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Mani, Kevin
Publications (10 of 81) Show all publications
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
Mani, K. & Melissano, G. (2018). Complex Endovascular Aneurysm Repair: Patient Benefit or a Waste of Money?. European Journal of Vascular and Endovascular Surgery, 56(1), 1-2
Open this publication in new window or tab >>Complex Endovascular Aneurysm Repair: Patient Benefit or a Waste of Money?
2018 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 56, no 1, p. 1-2Article in journal, Editorial material (Other academic) Published
Place, publisher, year, edition, pages
W B SAUNDERS CO LTD, 2018
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-367147 (URN)10.1016/j.ejvs.2018.05.006 (DOI)000444270700001 ()29803372 (PubMedID)
Available from: 2018-11-29 Created: 2018-11-29 Last updated: 2018-11-29Bibliographically 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
Behrendt, C.-A., Bertges, D., Eldrup, N., Beck, A. W., Mani, K., Venermo, M., . . . Cronenwett, J. (2018). International Consortium of Vascular Registries Consensus Recommendations for Peripheral Revascularisation Registry Data Collection. European Journal of Vascular and Endovascular Surgery, 56(2), 217-237
Open this publication in new window or tab >>International Consortium of Vascular Registries Consensus Recommendations for Peripheral Revascularisation Registry Data Collection
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2018 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 56, no 2, p. 217-237Article in journal (Refereed) Published
Abstract [en]

Objective/Background: To achieve consensus on the minimum core data set for evaluation of peripheral arterial revascularisation outcomes and enable collaboration among international registries.

Methods: A modified Delphi approach was used to achieve consensus among international vascular surgeons and registry members of the International Consortium of Vascular Registries (ICVR). Variables, including definitions, from registries covering open and endovascular surgery, representing 14 countries in ICVR, were collected and analysed to define a minimum core data set and to develop an optimum data set for registries. Up to three different levels of variable specification were suggested to allow inclusion of registries with simpler versus more complex data capture, while still allowing for data aggregation based on harmonised core definitions.

Results: Among 31 invited experts, 25 completed five Delphi rounds via internet exchange and face to face discussions. In total, 187 different items from the various registry data forms were identified for potential inclusion in the recommended data set. Ultimately, 79 items were recommended for inclusion in minimum core data sets, including 65 items in the level 1 data set, and an additional 14 items in the more specific level 2 and 3 recommended data sets. Data elements were broadly divided into (i) patient characteristics; (ii) comorbidities; (iii) current medications; (iv) lesion treated; (v) procedure; (vi) bypass; (vii) endarterectomy (viii) catheter based intervention; (ix) complications; and (x) follow up.

Conclusion: A modified Delphi study allowed 25 international vascular registry experts to achieve a consensus recommendation for a minimum core data set and an optimum data set for peripheral arterial revascularisation registries. Continued global harmonisation of registry infrastructure and definition of items will overcome limitations related to single country investigations and enhance the development of real world evidence.

Place, publisher, year, edition, pages
W B SAUNDERS CO LTD, 2018
Keywords
Consensus development, Delphi technique, Health services research, Peripheral arterial disease, Registries
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-365835 (URN)10.1016/j.ejvs.2018.04.006 (DOI)000444272200013 ()29776646 (PubMedID)
Available from: 2018-11-27 Created: 2018-11-27 Last updated: 2018-11-27Bibliographically approved
Behrendt, C.-A., Bertges, D., Eldrup, N., Beck, A., Mani, K., Venermo, M., . . . Cronenwett, J. (2018). International Consortiumof Vascular Registries Consensus Recommendations for Peripheral Revascularization Registry Data Collection. Paper presented at 45th Annual VEITH Symposium, NOV 14-15, 2018, New York, NY.. Journal of Vascular Surgery, 68(5), E115-E115
Open this publication in new window or tab >>International Consortiumof Vascular Registries Consensus Recommendations for Peripheral Revascularization Registry Data Collection
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2018 (English)In: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 68, no 5, p. E115-E115Article in journal, Meeting abstract (Other academic) Published
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-373534 (URN)10.1016/j.jvs.2018.08.016 (DOI)000450594000006 ()
Conference
45th Annual VEITH Symposium, NOV 14-15, 2018, New York, NY.
Note

Supplement

Meeting Abstract: LEA 5

Available from: 2019-01-21 Created: 2019-01-21 Last updated: 2019-01-21Bibliographically approved
Verhoeven, E. L. G. & Mani, K. (2018). New Technology Failures: Who to Blame or Time to be Cautious?. European Journal of Vascular and Endovascular Surgery, 56(3), 318-319
Open this publication in new window or tab >>New Technology Failures: Who to Blame or Time to be Cautious?
2018 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 56, no 3, p. 318-319Article in journal, Editorial material (Other academic) Published
Place, publisher, year, edition, pages
W B SAUNDERS CO LTD, 2018
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-367144 (URN)10.1016/j.ejvs.2018.07.009 (DOI)000444274900002 ()30190038 (PubMedID)
Available from: 2018-11-29 Created: 2018-11-29 Last updated: 2018-11-29Bibliographically approved
Heinola, I., Sörelius, K., Wyss, T. R., Eldrup, N., Settembre, N., Setacci, C., . . . Venermo, M. (2018). Open Repair of Mycotic Abdominal Aortic Aneurysms With Biological Grafts: An International Multicenter Study. Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, 7(12), Article ID e008104.
Open this publication in new window or tab >>Open Repair of Mycotic Abdominal Aortic Aneurysms With Biological Grafts: An International Multicenter Study
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2018 (English)In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 7, no 12, article id e008104Article in journal (Refereed) Published
Abstract [en]

Background-The treatment of mycotic abdominal aortic aneurysm requires surgery and antimicrobial therapy. Since prosthetic reconstructions carry a considerable risk of reinfection, biological grafts are noteworthy alternatives. The current study evaluated the durability, infection resistance, and midterm outcome of biological grafts in treatment of mycotic abdominal aortic aneurysm. Methods and Results-All patients treated with biological graft in 6 countries between 2006 and 2016 were included. Primary outcome measures were 30- and 90-day survival, treatment-related mortality, and reinfection rate. Secondary outcome measures were overall mortality and graft patency. Fifty-six patients (46 males) with median age of 69 years (range 35-85) were included. Sixteen patients were immunocompromised (29%), 24 (43%) had concomitant infection, and 12 (21%) presented with rupture. Bacterial culture was isolated from 43 (77%). In-situ aortic reconstruction was performed using autologous femoral veins in 30 patients (54%), xenopericardial tube-grafts in 12 (21%), cryopreserved arterial/venous allografts in 9 (16%), and fresh arterial allografts in 5 (9%) patients. During a median follow-up of 26 months (range 3 weeks-172 months) there were no reinfections and only 3 patients (5%) required assistance with graft patency. Thirty-day survival was 95% (n=53) and 90-day survival was 91% (n=51). Treatment-related mortality was 9% (n=5). Kaplan-Meier estimation of survival at 1 year was 83% (95% confidence interval, 73%-94%) and at 5 years was 71% (52%-89%). Conclusions-Mycotic abdominal aortic aneurysm repair with biological grafts is a durable option for patients fit for surgery presenting an excellent infection resistance and good overall survival.

Place, publisher, year, edition, pages
WILEY, 2018
Keywords
allograft, aneurysm, aorta, autologous vein, femoral vein, graft, in situ reconstruction, infection, vein
National Category
Cardiac and Cardiovascular Systems Surgery
Identifiers
urn:nbn:se:uu:diva-372905 (URN)10.1161/JAHA.117.008104 (DOI)000452696000008 ()29886419 (PubMedID)
Available from: 2019-01-11 Created: 2019-01-11 Last updated: 2019-01-11Bibliographically approved
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