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Venous thromboembolism (VTE) is a term used to include the formation of a blood clot (a thrombus) in a vein which may dislodge from its site of origin to travel in the blood, a phenomenon called embolism. A thrombus most commonly occurs in the deep veins of the legs; this is called deep vein thrombosis. A dislodged thrombus that travels to the lungs is known as a pulmonary embolism.

NICE Clinical Guidelines - National Clinical Guideline Centre – Acute and Chronic Conditions (UK).

Version: 2010

This guideline intends to show the place of both new and established treatments in the wider care pathway for Crohn's disease. This will be useful for clinicians and people with Crohn's disease because new drugs have been licensed for Crohn's disease in the last decade. The guideline also deals with those medications which are unlicensed for treatment of the condition, but which have been used in this way (off-label) for many years and their role is recognised in other NICE documents as well as the British National Formulary. They include azathioprine, mercaptopurine and methotrexate. The guideline aims to help improve the care offered to people with Crohn's disease and provide information about the clinical and cost effectiveness of potential care pathways. Management of Crohn's disease in specific populations (for example, in pregnancy) may require special consideration.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: October 10, 2012

Patients undergoing major vascular surgery are at high risk of complications around the time of their surgery. This is because many of them have generalised arterial disease. During surgery blood flow is reduced at the site of surgery, which results in a lack of oxygen and nutrients being delivered to the body tissues (ischaemia). After the blood supply is restored, further damage can occur because of cellular responses and the blood flushing through the tissues. This is known as ischaemia‐reperfusion injury.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

As the population is ageing, more people will undergo major vascular surgery, which carries an increased risk of cardiac complications. The increased risk of cardiac complications is often the result of asymptomatic heart disease. Treating severe symptoms, such as critical limb ischaemia (severely narrowed arteries of the lower limbs resulting in rest pain, ulcers, or gangrene), in people with peripheral arterial disease is a common reason for undergoing vascular surgery, which carries an increased risk heart attack (myocardial infarction) ranging from 5% to 24% during and shortly after surgery. There is clear evidence for the use of beta‐blockers (a class of medications used to treat certain heart conditions as well as high‐blood pressure and other conditions) to reduce cardiac risk in people with known heart disease, and it has been suggested that beta‐blockers may reduce short‐term cardiac illness (morbidity) and death (mortality) in people undergoing major non‐cardiac vascular surgery.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

In July 2012 we searched medical databases for controlled trials of participants who had undergone aortic or arterial surgery and were randomly assigned to either statins or placebo (or standard care). Many vascular surgery patients are already taking statins; therefore we also included trials that randomly assigned participants to different doses of statin. Statin treatment should have been started any time between the decision to operate and performance of the operation and continued for at least 48 hours after the operation. We wanted to investigate the effect of this short‐term statin therapy on the risk of death and cardiovascular events such as heart attack and stroke within 30 days of surgery. We also considered adverse effects of statins such as muscle pain.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

The purpose of this report is to identify and summarize the evidence for clinical utility, as well as evidence-based clinical guidelines, on the use of viscoelastometric point-of-care testing (POCT) for vascular surgery and obstetrical hemorrhage patients.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: January 4, 2016

Bibliographic details: Wiseman JT, Guzman AM, Fernandes-Taylor S, Engelbert TL, Saunders RS, Kent KC.  General and vascular surgery readmissions: a systematic review. Journal of the American College of Surgeons 2014; 219(3): 552-569.e225067801

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Atherosclerosis is a chronic inflammatory process that is responsible for reduced blood flow to some parts of the body, including the lower limbs. People who do not receive adequate treatment can lose their lower limbs. Bypassing arterial vascular obstruction in the legs is a surgical procedure that improves blood flow to reduce leg pain and sometimes to improve function. The mortality rate can be 10.5% after acute occlusion of an arterial blood vessel. The surgical procedure can improve outcomes when performed up to 12 hours after symptoms are first noted. Usually the procedure is performed with the patient unconscious and under general anaesthesia or awake but with legs numbed by neuraxial anaesthesia. Neuraxial anaesthesia may be administered as an injection of local anaesthetic around the spinal cord either in the back (spinal anaesthetic) or in the area where the nerves from the legs come together (epidural anaesthesia). A combination of general and neuraxial anaesthesia can be used. Other types of anaesthesia are used less often. At present, no single guideline shows why one anaesthetic technique is better than another. This systematic review is important because review authors assessed the risk of important outcomes after lower‐limb revascularization with the participant under neuraxial or general anaesthesia. They performed this systematic review to answer a single research question: What are the rates of death and major complications with spinal and epidural anaesthesia as compared with other types of anaesthesia for lower‐limb revascularization? In this second update of the Cochrane review, we searched the databases until April 2013 but found no new studies. The total number of participants in the four included studies was 696, of whom 417 received neuraxial anaesthesia and 279 received general anaesthesia. No evidence revealed differences in postoperative risk of death, myocardial infarction or leg amputation between the two types of anaesthetic. The risk of pneumonia was 9% after neuraxial anaesthesia and 20% after general anaesthesia. Evidence was insufficient to show the effects of neuraxial anaesthesia compared with other types of anaesthesia on cerebral stroke, duration of hospital stay, postoperative cognitive dysfunction, complications in the anaesthetic recovery room and transfusion requirements. No data described nerve dysfunction, postoperative wound infection, patient satisfaction, postoperative pain score, claudication distance and pain at rest. One study recruited more than 50% of all reported cases.This systematic review shows that neuraxial anaesthesia may reduce the risk of pneumonia after lower‐limb revascularization, but evidence is insufficient to support other benefits or harms. 

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

A surgical drain is a tube used to remove blood, pus or other fluid from a wound. We reviewed the evidence about whether inserting wound drains following leg artery surgery resulted in fewer complications compared with no drains.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

We reviewed the evidence on two drugs that are used to lower blood pressure (angiotensin‐converting enzyme inhibitors (ACEIs) or angiotensin II type 1 receptor blockers (ARBs)) around the time of surgery for reducing the risk of death and serious illness in adults undergoing surgery using a general anaesthetic.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2017

The most common symptom of chronic lower limb ischaemia (inadequate blood flow to the legs) is claudication, a cramping pain caused by a poor supply of blood to the affected muscle. It often affects the calf muscle, and is typically triggered by exercise and relieved by rest. More severe restriction of the blood supply may produce pain at rest, leg ulcers, or gangrene. These conditions, and severe claudication, may require bypass surgery or other treatments to improve blood flow to the leg.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: April 3, 2017

A person with severely diseased arteries in the leg(s), can experience pain on walking only short distances (critical claudication), pain at rest, or death of tissues in the leg. When the main thigh artery has a long blockage, the best option is to insert a bypass to carry the blood from an artery with good blood flow to the affected artery below the block. Bypass is intended to save limbs that might otherwise require amputation. The different types of material available to create the bypass include the person's own vein (autologous vein), human umbilical vein (HUV) and synthetic materials polytetrafluoroethylene (PTFE) or Dacron, alone or with the blood thinning agent heparin bonded to the inside of the graft. It has been clear for some time that bypass grafts extending to below the knee do not remain patent with good blood flow as well as do above the  knee grafts. The aim of this review was to determine the most effective type of material. We identified 13 randomised controlled trials that included 2313 patients, 1955 patients undergoing above the knee and 358 below the knee grafts.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

People with heart disease and diseased leg arteries often undergo investigations and treatments that involve placing a needle into the main artery in the groin (endovascular procedures, for example diagnostic arteriogram, angioplasty, cardiac catheterization). One possible complication is the formation of a large swelling in the artery (a pseudoaneurysm) in the groin. This happens when the hole that the needle makes in the wall of the artery does not seal properly afterwards and blood collects, causing pain, swelling and bruising. Small pseudoaneurysms may clot spontaneously or surgery may be required. Less invasive treatment is now possible to stop the blood flow into the swelling. This involves sedation or analgesia to allow pressure to be placed over the puncture in the artery using a special mechanical device or a probe guided by ultrasound. Another option is injection of a clotting agent (thrombin) through the skin into the swelling.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Anti‐vascular endothelial growth factor (VEGF) agents versus control or mitomycin C (MMC) for the outcome of trabeculectomy.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

This study found the use of the Aneurysm Repair Decision Aid (ARDA) provides detailed information on the potential consequences of abdominal aortic aneurysm repair or a decision not to repair that may be helpful to vascular surgeons and their patients in reaching informed decisions. The economic evaluation suggests that using the ARDA compared with current guidelines could be cost-effective but there is a high level of uncertainty.

Health Technology Assessment - NIHR Journals Library.

Version: April 2015

The purpose of this project was to provide national guidance on the optimal use of 99mTc during a situation of reduced supply. To accomplish this, our objective at CADTH was:

Optimal Use Report - Canadian Agency for Drugs and Technologies in Health.

Version: 2012

OBJECTIVE: The objective of this systematic review is to evaluate the results of clinical studies on laparoscopic surgery for aorto-iliac disease.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2007

In cardiovascular surgery, reduced organ perfusion and oxygen delivery contribute to increased postoperative morbidity and prolonged intensive care unit stay. Goal-directed therapy (GDT), a perioperative haemodynamic strategy aiming to increase cardiac output, is helpful in preventing postoperative complications, but studies in the context of cardiovascular surgery have produced conflicting results. The purpose of the present meta-analysis is to determine the effects of perioperative haemodynamic goal-directed therapy on mortality and morbidity in cardiac and vascular surgery. MEDLINE, EMBASE, The Cochrane Library and the DARE databases were searched until July 2011. Randomized controlled trials reporting on adult cardiac or vascular surgical patients managed with perioperative GDT or according to routine haemodynamic practice were included. Primary outcome measures were mortality and morbidity. Data synthesis was obtained by using odds ratio (OR) with 95% confidence interval (CI) by a random effects model. An OR <1 favoured GDT. Statistical heterogeneity was assessed by Q and I(2) statistics. Eleven articles (five cardiac surgery and six vascular procedures), enrolling a total sample of 1179 patients, were included in the analysis. As compared with routine haemodynamic practice, perioperative GDT did not reduce mortality in either cardiac or vascular surgery (pooled OR 0.87; 95% CI 0.37-2.02; statistical power 64%). GDT significantly reduced the number of cardiac patients with complications (OR 0.34; 95% CI 0.18-0.63; P = 0.0006), but no effect was observed in vascular patients (OR, 0.84; 95% CI 0.45-1.56; P = 0.58). Perioperative GDT prevents postoperative complications in cardiac surgery patients, while it has no effect in vascular surgery. The different characteristics and comorbidities of the population enrolled could explain these conflicting results. More trials conforming to the characteristics of low-risk-of-bias studies and enrolling a larger and well-defined population of patients are needed to better clarify the effect of GDT in the specific setting of cardiovascular surgery.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Patients with narrowing of one of the major blood vessels to the brain, the internal carotid artery, are at risk of stroke. The surgical operation to remove the narrowing (carotid endarterectomy) can reduce the long‐term risk of stroke. Drugs such as aspirin which prevent blood platelets forming clots (antiplatelet drugs) can also reduce the risk of stroke, but can sometimes cause serious bleeding. This review showed that antiplatelet drugs can also reduce the risk of stroke in patients undergoing carotid endarterectomy. There was limited information on bleeding risk. The review's conclusions supported the routine use of antiplatelet drugs such as aspirin in patients having carotid endarterectomy.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

OBJECTIVES: to summarize existing evidence regarding the benefits and the risks of all available interventional and medical means aimed at cardiac risk reduction in patients undergoing vascular surgery.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2003

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