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Wanhainen, Anders
Alternative names
Publications (10 of 157) Show all publications
Holsti, M., Wanhainen, A., Lundin, C., Björck, M., Tegler, G., Svensson, J. & Sund, M. (2018). Circulating Vascular Basement Membrane Fragments are Associated with the Diameter of the Abdominal Aorta and Their Expression Pattern is Altered in AAA Tissue. European Journal of Vascular and Endovascular Surgery, 56(1), 110-118
Open this publication in new window or tab >>Circulating Vascular Basement Membrane Fragments are Associated with the Diameter of the Abdominal Aorta and Their Expression Pattern is Altered in AAA Tissue
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2018 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 56, no 1, p. 110-118Article in journal (Refereed) Published
Abstract [en]

Objective: Abdominal aortic aneurysm (AAA) is characterised by enhanced proteolytic activity, and extracellular matrix (ECM) remodelling in the vascular wall. Type IV and XVIII collagen/endostatin are structural proteins in vascular basement membrane (VBM), a specialised ECM structure. Here the association between plasma levels of these collagens with the aortic diameter and expansion rate is studied, and their expression in aortic tissue characterised.

Methods: This was a retrospective population based cohort study. Type IV and XVIII collagen/endostatin were analysed in plasma by ELISA assay in 615 men, divided into three groups based on the aortic diameter: 1) normal aorta <= 25 mm, 2) sub-aneurysmal aorta (SAA) 26-29 mm, and 3) AAA >= 30 mm. Follow up data were available for 159 men. The association between collagen levels and aortic diameter at baseline, and with the expansion rate at follow up were analysed in ordinal logistic regression and linear regression models, controlling for common confounding factors. Tissue expression of the collagens was analysed in normal aorta (n = 6) and AAA (n = 6) by immunofluorescence.

Results: Plasma levels of type XVIII collagen/endostatin (136 ng/mL [SD 29] in individuals with a normal aorta diameter, 154 ng/ml [SD 45] in SAA, and 162 ng/ml [SD 46] in AAA; p = .001) and type IV collagen (105 ng/mL [SD 42] normal aorta, 124 ng/ml [SD 46] SAA, and 127 ng/ml [SD 47] AAA; p = .037) were associated with a larger aortic diameter. A significant association was found between the baseline levels of type XVIII/endostatin and the aortic expansion rate (p = .035), but in the multivariable model, only the initial aortic diameter remained significantly associated with expansion (p = .005). Altered expression patterns of both collagens were observed in AAA tissue.

Conclusion: Plasma levels of circulating type IV and XVIII collagen/endostatin increase with AAA diameter. The expression pattern of VBM proteins is altered in the aneurysm wall.

Place, publisher, year, edition, pages
W B SAUNDERS CO LTD, 2018
Keywords
Abdominal aortic aneurysm, Collagen, Basement membrane, Extracellular matrix, Circulation
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-365839 (URN)10.1016/j.ejvs.2018.03.002 (DOI)000444270700019 ()29656960 (PubMedID)
Funder
Swedish Research Council, K2013-64X-2040607-3Västerbotten County Council, VLL-582791Västerbotten County Council, VLL-680121Västerbotten County Council, VLL-764621Swedish Heart Lung Foundation, 2012-0353
Available from: 2018-11-27 Created: 2018-11-27 Last updated: 2018-11-27Bibliographically approved
Högberg, D., Mani, K., Wanhainen, A. & Svensjö, S. (2018). Clinical effect and cost effectiveness of screening for asymptomatic carotid stenosis: A Markov model. European Journal of Vascular and Endovascular Surgery, 55(6), 819-827
Open this publication in new window or tab >>Clinical effect and cost effectiveness of screening for asymptomatic carotid stenosis: A Markov model
2018 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 55, no 6, p. 819-827Article in journal (Refereed) Published
Abstract [en]

Objectives:   Screening for asymptomatic carotid artery stenosis (ACAS) is controversial. The cost-effectiveness of screening depends on screening cost, ACAS prevalence, and the potential stroke reducing effect of best medical treatment (BMT). The aim of the study was to determine the threshold values for these parameters in order for screening for ACAS to be cost-effective.

Material and methods: The clinical effect and cost-effectiveness of ultrasound-screening for ACAS with subsequent initiation of BMT versus not screening, was assessed in a Markov model with a life-time perspective. Key parameters; including stroke risk, all-cause mortality, and costs were based on contemporary published data, population statistics and ongoing screening programs. Prevalence of ACAS and rate of ongoing BMT was based on data from a population recently screened for ACAS. Minimum required stroke-risk reduction from BMT, incremental cost-efficiency ratio (ICER), absolute risk reduction for stroke (ARR), number needed to screen (NNS) were calculated. 

Results: Screening was cost-effective at an ICER of €5744 per incremental quality adjusted life-year (QALY) gained. ARR was 135 per 100000 screened, NNS was 741 and QALYs gained were 6700 per 100000 invited. At a willingness-to-pay (WTP) threshold of €50,000 per QALY the minimum required stroke risk reduction from BMT was 22%. The assumed degree of stroke risk reduction was the most important determinant of cost-efficiency.  

Conclusion: A moderate (22%) reduction in the risk of stroke from BMT was required for an ACAS screening strategy to be cost-effective at WTP of €50,000/QALY. Targeting populations with higher prevalence of ACAS could improve cost-efficiency.

Keywords
cost-eefectiveness, carotid stenosis, screening, preventive treatment
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Surgery
Identifiers
urn:nbn:se:uu:diva-328785 (URN)10.1016/j.ejvs.2018.02.029 (DOI)000434259600005 ()
Projects
Screening for asymptomatic carotid atherosclerosis
Funder
Swedish Research Council, K2013-64X-20406-07-3
Available from: 2017-08-31 Created: 2017-08-31 Last updated: 2018-08-30Bibliographically approved
Karthikesalingam, A., Grima, M. J., Holt, P. J., Vidal-Diez, A., Thompson, M. M., Wanhainen, A., . . . Mani, K. (2018). Comparative analysis of the outcomes of elective abdominal aortic aneurysm repair in England and Sweden. Paper presented at Annual Meeting of the British-Society-for-Endovascular-Therapy, JUN, 2017, Wotton under Edge, ENGLAND. British Journal of Surgery, 105(5), 520-528
Open this publication in new window or tab >>Comparative analysis of the outcomes of elective abdominal aortic aneurysm repair in England and Sweden
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2018 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 105, no 5, p. 520-528Article in journal (Refereed) Published
Abstract [en]

Background

There is substantial international variation in mortality after abdominal aortic aneurysm (AAA) repair; many non-operative factors influence risk-adjusted outcomes. This study compared 90-day and 5-year mortality for patients undergoing elective AAA repair in England and Sweden.

Methods

Patients were identified from English Hospital Episode Statistics and the Swedish Vascular Registry between 2003 and 2012. Ninety-day mortality and 5-year survival were compared after adjustment for age and sex. Separate within-country analyses were performed to examine the impact of co-morbidity, hospital teaching status and hospital annual caseload.

Results

The study included 36 249 patients who had AAA treatment in England, with a median age of 74 (i.q.r. 69–79) years, of whom 87·2 per cent were men. There were 7806 patients treated for AAA in Sweden, with a median of age 73 (68–78) years, of whom 82·9 per cent were men. Ninety‐day mortality rates were poorer in England than in Sweden (5·0 versus 3·9 per cent respectively; P < 0·001), but were not significantly different after 2007. Five‐year survival was poorer in England (70·5 versus 72·8 per cent; P < 0·001). Use of EVAR was initially lower in England, but surpassed that in Sweden after 2010. In both countries, poor outcome was associated with increased age. In England, institutions with higher operative annual volume had lower mortality rates.

Conclusion

Mortality for elective AAA repair was initially poorer in England than Sweden, but improved over time alongside greater uptake of EVAR, and now there is no difference. Centres performing a greater proportion of EVAR procedures achieved better results in England. Improving in England

National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-354237 (URN)10.1002/bjs.10749 (DOI)000428846100009 ()29468657 (PubMedID)
Conference
Annual Meeting of the British-Society-for-Endovascular-Therapy, JUN, 2017, Wotton under Edge, ENGLAND
Available from: 2018-06-29 Created: 2018-06-29 Last updated: 2018-06-29Bibliographically approved
Burdess, A., Mani, K., Tegler, G. & Wanhainen, A. (2018). Early Experience With a Novel Thoracic Stent Design for the Prevention of Distal Stent Graft-Induced New Entry Tears (d-SINE). Paper presented at 45th Annual VEITH Symposium, NOV 14-15, 2018, New York, NY. Journal of Vascular Surgery, 68(5), E153-E153
Open this publication in new window or tab >>Early Experience With a Novel Thoracic Stent Design for the Prevention of Distal Stent Graft-Induced New Entry Tears (d-SINE)
2018 (English)In: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 68, no 5, p. E153-E153Article in journal, Meeting abstract (Other academic) Published
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-373536 (URN)10.1016/j.jvs.2018.08.110 (DOI)000450594000100 ()
Conference
45th Annual VEITH Symposium, NOV 14-15, 2018, New York, NY
Note

Supplement

Meeting Abstract: AAN 2

Available from: 2019-01-21 Created: 2019-01-21 Last updated: 2019-01-21Bibliographically approved
Burdess, A., Wanhainen, A., Tegler, G. & Mani, K. (2018). Fenestrated and Branched Endovascular Repair of Aortic Arch Pathology. Paper presented at 45th Annual VEITHS ymposium, NOV 14-15, 2018, New York, NY. Journal of Vascular Surgery, 68(5), E154-E154
Open this publication in new window or tab >>Fenestrated and Branched Endovascular Repair of Aortic Arch Pathology
2018 (English)In: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 68, no 5, p. E154-E154Article in journal, Meeting abstract (Other academic) Published
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-373535 (URN)10.1016/j.jvs.2018.08.111 (DOI)000450594000101 ()
Conference
45th Annual VEITHS ymposium, NOV 14-15, 2018, New York, NY
Note

Supplement

Meeting Abstract: AAN 3

Available from: 2019-01-21 Created: 2019-01-21 Last updated: 2019-01-21Bibliographically approved
Baderkhan, H., Haller, O., Wanhainen, A., Björck, M. & Mani, K. (2018). Follow-up after endovascular aortic aneurysm repair can be stratified based on first postoperative imaging. British Journal of Surgery, 05(6), 709-718
Open this publication in new window or tab >>Follow-up after endovascular aortic aneurysm repair can be stratified based on first postoperative imaging
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2018 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 05, no 6, p. 709-718Article in journal (Refereed) Published
Abstract [en]

Background

Lifelong postoperative surveillance is recommended following endovascular aneurysm repair (EVAR). Although the purpose is to prevent and/or identify complications early, it also results in increased cost and workload. This study was designed to examine whether it may be possible to identify patients at low risk of complications based on their first postoperative CT angiogram (CTA).

Methods

All patients undergoing EVAR in two Swedish centres between 2001 and 2012 were identified retrospectively and categorized based on the first postoperative CTA as at low risk (proximal and distal sealing zone at least 10 mm and no endoleak) or high risk (sealing zone less than 10 mm and/or presence of any endoleak) of complications.

Results

Some 326 patients (273 men) with a CTA performed less than 1 year after EVAR were included (low risk 212, 65·0 per cent; high risk 114, 35·0 per cent). There was no difference between the groups in terms of sex, age, co‐morbidities, abdominal aortic aneurysm (AAA) diameter, preoperative AAA neck anatomy, stent‐graft type or duration of follow‐up (mean(s.d.) 4·8(3·2) years). Five‐year freedom from AAA‐related adverse events was 97·1 and 47·7 per cent in the low‐ and high‐risk groups respectively (P < 0·001). The corresponding freedom from AAA‐related reintervention was 96·2 and 54·1 per cent (P < 0·001). The method had a sensitivity of 88·3 per cent, specificity of 77·0 per cent and negative predictive value of 96·6 per cent to detect AAA‐related adverse events. The number of surveillance imaging per AAA‐related adverse event was 168 versus 11 for the low‐risk versus high‐risk group.

Conclusion

Two‐thirds of patients undergoing EVAR have an adequate seal and no endoleak on the first postoperative CTA, and a very low risk of AAA‐related events up to 5 years. Less vigilant follow‐up after EVAR may be considered for these patients.

National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:uu:diva-334332 (URN)10.1002/bjs.10766 (DOI)000430058000014 ()
Available from: 2017-11-22 Created: 2017-11-22 Last updated: 2018-08-08Bibliographically approved
Grip, O., Wanhainen, A., Michaëlsson, K., Lindhagen, L. & Björck, M. (2018). Open versus endovascular revascularization in the treatment of acute lower limb ischaemia. British Journal of Surgery, 105(12), 1598-1606
Open this publication in new window or tab >>Open versus endovascular revascularization in the treatment of acute lower limb ischaemia
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2018 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 105, no 12, p. 1598-1606Article in journal (Refereed) Published
Abstract [en]

Background: Consensus is lacking regarding intervention for patients with acute lower limb ischaemia (ALI). The aim was to study amputation-free survival in patients treated for ALI by either primary open or endovascular revascularization.

Methods: The Swedish Vascular Registry (Swedvasc) was combined with the Population Registry and National Patient Registry to determine follow-up on mortality and amputation rates. Revascularization techniques were compared by propensity score matching 1:1.

Results: Of 9736 patients who underwent open surgery and 6493 who had endovascular treatment between 1994 and 2014, 3365 remained in each group after propensity score matching. Results are from the matched cohort only. Mean age of the patients was 74⋅7 years; 47⋅5 per cent were women and mean follow-up was 4⋅3 years. At 30-day follow-up, the endovascular group had better patency (83⋅0 versus 78⋅6 per cent; P < 0⋅001). Amputation rates were similar at 30 days (7⋅0 per cent in the endovascular group versus 8⋅2 per cent in the open group; P = 0⋅113) and at 1 year (13⋅8 versus 14⋅8 per cent; P = 0⋅320). The mortality rate was lower after endovascular treatment, at 30 days (6⋅7 versus 11⋅1 per cent; P < 0⋅001) and after 1 year (20⋅2 versus 28⋅6 per cent; P < 0⋅001). Accordingly, endovascular treatment had better amputation-free survival at 30 days (87⋅5 versus 82⋅1 per cent; P < 0⋅001) and 1 year (69⋅9 versus 61⋅1 per cent; P < 0⋅001). The number needed to treat to prevent one death within the rst year was 12 with an endovascular compared with an open approach. Five years after surgery, endovascular treatment still had improved survival (HR 0⋅78, 99 per cent c.i. 0⋅70 to 0⋅86) but the difference between the treatment groups occurred mainly in the rst year.

Conclusion: Primary endovascular treatment for ALI appeared to reduce mortality compared with open surgery, without any difference in the risk of amputation.

National Category
Medical and Health Sciences Surgery
Research subject
Medical Science; Surgery
Identifiers
urn:nbn:se:uu:diva-363353 (URN)10.1002/bjs.10954 (DOI)000447124200007 ()
Available from: 2018-10-17 Created: 2018-10-17 Last updated: 2018-12-12Bibliographically approved
Budtz-Lilly, J., Wanhainen, A. & Mani, K. (2018). Outcomes of endovascular aortic repair in the modern era.. Journal of Cardiovascular Surgery, 59(2), 180-189
Open this publication in new window or tab >>Outcomes of endovascular aortic repair in the modern era.
2018 (English)In: Journal of Cardiovascular Surgery, ISSN 0021-9509, E-ISSN 1827-191X, Vol. 59, no 2, p. 180-189Article, review/survey (Refereed) Published
Abstract [en]

Monitoring outcomes following endovascular aortic repair (EVAR) is critical. Although evidence from randomized controlled trials has solidified the role of EVAR, the analysis of outcomes and "real-world" data has uncovered limitations, improved the selection of appropriate patients, and underscored the importance of instructions for use. Subsequent studies demonstrated the learning curve of EVAR and gradual improvement of outcomes over time. Outcomes analyses will continue to play an important role, particularly as technological growth of endovascular therapy has enabled treatment of more complex aneurysm pathologies and patients. The important analyses are herein reviewed, following the development of EVAR in the treatment of intact abdominal aortic aneurysms (AAA) to ruptured AAAs, and finally to complex aneurysms, including thoracoabdominal aortic aneurysms and mycotic aneurysms. This includes an overview of the more recent results from analyses of branched and fenestrated EVAR, as well as the use of chimney grafts. It is emphasized that the success of endovascular repair has paradoxically been hampered by its rapid growth and early achievements. Even the most advanced engineering developments cannot overcome the long-term effects of the progression of aortic disease. The long-term benefits thus require careful planning and considerations of the natural history of aneurysms and the life expectancy of the patient. Large and international data registry collaborations should continue to play a role in providing outcomes analyses to guide future improvements.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-336059 (URN)10.23736/S0021-9509.17.10332-0 (DOI)000432308200007 ()29206004 (PubMedID)
Available from: 2017-12-12 Created: 2017-12-12 Last updated: 2018-08-31Bibliographically approved
Rossignoli, A., Vorkapic, E., Wanhainen, A., Lanne, T., Skogberg, J., Folestad, E. & Wagsater, D. (2018). Plasma cholesterol lowering in an AngII-infused atherosclerotic mouse model with moderate hypercholesterolemia. International Journal of Molecular Medicine, 42(1), 471-478
Open this publication in new window or tab >>Plasma cholesterol lowering in an AngII-infused atherosclerotic mouse model with moderate hypercholesterolemia
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2018 (English)In: International Journal of Molecular Medicine, ISSN 1107-3756, E-ISSN 1791-244X, Vol. 42, no 1, p. 471-478Article in journal (Refereed) Published
Abstract [en]

Atherosclerosis is the main underlying causes of cardiovascular disease. There is a well‑established association between high blood cholesterol levels and the extent of atherosclerosis. Furthermore, atherosclerosis has been proposed to augment abdominal aortic aneurysm (AAA) formation. As patients with AAA often have parallel atherosclerotic disease and are therefore often on cholesterol‑lowering therapy, it is not possible to fully address the independent effects of plasma cholesterol lowering (PCL) treatment on AAA. The present study investigated the effect of angiotensin II (AngII)‑infusion in modestly hypercholesterolemic Ldlr‑/‑Apob100/100Mttpflox/floxMx1‑Cre mice with or without PCL treatment on a morphological and molecular level, in terms of atherosclerosis and AAA development. AngII infusion in the study mice resulted in an increased atherosclerotic lesion area and increased infiltration of inflammatory leukocytes, which was not observed in mice with PCL induced prior to AngII infusion. This suggested that AngII infusion in this mouse model induced atherosclerosis development, and that plasma cholesterol levels represent a controlling factor. Furthermore, AngII infusion in Ldlr‑/‑Apob100/100Mttpflox/floxMx1‑Cre mice caused a modest aneurysmal phenotype, and no differences in AAA development were observed between the different study groups. However, the fact that modest hypercholesterolemic mice did not develop AAA in a classical aneurysmal model indicated that plasma cholesterol levels are important for disease development.

Keywords
abdominal aortic aneurysm, cholesterol, angiotensin II, smooth muscle cell
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-364507 (URN)10.3892/ijmm.2018.3619 (DOI)000440580900046 ()29658561 (PubMedID)
Available from: 2018-11-05 Created: 2018-11-05 Last updated: 2018-11-05Bibliographically approved
Wallinder, J., Georgiou, A., Wanhainen, A. & Björck, M. (2018). Prevalence of Synchronous and Metachronous Aneurysms in Women With Abdominal Aortic Aneurysm. European Journal of Vascular and Endovascular Surgery, 56(3), 435-440
Open this publication in new window or tab >>Prevalence of Synchronous and Metachronous Aneurysms in Women With Abdominal Aortic Aneurysm
2018 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 56, no 3, p. 435-440Article in journal (Refereed) Published
Abstract [en]

Background: Abdominal aortic aneurysm (AAA) is three to five times more common among men compared with women, yet up to 38% of all aneurysm related deaths affect women. The aim of this study was to estimate the prevalence of synchronous or metachronous aneurysms among women with AAA, as diagnosis and treatment could improve survival. Patients and methods: This is a retrospective study of prospectively registered patients. All women operated on, or under surveillance for, AAA were identified at two Swedish hospitals. Aneurysms in different locations were identified using available imaging studies. Aneurysms were defined according to location: thoracic ascending aorta >= 42 mm, descending >= 33 mm, abdominal aorta >= 30 mm, common iliac artery >= 20 mm or 50% wider than the contralateral artery, common femoral artery >= 12 mm, popliteal artery >= 10 mm. Results: A total of 339 women with an AAA were included. The median follow up was 2.8 (range 0e15.7) years. Thirty-one per cent had an aneurysm in the thoracic aorta (67 of 217 investigated, 84% were located in the descending aorta), 13 (19%) underwent repair. Twelve per cent had a common iliac artery aneurysm (24/259, 76% were investigated). Common femoral artery aneurysms were identified in 4.3% (8/184, 54% investigated). Popliteal artery aneurysms were identified in 4.0% (6/149, 44% investigated). The prevalence of infrainguinal aneurysms was higher among patients with synchronous iliac aneurysms (40% vs. 1.6%, OR 42, 95% CI 6.4-279, p <.001). Conclusions: Thoracic aortic aneurysms are common among women with AAA, most commonly affecting the descending aorta, and detection frequently results in repair. Popliteal and femoral aneurysms are not rare among women with AAA, and even common if there is a synchronous iliac aneurysm.

Keywords
Female sex, Abdominal aortic aneurysm, Thoracic aortic aneurysm, Iliac aneurysm, Femoral aneurysm, Popliteal aneurysm
National Category
Surgery Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-365668 (URN)10.1016/j.ejvs.2018.05.015 (DOI)000444274900023 ()29935861 (PubMedID)
Available from: 2018-11-14 Created: 2018-11-14 Last updated: 2018-11-14Bibliographically approved
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