Ligation and debridement without arterial reconstruction was the preferred approach at initial surgical intervention (89%). Multidisciplinary management, ensuring holistic care and access to substance use services, also gained consensus agreement. Conclusion: This comprehensive consensus statement provides a strong insight into the standard of care for these patients

The Brachial Artery-basilic Vein Arterio-venous Fistula in Vascular Access for Haemodialysis—A Review Paper

AbstractAimsTo review the available literature regarding patency rates and complications of the brachial-basilic arterio-venous fistula (BBAVF) and to discuss this with relation to the current dialysis outcomes quality initiative guidelines.MethodsAn internet based literature search was performed using Pubmed, Medline and Medscape databases to identify all published reports of the BBAVF in the English language from which the full articles were retrieved and cross-referenced.ResultsOf 136 papers identified, 28 were directly relevant to this review including four prospective studies (one randomised trial, three non-randomised trials) and 24 retrospective studies. First described by Dagher in 1976, the BBAVF has since been modified to a two-stage procedure with initial fistula formation followed by superficialisation of the basilic vein 6 weeks later. It can be formed successfully in 95% of cases. Mean 1-year primary and secondary patency rates were 72 and 74.6%, respectively. Complications included haematoma (3.8%), stenosis (2.3%), thrombosis (9.7%), transient arm oedema (3.7%), steal syndrome (2.9%) and aneurysm/pseudoaneurysm formation (1.9%). The BBAVF had a lower rate of infection than prosthetic fistulas (3.6 vs. 16%).ConclusionsThe BBAVF has good primary and secondary patency rates with lower rates of infection than prosthetic fistulas making it a preferred secondary access procedure