Talk first, fix later: exploring shared decisions in vascular surgery and securing iliac limbs post-EVAR
Talk first, fix later: exploring shared decisions in vascular surgery and securing iliac limbs post-EVAR
Vascular surgery has changed significantly over the past decades. Patients are older, more vulnerable, and often have multiple health conditions at the same time, making treatment decisions more complex. It is important that doctors and patients make decisions together about the best treatment, taking into account not only medical factors but also the patient’s personal situation and preferences (shared decision-making). In practice, however, this does not always happen naturally. Patients do not always feel sufficiently involved, and medical information can be difficult to understand. Discussions between doctors often focus mainly on technical aspects, while personal factors receive less attention. In addition, patients do not always share all their concerns and preferences with their surgeon.
At the same time, technological innovation has transformed the field. An important example is the treatment of a bulging of the main abdominal artery (aneurysm). Today, this can often be treated with a minimally invasive procedure through the groin, in which a stent is placed (EVAR). While this approach is safer in the short term, problems can arise in the longer term if the stent no longer fits properly. This can lead to leakage (an endoleak), causing the aneurysm to come under pressure again. This thesis if Maria Annette Kooijman shows that such problems usually do not occur suddenly, but develop gradually and can already be detected on scans at an early stage. By identifying these changes in time, doctors can intervene earlier and prevent complications.
This thesis shows that modern vascular surgery lies at the intersection of technological innovation and patient-centred care. Improving shared decision-making requires dedicated efforts from patients, healthcare professionals, and the healthcare system. In addition, achieving durable treatment outcomes requires systematic attention to early warning signs of problems. Together, these insights contribute to care that is both technologically advanced and better tailored to the individual patient.