OAR@UM Collection:

Comparison of long-term results of lower limb bypass grafts using autogenous vein and prosthetic grafts

2019-01-01T00:00:00Z

Title: Comparison of long-term results of lower limb bypass grafts using autogenous vein and prosthetic grafts Abstract: Purpose: Infra-inguinal revascularisation surgeries performed locally involve either an autogenous vein or a prosthetic graft as a conduit. Local follow-up of patients post-operatively includes surveillance ultrasound scans for patients with an autogenous bypass graft compared to a single ultrasound scan one week post-operatively for patients with a prosthetic graft. The literature indicated conflicting studies with regards to the effectiveness of ultrasound surveillance for prosthetic bypass grafts after infra-inguinal revascularisation. Objectives: To compare patency rates and subsequent success rates of prosthetic bypass grafts when compared to autogenous vein grafts, of a cohort of patients who had undergone infrainguinal bypass surgery at a local general hospital in Malta. Another objective was to evaluate whether more regular follow-up ultrasound scans may be useful for patients undergoing revascularisation using a prosthetic bypass graft. Methodology: The study adopted a quantitative, descriptive, non-experimental research design that involved the collection of retrospective and prospective data. The sampled population comprised of 120 patients (62 prosthetic and 58 autogenous) who had undergone infrainguinal bypass revascularisation between 2008 and 2018 at a general hospital in Malta. Patients with a prosthetic bypass graft were prospectively recruited for a duplex ultrasound scan, during which measurements were taken to determine graft patency at a given postoperative date. Retrospective data pertaining to a cohort of patients who had underwent ultrasound surveillance for autogenous bypass revascularisation was also collected. Attention was taken to ensure that both cohorts comprised of patients with similar characteristics, so as to allow better comparison of findings. A Kaplan-Meier curve was used to demonstrate patency rates in the two groups of subjects in the study. Results: No significant differences were observed with respect to demographic data and risk factors between the two groups. Long-term patency results were found to be statistically significant (p = <0.001), with prosthetic grafts demonstrating overall patency rates of 40.3%, while that of autogenous grafts being 82.7%. Primary patency of prosthetic and autogenous grafts were 35.5% vs 53.4%, primary-assisted 37.1% vs 81.0% and secondary patency 40.3% vs 82.7% respectively, over a mean follow-up period of 1.7 years for prosthetic and 3.5 years for autogenous grafts. Major amputations were required in 17.7% of patients with a prosthetic graft compared to 0% of patients with an autogenous graft. Conclusion: The findings from this small scale study indicate that autogenous bypass grafts had superior long-term patency results and therefore remain the conduit of choice for revascularisation procedures. Graft occlusion and limb loss was significantly greater in patients with a prosthetic graft. Further research is required to determine whether ultrasound surveillance scans in patients with prosthetic grafts would improve patency rates. Description: M.SC.RADIOGRAPHY

Assessing and improving the ticket of referral to a national vascular clinic

2019-01-01T00:00:00Z

Title: Assessing and improving the ticket of referral to a national vascular clinic Abstract: Purpose: Patients requiring specialist treatment at the national vascular clinic are referred through a ticket of referral completed by a referring clinician. This ticket of referral is intended to provide the vascular specialist with the relevant information to determine the degree of urgency of the referral. In 2009 a study was conducted locally where the quality of the tickets of referral was evaluated. Research Questions: Has there been a change in quality in the tickets of referral since the study conducted in 2009? How can the ticket of referral be improved in practice? What information should ideally be included in the ticket of referral to the vascular clinic? Methodology: The research design employed was a Mixed Methods Design. For the quantitative phase, 200 tickets of referral received at the vascular clinic were evaluated. Statistics were applied to identify any statistically significant differences between the results of the two studies. The qualitative part consisted of a Delphi method, where seven experts in the vascular field were invited to participate. Results: The patient’s demographic and referring doctor’s details showed a significant improvement compared to the study performed in 2009. However, the information relating to vascular pathology remained the same and some even deteriorated. Additionally, the legibility of the tickets of referral fared worse than the previous study. Through the Delphi method, the respondents were in favour of a new referral specifically to the vascular clinic as this would serve as a checklist for the referring doctor to provide all the required information. Conclusions: It was concluded that the quality of the current tickets of referral to the vascular clinic was poor and remained poor compared to ten years ago, if not worse. Improvement mainly should be focused on the vascular related information and legibility of the tickets of referral. Therefore, referring doctors’ training is recommended together with a new vascular referral in both online and paper form. Description: M.SC.RADIOGRAPHY

Investigating the need for further ultrasound follow-up scans after radiofrequency ablation of the great saphenous vein

2019-01-01T00:00:00Z

Title: Investigating the need for further ultrasound follow-up scans after radiofrequency ablation of the great saphenous vein Abstract: Follow-up of patients post Radiofrequency ablation (RFA) of the Great Saphenous vein (GSV) is only carried out once locally, 6 weeks post ablation. The literature indicated that RFA is effective, yet studies reviewed were inconclusive with regards to follow-up timing strategies. In Malta, no study was previously carried out evaluating the success rate of RFA treatment after 6 weeks post RFA. Objectives The objective of the study was to investigate the success rate of RFA of the GSV performed in a state general hospital in Malta. This was done by scanning patients with ultrasound at different follow-up time intervals post RFA. Another aim was to justify if additional ultrasound follow-up scans need to be carried out post RFA. Methodology The research design adopted was a quantitative, prospective, descriptive and a nonexperimental one. Forty patients (52 limbs) who underwent RFA between January 2016 and January 2019 by the same vascular consultant were included in this study. These patients had to have had RFA performed within the following time frame: 6 months, 1 year, 1.5 years, 2 years, 2.5 years and 3 years, from the start of the data collection period. These patients were assessed by carrying out a clinical examination of the treated limb, followed by an ultrasound scan carried out by the researcher. Results Results indicated that the rate of occlusion of the GSV post RFA was successful in 92.5% of the participants (49/52 limbs). Moreover, no statistical relationship was seen between occlusion failures and the timing of the follow-up ultrasound scans post RFA. Orthopaedic surgery post RFA was the only risk factor associated with recanalisation. Conclusion It was concluded that no follow-up scans post RFA are needed, other than the routine 6 week visit. Description: M.SC.RADIOGRAPHY

Evaluation of International Ovarian Tumour Analysis Simple Rules and Risk of Malignancy Index to distinguish benign and malignant adnexal masses in the local scenario

2019-01-01T00:00:00Z

Title: Evaluation of International Ovarian Tumour Analysis Simple Rules and Risk of Malignancy Index to distinguish benign and malignant adnexal masses in the local scenario Abstract: Purpose: Adnexal masses are a common gynaecological problem. Early diagnosis of the nature of the adnexal mass is imperative in order to guide the patient’s management and improve prognosis. Ultrasound! is an important tool in the diagnosis of adnexal masses. A number of ultrasound scoring systems have been proposed to facilitate the discrimination between benign and malignant adnexal masses. The IOTA Simple Rules are a set of rules which can be used to predict benignity or malignancy. The RMI is a model incorporating ultrasound features, serum level of Ca125 and menopausal status, which may be used as a risk assessment tool. Objectives: To evaluate the efficacy of the IOTA Simple Rules and RMI in discriminating benign and malignant adnexal masses and establish. Their use as a tool in the early diagnosis of adnexal masses in the local clinical scenario. Methodology: A hospital-based prospective, quantitative, analytical, interventional, correlational study was carried out. Women who were diagnosed with an adnexal mass were scanned by an ultrasonographer and the mass was categorised into benign or malignant categories according to the IOTA Simple Rules and RMI. After the women underwent surgery, the predicted diagnosis by ultrasound was correlated with the goldstandard of histopathological diagnosis. The collected data was statistically analysed using the independent samples t-test and chi-square test. Results: Twenty-two women with adnexal masses were recruited for the study. The IOTA Simple Rules were applicable in nineteen adnexal masses. All twenty-two cases were classified by RMI. The sensitivity, specificity, positive predictive value and negative predictive value of the IOTA Simple Rules and RMI were 100%, 100%,100% and 100%, respectively. Conclusion: Both the IOTA Simple Rules and RMI were equally efficient in differentiating benign and malignant adnexal masses preoperatively with satisfactory reproducibility and ease of use. Description: M.SC.RADIOGRAPHY