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1. Behavioral sciences applied to acute care teams: a research agenda for the years ahead by a European research network

Author

Sandra Keller, Judith G. M. Jelsma, Franziska Tschan, Nick Sevdalis, Ruth M. Löllgen, Johan Creutzfeldt, Lauren R. Kennedy-Metz, Walter Eppich, Norbert K. Semmer, Isabelle Van Herzeele, Karin Pukk Härenstam, and Martine C. de Bruijne

Subjects
Research agenda, Teamwork, Acute care, Surgery, Public aspects of medicine, RA1-1270
Abstract

Abstract Background Multi-disciplinary behavioral research on acute care teams has focused on understanding how teams work and on identifying behaviors characteristic of efficient and effective team performance. We aimed to define important knowledge gaps and establish a research agenda for the years ahead of prioritized research questions in this field of applied health research. Methods In the first step, high-priority research questions were generated by a small highly specialized group of 29 experts in the field, recruited from the multinational and multidisciplinary “Behavioral Sciences applied to Acute care teams and Surgery (BSAS)” research network – a cross-European, interdisciplinary network of researchers from social sciences as well as from the medical field committed to understanding the role of behavioral sciences in the context of acute care teams. A consolidated list of 59 research questions was established. In the second step, 19 experts attending the 2020 BSAS annual conference quantitatively rated the importance of each research question based on four criteria – usefulness, answerability, effectiveness, and translation into practice. In the third step, during half a day of the BSAS conference, the same group of 19 experts discussed the prioritization of the research questions in three online focus group meetings and established recommendations. Results Research priorities identified were categorized into six topics: (1) interventions to improve team process; (2) dealing with and implementing new technologies; (3) understanding and measuring team processes; (4) organizational aspects impacting teamwork; (5) training and health professions education; and (6) organizational and patient safety culture in the healthcare domain. Experts rated the first three topics as particularly relevant in terms of research priorities; the focus groups identified specific research needs within each topic. Conclusions Based on research priorities within the BSAS community and the broader field of applied health sciences identified through this work, we advocate for the prioritization for funding in these areas.

Published
2024
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2. Adult essential extracorporeal membrane oxygenation (ECMO) skills for use in an e-learning program for ICU physicians, nurses and perfusionists: a consensus by a modified Delphi questionnaire

Author

Harlinde Peperstraete, Annelien Steenhout, Filip De Somer, Pieter Depuydt, Eric Hoste, and Isabelle Van Herzeele

Subjects
Extra corporeal membrane oxygenation, Education, Modified Delphi, Consensus, ICU, Knowledge, Special aspects of education, LC8-6691, Medicine
Abstract

Abstract Background Education in ECMO starts with basic theory and physiology. For this type of training, self-assessment e-learning modules may be beneficial. The aim of this study was to generate consensus on essential ECMO skills involving various professional groups involved in caring for ECMO patients. These skills can be used for educational purposes: development of an e-learning program and fine-tuning of ECMO-simulation programs. Methods Experts worldwide received an e-mail inviting them to participate in the modified Delphi questionnaire. A mixture of ECMO experts was contacted. The expert list was formed based on their scientific track record mainly in adult ECMO (research, publications, and invited presentations). This survey consisted of carefully designed questionnaires, organized into three categories, namely knowledge skills, technical skills, and attitudes. Each statement considered a skill and was rated on a 5-point Likert-scale and qualitative comments were made if needed. Based on the summarized information and feedback, the next round Delphi questionnaire was developed. A statement was considered as a key competency when at least 80% of the experts agreed or strongly agreed (rating 4/5 and 5/5) with the statement. Cronbach’s Alpha score tested internal consistency. Intraclass correlation coefficient was used as reliability index for interrater consistency and agreement. Results Consensus was achieved in two rounds. Response rate in the first round was 45.3% (48/106) and 60.4% (29/48) completed the second round. Experts had respectively for the first and second round: a mean age of 43.7 years (8.2) and 43.4 (8.8), a median level of experience of 11.0 years [7.0-15.0] and 12.0 years [8.3-14.8]. Consensus was achieved with 29 experts from Australia (2), Belgium (16), France (1), Germany (1), Italy (1), Russia (2), Spain (1), Sweden, (1), The Netherlands (4). The consensus achieved in the first round was 90.9% for the statements about knowledge, 54.5% about technical skills and 75.0% about attitudes. Consensus increased in the second round: 94.6% about knowledge skills, 90.9% about technical skills and 75.0% about attitudes. Conclusion An expert consensus was accomplished about the content of “adult essential ECMO skills”. This consensus was mainly created with participation of physicians, as the response rate for nurses and perfusion decreased in the second round.

Published
2022
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3. Documenting the Recovery of Vascular Services in European Centres Following the Initial COVID-19 Pandemic Peak: Results from a Multicentre Collaborative Study

Author

Ruth A. Benson, Maria Antonella Ruffino, Sharon Chan, Patrick Coughlin, Ayoola Awopetu, Philip Stather, Tristan Lane, Dimitrios Theodosiou, Mohamed Abozeid Ahmed, Thodur Vasudevan, Mohammed Ibrahim, Faraj Al Maadany, Mohamed Eljareh, Fatimah Saad Alkhafeefi, Raphael Coscas, Ertekin Utku Ünal, Raffaele Pulli, Sergio Zacà, Domenico Angiletta, Thomas Kotsis, Magdy Moawad, Matteo Tozzi, Nikolaos Patelis, Andreas M. Lazaris, Jason Chuen, Alexander Croo, Elpiniki Tsolaki, Gladiol Zenunaj, Dhafer Kamal, Mahmoud MH. Tolba, Martin Maresch, Vipul Khetarpaul, Joseph Mills, Gaurav Gangwani, Mohamed Elahwal, Rana Khalil, Mohammed A. Azab, Anver Mahomed, Richard Whiston, Ummul Contractor, Davide Esposito, Carlo Pratesi, Elena Giacomelli, Martín Veras Troncoso, Stephane Elkouri, Flavia Gentile Johansson, Ilias Dodos, Marie Benezit, José Vidoedo, João Rocha-Neves, António Henrique Pereira-Neves, Marina Felicidade Dias-Neto, Ana Filipa Campos Jácome, Luis Loureiro, Ivone Silva, Rodrigo Garza-Herrera, Victor Canata, Charlotte Bezard, Kathryn Bowser, Jorge Felipe Tobar, Carlos Gomez Vera, Carolina Salinas Parra, Eugenia Lopez, Yvis Gadelha Serra, Juan Varela, Vanessa Rubio, Gerardo Victoria, Adam Johnson, Leigh Ann O’Banion, Ragai Makar, Tamer Ghatwary Tantawy, Martin Storck, Vincent Jongkind, Orwa falah, Olivia McBride, Arda Isik, Athanasios Papaioannou, Paulo Eduardo Ocke Reis, Umberto Marcello Bracale, Ellie Atkins, Giovanni Tinelli, Emma Scott, Lucy Wales, Ashwin Sivaharan, Georgia Priona, Craig Nesbitt, Tabitha Grainger, Lauren Shelmerdine, Patrick Chong, Adnan Bajwa, Luke Arwynck, Nancy Hadjievangelou, Ahmed Elbasty, Oscar Rubio, Michael Ricardo, Jorge H. Ulloa, Marcos Tarazona, Manuel Pabon, Georgios Pitoulias, Kevin Corless, Orestis Ioannidis, Oliver Friedrich, Isabelle Van Herzeele, Badri Vijaynagar, Tina Cohnert, Rachel Bell, Hayley Moore, Prakash Saha, Edward Gifford, Matti Laine, Adel Barkat, Christos Karkos, Lenny Suryani Binti Safri, Gabriel Buitron, Javier Del Castillo, Paul Carrera, Nilson Salinas, Rodrigo Bruno Biagioni, Sergio Benites, César Andrés Mafla, Putera Mas Pian, Pereira Albino, Ernesto Serrano, Andres Marin, Marco González, Marsha Foreroga, Alejandro Russo, Andrés Reyes, Daniel Guglielmone, Lorena Grillo, Ronald Flumignan, Francisco Gomez Palones, Pierre Galvagni Silveira, Rosnelifaizur Bin Ramely, Sara Edeiken, Ian Chetter, Lucy Green, Abhilash Sudarsanam, Oliver Lyons, Gary Lemmon, Richard Neville, Mariano Castelli, Carlos A. Hinojosa, Rubén Rodríguez Carvajal, Aksim Rivera, Peng Wong, Laura Drudi, Jeremy Perkins, Kishore Sieunarine, Doaa Attia, Mahmoud Atef, Lostoridis Eftychios, Fred Weaver, Leong Chuo Ren, Mohannad Alomari, Reda Jamjoom, Qusai Aljarrah, Ayman Abbas, Faris Alomran, Ambrish Kumar, Abdulmajeed Altoijri, Kareem T. ElSanhoury, Ahmed Alhumaid, Tamer Fekry, Raghuram Sekhar, Panagiotis Theodoridis, Theodoridis Panagiotis, Konstantinos Roditis, Paraskevi Tsiantoula, Afroditi Antoniou, Raphael Soler, Natasha Hasemaki, Efstratia Baili, Eustratia Mpaili, Bella Huasen, Tom Wallace, Andrew Duncan, Matthew Metcalfe, Kristyn Mannoia, Carlos F. Bechara, Nikolaos Tsilimparis, Nathan Aranson, David Riding, Mariano Palena, Ciarán McDonnell, Nicolas J. Mouawad, Shonda Banegas, Peter Rossi, Taohid Oshodi, Rodney Diaz, Rana Afifi, Shiva Dindyal, Ankur Thapar, Ali Kordzadeh, Gonzalo Pullas, Stephanie Lin, Chris Davies, Katy Darvall, Akio Kodama, Thushan Gooneratne, Nalaka Gunawansa, Alberto Munoz, Ng Jun Jie, Nicholas Bradley, Wissam Al-Jundi, Felicity Meyer, Cheong Lee, Martin Malina, Sophie Renton, Dennis Lui, Andrew Batchelder, Grzegorz Oszkinis, Antonio Freyrie, Jacopo Giordano, Nikolaos Saratzis, Konstantinos Tigkiropoulos, Stavridis Kyriakos, Guriy Popov, Muhammad Usman Cheema, Pierfrancesco Lapolla, Yih Chun Ling Patricia, Raed Ennab, Brant W. Ullery, Ketino Pasenidou, Jacky Tam, Gabriel Sidel, Vivek Vardhan Jayaprakash, Lisa Bennett, Simon Hardy, Emma Davies, Sara Baker, Lasantha Wijesinghe, Adam Tam, Ken McCune, Manik Chana, Chris Lowe, Aaron Goh, Katarzyna Powezka, Ioanna Kyrou, Nishath Altaf, Denis Harkin, Hannah Travers, James Cragg, Atif sharif, Tasleem Akhtar, José Antonio Chávez, Claudia Ordonez, Martin Mazzurco, Edward Choke, Imran Asghar, Virginia Summerour, Paul Dunlop, Rachel Morley, Thomas Hardy, Paul Bevis, Robert Cuff, Konstantinos Stavroulakis, Efthymios Beropoulis, Angeliki Argyriou, Ian Loftus, Bilal Azhar, Sharvil Sheth, Marco Virgilio Usai, Asad Choudhry, Kira Nicole, Emily Boyle, Doireann Joyce, Mohammed Hassan Abdelaty Hassan, Alberto Saltiel, Gert Frahm-Jensen, George Antoniou, Muhammed Elhadi, Ali Kimyaghalam, Rafael Malgor, Leigh Ann O'Banion, Diego Telve, Andrej Isaak, Jürg Schmidli, Kevin McKevitt, Tam Siddiqui, Giuseppe Asciutto, Nikolaos Floros, George Papadopoulos, Alexandros Kafetzakis, Stylianos G. Koutsias, Petroula Nana, Athanasios Giannoukas, Stavros Kakkos, Konstantinos G. Moulakakis, Natasha Shafique, Arkadiusz Jawien, Matthew Popplewell, Chris Imray, Kumar Abayasekara, Timothy Rowlands, Ganesh Kuhan, Sriram Rajagopalan, Anthony Jaipersad, Uzma Sadia, Isaac Kobe, Devender Mittapalli, Ibrahim Enemosah, Christian-Alexander Behrendt, Adam Beck, Muayyad Almudhafer, Stefano Ancetti, Donald Jacobs, Priya Jayakumar, Fatemeh Malekpour, Sherene Shalhub, Boboyor Keldiyorov, Meryl Simon, Manar Khashram, Nicole Rich, Amanda Shepherd, Lewis Meecham, and Daniel Doherty

Subjects
AAA, COVID-19, PAD, Survey, Vascular surgery, Diseases of the circulatory (Cardiovascular) system, RC666-701, Surgery, RD1-811
Abstract

Objective: To document the recovery of vascular services in Europe following the first COVID-19 pandemic peak. Methods: An online structured vascular service survey with repeated data entry between 23 March and 9 August 2020 was carried out. Unit level data were collected using repeated questionnaires addressing modifications to vascular services during the first peak (March – May 2020, “period 1”), and then again between May and June (“period 2”) and June and July 2020 (“period 3”). The duration of each period was similar. From 2 June, as reductions in cases began to be reported, centres were first asked if they were in a region still affected by rising cases, or if they had passed the peak of the first wave. These centres were asked additional questions about adaptations made to their standard pathways to permit elective surgery to resume. Results: The impact of the pandemic continued to be felt well after countries’ first peak was thought to have passed in 2020. Aneurysm screening had not returned to normal in 21.7% of centres. Carotid surgery was still offered on a case by case basis in 33.8% of centres, and only 52.9% of centres had returned to their normal aneurysm threshold for surgery. Half of centres (49.4%) believed their management of lower limb ischaemia continued to be negatively affected by the pandemic. Reduced operating theatre capacity continued in 45.5% of centres. Twenty per cent of responding centres documented a backlog of at least 20 aortic repairs. At least one negative swab and 14 days of isolation were the most common strategies used for permitting safe elective surgery to recommence. Conclusion: Centres reported a broad return of services approaching pre-pandemic “normal” by July 2020. Many introduced protocols to manage peri-operative COVID-19 risk. Backlogs in cases were reported for all major vascular surgeries.

Published
2022
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4. Identifying a Big Implementation Gap in Simulation Based Education in Vascular Surgery in Europe: The VASSIM Study

Author

Jonathan Lawaetz, Gilles Soenens, Jonas Eiberg, Isabelle Van Herzeele, Salome Weiss, Lars Konge, Konstantinos Stavroulakis, Craig Nesbitt, Nuno Dias, Ramon Vila, Flavia Gentile, Leizl Joy Nayahangan, Sebastian Debus, Stephan Haulon, Enrico Cieri, Armando Mansilha, Stefano Ancetti, and Petar Zlatanovic

Subjects
Diseases of the circulatory (Cardiovascular) system, RC666-701, Surgery, RD1-811
Published
2022
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5. Outflow Through Aortic Side Branches Drives False Lumen Patency in Type B Aortic Dissection

Author

Gerlinde Logghe, Bram Trachet, Patrick Segers, Julie De Backer, Joscha Mulorz, Philip Dueppers, Frank Vermassen, Hubert Schelzig, Isabelle Van Herzeele, and Markus U. Wagenhäuser

Subjects
aortic dissection, minor branches, outflow, patency, TEVAR, false lumen, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Objective: Thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD) aims to induce false lumen (FL) thrombosis by sealing intimal tears between the true (TL) and the FL, and blocking the inflow into the FL. Incomplete thrombosis of the FL is correlated with poor clinical outcome. We hypothesize that the number of major and minor branches arising from the FL affects FL patency and may negatively influence TEVAR induced FL thrombosis.Methods: Computed tomography (CT)-scans from 89 patients diagnosed with TBAD [best medical treatment (BMT) n = 52, TEVAR n = 37] from two high-volume vascular surgery centers were analyzed retrospectively. Analysis included evaluation of the FL patency status, the number, location and size of intimal tears, and the presence of minor and major side branches originating from the FL. Multiple regression analysis was conducted to evaluate obtained parameters as predictors for FL thrombosis status.Results: In univariate analysis, the strongest correlation for FL patency was found for the number of major (R = 0.79) and minor (R = 0.86) side branches originating from the FL. When applying a multiple linear regression model, the number of major (normalized beta 0.37; P < 0.001) and minor (normalized beta 0.41; P < 0.01) side branches arising from the FL were valid predictors for the axial length of the patent and non-patent FL, and additionally determined the length of the patent FL at 12-month follow-up in patients that underwent TEVAR.Conclusions: Our data suggest that the number of minor side branches that originate from the FL in TBAD is an important determinant of FL patency, to a greater degree than previously assumed.

Published
2021
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6. Neurocognitive Functioning after Carotid Revascularization: A Systematic Review

Author

Maarten Plessers, Isabelle Van Herzeele, Frank Vermassen, and Guy Vingerhoets

Subjects
Cognitive outcome, Carotid endarterectomy, Carotid revascularization, Neuropsychology, Systematic review, Carotid artery stenting, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background: The objective of this study was to review the recent literature regarding the neurocognitive consequences of carotid endarterectomy (CEA) and carotid stenting (CAS). Methods and Results: A PubMed and Web of Science search was conducted using the key words ‘carotid' in combination with ‘cognitive', ‘cognition', ‘neurocognition', ‘neurocognitive', ‘neuropsychology', and ‘neuropsychological'. Bibliographies of relevant articles were cross-referenced. We included 37 studies published since 2007 of which 18 examined CEA, 12 CAS, and 7 compared CEA to CAS. There is a wide variability in the reported neurocognitive outcome following CEA and CAS. Nonetheless, none of the included studies unveiled significant differences between CEA and CAS on postoperative neurocognitive functioning. Postoperative changes observed for CEA and CAS separately seem limited to a small percentage (around 10-15%) of patients and can either present as an improvement or impairment. Key Messages: The available data seem to suggest that no obvious cognitive differences between CAS and CEA can be observed after intervention. Both improvement and deterioration in cognitive functioning can be observed following CAS or CEA. Methodological differences such as patient heterogeneity, implementation and type of control groups, type of psychometric tests used, statistical analyses, or timing of the assessments play an important role in explaining the sometimes divergent results of the included studies. Large-scale and methodologically solid studies comparing CEA and CAS on neurocognitive outcome remain warranted. Future studies should implement adequate control groups to correct for practice effects in the target groups.

Published
2014
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9. Editor's Choice – European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on Radiation Safety

Author

Bijan Modarai, Stéphan Haulon, Elizabeth Ainsbury, Dittmar Böckler, Eliseo Vano-Carruana, Joseph Dawson, Mark Farber, Isabelle Van Herzeele, Adrien Hertault, Joost van Herwaarden, Ashish Patel, Anders Wanhainen, Salome Weiss, null ESVS Guidelines Committee, Frederico Bastos Gonçalves, Martin Björck, Nabil Chakfé, Gert J. de Borst, Raphaël Coscas, Nuno V. Dias, Florian Dick, Robert J. Hinchliffe, Stavros K. Kakkos, Igor B. Koncar, Philippe Kolh, Jes S. Lindholt, Santi Trimarchi, Riikka Tulamo, Christopher P. Twine, Frank Vermassen, null Document Reviewers, Klaus Bacher, Elias Brountzos, Fabrizio Fanelli, Liliana A. Fidalgo Domingos, Mauro Gargiulo, Kevin Mani, Tara M. Mastracci, Blandine Maurel, Robert A. Morgan, Peter Schneider, Department of Surgery, Clinicum, and Verisuonikirurgian yksikkö

Subjects
Kirurgi, HSM CIR VASC, Surgery, Radiation Safety, Clinical Practice Guidelines, 3126 Surgery, anesthesiology, intensive care, radiology, Cardiology and Cardiovascular Medicine
Abstract

Funding Information: On behalf of the Public and Community Oversight Group (PCOG) of the Health Protection Research Unit in Chemical and Radiation Threats and Hazards: Ian Wright; John Phipps; Colette Kelly; Robert Goundry; Eve Smyth; Andrew Wood; Paul Dale (also of the Scottish Environment Protection Agency). On behalf of the Society and College of Radiographers Patient Advisory Group: Lynda Johnson; Philip Plant; Michelle Carmichael – Specialist Senior Staff Nurse Guy's and St Thomas’ NHS Foundation trust.

Published
2023

10. Effectiveness of an immersive virtual reality environment on curricular training for complex cognitive skills in liver surgery: a multicentric crossover randomized trial

Author

Nikdokht Rashidian, Mariano C. Giglio, Isabelle Van Herzeele, Peter Smeets, Zenichi Morise, Adnan Alseidi, Roberto I. Troisi, and Wouter Willaert

Subjects
Cognition, Liver, Hepatology, Virtual Reality, Gastroenterology, Humans, Clinical Competence, Curriculum
Abstract

Virtual reality (VR) is increasingly used in surgical education, but evidence of its benefits in complex cognitive training compared to conventional 3-dimensional (3D) visualization methods is lacking. The objective of this study is to assess the impact of 3D liver models rendered visible by VR or desktop interfaces (DIs) on residents' performance in clinical decision-making.From September 2020 to April 2021, a single-blinded, crossover randomized educational intervention trial was conducted at two university hospitals in Belgium and Italy. A proficiency-based stepwise curriculum for preoperative liver surgery planning was developed for general surgery residents. After completing the training, residents were randomized in one of two assessment sequences to evaluate ten real clinical scenarios.Among the 50 participants, 46 (23 juniors/23 seniors) completed the training and were randomized. Forty residents (86.96%) achieved proficiency in decision-making. The accuracy of virtual surgical planning using VR was higher than that using DI in both groups A (8.43 ± 1.03 vs 6.86 ± 1.79, p 0.001) and B (8.08 ± 0.9 vs 6.52 ± 1.37, p 0.001).Proficiency-based curricular training for liver surgery planning successfully resulted in the acquisition of complex cognitive skills. VR was superior to DI visualization of 3D models in decision-making.NCT04959630.

Published
2022

12. Step, Error, and Event Frameworks in Endovascular Aortic Repair

Author

Lauren Gordon, Gilles Soenens, Bart Doyen, Juliana Sunavsky, Mark Wheatcroft, Charles de Mestral, Vanessa Palter, Teodor Grantcharov, and Isabelle Van Herzeele

Subjects
Consensus, Delphi Technique, SURGERY, education (MeSH), medical error (MeSH), Delphi technique (MeSH), Nuclear Medicine and imaging, DELPHI TECHNIQUE, Medicine and Health Sciences, Humans, QUALITY, TOOL, Radiology, Nuclear Medicine and imaging, ROOM, OPERATIVE PERFORMANCE, SCALE, abdominal (MeSH), Endovascular Procedures, SKILL, COMPETENCE, Treatment Outcome, endovascular procedures (MeSH), Surgery, Clinical Competence, Radiology, Cardiology and Cardiovascular Medicine, Vascular Surgical Procedures, aortic aneurysm, Aortic Aneurysm, Abdominal
Abstract

Objective: Competency-based surgical education requires detailed and actionable feedback to ensure adequate and efficient skill development. Comprehensive operative capture systems such as the Operating Room Black Box (ORBB; Surgical Safety Technologies, Inc), which continuously records and synchronizes multiple sources of intraoperative data, have recently been integrated into hybrid rooms to provide targeted feedback to endovascular teams. The objective of this study is to develop step, error, and event frameworks to evaluate technical performance in elective endovascular aortic repair (EVAR) comprehensively captured by the ORBB (Surgical Safety Technologies, Inc; Toronto, Canada). Methods: This study is based upon a modified Delphi consensus process to create evaluation frameworks for steps, errors, and events in EVAR. International experts from Vascular Surgery and Interventional Radiology were identified, based on their records of publications and invited presentations, or serving on relevant journal editorial boards. In an initial open-ended survey round, experts were asked to volunteer a comprehensive list of steps, errors, and events for a standard EVAR of an infrarenal aorto-iliac aneurysm (AAA). In subsequent survey rounds, the identified items were presented to the expert panel to rate on a 5-point Likert scale. Delphi survey rounds were repeated until the process reached consensus with a predefined agreement threshold (Cronbach α>0.7). The final frameworks were constructed with items achieving an agreement (responses of 4 or 5) from greater than 70% of experts. Results: Of 98 invited proceduralists, 38 formed the expert consensus panel (39%), consisting of 29 vascular surgeons and 9 interventional radiologists, with 34% from North America and 66% from Europe. Consensus criteria were met following the third round of the Delphi consensus process (Cronbach α=0.82–0.93). There were 15, 32, and 25 items in the error, step, and event frameworks, respectively (within-item agreement=74%–100%). Conclusion: A detailed evaluation tool for the procedural steps, errors, and events in infrarenal EVAR was developed. This tool will be validated on recorded procedures in future work: It may focus skill development on common errors and hazardous steps. This tool might be used to provide high-quality feedback on technical performance of trainees and experienced surgeons alike, thus promoting surgical mastery.

Published
2022

13. Shared Decision Making and the Management of Intact Abdominal Aortic Aneurysm

Author

Matthew Machin, Isabelle Van Herzeele, Dirk Ubbink, and Janet T. Powell

Subjects
Surgery, Cardiology and Cardiovascular Medicine
Abstract

Objective: The aim of this study was to summarise the current knowledge of shared decision making (SDM) in patients facing a treatment decision about an intact abdominal aortic aneurysm (AAA), and to identify where further evidence is needed. Data sources: MEDLINE, Embase, and the Cochrane Library were searched on 18 July 2021. An updated search was run on 31 May 2022 for relevant studies published from 1 January 2000 to 31 May 2022. Review Methods: This scoping review was undertaken in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines following a pre-defined protocol, retrieving studies reporting on aspects of SDM in those with intact AAAs. Qualitative synthesis of the articles was performed, and the results grouped according to theme. Results: Fifteen articles reporting on a total of 1 344 participants (age range 62–74 years) from hospital vascular surgery clinics with intact AAAs were included. Studies were observational (n = 9), non-randomised studies of an intervention (n = 3), and randomised clinical trials (n = 3). The first theme was the preferences and practice of SDM. The proportion of patients preferring SDM ranged from 58% to 95% (three studies), although objective rating of SDM practice was consistently < 50% (three studies). Clinician training improved SDM practice. The second theme was poor provision of information. Fewer than half of patients (0 – 46%) surveyed were informed about all available treatment options (three studies). Publicly available information sources were rated as poor. The third theme concerned the utility of decision making support tools (DSTs). Two randomised trials demonstrated that the provision of DSTs improves patient knowledge and agreement between patient preference and repair type received but not objective measures of SDM for patients with AAAs. Conclusion: SDM for patients with an intact AAA appears to be in its infancy. Most patients with an AAA want SDM, but this is not commonly applied. Most patients with an AAA do not receive adequate information for SDM, although the use of bespoke DSTs leaves patients better informed to facilitate SDM.

Published
2023

14. Focused update on patients treated with the nellix endovascular aneurysm sealing (EVAS) system from the european society for vascular surgery (ESVS) abdominal aortic aneurysm clinical practice guidelines

Author

Jonathan R. Boyle, Nikolaos Tsilimparis, Isabelle Van Herzeele, Anders Wanhainen, F. Bastos Gonçalves, S. Bellmunt, X. Berard, M. D’Oria, C. Fernandez, C. Karkos, A. Kazimierczak, M. Koelemay, T. Kölbel, K. Mani, G. Melissano, J. Powell, S. Trimarchi, G. Antoniou, R. Coscas, N. Dias, P. Kolh, S. Lepidi, B. Mees, T. Resch, J.B. Ricco, R. Tulamo, C. Twine, and M. Björck

Subjects
Endovascular Aneurysm Sealing, Kardiologi, Endoleak, Kirurgi, Abdominal aortic aneurysm, Surgery, Cardiac and Cardiovascular Systems, Guidelines, Cardiology and Cardiovascular Medicine, Nellix, EVAS
Abstract

Objective: After alerts on EndoVascular Aneurysm Seal (EVAS) failure were raised, the European Society for Vascular Surgery (ESVS) Abdominal Aortic Aneurysm (AAA) Clinical Practice Guidelines Writing Committee (WC) initiated a task force with the aim to provide guidance on surveillance and management of patients with implanted EVAS devices.Methods: Based on a scoping review of risk for late serious aortic-related adverse events in patients treated with EVAS for AAA, the ESVS AAA Guidelines WC agreed on recommendations graded according to the European Society of Cardiology (ESC) grading system.Results: EVAS has a very high incidence of late endograft migration resulting in proximal type 1 endoleak with risk of rupture, requiring open conversion with device explantation. The reported mortality rate for elective explantation varies between 0% and 14%, while acute conversion for rupture has a very dismal prognosis with a 67 -75% mortality rate.Conclusion: It is recommended that all patients in whom a Nellix device has been implanted should be identified, properly informed, and enrolled in enhanced surveillance. If device failure is detected, early elective device explantation should be considered in surgically fit patients. The authors, on behalf of the ESVS AAA Guidelines Writing Committee and the ESVS Guidelines Steering Committee.

Published
2023

15. Surgeons’ leadership style and team behavior in the hybrid operating room : prospective cohort study

Author

Gilles Soenens, Benoit Marchand, Bart Doyen, Teodor Grantcharov, Isabelle Van Herzeele, and Peter Vlerick

Subjects
Medicine and Health Sciences, Surgery
Abstract

This study aimed to assess the relationship between surgeons' leadership style and team behavior in the hybrid operating room through video coding. Secondly, possible fluctuations in leadership styles and team behavior during operative phases were studied.Leadership is recognized as a key component to successful team functioning in high-risk industries. The 'full range of leadership' theory is commonly used to evaluate leadership, marking transformational, transactional and passive. Few studies have examined the effects of these leadership styles on team behavior in surgery and/or their fluctuations during surgery.A single-center study included patients planned for routine endovascular procedures. A medical data capture system was used to allow post-hoc video coding through Behavior Anchored Rating Scales. Multilevel statistical analysis was performed to assess possible correlations between leadership style and three team behavior indicators (speaking up, knowledge sharing, collaboration) on an operative phase level.Twenty-two cases were analyzed (47 hours recording). Transformational leadership is positively related to the extent to which team members work together (γ=0.20, P0.001), share knowledge (γ=0.45, P0.001) and speak up (γ=0.64, P0.001). Passive leadership is significantly positively correlated with speaking up (γ=0.29, P=0.004). Leadership style and team behavior clearly fluctuate during a procedure, with similar patterns across different types of endovascular procedures.Consistent with other professional fields, surgeons' transformational leadership enhances team behavior, especially during the most complex operative phases. This suggests that encouraging surgeons to learn and actively implement a transformational leadership style is meaningful to enhance patient safety and team performance.

Published
2023

16. Assessing endovascular team performances in a hybrid room using the Black Box system : a prospective cohort study

Author

Bart DOYEN, Gilles SOENENS, Blandine MAUREL, Adrien HERTAULT, Lauren GORDON, Peter VLERICK, Frank VERMASSEN, Teodor GRANTCHAROV, and Isabelle van HERZEELE

Subjects
Patient safety, Endovascular procedures, Medicine and Health Sciences, Surgery, General Medicine, Quality improvement, Cardiology and Cardiovascular Medicine, Vascular surgery procedures
Abstract

BACKGROUND: The hybrid room (HR) is a complex, high-risk environment, requiring teams (surgeons, anesthesiologists, nurses, technolo-gists) to master various skills, including the 'As Low As Reasonably Achievable' principle of radiation safety. This prospective single center cohort reports the first use of the Operating Room Black Box (ORBB) in a HR. This medical data recording system captures procedural and audio-visual data to facilitate structured team performance analysis.METHODS: Patients planned for endovascular repair of an infrarenal abdominal aortic aneurysm (EVAR) or treatment of symptomatic iliac-femoral-popliteal atherosclerotic disease (Peripheral Vascular Interventions or PVI) were included. Validated measures and established assess-ment tools were used to assess (non-)technical skills, radiation safety performance and environmental distractions. RESULTS: Six EVAR and sixteen PVI procedures were captured. Technical performance for one EVAR was rated 19/35 on the procedure -specific scale, below the 'acceptable' score of 21. Technical skills were rated above acceptable in all PVI procedures. Shared decision making and leadership were rated highly in 12/22 cases, whereas surgical communication and nurses' task management were rated low in 14/22 cases. Team members rarely stepped back from the C-arm during digital subtraction angiography. Radiation safety behavior was scored below 'accept-able' in 14/22 cases. A median (interquartile range) number of 12 (6-23) auditory distractions was observed per procedure. CONCLUSIONS: The ORBB facilitates holistic workplace-based assessment of endovascular performance in a HR by combining objec-tive assessment parameters and rating scale-based evaluations. Strengths and weaknesses were identified in team members' (non-)technical and radiation safety practices. This technology has the potential to improve vascular surgical practice, though human input remains crucial. (NCT04854278)

Published
2023

19. Reply To: Incisional Hernias After Open Abdominal Aortic Aneurysm Repair: More Attention Needed at Start and Finish

Author

Maxime Dewulf, Nicole D. Bouvy, Isabelle Van Herzeele, MUMC+: MA Heelkunde (9), RS: NUTRIM - R2 - Liver and digestive health, Surgery, and RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy

Subjects
Humans, Incisional Hernia, Abdominal Wound Closure Techniques, Surgery, Cardiology and Cardiovascular Medicine, Vascular Surgical Procedures, Hernia, Ventral, Aortic Aneurysm, Abdominal
Published
2022

21. Right-sided aortic arch with Kommerell’s diverticulum: a case report of a rare cause of type B dissection

Author

Sami Marzouki, Isabelle Van Herzeele, Bernard Peeters, and Sofie Gevaert

Subjects
Acute aortic syndrome, Case report, Medicine and Health Sciences, Congenital aortic anomaly, Aortic dissection, Kommerell's diverticulum, ENDOVASCULAR REPAIR, Cardiology and Cardiovascular Medicine, Right-sided aortic arch, DISEASE
Abstract

Background A right-sided aortic arch (RAArch) is present in approximately 0.1% of the population. A Kommerell’s diverticulum (KD), a remnant of the dorsal aortic arch usually refers to an aneurysmal aortic enlargement at the origin of an aberrant left subclavian artery (ALSA) and is associated with an increased risk of aortic dissection. Case summary A 59-year-old female smoker with a history of hypertension and hypercholesterolaemia presented with a 24-hour history of sudden-onset and severe stabbing chest pain radiating to the interscapular region. Physical examination was normal except for bilateral basal crepitations. Computed tomography angiography (CTA) showed a type B aortic dissection in a RAArch with an ALSA arising from KD with a peri-aortic haematoma and haemothorax without any active contrast extravasation. After medical stabilization, a semi-urgent hybrid repair was performed with a right carotid-subclavian bypass, thoracic endovascular aortic repair (TEVAR), a plug in the left subclavian artery, and left carotid-subclavian bypass due to severe ischaemia of the left arm. The postoperative CTA showed patent bypasses, aortic remodelling, and a minimal type IIa endoleak at the level of the ALSA. Discussion In patients with a type B dissection and KD, hybrid repair including TEVAR is feasible after careful pre-operative assessment of the patient’s unique anatomy and may reduce post-surgical morbidity and mortality compared to open surgery. Prophylactic repair may be considered in patients with an asymptomatic RAArch and KD.

Published
2022

22. Too Limited Use of Prophylactic Mesh After Open AAA Repair in Belgium and The Netherlands?

Author

Maxime Dewulf, Nick De Wever, Isabelle Van Herzeele, Barend M.E. Mees, Filip E. Muysoms, Nicole D. Bouvy, MUMC+: MA Heelkunde (9), Vascular Surgery, MUMC+: MA Med Staf Spec Vaatchirurgie (9), RS: Carim - V03 Regenerative and reconstructive medicine vascular disease, Surgery, RS: NUTRIM - R2 - Liver and digestive health, and RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy

Subjects
Surgery, Cardiology and Cardiovascular Medicine
Published
2022

23. Fenestrated and branched endovascular repair for juxtarenal and thoracoabdominal aortic aneurysms: analysis of the first 100 cases

Author

Gilles UIJTTERHAEGEN, Karen VAN LANGENHOVE, Nathalie MOREELS, Isabelle VAN HERZEELE, and Frank VERMASSEN

Subjects
Time Factors, Aortic Aneurysm, Thoracic, Endovascular Procedures, General Medicine, Blood Vessel Prosthesis, Cohort Studies, Blood Vessel Prosthesis Implantation, Postoperative Complications, Treatment Outcome, Humans, Surgery, Cardiology and Cardiovascular Medicine, Aortic Aneurysm, Abdominal, Retrospective Studies
Abstract

Endovascular aortic aneurysm repair (EVAR) has become the most popular technique to treat infrarenal abdominal aortic aneurysms. In aneurysms with unsuitable anatomy open surgical repair remains the golden standard but fenestrated EVAR (FEVAR) or branched EVAR (BEVAR) may be an alternative to treat juxtarenal or thoracoabdominal aneurysms. The aim of this study was to report our results and to evaluate its safety and feasibility.This is a single center cohort study analyzing all consecutive patients undergoing FEVAR or BEVAR.One hundred patients underwent a procedure between June 2012 and December 2019. Forty-seven percent had a history of coronary artery disease and 31% of previous aortic repair. Sixty percent were treated for a juxtarenal and 40% for a TAAA. Primary technical success was 87%. Overall, thirty-day mortality was 6%, with 50% of the deaths resulting from a myocardial infarction. Four percent had a bowel resection for ischemia, 3% developed a stroke and 3% spinal cord ischemia. Mean follow-up was 33.6±22.4 months, freedom from all-cause mortality was 89.3±3.2% at one year and 66.4±7.6% at five years. Six intraoperative target vessel events were noted (1.7%), six early postoperative (1.7%) and three late (0.8%). A total of ten (10%) late procedure related secondary interventions were performed, among which six for endoleak.This study confirms that fenestrated and branched endovascular repair is a safe and feasible treatment for juxtarenal and thoracoabdominal aortic aneurysms with acceptable complication rates. The perioperative cardiac mortality highlights the importance of preoperative risk assessment and patient selection.

Published
2022

24. Comparison of manual versus robot-assisted contralateral gate cannulation in patients undergoing endovascular aneurysm repair

Author

Celia Riga, Alexander Rolls, Isabelle Van Herzeele, Mohamad Hamady, Rafid Rahman, Danail Stoyanov, Ping-Lin Chang, Sheena Cheung, Mimi Li, Colin Bicknell, and Liesbeth Desender

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, 0206 medical engineering, Biomedical Engineering, Health Informatics, 02 engineering and technology, Endovascular aneurysm repair, Catheterization, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Aneurysm, Robotic Surgical Procedures, Interquartile range, medicine, Humans, Radiology, Nuclear Medicine and imaging, In patient, Embolization, Retrospective Studies, business.industry, Endovascular Procedures, Reproducibility of Results, Retrospective cohort study, Equipment Design, General Medicine, Navigation path, medicine.disease, 020601 biomedical engineering, Computer Graphics and Computer-Aided Design, Computer Science Applications, Surgery, Catheter, Treatment Outcome, Fluoroscopy, Female, Computer Vision and Pattern Recognition, business
Abstract

Robotic endovascular technology may offer advantages over conventional manual catheter techniques. Our aim was to compare the endovascular catheter path-length (PL) for robotic versus manual contralateral gate cannulation during endovascular aneurysm repair (EVAR), using video motion analysis (VMA). This was a multicentre retrospective cohort study with fluoroscopic video recordings of 24 EVAR cases (14 robotic, 10 manual) performed by experienced operators (> 50 procedures), obtained from four leading European centres. Groups were comparable with no statistically significant differences in aneurysm size (p = 0.47) or vessel tortuosity (p = 0.68). Two trained assessors used VMA to calculate the catheter PL during contralateral gate cannulation for robotic versus manual approaches. There was a high degree of inter-observer reliability (Cronbach’s α > 0.99) for VMA. Median robotic PL was 35.7 cm [interquartile range, IQR (30.8–51.0)] versus 74.1 cm [IQR (44.3–170.4)] for manual cannulation, p = 0.019. Robotic cases had a median cannulation time of 5.33 min [IQR (4.58–6.49)] versus 1.24 min [IQR (1.13–1.35)] in manual cases (p = 0.0083). Generated efficiency ratios (PL/aorto-iliac centrelines) was 1.6 (1.2–2.1) in robotic cases versus 2.6 (1.7–7.0) in manual, p = 0.031. Robot-assisted contralateral gate cannulation in EVAR leads to decreased navigation path lengths and increased economy of movement compared with manual catheter techniques. The benefit could be maximised by prioritising robotic catheter shaping over habituated reliance on guidewire manipulation. Robotic technology has the potential to reduce the endovascular footprint during manipulations even for experienced operators with the added advantage of zero radiation exposure.

Published
2020

25. Introduction of a surgical Black Box system in a hybrid angiosuite: Challenges and opportunities

Author

Peter Vlerick, Isabelle Van Herzeele, Lauren Gordon, Teodor P. Grantcharov, Bart Doyen, Klaus Bacher, Gilles Soenens, and Frank Vermassen

Subjects
Canada, Operating Rooms, medicine.medical_specialty, Quality management, Computer science, medicine.medical_treatment, media_common.quotation_subject, Automatic identification and data capture, Biophysics, General Physics and Astronomy, Context (language use), Plan (drawing), Endovascular aneurysm repair, 030218 nuclear medicine & medical imaging, Blood Vessel Prosthesis Implantation, 03 medical and health sciences, Patient safety, 0302 clinical medicine, medicine, Humans, Radiology, Nuclear Medicine and imaging, Medical physics, Quality (business), media_common, Endovascular Procedures, General Medicine, Identification (information), 030220 oncology & carcinogenesis, Aortic Aneurysm, Abdominal
Abstract

Purpose In laparoscopy, the Operating Room Black Box® (ORBB) provides insights into operative performance to improve patient safety. This technology may also enhance endovascular surgical practice; however, the use of a C-arm and X-rays pose important challenges, hindering transferability to an endovascular context. We describe the first implementation of ORBB technology in a hybrid angiosuite and illustrate its value in evaluating surgeons’ radiation safety, technical and non-technical performance. Methods Team members (surgeons, nurses, anaesthesiologists) and stakeholders were informed during several information sessions. Together with teams from Surgical Safety Technologies (Toronto, Canada), an implementation plan was developed, and video-evaluation frameworks were chosen. Radiation safety was assessed using dose measurements and video-evaluation of safety-related behaviours. Technical performance was assessed using ‘global’ (GRS) and ‘procedure-specific’ (PRS) rating scales and the ‘EndoVascular Aortic Repair Assessment of Technical Expertise’ (EVARATE) framework. Surgeons’ non-technical skills were assessed with the NOTSS framework. Results The system captures Audio-visual data from four ceiling-mounted cameras, three ceiling-array microphones, the fluoroscopy screen and anaesthesia monitor. After patient and team consent, an elective endovascular aneurysm repair was successfully analysed. Dose-Area-Product and Air Kerma were 71094 mGy.cm2 and 270 mGy, respectively. Behavioural analysis revealed deficiencies in stepping back and radiation safety communication. Technical skill assessment was feasible: GRS: 29/40; ‘PRS’: 27/35; EVARATE: 29/35. Non-technical analysis highlighted surgeons’ leadership qualities. Conclusion An innovative data capture platform has been successfully installed to evaluate overall performance during endovascular procedures. This technology may facilitate identification of (radiation) safety-related errors and instigate educational interventions based on real-world issues.

Published
2020

26. Team perception of the radiation safety climate in the hybrid angiography suite: A cross-sectional study

Author

Gilles Soenens, Peter Vlerick, Isabelle Van Herzeele, Frank Vermassen, and Bart Doyen

Subjects
Ionizing radiation, Mediation (statistics), ORGANIZATIONS, Cross-sectional study, media_common.quotation_subject, Applied psychology, CORONARY-ANGIOGRAPHY, Safety climate, PROTECTION CULTURE, PATIENT, 03 medical and health sciences, 0302 clinical medicine, Perception, Health care, Medicine and Health Sciences, Safety behaviors, Humans, Medicine, KNOWLEDGE, EXPOSURE, Angiography suite, CARDIOLOGY, media_common, Patient Care Team, Motivation, Radiation safety, Endovascular, business.industry, Angiography, General Medicine, ENDOVASCULAR PROCEDURES, Cross-Sectional Studies, Radiation safety behavior, 030220 oncology & carcinogenesis, Scale (social sciences), Healthcare worker, 030211 gastroenterology & hepatology, Surgery, Patient Safety, Radiation safety climate, business, BEHAVIOR, SYSTEM
Abstract

Background: Good radiation safety practice in the angiosuite is essential to protect patients and healthcare workers. Most strategies aim to advance radiation safety through technological upgrades and educational initiatives. However, safety literature suggests that additional ways to improve radiation safety in the angiosuite do exist. The safety climate reflects the way team members perceive various key characteristics of their work environment and is closely related to relevant safety outcomes. A specific ‘radiation safety climate’ has not been described nor studied in the hybrid angiosuite. This study explores the radiation safety climate in the hybrid angiosuite and its relation to team members' radiation safety behavior, knowledge and motivation. Materials and Methods: Vascular surgeons, fellows/trainees and operating room nurses active in the angiosuite at five hospitals were invited to complete an online self-report questionnaire assessing the radiation safety climate (28 items); radiation safety behavior; radiation safety knowledge and radiation safety motivation. Relations between climate scores and behavior were investigated using Pearson correlations. Mediation was analyzed using the Baron and Kenny analysis. P-Values < 0.05 were considered statistically significant. Results: No major differences were identified in total radiation safety climate scores between centers or team member functions. Scale reliability for radiation safety climate was good to excellent (α > 0.663). Total radiation safety climate scores were positively related to the radiation safety behavior score (r=0.403; p=0.015). This relation was partially mediated by radiation safety knowledge (β=0.1730; 95% CI: [0.0475; 0.3512]), while radiation safety motivation did not act as a mediator: (β=0.010; 95% CI: [-0.0561; 0.0998]). Conclusion: A well-developed radiation safety climate in the hybrid angiosuite fosters positive radiation safety behaviors, which may partially be explained through improved radiation safety knowledge transfer. Further research on (radiation) safety climate and its impact on radiation safety-related outcome measures for patients is recommended.

Published
2020

27. Using an application to measure trainees' procedural knowledge before chest tube insertion

Author

Leander De Mol, Joris Vangeneugden, Liesbeth Desender, Isabelle Van Herzeele, Lars Konge, and Wouter Willaert

Subjects
General Medicine
Abstract

Purpose of the study To collect validity evidence for the chest tube insertion (CTI) test mode on the medical simulation application Touch Surgery. This was done by using Messick’s contemporary framework. Methods Novice, intermediate and experienced participants provided informed consent and demographic information. After familiarisation with the application, they completed the CTI test mode. Validity evidence was collected from four sources: content, response process, relation to other variables and consequences. A post-study questionnaire with 5-point Likert scales assessed the perceived realism, relevance and utility of the assessment. Mean scores of the three groups were compared. Results A total of 25 novices, 11 intermediates and 19 experienced participants were recruited. Content evidence was collected by an expert in CTI and was based on published literature and guidelines. All users were familiarised with the application, and received standardised instructions throughout the test. Most users rated the simulation as realistic and suitable to assess cognitive skills. Novices received significantly lower (55.9±7.5) test mode scores than intermediates (80.6±4.4) (p Conclusion A robust validity argument was constructed for the CTI test mode, which can be implemented in surgical curricula to assess learners’ cognitive skills prior to hands-on simulation practice.

Published
2022

28. Editor's Choice - Covered vs. Bare Metal Stents in the Reconstruction of the Aortic Bifurcation: Early and Midterm Outcomes from the COBRA European Multicentre Registry

Author

Athanasios Saratzis, Angeliki Argyriou, Robert Davies, Theodosios Bisdas, Arindam Chaudhuri, Giovanni Torsello, Konstantinos Stavroulakis, Hany Zayed, Said Abisi, Raphael Coscas, Ramita Dey, Ansy Egun, Mauro Gargiulo, Phillippe Ghibu, Lorenzo Gibello, Bella Huasen, Pui Fong Lau, Martin Malina, Stefano Michelagnoli, Lorenzo Patrone, Maria Antonella Ruffino, Prakash Saha, Nicola Troisi, Sarah Vanderhaute, Isabelle Van Herzeele, Regis Renard, and Alessia Sonetto

Subjects
Aorto-iliac disease, Revascularisation, Endovascular, Chronic limb threatening ischaemia, Peripheral arterial disease, Surgery, Claudication, Cardiology and Cardiovascular Medicine
Abstract

To report outcomes following endovascular revascularisation for severe aorto-iliac occlusive disease (AIOD) using covered (CS) or bare metal (BMS) stent(s).This was a retrospective cohort study including patients who underwent treatment with CS or BMS for AIOD between November 2012 and March 2020 in 12 European centres. Outcome measures included death, freedom from target lesion revascularisation (TLR), major amputation, and major adverse cardiac and cerebrovascular events (MACCE).Overall, 252 patients (53% males; mean age 65 ± 10 years) were included (102 with a bare metal and 150 with a covered aortic stent); 122 (48%) presented with chronic limb threatening ischaemia (CLTI). Severe arterial calcification was noted in65% of patients, 70% presented with Trans-Atlantic Societies Consensus (TASC) D lesions, 32% and 46% had aortic or iliac chronic total occlusion (CTO), respectively. Median follow up was 17 months (range 6 - 40; none lost to follow up). Median inpatient stay was two days (range two to four). During the first 30 days, two patients died (both with covered aortic stents, because of cardiovascular events), none required TLR, two (1%) patients had a major amputation (all presented with CLTI), and three (1%) had a MACCE. At 17 months, mortality (BMS 14% vs. CS 7%, hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.42 - 2.26, p = .94, log rank test) and TLR (11% vs. 10%, HR 1.98, 95% CI 0.89 - 4.43, p = .095) did not differ statistically significantly between the two groups; only three patients had a major limb amputation during late follow up (all with a covered stent). In a multivariable model, the use of an aortic CS did not influence TLR. In a conditional Cox regression, however, the concomitant use of aortic and iliac CSs was associated with improved freedom from TLR.Endovascular reconstruction with aortic CSs or BMSs for severe AIOD showed comparable midterm performance. The use of both aortic and iliac CSs seems to be associated with reduced TLR.

Published
2022

29. Second asymptomatic carotid surgery trial (ACST-2): a randomised comparison of carotid artery stenting versus carotid endarterectomy

Author

Alison Halliday, Richard Bulbulia, Leo H Bonati, Johanna Chester, Andrea Cradduck-Bamford, Richard Peto, Hongchao Pan, John Potter, Hans Henning Eckstein, Barbara Farrell, Marcus Flather, Averil Mansfield, Boby Mihaylova, Kazim Rahimi, David Simpson, Dafydd Thomas, Peter Sandercock, Richard Gray, Andrew Molyneux, Cliff P Shearman, Peter Rothwell, Anna Belli, Will Herrington, Parminder Judge, Peter Leopold, Marion Mafham, Michael Gough, Piergiorgio Cao, Sumaira MacDonald, Vasha Bari, Clive Berry, S Bradshaw, Wojciech Brudlo, Alison Clarke, Robin Cox, Susan Fathers, Kamran Gaba, Mo Gray, Elizabeth Hayter, Constance Holliday, Rijo Kurien, Michael Lay, Steffi le Conte, Jessica McManus, Zahra Madgwick, Dylan Morris, Andrew Munday, Sandra Pickworth, Wiktor Ostasz, Michiel Poorthuis, Sue Richards, Louisa Teixeira, Sergey Tochlin, Lynda Tully, Carol Wallis, Monique Willet, Alan Young, Renato Casana, Chiara Malloggi, Andrea Odero Jr, Vincenzo Silani, Gianfranco Parati, Giuseppe Malchiodi, Giovanni Malferrari, Francesco Strozzi, Nicola Tusini, Enrico Vecchiati, Gioacchino Coppi, Antonio Lauricella, Roberto Moratto, Roberto Silingardi, Jessica Veronesi, Andrea Zini, Emanuele Ferrero, Michelangelo Ferri, Andrea Gaggiano, Carmelo Labate, Franco Nessi, Daniele Psacharopulo, Andrea Viazzo, Giovanni Malacrida, Daniela Mazzaccaro, Giovanni Meola, Alfredo Modafferi, Giovanni Nano, Maria Teresa Occhiuto, Paolo Righini, Silvia Stegher, Stefano Chiarandini, Filippo Griselli, Sandro Lepidi, Fabio Pozzi Mucelli, Marcello Naccarato, Mario D'Oria, Barbara Ziani, Andrea Stella, Mortalla Dieng, Gianluca Faggioli, Mauro Gargiulo, Sergio Palermo, Rodolfo Pini, Giovanni Maria Puddu, Andrea Vacirca, Domenico Angiletta, Claudio Desantis, Davide Marinazzo, Giovanni Mastrangelo, Guido Regina, Raffaele Pulli, Paolo Bianchi, Lea Cireni, Elisabetta Coppi, Rocco Pizzirusso, Filippo Scalise, Giovanni Sorropago, Valerio Tolva, Valeria Caso, Enrico Cieri, Paola DeRango, Luca Farchioni, Giacomo Isernia, Massimo Lenti, Gian Battista Parlani, Guglielmo Pupo, Grazia Pula, Gioele Simonte, Fabio Verzini, Federico Carimati, Maria Luisa Delodovici, Federico Fontana, Gabriele Piffaretti, Matteo Tozzi, Efrem Civilini, Giorgio Poletto, Bernhard Reimers, Barbara Praquin, Sonia Ronchey, Laura Capoccia, Wassim Mansour, Enrico Sbarigia, Francesco Speziale, Pasqualino Sirignano, Danilo Toni, Roberto Galeotti, Vincenzo Gasbarro, Francesco Mascoli, Tiberio Rocca, Elpiniki Tsolaki, Giulia Bernardini, Ester DeMarco, Alessia Giaquinta, Francesco Patti, Massimiliano Veroux, Pierfrancesco Veroux, Carla Virgilio, Nicola Mangialardi, Matteo Orrico, Vincenzo Di Lazzaro, Nunzio Montelione, Francesco Spinelli, Francesco Stilo, Carlo Cernetti, Sandro Irsara, Giuseppe Maccarrone, Diego Tonello, Adriana Visonà, Beniamino Zalunardo, Emiliano Chisci, Stefano Michelagnoli, Nicola Troisi, Maela Masato, Massimo Dei Negri, Andrea Pacchioni, Salvatore Saccà, Giovanni Amatucci, Alfredo Cannizzaro, Federico Accrocca, Cesare Ambrogi, Renzo Barbazza, Giustino Marcucci, Andrea Siani, Guido Bajardi, Giovanni Savettieri, Angelo Argentieri, Riccardo Corbetta, Attilio Odero, Pietro Quaretti, Federico Z Thyrion, Alessandro Cappelli, Domenico Benevento, Gianmarco De Donato, Maria Agnese Mele, Giancarlo Palasciano, Daniela Pieragalli, Alessandro Rossi, Carlo Setacci, Francesco Setacci, Domenico Palombo, Maria Cecilia Perfumo, Edoardo Martelli, Aldo Paolucci, Santi Trimarchi, Viviana Grassi, Luigi Grimaldi, Giuliana La Rosa, Domenico Mirabella, Matteo Scialabba, Leonildo Sichel, Costantino L D'Angelo, Gian Franco Fadda, Holta Kasemi, Mario Marino, Francesco Burzotta, Francesco Alberto Codispoti, Angela Ferrante, Giovanni Tinelli, Yamume Tshomba, Claudio Vincenzoni, Deborah Amis, Dawn Anderson, Martin Catterson, Mike Clarke, Michelle Davis, Anand Dixit, Alexander Dyker, Gary Ford, Ralph Jackson, Sreevalsan Kappadath, David Lambert, Tim Lees, Stephen Louw, James McCaslin, Noala Parr, Rebecca Robson, Gerard Stansby, Lucy Wales, Vera Wealleans, Lesley Wilson, Michael Wyatt, Hardeep Baht, Ibrahim Balogun, Ilse Burger, Tracy Cosier, Linda Cowie, Gunaratnam Gunathilagan, David Hargroves, Robert Insall, Sally Jones, Hannah Rudenko, Natasha Schumacher, Jawaharlal Senaratne, George Thomas, Audrey Thomson, Tom Webb, Ellen Brown, Bernard Esisi, Ali Mehrzad, Shane MacSweeney, Norman McConachie, Alison Southam, Wayne Sunman, Ahmed Abdul-Hamiq, Jenny Bryce, Ian Chetter, Duncan Ettles, Raghuram Lakshminarayan, Kim Mitchelson, Christopher Rhymes, Graham Robinson, Paul Scott, Alison Vickers, Ray Ashleigh, Stephen Butterfield, Ed Gamble, Jonathan Ghosh, Charles N McCollum, Mark Welch, Sarah Welsh, Leszek Wolowczyk, Mary Donnelly, Stephen D'Souza, Anselm A Egun, Bindu Gregary, Thomas Joseph, Christine Kelly, Shuja Punekar, M Asad Rahi, Sonia Raj, Dare Seriki, George Thomson, James Brown, Ragunath Durairajan, Iris Grunwald, Paul Guyler, Paula Harman, Matthew Jakeways, Christopher Khuoge, Ashish Kundu, Thayalini Loganathan, Nisha Menon, Raji O Prabakaran, Devesh Sinha, Vicky Thompson, Sharon Tysoe, Dennis Briley, Chris Darby, Linda Hands, Dominic Howard, Wilhelm Kuker, Ursula Schulz, Rachel Teal, David Barer, Andrew Brown, Susan Crawford, Paul Dunlop, Ramesh Krishnamurthy, Nikhil Majmudar, Duncan Mitchell, Min P Myint, Richard O'Brien, Janice O'Connell, Naweed Sattar, Shanmugam Vetrivel, Jonathan Beard, Trevor Cleveland, Peter Gaines, John Humphreys, Alison Jenkins, Craig King, Daniel Kusuma, Ralph Lindert, Robbie Lonsdale, Raj Nair, Shah Nawaz, Faith Okhuoya, Douglas Turner, Graham Venables, Paul Dorman, Andrea Hughes, Deborah Jones, David Mendelow, Helen Rodgers, Aidas Raudoniitis, Peter Enevoldson, Hans Nahser, Imelda O'Brien, Francesco Torella, Dave Watling, Richard White, Pauline Brown, Dipankar Dutta, Lorraine Emerson, Paula Hilltout, Sachin Kulkarni, Jackie Morrison, Keith Poskitt, Fiona Slim, Sarah Smith, Amanda Tyler, Joanne Waldron, Mark Whyman, Milda Bajoriene, Lucy Baker, Amanda Colston, Bekky Eliot-Jones, Gita Gramizadeh, Catherine Lewis-Clarke, Laura McCafferty, Deborah Oliver, Debbie Palmer, Abhijeet Patil, Suzannah Pegler, Gopi Ramadurai, Aisling Roberts, Tracey Sargent, Shivaprasad Siddegowda, Ravi Singh-Ranger, Akintunde Williams, Lucy Williams, Steve Windebank, Tadas Zuromskis, Lanka Alwis, Jane Angus, Asaipillai Asokanathan, Caroline Fornolles, Diana Hardy, Sophy Hunte, Frances Justin, Duke Phiri, Marie Mitabouana-Kibou, Lakshmanan Sekaran, Sakthivel Sethuraman, Margaret L Tate, Joyce Akyea-Mensah, Stephen Ball, Angela Chrisopoulou, Elizabeth Keene, Alison Phair, Steven Rogers, John V Smyth, Colin Bicknell, Jeremy Chataway, Nicholas Cheshire, Andrew Clifton, Caroline Eley, Richard Gibbs, Mohammad Hamady, Beth Hazel, Alex James, Michael Jenkins, Nyma Khanom, Austin Lacey, Maz Mireskandari, Joanna O'Reilly, Antony Pereira, Tina Sachs, John Wolfe, Philip Davey, Gill Rogers, Gemma Smith, Gareth Tervit, Ian Nichol, Andrew Parry, Gavin Young, Simon Ashley, James Barwell, Francis Dix, Azlisham M Nor, Chris Parry, Angela Birt, Paul Davies, Jim George, Anne Graham, Leon Jonker, Nicci Kelsall, Caroline Potts, Toni Wilson, Jamie Crinnion, Larissa Cuenoud, Nikola Aleksic, Srdan Babic, Nenad Ilijevski, Đorde Radak, Dragan Sagic, Slobodan Tanaskovic, Momcilo Colic, Vladimir Cvetic, Lazar Davidovic, Dejana R Jovanovic, Igor Koncar, Perica Mutavdžic, Miloš Sladojevic, Ivan Tomic, Eike S Debus, Ulrich Grzyska, Dagmar Otto, Götz Thomalla, Jessica Barlinn, Johannes Gerber, Kathrin Haase, Christian Hartmann, Stefan Ludwig, Volker Pütz, Christian Reeps, Christine Schmidt, Norbert Weiss, Sebastian Werth, Simon Winzer, Janine Gemper, Albrecht Günther, Bianka Heiling, Elisabeth Jochmann, Panagiota Karvouniari, Carsten Klingner, Thomas Mayer, Julia Schubert, Friederike Schulze-Hartung, Jürgen Zanow, Yvonne Bausback, Franka Borger, Spiridon Botsios, Daniela Branzan, Sven Bräunlich, Henryk Hölzer, Janin Lenzer, Christopher Piorkowski, Nadine Richter, Johannes Schuster, Dierk Scheinert, Andrej Schmidt, Holger Staab, Matthias Ulrich, Martin Werner, Hermann Berger, Gábor Biró, Hans-Henning Eckstein, Michael Kallmayer, Kornelia Kreiser, Alexander Zimmermann, Bärbel Berekoven, Klaus Frerker, Vera Gordon, Giovanni Torsello, Sebastian Arnold, Cora Dienel, Martin Storck, Bernhard Biermaier, Hans Martin Gissler, Christof Klötzsch, Tomas Pfeiffer, Ralph Schneider, Leander Söhl, Michael Wennrich, Angelika Alonso, Michael Keese, Christoph Groden, Andreas Cöster, Andreas Engelhardt, Christoph-Maria Ratusinski, Bengt Berg, Martin Delle, Johan Formgren, Peter Gillgren, Lotta Jarl, Torbjörn B Kall, Peter Konrad, Niklas Nyman, Claes Skiöldebrand, Johnny Steuer, Rabbe Takolander, Jonas Malmstedt, Stefan Acosta, Katarina Björses, Kerstin Brandt, Nuno Dias, Anders Gottsäter, Jan Holst, Thorarinn Kristmundsson, Tobias Kühme, Tilo Kölbel, Bengt Lindblad, Mats Lindh, Martin Malina, Tomas Ohrlander, Tim Resch, Viola Rönnle, Björn Sonesson, 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Crawford S., Dunlop P., Krishnamurthy R., Majmudar N., Mitchell D., Myint M.P., O'Brien R., O'Connell J., Sattar N., Vetrivel S., Beard J., Cleveland T., Gaines P., Humphreys J., Jenkins A., King C., Kusuma D., Lindert R., Lonsdale R., Nair R., Nawaz S., Okhuoya F., Turner D., Venables G., Dorman P., Hughes A., Jones D., Mendelow D., Rodgers H., Raudoniitis A., Enevoldson P., Nahser H., O'Brien I., Torella F., Watling D., White R., Brown P., Dutta D., Emerson L., Hilltout P., Kulkarni S., Morrison J., Poskitt K., Slim F., Smith S., Tyler A., Waldron J., Whyman M., Bajoriene M., Baker L., Colston A., Eliot-Jones B., Gramizadeh G., Lewis-Clarke C., McCafferty L., Oliver D., Palmer D., Patil A., Pegler S., Ramadurai G., Roberts A., Sargent T., Siddegowda S., Singh-Ranger R., Williams A., Williams L., Windebank S., Zuromskis T., Alwis L., Angus J., Asokanathan A., Fornolles C., Hardy D., Hunte S., Justin F., Phiri D., Mitabouana-Kibou M., Sekaran L., Sethuraman S., Tate M.L., Akyea-Mensah 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Golovkova M.S., Komakha B.B., Zherdev N.N., Belyasnik A., Chechulov P., Kandyba D., Stepanishchev I., Csobay-Novak C., Dosa E., Entz L., Nemes B., Szeberin Z., Barzo P., Bodosi M., Fako E., Fulop B., Nemeth T., Pazdernyik S., Skoba K., Voros E., Chatzinikou E., Giannoukas A., Karathanos C., Koutsias S., Kouvelos G., Matsagkas M., Ralli S., Rountas C., Rousas N., Spanos K., Brountzos E., Kakisis J.D., Lazaris A., Moulakakis K.G., Stefanis L., Tsivgoulis G., Vasdekis S., Antonopoulos C.N., Bellenis I., Maras D., Polydorou A., Polydorou V., Tavernarakis A., Ioannou N., Terzoudi M., Lazarides M., Mantatzis M., Vadikolias K., Dzieciuchowicz L., Gabriel M., Krasinski Z., Oszkinis G., Pukacki F., Slowinski M., Stanisic M.-G., Staniszewski R., Tomczak J., Zielinski M., Myrcha P., Rozanski D., Drelichowski S., Iwanowski W., Koncewicz K., Bialek P., Biejat Z., Czepel W., Czlonkowska A., Dowzenko A., Jedrzejewska J., Kobayashi A., Leszczynski J., Malek A., Polanski J., Proczka R., Skorski M., Szostek M., Andziak P., Dratwicki M., Gil R., Nowicki M., Pniewski J., Rzezak J., Seweryniak P., Dabek P., Juszynski M., Madycki G., Pacewski B., Raciborski W., Slowinski P., Staszkiewicz W., Bombic M., Chlouba V., Fiedler J., Hes K., Kostal P., Sova J., Kriz Z., Privara M., Reif M., Staffa R., Vlachovsky R., Vojtisek B., Hrbac T., Kuliha M., Prochazka V., Roubec M., Skoloudik D., Netuka D., Steklacova A., Benes III V., Buchvald P., Endrych L., Sercl M., Campos W., Casella I.B., de Luccia N., Estenssoro A.E.V., Presti C., Puech-Leao P., Neves C.R.B., da Silva E.S., Sitrangulo C.J., Monteiro J.A.T., Tinone G., Bellini Dalio M., Joviliano E.E., Pontes Neto O.M., Serra Ribeiro M., Cras P., Hendriks J.M.H., Hoppenbrouwers M., Lauwers P., Loos C., Yperzeele L., Geenens M., Hemelsoet D., van Herzeele I., Vermassen F., Astarci P., Hammer F., Lacroix V., Peeters A., Verhelst R., Cirelli S., Dormal P., Grimonprez A., Lambrecht B., Lerut P., Thues E., De Koster G., Desiron Q., Maertens de 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Gizewski E., Gruber I., Knoflach M., Kiechl S., Rantner B., Abdulamit T., Bergeron P., Padovani R., Trastour J.-C., Cardon J.-M., Le Gallou-Wittenberg A., Allaire E., Becquemin J.-P., Cochennec-Paliwoda F., Desgranges P., Hosseini H., Kobeiter H., Marzelle J., Almekhlafi M.A., Bal S., Barber P.A., Coutts S.B., Demchuk A.M., Eesa M., Gillies M., Goyal M., Hill M.D., Hudon M.E., Jambula A., Kenney C., Klein G., McClelland M., Mitha A., Menon B.K., Morrish W.F., Peters S., Ryckborst K.J., Samis G., Save S., Smith E.E., Stys P., Subramaniam S., Sutherland G.R., Watson T., Wong J.H., Zimmel L., Flis V., Matela J., Miksic K., Milotic F., Mrdja B., Stirn B., Tetickovic E., Gasparini M., Grad A., Kompara I., Milosevic Z., Palmiste V., Toomsoo T., Aidashova B., Kospanov N., Lyssenko R., Mussagaliev D., Beyar R., Hoffman A., Karram T., Kerner A., Nikolsky E., Nitecki S., Andonova S., Bachvarov C., Petrov V., Cvjetko I., Vidjak V., Haluzan D., Petrunic M., Liu B., Liu C.-W., Bartko D., Beno P., Rusnak F., Zelenak K., Ezura M., Inoue T., Kimura N., Kondo R., Matsumoto Y., Shimizu H., Endo H., Furui E., Bakke S., Krohg-Sorensen K., Nome T., Skjelland M., Tennoe B., Albuquerque e Castro J., Alves G., Bastos Goncalves F., de Aragao Morais J., Garcia A.C., Valentim H., Vasconcelos L., Belcastro F., Cura F., Zaefferer P., Abd-Allah F., Eldessoki M.H., Heshmat Kassem H., Soliman Gharieb H., Colgan M.P., Haider S.N., Harbison J., Madhavan P., Moore D., Shanik G., Kazan V., Nazzal M., Ramsey-Williams V., and Gargiulo M

Subjects
Male, medicine.medical_specialty, Time Factors, Time Factor, medicine.medical_treatment, Carotid Stenosi, MEDLINE, Carotid endarterectomy, Rate ratio, Risk Assessment, Asymptomatic, law.invention, Randomized controlled trial, law, Risk Factors, carotid artery stenting (CAS), carotid endarterectomy (CEA), Stent, medicine, Humans, Carotid Stenosis, Stroke, Endarterectomy, Aged, Endarterectomy, Carotid, business.industry, carotid artery, Risk Factor, Articles, General Medicine, trial, medicine.disease, Settore MED/22 - CHIRURGIA VASCOLARE, Surgery, Stenosis, Treatment Outcome, Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE, Female, Stents, Human medicine, medicine.symptom, business, Human
Abstract

Summary Background Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence. Methods ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362. Findings Between Jan 15, 2008, and Dec 31, 2020, 3625 patients in 130 centres were randomly allocated, 1811 to CAS and 1814 to CEA, with good compliance, good medical therapy and a mean 5 years of follow-up. Overall, 1% had disabling stroke or death procedurally (15 allocated to CAS and 18 to CEA) and 2% had non-disabling procedural stroke (48 allocated to CAS and 29 to CEA). Kaplan-Meier estimates of 5-year non-procedural stroke were 2·5% in each group for fatal or disabling stroke, and 5·3% with CAS versus 4·5% with CEA for any stroke (rate ratio [RR] 1·16, 95% CI 0·86–1·57; p=0·33). Combining RRs for any non-procedural stroke in all CAS versus CEA trials, the RR was similar in symptomatic and asymptomatic patients (overall RR 1·11, 95% CI 0·91–1·32; p=0·21). Interpretation Serious complications are similarly uncommon after competent CAS and CEA, and the long-term effects of these two carotid artery procedures on fatal or disabling stroke are comparable. Funding UK Medical Research Council and Health Technology Assessment Programme.

Published
2021

30. European Stroke Organisation guideline on endarterectomy and stenting for carotid artery stenosis

Author

Gert J. de Borst, Leo H. Bonati, Avtar Lal, Isabelle Van Herzeele, Dominick J. H. McCabe, Stavros K. Kakkos, Peter A. Ringleb, Joachim Berkefeld, Hans-Henning Eckstein, Alison Halliday, Jean-Baptiste Ricco, Igor Koncar, Richard Bulbulia, and Martin Taylor-Rowan

Subjects
Atherosclerotic stenosis, medicine.medical_specialty, business.industry, Carotid arteries, medicine.medical_treatment, Guideline, 030204 cardiovascular system & hematology, Guidelines, medicine.disease, 03 medical and health sciences, Stenosis, 0302 clinical medicine, Internal medicine, medicine.artery, medicine, Cardiology, Neurology (clinical), Internal carotid artery, Cardiology and Cardiovascular Medicine, business, Medical therapy, Stroke, 030217 neurology & neurosurgery, Endarterectomy
Abstract

Atherosclerotic stenosis of the internal carotid artery is an important cause of stroke. The aim of this guideline is to analyse the evidence pertaining to medical, surgical and endovascular treatment of patients with carotid stenosis. These guidelines were developed based on the ESO standard operating procedure and followed the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. The working group identified relevant questions, performed systematic reviews and meta-analyses of the literature, assessed the quality of the available evidence, and wrote recommendations. Based on moderate quality evidence, we recommend carotid endarterectomy (CEA) in patients with ≥60–99% asymptomatic carotid stenosis considered to be at increased risk of stroke on best medical treatment (BMT) alone. We also recommend CEA for patients with ≥70–99% symptomatic stenosis, and we suggest CEA for patients with 50–69% symptomatic stenosis. Based on high quality evidence, we recommend CEA should be performed early, ideally within two weeks of the last retinal or cerebral ischaemic event in patients with ≥50–99% symptomatic stenosis. Based on low quality evidence, carotid artery stenting (CAS) may be considered in patients

Published
2021

31. Is the Human Brain Capable of Controlling Seven Degrees of Freedom?

Author

Tim De Pauw, Frank Dewaele, Isabelle Van Herzeele, Alain Kalmar, Dirk Van Roost, Yves Van Nieuwenhove, Piet Pattyn, and Alexandre Mottrie

Subjects
Male, Students, Medical, Computer science, Random order, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Robotic Surgical Procedures, Humans, Torque, Range of Motion, Articular, Simulation, Cross-Over Studies, Suture Techniques, Degrees of freedom, Brain, Wrist, Forearm, Learning curve, 030220 oncology & carcinogenesis, Robot, Female, Laparoscopy, 030211 gastroenterology & hepatology, Surgery, Clinical Competence, Ergonomics, Learning Curve, Education, Medical, Undergraduate
Abstract

Background Conventional rigid laparoscopic instruments offer five degrees of freedom (DOF). Robotic instruments add two independent DOFs allowing unconstrained directional steering. Several nonrobotic instruments have been developed with the additional DOFs, but with these devices, surgeon's wrist movements are not intuitively transmitted into tip movements. In this study, a new articulated instrument has been evaluated. The aim of the study was to compare learning curves and performances of conventional laparoscopic instruments, the da Vinci system and Steerable devices in a crossover study. Materials and methods A total of 16 medical students without any laparoscopic experience were trained for 27 h to operate all of a rigid, a robotic, and a new Steerable instrument in a random order. Learning curves and ultimate experience scores were determined for each instrument. Strain in wrist and shoulders was assessed with a visual analog score. Results Performing the suturing task with rigid and robot instruments required 4 h of training, compared with 6 h to master the Steerable instrument. After 9 h of training with each instrument, completing the complex suturing pattern required 662 ± 308 s with rigid instruments, 279 ± 90 s with the da Vinci system, and 279 ± 53 s with the Steerable instrument. Pain scores were significantly higher after using the rigid instruments compared with the Steerable instruments. Conclusions Transmission of torque and the presence of additional two DOFs in combination with reduced crosstalk significantly improved the instrument dexterity where the Steerable platform is concerned. Although the learning curve is longer, once mastered, it provides enhanced surgical freedom.

Published
2019

32. Non-technical attributes and surgical experience: A cross-sectional study comparing communication styles and attitudes in surgical staff, trainees and applicants

Author

Peter Vlerick, Heidi Maertens, Frank Vermassen, Bart Doyen, and Isabelle Van Herzeele

Subjects
Adult, Male, Self-assessment, medicine.medical_specialty, Attitude of Health Personnel, Cross-sectional study, Population, 03 medical and health sciences, 0302 clinical medicine, Verbal aggressiveness, Cronbach's alpha, Emotionality, Surveys and Questionnaires, Communication styles, Medical Staff, Hospital, medicine, Humans, education, education.field_of_study, business.industry, Communication, General Medicine, Middle Aged, Surgical training, Cross-Sectional Studies, General Surgery, 030220 oncology & carcinogenesis, Family medicine, Female, 030211 gastroenterology & hepatology, Surgery, business
Abstract

Background This monocentric study aimed to explore whether key non-technical attributes can be reliably measured in a mixed population of candidates applying for surgical training, surgical trainees and staff and to identify any differences between these groups. Materials & methods Candidates applying for surgical training, surgical trainees and staff from four surgical specialties (general surgery, orthopedics, plastic surgery or urology) at a tertiary academic teaching hospital were all sent an online self-report questionnaire. The Communication Styles Inventory (CSI, 96 items) was used to assess a six-dimensional behavioral model of participant communication styles (expressiveness, preciseness, verbal aggressiveness, questioningness, emotionality and impression manipulativeness). Attitudes toward uncertainty and risks were assessed with the Physicians’ Reaction toward Uncertainty (PRU, 15 items) and Physician Risk Attitudes (PRA, 6 items) scales respectively. Data was encoded and analyzed using parametric testing. Results The questionnaire was completed by 177 participants (110 candidates; 42 trainees; 25 staff). All scales had very good internal consistency (Cronbach's alpha >0.80). After controlling for gender-based differences, surgical candidates scored significantly higher on ‘expressiveness’ (P = 0.012) and were significantly less risk-averse (P = 0.006) than trainees and staff. Surgical trainees scored lowest on the CSI ‘questioningness’ subscale (P = 0.019) and had significantly more difficulties dealing with uncertainty, characterized by their highest scores on the ‘concern about bad outcome’ (P = 0.021) and reluctance to disclose uncertainty to patients' (P = 0.05) subscales. Multiple subscales revealed gender-based differences in candidate and trainee groups, which were not noted for surgical staff. Conclusions Meaningful differences in non-technical attributes of surgical staff, trainees and candidates have been identified, which may be explained by differences in clinical experience and learning and may suggest that these develop over time. Further research on assessment of non-technical attributes during surgical selections and the role of both technical and non-technical attributes in surgery at large is needed.

Published
2019

33. International Implementation of a PROficiency based StePwise Endovascular Curricular Training (PROSPECT) in Daily Practice

Author

Isabelle Van Herzeele, Anne-Sophie Bamelis, Lars Konge, Jonathan Lawaetz, Leizl Joy Nayahangan, Jonas Eiberg, and Gilles Soenens

Subjects
Adult, Male, education, Training time, law.invention, Technical support, Peripheral Arterial Disease, Randomized controlled trial, Competency Based Education, law, Daily practice, Medicine and Health Sciences, Simulation training, Medicine, Humans, Prospective Studies, Registries, Simulation Training, Multiple choice, Surgeons, Medical education, business.industry, Endovascular Procedures, Virtual Reality, Surgical training, Checklist, Competency-Based Education, Test (assessment), Europe, Cross-Sectional Studies, Endovascular procedures, Education, Medical, Graduate, Surgery, Female, Clinical Competence, Educational Measurement, Cardiology and Cardiovascular Medicine, business, Vascular Surgical Procedures, Learning Curve
Abstract

Objective A randomised controlled trial (RCT) showed superior real life endovascular performance of trainees after PROficiency based StePwise Endovascular Curricular Training (PROSPECT) compared with traditional training. This study aimed to determine whether PROSPECT can be implemented routinely in surgical training (registry) and to identify the associated effects, facilitators, and barriers to implementation. Methods This was a multicentre prospective registry to evaluate real life PROSPECT implementation effects. Cognitive ability was tested with a Multiple Choice Question test (MCQ) (max. score 20 points), while technical skills were assessed with a Global Rating Scale (GRS) (max. score 55 points), Examiner’s Checklist (max, score 85 points), and simulator metrics. A cross sectional anonymous survey for both trainees and faculty evaluated the programme’s implementation. Results The PROSPECT registry was implemented in five centres in four countries over a period of three years. Only 17 of 48 starting trainees completed PROSPECT, resulting in a dropout rate of 65%. Participants who completed the programme showed significant improvement in the GRS (median 26 vs. 44, p = .018) and Examiner’s Checklist (median 53.5 vs. 80, p = .028) after the programme. The survey was completed by 13/17 faculty members (76%) and 38/57 trainees who participated either in the initial PROSPECT RCT or the registry (67%). PROSPECT was perceived to provide more endovascular training opportunities, but non-availability of logistical/technical support, lack of training time within the working schedule, and little trainee motivation hindered broad implementation. Conclusion PROSPECT has a significant effect on performance, and trainees and faculty agree that PROSPECT is a valuable addition to surgical training. However, external and internal factors pose significant barriers to integration of this simulation based programme into daily practice leading to a high dropout rate. To integrate PROSPECT into contemporary surgical training, it should be a prerequisite to treating real patients and protected training time should be provided, combined with accessible support.

Published
2021

34. The current state of below the knee revascularization in chronic limb threatening ischemia

Author

Nathalie Moreels and Isabelle Van Herzeele

Subjects
Leg, medicine.medical_specialty, business.industry, MEDLINE, Ischemia, General Medicine, medicine.disease, Peripheral Arterial Disease, Internal medicine, medicine, Cardiology, Humans, Surgery, Current (fluid), Cardiology and Cardiovascular Medicine, business, Vascular Surgical Procedures
Published
2021

37. Assessment of Endovascular Team Performances Using a Comprehensive Data Capture Platform in the Hybrid Room: A Pilot Study

Author

Peter Vlerick, Isabelle Van Herzeele, Gilles Soenens, Bart Doyen, Teodor P. Grantcharov, and Frank Vermassen

Subjects
Multimedia, business.industry, Data Collection, Automatic identification and data capture, Endovascular Procedures, Pilot Projects, computer.software_genre, Peripheral Arterial Disease, Outcome Assessment, Health Care, Medicine and Health Sciences, Medicine, Humans, Surgery, Clinical Competence, Cardiology and Cardiovascular Medicine, business, computer, Aortic Aneurysm, Abdominal
Published
2020

39. Simulation Based Training and Assessment in Open Vascular Surgery: A Systematic Review

Author

Jonas Eiberg, Lars Konge, Joachim S. Skovbo Kristensen, Jonathan Lawaetz, Leizl Joy Nayahangan, and Isabelle Van Herzeele

Subjects
medicine.medical_specialty, Future studies, Evidence-based practice, Trainer, Open vascular surgery, education, 030204 cardiovascular system & hematology, 030230 surgery, Cochrane Library, Assessment, 03 medical and health sciences, 0302 clinical medicine, medicine, Training, Humans, Medical physics, Technical skills, Simulation based, Simulation Training, Surgeons, business.industry, Vascular surgery, Data extraction, Education, Medical, Graduate, Surgery, Clinical Competence, Vascular skills, Cardiology and Cardiovascular Medicine, business, Vascular Surgical Procedures, Simulation, Learning Curve
Abstract

Objective The aim of this study was to systematically review the literature and give evidence based recommendations for future initiatives for simulation based training (SBT) and assessment in open vascular surgery. Data sources PubMed, Embase, and the Cochrane Library. Review methods A systematic review of PubMed, Embase, and the Cochrane Library was performed, with the last search on 31 March 2020, to identify studies describing SBT and assessment in open vascular surgery. Kirkpatrick's levels for efficacy of training were evaluated. Validity evidence for assessment tools was evaluated according to the recommended contemporary framework by Messick. Results Of 2 844 studies, 51 were included for data extraction. A high degree of heterogeneity in reporting standards and varying types of simulation was found. Vascular anastomosis was the most frequently simulated technical skill (43%). Assessment was mostly carried out using the Objective Structured Assessment of Technical Skills (55%). Validity evidence for assessment tools was found using outdated frameworks, and only one study used Messick's framework. Self directed training is valuable, the low trainer to trainee ratio is important to maximise efficiency, and experienced vascular surgeons are the most effective trainers. Conclusion Carefully designed and structured SBT is effective and can improve technical skills, especially in less experienced trainees. However, the supporting evidence lacks homogeneity in the reporting standards and types of simulations. Pass/fail standards that support proficiency based learning and studies investigating skills transfer should be the focus in future studies. Validity evidence of assessment tools needs to be addressed using contemporary frameworks.

Published
2020

40. Global impact of the first coronavirus disease 2019 (COVID-19) pandemic wave on vascular services

Author

Ruth A Benson, Sandip Nandhra, Joseph Shalhoub, Nikesh Dattani, Graeme K Ambler, David C Banquet, David C Bosanquet, Rachael Forsythe, Sarah Onida, George Dovell, Louise Hitchman, Ryan Preece, Athanasios Saratzis, Chris Imray, Adam Johnson, Andrew Choong, Jun Jie Ng, Sarah Aitken, Jana-Lee Moss, Abhilash Sudarsanam, Adam Tam, Adam W Beck, Adel Barkat, Adnan Bajwa, Ahmed Elbasty, A I Awopetu, Akio Kodama, Aksim G Rivera, Alberto Munoz, Alberto Saltiel, Alejandro Russo, Alex Rolls, Alexandros Kafetzakis, Ali Kimyaghalam, Ali Kordzadeh, Amanda Shepherd, Aminder Singh, Andrea Mingoli, Andreas M Lazaris, Andrej Isaak, Andres Marin, Andrés Reyes Valdivia, Andrew Batchelder, Andrew Duncan, Angeliki Argyriou, Anthony S Jaipersad, Antonio Freyrie, António Pereira-Neves, Anver Mahomed, Arda Isik, Arkadiusz Jawien, Asad J Choudhry, Ashwin Sivaharan, Athanasios Giannoukas, Athanasios Papaioannou, Ayman Abbas, Bakoyiannis Christos, Bekir Bogachan Akkaya, Bella Huasen, Bibombe Patrice, Mwipatayi, Bilal Azhar, Boboyor Keldiyorov, Brant W Ullery, Carlo Pratesi, Carlos A Hinojosa, Carlos F Bechara, Carolina Salinas Parra, Charalabopoulos Alexandros, Charlotte Bezard, Cheong Jun Lee, Chris Davies, Christian-Alexander Behrendt, Christopher Lowe, Christos D Karkos, Chun Ling Patricia Yih, Ciarán McDonnell, Claudia Ordonez, Craig Nesbitt, Croo Alexander, Daniel Guglielmone, Daniel T Doherty, David M Riding, Davide Esposito, Denis Harkin, Dennis H Lui, Dhafer M Kamal, Diego Telve, Dimitrios Theodosiou, Domenico Angiletta, Donald Jacobs, Edward Choke, Edward D Gifford, Efthymios Beropoulis, Eftychios Lostoridis, Eleanor Atkins, Elena Giacomelli, Elpiniki Tsolaki, Emma Davies, Emma Scott, Emmanouil Katsogridakis, Ernesto Serrano, Ertekin Utku Unal, Eugenia Lopez, Eustratia Mpaili, Fabrizio Minelli, Fatemeh Malekpour, Fatma Mousa, Felicity Meyer, Felipe Tobar, Filipa Jácome, Flavia Gentile Johansson, Fred Weaver, Gabriel Ab Proaño, Gabriel Sidel, Ganesh Kuhan, Gary Lemmon, George A Antoniou, George Papadopoulos, Georgios Pitoulias, Georgopoulos Sotirios, Gerardo Victoria, Gert Frahm-Jensen, Giovanni Tinelli, Giuseppe Asciutto, Gladiol Zenunaj, Gómez Vera Carlos Eduardo, Gonzalo Pullas, Grzegorz Oszkinis, Guriy Popov, Hakkı Zafer İscan, Hannah C Travers, Hashem Barakat, Hayrettin Levent Mavioglu, Ian Chetter, Ian Loftus, Ilias Dodos, Imran Asghar, Isabelle Van Herzeele, Jacopo Giordano, James Cragg, Jason Chuen, Javier Del Castillo Orrego, Jeremy Perkins, João Rocha-Neves, Jorge H Ulloa, José Antonio Chávez, José Vidoedo, Joseph Faraj, Joseph Mills, Juan Varela, Jürg Schmidli, Kakavia Kiriaki, Katarzyna Powezka, Kathryn Bowser, Katy Darvall, Kenneth McCune, Ketino Pasenidou, Kevin Corless, Kevin McKevitt, Kira Nicole Long, Konstantinos G Moulakakis, Konstantinos Roditis, Konstantinos Stavroulakis, Konstantinos Tigkiropoulos, Kristyn Mannoia, Kumar Abayasekara, Lalithapriya Jayakumar, Lasantha Wijesinghe, Laura Drudi, Lauren Shelmerdine, Leigh Ann O'Banion, Lewis Meecham, Lisa F Bennett, Lorena Grillo, Lucy Green, Lucy Wales, Luís Loureiro, Luis Mariano Palena, Mahmoud Mh Tolba, Manar Khashram, Manik Chana, Manuel Pabon, Marco González, Marco Virgilio Usai, Marcos Tarazona, Maria A Ruffino, Mariano Castelli, Marie Benezit, Marina Dias-Neto, Martin Malina, Martin Maresch, Martin Mazzurco, Martin Storck, Martín Veras Troncoso, Matt Popplewell, Matteo Tozzi, Matthew Metcalfe, Matti Laine, Mhammed Rawhi, Michael Ricardo, Mingzheng Aaron Goh, Mohamed Abozeid Ahmed, Mohammed Ibrahim, Mohannad Alomari, Muayyad Almudhafer, Muhammed Elhadi, Nalaka Gunawansa, Nancy Hadjievangelou, Natasha Hasemaki, Natasha Shafique, Nathan Aranson, Nicholas Bradley, Nicolas J Mouawad, Nicole C Rich, Nikolaos Floros, Nikolaos Patelis, Nikolaos Saratzis, Nikolaos Tsilimparis, Nilson Salinas, Nishath Altaf, Oliver Friedrich, Oliver Lyons, Olivia M B McBride, Orestis Ioannidis, Orwa Falah, Panagiotis Theodoridis, Paolo Sapienza, Paraskevi Tsiantoula, Patrick Chong, Patrick Coughlin, Paul Bevis, Paul Carrera, Paul Dunlop, Peng Foo Wong, Pereira Albino, Peter Rossi, Petroula Nana, Philip W Stather, Pierfrancesco Lapolla, Pierre Galvagni Silveira, Prakash Saha, Pranav Somaiya, Putera Mas Pian, Rachael L Morley, Rachel Bell, Raed M Ennab, Rafael Malgor, Raffaele Pulli, Ragai Makar, Raghuram Sekhar, Rana Afifi, Raphael Coscas, Raphael Soler, Robert F Cuff, Rodney Diaz, Rodrigo Biagioni, Rosnelifaizur Bin Ramely, Rubén Rodríguez Carvajal, Sandeep Jhajj, Sara Edeiken, Sergio Benites, Sergio Zacà, Sharath Paravastu, Sharon Chan, Sharvil Sheth, Sherene Shalhub, Shiva Dindyal, Shonda Banegas, Simon Hardy, Simona Sica, Siu Chung Tam, Sivaram Premnath, Sophie Renton, Sriram Rajagopalan, Stavridis Kyriakos, Stavros Kakkos, Stefano Ancetti, Stephane Elkouri, Stephanie Lin, Stephen Wing Keung Cheng, Stylianos G Koutsias, Tabitha Grainger, Tamer Fekry, Tamer Ghatwary Tantawy, Tamim Siddiqui, Taohid Oshodi, Tasleem Akhtar, Thomas James Hardy, Thomas Kotsis, Thushan Gooneratne, Timothy Rowlands, Tina U Cohnert, Tom Wallace, Tristan R A Lane, Umberto Marcello Bracale, Usman Cheema, Uzma Sadia, Vanessa Rubio, Victor Canata, Vincent Jongkind, Vipul Khetarpaul, Virginia Summerour, Walter Dorigo, Wissam Al-Jundi, Xun Luo, Yamume Tshomba, Yvis Gadelha Serra, A Benson, Ruth, Nandhra, Sandip, Shalhoub, Joseph, Dattani, Nikesh, K Ambler, Graeme, C Banquet, David, C Bosanquet, David, Forsythe, Rachael, Onida, Sarah, Dovell, George, Hitchman, Louise, Preece, Ryan, Saratzis, Athanasio, Imray, Chri, Johnson, Adam, Choong, Andrew, Jie Ng, Jun, Aitken, Sarah, Moss, Jana-Lee, Sudarsanam, Abhilash, Tam, Adam, W Beck, Adam, Barkat, Adel, Bajwa, Adnan, Elbasty, Ahmed, I Awopetu, A, Kodama, Akio, G Rivera, Aksim, Munoz, Alberto, Saltiel, Alberto, Russo, Alejandro, Rolls, Alex, Kafetzakis, Alexandro, Kimyaghalam, Ali, Kordzadeh, Ali, Shepherd, Amanda, Singh, Aminder, Mingoli, Andrea, M Lazaris, Andrea, Isaak, Andrej, Marin, Andre, Reyes Valdivia, André, Batchelder, Andrew, Duncan, Andrew, Argyriou, Angeliki, S Jaipersad, Anthony, Freyrie, Antonio, Pereira-Neves, António, Mahomed, Anver, Isik, Arda, Jawien, Arkadiusz, J Choudhry, Asad, Sivaharan, Ashwin, Giannoukas, Athanasio, Papaioannou, Athanasio, Abbas, Ayman, Christos, Bakoyianni, Bogachan Akkaya, Bekir, Huasen, Bella, Patrice, Bibombe, Mwipatayi, Azhar, Bilal, Keldiyorov, Boboyor, W Ullery, Brant, Pratesi, Carlo, A Hinojosa, Carlo, F Bechara, Carlo, Salinas Parra, Carolina, Alexandros, Charalabopoulo, Bezard, Charlotte, Jun Lee, Cheong, Davies, Chri, Behrendt, Christian-Alexander, Lowe, Christopher, D Karkos, Christo, Ling Patricia Yih, Chun, Mcdonnell, Ciarán, Ordonez, Claudia, Nesbitt, Craig, Alexander, Croo, Guglielmone, Daniel, T Doherty, Daniel, M Riding, David, Esposito, Davide, Harkin, Deni, H Lui, Denni, M Kamal, Dhafer, Telve, Diego, Theodosiou, Dimitrio, Angiletta, Domenico, Jacobs, Donald, Choke, Edward, D Gifford, Edward, Beropoulis, Efthymio, Lostoridis, Eftychio, Atkins, Eleanor, Giacomelli, Elena, Tsolaki, Elpiniki, Davies, Emma, Scott, Emma, Katsogridakis, Emmanouil, Serrano, Ernesto, Utku Unal, Ertekin, Lopez, Eugenia, Mpaili, Eustratia, Minelli, Fabrizio, Malekpour, Fatemeh, Mousa, Fatma, Meyer, Felicity, Tobar, Felipe, Jácome, Filipa, Gentile Johansson, Flavia, Weaver, Fred, Ab Proaño, Gabriel, Sidel, Gabriel, Kuhan, Ganesh, Lemmon, Gary, A Antoniou, George, Papadopoulos, George, Pitoulias, Georgio, Sotirios, Georgopoulo, Victoria, Gerardo, Frahm-Jensen, Gert, Tinelli, Giovanni, Asciutto, Giuseppe, Zenunaj, Gladiol, Vera Carlos Eduardo, Gómez, Pullas, Gonzalo, Oszkinis, Grzegorz, Popov, Guriy, Zafer İscan, Hakkı, C Travers, Hannah, Barakat, Hashem, Levent Mavioglu, Hayrettin, Chetter, Ian, Loftus, Ian, Dodos, Ilia, Asghar, Imran, Van Herzeele, Isabelle, Giordano, Jacopo, Cragg, Jame, Chuen, Jason, Del Castillo Orrego, Javier, Perkins, Jeremy, Rocha-Neves, João, H Ulloa, Jorge, Antonio Chávez, José, Vidoedo, José, Faraj, Joseph, Mills, Joseph, Varela, Juan, Schmidli, Jürg, Kiriaki, Kakavia, Powezka, Katarzyna, Bowser, Kathryn, Darvall, Katy, Mccune, Kenneth, Pasenidou, Ketino, Corless, Kevin, Mckevitt, Kevin, Nicole Long, Kira, G Moulakakis, Konstantino, Roditis, Konstantino, Stavroulakis, Konstantino, Tigkiropoulos, Konstantino, Mannoia, Kristyn, Abayasekara, Kumar, Jayakumar, Lalithapriya, Wijesinghe, Lasantha, Drudi, Laura, Shelmerdine, Lauren, Ann O'Banion, Leigh, Meecham, Lewi, F Bennett, Lisa, Grillo, Lorena, Green, Lucy, Wales, Lucy, Loureiro, Luí, Mariano Palena, Lui, Mh Tolba, Mahmoud, Khashram, Manar, Chana, Manik, Pabon, Manuel, González, Marco, Virgilio Usai, Marco, Tarazona, Marco, A Ruffino, Maria, Castelli, Mariano, Benezit, Marie, Dias-Neto, Marina, Malina, Martin, Maresch, Martin, Mazzurco, Martin, Storck, Martin, Veras Troncoso, Martín, Popplewell, Matt, Tozzi, Matteo, Metcalfe, Matthew, Laine, Matti, Rawhi, Mhammed, Ricardo, Michael, Aaron Goh, Mingzheng, Abozeid Ahmed, Mohamed, Ibrahim, Mohammed, Alomari, Mohannad, Almudhafer, Muayyad, Elhadi, Muhammed, Gunawansa, Nalaka, Hadjievangelou, Nancy, Hasemaki, Natasha, Shafique, Natasha, Aranson, Nathan, Bradley, Nichola, J Mouawad, Nicola, C Rich, Nicole, Floros, Nikolao, Patelis, Nikolao, Saratzis, Nikolao, Tsilimparis, Nikolao, Salinas, Nilson, Altaf, Nishath, Friedrich, Oliver, Lyons, Oliver, B McBride, Olivia M, Ioannidis, Oresti, Falah, Orwa, Theodoridis, Panagioti, Sapienza, Paolo, Tsiantoula, Paraskevi, Chong, Patrick, Coughlin, Patrick, Bevis, Paul, Carrera, Paul, Dunlop, Paul, Foo Wong, Peng, Albino, Pereira, Rossi, Peter, Nana, Petroula, W Stather, Philip, Lapolla, Pierfrancesco, Galvagni Silveira, Pierre, Saha, Prakash, Somaiya, Pranav, Mas Pian, Putera, L Morley, Rachael, Bell, Rachel, M Ennab, Raed, Malgor, Rafael, Pulli, Raffaele, Makar, Ragai, Sekhar, Raghuram, Afifi, Rana, Coscas, Raphael, Soler, Raphael, F Cuff, Robert, Diaz, Rodney, Biagioni, Rodrigo, Bin Ramely, Rosnelifaizur, Rodríguez Carvajal, Rubén, Jhajj, Sandeep, Edeiken, Sara, Benites, Sergio, Zacà, Sergio, Paravastu, Sharath, Chan, Sharon, Sheth, Sharvil, Shalhub, Sherene, Dindyal, Shiva, Banegas, Shonda, Hardy, Simon, Sica, Simona, Chung Tam, Siu, Premnath, Sivaram, Renton, Sophie, Rajagopalan, Sriram, Kyriakos, Stavridi, Kakkos, Stavro, Ancetti, Stefano, Elkouri, Stephane, Lin, Stephanie, Wing Keung Cheng, Stephen, G Koutsias, Styliano, Grainger, Tabitha, Fekry, Tamer, Ghatwary Tantawy, Tamer, Siddiqui, Tamim, Oshodi, Taohid, Akhtar, Tasleem, James Hardy, Thoma, Kotsis, Thoma, Gooneratne, Thushan, Rowlands, Timothy, U Cohnert, Tina, Wallace, Tom, A Lane, Tristan R, Bracale, UMBERTO MARCELLO, Cheema, Usman, Sadia, Uzma, Rubio, Vanessa, Canata, Victor, Jongkind, Vincent, Khetarpaul, Vipul, Summerour, Virginia, Dorigo, Walter, Al-Jundi, Wissam, Luo, Xun, Tshomba, Yamume, and Gadelha Serra, Yvis

Subjects
Global Health, Health Care Surveys, Health Services Accessibility, Humans, Pandemics, Practice Patterns, Physicians', Prospective Studies, Vascular Surgical Procedures, COVID-19, Physicians', Pandemic, Practice Patterns, Settore MED/22 - CHIRURGIA VASCOLARE, Prospective Studie, Global health, health care surveys, health services accessibility, humans, pandemics, practice patterns, physicians', prospective studies, vascular surgical procedures, Health Care Survey, Rapid Research Communication, Human, Vascular Surgical Procedure
Abstract

Graphical Abstract This online structured survey has demonstrated the global impact of the COVID-19 pandemic on vascular services. The majority of centres have documented marked reductions in operating and services provided to vascular patients. In the months during recovery from the resource restrictions imposed during the pandemic peaks, there will be a significant vascular disease burden awaiting surgeons. Graphical Abstract One of the most affected specialties

Published
2020

41. Key components of a hepatobiliary surgery curriculum for general surgery residents: results of the FULCRUM International Delphi consensus

Author

Rohan Jeyarajah, Atsushi Sugioka, Silvio Nadalin, Valerio Lucidi, Scott Helton, Gian L. Grazi, Jun Li, Fulvio Calise, Osamu Itano, Aude Vanlander, Sean P. Cleary, Kuo Hsin Chen, Saleh Alabbad, Nikdokht Rashidian, Hironori Kaneko, Javier Briceño-Delgado, Yuichiro Otsuka, Paul D. Hansen, Chet W. Hammill, Maria B. Doyle, Susanne G. Warner, Ho-Seong Han, Isabelle Van Herzeele, Yutaro Kato, Go Wakabayashi, Shoji Kubo, C.H.D. Kwon, Eugene P. Ceppa, T.T. Cheung, Pietro Majno, Erin Maynard, Ismael Dominguez-Rosado, Roberto Troisi, Zenichi Morise, Benjamin Samstein, Charles Chung Wei Lin, Ali Jafarian, Roberto Montalti, Alessandro Ferrero, Hiroyuki Nitta, Adnan Alseidi, Wouter Willaert, Minoru Tanabe, Olivier Soubrane, Daniel Cherqui, Fernando Rotellar, Guido Torzilli, Rashidian, N., Willaert, W., Van Herzeele, I., Morise, Z., Alseidi, A., Troisi, R. I., Alabbad, S., Doyle, M. B., Briceno-Delgado, J., Calise, F., Ceppa, E. P., Chen, K. -H., Cherqui, D., Cheung, T. T., Lin, C. C. -W., Cleary, S., David Kwon, C. H., Dominguez-Rosado, I., Ferrero, A., Warner, S. G., Grazi, G. L., Hammill, C., Han, H. -S., Hansen, P., Helton, S., Itano, O., Jafarian, A., Jeyarajah, R., Kaneko, H., Kato, Y., Kubo, S., Li, J., Lucidi, V., Majno, P., Maynard, E., Montalti, R., Nadalin, S., Nitta, H., Otsuka, Y., Rotellar, F., Samstein, B., Soubrane, O., Sugioka, A., Tanabe, M., Torzilli, G., Vanlander, A., Wakabayashi, G., Rashidian N., Willaert W., Van Herzeele I., Morise Z., Alseidi A., Troisi R.I., Alabbad S., Doyle M.B., Briceno-Delgado J., Calise F., Ceppa E.P., Chen K.-H., Cherqui D., Cheung T.T., Lin C.C.-W., Cleary S., David Kwon C.H., Dominguez-Rosado I., Ferrero A., Warner S.G., Grazi G.L., Hammill C., Han H.-S., Hansen P., Helton S., Itano O., Jafarian A., Jeyarajah R., Kaneko H., Kato Y., Kubo S., Li J., Lucidi V., Majno P., Maynard E., Montalti R., Nadalin S., Nitta H., Otsuka Y., Rotellar F., Samstein B., Soubrane O., Sugioka A., Tanabe M., Torzilli G., Vanlander A., and Wakabayashi G.

Subjects
Self-assessment, medicine.medical_specialty, Consensus, Delphi Technique, Liver, surgery, hepatectomy, education, MEDLINE, NO, Likert scale, 03 medical and health sciences, 0302 clinical medicine, Cronbach's alpha, medicine, Humans, Curriculum, computer.programming_language, Liver, surgery, hepatectomy, Hepatology, business.industry, General surgery, Gastroenterology, Internship and Residency, Educational research, Systematic review, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Clinical Competence, business, computer, Delphi
Abstract

Background In general surgery residency, hepatobiliary training varies significantly across the world. The aim of this study was to establish an international consensus among hepatobiliary surgeons on components of a hepatobiliary curriculum for general surgery residents. Methods A three-round modified Delphi technique was employed. Fifty-two hepatobiliary surgeons involved in general surgery training programs were invited. An initial questionnaire was developed by a group of experts in hepatobiliary and educational research after a systematic literature review. It comprised 90 statements about knowledge, technical skills, attitudes, and postoperative care. Panelists could add or alter items. The survey was delivered electronically and the panel was instructed to score the items based on 5-point Likert scale. Consensus was reached when at least 80% of panelists agreed on a statement with Cronbach's alpha value >0.8. Results Forty-one (79%) experts have participated. Sixteen panelists are based in Asia, 14 in Europe, and 11 in the Americas. Eighty percent of all proposed skills (81/101) were considered fundamental including knowledge (39/43), technical skills (16/32), attitude (15/15), and postoperative care (11/11). Conclusion An international consensus was achieved on components of a hepatobiliary curriculum. Acquiring broad knowledge is fundamental during residency. Advanced liver resection techniques require specialized hepatobiliary training.

Published
2019

42. Orsi Consensus Meeting on European Robotic Training (OCERT): Results from the First Multispecialty Consensus Meeting on Training in Robot-assisted Surgery

Author

Alexandre Mottrie, Henk G. van der Poel, Richard M. Satava, Justin W. Collins, Aude Vanlander, Xavier Rogiers, Elio Mazzone, Anthony G. Gallagher, and Isabelle Van Herzeele

Subjects
Medical education, Delphi Technique, business.industry, Urology, 030232 urology & nephrology, Certification, Certificate, 03 medical and health sciences, 0302 clinical medicine, Robotic Surgical Procedures, 030220 oncology & carcinogenesis, Medicine, Humans, Professional association, Robotic surgery, Metric (unit), Clinical Competence, business, Curriculum, computer, Delphi, Accreditation, computer.programming_language
Abstract

To improve patient outcomes in robotic surgery, robotic training and education need to be modernised and augmented. The skills and performance levels of trainees need to be objectively assessed before they operate on real patients. The main goal of the first Orsi Consensus Meeting on European Robotic Training (OCERT) was to establish the opinions of experts from different scientific societies on standardised robotic training pathways and training methodology. After a 2-d consensus conference, 36 experts identified 23 key statements allotted to three themes: training standardisation pathways, validation metrics, and implementation prerequisites and certification. After two rounds of Delphi voting, consensus was obtained for 22 of 23 questions among these three categories. Participants agreed that societies should drive and support the implementation of benchmarked training using validated proficiency-based pathways. All courses should deliver an internationally agreed curriculum with performance standards, be accredited by universities/professional societies, and, trainees should receive a certificate approved by professional societies and/or universities after successful completion of the robotic training courses. This OCERT meeting established a basis for bringing surgical robotic training out of the operating room by seeking input and consensus across surgical specialties for an objective, validated, and standardised training programme with transparent, metric-based training outcomes. PATIENT SUMMARY: The Orsi Consensus Meeting on European Robotic Training (OCERT) is an international, multidisciplinary, Delphi-panel study of scientific societies and experts focused on training in robotic surgery. The panel achieved consensus that standardised international training pathways should be the basis for a structured, validated, replicable, and certified approach to implementation of robotic technology.

Published
2019

43. Defining the Key Competencies in Radiation Protection for Endovascular Procedures

Author

Bart Doyen, Blandine Maurel, Jonathan Cole, Heidi Maertens, Tara Mastracci, Isabelle Van Herzeele, Bo Bech, Luca Bertoglio, Colin Bicknell, Marianne Brodmann, Tom Carrell, Tina Cohnert, Rick De Graaf, Jean Paul De Vries, Florian Dick, Fabrizio Fanelli, Roberto Ferraresi, Yann Gouëffic, Stéphan Haulon, Christos Karkos, Igor Končar, Mário Lachat, Johannes Lammer, Tim Lockie, Richard McWilliams, Germano Melissano, Stefan Müller-Hülsbeck, Christoph Nienaber, null O'Sullivan, Giuseppe Panuccio, Timothy Resch, Vincente Riambau, Robin Williams, Horst Sievert, Luc Stockx, Zoltán Szeberin, Joep Teijink, Paulo Gonçalves Dias, Josua Van Den Berg, Jan Van Der Heyden, Joost van Herwaarden, Frank Vermassen, Fabio Verzini, Anders Wanhainen, Doyen, Bart, Maurel, Blandine, Cole, Jonathan, Maertens, Heidi, Mastracci, Tara, Van Herzeele, Isabelle, Bech, Bo, Bertoglio, Luca, Bicknell, Colin, Brodmann, Marianne, Carrell, Tom, Cohnert, Tina, De Graaf, Rick, De Vries, Jean Paul, Dick, Florian, Fanelli, Fabrizio, Ferraresi, Roberto, Gouëffic, Yann, Haulon, Stéphan, Karkos, Christo, Končar, Igor, Lachat, Mário, Lammer, Johanne, Lockie, Tim, Mcwilliams, Richard, Melissano, Germano, Müller-Hülsbeck, Stefan, Nienaber, Christoph, O'Sullivan, Null, Panuccio, Giuseppe, Resch, Timothy, Riambau, Vincente, Williams, Robin, Sievert, Horst, Stockx, Luc, Szeberin, Zoltán, Teijink, Joep, Gonçalves Dias, Paulo, Van Den Berg, Josua, Van Der Heyden, Jan, van Herwaarden, Joost, Vermassen, Frank, Verzini, Fabio, Wanhainen, Anders, Obstetrics and gynaecology, Amsterdam Movement Sciences - Restoration and Development, Amsterdam Reproduction & Development (AR&D), RS: CAPHRI - R5 - Optimising Patient Care, and Epidemiologie

Subjects
Male, Delphi Technique, IMPACT, Delphi method, 030204 cardiovascular system & hematology, Electronic mail, 030218 nuclear medicine & medical imaging, Cardiologists, 0302 clinical medicine, Surveys and Questionnaires, Medicine, CRITERIA, Multispecialty, computer.programming_language, Delphi consensus, Education, Endovascular, Radiation protection, Surgery, Cardiology and Cardiovascular Medicine, Electronic Mail, Endovascular Procedures, INTERVENTIONAL RADIOLOGY, EDUCATION, Middle Aged, Female, Clinical Competence, Adult, Consensus, EUROPE, Attitude of Health Personnel, MEDLINE, SOCIETY, Likert scale, 03 medical and health sciences, JOINT GUIDELINE, Cronbach's alpha, Radiologists, Humans, KNOWLEDGE, EXPOSURE, Surgeons, Medical education, Delphi consensu, business.industry, X-Rays, FRAMEWORK, Key (cryptography), business, computer, Delphi
Abstract

Objectives: Radiation protection training courses currently focus on broad knowledge topics which may not always be relevant in daily practice. The goal of this study was to determine the key competencies in radiation protection that every endovascular team member should possess and apply routinely, through multispecialty clinical content expert consensus.Methods: Consensus was obtained through a two round modified Delphi methodology. The expert panel consisted of European vascular surgeons, interventional radiologists, and interventional cardiologists/angiologists experienced in endovascular procedures. An initial list of statements, covering knowledge skills, technical skills and attitudes was created, based on a literature search. Additional statements could be suggested by the experts in the first Delphi round. Each of the statements had to be rated on a 5-point Likert scale. A statement was considered to be a key competency when the internal consistency was greater than alpha = 0.80 and at least 80% of the experts agreed (rating 4/5) or strongly agreed (rating 5/5) with the statement. Questionnaires were emailed to panel members using the Surveymonkey service.Results: Forty-one of 65 (63.1%) invited experts agreed to participate in the study. The response rates were 36 out of 41 (87.8%): overall 38 out of 41(92.6%) in the first round and 36 out of 38 (94.7%) in the second round. The 71 primary statements were supplemented with nine items suggested by the panel. The results showed excellent consensus among responders (Cronbach's alpha = 0.937 first round; 0.958 s round). Experts achieved a consensus that 30 of 33 knowledge skills (90.9%), 23 of 27 technical skills (82.1%), and 15 of 20 attitudes (75.0%) should be considered as key competencies.Conclusions: A multispecialty European endovascular expert panel reached consensus about the key competencies in radiation protection. These results may serve to create practical and relevant radiation protection training courses in the future, enhancing radiation safety for both patients and the entire endovascular team. (C) 2017 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

Published
2018

44. Video motion analysis in live coronary angiography differentiates levels of experience and provides a novel method of skill assessment

Author

Mohamad Hamady, Sybghat U. Rahim, Danail Stoyanov, Ghada W. Mikhail, Celia Riga, Alexander Rolls, Nicholas J.W. Cheshire, Isabelle Van Herzeele, and Colin Bicknell

Subjects
Coronary angiography, Motion analysis, medicine.medical_specialty, Video Recording, 030204 cardiovascular system & hematology, Coronary Angiography, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, Percutaneous Coronary Intervention, 0302 clinical medicine, Text mining, Humans, Medicine, Fluoroscopy, Video recording, medicine.diagnostic_test, business.industry, Process assessment, Process Assessment, Health Care, Radiation dose, Surgery, Clinical Competence, Clinical competence, Cardiology and Cardiovascular Medicine, business, Nuclear medicine
Abstract

Video motion analysis (VMA) uses fluoroscopic sequences to derive catheter and guidewire movement, and is able to calculate 2D catheter-tip path length (PL) on the basis of frame-by-frame pixel coordinates. The objective of this study was to validate VMA in coronary angiography as a method of skill assessment.Forty-seven coronary interventions performed by 10 low- (1,000 cases; group A), five medium- (1,000-4,000; group B) and six high- (4,000; group C) experience-volume cardiologists were prospectively recorded and analysed using VMA software. Total PL was calculated and procedure, fluoroscopy times, and radiation dose were recorded. Comparisons of PL were made between groups of experience. Groups A, B and C performed 24, 14 and 6 paired (right and left coronary) cannulations, respectively. Calculation of PL was possible in all recorded cases and significantly correlated with procedure (p=0.001, rho=0.827) and fluoroscopy times (p=0.001, rho=0.888). Median total path length (combined right and left coronaries) was significantly shorter in group C which used 3,836 pixels of movement (IQR: 3,003-4,484) vs. 10,556 (7,242-31,408) in group A (p=0.001) and 8,725 (5,187-15,150) in group B (p=0.013).VMA in coronary angiography is feasible and PL is able to differentiate levels of experience.

Published
2017

46. Radiation Protection Training for Vascular Surgeons in Twenty-One European Countries

Author

Isabelle Van Herzeele and Salome Weiss

Subjects
Surgeons, medicine.medical_specialty, business.industry, MEDLINE, Radiation Exposure, Training (civil), Europe, Radiation Protection, Surgery, Computer-Assisted, Fluoroscopy, Occupational Exposure, medicine, Humans, Surgery, Medical physics, Radiation protection, 610 Medicine & health, Radiometry, Cardiology and Cardiovascular Medicine, business, Vascular Surgical Procedures
Published
2020

48. A Systematic Review on Simulation-based Education in Open Vascular Surgery Providing – An Overview of The Literature Including Recommendations for Effective Future Training-Programs

Author

Henrik Sillesen, J. Rasmussen, Leizl Joy Nayahangan, Isabelle Van Herzeele, Jonas Eiberg, Lars Konge, and Joachim Sejr Skovbo Kristensen

Subjects
medicine.medical_specialty, business.industry, medicine, Surgery, Medical physics, Vascular surgery, Cardiology and Cardiovascular Medicine, business, Simulation based, Training (civil)
Published
2019

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