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  • 351.
    Lindström, David
    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.
    Lundberg, Goran
    Karolinska Inst, Dept Vasc Surg, Karolinska Univ Hosp, Stockholm, Sweden.
    Wanhainen, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Bridging stent grafts in fenestrated and branched endovascular aortic repair: current practice and possible complications2019In: Journal of Cardiovascular Surgery, ISSN 0021-9509, E-ISSN 1827-191X, Vol. 60, no 4, p. 476-484Article, review/survey (Refereed)
    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.

  • 352. Linne, A.
    et al.
    Smidfelt, K.
    Langenskiold, M.
    Hultgren, R.
    Nordanstig, J.
    Kragsterman, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Lindstrom, D.
    Low Post-operative Mortality after Surgery on Patients with Screening-detected Abdominal Aortic Aneurysms: A Swedvasc Registry Study2014In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 48, no 6, p. 649-656Article in journal (Refereed)
    Abstract [en]

    Objectives: Screening for abdominal aortic aneurysms (AAAs) substantially reduces aneurysm-related mortality in men and is increasing worldwide. This cohort study compares post-operative mortality and complications in men with screening-detected vs. non-screening-detected AAAs. Methods: Data were extracted from the Swedish National Registry for Vascular Surgery (Swedvasc) for all screening-detected men treated for AAA (n = 350) and age-matched controls treated for non-screening-detected AAA (n = 350). Results: There were no differences in baseline characteristics besides age, which was lower in the screening-detected group than in the non-screening-detected group (median 66 vs. 68, p < .001). Open repair was used more frequently than endovascular aortic repair (EVAR) in patients with screening-detected AAAs than in nonscreening-detected controls (56% vs. 45% p = .005). No differences in major post-operative complications at 30 days were observed between the groups. In patients treated with open repair there were no differences in 30-day, 90-day or 1-year mortality in screening-detected patients compared to non-screening-detected controls (1.0% vs. 3.2% p = .25, 2.1% vs. 4.5% p = .23, 4.1% vs. 5.8% p = .61). None of the patients treated with EVAR in either group died within 30 days. The 90-day mortality after EVAR was lower in patients with screening-detected AAA than in those with non-screening-detected AAAs (0.0% vs. 3.1%, p = .04). No difference in the 1-year mortality was detected in the EVAR-patients between the two groups (1.4% vs. 4.7%, p = .12). Conclusions: The contemporary post-operative mortality after AAA surgery was low in this national audit of patients with screening-detected AAAs and age-matched controls. Patients with screening-detected AAAs have the same frequency of complications at 30 days as patients with non-screening-detected AAA. This study gives further support to national screening programs for the detection of AAA in men.

  • 353.
    Liungman, Krister
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Mani, Kevin
    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.
    Bosaeus, Linus
    Endovasc Dev Ltd, Vasagatan 5B, S-75313 Uppsala, Sweden..
    Lachat, Mario
    Univ Krankenhaus Zurich, Zurich, Switzerland..
    Safety and Functionality of a Guidewire Fixator: Clinical Investigation of a New Endovascular Tool2018In: Innovations (Philadelphia): technology and techniques in cardiothoracic and vascular surgery, ISSN 1556-9845, E-ISSN 1559-0879, Vol. 13, no 1, p. 51-53Article in journal (Refereed)
    Abstract [en]

    Objective: A new endovascular tool, the Liungman Guidewire Fixator, has been developed to simplify endovascular treatment in complex aortic aneurysms. The device has been extensively tested in bench models and animal trials. To verify the safety and functionality demonstrated in the porcine model, the device was tested in ten patients undergoing endovascular aortic repair (EVAR) or fenestrated endovascular aortic repair (f-EVAR) treatment for abdominal aortic aneurysm.

    Methods: The Liungman Guidewire Fixator consists of a braided stent-like, cylindrical structure with conical ends and a central channel for a 0.035 '' guidewire. When in use, it is slid along the guidewire and positioned in the target artery, where the Liungman Guidewire Fixator interacts with the arterial wall by anchoring the guidewire to the wall through a radial force. The Liungman Guidewire Fixator allows for uninterrupted blood flow passed the point of fixation. In this study, the Liungman Guidewire Fixator was tested in ten patients undergoing EVAR or f-EVAR treatment for abdominal aortic aneurysm. The device was deployed and retrieved crossover into the hypogastric artery, and the occurrence of thrombotic occlusion, arterial dissection, and vascular rupture or trauma was studied using angiography, as well as device ability to withstand guidewire tension.

    Results: There were no instances of occlusion, dissection, or vascular trauma detected using angiography. In all cases, deployment and retrieval were successful, and the devices could withstand an applied tension of 3 N. In one instance, retrieval was challenging because of significant tortuosity, which was resolved by a coaxial catheterization.

    Conclusions: Deployment was uneventful in all ten patients. Retrieval according to the intended instruction for use was performed in nine of the patients. In one patient, a coaxial catheterization was necessary. All devices withstood a retention force of 3 N.

  • 354.
    Ljungman, Christer
    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.
    Kragsterman, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Nyman, Rickard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Radiology.
    Eriksson, Lars-Gunnar
    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.
    Propositions for refinement of the hybrid surgical technique for treatment of thoraco-abdominal aortic aneurysm2008In: Scandinavian Journal of Surgery, ISSN 1457-4969, E-ISSN 1799-7267, Vol. 97, no 2, p. 174-177Article, review/survey (Refereed)
    Abstract [en]

    Traditional open repair of thoraco-abdominal aortic aneurysms Crawford type II-IV carries a high perioperative risk and mortality. The hybrid technique for combined surgical and endovascular treatment offers an interesting alternative with reduced risk of paraparesis and possibly a reduced mortality rate. Propositions for refinement of this approach are outlined based on a single centre experience.

  • 355. Ljungström, K-G.
    et al.
    Troëng, Thomas
    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.
    Time-trends in vascular access surgery in Sweden 1987-20062008In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 36, no 5, p. 592-6Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To study time-trends in vascular access surgery. DESIGN: Prospectively registered data. MATERIAL AND METHODS: The Swedish vascular registry (Swedvasc) was searched for haemodialysis access operations (HAO) 1987-2006. RESULTS: 12,342 open and endovascular operations were identified. Eighty-five percent of HAO 2004-2006 were reported to the registry. The median age of patients having their first HAO increased from 56 to 68 during the first decade (p<0.0001), then remained stable. The frequency of diabetes increased from 12% in 1987 to 32% in 2006 (p<0.0001). The percentage of first HAO of total workload decreased from 76% to 48%. The percentage of first HAO performed as vein fistulas remained unchanged. The number of patients recorded for ten or more previous HAO increased over time. Percutaneous angioplasties increased during the last decade. Of 4706 patients operated on with primary radiocephalic AV-fistulas, 2933 (62%) were operated only once. Analysis of 3739 subsequent operations in 1773 patients disclosed that at the tenth operation vein was still used in 54%. With an increasing number of operations, arterial inflow shifted towards a more proximal position. CONCLUSIONS: Over time, the patients undergoing HAO became older and more often diabetic, reoperations increased. Despite these circumstances, vascular surgeons perform AV-fistulas without grafts in most patients.

  • 356.
    Lundberg, Christina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Swärd, Johanna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Wanhainen, Anders
    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.
    Liu, Feiyu
    Zhao, Xihai
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Ahlström, Håkan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Johansson, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Measuring carotid plaque size in asymptomatic individuals: comparison and reproducibility of MRI and B-mode ultrasoundManuscript (preprint) (Other academic)
  • 357. Lundgren, F
    et al.
    Bergqvist, David
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Norgren, L
    Schroeder, T
    Carstensen, J
    Hälsa, T
    Almström, C
    Almgren, B
    Drott, C
    Jansson, I
    Hallstensson, S
    Jivegård, L
    Örtenwall, P
    Tuvesson, T
    Plate, G
    Potemkowski, A
    Lundqvist, B
    Emetrsjö, G
    Jonsson, B
    Jonung, T
    Lindblad, B
    Wingren, U
    Svensson, M
    Fornander, B
    Björck, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Brunes, L
    Johansson, G
    Karlström, L
    Tornell, P E
    Ljungman, Krister
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Aldman, A
    Forsberg, O
    Björkman, H
    Arfvidsson, B
    Bohlin, T
    Nielsen, J S
    Madsen, M S
    PTFE bypass to below-knee arteries: distal vein collar or not? A prospective randomised multicentre study2010In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 39, no 6, p. 747-754Article in journal (Refereed)
    Abstract [en]

    Background

    Patency and limb salvage after synthetic bypass to the arteries below-knee are inferior to that which can be achieved with autologous vein. Use of a vein collar at the distal anastomosis has been suggested to improve patency and limb salvage, a problem that is analysed in this randomised clinical study.

    Methods

    Patients with critical limb ischaemia undergoing polytetrafluoroethylene (PTFE) bypass to below-knee arteries were randomly either assigned a vein collar or not in two groups – bypass to the popliteal artery below-knee (femoro-popliteal below-knee (FemPopBK)) and more distal bypass (femoro-distal bypass (FemDist)). Follow-up was scheduled until amputation, death or at most 5 years, whichever event occurred first.

    Results

    In the FemPopBK and in the FemDist groups, 115/202 and 72/150 were randomised to have a vein collar, respectively. Information was available for 345 of 352 randomised patients (98%).

    At 3 years, primary patency was 26% (95% confidence interval (CI) 18–38) with a vein collar and 43 (33–58) without a vein collar for femoro-popliteal bypass and 20 (11–38), and 17 (9–33) for femoro-distal bypass, respectively. The corresponding figures for limb salvage were 64 (54–75) and 61 (50–74) for femoro-popliteal bypass, and 59 (46–76) and 44 (32–61) for femoro-distal bypass with and without a vein collar, respectively. Log-rank-test for the whole Kaplan–Meier life table curve showed no statistically significant differences with or without vein collar primary patency: p = 0.0853, p = 0.228; secondary patency: p = 0.317, p = 0.280; limb salvage: p = 0.757, p = 0.187 for FemPopBK and FemDist, respectively. The use of a vein collar did not influence patency or limb salvage.

    Conclusion

    This study failed to show any benefit for vein collar with PTFE bypass to a below-knee artery.

  • 358. Lundkvist, Jonas
    et al.
    Bergqvist, David
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Jönsson, Bengt
    Cost-effectiveness of extended prophylaxis with fondaparinux compared with low molecular weight heparin against venous thromboembolism in patients undergoing hip fracture surgery2007In: European Journal of Health Economics, ISSN 1618-7598, E-ISSN 1618-7601, Vol. 8, no 4, p. 313-323Article in journal (Refereed)
    Abstract [en]

    A model was developed to estimate costs and clinical effectiveness of fondaparinux compared with enoxaparin after hip fracture surgery in Sweden. Outcomes and costs of venous thromboembolism (VTE)-related care from a health care perspective were incorporated, with symptomatic deep-vein thrombosis and pulmonary embolism, recurrent VTE, post-thrombotic syndrome, major haemorrhage and all-cause death being included. Event probabilities were derived from fondaparinux clinical trial data and published data. VTE-related resource use and associated costs as well as costs of prophylaxis were based on local Swedish data. Extended prophylaxis with fondaparinux could avoid an additional 28 symptomatic VTE per 1,000 patients compared with extended prophylaxis with enoxaparin in hip fracture surgery patients. Although the prophylaxis costs were higher in the fondaparinux group, these were offset by the lower costs associated with treating fewer VTE, which thus indicates that extended fondaparinux prophylaxis is the dominant alternative when compared with enoxaparin in hip fracture surgery.

  • 359.
    Lyons, Oliver
    et al.
    Basildon & Thurrock Univ Hosp, Basildon, England;Kings Coll London, London, England.
    Mani, Kevin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Reducing the Mortality from Aortic Rupture: A Japanese Approach2019In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 57, no 6, p. 787-787Article in journal (Other academic)
  • 360.
    Mani, Kevin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Abdominal Aortic Aneurysm: Epidemiological and Health Economic Aspects2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Abdominal aortic aneurysm (AAA) is a common disease that is life threatening when rupture occurs. The aims of this thesis were to study (I) the long-term survival after AAA repair, (II) the cost of repair with open (OR) and endovascular (EVAR) technique, (III) the effect of different statistical methods on interpretation of cost data, (IV) the prevalence of the disease among patients with suspected arterial disease referred to the vascular laboratory, and (V) the cost-effectiveness of selective high-risk screening. Analyses of data from the Swedish vascular registry (Swedvasc), local patient registries, patient records and hospital cost registries form the basis of this thesis.

    Short- and long-term survival after intact AAA repair improved over the past two decades, despite increasing patient age and rate of comorbidities over time. Compared to a general population adjusted for age, sex and calendar year, the relative 5-year survival was 90% among those surviving repair. While short-term survival improved over time after ruptured repair, relative long-term survival was stable. Despite differences in patient selection and cost structure, the total cost of AAA repair with EVAR and OR was similar in a population based setting (€28,193). There was lack of consistency in the methods used in cost-analysis in the current literature, and p-values were highly dependent on test method.

    The practice of selective (non-population-based) screening for AAA among patients referred to the vascular laboratory was studied. The prevalence of AAA was 4.2% among male and 1.5% among female patients. AAA was associated with high age and prevalence of arterial stenosis. Of AAAs detected through selective screening, 21.5% had undergone elective repair at 7.5 years follow-up. In a health-economic evaluation, the incremental cost-effectiveness ratio of selective screening was €11,084 per life year gained.

    In conclusion, survival after intact AAA repair has improved over time, despite changes in case-mix. Results of health economic reports on cost of AAA repair can be highly dependent on patient selection as well as presentation of data and the statistical methods used. Selective screening for AAA among patients referred to the vascular laboratory is cost-effective.

    List of papers
    1. Improved long-term survival after abdominal aortic aneurysm repair
    Open this publication in new window or tab >>Improved long-term survival after abdominal aortic aneurysm repair
    2009 (English)In: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 120, no 3, p. 201-11Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: Treatment of abdominal aortic aneurysm (AAA) has changed significantly over the past 2 decades. In this perspective, time trends in long-term survival were studied. METHODS AND RESULTS: We identified 8663 primary intact and 4171 ruptured AAA repairs in the Swedish Vascular Registry from 1987 to 2005. Mortality was obtained from the national population registry. Crude survival was analyzed, including all mortality. To analyze the long-term outcome among those surviving the AAA repair, relative survival, which denotes the survival rate of patients compared with that of the general population adjusted for age, sex, and calendar year, was calculated, excluding 90-day mortality. In a comparison of AAA repairs from 1987 to 1999 and 2000 to 2005, age (71.4 versus 72.5 years; P<0.001), patients with comorbidities (65.0% versus 68.5%; P<0.001), and endovascular repair (1.6% versus 17.0%; P<0.001) increased. After intact AAA repair, crude 5-year survival was 69.0% (99% confidence interval [CI], 67.7 to 70.4), and relative 5-year survival excluding 90-day mortality was 90.3% (99% CI, 88.6 to 92.0). Relative 5-year survival was better for those operated on from 2000 to 2005 compared with 1987 to 1999 (difference, 4.7%; 99% CI, 1.3 to 8.1), for men versus women (4.6%; 99% CI, 0.4 to 8.8), and for octogenarians versus patients <80 years of age (10.2%; 99% CI, 1.5 to 18.8); no difference was observed between open and endovascular repair (6.0%; 99% CI, -1.5 to 13.4). After ruptured AAA repair, crude 5-year survival was 41.7% (99% CI, 39.6 to 43.7) and relative 5-year survival was 87.1% (99% CI, 83.9 to 90.3). No significant differences in relative 5-year survival were observed between time periods, sex, or age groups. CONCLUSIONS: Long-term survival improved over time after intact AAA repair despite a change in case mix toward older patients with more comorbidities. Long-term survival was stable after ruptured AAA repair.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-108642 (URN)10.1161/CIRCULATIONAHA.108.832774 (DOI)000268110900005 ()19581497 (PubMedID)
    Available from: 2009-09-25 Created: 2009-09-25 Last updated: 2017-12-13Bibliographically approved
    2. Similar cost for elective open and endovascular AAA repair in a population-based setting
    Open this publication in new window or tab >>Similar cost for elective open and endovascular AAA repair in a population-based setting
    2008 (English)In: Journal of Endovascular Therapy, ISSN 1526-6028, E-ISSN 1545-1550, Vol. 15, no 1, p. 1-11Article in journal (Refereed) Published
    Abstract [en]

    PURPOSE: To compare cost differences between elective open repair (OR) and endovascular repair (EVAR) of abdominal aortic aneurysm in a population-based setting. METHODS: Clinical data and hospital-related costs (pre-, peri-, and postoperative) were analyzed for 109 consecutive AAA procedures (98 men; mean age 73 years, range 48-95; mean aneurysm diameter 61 mm, range 42-120) performed from 2001 to 2005 (58 OR, 51 EVAR) in our primary catchment area. Data were obtained through case records and hospital accounting systems. Nonparametric bootstrap was used for cost comparison. RESULTS: EVAR patients were older (76 versus 70 years, p<0.001) and had more comorbidities (ASA class 2.6 versus 2.3, p = 0.025). OR patients more often had anatomically complex aneurysms (52% versus 14%, p<0.001). Comparison of data with diagnosis-based reimbursement levels nationally and internationally indicated adequate cost level in the study. No difference was observed in total cost between OR and EVAR (euro29,786 versus euro26,382; p = 0.336). Preoperative cost was lower for OR compared to EVAR (euro661 versus euro1494, p = 0.002). OR patients had higher cost of intensive care [36% (euro8921) of perioperative cost versus 7% (euro1460), p = 0.001], while EVAR had higher implant cost [36% (euro7468) versus 2% (euro448), p<0.001]. Mean follow-up was 2.5 years (range 0.5-5.4). Mean postoperative cost was similar (OR euro4613 versus EVAR euro4403, p = 0.209; 16% and 17% of total cost, respectively). Postoperative cost after OR was high early on, with lower cost thereafter. Postoperative cost after EVAR was more homogeneously distributed, leveling off at euro500 to euro1000 annually over 5 years. CONCLUSION: In a population-based setting, total cost was similar for OR and EVAR. There were, however, important differences in patient characteristics and cost structure.

    Keywords
    abdominal aortic aneurysm, surgery, endovascular aneurysm repair, hospital costs, cost-benefit analysis
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-108646 (URN)10.1583/07-2258.1 (DOI)000253060300001 ()18254676 (PubMedID)
    Available from: 2009-09-25 Created: 2009-09-25 Last updated: 2018-06-26Bibliographically approved
    3. Challenges in analysis and interpretation of cost data in vascular surgery
    Open this publication in new window or tab >>Challenges in analysis and interpretation of cost data in vascular surgery
    2010 (English)In: Journal of vascular surgery, ISSN 0741-5214, Vol. 51, no 1, p. 148-154Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE: Health economic arguments have become increasingly important in clinical decision making, especially when new treatment modalities are introduced. This study reviews the methods used in health economic reports of abdominal aortic aneurysm (AAA) repair and uses original cost data to study how different methods affect interpretation of results in terms of cost differences and economic efficiency. DESIGN: Publications referenced in PubMed from 2003 to 2008 studying cost of AAA repair were reviewed. Original population-based cost data of AAA repair were analyzed, comparing open (OR) and endovascular repair (EVAR). Means, medians, and cost distributions were calculated, and differences were analyzed with four different statistical methods. RESULTS: The review showed a mixture of statistical methods used in AAA treatment cost-comparison studies. Presentation of cost data and inclusion criteria varied between studies. The analysis of original data showed skewed distribution of cost data, with large differences between mean and median cost. Although mean values indicated a lower total, perioperative, and postoperative cost for EVAR, the median values indicated OR was the least costly method. Exclusion of extreme values lowered mean perioperative cost of OR by 10%, while cost of EVAR was unaffected. Inferential testing of cost differences by means of four statistical methods showed that P values were highly dependent on test methodology. CONCLUSIONS: Conclusions of health economic reports can be highly dependent on how the data are presented and the statistical methods that are used. We recommend that cost data be presented as mean values with distributions. Exclusion of outliers and focus on P values should be avoided.

    National Category
    Surgery
    Identifiers
    urn:nbn:se:uu:diva-110809 (URN)10.1016/j.jvs.2009.08.042 (DOI)000273708500027 ()19889511 (PubMedID)
    Available from: 2009-11-25 Created: 2009-11-25 Last updated: 2011-12-19Bibliographically approved
    4. Selective screening for abdominal aortic aneurysm among patients referred to the vascular laboratory
    Open this publication in new window or tab >>Selective screening for abdominal aortic aneurysm among patients referred to the vascular laboratory
    2008 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 35, no 6, p. 669-74Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: Patients examined for peripheral arterial disease at the vascular laboratory, Uppsala University Hospital, are since 1993 screened for abdominal aortic aneurysm (AAA). The objective of this study was to study the prevalence of AAA found at this selective high-risk screening. METHODS: All files in the vascular laboratory were retrospectively reviewed. Of 9296 persons examined with arterial duplex between 1993 and October 2005, 5924 were screened for AAA. The primary target vessel was the carotid arteries in 3772 subjects, the renal arteries in 1529 subjects and the lower extremity arteries in 1457 subjects. An AAA was defined as an infrarenal aortic diameter >/=30mm. RESULTS: 179 subjects were found to have an AAA. In a logistic regression model male gender, age and duplex-verified arterial stenosis were independently associated with AAA (odds ratio 3.2, 2.0/20 years and 2.0, respectively, p<0.001). In men <60 years the AAA prevalence was 0.9% (95% confidence interval 0.2-1.6%) when arterial stenosis was absent and 1.5% (0.0-3.2%) when present. In men >/=60 years the AAA prevalence was 4.0% (3.0-5.1%) when no arterial stenosis was found and 7.3% (5.7-8.9%) when found. The corresponding prevalences in women were 0%, 0%, 1.2% (0.5-1.8%), and 3.1% (1.9-4.3%), respectively. CONCLUSIONS: Men >/=60 years referred for arterial examination have a significant risk of having an AAA while only women >/=65 years with a duplex verified arterial stenosis have a sufficient risk of having an AAA. Studies to evaluate the benefit of selective high-risk screening are warranted.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-108645 (URN)10.1016/j.ejvs.2007.12.014 (DOI)000257044700006 ()18258461 (PubMedID)
    Available from: 2009-09-25 Created: 2009-09-25 Last updated: 2017-12-13Bibliographically approved
    5. Screening for Abdominal Aortic Aneurysm among Patients Referred to the Vascular Laboratory is Cost-effective
    Open this publication in new window or tab >>Screening for Abdominal Aortic Aneurysm among Patients Referred to the Vascular Laboratory is Cost-effective
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    2010 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 39, no 2, p. 208-216Article in journal (Refereed) Published
    Abstract [en]

    Screening for abdominal aortic aneurysm (AAA) in high-risk groups has been recommended based on a high prevalence of disease, while being questioned due to a high frequency of co-morbidities and inferior life-expectancy. We evaluated the long-term outcome and the cost-effectiveness of selective AAA screening among patients referred to the vascular laboratory for arterial examination. METHODS: A total of 5924 patients, referred to the vascular laboratory of a university hospital, were screened for AAA with ultrasound (definition: slashed circle>/=30mm), 1993-2005. Outcome data were gathered through hospital records and the national population registry. A Markov model was used for health-economic evaluation. RESULTS: An AAA was detected in 181 patients (mean age 72.8 years), of whom 21.5% underwent elective repair (perioperative mortality 5.1%) after 7.5 years of follow-up. Four of six patients diagnosed with AAA rupture were operated upon. Relative 5-year survival compared with the general Swedish population, controlled for age and sex, was 80.4% (95% confidence interval (CI): 70.8-88.8). The cost-effectiveness was robust in base-case (11 084 Euro/life year gained) and in sensitivity analyses of prevalence, cost and survival. CONCLUSIONS: Patients in whom AAA was detected at selective screening had inferior long-term survival and were operated on less frequently, compared with AAA patients described in previous studies. Yet, selective screening at the vascular laboratory was cost-effective.

    Keywords
    Abdominal aortic aneurysms, Screening, Cost-benefit analysis
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-108639 (URN)10.1016/j.ejvs.2009.11.004 (DOI)000275985900014 ()19942460 (PubMedID)
    Available from: 2009-09-25 Created: 2009-09-25 Last updated: 2017-12-13Bibliographically approved
  • 361.
    Mani, Kevin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Aortic Remodeling After TEVAR for Type B Dissection: Time for Consensus Definition2014In: Journal of Endovascular Therapy, ISSN 1526-6028, E-ISSN 1545-1550, Vol. 21, no 4, p. 526-528Article in journal (Refereed)
  • 362.
    Mani, Kevin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Endovascular Aneurysm Repair - To Avoid Rupture or to Improve Quality of Life?2011In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 41, no 3, p. 332-333Article in journal (Other academic)
  • 363.
    Mani, Kevin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Open repair for chronic type B dissection2015In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 50, no 6, p. 744-744Article in journal (Refereed)
  • 364.
    Mani, Kevin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Outcomes and challenges in modern AAA repair: an introduction2018In: Journal of Cardiovascular Surgery, ISSN 0021-9509, E-ISSN 1827-191X, Vol. 59, no 2, p. 178-179Article in journal (Other academic)
  • 365.
    Mani, Kevin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    The Importance of Re-interventions After Ruptured EVAR2015In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 49, no 6, p. 669-669Article in journal (Refereed)
  • 366.
    Mani, Kevin
    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.
    Alternatives to Randomised Controlled Trials for the Poor, the Impatient, and When Evaluating Emerging Technologies2019In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 57, no 4, p. 598-599Article in journal (Other academic)
  • 367.
    Mani, Kevin
    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.
    Lundkvist, Jonas
    Medical management centre, Karolinska institutet.
    Wanhainen, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Improved long-term survival after abdominal aortic aneurysm repair2009In: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 120, no 3, p. 201-11Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Treatment of abdominal aortic aneurysm (AAA) has changed significantly over the past 2 decades. In this perspective, time trends in long-term survival were studied. METHODS AND RESULTS: We identified 8663 primary intact and 4171 ruptured AAA repairs in the Swedish Vascular Registry from 1987 to 2005. Mortality was obtained from the national population registry. Crude survival was analyzed, including all mortality. To analyze the long-term outcome among those surviving the AAA repair, relative survival, which denotes the survival rate of patients compared with that of the general population adjusted for age, sex, and calendar year, was calculated, excluding 90-day mortality. In a comparison of AAA repairs from 1987 to 1999 and 2000 to 2005, age (71.4 versus 72.5 years; P<0.001), patients with comorbidities (65.0% versus 68.5%; P<0.001), and endovascular repair (1.6% versus 17.0%; P<0.001) increased. After intact AAA repair, crude 5-year survival was 69.0% (99% confidence interval [CI], 67.7 to 70.4), and relative 5-year survival excluding 90-day mortality was 90.3% (99% CI, 88.6 to 92.0). Relative 5-year survival was better for those operated on from 2000 to 2005 compared with 1987 to 1999 (difference, 4.7%; 99% CI, 1.3 to 8.1), for men versus women (4.6%; 99% CI, 0.4 to 8.8), and for octogenarians versus patients <80 years of age (10.2%; 99% CI, 1.5 to 18.8); no difference was observed between open and endovascular repair (6.0%; 99% CI, -1.5 to 13.4). After ruptured AAA repair, crude 5-year survival was 41.7% (99% CI, 39.6 to 43.7) and relative 5-year survival was 87.1% (99% CI, 83.9 to 90.3). No significant differences in relative 5-year survival were observed between time periods, sex, or age groups. CONCLUSIONS: Long-term survival improved over time after intact AAA repair despite a change in case mix toward older patients with more comorbidities. Long-term survival was stable after ruptured AAA repair.

  • 368.
    Mani, Kevin
    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.
    Lundkvist, Jonas
    Medical management centre, Karolinska institutet.
    Wanhainen, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Similar cost for elective open and endovascular AAA repair in a population-based setting2008In: Journal of Endovascular Therapy, ISSN 1526-6028, E-ISSN 1545-1550, Vol. 15, no 1, p. 1-11Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To compare cost differences between elective open repair (OR) and endovascular repair (EVAR) of abdominal aortic aneurysm in a population-based setting. METHODS: Clinical data and hospital-related costs (pre-, peri-, and postoperative) were analyzed for 109 consecutive AAA procedures (98 men; mean age 73 years, range 48-95; mean aneurysm diameter 61 mm, range 42-120) performed from 2001 to 2005 (58 OR, 51 EVAR) in our primary catchment area. Data were obtained through case records and hospital accounting systems. Nonparametric bootstrap was used for cost comparison. RESULTS: EVAR patients were older (76 versus 70 years, p<0.001) and had more comorbidities (ASA class 2.6 versus 2.3, p = 0.025). OR patients more often had anatomically complex aneurysms (52% versus 14%, p<0.001). Comparison of data with diagnosis-based reimbursement levels nationally and internationally indicated adequate cost level in the study. No difference was observed in total cost between OR and EVAR (euro29,786 versus euro26,382; p = 0.336). Preoperative cost was lower for OR compared to EVAR (euro661 versus euro1494, p = 0.002). OR patients had higher cost of intensive care [36% (euro8921) of perioperative cost versus 7% (euro1460), p = 0.001], while EVAR had higher implant cost [36% (euro7468) versus 2% (euro448), p<0.001]. Mean follow-up was 2.5 years (range 0.5-5.4). Mean postoperative cost was similar (OR euro4613 versus EVAR euro4403, p = 0.209; 16% and 17% of total cost, respectively). Postoperative cost after OR was high early on, with lower cost thereafter. Postoperative cost after EVAR was more homogeneously distributed, leveling off at euro500 to euro1000 annually over 5 years. CONCLUSION: In a population-based setting, total cost was similar for OR and EVAR. There were, however, important differences in patient characteristics and cost structure.

  • 369.
    Mani, Kevin
    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.
    Wanhainen, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Changes in the management of infrarenal abdominal aortic aneurysm disease in Sweden2013In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 100, no 5, p. 638-644Article in journal (Refereed)
    Abstract [en]

    Background Treatment of abdominal aortic aneurysm (AAA) has changed over time, with endovascular repair (EVAR) being the main technical revolution. This study assessed the effect of this change on outcome on a national basis over a 17-year interval. Methods Primary infrarenal AAA repairs in Swedish residents aged 50 years and older, in the Swedish Vascular Registry (Swedvasc) 19942010, were analysed. The rate per 100 000 population, patient characteristics, operative technique and outcome were assessed for the intervals 19941999, 20002005 and 20062010. Results Some 11 336 intact aneurysm repairs were performed. The overall rate per 100 000 increased (18 center dot 4 in 19941999, 19 center dot 4 in 20002005 and 24 center dot 0 in 20062010; P < 0 center dot 001), most noticeably among older people (18 per cent increase among those aged 5064 years, P = 0 center dot 004; 27 per cent in 6579-year-olds, P < 0 center dot 001; 128 per cent in those aged at least 80 years, P < 0 center dot 001). The use of EVAR increased rapidly after 2005 (rate: 0 center dot 6 in 19941999, 4 center dot 4 in 20002005 and 11 center dot 8 in 20062010; P < 0 center dot 001). The 30-day mortality rate decreased after open repair (4 center dot 7, 3 center dot 4 and 2 center dot 7 per cent respectively; P < 0 center dot 001), but was stable after EVAR (2 center dot 6, 2 center dot 2 and 1 center dot 6 per cent; P = 0 center dot 227). Some 4972 ruptured aneurysm (rAAA) repairs were performed. The rate decreased after 2005 (9 center dot 3 in 19931999, 9 center dot 3 in 20002005 and 8 center dot 4 in 20062010; P = 0 center dot 006). The use of EVAR for rAAA increased over time (rate: 0, 0 center dot 5 and 1 center dot 6 respectively; P < 0 center dot 001), whereas open repair decreased (9 center dot 3, 8 center dot 8 and 6 center dot 8; P < 0 center dot 001). Thirty-day mortality decreased over time (38 center dot 3, 32 center dot 8 and 28 center dot 4 per cent; P < 0 center dot 001). Conclusion The introduction of EVAR has been associated with an increased number of intact AAA repairs, which has accelerated recently, whereas the rate of rAAA repair has started to decline. Simultaneously, outcomes have improved.

  • 370.
    Mani, Kevin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Campbell, A
    Fitzpatrick, J
    Modarai, B
    Carrell, T
    Rashid, H
    Zayed, H
    A Novel Reverse Thermosensitive Polymer to Achieve Temporary Atraumatic Vessel Occlusion in Infra-popliteal Bypasses2013In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 45, no 1, p. 51-56Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The study aims to assess a novel thermosensitive polymer (LeGoo(®)) for distal vessel control during infra-popliteal (crural/pedal) bypass surgery in severe leg ischaemia. METHOD: Retrospective analysis of all distal bypasses from October 2009 to February 2012. Technical success, patency, limb salvage and amputation-free survival rates were analysed. RESULTS: Fifty-four infra-popliteal bypasses using the polymer were performed in 46 patients. The distal anastomosis was at the anterior tibial (n = 15, 28%), posterior tibial (n = 12, 22%), peroneal (n = 8, 15%), tibio-peroneal trunk (n = 8, 15%) and dorsalis pedis arteries (n = 11, 20%). Technical success was achieved in 51/54 (94.4%; failures: two inadequate haemostasis, one un-dissolved polymer). In-hospital duplex of the distal anastomosis showed a significant stenosis in two cases (4.3%). Outflow angioplasty was performed in three cases (two distal anastomotic, one run-off vessel, 5.6%). The 1-year patency rate was 76.2% (standard error (SE) 6.7%), limb salvage rate 79.3% (SE 6.7%). Amputation-free survival was 93.5% at 30 days (SE 3.6%) and 67.5% at 1 year (SE 7.5%). CONCLUSION: This thermosensitive polymer is a potentially safe and useful atraumatic device to achieve a blood-less distal anastomotic field in infra-popliteal bypasses. The technique avoids other potentially traumatic methods of vessel control, which may be particularly important in patients with calcified distal vessels.

  • 371.
    Mani, Kevin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Clough, R. E.
    Lyons, O. T. A.
    Bell, R. E.
    Carrell, T. W.
    Zayed, H. A.
    Waltham, M.
    Taylor, P. R.
    Predictors of Outcome after Endovascular Repair for Chronic Type B Dissection2012In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 43, no 4, p. 386-391Article in journal (Refereed)
    Abstract [en]

    Objectives: To assess the durability of endovascular repair (TEVAR) in chronic type B dissection (CD) and identify factors predictive of outcome. Design: Retrospective analysis of a prospective database.

    Materials: Patients undergoing TEVAR for CD at a tertiary referral centre 2000-2010.

    Methods: Analysis of pre-operative characteristics, operative outcome, false lumen thrombosis, aortic diameter and survival.

    Results: 58 consecutive patients were included (49 elective, 9 urgent, mean age 66 years). Mean aortic diameter was 6.4 cm (Standard deviation SD 1.3 cm). Three patients died perioperatively (5%, 1 urgent, 2 elective). Complications included retrograde type A dissection (n = 3), paraplegia (1), and transient ischaemic attack (1). Estimated survival (Kaplan-Meier) was 89% (1-year) and 64% (3-years). Forty-seven patients had mid-term imaging follow-up at mean 38 months. Reintervention rate was 15% at 1-year and 29% at 3-years. Aortic diameter decreased in 24, was stable in 15 and increased in 8. Mid-term survival was higher in patients with aortic remodelling (reduction of aortic diameter >0.5 cm; 3-year 89%) than without (54%; Log Rank p = 0.005). Remodelling occurred with extensive false lumen thrombosis.

    Conclusion: Satisfactory mid-term outcome after TEVAR for CD remains a challenge. Survival is associated with aortic remodelling, which is related to persistence of flow in the false lumen.

  • 372.
    Mani, Kevin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Clough, R
    Taylor, P
    Coeliac axis compression and nutcracker syndrome2012In: 34th Symposium Book: Vascular and Endovascular Controversies Update / [ed] Roger M Greenhalgh, London: BIBA Publishing , 2012Chapter in book (Other academic)
  • 373.
    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)
  • 374.
    Mani, Kevin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Kolh, Philippe
    Univ Liege, Dept Biomed & Preclin & Sci, Liege, Belgium.
    Lepidi, Sandro
    Univ Padua, Med Sch, Div Vasc & Endovasc Sci, Dept Cardiac Thorac & Vasc Sci, Padua, Italy.
    Treatment of Thoracic and Thoraco-abdominal Aortic Pathology in the Endovascular Era2019In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 57, no 4, p. 473-474Article in journal (Other academic)
  • 375.
    Mani, Kevin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Lees, T
    Beiles, B
    Jensen, L P
    Venermo, M
    Simo, G
    Palombo, D
    Halbakken, E
    Troëng, Thomas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Wigger, P
    Björck, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Treatment of abdominal aortic aneurysm in nine countries 2005-2009: a vascunet report2011In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 42, no 5, p. 598-607Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To study contemporary treatment and outcome of abdominal aortic aneurysm (AAA) repair in nine countries.

    DESIGN AND METHODS: Data on primary AAA repairs 2005-2009 were amalgamated from national and regional vascular registries in Australia, Denmark, Finland, Hungary, Italy, Norway, Sweden, Switzerland and the UK. Primary outcome was in-hospital or 30-day mortality. Multivariate logistic regression was used to assess case-mix.

    RESULTS: 31,427 intact AAA repairs were identified, mean age 72.6 years (95% CI 72.5-72.7). The rate of octogenarians and use of endovascular repair (EVAR) increased over time (p < 0.001). EVAR varied between countries from 14.7% (Finland) to 56.0% (Australia). Overall perioperative mortality after intact AAA repair was 2.8% (2.6-3.0) and was stable over time. The perioperative mortality rate varied from 1.6% (1.3-1.8) in Italy to 4.1% (2.4-7.0) in Finland. Increasing age, open repair and presence of comorbidities were associated with outcome. 7040 ruptured AAA repairs were identified, mean age 73.8 (73.6-74.0). The overall perioperative mortality was 31.6% (30.6-32.8), and decreased over time (p = 0.004).

    CONCLUSIONS: The rate of AAA repair in octogenarians as well as EVAR increased over time. Perioperative outcome after intact AAA repair was stable over time, but improved after ruptured repair. Geographical differences in treatment of AAA remain.

  • 376.
    Mani, Kevin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Lundkvist, Jonas
    Medical Management Centre, Karolinska Institutet.
    Holmberg, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery.
    Wanhainen, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Challenges in analysis and interpretation of cost data in vascular surgery2010In: Journal of vascular surgery, ISSN 0741-5214, Vol. 51, no 1, p. 148-154Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Health economic arguments have become increasingly important in clinical decision making, especially when new treatment modalities are introduced. This study reviews the methods used in health economic reports of abdominal aortic aneurysm (AAA) repair and uses original cost data to study how different methods affect interpretation of results in terms of cost differences and economic efficiency. DESIGN: Publications referenced in PubMed from 2003 to 2008 studying cost of AAA repair were reviewed. Original population-based cost data of AAA repair were analyzed, comparing open (OR) and endovascular repair (EVAR). Means, medians, and cost distributions were calculated, and differences were analyzed with four different statistical methods. RESULTS: The review showed a mixture of statistical methods used in AAA treatment cost-comparison studies. Presentation of cost data and inclusion criteria varied between studies. The analysis of original data showed skewed distribution of cost data, with large differences between mean and median cost. Although mean values indicated a lower total, perioperative, and postoperative cost for EVAR, the median values indicated OR was the least costly method. Exclusion of extreme values lowered mean perioperative cost of OR by 10%, while cost of EVAR was unaffected. Inferential testing of cost differences by means of four statistical methods showed that P values were highly dependent on test methodology. CONCLUSIONS: Conclusions of health economic reports can be highly dependent on how the data are presented and the statistical methods that are used. We recommend that cost data be presented as mean values with distributions. Exclusion of outliers and focus on P values should be avoided.

  • 377.
    Mani, Kevin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Melissano, Germano
    Univ Vita Salute San Raffaele, Sci Inst H San Raffaele, Div Vasc Surg, Milan, Italy.
    Complex Endovascular Aneurysm Repair: Patient Benefit or a Waste of Money?2018In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 56, no 1, p. 1-2Article in journal (Other academic)
  • 378.
    Mani, Kevin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Rantatalo, Matti
    Bjurholm, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Thelin, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Thoracic Surgery.
    Eriksson, Lars-Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Radiology.
    Wanhainen, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Aortic rupture after spinal correction for scoliosis in the presence of a thoracic stent graft2010In: Journal of Vascular Surgery, ISSN 0741-5214, Vol. 52, no 6, p. 1663-1657Article in journal (Refereed)
    Abstract [en]

    Corrective surgery for scoliosis often results in a lengthening of the spinal column and relative change of the position of the adjacent anatomical structures such as the aorta. The extent of these anatomical changes could be affected by the presence of a rigid aortic stent graft in the descending thoracic aorta. We present a case of aortic rupture after spinal correction for scoliosis in a 56-year-old female with a thoracic aortic stent graft. Extensive elongation of the aorta with concentration of the stress forces at the lower margin of the stent graft resulted in a weakening of the aortic wall and subsequent rupture.

  • 379.
    Mani, Kevin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Venermo, M.
    Beiles, B.
    Menyhei, G.
    Altreuther, M.
    Loftus, I.
    Björck, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Regional Differences in Case Mix and Peri-operative Outcome After Elective Abdominal Aortic Aneurysm Repair in the Vascunet Database2015In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 49, no 6, p. 646-652Article in journal (Refereed)
    Abstract [en]

    Objective/background: National differences exist in the outcome of elective abdominal aortic aneurysm (AAA) repair. The role of case mix variation was assessed based on an international vascular registry collaboration. Methods: All elective AAA repairs with aneurysm size data in the Vascunet database in the period 2005-09 were included. AAA size and pen-operative outcome (crude and age adjusted mortality) were analysed overall and in risk cohorts, as well as per country. Glasgow Aneurysm Score (GAS) was calculated as risk score, and patients were stratified in three equal sized risk cohorts based on GAS. Predictors of pen-operative mortality were analysed with multiple regression. Missing data were handled with multiple imputation. Results: Patients from Australia, Finland, Hungary, Norway, Sweden and the UK (n = 5,895) were analysed; mean age was 72.7 years and 54% had endovascular repair (EVAR). There were significant variations in GAS (lowest = Finland [75.7], highest = UK [79.4], p for comparison of all regions < .001), proportion of AAA < 5.5 cm (lowest = UK [6.4%], highest = Hungary [29.0%]; p < .001), proportion undergoing EVAR (lowest = Finland [10.1%], highest = Australia [58.9%]; p < .001), crude mortality (lowest = Norway [2.0%], highest = Finland [5.0%]; p = .006), and age adjusted mortality (lowest = Norway [2.5%], highest = Finland [6.0%]; p = .048). Both aneurysm size and pen-operative mortality were highest among patients with a GAS >82. Of those with a GAS >82, 8.4% of men and 20.8% of women had an AAA <5.5 cm. Conclusion: Important regional differences exist in case selection for elective AAA repair, including variations in AAA size and patient risk profile. These differences partly explain the variations in pen-operative mortality. Further audit is warranted to assess the underlying reasons for the regional variation in case-mix.

  • 380.
    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.
    Accurate and Reproducible Diameter Measurement is Essential in Surveillance and Treatment of Thoracic Aortic Aneurysms2014In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 47, no 1, p. 27-27Article in journal (Refereed)
  • 381.
    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.
    Björck, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Elective AAA repair in octo- and nonagenarians2015In: Vascular and Endovascular Controversies Update / [ed] Greenhalgh R, London: BIBA Publishing , 2015, p. 261-268Chapter in book (Other academic)
  • 382.
    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.

  • 383.
    Mani, Kevin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Ålund, Martina
    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.
    Lundkvist, Jonas
    Medical management centre, Karolinska Institutet.
    Wanhainen, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Screening for Abdominal Aortic Aneurysm among Patients Referred to the Vascular Laboratory is Cost-effective2010In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 39, no 2, p. 208-216Article in journal (Refereed)
    Abstract [en]

    Screening for abdominal aortic aneurysm (AAA) in high-risk groups has been recommended based on a high prevalence of disease, while being questioned due to a high frequency of co-morbidities and inferior life-expectancy. We evaluated the long-term outcome and the cost-effectiveness of selective AAA screening among patients referred to the vascular laboratory for arterial examination. METHODS: A total of 5924 patients, referred to the vascular laboratory of a university hospital, were screened for AAA with ultrasound (definition: slashed circle>/=30mm), 1993-2005. Outcome data were gathered through hospital records and the national population registry. A Markov model was used for health-economic evaluation. RESULTS: An AAA was detected in 181 patients (mean age 72.8 years), of whom 21.5% underwent elective repair (perioperative mortality 5.1%) after 7.5 years of follow-up. Four of six patients diagnosed with AAA rupture were operated upon. Relative 5-year survival compared with the general Swedish population, controlled for age and sex, was 80.4% (95% confidence interval (CI): 70.8-88.8). The cost-effectiveness was robust in base-case (11 084 Euro/life year gained) and in sensitivity analyses of prevalence, cost and survival. CONCLUSIONS: Patients in whom AAA was detected at selective screening had inferior long-term survival and were operated on less frequently, compared with AAA patients described in previous studies. Yet, selective screening at the vascular laboratory was cost-effective.

  • 384. Menyhei, G.
    et al.
    Björck, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Beiles, B.
    Halbakken, E.
    Jensen, L. P.
    Lees, T.
    Palombo, D.
    Thomson, I. A.
    Venermo, M.
    Wigger, P.
    Outcome Following Carotid Endarterectomy: Lessons Learned From a Large International Vascular Registry2011In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 41, no 6, p. 735-740Article in journal (Refereed)
    Abstract [en]

    Objectives:

    The aim of the study was to assess if technical and patient-related factors are related to outcome after carotid surgery.

    Design:

    Vascunet is a collaboration of national and regional registries with 10 contributing countries.

    Patients and methods:

    Data from 48 035 carotid endarterectomies (CEAs) performed in 383 centres, during 2003-2007, were merged into a common database.

    Results:

    CEA was performed without patch (34%), with patch (40%) or with eversion (26%) in 74% for symptomatic and in 26% for asymptomatic disease. Overall (in-hospital and 30-day) mortality was 0.45%. Type of CEA or anaesthesia did not affect mortality, nor did contralateral occlusion. Mortality was higher in patients above the age of 75 years, for both genders (p < 0.05). The overall (in-hospital) stroke rate was 1.9%, the method of anaesthesia did not affect stroke rate. It was higher in patients with contratateral occlusion (4.6% vs. 2.5%, p = 0.002). Standard CEA without patch had a higher stroke rate than when a patch was used (2.3 vs. 1.7%, p = 0.015). Female patients >75 years had a higher stroke rate than younger women (2.0% vs. 1.6%, p = 0.078); this difference was not observed in men.

    Conclusions:

    Although there are limitations with registry data, the large number of cases involved provides useful information on outcomes, supplementing data from the randomised clinical trials (RCTs).

  • 385.
    Milbrink, Jan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Bergqvist, David
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    The incidence of symptomatic venous thromboembolic events in orthopaedic surgery when using routine thromboprophylaxis2008In: VASA, ISSN 0301-1526, E-ISSN 1664-2872, Vol. 37, no 4, p. 353-357Article, review/survey (Refereed)
    Abstract [en]

    BACKGROUND: Few studies have shown the effect of thromboprophylactic regimen with low molecular weight heparin (LMWH) on the incidence of clinical venous thromboembolism (VTE) in common practice. The aim was to study the three-year incidence of clinically overt VTE events at a university based orthopaedic department with some 3300 operations performed and 15 000 patients treated annually. PATIENTS AND METHODS: Since all Swedish citizens have an individual identification number it was possible tp follow up all patients operated during a 3 year period (2000-2002) for a period of four months. RESULTS: The incidence of VTE in the classical high-risk groups of hip fracture surgery, total hip arthroplasty (THA) and total knee arthroplasty (TKA) was low - about 0.6 %, while the Pulmonary embolism (PE) incidence in the hip fracture group was 0.27%, with two cases of fatal PE occurring 72 and 109 days after surgery. Patients with ankle fractures had more VTE. The majority of clinical VTE occurred after discharge from hospital. CONCLUSIONS: When using routine thrombopropylaxis with LMWH in orthopaedic surgery the rate of symptomatic VTE is low.

  • 386. Mitchell, D
    et al.
    Venermo, M
    Mani, Kevin
    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.
    Troëng, Thomas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Debus, S
    Szeberin, Z
    Hansen, A K
    Beiles, B
    Setacci, C
    Bergqvist, David
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Menyhei, G
    Heller, G
    Danielsson, G
    Loftus, I
    Thomson, I
    Vogt, K
    Jensen, L
    Altreuther, M
    Eldrup, N
    Wigger, P
    Moreno-Carriles, R
    Lees, T
    Quality Improvement in Vascular Surgery: The Role of Comparative Audit and Vascunet.2015In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 49, no 1Article in journal (Refereed)
  • 387. Monsen, C.
    et al.
    Acosta, S.
    Mani, Kevin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Wann-Hansson, C.
    A randomised study of NPWT closure versus alginate dressings in peri-vascular groin infections: quality of life, pain and cost2015In: Journal of Wound Care, ISSN 0969-0700, E-ISSN 2052-2916, Vol. 24, no 6, p. 252-260Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to compare the vacuum assisted wound closure (VAC) system (negative pressure wound therapy; NPWT) and alginate wound dressings in terms of quality of life (QoL), pain resource use and cost in patients with deep peri-vascular groin infection after vascular surgery. Method: Patients with deep peri-vascular groin infection (Szilagyi grade III) were included and randomised to NPWT or alginate therapy. EuroQol 5D (EQ-5D) and brief pain inventory (BPI) were used to evaluate QoL and pain, respectively. l Results: Wound healing time until complete skin epithelialisation was shorter in the NPWT (n=9) compared to the alginate group (n=7), median 57 and 104 days, respectively (p=0.026). No difference was recorded in QoL and pain between the groups at study start and the second assessment. QoL analysis within groups between time points, showed that patients in NPWT groups improved in EQ-5D domains, 'self-care' (p= 0.034), 'usual activities' (p=0.046); EQ-5D index value (p=0.046) and EQ-VAS (p=0.028). Patients in the NPWT group reported significantly less pain 'affecting their relations with other people' and 'sleep' between time points. The NPWT group had significantly fewer dressing changes compared to the alginate group (p<0.001). The median frequency of wound dressing changes outside hospital was 20 (IQR 6-29) in the NPWT group (n=9), compared to 48 (IQR 42-77) in the alginate group (n=8; p=0.004). The saved personnel time for wound care in the first week for the NPWT group, compared with the alginate group, was 4.5 hours per week per nurse. The total hospitalised care cost was 83-87% of the total cost in both groups. Conclusion: NPWT therapy in patients with deep peri-vascular groin infection can be regarded as the dominant strategy due to improved clinical outcome with equal cost and quality of life measures.

  • 388. Mosti, G.
    et al.
    De Maeseneer, M.
    Cavezzi, A.
    Parsi, K.
    Morrison, N.
    Nelzén, Olle
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Rabe, E.
    Partsch, H.
    Caggiati, A.
    Simka, M.
    Obermayer, A.
    Malouf, M.
    Flour, M.
    Maleti, O.
    Perrin, M.
    Reina, L.
    Kalodiki, E.
    Mannello, F.
    Rerkasem, K.
    Cornu-Thenard, A.
    Chi, Y. W.
    Soloviy, M.
    Bottini, O.
    Mendyk, N.
    Tessari, L.
    Varghese, R.
    Etcheverry, R.
    Pannier, F.
    Lugli, M.
    Carvallo Lantz, A. J.
    Zamboni, P.
    Zuolo, M.
    Godoy, M. F. G.
    Godoy, J. M. P.
    Link, D. P.
    Junger, M.
    Scuderi, A.
    Society for Vascular Surgery and American Venous Forum Guidelines on the management of venous leg ulcers: the point of view of the International Union of Phlebology2015In: International Journal of Angiology, ISSN 0392-9590, E-ISSN 1827-1839, Vol. 34, no 3, p. 202-218Article, review/survey (Refereed)
  • 389.
    Nelzen, Olle
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Re: Commentary on 'Changes in the Aetiological Spectrum of Leg Ulcers after a Broad Scale Intervention in a Defined Geographical Population in Sweden'2013In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 45, no 3, p. 304-304Article in journal (Refereed)
  • 390.
    Nelzén, Olle
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    A medial approach for open redo groin surgery for varicose vein recurrence Safe and effective2013In: Phlebologie (Stuttgart), ISSN 0939-978X, Vol. 42, no 5, p. 247-252Article in journal (Refereed)
    Abstract [en]

    Aims: To describe the technique of a medial approach for redo groin surgery for varicose vein recurrence and to report the one year prospective results for this procedure. Method: The standardised technique employed is described. Prospective one year data regarding the effectiveness of this procedure was taken from a one year audit performed 2009-2010 at Skaraborg Hospital. Details regarding this patient cohort and the surgery performed were registered. The outcome was measured by using venous clinical severity score (VCSS) and the disease specific quality of life was measured with the Aberdeen varicose vein questionnaire (AVVQ). Venous duplex ultrasound scanning (DUS) was performed preoperatively, after 4-6 weeks and after one year. Results: Out of 255 venous operations 34 regarded redo groin surgery and these were assessed. Females dominated 25/34 and the median age was 55 years (range 26-80). All patients had a probable stump according to DUS. CEAP C3-C4 dominated 28 patients/legs and C5-C6 in 4 legs. The median operating time was 69 minutes (range 35-120) and the operating time was significantly correlated to the number of incisions (p<0.001). The complication rate was 15%, including 2 wound infections but no DVT or lymph leakage. Both the VCSS and the AVVQ scores were significantly improved after one year (p<0.001). After one year DUS detected recurrence in the groin was observed in 19%, mostly neovascularisation. Conclusion: Redo groin surgery by a standardised medial approach is a safe and not an especially technically demanding technique that can be performed reasonably rapidly. The one year results are promising and the early DUS recurrence rate seems low.

  • 391.
    Nelzén, Olle
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Fifty percent reduction in venous ulcer prevalence is achievable: Swedish experience2010In: Journal of vascular surgery, ISSN 0741-5214, Vol. 52, no 5 Suppl, p. 39S-44SArticle in journal (Refereed)
  • 392.
    Nelzén, Olle
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    The role of incompetent perforations2008In: Acta Phlebologica, ISSN 1593-232X, Vol. 9, no 3, p. 133-136Article in journal (Refereed)
  • 393.
    Nelzén, Olle
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Varicer - kirurgins gökunge eller kanske snarare dess fula ankunge2009In: Svensk Kirurgi, ISSN 0346-847X, Vol. 67, no 3, p. 112-116Article in journal (Refereed)
  • 394.
    Nelzén, Olle
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Fransson, I
    Early results from a randomized trial of saphenous surgery with or without subfascial endoscopic perforator surgery in patients with a venous ulcer2011In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 98, no 4, p. 495-500Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The aim was to clarify the role of incompetent perforators (IPs) in venous leg ulcers. This short-term report focused on safety, patient satisfaction and the fate of IPs after subfascial endoscopic perforator surgery (SEPS), or saphenous surgery alone.

    METHODS: Patients aged 30-78 years with an open or recently healed venous ulcer, and with an incompetent saphenous vein and IPs, were allocated randomly to saphenous surgery alone, or in combination with SEPS. A control duplex scan was performed 6-9 months after surgery, and clinical follow-up was scheduled after 1 week, 3 and 12 months. A standard questionnaire was completed at each clinical visit.

    RESULTS: Seventy-five patients were enrolled; 37 had SEPS and 38 had saphenous surgery alone. SEPS prolonged the operation by a median of 15 min (P = 0.003). Duplex imaging revealed significantly more remaining IPs in the no-SEPS group (P < 0.001). Compared with the preoperative scan, significantly more legs were free from IPs in the SEPS group compared with the no-SEPS group (21 of 36 versus 7 of 37 respectively; P < 0.001). There were no other major outcome differences between the groups.

    CONCLUSION: There was no short-term clinical benefit from adding SEPS to saphenous surgery in patients with varicose ulcers and IPs, although SEPS reduced the number of perforators re