T. Aherne

Supervised exercise therapy in the management of peripheral arterial disease – an assessment of compliance

BACKGROUND Supervised exercise therapy (SET) is an effective option in the management of peripheral arterial disease (PAD). Unfortunately, poor compliance remains prevalent. This study aimed to assess patient exercise compliance and to identify factors influencing symptomatic improvement and SET participation. PATIENTS AND METHODS Data regarding attendance at SET for this cohort study were extracted from a prospectively maintained database of patients with claudication attending SET at Dublin City University. All patients had ankle brachial index confirmed PAD with associated intermittent claudication. Exercise performance and symptomatic data were gathered retrospectively using patient charts and interviews. RESULTS Ninety-eight patients were referred for SET during the study period. The mean age was 69.2 (± 10.1) with 18 % being female. Median follow-up was 25.1 months (IQ range 17.0-31.6). Overall, the mean number of sessions attended per patient was 19.5. Exercise compliance was associated with a significant improvement in symptoms (p = 0.001). Other factors including anatomical level of claudication (P = 0.042) and educational level (p = 0.007) were found to affect the outcome of SET. Multivariate analysis revealed hypertension as a predictor of symptomatic outcome after SET (p = 0.045). Furthermore, ex-smokers (p = 0.021) and those previously diagnosed with hypercholesterolaemia (p = 0.020) or ischaemic heart disease (p = 0.029) had superior exercise compliance. Using linear regression, smoking history (p = 0.024) was identified as a predictor of compliance to SET. CONCLUSIONS Establishing exercise compliance remains challenging in the PAD cohort. Pre-exercise patient education and personalised exercise prescriptions may result in improvements in function and compliance.

Supervised Exercise Therapy (SET) in the Management of Peripheral Arterial Disease: Factors Determining Compliance and Functional Outcome

Type-3 endoleaks. Renal complications were seen in 3/11 patients, 2 acute kidney injuries resolved spontaneously. 1 patient re-admitted Day-19 with acute renal failure and bilateral renal artery occlusion, underwent endovascular recanalization and stenting of the left renal artery, remains dialysis dependent. 2/11 have died at 21 and 60 months, both from non-aneurysm related disease. One iliac limb has been extended for 1b endoleak and sac expansion. 2/11 endoleaks are under surveillance. Conclusions: Complex Endovascular Aneurysm Repair is feasible in patients considered unsuitable for standard endovascular. Mid-term results suggest this procedure is durable, but long-term follow-up is essential and awaited.

Radio-frequency ablation vs. open surgery in the treatment of varicose veins - a comparative study.

Methods This was a single centre retrospective cohort study. All patients with confirmed sapheno-femoral junctional incompetence who underwent surgical management treatment between January 2011 and December 2012 were included. Medical charts and computer records were reviewed. Radiological success, choice of anaesthesia and hospital length of stay was documented. Procedural cost was also calculated. A focused cohort analysis was undertaken to compare the initial 50 RFA procedures performed with the last 50. This allowed for departmental learning curve assessment over a 13-month period.