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T A Lees

Publications and source records attributed to T A Lees.

13 recordsLinked to original sources
PubMed2004

The Vanguard endovascular stent-graft: mid-term results from a single centre.

PURPOSE: Despite initial enthusiasm for endovascular aortic repair, few descriptions of longer-term follow-up of any endovascular device have been published. This paper represents the experience of a single centre with the Vanguard device over a 5-year period. METHODS: Fifty-five patients with a median age of 71 years (range 45-87 years) and aneurysm diameter of 59 mm (45-84 mm) received a bifurcated Vanguard stent-graft between December 1995 and July 1999. Follow-up was according to the Eurostar criteria (clinical assessment, plain film radiography and computed tomography) at 1, 3, 6, 12, 18 and 24 months and then annually thereafter. RESULTS: All primary stent deployments were successful. Median duration of surgery was 120 min (70-360 min). Median post-operative stay was 3 days (1-19 days) with a peri-operative mortality of 5.5%. In the follow-up period (median 40 months, range 6-64 months) there was one aneurysm associated death, and 14 deaths due to other causes. There have been three device migrations, 12 occluded graft limbs, four type II endoleaks and nine type III endoleaks. At 48 months, this has resulted in a survival rate of 67%, an endoleak free survival of 81% and intervention free survival of 59% (Kaplan-Meier). CONCLUSION: Medium term results with the Vanguard device appear to be at least equivalent to open repair with regard to morbidity and mortality. Nevertheless, several delayed complications appear to be related to endograft limb distortion. Important lessons have been learnt in relation to the deployment of bifurcated endografts to reduce the incidence of secondary limb related problems.

Aged↗
PubMed2000

Elastic compression stockings for prevention of deep vein thrombosis.

BACKGROUND: One of the settings in which deep vein thrombosis (DVT) in the lower limb and pelvic veins occurs is prolonged immobilisation in hospital for various surgical and medical illnesses. Use of graduated compression stockings (GCS) in these patients has been proposed to decrease the risk of DVT. OBJECTIVES: The objective of this review was to determine the magnitude of effectiveness of GCS in preventing DVT in various groups of hospitalised patients. SEARCH STRATEGY: The reviewers searched the Cochrane Peripheral Vascular Disease Group trials register, MEDLINE, and EMBASE and hand searched Indexes Medicus. Various GCS manufacturing companies and the trialists in the ongoing trials were contacted. SELECTION CRITERIA: Randomised controlled trials (RCT's) involving:. Graduated compression stockings alone. Graduated compression stockings used on a background of any other DVT prophylactic method. DATA COLLECTION AND ANALYSIS: One reviewer extracted the data, assessed the quality of trials and analysed the results (SVA) this was cross-checked and authenticated by the other reviewer (TAL). MAIN RESULTS: A total of 16 RCTs were identified. GCS were applied on the day before surgery or on the day of surgery. GCS were worn up until discharge or until the patients were fully mobile. In the majority of the included studies, DVT was identified by radioactive I 125 uptake test. GCS alone. Nine RCTs were identified in this group. In the treatment group (GCS) of 624 patients, 81 developed DVT (13%) in comparison to the control group of 581 patients, where 154 (27%) had DVT, Peto's odds ratio 0.34 (95% confidence interval 0.25, 0.46) favouring treatment with GCS. GCS on a background of another prophylactic method. Seven RCTs were identified this group. In the treatment group (GCS + another method) of 501 patients, 10 (2%) developed DVT whereas in the control group of 505 patients, 74 (15%) developed DVT, Peto's odds ratio 0.24 (95% confidence interval 0.15, 0.37). REVIEWER'S CONCLUSIONS: Analysis of these RCT's confirm that GCS are effective in diminishing the risk of DVT in hospitalised patients. Data examination also suggests, that GCS on a background of another method of prophylaxis is even more effective than GCS alone.

Bandages↗
PubMed1999

Sclerotherapy.

Explore the source record for details and available documents.

Humans↗
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↗
PubMed1993

Patterns of venous reflux in limbs with skin changes associated with chronic venous insufficiency.

The distribution of venous reflux in patients with skin changes associated with chronic venous insufficiency presenting to a specialist clinic was assessed. A total of 300 limbs in 153 patients were examined by Doppler ultrasonography with colour-flow imaging for the presence of venous reflux in superficial veins, deep veins and medial perforating veins, both above and below the knee. Ninety-eight limbs had skin changes, which included hyperpigmentation, lipodermatosclerosis, atrophie blanche and ulceration. Of this group, 2 per cent had no evidence of venous reflux on duplex scanning, 39 per cent had deep vein incompetence, 57 per cent had superficial vein incompetence and 2 per cent had isolated medial perforating vein reflux. Of 25 limbs with ulceration, 13 had superficial and 12 deep vein reflux. A total of 202 legs, which included 20 normal control limbs, had no skin changes; 22.3 per cent of these had no venous reflux, 8.4 per cent had deep vein incompetence, 65.3 per cent had superficial incompetence and 4.0 per cent had isolated medial calf perforating vein incompetence.

Adolescent↗
PubMed1993

Eye protection for the vascular surgeon.

Contamination occurring during vascular surgery was studied prospectively using a surgical mask incorporating a Splashguard visor. Over a 16-week period 78 vascular procedures were included; 44 were of < 2 h duration and 34 were of > or = 2 h. Contamination on both mask and visor from blood spots was recorded at the end of each procedure. Overall, 51 per cent of principal surgeons' visors were contaminated, with contamination of the mask itself in 32 per cent. When two surgeons were operating the contamination rate for the second was also high: 36 per cent for the visor and 42 per cent for the mask. Assistants had a contamination rate of 36 per cent for the visor and 13 per cent for the mask. The lowest rate of contamination occurred for the visor and mask of the scrub nurse, 10 and 4 per cent respectively. For emergency procedures the duration of operation had no influence on the frequency of contamination. However, for the principal surgeon elective operations of < 2 h duration were less likely to involve contamination than those of > or = 2 h (P < 0.035). Blood contamination of visors and masks is common in vascular surgery but rarely appreciated by the surgeon. Routine eye protection should be considered in vascular surgery, in particular for emergency and prolonged elective procedures.

Blood-Borne Pathogens↗
PubMed1992

Prevalence of lower limb ulceration in an urban health district.

Before establishing a community leg ulcer programme, a survey was performed to assess the incidence and prevalence of lower limb ulceration in the Newcastle Health District. The prevalence was 1.9 per 1000 in patients over the age of 45 years, and the annual incidence 3.5 per 1000 in the same age group. Recurrent ulcers represented 47 per cent of the total and 50 per cent of all ulcers had been present for > 6 months. District nurses spent 190 h per week in the community dressing leg ulcers, making a total number of 25,922 visits each year. In the treatment of leg ulcers 35 different types of dressing were used and only 14 per cent of ulcerated limbs were treated by appropriate compression. Of all patients with leg ulcers, 35 per cent had been seen by a hospital specialist but only 7 per cent had been examined by a vascular surgeon at any time.

Aged↗
PubMed1991

Survivorship analysis of the uncemented porous-coated anatomic knee replacement.

Ninety-six patients who had a total of 108 replacements with an uncemented porous-coated anatomic knee prosthesis were followed for an average of sixty-four months (range, thirty-nine to ninety-three months). At the time of the most recent follow-up, twenty-one implants (19 per cent) had failed, all due to problems with the tibial component. A patellar component was not used, and no noteworthy patellar problems were encountered after the operation. There were no infections about the prostheses, and no femoral implant was revised. The most common cause of failure was collapse of the anteromedial part of the tibial plateau, which occurred in fourteen knees. The prosthesis loosened without collapse of bone in two knees, and five knees were revised because of gross wear of the polyethylene. When the time of failure was defined as the point at which revision of the prosthesis was recommended, the cumulative rate of survival was 84 per cent (95 per cent confidence interval, +/- 7 per cent) at five years and 77 +/- 10 per cent at six years. When the time of failure was defined as the point at which the knee replacement was actually done, the five-year rate of survival was the same. No significant differences were demonstrated between groups that were stratified by age, sex, weight, or primary diagnosis. We therefore do not recommend the use of an uncemented porous-coated anatomic knee replacement of the design that was evaluated in this study.

Adult↗
PubMedDate not supplied

Percutaneous ablation of an internal iliac aneurysm using tissue adhesive.

We report the percutaneous injection of tissue adhesive (Tisseal, Immuno, Vienna, Austria) to ablate a 12-cm internal iliac aneurysm. The complex history of this lesion included previous surgery for a ruptured aortic aneurysm, attempted repair of the internal iliac aneurysm, and several embolization procedures. These factors precluded further open repair or transcatheter techniques and dictated the choice of a more direct approach.

Aged↗