Introduction Ankle/brachial indices are inaccurate in the presence of calcification, and physicians may rely on the measurement of digital pressures. As the population continues to age and with the escalation in type 2 diabetes, the importance of, and reliance on, toe pressure measurements will increase. The aim of this study was to assess the reproducibility of toe pressure measurements in a single vascular laboratory. Methods Repeated ankle/brachial indices and toe pressures were measured in 20 patients (10 with known peripheral vascular disease and 10 with aneurysmal or carotid artery disease but no history of PVD), and 10 control patients. Three measurements were made 48 hours apart. All measurements were made by a single vascular technologist. Reproducibility was assessed by the use of the repeatability coefficient and the intraclass correlation coefficient. Results Ankle/brachial indices ranged from 0.36 to 2.4, toe pressures from 18 mmHg to 173 mmHg, and toe/brachial indices from 0.11 to 1.1. The repeatability coefficient showed no significant difference between measurements ( p > 0.1) and the intraclass correlation coefficient estimates showed high agreement between repeated measurements (0.77–0.99). Bland-Altman plots indicated that the observer variability was equally distributed across the range of pressure measurements. Conclusion These results confirm the intraobserver reproducibility of toe pressure measurements; however, further work is required to demonstrate inter-observer reproducibility.

Hospital, by the senior author were included. Data was collected from statistics department, theatre database, discharge registry, ICU and HDU register and patient clinical notes. Study end-points included operative time, shunt use, perioperative stroke, 30 day mortality, restenosis and re intervention. Results: 114 cCEA procedures were undertaken from July 2008 to December 2011, while 63 eCEA performed during Jan 2012 to July 2014. Results are shown in Table 1. Intraarterial shunts were used in 19 % of cCEA and 1.6% of eCEA cases. Patients were followed postoperatively by Duplex imaging. Death and stroke rate in both groups was 0 %. Operative time for eCEA was significantly less that the cCEA. There were 5 restenosis in cCEA and only one in eCEA (range 20 to 70%). Conclusion: eCEA is safe and effective technique for carotid endarterectomy. It significantly reduces the operative time with low re-stenosis rate.