this study has shown that P-POSSUM methodology can be used to predict outcome after arterial surgery across a range of surgeons in different hospitals and could form the basis of a national outcome audit. It was also possible to obtain accurate models for both mortality and major morbidity from the POSSUM physiology scores alone.

Hand-held Doppler examination missed LSV or SSV incompetence in 11 per cent of legs, but these included cases with short-duration and low-velocity reflux of dubious clinical importance.

Patients with acute leg ischaemia are generally treated by vascular specialists, with modern methods and acceptable results. This is being achieved despite insufficient vascular surgeons and radiologists for formal emergency rotas in most hospitals.

A questionnaire was sent to 363 members of the Vascular Surgical Society of Great Britain and Ireland about their use of deep vein thrombosis (DVT) prophylaxis at the time of varicose vein surgery. Replies were received from 289 surgeons (80 percent), of whom only 29 percent regarded varicose veins as an important risk factor for DVT. Only 12 percent used subcutaneous heparin prophylaxis routinely, while 71 percent did so selectively, being influenced by a history of thromboembolism (95 percent), obesity (47 percent), age (35 percent), recurrent varicose veins (22 percent) and inpatient status (16 percent). At the end of the operation 52 percent applied crepe bandages, 25 percent other bandages, 13 percent stockings and 10 percent Tubigrip. Subsequently, antiembolism stockings were prescribed by 55 percent. There is a wide variation in opinion regarding DVT prophylaxis for patients having varicose vein surgery, which has both clinical and medicolegal implications.

A 'data economic' model for risk stratification of national data is feasible. The ability to use a minimal data set may facilitate the process of comparative audit within the NVD.

No abstract

Inappropriate fitting of prostheses can be kept to a minimum by a team approach to rehabilitation, but amputees may defy careful prediction by the development of new medical problems.

The use of a pneumatic tourniquet is safe and significantly reduces both blood loss and transfusion requirements during trans-tibial amputation. A pneumatic tourniquet reduces revision rates by over 50%, with subsequent cost savings.