Healthy Life-Year Costs of Treatment Speed From Arrival to Endovascular Thrombectomy in Patients With Ischemic Stroke: A Meta-analysis of Individual Patient Data From 7 Randomized Clinical Trials.

Importance: The benefits of endovascular thrombectomy (EVT) are time dependent. Prior studies may have underestimated the time-benefit association because time of onset is imprecisely known. Objective: To assess the lifetime outcomes associated with speed of endovascular thrombectomy in patients with acute ischemic stroke due to large-vessel occlusion (LVO). Data Sources: PubMed was searched for randomized clinical trials of stent retriever thrombectomy devices vs medical therapy in patients with anterior circulation LVO within 12 hours of last known well time, and for which a peer-reviewed, complete primary results article was published by August 1, 2020. Study Selection: All randomized clinical trials of stent retriever thrombectomy devices vs medical therapy in patients with anterior circulation LVO within 12 hours of last known well time were included. Data Extraction/Synthesis: Patient-level data regarding presenting clinical and imaging features and functional outcomes were pooled from the 7 retrieved randomized clinical trials of stent retriever thrombectomy devices (entirely or predominantly) vs medical therapy. All 7 identified trials published in a peer-reviewed journal (by August 1, 2020) contributed data. Detailed time metrics were collected including last known well-to-door (LKWTD) time; last known well/onset-to-puncture (LKWTP) time; last known well-to-reperfusion (LKWR) time; door-to-puncture (DTP) time; and door-to-reperfusion (DTR) time. Main Outcomes and Measures: Change in healthy life-years measured as disability-adjusted life-years (DALYs). DALYs were calculated as the sum of years of life lost (YLL) owing to premature mortality and years of healthy life lost because of disability (YLD). Disability weights were assigned using the utility-weighted modified Rankin Scale. Age-specific life expectancies without stroke were calculated from 2017 US National Vital Statistics. Results: Among the 781 EVT-treated patients, 406 (52.0%) were early-treated (LKWTP ≤4 hours) and 375 (48.0%) were late-treated (LKWTP >4-12 hours). In early-treated patients, LKWTD was 188 minutes (interquartile range, 151.3-214.8 minutes) and DTP 105 minutes (interquartile range, 76-135 minutes). Among the 298 of 380 (78.4%) patients with substantial reperfusion, median DTR time was 145.0 minutes (interquartile range, 111.5-185.5 minutes). Care process delays were associated with worse clinical outcomes in LKW-to-intervention intervals in early-treated patients and in door-to-intervention intervals in early-treated and late-treated patients, and not associated with LKWTD intervals, eg, in early-treated patients, for each 10-minute delay, healthy life-years lost were DTP 1.8 months vs LKWTD 0.0 months; P < .001. Considering granular time increments, the amount of healthy life-time lost associated with each 1 second of delay was DTP 2.2 hours and DTR 2.4 hours. Conclusions and Relevance: In this study, care delays were associated with loss of healthy life-years in patients with acute ischemic stroke treated with EVT, particularly in the postarrival time period. The finding that every 1 second of delay was associated with loss of 2.2 hours of healthy life may encourage continuous quality improvement in door-to-treatment times.

Endogenous calcitonin gene-related peptide in cerebrospinal fluid and early quality of life and mental health after good-grade spontaneous subarachnoid hemorrhage-a feasibility series.

The vasodilatory calcitonin gene-related peptide (CGRP) is excessively released after spontaneous subarachnoid hemorrhage (sSAH) and modulates psycho-behavioral function. In this pilot study, we prospectively analyzed the treatment-specific differences in the secretion of endogenous CGRP into cerebrospinal fluid (CSF) during the acute stage after good-grade sSAH and its impact on self-reported health-related quality of life (hrQoL). Twenty-six consecutive patients (f:m = 13:8; mean age 50.6 years) with good-grade sSAH were enrolled (drop out 19% (n = 5)): 35% (n = 9) underwent endovascular aneurysm occlusion, 23% (n = 6) microsurgery, and 23% (n = 6) of the patients with perimesencephalic SAH received standardized intensive medical care. An external ventricular drain was inserted within 72 h after the onset of bleeding. CSF was drawn daily from day 1-10. CGRP levels were determined via competitive enzyme immunoassay and calculated as "area under the curve" (AUC). All patients underwent a hrQoL self-report assessment (36-Item Short Form Health Survey (SF-36), ICD-10-Symptom-Rating questionnaire (ISR)) after the onset of sSAH (t1: day 11-35) and at the 6-month follow-up (t2). AUC CGRP (total mean ± SD, 5.7 ± 1.8 ng/ml/24 h) was excessively released into CSF after sSAH. AUC CGRP levels did not differ significantly when dichotomizing the aSAH (5.63 ± 1.77) and pSAH group (5.68 ± 2.08). aSAH patients revealed a higher symptom burden in the ISR supplementary item score (p = 0.021). Multiple logistic regression analyses corroborated increased mean levels of AUC CGRP in CSF at t1 as an independent prognostic factor for a significantly higher symptom burden in most ISR scores (compulsive-obsessive syndrome (OR 5.741, p = 0.018), anxiety (OR 7.748, p = 0.021), depression (OR 2.740, p = 0.005), the supplementary items (OR 2.392, p = 0.004)) and for a poorer performance in the SF-36 physical component summary score (OR 0.177, p = 0.001). In contrast, at t2, CSF AUC CGRP concentrations no longer correlated with hrQoL. To the best of our knowledge, this study is the first to correlate the levels of endogenous CSF CGRP with hrQoL outcome in good-grade sSAH patients. Excessive CGRP release into CSF may have a negative short-term impact on hrQoL and emotional health like anxiety and depression. While subacutely after sSAH, higher CSF levels of the vasodilator CGRP are supposed to be protective against vasospasm-associated cerebral ischemia, from a psychopathological point of view, our results suggest an involvement of CSF CGRP in the dysregulation of higher integrated behavior.

Patients' lived experiences of waiting for and undergoing endovascular aortic repair in a hybrid operating room: A qualitative study.

AIMS AND OBJECTIVES: The overall aim of the study was to illuminate the patients' lived experiences of waiting for and undergoing an endovascular aortic repair (EVAR) in a hybrid operating room (OR). BACKGROUND: The hybrid OR is an example of the technological advancements within hospitals. The environmental impact on humans is well recognised but is rarely taken into account when hospitals are designed or rebuilt. The patient's experience of a hybrid OR is not earlier described. DESIGN: A qualitative design based on hermeneutic phenomenology was implemented. METHODS: Interviews were conducted with 18 patients. A thematic interpretation based on van Manen's approach was then used to analyse the findings. The consolidated criteria for reporting qualitative studies (COREQ) were used (Data S1). RESULTS: The following three themes emerged from the interviews: (a) being scheduled for surgery induced both anxiety and hopefulness; (b) feeling watched over and surrendering to others in the technology intense environment and (c) feeling relief but unexpected exhaustion after surgery. In the discussion, the results were additionally reflected upon out from the four lifeworld existentials: lived body, lived space, lived time and lived others. CONCLUSIONS: The hybrid OR technology did not frighten the patients, but it was also not an environment that promoted or was conductive to having a dialogue with the staff. The disease and surgery brought feelings of anxiety, which was largely associated with the uncertainty of the situation. We suggest that continuity in contact with staff and patient-centred information could be solutions to further calm the patients. RELEVANCE TO CLINICAL PRACTICE: The hybrid OR environment itself did not seem to frighten the patient, but the way the high-tech environment increased the distance between the patient and the multiple staff members needs further investigation.

Strength of public preferences for endovascular or open aortic aneurysm repair.

BACKGROUND: This study evaluated public preferences for the treatment processes for abdominal aortic aneurysm repair in order to allow them to be incorporated into a cost-effectiveness analysis. METHODS: This was a telephone survey using a trade-off method in UK resident adults (aged at least 18 years) with no previous diagnosis of a vascular condition. RESULTS: Some 167 of 209 participants (79·9 per cent) stated that they would prefer endovascular aneurysm repair (EVAR), 40 (19·1 per cent) preferred open surgery and two (1·0 per cent) stated no preference. Participants preferred EVAR because of the less invasive nature of the intervention and quicker recovery. Participants preferring open surgery cited reasons such as having a single follow-up appointment, and a procedure that felt more permanent. When participants were asked to make a sacrifice in order to have their preferred treatment, 122 (58·4 per cent) favoured EVAR, 18 (8·6 per cent) favoured open surgery and 69 (33·0 per cent) had no preference. Those preferring EVAR were willing to give up a mean of 0·135 expected quality-adjusted life-years (QALYs) to have EVAR, compared with a willingness to give up 0·033 expected QALYs among those preferring open repair. CONCLUSION: These results indicate a clear preference for EVAR over open surgery for aortic aneurysm.

ANTECEDENTES: Este estudio evaluó las preferencias de la opinion pública en relación a las opciones de tratamiento para la reparación del aneurisma de aorta abdominal, con el objetivo de que dichas preferencias se puedan incorporar en un análisis de coste-efectividad. MÉTODOS: Se realizó una encuesta telefónica utilizando el método trade-off (solución de intercambio) en adultos residentes en el Reino Unido (mayores de 18 años) sin diagnóstico previo de enfermedad vascular. RESULTADOS: Un total de 167 (79,9%) de 209 participantes declararon que preferirían la reparación endovascular del aneurisma (endovascular aneurysm repair, EVAR), 40 (19,1%) prefirieron cirugía abierta y dos (1,0%) no tenían preferencia. Los participantes prefirieron el EVAR debido a la naturaleza menos invasiva de la intervención y a tiempos de recuperación más rápidos. Los participantes que preferían la cirugía abierta mencionaron como razones tener una única visita de seguimiento y consideraron que se trataba de un procedimiento más permanente. Cuando se pidió a los participantes que para recibir su tratamiento preferido hicieran un intercambio, 122 (58,4%) se decantaron por la EVAR, 18 (8,6%) por la cirugía abierta y 69 (33%) no tuvieron preferencia. Los que prefirieron EVAR estaban dispuestos a renunciar a una media de 0,135 años de vida ajustados por calidad (QALYs) esperados con tal de recibir una EVAR en comparación con la renuncia de 0,033 QALYs esperada entre quienes preferían la reparación abierta. CONCLUSIÓN: Estos resultados indican una clara preferencia por la EVAR sobre la cirugía abierta, lo que está en desacuerdo con la reciente recomendación de NICE de que la EVAR no debe recomendarse como una opción de tratamiento. Los hallazgos sugieren que se debe prestar mayor atención a las características del proceso de tratamiento. Al no incorporar explícitamente tales preferencias en el proceso de toma de decisiones, NICE corre el riesgo de recomendar opciones de tratamiento que son contrarias a las preferencias de la población del Reino Unido.

Long-term Neuropsychiatric and Neuropsychological Sequelae of Endovascularly Treated Aneurysmal Subarachnoid Hemorrhage.

INTRODUCTION: There is limited evidence regarding long-term outcomes of aneurysmal subarachnoid hemorrhage survivors. Most follow-up programs are relatively short and focused on physical functions. Endovascular aneurysmal embolization enables recovery of normal vascular architecture. However, there is growing evidence that neuropsychological and behavior sequelae can significantly impact the lives of these patients, even when treatment is successful. In this study, we reviewed cognition, psychiatric and neuropsychological symptoms, global functionality, and health-related quality of life 10 to 12 years after an aneurysmal subarachnoid hemorrhage. MATERIAL AND METHODS: A cross-sectional observational study was carried out in a university hospital. All cases of aneurysmal subarachnoid hemorrhage admitted between January 2004 and December 2006 and endovascularly treated were reviewed. Participants underwent a neuropsychological evaluation and a clinical interview with a psychiatrist. RESULTS: Fourteen patients participated in the study. Almost 70% (n = 10) showed cognitive impairment; in more than 40% (n = 6) of the subjects, significant symptoms of anxiety were identified, and 35% (n = 5) were classified as having clinical depression. Relevant posttraumatic symptoms were reported by more than 70% (n = 10) of patients, and almost 30% (n = 4) showed other moderate neuropsychiatric symptoms. Overall, health-related quality of life was impaired, and personality changes were frequently reported by the participants and their relatives. DISCUSSION: A significant prevalence of ongoing deficits in high-level functioning and reduced health-related quality of life were observed in a sample of young and professionally active individuals that were successfully treated and discharged from follow-up consultations. CONCLUSION: There is a need for better follow-up strategies, targeting more subtle deficits and psychological symptoms after aneurysmal subarachnoid hemorrhage.

Introdução: As evidências sobre a evolução a longo prazo dos sobreviventes de uma hemorragia subaracnoideia aneurismática são relativamente limitadas. A maioria dos programas de follow-up têm uma curta duração e são focados principalmente nas funções motoras. Apesar da embolização aneurismática endovascular permitir uma recuperação da arquitetura vascular normal, há evidências crescentes de que certas sequelas neuropsicológicas e comportamentais podem afetar significativamente a vida desses pacientes, a longo prazo, mesmo quando o tratamento é bem-sucedido. Neste estudo, analisamos os sintomas cognitivos, psiquiátricos e neuropsicológicos, a funcionalidade global e a qualidade de vida relacionada com a saúde, 10 a 12 anos após uma hemorragia subaracnoideia aneurismática. Material e Métodos: Um estudo observacional, transversal, foi realizado num hospital universitário. Todos os casos de hemorragia subaracnoideia aneurismática, admitidos entre janeiro de 2004 e dezembro de 2006, tratados endovascularmente, foram revistos. Os participantes foram sujeitos a uma avaliação neuropsicológicas e a uma entrevista clínica com um psiquiatra. Resultados: Participaram no estudo 14 doentes. Cerca de 70% (n = 10) apresentavam compromisso cognitivo; em mais de 40% (n = 6) foram identificados sintomas significativos de ansiedade e 35% (n = 5) foram classificados como tendo depressão clínica. Sintomas de stress pós-traumático relevantes foram relatados por mais de 70% (n = 10) e quase 30% (n = 4) apresentavam sintomas neuropsiquiátricos moderados. Em geral, a qualidade de vida relacionada com o estado de saúde encontrava-se reduzida e relatos de alterações de personalidade foram frequentemente feitos pelos participantes e seus familiares. Discussão: Uma prevalência significativa de défices em altos níveis de funcionamento e uma redução da qualidade de vida relacionada com a saúde foi observada numa amostra de indivíduos jovens e profissionalmente ativos, que foram tratados com sucesso e tiveram alta das consultas de seguimento. Conclusão: São necessárias melhores estratégias de follow-up, visando défices cognitivos e sintomas psicológicos mais subtis, após uma hemorragia subaracnoideia aneurismática.

Comparison of three generic quality-of-life metrics in peripheral arterial disease patients undergoing conservative and invasive treatments.

PURPOSE: To determine the effect of revascularisation for peripheral arterial disease (PAD) on QoL in the first and second year following diagnosis, to compare the effect depicted by Short Form Six Dimensions (SF-6D) and EuroQoL five Dimensions (EQ-5D) utilities, and Visual Analogue Scale (VAS) scores and to analyse heterogeneity in treatment response. METHODS: Longitudinal data from 229 PAD patients were obtained in an observational study in southern Netherlands. Utility scores were calculated with the international (SF-6D) and Dutch (EQ-5D) tariffs. We analysed treatment effect at years 1 and 2 through propensity score-matched ANCOVAs. Thereby, we estimated the marginal means (EMMs) of revascularisation and conservative treatment, and identified covariates of revascularisation effect. RESULTS: A year after diagnosis, 70 patients had been revascularised; the EMMs of revascularisation were 0.038, 0.077 and 0.019 for SF-6D, EQ-5D and VAS, respectively (always in this order). For conservative treatment these were - 0.017, 0.038 and 0.021. At 2-year follow-up, the EMMs of revascularisation were 0.015, 0.077 and 0.027, for conservative treatment these were - 0.020, 0.013 and - 0.004. Baseline QoL (and rest pain in year 2) were covariates of treatment effect. CONCLUSIONS: We measured positive effects of revascularisation and conservative treatment on QoL a year after diagnosis, the effect of revascularisation was sustained over 2 years. The magnitude of effect varied between the metrics and was largest for the EQ-5D, which may be most suitable for QoL measurement in PAD patients. Baseline QoL influenced revascularisation effect, in clinical practice this may inform expected QoL gain in individual patients.

Practical Incidence of Complications and Degree of Patient Satisfaction After Endovascular Coil Embolization for Unruptured Intracranial Saccular Aneurysm Based on Patients' Surveys.

OBJECTIVE: Endovascular treatment for unruptured intracranial aneurysms (UIAs) has been regarded as second to none management nowadays as the result of its proven efficacy and need for less-invasive treatment. Most researchers have focused on the anatomical outcome after endovascular treatment, so in this study we estimated the real incidence of untoward effect and degree of patients' satisfaction based on s survey. METHODS: This retrospective study was approved by the institutional review board, and 112 patients treated for saccular UIAs were evaluated among a total of 135 patients. After informed consent was obtained, these patients were sent a questionnaire regarding treatment effectiveness, complications, and patient satisfaction. These data were collected and compared with angiographic and clinical outcome. RESULTS: The response rate was 87.5% (98/112). Intracranial complications occurred in 10 aneurysms (10.2%): 7 ischemic and 3 hemorrhagic strokes. Other complications occurred in 30 patients (30.6%): 17 alopecia, 15 bleeding tendency, and 3 puncture-site complications. Overall, 89 (90.8%) patients reported being satisfied with their treatment. Patient satisfaction was closely correlated with clinically successful outcome of treatment. CONCLUSIONS: Ninety percent of patients were satisfied with the results after endovascular treatment of UIAs. Endovascular coil embolization was effective and safe procedure, with high clinical success rate and degree of satisfaction.

Endovascular therapy after acute ischaemic stroke-Experiences and needs of relatives.

AIMS AND OBJECTIVES: To explore the experiences and needs of relatives being part of the endovascular therapy (EVT) pathway. BACKGROUND: Ischaemic stroke is the third leading cause of death and the most common cause of acquired disability among adults in the Western world. The most recently approved treatment for major stroke is EVT. Removing the arterial occlusion has proven to be the best predictor of outcome. While patients are treated, relatives are left waiting. Facing the massive shock of their loved ones having a stroke may cause emotional turmoil and leave relatives with various needs. No previous studies have explored experiences and needs of relatives who are part of an EVT pathway. DESIGN: A qualitative design using a phenomenological-hermeneutic approach. METHODS: Semi-structured interviews and participant observations were carried out. Data were collected from April 2016-January 2017. Data were analysed using Ricoeur's theory of interpretation, capturing meaning and ensuring comprehensive understanding. RESULTS: Four themes emerged are as follows: (a) The first phase-shock, chaos and feeling paralysed; (b) the all-important information-sharing is pivotal; (c) professional loving care-being seen and heard by caring health professionals; and (d) adjusting to new roles. One essential finding that emerged across all themes was relatives' constant need for care, for support and for health professionals to "be there." CONCLUSION: Relatives need support and care during the entire EVT pathway. They tend to be modest and ignore their own needs. Relatives who experience chaos, fear and worry need to be met by professionals with real presence. RELEVANCE TO CLINICAL PRACTICE: These findings will be used as a foundation for development of local structures and policies that should provide knowledge and ensure a consistent and proactive approach to meet the needs of the relatives in a timely and efficient manner.

Quality of Life After Treatment of Unruptured Intracranial Aneurysms.

OBJECTIVE: Quality of life is an important factor in the decision making for the treatment of unruptured intracranial aneurysms (UIA). The data dealing with QoL in patients after the treatment are spare. We have evaluated QoL of patients after endovascular or surgical treatment of incidental intracranial aneurysm. METHODS: We performed a prospective analysis of retrospectively collected data. All patients received 36-Item Short Form Health Survey (SF-36), Hospital Anxiety and Depression Scale (HADS), German questionnaire for self-perceived deficits in attention (FEDA) and not standardized questionnaire analyzing personal job-related situation, family circumstances and chronic illnesses. RESULTS: 177 patients were treated during the evaluated period. 79 (44.6%) patients responded. In this cohort, 62.03% of patients underwent coiling. Complications were noted in 13.9% of patients. Stroke was the most common complication (7.6%). All SF-36 related data except for pain showed significant lower mean, if compared to the standard German population (p < 0.01). For both genders, anxiety (males, P = 0.003 and females, P = 0.002) but not depression was more common than in the standard population. According to the FEDA test, treated patients showed significant difference only for fatigue in comparison to healthy population (P < 0.001). 54.4% of patients suffered from chronic illnesses, and among them only 1 patient (1.3%) had aneurysm associated chronic disease. No significant differences were found between treatment modalities. CONCLUSIONS: The risk for depression and pain is not significantly increased after elective treatment of UIA. According to our results, decreased QoL is common in this cohort of patients but often related to factors not associated with aneurysm treatment.

Neuropsychological function after endovascular and neurosurgical treatment of subarachnoid hemorrhage: a systematic review and meta-analysis.

OBJECTIVE Subarachnoid hemorrhage (SAH) is treated with either surgical clipping or endovascular coiling, though the latter is the preferred treatment method given its more favorable functional outcomes. However, neuropsychological functioning after treatment is rarely taken into account. In this meta-analysis, the authors synthesized relevant data from the literature and compared neuropsychological functioning in patients after coiling and clipping of SAH. They hypothesized that the coiled patients would outperform the clipped patients; that group differences would be greater with higher posterior circulation rupture rates, in older patients, and in more recent publications; that group differences would be smaller with greater rates of middle cerebral artery (MCA) rupture; and that anterior communicating artery (ACoA) rupture rates would not influence effect sizes. METHODS The MEDLINE, Embase, and PsycINFO databases were searched for clinical studies that compared neuropsychological functioning after either endovascular coiling or surgical clipping for SAH. Hedge's g and 95% confidence intervals were calculated using random effects models. Patients who had undergone coiling or clipping were compared on test performance in 8 neuropsychological domains: executive functions, language, attention/processing speed, verbal memory, visual memory, spatial memory, visuospatial functions, and intelligence. Patients were also compared with healthy controls, and meta-regressions were used to explore the relation between effect sizes and publication year, delay between treatment and neuropsychological testing, mean patient age, and rates of posterior circulation, ACoA, and MCA ruptures. RESULTS Thirteen studies with 396 clipped cases, 314 coiled cases, and 169 healthy controls were included in the study. The coil-treated patients outperformed the clip-treated patients on executive function (g = 0.17, 95% CI 0.08-0.25) and language tests (g = 0.23, 95% CI 0.07-0.39), and all patients were impaired relative to healthy controls (g ranged from -0.93 to -0.29). Coiled patients outperformed clipped patients to a greater degree in more recent publications, over longer posttreatment testing delays, and among older patients. Higher rates of posterior circulation and MCA aneurysms were associated with smaller group differences, while ACoA rupture rates did not influence effect sizes. CONCLUSIONS Coiling of SAH may promote superior neuropsychological functioning under certain circumstances and could have applications for the specialized care of SAH patients.

Anxiety, depression and quality of life in patients with a treated or untreated unruptured intracranial aneurysm.

Living with an untreated unruptured intracranial aneurysm(UIA) is stressful, this study was aimed to assess the influence of UIA treatment (surgery clipping and endovascular coiling) on behavior such as anxiety and depression, as well as QoL. A series of 296 UIA patients (including 162 treated and 134 untreated) were analyzed. Postal questionnaires were sent to these patients, included Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale(SDS) and Short Form-36(SF-36). In total, 198 (66.9%) patients responded to our questionnaires. Patients with surgical clipping or endovascular coiling had a significant improvement in the physical function, body pain and mental health domains. No significant difference in the SAS, SDS and SF-36 was observed between the clipping and coiling group, while SF-36 in body pain domain was significant higher in the coiling group. Moreover, patients diagnosed 5years ago with or without treatment got lower score of SAS and SDS, higher SF-36 score than those diagnosed one year ago. Neurological complications may be an important factor causing lower quality of life. The QoL of patients with endovascular coiling appear to be better than those of surgical clipping, with no difference in anxiety or depression.

Perceived learning needs of patients with abdominal aortic aneurysm.

BACKGROUND: Patients undergoing surgical treatment of abdominal aortic aneurysm (AAA) should receive adequate information about the disease, treatment options, and self-care. Patients' learning needs should be acknowledged. The aim was to describe the perceived learning needs in patients with AAA. A secondary aim was to explore their experience of methods for patient education. METHODS: Three focus group interviews were conducted with 14 patients treated with open or endovascular repair of AAA. The interviews embraced initial diagnosis, surgical treatment, and follow-up from a learning perspective and were analyzed using qualitative content analysis. RESULTS: Three categories and 10 subcategories emerged. The health care staff failed to meet the participants' individual learning needs. Participants relied on other pathways to obtain knowledge, such as the internet or anecdotal information from friends and family. Learning needs pertained to risks and complications with surgery, self-care, and rupture risk. The participants were reluctant to ask questions due to a stressful environment. They requested accessible written information, along with a professional contact person for coordination and support during the care pathway. CONCLUSIONS: Patients with AAA describe unmet learning needs in regard to risks and complications with the disease and surgical treatment but also disease management and lifestyle factors. Education material should be consistent, individualized and easily accessible for patients and next of kin. Additional psychosocial support is warranted. Adjusting information to patients' needs may improve patient satisfaction.

Understanding Patient Acceptance of Risk with Treatment Options for Intermittent Claudication.

BACKGROUND: Intermittent claudication has a major impact on the quality of life and functional ability of the patient. However, when treating these patients, management is largely influenced by vascular surgeons' perceptions of risk. There is little information available regarding the level of risk that patients perceive to be acceptable, when considering complications of treatment. This study investigates patients' acceptance of risk associated with current management options for intermittent claudication and explores factors associated with greater risk acceptance. METHODS: Patients with confirmed intermittent claudication presenting to vascular clinic and supervised exercise classes were surveyed in a single-center prospective study. A standard gamble-type method was used to measure patients' acceptance of risk associated with medical treatment, angioplasty, and surgical bypass. Level of risk acceptance was correlated to patient factors. RESULTS: Fifty patients were surveyed; 74% were male, median age was 68 years (interquartile range [IQR] 59-74), maximal walking distance was 100 m (IQR 70-200), and ankle-brachial pressure index was 0.65 (IQR 0.60-0.78). Median risk acceptance for treatment failure was 70% for medical treatment, 50% for angioplasty, and 40% for surgical bypass. Median risk acceptance for major amputation and death was 0% for all 3 management options. Claudicants with maximal walking distance <100 m accepted higher risk of treatment failure (P = 0.0005 for medical treatment, P = 0.0038 for angioplasty), and death with medical treatment (P = 0.0009). There was no significance between claudication distance and risk acceptance of major amputation with any treatment modality or death with angioplasty or surgical bypass. There was no significant correlation among level of risk acceptance and age, gender, or diabetic status. CONCLUSIONS: Claudicants are prepared to accept significant risk of treatment failure, in order to gain benefit, but regardless of claudication distance, patients have low acceptance of the risk of amputation or death. Patient acceptance of risk should be considered when planning management.

Life satisfaction in patients with and without spinal cord ischemia after advanced endovascular therapy for extensive aortic disease at mid-term follow-up.

OBJECTIVE: Advanced endovascular aortic repair can be used to treat patients with extensive and complex aortic disease who are at risk of spinal cord ischaemia. The aim of this study was to compare whether life satisfaction differs between patients with and without spinal cord ischaemia at mid-term follow-up. DESIGN: Nested case-control study. PATIENTS: Among patients undergoing advanced endovascular aortic repair between 2009 and 2012, 18 patients with spinal cord ischaemia and 33 without were interviewed at home. METHODS: The Life Satisfaction Questionnaire (LiSat-11) and the Satisfaction With Life Scale (SWLS) were used. RESULTS: LiSat-11 found that patients with spinal cord ischaemia were more dissatisfied with their activities of daily living than were patients without spinal cord ischaemia (p=0.012). Both groups had similar, very low, scores in the sexual life domain; median 2.0 (interquartile range (IQR) 1.5-3.0) and 3.0 (IQR 2.0-4.0), respectively. There was no difference in SWLS between the groups. CONCLUSION: This study cohort of patients who underwent advanced endovascular aortic repair was rather homo-genous in their rating of life satisfaction and there was little difference between mid-term survivors who had spinal cord ischaemia and those who did not.

Quality of Life in Patients Suffering from Critical Limb Ischemia.

BACKGROUND: Various treatment options exist for patients suffering from critical limb ischemia (CLI). These options consist of endovascular procedures, surgical revascularization, primary amputation, or conservative therapy. The effect of the treatment is traditionally focused on outcomes, such as primary patency and limb salvage, though quality of life (QoL) is considered an important additional primary end point in a more patient-oriented healthcare system. The aim of this systematic review is to explore the best clinical decision making possible, to increase QoL in CLI patients. METHODS: This review is based on a systematic electronic literature search using the PubMed and EMBASE databases. Articles evaluating QoL in patients with CLI were selected for further analysis. Only prospective studies, written in English, describing QoL and health status (HS) after endovascular or surgical revascularization, amputation or conservative therapy were considered for inclusion. Treatment results were divided into short-term (≤3-month follow-up) and long-term results (≥1-year follow-up) to achieve a clear view of the QoL in patients suffering for CLI patients. RESULTS: Twenty-five articles describing HS in patients suffering from CLI were included. It was found that while most of these articles reported HS of patients, rarely did they report on QoL. As a result, it is difficult to determine the best treatment to increase HS as studies that focus on the comparison of treatment modalities are lacking. All 4 treatment modalities can raise HS in the short and the long terms; however, endovascular and surgical revascularization seem to positively effect HS the most. QoL results are lacking in both the short and long terms. CONCLUSIONS: All treatment methods included in the study resulted in an increase in patients' HS in both short and long terms. More comparative studies with inclusion of all different treatments of CLI are needed to assist in clinical decision making and perform tailored interventions for the individual patient. QoL and HS are confusingly used in current international literature with abundant HS research. To take patients individual opinions more into account, focus on QoL research is needed to designate the superior treatment in patients suffering from CLI.

[Dynamics of the emotional state of patients with atherosclerosis of lower limb arteries undergoing surgical treatment].

OBJECTIVE: The study was aimed at determining the dynamics of the emotional state and factors influencing thereupon in patients presenting with atherosclerosis of lower limb arteries and undergoing surgical treatment. MATERIAL AND METHODS: The study included a total of sixty-five 36-to-90-year-old patients (53 men and 12 women) subjected to examination twice - prior to surgery and before discharge by means of semi-structured interview, self-assessment scale of feeling and mood, methods "Integrative test of anxiety" and "Type of attitude towards the disease" (TOBOL), questionnaire for assessing health-related quality of life SF-36 and Krantz questionnaire in order to determine the position in the therapeutic process. RESULTS: After surgery (on postoperative day 7-10 of hospital stay) the patients demonstrated a decrease in the degree of anxiety and somatic complaints. Women (p=0.037), patients with the duration of the disease from 1 to 8 years (p=0.033), with signs of personality anxiety (p≤0.045), disadaptive variants of attitude to disease and treatment (p≤0.05), as well as clearly manifesting mistrust for medical recommendations (p=0.014) belong to a group of risk of emotional stress at the postoperative stage. CONCLUSION: Clinical and socio-demographic determinants are comparatively less important in formation of pronounced anxiety of postoperative period than the patient's personality.

Uncertainty in patients with unruptured intracranial aneurysms undergoing endovascular surgery: a qualitative and inductive study.

BACKGROUND: Advances in diagnostic imaging technology have increased opportunities to discover unruptured intracranial aneurysms (UIA), and prior research has shown that UIA patients experience uncertainty both when making choices regarding treatment and after surgery. OBJECTIVES: The purpose of this study was to clarify the nature of the uncertainty experienced by UIA patients who elect to undergo endovascular surgery. METHODS: Data from interviews with 31 subjects were synthesized with findings from previous research and then analyzed qualitatively and inductively. RESULTS: Six categories were derived from the analysis to describe the uncertainty experienced by UIA patients who undergo intravascular surgery: Nature of the Disease, Treatment Characteristics, Information, Decision-making, Course of the Future, and Living with UIA. DISCUSSION: The Treatment Characteristics and Decision-making categories reflect new aspects of uncertainty arising from advances in diagnostic imaging and appeared specific to patients with UIA. This suggests a need to select appropriate nursing methods adapted to the situation of each patient that can both reduce and manage their uncertainty. Developing an uncertainty scale for UIA patients based on the structural concepts clarified in this study and investigating reliability and validity of scores are topics for future research.

[Comparative analysis of quality of life of patients in the early and remote periods of iliofemoral phlebothrombosis].

The authors present in the article the results of studying quality of life of patients at various terms after endured iliofemoral phlebothrombosis (from 0 to 60 months), who, depending upon embologenicity of the thrombus in order to prevent pulmonary embolism, were either subjected to implantation of a cava filter or not. The patients were subdivided into two groups: the study group (129 subjects) included those presenting with acute or recently endured iliofemoral phlebothrombosis and a cava filter implanted at various time having elapsed after. The comparison group consisted of 96 patients with endured iliofemoral phlebothrombosis within the same terms and having received conservative treatment without implantation of a cava filter. Quality of life was assessed by two questionnaires, i.e. MOS-SF-36 and CIVIQ. The authors concluded that the patients with endured iliofemoral phlebothrombosis without implantation of a cava filter in the anamnesis demonstrated slightly better measures of quality of life.