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  • 1.
    Behrendt, Christian-Alexander
    et al.
    Univ Med Ctr Hamburg Eppendorf, Dept Vasc Med, Univ Heart Ctr Hamburg, Hamburg, Germany.
    Bertges, Daniel
    Univ Vermont, Med Ctr, Burlington, VT USA.
    Eldrup, Nikolaj
    Aarhus Univ Hosp, Dept Cardiothorac & Vasc Surg, Aarhus, Denmark.
    Beck, Adam
    Univ Alabama Birmingham, Div Vasc Surg & Endovasc Therapy, Birmingham, AL USA.
    Mani, Kevin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Venermo, Maarit
    Helsinki Univ Hosp, Dept Vasc Surg, Helsinki, Finland; Univ Helsinki, Helsinki, Finland.
    Szeberin, Zoltan
    Semmelweis Univ, Dept Vasc Surg, Budapest, Hungary.
    Menyhei, Gabor
    Pecs Univ, Dept Vasc Surg, Med Ctr, Pecs, Hungary.
    Thomson, Ian
    Dunedin Publ Hosp, Dept Vasc Surg, Dunedin Sch Med, Dunedin, New Zealand.
    Heller, Georg
    Kantonsspital St Gallen, Dept Vasc Surg, St Gallen, Switzerland.
    Wigger, Pius
    Kantonspital, Dept Surg, Winterthur, Switzerland.
    Danielsson, Gudmundur
    Domus Med, Reykjavik Venous Ctr, Reykjavik, Iceland.
    Galzerano, Giuseppe
    Usl Toscana Sud Est, Vasc Surg, Misericordia Hosp Grosseto, Grosseto, Italy.
    Lopez, Cristina
    Univ Hosp Granada, Dept Vasc Surg, Granada, Spain.
    Altreuther, Martin
    St Olavs Hosp, Dept Vasc Surg, Trondheim, Norway.
    Sigvant, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Riess, Henrik Christian
    Univ Med Ctr Hamburg Eppendorf, Dept Vasc Med, Univ Heart Ctr Hamburg, Hamburg, Germany.
    Sedrakyan, Art
    Weill Cornell Med Coll, Healthcare Policy & Res, New York, NY USA.
    Beiles, Barry
    Australian & New Zealand Soc Vasc Surg, Melbourne, Vic, Australia.
    Björck, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Debus, Eike Sebastian
    Univ Med Ctr Hamburg Eppendorf, Dept Vasc Med, Univ Heart Ctr Hamburg, Hamburg, Germany.
    Cronenwett, Jack
    Dartmouth Hitchcock Med Ctr, Dept Surg, Lebanon, NH USA.
    International Consortiumof Vascular Registries Consensus Recommendations for Peripheral Revascularization Registry Data Collection2018In: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 68, no 5, p. E115-E115Article in journal (Other academic)
  • 2.
    Bergqvist, David
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Regarding "Randomized comparison of percutaneous Viabahn stent grafts vs prosthetic femoral-popliteal bypass in the treatment of superficial femoral arterial occlusive disease"2007In: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 46, no 1, p. 176-176Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: This randomized prospective study was designed to compare the effectiveness of treating superficial femoral artery occlusive disease percutaneously with expanded polytetrafluoroethylene (ePTFE)/nitinol self-expanding stent grafts vs surgical femoral-to-above knee (AK) popliteal artery bypass with synthetic graft material. METHODS: From March 2004 to May 2005, 100 limbs in 86 patients with femoral-popliteal arterial occlusive disease were identified. Patients had symptoms ranging from claudication to rest pain, with or without tissue loss, and were prospectively randomized for treatment into one of two groups. The limbs were treated percutaneously with angioplasty and one or more self-expanding stent grafts (n = 50) or surgically with femoral-to-AK popliteal artery bypass using synthetic Dacron or ePTFE grafts (n = 50). The mean +/- SD total length of artery stented was 25.6 +/- 15 cm. Follow-up evaluation with ankle-brachial indices and color flow duplex sonography imaging were performed at 3, 6, 9, and 12 months after treatment. RESULTS: Patients were monitored for a median of 18 months. No statistical difference was found in the primary patency (P = .895) or secondary patency (P = .861) between the two treatment groups. Primary patency at 3, 6, 9, and 12 months of follow-up was 84%, 82%, 75.6%, and 73.5% for the stent graft group and 90%, 81.8%, 79.7%, and 74.2% for the femoral-popliteal surgical group. Thirteen patients in the stent graft group had 14 reinterventions, and 12 reinterventions occurred in the surgical group. This resulted in secondary patency rates of 83.9% for the stent graft group and 83.7% for the surgical group at the 12-month follow-up. CONCLUSIONS: Management of femoral-popliteal arterial occlusive disease using percutaneous treatment with a stent graft is comparable with surgical revascularization with conventional femoral-to-AK popliteal artery bypass using synthetic material up to 12 months. Longer-term follow-up would be helpful in determining ongoing efficacy.

  • 3.
    Björck, Martin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Orr, Nathan
    Univ Kentucky, Dept Surg, Lexington, KY USA..
    Endean, Eric D.
    Univ Kentucky, Dept Surg, Lexington, KY USA..
    Debate: Whether an endovascular-first strategy is the optimal approach for treating acute mesenteric ischemia2015In: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 62, no 3, p. 767-772Article in journal (Refereed)
    Abstract [en]

    Acute mesenteric ischemia continues to be a life-threatening insult in often-elderly patients with many comorbidities. Recognition and correct diagnosis can be an issue leading to delays in therapy that result in loss of bowel or life, or both. The basic surgical principals in treating acute mesenteric ischemia have long been early recognition, resuscitation, urgent revascularization, resection of necrotic bowel, and reassessment with second-look laparotomies. Endovascular techniques now offer a less invasive alternative, but whether an endovascular-first or open surgery-first approach is preferred in most patients is unclear. Our discussants will attempt to clarify these issues.

  • 4. Björnsson, Steinarr
    et al.
    Björck, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Block, Tomas
    Department of Anaesthesia and Intensive Care, St Göran Hospital, Stockholm, Sweden.
    Resch, Timothy
    Acosta, Stefan
    Thrombolysis for acute occlusion of the superior mesenteric artery2011In: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 54, no 6, p. 1734-1742Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: This study evaluated the incidence, complications, and outcome of local intra-arterial thrombolytic therapy for acute superior mesenteric artery (SMA) occlusion in Sweden.

    METHODS: Patients undergoing local intra-arterial thrombolytic therapy for acute SMA occlusion were identified in the Swedish Vascular Registry (SWEDVASC) between 1987 and 2009. Patient data were retrieved in a structured protocol by local vascular surgeons at each participating hospital.

    RESULTS: Included were 34 patients (20 women) from 12 hospitals. Median age was 78 years. The first patient was treated in 1997, and the annual number of patients undergoing thrombolysis increased continuously from 2004 to 2009. Twenty-eight patients (82%) had embolic occlusion. No patients (0%) had acute peritonitis, and one (3%) had bloody stools at admission. Thirty-two patients (94%) were diagnosed by computed tomography with intravenous contrast enhancement. The median dose of alteplase was 20 mg (interquartile range, 11.6-34.0). Successful thrombolysis was achieved in 30 patients (88%). Initial adjunctive aspiration thromboembolectomy was performed in 10 patients. There were six self-limiting bleeding complications; one from the gastrointestinal tract. Thirteen explorative laparotomies, 10 repeat laparotomies, and eight bowel resections were performed. The in-hospital mortality rate was 26% (9 of 34). Age was not associated with in-hospital death (P = .42). Successful thrombolysis was associated with decreased mortality (P = .048).

    CONCLUSION: Local thrombolysis for acute SMA occlusion is a minimally invasive and effective treatment alternative in a select group of patients without peritonitis. The few technique-related complications were mild.

  • 5.
    Blomgren, Lena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Johansson, Gunnar
    Dahlberg-Åkerman, Agneta
    Thermaenius, Peter
    Bergqvist, David
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Changes in superficial and perforating vein reflux after varicose vein surgery2005In: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 42, no 2, p. 315-320Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES:

    This prospective duplex study was conducted to study the effect of current surgical treatment for primary varicose veins on the development of venous insufficiency < or = 2 years after varicose vein surgery.

    METHODS:

    The patients were part of a randomized controlled study where surgery for primary varicose veins was planned from a clinical examination alone or with the addition of preoperative duplex scanning. Postoperative duplex scanning was done at 2 months and 2 years.

    RESULTS:

    Operations were done on 293 patients (343 legs), 74% of whom were women. The mean age was 47 years. In 126 legs, duplex scanning was done preoperatively, at 2 months and 2 years, and at 2 months and 2 years in 251 legs. Preoperative perforating vein incompetence (PVI) was present in 64 of 126 legs. Perforator ligation was not done on 42 of these; at 2 months, 23 of these legs (55%) had no PVI, and at 2 years, 25 legs (60%) had no PVI. Sixty-one legs had no PVI preoperatively, 5 (8%) had PVI at 2 months, and 11 (18%) had PVI at 2 years. In the group of 251 legs, reversal of PVI between 2 months and 2 years was found in 28 (41%) of 68 and was more common than new PVI, which occurred in 41 (22%) of 183 (P = .003). After 2 years, the number of legs without venous incompetence in which perforator surgery was not performed was 11 (26%) of 42 legs with preoperative PVI and 18 (30%) of 61 legs without preoperative PVI, (P = .713). After 2 years, new vessel formation was more common in the surgically obliterated saphenopopliteal junction (SPJ), 4 (40%) of 10, than in the saphenofemoral junction (SFJ), 17 (11%) of 151(P = .027), and new incompetence in a previously normal junction was more common in the SFJ, 11 (18%) of 63, than in the SPJ, 3 (1%) of 226 (P < .001). Reflux in the great saphenous vein (GSV) below the knee was abolished after stripping above the knee in 17 (34%) of 50 legs at 2 months and in 22 legs (44%) after 2 years.

    CONCLUSIONS:

    Varicose vein surgery induces changes in the remaining venous segments of the legs that continue for several months. In most patients, perforators and the GSV below the knee can be ignored at the primary surgery. A substantial number of recurrences in the SFJ and SPJ are unavoidable with present surgical knowledge because they stem from new vessel formation and progression of disease.

  • 6.
    Budtz-Lilly, Jacob
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Wanhainen, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Eriksson, Jacob
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Mani, Kevin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Adapting to a total endovascular approach for complex aortic aneurysm repair: Outcomes after fenestrated and branched endovascular aortic repair2017In: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 66, no 5, p. 1349-1356, article id S0741-5214(17)31065-0Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: This study reports the feasibility of adopting a total endovascular approach for the treatment of complex abdominal aortic aneurysms (AAAs) at a European aortic center and compares the short- and midterm results against those from large and multicenter studies.

    METHODS: All patients treated endovascular aortic repair (EVAR) for juxta/pararenal AAAs or thoracoabdominal aortic aneurysms (TAAAs), both elective and acute, as well as reoperations, from 2010 to 2015 were included. Treatment was fenestrated (FEVAR) or branched (BEVAR), and outcomes were analyzed for technical success and mortality at 30 and 90 days and by Kaplan-Meier curve estimates at 3 years. Outcomes on target vessels were reported as freedom from branch instability in the follow-up period. Reinterventions, endoleaks and perioperative and postoperative morbidities were analyzed.

    RESULTS: A total of 71 patients were treated for juxta/pararenal AAA (n = 40) or TAAA (n = 31): 14 type II, 4 type III, and 13 type IV. There were 47 FEVAR (including 2 physician-modified fenestrated grafts) and 24 BEVAR procedures performed. Four TAAAs were ruptured. No open repairs were performed for these pathologies in this period. Mortality was 2.8% (n = 2) at 30 days and 9.9% at 90 days (n = 7). One late rupture occurred in a patient whose treatment was a technical failure. Survival at 3 years was 77.9% ± 5.6% overall, 90.9% ± 5.2% for juxta/pararenal AAAs, and 60.7% ± 10.3% for TAAAs. Graft deployment was successful in 69 of 71 patients. Revascularization was successful in 205 of 208 target vessels (98.6%): 51 of 51 superior mesenteric arteries, 27 of 27 celiac arteries, and 127 of 130 renal arteries. There were 131 fenestrated bridging stent grafts and 74 branched bridging stent grafts. Technical success was 68 of 71 (95.7%). There were nine cases of branch instability (5 BEVARs, 4 FEVARs) in five patients (7.0%). Seven vessels (5 renal arteries and 2 superior mesenteric arteries) underwent reintervention: 5 for stenoses, 1 for occlusion, and 1 for stent migration. Freedom from branch instability at 3 years was 92.7% ± 2.5% overall, 88.6% ± 6.4% for BEVAR, and 94.6% for FEVAR.

    CONCLUSIONS: The short- and midterm results obtained here indicate that the benefits of a total endovascular treatment for complex aortic aneurysms, as demonstrated by large and multicenter studies, can be adapted and replicated at other centers with a dedicated aortic service. This may help guide future considerations of how to refer or treat this complex patient group.

  • 7.
    Burdess, Anne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Mani, Kevin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Tegler, Gustaf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Wanhainen, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Early Experience With a Novel Thoracic Stent Design for the Prevention of Distal Stent Graft-Induced New Entry Tears (d-SINE)2018In: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 68, no 5, p. E153-E153Article in journal (Other academic)
  • 8.
    Burdess, Anne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Wanhainen, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Tegler, Gustaf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Mani, Kevin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Fenestrated and Branched Endovascular Repair of Aortic Arch Pathology2018In: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 68, no 5, p. E154-E154Article in journal (Other academic)
  • 9. Clough, Rachel E
    et al.
    Mani, Kevin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Lyons, Oliver T
    Bell, Rachel E
    Zayed, Hany A
    Waltham, Matthew
    Carrell, Tom W
    Taylor, Peter R
    Endovascular treatment of acute aortic syndrome2011In: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 54, no 6, p. 1580-1587Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The term acute aortic syndrome (AAS) encompasses a range of conditions that have a risk of imminent aortic rupture and where delays in treatment result in increased mortality. Endovascular treatment offers an attractive alternative to open surgery but little is known about the durability of the repair and the factors that predict mortality.

    METHODS: Prospective data were collected for a cohort of 110 consecutive patients with endovascular treatment for AAS. Patient and procedural characteristics were related to short- and midterm outcome using multivariate logistic regression analysis.

    RESULTS: There were 75 men and 35 women with a median age of 68 (range 57-76) years. The pathologies treated were acute dissection (35), symptomatic aneurysm (32), infected aneurysm (18), transection (12), chronic dissection (9), penetrating ulcer (3), and intramural hematoma (1). Thirty-day mortality was 12.7% and this was associated with hypotension (odds ratio [OR], 5.25), use of general anesthetic (OR, 5.23), long procedure duration (OR, 2.03), and increasing age (OR, 1.07). The causes of death were aortic rupture (4), myocardial infarction (4), stroke (3), and multisystem organ failure (3). The stroke and paraplegia rates were 7.3% and 6.4%, respectively. The 1-year survival was 81% and the 5-year survival 63%. Secondary procedures were required in 13 (11.8%) patients. Factors associated with death at 1 year were presence of an aortic fistula (OR, 9.78), perioperative stroke (OR, 5.87), and use of general anesthetic (OR, 3.76); and at 5 years were aortic fistula (OR, 12.31) and increasing age (OR, 1.06).

    CONCLUSIONS: Acute aortic syndrome carries significant early and late mortality. Emergency endovascular repair offers a minimally invasive treatment option associated with acceptable short and midterm results. Continued surveillance is important as secondary procedures and aortic-related deaths continue to occur throughout the follow-up period.

  • 10. Daryapeyma, Alireza
    et al.
    Östlund, Ollie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Wahlgren, Carl
    Health Care Associated Infections After Lower Extremity Revascularization2013In: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 57, no 5, p. 35S-35SArticle in journal (Other academic)
  • 11.
    Hellgren, Tina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery. Sunderby Hospital, Luleå.
    Wanhainen, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Steuer, Johnny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery. Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm.
    Mani, Kevin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Outcome of endovascular repair for intact and ruptured thoracic aortic aneurysms2017In: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 66, no 1, p. 21-28Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The objective of this study was to assess long-term outcome after thoracic endovascular aortic repair (TEVAR) for thoracic aortic aneurysm (TAA).

    METHODS: All patients who underwent TEVAR for TAA at Uppsala University Hospital from December 1999 to December 2014 were included. Characteristics of the patients and outcome data were collected from medical records, national population registry, and cause of death registry. Perioperative survival was analyzed with the χ(2) test, and 5-year survival was estimated with Kaplan-Meier analysis. Predictors of long-term survival were assessed with Cox regression.

    RESULTS: There were 77 patients included in the study, 49 with intact TAAs (iTAAs) and 28 with ruptured TAAs (rTAAs). Mean follow-up was 83.7 months for iTAA patients and 82.0 months for rTAA patients (P = .853). Mean age was 71.5 years for iTAA patients and 74.8 years for rTAA patients (P = .04). Survival after iTAA repair was 95.9% at 30 days, 91.8% at 90 days, and 62.5% at 5 years. After rTAA repair, survival was 71.4% at 30 days and decreased to 57.1% at 90 days (P < .01), with most deaths after 30 days being related to the aortic event. The 3-year survival rate after rTAA repair was 27.8%, and only one rTAA patient with 5 years of follow-up remained alive. Six aorta-related deaths occurred after 90 days (three iTAA patients, three rTAA patients); five were due to rupture of nontreated aortic segments. The 5-year reintervention rate was 13.2% for iTAA patients and 17.9% for rTAA patients (P = .682). All reinterventions occurred within 14 months of TEVAR. The age-adjusted hazard ratio for long-term mortality was 4.4 after rTAA repair compared with iTAA repair.

    CONCLUSIONS: TEVAR for iTAA was associated with low perioperative mortality and acceptable 5-year survival at 62.5%. Results were more pessimistic after rTAA repair, however, for which two-thirds of the patients were deceased at 3-year follow-up. Improved selection of patients is necessary to identify patients who are likely to truly benefit from rTAA repair.

  • 12.
    Karacagil, Sadettin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Bergqvist, David
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Lower extremity arterial reconstructions based on duplex scanning without preoperative angiography1998In: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 4, no 3, p. 99-102Article in journal (Refereed)
    Abstract [en]

    Abstract

    The high accuracy of duplex scanning in the diagnosis of lower limb arterial insufficiency has prompted us to perform aortoiliac and infrainguinal reconstructions (n = 77) in a selected group of patients with atherosclerotic occlusive disease of the lower extremity as well as graft revisions. Duplex findings were in agreement with operative findings in all patients in regard to the selection of the proximal and distal sites of the bypass procedures. In conclusion, we recommend with caution that, in patients with satisfactory duplex examination, vascular surgical reconstructions for lower limb ischaemia can be safely performed without preoperative angiography.

  • 13.
    Karlsson, Lars
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Research and Development, Gävleborg.
    Gnarpe, Judy
    Bergqvist, David
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Lindbäck, Johan
    Uppsala University, Units outside the University.
    Pärsson, Håkan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    The effect of azithromycin and Chlamydophila pneumoniae infection on expansion of small abdominal aortic aneurysms: a prospective randomised double-blind trial2009In: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 50, no 1, p. 23-29Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of the study was to evaluate the effect of azithromycin on the expansion rate of small abdominal aortic aneurysms (AAAs), and to determine whether or not a correlation exists between serological markers for Chlamydophilia pneumonia (Cpn) infection and AAA expansion. METHODS: Nine vascular centers were included and 259 patients were invited to participate. Ten patients declined and 2 patients had chronic kidney failure, leaving a total of 247 patients. Inclusion criteria were: AAA 35-49 mm and age <80 years. Patients were randomized to receive either azithromycin (Azithromax, Pfizer Inc, New York, NY) 600 mg once daily for 3 days and then 600 mg once weekly for 15 weeks, or placebo in identical tablets. The ultrasound scans were performed in a standardized way within a month before inclusion and every 6 months for a minimum follow-up time of 18 months. Cpn serology was analyzed in blood samples taken at inclusion and 6 months later. Serum was analyzed for Cpn IgA and IgG antibodies by microimmunofluorescence (MIF). Computed tomography (CT) scans were done in 66 patients at inclusion and at 1 year for volume calculations. RESULTS: Thirty-four patients were excluded, ie, could not be followed for 18 months, 20 in the placebo group and 16 in the active treatment group. A total of 211 patients had at least two measurements and all were analyzed in an intention-to-treat analysis. Detectable IgA against Cpn was found in 115 patients and detectable IgG against Cpn in 160 patients. No statistically significant differences were found between the groups regarding median expansion rate measured by ultrasound scan (0.22 cm/year, interquartile range [IQR]: 0.09 to 0.34 in the placebo group vs 0.22, IQR: 0.12 to 0.36 in the treatment group, P = .85). Volume calculation did not change that outcome (10.4 cm(3)/year in the placebo group vs 15.9 cm(3)/year in the treatment group, P = .61). No correlation was found between serological markers for Cpn infection and the expansion rate. Patients taking statins in combination with acetylsalicylic acid (ASA) had significantly reduced expansion rate compared to patients who did not take statins or ASA, 0.14 cm/year vs 0.27 cm/year, P < .001. CONCLUSION: Azithromycin did not have any effect on AAA expansion. No correlation was found between serological markers for Cpn and AAA expansion, indicating no clinical relevance for Cpn testing in AAA surveillance. However, a significant reduction in AAA expansion rate was found in patients treated with a combination of ASA and statins.

  • 14.
    Kedora, John
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Regarding "Randomized comparison of percutaneous Viabalm stent grafts vs prosthetic femoral-popliteal bypass in the treatment of superficial Femoral arterial occlusive disease" - Reply2007In: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 46, no 1, p. 176-177Article in journal (Refereed)
  • 15.
    Kragsterman, Björn
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Pärsson, Håkan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Lindbäck, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Bergqvist, David
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Björck, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Outcomes of carotid endarterectomy in Sweden are improving: resluts from a population based registry2006In: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 44, no 1, p. 79-85Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: In large randomized trials, carotid endarterectomy (CEA) for asymptomatic stenosis has shown a net benefit compared with best medical treatment. To justify an increased number of procedures for this indication, the perioperative risk of stroke or death must not exceed that of the trials. The aim of this study was to evaluate the outcome in routine clinical practice in Sweden in a population-based study. METHODS: The Swedish Vascular Registry (Swedvasc) covers all centers performing CEA. Data on all registered CEAs during 1994 to 2003 were analyzed both for the whole time period and for two 5-year periods to study alterations over time. Four validation procedures of the registry were performed. Medical records were reviewed for both a random sample and a target sample (a total of 12% of the CEAs for asymptomatic stenosis). Swedvasc data were cross-matched with the In-Patient-Registry (used for reimbursement) and the Population-registry (death). RESULTS: A total of 6182 CEAs were registered, 671 being for asymptomatic stenosis. In the validation process, no missed registration of major stroke or death was found. Patients with asymptomatic stenosis had, when the whole time-period was analyzed, a perioperative combined stroke or death rate of 2.1%. Outcome improved over time; the combined stroke or death rate decreased from 3.3% (11/330) from 1994 to 1998 to 0.9% (3/341) from 1999 to 2003 (P = .026). During the second time period, no patient with a perioperative major stroke or death was reported. CONCLUSIONS: This extensively validated national audit of CEA for patients with asymptomatic carotid artery stenosis showed results well comparable with those of the randomized trials. The results improved over time.

  • 16.
    Mani, Kevin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Clough, Rachel E.
    Taylor, Peter R.
    Regarding "Patient outcomes and thoracic aortic volume and morphologic changes following thoracic endovascular aortic repair in patients with complicated chronic type B aortic dissection"2013In: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 57, no 3, p. 899-899Article in journal (Refereed)
  • 17.
    Mani, Kevin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Wanhainen, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Lundkvist, Jonas
    Lindstrom, David
    Cost-effectiveness of intensive smoking cessation therapy among patients with small abdominal aortic aneurysms2011In: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 54, no 3, p. 628-636Article in journal (Refereed)
    Abstract [en]

    Introduction: Smoking cessation is one of the few available strategies to decrease the risk for expansion and rupture of small abdominal aortic aneurysms (AAAs). The cost-effectiveness of an intensive smoking cessation therapy in patients with small AAAs identified at screening was evaluated. Methods: A Markov cohort simulation model was used to compare an 8-week smoking cessation intervention with adjuvant pharmacotherapy and annual revisits vs nonintervention among 65-year-old male smokers with a small AAA identified at screening. The smoking cessation rate was tested in one-way sensitivity analyses in the intervention group (range, 22%-57%) and in the nonintervention group (range, 3%-30%). Literature data on the effect of smoking on AAA expansion and rupture was factored into the model. Results: The intervention was cost-effective in all tested scenarios and sensitivity analyses. The smoking cessation intervention was cost-effective due to a decreased need for AAA repair and decreased rupture rate even when disregarding the positive effects of smoking cessation on long-term survival. The incremental cost/effectiveness ratio reached the willingness-to-pay threshold value of 25,000 per life-year gained when assuming an intervention cost of >(sic)3250 or an effect of <= 1% difference in long-term smoking cessation between the intervention and nonintervention groups. Smoking cessation resulted in a relative risk reduction for elective AAA repair by 9% and for rupture by 38% over 10 years of follow-up. Conclusions: An adequate smoking cessation intervention in patients with small AAAs identified at screening can cost-effectively increase long-term survival and decrease the need for AAA repair.

  • 18.
    Persson, Sven-Erik
    et al.
    Umea Univ, Dept Surg & Perioperat Sci, Surg, S-90185 Umea, Sweden..
    Boman, Kurt
    Skelleftea Cty Hosp, Dept Med, Skelleftea, Sweden..
    Wanhainen, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Carlberg, Bo
    Umea Univ, Dept Publ Hlth & Clin Med, Umea, Sweden..
    Arnerlöv, Conny
    Umea Univ, Dept Surg & Perioperat Sci, Surg, S-90185 Umea, Sweden..
    Decreasing prevalence of abdominal aortic aneurysm and changes in cardiovascular risk factors2017In: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 65, no 3, p. 651-658Article in journal (Refereed)
    Abstract [en]

    Objective: A significant reduction in the incidence of cardiovascular disease, including abdominal aortic aneurysm (AAA), has been observed in the past decades. In this study, a small but geographically well defined and carefully characterized population, previously screened for AAA and risk factors, was re-examined 11 years later. The aim was to study the reduction of AAA prevalence and associated factors. Methods: All men and women aged 65 to 75 years living in the Norsjo municipality in northern Sweden in January 2010 were invited to an ultrasound examination of the abdominal aorta, registration of body parameters and cardiovascular risk factors, and blood sampling. An AAA was defined as an infrarenal aortic diameter >= 30 mm. Results were compared with a corresponding investigation conducted in 1999 in the same region. Results: A total of 602 subjects were invited, of whom 540 (90%) accepted. In 2010, the AAA prevalence was 5.7% (95% confidence interval [CI], 2.8%-8.5%) among men compared with 16.9% (95% CI, 12.3%-21.6%) in 1999 (P < .001). The corresponding figure for women was 1.1% (95% CI, 0.0%-2.4%) vs 3.5% (95% CI, 1.2%-5.8%; P - .080). A low prevalence of smoking was observed in 2010 as well as in 1999, with only 13% and 10% current smokers, respectively (P = .16). Treatment for hypertension was significantly more common in 2010 (58% vs 44%; P < .001). Statins increased in the population (34% in 2010 vs 3% in 1999; P < .001), and the lipid profile in women had improved significantly between 1999 and 2010. Conclusions: A highly significant reduction in AAA prevalence was observed during 11 years in Norsjo. Treatment for hypertension and with statins was more frequent, whereas smoking habits remained low. This indicates that smoking is not the only driver behind AAA occurrence and that lifestyle changes and treatment of cardiovascular risk factors may play an equally important role in the observed recent decline in AAA prevalence.

  • 19. Rathenborg, LK
    et al.
    Venermo, M
    Troëng, T
    Jensen, LP
    Vikatmaa, P
    Wahlgren, C
    Ijäs, P
    Björck, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Kragsterman, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Safety of carotid endarterectomy after intravenous thrombolysis for acute ischaemic stroke: a case-controlled multicentre registry study2014In: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 60, p. 1712-Article in journal (Refereed)
  • 20.
    Sedrakyan, Art
    et al.
    Weill Cornell Med Coll, Dept Healthcare Policy & Res, New York, NY USA..
    Cronenwett, Jack L.
    Dartmouth Hitchcock Med Ctr, Dept Surg, Lebanon, NH 03766 USA..
    Venermo, Maarit
    Univ Helsinki, Dept Vasc Surg, Helsinki, Finland.;Helsinki Univ Hosp, Helsinki, Finland..
    Kraiss, Larry
    Univ Utah, Div Vasc Surg, Salt Lake City, UT USA..
    Marinac-Dabic, Danica
    US FDA, Div Epidemiol, Off Surveillance & Biometr, Ctr Devices & Radiol Hlth, Silver Spring, MD USA..
    Björck, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    An international vascular registry infrastructure for medical device evaluation and surveillance2017In: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 65, no 4, p. 1220-1222Article in journal (Refereed)
    Abstract [en]

    The Medical Device Epidemiology Network (MDEpiNet) is an innovative effort supported by the US Food and Drug Administration (FDA) that is committed to the development of a medical device science and surveillance infrastructure. Recently MDEpiNet sponsored a national medical device registry task force which developed a guidance document for 21st century medical device evaluation that highlights the importance of national and international registries, their linkages with other relevant data, and stakeholder involvement. 1 Two international efforts, the International Consortium of Orthopedic Registries (ICOR) and the International Consortium of Cardiovascular Registries (ICCR) 2 were launched in the past 4 years to study orthopedic and cardiovascular devices in this regard.

  • 21.
    Sigvant, Birgitta
    et al.
    Karlstad Cent Hosp, Dept Vasc Surg, S-65185 Karlstad, Sweden.;Karolinska Inst, Sodersjukhuset, Dept Clin Sci & Educ, Stockholm, Sweden..
    Hasvold, Pål
    AstraZeneca Gothenburg, Molndal, Sweden..
    Kragsterman, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Falkenberg, Mårten
    Sahlgrens Acad, Dept Radiol, Inst Clin Sci, Gothenburg, Sweden..
    Johansson, Saga
    AstraZeneca Gothenburg, Molndal, Sweden..
    Thuresson, Marcus
    Statisticon AB, Uppsala, Sweden..
    Nordanstig, Joakim
    Sahlgrenska Univ Hosp & Acad, Dept Vasc Surg, Gothenburg, Sweden.;Sahlgrenska Univ Hosp & Acad, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden..
    Cardiovascular outcomes in patients with peripheral arterial disease as an initial or subsequent manifestation of atherosclerotic disease: Results from a Swedish nationwide study2017In: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 66, no 2, p. 507-514e1Article in journal (Refereed)
    Abstract [en]

    Objective: Long-term progression of peripheral arterial disease (PAD) as initial manifestation of atherosclerotic arterial disease is not well described. Cardiovascular (CV) risk was examined in different PAD populations diagnosed in a hospital setting in Sweden. Methods: Data for this retrospective cohort study were retrieved by linking data on morbidity, medication use, and mortality from Swedish national registries. Primary CV outcome was a composite of myocardial infarction, ischemic stroke (IS), and CV death. Kaplan-Meier analysis and Cox proportional hazards modeling was used for describing risk and relative risk. Results: Of 66,189 patients with an incident PAD diagnosis (2006-2013), 40,136 had primary PAD, 16,786 had PAD _ coronary heart disease (CHD), 5803 had PAD _IS, and 3464 had PAD _IS _CHD. One-year cumulative incidence rates of major CV events for the groups were 12%, 21%, 29%, and 34%, respectively. Corresponding numbers for 1-year all-cause death were 16%, 22%, 33%, and 35%. Compared with the primary PAD population, the relative risk increase for CV events was highest in patients with PAD _IS _CHD (hazard ratio [HR], 2.01), followed by PAD _IS (HR, 1.87) and PAD _ CHD (HR, 1.42). Despite being younger, the primary PAD population was less intensively treated with secondary preventive drug therapy. Conclusions: PAD as initial manifestation of atherosclerotic disease diagnosed in a hospital-based setting conferred a high risk: one in eight patients experienced a major CV event and one in six patients died within 1 year. Despite younger age and substantial risk of future major CV events, patients with primary PAD received less intensive secondary preventive drug therapy.

  • 22.
    Sigvant, Birgitta
    et al.
    Karlstad Cent Hosp, Dept Vasc Surg, Karlstad, Sweden.;Karolinska Inst, Sodersjukhuset, Dept Clin Sci & Educ, Stockholm, Sweden..
    Kragsterman, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Falkenberg, Marten
    Sahlgrens Acad, Inst Clin Sci, Dept Radiol, Gothenburg, Sweden..
    Hasvold, Pal
    AstraZeneca, Global Med Affairs & Sweden Med Affairs, Med Evidence & Observat Res, Molndal, Sweden..
    Johansson, Saga
    AstraZeneca, Global Med Affairs & Sweden Med Affairs, Med Evidence & Observat Res, Molndal, Sweden..
    Thuresson, Marcus
    Statisticon AB, Uppsala, Sweden..
    Nordanstig, Joakim
    Sahlgrenska Univ Hosp & Acad, Dept Vasc Surg, Gothenburg, Sweden.;Sahlgrenska Univ Hosp & Acad, Dept Mol & Clin Med, Inst Med, Gothenburg, Sweden..
    Contemporary cardiovascular risk and secondary preventive drug treatment patterns in peripheral artery disease patients undergoing revascularization2016In: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 64, no 4, p. 1009-1017.e3Article in journal (Refereed)
    Abstract [en]

    Objective: Peripheral artery disease (PAD) is common worldwide, and PAD patients are increasingly offered lower limb revascularization procedures. The aim of this population-based study was to describe the current risk for cardiovascular (CV) events and mortality and also to elucidate the current pharmacologic treatment patterns in revascularized lower limb PAD patients. Methods: This observational, retrospective cohort study analyzed prospectively collected linked data retrieved from mandatory Swedish national health care registries. The Swedish National Registry for Vascular Surgery database was used to identify revascularized PAD patients. Current risk for CV events and death was analyzed, as were prescribed drugs aimed for secondary prevention. A Cox proportional hazard regression model was used to explore risk factors for suffering a CV event. Results: Between May 2008 and December 2013, there were 18,742 revascularized PAD patients identified. Mean age was 70.0 years among patients with intermittent claudication (IC; n = 6959) and 76.8 years among patients with critical limb ischemia (CLI; n = 11,783). Antiplatelet therapy, statins, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and beta-blockers were used by 73%, 60%, 57%, and 49% at admission for revascularization. CV event rate (a composite of myocardial infarction, ischemic stroke, or CV death) at 12, 24, and 36 months was 5.1% (95% confidence interval [CI], 4.5-5.6), 9.5% (95% CI, 8.7-10.3), and 13.8% (95% CI, 12.8-14.8) in patients with IC and 16.8% (95% CI, 16.1-17.6), 25.9% (95% CI, 25.0-26.8), and 34.3% (95% CI, 33.2-35.4) in patients with CLI. Best medical treatment, defined as any antiplatelet or anticoagulant therapy along with statin treatment, was offered to 65% of IC patients and 45% of CLI patients with little change during the study period. Statin therapy was associated with reduced CV events (hazard ratio, 0.76; 95% CI, 0.71-0.81; P < .001), whereas treatment with low-dose aspirin was not. Conclusions: Revascularized PAD patients are still at a high risk for CV events without a declining time trend. A large proportion of both IC and CLI patients were not offered best medical treatment. The most commonly used agent was aspirin, which was not associated with CV event reduction. This study calls for improved medical management and highlights an important and partly unmet medical need among revascularized PAD patients.

  • 23.
    Steuer, Johnny
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Wanhainen, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Thelin, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Thoracic Surgery.
    Nyman, Rickard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Radiology.
    Eriksson, Mats-Ola
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Radiology.
    Björck, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Outcome of endovascular treatment of traumatic aortic transection2012In: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 56, no 4, p. 973-978Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    The purpose of this study was to analyze our experience of thoracic endovascular aortic repair (TEVAR) in patients with traumatic aortic transection.

    METHODS:

    This was a single-center consecutive case series that was conducted at the Uppsala University Hospital, Tertiary Referral Center. There were a total of 17 consecutive patients undergoing TEVAR for traumatic thoracic aortic transection. All patients undergoing TEVAR for aortic transection were registered prospectively and their medical records were reviewed regarding technical details, mechanism of injury, and concomitant injuries. Long-term outcome was analyzed with respect to need for reintervention and survival.

    RESULTS:

    Between 2001 and 2010, 17 patients underwent TEVAR for traumatic aortic injury. Median age was 42 years (range, 18-77 years), and 15 of 17 patients (88%) were men. Fourteen patients had been involved in motor vehicle accidents, two had fallen from heights, and one fell off a bicycle on a slope. In all cases, the aortic injury was located in the proximity of the origin of the left subclavian artery. All patients had concomitant injuries. In all patients, a single stent graft was sufficient to exclude the injured part of the aorta. The median cover length was 120 mm (range, 100-200 mm). In-hospital mortality was 24% (4 of 17 patients). One patient died perioperatively and three postoperatively, two from brain injuries and one from multiorgan failure. After a median follow-up of 36 months (range, 10-98 months), three patients underwent reintervention (18%), each patient only once; one for a type-I endoleak, and two for pseudocoarctation secondary to stent graft infolding. Two were treated endovascularly, and one had a stent graft explantation.

    CONCLUSIONS:

    Endovascular repair allows rapid and minimally invasive therapy in patients with traumatic aortic injury with good technical results. The outcome is highly dependent on the severity of other concurrent injuries.

  • 24.
    Sveinsson, Magnus
    et al.
    Reg Hosp Helsingborg, Helsingborg, Sweden..
    Mani, Kevin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Kristmundsson, Thorarinn
    Skane Univ Hosp, Lund, Sweden..
    Dias, Nuno
    Skåne Univ Hosp, Lund, Sweden..
    Sonesson, Bjorn
    Skåne Univ Hosp, Lund, Sweden..
    Wanhainen, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Pesch, Timothy
    Skåne Univ Hosp, Lund, Sweden..
    Juxtarenal Endovascular Therapy With Fenestrated and Branched Stent Grafts After Previous Infrarenal Repair2017In: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 65, no 6, p. 149S-149SArticle in journal (Other academic)
  • 25.
    Tegler, Gustaf
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Ericson, Katharina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology.
    Sörensen, Jens
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Section of Nuclear Medicine and PET. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Björck, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Wanhainen, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Inflammation in the walls of asymptomatic abdominal aortic aneurysms is not associated with increased metabolic activity detectable by 18-fluorodeoxglucose positron-emission tomography2012In: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 56, no 3, p. 802-807Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    We hypothesized that the general inflammation observed in the wall of large, asymptomatic abdominal aortic aneurysms (AAAs) could be detected in vivo by 18-fluorodeoxglucose (FDG) positron-emission tomography (PET) and, if so, that this method could be used to study if active inflammation is an early pathogenetic finding in small AAAs detected by screening.

    METHODS:

    In this prospective clinical study, 12 men were examined with FDG-PET computed tomography. Seven had large asymptomatic AAAs (range, 52-66 mm) that required surgery, and five had small AAAs (range, 34-40 mm) under surveillance. In the surgery group, biopsy specimens were taken from the aneurysm wall for histologic examinations.

    RESULTS:

    Compared with normal segments of the aorta, liver, and blood and compared with healthy controls matched for age and sex, no increased FDG uptake, measured as standardized uptake value, was detected in any of the large or small AAAs. The SUVmean difference between infrarenal aorta and blood was -0.3 for cases and -0.1 for controls (P = .06). The corresponding differences between the infrarenal aorta and liver was -0.8 and -0.8 (P = .91) and between infrarenal aorta and suprarenal aorta was -0.2 and -0.1 for cases and controls, respectively (P = .20). The histologic examination of the aneurysm walls showed high inflammatory cell infiltration with T lymphocytes, B lymphocytes, and macrophages.

    CONCLUSIONS:

    The chronic inflammation observed in the wall of asymptomatic AAAs was not sufficiently metabolically active to result in an increased glucose metabolism detectable by FDG-PET by means of this standard protocol. To study the importance of inflammation in the pathogenesis of AAAs in vivo, PET tracers other than FDG need to be developed.

  • 26. Tsui, Janice C. S.
    et al.
    Souza, Domingos
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Thoracic Surgery.
    Filbey, Derek
    Karlsson, Mats
    Dashwood, Michael R.
    Localization of nitric oxide synthase in saphenous vein grafts harvested with a novel "no-touch" technique: potential role of nitric oxide contribution to improved early graft patency rates2002In: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 35, no 2, p. 356-362Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The use of the saphenous vein in coronary artery bypass graft surgery is associated with high 1-year occlusion rates of as much as 30%. A new "no-touch" technique of saphenous vein harvesting in which the vein is harvested with a pedicle of surrounding tissue and not distended may result in improved early patency rates. We hypothesize that nitric oxide synthase is better preserved with the no-touch technique, and the aim of this study was the investigation of whether nitric oxide synthase distribution and quantity in saphenous veins harvested with the no-touch technique differ from those veins harvested with the conventional technique. The separate contribution of perivascular tissue removal and distension to alterations in nitric oxide synthase was also studied.

    METHODS: Segments of 10 saphenous veins were harvested from 10 patients who underwent coronary artery bypass grafting surgery with the no-touch and conventional techniques. Samples were also taken from segments that were stripped of surrounding tissue but not distended. Nitric oxide synthase distribution was studied with reduced nicotinamide adenine dinucleotide phosphate--diaphorase histochemistry, and staining was quantified with image analysis. Immunohistochemistry was used for the identification of specific nitric oxide synthase isoforms, and immunomarkers were used for the identification of associated cell types.

    RESULTS: Nitric oxide synthase content was higher in no-touch vessels as compared with conventionally harvested vessels (35.5%; P <.05, with analysis of variance). This content was associated with endothelial nitric oxide synthase on the lumen while all three isoforms were present in the media. In the intact adventitia of no-touch vessels, all three isoforms of nitric oxide synthase were also present, associated with microvessels and perivascular nerves. Perivascular tissue stripping and venous distension both contribute to the reduced nitric oxide synthase in conventionally harvested veins.

    CONCLUSION: The new no-touch technique of saphenous vein harvesting preserves nitric oxide synthase, which suggests that improved nitric oxide availability may be an important mechanism in the success of this technique.

  • 27. Wahlgren, Carl
    et al.
    Kragsterman, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Management and Outcome of Pediatric Vascular Injuries2014In: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 59, no 6, p. 75S-75SArticle in journal (Other academic)
    Abstract [en]

    Vascular injuries in children are relatively uncommon. The objective of this population-based study was to investigate the epidemiology, management, and early outcomes of pediatric vascular injuries.

  • 28.
    Wanhainen, Anders
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Björck, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    The Swedish experience of screening for abdominal aortic aneurysm2011In: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 53, no 4, p. 1164-1165Article in journal (Refereed)
  • 29.
    Wanhainen, Anders
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Themudo, Raquel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Radiology.
    Ahlström, Håkan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Radiology.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Johansson, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Radiology.
    Thoracic and abdominal aortic dimension in 70-year-old men and women: a population-based whole-body magnetic resonance imaging (MRI) study2008In: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 47, no 3, p. 504-12Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of this population-based study was to determine the optimal dividing-line between normal aorta and aneurysm for different aortic segments in 70-year-old men and women by means of whole-body magnetic resonance imaging. METHODS: Two hundred thirty-one subjects (116 men), randomly recruited from a population-based cohort study, were included. The smallest outer diameter (dia) was measured on the axial survey scan on six predefined aortic segments: (1) ascending aorta, (2) descending aorta, (3) supraceliac aorta, (4) suprarenal aorta, (5) largest infrarenal abdominal aorta, and (6) aortic bifurcation. Relative aortic dia were calculated by dividing a given aortic dia by the suprarenal aortic dia. The dividing-line between normal aorta and aneurysm at different aortic segments was estimated by taking the mean dia +2 SD and/or mean ratio of the aortic segment to the suprarenal aorta +2 SD. RESULTS: The mean dia of the six segments were 4.0 cm (SD 0.4), 3.2 cm (0.3), 3.0 cm (0.3), 2.8 cm (0.3), 2.4 cm (0.5), and 2.3 cm (0.3) in men. The corresponding dia in women were 3.4 cm (0.4), 2.8 cm (0.3), 2.7 cm (0.3), 2.7 cm (0.3), 2.2 cm (0.3), and 2.0 cm (0.2). The mean ratio to the suprarenal aorta was 1.4 (SD 0.2) for the ascending aorta, 1.2 (0.1) for the descending aorta, and 0.9 (0.2) for the infrarenal aorta in men. The corresponding ratios in women were 1.3 (0.2), 1.0 (0.1), and 0.8 (0.1). CONCLUSION: For men the suggested dividing-line (dia and ratio) between normal aorta and aneurysm for the ascending aorta is 4.7 cm dia and 1.8 ratio, for the descending aorta 3.7 cm dia and 1.5 ratio, and for the infrarenal aorta is 3.0 cm dia and 1.1 ratio. The corresponding dividing-lines for women are 4.2 cm dia and 1.7 ratio, 3.3 cm dia and 1.3 ratio, and 2.7 cm dia and 1.0 ratio.

  • 30. Ye, Wei
    et al.
    Liu, Chang-Wei
    Ricco, Jean-Baptiste
    Mani, Kevin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Zeng, Rong
    Jiang, Jingmei
    Early and late outcomes of percutarreous treatment of TransAtlantic Inter-Society Consensus class C and D aorto-iliac lesions2011In: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 53, no 6, p. 1728-1737Article, review/survey (Refereed)
    Abstract [en]

    Objectives: The aim of this study was to analyze the technical success and long-term patency of the endovascular treatment of TransAtlantic Inter-Society Consensus (TASC) C and D aorto-iliac arterial lesions. Methods: All studies reporting original series of patients published in English between 2000 and 2010 were enrolled into meta-analysis. Separate meta-analyses were performed for groups with immediate technical success, 12-month patency, and long-term outcomes. Subgroup analyses were performed to determine if there were differences in outcomes between patients with varying types of lesions (TASC C or D lesions) or between different stenting strategies, including primary or selective stenting. Results: Sixteen articles consisting of 958 patients were enrolled in this meta-analysis. The pooled estimate for technical success was 92.8% (95% confidence interval [CI], 89.8%-95.0%, 749 cases). Primary patency at 12 months was 88.7% (95% CI, 85.9%-91.0%, 787 cases). Subgroup analyses demonstrated a technical success rate of 93.7% (95% CI, 88.9%-96.5%) and a 12-month primary patency rate of 89.6% (95% CI, 84.8%-93.0%) for TASC C lesions. For TASC D lesions, these rates were 90.1% (95% CI, 76.6%-96.2%) and 87.3% (95% CI, 82.5%-90.9%), respectively. The technical success and 12-month primary patency rates for primary stenting were 94.2% (95% CI, 91.8%-95.9%) and 92.1% (95% CI, 89.0%-94.3%), respectively; for selective stenting, these rates were 88.0% (95% CI, 67.9%-96.2%) and 82.9% (95% CI, 72.2%-90.0%), respectively. The long-term, primary patency rates for patients receiving primary stenting were significantly better than those receiving selective stenting. Publication bias was not significant for these analyses. Conclusions: This study demonstrates that early and midterm outcomes of endovascular treatment for TASC C and D aorto-iliac lesions were acceptable, with a better patency for primary stenting than selective stenting.

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