BACKGROUND: Evidence regarding the outcomes of Omniflow (R) II prosthesis in peripheral arterial revascularization at different anatomical sites and for different indications is scarce. Therefore,... Show moreBACKGROUND: Evidence regarding the outcomes of Omniflow (R) II prosthesis in peripheral arterial revascularization at different anatomical sites and for different indications is scarce. Therefore, the aim of this study was to evaluate the outcomes of the Omniflow (R) II used at various positions within the femoral tract both in infected and non-infected setting.METHODS: Patients who underwent reconstructive lower leg vascular surgery with implantation of an Omniflow (R) II from 2014 until 2021 at five medical centers were retrospectively included (N.=142). Patients were subdivided into the following categories: femoro-femoral crossover (N.= 19), femoral interposition (N.= 18), femoro-popliteal (above-the-knee [N.= 25; AK] or below-the-knee [N.= 47; BK]), and femoro-crural bypass grafts (N.= 33). Primary outcome was primary patency and secondary outcomes included primary assisted patency, secondary patency, major amputation, vascular graft infection, and mortality. Outcomes were compared according to different subgroups and the surgical setting (infected versus non-infected).RESULTS: The median follow-up was 35.0 (17.5-54.3) months. Three years primary patency of 58% was observed for femoro-femoral cross-over bypass, 75% for femoral interposition graft, 44% for femoro-popliteal above-the-knee bypass, 42% for femoro-popliteal below-the-knee bypass, and 27% in the femoro-crural position (P=0.006). Freedom from major amputation at three years were 84% for femoro-femoral cross-over bypass, 88% for femoral interposition bypass, 90% for femoro-popliteal AK bypass, 83% for femoro-popliteal BK bypass, and 50% for femoro-crural bypass (P<0.001).CONCLUSIONS: This study demonstrates the safety and feasibility of the use of Omniflow (R) II for femoro-femoral crossover-, femoral interposition-, and femoro-popliteal (AK and BK) bypass. Omniflow (R) II seems to be less suitable for femoro-crural bypass with a significantly lower patency compared to other positions. Show less
Non-invasive diagnostics are the first-line tools to diagnose an atherosclerotic vascular disease (carotid artery, renal artery and lower extremity). The accuracy of these non-invasive measurements... Show moreNon-invasive diagnostics are the first-line tools to diagnose an atherosclerotic vascular disease (carotid artery, renal artery and lower extremity). The accuracy of these non-invasive measurements is of utmost importance since it could have drastic consequences. As a result of the studies in this thesis, the foundation has been laid for the validation of ACCmax as a new diagnostic parameter in atherosclerotic disease. The ACCmax might play an increasingly important role in atherosclerotic diseases over the next few years in patients with PAD (in particular with MAC) as well as patients with renal and carotid arterial disease. Show less
Background: Because of the presence of medial calcific sclerosis, both ankle-branchial index and toe pressure measures can yield misleading results when attempting to diagnose peripheral artery... Show moreBackground: Because of the presence of medial calcific sclerosis, both ankle-branchial index and toe pressure measures can yield misleading results when attempting to diagnose peripheral artery disease (PAD). A new ultrasound parameter, maximal systolic acceleration (ACC(max)), can be an accurate tool for diagnosing PAD, including in diabetic patients. However, it has not been evaluated thoroughly. The aim of this study was to assess the feasibility of using ACC(max) to diagnose and assess the severity of PAD.Methods: The human circulatory system was simulated using an in vitro circulatory system driven by a pulsatile pneumatic pump. Arterial stenosis of various degrees (50%, 70%, 80%, and 90%) was simulated in order to investigate the change in several ultrasound parameters (including ACC(max)), as well as the intraluminal mean arterial pressure gradient. In a separate set of measurements, interobserver variability was measured using two investigators who were unaware of the degree of stenosis.Results: ACC(max) significantly decreased (P < .001), and the pressure gradient increased (P < .001) as the degree of stenosis increased. Moreover, we found a strong correlation between ACC(max) and the pressure gradient (R-2 = 0.937). Finally, interobserver variability with respect to ACC(max) was extremely low, with an intraclass correlation coefficient of 0.99.Conclusions: The results of this flow model study suggest that ACC(max) can be a valid, noninvasive tool for diagnosing PAD. Moreover, our finding that ACC(max) decreases as the severity of stenosis increases, together with the strong correlation between ACC(max) and the pressure gradient, suggests that ACC(max) may be useful as an alternative diagnostic tool for assessing the severity of PAD. These promising in vitro data warrant further study in a clinical setting. Show less
The studies included in this thesis demonstrated a preclinical murine model to study neovascularization in vivo and subsequently a number of potential targets to stimulate therapeutic... Show moreThe studies included in this thesis demonstrated a preclinical murine model to study neovascularization in vivo and subsequently a number of potential targets to stimulate therapeutic neovascularization. This thesis contributes to a better insight into mechanisms underlying post-ischemic neovascularization and offers new therapeutic perspective to current treatment strategies for patients with critical limb ischemia. Whether stagnated blood flow recovery after an occlusive event is due to restricted pre-existing collateral bed or due to decreased collateral remodeling, we are now closer to a tailor made treatment available for each patient with peripheral arterial disease. Show less
Bosch, H. van den; Westenberg, J.; Setz-Pels, W.; Kersten, E.; Tielbeek, A.; Duijm, L.; ... ; Roos, A. de 2016
This thesis addresses basic questions on cellular based and non-cellular (molecular) based therapeutic angiogenesis and provides valuable information on the resident vascular stem cell niche. As... Show moreThis thesis addresses basic questions on cellular based and non-cellular (molecular) based therapeutic angiogenesis and provides valuable information on the resident vascular stem cell niche. As the world population ages, the incidence of cardiovascular diseases and its morbidity and mortality are expected to rise. Traditional treatment of cardiovascular diseases such as minimizing risk factors (e.g. smoking cessation), exercise in case of PAD to promote collateral blood flow, pharmaceutical vasodilatation, and surgical revascularization, clearly does not suffice. Therefore, basic cardiovascular research from stem cells to immunomodulation is of utmost importance, eventually leading to further mechanistic insights and a broader range of therapeutic options for patients with cardiovascular disease. Show less
Welten, S.; Bastiaansen, T.; Jong, R. de; Vries, M. de; Peters, E.; Sheikh, S.; ... ; Nossent, Y. 2013
