This study supports the role of regional anesthetic techniques, combined with targeted, minimally invasive surgery--particularly for the management of high-risk patients presenting in the emergency setting.

Objective: To obtain an estimate of the frequency of fatal pulmonary embolism (PE) after varicose vein surgery. Methods: Firstly by analysis of official statistics and secondly by a postal questionnaire to surgeons carrying out varicose vein surgery. The response rate from the questionnaire was 68% (391/576). Surgeons were asked if they had encountered PE after varicose vein surgery, whether the outcome was fatal and how many years they had spent in the specialty. Further calculations were based on data obtained from the Vascular Society of Great Britain and Ireland that suggest that on average about 120 cases are operated per year per consultant surgeon. Results: Analysis of the statistics available from official sources suggested that the risk of fatal PE after varicose vein surgery is about 1 in 15,000. Respondents to the questionnaire reported a total of 396 pulmonary emboli, of which 73 were fatal. From the questionnaire, we estimate that between one in three and one in four surgeons will encounter a fatality in the course of a full career. From knowledge of the length of time spent in the specialty by our respondents and using the figure of 120 operated cases per consultant per year, we obtained a higher estimate of the risk of fatal PE, around one in 10,000 cases. Conclusions: While the methods used to collect these figures are imperfect and open to criticism, they suggest a risk between one in 10,000 and one in 15,000. We think it is reasonable, when obtaining consent, to warn patients of the very small risk of fatal PE, using the more pessimistic figure of one in 10,000.

No abstract

A 74-year-old woman presenting with acute abdominal pain underwent surgery for suspected small bowel ischaemia. At laparotomy, a sacrocolpopexy mesh in the pelvis, which had been inserted 8 years previously, was found to be causing strangulation of a 2-m length of the small bowel. Following resection and primary anastomosis, the patient spent several days in intensive care before her eventual discharge. This unusual life-threatening complication should be considered in patients presenting with abdominal pain even many years following abdominal sacrocolpopexy.

The rising number of patients with acute limb ischemia (ALI) brings the question if there is an opportunity to make a diagnosis safely and accurately. The current "gold standard" for diagnosis is digital subtraction angiography (DSA). However, current times show that computed tomography angiogram (CTA) builds popularity among doctors working in vascular surgery departments. The aim of this study is to collect evidence of the use of CTA for the assessment of patients with ALI and compare it to the "gold standard" (DSA). Methodology: This is a narrative synthesis, the search of 4 databases is done for relevant articles within a period from 2000 to 2021. Information extracted will be compared to leading guidelines for ALI published in 2 recent reviews by the American College of Radiology and the European Society for Vascular Surgery. Results: In total 48 articles were obtained: reviews (n = 13), studies (n = 4) and case reports (n = 31). Case reports were excluded from the study. CTA has multiple benefits, which can be put into 4 different groups: availability and accessibility, accuracy, affordability and additional information. Further disadvantages and similarities were discussed in 2 separate groups. Conclusion: The use of CTA in patients with ALI has a notable advantage in all 4 categories (availability, accuracy, affordability, and additional information). Disadvantages and similarities between CTA and DSA, do not vary and do not significantly affect the end decision. This makes CTA a valid tool as the first step in the assessment of the patient with ALI.