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| 2. |
- Grip, Olivia, et al.
(författare)
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Acute Compartment Syndrome Following Thrombolysis For Acute Lower Limb Ischemia
- 2022
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Ingår i: Annals of Vascular Surgery. - : Elsevier. - 0890-5096 .- 1615-5947. ; 79, s. 182-190
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Tidskriftsartikel (refereegranskat)abstract
- Background: Acute Compartment syndrome (ACS) with subsequent need for fasciotomy is a serious and insidious complication after revascularization for acute lower limb ischemia (ALI). The development of ACS during endovascular catheter directed thrombolysis is particularly difficult to identify. The aim was to identify the incidence, predisposing factors, wound treatment, and outcome in terms of amputation and survival for patients presenting with ALI that develop ACS during catheter directed thrombolysis. Patients who did not develop ACS after thrombolysis were analyzed as controls.Methods: Descriptive retrospective analysis of prospective databases from two large tertiaryreferral vascular centers. Patients with ACS after thrombolysis for ALI between 2001-2017 were analyzed.Results: Seventy-eight cases and 621 controls were identified. Mean age was 72 years and 30 (38.5%) were women in the ACS group. Patients that developed ACS presented with significantly more severe preoperative ischemia. With 38.5% having Rutherford 2b classification as compared to 22.7 % in the control group ( P = 0.002). Occluded popliteal arter y aneur ysms were also associated with a higher incidence of ACS ( P = 0.041). Treatment of the fasciotomy wound was most commonly treated with regular wound dressing in 45 (58%) of cases, while wound dressing and foot pump and vacuum assisted closure were used in 14 (18%) and 19 (24%) respectively. These differing approaches did not affect the number of wound infections and amputations, which was similar regardless of treatment type. Vacuum assisted closure was associated with a higher degree of skin graft closure ( P = 0.001). The median time to complete wound closure was 10 days. One year after thrombolysis, the major amputation rate in the ACS group was 31% as opposed to 17% in control group, P = 0.003. Mortality measured at 16.7% and 15.3%, respectively, P = 0.872. Amputation-free survival in the ACS group was 62% vs. 73% in the control group, P = 0.035. These differences level out, however, when applying long-term analysis of amputationfree survival in Kaplan-Meier analysis (log-rank 0.103).Conclusions: Patients that developed ACS during endovascular CDT presented with a more severe pre-operative ischemia, more occluded popliteal arter y aneur ysms and had a higher amputation rate during the first year, compared to controls. The development of ACS during endovascular treatment of ALI with thrombolysis is not uncommon and warrants both clinical awareness and rapid treatment.
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| 3. |
- Gunnarsson, Thordur, et al.
(författare)
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Intraprocedural Transcutaneous Oxygen Pressure and Systolic Toe Pressure Measurements During and After Endovascular Intervention in Patients with Chronic Limb Threatening Ischaemia
- 2021
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1078-5884 .- 1532-2165. ; 62:4, s. 583-589
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this study was to evaluate changes in transcutaneous oxygen pressure (tcpO2) and systolic toe pressure (TP) during endovascular intervention. Methods: This was a single centre prospective, non-randomised, observational feasibility study. Patients with chronic limb threatening ischaemia (CLTI) due to infrainguinal disease scheduled for endovascular treatment were included between March 2018 and December 2019. TcpO2 was measured continuously bilaterally at foot level throughout the procedure and at follow up. Specific time points during the intervention were chosen for comparison to baseline (before arterial puncture): average tcpO2 level five minutes prior to percutaneous transluminal angioplasty (PTA); 10 minutes after PTA; and at completion. Bilateral TP was recorded using laser Doppler flowmetry before arterial puncture, at completion, and at clinical follow up. Angiograms were analysed for successful revascularisation and vascular lesions classified according to the Global Limb Anatomical Scoring System (GLASS). Rutherford and WIfI (Wound, Ischaemia, and foot Infection) classifications were registered, as well as clinical outcome. Results: Twenty-one patients completed the study. Completion angiograms showed inline flow to the foot in all but two patients. Median time to follow up was 10 weeks (range 8 – 13 weeks) and all patients except one improved clinically. TcpO2 decreased during the initial stage of the intervention, from before arterial puncture to five minute average before PTA (p < .001) and did not recover to above baseline values at the end of intervention. TcpO2 increased significantly at follow up (p < .001). TP increased statistically significantly during intervention (p < .001) and at follow up (p < .001) compared with baseline. Conclusion: TcpO2 and TP measurements are safe and feasible non-invasive techniques for haemodynamic monitoring during endovascular revascularisation. TP increased significantly immediately after completion of the successful intervention, whereas tcpO2 did not. Both TP and tcpO2 demonstrated a significant increase at the 10 week follow up.
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| 4. |
- Gunnarsson, Thordur, et al.
(författare)
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Long Term Results of a Randomised Trial of Stenting of the Superficial Femoral Artery for Intermittent Claudication
- 2023
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1078-5884 .- 1532-2165. ; 65:4, s. 513-519
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Primary stenting of the superficial femoral artery (SFA) in intermittent claudication (IC) has been shown to increase health related quality of life (HRQoL) after 12 and 24 months. An extended follow up of HRQoL 36 and 60 months after randomisation is presented.Methods: A multicentre randomised controlled trial was conducted at seven vascular clinics in Sweden between 2010 and 2020. One hundred patients randomised to either primary stenting and best medical treatment (BMT; n = 48) or BMT alone (n = 52) were followed for 60 months. HRQoL, assessed by the Short Form 36 Health Survey (SF-36) and EuroQoL 5 dimensions (EQ5D) 36 and 60 months after randomisation, was the primary outcome. Walking Impairment Questionnaire (WIQ) score, re-interventions, progression to chronic limb threatening ischaemia (CLTI), amputation, and death were secondary outcomes.Results: At the 36 month follow up, the stent group (n = 32) had statistically significantly better scores in the SF -36 domain "Role Physical" (p = .023) and the Physical Component Summary (p = .032) compared with the control group (n = 30); however, there was no statistically significant difference in EQ5D scores (p = .52). WIQ was statistically significantly better in the stent group compared with the control group (p = .029) at 36 months. At the 60 month follow up, no statistically significant difference in HRQoL was seen between patients in the stent (n = 31) and control groups (n = 32). Crossover from the control group to the stent group was 25% at 60 months. There were no differences in progression to CLTI, amputation (2.1% vs. 1.9%), or mortality (14.6% vs. 15.4%) between groups. Conclusion: In patients with IC caused by isolated SFA lesions, primary stenting conferred benefits to HRQoL until 36 months from treatment vs. BMT alone, but these benefits were no longer detectable at 60 months, where a high crossover rate affected the power of the final analysis.
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| 6. |
- Hultman, Martin, 1992-, et al.
(författare)
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Comprehensive imaging of microcirculatory changes in the foot during endovascular intervention - A technical feasibility study
- 2022
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Ingår i: Microvascular Research. - Maryland Heights, MO, United States : Academic Press. - 0026-2862 .- 1095-9319. ; 141
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Tidskriftsartikel (refereegranskat)abstract
- Chronic limb-threatening ischemia (CLTI) has a major impact on patient's lives and is associated with a heavy health care burden with high morbidity and mortality. Treatment by endovascular intervention is mostly based on macrocirculatory information from angiography and does not consider the microcirculation. Despite successful endovascular intervention according to angiographic criteria, a proportion of patients fail to heal ischemic lesions. This might be due to impaired microvascular perfusion and variations in the supply to different angiosomes. Non-invasive optical techniques for microcirculatory perfusion and oxygen saturation imaging have the potential to provide the interventionist with additional information in real-time, supporting clinical decisions during the intervention. This study presents a novel multimodal imaging system, based on multi-exposure laser speckle contrast imaging and multi-spectral imaging, for continuous use during endovascular intervention. The results during intervention display spatiotemporal changes in the microcirculation compatible with expected physiological reactions during balloon dilation, with initially induced ischemia followed by a restored perfusion, and local administration of a vasodilator inducing hyperemia. We also present perioperative and postoperative follow-up measurements with a pulsatile microcirculation perfusion. Finally, cases of spatial heterogeneity in the observed oxygen saturation and perfusion are discussed. In conclusion, this technical feasibility study shows the potential of the methodology to characterize changes in microcirculation before, during, and after endovascular intervention.
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| 7. |
- Karlsson, Lars, 1959-, et al.
(författare)
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Expansion of small-diameter abdominal aortic aneurysms is not reflected by the release of inflammatory mediators IL-6, MMP-9 and CRP in plasma
- 2009
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1078-5884 .- 1532-2165. ; 37:4, s. 420-424
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Tidskriftsartikel (refereegranskat)abstract
- Abdominal aortic aneurysm (AAA) is a common disease that develops gradually over several years and is characterised by weakening and dilatation of the aortic wall. AAAs also demonstrates a marked inflammatory infiltrate throughout the aortic wall. Chlamydophila pneumoniae (C. pneumoniae), is a common bacterium. About 50% of the population has been infected in adolescence. Thirteen studies report the presence of either C. pneumoniae or its antigens in 35-100% of AAA specimens. The overall aim of this thesis was to evaluate the possible role of C. pneumoniae in inflammatory response and expansion of AAA from a clinical point of view. In paper I, viable C. pneumoniae was detected in a majority of 26 patients with AAA having open surgery. Patients operated for AAA had higher C. pneumoniae antibodies titers than controls. In paper II, 247 patients were randomised in a double-blind trial, to evaluate the effect of azithromycin on the expansion of small AAAs. No such effect was seen and there was no correlation between C. pneumoniae antibody titers and AAA expansion. In paper III, 42 patients with AAA were compared to 100 age- and sex matched controls with normal aortas. C. pneumoniae antibodies were analysed in plasma samples obtained at screening, and in samples from a study conducted 5-15 (mean 12) years previously on the same population. There was no significant difference between the groups. In paper IV, were 211 patients were analysed, we could not find an association between levels in plasma of three markers of inflammation (IL-6, MMP-9 and CRP) and AAA expansion. A significant reduction in AAA expansion rate was found in patients treated with a combination of ASA and statins. In conclusion, viable C. pneumoniae is found at the scene of the crime, but we were unable to reverse or halt expansion of AAA with antibiotic treatment. C. pneumoniae antibody titers cannot be used, to detect small AAA, or to evaluate AAA expansion. From a clinical point of view, based on the methods and analyses used in this thesis, the role of C. pneumoniae in the inflammatory response and expansion of abdominal aortic aneurysms is limited.
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| 8. |
- Karlsson, Lars, 1959-, et al.
(författare)
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The association between serological markers for chlamydophila pneumoniae and the development of abdominal aortic aneurysm
- 2011
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Ingår i: Annals of Vascular Surgery. - : Elsevier BV. - 0890-5096 .- 1615-5947. ; 25:3, s. 322-326
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Tidskriftsartikel (refereegranskat)abstract
- Background: To investigate the association between serological markers for Chlamydophila pneumoniae (Cpn) and the development of abdominal aortic aneurysm (AAA) in a population-based case-control study. Methods: A screening for AAA among 65-75-year-old men and women was performed in a population with high prevalence of disease. Most of the subjects had undergone previous testing at the age of 60, including blood sampling. A total of 42 patients with AAA were compared with 100 age- and gender-matched controls with normal aortas. Cpn immunoglobulin A (IgA) and immunoglobulin G (IgG) antibodies present in plasma samples obtained at the time of screening (current) and in the past 5-15 (mean, 12) years (historical) were analyzed. Cpn antibody titers (<1/64, 1/64, 1/264, and 1/1024) were analyzed using the microimmunofluorescence technique. Results: No differences in current Cpn immunoglobulin A and IgG antibodies titers (p = 0.111 and 0.659), historical titers (p = 0.449 and 0.228), or titer change (delta) (p = 0.794 and 0.172) were observed between patients with AAA and controls. In all, 82% of the patients with AAA had a current Cpn IgG titer of 1/1024 as compared with the 70% of the control group. All 11 patients who had an aortic diameter of >40 mm reported having high current Cpn IgG titers. The fact that such a large proportion of the healthy population demonstrated an immune response against Cpn made it difficult to demonstrate possible effects of Cpn infection on AAA formation in a case-control study. Conclusion: No significant associations were found between AAA detected by screening and Cpn antibody titer levels at the time of screening or during past screening at the age of 60.
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| 9. |
- Karlsson, Lars, 1959-, et al.
(författare)
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The effect of azithromycin and Chlamydophila pneumoniae infection on expansion of small abdominal aortic aneurysms : a prospective randomised double-blind trial
- 2009
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Ingår i: Journal of Vascular Surgery. - : Elsevier BV. - 0741-5214 .- 1097-6809. ; 50:1, s. 23-29
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The aim of the study was to evaluate the effect of azithromycin on the expansion rate of small abdominal aortic aneurysms (AAAs), and to determine whether or not a correlation exists between serological markers for Chlamydophilia pneumonia (Cpn) infection and AAA expansion. METHODS: Nine vascular centers were included and 259 patients were invited to participate. Ten patients declined and 2 patients had chronic kidney failure, leaving a total of 247 patients. Inclusion criteria were: AAA 35-49 mm and age <80 years. Patients were randomized to receive either azithromycin (Azithromax, Pfizer Inc, New York, NY) 600 mg once daily for 3 days and then 600 mg once weekly for 15 weeks, or placebo in identical tablets. The ultrasound scans were performed in a standardized way within a month before inclusion and every 6 months for a minimum follow-up time of 18 months. Cpn serology was analyzed in blood samples taken at inclusion and 6 months later. Serum was analyzed for Cpn IgA and IgG antibodies by microimmunofluorescence (MIF). Computed tomography (CT) scans were done in 66 patients at inclusion and at 1 year for volume calculations. RESULTS: Thirty-four patients were excluded, ie, could not be followed for 18 months, 20 in the placebo group and 16 in the active treatment group. A total of 211 patients had at least two measurements and all were analyzed in an intention-to-treat analysis. Detectable IgA against Cpn was found in 115 patients and detectable IgG against Cpn in 160 patients. No statistically significant differences were found between the groups regarding median expansion rate measured by ultrasound scan (0.22 cm/year, interquartile range [IQR]: 0.09 to 0.34 in the placebo group vs 0.22, IQR: 0.12 to 0.36 in the treatment group, P = .85). Volume calculation did not change that outcome (10.4 cm(3)/year in the placebo group vs 15.9 cm(3)/year in the treatment group, P = .61). No correlation was found between serological markers for Cpn infection and the expansion rate. Patients taking statins in combination with acetylsalicylic acid (ASA) had significantly reduced expansion rate compared to patients who did not take statins or ASA, 0.14 cm/year vs 0.27 cm/year, P < .001. CONCLUSION: Azithromycin did not have any effect on AAA expansion. No correlation was found between serological markers for Cpn and AAA expansion, indicating no clinical relevance for Cpn testing in AAA surveillance. However, a significant reduction in AAA expansion rate was found in patients treated with a combination of ASA and statins.
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| 10. |
- Karlsson, Lars, 1959-
(författare)
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The Role of Chlamydophila Pneumoniae in the Inflammatory Response and Expansion of Abdominal Aortic Aneurysms
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Abdominal aortic aneurysm (AAA) is a common disease that develops gradually over several years and is characterised by weakening and dilatation of the aortic wall. AAAs also demonstrates a marked inflammatory infiltrate throughout the aortic wall. Chlamydophila pneumoniae (C. pneumoniae), is a common bacterium. About 50% of the population has been infected in adolescence. Thirteen studies report the presence of either C. pneumoniae or its antigens in 35-100% of AAA specimens. The overall aim of this thesis was to evaluate the possible role of C. pneumoniae in inflammatory response and expansion of AAA from a clinical point of view. In paper I, viable C. pneumoniae was detected in a majority of 26 patients with AAA having open surgery. Patients operated for AAA had higher C. pneumoniae antibodies titers than controls. In paper II, 247 patients were randomised in a double-blind trial, to evaluate the effect of azithromycin on the expansion of small AAAs. No such effect was seen and there was no correlation between C. pneumoniae antibody titers and AAA expansion. In paper III, 42 patients with AAA were compared to 100 age- and sex matched controls with normal aortas. C. pneumoniae antibodies were analysed in plasma samples obtained at screening, and in samples from a study conducted 5-15 (mean 12) years previously on the same population. There was no significant difference between the groups. In paper IV, were 211 patients were analysed, we could not find an association between levels in plasma of three markers of inflammation (IL-6, MMP-9 and CRP) and AAA expansion. A significant reduction in AAA expansion rate was found in patients treated with a combination of ASA and statins. In conclusion, viable C. pneumoniae is found at the scene of the crime, but we were unable to reverse or halt expansion of AAA with antibiotic treatment. C. pneumoniae antibody titers cannot be used, to detect small AAA, or to evaluate AAA expansion. From a clinical point of view, based on the methods and analyses used in this thesis, the role of C. pneumoniae in the inflammatory response and expansion of abdominal aortic aneurysms is limited.
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