International Variations in Infrainguinal Bypass Surgery – A VASCUNET Report

Lees, Tim; Troëng, Thomas; Thomson, Ian; Menyhei, Gábor; Simo, G; Beiles, Barry; Jensen, Louise Kruse; Palombo, Domenico; Venermo, Maarit; Mitchell, David C.; Halbakken, E.; Wigger, Pius; Heller, Georg; Björck, Martin

doi:10.1016/j.ejvs.2012.05.006

Cited by 50 publications

(18 citation statements)

References 12 publications

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“…The fact that some data were collected retrospectively, and that comparisons may have been confounded by differences in case mix, are a major limitation of the study. Patients were registered prospectively in the Swedvasc registry and/or the local endovascular database, however, assuring good external validity17–19. Data on blood transfusion were also registered prospectively, and survival or death was confirmed with the population registry.…”

Section: Discussionmentioning

confidence: 99%

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Outcome and complications after intra-arterial thrombolysis for lower limb ischaemia with or without continuous heparin infusion

Grip

Kuoppala

Acosta

et al. 2014

British Journal of Surgery

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BackgroundThrombolysis is a common treatment for acute leg ischaemia. The purpose of this study was to evaluate different thrombolytic treatment strategies, and risk factors for complications.MethodsThis was a retrospective analysis of prospective databases from two vascular centres. One centre used a higher dose of heparin and recombinant tissue plasminogen activator (rtPA).ResultsSome 749 procedures in 644 patients of median age 73 years were studied; 353 (47·1 per cent) of the procedures were done in women. The aetiology of ischaemia was graft occlusion in 38·8 per cent, acute arterial thrombosis in 32·2 per cent, embolus in 22·3 per cent and popliteal aneurysm in 6·7 per cent. Concomitant heparin infusion was used in 63·2 per cent. The mean dose of rtPA administered was 21·0 mg, with a mean duration of 25·2 h. Technical success was achieved in 80·2 per cent. Major amputation and death within 30 days occurred in 13·1 and 4·4 per cent respectively. Bleeding complications occurred in 227 treatments (30·3 per cent). Blood transfusion was needed in 104 (13·9 per cent). Three patients (0·4 per cent of procedures) had intracranial bleeding; all were fatal. Amputation-free survival was 83·6 per cent at 30 days at both centres. In multivariable analysis, preoperative severe ischaemia with motor deficit was the only independent risk factor for major bleeding (odds ratio (OR) 2·98; P <0·001). Independent risk factors for fasciotomy were severe ischaemia (OR 2·94) and centre (OR 6·50). Embolic occlusion was protective for major amputation at less than 30 days (OR 0·30; P = 0·003). Independent risk factors for death within 30 days were cerebrovascular disease (OR 3·82) and renal insufficiency (OR 3·86).ConclusionBoth treatment strategies were successful in achieving revascularization with acceptable complication rates. Continuous heparin infusion during intra-arterial thrombolysis appeared to offer no advantage.

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Section: Discussionmentioning

confidence: 99%

“…Patients were identified through the local Swedvasc registry (a national register for vascular procedures, with high validity)17–19 and local endovascular databases. The regional ethics review board in Lund approved the study.…”

Section: Methodsmentioning

confidence: 99%

Outcome and complications after intra-arterial thrombolysis for lower limb ischaemia with or without continuous heparin infusion

Grip

Kuoppala

Acosta

et al. 2014

British Journal of Surgery

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show abstract

“…Data variables have been adjusted to conform to the international Vascunet recommended standard for carotid, aortic, and peripheral arterial diseases1 and for the purpose of processing national quality analysis. Existing data from administrative registers are used, when deemed valid.…”

Section: Main Variablesmentioning

confidence: 99%

“…Therefore, the DVR participates in the international collaboration, Vascunet, which is established to compare the practice between countries for common vascular interventions. The Vascunet collaboration has published comparative data on carotid endarterectomy,7 abdominal aortic aneurysms, lower limb revascularization, and rare conditions where national data are too limited to conduct studies 1. These analyses have revealed slight differences in practices and outcomes between countries and have supported local quality improvement initiatives.…”

Section: Main Variablesmentioning

confidence: 99%

The Danish Vascular Registry, Karbase

Eldrup

Cerqueira

Motte

et al. 2016

CLEP

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AimThe Danish Vascular Registry (DVR), Karbase, is monitoring arterial and advanced vein interventions conducted at all vascular departments in Denmark. The main aim of the DVR is to improve the quality of treatment for patients undergoing vascular surgery in Denmark by using the registry for quality assessment and research.Study populationAll patients undergoing vascular interventions (surgical and endovascular) at any vascular department in Denmark are registered in the DVR. The DVR was initiated in 1989, and each year, ∼9,000 procedures are added. By January 2016, >180,000 procedures have been recorded. Since 2001, data completeness has been >90% (compared to the Danish National Patient Register).Main variablesVariables include information on descriptive patient data (ie, age, sex, height, and weight) and comorbidity (ie, previous cardiovascular disease and diabetes). Process variable includes waiting time (time from event to medical contact and treatment) and the type of procedures conducted. Outcome variables for in-hospital complications (ie, wound complications, myocardial infarction, stroke, amputation, respiratory complications, and renal insufficiency) and 30-day patency are submitted. Variables for medical treatment (antithrombotic and statin treatment), amputation, and survival are extracted from nationwide, administrative registers.ConclusionThe DVR reports outcome on key indicators for monitoring the quality at all vascular departments in Denmark for the purpose of quality improvement. Furthermore, data are available for research and are being used in international collaborations on changes in clinical practices.

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“…Population-based registry systems were established for the purpose of administration, not for research, which might limit the depth of data 3. Besides demographics and psychiatric comorbidities, other potential confounders were not available.…”

Section: Limitationsmentioning

confidence: 99%

Impact of additive alcohol and substance use disorders on the mortality of people with schizophrenia and mood disorders

Chang¹

2016

Evid Based Mental Health

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International Variations in Infrainguinal Bypass Surgery – A VASCUNET Report

Cited by 50 publications

References 12 publications

Outcome and complications after intra-arterial thrombolysis for lower limb ischaemia with or without continuous heparin infusion

Outcome and complications after intra-arterial thrombolysis for lower limb ischaemia with or without continuous heparin infusion

The Danish Vascular Registry, Karbase

Impact of additive alcohol and substance use disorders on the mortality of people with schizophrenia and mood disorders

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