Economic analysis of hyperbaric oxygen therapy for the treatment of ischaemic diabetic foot ulcers.

Introduction: The aim was to determine the cost-effectiveness and cost-utility of additional hyperbaric oxygen therapy (HBOT) compared to standard care (SC) for ischaemic diabetic foot ulcers (DFUs) regarding limb salvage and health status.

Methods: An economic analysis was conducted, comprising cost-effectiveness and cost-utility analyses, with a 12-month time horizon, using data from the DAMO₂CLES multicentre randomised clinical trial. Cost-effectiveness was defined as cost per limb saved and cost-utility as cost per quality-adjusted life year (QALY).

Assessment of microcirculatory changes in local tissue oxygenation after revascularization for peripheral arterial disease with the Hyperview®, a portable hyperspectral imaging device.

Objectives: The Hyperview® is a hyperspectral camera, which can be used to assess the microcirculation of patients with peripheral arterial disease (PAD) and/or diabetes mellitus (DM). It measures local tissue oxygenation in concentrations of oxyhemoblobin (OXY), deoxyhemoglobin (DEOXY), and O-saturation (O2-SAT) in arbitrary units. The aim of this validation study is to assess whether the Hyperview® is able to monitor microcirculatory changes after revascularization in patients with PAD.

High inter- and intra-observer agreement for measuring tissue oxygenation of the plantar surface of the foot in healthy participants with the Hyperview®: A pilot study.

Objectives: The Hyperview® is a novel camera that applies hyperspectral imaging to project local concentrations of oxyhaemoglobin (OXY), deoxyhaemoglobin (DEOXY) and O-saturation (O2-SAT) in a map. In this pilot validation study, we assessed inter - and intra-observer agreement for measuring OXY, DEOXY and O2-SAT in healthy participants.

Methods: The plantar region of the right foot was assessed with the Hyperview® in 50 healthy participants.

Protocol for a prospective, longitudinal cohort study on the effect of arterial disease level on the outcomes of supervised exercise in intermittent claudication: the ELECT Registry.

Introduction: Despite guideline recommendations advocating conservative management before invasive treatment in intermittent claudication, early revascularisation remains widespread in patients with favourable anatomy. The aim of the Effect of Disease Level on Outcomes of Supervised Exercise in Intermittent Claudication Registry is to determine the effect of the location of stenosis on the outcomes of supervised exercise in patients with intermittent claudication due to peripheral arterial disease.

Methods And Analysis: This multicentre prospective cohort study aims to enrol 320 patients in 10 vascular centres across the Netherlands.

Is EVAR a durable solution? Indications for reinterventions.

Introducion: Indications for reinterventions after endovascular aneurysm repair (EVAR), as well as their occurrence in number and time, are important to establish in order to optimize patient selection, postprocedure surveillance and also to guide improvements in endograft designs. The aim of this report was to present an overview of current data on reinterventions after elective EVAR.

Evidence Acquisition: Qualitative review of studies reporting on reinterventions after elective EVAR, identified by a systematic literature search in MEDLINE, EMBASE and the Cochrane Library for publications from 2010 to 13th of November 2017.

What are the decision-making preferences of patients in vascular surgery? A mixed-methods study.

Objectives: Shared decision-making (SDM) has been advocated as the preferred method of choosing a suitable treatment option. However, patient involvement in treatment decision-making is not yet common practice in the field of vascular surgery. The aim of this mixed-methods study was to explore patients' decision-making preferences and to investigate which facilitators and barriers patients perceive as important for the application of SDM in vascular surgery.

Carotid arterial wall inflammation in peripheral artery disease is augmented by type 2 diabetes: a cross-sectional study.

Background: Patients with peripheral artery disease (PAD) are at increased risk of secondary events, which is exaggerated in the presence of type 2 diabetes mellitus. Diabetes is associated with a systemic pro-inflammatory state. We therefore investigated the cumulative impact of PAD and type 2 diabetes on carotid arterial wall inflammation.

The Merits of a Two-Day Evidence-Based Medicine Course for Surgical Residents.

Background: Over 10 years ago, we introduced a two-day, evidence-based surgery course for surgical residents. During the last 4 years, we evaluated its effect on the participants' evidence-based medicine (EBM) knowledge and skills.

Methods: Between 2012 and 2015, six courses were organised for residents of various surgical specialties of allied hospitals in the Amsterdam educational district.

Number Unnecessarily Treated in Relation to Harm: A Concept Physicians and Patients Need to Understand.

Physicians are legally and ethically compelled to present their patients with available evidence on the potentially beneficial and harmful effects of a proposed medical or surgical treatment. This, however, is only half the story. It does not offer the patient a clear view of the pros and cons of one treatment option versus another, or even versus no treatment at all.

Lowering iodinated contrast concentration in infrainguinal endovascular interventions: a three-armed randomized controlled non-inferiority trial.

Objectives: To determine the influence of lowering iodinated contrast concentration on confidence of interventional radiologists in diagnosing and treating lesions during endovascular interventions in patients with symptomatic peripheral arterial disease (PAD).

Methods: A randomized controlled non-inferiority trial was performed in 60 patients. Intervention was performed with contrast concentrations (in mg of iodine per mL, mgI/mL) of 300 (standard), 240, or 140 mgI/mL.

Functional Imaging of the Foot with Perfusion Angiography in Critical Limb Ischemia.

Purpose: To report on the first clinical experience with perfusion angiography (PA) of the foot in patients with chronic critical limb ischemia.

Materials And Methods: PA is a post-processing software algorithm and no extra digital subtraction angiography (DSA) has to be performed for this analysis. The data used to test the feasibility of PA were obtained from a consecutive group of 89 patients with CLI who were treated with standard below the knee angioplasty and 12 separate patients who were not suitable for endovascular revascularization.

Disease understanding in patients with intermittent claudication: A qualitative study.

The aim of our qualitative study was to investigate the understanding of patients with intermittent claudication (IC) regarding the etiology and atherosclerotic nature of their disease. Patients were recruited from participants of the SUPER study, a randomized trial comparing angioplasty and supervised exercise therapy for alleviation of IC owing to an iliac artery obstruction. Patients were submitted to explorative, semistructured, in-depth interviews that were fully transcribed, coded, and categorized.

Introducing the Concept of the Minimally Important Difference to Determine a Clinically Relevant Change on Patient-Reported Outcome Measures in Patients with Intermittent Claudication.

Purpose: The minimally important difference (MID) represents the smallest change in score on patient-reported outcome measures that is relevant to patients. The aim of this study was to introduce the MID for the Vascular Quality of Life Questionnaire (VascuQol) and the walking impairment questionnaire (WIQ) for patients with intermittent claudication (IC).

Methods: In this multicenter study, we recruited 294 patients with IC between July and October 2012.

Perfusion angiography of the foot in patients with critical limb ischemia: description of the technique.

Objective: To study the feasibility of 2D perfusion imaging in critical limb ischemia (CLI).

Methods/results: Perfusion angiography is a new technology which was tested in 18 patients with CLI of the foot. A standardized protocol was used with a catheter placed at the mid-part of the popliteal artery, and a total of 9 cc of non-ionic iodinated contrast material was injected at a rate of 3 cc/sec.

Outcomes of infrainguinal revascularizations with endovascular first strategy in critical limb ischemia.

Purpose: This study was designed to study the outcome of infrainguinal revascularization in patients with critical limb ischemia (CLI) in an institution with a preference towards endovascular intervention first in patients with poor condition, unfavourable anatomy for surgery, no venous material for bypass, and old age.

Methods: A prospective, observational cohort study was conducted between May 2007 and May 2010 in patients presenting with CLI. At baseline, the optimal treatment was selected, i.

Is additional hyperbaric oxygen therapy cost-effective for treating ischemic diabetic ulcers? Study protocol for the Dutch DAMOCLES multicenter randomized clinical trial?

Background: The value of hyperbaric oxygen therapy (HBOT) in the treatment of diabetic ulcers is still under debate. Available evidence suggests that HBOT may improve the healing of diabetic ulcers, but it comes from small trials with heterogeneous populations and interventions. The DAMOCLES-trial will assess the (cost-)effectiveness of HBOT for ischemic diabetic ulcers in addition to standard of care.

Changes in functional status after treatment of critical limb ischemia.

Objective: This study evaluated changes in functional status with the Academic Medical Center Linear Disability Score (ALDS) and in quality of life with the Vascular Quality of Life Questionnaire (VascuQol) in patients treated for critical limb ischemia (CLI).

Methods: We conducted a prospective observational cohort study in a single academic center that included consecutive patients with CLI who presented between May 2007 and May 2010. The ALDS and VascuQol questionnaires were administered before treatment (baseline) and after treatment at 6 and 12 months of follow-up.

Diagnostic performance of computed tomography angiography and contrast-enhanced magnetic resonance angiography in patients with critical limb ischaemia and intermittent claudication: systematic review and meta-analysis.

Objective: To evaluate the diagnostic performance of computed tomography angiography (CTA) and contrast-enhanced magnetic resonance angiography (CE-MRA) in detecting haemodynamically significant arterial stenosis or occlusion in patients with critical limb ischaemia (CLI) or intermittent claudication (IC).

Methods: Medline and Embase were searched for studies comparing CTA or CE-MRA with digital subtraction angiography as a reference standard, including patients with CLI or IC. Outcome measures were aortotibial arterial stenosis of more than 50 % or occlusion.

The relationship of walking distances estimated by the patient, on the corridor and on a treadmill, and the Walking Impairment Questionnaire in intermittent claudication.

Objective: Physicians and patients consider the limited walking distance and perceived disability when they make decisions regarding (invasive) treatment of intermittent claudication (IC). We investigated the relationship between walking distances estimated by the patient, on the corridor and on a treadmill, and the Walking Impairment Questionnaire (WIQ) in patients with IC due to peripheral arterial disease.

Methods: This was a single-center, prospective observational cohort study at a vascular laboratory in a university hospital in the Netherlands.

Three-dimensional rotational angiography of the foot in critical limb ischemia: a new dimension in revascularization strategy.

Purpose: To evaluate the additional value of three-dimensional rotational angiography (3DRA) of the foot compared with digital subtraction angiography (DSA) in patients with critical limb ischemia (CLI).

Technique: For 3DRA, the C-arm was placed in the propeller position with the foot in an isocentric position. The patient's unaffected foot was positioned in a footrest outside the field of view.

Validation of the Dutch version of the VascuQol questionnaire and the Amsterdam Linear Disability Score in patients with intermittent claudication.

Purpose: To assess the reliability and validity of the Dutch version of the vascular quality of life questionnaire (VascuQol) and the AMC Linear Disability Score (ALDS) in patients with stable intermittent claudication (IC).

Methods: During a 5-month period we performed a prospective study in which we included every patient with stable IC, who visited our vascular surgery outpatient clinic and consented to participate. Forty consecutive patients filled in the Dutch VascuQol, the ALDS, and Short Form-36 (SF-36).