Background: Frailty is an important clinical syndrome that is associated with adverse postoperative outcomes. The assessment of frailty provides an opportunity to enhance patient care. The National Vascular Registry (NVR) introduced frailty categories on all vascular procedure proformas in 2019. The aim of this survey was to capture the current practice of frailty assessment in vascular centres in the UK. Methods: A nationwide survey was carried out of all UK vascular centres who enter procedural data onto the NVR database. The Qualtrics online survey tool was used to distribute the survey through mailing lists and social media. The survey captured data on location of centres who responded, how frailty data are collected and vascular surgeons’ opinions of frailty assessments. The survey was live from 29 March 2022 to 29 May 2022. Results: The survey received responses from 48 UK vascular surgeons based in 31 UK vascular centres. Frailty assessment was undertaken in 61% (19/31) of centres that responded, of which 68% (13/19) used a frailty assessment tool. The Clinical Frailty Scale was the most frequently used tool (77%; 10/13). Vascular consultants personally perform frailty assessments in 47% (9/19) of centres and most assessments take place in the ward setting (68%; 13/19). Frailty was re-evaluated in 21% (4/19) of centres. Frailty status influenced clinical practice in 63% (12/19) of vascular centres. 58% (7/12) of responders plan to assess frailty in the future. Clinician-perceived barriers to assessing frailty was unfamiliarly with the tools and concerns over validity. Conclusion: There is variation in how frailty is measured in UK vascular centres. Uncertainty and concerns over validation of tools are perceived barriers to assessing frailty. Further research should target validation of frailty tools and their role in guiding patient care in vascular surgery.

Aim The purpose of this mixed methods feasibility study was to assess the feasibility of delivering ESWT to patients with DFUs. It also aimed to explore any potential clinical effect of ESWT on wound healing and investigate whether ESWT may offer any patient reported benefits. Method A single centre mixed methods feasibility study. Patients with a DFU who met the eligibility criteria underwent ESWT 3 times in over 7 days. Primary outcome was feasibility of delivering the intervention. Secondary outcomes included wound size, number of DFU healed at 12 weeks and quality of life. Semi-structured interviews explored participants experience of undergoing ESWT. Results 22.6% (24/106) of patients screened were recruited. The mean attendance to clinic was 90.9% and 65.1% to follow up. The mean score for acceptability and tolerability was 9.86 (SD 0.48, 95% CI 9.62-10.01) and 9.15 (SD 2.57, 95% CI 7.87-10.42) respectively. There were no serious adverse events or side effects. 45.5% of DFU healed during follow up and quality of life scores improved until 8 weeks. Key themes identified from the qualitative interviews were desire for the fast healing, improved quality of life, new treatments must be flexible and accessible on transport. Conclusions This study has shown it is possible to recruit and retain patents into this research. This study supports development of a large randomised control trial to determine the clinical and cost effectiveness of ESWT for DFU healing.