Marald Wikkeling

Amsterdam University Medical Center | VUmc · Department of Surgery

Objective This study aims to compare the 5-year outcomes of endoluminal bypass (EB) using heparin-bonded self-expanding covered stents versus bypass surgery for extensive femoropopliteal disease, including technical and clinical outcomes and health status. Background The surgical femoropopliteal bypass was the gold standard to treat peripheral art...

Long-term follow-up is crucial for patients with Pelvic venous disease (PeVD) and compression syndromes, regardless of the chosen treatment. The specific condition of the patient and the performed treatments will determine the frequency of follow-up appointments. The frequency of follow-up appointments can vary based on the severity of the conditio...

The creation of a virtual European network and reference centers, targeted at Pelvic venous disease, holds promising potential for the medical and research communities. Nevertheless, effective implementation of the initiative necessitates prudent planning, funding, and support. The establishment of such networks and reference centers requires certa...

Purpose Heparin is the most widely-used anticoagulant to prevent thrombo-embolic complications during non-cardiac arterial procedures (NCAP). Unfortunately, there is a lack of evidence and consequently non-uniformity in guidelines on perprocedural heparin management. Detailed insight into the current practice of antithrombotic strategies during NCA...

Purpose Octogenarians are known to have less-favorable outcomes following ruptured abdominal aortic aneurysm (rAAA) repair compared with their younger counterparts. Accurate information regarding perioperative outcomes following rAAA-repair is important to evaluate current treatment practice. The aim of this study was to evaluate perioperative outc...

Objectives Magnetic resonance venography (MRV) is underutilized in the evaluation of thrombus properties prior to endovascular treatment but may improve procedural outcomes. We therefore investigated the clinical impact of using a dedicated MRV scoring system to assess thrombus characteristics prior to endovascular intervention for iliofemoral deep...

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...

The two main mechanisms for pelvic venous disease (PeVD) are reflux of ovarian vein and obstruction of left common iliac or left renal vein. Some patients have a combination of the two. Adequate assessment of the location and degree of stenosis and delineation of venous anatomy are the key elements in the success of interventions to treat chronic o...

Pelvic venous disease (PeVD) is an overlooked condition that can affect daily life of patients. Although medical history and physical examination may lead to suspicion of PeVD, accurate imaging is important for establishing the diagnosis with high certainty. Despite the increasing popularity of magnetic resonance imaging and Duplex ultrasound as no...

Compression syndromes play an important role in pelvic venous disease (PeVD). Although compressive lesions of the common iliac and renal veins are common on non-invasive imaging studies, they are usually asymptomatic and the factors associated with the development of symptoms remain poorly understood. The prevalence of pelvic or lower-extremity sym...

Introduction: Isolated iliac artery aneurysms (IAA), accounting for 2-7 percent of all abdominal aneurysms, are nowadays often treated with the use of iliac branched endografts. Although outside of the manufacturer’s instructions for use, iliac branched devices can be used solely, without the adjunctive placement of an EVAR device, for the treatmen...

Objective Surgical site complications (SSCs) such as dehiscence and infection are a common issue within vascular surgeries and are a key concern to payers and clinicians. It is estimated that occurrence of complications in vascular surgery can increment length of stay by 9.72 days and costs by £3776 per episode. The objective of this research was t...

Background The CAVA (Ultrasound‐Accelerated Catheter‐Directed Thrombolysis Versus Anticoagulation for the Prevention of Post‐Thrombotic Syndrome) trial did not show a reduction of post‐thrombotic syndrome (PTS) after additional ultrasound‐accelerated catheter‐directed thrombolysis in patients with acute iliofemoral deep vein thrombosis at 1‐year fo...

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 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 The CAVA trial did not show the anticipated risk reduction for postthrombotic syndrome (PTS) after thrombus removal via additional ultrasound-accelerated catheter-directed thrombolysis (UACDT) in patients with acute iliofemoral deep vein thrombosis (IFDVT). Difficulties in achieving an effective degree of recanalization through thromboly...

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...

Background: Early thrombus removal might prevent post-thrombotic syndrome by preserving venous function and restoring flow. Previous trials comparing additional catheter-directed thrombolysis to standard treatment showed conflicting outcomes. We aimed to assess the benefit of additional ultrasound-accelerated catheter-directed thrombolysis for the...

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...

Background: Ruptured abdominal aortic aneurysm (rAAA) remains a critical life-threatening condition. We aimed to evaluate rAAA management in our center focusing on predictors of mortality at 48 hr of intensive care unit (ICU) and to develop a new mortality prediction score considering data at 48 hr postprocedure. External validation of the modifie...

Anastomotic leakage is a serious complication of gastro-intestinal surgery. Its prognosis is largely determined by early diagnosis and treatment, yet its symptoms can be aspecific and difficult to recognize in the postoperative phase. Here, we describe a case where recognition of serious anastomotic leakage was significantly delayed. This was due t...

Background: In endovascular valve and aortic repair, vascular access through a percutaneous approach has become the competing technique to an open surgical approach. The effect on postoperative complications and surgical site infections (SSIs) has been investigated, but randomized evidence is lacking. The objective was to investigate whether percu...

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....

Objective: The Gore Iliac Branch Endoprosthesis (IBE; W. L. Gore & Associates, Flagstaff, Ariz) has recently been approved by the Food and Drug Administration for treatment of common iliac artery (CIA) aneurysms. Despite early excellent results in clinical trial, none of 63 patients were treated for bilateral iliac aneurysms. The goal of this stud...

Objectives This study sought to compare heparin-bonded endografts with femoropopliteal bypass, including quality of life, using general health and disease-specific questionnaires as well as patency rates. Background Endovascular treatment continues to advance and is gaining acceptance as primary treatment for long occlusive or stenotic lesions in...

Background: The treatment of end-stage lymphoedema of the leg is challenging, especially when conservative treatment fails and there is a large volume difference between the affected and unaffected legs. Circumferential suction-assisted lipectomy (CSAL) has been described as a treatment option for end-stage lymphoedema of the leg. Here, the long-t...

A 70-year-old patient was referred to our emergency department with severe retrosternal pain after forceful vomiting. Computed tomography (CT) scan revealed a left-sided oesophageal rupture with accompanying pneumomediastinum and bilateral pleural effusions. Conservative treatment with cessation of oral intake, intravenous broad-spectrum antibiotic...

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 Febru...

Endovascular treatment options for the superficial femoral artery are evolving rapidly. For long lesions, the venous femoropopliteal bypass considered to be superior above the prosthetic bypass. An endoluminal bypass, however, may provide equal patency rates compared to the prosthetic above knee bypass. The introduction of heparin-bonded endografts...

Met betrekking tot het onderwerp chirurgie en lymfoedeem zijn er twee belangrijke vragen. Allereerst: bestaat er een wetenschappelijk bewezen c.q. wetenschappelijk aanvaardbare chirurgische behandeling van lymfoedeem? En vervolgens: kan men ‘straffeloos’ een operatie uitvoeren in de aanwezigheid van lymfoedeem?

The simple technique described here facilitates the left thoracoabdominal approach, preserves diaphragmatic function, and allows precise and safe reconstruction. It provides excellent exposure of the distal esophagus, esophagogastric junction and stomach, allows precise dissection and reconstruction, and is well tolerated by the patients.