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1. Editor's Choice - Randomised Clinical Trial of Supervised Exercise Therapy vs. Endovascular Revascularisation for Intermittent Claudication Caused by Iliac Artery Obstruction

Author: Mark J.W. Koelemay, Nick S. van Reijen, Susan van Dieren, Franceline A. Frans, Erik J.G. Vermeulen, Hessel C.J.L. Buscher, Jim A. Reekers, M.G.W. Dijkgraaf, R.J. de Haan, R. Balm, M.M. Idu, J.D. Blankensteijn, A.W. Hoksbergen, A.P. Conijn, R. Met, D.A. Legemate, S. Bipat, K.P. van Lienden, O.M. van Delden, E.J. Zijlstra, R. Lely, R.H.H. Engelbert, M.A. van Egmond, A. Poelgeest, E. Geleijn, A.J. de Nie, M.A. Schreve, A. Kamphuis, R.H.J. Kropman, J. Wille, J.P.M.M. de Vries, R.H. van de Mortel, H.D. van de Pavoord, D.A. van den Heuvel, M. van Leersum, M.J. van Strijen, J.A. Vos, D. Nio, A. Rijbroek, G.J.M. Akkersdijk, R. Metz, B.J. van Kelckhoven, H.J. van de Rest, V.J. Leijdekkers, A.C. Vahl, R.C. van Nieuwenhuizen, J.G. Blomjous, A.D. Montauban van Swijndregt, P.P.C. Poyck, M. van der Jagt, J.A. van der Vliet, L.J. Schultze Kool, P.L. Klemm, H.W. Slis, M.C.M. Willems, L.C. Huisman, J.H.D. de Bruine, M.J. Mallant, L. Smeets, S.M. van Sterkenburg, M.M. Reijnen, P.B. Veendrick, M.H. van Werkum, J.A. van Ostayen, B.H.P. Elsman, L.G. van der Hem, R.B.M. van Tongeren, C.F.M. Klok, W.E. Hellings, J.C. Aarts, A.M. Wiersema, T.A. van den Broek, A. Moolhuijzen, J.A. Teijink, M.R. van Sambeek, B.P. Keller, G.A. Vos, J.C. Breek†, J. Gravendeel, R. Oosterhof-Berktas, N.A. Koedam, E.J. Hollander, T. Pels Rijcken, S.S. van der Voort, B. Honing, D.M. Scharn, M.S. Lemson, J. Seegers, R.M. Krol, C.J. Buskens, C.J. Zeebregts, R.A. de Bie, H. van Overhagen, Surgery, ACS - Atherosclerosis & ischemic syndromes, Graduate School, APH - Personalized Medicine, APH - Quality of Care, APH - Methodology, Radiology and Nuclear Medicine, Epidemiology and Data Science, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, ACS - Amsterdam Cardiovascular Sciences, Rehabilitation medicine, AMS - Rehabilitation & Development, ARD - Amsterdam Reproduction and Development, ACS - Diabetes & metabolism, ACS - Heart failure & arrhythmias, APH - Health Behaviors & Chronic Diseases, VU University medical center, Radiology and nuclear medicine, Other Research, ACS - Microcirculation, Man, Biomaterials and Microbes (MBM), RS: CAPHRI - R3 - Functioning, Participating and Rehabilitation, and Epidemiologie
Subjects: Randomised controlled trial, Endovascular revascularisation, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Walking, Intermittent Claudication, Iliac Artery, Exercise Therapy, Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10], Peripheral Arterial Disease, Treatment Outcome, Intermittent Claudication/etiology, Quality of Life, Humans, Peripheral Arterial Disease/complications, Surgery, Cardiology and Cardiovascular Medicine, Supervised exercise therapy
Abstract: Contains fulltext : 251517.pdf (Publisher’s version ) (Open Access) OBJECTIVE: International guidelines recommend supervised exercise therapy (SET) as primary treatment for all patients with intermittent claudication (IC), yet primary endovascular revascularisation (ER) might be more effective in patients with iliac artery obstruction. METHODS: This was a multicentre RCT including patients with IC caused by iliac artery stenosis or occlusion (NCT01385774). Patients were allocated randomly to SET or ER stratified for maximum walking distance (MWD) and concomitant SFA disease. Primary endpoints were MWD on a treadmill (3.2 km/h, 10% incline) and disease specific quality of life (VascuQol) after one year. Additional interventions during a mean follow up of 5.5 years were recorded. RESULTS: Between November 2010 and May 2015, 114 patients were allocated to SET, and 126 to ER. The trial was terminated prematurely after 240 patients were included. Compliance with SET was 57/114 (50%) after six months. Ten patients allocated to ER (8%) did not receive this intervention. One year follow up was complete for 90/114 (79%) SET patients and for 104/126 (83%) ER patients. The mean MWD improved from 187 to 561 m in SET patients and from 196 to 574 m in ER patients (p = .69). VascuQol sumscore improved from 4.24 to 5.58 in SET patients, and from 4.28 to 5.88 in ER patients (p = .048). Some 33/114 (29%) SET patients had an ER within one year, and 2/114 (2%) surgical revascularisation (SR). Some 10/126 (8%) ER patients had additional ER within one year and 10/126 (8%) SR. After a mean of 5.5 years, 49% of SET patients and 27% of ER patients underwent an additional intervention for IC. CONCLUSION: Taking into account the many limitations of the SUPER study, both a strategy of primary SET and primary ER improve MWD on a treadmill and disease specific Qol of patients with IC caused by an iliac artery obstruction. It seems reasonable to start with SET in these patients and accept a 30% failure rate, which, of course, must be discussed with the patient. Patients continue to have interventions beyond one year.
Published: 2022
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2. 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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3. Cost Effectiveness of Endovascular Revascularisation vs. Exercise Therapy for Intermittent Claudication Due to Iliac Artery Obstruction

Author: Nick S. van Reijen, Susan van Dieren, Franceline A. Frans, Jim A. Reekers, Roderik Metz, Hessel C.J.L. Buscher, Mark J.W. Koelemay, D.A. Legemate, M.M. Idu, R. Balm, J.A. Reekers, K.P. van Lienden, O.M. van Delden, E.J. Zijlstra, A.P. Conijn, M.G.W. Dijkgraaf, R.H. Engelbert, A.J. De Nie, M.A. Schreve, R.H.J. Kropman, J. Wille, J.P.M. De Vries, H.D.W.M. van de Pavoort, R.H.W. van de Mortel, D.A.F. van den Heuvel, M.J.L. van Strijen, M. van Leersum, J.A. Vos, D. Nio, A. Rijbroek, E.G.J. Vermeulen, G.J.M. Akkersdijk, A. van de Elst, M. Truijers, B.J. van Kelckhoven, V.J. Leijdekkers, A.C. Vahl, J.G.A.M. Blomjous, P.P.C. Poyck, J.A. Van der Vliet, M. van der Jagt, P.L. Klemm, M.C.M. Willems, L.C. Huisman, M.M.A. Lensvelt, H. de Bruine, M.P.J.H. Mallant, L. Smeets, S.M.M. van Sterkenburg, P.B. Veendrick, M.H. van Werkum, B.H.P. Elsman, L.G. van der Hem, R.B.M. van Tongeren, C.F.M. Klok, W.E. Hellings, A.M. Wiersema, T.A.A. van den Broek, G.A. Vos, J.A.W. Teijink, M.R.H.M. van Sambeek, B.P.J.A. Keller, G.J. Glade, J.C. Breek, J. Gravendeel, R. Oosterhof-Berktas, N.A. Koedam, E.J.F. Hollander, D.M. Scharn, M.S. Lemson, J. Seegers, R.M. Krol, J.D. Blankensteijn, A.W.J. Hoksbergen, Epidemiology and Data Science, ACS - Diabetes & metabolism, ACS - Heart failure & arrhythmias, APH - Health Behaviors & Chronic Diseases, VU University medical center, Surgery, ACS - Atherosclerosis & ischemic syndromes, ACS - Microcirculation, Graduate School, APH - Personalized Medicine, APH - Quality of Care, APH - Methodology, Radiology and Nuclear Medicine, ACS - Amsterdam Cardiovascular Sciences, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, CCA -Cancer Center Amsterdam, Rehabilitation medicine, AMS - Rehabilitation & Development, and ARD - Amsterdam Reproduction and Development
Subjects: Intermittent claudication, Treatment Outcome, Cost-Benefit Analysis, Peripheral arterial disease, Quality of Life, Exercise therapy, Humans, Surgery, Quality-Adjusted Life Years, Cost–Benefit analysis, Cardiology and Cardiovascular Medicine, Iliac Artery, Health status
Abstract: Objective: To compare cost effectiveness of endovascular revascularisation (ER) and supervised exercise therapy (SET) as primary treatment for patients with intermittent claudication (IC) due to iliac artery obstruction. Methods: Cost utility analysis from a restricted societal perspective and time horizon of 12 months. Patients were included in a multicentre randomised controlled trial (SUPER study, NCT01385774, NTR2648) which compared effectiveness of ER and SET. Health status and health related quality of life (HRQOL) were measured using the Euroqol 5 dimensions 3 levels (EQ5D-3L) and VascuQol-25-NL. Incremental costs were determined per allocated treatment and use of healthcare during follow up. Effectiveness of treatment was determined in quality adjusted life years (QALYs). The difference between treatment groups was calculated by an incremental cost utility ratio (ICER). Results: Some 240 patients were included, and complete follow up was available for 206 patients (ER 111, SET 95). The mean costs for patients allocated to ER were €4 031 and €2 179 for SET, a mean difference of €1 852 (95% bias corrected and accelerated [bca] bootstrap confidence interval 1 185 – 2 646). The difference in QALYs during follow up was 0.09 (95% bcaCI 0.04 – 0.13) in favour of ER. The ICER per QALY was €20 805 (95% bcaCI 11 053 – 45 561). The difference in VascuQol sumscore was 0.64 (95% bcaCI 0.39 – 0.91), again in favour of ER. Conclusion: ER as a primary treatment, results in slightly better health outcome and higher QALYs and HRQOL during 12 months of follow up. Although these differences are statistically significant, clinical relevance must be discussed due to the small differences and relatively high cost of ER as primary treatment.
Published: 2022
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4. ACTION-1: study protocol for a randomised controlled trial on ACT-guided heparinization during open abdominal aortic aneurysm repair

Author: Jan D. Blankensteijn, E. Sebastian Debus, Mark J. W. Koelemaij, A.M. Wiersema, Ymke S. Fokma, Vincent Jongkind, Michel M.P.J. Reijnen, Liliane C. Roosendaal, Jan G.P. Tijssen, Jan M.M. Heyligers, Susan van Dieren, Saskia Middeldorp, Surgery, ACS - Atherosclerosis & ischemic syndromes, APH - Health Behaviors & Chronic Diseases, ACS - Microcirculation, ACS - Diabetes & metabolism, ACS - Heart failure & arrhythmias, Cardiology, APH - Methodology, Vascular Medicine, ACS - Pulmonary hypertension & thrombosis, Amsterdam Reproduction & Development (AR&D), and Amsterdam Gastroenterology Endocrinology Metabolism
Subjects: medicine.medical_specialty, Medicine (General), Adolescent, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Activated clotting time, Medicine (miscellaneous), law.invention, Study Protocol, Anticoagulation, Aneurysm, R5-920, Randomized controlled trial, law, medicine, Humans, Single-Blind Method, Pharmacology (medical), Randomized Controlled Trials as Topic, medicine.diagnostic_test, SARS-CoV-2, business.industry, Heparin, Open repair, COVID-19, Vascular surgery, medicine.disease, Abdominal aortic aneurysm, Surgery, Treatment Outcome, Inclusion and exclusion criteria, Bolus (digestion), business, RCT, Aortic Aneurysm, Abdominal, medicine.drug
Abstract: BackgroundHeparin is used worldwide for 70 years during all non-cardiac arterial procedures (NCAP) to reduce thrombo-embolic complications (TEC). But heparin also increases blood loss causing possible harm for the patient. Heparin has an unpredictable effect in the individual patient. The activated clotting time (ACT) can measure the effect of heparin. Currently, this ACT is not measured during NCAP as the standard of care, contrary to during cardiac interventions, open and endovascular. A RCT will evaluate if ACT-guided heparinization results in less TEC than the current standard: a single bolus of 5000 IU of heparin and no measurements at all. A goal ACT of 200–220 s should be reached during ACT-guided heparinization and this should decrease (mortality caused by) TEC, while not increasing major bleeding complications. This RCT will be executed during open abdominal aortic aneurysm (AAA) surgery, as this is a standardized procedure throughout Europe.MethodsSeven hundred fifty patients, who will undergo open AAA repair of an aneurysm originating below the superior mesenteric artery, will be randomised in 2 treatment arms: 5000 IU of heparin and no ACT measurements and no additional doses of heparin, or a protocol of 100 IU/kg bolus of heparin and ACT measurements after 5 min, and then every 30 min. The goal ACT is 200–220 s. If the ACT after 5 min is < 180 s, 60 IU/kg will be administered; if the ACT is between 180 and 200 s, 30 IU/kg. If the ACT is > 220 s, no extra heparin is given, and the ACT is measured after 30 min and then the same protocol is applied. The expected incidence for the combined endpoint of TEC and mortality is 19% for the 5000 IU group and 11% for the ACT-guided group.DiscussionThe ACTION-1 trial is an international RCT during open AAA surgery, designed to show superiority of ACT-guided heparinization compared to the current standard of a single bolus of 5000 IU of heparin. A significant reduction in TEC and mortality, without more major bleeding complications, must be proven with a relevant economic benefit.Trial registration {2a}NTR NL8421ClinicalTrials.govNCT04061798. Registered on 20 August 2019EudraCT 2018-003393-27Trial registration: data set {2b}Data categoryInformationPrimary registry and trial identifying numberClinicalTrials.gov: NCT04061798Date of registration in primary registry20-08-2019Secondary identifying numbersNTR:NL8421EudraCT: 2018-003393-27Source(s) of monetary or material supportZonMw: The Netherlands Organisation for Health Research and DevelopmentDijklander ZiekenhuisAmsterdam UMCPrimary sponsorDijklander ZiekenhuisSecondary sponsor(s)N/AContact for public queriesA.M. Wiersema, MD, PhDArno@wiersema.nu0031-229 208 206Contact for scientific queriesA.M. Wiersema, MD, PhDArno@wiersema.nu0031-229 208 206Public titleACT Guided Heparinization During Open Abdominal Aortic Aneurysm Repair (ACTION-1)Scientific titleACTION-1: ACT Guided Heparinization During Open Abdominal Aortic Aneurysm Repair, a Randomised TrialCountries of recruitmentThe Netherlands. Soon the recruitment will start in GermanyHealth condition(s) or problem(s) studiedAbdominal aortic aneurysm, arterial disease, surgeryIntervention(s)ACT-guided heparinization5000 IU of heparinKey inclusion and exclusion criteriaAges eligible for the study: ≥18 yearsSexes eligible for the study: bothAccepts healthy volunteers: noInclusion criteria:Study typeInterventionalAllocation: randomizedIntervention model: parallel assignmentMasking: single blind (patient)Primary purpose: treatmentPhase IVDate of first enrolmentMarch 2020Target sample size750Recruitment statusRecruitingPrimary outcome(s)The primary efficacy endpoint is 30-day mortality and in-hospital mortality during the same admission.The primary safety endpoint is the incidence of bleeding complications according to E-CABG classification, grade 1 and higher.Key secondary outcomesSerious complications as depicted in the Suggested Standards for Reports on Aneurysmal disease: all complications requiring re-operation, longer hospital stay, all complications
Published: 2021
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5. 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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6. 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

7. 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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8. 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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9. 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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10. 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

11. Failure to Rescue - a Closer Look at Mortality Rates Has No Added Value for Hospital Comparisons but Is Useful for Team Quality Assessment in Abdominal Aortic Aneurysm Surgery in The Netherlands

Author: Niki Lijftogt, Eleonora G. Karthaus, Anco Vahl, Erik W. van Zwet, Esmee M. van der Willik, Robertus A.E.M. Tollenaar, Jaap F. Hamming, Michel W.J.M. Wouters, 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, RS: CAPHRI - R5 - Optimising Patient Care, Epidemiologie, Surgery, Pediatrics, ACS - Atherosclerosis & ischemic syndromes, Pathology, Dermatology, ACS - Microcirculation, AII - Inflammatory diseases, and AGEM - Digestive immunity
Subjects: Clinical audit, medicine.medical_specialty, Funnel plot, TO-RESCUE, Time Factors, Failure to rescue, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], MODELS, 030204 cardiovascular system & hematology, 030230 surgery, PREVENTABILITY, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Aneurysm, medicine, Humans, Hospital Mortality, SURGICAL COLORECTAL AUDIT, Netherlands, TRAUMA, REPAIR, RISK, Surgical outcome, OUTCOMES, medicine.diagnostic_test, business.industry, Mortality rate, Endovascular Procedures, Glasgow Coma Scale, CARE, medicine.disease, Quality Improvement, CANCER, Hospitals, Abdominal aortic aneurysm, Surgery, Composite outcome measures, Elective Surgical Procedures, Cardiology and Cardiovascular Medicine, business, Electrocardiography, Aortic Aneurysm, Abdominal
Abstract: Objectives: Failure to rescue (FTR) is a composite quality indicator, defined as the proportion of deceased patients following major complications. The aims of this study were to compare FTR with mortality for hospital comparisons in abdominal aortic aneurysm (AAA) surgery in The Netherlands and investigate hospital volume and associated factors.Methods: Patients prospectively registered between 2013 and 2015 in the Dutch Surgical Aneurysm Audit (DSAA) were analysed. FTR was analysed for AAA patients and subgroups elective (EAAA) and acute (AAAA; symptomatic or ruptured) aneurysms. Variables and hospital volume were analysed by uni- and multivariable regression analysis. Adjusted hospital comparisons for mortality, major complications, and FTR were presented in funnel plots. Isomortality lines were constructed when presenting FTR and major complication rates.Results: A total of 9258 patients were analysed in 61 hospitals: 7149 EAAA patients (77.2%) and 2109 AAAA patients (22.8%). There were 2785 (30.1%) patients with complications (unadjusted range 5-65% per hospital): 2161 (77.6%) with major and 624 (28.4%) patients with minor complications. Overall mortality was 6.6% (adjusted range 0-16% per hospital) and FTR was 28.4% (n = 613) (adjusted range 0-60% per hospital). Glasgow Coma Scale, age, pulse, creatinine, electrocardiography, and operative setting were independently associated with FTR. Hospital volume was not associated with FTR. In AAAA patients hospital volume was significantly associated with a lower adjusted major complication and mortality rate (OR 0.62, 95% CI 0.49-0.78; and 0.64, 95% CI 0.48-0.87). Four hospitals had a significant lower adjusted FTR with different major complication rates on different isomortality lines.Conclusions: There was more variation in FTR than in mortality between hospitals. FTR identified the same best performing hospitals as for mortality and therefore was of limited additional value in measuring quality of care for AAA surgery. FTR can be used for internal quality improvement with major complications in funnel plots and diagrams with isomortality lines. (C) 2018 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.
Published: 2018
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12. 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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13. Periprocedural Prophylactic Antithrombotic Strategies in Interventional Radiology: Current Practice in the Netherlands and Comparison with the United Kingdom

Author: Otto M. van Delden, Frans L. Moll, Jan Albert Vos, Cornelis M. A. Bruijninckx, Anco Vahl, Michel M.P.J. Reijnen, Clark J. Zeebregts, A.M. Wiersema, ACS - Amsterdam Cardiovascular Sciences, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, CCA -Cancer Center Amsterdam, Radiology and Nuclear Medicine, Man, Biomaterials and Microbes (MBM), and Vascular Ageing Programme (VAP)
Subjects: medicine.medical_specialty, Ticlopidine, Percutaneous, Arteriosclerosis, medicine.medical_treatment, Angioplasty/angiogram, PERCUTANEOUS CORONARY INTERVENTION, SOCIETY, Radiology, Interventional, ANGIOGRAPHY, Perioperative Care, DISEASE, Endovasculartreatment, Fibrinolytic Agents, BIVALIRUDIN, ANTICOAGULATION, Surveys and Questionnaires, Antithrombotic, medicine, Humans, Radiology, Nuclear Medicine and imaging, Practice Patterns, Physicians', Clinical practise, Intensive care medicine, Netherlands, Arterial intervention, medicine.diagnostic_test, business.industry, Percutaneous coronary intervention, Thrombosis, Interventional radiology, Guideline, Vascular surgery, medicine.disease, Clopidogrel, United Kingdom, REGISTRY, GUIDELINE, HEPARIN, EXPERIENCE, Stents, Medical emergency, Cardiology and Cardiovascular Medicine, business, Vascular Surgical Procedures, medicine.drug
Abstract: The use of prophylactic antithrombotic drugs to prevent arterial thrombosis during the periprocedural period during (percutaneous) peripheral arterial interventions (PAIs) is still a matter of dispute, and clear evidence-based guidelines are lacking. To create those guidelines, a study group was formed in the Netherlands in cooperation with the Dutch Society of Vascular Surgery and the Society of Interventional Radiology. The study group is called "Consensus on Arterial PeriProcedural Anticoagulation (CAPPA)."The CAPPA study group devised and distributed a comprehensive questionnaire amongst Dutch interventional radiologists (IRs).One hundred forty-two IRs responded (68 %) to the questionnaire. Almost no IR stopped acetyl salicylic acid before interventions, and 40 % stopped clopidogrel before PAI but not before carotid artery stenting (CAS). A flushing solution on the sideport of the sheath was used routinely by 30 % of IRs in PAI and by 50 % of IRs during CAS. A minority of IRs used a heparinised flushing solution (28 %). Unfractionated heparin was used by 95 % of IRs as bolus; 5000 IU was the most used dosage. Timing of administration varied widely. A majority of IRs (75 %) repeated heparin administration after 1 h.A substantial variety exists amongst IRs in the Netherlands regarding the use of prophylactic periprocedural antithrombotic drugs to prevent arterial thrombosis during PAI. When compared with varying results regarding the use of heparin in the United Kingdom, the variety in the Netherlands showed a different pattern. The proven variety in these countries, and also between these countries, emphasises the need for authoritative studies to develop evidence-based practical guidelines.
Published: 2013
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14. Cost-effectiveness of Elective Endovascular Aneurysm Repair Versus Open Surgical Repair of Abdominal Aortic Aneurysms

Author: P.W.M. Cuypers, Johan L. Severens, Laura Burgers, Hence J.M. Verhagen, A.M. Wiersema, William K. Redekop, Anco C. Vahl, Health Technology Assessment (HTA), and Surgery
Subjects: Male, medicine.medical_specialty, Cost effectiveness, medicine.medical_treatment, Cost-Benefit Analysis, 030204 cardiovascular system & hematology, Endovascular aneurysm repair, 03 medical and health sciences, 0302 clinical medicine, Aneurysm, Risk Factors, Medicine, Humans, 030212 general & internal medicine, Postoperative Period, Aged, Netherlands, Surgical repair, business.industry, Endovascular Procedures, Health Care Costs, medicine.disease, Abdominal aortic aneurysm, Quality-adjusted life year, Surgery, Models, Economic, 30 day mortality, Cohort, Female, Cardiology and Cardiovascular Medicine, business, Aortic Aneurysm, Abdominal
Abstract: Objective/Background: The aim of this study was to estimate the lifetime cost-effectiveness of endovascular aneurysm repair (EVAR) versus open surgical repair (OSR) in the Netherlands, based on recently published literature. Methods: A model was developed to simulate a cohort of individuals (age 72 years, 87% men) with an abdominal aortic aneurysm (AAA) diameter of at least 5.5 cm and considered fit for both repairs. The model consisted of two sub-models that estimated the lifetime cost-effectiveness of EVAR versus OSR: (1) a decision tree for the first 30 post-operative days; and (2) a Markov model for the period thereafter (31 days-30 years). Results: In the base case analysis, EVAR was slightly more effective (4.704 vs. 4.669 quality adjusted life years) and less expensive ((sic)24,483 vs. (sic)25,595) than OSR. Improved effectiveness occurs because EVAR can reduce 30 day mortality risk, as well as the risk of events following the procedure, while lower costs are primarily due to a reduction in length of hospital stay. The cost-effectiveness of EVAR is highly dependent on the price of the EVAR device and the reduction in hospital stay, complications, and 30 day mortality. Conclusion: EVAR and OSR can be considered equally effective, while EVAR can be cost saving compared with OSR. EVAR can therefore be considered as a cost-effective solution for patients with AAAs. (C) 2016 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.
Published: 2015

15. ‘The use of heparin in patients with ruptured abdominal aortic aneurysms’

Author: Cornelis M. A. Bruijninckx, Michel M.P.J. Reijnen, and A.M. Wiersema
Subjects: Male, medicine.medical_specialty, Heparin, business.industry, Aortic Rupture, Anticoagulants, General Medicine, Surgery, Blood Vessel Prosthesis Implantation, Text mining, medicine, Humans, Female, Radiology, Nuclear Medicine and imaging, In patient, Cardiology and Cardiovascular Medicine, business, Aortic Aneurysm, Abdominal, Thrombectomy, medicine.drug
Published: 2013
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1. Editor's Choice - Randomised Clinical Trial of Supervised Exercise Therapy vs. Endovascular Revascularisation for Intermittent Claudication Caused by Iliac Artery Obstruction

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

3. Cost Effectiveness of Endovascular Revascularisation vs. Exercise Therapy for Intermittent Claudication Due to Iliac Artery Obstruction

4. ACTION-1: study protocol for a randomised controlled trial on ACT-guided heparinization during open abdominal aortic aneurysm repair

5. Toward Optimizing Risk Adjustment in the Dutch Surgical Aneurysm Audit

6. Nationwide Study to Predict Colonic Ischemia after Abdominal Aortic Aneurysm Repair in The Netherlands

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

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

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

10. 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

11. Failure to Rescue - a Closer Look at Mortality Rates Has No Added Value for Hospital Comparisons but Is Useful for Team Quality Assessment in Abdominal Aortic Aneurysm Surgery in The Netherlands

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

13. Periprocedural Prophylactic Antithrombotic Strategies in Interventional Radiology: Current Practice in the Netherlands and Comparison with the United Kingdom

14. Cost-effectiveness of Elective Endovascular Aneurysm Repair Versus Open Surgical Repair of Abdominal Aortic Aneurysms

15. ‘The use of heparin in patients with ruptured abdominal aortic aneurysms’

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