Three-centre audit of IVC filter insertion over 12 years

Abstract

association with thrombo-embolic complications and to refine our care of patients with this condition. Method: All patients referred for STP or query DVT, between 2000 and 2008 with STP had a colour flow duplex scan (CFDS). All case notes and scans were available for review. Results: Two hundred and ten patients had STP. Two hundred and ninetyone CFDS were performed and each patient had at least one scan. Predisposing factors to STP included varicose veins (31%), previous DVT/phlebitis (20%), cancer (13%), recent long distance travel (12%), trauma (6%), puerperium (2%) and use of oral contraceptive pills (2%). Thrombus was located along the course of the long saphenous vein in 171 patients (82%) and short saphenous vein in 39 patients (18%). Sixty-four patients (30%) had a thrombo-embolic complication: 57 DVTs; 7 PEs. Fourteen patients had DVT which progressed to PE. Treatment was a variety of combinations of antibiotics, NSAIDS, compression stockings, warfarin, low-molecular-weight heparin and surgical disconnection (28). Eleven patients had a change of treatment plan following a follow-up scan. Conclusion: Our findings show that STP is far from a benign condition with potential life-threatening thrombotic complications occurring in a third of patients. The benefits of operative intervention are unclear and studies are needed to answer this question as well as the best medical management.Objective: To compare percutaneous transluminal angioplasty (PTA), a supervised exercise programme (SEP) and combined therapy (PTA+SEP) in the treatment of intermittent claudication (IC) due to femoro-popliteal disease. Method: Over a 6-year period, 178 patients (108 men, median age 70 years) with angioplastiable femoro-popliteal lesions were randomised to: PTA, SEP or PTA+SEP. Patients were assessed prior to and at 1, 3 6 and 12 months post-treatment. ISCVS outcome criteria (ankle pressures, treadmill walking distances) and Quality of Life (QoL) questionnaires (SF-36 and VascuQoL) were analysed. Results: All groups were well matched at baseline. Thirty-three patients withdrew. Intra-group analysis: all groups demonstrated significant clinical and QoL improvements (Friedman test, p < 0·05); SEP (59 patients, 13 withdrew) −69·6% of patients (n = 32) improved following treatment (19 mild, 10 moderate, 3 marked), 13% (n = 6) no improvement and 17·4% (n = 8) deteriorated; PTA (60 patients, 8 withdrew) −71·2% of patients (n = 37) improved following treatment (16 mild, 16 moderate, 5 marked), 17·3% (n = 9) no improvement and 11·6% (n = 6) deteriorated; PTA+SEP (59 patients, 12 withdrew) −85·2% of patients (n = 40) improved following treatment (18 mild, 20 moderate, 2 marked), 14·9% (n = 7) no improvement and 0% (n = 0) deteriorated. Inter-group analysis: PTA+SEP produce a sustained