1
|
van den Berg R, den Hartog FPJ, Bali C, Matsagkas M, Bevis PM, Earnshaw JJ, Debus ES, Honig S, Berrevoet F, Detry O, Stabilini C, Muysoms F, Tanis PJ. Protocol for an independent patient data meta-analysis of prophylactic mesh placement for incisional hernia prevention after abdominal aortic aneurysm surgery: a collaborative European Hernia Society project (I-PREVENT-AAA). BMJ Open 2024; 14:e081046. [PMID: 38626979 PMCID: PMC11029178 DOI: 10.1136/bmjopen-2023-081046] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/05/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Incisional hernia (IH) is a prevalent and potentially dangerous complication of abdominal surgery, especially in high-risk groups. Mesh reinforcement of the abdominal wall has been studied as a potential intervention to prevent IHs. Randomised controlled trials (RCTs) have demonstrated that prophylactic mesh reinforcement after abdominal surgery, in general, is effective and safe. In patients with abdominal aortic aneurysm (AAA), prophylactic mesh reinforcement after open repair has not yet been recommended in official guidelines, because of relatively small sample sizes in individual trials. Furthermore, the identification of subgroups that benefit most from prophylactic mesh placement requires larger patient numbers. Our primary aim is to evaluate the efficacy and effectiveness of the use of a prophylactic mesh after open AAA surgery to prevent IH by performing an individual patient data meta-analysis (IPDMA). Secondary aims include the evaluation of postoperative complications, pain and quality of life, and the identification of potential subgroups that benefit most from prophylactic mesh reinforcement. METHODS AND ANALYSIS We will conduct a systematic review to identify RCTs that study prophylactic mesh placement after open AAA surgery. Cochrane Central Register of Controlled Trials, MEDLINE Ovid, Embase, Web of Science Core Collection and Google Scholar will be searched from the date of inception onwards. RCTs must directly compare primary sutured closure with mesh closure in adult patients who undergo open AAA surgery. Lead authors of eligible studies will be asked to share individual participant data (IPD). The risk of bias (ROB) for each included study will be assessed using the Cochrane ROB tool. An IPDMA will be performed to evaluate the efficacy, with the IH rate as the primary outcome. Any signs of heterogeneity will be evaluated by Forest plots. Time-to-event analyses are performed using Cox regression analysis to evaluate risk factors. ETHICS AND DISSEMINATION No new data will be collected in this study. We will adhere to institutional, national and international regulations regarding the secure and confidential sharing of IPD, addressing ethics as indicated. We will disseminate findings via international conferences, open-source publications in peer-reviewed journals and summaries posted online. PROSPERO REGISTRATION NUMBER CRD42022347881.
Collapse
Affiliation(s)
- Rudolf van den Berg
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Medicine, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Floris P J den Hartog
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Christina Bali
- Department of Surgery, University Hospital of Ioannina, Ioannina, Greece
| | | | - Paul M Bevis
- Department of Vascular Surgery, North Bristol NHS Trust, Westbury on Trym, UK
| | - Jonothan J Earnshaw
- Department of Vascular Surgery, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - Eike S Debus
- Department of Vascular Medicine, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Eppendorf, Hamburg, Germany
| | - Susanne Honig
- Department of Vascular Surgery, Hospital Robert Schuman Kirchberg Hospital, Luxembourg City, Luxembourg
| | - Frederik Berrevoet
- Department of General and Hepatobiliary Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Olivier Detry
- Department of Abdominal Surgery and Transplantation, Division of Abdominal Wall Surgery, CHU Liege, University of Liege, Liege, Belgium
| | - Cesare Stabilini
- Department of Surgical Sciences, University of Genoa, Genoa, Italy
| | - Filip Muysoms
- Department of Surgery, AZ Maria Middelares Hospital, Ghent, Belgium
| | - Pieter J Tanis
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| |
Collapse
|
2
|
Dietrich M, Besser M, Debus ES, Smeets R, Stuermer EK. Human skin biofilm model: translational impact on swabbing and debridement. J Wound Care 2023; 32:446-455. [PMID: 37405939 DOI: 10.12968/jowc.2023.32.7.446] [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: 07/07/2023]
Abstract
OBJECTIVE Wound biofilms are one of the greatest challenges in the therapy of hard-to-heal (chronic) wounds, as potent antimicrobial substances fail to eradicate bacteria within short incubation periods. Preclinical investigations using novel model systems that closely mimic the human wound environment and wound biofilm are required to identify new and effective therapeutic options. This study aims to identify bacterial colonisation patterns that are relevant for diagnosis and therapy. METHOD In this study, a recently established human plasma biofilm model (hpBIOM) was incorporated into a wound within human dermal resectates after abdominoplasty. The interaction of the biofilm-forming bacteria meticillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa with the skin cells was investigated. Possible effects on wound healing processes in correlation with the persistence of the biofilm in the wound environment were analysed in patients with leg ulcers of different aetiologies and biofilm burden. RESULTS Using haematoxylin and eosin staining, species-dependent infiltration modes of the bacteria into the wound tissue were determined for the pathogens MRSA and Pseudomonas aeruginosa. The spreading behaviour correlated with clinical observations of the spatial distributions of the bacteria. In particular, the clinically prominent Pseudomonas aeruginosa-specific distension of the wound margin was identified as epidermolysis due to persistent infiltration. CONCLUSION The hpBIOM applied in this study represents a potential tool for preclinical analyses dealing with approval processes for new antimicrobial applications. In terms of clinical practice, a microbiological swabbing technique including the wound margin should be routinely applied to prevent wound exacerbation.
Collapse
Affiliation(s)
- Michael Dietrich
- Institute of Virology and Microbiology, Faculty of Health, Centre for Biomedical Education and Research (ZBAF), Witten/Herdecke University, Germany
| | - Manuela Besser
- Clinic for General, Visceral and Transplant Surgery, University Hospital Muenster, Germany
| | - Eike S Debus
- Department of Vascular Medicine, University Heart Center, University Medical Center Hamburg-Eppendorf (UKE), Germany
| | - Ralf Smeets
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Germany
| | - Ewa K Stuermer
- Department of Vascular Medicine, University Heart Center, University Medical Center Hamburg-Eppendorf (UKE), Germany
| |
Collapse
|
3
|
Behrendt CA, Thomalla G, Rimmele DL, Petersen EL, Twerenbold R, Debus ES, Kölbel T, Blankenberg S, Schmidt-Lauber C, Peters F, Zyriax BC. Editor's Choice - Prevalence of Peripheral Arterial Disease, Abdominal Aortic Aneurysm, and Risk Factors in the Hamburg City Health Study: A Cross Sectional Analysis. Eur J Vasc Endovasc Surg 2023; 65:590-598. [PMID: 36634745 DOI: 10.1016/j.ejvs.2023.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [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: 10/10/2022] [Revised: 12/12/2022] [Accepted: 01/05/2023] [Indexed: 01/11/2023]
Abstract
OBJECTIVE There is a paucity of current figures on the prevalence of carotid and lower extremity peripheral arterial disease (PAD) and abdominal aortic aneurysm (AAA) as well as the associated cardiovascular risk factors to support considerations on screening programmes. METHODS In the population based Hamburg City Health Study, participants between 45 and 74 years were randomly recruited. In the current cross sectional analysis of the first 10 000 participants enrolled between February 2016 and November 2018, the prevalence of carotid artery disease (intima-media thickness ≥ 1 mm), lower extremity PAD (ankle brachial index ≤ 0.9), and AAA (aortic diameter ≥ 30 mm) was determined. Multivariable logistic regression models were applied to determine the association between vascular diseases and risk factors. To account for missing values, multiple imputation was performed. RESULTS A total of 10 000 participants were analysed (51.1% females, median age 63 years, median body mass index 26.1 kg/m2). In medians, the intima media thickness was 0.74 mm (interquartile range [IQR] 0.65 - 0.84), the ankle brachial index 1.04 (IQR 0.95 - 1.13), and the aortic diameter 17.8 mm (IQR 16.1 - 19.6). Concerning risk factors, 64% self reported any smoking, 39% hypertension, 5% coronary artery disease, 3% congestive heart failure, 5% atrial fibrillation, and 3% history of stroke or myocardial infarction, respectively. In males, the prevalence of carotid artery disease, lower extremity PAD, and AAA were 35.3%, 22.7%, and 1.3%, respectively, and in females, 23.4%, 24.8%, and 0.2%, respectively. Higher age and current smoking were likewise associated with higher prevalence while the impact of variables varied widely. CONCLUSION In this large population based cohort study of 10 000 subjects from Hamburg, Germany, a strikingly high prevalence of PAD was revealed. Almost 45% suffered from any index disease, while AAA was only diagnosed in 1.3% of males and 0.2% of females. The high prevalence of atherosclerotic disease and associated cardiovascular risk factors underline that it is essential to increase awareness and fuel efforts for secondary prevention.
Collapse
Affiliation(s)
- Christian-Alexander Behrendt
- Department of Vascular Medicine, University Heart and Vascular Centre UKE Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; University Centre of Cardiovascular Science, University Heart and Vascular Centre Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Department of Vascular and Endovascular Surgery, Asklepios Clinic Wandsbek, Asklepios Medical School, Hamburg, Germany.
| | - Götz Thomalla
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - David L Rimmele
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Elina L Petersen
- Department of Cardiology, University Heart and Vascular Centre, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Population Health Research Department, University Heart and Vascular Centre, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Raphael Twerenbold
- University Centre of Cardiovascular Science, University Heart and Vascular Centre Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; German Centre for Cardiovascular Research (DZHK) Partner Site Hamburg-Kiel-Lübeck, Germany; Department of Cardiology, University Heart and Vascular Centre, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Eike S Debus
- Department of Vascular Medicine, University Heart and Vascular Centre UKE Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Tilo Kölbel
- Department of Vascular Medicine, University Heart and Vascular Centre UKE Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Centre, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Population Health Research Department, University Heart and Vascular Centre, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | | | - Frederik Peters
- Department of Vascular Medicine, University Heart and Vascular Centre UKE Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Birgit-Christiane Zyriax
- Midwifery Science-Health Services Research and Prevention, Institute for Health Service Research in Dermatology and Nursing (IVDP), University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
| |
Collapse
|
4
|
Debus ES, von Kodolitsch Y, Behrendt CA, Kölbel T, Sachweh A, Preuß M. [Vascular surgery in old people]. Chirurgie (Heidelb) 2023; 94:10-16. [PMID: 36459217 DOI: 10.1007/s00104-022-01770-0] [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] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 12/05/2022]
Abstract
The age pyramid in Germany is upside down. According to the Federal Statistical Office this development will continue in the coming years, which presents a challenge for surgeons to surgically treat increasingly more and increasingly older people. Particularly in vascular surgery, which is a surgery of old people, this fact represents a special challenge. The frailty of old people is, among other things, due to a series of comorbidities, which must be taken into consideration within the framework of surgical treatment. They can have an important influence on the perioperative planning, the operation, the postoperative treatment and the outcome of the patient. This treatment planning becomes more and more challenging, because due to the progress in endovascular surgery there will soon be no limits to what is feasible; however, the question arises whether the feasible is also reasonable? Within the scope of this article the authors try to give answers to the treatment of old patients in vascular surgery and to find strategies for planning and to establish an individualized optimal treatment.
Collapse
Affiliation(s)
- E S Debus
- Klinik und Poliklinik für Gefäßmedizin (Gefäßchirurgie - Angiologie - Endovaskuläre Therapie), Universitären Herzzentrum Hamburg-Eppendorf, Deutsches Aortenzentrum des Universitären Herzzentrums Hamburg, Gebäude O70, Martinistraße 52, 20246, Hamburg, Deutschland.
| | - Y von Kodolitsch
- Klinik und Poliklinik für Gefäßmedizin (Gefäßchirurgie - Angiologie - Endovaskuläre Therapie), Universitären Herzzentrum Hamburg-Eppendorf, Deutsches Aortenzentrum des Universitären Herzzentrums Hamburg, Gebäude O70, Martinistraße 52, 20246, Hamburg, Deutschland
| | - Ch-A Behrendt
- Klinik und Poliklinik für Gefäßmedizin (Gefäßchirurgie - Angiologie - Endovaskuläre Therapie), Universitären Herzzentrum Hamburg-Eppendorf, Deutsches Aortenzentrum des Universitären Herzzentrums Hamburg, Gebäude O70, Martinistraße 52, 20246, Hamburg, Deutschland
| | - T Kölbel
- Klinik und Poliklinik für Gefäßmedizin (Gefäßchirurgie - Angiologie - Endovaskuläre Therapie), Universitären Herzzentrum Hamburg-Eppendorf, Deutsches Aortenzentrum des Universitären Herzzentrums Hamburg, Gebäude O70, Martinistraße 52, 20246, Hamburg, Deutschland
| | - A Sachweh
- Universitäres Herz- und Gefäßzentrum, UKE Hamburg-Eppendorf, Hamburg, Deutschland
| | - M Preuß
- Klinik und Poliklinik für Gefäßmedizin (Gefäßchirurgie - Angiologie - Endovaskuläre Therapie), Universitären Herzzentrum Hamburg-Eppendorf, Deutsches Aortenzentrum des Universitären Herzzentrums Hamburg, Gebäude O70, Martinistraße 52, 20246, Hamburg, Deutschland
| |
Collapse
|
5
|
Szarek M, Debus ES, Nehler MR, Anand SS, Patel MR, Haskell LP, Muehlhofer ES, Berkowitz SD, Bauersachs RM, Bonaca MP. Total hospitalizations after peripheral arterial revascularization in the VOYAGER trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1982] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In the VOYAGER PAD trial, rivaroxaban reduced first and total (first and subsequent) occurrences of major adverse limb and cardiovascular events in patients with peripheral artery disease (PAD) after lower extremity revascularization (LER), but also increased incident bleeding.
Purpose
Assessment of disease burden by the onset of a particular set of events does not necessarily capture all consequences of a disease process that negatively impact patients' quality of life, motivating the adoption of more patient-centered outcomes. The present analysis of VOYAGER PAD describes the total incidence and duration of hospitalizations reported during the study as a broader measure of total disease burden and net benefit of rivaroxaban therapy.
Methods
Patients were randomized 1:1 to rivaroxaban 2.5 mg twice daily plus aspirin (n=3286) or aspirin alone (n=3278). Investigators documented the primary reason and duration for each hospitalization occurring after randomization. Total hospitalization rates were estimated by events per 100 patient-years. Treatment group comparisons on total hospitalizations as a time-to-event outcome were by marginal proportional hazards models with death as a competing terminal event, while days in hospital were compared by zero-inflated Poisson regression. All analyses were intention-to-treat.
Results
A total of 7156 hospitalizations (3265 first, 3891 subsequent) occurred during a median 2.5 years of follow-up, with nearly 40% being hospitalizations for PAD and a small fraction attributed to bleeding events (Figure 1). The rivaroxaban rate was lower for PAD hospitalizations and higher for bleeding event hospitalizations, with more hospitalizations prevented than caused (Table 1). Mean days in hospital among patients hospitalized at least once was significantly lower in the rivaroxaban group for any reason, for PAD, and for bleeding, so that total days in hospital was numerically lower for rivaroxaban.
Conclusion
Patients with PAD undergoing LER have a high rate of subsequent hospitalizations after an index procedure, driven by re-hospitalizations for PAD. Rivaroxaban decreased both the incidence and duration of PAD hospitalizations. While rivaroxaban increased incident hospitalizations due to bleeding, the mean durations of these hospitalizations were lower relative to placebo, leading to fewer total days in hospital for bleeding (1252 vs. 1531 total days). These findings may be useful for clinicians and patients weighing the risks and benefits of rivaroxaban in PAD after revascularization.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): BayerJanssen
Collapse
Affiliation(s)
- M Szarek
- University of Colorado , Aurora , United States of America
| | - E S Debus
- The University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - M R Nehler
- University of Colorado , Aurora , United States of America
| | - S S Anand
- Population Health Research Institute , Hamilton , Canada
| | - M R Patel
- Duke Clinical Research Institute , Durham , United States of America
| | - L P Haskell
- Janssen Research and Development , Raritan , United States of America
| | | | - S D Berkowitz
- University of Colorado , Aurora , United States of America
| | | | - M P Bonaca
- University of Colorado , Aurora , United States of America
| |
Collapse
|
6
|
Heilman A, Bauersachs R, Anand S, Patel MR, Debus ES, Nehler M, Hess CN, Capell WH, Osiemo B, Hsia JA, Muehlhofer E, Haskell L, Berkowitz SD, Bonaca MP. BENEFITS OF RIVAROXABAN AFTER LOWER EXTREMITY REVASCULARIZATION FOR SYMPTOMATIC PERIPHERAL ARTERY DISEASE ARE CONSISTENT WITH AND WITHOUT BACKGROUND STATIN THERAPY. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02738-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
7
|
Preut J, Frosch KH, Debus ES, Grundmann RT. [Publication performance of university orthopedic trauma surgery in Germany]. Chirurg 2021; 93:702-710. [PMID: 34846538 PMCID: PMC9246789 DOI: 10.1007/s00104-021-01538-y] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2021] [Indexed: 11/28/2022]
Abstract
Hintergrund Zu den Leistungskriterien einer Universitätsklinik gehören ihre Publikationsaktivitäten. Ziel der vorliegenden bibliometrischen Untersuchung war es, die Publikationsaktivitäten deutscher unfallchirurgischer Universitätskliniken in einem Benchmarking vergleichend darzustellen. Material und Methodik Die Publikationsleistung der Führungsmannschaften, bestehend aus Chef- und Oberärzten, Sektions- und Bereichsleitern von 39 deutschen unfallchirurgischen Universitätskliniken wurde über 10 Jahre (01.01.2010 bis 31.12.2019) erfasst. Berücksichtigt wurden alle Publikationen, die in PubMed gelistet waren und bei denen die entsprechenden Personen Erst- oder Letztautor waren. Zusätzlich wurde der Impact-Faktor (IF) bestimmt. Ergebnisse Insgesamt wurden 4438 Veröffentlichungen erfasst, publiziert von 381 Chirurgen. Der Anteil der publizierenden Mitarbeiter betrug 72,8 %. Publiziert wurde in 545 Journalen. Der durchschnittliche IF aller Publikationen war 1,81. Die Publikationsaktivitäten der Kliniken zeigten eine hohe Streubreite, dies galt sowohl für die Publikationsanzahl als auch für die generierten IF des einzelnen Mitarbeiters. Die Publikationsaktivität reichte von durchschnittlich 16,4 Publikationen pro Mitarbeiter in der bestplatzierten Klinik bis 1,5 Publikationen bei der letztplatzierten. Gleiches ergab die Summe der IF. In der nach diesem Maßstab bestplatzierten Klinik erzielte der einzelne Mitarbeiter durchschnittlich kumuliert 42,1 IF verglichen mit 1,7 IF bei der letztplatzierten. Schlussfolgerung Die Publikationsleistung deutscher unfallchirurgischer Universitätskliniken zeigt eine hohe Varianz, wie dies auch bei anderen Disziplinen gefunden wurde. Die Ursachen müssen offen bleiben, eine unterschiedliche Forschungsmotivation ist aber nicht auszuschließen.
Collapse
Affiliation(s)
- J Preut
- Klinik und Poliklinik für Gefäßmedizin, Universitäres Herzzentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - K-H Frosch
- Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland.,Berufsgenossenschaftliches Klinikum Hamburg, Hamburg, Deutschland
| | - E S Debus
- Klinik und Poliklinik für Gefäßmedizin, Universitäres Herzzentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - R T Grundmann
- Klinik und Poliklinik für Gefäßmedizin, Universitäres Herzzentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland.
| |
Collapse
|
8
|
Sillesen H, Debus ES, Enggaard RBB, Frenkel O, Heled Y, Mansor-Lefebvre S, Bonaca MP. Effects of semaglutide on functional capacity in patients with type 2 diabetes and peripheral arterial disease: rationale and design of the STRIDE trial. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2027] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
Lower extremity peripheral arterial disease (PAD) is a severe form of atherosclerotic cardiovascular (CV) disease. The classical symptom is intermittent claudication (IC), associated with limited walking ability and poor health-related quality of life (QoL). Type 2 diabetes (T2D) is one of the leading causes of PAD; ∼30% of patients with PAD have T2D. While anti-atherosclerotic drugs and lifestyle changes are recommended, there are no effective drugs to specifically improve functional outcomes in PAD and T2D. Semaglutide is a glucagon-like peptide-1 receptor agonist (GLP-1RA) approved as an adjunct to diet and exercise for glycaemic control in patients with T2D. In the T2D SUSTAIN clinical trial programme, once-weekly (OW) subcutaneous semaglutide 0.5 and 1.0 mg was superior for glycaemic control and weight loss vs placebo and a range of approved antidiabetic drugs. In SUSTAIN 6, a dedicated CV outcomes trial, OW semaglutide resulted in a 26% reduction in three-point major adverse CV events (MACE) compared with placebo in patients with T2D at high CV risk, leading to its approval for MACE risk reduction in those with T2D and CV disease in the USA. Evidence suggests this may be partly attributable to the anti-inflammatory and anti-atherosclerotic effects of semaglutide, which may also apply to PAD.
Purpose
The STRIDE trial will demonstrate the effect of OW semaglutide 1.0 mg vs placebo on walking ability in patients with T2D and PAD with IC.
Methods
STRIDE is a 52-week, randomised, double-blind, placebo-controlled, phase 3b trial. Trial design and eligibility criteria are shown in the Figure; ∼800 patients will be randomised 1:1 to OW semaglutide 1.0 mg or placebo, both added to standard of care. The primary endpoint is change in maximum walking distance on a constant load treadmill test from baseline to week 52. Secondary confirmatory endpoints include changes in pain-free walking distance and PAD-specific, health-related patient-reported outcomes (Vascular QoL Questionnaire-6) from baseline to week 52.
Results
The trial started in October 2020 and is currently recruiting, with ∼120 sites in ∼20 countries across Asia, Europe, and North America.
Conclusion
STRIDE is the first and only dedicated PAD outcomes trial with a GLP-1RA and thus presents a unique trial design. While major adverse limb events typically occur in the later stages of PAD, STRIDE instead measures the effect of OW semaglutide on functional outcomes such as walking ability and QoL, which affect everyday living in patients with PAD and IC. STRIDE data will provide important clinical insights regarding the role of OW semaglutide in patients with T2D and PAD.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Novo Nordisk A/S
Collapse
Affiliation(s)
- H Sillesen
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - E S Debus
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | | | | | - Y Heled
- Kibbutzim College, Tel Aviv, Israel
| | | | - M P Bonaca
- University of Colorado Anschutz School of Medicine and CPC Clinical Research, Aurora, United States of America
| |
Collapse
|
9
|
Böckmann EC, Debus ES, Grundmann RT. Publication activity of chief and consultant general/visceral surgeons in German university hospitals-a ten-year analysis. Langenbecks Arch Surg 2021; 406:1659-1668. [PMID: 34309758 PMCID: PMC8370903 DOI: 10.1007/s00423-021-02241-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 06/10/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE The publication activity of 38 German general/visceral surgery university departments, documented by first or last authorship from staff surgeons (chief and consultants), was evaluated. METHODS The observation period extended from 2007 to 2017 and all PubMed-listed publications were considered. Impact factor (IF) was evaluated through the publishing journal's 5-year IF in 2016, as was the IF for each individual publication. Ranking was expressed in quartiles. RESULTS The staff surgeons of the 38 departments comprised 442 surgeons, of which only 351 (79.4%) were active as first or last authors. Four thousand six hundred and ninety-nine publications published in 702 journals were recorded. The four leading departments in publication number published as much as the last 20 departments (1330 vs. 1336 publications, respectively). The mean of the first (most active) department quartile was 19.6 publications, the second 15.4, the third 11.0, and the last quartile 7.6 per publishing surgeon. The total cumulative impact factor was 14,130. When examining the mean number of publications per publishing surgeons per the 10 year period, the mean of the first quartile was 57.9 cumulative IF, the second 45.0, the third 29.5, and the fourth quartile 17.1. With 352 (7.5%) publications, the most frequently used journal was Chirurg, followed by Langenbeck's Archives of Surgery with 274 (5.8%) publications. Pancreas-related topics led in terms of publication number and IF generated per individual publication. CONCLUSION A significant difference in publication performance of individual departments was apparent that cannot be explained by staff number. This indicates that there are as yet unknown factors responsible for minor publication activity in many university departments.
Collapse
Affiliation(s)
- Eva C Böckmann
- Department of Vascular Medicine, University Heart Center (UHC), University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - E S Debus
- Department of Vascular Medicine, University Heart Center (UHC), University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - R T Grundmann
- Department of Vascular Medicine, University Heart Center (UHC), University Hospital Hamburg-Eppendorf, Hamburg, Germany.
| |
Collapse
|
10
|
Honig S, Diener H, Kölbel T, Reinpold W, Zapf A, Bibiza-Freiwald E, Debus ES. Abdominal incision defect following AAA-surgery (AIDA): 2-year results of prophylactic onlay-mesh augmentation in a multicentre, double-blind, randomised controlled trial. Updates Surg 2021; 74:1105-1116. [PMID: 34287760 PMCID: PMC9213335 DOI: 10.1007/s13304-021-01125-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/25/2021] [Indexed: 11/24/2022]
Abstract
The reported incidence of incisional hernia following repair of abdominal aortic aneurysm (AAA) via midline laparotomy is up to 69%. This prospective, multicenter, double-blind, randomised controlled trial was conducted at eleven hospitals in Germany. Patients aged 18 years or older undergoing elective AAA-repair via midline incision were randomly assigned using a computer-generated randomisation sequence to one of three groups for fascial closure: with long-term absorbable suture (MonoPlus®, group I), long-term absorbable suture and onlay mesh reinforcement (group II) or extra long-term absorbable suture (MonoMax®, group III). The primary endpoint was the incidence of incisional hernia within 24 months of follow-up, analysed by intention to treat. Physicians conducting the postoperative visits and the patients were blinded. Between February 2011 and July 2013, 104 patients (69.8 ± 7.7 years) were randomised, 99 of them received a study intervention. The rate of incisional hernia within 24 months was not significantly reduced with onlay mesh augmentation compared to primary suture (p = 0.290). Furthermore, the rate of incisional hernia did not differ significantly between fascial closure with slow and extra long-term absorbable suture (p = 0.111). Serious adverse events related to study intervention occurred in five patients (5.1%) from treatment groups II and III. Wound healing disorders were more frequently seen after onlay mesh implantation on the day of discharge (p = 0.010) and three (p = 0.009) and six (p = 0.023) months postoperatively. The existing evidence on prophylactic mesh augmentation in patients undergoing AAA-repair via midline laparotomy probably needs critical review. As the implementation of new RCTs is considered difficult due to the increasing number of endovascular AAA treated, registry studies could help to collect and evaluate data in cases of open AAA-repair. Comparisons between prophylactic mesh implantation and the small bite technique are also required. Trial registration: ClinicalTrials.gov Identifier: NCT01353443. Funding Sources: Aesculap AG, Tuttlingen, Germany.
Collapse
Affiliation(s)
- S Honig
- Department for Vascular Medicine, Vascular Surgery, Endovascular Therapy and Angiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - H Diener
- Department for Vascular Medicine, Vascular Surgery, Endovascular Therapy and Angiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - T Kölbel
- Department for Vascular Medicine, Vascular Surgery, Endovascular Therapy and Angiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - W Reinpold
- Department for Surgery, Hospital Wilhelmsburg Groß-Sand, Groß-Sand 3, 21107, Hamburg, Germany
| | - A Zapf
- Institute for Medical Biometry and Epidemology, University Medical Center Hamburg Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - E Bibiza-Freiwald
- Institute for Medical Biometry and Epidemology, University Medical Center Hamburg Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - E S Debus
- Department for Vascular Medicine, Vascular Surgery, Endovascular Therapy and Angiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | | |
Collapse
|
11
|
Debus ES, Nehler M, Hiatt WR, Bauersachs RM, Bonaca MP, Anand SS, Patel MR, Debus ES, Nehler MR, Fanelli F. Reply to "The VOYAGER PAD Trial in Surgical Perspective: A Debate". Eur J Vasc Endovasc Surg 2021; 61:723-724. [PMID: 33814273 DOI: 10.1016/j.ejvs.2021.02.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- E Sebastian Debus
- Department of Vascular Medicine, Vascular Surgery-Angiology-Endovascular Therapy, University Heart & Vascular Centre, University of Hamburg-Eppendorf, Hamburg, Germany.
| | - Mark Nehler
- Department of Surgery, Division of Vascular Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Kotov A, Heidemann F, Kuchenbecker J, Peters F, Marschall U, Acar L, Debus ES, L'Hoest H, Behrendt CA. Sex Disparities in Long Term Outcomes After Open Surgery for Chronic Limb Threatening Ischaemia: A Propensity Score Matched Analysis of Health Insurance Claims. Eur J Vasc Endovasc Surg 2020; 61:423-429. [PMID: 33334673 DOI: 10.1016/j.ejvs.2020.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 09/07/2020] [Revised: 10/15/2020] [Accepted: 11/04/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Several studies suggest a disadvantage for women in peri-operative morbidity and mortality after open surgery in peripheral arterial occlusive disease. In addition to their heterogeneity regarding design and analysed cohorts, long term data are mostly missing. This study aimed to determine sex disparities in outcomes after open revascularisation in chronic limb threatening ischaemia (CLTI). METHODS Using health insurance claims data of the second largest insurance fund in Germany, BARMER, a large cohort of patients was sampled consecutively for analysis including index open surgical revascularisations of CLTI performed between 1 January 2010, and 31 December 2018. Propensity score matching was used to adjust for confounding. Sex related differences regarding overall survival, amputation free survival (AFS), and cardiovascular event free survival (CVEFS) during the five years after surgery were determined using Kaplan-Meier time to event curves, log rank test, logistic, and Cox regression. RESULTS Among 9 526 patients (49.5% women) in the entire cohort, 6 502 patients were matched. Before matching, women were older at presentation (78.0 vs. 71.8 years, p < .001) and suffered more often from multiple comorbidities (van Walraven score > 9, 55.5% vs. 50.6%, p < .001). During the hospital stay, there were 692 (7.3%) deaths, while 4 631 deaths (48.6%) occurred during the follow up. In the matched cohort, the median follow up was 746 days for women and 871 days for men. In the matched analyses, female sex was significantly associated with better overall survival (hazard ratio, HR, 0.80, log rank p < .001), AFS (HR 0.81, log rank p < .0001), and CVEFS (HR 0.84, log rank p < .001) five years after the index treatment. CONCLUSION In this largest propensity score matched analysis of health insurance claims to date from Germany, evidence was found for better long term outcomes in women after open surgical revascularisations for chronic limb threatening ischaemia. Future guidelines and studies should address the impact of sex on patient selection practice and outcomes to determine the underlying reasons for existing disparities.
Collapse
Affiliation(s)
- Artur Kotov
- Department of Vascular Medicine, Research Group GermanVasc, University Heart and Vascular Centre Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Franziska Heidemann
- Department of Vascular Medicine, Research Group GermanVasc, University Heart and Vascular Centre Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jenny Kuchenbecker
- Department of Vascular Medicine, Research Group GermanVasc, University Heart and Vascular Centre Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Frederik Peters
- Department of Vascular Medicine, Research Group GermanVasc, University Heart and Vascular Centre Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Eike S Debus
- Department of Vascular Medicine, Research Group GermanVasc, University Heart and Vascular Centre Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | | | - Christian-Alexander Behrendt
- Department of Vascular Medicine, Research Group GermanVasc, University Heart and Vascular Centre Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
| |
Collapse
|
13
|
Konstantinou N, Kölbel T, Debus ES, Rohlffs F, Tsilimparis N. Fenestrated versus debranching thoracic endovascular aortic repair for endovascular treatment of distal aortic arch and descending aortic lesions. J Vasc Surg 2020; 73:1915-1924. [PMID: 33253872 DOI: 10.1016/j.jvs.2020.10.078] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 06/28/2020] [Accepted: 10/21/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cervical debranching, followed by thoracic endovascular aortic repair (TEVAR), is well-established for treating aortic arch lesions. However, total endovascular repair with fenestrated endografts has not been adequately studied. Thus, we performed a comparison of the two techniques. METHODS The present study was a single-center, retrospective study comparing the treatment of thoracic aortic lesions with custom-made fenestrated stent-grafts (fenestrated TEVAR [fTEVAR]) with a single fenestration for the left subclavian artery (LSA), a scallop for the left carotid artery, and hybrid repair with a thoracic stent-graft and cervical debranching of the LSA. Emergency cases were excluded. RESULTS From 2012 to 2018, 19 patients (58% male) underwent elective fTEVAR (group A) and 17 patients (82% male) underwent debranching TEVAR (dTEVAR; group B). The mean age ± standard deviation in group A was 65.8 ± 2 years and 68 ± 3 years in group B. Left carotid-subclavian bypass was performed in 15 of 17 patients (88%) and transposition of the LSA in 2 of 17 patients (12%) in group B. The two groups were comparable regarding comorbidities, except for peripheral arterial disease: 5 of 19 patients in group A (26%) and none in group B had had peripheral arterial disease (P = .049). Dissection or post-dissection aneurysm was the indication for treatment in 6 of 19 patients in the fTEVAR group (group A) and in 12 of 17 patients in the dTEVAR group (group B; 31.6% vs 70.6%; P = .04). The indication for the remaining patients was a degenerative aortic aneurysm. Technical success was achieved in all cases, except for one case of dTEVAR owing to a type Ia endoleak. The mean endovascular operative time was 191 ± 120 minutes for fTEVAR and 130 ± 75 minutes for dTEVAR (P = NS). The mean operative time for the debranching procedure was 181 ± 97 minutes. No deaths or major strokes had occurred in the early postoperative period (30 days). Of the 17 patients in group B, 5 (29.4%) had experienced a local complication related to the debranching procedure. The mean follow-up was 14.6 ± 2 months for group A and 17 ± 2 months for group B. Of the 19 patients in group A and 17 patients in group B, 2 (10.5%) and 6 (35.3%) had required an unplanned reintervention related to the thoracic stent-graft during the follow-up period, respectively (P = NS). The estimated freedom from unplanned reintervention at 12 months was 86% for group A and 81% for group B. Primary patency of the LSA stent-graft or the carotid-subclavian bypass/transposition was 100% in both groups. CONCLUSIONS Both techniques showed excellent midterm patency rates for the target vessel and high technical success rate. The operation times were shorter for the fTEVAR group and complications related to the debranching procedure were avoided.
Collapse
Affiliation(s)
- Nikolaos Konstantinou
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center, Hamburg, Germany; Department of Vascular Surgery, University Hospital, LMU Munich, Munich, Germany.
| | - Tilo Kölbel
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center, Hamburg, Germany
| | - Eike S Debus
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center, Hamburg, Germany
| | - Fiona Rohlffs
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center, Hamburg, Germany
| | - Nikolaos Tsilimparis
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center, Hamburg, Germany; Department of Vascular Surgery, University Hospital, LMU Munich, Munich, Germany
| |
Collapse
|
14
|
Peters F, Kreutzburg T, Rieß HC, Heidemann F, Marschall U, L'Hoest H, Debus ES, Sedrakyan A, Behrendt CA. Editor's Choice – Optimal Pharmacological Treatment of Symptomatic Peripheral Arterial Occlusive Disease and Evidence of Female Patient Disadvantage: An Analysis of Health Insurance Claims Data. Eur J Vasc Endovasc Surg 2020; 60:421-429. [DOI: 10.1016/j.ejvs.2020.05.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 03/30/2020] [Accepted: 05/01/2020] [Indexed: 01/28/2023]
|
15
|
Conte MS, Bradbury AW, Kolh P, White JV, Dick F, Fitridge R, Mills JL, Ricco JB, Suresh KR, Murad MH, Aboyans V, Aksoy M, Alexandrescu VA, Armstrong D, Azuma N, Belch J, Bergoeing M, Bjorck M, Chakfé N, Cheng S, Dawson J, Debus ES, Dueck A, Duval S, Eckstein HH, Ferraresi R, Gambhir R, Gargiulo M, Geraghty P, Goode S, Gray B, Guo W, Gupta PC, Hinchliffe R, Jetty P, Komori K, Lavery L, Liang W, Lookstein R, Menard M, Misra S, Miyata T, Moneta G, Munoa Prado JA, Munoz A, Paolini JE, Patel M, Pomposelli F, Powell R, Robless P, Rogers L, Schanzer A, Schneider P, Taylor S, De Ceniga MV, Veller M, Vermassen F, Wang J, Wang S. Corrigendum to "Global Vascular Guidelines on the Management of Chronic Limb-Threatening Ischaemia" [Eur J Vasc Endovasc Surg 58 (1S) (2019) 1-109>]. Eur J Vasc Endovasc Surg 2020; 60:158-159. [PMID: 32622518 DOI: 10.1016/j.ejvs.2020.04.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Michael S Conte
- Division of Vascular and Endovascular Surgery, University of California, San Francisco, CA, USA.
| | - Andrew W Bradbury
- Department of Vascular Surgery, University of Birmingham, Birmingham, United Kingdom
| | - Philippe Kolh
- Department of Biomedical and Preclinical Sciences, University Hospital of Liège, Wallonia, Belgium
| | - John V White
- Department of Surgery, Advocate Lutheran General Hospital, Niles, IL, USA
| | - Florian Dick
- Department of Vascular Surgery, Kantonsspital St. Gallen, St. Gallen, University of Berne, Berne, Switzerland
| | - Robert Fitridge
- Department of Vascular and Endovascular Surgery, The University of Adelaide Medical School, Adelaide, South Australia, Australia
| | - Joseph L Mills
- Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine, Houston, TX, USA
| | - Jean-Baptiste Ricco
- Department of Clinical Research, University Hospital of Poitiers, Poitiers, France
| | | | - M Hassan Murad
- Mayo Clinic Evidence-Based Practice Centre, Rochester, MN, USA
| | - Victor Aboyans
- Department of Cardiology, Dupuytren, University Hospital, France
| | - Murat Aksoy
- Department of Vascular Surgery American, Hospital, Turkey
| | | | | | | | - Jill Belch
- Ninewells Hospital University of Dundee, UK
| | - Michel Bergoeing
- Escuela de Medicina Pontificia Universidad, Catolica de Chile, Chile
| | - Martin Bjorck
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Sweden
| | | | | | - Joseph Dawson
- Royal Adelaide Hospital & University of Adelaide, Australia
| | - Eike S Debus
- University Heart Centre Hamburg, University Hospital Hamburg-Eppendorf, Germany
| | - Andrew Dueck
- Schulich Heart Centre, Sunnybrook Health, Sciences Centre, University of Toronto, Canada
| | - Susan Duval
- Cardiovascular Division, University of Minnesota Medical School, USA
| | | | - Roberto Ferraresi
- Interventional Cardiovascular Unit, Cardiology Department, Istituto Clinico, Città Studi, Milan, Italy
| | | | - Mauro Gargiulo
- Diagnostica e Sperimentale, University of Bologna, Italy
| | | | | | | | - Wei Guo
- 301 General Hospital of PLA, Beijing, China
| | | | | | - Prasad Jetty
- Division of Vascular and Endovascular Surgery, The Ottawa Hospital and the University of Ottawa, Ottawa, Canada
| | | | | | - Wei Liang
- Renji Hospital, School of Medicine, Shanghai Jiaotong University, China
| | - Robert Lookstein
- Division of Vascular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, USA
| | | | | | | | | | | | | | - Juan E Paolini
- Sanatorio Dr Julio Mendez, University of Buenos Aires, Argentina
| | - Manesh Patel
- Division of Cardiology, Duke University Health System, USA
| | | | | | | | - Lee Rogers
- Amputation Prevention Centers of America, USA
| | | | - Peter Schneider
- Kaiser Foundation Hospital Honolulu and Hawaii Permanente Medical Group, USA
| | - Spence Taylor
- Greenville Health Center/USC School of Medicine Greenville, USA
| | | | - Martin Veller
- University of the Witwatersrand, Johannesburg, South Africa
| | | | - Jinsong Wang
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shenming Wang
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
16
|
Behrendt CA, Debus ES. Limb Salvage: The Heart and Soul of Vascular Surgery. Eur J Vasc Endovasc Surg 2020; 60:613. [PMID: 32466959 DOI: 10.1016/j.ejvs.2020.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Christian-Alexander Behrendt
- Research Group GermanVasc, Department of Vascular Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
| | - Eike S Debus
- Research Group GermanVasc, Department of Vascular Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
17
|
Conte MS, Bradbury AW, Kolh P, White JV, Dick F, Fitridge R, Mills JL, Ricco JB, Suresh KR, Murad MH, Aboyans V, Aksoy M, Alexandrescu VA, Armstrong D, Azuma N, Belch J, Bergoeing M, Bjorck M, Chakfé N, Cheng S, Dawson J, Debus ES, Dueck A, Duval S, Eckstein HH, Ferraresi R, Gambhir R, Garguilo M, Geraghty P, Goode S, Gray B, Guo W, Gupta PC, Hinchliffe R, Jetty P, Komori K, Lavery L, Liang W, Lookstein R, Menard M, Misra S, Miyata T, Moneta G, Munoa Prado JA, Munoz A, Paolini JE, Patel M, Pomposelli F, Powell R, Robless P, Rogers L, Schanzer A, Schneider P, Taylor S, Vega de Ceniga M, Veller M, Vermassen F, Wang J, Wang S. Corrigendum to ‘Global Vascular Guidelines on the Management of Chronic Limb-Threatening Ischemia’ [European Journal of Vascular & Endovascular Surgery 58/1S (2019) 1–109]. Eur J Vasc Endovasc Surg 2020; 59:492-493. [DOI: 10.1016/j.ejvs.2019.11.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
18
|
Rohlffs F, Spanos K, Debus ES, Heidemann F, Tsilimparis N, Kölbel T. Modern Image Acquisition System Reduces Radiation Exposure to Patients and Staff During Complex Endovascular Aortic Repair. Eur J Vasc Endovasc Surg 2020; 59:295-300. [DOI: 10.1016/j.ejvs.2019.07.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 06/26/2019] [Accepted: 07/05/2019] [Indexed: 01/31/2023]
|
19
|
Kreutzburg T, Peters F, Rieß HC, Hischke S, Marschall U, Kriston L, L'Hoest H, Sedrakyan A, Debus ES, Behrendt CA. Editor's Choice – Comorbidity Patterns Among Patients with Peripheral Arterial Occlusive Disease in Germany: A Trend Analysis of Health Insurance Claims Data. Eur J Vasc Endovasc Surg 2020; 59:59-66. [DOI: 10.1016/j.ejvs.2019.08.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 08/06/2019] [Accepted: 08/11/2019] [Indexed: 02/06/2023]
|
20
|
Björck M, Earnshaw JJ, Acosta S, Bastos Gonçalves F, Cochennec F, Debus ES, Hinchliffe R, Jongkind V, Koelemay MJW, Menyhei G, Svetlikov AV, Tshomba Y, Van Den Berg JC, Esvs Guidelines Committee, de Borst GJ, Chakfé N, Kakkos SK, Koncar I, Lindholt JS, Tulamo R, Vega de Ceniga M, Vermassen F, Document Reviewers, Boyle JR, Mani K, Azuma N, Choke ETC, Cohnert TU, Fitridge RA, Forbes TL, Hamady MS, Munoz A, Müller-Hülsbeck S, Rai K. Editor's Choice - European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia. Eur J Vasc Endovasc Surg 2019; 59:173-218. [PMID: 31899099 DOI: 10.1016/j.ejvs.2019.09.006] [Citation(s) in RCA: 209] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
21
|
Makaloski V, Kölbel T, Fiorucci B, Rohlffs F, Carpenter S, Law Y, Debus ES, Tsilimparis N. Fascial Suture Technique Vs. Open Femoral Access for Thoracic Endovascular Aortic Repair. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.06.1144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
22
|
Sandhu HK, Wipper SH, Larena-Avellaneda A, Stoberock K, Miller CC, Safi HJ, Kölbel T, Debus ES. Impact of Gender on Treatment of Carotid-Artery Stenosis: A Secondary Data Analysis on Space Trial. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.06.617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
23
|
Jagodzinski A, Johansen C, Koch-Gromus U, Aarabi G, Adam G, Anders S, Augustin M, der Kellen RB, Beikler T, Behrendt CA, Betz CS, Bokemeyer C, Borof K, Briken P, Busch CJ, Büchel C, Brassen S, Debus ES, Eggers L, Fiehler J, Gallinat J, Gellißen S, Gerloff C, Girdauskas E, Gosau M, Graefen M, Härter M, Harth V, Heidemann C, Heydecke G, Huber TB, Hussein Y, Kampf MO, von dem Knesebeck O, Konnopka A, König HH, Kromer R, Kubisch C, Kühn S, Loges S, Löwe B, Lund G, Meyer C, Nagel L, Nienhaus A, Pantel K, Petersen E, Püschel K, Reichenspurner H, Sauter G, Scherer M, Scherschel K, Schiffner U, Schnabel RB, Schulz H, Smeets R, Sokalskis V, Spitzer MS, Terschüren C, Thederan I, Thoma T, Thomalla G, Waschki B, Wegscheider K, Wenzel JP, Wiese S, Zyriax BC, Zeller T, Blankenberg S. Rationale and Design of the Hamburg City Health Study. Eur J Epidemiol 2019; 35:169-181. [PMID: 31705407 PMCID: PMC7125064 DOI: 10.1007/s10654-019-00577-4] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 10/31/2019] [Indexed: 01/19/2023]
Abstract
The Hamburg City Health Study (HCHS) is a large, prospective, long-term, population-based cohort study and a unique research platform and network to obtain substantial knowledge about several important risk and prognostic factors in major chronic diseases. A random sample of 45,000 participants between 45 and 74 years of age from the general population of Hamburg, Germany, are taking part in an extensive baseline assessment at one dedicated study center. Participants undergo 13 validated and 5 novel examinations primarily targeting major organ system function and structures including extensive imaging examinations. The protocol includes validate self-reports via questionnaires regarding lifestyle and environmental conditions, dietary habits, physical condition and activity, sexual dysfunction, professional life, psychosocial context and burden, quality of life, digital media use, occupational, medical and family history as well as healthcare utilization. The assessment is completed by genomic and proteomic characterization. Beyond the identification of classical risk factors for major chronic diseases and survivorship, the core intention is to gather valid prevalence and incidence, and to develop complex models predicting health outcomes based on a multitude of examination data, imaging, biomarker, psychosocial and behavioral assessments. Participants at risk for coronary artery disease, atrial fibrillation, heart failure, stroke and dementia are invited for a visit to conduct an additional MRI examination of either heart or brain. Endpoint assessment of the overall sample will be completed through repeated follow-up examinations and surveys as well as related individual routine data from involved health and pension insurances. The study is targeting the complex relationship between biologic and psychosocial risk and resilience factors, chronic disease, health care use, survivorship and health as well as favorable and bad prognosis within a unique, large-scale long-term assessment with the perspective of further examinations after 6 years in a representative European metropolitan population.
Collapse
Affiliation(s)
- Annika Jagodzinski
- Department of General and Interventional Cardiology, University Heart and Vascular Center, Hamburg, Germany. .,German Center for Cardiovascular Research (DZHK) Partner Site Hamburg/Lübeck/Kiel, Munich, Germany. .,Epidemiological Study Center, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
| | - Christoffer Johansen
- Epidemiological Study Center, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.,Oncology Clinic, Finsen Center, Copenhagen, Denmark.,Survivorship Research Unit, The Danish Cancer Society Research Center, Copenhagen, Denmark.,Institute for Medical Biometry and Epidemiology (IMBE), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Uwe Koch-Gromus
- Faculty of Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Ghazal Aarabi
- Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostics and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Sven Anders
- Department for Forensic Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Ramona B der Kellen
- Epidemiological Study Center, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Thomas Beikler
- Department of Periodontics, Preventive and Restorative Dentistry, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | | | - Christian S Betz
- Department of Otolaryngology, Head and Neck Surgery, Head and Neurocenter, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Carsten Bokemeyer
- Department of Oncology, Hematology, BMT with Section Pneumology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Katrin Borof
- Epidemiological Study Center, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Peer Briken
- Institute for Sexual Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Chia-Jung Busch
- Department of Otolaryngology, Head and Neck Surgery, Head and Neurocenter, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Christian Büchel
- Institute for Systemic Neurosciences, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Stefanie Brassen
- Institute for Systemic Neurosciences, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Eike S Debus
- Department of Vascular Medicine, University Heart and Vascular Center, Hamburg, Germany
| | - Larissa Eggers
- Epidemiological Study Center, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Jens Fiehler
- Clinic of Neuroradiological Diagnostics and Intervention, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Jürgen Gallinat
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Simone Gellißen
- Clinic of Neuroradiological Diagnostics and Intervention, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Evaldas Girdauskas
- Department for Cardiovascular Surgery, University Heart and Vascular Center, Hamburg, Germany
| | - Martin Gosau
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Markus Graefen
- Prostate Cancer Center, Martini-Clinic, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Volker Harth
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Christoph Heidemann
- Epidemiological Study Center, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Guido Heydecke
- Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias B Huber
- Medical Clinic and Polyclinic III, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Yassin Hussein
- Epidemiological Study Center, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Marvin O Kampf
- Epidemiological Study Center, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Olaf von dem Knesebeck
- Institute for Medical Sociology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Alexander Konnopka
- Institute for Health Economics and Healthcare Research, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Hans-Helmut König
- Institute for Health Economics and Healthcare Research, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Robert Kromer
- Clinic of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Christian Kubisch
- Institute of Human Genetics, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Simone Kühn
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Sonja Loges
- Department of Oncology, Hematology, BMT with Section Pneumology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.,Institute for Tumor Biology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Bernd Löwe
- Institute for Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Gunnar Lund
- Department of Diagnostics and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Christian Meyer
- German Center for Cardiovascular Research (DZHK) Partner Site Hamburg/Lübeck/Kiel, Munich, Germany.,Department of Electrophysiology, Hamburg University Heart Center, University Heart and Vascular Center, Hamburg, Germany
| | - Lina Nagel
- Epidemiological Study Center, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Albert Nienhaus
- Competence Center for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Klaus Pantel
- Institute for Tumor Biology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Elina Petersen
- Epidemiological Study Center, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Klaus Püschel
- Department for Forensic Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Hermann Reichenspurner
- Department for Cardiovascular Surgery, University Heart and Vascular Center, Hamburg, Germany
| | - Guido Sauter
- Department of Pathology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Martin Scherer
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Katharina Scherschel
- German Center for Cardiovascular Research (DZHK) Partner Site Hamburg/Lübeck/Kiel, Munich, Germany.,Department of Electrophysiology, Hamburg University Heart Center, University Heart and Vascular Center, Hamburg, Germany
| | - Ulrich Schiffner
- Department of Periodontics, Preventive and Restorative Dentistry, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Renate B Schnabel
- Department of General and Interventional Cardiology, University Heart and Vascular Center, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK) Partner Site Hamburg/Lübeck/Kiel, Munich, Germany
| | - Holger Schulz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Ralf Smeets
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Vladislavs Sokalskis
- Epidemiological Study Center, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Martin S Spitzer
- Clinic of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Claudia Terschüren
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Imke Thederan
- Prostate Cancer Center, Martini-Clinic, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Tom Thoma
- Epidemiological Study Center, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Benjamin Waschki
- Department of General and Interventional Cardiology, University Heart and Vascular Center, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK) Partner Site Hamburg/Lübeck/Kiel, Munich, Germany.,Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany
| | - Karl Wegscheider
- Institute for Medical Biometry and Epidemiology (IMBE), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Jan-Per Wenzel
- Department of General and Interventional Cardiology, University Heart and Vascular Center, Hamburg, Germany.,Epidemiological Study Center, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Susanne Wiese
- Epidemiological Study Center, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Birgit-Christiane Zyriax
- German Center for Cardiovascular Research (DZHK) Partner Site Hamburg/Lübeck/Kiel, Munich, Germany.,Competence Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Tanja Zeller
- Department of General and Interventional Cardiology, University Heart and Vascular Center, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK) Partner Site Hamburg/Lübeck/Kiel, Munich, Germany.,Epidemiological Study Center, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Stefan Blankenberg
- Department of General and Interventional Cardiology, University Heart and Vascular Center, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK) Partner Site Hamburg/Lübeck/Kiel, Munich, Germany
| |
Collapse
|
24
|
Abstract
AIM The aim of the present study was to describe the publication performance of the academic surgical management teams in Germany based on the preferred journals, their impact factors (IF) and the focal topics. METHODS The publications of the vascular surgical management teams, consisting of chief and senior physicians, of 37 German university hospitals were analyzed. Reference date for all considerations (staffing and publications) was 1 July 2017. The publication period covered the last 10 years. The literature search was based on an evaluation of the PubMed database. RESULTS A total of 1047 publications published in 197 journals were recorded. Among them were 3 German language journals with 136 (13.0%) publications but only 3.3% of all cumulative IFs. In 126 journals (64.0%) only one article was published and in 30 (15.2%) two articles. The three PubMed listed journals in which German university vascular surgeons published most frequently were the J Vasc Surg with 126 publications, Eur J Vasc Endovasc Surg with 94 and J Endovasc Ther with 88 publications. Of all 1047 publications 46.5% were published in an IF range under 2 and a total of 907/1047 publications (86.6%) in an IF range under 4. In 8.6% of the journals 44.1% of the IFs were generated. In terms of publication topics, thoracic and abdominal aorta were at the top of the list, accounting for almost half of all publications with 501 publications and with 52% of all 1252.08 accumulated IFs. CONCLUSION A total of 78.6% of the publications in the 17 journals, in which more than 10 publications were made, came from independent institutions, 19.3% from the sections. None of the 91 publications in journals with an IF > 4 came from a subordinate organizational structure, indicating a gap between independent departments, sections and subordinate structures. The number of publications was based on the achievable IF of the individual topic and thus its attractiveness. Peripheral arterial disease was underrepresented in the publication topics in relation to the number of patients, with a share of 8.5.
Collapse
Affiliation(s)
- F Haffke
- Klinik und Poliklinik für Gefäßmedizin, Universitäres Herzzentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - E S Debus
- Klinik und Poliklinik für Gefäßmedizin, Universitäres Herzzentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - R T Grundmann
- Klinik und Poliklinik für Gefäßmedizin, Universitäres Herzzentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland. .,, In den Grüben 144, Burghausen, Deutschland.
| |
Collapse
|
25
|
Schierling W, Wipper S, Behem CR, Hinck DC, Trepte CJ, Debus ES, Pfister K. Sonographic real-time imaging of tissue perfusion in a porcine haemorrhagic shock model. Ultrasound Med Biol 2019; 45:2797-2804. [PMID: 31277923 DOI: 10.1016/j.ultrasmedbio.2019.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 05/02/2019] [Accepted: 06/03/2019] [Indexed: 06/09/2023]
Abstract
Injection of fluorescence-labelled microspheres (FMs) in pigs allows only the postmortem determination of organ perfusion. Colour duplex ultrasound (CDU) and contrast-enhanced ultrasound were established as techniques for real-time imaging of tissue perfusion in a porcine haemorrhagic shock model. Haemorrhagic shock was provoked in nine domestic pigs by taking at least 15% of the calculated blood volume. Ultrasound examinations were performed with a Hitachi HI VISION Ascendus. SonoVue was injected for contrast-enhanced ultrasound. Monitoring of the resistive index and time-to-peak ratio enabled quantification of tissue perfusion in vivo during the entire study, allowing real-time differentiation of animals with systemic shock versus failing shock effect. Postmortem analyses of injected FMs confirmed the sonographic in vivo results. Determination of the resistive index and time-to-peak ratio by CDU and contrast-enhanced ultrasound allowed real-time monitoring of tissue perfusion. Effects of haemorrhagic shock and therapeutic approaches related to organ perfusion can be observed live and in vivo.
Collapse
Affiliation(s)
- Wilma Schierling
- Division of Vascular Surgery, University Medical Center Regensburg, Regensburg, Germany.
| | - Sabine Wipper
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph R Behem
- Centre of Anaesthesiology and Intensive Care Medicine, Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel C Hinck
- Section of Vascular Surgery, Department of General and Visceral Surgery, Bundeswehrkrankenhaus Hamburg, Hamburg, Germany
| | - Constantin J Trepte
- Centre of Anaesthesiology and Intensive Care Medicine, Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eike S Debus
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karin Pfister
- Division of Vascular Surgery, University Medical Center Regensburg, Regensburg, Germany
| |
Collapse
|
26
|
Hischke S, Rieß HC, Bublitz MK, Kriston L, Schwaneberg T, Härter M, Bertges D, S Debus E, Behrendt CA. Quality Indicators in Peripheral Arterial Occlusive Disease Treatment: A Systematic Review. Eur J Vasc Endovasc Surg 2019; 58:738-745. [PMID: 31526633 DOI: 10.1016/j.ejvs.2019.06.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 06/19/2019] [Accepted: 06/24/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This systematic review aimed to identify evidence based quality indicators for invasive revascularisation of symptomatic peripheral arterial occlusive disease (PAOD). METHODS A systematic search of clinical practice guidelines, consensus statements, systematic reviews, and meta-analyses reporting quality indicators in patients undergoing invasive open and percutaneous revascularisations for symptomatic PAOD (PROSPERO registration number: CRD42019116317) was performed. Furthermore, a grey literature search was conducted involving databases of professional vascular medical organisations. The identified publications were screened independently by two reviewers for possible inclusion and full texts of potentially relevant records were independently evaluated for eligibility. Disagreement was resolved by discussion involving a third reviewer. RESULTS From 685 articles initially identified, one systematic review and one consensus statement focusing on quality indicators were selected for inclusion in the review. From these sources, a total of three process quality indicators matched the search criteria: one on pharmacological intervention, another on smoking cessation, and a third on surveillance of lower extremity vein bypass grafts. The grey literature search revealed an additional 31 structure, process, and outcome quality indicators. CONCLUSIONS This study revealed a lack of published evidence based quality indicators concerning invasive treatment for PAOD in the literature. An additional 31 indicators from the databases of professional societies and organisations have not been incorporated in prior guidelines. Interestingly, no indicator related to patient reported outcomes could be identified from either high quality sources or grey literature. Further research and harmonisation of different quality indicators is needed to enhance their evidence and subsequently improve patient centred decision making on invasive treatment.
Collapse
Affiliation(s)
- Sandra Hischke
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Department of Vascular Medicine, Working Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Henrik C Rieß
- Department of Vascular Medicine, Working Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Maria K Bublitz
- Department of Vascular Medicine, Working Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Thea Schwaneberg
- Department of Vascular Medicine, Working Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Bertges
- Division of Vascular Surgery, University of Vermont Medical Centre, Burlington, VT, USA
| | - Eike S Debus
- Department of Vascular Medicine, Working Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Christian-Alexander Behrendt
- Department of Vascular Medicine, Working Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
| |
Collapse
|
27
|
Konstantinou N, Debus ES, Vermeulen CF, Wipper S, Diener H, Larena-Avellaneda A, Kölbel T, Tsilimparis N. Cervical Debranching in the Endovascular Era: A Single Centre Experience. Eur J Vasc Endovasc Surg 2019; 58:34-40. [DOI: 10.1016/j.ejvs.2018.12.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 12/09/2018] [Indexed: 11/26/2022]
|
28
|
Conte MS, Bradbury AW, Kolh P, White JV, Dick F, Fitridge R, Mills JL, Ricco JB, Suresh KR, Murad MH, Aboyans V, Aksoy M, Alexandrescu VA, Armstrong D, Azuma N, Belch J, Bergoeing M, Bjorck M, Chakfé N, Cheng S, Dawson J, Debus ES, Dueck A, Duval S, Eckstein HH, Ferraresi R, Gambhir R, Gargiulo M, Geraghty P, Goode S, Gray B, Guo W, Gupta PC, Hinchliffe R, Jetty P, Komori K, Lavery L, Liang W, Lookstein R, Menard M, Misra S, Miyata T, Moneta G, Munoa Prado JA, Munoz A, Paolini JE, Patel M, Pomposelli F, Powell R, Robless P, Rogers L, Schanzer A, Schneider P, Taylor S, De Ceniga MV, Veller M, Vermassen F, Wang J, Wang S. Global Vascular Guidelines on the Management of Chronic Limb-Threatening Ischemia. Eur J Vasc Endovasc Surg 2019; 58:S1-S109.e33. [PMID: 31182334 PMCID: PMC8369495 DOI: 10.1016/j.ejvs.2019.05.006] [Citation(s) in RCA: 670] [Impact Index Per Article: 134.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
GUIDELINE SUMMARY Chronic limb-threatening ischemia (CLTI) is associated with mortality, amputation, and impaired quality of life. These Global Vascular Guidelines (GVG) are focused on definition, evaluation, and management of CLTI with the goals of improving evidence-based care and highlighting critical research needs. The term CLTI is preferred over critical limb ischemia, as the latter implies threshold values of impaired perfusion rather than a continuum. CLTI is a clinical syndrome defined by the presence of peripheral artery disease (PAD) in combination with rest pain, gangrene, or a lower limb ulceration >2 weeks duration. Venous, traumatic, embolic, and nonatherosclerotic etiologies are excluded. All patients with suspected CLTI should be referred urgently to a vascular specialist. Accurately staging the severity of limb threat is fundamental, and the Society for Vascular Surgery Threatened Limb Classification system, based on grading of Wounds, Ischemia, and foot Infection (WIfI) is endorsed. Objective hemodynamic testing, including toe pressures as the preferred measure, is required to assess CLTI. Evidence-based revascularization (EBR) hinges on three independent axes: Patient risk, Limb severity, and ANatomic complexity (PLAN). Average-risk and high-risk patients are defined by estimated procedural and 2-year all-cause mortality. The GVG proposes a new Global Anatomic Staging System (GLASS), which involves defining a preferred target artery path (TAP) and then estimating limb-based patency (LBP), resulting in three stages of complexity for intervention. The optimal revascularization strategy is also influenced by the availability of autogenous vein for open bypass surgery. Recommendations for EBR are based on best available data, pending level 1 evidence from ongoing trials. Vein bypass may be preferred for average-risk patients with advanced limb threat and high complexity disease, while those with less complex anatomy, intermediate severity limb threat, or high patient risk may be favored for endovascular intervention. All patients with CLTI should be afforded best medical therapy including the use of antithrombotic, lipid-lowering, antihypertensive, and glycemic control agents, as well as counseling on smoking cessation, diet, exercise, and preventive foot care. Following EBR, long-term limb surveillance is advised. The effectiveness of nonrevascularization therapies (eg, spinal stimulation, pneumatic compression, prostanoids, and hyperbaric oxygen) has not been established. Regenerative medicine approaches (eg, cell, gene therapies) for CLTI should be restricted to rigorously conducted randomizsed clinical trials. The GVG promotes standardization of study designs and end points for clinical trials in CLTI. The importance of multidisciplinary teams and centers of excellence for amputation prevention is stressed as a key health system initiative.
Collapse
Affiliation(s)
- Michael S Conte
- Division of Vascular and Endovascular Surgery, University of California, San Francisco, CA, USA.
| | - Andrew W Bradbury
- Department of Vascular Surgery, University of Birmingham, Birmingham, United Kingdom
| | - Philippe Kolh
- Department of Biomedical and Preclinical Sciences, University Hospital of Liège, Wallonia, Belgium
| | - John V White
- Department of Surgery, Advocate Lutheran General Hospital, Niles, IL, USA
| | - Florian Dick
- Department of Vascular Surgery, Kantonsspital St. Gallen, St. Gallen, and University of Berne, Berne, Switzerland
| | - Robert Fitridge
- Department of Vascular and Endovascular Surgery, The University of Adelaide Medical School, Adelaide, South Australia, Australia
| | - Joseph L Mills
- Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine, Houston, TX, USA
| | - Jean-Baptiste Ricco
- Department of Clinical Research, University Hospitalof Poitiers, Poitiers, France
| | | | - M Hassan Murad
- Mayo Clinic Evidence-Based Practice Center, Rochester, MN, USA
| | - Victor Aboyans
- Department of Cardiology, Dupuytren, University Hospital, France
| | - Murat Aksoy
- Department of Vascular Surgery American, Hospital, Turkey
| | | | | | | | - Jill Belch
- Ninewells Hospital University of Dundee, UK
| | - Michel Bergoeing
- Escuela de Medicina Pontificia Universidad, Catolica de Chile, Chile
| | - Martin Bjorck
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Sweden
| | | | | | - Joseph Dawson
- Royal Adelaide Hospital & University of Adelaide, Australia
| | - Eike S Debus
- University Heart Center Hamburg, University Hospital Hamburg-Eppendorf, Germany
| | - Andrew Dueck
- Schulich Heart Centre, Sunnybrook Health, Sciences Centre, University of Toronto, Canada
| | - Susan Duval
- Cardiovascular Division, University of, Minnesota Medical School, USA
| | | | - Roberto Ferraresi
- Interventional Cardiovascular Unit, Cardiology Department, Istituto Clinico, Città Studi, Milan, Italy
| | | | - Mauro Gargiulo
- Diagnostica e Sperimentale, University of Bologna, Italy
| | | | | | | | - Wei Guo
- 301 General Hospital of PLA, Beijing, China
| | | | | | - Prasad Jetty
- Division of Vascular and Endovascular Surgery, The Ottawa Hospital and the University of Ottawa, Ottawa, Canada
| | | | | | - Wei Liang
- Renji Hospital, School of Medicine, Shanghai Jiaotong University, China
| | - Robert Lookstein
- Division of Vascular and Interventional Radiology, Icahn School of Medicine at Mount Sinai
| | | | | | | | | | | | | | - Juan E Paolini
- Sanatorio Dr Julio Mendez, University of Buenos Aires, Argentina
| | - Manesh Patel
- Division of Cardiology, Duke University Health System, USA
| | | | | | | | - Lee Rogers
- Amputation Prevention Centers of America, USA
| | | | - Peter Schneider
- Kaiser Foundation Hospital Honolulu and Hawaii Permanente Medical Group, USA
| | - Spence Taylor
- Greenville Health Center/USC School of Medicine Greenville, USA
| | | | - Martin Veller
- University of the Witwatersrand, Johannesburg, South Africa
| | | | - Jinsong Wang
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shenming Wang
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
29
|
Hinrichs DL, Debus ES, Grundmann RT. Surgical publication activity in the English literature over a 10-year interval. BJS Open 2019; 3:696-703. [PMID: 31592516 PMCID: PMC6773622 DOI: 10.1002/bjs5.50172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 02/06/2019] [Accepted: 03/08/2019] [Indexed: 11/09/2022] Open
Abstract
Background Surgical publication activity in the English literature over a 10-year interval may have changed. This study sought to identify which countries make the most contributions and whether significant shifts have occurred in this time. Methods Screening of 17 international journals in PubMed was performed for the time periods 2006-2007 and 2016-2017, for papers published by a first author belonging to a general surgical department. Data were collected by country regarding the total number of publications, cumulative impact factors (IFs), publications per inhabitant, IFs per inhabitant, and number of RCTs, meta-analyses and systematic reviews per country in both periods. Results A total of 2247 and 3029 papers were found for 2006-2007 and 2016-2017 respectively. In 2006-2007, most papers (605, 26·9 per cent; 2697·3 IFs) came from the USA, followed by Japan (284, 12·6 per cent; 1042·1 IFs) and the UK (197, 8·8 per cent; 923·1 IFs). In 2016-2017, the USA led again with 898 papers (29·6 per cent; 4575·3 IFs), followed by Japan with 414 papers (13·7 per cent; 1556·6 IFs) and the Netherlands with 167 (5·5 per cent; 885·2 IFs). From the top 15 countries, Sweden, the Netherlands and Switzerland contributed the most articles per inhabitant during both time periods. During both periods, the UK published the most RCTs, meta-analyses and systematic reviews. Conclusion Surgeons from the USA were the most productive in total number of publications during both time periods. However, smaller European countries were more active than the USA in relation to their population size.
Collapse
Affiliation(s)
- D L Hinrichs
- Department of Vascular Medicine University Heart Centre, University Hospital Hamburg-Eppendorf 52 Martinistrasse 20246 Hamburg Germany
| | - E S Debus
- Department of Vascular Medicine University Heart Centre, University Hospital Hamburg-Eppendorf 52 Martinistrasse 20246 Hamburg Germany
| | - R T Grundmann
- Department of Vascular Medicine University Heart Centre, University Hospital Hamburg-Eppendorf 52 Martinistrasse 20246 Hamburg Germany
| |
Collapse
|
30
|
Behrendt CA, Bischoff MS, Schwaneberg T, Hohnhold R, Diener H, Debus ES, Rieß HC. Population Based Analysis of Gender Disparities in 23,715 Percutaneous Endovascular Revascularisations in the Metropolitan Area of Hamburg. Eur J Vasc Endovasc Surg 2019; 57:658-665. [DOI: 10.1016/j.ejvs.2018.10.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 10/16/2018] [Indexed: 10/27/2022]
|
31
|
Reiff T, Eckstein HH, Mansmann U, Jansen O, Fraedrich G, Mudra H, Böckler D, Böhm M, Brückmann H, Debus ES, Fiehler J, Lang W, Mathias K, Ringelstein EB, Schmidli J, Stingele R, Zahn R, Zeller T, Hetzel A, Bodechtel U, Binder A, Glahn J, Hacke W, Ringleb PA. Angioplasty in asymptomatic carotid artery stenosis vs. endarterectomy compared to best medical treatment: One-year interim results of SPACE-2. Int J Stroke 2019; 15:1747493019833017. [PMID: 30873912 PMCID: PMC7416333 DOI: 10.1177/1747493019833017] [Citation(s) in RCA: 30] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 12/10/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Treatment of individuals with asymptomatic carotid artery stenosis is still handled controversially. Recommendations for treatment of asymptomatic carotid stenosis with carotid endarterectomy (CEA) are based on trials having recruited patients more than 15 years ago. Registry data indicate that advances in best medical treatment (BMT) may lead to a markedly decreasing risk of stroke in asymptomatic carotid stenosis. The aim of the SPACE-2 trial (ISRCTN78592017) was to compare the stroke preventive effects of BMT alone with that of BMT in combination with CEA or carotid artery stenting (CAS), respectively, in patients with asymptomatic carotid artery stenosis of ≥70% European Carotid Surgery Trial (ECST) criteria. METHODS SPACE-2 is a randomized, controlled, multicenter, open study. A major secondary endpoint was the cumulative rate of any stroke (ischemic or hemorrhagic) or death from any cause within 30 days plus an ipsilateral ischemic stroke within one year of follow-up. Safety was assessed as the rate of any stroke and death from any cause within 30 days after CEA or CAS. Protocol changes had to be implemented. The results on the one-year period after treatment are reported. FINDINGS It was planned to enroll 3550 patients. Due to low recruitment, the enrollment of patients was stopped prematurely after randomization of 513 patients in 36 centers to CEA (n = 203), CAS (n = 197), or BMT (n = 113). The one-year rate of the major secondary endpoint did not significantly differ between groups (CEA 2.5%, CAS 3.0%, BMT 0.9%; p = 0.530) as well as rates of any stroke (CEA 3.9%, CAS 4.1%, BMT 0.9%; p = 0.256) and all-cause mortality (CEA 2.5%, CAS 1.0%, BMT 3.5%; p = 0.304). About half of all strokes occurred in the peri-interventional period. Higher albeit statistically non-significant rates of restenosis occurred in the stenting group (CEA 2.0% vs. CAS 5.6%; p = 0.068) without evidence of increased stroke rates. INTERPRETATION The low sample size of this prematurely stopped trial of 513 patients implies that its power is not sufficient to show that CEA or CAS is superior to a modern medical therapy (BMT) in the primary prevention of ischemic stroke in patients with an asymptomatic carotid stenosis up to one year after treatment. Also, no evidence for differences in safety between CAS and CEA during the first year after treatment could be derived. Follow-up will be performed up to five years. Data may be used for pooled analysis with ongoing trials.
Collapse
Affiliation(s)
- T Reiff
- Department of Neurology, University
Hospital of Heidelberg, Heidelberg, Germany
| | - HH Eckstein
- Department for Vascular and
Endovascular Surgery, Technical University of Munich, Munich, Germany
| | - U Mansmann
- Institute of Medical Informatics,
Biometry and Epidemiology, Ludwig Maximilian University Munich, Munich,
Germany
| | - O Jansen
- Department of Radiology and
Neuroradiology, UKSH Campus Kiel, Kiel, Germany
| | - G Fraedrich
- Department of Vascular Surgery,
University Hospital of Innsbruck, Innsbruck, Austria
| | - H Mudra
- Department of Internal Medicine,
Städtisches Klinikum München-Neuperlach, Munich, Germany
| | - D Böckler
- Department of Vascular Surgery,
University Hospital of Heidelberg, Heidelberg, Germany
| | - M Böhm
- Department of Internal Medicine,
University Hospital of Homburg/Saar, Homburg, Germany
| | - H Brückmann
- Department of Neuroradiology,
Ludwig-Maximilians-Universität, Munich, Germany
| | - ES Debus
- Department of Vascular Surgery,
University Hospital of Hamburg, Hamburg, Germany
| | - J Fiehler
- Department of Neuroradiology,
University Hospital of Hamburg, Hamburg, Germany
| | - W Lang
- Department of Vascular Surgery,
University Hospital Erlangen, Erlangen, Germany
| | - K Mathias
- Department of Radiology, Klinikum
Dortmund, Dortmund, Germany
| | - EB Ringelstein
- Department of Neurology,
University Hospital of Münster, Münster, Germany
| | - J Schmidli
- Department of Vascular Surgery,
University Hospital of Bern, Bern, Switzerland
| | - R Stingele
- Department of Neurology,
University of Kiel, Kiel, Germany
| | - R Zahn
- Department of Internal Medicine,
Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - T Zeller
- Department of Angiology,
University Hospital Freiburg, Bad Krozingen, Germany
| | - A Hetzel
- Department of Neurology,
University Hospital Freiburg, Freiburg, Germany
| | - U Bodechtel
- Department of Neurology,
University Hospital of Dresden, Dresden, Germany
| | - A Binder
- Department of Neurology, UKSH
Campus Kiel, Kiel, Germany
| | - J Glahn
- Department of Neurology, Johannes
Wesling Klinikum, Minden, Germany
| | - W Hacke
- Department of Neurology, University
Hospital of Heidelberg, Heidelberg, Germany
| | - PA Ringleb
- Department of Neurology, University
Hospital of Heidelberg, Heidelberg, Germany
| |
Collapse
|
32
|
Erben Y, Oderich GS, Verhagen HJ, Witsenburg M, van den Hoven AT, Debus ES, Kölbel T, Arko FR, Torsello GB, Torsello GF, Lawrence PF, Harlander-Locke MP, Bacharach JM, Jordan WD, Eskandari MK, Hagler DJ. Multicenter experience with endovascular treatment of aortic coarctation in adults. J Vasc Surg 2019; 69:671-679.e1. [DOI: 10.1016/j.jvs.2018.06.209] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 06/25/2018] [Indexed: 11/26/2022]
|
33
|
Makaloski V, Kölbel T, Rohlffs F, Behrendt CA, Law Y, Debus ES, Tsilimparis N. Early Outcomes After Branched and Fenestrated Endovascular Aortic Repair in Octogenarians. Eur J Vasc Endovasc Surg 2018; 56:818-825. [DOI: 10.1016/j.ejvs.2018.08.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 08/06/2018] [Indexed: 11/29/2022]
|
34
|
Law Y, Tsilimparis N, Aleed S, Rohlffs F, Schofer N, Debus ES, Müller G, Kölbel T. Treatment of Aortic Coarctation by Self-expanding Thoracic Endograft with Left Subclavian In Situ Laser Fenestration. Ann Vasc Surg 2018; 56:350.e9-350.e13. [PMID: 30342211 DOI: 10.1016/j.avsg.2018.07.068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/16/2018] [Accepted: 07/16/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Thoracic endovascular aortic repair (TEVAR) with self-expanding endograft is increasingly used as a viable treatment option for adult aortic coarctation (AC). METHODS We hereby reported a 55-year-old gentleman with late presentation of AC, treated by a novel strategy with thoracic endograft and in situ laser fenestration for left subclavian artery (LSA) revascularization. RESULTS AC was incidentally discovered during coronary angiogram as an investigation for his angina pectoris. TEVAR with self-expanding endograft was chosen because preoperative computer tomography scan showed ectatic thoracic aorta and stenosis just distal to the LSA. The patient was planned for a timely second-stage aortic valve replacement and coronary artery bypass grafting using left internal mammary artery shortly after TEVAR, which required a patent LSA. The procedure was arranged semiurgently. A 34-mm thoracic tube endograft was placed across the coarctation with proximal landing distal to the left common carotid artery. In situ fenestration was created by laser catheter through retrograde left brachial access. The fenestration was then enlarged by balloon dilatation and bridged to the left subclavian origin with a 16-mm balloon-expandable covered stent. CONCLUSIONS TEVAR with in situ fenestration for LSA is a reliable choice for adult AC. The technique added to the armamentarium of treatment options.
Collapse
Affiliation(s)
- Yuk Law
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center of Hamburg, Hamburg, Germany; Division of Vascular Surgery, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong.
| | - Nikolaos Tsilimparis
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center of Hamburg, Hamburg, Germany
| | - Shadi Aleed
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center of Hamburg, Hamburg, Germany
| | - Fiona Rohlffs
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center of Hamburg, Hamburg, Germany
| | - Niklas Schofer
- Department of General and Interventional Cardiology, German Aortic Center Hamburg, University Heart Center Hamburg, Hamburg, Germany
| | - Eike S Debus
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center of Hamburg, Hamburg, Germany
| | - Goetz Müller
- Department of General and Interventional Cardiology, German Aortic Center Hamburg, University Heart Center Hamburg, Hamburg, Germany
| | - Tilo Kölbel
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center of Hamburg, Hamburg, Germany
| |
Collapse
|
35
|
Kirsten N, Herberger K, Augustin M, Tigges W, Behrendt C, Heidemann F, Debus ES, Diener H. [Modern wound treatment-from best practice to innovation]. Chirurg 2018; 89:931-942. [PMID: 30242438 DOI: 10.1007/s00104-018-0731-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 12/26/2022]
Abstract
According to the Research Group for Primary Medical Care (PMV), approximately 890,000 people in Germany were suffering from a chronic wound in 2012. This corresponds to a prevalence of 1.1%. Ulcus cruris, diabetic ulcers and decubital ulcers are among the most frequent causes of chronic wounds (57-80%). The guarantee for successful wound care is based on a good understanding of the physiology of the wound healing process. A disorder of the phase-like course can lead to complications, delays or suspension of wound healing. There are many reasons for pathological wound healing including infections, oxygen deficiency and non-phase-adapted wound care. In addition to established wound products, innovative products such as dermal matrixes, cold plasma therapy and platelet-rich plasma represent promising therapeutic alternatives for non-healing chronic wounds.
Collapse
Affiliation(s)
- N Kirsten
- Comprehensive Wound Center, Universitäres Herzzentrum Hamburg, Universitätsklinik Hamburg Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - K Herberger
- Comprehensive Wound Center, Universitäres Herzzentrum Hamburg, Universitätsklinik Hamburg Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland.,Institut für Versorgungsforschung Dermatologie, Universität Hamburg Eppendorf, Hamburg, Deutschland
| | - M Augustin
- Comprehensive Wound Center, Universitäres Herzzentrum Hamburg, Universitätsklinik Hamburg Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland.,Institut für Versorgungsforschung Dermatologie, Universität Hamburg Eppendorf, Hamburg, Deutschland
| | - W Tigges
- Klinik für Gefäßmedizin, AGAPLESION DIAKONIEKLINIKUM HAMBURG gGmbH, Hamburg, Deutschland
| | - C Behrendt
- Klinik und Poliklinik für Gefäßmedizin, Universitäres Herzzentrum Hamburg, UniversitätsklinikumHamburg-Eppendorf, Hamburg, Deutschland
| | - F Heidemann
- Klinik und Poliklinik für Gefäßmedizin, Universitäres Herzzentrum Hamburg, UniversitätsklinikumHamburg-Eppendorf, Hamburg, Deutschland
| | - E S Debus
- Klinik und Poliklinik für Gefäßmedizin, Universitäres Herzzentrum Hamburg, UniversitätsklinikumHamburg-Eppendorf, Hamburg, Deutschland.,Comprehensive Wound Center, Universitäres Herzzentrum Hamburg, Universitätsklinik Hamburg Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - H Diener
- Klinik und Poliklinik für Gefäßmedizin, Universitäres Herzzentrum Hamburg, UniversitätsklinikumHamburg-Eppendorf, Hamburg, Deutschland. .,Comprehensive Wound Center, Universitäres Herzzentrum Hamburg, Universitätsklinik Hamburg Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland.
| |
Collapse
|
36
|
Duprée A, Rieß H, Detter C, Debus ES, Wipper SH. Utilization of indocynanine green fluorescent imaging (ICG-FI) for the assessment of microperfusion in vascular medicine. Innov Surg Sci 2018; 3:193-201. [PMID: 31579783 PMCID: PMC6604578 DOI: 10.1515/iss-2018-0014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 06/26/2018] [Indexed: 01/06/2023] Open
Abstract
Intraoperative valuation of organ and tissue microperfusion is always a current topic in different surgical situations. Although indocyanine green fluorescent imaging (ICG-FI) has turned to be a more and more common technique to evaluate organ perfusion, only few studies tried to quantitatively validate the technique for microperfusion assessment. The aim of the following manuscript is to present the results of our interdisciplinary research confirming additional quantitative assessment tools in different surgical conditions. Thus, we are implementing the background-subtracted peak fluorescent intensity (BSFI), the slope of fluorescence intensity (SFI), and the time to slope (TTS) using ICG-FI in several regions of interest (ROI).
Collapse
Affiliation(s)
- Anna Duprée
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
- Anna Dupréee and Henrik Rieß contributed equally to the manuscript
| | - Henrik Rieß
- Department of Vascular Medicine, University Heart Center, University Medical Center, Hamburg-Eppendorf, Germany
- Anna Dupréee and Henrik Rieß contributed equally to the manuscript
| | - Christian Detter
- Centre of Cardiology and Cardiovascular Surgery, University Hospital Eppendorf, Hamburg, Germany
| | - Eike S. Debus
- Department of Vascular Medicine, University Heart Center, University Medical Center, Hamburg-Eppendorf, Germany
| | - Sabine H. Wipper
- Department of Vascular Medicine, University Heart Center, University Medical Center, Hamburg-Eppendorf, Germany
| |
Collapse
|
37
|
Dorweiler B, Trinh TT, Dünschede F, Vahl CF, Debus ES, Storck M, Diener H. The marine Omega3 wound matrix for treatment of complicated wounds: A multicenter experience report. Gefasschirurgie 2018; 23:46-55. [PMID: 30147244 PMCID: PMC6096721 DOI: 10.1007/s00772-018-0428-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Introduction The Kerecis™ Omega3 Wound matrix is a decellularized skin matrix derived from fish skin and represents an innovative concept to achieve wound healing. The aim of this study was to report the cumulative experience of three centers for vascular surgery regarding use of the Omega3 Wound matrix in selected patients with complicated wounds. Material and methods In this study 23 patients with 25 vascular and/or diabetes mellitus-associated complicated wounds and partially exposed bony segments were treated with the Omega3 Wound matrix in three vascular centers. In several patients, conventional wound treatment with vacuum therapy had previously been carried out sometimes over several weeks without durable success. Following initial debridement in the operating room, the matrix was applied and covered with a silicone mesh. In the further course, wound treatment was conducted on an outpatient setting if possible. Results In total 25 wounds were treated with localization at the level of the thigh (n = 2), the distal calf (n = 7), the forefoot (n = 14) and the hand (n = 2). The time to heal varied between 9 and 41 weeks and between 3 and 26 wound matrices were applied per wound. Interestingly, a reduction of analgesics intake was noted when the treatment with the Omega3 Wound matrix was initiated. Conclusion The novel Omega3 Wound matrix in this study represented an effective treatment option in 25 complicated wounds. Further studies are necessary to evaluate the impact of the wound matrix on stimulation of granulation tissue and re-epithelialization as well as the potential antinociceptive and analgetic effects.
Collapse
Affiliation(s)
- B Dorweiler
- 1Vascular Surgical Unit, Department of Cardiac, Thoracic, and Vascular Surgery, Mainz University Hospital, Langenbeckstraße 1, 55131 Mainz, Germany
| | - T T Trinh
- 1Vascular Surgical Unit, Department of Cardiac, Thoracic, and Vascular Surgery, Mainz University Hospital, Langenbeckstraße 1, 55131 Mainz, Germany
| | - F Dünschede
- 1Vascular Surgical Unit, Department of Cardiac, Thoracic, and Vascular Surgery, Mainz University Hospital, Langenbeckstraße 1, 55131 Mainz, Germany
| | - C F Vahl
- 1Vascular Surgical Unit, Department of Cardiac, Thoracic, and Vascular Surgery, Mainz University Hospital, Langenbeckstraße 1, 55131 Mainz, Germany
| | - E S Debus
- 2Department and Outpatient Clinic for Vascular Medicine, University Heart Center Hamburg, Hamburg-Eppendorf University Hospital, Hamburg, Germany
| | - M Storck
- Department of Vascular and Thoracic Surgery, Karlsruhe Hospital, Karlsruhe, Germany
| | - H Diener
- 2Department and Outpatient Clinic for Vascular Medicine, University Heart Center Hamburg, Hamburg-Eppendorf University Hospital, Hamburg, Germany
| |
Collapse
|
38
|
Behrendt CA, Rieß HC, Schwaneberg T, Larena-Avellaneda A, Kölbel T, Tsilimparis N, Spanos K, Debus ES, Sedrakyan A. Incidence, Predictors, and Outcomes of Colonic Ischaemia in Abdominal Aortic Aneurysm Repair. Eur J Vasc Endovasc Surg 2018; 56:507-513. [PMID: 30037737 DOI: 10.1016/j.ejvs.2018.06.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 02/24/2018] [Accepted: 06/06/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE/BACKGROUND Colonic ischaemia (CI) is a severe complication following abdominal aortic aneurysm (AAA) repair, leading to high morbidity and mortality. The aim of the study was to determine the incidence, predictors, and outcomes of CI following AAA repair. METHODS National claims from Germany's third largest insurance provider, DAK-Gesundheit, were used to investigate CI after intact (iAAA) and ruptured (rAAA) AAA repairs. Patients undergoing endovascular (EVAR) or open surgical (OSR) repairs between January 2008 and December 2017 were included in the study. RESULTS There were 9145 patients (8248 iAAA and 897 rAAA) undergoing EVAR or OSR procedures and the median follow up was 2.28 years. Most patients were male (79.2% iAAA, 79.3% rAAA); the median age was 73.0 years (iAAA group) and 76.0 years (rAAA group). Overall, CI occurred 97 (1.2%) times after iAAA and 95 (10.6%) after rAAA. In univariable analyses CI occurred less often after EVAR than after OSR (0.6% vs. 3.7%; p < .001). Acute post-operative renal and respiratory insufficiencies were also related to the occurrence of CI (p < .001). CI was associated with greater in hospital mortality (42.2% vs. 2.7% for iAAA, 64.2% vs. 36.3% for rAAA; p < .001) and lower long-term survival for iAAA (Kaplan-Meier analysis). In multivariable analyses, rAAA (odds ratio [OR] 5.59), and higher van Walraven comorbidity score (OR 1.09) were independently associated with greater risk of CI occurrence. EVAR use (OR 0.30) was protective. EVAR use remained protective in stratified analyses within iAAA (OR 0.32) and rAAA (OR 0.26). CONCLUSION Post-operative CI after AAA repair is not common but is associated with worse in hospital outcomes and lower long-term survival. EVAR was protective after both rAAA and iAAA repairs. When discussing the treatment of AAA with patients the protective effect of EVAR should be considered. Future studies should validate predictive scores and advance preventive strategies.
Collapse
Affiliation(s)
- Christian-Alexander Behrendt
- Department of Vascular Medicine, Working Group German Vasc, German Aortic Center Hamburg, University Heart Center Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
| | - Henrik C Rieß
- Department of Vascular Medicine, Working Group German Vasc, German Aortic Center Hamburg, University Heart Center Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Thea Schwaneberg
- Department of Vascular Medicine, Working Group German Vasc, German Aortic Center Hamburg, University Heart Center Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Axel Larena-Avellaneda
- Department of Vascular Medicine, Working Group German Vasc, German Aortic Center Hamburg, University Heart Center Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Tilo Kölbel
- Department of Vascular Medicine, Working Group German Vasc, German Aortic Center Hamburg, University Heart Center Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Nikolaos Tsilimparis
- Department of Vascular Medicine, Working Group German Vasc, German Aortic Center Hamburg, University Heart Center Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Kostas Spanos
- Department of Vascular Medicine, Working Group German Vasc, German Aortic Center Hamburg, University Heart Center Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Eike S Debus
- Department of Vascular Medicine, Working Group German Vasc, German Aortic Center Hamburg, University Heart Center Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Art Sedrakyan
- Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
| |
Collapse
|
39
|
Rohlffs F, Spanos K, Tsilimparis N, Debus ES, Kölbel T. Techniques and outcomes of false lumen embolization in chronic type B aortic dissection. J Cardiovasc Surg (Torino) 2018; 59:784-788. [PMID: 29943961 DOI: 10.23736/s0021-9509.18.10638-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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
Endovascular strategies have been increasingly used for the treatment of chronic type B aortic dissection (cTBAD) offering better outcomes in terms of mortality and morbidity compared to open surgical repair. Aortic remodeling after standard TEVAR is less likely in cTBAD due to rigidity of the dissection membrane. Another limitation of endovascular therapy is continued retrograde false lumen perfusion with back-flow from distal entry tears. Treatment strategies in cTBAD should aim at false lumen thrombosis. There are many approaches to achieve this goal of false lumen thrombosis, but concepts as open surgery or fenestrated and branched endovascular repair are limited by either high technical and logistic demands to the surgeon or high rates of mortality and morbidity. False lumen embolization techniques offer less invasive treatment strategies with promising early results. The main strategies for false lumen embolization include the "cork in the bottle neck" technique, the Candy-Plug technique or the Knickerbocker-technique. This article describes technical aspects and early results of these new endovascular techniques of false lumen embolization in chronic aortic dissection.
Collapse
Affiliation(s)
- Fiona Rohlffs
- Department of Vascular Medicine, German Aortic Center, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany -
| | - Konstantinos Spanos
- Department of Vascular Medicine, German Aortic Center, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Nikolaos Tsilimparis
- Department of Vascular Medicine, German Aortic Center, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Eike S Debus
- Department of Vascular Medicine, German Aortic Center, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Tilo Kölbel
- Department of Vascular Medicine, German Aortic Center, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
40
|
Behrendt CA, Rieß HC, Schwaneberg T, Heidemann F, Tsilimparis N, Larena-Avellaneda AA, Diener H, Kölbel T, Debus ES. Complex endovascular treatment of intact aortic aneurysms: An analysis of health insurance claims data. Gefasschirurgie 2018; 23:32-38. [PMID: 29950794 PMCID: PMC5997118 DOI: 10.1007/s00772-018-0387-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background The complex endovascular repair of aortic aneurysms and dissections with fenestrated or branched stent grafts (FB-EVAR) remains challenging for interventional vascular surgery. To date, the evidence regarding treatment patterns and outcome measures consists of single center studies; however, it might be reasonable to validate results with multicenter real-world evidence. Methods Health insurance claims data from Germany’s third largest insurance provider, DAK-Gesundheit, were used to determine outcomes following FB-EVAR of non-ruptured thoracic aorta (TA) or thoracoabdominal including pararenal abdominal (TAA) aorta. The study included patients operated between January 2008 and April 2017. Results Included were 984 patients (18.1% female) who underwent FB-EVAR. Patients with treatment of the TA were younger (71.7 vs. 73.2 years, p < 0.001) and more often female (38.5% vs. 17.0%, p < 0.001) as compared to patients with treatment of TAA. In the TA group peripheral arterial disease was less frequent compared to the TAA group (67.3% vs. 80.4%, p = 0.036). Mortality was significantly (p < 0.001) higher following repair of the TAA compared to the TA at discharge (17.3% vs. 4.6%), at 30 days (26.9% vs. 8.2%) and at 90 days (34.6% vs. 10.1%). Patients with treatment of the TAA suffered more often from stroke as compared to the TA group (7.7% vs. 1.2%, p = 0.002). Conclusion In this large-scale German analysis of claims data, multicenter real-world evidence was different from single center studies regarding patient risk-factors and outcome measures. Validated multicenter registry studies could help to further investigate this topic in times of increasing procedures.
Collapse
Affiliation(s)
- C-A Behrendt
- Department of Vascular Medicine, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - H C Rieß
- Department of Vascular Medicine, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - T Schwaneberg
- Department of Vascular Medicine, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - F Heidemann
- Department of Vascular Medicine, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - N Tsilimparis
- Department of Vascular Medicine, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A-A Larena-Avellaneda
- Department of Vascular Medicine, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - H Diener
- Department of Vascular Medicine, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - T Kölbel
- Department of Vascular Medicine, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - E S Debus
- Department of Vascular Medicine, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
41
|
Behrendt CA, Joassart Ir A, Debus ES, Kolh P. The Challenge of Data Privacy Compliant Registry Based Research. Eur J Vasc Endovasc Surg 2018; 55:601-602. [DOI: 10.1016/j.ejvs.2018.02.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 02/11/2018] [Indexed: 11/26/2022]
|
42
|
Debus ES, Kölbel T, Duprée A, Daum G, Sandhu HK, Manzoni D, Wipper SH. Feasibility Study of a Novel Thoraco-abdominal Aortic Hybrid Device (SPIDER-graft) in a Translational Pig Model. Eur J Vasc Endovasc Surg 2017; 55:196-205. [PMID: 29290476 DOI: 10.1016/j.ejvs.2017.11.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 04/26/2017] [Accepted: 11/15/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND The hybrid SPIDER-graft consists of a proximal descending aortic stent graft and a conventional six branched Dacron graft for open abdominal aortic repair. Technical feasibility with regard to avoiding thoracotomy and extracorporeal circulation (ECC) during thoraco-abdominal aortic hybrid repair and peri-procedural safety of this novel device are unknown. MATERIAL AND METHODS This was a feasibility and safety study in domestic pigs (75-85 kg). The abdominal aorta including iliac bifurcation, left renal artery, and visceral arteries were exposed via retroperitoneal access. The right iliac branch was first temporarily anastomosed end to side to the distal aorta via partial clamping. During inflow reduction and infra-coeliac cross-clamping, the coeliac trunk (CT) was divided and the proximal stent graft portion of the SPIDER-graft was deployed into the descending aorta via the CT ostium. Retrograde visceral and antegrade aorto-iliac blood flow was maintained via the iliac side branch. The visceral, renal, and iliac arteries were sequentially anastomosed, finally replacing the first iliac end to side anastomosis. Technical success, blood flow, periods of ischaemia, and peri-procedural complications were evaluated after intra-operative completion angiography and post-operative computed tomography angiography. RESULTS Six animals underwent successful thoracic stent graft deployment and distal open reconstruction without peri-operative death. The median thoracic graft implantation time was 4.5 min, and the median ischaemia times before reperfusion were 10 min for the CT, 8 min for the superior mesenteric artery, 13 min for the right renal artery, and 22 min for the left renal artery. Angiography demonstrated appropriate graft implantation and blood flow measurements confirmed sufficient blood flow through all side branches. CONCLUSION In this translational pig model, thoraco-abdominal hybrid repair using the novel SPIDER-graft was successful in avoiding thoracotomy and ECC. Technical feasibility and safety appear promising, but need to be reassessed in humans.
Collapse
Affiliation(s)
- Eike S Debus
- Department for Vascular Medicine, University Heart Centre, University Hospital Eppendorf, Hamburg, Germany.
| | - Tilo Kölbel
- Department for Vascular Medicine, University Heart Centre, University Hospital Eppendorf, Hamburg, Germany
| | - Anna Duprée
- Department of General and Visceral Surgery, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Günter Daum
- Department for Vascular Medicine, University Heart Centre, University Hospital Eppendorf, Hamburg, Germany
| | - Harleen K Sandhu
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Daniel Manzoni
- Department for Vascular Medicine, University Heart Centre, University Hospital Eppendorf, Hamburg, Germany
| | - Sabine H Wipper
- Department for Vascular Medicine, University Heart Centre, University Hospital Eppendorf, Hamburg, Germany
| |
Collapse
|
43
|
Augustin M, Baade K, Heyer K, Price PE, Herberger K, Wild T, Engelhardt M, Debus ES. Quality-of-life evaluation in chronic wounds: comparative analysis of three disease-specific questionnaires. Int Wound J 2017; 14:1299-1304. [PMID: 28875518 DOI: 10.1111/iwj.12803] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 05/24/2017] [Revised: 07/06/2017] [Accepted: 07/07/2017] [Indexed: 11/27/2022] Open
Abstract
The study directly compared the feasibility and performance of three instruments measuring health-related quality of life (HRQoL) in chronic ulcers: the Freiburg Life Quality Assessment for wounds (FLQA-w), the Cardiff Wound Impact Schedule (CWIS) and the Würzburg Wound Score (WWS). The questionnaires were evaluated in a randomly assigned order in a longitudinal observational study of leg ulcer patients. Psychometric properties (internal consistency, responsiveness and construct validity) were analysed. Patient acceptance was recorded. Analysis of n = 154 patients revealed good internal consistency (Cronbach's alpha ≥ 0·85) for all instruments. There were minor floor effects in all questionnaires (<1%) and some ceiling effects in the CWIS. Construct validity was satisfactory, for example, correlation with EuroQoL-5D was r = 0·70 in the FLQA-w, r = 0·47/0·67/0·68 in the CWIS dimensions and r = 0·60 in the WWS. The proportion of missing values was higher in the CWIS, and overall patient acceptance was highest in the FLQA-w for wounds (54% best preferences) and lowest in the WWS (14%). In conclusion, the FLQA-w, the CWIS and the WWS are reliable, sensitive and valid instruments for the assessment of HRQoL in leg ulcers. However, they show differences in clinical feasibility and patient acceptance.
Collapse
Affiliation(s)
- Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Katrin Baade
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Kristina Heyer
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Patricia E Price
- Department of Wound Healing, School of Medicine, Cardiff University, Cardiff, UK
| | - Katharina Herberger
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Thomas Wild
- Department of Dermatology, Venereology, Allergology, and Immunology, Dessau Medical Center, Dessau, Germany
| | - Michael Engelhardt
- Department of Vascular and Endovascular Surgery, Military Hospital Ulm, Ulm, Germany
| | - Eike S Debus
- University Heart Center, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| |
Collapse
|
44
|
Debus ES, Behrendt CA. Commentary on "Renal Complications After EVAR With Suprarenal Versus Infrarenal Fixation Among All Users and Routine Users". Eur J Vasc Endovasc Surg 2017; 54:294. [PMID: 28705452 DOI: 10.1016/j.ejvs.2017.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 06/07/2017] [Indexed: 11/18/2022]
Affiliation(s)
- E S Debus
- Department for Vascular Medicine, Vascular Surgery - Angiology - Endovascular Interventions, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
| | - C-A Behrendt
- Department for Vascular Medicine, Vascular Surgery - Angiology - Endovascular Interventions, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| |
Collapse
|
45
|
Kim GY, Lawrence PF, Moridzadeh RS, Zimmerman K, Munoz A, Luna-Ortiz K, Oderich GS, de Francisco J, Ospina J, Huertas S, de Souza LR, Bower TC, Farley S, Gelabert HA, Kret MR, Harris EJ, De Caridi G, Spinelli F, Smeds MR, Liapis CD, Kakisis J, Papapetrou AP, Debus ES, Behrendt CA, Kleinspehn E, Horton JD, Mussa FF, Cheng SWK, Morasch MD, Rasheed K, Bennett ME, Bismuth J, Lumsden AB, Abularrage CJ, Farber A. New predictors of complications in carotid body tumor resection. J Vasc Surg 2017; 65:1673-1679. [PMID: 28527929 DOI: 10.1016/j.jvs.2016.12.124] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 12/10/2016] [Indexed: 12/29/2022]
Abstract
OBJECTIVE This study examined the relationship between two new variables, tumor distance to base of skull (DTBOS) and tumor volume, with complications of carotid body tumor (CBT) resection, including bleeding and cranial nerve injury. METHODS Patients who underwent CBT resection between 2004 and 2014 were studied using a standardized, multi-institutional database. Demographic, perioperative, and outcomes data were collected. CBT measurements were determined from computed tomography, magnetic resonance imaging, and ultrasound examination. RESULTS There were 356 CBTs resected in 332 patients (mean age, 51 years; 72% female); 32% were classified as Shamblin I, 43% as Shamblin II, and 23% as Shamblin III. The mean DTBOS was 3.3 cm (standard deviation [SD], 2.1; range, 0-10), and the mean tumor volume was 209.7 cm3 (SD, 266.7; range, 1.1-1642.0 cm3). The mean estimated blood loss (EBL) was 257 mL (SD, 426; range, 0-3500 mL). Twenty-four percent of patients had cranial nerve injuries. The most common cranial nerves injured were the hypoglossal (10%), vagus (11%), and superior laryngeal (5%) nerves. Both Shamblin grade and DTBOS were statistically significantly correlated with EBL of surgery and cranial nerve injuries, whereas tumor volume was statistically significantly correlated with EBL. The logistic model for predicting blood loss and cranial nerve injury with all three variables-Shamblin, DTBOS, and volume (R2 = 0.171, 0.221, respectively)-was superior to a model with Shamblin alone (R2 = 0.043, 0.091, respectively). After adjusting for Shamblin grade and volume, every 1-cm decrease in DTBOS was associated with 1.8 times increase in risk of >250 mL of blood loss (95% confidence interval, 1.25-2.55) and 1.5 times increased risk of cranial nerve injury (95% confidence interval, 1.19-1.92). CONCLUSIONS This large study of CBTs demonstrates the value of preoperatively determining tumor dimensions and how far the tumor is located from the base of the skull. DTBOS and tumor volume, when used in combination with the Shamblin grade, better predict bleeding and cranial nerve injury risk. Furthermore, surgical resection before expansion toward the base of the skull reduces complications as every 1-cm decrease in the distance to the skull base results in 1.8 times increase in >250 mL of blood loss and 1.5 times increased risk of cranial nerve injury.
Collapse
Affiliation(s)
- Gloria Y Kim
- University of Michigan Health System, Ann Arbor, Mich; UCLA Health System, Los Angeles, Calif
| | | | - Rameen S Moridzadeh
- UCLA Health System, Los Angeles, Calif; NYU Langone Medical Center, New York, NY
| | | | | | | | | | | | | | | | | | | | | | | | - Marcus R Kret
- Colorado Cardiovascular Surgical Associates, Denver, Colo
| | - E John Harris
- Stanford University School of Medicine, Stanford, Calif
| | | | | | - Matthew R Smeds
- University of Arkansas for Medical Sciences, Little Rock, Ark
| | | | | | | | - Eike S Debus
- University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Joshua D Horton
- NYU Langone Medical Center, New York, NY; Medical University of South Carolina, Charleston, SC
| | - Firas F Mussa
- NYU Langone Medical Center, New York, NY; Columbia University, New York, NY
| | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Debus ES. Commentary on "Renal Arteries Stenosis in Patients with Peripheral Artery Disease: Prevalence, Risk Factors, and Long-Term Prognosis". Eur J Vasc Endovasc Surg 2017; 53:386. [PMID: 28189474 DOI: 10.1016/j.ejvs.2016.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 12/24/2016] [Indexed: 11/24/2022]
Affiliation(s)
- E S Debus
- Department for Vascular Medicine, Vascular Surgery - Endovascular Therapy - Angiology, University Heart Centre at University Medical Centre Hamburg-Eppendorf, Germany.
| |
Collapse
|
47
|
Abstract
Acute aortic thrombosis (AAT) is a rare life threatening event that leads to a sudden occlusion of the aorta. The mortality and morbidity of AAT is still high despite modern surgical techniques. Usually it is the result of a large saddle embolus to the aortic bifurcation, in situ thrombosis of an atherosclerotic aorta or acute occlusion of an abdominal aortic aneurysm. Clinical symptoms depend on the level of the aortic occlusion and can be mistaken for a stroke or similar neurological disease. The combination of age and advanced cardiac disease seems to be significant risks factors for AAT. In patients who have no cardiac or vascular disease this catastrophic event is very rare and is mostly due to hypercoagulable disorders. Revascularization of the ischemic organ/limb as soon as possible is the major aim in the therapy of AAT to avoid further ischemic damage. Surgical reperfusion is the first line approach. If the accepting clinic has no facilities for an immediate surgical intervention it is of primary importance that these patients should be referred to an appropriate center for further management. Paradox seems the fact that most of the patients die as a consequence of reperfusion injury/postperfusion syndrome that occurs after revascularization of acute ischemic limbs.
Collapse
Affiliation(s)
- Mark Kaschwich
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center, University Hospital Eppendorf, Hamburg, Germany -
| | - Christian A Behrendt
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center, University Hospital Eppendorf, Hamburg, Germany
| | - Nikolaos Tsilimparis
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center, University Hospital Eppendorf, Hamburg, Germany
| | - Tilo Kölbel
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center, University Hospital Eppendorf, Hamburg, Germany
| | - Sabine H Wipper
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center, University Hospital Eppendorf, Hamburg, Germany
| | - Eike S Debus
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center, University Hospital Eppendorf, Hamburg, Germany
| |
Collapse
|
48
|
Behrendt CA, Heidemann F, Haustein K, Grundmann RT, Debus ES. Percutaneous endovascular treatment of infrainguinal PAOD: Results of the PSI register study in 74 German vascular centers. Gefasschirurgie 2016; 22:17-27. [PMID: 28715513 PMCID: PMC5306226 DOI: 10.1007/s00772-016-0202-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background The percutaneous infrainguinal stent (PSI) register study aimed to collate all percutaneous endovascular procedures for infrainguinal peripheral arterial occlusive disease (PAOD) conducted in 74 German vascular centers between September and November 2015 (3 months). In order to obtain representative results all consecutive treatment procedures had to be submitted by the participating trial centers. Material and methods This was a prospective, nonrandomized multicenter study design. All patients suffering from intermittent claudication (IC, Fontaine stage II) or critical limb ischemia (CLI, Fontaine stages III and IV) were included. Trial centers with less than 5 cases reported within the 3‑month trial period or centers that could not ensure the submission of all treated patients were excluded. Results In the final assessment 2798 treated cases from 74 trial centers were reported of which 65 (87.8 %) centers were under the leadership of a vascular surgeon. Approximately 33 % of the interventions in centers under the leadership of vascular surgeons were conducted by radiologists. Risk factors, especially chronic renal disease, diabetes and cardiac risk factors were significantly different between patients with IC and CLI. Of the patients with Fontaine stage II PAOD 41.3 % had 3 patent crural vessels compared to only 10.8 % of patients with Fontaine stage IV. With respect to peri-interventional complications, percutaneous endovascular treatment of IC was a safe procedure with severe complications in less than 1 % and no fatalities. Only 4.5 % of the procedures were conducted under ambulatory conditions. In the supragenual region self-expanding bare metal stents, standard percutaneous transluminal angioplasty (PTA) and drug-coated balloons were the most frequently used procedures. For interventions below the knee, standard PTA was the most commonly employed treatment. Conclusion The main aim of the PSI study was to obtain a realistic picture of percutaneous endovascular techniques used to treat suprapopliteal and infrapopliteal PAOD lesions and to describe the treatment procedures used by vascular specialists in Germany. To investigate the change in trends for treatment over time, this study has to be repeated in the future in order to test how quickly the results of randomized studies can be implemented in practice. Electronic supplementary material A complete list of the PSI study collaborators is available under doi: 10.1007/s00772-016-0202-2.
Collapse
Affiliation(s)
- C-A Behrendt
- Department of Vascular Medicine, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - F Heidemann
- Department of Vascular Medicine, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - K Haustein
- Department of Vascular Medicine, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - R T Grundmann
- German Institute of Vascular Medicine and Health Research (DIGG) of the DGG, Berlin, Germany
| | - E S Debus
- Department of Vascular Medicine, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | |
Collapse
|
49
|
Duprée A, Rieß H, Kroge PV, Izbicki JR, Debus ES, Mann O, Wipper S. Intraoperative Quantifizierung der neoösophagealen Mikroperfusion mittels ICG-Fluoreszenz. Zentralbl Chir 2016. [DOI: 10.1055/s-0036-1587523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
50
|
Tsilimparis N, Saleptsis V, Rohlffs F, Wipper S, Debus ES, Kölbel T. New developments in the treatment of ruptured AAA. J Cardiovasc Surg (Torino) 2016; 57:233-241. [PMID: 26784556] [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: 06/05/2023]
Abstract
Ruptured Abdominal Aortic Aneurysms (rAAA) represent the most common abdominal aortic emergency with an incidence of 6.3 per 100,000 inhabitants whereas the incidence of rAAA in the population over 65 years was 35.5/100.000 inhabitants. Early suspicion and diagnosis of rAAA is essential for good outcomes and over the past decades a great variety of perioperative management concepts, techniques and materials have been implemented to further improve the outcomes of this acute and life-threatening disease. Corner-stones for the improvement of outcomes include the introduction of management protocols for rAAA, the principle of hypotensive hemostasis and the introduction of endovascular techniques as well as the improved anesthesia and postoperative intensive care therapy with early identification and management of devastating complications such as the abdominal compartment syndrome. While the role of endovascular aortic repair in rAAA is not yet answered, it appears to be very promising especially in the presence of new techniques that could resolve a number of the problems restricting success of EVAR in rAAAs.
Collapse
Affiliation(s)
- Nikolaos Tsilimparis
- German Aortic Center, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg Germany -
| | | | | | | | | | | |
Collapse
|