Concepts and data model for a co-operative neurovascular database

Assessing the database needs of vascular surgeons

BACKGROUND

Vascular surgery is an ideal specialty for developing a shared database, because outcomes measures are precise, national standards have been established, and vascular surgeons have traditionally collected data.

STUDY DESIGN

A questionnaire of database experience and needs was developed, reviewed by a Western Vascular Society advisory committee, and sent to Western Vascular Society and Rocky Mountain Vascular Surgical Society members. Additionally, we obtained software from existing commercial vascular databases.

RESULTS

We had a 57% response from 196 surveys: 36% of vascular surgeons have functional vascular databases, which have been used from 1 to 26 years and contain 71 to 15,000 patients. Databases are used for research, quality control, and billing. Time (38%), expense (19%), and expertise (8%) preclude database use. Of physicians without a database, 17% had used 1 previously, and 89% would like 1. Sixty percent of physicians are unwilling to spend more than 5 minutes on data entry, unless forced to do so for reimbursement or to maintain hospital privileges. Seventy-three percent believe it is more important to control data-entry time than number of variables; 98% are willing to share Health Insurance Portability and Accountability Act-compliant data; 82% have interest in a handheld data-entry system. Thirty-nine percent are willing to spend $1,000 for the initial database, and 88% are willing to spend $500 per year on maintenance.

CONCLUSIONS

Vascular surgeons have interest and experience with databases, although some have discontinued use. If databases have short entry times, limited costs, permit portable data entry, and allow data sharing, most vascular surgeons are enthusiastic about collecting clinical outcomes data.

Cerebral proliferative angiopathy: clinical and angiographic description of an entity different from cerebral AVMs

BACKGROUND AND PURPOSE

The purpose of this article is to describe "cerebral proliferative angiopathy" (CPA) as a clinical entity, which may be regarded as separate from "classical" brain AVMs in angioarchitecture, natural history, clinical presentation, and, therefore, treatment and which can be discerned from other cerebral AVMs by characteristic imaging features.

METHODS

In a prospectively entered databank encompassing 1434 patients with brain AVMs, a subgroup of 49 patients harboring specific angiographic characteristics were identified. Their charts and imaging films were retrospectively reviewed.

RESULTS

We found a preponderance of CPA in young (mean age: 22) females (67%). Clinical symptoms were seizures, disabling headaches, and stroke-like symptoms; hemorrhagic presentations were exceptional. On cross-sectional imaging, CPA demonstrated as a diffuse network of densely enhancing vascular spaces with intermingled normal brain parenchyma. The discrepancy between the large size of the nidus and the small shunting volume, the absence of flow-related aneurysms, the presence of diffuse angiogenesis (eg, transdural supply, progressive arterial occlusion), and the small calibre of a multitude of feeding arteries and draining veins were the angiographic hallmarks of this disease.

CONCLUSIONS

The diffuse angiogenetic activity is presumably related to reduced perinidal perfusion and subsequent chronic cortical ischemia. Natural history demonstrates a low risk of hemorrhage. CPA may be regarded as a separate clinical entity different to "classical" cerebral AVMs, because normal brain is interspersed with the abnormal vascular channels increasing the risk of neurological deficit in aggressive treatments, which in the light of the natural history does not seem to be indicated.