Vascular Conditions (priority setting in association with the JLA)

Access Top 10 Priorities

A workshop was held on 25th July 2021 to bring together patients and healthcare professionals to jointly agree a priority list for vascular access research. The results were as follows:

1. What can be done to make fistulas or grafts last as long as possible?
2. What staff education is needed to help them to understand the experience of patients living with a dialysis line, graft or fistula?
3. What education do patients need to be given about living with and looking after a dialysis line, graft or fistula and the effect this may have on their quality of life?
4. What can be done to avoid narrow segments from forming in fistulas or grafts?
5. Is a fistula always the best option for all patients who need dialysis,regardless of age?
6. What do patients need to know about the risk of having many procedures to place new fistulas, grafts and dialysis lines and the possibility of damage to the blood circulation system?
7. What features of a fistula or graft make it better or worse at providing dialysis?
8. What can be done to prevent fistulas becoming enlarged or at risk of a serious bleed?
9. What can be done to make needling of grafts and fistulas more accurate to lower the risk of problems?
10. What can be done to prevent infections related to dialysis lines?

The following questions were also discussed and put in order of priority at the workshop:

11. What can be done to make the needling of a fistula or graft less painful?
12. What do patients need to know about the risks and benefits of keeping a fistula that is not being used anymore?
13. What can be done to prevent swelling in the arm with a fistula or graft?
14. Does having the same staff needling the fistula help to make it last longer and improve the experience of dialysis?
15. Does it always have to be a doctor who puts in a line for dialysis or could a properly trained nurse or other member of staff do this instead?

Amputation Top 10 Priorties

A workshop was held on 25th January 2021 to bring together patients and healthcare professionals to jointly agree a priority list for amputation research. The results were as follows:

Priorities 8a-c were ranked equally at the workshop.

1. How can we reduce the rates of major lower limb amputations?
   
   
2. What are the best ways to support rehabilitation following amputation?
   
   
3. How can we improve clinical outcomes for patients following major limb amputation?
   
   
4. What are the best ways to prevent or treat pain (including phantom pain) after amputation?
   
   
5. How do we improve the information provided to patients undergoing amputation?
   
   
6. In a person who has undergone a minor amputation in the foot, how are the chances of a subsequent major lower limb amputation above the ankle reduced?
   
   
7. How do you improve healing of the amputated stump?
   
   

8. a) In a person who has undergone amputation, how do you reduce the chances of amputation in the other limb?
   
   

8. b) How do we optimise prosthetic limb use following amputation?
   
   

8. c) When is it appropriate to perform a major amputation?

The following questions were also discussed and put in order of priority at the workshop:

11. Is through or above knee amputation better?
    
    
12. What are the best mobility aids following amputation?

Aortic Top 10 Priorities

A workshop was held on 13th April 2021 to bring together patients and healthcare professionals to jointly agree a priority list for vascular aortic research. The results were as follows:

1. What is the optimal management of patients with aortic aneurysm disease using individualised risk benefit ratios?
2. What causes aneurysms to grow and/or rupture?
3. Can we develop a test that could diagnose patients at risk of aortic aneurysm/dissection?
4. How do surgeons decide which treatment is best for aneurysms and are these decisions based on the latest evidence available?
5. What is the optimum medical therapy for patients with AAA to minimise expansion / rupture?
6. What causes an aneurysm or is associated with aneurysm formation and how can we prevent one developing?
7. What is the best way to monitor people after treatments to repair aneurysms to make sure they don't develop problems with their repair?
8. How do we make aneurysm surgery safer and reduce the risk of complications?
9. How do we reduce the time it takes to recover from aortic operations?
10. Should siblings be screened for AAA when there is a family history of aneurysm?

The following questions were also discussed and put in order of priority at the workshop:

11. What methods, including digital technology, can be used to ensure that people with acute aortic conditions such as aneurysm rupture or dissection are diagnosed quickly and treated without delay?
12. Aneurysms behave differently in women compared to men but both men and women are treated the same way. Should we develop sex-specific pathways to care for people with aneurysms?
13. When should people with aneurysms be offered an operation to repair their aneurysm and how quickly should this be done if this is required?
14. How can the risk of another aneurysm or other long term aortic complications after aneurysm repair be minimised?
15. What is the best treatment option for "complex" AAA (e.g. those not suitable for standard stent grafts or low risk standard operations – eg short neck, iliac pathologies, juxtarenal)
16. What is the rate of aneurysm growth or aortic growth after dissection?
17. Can keyhole techniques and robotics make operations to repair aneurysms safer?
18. Does having an aneurysm affect life expectancy, how can any effect of having an aneurysm be minimised and how can the patient and doctor achieve this?

Carotid Top 10 Priorities

A workshop was held on 21st September 2021 to bring together patients and healthcare professionals to jointly agree a priority list for carotid research. The results were as follows:

1. Can doctors accurately predict which people with carotid artery disease are most at risk of a stroke?
2. Is there an association between carotid disease and cognitive decline?
3. What is the optimal management of patients with carotid disease using individualised risk benefit ratios?
4. Can the appearance of carotid narrowings (also called plaques) help predict an individual patient's stroke risk?
5. What is the best treatment for carotid artery disease? E.g.medicines, life-style changes, intervention.
6. What can be done to prevent re-narrowing and recurrent symptoms following carotid surgery?
7. Is screening for carotid artery disease worthwhile, and if so, what is the best screening test?
8. Following carotid surgery, is surveillance (i.e, scanning to detect re-narrowing) of the treated artery necessary?
9. Is surveillance of patients with known carotid artery disease worthwhile?
10. What is the optimal antiplatelet regime following carotid endarterectomy?

The following questions were also discussed and put in order of priority at the workshop:

11. How can the problems carotid artery disease can cause be better explained to patients and members of the public? E.g. warning signs and stroke risk
12. What is the role of monitoring brain perfusion during surgery? E.g. Trans cranial doppler
13. Are chronic kidney disease and carotid artery disease connected?
14. Is enhanced recovery beneficial following carotid endarterectomy?

Diabetic Foot Top 10 Priorities

A workshop was held on 14th June 2021 to bring together patients and healthcare professionals to jointly agree a priority list for diabetic foot research. The results were as follows:

1. What is the most effective way of preventing diabetic foot ulcers?
2. What is the most effective way of preventing further amputation after toe amputation for diabetic foot disease?
3. Why are there delays in referral for diabetic foot disease?
4. How can outcomes in diabetic patients with foot infection be improved?
5. What is the best way of improving blood flow to the leg in people with diabetes?
6. Can risk assessment be improved in patients with diabetic foot complications?
7. What is the most effective way of preventing recurrence of diabetic foot ulcers?
8. What factors affect healing time in diabetic foot disease?
9. How can awareness of diabetic foot complications be promoted?
10. Is an annual foot check for diabetic foot problems worthwhile?

The following questions were also discussed and put in order of priority at the workshop:

11. Could more patients learn to self-administer antibiotics if needed / required?
12. Is maggot therapy effective in diabetic foot ulcer healing?

Peripheral Arterial Disease PAD Top 10 Priorities

A workshop was held on 14th May 2021 to bring together patients and healthcare professionals to jointly agree a priority list for PAD research. The results were as follows:

1. What can be done to improve outcomes in patients with severe circulation problems to their legs?
2. What is the optimal exercise prescription for patients with poor circulation to the legs? How can we improve provision and access to exercise programs?
3. How can we diagnose patients with poor circulation to their legs earlier and better? Would this make a difference in the long term?
4. How can we educate other doctors and health care workers so that they gain a better understanding of the consequences of a diagnosis of poor circulation to the legs?
5. How can we help educate better those patients who have poor circulation to their legs?
6. How can we make it easier for patients to get help for this problem (poor circulation to the legs)?
7. What are the best ways to reduce the leg pain symptoms seen with patients with poor leg circulation without performing an operation?
8. How can we slow down any progression of symptoms in those patients with poor circulation to their legs?
9. How can we stop patients getting poor circulation to their legs?
10. How can we reduce cardiovascular risk in PAD patients?

The following questions were also discussed and put in order of priority at the workshop:

11. How can we make sure that operations to improve blood flow to the legs of people with poor circulation work for a long period of time?
12. What are the best operations to perform to improve the blood flow to the legs of people with poor circulation?

Service Organisation Top 10 Priorities

A workshop was held on 9th July 2021 to bring together patients and healthcare professionals to jointly agree a priority list for vascular service research. The results were as follows:

1. How can regional vascular services best be organised and delivered to provide the best outcomes and experience for vascular patients?
2. What can be done to ensure that GPs and other healthcare staff have a better understanding of vascular disease?
3. What can be done to make sure that people with vascular problems get to see the most appropriate professionals as quickly as possible?
4. What is the best way to help people with lifestyle changes such as diet, smoking cessation and exercise?
5. How can awareness of vascular disease be improved amongst people with vascular symptoms and the general public?
6. What can be done to improve communication between healthcare professionals and people with vascular disease?
7. What can be done to make sure that everyone involved in treating vascular patients communicates better with each other?
8. New and emerging technologies; how should they introduced and evaluated?
9. What can be done to make sure that everyone gets fair and equal access to the best vascular treatment, regardless of individual characteristics?
10. How can better treatments be developed for vascular conditions that do not require major operations?

The following questions were also discussed and put in order of priority at the workshop:

11. How can pre-op risk assessment be optimised and fitness improved in vascular patients?
12. Which tests are most useful for the diagnosis of vascular disease and where should they be carried out?
13. How can specialist vascular nurses improve the experience for people with vascular disease?
14. How can length of hospital stay for vascular patients be reduced safely?
15. What can be done to make sure that the outcome measures used for vascular services address the things that matter most to people with vascular disease?
16. How can the way people with vascular disease be better informed about treatment options, so that they can take a greater part in shared decision-making?
17. Should current screening programmes look for other vascular conditions?
18. What can be done to improve patient and public engagement and understanding of research?

Vascular Conditions Top 10s

The Vascular Conditions PSP set Top 10 priorities in nine areas

Access
Amputation
Aortic
Carotid
Diabetic Foot
Peripheral Arterial Disease PAD
Service Organisation
Venous
Wounds

Venous Top 10 Priorities

A final workshop was held 27th September 2021 and brought together patients and healthcare professionals to jointly agree a priority list for venous research.

1. How can all patients be given the opportunity to access the specialist assessment and treatment they need?
2. How can awareness and education of venous disease be improved?
3. How can leg symptoms and tissue damage be prevented and treated in people with deep venous disease including deep vein thrombosis (DVT)?
4. How can varicose veins be prevented from happening or coming back after treatment?
5. How can the number of patients actually using compression treatment be improved?
6. How can leg symptoms and tissue damage be prevented and treated in people with superficial venous disease?
7. How can venous leg ulcers be made to heal more quickly?
8. What is the best type of compression for patients with venous disease and how do we improve compliance?
9. How can pain be better controlled in venous leg ulcers?
10. How common is pelvic vein incompetence and is treatment effective?

The following questions were also discussed and put in order of priority at the workshop:

11. How can the early detection of deep vein thrombosis (DVT) be improved?
12. What is the most effective treatment for varicose veins?
13. Will a greater understanding of the bacteria living in venous leg ulcers result in less infection and/or greater wound healing?
14. What is the best way to prevent blood clots in the deep veins or lungs (DVT or PE) following treatment of varicose veins?

Wounds Top 10 Priorities

A workshop was held on 18th May 2021 to bring together patients and healthcare professionals to jointly agree a priority list for vascular wounds research. The results were as follows:

1. How can patient involvement in the decisions about their wounds be improved?
2. How can healing of open wounds be accelerated?
3. How can quality of life be improved in patients with open wounds?
4. How can wound care be personalised to meet patient circumstances or needs?
5. Which service configuration is associated with the best outcomes in wound patients?
6. How can communication between clinicians in wound care services be improved?
7. How can consistency in assessment, diagnosis and management inpatients with wounds be improved?
8. How can wounds be prevented from becoming infected?
9. How can wound healing be optimised in vascular patients?
10. How can communication be improved with patients with wounds?

The following questions were also discussed and put in order of priority at the workshop:

11. What is the best way to manage complex, hard to heal leg ulcers?
12. How can Surgical Site Infection in vascular surgery be reduced?
13. Which dressings are best for open wounds in specific situations?
14. How can wound odour be reduced?
15. What is the best way to debride (remove dead or unwanted material) from wounds?