6 research outputs found
Percutaneous treatment of peripheral arterial disease
This thesis presents 7 studies that examined the results of balloon
dilation and stent placement performed for treatment o
Cost and patency rate targets for the development of endovascular devices to treat femoropopliteal arterial disease
PURPOSE: To determine the criteria that would make use of an endovascular
device cost-effective compared with bypass surgery and percutaneous
transluminal angioplasty in the treatment of femoropopliteal arterial
disease. MATERIALS AND METHODS: A decision model was developed to compare
treatment with the use of a hypothetical endovascular device with
established therapies. Cost-effectiveness from the perspective of the
health care system was considered. Outcome measures were lifetime costs
and quality-adjusted life-years. With the use of net health benefit
calculations and threshold analysis, combinations of costs and patency
rates were determined that would make the device cost-effective compared
with established therapies. In subgroup and sensitivity analyses, the
effect on decision-making of sex, age, indication, lesion type, procedural
risk, and society's willingness to pay for incremental gain in health were
explored. RESULTS: Use of a device that costs $3,000 would be
cost-effective compared with bypass surgery for critical ischemia if the
5-year patency rate is 29%-46%. Use of the same device would be
cost-effective compared with angioplasty for disabling claudication and
stenosis if the 5-year patency rate is 69%-86%. CONCLUSION: The target
combinations of costs and patency rates found in this study are probably
attainable, and further development of such endovascular devices seems
warranted
Balloon dilation and stent implantation for treatment of femoropopliteal arterial disease: meta-analysis
PURPOSE: To perform a meta-analysis of long-term results of balloon
dilation and stent implantation in the treatment of femoropopliteal
arterial disease. MATERIALS AND METHODS: The English-language literature
was searched for studies published between 1993 and 2000. Inclusion
criteria for articles were presentation of long-term primary patency
rates, standard errors (explicitly reported or derivable), and baseline
characteristics of the study population. Two reviewers independently
extracted data, and discrepancies were resolved by consensus. Primary
patency rates were combined by using a technique that allows adjustment
for differences across study populations. Analyses were adjusted for
lesion type and clinical indication. RESULTS: Nineteen studies met the
inclusion criteria, representing 923 balloon dilations and 473 stent
implantations. Combined 3-year patency rates after balloon dilation were
61% (standard error, 2.2%) for stenoses and claudication, 48% (standard
error, 3.3%) for occlusions and claudication, 43% (standard error, 4.1%)
for stenoses and critical ischemia, and 30% (standard error, 3.7%) for
occlusions and critical ischemia. The 3-year patency rates after stent
implantation were 63%-66% (standard error, 4.1%) and were independent of
clinical indication and lesion type. Funnel plots demonstrated an
asymmetric distribution of the data points associated with stent studies.
CONCLUSION: Balloon dilation and stent implantation for claudication and
stenosis yield similar long-term patency rates. For more severe
femoropopliteal disease, the results of stent implantation seem more
favorable. Publication bias could not be ruled out
Accuracy of magnetic resonance imaging to detect cartilage loss in severe osteoarthritis of the first carpometacarpal joint: Comparison with histological evaluation
Background: Magnetic resonance imaging (MRI) is increasingly used for research in hand osteoarthritis, but imaging the thin cartilage layers in the hand joints remains challenging. We therefore assessed the accuracy of MRI in detecting cartilage loss in patients with symptomatic osteoarthritis of the first carpometacarpal (CMC1) joint. Methods: Twelve patients scheduled for trapeziectomy to treat severe symptomatic osteoarthritis of the CMC1 joint underwent a preoperative high resolution 3D spoiled gradient (SPGR) MRI scan. Subsequently, the resected trapezium was evaluated histologically. The sections were scored for cartilage damage severity (Osteoarthritis Research Society International (OARSI) score), and extent of damage (percentage surface area). Each MRI scan was scored for the area of normal cartilage, partial cartilage loss and full cartilage loss. The percentages of the total surface area with any cartilage loss and full-thickness cartilage loss were calculated using MRI and histological evaluation. Results: MRI and histological evaluation both identified large areas of overall cartilage loss. The median (IQR) surface area of any cartilage loss on MRI was 98% (82-100%), and on histological assessment 96% (87-98%). However, MRI underestimated the extent of full-thickness cartilage loss. The median (IQR) surface area of full-thickness cartilage loss on MRI was 43% (22-70%), and on histological evaluation 79% (67-85%). The difference was caused by a thin layer of high signal on the articulating surface, which was interpreted as damaged cartilage on MRI but which was not identified on histological evaluation. Conclusions: Three-dimensional SPGR MRI of the CMC1 joint demonstrates overall cartilage damage, but underestimates full-thickness cartilage loss in patients with advanced osteoarthritis
The reliability and reproducibility of the Hertel classification for comminuted proximal humeral fractures compared with the Neer classification
_Introduction_ The Neer classification is the most commonly used fracture classification system for proximal humeral fractures. Inter- and intra-observer agreement is limited, especially for comminuted fractures. A possibly more straightforward and reliable classification system is the Hertel classification. The aim of this study was to compare the inter- and intra-observer variability of the Hertel with the Neer classification in comminuted proximal humeral fractures.
_Materials and methods_ Four observers evaluated blinded radiographic images of 60 patients. After at least two months classification was repeated.
_Results_ Inter-observer agreement on plain X-rays was fair for both Hertel and Neer. Inter-observer agreement on CT-scans was substantial for Hertel and moderate for Neer. Inter-observer agreement on 3D-reconstructions was moderate for both Hertel and Neer. Intra-observer agreement on plain X-rays was fair for both Hertel and Neer. Intra-observer agreement on CT-scans was moderate for both Hertel and Neer. Intra-observer agreement on 3D-reconstructions was moderate for Hertel and substantial for Neer.
_Conclusions_ The Hertel and Neer classifications showed a fair to substantial inter- and intra-observer agreement on the three diagnostic modalities used. Although inter-observer agreement was highest for Hertel classification on CT-scans, Neer classification had the highest intra-observer agreement on 3D-reconstructions. Data of this study do not confirm superiority of either classification system for the classification of comminuted proximal humeral fractures
Erratum to: High rates of clinically relevant incidental findings by total-body CT scanning in trauma patients: Results of the REACT-2 trial
A technical error led to incorrect rendering of the author group in this article. The correct authorship is as follows: K. Treskes1, S.A. Bos1, L.F.M. Beenen2, J.C. Sierink1, M.J.R. Edwards3, B.J