Vascular Interventional Surgery Research Articles

Vascular surgery intervention in Lemierre's syndrome: case report and systematic review

Vascular surgery intervention in Lemierre's syndrome: case report and systematic review

A New Design of Two-Fingered Catheter Operating Robot for Vascular Interventional Surgery

A New Design of Two-Fingered Catheter Operating Robot for Vascular Interventional Surgery

Coronary Heart Disease Preoperative Gesture Interactive Diagnostic System Based on Augmented Reality.

Coronary heart disease preoperative diagnosis plays an important role in the treatment of vascular interventional surgery. Actually, most doctors are used to diagnosing the position of the vascular stenosis and then empirically estimating vascular stenosis by selective coronary angiography images instead of using mouse, keyboard and computer during preoperative diagnosis. The invasive diagnostic modality is short of intuitive and natural interaction and the results are not accurate enough. Aiming at above problems, the coronary heart disease preoperative gesture interactive diagnostic system based on Augmented Reality is proposed. The system uses Leap Motion Controller to capture hand gesture video sequences and extract the features which that are the position and orientation vector of the gesture motion trajectory and the change of the hand shape. The training planet is determined by K-means algorithm and then the effect of gesture training is improved by multi-features and multi-observation sequences for gesture training. The reusability of gesture is improved by establishing the state transition model. The algorithm efficiency is improved by gesture prejudgment which is used by threshold discriminating before recognition. The integrity of the trajectory is preserved and the gesture motion space is extended by employing space rotation transformation of gesture manipulation plane. Ultimately, the gesture recognition based on SRT-HMM is realized. The diagnosis and measurement of the vascular stenosis are intuitively and naturally realized by operating and measuring the coronary artery model with augmented reality and gesture interaction techniques. All of the gesture recognition experiments show the distinguish ability and generalization ability of the algorithm and gesture interaction experiments prove the availability and reliability of the system.

Vascular surgery: An essential hospital resource in modern health care

In modern health care, vascular surgeons frequently serve as a unique resource to other surgical specialties for vascular exposure, repair, reconstruction, or control. These services occur both in planned and unplanned clinical settings. We analyzed the frequency, outcomes, and value of vascular services in this setting to other surgical specialties and the hospital. Intraoperative planned and unplanned vascular surgery operative consultations were reviewed over a 3-year period (2013-2016). Patient demographics, requesting surgical specialty, indication and type of vascular intervention, and work relative value units generated were recorded. Univariate and multivariate analysis of factors affecting a composite outcome of in-hospital and 30-day mortality or morbidity, or both, was performed. Seventy-six vascular surgery intraoperative consultations were performed, of which 56% of the consultations were unplanned. The most common unplanned consultation was for bleeding (33%). The aorta and lower extremity were the most common vascular beds requiring vascular services. The mean work relative value units generated per vascular surgery intervention was 23.8. In-hospital and 30-day mortality was 9.2%. No difference in mortality and morbidity was found between planned and unplanned consultations. Factors associated with the composite mortality/morbidity outcome were coronary artery disease (P= .002), heart failure (P= .02), total operative blood loss (P= .009), consultation for limb ischemia (P= .013), and vascular consultation for the lower extremity (P= .01). On multivariate analysis, high operative blood loss (>5000mL) remained significant (P= .04), and coronary artery disease approached significance (P= .06). The need for vascular surgery services is frequent, involves diverse vascular beds, and occurs commonly in an unplanned setting. When requested, vascular surgery services effectively facilitate the completion of the nonvascular procedure, even those associated with significant intraoperative blood loss. Vascular surgery services are essential to other surgical specialties and the hospital in today's modern health care environment.

Usage of perioperative anxiety neuromarker for improving the quality of life of a patient operated on for critical stenosis of the internal carotid artery.

The aim of the study was to find a neuromarker of perioperative anxiety in a patient with critical carotid stenosis through the use of neuromarkers in Quantitative EEG (QEEG) and Event Related Potentials (ERPs). The indirect purpose of the research was evaluation of improvement in the patient's quality of life. A 45-year-old woman was admitted to the Department of Vascular Surgery and Endovascular Interventions at the John Paul II Hospital in Krakow, with the diagnosis of critical internal carotid stenosis (over 80%), confirmed by Doppler Ultrasound and Angio-CT examinations. Before hospitalization, the patient had not presented any symptoms of brain ischemia. It was found that severe anxiety on the Hospital Anxiety and Depression Scale (HAD) was worse before the surgery. After the operation, a reduction anxiety in occurred as well as an improvement in the majority of the dimensions of health. Therefore, her quality of life improved. Significant changes were observed on the Hospital Anxiety and Depression Scale (HAD). Modern neurotechnologies measures are necessary to capture all the changes in the symptoms of anxiety before and after the operation for a carotid stenosis. ERPs might be used to select patients with neuromarker of perioperative anxiety, and subsequently to serve in proper psychological care and minimalize the perioperative risk of complications.

Design and characteristics evaluation of a novel teleoperated robotic catheterization system with force feedback for vascular interventional surgery.

In this paper, we proposed a novel master-slave robotic catheterization system with force feedback for VIS (Vascular Interventional Surgery). The force feedback to the operator on the master side is the key factor to improve the safety during VIS. The developed system used the MR (magneto rheological) fluid to realize force feedback, and it used the developed multidimensional monitoring interface to realize the visualization of force feedback, the developed multidimensional monitoring interface can monitor the motion information of the catheter and contact force between catheter tip or side wall and blood vessel wall, and the motion data of the catheter was collected and generated diagram for reference to surgeon. We have developed a force sensor array to detect the contact force between catheter tip or side wall and blood vessel wall. The force information was detected by the developed contact force sensor array when the catheter contacted with the blood vessel. The force feedback and multidimensional information monitoring interface evaluation experiments were done, the tracking characteristic evaluation experiments were also carried out, the experimental results indicated that the developed novel robotic catheterization system with force feedback and visualization of force feedback is effective for VIS, it can improve the safety during VIS.

Combination of Vascular Intervention Surgery and Free Tissue Transfer for Critical Diabetic Limb Salvage.

Complex, nontraumatic diabetic foot ulcers with peripheral vascular compromise often lead to extensive lower-limb amputation. The aim of this study is to determine the outcome of combined vascular intervention and free tissue transfer for critical diabetic limb salvage. A total of 26 consecutive diabetic patients with 28 legs with diabetic foot ulcers who underwent limb salvage with a combination of revascularization (bypass surgery or endovascular angioplasty) and free flap transfers were reviewed. There were 14 male and 12 female patients. The average age was 58.8 years (range, 35-85 years). Amputation-free survival and complete wound healing were defined as the primary endpoints. All preoperative and postoperative data were retrospectively analyzed. Thirty flaps were used for reconstruction in 28 legs, including 21 free anterolateral thigh (ALT) perforator flaps, 3 ALT myocutaneous flaps, 5 gracilis muscle flaps, and 1 latissimus dorsi muscle flap. All flaps used end-to-side anastomoses for the recipient artery and end-to-end anastomoses for the recipient vein. The overall flap success rate was 90% (27/30). Two flaps failed completely because of severe arteriosclerosis, which resulted in anastomosed vessel thrombosis. New flaps were applied in both cases after debridement and trimming of necrotic tissue. One flap failed because of restenosis and inadequate perfusion combined with severe infection, resulting in pedicle thrombosis. A below-knee amputation was subsequently performed. Seven flaps exhibited a partial loss, including 6 ALT perforator flaps and 1 latissimus dorsi flap, because of inadequate margin perfusion. After debridement, the flap revision and wound care, 5 flaps healed uneventfully without additional intervention. The remaining 2 ALT perforator flaps required debridement with a skin graft. The limb-salvage rates were 92.8% after 1 year and 89.2% after 5 years. The combination of peripheral arterial intervention and free tissue transfer resulted in successful wound healing and limb salvage instead of amputation in select diabetic patients with difficult-to-heal wounds.

Design and characteristics evaluation of a novel VR-based robot-assisted catheterization training system with force feedback for vascular interventional surgery

Vascular interventional surgery has been become a specialized surgical technique because it can minimize the trauma and shorten the recovery time, but it needs more accurate operation and image to guide the surgery. In the meantime, it needs that the doctor has a great deal of experience. Moreover, it needs to train the novice because of the lack of experienced neurosurgeons. In order to solve aforementioned problems, the training system for vascular interventional surgery was proposed. A novel VR-based robot-assisted catheterization training system is designed to solve these problems. This system is composed of the virtual environment and the haptic device. The virtual environment included a catheter model and a vascular model to realize the synchronous movement with the haptic device. In order to imitate soft tissue deformation, mass-spring model has been proposed in physical modeling. In this paper we established a dynamics equation of the moving catheter. We analyzed the elasticity distribution of the wall of vascular according to the previous research. The haptic interaction device based on magneto-rheological fluid as the master manipulator was applied to control the movement of the catheter model in the virtual environment and realize haptic feedback. At the same time, a force feedback calculation model for the novel master manipulator has been proposed. Ten times experiments both in axial movement direction and in radial movement respectively, are carried out, there was within 0.74 mm error in axial movement direction and 3.5° error in radial movement direction. When the moving speed of the catheter is 5 mm/s, the force error between the virtual environment and the feedback force of the damper is within 0.3 mN. The error is in the range which is permitted during VIS. The proposed method improved accurate operability and traceability in this novel VR robotic catheter training system. It offers users better visualization and control. The experimental results indicate that the performance of the synchronous movement and the force feedback can meet our design requirement. The developed training system can be used to train novice for VIS.

SS06. Effect of Postoperative Anemia and Baseline Cardiac Risk on Adverse Outcomes After Vascular Surgery Interventions

Published data suggest that permissive anemia strategies allowing nadir hemoglobin (nHb) 7 g/dL or lower are safe in a variety of clinical settings. The appropriateness of these strategies in patients at high risk for adverse postoperative cardiac events remains unclear. We sought to determine the combined effect of postoperative nHb and cardiac risk status on major complications after vascular surgical interventions. This was a single-institution retrospective analysis of patients who underwent elective open procedures for occlusive vascular disease or aneurysm repair, either open or endovascular. The Revised Cardiac Risk Index (RCRI) was used to assess baseline cardiac risk. Primary outcome was a composite end point (CE) of mortality or major ischemic events (myocardial infarction, stroke, acute kidney injury, or coronary revascularization) within 90 days from the index operation. Secondary outcomes included ICU length of stay (ICU LOS), and 90-day respiratory complications (pneumonia, ventilator dependence for >48 hours postoperatively, or reintubation). Hierarchical multivariable regression was used to model each outcome with adjustment for age, type of operation, comorbidities, and intraoperative covariates. We analyzed 2509 operations performed over 8 years in 1872 patients with mean age 65 (range, 43 to 94) years. In the fully adjusted multivariable model, higher values of nHb were strongly protective from the primary CE (OR, 0.79; P < .0001), representing 21% reduction in the odds of the CE per g/dL increase in nHb). In the same model, RCRI class II (OR, 1.8; P < .0001), class III (OR, 2.07; P < 0.0001), and class IV (OR, 2.38; P < 00001) were associated with progressively increasing odds of the CE compared with RCRI class I (Table). The curvilinear association between the probability of the primary end point occurring over a range of nHb and cardiac risk strata is demonstrated in the Fig. An interaction term between transfusion and nHb was not significant statistically, indicating that the harmful effect of anemia was independent of blood transfusion. Higher values of nHb were favorably associated with respiratory complications (OR, 0.7; P < .0001) and ICU LOS (average 0.47 day reduction per g/dL increase of nHb; P < .0001). Postoperative anemia increases the rate of early postoperative mortality and major ischemic events, particularly in patients at higher baseline cardiac risk. It also adversely affects respiratory complications and ICU LOS. Until a randomized trial definitively settles the issue, restrictive transfusion strategies should be practiced with caution in patients undergoing major vascular interventions.TableThe final fully adjusted multivariate model with the composite end point of 90-day mortality or ischemic events as the dependent variablePredictorOR95% CIP valueNadir hemoglobin0.79(0.74-0.85)<.0001RCRI Class IReferenceReferenceReference II1.76(1.29-2.42)<.0001 III2.06(1.45-2.93)<.0001 IV2.35(1.58-3.48)<.0001Intraoperative blood lossa1.03(1.00-1.06).05ACE inhibitors0.78(0.61-0.99).04ACE, Angiotensin converting enzyme; CI, confidence interval; OR, odds ratio; RCRI, Revised Cardiac Risk Index.aIntraoperative blood loss is modeled in increments of 100 mL, so the demonstrated OR indicates odds of the composite end point per 100-mL increase in blood loss. Open table in a new tab

A fast and stable vascular deformation scheme for interventional surgery training system.

BackgroundThe emergence and development of robot assistant interventional vascular surgery technologies have benefited many patients with cardiovascular or cerebrovascular diseases. Due to the absence of effective training measures, these new advanced technologies have not been fully utilized and only few experienced surgeons can perform such complicated surgeries so far. In order to solve such problems, virtual reality based vascular interventional surgery training system, a promising way to train young surgeons or assist experienced surgeons to perform surgery, has been widely studied.MethodsIn this paper, we mainly conduct a thorough study on both reliable deformation and high real-time performance of an interactive surgery training system. An efficient hybrid geometric blood vessel model which handles the collision detection query and vascular deformation calculation separately is employed to enhance the real-time performance of our surgery training system. In addition, a position-based dynamic approach with volume conservation constraint is used to improve the vascular deformation result. Finally, a hash table based spatial adaptive acceleration algorithm which makes the training system much more efficient and reliable is described.ResultsSeveral necessary experiments are conducted to validate the vascular deformation scheme presented in this paper. From the results we can see that the position-based dynamic modeling method with volume conservation constraint can prevent the vascular deformation from the issue of penetration. In addition, the deformation calculation with spatial acceleration algorithm has enhanced the real-time performance significantly.ConclusionThe corresponding experimental results indicate that both the hybrid geometric blood vessel model and the hash table based spatial adaptive acceleration algorithm can enhance the performance of our surgery training system greatly without losing the deformation accuracy.

Design and initial enrollment in the Vascular Physicians Offer and Report (VAPOR) trial

Although patient smoking cessation is a key priority for vascular surgeons, significant variation exists in the manner in which vascular surgeons address this key process of care. We describe a multicenter, cluster-randomized trial that compares a standardized, brief smoking cessation intervention to usual care for patients facing vascular surgery or endovascular interventions. Eight centers were randomized to provide usual care for smoking cessation or a standardized protocol consisting of (1) physician "very brief advice" to stop smoking, (2) offering nicotine replacement therapy, and (3) referral to a phone-based counseling service. Trial enrollment began on September 1, 2014. At present, 142 patients had been enrolled in the trial across eight sites. Compared with patients in the usual care arm, patients enrolled in the smoking cessation intervention arm were more likely to receive physician advice (98% vs 77%), a prescription for nicotine replacement therapy (77% vs 13%), and quitline referral (93% vs 33%; all P< .001). Although final results of the intervention on smoking cessation rates are still forthcoming, surgeon delivery of a brief, evidence-based smoking cessation intervention appears feasible for patients facing invasive vascular care.

Design and performance evaluation of a novel robotic catheter system for vascular interventional surgery

Vascular interventional surgery (VIS) is an effective treatment method for vascular diseases. However, there are many problems in traditional VIS, such as surgeons are radiated by X-ray, the lack of well skilled surgeons, the security of the surgery will be reduced due to the Surgeons' fatigue, high risk of the surgery. To solve these problems, a robotic catheter system is needed to protect the surgeons and enhance the safety of the surgery. In this paper, a novel robotic catheter system with master---slave structure for VIS has been developed. This system is designed with the consideration of the operation method in traditional VIS, which allows the surgeon to operate a real catheter on the master side, then the surgeon make full use of the natural catheter manipulation experience and skills obtained in conventional catheter operation. The salve manipulator operates the catheter insert into the blood vessel with following the operation of the surgeon, and the operating force of the salve manipulator is detected. On the master side, a novel damper-based magnetorheological (MR) fluid is designed to realize the force feedback, which is also used to reappear the operation force from the salve manipulator. The damper connected directly with real catheter is a piston structure using the MR fluid to realize the force feedback. It can transmit the feedback force to surgeon's hand through the operating catheter connected with damper, which seems that the surgeon operates the catheter beside the patient. The operating transparency of the developed system has been enhanced. The mechanism of the developed system has been introduced in detail. Performance evaluation experiments for the developed robotic catheter system have been done. The experimental results indicated that the developed robotic catheter system is fit for VIS.

Transitions of care and long-term surveillance after vascular surgery

Quality care of vascular surgery patients extends to the postoperative coordination of care and long-term surveillance, including the medical management of vascular disease. This is particularly highlighted in contemporary modern vascular surgery practice, as tremendous focus is being placed on postoperative adverse events and hospital readmissions. The purpose of this review is to provide a contemporary perspective of transitions of care at discharge and long-term surveillance recommendations after vascular surgery interventions.

The importance of and current trends in the endovascular program – A single center experience

IntroductionOpen vascular surgery and endovascular (EV) interventions are continually developing and their application differs depending on the arterial regions treated. We aim to demonstrate that current EV procedures do not mean a restriction, but on the contrary, an increase in the number of patients who can be successfully treated. MethodsWe have retrospectively followed all open surgery procedures and endovascular interventions done for carotid artery stenosis and subrenal abdominal aortic aneurysms (AAA) from 1990/1993 to 2014 in the Vascular Surgery Department at Na Homolce Hospital. ResultsFrom 1990 to 2014, 1659 open AAA surgery procedures were done in our department. Since 1996, 1023 endovascular abdominal aortic aneurysm repairs (EVAR) have been performed and since the implementation of robotics, 64 aneurysm replacements were robot-assisted. Mortality rates in the OS, EVAR and robotic groups are 1.7%, 1.5% and 0.4%, respectively. The percentage of EVAR stabilized during the last 5 years at about 32% of the total number of treated patients. From 1993 to 2014 there were 5363 open carotid surgery procedures done in our department, 2856 for symptomatic and 2507 for asymptomatic stenosis. The total cohort combined stroke/death rate was 1.6%. Symptomatic, asymptomatic and urgently operated patients had a combined 30-day stroke/death rate of 1.0%, 1.7% and 4.4%, respectively. During the same period 274 carotid bifurcation and 55 common carotid artery percutaneous transluminal angioplasty (PTA) were done. The technical success of endovascular interventions was better than 95%. ConclusionIn the AAA group, the percentage of EVAR stabilized during the last 5 years at about 32% of the total number of treated patients. Given the excellent results of open carotid surgery and the unconvincing results of stenting trials, we consider open carotid surgery to be better than carotid artery primary stenting.

A virtual reality-based method of decreasing transmission time of visual feedback for a tele-operative robotic catheter operating system.

An Internet-based tele-operative robotic catheter operating system was designed for vascular interventional surgery, to afford unskilled surgeons the opportunity to learn basic catheter/guidewire skills, while allowing experienced physicians to perform surgeries cooperatively. Remote surgical procedures, limited by variable transmission times for visual feedback, have been associated with deterioration in operability and vascular wall damage during surgery. At the patient's location, the catheter shape/position was detected in real time and converted into three-dimensional coordinates in a world coordinate system. At the operation location, the catheter shape was reconstructed in a virtual-reality environment, based on the coordinates received. The data volume reduction significantly reduced visual feedback transmission times. Remote transmission experiments, conducted over inter-country distances, demonstrated the improved performance of the proposed prototype. The maximum error for the catheter shape reconstruction was 0.93 mm and the transmission time was reduced considerably. The results were positive and demonstrate the feasibility of remote surgery using conventional network infrastructures.

Operation and force analysis of the guide wire in a minimally invasive vascular interventional surgery robot system

To develop a robot system for minimally invasive surgery is significant, however the existing minimally invasive surgery robots are not applicable in practical operations, due to their limited functioning and weaker perception. A novel wire feeder is proposed for minimally invasive vascular interventional surgery. It is used for assisting surgeons in delivering a guide wire, balloon and stenting into a specific lesion location. By contrasting those existing wire feeders, the motion methods for delivering and rotating the guide wire in blood vessel are described, and their mechanical realization is presented. A new resistant force detecting method is given in details. The change of the resistance force can help the operator feel the block or embolism existing in front of the guide wire. The driving torque for rotating the guide wire is developed at different positions. Using the CT reconstruction image and extracted vessel paths, the path equation of the blood vessel is obtained. Combining the shapes of the guide wire outside the blood vessel, the whole bending equation of the guide wire is obtained. That is a risk criterion in the delivering process. This process can make operations safer and man-machine interaction more reliable. A novel surgery robot for feeding guide wire is designed, and a risk criterion for the system is given.

Outcomes of multimorbid vascular surgery patients with and without major amputation in a German geriatric rehabilitation clinic

In the course of demographic developments, an increase of vascular surgical procedures including major amputations in very elderly, multimorbid geriatric patients is expected. Due to the high vulnerability of these patients, geriatric rehabilitation directly following the acute inpatient treatment is likely to improve the abilities of these patients. This issue is not well analyzed in Germany up to now. This retrospective study includes all patients who were admitted to our clinic for geriatric rehabilitation after vascular surgery between 01June2012 and 31December2013. Geriatric assessments at the time of admission and discharge were considered. The group was divided into rehabilitation patients with major limb amputation and nonmajor limb amputation. Both groups were analyzed with respect to functional parameters and activities in daily life (ADL) during the course of rehabilitation as well as the discharge location (home versus nursing home). A total of 30major-limb-amputee and 77nonmajor-limb-amputee rehabilitants could be analyzed. Before surgical intervention, 100 % of patients lived in a home care situation. The median age was 78.3years. During rehabilitation, both groups showed highly significant improvements in ADL (Barthel index), Timed Up and Go test, walking distance, and stair climbing; however the nonmajor amputees surpassed the major amputees in most mobility assessments especially in the five chair-rising test. The rehabilitation time (median) was 41.8days for major and 23.9days for nonmajor amputees. More than 90 % of the rehabilitants in both groups could be discharged home. The data from this retrospective study indicate that even advanced old age, multimorbid patients benefit from geriatric rehabilitation after vascular surgery intervention. Although less distinct than the group of minor amputee rehabilitants, highly significant improvements were also demonstrated in the group of major amputee rehabilitants as assessed in the discharge mobility and ADL results compared to the admission assessment results. These improvements were achieved in an adequate time period and led to discharge into home care for the majority of patients.

Vascular elasticity determined mass-spring model for virtual reality simulators

In vascular interventional surgery, the virtual reality simulation is indispensable for catheter–based operation system because it provide the surgeon of visual scene between catheter and vascular. However, most VR systems only present the vascular geometry model which indicates vascular is a rigid object. So as to display the deformation of vascular, it is necessary to consider the vascular physical model. Several previous work uses mass–spring method (MSM) to characterise the vascular but few mentions how to determine the spring coefficient which is critical to vascular shape change. Thus, the objective of this paper is to use vascular mechanical properties identified spring coefficient to simulate vascular deformation. Instead of setting it manually, we analyse the elasticity distribution on the vascular wall and identify spring coefficient by the analytical results. In this way, the spring coefficient varies with circumferential force along the vascular. After the stiffness matrix of MSM is derived, the vascular deformation is relevant to the vascular radius. The analytical results suggest that the vascular with large radius deforms less dramatically than that of small radius.

New method for geometric calibration and distortion correction of conventional C-arm

Image distortion correction and geometric calibration are critical operations for using C-arm DSA (Digital Subtraction Angiography) images to digitally navigate vascular interventional surgery. In traditional ways, C-arm images are corrected with global or local correction methods where a supposed virtual ideal image is needed, and then the corrected images are utilized to calibrate the C-arm with a pin-hole model. In this paper, we propose a new method to calibrate the C-arm with a nonlinear model and to improve navigation performance. We first calibrate the C-arm with a nonlinear model and then the distortion correction is accomplished without virtual ideal image. In this paper, the nonlinear model of C-arm imaging system is addressed at first, and then the C-arm is calibrated with a two-stage method. In the first stage, the C-arm is calibrated with the markers in image center by RAC (radial alignment constraint) method, and in the second stage the calibration parameters are optimized with Levenberg-Marquadt algorithm by minimizing the sum of the square of difference between all markers׳ real distorted positions and their theoretical distorted positions in the phantom image. Based on the calibration result, the image distortion can be corrected. To verify our method, experiments were conducted with a conventional DSA C-arm machine in hospital. The errors in distortion correction and 3D (three-dimensional) reconstruction were quantitatively compared with the global polynomial correction method and visual model method, and the results showed that the proposed method had better performance in distortion correction and 3D reconstruction.

Illness Beliefs and Walking Behavior After Revascularization for Intermittent Claudication

Patients with peripheral artery disease (PAD) are recommended to increase physical activity to reduce cardiovascular risk. Vascular intervention (surgery or angioplasty) treats the symptom (intermittent claudication), but not the underlying cardiovascular disease. This study aims to explore the beliefs and physical activity behavior of patients with PAD who have received vascular intervention. Twenty participants who had received a vascular intervention for intermittent claudication between 6 months and 2 years previously participated in semistructured interviews. The interviews explored illness and treatment beliefs and walking behavior. Data were transcribed verbatim and analyzed thematically. Participants described a high level of ongoing symptoms (particularly pain) in their legs, despite having received vascular intervention. They viewed their illness as acute and treatable, and believed that pain was an indication of walking causing damage. They controlled their symptoms by avoiding walking and slowing their pace. Participants were generally unaware of the causes of the disease and were unaware of their increased risk of future cardiovascular health problems. There was a low level of congruence between participant beliefs about their illness and the recommendation to increase physical activity that may affect physical activity behavior. Our findings suggest that patients with PAD do not change physical activity behavior after diagnosis and treatment, because they hold dysfunctional and incongruous beliefs about PAD, treatment, and physical activity.