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C V Ruckley

Publications and source records attributed to C V Ruckley.

At least 145 records · Page 8Linked to original sources
PubMed1993

Edinburgh Regional Vascular Surgery Unit: development of emergency practice 1983-1992.

Emergency referrals made to the Edinburgh Regional Vascular Surgery Unit in the first two months of 1983, 1987 and 1992 have been analysed with respect to demographic information, source, diagnosis and management. The total number of referrals made in the study period of each year was 72, 129 and 200 respectively. The male to female ratio was 1:1 for each year. Patients referred in 1992 were significantly older than those referred in 1983 (P < 0.05 by two-sample t test). The marked increase in the number of referrals from other hospitals and centres has been largely responsible for the dramatic threefold increase in the emergency workload. Overall, 80% of patients were referred with arterial disease and in over 50% this was infra-inguinal. In 1983, 50% of acute limb ischaemia was embolic compared with less than 25% in 1992. There has been a marked increase in the number of asymptomatic and symptomatic but non-ruptured abdominal aortic aneurysms referred compared with only a small increase in the number of ruptured aneurysms. Vascular access for renal dialysis remains an important part of the overall workload. Overall, 50% of patients referred were admitted and 37.5%, 26.5% and 15.5% of patients underwent emergency surgery in 1983, 1987 and 1992 respectively.

Adult↗
PubMed1993

Foot volumetry can predict recurrent ulceration after subfascial ligation of perforators and saphenous ligation.

PURPOSE: The purpose of this study was to determine whether foot volumetry is of value in predicting the outcome after superficial venous surgery for chronic venous ulceration. METHODS: Fifty-three patients who underwent subfascial ligation of perforating veins with or without saphenous vein ligation for recurrent venous ulceration had foot volumetry performed before operation, immediately after operation (1 month), and at regular intervals during follow-up (median 60, range 3 to 144 months). RESULTS: Fourteen patients (26%) had recurrent ulceration (median time to recurrence 48, range 10 to 72 months) and 39 patients remained ulcer free. Before operation expulsion fraction (EF) and half refilling time (HRT) were significantly higher in the no recurrence group. Both groups gained improvement in EF and HRT from their surgery; however, although this was sustained in the no recurrence group, by the time of first recurrence in the recurrence group, EF and HRT had returned to preoperative levels. CONCLUSIONS: Preoperative foot volumetry can therefore predict failure after subfascial perforator and saphenous vein ligation, probably by identifying patients with deep venous incompetence. After operation deterioration in foot volumetry and can also be used to predict the onset of recurrent ulceration.

Adult↗
PubMed1993

Above-knee femoropopliteal bypass grafts and the consequences of graft failure.

In all, 290 femoral to above-knee popliteal artery bypasses were performed between January 1983 and September 1991. PTFE grafts were used in 113 cases (39%) and vein grafts in 177 (61%) (reversed in 146 cases and in situ in 31). Patients were followed up for a median time of 20 months. The 2-, 4- and 6-year patency rates for vein and PTFE grafts were 70%, 62% and 57%, respectively, compared with 58%, 46% and 41% (no statistical difference in survival curves, P = 0.2). The 2-, 4- and 6-year limb salvage rates were 82%, 78% and 62% compared with 75%, 64% and 58% (no statistical difference in survival curves, P = 0.6). A total of 99 grafts occluded during follow-up (45 PTFE and 54 vein grafts). Major amputation was required in 63 limbs; below-knee in 37 limbs (59%), and above-knee in 26 limbs (41%). There was no statistical difference in the amputation level with respect to the graft type. Final healing at the below-knee level was achieved in 23 of 35 (66%) failed vein grafts and in 14 of 28 (50%) failed PTFE grafts.

Adult↗
PubMed1993

Accuracy and reproducibility of duplex ultrasonography in grading femoropopliteal stenoses.

PURPOSE: The aim of this study was to determine the accuracy of Doppler waveform characteristics in grading femoropopliteal stenoses and to determine the interobserver and intraobserver reproducibility of measuring the same waveform characteristics. METHODS: Thirty patients with isolated areas of stenosis found by arteriography were evaluated by color duplex sonography. Each patient underwent scanning by two observers on two separate occasions. Each observer was blind to the other's results. Doppler spectra were recorded in areas where color change suggested the highest velocity and also at the nearest normal proximal area. Peak systolic velocity, spectral broadening, and waveform configuration were measured at each site. RESULTS: An increase in peak systolic velocity of more than 200% accurately predicted a 50% or greater reduction in luminal diameter on angiography (70% sensitivity, 96% specificity). The presence of spectral broadening and an abnormal waveform shape were found to correlate poorly with the degree of stenosis. Analysis of variance showed no significant difference between observers in velocity measurements (p = 0.78). CONCLUSIONS: We conclude that although stenoses of greater than 50% can be distinguished from minor stenoses, more precise definition of the degree of narrowing is unlikely. The good repeatability of the velocity ratio makes it an excellent tool for monitoring major changes in the progression of disease.

Analysis of Variance↗
PubMed1993

Accuracy and reproducibility of duplex ultrasound imaging in a phantom model of femoral artery stenosis.

PURPOSE: The improvement of management strategies in patients with intermittent claudication might depend on a better understanding of the natural history of femoral atherosclerosis. The grading of stenoses, the monitoring of their progression, and the assessment of response to treatment are critically dependent on a method's accuracy and variability. Duplex ultrasound imaging provides a noninvasive way of measuring localized disease, but there has been relatively little objective evaluation of its accuracy and reproducibility. The aim of this study was to evaluate the accuracy and variability of duplex velocity ratio measurements of stenosis. METHODS: In a laboratory flow model of the femoral artery, 14 concentric and eccentric stenoses were examined five times by three sonographers. Measurements were then repeated with a standardized technique in which Doppler angle and aperture position were fixed, giving a total of 420 measurements. RESULTS: Velocity ratio showed good correlation with degree of stenosis, R2 = 0.996. Intraobserver variability was low, but interobserver variability was significant with more severe stenosis (p = 0.002, analysis of variance). Standardization of the technique did not improve accuracy or variability. The 95% confidence limit was +/- 20% for a single reading of velocity ratio for stenoses of > 50% diameter reduction. CONCLUSIONS: We conclude that duplex ultrasound imaging can be used to accurately grade arterial stenosis in this range, and the potential exists for noninvasive monitoring of the progression of preocclusive femoral atherosclerosis and its response to treatment. In addition, repeated measurements of velocity ratio over time should be made by the same observer.

Analysis of Variance↗
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↗