VSGBI NEWS - Vascular Society...VSGBI NEWS July 2011 Audit & QI Committee Report 3 Training & Education Committee 4 Management of Venous Ulcer Disease 5 RCSImproving Outcomes Meeting

VSGBI NEWSJuly 2011

Audit & QI Committee Report 3Training & Education Committee 4Management of Venous Ulcer Disease 5RCS Improving Outcomes Meeting 6Quality Assurance 7AGM 2011 Edinburgh 8Report from Spring Meeting 10ACCEA 10

Circulation Foundation 11Research Committee 13Venous Forum 13CORESS Report 14Martin Birnstingl Obituary 15Nominations for Council Membership 15New Members 15Society Contacts, Officers, Sponsors 16

CONTENTS

Spring meeting2012 - Belfast

The ‘Vascular Society’s SpringMeeting’ will be in Belfastnext year and will run fromThursday 22nd March tolunchtime on Friday 23rdMarch 2012.

We are delighted that theNorthern Ireland VascularGroup and the Association ofIrish Vascular Surgery haveagreed to jointly host thismeeting, which will be held atthe famous Europa Hotel andConference Centre in the citycentre. The theme will bevascular trauma and theprogramme will cover topicson a wide range of vascularemergencies, drawing on localexpertise in vascular trauma.It will also include talks onthe endovascularmanagement of rupturedaortic aneurysms, thecomplications of EVAR, andvenous thromboembolism inpregnancy. In addition, therewill be a vascular traumaworkshop for trainees on theThursday morning. A galadinner will be held onThursday evening in aid of theCirculation Foundation.

We hope that Members willwish to sample the excellenthospitality which Belfast hasto offer, and we would like tothank Paul Blair for agreeingto co-ordinate the meeting onbehalf of the Society.

President’s Message

I am delighted to confirm, in this mid-term report, thatthe Society’s Council and sub-committees have beenhard at work on a number of current issues. Perhapsfirst and foremost, and the one I get questioned mostabout, is the progress of our separate specialtyapplication to the Department of Health. Clearly theDepartment have other things on their mind at the moment,in light of their need to revise the NHS reforms.

As a result the progress of our application has been slower than expected and afinal recommendation to the Minister of State is not likely to be decided now untilthe end of July. One downside of this delay is that it risks us missing thedeadlines for ST3 recruitment in August 2013, because it would still take another3 months from the decision by the Secretary of State to sign off the applicationbefore it would be legally entered as a statute in law. We may thus be held backuntil 2014 before we can start training in the new specialty. The delay has beenuseful to us though, in that it has allowed us to address concerns raised by theRoyal College of Radiologists and by the British Society of Interventional Radiologyregarding the proposed syllabus. An amended syllabus has now been jointly agreedand both RCR and BSIR have written to the DH to unreservedly withdraw theirobjections and express their full support for our new specialty application. Onemajor hurdle remains though, in that I have been advised that there are elementswithin the 4 Health Administrations (England, Wales, Scotland and NorthernIreland) who are opposed to new specialty applications on principle as being costlyand unnecessary in the current climate, even though the principle of a separatespecialty had already been signed off by the Secretary of State last September.The RCSEng is taking a lead on this application on behalf of the Surgical RoyalColleges and John Black has agreed to lobby for our cause in the corridors ofpower. We could not have got anywhere near as far as we have without JohnBlack’s positive support and the specialty will owe him a great debt of gratitudeshould our bid finally succeed.

In the meantime, Jonathan Beard has led the Education & Training Committee todevelop a newly updated version of the Society’s document setting out ourrecommended standards for training, which he has summarised for you in thisNewsletter. I personally believe this to be an excellent document and am delightedto report that it was approved unreservedly by Council in May. Should we get

continued on page 2

Peter Lamont

specialty approval, this document will be used toinform the Schools of Surgery and Deaneries of thestandards we will expect for vascular surgical trainingin the future.

David Mitchell has also been hard at work with theAudit and Quality Improvement Committee, dealing notonly with the complexities of IT for the NVD but alsoputting in an immense amount of effort to develop theAAA Quality Improvement Programme, which alreadyappears to be showing results with a reduction inelective AAA mortality recorded on the NVD over thepast year. Council have approved a bid to HQIP fromDavid and his Committee for a grant to provide the fullrunning costs of the NVD. Although there are somedownsides to this, in that the Society and its Memberswould no longer be the exclusive owners of the dataentered, such an investment would be a great help indeveloping the systems which all of us will need in thefuture, as submission of outcome data to a nationaldatabase is very likely to be amainstay requirement for GMCrevalidation.

To this end, I would also like toinitiate a discussion with SocietyMembers at our Annual Meeting inNovember on the controversialissue of the publication ofindividual surgeons’ results. Thecardiac surgeons have noted asignificant improvement inoutcomes since they started doingthis and we should at least have athink about it ourselves. Suchemphasis on outcome data isclearly high on Bruce Keogh’sagenda, as he advised us last yearin Brighton and it is also interesting that a number ofSHAs/PCTs are now stipulating contribution of data tothe NVD as a condition of vascular surgicalcommissioning. Should National Commissioning beadopted for vascular surgery (and the current advicefrom those advising the DH on the NHS reforms is thatit should be), I believe it highly likely that NVDsubmission will be required for any unitcommissioned to provide vascular surgical services,so if you are not submitting data now I suggest youconsider it for the future. The Society is happy toshare advice on how to set up a submission processand I am sure David Mitchell or Sara Baker would bewilling to help if you are having problems.

Ian Franklin has already injected new pace and energyinto the Circulation Foundation Committee after only afew months in the Chair and we are expectingsignificant new income streams for our charitable armas a result, much of which Shervanthi Homer-

Vanniasinkam’s new Research Committee has alreadyearmarked to spend on developing vascular researchprogrammes in a structured and organised way. Ianand Shervanthi’s work offers much potential for thefuture and both the initiatives started by Shervanthilast year, the Surgeon Scientist Award (£50,000) andthe President’s Early Career Award (£100,000) arebeing repeated this year. These awards are alsothanks in no small part to the organised and efficientway our Treasurer, Simon Parvin, has managed theaccounts and created a stable financial platform onwhich to base their continuation.

The Secretariat continues its sterling work, led soeffectively by Jeanette Robey and ably assisted byNeelam Seeboruth. Mike Wyatt has brought hisimmense energy and past experiences on SARS andASGBI Councils to bear on the office of HonorarySecretary. In addition to the heavy workload involved insupervising the administration of the Society, Mike has

taken on a revision of the Provision ofServices for Patients with VascularDisease 2009, as reported in theFebruary Newsletter. If you have anycomments to make on this subject,particularly if your SHA has beenconducting a review of vascularservice provision, then please do getin touch with Mike, who is reallykeen for your input into the revision.

Finally, I look forward to seeing asmany of you as possible at the AnnualMeeting in Edinburgh from 23rd to25th November. Full details are nowavailable on the VS website, buthighlights will include symposia on theimpact of volume/outcome on

vascular service provision, the use of hybrid theatresand the publication of surgeon outcomes. Theendovascular training workshop has now been movedto the Wednesday morning and will focus on EVARplanning, targeted particularly at existing consultantswho need to get more involved in sizing and orderingstents in the future if we are to retain our traditionalrole in AAA repair. I am delighted also to welcomeBSET, the ESVS and the UEMS Section of VascularSurgery to deliver sessions to the meeting for the firsttime. Bruce Campbell has agreed to deliver theRCSEng Kinmonth Lecture on “The Evolution ofEvidence” and Julie Brittenden has agreed to give alecture on behalf of the RCSEd in memory of AliBakran, who will have been known to many of you.Along with participation of the Venous Forum, SARS,SVT and SVN and with the usual excellent socialactivities, the event promises to deliver its usual highstandard and I hope to see you there.

2 • July 2011 VSGBI News

President’s Message continued from page 1

An amended syllabus has

now been jointly agreed

and both RCR and BSIR

have written to the DH to

unreservedly withdraw

their objections and

express their full support

for our new specialty

application.

VSGBI News July 2011 • 3

Quality improvementOur quality improvement programme for aortic aneurysm isnow in the active implementation phase. Most regions of thecountry have organised a planning day for the QI programmeand we aim to involve all parts of the UK by the end of theyear: you will have received an interim report on theprogramme with this Newsletter. The message is thatimproving consistency in what we do to patients is the keyto improving the quality of our service. The QI programmefor amputation is about to start, but we are currently unableto access timely HES data feeds. This means that we willnot be in a position to provide data feedback to vascularunits until such access is granted.

Mortality data for QI programmeThe QI team have recently mailed out comparison data forHES and NVD mortality for elective infra-renal AAA. This hasbeen sent to every UK unit undertaking AAA interventions.Some of this data is clearly contaminated, with widely varyingmortality rates. We plan to publish mortality rates in the finalQI report in Spring 2012, and to avoid units beingmisrepresented, we do need you to validate your owndata with some urgency (Deadline 15 July 2011).The questionnaire is available on the QIP websitethrough this link:www.aaaqip.com/aaaqip/datavalidation.html#tpPlease complete it as soon as you can so that we canpublicise accurate data about national AAA mortality.This validation has to be carried out within individualunits as we do not have access to patient identifiabledata and cannot do this exercise for you. If you areexperiencing any difficulty with the analysis, pleasecontact us via email or telephone.

Multi-disciplinary team meetingsThe last national membership survey of vascularpractice produced confusing responses around multi-disciplinary teams. The Society is of the opinion thatstandardising the process of decision making is in thebest interests of our patients and this view issupported by our patient focus group. There is astrong desire to see all team members involved inoptimising patient fitness for intervention and helpingto guide the choice of most-appropriate intervention.While the current focus of attention is on AAA care,this also applies to carotid surgery, lower limb bypassand amputation.

A multi-disciplinary team exists when a minimum of avascular surgeon, a vascular interventional radiologistand a vascular anaesthetist jointly assess and discussthe care for patients needing complex vascularinterventions (AAA, carotid, bypass and limbamputation, plus rare diseases). An x-ray meeting isnot a MDT. We recognise that not all units canconvene a meeting with all three parties in attendanceand present alternative models in the QIP report. It iscritical that all three specialty groups have formalinput prior to admission for intervention. The output

from the MDT should be formallydocumented in the patient notes andshared with the patient. Thereshould be joint decision makinginvolving the team and the patientin the choice of care provided.

It is not however possible togather a complete picture of AAApractice without capturing the cases“turned down” for intervention. To thisend, in September we are hoping toundertake a short (4 - 6 weeks) snapshot audit throughoutthe UK. Details will be distributed shortly and we wouldencourage you to get involved and help us to gain a morecomplete picture of our service. Finally I would like to thankall the members of the Society and our sister organisations,the BSIR, VASGBI, SVN and SVT, who have contributed to ourwork this year. You are too many to mention, but none of ourwork would take place without your enthusiasm andcommitment.

Mr David Mitchell, Chair

Report from the Audit and QI Committee


The work of the Committee over the last sixmonths has focused on refinements to theVascular Surgery Syllabus and the writing ofa new Training Standards Document.

The Syllabus will be required by the GMC once ourapplication for specialty status has been approved.Although a draft syllabus has already beensubmitted, there will be an opportunity for revision,and it is obviously important that the syllabusaccurately reflects the competencies required by afuture Vascular Specialist. This task has beenmade more difficult in that we do not knowwhether vascular surgery will be delivered througha regional outreach/in-reach service, or by a localnetwork. Both models have pros and cons, but it isdifficult to design a training programme that cancater for both. A local network model will require‘hybrid’ specialists who are trained in vascular

medicine, duplex imaging, axial image interpretation,open intervention, endovascular intervention andvascular access. I have my doubts whether such aspecialist can maintain sufficient competence in all theareas required. A regional model could be linked totrauma and cardiothoracic services and has theadvantage of larger volumes, which have been shownto improve outcomes. If this model prevails, traineeswill probably need to sub-specialise into one or twoareas in the last few years of training. We await withinterest the Department of Health’s decision onSpecialty Commissioning.

The new ‘Training in Vascular Surgery & Standards forVascular Surgery’ document has been approved byCouncil. The document explains the outline of vasculartraining and the standards required for a hospital thatwishes to provide training. Entry into specialty trainingwill require successful completion of core surgicaltraining and the IMRCS exam followed by a competitivenational selection process. Specialty training willconsist of a minimum of 6 indicative years, with aminimum of 4 years requiring exposure to emergencyvascular surgery. Intermediate training will consist ofthe first two years (ST3-4) and will include a year of GIsurgery. The final stage of training will be deliveredover four years, ST5-8. The first part of the VascularFRCS (test of knowledge) will be taken during ST5-6and the second part (test of clinical and proceduralskills) during ST7-8. Training rotations will be regional,with trainees working for different consultants and inseveral hospitals to allow a breadth of experience in allsubspecialty areas. An outline of the selection andassessment system is shown in Figure 1.

VSGBI Training and Education Committee ReportProfessor Jonathan Beard, Chair

Figure1. Outline of selection and assessment system for vascularspecialty training. A successful ARCP will also be required

at the end of each level of training (ST1-8).


Vascular training will be on specialist units withsurgeons who are in dedicated vascular practice andmembers of the Vascular Society. Vascular surgery unitswho wish to provide training must demonstrate

(1) a high volume of work

(2) outcomes in line with national defined standards and

(3) a consultant rota which provides a sustainable 24/7 emergency surgical and interventional radiology service.

Most vascular training units will have insufficientspecialty trainees to provide middle-grade cover,especially at night. There will be only approximately 120vascular trainees in the UK, with a trainee:consultant

ratio of 1:3 required to conform to national workforceplanning requirements. The timetable for vasculartrainees from ST5 upwards should maximise theirsupervised elective and emergency vascular experienceand is incompatible with shift-working. Alternativearrangements, such as on-call from home, or long-dayrather than night working will be required. If there aremore approved training places than trainees,placements may be allocated on the basis of the qualityof training and outcomes.

The ‘Training in Vascular Surgery & Standards forVascular Surgery’ document can be found atwww.vascularsociety.org.uk and I would welcomecomments from members. The Committee’s next tasksare to develop a national selection system and a newVascular FRCS examination.

You may recall a recent request to complete anonline survey regarding current practices in themanagement of Venous Ulcer Disease. I wouldlike to take this opportunity to thank those of youwho have already completed the survey: to datewe have a 40% response rate, with some veryuseful data emerging. If you have not yetcompleted the survey, we would be most gratefulif you could spare a few moments to visitwww.surveymonkey.com/s/PPCGC8P

We are most grateful for your support of thisimportant project and your views will be of greatuse in the development of both the VascularCurriculum and to continued work on themanagement of venous disease.

Thank you.

Professor Ian C Chetter Vascular Tutor Royal College of Surgeons ofEngland

The Managementof Venous Ulcer Disease

VASCULAR COURSES AT THE RCS(ENG)

Vascular Access for Dialysis, 20 - 21 September 2011www.rcseng.ac.uk/education/courses/vascular-access-for-dialysis

Modern Management of Varicose Veins, 18 October 2011www.rcseng.ac.uk/education/courses/modern-management-of-varicose-veins

6 • July 2011VSGBI News

The Royal College of Surgeons of England held aseminar entitled “Improving Performance throughOutcomes” on Wednesday 13th April 2011, atwhich the Vascular Society was invited toparticipate.

Bruce Keogh, NHS Medical Director began with anoverview of the NHS Outcomes Framework. He remindedthe audience that the 3 areas of health improvement,proposed by Lord Darzi, are effectiveness, patientexperience and safety. The 5 outcome goals which fitinto these are:

• to prevent premature death

• to enhance quality of life for long term illness

• to help people recover from ill health/injury

• to ensure a positive experience of care and

• to provide care in a safe environment and protectfrom avoidable harm.

NICE is planning to build a library of statementsregarding quality standards not only to inform thecommissioning board but also to shift payment awayfrom pure volume and more towards the quality of carealong the goals outlined above. These will enable aclinically focused commissioning outcomes framework,provider payment mechanisms incorporating tariff, astandard contract, CQUINs and QOFs, and commissioningguidance.

A presentation from the Society for Cardio-thoracicSurgery stressed the value of national audit. Whilst itcosts about £1.5m a year to run, the Society hasidentified about £5m savings in improved outcomes andbed savings based on intensive outcome data collectionand analysis. Dr Penny Wood from the Picker Institute

stressed the importance of improvingperformance through the assessment of thepatient experience in detail and the specific useof patient reported outcome measures. Otherspeakers used national studies to stress theimportance of clinical organisation and coding.David Cromwell from the RCS ClinicalEffectiveness Unit highlighted difficulties indrawing conclusions about clinical performance.He concluded that drawing conclusions aboutperformance demands:

• well defined outcome measures

• adequate data quality

• appropriate risk adjustment

• an indication of the effect of random variation

NICE are also drawing up quality statements todrive quality improvement in clinical care. We canexpect these to involve significant aspects of thecare that we provide to patients. Our current QIframeworks map closely to national strategy, butit is clear from these presentations that thereare significant challenges that face usprofessionally. We all need to focus onimproving the quality of our audit data and ournational audits need to focus, not just onmortality, but also on the pathways of care sothat we can demonstrate the quality of theservice that we provide. The Carotid Audit leadsthe way for the Vascular Society and we haverecently lodged a formal application to HQIP forfinancial support to re-develop the NationalVascular Database as a Vascular Registry tomeet the needs of both vascular surgeons andpatients in the future.

Ian Loftus & David Mitchell

RCS Improving Outcomes Meeting


The NHS Abdominal Aortic Aneurysm ScreeningProgramme (NAAASP) aims to reduce AAArelated mortality by providing a systematicpopulation-based screening programme for menduring their 65th year and for men over 65 onrequest. The programme commenced in March2009 and is currently being rolled out to all areasof England. It is expected to cover the whole ofEngland by March 2013.

As part of the programme, a quality assurance (QA)framework has been developed in order to ensure thatNAAASP delivers care of the highest possible standardand to provide information to the public andprofessionals about quality.

The programme has already developed qualitystandards which have been applied to the pre-implementation phase of new local screeningprogrammes in order to ensure that these localprogrammes work to a high standard. Thesestandards are based on those set out by theVascular Society of Great Britain and Ireland(VSGBI), defined in the ‘Framework for improvingthe results of elective AAA repair’. The QAassessment to date has included a desk basedassessment, and a QA visit, followed by a reporthighlighting any corrective or preventative actionrequired.

Once local programmes are up and running, furtherQA assessment will be required at defined timeintervals in order to ensure that screening isproceeding effectively and efficiently and to a highstandard. Whilst the screening programme is stillnew in many areas, some of the earlyimplementation centres have already been runningfor over a year. The NAAASP team is thereforeworking to put in place the QA process for ongoingregular assessment of the programme. This QAprocess will include a self-assessment componentalong with site visits and will sit within theframework for QA of the UK National ScreeningCommittee. The process will measure against thedefined quality standards and key performanceindicators will be produced. The QA assessmentwill examine both the screening process itself andthe outcomes in patients who are identified ashaving an AAA. Examples of QA data would be; thenumber of patients invited for screening and thenumber attending; variation in ultrasoundmeasurements of AAA size; the speed of referraland treatment of patients with an aneurysm of

≥ 5.5cm; the provision of patient information; thepercentage of patients referred for treatment whoundergo surgery; and mortality rates of patientsidentified as having an AAA, including those who do nothave treatment. Some of the information required willbe obtained from existing IT within the screeningprogramme and reports from the National VascularDatabase of the VSGBI. Therefore assessment of thesesystems will also be required, in particular assessmentof missing data and data accuracy.

These processes will identify any outliers and theNAAASP will seek to work with local programmes toassist them in implementing change.

Tim LeesRegional Adviser to NAAASP

Quality Assurance for the NHS Abdominal Aortic Aneurysm Screening Programme


ABSTRACT SUBMISSION

Abstract submission is now available on the Society’s website. The deadline is 4pm on Monday 1stAugust. Full details are available on the Society’s website and via the linkhttp://agm.vascularsociety.org.uk/

A summary of the guidelines:• The abstract must consist of four paragraphs, entitled: Objective, Methods, Results, Conclusions

• The abstracts are to be submitted as text only

• The text should be no longer than 250 words and fit comfortably on a single page of A4 using 12 font

• Since the abstract will be judged anonymously, the text may not reveal the institutional affiliation

• The category which best describes the subject of your work should be indicated

• If the paper is to be considered for a prize or a poster, the relevant box should be marked

• The material should not have been published or presented at any major national meeting before

The Vascular Society takes a serious view of Research Governance. Please ensure that the abstract hasbeen seen and agreed by all of the named authors before submission. All of the authors have aresponsibility to ensure that the data submitted is accurate, is not extrapolated and fairly represents thepresentation to be given at the Scientific Meeting.

Once selected, the abstracts will be available on the Society’s website for Members’ information prior tothe meeting. They will also be published in the Society’s Yearbook, which will be available at the AGM,and later by post to those Members who do not attend the AGM. The abstracts from the meeting will bepublished electronically via the BJS website.

POSTERS

Abstracts not selected for presentation at the meeting will be considered for poster display, and thesewill be displayed throughout the meeting at the conference centre.

Edinburgh

2011Annual

ScientificMeeting


PROGRAMME HIGHLIGHTS

Symposia on

• The impact of volume vs outcome on vascular service reconfiguration

• Should the National Vascular Database publish individual surgeon’s results

• The role of the UEMS section and board of vascular surgery

• Hybrid theatres

Key note lectures from Professor Eric Verhoeven and Professor Hans-Henning Eckstein

Kinmonth lecture by Professor Bruce Campbell on The Evolution of Evidence

Educational Masterclass on Rare Vascular Diagnosis

Endovascular Workshop on EVAR Planning for consultants

Dedicated sessions for:

Venous Forum Society of Vascular Nurses

SARS Society for Vascular Technology

BSET Circulation Foundation

SOCIETY OF VASCULAR NURSES AND SOCIETY FOR VASCULAR TECHNOLOGY

We are delighted that the SVN and SVT are holding their annual meetings alongside the VascularSociety AGM. Members are asked to encourage their vascular nurses and vascular scientists to attendboth their own Society meetings and the VS meetings, and to join in the Society’s Annual Dinner onThursday 24th November.

REGISTRATION

On-line registration is now available at http://agm.vascularsociety.org.uk

This year, the Society has introduced a discounted registration fee for Medical Students attending theconference. In addition, trainees, who are not currently Affiliate Members of the Society, will receivetheir first year’s membership at a subsidised rate if they join the Society at the same time asregistering for the AGM. Abstract presenters will receive a 10% discount if attending all three days ofthe AGM (Wednesday to Friday inclusive). Members are encouraged to take advantage of the early-birddiscount and register now. This rate will apply until the 16th October.


A big thank you to all who supported the recentVascular Society Spring Meeting in London. Thiswas timed to support the Vascular DiseaseAwareness Week entitled 'Are Your Legs KillingYou?' which ran between the 7th - 13th March2011. The meeting attracted a multi disciplinaryprofessional team, including vascular surgeons,radiologists and nurses, podiatrists,physiotherapists, diabetologists, rehabilitationphysicians and representatives from the VascularSociety Quality Improvement Framework.

A big thank you to Rob Hinchliffe for organising thisimportant event, which succeeding in highlighting theplight of patients with peripheral arterial disease andthreatened limbs due to diabetes, renal failure andvasculitis.

We discussed at length topics such as the diabeticfoot, reducing the burden of amputation, optimising

peri-operative care, limb salvage, the theories behindarteriogenesis and angiogenesis, and considered themany important adjuncts available to wound healing.Lessons learned from the BASIL trials were debatedalong with the prevention of re-ulceration, reducingamputation morbidity and mortality and rehabilitation.Many important talks were delivered during the two daymeeting and the Vascular Society will be producing ashort report on the meeting later this year.

The next Spring meeting is in Belfast from Thursday22nd - Friday 23rd March 2012 and the theme is'Trauma'. Do come and support your Society at thismeeting. Please bring your colleagues, nurses andradiologists and we guarantee you will have a great fewdays. A Circulation Foundation Dinner will be organisedfor the Thursday night. Come and enjoy the 'Craic' andat the same time support your charity, The CirculationFoundation.

Report from the Spring Meeting of the Vascular Society King's Fund London, 10th March 2011Michael Wyatt, Honorary Secretary

As you will know, ACCEA iscurrently under review by theDDRB, which is expected toreport to Ministers in July2011.

ACCEA is currently working on thebasis that the 2012 round will beproceeding as normal and ittherefore expects the timeframe tobe similar to that of previous years(i.e. the round will open inSeptember/October 2011 and closein December). The most likely datefor the closing deadline would beFriday 9 December. In addition toany direct submission to the ACCEA,you may also wish to considerenlisting the support of TheVascular Society. As a professionalorganisation, we are allowed to

support candidates in proportion tothe size of our membership.Although individual onlineapplications do not have to besubmitted to the ACCEA untilDecember, the supporting Societieshave to submit their ranking list tothe ASGBI and RCS by earlySeptember. The deadline is sothat the Society's AwardsCommittee can consider yourapplication citation in time to sendit on to the ASGBI and RCS AwardsCommittee, who considernominations from all of theassociated Specialty Associations.The ASGBI in turn has a deadline tosend their recommendations to theRoyal College, who considernominations from all the surgicalspecialties. While we can, and do,

send citations on any latesubmissions directly to the ACCEA,such submissions will miss theabove process for influencing aCollege citation.

The Society's Awards Committeetherefore needs to receive yourACCEA application by Friday 5thAugust 2011. We are hopeful thatthe results of the 2011 awardsallocation will be available from thebeginning of August. You will needto submit your application to the VSon the forms provided by ACCEA,which are available on the Societywebsite. You should also submit acopy of your form separately to theASGBI and to the RCS(Eng)(Deadline date 15th August) forconsideration by their AwardsCommittees.

ACCEA


The Circulation Foundation

RESEARCH PROGRAMME

Surgeon-Scientist Award 2011We would like to offer our congratulations to AlanKarthikesalingam of St George’s Vascular Institute whobeat off stiff competition to be awarded £55,000 for hisresearch into Stratification of the Risk of Re-interventionafter Endovascular Aneurysm Repair, and Rationalisationof Postoperative Surveillance.

This is a very exciting piece of work and one that theFoundation is delighted to be supporting with their newSurgeon-Scientist Award. We would also like to offerour congratulations to the other shortlisted candidates,all of whom had excellent projects and presentations.

1/4 million pounds a yearThe Foundation has committed to spend at least£250,000 a year for the next 4 years on research. Weare really looking forward to an exciting future, focusingthe majority of our funding on research and, byexploring new income streams, we very much hope tobe able to increase these amounts in the near future.

As the only UK charity which focuses entirely onvascular disease and with our heritage as thefundraising arm of The Vascular Society, funding avibrant research programme is our most importantobjective. We want to support and encourage vascularresearch in the UK to ensure that advances can bemade in the prevention and treatment of vasculardisease.

We will be announcing our new research awardsprogramme in the autumn.

CIRCULATION FOUNDATIONCOMMITTEE

We are currently developing our fundraising tools andare looking to increase awareness, as well as ourfunds! If you would like to be involved with theFoundation, we are currently looking for volunteers whowould like to help us at this exciting time. We arelooking for members of the Vascular Society to take onwell defined roles on the Committee and to help mouldthe future of the Foundation. If you are interested,please email Chairman Ian Franklin [email protected]

FUNDRAISING EVENTS

Vascular Disease Awareness WeekThank you to all who took part in Vascular DiseaseAwareness Week which ran between the 7th – 13thMarch 2011. 23 events took place around the country,ranging from promotional displays to drop in informationsessions, sponsored walks, fun runs and cake or fruitsales. We also had some fantastic coverage online inlifestyle and medical magazines which increased ourwebsite traffic by over 400% during the week.

The week aimed to increase awareness of the dangersof vascular disease in particular peripheral arterialdisease (PAD). Across the UK events were held atpublic venues and health centres. Vascular nursespecialists were on hand to offer advice andinformation on vascular disease to members of thegeneral public, especially to those with diabetes. The emphasis was on the need for early diagnosis andreferral. We alsodesigned andlaunched a vascularrisk checker on ourwebsite. Thissimple tool usesseries of multiplechoice questionswhich assesses theparticipant’svascular risk andhas had over 2000hits to date.

NHS Regatta Report 2011 Yet again the intrepid band of vascular surgeons set offwith the twin targets of raising money for the CirculationFoundation and winning the B. Braun sponsored NHSRegatta. The weather was kind – there was areasonable breeze on the practice day, but only justenough on the Saturday for one race. In the first racewe had an excellent start and played the tide and windright to be in the top three at the first mark. The goodnews was that we had won the B Braun Challenge Cupfor the winner of the first day - this was presented atthe event dinner in Cowes that evening.

The next morning dawned glassily calm; probably luckyas there were some rather jaded crews from the nightbefore! Eventually we moved to a start line and set offwith a good start and again 3rd at the windward mark.We then crept up to 2nd on the downwind leg but lost

www.circulationfoundation.org.uk


out to 4th on the last beat. We snatched a place backjust before the finish so were counting 1st and 3rd andthought we had won overall. Unfortunately the boat(from landlocked Birmingham!) that had been ‘gifted’the 2nd place in the first race won the second, and sowere one point better than us.

Second overall is one better than we have ever donebefore –we will just have to keep trying. We were verysorry not to have our usual mainsheet man, RayDawson from Edinburgh. He is recovering from majorsurgery but we were able to exchange good wishes andreport on the event and hope to have him back nextyear. We must thank Ian Brown and Rostra for theirvery generous sponsorship. I hope we will raise £3000for the Circulation Foundation – also better than everbefore. The Challenge Cup now proudly resides on theCirculation Foundation office mantelpiece.

The crew was as follows:

Andrew McIrvine (Kings College Hospital)

James Brown (Southend)

John Wolfe (St Mary’s)

Jonathan Beard (Sheffield)

Mike Wyatt (Newcastle)

John Thompson (Exeter)

Peter Lamont (Bristol)

Matt Waltham (St Thomas’)

London MarathonA huge well done to our three dedicated runners forcompleting what some people only dream of achievingin a life time - the London Marathon. On a warmSunday in mid-April, Olly Pickard, Nigel Roberts and GuySalter took to the streets of London for the gruelling26.2 mile route around the city. Together they haveraised over £8,000 for the Circulation Foundation anddonations are still coming in.

Places for the 2012 London Marathon are filling up fastso if you would like to be considered for one of ourmarathon places for 2012 and raise funds for the UK’sonly vascular disease charity, please get in touch withRebecca Wilkinson in the CF office on 0207 304 4779.

An easier way to giveYou can now donate to the CirculationFoundation by text! The great news isthat as there are no set-up or admincharges, we receive 100% of thedonation and it’s free for you to sendthe text.

All you need to do is text CIRC01 andthe amount you would like to give (up to£10) to 70070 and they do the rest.You’ll then receive a text with a link to aGift Aid form, which if you are a UKtaxpayer, allows us to claim the tax backmaking your gift 20% more valuable to us!

The Shackleton RouteOur next fund raising event is being organised by aprevious President of the Society, John Wolfe. He, alongwith a group of 7 friends, including two other membersof the Vascular Society (Tom Carrell, and MartinThomas), will be sailing across the Southern Oceanfrom The Falklands to South Georgia and will then bedragging sledges and skiing across South Georgia (theShackleton Route).

South Georgia remains relatively unexplored with manyunclimbed peaks. Its remoteness and harsh weatherconditions are not for the faint-hearted or ill prepared.Unlike Shackleton, they will not be in an open boat butwill be well supplied with modern equipment but theywill, nevertheless, hope to retrace the steps of that epicjourney. The training should help them stave offperipheral arterial disease and, if all goes well, theymay attempt an unclimbed peak. The group is seekingyour sponsorship for this event and all proceeds will bedonated to the Circulation Foundation.

This is an excellent opportunity to show your supportfor the Circulation Foundation. Their target is £25,000and if Members of the Society would like to contribute,you can do so by visiting Just Giving online atwww.justgiving.com/John-Wolfe-Circulation-Foundation.Further details of this journey can be found by visitingthe Circulation Foundation Website atwww.circulationfoundation.org.uk/

The Circulation Foundation - FundraisingThe Circulation Foundation 35-43 Lincoln's Inn Fields London WC2A 3PE

T: 020 7304 4779 F: 020 7430 9235 E: [email protected]


The Venous Forum (VF) continues to prosper inits role as the main specialist organisationrepresenting those who treat venous disorders inthe UK.

We see our role as promoting clinical best practice invenous disease, promoting and providing education,sponsorship of research into venous disorders andmore recently lobbying for improved resources forvenous disorders within the NHS. We are jointly linkedwith the Royal Society of Medicine (RSM) and theVascular Society (VS). We have also recently formed aprivate practice sub-committee to represent the viewsand interests of those who work in the independentsector. Additionally, our international links continue toexpand and we collaborate closely with the AmericanCollege of Phlebology, the American Venous Forum, theEuropean Venous Forum and other organisations.

We hold two main meeting a year, one at the RSM inthe Spring and one at the VS annual meeting. Thehighly successful 2011 Spring meeting was organisedby our current President, Professor Andrew Bradbury. Itwas a joint meeting with the Society of Vascular Nursesand the Association of Sclerotherapists, involvingseveral eminent overseas speakers and a highlyentertaining interactive voting session on difficultclinical scenarios. During the meeting, Mr Peter Holtgave his report on his 2010 pump priming grant “AcuteDVT. Management uncertainties and research priorities”.

You do not have to be a member of the VF to attendeither meeting, although we would encourage VSmembers with an interest in venous disorders to join

us. Others functions of the VF are to award travel andresearch grants and we have an arrangement formembers to receive a subscription of our closely linkedjournal, Phlebology, edited by Professor Alun Davies:this is cited on Medline and is the premier journalspecialising in venous disorders.

We believe that there is a real threat to NHS varicosevein surgery. Our recent document “Recommendationsfor the referral and treatment of patients with lowerlimb chronic venous insufficiency (including VaricoseVeins)” represents our view that varicose vein and othervenous treatments should continue to be provided bythe NHS. It has been circulated to all Chief Executivesand Primary Care Trusts, as well as to other keyorganisations and individuals. The document isavailable for download on our web site:www.rsm.ac.uk/academ/forvenou.phpWe have also published 2 special documents - the VEINprojects - the first on varicose veins and the second onleg ulcers. VEIN 3 on venous thrombosis is inpreparation for launch at next year’s Spring meeting.Again these are all freely available through our web site.

The Venous Forum is extremely keen to continue itssuccessful links with the Vascular Society and hopethat you will join us for our meeting on Wednesday 23rdNovember in Edinburgh for what I am sure will be amost stimulating morning of education and debate.

Gerard Stansby, Honorary Secretary

Andrew Bradbury, President

Isaac Nyamekye, Treasurer

Venous Forum

The Society’s Research Committee isnow firmly established, and over thepast year has developed a closeworking relationship with theCirculation Foundation. ProfessorAlison Halliday, a new member ofCouncil, has now joined theCommittee.

Following the successful launch last yearof the President’s Early Career Award(PECA), we are pleased to announce thatthe award continues this year. Consultantswithin 5 years of their substantiveappointment are supported by generous

funding (£100,000 over 2 years) as theydevelop an independent research career.

A second new grant, termed the Surgeon-Scientist Award (SSA), has beenestablished to fund vascular surgicaltrainees while they engage in a period offormal research.

These two awards, PECA and SSA, endorsethe Society’s view that research isfundamental to a career in academicvascular surgery.

The Research Committee looks forward tocontinuing its partnership with theCirculation Foundation in the future.

Research CommitteeProfessor Shervanthi Homer-Vanniasinkam


Vascular Reports from CORESSFrank CT Smith, CORESS Programme Director

The following reports have recently beensubmitted by consultants. Both draw attention tothe need for scrupulous checks whenadministering intravascular fluids.

Local anaesthetic line flush (Ref: 110)I undertook open insertion of a double lumen Hickmanline in a paediatric patient undergoing chemotherapy forosteosarcoma. The case proceeded normally. The linewas tunnelled from chest wall to cervical region, usingthe blunt tunnelling device in the kit, and inserted intothe internal jugular vein. Line tip position in the rightatrium was confirmed by image intensifier. The venotomywas closed with 6.0 prolene and both lumens of theHickman line were flushed with heparinised saline.

Just prior to closing I realised that I had inadvertentlytunnelled the line through the pectoralis major muscle,rather than superficial to it. Concerned that this mightcause pain or early occlusion, I removed the line and re-sited it superficial to the muscle. The radiographer wascalled back to theatre to re-confirm line tip position.After checking luminal back-bleeds again, I asked thescrub nurse for the heparinised saline and flushed bothLuer locks and line lumens. At this point the scrub nurserealised that she had given me a syringe containingBupivicaine instead of hepsal flush. Both syringes hadbeen contained in the same kidney dish, appropriatelylabelled with circumferential grey and white stickersaround the syringes respectively.

The anaesthetist was immediately informed and bothlines were back-bled again. Fortunately the instillate wasa small volume and no adverse sequelae or cardiacarrhythmias were noted. The patient made an uneventfulrecovery from the procedure.

Reporter’s Comments:I was distracted by the procedural revision and failed tocheck the flush prior to administration. In this case, boththe heparinised saline flush and Bupivicaine were insimilar syringes with pale-coloured labels. Syringescontaining separate drugs should be clearly labelled andkept separate. After giving local anaesthetic ensure thatany surplus has been thrown away before flushing thelines. Always re-check a solution before re-administeringit, even if it has already been checked before and hasalready been given.

CORESS Comments:This case illustrates a recurrent theme of inadvertentadministration of the wrong drug due to procedural andsystems failures, previously highlighted in recentCORESS reports.

When there are several solutions available, they must beclearly labelled. It is always the responsibility of theperson giving the drug to check that it is the appropriatesolution. This must be done even during a surgicalprocedure.

Wrong Dose Heparin (Ref: 126)There are times when the vascular surgeon becomesworried about systemic coagulopathy. On this occasion, Iwas performing a straightforward carotid endarterectomy,having stopped clopidogrel seven days before surgery,but having continued the patient on aspirin 75mg daily.Before cross clamping the carotid artery I requested theusual 5000 units of heparin to be given intravenously.

The endarterectomy was uneventful, but in recovery itbecame apparent that the skin edges were bruising, theRedivac drain filled with blood and the tissues becameinspissated with haematoma. This appeared to be dueto a coagulopathy, and we immediately ordered bloodtests to check INR, APPT, platelet count andhaemoglobin. The APPT was greater than 2.5 and thiswas therefore reversed judiciously with smallincremental doses of Protamine. This is a drug I dislikebecause of its hypotensive properties and indeed thesystolic pressure fell to 40mmHg for a short period.

The situation resolved without further adverse sequelaebut clearly both hypotension and use of Protamine couldhave resulted adverse thrombotic consequences for thefreshly endarterectomised site.

The cause of this problem was inadvertent intravenousinjection of 25,000 units of Heparin, rather than the5,000 units requested. We usually use 1000 units per1ml ampoules, but on this occasion the concentrationinadvertently used was 5000 units in 1ml.

CORESS & Reporter CommentsClearly this problem was due to human error, but thequestion of whether hospital operating theatres shouldstock only one concentration of heparin rather thanboth, or whether they should be stored separately israised.

The problem has already been brought to the attentionof Sir Liam Donaldson by Professor Brian Toft. Thearticle “The Dangers of Heparin Flushes” (Qual SafeHealthcare, April 2009, Vol 18; 2) was sent to the CMOwho responded: ”the NPSA guidance on anticoagulantsrecommends the use of 1000 units per ml Heparinproducts in clinical areas and the subsequent removal ofhigher strength products such as those involved in theincident you are investigating”

Clearly this message needs to be disseminated morewidely.


OBITUARY Martin BirnstinglMartin Birnstingl, President of The Vascular Society in 1986, passed away in January, aged86. He was a leading vascular surgeon and a passionate campaigner for human rights, whoemployed his medical expertise on many occasions to challenge the official line. After leavingschool, he studied at St Bartholomew’s Hospital Medical College. Beginning in the hospital’ssurgical unit, under Sir James Patterson Ross, Birnstingl soon developed an interest in thenew discipline of vascular surgery, which had been pioneered in America in 1948. In 1952 heand a visiting American fellow, Jack Connolly, toured the pioneering vascular surgery centres ofEurope. After a year at Stanford University, California, he returned to Barts’, becoming assistant director of thesurgical unit where he became one of the country’s most respected vascular surgeons.

There will be three vacancies onCouncil in November this year,due to the completion of the termsof office of Mr Paul Blair, ProfessorShervanthi Homer Vanniasinkam(who will continue as Chair of theResearch Committee), and MrShane MacSweeney.

A nomination form can bedownloaded from the VascularSociety website, which should bereturned to the Secretariat by 31stAugust 2011.

Members elected to Councilbecome Trustees of the Charity, andhave a responsibility to act inaccordance with Charity

Commission regulations in achievingthe Society’s objectives:

_ To take part in formulating andregularly reviewing the strategicaims of the organisation

_ To ensure that the policy andpractices of the organisation arein keeping with its aims

_ To ensure that the organisationfunctions within the legal andfinancial requirements of acharitable organisation andstrives to achieve best practice.

The Vascular Society is legallyresponsible for the operation of thefundraising activities of the

Circulation Foundation and Councilmembers are therefore encouragedto take an active interest insupporting the aims and objectivesof the Circulation Foundation.

The Council meet four times a year -February, May, September andNovember, and Council Membersare generally asked to serve on oneof the Society’s working committees- Audit and Quality Improvement,Training and Education, orResearch. Council also meet withthe Vascular Advisory Committeetwice a year.

Nominations for Membership of Council

Welcome to the following new members of the Vascular SocietyOrdinaryChris Davies Morriston Hospital

Adib Khanafer Christchurch Hospital

Christopher Parry Derriford Hospital

Jonathan Smout Aintree University Hospital Trust

AffiliateMuzaffar A Anwar Imperial College London

Rovan D’Souza Royal Free Hospital

Matthew J Fincher Royal Free Hospital

Hayley Moore Charing Cross Hospital

Alex Vesey Royal Alexandra Hospital

Ruwan Weerakkody St Mary’s Hospital


OFFICERSPresident:

Mr Peter Lamont

President Elect:Professor Ross Naylor

Vice-President Elect:Professor Julian Scott

Honorary Secretary:Mr Michael Wyatt

Honorary Treasurer:Mr Simon Parvin

Chairman Training & Education Committee:Professor Jonathan Beard

Chairman, Audit and Quality Improvement:Mr David Mitchell

Chairman, Research Committee:Professor Shervanthi Homer-Vanniasinkam

Chairman, Circulation Foundation Committee:Mr Ian Franklin

Chairman, Professional Standards Committee:Professor Michael Gough

Chief Executive:Ms Jeanette Robey

SOCIETY MAJOR SPONSORS

CONTACTSThe Vascular Society of Great Britain and IrelandAt The Royal College of Surgeons35-43 Lincoln’s Inn FieldsLondon WC2A 3PE

Tel: 020 7973 0306Fax: 020 7430 9235E-mail: [email protected]: www.vascularsociety.org.uk

Registered in England, limited by guarantee

Registered Company No 5060866Registered Charity No 1102769

The Vascular Society of Great Britain and Ireland

Documents

VSGBI NEWS - Vascular Society...VSGBI NEWS July 2011 Audit & QI Committee Report 3 Training & Education Committee 4 Management of Venous Ulcer Disease 5 RCSImproving Outcomes Meeting