- Imaging of critical limb ischemia
- Award date
- 21 April 2015
- Number of pages
- 's-Hertogenbosch: Boxpress
- Document type
- PhD thesis
- Faculty of Medicine (AMC-UvA)
This thesis aims to improve diagnostic evaluation, treatment selection, endovascular intervention, and outcome assessment in patients with PAD with a focus on CLI.
If the patient is referred for endovascular intervention, the patient will be exposed to intravascular iodinated contrast. Since this contrast can affect renal function, we studied whether the endovascular procedure can confidently be performed with the use of two lower iodinated contrast concentrations, comparing 240 and 140 mg iodine/ml with the standard concentration of 300 mg iodine/ml. The data from this study indicated that using lower concentrations should be a standard operating procedure.
In a cohort consisting of CLI patients were followed for one year after an infrainguinal revascularization. In this cohort the treatment strategy was that patients with poor condition due to comorbidities, unfavorable anatomy for surgery, no venous material for bypass or old age would primarily be treated endovascularly. Compared to other cohort studies and trials, the patients in our cohort showed equal or even slightly better clinical outcomes, indicating that an endovascular first strategy is justified.
In this thesis we also present several systematic reviews which show that: 1. CTA or CE-MRA can confidently be performed in patients with CLI or IC; 2. drug-eluting balloons and stents have no clear additional value over non-drug-eluting balloons and stents for femoropopliteal and tibial arterial lesions; 3. patient-reported outcome measures for evaluating quality of life and functional status in patients with intermittent claudication is not well evaluated.
- Research conducted at: Universiteit van Amsterdam