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Publications (10 of 184) Show all publications
Wanhainen, A. & Mani, K. (2020). Guidelines Are Perishable Goods that Can Go Bad Quickly. European Journal of Vascular and Endovascular Surgery, 59(2), 226-226
Open this publication in new window or tab >>Guidelines Are Perishable Goods that Can Go Bad Quickly
2020 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 59, no 2, p. 226-226Article in journal, Editorial material (Other academic) Published
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-407268 (URN)10.1016/j.ejvs.2019.08.019 (DOI)000512400000005 ()31542289 (PubMedID)
Available from: 2020-03-23 Created: 2020-03-23 Last updated: 2020-03-23Bibliographically approved
Cervin, A., Wanhainen, A. & Björck, M. (2020). Popliteal aneurysms are common among men with screening detected abdominal aortic aneurysms, and prevalence correlates with the diameters of the common iliac arteries. European Journal of Vascular and Endovascular Surgery, 59(1), 67-72
Open this publication in new window or tab >>Popliteal aneurysms are common among men with screening detected abdominal aortic aneurysms, and prevalence correlates with the diameters of the common iliac arteries
2020 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 59, no 1, p. 67-72Article in journal (Refereed) Published
Abstract [en]

Background: Data on the prevalence of popliteal artery aneurysm (PA) are scarce and difficult to interpret as the definition differs among papers. The aim was to investigate the prevalence among men with screening detected abdominal aortic aneurysms (>= 30 mm, AAAs) and subaneurysmal aortic dilatation (25-29 mm, SAA), and to explore whether the existence of a PA correlated with the diameters of the aorta, iliac, and femoral arteries.

Methods: In Uppsala, Sweden, a county with 376 000 inhabitants, AAA screening of 65 year old men was initiated in 2006. All men with AAA and SAA also had measurements of the common iliac artery (CIA). The common femoral (CFA), superficial femoral (SFA), and popliteal arteries were evaluated at re-examination, performed after 1-2 years for AAA and five years for SAA. PA was defined as >= 12 mm, or 1.5 times larger than the distal SFA according to the ISCVS/SVS Ad Hoc Committee. The relationships between PA and other vessel diameters were explored.

Results: A total of 19 820 65 year old men (84.6%) accepted the invitation to screening between 2006 and 2017. AAA was found in 173 (0.9%), and SAA in 149 subjects (1.1% of those screened 2006-2013, eligible for this study). In the whole cohort, 14.2% of those examined had at least one PA of any size, 3.0% were >= 15 mm and 2.2% >= 20 mm. There was no difference in PA prevalence between AAA and SAA: 15.9% vs. 12.2% (p = .48). There was no difference in aortic diameter in those with or without PA (p = .46), but there were significant correlations with CIA (p < .001), CFA (p < .001), and SFA (p < .001) diameters.

Conclusions: A high prevalence of PA among subjects with screening detected AAA and SAA was found. PA was not correlated with the aortic diameter in this cohort, where all had dilated aortas, while correlations with peripheral and iliac artery diameters were identified.

Keywords
Abdominal aortic aneurysm; Popliteal artery aneurysm; Iliac artery; Screening, Prevalence.
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:uu:diva-381518 (URN)10.1016/j.ejvs.2019.07.042 (DOI)000506204700013 ()31757587 (PubMedID)
Note

Title in dissertation list of papers: Popliteal aneurysms are common among men with screening detected abdominal aortic aneurysms, and the prevalence is correlated with the diameters of the common iliac arteries

Available from: 2019-04-10 Created: 2019-04-10 Last updated: 2020-01-27Bibliographically approved
Wanhainen, A., Mani, K., Kullberg, J., Svensjö, S., Bersztel, A., Karlsson, L., . . . Björck, M. (2020). The effect of ticagrelor on growth of small abdominal aortic aneurysms: a randomized controlled trial. Cardiovascular Research, 116(2), 450-456
Open this publication in new window or tab >>The effect of ticagrelor on growth of small abdominal aortic aneurysms: a randomized controlled trial
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2020 (English)In: Cardiovascular Research, ISSN 0008-6363, E-ISSN 1755-3245, Vol. 116, no 2, p. 450-456Article in journal (Refereed) Published
Abstract [en]

AIM: To evaluate if ticagrelor, an effective platelet inhibitor without known non-responders, could inhibit growth of small AAAs.

METHODS AND RESULTS: In this multi-center randomized controlled trial, double-blinded for ticagrelor and placebo, acetylic salicylic acid naïve patients with AAA and with a maximum aortic diameter 35-49 mm were included. The primary outcome was mean reduction in log-transformed AAA volume growth rate (%) measured with magnetic resonance imaging (MRI) at 12 months compared with baseline. Secondary outcomes include AAA-diameter growth rate and ILT volume enlargement rate. 144 patients from eight Swedish centers were randomized (72 in each group). MRI AAA volume increase was 9.1% for the ticagrelor-group and 7.5% for the placebo-group (p = 0.205) based on intention-to-treat analysis, and 8.5% vs 7.4% in a per-protocol-analysis (p = 0.372). MRI diameter change was 2.5 mm vs 1.8 mm (p = 0.113), US diameter change 2.3 mm vs 2.2 mm (p = 0.778), and ILT volume change 12.9% vs 10.4% (p = 0.590).

CONCLUSION: In this RCT platelet inhibition with ticagrelor did not reduce growth of small AAAs. Whether the ILT has an important pathophysiological role for AAA growth cannot be determined based on this study due to the observed lack of thrombus modulating effect of ticagrelor.

Keywords
Abdominal aortic aneurysm, Growth inhibitor, Intraluminal thrombus, Ticagrelor, Anti-platelet treatment, Randomized controlled trial, Aortic volume, Aortic diameter, bleeding
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-392825 (URN)10.1093/cvr/cvz133 (DOI)000515095600028 ()31135888 (PubMedID)
Funder
AstraZeneca
Available from: 2019-09-10 Created: 2019-09-10 Last updated: 2020-03-30Bibliographically approved
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: 2019-10-28Bibliographically approved
Ersryd, S., Gidlund, K. D., Wanhainen, A., Smith, L. & Björck, M. (2019). Editor's Choice - Abdominal Compartment Syndrome after Surgery for Abdominal Aortic Aneurysm: Subgroups, Risk Factors, and Outcome. European Journal of Vascular and Endovascular Surgery, 58(5), 671-679
Open this publication in new window or tab >>Editor's Choice - Abdominal Compartment Syndrome after Surgery for Abdominal Aortic Aneurysm: Subgroups, Risk Factors, and Outcome
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2019 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 58, no 5, p. 671-679Article in journal (Refereed) Published
Abstract [en]

Objectives: Abdominal compartment syndrome (ACS) is a serious complication after abdominal aortic aneurysm (AAA) repair. The aim was to investigate outcome among subgroups and factors associated with outcome, with emphasis on the duration of intra-abdominal hypertension before treatment.

Methods: Since 2008, ACS and decompressive laparotomy (DL) after AAA repair are registered prospectively in the Swedish vascular registry (Swedvasc). Registry data and case records were reviewed. Subgroups were defined by main pathophysiological finding at DL, timing of DL after AAA repair, and treatment modality.

Results: During 2008-2015, 120 of 8765 patients undergoing surgery for infrarenal AAA developed postoperative ACS (1.4%). Eighty-three followed ruptured AAA (rAAA); 45 open surgical repairs (OSR) and 38 endovascular (EVAR), and thirty-seven after intact AAA (iAAA); 30 OSR and seven EVAR. The main pathophysiological findings at DL were bowel ischaemia in 27 (23.3%), post-operative bleeding in 34 (29.3%), and general oedema in 55 (47.4%). DL was performed <24 hours after AAA repair in 56 (48.7%), 24-48 hours in 30 (26.1%), and >48 hours in 29 patients (25.2%). The overall 90 day mortality was 50.0%, neither different depending on main pathophysiological finding, nor on the timing of DL. In multivariable regression analysis, age was a predictor of mortality (p = .017), while duration of intra-abdominal hypertension (IAH) prior to DL predicted the need for renal replacement therapy (RRT) (p = .033). DL was performed earlier after EVAR compared with OSR in rAAA (p < .001).

Conclusions: Mortality in ACS was high, irrespective of the main pathophysiological finding and timing of DL. The duration of IAH prior to DL predicted the need for RRT. DL was performed earlier after EVAR than after OSR for rAAA, underlining the importance of monitoring IAP after EVAR for rAAA.

Place, publisher, year, edition, pages
W B SAUNDERS CO LTD, 2019
Keywords
Abdominal compartment syndrome, Aortic aneurysm-abdominal, Bowel ischaemia, Intra-abdominal pressure, Mortality, Renal replacement therapy
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-397582 (URN)10.1016/j.ejvs.2019.04.007 (DOI)000493954400008 ()31405726 (PubMedID)
Available from: 2019-11-25 Created: 2019-11-25 Last updated: 2019-11-25Bibliographically 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
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-3273-8726

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