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Terlouw LG, van Dijk LJD, van Noord D, Bakker OJ, Bijdevaate DC, Erler NS, Fioole B, Harki J, van den Heuvel DAF, Hinnen JW, Kolkman JJ, Nikkessen S, van Petersen AS, Smits HFM, Verhagen HJM, de Vries AC, de Vries JPPM, Vroegindeweij D, Geelkerken RH, Bruno MJ, Moelker A. Covered versus bare-metal stenting of the mesenteric arteries in patients with chronic mesenteric ischaemia (CoBaGI): a multicentre, patient-blinded and investigator-blinded, randomised controlled trial. Lancet Gastroenterol Hepatol 2024; 9:299-309. [PMID: 38301673 DOI: 10.1016/s2468-1253(23)00402-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND Mesenteric artery stenting with a bare-metal stent is the current treatment for atherosclerotic chronic mesenteric ischaemia. Long-term patency of bare-metal stents is unsatisfactory due to in-stent intimal hyperplasia. Use of covered stents might improve long-term patency. We aimed to compare the patency of covered stents and bare-metal stents in patients with chronic mesenteric ischaemia. METHODS We conducted a multicentre, patient-blinded and investigator-blinded, randomised controlled trial including patients with chronic mesenteric ischaemia undergoing mesenteric artery stenting. Six centres in the Netherlands participated in this study, including two national chronic mesenteric ischaemia expert centres. Patients aged 18 years or older were eligible for inclusion when an endovascular mesenteric artery revascularisation was scheduled and a consensus diagnosis of chronic mesenteric ischaemia was made by a multidisciplinary team of gastroenterologists, interventional radiologists, and vascular surgeons. Exclusion criteria were stenosis length of 25 mm or greater, stenosis caused by median arcuate ligament syndrome or vasculitis, contraindication for CT angiography, or previous target vessel revascularisation. Digital 1:1 block randomisation with block sizes of four or six and stratification by inclusion centre was used to allocate patients to undergo stenting with bare-metal stents or covered stents at the start of the procedure. Patients, physicians performing follow-up, investigators, and radiologists were masked to treatment allocation. Interventionalists performing the procedure were not masked. The primary study outcome was the primary patency of covered stents and bare-metal stents at 24 months of follow-up, evaluated in the modified intention-to-treat population, in which stents with missing data for the outcome were excluded. Loss of primary patency was defined as the performance of a re-intervention to preserve patency, or 75% or greater luminal surface area reduction of the target vessel. CT angiography was performed at 6 months, 12 months, and 24 months post intervention to assess patency. The study is registered with ClinicalTrials.gov (NCT02428582) and is complete. FINDINGS Between April 6, 2015, and March 11, 2019, 158 eligible patients underwent mesenteric artery stenting procedures, of whom 94 patients (with 128 stents) provided consent and were included in the study. 47 patients (62 stents) were assigned to the covered stents group (median age 69·0 years [IQR 63·0-76·5], 28 [60%] female) and 47 patients (66 stents) were assigned to the bare-metal stents group (median age 70·0 years [63·5-76·5], 33 [70%] female). At 24 months, the primary patency of covered stents (42 [81%] of 52 stents) was superior to that of bare-metal stents (26 [49%] of 53; odds ratio [OR] 4·4 [95% CI 1·8-10·5]; p<0·0001). A procedure-related adverse event occurred in 17 (36%) of 47 patients in the covered stents group versus nine (19%) of 47 in the bare-metal stent group (OR 2·4 [95% CI 0·9-6·3]; p=0·065). Most adverse events were related to the access site, including haematoma (five [11%] in the covered stents group vs six [13%] in the bare-metal stents group), pseudoaneurysm (five [11%] vs two [4%]), radial artery thrombosis (one [2%] vs none), and intravascular closure device (none vs one [2%]). Six (13%) patients in the covered stent group versus one (2%) in the bare-metal stent group had procedure-related adverse events not related to the access site, including stent luxation (three [6%] vs none), major bleeding (two (4%) vs none), mesenteric artery perforation (one [2%] vs one [2%]), mesenteric artery dissection (one [2%] vs one [2%]), and death (one [2%] vs none). INTERPRETATION The findings of this trial support the use of covered stents for mesenteric artery stenting in patients with chronic mesenteric ischaemia. FUNDING Atrium Maquet Getinge Group.
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Affiliation(s)
- Luke G Terlouw
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre, Rotterdam, Netherlands.
| | - Louisa J D van Dijk
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Desirée van Noord
- Department of Gastroenterology and Hepatology, Franciscus Gasthuis & Vlietland, Rotterdam, Netherlands
| | - Olaf J Bakker
- Department of Vascular Surgery, St Antonius Ziekenhuis, Nieuwegein, Netherlands; Department of Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Diederik C Bijdevaate
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Nicole S Erler
- Department of Biostatistics, Erasmus MC University Medical Centre, Rotterdam, Netherlands; Department of Epidemiology, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Bram Fioole
- Department of Vascular Surgery, Maasstad Ziekenhuis, Rotterdam, Netherlands
| | - Jihan Harki
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | | | - Jan Willem Hinnen
- Department of Vascular Surgery, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, Netherlands
| | - Jeroen J Kolkman
- Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede, Netherlands; Department of Gastroenterology and Hepatology, University Medical Centre Groningen, Groningen, Netherlands
| | - Suzan Nikkessen
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | | | - Henk F M Smits
- Department of Radiology, Bernhoven Hospital, Uden, Netherlands
| | - Hence J M Verhagen
- Department of Vascular Surgery, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Annemarie C de Vries
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Jean-Paul P M de Vries
- Department of Surgery, Division of Vascular Surgery, University Medical Centre Groningen, Groningen, Netherlands
| | - Dammis Vroegindeweij
- Department of Radiology and Nuclear Imaging, Maasstad Ziekenhuis, Rotterdam, Netherlands
| | - Robert H Geelkerken
- Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, Netherlands; Multi-modality Medical Imaging (M3I) group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Adriaan Moelker
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre, Rotterdam, Netherlands
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Jan Boer G, Bekken JA, Kuijper TM, Vroegindeweij D, Fioole B. The Ratio Between the Infrarenal and Suprarenal Aortic Diameter Is a Predictor of Durable Proximal Seal After Endovascular Aneurysm Repair. J Endovasc Ther 2024:15266028241228803. [PMID: 38323563 DOI: 10.1177/15266028241228803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
OBJECTIVES The aim of this study was to assess whether the ratio of the mean infrarenal neck diameter to the suprarenal aortic diameter is a predictor for a durable proximal seal after endovascular aneurysm repair (EVAR). METHODS A total of 439 patients who underwent elective EVAR between 2004 and 2018 in a single vascular referral center met our inclusion criteria. Ratios were calculated by dividing the mean infrarenal neck diameter by 4 different suprarenal aortic diameters. Patients who developed a late type 1A endoleak (n=20) or proximal neck dilatation mandating revision (n=8) were compared with the 411 patients without long-term proximal seal complications. RESULTS Patients who developed a late type 1A endoleak had more frequently hypertension, a shorter infrarenal neck length, and a larger mean infrarenal neck diameter. The ratio of the mean infrarenal neck diameter to all 4 suprarenal aortic diameters was higher in the late type 1A endoleak group compared with the group without a late type 1A endoleak. Least absolute shrinkage and selection operator (LASSO) logistic regression identified a combination of 6 variables as the best combination to predict a late type 1A endoleak: presence of hypertension, increased mean infrarenal neck diameter, decreased aneurysm neck length, larger ratio of the mean infrarenal neck diameter to the aortic diameter proximal to the superior mesenteric artery (SMA), larger ratio of the mean infrarenal neck diameter to the aortic diameter proximal to the upper renal artery, and increased β-angle. Of these, based on both the univariate area under the curve (AUC) and optimal LASSO model restricted to a single predictor, the ratio of the mean infrarenal neck diameter to the aortic diameter proximal to the SMA (AUC, 0.770; cutoff value, 0.997) was considered the best prognostic variable. CONCLUSION The ratio of the mean infrarenal neck diameter to the aortic diameter proximal to the SMA is a good predictor for a late type 1A endoleak. Patients with mean infrarenal neck diameter larger than the diameter proximal to the SMA (ratio >1) are at risk for a late type 1A endoleak. CLINICAL IMPACT In this single-center, retrospective cohort study, we found that the ratio of the mean infrarenal neck diameter to the aortic diameter proximal to the SMA is a good predictor for a late type 1A endoleak. We conclude that the suprarenal diameter must be taken into account before assessing endovascular aortic aneurysm repair eligibility. Patients with a ratio >1 may not be the best candidates for a durable result after EVAR and may be better off with fenestrated EVAR or open repair.
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Affiliation(s)
- Gert Jan Boer
- Department of Vascular Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - Joost A Bekken
- Department of Vascular Surgery, NoordWest Hospitalgroup, Haarlem, The Netherlands
| | | | | | - Bram Fioole
- Department of Vascular Surgery, Maasstad Hospital, Rotterdam, The Netherlands
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Boer GJ, Larbi N, Bekken JA, Kuijper TM, Vroegindeweij D, Fioole B. A Ratio Between Infrarenal and Suprarenal Aortic Diameters Corrects for Absolute Aortic Diameter Variations due to Patients' Sex and Body Size. J Endovasc Ther 2023:15266028231204812. [PMID: 37850720 DOI: 10.1177/15266028231204812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
OBJECTIVES Aortic diameters may differ significantly between patients with different gender and body size. The aim of this study was to relate absolute aortic diameters to age, sex, height, and weight of the patients and to correct for these factors by calculating the ratio between the infrarenal and the suprarenal aortic diameters. METHODS A total of 458 patients who underwent elective endovascular aneurysm repair (EVAR) between 2004 and 2018 were included. The aortic anatomy in this group of elective EVAR patients was compared with a control group of 75 patients without an abdominal aortic aneurysm (AAA). The aortic diameter was measured at 4 suprarenal points and 4 infrarenal points. Ratios were calculated by dividing the mean infrarenal neck diameter by 4 suprarenal measurements. RESULTS Patients in the aneurysm group had significantly larger suprarenal and infrarenal aortic diameters. The ratios between the mean infrarenal neck diameter and all 4 suprarenal measurements were larger in the AAA group than in the control group. In both groups, there was a significant correlation between the mean infrarenal neck diameter and sex, height, weight, and body surface area (BSA). However, in both groups, all 4 ratios between the mean infrarenal neck diameter and suprarenal aortic diameters were not correlated with age, sex, height, weight, or BSA, except for the ratio between the mean infrarenal neck diameter and the aortic diameter measurement proximal to the upper renal artery, which was correlated to weight and BSA in the control group. CONCLUSION The mean infrarenal neck diameter is correlated with sex, height, weight, and BSA. However, when the suprarenal aortic diameter was used as an internal control for the mean infrarenal neck diameter, we were able to correct for these variations in aortic diameters due to sex and body size. The clinical relevance of this ratio in patients treated by EVAR has yet to be assessed in future research. CLINICAL IMPACT In the assessment for EVAR suitability the absolute diameter of the aneurysm neck is taken into account. We believe that using absolute diameters is not the appropriate way to assess this suitability, but that patient characteristics such as age, gender and body size, should be factored into this assessment. In this paper, we show that suprarenal and infrarenal aortic diameters are both significantly increased in patients with an aneurysm compared with patients without an aneurysm. Besides, we found that mean infrarenal aortic diameter is correlated with sex, height, weight, and body surface area. Finally, we propose a new ratio system, using suprarenal diameters as an internal control, to correct for aortic diameter variations due to sex and body size.
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Affiliation(s)
- Gert Jan Boer
- Department of Vascular Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - Nora Larbi
- Department of Vascular Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - Joost A Bekken
- Department of Vascular Surgery, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | | | | | - Bram Fioole
- Department of Vascular Surgery, Maasstad Hospital, Rotterdam, The Netherlands
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van der Voet JA, Schiphof D, Vroegindeweij D, Oei EH, Bierma-Zeinstra SMA, Runhaar J. Association between baseline meniscal extrusion and long-term incident knee osteoarthritis in two different cohorts. Semin Arthritis Rheum 2023; 59:152170. [PMID: 36753837 DOI: 10.1016/j.semarthrit.2023.152170] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 01/20/2023] [Accepted: 01/24/2023] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Previously, we identified a significant association between meniscal extrusion and short-term incident knee osteoarthritis (KOA). To validate these findings, we evaluated long-term incident KOA in knees with meniscus extrusion, using two different cohorts. METHODS We used data from the PROOF study, which evaluated a high-risk population of overweight women, and a female subcohort of the population-based Rotterdam Study (RS). Meniscal extrusion was defined as ≥ 3 mm on MRI. Outcomes were incident radiographic (KL ≥ 2) or clinical KOA according to the ACR criteria, assessed at 6.6 years (PROOF) and 5.1 years (RS). With generalized estimating equations, we determined the association of knees with and without baseline meniscal extrusion and incident KOA, adjusting for confounders. Furthermore, we computed the population attributable risk percentage (PAR%) of meniscal extrusion. RESULTS PROOF: of 421 available knees 23% had baseline meniscal extrusion. Incident radiographic KOA was significantly higher in knees with meniscal extrusion compared to those without (adjusted OR 2.54, 95% CI 1.34, 4.80; p = 0.004; PAR 21%). Incident clinical KOA was also significantly higher (adjusted OR 2.44, 95% CI 1.29, 4.60; p = 0.006; PAR 19%). RS: 46% of 872 available knees had meniscal extrusion. Incident radiographic KOA was significantly higher (adjusted OR 9.86, 95% CI 2.13, 45.67; p = 0.002; PAR 77%). Incident clinical KOA was borderline significantly higher (adjusted OR 2.65, 95% CI 0.96, 7.30; p = 0.06; PAR 44%). CONCLUSION Meniscal extrusion is significantly associated with long-term incident KOA. A high number of incident cases were attributable to extrusion.
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Affiliation(s)
- Jan A van der Voet
- Dept. of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Dept. of Radiology, Alrijne Hospital, Leiderdorp, the Netherlands.
| | - Dieuwke Schiphof
- Dept. of General Practice, Erasmus MC University Medical Center Rotterdam, the Netherlands
| | | | - Edwin H Oei
- Dept. of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Sita M A Bierma-Zeinstra
- Dept. of General Practice, Erasmus MC University Medical Center Rotterdam, the Netherlands; Dept. of Orthopedics, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Jos Runhaar
- Dept. of General Practice, Erasmus MC University Medical Center Rotterdam, the Netherlands
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Bekken JA, Vroegindeweij D, Vos JA, de Vries JPPM, Lardenoije JWHP, Petri BJ, Pierie MEN, van Weel V, Teijink JAW, Fioole B. Editor's Choice - Two Year Results of the Randomised DISCOVER Trial Comparing Covered Versus Bare Metal Stents in the Common Iliac Artery. Eur J Vasc Endovasc Surg 2023; 65:359-368. [PMID: 36336284 DOI: 10.1016/j.ejvs.2022.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 09/26/2022] [Accepted: 11/01/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE It has been suggested that covered stents (CS) may lower restenosis rates compared with bare metal stents (BMS) after endovascular treatment of the common iliac artery. This trial aimed to provide additional evidence on the efficacy of CS vs. BMS in the common iliac artery. METHODS This multicentre, randomised, single blind controlled superiority trial compared balloon expandable CS and balloon expandable BMS for advanced atherosclerotic lesions in the common iliac artery; this was defined as a stenosis > 3 cm in length or occlusion. The primary end point was freedom from binary restenosis after two years of follow up. The study was conducted according to the principles of the Declaration of Helsinki (version: October 2008) and registered with the Dutch Trial register (NTR3381). RESULTS One hundred and seventy-four limbs were included between 2012 and 2019 with 87 limbs in each group. Six patients crossed over from the BMS group to the CS group but were analysed according to an intention to treat principle. Freedom from binary restenosis after two years of follow up was 84.7% (95% CI 76.7 - 92.7%) in the BMS group and 89.1% (95% CI 82.4 - 95.8%) in the CS group (p = .40). Freedom from occlusion was 95.0% (95% CI 90.3 - 95.7%) in the BMS group and 96.4% (95% CI 92.5 - 100%) in the CS group (p = .66). Freedom from target lesion revascularisation was 91.1% (95% CI 84.8 - 97.3%) and 95.2% (95% CI 90.7 -99.7%), respectively (p = .31). Technical success, complications, haemodynamic success, and clinical success were also comparable between both groups. Per-protocol analysis did not affect the outcomes of the study. CONCLUSION No difference was found between balloon expandable CS and BMS for treating advanced atherosclerotic lesions of the common iliac artery.
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Affiliation(s)
- Joost A Bekken
- Department of Vascular Surgery, Maasstad Hospital, Rotterdam, the Netherlands.
| | - Dammis Vroegindeweij
- Department of Interventional Radiology, Maasstad Hospital, Rotterdam, the Netherlands
| | - Jan Albert Vos
- Department of Interventional Radiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Jean-Paul P M de Vries
- Department of Surgery, Division of Vascular Surgery, University Medical Centre, Groningen, the Netherlands; Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | | | - Bart-Jeroen Petri
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | | | - Vincent van Weel
- Department of Vascular Surgery, Meander Medical Centre, Amersfoort, the Netherlands
| | - Joep A W Teijink
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Bram Fioole
- Department of Vascular Surgery, Maasstad Hospital, Rotterdam, the Netherlands
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van der Voet JA, Wesselius D, Zhang F, Vroegindeweij D, Oei EH, Bierma-Zeinstra SMA, Englund M, Runhaar J. Factors associated with longitudinal change of meniscal extrusion in overweight women without clinical signs of osteoarthritis. Rheumatology (Oxford) 2021; 60:5175-5184. [PMID: 33693533 DOI: 10.1093/rheumatology/keab228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/17/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To identify variables associated with longitudinal change in meniscal extrusion, which might be used as possible targets for knee osteoarthritis (KOA) prevention. METHODS In a high-risk population of middle-aged overweight women, meniscal extrusion was assessed with magnetic resonance imaging (1.5 T, coronal proton density, in-plane resolution 0.5 mm2, Sante DICOM Editor) at baseline and after 30 months. Outcomes were the absolute change in medial and lateral extrusion (mm) and relative change in extrusion (%). Based upon literature, 11 factors were hypothesized to be associated with longitudinal change. Generalized estimating equations were used to model the effect on meniscal change (P <0.05). RESULTS In total, 677 knees of 343 women were available for analysis, with a mean age of 55.7 years (+/-3.2) and a mean BMI of 32.3 kg/m2 (+/-4.2). The greatest change in meniscal extrusion appeared medially with incident meniscal tear (4.4%; absolute 0.9 mm (95% CI: 0.3, 1.5; P =0.004); relative 14.5% (4.4, 24.7; 0.005)). Varus malalignment was associated with an increase of medial extrusion of 0.6 mm (37.6%; 0.1, 1.0; 0.009). A 5 kg/m2 higher baseline BMI was associated with absolute and relative increase of medial extrusion of 0.2 mm and 2.96% (0.1, 0.3; <0.001 and 1.3, 4.8; 0.002). Less explicit but significant changes in extrusion appeared with longitudinal change in BMI. CONCLUSION Meniscal tears, varus malalignment and BMI were significantly associated with change in meniscal extrusion in middle-aged overweight women, providing viable therapeutic targets to prevent or reduce extrusion and thereby decelerate KOA development.
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Affiliation(s)
- Jan A van der Voet
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam.,Department of Radiology, Alrijne Hospital, Leiderdorp
| | - Daan Wesselius
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Fan Zhang
- Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund University, Lund, Sweden
| | | | - Edwin H Oei
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Orthopedics, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Martin Englund
- Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund University, Lund, Sweden
| | - Jos Runhaar
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
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de Boer SW, de Vries JPPM, Werson DA, Fioole B, Vroegindeweij D, Vos JA, van den Heuvel D. Drug coated balloon supported Supera stent versus Supera stent in intermediate and long-segment lesions of the superficial femoral artery: 2-year results of the RAPID Trial. J Cardiovasc Surg (Torino) 2019; 60:679-685. [PMID: 31603295 DOI: 10.23736/s0021-9509.19.11109-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Endovascular treatment of occlusive disease of the superficial femoral artery (SFA) has evolved from plain old balloon angioplasty (POBA) through primary stenting strategy to drug eluting technology-based approach. The RAPID Trial investigates the added value of drug coated balloons (DCB, Legflow) in a primary stenting strategy (Supera stent) for intermediate (5-15 cm) and long segment (>15 cm) SFA lesions. METHODS In this multicenter, patient-blinded trial, 160 patients with intermittent claudication, ischemic rest pain, or tissue loss due to intermediate or long SFA lesions were randomized (1:1) between Supera + DCB and Supera. Primary endpoint was primary patency at 2 years, defined as freedom from restenosis on duplex ultrasound (peak systolic velocity ratio <2.4). RESULTS At 2 years, primary patency was 55.1% (95% CI: 43.1-67.1%) in the Supera + DCB group versus 48.3% (95% CI: 35.6-61.0%) in the Supera group (P=0.957). Per protocol analysis showed a primary patency rate of 60.9% (95% CI: 48.6-73.2%) in the Supera + DCB group versus 49.8% (95% CI: 36.9-62.7%) in the Supera group (P=0.469). The overall mortality rate was 5% in both groups (P=0.975). Sustained functional improvement was similar in both groups. CONCLUSIONS The 2-year results in the current trial of a primary Supera stenting strategy are consistent with other trials reporting on treatment of intermediate and long SFA lesions. A DCB supported Supera stent strategy did not improve patency rate compared to a Supera stent only strategy.
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Affiliation(s)
- Sanne W de Boer
- Department of Radiology, St. Antonius Hospital, Nieuwegein, the Netherlands - .,Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands - .,CARIM School for Cardiovascular Diseases, University of Maastricht, Maastricht, the Netherlands -
| | - Jean Paul P M de Vries
- Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands.,Department of Vascular Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Debora A Werson
- Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Bram Fioole
- Department of Vascular Surgery, Maasstad Hospital, Rotterdam, the Netherlands
| | | | - Jan A Vos
- Department of Radiology, St. Antonius Hospital, Nieuwegein, the Netherlands
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Landsmeer MLA, de Vos BC, van der Plas P, van Middelkoop M, Vroegindeweij D, Bindels PJE, Oei EHG, Bierma-Zeinstra SMA, Runhaar J. Effect of weight change on progression of knee OA structural features assessed by MRI in overweight and obese women. Osteoarthritis Cartilage 2018; 26:1666-1674. [PMID: 30144512 DOI: 10.1016/j.joca.2018.08.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 07/17/2018] [Accepted: 08/06/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the effects of weight change on progression of knee osteoarthritis (OA) structural features by magnetic resonance imaging (MRI) in overweight and obese women without clinical knee OA. DESIGN 347 participants from the Prevention of Knee Osteoarthritis in Overweight Females (PROOF) study were classified with latent class growth analysis into a subgroup with steady weight (n = 260; +0.1 ± 4.0 kg, +0.2 ± 4.4%), weight gain (n = 43; +8.6 ± 4.0 kg, +9.8 ± 4.1%) or weight loss (n = 44; -9.0 ± 7.2 kg, -9.8 ± 7.5%) over 2.5 years. Baseline and follow-up 1.5T MRIs were scored with MRI Osteoarthritis Knee Score (MOAKS) for progression of bone marrow lesions (BMLs), cartilage defects, osteophytes, meniscal abnormalities, meniscal extrusion and synovitis. Associations between subgroups and change in MRI features at knee-level were assessed using adjusted Generalized Estimating Equations. RESULTS 687 knees from 347 women (median age 55.2 years, interquartile range (IQR) 5.5, median body mass index (BMI) 31.2 kg/m2, IQR 5.3) were analyzed. Progression of synovitis was 18% in the weight gain vs 7% in the stable weight subgroup (OR 2.88; 95%CI 1.39-5.94). The odds for progression of patellofemoral (PF) BMLs and cartilage defects increased with 62% (OR 1.62; 95%CI 0.92-2.84) and 53% (OR 1.53; 95%CI 0.92-2.56) in the weight gain vs the stable weight subgroup. CONCLUSIONS In overweight and obese women, progression of synovitis increased more than 2.5 times in a weight gain compared to a stable weight subgroup over 2.5 years. Large effect sizes were also found for the difference in progression of PF BMLs and PF cartilage defects between the weight gain and stable weight subgroup.
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Affiliation(s)
- M L A Landsmeer
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
| | - B C de Vos
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
| | - P van der Plas
- Department of Radiology, Spijkenisse Medical Center, Spijkenisse, The Netherlands.
| | - M van Middelkoop
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
| | - D Vroegindeweij
- Department of Radiology, Maasstad Hospital, Rotterdam, The Netherlands.
| | - P J E Bindels
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
| | - E H G Oei
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, the Netherlands.
| | - S M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands; Department of Orthopaedics, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
| | - J Runhaar
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
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Welten GMJM, Vroegindeweij D, Fioole B. [Hybrid operating room is indispensable for minimally invasive surgery]. Ned Tijdschr Geneeskd 2018; 162:D2282. [PMID: 30730119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The hybrid operating room is on the rise in the Netherlands. In this sterile room, more and more complex patients can be treated with minimally invasive techniques, supported by advanced image-guided technology, with special care for the safety of the patient and the operating team. This sterile room offers many possibilities for various specialties such as vascular surgery, interventional radiology, cardiology, oncology and traumatology. As a result, more and more patients will be treated with endovascular techniques in the hybrid operating room, which will improve the quality and outcome of this multidisciplinary care.
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Affiliation(s)
- G M J M Welten
- Maasstad Ziekenhuis, afd. Vaatchirurgie, Rotterdam
- Contact: G.M.J.M. Welten
| | | | - B Fioole
- Maasstad Ziekenhuis, afd. Vaatchirurgie, Rotterdam
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Rooijens P, Serafino G, Vroegindeweij D, Dammers R, Yo T, De Smet A, Tordoir J. Multi-Slice Computed Tomographic Angiography for Stenosis Detection in Forearm Hemodialysis Arteriovenous Fistulas. J Vasc Access 2018. [DOI: 10.1177/112972980800900409] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose A method of diagnosing the extent and severity of arteriovenous fistula (AVF) stenoses is multi-slice computed tomographic angiography (MS-CTA). The aim of this prospective study was to assess the accuracy of MS-CTA for the detection and grading of stenoses in AVF in comparison to digital subtraction angiography (DSA), which was used as the gold standard of reference. Methods Fifteen hemodialysis (HD) patients with dysfunctioning forearm AVF were included. These AVFs were evaluated by both DSA and MS-CTA and were read in a prospective, blinded manner by two radiologists experienced in vascular imaging. Results ROC analysis revealed areas under the curve of 0.90 ± 0.07 for observer I and 0.87 ± 0.08 for observer II at a stenosis cut-off level of ≥50% diameter reduction. The combined results for MS-CTA showed sensitivity, specificity and positive and negative predictive values of 82%, 98%, 82% and 98% for stenoses ≥50% and 71%, 99%, 77% and 98% for stenoses ≥75%. Inter-observer agreement for the detection of stenoses ≥50% diameter reduction was 0.70 and 1.0, for MS-CTA and DSA, respectively. Conclusion MS-CTA can provide good visualization of forearm HD access AVF and has moderate sensitivity, but high specificity for the detection of flow-limiting stenoses.
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Affiliation(s)
- P.P.G.M. Rooijens
- Department of Surgery, Medical Center Rijnmond Zuid, Rotterdam - The Netherlands
| | - G.P Serafino
- Department of Radiology, Medical Center Rijnmond Zuid, Rotterdam - The Netherlands
| | - D. Vroegindeweij
- Department of Radiology, Medical Center Rijnmond Zuid, Rotterdam - The Netherlands
| | - R. Dammers
- Department of Neurosurgery, Erasmus Medical Center, Rotterdam - The Netherlands
| | - T.I. Yo
- Department of Surgery, Medical Center Rijnmond Zuid, Rotterdam - The Netherlands
| | - A.A.E.A. De Smet
- Department of Surgery, Medical Center Rijnmond Zuid, Rotterdam - The Netherlands
| | - J.H.M. Tordoir
- Department of Surgery, University Hospital Maastricht, Maastricht - The Netherlands
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van Schaik TG, Yeung KK, Verhagen HJ, de Bruin JL, van Sambeek MR, Balm R, Zeebregts CJ, van Herwaarden JA, Blankensteijn JD, Grobbee D, Blankensteijn J, Bak A, Buth J, Pattynama P, Verhoeven E, van Voorthuisen A, Blankensteijn J, Balm R, Buth J, Cuypers P, Grobbee D, Prinssen M, van Sambeek M, Verhoeven E, Baas A, Hunink M, van Engelshoven J, Jacobs M, de Mol B, van Bockel J, Balm R, Reekers J, Tielbeek X, Verhoeven E, Wisselink W, Boekema N, Heuveling L, Sikking I, Prinssen M, Balm R, Blankensteijn J, Buth J, Cuypers P, van Sambeek M, Verhoeven E, de Bruin J, Baas A, Blankensteijn J, Prinssen M, Buth J, Tielbeek A, Blankensteijn J, Balm R, Reekers J, van Sambeek M, Pattynama P, Verhoeven E, Prins T, van der Ham A, van der Velden J, van Sterkenburg S, ten Haken G, Bruijninckx C, van Overhagen H, Tutein Nolthenius R, Hendriksz T, Teijink J, Odink H, de Smet A, Vroegindeweij D, van Loenhout R, Rutten M, Hamming J, Lampmann L, Bender M, Pasmans H, Vahl A, de Vries C, Mackaay A, van Dortmont L, van der Vliet A, Schultze Kool L, Boomsma J, van Dop H, de Mol van Otterloo J, de Rooij T, Smits T, Yilmaz E, Wisselink W, van den Berg F, Visser M, van der Linden E, Schurink G, de Haan M, Smeets H, Stabel P, van Elst F, Poniewierski J, Vermassen F. Long-term survival and secondary procedures after open or endovascular repair of abdominal aortic aneurysms. J Vasc Surg 2017; 66:1379-1389. [DOI: 10.1016/j.jvs.2017.05.122] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 05/18/2017] [Indexed: 11/30/2022]
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12
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Jongsma H, Akkersdijk GP, de Smet AA, Vroegindeweij D, de Vries JPP, Fioole B. Drug-eluting balloons and uncoated balloons perform equally to rescue infrainguinal autologous bypasses at risk. J Vasc Surg 2017; 66:454-460. [DOI: 10.1016/j.jvs.2017.02.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 02/06/2017] [Indexed: 10/19/2022]
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13
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Kastelein M, Luijsterburg PAJ, Koster IM, Verhaar JAN, Koes BW, Vroegindeweij D, Bierma-Zeinstra SMA, Oei EHG. Knee osteoarthritis in traumatic knee symptoms in general practice: 6-year cohort study. BMJ Open Sport Exerc Med 2016; 2:e000153. [PMID: 27900195 PMCID: PMC5125421 DOI: 10.1136/bmjsem-2016-000153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2016] [Indexed: 11/16/2022] Open
Abstract
Aim To identify degenerative knee abnormalities using MRI and radiography 6 years after knee trauma, their relation with persistent knee symptoms and baseline prognostic factors. Methods Adults (18–65 years) with incident traumatic knee symptoms visiting their general practitioner were followed up for 6 years and underwent baseline MRI and 6-year follow-up MRI and radiography. Logistic regression was used to analyse associations between various degenerative abnormalities on 6-year MRI and radiography, persistent knee symptoms and baseline prognostic factors for knee osteoarthritis (OA) on 6-year MRI. Results On 6-year radiography, 60% of patients showed no OA, 28% showed OA with Kellgren&Lawrence (K&L) grade 1 and 13% showed with K&L grade 2. On 6-year MRI, 55% of patients showed cartilage defect(s), 45% showed osteophyte(s), 36% showed subchondral cyst(s), 40% showed bone marrow oedema, 21% showed meniscal subluxation, 83% showed meniscal degeneration,11% showed effusion and 11% showed a Baker's cyst. Of these, most were significantly related with 6-year radiographic K&L grade, while only lateral cartilage defect(s), medial osteophyte(s) and medial meniscal subluxation were significantly related with persistent knee symptoms. 32% of patients showed new onset or progressive knee OA on 6-year MRI, for which age, history of non-traumatic knee symptoms and bone marrow oedema at baseline were independent prognostic factors. Conclusions Degenerative knee abnormalities on MRI are related to the K&L score; however, not all abnormalities are reflected in clinical outcome. Age, history of non-traumatic knee symptoms and bone marrow oedema predict knee OA 6 years after knee trauma, present in 32% of the patients.
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Affiliation(s)
- Marlous Kastelein
- Department of General Practice , Erasmus MC, University Medical Center Rotterdam , Rotterdam , The Netherlands
| | - Pim A J Luijsterburg
- Department of General Practice , Erasmus MC, University Medical Center Rotterdam , Rotterdam , The Netherlands
| | - Ingrid M Koster
- Department of Radiology , Albert Schweitzer Hospital , Dordrecht , The Netherlands
| | - Jan A N Verhaar
- Department of Orthopedics , Erasmus MC, University Medical Center Rotterdam , Rotterdam , The Netherlands
| | - Bart W Koes
- Department of General Practice , Erasmus MC, University Medical Center Rotterdam , Rotterdam , The Netherlands
| | | | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Edwin H G Oei
- Department of Radiology , Erasmus MC, University Medical Center Rotterdam , Rotterdam , The Netherlands
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14
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Runhaar J, de Vos BC, van Middelkoop M, Vroegindeweij D, Oei EHG, Bierma-Zeinstra SMA. Prevention of Incident Knee Osteoarthritis by Moderate Weight Loss in Overweight and Obese Females. Arthritis Care Res (Hoboken) 2016; 68:1428-33. [PMID: 26866630 DOI: 10.1002/acr.22854] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 01/12/2016] [Accepted: 01/26/2016] [Indexed: 01/05/2023]
Abstract
OBJECTIVE This study evaluated the effect of moderate weight loss on the incidence of knee osteoarthritis (OA) in middle-aged overweight and obese women, without clinical and radiologic knee OA at baseline. METHODS A total of 353 women (87%) with followup data available were selected from the Prevention of Knee Osteoarthritis in Overweight Females study, which evaluated the preventive effect of a diet and exercise intervention and of oral glucosamine sulfate on the incidence of knee OA. This was an exploratory proof-of-concept analysis, which compared the incidence of knee OA between women who reached the clinically relevant weight loss target of 5 kg or 5% of body weight after 30 months and those who did not reach this target. RESULTS The weight loss group showed a significantly lower incidence of knee OA according to the primary outcome measure, which was composed of the American College of Rheumatology criteria (clinical and radiographic), Kellgren/Lawrence grade ≥2, and joint space narrowing ≥1.0 mm (15% versus 20%; odds ratio 0.5, 95% confidence interval 0.3-0.9). Moreover, the weight loss also positively affected several health measures, such as blood glucose level, body fat percentage, and blood pressure. CONCLUSION A reduction of ≥5 kg or 5% of body weight over a 30-month period reduces the risk for the onset of radiographic knee OA in middle-aged overweight and obese women. Because of the slow progression of the disease, a longer followup period will be necessary before the number of prevented cases of knee OA by moderate weight loss becomes clinically more relevant.
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Affiliation(s)
- Jos Runhaar
- Erasmus Medical Center, Rotterdam, The Netherlands.
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de Bruin JL, Karthikesalingam A, Holt PJ, Prinssen M, Thompson MM, Blankensteijn JD, Grobbee D, Blankensteijn J, Bak A, Buth J, Pattynama P, Verhoeven E, van Voorthuisen A, Blankensteijn J, Balm R, Buth J, Cuypers P, Grobbee D, Prinssen M, van Sambeek M, Verhoeven E, Baas A, Hunink M, van Engelshoven J, Jacobs M, de Mol B, van Bockel J, Balm R, Reekers J, Tielbeek X, Verhoeven E, Wisselink W, Boekema N, Heuveling L, Sikking I, Prinssen M, Balm R, Blankensteijn J, Buth J, Cuypers P, van Sambeek M, Verhoeven E, de Bruin J, Baas A, Blankensteijn J, Prinssen M, Buth J, Tielbeek A, Blankensteijn J, Balm R, Reekers J, van Sambeek M, Pattynama P, Verhoeven E, Prins T, van der Ham A, van der Velden J, van Sterkenburg S, ten Haken G, Bruijninckx C, van Overhagen H, Tutein Nolthenius R, Hendriksz T, Teijink J, Odink H, de Smet A, Vroegindeweij D, van Loenhout R, Rutten M, Hamming J, Lampmann L, Bender M, Pasmans H, Vahl A, de Vries C, Mackaay A, van Dortmont L, van der Vliet A, Schultze Kool L, Boomsma J, van H, de Mol van Otterloo J, de Rooij T, Smits T, Yilmaz E, Wisselink W, van den Berg F, Visser M, van der Linden E, Schurink G, de Haan M, Smeets H, Stabel P, van Elst F, Poniewierski J, Vermassen F. Predicting reinterventions after open and endovascular aneurysm repair using the St George's Vascular Institute score. J Vasc Surg 2016; 63:1428-1433.e1. [DOI: 10.1016/j.jvs.2015.12.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 12/15/2015] [Indexed: 12/01/2022]
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16
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Landsmeer MLA, Runhaar J, van der Plas P, van Middelkoop M, Vroegindeweij D, Koes B, Bindels PJE, Oei EHG, Bierma-Zeinstra SMA. Reducing progression of knee OA features assessed by MRI in overweight and obese women: secondary outcomes of a preventive RCT. Osteoarthritis Cartilage 2016; 24:982-90. [PMID: 26748391 DOI: 10.1016/j.joca.2015.12.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 12/17/2015] [Accepted: 12/23/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the preventive effects of a randomized controlled trial on progression of Magnetic Resonance Imaging (MRI) features of knee osteoarthritis (OA) in overweight and obese women. DESIGN In a 2 × 2 factorial design, 2.5 years effects of a diet and exercise program and of glucosamine sulphate (double-blind, placebo-controlled) were evaluated in 407 middle-aged women with body mass index (BMI) ≥ 27 kg/m(2) without clinical signs of knee OA at baseline (ISRCTN 42823086). MRIs were scored with the MRI Osteoarthritis Knee Score (MOAKS). Progression was defined for bone marrow lesions (BMLs), cartilage defects, osteophytes, meniscal abnormalities and meniscal extrusion. Analyses on knee level were performed over the four intervention groups using adjusted Generalized Estimating Equations (GEE). RESULTS 687 knees of 347 women with mean age 55.7 years (±3.2 SD) and mean BMI 32.3 kg/m(2) (±4.2 SD) were analyzed. Baseline prevalence was 64% for BMLs, 70% for cartilage defects, 24% for osteophytes, 66% for meniscal abnormalities and 52% for meniscal extrusions. The diet and exercise program + placebo intervention showed significantly less progression of meniscal extrusion compared to placebo only (12% vs 22%, OR 0.50, 95% CI [0.27-0.92]). The interventions did not result in significant differences on other OA MRI features. CONCLUSIONS In subjects at high risk for future knee OA development, a diet and exercise program, glucosamine sulphate and their combination showed small and mainly non-significant effects on the progression of OA MRI features. Only progression of meniscal extrusion was significantly diminished by the diet and exercise program.
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Affiliation(s)
- M L A Landsmeer
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
| | - J Runhaar
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
| | - P van der Plas
- Department of Radiology, Maasstad Hospital, Rotterdam, The Netherlands.
| | - M van Middelkoop
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
| | - D Vroegindeweij
- Department of Radiology, Maasstad Hospital, Rotterdam, The Netherlands.
| | - B Koes
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
| | - P J E Bindels
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
| | - E H G Oei
- Department of Radiology, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
| | - S M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands; Department of Orthopaedics, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
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de Bruin JL, Groenwold RHH, Baas AF, Brownrigg JR, Prinssen M, Grobbee DE, Blankensteijn JD, Grobbee DE, Blankensteijn JD, Bak AAA, Buth J, Pattynama PM, Verhoeven ELG, van Voorthuisen AE, Blankensteijn JD, Balm R, Buth J, Cuypers PWM, Grobbee DE, Prinssen M, van Sambeek MRHM, G Verhoeven EL, Baas AF, Hunink MG, van Engelshoven JM, Jacobs MJHM, de Mol BAJM, van Bockel JH, Balm R, Reekers J, Tielbeek X, Verhoeven ELG, Wisselink W, Boekema N, Heuveling I Sikking LM, Prinssen M, Balm R, Blankensteijn JD, Buth J, Cuypers PWM, van Sambeek MRHM, Verhoeven ELG, de Bruin JL, Baas AF, Blankensteijn JD, Prinssen M, Buskens E, Buth J, Tielbeek AV, Blankensteijn JD, Balm R, Reekers JA, van Sambeek MRHM, Pattynama P, Verhoeven ELG, Prins T, van der Ham AC, van der Velden JJIM, van Sterkenburg SMM, ten Haken GB, Bruijninckx CMA, van Overhagen H, Tutein Nolthenius RP, Hendriksz TR, Teijink JAW, Odink HF, de Smet AAEA, Vroegindeweij D, van Loenhout RMM, Rutten MJ, Hamming JF, Lampmann LEH, Bender MHM, Pasmans H, Vahl AC, de Vries C, Mackaay AJC, van Dortmont LMC, van der Vliet AJ, Schultze Kool LJ, Boomsma JHB, van Dop HR, de Mol van Otterloo JCA, de Rooij TPW, Smits TM, Yilmaz EN, Wisselink W, van den Berg Vrije FG, Visser MJT, van der Linden E, Schurink GWH, de Haan M, Smeets HJ, Stabel P, van Elst F, Poniewierski J, Vermassen FEG. Quality of life from a randomized trial of open and endovascular repair for abdominal aortic aneurysm. Br J Surg 2016; 103:995-1002. [DOI: 10.1002/bjs.10130] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 11/10/2015] [Accepted: 01/14/2016] [Indexed: 11/11/2022]
Abstract
Abstract
Background
Long-term survival is similar after open or endovascular repair of abdominal aortic aneurysm. Few data exist on the effect of either procedure on long-term health-related quality of life (HRQoL) and health status.
Methods
Patients enrolled in a multicentre randomized clinical trial (DREAM trial; 2000–2003) in Europe of open repair versus endovascular repair (EVAR) of abdominal aortic aneurysm were asked to complete questionnaires on health status and HRQoL. HRQoL scores were assessed at baseline and at 13 time points thereafter, using generic tools, the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36®) and EuroQol 5D (EQ-5D™). Physical (PCS) and mental component summary scores were also calculated. Follow-up was 5 years.
Results
Some 332 of 351 patients enrolled in the trial returned questionnaires. More than 70 per cent of questionnaires were returned at each time point. Both surgical interventions had a short-term negative effect on HRQoL and health status. This was less severe in the EVAR group than in the open repair group. In the longer term the physical domains of SF-36® favoured open repair: mean difference in PCS score between open repair and EVAR −1·98 (95 per cent c.i. −3·56 to −0·41). EQ-5D™ descriptive and EQ-5D™ visual analogue scale scores for open repair were also superior to those for EVAR after the initial 6-week interval: mean difference −0·06 (−0·10 to −0·02) and −4·09 (−6·91 to −1·27) respectively.
Conclusion
In this study EVAR appeared to be associated with less severe disruption to HRQoL and health status in the short term. However, during longer-term follow-up to 5 years, patients receiving open repair appeared to have improved quality of life and health status.
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Affiliation(s)
- J L de Bruin
- Division of Vascular Surgery, Department of Surgery, VU Medical Centre, Amsterdam
- St George's Vascular Institute, St George's Healthcare NHS Trust, London, UK
| | - R H H Groenwold
- Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht
| | - A F Baas
- Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht
| | - J R Brownrigg
- St George's Vascular Institute, St George's Healthcare NHS Trust, London, UK
| | - M Prinssen
- Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht
| | - D E Grobbee
- Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht
| | - J D Blankensteijn
- Division of Vascular Surgery, Department of Surgery, VU Medical Centre, Amsterdam
| | | | | | | | - J Buth
- Catharina Hospital, Eindhoven
| | | | | | | | | | - R Balm
- Catharina Hospital, Eindhoven
| | - J Buth
- Catharina Hospital, Eindhoven
| | | | | | | | | | | | | | | | | | | | | | | | - R Balm
- Catharina Hospital, Eindhoven
| | | | | | | | | | | | | | | | - R Balm
- Catharina Hospital, Eindhoven
| | | | - J Buth
- Catharina Hospital, Eindhoven
| | | | | | | | | | | | | | | | | | - J Buth
- Catharina Hospital, Eindhoven
| | | | | | - R Balm
- Academic Medical Centre, Amsterdam
| | | | | | | | | | - T Prins
- University Hospital, Groningen
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - A C Vahl
- Onze Lieve Vrouwe Gasthuis, Amsterdam
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - M de Haan
- University Medical Centre, Maastricht
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Runhaar J, Deroisy R, van Middelkoop M, Barretta F, Barbetta B, Oei EH, Vroegindeweij D, Giacovelli G, Bruyère O, Rovati LC, Reginster JY, Bierma-Zeinstra SM. The role of diet and exercise and of glucosamine sulfate in the prevention of knee osteoarthritis: Further results from the PRevention of knee Osteoarthritis in Overweight Females (PROOF) study. Semin Arthritis Rheum 2016; 45:S42-8. [DOI: 10.1016/j.semarthrit.2015.11.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 11/04/2015] [Indexed: 12/23/2022]
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Runhaar J, van Middelkoop M, Reijman M, Willemsen S, Oei EH, Vroegindeweij D, van Osch G, Koes B, Bierma-Zeinstra SMA. Prevention of knee osteoarthritis in overweight females: the first preventive randomized controlled trial in osteoarthritis. Am J Med 2015; 128:888-895.e4. [PMID: 25818496 DOI: 10.1016/j.amjmed.2015.03.006] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 03/11/2015] [Accepted: 03/11/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND With accumulating knowledge on osteoarthritis development, the next step is to focus on possibilities for primary prevention. METHODS In a 2 × 2 factorial design, the effects of a diet-and-exercise program and of oral glucosamine sulfate (double blind and placebo-controlled) on the incidence of knee osteoarthritis were evaluated in a high-risk group of 407 middle-aged women with a body mass index ≥ 27 kg/m(2) without clinical signs of knee osteoarthritis at baseline (ISRCTN 42823086). Primary outcome was the incidence of knee osteoarthritis, defined as Kellgren & Lawrence grade ≥ 2, joint space narrowing of ≥ 1.0 mm, or clinical knee osteoarthritis (clinical and radiographic American College of Rheumatology criteria) after 2.5 years. RESULTS After 2.5 years, only 10% of all subjects were lost to follow-up, and 17% of all knees showed incident knee osteoarthritis. Accounting for the significant interaction between the interventions, no significant main effect of either intervention was found. Independently, both interventions alone showed indications of reduced knee osteoarthritis incidence (odds ratio [OR] 0.69; 95% CI, 0.39-1.21 for the diet-and-exercise program and OR 0.60; 95% CI, 0.31-1.12 for the glucosamine intervention). These effects were neutralized in subjects receiving both interventions (OR 0.97; 95% CI, 0.55-1.71). CONCLUSIONS No significant main effects of the diet-and-exercise program and of glucosamine sulfate were found on incident knee osteoarthritis. Nevertheless, this trial provides valuable insights for future trial design for preventive osteoarthritis studies.
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Affiliation(s)
- Jos Runhaar
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
| | - Marienke van Middelkoop
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Max Reijman
- Department of Orthopaedics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Sten Willemsen
- Department of Biostatistics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Edwin H Oei
- Department of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | | | - Gerjo van Osch
- Department of Orthopaedics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Bart Koes
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Orthopaedics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Runhaar J, van Middelkoop M, Reijman M, Vroegindeweij D, Oei EHG, Bierma-Zeinstra SMA. Malalignment: a possible target for prevention of incident knee osteoarthritis in overweight and obese women. Rheumatology (Oxford) 2014; 53:1618-24. [PMID: 24706992 DOI: 10.1093/rheumatology/keu141] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The present study aims to investigate the associations between malalignment and incident knee OA after 2.5 years in a high-risk group of 333 middle-aged overweight women (BMI ≥ 27 kg/m(2)) free of clinical and radiological knee OA at baseline. METHODS The primary outcome measure was the incidence of knee OA, defined as the incidence of radiographic knee OA (Kellgren and Lawrence grade ≥2), clinical knee OA (ACR criteria) or medial or lateral joint space narrowing (≥1.0 mm). Using generalized estimating equations, associations between valgus and varus alignment (compared with neutrally aligned knees) and the primary outcome measure and all its items separately were studied. RESULTS Neither varus- nor valgus-aligned knees had a significantly increased risk for incident knee OA according to the primary outcome measure. A significantly increased risk for the development of radiographic knee OA was found for varus-aligned knees [odds ratio (OR) 3.3, 95% CI 1.5, 7.3]. Valgus-aligned knees showed a borderline increased OR (2.8, 95% CI 1.0, 8.0) for the development of radiographic knee OA. No statistically significant effects were found for varus and valgus alignment on the incidence of clinical knee OA or medial or lateral joint space narrowing. CONCLUSION Since this study was performed in a true target population, current data suggest that malalignment might be a target for the prevention of radiographic knee OA in overweight and obese women.
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Affiliation(s)
- Jos Runhaar
- Department of General Practice, Department of Orthopaedics, Erasmus MC University Medical Centre Rotterdam, Department Radiology, Maasstad Hospital and Department of Radiology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands.
| | - Marienke van Middelkoop
- Department of General Practice, Department of Orthopaedics, Erasmus MC University Medical Centre Rotterdam, Department Radiology, Maasstad Hospital and Department of Radiology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Max Reijman
- Department of General Practice, Department of Orthopaedics, Erasmus MC University Medical Centre Rotterdam, Department Radiology, Maasstad Hospital and Department of Radiology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Dammis Vroegindeweij
- Department of General Practice, Department of Orthopaedics, Erasmus MC University Medical Centre Rotterdam, Department Radiology, Maasstad Hospital and Department of Radiology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Edwin H G Oei
- Department of General Practice, Department of Orthopaedics, Erasmus MC University Medical Centre Rotterdam, Department Radiology, Maasstad Hospital and Department of Radiology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Department of Orthopaedics, Erasmus MC University Medical Centre Rotterdam, Department Radiology, Maasstad Hospital and Department of Radiology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands.Department of General Practice, Department of Orthopaedics, Erasmus MC University Medical Centre Rotterdam, Department Radiology, Maasstad Hospital and Department of Radiology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
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Karimi A, de Boer SW, van den Heuvel DAF, Fioole B, Vroegindeweij D, Heyligers JMM, Lohle PNM, Elgersma O, Nolthenius RPT, Vos JA, de Vries JPPM. Randomized trial of Legflow(®) paclitaxel eluting balloon and stenting versus standard percutaneous transluminal angioplasty and stenting for the treatment of intermediate and long lesions of the superficial femoral artery (RAPID trial): study protocol for a randomized controlled trial. Trials 2013; 14:87. [PMID: 23537403 PMCID: PMC3651710 DOI: 10.1186/1745-6215-14-87] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 02/13/2013] [Indexed: 11/29/2022] Open
Abstract
Background Restenosis after percutaneous transluminal angioplasty (PTA) of the superficial femoral artery (SFA) may occur in 45% of patients at 2 years follow-up. Paclitaxel-coated balloons have been found to reduce neointimal hyperplasia, and thus reduce restenosis. Recently, the Legflow® paclitaxel-coated balloon (Cardionovum Sp.z.o.o., Warsaw, Poland) (LPEB) has been introduced. This balloon is covered with shellac, a Food and Drug Administration (FDA) approved natural resin, to obtain an equally distributed tissue concentration of paclitaxel. The RAPID trial is designed to assess restenosis after PTA using the Legflow balloon combined with nitinol stenting versus uncoated balloons with nitinol stenting in SFA lesions >5 cm. Methods/Design A total of 176 adult patients with Rutherford class 2 to class 6 symptoms due to intermediate (5–15 cm) or long (>15 cm) atherosclerotic lesions in the SFA will be randomly allocated for treatment with LPEB with nitinol stenting or uncoated balloon angioplasty with stenting. Stenting will be performed using the Supera® stent in both groups (IDEV Technologies Inc., Webster, TX). The primary endpoint is the absence of binary restenosis of the treated SFA segment. Secondary outcomes are target lesion revascularization (TLR), clinical and hemodynamic outcome, amputation rate, mortality rate, adverse events, and device-specific adverse events. Follow up consists of four visits in which ankle-brachial indices (ABI), toe pressure measurements, and duplex ultrasound (DUS) will be performed. Furthermore, a peripheral artery questionnaire (PAQ) will be completed by the patients at each follow-up. In the event that DUS reveals a symptomatic >50% restenosis, or a >75% asymptomatic restenosis, additional digital subtraction angiography will be performed with any necessary re-intervention. Discussion The RAPID trial is a multicenter randomized controlled patient blind trial that will provide evidence concerning whether the use of the Legflow paclitaxel/shellac coated balloons with nitinol stenting significantly reduces the frequency of restenosis in intermediate and long SFA lesions compared to standard PTA and stenting. Trial registration ISRCTN47846578
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Affiliation(s)
- Amine Karimi
- Department of Vascular Surgery, St. Antonius Hospital, PO box 2500, Nieuwegein, EM 3430, The Netherlands.
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Schrijver AM, Reijnen MMPJ, van Oostayen JA, Nolthenius RPJT, van der Valk PHM, Hoksbergen AWJ, Lely RJ, Fioole B, Vroegindeweij D, van Leersum M, de Vries JPPM. Dutch randomized trial comparing standard catheter-directed thrombolysis versus ultrasound-accelerated thrombolysis for thromboembolic infrainguinal disease (DUET): design and rationale. Trials 2011; 12:20. [PMID: 21255459 PMCID: PMC3033836 DOI: 10.1186/1745-6215-12-20] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Accepted: 01/23/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of thrombolytic therapy in the treatment of thrombosed infrainguinal native arteries and bypass grafts has increased over the years. Main limitation of this treatment modality, however, is the occurrence of bleeding complications. Low intensity ultrasound (US) has been shown to accelerate enzymatic thrombolysis, thereby reducing therapy time. So far, no randomized trials have investigated the application of US-accelerated thrombolysis in the treatment of thrombosed infra-inguinal native arteries or bypass grafts. The DUET study (Dutch randomized trial comparing standard catheter-directed thrombolysis versus Ultrasound-accElerated Thrombolysis for thrombo-embolic infrainguinal disease) is designed to assess whether US-accelerated thrombolysis will reduce therapy time significantly compared with standard catheter-directed thrombolysis. METHODS/DESIGN Sixty adult patients with recently (between 1 and 7 weeks) thrombosed infrainguinal native arteries or bypass grafts with acute limb ischemia class I or IIa, according to the Rutherford classification for acute ischemia, will be randomly allocated to either standard thrombolysis (group A) or US-accelerated thrombolysis (group B). Patients will be recruited from 5 teaching hospitals in the Netherlands during a 2-year period. The primary endpoint is the duration of catheter-directed thrombolysis needed for uninterrupted flow in the thrombosed infrainguinal native artery or bypass graft, with outflow through at least 1 crural artery. DISCUSSION The DUET study is a randomized controlled trial that will provide evidence of whether US-accelerated thrombolysis will significantly reduce therapy time in patients with recently thrombosed infrainguinal native arteries or bypass grafts, without an increase in complications. TRIAL REGISTRATION Current Controlled Trials ISRCTN72676102.
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Bax L, Woittiez AJJ, Kouwenberg HJ, Mali WPTM, Buskens E, Beek FJA, Braam B, Huysmans FTM, Schultze Kool LJ, Rutten MJCM, Doorenbos CJ, Aarts JCNM, Rabelink TJ, Plouin PF, Raynaud A, van Montfrans GA, Reekers JA, van den Meiracker AH, Pattynama PMT, van de Ven PJG, Vroegindeweij D, Kroon AA, de Haan MW, Postma CT, Beutler JJ. Stent placement in patients with atherosclerotic renal artery stenosis and impaired renal function: a randomized trial. Ann Intern Med 2009; 150:840-8, W150-1. [PMID: 19414832 DOI: 10.7326/0003-4819-150-12-200906160-00119] [Citation(s) in RCA: 393] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Little is known about the efficacy and safety of renal artery stenting in patients with atherosclerotic renal artery stenosis (ARAS) and impaired renal function. OBJECTIVE To determine the efficacy and safety of stent placement in patients with ARAS and impaired renal function. DESIGN Randomized clinical trial. Randomization was centralized and computer generated, and allocation was assigned by e-mail. Patients, providers, and persons who assessed outcomes were not blinded to treatment assignment. SETTING 10 European medical centers. PARTICIPANTS 140 patients with creatinine clearance less than 80 mL/min per 1.73 m(2) and ARAS of 50% or greater. INTERVENTION Stent placement and medical treatment (64 patients) or medical treatment only (76 patients). Medical treatment consisted of antihypertensive treatment, a statin, and aspirin. MEASUREMENTS The primary end point was a 20% or greater decrease in creatinine clearance. Secondary end points included safety and cardiovascular morbidity and mortality. RESULTS Forty-six of 64 patients assigned to stent placement had the procedure. Ten of the 64 patients (16%) in the stent placement group and 16 patients (22%) in the medication group reached the primary end point (hazard ratio, 0.73 [95% CI, 0.33 to 1.61]). Serious complications occurred in the stent group, including 2 procedure-related deaths (3%), 1 late death secondary to an infected hematoma, and 1 patient who required dialysis secondary to cholesterol embolism. The groups did not differ for other secondary end points. LIMITATION Many patients were falsely identified as having renal artery stenosis greater than 50% by noninvasive imaging and did not ultimately require stenting. CONCLUSION Stent placement with medical treatment had no clear effect on progression of impaired renal function but led to a small number of significant procedure-related complications. The study findings favor a conservative approach to patients with ARAS, focused on cardiovascular risk factor management and avoiding stenting.
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Affiliation(s)
- Liesbeth Bax
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
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Rooijens PPGM, Serafino GP, Vroegindeweij D, Dammers R, Yo TI, De Smet AAEA, Tordoir JHM. Multi-slice computed tomographic angiography for stenosis detection in forearm hemodialysis arteriovenous fistulas. J Vasc Access 2008; 9:278-284. [PMID: 19085898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
PURPOSE A method of diagnosing the extent and severity of arteriovenous fistula (AVF) stenoses is multislice computed tomographic angiography (MS-CTA). The aim of this prospective study was to assess the accuracy of MS-CTA for the detection and grading of stenoses in AVF in comparison to digital subtraction angiography (DSA), which was used as the gold standard of reference. METHODS Fifteen hemodialysis (HD) patients with dysfunctioning forearm AVF were included. These AVFs were evaluated by both DSA and MS-CTA and were read in a prospective, blinded manner by two radiologists experienced in vascular imaging. RESULTS ROC analysis revealed areas under the curve of 0.90+/-0.07 for observer I and 0.87+/-0.08 for observer II at a stenosis cut-off level of >or=50% diameter reduction. The combined results for MS-CTA showed sensitivity, specificity and positive and negative predictive values of 82%, 98%, 82% and 98% for stenoses>or=50% and 71%, 99%, 77% and 98% for stenoses>or=75%. Inter-observer agreement for the detection of stenoses>or=50% diameter reduction was 0.70 and 1.0, for MS-CTA and DSA, respectively. CONCLUSION MS-CTA can provide good visualization of forearm HD access AVF and has moderate sensitivity, but high specificity for the detection of flow-limiting stenoses.
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Affiliation(s)
- P P G M Rooijens
- Department of Surgery, Medical Center Rijnmond Zuid, Rotterdam, The Netherlands.
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Pijpers M, Hazebroek EJ, Coene PPLO, Beerman H, Vroegindeweij D. Herniation of the gall bladder through the abdominal wall. ACTA ACUST UNITED AC 2007; 51 Suppl:B296-8. [DOI: 10.1111/j.1440-1673.2007.01825.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Boks SS, Vroegindeweij D, Koes BW, Bernsen RMD, Hunink MGM, Bierma-Zeinstra SMA. MRI Follow-Up of Posttraumatic Bone Bruises of the Knee in General Practice. AJR Am J Roentgenol 2007; 189:556-62. [PMID: 17715100 DOI: 10.2214/ajr.07.2276] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Our purpose was to study the natural course of bone bruises in posttraumatic knees and to describe possible determinants of this course. SUBJECTS AND METHODS Prospective MRI follow-up data were gathered for patients with bone bruises after sustained knee trauma. Follow-up ceased when the bone bruise could no longer be discerned or after 1 year of follow-up. For each patient we studied the relationships between time to healing of all bone bruises and the explanatory variables age, sex, obesity, workload, sports load, number of bone bruises, osteoarthritis, and concomitant knee lesions using survival analyses. We also investigated the relationships between resolution of individual bone bruises and lesion type, size and location, and the explanatory variables at 6 months and at 12 months separately, using logistic regression analyses for repeated measurements and generalized estimating equations. RESULTS In 80 patients, 157 bone bruises were found. The estimated median healing time was 42.1 weeks. Healing was prolonged in patients having a higher number of bone bruises and in the presence of osteoarthritis. Resolution of individual bone bruises was prolonged in the presence of osteoarthritis and greater age. Reticular lesions were less likely to be present after 6 months than other bone bruise types. None of the remaining tested variables had prognostic value. CONCLUSION Median healing time of bone bruises is 42.1 weeks. Prognosis is particularly influenced by the presence of osteoarthritis. Age, type of bone bruise, and number of bruises also have prognostic value.
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Affiliation(s)
- Simone S Boks
- Department of General Practice, Erasmus MC, Rotterdam, The Netherlands.
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Abstract
BACKGROUND Bone bruise is often seen in posttraumatic knees, but the clinical relevance is unclear. HYPOTHESIS The presence of bone bruise is associated with increased pain severity in patients with sustained knee trauma. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS We collected prospective data of 132 patients visiting their general practitioner after sustained knee trauma. Patients with bone bruise underwent a magnetic resonance imaging follow-up study that was discontinued when the bone bruise could no longer be discerned or after 1 year of follow-up. Bone bruise was assessed on magnetic resonance imaging, and pain severity was scored on a numeric rating scale (0-10) at baseline, and at 3, 6, and 12 months after trauma. The presence of bone bruise and pain severity (over time) were compared using linear regression analyses for repeated measurements. Adjustment was made for possible confounders: presence of meniscal tears, cruciate or collateral ligament ruptures, severe effusion, osteoarthritis, obesity, age, gender, work load, and sports load. RESULTS At baseline as well as during follow-up, bone bruise was associated with a slightly higher pain score. The differences, however, were very small (adjusted difference in pain severity 0.34 or less) and not statistically significant nor clinically relevant. CONCLUSION There is no statistically significant relationship, nor a clinically relevant relationship, between the presence of bone bruise and pain severity in patients with sustained knee injury in general practice.
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Affiliation(s)
- Simone S Boks
- Department of Radiology, Diaconessenhuis Meppel, P.O. Box 502, 7940 AM Meppel, the Netherlands.
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Boks SS, Vroegindeweij D, Koes BW, Hunink MMGM, Bierma-Zeinstra SMA. Magnetic resonance imaging abnormalities in symptomatic and contralateral knees: prevalence and associations with traumatic history in general practice. Am J Sports Med 2006; 34:1984-91. [PMID: 16861575 DOI: 10.1177/0363546506290189] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND After trauma, internal knee lesions are found in approximately two thirds of patients. However, magnetic resonance imaging abnormalities have also been described in asymptomatic volunteers. HYPOTHESIS Not all visualized lesions in symptomatic posttraumatic knees are the result of recent trauma; there are subgroups of lesions that may be preexistent. STUDY DESIGN Cross-sectional study (prevalence); Level of evidence, 2. METHODS Patients visiting their general practitioners after knee trauma were invited for magnetic resonance imaging of both knees. Prevalence of knee abnormalities was compared between symptomatic and asymptomatic knees. Multivariable analysis was performed to investigate the association between lesions that were seen in symptomatic and asymptomatic knees (ie, effusion and meniscal tears) and recent trauma, history of old trauma, age, and osteoarthritis. RESULTS In 134 participants, ligament lesions were found almost exclusively in symptomatic knees. Meniscal lesions and effusion were almost equally found in symptomatic and asymptomatic knees. Effusion was related to recent trauma (odds ratio, 14.0; 95% confidence interval, 5.0-39.6) and osteoarthritis (odds ratio, 4.7; 95% confidence interval, 1.4-15.5) but not to history of old trauma and age. Meniscal tears were more common in older patients (odds ratio, 1.09; 95% confidence interval, 1.05-1.12) but were not related to osteoarthritis. History of old trauma was more strongly related to the group of radial, longitudinal, and complex meniscal tears (odds ratio, 8.6; 95% confidence interval, 3.3-22.5) than to horizontal tears (odds ratio, 2.3; 95% confidence interval, 0.9-5.6). Recent trauma was not related to horizontal meniscal tears but was strongly related to other types of meniscal tears (odds ratio, 3.2; 95% confidence interval, 1.4-6.9). CONCLUSION Ligament knee lesions are most probably the result of recent trauma. Radial, longitudinal, and complex meniscal tears are strongly related to trauma, whereas horizontal meniscal tears and effusion may be preexistent in many cases.
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Affiliation(s)
- Simone S Boks
- Department of General Practice, Erasmus MC, Rotterdam, Netherlands.
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Abstract
PURPOSE To perform a systematic review of the literature regarding the natural course of posttraumatic occult bone lesions (often referred to as bone bruises) detected at magnetic resonance (MR) imaging. MATERIALS AND METHODS A systematic review of the literature was performed by searching the MEDLINE database (from January 1966 to February 2003) with the keywords bone bruise, trauma, follow-up, and MRI. Keywords were linked by using the Boolean operator AND. Studies were included if all of the following criteria were fulfilled: patients sustained trauma, MR imaging was used as a diagnostic method, results of clinical or MR imaging follow-up were available, and study was written in English, Dutch, German, French, Spanish, Italian, Swedish, Danish, or Norwegian. The quality of each study was assessed by using a standardized criteria set, and kappa statistics were estimated to rate the level of agreement between the two reviewers. Results were compared with regard to study design and quality scores. RESULTS The MEDLINE search identified 266 articles, 13 of which met the inclusion criteria. The quality of the included studies was moderate. The two reviewers initially agreed on 179 quality items (kappa = 0.84). The study population was generally small, and follow-up periods ranged from 1 to 73 months. Four different classification systems were used, and in two studies bone bruise was not specified. Study results suggest a generally good clinical prognosis of bone bruises. Normalization of MR imaging appearance is possible and is most often encountered after the occurrence of reticular lesions. Cartilage loss at follow-up is often found in cases of initial cartilage damage (impaction or osteochondral fracture). CONCLUSION In general, a healing response was often encountered after sustained posttraumatic occult bone lesions. The initial MR imaging appearance appears to have prognostic value.
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Affiliation(s)
- Simone S Boks
- Department of Radiology, Rijnmond-Zuid Medical Center, Rotterdam, the Netherlands.
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Boks SS, Vroegindeweij D, Koes BW, Hunink MGM, Bierma-Zeinstra SMA. Follow-up of Posttraumatic Ligamentous and Meniscal Knee Lesions Detected at MR Imaging: Systematic Review. Radiology 2006; 238:863-71. [PMID: 16452395 DOI: 10.1148/radiol.2382050063] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To perform a systematic review of the literature regarding the natural course of ligamentous and meniscal knee lesions detected at magnetic resonance (MR) imaging. MATERIALS AND METHODS The MEDLINE database was searched from January 1966 to February 2003. Studies were included if all of the following criteria were met: patients had collateral ligament, cruciate ligament, or meniscal lesions; MR imaging was performed in all patients; study included a group and/or subgroup of patients who underwent conservative treatment during follow-up; patients returned to the clinic for follow-up and clinical data or MR imaging outcomes were noted; and article was written in English, Dutch, German, French, Spanish, Italian, Swedish, Danish, or Norwegian. The quality of each study was assessed by using a standardized criteria set, and kappa statistics were used to grade the level of agreement between the two reviewers. Studies with quality scores of 8 or more were designated as high quality. Results were compared with regard to study design and quality scores. RESULTS The literature search identified 649 articles, and 11 studies (five on posterior cruciate ligament [PCL] injuries, five on anterior cruciate ligament [ACL] injuries, and one on meniscal injuries) met the inclusion criteria. No studies on the follow-up of collateral ligament injuries were identified. Four studies were of high quality, and the kappa value for quality items was 0.80. Between 77% and 93% of the partial or complete PCL ruptures regained continuity. In cases of partial or total ACL rupture, repair of continuity was also possible. A possible association between MR imaging continuity and clinical stability was identified. CONCLUSION The ACL and PCL can regain continuity after partial or complete rupture. On the basis of this review, no conclusions can be drawn about the natural course of meniscal or collateral ligament injury seen at MR imaging.
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Affiliation(s)
- Simone S Boks
- Department of Radiology, Rijnmond-Zuid Medical Center, Rotterdam, the Netherlands.
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Abstract
We present a case of the rapid development and rupture of a mycotic celiac trunk aneurysm. Initially on multislice computed tomography (ms-CT) there was a normal celiac trunk with minimal haziness of the surrounding fat. Only 2 weeks later the patient went into hypovolemic shock due to a ruptured celiac aneurysm. Although aneurysms of the visceral arteries are rare, they are of major clinical importance as they carry a life-threatening risk of rupture. This case illustrates the use of ms-CT in detecting and evaluating visceral aneurysms, in order to prevent emergency operation.
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Affiliation(s)
- Gianpiero Serafino
- Department of Radiology, Medical Centre Rijnmond-Zuid, Olympiaweg 350, 3078 HT Rotterdam, The Netherlands.
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Abstract
We describe a case of multiple endoleaks following endovascular repair of an abdominal aortic aneurysm, treated by various methods. A new transabdominal embolization approach using color-flow duplex guidance is presented.
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Affiliation(s)
- Simone S Boks
- Department of Radiology, Medical Centre Rijnmond-Zuid, Olympiaweg 350, 3078 HT Rotterdam, The Netherlands.
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Bruens ML, De Smet A, Vroegindeweij D, Haverlag R, Van Der Harst E. Haemobilia 2 weeks after a low thoracic stab wound. HPB (Oxford) 2005; 7:318-9. [PMID: 18333215 PMCID: PMC2043103 DOI: 10.1080/13651820410033689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Haemobilia occurs in only 1.2-5% of patients with accidental liver trauma. We describe an unusual case 2 weeks after penetrating thoracic injury. CASE OUTLINE A 27-year-old man underwent laparotomy for hepatic bleeding after a low thoracic stab wound. Two weeks later rectal blood loss occurred. CT scan and angiography revealed intrahepatic contrast extravasation at the previous stab wound site. Coils were successfully placed into two branches of the right hepatic artery. DISCUSSION Haemobilia should be considered in patients presenting with gastrointestinal blood loss after liver injury. It is diagnosed with angiography and preferably treated by embolisation.
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Affiliation(s)
- M. L. Bruens
- Department of Surgery and Interventional Radiology, Medisch Centrum Rijnmond Zuidlocatie ClaraRotterdamThe Netherlands
| | - Aaea De Smet
- Department of Surgery and Interventional Radiology, Medisch Centrum Rijnmond Zuidlocatie ClaraRotterdamThe Netherlands
| | - D. Vroegindeweij
- Department of Surgery and Interventional Radiology, Medisch Centrum Rijnmond Zuidlocatie ClaraRotterdamThe Netherlands
| | - R. Haverlag
- Department of Surgery and Interventional Radiology, Medisch Centrum Rijnmond Zuidlocatie ClaraRotterdamThe Netherlands
| | - E. Van Der Harst
- Department of Surgery and Interventional Radiology, Medisch Centrum Rijnmond Zuidlocatie ClaraRotterdamThe Netherlands
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Bax L, Mali WPTM, Buskens E, Koomans HA, Beutler JJ, Braam B, Beek FJA, Rabelink TJ, Postma CT, Huysmans FTM, Deinum J, Thien T, Schultze Kool LJ, Woittiez AJJ, Kouwenberg JJ, van den Meiracker AH, Pattynama PMT, van de Ven PJG, Vroegindeweij D, Doorenbos CJ, Aarts JCNM, Kroon AA, de Leeuw PW, de Haan MW, van Engelshoven JMA, Rutten MJCM, van Montfrans GA, Reekers JA, Plouin PF, La Batide Alanore A, Azizi M, Raynaud A, Harden PN, Cowling M. The benefit of STent placement and blood pressure and lipid-lowering for the prevention of progression of renal dysfunction caused by Atherosclerotic ostial stenosis of the Renal artery. The STAR-study: rationale and study design. J Nephrol 2003; 16:807-12. [PMID: 14736007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
BACKGROUND Atherosclerotic renal artery stenosis (ARAS) is associated with progressive loss of renal function and is one of the most important causes of renal failure in the elderly. Current treatment includes restoration of the renal arterial lumen by endovascular stent placement. However, this treatment only affects damage caused by ARAS due to the stenosis and ensuing post-stenotic ischemia. ARAS patients have severe general vascular disease. Atherosclerosis and hypertension can also damage the kidney parenchyma causing renal failure. Medical treatment focuses on the latter. Lipid-lowering drugs (statins) could reduce renal failure progression and could reduce the overall high cardiovascular risk. The additional effect on preserving renal function of stent placement as compared to medical therapy alone is unknown. Therefore, the STAR-study aims to compare the effects of renal artery stent placement together with medication vs. medication alone on renal function in ARAS patients. METHOD Patients with an ARAS of > or = 50% and renal failure (creatinine (Cr) clearance < 80 mL/min/1.73 m2) are randomly assigned to stent placement with medication or to medication alone. Medication consists of statins, anti-hypertensive drugs and antiplatelet therapy. Patients are followed for 2 yrs with extended follow-up to 5 yrs. The primary outcome of this study is a reduction in Cr clearance > 20% compared to baseline. This trial will include 140 patients.
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Affiliation(s)
- Liesbeth Bax
- University Medical Centre Utrecht, The Netherlands
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Vroegindeweij D, Vos LD, Tielbeek AV, Buth J, vd Bosch HC. Balloon angioplasty combined with primary stenting versus balloon angioplasty alone in femoropopliteal obstructions: A comparative randomized study. Cardiovasc Intervent Radiol 1997; 20:420-5. [PMID: 9354709 DOI: 10.1007/s002709900186] [Citation(s) in RCA: 172] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To evaluate whether balloon angioplasty combined with stenting (ST) of symptomatic femoropopliteal disease would provide better results compared with balloon angioplasty alone (BA). METHODS Fifty-one patients were randomized between ST (24 patients) and BA (27 patients). Follow-up comprised clinical and hemodynamic assessment and color-flow duplex ultrasound examinations. RESULTS Residual stenosis (> or = 30% diameter reduction) occurred in three BA patients, but not in the ST patients. By life-table analysis the cumulative rate of clinical and hemodynamic success after 1 year with ST was 74% (SE 9%) and for those with BA 85% (SE 7%) (p = 0.25). The primary patency at 1 year assessed by color-flow duplex ultrasound was 62% (SE 9%) for ST-treated patients and 74% (SE 8%) for BA patients (p = 0.22). Occlusion occurred in five ST patients (21%) compared with two BA patients (7%). CONCLUSION ST does not improve clinical and hemodynamic outcome compared with BA. Moreover, the occlusion rate in ST-treated patients is higher.
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Affiliation(s)
- D Vroegindeweij
- Department of Radiology, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands
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Tielbeek AV, Vroegindeweij D, Gussenhoven EJ, Buth J, Landman GH. Evaluation of directional atherectomy studied by intravascular ultrasound in femoropopliteal artery stenosis. Cardiovasc Intervent Radiol 1997; 20:413-9. [PMID: 9354708 DOI: 10.1007/s002709900185] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To evaluate the role of intravascular ultrasound (IVUS) before and after directional atherectomy (DA) in the treatment of femoropopliteal artery stenosis. METHODS In 12 patients with 16 stenoses IVUS was performed before and immediately after an angiographically successful DA. This was defined as a diameter reduction (DR) < or = 50%, which was calculated using the minimal lumen diameter compared with the diameter of a nearby "normal" segment. In the presence of residual plaque on IVUS an additional DA was performed. Endpoints studied were DR < or = 30% on IVUS compared with the IVUS findings of the angiographically normal reference segment, or when no additional atherosclerotic material could be removed by further DA passages. RESULTS Additional DA (mean 1.6 per lesion) had to be performed in all patients. Initial DA increased the cross-sectional free lumen area (FLA) from 3.8 +/- 2.0 mm2 to 8.1 +/- 2.7 mm2 (p = 0.0004). Additional DA increased FLA to 9.3 +/- 2.3 mm2 (p = 0.002) after the second passage and to 9.8 +/- 2.4 mm2 (p = 0.09) after the final DA run. The plaque area (PLA) before DA decreased from 18.1 +/- 4.2 mm2 to 15.4 +/- 4.8 mm2 (p = 0.002) after the first passage, and to 13.5 +/- 5.0 mm2 (p = 0.004) and 12. 8 +/- 4.4 mm2 (p = 0.07) after the second and final DA runs, respectively. PLA of the reference segment (9.5 +/- 5.7 mm2) was significantly smaller (p = 0.006) than the final PLA of the treated lesion, indicating a large amount of retained plaque. As a result of DA there was an increase in the area bordered by the medial layer, i. e., the total vessel area (from 21.9 +/- 4.7 mm2 to 23.0 +/- 4.7 mm2), significantly in eccentric and soft lesions. On IVUS, dissection and plaque rupture after the final passage was seen in 12 of 16 stenoses; two dissections were seen on the completion angiogram. After the final passage in all stenoses except three, the DR with IVUS was < or = 30%. CONCLUSION Lumen enlargement following DA is predominantly due to plaque excision. Vessel expansion combined with plaque excision varies in different stenoses and is an important factor in eccentric and soft lesions. Despite additional DA considerable plaque remains.
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Affiliation(s)
- A V Tielbeek
- Department of Radiology, Catharina Hospital, Michelangelolaan 2, NL-5623 EJ Eindhoven, The Netherlands
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Vroegindeweij D, Tielbeek AV, Buth J, Vos LD, van den Bosch HC. Patterns of recurrent disease after recanalization of femoropopliteal artery occlusions. Cardiovasc Intervent Radiol 1997; 20:257-62. [PMID: 9211771 DOI: 10.1007/s002709900148] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE In this prospective study we investigated the site, occurrence, and development of stenoses and occlusions following recanalization of superficial femoral artery occlusions. METHODS Recanalization of an occluded femoropopliteal artery was attempted in 62 patients. Follow-up examinations included clinical examination and color-flow duplex scanning at regular intervals. Arteriography was used to determine the localization of the recurrent disease relative to the initially occluded segment. RESULTS During a mean follow-up of 23 months (range 0-69 months) 14 high-grade restenoses, indicated by a peak systolic velocity ratio >> 3.0, were detected by color-flow duplex scanning. Occlusion of the treated segment occurred in 11 patients. The cumulative 3-year primary patency rate for high-grade restenoses and occlusions combined was 44% (SE 9%). By arteriographic examination the site of restenosis was localized in the distal half of the treated vessel segment in 16 of 21 cases. CONCLUSION Most restenoses and occlusions occurred during the first year and most disease developed at the previous intervention site. The site of restenosis is more frequently in the distal part of the initially treated segment, a finding that may have therapeutic implications.
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Affiliation(s)
- D Vroegindeweij
- Department of Radiology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
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Vos LD, Tielbeek AV, Bom EP, Gooszen HC, Vroegindeweij D. The Günther temporary inferior vena cava filter for short-term protection against pulmonary embolism. Cardiovasc Intervent Radiol 1997; 20:91-7. [PMID: 9030497 DOI: 10.1007/s002709900113] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To evaluate clinically the Günther temporary inferior vena cava (IVC) filter. METHODS Eleven IVC filters were placed in 10 patients. Indications for filter placement were surgical pulmonary embolectomy in seven patients, pulmonary embolism in two patients, and free-floating iliofemoral thrombus in one patient. Eight filters were inserted from the right femoral approach, three filters from the left. Follow-up was by plain abdominal radiographs, cavography, and duplex ultrasound (US). Eight patients received systemic heparinization. Follow-up, during 4-60 months after filter removal was by clinical assessment, and imaging of the lungs was performed when pulmonary embolism (PE) was suspected. Patients received anticoagulation therapy for at least 6 months. RESULTS Ten filters were removed without complications 7-14 days (mean 10 days) after placement. One restless patient pulled the filter back into the common femoral vein, and a permanent filter was placed. In two patients a permanent filter was placed prior to removal. One patient developed sepsis, and one an infection at the insertion site. Clinically no recurrent PE developed with the filter in place or during removal. One patient had recurrent PE 7 months after filter removal. CONCLUSION The Günther temporary IVC filter can be safely placed for short-term protection against PE. The use of this filter is not appropriate in agitated or immunocompromised patients.
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Affiliation(s)
- L D Vos
- Department of Radiology, Catharina Hospital, Michelangelolaan 2, NL-5623 EJ Eindhoven, The Netherlands
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Hendrikx AJ, Dang CL, Vroegindeweij D, Korte JH. B-mode and colour-flow duplex ultrasonography: a useful adjunct in diagnosing scrotal diseases? Br J Urol 1997; 79:58-65. [PMID: 9043498 DOI: 10.1046/j.1464-410x.1997.30213.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine the value of ultrasonography (US) and colour-flow duplex ultrasonography (CFD) as routine investigations in the diagnosis of scrotal pathologies. PATIENTS AND METHODS The imaging techniques were applied to 215 consecutive patients with scrotal complaints. The diagnosis of a urologist (D1, made from the patient's history, physical examination and laboratory results) and that of the radiologist (D2, using US and CFD) were compared with the "gold standard' (D3, the operative findings and course of the disease). The sensitivity and specificity of the diagnostic pathways (D1, D2) were determined statistically and compared with D3. RESULTS The final diagnoses (D3) were testicular torsion (13 patients), torsion of the appendix testis (5), epididymitis (42), inguinal hernia (7), tumour (11), trauma (9), hydrocele (46), epididymal cyst (37), orchitis (10), varicocele (46) and other diagnoses (8). Using D1, the urologist missed seven diagnoses, of which one was a patient with a testicular torsion combined with an inguinal hernia, and one a patient with a tumour. Using US and CFD (D2), the radiologist missed five diagnoses, including one patient with combined testicular torsion and inguinal hernia. CONCLUSION For the diagnosis of scrotal disorders, the basic clinical evaluation usually provides the correct diagnosis. However, US and CFD are useful adjuncts which cause a minimal burden to the patient and that in most cases will lead to the correct diagnosis, especially with important diagnoses like testicular torsion, when US and CFD should be performed immediately. If this does not provide a clear diagnosis, the patient should be explored surgically.
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Affiliation(s)
- A J Hendrikx
- Department of Urology, Catharina Hospital, Eindhoven, The Netherlands
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40
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Tielbeek AV, Vroegindeweij D, Buth J, Landman GH. Comparison of balloon angioplasty and Simpson atherectomy for lesions in the femoropopliteal artery: angiographic and clinical results of a prospective randomized trial. J Vasc Interv Radiol 1996; 7:837-44. [PMID: 8951750 DOI: 10.1016/s1051-0443(96)70857-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE This study involves a prospective randomized trial comparing clinical and angiographic results of balloon angioplasty (BA) and Simpson directional atherectomy (DA) in patients with short lesions in the femoropopliteal artery causing symptoms of intermittent claudication. MATERIALS AND METHODS Thirty-five patients were treated with BA and 38 with DA. Procedural complications were seen in eight patients. Residual stenoses immediately after the procedure with between 30% and 50% diameter reduction (DR) were observed in three patients after BA and in five patients after DA. In all other patients, residual stenosis was less than 30% DR. Two study end-points during a 2-year follow-up were used: the angiographic occurrence of restenosis with a DR of 50% or greater or the recurrence of symptoms. RESULTS Clinical success after 2 years, according to the criteria of the Society for Vascular Surgery/International Society for Cardiovascular Surgery, was seen in 79% of the BA patients and 56% of the DA patients (P = .07). The 2-year primary angiographic patency rates were 67% in patients treated with BA and 44% in patients treated with DA (P = .06). The secondary angiographically determined patency rates were 80% and 65%, respectively (P = .15). CONCLUSION Simpson atherectomy is an interventional technique to treat arterial lesions in the femoropopliteal artery with an acceptably low complication rate. The clinical and angiographic results of DA and BA are comparable. DA should not be used to replace BA for routine treatment of short femoropopliteal lesions.
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Affiliation(s)
- A V Tielbeek
- Department of Radiology, Catharina Hospital, EJ Eindhoven, The Netherlands
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Tielbeek AV, Rietjens E, Buth J, Vroegindeweij D, Schol FP. The value of duplex surveillance after endovascular intervention for femoropopliteal obstructive disease. Eur J Vasc Endovasc Surg 1996; 12:145-50. [PMID: 8760975 DOI: 10.1016/s1078-5884(96)80099-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objective of the present study was to assess prospectively whether serial Duplex examination was useful in identifying impending failure after endovascular interventions of the femoropopliteal arteries. SETTING Non-university hospital. Prospective clinical study. METHODS 124 Patients were successfully treated by endovascular procedures during a 5 year period. The follow-up was by colour-flow Duplex examination at fixed intervals. At similar intervals clinical examination, including ankle blood pressure measurement was performed to assess the clinical/haemodynamic status of the patients according to the SVS/NAISCVS guidelines. For the diagnosis of impending failure the Duplex criterion was a peak systolic velocity ratio > 2.5 and the clinical/haemodynamic criterion was a level < +2. Actual failure of the vascular procedure was defined as the occurrence of an occlusion in the treated arterial segment or a recurrent stenosis causing symptoms severe enough to require a reintervention. No prophylactic reinterventions were performed on the basis of abnormal Duplex findings alone. RESULTS Abnormal Duplex findings indicating restenosis were observed in 52 patients. Duplex abnormalities predicted treatment failure with a sensitivity of 86% and a specificity of 75%, while clinical/haemodynamic assessment had a sensitivity of 93% and a specificity of 90%. The hypothetical management outcome if Duplex surveillance had been used as a basis for reintervention was assessed. It appeared that only one patient with failure would have received a redo endovascular procedure at the time he had a restenosis. CONCLUSIONS Clinical/haemodynamic assessment was more useful for the follow-up of endovascular interventions than Duplex surveillance.
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Affiliation(s)
- A V Tielbeek
- Department of Radiology, Catharina Hospital, Eindhoven, The Netherlands
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Vos LD, Tielbeek AV, Vroegindeweij D, van den Bosch HC, Buth J. Cystic adventitial disease of the popliteal artery demonstrated with intravascular US. J Vasc Interv Radiol 1996; 7:583-6. [PMID: 8855541 DOI: 10.1016/s1051-0443(96)70809-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- L D Vos
- Department of Radiology, Catharina Hospital, EJ Eindhoven, The Netherlands
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Tielbeek AV, Vroegindeweij D, Buth J, Schol FP, Mali WP. Comparison of intravascular ultrasonography and intraarterial digital subtraction angiography after directional atherectomy of short lesions in femoropopliteal arteries. J Vasc Surg 1996; 23:436-45. [PMID: 8601885 DOI: 10.1016/s0741-5214(96)80008-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE In this study a group of patients undergoing directional atherectomy for localized occlusive disease in the femoropopliteal arteries, the value of intravascular ultrasonography (IVUS) to improve the efficacy of plaque removal was evaluated. The findings obtained by IVUS were correlated with intraarterial digital subtraction angiography (IA DSA) performed during the procedure. In addition, the patency rates at follow-up in patients undergoing atherectomy with and without IVUS were compared. METHODS Forty patients were treated by atherectomy because of segmental lesions of the femoropopliteal arteries causing intermittent claudication. Twenty-two patients underwent atherectomy, guided by biplane IA DSA only, and 18 patients were also studied by IVUS. The groups were divided by means of consecutive presentation, IVUS being used in the second part of the study period. The median follow up was 16 months (range, 0 to 40 months). Variables, measured by IVUS during the procedure, were the minimal transverse luminal diameter (MTLD) and the free luminal area. Patency rates at follow-up were determined by regular color flow duplex examinations. Color-flow duplex criteria for occlusions were absence of arterial flow and, for stenosis, a ratio of peak systolic velocities at the diseased segment and a normal segment of 2.5 or greater. RESULTS Qualitative IVUS assessment prompted additional atherotome passages because of insufficient atheroma removal or nonaesthetic appearance of the vessel lumen in 15 of the 18 patients who underwent this examination. Only in four of these patients would abnormalities at IA DSA have been a reason for further attempts of atheroma removal. As for the quantitative findings during AT, after a first series of atherectomy passes the mean MTLD of the reference lesion resulted in an increase of the MTLD from a mean of 3.3 +/- 0.7 mm to 3.7 +/- 0.6mm (p = 0.001), and the free luminal area increased from a mean of 11.2 +/- 4.8 mm2 to 12.5 +/- 4.5 mm2 (p = 0.001). However the occurrence of restenosis during follow-up was comparable in patients monitored during the intervention by IVUS (1-year patency rate, 57%) and patients not studied by IA DSA only (1-year patency rate, 64%). In addition, the presence of an intimal dissection or a plaque rupture at IVUS examination did not predict restenosis. CONCLUSIONS The application of IVUS resulted in an improved luminal enlargement by directional atherectomy but not in a better 1-year patency rate.
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Affiliation(s)
- A V Tielbeek
- Department of Radiology, Catharina Hospital, Eindhoven, The Netherlands
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Abstract
A patient with a large congenital pelvic arteriovenous malformation presenting with irradiating pain to the leg, most likely due to sciatic nerve compression, is described. Congenital pelvic arteriovenous malformation are rare lesions, especially in males. Diagnosis was established by arteriography and contrast-enhanced computed tomography scan. Surgical resection of the AVM relieved our patient of all symptoms. However, endovascular therapy, either as primary treatment or followed by conventional surgery is the treatment of choice. Pelvic arteriovenous malformations should be considered in the differential diagnosis of unexplained sciatica.
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Affiliation(s)
- L D Vos
- Department of Radiology, Catharina Hospital, Eindhoven, Netherlands
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Vroegindeweij D, Idu M, Buth J, Nillesen C, Schol FP, Tielbeek AV. The cost-effectiveness of treatment of short occlusive lesions in the femoropopliteal artery: balloon angioplasty versus endarterectomy. Eur J Vasc Endovasc Surg 1995; 10:40-50. [PMID: 7633969 DOI: 10.1016/s1078-5884(05)80197-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To compare the short- and long-term outcome and the costs involved in balloon angioplasty (BA) and thromboendarterectomy (EA) of short femoropopliteal occlusions. DESIGN Retrospective study. PATIENTS AND METHODS Forty-one lower limbs underwent EA from 1980 until 1988 and BA was performed in 62 limbs between 1988 and 1993. The two groups of patients were well matched for age, gender, cardiovascular risk-factors and the length of the femoropopliteal occlusions. In addition to clinical follow-up colour-Duplex scanning and intraarterial DSA were performed. Complete occlusions or significant restenoses were considered failure of the reconstruction. Actual costs were calculated by the hospital economic administration. RESULTS The 3-year primary patency in EA patients was 87% and in the BA group 44% (p = 0.0002). Redo procedures were required in seven (17%) patients with EA and in 24 (39%) with BA. Patency after redo procedures, i.e. tertiary patency, was 94% and 74% after 3 years in the EA and BA group respectively (p = 0.14). The mean cost of the primary treatment was higher in EA than in BA patients (p < 0.0001). Mean total treatment costs including the expenses involved with redo procedures were also higher in the group with EA than with BA (p < 0.001). However, the cost-effectiveness expressed as the total costs per month tertiary patency, was not significantly different for the two treatment groups; in patients with EA the ratio of total treatment costs and tertiary patency was NFl 309, and in patients with BA NFl 287. CONCLUSION Contrary to the general view the expenses associated with surgical treatment are comparable with those of an endovascular procedure, if the costs are expressed as a cost-to-patency ratio.
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Affiliation(s)
- D Vroegindeweij
- Department of Radiology, Catharina Hospital, Eindhoven, The Netherlands
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Vroegindeweij D, Tielbeek AV, Buth J, van Kints MJ, Landman GH, Mali WP. Recanalization of femoropopliteal occlusive lesions: a comparison of long-term clinical, color duplex US, and arteriographic follow-up. J Vasc Interv Radiol 1995; 6:331-7. [PMID: 7647432 DOI: 10.1016/s1051-0443(95)72817-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
PURPOSE To assess the merits of clinical examination, color-flow duplex ultrasound (US), and arteriography in the follow-up of patients who have undergone femoropopliteal artery recanalization for occlusive disease. PATIENTS AND METHODS Recanalization of the occluded femoropopliteal artery was attempted in 62 patients. Follow- up included clinical examination, ankle-brachial blood pressure measurement, and duplex US scanning at 4-month intervals during the first year, at 6-month intervals during the second year, and one a year thereafter. Failure of recanalization included substantial restenosis or reocclusion of the treated segment. Arteriography was performed at the end of the first year or earlier if recurrence was suspected. Agreement of clinical findings with those of duplex US and those of arteriography was determined with kappa statistics; a kappa value of greater than 0.75 represented excellent agreement. RESULTS Recanalization was technically successful in 51 patients (82%). Clinical patency was 63% (standard error [SE], 6%) after 1 year, 56% (SE, 7%) after 2 years, and 46% (SE, 9%) after 3 years. When technical failures were included, the patency rate at duplex US was 58% (SE, 6%) after 1 year, 40% (SE, 7%) after 2 years, and 33% (SE, 8%) after 3 years. The patency rate at arteriography was 53% (SE, 7%) after 1 year, 33% (SE, 7%) after 2 years, and 30% (SE, 8%) after 3 years. When arteriographic examination was considered the standard of reference, diagnostic accuracy in the identification of recurrent lesions was 94% at duplex US (kappa = 0.88) and 74% at clinical examination (kappa = 0.51). CONCLUSION Rates of restenosis or occlusion detected at follow-up with duplex US and arteriography were comparable. However, clinical examination alone helped detect fewer cases of recurrent disease.
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Affiliation(s)
- D Vroegindeweij
- Department of Radiology, Catharina Hospital, Eindhoven, The Netherlands
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Vroegindeweij D, Tielbeek AV, Buth J, Schol FP, Hop WC, Landman GH. Directional atherectomy versus balloon angioplasty in segmental femoropopliteal artery disease: two-year follow-up with color-flow duplex scanning. J Vasc Surg 1995; 21:255-68; discussion 268-9. [PMID: 7853599 DOI: 10.1016/s0741-5214(95)70267-9] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE Directional atherectomy is an endovascular interventional technique for excision and removal of obstructive arterial lesions. To evaluate whether atherectomy would provide better results than conventional balloon angioplasty (BA) in symptomatic femoropopliteal disease, a prospective randomized study comparing the early and late outcomes of these techniques was conducted. The rate of restenosis or occlusion was assessed by use of color-flow duplex scanning during the follow-up period. METHODS Seventy-three patients were randomized between atherectomy (38 patients) and BA (35 patients). All patients had segmental lesions of the femoropopliteal arteries amenable to either technique. The median follow-up duration was 13 months (range 1 to 39). Follow-up comprised regular clinical and hemodynamic assessment and color-flow duplex examinations. Restenosis was defined on the basis of a peak systolic velocity ratio of 2.5 or greater, and occlusion of the treated segment was diagnosed if flow signals were absent, that is, loss of patency. RESULTS Residual stenoses (> or = 30% diameter reduction) resulted in five patients (13%) undergoing atherectomy and three patients (9%) undergoing BA. At 1 month clinical and hemodynamic improvement by Society for Vascular Surgery/International Society for Cardiovascular Surgery criteria for lower limb ischemia was observed in 34 patients (89%) treated with atherectomy and in 34 (97%) treated with BA. By life-table analysis the cumulative rate of clinical and hemodynamic success at 2 years was 52% in patients treated with atherectomy and 87% in patients treated with BA (p = 0.06). The patency rate at 2 years of treated segments was 34% in the atherectomy group and 56% in patients treated with BA (p = 0.07). In patients with lesions greater than 2 cm, the 1-year patency rate of AT was significantly lower than BA (p = 0.03). CONCLUSIONS Atherectomy does not result in an improved clinical and hemodynamic outcome. Furthermore atherectomy of segmental atherosclerotic femoropopliteal disease does not result in a better patency rate than BA, and, in lesions with greater length than 2 cm, the atherectomy results are significantly worse.
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Affiliation(s)
- D Vroegindeweij
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
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48
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Affiliation(s)
- L D Vos
- Department of Radiology, Catharina Hospital, Eindhoven, Netherlands
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49
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Affiliation(s)
- M J van Kints
- Department of Diagnostic Radiology, Catharina Hospital, Eindhoven, Netherlands
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50
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Vroegindeweij D, Kemper FJ, Tielbeek AV, Buth J, Landman G. Recurrence of stenoses following balloon angioplasty and Simpson atherectomy of the femoro-popliteal segment. A randomised comparative 1-year follow-up study using colour flow duplex. Eur J Vasc Surg 1992; 6:164-71. [PMID: 1533372 DOI: 10.1016/s0950-821x(05)80235-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The results of balloon angioplasty (BA) and atherectomy (AT) with the Simpson atherocath, were compared in a randomised prospective study. Thirty-one patients were randomised to one of these methods for the treatment of symptomatic stenotic or occlusive lesions in the superficial femoral and popliteal arteries. One patient died after randomisation but before the procedure, thus 30 patients were available for analysis. All patients had intermittent claudication and BA was used in 14 and AT in 16 limbs. A surveillance protocol included colour flow duplex scanning of the femoro-popliteal arteries after 6 weeks and then at 3-monthly intervals during the 1st year and every 6 months thereafter. The average duration of follow-up was 9.7 months. For confirmation intra-arterial digital subtraction angiography (DSA) was performed in all patients at 1 year following the intervention, when clinical symptoms occurred or when colour flow duplex indicated greater than 49% restenosis. Three small dissections were the only postoperative complications and residual stenoses greater than 20% diameter reduction (DR) were observed in two patients following BA and in two after AT. Improvement of clinical category according to the "Standards for evaluating results of interventional therapy for peripheral vascular disease" occurred in 13 of 14 BA patients and in 15 of 16 AT patients. Follow-up results were expressed as cumulative patency and clinical success. Endpoints for patency were recurrence of the stenosis at the treated segment or new lesions in different segments and endpoints for clinical success were a drop in clinical category (symptoms, ankle pressure indices and post-exercise ankle pressures). One-year patency (no restenosis greater than 49% DR) was 77% in patients with BA and 25% in patients with AT (p = 0.017).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- D Vroegindeweij
- Department of Radiology, Catharina Hospital, Eindhoven, The Netherlands
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