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Biomedical subjects

P T McCollum

Publications and source records attributed to P T McCollum.

At least 19 recordsLinked to original sources
PubMed2000

Tibial and peroneal artery bypasses using polytetrafluoroethylene (PTFE) with an interposition vein cuff.

UNLABELLED: The combined results of femoro-distal bypasses using prosthetic material with vein cuffs from two separate vascular units is presented. METHOD: Over the last five years, 89 infrainguinal bypasses using polytetrafluoroethylene (PTFE) with a distal interposition vein cuff to a tibial artery have been performed in two centres. All operations were for critical limb ischaemia. The mean age was 72 years (47-90), there were 46 males and 43 females, 27 of whom were diabetic. Twenty-eight patients had a history of angina and/or previous myocardial infarct. The median follow-up was 12 months (0-68 months). RESULTS: During the follow-up period there were 28 deaths, 35 major limb amputations and 44 graft failures. The graft patency rates at 12 and 24 months were 50 and 32%, and limb salvage rates were 53 and 44%, respectively. The patient survival rates were 66 and 61%, respectively. CONCLUSION: The authors believe that the likely improvement in pain free quality of life the patient may enjoy with a successful bypass shifts the balance in some individuals towards bypass surgery using PTFE with a vein cuff to a tibial artery when such an option is possible.

Aged↗
PubMed1999

Disruption of skin perfusion following longitudinal groin incision for infrainguinal bypass surgery.

OBJECTIVE: The objective of our study was to investigate whether such an incision results in a reduction in blood flow, and therefore haemoglobin oxygen saturation, across the wound. DESIGN: Microvascular oxygenation was measured with lightguide spectrophotometry in 21 patients undergoing femoropopliteal or femorodistal bypass procedures. A series of measurements were made in the groin, medial and lateral to the surface marking of the femoral artery. The mean oxygen saturation on each side was calculated, and the contra-lateral groin was used as a control. The measurements were repeated at 2 and 7 days postop. RESULTS: Oxygen saturation in the skin of the operated groins was increased significantly from baseline at 2 days postop (f = 25.80, p < 0.001) and had begun to return to normal by day 7. The rise was more marked on the lateral side of the wound than on the medial (f = 12.32, p < 0.001). There was no such difference in the control groins. All wounds healed at 10 days. CONCLUSIONS: These results show a significant difference in skin oxygenation between the lateral and medial sides of the groin following longitudinal incision. This may contribute to the relatively high incidence of postoperative infection in these wounds.

Aged↗
PubMed1999

Audit of the effect of introducing local guidelines for referral for carotid duplex scanning.

Guidelines for referral of patients for carotid duplex scanning were introduced stating that scans were only indicated for patients with hemispheric localising symptoms or asymptomatic bruits. A 19% reduction in referral rate was seen for new scans in a one year period. The number of "inappropriate" requests fell from 27.6% in 1994 to 12.8% in 1995. There was no reduction in the numbers of patients identified with effectively occult asymptomatic disease who may have been suitable for surgery in the same period. Guideline introduction had the effect of reducing unnecessary scans without any effect on the overall pick-up, rate for carotid disease.

Carotid Stenosis↗
PubMed1999

Accuracy of the recording of operative events by the Scottish Morbidity Record 1 (SMR1) for a teaching hospital vascular unit.

OBJECTIVE: To determine the accuracy of operative data collected for the Scottish Morbidity Record 1 (SMR1). DESIGN: Retrospective comparative analysis of operative data recorded by the Scottish Office Information and Statistics Division (ISD) with that recorded in a locally held vascular database where the clinical information was entered by medical personnel. SUBJECTS: All patients with a codeable operative procedure carried out under the care of a single consultant vascular surgeon in a Regional Vascular Unit in 1994. RESULTS: A total of 840 admissions involving at least one OPCS4 code were recorded in the Vascular Database and 793 by the Scottish Office ISD. Although there was good agreement of the total number of operations and admissions, operative codes for 23 patients undergoing major abdominal aortic surgery and 19 undergoing major limb reconstruction were not recorded by the ISD. This represents 14% of total major arterial reconstructions in a single year. CONCLUSION: Accurate data collection has wide implications for research, monitoring future health trends, and planning hospital bed numbers. SMR1 data may accurately record total number of admissions and operations but is poor at distinguishing between those admissions that may be resource-intensive.

Cardiovascular Surgical Procedures↗
PubMed1998

Management of iliac occlusions with a new self-expanding endovascular stent.

OBJECTIVES: To determine the patency and acceptability of the Memotherm endovascular stent in the treatment of iliac arterial occlusions. MATERIALS AND METHODS: Twenty-two patients (12 males and 10 females) underwent stenting of iliac occlusions of the aortoiliac bifurcation, the common iliac artery and the external iliac artery. All patients were reassessed at 3, 6 and 12 month intervals and then yearly to evaluate their symptoms and Doppler pressure measurements. Comparison was made with results from other studies treating iliac occlusions by angioplasty alone or combined with stenting. RESULTS: Out of 22 patients, 21 had an immediate and sustained improvement over the whole of the follow-up period. The Ankle-brachial Index (ABI) increased from a mean value of 0.49 to 0.81 3-months postprocedure and improved to 0.85 at 12 months (paired t-test p < 0.001). At 6 and 12 months the stent patency remained at 95.5%, which compares favourably with other studies. There were four minor and one major complication associated with the stenting procedure. CONCLUSIONS: The Memothern self-expanding stent is a useful, safe and effective device suitable for the majority of iliac occlusions. Further long-term evaluation is warranted to confirm its advantages over open surgery.

Aged↗
PubMed1997

Results and resource implications of treating end-stage limb ischaemia.

PURPOSE: To quantitate the workload, resource requirement and outcome involved in the management of patients with chronic limb-threatening ischaemia when adopting an aggressive reconstructive policy. METHODS: Prospective clinical audit of all patients with severe lower limb ischaemia presenting to a single specialist Vascular Surgeon in a 3 year period. RESULTS: A total of 228 patients were treated with 275 severely ischaemic limbs. Two hundred and thirty-five limbs (85.5%) had procedures to improve blood supply, 19 (6.9%) underwent primary amputation and 21 (7.7%) were treated conservatively. The principal outcome measures were limb-salvage, death and graft patency. The cumulative limb-salvage, including those undergoing primary amputation, at 30 days, 1, 2, 3 and 4 years was 94.2%, 82.7%, 73.1%, 68.3% and 65.3% respectively. The cumulative patient survival was 91.7%, 69.2%, 58.1%, 47.9% and 40.6% for the same intervals. For reconstructive vascular surgery, excluding amputation and rehabilitation, a total of 383 hospital admissions were required covering 7343 hospital days, 64.5% of patients were managed in a single admission. The median duration of stay was 16 days for the first admission. Operations included 361 separate procedures to improve blood supply and 70 major limb amputations. CONCLUSIONS: The management of chronic limb-threatening ischaemia presents major resource implications. An acceptable limb-salvage rate can be achieved although there is a high initial mortality. In view of the poor overall survival any benefits for these patients should be viewed as relatively short-term objectives.

Adult↗
PubMed1997

Glutaraldehyde-tanned bovine carotid artery graft for infrainguinal vascular reconstruction: 5-year follow-up.

OBJECTIVE: To assess the long-term patency of a modified biological conduit, the glutaraldehyde-tanned bovine carotid artery, in above-knee infrainguinal arterial reconstruction. PATIENTS AND METHODS: Prospective follow-up of a cohort of 58 above-knee femoropopliteal grafts in 55 patients. Graft patency was assessed at yearly intervals with doppler ankle pressure measurements. RESULTS: The median follow-up period has been 67 months. Nine grafts occluded within 30 days of surgery and a further 19 graft closures have been observed in the follow-up period. The overall cumulative primary graft patency at 1, 3 and 5 years was 70%, 61% and 56%, respectively. If the 30-day graft failures are excluded, the primary graft patency rises to 83%, 74% and 68% at 1, 3 and 5 years, respectively. Six limbs have been amputated, four above the knee and two below the knee. There were no graft aneurysms and no graft infections. CONCLUSION: Results indicate that the modified bovine carotid artery graft with an above-knee anastomosis does not seem to be inferior to PTFE, but is inferior to reversed vein. Modified biological conduits offer a reasonable alternative to synthetic grafts for infrainguinal arterial reconstruction and appear to maintain acceptable long-term mechanical stability.

Aged↗
PubMed1997

Carotid endarterectomy in the U.K. and Ireland: audit of 30-day outcome. The Audit Committee for the Vascular Surgical Society.

OBJECTIVES AND DESIGN: A prospective study of 709 patients undergoing carotid surgery in the U.K. and Ireland was performed to evaluate the performance of vascular surgeons. MATERIALS AND METHODS: Fifty-nine surgeons (range 2-39 cases each) were sampled and all patients undergoing surgery over a 6-month period (1 March 1994-31 August 1994) were included in the study. Indications for surgery were TIA (35.9%), AF (23.3%), CVA (21.4%) and "others" (19.6%). RESULTS: Mean ipsilateral stenosis was 82% (30%-99%). Thirty-one percent of patients had preoperative neurological consults. Shunts were used in 67.6%, tacking sutures in 40.1%, drains in 71.9% and patches in 54.4% of cases. At 30 days there were nine (1.3%) deaths (four cardiac, three neurological). There were 15 ipsilateral postoperative CVAs (2.1%); 19% of patients had one or more complication, usually minor. Statistical analysis showed no independent risk factor for CVA other than seniority of the surgeon. CONCLUSIONS: A combined stroke/death rate of 3% for the series was obtained at 30 days for all cases. This large, validated study suggests that members of the Vascular Society of G.B. and Ireland currently have a very low morbidity/mortality rate for performing carotid surgery. Continued audit is required to ensure that this quality of service does not deteriorate.

Adult↗
PubMed1997

Mesenteric revascularisation for acute-on-chronic intestinal ischaemia.

Eleven patients (eight women) underwent urgent revascularisation for acute-on-chronic mesenteric ischaemia. Four patients had dual vessel and seven single vessel reconstructions. Two patients underwent simultaneous bowel resection and one patient has had three separate grafts to the superior mesenteric artery. There were two peri-operative deaths and three have died in the late follow-up period after 18, 24 and 36 months. The remainder have survived for between five and 63 months. Revascularisation for acute-on-chronic mesenteric ischaemia has been shown to be technically possible and of substantial benefit to patients who would otherwise be treated as terminal cases.

Acute Disease↗
PubMed1997

Use of lightguide spectrophotometry to investigate the effect of postural changes on skin oxygenation in deep venous insufficiency.

BACKGROUND: Postural changes play an important role in the development of venous disease. The aim of this study was to investigate skin oxygenation in patients with deep venous insufficiency. METHODS: Haemoglobin oxygen saturation (SO2) was measured with macro- and micro-lightguide spectrophotometry in clinically normal skin at the gaiter area with the leg in the supine position, raised to 45 degrees and on standing. Similarly, transcutaneous oxygen tension (PtcO2) and laser Dopper flux (LDF) values were obtained. SO2 was also measured after heating the skin to 44 degrees C in the supine and standing positions. RESULTS: SO2 and PtcO2 decreased on leg raising (P < 0.05 and P < 0.01 respectively). SO2 fell on standing (P < 0.05) while PtcO2 rose (P < 0.05). On heating the skin, SO2 increased (P < 0.05) on standing. LDF fell on standing (P < 0.005) but increased on leg raising (P < 0.05). CONCLUSION: Lightguide spectrophotometry showed a profound decrease in skin oxygenation on standing and leg raising; PtcO2 measurements may miss the role of vasoconstriction with postural changes.

Adult↗