Review: Quality of Life in Lower Limb Peripheral Vascular Surgery

PURPOSE: Vascular intervention studies generally consider patency and limb salvage as primary outcomes. However, quality of life is increasingly considered an important patient-oriented outcome measurement of vascular interventions. Existing literature was analyzed to determine the effect of different treatments on quality of life for patients suffering from either claudication or critical limb ischemia. BASIC METHODS: A review of the literature was undertaken in the Medline library. A search was performed on quality of life in peripheral arterial disease. Results were stratified according to treatment groups. PRINCIPAL FINDINGS: Twenty-one articles described quality of life in approximately 4600 patients suffering from peripheral arterial disease. Invasive treatment generally results in better quality of life scores (at a maximum of 2 years of follow-up), compared with non-invasive treatment. In patients with critical limb ischemia, successful revascularization improves quality of life scores. Only one study reported long-term results. CONCLUSIONS: Increase in quality of life scores can be found for any intervention performed for peripheral arterial disease. However, there is scarce information on long-term quality of life after vascular intervention.info:eu-repo/semantics/publishedVersio

Clinical and scientific progress related to the interface between cardiology and psychology: lessons learned from 35 years of experience at the Thoraxcenter of the Erasmus Medical Center in Rotterdam

In November 1975, as the first in the Netherlands, a full-time psychologist was employed at the Department of Cardiology of the Thoraxcenter of the Erasmus Medical Center. This innovative decision was consistent with a view to treat the patient as a whole rather than the heart as a single body part in need of repair, combined with the understanding that the heart and mind interact to affect health. The present selective review addresses the broad range of contributions of 35 years of psychology to clinical cardiology and cardiovascular research with a focus on research, teaching, psychological screening and patient care. The review ends with lessons to be learned and challenges for the future with respect to improving the care and management of patients with heart disease in order to enhance secondary prevention and the role of behavioural and psychological factors in this endeavour

Acute Kidney Injury Following Elective Infrarenal and Complex Endovascular Aneurysm Repair:Incidence, Prognostic Significance, and Risk Factors

Objective:Acute kidney injury (AKI) is a well known complication following cardiovascular procedures. The objective of this study was to assess incidence, risk factors, and the prognostic significance of AKI following infrarenal endovascular aneurysm repair (EVAR) and complex EVAR (c-EVAR).Methods:Consecutive patients undergoing elective infrarenal EVAR or c-EVAR between 2000 and 2018 in two large teaching hospitals in the Netherlands were included. The primary outcome was incidence of peri-operative AKI development. Secondary outcomes included midterm renal function (RIFLE criteria), overall survival, and risk factors for AKI development. To determine survival and risk factors for AKI, multivariable analyses were performed, accounting for pre-operative renal function and other confounders.Results:Five hundred and forty patients were included who underwent infrarenal EVAR and 147 patients who underwent c-EVAR. Incidence of AKI was 8.7% (n = 47) in infrarenal EVAR patients, and 23% (n = 34) in c-EVAR patients (fenestrated EVAR 18%/branched EVAR 38%). After risk adjusted analysis, compared with non-AKI, post-operative AKI development was associated with higher three year mortality following both infrarenal and c-EVAR (infrarenal EVAR mortality HR 1.6 [95% CI 1.01 – 2.7], p = .046; c-EVAR mortality HR 2.4 [95% CI 1.1 – 5.2], p =.033). Following multivariable logistic regression, pre-operative chronic kidney disease (eGFR < 60; OR 2.2 [95% CI 1.03 – 4.8]) and neck diameter (OR[/mm] 1.1 [95% CI 1.01 – 1.2]) were statistically significantly associated with AKI following infrarenal EVAR, whereas for c-EVAR only contrast volume (OR[/10cc] 1.1 [95% CI 1.0 – 1.2]) was found to be statistically significantly associated with AKI.Conclusion:AKI is a well described complication following infrarenal EVAR and is common after c-EVAR. As AKI seems to be associated with permanent renal deterioration and lower survival, efforts to prevent AKI are essential

Risk factors and outcome of new-onset cardiac arrhythmias in vascular surgery patients

Background The pathophysiology of new-onset cardiac arrhythmias is complex and may bring about severe cardiovascular complications. The relevance of perioperative arrhythmias during vascular surgery has not been investigated. The aim of this study was to assess risk factors and prognosis of new-onset arrhythmias during vascular surgery. Methods A total of 513 vascular surgery patients, without a history of arrhythmias, were included. Cardiac risk factors, inflammatory status, and left ventricular function (LVF; N-terminal pro-B-type natriuretic peptide and echocardiography) were assessed. Continuous electrocardiography (ECG) recordings for 72 hours were used to identify ischemia and new-onset arrhythmias: atrial fibrillation, sustained ventricular tachycardia, supraventricular tachycardia, and ventricular fibrillation. Logistic regression analysis was applied to identify preoperative risk factors for arrhythmias. Cox regression analysis assessed the impact of arrhythmias on cardiovascular event-free survival during 1.7 years. Results New-onset arrhythmias occurred in 55 (11%) of 513 patients: atrial fibrillation, ventricular tachycardia, supraventricular tachycardia, and ventricular fibrillation occurred in 4%, 7%, 1%, and 0.2%, respectively. Continuous ECG showed myocardial ischemia and arrhythmias in 17 (3%) of 513 patients. Arrhythmia was preceded by ischemia in 10 of 55 cases. Increased age and reduced LVF were risk factors for the development of arrhythmias. Multivariate analysis showed that perioperative arrhythmias were associated with long-term cardiovascular events, irrespective of the presence of perioperative ischemia (hazard ratio 2.2, 95% CI 1.3-3.8, P=.004). Conclusion New-onset perioperative arrhythmias are common after vascular surgery. The elderly and patients with reduced LVF show arrhythmias. Perioperative continuous ECG monitoring helps to identify this high-risk group at increased risk of cardiovascular events and death. (Am Heart J 2010;159:1108-15.)Vascular Biology and Interventio