C J Zeebregts

Publications (76)142.08 Total impact

• Article: New insights in (acute) endovascular abdominal aneurysm repair: when fenestrated devices fall short.

  R A Pol, I F J Tielliu, C J Zeebregts
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  ABSTRACT: The suitability for endovascular aneurysm repair (EVAR) is determined primarily by abdominal aortic aneurysm (AAA) anatomy. For patients unsuitable for standard EVAR, due to proximal neck anatomy, fenestrated aortic stent-grafting (FEVAR) is a viable alternative to open repair surgery. Initially FEVAR stent-grafts were custom-made to fit the unique anatomical characteristics of each treated individual. This customization leads to production delays therefore excluding acute aneurysms from endovascular treatment. For patients in need for more urgent treatment, several alternatives have currently been developed. The aim of this review is to provide an overview on current developments and results in acute endovascular abdominal aortic aneurysm repair.
  The Journal of cardiovascular surgery 04/2013; 54(2):173-80. · 1.56 Impact Factor
• Article: Superior Two-year Results of Externally Unsupported Polyester Compared to Supported Grafts in Above-knee Bypass Grafting: A Multicenter Randomised Trial.

  B H R Vriens, R J van Det, R Meerwaldt, J van der Palen, D G Gerrits, C J Zeebregts, R H Geelkerken
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  ABSTRACT: OBJECTIVES: The aim of this study was to compare externally supported thin wall knitted polyester (P-EXS) and externally unsupported thin wall knitted polyester (P-non-EXS) for above-knee (AK) femoro-popliteal bypass grafting. DESIGN: A prospective multicenter randomised clinical trial. MATERIAL AND METHODS: Between 1999 and 2008, 265 AK femoro-popliteal bypass grafts (6 mm in diameter) were performed, including 136 P-EXS and 129 P-non-EXS. The selection of patients was based on the presence of disabling claudication or critical ischaemia. Follow-up took place at 3, 6, 12, 18, and 24 months and included clinical examination and duplex ultrasonography. The main end points of this study were primary patency rates at one and two years. Secondary end points were mortality, and primary assisted and secondary patency rates. Cumulative patency rates were calculated with life-table analysis and log-rank testing. RESULTS: The 1-year primary, primary assisted and secondary patency rates were 65%, 70% and 84%, respectively, for P-EXS and 76% (p = 0.05), 82% (p = 0.03) and 88% (p = 0.35), respectively, for P-non-EXS. Two-year primary, primary assisted and secondary patency rates were 45%, 57% and 70%, respectively, for P-EXS and 62% (p = 0.003), 75% (p = 0.005) and 84% (p = 0.02), respectively, for P-non-EXS. The overall mortality rate after two years was 11.3%. CONCLUSION: In above-knee femoro-popliteal bypass grafting patency rates of externally supported knitted polyester grafts were inferior to their unsupported counterpart. ISRCTN: At the time this study started this number was not the standard.
  European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery 01/2013; · 2.92 Impact Factor
• Article: [From CVA or TIA to carotid surgery: the clinical treatment course for patients with symptomatic carotid disease could be shorter].

  J P Kolkert, R H H Groenwold, J T M Blauw, R Meerwaldt, C J Zeebregts, R H Geelkerken
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  ABSTRACT: To gain insight into the duration and the various components of the clinical treatment course for patients with symptomatic carotid artery stenosis, in order to improve the care provided to these patients. Retrospective cohort study. All patients who had undergone a carotid intervention for significant symptomatic carotid stenosis from 2001 to 2011 were included. Quantile regression analysis was used to assess the changes which had occurred in the median duration of the period from neurological event to intervention from 2001 onward. In order to chart the clinical treatment course, it was split up in different components. In addition, the impact of the referrer and the relationship between the time of the intervention and the risk of perioperative complications were also evaluated. The median duration of the entire clinical treatment course decreased during the study period from 79 days (interquartile range (IQR): 59-113) in the reference period 2001-2004 to 19 days (IQR: 13-28) in 2011. All components of the clinical pathway had contributed to this decline. The duration of the clinical course in patients who had been externally referred was more than 3 times longer (median 67 vs. 21 days, p < 0.01). The total duration of the process did not affect the number of perioperative complications. In the last decennium, the duration of the clinical treatment course of care in patients with symptomatic carotid artery disease was greatly reduced. Analyses of the processes which make up the chain of events, however, reveal that there is still much to be gained in the period before initial presentation at the hospital for patients who are referred by their general practitioners as well as those referred by other hospitals.
  Nederlands tijdschrift voor geneeskunde 01/2013; 157(12):A5746.
• Article: Prophylactic Perioperative Anti-Thrombotics in Open and Endovascular Abdominal Aortic Aneurysm (AAA) Surgery: A Systematic Review.

  A M Wiersema, V Jongkind, C M A Bruijninckx, M M P J Reijnen, J A Vos, O M van Delden, C J Zeebregts, F L Moll
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  ABSTRACT: OBJECTIVE: Heparin is used worldwide by vascular surgeons as prophylaxis for arterial thrombo-embolic complications during open and endovascular arterial surgery. Possible harmful effect of heparin use is more perioperative blood loss, resulting in a higher morbidity and mortality. To evaluate the evidence for the use of heparin during aorto-iliac arterial surgery a review was performed. METHODS: A systematic review was performed of literature from MEDLINE, EMBASE and Cochrane databases, last search performed on March 8, 2012. RESULTS: For open surgery for abdominal aortic aneurysm (AAA), only 5 studies were eligible for review and for endovascular aneurysm repair (EVAR) only 1 study. Overall methodological quality of the included studies was poor. One randomised trial could be retrieved. Possible harmful effects of heparin were found of increasing operation time, more blood loss and more transfusion requirements when heparin was used for open AAA surgery in one study. No data were found comparing heparin to no intervention for EVAR. One study compared heparin to a direct thrombin antagonist during EVAR, showing no differences in clinical outcomes. CONCLUSION: Despite limitations this review showed no compelling evidence on the beneficiary effect of the prophylactic perioperative use of heparin during open surgery for (r)AAA. Authors will promote a randomised controlled multi-center trial on this topic for elective open surgical repair of AAA.
  European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery 07/2012; 44(4):359-367. · 2.92 Impact Factor
• Article: Type 2 diabetes mellitus is associated with an imbalance in circulating endothelial and smooth muscle progenitor cell numbers.

  J van Ark, J Moser, C P H Lexis, F Bekkema, I Pop, I C C van der Horst, C J Zeebregts, H van Goor, B H R Wolffenbuttel, J L Hillebrands
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  ABSTRACT: Individuals with type 2 diabetes mellitus have increased rates of macrovascular disease (MVD). Endothelial progenitor cells (EPCs), circulating angiogenic cells (CACs) and smooth muscle progenitor cells (SMPCs) are suggested to play a role in the pathogenesis of MVD. The relationship between vasoregenerative EPCs or CACs and damaging SMPCs and the development of accelerated MVD in diabetes is still unknown. We tried to elucidate whether EPC, CAC and SMPC numbers and differentiation capacities in vitro differ in patients with and without diabetes or MVD. Peripheral blood was obtained from individuals with and without diabetes and MVD (coronary or peripheral artery disease). EPC and SMPC numbers were determined with flow cytometry. Furthermore, CAC and SMPC numbers were quantified after in vitro culture. Their in vitro differentiation capacity was investigated with real-time RT-PCR and quantitative immunofluorescence. In diabetic patients both EPC and CAC levels were reduced (1.3-fold [p < 0.05] and 1.5-fold [p < 0.05], respectively). CAC outgrowth from diabetic patients with MVD was reduced 1.5-fold compared with diabetic patients without MVD (p < 0.05). SMPC levels were similar between diabetic patients and healthy controls. The CAC/SMPC ratio of in vitro cultured progenitor cells was reduced 2.3-fold in samples from diabetic patients (p < 0.001). The differentiation capacity of CACs and SMPCs in vitro remained similar independently of diabetes or MVD. The ratio between EPCs or CACs and SMPCs is disturbed in type 2 diabetes in favour of SMPCs. This may translate into reduced vascular repair capacity, thereby promoting MVD in type 2 diabetes.
  Diabetologia 06/2012; 55(9):2501-12. · 6.81 Impact Factor
• Article: Covered stents for aortoiliac reconstruction of chronic occlusive lesions.

  F A B Grimme, P A Goverde, J A Van Oostayen, C J Zeebregts, M M P J Reijnen
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  ABSTRACT: Bare metal stents have improved results of endovascular treatment of aortoiliac occlusive disease. Polytetrafluoroethylene covered stents may further improve patency rates by preventing tissue ingrowth, and might reduce complications. This study was conducted to assess possible assets or liabilities of covered stents used for aortoiliac occlusive disease and to conduct a comparison with bare metal stents. A review was performed of literature published until March 2012 for infrarenal aortic lesions, iliac lesions and complex aortoiliac lesions. Outcomes were technical success, patency rates, clinical success and complication rates. Results were addressed to the three anatomic regions: the infrarenal aorta, the aortoiliac bifurcation and iliac arteries. A total of 51 articles were included in the study. Overall technical success varied between 73% and 100%. Randomized data have proven the superiority of covered stents in extensive iliac occlusive lesions. Case series of patients with iliac occlusive disease demonstrated a 1-year primary patency of bare metal stents between 76% and 100% with a 5-year primary patency rate of 63%-83%. One-year primary patency of covered stents varied between 70% and 100%, while no long term patency rates with covered stents have been reported so far. Reliable comparisons between groups cannot be made due to variances in patient and lesion characteristics. Covered stents seem to improve results of kissing stents and are related to excellent results in isolated aortic lesions. No difference in complication rate between bare metal and covered stents have been described, to date. Covered stents improve results of endovascular treatment of extensive iliac occlusive lesions and are related to excellent results in isolated aortic lesions. They may provide a valid alternative for surgery in patients with extensive aortoiliac disease.
  The Journal of cardiovascular surgery 06/2012; 53(3):279-89. · 1.56 Impact Factor
• Article: B-cell lymphoma related iliac vein occlusion treated by endovenous stent placement.

  L Hermus, I F J Tielliu, C J Zeebregts, T R Prins, J J A M Van Den Dungen
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  ABSTRACT: Unilateral leg swelling is most often caused by deep vein thrombosis but other conditions may mimic this disorder. We describe the case of a patient with symptoms of unilateral lower extremity swelling caused by external compression of the iliac vein by a mass originating from the iliopsoas muscle. Initially this mass was diagnosed as an iliopsoas hematoma in a patient using anticoagulants. However, it proved to be B-cell non-Hodgkin lymphoma. Compression was relieved by placement of an endovenous stent in the left common iliac vein. Endovenous stenting is a relatively new treatment modality that is used to treat post-thrombotic venous occlusions and chronic venous insufficiency. Only a few case series have been described of stenting of compressed pelvic veins by adjacent structures such as gynecological malignancies. Although stent patency lasted only four weeks in this patient, venous stent placement quickly reliefs symptoms and should therefore be considered as an option to bridge time to allow development of sufficient venous collaterals.
  Minerva chirurgica 06/2012; 67(3):277-82. · 0.77 Impact Factor
• Article: Fenestrierte Prothesen am thorakoabdominalen Aortenabschnitt

  E.L.G. Verhoeven, T.R. Prins, C.J. Zeebregts, I.F.J. Tielliu, W.T.G.J. Bos, J.J.A.M. van den Dungen
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  ABSTRACT: Fenestrierte Stentprothesen können zur gezielten Therapie von Aneurysmen mit kurzen Halsstücken eingesetzt werden. Dank individueller Fenestrierungen bleibt die Durchgängigkeit wichtiger Gefäßseitenäste, wie z.B. der Aa.renales und der A.superior mesenterica, erhalten, wobei die Aortenprothese über diese Gefäße positioniert wird. Mit Hilfe der endovaskulären Implantation von verzweigten Prothesen können para-, suprarenale und thorakoabdominale Aneurysmen behandelt werden. Durch die Verwendung von fenestrierten Prothesen und der Implantation von beschichteten Stents durch die Prothesenfenster kann der gleiche Effekt wie bei der Verwendung von verzweigten Prothesen erzielt werden. Beide Therapieoptionen sind gut durchführbar, jedoch mit ihren ganz eigenen Vor- und Nachteilen behaftet. In diesem Artikel werden die Indikationen, das technische Vorgehen, die Limitationen der Methoden und die Resultate der beiden Techniken diskutiert. Fenestrated stent-grafts initially aimed at treating short-necked aneurysms. Thanks to customized fenestrations, patency of vital side branches such as the renal arteries and the superior mesenteric artery can be maintained, whilst positioning the graft over these aortic side branches. Pararenal, suprarenal and thoracoabdominal aneurysms can only be treated by endovascular means with branched grafts. This can be achieved with the same fenestrated grafts, but with the use of covered stents through the fenestrations or by fully branched grafts. Both options are feasible and present with specific advantages and disadvantages. This report discusses the following aspects of these techniques: indications, technical principles, limitations and results.
  Gefässchirurgie 05/2012; 12(5):331-337. · 0.24 Impact Factor
• Article: The use of endografts to create an endoluminal femoropopliteal bypass after failed above-knee femoropopliteal open bypass surgery.

  M M A Lensvelt, O R M Wikkeling, J A Van Oostayen, J G Roukema, C J Zeebregts, M M P J Reijnen
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  ABSTRACT: Redo femoropopliteal bypass surgery is associated with increased morbidity and related to a poorer outcome than primary procedures. Endografts might provide an alternative, avoiding dissection of a previously operated groin. Patients treated with a polytetrafluoroethylene-covered stents for superficial femoral artery occlusive disease between February 2009 and September 2011 were prospectively gathered. Demographics, clinical status, procedural aspects, and follow-up were retrieved. Seventy-four patients were included of which 5 (7%) were treated before with a femoropopliteal bypass. Indication for intervention was Rutherford category 3 in all patients and the median ankle-brachial index (ABI) was 0.68. Technical success was achieved in all cases. The postoperative course was uneventful in all and the ABI increased to 0.95. After a follow-up period of 18 months, 4 of 5 endografts remained patent. The use of endografts after failed femoropopliteal bypass surgery is feasible and safe and could be used to avoid or minimize a difficult and hazardous dissection of a previously operated area.
  Vascular and Endovascular Surgery 04/2012; 46(4):338-41. · 0.99 Impact Factor
• Article: Endovascular treatment of ruptured abdominal aortic aneurysm: is there a long-term benefit at follow-up?

  S G J Rödel, R Meerwaldt, R J Beuk, A B Huisman, C J Zeebregts, R H Geelkerken
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  ABSTRACT: Several studies have shown the feasibility of endovascular repair of ruptured abdominal aortic aneurysms (rEVAR). However, the role and value of rEVAR remains controversial due to selection bias and lack of long-term results. In the present study we describe our short- and long-term results of treating patients with rEVAR irrespective of hemodynamic condition and challenging anatomy. In April 2006 we started the single centre prospective non-randomised Ruptured Aneurysm Study (RASA). During a four year enrolment period all consecutive patients presenting with infrarenal ruptured AAA (rAAA, N.=117) were assessed for preferential rEVAR treatment. A rAAA was defined as extravasation of blood or hematoma outside the AAA due to transmural tear in the infrarenal abdominal aorta wall documented by preoperative computed tomography (CT) angiography examination or during open repair. Patients with challenging anatomy (infrarenal neck length below 15 mm and neck angulation above 60 degrees) were included as part of a damage control concept. Complication and mortality rates were studied at 30 days and yearly afterwards. Thirty-five patients (33% of all admitted rAAA) were treated with rEVAR and 42% of them were considered hemodynamically unstable (systolic blood pressure <100 mmHg) and 30% had challenging AAA anatomy. The mortality rate at 30 days in the rEVAR group was 17%, in the open repair group 31%, and in the entire rAAA group (including abstained patients) 36%. During the first 30 days, 18 rEVAR patients experienced complications with nine re-interventions as a result. Long-term mortality of the rEVAR patients was 34% after a median follow-up of 3.4 years. All deaths after one year follow-up were non-AAA related. Multivariate analysis shows that Hardman index, presence of peripheral arterial obstructive disease and lowest systolic blood pressure during surgery are independently associated with long-term survival. Challenging rAAA anatomy was not associated with impaired survival. Our study shows that rEVAR is feasible irrespective of hemodynamic condition and that it is associated with relative low mortality rates. Challenging rAAA anatomy may not affect overall long-term survival, but six out of ten patients remain unsuitable for rEVAR because of inappropriate anatomy.
  The Journal of cardiovascular surgery 02/2012; 53(1):83-9. · 1.56 Impact Factor
• Article: Treatment strategies for extensive chronic SFA occlusions: indications and results.

  M M A Lensvelt, M M P J Reijnen, B M Wallis De Vries, C J Zeebregts
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  ABSTRACT: Treatment modalities for extensive chronic occlusive disease of the superficial femoral artery (SFA) have changed during the last decades. In this chapter we provide an overview of current treatment modalities for extensive chronic occlusive disease of the SFA. Although the autologous venous conduit is still considered the gold standard for treatment of long occlusive SFA lesions, endoluminal therapy is gaining territory. Its' minimal invasive character has great advantages in the frail vascular patient population. Percutaneous transluminal angioplasty is first choice in short SFA lesions, but patency rates decrease with longer lesions. When percutaneous transluminal angioplasty is combined with nitinol stent placement patency rates significantly improve. Patency rates of percutaneous transluminal angioplasty combined with covered stents are within reach of patency rates of prosthetic surgical bypasses. Drug-bonding in surgical PTFE bypasses increased patency rates significantly. In the near future drug-eluting and drug-bonded devices might further increase results of endovascular treatment.
  The Journal of cardiovascular surgery 02/2012; 53(1 Suppl 1):161-70. · 1.56 Impact Factor
• Article: Medical treatment in carotid artery intervention.

  J L Kolkert, R Meerwaldt, J D Lefrandt, R H Geelkerken, C J Zeebregts
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  ABSTRACT: Medical treatment has a pivotal role in the treatment of patients with occlusive carotid artery disease. Large trials have provided the justification for operative treatment besides medical treatment in patients with recent significant carotid artery stenosis two decades ago. Since then, medical therapy has evolved tremendously. Next to aspirin, antiplatelet regimens acting on a different level in the modulation of platelet aggregation have made their entry. Moreover, statin therapy has been introduced. These changes among others in secondary stroke prevention, along with better understanding in life-style adjustments and perioperative medical management, have led to a decrease in stroke recurrence. Secondary prevention is therefore now the most important pillar of medical therapy. It consists of antiplatelet therapy, statins and blood pressure lowering agents in all patients. Small adjustments are recommended for those patients referred for invasive treatment. Moreover, long-term medical treatment is imperative. In this article, we summarize current evidence in literature regarding medical management in patients with previous stroke or TIA.
  The Journal of cardiovascular surgery 12/2011; 52(6):803-19. · 1.56 Impact Factor
• Article: Novel serum biomarkers in carotid artery stenosis: useful to identify the vulnerable plaque?

  Linda Hermus, Joost H N Schuitemaker, Rene A Tio, Jan Cees Breek, Riemer H J A Slart, Esther de Boef, Clark J Zeebregts
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  ABSTRACT: Serum biomarkers representing inflammatory activity in vulnerable carotid plaques may be used to identify high-risk patients for cerebral ischemic events. We aimed to analyze the relationship between concentrations of four novel biomarkers and neurological symptoms: Neopterin, PTX3, sCD163, and sTREM-1. In addition, we analyzed the relationship between these markers and the presence of coronary (CAD) and peripheral (PAD) artery disease. Serum biomarker levels were determined in 100 patients undergoing carotid endarterectomy; 33 for stroke, 32 for transient ischemic attack, and 23 for amaurosis fugax. 12 Patients were asymptomatic. Risk factors for atherosclerotic disease and history of CAD and PAD were also assessed. Symptomatic patients did not show significantly elevated biomarker levels compared to asymptomatic patients and levels did not differ among symptomatic subgroups. Neopterin levels were elevated in patients with concomitant coronary and peripheral artery disease (CAD (32%) 10.2 ± 6.6 vs no CAD (68%) 7.6 ± 2.9 nmol/L, PAD (20%) 12.3 ± 7.4 vs no PAD (80%) 7.5 ± 3.0 nmol/L, p<0.05). sTREM-1 was elevated in patients with CAD (50.8 ± 53.2 vs 28.0 ± 31.6 ng/L, p<0.05). PTX3 and sCD163 were not significantly elevated in CAD nor PAD. Our findings suggest that serum neopterin and sTREM-1 levels may be related to the presence of atherosclerotic disease, but not to carotid plaque vulnerability.
  Clinical biochemistry 09/2011; 44(16):1292-8. · 2.02 Impact Factor
• Article: Standardised frailty indicator as predictor for postoperative delirium after vascular surgery: a prospective cohort study.

  R A Pol, B L van Leeuwen, L Visser, G J Izaks, J J A M van den Dungen, I F J Tielliu, C J Zeebregts
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  ABSTRACT: To determine whether the Groningen Frailty Indicator (GFI) has a positive predictive value for postoperative delirium (POD) after vascular surgery. Between March and August 2010, 142 consecutive vascular surgery patients were prospectively evaluated. Preoperatively, the GFI was obtained and postoperatively patients were screened with the Delirium Observation Scale (DOS). Patients with a DOS-score ≥3 points were assessed by a geriatrician. Delirium was defined by the DSM-IV-TR criteria. Primary outcome variable was the incidence of POD. Secondary outcome variables were any surgical complication and hospital length of stay (HLOS) (>7 days). Ten patients (7%) developed POD. The highest incidence of POD was found after aortic surgery (17%) and amputation procedures (40%). Increased comorbidities (p = 0.006), GFI score (p = 0.03), renal insufficiency (p = 0.04), elevated C-reactive protein (p = 0.008), high American Society of Anaesthesiologists score (p = 0.05), a DOS-score of ≥3 points (p = 0.001), post-operative intensive care unit admittance (p = 0.01) and HLOS ≥7 days (p = 0.005) were risk factors for POD. The GFI score was not associated with a prolonged HLOS. A mean number of 2 ± 1 (range 0-5) complications were registered. The receiver operator characteristics (ROC) area under the curve for the GFI was 0.70. The GFI can be helpful in the early identification of POD after vascular surgery in a select group of high-risk patients.
  European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery 07/2011; 42(6):824-30. · 2.92 Impact Factor
• Article: [Results of endovascular repair of TAAA in the first 50  patients].

  E Verhoeven, I F Tielliu, C J Zeebregts, F Bekkema, G Vourliotakis, W Ritter, B Zipfel, H Renner
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  ABSTRACT: Developments with fenestrated and branched stent grafts have opened the way to treat complex aortic aneurysms involving the visceral arteries. First reports on endovascular treatment of thoracoabdominal aneurysms have demonstrated the feasibility of the technique. A literature review and results of first 50  patients treated with a custom-made Zenith device with fixed branches are presented. Most of the patients were refused open surgery mainly for the extent of the disease combined with co-morbidity, which included in most patients a combination of several risk factors. Mean aneurysm size was 71 mm and extent of the aneurysm was type  I (n = 9), type  II (n = 13), type  III (n = 19), and type  IV (n = 9), respectively. Primary and primary assisted technical successes in our series were 88 % (44 / 50) and 92 % (46 / 50), respectively. One patient died on day  1 from an intraoperative aneurysm rupture. In two patients a renal artery was lost, one due to rupture and one due to malpositioning of the bridging stent graft. In a fourth patient, a celiac artery could not be catheterised and was lost. Finally, in two more patients, catheterisation of in total three renal arteries proved impossible. This was solved by a retrograde approach for two renal arteries via laparotomy in one patient, and a spleno-renal bypass in the other patient. Thirty-day mortality was 8 %. Estimated survival at 6  months, 1  year, and 2  years was 91.2 %, 79.8 %, and 69.7 %, respectively. Freedom of reintervention of all kinds at 1 and 2  years was 81.9 % and 73.7 %, respectively. Results of fully endovascular repair of thoracoabdominal aneurysms in a high-risk cohort are promising. A learning curve should be expected. Although longer term results need to be awaited, it is likely that endovascular repair of thoracoabdominal aneurysms will become a preferential treatment option for many patients in the future.
  Zentralblatt für Chirurgie 07/2011; 136(5):451-7. · 1.02 Impact Factor
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  Available from: Hendrikus H Boersma

  Article: Myocardial perfusion reserve compared with peripheral perfusion reserve: a [13N]ammonia PET study.

  A M Scholtens, R A Tio, A Willemsen, R A J O Dierckx, H H Boersma, C J Zeebregts, A W J M Glaudemans, R H J A Slart
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  ABSTRACT: [13N]ammonia PET allows quantification of myocardial perfusion. The similarity between peripheral flow and myocardial perfusion is unclear. We compared perfusion flow in the myocardium with the upper limb during rest and adenosine stress [13N]ammonia PET to establish whether peripheral perfusion reserve (PPR) correlates with MPR. [13N]ammonia myocardial perfusion PET-scans of 58 patients were evaluated (27 men, 31 women, age 64 ± 13 years) and were divided in four subgroups: patients with coronary artery disease (CAD, n = 15), cardiac syndrome X (SX, n = 14), idiopathic dilating cardiomyopathy (DCM, n = 16), and normal controls (NC, n = 13). Peripheral limb perfusion was measured in the muscular tissue of the proximal upper limb and quantified through a 2-tissue-compartment model and the PPR was calculated (stress/rest ratio). MPR was also calculated by a 2-tissue-compartment model. The PPR results were compared with the MPR findings. Mean myocardial perfusion increased significantly in all groups as evidenced by the MPR (CAD 1.99 ± 0.47; SX 1.39 ± 0.31; DCM 1.72 ± 0.69; NC 2.91 ± 0.78). Mean peripheral perfusion also increased but not significantly and accompanied with great variations within and between groups (mean PPR: CAD 1.30 ± 0.79; SX 1.36 ± 0.71; DCM 1.60 ± 1.22; NC 1.27 ± 0.63). The mean difference between PPR and MPR for all subpopulations varied widely. No significant correlations in flow reserve were found between peripheral and myocardial microcirculatory beds in any of the groups (Total group: r = -0.07, SEE = 0.70, CAD: r = 0.14, SEE = 0.48, SX: r = 0.17, SEE = 0.30, DCM: r = -0.11, SEE = 0.71, NC: r = -0.19, SEE = 0.80). No correlations between myocardial and peripheral perfusion (reserve) were found in different patient populations in the same PET session. This suggests a functional difference between peripheral and myocardial flow in the response to intravenously administered adenosine stress.
  Journal of Nuclear Cardiology 02/2011; 18(2):238-46. · 2.67 Impact Factor
• Article: [Endarterectomy more favourable than stenting in symptomatic significant carotid stenosis: higher risk of ischaemic stroke or death following stenting].

  Robbert Meerwaldt, Roland J Beuk, Ad B Huisman, Sanne M Manschot, Clark J Zeebregts, Robert H Geelkerken
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  ABSTRACT: Carotid endarterectomy (CEA) has proven its value in the treatment of patients with recent significant carotid artery stenosis. Percutaneous transluminal angioplasty with carotid artery stenting ('stenting' in short) is an alternative to CEA. The results of stenting and CEA in patients with symptomatic significant carotid artery stenosis were evaluated in 9 prospective randomized controlled trials and 11 meta-analyses. Almost all of these trials failed to show superiority of stenting to CEA. According to the 4 largest and most recent studies in this field the risk of a stroke or death within 30 days after the intervention is considerably higher following stenting than following CEA. In the long run the results of stenting and CEA seem to be comparable. CEA remains the gold standard in treatment of significant carotid artery stenosis, in particular in patients older than 70.
  Nederlands tijdschrift voor geneeskunde 01/2011; 155:A2411.
• Article: Autonomic dysfunction in diabetes: a consequence of cardiovascular damage.

  J D Lefrandt, A J Smit, C J Zeebregts, R O B Gans, K H Hoogenberg
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  ABSTRACT: In 1976, D.J. Ewing showed a clear survival disadvantage for diabetic patients that had 'diabetic autonomic neuropathy', as assessed by heart rate and blood pressure variations during a battery of bedside tests. However, these variations do not solely depend on autonomic nervous system function, but also and possibly to a more important extent on the integrity of cardiovascular autonomic reflex loops. Increased intima media thickness at the site of the baroreceptors, reduced vascular distensibility, endothelial dysfunction and impaired cardiac function contribute to the cardiovascular autonomic dysfunction. Interestingly, these abnormalities are closely associated with the presence of (micro-) albuminuria that is regarded as a reflection of endothelial dysfunction or vascular damage in diabetes mellitus. Modern techniques to assess cardiovascular autonomic, vascular and cardiac function have improved the ability to detect early abnormalities. Analysis of heart rate variability, baroreflex sensitivity, muscle sympathetic nervous activity, LNMAinfusions and advanced echocardiography have shown that it is the interplay between autonomic control and cardiac and vascular properties that determines cardiovascular autonomic function. Moreover, these modern techniques have improved power to predict survival in diabetic patients in comparison with the classical Ewing's bedside tests. In conclusion, cardiovascular damage may be more important in cardiovascular autonomic dysfunction than neural function.
  Current diabetes reviews 09/2010; 6(6):348-58.
• Article: Accuracy of FDG-PET-CT in the diagnostic work-up of vascular prosthetic graft infection.

  J L M Bruggink, A W J M Glaudemans, B R Saleem, R Meerwaldt, H Alkefaji, T R Prins, R H J A Slart, C J Zeebregts
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  ABSTRACT: To investigate the diagnostic accuracy of fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) compared with computed tomography (CT) scanning and added value of fused FDG-PET-CT in diagnosing vascular prosthetic graft infection. Prospective cohort study with retrospective analysis. Twenty five patients with clinically suspected vascular prosthetic infection underwent CT and FDG-PET scanning. Two nuclear medicine physicians assessed the FDG-PET scans; all CT scans were assessed by two radiologists. Fused FDG-PET/CT were judged by the radiologist and the nuclear medicine physician. The concordance between CT and FDG-PET and the inter-observer agreement between the different readers were investigated. Fifteen patients had a proven infection by culture. Single FDG-PET had the best results (sensitivity 93%, specificity 70%, positive predictive value 82% and negative predictive value 88%). For CT, these values were 56%, 57%, 60% and 58%, respectively. Fused CT and FDG-PET imaging also showed high sensitivity and specificity rates and high positive and negative values. Inter-observer agreement for FDG-PET analysis was excellent (kappa = 1.00) and moderate for CT and fused FDG-PET-CT analysis (0.63 and 0.66, respectively). FDG-PET scanning showed a better diagnostic accuracy than CT for the detection of vascular prosthetic infection. This study suggests that FDG-PET provides a useful tool in the work-up for diagnosis of vascular prosthetic graft infection.
  European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery 09/2010; 40(3):348-54. · 2.92 Impact Factor
• Article: Intravenous leiomyomatosis: report of two cases and strategy for surgical resection.

  I F J Tielliu, M L Otterman, J J Meuzelaar, C J Zeebregts, P M J G Peeters
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  ABSTRACT: Intravenous leiomyomatosis is a rare smooth muscle tumour that arises from the myometrium and grows into the extrauterine venous system. It typically can extend into the vena cava inferior and even the cardiac chambers. This can lead to life threatening obstruction of cardiac valves. The only effective treatment is surgical resection. However, no clear guidelines with respect to surgical approach and further strategy are available in the literature. Especially the indications for a simultaneous thoracic approach and for either one-stage or two-stage approach are unclear. On the basis of two cases of intravenous leiomyomatosis with different levels of intracaval extension of the tumour, this article discusses a useful strategy for planning surgical resection, taking into account tumour characteristics and different levels of intracaval extension.
  Minerva chirurgica 08/2010; 65(4):489-93. · 0.77 Impact Factor