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Publications (10 of 108) Show all publications
Björck, M., Earnshaw, J. J., Acosta, S., Goncalves, F. B., Cochennec, F., Debus, E. S., . . . Rai, K. (2020). Editor's Choice - European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia. European Journal of Vascular and Endovascular Surgery, 59(2), 173-218
Open this publication in new window or tab >>Editor's Choice - European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia
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2020 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 59, no 2, p. 173-218Article in journal (Refereed) Published
Place, publisher, year, edition, pages
W B SAUNDERS CO LTD, 2020
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-407202 (URN)10.1016/j.ejvs.2019.09.006 (DOI)000512400000003 ()31899099 (PubMedID)
Available from: 2020-03-23 Created: 2020-03-23 Last updated: 2020-03-23Bibliographically approved
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
Sörelius, K., Wanhainen, A. & Mani, K. (2020). Infective Native Aortic Aneurysms: Call for Consensus on Definition, Terminology, Diagnostic Criteria, and Reporting Standards. European Journal of Vascular and Endovascular Surgery, 59(3), 333-334
Open this publication in new window or tab >>Infective Native Aortic Aneurysms: Call for Consensus on Definition, Terminology, Diagnostic Criteria, and Reporting Standards
2020 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 59, no 3, p. 333-334Article in journal, Editorial material (Other academic) Published
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-408066 (URN)10.1016/j.ejvs.2019.11.008 (DOI)000518375700001 ()32131984 (PubMedID)
Available from: 2020-04-03 Created: 2020-04-03 Last updated: 2020-04-03Bibliographically 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
Linder, F., Holmberg, L., Björck, M., Juhlin, C., Thorbjörnsen, K., Wisinger, J., . . . Mani, K. (2019). A prospective stepped wedge cohort evaluation of the new national trauma team activation criteria in Sweden - the TRAUMALERT study.. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 27(1), Article ID 52.
Open this publication in new window or tab >>A prospective stepped wedge cohort evaluation of the new national trauma team activation criteria in Sweden - the TRAUMALERT study.
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2019 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 27, no 1, article id 52Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Trauma triage based on prehospital information facilitates correct allocation of in-hospital resources. The Swedish national two-tier trauma team activation (TTA) criteria were revised in 2016. The current study aimed to evaluate the safety and efficacy of the new criteria.

METHODS: Five centres covering trauma care for 1.2 million inhabitants registered all trauma patients prospectively in the Swedish trauma registry (SweTrau) prior to and after stepwise introduction of new TTA criteria within the cohort (a prospective stepped-wedge cohort study design; period August 2016-November 2017). Evaluation of full- and limited-TTA frequency, under- and overtriage were performed at equal duration before and after this change.

RESULTS: The centres registered 1948 patients, 1882 (96.6%) of which were included in the study. With new criteria, frequency of full-TTA was unchanged, while limited-TTA decreased with 46.3% (from 988 to 531). 30-day trauma mortality was unchanged. The overtriage was 107/150 (71.3%) with former criteria, and 104/144 (72.2%) with new criteria, p = 0.866. Undertriage was 50/1037 (4.8%) versus 39/551 (7.1%), p = 0.063. Undertriage was consistently > 20% in patients with fall injury. Among patients with Injury Severity Score (ISS) > 15, 50/93 (53.8%) did not initiate full-TTA with former, vs 39/79 (49.4%) with new criteria, p = 0.565. Age > 60-years was a risk factor for undertriage (OR 2.89, p < 0.001), while low fall injuries indicated a trend (OR 2.70, p = 0.051).

CONCLUSIONS: The newly implemented Swedish TTA criteria result in a reduction in limited TTA frequency, indicating an increased efficiency in use of resources. The over- and undertriage is unchanged compared to former criteria, thus upholding patient safety.

Keywords
Epidemiology, Patient safety, Prospective stepped wedge cohort design, Trauma, Triage, Wounds and injuries
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-383430 (URN)10.1186/s13049-019-0619-1 (DOI)000466508600002 ()31039800 (PubMedID)
Available from: 2019-05-14 Created: 2019-05-14 Last updated: 2020-03-05Bibliographically approved
Mani, K. & Björck, M. (2019). Alternatives to Randomised Controlled Trials for the Poor, the Impatient, and When Evaluating Emerging Technologies. European Journal of Vascular and Endovascular Surgery, 57(4), 598-599
Open this publication in new window or tab >>Alternatives to Randomised Controlled Trials for the Poor, the Impatient, and When Evaluating Emerging Technologies
2019 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 57, no 4, p. 598-599Article 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-383053 (URN)10.1016/j.ejvs.2018.10.026 (DOI)000464932200028 ()30509892 (PubMedID)
Available from: 2019-05-08 Created: 2019-05-08 Last updated: 2019-05-08Bibliographically approved
Linder, F., Holmberg, L., Eklöf, H., Björck, M., Juhlin, C. & Mani, K. (2019). Better compliance with triage criteria in trauma would reduced costs with maintained patient safety. European journal of emergency medicine, 26(4), 283-288
Open this publication in new window or tab >>Better compliance with triage criteria in trauma would reduced costs with maintained patient safety
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2019 (English)In: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 26, no 4, p. 283-288Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To evaluate trauma triage criteria in terms of compliance, undertriage, and overtriage and identify risk factors for mistriage.

METHODS: In a retrospective cohort study, all consecutive trauma patients at a University Hospital in Sweden in 2012 were included. Patients were stratified into three groups on the basis of trauma team activation (full trauma team, limited trauma team, and no trauma team). Case records were reviewed for mechanism of injury, vital signs, and injuries. Compliance with alert criteria was evaluated and injury severity score combined with the Matrix method was used for assessment of overtriage and undertriage.

RESULTS: A total of 1424 trauma patients were included in the study. Seventy-three (5.1%) patients activated a full trauma team, 732 (51.4%) a limited trauma team, and 619 (43.5%) did not activate any trauma team. Undertriage was 2.7% [95% confidence interval (CI): 1.9-3.8%] and overtriage was 34.2% (95% CI: 23.5-46.3%) in the complete cohort. Compliance with 'trauma triage criteria' was assessed by comparing actual alerts with what was estimated to be the correct alert levels on the basis of prehospital case records. Compliance with full trauma team criteria was 80% (68-88%), limited trauma team was 54% (51-58%), and no trauma team was 79% (76-82%). Assuming full compliance with trauma criteria, the Matrix method resulted in an undertriage of 2.3% (95% CI: 1.6-3.3%) and an overtriage of 42.6% (95% CI: 32.4-53.2%).

CONCLUSION: The overtriage and undertriage in this study is in line with the recommendations of the American College of Surgeons Committee on Trauma. However, better compliance with trauma alert criteria would result in fewer trauma team activations without affecting patient safety.

National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-383431 (URN)10.1097/MEJ.0000000000000544 (DOI)000480684900011 ()29438134 (PubMedID)
Available from: 2019-05-14 Created: 2019-05-14 Last updated: 2020-03-05Bibliographically 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
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

Correction in: EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, Volume: 59, Issue: 3, Pages: 494-494, DOI: 10.1016/j.ejvs.2019.11.026

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: 2020-04-03Bibliographically approved
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