P.J. Kent

Percutaneous transluminal angioplasty for intermittent claudication: Evidence on which to base the medicine

OBJECTIVES This study aims to assess the impact of PTA on the quality of life (QoL) of claudicants and to analyse which patients and which arterial lesions derive the most benefit. DESIGN A prospective observational study. MATERIALS One hundred and seventeen claudicants undergoing PTA were studied; 35 patients had bilateral disease, whilst 82 had unilateral disease and underwent PTA to a solitary iliac lesion, solitary superficial femoral or a iliac lesion above a diseased superficial femoral artery in 24, 39 and 19 cases, respectively. METHODS Patients completed the Short Form 36 (SF36) and EuroQol (EQ) QoL assessment instruments prior to and at 1, 3, 6, and 12 months following intervention. The SF36 produces a QoL profile, whilst the EQ produces two QoL indices. RESULTS Claudication has a deleterious effect on QoL, especially in patients with multi-segment disease. PTA results in an immediate and lasting improvement in the QoL of claudicants. Unilateral claudicants undergoing PTA to a solitary iliac lesion demonstrate the most marked QoL benefits and 12 months post PTA report a QoL approaching that of an age-matched population. Patients with bilateral claudication undergoing unilateral PTA and unilateral claudicants undergoing PTA to a solitary SFA lesion demonstrate some QoL benefits, but at 12 months post PTA do not approach the QoL scores of an age-matched population. Unilateral claudicants undergoing iliac PTA above a diseased SFA demonstrate minimal QoL changes. CONCLUSIONS These results should influence decision making in the management of claudication and it may be possible to prioritise PTA waiting lists to ensure patients with greatest potential benefit are treated with most urgency.

Randomized clinical trial of intraoperative autotransfusion in surgery for abdominal aortic aneurysm.

Perioperative homologous blood transfusion (HBT) is associated with adverse reactions and risks transmission of infection. It has also been implicated as an immunosuppressive agent. Intraoperative autotransfusion (IAT) is a potential method of autologous transfusion.

SECONDARY HAEMORRHAGE FROM SAPHENOUS VEIN GRAFTS CAUSED BY METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS

Infection of prosthetic peripheral arterial grafts continues to be a serious complication of reconstructive vascular surgery. Autogenous saphenous vein, while providing superior patency rates, is considered relatively resistant to infection. In the past decade, methicillin-resistant Staphylococcus aureus (MRSA) has emerged as a major infection control problem in both hospitals and the community, but no reports exist of MRSA causing complications in vein grafts. We present two cases in which patients colonised by MRSA developed infection of a vein graft which resulted in secondary haemorrhage and, in one case, a major amputation.

Letter 2: Cold provocation testing and hand-arm vibration syndrome—an audit of the results of the Department of Trade and Industry for the evaluation of miners (Br J Surg 2003; 90: 1076-1079)

The Editors welcome topical correspondence from readers relating to articles published in the Journal. Responses can be sent electronically via the BJS website (www.bjs.co.uk) or by post. All letters will be reviewed and, if approved, appear on the website. A selection of these will be edited and published in the Journal. Letters must be no more than 250 words in length. Letters submitted by post should be typed on A4-sized paper in double spacing and should be accompanied by a disk.

EJVES Extra AbstractsRuptured Internal Iliac Artery Aneurysm Treated by Percutaneous Transcatheter Embolisation

Ruptured internal iliac artery aneurysms (IIAA) are rare. Operative treatment carries a high morbidity and mortality while endovascular treatment offers an alternative option. We report a case of ruptured IIAA treated successfully treated by an alternative form of percutaneous coil embolisation. Selective catheterization of all the outflow branches was impossible and the volume of the aneurysm sac precluded embolisation with conventional coils. The sac was, therefore, packed with 10 cm lengths of guidewire with the central mandrel removed.

Randomized clinical trial of routine preoperative duplex imaging before varicose vein surgery (Br J Surg 2005; 92: 688-694).

The Editors welcome topical correspondence from readers relating to articles published in the Journal. Responses can be sent electronically via the BJS website (http://www.bjs.co.uk) or by post. All letters will be reviewed and, if approved, appear on the website. A selection of these will be edited and published in the Journal. Letters must be no more than 250 words in length. Letters submitted by post should be typed on A4‐sized paper in double spacing and should be accompanied by a disk.