scholarly journals Day case angioplasty in a secondary care setting – initial experience

VASA ◽  
2021 ◽  
pp. 1-7
Author(s):  
Alexander Rodway ◽  
Michelle Stafford ◽  
Sophie Wilding ◽  
Nikolaos Ntagiantas ◽  
Vasileios Patsiogiannis ◽  
...  
Keyword(s):  
Secondary Care ◽  
Care Setting ◽  
Critical Limb Ischaemia ◽  
Lesion Length ◽  
Limb Ischaemia ◽  
Technical Success ◽  
Day Case ◽  
Procedural Complications ◽  
Secondary Care Setting ◽  
Case Based

Summary: Background: Peripheral artery disease presents an increasing healthcare burden worldwide. Day-case angioplasty in a secondary care setting can be a safe and effective means of meeting the growing demand for lower limb revascularisation. We evaluated the safety and efficacy of a day-case-based angioplasty service in a UK district general hospital. Patients and methods: Consecutive patients undergoing endovascular revascularisation between August 2018–February 2020 were analysed retrospectively. All patients were discussed at a multi-disciplinary (diabetic foot) team meeting following a day case algorithm. Patient and procedural characteristics, technical success, peri-procedural complications, and 30-day outcome of day-case angioplasties were compared with those requiring overnight stay or were hospitalized. Results: Fifty-seven percent of 138 patients were diabetic, mean age 75 ± 12 years, 95% had critical limb ischaemia (Fontaine III 12%, IV 83%), and baseline ankle brachial pressure index [ABPI] 0.40 ± 0.30. Sixty-three patients (45%) were treated as planned day cases, 21 (15%) required overnight admission for social indications. Fifteen (11%) were planned admissions with the need for sequential debridement procedures, and 39 (28%) were already hospitalised at the time of referral to the vascular service. The overall technical success was 92% and not successful procedures mainly occurred in patients > 80 years. The ABPI increased at the initial follow-up to 0.84 ± 0.18. Fifty-three percent required treatment of > 1 level, 80% included recanalisations of chronic total occlusions, and average total lesion length was 133 ± 90 mm. Closure devices were employed in all cases. There were no major peri-procedural complications. A single minor access-site related bleeding episode (0.8%) occurred, requiring 24 h observation in hospital. While significantly more wounds had closed in out-patients, the mortality, major amputation and target lesion revascularization did not differ between groups. Conclusions: Safe and effective day-case-based angioplasty can be provided in a secondary care setting for patients with critical limb ischaemia needing complex multi-level procedures.

AACE2021-A-1090: Health Status, of Medical and Allied Health Staff of a Secondary Care Setting in a Developing Country

2021 ◽  
Vol 27 (12) ◽  
pp. S23-S24
Author(s):  
Maryam Batool ◽  
Beenish Khan ◽  
Muhammad Zaka-Ul Haq ◽  
Muhammad Raza-Ul Haq
Keyword(s):  
Health Status ◽  
Developing Country ◽  
Secondary Care ◽  
Allied Health ◽  
Care Setting ◽  
Health Staff ◽  
Secondary Care Setting

Etiology and diagnosis of ascites: contemporary cohort study in a secondary care setting

2020 ◽  
Vol 73 ◽  
pp. S764
Author(s):  
Mohsan Subhani ◽  
Peuish Sugathan ◽  
Guruprasad Aithal ◽  
Emilie Wilkes ◽  
Naaventhan Palaniyappan
Keyword(s):  
Cohort Study ◽  
Secondary Care ◽  
Care Setting ◽  
Secondary Care Setting

scholarly journals Embolic Protection in Complex Femoropopliteal Interventions: Safety, Efficacy and Predictors of Filter Macroembolization

2020 ◽  
Author(s):  
Michael Czihal ◽  
Zeynep Findik ◽  
Christoph Bernau ◽  
Max Seidensticker ◽  
Jens Ricke ◽  
...  
Keyword(s):  
Risk Factors ◽  
Balloon Angioplasty ◽  
Critical Limb Ischaemia ◽  
Lesion Length ◽  
Limb Ischaemia ◽  
Distal Embolization ◽  
Embolic Protection ◽  
Endovascular Interventions ◽  
Directional Atherectomy ◽  
Peripheral Embolization

Abstract Objectives To evaluate the safety and efficacy of a filter embolic protection device (FEPD) in endovascular interventions of the femoropopliteal arteries. Methods Patients who underwent endovascular interventions of the femoropopliteal arteries between 2008 and 2016 and in whom the SpiderFXTM FEPD was applied were included in this retrospective study. Clinical and angiographic characteristics, filter macroembolization (FME), device-related complications, distal embolization, as well as the early clinical and hemodynamic outcome, were assessed. Potential risk factors for FME were evaluated by multivariate analysis. Results A total of 244 cases were identified (203 patients, claudication 60.4%, critical limb ischaemia 39.6%, mean lesion length 13.2 ± 12.9 cm, complete occlusions in 72.7%). Balloon angioplasty ± stenting (BAP), directional atherectomy ± balloon angioplasty ± stenting (DA) and rotational thrombectomy ± balloon angioplasty ± stenting (RT) were performed in 141, 61 and 42 cases, respectively. FEPD placement and retrieval were successful in all but one case each. Permanent filter-related vessel damage was not observed. The rate of FME was 37.3% (BAP 36.2%, DA 32.8%, RT 47.7%). Risk factors for FME in the BAP- and DA-group were total occlusion, lesion length > 19 cm, visible thrombus and diabetes mellitus. The distal embolization rate despite filter protection was 4.1 % (BAP 4.9%, DA 1.6%, RT 4.8%) and was higher in cases with FME compared with those without FME (8.7% vs. 1.5%, p = 0.02). Conclusion The Spider FXTM device is safe and effective in capturing embolic debris during femoropopliteal interventions. A residual risk of peripheral embolization remains. Level of Evidence III, Cohort study

scholarly journals Older age and frailty are the chief predictors of mortality in COVID-19 patients admitted to an acute medical unit in a secondary care setting- a cohort study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Rajkumar Chinnadurai ◽  
Onesi Ogedengbe ◽  
Priya Agarwal ◽  
Sally Money-Coomes ◽  
Ahmad Z. Abdurrahman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Secondary Care ◽  
Clinical Characteristics ◽  
Care Setting ◽  
Older Age ◽  
Medical Unit ◽  
Acute Medical Unit ◽  
Secondary Care Setting ◽  
Group 2 ◽  
Group 1

Abstract Background There is a need for more observational studies across different clinical settings to better understand the epidemiology of the novel COVID-19 infection. Evidence on clinical characteristics of COVID-19 infection is scarce in secondary care settings in Western populations. Methods We describe the clinical characteristics of all consecutive COVID-19 positive patients (n = 215) admitted to the acute medical unit at Fairfield General Hospital (secondary care setting) between 23 March 2020 and 30 April 2020 based on the outcome at discharge (group 1: alive or group 2: deceased). We investigated the risk factors that were associated with mortality using binary logistic regression analysis. Kaplan-Meir (KM) curves were generated by following the outcome in all patients until 12 May 2020. Results The median age of our cohort was 74 years with a predominance of Caucasians (87.4%) and males (62%). Of the 215 patients, 86 (40%) died. A higher proportion of patients who died were frail (group 2: 63 vs group 1: 37%, p < 0.001), with a higher prevalence of cardiovascular disease (group 2: 58 vs group 1: 33%, p < 0.001) and respiratory diseases (group 2: 38 vs group 1: 25%, p = 0.03). In the multivariate logistic regression models, older age (odds ratio (OR) 1.03; p = 0.03), frailty (OR 5.1; p < 0.001) and lower estimated glomerular filtration rate (eGFR) on admission (OR 0.98; p = 0.01) were significant predictors of inpatient mortality. KM curves showed a significantly shorter survival time in the frail older patients. Conclusion Older age and frailty are chief risk factors associated with mortality in COVID-19 patients hospitalised to an acute medical unit at secondary care level. A holistic approach by incorporating these factors is warranted in the management of patients with COVID-19 infection.

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