Publications by authors named "Clark J Zeebregts"

267 Publications

Position Paper on Young Vascular Surgeons Training of the Mediterranean Federation for the Advancing of Vascular Surgery (MeFAVS): State of the Art and Perspectives.

Ann Vasc Surg 2021 Aug 25. Epub 2021 Aug 25.

Vascular Surgery Division, Thorax Institute, Hospital Clinic, Barcelona, Spain.

The Mediterranean Federation for the Advancing of Vascular Surgery (MeFAVS) was founded in 2018, with the aim to promote cooperation among vascular professionals within Mediterranean countries. Due to its prominent social and economic impact on national health systems, diabetic peripheral artery was selected as the very first topic to be investigated by the federation. In this second paper, different experiences from delegates of participating countries were shared to define common strategies to harmonize, standardize, and optimize education and training in the Vascular Surgery specialty.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.avsg.2021.08.002DOI Listing
August 2021

Treatment of patch infection after carotid endarterectomy: a systematic review.

Ann Transl Med 2021 Jul;9(14):1213

Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

Carotid endarterectomy (CEA) with patch angioplasty is a widely used method for treating carotid artery stenosis. Patch infections are extremely rare, but the consequences may be serious. The current gold standard for treatment is patch excision and reconstruction with autologous material. However, no consensus has been reached and other options may be valuable as well in certain cases. The objective of this study was to evaluate the various treatment options for carotid patch infection after CEA with patch angioplasty on the basis of their outcomes (reinfection, ischemic stroke, and infection-related mortality). This systematic review was conducted in accordance with the PRISMA statement. The electronic bibliographic databases PubMed, Cochrane, and EMBASE were searched. Case series and case reports were included. Studies in languages other than English were excluded. Patients who developed a post-operative patch infection of CEA with patch angioplasty were included. Angioplasty could be performed with any type of patch. Patch infection needed to be confirmed by clinical presentation in combination with imaging, culture, or during the operation. The primary outcome measures were reinfection, ischemic stroke, and infection-related mortality. Eleven retrospective case series, two prospective case series, and seventeen case reports were included. The study size was 165 patients (mean age 69.7 years, M/F ratio 1.75:1). One hundred and seventy-one patches developed a patch infection after CEA with patch angioplasty and needed treatment. Treatment strategies included conservative treatment (14.0%), endovascular treatment (4.7%), and open surgery (81.4%). Mean follow-up was 34.8 months and extended up to 180 months. Reinfection rate was 4.7%, ischemic stroke rate 5.8%, and infection-related mortality rate 2.3%. No statistical comparison between treatment options could be performed, because of the heterogeneity of the included studies. Autologous material should be the primary choice of treatment if patch infection is diagnosed after CEA with patch angioplasty. In emergency situations, endovascular treatment, carotid ligation, or abscess drainage could be considered. Endovascular treatment and abscess drainage are temporary solutions. After the patient has recovered sufficiently, a more durable treatment i.e., open surgery is advised. Endo vacuum assisted closure (EndoVAC) seems to be promising. Further research is needed to determine the applicability of each treatment option.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.21037/atm-20-7531DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8350672PMC
July 2021

Clinical importance of testing for clopidogrel resistance in patients undergoing carotid artery stenting-a systematic review.

Ann Transl Med 2021 Jul;9(14):1211

Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

Dual antiplatelet therapy is frequently prescribed for patients undergoing carotid artery stenting (CAS), however clopidogrel resistance might cause thromboembolic complications. The role of testing for clopidogrel resistance in patients undergoing CAS is unclear. In this study, we aimed to review the periprocedural thromboembolic outcomes in clopidogrel resistant patients who underwent CAS. We conducted a review of PubMed, EMBASE, and the Cochrane Library up to October 7, 2020. Studies were included that investigated at least ten patients aged 18 years or older with a symptomatic carotid artery stenosis requiring CAS. Studies were excluded that investigated patients with a carotid artery dissection, case reports, case series of less than ten patients, reviews, commentaries, letters to the editors, and conference abstracts. The primary endpoint was the incidence of thromboembolic events. One hundred seventy-seven unique articles were identified of which three studies were included in our systematic review. The sample sizes ranged from 76 to 449 patients and the follow-up duration from 24 hours to 2 years postprocedural. Two retrospective observational studies determined clopidogrel resistance using measurement of P2Y12 reaction units, and one historical cohort study used genetic testing. Two studies concluded that clopidogrel resistance was a risk factor for thromboembolic complications, the other found higher values of P2Y12 reaction units in patients with thromboembolic events compared to those without. In conclusion, current literature supports a possible relationship between clopidogrel resistance and thromboembolic complications in patients who underwent CAS. Preprocedural testing for clopidogrel resistance might therefore be of additional value. Randomized studies using a valid, reliable clopidogrel resistance test and clinical endpoints, are however required to make a definitive statement and to determine the impact of the thromboembolic complications. This study was registered within PROSPERO (CRD42020197318).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.21037/atm-20-7153DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8350701PMC
July 2021

Role of pre-operative frailty status in relation to outcome after carotid endarterectomy: a systematic review.

Ann Transl Med 2021 Jul;9(14):1205

Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

Carotid endarterectomy (CEA) is a surgical treatment option to prevent ischemic cerebrovascular accidents. Patients that present with pre-operative frailty might have an elevated risk for unfavorable outcomes after the CEA. A systematic search, using Medline, Embase, Web of Science and Cochrane Database, was performed for relevant literature on frailty in patients undergoing CEA. The study protocol was registered with PROSPERO (CRD42020190345). Eight articles were included. The pooled prevalence for pre-operative frailty was 23.9% (95% CI: 12.98-34.82). A difference in the incidence of complications between frail and non-frail patients (6.4% 5.2%, respectively) and a difference in hospital length of stay [2 (IQR: 2-3) days 1 (IQR: 1-2) day, respectively] were described. The 30-day mortality after CEA was 0.6% for non-frail patients, 2.6% for frail patients, and 4.9% for very frail patients (P<0.001). For 3-year mortality, a >1.5-fold increased risk was found for frail patients (OR 1.7, 95% CI: 1.4-2.0) and a >2.5-fold increased risk for very frail patients (OR 2.6, 95% CI: 2.2-3.1). In conclusion, this review shows the impact of frailty on outcome after CEA. Pre-operative frailty assessment with a validated, multi-domain tool should be implemented in the clinical setting as it will provide information on post-operative surgical outcomes and mortality risk but also frailty trajectory and cognitive decline.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.21037/atm-20-7225DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8350627PMC
July 2021

VEGF-Targeted Multispectral Optoacoustic Tomography and Fluorescence Molecular Imaging in Human Carotid Atherosclerotic Plaques.

Diagnostics (Basel) 2021 Jul 7;11(7). Epub 2021 Jul 7.

Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands.

Vulnerable atherosclerotic carotid plaques are prone to rupture, resulting in ischemic strokes. In contrast to radiological imaging techniques, molecular imaging techniques have the potential to assess plaque vulnerability by visualizing diseases-specific biomarkers. A risk factor for rupture is intra-plaque neovascularization, which is characterized by overexpression of vascular endothelial growth factor-A (VEGF-A). Here, we study if administration of bevacizumab-800CW, a near-infrared tracer targeting VEGF-A, is safe and if molecular assessment of atherosclerotic carotid plaques in vivo is possible using multispectral optoacoustic tomography (MSOT). Healthy volunteers and patients with symptomatic carotid artery stenosis scheduled for carotid artery endarterectomy were imaged with MSOT. Secondly, patients were imaged two days after intravenous administration of 4.5 bevacizumab-800CW. Ex vivo fluorescence molecular imaging of the surgically removed plaque specimen was performed and correlated with histopathology. In this first-in-human MSOT and fluorescence molecular imaging study, we show that administration of 4.5 mg bevacizumab-800CW appeared to be safe in five patients and accumulated in the carotid atherosclerotic plaque. Although we could visualize the carotid bifurcation area in all subjects using MSOT, bevacizumab-800CW-resolved signal could not be detected with MSOT in the patients. Future studies should evaluate tracer safety, higher doses of bevacizumab-800CW or develop dedicated contrast agents for carotid atherosclerotic plaque assessment using MSOT.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/diagnostics11071227DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8305003PMC
July 2021

An International, Multicenter Retrospective Observational Study to Assess Technical Success and Clinical Outcomes of Patients Treated with an Endovascular Aneurysm Sealing Device for Type III Endoleak.

J Endovasc Ther 2021 Aug 3:15266028211031933. Epub 2021 Aug 3.

Department of Vascular Surgery, Rijnstate, Arnhem, The Netherlands.

Introduction: Type III endoleaks post-endovascular aortic aneurysm repair (EVAR) warrant treatment because they increase pressure within the aneurysm sac leading to increased rupture risk. The treatment may be difficult with regular endovascular devices. Endovascular aneurysm sealing (EVAS) might provide a treatment option for type III endoleaks, especially if located near the flow divider. This study aims to analyze clinical outcomes of EVAS for type III endoleaks after EVAR.

Methods: This is an international, retrospective, observational cohort study including data from 8 European institutions.

Results: A total of 20 patients were identified of which 80% had a type IIIb endoleak and the remainder (20%) a type IIIa endoleak. The median time between EVAR and EVAS was 49.5 months (28.5-89). Mean AAA diameter prior to EVAS revision was 76.6±19.9 mm. Technical success was achieved in 95%, 1 patient had technical failure due to a postoperative myocardial infarction resulting in death. Mean follow-up was 22.8±15.2 months. During follow-up 1 patient had a type Ia endoleak, and 1 patient had a new type IIIa endoleak at an untreated location. There were 5 patients with aneurysm growth. Five patients underwent AAA-related reinterventions indications being: growth with type II endoleak (n=3), type Ia endoleak (n=1), and iliac aneurysm (n=1). At 1-year follow-up, the freedom from clinical failure was 77.5%, freedom from all-cause mortality 94.7%, freedom from aneurysm-related mortality 95%, and freedom from aneurysm-related reinterventions 93.8%.

Conclusion: The EVAS relining can be safely performed to treat type III endoleaks with an acceptable technical success rate, a low 30-day mortality rate and no secondary ruptures at short-term follow-up. The relatively low clinical success rates, related to reinterventions and AAA enlargement, highlight the need for prolonged follow-up.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/15266028211031933DOI Listing
August 2021

Management of patients with asymptomatic carotid stenosis may need to be individualized: a multidisciplinary call for action. Republication of J Stroke 2021;23:202-212

Int Angiol 2021 07 27. Epub 2021 Jul 27.

Department of Neurology & Stroke Program, University of Maryland School of Medicine, Baltimore, MD, USA.

The optimal management of patients with asymptomatic carotid stenosis (ACS) is the subject of extensive debate. According to the 2017 European Society for Vascular Surgery guidelines, carotid endarterectomy should (Class IIa; Level of Evidence: B) or carotid artery stenting may be considered (Class IIb; Level of Evidence: B) in the presence of one or more clinical/imaging characteristics that may be associated with an increased risk of late ipsilateral stroke (e.g. silent embolic infarcts on brain computed tomography/magnetic resonance imaging, progression in the severity of ACS, a history of contralateral transient ischemic attack/stroke, microemboli detection on transcranial Doppler, etc.), provided documented perioperative stroke/death rates are <3% and the patient's life expectancy is >5 years. Besides these clinical/imaging characteristics, there are additional individual, ethnic/racial or social factors that should probably be evaluated in the decision process regarding the optimal management of these patients, such as individual patient needs/patient choice, patient compliance with best medical treatment, patient sex, culture, race/ethnicity, age and comorbidities, as well as improvements in imaging/operative techniques/outcomes. The present multispecialty position paper will present the rationale why the management of patients with ACS may need to be individualized.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.23736/S0392-9590.21.04751-9DOI Listing
July 2021

Clinical Response to Procedural Stroke Following Carotid Endarterectomy: A Delphi Consensus Study.

Eur J Vasc Endovasc Surg 2021 Sep 24;62(3):350-357. Epub 2021 Jul 24.

Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht University, the Netherlands. Electronic address:

Objective: No dedicated studies have been performed on the optimal management of patients with an acute stroke related to carotid intervention nor is there a solid recommendation given in the European Society for Vascular Surgery guideline. By implementation of an international expert Delphi panel, this study aimed to obtain expert consensus on the optimal management of in hospital stroke occurring during or following CEA and to provide a practical treatment decision tree.

Methods: A four round Delphi consensus study was performed including 31 experts. The aim of the first round was to investigate whether the conceptual model indicating the traditional division between intra- and post-procedural stroke in six phases was appropriate, and to identify relevant clinical responses during these six phases. In rounds 2, 3, and 4, the aim was to obtain consensus on the optimal response to stroke in each predefined setting. Consensus was reached in rounds 1, 3, and 4 when ≥ 70% of experts agreed on the preferred clinical response and in round 2 based on a Likert scale when a median of 7 - 9 (most adequate response) was given, IQR ≤ 2.

Results: The experts agreed (> 80%) on the use of the conceptual model. Stroke laterality and type of anaesthesia were included in the treatment algorithm. Consensus was reached in 17 of 21 scenarios (> 80%). Perform diagnostics first for a contralateral stroke in any phase, and for an ipsilateral stroke during cross clamping, or apparent stroke after leaving the operation room. For an ipsilateral stroke during the wake up phase, no formal consensus was achieved, but 65% of the experts would perform diagnostics first. A CT brain combined with a CTA or duplex ultrasound of the carotid arteries should be performed. For an ipsilateral intra-operative stroke after flow restoration, the carotid artery should be re-explored immediately (75%).

Conclusion: In patients having a stroke following carotid endarterectomy, expedited diagnostics should be performed initially in most phases. In patients who experience an ipsilateral intra-operative stroke following carotid clamp release, immediate re-exploration of the index carotid artery is recommended.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ejvs.2021.05.033DOI Listing
September 2021

Results from a nationwide prospective registry on open surgical or endovascular repair of juxtarenal abdominal aortic aneurysms.

J Vasc Surg 2021 Jun 28. Epub 2021 Jun 28.

Department of Surgery (Division of Vascular Surgery), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

Background: Juxtarenal abdominal aortic aneurysms (JRAAA) can be treated either with open surgical repair (OSR) including suprarenal clamping or by complex endovascular aneurysm repair (cEVAR). In this study we present the comparison between the short-term mortality and complications of the elective JRAAA treatment modalities from a national database reflecting daily practice in the Netherlands.

Methods: All patients undergoing elective JRAAA open repair or cEVAR (fenestrated EVAR or chimney EVAR) between January 2016 and December 2018 registered in the Dutch Surgical Aneurysm Audit (DSAA) were eligible for inclusion. Descriptive perioperative variables and outcomes were compared between patients treated with open surgery or endovascularly. Adjusted odds ratios for short-term outcomes were calculated by logistic regression analysis.

Results: In all, 455 primary treated JRAAA patients could be included (258 OSR, 197 cEVAR). Younger patients and female patients were treated more often with OSR vs cEVAR (72±6.1 vs. 76±6.0, p<0.001, 22% vs 15%, p=0.047, respectively). Patients treated with OSR had significantly more major and minor complications as well as a higher chance of early mortality (OSR: cEVAR, 45% vs. 21%, p<0.001; 34% vs. 23%, p =0.011; 6.6% vs. 2.5%, p=0.046, respectively). After logistic regression with adjustment for confounders, patients who were treated with OSR showed an odds ratio of 3.64 (95%CI 2.25-5.89, p<0.001) for major complications compared to patients treated with cEVAR and for minor complications the odds ratios were 2.17 (95%CI 1.34-3.53, p=0.002) higher. For early mortality the odds ratios were 3.79 (95%CI 1.26-11.34, p=0.017) higher after OSR compared to cEVAR.

Conclusion: In this study, after primary elective OSR for JRAAA the odds for major complications, minor complications, and short-term mortality were significantly higher compared to cEVAR.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jvs.2021.06.031DOI Listing
June 2021

Survival After Endovascular Aneurysm Sealing Compared With Endovascular Aneurysm Repair.

J Endovasc Ther 2021 10 21;28(5):788-795. Epub 2021 Jun 21.

Department of Radiology, Auckland City Hospital, Auckland, New Zealand.

Introduction: Endovascular aneurysm sealing (EVAS) is a sac-filling device with a blunted systemic inflammatory response compared to conventional endovascular aneurysm repair (EVAR), with a suggested impact on all-cause mortality. This study compares mortality after both EVAS and EVAR.

Materials And Methods: This is a retrospective observational study including data from 2 centres, with ethical approval. Elective procedures on asymptomatic infrarenal aneurysms performed between January 2011 until April 2018 were enrolled. Laboratory values (serum creatinine, haemoglobin, white blood cell count, platelet count) were measured pre- and postoperatively and at 1 and 2 years, respectively. Mortality and cause of death were recorded during follow-up.

Results: A total of 564 patients were included (225 EVAS, 369 EVAR), after propensity score matching there were 207 patients in both groups. Baseline characteristics were similar, except for larger neck angulation and more pulmonary disease in the EVAR group. The median follow-up time was 49 (EVAS) and 44 (EVAR) months. No significant differences regarding creatinine and haemoglobin were observed. Preoperative white blood cell count was higher in the EVAR group (p=0.011), without significant differences during follow-up. Median platelet count was lower in the EVAR group preoperatively (p=0.001), but was significantly higher at 1 year follow-up (p=0.003). There were 43 deaths within the EVAS group (20.8%) and 52 within the EVAR group (25.1%) (p=0.293). Of these, 4 were aneurysm related (EVAS n=3, EVAR n=1; p=0.222) and 14 cardiovascular (EVAS n=6, EVAR n=8, p=0.845). For the EVAS cohort, survival was 95.5% at 1 year and 74.9% at 5 years. For the EVAR cohort, this was 93.3% at 1 year and 75.5% at 5 years. No significant differences were observed in causes of death.

Conclusion: This study showed comparable survival rates through 5 years between EVAS and EVAR with a tendency toward higher inflammatory response in the EVAR patients through the first 2 years.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/15266028211025030DOI Listing
October 2021

Management of Patients with Asymptomatic Carotid Stenosis May Need to Be Individualized: A Multidisciplinary Call for Action.

J Stroke 2021 May 31;23(2):202-212. Epub 2021 May 31.

Department of Neurology & Stroke Program, University of Maryland School of Medicine, Baltimore, MD, USA.

The optimal management of patients with asymptomatic carotid stenosis (ACS) is the subject of extensive debate. According to the 2017 European Society for Vascular Surgery guidelines, carotid endarterectomy should (Class IIa; Level of Evidence: B) or carotid artery stenting may be considered (Class IIb; Level of Evidence: B) in the presence of one or more clinical/imaging characteristics that may be associated with an increased risk of late ipsilateral stroke (e.g., silent embolic infarcts on brain computed tomography/magnetic resonance imaging, progression in the severity of ACS, a history of contralateral transient ischemic attack/stroke, microemboli detection on transcranial Doppler, etc.), provided documented perioperative stroke/death rates are <3% and the patient's life expectancy is >5 years. Besides these clinical/imaging characteristics, there are additional individual, ethnic/racial or social factors that should probably be evaluated in the decision process regarding the optimal management of these patients, such as individual patient needs/patient choice, patient compliance with best medical treatment, patient sex, culture, race/ethnicity, age and comorbidities, as well as improvements in imaging/operative techniques/outcomes. The present multispecialty position paper will present the rationale why the management of patients with ACS may need to be individualized.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5853/jos.2020.04273DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8189852PMC
May 2021

Outcomes of Advanta V12 Covered Stents After Fenestrated Endovascular Aneurysm Repair.

J Endovasc Ther 2021 10 19;28(5):700-706. Epub 2021 May 19.

Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.

Purpose: Fenestrated endovascular aneurysm repair (FEVAR) is a well-established endovascular treatment option for pararenal abdominal aortic aneurysms in which balloon-expandable covered stents (BECS) are used to bridge the fenestration to the target vessels. This study presents midterm clinical outcomes and patency rates of the Advanta V12 BECS used as a bridging stent.

Methods: All patients treated with FEVAR with at least 1 Advanta V12 BECS were included from 2 large-volume vascular centers between January 2012 and December 2015. Primary endpoints were freedom from all-cause reintervention, and freedom from BECS-associated complications and reintervention. BECS-associated complications included significant stenosis, occlusion, type 3 endoleak, or stent fracture. Secondary endpoints included all-cause mortality in-hospital and during follow-up.

Results: This retrospective study included 194 FEVAR patients with a mean age of 72.2±8.0 years. A total of 457 visceral arteries were stented with an Advanta V12 BECS. Median (interquartile range) follow-up time was 24.6 (1.6, 49.9) months. The FEVAR procedure was technically successful in 93% of the patients. Five patients (3%) died in-hospital. Patient survival was 77% (95% CI 69% to 84%) at 3 years. Freedom from all-cause reintervention was 70% (95% CI 61% to 78%) at 3 years, and 33% of all-cause reinterventions were BECS associated. Complications were seen in 24 of 457 Advanta V12 BECSs: type 3 endoleak in 8 BECSs, significant stenosis in 4 BECSs, occlusion in 6 BECSs, and stent fractures in 3 BECSs. A combination of complications occurred in 3 BECSs: type 3 endoleak and stenosis, stent fracture and stenosis, and stent fracture and occlusion. The freedom from BECS-associated complications for Advanta V12 BECSs was 98% (95% CI 96% to 99%) at 1 year and 92% (95% CI 88% to 95%) at 3 years. The freedom from BECS-associated reinterventions was 98% (95% CI 95% to 100%) at 1 year and 94% (95% CI 91% to 97%) at 3 years.

Conclusion: The Advanta V12 BECS used as bridging stent in FEVAR showed low complication and reintervention rates at 3 years. A substantial number of FEVAR patients required a reintervention, but most were not BECS related.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/15266028211016423DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8438773PMC
October 2021

Blood Flow Quantification in Peripheral Arterial Disease: Emerging Diagnostic Techniques in Vascular Surgery.

Surg Technol Int 2021 May;38:294-304

Department of Vascular Surgery, Rijnstate, Arnhem, The Netherlands.

The assessment of local blood flow patterns in patients with peripheral arterial disease is clinically relevant, since these patterns are related to atherosclerotic disease progression and loss of patency in stents placed in peripheral arteries, through mechanisms such as recirculating flow and low wall shear stress (WSS). However, imaging of vascular flow in these patients is technically challenging due to the often complex flow patterns that occur near atherosclerotic lesions. While several flow quantification techniques have been developed that could improve the outcomes of vascular interventions, accurate 2D or 3D blood flow quantification is not yet used in clinical practice. This article provides an overview of several important topics that concern the quantification of blood flow in patients with peripheral arterial disease. The hemodynamic mechanisms involved in the development of atherosclerosis and the current clinical practice in the diagnosis of this disease are discussed, showing the unmet need for improved and validated flow quantification techniques in daily clinical practice. This discussion is followed by a showcase of state-of-the-art blood flow quantification techniques and how these could be used before, during and after treatment of stenotic lesions to improve clinical outcomes. These techniques include novel ultrasound-based methods, Phase-Contrast Magnetic Resonance Imaging (PC-MRI) and Computational Fluid Dynamics (CFD). The last section discusses future perspectives, with advanced (hybrid) imaging techniques and artificial intelligence, including the implementation of these techniques in clinical practice.
View Article and Find Full Text PDF

Download full-text PDF

Source
May 2021

Risk Factors for Delirium after Vascular Surgery: A Systematic Review and Meta-Analysis.

Ann Vasc Surg 2021 Apr 24. Epub 2021 Apr 24.

Department of Surgery, Division of Transplantation Surgery, University Medical Center Groningen, Groningen, The Netherlands.

Background: Vascular surgery is considered a risk factor for the development of postoperative delirium (POD). In this systematic review we provide a report on the incidence and risk-factors of POD after vascular surgery.

Methods: A systematic literature search was conducted using Pubmed with the MeSH terms and key words "delirium" or "confusion", "vascular surgery procedures" and "risk factors or "risk assessment". Studies were selected for review after meeting the following inclusion criteria: vascular surgery, POD diagnosed using validated screening tools, and DSM-derived criteria to assess delirium. A meta-analysis was performed for each endpoint if at least two studies could be combined.

Results: Sixteen articles met the abovementioned criteria. The incidence of delirium ranged from 5% to 39%. Various preoperative risk factors were identified that is, age (Random MD 3.96, CI 2.57-5.35), hypertension (Fixed OR 1.30, CI 1.05-1.59), diabetes mellitus (Random OR 2.15, CI 1.30-3.56), hearing impairment (Fixed OR 1.89, CI 1.28-2.81), history of cerebrovascular incident or transient ischemic attack (Fixed OR 2.20, CI 1.68-2.88), renal failure (Fixed OR 1.61, CI 1.19-2.17), and pre-operative low haemoglobin level (fixed MD -0.76, CI -1.04 to -0.47). Intra-operative risk factors were duration of surgery (Random MD 15.68; CI 2.79-28.57), open aneurysm repair (Fixed OR 4.99, CI 3.10-8.03), aortic cross clamping time (fixed MD 7.99, CI 2.56-13.42), amputation surgery (random OR 3.77, CI 2.13-6.67), emergency surgery (Fixed OR 4.84, CI 2.81-8.32) and total blood loss (Random MD 496.5, CI 84.51-908.44) and need for blood transfusion (Random OR 3.72, CI 1.57-8.80). Regional anesthesia on the other hand, had a protective effect. Delirium was associated with longer ICU and hospital length of stay, and more frequent discharge to a care facility.

Conclusions: POD after vascular surgery is a frequent complication and effect-size pooling supports the concept that delirium is a heterogeneous disorder. The risk factors identified can be used to either design a validated risk factor model or individual preventive strategies for high-risk patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.avsg.2021.03.034DOI Listing
April 2021

Reliability assessment of hyperspectral imaging with the HyperView™ system for lower extremity superficial tissue oxygenation in young healthy volunteers.

J Clin Monit Comput 2021 Apr 12. Epub 2021 Apr 12.

Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, BA60, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.

Purpose: Hyperspectral imaging (HSI) is a noninvasive spectroscopy technique for determining superficial tissue oxygenation. The HyperView™ system is a hand-held camera that enables perfusion image acquisition. The evaluation of superficial tissue oxygenation is warranted in the evaluation of patients with peripheral arterial disease. The aim was to determine the reliability of repeated HSI measurements.

Methods: In this prospective cohort study, HSI was performed on 50 healthy volunteers with a mean age of 26.4 ± 2.5 years, at the lower extremity. Two independent observers performed HSI during two subsequent measurement sessions. Short term test-retest reliability and intra- and inter-observer reliability were determined, and generalizability and decision studies were performed. Transcutaneous oxygen pressure (TcPO) measurements were also performed.

Results: The short term test-retest reliability was good for the HSI values determined at the lower extremity, ranging from 0.72 to 0.90. Intra- and inter-observer reliability determined at different days were poor to moderate for both HSI (0.24 to 0.71 and 0.30 to 0.58, respectively) and TcPO (0.54 and 0.56, and 0.51 and 0.31, respectively). Reliability can be increased to >0.75 by averaging two measurements on different days.

Conclusion: This study showed good short term test-retest reliability for HSI measurements, however low intra- and inter-observer reliability was observed for tissue oxygenation measurements with both HSI and TcPO performed at separate days in young healthy volunteers. Reliability of HSI can be improved when determined as a mean of two measurements taken on different days.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10877-021-00698-wDOI Listing
April 2021

Functional Status and Out-of-Hospital Outcomes in Different Types of Vascular Surgery Patients.

Ann Vasc Surg 2021 Aug 5;75:461-470. Epub 2021 Apr 5.

Division of Renal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.

Background: We aimed to determine the correlation between the functional status at discharge in non-cardiac vascular surgery patients and the out-of-hospital mortality.

Methods: We performed a retrospective cohort study including adult non-cardiac vascular surgery patients (open, endovascular and venous procedures) surviving hospitalization in Boston, Massachusetts, USA. The exposure of interest was functional status determined by a licensed physical therapist at hospital discharge and rated based on qualitative categories adapted from the Functional Independence Measure. The primary outcome was all cause 90-day mortality after hospital discharge. The secondary outcome was readmission within 30days. Adjusted odds ratios were estimated by multivariable logistic regression models.

Results: This cohort included 2318 patients (male 51%; mean age 61 ± 17.7). After evaluation by a physiotherapist, 425 patients scored the lowest functional status, 631 scored moderately low, 681 moderately high and 581 scored the highest functional status. The lowest functional status was associated with a 3.41-fold increased adjusted odds for 90-day mortality (95%CI, 1.70-6.84) compared to patients with the highest functional status. When excluding venous intervention patients, the adjusted odds ratio was 6.76 (95%CI, 2.53-18.12) for the 90-day mortality post-discharge. The adjusted odds for readmission within 30-days was 1.5-fold increase in patients with the lowest functional status (95%CI, 1.04-2.20).

Conclusions: In vascular surgery patients surviving hospitalization, functional status is strongly associated with out-of-hospital mortality and readmission rate. Future trials could provide evidence if improvement of functional status could prevent adverse outcomes in the postoperative setting.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.avsg.2021.02.049DOI Listing
August 2021

Feasibility of ex vivo fluorescence imaging of angiogenesis in (non-) culprit human carotid atherosclerotic plaques using bevacizumab-800CW.

Sci Rep 2021 Feb 3;11(1):2899. Epub 2021 Feb 3.

Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.

Vascular endothelial growth factor-A (VEGF-A) is assumed to play a crucial role in the development and rupture of vulnerable plaques in the atherosclerotic process. We used a VEGF-A targeted fluorescent antibody (bevacizumab-IRDye800CW [bevacizumab-800CW]) to image and visualize the distribution of VEGF-A in (non-)culprit carotid plaques ex vivo. Freshly endarterectomized human plaques (n = 15) were incubated in bevacizumab-800CW ex vivo. Subsequent NIRF imaging showed a more intense fluorescent signal in the culprit plaques (n = 11) than in the non-culprit plaques (n = 3). A plaque received from an asymptomatic patient showed pathologic features similar to the culprit plaques. Cross-correlation with VEGF-A immunohistochemistry showed co-localization of VEGF-A over-expression in 91% of the fluorescent culprit plaques, while no VEGF-A expression was found in the non-culprit plaques (p < 0.0001). VEGF-A expression was co-localized with CD34, a marker for angiogenesis (p < 0.001). Ex vivo near-infrared fluorescence (NIRF) imaging by incubation with bevacizumab-800CW shows promise for visualizing VEGF-A overexpression in culprit atherosclerotic plaques in vivo.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41598-021-82568-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7858611PMC
February 2021

Did Percutaneous Compared with Cutdown Access for Endovascular Aneurysm Repair Really Make a Difference?

Eur J Vasc Endovasc Surg 2021 03 9;61(3):395. Epub 2021 Jan 9.

Department of Surgery, Division of Vascular Surgery, University Medical Centre of Groningen, University of Groningen, Groningen, the Netherlands.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ejvs.2020.12.006DOI Listing
March 2021

Frailty leads to poor long-term survival in patients undergoing elective vascular surgery.

J Vasc Surg 2021 Jun 31;73(6):2132-2139.e2. Epub 2020 Dec 31.

Division of Vascular Surgery, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. Electronic address:

Objective: Frailty has persistently been associated with unfavorable short-term outcomes after vascular surgery, including an increased complication risk, greater readmission rate, and greater short-term mortality. However, a knowledge gap remains concerning the association between preoperative frailty and long-term mortality. In the present study, we aimed to determine this association in elective vascular surgery patients.

Methods: The present study was a part of a large prospective cohort study initiated in 2010 in our tertiary referral teaching hospital to study frailty in elderly elective vascular surgery patients (Vascular Ageing Study). A total of 639 patients with a minimal follow-up of 5 years, who had been treated from 2010 to 2014, were included in the present study. The Groningen Frailty Indicator, a 15-item self-administered questionnaire, was used to determine the presence and degree of frailty.

Results: Of the 639 patients, 183 (28.6%) were considered frail preoperatively. For the frail patients, the actuarial survival after 1, 3, and 5 years was 81.4%, 66.7%, and 55.7%, respectively. For the nonfrail patients, the corresponding survival was 93.6%, 83.3%, and 75.2% (log-rank test, P < .001). Frail patients had a significantly greater risk of 5-year mortality (unadjusted hazard ratio, 2.09; 95% confidence interval, 1.572-2.771; P < .001). After adjusting for surgical- and patient-related risk factors, the hazard ratio was 1.68 (95% confidence interval, 1.231-2.286; P = .001).

Conclusions: The results of our study have shown that preoperative frailty is associated with significantly increased long-term mortality after elective vascular surgery. Knowledge of a patient's preoperative frailty state could, therefore, be helpful in shared decision-making, because it provides more information about the procedural benefits and risks.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jvs.2020.10.088DOI Listing
June 2021

Treatment of the extracranial carotid artery in tandem lesions during endovascular treatment of acute ischemic stroke: a systematic review and meta-analysis.

Ann Transl Med 2020 Oct;8(19):1278

Division of Vascular Surgery, Department of Surgery, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

Endovascular treatment (EVT) is the standard treatment for patients with an acute ischemic stroke due to occlusion of large vessel occlusion (LVO). In 20% of patients, concomitant extracranial internal carotid artery (EICA) lesion is present. These tandem lesions (TL) offer a technical challenge. The treatment strategy for the treatment of the ipsilateral EICA is unclear. The aim of this review is to compare two treatment strategies for TL during EVT: balloon angioplasty (BA) only and immediate carotid artery stenting (iCAS). A systematic review and meta-analysis was performed. Data for each included study was extracted. For comparative studies a meta-analysis was performed. Functional outcome was expressed with the modified Rankin scale and safety endpoints were mortality and symptomatic intracranial hemorrhage (sICH). A total of 72 full text articles evaluating treatment of TL during EVT were screened. Sixteen iCAS and five comparative studies were included for meta-analysis. 53% of patients undergoing iCAS during EVT had good functional outcome in comparison to 45% of patients who underwent only BA. Mortality was comparable at 16% for both groups. The incidences of sICH were 8% and 4% for iCAS and BA respectively. In the meta-analysis, iCAS was associated with good functional outcome, with no significant differences in mortality and sICH with compared to BA. This study shows that treatment with iCAS of a simultaneously ipsilateral EICA lesion during EVT is associated with a favorable functional outcome compared to BA only with no significant difference in mortality or sICH. No conclusion could be drawn about the intracranial or extracranial first approach due to scarce of data. More studies are needed to determine long-term neurological outcomes, the necessity of re-interventions and optimal technical approach (intracranial or extracranial first).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.21037/atm-2020-cass-17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7607118PMC
October 2020

Debating the Usefulness of Abdominal Aortic Aneurysm Screening Programs: A Never-Ending Story.

Angiology 2021 04 15;72(4):392-393. Epub 2020 Sep 15.

Division of Vascular Surgery, New York University Langone Medical Center, NY, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0003319720958336DOI Listing
April 2021

Migration After Endovasclar Aneurysm Sealing in Conjunction With Chimney Grafts.

J Endovasc Ther 2021 Feb 10;28(1):165-172. Epub 2020 Sep 10.

Department of Interventional Radiology and Vascular Surgery, Auckland City Hospital, Auckland, New Zealand.

Purpose: To assess the incidence of migration after endovascular aneurysm sealing (EVAS) in conjunction with chimney grafts (chEVAS) for repair of abdominal aortic aneurysms (AAAs).

Materials And Methods: A retrospective, observational cohort study was conducted of 31 patients (mean age 75.7 years; 27 men) treated for juxtarenal AAA between April 2013 and December 2018 at single centers in New Zealand and the Netherlands. The majority of patients received >1 chimney graft (13 single, 13 double, and 5 triple) during chEVAS. Six patients had only the first postoperative scan, so the migration analysis was based on 25 patients.

Results: Median seal length assessed on the first postoperative computed tomography scan was 36.5 mm. The assisted technical success rate was 93.5% with 2 technical failures. Median time to final imaging follow-up was 17 months in 25 patients. At the latest follow-up, there were no cases of caudal migration >10 mm. Freedom from caudal movement of 5 to 9 mm was estimated as 86.1% at 1 year and 73.9% at 2 years; freedom from clinically relevant migration (movement requiring reintervention) was 100% at both time intervals. However, at 3 years there were 2 cases of caudal movement of 5 to 9 mm and a type Ia endoleak warranting reintervention. No correlation between migration and aneurysm growth (p=0.851), endoleak (p=0.562), or the number of chimney grafts (p=0.728) was found. During follow-up, 2 patients (7%) had aneurysm rupture and 10 (33%) had reinterventions. Eight patients (27%) died; 2 were aneurysm-related (7%) and due to the consequences of a reintervention.

Conclusion: In the 2 years following chEVAS, there was no caudal migration >10 mm, but nearly a quarter of patients had caudal movement of 5 to 9 mm. A trend was observed toward ongoing migration that required intervention at 3-year follow-up. chEVAS is technically challenging and should be considered only for patients with no viable alternative treatment option.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1526602820957279DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7816544PMC
February 2021

A systematic review and meta-analysis of F-fluoro-d-deoxyglucose positron emission tomography interpretation methods in vascular graft and endograft infection.

J Vasc Surg 2020 12 6;72(6):2174-2185.e2. Epub 2020 Jul 6.

Division of Vascular Surgery, Department of Surgery, Groningen, The Netherlands.

Objective: Vascular graft and endograft infection (VGEI) has high morbidity and mortality rates. Diagnosis is complicated because symptoms vary and can be nonspecific. A meta-analysis identified F-fluoro-d-deoxyglucose positron emission tomography-computed tomography (F-FDG PET/CT) as the most valuable tool for diagnosis of VGEI and favorable to computed tomography as the current standard. However, the availability and varied use of several interpretation methods, without consensus on which interpretation method is best, complicate clinical use. The aim of this study was to evaluate the diagnostic performance of different interpretation methods of F-FDG PET/CT in diagnosis of VGEI.

Methods: A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data sources included PubMed/MEDLINE, Embase, and Cochrane Library. A meta-analysis was conducted on the different interpretation methods for F-FDG PET/CT in diagnosis of VGEI, including visual FDG uptake intensity, visual FDG uptake pattern, and quantitative maximum standardized uptake (SUVmax).

Results: Of 613 articles, 13 were included (10 prospective and 3 retrospective articles). The FDG uptake pattern method (I = 26.2%) showed negligible heterogeneity, whereas the FDG uptake intensity (I = 42.2%) and SUVmax (I = 42.1%) methods showed moderate heterogeneity. The pooled sensitivity for FDG uptake intensity was 0.90 (95% confidence interval [CI], 0.79-0.96); for uptake pattern, 0.94 (95% CI, 0.89-0.97); and for SUVmax, 0.95 (95% CI, 0.76-0.99). The pooled specificity for FDG uptake intensity was 0.59 (95% CI, 0.38-0.78); for FDG uptake pattern, 0.81 (95% CI, 0.71-0.88); and for SUVmax, 0.77 (95% CI, 0.63-0.87). The uptake pattern interpretation method demonstrated the best positive and negative post-test probability, 82% and 10%, respectively.

Conclusions: This meta-analysis identified the FDG uptake pattern as the most accurate assessment method of F-FDG PET/CT for diagnosis of VGEI. The optimal SUVmax cutoff, depending on the vendor, demonstrated strong sensitivity and moderate specificity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jvs.2020.05.065DOI Listing
December 2020

Endograft Conformability in Fenestrated Endovascular Aneurysm Repair for Complex Abdominal Aortic Aneurysms.

J Endovasc Ther 2020 10 22;27(5):848-856. Epub 2020 Jun 22.

Department of Surgery, Rijnstate, Arnhem, the Netherlands.

To compare the impact of 2 commercially available custom-made fenestrated endografts on patient anatomy. The records of 234 patients who underwent fenestrated endovascular aneurysm repair for abdominal aortic aneurysm from March 2002 to July 2016 in 2 hospitals were screened to identify those who had pre- and postoperative computed tomography angiography assessments with a slice thickness of ≤2 mm. The search identified 145 patients for further analysis: 110 patients (mean age 72.4±7.1 years; 94 men) who had been treated with the Zenith Fenestrated (ZF) endograft and 35 patients (mean age 72.3±7.3 years; 30 men) treated with the Fenestrated Anaconda (FA) endograft. Measurements included aortic diameters at the level of the superior mesenteric artery (SMA) and renal arteries, target vessel angles, target vessel clock positions, and the target vessel tortuosity index. Variables were tested for inter- and intraobserver agreement. There was a good agreement between observers in all tested variables. The native anatomy changed in both groups after endograft implantation. In the ZF group, changes were seen in the angles of the celiac artery (p=0.012), SMA (p=0.022), left renal artery (LRA) (p<0.001), and the right renal artery (RRA) (p<0.001); the aortic diameter at the SMA level (p<0.001); and the LRA (p<0.001) and RRA (p<0.001) clock positions. In the FA group, changes were seen in the angles of the LRA (p=0.001) and RRA (p<0.001) and in the SMA tortuosity index (p=0.044). Between group differences in changes were seen for the aortic diameters at the SMA and renal artery levels (p<0.001 for both) and the LRA clock position (p=0.019). Both custom-made fenestrated endografts altered vascular anatomy. The data suggest a higher conformability of the Fenestrated Anaconda endograft compared with the Zenith Fenestrated.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1526602820936185DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7536524PMC
October 2020

Transition in Frailty State Among Elderly Patients After Vascular Surgery.

World J Surg 2020 10;44(10):3564-3572

Department of Surgery, Division of Vascular Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.

Background: Frailty in the vascular surgical ward is common and predicts poor surgical outcomes. The aim of this study was to analyze transitions in frailty state in elderly patients after vascular surgery and to evaluate influence of patient characteristics on this transition.

Methods: Between 2014 and 2018, 310 patients, ≥65 years and scheduled for elective vascular surgery, were included in this cohort study. Transition in frailty state between preoperative and follow-up measurement was determined using the Groningen Frailty Indicator (GFI), a validated tool to measure frailty in vascular surgery patients. Frailty is defined as a GFI score ≥4. Patient characteristics leading to a transition in frailty state were analyzed using multivariable Cox regression analysis.

Results: Mean age was 72.7 ± 5.2 years, and 74.5% were male. Mean follow-up time was 22.7 ± 9.5 months. At baseline measurement, 79 patients (25.5%) were considered frail. In total, 64 non-frail patients (20.6%) shifted to frail and 29 frail patients (9.4%) to non-frail. Frail patients with a high Charlson Comorbidity Index (HR = 0.329 (CI: 0.133-0.812), p = 0.016) and that underwent a major vascular intervention (HR = 0.365 (CI: 0.154-0.865), p = 0.022) had a significantly higher risk to remain frail after the intervention.

Conclusions: The results of this study, showing that after vascular surgery almost 21% of the non-frail patients become frail, may lead to a more effective shared decision-making process when considering treatment options, by providing more insight in the postoperative frailty course of patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00268-020-05619-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7458900PMC
October 2020

Preventing stroke in symptomatic carotid artery disease during the COVID-19 pandemic.

J Vasc Surg 2020 08 21;72(2):755-756. Epub 2020 May 21.

Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jvs.2020.04.476DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7241312PMC
August 2020

Effect of muscle depletion on survival in peripheral arterial occlusive disease: Quality over quantity.

J Vasc Surg 2020 12 21;72(6):2006-2016.e1. Epub 2020 Apr 21.

Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. Electronic address:

Objective: Patients with peripheral arterial occlusive disease (PAOD) have a poor prognosis and a high prevalence of comorbidity. This study investigated whether sarcopenia and/or myosteatosis negatively affect long-term survival in patients with PAOD.

Methods: This was a single-center, retrospective cohort study of 686 consecutive patients diagnosed and treated for PAOD and who underwent computed tomography scanning. Cross-sectional muscle measurements were obtained at the level of the third lumbar vertebra. Optimal stratification was used to define sex-specific and body mass index-specific cutoff values for sarcopenia and myosteatosis, respectively. The Cox proportional hazards model was used to determine the effect of sarcopenia and myosteatosis on overall survival.

Results: Sarcopenia was associated with age, body mass index, myosteatosis, malignancy, congestive heart failure, hemodialysis, and Fontaine 4 classification. Myosteatosis was associated with age, sarcopenia, type 2 diabetes mellitus, hypertension, chronic obstructive pulmonary disease, malignancy, congestive heart failure, ischemic stroke, and Fontaine 4 classification. Sarcopenia (hazard ratio [HR], 2.82; 95% confidence interval [CI], 2.05-3.86; P < .001) and myosteatosis (HR, 4.13; 95% CI, 3.03-5.63; P < .001) were both associated with reduced survival in univariable analysis. When adjusted for other prognostic markers, myosteatosis (HR, 2.09; 95% CI, 1.46-2.99; P < .001) was still associated with lower overall survival in the multivariable model, but sarcopenia (HR, 1.40; 95% CI, 0.97-2.01; P = .073) was not.

Conclusions: Muscle depletion is independently associated with a poorer overall survival in patients with PAOD. Myosteatosis is a stronger predictor than sarcopenia, which indicates that quality is more important than quantity. Results should be interpreted with caution owing to missing data on medication usage.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jvs.2020.03.050DOI Listing
December 2020

Physiological Appearance of Hybrid FDG-Positron Emission Tomography/Computed Tomography Imaging Following Uncomplicated Endovascular Aneurysm Sealing Using the Nellix Endoprosthesis.

J Endovasc Ther 2020 06 15;27(3):509-515. Epub 2020 Apr 15.

Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands.

To investigate the physiological uptake of hybrid fluorine-18-fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography (PET/CT) before and after an uncomplicated endovascular aneurysm sealing (EVAS) procedure as a possible tool to diagnose EVAS graft infection and differentiate from postimplantation syndrome. Eight consecutive male patients (median age 78 years) scheduled for elective EVAS were included in the prospective study ( identifier NCT02349100). FDG-PET/CT scans were performed in all patients before the procedure and 6 weeks after EVAS. The abdominal aorta was analyzed in 4 regions: suprarenal, infrarenal neck, aneurysm sac, and iliac. The following parameters were obtained for each region: standard uptake value (SUV), tissue to background ratio (TBR), and visual examination of FDG uptake to ascertain its distribution. Demographic data were obtained from medical files and scored based on reporting standards. Visual examination showed no difference between pre- and postprocedure FDG uptake, which was homogenous. In the suprarenal region no significant pre- and postprocedure differences were observed for the SUV and TBR parameters. The infrarenal neck region showed a significant decrease in the SUV and no significant decrease in the TBR. The aneurysm sac and iliac regions both showed a significant decrease in SUV and TBR between the pre- and postprocedure scans. Physiological FDG uptake after EVAS was stable or decreased with regard to the preprocedure measurements. Future research is needed to assess the applicability and cutoff values of FDG-PET/CT scanning to detect endograft infection after EVAS.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1526602820913888DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7288856PMC
June 2020

Mycotic Abdominal Aortic and Iliac Aneurysm Caused by Streptococcus equi Subspecies zooepidemicus Bacteremia.

Aorta (Stamford) 2019 Dec 19;7(6):172-175. Epub 2020 Feb 19.

Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

This report describes a case of a taxidermist who presented with sepsis and excruciating back pain a few weeks after contact with a deceased horse. subspecies (SESZ) was isolated from patient's blood and two isolated mycotic aneurysms were found. The first was located in the distal abdominal aorta and the second in the right common iliac artery. Treatment consisted of penicillin administration for 6 weeks and surgical debridement of the infected tissue combined with autologous vein reconstruction. The patient was infection-free without complaints 1 year after discharge and the venous reconstruction was patent. Reports in literature of bacteremia with SESZ leading to the development of mycotic aneurysms are very scarce and show that prognosis is generally unfavorable.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0039-3401995DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7145433PMC
December 2019

Outcomes after endovascular mechanical thrombectomy in occluded vascular access used for dialysis purposes.

Catheter Cardiovasc Interv 2020 03 14;95(4):758-764. Epub 2020 Jan 14.

Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

Purpose: Endovascular mechanical thrombectomy using the AngioJet™ system can be considered to reestablish patency in occluded vascular access. The aim of this study was to review our results for endovascular mechanical thrombectomy using the AngioJet™ system in patients with arteriovenous fistulae (AVF) and arteriovenous grafts (AVG).

Methods: Data collected in a database of patients requiring hemodialysis for renal failure were analyzed. Patients who underwent endovascular mechanical thrombectomy procedures with the AngioJet™ system for occlusion of vascular access were included. Clinical and technical success rates and patency rates were calculated. Multivariate analysis was used to identify factors of influence.

Results: A total of 92 AngioJet™ procedures in 60 patients with thrombosed vascular access were reviewed during a mean follow-up period of 21.5 months in patients with an AVF and 11.9 months in patients with an AVG. Technical and clinical success was achieved in 92.6% of AVF cases and 92.0 and 90.8% of AVG cases with an AVG, respectively. Significantly higher primary and primary-assisted patency rates were observed in the AVF group. Multivariate regression analysis indicated that left-sided vascular access and female sex were independent predictors for failure regarding primary patency in AVG patients. Immunosuppressive drugs and older age were negative predictors for secondary patency in AVG patients.

Conclusions: The AngioJet™ system can be deemed an effective technique to reestablish patency in occluded vascular access with minimal use of central venous catheters for dialysis. Good technical and clinical success rates were achieved with acceptable patency rates, especially in AVF patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/ccd.28730DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7079151PMC
March 2020
-->