http://repub.eur.nl/res/aut/10160/ List of Publications en http://repub.eur.nl/static-eur/img/logo.png http://repub.eur.nl http://repub.eur.nl/res/pub/32023/ 2002-10-30T00:00:00Z This thesis presents 7 studies that examined the results of balloon dilation and stent placement performed for treatment of Peripheral Arterial Disease (PAD). The first 2 studies (chapter 2 and 3) explored the prognostic value of baseline characteristics on the outcome of the intervention. The outcome measures considered included occurrence of complications. improvement in ABI. and improvement in symptomatic status. The main results were that symptomatic status prior to intervention and renal function are important independent predictors of the occurrence of a systemic complication and that symptomatic status. diabetic status, lesion length, severity of stenosis, lesion localization, arterial runoff are important independent predictors for failure to improve symptomatic status and failure to improve the ABI. Furthermore the results showed that patients with lesions shorter than 10 em had a better prognosis than patients with lesions longer than 10 em. Within the group of patients with lesions shorter than 10 em no difference in prognosis was detected. Patients treated for severe stenoses or even occlusions had a better prognosis on improvement of symptomatic status or ABI than patients treated with milder stenoses http://repub.eur.nl/res/pub/9586/ 2001-01-01T00:00:00Z PURPOSE: To determine the criteria that would make use of an endovascular device cost-effective compared with bypass surgery and percutaneous transluminal angioplasty in the treatment of femoropopliteal arterial disease. MATERIALS AND METHODS: A decision model was developed to compare treatment with the use of a hypothetical endovascular device with established therapies. Cost-effectiveness from the perspective of the health care system was considered. Outcome measures were lifetime costs and quality-adjusted life-years. With the use of net health benefit calculations and threshold analysis, combinations of costs and patency rates were determined that would make the device cost-effective compared with established therapies. In subgroup and sensitivity analyses, the effect on decision-making of sex, age, indication, lesion type, procedural risk, and society's willingness to pay for incremental gain in health were explored. RESULTS: Use of a device that costs $3,000 would be cost-effective compared with bypass surgery for critical ischemia if the 5-year patency rate is 29%-46%. Use of the same device would be cost-effective compared with angioplasty for disabling claudication and stenosis if the 5-year patency rate is 69%-86%. CONCLUSION: The target combinations of costs and patency rates found in this study are probably attainable, and further development of such endovascular devices seems warranted. http://repub.eur.nl/res/pub/9763/ 2001-01-01T00:00:00Z PURPOSE: To perform a meta-analysis of long-term results of balloon dilation and stent implantation in the treatment of femoropopliteal arterial disease. MATERIALS AND METHODS: The English-language literature was searched for studies published between 1993 and 2000. Inclusion criteria for articles were presentation of long-term primary patency rates, standard errors (explicitly reported or derivable), and baseline characteristics of the study population. Two reviewers independently extracted data, and discrepancies were resolved by consensus. Primary patency rates were combined by using a technique that allows adjustment for differences across study populations. Analyses were adjusted for lesion type and clinical indication. RESULTS: Nineteen studies met the inclusion criteria, representing 923 balloon dilations and 473 stent implantations. Combined 3-year patency rates after balloon dilation were 61% (standard error, 2.2%) for stenoses and claudication, 48% (standard error, 3.3%) for occlusions and claudication, 43% (standard error, 4.1%) for stenoses and critical ischemia, and 30% (standard error, 3.7%) for occlusions and critical ischemia. The 3-year patency rates after stent implantation were 63%-66% (standard error, 4.1%) and were independent of clinical indication and lesion type. Funnel plots demonstrated an asymmetric distribution of the data points associated with stent studies. CONCLUSION: Balloon dilation and stent implantation for claudication and stenosis yield similar long-term patency rates. For more severe femoropopliteal disease, the results of stent implantation seem more favorable. Publication bias could not be ruled out.