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C V Ruckley

Publications and source records attributed to C V Ruckley.

At least 19 recordsLinked to original sources
PubMed1992

Smoking, lipids, glucose intolerance, and blood pressure as risk factors for peripheral atherosclerosis compared with ischemic heart disease in the Edinburgh Artery Study.

The aim was to determine if certain risk factors in the general population are more strongly related to peripheral arterial disease than to ischemic heart disease. Arterial disease in the lower limbs was measured by means of the World Health Organization questionnaire on intermittent claudication, the ankle brachial pressure index, and a reactive hyperemia test in 1,592 men and women aged 55-74 years selected randomly in 1988 from the age-sex registers of 10 general practices in Edinburgh, Scotland. Peripheral arterial disease was strongly related to lifetime cigarette smoking, with additional risks in current and exsmokers of less than 5 years. Multiple regression of risk factors on measures of peripheral arterial disease showed associations with diabetes mellitus (but not impaired glucose tolerance), systolic blood pressure, and serum cholesterol; inverse association with high-density lipoprotein cholesterol; and only univariate association with triglycerides. In multiple logistic regressions of risk factors on six separate indicators of cardiovascular disease, the only consistent difference was that smoking increased the risk of peripheral arterial disease (range of odds ratios, 1.8-5.6) more than heart disease (range of odds ratios, 1.1-1.6). Diabetes mellitus was not a stronger risk factor for peripheral arterial disease.

Aged↗
PubMed1992

Monitoring and cerebral protection during carotid endarterectomy.

Two recently published multicentre trials have confirmed the overall benefit of carotid endarterectomy in symptomatic patients with severe carotid artery disease. The key to improving further the long-term advantages of carotid endarterectomy, however, remains the continued reduction of the initial operative risk. While the principal responsibility for this continues to be borne by the surgeon, specifically in reducing technical error, the time is perhaps approaching when he or she might also be able to apply some of the recent advances in cerebrovascular research to reduce operative morbidity still further in the future. This article summarizes the aetiology and pathophysiology of operation-related neurological deficits and reviews current approaches towards intraoperative monitoring, cerebral protection and assessment of quality control.

Brain Ischemia↗
PubMed1992

Screening patients with claudication from femoropopliteal disease before angioplasty using Doppler colour flow imaging.

Time, expense, risk and discomfort are incurred by arteriography in patients with intermittent claudication who might be candidates for percutaneous transluminal angioplasty (PTA). A valid screening technique could reduce the need for arteriography in patients found to have lesions not amenable to PTA. Agreement between Doppler colour flow imaging (DCFI) and angiography for detecting haemodynamically significant lesions is high, but DCFI may not identify lesions suitable for angioplasty. A total of 36 limbs in 30 patients were studied using DCFI before angiography. Agreement between the two methods was excellent (kappa = 0.91), and the predictive accuracy of DCFI for lesions amenable to PTA was good (kappa = 0.78, sensitivity 94 per cent, specificity 85 per cent, positive predictive value 83 per cent, negative predictive value 94 per cent, overall accuracy 89 per cent). DCFI is a useful screening process that may prevent unnecessary angiography, with consequent financial savings and clinical benefit.

Aged↗
PubMed1991

Reoperations for late complications following abdominal aortic operation.

Fifty patients were identified who, following abdominal aortic operation, developed late complications affecting the vascular graft or endarterectomy and who underwent their first reoperation between 1979 and 1989. Thrombosis was the commonest complication affecting 28 (56 per cent) patients, followed by false aneurysm in 11 (22 per cent), enteric fistula in nine (18 per cent) and graft infection in two (4 per cent). The 30-day mortality rate for reoperation was 8 per cent; longer follow-up revealed mortality rates of 22, 50 and 63 per cent at 1, 3 and 5 years respectively. Thirty-four complications required reoperation within 5 years of the original surgery. Reoperation was needed for 35 patients whose original pathology was occlusive disease and for 15 whose original pathology was aneurysm. The nature of the complication was related to initial pathology; thrombosis was far commoner in those with occlusive disease, and enteric fistula and false aneurysm were commoner in those with aneurysmal disease.

Adult↗
PubMed1991

Ruptured aortic aneurysm: a proposed classification.

There is a wide variation in reported operative mortality rates for ruptured abdominal aortic aneurysm, ranging from 14 to 70 per cent. Although many factors influence this variation, such as the expertise and facilities available at an individual institution, considerable differences could be due to variations in the pattern of referral and the proportion of cases accepted for operation. In this paper a classification applicable to all patients with ruptured aortic aneurysm is proposed; it has been applied prospectively to 100 consecutive patients with ruptured abdominal aortic aneurysm referred to the Edinburgh Vascular Surgical Unit. The classification illustrates how surgical mortality rates ranging from 29 to 52 per cent may be reported using the same mortality data. Two major benefits may derive from the use of such a standard reporting system. Firstly, it allows management deficiencies to be identified easily and, secondly, it should facilitate comparison of results reported from different centres.

Age Factors↗
PubMed1991

Transcranial Doppler monitoring during carotid endarterectomy.

Transcranial Doppler monitoring of the middle cerebral artery blood flow velocity was used as an adjunct to routine methods of cerebral monitoring in a prospective study of 30 consecutive patients undergoing carotid endarterectomy to investigate whether transcranial Doppler monitoring provided information influencing operative technique. Application of carotid clamps caused a significant fall in middle cerebral artery velocity and there was a linear relationship between middle cerebral artery velocity and internal carotid artery stump pressure. Assuming a stump pressure of less than 50 mmHg to be an indication for shunting, this would correspond to a systolic middle cerebral artery velocity of less than 42 cm/s and a mean velocity of less than 30 cm/s. Transcranial Doppler monitoring immediately identified problems with shunt function and demonstrated a higher frequency of intraoperative embolization than had been anticipated, particularly after shunt insertion and final restoration of flow. With revision of operative technique this phenomenon is rarely encountered now. Two of the 30 patients exhibited a minor neurological deficit on recovery of consciousness, and transcranial Doppler monitoring was able to identify the probable underlying cause in both cases. Unnecessary and potentially hazardous re-exploration was avoided. In the absence of transcranial Doppler monitoring the neurological deficit in one of the patients might have been much worse.

Blood Flow Velocity↗
PubMed1991

Risk factors for intra-operative neurological deficit during carotid endarterectomy.

Although embolism is considered to be the major cause of intra-operative neurological deficit (IOND) during carotid endarterectomy, the possibility that patients may vary in susceptibility to ischaemic damage following minor embolisation or falls in cerebral perfusion pressure is rarely considered. A prospective study was undertaken in 60 consecutive patients undergoing carotid endarterectomy to identify risk factors for IOND. The hypothesis was that patients with impaired cerebral vascular reserve (CVR) may be more vulnerable to intra-operative emboli or falls in cerebral perfusion pressure than normal subjects. Recent work using Positron Emission Tomography has indicated that the best index of CVR is the ratio of cerebral blood flow to cerebral blood volume, which is another expression for the reciprocal of mean cerebral transit time (MCTT). In this study, a new isotopic method of quantifying MCTT was used to identify patients with impaired CVR. Six patients (10%) recovered from anaesthesia with an IOND, only one of which was disabling. Significant risk factors for IOND were: (i) age over 65 years (Odds Ratio 13.0 (95%CI 1.4-121), p = 0.013); (ii) a residual neurological deficit prior to operation (Odds Ratio 7.0 (95%CE 1.1-43), p = 0.038); (iii) complex plaque morphology (Odds Ratio 6.4 (95%CI 1.06-34), p = 0.046); and (iv) the combination of impaired CVR and a CT scan infarct in the symptomatic hemisphere (Odds Ratio 9.8 (95%CI 1.5-62), p = 0.026). These observations suggest that certain risk factors for IOND can be identified preoperatively and this may enable a more discriminating approach to patient selection for operation and a more critical evaluation of operative technique and methods for intra-operative protection and monitoring in the future.

Age Factors↗
PubMed1991

Skewflap versus long posterior flap in below-knee amputations: multicenter trial.

A multicenter trial of alternative techniques for below-knee amputation is described in which surgeons in 11 centers randomized 191 patients with end-stage occlusive vascular disease to two different methods of stump construction. The skewflap technique was performed in 98 and the long posterior flap was performed in 93. The two groups were well matched in respect to age, sex, smoking, diabetes, and indications for amputation. Early outcome was compared in terms of 30-day mortality rate: skew 11 (11%) deaths versus long posterior flap 16 (17%); the state of the wound at 1 week (primary healing 60% in both groups); the need for surgical revision at the same level 7 (7%) versus 7 (8%), and revision to a higher level 10 (10%) versus 7 (8%). Follow-up information at 6 months was available from records or by mailed questionnaire in 188 (98%) at 6 months, 20 died during that interval. It showed that a prosthetic limb was fitted to 64 (84%) of skew flaps and 50 (77%) of long posterior flaps. Walking, alone or with support, was achieved in 59 (78%) and 46 (71%), respectively. None of these differences reached statistical significance. It is concluded that the skew flap is just as effective as the long posterior flap and is an excellent option for below-knee amputation.

Aged↗
PubMed1991

Edinburgh Artery Study: prevalence of asymptomatic and symptomatic peripheral arterial disease in the general population.

Intermittent claudication has been studied in cardiovascular surveys but limited information is available on asymptomatic peripheral arterial disease. The purpose of this paper is to describe the prevalence of both asymptomatic and symptomatic disease and relation to ischaemic heart disease in the Edinburgh Artery Study. A cross-sectional survey was conducted on an age-stratified sample of men and women aged 55 to 74 years selected from age-sex registers in ten general practices in the city. Arterial disease was assessed in 1592 participants by means of the WHO questionnaire on intermittent claudication and measurement of the ankle brachial systolic pressure index (ABPI) and change in ankle systolic pressure during reactive hyperaemia. The prevalence of intermittent claudication was 4.5% (95% confidence interval (CI): 3.5%-5.5%). Major asymptomatic disease causing a significant impairment of blood flow occurred in 8.0% (95% CI: 6.6%-9.4%). A further 16.6% (95% CI: 14.6%-18.5%) had criteria considered abnormal in clinical practice: 9.0% had ABPI less than 0.9 and 7.6% had reactive hyperaemia pressure reduction greater than 20%. Intermittent claudication was equally common in both sexes. The ABPI and reactive hyperaemia results suggested a slight preponderance of asymptomatic disease in males and were consistent with an increasing prevalence with age and lower social class. Mean ABPI was higher in normal men than women, and was lower in the left leg than the right suggesting a unilateral predisposition to disease. Subjects with major asymptomatic disease had more evidence of ischaemic heart disease than in the normal population (relative risk (RR) 1.6; 95% CI: 1.3-1.9).(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1991

Echocardiography in acute limb ischaemia.

In a retrospective study carried out over a 5-year period, 88 patients with acute limb ischaemia underwent echocardiography. Of this group, 74 were thought to have an embolic cause of ischaemia on either operative or arteriographic findings. Two-dimensional echocardiography detected a cardiac source in 30 patients (sensitivity 41%, specificity 100%). Clinical examination on admission correctly indicated an embolic source in 36 patients (sensitivity 49%, specificity 36%). The combination of echocardiography and clinical examination detected an embolic source in 60 of 74 (81%) patients. In this study echocardiography complemented clinical examination in the diagnosis of a cardiac source of acute limb ischaemia.

Acute Disease↗
PubMed1991

Doppler colour flow imaging in peripheral arterial disease.

Duplex scanning is unique in its ability to provide both anatomical and physiological information about the circulation, but it is time-consuming and difficult to perform. Technological advances now allow the Doppler information to be colour-coded, making scanning both quicker and more accurate. This article describes the technique and potential use of Doppler colour flow imaging in the investigation and treatment of peripheral arterial disease.

Arterial Occlusive Diseases↗
PubMed1990

Vacuum drainage of groin wounds after vascular surgery: a controlled trial.

A pilot study of 100 consecutive groin wounds after vascular surgery demonstrated lymph leaks in 12 per cent. Lymph leak was significantly associated with wound infection and with prolongation of in-patient stay. A controlled trial was therefore instituted to assess the influence of vacuum drainage in groin wound healing. One hundred and twenty-seven wounds were randomized to drainage (n = 65) or no drainage (n = 62) and the wounds were examined 'blind' by independent observers. No difference in the incidence of lymph leakage or wound infection was noted between the two groups. The routine use of suction drainage for groin wounds in vascular surgery is unnecessary.

Aged↗