Routine use of concurrent fluoroscopic imaging during superficial endovenous interventions: A position statement of the International Union of Phlebology, the Australasian College of Phlebology, the Australia and New Zealand Society for Vascular Surgery, the American Venous Forum, the American Vein and Lymphatic Society, the European College of Phlebology and the Interventional Radiology Society of Australasia.

International evidence-based guidelines recommend preoperative duplex ultrasound mapping in the assessment of chronic venous disease, and concurrent ultrasound imaging to guide superficial endovenous interventions such as endovenous laser ablation, radiofrequency ablation, cyanoacrylate adhesive closure, and sclerotherapy (ultrasound-guided sclerotherapy). Other imaging modalities such as venography, alone or in combination with computed tomography scan or magnetic resonance imaging, may be included in the preoperative assessment of a small and select group of patients to exclude central venous obstruction, certain deep venous pathologies, pelvic origin extrapelvic varices, and complex vascular malformations. The signatory scientific and medical societies recommend against the routine use of fluoroscopy and other radiation-based imaging in the investigation and treatment of superficial venous disease.

Routine use of concurrent fluoroscopic imaging during superficial endovenous interventions: A position statement of the International Union of Phlebology (UIP), the Australasian College of Phlebology (ACP), the Australia and New Zealand Society for Vascular Surgery (ANZSVS), the American Venous Forum (AVF), the American Vein and Lymphatic Society (AVLS), the European College of Phlebology (ECoP) and the Interventional Radiology Society of Australasia (IRSA).

International evidence-based guidelines recommend preoperative duplex ultrasound mapping in the assessment of chronic venous disease, and concurrent ultrasound imaging to guide superficial endovenous interventions such as endovenous laser ablation, radiofrequency ablation, cyanoacrylate adhesive closure, and sclerotherapy (ultrasound-guided sclerotherapy). Other imaging modalities such as venography, alone or in combination with computed tomography scan or magnetic resonance imaging, may be included in the preoperative assessment of a small and select group of patients to exclude central venous obstruction, certain deep venous pathologies, pelvic origin extrapelvic varices, and complex vascular malformations. The signatory scientific and medical societies recommend against the routine use of fluoroscopy and other radiation-based imaging in the investigation and treatment of superficial venous disease.

The sharp end of cardiovascular disease in New Zealand: A review of acute type A aortic dissections of the Waikato.

AIM: Acute type A aortic dissections are lethal cardiovascular surgical emergencies. This study is a retrospective comparative review of mortality in Type A aortic dissections between Maori and non-Maori populations of the Midland DHBs catchment area. METHOD: 143 patients identified with diagnosis of type A aortic dissections at Waikato Hospital from 1990 to 2013, as identified in Waikato Hospital clinical records and cardiothoracic surgery database. The Maori and non-Maori populations were compared according to demographics, 30-day survival and 5-year survival. RESULT: The overall 30-day mortality rate of 28% was consistent with published international data, but there were significant ethnic and gender disparities related to the high prevalence of cardiovascular risk factors, particularly in the Maori population. Maori have a significantly higher prevalence of type A aortic dissections (2.5 per 10,000) compared to non-Maori (1.4 per 10,000) and have a 5-year earlier mean age at presentation compared to non-Maori. Maori females have the highest mortality rates with almost half succumbing within 30 days of surgery (45.5%). CONCLUSION: The future promises an increasing incidence of acute type A aortic dissections in a younger Maori population with severe disease burden and less reserve, as well as in an elderly population where age is an independent predictor of worse operative mortality, morbidity and reduced long-term survival. GP and specialist collaborative directions are identified towards evolution of surgery and systems to maintain, if not improve, early and late survival rates in the Midland DHBs catchment region.

Long-term follow-up of last autogenous option arm vein bypass.

BACKGROUND: The superiority of autogenous conduits in infrainguinal bypass surgery is well established. At our institution, arm vein is utilized as the last autogenous option for infrainguinal bypass surgery. The aim of this study was to review the long-term outcomes of last autogenous option arm vein bypass. METHODS: All infrainguinal arm vein bypasses performed between 1997 and 2005 by The Queen Elizabeth Hospital vascular surgeons were identified. Patency, reintervention, limb salvage and survival were calculated using the Kaplan-Meier survival estimate method. RESULTS: Thirty-eight arm vein bypasses were performed in 35 patients. Eighty-nine per cent were performed for critical limb ischaemia. Median follow-up was 58 months (range 2-121). Twelve-month primary, assisted primary and secondary patency rates were 52%, 73% and 76%, respectively. Three-year primary, assisted primary and secondary patency rates were 32%, 61% and 63%, respectively. Five-year primary, assisted primary and secondary patency rates were 21%, 47% and 49%, respectively. Patency was superior in single compared with spliced vein grafts (P < 0.05). Limb salvage rates at 1, 3 and 5 years were 94%, 87% and 76%, respectively. Patient survival at 1, 3 and 5 years was 92%, 68% and 49%, respectively. DISCUSSION: Infrainguinal bypass surgery with arm vein can be performed safely with favourable patency and high rates of limb salvage. Secondary interventions to maintain patency are common and we recommend a vigilant surveillance programme to identify the threatened graft.