| 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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| 11. |
- Frank, U, et al.
(författare)
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ESVM Guideline on peripheral arterial disease
- 2019
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Ingår i: VASA. Zeitschrift fur Gefasskrankheiten. - : Hogrefe Publishing Group. - 0301-1526. ; 48:Suppl 102, s. 7-79
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Tidskriftsartikel (refereegranskat)
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| 12. |
- Pakeliani, D, et al.
(författare)
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Improved technique for sheath supported contralateral limb gate cannulation in endovascular abdominal aortic aneurysm repair
- 2020
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Ingår i: VASA. Zeitschrift fur Gefasskrankheiten. - : Hogrefe Publishing Group. - 0301-1526. ; 49:1, s. 39-42
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Tidskriftsartikel (refereegranskat)abstract
- Summary: Background: To present a technique of sheath supported contralateral limb gate (CLG) cannulation of modular bifurcated stent-graft in endovascular abdominal aortic repair. Materials and methods: After totally percutaneous bilateral femoral access, the 9F introducer sheath is exchanged to a 30 cm 12 fr introducer sheath over a stiff wire contralateral to the intended main stent-graft insertion side and advanced into the aorta below the lowest renal artery. Parallel to the stiff wire within the sheath an additional standard J-tip guidewire with a 5 fr Pigtail angiographic catheter is advanced to the level of the renal arteries. After main body deployment, the 12 fr introducer sheath and J-tip wire with pigtail catheter are retracted until the CLG opening level, maintaining the stiff “buddy” wire in position to support the 12 fr sheath, maintaining its distal opening close to the contralateral gate opening to achieve easy cannulation. Results: Retrospective analysis of video archive from July 2016 to February 2018 evidenced 55 recorded EVAR cases. All CLG cannulations were obtained with Standard J-tip or Terumo Glidewire wires and with Pig-Tail or Berenstein catheters. Technical success was 100 %. Mean fluoroscopy time to accomplish CLG cannulation was 37.6 33 (range 1–105) seconds. The aortic carrefour angulation on coronal axis strongly correlates with cannulation time p = <.001, with longer cannulation time for higher carrefour angulations on coronal axis (Pearson correlation coefficient 0.47). Conclusions: The use of 12 fr sheath with parallel wire introduction technique, appears to be a safe and reliable tool to facilitate CLG cannulation during EVAR procedures.
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| 13. |
- Wanhainen, Anders, et al.
(författare)
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Immune-response against Streptococcus pyogenes in the development of abdominal aortic aneurysm - A population-based case-control study
- 2008
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Ingår i: Vasa: European Journal of Vascular Medicine. - : Hogrefe Publishing Group. - 0301-1526 .- 1664-2872. ; 37:2, s. 143-149
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Tidskriftsartikel (refereegranskat)abstract
- Background: In a population -based case-control study the association between antibodies to Streptococcus pyogenes antigens and the development of abdominal aortic aneurysm (AAA) was analysed. Patients and methods: Forty-two patients with screening-detected AAA were compared to 100 age- and sex matched controls with normal aortas. Antibodies against three recently characterized cell wall-attached proteins of S. pyogenes (SclA, ScIB and GRAB) were analysed in plasma samples obtained at screening (current), and in samples obtained from a study conducted 12 years previously on the same population (historical). Results: Historical antibody levels against the S. pyogenes antigen GRAB were significantly higher in AAA patients compared with controls (0.25 vs 0.17, p = 0.021). A similar trend was observed in current GRAB antibody levels (0.23 vs 0. 17, p = 0.072). GRAB-antibody levels at age 60 years retained the association with AAA in a logistic regression model after adjustment for a history of atherosclerosis (OR 20.2, p = 0.022), current smoking (OR 21.4, p = 0.025) and family history of AAA (OR 12.9, p = 0.053). Current and historical antibody levels against ScIA and SclB in AAA patients were similar to those in controls. Conclusions: The results indicate that the immune response against S. pyogenes protein GRAB may be involved in the pathogenesis of AAA.
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| 14. |
- Balaz, Peter, et al.
(författare)
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Early and late outcomes of hybrid endovascular and open repair procedures in patients with peripheral arterial disease
- 2013
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Ingår i: VASA. - : Hogrefe Publishing Group. - 0301-1526 .- 1664-2872. ; 42:4, s. 292-300
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Tidskriftsartikel (refereegranskat)abstract
- Background: Hybrid endovascular and open reconstructions are used increasingly often for multilevel revascularization for lower limb ischaemia. The aim was to evaluate outcomes after such procedures in a single-center non-randomized retrospective study. Patients and methods: Consecutive patients with multilevel arterial disease who underwent single session hybrid procedures were analyzed depending on the type of ischaemia and the type of revascularization. Results: 164 patients were included with a median follow up time of 14 months (range: 0 - 70). Indication was claudication (group 1, 47 %), critical limb ischaemia (group 2, 33 %) and acute limb ischaemia (group 3, 20 %). Technical success rate was 99.3%, perioperative mortality 2%. Primary, assisted-primary and secondary patency rates at one year were 60%, 61% and 64%, respectively. Primary, primary assisted and secondary patency were lower in group 2 and 3 compared to group 1 (all p < 0.05). Results were better when endovascular repairs were performed above compared to below the open repair site (all p < 0.05). Limb salvage at 1 year in groups 1 - 3 were 98%, 92% and 90%, respectively. The risk of major amputation was highest in group 3 compared to group 1 (p = 0.001) or group 2 (p < 0.04). Conclusions: The results depend on the type of ischaemia and the localization of endovascular procedures.
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| 15. |
- Bergqvist, David, et al.
(författare)
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Validation of the VASCUNET registry - pilot study
- 2014
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Ingår i: VASA. - : Hogrefe Publishing Group. - 0301-1526 .- 1664-2872. ; 43:2, s. 141-144
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Tidskriftsartikel (refereegranskat)abstract
- Background: VASCUNET is an international registry of vascular surgical (open and endovascular) procedures since 1997. The aim of this paper is to describe a pilot validation performed at three hospitals in Hungary in September 2012. Patients and methods: Three core indications were checked: abdominal aortic aneurysm, carotid artery disease and limb ischemia with infrainguinal treatment. Results: 2439 registered procedures had been reported with between 94 and 109 per cent agreement with hospital administrative numbers. In a random sample of 29 patients the VASCUNET data were compared with the patient records regarding risk factors, procedures performed and in hospital results. Only few discrepancies were found. Conclusions: The conclusions are that validation is feasible, that this pilot project in Hungary showed good agreement between registry and local patient records. For a registry to be accepted and used both for practical and scientific purposes regular validation by senior surgeons should be undertaken and the vascular surgical community must have a budget for such a process.
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| 16. |
- Gratl, A, et al.
(författare)
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Treatment options of crural pseudoaneurysms
- 2014
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Ingår i: VASA. Zeitschrift fur Gefasskrankheiten. - : Hogrefe Publishing Group. - 0301-1526. ; 43:3, s. 209-215
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Tidskriftsartikel (refereegranskat)abstract
- Background: Pseudoaneurysms (PAs) of crural arteries represent rare complications of vascular interventions or surgery. Management of crural PAs includes different treatment options, conservative treatment as well as open surgery or endovascular procedures. We reviewed our experience. Patients and methods: We retrospectively analysed all patients who were diagnosed with crural PAs since 2003. We evaluated etiology, treatment and outcome. Endpoints were target vessel patency, vascular re-intervention and limb loss. Results: A total of 30 patients were diagnosed with crural PAs. PA was caused by vascular intervention in 27 patients (90 %): open balloon thrombectomy (n = 25), subfascial endoscopic perforator vein surgery (n = 1) and transcutaneous catheter-assisted thrombus aspiration (n = 1). In 3 patients (10 %) it was caused by orthopaedic surgical procedures. Location of crural PAs were peroneal artery (n = 11; 36.7 %), posterior tibial artery (n = 10; 33.3 %), anterior tibial artery (n = 5; 16.7 %), and tibioperoneal trunk (n = 4; 13.3 %). Treatment of crural PAs included open surgery (n = 3; 10 %), endovascular procedures (n = 13; 43.3 %) such as endograft implantation (n = 9) or coil embolisation (n = 4), and conservative management (n = 14; 46.7 %). After a median follow-up period of 7 months (range: 0 - 46 months) 8 of 9 endografts were occluded, in none of these patients a minor or a major amputation was necessary. None of the surgically, endovascularly and conservatively treated patients needed a re-intervention for crural PA. A major amputation was necessary in 4 patients due to progression of peripheral arterial disease; none was a directly consequence of the crural PA. Conclusions: Crural PAs are mainly caused by vascular intervention, most frequently by catheter thrombectomy. As a consequence, we recommend fluoroscopic-assisted balloon thrombectomy over a guide wire as routine technique. In many cases of crural PAs, conservative management is sufficient. The choice of treatment of crural PAs depends on size, location and associated symptoms. Endovascular treatment using endografts is limited by poor long-term patency.
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| 17. |
- Håkansson, Anders, et al.
(författare)
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Patient specific biomodel of the whole aorta - the importance of calcified plaque removal
- 2011
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Ingår i: VASA. - : Hogrefe Publishing Group. - 0301-1526 .- 1664-2872. ; 40:6, s. 453-459
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Tidskriftsartikel (refereegranskat)abstract
- Background: The use of anatomical models produced by 3D printing technique (rapid prototyping, RP) is gaining increased acceptance as a complementary tool for planning complex surgical interventions. This paper describes a method for creating a patient specific replica of the whole aorta. Methods: Computed tomography angiography (CTA) DICOM-data was converted to a three-dimensional computer aided design-model (CAD) of the inner wall of the aorta representing the lumen where the calcified plaque contribution was removed in a multi-step editing-manoeuvre. The edited CAD-model was used for creating a physical plaster model of the true lumen in a 3D-printer. Elastic and transparent silicon was applied onto the plaster model, which was then removed leaving a silicon replica of the aorta. Results: The median (interquartile range) difference between diameters obtained from CTA- and RP plaster-model at 19 predefined locations was 0.5 mm (1 mm) which corresponds to a relative median difference of 4.6% (7.0%). The average wall thickness of the silicone model was 3.5 mm. The elasticity property and performance during intervention was good with an acceptable transparency. Conclusions: The integration of RP-techniques with CAD based reconstruction of 3D-medical imaging data provides the needed tools for making a truly patient specific replica of the whole aorta with high accuracy. Plaque removal postprocessing is necessary to obtain a true inner wall configuration.
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| 18. |
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| 19. |
- Reutersberg, B, et al.
(författare)
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CXCR4 - a possible serum marker for risk stratification of abdominal aortic aneurysms
- 2023
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Ingår i: VASA. Zeitschrift fur Gefasskrankheiten. - : Hogrefe Publishing Group. - 0301-1526. ; 52:2, s. 124-132
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Tidskriftsartikel (refereegranskat)abstract
- Summary: Background: Abdominal aortic aneurysm (AAA) rupture is still associated with a mortality rate of 80–90%. Imaging techniques or molecular fingerprinting for patient-specific risk stratification to identify pending rupture are still lacking. The chemokine (C-X-C motif) receptor (CXCR4) activation by CXCL12 ligand has been identified as a marker of inflammation and atherosclerosis, associated with AAA. Both are highly expressed in the aortic aneurysm wall. However, it is still unclear whether different expression levels of CXCR4 and CXCL12 can distinguish ruptured AAAs (rAAA) from intact AAAs (iAAA). Patients and methods: Abdominal aortic tissue samples (rAAA: n=29; iAAA: n=54) were excised during open aortic repair. Corresponding serum samples from these patients (n=9 from rAAAs; n=47 from iAAA) were drawn pre-surgery. Healthy aortic tissue samples (n=8) obtained from adult kidney donors during transplantation and serum samples from healthy adult volunteers were used as controls (n=5 each). Results: CXCR4 was mainly expressed in the media of the aneurysmatic tissue. Focal positive staining was also observed in areas of inflammatory infiltrates within the adventitia. In tissue lysates, no significant differences between iAAA, rAAA, and healthy controls were observed upon ELISA analysis. In serum samples, the level of CXCR4 was significantly increased in rAAA by 4-fold compared to healthy controls ( p=0.011) and 3.0-fold for rAAA compared to iAAA ( p<0.001). Furthermore a significant positive correlation between aortic diameter and serum CXCR4 concentration was found for both, iAAA and rAAA ( p=0.042). Univariate logistic regression analysis showed that increased CXCR4 serum concentrations were associated with AAA rupture (OR: 4.28, 95% CI: 1.95–12.1, p=0.001). Conclusions: CXCR4 concentration was significantly increased in serum of rAAA patients and showed a significant correlation with an increased aortic diameter. The level of CXCR4 in serum was associated with a more than 4-fold risk increase for rAAA and thus could possibly serve as a biomarker in the future. However, further validation in larger studies is required.
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| 20. |
- Reutersberg, B, et al.
(författare)
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CXCR4 - a possible serum marker for risk stratification of abdominal aortic aneurysms
- 2023
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Ingår i: VASA. Zeitschrift fur Gefasskrankheiten. - : Hogrefe Publishing Group. - 0301-1526. ; 52:2, s. 124-132
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Tidskriftsartikel (refereegranskat)abstract
- Summary: Background: Abdominal aortic aneurysm (AAA) rupture is still associated with a mortality rate of 80–90%. Imaging techniques or molecular fingerprinting for patient-specific risk stratification to identify pending rupture are still lacking. The chemokine (C-X-C motif) receptor (CXCR4) activation by CXCL12 ligand has been identified as a marker of inflammation and atherosclerosis, associated with AAA. Both are highly expressed in the aortic aneurysm wall. However, it is still unclear whether different expression levels of CXCR4 and CXCL12 can distinguish ruptured AAAs (rAAA) from intact AAAs (iAAA). Patients and methods: Abdominal aortic tissue samples (rAAA: n=29; iAAA: n=54) were excised during open aortic repair. Corresponding serum samples from these patients (n=9 from rAAAs; n=47 from iAAA) were drawn pre-surgery. Healthy aortic tissue samples (n=8) obtained from adult kidney donors during transplantation and serum samples from healthy adult volunteers were used as controls (n=5 each). Results: CXCR4 was mainly expressed in the media of the aneurysmatic tissue. Focal positive staining was also observed in areas of inflammatory infiltrates within the adventitia. In tissue lysates, no significant differences between iAAA, rAAA, and healthy controls were observed upon ELISA analysis. In serum samples, the level of CXCR4 was significantly increased in rAAA by 4-fold compared to healthy controls ( p=0.011) and 3.0-fold for rAAA compared to iAAA ( p<0.001). Furthermore a significant positive correlation between aortic diameter and serum CXCR4 concentration was found for both, iAAA and rAAA ( p=0.042). Univariate logistic regression analysis showed that increased CXCR4 serum concentrations were associated with AAA rupture (OR: 4.28, 95% CI: 1.95–12.1, p=0.001). Conclusions: CXCR4 concentration was significantly increased in serum of rAAA patients and showed a significant correlation with an increased aortic diameter. The level of CXCR4 in serum was associated with a more than 4-fold risk increase for rAAA and thus could possibly serve as a biomarker in the future. However, further validation in larger studies is required.
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| 21. |
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| 22. |
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| 23. |
- Zhan, YQ, et al.
(författare)
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Predicting the prevalence of peripheral arterial diseases: modelling and validation in different cohorts
- 2016
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Ingår i: VASA. Zeitschrift fur Gefasskrankheiten. - : Hogrefe Publishing Group. - 0301-1526. ; 45:1, s. 31-36
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Tidskriftsartikel (refereegranskat)abstract
- Abstract. Background: To develop models for prevalence estimation of peripheral arterial disease (PAD) and to validate them in an external cohort. Methods: Model training cohort was a population based cross-sectional survey. Age, sex, smoking status, body mass index, total cholesterol (TC), high density lipoprotein (HDL), TC/HDL ratio, low density lipoprotein, fasting glucose, diabetes, hypertension, pulse pressure, and stroke history were considered candidate predicting variables. Ankle brachial index ≤ 0.9 was defined as the presence of peripheral arterial disease. Logistic regression method was used to build the prediction models. The likelihood ratio test was applied to select predicting variables. The bootstrap method was used for model internal validation. Model performance was validated in an external cohort. Results: The final models included age, sex, pulse pressure, TC/HDL ratio, smoking status, diabetes, and stroke history. Area under receiver operating characteristics (AUC) with 95% confidence interval (CI) of the final model from the training cohort was 0.74 (0.70, 0.77). Model validation in another cohort revealed AUC (95% CI) of 0.72 (0.70, 0.73). P value of Hosmer-Lemeshow’s model goodness of fit test was 0.75 indicating good model calibration. Conclusions: The developed model yielded a moderate usefulness for predicting the prevalence of PAD in general population.
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| 24. |
- Blomgren, Lena, 1957-, et al.
(författare)
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Coagulation and fibrinolysis in chronic venous insufficiency
- 2001
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Ingår i: VASA. - : Hogrefe & Huber Publishers. - 0301-1526 .- 1664-2872. ; 30:3, s. 184-187
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Varicose veins (VV) are common, but only some patients will develop chronic venous insufficiency (CVI) with skin changes or venous ulcer. The pathophysiology of venous ulcer development is complex, and may involve abnormalities in coagulation, fibrinolysis and proinflammatory cytokines. The purpose of this study was to correlate plasma markers within these systems and skin pathology.METHOD: A group of twenty consecutive patients with active or recent venous ulcer were matched for sex and age with further three groups of individuals i.e. controls and patients with VV with and without skin changes respectively. Blood samples were analysed for hemoglobin (HB), total platelet count (TPC), C-reactive protein (CRP), activated partial thromboplastin time (APTT), prothrombin complex (PT), fibrinogen, interleukin-1 beta (IL-1 beta), tumor necrosis factor alpha (TNF alpha), D-dimer, tissue plasminogen activator (t-PA), plasminogen activator inhibitor 1 (PAI-1), prothrombin fragments 1 and 2 (F1 + 2), and thrombin antithrombin III complex (TAT).RESULTS AND CONCLUSION: There was an increase of systemic levels of PAI-1 activity and tPA with progressive skin pathology in patients with CVI, and in the group with active ulcer there was an elevation of F1 + 2. Those findings could reflect a defect fibrinolysis, a thrombotic potential or a damaged endothelium.
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| 25. |
- Milbrink, Jan, et al.
(författare)
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The incidence of symptomatic venous thromboembolic events in orthopaedic surgery when using routine thromboprophylaxis
- 2008
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Ingår i: VASA. - : Hogrefe Publishing Group. - 0301-1526 .- 1664-2872. ; 37:4, s. 353-357
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Forskningsöversikt (refereegranskat)abstract
- BACKGROUND: Few studies have shown the effect of thromboprophylactic regimen with low molecular weight heparin (LMWH) on the incidence of clinical venous thromboembolism (VTE) in common practice. The aim was to study the three-year incidence of clinically overt VTE events at a university based orthopaedic department with some 3300 operations performed and 15 000 patients treated annually. PATIENTS AND METHODS: Since all Swedish citizens have an individual identification number it was possible tp follow up all patients operated during a 3 year period (2000-2002) for a period of four months. RESULTS: The incidence of VTE in the classical high-risk groups of hip fracture surgery, total hip arthroplasty (THA) and total knee arthroplasty (TKA) was low - about 0.6 %, while the Pulmonary embolism (PE) incidence in the hip fracture group was 0.27%, with two cases of fatal PE occurring 72 and 109 days after surgery. Patients with ankle fractures had more VTE. The majority of clinical VTE occurred after discharge from hospital. CONCLUSIONS: When using routine thrombopropylaxis with LMWH in orthopaedic surgery the rate of symptomatic VTE is low.
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| 26. |
- Pahlsson, HI, et al.
(författare)
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The cuff width influences the toe blood pressure value
- 2004
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Ingår i: VASA. Zeitschrift fur Gefasskrankheiten. - : Hogrefe Publishing Group. - 0301-1526. ; 33:4, s. 215-218
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Tidskriftsartikel (refereegranskat)abstract
- Background: Toe blood pressure is a valuable and often used parameter when lower limb ischaemia is evaluated in patients with diabetes, but little has been done to standardise the method. The aim of this study was to evaluate if the cuff size influences the toe blood pressure values obtained in patients with diabetes. Patients and methods: Eleven patients with diabetes without a history of peripheral vascular disease, and six age matched healthy subjects were investigated. Their blood pressures were measured in the upper arm and at the ankle level repetitively. For measurement of toe blood pressure two different cuff widths were used. Results: All blood pressures were similar in patients and control subjects, as well as over time. The toe blood pressure values were 18 mmHg higher (p < 0.01) if measured with a 2.0-cm compared to a 2.5-cm wide cuff. There was a relationship (r = 0.63, p < 0.05 for patients) between toe circumference and the toe blood pressure value, where smaller halluxes gave lower values. Conclusions: The cuff width influences the obtained toe blood pressure value and needs to be considered when evaluating limb ischemia in patients with diabetes.
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| 27. |
- Bergqvist, D, et al.
(författare)
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Thromboprophylaxis with a low molecular weight heparin (tinzaparin) in emergency abdominal surgery. A double-blind multicenter trial
- 1996
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Ingår i: Vasa: European Journal of Vascular Medicine. - 0301-1526. ; 25:2, s. 156-160
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Tidskriftsartikel (refereegranskat)abstract
- In this prospective randomized double-blind study the thromboprophylactic effect of postoperative low molecular weight heparin (tinzaparin) was compared with placebo in 80 patients undergoing emergency abdominal surgery. The fibrinogen uptake test was used but because of withdrawal of the labelled fibrinogen from the market the calculated number of patients was not reached. However, this is one of the few studies in emergency abdominal surgery we thought it important to report. The frequency of deep vein thrombosis was reduced with prophylaxis from 22% (95% conf. intervall 11-38%) to 8% (2-21%), a risk reduction of 65%, which is however not significant. Together with data from the few previously published studies it can be concluded that patients undergoing emergency abdominal surgery seem to benefit from prophylaxis, which should be instituted either before operation or at latest 24 hours after. The exact prophylactic relation between pre- and post-operative start would, however, require a separate, randomized study.
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| 28. |
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| 29. |
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| 30. |
- Hierton, T., et al.
(författare)
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Long term follow-up of autologous vein grafts. 40 years after reconstruction for cystic adventitial disease
- 1995
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Ingår i: VASA. - 0301-1526 .- 1664-2872. ; 24:3, s. 250-252
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Tidskriftsartikel (refereegranskat)abstract
- Long term follow-up (38-41 years postoperatively) has been undertaken in three patients who were initially operated on with autologous reversed vein grafts due to cystic adventitial disease of the popliteal artery. The patients were evaluated clinically as well as with colour coded ultrasonography and phase-locked echo-tracking ultrasonography. One vein graft was occluded, the others were patent, without dilatation and with a compliance similar to that in the femoral artery. Autologous vein grafts below the groin are very durable.
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| 31. |
- Ljungman, Christer, et al.
(författare)
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A multivariate analysis of factors affecting patency of femoropopliteal and femorodistal bypass grafting
- 2000
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Ingår i: VASA. - 0301-1526 .- 1664-2872. ; 29:3, s. 215-220
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The most important factors that determine the outcome after femoropopliteal and femorodistal arterial reconstruction are still controversial. This report analysis the factors that determine the early and late patency of distal arterial reconstruction. PATIENTS AND METHODS: A retrospective analysis of patency after femorodistal arterial reconstruction with a new method for evaluation of angiographic runoff was performed for 336 arterial reconstructions. The different pre-, per- and postoperative risk factors were analysed in a Cox proportional hazards model. RESULT: The patency was significantly better for vein grafts in comparison to composite grafts and prosthetic grafts. It was 74% for vein, 46% for composite and 43% for prosthetic reconstructions, respectively, at 12 months after arterial reconstruction. The cumulative life table patency rate in extremities with good, intermediate and poor runoff was 62, 30 and 10%, respectively at 36 months. The patency rates for extremities operated on for claudication was significantly better than for extremities operated on for critical ischaemia. The multivariate analysis of different factors in a Cox analysis revealed that only the status of distal runoff, the graft material and the site of the distal anastomosis independently and significantly influenced the patency rates. CONCLUSIONS: A new model for evaluation of distal runoff proved to predict the patency rate of femoropopliteal and femorodistal arterial reconstructions reasonably well in this retrospective analysis.
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| 32. |
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| 33. |
- Pärsson, Håkan, et al.
(författare)
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The effect of dextran 40 and Dazmegrel on early platelet deposition onto vascular grafts
- 1990
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Ingår i: Vasa: European Journal of Vascular Medicine. - 0301-1526. ; 19:3, s. 242-246
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Tidskriftsartikel (refereegranskat)abstract
- Platelet deposition onto double velour Dacron (n = 14) and double velour Dacron with internal collagen (n = 14) interposition grafts were examined experimentally. The accumulation was assessed by reinfusion of 111In labelled platelets and imaging with a scintillation camera. One group received Dextran-40 intravenously (n = 14) and one group received Dazmegrel (n = 14) intravenously. No graft occlusions were noted. Differences in effects of Dextran-40 and Dazmegrel were not observed. The study indicates a beneficial effect of infused Dextran-40 as well as Dazmegrel. The explanation might be reduced interaction graft wall versus blood-platelets.
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