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Publications (10 of 20) Show all publications
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
Hultgren, R., Linne, A. & Svensjö, S. (2019). Cost-effectiveness of targeted screening for abdominal aortic aneurysm in siblings. British Journal of Surgery, 106(3), 206-216
Open this publication in new window or tab >>Cost-effectiveness of targeted screening for abdominal aortic aneurysm in siblings
2019 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 106, no 3, p. 206-216Article in journal (Refereed) Published
Abstract [en]

Background: Population screening for abdominal aortic aneurysm (AAA) in 65‐year‐old men has been shown to be cost‐effective. A risk group with higher prevalence is siblings of patients with an AAA. This health economic model‐based study evaluated the potential cost‐effectiveness of targeted AAA screening of siblings.

Methods: A Markov model validated against other screening programmes was used. Two methods of identifying siblings were analysed: direct questioning of patients with an AAA (method A), and employing a national multigeneration register (method B). The prevalence was based on observed ultrasound data on AAAs in siblings. Additional parameters were extracted from RCTs, vascular registers, literature and ongoing screening. The outcome was cost‐effectiveness, probability of cost‐effectiveness at different willingness‐to‐pay (WTP) thresholds, reduction in AAA death, quality‐adjusted life‐years (QALYs) gained and total costs on a national scale.

Results_ Methods A and B were estimated to reduce mortality from AAA, at incremental cost‐effectiveness ratios of €7800 (95 per cent c.i. 4627 to 12 982) and €7666 (5000 to 13 373) per QALY respectively. The probability of cost‐effectiveness was 99 per cent at a WTP of €23 000. The absolute risk reduction in AAA deaths was five per 1000 invited. QALYs gained were 27 per 1000 invited. In a population of ten million, methods A and B were estimated to prevent 12 and 17 AAA deaths, among 2418 and 3572 siblings identified annually, at total costs of €499 500 and €728 700 respectively.

Conclusion: The analysis indicates that aneurysm‐related mortality could be decreased cost‐effectively by applying a targeted screening method for siblings of patients with an AAA.

National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-378733 (URN)10.1002/bjs.11047 (DOI)000458933900008 ()30702746 (PubMedID)
Funder
Swedish Heart Lung FoundationStockholm County Council
Available from: 2019-03-08 Created: 2019-03-08 Last updated: 2019-03-08Bibliographically 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
Thorbjörnsen, K., Svensjö, S., Gidlund, K. D., Gilgen, N.-P. & Wanhainen, A. (2019). Prevalence and natural history of and risk factors for subaneurysmal aorta among 65-year-old men. Upsala Journal of Medical Sciences, 124(3), 180-186
Open this publication in new window or tab >>Prevalence and natural history of and risk factors for subaneurysmal aorta among 65-year-old men
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2019 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 124, no 3, p. 180-186Article in journal (Refereed) Published
Abstract [en]

Background: The aims of this study were to determine the prevalence of screening-detected subaneurysmal aorta (SAA), i.e. an aortic diameter of 2.5-2.9 cm, its associated risk factors, and natural history among 65-year-old men.

Methods: A total of 14,620 men had their abdominal aortas screened with ultrasound and completed a health questionnaire containing information on smoking habits and medical history. They were categorized based on the aortic diameter: normal aorta (n = 14,129), SAA (2.5-2.9 cm; n = 258), and abdominal aortic aneurysm (AAA) (>= 3.0 cm; n = 233). The SAA-group was rescanned after 5 years. Associated risk factors were analyzed.

Results: The SAA-prevalence was 1.9% (95% confidence interval 1.7%-2.1%), with 57.0% (50.7%-63.3%) expanding to >= 3.0 cm within 5 years. Frequency of smoking, coronary artery disease, hypertension, hyperlipidemia, and claudication were significantly higher in those with SAA and AAA compared to those with normal aortic diameter. Current smoking was the strongest risk factor for SAA (odds ratio [OR] 2.8; P < 0.001) and even stronger for AAA (OR 3.6; P < 0.001). Men with SAA expanding to AAA within 5 years presented pronounced similarities to AAA at baseline.

Conclusions: Men with SAA and AAA presented marked similarities in the risk factor profile. Smoking was the strongest risk factor with an incremental association with disease severity, and disease progression. This indicates that SAA and AAA may have the same pathophysiological origin and that SAA should be considered as an early stage of aneurysm formation. Further research on the cost-effectiveness and potential benefits of surveillance as well as smoking cessation and secondary cardiovascular prevention in this subgroup is warranted.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD, 2019
Keywords
Abdominal aortic aneurysm, prevention and control, screening, smoking, subaneurysmal aorta, ultrasonography
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-396108 (URN)10.1080/03009734.2019.1648611 (DOI)000484518700001 ()31460822 (PubMedID)
Funder
Swedish Heart Lung Foundation
Available from: 2019-11-01 Created: 2019-11-01 Last updated: 2019-11-01Bibliographically approved
Wanhainen, A., Svensjö, S., Holst, J., Björck, M. & Gottsäter, A. (2019). Screening for abdominal aortic aneurysm [Letter to the editor]. The Lancet, 393(10166), 27-28
Open this publication in new window or tab >>Screening for abdominal aortic aneurysm
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2019 (English)In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 393, no 10166, p. 27-28Article in journal, Letter (Other academic) Published
Place, publisher, year, edition, pages
ELSEVIER SCIENCE INC, 2019
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-374864 (URN)10.1016/S0140-6736(18)32761-2 (DOI)000454925000022 ()30614453 (PubMedID)
Available from: 2019-01-31 Created: 2019-01-31 Last updated: 2019-01-31Bibliographically 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
Wanhainen, A., Björck, M., Svensjö, S., Gottsäter, A., Holst, J., Hultgren, R., . . . Wahlgren, C.-M. (2018). [Misleading study in The Lancet on the outcome of the Swedish AAA screening program].. Läkartidningen, 115, Article ID FCAA.
Open this publication in new window or tab >>[Misleading study in The Lancet on the outcome of the Swedish AAA screening program].
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2018 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 115, article id FCAAArticle in journal (Refereed) Published
Abstract [sv]

In a recent publication in The Lancet Johansson and colleagues claim no effect on aneurysm mortality among men participating in the Swedish AAA screening program, and question its justification. The study is, however, limited by a corrupt study design and incorrect data, making the publication misleading. On the contrary, several RCTs and contemporary nationwide data with sufficient follow-up clearly show that AAA screening saves lives and is highly cost-effective. The program has so far identified about 6000 men with an AAA, of whom 1500 have been operated on to prevent rupture. Thus, more than 750 men have experienced a longer life (by a mean of 8 years) as a result of the program. Continuous evaluation of the program is important but requires a scientifically sound methodology.

National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-374360 (URN)30204225 (PubMedID)
Available from: 2019-01-21 Created: 2019-01-21 Last updated: 2019-05-22Bibliographically approved
Söderberg, P., Wanhainen, A. & Svensjö, S. (2017). Five Year Natural History of Screening Detected Sub-Aneurysms and Abdominal Aortic Aneurysms in 70 Year Old Women and Systematic Review of Repair Rate in Women. European Journal of Vascular and Endovascular Surgery, 53(6), 802-809
Open this publication in new window or tab >>Five Year Natural History of Screening Detected Sub-Aneurysms and Abdominal Aortic Aneurysms in 70 Year Old Women and Systematic Review of Repair Rate in Women
2017 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 53, no 6, p. 802-809Article in journal (Refereed) Published
Abstract [en]

Objective: The aim of this study was to report on the natural history of a population based cohort of 70 year old women with screening detected dilated aortas, and to systematically review publications reporting the rate of intact infrarenal aneurysm repair in women.

Material and methods: In a previous study, 5140 (74%) of 6925 invited women attended an ultrasound (US) examination of the abdominal aorta at age 70 years. All 52 women with screening detected sub-aneurysms (SA, diameter 25-29 mm) and abdominal aortic aneurysms (AAA, diameter >= 30 mm), were followed for 5 years with US. Infrarenal aortic diameters, AAA repair, all-cause and AAA specific mortality, and risk factors were recorded. In addition, a systematic review was conducted of the rate of intact infrarenal aneurysm repair in women.

Results: A total of 33 (0.6%) women had a SA at the age of 70; two (6%) declined follow-up, five (15%) had died, and 26 were re-examined after 5 years follow-up at age 75. Twelve of 26 (46%) had progressed to AAAs, where one was directly qualified for surgery. Smoking (p = .010) and aortic diameter (p = .040) were associated with progression to AAA. A total of 19 (0.4%) women had an AAA at age 70; two (11%) had died, six (32%) had been electively repaired with no 30 day mortality, and 11 (58%) had an AAA still under surveillance after 5 years follow-up at age 75 years. In the systematic search four studies with heterogeneous cohorts were identified and data on natural history were extracted and reviewed.

Conclusion: Screening detected AAAs and sub-aneurysms are clinically relevant in women. Within 5 years of detection a high proportion of AAAs require elective surgery, and a high proportion of sub-aneurysms progress to AAAs. Consequently, surveillance of sub-aneurysms in women with reasonable life expectancy can be considered. Publications on repair rate in women with intact AAAs are scarce and heterogeneous.

Keywords
Abdominal aortic aneurysm, Women, Mass screening, Smoking, Ultrasonography
National Category
Cardiac and Cardiovascular Systems Surgery
Identifiers
urn:nbn:se:uu:diva-329711 (URN)10.1016/j.ejvs.2017.02.024 (DOI)000403518800009 ()28389251 (PubMedID)
Available from: 2017-10-03 Created: 2017-10-03 Last updated: 2017-10-03Bibliographically approved
Björck, M., Bown, M. J., Choke, E., Earnshaw, J., Flørenes, T., Glover, M., . . . Wanhainen, A. (2015). International update on screening for abdominal aortic aneurysms: issues and opportunities.. European Journal of Vascular and Endovascular Surgery, 49(2)
Open this publication in new window or tab >>International update on screening for abdominal aortic aneurysms: issues and opportunities.
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2015 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 49, no 2Article in journal (Refereed) Published
Keywords
percutaneous coronary intervention, stents
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-267090 (URN)10.1016/j.ejvs.2014.08.015 (DOI)25242612 (PubMedID)
Available from: 2015-11-17 Created: 2015-11-17 Last updated: 2017-12-01
Svensjö, S. (2014). Abdominal Aortic Aneurysm Screening in Sweden. Gefässchirurgie, 19(6), 540-544
Open this publication in new window or tab >>Abdominal Aortic Aneurysm Screening in Sweden
2014 (English)In: Gefässchirurgie, ISSN 0948-7034, E-ISSN 1434-3932, Vol. 19, no 6, p. 540-544Article in journal (Refereed) Published
Abstract [en]

A large body of evidence from four international randomised controlled trials (RCT) on abdominal aortic aneurysm (AAA) screening indicate that ultrasound-based screening in elderly men with a high prevalence (4 %–7 %) reduces AAA-related mortality by 40 % through early AAA detection and increased preventive elective repair and subsequently halves rupture incidence. Coinciding with the planned launch of national AAA screening programs, a dramatic change in AAA epidemiology became evident: a lower AAA prevalence in the targeted population of men and falling mortality rates, most likely related to a drop in rates of smoking, and a paradoxical increase in elective AAA repairs. These changes have called AAA screening in today’s context into question. Sweden was the first country to provide national coverage with an AAA screening program targeting 65-year-old men. The scientifically evaluated screening initiative, started in 2006, reported the lower than expected prevalence (1.7 %) in 65-year-old men early on. Cost-effectiveness seems to be maintained despite the altered epidemiology, as shown in a health-economic study. The current prevalence of AAA among Swedish women is very low, and general population-based screening of women is likely to be futile, although targeted screening among female smokers should be evaluated. Sub-aneurysmal aortas detected at screening are likely to progress to a true AAA within 5 years, indicating a need for continued surveillance in this group. Differences in screening compliance seem to be linked to socio-economic factors. The aim of this topical review is to highlight AAA screening within a Swedish context and point to areas where information is lacking and further research is needed.

Place, publisher, year, edition, pages
Springer Berlin/Heidelberg, 2014
Keywords
Abdominal aortic aneurysm Screening Ultrasound Smoking Epidemiology
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-365316 (URN)10.1007/s00772-014-1332-z (DOI)
Available from: 2018-11-12 Created: 2018-11-12 Last updated: 2019-03-29Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-5616-8393

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