2017-2018 Royal Free London Vascular Surgery 2017-2018

2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 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Royal

The team photos in this book were masterfully taken by David Bishop, and the book itself was lovingly compiled by consultant vascular

surgeons at Royal Free London

Royal Free London Vascular Care


Royal Free LondonVascular SurgeryThe Department of Vascular Surgery at Royal Free London is dedicated to excellent evidence-based, patient-centred care. We are developing clinical care pathways and expanding our scope of research and teaching to ensure that our patients benefit from the latest treatments and technologies. We are proud of our delivery of world class vascular care for patients at all stages in their vascular disease, and are dedicated to contributing our innovations to improve care and medical education across the entire NHS and around the world.


Royal Free London Vascular Surgery

Over the last five years the department experi-enced a major reorganisation under the leader-ship of Daryll Baker, who merged three London

units, and Ben Lindsey, who introduced a firm structure to align practice and improve clinical

care. In 2017 this was further reinforced with a reorganisation of theatre resources, moving all

venous surgery, except the most complex, to the Chase Farm and Hadley Wood sites, and division of theatre sessions to a team-based

model. Team based working has provided more continuity of care and improved patient

experience. As a result, we have been able to accommodate more urgent and semi-urgent

cases, shortening length of stay and improving theatre utilisation to >80%. When theatre

resources are optimised, our patients benefit. ▲Theatre utilisation and improvement of resource use.

◄The 7 West multidiscipinary board rounds

Royal Free LondonVascular by the Numbers

Patient DemographicsBy Commissioner

In 2017 the length of stay

after amputation at Royal Free London was 21 days, com-pared with an aver-age of 29 days at

other London trusts.


Non-NCL CCG

NHSE

Other Islington

Haringey

Enfield

Camden

Barnet

2017 StatisticsClinical sites

Clinics per weekVascular procedures

Follow up appointmentsNew patients seen

919

1,28612,12512,271

Royal Free LondonDepartmental Organisation

The Tissue Viability Service at Royal Free London is a nurse-led service that manages venous and some arterial wounds both for inpatients and in the community. This service, led by Jemell Geraghty and her team of nurses provides outpatient treatment for complex wounds. The service is so successful that it has been oversubscribed in the last few years. In 2017 Jemell and her team saw over 1000 patients to manage and treat leg wounds. We are working towards expanding this service so that the needs of the North Central London community can be met.

Tissue Viability Service

Vascular Specialist NursingThe nurse clinicians at Royal Free London Vascular Surgery are responsible for driving the clinical practice. Nick Evans and Yasmin Uddin are highly trained specialist nurses who assist with clinical assessment and manage the day to day care of our outpatients. They also run Nurse-Led clinics for aneurysm surveillance, both pre- and postoperatively, which lets them provide one-stop service for patients. Yvonne Gleeson is our specialist research nurse who manages our research studies and is the voice of clinical research for our patients enrolled in clinical trials.

2018 saw the introduction of the North London Abdominal Aortic Aneurysm Screening Programme, a service delivered for the first time by InHealth on behalf of the National Screening programme. The Clinical Director of this programme, which is responsible for screening a population of 21,600 men aged 65 years in 2018, is Royal Free London Surgeon Meryl Davis. The new programme brought togeth-er three providers in North London under one operational service with a new clinical footprint. Together with InHealth, Miss Davis is hoping to make screening more cost-effective across a very large territory, and standardise clinical care.

Aneurysm Screening in North London

Royal Free London Vascular Surgery has a team of patient navigators that always go the extra mile for our

patients. Sitting at the beating heart of our depart-ment, they are our first line of communication and work

hard to connect patients to their needs. Our naviga-tors maintain the rapidly changing waiting lists and are

diligent at ensuring that patients progress along their clinical care path in a timely and expeditious fashion.

Our team consists of Vanessa Swann, Rita Makali, Leon Fagan, Joanne Phillips and Krisharna Quildon.

They are led by our expert team of senior administra-tors, which includes Layla Kelly, Sarah Alzayady and

Catherine Endeley-Brown.

VASCOT (Vascular Occupational Therapy)As part of the ‘Improvement Science in Action’ programme, a truly multidisciplinary team was set up to improve the care of patients with peripheral vascular disease at Royal Free London. Vascular patients with complex medical and social needs were identified in the pre-assessment clinic, and highlighted for intensive preoperative input with the VASCOT team. This allows the team time to put in place measures which can lead to better discharge planning, allowing patients to get home sooner and also reducing the number of days patients are in hospital. The results of this programme have had a dramatic impact on the length of time patients stayed in hospital.

Vascular StudiesVascular Studies are duplex scans of arteries in the body, and are often our first window to the function-al and structural vascular disease. Our team of vascular scientists run clinics at 4 sites and partner with nurses and surgeons to diagnose and survey patients within the practice. In addition to running both inpatient and outpatient clinics, the vascular scientists often provide bedside and intraoperative support at all hours. Vascular Studies are our eyes into the vascular system, and help to delineate vascular problems. Their input is invaluable and testament to their success they are busier than ever.

Patient Navigators and Administration

The Vascular Malfor-mation Service at

Royal Free London is one of the largest of its

kind in the United Kingdom. It is a multi-

disciplinary team consisting of vascular

surgeons, radiologists, nurse clinicians, plastic

surgeons and psy-chologists who see

patients from birth to much older. The team evaluates each patient in a unique multidisci-plinary clinic, and then

plans an approach that is bespoke for the

patient. Recently the team has started

evaluating their five year outcomes and the

benefits of this approach have paid

off: in many of the diseases studied we

have better outcomes than the reported

literature.

Venous SurgeryThe Royal Free London Deep Venous Thrombosis Lysis Team is a multidisciplinary team of consultants from the Haemophilia and Thrombosis, Vascular Surgery and Interventional Radiology services. This Team aims to streamline the process from the first clinical diagnosis of proximal DVT of upper and lower limbs to multidiscipli-nary consultation and risk-adjusted treatment. The DVT Lysis Team was initially formed by Dr Anja Drebes, Mr Rovan D’Souza and Dr Neil Davies, and recently expanded to include two new consultant vascular surgeons, Mr Chung Sim Lim and Miss Anna Prent. The DVT Lysis Team offers modern early removal of thrombus which includes catheter-directed and pharmacomechanical thrombolysis to prevent or reduce the risk of development of severe post-thrombotic syndrome based on up to date evidence and national guidelines. Intervention is provided with the close monitoring and support from the haemophilia and thrombosis physicians, based on clear local DVT lysis guidelines to optimise effectiveness and safety. The DVT Lysis Team also runs a surveillance clinic every month on the third Tuesday at the Royal Free London.

In April 2018 the DVT Lysis Team updated the local guidelines. The key changes include acute patient assessment in the next working day in outpatient clinic at Royal Free London to reduce unnecessary wait for inpatient transfer and bed occupancy unless deemed high risk for phlegmasia.

◄Before (1) and after (2) venograms of deep venous thrombosis if the iliac veins and vena cava

1 2


In an ongoing project to review the 5 year outcomes for the entire arteriovenous malformation service, Chung Lim and his colleague Ishapreet Kaur have reviewed the management of lower extremity VMs. They found 107 patients who underwent 168 procedures from 2013 to 2017. Many of the patients had hereditary conditions such as Klippel-Trenaunay Syndrome, Mafucci’s Syndrome and Milroy’s Disease. Using embolosclerotherapy, the serious complication rate is 4.7% which is less than half the rate reported in the literature. This evidence demon-strates that we are achieving our goal of providing world class service for patients with VM.

Minimally invasive, embolo-sclerotherapy (EST) for upper extremity vascu-lar malformations (VM) carries significant risk of serious complications - ischemia, infarction, amputation, nerve injury, contracture, and ulceration. In the global literature, complication rates as high as 61% for hand treat-ments have been recently reported. Despite improved care in specialist centres, up to date estimates of complication risk estimates are scarce. Nick Evans and the VM team reviewed our experience with all VM patients with upper extremity malformations from 2013 to 2017. They identified 70 treated patients who had collectively 150 procedures. In high flow malfor-mations, 5.1% of patients had a complication and in low flow malforma-tions, 6.4% of patients suffered a complication. These rates are remarka-bly lower than other reported case series. This suggests our multidiscipli-nary team approach is offering Royal Free patients the best reported outcomes in the world for upper extremity malformations.

Upper Extremity Vascular Malformations

Lower Extremity Vascular Malformations

Royal Free LondonVascular Malformations

◄MRI depicting an upper extremity VM

▼Before, intraoperative and after images of a VM on a toe

Royal Free LondonAortic Surgery

Survival After Elective Aneurysm RepairFollowing the trend at aortic centres worldwide, the approach to aneu-rysm repair has shifted since 2014. We treat each aneurysm with the modality and complexity of repair that will optimise short term outcomes, while ensuring long term durability. The result of this multidis-ciplinary consideration for each patient has been an increase in elective survival over time, despite increasing complexity of repair across all anatomic boundaries.

Given the concerted effort in the last 4 years to evolve the Com-plex Aortic Service, we recently audited our repair practice. In keeping with recent reports that more complex endografts improve durability, we have achieved an increase in complex-ity. This has been accompanied by a decrease in contrast use intraoperatively, and a decrease in procedure time with no increase in mortality. -- S El Batti

Increasing Number of Fenestrations and Branches Improves Durability

Num

ber of Branch Vessels Incorporated

Time Quartile (over 4 years)


The total number and complexity of aneurysm

repairs increased in 2017. Standardization of the care path and a

more structured multidis-ciplinary team process

has also meant that more of the younger

patients are being offered open surgery to

ensure durability. There has been an increase in

complex surgery performed, and the

aortic team continues to attract and benefit from

international fellows who work and learn with us.

Increasing Complexity of Aneurysm Repair

Salma Graph radiation dose

Reviewing EVAR Surveillance All patients treated with an EVAR in 2015 and 2016 were audited to determine the surveillance practice at Royal Free. A total of 116 patients were included for analysis. Of the 116 patients 75% had a comput-ed tomographic angiography (CTA) scan 6-12 weeks after initial surgery and 32% had annual duplex ultrasound imaging in the median follow up of 2 years. Based on our practice and the literature we developed a new trust wide protocol which will be implemented in September 2018. Standardisa-tion improves teamwork within disciplines, and across the Trust. We hope to achieve optimal patient care according to the recent literature and current guidelines and to avoid unnecessary imag-ing. -- A Prent ▲Radiation dose after complex aneurysm

repair has remained low since 2014, despite increasing complexity

Women get aneurysms less frequently than men, and it is thought that their anatomy is

more challenging for endovascular aneurysm repair. Although this has been shown in

simple aneurysm repair, it had never been demonstrated for complex aneurysms. Debra

Chong reviewed our experience of women having complex aneurysm repair and

combined the data with that from Lille Univer-sity in France. She reviewed data for 40

women with an average age of 71 years and found that women had a slightly higher risk of

death and complications across the sites, leading us to conclude that women are at higher risk when undergoing surgery. -- D

Chong

Complex Aneurysms in Women

The Royal Free London Aortic Team has partnered with CYDAR Ltd and is contributing real time experi-ence to pioneering work on fusion imaging in complex aneurysm repair. Thanks to the image-based fusion of the CYDAR system, which has been used at Royal Free London since 2016, our patients have some of the lowest contrast and radiation doses in the world. This year, we are hoping to expand the benefit that fusion imaging has for our patients by working with CYDAR to develop a system that uses machine learning to predict the changes in the aortic anatomy during surgery. Our Aortic Fellow, Salma El Batti, after completing her PhD in Anatomy, has turned her attention to this interesting problem. She has identified two different types of aortic movement and has found that direc-tion that the aorta moves when in surgery can be predicted. She is working with the engineers at CYDAR to determine the risk factors for aortic deformation, and to contribute to algorithms that will make the prediction of movement more accurate in surgery. This work will be presented at the European Society of Vascular Surgery in Valencia in September 2018. -- S El Batti

Intraoperative Aortic Deformation

▲Screen shot of prototype aortic deformation tool being tested at Royal Free and developed by CYDAR Medical

▲The Aortic Team getting proximal access for a T-branch procedure, with transoesoph-ageal echocardiography monitoring by Nick Schofield

Royal Free LondonVascular Research

Timely and expedient treatment of ruptured aneurysms is the mark of a world class aortic centre, and for over 12 months, Andrew Trew and Tara Mastracci have been developing an mobile application (’app’) that will make it easier for us to deliver rapid treatment to patients in emergency settings. The HERMES app (handheld electronic referral management for emergency surgery) was registered on the iTunes store in March 2018, and was beta-tested in a simulated rupture for the first time in August 2018. The application has two functions. It will be used by referrers to expedite a referral for surgical treatment to the Royal Free London from anywhere in the NHS. This will initially roll out for ruptured aneurysm, and then be extended to other services, such as hand trauma and emergency surgery. The applica-tion will also have a clinician-facing component that provides a decision pathway for evidence-based support, and an encrypted chat feature available to all members of the on call ruptured aneurysm team. By improving communication with referring hospitals and between care providers, we are ensuring that our patients get rapid access to life-saving care. Stay tuned for more publications reporting our progress on this service improvement.

Recently published results from the COM-PASS trial has shown that low-dose rivarox-

aban plus aspirin reduced major adverse cardiovascular and limb events when

compared with aspirin alone in patients with stable coronary or peripheral arterial disease (PAD). However, Mital Desai and colleagues

reviewed a database of 500 patients screened for inclusion in the trial and found

that less that 18% met criteria for the COMPASS trial. Therefore only a small fraction of PAD patients in North Central

London undergoing infrainguinal bypass will benefit from this anticoagulant. We hope

this finding will reducing bleeding in post-re-vascularisation patients. -- M Desai, A

Tasnim, Y Gleeson, G Hamilton, J Tsui

Improving Communication for Ruptured Aneurysms

Bleeding, Blood Thinners, and Revascularisation

Royal Free LondonDiabetic Foot Team

Remote ischaemic preconditioning (RIPC) is a non-invasive therapeutic strategy thought to improve cardiac outcomes in patients undergo-ing open vascular or endovascular surgery. However, it remains uncertain whether this is observed in clinical outcomes. Mital Desai and colleagues performed a metaanalysis of randomised trials to determine if the literature could support this theory in practice. After reviewing the evidence, they found that patients treated with RIPC had no statistically significant difference in perioperative mortality, heart attack, heart dysfunction, kidney dysfunction, and neurological dysfunction. There was no significant difference in length of hospital and intensive care stay. They plan to investigate further in future research. –M Desai, J Tsui, G Hamilton

Remote Ischaemic Preconditioning

We are developing the treatments of the future and improving current therapies by using our clinical and scientific knowledge combined with close links with University College London. We have an on-going research project investigating the effect of high blood sugars on the immune system, and the destructive effect of activation of this abnormal immune reaction, leading to excessive inflammation. We have shown that diabetes exaggerates the effect of poor blood supply. This research has identified a possible mechanism for the profound impairment of wound healing. Early experiments in blocking these immune reactions has shown very positive benefits in diabetic conditions, even without adequate blood supply. We are continuing work on this exciting development with the eventual aim of offering a new treatment never before used in non-healing wounds. – M Portou and J Tsui

▲Skin samples showing excessive inflammation in diabetic patients


The Diabetic Foot Team at Royal Free London has expanded in the last few years, with 162 new referrals, 152 inpatients and over 700 outpatients treated by our podiatrists in the first three months of 2018. We have also introduced a weekly multidisciplinary inpatient diabetic foot ward round, comprising mem-bers from vascular surgery, diabetology, infectious disease and podiatry teams, aiming to tackle all aspects of patient care, improve outcomes and reduce length of stay in this complex group of patients. The podiatry ‘hot clinic’ service offers 7 days a week rapid access to acute foot services, allowing community and straight-from-A&E referral to target early intervention, reduce need for admission and early introduction to diabetic foot management expertise. Within the first 7 weeks this service assessed and treated over 70 patients, and is a vanguard for similar services in the NHS. This is the work of Richard Leigh, our head Podiatrist, and recently appointed lead for Diabetic Foot Services for NHS London. This year the Diabetic Foot Team at Royal Free London began the use of drug coated balloons, and we continue to treat the majority of our patients undergo-ing complex angioplasty, particularly the smaller vessels, with the latest drug coated balloon technology. This provides additional treatment options for patients with challenging small vessel disease to augment the complex distal surgery we have offered for years.

VOYAGER PAD (RCT low dose rivaroxaban/ placebo + aspirin post lower

limb revascularisation for PAD) UK lead site

Status: In follow-up phase.

SAVERStellerex drug coated balloon

e-registryStatus: recruiting

BASIL 2

(RCT vein bypass/ endovascu-lar first for severe limb ischae-

mia due to infrapopliteal disease)

Status: recruiting

MIDFUT(Comparing multiple interven-

tions in diabetic ulcer treat trial, RCT comparing hydrosurgical

debridement/ negative pres-sure wound therapy, decellular-

ised dermal allograft)Status: recruiting

GEKO

A Prospective, Multicentre, Randomised, Assessor Blinded

Study Comparing the Efficacy and Patient Reported

Outcomes of Two Different Daily Treatments in Patients

with Venous Leg Ulcers Status: recruiting

ILLUMINATE

Below the knee DCB post market study

Status: about to open

Our Favourite A

ctive Clinical Trials

▲Our Hardworking theatre team has been specially trained to do both endovascular and open surgery, meaning that our patients get the procedure they need in a single setting.

Chronic Ischaemic Limb Pain Prevention StudyWe are conducting pioneering research exploring the use of lidocaine for intractable ischaemic pain that has been unresponsive to traditional therapy. Neuropathic pain, which describes pain that is mediated by the nervous system, is common in critical limb ischaemia and can be difficult to manage. Achieving pain control is vital in improving quality of life for patients with critical limb ischaemia. Lidocaine has been used very successfully in other types of long-standing pain. We believe lidocaine will reduce neuropathic pain in patients with critical limb ischaemia and will allow a reduction in the amount of other drugs needed to control pain. This study will be starting soon at Royal Free London and has been supported by the Association of Vascular Anaesthesia in the UK.

Preoperative Exercise StudyThere is mounting evidence linking

physical fitness and improved surgical outcomes. We assessed the feasibility

and effectiveness of a six week exercise training programme in patients awaiting

complex fenestrated endovascular aneurysm repair (FEVAR). Patients were recruited to take part in a 6 week, in-hos-pital exercise training programme, over a period of 18 months from June 2016. The

intervention arm consisted of 3x 40min sessions per week of individualised,

interval training formulated from baseline CPET (CardioPulmonary Exercise

Testing) parameters, on a static bike. CPET parameters at baseline and at 6

weeks were compared to a group of matched patients also awaiting aneurysm

surgery, who had not undergone the exercise intervention. The study demon-strated excellent patient compliance and safety of an in-hospital exercise training

programme for patients awaiting FEVAR. There was an improvement in physiologi-

cal fitness alongside an increase in day-to-day activity over the course of the

6 week study period in the exercise group. Results will be presented at the

VASGBI Conference in September 2018.

Vascular AnaesthesiaRoyal Free London

Kidney Injury Following FEVARRetrospective data was collected for 122 patients who underwent elective FEVAR for aortic aneurysm repair between November 2014 and September 2017. Pre-operative chronic kidney disease (CKD) was common, with 37.7% of patients presenting with CKD2, and 30.3% with CKD3. The incidence and severity of renal injury increased over time with an 11.8% incidence of acute kidney injury (AKI) within the first three post-operative days, of which 4.8% were AKI grade 2. The contrast dose and aneurysm diameter correlated with post-opera-tive renal dysfunction but not with AKI criteria. The presence of an AKI and the severity of that AKI correlat-ed with the length of hospital stay and post-operative mortality. This retrospective analysis identifies a relatively low incidence of AKI following FEVAR in this high-volume centre. Despite this, the develop-ment of a post-operative AKI is a strong risk factor for prolonged length of stay. The identification of risk factors for renal dysfunction will permit quantitative risk stratification and potential interventions to ameliorate reversible risk factors. Results will be presented at the VASGBI Conference in September 2018.

The Vascular Prehabilitation SchoolPrehabilitation involves improving 'fitness for surgery' through a range of interventions to modify factors which may impact recovery from surgery. Prehabilitation is most effective when commenced as early as possible. This maximises the time available to make meaningful changes and modify perioperative risk. We are developing a prehabilitation programme which improves modifiable factors which may impair recovery from surgery, such as smoking, alcohol and poor nutrition. The programme will also involve bespoke exercise classes to improve cardiovascular fitness and strength, ensuring patients are in the best possible shape for surgery. The programme is a truly multidisciplinary team project with support from a wide range of professionals.

Royal Free London has a proud tradition in medical education and Vascular Surgery has endeavoured to continue to maintain and build on this, offering great training opportunities for all. This starts with an exciting work experience programme for young students wishing to pursue a career in medicine, and it continues for UCL medical students who have consistently given excellent feedback after their week in the department. We now have regular teaching sessions on Friday mornings at 8am for the junior doctors which are well attended and are evolving into a teaching programme that benefits all members of our department. We are proud of our team approach and regular multidis-ciplinary team meetings. The Amputation course organised by Kate Conneally and Catherine Wilkinson continues to be a great success and attracts a large audience. The regular Radiation Safety sessions at Royal Free have been useful to all users of x-ray equipment. On a similar theme we now run regular ultrasound teaching at Barnet hospital on a Thursday morning which is organised by our team of experienced vascular scientists. More recently, we have improved access to IRCU on Fridays at Royal Free and Barnet on Wednesday and Thursday mornings, this has allowed an integrated learning opportunity for the IR and VS trainees. The well organised Audit meetings now incorporate a Local Faculty Group meeting which is attended by the Post Graduate Medical Department that allows us to openly discuss any trainee issues and needs. Furthermore, one of our most experienced surgeons, Ms Fiona Myint, has partnered with Harvard University this year to create an international post graduate course for medical leadership. The Vascular department continues to demonstrate a strong commitment to excellence in teaching tomorrow’s medical leaders. -- J Constantinou, Educational Lead

Royal Free LondonVascular Education

Royal Free LondonSelected Vascular Publications

Is there a role for remote ischaemic preconditioning for vascular and endovascular surgery? A meta-analysis of randomised controlled trials. Desai M, Tsui J, Hamilton G. Oral presentation at the 6th ESVS Spring Meeting, Frankfurt, May 2018External applicability of the COMPASS trial: analysis of a screened population with peripheral arterial disease undergoing infra-inguinal revascularisation in North Central London. Desai M, Tasnim A, Gleeson Y, Hamilton G, Tsui J. Oral presentation at the 6th ESVS Spring Meeting, Frankfurt, May 2018. Winner of best oral presentation prize.

Assessment of 'on-treatment platelet reactivity' and relationship with cerebral micro-embolic signals in asymptomatic and symptomatic carotid stenosis. Kinsella JA, Oliver Tobin W, Tierney S, Feeley TM, Egan B, Coughlan T, Ronan Collins D, O'Neill D, Harbison JA, Doherty CP, Madhavan P,Moore DJ, O'Neill SM, Colgan MP, Saqqur M, Murphy RP, Moran N, Hamilton G, McCabe DJH. J Neurol Sci. 2017; 376:133-139.

Meta-analysis of individual-patient data from EVAR-1, DREAM, OVER and ACE trials comparing outcomes of endovascular or open repair for abdominal aortic aneurysm over 5 years. Powell JT, Sweeting MJ, Ulug P, Blankensteijn JD, Lederle FA, Becquemin JP,Greenhalgh RM; EVAR-1, DREAM, OVER and ACE Trialists. Br J Surg. 2017; 104(3):166-178.

Restenosis and risk of stroke after stenting or endarterectomy for symptomatic carotid stenosis in the International Carotid Stenting Study (ICSS): secondary analysis of a randomised trial International Carotid Stenting Study investigator. Lancet Neurol. 2018 Jul; 17(7):587-596.

A nanocomposite polymer POSS-PCU for the development of compliant endovascular stent grafts with long term durability. Desai M, Tsui J, Cousins B, Hamilton G. Oral presentation at the Society of Academic and Research Surgery Annual Meeting, Ireland, 18-19 January 2017.

Ureteric Stricture following Pediatric Dual En-Bloc Renal Transplantation Phillips BL , Forman CJ and Banga NR. Case Report, Vol 4(1)

External iliac vein aneurysm: a case report and review of the literature. Fanshawe AE, Hamilton HEC, Constantinou J. J Surg Case Rep. 2018

Insights in Transplanting Complex Pediatric Renal Recipients With Vascular Anomalies. Chandak P, et al. Transplantation. 2017.

Good news for people with foot and leg ulcers. Geraghty, J. (2018). Guardian, Media Planet, Health Awareness.

Placing our best leg forward: preventing lower leg conditions for our workforce and the general public. Geraghty, J. & Biasi, L. (2018). Journal of General Practice Nursing, 4 (1),

Restenosis and risk of stroke after stenting or endarterectomy for symptomatic carotid stenosis in the International Carotid Stenting Study (ICSS): secondary analysis of a randomised trial. Bonati LH, Gregson J, Dobson J, McCabe DJH, Nederkoorn PJ, van der Worp HB, de Borst GJ, Richards T, Cleveland T, Müller MD, Wolff T, Engelter ST, Lyrer PA, Brown MM; International Carotid Stenting Study investigators. Lancet Neurol. 2018 Jul;17(7):587-596.

Editor's Choice - Vascular Access: 2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Schmidli J, Widmer MK, Basile C, de Donato G, Gallieni M, Gibbons CP, Haage P, Hamilton G, Hedin U, Kamper L, Lazarides MK, Lindsey B, Mestres G, Pegoraro M, Roy J, Setacci C, Shemesh D, Tordoir JHM, van Loon M, Esvs Guidelines Committee, Kolh P, de Borst GJ, Chakfe N, Debus S, Hinchliffe R, Kakkos S, Koncar I, Lindholt J, Naylor R, Vega de Ceniga M, Vermassen F, Verzini F, Esvs Guidelines Reviewers, Mohaupt M, Ricco JB, Roca-Tey R. Eur J Vasc Endovasc Surg. 2018 Jun;55(6):757-818.

Editor's Choice - Management of Atherosclerotic Carotid and Vertebral Artery Disease: 2017 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Naylor AR, Ricco JB, de Borst GJ, Debus S, de Haro J, Halliday A, Hamilton G, Kakisis J, Kakkos S, Lepidi S, Markus HS, McCabe DJ, Roy J, Sillesen H, van den Berg JC, Vermassen F, Esvs Guidelines Committee, Kolh P, Chakfe N, Hinchliffe RJ, Koncar I, Lindholt JS, Vega de Ceniga M, Verzini F, Esvs Guideline Reviewers, Archie J, Bellmunt S, Chaudhuri A, Koelemay M, Lindahl AK, Padberg F, Venermo M. Eur J Vasc Endovasc Surg. 2018 Jan;55(1):3-81.

Paclitaxel-coated balloon fistuloplasty versus plain balloon fistuloplasty only to preserve the patency of arteriovenous fistulae used for haemodialysis (PAVE): study protocol for a randomised controlled trial. Karunanithy N, et al. Trials. 2016.

Learning curve in fenestrated and branched grafting. Martin-Gonzalez T, Mastracci TM. J Cardiovasc Surg (Torino). 2017 Apr;58(2):261-263

Screening Programs for Abdominal Aortic Aneurysms: Luxury or Necessity? Paraskevas KI, Brar R, Constantinou J, Tsui J, Baker DM. Angiology. Jan 1 2018 Accuracy of implementing principles of fusion imaging in the follow up and surveillance of complex aneurysm repair. Martin-Gonzalez T, Penney G, Chong D, Davis M, Mastracci TM. Vasc Med. 2018 May 1:

A prospective observational trial of fusion imaging in infrarenal aneurysms. Maurel B, Martin-Gonzalez T, Chong D, Irwin A, Guimbretière G, Davis M, Mastracci TM. J Vasc Surg. 2018 May 24.

Aneurysms don't have borders. Mastracci TM. J Vasc Surg. 2018 May;67(5):1328-1336.

The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. Chaikof EL, Dalman RL, Eskandari MK, Jackson BM, Lee WA, Mansour MA, Mastracci TM, Mell M, Murad MH, Nguyen LL, Oderich GS, Patel MS, Schermerhorn ML, Starnes BW. J Vasc Surg. 2018 Jan;67(1):2-77.e2

Invited commentary. Mastracci TM. J Vasc Surg. 2017 Oct;66(4):1017.

Results from multiple prospective single-center clinical trials of the off-the-shelf p-Branch fenestrated stent graft. Farber MA, Eagleton MJ, Mastracci TM, McKinsey JF, Vallabhaneni R, Sonesson B, Dias N, Resch T. J Vasc Surg. 2017 Oct;66(4):982-990.

Ten-year single-centre experience with type II endoleaks: Intervention versus observation. Haq IU, Kelay A, Davis M, Brookes J, Mastracci TM, Constantinou J. Vasc Med. 2017 Aug;22(4):316-323.

Unlocking the phenotype of aneurysm disease: Are women the key? Mastracci TM. Vasc Med. 2017 Apr;22(2):119-120.

Early experience with a modified preloaded system for fenestrated endovascular aortic repair. Maurel B, Resch T, Spear R, Roeder B, Bracale UM, Haulon S, Mastracci TM. J Vasc Surg. 2017 Apr;65(4):972-980.

Vertebral Tortuosity Index in Patients with Non-Connective Tissue Disorder-Related Aneurysm Disease. Virgilio F, Maurel B, Davis M, Hamilton G, Mastracci TM. Eur J Vasc Endovasc Surg. 2017 Mar;53(3):425-430.

Development of a pro-healing vascular stent coating incorporating antibody stem cell capture technology. Pang JH, Darbyshire A, Zhao J, Tsui J, Cousins B. Oral presentation at the 5th ESVS Spring Meeting, Leiden, The Netherlands, 19-20 May 2017.

Biofunctionalization of chemical-cured urethane composite with endothelial cell selectivity for cardiovascular implants. Pang JH, Darbyshire A, Tsui J, Cousins B. Oral presentation at the 28th Annual Conference of the European Society for Biomaterials, Athens, Greece, 4-8 Sept 2017.

Polymer nano-island surface coatings for intracranial stents. Zhao J, Pang JH, Gayle K, Tsui J, Cousins B. Oral presentation at the 28th Annual Conference of the European Society for Biomaterials, Athens, Greece, 4-8 Sept 2017.

Antimicrobial, hyperelastic, nanofibrous polyhexamethylene biguanide-polyure-thane membranes for wound care. Worsley A, Song W, Tsui J, Good L. Poster presentation at the Tissue Engineering and Regenerative Medicine International Society (TERMIS) World Congress, Kyoto, Japan, Sept 2018.

The functional influence of ischaemic myotube exosomes on the regenerative potential of myoblast. Lewis S, Lawson C, Shiwen-X, Abraham D, Tsui J. Oral presentation at the 5th ESVS Spring Meeting, Leiden, The Netherlands, 19-20 May 2017. Winner, best oral presentation prize.

The functional influence of ischaemic myotube exosomes on the regenerative potential of myoblast. Lewis S, Lawson C, Shiwen-X, Abraham D, Tsui J. Oral presentation at the ESVS Annual Meeting, Lyon, September 2017

Ischaemic myotubes stimulate angiogenesis via exosomes. Lewis S, Konig J, Lawson C, Collinson L, Tsui J. Oral presentation at the 6th ESVS Spring Meeting, Frankfurt, May 2018

Collecting in vivo flow data and medical imaging for successful computational flow dynamics modelling. Bartlett M, Tsui J, Diaz V. Poster presentation at the 5th ESVS Spring Meeting, Leiden, The Netherlands, 19-20 May 2017.

Diagnosis and management of venous leg ulcers. Lim CS, Baruah M, Bahia SS. BMJ 2018

2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free 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2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 Royal Free London Vascular Surgery 2017-2018 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