Transcript Thoracic Outlet Syndrome Commissioning and Organisation of

Thoracic Outlet Syndrome
Commissioning and Organisation of
Vascular Services
David Gerrard
Thoracic Outlet Syndrome
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Cervical Rib
Fibrous bands
Idiopathic
Iatrogenic
Physiological
– Exercise
– Work related
Anatomy
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Compression of neurovascular
structures exiting the neck
Varying pattern of symptoms
• Purely Neurological
• Purely Arterial
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Embolic or thrombotic
Purely Venous
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Usually thrombotic
Mixed
Diagnosis
• High Clinical Suspicion
• By Exclusion
• Examination
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Cervical spine/shoulder MS exam
Inspection
Pulse
BP in each arms
Adson’s Test
Roos’ Test
Investigations
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Thoracic Outlet X-Ray
Venous/Arterial Duplex
Cervical MRI/CTA
Venography
Nerve Conduction Studies
Thoracic Outlet Syndrome
Thoracic Outlet Syndrome
Treatment
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3-6 months physiotherapy
Adjust lifestyle
Job
Venoplasty
Surgery
Surgical Approaches
Commissioning of Vascular
Services
• Varicose Veins
• Hyperhidrosis
• Complex AAA repair
Commissioning of Vascular
Services
• Varicose Veins
– Based upon CEAP classification
CEAP classification
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Clinical classification
Etiology classification
Anatomic classification
Pathophysiological
CEAP classification
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Clinical classification
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C0: no visible or palpable signs of venous disease
C1: telangiectasies or reticular veins
C2: varicose veins
C3: edema
C4a: pigmentation or eczema
C4b: lipodermatosclerosis or athrophîe blanche
C5: healed venous ulcer
C6: active venous ulcer
S: symptomatic, including ache, pain, tightness, skin irritation, heaviness, and muscle cramps,
and other complaints attributable to venous dysfunction
– A: Asymptomatic
CEAP classification
• Etiology classification
– Ec: congenital
– Ep: primary
– Es: secondary
– En: no venous cause identified
CEAP classification
• Anatomic classification
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As: superficial veins
Ap: perforating veins
Ad: deep veins
An: no venous location identified
CEAP classification
• Pathophysiological
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Pr: reflux
Po: obstruction
Pr,o: reflux and obstruction
Pn: no venous pathophysiology identifiable
Commissioning of Vascular
Services
• Varicose Veins
– Differing policies in Surrey, Hampshire & Berkshire
Commissioning of Vascular
Services
• Varicose Veins
– Surrey
• CEAP 3
• Otherwise IFR required
Commissioning of Vascular
Services
• Varicose Veins
– N Hampshire
• CEAP 6
• Otherwise IFR required
Commissioning of Vascular
Services
• Varicose Veins
– Berkshire
• Prior authorisation
Commissioning of Vascular
Services
• Hyperhidrosis
– Botox
– Cervical Sympathectomy
• Common Policies
– Not funded outside IFR
• Commissioning of Vascular
Services
Complex AAA repair
F-EVAR
‘Nellix’
Organisation of Vascular Services
• Pre-2012
– Network with ASPH
• S Central Review 2011
– Separate hubs
– Separation agreement
• Screening Programme
Current Situation
• Surrey and Sussex commissioners wish to
retain 2 hub model
– ? Timeframe
– Outside pressures to Centralise even further
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Expertise, surgical, anaesthetic, nursing
Expense
Training
Outcomes
The Future
• FHFT
– Basingstoke, +/- RSCH
• ASPH
– +/- Epsom, +/- RSCH, +/- East Surrey
• One Vascular Centre
FHFT Clinics
FHFT Contact Details
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VASCULAR DEPARTMENT CONTACT DETAILS
Contact details:
Frimley Park Hospital main switchboard
01276 604604
Medical Secretaries for:
Mr P W Leopold & Mr M Cleanthis:
01276 604291 (Tracy Cullen)
Mr D J Gerrard & Mr N Dastur:
01276 604772 (Eileen Kean)
Mr P F S Chong:
01276 522141 (Sally Dolman)
Miss S Sonnenberg:
01256 313569 (Laura Dobson / Sally Dolman)
FHFT Contact Details
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Vascular Specialist Nurses
Claire Martin
Jean Nixon
Tracey Craig
Andrea Croucher
Amy Dickenson (NHH)
Direct Dial
Email:
07799 862858
01276 526302 or Bleep 407 / 349 / 452
[email protected]
Vascular Support Secretary
01276 522555 (Joanne Briggs)
Vascular Office Fax Number:
01276 526516
Vascular Specialist Registrars
Bleep 020 / 014
Senior House Officer
Bleep 170
House Officer
Bleep 019