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1.
Eur J Vasc Endovasc Surg ; 67(6): 980-986, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38159674

RESUMO

OBJECTIVE: At present, there is no clear, optimal approach to surveillance after invasive treatment of peripheral artery disease (PAD) in terms of modality, duration, clinical benefit, and cost effectiveness. The ongoing debate on the clinical benefit and cost effectiveness of standard surveillance creates a clear knowledge gap and may result in overtreatment or undertreatment. In this study, a survey was conducted among vascular surgeons in the Netherlands to assess the currently applied surveillance programmes. METHODS: All vascular surgeons from the Dutch Society for Vascular Surgery received an online survey on follow up after open and endovascular revascularisation in patients with PAD. Surveillance was defined as at least one follow up visit after intervention with or without additional imaging or ankle brachial index (ABI) measurement. Ten types of PAD intervention were surveyed. RESULTS: Surveys were returned by 97 (46.2%) of 210 vascular surgeons, and 76% reported using a routine follow up protocol after an invasive intervention. Clinical follow up only is most commonly performed after femoral endarterectomy (53%). After peripheral bypass surgery, clinical follow up only is applied rarely (4 - 8%). In six of the 10 interventions surveyed, duplex ultrasound (DUS) was the most used imaging modality for follow up. After bypass surgery, 76 - 86% of vascular surgeons perform DUS with or without ABI measurement. After endovascular interventions, 21 - 60% performed DUS surveillance. Lifelong surveillance is most often applied after aortobifemoral bypass (57%). Surveillance frequency and duration vary greatly within the same intervention. Frequencies range from every three or six months to annually. Duration ranges from one time surveillance to lifelong follow up. CONCLUSION: There is significant practice variation in surveillance after surgical and endovascular treatment of patients with PAD in the Netherlands. Prospective studies to evaluate treatment outcomes and to define the clinical need and cost effectiveness of standardised surveillance programmes for patients with PAD are recommended.


Assuntos
Procedimentos Endovasculares , Doença Arterial Periférica , Humanos , Doença Arterial Periférica/cirurgia , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/diagnóstico , Países Baixos/epidemiologia , Procedimentos Endovasculares/efeitos adversos , Padrões de Prática Médica/estatística & dados numéricos , Padrões de Prática Médica/tendências , Pesquisas sobre Atenção à Saúde , Índice Tornozelo-Braço , Resultado do Tratamento , Fatores de Tempo , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/estatística & dados numéricos , Ultrassonografia Doppler Dupla , Inquéritos e Questionários
2.
Pediatr Int ; 58(7): 637-9, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27072993

RESUMO

We describe the cases of two childhood cancer survivors (CCS) who developed colorectal cancer at 21 and 30 years of age. They had been treated with 30 Gy abdominal irradiation and chemotherapy including platinum and high-dose alkylating agents at age 1 year, and 12 Gy total body irradiation and high-dose cyclophosphamide at age 15 years, respectively. Both had not been screened for colorectal cancer. One patient with advanced cancer died, whereas the other with early cancer was still alive at the time of writing. Two guidelines for long-term follow-up of CCS recommend that CCS who had >30 Gy irradiation receive periodic check-ups at age ≥ 35 years. The present cases suggest that CCS, even with irradiation <30 Gy, should receive earlier check-ups for colorectal cancer. © 2016 Japan Pediatric Society.


Assuntos
Neoplasias Colorretais/diagnóstico , Sobreviventes , Adulto , Idade de Início , Criança , Neoplasias Colorretais/terapia , Terapia Combinada , Feminino , Seguimentos , Humanos , Japão , Masculino , Fatores de Risco , Fatores de Tempo , Adulto Jovem
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