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

Author

Mark J.W. Koelemay, Nick S. van Reijen, Susan van Dieren, Franceline A. Frans, Erik J.G. Vermeulen, Hessel C.J.L. Buscher, Jim A. Reekers, M.G.W. Dijkgraaf, R.J. de Haan, R. Balm, M.M. Idu, J.D. Blankensteijn, A.W. Hoksbergen, A.P. Conijn, R. Met, D.A. Legemate, S. Bipat, K.P. van Lienden, O.M. van Delden, E.J. Zijlstra, R. Lely, R.H.H. Engelbert, M.A. van Egmond, A. Poelgeest, E. Geleijn, A.J. de Nie, M.A. Schreve, A. Kamphuis, R.H.J. Kropman, J. Wille, J.P.M.M. de Vries, R.H. van de Mortel, H.D. van de Pavoord, D.A. van den Heuvel, M. van Leersum, M.J. van Strijen, J.A. Vos, D. Nio, A. Rijbroek, G.J.M. Akkersdijk, R. Metz, B.J. van Kelckhoven, H.J. van de Rest, V.J. Leijdekkers, A.C. Vahl, R.C. van Nieuwenhuizen, J.G. Blomjous, A.D. Montauban van Swijndregt, P.P.C. Poyck, M. van der Jagt, J.A. van der Vliet, L.J. Schultze Kool, P.L. Klemm, H.W. Slis, M.C.M. Willems, L.C. Huisman, J.H.D. de Bruine, M.J. Mallant, L. Smeets, S.M. van Sterkenburg, M.M. Reijnen, P.B. Veendrick, M.H. van Werkum, J.A. van Ostayen, B.H.P. Elsman, L.G. van der Hem, R.B.M. van Tongeren, C.F.M. Klok, W.E. Hellings, J.C. Aarts, A.M. Wiersema, T.A. van den Broek, A. Moolhuijzen, J.A. Teijink, M.R. van Sambeek, B.P. Keller, G.A. Vos, J.C. Breek†, J. Gravendeel, R. Oosterhof-Berktas, N.A. Koedam, E.J. Hollander, T. Pels Rijcken, S.S. van der Voort, B. Honing, D.M. Scharn, M.S. Lemson, J. Seegers, R.M. Krol, C.J. Buskens, C.J. Zeebregts, R.A. de Bie, H. van Overhagen, Surgery, ACS - Atherosclerosis & ischemic syndromes, Graduate School, APH - Personalized Medicine, APH - Quality of Care, APH - Methodology, Radiology and Nuclear Medicine, Epidemiology and Data Science, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, ACS - Amsterdam Cardiovascular Sciences, Rehabilitation medicine, AMS - Rehabilitation & Development, ARD - Amsterdam Reproduction and Development, ACS - Diabetes & metabolism, ACS - Heart failure & arrhythmias, APH - Health Behaviors & Chronic Diseases, VU University medical center, Radiology and nuclear medicine, Other Research, ACS - Microcirculation, Man, Biomaterials and Microbes (MBM), RS: CAPHRI - R3 - Functioning, Participating and Rehabilitation, and Epidemiologie

Subjects
Randomised controlled trial, Endovascular revascularisation, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Walking, Intermittent Claudication, Iliac Artery, Exercise Therapy, Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10], Peripheral Arterial Disease, Treatment Outcome, Intermittent Claudication/etiology, Quality of Life, Humans, Peripheral Arterial Disease/complications, Surgery, Cardiology and Cardiovascular Medicine, Supervised exercise therapy
Abstract

Contains fulltext : 251517.pdf (Publisher’s version ) (Open Access) OBJECTIVE: International guidelines recommend supervised exercise therapy (SET) as primary treatment for all patients with intermittent claudication (IC), yet primary endovascular revascularisation (ER) might be more effective in patients with iliac artery obstruction. METHODS: This was a multicentre RCT including patients with IC caused by iliac artery stenosis or occlusion (NCT01385774). Patients were allocated randomly to SET or ER stratified for maximum walking distance (MWD) and concomitant SFA disease. Primary endpoints were MWD on a treadmill (3.2 km/h, 10% incline) and disease specific quality of life (VascuQol) after one year. Additional interventions during a mean follow up of 5.5 years were recorded. RESULTS: Between November 2010 and May 2015, 114 patients were allocated to SET, and 126 to ER. The trial was terminated prematurely after 240 patients were included. Compliance with SET was 57/114 (50%) after six months. Ten patients allocated to ER (8%) did not receive this intervention. One year follow up was complete for 90/114 (79%) SET patients and for 104/126 (83%) ER patients. The mean MWD improved from 187 to 561 m in SET patients and from 196 to 574 m in ER patients (p = .69). VascuQol sumscore improved from 4.24 to 5.58 in SET patients, and from 4.28 to 5.88 in ER patients (p = .048). Some 33/114 (29%) SET patients had an ER within one year, and 2/114 (2%) surgical revascularisation (SR). Some 10/126 (8%) ER patients had additional ER within one year and 10/126 (8%) SR. After a mean of 5.5 years, 49% of SET patients and 27% of ER patients underwent an additional intervention for IC. CONCLUSION: Taking into account the many limitations of the SUPER study, both a strategy of primary SET and primary ER improve MWD on a treadmill and disease specific Qol of patients with IC caused by an iliac artery obstruction. It seems reasonable to start with SET in these patients and accept a 30% failure rate, which, of course, must be discussed with the patient. Patients continue to have interventions beyond one year.

Published
2022
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2. Editor's Choice – Nationwide Analysis of Patients Undergoing Iliac Artery Aneurysm Repair in the Netherlands

Author

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

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

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

Published
2020
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3. Cost Effectiveness of Endovascular Revascularisation vs. Exercise Therapy for Intermittent Claudication Due to Iliac Artery Obstruction

Author

Nick S. van Reijen, Susan van Dieren, Franceline A. Frans, Jim A. Reekers, Roderik Metz, Hessel C.J.L. Buscher, Mark J.W. Koelemay, D.A. Legemate, M.M. Idu, R. Balm, J.A. Reekers, K.P. van Lienden, O.M. van Delden, E.J. Zijlstra, A.P. Conijn, M.G.W. Dijkgraaf, R.H. Engelbert, A.J. De Nie, M.A. Schreve, R.H.J. Kropman, J. Wille, J.P.M. De Vries, H.D.W.M. van de Pavoort, R.H.W. van de Mortel, D.A.F. van den Heuvel, M.J.L. van Strijen, M. van Leersum, J.A. Vos, D. Nio, A. Rijbroek, E.G.J. Vermeulen, G.J.M. Akkersdijk, A. van de Elst, M. Truijers, B.J. van Kelckhoven, V.J. Leijdekkers, A.C. Vahl, J.G.A.M. Blomjous, P.P.C. Poyck, J.A. Van der Vliet, M. van der Jagt, P.L. Klemm, M.C.M. Willems, L.C. Huisman, M.M.A. Lensvelt, H. de Bruine, M.P.J.H. Mallant, L. Smeets, S.M.M. van Sterkenburg, P.B. Veendrick, M.H. van Werkum, B.H.P. Elsman, L.G. van der Hem, R.B.M. van Tongeren, C.F.M. Klok, W.E. Hellings, A.M. Wiersema, T.A.A. van den Broek, G.A. Vos, J.A.W. Teijink, M.R.H.M. van Sambeek, B.P.J.A. Keller, G.J. Glade, J.C. Breek, J. Gravendeel, R. Oosterhof-Berktas, N.A. Koedam, E.J.F. Hollander, D.M. Scharn, M.S. Lemson, J. Seegers, R.M. Krol, J.D. Blankensteijn, A.W.J. Hoksbergen, Epidemiology and Data Science, ACS - Diabetes & metabolism, ACS - Heart failure & arrhythmias, APH - Health Behaviors & Chronic Diseases, VU University medical center, Surgery, ACS - Atherosclerosis & ischemic syndromes, ACS - Microcirculation, Graduate School, APH - Personalized Medicine, APH - Quality of Care, APH - Methodology, Radiology and Nuclear Medicine, ACS - Amsterdam Cardiovascular Sciences, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, CCA -Cancer Center Amsterdam, Rehabilitation medicine, AMS - Rehabilitation & Development, and ARD - Amsterdam Reproduction and Development

Subjects
Intermittent claudication, Treatment Outcome, Cost-Benefit Analysis, Peripheral arterial disease, Quality of Life, Exercise therapy, Humans, Surgery, Quality-Adjusted Life Years, Cost–Benefit analysis, Cardiology and Cardiovascular Medicine, Iliac Artery, Health status
Abstract

Objective: To compare cost effectiveness of endovascular revascularisation (ER) and supervised exercise therapy (SET) as primary treatment for patients with intermittent claudication (IC) due to iliac artery obstruction. Methods: Cost utility analysis from a restricted societal perspective and time horizon of 12 months. Patients were included in a multicentre randomised controlled trial (SUPER study, NCT01385774, NTR2648) which compared effectiveness of ER and SET. Health status and health related quality of life (HRQOL) were measured using the Euroqol 5 dimensions 3 levels (EQ5D-3L) and VascuQol-25-NL. Incremental costs were determined per allocated treatment and use of healthcare during follow up. Effectiveness of treatment was determined in quality adjusted life years (QALYs). The difference between treatment groups was calculated by an incremental cost utility ratio (ICER). Results: Some 240 patients were included, and complete follow up was available for 206 patients (ER 111, SET 95). The mean costs for patients allocated to ER were €4 031 and €2 179 for SET, a mean difference of €1 852 (95% bias corrected and accelerated [bca] bootstrap confidence interval 1 185 – 2 646). The difference in QALYs during follow up was 0.09 (95% bcaCI 0.04 – 0.13) in favour of ER. The ICER per QALY was €20 805 (95% bcaCI 11 053 – 45 561). The difference in VascuQol sumscore was 0.64 (95% bcaCI 0.39 – 0.91), again in favour of ER. Conclusion: ER as a primary treatment, results in slightly better health outcome and higher QALYs and HRQOL during 12 months of follow up. Although these differences are statistically significant, clinical relevance must be discussed due to the small differences and relatively high cost of ER as primary treatment.

Published
2022
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4. Toward Optimizing Risk Adjustment in the Dutch Surgical Aneurysm Audit

Author

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

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

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

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

Author

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

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

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

Published
2021

6. Randomised Clinical Trial of Supervised Exercise Therapy vs Endovascular Revascularisation for Intermittent Claudication Caused by Iliac Artery Obstruction: The SUPER study

Author

M.J.W. Koelemay, N.S. van Reijen, S. van Dieren, F.A. Frans, E.J.G. Vermeulen, H.C.J.L. Buscher, J.A. Reekers, M.G.W. Dijkgraaf, R.J. de Haan, R. Balm, M.M. Idu, J.D. Blankensteijn, A.W. Hoksbergen, A.P. Conijn, R. Met, D.A. Legemate, S. Bipat, K.P. van Lienden, O.M. van Delden, E.J. Zijlstra, R. Lely, R.H.H. Engelbert, M.A. van Egmond, A. Poelgeest, E. Geleijn, A.J. de Nie, M.A. Schreve, A. Kamphuis, R.H.J. Kropman, J. Wille, J.P.M.M. de Vries, R.H. van de Mortel, H.D. van de Pavoord, D.A. van den Heuvel, M. van Leersum, M.J. van Strijen, J.A. Vos, D. Nio, A. Rijbroek, G.J.M. Akkersdijk, R. Metz, B.J. van Kelckhoven, H.J. van de Rest, V.J. Leijdekkers, A.C. Vahl, R.C. van Nieuwenhuizen, J.G. Blomjous, A.D. Montauban van Swijndregt, P.P.C. Poyck, M. van der Jagt, J.A. van der Vliet, L.J. Schultze Kool, P.L. Klemm, H.W. Slis, M.C.M. Willems, L.C. Huisman, J.H.D. de Bruine, M.J. Mallant, L. Smeets, S.M. van Sterkenburg, M.M. Reijnen, P.B. Veendrick, M.H. van Werkum, J.A. van Ostayen, B.H.P. Elsman, L.G. van der Hem, R.B.M. van Tongeren, C.F.M. Klok, W.E. Hellings, J.C. Aarts, A.M. Wiersema, T.A. van den Broek, A. Moolhuijzen, J.A. Teijink, M.R. van Sambeek, B.P. Keller, G.A. Vos, J.C. Breek†, J. Gravendeel, R. Oosterhof-Berktas, N.A. Koedam, E.J. Hollander, T. Pels Rijcken, S.S. van der Voort, B. Honing, D.M. Scharn, M.S. Lemson, J. Seegers, and R.M. Krol

Subjects
Surgery, Cardiology and Cardiovascular Medicine
Published
2022
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7. Nationwide study of the treatment of mycotic abdominal aortic aneurysms comparing open and endovascular repair in The Netherlands

Author

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

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

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

Published
2020
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8. Failure to Rescue - a Closer Look at Mortality Rates Has No Added Value for Hospital Comparisons but Is Useful for Team Quality Assessment in Abdominal Aortic Aneurysm Surgery in The Netherlands

Author

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

Subjects
Clinical audit, medicine.medical_specialty, Funnel plot, TO-RESCUE, Time Factors, Failure to rescue, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], MODELS, 030204 cardiovascular system & hematology, 030230 surgery, PREVENTABILITY, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Aneurysm, medicine, Humans, Hospital Mortality, SURGICAL COLORECTAL AUDIT, Netherlands, TRAUMA, REPAIR, RISK, Surgical outcome, OUTCOMES, medicine.diagnostic_test, business.industry, Mortality rate, Endovascular Procedures, Glasgow Coma Scale, CARE, medicine.disease, Quality Improvement, CANCER, Hospitals, Abdominal aortic aneurysm, Surgery, Composite outcome measures, Elective Surgical Procedures, Cardiology and Cardiovascular Medicine, business, Electrocardiography, Aortic Aneurysm, Abdominal
Abstract

Objectives: Failure to rescue (FTR) is a composite quality indicator, defined as the proportion of deceased patients following major complications. The aims of this study were to compare FTR with mortality for hospital comparisons in abdominal aortic aneurysm (AAA) surgery in The Netherlands and investigate hospital volume and associated factors.Methods: Patients prospectively registered between 2013 and 2015 in the Dutch Surgical Aneurysm Audit (DSAA) were analysed. FTR was analysed for AAA patients and subgroups elective (EAAA) and acute (AAAA; symptomatic or ruptured) aneurysms. Variables and hospital volume were analysed by uni- and multivariable regression analysis. Adjusted hospital comparisons for mortality, major complications, and FTR were presented in funnel plots. Isomortality lines were constructed when presenting FTR and major complication rates.Results: A total of 9258 patients were analysed in 61 hospitals: 7149 EAAA patients (77.2%) and 2109 AAAA patients (22.8%). There were 2785 (30.1%) patients with complications (unadjusted range 5-65% per hospital): 2161 (77.6%) with major and 624 (28.4%) patients with minor complications. Overall mortality was 6.6% (adjusted range 0-16% per hospital) and FTR was 28.4% (n = 613) (adjusted range 0-60% per hospital). Glasgow Coma Scale, age, pulse, creatinine, electrocardiography, and operative setting were independently associated with FTR. Hospital volume was not associated with FTR. In AAAA patients hospital volume was significantly associated with a lower adjusted major complication and mortality rate (OR 0.62, 95% CI 0.49-0.78; and 0.64, 95% CI 0.48-0.87). Four hospitals had a significant lower adjusted FTR with different major complication rates on different isomortality lines.Conclusions: There was more variation in FTR than in mortality between hospitals. FTR identified the same best performing hospitals as for mortality and therefore was of limited additional value in measuring quality of care for AAA surgery. FTR can be used for internal quality improvement with major complications in funnel plots and diagrams with isomortality lines. (C) 2018 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.

Published
2018
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9. The Dutch Audit of Carotid Interventions: Transparency in Quality of Carotid Endarterectomy in Symptomatic Patients in the Netherlands

Author

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

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

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

Published
2018
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10. Significant Savings with a Stepped Care Model for Treatment of Patients with Intermittent Claudication

Author

Joep A.W. Teijink, Hugo J.P. Fokkenrood, F. Hasaart, Marc R. Scheltinga, J.C. Breek, Mark J.W. Koelemay, Anco C. Vahl, Amsterdam Cardiovascular Sciences, Surgery, Epidemiologie, Health Services Research, RS: CAPHRI School for Public Health and Primary Care, and RS: CAPHRI - Clinical epidemiology

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Cost-Benefit Analysis, Psychological intervention, Guidelines as Topic, Revascularization, Cost Savings, Peripheral arterial disease, Health care, Cost-analysis, Medicine, Humans, Stepped care, Hospital Costs, Aged, Netherlands, Retrospective Studies, Medicine(all), Cost–benefit analysis, business.industry, Retrospective cohort study, Intermittent Claudication, Intermittent claudication, Exercise Therapy, Models, Organizational, Physical therapy, Treatment strategy, Female, Surgery, medicine.symptom, business, Cardiology and Cardiovascular Medicine, Vascular Surgical Procedures, Treatment strategies, Follow-Up Studies
Abstract

WHAT THIS PAPER ADDS The aim of this study was to perform a cost-analysis of a recommended but largely underutilized SET first treatment strategy in intermittent claudication (IC). Until now no study has been performed to investigate the overall economic consequences of a nationwide SET first approach (stepped care). As the study used a large database (3.4 million people), daily practice is reflected well in the results. Implementation of a stepped care treatment for patients with IC may lead to significant savings of healthcare resources. These findings may be generalizable to other European healthcare systems. Objectives: International guidelines recommend supervised exercise therapy (SET) as primary treatment for intermittent claudication (IC). The aim of this study was to calculate treatment costs in patients with IC and to estimate nationwide annual savings if a stepped care model (SCM, primary SET treatment followed by revascularization in case of SET failure) was followed. Methods: Invoice data of all patients with IC in 2009 were obtained from a Dutch health insurance company (3.4 millionmembers).Patientsweredividedintothreegroupsbasedoninitialtreatmentafterdiagnosis(t0).TheSETgroup receivedSETinitiatedatanytimebetween12monthsbeforeandupto3monthsaftert0.Theinterventiongroup(INT) underwentendovascularoropenrevascularizationbetweent0andtþ 3m onths.Thethirdgroup(REST)receivedneither SET nor any intervention. All peripheral arterial disease related invoices were recorded during 2 years and average costs per patient were calculated. Savings following use of a SCM were calculated for three scenarios. Results: Data on 4954 patients were analyzed. Initial treatment was SET (n ¼ 701, 14.1%), INT (n ¼ 1363, 27.5%), or REST (n ¼ 2890, 58.3%). Within 2 years from t0, invasive revascularization in the SET group was performed in 45 patients (6.4%). Additional interventions (primary at other location and/or re-interventions) were performed in 480 INT patients (35.2%). Some 431 REST patients received additional SET (n ¼ 299, 10.3%) or an intervention (n ¼ 132, 4.5%). Mean total IC related costs per patient were V2,191, V9851 and V824 for SET, INT, and REST, respectively. Based on a hypothetical worst, moderate, and best case scenario, some 3.8, 20.6, or 33.0 million euros would have been saved per annum if SCM was implemented in the Dutch healthcare system. Conclusion: Implementation of a SCM treatment for patients with IC may lead to significant savings of health care resources.

Published
2014
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11. Assessment of disease impact in patients with intermittent claudication

Author

G.L. van Heck, D.P. van Berge Henegouwen, Jaap F. Hamming, J. de Vries, J.C. Breek, University of Groningen, and Medical and Clinical Psychology

Subjects
Adult, Male, medicine.medical_specialty, ASSESSMENT WHOQOL, Health Status, ComputingMilieux_LEGALASPECTSOFCOMPUTING, Disease, ORGANIZATION, Quality of life (healthcare), Surveys and Questionnaires, medicine, Health Status Indicators, Humans, Outpatient clinic, In patient, VERSION, Aged, Aged, 80 and over, business.industry, MEDICINE, Intermittent Claudication, Middle Aged, Intermittent claudication, ISCHEMIA, Quartile, Quality of Life, Physical therapy, Female, Observational study, Surgery, medicine.symptom, Claudication, business, Cardiology and Cardiovascular Medicine
Abstract

Objective: To describe similarities and differences between health status and quality of life in patients with intermittent claudication.Methods: This was an observational study in the vascular outpatient department of a teaching hospital; it concerned 200 consecutive patients with intermittent claudication. Health status was assessed with the RAND-36, and quality of life was assessed with a reduced version of the World Health Organization Quality of Life assessment instrument-100. Scores were compared with those of sex- and age-matched healthy controls. Mann-Whitney U tests were used to detect statistically significant differences (P Results: Health status was significantly impaired in all domains. Quality of life was significantly worse with respect to aspects of physical health and level of independence and one global evaluative facets overall quality of life and general health. Quality-of-life assessment with the World Health Organization Quality of Life instrument disclosed patient-reported problems that had not been identified in health status. Conversely, patients did not regard all objective functional impairments as a problem. Pearson correlations ranged from 0.20 to 0.74. There were patients with excellent and very poor quality-of-life scores in nearly all the quartiles of the corresponding health status domains.Conclusions. Health status and quality of life represent different outcomes in patients with intermittent claudication. In addition to functional restrictions as measured in health status, quality of life also permits a personal evaluation of these restrictions. Objective functioning and subjective appraisal of functioning are complementary and not identical. Combining these measures should direct treatment in a way that meets patients' needs.

Published
2005

12. Assessing the Quality of Available Patient Reported Outcome Measures for Intermittent Claudication: A Systematic Review Using the COSMIN Checklist

Author

C.B. Terwee, J.C. Breek, Mark J.W. Koelemay, S. Jens, A.P. Conijn, Epidemiology and Data Science, and EMGO - Musculoskeletal health

Subjects
medicine.medical_specialty, Activities of daily living, Health Status, MEDLINE, Prom, Walking, Physical medicine and rehabilitation, Quality of life (healthcare), Cost of Illness, Predictive Value of Tests, Surveys and Questionnaires, Activities of Daily Living, Medicine, Humans, Quality Indicators, Health Care, Medicine(all), Evidence-Based Medicine, Exercise Tolerance, business.industry, Construct validity, Reproducibility of Results, Functional status, Evidence-based medicine, Intermittent Claudication, Patient reported outcome measures, Checklist, female genital diseases and pregnancy complications, Systematic review, Physical therapy, Quality of Life, Patient-reported outcome, Surgery, business, Cardiology and Cardiovascular Medicine, Measurement properties
Abstract

Objective The aim was to critically appraise, compare, and summarize the quality of the measurement properties of all available disease specific patient reported outcome measures (PROMs) on health related quality of life and functional status validated in patients with intermittent claudication (IC). Methods A systematic search was carried out in Embase and Medline (last search November 18, 2013). The quality of the identified studies was assessed per measurement property according to the COnsensus-based Standards for the selection of health Measurements Instruments (COSMIN) checklist. Data on the measurement properties were extracted to determine a level of evidence per measurement property per instrument. Results Forty three studies were found evaluating 10 health related quality of life and two functional status PROMs. Evidence for the existence of subscales (structural validity) and for internal consistency (interrelatedness of items within subscales) for PROMs was generally poor. Evidence for construct validity was limited. Accuracy and reproducibility of PROMs were often uncertain, since reliability studies were mostly performed in small patient samples. Responsiveness, or the ability of PROMs to detect change over time, was hardly ever studied. Conclusion The quality of the validation of most disease specific PROMs for IC is alarming, hampering all conclusion based on these PROMs. Considering the results, the PAD quality of life questionnaire (PADQOL), Intermittent claudication questionnaire (ICQ) and the Vascular quality of life questionnaire (VascuQol) might be appropriate PROMs for health related quality of life, while the Walking impairment questionnaire (WIQ) and Estimate ambulation capacity by history questionnaire (EACH-Q) appear suitable PROMs for functional status. However, all PROMs require further validation studies to fill the gaps in their measurement properties. The shortcomings highlighted in this review should be taken into account when interpreting PROM results.

Published
2015
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13. The impact of walking impairment, cardiovascular risk factors, and comorbidity on quality of life in patients with intermittent claudication

Author

D.P. van Berge Henegouwen, Jaap F. Hamming, J. de Vries, G.L. van Heck, and J.C. Breek

Subjects
Adult, Male, medicine.medical_specialty, Activities of daily living, ComputingMilieux_LEGALASPECTSOFCOMPUTING, Comorbidity, Walking, Severity of Illness Index, Sex Factors, Quality of life, Predictive Value of Tests, Risk Factors, Sickness Impact Profile, Severity of illness, Medicine, Outpatient clinic, Humans, Prospective Studies, Prospective cohort study, Aged, Netherlands, Aged, 80 and over, business.industry, Intermittent Claudication, Middle Aged, medicine.disease, Intermittent claudication, humanities, Cardiovascular Diseases, Physical therapy, Quality of Life, Female, Surgery, medicine.symptom, business, Claudication, Cardiology and Cardiovascular Medicine, Magnetic Resonance Angiography
Abstract

Objective: The objective of this study was to assess the impact of walking impairment, cardiovascular risk factors, and comorbidity on quality of life (QOL) in patients with intermittent claudication (IC). Material and Methods: The prospective observational study was conducted in the setting of a vascular outpatient department of a teaching hospital. QOL was assessed in 200 consecutive patients with IC, with a reduced version of the World Health Organization Quality of Life Assessment Instrument-100. The reduced instrument assesses 17 facets of QOL within five domains (Physical and Psychological Health, Level of Independence, Social Relationships, and Environment). Age, gender, degree of IC, risk factors, comorbidity, as recommended by the Society for Vascular Surgery/North American Chapter of the International Society for Cardiovascular Surgery (SVS/ISCVS), and the presence of back, hip, or knee symptoms were analyzed as possible predictors of QOL. Multiple regression analyses were run with each of the QOL facets and domains as dependent variable. A probability value of less than .05 was considered to be statistically significant. Results: Male gender was found to be a predictor of better scores for Energy and Fatigue and for Sleep and Rest. Women had more Negative Feelings. The presence of back, hip, or knee symptoms was a significant predictive value for many aspects of QOL. With more concomitant diseases, patients had lower scores on the facets of Overall QOL and General Health and of Energy and Fatigue and showed more dependence on medication and treatments. The degree of IC, as expressed in the SVS/ISCVS classification, was a statistically significant predictor of QOL on the domain Level of Independence and its facets Mobility, Activities of Daily Living, and Working Capacity and the facets Pain and Discomfort, Sexual Activity, and Transport. Hypertension was the second most important single predictor of QOL in patients with IC. Conclusion: QOL in patients with IC is only partially determined by the severity of walking limitation as expressed in the SVS/ISCVS classification. The significant impact of cardiovascular risk factors and comorbidity and the presence of back, hip, or knee symptoms on QOL should be recognized and taken into account in the treatment policy. (J Vasc Surg 2002;36:94-9.)

Published
2002
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14. Quality of Life in Patients with Intermittent Claudication Using The World Health Organisation (WHO) Questionnaire

Author

Annelies E. Aquarius, D.P. van Berge Henegouwen, Jaap F. Hamming, J. de Vries, and J.C. Breek

Subjects
Adult, Male, medicine.medical_specialty, Activities of daily living, media_common.quotation_subject, Disease, World Health Organization, Affect (psychology), Quality of life, Surveys and Questionnaires, Humans, Medicine, Prospective Studies, Prospective cohort study, Aged, media_common, Medicine(all), Aged, 80 and over, business.industry, Intermittent Claudication, Middle Aged, humanities, Intermittent claudication, Vascular surgery, Feeling, Health status, Quality of Life, Physical therapy, Female, Surgery, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Claudication
Abstract

Objective: to assess quality of life (QOL) in patients with intermittent claudication.Design : a prospective, open study. Material and method: one hundred and fifty-one consecutive claudicants (100 men, 51 women), and 161 healthy controls (70 men and 91 women) completed an adapted version of the World Health Organisation Quality of Life Assessment Instrument-100. Results: patients scored significantly worse on the domains Physical health and Level of independence, as well as on the facets Pain and discomfort, Energy and fatigue, Mobility, Activities of daily living, Dependence on medication and treatments, Working capacity, Negative feelings, Recreation and leisure and Overall QOL and general health. Increasing disease to incapacitating claudication affected only the facet Mobility and the domain Level of independence.Conclusion : QOL in patients with intermittent claudication is reduced in many aspects. Where co-morbidity seems to affect QOL strongly, the effect of walking distance on QOL might be small. These findings may justify a reserved attitude towards invasive, even minimally invasive treatment of these patients.

Published
2001
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15. The additional value of angiography after colour-coded duplex on decision making in patients with critical limb ischaemia. A prospective study

Author

D.P. van Berge Henegouwen, J.C. Breek, Leo E.H. Lampmann, J.K.A. Avenarius, Paul N.M. Lohle, and Jaap F. Hamming

Subjects
Male, Reoperation, medicine.medical_specialty, genetic structures, Critical Care, Decision Making, Arterial Occlusive Diseases, Iliac Artery, Amputation, Surgical, Duplex scanning, Ischemia, medicine.artery, medicine, Humans, In patient, Popliteal Artery, Prospective Studies, Prospective cohort study, Vascular Patency, Aged, Medicine(all), Aged, 80 and over, Leg, Ultrasonography, Doppler, Duplex, medicine.diagnostic_test, business.industry, Angiography, Critical limb ischemia, Middle Aged, Duplex scanning, Angiography, Arterial disease, Patient management, Critical limb ischaemia, Surgery, body regions, Femoral Artery, Posterior tibial artery, medicine.anatomical_structure, Treatment Outcome, Duplex (building), Female, Ankle, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Angioplasty, Balloon
Abstract

Objective: to investigate prospectively the additional value of intra arterial digital subtraction arteriography (IADSA) for decision making in patients with critical limb ischemia (CLI). Treatment plans based on colour-duplex imaging (CDI) were compared with treatment plans based on IADSA.Methods: ninety-eight consecutive patients with 112 legs with CLI were investigated by CDI and IADSA. Treatment plans based on CDI and IADSA were made separately during a multidisciplinary meeting. Both plans were retrospectively analysed with the outcome of the operation or the endovascular procedure as a reference.Results: eighty-eight patients with 101 legs could be analysed. In 91 out of the 101 legs (90%) CDI offered the same strategy as the IADSA. In 10 legs IADSA provided additional information. Most of the additional information concerned the crural vessels.Conclusion: the preoperative planning of treatment in patients with chronic critical ischaemia of the lower limbs can be based on CDI alone in most patients. For planning crural revascularisation additional information may be needed. If severe calcification prevents adequate visualisation of the crural vessels or no patent anterior or posterior tibial artery with outflow across the ankle is present, IADSA should be performed.

Published
2002

16. The Influence of Diabetes Mellitus and Insulin Use on the Prevalence of AAA Among Patients Referred for Peripheral Artery Disease

Author

J.C. Breek, B.P.J.A. Keller, G.J. Glade, J.I.L. Wegerif, and R.M. Krol

Subjects
Medicine(all), medicine.medical_specialty, business.industry, Arterial disease, Disease, medicine.disease, INSULIN USE, Internal medicine, Diabetes mellitus, Cardiology, Medicine, Surgery, Cardiology and Cardiovascular Medicine, business
Published
2014
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17. The Oslo Balloon Angioplasty versus Conservative Treatment Study (OBACT)—The 2-years Results of a Single Centre, Prospective, Randomised Study in Patients with Intermittent Claudication. Eur J Vasc Endovasc Surg 2007;33:3–12

Author

J. de Vries, Jaap F. Hamming, and J.C. Breek

Subjects
Medicine(all), medicine.medical_specialty, business.industry, medicine.medical_treatment, Balloon, Intermittent claudication, Surgery, Conservative treatment, Single centre, Angioplasty, medicine, In patient, medicine.symptom, Cardiology and Cardiovascular Medicine, business
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