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Gottsäter A. Bypassing Amputations in BEST-CLI. Eur J Vasc Endovasc Surg 2024:S1078-5884(24)00493-3. [PMID: 38906367 DOI: 10.1016/j.ejvs.2024.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 06/16/2024] [Indexed: 06/23/2024]
Affiliation(s)
- Anders Gottsäter
- Department of Internal Medicine, Clinical Research Unit, Lund University, Skåne University Hospital, Malmö, Sweden.
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2
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Behrendt CA, Koncar I. Treatment of Lower Extremity Peripheral Arterial Disease. Eur J Vasc Endovasc Surg 2024:S1078-5884(24)00474-X. [PMID: 38871212 DOI: 10.1016/j.ejvs.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Accepted: 06/05/2024] [Indexed: 06/15/2024]
Affiliation(s)
- Christian-Alexander Behrendt
- Department of Vascular and Endovascular Surgery, Asklepios Clinic Wandsbek, Asklepios Medical School, Hamburg, Germany; Medical School Brandenburg, Theodor Fontane, Neuruppin, Germany.
| | - Igor Koncar
- Clinic for Vascular and Endovascular Surgery, University Clinical Centre of Serbia, Belgrade, Serbia
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3
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Fransson T, Sturedahl AD, Resch T, Björn E, Gottsäter A. Nationwide Study of the Outcome of Treatment of Lower Extremity Atherosclerotic Lesions With Endovascular Surgery With or Without Drug Eluting Methods in Patients With Diabetes. J Endovasc Ther 2024:15266028241241967. [PMID: 38577781 DOI: 10.1177/15266028241241967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
CLINICAL IMPACT This retrospective observational registry trial combines national registries for vascular surgical procedures and diabetes mellitus to clarify results of drug eluting technology in treating diabetic subjects with intermittent claudication or chronic limb threatening ischemia compared to treatment of non-diabetic subjects. As earlier proposed and showed in this trial, there may be an implication for a beneficial treatment efficacy with drug eluting therapy in the diabetic population with PAD compared to the non-diabetic population. A finding worth further exploration.
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Affiliation(s)
- Torbjörn Fransson
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Vascular Center, Department of Thoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden
| | - Andrea Dahl Sturedahl
- National Diabetes Register, Department of Data Management and Analysis, Region Västra Götaland, Gothenburg, Sweden
| | - Timothy Resch
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Vascular Surgery, Copenhagen University Hospital, Copenhagen, Denmark
- Faculty of Health Sciences, Copenhagen University, Copenhagen, Denmark
| | - Eliasson Björn
- National Diabetes Register, Department of Data Management and Analysis, Region Västra Götaland, Gothenburg, Sweden
- Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anders Gottsäter
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Medicine, Skåne University Hospital, Malmö, Sweden
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4
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Gormley S, Mao J, Sedrakyan A, Beck AW, Mani K, Beiles B, Szeberin Z, Venermo M, Cassar K, Khashram M. The association of ruptured abdominal aortic aneurysm diameter with mortality in the International Consortium of Vascular Registries. J Vasc Surg 2024; 79:748-754.e2. [PMID: 38013041 PMCID: PMC11144387 DOI: 10.1016/j.jvs.2023.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 11/15/2023] [Accepted: 11/21/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND The mortality after ruptured abdominal aortic aneurysm (rAAA) repair is high, despite improvements in perioperative care, centralization of emergency vascular surgical services, and the introduction of endovascular aneurysm repair (EVAR). The diameter of intact AAA has been shown to be a predictor of short- and long-term survival. The aim of this study was to analyze the impact of AAA diameter on mortality for rAAA repair using contemporary data collected from the International Consortium of Vascular Registries and compare outcomes by sex and the type of repair patients received. METHODS Prospective registry data on repair of rAAA from seven countries were collected from 2010 to 2016. The primary outcome was perioperative mortality after EVAR and open surgical repair (OSR). Data were stratified by type of repair and sex. Logistic regression models were used to estimate odds ratio (OR) for the association between AAA diameter and perioperative mortality and the association between type of repair and mortality. Multivariable logistic regression models were used to adjust for differences in patient characteristics. RESULTS The study population consisted of 6428 patients with a mean age ranging from 70.2 to 75.4 years; the mean AAA diameter was 7.7 ± 1.8 cm. Females had a significantly smaller AAA diameter at presentation compared with males (6.9 ± 1.6 cm vs 7.9 ± 1.8 cm; P < .001). who underwent OSR had larger AAA diameters compared with those who underwent EVAR (P < .001). Females who underwent repair were significantly older (P < .001). Males were more likely to have cardiac disease, diabetes mellitus, and renal impairment. Overall, AAA diameter was a predictor of mortality in univariate and multivariate analysis. When analyzing EVAR and OSR separately, the impact of AAA diameter per cm increase on mortality was apparent in both males and females undergoing EVAR, but not OSR (EVAR: male OR, 1.09 [95% confidence interval, 1.03-1.16] and EVAR: female OR, 1.17 [95% confidence interval, 1.02-1.35]). The early mortality rate for males and females who underwent EVAR was 18.9% and 25.9% (P < .001), respectively. The corresponding mortality for males and females who underwent OSR was 30.2% and 38.6% (P < .001), respectively. CONCLUSIONS In these real-world international data, there is a significant association between rAAA diameters and early mortality in males and females. This association was more evident in patients undergoing EVAR, but not shown in OSR. Despite improvements in overall AAA repair outcomes, the risk of mortality after rAAA repair is consistently higher for females.
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Affiliation(s)
- Sinead Gormley
- Department of Surgery, University of Auckland, Auckland, NZ; Department of Vascular & Endovascular Surgery, Waikato Hospital, Hamilton, NZ
| | - Jialin Mao
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY
| | - Art Sedrakyan
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY
| | - Adam W Beck
- Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AL
| | - Kevin Mani
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Barry Beiles
- Australasian Vascular Audit, Australia & New Zealand Society for Vascular Surgery, Melbourne, Australia
| | - Zoltan Szeberin
- Department of Vascular Surgery, Semmelweis University, Budapest, Hungary
| | - Maarit Venermo
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kevin Cassar
- Department of Surgery, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Manar Khashram
- Department of Surgery, University of Auckland, Auckland, NZ; Department of Vascular & Endovascular Surgery, Waikato Hospital, Hamilton, NZ.
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5
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Nordanstig J, Behrendt CA, Baumgartner I, Belch J, Bäck M, Fitridge R, Hinchliffe R, Lejay A, Mills JL, Rother U, Sigvant B, Spanos K, Szeberin Z, van de Water W, Antoniou GA, Björck M, Gonçalves FB, Coscas R, Dias NV, Van Herzeele I, Lepidi S, Mees BME, Resch TA, Ricco JB, Trimarchi S, Twine CP, Tulamo R, Wanhainen A, Boyle JR, Brodmann M, Dardik A, Dick F, Goëffic Y, Holden A, Kakkos SK, Kolh P, McDermott MM. Editor's Choice -- European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Asymptomatic Lower Limb Peripheral Arterial Disease and Intermittent Claudication. Eur J Vasc Endovasc Surg 2024; 67:9-96. [PMID: 37949800 DOI: 10.1016/j.ejvs.2023.08.067] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 08/14/2023] [Indexed: 11/12/2023]
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Shafiee F, Sarbaz M, Marouzi P, Banaye Yazdipour A, Kimiafar K. Providing a framework for evaluation disease registry and health outcomes Software: Updating the CIPROS checklist. J Biomed Inform 2024; 149:104574. [PMID: 38101688 DOI: 10.1016/j.jbi.2023.104574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 11/27/2023] [Accepted: 12/08/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND AND AIMS Properly designed and implemented registry systems play an important role in improving health outcomes and reducing care costs, and can provide a true representation of clinical practice, disease outcomes, safety, and efficacy. Therefore, the aim of this study was to redesign and develop a checklist with items for a patient registry software system (CIPROS) Checklist. METHOD The study is descriptive-cross-sectional. The extraction of the data elements of the checklist was first done through a comprehensive review of the texts in PubMed, Science Direct and Scopus databases and receiving articles related to the evaluation of registry systems. Based on the extracted data, a five-point Likert scale questionnaire was created and 30 experts in this field were asked for their opinions using the two-step Delphi method. RESULTS A total of 100 information items were determined as a registry software evaluation checklist. This checklist included 12 groups of software architecture factors, development, interfaces and interactivity, semantics and standardization, internationality, data management, data quality and usability, data analysis, security, privacy, organizational, education and public factors. CONCLUSION By using the results of this research, it is possible to identify the defects and possible strengths of the registry software and put it at the disposal of the relevant officials to make a decision in this field. In this way, among the designers and developers of these softwares, the best and most appropriate ones are selected with the needs of the registry programs.
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Affiliation(s)
- Fatemeh Shafiee
- Department of Health Information Technology, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Masoume Sarbaz
- Department of Health Information Technology, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Parviz Marouzi
- Department of Health Information Technology, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Alireza Banaye Yazdipour
- Department of Health Information Technology, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Health Information Management and Medical Informatics, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran; Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran.
| | - Khalil Kimiafar
- Department of Health Information Technology, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran.
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7
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Lopez-Espada C, Linares-Palomino J, Guerra Requena M, Serrano Hernando FJ, Iborra Ortega E, Fernández-Samos R, Zanabili Al-Sibbai A, González Cañas E, Rodriguez Sánchez JM, Zaragozá García JM, García León A, Manzano Grossi S, de Benito L, Gil Sala D, Revuelta Mariño L. Multicenter Comparative Analysis of Late Open Conversion in Patients With Adherence and Nonadherence to Instructions for Use Endovascular Aneurysm Repair. J Endovasc Ther 2023; 30:867-876. [PMID: 35735201 DOI: 10.1177/15266028221102658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The widespread adoption of endovascular aneurysm repair (EVAR) as preferred treatment modality for abdominal aortic aneurysm (AAA) has enlarged the number of patients needing open surgical conversion (OSC). The relationship between adherence to Instructions For Use (IFU) and EVAR long-term outcomes remains controversial. The aim of this study is to compare preoperative differences and postoperative outcomes between EVAR patients not adjusted to IFU and adjusted to IFU who underwent OSC. METHODS This multicenter retrospective study reviewed 33 explanted EVARs between January 2003 and December 2019 at 14 Vascular Units. Patients were included if OSC occurred >30 days after implantation and excluded if explantation was performed to treat an endograft infection, aortic dissection, or traumatic transections. Variables analyzed included baseline characteristics, adherence to IFU, implant and explant procedural details, secondary reinterventions, and postoperative outcomes. RESULTS Fifteen explanted patients (15/33, 45.5%) were identified not accomplished to IFU (out-IFU) at initial EVAR vs 18 explanted patients adjusted (in-IFU). During follow-up, a mean of 1.73±1.2 secondary reinterventions were performed, with more type I endoleaks treated in the subgroup out-IFU: 16.7% vs 6.3% in-IFU patients and more type III endoleaks (8.3% vs 0%). Patients out-IFU had shorter mean interval from implant to explant: 47.60±28.8 months vs 71.17±48. Type II endoleak was the most frequent indication for explantation. Low-flow endoleaks (types II, IV, V) account for 44% of indications for OSC in subgroup of patients in-IFU, compared with 13.3% in patients out-IFU and high-flow endoleaks (types I and III) were the main indication for patients out-IFU (33.3% vs 16.7% in-IFU). Total endograft explantation was performed in 57.5% of cases (19/33) and more suprarenal clamping was required in the subgroup out-IFU. Overall, 30-day mortality rate was 12.1% (4/33): 20% for patients out-IFU and 5.6% in-IFU. CONCLUSIONS In our experience, type II endoleak is the most common indication for conversion and differences have been found between patients treated outside IFU with explantation taking place earlier during follow-up, mainly due to high-flow endoleaks and with higher mortality in comparison with patients adjusted to IFU. Ongoing research is required to delve into these differences.
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Affiliation(s)
| | - Jose Linares-Palomino
- Vascular Surgery Unit, University Hospital Virgen de las Nieves, Granada, Spain
- Department of Surgery, University of Granada, Granada, Spain
| | | | | | | | | | | | - Elena González Cañas
- Vascular Surgery Unit, Corporació Sanitaria Parc Tauli de Sabadell, Sabadell, Spain
| | | | | | - Andrés García León
- Vascular Surgery Unit, University Hospital Virgen de Valme, Sevilla, Spain
| | | | - Luis de Benito
- Vascular Surgery Unit, University Hospital Fundación Alcorcón, Madrid, Spain
| | - Daniel Gil Sala
- Vascular Surgery Unit, Vall d'Hebron University Hospital, Barcelona, Spain
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Roosendaal LC, Radović M, Hoebink M, Wiersema AM, Blankensteijn JD, Jongkind V. The Additional Value of Activated Clotting Time-Guided Heparinization During Interventions for Peripheral Arterial Disease. J Endovasc Ther 2023:15266028231213611. [PMID: 38008930 DOI: 10.1177/15266028231213611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023]
Abstract
PURPOSE Unfractionated heparin is widely used to lower the risk of arterial thromboembolic complications (ATECs) during interventions for peripheral arterial disease (PAD), but it is still unknown which heparin dose is the safest in terms of preventing ATECs and bleeding complications. This study aims to evaluate the incidence of complications during interventions for PAD and the relation between this incidence and different heparinization protocols. MATERIALS AND METHODS A retrospective analysis of a prospective multicenter cohort study was performed. Between June 2015 and September 2022, 355 patients who underwent peripheral interventions for PAD were included. All patients who were included before July 2018 received 5000 international units (IU) of heparin (group 1). Starting from July 2018, all included patients received an initial dose of 100 IU/kg, with potential additional heparin doses based on activated clotting time (ACT) values (group 2). Data on ACT values and complications within 30 days post-procedurally were collected. RESULTS In total, 24 ATECs and 48 bleeding complications occurred. In group 1, 8.7% (n=11) of patients suffered from ATEC, compared with 5.7% (n=13) in group 2. Thirteen percent of patients (n=17) in group 1 had a bleeding complication, compared with 14% (n=31) in group 2. Arterial thromboembolic complications were more often found in patients with peak ACT values of <200 seconds, compared with ACT values between 200 and 250 seconds, 15% (n=6) versus 5.9% (n=9), respectively, p=0.048. Patients with peak ACT values >250 seconds had a higher incidence of bleeding complications compared with an ACT between 200 and 250 seconds, 24% (n=21) versus 9.8% (n=15), respectively, p=0.003. Forty-four percent of patients (n=23) in group 1 reached a peak ACT of >200 seconds, compared with 95% (n=218) of patients in group 2 (p=0.001). CONCLUSION ATEC was found in 6.8% (n=24) and bleeding complications in 14% (n=48) of patients who underwent a procedure for PAD. There was a significantly higher incidence of ATECs in patients with a peak ACT value <200 seconds, and a higher incidence of bleeding complications in patients with a peak ACT value >250 seconds. The findings obtained from this study may serve as a basis for conducting future research on heparinization during procedures for PAD, with a larger sample size. CLINICAL IMPACT Heparin is administered during arterial interventions for peripheral arterial disease (PAD) to decrease the risk of arterial (thrombo)embolic complications (ATEC) during or shortly following surgery. The effect of heparin is unpredictable in the individual patient, and the optimal dosage of this anticoagulant has not yet been established. Using the activated clotting time (ACT), the anticoagulatory effect of heparin can be monitored periprocedurally. Previous research on the incidence of both ATEC and bleeding complications, or on the optimal dosage of heparin administration, is scarce. This study aims to investigate the incidence of ATEC and bleeding complications between 2 different dosage protocols of heparin-a standard bolus of 5000 IU or ACT-guided heparinization-and thereby provide clarity on the optimal dose of heparin during peripheral arterial interventions for PAD.
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Affiliation(s)
- Liliane C Roosendaal
- Department of Vascular Surgery, Dijklander Ziekenhuis, Hoorn, The Netherlands
- Department of Vascular Surgery, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
- Microcirculation, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Mila Radović
- Department of Vascular Surgery, Dijklander Ziekenhuis, Hoorn, The Netherlands
| | - Max Hoebink
- Department of Vascular Surgery, Dijklander Ziekenhuis, Hoorn, The Netherlands
- Department of Vascular Surgery, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
- Microcirculation, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Arno M Wiersema
- Department of Vascular Surgery, Dijklander Ziekenhuis, Hoorn, The Netherlands
- Department of Vascular Surgery, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
- Microcirculation, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Jan D Blankensteijn
- Department of Vascular Surgery, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
- Microcirculation, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Vincent Jongkind
- Department of Vascular Surgery, Dijklander Ziekenhuis, Hoorn, The Netherlands
- Department of Vascular Surgery, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
- Microcirculation, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
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Nugteren MJ, Hazenberg CEVB, Akkersdijk GP, Bakker OJ, Dinkelman MK, Fioole B, van den Heuvel DAF, Heyligers JMM, Hinnen JW, Pierie M, Schouten O, Schreve MA, Verhoeven BAN, de Borst GJ, Ünlü Ç. The Dutch chronic lower limb-threatening ischemia registry (THRILLER): A study protocol for popliteal and infrapopliteal endovascular interventions. PLoS One 2023; 18:e0288912. [PMID: 37471351 PMCID: PMC10358906 DOI: 10.1371/journal.pone.0288912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 07/04/2023] [Indexed: 07/22/2023] Open
Abstract
INTRODUCTION Chronic limb-threatening ischemia (CLTI) is the end stage of peripheral arterial disease (PAD) and is associated with high amputation rates, mortality and disease-related health care costs. In infrapopliteal arterial disease (IPAD), endovascular revascularization should be considered for the majority of anatomical and clinical subgroups of CLTI. However, a gap of high-quality evidence exists in this field. The aim of the Dutch Chronic Lower Limb-Threatening Ischemia Registry (THRILLER) is to collect real world data on popliteal and infrapopliteal endovascular interventions. METHODS THRILLER is a clinician-driven, prospective, multicenter, observational registry including all consecutive patients that undergo a popliteal or infrapopliteal endovascular intervention in seven Dutch hospitals. We estimate that THRILLER will include 400-500 interventions annually. Standardized follow-up visits with wound monitoring, toe pressure measurement and duplex ultrasonography will be scheduled at 6-8 weeks and 12 months after the intervention. The independent primary endpoints are primary patency, limb salvage and amputation free survival. Patients must give informed consent before participation and will be included according to predefined reporting standards. A data log of patients who meet the inclusion criteria but are not included in the registry will be maintained. We intend to conduct the first interim analysis two years after the start of inclusion. The results will be published in a scientific journal. DISCUSSION Despite innovations in medical therapy and revascularization techniques, patients with CLTI undergoing endovascular revascularization still have a moderate prognosis. Previous prospective cohort studies were hampered by small sample sizes or heterogeneous reporting. Randomized controlled trials (RCTs) have high costs, potential conflicts of interest and give a limited reflection of daily practice. THRILLER aims to provide the largest prospective well phenotyped up-to-date dataset on treatment outcomes in CLTI patients to answer multiple underexplored research questions regarding diagnostics, medication, patient selection, treatment strategies and post intervention follow-up.
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Affiliation(s)
- Michael J Nugteren
- Department of Vascular Surgery, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - George P Akkersdijk
- Department of Vascular Surgery, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | - Olaf J Bakker
- Department of Vascular Surgery, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | - Maarten K Dinkelman
- Department of Vascular Surgery, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands
| | - Bram Fioole
- Department of Vascular Surgery, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | | | - Jan M M Heyligers
- Department of Vascular Surgery, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands
| | - Jan-Willem Hinnen
- Department of Vascular Surgery, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, The Netherlands
| | - Maurice Pierie
- Department of Vascular Surgery, Isala Ziekenhuis, Zwolle, The Netherlands
| | - Olaf Schouten
- Department of Vascular Surgery, Isala Ziekenhuis, Zwolle, The Netherlands
| | - Michiel A Schreve
- Department of Vascular Surgery, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Bart A N Verhoeven
- Department of Vascular Surgery, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, The Netherlands
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Çağdaş Ünlü
- Department of Vascular Surgery, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
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10
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Peters F, Behrendt CA. Limb Related Outcomes of Endovascular vs. Open Surgical Revascularisation in Patients with Peripheral Arterial Occlusive Disease: A Report from the Prospective GermanVasc Cohort Study. Eur J Vasc Endovasc Surg 2023; 66:85-93. [PMID: 36972814 DOI: 10.1016/j.ejvs.2023.03.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 03/01/2023] [Accepted: 03/23/2023] [Indexed: 03/28/2023]
Abstract
OBJECTIVE The goal of this study was to compare clinical outcomes in patients with peripheral arterial occlusive disease undergoing revascularisation by peripheral endovascular intervention (EVI), bypass surgery, endarterectomy (EA), and hybrid surgery in an unselected real world setting. METHODS This was a German, prospective, multicentre, comparative cohort study, enrolling patients at hospital admission for revascularisation at 35 vascular centres with 12 months of follow up. Primary composite endpoints were major amputation or death, major adverse limb events, and any minor or major amputation. Twelve month incidences and hazard ratios (HRs) for the four subgroups and 95% confidence intervals (CIs) were estimated using Kaplan-Meier functions and Cox proportional hazard models. Sociodemographic and clinical characteristics, pharmacological treatment, and comorbidities were used to adjust for patient differentials (unique identifier ClinicalTrials.gov: NCT03098290). RESULTS In total, 4 475 patients were analysed (mean age 69 years, 69.4% males, and 31.5% suffering from chronic limb threatening ischaemia). After 12 months of follow up, 5.3% (95% CI 3.6 - 6.9%) of the patients experienced either death or major amputation, 7.2% (95% CI 4.8 - 9.6%) major adverse limb event, and 6.6% (95% CI 5.0 - 8.2%) any minor or major amputation. Compared with EVI, bypass surgery was associated with an increased risk of amputation or death (HR 2.59, 95% CI 1.75 - 3.85), major adverse limb event (HR 1.93, 95% CI 1.11 - 3.36), and any minor or major amputation (HR 2.12, 95% CI 1.42 - 3.16), and hybrid surgery with an increased risk of amputation or death (HR 2.29, 95% CI 1.27 - 4.13) and major adverse limb event (HR 1.62, 95% CI 1.03 - 2.54). After adjusting for patient differentials, no significant differences among study groups remained. CONCLUSION More favourable outcomes after EVI were completely attributed to differentials in patient characteristics and not procedure type. The current study emphasised that all competing approaches performed similarly in a real world setting.
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Affiliation(s)
- Frederik Peters
- Research Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Christian-Alexander Behrendt
- Research Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Department of Vascular and Endovascular Surgery, Asklepios Clinic Wandsbek, Asklepios Medical School, Hamburg, Germany; Brandenburg Medical School Theodor Fontane, Neuruppin, Germany.
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11
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Bryant E, Broomfield C, Burrows J, McLean S, Marks P, Maloney D, Touyz S, Maguire S. Gaining consensus on clinical quality outcomes for eating disorders: Framework for the development of an Australian national minimum dataset. BMJ Open 2023; 13:e071150. [PMID: 37076147 PMCID: PMC10124290 DOI: 10.1136/bmjopen-2022-071150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
OBJECTIVES Eating disorders (EDs) are complex psychiatric illnesses requiring multidisciplinary care across both mental and medical healthcare settings. Currently, no nationally comprehensive, consistent, agreed on or mandated data set or data collection strategy exists for EDs in Australia: thus, little is known about the outcomes of care nor treatment pathways taken by individuals with EDs. InsideOut Institute was contracted by the Australian Government Department of Health to develop a minimum dataset (MDS) for the illness group with consideration given to data capture mechanisms and the scoping of a national registry. DESIGN A four-step modified Delphi methodology was used, including national consultations followed by three rounds of quantitative feedback by an expert panel. SETTING Due to social distancing protocols throughout the global SARS-CoV-2 pandemic, the study was conducted online using video conferencing (Zoom and Microsoft Teams) (Step 1), email communication and the REDCap secure web-based survey platform (Steps 2-4). PARTICIPANTS 14 data management organisations, 5 state and territory government departments of health, 2 Aboriginal and Torres Strait Islander advising organisations and 28 stakeholders representing public and private health sectors across Australia participated in consultations. 123 ED experts (including lived experience) participated in the first quantitative round of the Delphi survey. Retention was high, with 80% of experts continuing to the second round and 73% to the third. MAIN OUTCOME MEASURES Items and categories endorsed by the expert panel (defined a priori as >85% rating an item or category 'very important' or 'imperative'). RESULTS High consensus across dataset items and categories led to the stratification of an identified MDS. Medical status and quality of life were rated the most important outcomes to collect in an MDS. Other items meeting high levels of consensus included anxiety disorders, depression and suicidality; type of treatment being received; body mass index and recent weight change. CONCLUSIONS Understanding presentation to and outcomes from ED treatment is vital to drive improvements in healthcare delivery. A nationally agreed MDS has been defined to facilitate this understanding and support improvements.
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Affiliation(s)
- Emma Bryant
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Camperdown, Sydney, Australia
| | - Catherine Broomfield
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Camperdown, Sydney, Australia
| | - Jennifer Burrows
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Camperdown, Sydney, Australia
| | - Sian McLean
- Department of Psychology, Counselling and Therapy, La Trobe University, Melbourne, Victoria, Australia
- Australia and New Zealand Academy for Eating Disorders, Castlecrag, New South Wales, Australia
| | - Peta Marks
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Camperdown, Sydney, Australia
| | - Danielle Maloney
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Camperdown, Sydney, Australia
| | - Stephen Touyz
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Camperdown, Sydney, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Camperdown, Sydney, Australia
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Behrendt CA, Larena-Avellaneda A, Gombert A, Rother U. Evidenzbasierte antithrombotische Therapie der peripheren arteriellen Verschlusskrankheit (PAVK). GEFÄSSCHIRURGIE 2023. [DOI: 10.1007/s00772-023-00992-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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13
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Bouguennec N, Thaunat M, Barth J, Cavaignac E, Gunepin FX, Letartre R, Netten A, Pujol N, Rousseau T, Sbihi J, Mouton C, Sfa TFAS. Consensus statement on data to be entered in the ACL tear registry: SFA-DataLake. Orthop Traumatol Surg Res 2022; 108:103392. [PMID: 36064107 DOI: 10.1016/j.otsr.2022.103392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/11/2022] [Accepted: 07/15/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Anterior cruciate ligament (ACL) reconstruction is a frequent procedure, with room for improvement by rehabilitation measures and associated peripheral and meniscal surgeries that are currently under assessment, requiring follow-up. Outside France, there have been ACL registries for 20 years now. The French Arthroscopy Society (SFA) decided to set up an ACL tear registry within its SFA DataLake registry platform. MATERIAL AND METHOD This article presents the methodology underlying the ACL Tear Registry: i.e., identification, definition and coding of essential and relevant data. A test phase comprised an initial assessment to improve data quality and overall coherence, to optimize data-entry time for patients and practitioners, who are the guarantors of the registry's use and efficacy. RESULTS The SFA DataLake ACL Tear Registry was made available to SFA members in December 2021. It aims to enable a review of practices for surgeons, early detection of failure of procedures and implants, with rates of failure and abnormal complications, and identification of prognostic factors for outcome, especially regarding original items that do not figure in previous registries. CONCLUSION SFA DataLake strikes a balance between "indispensable" and "original" items. The choice of contents and data quality is founded on a robust methodology with overall coherence, enabling analysis of large cohorts and comparisons with the literature and other registries. However, it remains to assess rates of data entry and item relevance as the Registry progresses. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | - Mathieu Thaunat
- Ramsay santé, centre orthopédique Santy, hôpital privé Jean-Mermoz, 24, avenue Paul-Santy, 69008 Lyon, France
| | - Johannes Barth
- Clinique des Cèdres, 21, avenue Albert-Londres, 38130 Échirolles, France
| | - Etienne Cavaignac
- Clinique universitaire du sport, 1, place du Docteur Joseph-Baylac, 31300 Toulouse, France
| | - François-Xavier Gunepin
- Clinique mutualiste de la porte de l'Orient, 3 rue Robert-de-La-Croix, 56100 Lorient, France
| | - Romain Letartre
- Ramsay santé, hôpital privé la Louvière, 126, rue de la Louvière, 59800 Lille, France
| | | | - Nicolas Pujol
- Centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France
| | - Thomas Rousseau
- Clinique mutualiste catalane, 60, rue Louis-Mouillard, 66000 Perpignan, France
| | - Jaafar Sbihi
- Clinique Juge, 116, rue J.-Mermoz, 13008 Marseille, France
| | - Caroline Mouton
- Department of Orthopaedic Surgery, Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, centre hospitalier Luxembourg, clinique d'Eich, Luxembourg, Luxembourg
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Sedrakyan A, Marinac-Dabic D, Campbell B, Aryal S, Baird CE, Goodney P, Cronenwett JL, Beck AW, Paxton EW, Hu J, Brindis R, Baskin K, Cowley T, Levy J, Liebeskind DS, Poulose BK, Rardin CR, Resnic FS, Tcheng J, Fisher B, Viviano C, Devlin V, Sheldon M, Eldrup-Jorgensen J, Berlin JA, Drozda J, Matheny ME, Dhruva SS, Feeney T, Mitchell K, Pappas G. Advancing the Real-World Evidence for Medical Devices through Coordinated Registry Networks. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2022; 4:e000123. [PMID: 36393894 PMCID: PMC9660584 DOI: 10.1136/bmjsit-2021-000123] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/31/2021] [Indexed: 11/16/2022] Open
Abstract
ObjectivesGenerating and using real-world evidence (RWE) is a pragmatic solution for evaluating health technologies. RWE is recognized by regulators, health technology assessors, clinicians, and manufacturers as a valid source of information to support their decision-making. Well-designed registries can provide RWE and become more powerful when linked with electronic health records and administrative databases in coordinated registry networks (CRNs). Our objective was to create a framework of maturity of CRNs and registries, so guiding their development and the prioritization of funding.Design, setting, and participantsWe invited 52 stakeholders from diverse backgrounds including patient advocacy groups, academic, clinical, industry and regulatory experts to participate on a Delphi survey. Of those invited, 42 participated in the survey to provide feedback on the maturity framework for CRNs and registries. An expert panel reviewed the responses to refine the framework until the target consensus of 80% was reached. Two rounds of the Delphi were distributed via Qualtrics online platform from July to August 2020 and from October to November 2020.Main outcome measuresConsensus on the maturity framework for CRNs and registries consisted of seven domains (unique device identification, efficient data collection, data quality, product life cycle approach, governance and sustainability, quality improvement, and patient-reported outcomes), each presented with five levels of maturity.ResultsOf 52 invited experts, 41 (79.9%) responded to round 1; all 41 responded to round 2; and consensus was reached for most domains. The expert panel resolved the disagreements and final consensus estimates ranged from 80.5% to 92.7% for seven domains.ConclusionsWe have developed a robust framework to assess the maturity of any CRN (or registry) to provide reliable RWE. This framework will promote harmonization of approaches to RWE generation across different disciplines and health systems. The domains and their levels may evolve over time as new solutions become available.
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Affiliation(s)
- Art Sedrakyan
- Department of Population Health Sciences; Medical Devices Epidemiology Network (MDEpiNet) Coordinating Center, Weill Cornell Medical College, New York, New York, USA
| | - Danica Marinac-Dabic
- Center for Devices and Radiological Health (CDRH), US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Bruce Campbell
- Vascular Surgery, University of Exeter Medical School, Exter, UK
| | - Suvekshya Aryal
- Department of Population Health Sciences; Medical Devices Epidemiology Network (MDEpiNet) Coordinating Center, Weill Cornell Medical College, New York, New York, USA
| | - Courtney E Baird
- Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Philip Goodney
- Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Jack L Cronenwett
- Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Adam W Beck
- Division of Vascular Surgery and Endovascular Therapy, University of Alabama, Birmingham, Alabama, USA
| | - Elizabeth W Paxton
- Surgical Outcomes and Analysis, Kaiser Permanente, Harbor City, California, USA
| | - Jim Hu
- Department of Urology, Weill Cornell Medical College, New York, New York, USA
| | - Ralph Brindis
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
| | - Kevin Baskin
- Vascular and Interventional Radiology, Conemaugh Memorial Medical Center, Johnstown, Pennsylvania, USA
| | | | - Jeffery Levy
- Robotic Surgery, Institute of Surgical Excellence, Philadelphia, Pennsylvania, USA
| | - David S Liebeskind
- Department of Neurology, Stroke Center, University of California Los Angeles, Los Angeles, California, USA
| | - Benjamin K Poulose
- Center for Abdominal Core Health, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Charles R Rardin
- Department of Obstetrics and Gyencology, Women and Infants Hospital of Rhode Island, Providence, Rhode Island, USA
| | - Frederic S Resnic
- Department of Cardiology, Comparative Effective Research Institute, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - James Tcheng
- Department of Medicine, Division of Cardiology, Duke University, Durham, North Carolina, USA
| | - Benjamin Fisher
- Center for Devices and Radiological Health (CDRH), US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Charles Viviano
- Center for Devices and Radiological Health (CDRH), US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Vincent Devlin
- Center for Devices and Radiological Health (CDRH), US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Murray Sheldon
- Center for Devices and Radiological Health (CDRH), US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Jens Eldrup-Jorgensen
- Vascular Surgery, Maine Medical Center, Portland, Maine, USA
- Surgery, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Jesse A Berlin
- Global Epidemiology, Johnson and Johnson Limited, New Brunswick, New Jersey, USA
| | - Joseph Drozda
- Outcomes Research, Mercy Health, St. Louis, Missouri, USA
| | - Michael E Matheny
- Department of Biomedical Informatics and Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sanket S Dhruva
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Timothy Feeney
- Department of Surgery, Boston University, Boston, Massachusetts, USA
| | | | - Gregory Pappas
- Center for Biologicals Evaluation and Research (CBER), US Food and Drug Administration, Silver Spring, Maryland, USA
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Baird CE, Chughtai B, Bradley CS, Kobashi K, Jung M, Sedrakyan A, Andrews S, Ferriter A, Cornelison T, Marinac-Dabic D. Development of a coordinated registry network for pelvic organ prolapse technologies. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2022; 4:e000076. [PMID: 36393893 PMCID: PMC9660621 DOI: 10.1136/bmjsit-2020-000076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/13/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives The accumulation of data through a prospective, multicenter Coordinated Registry Network (CRN) could be a robust and cost-effective way to gather real-world evidence on the performance of pelvic organ prolapse (POP) technologies for device-based and intervention-based studies. To develop the CRN, a group of POP experts consisting of representatives from professional societies, the Food and Drug Administration, academia, industry, and the patient community, was convened to discuss the role and feasibility of the CRN and to identify the core data elements important to assess POP technologies. Design A Delphi method approach was employed to achieve consensus on a core minimum dataset for the CRN. A series of surveys were sent to the panel and answered by each expert anonymously and individually. Results from the surveys were collected, collated, and analyzed by the study design team from Weill Cornell Medicine. Questions for the next round were based on the analysis process and discussed with group members via conference call. This process was repeated twice over a 6-month time period during which consensus was achieved. Results Twenty-one experts participated in the effort and proposed 120 data elements. Participation rates in the first and second round of the Delphi survey were 95.2% and 71.4%, respectively. The working group reached final consensus among responders on 90 data elements capturing relevant general medical and surgical history, procedure and discharge, short-term and long-term follow-up, device factors, and surgery and surgeon factors. Conclusions The CRN successfully developed a set of core data elements to support the study of POP technologies through convening an expert panel on POP technologies and using the Delphi method. These standardized data elements have the potential to influence patient and provider decisions about treatments and include important outcomes related to efficacy and safety.
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Affiliation(s)
- Courtney E Baird
- Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medicine, New York, New York, USA
| | - Catherine S Bradley
- Department of Obstetrics and Gynecology, The University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA
| | - Kathleen Kobashi
- Department of Urology, Houston Methodist Hospital, Houston, Texas, USA
| | - Mary Jung
- Center for Devices and Radiological Health (CDRH), US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Art Sedrakyan
- Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Sharon Andrews
- Center for Devices and Radiological Health (CDRH), US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Ann Ferriter
- Center for Devices and Radiological Health (CDRH), US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Terri Cornelison
- Center for Devices and Radiological Health (CDRH), US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Danica Marinac-Dabic
- Center for Devices and Radiological Health (CDRH), US Food and Drug Administration, Silver Spring, Maryland, USA
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Baird CE, Guiahi M, Chudnoff S, Loyo-Berrios N, Garcia S, Jung M, Gressler LE, Mao J, Hodshon B, Sedrakyan A, Andrews S, Colden K, Roberts J, Anderson A, Sewell C, Marinac-Dabic D. Building Blocks for the Long-acting and Permanent Contraceptives Coordinated Registry Network. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2022; 4:e000075. [PMID: 36393889 PMCID: PMC9660629 DOI: 10.1136/bmjsit-2020-000075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/14/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives A multistakeholder expert group under the Women’s Health Technology Coordinated Registry Network (WHT-CRN) was organized to develop the foundation for national infrastructure capturing the performance of long-acting and permanent contraceptives. The group, consisting of representatives from professional societies, the US Food and Drug Administration, academia, industry and the patient community, was assembled to discuss the role and feasibility of the CRN and to identify the core data elements needed to assess contraceptive medical product technologies. Design We applied a Delphi survey method approach to achieve consensus on a core minimum data set for the future CRN. A series of surveys were sent to the panel and answered by each expert anonymously and individually. Results from the surveys were collected, collated and analyzed by a study design team from Weill Cornell Medicine. After the first survey, questions for subsequent surveys were based on the analysis process and conference call discussions with group members. This process was repeated two times over a 6-month time period until consensus was achieved. Results Twenty-three experts participated in the Delphi process. Participation rates in the first and second round of the Delphi survey were 83% and 100%, respectively. The working group reached final consensus on 121 core data elements capturing reproductive/gynecological history, surgical history, general medical history, encounter information, long-acting/permanent contraceptive index procedures and follow-up, procedures performed in conjunction with the index procedure, product removal, medications, complications related to the long-acting and/or permanent contraceptive procedure, pregnancy and evaluation of safety and effectiveness outcomes. Conclusions The WHT-CRN expert group produced a consensus-based core set of data elements that allow the study of current and future contraceptives. These data elements influence patient and provider decisions about treatments and include important outcomes related to safety and effectiveness of these medical devices, which may benefit other women’s health stakeholders.
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Affiliation(s)
- Courtney E Baird
- Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Maryam Guiahi
- Department of Obstetrics and Gynecology, Division of Family Planning, University of Colorado—Anschutz Medical Campus, Aurora, Colorado, USA
| | - Scott Chudnoff
- Department of Obstetrics and Gynecology, Stamford Hospital, Stamford, Connecticut, USA
| | - Nilsa Loyo-Berrios
- Center for Devices and Radiological Health (CDRH), US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Stephanie Garcia
- Office of the National Coordinator for Health Information Technology, Washington, District of Columbia, USA
| | - Mary Jung
- Center for Devices and Radiological Health (CDRH), US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Laura Elisabeth Gressler
- Center for Devices and Radiological Health (CDRH), US Food and Drug Administration, Silver Spring, Maryland, USA
- Department of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Jialin Mao
- Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Beth Hodshon
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Art Sedrakyan
- Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Sharon Andrews
- Center for Devices and Radiological Health (CDRH), US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Kelly Colden
- Center for Devices and Radiological Health (CDRH), US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Jason Roberts
- Center for Devices and Radiological Health (CDRH), US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Abby Anderson
- Center for Drug Evaluation and Research (CDER), US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Catherine Sewell
- Center for Drug Evaluation and Research (CDER), US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Danica Marinac-Dabic
- Center for Devices and Radiological Health (CDRH), US Food and Drug Administration, Silver Spring, Maryland, USA
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Baird CE, Myers E, Jacoby V, Gressler LE, Venable S, O'Neill A, Price V, Lee A, Roberts J, Andrews S, Sedrakyan A, Marinac-Dabic D. Development of a core minimum data set to advance real-world evidence generation for uterine fibroids treatment technologies. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2022; 4:e000094. [PMID: 36393887 PMCID: PMC9660574 DOI: 10.1136/bmjsit-2021-000094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 05/13/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives The accumulation of data through a prospective, multicenter coordinated registry network (CRN) is a robust and cost-effective way to gather real-world evidence on the performance of uterine fibroids treatment technologies for device-based and intervention-based studies. To develop the CRN, a group of uterine fibroids experts, consisting of representatives from professional societies, the US Food and Drug Administration, academia, industry, and the patient community, was convened to discuss the role and feasibility of the CRN and to identify the core data elements needed to assess uterine fibroid treatment technologies. Design A Delphi method approach was employed to achieve consensus on a core minimum data set for the CRN. A series of surveys were sent to the panel and answered by each expert anonymously and individually. Results from the surveys were collected, collated, and analyzed by a study design team from Weill Cornell Medicine. Questions for the next round were based on the analysis process and discussed with group members via a conference call. This process was repeated twice over a 3-month time period until consensus was achieved. Results Twenty-nine experts participated in the Delphi surveys, which began with an initial list of 200 data elements. The working group reached final consensus on 97 data elements capturing patient medical history, imaging data, procedure-related data, post-procedure data, and long-term follow-up data. Conclusions The CRN successfully convened an expert panel on uterine fibroids treatment technologies and used the Delphi method to produce a consensus-based core set of data elements. These identified data elements include important outcomes related to efficacy and safety and thus, influence patient, provider, and regulatory decision-making about treatments for uterine fibroids. Finally, the core data elements provide the foundation of the infrastructure needed for the CRN that will allow for the comparative study of uterine fibroid treatment devices and technologies.
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Affiliation(s)
- Courtney E Baird
- Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Evan Myers
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina, USA
| | - Vanessa Jacoby
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
| | - Laura Elisabeth Gressler
- Department of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - Allison O'Neill
- Center for Devices and Radiological Health, United States Food and Drug Administration, Silver Spring, Maryland, USA
| | - Veronica Price
- Center for Devices and Radiological Health, United States Food and Drug Administration, Silver Spring, Maryland, USA
| | - Angie Lee
- Center for Devices and Radiological Health, United States Food and Drug Administration, Silver Spring, Maryland, USA
| | - Jason Roberts
- Center for Devices and Radiological Health, United States Food and Drug Administration, Silver Spring, Maryland, USA
| | - Sharon Andrews
- Center for Devices and Radiological Health, United States Food and Drug Administration, Silver Spring, Maryland, USA
| | - Art Sedrakyan
- Healthcare Polcy and Research, Weill Cornell Medical College, New York, New York, USA
| | - Danica Marinac-Dabic
- Center for Devices and Radiological Health, United States Food and Drug Administration, Silver Spring, Maryland, USA
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Behrendt CA, Adili F, Böckler D, Cotta L, Görtz H, Heckenkamp J, Peter J, Schmandra T, Stojanovic T, Uhl C, Steinbauer M. Das Qualitätssicherungs- und Deviceregister des Deutschen Instituts für Gefäßmedizinische Gesundheitsforschung der DGG im Zeitalter von COVID-19, Big Data und künstlicher Intelligenz. GEFÄSSCHIRURGIE 2022; 27:317-320. [PMID: 36090201 PMCID: PMC9450836 DOI: 10.1007/s00772-022-00916-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 11/09/2022]
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Kotov A, Blasche DA, Peters F, Pospiech P, Rother U, Stavroulakis K, Remig J, Schmidt-Lauber C, Zeller T, Görtz H, Teßarek J, Behrendt CA. The Impact of Chronic Kidney Disease on Mid-Term Outcomes after Revascularisation of Peripheral Arterial Occlusive Disease: Results from a Prospective Cohort Study. J Clin Med 2022; 11:jcm11164750. [PMID: 36012989 PMCID: PMC9409847 DOI: 10.3390/jcm11164750] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/09/2022] [Accepted: 08/12/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: The current study aimed to determine the relationship between chronic kidney disease (CKD) and major 12-month outcomes for patients with in-hospital treatment for symptomatic peripheral arterial occlusive disease (PAOD). Methods: An analysis of the prospective longitudinal multicentric cohort study with 12-month follow-up was conducted including patients who underwent endovascular or open surgery for symptomatic PAOD at 35 German vascular centres (initial study protocol: NCT03098290). Severity of CKD was grouped into four stages combining information about the estimated glomerular filtration rate (eGFR) at baseline and dialysis dependency. Outcomes included overall mortality as well as the two composite endpoints of amputation or death, and of major cardiovascular events (MACE). 12-month incidences and adjusted hazard ratios were estimated using the Kaplan–Meier function and Cox proportional hazard models. Results: A total of 4354 patients (32% female, 69 years mean age, 68% intermittent claudication, 69% percutaneous endovascular revascularisation) were included and followed for 244 days in median. Thereof, 22% had any CKD and 5% had end stage kidney disease (ESKD) at baseline. The 12-month overall mortality rate was 3.6% (95% CI 2.3–4.9) with 96 events in the entire cohort: 147 were amputated or died (5.3%, 95% CI 5.2–5.3), and 277 had a MACE (9.5%, 95% CI 9.4–9.5). When compared with patients without kidney disease, ESKD was significantly associated with overall mortality (HR 1.9; 95% CI 1.1–3.5), amputation or death (HR 2.4; 95% CI 1.4–4.1), and MACE (HR 2.0; 95% CI 1.3–3.2). Conclusions: In the current study on mid-term outcomes after invasive revascularisation for symptomatic PAOD, one out of five patients suffered from any CKD while those few with ESKD had twice the odds of death, of amputation or death, and of major adverse cardiovascular events after twelve months. These results emphasise that concomitant CKD and its impact on outcomes should be considered by severity while mild and moderate grades should not lead to ineffectual treatment strategies.
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Affiliation(s)
- Artur Kotov
- Research Group GermanVasc, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Deven A. Blasche
- Research Group GermanVasc, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Frederik Peters
- Research Group GermanVasc, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Philip Pospiech
- Research Group GermanVasc, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Ulrich Rother
- Department of Vascular Surgery, University Medical Centre Erlangen, 91054 Erlangen, Germany
- Commission on Peripheral Artery Disease and Diabetic Foot Syndrome, German Society for Vascular Surgery and Vascular Medicine, 10115 Berlin, Germany
| | - Konstantinos Stavroulakis
- Commission on Peripheral Artery Disease and Diabetic Foot Syndrome, German Society for Vascular Surgery and Vascular Medicine, 10115 Berlin, Germany
- Department of Vascular Surgery, Ludwig Maximilians University Hospital, 80539 Munich, Germany
| | - Jürgen Remig
- Bonn Community Hospital, Haus St. Petrus, 53113 Bonn, Germany
| | - Christian Schmidt-Lauber
- III. Department of Medicine, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Thomas Zeller
- Clinic for Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, 79189 Bad Krozingen, Germany
| | - Hartmut Görtz
- Commission on Peripheral Artery Disease and Diabetic Foot Syndrome, German Society for Vascular Surgery and Vascular Medicine, 10115 Berlin, Germany
- St. Boniface Hospital Lingen, 49808 Lingen, Germany
| | - Jörg Teßarek
- St. Boniface Hospital Lingen, 49808 Lingen, Germany
| | - Christian-Alexander Behrendt
- Research Group GermanVasc, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany
- Commission on Peripheral Artery Disease and Diabetic Foot Syndrome, German Society for Vascular Surgery and Vascular Medicine, 10115 Berlin, Germany
- Brandenburg Medical School Theodor Fontane, 16816 Neuruppin, Germany
- Correspondence:
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20
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Wolbert L, Kreutzburg T, Zyriax BC, Adegbola A, Westenhöfer J, Jagemann B, Alexander Neumann F, Preuß M, Debus ES, Rieß HC, Behrendt CA. A cross-sectional survey study on the nutrition patterns of patients with peripheral artery disease. VASA 2022; 51:239-246. [PMID: 35499268 DOI: 10.1024/0301-1526/a001005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background: Even though nutrition was demonstrated to have an impact on chronic atherosclerotic disease, there is a paucity of corresponding recommendations for patients with peripheral artery disease (PAD). A Mediterranean Diet based on daily intake of fruits and vegetables with high fibre, vegetable oil, and unsalted nuts including fish several times a week may have protective effects. This cross-sectional survey aimed to determine nutritional patterns amongst inpatients with PAD. Methods: All inpatients with symptomatic PAD who underwent revascularisation at a single centre between 1st May 2018 and 31st December 2021 were asked to fill out a questionnaire on nutritional intake. An 8-item frequency rating scale (from never to three times a day) was used for 15 food groups. For 11 of them, an adapted Mediterranean Diet score was calculated using the answers. The descriptive results were stratified by sex and disease stage (intermittent claudication vs. chronic limb-threatening ischaemia). Results: A total of 319 patients (31.7% female, 69.4 years in mean) were included. Thereof, 71.8% reported they did never receive any nutritional information considering their PAD disease. The mean adapted Mediterranean Diet score was 2.7 points (of maximum 11) with most patients not achieving the recommended servings per week for fruits (1.6%), vegetables (1.0%), and unsalted nuts (12.2%). The intake of cereals was sufficient (43.3%). When compared with men, women consumed more fruits and less meat. Conclusions: This survey demonstrated that although healthy nutrition may have a positive impact on patients with PAD, the education and adherence to a Mediterranean Diet was inappropriate. Nutritional patterns should be more focused in future PAD studies to derive specific recommendations and nutritional programmes as well as patient education in clinical practice.
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Affiliation(s)
- Lara Wolbert
- Research Group GermanVasc, Department of Vascular Medicine, University Heart and Vascular Centre UKE Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,The first two authors contributed equally
| | - Thea Kreutzburg
- Research Group GermanVasc, Department of Vascular Medicine, University Heart and Vascular Centre UKE Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,The first two authors contributed equally
| | - Birgit-Christiane Zyriax
- Midwifery Science - Health Care Research and Prevention, Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Abiodun Adegbola
- Research Group GermanVasc, Department of Vascular Medicine, University Heart and Vascular Centre UKE Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Joachim Westenhöfer
- Competence Center Health, Faculty of Life Sciences, University of Applied Sciences (HAW), Hamburg, Germany
| | - Bettina Jagemann
- Midwifery Science - Health Care Research and Prevention, Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Felix Alexander Neumann
- Midwifery Science - Health Care Research and Prevention, Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mark Preuß
- Research Group GermanVasc, Department of Vascular Medicine, University Heart and Vascular Centre UKE Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - E Sebastian Debus
- Research Group GermanVasc, Department of Vascular Medicine, University Heart and Vascular Centre UKE Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Henrik C Rieß
- Research Group GermanVasc, Department of Vascular Medicine, University Heart and Vascular Centre UKE Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Christian-Alexander Behrendt
- Research Group GermanVasc, Department of Vascular Medicine, University Heart and Vascular Centre UKE Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
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21
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Vorhersage von schweren Blutungsereignissen bei Patienten mit peripherer arterieller Verschlusskrankheit: Der OAC3-PAD-Risikoscore. GEFÄSSCHIRURGIE 2022; 27:208-212. [PMID: 35291723 PMCID: PMC8913852 DOI: 10.1007/s00772-022-00881-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 11/29/2022]
Abstract
Obwohl Patient:innen mit einer peripheren arteriellen Verschlusskrankheit (PAVK) aufgrund ihres Komorbiditäts- und Risikoprofils ein insgesamt erhöhtes Blutungsrisiko aufweisen, standen bisher keine validierten Werkzeuge zur Vorhersage des Blutungsrisikos zur Verfügung. Erschwerend kommt hinzu, dass viele randomisierte und kontrollierte Studien zu antithrombotischen Therapien Patient:innen mit erhöhtem Blutungsrisiko ausgeschlossen haben. Anhand von Routinedaten der Krankenkasse wurde mittels Verfahren des maschinellen Lernens ein pragmatisches Vorhersagemodell entwickelt und intern validiert. Mit dem OAC3-PAD-Risikoscore wurden acht Variablen identifiziert, die das Risiko von schweren Blutungsereignissen innerhalb eines Jahres nach stationärer Behandlung der PAVK vorhersagen können. Dieser Risikoscore kann dabei helfen, eine patientenzentrierte Risiko-Nutzen-Abwägung durchzuführen, um das maximale Potenzial aus den verfügbaren antithrombotischen Therapiestrategien zu schöpfen.
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22
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Saratzis A, Argyriou A, Davies R, Bisdas T, Chaudhuri A, Torsello G, Stavroulakis K, Zayed H. Covered vs. Bare Metal Stents in the Reconstruction of the Aortic Bifurcation: Early and Midterm Outcomes from the COBRA European Multicentre Registry. Eur J Vasc Endovasc Surg 2022; 63:688-695. [PMID: 35337725 DOI: 10.1016/j.ejvs.2021.12.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 11/22/2021] [Accepted: 12/04/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To report outcomes following endovascular revascularisation for severe aorto-iliac occlusive disease (AIOD) using covered (CS) or bare metal (BMS) stent(s). METHODS This was a retrospective cohort study including patients who underwent treatment with CS or BMS for AIOD between November 2012 and March 2020 in 12 European centres. Outcome measures included death, freedom from target lesion revascularisation (TLR), major amputation, and major adverse cardiac and cerebrovascular events (MACCE). RESULTS Overall, 252 patients (53% males; mean age 65 ± 10 years) were included (102 with a bare metal and 150 with a covered aortic stent); 122 (48%) presented with chronic limb threatening ischaemia (CLTI). Severe arterial calcification was noted in > 65% of patients, 70% presented with Trans-Atlantic Societies Consensus (TASC) D lesions, 32% and 46% had aortic or iliac chronic total occlusion (CTO), respectively. Median follow up was 17 months (range 6 - 40; none lost to follow up). Median inpatient stay was two days (range two to four). During the first 30 days, two patients died (both with covered aortic stents, because of cardiovascular events), none required TLR, two (1%) patients had a major amputation (all presented with CLTI), and three (1%) had a MACCE. At 17 months, mortality (BMS 14% vs. CS 7%, hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.42 - 2.26, p = .94, log rank test) and TLR (11% vs. 10%, HR 1.98, 95% CI 0.89 - 4.43, p = .095) did not differ statistically significantly between the two groups; only three patients had a major limb amputation during late follow up (all with a covered stent). In a multivariable model, the use of an aortic CS did not influence TLR. In a conditional Cox regression, however, the concomitant use of aortic and iliac CSs was associated with improved freedom from TLR. CONCLUSION Endovascular reconstruction with aortic CSs or BMSs for severe AIOD showed comparable midterm performance. The use of both aortic and iliac CSs seems to be associated with reduced TLR.
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Affiliation(s)
- Athanasios Saratzis
- Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, UK
| | - Angeliki Argyriou
- Department of Vascular and Endovascular Surgery, St. Franziskus Hospital Muenster, Germany.
| | - Robert Davies
- Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, UK
| | - Theodosios Bisdas
- Department of Vascular and Endovascular Surgery, St. Franziskus Hospital Muenster, Germany; Department of Vascular and Endovascular Surgery, Athens Medical Centre, Greece
| | | | - Giovanni Torsello
- Department of Vascular and Endovascular Surgery, St. Franziskus Hospital Muenster, Germany
| | - Konstantinos Stavroulakis
- Department of Vascular and Endovascular Surgery, St. Franziskus Hospital Muenster, Germany; Department of Vascular Surgery, Ludwig-Maximilians-University Hospital Munich, Germany
| | - Hany Zayed
- Department of Vascular Surgery, Guy's and St. Thomas' NHS Foundation Trust, UK
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23
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Gahide G, Banine A, Cossette M, Budimir M, Chen L, Lefebvre J, Phaneuf SC, Haddad I, Vendrell JF, Beland M, Despatis MA, Maghsoudloo K. Reporting Peripheral Artery Disease in Claudicants: Lessons Learned From the TASC-Ability Study. J Endovasc Ther 2022; 30:259-268. [PMID: 35236151 DOI: 10.1177/15266028221081093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Trans-Atlantic Inter-Society Consensus Document (TASC II) aims to comprehensively describe the case scenarios of aortoiliac and femoropopliteal lesions to suggest an endovascular or a surgical approach. Over time, it has become a guide for describing the gravity of arterial lesions. PURPOSE To assess the revised TASC II system for classifying arterial lesions in a large database of patients presenting with claudication. MATERIALS AND METHODS This study was a retrospective review of the arteriograms of patients with intermittent claudication. Aortoiliac and femoropopliteal lesions were classified according to the TASC II. When no consensus was reached, the lesion was rated as unTASCable. RESULTS In total, 1454 patients were included (male: 62.1%, 66.8±9.3 years). There were 39% aortoiliac lesions (n=960/2462) and 61% femoropopliteal lesions (n=1502/2462); 33.6% of the patients (n=489/1454) were associated with aortoiliac and femoropopliteal lesions. In addition, 20% of the lesions (n=493/2462) were unTASCable, and 26.7% of the patients (n=388/1454) had at least 1 unTASCable lesion. There were 4 categories of unTASCable lesions: (1) association with a common femoral artery lesion in 53.1% (n=262/493); (2) iliac artery lesions in 23.1% (n=114/493); (3) femoropopliteal lesions whose lengths did not fit into any category in 16.6% (n=82/493); and (4) association with an aortic lesion in 7.1% (n=35/493). The interobserver agreement was 0.97 for anatomically describing the infrarenal arterial tree and 0.85 for TASCing, with the lesions lowering to 0.69 for aortoiliac lesions. CONCLUSION Using the revised TASC II case scenario, 26.7% of the patients had at least 1 unTASCable lesion. Reporting peripheral artery disease using a comprehensive anatomical description of the infrarenal arterial tree showed better interobserver reproducibility.
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Affiliation(s)
- Gérald Gahide
- Service d'Angioradiologie, Département d'Imagerie Médicale, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada.,Centre de Recherche du CHUS, Etienne Le Bel, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Amine Banine
- Université de Sherbrooke, Sherbrooke, QC, Canada
| | | | | | - Lois Chen
- Université de Sherbrooke, Sherbrooke, QC, Canada
| | | | - Samuel C Phaneuf
- Service d'Angioradiologie, Département d'Imagerie Médicale, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Iskandar Haddad
- Service d'Angioradiologie, Département d'Imagerie Médicale, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Jean-Francois Vendrell
- Service d'Angioradiologie, Département d'Imagerie Médicale, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Mathieu Beland
- Département de Radiologie, Centre Hospitalier Universitaire de Québec, Quebec City, Canada
| | - Marc-Antoine Despatis
- Centre de Recherche du CHUS, Etienne Le Bel, Université de Sherbrooke, Sherbrooke, QC, Canada.,Service de Chirurgie Vasculaire, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
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24
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The OAC3-PAD Risk Score Predicts Major Bleeding Events one Year after Hospitalisation for Peripheral Artery Disease. Eur J Vasc Endovasc Surg 2022; 63:503-510. [DOI: 10.1016/j.ejvs.2021.12.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/16/2021] [Accepted: 12/04/2021] [Indexed: 12/13/2022]
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25
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Kotov A, Peters F, Debus ES, Zeller T, Heider P, Stavroulakis K, Remig J, Gussmann A, Hoffmann J, Friedrich O, Nolte T, Behrendt CA. The prospective GermanVasc cohort study. VASA 2021; 50:446-452. [PMID: 34279120 DOI: 10.1024/0301-1526/a000966] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: Previous observational studies reported a wide variation and possible room for improvement in the treatment of patients suffering from symptomatic peripheral artery disease (PAD). Yet, systematic assessment of everyday clinical practice is lacking. A General Data Protection Regulation (GDPR) compliant registry was developed and used to collect comprehensive data on clinical treatment and outcomes regarding PAD in Germany. Here, we report baseline characteristics of patients prospectively enrolled until the end of 2020. Methods: The GermanVasc registry study is a prospective longitudinal multicentre cohort study. Between 1st May 2018 and 31st December 2020, invasive endovascular, open-surgical, and hybrid revascularisations of patients suffering from chronic symptomatic PAD were prospectively included after explicit informed consent (NCT03098290). For ensuring high quality of the data, we performed comprehensive risk-based and random-sample external and internal validation. Results: In total, 5608 patients from 31 study centres were included (34% females, median 69 years). On-site monitoring visits were performed at least once in all centres. The proportion of chronic limb-threatening ischaemia was 30% and 13% were emergent admissions. 55% exhibited a previous revascularisation. Endovascular techniques made 69% among all documented invasive procedures (n=6449). Thirty-five percent were classified as patients with severe systemic disease, and 3% exhibited a constant threat to life according to the American Society of Anaesthesiologists classification. The risk profile comprised of 75% former or current smokers, 36% diabetes mellitus, and in 30% a current ischemic heart disease was present. At discharge, 93% of the patients received antiplatelets and 77% received statins. Conclusions: The GermanVasc registry study provides insights into real-world practice of treatment and outcomes of 5,608 patients with symptomatic PAD in Germany. The cohort covers a broader range of disease severity and types of interventions than usually found in trials. In future studies, comparative outcomes will be analysed in more detail.
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Affiliation(s)
- Artur Kotov
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Frederik Peters
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Thomas Zeller
- University Heart Center Freiburg-Bad Krozingen, Germany
| | | | | | - Jürgen Remig
- Bonn Community Hospital, Haus St. Petrus, Bonn, Germany
| | | | | | | | - Thomas Nolte
- Bad Bevensen Heart and Vascular Centre, Bad Bevensen, Germany
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26
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Saratzis A, Salem M, Sabbagh C, Abisi S, Huasen B, Egun A, Nash J, Lau PF, Chaudhuri A, Dey R, Patrone L, Malina M, Davies R, Zayed H. Treatment of Aortoiliac Occlusive Disease With the Covered Endovascular Reconstruction of the Aortic Bifurcation (CERAB) Technique: Results of a UK Multicenter Study. J Endovasc Ther 2021; 28:737-745. [PMID: 34160321 DOI: 10.1177/15266028211025028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This UK multicenter study aims to report early- and medium-term results following covered endovascular reconstruction of aortic bifurcation (CERAB) for the treatment of aortoiliac occlusive disease (AIOD) in patients with chronic limb threatening ischemia (CLTI) or intermittent claudication (IC). MATERIALS AND METHODS Retrospective case analysis was performed of patients who underwent CERAB between November 1, 2012 and March 31, 2020 in 6 centers across the United Kingdom. Anatomical data, including degree of plaque calcification, were assessed using preoperative imaging. Outcome measures included mortality, perioperative complications, target lesion reintervention (TLR), and major limb amputation. Primary, assisted primary, and secondary patencies were calculated at set intervals. RESULTS A total of 116 patients underwent CERAB over the study period for the following reasons [48% presenting with CLTI (Rutherford 4-6) and 52% with IC (Rutherford 1-3)]; 82% presented had Trans-Atlantic Inter-Society Consensus (TASC) D AIOD disease. Median age was 65 years (range 42-90 years); 76% of the cohort were male. Severely calcified aortic and iliac lesions were noted in 90% and 80% of patients, respectively. Over a median follow-up of 18 months (range 1-91 months), 2 (1.7%) patients were lost to follow up. In total 5, (4.3%) patients died and 2 (1.7%) had a major amputation. Endovascular TLR was required in 14 (12.1%) patients at last follow up. Surgical TLR was performed in 4 (3.4%) patients at last follow-up. Seven (6%) patients developed an aortic/iliac stent occlusion at last follow-up. The Kaplan-Meier (KM) freedom from TLR at 1 year was 94% and KM 1-year primary patency, assisted primary patency, and secondary patency were 88%, 94%, and 98% respectively. Subanalysis found the following features were associated with need for TLR; TASC D disease (OR = 2.45, 95% CI 1.44 to 3.71), severe aortic calcification (OR = 2.01, 95% CI 1.03 to 2.20), and presence of tissue loss at baseline (OR = 1.43, 95% CI 1.01 to 4.63). CONCLUSION Perioperative (<30 days) and medium-term morbidity, mortality, and patency rates in this pragmatic cohort of patients with severe AIOD lesions show that CERAB is a valid revascularization option. A direct comparison with surgical treatments for AIOD in a randomized controlled trial is justified.
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Affiliation(s)
- Athanasios Saratzis
- Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, Leicester, Leicestershire, UK
| | - Murtaza Salem
- Department of Vascular Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Cezar Sabbagh
- Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, Leicester, Leicestershire, UK
| | - Said Abisi
- Department of Vascular Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Bella Huasen
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Ansy Egun
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Jennifer Nash
- University Hospital Hairmyres, NHS Lanarkshire, Edinburgh, UK
| | - Pui Fong Lau
- University Hospital Hairmyres, NHS Lanarkshire, Edinburgh, UK
| | | | - Ramita Dey
- Bedfordshire Hospitals NHS Foundation Trust, Bedford, UK
| | - Lorenzo Patrone
- London North West University Healthcare NHS Trust, London, UK
| | - Martin Malina
- London North West University Healthcare NHS Trust, London, UK
| | - Robert Davies
- Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, Leicester, Leicestershire, UK
| | - Hany Zayed
- Department of Vascular Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
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27
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Aziz F, Behrendt CA, Sullivan K, Beck AW, Beiles CB, Boyle JR, Mani K, Benson RA, Wohlauer MV, Khashram M, Jorgensen JE, Lemmon GW. The impact of COVID-19 pandemic on vascular registries and clinical trials. Semin Vasc Surg 2021; 34:28-36. [PMID: 34144744 PMCID: PMC8137351 DOI: 10.1053/j.semvascsurg.2021.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/26/2021] [Accepted: 04/30/2021] [Indexed: 02/06/2023]
Abstract
Quality improvement programs and clinical trial research experienced disruption due to the coronavirus disease 2019 (COVID-19) pandemic. Vascular registries showed an immediate impact with significant declines in second-quarter vascular procedure volumes witnessed across Europe and the United States. To better understand the magnitude and impact of the pandemic, organizations and study groups sent grass roots surveys to vascular specialists for needs assessment. Several vascular registries responded quickly by insertion of COVID-19 variables into their data collection forms. More than 80% of clinical trials have been reported delayed or not started due to factors that included loss of enrollment from patient concerns or mandated institutional shutdowns, weighing the risk of trial participation on patient safety. Preliminary data of patients undergoing vascular surgery with active COVID-19 infection show inferior outcomes (morbidity) and increased mortality. Disease-specific vascular surgery study collaboratives about COVID-19 were created for the desire to study the disease in a more focused manner than possible through registry outcomes. This review describes the pandemic effect on multiple VASCUNET registries including Germany (GermanVasc), Sweden (SwedVasc), United Kingdom (UK National Vascular Registry), Australia and New Zealand (bi-national Australasian Vascular Audit), as well as the United States (Society for Vascular Surgery Vascular Quality Initiative). We will highlight the continued collaboration of VASCUNET with the Vascular Quality Initiative in the International Consortium of Vascular Registries as part of the Medical Device Epidemiology Network coordinated registry network. Vascular registries must remain flexible and responsive to new and future real-world problems affecting vascular patients.
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Affiliation(s)
- Faisal Aziz
- Integrated Vascular Surgery Program, Penn State Health Heart and Vascular Institute, Hershey, PA
| | | | | | - Adam W Beck
- Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AL
| | - C Barry Beiles
- Australian and New Zealand Society for Vascular Surgery, Australasian Vascular Audit, Melbourne, Victoria, Australia
| | - Jon R Boyle
- University of Cambridge, Cambridge, Cambridgeshire, UK; Vascular Society of Great Britain and Ireland, Staffordshire, UK
| | - Kevin Mani
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Ruth A Benson
- University Hospital Coventry and Warwickshire, West Midlands, UK
| | - Max V Wohlauer
- Vascular Surgery, University of Colorado, Denver, CO; Vascular Surgery COVID-19 Collaborative
| | - Manar Khashram
- Department of Surgery, University of Auckland, Auckland, NZ
| | - Jens Eldrup Jorgensen
- Tufts University School of Medicine, Boston, MA; Patient Safety Organization, Society for Vascular Surgery, Rosemont, IL
| | - Gary W Lemmon
- Patient Safety Organization, Society for Vascular Surgery, Rosemont, IL; Indiana University, 1801 N Senate Boulevard, D-3500, Indianapolis, IN 46202.
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28
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Lottes AE, Whatley EM, Royce SM, Bertges DJ, Erickson CA, Farb A, Fox ML, Jiang JH, Wang L, Lin AY, Malone ML, Papandreou G, Wilgus RW, Rosenfield K, Krucoff MW. Important considerations for trials for peripheral arterial disease: Lessons learned from the paclitaxel mortality signal: A report on behalf of the registry assessment for peripheral interventional Devices (RAPID) Paclitaxel Pathways Program. Am Heart J 2021; 232:71-83. [PMID: 33157067 DOI: 10.1016/j.ahj.2020.10.070] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 01/06/2023]
Abstract
The Registry Assessment of Peripheral Devices (RAPID) convened a multidisciplinary group of stakeholders including clinicians, academicians, regulators and industry representatives to conduct an in-depth review of limitations associated with the data available to assess the paclitaxel mortality signal. Available studies were evaluated to identify strengths and limitations in the study design and data quality, which were translated to lessons learned to help guide the design, execution, and analyses of future studies. We suggest numerous actionable responses, such as the development and use of harmonized data points and outcomes in a consensus lean case report form. We advocate for reduction in missing data and efficient means for accrual of larger sample sizes in Peripheral arterial disease studies or use of supplemental datasets. Efforts to share lessons learned and working collaboratively to address such issues may improve future data in this device area and ultimately benefit patients. Condensed Abstract: Data sources evaluating paclitaxel-coated devices were evaluated to identify strengths and limitations in the study design and data quality, which were translated to lessons learned to help guide the design, execution, and analyses of future studies. We suggest numerous actionable responses, which we believe may improve future data in this device area and ultimately benefit patients.
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Impact of COVID-19 Pandemic on the outcomes in patients with Critical Limb Threatening Ischaemia and Diabetic Foot Infection. Ann Surg 2020; 275:1037-1042. [PMID: 33630476 PMCID: PMC9132240 DOI: 10.1097/sla.0000000000004677] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Examine the impact of Coronavirus-2019(COVID-19) pandemic on the outcomes in patients with critical limb threatening ischemia(CLTI) or diabetic foot infection(DFI). BACKGROUND Patients with CLTI and/or DFI are at risk of amputations if not treated in a timely manner. METHODS We compared the outcomes in patients with CLTI or DFI during two periods; Period 1[P1] (15/03/2019-31/05/2019) and period 2[P2] (15/03/2020-31/05/2020- corresponding to COVID-19 pandemic). RESULTS 139 patients were treated in P1 [mean age 70 years (±11), Male:Female=102:37] while 95 patients were treated in P2 [mean age 67(±12), Male:Female=64:31]. The two cohorts were matched regarding Rutherford category (P=0.25) and GLASS classification (P=0.38). Notably, the time from onset of symptom to clinical presentation was significantly longer [31(1-105) days vs 27(0-78) days, (P=0.017)], whereas the time from presentation to first intervention was significantly shorter [3 (0-61) days vs 5 (0-65) days, (P=0.013)] in P2 compared to P1. There was a significantly higher WCC(P=0.014) and CRP(P=0.004) on admission in P2. Having treatment for CLTI or DFI in P2 was an independent predictor of worse primary patency rate and Freedom from major adverse limb events (F-MALE). At 90 days, amputation-free survival (AFS) and Limb salvage (LS) were noticeably worse in P2 compared to P1 (AFS was 80% and 87% while LS was 64% and 72% in P2 and P1 respectively). CONCLUSIONS Patients with CLTI and DFI experienced a significantly delayed presentation with features of sepsis on admission in P2. Treatment in P2 was a predictor of worse primary patency and F-MALE and therefore close and long follow-up is advisable.
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Lee YJ, Kook H, Ko YG, Yu CW, Joo HJ, Ahn CM, Choi D. Drug Eluting Stent vs. Drug Coated Balloon for Native Femoropopliteal Artery Disease: A Two Centre Experience. Eur J Vasc Endovasc Surg 2020; 61:287-295. [PMID: 33223281 DOI: 10.1016/j.ejvs.2020.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 10/01/2020] [Accepted: 10/18/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE There have been limited clinical trials comparing drug eluting stents (DESs) and drug coated balloons (DCBs) in the treatment of femoropopliteal artery disease. This two centre retrospective and prospective cohort study sought to compare DES with DCB for the treatment of native femoropopliteal artery disease. METHODS A total of 288 limbs (242 patients) with native femoropopliteal artery disease were treated with DESs (Zilver PTX; 102 limbs) or DCBs (IN.PACT Admiral; 186 limbs) in two Korean endovascular centres between 19 January 2013 and 5 May 2018 and followed for a median duration of 19.6 months. The primary endpoint was primary clinical patency. Propensity score matching (PSM, 162 limbs) and inverse probability weighted (IPW) adjustment were performed to adjust for confounding baseline characteristics. RESULTS The DCB group had fewer lesions with Trans-Atlantic Inter-Society Consensus (TASC) II type C/D (55.9% vs. 70.6%, p = .021) or total occlusions (43.5% vs. 77.5%, p < .001) and showed shorter lesion lengths (164.2 ± 105.4 mm vs. 194.8 ± 86.8 mm, p = .009) than the DES group. After PSM, baseline clinical and lesion characteristics of the two groups were comparable except for larger reference vessel diameter in the DES group (5.4 ± 0.6 vs. 5.1 ± 0.7, p = .025). Adjunctive atherectomy was performed in 32.1% of the DCB group and in 2.5% of the DES group (p < .001). The provisional stenting was required in 14.8% of the DCB group. At two year follow up, the DCB group showed higher primary clinical patency (74.6% vs. 56.7%, hazard ratio [HR] 0.51, 95% confidence interval [CI] 0.27-0.96, p = .032) and freedom from target lesion revascularisation (85.9% vs. 71.3%, HR 0.39, 95% CI 0.17-0.89, p = .021) than the DES group. Survival from all cause death did not differ between groups (87.6% vs. 92.1%, HR 1.85, 95% CI 0.62-5.52, p = .26). CONCLUSION In this two centre cohort, DCBs with selective use of adjunctive atherectomy achieved more favourable outcomes than DESs for native femoropopliteal artery disease.
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Affiliation(s)
- Yong-Joon Lee
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Hyungdon Kook
- Korea University Anam Hospital, Seoul, Republic of Korea
| | - Young-Guk Ko
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Cheol Woong Yu
- Korea University Anam Hospital, Seoul, Republic of Korea.
| | - Hyung Joon Joo
- Korea University Anam Hospital, Seoul, Republic of Korea
| | - Chul-Min Ahn
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Donghoon Choi
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
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Kahlberg A, Mascia D, Bellosta R, Attisani L, Pegorer M, Socrate AM, Ferraris M, Trabattoni P, Rinaldi E, Melloni A, Monaco F, Melissano G, Chiesa R. Vascular Surgery During COVID-19 Emergency in Hub Hospitals of Lombardy: Experience on 305 Patients. Eur J Vasc Endovasc Surg 2020; 61:306-315. [PMID: 33262093 PMCID: PMC7664352 DOI: 10.1016/j.ejvs.2020.10.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/21/2020] [Accepted: 10/28/2020] [Indexed: 02/01/2023]
Abstract
Objective During the most aggressive phase of the COVID-19 outbreak in Italy, the Regional Authority of Lombardy identified a number of hospitals, named Hubs, chosen to serve the whole region for highly specialised cases, including vascular surgery. This study reports the experience of the four Hubs for Vascular Surgery in Lombardy and provides a comparison of in hospital mortality and major adverse events (MAEs) according to COVID-19 testing. Methods Data from all patients who were referred to the Vascular Surgery Department of Hubs from 9 March to 28 April 2020 were collected prospectively and analysed. A positive COVID-19 polymerase chain reaction swab test, or symptoms (fever > 37.5 °C, upper respiratory tract symptoms, chest pain, and contact/travel history) associated with interstitial pneumonia on chest computed tomography scan were considered diagnostic of COVID-19 disease. Patient characteristics, operative variables, and in hospital outcomes were compared according to COVID-19 testing. A multivariable model was used to identify independent predictors of in hospital death and MAEs. Results Among 305 included patients, 64 (21%) tested positive for COVID-19 (COVID group) and 241 (79%) did not (non-COVID group). COVID patients presented more frequently with acute limb ischaemia than non-COVID patients (64% vs. 23%; p < .001) and had a significantly higher in hospital mortality (25% vs. 6%; p < .001). Clinical success, MAEs, re-interventions, and pulmonary and renal complications were significantly worse in COVID patients. Independent risk factors for in hospital death were COVID (OR 4.1), medical treatment (OR 7.2), and emergency setting (OR 13.6). COVID (OR 3.4), obesity class V (OR 13.5), and emergency setting (OR 4.0) were independent risk factors for development of MAEs. Conclusion During the COVID-19 pandemic in Lombardy, acute limb ischaemia was the most frequent vascular disease requiring surgical treatment. COVID-19 was associated with a fourfold increased risk of death and a threefold increased risk of major adverse events.
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Affiliation(s)
- Andrea Kahlberg
- Vascular Surgery, Vita-Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Daniele Mascia
- Vascular Surgery, Vita-Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Raffaello Bellosta
- Vascular Surgery, Department Cardiovascular Surgery, Fondazione Poliambulanza, Brescia, Italy
| | - Luca Attisani
- Vascular Surgery, Department Cardiovascular Surgery, Fondazione Poliambulanza, Brescia, Italy
| | - Matteo Pegorer
- Vascular Surgery, Department Cardiovascular Surgery, Fondazione Poliambulanza, Brescia, Italy
| | | | | | - Piero Trabattoni
- Department of Cardiovascular Disease, Vascular Surgery Unit, IRCCS Centro Cardiologico Monzino, Milan, Italy
| | - Enrico Rinaldi
- Vascular Surgery, Vita-Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Melloni
- Vascular Surgery, Vita-Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabrizio Monaco
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Germano Melissano
- Vascular Surgery, Vita-Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberto Chiesa
- Vascular Surgery, Vita-Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Behrendt CA, Sigvant B, Kuchenbecker J, Grima MJ, Schermerhorn M, Thomson IA, Altreuther M, Setacci C, Svetlikov A, Laxdal EH, Goncalves FB, Secemsky EA, Debus ES, Cassar K, Beiles B, Beck AW, Mani K, Bertges D. Editor's Choice - International Variations and Sex Disparities in the Treatment of Peripheral Arterial Occlusive Disease: A Report from VASCUNET and the International Consortium of Vascular Registries. Eur J Vasc Endovasc Surg 2020; 60:873-880. [PMID: 33004283 PMCID: PMC8080993 DOI: 10.1016/j.ejvs.2020.08.027] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/30/2020] [Accepted: 08/17/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The aim of this study was to determine sex specific differences in the invasive treatment of symptomatic peripheral arterial occlusive disease (PAOD) between member states participating in the VASCUNET and International Consortium of Vascular Registries. METHODS Data on open surgical revascularisation and peripheral vascular intervention (PVI) of symptomatic PAOD from 2010 to 2017 were collected from population based administrative and registry data from 11 countries. Differences in age, sex, indication, and invasive treatment modality were analysed. RESULTS Data from 11 countries covering 671 million inhabitants and 1 164 497 hospitalisations (40% women, mean age 72 years, 49% with intermittent claudication, 54% treated with PVI) in Europe (including Russia), North America, Australia, and New Zealand were included. Patient selection and treatment modality varied widely for the proportion of female patients (23% in Portugal and 46% in Sweden), the proportion of patients with claudication (6% in Italy and 69% in Russia), patients' mean age (70 years in the USA and 76 years in Italy), the proportion of octogenarians (8% in Russia and 33% in Sweden), and the proportion of PVI (24% in Russia and 88% in Italy). Numerous differences between females and males were observed in regard to patient age (72 vs. 70 years), the proportion of octogenarians (28% vs. 15%), proportion of patients with claudication (45% vs. 51%), proportion of PVI (57% vs. 51%), and length of hospital stay (7 days vs. 6 days). CONCLUSION Remarkable differences regarding the proportion of peripheral vascular interventions, patients with claudication, and octogenarians were seen across countries and sexes. Future studies should address the underlying reasons for this, including the impact of national societal guidelines, reimbursement, and differences in health maintenance.
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Affiliation(s)
- Christian-Alexander Behrendt
- Department of Vascular Medicine, Research Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
| | - Birgitta Sigvant
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Jenny Kuchenbecker
- Department of Vascular Medicine, Research Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Matthew J Grima
- Department of Surgery, Vascular Unit, Mater Dei Hospital, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Marc Schermerhorn
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Centre, Boston, MA, USA
| | - Ian A Thomson
- Department of Surgical Sciences, University of Otago, Dunedin, New Zealand
| | - Martin Altreuther
- Department of Vascular Surgery, St. Olavs Hospital, Trondheim, Norway
| | - Carlo Setacci
- Università degli Studi di Siena, Vascular and Endovascular Surgery, Siena, Italy
| | - Alexei Svetlikov
- Department of Cardiovascular Surgery, The I.I. Mechnikov North-Western State Medical University, St. Petersburg, Russia
| | - Elin H Laxdal
- Department of Vascular Surgery, Landspitali University Hospital, Reykjavik, Iceland
| | | | - Eric A Secemsky
- Division of Cardiology, Beth Israel Deaconess Medical Centre, Boston, MA, USA
| | - E Sebastian Debus
- Department of Vascular Medicine, Research Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Kevin Cassar
- Department of Surgery, Vascular Unit, Mater Dei Hospital, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Barry Beiles
- Australian and New Zealand Society for Vascular Surgery, Melbourne, Australia
| | - Adam W Beck
- Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, AB, USA
| | - Kevin Mani
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Daniel Bertges
- Division of Vascular Surgery, University of Vermont Medical Centre, Burlington, VT, USA
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Grip O, Mani K, Altreuther M, Bastos Gonçalves F, Beiles B, Cassar K, Davidovic L, Eldrup N, Lattmann T, Laxdal E, Menyhei G, Setacci C, Settembre N, Thomson I, Venermo M, Björck M. Contemporary Treatment of Popliteal Artery Aneurysms in 14 Countries: A Vascunet Report. Eur J Vasc Endovasc Surg 2020; 60:721-729. [PMID: 32807672 DOI: 10.1016/j.ejvs.2020.07.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 06/05/2020] [Accepted: 07/02/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Popliteal artery aneurysm (PAA) is the second most common arterial aneurysm. Vascunet is an international collaboration of vascular registries. The aim was to study treatment and outcomes. METHODS This was a retrospective analysis of prospectively registered population based data. Fourteen countries contributed data (Australia, Denmark, Finland, France, Hungary, Iceland, Italy, Malta, New Zealand, Norway, Portugal, Serbia, Sweden, and Switzerland). RESULTS During 2012-2018, data from 10 764 PAA repairs were included. Mean values with between countries ranges in parenthesis are given. The incidence was 10.4 cases/million inhabitants/year (2.4-19.3). The mean age was 71.3 years (66.8-75.3). Most patients, 93.3%, were men and 40.0% were active smokers. The operations were elective in 73.2% (60.0%-85.7%). The mean pre-operative PAA diameter was 32.1 mm (27.3-38.3 mm). Open surgery dominated in both elective (79.5%) and acute (83.2%) cases. A medial surgical approach was used in 77.7%, and posterior in 22.3%. Vein grafts were used in 63.8%. Of the emergency procedures, 91% (n = 2 169, 20.2% of all) were for acute thrombosis and 9% for rupture (n = 236, 2.2% of all). Thrombosis patients had larger aneurysms, mean diameter 35.5 mm, and 46.3% were active smokers. Early amputation and death were higher after acute presentation than after elective surgery (5.0% vs. 0.7%; 1.9% vs. 0.5%). This pattern remained one year after surgery (8.5% vs. 1.0%; 6.1% vs. 1.4%). Elective open compared with endovascular surgery had similar one year amputation rates (1.2% vs. 0.2%; p = .095) but superior patency (84.0% vs. 78.4%; p = .005). Veins had higher patency and lower amputation rates, at one year compared with synthetic grafts (86.8% vs. 72.3%; 1.8% vs. 5.2%; both p < .001). The posterior open approach had a lower amputation rate (0.0% vs. 1.6%, p = .009) than the medial approach. CONCLUSION Patients presenting with acute ischaemia had high risk of amputation. The frequent use of endovascular repair and prosthetic grafts should be reconsidered based on these results.
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Affiliation(s)
- Olivia Grip
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala, Sweden.
| | - Kevin Mani
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala, Sweden
| | - Martin Altreuther
- Department of Vascular Surgery, St Olavs Hospital, Trondheim, Norway
| | | | - Barry Beiles
- Australian and New Zealand Society for Vascular Surgery, Melbourne, Australia
| | - Kevin Cassar
- Vascular Unit, Department of Surgery, Mater Dei Hospital, Malta
| | - Lazar Davidovic
- Clinic for Vascular and Endovascular Surgery, Serbian Clinical Centre, Belgrade, Serbia
| | - Nikolaj Eldrup
- Department of Vascular Surgery, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Thomas Lattmann
- Clinic of Vascular Surgery, Cantonal Hospital, Winterthur, Switzerland
| | - Elin Laxdal
- Department of Vascular Surgery, Landspitalinn University Hospital, Reykjavik, Iceland
| | - Gabor Menyhei
- Department of Vascular Surgery Medical Centre, Pecs University, Pecs, Hungary
| | | | - Nicla Settembre
- Department of Vascular and Endovascular Surgery, Nancy University Hospital, University of Lorraine, Nancy, France
| | - Ian Thomson
- Department of Surgical Sciences, Otago University, Dunedin, New Zealand
| | - Maarit Venermo
- Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Martin Björck
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala, Sweden
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Paclitaxel and Mortality Following Peripheral Angioplasty: An Adjusted and Case Matched Multicentre Analysis. Eur J Vasc Endovasc Surg 2020; 60:220-229. [DOI: 10.1016/j.ejvs.2020.04.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/16/2020] [Accepted: 04/07/2020] [Indexed: 11/20/2022]
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Sutzko DC, Mani K, Behrendt CA, Wanhainen A, Beck AW. Big data in vascular surgery: registries, international collaboration and future directions. J Intern Med 2020; 288:51-61. [PMID: 32303118 DOI: 10.1111/joim.13077] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/21/2020] [Accepted: 04/06/2020] [Indexed: 01/09/2023]
Abstract
Given the increasing availability of large data set, small single-institutional series raise decreasing attention. Rapid expansion of technology from electronic medical records to easily accessible internet access, and widespread use and acceptance of registries in the medical world has allowed for research and quality improvement efforts using 'big data'. Big data, although technically not defined, typically refers to large databases that can be used to investigate common or rare disease processes or outcomes, describe variation in clinical practices across and between different specialties at various practice location, whilst allowing important information about trends over time. Big data have allowed investigators to quickly assimilate cohorts of patients and/or procedures to answer current questions, with more complete population representation and improved generalizability whilst decreasing the likelihood of power problems and type II errors. On the other hand, pitfalls still exist with the growing problem of hypothesis fishing, lack of granularity and the fear by many clinicians that registry transparency may have already gone too far, where surgery groups or individual surgeon outcomes are readily available to patients and referring providers. Within vascular surgery specifically, big data have expanded over the last decade and now includes regional, national and global registries that have major benefits of gathering specific clinical and procedural information within vascular surgery. In this review, we highlight the main vascular surgery registries and recap a few success stories of how the registries have been leveraged to benefit discovery, quality improvement and ultimately patient care. Additionally, we outline future directions that will be imperative for continued expansion, acceptance and adoption of 'big data' utilization inpatients with vascular disease.
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Affiliation(s)
- D C Sutzko
- From the, Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AB, USA
| | - K Mani
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - C-A Behrendt
- Department of Vascular Medicine, Research Group GermanVasc, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Wanhainen
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - A W Beck
- From the, Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AB, USA
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Lazaris AM, Lazaris MA, Moulakakis KG. Design and Use of an Interactive Online Registry to Track and Illustrate Vascular Surgery Practice in Greece. Eur J Vasc Endovasc Surg 2020; 60:321-322. [PMID: 32527715 DOI: 10.1016/j.ejvs.2020.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/01/2020] [Accepted: 04/15/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Andreas M Lazaris
- Department of Vascular Surgery, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece; Steering Committee of Hellenic Vascular Registry, Hellenic Society of Vascular and Endovascular Surgery, Athens, Greece.
| | - Michael A Lazaris
- Department of Civil Engineering, School of Engineering, University of Patras, Patras, Greece
| | - Konstantinos G Moulakakis
- Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece; Steering Committee of Hellenic Vascular Registry, Hellenic Society of Vascular and Endovascular Surgery, Athens, Greece
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Eldrup N, Debus ES. International Validation of the Population Based Malta Vascular Registry: A Vascunet Report. EJVES Vasc Forum 2020; 48:5-7. [PMID: 33078161 PMCID: PMC7301168 DOI: 10.1016/j.ejvsvf.2020.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 04/20/2020] [Accepted: 05/19/2020] [Indexed: 10/29/2022] Open
Abstract
Introduction Quality registries can be used to study treatment patterns and changes in trends of complications related to procedures and devices. To ensure that such study is possible in registries, there is a need to use standardised variables and the registry must have high internal and external validity. This study was an international external and internal validation of the newly initiated Maltese Vascular Registry. Report Two international vascular registry consultants visited the Maltese Vascular Registry (MVR), and conducted an external validation on all carotid and aortic aneurysm repairs performed in 2017-18. The external validation was conducted by comparing hospital administration lists with the MVR list. Using randomly chosen numbers, an internal validation was conducted of 20 random cases of carotid and 20 aortic aneurysms, 10 from 2017 and 10 from 2018, to validate date of operation and procedure against the patient's medical record. The registry is built as a database using national personal identifier codes, with variables for date and type of procedure, and anaesthetic method used, to which a note is attached describing the indication, intervention, and follow up. Between the hospital registry and the MVR, 111 of 115 cases could be identified correctly, corresponding to 97% external validity. Between the patient case records and the MVR, the dates and procedures of 20/20 carotid and 20/20 aortic aneurysm procedure were identical, indicating 100% internal validity. Discussion The MVR showed an external validity of 97% and internal validity of 100%. Future work should incorporate specific variables for comorbidity, procedures, and outcomes, with the registry aiming to incorporate international recommended variables for comorbidity, procedure, and outcome.
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Affiliation(s)
- Nikolaj Eldrup
- Rigshospitalet, Copenhagen University, Denmark.,Karbase (Danish Vascular Registry), Danish Regions, Aarhus, Denmark
| | - E Sebastian Debus
- University Heart & Vascular Centre, University Hospital Hamburg-Eppendorf, Germany.,GermanVasc, Hamburg, Germany
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Registries, Research, and Quality Improvement. Eur J Vasc Endovasc Surg 2020; 59:503-509. [DOI: 10.1016/j.ejvs.2020.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/04/2020] [Accepted: 02/18/2020] [Indexed: 12/28/2022]
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Cronenwett JL. Why should I join the Vascular Quality Initiative? J Vasc Surg 2020; 71:364-373. [DOI: 10.1016/j.jvs.2019.10.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 10/04/2019] [Indexed: 01/12/2023]
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Björck M, Earnshaw JJ, Acosta S, Bastos Gonçalves F, Cochennec F, Debus ES, Hinchliffe R, Jongkind V, Koelemay MJW, Menyhei G, Svetlikov AV, Tshomba Y, Van Den Berg JC, Esvs Guidelines Committee, de Borst GJ, Chakfé N, Kakkos SK, Koncar I, Lindholt JS, Tulamo R, Vega de Ceniga M, Vermassen F, Document Reviewers, Boyle JR, Mani K, Azuma N, Choke ETC, Cohnert TU, Fitridge RA, Forbes TL, Hamady MS, Munoz A, Müller-Hülsbeck S, Rai K. Editor's Choice - European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia. Eur J Vasc Endovasc Surg 2019; 59:173-218. [PMID: 31899099 DOI: 10.1016/j.ejvs.2019.09.006] [Citation(s) in RCA: 223] [Impact Index Per Article: 44.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Kolossváry E, Ferenci T, Kováts T. Potentials, challenges, and limitations of the analysis of administrative data on vascular limb amputations in health care. VASA 2019; 49:87-97. [PMID: 31638459 DOI: 10.1024/0301-1526/a000823] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Although more and more data on lower limb amputations are becoming available by leveraging the widening access to health care administrative databases, the applicability of these data for public health decisions is still limited. Problems can be traced back to methodological issues, how data are generated and to conceptual issues, namely, how data are interpreted in a multidimensional environment. The present review summarised all of the steps from converting the claims data of administrative databases into the analytical data and reviewed the wide array of sources of potential biases in the analysis of such data. The origins of uncertainty of administrative data analysis include uncontrolled confounding due to a lack of clinical data, the left- and right-censored nature of data collection, the non-standardized diagnosis/procedure-based data extraction methods (i.e., numerator/denominator problems) and additional methodological problems associated with temporal and spatial analyses. The existence of these methodological challenges in the administrative data-based analysis should not deter the analysts from using these data as a powerful tool in the armamentarium of clinical research. However, it must be done with caution and a thorough understanding and respect of the methodological limitations. In addition to this requirement, there is a profound need for pursuing further research on methodology and widening the search for other indicators (structural, process or outcome) that allow a deeper insight how the quality of vascular care may be assessed. Effective research using administrative data is based on strong collaboration in three domains, namely expertise in claims data handling and processing, the clinical field, and statistical analysis. The final interpretations of results and the countermeasures on the level of vascular care ought to be grounded on the integrity of research, open discussions and institutionalized mechanisms of science arbitration and honest brokering.
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Affiliation(s)
- Endre Kolossváry
- St. Imre University Teaching Hospital, Department of Angiology, Budapest, Hungary
| | - Tamás Ferenci
- Óbuda University, Physiological Controls Research Center, Budapest, Hungary
| | - Tamás Kováts
- National Healthcare Service Center (ÁEEK), Directorate General of IT and Health System Analysis, Budapest, Hungary
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Altreuther M, Menyhei G. International Validation of the Danish Vascular Registry Karbase: A Vascunet Report. Eur J Vasc Endovasc Surg 2019; 58:609-613. [DOI: 10.1016/j.ejvs.2019.04.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/31/2019] [Accepted: 04/08/2019] [Indexed: 02/03/2023]
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43
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Hischke S, Rieß HC, Bublitz MK, Kriston L, Schwaneberg T, Härter M, Bertges D, S Debus E, Behrendt CA. Quality Indicators in Peripheral Arterial Occlusive Disease Treatment: A Systematic Review. Eur J Vasc Endovasc Surg 2019; 58:738-745. [PMID: 31526633 DOI: 10.1016/j.ejvs.2019.06.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 06/19/2019] [Accepted: 06/24/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This systematic review aimed to identify evidence based quality indicators for invasive revascularisation of symptomatic peripheral arterial occlusive disease (PAOD). METHODS A systematic search of clinical practice guidelines, consensus statements, systematic reviews, and meta-analyses reporting quality indicators in patients undergoing invasive open and percutaneous revascularisations for symptomatic PAOD (PROSPERO registration number: CRD42019116317) was performed. Furthermore, a grey literature search was conducted involving databases of professional vascular medical organisations. The identified publications were screened independently by two reviewers for possible inclusion and full texts of potentially relevant records were independently evaluated for eligibility. Disagreement was resolved by discussion involving a third reviewer. RESULTS From 685 articles initially identified, one systematic review and one consensus statement focusing on quality indicators were selected for inclusion in the review. From these sources, a total of three process quality indicators matched the search criteria: one on pharmacological intervention, another on smoking cessation, and a third on surveillance of lower extremity vein bypass grafts. The grey literature search revealed an additional 31 structure, process, and outcome quality indicators. CONCLUSIONS This study revealed a lack of published evidence based quality indicators concerning invasive treatment for PAOD in the literature. An additional 31 indicators from the databases of professional societies and organisations have not been incorporated in prior guidelines. Interestingly, no indicator related to patient reported outcomes could be identified from either high quality sources or grey literature. Further research and harmonisation of different quality indicators is needed to enhance their evidence and subsequently improve patient centred decision making on invasive treatment.
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Affiliation(s)
- Sandra Hischke
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Department of Vascular Medicine, Working Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Henrik C Rieß
- Department of Vascular Medicine, Working Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Maria K Bublitz
- Department of Vascular Medicine, Working Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Thea Schwaneberg
- Department of Vascular Medicine, Working Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Bertges
- Division of Vascular Surgery, University of Vermont Medical Centre, Burlington, VT, USA
| | - Eike S Debus
- Department of Vascular Medicine, Working Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Christian-Alexander Behrendt
- Department of Vascular Medicine, Working Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
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Nayahangan LJ, Van Herzeele I, Konge L, Koncar I, Cieri E, Mansilha A, Debus S, Eiberg JP. Achieving Consensus to Define Curricular Content for Simulation Based Education in Vascular Surgery: A Europe Wide Needs Assessment Initiative. Eur J Vasc Endovasc Surg 2019; 58:284-291. [DOI: 10.1016/j.ejvs.2019.03.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 03/13/2019] [Accepted: 03/16/2019] [Indexed: 10/26/2022]
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45
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Venermo M. No Complaints on the Validity of Karbase. Eur J Vasc Endovasc Surg 2019; 58:614. [PMID: 31327539 DOI: 10.1016/j.ejvs.2019.06.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 06/16/2019] [Accepted: 06/21/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Maarit Venermo
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
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46
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Conte MS, Bradbury AW, Kolh P, White JV, Dick F, Fitridge R, Mills JL, Ricco JB, Suresh KR, Murad MH, Aboyans V, Aksoy M, Alexandrescu VA, Armstrong D, Azuma N, Belch J, Bergoeing M, Bjorck M, Chakfé N, Cheng S, Dawson J, Debus ES, Dueck A, Duval S, Eckstein HH, Ferraresi R, Gambhir R, Gargiulo M, Geraghty P, Goode S, Gray B, Guo W, Gupta PC, Hinchliffe R, Jetty P, Komori K, Lavery L, Liang W, Lookstein R, Menard M, Misra S, Miyata T, Moneta G, Munoa Prado JA, Munoz A, Paolini JE, Patel M, Pomposelli F, Powell R, Robless P, Rogers L, Schanzer A, Schneider P, Taylor S, De Ceniga MV, Veller M, Vermassen F, Wang J, Wang S. Global Vascular Guidelines on the Management of Chronic Limb-Threatening Ischemia. Eur J Vasc Endovasc Surg 2019; 58:S1-S109.e33. [PMID: 31182334 PMCID: PMC8369495 DOI: 10.1016/j.ejvs.2019.05.006] [Citation(s) in RCA: 718] [Impact Index Per Article: 143.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
GUIDELINE SUMMARY Chronic limb-threatening ischemia (CLTI) is associated with mortality, amputation, and impaired quality of life. These Global Vascular Guidelines (GVG) are focused on definition, evaluation, and management of CLTI with the goals of improving evidence-based care and highlighting critical research needs. The term CLTI is preferred over critical limb ischemia, as the latter implies threshold values of impaired perfusion rather than a continuum. CLTI is a clinical syndrome defined by the presence of peripheral artery disease (PAD) in combination with rest pain, gangrene, or a lower limb ulceration >2 weeks duration. Venous, traumatic, embolic, and nonatherosclerotic etiologies are excluded. All patients with suspected CLTI should be referred urgently to a vascular specialist. Accurately staging the severity of limb threat is fundamental, and the Society for Vascular Surgery Threatened Limb Classification system, based on grading of Wounds, Ischemia, and foot Infection (WIfI) is endorsed. Objective hemodynamic testing, including toe pressures as the preferred measure, is required to assess CLTI. Evidence-based revascularization (EBR) hinges on three independent axes: Patient risk, Limb severity, and ANatomic complexity (PLAN). Average-risk and high-risk patients are defined by estimated procedural and 2-year all-cause mortality. The GVG proposes a new Global Anatomic Staging System (GLASS), which involves defining a preferred target artery path (TAP) and then estimating limb-based patency (LBP), resulting in three stages of complexity for intervention. The optimal revascularization strategy is also influenced by the availability of autogenous vein for open bypass surgery. Recommendations for EBR are based on best available data, pending level 1 evidence from ongoing trials. Vein bypass may be preferred for average-risk patients with advanced limb threat and high complexity disease, while those with less complex anatomy, intermediate severity limb threat, or high patient risk may be favored for endovascular intervention. All patients with CLTI should be afforded best medical therapy including the use of antithrombotic, lipid-lowering, antihypertensive, and glycemic control agents, as well as counseling on smoking cessation, diet, exercise, and preventive foot care. Following EBR, long-term limb surveillance is advised. The effectiveness of nonrevascularization therapies (eg, spinal stimulation, pneumatic compression, prostanoids, and hyperbaric oxygen) has not been established. Regenerative medicine approaches (eg, cell, gene therapies) for CLTI should be restricted to rigorously conducted randomizsed clinical trials. The GVG promotes standardization of study designs and end points for clinical trials in CLTI. The importance of multidisciplinary teams and centers of excellence for amputation prevention is stressed as a key health system initiative.
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Affiliation(s)
- Michael S Conte
- Division of Vascular and Endovascular Surgery, University of California, San Francisco, CA, USA.
| | - Andrew W Bradbury
- Department of Vascular Surgery, University of Birmingham, Birmingham, United Kingdom
| | - Philippe Kolh
- Department of Biomedical and Preclinical Sciences, University Hospital of Liège, Wallonia, Belgium
| | - John V White
- Department of Surgery, Advocate Lutheran General Hospital, Niles, IL, USA
| | - Florian Dick
- Department of Vascular Surgery, Kantonsspital St. Gallen, St. Gallen, and University of Berne, Berne, Switzerland
| | - Robert Fitridge
- Department of Vascular and Endovascular Surgery, The University of Adelaide Medical School, Adelaide, South Australia, Australia
| | - Joseph L Mills
- Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine, Houston, TX, USA
| | - Jean-Baptiste Ricco
- Department of Clinical Research, University Hospitalof Poitiers, Poitiers, France
| | | | - M Hassan Murad
- Mayo Clinic Evidence-Based Practice Center, Rochester, MN, USA
| | - Victor Aboyans
- Department of Cardiology, Dupuytren, University Hospital, France
| | - Murat Aksoy
- Department of Vascular Surgery American, Hospital, Turkey
| | | | | | | | - Jill Belch
- Ninewells Hospital University of Dundee, UK
| | - Michel Bergoeing
- Escuela de Medicina Pontificia Universidad, Catolica de Chile, Chile
| | - Martin Bjorck
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Sweden
| | | | | | - Joseph Dawson
- Royal Adelaide Hospital & University of Adelaide, Australia
| | - Eike S Debus
- University Heart Center Hamburg, University Hospital Hamburg-Eppendorf, Germany
| | - Andrew Dueck
- Schulich Heart Centre, Sunnybrook Health, Sciences Centre, University of Toronto, Canada
| | - Susan Duval
- Cardiovascular Division, University of, Minnesota Medical School, USA
| | | | - Roberto Ferraresi
- Interventional Cardiovascular Unit, Cardiology Department, Istituto Clinico, Città Studi, Milan, Italy
| | | | - Mauro Gargiulo
- Diagnostica e Sperimentale, University of Bologna, Italy
| | | | | | | | - Wei Guo
- 301 General Hospital of PLA, Beijing, China
| | | | | | - Prasad Jetty
- Division of Vascular and Endovascular Surgery, The Ottawa Hospital and the University of Ottawa, Ottawa, Canada
| | | | | | - Wei Liang
- Renji Hospital, School of Medicine, Shanghai Jiaotong University, China
| | - Robert Lookstein
- Division of Vascular and Interventional Radiology, Icahn School of Medicine at Mount Sinai
| | | | | | | | | | | | | | - Juan E Paolini
- Sanatorio Dr Julio Mendez, University of Buenos Aires, Argentina
| | - Manesh Patel
- Division of Cardiology, Duke University Health System, USA
| | | | | | | | - Lee Rogers
- Amputation Prevention Centers of America, USA
| | | | - Peter Schneider
- Kaiser Foundation Hospital Honolulu and Hawaii Permanente Medical Group, USA
| | - Spence Taylor
- Greenville Health Center/USC School of Medicine Greenville, USA
| | | | - Martin Veller
- University of the Witwatersrand, Johannesburg, South Africa
| | | | - Jinsong Wang
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shenming Wang
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Editor's Choice – Recommendations for Registry Data Collection for Revascularisations of Acute Limb Ischaemia: A Delphi Consensus from the International Consortium of Vascular Registries. Eur J Vasc Endovasc Surg 2019; 57:816-821. [DOI: 10.1016/j.ejvs.2019.02.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 02/23/2019] [Indexed: 11/23/2022]
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48
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Conte MS, Bradbury AW, Kolh P, White JV, Dick F, Fitridge R, Mills JL, Ricco JB, Suresh KR, Murad MH. Global vascular guidelines on the management of chronic limb-threatening ischemia. J Vasc Surg 2019; 69:3S-125S.e40. [PMID: 31159978 PMCID: PMC8365864 DOI: 10.1016/j.jvs.2019.02.016] [Citation(s) in RCA: 693] [Impact Index Per Article: 138.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Chronic limb-threatening ischemia (CLTI) is associated with mortality, amputation, and impaired quality of life. These Global Vascular Guidelines (GVG) are focused on definition, evaluation, and management of CLTI with the goals of improving evidence-based care and highlighting critical research needs. The term CLTI is preferred over critical limb ischemia, as the latter implies threshold values of impaired perfusion rather than a continuum. CLTI is a clinical syndrome defined by the presence of peripheral artery disease (PAD) in combination with rest pain, gangrene, or a lower limb ulceration >2 weeks duration. Venous, traumatic, embolic, and nonatherosclerotic etiologies are excluded. All patients with suspected CLTI should be referred urgently to a vascular specialist. Accurately staging the severity of limb threat is fundamental, and the Society for Vascular Surgery Threatened Limb Classification system, based on grading of Wounds, Ischemia, and foot Infection (WIfI) is endorsed. Objective hemodynamic testing, including toe pressures as the preferred measure, is required to assess CLTI. Evidence-based revascularization (EBR) hinges on three independent axes: Patient risk, Limb severity, and ANatomic complexity (PLAN). Average-risk and high-risk patients are defined by estimated procedural and 2-year all-cause mortality. The GVG proposes a new Global Anatomic Staging System (GLASS), which involves defining a preferred target artery path (TAP) and then estimating limb-based patency (LBP), resulting in three stages of complexity for intervention. The optimal revascularization strategy is also influenced by the availability of autogenous vein for open bypass surgery. Recommendations for EBR are based on best available data, pending level 1 evidence from ongoing trials. Vein bypass may be preferred for average-risk patients with advanced limb threat and high complexity disease, while those with less complex anatomy, intermediate severity limb threat, or high patient risk may be favored for endovascular intervention. All patients with CLTI should be afforded best medical therapy including the use of antithrombotic, lipid-lowering, antihypertensive, and glycemic control agents, as well as counseling on smoking cessation, diet, exercise, and preventive foot care. Following EBR, long-term limb surveillance is advised. The effectiveness of nonrevascularization therapies (eg, spinal stimulation, pneumatic compression, prostanoids, and hyperbaric oxygen) has not been established. Regenerative medicine approaches (eg, cell, gene therapies) for CLTI should be restricted to rigorously conducted randomizsed clinical trials. The GVG promotes standardization of study designs and end points for clinical trials in CLTI. The importance of multidisciplinary teams and centers of excellence for amputation prevention is stressed as a key health system initiative.
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Affiliation(s)
- Michael S Conte
- Division of Vascular and Endovascular Surgery, University of California, San Francisco, Calif.
| | - Andrew W Bradbury
- Department of Vascular Surgery, University of Birmingham, Birmingham, United Kingdom
| | - Philippe Kolh
- Department of Biomedical and Preclinical Sciences, University Hospital of Liège, Wallonia, Belgium
| | - John V White
- Department of Surgery, Advocate Lutheran General Hospital, Niles, Ill
| | - Florian Dick
- Department of Vascular Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Robert Fitridge
- Department of Vascular and Endovascular Surgery, The University of Adelaide Medical School, Adelaide, South Australia
| | - Joseph L Mills
- Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine, Houston, Tex
| | - Jean-Baptiste Ricco
- Department of Clinical Research, University Hospitalof Poitiers, Poitiers, France
| | | | - M Hassan Murad
- Mayo Clinic Evidence-Based Practice Center, Rochester, Minn
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Behrendt CA, Schwaneberg T, Hischke S, Müller T, Petersen T, Marschall U, Debus S, Kriston L. Data Privacy Compliant Validation of Health Insurance Claims Data: the IDOMENEO Approach. DAS GESUNDHEITSWESEN 2019; 82:S94-S100. [PMID: 31121613 PMCID: PMC7521113 DOI: 10.1055/a-0883-5098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Recently, health insurance claims have regained the attention of the scientific community as a source of real-world evidence in health care research and quality improvement. To date, very few studies are available which investigate the validity of health insurance claims; these may be affected by bias from several sources, such as possible upcoding of co-morbidities and complications for reimbursement advantages. The IDOMENEO study investigates the inpatient treatment of peripheral arterial disease (PAD) comprehensively using various data sources with a consortium involving experts from health care research and data privacy, a large health insurance fund, biostatisticians, jurists, and computer scientists. Prospective registry data were collected from 30-40 vascular centres in Germany using the GermanVasc registry. In addition, health insurance claims data were prospectively collected from BARMER, the second largest health insurance fund in Germany. The consortium is currently developing a data privacy compliant method of health insurance claims data validation, the methodological foundations of which are described here.
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Affiliation(s)
| | - Thea Schwaneberg
- Department of Vascular Medicine, Work Group GermanVasc, University Medical Center Hamburg-Eppendorf, Hamburg
| | - Sandra Hischke
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg.,Department of Vascular Medicine, Work Group GermanVasc, University Medical Center Hamburg-Eppendorf, Hamburg
| | - Tobias Müller
- Department of Informatics, University of Hamburg, Hamburg
| | - Tom Petersen
- Department of Informatics, University of Hamburg, Hamburg
| | | | - Sebastian Debus
- Department of Vascular Medicine, Work Group GermanVasc, University Medical Center Hamburg-Eppendorf, Hamburg
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg
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