Review: Quality of Life in Lower Limb Peripheral Vascular Surgery

PURPOSE: Vascular intervention studies generally consider patency and limb salvage as primary outcomes. However, quality of life is increasingly considered an important patient-oriented outcome measurement of vascular interventions. Existing literature was analyzed to determine the effect of different treatments on quality of life for patients suffering from either claudication or critical limb ischemia. BASIC METHODS: A review of the literature was undertaken in the Medline library. A search was performed on quality of life in peripheral arterial disease. Results were stratified according to treatment groups. PRINCIPAL FINDINGS: Twenty-one articles described quality of life in approximately 4600 patients suffering from peripheral arterial disease. Invasive treatment generally results in better quality of life scores (at a maximum of 2 years of follow-up), compared with non-invasive treatment. In patients with critical limb ischemia, successful revascularization improves quality of life scores. Only one study reported long-term results. CONCLUSIONS: Increase in quality of life scores can be found for any intervention performed for peripheral arterial disease. However, there is scarce information on long-term quality of life after vascular intervention.info:eu-repo/semantics/publishedVersio

Clinical and scientific progress related to the interface between cardiology and psychology: lessons learned from 35 years of experience at the Thoraxcenter of the Erasmus Medical Center in Rotterdam

In November 1975, as the first in the Netherlands, a full-time psychologist was employed at the Department of Cardiology of the Thoraxcenter of the Erasmus Medical Center. This innovative decision was consistent with a view to treat the patient as a whole rather than the heart as a single body part in need of repair, combined with the understanding that the heart and mind interact to affect health. The present selective review addresses the broad range of contributions of 35 years of psychology to clinical cardiology and cardiovascular research with a focus on research, teaching, psychological screening and patient care. The review ends with lessons to be learned and challenges for the future with respect to improving the care and management of patients with heart disease in order to enhance secondary prevention and the role of behavioural and psychological factors in this endeavour

Review: Quality of Life in Lower Limb Peripheral Vascular Surgery

PURPOSE: Vascular intervention studies generally consider patency and limb salvage as primary outcomes. However, quality of life is increasingly considered an important patient-oriented outcome measurement of vascular interventions. Existing literature was analyzed to determine the effect of different treatments on quality of life for patients suffering from either claudication or critical limb ischemia. BASIC METHODS: A review of the literature was undertaken in the Medline library. A search was performed on quality of life in peripheral arterial disease. Results were stratified according to treatment groups. PRINCIPAL FINDINGS: Twenty-one articles described quality of life in approximately 4600 patients suffering from peripheral arterial disease. Invasive treatment generally results in better quality of life scores (at a maximum of 2 years of follow-up), compared with non-invasive treatment. In patients with critical limb ischemia, successful revascularization improves quality of life scores. Only one study reported long-term results. CONCLUSIONS: Increase in quality of life scores can be found for any intervention performed for peripheral arterial disease. However, there is scarce information on long-term quality of life after vascular intervention.info:eu-repo/semantics/publishedVersio

Early Sac Shrinkage Predicts a Low Risk of Late Complications After Endovascular Aortic Aneurysm Repair

BACKGROUND: Aneurysm shrinkage has been proposed as a marker of successful endovascular aneurysm repair (EVAR). Patients with early postoperative shrinkage may experience fewer subsequent complications, and consequently require less intensive surveillance. METHODS: Patients undergoing EVAR from 2000 to 2011 at three vascular centres (in 2 countries), who had two imaging examinations (postoperative and after 6-18 months), were included. Maximum diameter, complications and secondary interventions during follow-up were registered. Patients were categorized according to early sac dynamics. The primary endpoint was freedom from late complications. Secondary endpoints were freedom from secondary intervention, postimplant rupture and direct (type I/III) endoleaks. RESULTS: Some 597 EVARs (71.1 per cent of all EVARs) were included. No shrinkage was observed in 284 patients (47.6 per cent), moderate shrinkage (5-9 mm) in 142 (23.8 per cent) and major shrinkage (at least 10 mm) in 171 patients (28.6 per cent). Four years after the index imaging, the rate of freedom from complications was 84.3 (95 per cent confidence interval 78.7 to 89.8), 88.1 (80.6 to 95.5) and 94.4 (90.1 to 98.7) per cent respectively. No shrinkage was an independent risk factor for late complications compared with major shrinkage (hazard ratio (HR) 3.11; P < 0.001). Moderate compared with major shrinkage (HR 2.10; P = 0.022), early postoperative complications (HR 3.34; P < 0.001) and increasing abdominal aortic aneurysm baseline diameter (HR 1.02; P = 0.001) were also risk factors for late complications. Freedom from secondary interventions and direct endoleaks was greater for patients with major sac shrinkage. CONCLUSION: Early change in aneurysm sac diameter is a strong predictor of late complications after EVAR. Patients with major sac shrinkage have a very low risk of complications for up to 5 years. This parameter may be used to tailor postoperative surveillance

Acute Kidney Injury Following Elective Infrarenal and Complex Endovascular Aneurysm Repair:Incidence, Prognostic Significance, and Risk Factors

Objective:Acute kidney injury (AKI) is a well known complication following cardiovascular procedures. The objective of this study was to assess incidence, risk factors, and the prognostic significance of AKI following infrarenal endovascular aneurysm repair (EVAR) and complex EVAR (c-EVAR).Methods:Consecutive patients undergoing elective infrarenal EVAR or c-EVAR between 2000 and 2018 in two large teaching hospitals in the Netherlands were included. The primary outcome was incidence of peri-operative AKI development. Secondary outcomes included midterm renal function (RIFLE criteria), overall survival, and risk factors for AKI development. To determine survival and risk factors for AKI, multivariable analyses were performed, accounting for pre-operative renal function and other confounders.Results:Five hundred and forty patients were included who underwent infrarenal EVAR and 147 patients who underwent c-EVAR. Incidence of AKI was 8.7% (n = 47) in infrarenal EVAR patients, and 23% (n = 34) in c-EVAR patients (fenestrated EVAR 18%/branched EVAR 38%). After risk adjusted analysis, compared with non-AKI, post-operative AKI development was associated with higher three year mortality following both infrarenal and c-EVAR (infrarenal EVAR mortality HR 1.6 [95% CI 1.01 – 2.7], p = .046; c-EVAR mortality HR 2.4 [95% CI 1.1 – 5.2], p =.033). Following multivariable logistic regression, pre-operative chronic kidney disease (eGFR &lt; 60; OR 2.2 [95% CI 1.03 – 4.8]) and neck diameter (OR[/mm] 1.1 [95% CI 1.01 – 1.2]) were statistically significantly associated with AKI following infrarenal EVAR, whereas for c-EVAR only contrast volume (OR[/10cc] 1.1 [95% CI 1.0 – 1.2]) was found to be statistically significantly associated with AKI.Conclusion:AKI is a well described complication following infrarenal EVAR and is common after c-EVAR. As AKI seems to be associated with permanent renal deterioration and lower survival, efforts to prevent AKI are essential

Acute Kidney Injury Following Elective Infrarenal and Complex Endovascular Aneurysm Repair:Incidence, Prognostic Significance, and Risk Factors

Objective:Acute kidney injury (AKI) is a well known complication following cardiovascular procedures. The objective of this study was to assess incidence, risk factors, and the prognostic significance of AKI following infrarenal endovascular aneurysm repair (EVAR) and complex EVAR (c-EVAR).Methods:Consecutive patients undergoing elective infrarenal EVAR or c-EVAR between 2000 and 2018 in two large teaching hospitals in the Netherlands were included. The primary outcome was incidence of peri-operative AKI development. Secondary outcomes included midterm renal function (RIFLE criteria), overall survival, and risk factors for AKI development. To determine survival and risk factors for AKI, multivariable analyses were performed, accounting for pre-operative renal function and other confounders.Results:Five hundred and forty patients were included who underwent infrarenal EVAR and 147 patients who underwent c-EVAR. Incidence of AKI was 8.7% (n = 47) in infrarenal EVAR patients, and 23% (n = 34) in c-EVAR patients (fenestrated EVAR 18%/branched EVAR 38%). After risk adjusted analysis, compared with non-AKI, post-operative AKI development was associated with higher three year mortality following both infrarenal and c-EVAR (infrarenal EVAR mortality HR 1.6 [95% CI 1.01 – 2.7], p = .046; c-EVAR mortality HR 2.4 [95% CI 1.1 – 5.2], p =.033). Following multivariable logistic regression, pre-operative chronic kidney disease (eGFR &lt; 60; OR 2.2 [95% CI 1.03 – 4.8]) and neck diameter (OR[/mm] 1.1 [95% CI 1.01 – 1.2]) were statistically significantly associated with AKI following infrarenal EVAR, whereas for c-EVAR only contrast volume (OR[/10cc] 1.1 [95% CI 1.0 – 1.2]) was found to be statistically significantly associated with AKI.Conclusion:AKI is a well described complication following infrarenal EVAR and is common after c-EVAR. As AKI seems to be associated with permanent renal deterioration and lower survival, efforts to prevent AKI are essential