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Azhar B, Loftus IM. Centralisation of Aortic Services: More Fuel to the Fire. Eur J Vasc Endovasc Surg 2024; 68:39. [PMID: 38485047 DOI: 10.1016/j.ejvs.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 03/11/2024] [Indexed: 04/20/2024]
Affiliation(s)
- Bilal Azhar
- St Georges Vascular Institute, St Georges University Hospital NSH Trust, London, UK.
| | - Ian M Loftus
- St Georges Vascular Institute, St Georges University Hospital NSH Trust, London, UK
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2
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Björck M, Bastos Gonçalves F, Mani K. Which Direction Does the UK-COMPASS Point To? Eur J Vasc Endovasc Surg 2024; 67:533-535. [PMID: 38431126 DOI: 10.1016/j.ejvs.2024.02.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Affiliation(s)
- Martin Björck
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.
| | - Frederico Bastos Gonçalves
- Hospital de Santa Marta, Unidade Local de Saúde São José, Centro Clínico Académico de Lisboa, Lisbon, Portugal; NOVA Medical School | Faculdade de Ciências Médicas, NMS|FCM, Universidade Nova de Lisboa, Lisbon, Portugal; Hospital CUF Tejo, Lisbon, Portugal
| | - Kevin Mani
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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Blauw JTM, Metz FM, Nuzzo A, van Etten-Jamaludin FS, Brusse-Keiser M, Boermeester MA, Peppelenbosch M, Geelkerken RH. The Diagnostic Value of Biomarkers in Acute Mesenteric Ischaemia Is Insufficiently Substantiated: A Systematic Review. Eur J Vasc Endovasc Surg 2024; 67:554-569. [PMID: 37640253 DOI: 10.1016/j.ejvs.2023.08.059] [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: 03/02/2023] [Revised: 07/30/2023] [Accepted: 08/23/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE There is an urgent need for accurate biomarkers to support timely diagnosis of acute mesenteric ischaemia (AMI) and thereby improve clinical outcomes. With this systematic review, the aim was to substantiate the potential diagnostic value of biomarkers for arterial occlusive AMI. DATA SOURCES The Pubmed, Embase, and the Cochrane Library electronic databases were searched. REVIEW METHODS A systematic review of the literature has been conducted to define the potential diagnostic value of biomarkers for arterial occlusive AMI. All studies including ≥ 10 patients describing biomarkers for macrovascular occlusive AMI between 1950 and 17 February 2023 were identified within the Pubmed, Embase, and the Cochrane Library electronic databases. There were no restrictions to any particular study design, but letters and editorials were excluded. The QUADAS-2 tool was used for the critical appraisal of quality. The study protocol was registered on Prospero (CRD42021254970). RESULTS Fifty of 4334 studies were eligible for inclusion in this review. Ninety per cent of studies were of low quality. A total of 60 biomarkers were identified, with 24 in two or more studies and 15 in five or more studies. There was variation in reported units, normal range, and cut off values. Meta-analysis was not possible due to study heterogeneity. Biomarkers currently recommended by the European Journal of Vascular and Endovascular Surgery, European Society for Trauma and Emergency Surgery 2016, and World Society of Emergency Surgery 2017 guidelines also had heterogeneous low quality data for use in the diagnosis of AMI. CONCLUSION This systematic review demonstrates high heterogeneity and low quality of the available evidence on biomarkers for arterial occlusive AMI. No clinical conclusions can be drawn on a biomarker or combination of biomarkers for patients suspected of arterial occlusive AMI. Restraint is advised when rejecting or determining AMI solely based on biomarkers.
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Affiliation(s)
- Juliëtte T M Blauw
- Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, The Netherlands; Department of Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Flores M Metz
- Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, The Netherlands; Dutch Expert Centre for Gastrointestinal Ischaemia, Enschede, The Netherlands; Multi-Modality Medical Imaging group, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - Alexandre Nuzzo
- Structure d'Urgences Vasculaires Intestinales Gastroentérologie, MICI et Assistance Nutritive, Hôpital Beaujon APHP, Université de Paris, France
| | | | - Marjolein Brusse-Keiser
- Dutch Expert Centre for Gastrointestinal Ischaemia, Enschede, The Netherlands; Medical School Twente, Medisch Spectrum Twente, Enschede, The Netherlands; Health Technology and Services Research (HTSR), BMS Faculty, University of Twente, Enschede, The Netherlands
| | - Marja A Boermeester
- Department of Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Maikel Peppelenbosch
- Department of Gastroenterology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Robert H Geelkerken
- Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, The Netherlands; Dutch Expert Centre for Gastrointestinal Ischaemia, Enschede, The Netherlands; Multi-Modality Medical Imaging group, TechMed Centre, University of Twente, Enschede, The Netherlands.
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Bastos Gonçalves F, Mendes Pedro L. Centralisation of Vascular Care in Portugal. Eur J Vasc Endovasc Surg 2024; 67:370-372. [PMID: 38253170 DOI: 10.1016/j.ejvs.2024.01.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/17/2024] [Indexed: 01/24/2024]
Affiliation(s)
- Frederico Bastos Gonçalves
- NOVA Medical School|Faculdade de Ciências Médicas, NMS|FCM, Universidade Nova de Lisboa, Lisbon, Portugal; Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal; Hospital CUF Tejo, Lisbon, Portugal.
| | - Luís Mendes Pedro
- Vascular Surgery Department, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), Lisbon, Portugal; Faculty of Medicine, University of Lisbon, Lisbon, Portugal
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Loftus I, Sayers R. More or Less a Transatlantic View of AAA Case Volumes. Eur J Vasc Endovasc Surg 2023; 66:765. [PMID: 37454967 DOI: 10.1016/j.ejvs.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 06/30/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
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Hakeem A, Najem M. Impact of Vascular Service Centralization on the Carotid Endarterectomy Pathway: A Study at the Bedfordshire, Luton, and Milton Keynes Vascular Network. Cureus 2023; 15:e49726. [PMID: 38050531 PMCID: PMC10693671 DOI: 10.7759/cureus.49726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2023] [Indexed: 12/06/2023] Open
Abstract
Introduction Carotid endarterectomy (CEA) is the gold standard intervention for patients experiencing transient ischemic attacks (TIAs) or embolic strokes with >50% internal carotid artery (ICA) stenosis supplying index hemispheric territory. The recommended period for CEA is 14 days post-index event; this period carries a heightened risk for second ischemic events. However, implementation of this stringent timeline often encounters delays stemming from multifaceted factors. The centralization of vascular services, designed to enhance patient care, introduces a paradigm shift. Centralization's efficacy in improving patient outcomes, particularly in the CEA pathway, is a subject of ongoing investigation. Our study aims to discern the impact of centralized services on the timeliness of CEA for symptomatic carotid artery stenosis, shedding light on this complex interplay of factors. Methods This retrospective study analyzed CEA data at the Bedfordshire, Luton, and Milton Keynes Vascular Network between January 2021 and June 2023. Eligible patients exhibited symptomatic carotid artery stenosis, with asymptomatic cases; those unfit for surgery or receiving best medical therapy only were excluded. Patients were categorized by their primary referral location: Hub, Spoke-1, or Spoke-2. Demographic and referral data were collected, and timelines from symptom onset to surgery were recorded. Continuous variables were expressed as means and standard deviations, and categorical variables as counts and percentages. Box plots illustrated the relationship between referral origin and surgery timing, and the Classification and Regression Tree (CART) assessed second events. Statistical significance was determined using Fisher's exact and chi-square tests, with p<0.05 indicating significance. Results A total of 148 patients underwent CEA after implementing exclusion criteria. 35.5% (n=53) of patients were referred from the Hub, while 45.6% (n=67) and 18.8% (n=28) were from Spoke-1 and Spoke-2, respectively. 40% (n=59) received CEA within the recommended timeframe, and 15.4% (n=23) experienced a second ischemic event pre-surgery. Time from TIA clinic review to referral was 5.5±8 days and 16.4±20 days from vascular referral to surgery. Patterns of delays were observed, with Spoke-2 exhibiting the most significant delays. Notably, amaurosis fugax and embolic stroke correlated with recurrent ischemic events, emphasizing the importance of timely care in CEA. Conclusion Our study underscores the significant benefits and challenges of the Hub and Spoke model in vascular surgery. The growing referral delays from Spoke sites are concerning, emphasizing the need for a multi-disciplinary team approach within Spoke sites to ensure efficient and standardized care delivery.
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Affiliation(s)
- Abdul Hakeem
- Vascular Surgery, Bedfordshire-Milton Keynes Vascular Centre, Bedford, GBR
| | - Mojahid Najem
- Vascular Surgery, Bedfordshire-Milton Keynes Vascular Centre, Bedford, GBR
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Debus ES, Dorweiler B, Steinbauer M, Heckenkamp J. Centralisation of Vascular Surgery in Germany: Current and Future Hospital Planning. Eur J Vasc Endovasc Surg 2023; 66:451-453. [PMID: 37558201 DOI: 10.1016/j.ejvs.2023.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 08/03/2023] [Indexed: 08/11/2023]
Affiliation(s)
- E Sebastian Debus
- Department for Vascular Medicine (Vascular Surgery, Angiology, Endovascular Care), University Heart & Vascular Centre Hamburg, University Hospital, Hamburg-Eppendorf, Germany.
| | - Bernhard Dorweiler
- Department for Vascular Surgery, University Hospital Cologne, Cologne, Germany
| | - Markus Steinbauer
- Department of Vascular Surgery, Vascular Centre, Krankenhaus Barmherzige Brüder Regensburg, Germany
| | - Jörg Heckenkamp
- Department for Vascular Surgery, Niels-Stensen-Kliniken, Marienhospital Osnabrück
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Eiberg JP, Mejnert Jørgensen TM, Budtz-Lilly JW. Centralisation of Vascular Surgery: A Danish Perspective. Eur J Vasc Endovasc Surg 2023; 65:772-773. [PMID: 36921756 DOI: 10.1016/j.ejvs.2023.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/07/2023] [Indexed: 03/16/2023]
Affiliation(s)
- Jonas Peter Eiberg
- Department of Vascular Surgery, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark.
| | | | - Jacob W Budtz-Lilly
- Division of Vascular Surgery, Department of Cardiovascular Surgery, Aarhus University Hospital, Aarhus, Denmark
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Gormley S, Bernau O, Xu W, Sandiford P, Khashram M. Incidence and Outcomes of Abdominal Aortic Aneurysm Repair in New Zealand from 2001 to 2021. J Clin Med 2023; 12:jcm12062331. [PMID: 36983332 PMCID: PMC10054325 DOI: 10.3390/jcm12062331] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/08/2023] [Accepted: 03/12/2023] [Indexed: 03/19/2023] Open
Abstract
Purpose: The burden of abdominal aortic aneurysms (AAA) has changed in the last 20 years but is still considered to be a major cause of cardiovascular mortality. The introduction of endovascular aortic repair (EVAR) and improved peri-operative care has resulted in a steady improvement in both outcomes and long-term survival. The objective of this study was to identify the burden of AAA disease by analysing AAA-related hospitalisations and deaths. Methodology: All AAA-related hospitalisations in NZ from January 2001 to December 2021 were identified from the National Minimum Dataset, and mortality data were obtained from the NZ Mortality Collection dataset from January 2001 to December 2018. Data was analysed for patient characteristics including deprivation index, repair methods and 30-day outcomes. Results: From 2001 to 2021, 14,436 patients with an intact AAA were identified with a mean age of 75.1 years (SD 9.7 years), and 4100 (28%) were females. From 2001 to 2018, there were 5000 ruptured AAA with a mean age of 77.8 (SD 9.4), and 1676 (33%) were females. The rate of hospitalisations related to AAA has decreased from 43.7 per 100,000 in 2001 to 15.4 per 100,000 in 2018. There was a higher proportion of rupture AAA in patients living in more deprived areas. The use of EVAR for intact AAA repair has increased from 18.1% in 2001 to 64.3% in 2021. The proportion of octogenarians undergoing intact AAA repair has increased from 16.2% in 2001 to 28.4% in 2021. The 30-day mortality for intact AAA repair has declined from 5.8% in 2001 to 1.7% in 2021; however, it has remained unchanged for ruptured AAA repair at 31.6% across the same period. Conclusions: This study highlights that the incidence of AAA has declined in the last two decades. The mortality has improved for patients who had a planned repair. Understanding the contemporary burden of AAA is paramount to improve access to health, reduce variation in outcomes and promote surgical quality improvement.
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Affiliation(s)
- Sinead Gormley
- Department of Vascular & Endovascular Surgery, Waikato Hospital, Hamilton 3204, New Zealand
- Faculty of Medical & Health Sciences, University of Auckland, Auckland 1010, New Zealand
| | - Oliver Bernau
- Faculty of Medical & Health Sciences, University of Auckland, Auckland 1010, New Zealand
| | - William Xu
- Faculty of Medical & Health Sciences, University of Auckland, Auckland 1010, New Zealand
| | - Peter Sandiford
- Planning Funding and Outcomes Unit, Auckland and Waitemata District Health Boards, Auckland 1010, New Zealand
- School of Population Health, University of Auckland, Auckland 1010, New Zealand
| | - Manar Khashram
- Department of Vascular & Endovascular Surgery, Waikato Hospital, Hamilton 3204, New Zealand
- Faculty of Medical & Health Sciences, University of Auckland, Auckland 1010, New Zealand
- Correspondence:
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Behrendt CA. Is There Any Fun in a Puzzle When All Pieces Look the Same? Eur J Vasc Endovasc Surg 2023; 65:747. [PMID: 36803705 DOI: 10.1016/j.ejvs.2023.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 02/13/2023] [Indexed: 02/21/2023]
Affiliation(s)
- Christian-Alexander Behrendt
- Department of Vascular and Endovascular Surgery, Asklepios Clinic Wandsbek, Asklepios Medical School, Hamburg, Germany; German Institute for Vascular Research, Berlin, Germany; Medical School Brandenburg, Theodor Fontane, Neuruppin, Germany.
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