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1. Long Term Health Related Quality of Life After Acute Type B Aortic Dissection: a Cross Sectional Survey Study.

Author

Meccanici, F., Thijssen, Carlijn G.E., Gökalp, A.L., Bom, A.W., Bruin, J.L. De, Bekkers, J.A., Kimmenade, R.R.J. van, Geuzebroek, G.S.C., Poyck, P., Woorst, J.J.T., Peels, K., Sjatskig, J., Heijmen, R.H., Post, M.C., Mokhles, M.M., Verhagen, H.J.M., Takkenberg, J.J.M., Roos-Hesselink, J.W., Meccanici, F., Thijssen, Carlijn G.E., Gökalp, A.L., Bom, A.W., Bruin, J.L. De, Bekkers, J.A., Kimmenade, R.R.J. van, Geuzebroek, G.S.C., Poyck, P., Woorst, J.J.T., Peels, K., Sjatskig, J., Heijmen, R.H., Post, M.C., Mokhles, M.M., Verhagen, H.J.M., Takkenberg, J.J.M., and Roos-Hesselink, J.W.

Abstract

01 september 2023, Contains fulltext : 296540.pdf (Publisher’s version ) (Open Access), OBJECTIVE: Acute type B aortic dissection (ATBD) is a rare yet serious cardiovascular event that potentially has an impact on health related quality of life (HRQoL). However, long term follow up data on this topic are scarce. This study aimed to review the long term HRQoL among patients treated for ATBD. METHODS: In this multicentre, cross sectional survey study, consecutive treated patients with ATBD between 2007 and 2017 in four referral centres in the Netherlands were retrospectively included and baseline data were collected. Between 2019 and 2021 the 36 Item Short Form Survey (SF-36) was sent to all surviving patients (n = 263) and was compared with validated SF-36 scores in the Dutch general population stratified by age and sex. RESULTS: In total, 144 of 263 surviving patients completed the SF-36 (response rate 55%). Median (IQR) age was 68 (61, 76) years at completion of the questionnaire, and 40% (n = 58) were female. Initial treatment was medical in 55% (n = 79), endovascular in 41% (n = 59), and surgical in 4% (n = 6) of ATBD patients. Median follow up time was 6.1 (range 1.7-13.9; IQR 4.0, 9.0) years. Compared with the general population, patients scored significantly worse on six of eight SF-36 subdomains, particularly physical domains. Apart from bodily pain, there were no substantial differences in HRQoL between male and female ATBD patients. Compared with sex matched normative data, females scored significantly worse on five of eight subdomains, whereas males scored significantly lower on six subdomains. Younger patients aged 41-60 years seemed more severely impaired in HRQoL compared with the age matched general population. Treatment strategy did not influence HRQoL outcomes. Follow up time was associated with better Physical and Mental Component Summary scores. CONCLUSION: Long term HRQoL was impaired in ATBD patients compared with the Dutch general population, especially regarding physical status. This warrants more attention for HRQoL during clinic

Published
2023

2. Administrative healthcare data as an addition to the Dutch surgical aneurysm audit to evaluate mid-term reinterventions following abdominal aortic aneurysm repair: A pilot study

Author

Alberga, A.J., Stangenberger, V.A., Bruin, J.L. de, Wever, J.J., Wilschut, J.A., Brand, C.L. van den, Verhagen, H.J.M., Wouters, M.W.J.M., Surgery, and Emergency Medicine

Subjects
Follow-up, Administrative, Endovascular Procedures, Health Informatics, Reintervention, Pilot Projects, Aneurysm, Reimbursement, Blood Vessel Prosthesis Implantation, Postoperative Complications, Treatment Outcome, Quality registry, Risk Factors, Humans, Delivery of Health Care, Aortic Aneurysm, Abdominal, Retrospective Studies
Abstract

Background: The Dutch Surgical Aneurysm Audit (DSAA) is a nationwide mandatory quality registry that evaluates the perioperative outcomes of abdominal aortic aneurysms (AAAs). The DSAA includes perioperative outcomes that occur up to 30 days, but various complications following AAA repair occur after this period. Administrative healthcare data yield the possibility to evaluate later occuring outcomes such as reinterventions, without increasing the registration burden. The aim of this study is to assess the feasibility and the potential benefit of administrative healthcare data to evaluate mid-term reinterventions following intact AAA repair. Method: All patients that underwent primary endovascular aneurysm repair (EVAR) or open surgical repair (OSR) for an intact infrarenal AAA between January 2017 and December 2018 were selected from the DSAA. Subsequently, these patients were identified in a database containing reimbursement data. Healthcare activity codes that refer to reinterventions following AAA repair were examined to assess reinterventions within 12 and 15 months following EVAR and OSR. Results: We selected 4043 patients from the DSAA, and 2059 (51%) patients could be identified in the administrative healthcare database. Reintervention rates of 10.4% following EVAR and 9.5% following OSR within 12 months (p = 0.719), and 11.5% following EVAR and 10.8% following OSR within 15 months (p = 0.785) were reported. Conclusion: Administrative healthcare data as an addition to the DSAA is potentially beneficial to evaluate mid-term reinterventions following intact AAA repair without increasing the registration burden for clinicians. Further validation is necessary before reliable implementation of this tool is warranted.

Published
2022
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3. Treatment Outcome Trends for Non-Ruptured Abdominal Aortic Aneurysms: A Nationwide Prospective Cohort Study

Author

Alberga, A.J., Karthaus, E.G., Wilschut, Janneke, Bruin, J.L. De, Akkersdijk, G.P., Geelkerken, R.H., Hamming, J.F., Warle, M.C., Wever, J.J., Verhagen, H.J., Alberga, A.J., Karthaus, E.G., Wilschut, Janneke, Bruin, J.L. De, Akkersdijk, G.P., Geelkerken, R.H., Hamming, J.F., Warle, M.C., Wever, J.J., and Verhagen, H.J.

Abstract

Contains fulltext : 251573.pdf (Publisher’s version ) (Open Access), OBJECTIVE: The Dutch Surgical Aneurysm Audit (DSAA) initiative was established in 2013 to monitor and improve nationwide outcomes of aortic aneurysm surgery. The objective of this study was to examine whether outcomes of surgery for intact abdominal aortic aneurysms (iAAA) have improved over time. METHODS: Patients who underwent primary repair of an iAAA by standard endovascular (EVAR) or open surgical repair (OSR) between 2014 and 2019 were selected from the DSAA for inclusion. The primary outcome was peri-operative mortality trend per year, stratified by OSR and EVAR. Secondary outcomes were trends per year in major complications, textbook outcome (TbO), and characteristics of treated patients. The trends per year were evaluated and reported in odds ratios per year. RESULTS: In this study, 11 624 patients (74.8%) underwent EVAR and 3 908 patients (25.2%) underwent OSR. For EVAR, after adjustment for confounding factors, there was no improvement in peri-operative mortality (aOR [adjusted odds ratio] 1.06, 95% CI 0.94 - 1.20), while major complications decreased (2014: 10.1%, 2019: 7.0%; aOR 0.91, 95% CI 0.88 - 0.95) and the TbO rate increased (2014: 68.1%, 2019: 80.9%; aOR 1.13, 95% CI 1.10 - 1.16). For OSR, the peri-operative mortality decreased (2014: 6.1%, 2019: 4.6%; aOR 0.89, 95% CI 0.82 - 0.98), as well as major complications (2014: 28.6%, 2019: 23.3%; aOR 0.95, 95% CI 0.91 - 0.99). Furthermore, the proportion of TbO increased (2014: 49.1%, 2019: 58.3%; aOR 1.05, 95% CI 1.01 - 1.10). In both the EVAR and OSR group, the proportion of patients with cardiac comorbidity increased. CONCLUSION: Since the establishment of this nationwide quality improvement initiative (DSAA), all outcomes of iAAA repair following EVAR and OSR have improved, except for peri-operative mortality following EVAR which remained unchanged.

Published
2022

4. Outcomes in Octogenarians and the Effect of Comorbidities After Intact Abdominal Aortic Aneurysm Repair in the Netherlands: A Nationwide Cohort Study

Author

Alberga, A.J., Karthaus, E.G., Zwet, E.W. van, Bruin, J.L. De, Herwaarden, J.A. van, Warle, M.C., Wever, J.J., Verhagen, H.J., Alberga, A.J., Karthaus, E.G., Zwet, E.W. van, Bruin, J.L. De, Herwaarden, J.A. van, Warle, M.C., Wever, J.J., and Verhagen, H.J.

Abstract

Contains fulltext : 239384.pdf (Publisher’s version ) (Open Access), OBJECTIVE: Age is an independent risk factor for mortality after both elective open surgical repair (OSR) and endovascular aneurysm repair (EVAR). As a result of an ageing population, and the less invasive nature of EVAR, the number of patients over 80 years (octogenarians) being treated is increasing. The mortality and morbidity following aneurysm surgery are increased for octogenarians. However, the mortality for octogenarians who have either low or high peri-operative risks remains unclear. The aim of this study was to provide peri-operative outcomes of octogenarians vs. non-octogenarians after OSR and EVAR for intact aneurysms, including separate subanalyses for elective and urgent intact repair, based on a nationwide cohort. Furthermore, the influence of comorbidities on peri-operative mortality was examined. METHODS: All patients registered in the Dutch Surgical Aneurysm Audit (DSAA) undergoing intact AAA repair between 2013 and 2018, were included. Patient characteristics and peri-operative outcomes (peri-operative mortality, and major complications) of octogenarians vs. non-octogenarians for both OSR and EVAR were compared using descriptive statistics. Multivariable logistic regression analyses were used to examine whether age and the presence of cardiac, pulmonary, or renal comorbidities were associated with mortality. RESULTS: This study included 12 054 EVAR patients (3 015 octogenarians), and 3 815 OSR patients (425 octogenarians). Octogenarians in both the EVAR and OSR treatment groups were more often female and had more comorbidities. In both treatment groups, octogenarians had significantly higher mortality rates following intact repair as well as higher major complication rates. Mortality rates of octogenarians were 1.9% after EVAR and 11.8% after OSR. Age ≥ 80 and presence of cardiac, pulmonary, and renal comorbidities were associated with mortality after EVAR and OSR. CONCLUSION: Because of the high peri-operative mortality rates of octogenarians, a

Published
2021

5. Saccular Abdominal Aortic Aneurysms Patient Characteristics, Clinical Presentation, Treatment, and Outcomes in the Netherlands

Author

Karthaus, E.G., Tong, T.M.L., Vahl, A., Hamming, J.F., Akker, L.H. van den, Akker, P.J. van den, Akkersdijk, G.J., Akkersdijk, G.P., Akkersdijk, W.L., Kempenaer, M.G.V. de, Arts, C.H., Avontuur, J.A., Baal, J.G., Bakker, O.J., Balm, R., Barendregt, W.B., Bender, M.H., Bendermacher, B.L., Berg, M. van den, Berger, P., Beuk, R.J., Blankensteijn, J.D., Bleker, R.J., Bockel, J.H., Bodegom, M.E., Bogt, K.E., Boll, A.P., Booster, M.H., Burg, B.L.B. van der, Borst, G.J. de, Bos-van Rossum, W.T., Bosma, J., Botman, J.M., Bouwman, L.H., Breek, J.C., Brehm, V., Brinckman, M.J., Broek, T.H. van den, Brom, H.L., Bruijn, M.T. de, Bruin, J.L. de, Brummel, P., Brussel, J.P. van, Buijk, S.E., Buimer, M.G., Burger, D.H., Buscher, H.C., Butter, G. den, Cancrinus, E., Castenmiller, P.H., Cazander, G., Coveliers, H.M., Cuypers, P.H., Daemen, J.H., Dawson, I., Derom, A.F., Dijkema, A.R., Diks, J., Dinkelman, M.K., Dirven, M., Dolmans, D.E., Doorn R, C. van, Dortmont, L.M. van, Eb, M.M. van der, Eefting, D., Eijck, G.J. van, Elshof, J.W., Elsman, B.H., Elst, A. van der, Engeland, M.I. van, Eps, R.G. van, Faber, M.J., Fijter, W.M. de, Fioole, B., Fritschy, W.M., Geelkerken, R.H., Gent, W.B. van, Glade, G.J., Govaert, B., Groenendijk, R.P., Groot, H.G. de, Haak, R.F. van den, Haan, E.F. de, Hajer, G.F., Hattum, E.S. van, Hazenberg, C.E., Joosten, P.P.H.M., Helleman, J.N., Hem, L.G. van der, Hendriks, J.M., Herwaarden, J.A. van, Heyligers, J.M., Hinnen, J.W., Hissink, R.J., Ho, G.H., Hoed, P.T. den, Hoedt, M.T., Hoek, F. van, Hoencamp, R., Hoffmann, W.H., Hoksbergen, A.W., Hollander, E.J., Huisman, L.C., Hulsebos, R.G., Hunt-Jens, K.M., Idu, M.M., Jacobs, M.J., Jagt, M.F. van der, Jansbeken, J.R., Janssen, R.J., Jiang, H.H., Jong, S.C. de, Jongkind, V., Kapma, M.R., Keller, B.P., Jahrome, A.K., Kievit, J.K., Klemm, P.L., Klinkert, P., Knippenberg, B., Koedam, N.A., Koelemaij, M.J., Kolkert, J.L., Koning, G.G., Koning, O.H., Krasznai, A.G., Krol, R.M., Kropman, R.H., Kruse, R.R., Laan, L. van der, Laan, M.J. van der, Laanen, J.H. van, Lardenoye, J.H., Lawson, J.A., Legemate, D.A., Leijdekkers, V.J., Lemson, M.S., Lensvelt, M.M., Lijkwan, M.A., Lind, R.C., Linden, F.T. van der, Lung, P.F.L., Loos, M.J., Loubert, M.C., Mahmoud, D.E., Manshanden, C.G., Mattens, E.C., Meerwaldt, R., Mees, B.M., Metz, R., Minnee, R.C., Mol van Otterloo , J.C. de, Moll, F.L., Swijndregt, Y.C.M. van, Morak, M.J., Mortel, R.H. van de, Mulder, W., Nagesser, S.K., Naves, C.C., Nederhoed, J.H., Nevenzel-Putters, A.M., Nie, A.J. de, Nieuwenhuis, D.H., Nieuwen-Huizen, J., Nieuwenhuizen, R.C. van, Nio, D., Oomen, A.P., Oranen, B.I., Oskam, J., Palamba, H.W., Peppelenbosch, A.G., Petersen, A.S. van, Peterson, T.F., Petri, B.J., Pierie, M.E., Ploeg, A.J., Pol, R.A., Ponfoort, E.D., Poyck, P.P., Prent, A., Raa, S. ten, Raymakers, J.T., Reichart, M., Reichmann, B.L., Reijnen, M.M., Rijbroek, A., Rijn, M.J. van, Roo, R.A. de, Rouwet, E.V., Rupert, C.G., Saleem, B.R., Sambeek, M.R. van, Samyn, M.G., Sant, H.P. van 't, Schaik, J. van, Schaik, P.M. van, Scharn, D.M., Scheltinga, M.R., Schepers, A., Schlejen, P.M., Schlosser, F.J., Schol, F.P., Schouten, O., Schreinemacher, M.H., Schreve, M.A., Schurink, G.W., Sikkink, C.J., Siroen, M.P., Slaa, A. te, Smeets, H.J., Smeets, L., Smet, A.A. de, Smit, P. de, Smit, P.C., Smits, T.M., Snoeijs, M.G., Sondakh, A.O., Steenhoven, T.J. van der, Sterkenburg, S.M. van, Stigter, D.A., Stigter, H., Strating, R.P., Stultiens, G.N., Sybrandy, J.E., Teijink, J.A., Telgenkamp, B.J., Testroote, M.J., The, R.M., Thijsse, W.J., Tielliu, I.F., Tongeren, R.B. van, Toorop, R.J., Tordoir, J.H., Tournoij, E., Truijers, M., Turkean, K., Nolthenius, R.P.T., Unlu, C., Vafi, A.A., Vahl, A.C., Veen, E.J., Veger, H.T., Veldman, M.G., Verhagen, H.J., Verhoeven, B.A., Vermeulen, C.F., Vermeulen, E.G., Vierhout, B.P., Visser, M.J., Vliet, J.A. van der, Vlijmen-van Kuelen, C.J., Voesten, H.G., Voorhoeve, R., and Vos

Subjects
Male, medicine.medical_specialty, Aortic Rupture, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Treatment outcome, Patient characteristics, Hospital mortality, 030204 cardiovascular system & hematology, Dutch Surgical Aneurysm Audit (DSAA), Risk Assessment, Blood Vessel Prosthesis Implantation, 03 medical and health sciences, Aortic aneurysm, 0302 clinical medicine, Intervention (counseling), medicine, Humans, Hospital Mortality, Registries, 030212 general & internal medicine, cardiovascular diseases, threshold for elective surgery, Aged, Netherlands, Retrospective Studies, business.industry, General surgery, Follow up studies, Retrospective cohort study, Middle Aged, Saccular abdominal aortic aneurysm, medicine.disease, Survival Analysis, Surgery, Treatment Outcome, Elective Surgical Procedures, 030220 oncology & carcinogenesis, cardiovascular system, Female, 030211 gastroenterology & hepatology, Emergencies, Presentation (obstetrics), Tomography, X-Ray Computed, Cardiology and Cardiovascular Medicine, business, Aortic Aneurysm, Abdominal, Follow-Up Studies, Abdominal surgery
Abstract

Objective: The aim of this was to analyze differences between saccularshaped abdominal aortic aneurysms (SaAAAs) and fusiform abdominal aortic aneurysms (FuAAAs) regarding patient characteristics, treatment, and outcome, to advise a threshold for intervention for SaAAAs.Background: Based on the assumption that SaAAAs are more prone to rupture, guidelines suggest early elective treatment. However, little is known about the natural history of SaAAAs and the threshold for intervention is not substantiated.Methods: Observational study including primary repairs of degenerative AAAs in the Netherlands between 2016 and 2018 in which the shape was registered, registered in the Dutch Surgical Aneurysm Audit (DSAA). Patients were stratified by urgency of surgery; elective versus acute (symptomatic/ruptured). Patient characteristics, treatment, and outcome were compared between SaAAAs and FuAAAs.Results: A total of 7659 primary AAA-patients were included, 6.1% (n = 471) SaAAAs and 93.9% (n = 7188) FuAAAs. There were 5945 elective patients (6.5% SaAAA) and 1714 acute (4.8% SaAAA). Acute SaAAApatients were more often female (28.9% vs 17.2%, P = 0.007) compared with acute FuAAA-patients. SaAAAs had smaller diameters than FuAAAs, in elective (53.0mm vs 61 mm, P = 0.000) and acute (68mm vs 75 mm, P = 0.002) patients, even after adjusting for sex. In addition, 25.2% of acute SaAAA-patients presented with diameters

Published
2019

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

Author

Schaik, T.G. van, Yeung, K.K., Verhagen, H.J., Bruin, J.L. De, Sambeek, M. van, Balm, R., Zeebregts, C.J.A., Schultze Kool, L.J., Herwaarden, J.A. van, Blankensteijn, J.D., Schaik, T.G. van, Yeung, K.K., Verhagen, H.J., Bruin, J.L. De, Sambeek, M. van, Balm, R., Zeebregts, C.J.A., Schultze Kool, L.J., Herwaarden, J.A. van, and Blankensteijn, J.D.

Abstract

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

Published
2017

7. Long-term outcome of open or endovascular repair of abdominal aortic aneurysm.

Author

Bruin, J.L. De, Baas, A.F., Buth, J., Prinssen, M., Verhoeven, E.L., Cuypers, P.W., Sambeek, M.R. van, Balm, R., Grobbee, D.E., Blankensteijn, J.D., Bruin, J.L. De, Baas, A.F., Buth, J., Prinssen, M., Verhoeven, E.L., Cuypers, P.W., Sambeek, M.R. van, Balm, R., Grobbee, D.E., and Blankensteijn, J.D.

Abstract

Contains fulltext : 87282.pdf (publisher's version ) (Open Access), BACKGROUND: For patients with large abdominal aortic aneurysms, randomized trials have shown an initial overall survival benefit for elective endovascular repair over conventional open repair. This survival difference, however, was no longer significant in the second year after the procedure. Information regarding the comparative outcome more than 2 years after surgery is important for clinical decision making. METHODS: We conducted a long-term, multicenter, randomized, controlled trial comparing open repair with endovascular repair in 351 patients with an abdominal aortic aneurysm of at least 5 cm in diameter who were considered suitable candidates for both techniques. The primary outcomes were rates of death from any cause and reintervention. Survival was calculated with the use of Kaplan-Meier methods on an intention-to-treat basis. RESULTS: We randomly assigned 178 patients to undergo open repair and 173 to undergo endovascular repair. Six years after randomization, the cumulative survival rates were 69.9% for open repair and 68.9% for endovascular repair (difference, 1.0 percentage point; 95% confidence interval [CI], -8.8 to 10.8; P=0.97). The cumulative rates of freedom from secondary interventions were 81.9% for open repair and 70.4% for endovascular repair (difference, 11.5 percentage points; 95% CI, 2.0 to 21.0; P=0.03). CONCLUSIONS: Six years after randomization, endovascular and open repair of abdominal aortic aneurysm resulted in similar rates of survival. The rate of secondary interventions was significantly higher for endovascular repair. (ClinicalTrials.gov number, NCT00421330.)

Published
2010

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