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  • 1
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    Short-term outcomes of open surgical abdominal aortic aneurysm repair from the Dutch Surgical Aneurysm Audit
    Oxford University Press (OUP) ; 2021
    In:  BJS Open Vol. 5, No. 5 ( 2021-09-06)
    Details
    In: BJS Open, Oxford University Press (OUP), Vol. 5, No. 5 ( 2021-09-06)
    Abstract: The sharp decrease in open surgical repair (OSR) for abdominal aortic aneurysm (AAA) has raised concerns about contemporary postoperative outcomes. The study was designed to analyse the impact of complications on clinical outcomes within 30 days following OSR. Methods Patients who underwent OSR for intact AAA registered prospectively between 2016 and 2019 in the Dutch Surgical Aneurysm Audit were included. Complications and outcomes (death, secondary interventions, prolonged hospitalization) were evaluated. The adjusted relative risk (aRr) and 95 per cent confidence intervals were computed using Poisson regression. Subsequently, the population-attributable fraction (PAF) was calculated. The PAF reflects the expected percentage reduction of an outcome if a complication were to be completely prevented. Results A total of 1657 patients were analysed. Bowel ischaemia and renal complications had the largest impact on death (aRr 12·44 (95 per cent c.i. 7·95 to 19·84) at PAF 20 (95 per cent c.i. 8·4 to 31·5) per cent and aRr 5·07 (95 per cent c.i. 3·18 to 8.07) at PAF 14 (95 per cent c.i. 0·7 to 27·0) per cent, respectively). Arterial occlusion had the greatest impact on secondary interventions (aRr 11·28 (95 per cent c.i. 8·90 to 14·30) at PAF 21 (95 per cent c.i. 14·7 to 28·1) per cent), and pneumonia (aRr 2·52 (95 per cent c.i. 2·04 to 3·10) at PAF 13 (95 per cent c.i. 8·3 to 17·8) per cent) on prolonged hospitalization. Small effects were observed on outcomes for other complications. Conclusion The greatest clinical impact following OSR can be made by focusing on measures to reduce the occurrence of bowel ischaemia, arterial occlusion and pneumonia.
    Type of Medium: Online Resource
    ISSN: 2474-9842
    URL: Article
    DOI: 10.1093/bjsopen/zrab086
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
    detail.hit.zdb_id: 2902033-5
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  • 2
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    Meta-analysis of individual-patient data from EVAR-1, DREAM, OVER and ACE trials comparing outcomes of endovascular or open repair for abdominal aortic aneurysm over 5 years
    Oxford University Press (OUP) ; 2017
    In:  British Journal of Surgery Vol. 104, No. 3 ( 2017-02-03), p. 166-178
    Details
    In: British Journal of Surgery, Oxford University Press (OUP), Vol. 104, No. 3 ( 2017-02-03), p. 166-178
    Abstract: The erosion of the early mortality advantage of elective endovascular aneurysm repair (EVAR) compared with open repair of abdominal aortic aneurysm remains without a satisfactory explanation. Methods An individual-patient data meta-analysis of four multicentre randomized trials of EVARversus open repair was conducted to a prespecified analysis plan, reporting on mortality, aneurysm-related mortality and reintervention. Results The analysis included 2783 patients, with 14 245 person-years of follow-up (median 5·5 years). Early (0–6 months after randomization) mortality was lower in the EVAR groups (46 of 1393 versus 73 of 1390 deaths; pooled hazard ratio 0·61, 95 per cent c.i. 0·42 to 0·89; P = 0·010), primarily because 30-day operative mortality was lower in the EVAR groups (16 deaths versus 40 for open repair; pooled odds ratio 0·40, 95 per cent c.i. 0·22 to 0·74). Later (within 3 years) the survival curves converged, remaining converged to 8 years. Beyond 3 years, aneurysm-related mortality was significantly higher in the EVAR groups (19 deaths versus 3 for open repair; pooled hazard ratio 5·16, 1·49 to 17·89; P = 0·010). Patients with moderate renal dysfunction or previous coronary artery disease had no early survival advantage under EVAR. Those with peripheral artery disease had lower mortality under open repair (39 deaths versus 62 for EVAR; P = 0·022) in the period from 6 months to 4 years after randomization. Conclusion The early survival advantage in the EVAR group, and its subsequent erosion, were confirmed. Over 5 years, patients of marginal fitness had no early survival advantage from EVAR compared with open repair. Aneurysm-related mortality and patients with low ankle : brachial pressure index contributed to the erosion of the early survival advantage for the EVAR group. Trial registration numbers: EVAR-1, ISRCTN55703451; DREAM (Dutch Randomized Endovascular Aneurysm Management), NCT00421330; ACE (Anévrysme de l'aorte abdominale, Chirurgie versus Endoprothèse), NCT00224718; OVER (Open Versus Endovascular Repair Trial for Abdominal Aortic Aneurysms), NCT00094575.
    Type of Medium: Online Resource
    ISSN: 0007-1323 , 1365-2168
    URL: Article
    DOI: 10.1002/bjs.10430
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2017
    detail.hit.zdb_id: 2006309-X
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  • 3
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    Impact of the COVID-19 pandemic on surgical care in the Netherlands
    Oxford University Press (OUP) ; 2022
    In:  British Journal of Surgery Vol. 109, No. 12 ( 2022-11-22), p. 1282-1292
    Details
    In: British Journal of Surgery, Oxford University Press (OUP), Vol. 109, No. 12 ( 2022-11-22), p. 1282-1292
    Abstract: The COVID-19 pandemic caused disruption of regular healthcare leading to reduced hospital attendances, repurposing of surgical facilities, and cancellation of cancer screening programmes. This study aimed to determine the impact of COVID-19 on surgical care in the Netherlands. Methods A nationwide study was conducted in collaboration with the Dutch Institute for Clinical Auditing. Eight surgical audits were expanded with items regarding alterations in scheduling and treatment plans. Data on procedures performed in 2020 were compared with those from a historical cohort (2018–2019). Endpoints included total numbers of procedures performed and altered treatment plans. Secondary endpoints included complication, readmission, and mortality rates. Results Some 12 154 procedures were performed in participating hospitals in 2020, representing a decrease of 13.6 per cent compared with 2018–2019. The largest reduction (29.2 per cent) was for non-cancer procedures during the first COVID-19 wave. Surgical treatment was postponed for 9.6 per cent of patients. Alterations in surgical treatment plans were observed in 1.7 per cent. Time from diagnosis to surgery decreased (to 28 days in 2020, from 34 days in 2019 and 36 days in 2018; P & lt; 0.001). For cancer-related procedures, duration of hospital stay decreased (5 versus 6 days; P & lt; 0.001). Audit-specific complications, readmission, and mortality rates were unchanged, but ICU admissions decreased (16.5 versus 16.8 per cent; P & lt; 0.001). Conclusion The reduction in the number of surgical operations was greatest for those without cancer. Where surgery was undertaken, it appeared to be delivered safely, with similar complication and mortality rates, fewer admissions to ICU, and a shorter hospital stay.
    Type of Medium: Online Resource
    ISSN: 0007-1323 , 1365-2168
    URL: Article
    DOI: 10.1093/bjs/znac301
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 2006309-X
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  • 4
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    Quality of life from a randomized trial of open and endovascular repair for abdominal aortic aneurysm
    Oxford University Press (OUP) ; 2016
    In:  British Journal of Surgery Vol. 103, No. 8 ( 2016-06-15), p. 995-1002
    Details
    In: British Journal of Surgery, Oxford University Press (OUP), Vol. 103, No. 8 ( 2016-06-15), p. 995-1002
    Abstract: Long-term survival is similar after open or endovascular repair of abdominal aortic aneurysm. Few data exist on the effect of either procedure on long-term health-related quality of life (HRQoL) and health status. Methods Patients enrolled in a multicentre randomized clinical trial (DREAM trial; 2000–2003) in Europe of open repair versus endovascular repair (EVAR) of abdominal aortic aneurysm were asked to complete questionnaires on health status and HRQoL. HRQoL scores were assessed at baseline and at 13 time points thereafter, using generic tools, the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36®) and EuroQol 5D (EQ-5D™). Physical (PCS) and mental component summary scores were also calculated. Follow-up was 5 years. Results Some 332 of 351 patients enrolled in the trial returned questionnaires. More than 70 per cent of questionnaires were returned at each time point. Both surgical interventions had a short-term negative effect on HRQoL and health status. This was less severe in the EVAR group than in the open repair group. In the longer term the physical domains of SF-36® favoured open repair: mean difference in PCS score between open repair and EVAR −1·98 (95 per cent c.i. −3·56 to −0·41). EQ-5D™ descriptive and EQ-5D™ visual analogue scale scores for open repair were also superior to those for EVAR after the initial 6-week interval: mean difference −0·06 (−0·10 to −0·02) and −4·09 (−6·91 to −1·27) respectively. Conclusion In this study EVAR appeared to be associated with less severe disruption to HRQoL and health status in the short term. However, during longer-term follow-up to 5 years, patients receiving open repair appeared to have improved quality of life and health status.
    Type of Medium: Online Resource
    ISSN: 0007-1323 , 1365-2168
    URL: Article
    DOI: 10.1002/bjs.10130
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2016
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  • 5
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    Analysis of Outcomes After Endovascular Abdominal Aortic Aneurysm Repair in Patients With Abnormal Findings on the First Postoperative Computed Tomography Angiography
    SAGE Publications ; 2021
    In:  Journal of Endovascular Therapy Vol. 28, No. 6 ( 2021-12), p. 878-887
    Details
    In: Journal of Endovascular Therapy, SAGE Publications, Vol. 28, No. 6 ( 2021-12), p. 878-887
    Abstract: Lifelong follow-up after endovascular abdominal aortic aneurysm repair (EVAR) is recommended due to a continued risk of complications, especially if the first postoperative imaging shows abnormal findings. We studied the long-term outcomes in patients with abnormalities on the first postoperative computed tomography angiography (CTA) following EVAR. Materials and Methods: This is a retrospective study of all consecutive patients who underwent elective EVAR for nonruptured abdominal aortic aneurysm (AAA) between January 2007 and January 2012 in 16 Dutch hospitals with follow-up until December 2018. Patients were included if the first postoperative CTA showed one of the following abnormal findings: endoleak type I–IV, endograft kinking, infection, or limb occlusion. AAA diameter, complications, and secondary interventions during follow-up were registered. Primary endpoint was overall survival, and other endpoints were secondary interventions and intervention-free survival. Kaplan-Meier analyses were used to estimate overall and intervention-free survival. Cox regression analyses were used to identify the association of independent determinants with survival and secondary interventions. Results: A total of 502 patients had abnormal findings on the first postoperative CTA after EVAR and had a median follow-up (interquartile range IQR) of 83.0 months (59.0). The estimated overall survival rate at 1, 5, and 10 years was 84.7%, 51.0%, and 30.8%, respectively. Age [hazard ratio (HR) 1.06, 95% confidence interval (CI) 1.05 to 1.10] and American Society of Anesthesiologists (ASA) classification (ASA IV HR 3.20, 95% CI 1.99 to 5.15) were significantly associated with all-cause mortality. Overall, 167 of the 502 patients (33.3%) underwent 238 secondary interventions in total. Fifty-eight patients (12%) underwent an intervention based on a finding on the first postoperative CTA. Overall survival was 38.4% for patients with secondary interventions and 44.5% for patients without (log rank; p=0.166). The intervention-free survival rate at 1, 5, and 10 years was 82.9%, 61.3%, and 45.6%, respectively. Conclusions: Patients with abnormalities on the first postoperative CTA after elective EVAR for infrarenal AAA cannot be discharged from regular imaging follow-up due to a high risk of secondary interventions. Patients who had a secondary intervention had similar overall survival as those without secondary interventions.
    Type of Medium: Online Resource
    ISSN: 1526-6028 , 1545-1550
    URL: Article
    DOI: 10.1177/15266028211030539
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
    detail.hit.zdb_id: 2049858-5
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  • 6
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    Endothelial cells (ECs) for vascular tissue engineering: venous ECs are less thrombogenic than arterial ECs : Arterial vs venous endothelial cells for tissue engineering
    Hindawi Limited ; 2015
    In:  Journal of Tissue Engineering and Regenerative Medicine Vol. 9, No. 5 ( 2015-05), p. 564-576
    Details
    In: Journal of Tissue Engineering and Regenerative Medicine, Hindawi Limited, Vol. 9, No. 5 ( 2015-05), p. 564-576
    Type of Medium: Online Resource
    ISSN: 1932-6254
    URL: Article
    DOI: 10.1002/term.1642
    Language: English
    Publisher: Hindawi Limited
    Publication Date: 2015
    detail.hit.zdb_id: 2316155-3
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  • 7
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    Endovascular treatment of traumatic rupture of the thoracic aorta
    Oxford University Press (OUP) ; 2007
    In:  British Journal of Surgery Vol. 94, No. 5 ( 2007-04-19), p. 525-533
    Details
    In: British Journal of Surgery, Oxford University Press (OUP), Vol. 94, No. 5 ( 2007-04-19), p. 525-533
    Abstract: Traumatic rupture of the thoracic aorta is a life-threatening event. Open surgical repair is the ‘gold standard’, but is associated with high mortality and morbidity rates. Endovascular repair is emerging as a potentially safer alternative. Methods A systematic review was performed of all published literature on this subject, including the authors' own experience. Using Sumsearch, PubMed and cross-references, all published reports up to January 2006 were identified, and analysed for injuries, perioperative morbidity, mortality, operating time, hospital stay and follow-up. Results A total of 284 patients were identified. Reported mortality rates range from 0 to 6 per cent. The procedure-related mortality rate is about 1·5 per cent. Some 6·7 per cent of all procedures were complicated by endoleak and the overall procedure-related morbidity rate was 14·4 per cent. These results are promising compared with those of open repair, but individual experience is limited and there may be some publication bias. Conclusion Endovascular repair of traumatic rupture of the thoracic aorta seems to reduce morbidity and mortality in patients with multiple trauma. Ideally, both devices and experienced personnel should be available in trauma centres.
    Type of Medium: Online Resource
    ISSN: 0007-1323 , 1365-2168
    URL: Article
    DOI: 10.1002/bjs.5795
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2007
    detail.hit.zdb_id: 2006309-X
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  • 8
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    Endoleak after stent-graft treatment of abdominal aortic aneurysm: a meta-analysis of clinical studies
    Oxford University Press (OUP) ; 1999
    In:  Journal of British Surgery Vol. 86, No. 5 ( 1999-05-01), p. 581-587
    Details
    In: Journal of British Surgery, Oxford University Press (OUP), Vol. 86, No. 5 ( 1999-05-01), p. 581-587
    Abstract: Endoleak is the major complication after endovascular treatment of abdominal aortic aneurysm (AAA) and its incidence seems to remain significant. Little is known about the association of device type and configuration with respect to the incidence, location, time of onset and fate of endoleakage. Methods A meta-analysis was performed via a Medline search of clinical studies after 1995 dealing with the endovascular treatment of AAA. Details of number of patients treated, configuration and type of endovascular device were collected. Data concerning site of origin, time of occurrence and fate of the endoleak were retrieved, along with information on change in diameter of the aneurysm with time. Results The 23 publications included reported on 1189 patients. The 1118 patients with successfully inserted transfemoral endovascular grafts experienced 270 endoleaks (24 per cent). The majority arose from the distal stent attachment site (36 per cent), were present immediately after stent-graft placement (66 per cent) and were persistent in time (37 per cent). Tube grafts were more frequently affected by endoleakage (35 per cent; P & lt; 0·0001), especially at the distal stent attachment site (51 per cent), than bifurcated grafts (18 per cent; P = 0·004) and aortounilateral devices (20 per cent; P = 0·70). Self- expandable stent-grafts were more frequently associated with endoleaks (25 per cent) than balloon-expandable stent-grafts (17 per cent) (P = 0·037). Conclusion Endovascular treatment of AAA is an evolving field. Even after the initial learning curve and attention to device-related problems, it is still accompanied by a significant number of endoleaks. Uniform presentation of results of treatment is necessary for analysing the effect of differences between patients, aneurysm morphology and device type.
    Type of Medium: Online Resource
    ISSN: 0007-1323 , 1365-2168
    URL: Article
    DOI: 10.1046/j.1365-2168.1999.01119.x
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 1999
    detail.hit.zdb_id: 2006309-X
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  • 9
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    Online Resource
    TRANSPLANTING HORSESHOE KIDNEYS : A WORLDWIDE SURVEY
    Ovid Technologies (Wolters Kluwer Health) ; 2001
    In:  The Journal of Urology
    Details
    In: The Journal of Urology, Ovid Technologies (Wolters Kluwer Health)
    Type of Medium: Online Resource
    ISSN: 0022-5347
    URL: Article
    DOI: 10.1097/00005392-200112000-00007
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2001
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  • 10
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    Management of aortic aneurysm in the presence of a horseshoe kidney
    Oxford University Press (OUP) ; 2002
    In:  British Journal of Surgery Vol. 88, No. 4 ( 2002-12-06), p. 500-509
    Details
    In: British Journal of Surgery, Oxford University Press (OUP), Vol. 88, No. 4 ( 2002-12-06), p. 500-509
    Abstract: The coexistence of an aortic aneurysm and a horseshoe kidney poses a technical challenge to the vascular surgeon at the time of aneurysm repair. The aim of this review is to develop a guideline for the treatment of patients with this dual pathology. Method A literature review combined with local experience provided a total of 176 cases. These were divided into two groups: asymptomatic aneurysms (134) and ruptured aneurysms (42), both in combination with a horseshoe kidney. Results Six types of operative approach were described: transperitoneal approach with or without separation of the renal isthmus, retroperitoneal approach, placement of a stent-graft, aneurysmal wrap and exploration without exclusion of the aneurysm. Diagnosis of the horseshoe kidney was made before operation in 81 per cent of patients in the asymptomatic group, and in 55 per cent (23 of 42) in the ruptured group. Computed tomography proved to be the most reliable diagnostic procedure. Occlusion of renal arteries originating from the aneurysm was reported in 51 per cent in the asymptomatic group, and in 74 per cent (23 of 31) in the ruptured group. Conclusion The preferred surgical options for asymptomatic patients with an aortic aneurysm and a horseshoe kidney are the placement of a stent-graft or a retroperitoneal approach; both avoid many of the technical difficulties related to the presence of the horseshoe kidney. The approach of choice for a ruptured aneurysm is transperitoneal. Separation of the renal isthmus should be avoided.
    Type of Medium: Online Resource
    ISSN: 0007-1323 , 1365-2168
    URL: Article
    DOI: 10.1046/j.1365-2168.2001.01718.x
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2002
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