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J D Beard

Publications and source records attributed to J D Beard.

At least 37 records · Page 2Linked to original sources
PubMed2001

A model for national outcome audit in vascular surgery.

OBJECTIVE: The aim was to model vascular surgical outcome in a national study using POSSUM scoring. METHODS: One hundred and twenty-one British and Irish surgeons completed data questionnaires on patients undergoing arterial surgery under their care (mean 12 patients, range 1-49) in May/June 1998. A total of 1480 completed data records were available for logistic regression analysis using P-POSSUM methodology. Information collected included all POSSUM data items plus other factors thought to have a significant bearing on patient outcome: "extra items". The main outcome measures were death and major postoperative complications. The data were checked and inconsistent records were excluded. The remaining 1313 were divided into two sets for analysis. The first "training" set was used to obtain logistic regression models that were applied prospectively to the second "test" dataset. RESULTS: using POSSUM data items alone, it was possible to predict both mortality and morbidity after vascular reconstruction using P-POSSUM analysis. The addition of the "extra items" found significant in regression analysis did not significantly improve the accuracy of prediction. It was possible to predict both mortality and morbidity derived from the preoperative physiology components of the POSSUM data items alone. CONCLUSION: this study has shown that P-POSSUM methodology can be used to predict outcome after arterial surgery across a range of surgeons in different hospitals and could form the basis of a national outcome audit. It was also possible to obtain accurate models for both mortality and major morbidity from the POSSUM physiology scores alone.

Diagnosis-Related Groups↗
PubMed2001

Thoracic aortic stent grafts--early experience from two centres using commercially available devices.

OBJECTIVES: open surgical intervention for aneurysms of the distal arch and descending thoracic aorta is associated with high morbidity and mortality. Stent grafts offer an attractive alternative treatment for these aneurysms. The aim of this study was to assess the morbidity and mortality of endovascular treatment for these aneurysms with stent grafts. DESIGN, PATIENTS AND METHODS: a prospective observational study was performed of 37 consecutive patients treated from July 1997 to October 2000 (30 at Guy's and St. Thomas' and 7 at Sheffield). Indications included degenerative aneurysms (n=18), false aneurysm (5), acute dissection (4), aortic transection (4), aneurysm related to previous surgery for coarctation (3), chronic dissection (2) and traumatic dissection (1). Nineteen were performed as elective and 18 as non-elective procedures. RESULTS: three non-elective patients died in hospital (in-hospital and 30-day mortality 8%) and one suffered a stroke with spontaneous full recovery. No elective patient died. One patient with a persistent proximal endoleak required conversion to open repair at 6 weeks. Two patients with persistent flow into the sac at 24 h spontaneously thrombosed at subsequent 3 month follow-up. Two further patients developed new distal endoleaks at 3 months and required distal extension cuffs. One patient died at 28 months of aortic rupture. Serial CT scans had shown prolapse of the stent graft into the aneurysm sac and the patient died just before planned endovascular repair. No patient suffered paraplegia or renal failure. Intensive care facilities were only required for patients who needed them preoperatively. CONCLUSIONS: thoracic stent grafts can be performed with low morbidity and mortality. They offer a realistic alternative to open surgery. Long term follow up is required to assess their durability.

Aged↗
PubMed2000

Randomized, multicentre, double-blind, placebo-controlled trial of the use of aprotinin in the repair of ruptured abdominal aortic aneurysm. On behalf of the Joint Vascular Research Group.

BACKGROUND: The use of aprotinin in cardiac surgery reduces blood transfusion requirements. The aim of this trial was to see whether the same benefit applies in the repair of ruptured abdominal aortic aneurysm (AAA). METHODS: In this prospective, randomized trial, nine centres with local ethics committee approval recruited 77 patients with a ruptured AAA. A bolus of aprotinin 2 x 106 units, followed by an infusion of 0.5 x 106 units every 30 min, was administered to 38 patients, and 39 received a placebo infusion. The quantity of blood products transfused during surgery and in the first 12 h after operation was noted, along with the incidence of complications, mortality rates and length of hospital stay. RESULTS: Seventeen of the 38 patients who received aprotinin and 17 of the 39 given placebo died within 30 days (overall mortality rate 44 per cent). The median amount of blood given to the aprotinin group after operation was 1 (range 0-14) unit, while for the placebo group it was 3 (range 0-13) units (P = 0.02). However, the difference in the total number of units of blood transfused did not reach significance (10 (range 2-29) versus 14 (range 4-38) units respectively). CONCLUSION: The use of high-dose aprotinin during the repair of a ruptured AAA reduced blood transfusion requirements in the first 12 h after operation, but had no significant effect on the overall blood transfusion requirement.

Aged↗
PubMed2000

Using the Boazul cuff to reduce blood loss in varicose vein surgery.

OBJECTIVE: this study was designed to assess if the use of a sterile exsanguination tourniquet (Boazul cuff) reduced blood loss from the groin and avulsion wounds during varicose vein surgery, (saphenofemoral disconnection, stripping to knee and multiple avulsions). DESIGN: prospective, parallel cohort study. MATERIALS: thirty-eight patients undergoing primary varicose vein surgery. METHODS: the blood loss and number of avulsion wounds were recorded for each patient. RESULTS: the tourniquet was used on 21 legs and there were 24 legs in the non-tourniquet group. In the tourniquet group, the median blood loss from the groin was 15 ml, (range 5-70 ml), and from the leg was 5 ml, (range 0-120 ml). The corresponding figures for the group without the tourniquet were a median of 17.5 ml, (range 5-105 ml), and a median of 95 ml, (range 10-505 ml). The mean number of avulsions in the tourniquet group was 25 (range 9-38), and in the non-tourniquet group was 15, (range 5-40). There was significantly less blood loss from the leg in the tourniquet group (p<0.0001) despite the fact that there were more avulsions in the tourniquet group (p<0.001). CONCLUSIONS: use of the Boazul cuff significantly decreases the blood loss from the avulsion sites during routine varicose vein surgery, and may encourage the surgeon to perform more avulsions.

Adolescent↗
PubMed1999

The effects of crossing porcine renal artery ostia with various endovascular stents.

OBJECTIVES: To compare the effects of crossing renal artery ostia with various stents. METHODS: The renal artery ostia of 24 large white pigs were covered with a Wallstent (nine ostia), a Palmaz stent (nine ostia) and a Memotherm stent (13 ostia). After an interval of 6-15 weeks, aortography, renal pressure and blood samples were performed and the pigs then sacrificed for histological examination. RESULTS: Histological examination revealed an organised collagen matrix with endothelial cells covering the struts in contact with the aorta. This occurred with all stents but was most organised with the Wallstent. This matrix did not involve the renal artery ostia crossed by Wallstents, but in one Palmaz stent and in 12/13 Memotherm stents, a disorganised acellular matrix caused partial ostial occlusion. There was no mean fall in renal artery pressure but traces were damped in 8/13 cases of partial occlusion. There was a rise in serum creatinine in two cases using the Palmaz stent. CONCLUSIONS: Covering renal arteries with the Wallstent appears to be safe in the short-term. Placement of stents with larger struts across renal arteries will require imaging methods, such as intravascular ultrasound (IVUS) to ensure that the ostia are not obstructed.

Animals↗
PubMed1999

A survey of the current management of varicose veins by members of the Vascular Surgical Society.

The assessment and treatment of varicose veins by members of the Vascular Surgical Society of Great Britain and Ireland has been assessed by postal questionnaire. The response rate was 65%, of which 77% were general surgeons with a vascular interest, 21% were vascular surgeons only and 2% were non-vascular. Approximately four new patients with varicose veins are seen per surgeon per week in clinics with a median waiting time to be seen of 12 weeks. A median of three varicose vein operations per surgeon per week are undertaken with 10-15% of surgery being performed for recurrent disease. The commonest indications for surgery are symptomatic (97%) and complicated (98%) varicose veins, although 55% of surgeons also perform surgery for cosmesis. 65% surgeons routinely use hand-held Doppler in the assessment of varicose veins; of the other methods available, Duplex scanning was used as the first line investigation by 83%. Although over 60% of surgeons use sclerotherapy surgery is the preferred option for primary treatment for varicose veins associated with long or short saphenous reflux. 62% surgeons use deep venous thrombosis prophylaxis in patients undergoing varicose veins surgery selectively, and 27% use it routinely.

Health Care Surveys↗
PubMed1998

A combined approach to the treatment of proximal arterial occlusions of the upper limb with endovascular stents.

BACKGROUND: The traditional transfemoral approach to endovascular stenting is not ideal for proximal arterial lesions of the upper limb. The distance of the lesion from the femoral puncture site, flexibility and unsupported length of guide-wires/delivery systems and often acutely angled origins of the great vessels combine to make crossing the lesions and accurate deployment of the device difficult or impossible. Deployment of the stent via a brachial arteriotomy should obviate these problems. AIM: The authors report a series of patients with proximal arterial occlusions of the upper limb treated by endoluminal stenting using a combined surgical/radiological approach. PATIENTS AND METHODS: Using the combined approach we have attempted to treat 18 proximal upper limb occlusions (eight brachiocephalic origin, six subclavian origin, two subclavian artery and two axillary artery). Where possible, occlusions were treated by primary stent deployment. All patients received perioperative i.v. heparin followed by long-term aspirin. RESULTS: Revascularisation was successful in 15 of 18 proximal occlusions with complete resolution of symptoms. All stented vessels remain patent up to 36 months after the procedure and there have been no complications arising from the brachial arteriotomy sites. CONCLUSIONS: Primary stenting is the treatment of choice for proximal occlusions of the upper limb vessels. A combined surgical/radiological approach via a brachial arteriotomy can be used in these cases and is now the method of choice for the treatment of such lesions in this unit.

Aged↗
PubMed1998

Trials and tribulations of vascular surgical benchmarking.

BACKGROUND: Benchmarking is a new tool to assess the efficiency of different hospitals. Classification of operations using healthcare resource groups (HRGs) is related to parameters including number of cases, length of stay (LOS) and age profile. METHODS: A National Comparative Database was used to compare three hospitals. Analysis was confined to the major HRGs involved with vascular/venous surgery. RESULTS: For high-volume low-complexity varicose vein surgery, all three hospitals had similar numbers of patients and LOS. In contrast, the LOS for routine vascular operations in hospital A was double that in hospital B (16.3 versus 7.4 days). Hospital A had three times as many patients classified as 'other - peripheral vascular disease' as hospital C and six times as many as hospital B (329, 49 and 111 for hospitals A, B and C respectively). LOS following major amputation in hospitals A and C was nearly double that in hospital B (32.4, 18.3 and 33.6 days for hospitals A, B and C respectively). CONCLUSION: There were a number of significant variations between the three hospitals during the 9-month interval. Explanations included the methods of coding, local facilities including availability of rehabilitation beds and difference in the patients' age profiles. Benchmarking in its present format reveals a number of variations which may not necessarily reflect real differences in clinical performance.

Benchmarking↗