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Henry AC, Smits FJ, van Lienden K, van den Heuvel DAF, Hofman L, Busch OR, van Delden OM, Zijlstra IJA, Schreuder SM, Lamers AB, van Leersum M, van Strijen MJL, Vos JA, Te Riele WW, Molenaar IQ, Besselink MG, van Santvoort HC. Biliopancreatic and biliary leak after pancreatoduodenectomy treated by percutaneous transhepatic biliary drainage. HPB (Oxford) 2022; 24:489-497. [PMID: 34556407 DOI: 10.1016/j.hpb.2021.08.941] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/02/2021] [Accepted: 08/16/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Complementary to percutaneous intra-abdominal drainage, percutaneous transhepatic biliary drainage (PTBD) might ameliorate healing of pancreatic fistula and biliary leakage after pancreatoduodenectomy by diversion of bile from the site of leakage. This study evaluated technical and clinical outcomes of PTBD for this indication. METHODS All patients undergoing PTBD for leakage after pancreatoduodenectomy were retrospectively evaluated in two tertiary pancreatic centers (2014-2019). Technical success was defined as external biliary drainage. Clinical success was defined as discharge with a resolved leak, without additional surgical interventions for anastomotic leakage other than percutaneous intra-abdominal drainage. RESULTS Following 822 pancreatoduodenectomies, 65 patients (8%) underwent PTBD. Indications were leakage of the pancreaticojejunostomy (n = 25; 38%), hepaticojejunostomy (n = 15; 23%) and of both (n = 25; 38%). PTBD was technically successful in 64 patients (98%) with drain revision in 40 patients (63%). Clinical success occurred in 60 patients (94%). Leakage resolved after median 33 days (IQR 21-60). PTBD related complications occurred in 23 patients (35%), including cholangitis (n = 14; 21%), hemobilia (n = 7; 11%) and PTBD related bleeding requiring re-intervention (n = 4; 6%). In hospital mortality was 3% (n = 2). CONCLUSION Although drain revisions and complications are common, PTBD is highly feasible and appears to be effective in the treatment of biliopancreatic leakage after pancreatoduodenectomy.
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Affiliation(s)
- Anne Claire Henry
- Department of Hepato-Pancreato-Biliary Surgery, Regional Academic Cancer Center Utrecht, St. Antonius Hospital Nieuwegein and University Medical Center Utrecht, the Netherlands
| | - F Jasmijn Smits
- Department of Hepato-Pancreato-Biliary Surgery, Regional Academic Cancer Center Utrecht, St. Antonius Hospital Nieuwegein and University Medical Center Utrecht, the Netherlands
| | - Krijn van Lienden
- Department of Interventional Radiology, Regional Academic Cancer Center Utrecht, St. Antonius Hospital Nieuwegein, the Netherlands
| | - Daniel A F van den Heuvel
- Department of Interventional Radiology, Regional Academic Cancer Center Utrecht, St. Antonius Hospital Nieuwegein, the Netherlands
| | - Lieke Hofman
- Department of Hepato-Pancreato-Biliary Surgery, Regional Academic Cancer Center Utrecht, St. Antonius Hospital Nieuwegein and University Medical Center Utrecht, the Netherlands
| | - Olivier R Busch
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Otto M van Delden
- Department of Interventional Radiology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - IJsbrand A Zijlstra
- Department of Interventional Radiology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Sanne M Schreuder
- Department of Interventional Radiology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Armand B Lamers
- Department of Interventional Radiology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Marc van Leersum
- Department of Interventional Radiology, Regional Academic Cancer Center Utrecht, St. Antonius Hospital Nieuwegein, the Netherlands
| | - Marco J L van Strijen
- Department of Interventional Radiology, Regional Academic Cancer Center Utrecht, St. Antonius Hospital Nieuwegein, the Netherlands
| | - Jan A Vos
- Department of Interventional Radiology, Regional Academic Cancer Center Utrecht, St. Antonius Hospital Nieuwegein, the Netherlands
| | - Wouter W Te Riele
- Department of Hepato-Pancreato-Biliary Surgery, Regional Academic Cancer Center Utrecht, St. Antonius Hospital Nieuwegein and University Medical Center Utrecht, the Netherlands
| | - I Quintus Molenaar
- Department of Hepato-Pancreato-Biliary Surgery, Regional Academic Cancer Center Utrecht, St. Antonius Hospital Nieuwegein and University Medical Center Utrecht, the Netherlands
| | - Marc G Besselink
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Hjalmar C van Santvoort
- Department of Hepato-Pancreato-Biliary Surgery, Regional Academic Cancer Center Utrecht, St. Antonius Hospital Nieuwegein and University Medical Center Utrecht, the Netherlands.
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Benali F, Stolze LJ, Rozeman AD, Dinkelaar W, Coutinho JM, Emmer BJ, Gons RAR, Yo LFS, van Tuijl JH, Boukrab I, van Dam-Nolen DHK, van den Wijngaard IR, Lycklama À Nijeholt GJ, de Laat KF, van Dijk LC, den Hertog HM, Flach HZ, Wermer MJH, van Walderveen MAA, Brouwers PJAM, Bulut T, Vermeer SE, Bernsen MLE, Uyttenboogaart M, Bokkers RPH, Boogaarts JD, de Leeuw FE, van der Worp HB, van der Schaaf IC, Schonewille WJ, Vos JA, Remmers MJM, Imani F, Dippel DWJ, van Zwam WH, Nederkoorn PJ, van Oostenbrugge RJ. Impact of the lockdown on acute stroke treatments during the first surge of the COVID-19 outbreak in the Netherlands. BMC Neurol 2022; 22:22. [PMID: 35016635 PMCID: PMC8749107 DOI: 10.1186/s12883-021-02539-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 12/20/2021] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION We investigated the impact of the Corona Virus Disease 2019 (COVID-19) pandemic and the resulting lockdown on reperfusion treatments and door-to-treatment times during the first surge in Dutch comprehensive stroke centers. Furthermore, we studied the association between COVID-19-status and treatment times. METHODS We included all patients receiving reperfusion treatment in 17 Dutch stroke centers from May 11th, 2017, until May 11th, 2020. We collected baseline characteristics, National Institutes of Health Stroke Scale (NIHSS) at admission, onset-to-door time (ODT), door-to-needle time (DNT), door-to-groin time (DGT) and COVID-19-status at admission. Parameters during the lockdown (March 15th, 2020 until May 11th, 2020) were compared with those in the same period in 2019, and between groups stratified by COVID-19-status. We used nationwide data and extrapolated our findings to the increasing trend of EVT numbers since May 2017. RESULTS A decline of 14% was seen in reperfusion treatments during lockdown, with a decline in both IVT and EVT delivery. DGT increased by 12 min (50 to 62 min, p-value of < 0.001). Furthermore, median NIHSS-scores were higher in COVID-19 - suspected or positive patients (7 to 11, p-value of 0.004), door-to-treatment times did not differ significantly when stratified for COVID-19-status. CONCLUSIONS During the first surge of the COVID-19 pandemic, a decline in acute reperfusion treatments and a delay in DGT was seen, which indicates a target for attention. It also appeared that COVID-19-positive or -suspected patients had more severe neurologic symptoms, whereas their EVT-workflow was not affected.
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Affiliation(s)
- Faysal Benali
- Department of Neurology and Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Lotte J Stolze
- Department of Neurology and Radiology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Anouk D Rozeman
- Department of Neurology and Radiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Wouter Dinkelaar
- Department of Neurology and Radiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Jonathan M Coutinho
- Department of Neurology and Radiology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Bart J Emmer
- Department of Neurology and Radiology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Rob A R Gons
- Department of Neurology and Radiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Lonneke F S Yo
- Department of Neurology and Radiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Julia H van Tuijl
- Department of Neurology and Radiology, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands
| | - Issam Boukrab
- Department of Neurology and Radiology, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands
| | - Dianne H K van Dam-Nolen
- Department of Neurology and Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ido R van den Wijngaard
- Department of Neurology and Radiology, Haaglanden Medical Center, The Hague, the Netherlands
| | | | - Karlijn F de Laat
- Department of Neurology and Radiology, Haga Hospital, The Hague, the Netherlands
| | - Lukas C van Dijk
- Department of Neurology and Radiology, Haga Hospital, The Hague, the Netherlands
| | - Heleen M den Hertog
- Department of Neurology and Radiology, Isala Hospital, Zwolle, the Netherlands
| | - H Zwenneke Flach
- Department of Neurology and Radiology, Isala Hospital, Zwolle, the Netherlands
| | - Marieke J H Wermer
- Department of Neurology and Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Paul J A M Brouwers
- Department of Neurology and Radiology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Tomas Bulut
- Department of Neurology and Radiology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Sarah E Vermeer
- Department of Neurology and Radiology, Rijnstate Hospital, Arnhem, the Netherlands
| | | | - Maarten Uyttenboogaart
- Department of Neurology and Radiology, University Medical Center Groningen, Groningen, the Netherlands
| | - Reinoud P H Bokkers
- Department of Neurology and Radiology, University Medical Center Groningen, Groningen, the Netherlands
| | - Jeroen D Boogaarts
- Department of Neurosurgery and Neurology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurosurgery and Neurology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - H Bart van der Worp
- Department of Neurology and Neurosurgery and Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Irene C van der Schaaf
- Department of Neurology and Neurosurgery and Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Wouter J Schonewille
- Department of Neurology and Radiology, Sint Antonius Hospital, Nieuwegein, the Netherlands
| | - Jan A Vos
- Department of Neurology and Radiology, Sint Antonius Hospital, Nieuwegein, the Netherlands
| | - Michel J M Remmers
- Department of Neurology and Radiology, Amphia Hospital, Breda, the Netherlands
| | - Farshad Imani
- Department of Neurology and Radiology, Amphia Hospital, Breda, the Netherlands
| | - Diederik W J Dippel
- Department of Neurology and Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Wim H van Zwam
- Department of Neurology and Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Paul J Nederkoorn
- Department of Neurology and Radiology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Robert J van Oostenbrugge
- Department of Neurology and Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
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Kauw F, Greving JP, Takx RAP, de Jong HWAM, Schonewille WJ, Vos JA, Wermer MJH, van Walderveen MAA, Kappelle LJ, Velthuis BK, Dankbaar JW. Prediction of long-term recurrent ischemic stroke: the added value of non-contrast CT, CT perfusion, and CT angiography. Neuroradiology 2020; 63:483-490. [PMID: 32857214 PMCID: PMC7966192 DOI: 10.1007/s00234-020-02526-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/16/2020] [Indexed: 11/30/2022]
Abstract
Purpose The aim of this study was to evaluate whether the addition of brain CT imaging data to a model incorporating clinical risk factors improves prediction of ischemic stroke recurrence over 5 years of follow-up. Methods A total of 638 patients with ischemic stroke from three centers were selected from the Dutch acute stroke study (DUST). CT-derived candidate predictors included findings on non-contrast CT, CT perfusion, and CT angiography. Five-year follow-up data were extracted from medical records. We developed a multivariable Cox regression model containing clinical predictors and an extended model including CT-derived predictors by applying backward elimination. We calculated net reclassification improvement and integrated discrimination improvement indices. Discrimination was evaluated with the optimism-corrected c-statistic and calibration with a calibration plot. Results During 5 years of follow-up, 56 patients (9%) had a recurrence. The c-statistic of the clinical model, which contained male sex, history of hyperlipidemia, and history of stroke or transient ischemic attack, was 0.61. Compared with the clinical model, the extended model, which contained previous cerebral infarcts on non-contrast CT and Alberta Stroke Program Early CT score greater than 7 on mean transit time maps derived from CT perfusion, had higher discriminative performance (c-statistic 0.65, P = 0.01). Inclusion of these CT variables led to a significant improvement in reclassification measures, by using the net reclassification improvement and integrated discrimination improvement indices. Conclusion Data from CT imaging significantly improved the discriminatory performance and reclassification in predicting ischemic stroke recurrence beyond a model incorporating clinical risk factors only. Electronic supplementary material The online version of this article (10.1007/s00234-020-02526-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Frans Kauw
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. .,Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Jacoba P Greving
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Richard A P Takx
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Hugo W A M de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | | | - Jan A Vos
- Department of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Marieke J H Wermer
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - L Jaap Kappelle
- Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Birgitta K Velthuis
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Jan W Dankbaar
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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de Boer SW, de Vries JPPM, Werson DA, Fioole B, Vroegindeweij D, Vos JA, van den Heuvel D. Drug coated balloon supported Supera stent versus Supera stent in intermediate and long-segment lesions of the superficial femoral artery: 2-year results of the RAPID Trial. J Cardiovasc Surg (Torino) 2019; 60:679-685. [PMID: 31603295 DOI: 10.23736/s0021-9509.19.11109-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Endovascular treatment of occlusive disease of the superficial femoral artery (SFA) has evolved from plain old balloon angioplasty (POBA) through primary stenting strategy to drug eluting technology-based approach. The RAPID Trial investigates the added value of drug coated balloons (DCB, Legflow) in a primary stenting strategy (Supera stent) for intermediate (5-15 cm) and long segment (>15 cm) SFA lesions. METHODS In this multicenter, patient-blinded trial, 160 patients with intermittent claudication, ischemic rest pain, or tissue loss due to intermediate or long SFA lesions were randomized (1:1) between Supera + DCB and Supera. Primary endpoint was primary patency at 2 years, defined as freedom from restenosis on duplex ultrasound (peak systolic velocity ratio <2.4). RESULTS At 2 years, primary patency was 55.1% (95% CI: 43.1-67.1%) in the Supera + DCB group versus 48.3% (95% CI: 35.6-61.0%) in the Supera group (P=0.957). Per protocol analysis showed a primary patency rate of 60.9% (95% CI: 48.6-73.2%) in the Supera + DCB group versus 49.8% (95% CI: 36.9-62.7%) in the Supera group (P=0.469). The overall mortality rate was 5% in both groups (P=0.975). Sustained functional improvement was similar in both groups. CONCLUSIONS The 2-year results in the current trial of a primary Supera stenting strategy are consistent with other trials reporting on treatment of intermediate and long SFA lesions. A DCB supported Supera stent strategy did not improve patency rate compared to a Supera stent only strategy.
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Affiliation(s)
- Sanne W de Boer
- Department of Radiology, St. Antonius Hospital, Nieuwegein, the Netherlands - .,Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands - .,CARIM School for Cardiovascular Diseases, University of Maastricht, Maastricht, the Netherlands -
| | - Jean Paul P M de Vries
- Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands.,Department of Vascular Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Debora A Werson
- Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Bram Fioole
- Department of Vascular Surgery, Maasstad Hospital, Rotterdam, the Netherlands
| | | | - Jan A Vos
- Department of Radiology, St. Antonius Hospital, Nieuwegein, the Netherlands
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Hinsenveld WH, de Ridder IR, van Oostenbrugge RJ, Vos JA, Groot AE, Coutinho JM, Lycklama À Nijeholt GJ, Boiten J, Schonewille WJ. Workflow Intervals of Endovascular Acute Stroke Therapy During On- Versus Off-Hours: The MR CLEAN Registry. Stroke 2019; 50:2842-2850. [PMID: 31869287 DOI: 10.1161/strokeaha.119.025381] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Endovascular treatment (EVT) of patients with acute ischemic stroke because of large vessel occlusion involves complicated logistics, which may cause a delay in treatment initiation during off-hours. This might lead to a worse functional outcome. We compared workflow intervals between endovascular treatment-treated patients presenting during off- and on-hours. Methods- We retrospectively analyzed data from the MR CLEAN Registry, a prospective, multicenter, observational study in the Netherlands and included patients with an anterior circulation large vessel occlusion who presented between March 2014 and June 2016. Off-hours were defined as presentation on Monday to Friday between 17:00 and 08:00 hours, weekends (Friday 17:00 to Monday 8:00) and national holidays. Primary end point was first door to groin time. Secondary end points were functional outcome at 90 days (modified Rankin Scale) and workflow time intervals. We stratified for transfer status, adjusted for prognostic factors, and used linear and ordinal regression models. Results- We included 1488 patients of which 936 (62.9%) presented during off-hours. Median first door to groin time was 140 minutes (95% CI, 110-182) during off-hours and 121 minutes (95% CI, 85-157) during on-hours. Adjusted first door to groin time was 14.6 minutes (95% CI, 9.3-20.0) longer during off-hours. Door to needle times for intravenous therapy were slightly longer (3.5 minutes, 95% CI, 0.7-6.3) during off-hours. Groin puncture to reperfusion times did not differ between groups. For transferred patients, the delay within the intervention center was 5.0 minutes (95% CI, 0.5-9.6) longer. There was no significant difference in functional outcome between patients presenting during off- and on-hours (adjusted odds ratio, 0.92; 95% CI, 0.74-1.14). Reperfusion rates and complication rates were similar. Conclusions- Presentation during off-hours is associated with a slight delay in start of endovascular treatment in patients with acute ischemic stroke. This treatment delay did not translate into worse functional outcome or increased complication rates.
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Affiliation(s)
- Wouter H Hinsenveld
- From the Department of Neurology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands (W.H.H., I.R.d.R., R.J.v.O.)
| | - Inger R de Ridder
- From the Department of Neurology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands (W.H.H., I.R.d.R., R.J.v.O.)
| | - Robert J van Oostenbrugge
- From the Department of Neurology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands (W.H.H., I.R.d.R., R.J.v.O.)
| | - Jan A Vos
- Department of Radiology (J.A.V.), St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Adrien E Groot
- Department of Neurology, Amsterdam UMC, University of Amsterdam, the Netherlands (A.E.G., J.M.C.)
| | - Jonathan M Coutinho
- Department of Neurology, Amsterdam UMC, University of Amsterdam, the Netherlands (A.E.G., J.M.C.)
| | - Geert J Lycklama À Nijeholt
- Department of Neurology and Radiology, Haaglanden Medical Center, The Hague, the Netherlands (G.J.L.à.N., J.B.)
| | - Jelis Boiten
- Department of Neurology and Radiology, Haaglanden Medical Center, The Hague, the Netherlands (G.J.L.à.N., J.B.)
| | - Wouter J Schonewille
- Department of Neurology (W.J.S.), St. Antonius Hospital, Nieuwegein, the Netherlands
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Spreen MI, Gremmels H, Teraa M, Sprengers RW, Martens JM, Verhaar MC, Wever JJ, de Borst GJ, Vos JA, Mali WP, van Overhagen H. High and immeasurable ankle-brachial index as predictor of poor amputation-free survival in critical limb ischemia. J Vasc Surg 2018; 67:1864-1871.e3. [DOI: 10.1016/j.jvs.2017.10.061] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 10/03/2017] [Indexed: 01/26/2023]
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7
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Kappelhof M, Marquering HA, Berkhemer OA, Borst J, van der Lugt A, van Zwam WH, Vos JA, Lycklama À Nijeholt G, Majoie CBLM, Emmer BJ. Accuracy of CT Angiography for Differentiating Pseudo-Occlusion from True Occlusion or High-Grade Stenosis of the Extracranial ICA in Acute Ischemic Stroke: A Retrospective MR CLEAN Substudy. AJNR Am J Neuroradiol 2018; 39:892-898. [PMID: 29622556 DOI: 10.3174/ajnr.a5601] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 01/15/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The absence of opacification on CTA in the extracranial ICA in acute ischemic stroke may be caused by atherosclerotic occlusion, dissection, or pseudo-occlusion. The latter is explained by sluggish or stagnant flow in a patent artery caused by a distal intracranial occlusion. This study aimed to explore the accuracy of CTA for differentiating pseudo-occlusion from true occlusion of the extracranial ICA. MATERIALS AND METHODS All patients from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) with an apparent ICA occlusion on CTA and available DSA images were included. Two independent observers classified CTA images as atherosclerotic cause (occlusion/high-grade stenosis), dissection, or suspected pseudo-occlusion. Pseudo-occlusion was suspected if CTA showed a gradual contrast decline located above the level of the carotid bulb, especially in the presence of an occluded intracranial ICA bifurcation (T-occlusion). DSA images, classified into the same 3 categories, were used as the criterion standard. RESULTS In 108 of 476 patients (23%), CTA showed an apparent extracranial carotid occlusion. DSA was available in 46 of these, showing an atherosclerotic cause in 13 (28%), dissection in 16 (35%), and pseudo-occlusion in 17 (37%). The sensitivity for detecting pseudo-occlusion on CTA was 82% (95% CI, 57-96) for both observers; specificity was 76% (95% CI, 56-90) and 86% (95% CI, 68-96) for observers 1 and 2, respectively. The κ value for interobserver agreement was .77, indicating substantial agreement. T-occlusions were more frequent in pseudo- than true occlusions (82% versus 21%, P < .001). CONCLUSIONS On CTA, extracranial ICA pseudo-occlusions can be differentiated from true carotid occlusions.
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Affiliation(s)
- M Kappelhof
- From the Departments of Radiology (M.K., H.A.M., O.A.B., J.B., C.B.L.M.M, B.J.E.)
| | - H A Marquering
- From the Departments of Radiology (M.K., H.A.M., O.A.B., J.B., C.B.L.M.M, B.J.E.).,Biomedical Engineering and Physics (H.A.M.), Academic Medical Center, Amsterdam, the Netherlands
| | - O A Berkhemer
- From the Departments of Radiology (M.K., H.A.M., O.A.B., J.B., C.B.L.M.M, B.J.E.).,Neurology (O.A.B.), Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Radiology (O.A.B., W.H.v.Z.), Maastricht University Medical Center, Maastricht, the Netherlands
| | - J Borst
- From the Departments of Radiology (M.K., H.A.M., O.A.B., J.B., C.B.L.M.M, B.J.E.)
| | | | - W H van Zwam
- Department of Radiology (O.A.B., W.H.v.Z.), Maastricht University Medical Center, Maastricht, the Netherlands
| | - J A Vos
- Department of Radiology (J.A.V.), St. Antonius Hospital, Nieuwegein, the Netherlands
| | - G Lycklama À Nijeholt
- Department of Radiology (G.L.à.N.), Haaglanden Medical Centre, The Hague, the Netherlands
| | - C B L M Majoie
- From the Departments of Radiology (M.K., H.A.M., O.A.B., J.B., C.B.L.M.M, B.J.E.)
| | - B J Emmer
- From the Departments of Radiology (M.K., H.A.M., O.A.B., J.B., C.B.L.M.M, B.J.E.)
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Roosen LJ, Karamermer Y, Vos JA, de Jong GM, Bos WJ, Elgersma OE. Paclitaxel-coated balloons do not prevent recurrent stenosis in hemodialysis access fistulae: results of a randomized clinical trial. Ital J Vasc Endovasc Surg 2017. [DOI: 10.23736/s1824-4777.17.01282-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
Embolic protection devices (EPDs) are often used during carotid angioplasty and stenting (CAS) to reduce procedural cerebral emboli. This manuscript seeks to present an overview of evidence on EPDs during CAS. There are three categories of EPDs: distal occlusion (DO-EPD), filter (F-EPD) and proximal occlusion (PO-EPD). DO and F-EPDs have the disadvantage that the device has to be advanced through the stenosis, without protection and that the device may damage the distal internal carotid artery (ICA). F-EPDs have the advantage of maintaining antegrade flow throughout the procedure. PO-EPDs occlude the ICA and external carotid artery (ECA) (blocking antegrade flow), but do not require manipulation of the stenosis before protection is established. All devices add to procedural time and costs. Many single-center series and meta-analyses have shown lower incidence of procedural complications and surrogate endpoints when EPDs are used. However, these series are hampered by a serious confounder: protected cases were generally performed later, when institutions had more experience and when newer stents, techniques etc. had become available. Two small randomized trials showed no difference between filter-protected and unprotected procedures in clinical outcome, but found significantly more surrogate endpoints (diffusion-weighted MRI lesions and transcranial Doppler detected micro-emboli) in the protected groups. Comparing between groups of EPDs, some studies slightly favored PO to F-EPDs, while others found no difference. All devices were associated with low numbers of clinical cerebral complications, but frequent surrogate signs of cerebral embolization. In conclusion, all currently available EPDs still result in some degree of cerebral embolization. No solid recommendation for a particular type of EPDs, if any, can be derived from literature.
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Affiliation(s)
- Jan A Vos
- Department of Interventional Radiology, St Antonius Hospital, Nieuwegein, The Netherlands -
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10
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VAN Noort K, Schuurmann RC, Slump CH, Vos JA, Devries JP. A new method for precise determination of endograft position and apposition in the aortic neck after endovascular aortic aneurysm repair. J Cardiovasc Surg (Torino) 2016; 57:737-746. [PMID: 27286523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Follow-up imaging after endovascular aortic aneurysm repair (EVAR) focuses on detection of gross abnormalities: endoleaks and significant (>10 mm) migration. Precise determination of endograft position and wall apposition may predict late complications. We present a new measurement method to determine precise position and apposition of endografts in the aortic neck. METHODS Four patients were selected from our EVAR database. These patients had late (>1 year) type IA endoleak or >1 cm endograft migration. Twenty patients with uneventful follow-up were measured as controls. The new software adds six parameters to define endograft position and neck apposition: fabric distance to renal arteries, tilt, endograft expansion (% of the maximum original diameter), neck surface, apposition surface, and shortest apposition length. These parameters were determined on preoperative and all available postoperative CT-scans, to detect subtle changes during follow-up. RESULTS All patients with endoleak or migration had increases in fabric distance, tilt, or endograft expansion or decrease of apposition surface. Changes occurred at least one CT scan before the endoleak or migration was noted in the CT reports. The patient without complications showed no changes in position or apposition during follow-up. CONCLUSIONS The new measurement method detected subtle changes in endograft position and apposition during CT follow-up, not recognized initially. It can potentially determine endograft movements and decrease of apposition surface before they lead to complications like type IA endoleaks or uncorrectable migration. A larger follow-up study comparing complicated and non-complicated EVAR patients is needed to corroborate these results.
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Affiliation(s)
- Kim VAN Noort
- Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands -
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11
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van Os HJA, Mulder IA, van der Schaaf IC, Kappelle LJ, Velthuis BK, Broersen A, Vos JA, Terwindt GM, Schonewille W, Ferrari MD, Algra A, van Walderveen MAA, Wermer MJH. Role of atherosclerosis, clot extent, and penumbra volume in headache during ischemic stroke. Neurology 2016; 87:1124-30. [PMID: 27534709 DOI: 10.1212/wnl.0000000000003092] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 06/01/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the role of large vessel atherosclerosis, blood clot extent, and penumbra volume in relation to headache in ischemic stroke patients. METHODS In this cross-sectional study, we performed noncontrast CT, CT angiography (CTA), and CT perfusion (CTP) in 284 participants from the Dutch Acute Stroke Study and Leiden Stroke Cohort within 9 hours after ischemic stroke onset. We collected headache characteristics prospectively using a semi-structured questionnaire. Atherosclerosis was assessed by evaluating presence of plaques in extracranial and intracranial vessels and by quantifying intracranial carotid artery calcifications. Clot extent was estimated by the clot burden score on CTA and penumbra volume by CTP. We calculated risk ratios (RRs) with adjustments (aRR) for possible confounders using multivariable Poisson regression. RESULTS Headache during stroke was reported in 109/284 (38%) participants. Headache was less prevalent in patients with than in patients without atherosclerosis in the extracranial anterior circulation (35% vs 48%; RR 0.72; 95% confidence interval [CI] 0.54-0.97). Atherosclerosis in the intracranial arteries was also associated with less headache, but this association was not statistically significant. Penumbra volume (aRR 1.08; 95% CI 0.63-1.85) and clot extent (aRR 1.02; 95% CI 0.86-1.20) were not related with headache. CONCLUSIONS Headache in the early phase of ischemic stroke tends to occur less often in patients with atherosclerosis than in patients without atherosclerosis in the large cerebral arteries. This finding lends support to the hypothesis that vessel wall elasticity is a necessary contributing factor in the occurrence of headache during acute ischemic stroke.
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Affiliation(s)
- Hendrikus J A van Os
- From the Department of Neurology (H.J.A.v.O., I.A.M., G.M.T., M.D.F., M.J.H.W.) and Department of Radiology (M.A.A.v.W.), Division of Image Processing (A.B.), Leiden University Medical Center; Departments of Radiology (I.C.v.d.S., B.K.V.) and Neurology (L.J.K.), Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht; and Department of Neurology (J.A.V., W.S.), St Antonius Hospital, Nieuwegein, Netherlands.
| | - Inge A Mulder
- From the Department of Neurology (H.J.A.v.O., I.A.M., G.M.T., M.D.F., M.J.H.W.) and Department of Radiology (M.A.A.v.W.), Division of Image Processing (A.B.), Leiden University Medical Center; Departments of Radiology (I.C.v.d.S., B.K.V.) and Neurology (L.J.K.), Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht; and Department of Neurology (J.A.V., W.S.), St Antonius Hospital, Nieuwegein, Netherlands
| | - Irene C van der Schaaf
- From the Department of Neurology (H.J.A.v.O., I.A.M., G.M.T., M.D.F., M.J.H.W.) and Department of Radiology (M.A.A.v.W.), Division of Image Processing (A.B.), Leiden University Medical Center; Departments of Radiology (I.C.v.d.S., B.K.V.) and Neurology (L.J.K.), Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht; and Department of Neurology (J.A.V., W.S.), St Antonius Hospital, Nieuwegein, Netherlands
| | - L Jaap Kappelle
- From the Department of Neurology (H.J.A.v.O., I.A.M., G.M.T., M.D.F., M.J.H.W.) and Department of Radiology (M.A.A.v.W.), Division of Image Processing (A.B.), Leiden University Medical Center; Departments of Radiology (I.C.v.d.S., B.K.V.) and Neurology (L.J.K.), Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht; and Department of Neurology (J.A.V., W.S.), St Antonius Hospital, Nieuwegein, Netherlands
| | - Birgitta K Velthuis
- From the Department of Neurology (H.J.A.v.O., I.A.M., G.M.T., M.D.F., M.J.H.W.) and Department of Radiology (M.A.A.v.W.), Division of Image Processing (A.B.), Leiden University Medical Center; Departments of Radiology (I.C.v.d.S., B.K.V.) and Neurology (L.J.K.), Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht; and Department of Neurology (J.A.V., W.S.), St Antonius Hospital, Nieuwegein, Netherlands
| | - Alexander Broersen
- From the Department of Neurology (H.J.A.v.O., I.A.M., G.M.T., M.D.F., M.J.H.W.) and Department of Radiology (M.A.A.v.W.), Division of Image Processing (A.B.), Leiden University Medical Center; Departments of Radiology (I.C.v.d.S., B.K.V.) and Neurology (L.J.K.), Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht; and Department of Neurology (J.A.V., W.S.), St Antonius Hospital, Nieuwegein, Netherlands
| | - Jan A Vos
- From the Department of Neurology (H.J.A.v.O., I.A.M., G.M.T., M.D.F., M.J.H.W.) and Department of Radiology (M.A.A.v.W.), Division of Image Processing (A.B.), Leiden University Medical Center; Departments of Radiology (I.C.v.d.S., B.K.V.) and Neurology (L.J.K.), Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht; and Department of Neurology (J.A.V., W.S.), St Antonius Hospital, Nieuwegein, Netherlands
| | - Gisela M Terwindt
- From the Department of Neurology (H.J.A.v.O., I.A.M., G.M.T., M.D.F., M.J.H.W.) and Department of Radiology (M.A.A.v.W.), Division of Image Processing (A.B.), Leiden University Medical Center; Departments of Radiology (I.C.v.d.S., B.K.V.) and Neurology (L.J.K.), Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht; and Department of Neurology (J.A.V., W.S.), St Antonius Hospital, Nieuwegein, Netherlands
| | - Wouter Schonewille
- From the Department of Neurology (H.J.A.v.O., I.A.M., G.M.T., M.D.F., M.J.H.W.) and Department of Radiology (M.A.A.v.W.), Division of Image Processing (A.B.), Leiden University Medical Center; Departments of Radiology (I.C.v.d.S., B.K.V.) and Neurology (L.J.K.), Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht; and Department of Neurology (J.A.V., W.S.), St Antonius Hospital, Nieuwegein, Netherlands
| | - Michel D Ferrari
- From the Department of Neurology (H.J.A.v.O., I.A.M., G.M.T., M.D.F., M.J.H.W.) and Department of Radiology (M.A.A.v.W.), Division of Image Processing (A.B.), Leiden University Medical Center; Departments of Radiology (I.C.v.d.S., B.K.V.) and Neurology (L.J.K.), Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht; and Department of Neurology (J.A.V., W.S.), St Antonius Hospital, Nieuwegein, Netherlands
| | - Ale Algra
- From the Department of Neurology (H.J.A.v.O., I.A.M., G.M.T., M.D.F., M.J.H.W.) and Department of Radiology (M.A.A.v.W.), Division of Image Processing (A.B.), Leiden University Medical Center; Departments of Radiology (I.C.v.d.S., B.K.V.) and Neurology (L.J.K.), Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht; and Department of Neurology (J.A.V., W.S.), St Antonius Hospital, Nieuwegein, Netherlands
| | - Marianne A A van Walderveen
- From the Department of Neurology (H.J.A.v.O., I.A.M., G.M.T., M.D.F., M.J.H.W.) and Department of Radiology (M.A.A.v.W.), Division of Image Processing (A.B.), Leiden University Medical Center; Departments of Radiology (I.C.v.d.S., B.K.V.) and Neurology (L.J.K.), Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht; and Department of Neurology (J.A.V., W.S.), St Antonius Hospital, Nieuwegein, Netherlands
| | - Marieke J H Wermer
- From the Department of Neurology (H.J.A.v.O., I.A.M., G.M.T., M.D.F., M.J.H.W.) and Department of Radiology (M.A.A.v.W.), Division of Image Processing (A.B.), Leiden University Medical Center; Departments of Radiology (I.C.v.d.S., B.K.V.) and Neurology (L.J.K.), Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht; and Department of Neurology (J.A.V., W.S.), St Antonius Hospital, Nieuwegein, Netherlands
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12
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Jansen IGH, Berkhemer OA, Yoo AJ, Vos JA, Lycklama À Nijeholt GJ, Sprengers MES, van Zwam WH, Schonewille WJ, Boiten J, van Walderveen MAA, van Oostenbrugge RJ, van der Lugt A, Marquering HA, Majoie CBLM. Comparison of CTA- and DSA-Based Collateral Flow Assessment in Patients with Anterior Circulation Stroke. AJNR Am J Neuroradiol 2016; 37:2037-2042. [PMID: 27418474 DOI: 10.3174/ajnr.a4878] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 05/11/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Collateral flow is associated with clinical outcome after acute ischemic stroke and may serve as a parameter for patient selection for intra-arterial therapy. In clinical trials, DSA and CTA are 2 imaging modalities commonly used to assess collateral flow. We aimed to determine the agreement between collateral flow assessment on CTA and DSA and their respective associations with clinical outcome. MATERIALS AND METHODS Patients randomized in MR CLEAN with middle cerebral artery occlusion and both baseline CTA images and complete DSA runs were included. Collateral flow on CTA and DSA was graded 0 (absent) to 3 (good). Quadratic weighted κ statistics determined agreement between both methods. The association of both modalities with mRS at 90 days was assessed. Also, association between the dichotomized collateral score and mRS 0-2 (functional independence) was ascertained. RESULTS Of 45 patients with evaluable imaging data, collateral flow was graded on CTA as 0, 1, 2, 3 for 3, 10, 20, and 12 patients, respectively, and on DSA for 12, 17, 10, and 6 patients, respectively. The κ-value was 0.24 (95% CI, 0.16-0.32). The overall proportion of agreement was 24% (95% CI, 0.12-0.38). The adjusted odds ratio for favorable outcome on mRS was 2.27 and 1.29 for CTA and DSA, respectively. The relationship between the dichotomized collateral score and mRS 0-2 was significant for CTA (P = .01), but not for DSA (P = .77). CONCLUSIONS Commonly applied collateral flow assessment on CTA and DSA showed large differences, indicating that these techniques are not interchangeable. CTA was significantly associated with mRS at 90 days, whereas DSA was not.
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Affiliation(s)
- I G H Jansen
- From the Departments of Radiology (I.G.H.J., O.A.B., M.E.S.S., C.B.L.M.M.)
| | - O A Berkhemer
- From the Departments of Radiology (I.G.H.J., O.A.B., M.E.S.S., C.B.L.M.M.).,Departments of Neurology (O.A.B.)
| | - A J Yoo
- Texas Stroke Institute (A.J.Y.), Plano, Texas
| | - J A Vos
- Departments of Radiology (J.A.V.)
| | | | - M E S Sprengers
- From the Departments of Radiology (I.G.H.J., O.A.B., M.E.S.S., C.B.L.M.M.)
| | | | - W J Schonewille
- Neurology (W.J.S.), St. Antonius Hospital, Nieuwegein, the Netherlands
| | - J Boiten
- Neurology (J.B.), Haaglanden Medical Center, The Haag, the Netherlands
| | - M A A van Walderveen
- Department of Radiology (M.A.A.v.W.), Leiden University Medical Center, Leiden, the Netherlands
| | - R J van Oostenbrugge
- Neurology (R.J.v.O.), Cardiovascular Research Institute, Maastricht, the Netherlands
| | - A van der Lugt
- Radiology (A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - H A Marquering
- Biomedical Engineering and Physics (H.A.M.), Academic Medical Center, Amsterdam, the Netherlands
| | - C B L M Majoie
- From the Departments of Radiology (I.G.H.J., O.A.B., M.E.S.S., C.B.L.M.M.)
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13
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Vorselaars VMM, Velthuis S, Snijder RJ, Westermann CJJ, Vos JA, Mager JJ, Post MC. Follow-up of pulmonary right-to-left shunt in hereditary haemorrhagic telangiectasia. Eur Respir J 2016; 47:1750-7. [PMID: 26965291 DOI: 10.1183/13993003.01588-2015] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 01/14/2016] [Indexed: 11/05/2022]
Abstract
Pulmonary arteriovenous malformations (PAVMs) are associated with severe neurological complications in hereditary haemorrhagic telangiectasia (HHT). Transthoracic contrast echocardiography (TTCE) is recommended for screening of pulmonary right-to-left shunts (RLS). Although growth of PAVMs is shown in two small studies, no studies on follow-up with TTCE exist.All HHT patients underwent a second TTCE 5 years after initial screening. Patients with a history of PAVM embolisation were excluded. Pulmonary RLS grade on TTCE after 5 years was compared to the grade at screening.200 patients (53.5% female, mean±sd age at screening 44.7±14.1 years) were included. Increase in RLS grade occurred in 36 (18%) patients, of whom six (17%) underwent embolisation. The change in grade between screening and follow-up was not more than one grade. Of patients with nontreatable pulmonary RLS at screening (n=113), 14 (12.4%) underwent embolisation. In patients without pulmonary RLS at initial screening (n=87), no treatable PAVMs developed during follow-up.Within 5 years, no treatable PAVMs developed in HHT patients without pulmonary RLS at initial screening. Increase in pulmonary RLS grade occurred in 18% of patients, and never increased by more than one grade. Of patients with nontreatable pulmonary RLS at initial screening, 12% underwent embolisation.
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Affiliation(s)
| | | | - Repke J Snijder
- Dept of Pulmonology, St Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Jan A Vos
- Dept of Interventional Radiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Johannes J Mager
- Dept of Pulmonology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Martijn C Post
- Dept of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands
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14
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de Vries JPPM, Vos JA. Commentary on 'Selective AAA sac Embolization During EVAR to Prevent Type II Endoleaks'. Eur J Vasc Endovasc Surg 2016; 51:640. [PMID: 26952344 DOI: 10.1016/j.ejvs.2016.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 01/24/2016] [Indexed: 11/19/2022]
Affiliation(s)
- J P P M de Vries
- Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
| | - J A Vos
- Department of Interventional Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands
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15
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Schrijver AM, De Borst GJ, Van Herwaarden JA, Vonken EJ, Moll FL, Vos JA, De Vries JPPM. Catheter-directed thrombolysis for acute upper extremity ischemia. J Cardiovasc Surg (Torino) 2015; 56:433-439. [PMID: 25729917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM Acute nontraumatic upper extremity ischemia has significant chronic disability when not treated adequately and timely. As surgical treatment can be challenging, this study evaluates catheter-directed thrombolysis as first-line treatment for acute upper extremity ischemia. METHODS Between January 2006 and December 2010, 28 patients (22 women; mean age, 63±16 years) underwent catheter-directed thrombolysis for acute upper extremity ischemia, Rutherford class I or IIa. Proximal extent of the occlusion was in the subclavian (32%), axillary (7%), brachial (25%) and forearm arteries (36%). Median occlusion length was 18 cm (range, 12-43). Causes were embolus (14%), thrombus (39%), thoracic outlet syndrome (14%), paraneoplastic (4%), or unknown (29%). RESULTS Technical success was 96%, radiologic success (>95% clot lysis) 61%, and clinical success 68%. Median duration of thrombolysis was 24 hours (range, 18-96). Of the 11 radiologically unsuccessful patients (39%), five were treated conservatively and six underwent surgical intervention. In-hospital amputation-rate was 7%. Four complications occurred: embolization to the lower extremity, a transient ischemic attack, a subcapsular splenic hematoma and a pseudoaneurysm. Cumulative amputation-free survival at six months was 93%, standard error (SE) 4.87 and at one year 88%, SE 6.50. CONCLUSION These results show that catheter-directed thrombolysis is effective in over 60% of patients as first-line treatment of extensive acute upper extremity ischemia and can prevent surgical intervention in these patients.
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Affiliation(s)
- A M Schrijver
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands -
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16
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Van Strijen MJL, Vos JA. Experience with new techniques for the treatment of type II endoleaks post-EVAR. J Cardiovasc Surg (Torino) 2014; 55:581-592. [PMID: 25033921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Endovascular aneurysm management (EVAR) is hampered by persistent arterial blood flow in the aneurysm sac after treatment, known as endoleak (EL). Type II EL consist of blood flow from one or more aortic branch vessels; they only require treatment when the aneurysm sac fails to shrink. Post-EVAR follow up is mostly done with contrast enhanced computed tomography. If a type II EL requiring treatment is found, a variety of options exist, depending on the source of EL and the anatomy. Inferior mesenteric artery EL is best treated by endovascular embolization through the superior mesenteric artery and Riolans' arc. In hypogastric to lumbar artery EL success of endovascular treatment is limited. In these cases a successful embolization of the EL can often be performed by a direct percutaneous approach to the EL inside the aneurysmal sac. CT guidance provides a good way to exactly puncture the EL percutaneously in most cases, but limited workspace and lack of fluoroscopy availability for the ensuing catheter manipulation hampers this technique. A novel way to puncture the EL and subsequently treat it is performed on flat panel detector angiography units. By a rotation around the patients these units provide the possibility to create a cone-beam CT (CBCT) in the angio suite. Using the 3-dimensional dataset thus acquired, a needle path can be planned and the EL nidus can be punctured with great confidence and without danger of inadvertently perforating vital structures. After the EL has been punctured, microcatheters can be inserted to embolize the origins of branch vessels and/or the aneurysm sac can be filled with thrombogenic agents or glue. CBCT guided procedures incur lower radiation dose and have higher accuracy compared to conventional CT guided procedures. Details of CBCT guided procedures; the materials and technique used are detailed in this manuscript.
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Affiliation(s)
- M J L Van Strijen
- Department of Interventional Radiology St. Antonius Hospital, Nieuwegein, The Netherlands -
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17
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Vorselaars VMM, Velthuis S, Mager JJ, Snijder RJ, Bos WJ, Vos JA, van Strijen MJL, Post MC. Direct haemodynamic effects of pulmonary arteriovenous malformation embolisation. Neth Heart J 2014; 22:328-33. [PMID: 24604121 PMCID: PMC4099429 DOI: 10.1007/s12471-014-0539-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Transcatheter embolisation is widely used to close pulmonary arteriovenous malformations (PAVMs) in patients with hereditary haemorrhagic telangiectasia (HHT). Data on the direct cardiovascular haemodynamic changes induced by this treatment are scarce. OBJECTIVES We investigated the direct haemodynamic effects of transcatheter embolisation of PAVMs, using non-invasive finger pressure measurements. METHODS During the procedure, blood pressure, heart rate (HR), stroke volume (SV), cardiac output (CO), total peripheral resistance (TPR) and delta pressure/delta time (dP/dt) were continuously monitored using a Finometer®. Potential changes in these haemodynamic parameters were calculated from the pressure registrations using Modelflow® methodology. Absolute and relative changes were calculated and compared using the paired sample t-test. RESULTS The present study includes 29 HHT patients (mean age 39 ± 15 years, 11 men) who underwent transcatheter embolotherapy of PAVMs. The total number of embolisations was 72 (mean per patient 2.5). Directly after PAVM closure, SV and CO decreased significantly by -11.9 % (p = 0.01) and -9.5 % (p = 0.01) respectively, without a significant change in HR (1.8 %). Mean arterial blood pressure increased by 4.1 % (p = 0.02), while the TPR and dP/dt did not increase significantly (5.8 % and 0.2 %, respectively). CONCLUSIONS Significant haemodynamic changes occur directly after transcatheter embolisation of PAVMs, amongst which a decrease in stroke volume and cardiac output are most important.
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Affiliation(s)
- V M M Vorselaars
- Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, the Netherlands,
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18
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Velthuis S, Buscarini E, Mager JJ, Vorselaars VMM, van Gent MWF, Gazzaniga P, Manfredi G, Danesino C, Diederik AL, Vos JA, Gandolfi S, Snijder RJ, Westermann CJJ, Post MC. Predicting the size of pulmonary arteriovenous malformations on chest computed tomography: a role for transthoracic contrast echocardiography. Eur Respir J 2014; 44:150-9. [PMID: 24603816 DOI: 10.1183/09031936.00133713] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
This study aimed to investigate whether pulmonary shunt grade on transthoracic contrast echocardiography (TTCE) predicts the size of pulmonary arteriovenous malformations (PAVMs) on chest computed tomography (CT) and subsequent feasibility for transcatheter embolotherapy. We prospectively included 772 persons with possible or definite hereditary haemorrhagic telangiectasia, who underwent both TTCE and chest CT for screening of PAVMs. A quantitative three-point grading scale was used to classify the pulmonary shunt size on TTCE (grade 1-3). Transcatheter embolotherapy was performed for PAVMs deemed large enough for endovascular closure on chest CT. TTCE documented pulmonary shunting in 510 (66.1%) patients. The positive predictive value of a pulmonary shunt grade 1, 2 and 3 on TTCE for presence of PAVMs on chest CT was 13.4%, 45.3% and 92.5%, respectively (p<0.001). None of the 201 persons with a pulmonary shunt grade 1 on TTCE had PAVMs on chest CT large enough for transcatheter embolotherapy, while 38 (25.3%) and 123 (77.4%) individuals with a pulmonary shunt grade 2 and 3 on TTCE, respectively, underwent endovascular closure of PAVMs. Pulmonary shunt grade on TTCE predicts the size of PAVMs on chest CT and their feasibility for subsequent transcatheter embolotherapy. Chest CT can be safely withheld from all persons with a pulmonary shunt grade 1 on TTCE, as any PAVM found in these subjects will be too small for transcatheter embolotherapy.
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Affiliation(s)
| | | | | | | | | | | | | | - Cesare Danesino
- Dept of Molecular Medicine, University of Pavia and IRCCS, S. Matteo, Pavia
| | - Arjen L Diederik
- Dept of Radiology, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Jan A Vos
- Dept of Radiology, St Antonius Hospital, Nieuwegein, the Netherlands
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Van Der Heyden J, Van Werkum J, Hackeng CM, Kelder JC, Breet NJ, Deneer VHM, Ackerstaff RGA, Tromp SC, De Vries JPPM, Vos JA, Suttorp MJ, Elsenberg EHA, Van Neerven D, Schonewille WJ, Wolters F, Ten Berg JM. High versus standard clopidogrel loading in patients undergoing carotid artery stenting prior to cardiac surgery to assess the number of microemboli detected with transcranial Doppler: results of the randomized IMPACT trial. J Cardiovasc Surg (Torino) 2013; 54:337-347. [PMID: 23138609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM The aim of this study was to compare the effects of 300 mg or 600 mg clopidogrel loading dose, prior to carotid artery stenting (CAS) on the number of transcranial Doppler (TCD)-detected microembolic signals (MES) and to investigate the relationship between the magnitude of platelet reactivity and MES. METHODS In this prospective randomized, double-blind study, 35 consecutive asymptomatic patients (17.1% females), scheduled for CAS and cardiac surgery were included. The primary endpoint was the number of TCD-detected MES. The secondary endpoints were the absolute magnitude of on-treatment platelet reactivity and the adverse cerebral events. Negative binomial regression to find predictors for sum of single emboli, the student's t-test to assess the association between platelet function tests and randomized dose of 300 mg or 600 mg clopidogrel, and the R2 calculation for the assessment of the association between platelet function tests and embolic load, were used. RESULTS No statistically significant difference in the number of TCD-detected MES, in the sum of all the single emboli or showers and platelet aggregation measurements between the two groups was observed (aggregometry: 21.7±18.3 versus 23±18%, P=0.8499 and 45.8±17.5 versus 46.5±14.5%, P=0.9003) (verifyNow P2Y12 assay: 231±93 PRU versus 222±86 PRU, P=0.7704). In one patient a transient ischemic attack occurred. CONCLUSION A loading dose of 300 mg of clopidogrel in combination with aspirin is as effective as 600 mg of clopidogrel in achieving adequate platelet inhibition and preventing periprocedural events in asymptomatic patients undergoing CAS prior to cardiac surgery.
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Affiliation(s)
- J Van Der Heyden
- Department of Interventional Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands.
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20
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Avci M, Vos JA, Kolvenbach RR, Verhoeven EL, Perdikides T, Resch TA, Espinosa G, Böckler D, De Vries JPPM. The use of endoanchors in repair EVAR cases to improve proximal endograft fixation. J Cardiovasc Surg (Torino) 2012; 53:419-426. [PMID: 22854521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM The aim of this paper was to evaluate short-term outcome of the use of endoanchors to secure the primary migrated endograft and additional extender cuffs to the aortic wall in patients with previous failed endovascular aortic aneurysm repair. METHODS Consecutive patients who needed proximal repair of a primary failed endograft due to migration (with or without type IA endoleaks) were treated with endoanchors, with or without additional extender cuffs. Data of this group were prospectively gathered in vascular referral centers that were early adopters of the endoanchor technique. Preprocedural and periprocedural data were prospectively gathered and retrospectively analyzed. Follow-up after endoanchor placement consisted of regular hospital visits, with computed tomography or duplex scanning at 1, 6, and 12 months. RESULTS From July 2010 to May 2011, 11 patients (8 men), mean age 77 years (range, 59-88 years), were treated with endoanchors for a failed primary endograft (2 Excluder endografts, 1 AneuRx endograft, and 8 Talent endografts) due to distal migration of the main body, with or without type IA endoleak. Revision consisted of using endoanchors to secure the body of the primary endograft to the aortic wall to avoid persistent migration. Most patients had additional proximal extender cuffs with suprarenal fixation, which were secured with endoanchors to the aortic wall and in some patients also to the primary endograft. A median of 6 endoanchors were implanted. All endoanchors were positioned correctly but one. One endoanchor dislodged but was successfully retrieved using an endovascular snare. During a mean follow-up of 10 months (range, 3-18 months) no endoanchor-related complications or renewed migration of the endografts occurred. Two patients underwent repeat intervention due to persistent type IA endoleak during follow-up. CONCLUSION The use of endoanchors to secure migrated endografts to the aortic wall is safe and feasible and might help to overcome persistent migration of primary failed endografts. In combination with the use of sole extender cuffs the majority of proximal EVAR failures can be solved.
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Affiliation(s)
- M Avci
- Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
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21
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De Raet JM, Vos JA, Morshuis WJ, van Boven WJP. Surgical management of superior vena cava syndrome after failed endovascular stenting. Interact Cardiovasc Thorac Surg 2012; 15:915-7. [PMID: 22843656 DOI: 10.1093/icvts/ivs316] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The superior vena cava syndrome encompasses a constellation of symptoms and signs resulting from obstruction of the superior vena cava. We report a successful surgical management after failed endovascular stenting for superior vena cava syndrome, caused by a postradiation fibrosis after conventional radiotherapy for breast cancer. We emphasize the rarity of this uncommon surgical procedure and the bailout procedure for failed angioplasty and intravascular stenting. Key points of superior vena cava syndrome and its management are discussed.
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Affiliation(s)
- Jan M De Raet
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, Netherlands.
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de Vries JPPM, Vos JA. Comments regarding 'Carotid endarterectomy within seven days after the neurological index event is safe and effective in stroke prevention'. Eur J Vasc Endovasc Surg 2011; 42:740-1. [PMID: 21944568 DOI: 10.1016/j.ejvs.2011.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 09/06/2011] [Indexed: 11/16/2022]
Affiliation(s)
- J P P M de Vries
- Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
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Compter A, van der Worp HB, Schonewille WJ, Vos JA, Algra A, Lo TH, Mali WPTM, Moll FL, Kappelle LJ. VAST: Vertebral Artery Stenting Trial. Protocol for a randomised safety and feasibility trial. Trials 2008; 9:65. [PMID: 19025615 PMCID: PMC2611963 DOI: 10.1186/1745-6215-9-65] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2008] [Accepted: 11/24/2008] [Indexed: 11/10/2022] Open
Abstract
Background Twenty to 30 percent of all transient ischaemic attacks and ischaemic strokes involve tissue supplied by the vertebrobasilar circulation. Atherosclerotic stenosis ≥ 50% in the vertebral artery accounts for vertebrobasilar stroke in at least one third of the patients. The risk of recurrent vascular events in patients with vertebral stenosis is uncertain and revascularisation of vertebral stenosis is rarely performed. Observational studies have suggested that the risk of subsequent stroke or death in patients with vertebrobasilar ischaemic events is comparable with that in patients with carotid territory events. Treatment of vertebral stenosis by percutaneous transluminal angioplasty has been introduced as an attractive treatment option. The safety and benefit of stenting of symptomatic vertebral stenosis as compared with best medical therapy alone remains to be elucidated in a randomised clinical trial. Study objectives The primary aim of the Vertebral Artery Stenting Trial (VAST) is to assess whether stenting for symptomatic vertebral artery stenosis ≥ 50% is feasible and safe. A secondary aim is to assess the rate of new vascular events in the territory of the vertebrobasilar arteries in patients with symptomatic vertebral stenosis ≥ 50% on best medical therapy with or without stenting. Design This is a randomised, open clinical trial, comparing best medical treatment with or without vertebral artery stenting in patients with recently symptomatic vertebral artery stenosis ≥ 50%. The trial will include a total of 180 patients with transient ischaemic attack or non-disabling ischaemic stroke attributed to vertebral artery stenosis ≥ 50%. The primary outcome is any stroke, vascular death, or non-fatal myocardial infarction within 30 days after start of treatment. Secondary outcome measures include any stroke or vascular death during follow-up and the degree of (re)stenosis after one year. Discussion Improvements both in imaging of the vertebral artery and in endovascular techniques have created new opportunities for the treatment of symptomatic vertebral artery stenosis. This trial will assess the feasibility and safety of stenting for symptomatic vertebral artery stenosis and will provide sufficient data to inform a conclusive randomised trial testing the benefit of this treatment strategy. The VAST is supported by the Netherlands Heart Foundation (2007B045; ISRCTN29597900).
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Affiliation(s)
- A Compter
- Department of Neurology, Rudolf Magnus Institute for Neuroscience, University Medical Centre Utrecht, HP G 03,228, PO Box 85500, 3508 GA Utrecht, The Netherlands.
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24
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de Borst GJ, Vos JA, Reichmann B, Hellings WE, de Vries JPPM, Suttorp MJ, Moll FL, Ackerstaff RGA. The Fate of the External Carotid Artery after Carotid Artery Stenting. A Follow-up Study with Duplex Ultrasonography. Eur J Vasc Endovasc Surg 2007; 33:657-63. [PMID: 17337347 DOI: 10.1016/j.ejvs.2007.01.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2006] [Accepted: 01/16/2007] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the long-term effect of carotid angioplasty and stenting (CAS) of the internal carotid artery (ICA) on the ipsilateral external carotid artery (ECA). SUBJECTS AND METHODS We prospectively registered the pre- and post-interventional duplex scans obtained from 312 patients (mean age 70 years) who underwent CAS. Duplex scans were scheduled the day before CAS, 3 and 12 months post-procedurally and yearly thereafter, to study progression of obstructive disease in the ipsilateral ECA compared to the contralateral ECA. The duplex ultrasound criteria used to identify ECA stenosis >or=50% were Peak Systolic Velocities of >or=125 cm/s. RESULTS Preprocedural evaluation of the ipsilateral ECA demonstrated >or=50% stenosis in 32.7% of cases vs 30% contralateral. Both ipsilateral and contralateral 3 (1%) ECA occlusions were noted. After stenting 5 (1.8%) occlusions were seen vs 1% contralateral. No additional ipsilateral occlusions and 2 additional contralateral occlusions were noted at extended follow-up. The prevalence of >or=50% stenosis of the ipsilateral ECA (Kaplan-Meier estimates) progressed from 49.1% at 3, to 56.4%, 64.7%, 78.2%, 72.3%, and 74% at 12, 24, 36, 48, and 60 months respectively. Contralateral prevalences were 31.3%, 37.7%, 41.7%, 43.1%, 46.0%, and 47.2% respectively (p<0.001). Progression of stenosis was more pronounced in 234 patients (75%) with overstenting of the carotid bifurcation (p=0.004). CONCLUSION Our results show that significant progression of >or=50% stenosis in the ipsilateral ECA occurs after CAS. There was greater progression of disease in the ipsilateral compared with the contralateral ECA. Progression of disease in the ECA did not lead to the occurrence of occlusion during follow up.
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Affiliation(s)
- G J de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, The Netherlands.
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25
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Kropman RHJ, Bemelman M, Vos JA, van den Berg JC, van de Pavoordt HDWM, van de Mortel RHW, Moll FL, de Vries JPPM. Long-term Results of Percutaneous Transluminal Angioplasty for Symptomatic Iliac In-stent Stenosis. Eur J Vasc Endovasc Surg 2006; 32:634-8. [PMID: 16875851 DOI: 10.1016/j.ejvs.2006.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2006] [Accepted: 06/07/2006] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study describes the long-term results of endoluminal therapy for iliac in-stent obstructions. DESIGN This is a retrospective study. MATERIALS AND METHODS From 1992 to 2005, 68 patients (22 women), with a mean age of 61+/- 13 years and 16 bi-iliac in-stent obstructions, underwent 84 endovascular interventions for focal iliac in-stent stenoses (n = 61) or occlusions (n = 23). Primarily, only uncovered stents were placed. All patients were symptomatic: 70% had disabling intermittent claudication, 23% had resting pain, and 7% had trophic changes. All had in-stent diameter reduction exceeding 50% that was confirmed by duplex scanning and angiography. Procedures were performed under local anesthesia via the femoral route. RESULTS All interventions were initially technically successful, with a minor complication of pneumonia in one patient (2%). Initial clinical success was achieved in 86% of patients. PTA alone was used to treat 72 (86%) in-stent obstructions, the other 12 (14%) had PTA and renewed stent placement. The 30-day mortality rate was 0%. Mean follow-up was 35 months (range, 3 months to 10 years) and included duplex scanning. Primary clinical patency was 88% at 1 year, 62% at 3 years, and 38% at 5 years follow-up. During follow-up, 28 (33%) of 84 extremities required secondary reinterventions because of symptomatic renewed in-stent stenosis, and 11 were treated successfully with repeated endovascular interventions. Secondary patency at 1 year was 94%, 78% at 3 years, and 63% at 5 years. Surgical intervention was eventually needed in 17 (20%) of the 84 extremities. CONCLUSIONS Endoluminal therapy for iliac focal in-stent obstructive disease seems to be a safe technique with acceptable long-term outcome and therefore a true alternative to primary surgical reconstruction.
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Affiliation(s)
- R H J Kropman
- Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
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26
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Abstract
We report transection and embolization to the heart of a subclavian venous catheter in an immobilized and mechanical ventilated patient. The catheter tip was retrieved using a percutaneous method via the left femoral vein. Mechanical compression of the subclavian venous catheter at the costoclavicular area is termed pinch-off syndrome. It can be recognized by intermittent difficulties with drug injection, and chest wall swelling at the insertion site. The diagnosis can be confirmed by chest radiography with or without contrast administration. A more lateral approach of the subclavian vein is advocated to prevent compression.
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Affiliation(s)
- J C de Graaff
- Department of Anesthesiology and Intensive Care, St Antonius Hospital PO Box 2500, 3430 EM Nieuwegein, The Netherlands.
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Biemans JMA, Vos JA. Bleeding stromal tumor in Meckel's diverticulum. JBR-BTR 2005; 88:112-3. [PMID: 16038218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Affiliation(s)
- J M A Biemans
- Department of Radiology, Stichting Sint Antoniusziekenhuis, Nieuwegein, The Netherlands
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Ackerstaff RG, Suttorp MJ, van den Berg JC, Overtoom TTC, Vos JA, Bal ET, Zanen P. Prediction of early cerebral outcome by transcranial Doppler monitoring in carotid bifurcation angioplasty and stenting. J Vasc Surg 2005; 41:618-24. [DOI: 10.1016/j.jvs.2005.01.034] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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van der Laan L, Vos JA, de Boer E, van den Berg JC, Moll FL. [The central-venous compression syndrome: rare, but adequately treatable with endovascular stenting]. Ned Tijdschr Geneeskd 2004; 148:433-7. [PMID: 15038205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Two patients, women aged 30 and 29, had severe chronic pain in the left leg, and a woman aged 36 had pain in the left flank. On the grounds of the clinical symptoms, phlebography and venous-duplex ultrasonography, a central-venous compression syndrome was diagnosed: compression of the left common iliac vein between the crossing right common iliac artery and the body of the fifth lumbar vertebra (May-Thurner syndrome). The patient with left flank pain also had haematuria. Angiography, computed tomography and phlebography revealed that these symptoms were due to compression of the left renal vein between the abdominal aorta and the superior mesenteric artery (nutcracker phenomenon). The treatment of all 3 patients consisted of venous endovascular stenting. At follow-up after 12, 30 and 15 months, respectively, the complaints had subsided considerably.
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de Vries JPPM, van Den Heuvel DAF, Vos JA, van Den Berg JC, Moll FI. Freedom from secondary interventions to treat stenotic disease after percutaneous transluminal angioplasty of infrarenal aorta: long-term results. J Vasc Surg 2004; 39:427-31. [PMID: 14743148 DOI: 10.1016/j.jvs.2003.08.032] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE The purpose of this study was to determine the long-term results (1-15 years) of percutaneous transluminal angioplasty (PTA) of localized atherosclerotic lesions of the infrarenal aorta. METHODS This was a retrospective study. From January 1987 to January 2002, 69 patients underwent PTA of an isolated stenosis of the lower abdominal aorta under local anesthesia in the department of interventional radiology. All atherosclerotic lesions were hemodynamically significant, defined as a subjective report of walking distance less than one block, resting pain, or trophic changes in combination with diameter reduction of 50% or greater at duplex ultrasound scanning and angiography. RESULTS The female-male ratio of study patients was 3.6:1; mean age was 58 years. Endovascular treatment was initially technically and clinically successful in all but one patient (98%), who had a near total occlusion. No major complications were noted. Mean follow-up was 57 months (range, 6 months-15 years). At life table analysis, 5-year primary patency was 75%, and secondary patency was 97%. Twelve patients (17%) required repeat interventions because of hemodynamically significant recurrent stenosis in combination with severe clinical symptoms. Most recurrent stenoses (67%) were successfully treated with repeat endovascular procedures. CONCLUSIONS Early and long-term results of PTA (with additional stent placement) of isolated stenosis of the infrarenal aorta are good. This minimally invasive procedure is a true alternative to traditional surgical methods.
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Affiliation(s)
- J P P M de Vries
- Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, The Netherlands.
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Abstract
PURPOSE In this article we will review some of the issues surrounding the relationship between TCD-detected emboli and brain function and architecture, both during conventional surgical carotid endarterectomy (CEA) and carotid angioplasty and stenting (CAS). MATERIAL AND METHODS In both procedures, the cerebral embolic load was semi quantitatively assessed and associated with clinical outcome during the procedure and after a symptom free interval within 7 days. RESULTS In CEA, particulate emboli that occurred during the wound closure stage were associated with intraoperative stroke and stroke related death, odds ratios [OR] 2.3 95% CI 1.2-4.4, p = 0.007. In CAS, showers of microemboli that appeared at postdilatation of the stent (OR 3.2, 95% CI 1.5-6.9, p = 0.002), particulate macroembolism (relative risk [RR] 10.2, 95% CI 5.9-17.3, p < 0.001), and massive air embolism (RR 10.2, 95%CI 5.8-17.7, p < 0.001) were associated with new transient and persistent cerebral deficits. CONCLUSION In both CEA and CAS, recording of cerebral emboli by TCD ultrasonography provides insight in the pathogenesis of procedure related adverse cerebral outcome. In several centres TCD monitoring during CEA is now accepted as a clinically relevant tool that helps the surgeon to make the operation safer. In CAS more research is needed, particularly with respect to the impact of cerebral protection devices.
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Affiliation(s)
- R G A Ackerstaff
- Department of Clinical Neurophysiology, St. Antonius Hospital, Nieuwegein (Utrecht), The Netherlands.
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van den Bosch MAAJ, Vos JA, de Letter MACJ, de Ru JA, van Diemen-Steenvoorde RAAM, Plötz FB. MRI findings in a child with sigmoid sinus thrombosis following mastoiditis. Pediatr Radiol 2003; 33:877-9. [PMID: 13680004 DOI: 10.1007/s00247-003-1056-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2002] [Revised: 07/07/2003] [Accepted: 07/15/2003] [Indexed: 10/26/2022]
Abstract
We describe the MRI features of sigmoid sinus thrombosis following mastoiditis in a 3-year-old girl. The features consisted of increased signal from the sinus on T2-weighted images and absence of flow on MR venography. It is concluded that MRI enabled a timely diagnosis of this life-threatening disease. MRI, as a non-invasive technique that does not use ionizing radiation, should be considered the investigation of first choice, especially in young patients.
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Affiliation(s)
- Maurice A A J van den Bosch
- Department of Radiology, University Medical Centre Utrecht, Room E01-132, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
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Vos JA. [Diagnostic image (63). Paraganglioma]. Ned Tijdschr Geneeskd 2001; 145:2173. [PMID: 11727616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
A 33-year-old woman was examined for a non-tender mass in the neck. Imaging findings were consistent with paraganglioma. The diagnosis was confirmed at surgery.
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Affiliation(s)
- J A Vos
- St. Antonius Ziekenhuis, afd. Radiologie, Koekoekslaan 1, 3435 CM Nieuwegein
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van Heesewijk HP, van der Graff Y, de Valois JC, Vos JA, Feldberg MA. Digital chest imaging using a selenium detector. The impact of hard copy size on observer performance: a computed tomography-controlled study. Invest Radiol 1997; 32:363-7. [PMID: 9179712 DOI: 10.1097/00004424-199706000-00008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
RATIONALE AND OBJECTIVES The authors compare radiologist detection performance under clinical conditions for assessment of the effect of size reduction on the diagnostic performance of digital chest images obtained with a selenium detector. METHODS Sixty-five patients were examined with the digital system. The images were acquired without an antiscatter grid. Sixty-five posteroanterior life-size images (35 x 43 cm) and sixty-five posteroanterior minified images (56% of life size) were analyzed by three observers for detection of pulmonary, mediastinal, and pleural pathology, using computed tomography as the reference standard. The diagnostic value of life-size and minified images for the detection of these chest abnormalities was analyzed with receiver operating characteristic (ROC) methods. RESULTS For the detection of the various abnormalities by all radiologists, the areas under the ROC curves with life-size images versus minified images, respectively, were as follows: pulmonary opacities, 0.78 versus 0.78; interstitial disease, 0.74 versus 0.75; mediastinal disease, 0.70 versus 0.72; and pleural abnormalities 0.72 versus 0.67. CONCLUSIONS There was no statistically significant difference between the radiologists' performance in detecting pulmonary, mediastinal, and pleural pathology with life-size versus that with minified (56% of life size) digital selenium chest radiography.
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Affiliation(s)
- H P van Heesewijk
- Department of Diagnostic Radiology, St. Antonius Hospital, Utrecht, The Netherlands
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Litz CE, Vos JA, Copenhaver CM. Aberrant methylation of the major breakpoint cluster region in chronic myeloid leukemia. Blood 1996; 88:2241-9. [PMID: 8822945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Isolated hypomethylated sites exist in the major breakpoint cluster region (M-bcr) where most Philadelphia chromosome (Ph) breakpoints are located. Twenty of 50 (40%) chronic myeloid leukemia (CML) patients were found to have aberrant hypermethylation of these sites on the rearranged M-bcr when compared with control marrows. The aberrancy correlated strongly with M-bcr breakpoint location; 19 of 20 cases had breakpoints located 5' of the M-bcr Sca I site, and 28 of 30 cases with normal M-bcr methylation had breakpoints located 3' of the M-bcr Sca I site. Sequence analysis of the Ph M-bcr breakpoints failed to find an M-bcr nucleotide position that delineated the transition between abnormally and normally methylated cases, indicating that the translocation of a critical M-bcr sequence was not responsible for the methylation abnormality. In 3 of 8 CML patients, cells without the t(9;22) were found to have abnormally methylated, unrearranged M-bcrs. The data indicate that abnormally methylated rearranged M-bcrs are present in CML cases with Ph breakpoints 5' of the M-bcr Sca I site and that the M-bcr in Ph- cells of patients with CML may also be abnormally methylated.
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Affiliation(s)
- C E Litz
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis
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van Heesewijk HP, van der Graaf Y, de Valois JC, Vos JA, Feldberg MA. Chest imaging with a selenium detector versus conventional film radiography: a CT-controlled study. Radiology 1996; 200:687-90. [PMID: 8756915 DOI: 10.1148/radiology.200.3.8756915] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare radiologist detection performance under clinical conditions for assessment of conventional radiographs and digital chest images obtained with a selenium detector. MATERIALS AND METHODS One hundred four patients were examined with the digital and conventional systems under near identical technical conditions. The digital images were acquired without an antiscatter grid. Two hundred eight images were analyzed by three radiologists for detection of pulmonary, mediastinal, and pleural abnormalities; computed tomography was used as the reference standard. The diagnostic value of both techniques for the detection of these chest abnormalities was analyzed with receiver operating characteristic (ROC) methods. RESULTS For detection of the various abnormalities by all radiologists, the areas under the ROC curves with conventional imaging versus digital imaging, respectively, were as follows: pulmonary opacities, 0.81 versus 0.79; interstitial disease, 0.69 versus 0.73; mediastinal disease, 0.79 versus 0.74; and pleural abnormalities, 0.73 versus 0.68. CONCLUSION There was no statistically significant difference between the radiologists' performance in detecting pulmonary, mediastinal, and pleural abnormalities with conventional radiography versus that with digital selenium chest radiography.
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Affiliation(s)
- H P van Heesewijk
- Department of Diagnostic Radiology, St. Antonius Hospital, Nieuwegein (Utrecht), The Netherlands
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van Erp-Baart AM, Saris WM, Binkhorst RA, Vos JA, Elvers JW. Nationwide survey on nutritional habits in elite athletes. Part II. Mineral and vitamin intake. Int J Sports Med 1989; 10 Suppl 1:S11-6. [PMID: 2744923 DOI: 10.1055/s-2007-1024948] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The nutritional habits of elite athletes competing at a national and international top level were determined. Groups of endurance strength, and team sport athletes participated. All athletes trained at least 1-2 h daily. The purpose of the study was to quantify the mineral and vitamin intake and to identify the magnitude of the nutrient supplementation use. Information on food intake was obtained by a 4- or 7-day food diary. It was found that calcium and iron intake was positively related to energy intake. In low energy intakes (less than 10 MJ) iron intake might be insufficient. In general, vitamin intake with food was in agreement with the Dutch recommendations. However, if energy intake is high (greater than 20 MJ) the amount of refined carbohydrate is increased. Consequently, the nutrient density for vitamin B1 drops. Therefore, under these conditions, supplementation for vitamin B1 must be considered. The low vitamin intake found in lower energy intakes can be improved by proper nutritional advice. In body building and in professional cycling, high dosages of vitamins are used. The other groups of athletes used only moderate quantities of vitamin supplements. It is concluded that vitamin and mineral intake is sufficient, when energy intake ranges between 10 and 20 MJ/day.
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van Erp-Baart AM, Saris WH, Binkhorst RA, Vos JA, Elvers JW. Nationwide survey on nutritional habits in elite athletes. Part I. Energy, carbohydrate, protein, and fat intake. Int J Sports Med 1989; 10 Suppl 1:S3-10. [PMID: 2744927 DOI: 10.1055/s-2007-1024947] [Citation(s) in RCA: 93] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Information about habitual food intake was systematically obtained from elite endurance, strength, and team sport athletes. The athletes (n = 419) trained at least 1-2 h daily and competed on an international level. A 4- or 7-day food diary was kept. For analysis of the data, a computerized food table was used. Mean energy intake varied from 12.1-24.7 MJ per day for male and 6.8-12.9 MJ per day for female athletes. Protein intake was in agreement with or higher than the Dutch recommendations. Contribution of carbohydrate intake to total energy intake varied from 40%-63%. Fat intake tended to meet the criteria for a prudent diet (less than 35%). Snacks contributed about 35% to the total energy intake and the bread/cereals and dairy food groups were the most important energy sources. It is concluded that in general there are two major concerns. In those sports in which body composition plays an important role, energy and thus nutrient intake is often marginal. In all groups of athletes intake of carbohydrate is insufficient.
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Lenders JW, Demacker PN, Vos JA, Jansen PL, Hoitsma AJ, van 't Laar A, Thien T. Deleterious effects of anabolic steroids on serum lipoproteins, blood pressure, and liver function in amateur body builders. Int J Sports Med 1988; 9:19-23. [PMID: 3366514 DOI: 10.1055/s-2007-1024972] [Citation(s) in RCA: 78] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The effects of self-administered anabolic steroids (AS) on lipoproteins, liver function, and blood pressure were studied in male amateur body builders. Twenty body builders were studied at the end of a course of AS (group 1) and 42 body builders were studied after discontinuation of the AS for a mean of 5 months (group 2). Sixteen body builders were studied after discontinuation of AS for at least 2 months and at the end of a 9-week course of AS (group 3). A group of 13 body builders who never used AS served as a control group. Both groups 1 and 2 showed higher levels of transaminas and a higher systolic blood pressure than the controls (P less than 0.05). Group 3 showed an increase of the transaminases an a slight but significant increase of systolic blood pressure (+3 mm Hg) and heart rate (+7 bts/min) after one course of AS (P less than 0.05). Group 1 showed a considerably lower high-density lipoprotein cholesterol (HDLC) (P less than 0.001), a higher low-density lipoprotein cholesterol (LDLC) (P less than 0.05), and a lower apoprotein A-l/B ratio (Apo A-l/ApoB) (P less than 0.001) than the controls and group 2. The ratio of LDLC/HDLC in group 1 was fourfold higher than in the controls (P less than 0.01). In group 3 HDLC decreased from 1.18 +/- 0.05 to 0.60 +/- 0.08 mmol/l (P less than 0.001) and LDLC increased from 3.97 +/- 0.39 to 5.74 +/- 0.71 mmol/l (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- J W Lenders
- Department of Medicine, St. Radboud Hospital, University of Nijmegen, The Netherlands
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de Koning FL, van't Hof MA, Binkhorst RA, Vos JA. Parameters of the force-velocity curve of human muscle in relation to body dimensions. Hum Biol 1986; 58:221-38. [PMID: 3710463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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de Koning FL, Binkhorst RA, Vos JA, van 't Hof MA. The force-velocity relationship of arm flexion in untrained males and females and arm-trained athletes. Eur J Appl Physiol Occup Physiol 1985; 54:89-94. [PMID: 4018062 DOI: 10.1007/bf00426305] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The force-velocity curve (FVC) of arm flexion was established in 123 untrained males and 110 untrained females aged from 15 to 36 years, and 48 arm-trained athletes competing in different sport disciplines. The FVC was described by Hill's equation and defined by the parameters: maximal static moment (M0), maximal angular velocity (omega 0), maximal power (P0) and the concavity of the FVC (H). Within the given age range the level of the curve parameters of both untrained men and women was independent of age. On average, H was the same in all three groups. As compared to M0 of the untrained males, M0 of the athletes was 33% higher and M0 of the females was 38% lower; with regard to P0 these differences were +30% and -43% respectively. omega 0 was the same for trained and untrained males, whereas omega 0 of the women was 10% lower than omega 0 of the men.
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de Koning FL, Vos JA, Binkhorst RA, Vissers AC. Influence of training on the force-velocity relationship of the arm flexors of active sportsmen. Int J Sports Med 1984; 5:43-6. [PMID: 6698682 DOI: 10.1055/s-2008-1025879] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The aim of this study was to investigate the influence of specific types of muscle training, performed by previously well-trained competitive athletes, on the force-velocity relationship of the arm flexors. Four rowers, five athletes competing in tug-of-war, and six middle- and long-distance runners were measured at different stages of their training program during the period of 1 training year. The runners performed no special arm training and were included for comparative purposes. A record was made of the type and intensity of training. The force-velocity curve (FVC) was established by measuring the torques (M) and corresponding angular velocities (omega) of maximal arm flexions against different constant torques. Using Hill's equation: (M + a) (omega + b) = constant, a best fitting curve was calculated through the points of measurement. Two-way analysis of variance revealed only few statistically significant (P less than 0.05) changes in the parameters describing the course of the FVC. The results suggest that the force-velocity characteristics of muscle of previously well-trained sportsmen can hardly be influenced.
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De Koning FL, Binkhorst RA, Vissers AC, Vos JA. Influence of static strength training on the force-velocity relationship of the arm flexors. Int J Sports Med 1982; 3:25-8. [PMID: 7068294 DOI: 10.1055/s-2008-1026057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Twenty-nine boys about 16 years old were divided into a training group and a control group. The training group exercised the arm flexors in a static strength training program with 90% of the maximal static strength during 9 weeks, three times a week. Before and after the training period, the force-velocity relationship of the arm flexors was established. For this purpose the maximal speed of flexion against different but constant loads was measured. A best fitting curve was computed according to Hill's equation: (F+a) (v+b) = C. The mean maximal static strength of the training group increased from 238 N to 270 N. No change occurred in the maximal speed at low forces but the speed increased at high forces. This resulted in a more concave course of the F-v curve. Maximal power did not change significantly. No significant changes were observed in the control group.
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Pool J, Binkhorst RA, Vos JA. Some anthropometric and physiological data in relation to performance of top female gymnasts. Int Z Angew Physiol 1969; 27:329-38. [PMID: 5403931 DOI: 10.1007/bf00698535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Binkhorst RA, Vos JA. Contraction characteristics of the M. plantaris of the rat. Pflugers Arch Gesamte Physiol Menschen Tiere 1967; 296:346-51. [PMID: 5239191 DOI: 10.1007/bf00362534] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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