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Steuer, J
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Steuer, J., Bergqvist, D. & Björck, M. (2019). Surgical Renovascular Reconstruction for Renal Artery Stenosis and Aneurysm: Long-Term Durability and Survival. European Journal of Vascular and Endovascular Surgery, 57(4), 562-568
Åpne denne publikasjonen i ny fane eller vindu >>Surgical Renovascular Reconstruction for Renal Artery Stenosis and Aneurysm: Long-Term Durability and Survival
2019 (engelsk)Inngår i: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 57, nr 4, s. 562-568Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Objective: To study functional outcome, mortality, and dialysis free survival in patients undergoing open primary surgical repair of renal artery stenosis (RAS) or aneurysm (RAA).

Methods: This was a retrospective single centre study of patients undergoing open surgical renal artery reconstruction from 1993 to 2007. Blood pressure, renal function, dialysis dependence, vessel patency, and mortality were registered. Survival was investigated by cross matching with the population registry, yielding up to 20 years of follow up.

Results: Of the 40 patients operated on, 25 (63%) were women. RAS was the indication for reconstruction in 31 patients; 23 had atherosclerotic aetiology (ARAS), and eight had fibromuscular dysplasia (FMD). Nine patients had RAA. Patients with ARAS were older (p = .008), had more extensive peripheral arterial disease (p = .004), and inferior renal function (p = .003) compared with patients with FMD or RAA. In FMD and RAA, the right renal artery was affected in 13/17 (76%) cases, whereas in ARAS the disease was evenly distributed. In patients with ARAS, 15/25 (60%) stenotic renal arteries (two bilateral procedures) were managed by aorto-renal bypass, and 2/25 (8%) through ilio-renal bypass. In 8/25 (32%) endarterectomy was performed. In FMD, all but one patient underwent aorto-renal bypass. Early mortality was 2.5% (one patient with ARAS). One patient with ARAS required dialysis post-operatively. Systolic blood pressure was significantly reduced in patients with ARAS, from 180 mmHg (median) pre-operatively to 155 mmHg at one month (p = .003) and 160 mmHg at one year (p = .03). Need for medication decreased from three or more drugs to two drugs at one month (p = .01). In FMD, there was a similar tendency. Three patients underwent re-intervention for restenosis: two endovascularly and one by open surgery. The overall 5 year survival was 88%. Median follow up was 10.6 years.

Conclusion: Open surgical renal arterial reconstruction was performed with low mortality, fairly low morbidity, and excellent durability. Open surgery should still be considered a therapeutic option in complex renal artery disease.

Emneord
Fibromuscular dysplasia, Hypertension, Long-term follow up, Renal artery aneurysm, Renal artery stenosis, Renovascular, Survival
HSV kategori
Identifikatorer
urn:nbn:se:uu:diva-382984 (URN)10.1016/j.ejvs.2018.09.014 (DOI)000464932200019 ()30343992 (PubMedID)
Tilgjengelig fra: 2019-05-13 Laget: 2019-05-13 Sist oppdatert: 2019-05-13bibliografisk kontrollert
Hellgren, T., Wanhainen, A., Steuer, J. & Mani, K. (2017). Outcome of endovascular repair for intact and ruptured thoracic aortic aneurysms. Journal of Vascular Surgery, 66(1), 21-28
Åpne denne publikasjonen i ny fane eller vindu >>Outcome of endovascular repair for intact and ruptured thoracic aortic aneurysms
2017 (engelsk)Inngår i: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 66, nr 1, s. 21-28Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

OBJECTIVE: The objective of this study was to assess long-term outcome after thoracic endovascular aortic repair (TEVAR) for thoracic aortic aneurysm (TAA).

METHODS: All patients who underwent TEVAR for TAA at Uppsala University Hospital from December 1999 to December 2014 were included. Characteristics of the patients and outcome data were collected from medical records, national population registry, and cause of death registry. Perioperative survival was analyzed with the χ(2) test, and 5-year survival was estimated with Kaplan-Meier analysis. Predictors of long-term survival were assessed with Cox regression.

RESULTS: There were 77 patients included in the study, 49 with intact TAAs (iTAAs) and 28 with ruptured TAAs (rTAAs). Mean follow-up was 83.7 months for iTAA patients and 82.0 months for rTAA patients (P = .853). Mean age was 71.5 years for iTAA patients and 74.8 years for rTAA patients (P = .04). Survival after iTAA repair was 95.9% at 30 days, 91.8% at 90 days, and 62.5% at 5 years. After rTAA repair, survival was 71.4% at 30 days and decreased to 57.1% at 90 days (P < .01), with most deaths after 30 days being related to the aortic event. The 3-year survival rate after rTAA repair was 27.8%, and only one rTAA patient with 5 years of follow-up remained alive. Six aorta-related deaths occurred after 90 days (three iTAA patients, three rTAA patients); five were due to rupture of nontreated aortic segments. The 5-year reintervention rate was 13.2% for iTAA patients and 17.9% for rTAA patients (P = .682). All reinterventions occurred within 14 months of TEVAR. The age-adjusted hazard ratio for long-term mortality was 4.4 after rTAA repair compared with iTAA repair.

CONCLUSIONS: TEVAR for iTAA was associated with low perioperative mortality and acceptable 5-year survival at 62.5%. Results were more pessimistic after rTAA repair, however, for which two-thirds of the patients were deceased at 3-year follow-up. Improved selection of patients is necessary to identify patients who are likely to truly benefit from rTAA repair.

HSV kategori
Identifikatorer
urn:nbn:se:uu:diva-319771 (URN)10.1016/j.jvs.2016.12.101 (DOI)000405546300004 ()28216352 (PubMedID)
Tilgjengelig fra: 2017-04-10 Laget: 2017-04-10 Sist oppdatert: 2017-10-31bibliografisk kontrollert
Steuer, J., Lachat, M., Veith, F. J. & Wanhainen, A. (2016). Endovascular grafts for abdominal aortic aneurysm.. European Heart Journal, 37(2), 145-151
Åpne denne publikasjonen i ny fane eller vindu >>Endovascular grafts for abdominal aortic aneurysm.
2016 (engelsk)Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 37, nr 2, s. 145-151Artikkel, forskningsoversikt (Fagfellevurdert) Published
Abstract [en]

During the last two decades, endovascular technology has revolutionized the management of patients with abdominal aortic aneurysm (AAA). Today, endovascular aortic repair (EVAR) is the treatment of choice for the majority of patients with an AAA. Randomized controlled trials provide robust evidence for the indication of AAA repair and the rationale for the use of EVAR in selected patients. However, despite that, practice varies and several areas need further elucidation. Important future challenges and areas of research include the role of medical therapy in AAA, whether the indication for repair should be any different in women and in the elderly, and long-term follow-up of patients undergoing complex EVAR with adjuncts, both for elective treatment and for ruptured AAA. Continuous rapid technical and clinical development is to be expected. In this paper, we review the current practice and evidence of stenting in AAA.

HSV kategori
Identifikatorer
urn:nbn:se:uu:diva-266496 (URN)10.1093/eurheartj/ehv593 (DOI)000370974300010 ()26543044 (PubMedID)
Tilgjengelig fra: 2015-11-10 Laget: 2015-11-10 Sist oppdatert: 2017-12-01bibliografisk kontrollert
Lachat, M., Pecoraro, F. & Steuer, J. (2015). CardioPulse: developments in the treatment of aortic aneurysms in 2014.. European Heart Journal, 36(10)
Åpne denne publikasjonen i ny fane eller vindu >>CardioPulse: developments in the treatment of aortic aneurysms in 2014.
2015 (engelsk)Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 36, nr 10Artikkel i tidsskrift (Fagfellevurdert) Published
HSV kategori
Identifikatorer
urn:nbn:se:uu:diva-266497 (URN)25927114 (PubMedID)
Tilgjengelig fra: 2015-11-10 Laget: 2015-11-10 Sist oppdatert: 2017-12-01
Steuer, J., Björck, M., Sonesson, B., Resch, T., Dias, N., Hultgren, R., . . . Pfammatter, T. (2015). Editor's Choice - Durability of Endovascular Repair in Blunt Traumatic Thoracic Aortic Injury: Long-Term Outcome from Four Tertiary Referral Centers. European Journal of Vascular and Endovascular Surgery, 50(4), 460-465
Åpne denne publikasjonen i ny fane eller vindu >>Editor's Choice - Durability of Endovascular Repair in Blunt Traumatic Thoracic Aortic Injury: Long-Term Outcome from Four Tertiary Referral Centers
Vise andre…
2015 (engelsk)Inngår i: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 50, nr 4, s. 460-465Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Objectives: To analyze the early and long-term survival and re-intervention rate in patients undergoing TEVAR for blunt traumatic thoracic aortic injury. Methods: This was a consecutive case series. Between the years 2001 and 2010, a total of 74 patients underwent TEVAR for blunt traumatic thoracic aortic injury at four tertiary referral centers, three in Sweden and one in Switzerland. The median age of the patients was 41 years, and 16% were women. Demographic, procedural, and outcome data were collected and reviewed retrospectively. The patients were followed up during 2013-2014. Results: Early (30 day) mortality was 9% (7 patients), with only two cases directly related to the aortic injury; in hospital mortality was 14% as three patients died during the primary hospital admission within the first 6 months. Most patients had sustained severe injuries to other organ systems, and among all in hospital deaths brain injury was the predominant cause. Five year survival in the whole group was 81%. Re-intervention was needed in 16% (12 patients) during the first year, half of them within the first month. Only one patient underwent re-intervention more than 1 year after the initial procedure. Infolding and partial stentgraft collapse was the reason for the secondary procedure in five of the 13 patients; in three it occurred within 3 weeks of the acute TEVAR. Conclusion: TEVAR allows rapid and effective therapy in trauma patients with blunt aortic injury. The outcome is dependent on the severity of the concomitant injuries. The treatment is durable during the first decade after the procedure, but even longer follow up is needed to determine the impact of TEVAR in young patients on the degenerative changes that take place in the aging aorta.

Emneord
Blunt injury, Endovascular technique, Thoracic aorta
HSV kategori
Identifikatorer
urn:nbn:se:uu:diva-264824 (URN)10.1016/j.ejvs.2015.05.012 (DOI)000361862000011 ()26143100 (PubMedID)
Tilgjengelig fra: 2015-10-29 Laget: 2015-10-19 Sist oppdatert: 2017-12-01bibliografisk kontrollert
Lachat, M. & Steuer, J. (2015). Outcome of ruptured abdominal aortic aneurysm repair: impact of aortic morphology.. European Heart Journal, 36(21)
Åpne denne publikasjonen i ny fane eller vindu >>Outcome of ruptured abdominal aortic aneurysm repair: impact of aortic morphology.
2015 (engelsk)Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 36, nr 21Artikkel i tidsskrift (Fagfellevurdert) Published
HSV kategori
Identifikatorer
urn:nbn:se:uu:diva-266498 (URN)10.1093/eurheartj/ehv096 (DOI)25839669 (PubMedID)
Tilgjengelig fra: 2015-11-10 Laget: 2015-11-10 Sist oppdatert: 2017-12-01
Steuer, J., Wanhainen, A. & Björck, M. (2014). Acute aortic transection: follow-up policy. In: Greenhalgh R (Ed.), Vascular and Endovascular Consensus Update: (pp. 45-52). London: BIBA Publishing
Åpne denne publikasjonen i ny fane eller vindu >>Acute aortic transection: follow-up policy
2014 (engelsk)Inngår i: Vascular and Endovascular Consensus Update / [ed] Greenhalgh R, London: BIBA Publishing , 2014, s. 45-52Kapittel i bok, del av antologi (Annet vitenskapelig)
sted, utgiver, år, opplag, sider
London: BIBA Publishing, 2014
HSV kategori
Identifikatorer
urn:nbn:se:uu:diva-244922 (URN)978-0-9570419-2-9 (ISBN)
Tilgjengelig fra: 2015-02-23 Laget: 2015-02-23 Sist oppdatert: 2016-06-27
Steuer, J., Björck, M., Mayer, D., Wanhainen, A., Pfammatter, T. & Lachat, M. (2013). Distinction between Acute and Chronic Type B Aortic Dissection: Is there a Sub-acute Phase?. European Journal of Vascular and Endovascular Surgery, 45(6), 627-631
Åpne denne publikasjonen i ny fane eller vindu >>Distinction between Acute and Chronic Type B Aortic Dissection: Is there a Sub-acute Phase?
Vise andre…
2013 (engelsk)Inngår i: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 45, nr 6, s. 627-631Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

OBJECTIVES:

This study aims to assess the relevance of the definition of acute dissection, to analyse whether there is a sub-acute phase and to determine early outcome of thoracic endovascular aortic repair (TEVAR) in acute complicated type B aortic dissection.

DESIGN:

Dual-centre consecutive case series.

MATERIALS:

Between 1999 and 2011, 102 patients underwent TEVAR for non-traumatic acute complicated type B dissection in Zurich, Switzerland, and Uppsala, Sweden. In addition, 22 patients treated for an acute dissection-related complication occurring >14 days after onset of symptoms were included. Median age was 68 years, 35% were women.

METHODS:

Demographic, procedural and outcome data were collected prospectively. The patients were followed up on 1 January 2012.

RESULTS:

In the 22 sub-acute patients (18%), there were no early deaths or neurological complications. The predominant complication in these patients was rapid aortic enlargement, whereas rupture was more prevalent in patients treated within 14 days. In total, there were nine (7%) early deaths, three (2%) post-intervention paraplegias and six cases of stroke (5%).

CONCLUSIONS:

TEVAR was performed with low early mortality and few neurological complications. A significant proportion of patients presented with acute complications >14 days after onset of symptoms, indicative of a sub-acute phase in the transition between acute and chronic dissection, questioning the relevance of the current definition.

Emneord
Aortic dissection; Endovascular techniques; Survival
HSV kategori
Identifikatorer
urn:nbn:se:uu:diva-199890 (URN)10.1016/j.ejvs.2013.03.013 (DOI)000320745100018 ()23602854 (PubMedID)
Tilgjengelig fra: 2013-05-17 Laget: 2013-05-17 Sist oppdatert: 2017-12-06bibliografisk kontrollert
Eriksson, M.-O., Steuer, J., Wanhainen, A., Thelin, S., Eriksson, L.-G. & Nyman, R. (2013). Morphologic Outcome after Endovascular Treatment of Complicated Type B Aortic Dissection. Journal of Vascular and Interventional Radiology, 24(12), 1826-1833
Åpne denne publikasjonen i ny fane eller vindu >>Morphologic Outcome after Endovascular Treatment of Complicated Type B Aortic Dissection
Vise andre…
2013 (engelsk)Inngår i: Journal of Vascular and Interventional Radiology, ISSN 1051-0443, E-ISSN 1535-7732, Vol. 24, nr 12, s. 1826-1833Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

PURPOSE:

To investigate the long-term morphologic changes of the aorta after thoracic endovascular aortic repair (TEVAR) for acute complicated type B aortic dissection and to analyze whether these changes differed between DeBakey class IIIa and IIIb dissections.

MATERIALS AND METHODS:

During the period 1999-2009, 58 patients with acute complicated type B aortic dissection were treated with TEVAR. Seven patients lacked follow-up data, leaving 51 patients-17 patients with DeBakey IIIa aortic dissection and 34 patients with DeBakey IIIa aortic dissection IIIb-for inclusion in the study. Computed tomography scans performed before and after TEVAR were evaluated. Maximum thoracic and abdominal aortic diameters and diameters of the true lumen and false lumen at the level of the maximum aortic diameter in the thorax and abdomen were analyzed as well as degree of thrombosis of the false lumen.

RESULTS:

There was an overall significant reduction of the thoracic aortic diameter, increased true lumen diameter, and reduced false lumen diameter (P < .05). Total thrombosis of the false lumen, with or without reintervention, was seen in 53% of all patients, in 41% primarily and in 12% after reintervention. The IIIa group had a higher degree of total false lumen thrombosis. All patients in the IIIb group had total thrombosis of the false lumen along the stent graft.

CONCLUSIONS:

Long-term follow-up showed favorable aortic remodeling after TEVAR for acute complicated type B aortic dissection. Total thrombosis of the false lumen occurred more often in patients with DeBakey IIIa aortic dissection compared with patients with DeBakey IIIb aortic dissection.

HSV kategori
Identifikatorer
urn:nbn:se:uu:diva-210382 (URN)10.1016/j.jvir.2013.08.016 (DOI)000327808700010 ()24144537 (PubMedID)
Tilgjengelig fra: 2013-11-06 Laget: 2013-11-06 Sist oppdatert: 2017-12-06bibliografisk kontrollert
Skagius, E., Bosnjak, M., Björck, M., Steuer, J., Nyman, R. & Wanhainen, A. (2013). Percutaneous Closure of Large Femoral Artery Access with Prostar XL in Thoracic Endovascular Aortic Repair. European Journal of Vascular and Endovascular Surgery, 46(5), 558-563
Åpne denne publikasjonen i ny fane eller vindu >>Percutaneous Closure of Large Femoral Artery Access with Prostar XL in Thoracic Endovascular Aortic Repair
Vise andre…
2013 (engelsk)Inngår i: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 46, nr 5, s. 558-563Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

OBJECTIVES:

To investigate the technical success rate of Prostar XL for closure of large (≥20F) femoral vascular access sites in thoracic endovascular aortic repair (TEVAR) procedures.

METHODS:

This was a single-center consecutive case series. All TEVAR procedures at Uppsala University Hospital 2006-2010 were registered prospectively. Reoperations and cases with open closure technique were excluded. Primary (early) technical failure was defined as closure failure requiring immediate (on-table) open surgical repair; late access-related complication occurred thereafter. The medical records, pre- and postoperative computed tomography images were reviewed retrospectively.

RESULTS:

A total of 164 TEVAR procedures were identified, of which 118 (71%) had a median 22F (range 20-26F) access site sealed with tandem Prostar XL. The indications for TEVAR were dissection (47%), aneurysm (42%), trauma (8%), and miscellaneous (3%). Median follow-up time was 10 months (range 1-62). Primary technical failure occurred in 10 of 118 (8%). These cases were converted to cut-downs and surgical repair (n = 7), femoral fascia suturing (n = 2), and external compression with the Femo-Stop device (n = 1). Hypertension was associated with primary failure (p = .005), and a trend was observed for high age (p = .078) and increased groin subcutaneous fat layer (p = .077). Late access-related complications included pseudo-aneurysms (n = 12), small hematomas (n = 7), superficial groin infections (n = 2), and deep venous thrombosis (n = 1). None of the late complications required surgical treatment.

CONCLUSIONS:

The access closure technique with tandem Prostar XL for large access sites during TEVAR is safe, in experienced hands. Few technical failures and few late complications occur, and they are usually benign.

HSV kategori
Identifikatorer
urn:nbn:se:uu:diva-208802 (URN)10.1016/j.ejvs.2013.08.009 (DOI)000327232500011 ()24064388 (PubMedID)
Tilgjengelig fra: 2013-10-08 Laget: 2013-10-08 Sist oppdatert: 2017-12-06bibliografisk kontrollert
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