| 1. |
- Belch, Jill, et al.
(författare)
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ESVM guidelines – the diagnosis and management of raynaud’s phenomenon
- 2017
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Ingår i: Vasa - European Journal of Vascular Medicine. - : Hogrefe Publishing Group. - 0301-1526. ; 46:6, s. 413-423
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Forskningsöversikt (refereegranskat)abstract
- Regarding the clinical diagnosis of Raynaud’s phenomenon and its associated conditions, investigations and treatment are substantial, and yet no international consensus has been published regarding the medical management of patients presenting with this condition. Most knowledge on this topic derives from epidemiological surveys and observational studies; few randomized studies are available, almost all relating to drug treatment, and thus these guidelines were developed as an expert consensus document to aid in the diagnosis and management of Raynaud’s phenomenon. This consensus document starts with a clarification about the definition and terminology of Raynaud’s phenomenon and covers the differential and aetiological diagnoses as well as the symptomatic treatment.
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| 2. |
- Heiss, Christian, et al.
(författare)
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The compelling arguments for the need of medical vascular physicians in Europe
- 2019
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Ingår i: Vasa - European Journal of Vascular Medicine. - : Hogrefe Publishing Group. - 0301-1526. ; 48:6
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Tidskriftsartikel (refereegranskat)abstract
- The burden of vascular diseases is growing worldwide, as the population ages, prompting a call to action not only in terms of awareness but also and most urgently in recognizing the need for vascular physicians, also called angiologists. Vascular medicine views the vascular system (arteries, veins, and lymphatics) as a whole, unique, and independent entity requiring specialized competencies. Vascular physicians offer a holistic and comprehensive approach to vascular patients including provision of interventional procedures, management of a heterogeneous group of multi-morbid and frail patients affected by multi-vessel diseases, and connecting different specialists in a multidisciplinary effort. Vascular medicine practise varies across European countries. While it is a firmly accepted medical speciality in many European countries it is not formally recognized by the European Union limiting adoption in the other countries. The lack of vascular physicians likely accounts for inequality of care of vascular patients as compared for example to patients with heart disease and might contribute to adverse outcomes and healthcare costs associated with vascular diseases. To move forward in the struggle to provide efficient care for multimorbid poly-vascular patients, it is essential to establish vascular medicine programs in Europe and worldwide. Important steps to achieve this goal include improving public awareness of vascular diseases, attain formal recognition by the EU of angiology/vascular medicine as a medical specialty, creating specialized treatment guidelines, and to harmonize vascular care in Europe.
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| 3. |
- Alhadad, Alaa, et al.
(författare)
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Erythromelalgia: Incidence and clinical experience in a single centre in Sweden.
- 2012
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Ingår i: Vasa: European Journal of Vascular Medicine. - : Hogrefe Publishing Group. - 0301-1526. ; 41:1, s. 43-48
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Tidskriftsartikel (refereegranskat)abstract
- Background: Erythromelalgia (EM) incidence has not been well studied and there are only two studies published on this subject as far as we know. The aims are to study the incidence of this rare condition in the south of Sweden, to report the clinical experience from a single centre including characterisation of comorbidity and to report on prognosis. Patients and methods: Retrospective study of a population-based analysis of data from the southernmost part of Sweden corresponding to the median age of the patients (Statistics Sweden). The diagnosis of EM is based on the medical record reflecting the triad of redness, burning pain and increased temperature of the feet or hands or both. We evaluated the presence or absence of EM triad by recording the history, physical examination, laboratory analysis, cold provocation test and laser Doppler imaging, and by searching for any confounding disease in cases of suspected EM. Results: During a 10.5 year period we clinically identified 27 patients with EM. Median age was 49 [IQR (34 - 68)] years, 19 (70 %) were women. The mean delay from the onset of the symptoms to the time of diagnosis was 4.5 (SD ± 3.9) years. Gender and age adjusted incidence of EM for our region was calculated to be 0.36 per 100 000 persons per year. Three patients developed intraabdominal cancer during the follow up, but there was no mortality directed related to EM. Conclusions: The overall population-based incidence of erythromelalgia was 0.36 per 100 000 which is identical with a previous report in a Scandinavian population.
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| 4. |
- Asciutto, Giuseppe, et al.
(författare)
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Catheter-directed foam sclerotherapy treatment of saphenous vein incompetence.
- 2012
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Ingår i: Vasa: European Journal of Vascular Medicine. - : Hogrefe Publishing Group. - 0301-1526. ; 41:2, s. 120-124
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Tidskriftsartikel (refereegranskat)abstract
- Background: The aim of this study is to report the short-term results of catheter-directed foam sclerotherapy (CDFS) in the treatment of axial saphenous vein incompetence. Patients and methods: Data of all patients undergoing CDFS for symptomatic primary incompetence of the great or small saphenous vein were prospectively collected. Treatment results in terms of occlusion rate and patients grade of satisfaction were analysed. All successfully treated patients underwent clinical and duplex follow-up examinations one year postoperatively. Results: Between September 2006 and September 2010, 357 limbs (337 patients) were treated with CDFS at our institution. Based on the CEAP classification, 64 were allocated to clinical class C3 , 128 to class C4, 102 to class C5 and 63 to class C6. Of the 188 patients who completed the one year follow up examination, 67 % had a complete and 14 % a near complete obliteration of the treated vessel. An ulcer-healing rate of 54 % was detected. 92 % of the patients were satisfied with the results of treatment. We registered six cases of thrombophlebitis and two cases of venous thromboembolism, all requiring treatment. Conclusions: The short-term results of CDFS in patients with axial vein incompetence are acceptable in terms of occlusion and complications rates.
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| 5. |
- Dakhel, Ardwan, et al.
(författare)
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Higher long-term cardiovascular morbidity after open surgery for intermittent claudication caused by infrainguinal atherosclerotic disease in patients with diabetes - A nationwide observational cohort study
- 2021
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Ingår i: Vasa - European Journal of Vascular Medicine. - : Hogrefe Publishing Group. - 0301-1526. ; 50:3, s. 224-230
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Tidskriftsartikel (refereegranskat)abstract
- Summary: Background: Diabetes mellitus (DM) is a risk factor for peripheral arterial disease (PAD). Indications for open surgery in infrainguinal intermittent claudication (IC) are limited, and reports are lacking regarding outcomes in DM patients. Study aims were to compare short and long-term effects on major adverse cardiovascular events (MACE), acute myocardial infarction (AMI), stroke, major amputation, and mortality after infrainguinal open surgery for IC in patients with and without DM, and to evaluate relationships between glycaemic control and outcomes. Methods: Nationwide observational cohort study of all patients registered in the Swedish Vascular Registry after planned infrainguinal open surgery for IC from January 1st 2010 to December 31st 2014. Patients registered in the National Diabetes Registry were compared with patients without diabetes by propensity score adjusted comparison of MACE, AMI, stroke, major amputation, and mortality. Results: After 30 days, there were no differences in MACE, AMI, stroke, major amputation, or mortality between patients with (n = 323, mean age 70.5 [SD 7.4] years, 92 [28.5%] females) and without (n = 679, mean age 69.7 years [SD 11.2], 234 [34.5%] females) DM. At last follow-up after median 5.2 years, patients with DM showed higher rates of MACE (Hazard ratio [HR] 1.33, confidence interval [CI] 1.08-1.62; p < 0.01), and AMI (HR 2.21, CI 1.46-3.35; p < 0.01) than patients without diabetes. Among DM patients, higher glycated haemoglobin (HbA1c) was associated with higher rates of MACE (HR 1.02, CI 1.00-1.03; p = 0.02), stroke (HR 1.05, CI 1.00-1.11; p = 0.04), and total mortality (HR 1.03, CI 1.01-1.06; p < 0.01), during follow-up, whereas duration of diabetes was associated with higher rate of major amputation (HR 1.08, CI 1.02-1.15; p < 0.01). Conclusions: DM patients showed higher rates of MACE and AMI in propensity score adjusted analysis five years after planned infrainguinal open surgery for IC. Higher HbA1c was associated with MACE, stroke, and total mortality in patients with DM, whereas longer duration of DM was associated with major amputation.
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| 6. |
- Dakhel, Ardwan, et al.
(författare)
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Novel cardiovascular biomarkers associated with peripheral arterial disease in men screened for abdominal aortic aneurysm
- 2022
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Ingår i: Vasa - European Journal of Vascular Medicine. - : Hogrefe Publishing Group. - 0301-1526. ; 51:3, s. 167-173
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Tidskriftsartikel (refereegranskat)abstract
- Background: Peripheral arterial disease (PAD) is a common atherosclerotic disease with severity ranging from asymptomatic to chronic limb threatening ischemia. The aim of the present cross-sectional study was to identify novel biomarkers associated with PAD. Patients and methods: Levels of 91 cardiovascular specific proteins in plasma samples were measured by the Proseek Multiplex CVD III96x96 panel from a cohort consisting of 267 65-year-old men recruited from a screening program for abdominal aortic aneurysm (AAA) Levels of protein biomarkers were compared in men with and without PAD (defined as an ankle brachial index of <0.9) and their diagnostic potential was calculated by receiver-operating characteristic analysis. Results: The prevalence of PAD was 14.2% (38/267). After adjustment for multiple comparisons, levels of the following 11 biomarkers remained significantly higher (p<0.0001) in patients with PAD: secretoglobin family 3A member 2, osteoprotegerin, urokinase-type plasminogen activator surface receptor, serum macrophage chemokine ligand 16, matrix metalloproteinase 9, p-selectin, growth differentiation factor 15, elafin, cystatin B, trefoil factor 3, and fatty acid-binding protein 4. Multivariable logistic regression analysis (adjusted for smoking, use of antihypertensive and lipid-lowering medication, and metformin) showed that 11 biomarkers were significantly associated with higher risk of PAD with odds ratios ranging from 1.6 to 2.4. Area under curve calculated by receiver operating characteristic curve analysis (diagnostic value) for each protein biomarker ranged from 0.63 to 0.74. Conclusions: We have identified multiple proteins with a potential to be diagnostic biomarkers for PAD, and further research is warranted to clarify their potential predictive and prognostic value.
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| 7. |
- Fransson, T, et al.
(författare)
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In situ saphenous vein bypass grafting - still first line treatment? : A prospective study comparing surgical results between diabetic and non-diabetic populations
- 2010
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Ingår i: Vasa - European Journal of Vascular Medicine. - : Hogrefe Publishing Group. - 0301-1526. ; 39:1, s. 59-65
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: This prospective study compares results of infrainguinal revascularisation with autologous vein in diabetic and non-diabetic populations.PATIENTS AND METHODS: 101 patients (diabetics (A) n = 50 and non-diabetics (B) n = 51) were operated upon with an in situ saphenous vein bypass to the popliteal artery below knee or to crural arteries, due to critical ischemia. Data on operative details, morbidity, mortality, secondary interventions and graft patency, were collected prospectively. All patients were followed up for 5 years.RESULTS: The two groups were similar except that diabetics more often suffered from gangrene or tissue loss. The distal anastomoses were constructed significantly more distally in diabetics. There were no differences in perioperative bleeding, length of operation, hospital stay or 30 d mortality. The 5 year patency did not differ significantly between groups, A 68 % vs. B 72 %. The limb salvage was equal in both groups, 86 % after 5 years. Mortality during follow up was significantly higher among diabetics, at two years A 31 % vs. B 14 %.CONCLUSIONS: Distal revascularisation with in situ technique is a durable procedure that can be performed with very good results in both diabetics and non-diabetics. The survival among diabetics is however significantly lower, although reaching 69 % at two years.
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| 8. |
- Taimour, Soumia, et al.
(författare)
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No relation between biomarkers at age 47-49 and aortic diameter after 14-19 years of follow-up - a population-based study
- 2017
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Ingår i: Vasa - European Journal of Vascular Medicine. - : Hogrefe Publishing Group. - 0301-1526. ; 46:4, s. 291-295
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Biomarkers reflecting diverse pathophysiological pathways may play an important role in the pathogenesis of abdominal aortic aneurysm (aortic diameter ≥30 mm, AAA), levels of many biomarkers are elevated and correlated to aortic diameter among 65-year-old men undergoing ultrasound (US) screening for AAA.PROBANDS AND METHODS: To evaluate potential relationships between biomarkers and aortic dilatation after long-term follow-up, levels of C-reactive protein (CRP), proneurotensin (PNT), copeptin (CPT), lipoprotein-associated phospholipase 2 (Lp-PLA2), cystatin C (Cyst C), midregional proatrial natriuretic peptide (MR-proANP), and midregional proadrenomedullin (MR-proADM) were measured in 117 subjects (114 [97 %] men) aged 47-49 in a prospective population-based cohort study, and related to aortic diameter at US examination of the aorta after 14-19 years of follow-up.RESULTS: Biomarker levels at baseline did not correlate with aortic diameter after 14-19 years of follow up (CRP [r = 0.153], PNT [r = 0.070], CPT [r = -.156], Lp-PLA2 [r = .024], Cyst C [r = -.015], MR-proANP [r = 0.014], MR-proADM [r = -.117]). Adjusting for age and smoking at baseline in a linear regression model did not reveal any significant correlations.CONCLUSIONS: Tested biomarker levels at age 47-49 were not associated with aortic diameter at ultrasound examination after 14-19 years of follow-up. If there are relationships between these biomarkers and aortic dilatation, they are not relevant until closer to AAA diagnosis.
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| 9. |
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| 10. |
- Belch, JJF, et al.
(författare)
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Lipid-lowering and anti-thrombotic therapy in patients with peripheral arterial disease
- 2021
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Ingår i: VASA. Zeitschrift fur Gefasskrankheiten. - : Hogrefe Publishing Group. - 0301-1526. ; 50:6, s. 401-411
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Tidskriftsartikel (refereegranskat)abstract
- Summary: Patients with peripheral arterial disease (PAD) are at very high risk of cardiovascular events, but risk factor management is usually suboptimal. This Joint Task Force from the European Atherosclerosis Society and the European Society of Vascular Medicine has updated evidence on the management on dyslipidaemia and thrombotic factors in patients with PAD. Guidelines recommend a low-density lipoprotein cholesterol (LDLC) goal of more than 50% reduction from baseline and <1.4 mmol/L (<55 mg/dL) in PAD patients. As demonstrated by randomized controlled trials, lowering LDL-C not only reduces cardiovascular events but also major adverse limb events (MALE), including amputations, of the order of 25%. Addition of ezetimibe or a PCSK9 inhibitor further decreases the risk of cardiovascular events, and PCSK9 inhibition has also been associated with reduction in the risk of MALE by up to 40%. Furthermore, statin- based treatment improved walking performance, including maximum walking distance, and pain-free walking distance and duration. This Task Force recommends strategies for managing statin-associated muscle symptoms to ensure that PAD patients benefit from lipid-lowering therapy. Antiplatelet therapy, either daily clopidogrel 75 mg or the combination of aspirin 100 mg and rivaroxaban (2×2.5 mg) is also indicated to prevent cardiovascular events. Dual pathway inhibition (aspirin and rivaroxaban) may be considered following revascularization, taking into account bleeding risk. This Joint Task Force believes that adherence with these recommendations for lipid-lowering and antithrombotic therapy will improve the morbidity and mortality in patients with PAD.
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