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[The added value of a structured evaluation of patients with vascular disease]
S J H Bredie1, H C H Wollersheim, J W M Lenders
1Universitair Medisch Centrum St Radboud, afd. Algemeen Interne Geneeskunde, Postbus 9101, 6500 HB Nijmegen. s.bredie@aig.azn.nl
Insights
A structured, vascular-system-wide approach improved diagnosis and management for patients with complex vascular conditions. This holistic strategy, involving multidisciplinary teams, is crucial for optimizing patient care and outcomes.
Area of Science:
- Vascular Medicine
- Cardiology
- Diagnostic Medicine
Background:
- Traditional organ-specific diagnostic methods failed to identify the underlying cause in patients with complex, widespread vascular conditions.
- Patients presented with diverse symptoms indicative of systemic vascular issues, challenging conventional diagnostic pathways.
Observation:
- An organ-specific diagnostic approach was insufficient for three patients with extensive vascular conditions.
- A structured, protocol-based evaluation focusing on the entire vascular system and associated risk factors was implemented.
Findings:
- The holistic approach identified treatable risk factors, improving outcomes for two patients.
- One patient experienced a fatal outcome (ventricular fibrillation), highlighting the critical nature of early and accurate diagnosis in vascular disease.
- Risk factor modification obviated the need for a planned bypass surgery in one male patient.
Implications:
- A multidisciplinary team approach, including vascular specialists and nurse practitioners with expertise in risk factors and lifestyle interventions, is essential for optimizing care.
- Structured evaluation of the entire vascular system is critical for accurate diagnosis and effective management of complex vascular disorders.
- Early identification and management of vascular risk factors can significantly alter disease progression and treatment necessity.
Abstract:
In 3 patients, 2 women aged 21 and 34 years and a man aged 56 years, with complaints related to wide-ranging and extensive vascular conditions, an organ-specific diagnostic approach and treatment did not lead to the correct diagnosis of the underlying clinical condition. Hereafter a structured, partly protocol-based approach was started which considered the entire vascular system and risk factors for vascular disease. The youngest women died a few years later due to ventricular fibrillation, while the two other patients were assisted in reducing those risk factors that could be influenced. As a result, the planned bypass operation was no longer necessary for the male patient. A structured evaluation by a multidisciplinary team can optimise the care of these patients. The basis of such a team consists of a vascular specialist and vascular nurse-practitioner, both of whom should have specific knowledge of risk factors, aetiology, life style intervention and treatment of these disorders.