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London Cardiovascular Project

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Vascular surgery

The London Cardiovascular Project aims to improve treatment, care and outcomes for all patients with cardiovascular disease in the capital. The project has three main areas of focus: Cardiac surgery, Cardiology, and Vascular services.

The UK has the worst mortality rates following arterial vascular surgery in the developed world.

Clinical evidence highlights four factors that influence outcomes following arterial vascular surgery:

  • Vascular surgery should be undertaken by a specialist vascular surgeon.
  • Endovascular surgery reduces LOS, HAI risk and surgical mortality.
  • Surgeons should maintain high volumes of surgery.
  • Hospitals should perform high volumes of surgery.

Implementation

The London clusters will lead on implementation with support from the London Cardiac Networks.

Aims

Vascular services to be provided as part of an effective comprehensive network system.

There will be five central units across London that will provide arterial vascular surgery, each linked with several local units.

Central units:

  • Perform all elective and emergency arterial surgery
  • Be staffed by vascular specialists
  • Operate 24/7
  • Ensure all patients have their surgery at a high volume hospital by an experience vascular specialist, using the latest technology and techniques

Local hospitals:

  • Ensure high quality, equitable vascular care
  • Continue to deliver the majority of vascular services, including the full range of day surgery procedures, supported by outpatient and diagnostic facilities
  • Continue to deliver varicose vein surgery, amputation and selected limb interventions (representing approximately 75 percent of all vascular services

Pathway

vascular pathway

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Implementation update

  • North West London - Services have been centralised onto the Northwick Park and St Mary's hospital sites from October 2011.
  • North Central London - The cluster has agreed the hub for complex arterial surgery will be the Royal Free. All complex aortic work will centralise at the hub. Carotid endarterectomy will be undertaken at the hub and also at University College Hospital, but only for high risk patients coming thorough the hyper acute stroke unit.
  • North East London - Complex arterial vascular surgery has been centralised at The Royal London and Queen's Hospital Romford sites.
  • South West London - Complex arterial vascular surgery is centralised at St George's Hospital site.
  • South East London - Complex arterial vascular surgery is currently being undertaken at St Thomas' Hospital, King's College Hospital and University Hospital Lewisham. From March 2012 service will transfer from Lewisham Hospital. From summer 2012 King's Health Partners will centralise vascular services to the St Thomas' site.

There will be five central units across London that will provide arterial vascular surgery, each linked with several local units.

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Pathway

vascular pathway

Click to enlarge

Project documents

Model of care (summary)
Model of care (detailed)
Patient perspective
Responses to engagement
Case for change
Co-dependencies framework
Financial analysis

More on the
patient perspective