She participated very actively in the process of developing these guidelines, in particular the important chapters on chronic arterial and venous mesenteric ischaemia. Six days after the second meeting of the task force she died unexpectedly, to our great despair and loss. We honour her dedication and scientific integrity by completing these guidelines. Among many other commitments she was a very productive reviewer and an associate editor of this journal. You can read more about Paola's important contributions to science and to the vascular community in the April 2016 issue of the European Journal of Vascular and Endovascular Surgery. 1

No abstract

The assessment and diagnosis of lower limb peripheral arterial occlusive disease (PAOD) is important since it can lead progressively to disabling claudication, ischaemic rest pain and gangrene. Historically, the first assessment has been palpation of the peripheral pulse since it can become damped, delayed and diminished with disease. In this study we investigated the clinical value of objective photoplethysmography (PPG) pulse measurements collected simultaneously from the right and left great toes to diagnose disease in the lower limbs. In total, 63 healthy subjects and 44 patients with suspected lower limb disease were studied. Pulse wave analysis techniques extracted timing, amplitude and shape characteristics for both toes and for right-to-left toe differences. Normative ranges of pulse characteristics were then calculated for the healthy subject group. The relative diagnostic values of the different pulse features for detecting lower limb arterial disease were determined, referenced to the established ankle-brachial pressure index (ABPI) measurement. The ranges of pulse characteristics and degree of bilateral similarity in healthy subjects were established, and the degrees of pulse delay, amplitude reduction, and damping and bilateral asymmetry were quantified for different grades of disease. When pulse timing, amplitude and shape features were ranked in order of diagnostic performance, the shape index (SI) gave substantial agreement with ABPI (>90% accuracy, kappa 0.75). SI also detected higher grade disease, for legs with an ABPI less than 0.5, with a sensitivity of 100%. The simple-to-calculate timing differences between pulse peaks produced a diagnostic accuracy of 88% for all grades of arterial disease (kappa 0.70), and 93% for higher grade disease (kappa 0.77). These contrasted with the limited discriminatory value of PPG pulse amplitude. The low-cost and simplicity of this optical-based technology could offer significant benefits to healthcare, such as in primary care where non-invasive, accurate and simple-to-use (de-skilled) diagnostic techniques are desirable.

Elastic compression stockings for prevention of deep vein thrombosis.

No abstract

Background Hospitalised patients are at increased risk of developing deep vein thrombosis (DVT) in the lower limb and pelvic veins, on a background of prolonged immobilisation associated with their medical or surgical illness. Patients with DVT are at increased risk of developing a pulmonary embolism (PE). The use of graduated compression stockings (GCS) in hospitalised patients has been proposed to decrease the risk of DVT. This is an update of a Cochrane Review first published in 2000, and last updated in 2014. Objectives To evaluate the e ectiveness and safety of graduated compression stockings in preventing deep vein thrombosis in various groups of hospitalised patients.

The distribution of venous reflux in patients with skin changes associated with chronic venous insufficiency presenting to a specialist clinic was assessed. A total of 300 limbs in 153 patients were examined by Doppler ultrasonography with colour-flow imaging for the presence of venous reflux in superficial veins, deep veins and medial perforating veins, both above and below the knee. Ninety-eight limbs had skin changes, which included hyperpigmentation, lipodermatosclerosis, atrophie blanche and ulceration. Of this group, 2 per cent had no evidence of venous reflux on duplex scanning, 39 per cent had deep vein incompetence, 57 per cent had superficial vein incompetence and 2 per cent had isolated medial perforating vein reflux. Of 25 limbs with ulceration, 13 had superficial and 12 deep vein reflux. A total of 202 legs, which included 20 normal control limbs, had no skin changes; 22.3 per cent of these had no venous reflux, 8.4 per cent had deep vein incompetence, 65.3 per cent had superficial incompetence and 4.0 per cent had isolated medial calf perforating vein incompetence.

Before establishing a community leg ulcer programme, a survey was performed to assess the incidence and prevalence of lower limb ulceration in the Newcastle Health District. The prevalence was 1.9 per 1000 in patients over the age of 45 years, and the annual incidence 3.5 per 1000 in the same age group. Recurrent ulcers represented 47 per cent of the total and 50 per cent of all ulcers had been present for > 6 months. District nurses spent 190 h per week in the community dressing leg ulcers, making a total number of 25,922 visits each year. In the treatment of leg ulcers 35 different types of dressing were used and only 14 per cent of ulcerated limbs were treated by appropriate compression. Of all patients with leg ulcers, 35 per cent had been seen by a hospital specialist but only 7 per cent had been examined by a vascular surgeon at any time.