Vascular surgical society of great britain and ireland: first year of a fast-track carotid duplex service.

Abstract

BACKGROUND: The risk of a major stroke after a transient ischaemic attack (TIA) is highest in the first 3 months after the onset of symptoms. Urgent endarterectomy in appropriate cases is recommended through a fast-track one-stop assessment clinic. METHODS: Local general practitioners (GPs) were informed that a duplex scan would be guaranteed within 14 days of referral of any patient who had a recent clearly documented TIA or amaurosis fugax. Referral letters were faxed and the scan was authorized by a consultant surgeon. Those with significant disease were seen in the clinic in preparation for operation. Non-significant results were conveyed by post to the GPs with no further action. RESULTS: In the first 12 months of the service, 90 scans were performed through the fast track. In the same interval 490 non-fast-track scans were done after request by a physician (38 per cent), geriatrician (24 per cent), neurologist (14 per cent), vascular surgeon (11 per cent), ophthalmologist (8 per cent) or others (4 per cent). Thirteen (14 per cent) of 90 patients in the fast-track group had carotid endarterectomy, with a median period between referral and operation of 30 (range 20-45) days and median time between onset of symptoms and surgery of 7 (range 4-58) weeks. Endarterectomy was carried out in 12 (2 per cent) of 490 patients in the routine group with a median duration between referral and operation of 127 (range 64-184) days. CONCLUSION: A fast-track service can significantly reduce the time between referral and operation, and increase the number of endarterectomies. Urgent and appropriate referral from the GPs is vital for the service to work efficiently.