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- Andersson, Mattias, et al.
(författare)
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Editor's Choice – Structured Computed Tomography Analysis can Identify the Majority of Patients at Risk of Post-Endovascular Aortic Repair Rupture
- 2022
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1078-5884 .- 1532-2165. ; 64, s. 166-174
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The main objective was to report mechanisms and precursors for post-endovascular aneurysm repair (EVAR) rupture. The second was to apply a structured protocol to explore whether these factors were identifiable on follow up computed tomography (CT) prior to rupture. The third objective was to study the incidence, treatment, and outcome of post-EVAR rupture. Methods: This was a multicentre, retrospective study of patients treated with standard EVAR at five Swedish hospitals from 2008 to 2018. Patients were identified from the Swedvasc registry. Medical records were reviewed up to 2020. Index EVAR and follow up data were recorded. The primary endpoint was post-EVAR rupture. CT at follow up and at post-EVAR rupture were studied, using a structured protocol, to determine rupture mechanisms and identifiable precursors. Results: In 1 805 patients treated by EVAR, 45 post-EVAR ruptures occurred in 43 patients. The cumulative incidence was 2.5% over a mean follow up of 5.2 years. The incidence rate was 4.5/1 000 person years. Median time to post-EVAR rupture was 4.1 years. A further six cases of post-EVAR rupture in five patients found outside the main cohort were included in the analysis of rupture mechanisms only. The rupture mechanism was type IA in 20 of 51 cases (39%), IB in 20 of 51 (39%) and IIIA/B in 11 of 51 (22%). One of these had type IA + IB combined. One patient had an aortoduodenal fistula without another mechanism being identified. Precursors had been noted on CT follow up prior to post-EVAR rupture in 16 of 51 (31%). Retrospectively, using the structured protocol, precursors could be identified in 43 of 51 (84%). In 17 of 27 (63%) cases missed on follow up but retrospectively identifiable, the mechanisms were type IB/III. Overall, the 30 day mortality rate after post-EVAR rupture was 47% (n = 24/51) and the post-operative mortality rate was 21% (n = 7/33). Conclusions: Most precursors of post-EVAR rupture are underdiagnosed but identifiable before rupture using a structured follow up CT protocol. Precursors of type IB and III failures caused the majority of post-EVAR ruptures.
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| 4. |
- Fattahi, Nina, et al.
(författare)
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Prevalence of abdominal aortic aneurysm (AAA) in first-degree relatives : detecting AAA in adult offspring of AAA patients
- 2024
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Ingår i: BJS Open. - : Oxford University Press. - 2474-9842. ; 8:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundFirst-degree relatives of patients with abdominal aortic aneurysm (AAA) may have an increased risk of developing the disease. The primary aim was to report the prevalence of AAA in adult male and female offspring of patients with AAA. The secondary aim was to explore the efficiency of a registry-based detection route, and the third aim was to report contemporary prevalence in the population.MethodsAdult offspring of individuals with AAA and matched controls were identified through national registries. The examination included questionnaires and ultrasound examinations of the infrarenal aorta. Aortic pathology was defined as an aortic diameter ≥25 mm, AAA ≥30 mm.ResultsThe participation rate among male and female adult offspring was 64% (350/543) and 69% (402/583), respectively. A lower participation rate was found in male and female controls (51% and 52%). No difference in prevalence of AAA was observed between male adult offspring and controls (0.9%, c.i. 0.2 to 2.3%) or in the female population (prevalence of 0.2% in adult offspring and controls). Aortic pathology and previously diagnosed AAA were detected in 5.3% (c.i. 3.3 to 8.0%) of male adult offspring and 2.3% (c.i. 1.1 to 4.2%) in controls. Aortic pathology was more prevalent among adult offspring of females with AAA.ConclusionThe prevalence of AAA in the general population is low, but aortic pathology is notably higher among male first-degree relatives. Increased awareness should be directed towards individuals with a possible hereditary predisposition, particularly offspring of females with AAA and older smokers. Risk factor-based targeted screening of adult offspring of patients with AAA after registry-based detection should be further explored.
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| 5. |
- Fattahi, Nina, et al.
(författare)
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Risk factors in 50-year-old men predicting development of abdominal aortic aneurysm
- 2020
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Ingår i: Journal of Vascular Surgery. - : Elsevier BV. - 0741-5214 .- 1097-6809. ; 72:4, s. 1337-1346
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Tidskriftsartikel (refereegranskat)abstract
- Background: Abdominal aortic aneurysm (AAA) is a potentially lethal condition associated with several well-known risk factors including age, smoking, and male sex. The aim of this study was to identify risk factors predicting future development of AAA, which could influence future prevention strategies.Methods: This study collected the data sets of the Westmannia Cardiovascular Risk Factors Study (WICTORY) from 1990 to 1999 and combined them with cases of individuals who have undergone ultrasound examination of the infrarenal aortic diameter as part of the Vastmanland County's ongoing AAA screening program that commenced in 2007 or for other purposes. The study analyzed 5817 men aged 50 years at the time they participated in WICTORY and who underwent an ultrasound examination of the infrarenal aorta on average 15 years later.Results: The prevalence of AAA in our study was 2.6%. Age, smoking status, angina pectoris treatment, prior myocardial infarction, blood pressure treatment, body mass index, waist circumference, systolic blood pressure, heart rate, and total cholesterol level were found to be associated with the development of AAA later in life in the univariate analysis. In the multivariate analysis, current smokers at age 50 years had 11 times higher risk for later development of AAA (hazard ratio [HR], 11.178; confidence interval [CI], 6.277-19.908; P < .001). Former smokers did not suffer a similar risk of AAA development. Elevated total cholesterol concentration at baseline was associated with later AAA development (HR, 1.275; CI, 1.119-1.451; P < .001), as were increasing age (HR, 1.702; CI, 1.153-2.512; P = .007) and waist circumference (HR, 1.019; CI, 1.002-1.037; P = .031).Conclusions: Both the well-known and the somewhat less established possible predictors for future development of AAA identified in this study can support improvement of strategic preventive measures toward specific risk groups and thereby possibly reduce the risk for development of AAA later in life or at least increase the possibility of an early diagnosis in patients with intact AAA.
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| 6. |
- Glimskär, Anders, et al.
(författare)
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Sustainable Grazing by Cattle and Sheep for Semi-Natural Grasslands in Sweden
- 2023
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Ingår i: Agronomy. - 2073-4395. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- Despite their importance for biodiversity and other ecosystem services, many semi-natural grasslands deteriorate or have even disappeared due to insufficient grazing and neglect. Preservation of grassland habitats depends on a good understanding of sustainable grazing management as well as effective agricultural policy measures that ensure long-term economic sustainability for the farmer. Through meta-evaluation and synthesis of previous investigations and discussion of scientific literature, we aimed to evaluate factors that determine the extent to which cattle and sheep in Sweden graze semi-natural grasslands instead of more productive land and what this means for biodiversity and sustainability. We also aimed to propose which practises and policy measures may be the most cost-effective to promote habitat quality and the sustainable use of grasslands. Results from a nationwide survey of Swedish farmers' attitudes towards agri-environmental payment schemes are discussed in relation to farm characteristics and other factors influencing the use of cattle and sheep for sustainable grazing. This study supports recommendations by environmental economists that payments should be targeted more strongly at the most valuable grasslands, emphasising the need for a more detailed and nuanced framework for classifying grasslands in Europe. A comparison with independent estimates of the area of agricultural land from nation-wide, sample-based monitoring shows that the data from official statistics normally used for nationwide evaluations are partly biased and of insufficient quality, underscoring the need for more sophisticated and precise methods for monitoring both overall trends and detailed environmental effects related to the preservation of semi-natural grasslands.
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- Hammo, Sari, et al.
(författare)
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Outcome After Endovascular Repair of Ruptured Descending Thoracic Aortic Aneurysm : A National Multicentre Study
- 2019
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Saunders Elsevier. - 1078-5884 .- 1532-2165. ; 57:6, s. 788-794
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The purpose of this multicentre study was to analyse the outcome of thoracic endovascular aortic repair (TEVAR) in patients with ruptured descending thoracic aortic aneurysm (rDTAA).Methods: This is a nationwide retrospective study including all patients who underwent TEVAR for rDTAA at six major vascular university centres in Sweden between January 2000 and December 2015. Outcome measures were analysed using Kaplan-Meier estimator and multivariable Cox regression.Results: There were 140 patients (age [mean +/- SD] 74.1 +/- 8.8 years; 56% men; aneurysm size 64.8 +/- 19 mm), with rDTAA. In 53 patients (37.9%), the left subclavian artery was covered, and in 25 patients (17.9%) arch vessel revascularisation was performed. In total, 61/136 patients (45%) had a major complication within 30 days post TEVAR. Stroke (n = 20; 14.7%) was the most common complication, followed by paraplegia (n = 13; 9.6%) and major bleeding (n = 13; 9.6%). TEVAR related complications during follow up included endoleaks 22.1% (30/136; 14 type 1a, six type 1b, 10 not defined). In total, re-interventions (n = 31) were required in 27/137 (19.7%) patients. The median follow up time was 17.0 months (range 0-132 months). The Kaplan-Meier estimated survival was 80.0% at one month, 71.7% at three months, 65.3% at one year, 45.9% at three years, and 31.9% at five years. Age (HR 1.03; 95% CI 1.00-1.07; p = .046), history of stroke (HR 2.35; 95% CI 1.194.63; p = .014), previous aortic surgery (HR 2.11; 95% CI 1.15-3.87; p = .016) as well as post-operative major bleeding (HR 4.40; 95% CI 2.20-8.81; p = .001), stroke (HR 2.63; 95% CI 1.37-5.03; p = .004), and renal failure (HR 8.25; 95% CI 2.69-25.35; p = .001) were all associated with mortality.Conclusions: This nationwide multicentre study of patients with rDTAA undergoing TEVAR showed acceptable short- but poor long-term survival. Adequate proximal and distal aortic sealing zones are important for technical success. High risk patients and post-operative complications need to be further addressed in an effort to improve outcome.
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| 8. |
- Hultgren, Rebecka, et al.
(författare)
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Evaluating feasibility of using national registries for identification, invitation, and ultrasound examination of persons with hereditary risk for aneurysm disease-detecting abdominal aortic aneurysms in first degree relatives (adult offspring) to AAA patients (DAAAD)
- 2022
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Ingår i: Pilot and Feasibility Studies. - : BioMed Central (BMC). - 2055-5784. ; 8:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundSweden and the UK invite all 65-year-old men to a population-based ultrasound-based screening program to detect abdominal aortic aneurysms (AAA). First-degree relatives of patients with AAA are reported to have an increased risk to develop AAA, both women and men, but are not invited to screening. The "Detecting AAA in First Degree Relatives to AAA patients " (DAAAD) was designed to detect the true prevalence in adult offspring to AAA patients and to evaluate if national registries could be used for identification of index persons and their adult children with a high risk for the disease. The aim of this study is to summarize the design and methodology for this registry-based study. MethodsThe study is based on a registry-based extraction and identification of a risk group in the population with a subsequent identification of their adult offspring. The targeted risk group suffers a heredity for a potentially lethal disease, AAA (n = 750) and matched control group without heredity for AAA is also identified and invited (n = 750). The participation rate in the population-based AAA screening program for men is 75% regionally. This population is younger and have a lower prevalence. A participation rate of 65% is considered clinically adequate. For the DAAAD study, a stratified analysis of the primary outcome, prevalence, will be performed for women and men separately. Two other planned projects are based on the material: firstly, evaluation of the anxiety for disease and health-related quality of life (HRQoL) and, secondly, the cost-effectiveness of the study. DiscussionIn conclusion, this feasibility study will be instrumental in supporting the development of a possible new model to invite persons with high risk to develop hereditary rare diseases. To our knowledge, this is a unique, safe, and most likely to be a cost-efficient model to invite targeted risk groups for selected screening. If the study design and the results are shown to be cost-effective at the detected participation rate and prevalence, it should be further evaluated and adopted to a national screening program. The model also invites both women and men, which is unique for this specific patient group, considering that all population-based screening programs only include men.
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| 9. |
- Hultgren, Rebecka
(författare)
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Lower limb ischemia in women
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Arteriosclerosis is a general disease affecting different parts of the arterial system. In coronary heart disease (CHD) women have different risk factors, symptoms, indication for treatment, interpretation of diagnostic data and outcome than men. The overall aim of this thesis was to test the hypothesis that similar gender differences exist in patients with symptomatic arteriosclerosis in the arteries of the lower limb (LLI) and to investigate the magnitude of the problem. The Stockholm Study. The number of procedures performed, development over time, survival and amputation rates in women and men were investigated in a large epidemiological study of all patients treated with vascular interventions for lower limb ischemia (LLI) in the county of Stockholm in 1970-1994 (8660 patients, 12200 interventions). An increase from 18 vascular interventions to 786 / million inhabitants and in the proportion of women from 34% in 1970 to 48% in 1994 was shown. Mean age increased from 63 to 71 years. Women were older than men (71 years vs 66, p<0.001). The localisation of lesions treated for chronic LLI was similarly distributed between women and men. Women had poorer survival than men. In a Cox regression model, increasing age, later calendar years and being a man were risk factors for poorer survival. In a multivariate analysis of the risk for amputation, age and calendar year were important risk factors, not gender. Our results confirmed the clinical observation of an increasing proportion of women and elderly, possibly related to an increasing prevalence, better knowledge about LLI among referring doctors, improved technique and wider indication for treatment, especially in elderly. The similar or better results after intervention in women could be explained by the generally better survival in women in the population as well as a restrictive attitude towards treating women compared to men. Women treated for critical ischemia. Specific gender differences in preoperative conditions, localisation of treated lesions, complications and long-term outcome was retrospectively investigated in patients treated for chronic critical limb ischemia at the Karolinska Hospital (KH) in 1993-1994 (n=234 patients). Women were older than men (74 vs 68 years), smoking and diabetes was less frequent among women (smokers: 63 % vs 82%, p=0.005; diabetes: 22% vs 43%, p=0.0004). Other preoperative conditions were not worse in women. Women were more commonly treated with suprainguinal interventions than men (44% versus 19%). Outcome was similar for women and men. The greatest disadvantage for women is their high mean age. The later onset for women could depend on biological differences combined with a different distribution of risk factors than in men. The different localisation of treated lesions can be related to age and anatomical differences. The similarities in outcome despite different preoperative conditions indicate that diabetic women with severe LLI are less frequently treated, alternatively men with high risk are offered interventions more generously. Reproductive History. In order to evaluate the reproductive history in women with LLI compared with women in the population, 173 women treated for LLI in 1994-1996 at KH and 348 women living in the hospital catchment area were sent a validated questionnaire. Age at menopause and menarche, pregnancies, hysterectomy and hormone replacement therapy were similar between women treated for LLI and women in the population. More references had used oral contraceptives than patients (53% vs 16%, p<0.001). Women with LLI do not have a different reproductive history than women in the population, contradictory to women with CHD. The influence on the development of arteriosclerotic disease by other risk factors could be more important in LLI patients. Maybe oestrogen levels are less important for the progression of arteriosclerotic disease in other peripheral arteries compared to coronary and carotid arteries. Conclusion. The number of vascular interventions, especially in women, have probably increased further after the observed period, and the increase can be expected to continue. Biological and anatomical differences can probably explain several of the found differences between the sexes, such as localisation of treated lesions and age. The similar outcome between women and men indicates that we should continue to focus on established risk factors in our preoperative evaluation, rather than gender or reproductive history in women.
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