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R J Ashleigh

Publications and source records attributed to R J Ashleigh.

11 recordsLinked to original sources
PubMed2005

A cross-site vascular radiology on-call service: the Manchester experience.

AIM: A cross-site vascular radiology on-call service was established 5 years ago to cover two vascular centres in Manchester. We aimed to review the service. MATERIALS AND METHODS: A prospective audit of out-of hours referrals and procedures over a three month period (March-May 2003) was undertaken. RESULTS: There were 52 incidents in 49 patients (mean 4 calls per week). Nine involved telephone advice only, the remainder (82%) required a procedure. Angiography was performed on 88% of patients and therapeutic radiological intervention on 50%. 71% of calls occurred at a weekend. 50% of the calls were from vascular surgery and 50% from other sources. The consultant vascular radiologist was present for 93% of procedures. CONCLUSIONS: The workload suggests that a vascular radiology on call service is justified in Manchester. There have been no major problems with its implementation and operation. This is a consultant led service, with very few cases being devolved to a specialist registrar (SpR).

After-Hours Care↗
PubMed2000

Early mobilization following angioplasty.

AIM: To assess the incidence of puncture site complications in in-patients undergoing early mobilization following angioplasty with a view to performing day case angioplasty. MATERIALS AND METHODS: One hundred and twenty-eight patients undergoing peripheral and renal angioplasty using a sheath size of up to 6 French were recruited prospectively. The mobilization protocol consisted of supine bed rest for 2 h, followed by gradual mobilization, so that the patient was ambulant 4 h after the procedure. Mobilization was delayed if clinically appropriate. Puncture sites were scored for discomfort, paraesthesia, visible bruising and palpable haematoma after groin compression and the following morning. RESULTS: One hundred and forty-four puncture sites were studied. There were 44 haematomas in total, of which 37 (26%) were less than 2.5 cm and seven (4.9%) were between 2.5 cm and 7.5 cm. Four patients (2.8%) had visible bruising greater than 7.5 cm. No patient assessed discomfort higher than moderate at any stage. Mobilization was delayed in 15 patients. In 11 this was due to puncture site oozing, haematoma in one, two were hypertensive and one required surgery for limb ischaemia. All complications occurred within 4 h of angioplasty. No patient required surgery or transfusion for haemorrhagic complications. CONCLUSION: Mobilization at 4 h was successful in 90% of cases but 10% require more prolonged bed rest. No delayed complications occurred. These results suggest that day case angioplasty is feasible in most cases.Butterfield, J. S. (2000). Clinical Radiology55, 874-877

Adult↗
PubMed2000

A comparison of bolus chasing and static digital subtraction arteriography in peripheral vascular disease.

The purpose of this study was to compare the techniques of bolus chasing angiography (BCA) and digital subtraction angiography (DSA). 75 patients with symptomatic atherosclerotic peripheral vascular disease were randomly assigned to have their lower limbs examined by BCA or DSA. Dose-area product (DAP), time of examination and dose of contrast medium were measured. Staff doses were measured with personal electronic dosemeters. Image quality was assessed from the laser printed images. DSA produced better images of vessels below the inguinal ligament, particularly the crural vessels (1/76 vs 17/74 non-diagnostic examinations, p < 0.00001) but at a higher DAP (median 53.8 Gy cm2 vs 18.9 Gy cm2, p < 0.01). Contrast medium dose was higher with BCA (29.8 gI2 vs 25.3 gI2, p < 0.01). Staff doses per unit patient dose were 2.3-3.3 times higher with BCA than DSA. Because of the poor long-term prognosis of patients with peripheral vascular disease, the improved image quality obtained by DSA justifies the increased radiation dose.

Aged↗
PubMed1998

Result of angioplasty of brescia-cimino haemodialysis fistulae: medium-term follow-up.

AIM: To determine the results of transluminal angioplasty in patients with Brescia-Cimino arteriovenous fistulae. PATIENTS AND METHODS: Thirty-one patients underwent transluminal angioplasty of 36 stenotic lesions related to Brescia-Cimino arteriovenous fistulae over a 5-year period. The lesions treated were characterized by review of pre-angioplasty fistulograms. Medical and radiological records were reviewed to assess medium-term patency of each patient's fistula. RESULTS: Angioplasty was performed successfully in 28 out of 31 patients initially (90% technical success rate). Duration of follow-up for the 31 patients ranged from 4 to 65 months (median = 34 months). At 6 months, seven patients required further surgical or endovascular intervention (18 patients remained event-free) and at 1 year, 10 patients required further endovascular or surgical intervention (14 patients remained event-free). Life-table analysis revealed primary patency rates of 77%, 64% and 39% at 6 months, 1 year and 2 years, respectively. At 6 months and 1 year, four and five patients, respectively, required surgical revision or closure of fistula. Secondary patency rates were 85%, 81% and 65% at 6 months, 1 year and 2 years, respectively. All patients with a primary patency at 2 years remained event-free during the follow-up period. CONCLUSIONS: Transluminal angioplasty is an effective treatment for stenoses developed in relation to Brescia-Cimino haemodialysis fistulae. Further endovascular procedures may be required, especially in the first 24 months, to preserve patency. These techniques extend the lifetime of fistulae, thereby preserving proximal venous access sites for future use. Our result is in broad agreement with results from other series.

Angioplasty, Balloon↗
PubMed1995

Technical note: inspiration or expiration? Reducing motion artefact in digital subtraction arch angiography of the extracranial carotid arteries.

100 consecutive patients underwent digital subtraction aortic arch angiography for suspected carotid bifurcation disease. Patients were prospectively randomized to suspend respiration in inspiration or expiration during image acquisition. Images were assessed qualitatively as "excellent", "adequate" or "poor". 92 studies were available for review. Adequate and poor groups were combined into a non-excellent group due to the small numbers that were scored poor. There were 27 (53%) excellent, 24 (47%) non-excellent in the expiration group and 12 (29%) excellent, 29 (71%) non-excellent in the inspiration group. Analysis of angiogram scores gave chi 2(1) = 4.3; p = 0.038, indicating that the higher angiogram scores of the expiration group were statistically significant. Pixel shifting was used in 61 cases (66.3%). The proportion was 34.4% lower in the expiration group (95% CI; 17-52%) with chi 2(1) = 10.5; p = 0.0012 indicating that the reduction in the use of pixel shifting for the expiration group was statistically significant. The superiority of arch angiograms obtained with the patient suspending respiration in expiration rather than inspiration has been demonstrated. This was achieved with significantly reduced use of pixel shifting, encouraging greater confidence in the validity of the angiographic findings. The technique is free of cost or time implications.

Adult↗