Zinvolle interventies bij perifeer vaatlijden: Stoppen met primair verwijzen en dotteren

In de beschouwing gaan wij nader in op belangrijke aspecten van succesvolle implementatie van deze beweeg- en leefstijlinterventie. Daarnaast pleiten we voor het toepassen van deze interventie in de zorg voor patiënten met andere chronische aandoeningen

Venous Thoracic Outlet Syndrome Caused by Double Compression of the Axillosubclavian Vein:A Case Report

Introduction: In venous thoracic outlet syndrome (VTOS), pathology around the axillosubclavian vein causes venous compression with the subsequent development of upper extremity symptoms. This case report describes the analysis of all possible compression sites and subsequent treatment of VTOS patients with multiple compression points. Report: A 22 year old male presented with severe pain and swelling in his right arm, which persisted after a conservatively managed primary upper extremity deep vein thrombosis. Compression of the axillosubclavian vein was seen both at the level of the pectoralis minor and the costoclavicular spaces. Both compression points were successfully treated by combining thoracic outlet decompression surgery with pectoralis minor tenotomy. Discussion: This report underlines the importance of considering the possibility of multiple compression sites in patients with VTOS. Incomplete surgical release of all compression points leaves patients prone to re-thrombosis and/or persistent post-thrombotic syndrome. Timely recognition of all abnormalities on venography may allow for adjustment of surgical treatment accordingly

Manipulating spatial distance in virtual reality: Effects on treadmill walking performance in patients with intermittent claudication

Research indicates that the manipulation of spatial distance between objects in a previously observed environment may go unnoticed when the categorical information of these objects, such as their order, matches that of memory for the environment. Using a repeated measures design, we investigated whether manipulations of spatial distance in virtual reality (VR) can influence treadmill exercise performance (i.e., walking distance) in patients with intermittent claudication; a cramping pain or discomfort in the legs, which occurs during exercise. Participants (N = 19) carried out four treadmill exercise sessions; one without VR and three with a VR environment to move through while walking. They were instructed to walk until the pain forced them to stop. All VR sessions contained the same environment, but in the second and third session it was ‘stretched’ and ‘compressed’. Walking distance was not influenced by the mere addition of VR. However, both VR manipulations led to greater walking distance than the VR baseline session and participants walked furthest when presented with the stretched environment. The results indicate that the manipulation of spatial distance in VR can be of clinical relevance; a finding that may be applied in the development of future medical applications

Vascular Quality of Life Questionnaire-6 Before and After Supervised Exercise Therapy in Patients with Intermittent Claudication

OBJECTIVE: The Vascular Quality of Life Questionnaire-6 (VascuQoL-6) is a short, disease specific instrument used to determine health related quality of life (HRQoL) in patients with peripheral arterial disease. This study aimed to assess the minimally important difference (MID) and substantial clinical benefit (SCB) of the VascuQoL-6 in Dutch patients with intermittent claudication (IC) receiving supervised exercise therapy (SET). METHODS: Consecutive patients with IC who were recruited from a single centre between January 2016 and December 2016 completed the VascuQoL-6 before initiation and after three months of SET. They subsequently answered an anchor question rating their current health status as much improved, improved, unchanged, deteriorated, or much deteriorated, compared with baseline. The MID for improvement and deterioration and SCB were calculated using anchor based and distribution based methods. RESULTS: A total of 124 patients with IC (58% male, mean age 68 years) completed the study protocol. Baseline VascuQoL-6 scores increased from 16.3 ± 4.4 to 18.7 ± 3.8 after three months of SET (p < .001). MID values ranged from +2.0 to +3.8 points regarding HRQoL improvement and from +0.2 to -2.2 points regarding HRQoL deterioration. The SCB ranged from +3.7 to +5.0 points. Depending on the MID approach, 32% - 41% of patients achieved a clinically meaningful improvement in HRQoL. CONCLUSION: Approximately one in three patients with IC reported a clinically meaningful improvement in HRQoL after three months of SET. The range of MID and SCB values provides caregivers with an idea of how much change in VascuQoL-6 scores is considered relevant or substantial by their patients. Applying cutoff points for MID and SCB may optimise the interpretation of trial results and may help to set a benchmark for success of SET