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Grip, O., Wanhainen, A. & Björck, M. (2019). Acute Aortic Occlusion: Nationwide Cohort Study [Letter to the editor]. Circulation, 139(2), 292-294
Open this publication in new window or tab >>Acute Aortic Occlusion: Nationwide Cohort Study
2019 (English)In: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 139, no 2, p. 292-294Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS & WILKINS, 2019
Keywords
arterial occlusive diseases, embolism, graft occlusion, vascular, ischemia, thrombosis
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-379086 (URN)10.1161/CIRCULATIONAHA.118.036420 (DOI)000459428700019 ()30615512 (PubMedID)
Available from: 2019-03-12 Created: 2019-03-12 Last updated: 2019-03-12Bibliographically approved
Powell, J. T., Ambler, G. K., Svensjö, S., Wanhainen, A. & Bown, M. J. (2019). Beyond the AAA Guidelines: Core Outcome Sets to Make Life Better for Patients. European Journal of Vascular and Endovascular Surgery, 57(1), 6-7
Open this publication in new window or tab >>Beyond the AAA Guidelines: Core Outcome Sets to Make Life Better for Patients
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2019 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 57, no 1, p. 6-7Article in journal, Editorial material (Other academic) Published
Place, publisher, year, edition, pages
W B SAUNDERS CO LTD, 2019
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-377799 (URN)10.1016/j.ejvs.2018.10.028 (DOI)000458013000003 ()30545777 (PubMedID)
Available from: 2019-02-28 Created: 2019-02-28 Last updated: 2019-02-28Bibliographically approved
Lindström, D., Mani, K., Lundberg, G. & Wanhainen, A. (2019). Bridging stent grafts in fenestrated and branched endovascular aortic repair: current practice and possible complications. Journal of Cardiovascular Surgery, 60(4), 476-484
Open this publication in new window or tab >>Bridging stent grafts in fenestrated and branched endovascular aortic repair: current practice and possible complications
2019 (English)In: Journal of Cardiovascular Surgery, ISSN 0021-9509, E-ISSN 1827-191X, Vol. 60, no 4, p. 476-484Article, review/survey (Refereed) Published
Abstract [en]

Fenestrated and branched endovascular aortic repair (F/B-EVAR) is associated with a high degree of technical and clinical success. Despite this, studies have also reported high reintervention rates, and these are often related to the bridging stent grafts. Often new devices appear on the market before they have been tested in the bridging stent graft position. This review aims to assess the current literature on bridging stent grafts and discuss complications, illustrated by case reports. Complications reported with bridging stem grafts include; endoleak, kink, fracture, migration, occlusion, stenosis and perforation. Some known risk factors for bridging stent occlusions are renal artery stent grafts vs. SMA and celiac artery stent grafts. Some device specific complications have also been reported such as type IIIc endoleak with the Lifestream stent graft (Bard Peripheral Vascular, Tempe, AZ, USA) fractures and type Hid endoleaks with the 1st generation of Begraft (BentleyinnoMed, Hechingen, Germany). In addition, this review also discusses some newer devices with possible relation to complications such as stenosis and target vessel perforation. In conclusion, bridging stent grafts in fenestrated and branched aortic repair have a good midterm patency. Despite this, remaining issues are often related to the bridging stent grafts. Thorough follow-up and attention are needed, especially when new devices are introduced. The endovascular community should work towards a common global feedback system.

Place, publisher, year, edition, pages
EDIZIONI MINERVA MEDICA, 2019
Keywords
Stents, Aortic aneurysm, Endovascular procedures
National Category
Cardiac and Cardiovascular Systems Surgery
Identifiers
urn:nbn:se:uu:diva-390415 (URN)10.23736/S0021-9509.19.10942-1 (DOI)000474882900008 ()30916523 (PubMedID)
Available from: 2019-08-12 Created: 2019-08-12 Last updated: 2019-08-12Bibliographically approved
Budtz-Lilly, J., Liungman, K., Wanhainen, A. & Mani, K. (2019). Correlations Between Branch Vessel Catheterization and Procedural Complexity in Fenestrated and Branched Endovascular Aneurysm Repair. Vascular and Endovascular Surgery, 53(4), 277-283
Open this publication in new window or tab >>Correlations Between Branch Vessel Catheterization and Procedural Complexity in Fenestrated and Branched Endovascular Aneurysm Repair
2019 (English)In: Vascular and Endovascular Surgery, ISSN 1538-5744, E-ISSN 1938-9116, Vol. 53, no 4, p. 277-283Article in journal (Refereed) Published
Abstract [en]

Introduction: The use of fenestrated and branched endovascular technologies in complex aortic aneurysm repair (F/BEVAR) is increasing, with a trend toward using longer sealing zones and incorporating more target vessels. Successful aneurysm exclusion and prevention of long-term treatment failure need to be balanced against the increased complexity of more extensive procedures. The aim of this study was to analyze relationships between the number of catheterized vessels and multiple operative variables as a means for evaluating procedural complexity.

Methods: Operative data from consecutive F/BEVAR procedures performed at a single center from 2012 to 2015 were analyzed. An equal number of EVAR procedures, randomly selected, from this period were also analyzed. Only intact aneurysms were included. Complex aneurysms were grouped based on the required number of target vessel catheterization. Ten procedural variables, categorized as perioperative, postoperative, and radiologic-related, were compared. Pearson correlation analysis and regression analysis were performed. The correlation coefficients, r, were classified using Cohen boundaries, r >= 0.5 indicating a strong relationship.

Results: There were 63 EVAR, 40 FEVAR, and 22 BEVAR procedures. There was no significant difference in patient comorbidities between conventional EVAR and complex procedure groups. The complex procedures included 23 two-vessel, 20 three-vessel, and 19 four-vessel catheterizations. Strong linear relationships between the number of branch vessel catheterizations and the following variables were identified: accumulated skin dose (r = .504), contrast volume (r = .652), fluoroscopy duration (r = .598), number of angiography series (r = .650), anesthesiology duration (r = .742), procedure duration (r = .554), and total length of stay (r = .533).

Conclusion: The complexity of FEVAR and BEVAR procedures reveals strong correlations between multiple peri- and postoperative variables. These exposures and risks should be borne in mind when considering treatment of complex abdominal aortic aneurysms as well as long-term clinical outcomes.

Place, publisher, year, edition, pages
SAGE PUBLICATIONS INC, 2019
Keywords
endovascular aneurysm repair, FEVAR, BEVAR, catheterization, radiation exposure, abdominal aortic aneurysm
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-382819 (URN)10.1177/1538574418823594 (DOI)000464423700001 ()30614400 (PubMedID)
Available from: 2019-05-06 Created: 2019-05-06 Last updated: 2019-05-06Bibliographically approved
Wanhainen, A., Verzini, F., Van Herzeele, I., Allaire, E., Bown, M., Cohnert, T., . . . Szeberin, Z. (2019). Editor's Choice – European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. European Journal of Vascular and Endovascular Surgery, 57(1), 8-93
Open this publication in new window or tab >>Editor's Choice – European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms
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2019 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 57, no 1, p. 8-93Article in journal (Refereed) Published
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-377705 (URN)10.1016/j.ejvs.2018.09.020 (DOI)000458013000004 ()30528142 (PubMedID)
Note

ESVS Guidelines Committee : Gert J. de Borst (chair) (Utrecht, Netherlands), Nabil Chakfe (Stratsbourg, France), Sebastian Debus (Hamburg, Germany), Rob Hinchliffe (Brinstol, United Kingdom), Stavros Kakkos (Patras, Greece), Igor Koncar (guideline coordinator) (Belgrade, Serbia), Philippe Kolh (Liege, Belgium), Jes S. Lindholt (Odense, Denmark), Melina de Vega (Bilbao, Spain), Frank Vermassen (Ghent, Belgium).

Document reviewers: Martin Björck (Uppsala, Sweden), Stephen Cheng (Hong Kong, China), Ronald Dalman (Stanford, USA), Lazar Davidovic (Belgrade, Serbia), Konstantinos Donas (Munster, Germany), Jonothan Earnshaw (Gloucester, United Kingdom), Hans-Henning Eckstein (Munich, Germany), Jonathan Golledge (Queensland, Australia), Stephan Haulon (Paris, France), Tara Mastracci (London, United Kingdom), Ross Naylor (Leicester, United Kingdom), Jean-Baptiste Ricco (Poitiers, France), Hence Verhagen (Rotterdam, Netherlands).

Available from: 2019-02-25 Created: 2019-02-25 Last updated: 2019-02-25Bibliographically approved
Högberg, D., Björck, M., Mani, K., Svensjö, S. & Wanhainen, A. (2019). Five Year Outcomes in Men Screened for Carotid Artery Stenosis at 65 Years of Age: A Population Based Cohort Study. European Journal of Vascular and Endovascular Surgery, 57(6), 759-766
Open this publication in new window or tab >>Five Year Outcomes in Men Screened for Carotid Artery Stenosis at 65 Years of Age: A Population Based Cohort Study
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2019 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 57, no 6, p. 759-766Article in journal (Refereed) Published
Abstract [en]

Objective: This study aimed to determine the outcome of 65 year old men five years after carotid ultrasound screening, as well as risk factors for disease progression. Methods: All 65 year old men living in the county of Uppsala 2007-2009 were invited to an ultrasound examination of both carotid arteries and re-invited at age 70. The cohort was grouped into normal carotids, plaque without significant stenosis, moderate stenosis (50-79%), and severe stenosis (80-99%). The rate of disease progression was assessed from ultrasound data. Data on mortality, ipsilateral neurological events, risk factors, and medication were obtained from patient records and population registries. Results: Among men participating in carotid screening at age 65, 3,057 were re-screened at age 70. In those with normal carotids (n = 2,318), 23 (1.0%) progressed to a moderate stenosis, and four (0.2%) to a symptomatic severe stenosis. Among those with plaque (n = 696), 25 (3.6%) progressed to moderate stenosis, and eight (1.1%) to severe stenosis, of whom four (0.6%) had symptoms. Of 31 men with 50-79% stenosis, four (12.9%) had progressed to a severe stenosis, of whom two (6.5%) developed symptoms. Five of twelve subjects (42%) with 80-99% stenosis developed symptoms. Disease regression was present among 289/692 plaque (41.7%) and 16/33 stenosis (48.4%). In multivariable analysis, smoking, coronary artery disease and hypercholesterolemia were associated with disease progression. The proportions of antiplatelet, statin, and antihypertensive treatment in the population at age 70 were 22%, 29%, and 55%, respectively. Conclusion: Men with plaques and moderate stenosis have a good prognosis, but in those with severe stenosis there is a high risk of neurological events.

Place, publisher, year, edition, pages
W B SAUNDERS CO LTD, 2019
Keywords
Atherosclerotic plaque, Carotid stenosis, Mortality, Natural history, Stroke rate
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-390031 (URN)10.1016/j.ejvs.2019.02.005 (DOI)000471825900003 ()31142437 (PubMedID)
Funder
Swedish Research Council, K2013-64X-20406-07-3
Available from: 2019-08-07 Created: 2019-08-07 Last updated: 2019-08-07Bibliographically approved
Sörelius, K., Wanhainen, A., Wahlgren, C.-M., Langenskiöld, M., Roos, H., Resch, T., . . . Mani, K. (2019). Nationwide Study on Treatment of Mycotic Thoracic Aortic Aneurysms. European Journal of Vascular and Endovascular Surgery, 57(2), 239-246
Open this publication in new window or tab >>Nationwide Study on Treatment of Mycotic Thoracic Aortic Aneurysms
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2019 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 57, no 2, p. 239-246Article in journal (Refereed) Published
Abstract [en]

Objective: Mycotic aortic aneurysms are rare, life threatening, and complex. This nationwide study aimed to assess outcome after repair of mycotic thoracic aortic aneurysms (MTAAs).

Methods: Patients treated in Sweden for MTAAs between 2000 and 2016 were identified in the Swedish vascular registry (2010-16) and local patient registries (2000-09). Primary outcome was survival, and secondary outcomes included surgical strategy, rate of infection related complications (IRC), and re-operations.

Results: Fifty-two patients (median age 71 +/- 8.1 years; 28 [54%] men, 13 [25%] ruptured) were identified (3.6% of all thoracic aortic aneurysm repairs in Sweden). Aneurysm location was aortic arch (n = 6; 11%), descending aorta (n = 42; 81%), and multiple locations (n = 4; 8%). Twenty-nine (56%) patients had positive cultures; the most prevalent agent was Staphylococcus aureus (n = 16; 31%). Operative techniques included thoracic endovascular aortic repair (TEVAR; n = 35 [67%]), fenestrated/branched TEVAR (n = 8; 15%), hybrid repair (n = 7; 14%), and open patch repair (n = 2; 4%). Survival was 92% (95% confidence interval [CI] 88-96) at 30 days, 88% (95% CI 84-93) at three months, 78% (73-84) at one year, and 71% (64-77) at five years. The mean follow up among survivors (> 90 days) was 45 months (range 4-216 months). Antibiotics were administered for a median of 15 weeks (range 0-220 weeks). IRCs occurred in nine patients (17%): sepsis (n = 3), graft infection (n = 3), recurrent mycotic aneurysm (n = 1), aorto-oesophageal/bronchial fistula (n = 2). Six (67%) IRCs were fatal; 80% occurred within the first year. Re-operations were performed in nine patients (17%).

Conclusions: TEVAR was often used as treatment for MTAAs, with acceptable short- and long-term survival when compared with open cohorts in the literature. IRCs are of concern and warrant follow up and long-term antibiotic treatment.

Place, publisher, year, edition, pages
W B SAUNDERS CO LTD, 2019
Keywords
Aneurysm, Aorta, Infected, Mycotic, Thoracic, Treatment
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-379269 (URN)10.1016/j.ejvs.2018.08.052 (DOI)000459894800012 ()30340857 (PubMedID)
Available from: 2019-03-18 Created: 2019-03-18 Last updated: 2019-03-18Bibliographically approved
Hammo, S., Larzon, T., Hultgren, R., Wanhainen, A., Mani, K., Resch, T., . . . Wahlgren, C.-M. (2019). Outcome After Endovascular Repair of Ruptured Descending Thoracic Aortic Aneurysm: A National Multicentre Study. European Journal of Vascular and Endovascular Surgery, 57(6), 788-794
Open this publication in new window or tab >>Outcome After Endovascular Repair of Ruptured Descending Thoracic Aortic Aneurysm: A National Multicentre Study
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2019 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 57, no 6, p. 788-794Article in journal (Refereed) Published
Abstract [en]

Objective: The purpose of this multicentre study was to analyse the outcome of thoracic endovascular aortic repair (TEVAR) in patients with ruptured descending thoracic aortic aneurysm (rDTAA). Methods: This is a nationwide retrospective study including all patients who underwent TEVAR for rDTAA at six major vascular university centres in Sweden between January 2000 and December 2015. Outcome measures were analysed using Kaplan-Meier estimator and multivariable Cox regression. Results: There were 140 patients (age [mean +/- SD] 74.1 +/- 8.8 years; 56% men; aneurysm size 64.8 +/- 19 mm), with rDTAA. In 53 patients (37.9%), the left subclavian artery was covered, and in 25 patients (17.9%) arch vessel revascularisation was performed. In total, 61/136 patients (45%) had a major complication within 30 days post TEVAR. Stroke (n = 20; 14.7%) was the most common complication, followed by paraplegia (n = 13; 9.6%) and major bleeding (n = 13; 9.6%). TEVAR related complications during follow up included endoleaks 22.1% (30/136; 14 type 1a, six type 1b, 10 not defined). In total, re-interventions (n = 31) were required in 27/137 (19.7%) patients. The median follow up time was 17.0 months (range 0-132 months). The Kaplan-Meier estimated survival was 80.0% at one month, 71.7% at three months, 65.3% at one year, 45.9% at three years, and 31.9% at five years. Age (HR 1.03; 95% CI 1.00-1.07; p = .046), history of stroke (HR 2.35; 95% CI 1.194.63; p = .014), previous aortic surgery (HR 2.11; 95% CI 1.15-3.87; p = .016) as well as post-operative major bleeding (HR 4.40; 95% CI 2.20-8.81; p = .001), stroke (HR 2.63; 95% CI 1.37-5.03; p = .004), and renal failure (HR 8.25; 95% CI 2.69-25.35; p = .001) were all associated with mortality. Conclusions: This nationwide multicentre study of patients with rDTAA undergoing TEVAR showed acceptable short- but poor long-term survival. Adequate proximal and distal aortic sealing zones are important for technical success. High risk patients and post-operative complications need to be further addressed in an effort to improve outcome.

Place, publisher, year, edition, pages
W B SAUNDERS CO LTD, 2019
Keywords
Thoracic aortic aneurysm, Rupture, TEVAR
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-390032 (URN)10.1016/j.ejvs.2018.10.029 (DOI)000471825900011 ()30910493 (PubMedID)
Available from: 2019-08-07 Created: 2019-08-07 Last updated: 2019-08-07Bibliographically approved
Stackelberg, O., Lindström, D., Mani, K., Lundberg, G., Linné, A., Delle, M., . . . Gillgren, P. (2019). Outcomes after endovascular repair of abdominal aortic aneurysm involving the renovisceral arteries: A multi-center follow-up study. Vascular, 27(4), 397-404
Open this publication in new window or tab >>Outcomes after endovascular repair of abdominal aortic aneurysm involving the renovisceral arteries: A multi-center follow-up study
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2019 (English)In: Vascular, ISSN 1708-5381, E-ISSN 1708-539X, Vol. 27, no 4, p. 397-404Article in journal (Refereed) Published
Abstract [en]

Objectives: To evaluate outcomes after endovascular treatment of abdominal aortic aneurysms (AAA) involving the renovisceral arteries and to compare outcomes after fenestrated/branched endovascular aortic repair (f/b-EVAR), chimney/periscope EVAR (ch-EVAR), and bailout ch-EVAR.

Methods: A retrospective multicenter study including all patients with AAA involving the renovisceral segment, treated with f/b-EVAR, ch-EVAR, or bailout ch-EVAR, between 1 January 2005 and 30 June 2015, in three Swedish vascular centers. Patient charts were reviewed for data. Renovisceral stent graft patency was assessed on follow-up CT. Mortality was cross-checked against the Swedish Population Registry. Bailout ch-EVAR was defined as a perioperative decision of renovisceral endografting, as the artery was accidentally covered, or as the aneurysm neck sealing zone was considered inadequate.

Results: Of the 99 identified patients (76 men; mean age 74 years (range 58-89 years)), 68 underwent f/b-EVAR, 18 ch-EVAR, and 13 bailout ch-EVAR. Follow-up lasted for a median of 3.2 years (Q1, Q3 (2.1, 4.7 years)). Elective surgery comprised 87.9% (n = 87) of the cases. Six patients died within 30 days, and the 30-day mortality after elective surgery was 4.6% (95% CI, 1.3%-11.4%) overall, 1.6% after f/b-EVAR (95% CI, 0.0%-11.4%), 15.4% after ch-EVAR (95% CI, 1.9%-45.4%), and 10.0% (95% CI, 0.3%-44.5%) after bailout ch-EVAR. During follow-up, there were 16 secondary interventions, of which 75% (n = 12) were performed within six months after the primary intervention. Compared with f/b-EVAR, ch-EVAR was associated with a higher degree of type 1 endoleaks (1.5% vs. 22.2%, P = 0.001) and re-interventions during follow-up (13.2% vs. 33.3%, P = 0.046). The overall assisted target vessel patency was 96.1% (95% CI, 91.7%-98.6%) at one year and 95.2% (95% CI, 89.2%-98.4%) at two years.

Conclusions: Results after EVAR involving endografting of renovisceral arteries from three centers in Sweden with medium volumes are consistent with results previously reported from centers with larger volumes.

Place, publisher, year, edition, pages
SAGE PUBLICATIONS LTD, 2019
Keywords
Abdominal aortic aneurysm, endovascular aneurysm repair, patency, mortality, outcome analysis
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-391295 (URN)10.1177/1708538119836016 (DOI)000476526100009 ()30871441 (PubMedID)
Available from: 2019-08-22 Created: 2019-08-22 Last updated: 2019-08-22Bibliographically approved
Ekström, C., Wilger, S. & Wanhainen, A. (2019). Pseudoexfoliation and aortic aneurysm: a long-term follow-up study. Acta Ophthalmologica, 97(1), 80-83
Open this publication in new window or tab >>Pseudoexfoliation and aortic aneurysm: a long-term follow-up study
2019 (English)In: Acta Ophthalmologica, ISSN 1755-375X, E-ISSN 1755-3768, Vol. 97, no 1, p. 80-83Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To study the relationship between pseudoexfoliation (PEX) and aortic aneurysm in a population with a high prevalence of PEX.

METHODS: Survival analyses were performed in a cohort of 735 residents aged 65-74 years, examined in a population survey in the municipality of Tierp, Sweden, 1984-1986. To expand the sample size, 1040 people were recruited by means of glaucoma case records established at the Eye Department in Tierp in 1978-2007. In this way, the cohort comprised 1775 subjects, representing more than 25 400 person-years at risk. Medical records and autopsy reports were reviewed to identify subjects diagnosed with aneurysm. Those with a follow-up time shorter than 1 year were excluded.

RESULTS: By the end of the study in September 2017, 60 new cases of aortic aneurysm had been found. Of these cases, 23% (14 subjects) were affected by PEX at baseline, compared with 28% among subjects without aneurysm. No association between PEX and aortic aneurysm was found (hazard ratio 0.97; 95% confidence interval 0.53-1.77).

CONCLUSION: In this population-based study, we were unable to verify a relationship between PEX and the development of aortic aneurysm.

Keywords
Epidemiology, Pseudoexfoliation, aortic aneurysm, exfoliation syndrome, risk factor, vascular disease
National Category
Ophthalmology
Identifiers
urn:nbn:se:uu:diva-367265 (URN)10.1111/aos.13882 (DOI)000456872000021 ()30238683 (PubMedID)
Available from: 2018-11-29 Created: 2018-11-29 Last updated: 2019-03-07Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0002-3273-8726

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