Objective: It is purported that patients with peripheral arterial disease (PAD) may have impaired cognitive function due to concomitant cerebrovascular disease. Such disease may be clinically unrecognised but can impact on a patient's recovery and prognosis. The purpose of this systematic review was to interrogate the body of published evidence on undiagnosed dementia in PAD patients. Methods: A search strategy encompassing MEDLINE, Scopus, and the Cochrane database was developed to identify peer reviewed articles examining rates of undiagnosed dementia in patients with PAD. The following search terms were used: "PAD"; "PVD"; "dementia"; "peripheral arterial disease"; "peripheral vascular disease"; "cognitive impairment"; "Alzheimer's disease", and "cogniti". The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 guidelines were followed throughout. The primary outcome was the incidence of previously undiagnosed dementia in patients with PAD. Results: The initial electronic literature search yielded 1 492 titles. After removal of duplicates, 994 abstracts were screened in order to ascertain if they were potentially eligible for inclusion. Abstract review yielded 62 full texts for further evaluation, and from this eight caseecontrol studies consisting of 1 161 patients were included in the review. Analysis of these studies revealed that PAD patients performed significantly worse than controls on a variety of neuropsychological measures of executive function (six out of eight studies). Conclusion: The review indicated that PAD patients are more likely to have undiagnosed dementia than healthy controls. This condition may impact on their ability to comply with treatment strategies and should be borne in mind when managing this challenging patient cohort.

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Background The COVID-19 pandemic has necessitated significant changes to the manner in which healthcare is delivered. Chief among these has been the need to rapidly adopt virtual, or telephone clinics as a means of reducing unnecessary patient exposure to hospitals and clinical care settings. We were greatly aided in our adoption of virtual clinics by our experience in the establishment and maintenance of a Clinical Nurse Specialist-led, virtual clinic for both abdominal aortic (AAA) and extra-aortic aneurysm (EAA) surveillance within our department since 2016. Patients undergoing surveillance for abdominal aortic aneurysm (AAA) require frequent and lifelong clinical review. Previous studies have shown that post-operative surveillance in particular is critical in prolonging survival in AAA patients and in the early detection of late complications particularly following endovascular repair (EVAR). Poor compliance with EVAR surveillance has been shown to result in worse outcomes Aim The aim of this study was to evaluate the success of a nurse-led virtual clinic programme in terms of the safe management of patients undergoing AAA surveillance in a nurse-led virtual clinic. Results Over the course of the 4-year period from 2016 to 2019, 1352 patients were enrolled in the virtual aneurysm surveillance clinic. The majority of patients each year were male, ranging from 78.2% in 2016 to 85.2% in 2017. The majority of patients encountered the service owing to pre-operative surveillance of an AAA, with this group comprising at least 65% of the total cohort of patients each year. Over the course of the 4-year period of the virtual clinic there were 1466 patient encounters. Each ambulatory day care centre (ADCC) attendance normally costs the hospital €149. Therefore, a total saving of €218,434 resulted from this initiative alone. No patient presented as an emergency with a ruptured aneurysm during the time period studied. Conclusion Patients with AAA can be safely kept under surveillance in a nurse-led virtual clinic. Our experience with this model of care proved to be particularly advantageous during the period of the early COVID-19 pandemic.