Ankle-brachial index use in peripheral vascular interventions for claudication.

OBJECTIVE: The ankle-brachial index (ABI) has been recommended as the first-line noninvasive test to establish a diagnosis of peripheral arterial disease in patients with claudication (grade 1, level A evidence). The ABI can also be used to monitor disease progression and assess the benefits of treatment after peripheral vascular intervention (PVI). The Upper Midwest Region of the Vascular Quality Initiative has a unique balance of participation from vascular surgeons, interventional radiologists, and cardiologists performing PVI. We sought to identify the use of ABI and assess the functional outcomes of patients who had undergone PVI for claudication. METHODS: We conducted a review of the Upper Midwest Region of the Vascular Quality Initiative to identify PVI performed for claudication from native artery atherosclerotic occlusive disease in nondiabetic patients from 2010 to 2020. Patients who had undergone PVI with infection, tissue loss, rest pain, bypass graft stenosis, or aneurysmal disease were excluded. The primary outcomes included the ABI, ambulation status, and functional status before and after PVI. RESULTS: A total of 3787 patients (58.0% male, 42.0% female; mean age, 68.4 years) who had undergone 3830 procedures were identified. Of the 3787 patients, 2665 (69.5%) had had the ABI measured: 1803 (47.1%) before PVI only, 190 (4.9%) after PVI only, and 862 (22.5%) before and after PVI. In addition, 975 patients (25.5%) had never had the ABI performed. Statistical analysis of the entire cohort found no change in ambulation status (P = .33-.95 for all comparisons) or functional status (P = .42-.61 for all comparisons) regardless of the use of the ABI. However, a significant number of patients who had never had the ABI measured had decreased from full functional status before PVI to only being functional with light work after PVI (P = .015). CONCLUSIONS: Despite the grade 1, level A evidence, ABI had been used before and after PVI for only 22.5% of the patients who had undergone PVI for claudication. In addition, we found overall functional status had decreased significantly after PVI for those patients who had never had an ABI performed. Accurately identifying patients with claudication due to PAD using the ABI remains critically important before PVI. Given the lack of overall improvement in ambulation after PVI found in the present study, identifying the patients who will benefit from PVI to treat claudication remains elusive.

Access to chlamydia testing in remote and rural Scotland.

INTRODUCTION: The aim of this study was to assess access to sexual health care in remote and rural settings using Chlamydia testing as a focus by measuring the extent of Chlamydia testing and positivity across the Scottish Highlands in relation to the Scottish Index of Multiple Deprivation Quintile (SIMD) and Urban Rural 8-fold index (UR8). METHODS: Tests processed through Raigmore Hospital in Inverness, the main testing laboratory for microbiology tests in North and West and South and Mid Highlands, were studied. Where people are tested in relation to where they live was assessed, as well as the type of test they opt for. Also assessed was the rate of positivity in male and female patients in rural compared with urban settings using the Scottish Government UR8 and in relation to the SIMD. RESULTS: 9644 results were analysed. 77.2% of the results were for females and 22.4% for males. 8.1% of the results were positive and 84.4% were negative. There were proportionately more positive tests from the sexual health sources than from general practice. The proportion of men who had positive tests was almost double that for women (12.7% vs 6.6%) although men made up only 27.9% of the total number of tests. There was no significant difference in positivity when compared with UR8 index or SIMD. 37.7% of people living in the most rural areas (UR8 7-8) had their test performed in a more urban setting (UR8 1-6), and 20.4% people had their test performed in a very urban setting (UR8 1-2). Of these tests, there was a tendency for UR8 7-8 patients to be more likely to have a positive test if tested in an urban setting. CONCLUSIONS: These results are similar to previous results in other countries that suggest that Chlamydia positivity is similar in rural and urban settings. A large proportion of people living in more rurally classified areas, and perhaps those with a higher risk, have their test in a central setting, suggesting that they may be bypassing local resources to get a test. The reason for this is not clear. The results also show that men are more likely to have their test in a genitourinary setting as well as have proportionately more positive results. These results support the case for customising sexual health services to the most rural areas and suggest that providing an anonymous testing service in these areas might be beneficial, especially for men.