The members were treated to a comprehensive review of the hospitals’ Vascular Services at this event, which included presentations by two patients both of whom had been successfully treated for life-threatening conditions.
Mr Kieran Dawson and his team started by explaining the current reorganisation of Vascular Services in the United Kingdom with Vascular Services no longer being part of General Surgery. These were being concentrated in 45/50 specialist locations, each capable of serving around one million patients. The objective was for patients to have 24/7 access to specialist treatment and there was to be one specialist for every 150,000 patients. For Surrey and North Hampshire these services were to be provided by the team at St Peter’s Hospital which would shortly grow to six specialists. The Government’s objective in concentrating the services was to reduce the morbidity ratio further. Five years ago the ratio for AAA elective surgery was 7.5%. The current ratio is 5% and the objective is to reduce it to 3.5% cent by 2013. The current ratio at St Peter’s is 2.4%, more than twice as good as the current national average.
Currently 80% of patients who suffer an Abdominal Aortic Aneurysm (AAA) outside the hospital environment die before they can be treated. Of the rest, only 50% survive. This is why the National Abdominal Aortic Aneurysm Screening Programme (NAAASP) for men aged 65 is so important (AAA is far more common in men). The NAAASP screening program is anticipated to reduce the death rate by 50%. Men over 65 can self-refer, so theoretically anyone at risk could be screened. Mr Browning is the Programme Director for screening in Surrey and Hampshire which is being run through the Ashford site. He outlined the programme and benefits of the screening programme for the county.
Elective surgery is offered and takes one of two forms. The first is open surgery, which is more invasive and results in a stay in hospital of around two weeks. The second involves keyhole treatment via the groin and patients can be discharged as early as the next day (which was the case for the patient who discussed his treatment with the meeting). Keyhole surgery is particularly suitable for patients who may not be able to withstand the trauma of the more invasive, open method.
Dr Brendan Affley from Epsom General Hospital explained the difference between a stroke and a transient ischemic attack (or mini-stroke). Strokes which tend to cause some permanent damage to the brain are the third most common cause of death in the United Kingdom and the risk of having one increases after the age of 45. Major contributing factors to the degree of risk include high blood pressure, diabetes, atrial fibrillation and high cholesterol. In the old days the treatment for strokes was relatively passive with the patient being confined to bed. Mr Tahir Ali discussed with the audience that today, strokes were much more actively managed with it being important for the patient to undergo a CT scan when a stroke is detected and be given clot-busting drugs as soon as possible after the attack with a view to minimising any permanent damage. A 24/7 network had accordingly been set up in Surrey so that stroke victims could be actively managed by specialists whatever their location. All mini-stroke victims should also be referred to hospital within 24 hours as patients suffering a mini stroke had a 10% chance of succumbing to a stroke within the next 48 hours. Treatment for both conditions could involve surgery on the carotid artery in the neck.
Finally, the meeting addressed arterial and venous issues in other parts of the body where treatment could involve stents, clot-busting drugs and, in rare extreme circumstances, an amputation.
So all in all, a very comprehensive tour of the services on offer. Now where are my blood pressure pills!
David Frank, Governor for Surrey Heath