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Leinweber ME, Geisbuesch P, Balzer K, Schmandra T, Karl T, Popp S, Hoffmann J, Schmitz-Rixen T, Jung G, Oikonomou K, Storck M, Balzer K, Kugelmann U, Schneider C, Engelhardt M, Petzold M, Weis-Mueller B, Wortmann M, Popp S, Grotemeyer D, Wenk H, Shayesteh-Kheslat R, Torsello G, Böckler D, Meisenbacher K, Hoffmann J, Schelzig H, Roopa Y, Strohschneider T, Noppeney T, Reichert V, Lorenz U, Pfister K, Damirchi S, Stojanovic T, Oberhuber A, Lobenstein B, Sagban TA, Pfeiffer T, Koller J, Sprenger C, Kruschwitz T, Schmedt CG, Marquardt F, Schmandra T, Bail D. Sex disparities in popliteal artery aneurysms. J Vasc Surg 2024; 79:1179-1186.e1. [PMID: 38145634 DOI: 10.1016/j.jvs.2023.12.036] [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] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/16/2023] [Accepted: 12/18/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE Only 5% of patients with popliteal artery aneurysms (PAAs) are female. Evidence on PAA treatment and outcomes in women is therefore scarce. The POPART Registry provides one of Europe's largest data collections regarding PAA treatment. Data on clinical presentation, aneurysm morphology, and perioperative outcomes after open surgical PAA repair in women will be presented. METHODS POPART is a multicenter, noninterventional registry for open and endovascular PAA repair, with 42 participating centers in Germany and Luxembourg. All patients aged >18 years who have been treated for PAA since 2010 are eligible for study inclusion. Data collection is based on an online electronic case report form. RESULTS Of the 1236 PAAs, 58 (4.8%) were in women. There were no significant differences in age or cardiopulmonary comorbidities. However, female patients had a lower prevalence of contralateral PAAs and abdominal aortic aneurysms (P < .05). PAAs in women were more likely to be symptomatic before surgery (65.5% vs 49.4%; P = .017), with 19% of women presenting with acute limb ischemia (vs 11%; P = .067). Women had smaller aneurysm diameters than men (22.5 mm vs 27 mm; P = .004) and became symptomatic at smaller diameters (20 mm vs 26 mm; P = .002). Only 8.6% of women and 11.6% of men underwent endovascular aneurysm repair (P > .05); therefore, the perioperative outcome analysis focused on open surgical repair. In total, 23.5% of women and 16.9% of men developed perioperative complications (P > .05). There were no differences in major cardiovascular events (P > .05), but women showed a higher incidence of impaired wound healing (15.7% vs 7.2%; P = .05) and major amputation (5.9% vs 1.1%; P = .027). Female sex was significantly associated with the need for nonvascular reinterventions within 30 days after surgery (odds ratio: 2.48, 95% confidence interval: 1.26-4.88), whereas no significant differences in the odds for vascular reinterventions were observed (odds ratio: 1.98, 95% confidence interval: 0.68-5.77). In the multiple logistic regression model, female sex, symptomatic PAAs, poor quality of outflow vessels, and graft material other than vein graft were independently associated with perioperative reinterventions. CONCLUSIONS Women have smaller PAAs, are more likely to be symptomatic before treatment, and are more often affected by nonvascular reinterventions in the perioperative course. As our understanding of aneurysmatic diseases in women continues to expand, sex-specific treatment strategies and screening options for women in well-selected cohorts with modified screening protocols should be continuously re-evaluated.
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Affiliation(s)
| | - Phillip Geisbuesch
- Department of Vascular and Endovascular Surgery, Klinikum Stuttgart, Stuttgart, Germany
| | - Kai Balzer
- Department of Vascular and Endovascular Surgery, St. Marien-Hospital, GFO-Kliniken, Bonn, Germany
| | - Thomas Schmandra
- Department of Vascular Surgery, Sana Klinikum Offenbach, Offenbach, Germany
| | - Thomas Karl
- Department of Vascular and Endovascular Surgery, Klinikum am Plattenwald, SLK-Kliniken Heilbronn GmbH, Bad Friedrichshall, Germany
| | - Sebastian Popp
- Department of Vascular Surgery, RoMed Klinik Wasserburg am Inn, Wasserburg am Inn, Germany
| | - Johannes Hoffmann
- Department of Vascular Surgery and Phlebology, Contilia Herz und Gefaeßzentrum, Essen, Germany
| | | | - Georg Jung
- Department of Vascular and Endovascular Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
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Bischoff M, Meisenbacher K, Rother U, Cotta L, Böhner H, Storck M, Behrendt CA. Awareness of smoking cessation amongst German vascular surgeons. VASA 2024; 53:129-134. [PMID: 38319124 DOI: 10.1024/0301-1526/a001113] [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] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Background: Smoking represents the well-known enemy of vascular well-being. Numerous previous studies emphasised the important role of smoking on the development and progression of atherosclerotic cardiovascular disease. The current study aimed to identify hurdles and barriers for an insufficient implementation of secondary prevention in the treatment of lower extremity peripheral arterial disease (PAD). Methods: All members of the German Society for Vascular Surgery and Vascular Medicine (DGG) with valid email addresses were invited to participate in an electronic survey on smoking. Results are descriptively presented. Results: Amongst 2716 invited participants, 327 (12%) submitted complete responses, thereof 33% women and 80% between 30 and 59 years old (87% board certified specialists). 83% were employed by hospitals (56% teaching hospital, 14% university, 13% non-academic) and 16% by outpatient facilities. 6% are active smokers (63% never) while a mean of five medical education activities on smoking cessation were completed during the past five years of practice. Only 27% of the institutions offered smoking cessation programs and 28% of the respondents were aware of local programs while a mean of 46% of their patients were deemed eligible for participation. 63% of the respondents deemed outpatient physicians primarily responsible for smoking cessation, followed by medical insurance (26%). Conclusions: The current nationwide survey of one scientific medical society involved in the care of patients with vascular disease revealed that smoking cessation, although being commonly accepted as important pillar of comprehensive holistic care, is not sufficiently implemented in everyday clinical practice.
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Affiliation(s)
- Moritz Bischoff
- Department of Vascular and Endovascular Surgery, University Medical Centre Heidelberg, Germany
| | - Katrin Meisenbacher
- Department of Vascular and Endovascular Surgery, University Medical Centre Heidelberg, Germany
| | - Ulrich Rother
- Department of Vascular Surgery, Friedrich Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- German Institute for Vascular Research, Berlin, Germany
| | - Livia Cotta
- German Institute for Vascular Research, Berlin, Germany
| | - Hinrich Böhner
- Department of Vascular Surgery, St. Rochus-Hospital Castrop-Rauxel, Dortmund, Germany
| | - Martin Storck
- Department of Vascular and Thoracic Surgery, Klinikum Karlsruhe, Academic Teaching Hospital, Germany
| | - Christian-Alexander Behrendt
- German Institute for Vascular Research, Berlin, Germany
- Department of Vascular and Endovascular Surgery, Asklepios Clinic Wandsbek, Asklepios Medical School, Hamburg, Germany
- Medical School Brandenburg Theodor-Fontane, Neuruppin, Germany
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Kroeger K, Buss VH, Shahab L, Storck M. Use of electronic nicotine delivery systems and cigarette smoking-Add-on vs. displacement dual use. Front Public Health 2024; 11:1281999. [PMID: 38239784 PMCID: PMC10794717 DOI: 10.3389/fpubh.2023.1281999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/06/2023] [Indexed: 01/22/2024] Open
Affiliation(s)
- Knut Kroeger
- Department of Angiology, HELIOS Klinikum Krefeld, Krefeld, Germany
| | - Vera Helen Buss
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Lion Shahab
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Martin Storck
- Department for Vascular and Thoracic Surgery, Städtisches Klinikum Karlsruhe gGmbH, Karlsruhe, Germany
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Abu Rached N, Kley S, Storck M, Meyer T, Stücker M. Cold Plasma Therapy in Chronic Wounds-A Multicenter, Randomized Controlled Clinical Trial (Plasma on Chronic Wounds for Epidermal Regeneration Study): Preliminary Results. J Clin Med 2023; 12:5121. [PMID: 37568525 PMCID: PMC10419810 DOI: 10.3390/jcm12155121] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/27/2023] [Accepted: 08/02/2023] [Indexed: 08/13/2023] Open
Abstract
Chronic wounds (CWs) pose a significant health challenge in clinical practice. Standard wound therapy (SWT) is currently considered the gold standard. However, recent evidence suggests that cold plasma therapy (CPT) holds promise for improving CWs. In light of this, the POWER study was conducted as a multicenter, randomized clinical trial to investigate the effect of large-area plasma application compared with SWT in patients with chronic, non-healing arterial or venous wounds on the lower leg. To analyze the interim results, we employed a comprehensive range of statistical tests, including both parametric and non-parametric methods, as well as GLS model regression and an ordinal mixed model. Our findings clearly demonstrate that CPT therapy significantly accelerates wound closure compared with SWT. In fact, complete wound closure was exclusively observed in the CPT group during the intervention period. Additionally, the CPT group required significantly less antibiotic therapy (4%) compared with the SWT group (23%). Furthermore, CPT led to a significant reduction in wound pain and improved quality of life compared with SWT. In conclusion, the study highlights that the combination of CPT and SWT surpasses monotherapy with SWT alone.
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Affiliation(s)
- Nessr Abu Rached
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Gudrunstr. 56, 44791 Bochum, Germany;
| | - Susanne Kley
- Scientific Institute for Health Economics and Health Research, Markt 9, 04109 Leipzig, Germany;
| | - Martin Storck
- Municipal Hospital Karlsruhe gGmbH, Moltkestraße 90, 76133 Karlsruhe, Germany;
| | - Thomas Meyer
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Gudrunstr. 56, 44791 Bochum, Germany;
| | - Markus Stücker
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Gudrunstr. 56, 44791 Bochum, Germany;
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Storck M. Struktur- und Qualitätsempfehlungen zur invasiven Behandlung der extrakraniellen Karotisstenose. Aktuelle Kardiologie 2022. [DOI: 10.1055/a-1693-2139] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ZusammenfassungDie Versorgungsqualität bei Eingriffen an der extrakraniellen A. carotis wird von der
Expertise des Operateurs, indirekt somit auch von Mindestmengen und außerdem von
Strukturmerkmalen der behandelnden Einrichtungen beeinflusst. In einer kurzen Übersicht werden
aktuelle Analysen aus dem Bereich der Versorgungsforschung sowie die aktuellen
Leitlinien-Empfehlungen dargelegt. Die Mindestmenge von 20 Eingriffen pro Jahr bei Operationen
(CEA) und 10 Eingriffen bei Stentangioplastien (CAS) sollte nach derzeitiger Empfehlung nicht
unterschritten werden. Eine 24-Stunden-Verfügbarkeit von Fachärzten sowie der
Bildgebungsverfahren (CT, MRA) wird empfohlen, optimalerweise auch eine organisierte enge
Kooperation mit Neuro-Interventionalisten sowie einer Stroke Unit.
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Affiliation(s)
- Martin Storck
- Klinik für Gefäß- und Thoraxchirurgie, Städtisches Klinikum Karlsruhe gGmbH, Karlsruhe, Deutschland
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Eckstein HH, Kühnl A, Berkefeld J, Lawall H, Storck M, Sander D. [Webinar for S3 guideline "diagnosis, treatment, and aftercare of extracranial carotid stenosis"]. Chirurg 2021; 92:383-384. [PMID: 33792754 DOI: 10.1007/s00104-021-01393-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Hans-Henning Eckstein
- Klinikum rechts der Isar der Technischen Universität München (TUM), Ismaningerstraße 22, 81675, München, Deutschland.
| | - Andreas Kühnl
- Klinikum rechts der Isar der Technischen Universität München (TUM), Ismaningerstraße 22, 81675, München, Deutschland
| | | | | | | | - Dirk Sander
- Benedictus Krankenhaus Tutzing, Tutzing, Deutschland
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7
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Eckstein HH, Kühnl A, Berkefeld J, Lawall H, Storck M, Sander D. Diagnosis, Treatment and Follow-up in Extracranial Carotid Stenosis. Dtsch Arztebl Int 2021; 117:801-807. [PMID: 33549156 DOI: 10.3238/arztebl.2020.0801] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/05/2020] [Accepted: 06/22/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Around 15% of cerebral ischemias are caused by lesions of the extracranial carotid artery. The goal of this guideline is to provide evidence- and consensus-based recommendations for the management of patients with extracranial carotid stenoses throughout Germany and Austria. METHODS A systematic literature search (1990-2019) and methodical assessment of existing guidelines and systematic reviews; consensus-based answers to 37 key questions with evidence-based recommendations. RESULTS The prevalence of extracranial carotid artery stenoses is around 4% overall, higher from the age of 65 years. The most important examination modality is duplex sonography. Randomized trials have shown that carotid endarterectomy (CEA) significantly reduces the 5-year risk of stroke in patients with 60-99 % asymptomatic stenoses (absolute risk reduction [ARR] 4.1% over 5 years, number needed to treat [NNT] 24) or 50-99% symptomatic stenoses (50-69%: ARR 4.6 % over 5 years, NNT 22; 70-99%: 15.9 % over 5 years, NNT 6). With the aid of intensive conservative treatment, the carotid artery-associated risk of stroke can be reduced to as little as 1% per year. Critical determination of indications and strict quality criteria are therefore necessary for CEA and carotid artery stenting (CAS). Systematic reviews of controlled trials comparing CEA and CAS show that the procedural risk of stroke is higher for CAS (asymptomatic: 2.6% versus 1.3%; symptomatic: 6.2% versus 3.8%). There are no differences in the long term. CEA is recommended as standard procedure for high-grade asymptomatic and moderate to high-grade symptomatic carotid artery stenoses; CAS may be considered as an alternative. For both procedures, the periprocedural combined rate of stroke or death should not exceed 2% for asymptomatic stenoses or 4% for symptomatic stenoses. CONCLUSION Future studies should evaluate even better selection criteria for optimal individualized treatment, whether conservative, surgical, or endovascular.
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Affiliation(s)
- Hans-Henning Eckstein
- Spokesman (HHE) and Secretary (AK) of the Steering Group, Department forf Vascular and Endovascular Surgery, University Hospital "rechts der Isar", Technical University of Munich; Member of the Steering Group, Institute for Neuroradiology, University Hospital Frankfurt; Member of the Steering Group, Ettlingen; Member of the Steering Group, Department of Vascular and Thoracic Surgery, Karlsruhe Municipal Hospital Member of the Steering Group, Department of Neurology and Stroke Unit, Benedictus Hospital Tutzing; German Vascular Society (DGG); German Society of Neuroradiology (DGNR); German Society for Angiology/Vascular Medicine (DGA); German Society of Surgery (DGCH); German Society of Neurology (DGN)
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8
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Storck M, Sandmann S, Bruland P, Pereira MP, Steinke S, Riepe C, Soto-Rey I, Garcovich S, Augustin M, Blome C, Bobko S, Legat FJ, Potekaev N, Lvov A, Misery L, Weger W, Reich A, Şavk E, Streit M, Serra-Baldrich E, Szepietowski JC, Dugas M, Ständer S, Zeidler C. Pruritus Intensity Scales across Europe: a prospective validation study. J Eur Acad Dermatol Venereol 2021; 35:1176-1185. [PMID: 33411947 DOI: 10.1111/jdv.17111] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/01/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Chronic pruritus (CP) is a subjective symptom, and it is necessary to assess its intensity with validated patient-reported outcome tools in order to allow determination of the treatment course. OBJECTIVES So far, the itch intensity scales were validated in small cohorts and in single languages. Here, we report the validation of the numerical rating scale, the verbal rating scale and the visual analogue scale for the worst and average pruritus intensity in the last 24h in several languages across Europe and across different pruritic dermatoses. METHODS After professional translation, the intensity scales were digitized for use as a tablet computer application. Validation was performed in clinics for Dermatology in Austria, France, Germany, Italy, Poland, Russia, Spain, Switzerland and Turkey. RESULTS A total of 547 patients with contact dermatitis, chronic nodular prurigo, psoriasis vulgaris, lichen planus or cutaneous T-cell lymphoma were included. The intensity scales showed a high level of reproducibility and inter-correlations with each other. The correlation with the Dermatology Life Quality Index was weak to strong in nearly all countries and dermatoses with the exception of France and patients with chronic nodular prurigo, for which no statistically significant correlations were found. CONCLUSIONS The numerical rating scale, the verbal rating scale und the visual analogue scales are valid instruments with good reproducibility and internal consistency in German (Germany, Austria, Switzerland), French, Italian, Polish, Russian, Spanish and Turkish for different pruritic dermatoses. VAS worst was the best reproducible and consistent measuring instrument in all countries.
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Affiliation(s)
- M Storck
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - S Sandmann
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - P Bruland
- Institute of Medical Informatics, University of Münster, Münster, Germany.,inIT - Institute Industrial IT, Ostwestfalen-Lippe University of Applied Sciences, Lemgo, Germany
| | - M P Pereira
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - S Steinke
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - C Riepe
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - I Soto-Rey
- Institute of Medical Informatics, University of Münster, Münster, Germany.,IT-Infrastructure for Translational Medical Research, Faculty of Applied Computer Science, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - S Garcovich
- Dermatology, F. Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - M Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Blome
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Bobko
- Moscow Scientific and Practical Center of Dermatovenerology and Cosmetology, Moscow, Russia
| | - F J Legat
- Department of Dermatology, Medical University of Graz, Graz, Austria.,Das Kurhaus, Bad Gleichenberg, Austria
| | - N Potekaev
- Moscow Scientific and Practical Center of Dermatovenerology and Cosmetology, Moscow, Russia
| | - A Lvov
- Moscow Scientific and Practical Center of Dermatovenerology and Cosmetology, Moscow, Russia
| | - L Misery
- Department of Dermatology, University Hospital of Brest, Brest, France
| | - W Weger
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - A Reich
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszów, Poland
| | - E Şavk
- Department of Dermatology, Aydin Adnan Menderes University, Aydin, Turkey
| | - M Streit
- Department of Dermatology, Kantonsspital Aarau, Aarau, Switzerland
| | - E Serra-Baldrich
- Cutaneous Allergy Unit, Department of Dermatology, Hospital Sant Pau, Universitat Autònoma, Barcelona, Barcelona, Spain
| | - J C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - M Dugas
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - S Ständer
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - C Zeidler
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
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Zeidler C, Pereira MP, Dugas M, Augustin M, Storck M, Weyer-Elberich V, Schneider G, Ständer S. The burden in chronic prurigo: patients with chronic prurigo suffer more than patients with chronic pruritus on non-lesional skin: A comparative, retrospective, explorative statistical analysis of 4,484 patients in a real-world cohort. J Eur Acad Dermatol Venereol 2020; 35:738-743. [PMID: 32924186 DOI: 10.1111/jdv.16929] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/05/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Chronic prurigo (CPG) is known as a high burdensome disease characterized by severe pruritus and multiple pruriginous lesions. Interestingly, the disease-specific burden is not well established and there are no data which compare the impact of CPG with chronic pruritus (CP) on non-lesional skin (CP-NL). OBJECTIVES To address this issue, we analysed datasets from 4484 patients with either CPG or CP-NL. METHODS Demographic medical data and additional information collected by validated patient reported outcome tools were analysed. The visual analogue scale and numerical rating scale (NRS) were used for assessing the pruritus intensity, the ItchyQoL for patients' quality of life, the Hospital Anxiety and Depression Scale and the Patient Needs Questionnaire' as a part of Patient Benefit Index for Pruritus for measuring the importance of 27 patient needs in terms of treatment goals. The Neuroderm questionnaire was used to assess the history of pruritus characteristics and the impact on sleep. RESULTS Patients with CPG suffered longer and with a higher intensity from pruritus [NRS worst the last 24 h, CPG 6.0 (4.0;8.0) vs. CP-NL 3.0 (5.0;7.0), P < 0.001]. In them, pruritus occurred more often and the whole day and night which led to more loss in sleeping hours [CPG 3.0 h (2.0;4.0) vs. CP-NL 2.0 h (1.0;4.0), P < 0.001]. Patients with CPG showed higher scores for depression [HADS-D, CPG 6.0 (3.0;10.0) vs. CP-NL 5.0 (2.0;8.0), P < 0.001], more impaired quality of life [ItchyQol; CPG: 72.6 (61.6;83.6) vs. CP-NL 59.4 (48.4;70.4), P < 0.001] and higher weighted needs in the predefined treatment goals. DISCUSSION Not only the presence of severe pruritus and pruriginous lesions but also sleep disorders and other mental symptoms may contribute to a higher burden in patients with CPG when compared with patients with CP-NL.
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Affiliation(s)
- C Zeidler
- Center for Chronic Pruritus, University Hospital Münster, Muenster, Germany
| | - M P Pereira
- Center for Chronic Pruritus, University Hospital Münster, Muenster, Germany
| | - M Dugas
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - M Augustin
- German 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
| | - M Storck
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - V Weyer-Elberich
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - G Schneider
- Department of Psychosomatics and Psychotherapy, University Hospital Münster, Muenster, Germany
| | - S Ständer
- Center for Chronic Pruritus, University Hospital Münster, Muenster, Germany
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Stavroulakis K, Gkremoutis A, Borowski M, Torsello G, Böckler D, Zeller T, Steinbauer M, Tsilimparis N, Bisdas T, Adili F, Balzer K, Billing A, Brixner D, Debus SE, Florek HJ, Grundmann R, Hupp T, Keck T, Gerß J, Wojciech K, Lang W, May B, Meyer A, Mühling B, Oberhuber A, Reinecke H, Reinhold C, Ritter RG, Schelzig H, Schlensack C, Schmitz-Rixen T, Schulte KL, Spohn M, Storck M, Trede M, Uhl C, Weis-Müller B, Wenk H, Zhorzel S, Zimmermann A. Bypass Grafting vs Endovascular Therapy in Patients With Non-Dialysis-Dependent Chronic Kidney Disease and Chronic Limb-Threatening Ischemia (CRITISCH Registry). J Endovasc Ther 2020; 27:599-607. [DOI: 10.1177/1526602820938465] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Purpose: To report the outcomes of bypass grafting (BG) vs endovascular therapy (EVT) in patients with non-dialysis-dependent chronic kidney disease (CKD) and chronic limb-threatening ischemia (CLTI). Materials and Methods: The CRITISCH Registry is a prospective, national, interdisciplinary, multicenter registry evaluating the current practice of all available treatment options in 1200 consecutive CLTI patients. For the purposes of this analysis, only the 337 patients with non-dialysis-dependent CKD treated by either BG (n=86; median 78 years, 48 men) or EVT (n=251; median age 80 years, 135 men) were analyzed. The primary composite outcome was amputation-free survival (AFS); secondary outcomes were overall survival (OS) and amputation-free time (AFT). All outcomes were evaluated in Cox proportional hazards models; the results are reported as the hazard ratio (HR) and 95% confidence interval (CI). Results: The Cox regression analysis revealed a significantly greater hazard of amputation or death after BG (HR 1.78, 95% CI 1.05 to 3.03, p=0.028). The models for AFT and overall survival also suggested a higher hazard for BG, but the differences were not significant (AFT: HR 1.66, 95% CI 0.78 to 3.53, p=0.188; OS: HR 1.41, 95% CI 0.80 to 2.47, p=0.348). The absence of runoff vessels (HR 1.73, 95% CI 1.15 to 2.60, p=0.008) was associated with a decreased AFS. The likelihood of amputation was higher in male patients (HR 2.21, 95% CI 1.10 to 4.45, p=0.027) and was associated with a lack of runoff vessels (HR 1.95, 95% CI 0.96 to 3.95, p=0.065) and myocardial infarction (HR 3.74, 95% CI 1.23 to 11.35, p=0.020). Death was more likely in patients without runoff vessels (HR 1.76, 95% CI 1.11 to 2.80, p=0.016) and those with a higher risk score (HR 1.73, 95% CI 1.03 to 2.91, p=0.038). Conclusion: This analysis suggested that BG was associated with poorer AFS than EVT in patients with non-dialysis-dependent CKD and CLTI. Male sex, previous myocardial infarction, and the absence of runoff vessels were additionally identified as predictors of poorer outcomes.
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Affiliation(s)
- Konstantinos Stavroulakis
- Department of Vascular Surgery, St. Franziskus Hospital Münster, Germany
- Department of Vascular Surgery, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Asimakis Gkremoutis
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust, London, UK
| | - Matthias Borowski
- Institute of Biostatistics and Clinical Research, Westfälische Wilhelms-Universität Münster, Germany
| | - Giovanni Torsello
- Department of Vascular Surgery, St. Franziskus Hospital Münster, Germany
| | - Dittmar Böckler
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Germany
| | - Thomas Zeller
- Clinic Cardiology and Angiology II, Universitäts-Herzzentrum Freiburg–Bad Krozingen, Bad Krozingen, Germany
| | - Markus Steinbauer
- Department of Vascular Surgery, Barmherzige Brueder Regensburg, Germany
| | - Nikolaos Tsilimparis
- Department of Vascular Surgery, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Theodosios Bisdas
- Department of Vascular Surgery, St. Franziskus Hospital Münster, Germany
- Department of Vascular and Endovascular Surgery, Athens Medical Center, Athens, Greece
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Pereira MP, Hoffmann V, Weisshaar E, Wallengren J, Halvorsen JA, Garcovich S, Misery L, Brenaut E, Savk E, Potekaev N, Lvov A, Bobko S, Szepietowski JC, Reich A, Bozek A, Legat FJ, Metz M, Streit M, Serra-Baldrich E, Gonçalo M, Storck M, Greiwe I, Nau T, Steinke S, Dugas M, Ständer S, Zeidler C. Chronic nodular prurigo: clinical profile and burden. A European cross-sectional study. J Eur Acad Dermatol Venereol 2020; 34:2373-2383. [PMID: 32078192 DOI: 10.1111/jdv.16309] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/27/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Chronic nodular prurigo (CNPG) is a condition characterized by chronic itch, a prolonged scratching behaviour and the presence of pruriginous nodules. A comprehensive understanding of this condition, especially regarding its clinical characteristics and impact on quality of life is still lacking. OBJECTIVES Aim of this pan-European multicentre cross-sectional study was to establish the clinical profile of CNPG, including its associated burden. METHODS Fifteen centres from 12 European countries recruited CNPG patients presenting at the centre or using the centres' own databases. Patients were asked to complete a questionnaire in paper or electronic format. Demography, current co-morbidities, underlying disease, itch intensity, additional sensory symptoms, quality of life, highest burden and emotional experience of itch were assessed. RESULTS A total of 509 patients (210 male, median age: 64 years [52; 72]) were enrolled. Of these, 406 reported itch and CNPG lesions in the previous 7 days and qualified to complete the whole questionnaire. We recorded moderate to severe worst itch intensity scores in the previous 24 h. Scores were higher in patients with lower educational levels and those coming from Eastern or Southern Europe. Most patients experience itch often or always (71%) and report that their everyday life is negatively affected (53%). Itch intensity was considered to be the most burdensome aspect of the disease by 49% of the patients, followed by the visibility of skin lesions (21%) and bleeding of lesions (21%). The majority of patients was unaware of an underlying condition contributing to CNPG (64%), while psychiatric diseases were the conditions most often mentioned in association with CNPG (19%). CONCLUSIONS This multicentre cross-sectional study shows that itch is the dominant symptom in CNPG and reveals that the profile of the disease is similar throughout Europe.
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Affiliation(s)
- M P Pereira
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - V Hoffmann
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - E Weisshaar
- Occupational Medicine, Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - J Wallengren
- Department of Clinical Sciences Lund, Dermatology and Venereology and Skane University Hospital, Lund, Sweden
| | - J A Halvorsen
- Department of Dermatology, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - S Garcovich
- Institute of Dermatology, F. Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - L Misery
- Department of Dermatology, University Hospital of Brest, Brest, France
| | - E Brenaut
- Department of Dermatology, University Hospital of Brest, Brest, France
| | - E Savk
- Department of Dermatology, Aydin Adnan Menderes University, Aydın, Turkey
| | - N Potekaev
- Moscow Scientific and Practical Center of Dermatovenerology and Cosmetology, Moscow, Russia
| | - A Lvov
- Moscow Scientific and Practical Center of Dermatovenerology and Cosmetology, Moscow, Russia
| | - S Bobko
- Moscow Scientific and Practical Center of Dermatovenerology and Cosmetology, Moscow, Russia
| | - J C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - A Reich
- Department of Dermatology, University of Rzeszów, Rzeszów, Poland
| | - A Bozek
- Department of Dermatology, School of Medicine, University of Information Technology and Management, Rzeszow, Poland
| | - F J Legat
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - M Metz
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - M Streit
- Department of Dermatology, Kantonsspital Aarau, Aarau, Switzerland
| | | | - M Gonçalo
- Department of Dermatology, University Hospital and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - M Storck
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - I Greiwe
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - T Nau
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - S Steinke
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - M Dugas
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - S Ständer
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - C Zeidler
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
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Seidel D, Storck M, Lawall H, Wozniak G, Mauckner P, Hochlenert D, Wetzel-Roth W, Sondern K, Hahn M, Rothenaicher G, Krönert T, Zink K, Neugebauer E. Negative pressure wound therapy compared with standard moist wound care on diabetic foot ulcers in real-life clinical practice: results of the German DiaFu-RCT. BMJ Open 2020; 10:e026345. [PMID: 32209619 PMCID: PMC7202734 DOI: 10.1136/bmjopen-2018-026345] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES The aim of the DiaFu study was to evaluate effectiveness and safety of negative pressure wound therapy (NPWT) in patients with diabetic foot wounds in clinical practice. DESIGN In this controlled clinical superiority trial with blinded outcome assessment patients were randomised in a 1:1 ratio stratified by study site and ulcer severity grade using a web-based-tool. SETTING This German national study was conducted in 40 surgical and internal medicine inpatient and outpatient facilities specialised in diabetes foot care. PARTICIPANTS 368 patients were randomised and 345 participants were included in the modified intention-to-treat (ITT) population. Adult patients suffering from a diabetic foot ulcer at least for 4 weeks and without contraindication for NPWT were allowed to be included. INTERVENTIONS NPWT was compared with standard moist wound care (SMWC) according to local standards and guidelines. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome was wound closure within 16 weeks. Secondary outcomes were wound-related and treatment-related adverse events (AEs), amputations, time until optimal wound bed preparation, wound size and wound tissue composition, pain and quality of life (QoL) within 16 weeks, and recurrences and wound closure within 6 months. RESULTS In the ITT population, neither the wound closure rate (difference: n=4 (2.5% (95% CI-4.7% - 9.7%); p=0.53)) nor the time to wound closure (p=0.244) was significantly different between the treatment arms. 191 participants (NPWT 127; SMWC 64) had missing endpoint documentations, premature therapy ends or unauthorised treatment changes. 96 participants in the NPWT arm and 72 participants in the SMWC arm had at least one AE (p=0.007), but only 16 AEs were related to NPWT. CONCLUSIONS NPWT was not superior to SMWC in diabetic foot wounds in German clinical practice. Overall, wound closure rate was low. Documentation deficits and deviations from treatment guidelines negatively impacted the outcome wound closure. TRIAL REGISTRATION NUMBERS NCT01480362 and DRKS00003347.
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Affiliation(s)
- Dörthe Seidel
- Institut für Forschung in der Operativen Medizin (IFOM), Universität Witten/Herdecke, Köln, Germany
| | - Martin Storck
- Klinik für Gefäß- und Thoraxchirurgie, Städtisches Klinikum Karlsruhe gGmbH, Karlsruhe, Germany
| | - Holger Lawall
- Praxis für Herzkreislauferkrankungen, Ettlingen, Germany
- Innere Medizin, Max-Grundig Klinik, Bühlerhöhe, Germany
| | - Gernold Wozniak
- Gefäßchirurgische Klinik, Knappschaftskrankenhaus Bottrop GmbH, Bottrop, Germany
| | - Peter Mauckner
- Innere Medizin, St. Remigius Krankenhaus Opladen, Leverkusen, Germany
| | - Dirk Hochlenert
- Gemeinschaftspraxis Schlotmann-Hochlenert-Zavaleta-Haberstock, Köln, Germany
| | | | - Klemens Sondern
- Klinik für Innere Medizin/Diabetologie, Marien Hospital Dortmund-Hombruch, Dortmund, Germany
| | - Matthias Hahn
- Allgemein- und Viszeralchirurgie, Helfenstein Klinik, Geisslingen, Germany
| | | | - Thomas Krönert
- Klinik für Gefäßchirurgie, Thüringen-Kliniken "Georgius Agricola" GmbH, Saalfeld, Germany
| | - Karl Zink
- Diabetes Klinik, Diabetes Zentrum Mergentheim, Bad Mergentheim, Germany
| | - Edmund Neugebauer
- Department fur Humanmedizin, Universität Witten/Herdecke, Witten, Germany
- Medizinische Hochschule Brandenburg -Theodor Fontane, Neuruppin, Germany
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Storck M, Noppeney T, Kallmayer M, Eckstein HH. German Carotid National Registry – Value and Limitations. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.09.130] [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]
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Swiecka E, Storck M, Zippel R, Hinze O. Neurological Complication Rates of Intravenous Thrombolysis Combined With Early Carotid Endarterectomy for Treatment of Hyperacute Ischaemic Stroke. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.09.330] [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: 11/17/2022]
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Swiecka E, Storck M, Zippel R. CAR 3. Neurologic Complication Rates of Intravenous Thrombolysis Combined With Early Carotid Endarterectomy for Treatment of Hyperacute Ischemic Stroke. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.08.124] [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]
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16
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Bauersachs R, Espinola-Klein C, Lawall H, Storck M, Zeller T, Debus S. [Anti-Thrombotic Therapy of Peripheral Arterial Disease - A Review of Current Evidence, Practice and Outlook]. Dtsch Med Wochenschr 2019; 144:683-689. [PMID: 31083738 DOI: 10.1055/a-0826-2868] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Peripheral arterial occlusive disease is a frequent and chronic vascular disorder mostly affecting the lower limbs and caused by fibrous plaques in arteries that can result in stenoses and thrombi. Patients suffering from this condition show a high risk for cardiovascular complications of the complete arterial vascular system, especially post-procedural. Thus, there is a need to optimize anti-thrombotic therapy. Data on multiple antiplatelet aggregation therapy including new drug classes are expected in the coming years. In addition, recent studies showed that direct oral anticoagulation provided clinical advantages combined with a reasonable safety profile. Management of risk factors such as overweight and nicotine and correction of metabolic disorders are not to be ignored and the background to further therapy. All treating physicians should be aware of these aspects to guarantee an optimal care and motivation of their patients.
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Zimmermann A, Knappich C, Tsantilas P, Kallmayer M, Schmid S, Breitkreuz T, Storck M, Kuehnl A, Eckstein HH. Different perioperative antiplatelet therapies for patients treated with carotid endarterectomy in routine practice. J Vasc Surg 2018; 68:1753-1763. [DOI: 10.1016/j.jvs.2018.01.063] [Citation(s) in RCA: 14] [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: 11/27/2017] [Accepted: 01/27/2018] [Indexed: 11/17/2022]
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18
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Soto-Rey I, Rehr M, Bruland P, Zeidler C, Riepe C, Steinke S, Ständer S, Dugas M, Storck M. Electronic Collection of Multilingual Patient-Reported Outcomes across Europe. Methods Inf Med 2018; 57:e107-e114. [PMID: 30453339 DOI: 10.1055/s-0038-1675397] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Patient-reported outcomes (PROs) are information provided directly by patients that helps in improving patient diagnosis and treatment. Validated translations of PROs can be used to treat international patients. Electronic systems and especially mobile devices provide a great opportunity for their collection; however, these systems are normally study-oriented and therefore single language, not scalable, and not interoperable. OBJECTIVES This article reports the development of a multicenter, multilingual, and interoperable electronic PRO (ePRO) system and evaluates its user satisfaction in an international clinical study. METHODS The ePRO named "MoPat2" was developed using Java 8 and jQuery Mobile 1.4.5. The system was evaluated in the context of the European dermatology project "European Network on Assessment of Severity and Burden of Pruritus"(PruNet), which aimed to unify the assessment of itch in routine dermatological care in Europe. Twenty-six clinicians and 468 patients from 8 European clinical centers were asked to complete a user satisfaction questionnaire regarding the use of MoPat2 with a tablet personal computer. The results were then analyzed and correlated with the age, gender, and language of the respondents. RESULTS MoPat2 was enhanced with multilingual capabilities and is now able to conduct surveys in several languages, as well as store and display the results in the local language. The interviewed clinicians rated the system with an average score of 2.0 ("good") in a 1 to 5 Likert scale. Note that 93.9% of the patients (439 of 468) reported having got on well using the system and 88.9% (416 of 456) would be willing to further use it. The age of the patients not willing to further use MoPat2 was, in average, considerably higher than the age of patients willing to use the system. CONCLUSIONS This study represents the first use of an ePRO system for the collection of multilingual PROs in an international, multicenter setting. MoPat2 has been evaluated by both clinicians and patients in the context of a European dermatological study, resulting in a high user satisfaction. The system will be further developed to include new features such as patient follow-ups outside of the clinical setting.
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Affiliation(s)
- I Soto-Rey
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - M Rehr
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - P Bruland
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - C Zeidler
- Center for Chronic Pruritus and Department of Dermatology, University Hospital Münster, University of Münster, Münster, Germany
| | - C Riepe
- Center for Chronic Pruritus and Department of Dermatology, University Hospital Münster, University of Münster, Münster, Germany
| | - S Steinke
- Center for Chronic Pruritus and Department of Dermatology, University Hospital Münster, University of Münster, Münster, Germany
| | - S Ständer
- Center for Chronic Pruritus and Department of Dermatology, University Hospital Münster, University of Münster, Münster, Germany
| | - M Dugas
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - M Storck
- Institute of Medical Informatics, University of Münster, Münster, Germany
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Zeidler C, Steinke S, Riepe C, Bruland P, Soto-Rey I, Storck M, Garcovich S, Blome C, Bobko S, Legat FJ, Potekaev N, Lvov A, Misery L, Weger W, Reich A, Şavk E, Streit M, Serra-Baldrich E, Szepietowski JC, Yosipovitch G, Chen SC, Dugas M, Ständer S. Cross-European validation of the ItchyQoL in pruritic dermatoses. J Eur Acad Dermatol Venereol 2018; 33:391-397. [PMID: 30193410 DOI: 10.1111/jdv.15225] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 07/26/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Chronic pruritus (CP) is a frequently occurring symptom in inflammatory dermatoses, causing a high burden and limitations to health-related quality of life (HRQoL). OBJECTIVE The ItchyQoL was developed to assess the impairment to HRQoL in patients with CP. However, it has only been validated in English and German. Here, we report the validation in several languages across Europe. METHODS After professional translation, the versions of ItchyQoL were digitized for use as a tablet application. Validation was performed in clinics for dermatology in Austria, France, Germany, Italy, Poland, Russia, Spain, Switzerland and Turkey. RESULTS Five hundred and thirty-five patients with either contact dermatitis, chronic prurigo - nodular type, psoriasis vulgaris, lichen planus or mycosis fungoides/Sézary syndrome and with CP ≥ 3 on the numerical rating scale were included. ItchyQoL showed a high level of consistency (Cronbach's-α, all: 0.95) and test-retest reliability (intraclass correlation: 0.91). It strongly correlated with the Dermatology Life Quality Index (r = 0.72, P < 0.001) and moderately correlated with itch intensity scales in the study population (visual analogue scale r = 0.46; numerical rating scale r = 0.51; verbal rating scale r = 0.51, for all: P < 0.001). CONCLUSION ItchyQoL is now also validated in French, Italian, Polish, Russian, Spanish and Turkish and can be used in clinical trials in countries speaking these languages.
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Affiliation(s)
- C Zeidler
- Department of Dermatology and Center for Chronic Pruritus, University Hospital of Münster, Münster, Germany
| | - S Steinke
- Department of Dermatology and Center for Chronic Pruritus, University Hospital of Münster, Münster, Germany
| | - C Riepe
- Department of Dermatology and Center for Chronic Pruritus, University Hospital of Münster, Münster, Germany
| | - P Bruland
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - I Soto-Rey
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - M Storck
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - S Garcovich
- Institute of Dermatology, Policlinico A. Gemelli University Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - C Blome
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg, Hamburg, Germany
| | - S Bobko
- Moscow Scientific and Practical Center of Dermatovenerology and Cosmetology, Moscow, Russia
| | - F J Legat
- Department of Dermatology, Medical University of Graz, Graz, Austria.,Das Kurhaus, Bad Gleichenberg, Austria
| | - N Potekaev
- Moscow Scientific and Practical Center of Dermatovenerology and Cosmetology, Moscow, Russia
| | - A Lvov
- Moscow Scientific and Practical Center of Dermatovenerology and Cosmetology, Moscow, Russia
| | - L Misery
- Department of Dermatology, University Hospital of Brest, Brest, France
| | - W Weger
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - A Reich
- Department of Dermatology, University of Rzeszów, Rzeszów, Poland
| | - E Şavk
- Department of Dermatology, Adnan Menderes University, Aydın, Turkey
| | - M Streit
- Department of Dermatology, Kantonsspital Aarau, Aarau, Switzerland
| | - E Serra-Baldrich
- Cutaneous Allergy Unit, Department of Dermatology, Hospital Sant Pau, Universitat Autònoma Barcelona, Barcelona, Spain
| | - J C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - G Yosipovitch
- Department of Dermatology and Cutaneous Surgery and Miami Itch Center, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - S C Chen
- Department of Dermatology, University of Rzeszów, Rzeszów, Poland
| | - M Dugas
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - S Ständer
- Department of Dermatology and Center for Chronic Pruritus, University Hospital of Münster, Münster, Germany
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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.
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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
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Storck M, Kallmayer M, Noppeney T, Berkefeld J, Schmitz-Rixen T, Eckstein HH. IF02. In-Hospital Outcome of Carotid Endarterectomy and Carotid Artery Stenting in the German National Carotid Registry (2014-2016). J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2018.03.030] [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: 10/16/2022]
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Abstract
This article summarizes the current study situation on treatment of asymptomatic carotid artery stenosis and discusses the evidence situation in the literature. The 10-year results of the ACST study have shown that in comparison to conservative treatment, carotid endarterectomy (CEA) has retained a positive long-term effect on the reduction of all forms of stroke. All multicenter randomized controlled trials comparing CEA with carotid artery stenting (CAS) and, in particular the SAPHIRE and CAVATAS studies, have in common that despite a basic evidence level of Ib, the case numbers of asymptomatic patients are too small for a conclusive therapy recommendation. In the overall assessment of the CREST study the resulting difference in the questionable endpoint of “perioperative myocardial infarction” in favor of the CAS methods, could not be confirmed for exclusively asymptomatic patients. In the long-term course of the CREST study, both methods were classified as equivalent, even when the 4‑year results of periprocedural and postprocedural stroke rates in the separate assessment of the asymptomatic study participants clearly favored the CEA. The results of the ACST-1 study showed an equivalent effect of both treatment methods with respect to all investigated endpoints; however, the unequal sizes of the groups in addition to the statistically insufficient case numbers put a question mark on the validity of the study results. The results of the ASCT-2 and CREST-2 studies are to be awaited, which also investigate the significance of “CEA versus CAS” (ASCT-2) and “CEA/CAS + best medical treatment (BMT) versus BMT alone” in only asymptomatic stenoses. The current S3 guidelines allow operative therapy to be considered in patients with a 60–99% asymptomatic carotid artery stenosis, because the risk of stroke is statistically significantly reduced.
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Affiliation(s)
- S Demirel
- 1Department of Vascular and Endovascular Surgery, Department of Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - D Böckler
- 1Department of Vascular and Endovascular Surgery, Department of Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - M Storck
- Department of Vascular and Chest Surgery, Municipal Hospital Karlsruhe, Karlsruhe, Germany
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Dorweiler B, Trinh TT, Dünschede F, Vahl CF, Debus ES, Storck M, Diener H. Die marine Omega-3-Wundmatrix zur Behandlung komplizierter Wunden. Gefässchirurgie 2017. [DOI: 10.1007/s00772-017-0333-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Diener H, Debus E, Herberger SK, Heyer K, Augustin M, Tigges W, Karl T, Storck M. Versorgungssituation gefäßmedizinischer Wunden in Deutschland. Gefässchirurgie 2017. [DOI: 10.1007/s00772-017-0326-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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25
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Stavroulakis K, Borowski M, Torsello G, Bisdas T, Adili F, Balzer K, Billing A, Böckler D, Brixner D, Debus SE, Eckstein HH, Florek HJ, Gkremoutis A, Grundmann R, Hupp T, Keck T, Gerß J, Klonek W, Lang W, May B, Meyer A, Mühling B, Oberhuber A, Reinecke H, Reinhold C, Ritter RG, Schelzig H, Schlensack C, Schmitz-Rixen T, Schulte KL, Spohn M, Steinbauer M, Storck M, Trede M, Uhl C, Weis-Müller B, Wenk H, Zeller T, Zhorzel S, Zimmermann A. Association between statin therapy and amputation-free survival in patients with critical limb ischemia in the CRITISCH registry. J Vasc Surg 2017; 66:1534-1542. [DOI: 10.1016/j.jvs.2017.05.115] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 05/15/2017] [Indexed: 01/04/2023]
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26
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Dissemond J, Storck M, Kröger K, Stücker M. [Indications and contraindications for modern compression therapy]. Wien Med Wochenschr 2017; 168:228-235. [PMID: 29058156 DOI: 10.1007/s10354-017-0605-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 04/19/2017] [Accepted: 10/04/2017] [Indexed: 12/12/2022]
Abstract
Compression therapy is a physical therapy with few side effects, which is used especially in patients with edema of the lower extremities. The indication for compression therapy is given here for edema of very different origins such as, for example, venous or lymphatic disease symptoms as well as renal insufficiency, obesity or inflammation. However, different contraindications must be considered in these patients. Of particular importance are the advanced peripheral arterial occlusive disease and the polyneuropathy, which need special attention.Due to the large number of different compression materials and systems available today, in spite of these contraindications, compression therapy can be carried out with a large proportion of patients with edema of the lower extremities. The therapy should be adapted to the comorbidities and individual needs as well as personal abilities in the context of a patient-oriented care.
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Affiliation(s)
- Joachim Dissemond
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstraße 55, 45122, Essen, Deutschland.
| | - Martin Storck
- Gefäßzentrum, Klinik für Gefäß- und Thoraxchirurgie, Städt. Klinikum, Karlsruhe, Deutschland
| | - Knut Kröger
- Klinik für Gefäßmedizin, Abteilung für Angiologie, HELIOS Klinikum Krefeld, Krefeld, Deutschland
| | - Markus Stücker
- Klinik für Dermatologie, Venerologie und Allergologie und Venenzentrum der Dermatologischen und Gefäßchirurgischen Kliniken, Kliniken der Ruhr-Universität Bochum, Bochum, Deutschland
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Pereira M, Steinke S, Zeidler C, Forner C, Riepe C, Augustin M, Bobko S, Dalgard F, Elberling J, Garcovich S, Gieler U, Gonçalo M, Halvorsen JA, Leslie T, Metz M, Reich A, Şavk E, Schneider G, Serra-Baldrich E, Ständer H, Streit M, Wallengren J, Weller K, Wollenberg A, Bruland P, Soto-Rey I, Storck M, Dugas M, Weisshaar E, Szepietowski J, Legat F, Ständer S. European academy of dermatology and venereology European prurigo project: expert consensus on the definition, classification and terminology of chronic prurigo. J Eur Acad Dermatol Venereol 2017; 32:1059-1065. [DOI: 10.1111/jdv.14570] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 08/03/2017] [Indexed: 11/27/2022]
Affiliation(s)
- M.P. Pereira
- Department of Dermatology; Competence Center for Chronic Pruritus; University Hospital Münster; Münster Germany
| | - S. Steinke
- Department of Dermatology; Competence Center for Chronic Pruritus; University Hospital Münster; Münster Germany
| | - C. Zeidler
- Department of Dermatology; Competence Center for Chronic Pruritus; University Hospital Münster; Münster Germany
| | - C. Forner
- Department of Dermatology; Competence Center for Chronic Pruritus; University Hospital Münster; Münster Germany
| | - C. Riepe
- Department of Dermatology; Competence Center for Chronic Pruritus; University Hospital Münster; Münster Germany
| | - M. Augustin
- Competence Center for Healthcare Research in Dermatology (CVderm); Institute for Healthcare Research in Dermatology and Nursing (IVDP); University Hospital of Hamburg-Eppendorf; Hamburg Germany
| | - S. Bobko
- Moscow Scientific and Practical Center of Dermatovenerology and Cosmetology; Moscow Russia
| | - F. Dalgard
- Department of Dermatology and Venereology; Skåne University Hospital; Lund University; Malmö Sweden
| | - J. Elberling
- Department of Dermatology; University Hospital Gentofte; Copenhagen Denmark
| | - S. Garcovich
- Institute of Dermatology; Catholic University of the Sacred Heart; Rome Italy
| | - U. Gieler
- Justus Liebig University; Giessen Germany
| | - M. Gonçalo
- Department of Dermatology; University Hospital and Faculty of Medicine; University of Coimbra; Coimbra Portugal
| | - J. A. Halvorsen
- Department of Dermatology; Oslo University Hospital; University of Oslo; Oslo Norway
| | - T.A. Leslie
- Department of Dermatology; Royal Free Hospital; London UK
| | - M. Metz
- Department of Dermatology and Allergy; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - A. Reich
- Department of Dermatology; University of Rzeszow; Rzeszow Poland
| | - E. Şavk
- Department of Dermatology; Adnan Menderes University; Aydın Turkey
| | - G. Schneider
- Department of Psychosomatics and Psychotherapy; Münster University Hospital; Münster Germany
| | - E. Serra-Baldrich
- Department of Dermatology; Cutaneous Allergy Unit; Hospital Sant Pau; Universitat Autònoma Barcelona; Barcelona Spain
| | - H.F. Ständer
- Dermatological Practice; Bad Bentheim and Department of Dermatology; Klinikum Dortmund GmbH; Dortmund Germany
| | - M. Streit
- Department of Dermatology; Kantonsspital Aarau; Aarau Switzerland
| | - J. Wallengren
- Department of Dermatology and Venereology; Skåne University Hospital SUS Lund; Lund University; Lund Sweden
| | - K. Weller
- Department of Dermatology and Allergy; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - A. Wollenberg
- Department of Dermatology and Allergology; Ludwig Maximilian University; Munich Germany
| | - P. Bruland
- Institute of Medical Informatics; University of Münster; Münster Germany
| | - I. Soto-Rey
- Institute of Medical Informatics; University of Münster; Münster Germany
| | - M. Storck
- Institute of Medical Informatics; University of Münster; Münster Germany
| | - M. Dugas
- Institute of Medical Informatics; University of Münster; Münster Germany
| | - E. Weisshaar
- Department of Social Medicine, Occupational and Environmental Dermatology; University of Heidelberg; Heidelberg Germany
| | - J.C. Szepietowski
- Department of Dermatology, Venereology and Allergology; Wroclaw Medical University; Wroclaw Poland
| | - F.J. Legat
- Department of Dermatology; Medical University of Graz; Graz Austria
| | - S. Ständer
- Department of Dermatology; Competence Center for Chronic Pruritus; University Hospital Münster; Münster Germany
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Uhl C, Steinbauer M, Torsello G, Bisdas T, Adili F, Balzer K, Billing A, Böckler D, Brixner D, Debus SE, Eckstein HH, Florek HJ, Gkremoutis A, Grundmann R, Hupp T, Hwang SW, Keck T, Wojciech K, Lang W, May B, Meyer A, Mühling B, Oberhuber A, Reinecke H, Reinhold C, Ritter RG, Schelzig H, Schlensack C, Schmitz-Rixen T, Schulte KL, Spohn M, Stavroulakis K, Storck M, Trede M, Weis-Müller B, Wenk H, Zeller T, Zhorzel S, Zimmermann A. Outcomes After Endovascular Revascularization in Octogenarians and Non-Octogenarians With Critical Limb Ischemia. J Endovasc Ther 2017; 24:471-477. [DOI: 10.1177/1526602817711424] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Christian Uhl
- Department of Vascular Surgery, Barmherzige Brueder Hospital, Regensburg, Germany
| | - Markus Steinbauer
- Department of Vascular Surgery, Barmherzige Brueder Hospital, Regensburg, Germany
| | - Giovanni Torsello
- Department of Vascular Surgery, University Clinic of Münster, Germany
- Department of Vascular Surgery, St Franziskus Hospital GmbH, Münster, Germany
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Trenner M, Haller B, Storck M, Reutersberg B, Kallmayer M, Eckstein HH. Trends in Patient Safety of Intact Abdominal Aortic Aneurysm Repair: German Registry Data on 36,594 Procedures. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Gombert A, Barbati ME, Storck M, Kotelis D, Keschenau P, Pape HC, Andruszkow H, Lefering R, Hildebrand F, Greiner A, Jacobs MJ, Grommes J. Treatment of blunt thoracic aortic injury in Germany-Assessment of the TraumaRegister DGU®. PLoS One 2017; 12:e0171837. [PMID: 28346475 PMCID: PMC5367684 DOI: 10.1371/journal.pone.0171837] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 09/26/2016] [Accepted: 01/26/2017] [Indexed: 12/30/2022] Open
Abstract
Purpose Using the data delivered by the German Trauma Register DGU® from 2002 till 2013, the value of different therapies of blunt thoracic aortic injury (BTAI) in Germany was analyzed. Methods Prospectively collected data of patients suffering from BTAI were retrospectively analyzed with focus on the different treatment modalities for grade I–IV injuries. Results 821 patients suffering from BTAI were identified: 51.6% (424) grade I injury, 35.4% (291) grade II or III injury and 12.9% (106) grade IV injury (77.5% men [44.94 ± 20.6 years]). The main patterns of injury were high- speed accidents and falls (78.0% [n = 640], 21.8% [n = 171] respectively). Significant differences between grade I and grade II/III as well as IV injuries could be assessed for the incidence of cardiopulmonary resuscitation, a Glasgow Coma Scale score below 8 and a systolic blood pressure below 90 mmHg (p-value: <0.001). In the primary admission subgroup, 44.1% (197/447) of the patients received best medical treatment, 55.9% received surgical intervention (250/447): Thereof 37.2% (93/250) received open surgery and 62.8% (147/250) had been treated by endovascular means. Significantly lower 24-h- and in-hospital-mortality rates were encountered after endovascular treatment for all gradings of BTAI (p-value: <0.001). Yet this subgroup of patients showed the lowest incidence of further severe injuries and cardiac arrest. Conclusion Endovascular therapy became the treatment of choice for BTAI in Germany. Patients who have been treated by surgical means showed the highest survival rate, especially endovascular therapy showed a favorable low mortality rate.
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Affiliation(s)
- Alexander Gombert
- European Vascular Center Aachen-Maastricht, University Hospital RWTH Aachen, Aachen, Germany
| | - Mohammad E Barbati
- European Vascular Center Aachen-Maastricht, University Hospital RWTH Aachen, Aachen, Germany
| | - Martin Storck
- Klinikum Karlsruhe, Academic Teaching Hospital Univ. Freiburg, Karlsruhe, Germany
| | - Drosos Kotelis
- European Vascular Center Aachen-Maastricht, University Hospital RWTH Aachen, Aachen, Germany
| | - Paula Keschenau
- European Vascular Center Aachen-Maastricht, University Hospital RWTH Aachen, Aachen, Germany
| | - Hans-Christoph Pape
- Department of Orthopedic Trauma at Aachen University and Harald Tscherne Laboratory, University Hospital RWTH Aachen, Aachen, Germany
| | - Hagen Andruszkow
- Department of Orthopedic Trauma at Aachen University and Harald Tscherne Laboratory, University Hospital RWTH Aachen, Aachen, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Cologne, Germany
| | - Frank Hildebrand
- Department of Orthopedic Trauma at Aachen University and Harald Tscherne Laboratory, University Hospital RWTH Aachen, Aachen, Germany
| | - Andreas Greiner
- Department of Vascular Surgery, University Hospital Charité Berlin, Berlin, Germany
| | - Michael J Jacobs
- European Vascular Center Aachen-Maastricht, University Hospital RWTH Aachen, Aachen, Germany
| | - Jochen Grommes
- European Vascular Center Aachen-Maastricht, University Hospital RWTH Aachen, Aachen, Germany
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Trenner M, Haller B, Storck M, Reutersberg B, Kallmayer MA, Eckstein HH. Trends in Patient Safety of Intact Abdominal Aortic Aneurysm Repair: German Registry Data on 36,594 Procedures. Eur J Vasc Endovasc Surg 2017; 53:641-647. [PMID: 28110907 DOI: 10.1016/j.ejvs.2016.12.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 09/26/2016] [Accepted: 12/14/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE/BACKGROUND The study aim was to determine whether patient safety for non-ruptured abdominal aortic aneurysm (nrAAA) repair has changed between 1999 and 2010 in a large German cohort. METHODS The data source was the prospective quality assurance registry of the German Vascular Society from 1999 to 2010. Patient characteristics, surgical techniques (open aortic repair [OAR], endovascular aortic repair [EVAR]), procedural time and outcomes, including the length of hospital stay (LOS), were analysed using the Cochran-Armitage test for binary parameters and Spearman's correlation coefficient for quantitative parameters. RESULTS A total of 36,594 operations (23,037 OAR, 13,557 EVAR) for infrarenal nrAAA in 201 hospitals in Germany were investigated. Patients' mean age increased from 69.6 to 72.0 years (p < .001). The rate of patients with American Society of Anesthesiologists scores of 3 or 4 increased (p < .001). Use of EVAR increased (1999: 16.7%; 2010: 62.7%; p < .001), and since 2009, EVAR has been more frequently used than OAR. The overall in hospital mortality decreased from 3.1% in 1999 to 2.3% in 2010 (p < .001). There were no temporal trends for mortality rates for EVAR (p = .233) or OAR (p = .281) when considered separately. Cardiac (1999: 8.1%; 2010: 5.1%; p < .001) and pulmonary (1999: 7.8%; 2010: 4.8%; p < .001) complications decreased. The rate of post-operative renal failure increased (1999: 3.6%; 2010 4.1%; p = .017), without increasing the rate of patients needing dialysis (1999: 1.7%; 2010: 1.7%; p = .171). The median LOS decreased from 17 days in 1999 to 10 days in 2010 (p < .001). CONCLUSION This study shows significantly improved post-procedural in hospital outcomes and decreased use of resources for nrAAA repair. This trend can probably be attributed to the implementation of EVAR as a standard technique, but some trends could also possibly be explained by a change in the remuneration system. The main limitation of the registry is the lack of internal and external validation. However, in hospital patient safety for AAA repair seems to have improved significantly in the participating hospitals.
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Affiliation(s)
- M Trenner
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - B Haller
- Institute for Medical Statistics and Epidemiology, Technical University of Munich, Munich, Germany
| | - M Storck
- Department for Vascular and Thoracic Surgery, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany; Commission for Quality and Safety, German Vascular Society (Deutsche Gesellschaft für Gefäßchirurgie und Gefäßmedizin, DGG), Berlin, Germany
| | - B Reutersberg
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - M A Kallmayer
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - H-H Eckstein
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
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Demirel S, Böckler D, Storck M. Langzeitergebnisse der Karotisendarteriektomie im Methodenvergleich bei asymptomatischer Karotisstenose. Gefässchirurgie 2017. [DOI: 10.1007/s00772-016-0238-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bisdas T, Borowski M, Stavroulakis K, Torsello G, Adili F, Balzer K, Billing A, Böckler D, Brixner D, Debus SE, Eckstein HH, Florek HJ, Gkremoutis A, Grundmann R, Hupp T, Keck T, Gerß J, Klonek W, Lang W, May B, Meyer A, Mühling B, Oberhuber A, Reinecke H, Reinhold C, Ritter RG, Schelzig H, Schlensack C, Schmitz-Rixen T, Schulte KL, Spohn M, Steinbauer M, Storck M, Trede M, Uhl C, Weis-Müller B, Wenk H, Zeller T, Zhorzel S, Zimmermann A. Endovascular Therapy Versus Bypass Surgery as First-Line Treatment Strategies for Critical Limb Ischemia. JACC Cardiovasc Interv 2016; 9:2557-2565. [DOI: 10.1016/j.jcin.2016.09.039] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 09/21/2016] [Accepted: 09/25/2016] [Indexed: 12/19/2022]
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Tsantilas P, Kuehnl A, König T, Breitkreuz T, Kallmayer M, Knappich C, Schmid S, Storck M, Zimmermann A, Eckstein HH. Short Time Interval Between Neurologic Event and Carotid Surgery Is Not Associated With an Increased Procedural Risk. Stroke 2016; 47:2783-2790. [DOI: 10.1161/strokeaha.116.014058] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 09/15/2016] [Indexed: 12/31/2022]
Abstract
Background and Purpose—
Guidelines recommend that carotid endarterectomy should be performed within 2 weeks in patients with a symptomatic carotid stenosis. Because a Swedish register study indicated that patients treated within the first days after a stroke or transient ischemic attack might have an increased perioperative stroke and mortality risk, this study aimed to find out whether these findings are also true under everyday conditions in Germany.
Methods—
Secondary data analysis including 56 336 elective carotid endarterectomy procedures performed for symptomatic carotid stenosis under everyday conditions between 2009 and 2014. The patient cohort was divided into 4 groups according to time interval between index event and surgery (I: 0–2, II: 3–7, III: 8–14, and IV: 14–180 days). Primary outcome was any in-hospital stroke or death. For risk-adjusted analyses, a multilevel multivariable regression model was used.
Results—
Mean patients’ age was 71.1±9.6 years; 67.5% were men. Overall rate of any stroke or death was 2.5% (n=1434). Risk of any in-hospital stroke or death was 3.0% in group I, 2.5% in group II, 2.6% in group III, and 2.3% in group IV. Multivariable regression analysis revealed that the time interval was not significantly associated with the primary outcome.
Conclusions—
The time interval between the index event and carotid endarterectomy was not associated with the risk of any in-hospital stroke or death in patients with symptomatic carotid stenosis in Germany. In clinically stable patients, carotid endarterectomy might, therefore, be performed safely as soon as possible after the neurological index event.
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Affiliation(s)
- Pavlos Tsantilas
- From the Department of Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, Germany (P.T., A.K., M.K., C.K., S.S., A.Z., H.-H.E.); AQUA - Institute for Applied Quality Improvement and Research in Health GmbH, Göttingen, Germany (T.K., T.B.); and Department for Vascular and Thoracic Surgery, Klinikum Karlsruhe, Academic Teaching Hospital University of Freiburg, Karlsruhe, Germany (M.S.)
| | - Andreas Kuehnl
- From the Department of Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, Germany (P.T., A.K., M.K., C.K., S.S., A.Z., H.-H.E.); AQUA - Institute for Applied Quality Improvement and Research in Health GmbH, Göttingen, Germany (T.K., T.B.); and Department for Vascular and Thoracic Surgery, Klinikum Karlsruhe, Academic Teaching Hospital University of Freiburg, Karlsruhe, Germany (M.S.)
| | - Thomas König
- From the Department of Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, Germany (P.T., A.K., M.K., C.K., S.S., A.Z., H.-H.E.); AQUA - Institute for Applied Quality Improvement and Research in Health GmbH, Göttingen, Germany (T.K., T.B.); and Department for Vascular and Thoracic Surgery, Klinikum Karlsruhe, Academic Teaching Hospital University of Freiburg, Karlsruhe, Germany (M.S.)
| | - Thorben Breitkreuz
- From the Department of Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, Germany (P.T., A.K., M.K., C.K., S.S., A.Z., H.-H.E.); AQUA - Institute for Applied Quality Improvement and Research in Health GmbH, Göttingen, Germany (T.K., T.B.); and Department for Vascular and Thoracic Surgery, Klinikum Karlsruhe, Academic Teaching Hospital University of Freiburg, Karlsruhe, Germany (M.S.)
| | - Michael Kallmayer
- From the Department of Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, Germany (P.T., A.K., M.K., C.K., S.S., A.Z., H.-H.E.); AQUA - Institute for Applied Quality Improvement and Research in Health GmbH, Göttingen, Germany (T.K., T.B.); and Department for Vascular and Thoracic Surgery, Klinikum Karlsruhe, Academic Teaching Hospital University of Freiburg, Karlsruhe, Germany (M.S.)
| | - Christoph Knappich
- From the Department of Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, Germany (P.T., A.K., M.K., C.K., S.S., A.Z., H.-H.E.); AQUA - Institute for Applied Quality Improvement and Research in Health GmbH, Göttingen, Germany (T.K., T.B.); and Department for Vascular and Thoracic Surgery, Klinikum Karlsruhe, Academic Teaching Hospital University of Freiburg, Karlsruhe, Germany (M.S.)
| | - Sofie Schmid
- From the Department of Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, Germany (P.T., A.K., M.K., C.K., S.S., A.Z., H.-H.E.); AQUA - Institute for Applied Quality Improvement and Research in Health GmbH, Göttingen, Germany (T.K., T.B.); and Department for Vascular and Thoracic Surgery, Klinikum Karlsruhe, Academic Teaching Hospital University of Freiburg, Karlsruhe, Germany (M.S.)
| | - Martin Storck
- From the Department of Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, Germany (P.T., A.K., M.K., C.K., S.S., A.Z., H.-H.E.); AQUA - Institute for Applied Quality Improvement and Research in Health GmbH, Göttingen, Germany (T.K., T.B.); and Department for Vascular and Thoracic Surgery, Klinikum Karlsruhe, Academic Teaching Hospital University of Freiburg, Karlsruhe, Germany (M.S.)
| | - Alexander Zimmermann
- From the Department of Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, Germany (P.T., A.K., M.K., C.K., S.S., A.Z., H.-H.E.); AQUA - Institute for Applied Quality Improvement and Research in Health GmbH, Göttingen, Germany (T.K., T.B.); and Department for Vascular and Thoracic Surgery, Klinikum Karlsruhe, Academic Teaching Hospital University of Freiburg, Karlsruhe, Germany (M.S.)
| | - Hans-Henning Eckstein
- From the Department of Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, Germany (P.T., A.K., M.K., C.K., S.S., A.Z., H.-H.E.); AQUA - Institute for Applied Quality Improvement and Research in Health GmbH, Göttingen, Germany (T.K., T.B.); and Department for Vascular and Thoracic Surgery, Klinikum Karlsruhe, Academic Teaching Hospital University of Freiburg, Karlsruhe, Germany (M.S.)
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Strohal R, Assenheimer B, Augustin M, Hämmerle G, Läuchli S, Pundt B, Stern G, Storck M, Ulrich C. [Wound management with enzyme alginogels : Expert consensus]. Hautarzt 2016; 68:36-42. [PMID: 27680011 DOI: 10.1007/s00105-016-3878-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The challenges of modern wound management, such as the treatment of chronic wounds and their phase-specific handling, are demanding and require optimally adapted therapeutic measures. The principles of moist wound care as well as an adequate debridement have priority here. To support these necessary measures, different options are available, e.g., a new product group operating across several wound phases. OBJECTIVE A new treatment principle in modern wound management based on an expert consensus is presented. METHODS On the basis of clinical experience reports and published evidence, the current and new principles of wound treatment were discussed in a panel of experts and formulated as a consensus statement. RESULTS Enzyme alginogels represent a combination of agents that allow phase-specific wound care. They exhibit autolytic, absorbent, and antimicrobial properties and simultaneously cover three components of wound management based on the TIME framework. Thus, according to the experts, they differ from other wound healing products and can be classified in a distinct product group. Clinical studies, as well as clinical experiences, provide evidence for the efficacy of enzyme alginogels. DISCUSSION According to the experts, the potential of enzyme alginogels used considering the principles of moist wound care, comprises the three-fold effect (continuous and significantly simplified debridement, maintaining a moist wound environment and antimicrobial effect without cytotoxicity), the ease of use, and the flexible application. In addition, the flexibility of the product class regarding frequency of application, duration of treatment and combinability with secondary dressings, are of economic benefit in the health care sector.
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Affiliation(s)
- R Strohal
- Abteilung für Dermatologie und Venerologie, LKH Feldkirch, Akademisches Lehrspital, Carinagasse 45-47, 6800, Feldkirch, Österreich.
| | - B Assenheimer
- Arbeitsgruppe Dekubitus/Wundpflege, Universitätsklinikum Tübingen, Geissweg 3, 72076, Tübingen, Deutschland.,Initiative Chronische Wunden e. V., Pölle 27/28, 06484, Quedlinburg, Deutschland
| | - M Augustin
- Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - G Hämmerle
- Wundambulanz, LKH Bregenz, Carl-Pedenz-Str. 2, 6900, Bregenz, Österreich
| | - S Läuchli
- Dermatologische Klinik, Universitätsspital Zürich, Gloriastr. 31, 8091, Zürich, Schweiz
| | - B Pundt
- Gemeinschaftspraxis für Allgemeinmedizin, Bahnhofstr. 18, 26180, Rastede, Deutschland
| | - G Stern
- Ambulantes-Therapie-Zentrum ATZ Stern, Barloer Weg 127b, 46397, Bocholt, Deutschland
| | - M Storck
- Klinik für Gefäß- und Thoraxchirurgie, Städt. Klinikum Karlsruhe, Moltkestr. 90, 76133, Karlsruhe, Deutschland
| | - C Ulrich
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
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Abstract
From 1990 through 1992, 17 severely stenosed central venous segments were diagnosed in 13 patients. In 9 patients, 11 stenoses were detected during follow-up after trans- femoral venous thrombectomy. The other 6 stenoses occurred in the venous outflow tract of 4 hemodialysis shunts. Six stenoses were treated by percutaneous transvenous angio plasty (PTA) alone, and 11 stenoses by PTA plus stent implantation (PTA+S). For PTA+S, a flexible, self-expanding stent was used. Acute procedure-related complications were not observed. After a median follow-up time of eighteen months (three to thirty-six months), all patients were examined clinically, duplex-sonographically, and angiographically. Following PTA alone (n = 6), there was only 1 excellent result, and 5 patients developed high-grade restenoses. Two of these patients had to be reoperated on, and 1 patient underwent another PTA with stent placement. PTA+S (n = 11) for initial treatment of central venous stenoses gave excellent results in 8 cases, a good result in 1 case, and 2 insufficient results caused by intimal hyperplasia within the stent. These restenoses were successfully treated by another PTA.
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Affiliation(s)
- Volker Mickley
- Department of Thoracic and Vascular Surgery, University of Ulm
| | | | | | - Martin Storck
- Department of Thoracic and Vascular Surgery, University of Ulm
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Abstract
The choice of suture material in surgery is often individual and a result of personal experience. Cardiovascular surgeons have always been reluctant to use absorbable suture material for direct arterial or venous anastomoses for differ ent reasons, mainly because of suspected anastomotic dilatation or even rupture during or after the absorption phase. More than ten years ago, a new class of synthetic, monofilament, flexible, biodegradable suture material was intro duced for clinical use. Since then, much experimental and clinical work has been carried out to evaluate physical and biological characteristics of this class of suture material (polydioxanone/polydimethylsiloxane = [PDS] and polytri methylene-carbonate = [PTMC]) in many different tissues, including vascular tissue. There is increasing evidence that slow-absorbable sutures will gain clini cal importance for cardiovascular and peripheral vascular surgery in the fu ture, since many experimental and clinical studies during the last forty years have proven histologic superiority over nonabsorbable materials. Descriptions of healing processes in blood vessels after surgical anastomoses lead to the con clusion that persisting foreign suture material results in persistent cellular reac tions and chronic inflammatory responses and may consequently disturb physi ologic functions such as compliance at the anastomotic site. It is the purpose of this article to give a review of the literature. Implications are discussed for surgery of growing vessels, transplantation surgery, microsurgery, and surgery in infected anastomoses. Nonabsorbable suture material should no longer be used for direct vascular anastomoses.
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Affiliation(s)
- Martin Storck
- Department of Vascular, Thoracic, and Cardiac Surgery, University of Ulm
| | - Karl-Heinz Orend
- Department of Vascular, Thoracic, and Cardiac Surgery, University of Ulm
| | - Thomas Schmitz-Rixen
- Department of General, Abdominal, Thoracic, and Vascular Surgery, University of Cologne
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Abstract
Venous leg ulcer (VLU) counts among the most common chronic wounds in Europe. Treatment is lengthy, cumbersome and costly, and there is a high rate of recurrence. This review shows the measures that should be offered to every patient with healed VLU to permanently prevent recurrence. To prevent VLU in case of varicose veins, the progression of chronic venous insufficiency (CVI) has to be stopped. There is convincing evidence that the effective treatment of varicose veins reduces the recurrence rate in patients with VLU. In patients with post-thrombotic syndrome (PTS), further thrombosis should be prevented through targeted prophylaxis of new thromboembolic events. The benefit of endovascular revascularization on the VLU recurrence rate in patients with post-thrombotic damage in the pelvic veins has not been proven in clinical studies. On the other hand, it has been clearly demonstrated in several studies that compression therapy is the basic procedure for the prevention of recurrent VLU in patients with varicose veins or PTS, regardless of whether other measures have been implemented or not. Good adherence in patients with compression therapy is more important than choosing the highest possible compression class. Future efforts for patients with VLU must aim to provide therapists with tools and treatment strategies to guide their patients and to increase patients' acceptance and understanding of the importance of self-management, in particular regarding compression therapy for the prevention of recurrent VLU.
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Affiliation(s)
- K Kroeger
- Angiologie, HELIOS Kliniken Krefeld, Deutschland
| | - M Storck
- Gefäßzentrum Karlsruhe, Städt. Klinikum Karlsruhe, Deutschland
| | - P Kujath
- Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
| | - E Rabe
- Klinik für Dermatologie, Universitätsklinik Bonn, Deutschland
| | - J Dissemond
- Klinik für Dermatologie, Universitätsklinik Essen, Deutschland
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Storck M, Nolte T, Tenholt M, Maene L, Maleux G, Scheinert D. Women and men derive comparable benefits from an ultra-low-profile endograft: 1-year results of the European OVATION registry. J Cardiovasc Surg (Torino) 2016; 58:658-664. [PMID: 27327216 DOI: 10.23736/s0021-9509.16.09304-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Female patients are underrepresented in most stent-graft (EVAR) trials due to a reduced anatomical eligibility for endovascular treatment. The purpose of this analysis was to determine the performance of the Ovation® and Ovation Prime® stent graft in women versus men for elective abdominal aortic aneurysm (AAA) repair. METHODS From May 2011 to December 2013, 501 patients (86% men, mean age 73 years) from 30 sites were prospectively enrolled in the OVATION Registry and electively treated with endovascular aneurysm repair. Patients returned for clinical and imaging follow-up at 1 month, 6 months, and 1 year. A post-hoc analysis was performed to assess the influence of gender on patient outcomes. RESULTS Women were older (median 77 vs. 73 years, P<0.01) although men reported a higher frequency of ASA class III/IV (54% vs. 34%), coronary artery disease (43% vs. 29%), diabetes mellitus (19% vs. 7%), and history of tobacco use (50% vs. 33%). Median external iliac diameter was 6.4 mm in women and 7.5 mm in men (P<0.001). Proximal neck diameter was larger in men versus women (24 vs. 22 mm). Technical success was 100% in women and 99.5% in men. Type I endoleak was identified in 5 men (1.5%) and a type III leak was identified in 1 (0.3%) man. No woman presented with type I or III endoleak at 1 year. The rate of AAA enlargement was similar in women (2.5%) and men (2.7%). Freedom from aneurysm-related mortality through 1 year was 100% in women and 99.3% in men (log-rank P=0.49). Freedom from all-cause mortality through 1 year was 94.0% in women and 95.8% in men (log-rank P=0.51). One contained AAA rupture was reported in a male patient. One female patient underwent conversion to open surgery. Freedom from a secondary intervention through 1 year was 88.2% in women and 93.7% in men (log-rank P=0.11). CONCLUSIONS Women and men derive similarly favorable benefits with the Ovation stent graft through 1-year follow-up. Longer-term follow-up will be required to determine the durability of these outcomes.
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Affiliation(s)
| | - Thomas Nolte
- Bad Bevensen Heart and Vascular Center, Bad Bevensen, Germany
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Noppeney T, Storck M, Nüllen H, Schmedt CG, Kellersmann R, Böckler D, Walluscheck K, Torsello G, Debus S. Perioperative quality assessment of varicose vein surgery. Langenbecks Arch Surg 2016; 401:375-80. [DOI: 10.1007/s00423-016-1387-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 02/17/2016] [Indexed: 10/22/2022]
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Georgakarakos E, Ioannou CV, Georgiadis GS, Storck M, Trellopoulos G, Koutsias S, Lazarides MK. The ovation abdominal stent graft for the treatment of abdominal aortic aneurysms: current evidence and future perspectives. Expert Rev Med Devices 2016; 13:253-62. [DOI: 10.1586/17434440.2016.1147949] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kallmayer MA, Tsantilas P, Knappich C, Haller B, Storck M, Stadlbauer T, Kühnl A, Zimmermann A, Eckstein HH. Patient characteristics and outcomes of carotid endarterectomy and carotid artery stenting: analysis of the German mandatory national quality assurance registry - 2003 to 2014. J Cardiovasc Surg (Torino) 2015; 56:827-836. [PMID: 26381216] [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
AIM In Germany, every surgical or endovascular procedure on the extracranial carotid artery is documented in a mandatory quality assurance registry. The purpose of this study is to describe the patient characteristics, the indications for treatment, and the short-term outcomes as well as to analyse the corresponding trends from 2003 to 2014. METHODS Data on demographics, peri-procedural measures, and outcomes were extracted from the annual quality reports published by the Federal Agency for Quality Assurance and the Institute for Applied Quality Improvement and Research in Health Care. Data were available from 2003 to 2014 for carotid endarterectomy (CEA) and from 2012 to 2014 for carotid artery stenting (CAS). The primary outcome event of this study is any stroke or death until discharge from hospital. Temporal trends of categorical variables were statistically analysed using the Cochran-Armitage test for trend. RESULTS Between 2003 and 2014, 309,405 CEAs and 18,047 CAS procedures were documented in the database; 68.1% of all patients were male. The mean age of patients treated with CEA increased from 68.9 years in 2003 to 70.9 years in 2014. The proportion of patients with ASA stages III to V increased from 65% to 71% in CEA, whereas it decreased from 44% to 41% in CAS patients. 53.1% of all CEAs were performed for asymptomatic patients (group A), 34.4% for symptomatic patients treated electively (group B), and 11.2% a in a collective group including other indications for CEA or CAS (such as recurrent stenosis, carotid aneurysms, emergency treatment due to stroke-in-evolution). The corresponding data for CAS are 49.3%, 26.1% and 26.3% respectively. In group B, the interval between the neurological index event and CEA decreased from 28 to 8 days (P<0.001). In patients treated with CAS, this interval was 9 days in 2012 (no further data available). On average, 67.1% and 48.2% of surgically treated patients as well as 77.8% and 69.8% of CAS patients were neurologically assessed before and after the procedure, respectively. From 2003 to 2014, CEA procedures were performed more frequently in locoregional anesthesia (10.1% to 29.1%, P<0.001). The same trend was observed for the application of the eversion technique (37.0% to 41.6%, P<0.001), the neurophysiological monitoring (49.8% to 61.8%, P<0.001), and the intra-procedural assessment of the treated artery (44.5% to 69.7%, P<0.001). In contrast, shunting was used less frequently (48.1% to 43.0%, P<0.001). Averagely 95.7% of all endovascular procedures were performed using stent-angioplasty. In 54.2% a protection device was used. Nitinol and bare metal stents were used in 74.1% and 21.4% of cases, respectively. The in-hospital rate of any stroke or death decreased from 2.0% to 1.1% in asymptomatic patients treated with CEA without a contralateral stenosis ≥75% or occlusion, P<0.001). In patients treated with CAS this rate did not increase (1.7% to 1.8%, p=0.909). The corresponding rates in CEA and CAS patients with severe contralateral stenosis or occlusion varied between 1.9%-3.1% and 2.2%-2.6%, respectively. In symptomatic patients (group B) with a stenosis of 50 percent or more, the rate of any stroke or death decreased significantly after CEA from 4.2% to 2.4% (P<0.001) and remained stable after CAS (3.9% to 3.5%, P=0.577). CONCLUSION This report on 327,452 carotid procedures analysed one of the largest quality registries on CEA and CAS worldwide. Data indicate that treated patients became older and sicker, whereas in contrast, the in-hospital rates of stroke or death are decreasing over time.
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Affiliation(s)
- M A Kallmayer
- Department for Vascular and Endovascular Surgery, Klinikum rechts der IsarTechnische Universität München, Munich, Germany -
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Ständer S, Zeidler C, Riepe C, Steinke S, Fritz F, Bruland P, Soto‐Rey I, Storck M, Agner T, Augustin M, Blome C, Dalgard F, Evers A, Garcovich S, Gonçalo M, Lambert J, Legat F, Leslie T, Misery L, Raap U, Reich A, Şavk E, Streit M, Serra‐Baldrich E, Szepietowski J, Wallengren J, Weisshaar E, Dugas M. European
EADV
network on assessment of severity and burden of Pruritus (PruNet): first meeting on outcome tools. J Eur Acad Dermatol Venereol 2015; 30:1144-7. [DOI: 10.1111/jdv.13296] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 06/23/2015] [Indexed: 11/28/2022]
Affiliation(s)
- S. Ständer
- Department of Dermatology, Competence Center for Chronic Pruritus University Hospital of Münster Münster Germany
| | - C. Zeidler
- Department of Dermatology, Competence Center for Chronic Pruritus University Hospital of Münster Münster Germany
| | - C. Riepe
- Department of Dermatology, Competence Center for Chronic Pruritus University Hospital of Münster Münster Germany
| | - S. Steinke
- Department of Dermatology, Competence Center for Chronic Pruritus University Hospital of Münster Münster Germany
| | - F. Fritz
- Institute of Medical Informatics University of Münster Münster Germany
| | - P. Bruland
- Institute of Medical Informatics University of Münster Münster Germany
| | - I. Soto‐Rey
- Institute of Medical Informatics University of Münster Münster Germany
| | - M. Storck
- Institute of Medical Informatics University of Münster Münster Germany
| | - T. Agner
- Department of Dermatology University of Copenhagen Copenhagen Denmark
| | - M. Augustin
- Institute for Health Services Research in Dermatology and Nursing University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - C. Blome
- Institute for Health Services Research in Dermatology and Nursing University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - F. Dalgard
- Department of Dermatology Oslo University Hospital Oslo Norway
| | - A.W.M. Evers
- Department of Health, Medical and Neuropsychology Institute of Psychology Leiden University Leiden The Netherlands
| | - S. Garcovich
- Catholic University of the Sacred Heart, Milano Lombardy Italy
| | - M. Gonçalo
- Department of Dermatology University Hospital and Faculty of Medicine University of Coimbra Coimbra Portugal
| | - J. Lambert
- Department of Dermatology University Hospital of Antwerp Antwerp Belgium
| | - F.J. Legat
- Department of Dermatology Medical University of Graz Graz Austria
| | - T. Leslie
- Royal Free London and St John's Institute of Dermatology Guy's & St Thomas’ Hospital London United Kingdom
| | - L. Misery
- Department of Dermatology University Hospital of Brest Brest France
| | - U. Raap
- Department of Dermatology and Allergy Hannover Medical School Hannover Germany
| | - A. Reich
- Department of Dermatology, Venereology and Allergology Wroclaw Medical University Wroclaw Poland
| | - E. Şavk
- Department of Dermatology Adnan Menderes University Aydın Turkey
| | - M. Streit
- Department of Dermatology Kantonsspital Aarau Aarau Switzerland
| | - E. Serra‐Baldrich
- Cutaneous Allergy Unit Department of Dermatology Hospital Sant Pau Universitat Autònoma Barcelona Barcelona Spain
| | - J. Szepietowski
- Department of Dermatology, Venereology and Allergology Wroclaw Medical University Wroclaw Poland
| | - J. Wallengren
- Department of Dermatology and Venereology University Hospital of Lund Lund Sweden
| | - E. Weisshaar
- Department of Social Medicine, Occupational and Environmental Dermatology University of Heidelberg Heidelberg Germany
| | - M. Dugas
- Institute of Medical Informatics University of Münster Münster Germany
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Reimer P, Vosshenrich R, Storck M. [Acute aortic diseases. Diagnostic imaging and therapy]. Radiologe 2015; 55:803-15, quiz 816. [PMID: 26336960 DOI: 10.1007/s00117-015-0010-9] [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: 11/30/2022]
Abstract
Diagnostic imaging is crucial in the work-up of acute aortic diseases. Current imaging algorithms enable radiologists differentiating the various entities with subsequent clinically relevant treatment options. Within this educational overview we focus on non-traumatic acute aortic disease. Recent developments of cross sectional imaging are summarized. As for acute aortic disease, we discuss dissections, intramural hematoma, penetrating aortic ulcer, and aortitis. Current treatment options are presented.
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Affiliation(s)
- P Reimer
- Institut für diagnostische und interventionelle Radiologie, Klinikum Karlsruhe, Moltkestraße 90, 79133, Karlsruhe, Deutschland.
| | - R Vosshenrich
- Praxis für moderne Schnittbild-Diagnostik, Bahnhofsallee 1d, 37081, Göttingen, Deutschland
| | - M Storck
- Klinik für Gefäß- und Thoraxchirurgie, Klinikum Karlsruhe, Moltkestraße 90, 79133, Karlsruhe, Deutschland
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Kallmayer M, Kühnl A, Haller B, Storck M, Zimmermann A, Eckstein H. Trends and Outcomes of Carotid Endarterectomy and Carotid Stenting in Germany Between 2003 and 2013 -– Results from the German Mandatory National Quality Assurance Registry. Eur J Vasc Endovasc Surg 2015. [DOI: 10.1016/j.ejvs.2015.06.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Trenner M, Haller B, Storck M, Eckstein HH. How EVAR Changed the Game: Trends in Patient Characteristics, Surgical Techniques and Outcomes of Non–-ruptured AAA Repair in Germany from 1999 to 2010. Eur J Vasc Endovasc Surg 2015. [DOI: 10.1016/j.ejvs.2015.06.066] [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: 10/23/2022]
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Kallmayer M, Tsantilas P, Knappich C, Deutsch L, Haller B, Söllner H, Storck M, Kühnl A, Zimmermann A, Eckstein HH. Trends und Ergebnisse der Karotischirurgie in Deutschland 2003–2013. Gefässchirurgie 2015. [DOI: 10.1007/s00772-015-0040-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Risse A, Dissemond J, Engels G, Glau S, Hochlenert D, Jecht M, Kersken J, Kramer A, Kröger K, Landgraf R, Lobmann R, May M, Mohrmann M, Morbach S, Pralle K, Reuter HM, Storck M, Tonn C, Trocha A, Wozniak G. Diabetisches-Fuß-Syndrom-Register. Diabetologe 2015. [DOI: 10.1007/s11428-014-1285-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lumsden AB, Morrissey NJ, Staffa R, Lindner J, Janousek L, Treska V, Stadler P, Moursi M, Storck M, Johansen K, Schermerhorn M, Powell R, Panneton J, Zhou W, Naoum J, Lipsitz E, Buckley C, Timaran C, Jordan W, Darling RC, Silhart Z, Buckley C, Armstrong P, Belkin M, Morrissey N, Porreca F, Cayne N. Randomized controlled trial comparing the safety and efficacy between the FUSION BIOLINE heparin-coated vascular graft and the standard expanded polytetrafluoroethylene graft for femoropopliteal bypass. J Vasc Surg 2015; 61:703-12.e1. [DOI: 10.1016/j.jvs.2014.10.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 10/06/2014] [Indexed: 11/25/2022]
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Affiliation(s)
- J. Dissemond
- Professor, Department for Dermatology, Venerology and Allergology, University School of Medicine, Essen, Germany
| | - K. Kröger
- Professor, Clinic Director, Department for Vascular Medicine, HELIOS Clinic, Krefeld, Germany
| | - M. Storck
- Professor Clinic Director, Department for Vascular and Thoracic Surgery, Municipal Hospital Karlsruhe, Academic Teaching Hospital Univ. Freiburg, Germany
| | - A. Risse
- Clinic-Center North, Center for Diabetes, Dortmund, Germany
| | - P. Engels
- EngelsConsult, Bergisch Gladbach, Germany
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