| 1. |
- Starck, Joachim, et al.
(författare)
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Abdominal aortic aneurysm growth rates are not correlated to body surface area in screened men
- 2023
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Ingår i: International Angiology. - : EDIZIONI MINERVA MEDICA. - 1827-1839 .- 0392-9590. ; 42:1, s. 65-72
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Screening for abdominal aortic aneurysm (AAA) in 65-year-old males reduces aneurysm related mortality. Infrarenal aortic diameter (IAD) has been shown to correlate to body surface area (BSA) which could influence diagnostic criteria for AAA. This study investigates whether AAA growth rates are also dependent on BSA, as that might have potential effects on surveillance of small AAAs.METHODS: We conducted a retrospective, single center cohort study of 301 men with screening detected AAA between 2010-2017 with surveillance to 2021. AAA growth rates were analyzed in relation to the subject's BSA, smoking habits, and diabetic disease using a linear mixed-effects model. All men were offered smoking cessation program, optimized medical treatment, and advice on physical activity.RESULTS: The screening program included 28,784 men. Of the 22,819 (79%) attending the examinations, 374 men (1.6%) were found to have an AAA out of which 301 men had undergone two or more examinations during surveillance and were included with a median follow-up of 1846 days (IQR: 1 399). Mean unadjusted AAA growth rate was 1.60 mm/year (95% CI: 1.41-1.80). Diabetes mellitus had a statistically significant negative impact, smoking had a statistically significant positive impact on AAA growth rates whereas no correlation between AAA growth rate and BSA could be found.CONCLUSIONS: Body surface area could not be found to have a statistically significant correlation to AAA growth rates. The impact of smoking and diabetes on AAA growth rates remains similar to previously reported.
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| 2. |
- Asciutto, Giuseppe, et al.
(författare)
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Early experience with the Bolton Relay Pro/Plus for physician-modified fenestrated TEVAR
- 2022
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Ingår i: International Journal of Angiology. - : Edizioni Minerva Medica. - 0392-9590 .- 1827-1839. ; 41:2, s. 105-109
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Tidskriftsartikel (refereegranskat)abstract
- Background: Thoracic endovascular aortic repair (TEVAR) can be challenging in cases involving the aortic arch and the visceral segment. We report our initial experience with fenestrated TEVAR (f-TEVAR) for thoracic aortic disease involving aortic branches using physician-modified stent grafts (PMSGs). Methods: Between February 2019 and November 2020 nine patients were treated with a PMSG. Indication to treatment were a symptomatic acute type B aortic dissection (TBAD) in three cases, a penetrating aortic ulcer in three cases (two in zone 3 and one in zone 6), one case of an endoleak type IA after TEVAR, a chronic TBAD after TEVAR in one case and one case of a contained rupture of a thoracoabdominal aneurysm in zone 3. Pre-, intra-and postoperative clinical data were recorded. Results: The median patient age was 65 (IQR 60.5-71) years, and eight (89%) patients were men. Nine stent grafts (six Bolton Relay Plus and three Bolton Relay Pro, Terumo Aortic, Vascutek Ltd., Inchinnan, UK) were deployed. Small fenestrations (8 mm) were created on table, median duration for on table stent graft modifications was 20 minutes (range 13-22). The technical success rate was 100%. Median operative time was 188 (range 116-252) minutes. No major adverse events of any sort occurred during the first 30-day postoperatively. There were no type I or type III endoleaks at the end of the procedure, and no cases of spinal cord ischemia. Two access related complications occurred (22%). After a median of 12 (range 5-12) months all patients survived and all target vessels remained patent with one case of fenestration-related type I endoleak, which required open conversion. Conclusions: The results of our initial experience with f-TEVAR using PMSGs with the Bolton Relay stentgraft for the treatment of aortic diseases are acceptable. These results should be confirmed on larger patient cohorts. (Cite this article as: Asciutto G, Usai MV, Ibrahim A, Oberhuber A. Early experience with the Bolton Relay Pro/Plus for physician-modified fenestrated TEVAR. Int Angiol 2022;41:105-9. DOI: 10.23736/S03929590.22.04745-9)
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| 3. |
- Hager, Jakob, et al.
(författare)
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Revisiting the cost-effectiveness of screening 65-year-old men for abdominal aortic aneurysm based on data from an implemented screening programme.
- 2017
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Ingår i: International Journal of Angiology. - : Edizioni Minerva Medica. - 0392-9590 .- 1827-1839. ; 36:6, s. 517-525
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Health economic analyses based on randomized trials have shown that screening for abdominal aortic aneurysm (AAA) cost-effectively decreases AAA-related, as well as all- cause mortality. However, follow-up from implemented screening programmes now reveal substantially changed conditions in terms of prevalence, attendance rate, costs and mortality after intervention. Our aim was to evaluate whether screening for AAA among 65-year-old men is cost-effective based on contemporary data on prevalence and attendance rates from an ongoing AAA screening programme.METHODS: A decision-analytic model, previously used to analyse the cost-effectiveness of an AAA screening programme prior to implementation in clinical practice, was updated using data collected from an implemented screening programme as well as data from contemporary published data and the Swedish register for vascular surgery (Swedvasc).RESULTS: The base-case analysis showed that the cost per life-year gained and quality-adjusted life year (QALY) gained were €4832 and €6325, respectively. Based on conventional threshold values of cost-effectiveness, the probability of screening being cost-effective was high.CONCLUSION: Despite the reduction of AAA-prevalence and changes in AAA-management over time, screening 65-year-old men for AAA still appears to yield health outcomes at a cost below conventional thresholds of cost-effectiveness.
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| 4. |
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| 5. |
- Acosta, Stefan, et al.
(författare)
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The clinical importance in differentiating portal from mesenteric venous thrombosis
- 2011
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Ingår i: International Journal of Angiology. - 0392-9590 .- 1827-1839. ; 30:1, s. 71-78
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Tidskriftsartikel (refereegranskat)abstract
- Aim. To relate the extent of portomesenteric thrombosis to the risk of intestinal infarction, concomitant venous thromboembolism and underlying diseases. Methods. Identification of patients with mesenteric (MVT) and portal vein thrombosis (PVT) at Malmo University Hospital from a clinical series from 2000 - 2006 as well as an autopsy cohort of 24000 consecutive autopsies from 1970 - 1982. Results. In the clinical comparative study, MVT (n=51) was associated with more thrombophilic disorders (P=0.040) and intestinal infarctions (P=0.046), whereas patients with PVT without extension to the superior mesenteric vein (n=20) more often had liver disease (P < 0.001). At autopsy, 270 patients with portomesenteric venous thrombosis were found; twenty-nine out of the 31 cases with MVT had intestinal infarction. None (0%) of the 239 patients with PVT without extension into the superior mesenteric vein had intestinal infarction. Portomesenteric venous thrombosis and intestinal infarction was associated with concomitant venous thromboembolism (O. R. 6.1 [95% CI 1.8-21]). Conclusions. MVT carries a high risk of developing intestinal infarction and is associated with concomitant venous thromboembolism, whereas PVT is associated with liver disease.
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| 6. |
- Barani, Jamal, et al.
(författare)
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Suboptimal treatment of risk factors for atherosclerosis in critical limb ischemia
- 2005
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Ingår i: International Angiology. - 0392-9590 .- 1827-1839. ; 24:1, s. 59-63
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Tidskriftsartikel (refereegranskat)abstract
- Aim. The epidemiology of critical limb ischemia (CLI) is insufficiently studied, and treatment of risk factors for atherosclerosis has received less attention in CLI patients than in patients with coronary or precerebral atherosclerosis. The aim of this study was to establish the incidence of CLI and the quality of risk factor treatment in Swedish CLI patients. Methods. During 14 months, 316 consecutive CLI patients were referred to the Malmö Department of Vascular Diseases. Two hundred and fifty-nine (82%) consented to evaluation of intercurrent disease, medication, ankle and arm blood pressures (BP), plasma glucose and lipid levels, phomocysteine, cardiolipin antibodies and activated protein C (APC)-resistance. Results. The incidence of CLI was 38/100 000 inhabitants/year. Patient age was 75±10 years, and BP 147±26/75±14 mmHg. Systolic or diastolic BP above recommended levels (140/90 mmHg) occurred in 137 (53%) patients. P-cholesterol was 4.8±1.2 mMol/L, but cholesterol above recommended level (5 mMol/L) or LDL above recommended level (3 mMol/L) occurred in 125 (48%) patients. Only 24% of patients met national recommendations for both BP and lipid levels. Diabetes mellitus was previously known in 123 (47%) patients, and another 12 (5%) patients showed diabetic fasting glucose levels during the hospital stay. Eightyfour (32%) patients were active, and 72 (28%) were former smokers. Myocardial infarction or angina pectoris had previously been diagnosed in 123 (47%) patients. P-homocysteine was 17±7 μol/l, cardiolipin antibodies occurred in 71 (27%) and APC-resistance in 34 (13%) patients. Conclusion. Patients with CLI show high comorbidity in vascular diseases and high prevalence of modifiable risk factors for atherosclerotic vascular disease. The use of evidence-based medical therapy is suboptimal in this high-risk group.
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| 7. |
- Bergqvist, David, et al.
(författare)
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Abdominal aortic aneurysm and new WHO criteria for screening
- 2013
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Ingår i: International Journal of Angiology. - 0392-9590 .- 1827-1839. ; 32:1, s. 37-41
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Forskningsöversikt (refereegranskat)abstract
- Does screening of abdominal aortic aneurysm (AAA) fulfil the recently revised the World Health Organization WHO criteria for screening? Contemporary data from the literature are used to analyze whether the ten recent WHO criteria can be used to motivate AAA screening. Although the prevalence of AAA seems to decrease, at least screening of 65-year old males saves lives and is cost-effective. Ultrasonographic screening for AAA in risk populations fulfils the new WHO criteria for screening.
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| 8. |
- Bergqvist, David
(författare)
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Vascular injuries caused by acupuncture : A systematic review
- 2013
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Ingår i: International Journal of Angiology. - 0392-9590 .- 1827-1839. ; 32:1, s. 1-8
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Forskningsöversikt (refereegranskat)abstract
- AIM: The aim of the study was to systematically review the literature on vascular injuries caused by acupuncture.METHODS: This was a systematic literature search in Medline and PubMed.RESULTS: Thirty-one cases were identified and the majority developed symptoms in direct connection with the acupuncture treatment. Three patients died, two from pericardial tamponade and one from an aortoduodenal fistula. There were seven more tamponades, eight pseudoaneurysms, two with ischemia, two with venous thrombosis, one with compartment syndrome and seven with bleeding (five in the central nervous system). The two patients with ischemia had remaining sequeleae. Information on follow-up was suboptimal with no information in fourteen patients.CONCLUSION: Vascular injuries are rare, bleeding and pseudoaneurysm dominating. Follow-up is insufficient in the hitherto published papers.
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| 9. |
- Danielsson, P., et al.
(författare)
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Systemic white blood and endothelial cell response after revascularization of critical limb ischemia is only influenced in case of ischemic ulcers
- 2006
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Ingår i: International Journal of Angiology. - 0392-9590 .- 1827-1839. ; 25:3, s. 310-315
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The aim of this study was to study the inflammatory response to open revascularization of an ischemic leg in terms of activation of white blood cells (WBC), platelets and endothelial cells. DESIGN: prospective study. METHODS: Venous samples from 21 patients suffering critical limb ischemia (CLI) were drawn before, and 4 weeks after (20 patients) revascularization. Total WBC, differentiated WBC, and platelets were counted. Expression of CD11b/CD18 on granulocytes and monocytes and CD41 on platelets was measured by flow cytometry. Soluble endothelial markers (sICAM-1, sVCAM-1, sE-selectin and sP-selectin) were analysed with ELISA. RESULTS: WBC and granulocyte count decreased in the subgroup of patients with ulcer and gangrene but no change in activation of WBC was recorded. The endothelial marker sICAM-1 decreased while VCAM-1 increased following surgery, most evident in the subgroup with ulcers and gangrene. CONCLUSIONS: This study shows that revascularization of CLI does not significantly influence the inflammatory response in patients with rest pain only, but a limited response of down regulation was found in the ulcer/gangrene patients probably as an effect of healing ulcers.
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| 10. |
- El Marghani, Ahmed M., et al.
(författare)
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High MAPK p38 activity and low level of IL-10 in intermittent claudication as opposed to stable angina
- 2010
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Ingår i: International Journal of Angiology. - Torino : Minerva Medica. - 0392-9590 .- 1827-1839. ; 29:4, s. 331-337
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Tidskriftsartikel (refereegranskat)abstract
- AIM:The aim of the present pilot study was to relate the activity of MAPK p38 with the levels of pro- and anti-inflammatory cytokines in a small cohort of patients with either stable angina (N=5) or intermittent claudication (N=5) compared to healthy controls (N=10).METHODS:The activity of MAPK p38 was determined in peripheral blood mononuclear cells, isolated from whole blood by western blot using phospho-specific anti-MAPK p38 antibodies. Cytokine levels of 11 pro- and anti-inflammatory cytokines were determined from the serum using flow cytometry.RESULTS:We found a significant elevation of the MAPK p38 activity in the intermittent claudication group (P=0.0027) compared with the healthy control group whereas the stable angina group showed similar MAPK p38 activity as the healthy control group. The IL-10 level in serum found in the stable angina group was significantly higher compared with both the healthy control group (P=0.0116) and the intermittent claudication group (P=0.0317).CONCLUSION:Our results imply that there is a casual relationship between increased levels of the anti-inflammatory cytokines IL-10 and IL-4 and the activity of the MAPK p38. Possibly has IL-10 a protective role that down-regulates the activity of MAPK p38 and thereby further inflammatory processes in stable angina patients.
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