| 1. |
- Bergqvist, David, et al.
(författare)
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Inga dödsfall/slaganfall efter kirurgi vid asymtomatisk karotisstenos : femårsresultat redovisat i riksstäckande register
- 2006
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 103:5, s. 301-302
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Tidskriftsartikel (refereegranskat)abstract
- In the Swedish vascular registry 7473 carotid endarterectomies are registered, in 10% the indication being a symptomatic stenosis. There are great variations in indication for carotid endarterectomy within Sweden. During the last five years the combined postoperative mortality and/or postoperative permanent stroke has varied between 3% in 1999 and 1.5% in 2003. During the same period not a single patient operated on for a symptomatic carotid stenosis experienced these complications.
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| 2. |
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| 3. |
- Jonsson, Magnus, et al.
(författare)
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Long-Term Outcome After Carotid Artery Stenting : A Population-Based Matched Cohort Study
- 2016
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Ingår i: Stroke. - 0039-2499 .- 1524-4628. ; 47:8, s. 2083-2089
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Tidskriftsartikel (refereegranskat)abstract
- Background and Purpose-Long-term outcome after carotid artery stenting (CAS), a less invasive technique than carotid endarterectomy (CEA), for prevention of stroke, is unclear. The aim was to assess long-term outcomes after CAS, compared with CEA, in a nationwide cohort study.Methods-All patients registered in the national Swedish Vascular Registry (Swedvasc) treated with primary CAS between 2005 and 2012 were identified. For every CAS, 2 CEA controls, matched for sex, age, procedure year, and indication (symtomatic/asymtomatic), were chosen. Postoperative stroke was identified by cross-matching the cohort with the InPatient Registry and charts review. Primary end point was ipsilateral stroke or death >30 days postoperatively.Results-A total of 1157 patients were included, 409 CAS and 748 CEA; 73% men with mean age 70 years and 69% were symptomatic. Risk factor profile was similar between the 2 groups. Median follow-up time was 4.1 years. Ipsilateral stroke or death of >30 days postoperatively occurred in 95 of 394 in the CAS group versus 120 of 724 in the CEA group (adjusted hazard ratio, 1.59; 95% confidence interval, 1.15-2.18). The corresponding adjusted rates for death, ipsilateral stroke of >30 days, and any stroke or death of >30 days were 25.7% versus 18.6% (hazard ratio, 1.20; 95% confidence interval, 0.84-1.72), 9.4% versus 2.9% (hazard ratio, 3.40; 95% confidence interval, 1.53-7.53), 34.2% versus 23.6% (hazard ratio, 1.49; 95% confidence interval, 1.10-2.00) for the CAS group versus CEA group, respectively.Conclusions-In this nationwide cohort study, CAS was associated with an increased long-term risk of ipsilateral stroke and death during after the perioperative phase when compared with CEA.
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| 4. |
- Malmstedt, Jonas
(författare)
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Diabetes and peripheral arterial disease
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Diabetes mellitus increases the risk for peripheral arterial disease (PAD) early in life and the disease is likely to progress to advanced stages. Mechanisms responsible for premature PAD in diabetes are partly unknown. Leg ischaemia from PAD, together with other diabetic complications, is the key player in the pathway from ulceration to gangrene and infection, which ultimately results in major amputation. Infrainguinal bypass surgery (IBS) is carried out to restore leg perfusion and avoid amputations. Whether outcomes for this procedure are less favourable in patients with diabetes than in patients without diabetes is unclear. Aims: To explore the impact of hyperglycaemia on outcome after IBS in patients with diabetes; To assess amputation-free survival (AFS) after IBS for critical limb ischaemia; To assess amputation-free survival (AFS) in patients with diabetes but without PAD during long term follow up; To investigate if receptor for advanced glycation end products (RAGE) and advanced glycation end products (AGE) are increased in plasma and vein grafts in diabetes patients; To investigate if the AGE-RAGE system predicts AFS and development of PAD, and if it is associated with AFS after IBS in patients with diabetes. Results: In Paper I, we demonstrated an association between hyperglycaemia the first 48 hours after IBS and increased risk for wound complications, graft occlusion and amputation or death during the first 3 months in 91 patients with diabetes. Patients in the highest quartile of glucose exposure had an odds ratio of 13‒14 in multivariate logistic regression. In Paper II, we performed a nationwide, population-based cohort study and compared postoperative AFS in patients with and without diabetes. The analysis included data for 1 840 patients from the Swedish Vascular Registry who, during 2001–2003, underwent their first unilateral, below-knee, IBS procedure for critical limb ischaemia. Of these patients, 742 had diabetes and 1,098 did not. Patients were followed up until the end of 2005. Overall, 446 and 558 patients with and without diabetes, respectively, had undergone ipsilateral amputation or died by the end of the follow-up period. Patients with diabetes had a shorter AFS than patients without diabetes (2.3 years, 95% CI 1.9–2.8 years versus 3.4 years, 95% CI 3.1–3.7 years). The hazard ratio and incidence for ipsilateral amputation or death in patients with diabetes, adjusted for age, sex, smoking and other confounding variables, was 1.46 (95% CI 1.26–1.69) and 30.2 events per 100 person-years respectively. The incidence of amputation or death was 2.8 per 100 person-years, (95% CI 2.0 to 3.7) in the cohort of patients with type 2 diabetes who were free from PAD at start of follow up. In Paper III and IV we showed that S100A12, a ligand to RAGE, is associated with AFS after IBS in patients with (n=38) and without (n=30) diabetes, and with AFS as well as development of PAD in a prospective longitudinal (10-year) population-based cohort (n=146) of patients with type 2 diabetes, free from signs of PAD at inclusion. Presence of AGE, RAGE and S100A12 were demonstrated in saphenous vein tissue with no difference between patients with and without diabetes. Conclusions: Postoperative hyperglycaemia is associated with unfavourable outcome after IBS in patients with diabetes. Diabetes is associated with lower AFS after IBS for critical limb ischaemia. Plasma levels of S100A12 and RAGE components are elevated in PAD disease and markers of RAGE and its ligands are found in vein tissue used for bypass. This is consistent with a role for S100A12 in PAD complications by activation of the RAGE system. Higher plasma levels of S100A12 and the combined effect of RAGE components seem to be associated with AFS in patients with diabetes. Further study is needed to find methods of reducing this excess risk and prolonging AFS.
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| 5. |
- Malmstedt, Jonas, et al.
(författare)
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Outcome after leg bypass surgery for critical limb ischemia is poor in patients with diabetes
- 2008
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Ingår i: Diabetes Care. - Alexandria, VA, United States : American Diabetes Association. - 0149-5992 .- 1935-5548. ; 31:5, s. 887-892
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE—Our aim was to assess the risk of major amputation or death after leg bypass surgery for critical limb ischemia in patients with diabetes versus those without.RESEARCH DESIGN AND METHODS—We did a population-based cohort study by linking nationwide databases in Sweden. We identified 1,840 patients in the Swedish Vascular Registry who had their first leg bypass procedure for critical lower-limb ischemia between 1 January 2001 and 31 December 2003—742 with and 1,098 without diabetes. Our primary end point was first major amputation of the limb on which bypass was done or death. Individuals were followed up until 31 December 2005 through the National Hospital Patient Registry and the Cause-of-Death Registry.RESULTS—Incidence of ipsilateral amputation or death was higher in patients with diabetes than in patients without (30.2 vs. 22 events/100 person-years; crude hazard ratio [HR] 1.32 [95% CI 1.17–1.50]). Similarly, individuals with diabetes had a shorter amputation-free survival period than individuals without (2.3 years, range 1.9–2.8 vs. 3.4 years, range 3.1–3.7). Adjustment for demographic characteristics, comorbidities, and risk factors for amputation or death did not substantially affect the risk (HR 1.46 [95% CI 1.26–1.69]). The effect was more pronounced in male (1.75 [1.47–2.08]) than in female (1.35 [1.11–1.64]) patients after adjustment for age.CONCLUSIONS—Diabetes is associated with lower amputation–free survival after leg bypass for critical limb ischemia. Patients with diabetes and limb ischemia need intensified treatment of diabetes-related risk factors to improve outcome.
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| 6. |
- Torbjörnsson, Eva, et al.
(författare)
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Health-related quality of life and prosthesis use among patients amputated due to peripheral arterial disease : a one-year follow-up
- 2022
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Ingår i: Disability and Rehabilitation. - : Taylor & Francis. - 0963-8288 .- 1464-5165. ; 44:10, s. 2149-2157
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: A major amputation affects the patients' independence, well-being and HRQoL. However, prosthesis use and the impact on the patient's HRQoL are scarcely described. The aim was to compare HRQoL between walker and non-walker amputees. Secondary aim was to evaluate prosthesis use and habits.Method: Ninety-eight patients with a major amputation due to peripheral arterial disease were included during 2014-2018. They were interviewed using EQ-5D-3L (HRQoL), Stanmore Harold Wood mobility grade (prosthesis use) and Houghton scale (prosthesis habits).Results: Seventy-three patients completed the one-year follow-up, out of them 56 got a prosthesis. Twenty-three used it to walk both inside and outside. EQ-5D-3L at follow-up was increased in all patients in comparison to baseline (0.16 versus 0.59,p< 0.001). Patients walking with prosthesis had the largest improvement (0.12 versus 0.78,p< 0.001). A sub-analysis aiming to study the importance of independent movement showed an improved HRQoL at follow-up among those classified as prosthesis-user (p<0.001) and walker (p<0.001), but not among non-prosthesis users (p= 0.245).Conclusion: Learning how to use, not exclusively to walk with, a prosthesis after an amputation is important for the patients' HRQoL. At follow-up, patients using their prosthesis to walk or to move to a wheelchair, showed an improved HRQoL compared to baseline.
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| 7. |
- Torbjörnsson, Eva, et al.
(författare)
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Risk factors for amputation are influenced by competing risk of death in patients with critical limb ischemia
- 2020
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Ingår i: Journal of Vascular Surgery. - : Elsevier. - 0741-5214 .- 1097-6809. ; 71:4, s. 1305-1314.e5
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Patients with critical limb ischemia (CLI) have a high risk of amputation and death. Death is a competing risk that affects the estimated amputation risk. Our aim was to find the specific risk factors for amputation for patients with CLI using competing risk analyses and compared these results with those from standard Cox regression analysis.METHODS: Patients who had undergone revascularization for CLI (2009-2013, with follow-up data until 2017) in Stockholm were identified from the Swedish National Registry for Vascular Surgery. The main outcome was major amputation. The risk factors for amputation were assessed using competing risk analysis and compared with the risk factors for amputation-free survival identified using Cox proportional hazards regression analysis.RESULTS: Of 855 patients with CLI, 178 had required a major amputation and 415 had died during the 8-year follow-up period. In the competing risk regression, age (subdistribution hazard ratio [sub-HR], 0.98; 95% confidence interval [CI], 0.97-1.00), ambulatory status (independent vs bedridden; sub-HR, 4.10; 95% CI, 2.14-7.86), and ischemic wound vs rest pain (sub-HR, 3.03; 95% CI, 1.72-5.36) were associated with amputation, considering death as a competing risk. In contrast, Cox regression analysis identified female vs male (hazard ratio [HR], 0.77; 95% CI, 0.64-0.94), age (HR, 1.02; 95% CI, 1.01-1.03), renal impairment (HR, 2.08; 95% CI, 1.61-2.67), ambulatory status (independent vs bedridden; HR, 3.45; 95% CI, 2.30-5.18), and ischemic wound vs rest pain (HR, 2.41; 95% CI, 1.78-3.25) as risk factors.CONCLUSIONS: The risk factors associated with amputation differed when analyzing the data using competing risk regression vs Cox regression. The differences between the analyses indicated that a risk exists for biased estimates using standard survival methods when a strong competing risk such as death is present.
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| 8. |
- Torbjörnsson, Eva, et al.
(författare)
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Risk factors for reamputations in patients amputated after revascularization for critical limb-threatening ischemia
- 2021
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Ingår i: Journal of Vascular Surgery. - : Elsevier. - 0741-5214 .- 1097-6809. ; 73:1, s. 258-266.e1
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Despite vascular intervention, patients with critical limb-threatening ischemia (CLTI) have a high risk of amputation. Furthermore, this group has a high risk for stump complications and reamputation. The primary aim of this study was to identify risk factors predicting reamputation after a major lower limb amputation in patients revascularized because of CLTI. The secondary aim was to investigate mortality after major lower limb amputation.METHODS: There were 288 patients who underwent a major ipsilateral amputation after revascularization because of CLTI in Stockholm, Sweden, during 2007 to 2013. The main outcome was ipsilateral reamputation.RESULTS: Of 288 patients, 50 patients had a reamputation and 222 died during the 11-year follow-up. Patients with ischemic pain as an indication for primary amputation had nearly four times higher risk for a reamputation compared with those with a nonhealing ulcer (subdistribution hazard ratio, 3.55; confidence interval, 1.55-8.17). Higher age was associated with an increased risk for death in the multivariable analysis (hazard ratio, 1.03; confidence interval, 1.02-1.04).CONCLUSIONS: Patients with ischemic pain as an indication for amputation have an elevated risk of reamputation. Ischemic pain may be indicative of a more extensive and proximal ischemia compared with patients with foot tissue loss. An extended evaluation of the preoperative circulation before amputation may facilitate the choice of amputation level and could lead to a reduction of reamputations.
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| 9. |
- Wassélius, Johan, et al.
(författare)
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High 18F-FDG Uptake in synthetic aortic vascular grafts on PET/CT in symptomatic and asymptomatic patients
- 2008
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Ingår i: Journal of Nuclear Medicine. - : Society of Nuclear Medicine. - 0161-5505 .- 1535-5667 .- 2159-662X. ; 49:10, s. 1601-5
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Tidskriftsartikel (refereegranskat)abstract
- Graft infection is a serious complication to vascular surgery. The aim of this study was to assess (18)F-FDG uptake in vascular grafts in patients with or without symptoms of graft infection. METHODS: In all 2,045 patients examined by PET/CT at our clinic, 16 patients with synthetic aortic grafts were identified and reevaluated for (18)F-FDG accumulation. Clinical and biochemical data were obtained from patient records. RESULTS: High (18)F-FDG uptake was found in 10 of 12 grafts in the patients who underwent open surgery and in 1 of 4 grafts in patients who underwent endovascular aneurysm repair. On the basis of biochemical and clinical data, it was concluded that 1 of the 16 patients had a graft infection at the time of investigation. CONCLUSION: (18)F-FDG uptake in vascular grafts was found in the vast majority of patients without graft infection. The risk of a false-positive diagnosis of graft infection by (18)F-FDG PET/CT is evident.
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