The many faces of diabetes. Is there a need for re-classification? A narrative review.

The alarming rise in the worldwide prevalence of obesity and associated type 2 diabetes mellitus (T2DM) have reached epidemic portions. Diabetes in its many forms and T2DM have different physiological backgrounds and are difficult to classify. Bariatric surgery (BS) is considered the most effective treatment for obesity in terms of weight loss and comorbidity resolution, improves diabetes, and has been proven superior to medical management for the treatment of diabetes.

A Comparison of Health Status and Quality of Life in Patients with Intermittent Claudication.

Background: Patient reported outcome measures (PROMs) such as health status (HS) and quality of life (QOL) are frequently used interchangeably while they represent different outcomes. Whether a discrepancy exists in patients with intermittent claudication (IC) in changes over time between HS and QOL is unclear. This study aimed to investigate the strength and the direction of the association between HS and QOL over time in patients with IC that underwent supervised exercise therapy (SET).

The Effect of Arterial Disease Level on Outcomes of Supervised Exercise Therapy for Intermittent Claudication: A Prospective Cohort Study.

Objective: To assess whether level of arterial obstruction determines the effectiveness of SET in patients with IC.

Background Data: Guidelines advocate SET before invasive treatment for IC, but early revascularization remains widespread, especially in patients with aortoiliac disease.

Methods: Patients were recruited from 10 Dutch centers between October 2017 and October 2018.

A Comparison of Quality of Life in Elderly Patients with Intermittent Claudication and Chronic Limb-Threatening Ischemia.

Background: Intermittent claudication (IC) and chronic limb-threatening ischemia (CLTI) are both associated with a decreased health status and possibly quality of life (QOL). A better understanding of the differences in QOL between patients with IC and CLTI could be of additional value in shared decision-making. The aim of this study was to compare the QOL at baseline between patients with IC and patients with CLTI.

Editor's Choice - Nationwide Analysis of Patients Undergoing Iliac Artery Aneurysm Repair in the Netherlands.

Objective: The new 2019 guideline of the European Society for Vascular Surgery (ESVS) recommends consideration for elective iliac artery aneurysm (eIAA) repair when the iliac diameter exceeds 3.5 cm, as opposed to 3.0 cm previously.

Radiation exposure in an endovascular aortic aneurysm repair program after introduction of a hybrid operating theater.

Background: A hybrid operating theater (HOT) enables optimal image quality, improved ergonomics, and excellent sterility for complex endovascular and hybrid procedures. We hypothesize that the commissioning of a new HOT involves a learning curve. It is unclear how steep the learning curve of these advanced HOTs is.

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.

Limited Adherence to Peripheral Arterial Disease Guidelines and Suboptimal Ankle Brachial Index Reliability in Dutch Primary Care.

Objective/background: The Dutch College of General Practitioners' guideline on peripheral arterial disease (PAD) provides clear recommendations on the management of PAD. An ankle brachial index (ABI) measurement, prescription of antiplatelet drugs and statins, and supervised exercise therapy (SET) for intermittent claudication (IC) are advised. The aims of this study were to determine the adherence of general practitioners (GPs) to their own guideline on PAD and to evaluate the reliability of primary care ABI measurements.

Symptomatic abdominal aortic aneurysm repair: to wait or not to wait.

Background: In patients with a symptomatic abdominal aortic aneurysm (sAAA), acute intervention theoretically reduces rupture risk prior to surgery whereas delayed intervention provides surgery under optimised conditions. In the present study we evaluated differences in 30-day mortality in patients with a sAAA operated within 12 hours compared to patients who received treatment after 12 hours and who were optimized for surgery.

Methods: All patients with a sAAA who were treated within one week after presentation were included in the analyses.

Preoperative exercise therapy in surgical care: a scoping review.

Objectives: Several systematic reviews have focused on the role of preoperative exercise therapy (PET) in various fields of surgical care. Aims of the present scoping review are to summarize research findings and to identify gaps in existing literature.

Methods: Two authors independently conducted a comprehensive literature search on systematic reviews regarding PET.

Beneficial Effects of Pre-operative Exercise Therapy in Patients with an Abdominal Aortic Aneurysm: A Systematic Review.

Objective/background: The impact of post-operative complications in abdominal aortic aneurysm (AAA) surgery is substantial, and increases with age and concomitant co-morbidities. This systematic review focuses on the possible effects of pre-operative exercise therapy (PET) in patients with AAA on post-operative complications,aerobic capacity, physical fitness, and recovery.

Methods: A systematic search on PET prior to AAA surgery was conducted.

Preoperative exercise therapy for elective major abdominal surgery: a systematic review.

Objectives: The impact of postoperative complications after Major Abdominal Surgery (MAS) is substantial, especially when socio-economical aspects are taken into account. This systematic review focuses on the effects of preoperative exercise therapy (PEXT) on physical fitness prior to MAS, length of hospital admission and postoperative complications in patients eligible for MAS, and on what is known about the most effective kind of exercise regime.

Methods: A systematic search identified randomised controlled trials on exercise therapy and pulmonary physiotherapy prior to MAS.

Supervised exercise therapy versus non-supervised exercise therapy for intermittent claudication.

Background: Although supervised exercise therapy is considered to be of significant benefit for people with leg pain (peripheral arterial disease (PAD)), implementing supervised exercise programs (SETs) in daily practice has limitations. This is an update of a review first published in 2006.

Objectives: The main objective of this review was to provide an accurate overview of studies evaluating the effects of supervised versus non-supervised exercise therapy on maximal walking time or distance on a treadmill for people with intermittent claudication.

Treatment of temporal artery pseudoaneurysms.

Purpose: To give an overview of the etiology and diagnostic process of superficial temporal artery pseudoaneurysms and to evaluate different treatment modalities.

Basic Methods: PubMed was used for searching multiple databases for relevant clinical studies.

Principal Findings: A total of 62 studies were included, harboring 82 patients.

[A chance finding in a woman with abdominal pain].

A 73-year-old woman was presented to the emergency department with severe abdominal pain. A CT-scan of the abdomen showed coprostasis and a visceral abdominal aneurysm of the splenic artery. Subsequently, the aneurysm was treated with endovascular coiling.

Challenging the evidence for pre-emptive coil embolisation of the internal iliac artery during endovascular aneurysm repair.

Objectives: We retrospectively analysed the results of a strategy in which coverage of the internal iliac artery (IIA) during endovascular aneurysm repair (EVAR) was routinely performed without coil embolisation.

Methods: From January 2010 until May 2012, 32 patients (96.9% men; mean age 73.

Applicability of the ankle-brachial-index measurement as screening device for high cardiovascular risk: an observational study.

Background: Screening with ankle-brachial index (ABI) measurement could be clinically relevant to avoid cardiovascular events in subjects with asymptomatic atherosclerosis. To assess the practical impact of guidelines regarding the use of ABI as a screening tool in general practice, the corresponding number needed to screen, including the required time investment, and the feasibility of ABI performance, was assessed.

Methods: An observational study was performed in the setting of 955 general practices in the Netherlands.

Early and mid-term results of a prospective observational study comparing emergency endovascular aneurysm repair with open surgery in both ruptured and unruptured acute abdominal aortic aneurysms.

The aim of the paper is to prospectively describe early and mid-term outcomes for emergency endovascular aneurysm repair (eEVAR) versus open surgery in acute abdominal aortic aneurysms (aAAAs), both unruptured (symptomatic) and ruptured. We enrolled all consecutive patients treated for aAAA at our center between April 2002 and April 2008. The main outcome parameters were 30-day, 6- and 12-month mortality (all-cause and aneurysm-related).

Supervised exercise therapy for intermittent claudication: current status and future perspectives.

Intermittent claudication (IC) has a high prevalence in the older population and is closely associated with cardiovascular and cerebrovascular disease. High mortality rates are reported due to ongoing atherosclerotic disease. Because of these serious health risks, treatment of IC should address reduction of cardiovascular events (and related morbidity/mortality) and improvement of the poor health-related quality of life (QoL) and functional capacity.

Systematic approach to ruptured abdominal aortic aneurysm in the endovascular era: Intention-to-treat eEVAR protocol.

Emergency endovascular aneurysm repair (eEVAR) for ruptured abdominal aortic aneurysms (rAAA) is still a relatively new treatment option. A pre-defined strategy of an eEVAR first approach for rAAA is associated with improved mortality rates. After establishing and implementing the Intention-to-treat eEVAR protocol for rAAAs the mortality and morbidity rates improved significantly.

EVAR suitability is not a predictor for early and midterm mortality after open ruptured AAA repair.

Objective: The reported mortality reduction of emergency endovascular aneurysm repair (eEVAR) compared with open repair in patients with a ruptured abdominal aortic aneurysm (rAAA), as observed in observational studies, might be flawed by selection bias based on anatomical suitability for eEVAR. In the present study, we compared mortality in EVAR suitable versus non-EVAR-suitable patients with a ruptured AAA who were all treated with conventional open repair.

Materials And Methods: In all patients presenting with a suspected rAAA, computed tomography angiography (CTA) scanning was performed.

Endovascular aneurysm repair is superior to open surgery for ruptured abdominal aortic aneurysms in EVAR-suitable patients.

Objective: Efficacy results of endovascular repair (rEVAR) for ruptured abdominal aortic aneurysm (rAAA) compared with open surgery are based on several observational studies containing selection bias. The present study compared rEVAR with open surgery in EVAR-suitable patients with an rAAA who all underwent the same preoperative imaging protocol.

Methods: Our policy is to perform a computed tomography angiography on all patients with a suspected rAAA.

Functional claudication distance: a reliable and valid measurement to assess functional limitation in patients with intermittent claudication.

Background: Disease severity and functional impairment in patients with intermittent claudication is usually quantified by the measurement of pain-free walking distance (intermittent claudication distance, ICD) and maximal walking distance (absolute claudication distance, ACD). However, the distance at which a patient would prefer to stop because of claudication pain seems a definition that is more correspondent with the actual daily life walking distance. We conducted a study in which the distance a patient prefers to stop was defined as the functional claudication distance (FCD), and estimated the reliability and validity of this measurement.

Timing and necessity of a flexible sigmoidoscopy in patients with symptoms suggestive of haemorrhoids.

Objective: This study was performed to determine the probability of finding additional pathology, requiring treatment or follow-up, in patients referred with symptoms suggestive of haemorrhoids. Secondly, to determine, at what age a flexible sigmoidoscopy should be performed in these patients.

Method: All patients referred for the treatment of haemorrhoids over a period of 5 years were prospectively included in a database.