This systematic narrative review of randomised controlled trials (RCTs) identifies and evaluates the efficacy of behaviour-change techniques explicitly aimed at walking in individuals with intermittent claudication. An electronic database search was conducted up to December 2012. RCTs were included comparing interventions incorporating behaviour-change techniques with usual care, walking advice or exercise therapy for increasing walking in people with intermittent claudication. Studies were evaluated using the Cochrane Collaboration risk of bias tool. The primary outcome variable was maximal walking ability at least 3 months after the start of an intervention. Secondary outcome variables included pain-free walking ability, self-report walking ability and daily walking activity. A total of 3,575 records were retrieved. Of these, six RCTs met the inclusion criteria. As a result of substantial heterogeneity between studies, no meta-analysis was conducted. Overall, 11 behaviour-change techniques were identified; barrier identification with problem solving, self-monitoring and feedback on performance were most frequently reported. There was limited high-quality evidence and findings were inconclusive regarding the utility of behaviour-change techniques for improving walking in people with intermittent claudication. Rigorous, fully powered trials are required that control for exercise dosage and supervision in order to isolate the effect of behaviour-change techniques alongside exercise therapy.

OBJECTIVE:

We describe and present the results of our novel technique for eversion endarterectomy of the external iliac artery (EIA).

METHODS:

For our prospective follow-up study, antegrade eversion endarterectomy (AEEA) of the EIA was mostly performed as a bail-out procedure, if (endovascular-assisted) remote endarterectomy from the groin had failed. Postoperative clinical and hemodynamic changes were reported according to the recommendations of the Society for Vascular Surgery. To evaluate the data, we used the Kaplan-Meier product limit method.

RESULTS:

Thirty patients (mean age 65.5 years) underwent AEEA on 33 EIAs for atherosclerotic occlusive disease over a 10-year period. The mean follow-up was 50 months. The primary technical success rate was 100%. The 30-day mortality was 0. There were no early occlusions. Two patients required redo surgery for retroperitoneal haematomas. Postoperative improvement was marked in 30%, moderate in 64% and minimal in 6%, explained by 21 (64%) concomitant occlusions of the superficial femoral arteries. The 1-, 3- and 5-year primary patency rates were 100%, 96% and 90%, and primary assisted patency rates were 100%, 96% and 96% respectively. Fourteen patients (47%) died during the long follow-up period from unrelated causes.

CONCLUSION:

AEEA is a safe autologous surgical technique with promising results.

BACKGROUND:

To assess the accuracy of the aortic outer curvature length for thoracic endograft planning.

METHODS:

Seventy-four patients (58 men, 66.4 ± 14 years) who underwent thoracic endovascular aortic repair between 2009 and 2011 treated with a Cook Medical endograft were enrolled in this retrospective study. Immediate postoperative CT scans were analysed using EndoSize software. Three vessel lengths were computed between two fixed landmarks placed at each end of the endograft: the straightline (axial) length, the centerline length and the outer curvature length. A tortuosity index was defined as the ratio of the centerline length/straightline length. A Student t test and a Pearson correlation coefficient were used to examine the results.

RESULTS:

We found a significant difference between the centerline length (135.4 ± 24 mm) and that of the endograft (160 ± 29 mm) (p < .0001). This difference correlates with the tortuosity index (r = .818, p < .0001), the endograft length (r = .587, p < .0001), and the diameter of the endograft (r = .53, p < .0001). However, the outer curvature length (161.3 ± 29 mm) and the endograft length (160 ± 29 mm) were similar (p = .792).

CONCLUSION:

The outer curvature length more accurately reflects that of the deployed endograft and may prove more accurate than centerlines in planning thoracic endografts.

OBJECTIVE:

To explore the associations between beta-blocker use and clinical outcomes (death, hospitalisation with myocardial infarction (MI) or stroke, major amputation and recurrent vascular surgery) after primary vascular reconstruction.

METHODS:

Patients who had primary vascular surgical or endovascular reconstruction due to symptomatic peripheral arterial disease, in Denmark between 1996 and 2007 were included. We obtained data on filled prescriptions, clinical outcomes and confounding factors from population-based healthcare registries. Beta-blocker users were matched to non-users by propensity score, and Cox-regression was performed. All medications were included as time-dependent variables.

RESULTS:

We studied 16,945 matched patients (7828 beta-blocker users and 9117 non-users) with a median follow-up period of 582 days (range, 30-4379 days). The cumulative risks were as follows: all-cause mortality, 17.9%; MI, 5.3%; stroke, 5.6%; major amputation, 9.1%; and recurrent vascular surgery, 23.1%. When comparing beta-blocker users with non-users: adjusted hazard ratio: MI, 1.52 (95% CI, 1.31-1.78); stroke, 1.21 (95% CI, 1.03-1.43); and major amputation, 0.80 (95% CI, 0.70-0.93).

CONCLUSION:

Beta-blocker use after primary vascular surgery was associated with a lower risk of major amputation but an increased risk of hospitalisation with MI and stroke. No associations were found between beta-blocker use and all-cause mortality or the risk of recurrent vascular surgery. However, our results are not sufficient to alter the indication for beta-blocker use among symptomatic peripheral arterial disease patients.