Multidisciplinary team decision is rare and decreasing in                     percutaneous vascular interventions despite positive impact on in-hospital                     outcomes

Behrendt, Christian‐Alexander; Kölbel, Tilo; Schwaneberg, Thea; Diener, Holger; Hohnhold, Ralf; Debus, Eike Sebastian; Rieß, Henrik

doi:10.1024/0301-1526/a000771

Cited by 11 publications

(4 citation statements)

References 21 publications

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“…Multidisciplinary “foot teams” following the role model of previously established “heart teams” may be an appropriate way to follow the recommendations for a stepwise care system. Unfortunately, there is striking data suggesting that multidisciplinary team discussions are still the Achilles heel of PAOD treatment [ 34 ]. To provide more data for the establishment of evidence-based therapy, future studies should avoid an exclusion of patients with concomitant CKD or ESKD as there was a severity dependent increase of the incidence of adverse outcomes.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Chronic Kidney Disease on Mid-Term Outcomes after Revascularisation of Peripheral Arterial Occlusive Disease: Results from a Prospective Cohort Study

Kotov

Blasche

Peters

et al. 2022

JCM

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Objective: The current study aimed to determine the relationship between chronic kidney disease (CKD) and major 12-month outcomes for patients with in-hospital treatment for symptomatic peripheral arterial occlusive disease (PAOD). Methods: An analysis of the prospective longitudinal multicentric cohort study with 12-month follow-up was conducted including patients who underwent endovascular or open surgery for symptomatic PAOD at 35 German vascular centres (initial study protocol: NCT03098290). Severity of CKD was grouped into four stages combining information about the estimated glomerular filtration rate (eGFR) at baseline and dialysis dependency. Outcomes included overall mortality as well as the two composite endpoints of amputation or death, and of major cardiovascular events (MACE). 12-month incidences and adjusted hazard ratios were estimated using the Kaplan–Meier function and Cox proportional hazard models. Results: A total of 4354 patients (32% female, 69 years mean age, 68% intermittent claudication, 69% percutaneous endovascular revascularisation) were included and followed for 244 days in median. Thereof, 22% had any CKD and 5% had end stage kidney disease (ESKD) at baseline. The 12-month overall mortality rate was 3.6% (95% CI 2.3–4.9) with 96 events in the entire cohort: 147 were amputated or died (5.3%, 95% CI 5.2–5.3), and 277 had a MACE (9.5%, 95% CI 9.4–9.5). When compared with patients without kidney disease, ESKD was significantly associated with overall mortality (HR 1.9; 95% CI 1.1–3.5), amputation or death (HR 2.4; 95% CI 1.4–4.1), and MACE (HR 2.0; 95% CI 1.3–3.2). Conclusions: In the current study on mid-term outcomes after invasive revascularisation for symptomatic PAOD, one out of five patients suffered from any CKD while those few with ESKD had twice the odds of death, of amputation or death, and of major adverse cardiovascular events after twelve months. These results emphasise that concomitant CKD and its impact on outcomes should be considered by severity while mild and moderate grades should not lead to ineffectual treatment strategies.

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Section: Discussionmentioning

confidence: 99%

The Impact of Chronic Kidney Disease on Mid-Term Outcomes after Revascularisation of Peripheral Arterial Occlusive Disease: Results from a Prospective Cohort Study

Kotov

Blasche

Peters

et al. 2022

JCM

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“…In the current study, three different medical specialties were almost equally involved in the endovascular procedures, emphasizing the importance to include all specialties in data collections on endovascular treatments. Against that backdrop it appears noteworthy to highlight that all valid practice guidelines recommend a multidisciplinary approach but there is evidence suggesting an insufficient adherence concerning multidisciplinary team decisions in PAD treatment [22]. From 2013 through 2014, the German national registry for first line treatment strategies in patients with critical limb ischemia (CRITISCH register) collected multicentre data on 1200 patients suffering from CLTI from 27 selected centres.…”

Section: Discussionmentioning

confidence: 99%

The prospective GermanVasc cohort study

Kotov

Peters

Debus

et al. 2021

Vasa

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Summary: Background: Previous observational studies reported a wide variation and possible room for improvement in the treatment of patients suffering from symptomatic peripheral artery disease (PAD). Yet, systematic assessment of everyday clinical practice is lacking. A General Data Protection Regulation (GDPR) compliant registry was developed and used to collect comprehensive data on clinical treatment and outcomes regarding PAD in Germany. Here, we report baseline characteristics of patients prospectively enrolled until the end of 2020. Methods: The GermanVasc registry study is a prospective longitudinal multicentre cohort study. Between 1st May 2018 and 31st December 2020, invasive endovascular, open-surgical, and hybrid revascularisations of patients suffering from chronic symptomatic PAD were prospectively included after explicit informed consent (NCT03098290). For ensuring high quality of the data, we performed comprehensive risk-based and random-sample external and internal validation. Results: In total, 5608 patients from 31 study centres were included (34% females, median 69 years). On-site monitoring visits were performed at least once in all centres. The proportion of chronic limb-threatening ischaemia was 30% and 13% were emergent admissions. 55% exhibited a previous revascularisation. Endovascular techniques made 69% among all documented invasive procedures (n=6449). Thirty-five percent were classified as patients with severe systemic disease, and 3% exhibited a constant threat to life according to the American Society of Anaesthesiologists classification. The risk profile comprised of 75% former or current smokers, 36% diabetes mellitus, and in 30% a current ischemic heart disease was present. At discharge, 93% of the patients received antiplatelets and 77% received statins. Conclusions: The GermanVasc registry study provides insights into real-world practice of treatment and outcomes of 5,608 patients with symptomatic PAD in Germany. The cohort covers a broader range of disease severity and types of interventions than usually found in trials. In future studies, comparative outcomes will be analysed in more detail.

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“… 95 ) Behrendt et al promoted multidisciplinary team decision-making, which contributed to the technical success of peripheral vascular interventions and better in-hospital outcomes. 96 ) Kolte et al recently reported that a vascular team approach has the potential to significantly enhance quality of care, improve clinical outcomes, and reduce costs. 97 ) In addition to a vascular team, vascular nursing has been determined to be an important option that will provide a comprehensive approach to the treatment of patients with various vascular diseases.…”

Section: Potential Treatment or Strategy For Frailty And Sarcopenia I...mentioning

confidence: 99%

Current Clinical Implications of Frailty and Sarcopenia in Vascular Surgery: A Comprehensive Review of the Literature and Consideration of Perioperative Management

Furukawa

2022

Annals of Vascular Diseases

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Frailty is a well-known geriatric syndrome of impaired physiological reserve and increased vulnerability to stressors. Sarcopenia is also used as a parameter of physical impairment characterized by muscle weakness. As population aging has become more prominent in recent years, both modalities are now regarded as clinically important prognostic tools defined by multidimensional factors that may affect clinical outcomes in various clinical settings. A preoperative surgical risk analysis is mandatory to predict clinical and surgical outcomes in all surgical practices, particularly in high-risk surgical patients. In vascular surgical settings, frailty and sarcopenia have been accepted as useful prognostic tools to evaluate patient characteristics before surgery, as these may predict perioperative clinical and surgical outcomes. Although minimally invasive surgical approaches, such as endovascular therapy, and hybrid approaches have been universally developed, achieving good vascular surgical outcomes for high-risk cohorts remains to be challenge due to the increasing prevalence of elderly patients and multiple preoperative co-morbidities in addition to frailty and sarcopenia. Therefore, to further improve clinical and surgical outcomes, these preoperative geriatric prognostic factors will be of great importance and interest in vascular surgical settings for both physicians and surgeons.

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Multidisciplinary team decision is rare and decreasing in percutaneous vascular interventions despite positive impact on in-hospital outcomes

Cited by 11 publications

References 21 publications

The Impact of Chronic Kidney Disease on Mid-Term Outcomes after Revascularisation of Peripheral Arterial Occlusive Disease: Results from a Prospective Cohort Study

The Impact of Chronic Kidney Disease on Mid-Term Outcomes after Revascularisation of Peripheral Arterial Occlusive Disease: Results from a Prospective Cohort Study

The prospective GermanVasc cohort study

Current Clinical Implications of Frailty and Sarcopenia in Vascular Surgery: A Comprehensive Review of the Literature and Consideration of Perioperative Management

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