| 1. |
- Acosta, Stefan, et al.
(författare)
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Increasing incidence of ruptured abdominal aortic aneurysm : a population-based study
- 2006
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Ingår i: Journal of Vascular Surgery. - : Elsevier BV. - 0741-5214 .- 1097-6809. ; 44:2, s. 237-243
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of the present population-based study was to assess the trends of age- and gender-specific incidence of ruptured abdominal aortic aneurysm (rAAA). Methods. Patients with rAAA from the city of Malmo, Sweden, were studied between 2000 and 2004. An analysis of trends of incidence and mortality of rAAA in Malmo was possible because of a previous population-based study on patients with rAAA between 1971 and 1986 (autopsy rate 85% compared with 25% for the time period 2000 to 2004). The in-hospital registry of Malmo University Hospital and the databases at the Department of Pathology, Malmo, and the Institution of Forensic Medicine, Lund, identified patients with rAAA, and the in-hospital registry identified all elective repairs for AAA. Results. Compared with the time period 1971 to 1986, the overall incidence of rAAA significantly increased from 5.6 (95 % confidence interval [CI], 4.9 to 6.3) to 10.6 (95% CI, 8.9 to 12.4) per 100,000 person-years (standardized mortality ratio, 1.6; 95% CI, 1.0 to 2.1). In men aged 60 to 69 and 70 to 79 years, the incidence increased significantly from 16 (95% CI, 11 to 21) and 56 (95% Cl, 43 to 69) to 46 (95% Cl, 28 to 63) and 117 (95% CI, 84 to 149) per 100,000 person-years, respectively, whereas no increase in the age-specific incidence in women could be demonstrated. The overall incidence of elective repair of AAA increased significantly from 3.4 (95% CI, 2.8 to 4.0) to 7.0 (95% CI, 5.6 to 8.4) per 100,000 person-years and increased most significantly from 12 (95% CI, 3.4 to 32) to 68 (95% CI, 34 to 102) per 100,000 person-years in men aged 80 to 89 years and from 5.1 (95% CI, 2.4 to 9.3) to 28 (95% CI, 15 to 41) per 100,000 person-years in women aged 70 to 79 years. The elective-acute repair ratio in women increased from 2.4 to 5.6 and decreased in men from 2.1 to 1.0. Conclusions: Between 1971 to 1986 and 2000 to 2004, the incidence of rAAA increased significantly, despite a 100% increase in elective repairs and notwithstanding a potential for bias towards underestimation due to lower autopsy rates in recent years. The reason behind this increase is unclear, and further studies are needed to identify risk groups for direction of effective prevention and screening.
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| 2. |
- Acosta, Stefan, 1967-
(författare)
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On Acute Thrombo-Embolic Occlusion of the Superior Mesenteric Artery
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Acute thrombo-embolic occlusion of the superior mesenteric artery (SMA) with intestinal infarction is a lethal disease, difficult to diagnose in time, with unknown incidence and cause-specific mortality. The aim of this thesis was to characterize the disease and to develop diagnostic methods. Two laboratory studies were conducted on patients with suspected acute SMA occlusion. A pilot-study showed that the fibrinolytic marker D-dimer was elevated in six patients with the disease. In the subsequent study including 101 patients, D-dimer was the only elevated coagulation marker in nine patients with the disease. In a prospective study 24 patients (median age 84 years) were identified, of whom four were diagnosed at autopsy, despite an autopsy-rate of 10%. One-fourth were initially nursed in non-surgical wards. Length of the intestinal infarction was a predictor for death. An analysis of patients from the three studies showed that D-Dimer was elevated in all 16 tested patients with the disease.Sixty patients with acute SMA occlusion underwent intestinal revascularisation and were registered in the Swedish Vascular Registry (SWEDVASC). One-year survival-rate was 40%. Previous vascular surgery was a negative risk-factor.A population-based study was conducted in Malmö, based on an autopsy-rate of 87%. Among 270 patients with the disease, 2/3 were diagnosed only at autopsy and 1/2 were managed in non-surgical wards. The incidence was 8.6 per 100000 person years. The age-standardized incidence increased exponentially without gender differences. The diagnosis was the cause of death in 1.2% among octogenarians and beyond. Thrombotic occlusions were located proximally within the SMA and associated with extensive intestinal infarctions. Synchronous embolism, often multiple, occurred in 2/3 of the patients with embolic occlusions.Conclusions: A normal D-dimer at presentation most likely excludes the diagnosis. Acute SMA occlusion was more frequent than previously estimated from clinical series. The patients were often nursed in non-surgical wards.
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| 3. |
- Acosta, Stefan, et al.
(författare)
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Predictors for Outcome After Open and Endovascular Repair of Ruptured Abdominal Aortic Aneurysms.
- 2007
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1532-2165 .- 1078-5884. ; 33:Nov 8, s. 277-284
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Tidskriftsartikel (refereegranskat)abstract
- Objectives. The aims of the present study were to analyze patient- and management-related predictors for outcome after open (OR) and endovascular repair (EVAR) of ruptured abdominal aortic aneurysm (rAAA). Design. Retrospective study. Materials. The in-hospital registry of Malmo University Hospital identified 162 patients operated on due to rAAA between 2000 and 2004. Methods. Patient- and management-related predictors for outcome were analysed. Results. Preoperative CT in 39 out of 62 circulatory unstable patients was not associated with increased mortality (P = 0.60). There was a significant increase in repairs performed by EVAR during the study period (p < 0.001), and in 2004 EVAR exceeded the annual rate of OR. Patients in the EVAR group were older (p = 0.025), whereas patients in the OR group more often suffered from unconsciousness after presentation (p = 0.004). Age, unconsciousness after presentation and haemoglobin were significantly associated with in-hospital mortality when tested in a multivariate logistic regression model (p = 0.002, p = 0.003 and p < 0.001, respectively). The in-hospital mortality for patients undergoing OR and EVAR was 45% (48/106) and 34% (19/56), respectively (p = 0.16). Diagnosis of abdominal compartment syndrome (p = 0.005) and intestinal infarction (p = 0.002) was associated with poor survival. Conclusions. Patient-related factors such as age, loss of consciousness and haemoglobin predicts outcome in a population where both emergency OR and EVAR for the treatment of rAAA is feasible.
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| 4. |
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| 5. |
- Acosta, Stefan, et al.
(författare)
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The Hardman index in patients operated on for ruptured abdominal aortic aneurysm: A systematic review.
- 2006
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Ingår i: Journal of Vascular Surgery. - : Elsevier BV. - 1097-6809 .- 0741-5214. ; 44:5, s. 949-954
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Forskningsöversikt (refereegranskat)abstract
- Background. The aims of the present study were to (1) analyze preoperative predictors for outcome suggested by Hardman and surgical mortality after open repair and endovascular repair (EVAR) of ruptured abdominal aortic aneurysms (rAAA), and (2) further evaluate the Hardman index in a systematic review. Methods. Patients operated on for rAAA during a 5-year period between 2000 and 2004 were scored according to Hardman-1 point for either age > 76 years, loss of consciousness after presentation, hemoglobin < 90 g/L, serum creatinine > 190 mu mol/L or electrocardiographic (ECG) signs of ischemia-with blinded evaluation of ECGs by a specialist in clinical physiology. The results were included in a systematic review of studies evaluating the Hardman index. Results: In-hospital mortality after operation was 41% (67/162). There was no difference in in-hospital mortality between open repair (n=106) and EVAR (n=56), whereas the Hardman index was associated with operative mortality in our institution and in the systematic review of 970 patients (P <.001). Mortality rate in patients with Hardman index >= 3 was 77% in the pooled analysis. A full data set of all five scoring variables was obtained in 94 (58%) of 162 patients in our study, and potential underscoring was thus possible in 68 patients. Of the available ECGs, 12 (8.7%) of 138 were judged nondiagnostic. Five studies did not state their missing data on ECG and hemoglobin and serum creatinine concentrations, nor did they specify the criteria for ECG ischermia. Conclusions: A strong correlation between the Hardman index and mortality was found. A Hardman index >= 3 cannot be used as an absolute limit for denial of surgery. The utility of the Hardman index seems to be impeded by variability in scoring resulting from missing or nondiagnostic data.
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| 6. |
- Kuoppala, Monica, et al.
(författare)
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Long-term prognostic factors after thrombolysis for lower limb ischemia.
- 2008
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Ingår i: Journal of Vascular Surgery. - : Elsevier BV. - 1097-6809 .- 0741-5214. ; 47:6, s. 1243-1250
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: This study assessed prognostic factors regarding long-term outcome for amputation and death among patients who underwent intra-arterial thrombolysis due to lower limb ischemia. METHODS: Consecutive patients with intra-arterial thrombolysis due to lower limb ischemia treated at the Department of Vascular Diseases, University Hospital of Malmö, between January 1, 2001, and December 31, 2005, were retrospectively reviewed. A multivariate Cox regression analysis was performed to determine independent predictors for amputation and death. RESULTS: A total of 220 intra-arterial thrombolysis procedures were performed in 195 patients (46% women). Median age was 73 years. Complete and partial thrombolysis was obtained in 41% and 38%, respectively. Hemorrhagic complications were documented in 33%, but only 6% (13 of 220) were interrupted. The amputation rate was 26% and mortality was 35% during a median follow-up of 32 months. Degree of lysis (hazard ratio [HR], 4.8; 95% confidence interval [CI], 2.4-9.7; P < .001), motor deficit at admission (HR, 4.0; 95% CI, 1.8-8.7; P = .001), foot ulcers (HR, 7.2; 95% CI, 2.2-23.4; P = .001), and ischemic heart disease (HR, 2.3; 95% CI, 1.1-4.8; P = .024) remained as independent factors associated with amputation. Renal insufficiency (HR, 2.4; 95% CI, 1.4-4.2; P = .003), ischemic heart disease (HR, 2.1; 95% CI, 1.2-3.7; P = .007), cerebrovascular disease (HR, 2.2; 95% CI, 1.2-4.0; P = .009), foot ulcers (HR, 3.2; 95% CI, 1.2-8.6; P = .019), and acute lower limb ischemia (HR, 3.4; 95% CI, 1.1-10.1; P = .028) remained as independent factors associated with mortality. CONCLUSIONS: Thrombolysis is successful, with few major complications in most patients with lower limb ischemia. Patients with ischemic heart disease and foot ulcers are at higher long-term risk for both amputation and death. A lesser degree of lysis and motor deficit were associated with higher amputation rates. The presence of such negative prognostic factors may help clinicians to deny further invasive vascular treatment. Renal insufficiency, cerebrovascular disease, and acute lower limb ischemia were associated with increased mortality.
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| 7. |
- Kuoppala, Monica, et al.
(författare)
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Risk factors for hemorrhage during local intra-arterial thrombolysis for lower limb ischaemia
- 2011
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Ingår i: Journal of Thrombosis and Thrombolysis. - : Springer Science and Business Media LLC. - 1573-742X .- 0929-5305. ; 31:2, s. 226-232
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Tidskriftsartikel (refereegranskat)abstract
- Assessment of clinical risk factors for haemorrhagic complications in patients undergoing intra-arterial thrombolysis for lower limb ischaemia. Retrospective reviews of consecutive patients subjected to intra-arterial thrombolysis due to lower limb ischemia at the Vascular Center, Malmö University Hospital, during a 5-year period from 2001 to 2005. Two hundred and twenty intra-arterial thrombolytic procedures were carried out in 195 patients (46% women), median age 73 years. Haemorrhagic complications were recorded in 72 procedures (33%), of which 13 were discontinued. Haemorrhage at the introducer and distant sites occurred in 53 and 32 procedures, respectively. Thrombolysis for occluded synthetic grafts was associated with higher risk of haemorrhage (P = 0.043). The platelet count was lower (P = 0.017) and the dose of alteplas higher (P = 0.041) in bleeders than in non-bleeders. Age was not associated with haemorrhage (P = 0.30). Two patients died during thrombolysis, one of them due to intracerebral haemorrhage. The grade of thrombolysis was an independent predictor of both in-hospital amputation (P < 0.001; OR 3.5 [95% CI 2.1-5.8]) and mortality (P = 0.021; OR 3.0 [95% CI 1.2-7.9]). The in-hospital amputation-free survival rate was 85% (188/220). Haemorrhage associated with thrombolysis is common, but does seldom require discontinuation of treatment. Insertion of introducers for local thrombolysis through synthetic grafts, lower platelet count and higher alteplas dose were found to be risk factors for haemorrhage. An algorithm for clinical management of haemorrhage has been proposed.
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| 8. |
- Nessvi, Sofia, et al.
(författare)
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Inflammatory mediators after endovascular aortic aneurysm repair.
- 2014
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Ingår i: Cytokine. - : Elsevier BV. - 1096-0023 .- 1043-4666. ; 70:2, s. 151-155
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Tidskriftsartikel (refereegranskat)abstract
- To evaluate patterns of inflammatory mediators before and after elective endovascular aortic aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA).
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| 9. |
- Otterhag, Sofia Nessvi, et al.
(författare)
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Decreasing incidence of ruptured abdominal aortic aneurysm already before start of screening.
- 2016
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Ingår i: BMC Cardiovascular Disorders. - : Springer Science and Business Media LLC. - 1471-2261. ; 16:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The aim of this study was to evaluate whether screening for abdominal aortic aneurysm (AAA) has led to a decrease in ruptured AAA (rAAA) incidence. METHOD: The Malmö population was evaluated regarding the incidence of rAAA and elective AAA surgery 4 years before and after start of AAA-screening in 2010. Data from 1971 to 1986 (J Vasc Surg 18:74-80, 1993) and 2000-2004 (J Vasc Surg 44:237-43, 2006), enabled analysis of trends over time. RESULTS: Analysis of time-periods 1971-1986, 2000-2004, 2006-2010 and 2010-2014 showed an incidence of rAAA of 5.6 (4.9-6.3), 10.6 (8.9-12.4), 6.1 (4.6-7.6) and 4.0 (2.9-5.1), respectively. In men aged 60-69 years the incidences were 16.0 (10.7-21.3), 45.6 (27.7-63.4), 19.3 (9.2-35.3) and 8.9 (2.8-20.6), respectively. The incidences of elective AAA surgery in men aged 60-69 years were 22.9 (16.5-29.2), 34.6 (19.1-50.2), 9.7 (1.2-18.5) and 44.2 (27.0-61.6), respectively. CONCLUSIONS: A decrease in incidence of rAAA in men was evident before the implementation of screening. We were yet not able to demonstrate a certain reduction in rAAA incidence after the start of screening.
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