
Gwan H HoAmphia Ziekenhuis · Department of Surgery
Gwan H Ho
MD PhD
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Publications (90)
Objective
The aim of this study was to identify risk factors for 90 day mortality after elective open surgical repair (OSR) of abdominal aortic aneurysms (AAAs) in women.
Methods
This was a multicentre case–control study. The nationwide Dutch Surgical Aneurysm Audit registry (2013 – 2019) was solely used to identify women who underwent elective OS...
Objective
The Dutch Surgical Aneurysm Audit (DSAA) initiative was established in 2013 to monitor and improve nationwide outcomes of aortic aneurysm surgery. The objective of this study was to examine whether outcomes of surgery for intact abdominal aortic aneurysms (iAAA) have improved over time.
Methods
Patients who underwent primary repair of an...
Objective
Age is an independent risk factor for mortality after both elective open surgical repair (OSR) and endovascular aneurysm repair (EVAR). As a result of an ageing population, and the less invasive nature of EVAR, the number of patients over 80 years (octogenarians) being treated is increasing. The mortality and morbidity following aneurysm...
Objective:
The goal of this study was to assess the long-term effectiveness of combination therapy for intermittent claudication, compared with supervised exercise only.
Background:
Supervised exercise therapy is recommended as first-line treatment for intermittent claudication by recent guidelines. Combining endovascular revascularization plus...
Objective
Composite measures may better objectify hospital performance than individual outcome measures (IOM). Textbook outcome (TO) is an outcome measure achieved for an individual patient when all undesirable outcomes are absent. The aim of this study was to assess TO as an additional outcome measure to evaluate quality of care in symptomatic pat...
Background:
Health-care systems nowadays rely on complementary patient care by informal caregivers. The need for, and burden on, informal caregivers will likely increase in the upcoming years. This study aimed to examine the burden on caregivers when providing care for elderly patients undergoing major abdominal surgery.
Methods:
A single-centre...
Objective
The new 2019 guideline of the European Society for Vascular Surgery (ESVS) recommends consideration for elective iliac artery aneurysm (eIAA) repair when the iliac diameter exceeds 3.5 cm, as opposed to 3.0 cm previously. The current study assessed diameters at time of eIAA repair and ruptured IAA (rIAA) repair and compared clinical outco...
Objective:
Mycotic aneurysms of the abdominal aorta (MAAA) can be treated by open repair (OR) or endovascular aneurysm repair (EVAR). This nationwide study provides an overview of the situation of MAAA treatment in The Netherlands in 2016.
Methods:
A retrospective cohort study was conducted with all centers that registered aortic abdominal aneur...
Introduction
Revascularization is the cornerstone of the treatment of critical limb ischemia (CLI), but the number of elderly frail patients increase. Revascularization is not always possible in these patients and conservative therapy seems to be an option. The goals of this study are to analyze the 1-year quality of life (QoL) results and mortalit...
Objective:
To aid physicians in the process of shared decision-making, many predictive models for critical limb ischemia (CLI) have been constructed. However, none of these models is in widespread use. Predicting survival outcomes for a specific individual may be used to guide treatment selection. The aim of this study was to construct a 6-month s...
Introduction:
Both surgical and endovascular treatment in elderly patients with critical limb ischemia are associated with high mortality rates. Patients with critical limb ischemia are at increased risk of adverse cardiovascular events and subsequent cardiovascular death. Little is known about the incidence and consequences of these adverse event...
Objective:
The treatment of critical limb ischemia (CLI), with the intention to prevent limb loss, is often an intensive and expensive therapy. The aim of this study was to examine the cost-effectiveness of endovascular and conservative treatment of elderly CLI patients unsuitable for surgery.
Methods:
In this prospective observational cohort st...
Background:
Prehabilitation programs have recently been suggested as potentially able to lower the incidence of delirium in elderly patients undergoing major abdominal surgery. For these prehabilitation programs to become successful, it is essential to identify those patients who are most likely to develop a delirium.
Material and methods:
A sin...
Introduction
Critical limb ischemia (CLI) patients are often of advanced age with reduced health status (HS) and quality of life (QoL) at baseline. Physical health is considered as the most affected domain due to reduced mobility and ischemic pain. QoL and HS are often used interchangeably in the current literature. HS refers to objectively perceiv...
Purpose
Despite high amputation rates, data on patient-reported outcomes is scarce in the elderly population with critical limb ischemia. The aim of this study was to provide mortality rates and long-term changes of the following patient-reported outcomes in elderly critical limb ischemia amputees: quality of life (QoL), health status (HS), and sym...
Background
Delirium is a common and serious complication in elderly patients undergoing major abdominal surgery, with significant adverse outcomes. Successful strategies or therapies to reduce the incidence of delirium are scarce. The objective of this study was to assess the role of prehabilitation in reducing the incidence of delirium in elderly...
Background:
To compare hospital outcomes of aortic aneurysm surgery, casemix correction for preoperative variables is essential. Most of these variables can be deduced from mortality risk prediction models. Our aim was to identify the optimal set of preoperative variables associated with mortality to establish a relevant and efficient casemix mode...
Objective: To determine the effect of primary conservative treatment without revascularization in patients with proven aortoiliac occlusive disease (AIOD) presenting with intermittent claudication (IC).
Background: The initial treatment of IC should focus on supervised exercise therapy (SET) and pharmacotherapy. Nowadays, primary endovascular revas...
Background
Due to the increase in elderly patients who undergo major abdominal surgery there is a subsequent increase in postoperative complications, prolonged hospital stays, health-care costs and mortality rates. Delirium is a frequent and severe complication in the ‘frail’ elderly patient. Different preoperative approaches have been suggested to...
Background:
Delirium in patients with critical limb ischemia (CLI) is associated with increased mortality. The main goal of this study was to investigate the association between delirium and mortality in patients undergoing major lower limb amputation for CLI. In addition, other risk factors associated with mortality were analyzed.
Methods:
An o...
Background
In patients with critical limb ischemia, an association is assumed between depression and worse outcome for morbidity, such as major limb amputation. After major amputation, anxiety and depression are common. We aimed to determine the association of depressive and anxiety symptoms in the elderly with critical limb ischemia, especially af...
Objectives
A patient-oriented appraisal of treatment has become extremely important, particularly in elderly patients with critical limb ischaemia (CLI). Quality of life (QoL) is an important patient-reported outcome in vascular surgery. Frequently, the physical domain of QoL questionnaires represents an ‘objective’ evaluation of performing activit...
Background:
The Dutch Audit for Carotid Interventions (DACI) registers all patients undergoing interventions for carotid artery stenosis in the Netherlands. This study describes the design of the DACI and results of patients with a symptomatic stenosis undergoing carotid endarterectomy (CEA). It aimed to evaluate variation between hospitals in pro...
Objectives:
Failure to rescue (FTR) is a composite quality indicator, defined as the proportion of deceased patients following major complications. The aims of this study were to compare FTR with mortality for hospital comparisons in abdominal aortic aneurysm (AAA) surgery in The Netherlands and investigate hospital volume and associated factors....
Background:
Endovascular first strategy for critical limb ischemia is widely accepted, because of the increasing patency rates and minimal invasive character, especially in elderly patients. Nonetheless, the impact of reinterventions because of endovascular treatment failure in this population is not well known. The aim of this study is to evaluat...
Introduction:
Hybrid revascularization combines open lower extremity surgery and endovascular procedures to simultaneously treat atherosclerotic lesions on multiple levels in patients with peripheral arterial occlusive disease. Hybrid surgery appears to be a safe strategy for multilevel stenosis revascularization, though the risk of surgical site...
Introduction:
Revascularisation to relieve ischemic pain and prevent limb loss is the cornerstone of critical limb ischemia (CLI) treatment, however not all elderly patients are deemed fit for revascularisation. Patient related outcome measurements are important in these patients. Quality of Life (QoL) results regarding the effect of endovascular,...
Background:
Surgical site infections (SSIs) cause considerable morbidity and deaths among patients undergoing vascular surgery. Pre-operative screening and subsequent treatment of nasal Staphylococcus aureus carriers with mupirocin and chlorhexidine reduces the risk of SSIs in cardiothoracic and orthopedic surgery. The aim of this study was to inv...
Background:
Surgical site infections (SSIs) constitute one of many major complications after aortic aneurysm surgery and its details and outcome have not been evaluated extensively. This research evaluates the incidence and outcome of SSI and graft infection in open and endovascular abdominal aortic aneurysm surgery.
Patients and methods:
A retr...
Background
Owing to the aging population, the number of elderly patients with critical limb ischemia (CLI) has increased. The consequence of amputation is immense. However, at the moment, information about the mortality after amputation in the elderly vascular patients is unknown. For this reason, this study evaluated mortality rates and patient-re...
BACKGROUND
Treatment of critical limb ischemia (CLI) in the elderly patients is challenging because of the comorbidity and fragility of these patients. We analysed survival in relation to different treatment options, and estimated life expectancy of our study group by age and gender.
METHODS
All patients aged ≥70 years, presenting with chronic CLI...
Background:
Critical limb ischemia (CLI) is a disease that is most prevalent in the elderly population. This group of patients includes patients suffering from comorbidities such as dementia. Mortality rates of both CLI and dementia are higher when compared with the nonaffected population. These demented vascular patients are often deemed unfit fo...
Importance
Supervised exercise is recommended as a first-line treatment for intermittent claudication. Combination therapy of endovascular revascularization plus supervised exercise may be more promising but few data comparing the 2 therapies are available.Objective
To assess the effectiveness of endovascular revascularization plus supervised exe...
Purpose
Vascular intervention studies generally consider patency and limb salvage as primary outcomes. However, quality of life is increasingly considered an important patient-oriented outcome measurement of vascular interventions. Existing literature was analyzed to determine the effect of different treatments on quality of life for patients suffe...
Vascular surgery patients are frequently deemed to be in a frail clinical condition and at risk for delirium. Therefore, we evaluated the incidence and independent perioperative risk factors for delirium. In addition we describe factors on frailty in the various vascular disease groups in current practice.
This observational longitudinal study incl...
Optimal management of an abdominal aortic aneurysm (AAA) in the elderly is not straightforward. We evaluated treatment results of elderly patients with asymptomatic abdominal aortic aneurysm that met the treatment criteria in our clinic.
Hospital charts between January 2005-December 2012 were reviewed of all patients 70 years and older diagnosed wi...
To assess outcome and the occurrence and consequences of adverse events (AEs) after treatment of acute limb ischemia (ALI).
Retrospective analysis on intra-arterial thrombolysis (group I) and thromboembolectomy (group II). Outcome measures were primary patency - and limb salvage rates. AEs and consequences were registered during admission and 30 da...
Background:
Patients with peripheral arterial disease (PAD) are at risk for revision surgery in the groin and therefore at potential risk for surgical site infections (SSIs). In an observational study, a cohort of patients with peripheral arterial disease was followed to examine the effect of different incision intervals on SSI-free survival.
Met...
Background
Despite advances in operative repair, ruptured abdominal aortic aneurysm (rAAA) remains associated with high mortality and morbidity rates, especially in elderly patients. The purpose of this study was to evaluate the outcomes of emergency endovascular aneurysm repair (eEVAR), conventional open repair (OPEN), and conservative treatment i...
In selected patients who suffer from severe peripheral artery disease (PAD) a revascularization with a peripheral bypass might be considered. Postoperative edema is a well-known phenomenon following peripheral bypass surgery and is probably caused by multiple factors. Although postoperative edema causes discomfort to patients, the effects on the qu...
Long-term results of precuffed expanded polytetrafluoroethylene (ePTFE) grafts used for peripheral bypass surgery are lacking. The aim of this study was to obtain the long-term outcomes of precuffed ePTFE grafts compared with autologous saphenous vein (ASV) grafts used in patients with peripheral arterial disease (PAD).
A single-institution retrosp...
This study aims to evaluate early results of a precuffed expanded polytetrafluoroethylene (ePTFE) Distaflo® Mini-Cuff Bypass Graft versus autologous saphenous vein (ASV) grafting in patients with peripheral arterial obstructive disease (PAOD).
This retrospective single-center study analyzed 42 patients who received a femorocrural bypass graft becau...
An increasing number of vascular surgery units expand their team with nurse practitioners (NPs) to optimize patient care. There are no previously performed studies which assessed the influence of NPs on patients' quality of life (QoL), anxiety, and depressive symptom levels. The transition in care from surgeon to NP in the vascular surgery unit of...
Background:
Registration of complications of treatment is an important instrument for measuring the quality of health care. Reliable registration depends on definitions, the case-finding method that is used, and the registration method itself. We conducted a comparative study of two different methods of registration for the surveillance of surgica...
Purpose
We performed a retrospective study on hemodialysis fistulae in patients aged 75 years and older.
Methods
Dialysis records of 2 hospitals were searched for patients of 75 years and older who had primary autologous radiocephalic arteriovenous fistulae (RCAVFs) and brachiocephalic arteriovenous fistulae (BCAVFs). Outcome measures were primary...
Peripheral bypass surgery is an important treatment option for patients with peripheral arterial disease. Short-term results of quality of life (QoL) after peripheral bypass surgery showed an increase in QoL at 3 months. Little is known about QoL at more than 2 years of follow-up. This study was performed to analyze QoL at midterm follow-up, and ov...
Aim:
The DREAM and EVAR-1 trial show a higher reintervention rate after endovascular aneurysm repair (EVAR) compared to open repair. Since the initiation of these trials, endovascular-graft design and the experiences with EVAR have evolved substantially. The aim of this study was to compare the need for reinterventions in our recent EVAR procedure...
Substantial lower-limb edema affects the majority of patients who undergo peripheral bypass surgery. Edema has impairing effects on the microvascular and the macrovascular circulation, causes discomfort and might delay the rehabilitation process of the patient. However, the pathophysiology of this edema is not well understood. The Cochrane Library...
Background:
Critical limb ischemia (CLI) has a poor outcome when left untreated. The benefits of revascularization in the very elderly might be limited because of co-morbidities and short life expectancy. Therefore, optimal management of CLI in the elderly is not straightforward. We analyzed treatment results for elderly patients with CLI (Rutherf...
To examine the effects of peripheral bypass surgery on patients' quality of life (QoL) as well as to compare two treatment modalities to reduce postoperative edema with regard to patients' QoL.
This was a randomized controlled trial set in the department of vascular surgery in a nonacademic teaching hospital. Ninety-three patients (mean age, 70 yea...
The pathophysiological mechanisms that induce postrevascularization edema after femoropopliteal bypass surgery are not completely understood. Reperfusion-associated injury to revascularized tissue and damage to lymphatic structures are both likely to play a role. Aim of this study was to study edema formation after peripheral bypass surgery with ma...
Introduction: The graft of choice in lower limb bypass surgery is the autologous saphenous vein (ASV). However, a prosthetic graft is needed in the absence of an ASV. In such situations, we used an expanded polytetrafluoroethylene (ePTFE) pre-cuffed Dynaflo graft as supragenicular bypass or Distaflo graft as infragenicular or femorocrural bypass. I...
We compared the outcomes of 56 patients with a ruptured abdominal aortic aneurysm (RAAA) who underwent either open repair or emergency endovascular aneurysm repair (eEVAR) in a general hospital. It seems feasible that the availability of eEVAR for treatment of RAAA could lead to a decrease in hospital mortality.
We analyzed all admitted patients wi...
Het thoracic-outletsyndroom (TOS) is een verzamelnaam van aandoeningen die worden veroorzaakt door compressie van de neurovasculaire structuren plexus brachialis en de arteria (a.) en vena (v.) subclavia. Een groot gedeelte van de klachten wordt veroorzaakt door neurogene compressie. Arteriële complicaties worden zelden gezien, maar kunnen leiden t...
Patients who undergo autologous femoropopliteal bypass surgery develop postoperative edema in the revascularized leg. The effects of intermittent pneumatic compression (IPC) to treat and to prevent postreconstructive edema were examined in this study.
In a prospective randomized trial, patients were assigned to one of two groups. All patients suffe...
To investigate the efficacy of A-V impulse technology (A-V) for oedema prevention and treatment following PTFE femoropopliteal surgery.
Prospective randomized clinical trial.
36 patients undergoing PTFE femoropopliteal bypass reconstructions, either being treated postoperatively with a compression stocking (CS) (Group-1, n = 19) or with A-V (Group-...
The aim of this study is to determine the reliability and reproducibility of repeated tape measurements to assess the leg circumference during a long period.
A tape measure is a simple instrument that is applicable in the presence of oedema. Measurements were performed by four observers on 11 volunteers. Four measurements were done in the first wee...
The purpose of this study is to report a new method of removing an infected endoprosthesis from the abdominal aorta using a wire cutter. A 65-year-old man with a ruptured abdominal aortic aneurysm was admitted to our hospital. He was treated with an endovascular abdominal endoprosthesis and discharged one week later. Three months after placement, t...
A large amount of Zenith endovascular stent complications is due to problems with the leg extensions. This kind of complication has never been reported in literature. The aim of this study was to monitor the complications of endovascular abdominal aneurysm repair (EVAR) performed with the Zenith endovascular graft occurred in the Amphia Ziekenhuis...
The clinical consequences of re-occlusion after initially successful arterial revascularization procedures might be as important as patency when it comes to procedure selection. This study evaluates the clinical consequences of re-occlusion after initially successful remote superficial femoral artery endarterectomy (RSFAE), in particular the recurr...
Today's patients increasingly desire a low-risk procedure with rapid return to functional status following surgery. Many patients actively seek a minimally invasive option. During the last decade, minimally invasive surgical and radiological procedures emerged from their infancy to become an integral part of the treatment strategy in both periphera...
To compare the consequences of occlusion of infrainguinal venous and prosthetic grafts.
In total, 2690 patients were included in the Dutch BOA study, a multicenter randomised trial that compared the effectiveness of oral anticoagulants with aspirin in the prevention of infrainguinal bypass graft occlusion. Two thousand four hundred and four patient...
The purpose of this study was to compare the perioperative and long-term results of initial successful remote iliac artery endarterectomies (RIAEs) with converted procedures.
From April 1994 to September 2003, 63 remote endarterectomies of the external and/or common iliac artery were planned in 62 patients (41 males, 42 procedures). The median age...
Remote endarterectomy of external and common iliac artery occlusions through a single, groin incision under fluoroscopic guidance is a relative unknown surgical procedure. This prospective single center cohort study describes this less invasive endovascular technique with the ring strip cutter and its early complications. The results at midterm fol...
to report the long term results of remote superficial femoral artery endarterectomy (RSFAE) with the MollRing Cutter for the treatment of long segmental SFA occlusive disease.
retrospective open study.
from March 1994 to August 2000 183 RSFAEs were performed in 164 selected patients (105 males, 120 procedures) with a median age of 63 years (43-84 y...
to evaluate the feasibility of endovascular femoropopliteal bypass in combination with remote endarterectomy of the superficial femoral artery (SFA).
prospective, open study.
thirteen patients with chronic lower-leg ischaemia due to femoropopliteal occlusive disease underwent 14 SFA remote endarterectomy procedures followed by endovascular ePTFE fe...
to investigate the results of revision of recurrent stenoses after superficial femoral artery (SFA) remote endarterectomy.
prospective, non-open, study.
eighty-eight consecutive patients with long segmental SFA occlusive disease underwent 101 remote end-arterectomy procedures. All patients had chronic lower extremity ischaemia necessitating surgica...
To demonstrate the deformation of self-expandable stents after endovascular repair of peripheral aneurysms.
The Corvita Endoluminal Graft was used to treat a traumatic false aneurysm of the right subclavian artery and a common iliac artery aneurysm in 2 patients. In the subclavian case, the stent-graft showed a "cigar-shaped" deformation with hemod...
The incidence, time-of-onset, and anatomical distribution of recurrent stenoses after remote endarterectomy in superficial femoral artery (SFA) occlusive disease were studied.
Patients undergoing SFA remote endarterectomy procedures were examined with duplex surveillance. Patients were examined at 6 weeks, 3, 6, 9, and 12 months, and then annually....
Semiclosed endarterectomy of the SFA belongs in the armamentarium of the vascular surgeon. New technology offers the possibility of performing this less invasive operation so that only a single incision is needed to obtain access to the artery and perform remote disobliteration. Strong indications show that the anticipated restenosis of long, segme...
Endovascular surgical procedures have become an integral part of the treatment of arterial occlusive disease in the femoropopliteal segment—an adjunct to conventional peripheral arterial reconstructions.1–3 Additionally, new percutaneous arterial disobliteration devices have been designed. Catheter-based therapies such as percutaneous transluminal...
The authors present a new modified endarterectomy technique for the treatment of artherosclerotic occlusive disease of the superficial femoral artery (SFA). The SFA remote endarterectomy procedure can be performed through a single groin incision using a ring strip cutter and stenting the distal endpoint. Complete disobliteration of lengthy occlusio...
A 35-year-old man developed bilateral compartment syndrome in the lower legs after prolonged colorectal surgery in the lithotomy position. This complication of a prolonged non-physiological operation position is a rare event and the diagnosis is therefore often delayed, with sometimes serious irreversible neuromuscular damage. In this case the comp...
Closed superficial femoral artery endarterectomy is a minimal invasive technique. Through a single groin incision the occluded intima is remotely removed by a newly modified ring stripper. This device has a double ring which acts like remote scissors and enables the surgeon to recanalize long segmental femoral popliteal occlusive disease. The devic...
Closed superficial femoral artery endarterectomy is a minimal invasive technique. Through a single groin incision the occluded intima is remotely removed by a newly modified ring stripper. This device has a double ring which acts like remote scissors and enables the surgeon to recanalize long segmental temoral popliteal occlusive disease. The devic...
Report of 1-8 year follow-up of patients treated by percutaneous transluminal angioplasty (PTA) for obstructive atherosclerosis of the infrarenal aorta.
Cohort study.
Thirty-eight patients aged 26-81 years (mean 50 years) were submitted to undergo percutaneous transluminal angioplasty of the infrarenal aorta. All patients had symptomatic isolated s...
One-year clinical outcome of a new endovascular treatment for long segmental arterial occlusive disease using a ring strip cutter (RSC) to minimise surgical exposure.
Prospective, open study.
Thirty-eight consecutive RSC procedures in 36 consecutive patients with lengthy occlusive (34) or multiple stenotic (4) femoropopliteal lesions were performed...
To define the prognosis of nonrevised graft stenosis, we studied 68 infragenicular bypass grafts in patients entered into our duplex surveillance program between 1986 and 1987. Patients were grouped according to the grade of stenosis as follows: grade I = < 50% stenosis, grade II = 50% to 75% stenosis, and grade III = 75% to 99% stenosis. Time unti...
Transluminal endarterectomy was first reported by the Portuguese surgeon Dos Santos1 in 1943. Four years later, he performed the first disobliteration in an atherosclerotic diseased superficial femoral artery (SFA) through a proximal and distal arteriotomy in a 66-year old man with an ischemic leg; he called this disobliteration a thromboendarterec...
To evaluate the feasibility and efficacy of the Mollring Cutter remote endarterectomy (EA) technique in the treatment of occlusive superficial femoral artery (SFA) disease.
A new device was developed to perform remote EA of occluded SFAs through a single groin incision. The technique initially uses a conventional ring stripper, which is exchanged f...