S. Rajagopalan

Re “Analysis of the Elective Treatment Process for Critical Limb Ischaemia with Tissue Loss: Diabetic Patients Require Rapid Revascularisation”

We read with interest this article by Noronen et al. in EJVES in our weekly journal club. We wish to make some comments on this paper. This is a retrospective analysis in 2017 of data collected 6 years ago for a single centre using a single vascular consultant’s database. The aim was to recognise reasons for “delay” in the elective treatment of critical ischaemia, by following patients through their treatments over 2 years. The results showed comparative “delay” in treatments regardless of their treatments however, but does not answer the primary outcome “to analyse the treatment process from referral to revascularisation, to discover possible delays and reasons behind them, and to distinguish patients benefitting the most from early revascularisation.” Instead it compared the information of their diabetic patients versus other patients without critical ischaemia. The paper would have been more attractive if it had evaluated the reasons for “delay” in patient treatment, or for that matter, if it had clarified and quantified the delay or in which part of the pathway the delay was; for example, onset of ulcer to primary care or primary care to vascular services, or in the vascular surgery department itself. Subgroup comparisons or analysis were not set out in the aim of the study. While the results are shown in colourful diagrams, they are difficult to comprehend because of their complexity. Figure 4 would have benefitted greatly from a “number at risk table” below the graph. This would also have shown the attrition clearly in a retrospective data analysis. The discussion section does admit the difficulties often encountered in a retrospective study. The concluding paragraph went too far from the objective in stating that open revascularisation was better than the endovascular method, which was not the objective of the study. Overall, the study, though well intended, does not have strong grounds to change any practice and has pitfalls in its sections.

Phlebotomy tips for junior doctors.

The term phlebotomy refers to the ancient practice of blood letting, which involved the withdrawal of large amounts of blood in an attempt to cure illnesses and disease. This practice has been virtually abandoned but the term phlebotomy is still widely used for the withdrawal of blood from a vein, artery, or the capillary bed into blood specimen collection tubes for laboratory analysis or blood transfusion.