| Biography | |
|---|---|
 Dr. Maher Hamish Northampton General Hospital NHS Trust, UK |
|
| Title: Outcome of endo-vascular management of patients with Critical limb Ischemia | |
| Abstract: Objective The aim of this cohort study is to compare two modalities of treating long occlusion (more than 15 cm) in the superficial femoral artery (SFA) as a cause for critical leg ischemia in real life practice in a large District General Hospital. The treatment methods compared were angioplasty with stenting vs a femoral-popliteal bypass. The end points reviewed was patency and the rate of intervention needed to maintain patency. Method We retrospectively obtained and reviewed data on all patients at the Northampton General hospital with severe peripheral vascular disease who had long SFA stents during a 3 year interval commencing from April 1 2014 to March 31st 2017 and compared the patency rate and the need for a secondary intervention to a group of patients who had a femoral popliteal bypass (FPB) during this same time period for the same indication. The end points were stent and or graft patency, limb salvage, mortality & morbidity. All patients involved in this study were patients with severe peripheral vascular disease failing best medical management or presenting with evidence of critical limb ischaemia with evidence of tissue loss or rest pain. Best medical management entails patients being on a statin, an antiplatelet, having good control of hypertension and diabetes and smoking cessation advice. All patients had an arterial duplex and or computed tomographic angiography assessment before an intervention to assess disease severity; and surveillance using duplex to assess patency. Femoral-popliteal bypass procedure included patients who had either above or below knee bypass as well as patients who had a vein or a prosthetic used for the conduit. Primary patency was calculated from the time of the initial intervention until the time of occlusion. For patients who developed a significant stenosis and needed an intervention to maintain patency they were referred to as assisted primary patency and was calculated from the time of initial procedure to the time of occlusion. The limb salvage rate was also recorded. Results Femoral-Popliteal Bypass All the patients who had femoral-popliteal bypass were classified as Rutherford 4 or 5. Of the 28 patients who had a femoral-popliteal bypass procedure, 22 were males and 6 females. The mean age of patients in this study was 72.1 years. The youngest patient to have this procedure was 49 years old with the oldest being 92 years of age and almost half of this cohort (46.4%) were over the age of 75 years. Of the 28 patients that were operated on 2(7.7%) died in hospital or within 30 days of having the operation, hence leaving only 26 patients in the surveillance population. All the patients who died were over the 78 years of age. 20 (77%) patients in this study had the long saphenous vein used for their bypass conduit while 6(23%) patients had PTFE. 16 (61.5%) of 26 patients had at least one previous angioplasty that failed prior to having the bypass. The primary patency rate at 12 months was for bypass was 77% (20 of 26 patients). 6(23%) of patients had severe stenosis of the bypass of which 5 was salvageable with angioplasty resulting in 25% (5 of 20) of the patency being assisted primary patency .There was one (3.8%) patient who went on to have an above knee amputation due to a blocked bypass which was unsalvageable post angioplasty. | |
| Biography: I work as a Senior Consultant in Vascular and Vascular Surgery at both Northampton and Kettering General Hospitals and I hold weekly clinics for both Private and NHS patients at BMI Three Shires In Northampton and Woodland Hospital in Kettering . After medical school and basic surgical training, I completed specialist training in general, laparoscopic and endocrine surgery at Leeds General Infirmary and Derriford Hospital in Plymouth. I finished my research degree in 2005 at Imperial College London before going on to develop my experience and knowledge further with over 4 years in vascular, endovascular and organ transplantation surgical training at Charing Cross and Hammersmith Hospitals in London. Following this, I spent 3 years living on the Sunshine Coast in Australia where he worked as a Senior level Consultant Surgeon in Vascular & endovascular surgery. As a vascular specialist I treats the complete range of vascular diseases including aortic aneurysm, carotid, diabetic foot and peripheral arterial disease. I have a special interest in the endovascular management of cardiovascular disease and dedicate my time to training fellow surgeons in these minimally invasive techniques, both in the UK and abroad. I am the Lead for Endovascular Service at NVS network in Northamptonshire and the Research Lead for Vascular Service at NVS. I have great interest in Endovascular treatment for Aorto_iliac disease and diabetic foot. I am a faculty member of many regional, national and international conferences and committees, including national selection committee for high surgical training. | |
