National Services Division
Area 062
Gyle Square
1 South Gyle Crescent
Edinburgh EH12 9EB
Telephone 0131 275 6575
Fax 0131 275 7614
www.nsd.scot.nhs.uk
Scottish National Service for the treatment of TAAA (Thoracic and Thoraco-Abdominal
Aortic Aneurysms)
July 2010
Dear Colleague
(see over for list)
This letter is intended to serve as a reminder to all colleagues around the country as to the
current status of the above Nationally Designated Specialist Service. The TAAA Service
was commissioned by NSD in 2001 and is provided by NHS Lothian at the Royal Infirmary
of Edinburgh under the clinical leadership of the service director Mr Rod Chalmers. There
are two surgeons directly involved in the service (Mr RTA Chalmers and Mr PJ Burns), as
well as two vascular anaesthetists (Dr A Nimmo and Dr C Moores); strongly supported by
expert colleagues in other disciplines, especially interventional radiology, cardiology,
intensive care and renal medicine.
The service is now fully established and provides a comprehensive, multidisciplinary
service for the treatment of aneurysm disease affecting the aorta from the innominate
artery to the iliac arteries. Referrals can be made in writing, by fax or by direct
telephone contact at the numbers listed. The team are always happy to discuss
patients with colleagues and the National PACS system allows immediate viewing of
recent imaging. Although a purely an elective service at its inauguration, the service now
treats urgent cases, especially if an endovascular approach is possible.
Initially the team delivered a purely surgical service, but now treats patients with all
interventions available; including open surgery, endovascular stent-grafting; and so-called
“hybrid” repair where open surgery and endovascular techniques are combined. This
latter modality is especially useful in the treatment of aortic arch aneurysms. The service
is considering a move into the field of fenestrated and branched endografts to treat
aneurysms of the visceral and thoraco-abdominal aorta. Mr Burns undertook training in
this technique in Sydney, Australia prior to his appointment.
The results of TAAA treatment in Edinburgh have been presented nationally and
internationally and the Scottish National TAAA Service is now recognised as achieving
outcomes that compare to the best centres in Europe and the United States of America.
Patient assessment involves a comprehensive cardio-respiratory work-up including
cardiology opinion, dobutamine stress echocardiography, CT coronary angiography and
cardiopulmonary exercise testing. We assess approximately 50 patients a year and treat
between 20 and 30. Following referral the TAAA team expect to continue to work with the
referring surgeon / team; and if agreed by all parties would be happy to invite the referring
surgeon to participate in the surgical intervention in Edinburgh.
TAAA update letter 23July 2010 v0.4
In the exceptionally rare circumstance that the specialist treatment for TAAA cannot be
delivered at the Royal Infirmary of Edinburgh; NSD would wish to emphasise that national
funding will only be authorised to fund referral to an English centre if the case has been
discussed with the TAAA team in NHS Lothian, and they have offered an opinion that such
a referral is appropriate.
It is intended that a revised care pathway will be circulated in the near future for
consideration by the vascular surgical and interventional radiologist clinical communities.
If there are any issues arising from this letter please do not hesitate to contact either Mr
Chalmers at RIE, Belinda Henshaw Programme Manager at NSD or myself
Dr Mike Winter
Mr Rod Chalmers
Dr Mike Winter
Medical Director
NSD
Mr Rod Chalmers
Director TAAA service
NHS Lothian
CONTACTS for TAAA service
Tel.
Mr Rod Chalmers
0131 242 1059
Mr Paul Burns
Dr Alistair Nimmo
Mr Graeme Morrice
0131 242 3640
E Mail
Rod.chalmers@luht.scot.nhs.uk
Paul.burns@luht.scot.nhs.uk
a.nimmo@ed.ac.uk
Graeme.morrice@nhs.net
CONTACTS for NSD
Dr Mike Winter,
Medical Director
Katherine Collins,
Programme Director
Belinda Henshaw,
Programme Manager
Tel.
0131 275 7023
e Mail
mike.winter@nhs.net
0131 275 6157
katherine.collins@nhs.net
0131 275 6231
belinda.henshaw@nhs.net
Letter sent to
Vascular Surgeons and Interventional Radiologists in NHS Scotland
NHS Board Medical Directors
TAAA update letter 23July 2010 v0.4