1
|
Brouwers JJWM, van Doorn LP, Pronk L, van Wissen RC, Putter H, Schepers A, Hamming JF. Doppler Ultrasonography Derived Maximal Systolic Acceleration: Value Determination With Artificially Induced Stenosis. Vasc Endovascular Surg 2022; 56:472-479. [PMID: 35235487 PMCID: PMC9163776 DOI: 10.1177/15385744221076269] [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] [Indexed: 11/15/2022]
Abstract
In diagnosing peripheral arterial disease (PAD), medial arterial calcification (MAC) hampers arterial compression and could lead to unreliable ankle brachial index (ABI), toe brachial index (TBI) and toe pressure (TP). Doppler ultrasonography (DUS) derived maximal systolic acceleration (ACCmax) might be more accurate to diagnose PAD. In an in vitro study, a strong correlation between ACCmax and the severity of stenotic disease was determined. The aim of this study was to investigate the ACCmax in correlation with conventional non-invasive diagnostics in an in vivo setting. Methods: In twelve healthy individuals, an arterial stenosis was mimicked by compression on the common femoral artery by an ultrasounds probe, creating a local stenosis of 50%, 70% and 90%. The ABI, TBI, TP and several DUS parameters (including ACCmax) were assessed at the ankle during these different degrees of stenosis. All DUS parameters were measured separately by two observers to determine the interobserver variability. Results: Overall the ABI, TBI, TP, ACCmax, ACCsys and PSV decreased significantly when the degree of stenosis increased. The ACCmax showed the highest correlation with the degree of stenosis (r −.884), compared to ABI (r −.726), TBI (r −.716) and TP (r −.758). Furthermore, the interobserver variability of ACCmax was excellent, with an intraclass correlation coefficient (ICC) of .97. Conclusion: ACCmax is an accurate non-invasive DUS parameter to diagnose and assess the severity of a mimicked arterial stenosis in healthy individuals. Further prospective assessment of the clinical value of ACCmax and its potential benefits in patients with PAD is needed.
Collapse
Affiliation(s)
- Jeroen J W M Brouwers
- Department of Vascular Surgery, 4501Leiden University Medical Center, Leiden, The Netherlands.,Department of Surgery, HagaHospital, The Hague, The Netherlands
| | - Louk P van Doorn
- Department of Vascular Surgery, 4501Leiden University Medical Center, Leiden, The Netherlands
| | - Laurie Pronk
- Department of Vascular Surgery, 4501Leiden University Medical Center, Leiden, The Netherlands
| | - Rob C van Wissen
- Department of Vascular Surgery, 4501Leiden University Medical Center, Leiden, The Netherlands
| | - Hein Putter
- Department of Medical Statistics and Bioinformatics, 4501Leiden University Medical Center, Leiden, The Netherlands
| | - Abbey Schepers
- Department of Vascular Surgery, 4501Leiden University Medical Center, Leiden, The Netherlands
| | - Jaap F Hamming
- Department of Vascular Surgery, 4501Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
2
|
Brouwers JJWM, Jiang JFY, Feld RT, van Doorn LP, van Wissen RC, van Walderveen MAA, Hamming JF, Schepers A. A New Doppler-Derived Parameter to Quantify Internal Carotid Artery Stenosis: Maximal Systolic Acceleration. Ann Vasc Surg 2021; 81:202-210. [PMID: 34780944 DOI: 10.1016/j.avsg.2021.09.056] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Doppler ultrasonography (DUS) is used as initial measurement to diagnose and classify carotid artery stenosis. Local distorting factors such as vascular calcification can influence the ability to obtain DUS measurements. The DUS derived maximal systolic acceleration (ACCmax) provides a different way to determine the degree of stenosis. While conventional DUS parameters are measured at the stenosis itself, ACCmax is measured distal to the internal carotid artery (ICA) stenosis. The value of ACCmax in ICA stenosis was investigated in this study. MATERIAL AND METHODS All carotid artery DUS studies of a tertiary academic center were reviewed from October 2007 until December 2017. Every ICA was included once. The ACCmax was compared to conventional DUS parameters: ICA peak systolic velocity (PSV), and PSV ratio (ICA PSV/ CCA PSV). ROC-curve analysis was used to evaluate accuracy of ACCmax, ICA PSV and PSV ratio as compared to CT-angiography (CTA) derived stenosis measurement as reference test. RESULTS The study population consisted of 947 carotid arteries and was divided into 3 groups: <50% (710/947), 50-69% (109/947), and ≥70% (128/947). Between these groups ACCmax was significantly different. Strong correlations between ACCmax and ICA PSV (R2 0.88) and PSV ratio (R2 0.87) were found. In ROC subanalysis, the ACCmax had a sensitivity of 90% and a specificity of 89% to diagnose a ≥70% ICA stenosis, and a sensitivity of 82% and a specificity of 88% to diagnose a ≥50% ICA stenosis. For diagnosing a ≥50% ICA stenosis the area under the curve (AUC) of ACCmax (0.88) was significantly lower than the AUC of PSV ratio (0.94) and ICA PSV (0.94). To diagnose a ≥70% ICA stenosis there were no significant differences in AUC between ACCmax (0.89), PSV ratio (0.93) and ICA PSV (0.94). CONCLUSIONS ACCmax is an interesting additional DUS measurement in determining the degree of ICA stenosis. ACCmax is measured distal to the stenosis and is not hampered by local distorting factors at the site of the stenosis. ACCmax can accurately diagnose an ICA stenosis, but was somewhat inferior compared to ICA PSV and PSV ratio to diagnose a ≥50% ICA stenosis.
Collapse
Affiliation(s)
- Jeroen J W M Brouwers
- Department of Vascular Surgery, Leiden University Medical Center, The Netherlands; Department of Surgery, HagaHospital, The Hague, The Netherlands.
| | - Janey F Y Jiang
- Department of Radiology, Leiden University Medical Center, The Netherlands
| | - Robert T Feld
- Department of Vascular Surgery, Leiden University Medical Center, The Netherlands
| | - Louk P van Doorn
- Department of Vascular Surgery, Leiden University Medical Center, The Netherlands
| | - Rob C van Wissen
- Department of Vascular Surgery, Leiden University Medical Center, The Netherlands
| | | | - Jaap F Hamming
- Department of Vascular Surgery, Leiden University Medical Center, The Netherlands
| | - Abbey Schepers
- Department of Vascular Surgery, Leiden University Medical Center, The Netherlands
| |
Collapse
|
3
|
Nieuwstraten JA, van Doorn LP, Gebhardt WA, Hamming JF. Stakeholder Values and Preferences in Lower Limb Amputation for No-Option Chronic Limb Threatening Ischemia. Patient Prefer Adherence 2021; 15:1051-1059. [PMID: 34045851 PMCID: PMC8144360 DOI: 10.2147/ppa.s309366] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/15/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE This study focusses on identifying values and preferences of patients, caregivers and healthcare professionals who have dealt with lower limb amputation for no-option chronic limb threatening ischemia. No-option chronic limb threatening ischemia is defined as limb ischemia for which no treatment options exist and where lower limb amputation is necessary in the short term. The values and preferences identified in this study can help improve decision-making processes. PATIENTS AND METHODS This was a qualitative study, using semi-structured interviews to gather data from patients, caregivers and healthcare professionals. Participants were selected from the patient and employee population of an academic medical center in The Netherlands. Nine patients and seven caregivers who dealt with lower limb amputation for no-option chronic limb threatening ischemia six to twelve months prior to the interview and were not cognitively impaired were selected. Nine healthcare professionals dealing with patients with no-option chronic limb threatening ischemia and lower limb amputation were selected. RESULTS Lower limb amputation was explicitly discussed late in the disease process, sometimes during an emergency setting. Patients stated goals were never discussed, healthcare professionals stated they were. The most important goal for patients was to live independently after lower limb amputation. Patients and caregivers feel healthcare professionals should be upfront about the possible necessity of lower limb amputation. Reasons to undergo lower limb amputation were absence of treatment options, pain and wanting to enjoy life again. Participants indicated accelerating lower limb amputation was not a viable option. CONCLUSION All stakeholders reported overlapping values and preferences regarding main reasons for lower limb amputation, the primary goals after lower limb amputation, and the absence of a desire to accelerate lower limb amputation. The main difference in values and preferences is the preferred timing of discussing lower limb amputation.
Collapse
Affiliation(s)
- Jelle A Nieuwstraten
- Department of Vascular Surgery, Leiden University Medical Center, Leiden, the Netherlands
- Correspondence: Jelle A Nieuwstraten Department of Vascular Surgery, Leiden University Medical Center, Postzone K6-R, Postbus 9600, Leiden, RC, 2300, the NetherlandsTel +31 618849873 Email
| | - Louk P van Doorn
- Department of Vascular Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Winifred A Gebhardt
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, the Netherlands
| | - Jaap F Hamming
- Department of Vascular Surgery, Leiden University Medical Center, Leiden, the Netherlands
| |
Collapse
|
4
|
van Doorn LP, Sijberden JP, Brouwers JJWM, Goossens LD, Hamming JF. Validation of the Dutch translation of the Cardiff wound impact schedule for evaluation of the health‐related quality of life of patients with chronic wounds. Int Wound J 2020; 17:1225-1230. [PMID: 32350991 PMCID: PMC7540679 DOI: 10.1111/iwj.13388] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 03/09/2020] [Accepted: 04/02/2020] [Indexed: 11/30/2022] Open
Abstract
The aim of this study was to validate a Dutch translation of the Cardiff wound impact schedule (CWIS), a disease‐specific instrument to measure the health‐related quality of life (HRQoL) in patients with chronic leg ulcers. To achieve this, the original instrument was translated. A total of 83 patients with chronic lower leg ulcers were included and completed the translated instrument and SF36 at baseline after assessment of their wound severity. Follow‐up was performed 1 week after inclusion. The psychometric properties of the instrument were assessed. Construct validity was positively evaluated by an expert panel. Face validity was positively evaluated in a cognitive debriefing of a pilot group. Discriminant validity was assessed by correlating 1‐year amputation risk according to the Wound, Ischaemia, foot Infection classification system with the instrument scores. Significant correlation could not be proven. Criterion validity was assessed by correlating domain scores of the instrument with domain scores of the gold standard: SF36. Moderate to high correlation was calculated for most domains of the instrument. Test‐retest reliability and internal consistency were evaluated as acceptable. In conclusion, the Dutch translation of the CWIS is a valid and reliable disease‐specific instrument to assess the HRQoL in patients with chronic lower leg ulcers.
Collapse
Affiliation(s)
- Louk P. van Doorn
- Deparment of Surgery, Leiden University Medical Center Leiden The Netherlands
| | - Jasper P. Sijberden
- Deparment of Surgery, Leiden University Medical Center Leiden The Netherlands
| | | | | | - Jaap F. Hamming
- Deparment of Surgery, Leiden University Medical Center Leiden The Netherlands
| |
Collapse
|
5
|
Brouwers JJ, van Doorn LP, van Wissen RC, Putter H, Hamming JF. Using maximal systolic acceleration to diagnose and assess the severity of peripheral artery disease in a flow model study. J Vasc Surg 2020; 71:242-249. [DOI: 10.1016/j.jvs.2019.01.088] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 01/11/2019] [Indexed: 12/27/2022]
|
6
|
Abstract
Success rates of Maggot Debridement Therapy (MDT) differ, but range from 70% to 80%. In this article it is argued that wound closure is not always feasible and is not always the aim of the treatment. A patient is described in whom the intent of MDT was not wound closure, but infection removal, reduction of odor, and eventually prevention of a below knee amputation. This succeeded: the pain was diminished, the odor reduced, and the wound showed signs of healing. Still the patient died. In maggot literature, as with other wound treatments, outcome is recorded as closed or as failed. In our opinion, MDT has other indications besides wound closure.
Collapse
|
7
|
Stegeman SA, van Doorn LP, Calame JJ, Steenvoorde P. Use of Cadaveric Donor Skin to Predict Success of a Definitive Split-thickness Skin Graft in Complicated Wounds. Wounds 2010; 22:284-288. [PMID: 25901518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
UNLABELLED Split-thickness skin grafts (STSG) are used for covering large wound beds. This procedure is sometimes postponed due to a positive culture swab. In those cases, prolonged antibiotic therapy is advised. The present study shows that if a temporary cadaveric donor skin has good take, antibiotic therapy is not necessary and a normal STSG can be performed directly with acceptable results. METHODS Cadaveric donor skin was applied in 35 consecutive patients. If the cadaveric donor skin had a good take (adherence) to the wound bed, the patient was scheduled for a STSG. In cases where the cadaveric donor skin failed to take, the definitive skin graft procedure was postponed. In six consecutive cases the cadaveric donor skin was evaluated for possible pathological changes. RESULTS In 25 out of 35 patients the cadaveric donor skin had full take. In 22 of these 25 patients a STSG was performed, which led to 91% complete graft take rate. These patients were not treated routinely with antibiotics and if they were treated, surgery was not postponed. CONCLUSION Delaying STSG while waiting for swab culture results is not necessary if the cadaveric donor skin has good take 3 days after application; in such cases, the take (attachment) of a STSG in a complicated set of patients is > 90%. The cadaveric donor skin, with positive take, showed more granulocytic influx in the epidermal layer and more vitality than those with no adherence to the wound bed. Vascular in-growth was not noted in any of the cases .
Collapse
Affiliation(s)
- Sylvia A Stegeman
- Leiden University Medical Centre, Department of Surgery, Leiden, The Netherlands;
| | | | | | | |
Collapse
|
8
|
Vermeiden J, Doorn LPV, Da Costa A, Kaptein AA, Steenvoorde P. Coping Strategies Used By Patients With Chronic and/or Complex Wounds . Wounds 2009; 21:324-328. [PMID: 25902921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
UNLABELLED Objective. The aim of this study was to investigate coping strategies used by patients with chronic and/or complex wounds treated in an outpatient wound clinic. METHODS Coping strategies were assessed using the Utrecht Coping List (UCL). The Mini-Mental State Examination (MMSE) was used to assess the patient's cognitive functioning. Fifty patients were selected for this study. The wound etiologies studied were: diabetic foot ulcers, lower extremity ulcers, surgical wounds, trauma wounds, and pressure ulcers. RESULTS Scores on the coping measure for men and women differed significantly from the control groups. It was also found that each wound etiology showed a preference toward different coping strategies. Furthermore, 28% of the studied group had a lowered score on the MMSE, indicating possible cognitive impairments. CONCLUSION There might be an association between wound etiology and the coping strategy that is preferred; this knowledge could be used to guide treatment strategies used by clinicians. Further research could focus on the effects of coping strategies on wound healing rates .
Collapse
Affiliation(s)
- J Vermeiden
- Afd. Wondcentrum, Simon Smitweg, The Netherlands;
| | | | | | | | | |
Collapse
|
9
|
Leijnen M, Steenvoorde P, van Doorn LP, da Costa SA, Schuttevaer HM, van Leeuwen GAM, Oskam J. A Non-healing Sinus of the Lower Leg 5 Years After Vacuum-assisted Closure Therapy Due To a Gossypiboma. Wounds 2007; 19:227-230. [PMID: 26110367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Since its introduction, vacuum-assisted closure (V.A.C.® Therapy™, KCI, San Antonio,Tex) therapy has proven to be an adequate and noninvasive method in the treatment of complicated wounds. Vacuumassisted closure can be used in the treatment of many types of chronic wounds, such as venous stasis ulcers, pressure ulcers, dehisced surgical wounds, arterial and diabetic ulcers, and a wide variety of miscellaneous, long-existing wounds. Although complications related to its use are rare; localized superficial skin irritation is the most common complication reported in the literature. Further complications involve pain, infection, bleeding, and fluid depletion. Although rare, severe complications, such as toxic shock syndrome, anaerobic sepsis, or thrombosis have been reported. This case report presents an unusual complication of vacuum-assisted closure therapy, which to the authors' knowledge has only once been reported in the literature.
Collapse
|