Papers by Isabelle Van Herzeele
日本外科学会雑誌, 2007
... Brightwell Rob; Department of Biosurgery and Surgical Technology, Imperial College London. Da... more ... Brightwell Rob; Department of Biosurgery and Surgical Technology, Imperial College London. Darzi Ara; Department of Biosurgery and Surgical Technology, Imperial College London. CheshireNick; Department of Biosurgery and Surgical Technology, Imperial College London. ...
British Journal of Surgery, 2012
Background Recent advances in simulation science permit patient-specific rehearsal of endovascula... more Background Recent advances in simulation science permit patient-specific rehearsal of endovascular stenting procedures. This study aimed to evaluate how effectively real interventions are replicated by patient-specific rehearsal technology, and to assess its value as a preparatory tool for the interventionalist and the operating team. Methods All patients deemed candidates for carotid artery stenting procedures with suitable computed tomography images were enrolled. Each team member rehearsed the virtual procedure in the laboratory, simulated operating theatre or angiography suite environment immediately before treating the real patient. Dexterity and qualitative metrics were recorded. Subjective questionnaires used a Likert scale from 1 (poor) to 5 (excellent). Results Of 18 patients, three were excluded. In 11 of 15 and 13 of 15 patients respectively endovascular tool use and fluoroscopy angles were identical during rehearsal and the real procedure. In a third of patients, the sim...
European Journal of Vascular and Endovascular Surgery
Asian Cardiovascular and Thoracic Annals, 2013
A 39-year-old man was referred with a diagnosis of double aortic arch. Chest radiography showed m... more A 39-year-old man was referred with a diagnosis of double aortic arch. Chest radiography showed mild enlargement of the upper mediastinum. Chest computed tomography revealed a right-sided aortic arch with specular transposition of the epiaortic vessels and a Kommerell’s diverticulum at the origin of the left subclavian artery (Figure 1(A) and (B)), as well as a left-sided hypoplastic aortic arch (Figure 1(C) Asian Cardiovascular & Thoracic Annals 21(2) 243–244 The Author(s) 2012 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0218492312450022 aan.sagepub.com
The Journal of Cardiovascular Surgery, 2019
BACKGROUND Concomitant malignant disease and abdominal aortic aneurysms (AAA) represent a challen... more BACKGROUND Concomitant malignant disease and abdominal aortic aneurysms (AAA) represent a challenging issue in terms of treatment priority, timing and perspectives. This narrative review provides an overview of the available literature managing AAA and concomitant malignant disease. METHODS We conducted a literature search of all the English-language medical literature in Medline (through PubMed), Embase, Clinical Trial databases and the Cochrane Library up to December 31st, 2018. RESULTS The literature about AAA and concomitant malignant disease is mostly based on retrospective small case series. Two recently published meta-analyses focusing on the management of AAA and concomitant abdominal neoplasms came to the same conclusion "treat what is most threatening or symptomatic first". The threshold to treat asymptomatic AAA should not be altered in patients with AAA and concomitant cancer including cases under chemotherapy. An asymptomatic AAA of at least 55 mm anatomically suitable for EVAR, should only be treated first in patients with at least a life expectancy of two years followed by staged cancer surgery two weeks later. CONCLUSIONS Decisions about management of AAA and concomitant malignant disease should be based on clinical judgment applied individually in a multidisciplinary setting "Treat first, what kills first". The indication for treatment is not different than in patients with AAA without cancer. A staged approach is preferable and ideally the AAA should be excluded by endovascular means if anatomically suitable. An international registry should be initiated to gather more evidence about the management and outcomes of patients with AAA and concomitant carcinoma.
Acta Chirurgica Belgica, 2022
Epithelioid angiosarcoma is a rare soft tissue sarcoma with a poor prognosis.We report two cases ... more Epithelioid angiosarcoma is a rare soft tissue sarcoma with a poor prognosis.We report two cases of patients who presented with a history of lower back pain, inflammatory signs and weight loss five and six years after endovascular aortic repair (EVAR) of an elective infrarenal abdominal aortic aneurysm (AAA). Imaging suggested graft infection but tissue samples revealed an epithelioid angiosarcoma. The objective is to report the clinical presentation, investigative modalities and immunohistochemical findings of an angiosarcoma after EVAR. Two cases are described of an angiosarcoma of the aorta after EVAR. A literature search using PubMed, Embase and Web of Science was performed in English about angiosarcoma after EVAR published between 2007 and 2021. Relevant reports were selected and analysed. Fifteen case reports were identified, including the current two cases. Time to tumour detection after EVAR ranged from 6 to 120 months with a mean interval of 68 months. Most patients underwent endovascular repair of an AAA (13/15). Males (13 male/2 female patients) were predominant with a median age of 72 years (IQR 68-78 years). Over half of the patients had metastases at the time of diagnosis (9/15), most frequently in bones and liver. Diagnosis of angiosarcoma after EVAR remains challenging due to indistinctive clinical and radiological findings mimicking graft infection or endoleak. Angiosarcoma should be included in the differential diagnosis in patients previously treated with EVAR presenting with unintended weight loss, abdominal back pain and contrast enhancement of the aortic wall.
Journal of Vascular Surgery, 2022
Postgraduate Medical Journal, 2022
Purpose of the studyTo collect validity evidence for the chest tube insertion (CTI) test mode on ... more Purpose of the studyTo collect validity evidence for the chest tube insertion (CTI) test mode on the medical simulation application Touch Surgery. This was done by using Messick’s contemporary framework.MethodsNovice, intermediate and experienced participants provided informed consent and demographic information. After familiarisation with the application, they completed the CTI test mode. Validity evidence was collected from four sources: content, response process, relation to other variables and consequences. A post-study questionnaire with 5-point Likert scales assessed the perceived realism, relevance and utility of the assessment. Mean scores of the three groups were compared.ResultsA total of 25 novices, 11 intermediates and 19 experienced participants were recruited. Content evidence was collected by an expert in CTI and was based on published literature and guidelines. All users were familiarised with the application, and received standardised instructions throughout the tes...
The Journal of Cardiovascular Surgery, 2021
Journal of Endovascular Therapy, 2022
Objective: Competency-based surgical education requires detailed and actionable feedback to ensur... more Objective: Competency-based surgical education requires detailed and actionable feedback to ensure adequate and efficient skill development. Comprehensive operative capture systems such as the Operating Room Black Box (ORBB; Surgical Safety Technologies, Inc), which continuously records and synchronizes multiple sources of intraoperative data, have recently been integrated into hybrid rooms to provide targeted feedback to endovascular teams. The objective of this study is to develop step, error, and event frameworks to evaluate technical performance in elective endovascular aortic repair (EVAR) comprehensively captured by the ORBB (Surgical Safety Technologies, Inc; Toronto, Canada). Methods: This study is based upon a modified Delphi consensus process to create evaluation frameworks for steps, errors, and events in EVAR. International experts from Vascular Surgery and Interventional Radiology were identified, based on their records of publications and invited presentations, or serv...
Frontiers in Cardiovascular Medicine, 2021
Objective: Thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD) aims t... more Objective: Thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD) aims to induce false lumen (FL) thrombosis by sealing intimal tears between the true (TL) and the FL, and blocking the inflow into the FL. Incomplete thrombosis of the FL is correlated with poor clinical outcome. We hypothesize that the number of major and minor branches arising from the FL affects FL patency and may negatively influence TEVAR induced FL thrombosis.Methods: Computed tomography (CT)-scans from 89 patients diagnosed with TBAD [best medical treatment (BMT) n = 52, TEVAR n = 37] from two high-volume vascular surgery centers were analyzed retrospectively. Analysis included evaluation of the FL patency status, the number, location and size of intimal tears, and the presence of minor and major side branches originating from the FL. Multiple regression analysis was conducted to evaluate obtained parameters as predictors for FL thrombosis status.Results: In univariate analysis, the str...
European Journal of Vascular and Endovascular Surgery, 2021
American Journal of Cardiology, 2006
The last decade has witnessed exponential growth in the field of endovascular interventions, alth... more The last decade has witnessed exponential growth in the field of endovascular interventions, although only in the last few years has there been a widespread interest in the carotid artery stent (CAS). Endovascular physicians with different medical backgrounds such as interventional cardiologists, radiologists, and vascular surgeons all recognize the importance of this changing technology. 1 This procedure is almost unique, as the risks to the patient (stroke and death) as a result of the physician’s learning curve are unacceptably high. This has been summarized by editorials written after the publication of the Carotid and Vertebral Artery Angioplasty Study (CAVATAS) 2‐4 and the Endarterectomy versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis trial (EVA-3S). 5‐7 Recent publications of the rates of medical errors and adverse events within healthcare 8 have drawn the spotlight toward methods of establishing credentials for physicians preparing to perform complex ...
European Journal of Vascular and Endovascular Surgery, 2021
A randomised controlled trial (RCT) showed superior real life endovascular performance of trainee... more A randomised controlled trial (RCT) showed superior real life endovascular performance of trainees after PROficiency based StePwise Endovascular Curricular Training (PROSPECT) compared with traditional training. This study aimed to determine whether PROSPECT can be implemented routinely in surgical training (registry) and to identify the associated effects, facilitators, and barriers to implementation. This was a multicentre prospective registry to evaluate real life PROSPECT implementation effects. Cognitive ability was tested with a Multiple Choice Question test (MCQ) (max. score 20 points), while technical skills were assessed with a Global Rating Scale (GRS) (max. score 55 points), Examiner's Checklist (max, score 85 points), and simulator metrics. A cross sectional anonymous survey for both trainees and faculty evaluated the programme's implementation. The PROSPECT registry was implemented in five centres in four countries over a period of three years. Only 17 of 48 starting trainees completed PROSPECT, resulting in a dropout rate of 65%. Participants who completed the programme showed significant improvement in the GRS (median 26 vs. 44, p = .018) and Examiner's Checklist (median 53.5 vs. 80, p = .028) after the programme. The survey was completed by 13/17 faculty members (76%) and 38/57 trainees who participated either in the initial PROSPECT RCT or the registry (67%). PROSPECT was perceived to provide more endovascular training opportunities, but non-availability of logistical/technical support, lack of training time within the working schedule, and little trainee motivation hindered broad implementation. PROSPECT has a significant effect on performance, and trainees and faculty agree that PROSPECT is a valuable addition to surgical training. However, external and internal factors pose significant barriers to integration of this simulation based programme into daily practice leading to a high dropout rate. To integrate PROSPECT into contemporary surgical training, it should be a prerequisite to treating real patients and protected training time should be provided, combined with accessible support.
European Stroke Journal, 2021
Atherosclerotic stenosis of the internal carotid artery is an important cause of stroke. The aim ... more Atherosclerotic stenosis of the internal carotid artery is an important cause of stroke. The aim of this guideline is to analyse the evidence pertaining to medical, surgical and endovascular treatment of patients with carotid stenosis. These guidelines were developed based on the ESO standard operating procedure and followed the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. The working group identified relevant questions, performed systematic reviews and meta-analyses of the literature, assessed the quality of the available evidence, and wrote recommendations. Based on moderate quality evidence, we recommend carotid endarterectomy (CEA) in patients with ≥60–99% asymptomatic carotid stenosis considered to be at increased risk of stroke on best medical treatment (BMT) alone. We also recommend CEA for patients with ≥70–99% symptomatic stenosis, and we suggest CEA for patients with 50–69% symptomatic stenosis. Based on high quality evidence, we re...
European Journal of Vascular and Endovascular Surgery, 2021
OBJECTIVE The aim of this study was to systematically review the literature and give evidence bas... more OBJECTIVE The aim of this study was to systematically review the literature and give evidence based recommendations for future initiatives for simulation based training (SBT) and assessment in open vascular surgery. DATA SOURCES PubMed, Embase, and the Cochrane Library. REVIEW METHODS A systematic review of PubMed, Embase, and the Cochrane Library was performed, with the last search on 31 March 2020, to identify studies describing SBT and assessment in open vascular surgery. Kirkpatrick's levels for efficacy of training were evaluated. Validity evidence for assessment tools was evaluated according to the recommended contemporary framework by Messick. RESULTS Of 2 844 studies, 51 were included for data extraction. A high degree of heterogeneity in reporting standards and varying types of simulation was found. Vascular anastomosis was the most frequently simulated technical skill (43%). Assessment was mostly carried out using the Objective Structured Assessment of Technical Skills (55%). Validity evidence for assessment tools was found using outdated frameworks, and only one study used Messick's framework. Self directed training is valuable, the low trainer to trainee ratio is important to maximise efficiency, and experienced vascular surgeons are the most effective trainers. CONCLUSION Carefully designed and structured SBT is effective and can improve technical skills, especially in less experienced trainees. However, the supporting evidence lacks homogeneity in the reporting standards and types of simulations. Pass/fail standards that support proficiency based learning and studies investigating skills transfer should be the focus in future studies. Validity evidence of assessment tools needs to be addressed using contemporary frameworks.
US Cardiology Review, 2008
European Journal of Vascular and Endovascular Surgery, 2019
Conclusion -A systematic review of 113 reports of endovascular therapy for blunt carotid trauma s... more Conclusion -A systematic review of 113 reports of endovascular therapy for blunt carotid trauma showed that this treatment modality resulted in similar stroke incidence with a lower overall mortality rate when compared with conventional surgery 2 . However, further prospective analysis is justified, as clear indications for treatment, the endovascular approach associated with the best outcome and longterm follow-up results are required 3 . References 1. Fusco, MR, Harrigan, MR. Cerebrovascular dissections: a review. Part II: blunt cerebrovascular injury.
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Papers by Isabelle Van Herzeele