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1. Editor's Choice – Nationwide Analysis of Patients Undergoing Iliac Artery Aneurysm Repair in the Netherlands

Author

Hamid Jalalzadeh, Reza Indrakusuma, Mark J.W. Koelemay, Ron Balm, L.H. Van den Akker, P.J. Van den Akker, G.J. Akkersdijk, G.P. Akkersdijk, W.L. Akkersdijk, M.G. van Andringa de Kempenaer, C.H. Arts, J.A. Avontuur, J.G. Baal, O.J. Bakker, R. Balm, W.B. Barendregt, M.H. Bender, B.L. Bendermacher, M. van den Berg, P. Berger, R.J. Beuk, J.D. Blankensteijn, R.J. Bleker, J.H. Bockel, M.E. Bodegom, K.E. Bogt, A.P. Boll, M.H. Booster, B.L. Borger van der Burg, G.J. de Borst, W.T. Bos-van Rossum, J. Bosma, J.M. Botman, L.H. Bouwman, J.C. Breek, V. Brehm, M.J. Brinckman, T.H. van den Broek, H.L. Brom, M.T. de Bruijn, J.L. de Bruin, P. Brummel, J.P. van Brussel, S.E. Buijk, M.G. Buimer, D.H. Burger, H.C. Buscher, G. den Butter, E. Cancrinus, P.H. Castenmiller, G. Cazander, H.M. Coveliers, P.H. Cuypers, J.H. Daemen, I. Dawson, A.F. Derom, A.R. Dijkema, J. Diks, M.K. Dinkelman, M. Dirven, D.E. Dolmans, R.C. van Doorn, L.M. van Dortmont, M.M. van der Eb, D. Eefting, G.J. van Eijck, J.W. Elshof, B.H. Elsman, A. van der Elst, M.I. van Engeland, R.G. van Eps, M.J. Faber, W.M. de Fijter, B. Fioole, W.M. Fritschy, R.H. Geelkerken, W.B. van Gent, G.J. Glade, B. Govaert, R.P. Groenendijk, H.G. de Groot, R.F. van den Haak, E.F. de Haan, G.F. Hajer, J.F. Hamming, E.S. van Hattum, C.E. Hazenberg, P.P. Hedeman Joosten, J.N. Helleman, L.G. van der Hem, J.M. Hendriks, J.A. van Herwaarden, J.M. Heyligers, J.W. Hinnen, R.J. Hissink, G.H. Ho, P.T. den Hoed, M.T. Hoedt, F. van Hoek, R. Hoencamp, W.H. Hoffmann, A.W. Hoksbergen, E.J. Hollander, L.C. Huisman, R.G. Hulsebos, K.M. Huntjens, M.M. Idu, M.J. Jacobs, M.F. van der Jagt, J.R. Jansbeken, R.J. Janssen, H.H. Jiang, S.C. de Jong, V. Jongkind, M.R. Kapma, B.P. Keller, A. Khodadade Jahrome, J.K. Kievit, P.L. Klemm, P. Klinkert, B. Knippenberg, N.A. Koedam, M.J. Koelemay, J.L. Kolkert, G.G. Koning, O.H. Koning, A.G. Krasznai, R.M. Krol, R.H. Kropman, R.R. Kruse, L. van der Laan, M.J. van der Laan, J.H. van Laanen, J.H. Lardenoye, J.A. Lawson, D.A. Legemate, V.J. Leijdekkers, M.S. Lemson, M.M. Lensvelt, M.A. Lijkwan, R.C. Lind, F.T. van der Linden, P.F. Liqui Lung, M.J. Loos, M.C. Loubert, D.E. Mahmoud, C.G. Manshanden, E.C. Mattens, R. Meerwaldt, B.M. Mees, R. Metz, R.C. Minnee, J.C. de Mol van Otterloo, F.L. Moll, Y.C. Montauban van Swijndregt, M.J. Morak, R.H. van de Mortel, W. Mulder, S.K. Nagesser, C.C. Naves, J.H. Nederhoed, A.M. Nevenzel-Putters, A.J. de Nie, D.H. Nieuwenhuis, J. Nieuwenhuizen, R.C. van Nieuwenhuizen, D. Nio, A.P. Oomen, B.I. Oranen, J. Oskam, H.W. Palamba, A.G. Peppelenbosch, A.S. van Petersen, T.F. Peterson, B.J. Petri, M.E. Pierie, A.J. Ploeg, R.A. Pol, E.D. Ponfoort, P.P. Poyck, A. Prent, S. ten Raa, J.T. Raymakers, M. Reichart, B.L. Reichmann, M.M. Reijnen, A. Rijbroek, M.J. van Rijn, R.A. de Roo, E.V. Rouwet, C.G. Rupert, B.R. Saleem, M.R. van Sambeek, M.G. Samyn, H.P. van ’t Sant, J. van Schaik, P.M. van Schaik, D.M. Scharn, M.R. Scheltinga, A. Schepers, P.M. Schlejen, F.J. Schlosser, F.P. Schol, O. Schouten, M.H. Schreinemacher, M.A. Schreve, G.W. Schurink, C.J. Sikkink, M.P. Siroen, A. te Slaa, H.J. Smeets, L. Smeets, A.A. de Smet, P. de Smit, P.C. Smit, T.M. Smits, M.G. Snoeijs, A.O. Sondakh, T.J. van der Steenhoven, S.M. van Sterkenburg, D.A. Stigter, H. Stigter, R.P. Strating, G.N. Stultiëns, J.E. Sybrandy, J.A. Teijink, B.J. Telgenkamp, M.J. Testroote, R.M. The, W.J. Thijsse, I.F. Tielliu, R.B. van Tongeren, R.J. Toorop, J.H. Tordoir, E. Tournoij, M. Truijers, K. Türkcan, R.P. Tutein Nolthenius, Ç. Ünlü, A.A. Vafi, A.C. Vahl, E.J. Veen, H.T. Veger, M.G. Veldman, H.J. Verhagen, B.A. Verhoeven, C.F. Vermeulen, E.G. Vermeulen, B.P. Vierhout, M.J. Visser, J.A. van der Vliet, C.J. Vlijmen - van Keulen, H.G. Voesten, R. Voorhoeve, A.W. Vos, B. de Vos, G.A. Vos, B.H. Vriens, P.W. Vriens, A.C. de Vries, J.P. de Vries, M. de Vries, C. van der Waal, E.J. Waasdorp, B.M. Wallis de Vries, L.A. van Walraven, J.L. van Wanroij, M.C. Warlé, V. van Weel, A.M. van Well, G.M. Welten, R.J. Welten, J.J. Wever, A.M. Wiersema, O.R. Wikkeling, W.I. Willaert, J. Wille, M.C. Willems, E.M. Willigendael, W. Wisselink, M.E. Witte, C.H. Wittens, I.C. Wolf-de Jonge, O. Yazar, C.J. Zeebregts, M.L. van Zeeland, Surgery, ACS - Atherosclerosis & ischemic syndromes, Pathology, VU University medical center, Pediatrics, Dermatology, ACS - Microcirculation, ACS - Diabetes & metabolism, Graduate School, 02 Surgical specialisms, ​Robotics and image-guided minimally-invasive surgery (ROBOTICS), Neurology, Erasmus MC other, Molecular Genetics, Erasmus School of Economics, Socio-Medical Sciences (SMS), Cell biology, Gynecological Oncology, Research & Education, Child and Adolescent Psychiatry / Psychology, Cardiology, Urology, Erasmus School of Health Policy & Management, Erasmus School of Social and Behavioural Sciences, Erasmus School of Law, Department of History, Department of Psychology, Education and Child Studies, Obstetrics & Gynecology, Department of Finance, General Practice, Applied Economics, Pediatric Surgery, Department of Business-Society Management, Commercial Law and Financial Law, Radiology & Nuclear Medicine, Business Economics, Neurosurgery, Public Health, Anesthesiology, Internal Medicine, Hematology, Intensive Care, Psychiatry, WP ESPhil, and Gastroenterology & Hepatology

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Iliac Aneurysm/epidemiology, Patient characteristics, Netherlands/epidemiology, 030204 cardiovascular system & hematology, 030230 surgery, Iliac Artery/pathology, Endovascular aneurysm repair, Iliac Artery, 03 medical and health sciences, 0302 clinical medicine, Aneurysm, Sex Factors, medicine, 80 and over, Humans, EVAR, Registries, Iliac artery aneurysm, Aged, Netherlands, Retrospective Studies, Surgical repair, Aged, 80 and over, business.industry, Open repair, Endovascular Procedures, Retrospective cohort study, Guideline, Vascular surgery, medicine.disease, Guideline Adherence/statistics & numerical data, Surgery, Endovascular Procedures/methods, Aneurysm repair, Treatment Outcome, Iliac Aneurysm, Female, Guideline Adherence, Cardiology and Cardiovascular Medicine, business
Abstract

OBJECTIVE: The new 2019 guideline of the European Society for Vascular Surgery (ESVS) recommends consideration for elective iliac artery aneurysm (eIAA) repair when the iliac diameter exceeds 3.5 cm, as opposed to 3.0 cm previously. The current study assessed diameters at time of eIAA repair and ruptured IAA (rIAA) repair and compared clinical outcomes after open surgical repair (OSR) and endovascular aneurysm repair (EVAR).METHODS: This retrospective observational study used the nationwide Dutch Surgical Aneurysm Audit (DSAA) registry that includes all patients who undergo aorto-iliac aneurysm repair in the Netherlands. All patients who underwent primary IAA repair between 1 January 2014 and 1 January 2018 were included. Diameters at time of eIAA and rIAA repair were compared in a descriptive fashion. The anatomical location of the IAA was not registered in the registry. Patient characteristics and outcomes of OSR and EVAR were compared with appropriate statistical tests.RESULTS: The DSAA registry comprised 974 patients who underwent IAA repair. A total of 851 patients were included after exclusion of patients undergoing revision surgery and patients with missing essential variables. eIAA repair was carried out in 713 patients, rIAA repair in 102, and symptomatic IAA repair in 36. OSR was performed in 205, EVAR in 618, and hybrid repairs and conversions in 28. The median maximum IAA diameter at the time of eIAA and rIAA repair was 43 (IQR 38-50) mm and 68 (IQR 58-85) mm, respectively. Mortality was 1.3% (95% CI 0.7-2.4) after eIAA repair and 25.5% (95% CI 18.0-34.7) after rIAA repair. Mortality was not significantly different between the OSR and EVAR subgroups. Elective OSR was associated with significantly more complications than EVAR (intra-operative: 9.8% vs. 3.6%, post-operative: 34.0% vs. 13.8%, respectively).CONCLUSION: In the Netherlands, most eIAA repairs are performed at diameters larger than recommended by the ESVS guideline. These findings appear to support the recent increase in the threshold diameter for eIAA repair.

Published
2020
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2. Toward Optimizing Risk Adjustment in the Dutch Surgical Aneurysm Audit

Author

Niki Lijftogt, Anco Vahl, Esmee M. van der Willik, Vanessa J. Leijdekkers, Michel W.J.M. Wouters, Jaap F. Hamming, L.H. Van den Akker, P.J. Van den Akker, G.J. Akkersdijk, G.P. Akkersdijk, W.L. Akkersdijk, M.G. van Andringa de Kempenaer, C.H. Arts, J.A. Avontuur, J.G. Baal, O.J. Bakker, R. Balm, W.B. Barendregt, M.H. Bender, B.L. Bendermacher, M. van den Berg, P. Berger, R.J. Beuk, J.D. Blankensteijn, R.J. Bleker, J.H. Bockel, M.E. Bodegom, K.E. Bogt, A.P. Boll, M.H. Booster, B.L. Borger van der Burg, G.J. de Borst, W.T. Bos-van Rossum, J. Bosma, J.M. Botman, L.H. Bouwman, J.C. Breek, V. Brehm, M.J. Brinckman, T.H. van den Broek, H.L. Brom, M.T. de Bruijn, J.L. de Bruin, P. Brummel, J.P. van Brussel, S.E. Buijk, M.G. Buimer, D.H. Burger, H.C. Buscher, G. den Butter, E. Cancrinus, P.H. Castenmiller, G. Cazander, H.M. Coveliers, P.H. Cuypers, J.H. Daemen, I. Dawson, A.F. Derom, A.R. Dijkema, J. Diks, M.K. Dinkelman, M. Dirven, D.E. Dolmans, R.C. van Doorn, L.M. van Dortmont, M.M. van der Eb, D. Eefting, G.J. van Eijck, J.W. Elshof, B.H. Elsman, A. van der Elst, M.I. van Engeland, R.G. van Eps, M.J. Faber, W.M. de Fijter, B. Fioole, W.M. Fritschy, R.H. Geelkerken, W.B. van Gent, G.J. Glade, B. Govaert, R.P. Groenendijk, H.G. de Groot, R.F. van den Haak, E.F. de Haan, G.F. Hajer, J.F. Hamming, E.S. van Hattum, C.E. Hazenberg, P.P. Hedeman Joosten, J.N. Helleman, L.G. van der Hem, J.M. Hendriks, J.A. van Herwaarden, J.M. Heyligers, J.W. Hinnen, R.J. Hissink, Ho GH, P.T. den Hoed, M.T. Hoedt, F. van Hoek, R. Hoencamp, W.H. Hoffmann, A.W. Hoksbergen, E.J. Hollander, L.C. Huisman, R.G. Hulsebos, K.M. Huntjens, M.M. Idu, M.J. Jacobs, M.F. van der Jagt, J.R. Jansbeken, R.J. Janssen, H.H. Jiang, S.C. de Jong, V. Jongkind, M.R. Kapma, B.P. Keller, A. Khodadade Jahrome, J.K. Kievit, P.L. Klemm, P. Klinkert, B. Knippenberg, N.A. Koedam, M.J. Koelemaij, J.L. Kolkert, G.G. Koning, O.H. Koning, A.G. Krasznai, R.M. Krol, R.H. Kropman, R.R. Kruse, L. van der Laan, M.J. van der Laan, J.H. van Laanen, J.H. Lardenoye, J.A. Lawson, D.A. Legemate, V.J. Leijdekkers, M.S. Lemson, M.M. Lensvelt, M.A. Lijkwan, R.C. Lind, F.T. van der Linden, P.F. Liqui Lung, M.J. Loos, M.C. Loubert, D.E. Mahmoud, C.G. Manshanden, E.C. Mattens, R. Meerwaldt, B.M. Mees, R. Metz, R.C. Minnee, J.C. de Mol van Otterloo, F.L. Moll, Y.C. Montauban van Swijndregt, M.J. Morak, R.H. van de Mortel, W. Mulder, S.K. Nagesser, C.C. Naves, J.H. Nederhoed, A.M. Nevenzel-Putters, A.J. de Nie, D.H. Nieuwenhuis, J. Nieuwenhuizen, R.C. van Nieuwenhuizen, D. Nio, A.P. Oomen, B.I. Oranen, J. Oskam, H.W. Palamba, A.G. Peppelenbosch, A.S. van Petersen, T.F. Peterson, B.J. Petri, M.E. Pierie, A.J. Ploeg, R.A. Pol, E.D. Ponfoort, P.P. Poyck, A. Prent, S. ten Raa, J.T. Raymakers, M. Reichart, B.L. Reichmann, M.M. Reijnen, A. Rijbroek, M.J. van Rijn, R.A. de Roo, E.V. Rouwet, C.G. Rupert, B.R. Saleem, M.R. van Sambeek, M.G. Samyn, H.P. van 't Sant, J. van Schaik, P.M. van Schaik, D.M. Scharn, M.R. Scheltinga, A. Schepers, P.M. Schlejen, F.J. Schlosser, F.P. Schol, O. Schouten, M.H. Schreinemacher, M.A. Schreve, G.W. Schurink, C.J. Sikkink, M.P. Siroen, A. te Slaa, H.J. Smeets, L. Smeets, A.A. de Smet, P. de Smit, P.C. Smit, T.M. Smits, M.G. Snoeijs, A.O. Sondakh, T.J. van der Steenhoven, S.M. van Sterkenburg, D.A. Stigter, H. Stigter, R.P. Strating, G.N. Stultiëns, J.E. Sybrandy, J.A. Teijink, B.J. Telgenkamp, M.J. Testroote, R.M. The, W.J. Thijsse, I.F. Tielliu, R.B. van Tongeren, R.J. Toorop, J.H. Tordoir, E. Tournoij, M. Truijers, K. Türkcan, R.P. Tutein Nolthenius, Ç. Ünlü, A.A. Vafi, A.C. Vahl, E.J. Veen, H.T. Veger, M.G. Veldman, H.J. Verhagen, B.A. Verhoeven, C.F. Vermeulen, E.G. Vermeulen, B.P. Vierhout, M.J. Visser, J.A. van der Vliet, C.J. Vlijmen - van Keulen, H.G. Voesten, R. Voorhoeve, A.W. Vos, B. de Vos, G.A. Vos, B.H. Vriens, Vriens PW, A.C. de Vries, J.P. de Vries, M. de Vries, C. van der Waal, E.J. Waasdorp, B.M. Wallis de Vries, L.A. van Walraven, J.L. van Wanroij, M.C. Warlé, V. van Weel, A.M. van Well, G.M. Welten, R.J. Welten, J.J. Wever, A.M. Wiersema, O.R. Wikkeling, W.I. Willaert, J. Wille, M.C. Willems, E.M. Willigendael, W. Wisselink, M.E. Witte, C.H. Wittens, I.C. Wolf-de Jonge, O. Yazar, C.J. Zeebregts, M.L. van Zeeland, Surgery, ACS - Atherosclerosis & ischemic syndromes, Multi-Modality Medical Imaging, Gastroenterology and hepatology, Pediatrics, Hematology laboratory, Obstetrics and gynaecology, Amsterdam Movement Sciences - Restoration and Development, Public and occupational health, AGEM - Digestive immunity, Amsterdam Reproduction & Development (AR&D), ACS - Microcirculation, ACS - Diabetes & metabolism, RS: CAPHRI - R5 - Optimising Patient Care, and Epidemiologie

Subjects
Male, medicine.medical_specialty, Time Factors, SURGERY, Aortic Rupture, UT-Hybrid-D, 030204 cardiovascular system & hematology, Logistic regression, Risk Assessment, Decision Support Techniques, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, Risk Factors, Electronic Health Records, Humans, Medicine, Prospective Studies, Registries, Prospective cohort study, Aged, Netherlands, Aged, 80 and over, ABDOMINAL AORTIC-ANEURYSM, Medical Audit, business.industry, MORTALITY, Glasgow Coma Scale, Reproducibility of Results, General Medicine, medicine.disease, Comorbidity, Abdominal aortic aneurysm, n/a OA procedure, ERA, MODEL, Treatment Outcome, Predictive value of tests, Emergency medicine, Female, Cardiology and Cardiovascular Medicine, business, Risk assessment, Vascular Surgical Procedures, Aortic Aneurysm, Abdominal, Abdominal surgery
Abstract

Background: To compare hospital outcomes of aortic aneurysm surgery, casemix correction for preoperative variables is essential. Most of these variables can be deduced from mortality risk prediction models. Our aim was to identify the optimal set of preoperative variables associated with mortality to establish a relevant and efficient casemix model.Methods: All patients prospectively registered between 2013 and 2016 in the Dutch Surgical Aneurysm Audit (DSAA) were included for the analysis. After multiple imputation for missing variables, predictors for mortality following univariable logistic regression were analyzed in a manual backward multivariable logistic regression model and compared with three standard mortality risk prediction models: Glasgow Aneurysm Score (GAS, mainly clinical parameters), Vascular Biochemical and Haematological Outcome Model (VBHOM, mainly laboratory parameters), and Dutch Aneurysm Score (DAS, both clinical and laboratory parameters). Discrimination and calibration were tested and considered good with a C-statistic > 0.8 and Hosmer-Lemeshow (H-L) P > 0.05.Results: There were 12,401 patients: 9,537 (76.9%) elective patients (EAAA), 913 (7.4%) acute symptomatic patients (SAAA), and 1,951 (15.7%) patients with acute rupture (RAAA). Overall postoperative mortality was 6.5%; 1.8% after EAAA surgery, 6.6% after SAAA, and 29.6% after RAAA surgery. The optimal set of independent variables associated with mortality was a mix of clinical and laboratory parameters: gender, age, pulmonary comorbidity, operative setting, creatinine, aneurysm size, hemoglobin, Glasgow coma scale, electrocardiography, and systolic blood pressure (C-statistic 0.871). External validation overall of VBHOM, DAS, and GAS revealed C-statistics of 0.836, 0.782, and 0.761, with an H-L of 0.028, 0.00, and 0.128, respectively.Conclusions: The optimal set of variables for casemix correction in the DSAA comprises both clinical and laboratory parameters, which can be collected easily from electronic patient files and will lead to an efficient casemix model.

Published
2019
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3. Nationwide Study to Predict Colonic Ischemia after Abdominal Aortic Aneurysm Repair in The Netherlands

Author

Saskia Irene Willemsen, Martijn Geert ten Berge, Randolph George Statius van Eps, Hugo Thomas Christian Veger, Hans van Overhagen, Lukas Carolus van Dijk, Hein Putter, Jan Jacob Wever, L.H. Van den Akker, P.J. Van den Akker, G.J. Akkersdijk, G.P. Akkersdijk, W.L. Akkersdijk, M.G. van Andringa de Kempenaer, C.H. Arts, J.A. Avontuur, J.G. Baal, O.J. Bakker, R. Balm, W.B. Barendregt, M.H. Bender, B.L. Bendermacher, M. van den Berg, P. Berger, R.J. Beuk, J.D. Blankensteijn, R.J. Bleker, J.H. Bockel, M.E. Bodegom, K.E. Bogt, A.P. Boll, M.H. Booster, B.L. Borger van der Burg, G.J. de Borst, W.T. Bos-van Rossum, J. Bosma, J.M. Botman, L.H. Bouwman, J.C. Breek, V. Brehm, M.J. Brinckman, T.H. van den Broek, H.L. Brom, M.T. de Bruijn, J.L. de Bruin, P. Brummel, J.P. van Brussel, S.E. Buijk, M.G. Buimer, D.H. Burger, H.C. Buscher, G. den Butter, E. Cancrinus, P.H. Castenmiller, G. Cazander, H.M. Coveliers, P.H. Cuypers, J.H. Daemen, I. Dawson, A.F. Derom, A.R. Dijkema, J. Diks, M.K. Dinkelman, M. Dirven, D.E. Dolmans, R.C. van Doorn, L.M. van Dortmont, M.M. van der Eb, D. Eefting, G.J. van Eijck, J.W. Elshof, B.H. Elsman, A. van der Elst, M.I. van Engeland, R.G. van Eps, M.J. Faber, W.M. de Fijter, B. Fioole, W.M. Fritschy, R.H. Geelkerken, W.B. van Gent, G.J. Glade, B. Govaert, R.P. Groenendijk, H.G. de Groot, R.F. van den Haak, E.F. de Haan, G.F. Hajer, J.F. Hamming, E.S. van Hattum, C.E. Hazenberg, P.P. Hedeman Joosten, J.N. Helleman, L.G. van der Hem, J.M. Hendriks, J.A. van Herwaarden, J.M. Heyligers, J.W. Hinnen, R.J. Hissink, G.H. Ho, P.T. den Hoed, M.T. Hoedt, F. van Hoek, R. Hoencamp, W.H. Hoffmann, A.W. Hoksbergen, E.J. Hollander, L.C. Huisman, R.G. Hulsebos, K.M. Huntjens, M.M. Idu, M.J. Jacobs, M.F. van der Jagt, J.R. Jansbeken, R.J. Janssen, H.H. Jiang, S.C. de Jong, V. Jongkind, M.R. Kapma, B.P. Keller, A. Khodadade Jahrome, J.K. Kievit, P.L. Klemm, P. Klinkert, B. Knippenberg, N.A. Koedam, M.J. Koelemaij, J.L. Kolkert, G.G. Koning, O.H. Koning, A.G. Krasznai, R.M. Krol, R.H. Kropman, R.R. Kruse, L. van der Laan, M.J. van der Laan, J.H. van Laanen, J.H. Lardenoye, J.A. Lawson, D.A. Legemate, V.J. Leijdekkers, M.S. Lemson, M.M. Lensvelt, M.A. Lijkwan, R.C. Lind, F.T. van der Linden, P.F. Liqui Lung, M.J. Loos, M.C. Loubert, D.E. Mahmoud, C.G. Manshanden, E.C. Mattens, R. Meerwaldt, B.M. Mees, R. Metz, R.C. Minnee, J.C. de Mol van Otterloo, F.L. Moll, Y.C. Montauban van Swijndregt, M.J. Morak, R.H. van de Mortel, W. Mulder, S.K. Nagesser, C.C. Naves, J.H. Nederhoed, A.M. Nevenzel-Putters, A.J. de Nie, D.H. Nieuwenhuis, J. Nieuwenhuizen, R.C. van Nieuwenhuizen, D. Nio, A.P. Oomen, B.I. Oranen, J. Oskam, H.W. Palamba, A.G. Peppelenbosch, A.S. van Petersen, T.F. Peterson, B.J. Petri, M.E. Pierie, A.J. Ploeg, R.A. Pol, E.D. Ponfoort, P.P. Poyck, A. Prent, S. ten Raa, J.T. Raymakers, M. Reichart, B.L. Reichmann, M.M. Reijnen, A. Rijbroek, M.J. van Rijn, R.A. de Roo, E.V. Rouwet, C.G. Rupert, B.R. Saleem, M.R. van Sambeek, M.G. Samyn, H.P. van’t Sant, J. van Schaik, P.M. van Schaik, D.M. Scharn, M.R. Scheltinga, A. Schepers, P.M. Schlejen, F.J. Schlosser, F.P. Schol, O. Schouten, M.H. Schreinemacher, M.A. Schreve, G.W. Schurink, C.J. Sikkink, M.P. Siroen, A. te Slaa, H.J. Smeets, L. Smeets, A.A. de Smet, P. de Smit, P.C. Smit, T.M. Smits, M.G. Snoeijs, A.O. Sondakh, T.J. van der Steenhoven, S.M. van Sterkenburg, D.A. Stigter, H. Stigter, R.P. Strating, G.N. Stultiëns, J.E. Sybrandy, J.A. Teijink, B.J. Telgenkamp, M.J. Testroote, R.M. The, W.J. Thijsse, I.F. Tielliu, R.B. van Tongeren, R.J. Toorop, J.H. Tordoir, E. Tournoij, M. Truijers, K. Türkcan, R.P. Tutein Nolthenius, Ç. Ünlü, A.A. Vafi, A.C. Vahl, E.J. Veen, H.T. Veger, M.G. Veldman, H.J. Verhagen, B.A. Verhoeven, C.F. Vermeulen, E.G. Vermeulen, B.P. Vierhout, M.J. Visser, J.A. van der Vliet, C.J. Vlijmen-van Keulen, H.G. Voesten, R. Voorhoeve, A.W. Vos, B. de Vos, G.A. Vos, B.H. Vriens, P.W. Vriens, A.C. de Vries, J.P. de Vries, M. de Vries, C. van der Waal, E.J. Waasdorp, B.M. Wallis de Vries, L.A. van Walraven, J.L. van Wanroij, M.C. Warlé, V. van Weel, A.M. van Well, G.M. Welten, R.J. Welten, J.J. Wever, A.M. Wiersema, O.R. Wikkeling, W.I. Willaert, J. Wille, M.C. Willems, E.M. Willigendael, W. Wisselink, M.E. Witte, C.H. Wittens, I.C. Wolf-de Jonge, O. Yazar, C.J. Zeebregts, M.L. van Zeeland, TechMed Centre, Multi-Modality Medical Imaging, Technical Medicine, Surgery, ACS - Atherosclerosis & ischemic syndromes, Medical Biochemistry, ACS - Diabetes & metabolism, Amsterdam Gastroenterology Endocrinology Metabolism, APH - Methodology, and APH - Quality of Care

Subjects
Male, Time Factors, medicine.medical_treatment, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], 030204 cardiovascular system & hematology, Logistic regression, Endovascular aneurysm repair, 030218 nuclear medicine & medical imaging, 0302 clinical medicine, Risk Factors, Colon/blood supply, 80 and over, Medicine, Aortic Aneurysm, Abdominal/surgery, Netherlands, Aged, 80 and over, Univariate analysis, education.field_of_study, Endovascular Procedures, General Medicine, Middle Aged, Abdominal aortic aneurysm, Aortic Aneurysm, Treatment Outcome, Elective Surgical Procedures, Cardiology, Female, Cardiology and Cardiovascular Medicine, Cohort study, medicine.medical_specialty, Colon, Population, Mesenteric Ischemia/diagnosis, Risk Assessment, 03 medical and health sciences, Blood Vessel Prosthesis Implantation, Aneurysm, Internal medicine, Humans, Endovascular Procedures/adverse effects, cardiovascular diseases, Blood Vessel Prosthesis Implantation/adverse effects, education, Aged, Retrospective Studies, business.industry, Colonic ischemia, Abdominal/surgery, medicine.disease, Mesenteric Ischemia, Surgery, Emergencies, business, Aortic Aneurysm, Abdominal
Abstract

BACKGROUND: Colonic ischemia remains a severe complication after abdominal aortic aneurysm (AAA) repair and is associated with a high mortality. With open repair being one of the main risk factors of colonic ischemia, deciding between endovascular or open aneurysm repair should be based on tailor-made medicine. This study aims to identify high-risk patients of colonic ischemia, a risk that can be taken into account while deciding on AAA treatment strategy.METHODS: A nationwide population-based cohort study of 9,433 patients who underwent an AAA operation between 2014 and 2016 was conducted. Potential risk factors were determined by reviewing prior studies and univariate analysis. With logistic regression analysis, independent predictors of intestinal ischemia were established. These variables were used to form a prediction model.RESULTS: Intestinal ischemia occurred in 267 patients (2.8%). Occurrence of intestinal ischemia was seen significantly more in open repair versus endovascular aneurysm repair (7.6% vs. 0.9%; P < 0.001). This difference remained significant after stratification by urgency of the procedure, in both intact open (4.2% vs. 0.4%; P < 0.001) and ruptured open repair (15.0% vs. 6.2%); P < 0.001). Rupture of the AAA was the most important predictor of developing intestinal ischemia (odds ratio [OR], 5.9, 95% confidence interval [CI] 4.4-8.0), followed by having a suprarenal AAA (OR 3.4; CI 1.1-10.6). Associated procedural factors were open repair (OR 2.8; 95% CI 1.9-4.2), blood loss >1L (OR 3.6; 95% CI 1.7-7.5), and prolonged operating time (OR 2.0; 95% CI 1.4-2.8). Patient characteristics included having peripheral arterial disease (OR 2.4; 95% CI 1.3-4.4), female gender (OR 1.7; 95% CI 1.2-2.4), renal insufficiency (OR 1.7; 1.3-2.2), and pulmonary history (OR 1.6; 95% CI 1.2-2.2). Age CONCLUSIONS: One of the main risk factors is open repair. Several other risk factors can contribute to developing colonic ischemia after AAA repair. The proposed prediction model can be used to identify patients at high risk for developing colonic ischemia. With the current trend in AAA repair leaning toward open repair for better long-term results, our prediction model allows a better informed decision can be made in AAA treatment strategy.

Published
2021

4. National Numbers of Secondary Aortic Reinterventions after Primary Abdominal Aortic Aneurysm Surgery from the Dutch Surgical Aneurysm Audit

Author

Eleonora G. Karthaus, Anco Vahl, Bernard H.P. Elsman, Michel W.J.M. Wouters, Gert J. de Borst, Jaap F. Hamming, P.J. Van den Akker, G.J. Akkersdijk, G.P. Akkersdijk, W.L. Akkersdijk, M.G. van Andringa de Kempenaer, C.H. Arts, J.A. Avontuur, O.J. Bakker, R. Balm, W.B. Barendregt, J.A. Bekken, M.H. Bender, B.L. Bendermacher, M. van den Berg, P. Berger, R.J. Beuk, J.D. Blankensteijn, R.J. Bleker, J.J. Blok, A.S. Bode, M.E. Bodegom, K.E. van der Bogt, A.P. Boll, M.H. Booster, B.L. Borger van der Burg, G.J. de Borst, W.T. Bos-van Rossum, J. Bosma, J.M. Botman, L.H. Bouwman, V. Brehm, M.T. de Bruijn, J.L. de Bruin, P. Brummel, J.P. van Brussel, S.E. Buijk, M.A. Buijs, M.G. Buimer, D.H. Burger, H.C. Buscher, E. Cancrinus, P.H. Castenmiller, G. Cazander, A.M. Coester, P.H. Cuypers, J.H. Daemen, I. Dawson, J.E. Dierikx, M.L. Dijkstra, J. Diks, M.K. Dinkelman, M. Dirven, D.E. Dolmans, R.C. van Doorn, L.M. van Dortmont, J.W. Drouven, M.M. van der Eb, D. Eefting, G.J. van Eijck, J.W. Elshof, B.H. Elsman, A. van der Elst, M.I. van Engeland, R.G. van Eps, M.J. Faber, W.M. de Fijter, B. Fioole, T.M. Fokkema, F.A. Frans, W.M. Fritschy, P.H. Fung Kon Jin, R.H. Geelkerken, W.B. van Gent, G.J. Glade, B. Govaert, R.P. Groenendijk, H.G. de Groot, R.F. van den Haak, E.F. de Haan, G.F. Hajer, J.F. Hamming, E.S. van Hattum, C.E. Hazenberg, P.P. Hedeman Joosten, J.N. Helleman, L.G. van der Hem, J.M. Hendriks, J.A. van Herwaarden, J.M. Heyligers, J.W. Hinnen, R.J. Hissink, G.H. Ho, P.T. den Hoed, M.T. Hoedt, F. van Hoek, R. Hoencamp, W.H. Hoffmann, W. Hogendoorn, A.W. Hoksbergen, E.J. Hollander, M. Hommes, C.J. Hopmans, L.C. Huisman, R.G. Hulsebos, K.M. Huntjens, M.M. Idu, M.J. Jacobs, M.F. van der Jagt, J.R. Jansbeken, R.J. Janssen, H.H. Jiang, S.C. de Jong, T.A. Jongbloed-Winkel, V. Jongkind, M.R. Kapma, B.P. Keller, A. Khodadade Jahrome, J.K. Kievit, P.L. Klemm, P. Klinkert, N.A. Koedam, M.J. Koelemaij, J.L. Kolkert, G.G. Koning, O.H. Koning, R. Konings, A.G. Krasznai, R.M. Krol, R.H. Kropman, R.R. Kruse, L. van der Laan, M.J. van der Laan, J.H. van Laanen, G.W. van Lammeren, D.A. Lamprou, J.H. Lardenoye, G.J. Lauret, B.J. Leenders, D.A. Legemate, V.J. Leijdekkers, M.S. Lemson, M.M. Lensvelt, M.A. Lijkwan, R.C. Lind, F.T. van der Linden, P.F. Liqui Lung, M.J. Loos, M.C. Loubert, K.M. van de Luijtgaarden, D.E. Mahmoud, C.G. Manshanden, E.C. Mattens, R. Meerwaldt, B.M. Mees, G.C. von Meijenfeldt, T.P. Menting, R. Metz, R.C. Minnee, J.C. de Mol van Otterloo, M.J. Molegraaf, Y.C. Montauban van Swijndregt, M.J. Morak, R.H. van de Mortel, W. Mulder, S.K. Nagesser, C.C. Naves, J.H. Nederhoed, A.M. Nevenzel-Putters, A.J. de Nie, D.H. Nieuwenhuis, J. Nieuwenhuizen, R.C. van Nieuwenhuizen, D. Nio, V.J. Noyez, A.P. Oomen, B.I. Oranen, J. Oskam, H.W. Palamba, A.G. Peppelenbosch, A.S. van Petersen, B.J. Petri, M.E. Pierie, A.J. Ploeg, R.A. Pol, E.D. Ponfoort, I.C. Post, P.P. Poyck, A. Prent, S. ten Raa, J.T. Raymakers, M. Reichart, B.L. Reichmann, M.M. Reijnen, J.A. de Ridder, A. Rijbroek, M.J. van Rijn, R.A. de Roo, E.V. Rouwet, B.R. Saleem, P.B. Salemans, M.R. van Sambeek, M.G. Samyn, H.P. van't Sant, J. van Schaik, P.M. van Schaik, D.M. Scharn, M.R. Scheltinga, A. Schepers, P.M. Schlejen, F.J. Schlosser, F.P. Schol, V.P. Scholtes, O. Schouten, M.A. Schreve, G.W. Schurink, C.J. Sikkink, A. te Slaa, H.J. Smeets, L. Smeets, R.R. Smeets, A.A. de Smet, P.C. Smit, T.M. Smits, M.G. Snoeijs, A.O. Sondakh, M.J. Speijers, T.J. van der Steenhoven, S.M. van Sterkenburg, D.A. Stigter, R.A. Stokmans, R.P. Strating, G.N. Stultiëns, J.E. Sybrandy, J.A. Teijink, B.J. Telgenkamp, M. Teraa, M.J. Testroote, T. Tha-In, R.M. The, W.J. Thijsse, I. Thomassen, I.F. Tielliu, R.B. van Tongeren, R.J. Toorop, E. Tournoij, M. Truijers, K. Türkcan, R.P. Tutein Nolthenius, Ç. Ünlü, R.H. Vaes, A.A. Vafi, A.C. Vahl, E.J. Veen, H.T. Veger, M.G. Veldman, S. Velthuis, H.J. Verhagen, B.A. Verhoeven, C.F. Vermeulen, E.G. Vermeulen, B.P. Vierhout, R.J. van der Vijver-Coppen, M.J. Visser, J.A. van der Vliet, C.J. Vlijmen-van Keulen, R. Voorhoeve, J.R. van der Vorst, A.W. Vos, B. de Vos, C.G. Vos, G.A. Vos, M.T. Voute, B.H. Vriens, P.W. Vriens, A.C. de Vries, D.K. de Vries, J.P. de Vries, M. de Vries, C. van der Waal, E.J. Waasdorp, W. de Vries, L.A. van Walraven, J.L. van Wanroij, M.C. Warlé, W. van de Water, V. van Weel, A.M. van Well, G.M. Welten, R.J. Welten, J.J. Wever, A.M. Wiersema, O.R. Wikkeling, W.I. Willaert, J. Wille, M.C. Willems, E.M. Willigendael, E.D. Wilschut, W. Wisselink, M.E. Witte, C.H. Wittens, C.Y. Wong, R. Wouda, O. Yazar, K.K. Yeung, C.J. Zeebregts, M.L. van Zeeland, Surgery, ACS - Atherosclerosis & ischemic syndromes, Pathology, VU University medical center, Pediatrics, Dermatology, ACS - Microcirculation, ACS - Diabetes & metabolism, Amsterdam Gastroenterology Endocrinology Metabolism, Multi-Modality Medical Imaging, Technical Medicine, RS: CAPHRI - R5 - Optimising Patient Care, and Epidemiologie

Subjects
Male, Time Factors, medicine.medical_treatment, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], UT-Hybrid-D, EVAR TRIAL 1, OPEN REPAIR, 030204 cardiovascular system & hematology, Endovascular aneurysm repair, 030218 nuclear medicine & medical imaging, Postoperative Complications, 0302 clinical medicine, LONG-TERM OUTCOMES, Risk Factors, FAILURE, Registries, skin and connective tissue diseases, Netherlands, Aged, 80 and over, Medical Audit, Endovascular Procedures, General Medicine, EDITORS CHOICE, Abdominal aortic aneurysm, Treatment Outcome, Cohort, cardiovascular system, INSTRUCTIONS, Female, Cardiology and Cardiovascular Medicine, Reoperation, medicine.medical_specialty, Blood Vessel Prosthesis Implantation, 03 medical and health sciences, Aneurysm, medicine, Humans, Aged, Surgical repair, business.industry, MORTALITY, fungi, Stent, ENDOVASCULAR REPAIR, Odds ratio, medicine.disease, Confidence interval, Surgery, body regions, business, SYSTEM, Aortic Aneurysm, Abdominal
Abstract

Contains fulltext : 226469.pdf (Publisher’s version ) (Open Access) BACKGROUND: Long-term secondary aortic reinterventions (SARs) can be a sign of (lack of) effectiveness of abdominal aortic aneurysm (AAA) surgery. This study provides insight into the national number of SARs after primary AAA repair by endovascular aneurysm repair (EVAR) or by open surgical repair in the Netherlands. METHODS: Observational study included all patients undergoing SAR between 2016 and 2017, registered in the compulsory Dutch Surgical Aneurysm Audit (DSAA). The DSAA started in 2013, SARs are registered from 2016. Characteristics of SAR and postoperative outcomes (mortality/complications) were analyzed, stratified by urgency of SAR. Data of SARs were merged with data of their preceded primary AAA repair, registered in the DSAA after January 2013. In these patients undergoing SAR, treatment characteristics of the preceded primary AAA repair were additionally described, with focus on differences between stent grafts. RESULTS: Between 2016 and 2017, 691 patients underwent SAR, this concerned 9.3% of all AAA procedures (infrarenal/juxtarenal/suprarenal) in the Netherlands (77% elective/11% acute symptomatic/12% ruptured). Endoleak (60%) was the most frequent indication for SAR. SARs were performed with EVAR in 66%. Postoperative mortalities after SAR were 3.4%, 11%, and 29% in elective, acute symptomatic, and ruptured patients, respectively. In 26% (n = 181) of the patients undergoing SAR their primary AAA repair was performed after January 2013 and data of primary and SAR procedures could be merged. In 93% (n = 136), primary AAA repair was EVAR. Endografts primarily used were nitinol/polyester (62%), nitinol/polytetrafluoroethylene (8%), endovascular sealing (21%), and others (9%), compared with their national market share of 76% (odds ratio [OR], 0.52; 95% confidence interval [CI], 0.38-0.71), 15% (OR, 0.50; CI, 0.29-0.89), 4.9% (OR, 5.04; CI, 3.44-7.38), and 4.1% (OR, 2.81; CI, 1.66-4.74), respectively. CONCLUSIONS: In the Netherlands, about one-tenth of the annual AAA procedures concerns an SAR. A quarter of this cohort had an SAR within 1-5 years after their primary AAA repair. Most SARs followed after primary EVAR procedures, in which an overrepresentation of endovascular sealing grafts was seen. Postoperative mortality after SAR is comparable with primary AAA repair.

Published
2020
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5. A Composite Measure for Quality of Care in Patients with Symptomatic Carotid Stenosis Using Textbook Outcome

Author

Laurien S. Kuhrij, Eleonora G. Karthaus, Anco C. Vahl, Martine C.M. Willems, Jan W. Elshof, Gert J. de Borst, P.J. Van den Akker, G.J. Akkersdijk, G.P. Akkersdijk, W.L. Akkersdijk, M.G. van Andringa de Kempenaer, C.H. Arts, J.A. Avontuur, O.J. Bakker, R. Balm, W.B. Barendregt, J.A. Bekken, M.H. Bender, B.L. Bendermacher, M. van den Berg, P. Berger, R.J. Beuk, J.D. Blankensteijn, R.J. Bleker, J.J. Blok, A.S. Bode, M.E. Bodegom, K.E. van der Bogt, A.P. Boll, M.H. Booster, B.L. Borger van der Burg, G.J. de Borst, W.T. Bos-van Rossum, J. Bosma, J.M. Botman, L.H. Bouwman, V. Brehm, M.T. de Bruijn, J.L. de Bruin, P. Brummel, J.P. van Brussel, S.E. Buijk, M.A. Buijs, M.G. Buimer, D.H. Burger, H.C. Buscher, E. Cancrinus, P.H. Castenmiller, G. Cazander, A.M. Coester, P.H. Cuypers, J.H. Daemen, I. Dawson, J.E. Dierikx, M.L. Dijkstra, J. Diks, M.K. Dinkelman, M. Dirven, D.E. Dolmans, R.C. van Doorn, L.M. van Dortmont, J.W. Drouven, M.M. van der Eb, D. Eefting, G.J. van Eijck, J.W. Elshof, B.H. Elsman, A. van der Elst, M.I. van Engeland, R.G. van Eps, M.J. Faber, W.M. de Fijter, B. Fioole, T.M. Fokkema, F.A. Frans, W.M. Fritschy, P.H. Fung Kon Jin, R.H. Geelkerken, W.B. van Gent, G.J. Glade, B. Govaert, R.P. Groenendijk, H.G. de Groot, R.F. van den Haak, E.F. de Haan, G.F. Hajer, J.F. Hamming, E.S. van Hattum, C.E. Hazenberg, P.P. Hedeman Joosten, J.N. Helleman, L.G. van der Hem, J.M. Hendriks, J.A. van Herwaarden, J.M. Heyligers, J.W. Hinnen, R.J. Hissink, G.H. Ho, P.T. den Hoed, M.T. Hoedt, F. van Hoek, R. Hoencamp, W.H. Hoffmann, W. Hogendoorn, A.W. Hoksbergen, E.J. Hollander, M. Hommes, C.J. Hopmans, L.C. Huisman, R.G. Hulsebos, K.M. Huntjens, M.M. Idu, M.J. Jacobs, M.F. van der Jagt, J.R. Jansbeken, R.J. Janssen, H.H. Jiang, S.C. de Jong, T.A. Jongbloed-Winkel, V. Jongkind, M.R. Kapma, B.P. Keller, A. Khodadade Jahrome, J.K. Kievit, P.L. Klemm, P. Klinkert, N.A. Koedam, M.J. Koelemaij, J.L. Kolkert, G.G. Koning, O.H. Koning, R. Konings, A.G. Krasznai, R.M. Krol, R.H. Kropman, R.R. Kruse, L. van der Laan, M.J. van der Laan, J.H. van Laanen, G.W. van Lammeren, D.A. Lamprou, J.H. Lardenoye, G.J. Lauret, B.J. Leenders, D.A. Legemate, V.J. Leijdekkers, M.S. Lemson, M.M. Lensvelt, M.A. Lijkwan, R.C. Lind, F.T. van der Linden, P.F. Liqui Lung, M.J. Loos, M.C. Loubert, K.M. van de Luijtgaarden, D.E. Mahmoud, C.G. Manshanden, E.C. Mattens, R. Meerwaldt, B.M. Mees, G.C. von Meijenfeldt, T.P. Menting, R. Metz, R.C. Minnee, J.C. de Mol van Otterloo, M.J. Molegraaf, Y.C. Montauban van Swijndregt, M.J. Morak, R.H. van de Mortel, W. Mulder, S.K. Nagesser, C.C. Naves, J.H. Nederhoed, A.M. Nevenzel-Putters, A.J. de Nie, D.H. Nieuwenhuis, J. Nieuwenhuizen, R.C. van Nieuwenhuizen, D. Nio, V.J. Noyez, A.P. Oomen, B.I. Oranen, J. Oskam, H.W. Palamba, A.G. Peppelenbosch, A.S. van Petersen, B.J. Petri, M.E. Pierie, A.J. Ploeg, R.A. Pol, E.D. Ponfoort, I.C. Post, P.P. Poyck, A. Prent, S. ten Raa, J.T. Raymakers, M. Reichart, B.L. Reichmann, M.M. Reijnen, J.A. de Ridder, A. Rijbroek, M.J. van Rijn, R.A. de Roo, E.V. Rouwet, B.R. Saleem, P.B. Salemans, M.R. van Sambeek, M.G. Samyn, H.P. van ’t Sant, J. van Schaik, P.M. van Schaik, D.M. Scharn, M.R. Scheltinga, A. Schepers, P.M. Schlejen, F.J. Schlosser, F.P. Schol, V.P. Scholtes, O. Schouten, M.A. Schreve, G.W. Schurink, C.J. Sikkink, A. te Slaa, H.J. Smeets, L. Smeets, R.R. Smeets, A.A. de Smet, P.C. Smit, T.M. Smits, M.G. Snoeijs, A.O. Sondakh, M.J. Speijers, T.J. van der Steenhoven, S.M. van Sterkenburg, D.A. Stigter, R.A. Stokmans, R.P. Strating, G.N. Stultiëns, J.E. Sybrandy, J.A. Teijink, B.J. Telgenkamp, M. Teraa, M.J. Testroote, T. Tha-In, R.M. The, W.J. Thijsse, I. Thomassen, I.F. Tielliu, R.B. van Tongeren, R.J. Toorop, E. Tournoij, M. Truijers, K. Türkcan, R.P. Tutein Nolthenius, Ç. Ünlü, R.H. Vaes, A.A. Vafi, A.C. Vahl, E.J. Veen, H.T. Veger, M.G. Veldman, S. Velthuis, H.J. Verhagen, B.A. Verhoeven, C.F. Vermeulen, E.G. Vermeulen, B.P. Vierhout, R.J. van der Vijver-Coppen, M.J. Visser, J.A. van der Vliet, C.J. Vlijmen - van Keulen, R. Voorhoeve, J.R. van der Vorst, A.W. Vos, B. de Vos, C.G. Vos, G.A. Vos, M.T. Voute, B.H. Vriens, P.W. Vriens, A.C. de Vries, D.K. de Vries, J.P. de Vries, M. de Vries, C. van der Waal, E.J. Waasdorp, B.M. Wallis de Vries, L.A. van Walraven, J.L. van Wanroij, M.C. Warlé, W. van de Water, V. van Weel, A.M. van Well, G.M. Welten, R.J. Welten, J.J. Wever, A.M. Wiersema, O.R. Wikkeling, W.I. Willaert, J. Wille, M.C. Willems, E.M. Willigendael, E.D. Wilschut, W. Wisselink, M.E. Witte, C.H. Wittens, C.Y. Wong, R. Wouda, O. Yazar, K.K. Yeung, C.J. Zeebregts, M.L. van Zeeland, Surgery, ACS - Atherosclerosis & ischemic syndromes, Pathology, VU University medical center, Pediatrics, ACS - Microcirculation, ACS - Diabetes & metabolism, Multi-Modality Medical Imaging, Technical Medicine, RS: CAPHRI - R5 - Optimising Patient Care, Epidemiologie, Graduate School, ANS - Neurovascular Disorders, APH - Methodology, and APH - Quality of Care

Subjects
Male, Time Factors, medicine.medical_treatment, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Psychological intervention, UT-Hybrid-D, Carotid endarterectomy, 030204 cardiovascular system & hematology, 030230 surgery, Logistic regression, 0302 clinical medicine, Risk Factors, Carotid Stenosis, Registries, Stroke, Netherlands, Outcome, Aged, 80 and over, RISK, Endarterectomy, Carotid, ENDARTERECTOMY, Middle Aged, Outcome and Process Assessment, Health Care, Treatment Outcome, Ischemic Attack, Transient, Female, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, Funnel plot, Postoperative Hemorrhage, Patient Readmission, 03 medical and health sciences, Case mix index, Internal medicine, medicine, Humans, HOSPITAL QUALITY, Healthcare Disparities, Aged, Quality Indicators, Health Care, business.industry, Quality of care, 22/2 OA procedure, Length of Stay, medicine.disease, Comorbidity, Cranial Nerve Diseases, Stenosis, Surgery, business
Abstract

Contains fulltext : 226467.pdf (Publisher’s version ) (Closed access) OBJECTIVE: Composite measures may better objectify hospital performance than individual outcome measures (IOM). Textbook outcome (TO) is an outcome measure achieved for an individual patient when all undesirable outcomes are absent. The aim of this study was to assess TO as an additional outcome measure to evaluate quality of care in symptomatic patients treated by carotid endarterectomy (CEA). METHODS: All symptomatic patients treated by CEA in 2018, registered in the Dutch Audit for Carotid Interventions, were included. TO was defined as a composite of the absence of 30 day mortality, neurological events (any stroke or transient ischaemic attack [TIA]), cranial nerve deficit, haemorrhage, 30 day readmission, prolonged length of stay (LOS; > 5 days) and any other surgical complication. Multivariable logistic regression was used to identify covariables associated with achieving TO, which were used for casemix adjustment for hospital comparison. For each hospital, an observed vs. expected number of events ratio (O/E ratio) was calculated and plotted in a funnel plot with 95% control limits. RESULTS: In total, 70.7% of patients had a desired outcome within 30 days after CEA and therefore achieved TO. Prolonged LOS was the most common parameter (85%) and mortality the least common (1.1%) for not achieving TO. Covariates associated with achieving TO were younger age, the absence of pulmonary comorbidity, higher haemoglobin levels, and TIA as index event. In the case mix adjusted funnel plot, the O/E ratios between hospitals ranged between 0.63 and 1.27, with two hospitals revealing a statistically significantly lower rate of TO (with O/E ratios of 0.63 and 0.66). CONCLUSION: In the Netherlands, most patients treated by CEA achieve TO. Variation between hospitals in achieving TO might imply differences in performance. TO may be used as an additive to the pre-existing IOM, especially in surgical care with low baseline risk such as CEA.

Published
2020
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6. Long-term survival and secondary procedures after open or endovascular repair of abdominal aortic aneurysms

Author

Theodorus G. van Schaik, Kak K. Yeung, Hence J. Verhagen, Jorg L. de Bruin, Marc R.H.M. van Sambeek, Ron Balm, Clark J. Zeebregts, Joost A. van Herwaarden, Jan D. Blankensteijn, D.E. Grobbee, J.D. Blankensteijn, A.A.A. Bak, J. Buth, P.M. Pattynama, E.L.G. Verhoeven, A.E. van Voorthuisen, R. Balm, P.W.M. Cuypers, M. Prinssen, M.R.H.M. van Sambeek, A.F. Baas, M.G. Hunink, J.M. van Engelshoven, M.J.H.M. Jacobs, B.A.J.M. de Mol, J.H. van Bockel, J. Reekers, X. Tielbeek, W. Wisselink, N. Boekema, L.M. Heuveling, I. Sikking, J.L. de Bruin, A.V. Tielbeek, J.A. Reekers, P. Pattynama, T. Prins, A.C. van der Ham, J.J.I.M. van der Velden, S.M.M. van Sterkenburg, G.B. ten Haken, C.M.A. Bruijninckx, H. van Overhagen, R.P. Tutein Nolthenius, T.R. Hendriksz, J.A.W. Teijink, H.F. Odink, A.A.E.A. de Smet, D. Vroegindeweij, R.M.M. van Loenhout, M.J. Rutten, J.F. Hamming, L.E.H. Lampmann, M.H.M. Bender, H. Pasmans, A.C. Vahl, C. de Vries, A.J.C. Mackaay, L.M.C. van Dortmont, A.J. van der Vliet, L.J. Schultze Kool, J.H.B. Boomsma, H.R. van Dop, J.C.A. de Mol van Otterloo, T.P.W. de Rooij, T.M. Smits, E.N. Yilmaz, F.G. van den Berg, M.J.T. Visser, E. van der Linden, G.W.H. Schurink, M. de Haan, H.J. Smeets, P. Stabel, F. van Elst, J. Poniewierski, F.E.G. Vermassen, Cardiovascular Biomechanics, Surgery, ACS - Amsterdam Cardiovascular Sciences, Cardiothoracic Surgery, Radiology and Nuclear Medicine, ACS - Atherosclerosis & ischemic syndromes, ACS - Heart failure & arrhythmias, Man, Biomaterials and Microbes (MBM), Vascular Ageing Programme (VAP), Amsterdam Gastroenterology Endocrinology Metabolism, and ACS - Microcirculation

Subjects
Male, Time Factors, medicine.medical_treatment, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Postoperative Complications/diagnostic imaging, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, Endovascular aneurysm repair, law.invention, Aortic aneurysm, 0302 clinical medicine, Postoperative Complications, Randomized controlled trial, Belgium, law, Risk Factors, Cause of Death, 030212 general & internal medicine, Cause of death, Netherlands, OUTCOMES, Endovascular Procedures, II ENDOLEAK, Middle Aged, RANDOMIZED CONTROLLED-TRIAL, Abdominal aortic aneurysm, Aortic Aneurysm, Intention to Treat Analysis, Treatment Outcome, Retreatment, cardiovascular system, Female, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, Abdominal/diagnostic imaging, Disease-Free Survival, 03 medical and health sciences, Blood Vessel Prosthesis Implantation, Aneurysm, medicine, Humans, Endovascular Procedures/adverse effects, cardiovascular diseases, EXPOSURE, Blood Vessel Prosthesis Implantation/adverse effects, Aged, Intention-to-treat analysis, business.industry, medicine.disease, Surgery, RADIATION, business, FOLLOW-UP, Abdominal surgery, Aortic Aneurysm, Abdominal, Aortic Aneurysm, Abdominal/diagnostic imaging
Abstract

Item does not contain fulltext OBJECTIVE: Randomized trials have shown an initial survival benefit of endovascular over conventional open abdominal aortic aneurysm repair but no long-term difference up to 6 years after repair. Longer follow-up may be required to demonstrate the cumulative negative impact on survival of higher reintervention rates associated with endovascular repair. METHODS: We updated the results of the Dutch Randomized Endovascular Aneurysm Management (DREAM) trial, a multicenter, randomized controlled trial comparing open with endovascular aneurysm repair, up to 15 years of follow-up. Survival and reinterventions were analyzed on an intention-to-treat basis. Causes of death and secondary interventions were compared by use of an events per person-year analysis. RESULTS: There were 178 patients randomized to open and 173 to endovascular repair. Twelve years after randomization, the cumulative overall survival rates were 42.2% for open and 38.5% for endovascular repair, for a difference of 3.7 percentage points (95% confidence interval, -6.7 to 14.1; P = .48). The cumulative rates of freedom from reintervention were 78.9% for open repair and 62.2% for endovascular repair, for a difference of 16.7 percentage points (95% confidence interval, 5.8-27.6; P = .01). No differences were observed in causes of death. Cardiovascular and malignant disease account for the majority of deaths after prolonged follow-up. CONCLUSIONS: During 12 years of follow-up, there was no survival difference between patients who underwent open or endovascular abdominal aortic aneurysm repair, despite a continuously increasing number of reinterventions in the endovascular repair group. Endograft durability and the need for continued endograft surveillance remain key issues.

Published
2017
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7. Nationwide study of the treatment of mycotic abdominal aortic aneurysms comparing open and endovascular repair in The Netherlands

Author

Quan Dang, Randolph G. Statius van Eps, Jan J. Wever, Hugo T.C. Veger, L.H. Van den Akker, P.J. Van den Akker, G.J. Akkersdijk, G.P. Akkersdijk, W.L. Akkersdijk, M.G. van Andringa de Kempenaer, C.H. Arts, J.A. Avontuur, J.G. Baal, O.J. Bakker, R. Balm, W.B. Barendregt, M.H. Bender, B.L. Bendermacher, M. van den Berg, P. Berger, R.J. Beuk, J.D. Blankensteijn, R.J. Bleker, J.H. Bockel, M.E. Bodegom, K.E. Bogt, A.P. Boll, M.H. Booster, B.L. Borger van der Burg, G.J. de Borst, W.T. Bos- van Rossum, J. Bosma, J.M. Botman, L.H. Bouwman, J.C. Breek, V. Brehm, M.J. Brinckman, T.H. van den Broek, H.L. Brom, M.T. de Bruijn, J.L. de Bruin, P. Brummel, J.P. van Brussel, S.E. Buijk, M.G. Buimer, D.H. Burger, H.C. Buscher, G. den Butter, E. Cancrinus, P.H. Castenmiller, G. Cazander, H.M. Coveliers, P.H. Cuypers, J.H. Daemen, I. Dawson, A.F. Derom, A.R. Dijkema, J. Diks, M.K. Dinkelman, M. Dirven, D.E. Dolmans, R.C. van Doorn, L.M. van Dortmont, M.M. van der Eb, D. Eefting, G.J. van Eijck, J.W. Elshof, B.H. Elsman, A. van der Elst, M.I. van Engeland, R.G. van Eps, M.J. Faber, W.M. de Fijter, B. Fioole, W.M. Fritschy, R.H. Geelkerken, W.B. van Gent, G.J. Glade, B. Govaert, R.P. Groenendijk, H.G. de Groot, R.F. van den Haak, E.F. de Haan, G.F. Hajer, J.F. Hamming, E.S. van Hattum, C.E. Hazenberg, P.P. Hedeman Joosten, J.N. Helleman, L.G. van der Hem, J.M. Hendriks, J.A. van Herwaarden, J.M. Heyligers, J.W. Hinnen, R.J. Hissink, G.H. Ho, P.T. den Hoed, M.T. Hoedt, F. van Hoek, R. Hoencamp, W.H. Hoffmann, A.W. Hoksbergen, E.J. Hollander, L.C. Huisman, R.G. Hulsebos, K.M. Huntjens, M.M. Idu, M.J. Jacobs, M.F. van der Jagt, J.R. Jansbeken, R.J. Janssen, H.H. Jiang, S.C. de Jong, V. Jongkind, M.R. Kapma, B.P. Keller, A. Khodadade Jahrome, J.K. Kievit, P.L. Klemm, P. Klinkert, B. Knippenberg, N.A. Koedam, M.J. Koelemaij, J.L. Kolkert, G.G. Koning, O.H. Koning, A.G. Krasznai, R.M. Krol, R.H. Kropman, R.R. Kruse, L. van der Laan, M.J. van der Laan, J.H. van Laanen, J.H. Lardenoye, J.A. Lawson, D.A. Legemate, V.J. Leijdekkers, M.S. Lemson, M.M. Lensvelt, M.A. Lijkwan, R.C. Lind, F.T. van der Linden, P.F. Liqui Lung, M.J. Loos, M.C. Loubert, D.E. Mahmoud, C.G. Manshanden, E.C. Mattens, R. Meerwaldt, B.M. Mees, R. Metz, R.C. Minnee, J.C. de Mol van Otterloo, F.L. Moll, Y.C. Montauban van Swijndregt, M.J. Morak, R.H. van de Mortel, W. Mulder, S.K. Nagesser, C.C. Naves, J.H. Nederhoed, A.M. Nevenzel-Putters, A.J. de Nie, D.H. Nieuwenhuis, J. Nieuwenhuizen, R.C. van Nieuwenhuizen, D. Nio, A.P. Oomen, B.I. Oranen, J. Oskam, H.W. Palamba, A.G. Peppelenbosch, A.S. van Petersen, T.F. Peterson, B.J. Petri, M.E. Pierie, A.J. Ploeg, R.A. Pol, E.D. Ponfoort, P.P. Poyck, A. Prent, S. ten Raa, J.T. Raymakers, M. Reichart, B.L. Reichmann, M.M. Reijnen, A. Rijbroek, M.J. van Rijn, R.A. de Roo, E.V. Rouwet, C.G. Rupert, B.R. Saleem, M.R. van Sambeek, M.G. Samyn, H.P. van ’t Sant, J. van Schaik, P.M. van Schaik, D.M. Scharn, M.R. Scheltinga, A. Schepers, P.M. Schlejen, F.J. Schlosser, F.P. Schol, O. Schouten, M.H. Schreinemacher, M.A. Schreve, G.W. Schurink, C.J. Sikkink, A. te Slaa, H.J. Smeets, L. Smeets, A.A. de Smet, P. de Smit, P.C. Smit, T.M. Smits, M.G. Snoeijs, A.O. Sondakh, T.J. van der Steenhoven, S.M. van Sterkenburg, D.A. Stigter, H. Stigter, R.P. Strating, G.N. Stultiëns, J.E. Sybrandy, J.A. Teijink, B.J. Telgenkamp, M.J. Testroote, R.M. The, W.J. Thijsse, I.F. Tielliu, R.B. van Tongeren, R.J. Toorop, J.H. Tordoir, E. Tournoij, M. Truijers, K. Türkcan, R.P. Tutein Nolthenius, Ç. Ünlü, A.A. Vafi, A.C. Vahl, E.J. Veen, H.T. Veger, M.G. Veldman, H.J. Verhagen, B.A. Verhoeven, C.F. Vermeulen, E.G. Vermeulen, B.P. Vierhout, M.J. Visser, J.A. van der Vliet, C.J. Vlijmen - van Keulen, H.G. Voesten, R. Voorhoeve, A.W. Vos, B. de Vos, G.A. Vos, B.H. Vriens, P.W. Vriens, A.C. de Vries, J.P. de Vries, M. de Vries, C. van der Waal, E.J. Waasdorp, B.M. Wallis de Vries, L.A. van Walraven, J.L. van Wanroij, M.C. Warlé, V. van Weel, A.M. van Well, G.M. Welten, R.J. Welten, J.J. Wever, A.M. Wiersema, O.R. Wikkeling, W.I. Willaert, J. Wille, M.C. Willems, E.M. Willigendael, W. Wisselink, M.E. Witte, C.H. Wittens, I.C. Wolf-de Jonge, O. Yazar, C.J. Zeebregts, M.L. van Zeeland, RS: CAPHRI - R5 - Optimising Patient Care, Epidemiologie, Surgery, ACS - Atherosclerosis & ischemic syndromes, Pathology, VU University medical center, Pediatrics, Dermatology, ACS - Microcirculation, ACS - Diabetes & metabolism, and Multi-Modality Medical Imaging

Subjects
Male, Clinical audit, Time Factors, SURGERY, medicine.medical_treatment, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Abdominal aneurysm, 030204 cardiovascular system & hematology, Endovascular aneurysm repair, Postoperative Complications, 0302 clinical medicine, Risk Factors, Registries, 030212 general & internal medicine, Mycotic, Netherlands, Medical Audit, OUTCOMES, Incidence, Incidence (epidemiology), Endovascular Procedures, Abdominal aorta, Clinical course, Infectious, Middle Aged, Anti-Bacterial Agents, Treatment Outcome, Female, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, Patient Readmission, Risk Assessment, Drug Administration Schedule, Blood Vessel Prosthesis Implantation, 03 medical and health sciences, Aneurysm, THORACIC AORTA, medicine.artery, medicine, Humans, Aged, Retrospective Studies, ILIAC ARTERIES, business.industry, MORTALITY, Retrospective cohort study, medicine.disease, n/a OA procedure, Surgery, VOLUME, business, Aneurysm, Infected, Aortic Aneurysm, Abdominal
Abstract

Contains fulltext : 226470.pdf (Publisher’s version ) (Closed access) OBJECTIVE: Mycotic aneurysms of the abdominal aorta (MAAA) can be treated by open repair (OR) or endovascular aneurysm repair (EVAR). This nationwide study provides an overview of the situation of MAAA treatment in The Netherlands in 2016. METHODS: A retrospective cohort study was conducted with all centers that registered aortic abdominal aneurysms in the Dutch Surgical Aneurysm Audit in 2016. Questionnaires on 1-year outcomes were sent to all centers that treated patients with MAAA. The primary aim was to determine 30-day and 1-year mortality and morbidity of OR- and EVAR-treated patients. Morbidity was determined by the need for reoperations and the number of readmissions to the hospital. RESULTS: Twenty-six MAAA were detected in the Dutch Surgical Aneurysm Audit database of 2016, resulting in an incidence of 0.7% of all registered abdominal aortic aneurysms. The 30-day mortality for OR and EVAR treated patients was 1 in 13 and 0 in 13, respectively. Major and minor reinterventions within 30 days were needed for two (one OR and one EVAR) and two (one OR and one EVAR) patients, respectively. Two patients (15.4%) in the OR group and one patient (7.7%) in the EVAR group were readmitted to hospital within 30 days. In total, 1-year outcomes of 23 patients were available. In the OR group, one patient (9.1%) died in the first postoperative year. There was one major reintervention (removal of endoprosthesis and spiralvein reconstruction) in the EVAR group. Two patients (18.2%) treated with OR and two (16.7%) treated with EVAR required a minor reintervention. In both groups, four patients (OR, 36.4%; EVAR, 33.3%) were readmitted to hospital within 1 year postoperatively. CONCLUSIONS: Both OR- and EVAR-treated patients show acceptable clinical outcomes after 30 days and at the 1-year follow-up. Depending on the clinical course of the patient, EVAR may be considered in the management of this disease.

Published
2020
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8. Patients with a Ruptured Abdominal Aortic Aneurysm Are Better Informed in Hospitals with an 'EVAR-preferred' Strategy: An Instrumental Variable Analysis of the Dutch Surgical Aneurysm Audit

Author

Eleonora G. Karthaus, Niki Lijftogt, Anco Vahl, Esmee M. van der Willik, Sonia Amodio, Erik W. van Zwet, Jaap F. Hamming, P.J. Van den Akker, G.J. Akkersdijk, G.P. Akkersdijk, W.L. Akkersdijk, M.G. van Andringa de Kempenaer, C.H. Arts, J.A. Avontuur, O.J. Bakker, R. Balm, W.B. Barendregt, J.A. Bekken, M.H. Bender, B.L. Bendermacher, M. van den Berg, P. Berger, R.J. Beuk, J.D. Blankensteijn, R.J. Bleker, J.J. Blok, A.S. Bode, M.E. Bodegom, K.E. van der Bogt, A.P. Boll, M.H. Booster, B.L. Borger van der Burg, G.J. de Borst, W.T. Bos- van Rossum, J. Bosma, J.M. Botman, L.H. Bouwman, V. Brehm, M.T. de Bruijn, J.L. de Bruin, P. Brummel, J.P. van Brussel, S.E. Buijk, M.A. Buijs, M.G. Buimer, D.H. Burger, H.C. Buscher, E. Cancrinus, P.H. Castenmiller, G. Cazander, A.M. Coester, P.H. Cuypers, J.H. Daemen, I. Dawson, J.E. Dierikx, M.L. Dijkstra, J. Diks, M.K. Dinkelman, M. Dirven, D.E. Dolmans, R.C. van Doorn, L.M. van Dortmont, J.W. Drouven, M.M. van der Eb, D. Eefting, G.J. van Eijck, J.W. Elshof, B.H. Elsman, A. van der Elst, M.I. van Engeland, R.G. van Eps, M.J. Faber, W.M. de Fijter, B. Fioole, T.M. Fokkema, F.A. Frans, W.M. Fritschy, P.H. Fung Kon Jin, R.H. Geelkerken, W.B. van Gent, G.J. Glade, B. Govaert, R.P. Groenendijk, H.G. de Groot, R.F. van den Haak, E.F. de Haan, G.F. Hajer, J.F. Hamming, E.S. van Hattum, C.E. Hazenberg, P.P. Hedeman Joosten, J.N. Helleman, L.G. van der Hem, J.M. Hendriks, J.A. van Herwaarden, J.M. Heyligers, J.W. Hinnen, R.J. Hissink, G.H. Ho, P.T. den Hoed, M.T. Hoedt, F. van Hoek, R. Hoencamp, W.H. Hoffmann, W. Hogendoorn, A.W. Hoksbergen, E.J. Hollander, M. Hommes, C.J. Hopmans, L.C. Huisman, R.G. Hulsebos, K.M. Huntjens, M.M. Idu, M.J. Jacobs, M.F. van der Jagt, J.R. Jansbeken, R.J. Janssen, H.H. Jiang, S.C. de Jong, T.A. Jongbloed-Winkel, V. Jongkind, M.R. Kapma, B.P. Keller, A. Khodadade Jahrome, J.K. Kievit, P.L. Klemm, P. Klinkert, N.A. Koedam, M.J. Koelemaij, J.L. Kolkert, G.G. Koning, O.H. Koning, R. Konings, A.G. Krasznai, R.M. Krol, R.H. Kropman, R.R. Kruse, L. van der Laan, M.J. van der Laan, J.H. van Laanen, G.W. van Lammeren, D.A. Lamprou, J.H. Lardenoye, G.J. Lauret, B.J. Leenders, D.A. Legemate, V.J. Leijdekkers, M.S. Lemson, M.M. Lensvelt, M.A. Lijkwan, R.C. Lind, F.T. van der Linden, P.F. Liqui Lung, M.J. Loos, M.C. Loubert, K.M. van de Luijtgaarden, D.E. Mahmoud, C.G. Manshanden, E.C. Mattens, R. Meerwaldt, B.M. Mees, G.C. von Meijenfeldt, T.P. Menting, R. Metz, R.C. Minnee, J.C. de Mol van Otterloo, M.J. Molegraaf, Y.C. Montauban van Swijndregt, M.J. Morak, R.H. van de Mortel, W. Mulder, S.K. Nagesser, C.C. Naves, J.H. Nederhoed, A.M. Nevenzel-Putters, A.J. de Nie, D.H. Nieuwenhuis, J. Nieuwenhuizen, R.C. van Nieuwenhuizen, D. Nio, V.J. Noyez, A.P. Oomen, B.I. Oranen, J. Oskam, H.W. Palamba, A.G. Peppelenbosch, A.S. van Petersen, B.J. Petri, M.E. Pierie, A.J. Ploeg, R.A. Pol, E.D. Ponfoort, I.C. Post, P.P. Poyck, A. Prent, S. ten Raa, J.T. Raymakers, M. Reichart, B.L. Reichmann, M.M. Reijnen, J.A. de Ridder, A. Rijbroek, M.J. van Rijn, R.A. de Roo, E.V. Rouwet, B.R. Saleem, P.B. Salemans, M.R. van Sambeek, M.G. Samyn, H.P. van ’t Sant, J. van Schaik, P.M. van Schaik, D.M. Scharn, M.R. Scheltinga, A. Schepers, P.M. Schlejen, F.J. Schlosser, F.P. Schol, V.P. Scholtes, O. Schouten, M.A. Schreve, G.W. Schurink, C.J. Sikkink, A. te Slaa, H.J. Smeets, L. Smeets, R.R. Smeets, A.A. de Smet, P.C. Smit, T.M. Smits, M.G. Snoeijs, A.O. Sondakh, M.J. Speijers, T.J. van der Steenhoven, S.M. van Sterkenburg, D.A. Stigter, R.A. Stokmans, R.P. Strating, G.N. Stultiëns, J.E. Sybrandy, J.A. Teijink, B.J. Telgenkamp, M. Teraa, M.J. Testroote, T. Tha-In, R.M. The, W.J. Thijsse, I. Thomassen, I.F. Tielliu, R.B. van Tongeren, R.J. Toorop, E. Tournoij, M. Truijers, K. Türkcan, R.P. Tutein Nolthenius, Ç. Ünlü, R.H. Vaes, A.A. Vafi, A.C. Vahl, E.J. Veen, H.T. Veger, M.G. Veldman, S. Velthuis, H.J. Verhagen, B.A. Verhoeven, C.F. Vermeulen, E.G. Vermeulen, B.P. Vierhout, R.J. van der Vijver-Coppen, M.J. Visser, J.A. van der Vliet, C.J. Vlijmen - van Keulen, R. Voorhoeve, J.R. van der Vorst, A.W. Vos, B. de Vos, C.G. Vos, G.A. Vos, M.T. Voute, B.H. Vriens, P.W. Vriens, A.C. de Vries, D.K. de Vries, J.P. de Vries, M. de Vries, C. van der Waal, E.J. Waasdorp, B.M. Wallis de Vries, L.A. van Walraven, J.L. van Wanroij, M.C. Warlé, W. van de Water, V. van Weel, A.M. van Well, G.M. Welten, R.J. Welten, J.J. Wever, A.M. Wiersema, O.R. Wikkeling, W.I. Willaert, J. Wille, M.C. Willems, E.M. Willigendael, E.D. Wilschut, W. Wisselink, M.E. Witte, C.H. Wittens, C.Y. Wong, R. Wouda, O. Yazar, K.K. Yeung, C.J. Zeebregts, M.L. van Zeeland, Multi-Modality Medical Imaging, Surgery, ACS - Atherosclerosis & ischemic syndromes, APH - Methodology, APH - Quality of Care, RS: CAPHRI - R5 - Optimising Patient Care, and Epidemiologie

Subjects
Male, Time Factors, medicine.medical_treatment, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], UT-Hybrid-D, 030204 cardiovascular system & hematology, Logistic regression, Endovascular aneurysm repair, 030218 nuclear medicine & medical imaging, law.invention, Postoperative Complications, 0302 clinical medicine, Randomized controlled trial, Risk Factors, law, 80 and over, Hospital Mortality, Prospective Studies, Prospective cohort study, Netherlands, Aged, 80 and over, OUTCOMES, Medical Audit, education.field_of_study, Endovascular Procedures, Confounding, Absolute risk reduction, General Medicine, EDITORS CHOICE, Aortic Aneurysm, Treatment Outcome, OPEN SURGERY, TRIAL, Female, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, Aortic Rupture, Clinical Decision-Making, Population, Abdominal/diagnostic imaging, Postoperative Complications/mortality, Risk Assessment, Blood Vessel Prosthesis Implantation, 03 medical and health sciences, medicine, Humans, Endovascular Procedures/adverse effects, Blood Vessel Prosthesis Implantation/adverse effects, education, Aged, business.industry, MORTALITY, ENDOVASCULAR REPAIR, Surgery, Aortic Rupture/diagnostic imaging, Propensity score matching, business, Aortic Aneurysm, Abdominal/diagnostic imaging, Aortic Aneurysm, Abdominal
Abstract

Contains fulltext : 229914.pdf (Publisher’s version ) (Open Access) BACKGROUND: While several observational studies suggested a lower postoperative mortality after minimal invasive endovascular aneurysm repair (EVAR) in patients with a ruptured abdominal aortic aneurysm (RAAA) compared to conventional open surgical repair (OSR), landmark randomized controlled trials have not been able to prove the superiority of EVAR over OSR. Randomized controlled trials contain a selected, homogeneous population, influencing external validity. Observational studies are biased and adjustment of confounders can be incomplete. Instrumental variable (IV) analysis (pseudorandomization) may help to answer the question if patients with an RAAA have lower postoperative mortality when undergoing EVAR compared to OSR. METHODS: This is an observational study including all patients with an RAAA, registered in the Dutch Surgical Aneurysm Audit between 2013 and 2017. The risk difference (RD) in postoperative mortality (30 days/in-hospital) between patients undergoing EVAR and OSR was estimated, in which adjustment for confounding was performed in 3 ways: linear model adjusted for observed confounders, propensity score model (multivariable logistic regression analysis), and IV analysis (two-stage least square regression), adjusting for observed and unobserved confounders, with the variation in percentage of EVAR per hospital as the IV instrument. RESULTS: 2419 patients with an RAAA (1489 OSR and 930 EVAR) were included. Unadjusted postoperative mortality was 34.9% after OSR and 22.6% after EVAR (RD 12.3%, 95% CI 8.5-16%). The RD adjusted for observed confounders using linear regression analysis and propensity score analysis was, respectively, 12.3% (95% CI 9.6-16.7%) and 13.2% (95%CI 9.3-17.1%) in favor of EVAR. Using IV analysis, adjusting for observed and unobserved confounders, RD was 8.9% (95% CI -1.1-18.9%) in favor of EVAR. CONCLUSIONS: Adjusting for observed confounders, patients with an RAAA undergoing EVAR had a significant better survival than OSR in a consecutive large cohort. Adjustment for unobserved confounders resulted in a clinical relevant RD. An "EVAR preference strategy" in patients with an RAAA could result in lower postoperative mortality.

Published
2020

9. International validation of a risk score for complications and reinterventions after endovascular aneurysm repair

Author

Peter J. Holt, Alberto Vidal-Diez, J.L. de Bruin, A. Karthikesalingam, I.M. Loftus, Robert J. Hinchliffe, and Matt M. Thompson

Subjects
Male, Reoperation, medicine.medical_specialty, Cost effectiveness, medicine.medical_treatment, Risk Assessment, Endovascular aneurysm repair, Preoperative care, Aneurysm, Preoperative Care, medicine, Humans, Aged, Framingham Risk Score, business.industry, Incidence (epidemiology), Endovascular Procedures, Composite outcomes, medicine.disease, Abdominal aortic aneurysm, Surgery, Female, Radiology, Tomography, X-Ray Computed, business, Aortic Aneurysm, Abdominal
Abstract

Background Lifelong surveillance is considered mandatory after endovascular repair (EVAR) of abdominal aortic aneurysms to detect endograft complications and prevent aneurysm rupture. Current protocols are not cost-effective or clinically effective. The international validity of the St George's Vascular Institute (SGVI) score for EVAR complications was examined. Methods The ENGAGE registry recruited patients undergoing EVAR at 79 centres in 30 countries. Reinterventions and endograft complications were recorded for up to 3 years after surgery. Preoperative aneurysm morphology was extracted from the registry database, and used to predict whether patients would be at low or high risk of complications after EVAR based on the SGVI score. Kaplan–Meier analysis was used to compare the incidence of endograft complications and reinterventions in patients predicted to be at low risk compared with those predicted to be at high risk. Results Some 1207 patients underwent EVAR, with follow-up of up to 3 years. The SGVI score accurately discriminated freedom from reinterventions (90·5 versus 79·3 per cent in low- versus high-risk patients; P < 0·001), freedom from endograft complications (77·9 versus 69·6 per cent in low- versus high-risk patients; P = 0·012), and freedom from a composite outcome measure of reinterventions or endograft complications (75·0 versus 66·1 per cent in low- versus high-risk patients; P = 0·006) during mid-term follow-up. Conclusion This study has provided international validation of a morphological risk score that predicts mid-term reinterventions and endograft complications. The results may enable risk-stratified surveillance after EVAR.

Published
2015
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10. The Dutch Audit of Carotid Interventions: Transparency in Quality of Carotid Endarterectomy in Symptomatic Patients in the Netherlands

Author

Eleonora G. Karthaus, Anco Vahl, Laurien S. Kuhrij, Bernard H.P. Elsman, Robert H. Geelkerken, Michel W.J.M. Wouters, Jaap F. Hamming, Gert J. de Borst, L.H. Van den Akker, P.J. Van den Akker, G.J. Akkersdijk, G.P. Akkersdijk, W.L. Akkersdijk, M.G. van Andringa de Kempenaer, C.H. Arts, J.A. Avontuur, J.G. Baal, O.J. Bakker, R. Balm, W.B. Barendregt, M.H. Bender, B.L. Bendermacher, M. van den Berg, P. Berger, R.J. Beuk, J.D. Blankensteijn, R.J. Bleker, J.H. Bockel, M.E. Bodegom, K.E. Bogt, A.P. Boll, M.H. Booster, B.L. Borger van der Burg, G.J. de Borst, W.T. Bos- van Rossum, J. Bosma, J.M. Botman, L.H. Bouwman, J.C. Breek, V. Brehm, M.J. Brinckman, T.H. van den Broek, H.L. Brom, M.T. de Bruijn, J.L. de Bruin, P. Brummel, J.P. van Brussel, S.E. Buijk, M.G. Buimer, D.H. Burger, H.C. Buscher, G. den Butter, E. Cancrinus, P.H. Castenmiller, G. Cazander, H.M. Coveliers, P.H. Cuypers, J.H. Daemen, I. Dawson, A.F. Derom, A.R. Dijkema, J. Diks, M.K. Dinkelman, M. Dirven, D.E. Dolmans, R.C. van Doorn, L.M. van Dortmont, M.M. van der Eb, D. Eefting, G.J. van Eijck, J.W. Elshof, B.H. Elsman, A. van der Elst, M.I. van Engeland, R.G. van Eps, M.J. Faber, W.M. de Fijter, B. Fioole, W.M. Fritschy, R.H. Geelkerken, W.B. van Gent, G.J. Glade, B. Govaert, R.P. Groenendijk, H.G. de Groot, R.F. van den Haak, E.F. de Haan, G.F. Hajer, J.F. Hamming, E.S. van Hattum, C.E. Hazenberg, P.P. Hedeman Joosten, J.N. Helleman, L.G. van der Hem, J.M. Hendriks, J.A. van Herwaarden, J.M. Heyligers, J.W. Hinnen, R.J. Hissink, G.H. Ho, P.T. den Hoed, M.T. Hoedt, F. van Hoek, R. Hoencamp, W.H. Hoffmann, A.W. Hoksbergen, E.J. Hollander, L.C. Huisman, R.G. Hulsebos, K.M. Huntjens, M.M. Idu, M.J. Jacobs, M.F. van der Jagt, J.R. Jansbeken, R.J. Janssen, H.H. Jiang, S.C. de Jong, V. Jongkind, M.R. Kapma, B.P. Keller, A. Khodadade Jahrome, J.K. Kievit, P.L. Klemm, P. Klinkert, B. Knippenberg, N.A. Koedam, M.J. Koelemaij, J.L. Kolkert, G.G. Koning, O.H. Koning, A.G. Krasznai, R.M. Krol, R.H. Kropman, R.R. Kruse, L. van der Laan, M.J. van der Laan, J.H. van Laanen, J.H. Lardenoye, J.A. Lawson, D.A. Legemate, V.J. Leijdekkers, M.S. Lemson, M.M. Lensvelt, M.A. Lijkwan, R.C. Lind, F.T. van der Linden, P.F. Liqui Lung, M.J. Loos, M.C. Loubert, D.E. Mahmoud, C.G. Manshanden, E.C. Mattens, R. Meerwaldt, B.M. Mees, R. Metz, R.C. Minnee, J.C. de Mol van Otterloo, F.L. Moll, Y.C. Montauban van Swijndregt, M.J. Morak, R.H. van de Mortel, W. Mulder, S.K. Nagesser, C.C. Naves, J.H. Nederhoed, A.M. Nevenzel-Putters, A.J. de Nie, D.H. Nieuwenhuis, J. Nieuwenhuizen, R.C. van Nieuwenhuizen, D. Nio, A.P. Oomen, B.I. Oranen, J. Oskam, H.W. Palamba, A.G. Peppelenbosch, A.S. van Petersen, T.F. Peterson, B.J. Petri, M.E. Pierie, A.J. Ploeg, R.A. Pol, E.D. Ponfoort, P.P. Poyck, A. Prent, S. ten Raa, J.T. Raymakers, M. Reichart, B.L. Reichmann, M.M. Reijnen, A. Rijbroek, M.J. van Rijn, R.A. de Roo, E.V. Rouwet, C.G. Rupert, B.R. Saleem, M.R. van Sambeek, M.G. Samyn, H.P. van 't Sant, J. van Schaik, P.M. van Schaik, D.M. Scharn, M.R. Scheltinga, A. Schepers, P.M. Schlejen, F.J. Schlosser, F.P. Schol, O. Schouten, M.H. Schreinemacher, M.A. Schreve, G.W. Schurink, C.J. Sikkink, M.P. Siroen, A. te Slaa, H.J. Smeets, L. Smeets, A.A. de Smet, P. de Smit, P.C. Smit, T.M. Smits, M.G. Snoeijs, A.O. Sondakh, T.J. van der Steenhoven, S.M. van Sterkenburg, D.A. Stigter, H. Stigter, R.P. Strating, D. Stultiëns, J.E. Sybrandy, J.A. Teijink, B.J. Telgenkamp, M.J. Testroote, R.M. The, W.J. Thijsse, I.F. Tielliu, R.B. van Tongeren, R.J. Toorop, J.H. Tordoir, E. Tournoij, M. Truijers, K. Türkcan, R.P. Tutein Nolthenius, Ç. Ünlü, A.A. Vafi, A.C. Vahl, E.J. Veen, H.T. Veger, M.G. Veldman, H.J. Verhagen, B.A. Verhoeven, C.F. Vermeulen, E.G. Vermeulen, B.P. Vierhout, M.J. Visser, J.A. van der Vliet, C.J. Vlijmen - van Keulen, H.G. Voesten, R. Voorhoeve, A.W. Vos, B. de Vos, G.A. Vos, B.H. Vriens, P.W. Vriens, A.C. de Vries, J.P. de Vries, M. de Vries, C. van der Waal, E.J. Waasdorp, B.M. Wallis de Vries, L.A. van Walraven, J.L. van Wanroij, M.C. Warlé, V. van Weel, A.M. van Well, G.M. Welten, R.J. Welten, J.J. Wever, A.M. Wiersema, O.R. Wikkeling, W.I. Willaert, J. Wille, M.C. Willems, E.M. Willigendael, W. Wisselink, M.E. Witte, C.H. Wittens, I.C. Wolf-de Jonge, O. Yazar, C.J. Zeebregts, M.L. van Zeeland, Jan-Willem Elshof, Martine C. Willems, Surgery, ACS - Atherosclerosis & ischemic syndromes, Pathology, Pediatrics, Dermatology, ACS - Microcirculation, AII - Inflammatory diseases, AGEM - Digestive immunity, RS: CAPHRI - R5 - Optimising Patient Care, Epidemiologie, ANS - Neurovascular Disorders, Graduate School, and Multi-Modality Medical Imaging

Subjects
Male, medicine.medical_specialty, Patients, medicine.medical_treatment, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Psychological intervention, Carotid endarterectomy, 030204 cardiovascular system & hematology, Revascularization, Logistic regression, STENOSIS, Risk Assessment, 03 medical and health sciences, 0302 clinical medicine, CEA, National clinical audit, Risk Factors, medicine, Humans, Carotid Stenosis, Hospital Mortality, 030212 general & internal medicine, PREDICTORS, Stroke, Netherlands, OUTCOMES, COMPLICATIONS, Endarterectomy, Carotid, business.industry, Mortality rate, DEATH, Quality of care, Symptomatic carotid artery stenosis, medicine.disease, n/a OA procedure, Stenosis, TRIALS, Treatment Outcome, Cohort, Emergency medicine, REVASCULARIZATION, Female, Surgery, Cardiology and Cardiovascular Medicine, business
Abstract

Background: The Dutch Audit for Carotid Interventions (DACI) registers all patients undergoing interventions for carotid artery stenosis in the Netherlands. This study describes the design of the DACI and results of patients with a symptomatic stenosis undergoing carotid endarterectomy (CEA). It aimed to evaluate variation between hospitals in process of care and (adjusted) outcomes, as well as predictors of major stroke/death after CEA.Methods: All patients with a symptomatic stenosis, who underwent CEA and were registered in the DACI between 2014 and 2016 were included in this cohort. Descriptive analyses of patient characteristics, process of care, and outcomes were performed. Casemix adjusted hospital procedural outcomes as (30 day/in hospital) mortality, stroke/death, and major stroke/death, were compared with the national mean. A multivariable logistic regression model (backward elimination at p > 0.10) was used to identify predictors of major stroke/death.Results: A total of 6459 patients, registered by 52 hospitals, were included. The majority (4,832, 75%) were treated Conclusion: CEA in The Netherlands is associated with an overall low mortality and (major) stroke/death rate. Whereas the indicator time to intervention varied between hospitals, mortality and (major) stroke/death were not significantly distinctive enough to identify worse practices and therefore were unsuitable for hospital comparison in the Dutch setting. Additionally, predictors of major stroke/death at population level could be identified. (C) 2018 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.

Published
2018
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11. Renal function 5 years after open and endovascular aortic aneurysm repair from a randomized trial

Author

Jan D. Blankensteijn, M. Prinssen, M.G. Vervloet, J.L. de Bruin, Annette F. Baas, M.G. Buimer, Surgery, Nephrology, and ICaR - Ischemia and repair

Subjects
Male, medicine.medical_specialty, Renal function, Preoperative care, chemistry.chemical_compound, Aortic aneurysm, Postoperative Complications, medicine, Humans, Prospective Studies, Renal Insufficiency, Chronic, Aged, Creatinine, Kidney, business.industry, Endovascular Procedures, medicine.disease, Abdominal aortic aneurysm, Surgery, medicine.anatomical_structure, chemistry, Female, business, Aortic Aneurysm, Abdominal, Follow-Up Studies, Glomerular Filtration Rate, Abdominal surgery, Kidney disease
Abstract

Background Deterioration of renal function after major vascular surgery is an important complication, and may vary between patients undergoing endovascular (EVAR) or open surgical (OR) repair of an abdominal aortic aneurysm (AAA). The objective was to determine the impact of OR and EVAR on renal function after 5 years. Methods This was a post hoc analysis of data collected prospectively from the Dutch Randomized Endovascular Aneurysm Management (DREAM) trial. Five years after surgery, creatinine levels were available for 189 patients (94 after OR and 95 after EVAR). The severity of renal disease was staged using the chronic kidney disease classification of the US National Kidney Foundation clinical guidelines. Results Using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, the estimated glomerular filtration rate (eGFR) for the entire group declined over time, with a mean(s.d.) preoperative value of 80·0(7·6) ml per min per 1·73 m2 compared with 75·7(9·7) ml per min per 1·73 m2 after 5 years (mean difference 4·2 (95 per cent confidence interval 3·2 to 5·3) ml per min per 1·73 m2; P < 0·001). Five years after surgery, the mean eGFR (CKD-EPI equation) was not significantly different between the OR and EVAR groups: 76·3(9·3) versus 75·1(10·0) ml per min per 1·73 m2 (mean difference 1·2 (−1·6 to 3·9) ml per min per 1·73 m2; P = 0·410). Conclusion Renal function 5 years after OR and EVAR for AAA was similar. Neither surgical procedure accelerated the loss of renal function. Registration number: NCT00421330 (http://www.clinicaltrials.gov).

Published
2013
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12. Predicting reinterventions after open and endovascular aneurysm repair using the St George's Vascular Institute score

Author

Jorg Lucas de Bruin, Alan Karthikesalingam, Peter J. Holt, Monique Prinssen, Matt M. Thompson, Jan D. Blankensteijn, D.E. Grobbee, J.D. Blankensteijn, A.A.A. Bak, J. Buth, P.M. Pattynama, E.L.G. Verhoeven, A.E. van Voorthuisen, R. Balm, P.W.M. Cuypers, M. Prinssen, M.R.H.M. van Sambeek, A.F. Baas, M.G. Hunink, J.M. van Engelshoven, M.J.H.M. Jacobs, B.A.J.M. de Mol, J.H. van Bockel, J. Reekers, X. Tielbeek, W. Wisselink, N. Boekema, L.M. Heuveling, I. Sikking, J.L. de Bruin, A.V. Tielbeek, J.A. Reekers, P. Pattynama, T. Prins, A.C. van der Ham, J.J.I.M. van der Velden, S.M.M. van Sterkenburg, G.B. ten Haken, C.M.A. Bruijninckx, H. van Overhagen, R.P. Tutein Nolthenius, T.R. Hendriksz, J.A.W. Teijink, H.F. Odink, A.A.E.A. de Smet, D. Vroegindeweij, R.M.M. van Loenhout, M.J. Rutten, J.F. Hamming, L.E.H. Lampmann, M.H.M. Bender, H. Pasmans, A.C. Vahl, C. de Vries, A.J.C. Mackaay, L.M.C. van Dortmont, A.J. van der Vliet, L.J. Schultze Kool, J.H.B. Boomsma, H.R. van, J.C.A. de Mol van Otterloo, T.P.W. de Rooij, T.M. Smits, E.N. Yilmaz, F.G. van den Berg, M.J.T. Visser, E. van der Linden, G.W.H. Schurink, M. de Haan, H.J. Smeets, P. Stabel, F. van Elst, J. Poniewierski, F.E.G. Vermassen, Epidemiologie, RS: FHML non-thematic output, RS: CAPHRI - R5 - Optimising Patient Care, RS: CARIM - R3.08 - Regenerative and reconstructive medicine for vascular disease, Surgery, ICaR - Ischemia and repair, Cardiothoracic Surgery, and Radiology and Nuclear Medicine

Subjects
Male, Reoperation, medicine.medical_specialty, Time Factors, medicine.medical_treatment, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, 030230 surgery, Risk Assessment, Endovascular aneurysm repair, Disease-Free Survival, Decision Support Techniques, law.invention, Blood Vessel Prosthesis Implantation, 03 medical and health sciences, Aortic aneurysm, Postoperative Complications, 0302 clinical medicine, Aneurysm, Belgium, Randomized controlled trial, Predictive Value of Tests, Risk Factors, law, Multicenter trial, medicine, Journal Article, Humans, Comparative Study, Aged, Netherlands, business.industry, Endovascular Procedures, Hazard ratio, Middle Aged, medicine.disease, Abdominal aortic aneurysm, Surgery, Multicenter Study, Treatment Outcome, Randomized Controlled Trial, Female, business, Cardiology and Cardiovascular Medicine, Aortic Aneurysm, Abdominal, Abdominal surgery
Abstract

Background: Identifying patients at risk for aneurysm rupture and sac expansion after open and endovascular abdominal aortic aneurysm (AAA) repair (EVAR) may help to attenuate this risk by intensifying follow-up and early detection of problems. The goal of this study was to validate the St George’s Vascular Institute (SGVI) score to identify patients at risk for a secondary intervention after elective aneurysm repair. Methods: A post hoc on-treatment analysis of a randomized trial comparing open AAA repair and EVAR was performed. In this multicenter trial, 351 patients were randomly assigned to undergo open AAA repair or EVAR. Information on survival and reinterventions was available for all patients at 5 years postoperatively, for 79% at 6 years, and for 53% at 7 years. Open repair was completed in 173 patients and EVAR in 171, based on an on-treatment analysis. Because 17 patients had incomplete anatomic data, 327 patients (157 open repair and 170 EVAR) were available for analysis. During 6 years of follow-up, 78 patients underwent at least one reintervention. The SGVI score, which is calculated from preoperative AAA morphology using aneurysm and iliac diameter, predictively dichotomized patients into groups at highrisk or low-risk for a secondary intervention. The observed freedom from reintervention was compared between groups at predicted high-risk and predicted low-risk. Results: The 20 patients in the high-risk group were indeed at higher risk for a secondary intervention compared with the 307 patients predicted to be at low risk (hazard ratio [HR], 3.82; 95% confidence interval [CI], 2.05-7.11; P < .001). Discrimination between high-risk and low-risk groups was valid for EVAR (HR, 4.06; 95% CI, 1.93-8.51; P < .001) and for open repair (HR, 3.41; 95% CI, 1.02-11.4; P [ .033). Conclusions: The SGVI score appears to be a useful tool to predict reintervention risk in patients after open repair and EVAR.

Published
2016
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13. Residual Infrarenal Aortic Neck following Endovascular and Open Aneurysm Repair

Author

J.L. De Bruin, S. de Jong, J. Pol, M. van der Jagt, M. Prinssen, J.D. Blankensteijn, Surgery, and ICaR - Ischemia and repair

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Anastomosis, Endovascular aneurysm repair, law.invention, Aortic aneurysm, Aneurysm, Randomized controlled trial, law, medicine.artery, medicine, Humans, Aortic neck, cardiovascular diseases, Renal artery, Aged, Medicine(all), Infrarenal Aortic Segment, business.industry, Endovascular Procedures, medicine.disease, Surgery, Open aneurysm repair, cardiovascular system, Female, Radiology, Cardiology and Cardiovascular Medicine, business, Vascular Surgical Procedures, Aortic Aneurysm, Abdominal, Abdominal surgery
Abstract

BackgroundThe effectiveness of open and endovascular aneurysm repair of aortic abdominal aneurysms (AAAs) can be jeopardised by deterioration of the residual infrarenal neck of the aneurysm.ObjectiveThe study aims to determine the length of the residual infrarenal aortic segment after endovascular and open aneurysm repair.MethodsIn a multicentre randomised controlled trial comparing open and endovascular AAA repair, 165 patients were discharged after open AAA repair (OR) and 169 after endovascular repair (EVAR). Immediately after the operation, surgeons were asked to enter in the case record form whether the level of their anastomosis after open repair was within or beyond 10 mm of the caudal renal artery. Postoperative computed tomography (CT) scans that were obtained within 6 months after surgery were used for comparative analysis. The distance between the caudal renal artery and the proximal anastomosis of the (endo-) graft was measured using axial CT slices and a standardised protocol. CT images were available and suitable for analysis in 156 (95%) of 165 OR patients and in 160 (95%) of 169 EVAR patients. Data are presented as median (range). Differences were analysed using the Mann–Whitney test.ResultsThe distance from the caudal renal artery to the proximal anastomosis was 24 mm (16–30 mm) in the OR group versus 0 mm (0–6 mm) in the EVAR group (p

Published
2012
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14. The Endovascular Sealing Device in Combination with Parallel Grafts for Treatment of Juxta/Suprarenal Abdominal Aortic Aneurysms: Short-term Results of a Novel Alternative

Author

Peter J. Holt, Benjamin O. Patterson, Alan Karthikesalingam, Matt M. Thompson, J.L. de Bruin, Ian M. Loftus, Robert J. Hinchliffe, and Jack Brownrigg

Subjects
Novel technique, Male, medicine.medical_specialty, medicine.medical_treatment, 030204 cardiovascular system & hematology, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, Blood Vessel Prosthesis Implantation, 0302 clinical medicine, Aneurysm, medicine.artery, medicine, Humans, Superior mesenteric artery, Renal replacement therapy, Aged, Aged, 80 and over, Aneurysm morphology, business.industry, Juxta, Endovascular Procedures, Middle Aged, medicine.disease, Surgery, Mortality data, Open repair, Female, Radiology, Cardiology and Cardiovascular Medicine, business, Aortic Aneurysm, Abdominal
Abstract

Background The chimney technique using parallel grafts offers an alternative to fenestrated or branched endovascular solutions for juxtarenal and suprarenal aneurysms. Endograft deployment proximal to the renal or visceral ostia is combined with parallel stents to the aortic side branches. Application of the chimney technique using the Nellix device (Ch-EVAS) may offer some potential advantages with respect to the seal between the endograft and the parallel grafts. This study aimed to investigate the feasibility and efficacy of the Nellix endovascular aneurysm sealing (EVAS) system in conjunction with parallel grafts for the treatment of juxtarenal and suprarenal aneurysms. Methods A prospective evaluation of patients treated for juxtarenal and suprarenal non-ruptured aortic aneurysms using Ch-EVAS was undertaken in a single vascular unit. Patients were treated with this technique if they were unsuitable for either open repair or a custom-made complex branched/fenestrated endograft. Procedural, postoperative morbidity, and mortality data were recorded. Results Between March 2013 and April 2015, 28 patients were treated with Ch-EVAS. The median age was 75 years (range 60–87 years) and the median aneurysm diameter 66 mm (IQR 60–73 mm). Eight patients underwent suprarenal aneurysm repair including parallel grafts in the superior mesenteric artery and renal arteries. Five patients had a double chimney configuration; all the other patients were treated with a single chimney configuration. There was one 30-day or in-hospital mortality in a patient with a symptomatic aneurysm (4%) and three further deaths within 1 year of follow-up. One proximal type I endoleak and one type II endoleak occurred. Four patients underwent a reintervention. One patient experienced a transient ischemic attack and two patients suffered from a minor stroke (7%), therefore the total number of cerebrovascular complications was 11%. No patient required postoperative renal replacement therapy. Conclusions Ch-EVAS appears to offer a feasible solution for juxtarenal and suprarenal aneurysms with adverse morphology. In this short-term follow-up endoleak rates were low and re-intervention rates were acceptable. Outcomes over extended follow-up will determine the application of this novel technique and better define which patients and aneurysm morphology can be treated effectively.

Published
2015

15. Endovascular aneurysm sealing for infrarenal abdominal aortic aneurysms: 30-day outcomes of 105 patients in a single centre

Author

Matt M. Thompson, Jack Brownrigg, Alan Karthikesalingam, J.L. de Bruin, Ian M. Loftus, Benjamin O. Patterson, L. Rossi, Peter J. Holt, R.H. Hinchliffe, and Robert Morgan

Subjects
Male, medicine.medical_specialty, Time Factors, Endoleak, medicine.medical_treatment, Prosthesis Design, Endovascular aneurysm repair, Aortography, Infrarenal, Blood Vessel Prosthesis Implantation, Aneurysm, Angioplasty, Occlusion, London, medicine, Humans, Prospective Studies, EVAS, Aged, Medicine(all), Aged, 80 and over, Ultrasonography, Doppler, Duplex, Endovascular, business.industry, Ultrasound, Graft Occlusion, Vascular, medicine.disease, Embolization, Therapeutic, Abdominal aortic aneurysm, Surgery, Blood Vessel Prosthesis, Stenosis, Treatment Outcome, Cohort, Female, Stents, Radiology, business, Nellix, Cardiology and Cardiovascular Medicine, Tomography, X-Ray Computed, Angioplasty, Balloon, Aortic Aneurysm, Abdominal
Abstract

ObjectiveEndovascular aneurysm sealing (EVAS) has been proposed as a novel alternative to endovascular aneurysm repair (EVAR) in patients with infrarenal abdominal aortic aneurysms (AAA). The early clinical experience, technical refinements, and learning curve of EVAS in the treatment of AAA at a single institution are presented.MethodsOne-hundred and five patients were treated with EVAS between March 2013 and November 2014. Prospective data were recorded on consecutive patients receiving EVAS. Data included demographics, preoperative aneurysm morphology, and 30-day outcomes, including rates of endoleak, limb occlusion, reintervention, and death. Postoperative imaging consisted of duplex ultrasound and computed tomographic angiography.ResultsThe mean age of the cohort was 76 ± 8 years and 12% were female. Adverse neck morphology was present in 72 (69%) patients, including aneurysm neck length 32 mm (18%), β-angulation >60° (21%), and conical aneurysm neck (51%). There was one death within 30 days. The incidence of Type 1 endoleak within 30 days was 4% (n = 4); all were treated successfully with transcatheter embolisation. All four proximal endoleaks were associated with technical issues that resulted in procedure refinement, and all were in patients with adverse proximal aortic necks. The persistent Type 1 endoleak rate at 30 days was 0% and there were no Type 2 or Type 3 endoleaks. Angioplasty and adjunctive stenting were performed for postoperative limb stenosis in three patients (3%).ConclusionsEVAS appears to be associated with reasonable 30-day outcomes despite the necessity of procedural evolution in the early adoption of this technique. EVAS appears to be applicable to patients with challenging aortic morphology and endoleak rates should reduce with procedural experience. The utility of EVAS will be defined by the durability of the device in long-term follow-up, although the absence of Type 2 endoleaks is encouraging.

Published
2014

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