Editor's Choice - Quality Assessment of European Society for Vascular Surgery Clinical Practice Guidelines.

OBJECTIVE: An increasing number of clinical practice guidelines (CPGs) have emerged over recent years. To have clinical utility, they need to be rigorously developed and scientifically robust. Instruments have been developed to assess the quality of clinical guideline development and reporting. The aim of this study was to evaluate CPGs from the European Society for Vascular Surgery (ESVS) using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. METHODS: CPGs published by the ESVS during the period January 2011 to January 2023 were included. Two independent reviewers assessed the guidelines after receiving training in the use and application of the AGREE II instrument. Inter-reviewer reliability was assessed with the intraclass correlation coefficient. Maximum scaled scores were 100. Statistical analysis was performed using SPSS Statistics v.26. RESULTS: Sixteen guidelines were included in the study. Good inter-reviewer score reliability was found on statistical analysis (> 0.9). The mean ± standard deviation domain scores were 68.1 ± 20.3% for scope and purpose, 57.1 ± 21.1% for stakeholder involvement, 67.8 ± 19.5% for rigour of development, 78.1 ± 20.6% for clarity of presentation, 50.3 ± 15.4% for applicability, 77.6 ± 17.6% for editorial independence, and 69.8 ± 20.1% for overall quality. Stakeholder involvement and applicability have improved in quality over time but are still the lowest scoring domains. CONCLUSION: Most ESVS clinical guidelines are of high quality and reporting. There is scope for improvement, specifically by addressing the domains of stakeholder involvement and clinical applicability.

Intermittent malperfusion of bilateral upper limbs - An uncommon presentation of Type A Acute Aortic Dissection (TAAD).

INTRODUCTION: Aortic dissection occurs following a tear in the tunica intima of the aortic wall resulting in blood entering between the intima and media. Type A aortic dissection can rarely manifest as upper limb malperfusion. CASE PRESENTATION: This is regarding a patient who presented with intermittent malperfusion of the bilateral upper limbs and was initially managed as acute limb ischemia. An attempt of embolectomy didn't yield any clots. Urgent imaging with computed tomography angiogram of bilateral upper limbs revealed type A aortic dissection (TAAD). DISCUSSION: TAAD is a surgical emergency which can rarely manifest as intermittent malperfusion of upper limbs. This could be explained by the dissection flap's dynamic obstruction of the right brachiocephalic trunk and left subclavian artery. CONCLUSION: In patients with a discrepancy in pulse between both limbs or intermittent ischemia of limbs, aortic dissection should be considered a differential diagnosis.