| 1. |
- Alhadad, Alaa, et al.
(författare)
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Percutaneous transluminal renal angioplasty (PTRA) and surgical revascularisation in renovascular disease - A retrospective comparison of results, complications, and mortality
- 2004
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1532-2165 .- 1078-5884. ; 27:2, s. 151-156
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To evaluate results, complications and mortality following percutaneous transluminal renal angioplasty (PTRA) and open surgical revascularisation for renovascular disease. Methods. A retrospective evaluation of 381 renovascular patients (median age 64, range 9-99 years, 152 women) treated at Malmo University Hospital during 1987-1996. Two hundred and sixty-two (69%) of the patients were treated with PTRA, 106 (28%) with open revascularisation. Results. Thirty-day mortality was 2% in the PTRA group and 9% after open surgery (p < 0.001). There were no differences between groups concerning the number of re-do procedures, but first re-do was performed after seven (IQR 3-14) months in the PTRA group, and after 15 (IQR 10-44) months after open revascularisation (p < 0.0001). After a median follow-up of 4 months (IQR 0-13) systolic and diastolic blood pressure (BP) had decreased (p < 0.0001) in both groups. The number of antihypertensive drugs was reduced (p < 0.0001) and S-creatinine levels were unchanged in both groups. Longtime survival assessed with log-rank analysis was better (p < 0.01) in the PTRA group. The risk ratio for death with open revascularisation was 1.69 (p < 0.01). Conclusions. In this retrospective comparison, PTRA was as effective as open revascularisation, with lower complication rate and lower early and long-time mortality, but with shorter time to first re-do.
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| 2. |
- Alhadad, Alaa, et al.
(författare)
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Predictors of long-term beneficial effects on blood pressure after percutaneous transluminal renal angioplasty in atherosclerotic renal artery stenosis.
- 2009
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Ingår i: International Angiology. - 1827-1839. ; 28:2, s. 106-112
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Tidskriftsartikel (refereegranskat)abstract
- AIM: This retrospective study evaluated long-term effects of percutaneous transluminal renal angioplasty (PTRA) in atherosclerotic renal artery stenosis (ARAS), and predictors of benefit on blood pressure (BP). METHODS: During 1997-2003, 234 patients (age 69+/-11 years, 138 [59%] males) underwent PTRA for ARAS at Malmö Vascular Centre. Cure was defined as diastolic (D)BP<90 mmHg and systolic (S)BP <140 mmHg off antihypertensive medication. Improvement was defined as DBP <90 mmHg and/or SBP <140 mmHg on the same or reduced number of medications, or reduction in DBP of 15 mmHg with the same or reduced number of medications. Benefit was defined as cure or improvement. RESULTS: After PTRA, SBP and DBP decreased (P<0.001), and remained lower (P<0.001) until last follow-up after 4.1+/-3.3 years. Antihypertensive medication decreased (P<0.001), and remained lower at one month (P<0.001), one year (P<0.01), and last follow-up (P<0.05). Renal function was unchanged until last follow-up, when it deteriorated (P<0.001). Patients showing benefit of PTRA on BP at last follow-up (N.=150 [64%]) used more antihypertensive drugs before PTRA (P=0.012), especially angiotensin converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARBs) (P=0.010), and diuretics (P=0.015). In logistic regression, use of ACEi or ARBs failed to reach significancy (P=0.054). Patients dying during follow up (N.=100 [43%]) showed higher age (P<0.0001) and s-creatinine (P<0.0001), lower glomerular filtration rate (P<0.0001), and higher frequency of diabetes mellitus (P<0.005). In logistic regression only age (P=0.009) and diabetes mellitus (P=0.014) predicted mortality. CONCLUSIONS: We confirmed beneficial effects on BP with PTRA in ARAS. ACEi, ARB and diuretic treatment before PTRA predict favourable long-term BP-response in univariate analysis.
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| 3. |
- Alhadad, Alaa, et al.
(författare)
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Revascularisation of renal artery stenosis caused by fibromuscular dysplasia: effects on blood pressure during 7-year follow-up are influenced by duration of hypertension and branch artery stenosis
- 2005
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Ingår i: Journal of Human Hypertension. - : Springer Science and Business Media LLC. - 1476-5527 .- 0950-9240. ; 19:10, s. 761-767
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Tidskriftsartikel (refereegranskat)abstract
- Fibromuscular dysplasia (FMD) mainly affects renal arteries. Percutaneous transluminal renal angioplasty (PTRA) and surgery are effective treatments, but longtime follow-up is lacking. Retrospective follow-up for 7.0 +/- 4.7 years of 69 consecutive patients ( age 44 +/- 13 years) treated for hypertension due to FMD, 59 patients underwent PTRA and eight patients surgery. In two patients no PTRA was performed. Technical success was achieved in 56 (95%) patients undergoing PTRA and all eight undergoing surgery. After successful PTRA, both systolic and diastolic blood pressures (SBP and DBP) had decreased at discharge ( from 174 +/- 33/ 100 +/- 13 to 138 +/- 19/80 +/- 15 mmHg; P<0.0001), and remained lower at 1 month, 1 year, and last follow-up after 7.0 +/- 4.7 years (140 +/- 25/83 +/- 12 mmHg; P<0.0001). Serum-creatinine had decreased both at 1 year ( from 84 +/- 28 to 75 +/- 13 mu mol/ l; P = 0.0030) and last follow-up (75 +/- 16 mu mol/ l; P = 0.0017). The number of antihypertensive drugs decreased ( from 2.3 +/- 1.2 before PTRA to 1.4 +/- 1.3 at discharge and at 1 month; P<0.0001, and 1.6 +/- 1.5 at last follow-up; P = 0.0011). SBP decreased more after PTRA among patients with FMD only in the main renal artery than in those with branch artery involvement (43 +/- 29 vs 20 +/- 41 mmHg; P = 0.0198). Beneficial effects on BP, creatinine and antihypertensive drugs also occurred after surgery. Patients on antihypertensive drugs at last follow-up had longer hypertension duration before PTRA than those without (5.9 +/- 7.7 vs 1.8 +/- 4.1 years; P = 0.0349). Cure was achieved in 16 (24%), improvement in another 26(39%), and benefit in 42(63%). In conclusion, renal artery FMD, PTRA and surgery have beneficial long-term effects, negatively affected by hypertension duration and branch artery involvement.
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| 4. |
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| 5. |
- Alhadad, Alaa, et al.
(författare)
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Vena cava-filter vid komplicerad venos tromboembolisk sjukdom. Tio ars erfarenheter fran Universitetssjukhuset MAS
- 2002
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Ingår i: Läkartidningen. - 0023-7205. ; 99:45, s. 4462-4468
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Tidskriftsartikel (refereegranskat)abstract
- All 74 patients treated with vena cava filter insertion during 1991-2000 at Malmo University Hospital were reviewed. Thirty-nine patients (53%) died during follow-up. Indications for permanent filter insertion (n = 63, age 25-89 years, 35 men) were contraindication for or side effects of anticoagulant treatment, or pulmonary embolism during anticoagulant treatment. Temporary vena cava filters (n = 11, age 19-85 years, three men) were inserted during surgery or thrombolysis. No complications occurred during temporary filter insertion. During 33 (1-120) months of follow-up of patients with permanent vena cava filters 37 patients (59%) died, thrombosis of the inferior vena cava occurred in 14 patients (22%), and recurrent pulmonary embolism in five patients (8%). Vena cava filter insertion should be considered as an alternative treatment in a selected group of patients with contraindications to or insufficient effect of anticoagulant treatment.
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| 6. |
- Björses, Katarina, et al.
(författare)
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Kissingstents in the Aortic Bifurcation - a Valid Reconstruction for Aorto-iliac Occlusive Disease.
- 2008
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Ingår i: European journal of vascular and endovascular surgery. - : Elsevier BV. - 1532-2165 .- 1078-5884. ; Aug 7, s. 424-431
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate outcome and patency predicting factors of kissingstent treatment for aorto iliac occlusive disease (AIOD). METHODS: Patients treated with kissingstents for AOID between 1995 and 2004 at a tertiary referral center were identified through local databases. Chart review and preoperative images were used for TASC and Fontaine classification. Follow-up consisted of clinical exams, ABI and/or duplex. Patency rates were estimated by Kaplan-Meier analysis, and Cox multivariate regression was used to determine factors associated with patency. RESULTS: 173 consecutive patients (46% male, mean 64 years) were identified. TASC distribution was: A 15%, B 34%, C 10%, D 41%. Mean follow-up was 36 months (range: 1-144). 30-day mortality was 1% (2 patients), and 1-year survival was 91% (157 patients). 2 patients underwent late, open conversion and 13 patients suffered minor puncture site complications. Primary, assisted primary and secondary patency was: 97%, 99% and 100%, and 83%, 90% and 95% at twelve and 36 months respectively. There was no significant difference in patency between the TASC groups. Patency was significantly worse for patients in Fontaine class III. CONCLUSIONS: Aortoiliac kissing stents is a valid alternative to open repair for TASC A-D lesions. The procedure has low mortality and morbidity and good patency at 3 years.
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| 7. |
- Bonati, Leo, et al.
(författare)
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Restenosis and risk of stroke after stenting or endarterectomy for symptomatic carotid stenosis in the International Carotid Stenting Study (ICSS): secondary analysis of a randomised trial
- 2018
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Ingår i: Lancet Neurology. - 1474-4465. ; 17:7, s. 587-596
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Tidskriftsartikel (refereegranskat)abstract
- Background: The risk of stroke associated with carotid artery restenosis after stenting or endarterectomy is unclear. We aimed to compare the long-term risk of restenosis after these treatments and to investigate if restenosis causes stroke in a secondary analysis of the International Carotid Stenting Study (ICSS). Methods: ICSS is a parallel-group randomised trial at 50 tertiary care centres in Europe, Australia, New Zealand, and Canada. Patients aged 40 years or older with symptomatic carotid stenosis measuring 50% or more were randomly assigned either stenting or endarterectomy in a 1:1 ratio. Randomisation was computer-generated and done centrally, with allocation by telephone or fax, stratified by centre, and with minimisation for sex, age, side of stenosis, and occlusion of the contralateral carotid artery. Patients were followed up both clinically and with carotid duplex ultrasound at baseline, 30 days after treatment, 6 months after randomisation, then annually for up to 10 years. We included patients whose assigned treatment was completed and who had at least one ultrasound examination after treatment. Restenosis was defined as any narrowing of the treated artery measuring 50% or more (at least moderate) or 70% or more (severe), or occlusion of the artery. The degree of restenosis based on ultrasound velocities and clinical outcome events were adjudicated centrally; assessors were masked to treatment assignment. Restenosis was analysed using interval-censored models and its association with later ipsilateral stroke using Cox regression. This trial is registered with the ISRCTN registry, number ISRCTN25337470. This report presents a secondary analysis, and follow-up is complete. Findings: Between May, 2001, and October, 2008, 1713 patients were enrolled and randomly allocated treatment (855 were assigned stenting and 858 endarterectomy), of whom 1530 individuals were followed up with ultrasound (737 assigned stenting and 793 endarterectomy) for a median of 4·0 years (IQR 2·3–5·0). At least moderate restenosis (≥50%) occurred in 274 patients after stenting (cumulative 5-year risk 40·7%) and in 217 after endarterectomy (29·6%; unadjusted hazard ratio [HR] 1·43, 95% CI 1·21–1·72; p<0·0001). Patients with at least moderate restenosis (≥50%) had a higher risk of ipsilateral stroke than did individuals without restenosis in the overall patient population (HR 3·18, 95% CI 1·52–6·67; p=0·002) and in the endarterectomy group alone (5·75, 1·80–18·33; p=0·003), but no significant increase in stroke risk after restenosis was recorded in the stenting group (2·03, 0·77–5·37; p=0·154; p=0·10 for interaction with treatment). No difference was noted in the risk of severe restenosis (≥70%) or subsequent stroke between the two treatment groups. Interpretation: At least moderate (≥50%) restenosis occurred more frequently after stenting than after endarterectomy and increased the risk for ipsilateral stroke in the overall population. Whether the restenosis-mediated risk of stroke differs between stenting and endarterectomy requires further research.
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| 8. |
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| 9. |
- Chuter, Timothy A M, et al.
(författare)
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A telescopic stent-graft for aortoiliac implantation
- 1997
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Ingår i: European Journal of Vascular and Endovascular Surgery. - 1532-2165. ; 13:1, s. 79-84
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To test a new delivery system for a telescopic stent-graft. MATERIALS: Variable overlap between the components of this stent-graft combination allows length adjustment. This device differs from other multi-component stent-grafts in that both components are contained within a single delivery system. METHODS: The stent-graft was implanted in the distal thoracic to suprarenal aorta of five pigs (35-50 kg), where the arterial diameter falls by almost 50%. The proximal and distal components of the stent-graft were targeted to bony landmarks in the vertebral column. RESULTS: Inspection of completion angiograms showed both proximal and distal stent-grafts to be within 1 mm of their target locations in all five experiments. Overall combined stent-graft length varied from 13.5 cm to 16.1 cm depending on the location of the bony landmark chosen as the distal target, and on the size of the pig. CONCLUSIONS: This system may be useful for the repair of abdominal aortic aneurysm whenever preoperative sizing is difficult due to aortic tortuosity, or precluded due to the urgency of the procedure.
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| 10. |
- Chuter, Timothy A M, et al.
(författare)
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Aneurysm pressure following endovascular exclusion
- 1997
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Ingår i: European Journal of Vascular and Endovascular Surgery. - 1532-2165. ; 13:1, s. 85-87
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To assess the effect of stent-graft implantation on the pressure within an abdominal aortic aneurysm. METHODS: Aneurysm exclusion was performed using an aorto-uniiliac stent-graft in eight patients. Following stent-graft implantation, pressure measurements were performed through a catheter adjacent to the graft in the aneurysm. This "aneurysm pressure" was compared with radial arterial pressure. RESULTS: The pressure was lower in the aneurysm than in the radial artery, in all cases. Mean aneurysm pressure was 36.5/33.8 mmHg, while mean radial arterial pressure was 118.5/50.5 mmHg (p < 0.05, for both systolic and diastolic pressures). These findings corresponded with a reduction in the palpable abdominal pulse, and an absence of perigraft perfusion on follow-up computerised tomography. CONCLUSION: Stent-graft implantation produces a fall in the pressure within an abdominal aortic aneurysm.
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