Search

Your search keyword '"Smits TM"' showing total 25 results
Start Over Author "Smits TM"
25 results on '"Smits TM"'

1. Nationwide Outcomes of Octogenarians Following Open or Endovascular Management After Ruptured Abdominal Aortic Aneurysms

Author

Anna J. Alberga, Jorg L. de Bruin, Frederico Bastos Gonçalves, Eleonora G. Karthaus, Janneke A. Wilschut, Joost A. van Herwaarden, Jan J. Wever, Hence J. M. Verhagen, Van den Akker PJ, Akkersdijk GJ, Akkersdijk GP, Akkersdijk WL, van Andringa de Kempenaer MG, Arts CH, Avontuur JA, Bakker OJ, Balm R, Barendregt WB, Bekken JA, Bender MH, Bendermacher BL, van den Berg M, Berger P, Beuk RJ, Blankensteijn JD, Bleker RJ, Blok JJ, Bode AS, Bodegom ME, van der Bogt KE, Boll AP, Booster MH, Borger van der Burg BL, de Borst GJ, Bos-van Rossum WT, Bosma J, Botman JM, Bouwman LH, Brehm V, de Bruijn MT, de Bruin JL, Brummel P, van Brussel JP, Buijk SE, Buijs MA, Buimer MG, Burger DH, Buscher HC, Cancrinus E, Castenmiller PH, Cazander G, Coester AM, Cuypers PH, Daemen JH, Dawson I, Dierikx JE, Dijkstra ML, Diks J, Dinkelman MK, Dirven M, Dolmans DE, van Doorn RC, van Dortmont LM, Drouven JW, van der Eb MM, Eefting D, van Eijck GJ, Elshof JW, Elsman BH, van der Elst A, van Engeland MI, van Eps RG, Faber MJ, de Fijter WM, Fioole B, Fokkema TM, Frans FA, Fritschy WM, Fung Kon Jin PH, Geelkerken RH, van Gent WB, Glade GJ, Govaert B, Groenendijk RP, de Groot HG, van den Haak RF, de Haan EF, Hajer GF, Hamming JF, van Hattum ES, Hazenberg CE, Hedeman Joosten PP, Helleman JN, van der Hem LG, Hendriks JM, van Herwaarden JA, Heyligers JM, Hinnen JW, Hissink RJ, Ho GH, den Hoed PT, Hoedt MT, van Hoek F, Hoencamp R, Hoffmann WH, Hogendoorn W, Hoksbergen AW, Hollander EJ, Hommes M, Hopmans CJ, Huisman LC, Hulsebos RG, Huntjens KM, Idu MM, Jacobs MJ, van der Jagt MF, Jansbeken JR, Janssen RJ, Jiang HH, de Jong SC, Jongbloed-Winkel TA, Jongkind V, Kapma MR, Keller BP, Khodadade Jahrome A, Kievit JK, Klemm PL, Klinkert P, Koedam NA, Koelemaij MJ, Kolkert JL, Koning GG, Koning OH, Konings R, Krasznai AG, Krol RM, Kropman RH, Kruse RR, van der Laan L, van der Laa n MJ, van Laanen JH, van Lammeren GW, Lamprou DA, Lardenoye JH, Lauret GJ, Leenders BJ, Legemate DA, Leijdekkers VJ, Lemson MS, Lensvelt MM, Lijkwan MA, Lind RC, van der Linden FT, Liqui Lung PF, Loos MJ, Loubert MC, van de Luijtgaarden KM, Mahmoud DE, Manshanden CG, Mattens EC, Meerwaldt R, Mees BM, von Meijenfeldt GC, Menting TP, Metz R, Minnee RC, de Mol van Otterloo JC, Molegraaf MJ, Montauban van Swijndregt YC, Morak MJ, van de Mortel RH, Mulder W, Nagesser SK, Naves CC, Nederhoed JH, Nevenzel-Putters AM, de Nie AJ, Nieuwenhuis DH, Nieuwenhuizen J, van Nieuwenhuizen RC, Nio D, Noyez VJ, Oomen AP, Oranen BI, Oskam J, Palamba HW, Peppelenbosch AG, van Petersen AS, Petri BJ, Pierie ME, Ploeg AJ, Pol RA, Ponfoort ED, Post IC, Poyck PP, Prent A, ten Raa S, Raymakers JT, Reichart M, Reichmann BL, Reijnen MM, de Ridder JA, Rijbroek A, van Rijn MJ, de Roo RA, Rouwet EV, Saleem BR, Salemans PB, van Sambeek MR, Samyn MG, van ‘t Sant HP, van Schaik J, van Schaik PM, Scharn DM, Scheltinga MR, Schepers A, Schlejen PM, Schlosser FJ, Schol FP, Scholtes VP, Schouten O, Schreve MA, Schurink GW, Sikkink CJ, te Slaa A, Smeets HJ, Smeets L, Smeets RR, de Smet AA, Smit PC, Smits TM, Snoeijs MG, Sondakh AO, Speijers MJ, van der Steenhoven TJ, van Sterkenburg SM, Stigter DA, Stokmans RA, Strating RP, Stultiëns GN, Sybrandy JE, Teijink JA, Telgenkamp BJ, Teraa M, Testroote MJ, Tha-In T, The RM, Thijsse WJ, Thomassen I, Tielliu IF, van Tongeren RB, Toorop RJ, Tournoij E, Truijers M, Türkcan K, Tutein Nolthenius RP, Ünlü Ç, Vaes RH, Vafi AA, Vahl AC, Veen EJ, Veger HT, Veldman MG, Velthuis S, Verhagen HJ, Verhoeven BA, Vermeulen CF, Vermeulen EG, Vierhout BP, van der Vijver-Coppen RJ, Visser MJ, van der Vliet JA, Vlijmen—van Keulen CJ, Voorhoeve R, van der Vorst JR, Vos AW, de Vos B, Vos CG, Vos GA, Voute MT, Vriens BH, Vriens PW, de Vries AC, de Vries DK, de Vries JP, de Vries M, van der Waal C, Waasdorp EJ, Wallis de Vries BM, van Walraven LA, van Wanroij JL, Warlé MC, van de Water W, van Weel V, van Well AM, Welten GM, Welten RJ, Wever JJ, Wiersema AM, Wikkeling OR, Willaert WI, Wille J, Willems MC, Willigendael EM, Wilschut ED, Wisselink W, Witte ME, Wittens CH, Wong CY, Wouda R, Yazar O, Yeung KK, Zeebregts CJ, van Zeeland ML, NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), and Surgery

Subjects
Radiology, Nuclear Medicine and imaging, Surgery, Cardiology and Cardiovascular Medicine
Abstract

Purpose: Octogenarians are known to have less-favorable outcomes following ruptured abdominal aortic aneurysm (rAAA) repair compared with their younger counterparts. Accurate information regarding perioperative outcomes following rAAA-repair is important to evaluate current treatment practice. The aim of this study was to evaluate perioperative outcomes of octogenarians and to identify factors associated with mortality and major complications after open surgical repair (OSR) or endovascular aneurysm repair (EVAR) of a rAAA using nationwide, real-world, contemporary data. Methods: All patients that underwent EVAR or OSR of an infrarenal or juxtarenal rAAA between January 1, 2013, and December 31, 2018, were prospectively registered in the Dutch Surgical Aneurysm Audit (DSAA) and included in this study. The primary outcome was the comparison of perioperative outcomes of octogenarians versus non-octogenarians, including adjustment for confounders. Secondary outcomes were the identification of factors associated with mortality and major complications in octogenarians. Results: The study included 2879 patients, of which 1146 were treated by EVAR (382 octogenarians, 33%) and 1733 were treated by OSR (410 octogenarians, 24%). Perioperative mortality of octogenarians following EVAR was 37.2% versus 14.8% in non-octogenarians (adjusted OR=2.9, 95% CI=2.8–3.0) and 50.0% versus 29.4% following OSR (adjusted OR=2.2, 95% CI=2.2–2.3). Major complication rates of octogenarians were 55.4% versus 31.8% in non-octogenarians following EVAR (OR=2.7, 95% CI=2.1–3.4), and 68% versus 49% following OSR (OR=2.2, 95% CI=1.8–2.8). Following EVAR, 30.6% of the octogenarians had an uncomplicated perioperative course (UPC) versus 49.5% in non-octogenarians (OR=0.5, 95% CI=0.4–0.6), while following OSR, UPC rates were 20.7% in octogenarians versus 32.6% in non-octogenarians (OR=0.5, 95% CI=0.4–0.7). Cardiac or pulmonary comorbidity and loss of consciousness were associated with mortality and major complications in octogenarians. Interestingly, female octogenarians had lower mortality rates following EVAR than male octogenarians (adjusted OR=0.7, 95% CI=0.6–0.8). Conclusion: Based on this nationwide study with real-world registry data, mortality rates of octogenarians following ruptured AAA-repair were high, especially after OSR. However, a substantial proportion of these octogenarians following OSR and EVAR had an uneventful recovery. Known preoperative factors do influence perioperative outcomes and reflect current treatment practice.

Published
2022

2. Meta-analysis of individual-patient data from EVAR-1, DREAM, OVER and ACE trials comparing outcomes of endovascular or open repair for abdominal aortic aneurysm over 5 years

Author

Powell, JT, Sweeting, MJ, Ulug, P, Blankensteijn, JD, Lederle, FA, Becquemin, J-P, Greenhalgh, RM, Beard, JD, Buxton, MJ, Brown, LC, Harris, PL, Rose, JDG, Russell, IT, Sculpher, MJ, Thompson, SG, Lilford, RJ, Bell, PRF, Whitaker, SC, Poole-Wilson, PA, Ruckley, CV, Campbell, WB, Dean, MRE, Ruttley, MST, Coles, EC, Halliday, A, Gibbs, SJ, Epstein, D, Hannon, RJ, Johnston, L, Bradbury, AW, Henderson, MJ, Parvin, SD, Shepherd, DFC, Mitchell, AW, Edwards, PR, Abbott, GT, Higman, DJ, Vohra, A, Ashley, S, Robottom, C, Wyatt, MG, Byrne, D, Edwards, R, Leiberman, DP, McCarter, DH, Taylor, PR, Reidy, JF, Wilkinson, AR, Ettles, DF, Clason, AE, Leen, GLS, Wilson, NV, Downes, M, Walker, SR, Lavelle, JM, Gough, MJ, McPherson, S, Scott, DJA, Kessell, DO, Naylor, R, Sayers, R, Fishwick, NG, Gould, DA, Walker, MG, Chalmers, NC, Garnham, A, Collins, MA, Gaines, PA, Ashour, MY, Uberoi, R, Braithwaite, B, Davies, JN, Travis, S, Hamilton, G, Platts, A, Shandall, A, Sullivan, BA, Sobeh, M, Matson, M, Fox, AD, Orme, R, Yusef, W, Doyle, T, Horrocks, M, Hardman, J, Blair, PHB, Ellis, PK, Morris, G, Odurny, A, Vohra, R, Duddy, M, Thompson, M, Loosemore, TML, Belli, AM, Morgan, R, Adiseshiah, M, Brookes, JAS, McCollum, CN, Ashleigh, R, Aukett, M, Baker, S, Barbe, E, Batson, N, Bell, J, Blundell, J, Boardley, D, Boyes, S, Brown, O, Bryce, J, Carmichael, M, Chance, T, Coleman, J, Cosgrove, C, Curran, G, Dennison, T, Devine, C, Dewhirst, N, Errington, B, Farrell, H, Fisher, C, Fulford, P, Gough, M, Graham, C, Hooper, R, Horne, G, Horrocks, L, Hughes, B, Hutchings, T, Ireland, M, Judge, C, Kelly, L, Kemp, J, Kite, A, Kivela, M, Lapworth, M, Lee, C, Linekar, L, Mahmood, A, March, L, Martin, J, Matharu, N, McGuigen, K, Morris-Vincent, P, Murray, S, Murtagh, A, Owen, G, Ramoutar, V, Rippin, C, Rowley, J, Sinclair, J, Spencer, S, Taylor, V, Tomlinson, C, Ward, S, Wealleans, V, West, J, White, K, Williams, J, Wilson, L, Grobbee, DE, Bak, AAA, Buth, J, Pattynama, PM, Verhoeven, ELG, van Voorthuisen, AE, Balm, R, Cuypers, PWM, Prinssen, M, van Sambeek, MRHM, Baas, AF, Hunink, MG, van Engelshoven, JM, Jacobs, MJHM, de Mol, BAJM, van Bockel, JH, Reekers, J, Tielbeek, X, Wisselink, W, Boekema, N, Heuveling, LM, Sikking, I, de Bruin, JL, Buskens, E, Tielbeek, AV, Reekers, JA, Pattynama, P, Prins, T, van der Ham, AC, van der Velden, JJIM, van Sterkenburg, SMM, ten Haken, GB, Bruijninckx, CMA, van Overhagen, H, Tutein Nolthenius, RP, Hendriksz, TR, Teijink, JAW, Odink, HF, de Smet, AAEA, Vroegindeweij, D, van Loenhout, RMM, Rutten, MJ, Hamming, JF, Lampmann, LEH, Bender, MHM, Pasmans, H, Vahl, AC, de Vries, C, Mackaay, AJC, van Dortmont, LMC, van der Vliet, AJ, Schultze Kool, LJ, Boomsma, JHB, van Dop, HR, de Mol van Otterloo, JCA, de Rooij, TPW, Smits, TM, Yilmaz, EN, van den Berg, FG, Visser, MJT, van der Linden, E, Schurink, GWH, de Haan, M, Smeets, HJ, Stabel, P, van Elst, F, Poniewierski, J, Vermassen, FEG, Freischlag, JA, Kohler, TR, Latts, E, Matsumura, J, Padberg, FT, Kyriakides, TC, Swanson, KM, Guarino, P, Peduzzi, P, Antonelli, M, Cushing, C, Davis, E, Durant, L, Joyner, S, Kossack, A, LeGwin, M, McBride, V, O'Connor, T, Poulton, J, Stratton, S, Zellner, S, Snodgrass, AJ, Thornton, J, Haakenson, CM, Stroupe, KT, Jonk, Y, Hallett, JW, Hertzer, N, Towne, J, Katz, DA, Karrison, T, Matts, JP, Marottoli, R, Kasl, S, Mehta, R, Feldman, R, Farrell, W, Allore, H, Perry, E, Niederman, J, Randall, F, Zeman, M, Beckwith, D, O'Leary, TJ, Huang, GD, Bader, M, Ketteler, ER, Kingsley, DD, Marek, JM, Massen, RJ, Matteson, BD, Pitcher, JD, Langsfeld, M, Corson, JD, Goff, JM, Kasirajan, K, Paap, C, Robertson, DC, Salam, A, Veeraswamy, R, Milner, R, Guidot, J, Lal, BK, Busuttil, SJ, Lilly, MP, Braganza, M, Ellis, K, Patterson, MA, Jordan, WD, Whitley, D, Taylor, S, Passman, M, Kerns, D, Inman, C, Poirier, J, Ebaugh, J, Raffetto, J, Chew, D, Lathi, S, Owens, C, Hickson, K, Dosluoglu, HH, Eschberger, K, Kibbe, MR, Baraniewski, HM, Endo, M, Busman, A, Meadows, W, Evans, M, Giglia, JS, El Sayed, H, Reed, AB, Ruf, M, Ross, S, Jean-Claude, JM, Pinault, G, Kang, P, White, N, Eiseman, M, Jones, R, Timaran, CH, Modrall, JG, Welborn, MB, Lopez, J, Nguyen, T, Chacko, JKY, Granke, K, Vouyouka, AG, Olgren, E, Chand, P, Allende, B, Ranella, M, Yales, C, Whitehill, TA, Krupski, WC, Nehler, MR, Johnson, SP, Jones, DN, Strecker, P, Bhola, MA, Shortell, CK, Gray, JL, Lawson, JH, McCann, R, Sebastian, MW, Kistler Tetterton, J, Blackwell, C, Prinzo, PA, Lee, N, Cerveira, JJ, Zickler, RW, Hauck, KA, Berceli, SA, Lee, WA, Ozaki, CK, Nelson, PR, Irwin, AS, Baum, R, Aulivola, B, Rodriguez, H, Littooy, FN, Greisler, H, O'Sullivan, MT, Kougias, P, Lin, PH, Bush, RL, Guinn, G, Bechara, C, Cagiannos, C, Pisimisis, G, Barshes, N, Pillack, S, Guillory, B, Cikrit, D, Lalka, SG, Lemmon, G, Nachreiner, R, Rusomaroff, M, O'Brien, E, Cullen, JJ, Hoballah, J, Sharp, WJ, McCandless, JL, Beach, V, Minion, D, Schwarcz, TH, Kimbrough, J, Ashe, L, Rockich, A, Warner-Carpenter, J, Moursi, M, Eidt, JF, Brock, S, Bianchi, C, Bishop, V, Gordon, IL, Fujitani, R, Kubaska, SM, Behdad, M, Azadegan, R, Ma Agas, C, Zalecki, K, Hoch, JR, Carr, SC, Acher, C, Schwarze, M, Tefera, G, Mell, M, Dunlap, B, Rieder, J, Stuart, JM, Weiman, DS, Abul-Khoudoud, O, Garrett, HE, Walsh, SM, Wilson, KL, Seabrook, GR, Cambria, RA, Brown, KR, Lewis, BD, Framberg, S, Kallio, C, Barke, RA, Santilli, SM, d'Audiffret, AC, Oberle, N, Proebstle, C, Johnson, LL, Jacobowitz, GR, Cayne, N, Rockman, C, Adelman, M, Gagne, P, Nalbandian, M, Caropolo, LJ, Pipinos, II, Johanning, J, Lynch, T, DeSpiegelaere, H, Purviance, G, Zhou, W, Dalman, R, Lee, JT, Safadi, B, Coogan, SM, Wren, SM, Bahmani, DD, Maples, D, Thunen, S, Golden, MA, Mitchell, ME, Fairman, R, Reinhardt, S, Wilson, MA, Tzeng, E, Muluk, S, Peterson, NM, Foster, M, Edwards, J, Moneta, GL, Landry, G, Taylor, L, Yeager, R, Cannady, E, Treiman, G, Hatton-Ward, S, Salabsky, B, Kansal, N, Owens, E, Estes, M, Forbes, BA, Sobotta, C, Rapp, JH, Reilly, LM, Perez, SL, Yan, K, Sarkar, R, Dwyer, SS, Perez, S, Chong, K, Hatsukami, TS, Glickerman, DG, Sobel, M, Burdick, TS, Pedersen, K, Cleary, P, Back, M, Bandyk, D, Johnson, B, Shames, M, Reinhard, RL, Thomas, SC, Hunter, GC, Leon, LR, Westerband, A, Guerra, RJ, Riveros, M, Mills, JL, Hughes, JD, Escalante, AM, Psalms, SB, Day, NN, Macsata, R, Sidawy, A, Weiswasser, J, Arora, S, Jasper, BJ, Dardik, A, Gahtan, V, Muhs, BE, Sumpio, BE, Gusberg, RJ, Spector, M, Pollak, J, Aruny, J, Kelly, EL, Wong, J, Vasilas, P, Joncas, C, Gelabert, HA, DeVirgillio, C, Rigberg, DA, Cole, L, Marzelle, J, Sapoval, M, Favre, J-P, Watelet, J, Lermusiaux, P, Lepage, E, Hemery, F, Dolbeau, G, Hawajry, N, Cunin, P, Harris, P, Stockx, L, Chatellier, G, Mialhe, C, Fiessinger, J-N, Pagny, L, Kobeiter, H, Boissier, C, Lacroix, P, Ledru, F, Pinot, J-J, Deux, J-F, Tzvetkov, B, Duvaldestin, P, Jourdain, C, David, V, Enouf, D, Ady, N, Krimi, A, Boudjema, N, Jousset, Y, Enon, B, Blin, V, Picquet, J, L'Hoste, P, Thouveny, F, Borie, H, Kowarski, S, Pernes, J-M, Auguste, M, Desgranges, P, Allaire, E, Meaulle, P-Y, Chaix, D, Juliae, P, Fabiani, JN, Chevalier, P, Combes, M, Seguin, A, Belhomme, D, Baque, J, Pellerin, O, Favre, JP, Barral, X, Veyret, C, Peillon, C, Plissonier, D, Thomas, P, Clavier, E, Martinez, R, Bleuet, F, C, D, Verhoye, JP, Langanay, T, Heautot, JF, Koussa, M, Haulon, S, Halna, P, Destrieux, L, Lions, C, Wiloteaux, S, Beregi, JP, Bergeron, P, Patra, P, Costargent, A, Chaillou, P, D'Alicourt, A, Goueffic, Y, Cheysson, E, Parrot, A, Garance, P, Demon, A, Tyazi, A, Pillet, J-C, Lescalie, F, Tilly, G, Steinmetz, E, Favier, C, Brenot, R, Krause, D, Cercueil, JP, Vahdat, O, Sauer, M, Soula, P, Querian, A, Garcia, O, Levade, M, Colombier, D, Cardon, J-M, Joyeux, A, Borrelly, P, Dogas, G, Magnan, P-É, Branchereau, A, Bartoli, J-M, Hassen-Khodja, R, Batt, M, Planchard, P-F, Bouillanne, P-J, Haudebourg, P, Bayne, J, Gouny, P, Badra, A, Braesco, J, Nonent, M, Lucas, A, Cardon, A, Kerdiles, Y, Rolland, Y, Kassab, M, Brillu, C, Goubault, F, Tailboux, L, Darrieux, H, Briand, O, Maillard, J-C, Varty, K, Cousins, C, EVAR-1, DREAM, OVER and ACE Trialists, Surgery, ICaR - Ischemia and repair, ACS - Microcirculation, ACS - Atherosclerosis & ischemic syndromes, Halliday, A, Sweeting, Michael [0000-0003-0980-8965], Apollo - University of Cambridge Repository, and National Institute for Health Research

Subjects
Male, medicine.medical_treatment, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], 030204 cardiovascular system & hematology, Endovascular aneurysm repair, Medical and Health Sciences, law.invention, Aortic aneurysm, 0302 clinical medicine, Randomized controlled trial, DESIGN, law, Models, 80 and over, Multicenter Studies as Topic, 030212 general & internal medicine, Randomized Controlled Trials as Topic, RISK, Aged, 80 and over, Hazard ratio, Endovascular Procedures, DREAM, 11 Medical And Health Sciences, Statistical, Middle Aged, Corrigenda, Abdominal aortic aneurysm, Aortic Aneurysm, Treatment Outcome, CARDIOVASCULAR-DISEASE, Elective Surgical Procedures, Female, Reoperation, medicine.medical_specialty, and over, 03 medical and health sciences, Aneurysm, medicine, Journal Article, MANAGEMENT, Humans, Comparative Study, Abdominal, OVER and ACE Trialists, Aged, Models, Statistical, business.industry, MORTALITY, Odds ratio, medicine.disease, Surgery, Vascular Grafting, business, Abdominal surgery, Meta-Analysis, EVAR-1, Aortic Aneurysm, Abdominal
Abstract

Background The erosion of the early mortality advantage of elective endovascular aneurysm repair (EVAR) compared with open repair of abdominal aortic aneurysm remains without a satisfactory explanation. Methods An individual-patient data meta-analysis of four multicentre randomized trials of EVARversus open repair was conducted to a prespecified analysis plan, reporting on mortality, aneurysm-related mortality and reintervention. Results The analysis included 2783 patients, with 14 245 person-years of follow-up (median 5·5 years). Early (0–6 months after randomization) mortality was lower in the EVAR groups (46 of 1393 versus 73 of 1390 deaths; pooled hazard ratio 0·61, 95 per cent c.i. 0·42 to 0·89; P = 0·010), primarily because 30-day operative mortality was lower in the EVAR groups (16 deaths versus 40 for open repair; pooled odds ratio 0·40, 95 per cent c.i. 0·22 to 0·74). Later (within 3 years) the survival curves converged, remaining converged to 8 years. Beyond 3 years, aneurysm-related mortality was significantly higher in the EVAR groups (19 deaths versus 3 for open repair; pooled hazard ratio 5·16, 1·49 to 17·89; P = 0·010). Patients with moderate renal dysfunction or previous coronary artery disease had no early survival advantage under EVAR. Those with peripheral artery disease had lower mortality under open repair (39 deaths versus 62 for EVAR; P = 0·022) in the period from 6 months to 4 years after randomization. Conclusion The early survival advantage in the EVAR group, and its subsequent erosion, were confirmed. Over 5 years, patients of marginal fitness had no early survival advantage from EVAR compared with open repair. Aneurysm-related mortality and patients with low ankle : brachial pressure index contributed to the erosion of the early survival advantage for the EVAR group. Trial registration numbers: EVAR-1, ISRCTN55703451; DREAM (Dutch Randomized Endovascular Aneurysm Management), NCT00421330; ACE (Anévrysme de l'aorte abdominale, Chirurgie versus Endoprothèse), NCT00224718; OVER (Open Versus Endovascular Repair Trial for Abdominal Aortic Aneurysms), NCT00094575.

Published
2017

3. VARIABILITY OF CONTINUOUSLY MEASURED ARTERIAL PH AND BLOOD-GAS VALUES IN THE NEAR-TERM FETAL LAMB

Author

WOUDSTRA, BR, DEWOLF, BTHM, SMITS, TM, NATHANIELSZ, PW, ZIJLSTRA, WG, AARNOUDSE, JG, and Faculteit Medische Wetenschappen/UMCG

Subjects
ACUTE HYPOXEMIA, SHEEP, FETUS, ELECTROCORTICAL ACTIVITY, UTERINE, HYPOXIA, GESTATION, RESPONSES
Abstract

In fetal sheep, arterial blood gas values show considerable spontaneous fluctuations. The aim of the present study was to obtain quantitative data on fetal blood gas variability. Accurate assessment of the intraindividual variations can hardly be obtained from intermittent blood samples, but requires continuous measurement. For this purpose we developed a small extracorporeal flow-through cuvette, containing pH and blood gas electrodes and the fiber optic probe of an oximeter. The cuvette is connected through two catheters to the fetal circulation. Blood from the carotid artery flows through the cuvette at a constant rate of 2 mL/min and is drained into the jugular vein. Continuous recordings for 6 h were obtained from five chronically instrumented sheep fetuses at 134-137-d gestational age. Intraindividual variability of fetal arterial blood pH (pHa), partial pressure of arterial blood CO2 (Pace,) and O-2 (Pao(2)), and saturation of arterial blood (Sao(2)) is quantitatively described. The individual variation coefficients ranged from 0.1 to 0.4% (pHa), from 1.4 to 7.6% (Paco(2)), from 2.5 to 5.5% (Pao(2)), and from 3.6 to 7.0% (Sao(2)). The 5th to 95 percentile intervals (a) of the individual blood gas values ranged from 0.03 to 0.09 (pHa), from 0.3 to 1.6 kPa (Paco(2)), from 0.22 to 0.5 kPa (Pao(2)), and from 10.5 to 26.0% (Sao(2)), These findings indicate that considerable fluctuations in fetal arterial blood gases occur during a 6-h period, These fluctuations are associated with uterine contractures and changes in maternal and fetal activity.

Published
1995

4. THE MICROVASCULAR ARCHITECTURE OF THE SCALP IN THE HUMAN FETUS AT TERM - IMPLICATIONS FOR MEASURING BLOOD-GASES AND FLOW-RATE

Author

SMITS, TM, HILLEN, B, AARNOUDSE, JG, ZIJLSTRA, RJ, ZIJLSTRA, WG, and University of Groningen

Subjects
LIGHT, SCALP, FETUS, LASER DOPPLER, MICROCIRCULATION, GLYCOL METHACRYLATE, LABOR, SKIN, BLOOD FLOW
Abstract

A microscopic study is presented on the depth distribution of the microvessels in the scalp of two human fetuses at term. The basal membrane showed a smooth line without papillary structures resulting in a thin epidermal layer of 25-mu-m. The distance from the scalp surface to the periosteum appeared to be almost 1.8 mm. The capillary density showed a peak of approximately 1.2 capillary cross-sections per 10(4) mu-m2 in the first 200-mu-m of the dermis. In the middle of the dermis the capillary density fell to 0.2 cross-sections per 10(4) mu-m2 to rise again in the lower part of the dermis to 1.6 cross-sections per 10(4) mu-2, which remained the approximate count in the subcutaneous tissue. The arterioles and venules showed significant numbers in the lower part of the dermis and were virtually absent in the subcutis. Of all 4570 microvessel cross-sections that were studied in a tissue volume of 0.6 mm3, not a single one showed the features of an arteriovenous anastomosis. The possible implications for laser Doppler flowmetry and continuous blood gas measurement of the fetal scalp are discussed.

Published
1992

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

Author

Jalalzadeh H, Indrakusuma R, Koelemay MJW, Balm R, Van den Akker LH, Van den Akker PJ, Akkersdijk GJ, Akkersdijk GP, Akkersdijk WL, van Andringa de Kempenaer MG, Arts CH, Avontuur JA, Baal JG, Bakker OJ, Balm R, Barendregt WB, Bender MH, Bendermacher BL, van den Berg M, Berger P, Beuk RJ, Blankensteijn JD, Bleker RJ, Bockel JH, Bodegom ME, Bogt KE, Boll AP, Booster MH, Borger van der Burg BL, de Borst GJ, Bos-van Rossum WT, Bosma J, Botman JM, Bouwman LH, Breek JC, Brehm V, Brinckman MJ, van den Broek TH, Brom HL, de Bruijn MT, de Bruin JL, Brummel P, van Brussel JP, Buijk SE, Buimer MG, Burger DH, Buscher HC, den Butter G, Cancrinus E, Castenmiller PH, Cazander G, Coveliers HM, Cuypers PH, Daemen JH, Dawson I, Derom AF, Dijkema AR, Diks J, Dinkelman MK, Dirven M, Dolmans DE, van Doorn RC, van Dortmont LM, van der Eb MM, Eefting D, van Eijck GJ, Elshof JW, Elsman BH, van der Elst A, van Engeland MI, van Eps RG, Faber MJ, de Fijter WM, Fioole B, Fritschy WM, Geelkerken RH, van Gent WB, Glade GJ, Govaert B, Groenendijk RP, de Groot HG, van den Haak RF, de Haan EF, Hajer GF, Hamming JF, van Hattum ES, Hazenberg CE, Hedeman Joosten PP, Helleman JN, van der Hem LG, Hendriks JM, van Herwaarden JA, Heyligers JM, Hinnen JW, Hissink RJ, Ho GH, den Hoed PT, Hoedt MT, van Hoek F, Hoencamp R, Hoffmann WH, Hoksbergen AW, Hollander EJ, Huisman LC, Hulsebos RG, Huntjens KM, Idu MM, Jacobs MJ, van der Jagt MF, Jansbeken JR, Janssen RJ, Jiang HH, de Jong SC, Jongkind V, Kapma MR, Keller BP, Khodadade Jahrome A, Kievit JK, Klemm PL, Klinkert P, Knippenberg B, Koedam NA, Koelemay MJ, Kolkert JL, Koning GG, Koning OH, Krasznai AG, Krol RM, Kropman RH, Kruse RR, van der Laan L, van der Laan MJ, van Laanen JH, Lardenoye JH, Lawson JA, Legemate DA, Leijdekkers VJ, Lemson MS, Lensvelt MM, Lijkwan MA, Lind RC, van der Linden FT, Liqui Lung PF, Loos MJ, Loubert MC, Mahmoud DE, Manshanden CG, Mattens EC, Meerwaldt R, Mees BM, Metz R, Minnee RC, de Mol van Otterloo JC, Moll FL, Montauban van Swijndregt YC, Morak MJ, van de Mortel RH, Mulder W, Nagesser SK, Naves CC, Nederhoed JH, Nevenzel-Putters AM, de Nie AJ, Nieuwenhuis DH, Nieuwenhuizen J, van Nieuwenhuizen RC, Nio D, Oomen AP, Oranen BI, Oskam J, Palamba HW, Peppelenbosch AG, van Petersen AS, Peterson TF, Petri BJ, Pierie ME, Ploeg AJ, Pol RA, Ponfoort ED, Poyck PP, Prent A, Ten Raa S, Raymakers JT, Reichart M, Reichmann BL, Reijnen MM, Rijbroek A, van Rijn MJ, de Roo RA, Rouwet EV, Rupert CG, Saleem BR, van Sambeek MR, Samyn MG, van 't Sant HP, van Schaik J, van Schaik PM, Scharn DM, Scheltinga MR, Schepers A, Schlejen PM, Schlosser FJ, Schol FP, Schouten O, Schreinemacher MH, Schreve MA, Schurink GW, Sikkink CJ, Siroen MP, Te Slaa A, Smeets HJ, Smeets L, de Smet AA, de Smit P, Smit PC, Smits TM, Snoeijs MG, Sondakh AO, van der Steenhoven TJ, van Sterkenburg SM, Stigter DA, Stigter H, Strating RP, Stultiëns GN, Sybrandy JE, Teijink JA, Telgenkamp BJ, Testroote MJ, The RM, Thijsse WJ, Tielliu IF, van Tongeren RB, Toorop RJ, Tordoir JH, Tournoij E, Truijers M, Türkcan K, Tutein Nolthenius RP, Ünlü Ç, Vafi AA, Vahl AC, Veen EJ, Veger HT, Veldman MG, Verhagen HJ, Verhoeven BA, Vermeulen CF, Vermeulen EG, Vierhout BP, Visser MJ, van der Vliet JA, Vlijmen-van Keulen CJ, Voesten HG, Voorhoeve R, Vos AW, de Vos B, Vos GA, Vriens BH, Vriens PW, de Vries AC, de Vries JP, de Vries M, van der Waal C, Waasdorp EJ, Wallis de Vries BM, van Walraven LA, van Wanroij JL, Warlé MC, van Weel V, van Well AM, Welten GM, Welten RJ, Wever JJ, Wiersema AM, Wikkeling OR, Willaert WI, Wille J, Willems MC, Willigendael EM, Wisselink W, Witte ME, Wittens CH, Wolf-de Jonge IC, Yazar O, Zeebregts CJ, and van Zeeland ML

Subjects
Aged, Aged, 80 and over, Endovascular Procedures methods, Endovascular Procedures mortality, Endovascular Procedures statistics & numerical data, Female, Guideline Adherence statistics & numerical data, Humans, Iliac Aneurysm epidemiology, Iliac Aneurysm mortality, Iliac Aneurysm pathology, Iliac Artery pathology, Iliac Artery surgery, Male, Netherlands epidemiology, Registries, Retrospective Studies, Sex Factors, Treatment Outcome, Iliac Aneurysm surgery
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., (Copyright © 2020 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)

Published
2020
Full Text
View/download PDF

12. Endovascular Revascularization and Supervised Exercise for Peripheral Artery Disease and Intermittent Claudication: A Randomized Clinical Trial.

Author

Fakhry F, Spronk S, van der Laan L, Wever JJ, Teijink JA, Hoffmann WH, Smits TM, van Brussel JP, Stultiens GN, Derom A, den Hoed PT, Ho GH, van Dijk LC, Verhofstad N, Orsini M, van Petersen A, Woltman K, Hulst I, van Sambeek MR, Rizopoulos D, Rouwet EV, and Hunink MG

Subjects
Aged, Combined Modality Therapy methods, Female, Health Status, Humans, Intention to Treat Analysis, Male, Quality of Life, Treatment Outcome, Walking, Exercise Therapy methods, Intermittent Claudication therapy, Peripheral Arterial Disease therapy, Vascular Surgical Procedures methods
Abstract

Importance: Supervised exercise is recommended as a first-line treatment for intermittent claudication. Combination therapy of endovascular revascularization plus supervised exercise may be more promising but few data comparing the 2 therapies are available., Objective: To assess the effectiveness of endovascular revascularization plus supervised exercise for intermittent claudication compared with supervised exercise only., Design, Setting, and Participants: Randomized clinical trial of 212 patients allocated to either endovascular revascularization plus supervised exercise or supervised exercise only. Data were collected between May 17, 2010, and February 16, 2013, in the Netherlands at 10 sites. Patients were followed up for 12 months and the data were analyzed according to the intention-to-treat principle., Interventions: A combination of endovascular revascularization (selective stenting) plus supervised exercise (n = 106) or supervised exercise only (n = 106)., Main Outcomes and Measures: The primary end point was the difference in maximum treadmill walking distance at 12 months between the groups. Secondary end points included treadmill pain-free walking distance, vascular quality of life (VascuQol) score (1 [worst outcome] to 7 [best outcome]), and 36-item Short-Form Health Survey (SF-36) domain scores for physical functioning, physical role functioning, bodily pain, and general health perceptions (0 [severe limitation] to 100 [no limitation])., Results: Endovascular revascularization plus supervised exercise (combination therapy) was associated with significantly greater improvement in maximum walking distance (from 264 m to 1501 m for an improvement of 1237 m) compared with the supervised exercise only group (from 285 m to 1240 m for improvement of 955 m) (mean difference between groups, 282 m; 99% CI, 60-505 m) and in pain-free walking distance (from 117 m to 1237 m for an improvement of 1120 m vs from 135 m to 847 m for improvement of 712 m, respectively) (mean difference, 408 m; 99% CI, 195-622 m). Similarly, the combination therapy group demonstrated significantly greater improvement in the disease-specific VascuQol score (1.34 [99% CI, 1.04-1.64] in the combination therapy group vs 0.73 [99% CI, 0.43-1.03] in the exercise group; mean difference, 0.62 [99% CI, 0.20-1.03]) and in the score for the SF-36 physical functioning (22.4 [99% CI, 16.3-28.5] vs 12.6 [99% CI, 6.3-18.9], respectively; mean difference, 9.8 [99% CI, 1.4-18.2]). No significant differences were found for the SF-36 domains of physical role functioning, bodily pain, and general health perceptions., Conclusions and Relevance: Among patients with intermittent claudication after 1 year of follow-up, a combination therapy of endovascular revascularization followed by supervised exercise resulted in significantly greater improvement in walking distances and health-related quality-of-life scores compared with supervised exercise only., Trial Registration: Netherlands Trial Registry Identifier: NTR2249.

Published
2015
Full Text
View/download PDF

13. Deoxygenation of carbohydrates by thiol-catalysed radical-chain redox rearrangement of the derived benzylidene acetals.

Author

Dang HS, Roberts BP, Sekhon J, and Smits TM

Subjects
Catalysis, Magnetic Resonance Spectroscopy, Oxidation-Reduction, Acetals chemistry, Carbohydrates chemistry, Oxygen chemistry, Sulfhydryl Compounds chemistry
Abstract

Five- or six-membered cyclic benzylidene acetals, derived from 1,2- or 1,3-diol functionality in carbohydrates, undergo an efficient thiol-catalysed radical-chain redox rearrangement resulting in deoxygenation at one of the diol termini and formation of a benzoate ester function at the other. The role of the thiol is to act as a protic polarity-reversal catalyst to promote the overall abstraction of the acetal hydrogen atom by a nucleophilic alkyl radical. The redox rearrangement is carried out in refluxing octane and/or chlorobenzene as solvent at ca. 130 degrees C and is initiated by thermal decomposition of di-tert-butyl peroxide (DTBP) or 2,2-bis(tert-butylperoxy)butane. The silanethiols (Bu(t)O)3SiSH and Pr(i)3SiSH (TIPST) are particularly efficient catalysts and the use of DTBP in conjunction with TIPST is generally the most effective and convenient combination. The reaction has been applied to the mono-deoxygenation of a variety of monosaccharides by way of 1,2-, 3,4- and 4,6-O-benzylidene pyranoses and a 5,6-O-benzylidene furanose. It has also been applied to bring about the dideoxygenation of mannose and of the disaccharide alpha,alpha-trehalose. The use of p-methoxybenzylidene acetals offers no great advantage and ethylene acetals do not undergo significant redox rearrangement under similar conditions. Functional group compatibility is good and tosylate, epoxide and ketone functions do not interfere; it is not necessary to protect free OH groups. Because of the different mechanisms of the ring-opening step (homolytic versus heterolytic), the regioselectivity of the redox rearrangement can differ usefully from that resulting from the Hanessian-Hullar (H.-H.) and Collins reactions for brominative ring opening of benzylidene acetals. When simple deoxygenation of a carbohydrate is desired, the one-pot redox rearrangement offers an advantage over H.-H./Collins-based procedures in that the reductive debromination step (which often involves the use of toxic tin hydrides) required by the latter methodology is avoided.

Published
2003
Full Text
View/download PDF

14. [A swelling in the distal part of the thigh].

Author

Smits TM, van den Dungen JJ, Koops HS, Mooyaart EL, and Hoekstra HJ

Subjects
Adolescent, Aged, Aged, 80 and over, Diagnosis, Differential, Diagnostic Techniques, Surgical, Humans, Knee, Magnetic Resonance Imaging, Male, Middle Aged, Thigh, Tomography, Emission-Computed, Ultrasonography, Aneurysm, Infected diagnosis, Aneurysm, Ruptured diagnosis, Edema etiology, Liposarcoma, Myxoid diagnosis, Soft Tissue Infections diagnosis, Soft Tissue Neoplasms diagnosis
Abstract

A swelling in the distal thigh may be caused by a tumour of bone or soft tissues, an aneurysm or an inflammation. Signs of inflammation may render interpretation more difficult. Four males aged 60, 48, 15 and 81 years had had a swelling in the popliteal space or above the knee, in some cases with pain. Supplementary examinations, especially MRI scanning and arteriography did not always result in a diagnosis. The diagnosis could be made, however, during operation: an empyemic thrombosed popliteal artery aneurysm, a liposarcoma, pyomyositis and suture dehiscence of a plastic prosthesis of the popliteal artery. After treatment, consisting of or started during the operation, uneventful recovery occurred.

Published
1998

15. Variability of continuously measured arterial pH and blood gas values in the near term fetal lamb.

Author

Woudstra BR, de Wolf BT, Smits TM, Nathanielsz PW, Zijlstra WG, and Aarnoudse JG

Subjects
Analysis of Variance, Animals, Arteries, Female, Gestational Age, Hydrogen-Ion Concentration, Oximetry instrumentation, Pregnancy, Sheep, Time Factors, Carbon Dioxide blood, Fetal Blood metabolism, Oxygen blood
Abstract

In fetal sheep, arterial blood gas values show considerable spontaneous fluctuations. The aim of the present study was to obtain quantitative data on fetal blood gas variability. Accurate assessment of the intraindividual variations can hardly be obtained from intermittent blood samples, but requires continuous measurement. For this purpose we developed a small extracorporeal flow-through cuvette, containing pH and blood gas electrodes and the fiber optic probe of an oximeter. The cuvette is connected through two catheters to the fetal circulation. Blood from the carotid artery flows through the cuvette at a constant rate of 2 mL/min and is drained into the jugular vein. Continuous recordings for 6 h were obtained from five chronically instrumented sheep fetuses at 134-137-d gestational age. Intraindividual variability of fetal arterial blood pH (pHa), partial pressure of arterial blood CO2 (Paco2) and O2 (Pao2), and saturation of arterial blood (Sao2) is quantitatively described. The individual variation coefficients ranged from 0.1 to 0.4% (pHa), from 1.4 to 7.6% (Paco2), from 2.5 to 5.5% (Pao2), and from 3.6 to 7.0% (Sao2). The 5th to 95 percentile intervals (delta) of the individual blood gas values ranged from 0.03 to 0.09 (pHa), from 0.3 to 1.6 kPa (Paco2), from 0.22 to 0.5 kPa (Pao2), and from 10.5 to 26.0% (Sao2). These findings indicate that considerable fluctuations in fetal arterial blood gases occur during a 6-h period. These fluctuations are associated with uterine contractures and changes in maternal and fetal activity.

Published
1995
Full Text
View/download PDF

16. The microvascular architecture of the scalp in the human fetus at term. Implications for measuring blood gases and flow rate.

Author

Smits TM, Hillen B, Aarnoudse JG, Zijlstra RJ, and Zijlstra WG

Subjects
Blood Flow Velocity, Blood Gas Analysis, Female, Fetal Monitoring methods, Humans, Infant, Newborn, Microcirculation anatomy & histology, Microcirculation physiology, Pregnancy, Scalp blood supply
Abstract

A microscopic study is presented on the depth distribution of the microvessels in the scalp of two human fetuses at term. The basal membrane showed a smooth line without papillary structures resulting in a thin epidermal layer of 25 microns. The distance from the scalp surface to the periosteum appeared to be almost 1.8 mm. The capillary density showed a peak of approximately 1.2 capillary cross-sections per 10(4) microns 2 in the first 200 microns of the dermis. In the middle of the dermis the capillary density fell to 0.2 cross-sections per 10(4) microns 2 to rise again in the lower part of the dermis to 1.6 cross-sections per 10(4) microns 2, which remained the approximate count in the subcutaneous tissue. The arterioles and venules showed significant numbers in the lower part of the dermis and were virtually absent in the subcutis. Of all 4570 microvessel cross-sections that were studied in a tissue volume of 0.6 mm3, not a single one showed the features of an arteriovenous anastomosis. The possible implications for laser Doppler flowmetry and continuous blood gas measurement of the fetal scalp are discussed.

Published
1992

17. Scalp blood flow, measured by laser Doppler flowmetry, and transcutaneous PO2 and PCO2 in the lamb.

Author

Smits TM, Aarnoudse JG, and Zijlstra WG

Subjects
Animals, Female, Regional Blood Flow, Rheology, Sheep, Blood Gas Monitoring, Transcutaneous methods, Lasers, Scalp blood supply
Abstract

To describe the relation between scalp blood flow and transcutaneous PO2 and PCO2, these three signals were recorded simultaneously in eight experiments on four healthy lambs in the first weeks after birth. Scalp blood flow was recorded by a laser Doppler flow sensor that was incorporated in the transcutaneous PO2 electrode. Scalp blood flow was varied by applying a circular pressure on the scalp surrounding the sensors. A decrease in laser Doppler blood flow was associated with a decrease in transcutaneous PO2 and an increase in transcutaneous PCO2, according to a hyperbolic curve. The steep parts of the hyperbolic curves were observed at low scalp blood flow, whereas the flat parts were found at high flow values. Even during heat-induced hyperemia only a small part of these hyperbolic curves showed a reasonable independence of the transcutaneous blood gas values of changes in blood flow. In view of the previously observed decrease in intrapartum scalp blood flow, the present data render the transcutaneous measurement of blood gas values doubtful for fetal monitoring during labor.

Published
1990
Full Text
View/download PDF

19. Fetal scalp blood flow as recorded by laser Doppler flowmetry and transcutaneous PO2 during labour.

Author

Smits TM, Aarnoudse JG, and Zijlstra WG

Subjects
Blood Gas Monitoring, Transcutaneous, Female, Humans, Labor, Obstetric, Lasers, Pregnancy, Regional Blood Flow, Scalp embryology, Fetal Monitoring methods, Scalp blood supply
Abstract

Laser Doppler flowmetry was used to evaluate the relationship between the changes in scalp blood flow and transcutaneous PO2 (PtcO2) during labour. Laser Doppler flow (LDF) and PtcO2 were measured simultaneously in fourteen women using a combined sensor. Scatter diagrams of LDF and PtcO2 show a hyperbolic curve, i.e. at high flow levels PtcO2 is independent of the flow rate and will reflect the arterial PO2 value, whereas at lower flow levels PtcO2 becomes highly dependent on the blood flow rate. The latter situation occurred in most of the fetuses when labour progressed. An inverse relationship between LDF and PtcO2 was observed in two fetuses in those parts of the recordings which coincided with repetitive severe variable decelerations++ in the FHR tracing (r = -0.59 and -0.65), suggesting a compensatory increase in scalp blood flow during hypoxemia. It is concluded that the PtcO2 signal is considerably influenced by local scalp blood flow in the majority of the patients and thus is a questionable parameter for monitoring fetal carotid arterial PO2.

Published
1989
Full Text
View/download PDF

21. Hyperventilation-induced changes in periodic oscillations in forehead skin blood flow measured by laser Doppler flowmetry.

Author

Smits TM, Aarnoudse JG, Geerdink JJ, and Zijlstra WG

Subjects
Adult, Blood Gas Analysis, Female, Hot Temperature, Humans, Lasers, Lidocaine pharmacology, Male, Blood Flow Velocity, Forehead blood supply, Hyperventilation blood, Rheology
Abstract

Rhythmic oscillations in forehead skin blood flow were studied with the laser Doppler technique in thirteen healthy subjects. During voluntary hyperventilation, a three-fold increase in relative amplitude of the spontaneous rhythmic oscillations in forehead skin blood flow was observed, whereas mean blood flow decreased by 15%. During hyperventilation, the relative amplitude of the oscillations was on average 36% of the mean blood flow value. The mean incidence of the oscillations increased significantly, from 68% of the measuring time before, to 96% of the measuring time during hyperventilation. The oscillation frequency was not affected by hyperventilation. Before, during and after hyperventilation the average oscillation frequency was 0.140 Hz (8.4 min-1), 0.145 Hz (8.7 min-1) respectively. The application of heat or a local anaesthetic to the skin attenuated the relative amplitude of the oscillations in forehead skin blood flow during hyperventilation as well as before and after.

Published
1987

22. Oxygen tension in the fetal scalp during labour.

Author

Aarnoudse JG, Cornel M, and Smits TM

Subjects
Electrodes, Female, Fetal Heart physiology, Heart Rate, Humans, Oximetry, Partial Pressure, Pregnancy, Uterine Contraction, Fetus metabolism, Labor, Obstetric, Oxygen analysis, Scalp blood supply
Published
1985
Full Text
View/download PDF

24. Red blood cell flow in the fetal scalp during hypoxemia in the chronic sheep experiment: a laser Doppler flow study.

Author

Smits TM, Aarnoudse JG, and Zijlstra WG

Subjects
Animals, Female, Lasers, Pregnancy, Regional Blood Flow, Rheology, Sheep, Erythrocytes physiology, Fetal Diseases physiopathology, Hypoxia physiopathology, Scalp blood supply
Abstract

Reliable monitoring of arterial blood gas values in the fetal scalp microcirculation requires an unimpaired local skin blood flow. Previous studies have shown that in the fetus blood flow to "nonvital" organs and tissues is reduced during hypoxemia. However, data on fetal scalp blood flow during hypoxemia have not been reported. Therefore, the influence of hypoxemia on scalp blood flow was studied in four chronically catheterized fetal lambs of 125-135 days of gestation. Red blood cell flow in the fetal scalp was continuously measured by the laser Doppler method during nine experiments. Reducing the oxygen saturation of fetal carotid arterial blood from an average control value of 52 to 21% for 20 min resulted in an average decrease of the laser Doppler flow index of 7%. In vitro studies revealed that more than half of the observed decrease in laser Doppler flow index could be attributed to enhanced absorption of light from the HeNe-laser caused by the deoxygenation of oxyhemoglobin itself. In the first 20 min after hypoxia, fetal scalp blood flow remained below the prehypoxic value. It is concluded that moderate hypoxemia causes only a small decrease in fetal scalp blood flow, certainly when compared to the dramatic fall in scalp blood flow that has been observed when local or circular pressure is exerted onto the fetal scalp.

Published
1986
Full Text
View/download PDF

25. Variability of fetal scalp blood flow during labour: continuous transcutaneous measurement by the laser Doppler technique.

Author

Smits TM and Aarnoudse JG

Subjects
Doppler Effect, Female, Humans, Infant, Newborn, Pregnancy, Regional Blood Flow, Uterine Contraction, Fetal Monitoring, Labor, Obstetric, Lasers, Scalp blood supply
Abstract

Variability of fetal scalp blood flow was measured in 15 patients in labour. Using the continuous transcutaneous laser Doppler technique adapted for fetal intrapartum measurements, it was possible to obtain recordings from a cervical dilatation of 3 cm until delivery. The general trend of fetal scalp blood flow showed a decrease in the majority of the patients during the first and the second stages of labour, with a fall of more than 50% of the initial value at the end of the first stage in seven. During the second stage the decrease in flow was generally less pronounced, although in one fetus scalp blood flow fell to 18% of the initial level by the end of the second stage. Of all the uterine contractions recorded, 57% were accompanied by a transient decrease in blood flow, often by 40-50%, but a temporary increase in scalp blood flow was found in 25% of contractions. Caput succedaneum formation was associated with a more pronounced transient decrease in local scalp blood flow during contractions. It is concluded that during labour a considerable reduction in fetal scalp blood flow occurs. It follows that the reliability of fetal transcutaneous blood gas monitoring techniques, which need a substantial increase in local capillary blood flow, seems highly questionable.

Published
1984
Full Text
View/download PDF

Catalog

Books, media, physical & digital resources
See catalog results