Improving care for vascular surgery patients: a plea for health literacy and perfusion assessments
Improving care for vascular surgery patients: a plea for health literacy and perfusion assessments
This thesis of Goudje van Leeuwen focuses on two common vascular surgical conditions: peripheral arterial disease (PAD) and abdominal aortic aneurysm (AAA). In both conditions, treatment decisions are often complex and depend on individual circumstances, risks, and patient preferences. Clear information and shared decision-making are therefore essential components of high-quality care.
The first part of this thesis examines health literacy, disease knowledge, and experiences with shared decision-making among patients with PAD and AAA. A literature review shows that health literacy and disease knowledge in vascular surgical patients are often limited and measured in highly variable ways. In a quantitative study, a substantial proportion of patients was found to have low health literacy, particularly among frail patients and those with a lower educational level. This proportion may be underestimated, as the assessment tool used relies on self-report. Qualitative interviews revealed that many patients feel insufficiently involved in treatment decisions. Personal values and concerns are not always discussed, and levels of disease understanding vary widely, even among patients who believe they are well informed.
The second part of this thesis focuses on tissue perfusion assessment and novel endovascular treatments in PAD. Because the severity of large-vessel stenoses does not always correspond to actual tissue perfusion in the leg, reliable methods to measure tissue-level blood flow are needed. Although several invasive and non-invasive techniques show promise, a clear gold standard is currently lacking. This thesis demonstrates that ¹⁵O-H₂O PET-CT is technically reliable for measuring calf muscle perfusion, although further research is required to determine its clinical applicability. In addition, studies on new endovascular techniques show that these approaches are technically feasible, but emphasize the importance of careful patient selection and consideration of long-term outcomes.