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Surgical site infections (SSIs) of groin wounds are a common and potentially preventable cause of morbidity, mortality, and healthcare costs in vascular surgery. Our aim was to define the contemporaneous rate of groin SSIs, determine clinical sequelae, and identify risk factors for SSI. An international multicentre prospective observational cohort study of consecutive patients undergoing groin incision for femoral vessel access in vascular surgery was undertaken over 3 months, follow-up was 90 days. The primary outcome was the incidence of groin wound SSI. 1337 groin incisions (1039 patients) from 37 centres were included. 115 groin incisions (8.6%) developed SSI, of which 62 (4.6%) were superficial. Patients who developed an SSI had a significantly longer length of hospital stay (6 versus 5 days, P = .005), a significantly higher rate of post-operative acute kidney injury (19.6% versus 11.7%, P = .018), with no significant difference in 90-day mortality. Female sex, Body mass index≥30 kg/m 2 , ischaemic heart disease, aqueous betadine skin preparation, bypass/patch use (vein, xenograft, or prosthetic), and increased operative time were independent predictors of SSI. Groin infections, which are clinically apparent to the treating vascular unit, are frequent and their development carries significant clinical sequelae. Risk factors include modifiable and non-modifiable variables.

Summary: The treatment of non-thrombotic iliac vein lesions (NIVL) remains debatable with many advocating conservative treatments, whilst others offering venous stenting. The objective of this review was to systematically assess the treatment options for symptomatic iliac vein compression syndrome (IVCS) in patients without evidence of thrombotic disease at the time of diagnosis. An online search of published literature looking for randomised controlled trials and observational studies that evaluated the treatment for symptomatic NIVL was performed. Nine studies were included with a total 953 patients of which 782 patients had NIVL. Patency rates ranged between 94.8%–100% in the first month, 88.2%–94.1% in six months and 73.4%–98% in 12 months, in patients with NIVL post stenting. Longer follow-up of up to 5 years shows promising patency rates of 94% in patients with IVCS. Patients with IVCS are likely to benefit from a combination of endovenous treatment at the time of diagnosis including stent placement to maintain lumen patency and prevent recurrent deep venpus thrombosis and/or postthrombotic syndrome.

BackgroundThe purpose of this study was to assess the functional effects and acceptability of rocker-soled shoes that were designed to relatively “unload” the calf muscles during walking in people with calf claudication due to peripheral arterial disease.MethodsIn this randomised AB/BA crossover trial, participants completed two assessment visits up to two weeks apart. At each visit, participants completed walking tests whilst wearing the unloading shoes or visually-similar control shoes. At the end of the second visit, participants were given either the unloading or control shoes to use in their home environment for 2 weeks, with the instruction to wear them for at least 4 h every day. The primary outcome was 6-min walk distance. We also assessed pain-free walking distance and gait biomechanical variables during usual-pace walking, adverse events, and participants’ opinions about the shoes. Data for continuous outcomes are presented as mean difference between conditions with corresponding 95% confidence interval.ResultsThirty-four participants (27 males, mean age 68 years, mean ankle-brachial index 0.54) completed both assessment visits. On average, the 6-min walk distance was 11 m greater when participants wore the control shoes (95% CI -5 to 26), whereas mean pain-free walking distance was 7 m greater in the unloading shoes (95% CI -17 to 32). Neither of these differences were statistically significant (p = 0.18 and p = 0.55, respectively). This was despite the unloading shoes reducing peak ankle plantarflexion moment (mean difference 0.2 Nm/kg, 95% CI 0.0 to 0.3) and peak ankle power generation (mean difference 0.6 W/kg, 95% CI 0.2 to 1.0) during pain-free walking. The survey and interview data was mixed, with no clear differences between the unloading and control shoes.ConclusionsShoes with modified soles to relatively unload the calf muscles during walking conferred no substantial acute functional benefit over control shoes.Trial registrationClinicaltrials.gov, Trial Registration Number: NCT02505503, First registered 22 July 2015.Electronic supplementary materialThe online version of this article (10.1186/s12872-017-0716-x) contains supplementary material, which is available to authorized users.

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