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Pedras S, Oliveira R, Veiga C, Silva I. Illness beliefs relation to physical activity and quality of life in patients with peripheral arterial disease. PSYCHOL HEALTH MED 2024; 29:1331-1348. [PMID: 38477257 DOI: 10.1080/13548506.2024.2325378] [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: 11/29/2022] [Accepted: 02/26/2024] [Indexed: 03/14/2024]
Abstract
Intermittent claudication is the most common symptom of Peripheral Arterial Disease (PAD) and is associated with decreased quality of life (QoL) due to walking impairment. The level of threat attributed to the disease affects QoL and physical activity. This study explores beliefs and illness drawings, and their relationship with quality of life and physical activity in patients undergoing conservative treatment for PAD. A cross-sectional study was carried out including 119 patients with PAD and Intermittent Claudication, in which patients were asked to freely draw their disease and 33 agreed to participate. The profile of beliefs about PAD is characterized by a low level of threat. Belief in the emotional impact of the disease, representations about the consequences and concern about the disease were associated with worse quality of life; the belief of having a high personal control over the disease was associated with more physical activity. The analysis of the disease drawings revealed three categories: extension of the disease (category 1), location and representations of the disease (category 2), and level of detail and complexity of the drawings (category 3). Greater disease extent was associated with more disease symptoms (IPQ 6) (rs = 0.399, p = .021). It is necessary to address beliefs and representations about the disease in consultations with patients with PAD. Patient drawings are a useful, practical, and free tool that does not require a lot of time and can facilitate the approach of health professionals to patient training and education.
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Affiliation(s)
- Susana Pedras
- Angiology & Vascular Surgery Department, Centro Hospitalar Universitário Porto (CHUP), Porto, Portugal
| | - Rafaela Oliveira
- Bachelor of Science degree in Clinical Physiology, Angiology & Vascular Surgery Department, Centro Hospitalar Universitário Porto (CHUP), Porto, Portugal
| | - Carlos Veiga
- Master in Medicine, Angiology & Vascular Surgery Department, Centro Hospitalar Universitário Porto (CHUP), Porto, Portugal
| | - Ivone Silva
- Angiology & Vascular Surgery Department, Centro Hospitalar Universitário Porto (CHUP), Porto, Portugal
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Peñín-Grandes S, López-Ortiz S, Maroto-Izquierdo S, Menéndez H, Pinto-Fraga J, Martín-Hernández J, Lista S, Lucia A, Santos-Lozano A. Winners do what they fear: exercise and peripheral arterial disease-an umbrella review. Eur J Prev Cardiol 2024; 31:380-388. [PMID: 37611200 DOI: 10.1093/eurjpc/zwad261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/02/2023] [Accepted: 08/06/2023] [Indexed: 08/25/2023]
Abstract
AIMS This systematic review aims to evaluate and summarize findings from published meta-analyses on the effects of regular exercise in patients with peripheral arterial disease (PAD). The review will assess the impact of exercise on functional parameters, health-related quality of life, haemodynamic parameters, physical activity levels, adverse events, and mortality. METHODS AND RESULTS A systematic search was performed in PubMed, Web of Science, Scopus, and Cochrane Library databases (up to May 2023) to identify meta-analyses including randomized controlled trials that examined the effects of regular exercise in patients with PAD. Sixteen studies, with a total of 198 meta-analyses, were identified. Results revealed with strong evidence that patients with PAD who exercised improved functional and health-related quality of life parameters. Specifically, supervised aerobic exercise (i.e. walking to moderate-maximum claudication pain) improves maximum walking distance [mean difference (MD): 177.94 m, 95% confidence interval (CI) 142.29-213.60; P < 0.00001; I2: 65%], pain-free walking distance (fixed MD: 68.78 m, 95% CI 54.35-83.21; P < 0.00001; I2: 67%), self-reported walking ability [i.e. distance score (MD: 9.22 points, 95% CI 5.74-12.70; P < 0.00001; I2: 0%), speed score (MD: 8.71 points, 95% CI 5.64-11.77; P < 0.00001, I2: 0%), stair-climbing score (MD: 8.02 points, 95% CI 4.84-11.21; P < 0.00001, I2: 0%), and combined score (MD: 8.76 points, 95% CI 2.78-14.74; P < 0.0001, I2: 0%)], aerobic capacity (fixed MD: 0.62 mL/kg/min, 95% CI 0.47-0.77, P < 0.00001, I2: 64%), and pain score (MD: 7.65, 95% CI 3.15-12.15; P = 0.0009; I2: 0%), while resistance exercise improves lower limb strength (standardized mean difference: 0.71, 95% CI 0.29-1.13, P = 0.0009; I2: 0%]. Regarding other outcomes, such as haemodynamic parameters, no significant evidence was found, while physical activity levels, adverse events, and mortality require further investigation. CONCLUSION Synthesis of the currently available meta-analyses suggests that regular exercise may be beneficial for a broad range of functional tasks improving health-related quality of life in patients with PAD. Supervised aerobic exercise is the best type of exercise to improve walking-related outcomes and pain, while resistance exercise is more effective to improve lower limb strength.
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Affiliation(s)
- Saúl Peñín-Grandes
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), Padre Julio Chevalier Street, 2, 47012, Valladolid, Castilla y León, Spain
| | - Susana López-Ortiz
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), Padre Julio Chevalier Street, 2, 47012, Valladolid, Castilla y León, Spain
| | - Sergio Maroto-Izquierdo
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), Padre Julio Chevalier Street, 2, 47012, Valladolid, Castilla y León, Spain
| | - Héctor Menéndez
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), Padre Julio Chevalier Street, 2, 47012, Valladolid, Castilla y León, Spain
| | - José Pinto-Fraga
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), Padre Julio Chevalier Street, 2, 47012, Valladolid, Castilla y León, Spain
| | - Juan Martín-Hernández
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), Padre Julio Chevalier Street, 2, 47012, Valladolid, Castilla y León, Spain
| | - Simone Lista
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), Padre Julio Chevalier Street, 2, 47012, Valladolid, Castilla y León, Spain
| | - Alejandro Lucia
- Research Institute of the Hospital 12 de Octubre ('imas12' and 'PaHerg group'), Madrid, Spain
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Alejandro Santos-Lozano
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), Padre Julio Chevalier Street, 2, 47012, Valladolid, Castilla y León, Spain
- Research Institute of the Hospital 12 de Octubre ('imas12' and 'PaHerg group'), Madrid, Spain
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Vossen RJ, Fokkema TM, Vahl AC, Balm R. Systematic review and meta-analysis comparing the autogenous vein bypass versus a prosthetic graft for above-the-knee femoropopliteal bypass surgery in patients with intermittent claudication. Vascular 2024; 32:91-101. [PMID: 36066001 DOI: 10.1177/17085381221124701] [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: 12/24/2022]
Abstract
OBJECTIVES According to guidelines, the autogenous saphenous vein (ASV) is the preferred conduit for femoropopliteal bypass surgery in all patients with peripheral artery disease. However, in contrast to patients with critical limb ischemia (CLI), patients with intermittent claudication (IC) only, tend to have milder disease, and thus a prosthetic graft may be as good as a vein conduit. The objective of this study was to compare patency rates of the ASV and a prosthetic graft in femoropopliteal bypass surgery in patients with IC. METHODS A systematic literature search was performed in the PubMed, Embase, and Cochrane databases to identify randomized controlled trials comparing prosthetic graft versus ASV in patients with IC. Articles with a mixed IC and CLI study population were included if more than 50% of the study cohort was treated for IC. Primary analysis was performed on IC patients only. Secondary analysis was performed on the mixed group. The primary endpoint was short- and long-term patency and secondary endpoints were complications, limb salvage, and mortality. RESULTS In total, six studies with 524 patients were included. Only two studies reported solely on patients with IC. All these patients underwent above-the-knee bypasses and average patency rates at one and 5 years were 88% and 76% vs 81% and 68% in the ASV and the PTFE groups, respectively. One and five-year patency was not statistically different between the groups (OR 5.21; 95% CI 0.60-45.36 and OR 2.10; 95% CI 0.88-5.01). In a mixed population of patients with IC and CLI (84% IC patients), 1 year patency was comparable (OR 1.40; 95% CI 0.87-2.25). However, after a follow-up of over 3 years, this mixed group had significantly higher patency rates in favour of the ASV (OR 2.06; 95 % CI 1.30-3.26). Complication and amputation rates were comparable in both groups. CONCLUSIONS Limited data are available for patients receiving above-the-knee femoropopliteal bypass for intermittent claudication. The ASV remains the conduit of choice for femoropopliteal bypass surgery. However, the prosthetic conduit seems a feasible alternative for patients with intermittent claudication in whom the ASV is not present or unsuitable.
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Affiliation(s)
- R J Vossen
- Department of Vascular Surgery, OLVG Amsterdam, Amsterdam, The Netherlands
- Department of Anesthesiology, Erasmus Medical Center, The Netherlands
| | - T M Fokkema
- Department of Vascular Surgery, Länssjukhuset Ryhov, Jönköping, Sweden
| | - A C Vahl
- Department of Vascular Surgery, OLVG Amsterdam, Amsterdam, The Netherlands
- Clinical Epidemiology, OLVG Amsterdam, Amsterdam, The Netherlands
| | - R Balm
- Department of Surgery, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
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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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Kobayashi Y, Fujikawa T, Haruna A, Kawano R, Ozawa M, Haze T, Komiya S, Suzuki S, Ohki Y, Fujiwara A, Saka S, Hirawa N, Toya Y, Tamura K. Omega-3 Fatty Acids Reduce Remnant-like Lipoprotein Cholesterol and Improve the Ankle-Brachial Index of Hemodialysis Patients with Dyslipidemia: A Pilot Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 60:75. [PMID: 38256336 PMCID: PMC10818298 DOI: 10.3390/medicina60010075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/22/2023] [Accepted: 12/28/2023] [Indexed: 01/24/2024]
Abstract
Background and Objectives: Omega-3 fatty acids have potent lipid-lowering and antiplatelet effects; however, randomized controlled trials have yet to examine the effect of high-dose omega-3 fatty acid administration on peripheral artery disease (PAD) in hemodialysis patients with dyslipidemia. Therefore, this study aimed to evaluate the effects of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) on the ankle-brachial index (ABI) and remnant-like lipoprotein cholesterol (RLP-C) levels, which are indicators of PAD severity. Materials and Methods: Thirty-eight participants (mean age: 73.6 ± 12.7 years) were randomly assigned using stratified block randomization to either conventional therapy alone or conventional therapy supplemented with high-dose EPA/DHA (EPA: 1860 mg; DHA: 1500 mg) for a three-month intervention period. Patients in the conventional therapy alone group who opted to continue were provided with a low-dose EPA/DHA regimen (EPA: 930 mg; DHA: 750 mg) for an additional three months. The baseline and 3-month values for RLP-C, an atherogenic lipid parameter, and the ABI were recorded. Results: The results of the 3-month assessments revealed that the mean RLP-C changes were -3.25 ± 3.15 mg/dL and 0.44 ± 2.53 mg/dL in the EPA/DHA and control groups, respectively (p < 0.001), whereas the changes in the mean ABI values were 0.07 ± 0.11 and -0.02 ± 0.09 in the EPA/DHA and control groups, respectively (p = 0.007). In the EPA/DHA group, a significant negative correlation was found between the changes in RLP-C levels and the ABI (r = -0.475, p = 0.04). Additionally, the change in the RLP-C levels independently influenced the change in the ABI in the EPA/DHA group, even after adjusting for age, sex, and statin use (p = 0.042). Conclusions: Add-on EPA/DHA treatment improved the effectiveness of conventional therapy (such as statin treatment) for improving the ABI in hemodialysis patients with dyslipidemia by lowering RLP-C levels. Therefore, clinicians involved in dialysis should focus on RLP-C when considering residual cardiovascular disease risk in hemodialysis patients and should consider screening patients with elevated levels.
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Affiliation(s)
- Yusuke Kobayashi
- Center for Novel and Exploratory Clinical Trials (Y-NEXT), Yokohama City University, Yokohama 236-0004, Japan
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan (K.T.)
| | - Tetsuya Fujikawa
- Center for Health Service Sciences, Yokohama National University, Yokohama 240-8501, Japan
| | - Aiko Haruna
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan (K.T.)
- Department of Nephrology and Hypertension, Yokohama City University Medical Center, Yokohama 232-0024, Japan (N.H.)
| | - Rina Kawano
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan (K.T.)
- Department of Nephrology and Hypertension, Yokohama City University Medical Center, Yokohama 232-0024, Japan (N.H.)
| | - Moe Ozawa
- Department of Nephrology and Hypertension, Saiseikai Yokohamashi Nanbu Hospital, Yokohama 234-0054, Japan
| | - Tatsuya Haze
- Center for Novel and Exploratory Clinical Trials (Y-NEXT), Yokohama City University, Yokohama 236-0004, Japan
- Department of Nephrology and Hypertension, Yokohama City University Medical Center, Yokohama 232-0024, Japan (N.H.)
| | - Shiro Komiya
- Department of Nephrology and Hypertension, Saiseikai Yokohamashi Nanbu Hospital, Yokohama 234-0054, Japan
| | - Shota Suzuki
- Department of Nephrology and Hypertension, Yokohama City University Medical Center, Yokohama 232-0024, Japan (N.H.)
| | - Yuki Ohki
- Department of Nephrology and Hypertension, Yokohama City University Medical Center, Yokohama 232-0024, Japan (N.H.)
| | - Akira Fujiwara
- Department of Nephrology and Hypertension, Yokohama City University Medical Center, Yokohama 232-0024, Japan (N.H.)
| | - Sanae Saka
- Department of Nephrology and Hypertension, Saiseikai Yokohamashi Nanbu Hospital, Yokohama 234-0054, Japan
| | - Nobuhito Hirawa
- Department of Nephrology and Hypertension, Yokohama City University Medical Center, Yokohama 232-0024, Japan (N.H.)
| | - Yoshiyuki Toya
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan (K.T.)
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan (K.T.)
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Koo MPM, Bookun HR. Post-operative transfusion is associated with infrainguinal bypass graft failure: contemporary Australian tertiary centre experience. ANZ J Surg 2023; 93:2382-2387. [PMID: 37698158 DOI: 10.1111/ans.18690] [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: 02/21/2023] [Revised: 07/31/2023] [Accepted: 08/18/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUNDS Peripheral arterial disease (PAD) is an increasingly prevalent and highly morbid pathology affecting the older population. Infra-inguinal bypass (IIB) surgery remains a robust revascularization option in these patients. This study aimed to identify modifiable predictors associated with graft patency and functional outcomes in contemporary Australian vascular surgical practice. METHODS A retrospective analysis of patients undergoing IIB between 2010 and 2020 at a tertiary vascular surgery centre in Australia was performed. Data regarding patient demographics, co-morbidities, pre-operative investigations, bypass characteristics, and discharge outcomes were collected. Surveillance ultrasound scans were reviewed to gain information on graft patency and compliance up to 2 years post-operatively. The primary outcome was graft failure. Secondary outcomes were mobility status and amputation-free survival at 1 year. RESULTS A total of 239 IIBs were performed on 207 patients during the 10-year period. Significant predictors for primary graft occlusion included regional referral (P < 0.01), low pre-operative haemoglobin level (P < 0.01), post-operative transfusion requirement (P = 0.02), use of prosthetic conduit (P < 0.01) and non-compliance to ultrasound surveillance (P < 0.01). Patients with a thrombosed graft were 2.4 times more likely to experience deterioration in mobility status (P < 0.01) and 8.6 times more likely to have major limb amputation or death at 1 year. The amputation-free survival was 88.3% at 1 year. CONCLUSION Optimization of pre-operative haemoglobin level for IIB should be advocated in clinical practice in order to reduce the risk of graft failure, deterioration in ambulatory function, major limb amputation and mortality.
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Affiliation(s)
- Mei Ping Melody Koo
- Department of Vascular Surgery, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Hansraj Riteesh Bookun
- Department of Vascular Surgery, Townsville University Hospital, Townsville, Queensland, Australia
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Haile ST, Johansson UB, Lööf H, Linné A, Joelsson-Alm E. Patient Related Outcomes After Receiving a Person Centred Nurse Led Follow Up Programme Among Patients Undergoing Revascularisation for Intermittent Claudication: A Secondary Analysis of a Randomised Clinical Trial. Eur J Vasc Endovasc Surg 2023; 66:371-379. [PMID: 37391012 DOI: 10.1016/j.ejvs.2023.06.030] [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: 08/08/2022] [Revised: 06/05/2023] [Accepted: 06/22/2023] [Indexed: 07/02/2023]
Abstract
OBJECTIVE The aim was to evaluate the effect of a person centred nurse led follow up programme on health related quality of life (HRQoL), health literacy, and general self efficacy compared with standard care for patients undergoing revascularisation for intermittent claudication (IC), and to describe factors associated with HRQoL one year after revascularisation. METHODS This was a secondary analysis of a randomised controlled trial. Patients with IC scheduled for revascularisation at two vascular surgery centres in Sweden between 2016 and 2018 were randomised to intervention or control. During the first year after surgery, the intervention group received a person centred follow up programme with three visits and two telephone calls with a vascular nurse, while the control group received standard follow up with two visits to a vascular surgeon or vascular nurse. Outcomes were HRQoL measured by VascuQol-6, health literacy, and general self efficacy measured by validated questionnaires. RESULTS Overall, 214 patients were included in the trial; this secondary analysis comprised 183 patients who completed the questionnaires. One year after revascularisation, HRQoL had improved with a mean increase in VascuQol-6 of 7.0 scale steps (95% CI 5.9 - 8.0) for the intervention and 6.0 scale steps (95% CI 4.9 - 7.0) for the control group; the difference between the groups was not significant (p = .18). In an adjusted regression analysis, the intervention was associated with higher VascuQoL-6 (2.0 scale steps, 95% CI 0.08 - 3.93). There was no significant difference between the groups regarding health literacy or general self efficacy. The prevalence of insufficient health literacy among all participants was 38.7% (46/119) at baseline and 43.2% (51/118) at one year. CONCLUSION In this study, a person centred, nurse led follow up programme had no significant impact on HRQoL, health literacy, or general self efficacy among patients undergoing revascularisation for IC. The prevalence of insufficient health literacy was high and should be addressed by healthcare givers and researchers.
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Affiliation(s)
- Sara T Haile
- Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden; Department of Surgery, Södersjukhuset, Stockholm, Sweden.
| | - Unn-Britt Johansson
- Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden; Sophiahemmet University, Department of Health Promoting Science, Stockholm, Sweden
| | - Helena Lööf
- Sophiahemmet University, Department of Health Promoting Science, Stockholm, Sweden; Mälardalen University, Division of Caring Sciences, School of Healthcare and Social Welfare, Västerås, Sweden
| | - Anneli Linné
- Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden; Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - Eva Joelsson-Alm
- Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden; Department of Anaesthesiology and Intensive Care, Södersjukhuset, Stockholm, Sweden
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Arndt H, Behrendt CA. Was ist eine Lebensstil limitierende Claudicatio? Patientenberichtete Endpunkte in der Behandlung der peripheren arteriellen Verschlusskrankheit (PAVK). GEFÄSSCHIRURGIE 2022. [DOI: 10.1007/s00772-022-00963-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Vossen RJ, Ras D, Vahl AC, Leijdekkers VJ, Montauban van Swijndregt AD, Wisselink W, Balm R. Correlation of patient-reported outcome measures and the ankle–brachial index in patients who underwent revascularization for peripheral artery disease. Vasc Med 2022:1358863X221138879. [DOI: 10.1177/1358863x221138879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Rianne J Vossen
- Department of Vascular Surgery, OLVG Amsterdam, Amsterdam, The Netherlands
- Department of Anesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Dianne Ras
- Department of Health Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Anco C Vahl
- Department of Vascular Surgery, OLVG Amsterdam, Amsterdam, The Netherlands
| | | | | | - Willem Wisselink
- Department of Vascular Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ron Balm
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
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Arndt H, Nordanstig J, Bertges DJ, Budtz-Lilly J, Venermo M, Espada CL, Sigvant B, Behrendt CA. A Delphi Consensus on Patient Reported Outcomes for Registries and Trials Including Patients with Intermittent Claudication: Recommendations and Reporting Standard. Eur J Vasc Endovasc Surg 2022; 64:526-533. [PMID: 35985529 DOI: 10.1016/j.ejvs.2022.08.011] [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: 03/10/2022] [Revised: 07/14/2022] [Accepted: 08/05/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE This study aimed to develop a core set of patient reported outcome quality indicators (QIs) for the treatment of patients with intermittent claudication (IC), that allow a broad international implementation across different vascular registries and within trials. METHODS A rigorous modified two stage Delphi technique was used to promote consensus building on patient reported outcome QIs among an expert panel consisting of international vascular specialists, patient representatives, and registry members of the VASCUNET and the International Consortium of Vascular Registries. Potential QIs identified through an extensive literature search or additionally proposed by the panel were validated by the experts in a preliminary survey and included for evaluation. Consensus was reached if ≥ 80% of participants agreed that an item was both clinically relevant and practical. RESULTS Participation rates in two Delphi rounds were 66% (31 participants of 47 invited) and 90% (54 of 60), respectively. Initially, 145 patient reported outcome QIs were documented. Following the two Delphi rounds, 18 quality indicators remained, all of which reached consensus regarding clinical relevance. The VascuQoL questionnaire (VascuQoL-6), currently the most common patient reported outcome measurement (PROM) used within vascular registries, includes a total of six items. Five of these six items also matched with high rated indicators identified in the Delphi study. Consequently, the panel recommends the use of the VascuQoL-6 survey as a preferred core PROM QI set as well as an optional extension of 12 additional patient reported QIs that were also identified in this study. CONCLUSION The current recommendation based on the Delphi consensus building approach, strengthens the international harmonisation of registry data collection in relation to patient reported outcome quality. Continuous and standardised quality assurance will ensure that registry data may be used for future quality benchmarking studies and, ultimately, positively impact the overall quality of care provided to patients with peripheral arterial occlusive disease.
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Affiliation(s)
- Helene Arndt
- Department of Vascular Medicine, Research Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Joakim Nordanstig
- Institute of Medicine, Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Daniel J Bertges
- Division of Vascular Surgery, University of Vermont Medical Centre, Burlington, VT, USA
| | | | - Maarit Venermo
- Vascular Surgery, Abdominal Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Cristina Lopez Espada
- Department of Vascular Surgery, University Hospital Virgen de las Nieves, Granada, Spain
| | - Birgitta Sigvant
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Christian-Alexander Behrendt
- Department of Vascular Medicine, Research Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Brandenburg Medical School Theodor Fontane, Neuruppin, Germany.
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Peñín-Grandes S, Martín-Hernández J, Valenzuela PL, López-Ortiz S, Pinto-Fraga J, Solá LDR, Emanuele E, Lista S, Lucia A, Santos-Lozano A. Exercise and the hallmarks of peripheral arterial disease. Atherosclerosis 2022; 350:41-50. [DOI: 10.1016/j.atherosclerosis.2022.04.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/06/2022] [Accepted: 04/21/2022] [Indexed: 01/08/2023]
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12
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Paisley MJ, Adkar S, Sheehan BM, Stern JR. Aortoiliac Occlusive Disease. Semin Vasc Surg 2022; 35:162-171. [DOI: 10.1053/j.semvascsurg.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/11/2022] [Accepted: 04/11/2022] [Indexed: 12/24/2022]
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13
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Sahba M, Krog AH, Pettersen EM, Wisløff T, Sundhagen JO, Kazmi SSH. Quality of Life (QoL) Assessment in the Patients Operated with Either Laparoscopic or an Open Aortobifemoral Bypass for Aortoiliac Occlusive Disease (AIOD): 2 Years Results of a Randomized Controlled Trial. Vasc Health Risk Manag 2022; 18:61-71. [PMID: 35221689 PMCID: PMC8865903 DOI: 10.2147/vhrm.s350836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/11/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Mehdi Sahba
- Department of Vascular Surgery, Østfold Central Hospital, Kalnes, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anne Helene Krog
- Department of Vascular Surgery, Østfold Central Hospital, Kalnes, Norway
| | | | - Torbjørn Wisløff
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Jon Otto Sundhagen
- Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Syed Sajid Hussain Kazmi
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Ullevål, Oslo, Norway
- Correspondence: Syed Sajid Hussain Kazmi, Tel +47 92468309, Email
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14
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Bertges DJ, Simons JP, Corriere MA, Berman SS, Eldrup-Jorgensen J. Patient-reported outcomes for peripheral vascular interventions in the vascular quality initiative. J Vasc Surg 2021; 74:1689-1692.e3. [PMID: 34688397 DOI: 10.1016/j.jvs.2021.05.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/17/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Daniel J Bertges
- Division of Vascular Surgery, University of Vermont Medical Center, Burlington, Vt.
| | - Jessica P Simons
- Division of Vascular and Endovascular Surgery, University of Massachusetts Medical Center, Worchester, Mass
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15
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Peñín-Grandes S, Santos-Lozano A, Pinto-Fraga J, de la Fuente Gómez M, Del Río Solá ML, Martín-Hernández J. Moderate Intensity Functional Training as Adjuvant Treatment in Patients With Peripheral Arterial Disease: A Case Report. Ann Vasc Surg 2021; 79:439.e1-439.e6. [PMID: 34648862 DOI: 10.1016/j.avsg.2021.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/08/2021] [Accepted: 07/20/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Traditional aerobic training and muscle resistance ("strength") training have been shown to be effective for improving functional and health-related quality of life (HRQoL) outcomes in peripheral arterial disease (PAD). However, the transfer of the current resistance exercise modes proposed to other activities of daily living (ADLs) is questionable. Moderate intensity functional training (MIFT) has emerged with the aim of achieving cardiovascular and neuromuscular adaptations simultaneously with functional exercises typical of ADLs. The effect of MIFT in patients with PAD is not yet known. Our purpose is to verify the influence of the combination of intermittent treadmill walking exercise with MIFT on functional capacity and HRQoL in patients with PAD. METHODS Three patients with PAD participated in a novel supervised exercise therapy program of 6 weeks duration based on intermittent treadmill walking exercise and MIFT. RESULTS After the training period, the 3 patients showed high adherence to the program (95%) and they improved total distance (TD) (25%, 9%, and 21%), claudication onset distance (COD) (56%, 19%, and 151%), total number of repetitions (33%, 24%, and 33%) and total work capacity (80%, 79%, and 72%). Also, physical component in Short Form-36 Health Survey (SF-36) and Vascular Quality of Life Questionnaire-6 (VascuQol-6) showed increases in the patients. CONCLUSIONS The 6-week intervention in patients with PAD, based on intermittent treadmill walking exercise and MIFT, seems to improve their functional status and total work capacity in functional exercises as well as their HRQoL.
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Affiliation(s)
| | - Alejandro Santos-Lozano
- i+HeALTH, European University Miguel de Cervantes, Valladolid, Spain; Research Institute of the Hospital 12 de Octubre ('imas12'), Madrid, Spain
| | - José Pinto-Fraga
- i+HeALTH, European University Miguel de Cervantes, Valladolid, Spain
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16
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Nugteren MJ, Catarinella FS, Koning OHJ, Hinnen JW. Mobile applications in peripheral arterial disease (PAD): a review and introduction of a new innovative telemonitoring application: JBZetje. Expert Rev Med Devices 2021; 18:581-586. [PMID: 34057375 DOI: 10.1080/17434440.2021.1935876] [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: 10/21/2022]
Abstract
Introduction:Peripheral arterial disease (PAD) is an occlusive vascular disease of the lower extremities with increasing incidence and prevalence numbers and therefore rising health care costs. Mobile applications have great potential to improve health system efficiency and can assist in overcoming the increasing health care costs. In this review all available mobile applications developed for PAD are summarized and a new innovative application is introduced.Areas covered:Available applications for PAD are scarce and currently aim at prevention, teleconsultation and telemonitoring via questionnaires and activity tracking. Integration in the daily workflow of the physician is an overlooked aspect of these applications. JBZetje is an innovative mobile application that provides remote care, information services and self-service tools, and enables connection with the electronic health record (EHR).Expert opinion:Connection of the application with the EHR generates a complete overview of a patient's current health status. This will reinforce the tendency toward personalized medicine and will probably lead to reduced health care costs and increase the quality of care. Future feasibility studies should answer the question whether the use of mobile applications is feasible in the PAD population.
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Affiliation(s)
- Michael J Nugteren
- Department of Vascular Surgery, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, GZ, The Netherlands
| | | | - Olivier H J Koning
- Department of Vascular Surgery, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, GZ, The Netherlands
| | - Jan-Willem Hinnen
- Department of Vascular Surgery, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, GZ, The Netherlands
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17
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Raja A, Spertus J, Yeh RW, Secemsky EA. Assessing health-related quality of life among patients with peripheral artery disease: A review of the literature and focus on patient-reported outcome measures. Vasc Med 2021; 26:317-325. [PMID: 33295253 PMCID: PMC8169614 DOI: 10.1177/1358863x20977016] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Peripheral artery disease (PAD) is a progressive atherosclerotic disease associated with high rates of morbidity and mortality. Symptomatic PAD typically presents with claudication, and symptom severity strongly associates with reduced health-related quality of life (HRQoL). Existing treatment strategies for PAD are aimed at reducing symptom severity and improving functional outcomes. However, there is a need to incorporate patient-reported outcome measures (PROMs) into PAD treatment and research in order to provide more patient-centered care. This review will discuss the impact of PAD on HRQoL, existing PROMs available to assess PAD-related HRQoL, utilization of PROMs in research studies and registries, and challenges and solutions related to the integration of PROMs into research and clinical settings.
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Affiliation(s)
- Aishwarya Raja
- Richard A and Susan F Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - John Spertus
- Department of Cardiovascular Medicine, Saint Luke’s Mid America Heart Institute, Kansas City, MO, USA
| | - Robert W Yeh
- Richard A and Susan F Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA,Harvard Medical School, Boston, MA, USA,Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Eric A Secemsky
- Richard A and Susan F Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA,Harvard Medical School, Boston, MA, USA,Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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18
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Ahner MM, Pereira AH, Pereira AA, Fonseca GA, Zubaran GPDR, Macedo DDS, Garcia EL, Franzoni LT. Importance of physical detraining in functional capacity of individuals with chronic peripheral arterial occlusive disease: a cross-sectional pilot study. J Vasc Bras 2021; 20:e20200237. [PMID: 34093694 PMCID: PMC8147877 DOI: 10.1590/1677-5449.200237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Physical training is a well-established strategy for rehabilitation of the functional capacity of individuals with chronic peripheral arterial occlusive disease (PAOD). However, some individuals quit training after participating in a physical training program, undergoing detraining. There is scant literature on the effects of physical detraining in individuals with PAOD and it is therefore important to investigate the effects of this phenomenon. Objectives The objective of this article was to evaluate the effects of physical detraining on functional capacity in individuals with PAOD. Methods Cross-sectional study with 22 individuals. Participants were divided into two groups: a detraining group (DG) and a control group (CG). The distance covered in the 6-minute walk test (6MWTD) and the pain-free walking distance (PFWD) were evaluated. The PFWD is the distance covered until claudication begins, i.e., the distance covered without pain. Results Mean age was 66 ± 8 in the DG and 67 ± 7 in the CG. There were no differences between the groups in either the 6MWTD or the PFWD (p = 0.428; p = 0.537, respectively). Conclusions The present pilot study allows us to conclude that the functional capacity of individuals with PAOD who participated in a physical training program and subsequently underwent detraining was not superior in relation to individuals who did not participate in a physical training program. The results of the present study serve to encourage maintenance of physical exercise, since physical training is no longer effective if detraining occurs.
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Affiliation(s)
- Mabel Marciela Ahner
- Universidade Federal do Rio Grande do Sul - UFRGS, Hospital de Clínicas de Porto Alegre - HCPA, Porto Alegre, RS, Brasil.,Universidade Federal do Rio Grande do Sul - UFRGS, Hospital de Clínicas de Porto Alegre - HCPA, Ambulatório de Cirurgia Vascular, Porto Alegre, RS, Brasil
| | - Adamastor Humberto Pereira
- Universidade Federal do Rio Grande do Sul - UFRGS, Hospital de Clínicas de Porto Alegre - HCPA, Porto Alegre, RS, Brasil.,Universidade Federal do Rio Grande do Sul - UFRGS, Hospital de Clínicas de Porto Alegre - HCPA, Ambulatório de Cirurgia Vascular, Porto Alegre, RS, Brasil
| | - Alexandre Araújo Pereira
- Universidade Federal do Rio Grande do Sul - UFRGS, Hospital de Clínicas de Porto Alegre - HCPA, Porto Alegre, RS, Brasil.,Universidade Federal do Rio Grande do Sul - UFRGS, Hospital de Clínicas de Porto Alegre - HCPA, Ambulatório de Cirurgia Vascular, Porto Alegre, RS, Brasil
| | - Gabriel Alves Fonseca
- Universidade Federal do Rio Grande do Sul - UFRGS, Hospital de Clínicas de Porto Alegre - HCPA, Porto Alegre, RS, Brasil.,Universidade Federal do Rio Grande do Sul - UFRGS, Hospital de Clínicas de Porto Alegre - HCPA, Ambulatório de Cirurgia Vascular, Porto Alegre, RS, Brasil
| | - Gabriel Pereira Dos Reis Zubaran
- Universidade Federal do Rio Grande do Sul - UFRGS, Hospital de Clínicas de Porto Alegre - HCPA, Porto Alegre, RS, Brasil.,Universidade Federal do Rio Grande do Sul - UFRGS, Hospital de Clínicas de Porto Alegre - HCPA, Ambulatório de Cirurgia Vascular, Porto Alegre, RS, Brasil
| | - Débora Dos Santos Macedo
- Universidade Federal do Rio Grande do Sul - UFRGS, Hospital de Clínicas de Porto Alegre - HCPA, Porto Alegre, RS, Brasil.,Universidade Federal do Rio Grande do Sul - UFRGS, Hospital de Clínicas de Porto Alegre - HCPA, Ambulatório de Cirurgia Vascular, Porto Alegre, RS, Brasil.,Universidade Federal do Rio Grande do Sul - UFRGS, Programa de Pós-graduação em Ciências da Saúde: Cardiologia e Ciências Cardiovasculares, Porto Alegre, RS, Brasil
| | - Eduardo Lima Garcia
- Universidade Federal do Rio Grande do Sul - UFRGS, Hospital de Clínicas de Porto Alegre - HCPA, Porto Alegre, RS, Brasil.,Universidade Federal do Rio Grande do Sul - UFRGS, Hospital de Clínicas de Porto Alegre - HCPA, Ambulatório de Cirurgia Vascular, Porto Alegre, RS, Brasil
| | - Leandro Tolfo Franzoni
- Universidade Federal do Rio Grande do Sul - UFRGS, Hospital de Clínicas de Porto Alegre - HCPA, Porto Alegre, RS, Brasil.,Universidade Federal do Rio Grande do Sul - UFRGS, Hospital de Clínicas de Porto Alegre - HCPA, Ambulatório de Cirurgia Vascular, Porto Alegre, RS, Brasil.,Universidade Federal do Rio Grande do Sul - UFRGS, Programa de Pós-graduação em Ciências da Saúde: Cardiologia e Ciências Cardiovasculares, Porto Alegre, RS, Brasil
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19
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Mahé G, Boge G, Bura-Rivière A, Chakfé N, Constans J, Goueffic Y, Lacroix P, Le Hello C, Pernod G, Perez-Martin A, Picquet J, Sprynger M, Behar T, Bérard X, Breteau C, Brisot D, Chleir F, Choquenet C, Coscas R, Detriché G, Elias M, Ezzaki K, Fiori S, Gaertner S, Gaillard C, Gaudout C, Gauthier CE, Georg Y, Hertault A, Jean-Baptiste E, Joly M, Kaladji A, Laffont J, Laneelle D, Laroche JP, Lejay A, Long A, Loric T, Madika AL, Magnou B, Maillard JP, Malloizel J, Miserey G, Moukarzel A, Mounier-Vehier C, Nasr B, Nelzy ML, Nicolini P, Phelipot JY, Sabatier J, Schaumann G, Soudet S, Tissot A, Tribout L, Wautrecht JC, Zarca C, Zuber A. Disparities Between International Guidelines (AHA/ESC/ESVS/ESVM/SVS) Concerning Lower Extremity Arterial Disease: Consensus of the French Society of Vascular Medicine (SFMV) and the French Society for Vascular and Endovascular Surgery (SCVE). Ann Vasc Surg 2021; 72:1-56. [DOI: 10.1016/j.avsg.2020.11.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 11/05/2020] [Indexed: 12/24/2022]
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20
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Biswas MP, Capell WH, McDermott MM, Jacobs DL, Beckman JA, Bonaca MP, Hiatt WR. Exercise Training and Revascularization in the Management of Symptomatic Peripheral Artery Disease. JACC Basic Transl Sci 2021; 6:174-188. [PMID: 33665516 PMCID: PMC7907537 DOI: 10.1016/j.jacbts.2020.08.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 08/31/2020] [Accepted: 08/31/2020] [Indexed: 01/01/2023]
Abstract
In the management of symptomatic peripheral artery disease, aerobic exercise therapy and lower extremity revascularization are the mainstays of therapy. In this structured review, the most effective therapies, with 6 to 18 months of follow-up, indicated that exercise therapy and lower extremity revascularization each independently improve peak walking performance. The combination of therapies was superior to either therapy alone and may decrease the need for subsequent revascularization. Further research is needed to evaluate the long-term durability of these interventions, their impacts on subsequent invasive procedures, and predictors of response.
Exercise therapy and lower extremity revascularization both improve walking performance in symptomatic patients with peripheral artery disease. The combination of therapies provides greater benefit than either alone and may reduce the need for subsequent revascularization procedures, but further trials with longer follow-up are needed for the outcome of subsequent revascularization.
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Key Words
- 6MW, 6-minute walk
- CMS, Centers for Medicare and Medicaid Services
- ET, exercise therapy
- HBE, home-based exercise
- LER, lower extremity revascularization
- MCID, minimum clinically important difference
- PAD, peripheral artery disease
- PRO, patient-reported outcome
- PWD, peak walking distance
- PWT, peak walking time
- SET, supervised exercise training
- SF-36, Medical Outcomes Short Form–36
- VascuQOL, Vascular Quality of Life
- WIQ, Walking Impairment Questionnaire
- evidence
- exercise therapy (supervised exercise training, home-based exercise programs)
- lower extremity revascularization
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Affiliation(s)
- Minakshi P Biswas
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,CPC Clinical Research, Aurora, Colorado, USA
| | - Warren H Capell
- CPC Clinical Research, Aurora, Colorado, USA.,Division of Endocrinology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Mary M McDermott
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Donald L Jacobs
- Division of Vascular Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Joshua A Beckman
- Division of Cardiology, Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Marc P Bonaca
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,CPC Clinical Research, Aurora, Colorado, USA
| | - William R Hiatt
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,CPC Clinical Research, Aurora, Colorado, USA
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21
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Kim TI, Kiwan G, Mohamedali A, Zhang Y, Dardik A, Guzman RJ, Ochoa Chaar CI. Multiple Reinterventions for Claudication are Associated with Progression to Chronic Limb-Threatening Ischemia. Ann Vasc Surg 2020; 72:166-174. [PMID: 33227462 DOI: 10.1016/j.avsg.2020.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/27/2020] [Accepted: 10/06/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Claudication has a relatively benign natural history, associated with a low risk of limb loss. However, rates of progression to chronic limb-threatening ischemia (CLTI) following lower extremity revascularization (LER) for claudication remain unclear. This study examines the long-term outcomes and risk factors associated with progression to CLTI after LER for claudication. METHODS A single-center retrospective review of patients undergoing LER for claudication was performed from 2013-2016. Patients were stratified based on whether they progressed to CLTI or not. RESULTS There were 448 patients (502 limbs) treated for claudication, and 57 (12.7%) progressed to CLTI with a mean follow up time of 3.7 ± 1.5 years. Among patients who progressed, 23 (5.1%) developed tissue loss, 34 (7.6%) developed rest pain, and 6 (1.2%) underwent major amputation. The mean time of progression to CLTI was 1.6 ± 1.5 years after index LER. Patients who progressed to CLTI were more likely to have a history of congestive heart failure and prior open revascularizations compared with those who did not progress. There was no difference in type or level of index revascularization between the two groups and no difference in perioperative complications. Patients who developed CLTI had significantly higher rates of reinterventions and a mean number of reinterventions after index LER prior to developing CLTI compared to those who did not progress. Multivariable logistic regression demonstrated that history of congestive heart failure (OR = 2.8 [1.2-6.6]), stroke (OR = 2.6 [1.1-6.1]), prior open procedure (OR = 2.8 [1.3-5.9]) and increasing number of reinterventions after index LER (OR = 2.9 [1.5-5.7]) were independently associated with disease progression to CLTI. CONCLUSIONS Multiple reinterventions and previous open revascularization are associated with progression to CLTI following LER for claudication. Patients with atherosclerosis in the coronary and cerebrovascular beds are also more likely to have a progression of claudication to CLTI after LER.
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Affiliation(s)
- Tanner I Kim
- Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Gathe Kiwan
- Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Alaa Mohamedali
- Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Yawei Zhang
- Department of Surgery, Yale School of Medicine, Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT
| | - Alan Dardik
- Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Raul J Guzman
- Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
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22
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Choma EA, Mays RJ, Mizner RL, Santasier AM. Patient perspectives of ankle-foot orthoses for walking ability in peripheral artery disease: A qualitative study. JOURNAL OF VASCULAR NURSING 2020; 38:100-107. [PMID: 32950110 DOI: 10.1016/j.jvn.2020.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 06/20/2020] [Accepted: 07/21/2020] [Indexed: 12/31/2022]
Abstract
Calf claudication associated with peripheral artery disease results in limited walking ability and diminished quality of life. Ankle-foot orthoses (AFO) have been used to mitigate calf pain during community-based walking exercise, yet little is known about patients' perspectives of this novel device. The purpose of this qualitative study was to determine the personal impact AFO had on patients who used them. Ten patients with calf claudication who previously completed a 12-week unstructured community-based walking program supplemented by AFO participated in a semi-structured recorded focus group. After data saturation was achieved, transcripts were coded and analyzed, and 2 primary themes emerged from the focus groups: 1) positive functional impact of AFO on walking ability and quality of life and 2) self-selected AFO usage patterns. Six subthemes included 1) positive ambulatory changes from using AFO, 2) sustained ambulatory improvements without AFO, 3) positive psychosocial impact, 4) optimal conditions for AFO usage, 5) optimal ambulatory surfaces when using AFO, and 6) challenges with comorbidities. The AFO were influential in decreasing claudication symptoms, improving walking capacity, and enhancing participation in meaningful daily and recreational activities. This study explores experiential knowledge of patients with calf claudication describing AFO as an effective tool to enhance unstructured walking programs. Further trials are needed to optimize device design and effectiveness in varying walking environments.
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Affiliation(s)
- Elizabeth A Choma
- Adult and Gerontological Health Cooperative, School of Nursing, University of Minnesota, Minneapolis, Minnesota.
| | - Ryan J Mays
- Adult and Gerontological Health Cooperative, School of Nursing, University of Minnesota, Minneapolis, Minnesota
| | - Ryan L Mizner
- School of Physical Therapy and Rehabilitation Science, College of Health Professions and Biomedical Sciences, University of Montana, Missoula, Montana
| | - Anita M Santasier
- School of Physical Therapy and Rehabilitation Science, College of Health Professions and Biomedical Sciences, University of Montana, Missoula, Montana
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23
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Duwayri YM, Woo K, Aiello FA, Adams JG, Ryan PC, Tracci MC, Hurie J, Davies MG, Shutze WP, McDevitt D, Lum YW, Sideman M, Zwolak RM. The Society for Vascular Surgery Alternative Payment Model Task Force report on opportunities for value-based reimbursement in care for patients with peripheral artery disease. J Vasc Surg 2020; 73:1404-1413.e2. [PMID: 32931874 DOI: 10.1016/j.jvs.2020.08.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/15/2020] [Indexed: 10/23/2022]
Abstract
The Society for Vascular Surgery Alternative Payment Model (APM) Taskforce document explores the drivers and implications for developing objective value-based reimbursement plans for the care of patients with peripheral arterial disease (PAD). The APM is a payment approach that highlights high-quality and cost-efficient care and is a financially incentivized pathway for participation in the Quality Payment Program, which aims to replace the traditional fee-for-service payment method. At present, the participation of vascular specialists in APMs is hampered owing to the absence of dedicated models. The increasing prevalence of PAD diagnosis, technological advances in therapeutic devices, and the increasing cost of care of the affected patients have financial consequences on care delivery models and population health. The document summarizes the existing measurement methods of cost, care processes, and outcomes using payor data, patient-reported outcomes, and registry participation. The document also evaluates the existing challenges in the evaluation of PAD care, including intervention overuse, treatment disparities, varied clinical presentations, and the effects of multiple comorbid conditions on the cost potentially attributable to the vascular interventionalist. Medicare reimbursement data analysis also confirmed the prolonged need for additional healthcare services after vascular interventions. The Society for Vascular Surgery proposes that a PAD APM should provide patients with comprehensive care using a longitudinal approach with integration of multiple key medical and surgical services. It should maintain appropriate access to diagnostic and therapeutic advancements and eliminate unnecessary interventions. It should also decrease the variability in care but must also consider the varying complexity of the presenting PAD conditions. Enhanced quality of care and physician innovation should be rewarded. In addition, provisions should be present within an APM for high-risk patients who carry the risk of exclusion from care because of the naturally associated high costs. Although the document demonstrates clear opportunities for quality improvement and cost savings in PAD care, continued PAD APM development requires the assessment of more granular data for accurate risk adjustment, in addition to largescale testing before public release. Collaboration between payors and physician specialty societies remains key.
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Affiliation(s)
- Yazan M Duwayri
- Division of Vascular Surgery and Endovascular Therapy, Emory University School of Medicine, Atlanta, Ga.
| | - Karen Woo
- University of California, Los Angeles, Los Angeles, Calif
| | | | | | | | | | - Justin Hurie
- Wake Forest School of Medicine, Winston-Salem, NC
| | - Mark G Davies
- University of Texas Health at San Antonio, San Antonio, Tex
| | | | | | - Ying Wei Lum
- The Johns Hopkins School of Medicine, Baltimore, Md
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24
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Rodrigues E, Silva I. Supervised exercise therapy in intermittent claudication: a systematic review of clinical impact and limitations. INT ANGIOL 2020; 39:60-75. [DOI: 10.23736/s0392-9590.19.04159-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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25
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Sasajima T, Sasajima Y, Akazawa K, Saito Y. Arterial Reconstruction for Patients with Chronic Limb Ischemia Improves Ambulatory Function and Health-related Quality of Life. Ann Vasc Surg 2020; 66:518-528. [PMID: 32035265 DOI: 10.1016/j.avsg.2020.01.103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/02/2020] [Accepted: 01/26/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Arterial reconstruction (AR) for limb ischemia may improve ambulatory function (AF) and health-related quality of life (HR-QoL). However, the efficacy of AR in terms of HR-QoL varies in studies, probably because of cohort differences in disease severity, hemodynamic outcomes, and observation duration. We assessed HR-QoL for patients with various severities of ischemia in a 3-year observational study. METHODS We conducted a single-center 3-year observational study using Short Form 36 in patients with chronic limb ischemia. Between 2001 and 2009, 515 consecutive patients had AR, and 330 who underwent elective AR consented to the study. Of the 330 patients (claudicants 49%, critical limb ischemia [CLI] 51%), 307 underwent bypass and 23 endovascular therapy. Postal questionnaires were sent after AR, and 8 domains, the physical and mental component summary (PCS and MCS) scores, and the patient-reported AF were compared, and negative predictors were identified. RESULTS Overall, the MCS was minimally affected, but AF and the PCS were impaired. After AR, these measures were significantly improved, and maximum recovery was attained at 6 months. In subgroup analysis, significant predictors of a negative impact on postoperative PCS included age ≥80, CLI, physical aftereffects of stroke (PAS), and previous major amputation (PMA). Of these, PMA was associated with the lowest PCS score, followed by PAS; for these patients, AR contributed minimally to HR-QoL recovery. PCS scores of claudicants attained a maximum value at 6 months; however, PCS scores of CLI patients were significantly lower than intermittent claudication patients (P < 0.0001), and patients with major tissue loss required 2 years to attain maximum PCS recovery. CONCLUSIONS This 3-year observational study verified the efficacy of AR in improving AF and HR-QoL. Age ≥80, CLI, PAS, and PMA were definitive predictors, and for patients with the latter 2, AR contributed minimally to improving HR-QoL.
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Affiliation(s)
- Tadahiro Sasajima
- Center of Vascular Diseases, Edogawa Hospital, Tokyo, Japan; Department of Vascular Surgery, Asahikawa Medical University, Asahikawa, Japan.
| | - Yumi Sasajima
- Health Care Center, Hokkaido University of Education, Asahikawa College, Asahikawa, Japan
| | - Kohhei Akazawa
- Department of Medical Information, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Yukihiro Saito
- Department of Vascular Surgery, Asahikawa Medical University, Asahikawa, Japan
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Baram A, Baban ZT. Short and long-term outcomes of the peripheral arterial indirect bypass in diabetic patients with chronic limb-threatening ischemia: Single-center case series. INTERNATIONAL JOURNAL OF SURGERY OPEN 2020. [DOI: 10.1016/j.ijso.2020.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Midterm Outcomes of Drug-Coated Balloon Angioplasty in Femoropopliteal Lesions in a Daily Practice Cohort. Ann Vasc Surg 2019; 64:188-197. [PMID: 31634609 DOI: 10.1016/j.avsg.2019.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 09/17/2019] [Accepted: 09/18/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Most previous drug-coated balloon (DCB) angioplasty studies used strict inclusion and exclusion criteria and therefore might not be representative for daily practice. This study was performed to evaluate the midterm outcomes of DCB angioplasty in femoropopliteal artery disease and to identify risk factors for restenosis. MATERIALS AND METHODS All patients treated with DCB angioplasty between January 2015 and September 2016 were included. Provisional stents were placed if indicated. Data were retrospectively collected from digital patient records. No exclusion criteria were applied. The primary end point was primary patency. Secondary end points were primary assisted patency, secondary patency, clinically driven target lesion revascularization (CD-TLR) and major adverse events. All end points were calculated with the Kaplan-Meier analysis. The univariable and multivariable Cox regression analyses were performed to identify risk factors for restenosis. RESULTS A total of 109 patients (113 legs) were included (45% male; mean age, 72 ± 10). The rate of critical limb ischemia was 52% and total occlusions were treated in 38%. The mean follow-up was 24 ± 13 months. Primary patency rates were 87%, 79%, and 61% at 1, 2, and 3 years, respectively. Primary assisted patency rates were 95%; 89%, and 79%; secondary patency rates were 99%, 97%, and 91%; and CD-TLR rates were 6.9%, 14.3%, and 20.6% at 1, 2, and 3 years, respectively. Overall mortality and major target limb amputation rates were 18% and 5% at 3 years. Multivariable analysis demonstrated that only Trans-Atlantic Inter-Society Consensus (TASC) D lesions were associated with restenosis (P = 0.008). CONCLUSIONS DCB angioplasty is an effective and safe treatment option for femoropopliteal lesions in daily practice with excellent 1- and 2-year results. The 3-year results were slightly less favorable, which may be caused by the ongoing vascular disease or a late "catch-up" phenomenon. Only TASC D lesions were associated with loss of primary patency after adjustment for confounders.
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LASLOVICH STEVE, ALVAR BRENTA, ALLISON MATTHEW, RAUH MITCHELLJ. Effects of Lifestyle Physical Activity on Vascular Function in Asymptomatic Peripheral Arterial Disease. Med Sci Sports Exerc 2019; 52:8-15. [DOI: 10.1249/mss.0000000000002109] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Smolderen KG, Gosch K, Patel M, Jones WS, Hirsch AT, Beltrame J, Fitridge R, Shishehbor MH, Denollet J, Vriens P, Heyligers J, Stone MEd N, Aronow H, Abbott JD, Labrosciano C, Tutein-Nolthenius R, A Spertus J. PORTRAIT (Patient-Centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease: Investigating Trajectories): Overview of Design and Rationale of an International Prospective Peripheral Arterial Disease Study. Circ Cardiovasc Qual Outcomes 2019; 11:e003860. [PMID: 29440123 DOI: 10.1161/circoutcomes.117.003860] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 12/21/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Health status outcomes, including symptoms, functional status, and quality of life, are critically important outcomes from patients' perspectives. The PORTRAIT study (Patient-Centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease: Investigating Trajectories) was designed to prospectively define health status outcomes and examine associations between patients' characteristics and care to these outcomes among those presenting with new-onset or worsened claudication. METHODS AND RESULTS PORTRAIT screened 3637 patients with an abnormal ankle-brachial index and new, or worsened, claudication symptoms from 16 peripheral arterial disease (PAD) specialty clinics in the United States, the Netherlands, and Australia between June 2, 2011, and December 3, 2015. Of the 1608 eligible patients, 1275 (79%) were enrolled. Before treatment, patients were interviewed to obtain their demographics, PAD symptoms and health status, psychosocial characteristics, preferences for shared decision-making, socioeconomic, and cardiovascular risk factors. Patients' medical history, comorbidities, and PAD diagnostic information were abstracted from patients' medical records. Serial information about patients' health status, psychosocial, and lifestyle factors was collected at 3, 6, and 12 months by a core laboratory. Follow-up rates ranged from 84.2% to 91%. Clinical follow-up for PAD-related hospitalizations and major cardiovascular events is ongoing. CONCLUSIONS PORTRAIT systematically collected serial PAD-specific health status data as a foundation for risk stratification, comparative effectiveness studies, and clinicians' adherence to quality-based performance measures. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT01419080.
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Affiliation(s)
- Kim G Smolderen
- From the Department of Biomedical & Health Informatics, University of Missouri Kansas City (K.G.S., J.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., K.G., N.S., J.S.); Department of Cardiology, Duke University School of Medicine, Durham, NC (M.P., S.J.); Department of Cardiology, University of Minnesota, Minneapolis (A.T.H.); Departments of Cardiology and Vascular Surgery, Queen Elisabeth Hospital, Adelaide, Australia (J.B., R.F., C.L.); Department of Cardiology, University Hospitals of Cleveland, OH (M.H.S.); Department of Medical Psychology, Tilburg University, The Netherlands (J.D.); Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands (P.V., J.H.); and Department of Cardiology, Rhode Island Hospital, Providence (H.A., D.A.).
| | - Kensey Gosch
- From the Department of Biomedical & Health Informatics, University of Missouri Kansas City (K.G.S., J.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., K.G., N.S., J.S.); Department of Cardiology, Duke University School of Medicine, Durham, NC (M.P., S.J.); Department of Cardiology, University of Minnesota, Minneapolis (A.T.H.); Departments of Cardiology and Vascular Surgery, Queen Elisabeth Hospital, Adelaide, Australia (J.B., R.F., C.L.); Department of Cardiology, University Hospitals of Cleveland, OH (M.H.S.); Department of Medical Psychology, Tilburg University, The Netherlands (J.D.); Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands (P.V., J.H.); and Department of Cardiology, Rhode Island Hospital, Providence (H.A., D.A.)
| | - Manesh Patel
- From the Department of Biomedical & Health Informatics, University of Missouri Kansas City (K.G.S., J.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., K.G., N.S., J.S.); Department of Cardiology, Duke University School of Medicine, Durham, NC (M.P., S.J.); Department of Cardiology, University of Minnesota, Minneapolis (A.T.H.); Departments of Cardiology and Vascular Surgery, Queen Elisabeth Hospital, Adelaide, Australia (J.B., R.F., C.L.); Department of Cardiology, University Hospitals of Cleveland, OH (M.H.S.); Department of Medical Psychology, Tilburg University, The Netherlands (J.D.); Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands (P.V., J.H.); and Department of Cardiology, Rhode Island Hospital, Providence (H.A., D.A.)
| | - W Schuyler Jones
- From the Department of Biomedical & Health Informatics, University of Missouri Kansas City (K.G.S., J.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., K.G., N.S., J.S.); Department of Cardiology, Duke University School of Medicine, Durham, NC (M.P., S.J.); Department of Cardiology, University of Minnesota, Minneapolis (A.T.H.); Departments of Cardiology and Vascular Surgery, Queen Elisabeth Hospital, Adelaide, Australia (J.B., R.F., C.L.); Department of Cardiology, University Hospitals of Cleveland, OH (M.H.S.); Department of Medical Psychology, Tilburg University, The Netherlands (J.D.); Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands (P.V., J.H.); and Department of Cardiology, Rhode Island Hospital, Providence (H.A., D.A.)
| | - Alan T Hirsch
- From the Department of Biomedical & Health Informatics, University of Missouri Kansas City (K.G.S., J.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., K.G., N.S., J.S.); Department of Cardiology, Duke University School of Medicine, Durham, NC (M.P., S.J.); Department of Cardiology, University of Minnesota, Minneapolis (A.T.H.); Departments of Cardiology and Vascular Surgery, Queen Elisabeth Hospital, Adelaide, Australia (J.B., R.F., C.L.); Department of Cardiology, University Hospitals of Cleveland, OH (M.H.S.); Department of Medical Psychology, Tilburg University, The Netherlands (J.D.); Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands (P.V., J.H.); and Department of Cardiology, Rhode Island Hospital, Providence (H.A., D.A.)
| | - John Beltrame
- From the Department of Biomedical & Health Informatics, University of Missouri Kansas City (K.G.S., J.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., K.G., N.S., J.S.); Department of Cardiology, Duke University School of Medicine, Durham, NC (M.P., S.J.); Department of Cardiology, University of Minnesota, Minneapolis (A.T.H.); Departments of Cardiology and Vascular Surgery, Queen Elisabeth Hospital, Adelaide, Australia (J.B., R.F., C.L.); Department of Cardiology, University Hospitals of Cleveland, OH (M.H.S.); Department of Medical Psychology, Tilburg University, The Netherlands (J.D.); Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands (P.V., J.H.); and Department of Cardiology, Rhode Island Hospital, Providence (H.A., D.A.)
| | - Rob Fitridge
- From the Department of Biomedical & Health Informatics, University of Missouri Kansas City (K.G.S., J.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., K.G., N.S., J.S.); Department of Cardiology, Duke University School of Medicine, Durham, NC (M.P., S.J.); Department of Cardiology, University of Minnesota, Minneapolis (A.T.H.); Departments of Cardiology and Vascular Surgery, Queen Elisabeth Hospital, Adelaide, Australia (J.B., R.F., C.L.); Department of Cardiology, University Hospitals of Cleveland, OH (M.H.S.); Department of Medical Psychology, Tilburg University, The Netherlands (J.D.); Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands (P.V., J.H.); and Department of Cardiology, Rhode Island Hospital, Providence (H.A., D.A.)
| | - Mehdi H Shishehbor
- From the Department of Biomedical & Health Informatics, University of Missouri Kansas City (K.G.S., J.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., K.G., N.S., J.S.); Department of Cardiology, Duke University School of Medicine, Durham, NC (M.P., S.J.); Department of Cardiology, University of Minnesota, Minneapolis (A.T.H.); Departments of Cardiology and Vascular Surgery, Queen Elisabeth Hospital, Adelaide, Australia (J.B., R.F., C.L.); Department of Cardiology, University Hospitals of Cleveland, OH (M.H.S.); Department of Medical Psychology, Tilburg University, The Netherlands (J.D.); Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands (P.V., J.H.); and Department of Cardiology, Rhode Island Hospital, Providence (H.A., D.A.)
| | - Johan Denollet
- From the Department of Biomedical & Health Informatics, University of Missouri Kansas City (K.G.S., J.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., K.G., N.S., J.S.); Department of Cardiology, Duke University School of Medicine, Durham, NC (M.P., S.J.); Department of Cardiology, University of Minnesota, Minneapolis (A.T.H.); Departments of Cardiology and Vascular Surgery, Queen Elisabeth Hospital, Adelaide, Australia (J.B., R.F., C.L.); Department of Cardiology, University Hospitals of Cleveland, OH (M.H.S.); Department of Medical Psychology, Tilburg University, The Netherlands (J.D.); Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands (P.V., J.H.); and Department of Cardiology, Rhode Island Hospital, Providence (H.A., D.A.)
| | - Patrick Vriens
- From the Department of Biomedical & Health Informatics, University of Missouri Kansas City (K.G.S., J.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., K.G., N.S., J.S.); Department of Cardiology, Duke University School of Medicine, Durham, NC (M.P., S.J.); Department of Cardiology, University of Minnesota, Minneapolis (A.T.H.); Departments of Cardiology and Vascular Surgery, Queen Elisabeth Hospital, Adelaide, Australia (J.B., R.F., C.L.); Department of Cardiology, University Hospitals of Cleveland, OH (M.H.S.); Department of Medical Psychology, Tilburg University, The Netherlands (J.D.); Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands (P.V., J.H.); and Department of Cardiology, Rhode Island Hospital, Providence (H.A., D.A.)
| | - Jan Heyligers
- From the Department of Biomedical & Health Informatics, University of Missouri Kansas City (K.G.S., J.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., K.G., N.S., J.S.); Department of Cardiology, Duke University School of Medicine, Durham, NC (M.P., S.J.); Department of Cardiology, University of Minnesota, Minneapolis (A.T.H.); Departments of Cardiology and Vascular Surgery, Queen Elisabeth Hospital, Adelaide, Australia (J.B., R.F., C.L.); Department of Cardiology, University Hospitals of Cleveland, OH (M.H.S.); Department of Medical Psychology, Tilburg University, The Netherlands (J.D.); Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands (P.V., J.H.); and Department of Cardiology, Rhode Island Hospital, Providence (H.A., D.A.)
| | - Nancy Stone MEd
- From the Department of Biomedical & Health Informatics, University of Missouri Kansas City (K.G.S., J.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., K.G., N.S., J.S.); Department of Cardiology, Duke University School of Medicine, Durham, NC (M.P., S.J.); Department of Cardiology, University of Minnesota, Minneapolis (A.T.H.); Departments of Cardiology and Vascular Surgery, Queen Elisabeth Hospital, Adelaide, Australia (J.B., R.F., C.L.); Department of Cardiology, University Hospitals of Cleveland, OH (M.H.S.); Department of Medical Psychology, Tilburg University, The Netherlands (J.D.); Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands (P.V., J.H.); and Department of Cardiology, Rhode Island Hospital, Providence (H.A., D.A.)
| | - Herbert Aronow
- From the Department of Biomedical & Health Informatics, University of Missouri Kansas City (K.G.S., J.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., K.G., N.S., J.S.); Department of Cardiology, Duke University School of Medicine, Durham, NC (M.P., S.J.); Department of Cardiology, University of Minnesota, Minneapolis (A.T.H.); Departments of Cardiology and Vascular Surgery, Queen Elisabeth Hospital, Adelaide, Australia (J.B., R.F., C.L.); Department of Cardiology, University Hospitals of Cleveland, OH (M.H.S.); Department of Medical Psychology, Tilburg University, The Netherlands (J.D.); Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands (P.V., J.H.); and Department of Cardiology, Rhode Island Hospital, Providence (H.A., D.A.)
| | - J Dawn Abbott
- From the Department of Biomedical & Health Informatics, University of Missouri Kansas City (K.G.S., J.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., K.G., N.S., J.S.); Department of Cardiology, Duke University School of Medicine, Durham, NC (M.P., S.J.); Department of Cardiology, University of Minnesota, Minneapolis (A.T.H.); Departments of Cardiology and Vascular Surgery, Queen Elisabeth Hospital, Adelaide, Australia (J.B., R.F., C.L.); Department of Cardiology, University Hospitals of Cleveland, OH (M.H.S.); Department of Medical Psychology, Tilburg University, The Netherlands (J.D.); Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands (P.V., J.H.); and Department of Cardiology, Rhode Island Hospital, Providence (H.A., D.A.)
| | - Clementine Labrosciano
- From the Department of Biomedical & Health Informatics, University of Missouri Kansas City (K.G.S., J.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., K.G., N.S., J.S.); Department of Cardiology, Duke University School of Medicine, Durham, NC (M.P., S.J.); Department of Cardiology, University of Minnesota, Minneapolis (A.T.H.); Departments of Cardiology and Vascular Surgery, Queen Elisabeth Hospital, Adelaide, Australia (J.B., R.F., C.L.); Department of Cardiology, University Hospitals of Cleveland, OH (M.H.S.); Department of Medical Psychology, Tilburg University, The Netherlands (J.D.); Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands (P.V., J.H.); and Department of Cardiology, Rhode Island Hospital, Providence (H.A., D.A.)
| | - Rudolf Tutein-Nolthenius
- From the Department of Biomedical & Health Informatics, University of Missouri Kansas City (K.G.S., J.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., K.G., N.S., J.S.); Department of Cardiology, Duke University School of Medicine, Durham, NC (M.P., S.J.); Department of Cardiology, University of Minnesota, Minneapolis (A.T.H.); Departments of Cardiology and Vascular Surgery, Queen Elisabeth Hospital, Adelaide, Australia (J.B., R.F., C.L.); Department of Cardiology, University Hospitals of Cleveland, OH (M.H.S.); Department of Medical Psychology, Tilburg University, The Netherlands (J.D.); Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands (P.V., J.H.); and Department of Cardiology, Rhode Island Hospital, Providence (H.A., D.A.)
| | - John A Spertus
- From the Department of Biomedical & Health Informatics, University of Missouri Kansas City (K.G.S., J.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., K.G., N.S., J.S.); Department of Cardiology, Duke University School of Medicine, Durham, NC (M.P., S.J.); Department of Cardiology, University of Minnesota, Minneapolis (A.T.H.); Departments of Cardiology and Vascular Surgery, Queen Elisabeth Hospital, Adelaide, Australia (J.B., R.F., C.L.); Department of Cardiology, University Hospitals of Cleveland, OH (M.H.S.); Department of Medical Psychology, Tilburg University, The Netherlands (J.D.); Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands (P.V., J.H.); and Department of Cardiology, Rhode Island Hospital, Providence (H.A., D.A.)
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Changes in Gait Variables in Patients with Intermittent Claudication. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7276865. [PMID: 31263707 PMCID: PMC6556794 DOI: 10.1155/2019/7276865] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 03/29/2019] [Accepted: 05/19/2019] [Indexed: 11/22/2022]
Abstract
Objective Intermittent claudication (IC) is a pathological symptom with a particular effect on human gait patterns. Therefore, analyzing these patterns can facilitate rehabilitation or treatment through comparison of the values of kinematic and kinetic variables of patients with the normal values of healthy people. Therefore, the aim of this study was to find differences in the values of gait variables between patients with IC and healthy people. Methods The study included 98 patients diagnosed with peripheral arterial disease with IC. The patients traveled a distance of 6 m at a voluntary gait velocity. Ground reaction forces while the foot contacted the ground and kinematic variables of lower limb movements were recorded. The values of normal gait variables were computed based on the results obtained in a group of 30 healthy people. Results Patients used a gait velocity below the norm for healthy people. The velocity during the lower limb swing and the step and stride length in patients with IC were below the norm. Differences were also found in the ranges of motion between patients with IC and healthy people for the pelvic obliquity, pelvic rotation, hip flexion-extension, hip abduction-adduction, hip internal-external rotation, knee flexion-extension, ankle dorsi-plantar flexion, and foot progression angles. Conclusions The presented kinematic and kinetic characteristics measured by gait variables suggest differences between patients with IC and healthy people. Considering kinematic and kinetic gait variables during the rehabilitation process would facilitate the development of a more economic gait technique (with increased stride length and range of motion in the lower limb joints) to obtain the desired rehabilitation effects. Patients with IC should receive rehabilitation oriented towards improving mobility and increasing muscle strength in selected lower limb joints to increase gait velocity and stride length.
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Vossen RJ, Philipszoon PC, Vahl AC, Montauban van Swijndregt AD, Leijdekkers VJ, Balm R. A Comparative Cost-Effectiveness Analysis of Percutaneous Transluminal Angioplasty With Optional Stenting and Femoropopliteal Bypass Surgery for Medium-Length TASC II B and C Femoropopliteal Lesions. J Endovasc Ther 2019; 26:172-180. [DOI: 10.1177/1526602819833646] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Purpose: To evaluate the total midterm costs and cost-effectiveness of percutaneous transluminal angioplasty with optional stenting (PTA/S) as initial treatment compared with femoropopliteal bypass (FPB) surgery in patients with medium-length TransAtlantic Inter-Society Consensus II (TASC) B and C femoropopliteal lesions. Materials and Methods: Over a period of 3 years, all hospital health care costs for 226 consecutive patients were calculated: 170 patients with a TASC B lesion and 56 patients with a TASC C lesion. In the 135-patient PTA/S group (mean age 69.9±10.9 years; 83 men), 108 (63.5%) patients had TASC B lesions and 27 (48.2%) patients had TASC C lesions. Ninety-one patients (mean age 68.4±10.9 years; 60 men) were treated with FPB for 62 TASC B and 29 TASC C femoropopliteal lesions. The main outcome measure was the primary patency rate at 3-year follow-up. Multiple imputation and bootstrapping techniques were used to analyze the data. The adjusted incremental cost-effectiveness ratios (ICERs) were calculated by dividing the difference in total costs by the difference in 3-year primary patency rate. Costs were expressed in euros (€), and cost differences are presented with the 95% confidence interval (CI). Results: Mean total costs per patient were €29,058 in the PTA/S treatment group vs €42,437 in the FPB group (mean adjusted difference –€14,820, 95% CI –€29,044 to −€5976). Differences in 3-year primary patency between PTA/S and FPB were small and nonsignificant (68.9% and 70.3%, respectively). An ICER of 563,716 was found, indicating that FPB costs €563,716 more per one extra patient reaching 3-year primary patency in comparison with PTA/S treatment. Conclusion: FPB in medium-length femoropopliteal lesions involved higher total costs when evaluated over a 3-year follow-up period. An endovascular-first approach is recommended, as this will result in cost minimization for patients with medium-length femoropopliteal disease.
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Affiliation(s)
- Rianne J. Vossen
- Department of Vascular Surgery, Onze Lieve Vrouwe Gasthuis (OLVG) Amsterdam, the Netherlands
| | - Pilar C. Philipszoon
- Department of Health Sciences, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Anco C. Vahl
- Department of Vascular Surgery, Onze Lieve Vrouwe Gasthuis (OLVG) Amsterdam, the Netherlands
- Clinical Epidemiology, OLVG Amsterdam, the Netherlands
| | | | - Vanessa J. Leijdekkers
- Department of Vascular Surgery, Onze Lieve Vrouwe Gasthuis (OLVG) Amsterdam, the Netherlands
| | - Ron Balm
- Amsterdam Cardiovascular Sciences, Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, the Netherlands
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Vossen RJ, Vahl AC, Fokkema TM, Leijdekkers VJ, van Swijndregt ADM, Balm R. Endovascular therapy versus femoropopliteal bypass surgery for medium-length TASC II B and C lesions of the superficial femoral artery: An observational propensity-matched analysis. Vascular 2019; 27:542-552. [DOI: 10.1177/1708538119837134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objectives This study was designed to compare clinical outcomes of percutaneous transluminal angioplasty with optional stenting (PTA/s) and femoropopliteal bypass (FPB) surgery as primary invasive treatment in patients with medium-length superficial femoral artery (SFA) lesions. Methods We performed a single-center retrospective, observational analysis in all consecutive patients who had undergone initial invasive treatment for medium-length, TASC II B and TASC II C, SFA lesions from 2004 to 2015. Primary endpoints were primary and secondary clinical patency. Secondary endpoints were complication rates and number of amputations. Kaplan–Meier curves were used to compare patency rates in the two treatment groups. Multivariate Cox regression analysis was performed to adjust for confounding variables and propensity score matching analysis was used to balance treatment groups. Results A total of 362 patients with a mean observation period of 4.0 years (SD ± 2.6) were analyzed. In this group, 231 patients (64%) underwent PTA/s and 131 patients (36%) FPB surgery. There was no difference in primary clinical patency at one-, three- and five-year follow-up between the PTA/s and FPB group, with rates of 79% vs. 63%, 53% vs. 78% and 71% vs. 66%, respectively ( P = 0.46). Secondary clinical patency estimates were comparable, resulting in one-, three- and five-year secondary clinical patency rates of 88%, 76% and 67% in the PTA/s group versus 88%, 80% and 79% in the bypass group ( P = 0.40). Multivariate analysis revealed no significant differences between the PTA/s and FPB groups in terms of primary clinical patency (HR 1.4; 95% CI 0.9–2.2) and secondary clinical patency (HR 1.7; 95% CI 0.9–2.9). This was confirmed in the propensity score analysis. Hospital stay (4.8 vs. 10.3 days) and complication rate (2.6% vs. 18.3%) were significantly lower in the PTA/s group ( P = 0.00). The number of amputations was comparable ( P = 0.75). Conclusions The clinical success of endovascular therapy and surgery for medium-length SFA lesions is comparable. Taking into account the lower morbidity rate, shorter length of hospital stay and the less invasive character of PTA/s compared with bypass surgery, patients with medium-length SFA lesions are ideally treated by an endovascular-first approach.
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Affiliation(s)
- RJ Vossen
- Department of Vascular Surgery, OLVG Amsterdam, Amsterdam, The Netherlands
| | - AC Vahl
- Department of Vascular Surgery, OLVG Amsterdam, Amsterdam, The Netherlands
- Clinical Epidemiology OLVG Amsterdam, Amsterdam, The Netherlands
| | - TM Fokkema
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - VJ Leijdekkers
- Department of Vascular Surgery, OLVG Amsterdam, Amsterdam, The Netherlands
| | | | - R Balm
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
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Jiang Q, Lin T, Qu L. Predictors of Health-Related Quality of Life for Mental Health Status in Patients After Carotid Endarterectomy. World Neurosurg 2019; 126:e379-e384. [PMID: 30822584 DOI: 10.1016/j.wneu.2019.02.060] [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: 12/18/2018] [Revised: 02/15/2019] [Accepted: 02/16/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate the health-related quality of life (HRQoL) in patients with carotid stenosis and identify the predictive factors that affect the mental health status in patients after carotid endarterectomy (CEA). METHODS A retrospective study was conducted of all patients presenting with carotid stenosis treated with CEA. Clinical data and demographics were collected for logistic regression analysis. The Short-Form General Health Survey Questionnaire (SF-36) and minimum clinically important difference were used to evaluate the mental health status of patients after CEA. RESULTS Between January 2015 and September 2017, a total of 224 patients were enrolled in this study. At baseline, mean SF-36 scores for physical component summary (PCS) (60.1 ± 26.3) and mental component summary (MCS) (59.9 ± 23.1) were significantly lower in patients with carotid disease than the urban population (P < 0.001). After CEA, the SF-36 scores for PCS (62.5 ± 21.7) and MCS (68.4 ± 18.7) were increased. However, only the improvement of MCS achieved minimum clinically important difference. After multiple logistic regression analysis, contralateral stenosis ≥50% (odds ratio [OR] 0.266, 95% confidence interval [CI] 0.141-0.517) and hoarseness (OR 0.160, 95% CI 0.040-0.644) had negative effects on MCS. Dizziness improvement had positive effects on MCS (OR 2.882, 95% CI 1.569-5.298). CONCLUSIONS Contralateral stenosis, dizziness improvement, and hoarseness may be the predictive factors that affect the mental health status in patients after CEA.
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Affiliation(s)
- Qingjun Jiang
- Department of Vascular and Endovascular Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Tao Lin
- Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Lefeng Qu
- Department of Vascular and Endovascular Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China.
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Salisbury DL, Whipple MO, Burt M, Brown R, Mays RJ, Bakken M, Treat-Jacobson D. Experience Implementing Supervised Exercise Therapy for Peripheral Artery Disease. ACTA ACUST UNITED AC 2019; 8:1-12. [PMID: 31131157 DOI: 10.31189/2165-6193-8.1.1] [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: 01/08/2023]
Abstract
Background Supervised exercise therapy (SET) is a cornerstone of treatment for improving walking distance for individuals with symptomatic peripheral artery disease and claudication. High quality randomized controlled trials have documented the efficacy of SET as a claudication treatment and led to the recent Centers for Medicare and Medicaid decision to cover supervised exercise therapy (SET). However, to date, the translation of highly controlled, laboratory based SET programs in real world cardiopulmonary rehabilitation settings has been unexplored. Methods In this article, we describe our experience integrating SET into existing cardiopulmonary rehabilitation programs, focusing on patient evaluation, exercise prescription, outcome assessments, strategies to maximize program adherence, and transitioning to home and community-based exercise training. Results Our team has over 3 years experience successfully implementing SET in cardiac rehabilitation settings. The experiences communicated within can serve as a model for rehabilitation therapists to follow as they begin to incorporate SET in their rehabilitation programs. Conclusions CMS reimbursement has the potential to change clinical practice and utilization of SET for patients with symptomatic peripheral artery disease. The experience we have gained through implementation of SET programs across the M Health and Fairview Health Systems and in other Minnesota communities, including specific elements in our programs and the lessons learned from our clinical experience, can inform and help to guide development of new programs. Brief Abstract The recent Centers for Medicare and Medicaid decision to cover supervised exercise therapy (SET) for beneficiaries with peripheral artery disease (PAD) has the potential to transform practice. In this article, we describe our experience integrating SET into existing cardiopulmonary rehabilitation programs, which could serve as a model for new programs.
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Affiliation(s)
| | - Mary O Whipple
- University of Minnesota, School of Nursing, Minneapolis, MN
| | | | - Rebecca Brown
- University of Minnesota, School of Nursing, Minneapolis, MN
| | - Ryan J Mays
- University of Minnesota, School of Nursing, Minneapolis, MN.,Department of Medicine, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Mark Bakken
- University of Minnesota Physicians, Minneapolis, MN
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Treat-Jacobson D, McDermott MM, Bronas UG, Campia U, Collins TC, Criqui MH, Gardner AW, Hiatt WR, Regensteiner JG, Rich K. Optimal Exercise Programs for Patients With Peripheral Artery Disease: A Scientific Statement From the American Heart Association. Circulation 2019; 139:e10-e33. [DOI: 10.1161/cir.0000000000000623] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Baram A, Abdullah TN, Taha AY. Femoropopliteal bypass for chronic lower limb ischemia: A prospective cohort study and single center cases series. INTERNATIONAL JOURNAL OF SURGERY OPEN 2019. [DOI: 10.1016/j.ijso.2019.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Debus ES, Kriston L, Schwaneberg T, Hischke S, Rieß HC, Härter M, Marschall U, Federrath H, Behrendt CA. Rationale and methods of the IDOMENEO health outcomes of the peripheral arterial disease revascularisation study in the GermanVasc registry. VASA 2018; 47:499-505. [DOI: 10.1024/0301-1526/a000730] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Abstract. Background: Atherosclerotic disease of the lower extremity arteries (PAD) remains a significant burden on global healthcare systems with increasing prevalence. Various guidelines on the diagnosis and treatment of patients with PAD are available but they often lack a sufficient evidence base for high-grade recommendations since randomized and controlled trials (RCT) remain rare or are frequently subject to conflicts of interest. This registry trial aims to evaluate the outcomes of catheter-based endovascular revascularisations vs. open-surgical endarterectomy vs. bypass surgery for symptomatic PAD on medical and patient-reported outcomes. Methods and design: The study is a prospective non-randomized multicentre registry trial including invasive revascularisations performed in 10 000 patients treated for symptomatic PAD at 30 to 40 German vascular centres. All patients matching the inclusion criteria are consecutively included for a recruitment period of six months (between May and December 2018) or until 10 000 patients have been included in the study registry. There are three follow-up measures at three, six, and 12 months. Automated completeness and plausibility checks as well as independent site visit monitoring will be performed to assure high internal and external validity of the study data. Study endpoints include relevant major cardiovascular and limb events and patient-reported outcomes from two Delphi studies with experts in vascular medicine and registry-based research. Discussion: It remains unclear if results from RCT can reflect daily treatment practice. Furthermore, great costs and complexity make it challenging to accomplish high quality randomized trials in PAD treatment. Prospective registry-based studies to collect real-world evidence can help to overcome these limitations.
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Affiliation(s)
- Eike Sebastian Debus
- Working Group GermanVasc, Department of Vascular Medicine, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thea Schwaneberg
- Working Group GermanVasc, Department of Vascular Medicine, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sandra Hischke
- Working Group GermanVasc, Department of Vascular Medicine, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Henrik Christian Rieß
- Working Group GermanVasc, Department of Vascular Medicine, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Hannes Federrath
- Working Group Security in Distributed Systems, Department of Computer Science, University of Hamburg, Hamburg, Germany
| | - Christian-Alexander Behrendt
- Working Group GermanVasc, Department of Vascular Medicine, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Vossen RJ, Vahl AC, Leijdekkers VJ, Montauban van Swijndregt AD, Balm R. Long-Term Clinical Outcomes of Percutaneous Transluminal Angioplasty with Optional Stenting in Patients with Superficial Femoral Artery Disease: A Retrospective, Observational Analysis. Eur J Vasc Endovasc Surg 2018; 56:690-698. [PMID: 30108029 DOI: 10.1016/j.ejvs.2018.06.063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 06/23/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVE The recent ESC guideline advises primary stent placement in superficial femoral arterial disease (SFAD). The aim of this study was to compare clinical outcomes of SFAD patients selected for stent placement with plain percutaneous transluminal angioplasty (PTA). MATERIALS AND METHODS A single centre retrospective, observational analysis was performed of all consecutive patients undergoing endovascular treatment for SFAD from 2004 to 2015. Primary endpoints were primary and secondary clinical patency rates in patients with or without stent placement. Secondary endpoints were recurrence rates and number of amputations. Kaplan-Meier curves were used to compare patency rates. Multivariable Cox regression analysis was performed to adjust for confounding variables and to identify variables associated with loss of patency. RESULTS A total of 389 patients were analysed with a median follow up of 42 months. Two hundred and fifty one patients (64.5%) were stented. Primary clinical patency rates at 1, 3, and 5 years were 82.8%, 71.0%, and 65.6% after PTA and 76.3%, 65.7%, and 58.1% after stent placement (PTA-S), respectively (p = .30). Secondary patency rates were also comparable for the PTA and PTA-S group resulting in 1, 3 and 5 year clinical secondary patency of 89.1%, 81.0%, and 76.3% in the PTA group versus 87.8%, 78.5%, and 71.9% in the PTA-S group (p = .58). Multivariable analysis revealed equal primary and secondary clinical patency between the treatment groups. The absolute re-intervention rate was 29.3%. The number of re-interventions and amputation rate did not significantly differ between the two groups (p = .41 and p = .75). CONCLUSIONS Selective stenting in patients with SFAD shows comparable results in long-term clinical outcomes in patients who were treated with plain PTA as well as patients who are selected for stent placement. An approach of selective stenting is justified.
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Affiliation(s)
- Rianne J Vossen
- Department of Vascular Surgery, OLVG, Amsterdam, The Netherlands.
| | - Anco C Vahl
- Department of Vascular Surgery, OLVG, Amsterdam, The Netherlands
| | | | | | - Ron Balm
- Department of Vascular Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands
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Gommans LN, Smid AT, Scheltinga MR, Cancrinus E, Brooijmans FA, Meijer K, Teijink JA. Prolonged stance phase during walking in intermittent claudication. J Vasc Surg 2017; 66:515-522. [DOI: 10.1016/j.jvs.2017.02.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 02/10/2017] [Indexed: 11/24/2022]
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40
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Kazmi SS, Krog AH, Berge ST, Sundhagen JO, Sahba M, Falk RS. Patient-perceived health-related quality of life before and after laparoscopic aortobifemoral bypass. Vasc Health Risk Manag 2017; 13:169-176. [PMID: 28546754 PMCID: PMC5437970 DOI: 10.2147/vhrm.s134669] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background In patients operated with laparoscopic aortobifemoral bypass (LABFB) for atherosclerotic obstruction in aortoiliac segment, the main focus of the reports published during the last two decades has been morbidity and mortality. The primary objective of this study was to examine the health-related quality of life (HRQL) in these patients before and after LABFB. Patients and methods Fifty consecutive patients (27 females) with Trans-Atlantic Inter-Society Consensus II, type D lesions were prospectively included. Short-Form 36 (SF-36) questionnaire was used to get information about the HRQL before LABFB and at 1, 3 and 6 months after the operation. Main indication for LABFB was intermittent claudication. Linear mixed-effect models were used to assess changes in HRQL over time. Age, gender, smoking, blood loss, operation time, concomitant operation, the American Society of Anesthesiologists category, length of hospital stay, previous vascular procedures and aorta cross-clamping were used as fixed factors and their impact on the physical components of the SF-36, as well as the summary scores were determined with univariate analysis. Variables with P<0.2 were included in the multivariate regression analysis. P<0.05 was considered statistically significant. Results Statistically significant improvement was found in all SF-36 domains as well as in the summary scores after LABFB compared to the preoperative scores. The improvement in scores was substantial already at 1 month and the effect was maintained at 3 and 6 months survey time points. Concomitant operations had a statistically significant negative impact on the physical components of SF-36. Data completeness of item questionnaires was 93% in the whole material. Reliability scale and homogeneity estimates for the eight domains had high internal consistency. Conclusion Patients operated with LABFB for Trans-Atlantic Inter-Society Consensus II, type D lesions have reduced HRQL. LABFB leads to substantial and statistically significant improvement in the patients’ HRQL, when examined with SF-36. These results need to be replicated by a randomized clinical trial.
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Affiliation(s)
- Syed Sh Kazmi
- Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital
| | - Anne H Krog
- Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital.,Institute of Clinical Medicine, University of Oslo, Oslo
| | - Simen T Berge
- Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital
| | - Jon O Sundhagen
- Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital
| | - Mehdi Sahba
- Department of Vascular Surgery, Østfold Central Hospital, Kalnes
| | - Ragnhild S Falk
- Oslo Centre for Biostatistics and Epidemiology (OCBE), Oslo University Hospital, Oslo, Norway
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Kleinegris MCF, Konings J, Daemen JW, Henskens Y, de Laat B, Spronk HMH, Ten Cate-Hoek AJ, Ten Cate H. Increased Clot Formation in the Absence of Increased Thrombin Generation in Patients with Peripheral Arterial Disease: A Case-Control Study. Front Cardiovasc Med 2017; 4:23. [PMID: 28473975 PMCID: PMC5397513 DOI: 10.3389/fcvm.2017.00023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 03/31/2017] [Indexed: 11/22/2022] Open
Abstract
Background In peripheral arterial disease (PAD), activation of the hemostatic system may contribute to atherosclerosis progression and atherothrombotic events. Objective This case–control study assesses the overall coagulation status in PAD patients by evaluating coagulation markers in combination with thrombin generation potential, whole blood (WB) clot formation, and fibrinolysis. Methods In blood from 40 PAD patients (n = 20 with cardiovascular event within 1 year after initial diagnosis, n = 20 without) and 40 apparently healthy controls, thrombin generation was determined in WB and platelet-poor plasma. Whole blood rotational thromboelastometry (ROTEM) measurements were triggered with tissue factor with/without tissue plasminogen activator. Results We observed increased levels of erythrocyte sedimentation rate, leukocytes, eosinophil granulocytes, vWF antigen, fibrinogen, and D-dimer in PAD patients (p < 0.05). Markers of thrombin generation potential showed no difference between patients and healthy controls. In PAD patients with event compared to patients without, WB-thrombin generation showed a lower thrombin potential when triggered with 0 and 2.5 pM tissue factor. The ROTEM clotting assay showed significantly faster clot formation and increased clot firmness in PAD patients compared to controls. No significant differences were found for parameters of clot degradation. Conclusion There are no significant differences between the thrombin generation profiles of PAD patients and healthy controls. Between PAD patients with and without cardiovascular event, the WB thrombin generation appears to differ. Mechanistically, PAD patients show an increased ability to form a stable clot in WB in comparison to healthy controls. This is most likely due to the increased fibrinogen levels related to the inflammation in atherosclerosis, confirming the importance of the inflammation-coagulation axis.
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Affiliation(s)
- Marie-Claire F Kleinegris
- Laboratory for Clinical Thrombosis and Hemostasis, Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, Netherlands
| | - Joke Konings
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, Netherlands.,Synapse BV, Maastricht, Netherlands
| | - Jan W Daemen
- Department of Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Yvonne Henskens
- Central Diagnostic Laboratory, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Bas de Laat
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, Netherlands.,Synapse BV, Maastricht, Netherlands
| | - Henri M H Spronk
- Laboratory for Clinical Thrombosis and Hemostasis, Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, Netherlands
| | - Arina J Ten Cate-Hoek
- Laboratory for Clinical Thrombosis and Hemostasis, Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, Netherlands
| | - Hugo Ten Cate
- Laboratory for Clinical Thrombosis and Hemostasis, Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, Netherlands
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Monaro S, West S, Gullick J. An integrative review of health-related quality of life in patients with critical limb ischaemia. J Clin Nurs 2017; 26:2826-2844. [PMID: 27808440 DOI: 10.1111/jocn.13623] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2016] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To examine the domains and the domain-specific characteristics within a peripheral arterial disease health-related quality of life framework for their usefulness in defining critical limb ischaemia health-related quality of life. BACKGROUND Critical Limb Ischaemia presents a highly individualised set of personal and health circumstances. Treatment options include conservative management, revascularisation or amputation. However, the links between treatment decisions and quality of life require further investigation. DESIGN The framework for this integrative review was the peripheral arterial disease-specific health-related quality of life domains identified by Treat-Jacobson et al. RESULTS The literature expanded and refined Treat-Jacobson's framework by modifying the characteristics to better describe health-related quality of life in critical limb ischaemia. CONCLUSIONS Given that critical limb ischaemia is a highly individualised situation with powerful health-related quality of life implications, further research focusing on patient and family-centred decision-making relating to therapeutic options and advanced care planning is required. RELEVANCE TO CLINICAL PRACTICE A critical limb ischaemia-specific, health-related quality of life tool is required to capture both the unique characteristics of this disorder, and the outcomes for active or conservative care among this complex group of patients.
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Affiliation(s)
- Susan Monaro
- Concord Repatriation General Hospital, Concord, NSW, Australia.,Sydney Nursing School, University of Sydney, Sydney, NSW, Australia
| | - Sandra West
- Sydney Nursing School, University of Sydney, Sydney, NSW, Australia
| | - Janice Gullick
- Sydney Nursing School, University of Sydney, Sydney, NSW, Australia.,Sydney Local Health District, Sydney, NSW, Australia
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Roumia M, Aronow HD, Soukas P, Gosch K, Smolderen KG, Spertus JA, Abbott JD. Sex differences in disease-specific health status measures in patients with symptomatic peripheral artery disease: Data from the PORTRAIT study. Vasc Med 2017; 22:103-109. [DOI: 10.1177/1358863x16686408] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Mazen Roumia
- Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Herbert D Aronow
- Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Peter Soukas
- Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Kensey Gosch
- Saint Luke’s Mid America Heart Institute, Kansas City, MO, USA
| | - Kim G Smolderen
- Saint Luke’s Mid America Heart Institute, Kansas City, MO, USA
- UMKC School of Medicine – Department of Biomedical & Health Informatics, Kansas City, MO, USA
| | - John A Spertus
- Saint Luke’s Mid America Heart Institute, Kansas City, MO, USA
- UMKC School of Medicine – Department of Biomedical & Health Informatics, Kansas City, MO, USA
| | - J Dawn Abbott
- Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI, USA
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Abstract
Surgical endarterectomy has long been the standard approach for treating atherosclerotic stenosis in the common femoral artery. Its major advantage is the associated long-term patency, which approaches 95% at 5 years. Nevertheless, recent studies have suggested that percutaneous treatment may be a valid alternative to surgery.
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Khambati H, Boles K, Jetty P. Google Maps offers a new way to evaluate claudication. J Vasc Surg 2017; 65:1467-1472. [PMID: 28259575 DOI: 10.1016/j.jvs.2016.11.047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 11/15/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Accurate determination of walking capacity is important for the clinical diagnosis and management plan for patients with peripheral arterial disease. The current "gold standard" of measurement is walking distance on a treadmill. However, treadmill testing is not always reflective of the patient's natural walking conditions, and it may not be fully accessible in every vascular clinic. The objective of this study was to determine whether Google Maps, the readily available GPS-based mapping tool, offers an accurate and accessible method of evaluating walking distances in vascular claudication patients. METHODS Patients presenting to the outpatient vascular surgery clinic between November 2013 and April 2014 at the Ottawa Hospital with vasculogenic calf, buttock, and thigh claudication symptoms were identified and prospectively enrolled in our study. Onset of claudication symptoms and maximal walking distance (MWD) were evaluated using four tools: history; Walking Impairment Questionnaire (WIQ), a validated claudication survey; Google Maps distance calculator (patients were asked to report their daily walking routes on the Google Maps-based tool runningmap.com, and walking distances were calculated accordingly); and treadmill testing for onset of symptoms and MWD, recorded in a double-blinded fashion. RESULTS Fifteen patients were recruited for the study. Determination of walking distances using Google Maps proved to be more accurate than by both clinical history and WIQ, correlating highly with the gold standard of treadmill testing for both claudication onset (r = .805; P < .001) and MWD (r = .928; P < .0001). In addition, distances were generally under-reported on history and WIQ. The Google Maps tool was also efficient, with reporting times averaging below 4 minutes. CONCLUSIONS For vascular claudicants with no other walking limitations, Google Maps is a promising new tool that combines the objective strengths of the treadmill test and incorporates real-world walking environments. It offers an accurate, efficient, inexpensive, and readily accessible way to assess walking distances in patients with peripheral vascular disease.
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Affiliation(s)
- Husain Khambati
- Division of Vascular and Endovascular Surgery, Ottawa Hospital and the University of Ottawa, Ottawa, Ontario, Canada
| | - Kim Boles
- Division of Vascular and Endovascular Surgery, Ottawa Hospital and the University of Ottawa, Ottawa, Ontario, Canada
| | - Prasad Jetty
- Division of Vascular and Endovascular Surgery, Ottawa Hospital and the University of Ottawa, Ottawa, Ontario, Canada.
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Fowkes FGR, Aboyans V, Fowkes FJI, McDermott MM, Sampson UKA, Criqui MH. Peripheral artery disease: epidemiology and global perspectives. Nat Rev Cardiol 2016; 14:156-170. [PMID: 27853158 DOI: 10.1038/nrcardio.2016.179] [Citation(s) in RCA: 406] [Impact Index Per Article: 50.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Global populations are undergoing a major epidemiological transition in which the burden of atherosclerotic cardiovascular diseases is shifting rapidly from high-income to low-income and middle-income countries (LMICs). Peripheral artery disease (PAD) is no exception, so that greater focus is now required on the prevention and management of this disease in less-advantaged countries. In this Review, we examine the epidemiology of PAD and, where feasible, take a global perspective. However, the dearth of publications in LMICs means an unavoidable over-reliance on studies in high-income countries. Research to date suggests that PAD might affect a greater proportion of women than men in LMICs. Although factors such as poverty, industrialization, and infection might conceivably influence the development of PAD in such settings, the ageing of the population and increase in traditional cardiovascular risk factors, such as smoking, diabetes mellitus, and hypertension, are likely to be the main driving forces.
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Affiliation(s)
- F Gerry R Fowkes
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital, 2 Avenue Martin Luther King, 87000 Limoges, France
| | - Freya J I Fowkes
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Mary M McDermott
- Department of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, 675 North Saint Clair, Chicago, Illinois 60611, USA
| | - Uchechukwu K A Sampson
- Center for Translational Research and Implementation Science, National Heart, Lung and Blood Institute, National Institutes of Health, 6705 Rockledge Drive, Bethesda, Maryland 20824, USA
| | - Michael H Criqui
- Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Drive, La Jolla, California 92093, USA
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Ramachandra R, Elmslie KS. EXPRESS: Voltage-dependent sodium (NaV) channels in group IV sensory afferents. Mol Pain 2016; 12:12/0/1744806916660721. [PMID: 27385723 PMCID: PMC4956173 DOI: 10.1177/1744806916660721] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Patients with intermittent claudication suffer from both muscle pain and an exacerbated exercise pressor reflex. Excitability of the group III and group IV afferent fibers mediating these functions is controlled in part by voltage-dependent sodium (NaV) channels. We previously found tetrodotoxin-resistant NaV1.8 channels to be the primary type in muscle afferent somata. However, action potentials in group III and IV afferent axons are blocked by TTX, supporting a minimal role of NaV1.8 channels. To address these apparent differences in NaV channel expression between axon and soma, we used immunohistochemistry to identify the NaV channels expressed in group IV axons within the gastrocnemius muscle and the dorsal root ganglia sections. Positive labeling by an antibody against the neurofilament protein peripherin was used to identify group IV neurons and axons. We show that >67% of group IV fibers express NaV1.8, NaV1.6, or NaV1.7. Interestingly, expression of NaV1.8 channels in group IV somata was significantly higher than in the fibers, whereas there were no significant differences for either NaV1.6 or NaV1.7. When combined with previous work, our results suggest that NaV1.8 channels are expressed in most group IV axons, but that, under normal conditions, NaV1.6 and/or NaV1.7 play a more important role in action potential generation to signal muscle pain and the exercise pressor reflex.
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Affiliation(s)
- Renuka Ramachandra
- The Baker Laboratory of Pharmacology, Department of Pharmacology, AT Still University of Health Sciences, Kirksville, MO, USA
- Renuka Ramachandra, The Baker Laboratory of Pharmacology, Department of Pharmacology, Kirksville College of Osteopathic Medicine, AT Still University of Health Sciences, Kirksville, MO 63501, USA.
| | - Keith S Elmslie
- The Baker Laboratory of Pharmacology, Department of Pharmacology, AT Still University of Health Sciences, Kirksville, MO, USA
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Reporting standards of the Society for Vascular Surgery for endovascular treatment of chronic lower extremity peripheral artery disease. J Vasc Surg 2016; 64:e1-e21. [DOI: 10.1016/j.jvs.2016.03.420] [Citation(s) in RCA: 204] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 03/12/2016] [Indexed: 12/13/2022]
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Stoller M, Stoller D, Seiler C. Physical exercise and quantitative lower limb collateral function. Open Heart 2016; 3:e000355. [PMID: 26977310 PMCID: PMC4785434 DOI: 10.1136/openhrt-2015-000355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 01/11/2016] [Accepted: 01/14/2016] [Indexed: 11/06/2022] Open
Abstract
Objective This study tested the hypothesis that global physical activity and physical performance parameters are directly related to invasively obtained left superficial femoral artery (SFA) collateral flow index (CFI). Background So far, the association between different measures of physical exercise activity and quantitative lower limb collateral function has not been investigated. Methods The primary study end point was pressure-derived CFI as obtained during a 3 min left SFA balloon occlusion. CFI is the ratio of simultaneously recorded mean SFA distal occlusive pressure divided by mean aortic pressure, both subtracted by central venous pressure. As independent variables, the items of the Global Physical Activity Questionnaire (GPAQ) and physical exercise performance (maximal workload in watts) as achieved during a bicycle or treadmill exercise test were determined. The secondary study end point was transcutaneous left calf partial oxygen pressure (PO2 in mm Hg) divided by transcutaneous PO2 at a non-ischaemic reference site as obtained simultaneously to CFI measurement. Results Of the 110 study patients undergoing diagnostic coronary angiography, 79 belonged to the group without and 31 with engagement in regular intensive leisure time physical activity according to GPAQ. Left SFA CFI tended to be lower in the group without than with intensive leisure time physical activity: 0.514 ±0.141 vs 0.560 ±0.184 (p =0.0566). Transcutaneous PO2 index was associated with simultaneous left SFA CFI: CFI =018 +0.57 PO2 index; p<0.0001. Maximal physical workload was directly associated with left SFA CFI: CFI =0.40 +0.0009 maximal workload; p =0.0044. Conclusions Quantitative left SFA collateral function is directly reflected by maximal physical workload as achieved during an exercise test. Trial registration number NCTO02063347.
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Affiliation(s)
- Michael Stoller
- Department of Cardiology , University Hospital , Bern , Switzerland
| | - David Stoller
- Department of Cardiology , University Hospital , Bern , Switzerland
| | - Christian Seiler
- Department of Cardiology , University Hospital , Bern , Switzerland
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